Aureus University School of Medicine (previously named as All Saints University of Medicine) is a private university located in Oranjestad, Aruba. Aureus confers upon its graduates the Doctor of Medicine (MD) degree.
Cardiogenic shock (CS) is a life-threatening condition with severely impaired myocardial contractility, causing systemic hypoperfusion, tissue hypoxia, and organ dysfunction. Despite the advances in revascularisation and pharmacological therapies, CS carries high mortality among patients with acute myocardial infarctions and other acute cardiac syndromes. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) offers short-term mechanical circulatory support in refractory CS by restoring systemic perfusion and maintaining end-organ oxygenation. This narrative review aims to explain the physiological basis of V-A ECMO, summarize the findings from randomized clinical trials (RCTs) and observational studies, and evaluate the clinical factors that affect mortality outcomes in CS. Recent RCTs assessing routine early V-A ECMO initiation in acute myocardial infarction - related CS include ECLS-SHOCK, ECMO-CS, and EURO-SHOCK. The results did not show a clear early mortality benefit with routine ECMO initiation and reported higher rates of bleeding and vascular complications. Appropriate patient selection based on shock phenotype, optimal timing of support, clinical assessment, and management of V-A ECMO-associated complications are critical determinants of clinical effectiveness. It is still a valuable rescue option for refractory CS when appropriately selected based on reversibility potential and institutional capabilities, rather than as routine first-line therapy for all patients with acute MI-related shock.
Chronic kidney disease (CKD) is a global health challenge affecting more than 850 million people worldwide. Early and accurate assessment of kidney function is crucial for timely diagnosis and management. While serum creatinine (SCr) has traditionally been the primary biomarker for estimating glomerular filtration rate (GFR), it is influenced by factors such as muscle mass, age, sex, and diet, among others, leading to potential inaccuracies. This review evaluates the biological basis, clinical performance, and limitations of cystatin C as an alternative and complementary biomarker to serum creatinine for estimating GFR in CKD. We reviewed epidemiologic, mechanistic, and clinical studies examining cystatin C metabolism, assay methodologies, and its performance in estimating GFR and predicting CKD-related outcomes. Evidence comparing creatinine-based, cystatin C - based, and combined eGFR equations was synthesized. Cystatin C, a low-molecular-weight protein produced by all nucleated cells, is less influenced by muscle mass and dietary factors than creatinine. Cystatin C based and combined creatinine - cystatin C eGFR equations demonstrate improved accuracy for detecting early CKD and more reliably predict CKD progression, cardiovascular events, and mortality. However, cystatin C levels may be affected by thyroid dysfunction, corticosteroid use, inflammation, smoking, obesity, and malignancy, requiring careful interpretation. Cystatin C provides important diagnostic and prognostic information beyond serum creatinine alone and enhances the accuracy of GFR estimation when used in combination with creatinine. Its integration into clinical practice may improve CKD detection and risk stratification, particularly in populations where creatinine-based estimates are unreliable.
Purpose of Research: This review synthesizes current evidence on vitamin D's pathophysiological role in chronic obstructive pulmonary disease (COPD), emphasizing its potential as an adjunctive therapy to reduce exacerbations, improve lung function, and address the gaps in mechanistic and translational understanding. Major Findings: COPD is a diverse lung inflammatory condition marked by abnormal airflow restriction. Recent evidence highlights vitamin D deficiency as a modifiable risk factor correlating with increased exacerbations, accelerated lung function decline, and systemic complications. It is synthesized via sunlight exposure or absorbed through dietary intake and exerts its pleiotropic effects through the active metabolite 1,25-dihydroxy vitamin D. This active metabolite binds to vitamin D receptors throughout the body in cells that are involved in calcium and bone metabolism, immunomodulation, and many other tissues. Via these mechanisms it is implicated in potentially mitigating acute exacerbations of COPD. Further, its deficiency may contribute to skeletal muscle dysfunction, osteoporosis, and the cardiovascular comorbidities seen in COPD patients. While observational studies link low vitamin D levels to poorer clinical outcomes in COPD, clinical trials on supplementation remain inconclusive. Conclusions: This review consolidates understanding of vitamin D's role in COPD pathophysiology and highlights its significant therapeutic potential to improve clinical outcomes. Definitive evidence from robust clinical trials is needed to establish optimal dosing, efficacy and translating the evidence into clinical practice.
By turning into very reactive free radicals, various substances, including environmental pollutants and some medications, damage cells in many organs. The most harmful of these is carbon tetrachloride (CCl4). It affects not only the liver but also the kidneys, brain, heart, lungs, and reproductive organs. CCl4 is toxic to the liver and kidneys. It breaks down into more reactive radicals in the liver through the cytochrome P450 enzyme system. The main radicals produced are trichloromethyl (CCl4) and trichloromethyl peroxyl (OOCCl4). These radicals cause harm by producing lipid peroxidation, disrupting mitochondrial function, and ultimately leading to cell death through processes like ferroptosis, necrosis, and apoptosis.This imbalance between antioxidants and free radicals leads to ongoing oxidative stress. This stress is connected to long-term issues like cancer, neurological diseases, and liver fibrosis. While synthetic medications can have side effects, plant-based natural antioxidants may neutralize these harmful radicals. They also offer anti-inflammatory, anti-cancer, and protective properties. This paper emphasizes the damaging effects of CCl4 on cell and tissue membranes and explores how natural antioxidants could help prevent this damage.
There has been a persistent demand for an innovative modality in real-time histologic imaging, distinct from the conventional frozen section technique. We developed an artificial intelligence-driven real-time evaluation model for gastric cancer tissue using confocal laser endomicroscopic system. The remarkable performance of the model suggests its potential utilization as a standalone modality for instantaneous histologic assessment and as a complementary tool for pathologists' interpretation.
