Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Acute mesenteric ischemia(AMI)is a severe condition associated with poor prognosis,ultimately leading to death due to multiorgan failure.Several mechanisms may lead to AMI,and non-occlusive mesenteric ischemia(NOMI)represents a particular form of AMI.NOMI is prevalent in intensive care units in critically ill patients.In NOMI management,promptness and accuracy of diagnosis are paramount to achieve decisive treatment,but the last decades have been marked by failure to improve NOMI prognosis,due to lack of tools to detect this condition.While real-life diagnostic management relies on a combination of physical examination,several biomarkers,imaging,and endoscopy to detect the possibility of several grades of NOMI,research studies only focus on a few elements at a time.In the era of artificial intelligence(AI),which can aggregate thousands of variables in complex longitudinal models,the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought.In the following work,we bring you a state-of-the-art literature review regarding NOMI,its presentation,its mechanics,and the pitfalls of routine work-up diagnostic exams including biomarkers,imaging,and endoscopy,we raise the perspectives of new biomarker exams,and finally we discuss what AI may add to the field,after summarizing what this technique encompasses.

Interactions between diabetes and COVID-19:A narrative review

Diabetes,whether due to pancreatic beta cells insufficiency or peripheral resistance to insulin,has been suggested as a risk factor of developing severe acute respiratory disease coronavirus-2(SARS-CoV-2)infections.Indeed,diabetes has been associated with a higher risk of infections and higher risk of developing severe forms of coronavirus disease 2019(COVID-19)related pneumonia.Diabetic patients often present associated comorbidities such as obesity,hypertension and cardiovascular diseases,and complications of diabetes,including chronic kidney disease,vasculopathy and relative immune dysfunction,all of which make them more susceptible to infectious complications.Moreover,they often present lowgrade inflammation with increased circulating interleukin levels,endothelial susceptibility to inflammation and dysfunction,and finally,hyperglycemia,which increases this risk.Additionally,corticosteroids,which count among the few medications which showed benefit on survival and mechanical ventilation requirement in COVID-19 pneumonia in large randomized controlled trials,are associated to new onsets of diabetes,and metabolic disorders in patients with previous history of diabetes.Finally,SARS-CoV-2 via the alternate effects of the renin-angiotensin system,mediated by the angiotensin-converting-enzyme 2,was also associated with insulin resistance in key tissues involved in glucose homeostasis,such as liver,skeletal muscles,and adipose tissue;and also,with impaired insulin secretion by pancreaticβ-cells.In this work,we reviewed all elements which may help understand how diabetes affects patients with COVID-19,how treatments affect outcomes in patients with COVID-19,how they may cause new onsets of diabetes,and finally review how SARS-CoV-2 may inherently be a risk factor of developing diabetes,through immune-mediated diabetogenic mechanisms.

Sickle-cell and alpha-thalassemia traits resulting in nonatherosclerotic myocardial infarction:Beyond coincidence?

Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.

A review of potential mechanisms and uses of SGLT2 inhibitors in ischemia-reperfusion phenomena

Recently added to the therapeutic arsenal against chronic heart failure as a first intention drug,the antidiabetic drug-class sodium-glucose cotransporter-2 inhibitors(SGLT2i)showed efficacy in decreasing overall mortality,hospitalization,and sudden death in patients of this very population,in whom chronic or acute ischemia count among the first cause.Remarkably,this benefit was observed independently from diabetic status,and benefited both preserved and altered ventricular ejection fraction.This feature,observed in several large randomized controlled trials,suggests additional effects from SGLT2i beyond isolated glycemia control.Indeed,both in-vitro and animal models suggest that inhibiting the Na+/H+exchanger(NHE)may be key to preventing ischemia/reperfusion injuries,and by extension may hold a similar role in ischemic damage control and ischemic preconditioning.Yet,several other mechanisms may be explored which may help better target those who may benefit most from SGLT2i molecules.Because of a large therapeutic margin with few adverse events,ease of prescription and potential pharmacological efficacity,SGLT2i could be candidate for wider indications.In this review,we aim to summarize all evidence which link SGLT2i and ischemia/reperfusion injuries modulation,by first listing known mechanisms,including metabolic switch,prevention of lethal arrythmias and others,which portend the latter,and second,hypothesize how the former may interact with these mechanisms.