Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

/pdf/guidelines-for-the-early-management-of-patients-with-acute-19udbft6e7.pdf

Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

The Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular riskThe Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)

Chronic kidney disease1 (CKD) is a worldwide public health problem. In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost. The number of individuals with kidney failure treated by dialysis and transplantation exceeded 320 000 in 1998 and is expected to surpass 650 000 by 2010.1,2 There is an even higher prevalence of earlier stages of CKD (Table 1).1,3 Kidney failure requiring treatment with dialysis or transplantation is the most visible outcome of CKD. However, cardiovascular disease (CVD) is also frequently associated with CKD, which is important because individuals with CKD are more likely to die of CVD than to develop kidney failure,4 CVD in CKD is treatable and potentially preventable, and CKD appears to be a risk factor for CVD. In 1998, the National Kidney Foundation (NKF) Task Force on Cardiovascular Disease in Chronic Renal Disease issued a report emphasizing the high risk of CVD in CKD.5 This report showed that there was a high prevalence of CVD in CKD and that mortality due to CVD was 10 to 30 times higher in dialysis patients than in the general population (Figure 1 and Table 2).6–18 The task force recommended that patients with CKD be considered in the “highest risk group” for subsequent CVD events and that treatment recommendations based on CVD risk stratification should take into account the highest-risk status of patients with CKD. 

View this table:

TABLE 1. Stages of CKD 





Figure 1. Cardiovascular mortality defined by death due to arrhythmias, cardiomyopathy, cardiac arrest, myocardial infarction, atherosclerotic heart disease, and pulmonary edema in general population (GP; National Center for Health Statistics [NCHS] multiple cause of mortality data files International Classification of Diseases, 9th Revision [ICD 9] codes 402, 404, 410 to 414, and …

Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention.

OBJECTIVE We set out to examine the association between resting heart rate and haematological factors and blood lipids, all believed to be associated with coronary heart disease. METHODS In a cross-sectional study, 6016 industrial employees in Israel were screened between 1985 and 1987 for cardiovascular disease risk factors [the CORDIS Study (Cardiovascular Occupational Risk Factors Detection in Israeli Industries)]. Repeated measures of resting heart rates were obtained. Complete data were available for 5393 participants. The lowest mean measure was used to examine the association with individual factors. RESULTS For men, of the blood lipids, only triglycerides were independently positively associated with resting heart rate after controlling for all the possible confounding factors (P 150 mg/dl). Platelet count and haemoglobin were independently positively associated with heart rate (P < 0.0001 in both groups). For women, low-density lipoprotein cholesterol and leucocyte count were independently positively associated with resting heart rate (P < 0.05 and P = 0.006, respectively). CONCLUSION These associations suggest that the role of resting heart rate as a predictor of coronary heart disease may be partly explained by its association with triglycerides, haemoglobin, platelet count and leucocyte count, which may be confounding factors or intervening variables.

Serum Lipids and Haematological Factors Associated with Resting Heart Rate: The Cordis Study

Background
Early in the COVID-19 pandemic, it was noted that males seemed to be more affected than females. We examined the magnitude and consistency of the sex differences in age-specific case-fatality rates (CFRs) in six countries. 
Methods 
Data on the cases and deaths from COVID-19, by sex and age group, were extracted from the published reports from Denmark, England, Israel, Italy, Spain, and the United States. Age-specific CFRs were computed for males and females separately. The ratio of the male to female CFRs were computed and meta-analytic methods were used to obtained pooled estimates of the male to female ratio of the CFRs over the six countries, for seven age-groups. 
Findings
The CFRs were consistently higher in males at all ages. The differences were greater in the younger age groups. The pooled M:F CFR ratios were 2.53, 2.92, 2.57, 1.83, 1.57, 1.58 and 1.48 for ages 0-39, 40-49, 50-59, 60-69, 70-79, 80-89 and 90+. There was remarkable consistency between countries in the magnitude of the M:F CFRs, in each age group. In meta-regression, age group explained almost all the heterogeneity in the CFR ratios.
Conclusions
The sex differences in the CFRs are intriguing and are compatible with the male dominance in the incidence rates of many infectious diseases. For COVID-19, factors such as sex differences in the prevalence of underlying diseases may play a part in the CFR differences. However, the greater severity of the disease in males, particularly at younger ages, may be part of the disease mechanism and should be explored further.

Funding
No funding was provided for this study. The authors declare no conflict of interests

Key words: Sex differences, COVID-19, SARS-CoV-2, meta-analysis, case-fatality rate, infection-fatality rate, male predominance, age-related effects

https://www.medrxiv.org/content/medrxiv/early/2020/06/17/2020.06.11.20128439.full.pdf

The male excess in case-fatality rates for COVID-19. A meta-analytic study of the age-related differences and consistency over six countries

Different outdoor temperatures, the association between indoor temperature control at the workplace and working heart rates of industrial employees were evaluated. The subjects, 6,016 male and female employees in 21 industrial plants in Israel, were screened for cardiovascular risk factors between 1985–87 (The CORDIS Study). The data collected included resting heart rate, working heart rate (based on one hour ambulatory ECG), outdoor temperatures, temperature control (TC) status of the plant, workload, age and health-related habits. At outdoor temperatures below or above 22–28°C, subjects working in plants with TC had lower mean working heart rate HR (- 2 bpm) than those working in plants without TC (p < 0·0004 after adjustment for confounders). No statistically significant differences in mean working HR were found between subjects working with TC (at all the outdoor temperatures) and those without TC within the outdoor temperature range 22–28°C. Based on working heart rate, indoor temperature control in ...

Heart rate response to industrial work at different outdoor temperatures with or without temperature control system at the plant

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)62025-5/pdf

Prevalence and correlates of diphtheria toxoid antibodies in children and adults in Israel.

Large outbreaks of diphtheria occurred recently in the former USSR. Between 1989 and 1994, a total of about 600,000 Soviet immigrants arrived in Israel. The immune status against diphtheria in a sample of 992 men aged 17-49 and 195 women aged 17-19, who arrived in Israel during 1990-91, was studied in order to evaluate the need for vaccination. Participants completed a self-administered questionnaire and diphtheria antitoxin antibody levels were measured by means of ELISA. At age 17-19, the prevalence of antitoxin antibody levels below the protective level of 0.01 IU/ml was 4.8% in the men and 2.1% in the women. Among the men, the percentage lacking protection declined from 4.8% at age 17-19 years to 1.6% at age 20-24, and increased to 18.2% at age 35-49. In the oldest group, the prevalence of those lacking protection was considerably higher than for the general Israeli population. In the multivariate analysis, age, mother's education and republic of origin were significantly associated with the absence of protection. Immigrants from the former USSR appear to be more susceptible to diphtheria, thus increasing the possibility of clinical disease, and it is recommended that they receive booster doses of diphtheria toxoid.

Manfred S. Green

Papers

Serum Lipids and Haematological Factors Associated with Resting Heart Rate: The Cordis Study

The male excess in case-fatality rates for COVID-19. A meta-analytic study of the age-related differences and consistency over six countries

Heart rate response to industrial work at different outdoor temperatures with or without temperature control system at the plant

Prevalence and correlates of diphtheria toxoid antibodies in children and adults in Israel.

Immune status against diphtheria among immigrants from the former USSR who arrived in Israel during 1990–1991