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Kanungo J, Sorkin BC, Krzykwa J, Mitchell CA, Embry M, Spencer P, Harry GJ, Cannon J, Liu F, McPherson CA, Gafner S, Westerink RHS. Screening tools to evaluate the neurotoxic potential of botanicals: building a strategy to assess safety. Expert Opin Drug Metab Toxicol 2024; 20:629-646. [PMID: 38984683 DOI: 10.1080/17425255.2024.2378895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/08/2024] [Indexed: 07/11/2024]
Abstract
AREAS COVERED This paper outlines the selection of NAMs, including in vitro assays using primary rat cortical neurons, zebrafish embryos, and Caenorhabditis elegans. These assays aim to assess neurotoxic endpoints such as neuronal activity and behavioral responses. Microelectrode array recordings of rat cortical neurons provide insights into the impact of botanical extracts on neuronal function, while the zebrafish embryos and C. elegans assays evaluate neurobehavioral responses. The paper also provides an account of the selection of botanical case studies based on expert judgment and existing neuroactivity/toxicity information. The proposed battery of assays will be tested with these case studies to evaluate their utility for neurotoxicity screening. EXPERT OPINION The complexity of botanicals necessitates the use of multiple NAMs for effective neurotoxicity screening. This paper discusses the evaluation of methodologies to develop a robust framework for evaluating botanical safety, including complex neuronal models and key neurodevelopmental process assays. It aims to establish a comprehensive screening framework.
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Affiliation(s)
- Jyotshna Kanungo
- Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Barbara C Sorkin
- Office of Dietary Supplements, Division of Program Coordination, Planning, and Strategic Initiatives, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Julie Krzykwa
- Health and Environmental Sciences Institute, Washington, DC, USA
| | | | - Michelle Embry
- Health and Environmental Sciences Institute, Washington, DC, USA
| | - Peter Spencer
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - G Jean Harry
- Mechanistic Toxicology Branch, Division of Translational Toxicology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, USA
| | - Jason Cannon
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA
| | - Fang Liu
- Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, USA
| | - Christopher A McPherson
- Mechanistic Toxicology Branch, Division of Translational Toxicology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, USA
| | | | - Remco H S Westerink
- Division of Toxicology, Institute for Risk Assessment Sciences (IRAS), Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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202
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King B, Hook M, Brown R, Mahoney J, Steege L. Implementation of MOVIN by a Nurse-Led Clinical Team: A Multiple Methods Evaluation Using the RE-AIM Framework. Res Gerontol Nurs 2024; 17:189-201. [PMID: 39047229 DOI: 10.3928/19404921-20240621-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE To evaluate the implementation of MOVIN, a multicomponent mobility intervention, by a nurse-led team and measure the effectiveness on unit-level outcomes. METHOD A pragmatic quasi-experimental study was conducted on an inpatient adult medical unit. Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Interviews with 13 organizational partners were conducted to understand barriers and facilitators to adoption. Thematic analysis was used to analyze the data. Quantitative data to determine effectiveness on distance of patient ambulation and percent of patients ambulated by nursing staff were analyzed using an interrupted time series. RESULTS A significant increase in total weekly distances for patient ambulation and percent of patients ambulated by nursing staff occurred between preintervention, intervention, and postintervention periods. Themes for adoption included: Value, Immediate Feedback, Inclusive Implementation, Resource Needs, and Lack of Organizational Evidence. The nurse-led team demonstrated high fidelity to maintaining the core components of MOVIN. CONCLUSION A nurse-led team can successfully launch a multicomponent mobility intervention and sustain impact. RE-AIM supported assessments of key partners at multiple organizational levels, capturing critical unit level outcomes. Multiple methods for data collection and analysis yielded rich results to inform future dissemination of MOVIN. [Research in Gerontological Nursing, 17(4), 189-201.].
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203
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Muhammad M, Foster JA, Griffin JT, Kinchelow DL, Sierra-Arce CR, Southall WGS, Albitar F, Moghadamian ES, Wright RD, Matuszewski PE, Zuelzer DA, Primm DD, Hawk GS, Aneja A. Nonoperative Treatment of Humeral Shaft Fractures With Immediate Functional Bracing Versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study. J Orthop Trauma 2024; 38:383-389. [PMID: 38527088 DOI: 10.1097/bot.0000000000002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To compare radiographic and clinical outcomes in nonoperative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. METHODS DESIGN Retrospective cohort study. SETTING Academic Level 1 Trauma Center. PATIENT SELECTION CRITERIA Patients with closed humeral shaft fractures managed nonoperatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months of follow-up were excluded. OUTCOME MEASURES AND COMPARISONS The primary outcome was coronal and sagittal radiographic alignment assessed at the final follow-up. Secondary outcomes included rate of failure of nonoperative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear. RESULTS Ninety-seven patients were managed nonoperatively with delayed FB (n = 58) or immediate FB (n = 39). Overall, the mean age was 49.9 years (range 18-94 years), and 64 (66%) patients were female. The immediate FB group had less smokers ( P = 0.003) and lower incidence of radial nerve palsy ( P = 0.025), with more proximal third humeral shaft fractures ( P = 0.001). There were no other significant differences in demographic or clinical characteristics ( P > 0.05). There were no significant differences in coronal ( P = 0.144) or sagittal ( P = 0.763) radiographic alignment between the groups. In total, 33 (34.0%) humeral shaft fractures failed nonoperative management, with 11 (28.2%) in the immediate FB group and 22 (37.9%) in the delayed FB group ( P = 0.322). There were no significant differences in fracture union ( P = 0.074) or skin complications ( P = 0.259) between the groups. CONCLUSIONS This study demonstrated that nonoperative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with CS followed by delayed functional bracing. Future prospective studies assessing patient-reported outcomes will further guide clinical decision making. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maaz Muhammad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Jeffrey A Foster
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Jarod T Griffin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Daria L Kinchelow
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | | | - Wyatt G S Southall
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Ferras Albitar
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Eric S Moghadamian
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Raymond D Wright
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Paul E Matuszewski
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - David A Zuelzer
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Daniel D Primm
- Department Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY; and
| | - Gregory S Hawk
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY
| | - Arun Aneja
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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McFarlane IV, Wong M, Alder-Price AC. Subscapular abscesses: A literature review and evidence-based treatment guidelines. Shoulder Elbow 2024; 16:232-238. [PMID: 38818095 PMCID: PMC11135199 DOI: 10.1177/17585732231165194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/01/2024]
Abstract
Background An intramuscular abscess of the subscapularis is a rare phenomenon but important pathology for surgeons to be aware of because clinical deterioration can be rapid and diagnosis difficult. The presentation often mimics other common shoulder pathologies with subacute shoulder pain and stiffness. Early diagnosis, antibiotics and surgical drainage are critical to reduce the spread and joint destruction. Methods A search of PubMed and Google Scholar databases identified cases of subscapular intramuscular abscess. Data collected about each case included patient demographics, presentation, pathology, surgical treatment and outcome. The authors report one additional subscapular abscess case. Results Data from 17 cases of subscapular abscess were found, 16 in the literature and one case described by the authors. Sixteen of 17 cases (94.1%) presented with shoulder pain and reduced range of motion worsening over a mean of 6.7 days prior to presentation. Surgical approaches utilised included a posterior inferomedial approach, deltoid-pectoral approach and one posterior inferolateral approach. Discussion and conclusions From the limited data available regarding subscapular intramuscular abscess, the authors make the following recommendations: (1) Empirical antibiotics covering Staphylococcus aureus +/- methicillin-resistant Staphylococcus aureus, (2) drainage is indicated in all cases; and (3) tendon-sparing approaches can access an abscess in most locations within the subscapular space.
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Affiliation(s)
- Isobel V McFarlane
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Marcus Wong
- Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Angela Chang Alder-Price
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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205
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Tanzer T, Pham B, Warren N, Barras M, Kisely S, Siskind D. Overcoming clozapine's adverse events: a narrative review of systematic reviews and meta-analyses. Expert Opin Drug Saf 2024; 23:811-831. [PMID: 38814794 DOI: 10.1080/14740338.2024.2362796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/29/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Clozapine is the gold standard treatment for treatment-resistant schizophrenia, however adverse events remain a clinical challenge. AREAS COVERED This review presents a narrative synthesis of systematic reviews and meta-analyses that have reported the onset, incidence, prevalence, and management of clozapine's adverse events. We conducted a systematic literature search using PubMed, Embase, PsycINFO, OvidMEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews from inception to April 2024. EXPERT OPINION Effective management of clozapine's adverse events necessitates multi-faceted, individualized, and shared-decision strategies. Despite a lack of high-quality systematic evidence, expert inter-disciplinary solutions are provided to help address a critical need for clinical guidance. This 35-year update offers an evidence-based framework to assist clinicians, patients, and caregivers navigate the adverse events associated with clozapine therapy.
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Affiliation(s)
- Timothy Tanzer
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- Medicine, University of Queensland, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Betty Pham
- Department of Pharmacy, Metro South Community and Oral Health, Brisbane, Australia
| | - Nicola Warren
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Michael Barras
- Princess Alexandra Hospital, Department of Pharmacy, Brisbane, Australia
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Steve Kisely
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
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206
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Ralph-Nearman C, Osborn KD, Chang RS, Barber KE. Momentary physiological indices related to eating disorders: A systematic and methodological review. EUROPEAN EATING DISORDERS REVIEW 2024; 32:700-717. [PMID: 38446505 PMCID: PMC11144111 DOI: 10.1002/erv.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 12/29/2023] [Indexed: 03/07/2024]
Abstract
Eating disorders (ED) are serious psychiatric illnesses, with no everyday support to intervene on the high rates of relapse. Understanding physiological indices that can be measured by wearable sensor technologies may provide new momentary interventions for individuals with ED. This systematic review, searching large databases, synthesises studies investigating peripheral physiological (PP) indices commonly included in wearable wristbands (heart rate [HR], heart rate variability [HRV], electrodermal activity [EDA], peripheral skin temperature [PST], and acceleration) in ED. Inclusion criteria included: (a) full peer-reviewed empirical articles in English; (b) human participants with active ED; and (c) containing one of five wearable physiological measures. Kmet risk of bias was assessed. Ninety-four studies were included (Anorexia nervosa [AN; N = 4418], bulimia nervosa [BN; N = 916], binge eating disorder [BED; N = 1604], other specified feeding and eating disorders [OSFED; N = 424], and transdiagnostic [N = 47]). Participants with AN displayed lower HR and EDA and higher HRV compared to healthy individuals. Those with BN showed higher HRV, and lower EDA and PST compared to healthy individuals. Other ED and Transdiagnostic samples showed mixed results. PP differences are indicated through various assessments in ED, which may suggest diagnostic associations, although more studies are needed to validate observed patterns. Results suggest important therapeutic potential for PP in ED, and larger studies including diverse participants and diagnostic groups are needed to fully uncover their role in ED.
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Affiliation(s)
| | - Kimberly D. Osborn
- Department of Psychological and Brain Sciences, University of Louisville, Kentucky
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Rose Seoyoung Chang
- Department of Psychological and Brain Sciences, University of Louisville, Kentucky
- Department of Psychology, Seoul National University, Seoul, South Korea
| | - Kathryn E. Barber
- Department of Psychological and Brain Sciences, University of Louisville, Kentucky
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
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207
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Kim SH, Moon JY, Min KH, Lee H. Proposed Etiotypes for Chronic Obstructive Pulmonary Disease: Controversial Issues. Tuberc Respir Dis (Seoul) 2024; 87:221-233. [PMID: 38317417 PMCID: PMC11222089 DOI: 10.4046/trd.2023.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) revised the definition of chronic obstructive pulmonary disease (COPD) to broadly include a variety of etiologies. A new taxonomy, composed of etiotypes, aims to highlight the heterogeneity in causes and pathogenesis of COPD, allowing more personalized management strategies and emphasizing the need for targeted research to understand and manage COPD better. However, controversy arises with including some diseases under the umbrella term of COPD, as their clinical presentations and treatments differ from classical COPD, which is smoking-related. COPD due to infection (COPD-I) and COPD due to environmental exposure (COPD-P) are classifications within the new taxonomy. Some disease entities in these categories show distinct clinical features and may not benefit from conventional COPD treatments, raising questions about their classification as COPD subtypes. There is also controversy regarding whether bronchiectasis with airflow limitations should be classified as an etiotype of COPD. This article discusses controversial issues associated with the proposed etiotypes for COPD in terms of COPD-I, COPD-P, and bronchiectasis. While the updated COPD definition by GOLD 2023 is a major step towards recognizing the disease's complexity, it also raises questions about the classification of related respiratory conditions. This highlights the need for further research to improve our understanding and approach to COPD management.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Republic of Korea
| | - Ji-Yong Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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208
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Saberian C, Lurain K, Hill LK, Marshall V, Cornejo Castro EM, Labo N, Miley W, Moore K, Roshan R, Ruggerio M, Ryan K, Widell A, Ekwede I, Mangusan R, Rupert A, Barochia A, Whitby D, Yarchoan R, Ramaswami R. Kaposi sarcoma herpesvirus viral load in bronchoalveolar lavage as a diagnostic marker for pulmonary Kaposi sarcoma. AIDS 2024; 38:1172-1180. [PMID: 38564482 PMCID: PMC11141217 DOI: 10.1097/qad.0000000000003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Kaposi sarcoma is a vascular tumor that affects the pulmonary system. However, the diagnosis of airway lesions suggestive of pulmonary Kaposi sarcoma (pKS) is reliant on bronchoscopic visualization. We evaluated the role of Kaposi sarcoma herpesvirus (KSHV) viral load in bronchoalveolar lavage (BAL) as a diagnostic biomarker in patients with bronchoscopic evidence of pKS and evaluated inflammatory cytokine profiles in BAL and blood samples. DESIGN In this retrospective study, we evaluated KSHV viral load and cytokine profiles within BAL and blood samples in patients who underwent bronchoscopy for suspected pKS between 2016 and 2021. METHODS KSHV viral load and cytokine profiles were obtained from both the circulation and BAL samples collected at the time of bronchoscopy to evaluate compartment-specific characteristics. BAL was centrifuged and stored as cell pellets and KSHV viral load was measured using primers for the KSHV K6 gene regions. RESULTS We evaluated 38 BAL samples from 32 patients (30 with HIV co-infection) of whom 23 had pKS. In patients with airway lesions suggestive of pKS, there was higher KSHV viral load (median 3188 vs. 0 copies/10 6 cell equivalent; P = 0.0047). A BAL KSHV viral load cutoff of 526 copies/10 6 cells had a sensitivity of 72% and specificity of 89% in determining lesions consistent with pKS. Those with pKS also had higher IL-1β and IL-8 levels in BAL. The 3-year survival rate for pKS patients was 55%. CONCLUSION KSHV viral load in BAL shows potential for aiding in pKS diagnosis. Patients with pKS also have evidence of cytokine dysregulation in BAL.
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Affiliation(s)
- Chantal Saberian
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Kathryn Lurain
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Lindsay K Hill
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Vickie Marshall
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Elena M. Cornejo Castro
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Kyle Moore
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Romin Roshan
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Margie Ruggerio
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Kerry Ryan
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Anaida Widell
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Irene Ekwede
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Ralph Mangusan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Adam Rupert
- AIDS Monitoring Laboratory, Leidos Biomedical Research, Frederick, MD
| | - Amisha Barochia
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
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Kogon AJ, Hooper SR. Mental health and social-emotional functioning in children and adolescents with chronic kidney disease. Pediatr Nephrol 2024; 39:2015-2031. [PMID: 37878136 DOI: 10.1007/s00467-023-06151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/24/2023] [Accepted: 08/19/2023] [Indexed: 10/26/2023]
Abstract
For children and young adults, living with chronic kidney disease (CKD) poses physical, mental, and social challenges. The mental health functioning of children and adolescents with CKD plays an important role in the medical, educational, vocational, and quality of life outcomes, yet receives little systematic attention in the busy pediatric nephrology clinic. This article will provide an overview of the prevalence of mental illness and symptoms in children and young adults with CKD, strategies to assess for dysfunction, and the long-term outcomes associated with impaired functioning. While there is a relative dearth of literature regarding evidence-based interventions in this population to improve mental health functioning, we provide "best practice" strategies based on the available literature to address emotional and/or behavioral challenges once they are identified. More research is needed to define appropriate interventions to alleviate mental health issues and social-emotional distress, and this review of the literature will serve to provide directions for future research.
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Affiliation(s)
- Amy J Kogon
- Children's Hospital of Philadelphia, Division of Pediatric Nephrology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Stephen R Hooper
- Department of Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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210
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Malinzak EB, Vail EA, Wixson M, Lee A. Enhancing Our Workforce: Recruitment and Retention in Anesthesiology. Int Anesthesiol Clin 2024; 62:26-34. [PMID: 38785107 DOI: 10.1097/aia.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.
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Affiliation(s)
| | - Emily A Vail
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Wixson
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Allison Lee
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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211
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Tee ZJ. Prochlorperazine-induced neuroleptic malignant syndrome. Am J Emerg Med 2024; 81:160.e1-160.e2. [PMID: 38575461 DOI: 10.1016/j.ajem.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 04/06/2024] Open
Abstract
Neuroleptic malignant syndrome (NMS) is a rare yet severe condition typically associated with antipsychotic medications. Here, we present a case of NMS induced by prochlorperazine in a 76-year-old male with multiple comorbidities, aiming to delineate its clinical manifestation, diagnostic complexities, and treatment approaches. Our methodology involved a thorough documentation of the patient's medical history, initial symptoms, physical examination findings, laboratory results, diagnostic processes, and subsequent therapeutic interventions. The patient exhibited classic NMS symptoms, including fever, altered mental status, autonomic dysregulation, and generalized rigidity, consistent with diagnostic criteria. Notably, laboratory investigations failed to reveal the typical abnormalities often seen in NMS cases, highlighting the diverse presentation of this syndrome. Management strategies primarily focused on benzodiazepines and amantadine, leading to a gradual improvement in symptoms and eventual resolution of NMS. This underscores the critical role of early recognition and appropriate pharmacotherapy in managing prochlorperazine-induced NMS, even at standard dosage levels. The absence of characteristic laboratory findings in NMS poses challenges in diagnosis, necessitating a comprehensive clinical assessment for accurate identification. Moreover, this case emphasizes the need for further research to better understand the pathophysiology of prochlorperazine-induced NMS and optimize treatment protocols. In conclusion, our case report sheds light on the complexities surrounding NMS induced by prochlorperazine, emphasizing the importance of vigilant monitoring and tailored therapeutic strategies in mitigating its potentially life-threatening consequences.
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Affiliation(s)
- Zong-Jun Tee
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
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Bastawy N, El-Mosallamy AEMK, Aljuaydi SH, AbuBakr HO, Rasheed RA, Sadek AS, Khattab RT, Abualyamin WB, Abdelaal SE, Boushra AF. SGLT2 inhibitor as a potential therapeutic approach in hyperthyroidism-induced cardiopulmonary injury in rats. Pflugers Arch 2024; 476:1125-1143. [PMID: 38700719 PMCID: PMC11166784 DOI: 10.1007/s00424-024-02967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/01/2024] [Accepted: 04/17/2024] [Indexed: 06/13/2024]
Abstract
Hyperthyroidism-induced cardiac disease is an evolving health, economic, and social problem affecting well-being. Sodium-glucose cotransporter protein 2 inhibitors (SGLT2-I) have been proven to be cardio-protective when administered in cases of heart failure. This study intended to investigate the potential therapeutic effect of SGLT2-I on hyperthyroidism-related cardiopulmonary injury, targeting the possible underlying mechanisms. The impact of the SGLT2-I, dapagliflozin (DAPA), (1 mg/kg/day, p.o) on LT4 (0.3 mg/kg/day, i.p)-induced cardiopulmonary injury was investigated in rats. The body weight, ECG, and serum hormones were evaluated. Also, redox balance, DNA fragmentation, inflammatory cytokines, and PCR quantification in heart and lung tissues were employed to investigate the effect of DAPA in experimentally induced hyperthyroid rats along with histological and immunohistochemical examination. Coadministration of DAPA with LT4 effectively restored all serum biomarkers to nearly average levels, improved ECG findings, and reinstated the redox balance. Also, DAPA could improve DNA fragmentation, elevate mtTFA, and lessen TNF-α and IGF-1 gene expression in both organs of treated animals. Furthermore, DAPA markedly improved the necro-inflammatory and fibrotic cardiopulmonary histological alterations and reduced the tissue immunohistochemical expression of TNF-α and caspase-3. Although further clinical and deep molecular studies are required before transposing to humans, our study emphasized DAPA's potential to relieve hyperthyroidism-induced cardiopulmonary injury in rats through its antioxidant, anti-inflammatory, and anti-apoptotic effects, as well as via antagonizing the sympathetic over activity.
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Affiliation(s)
- Nermeen Bastawy
- Department of Medical Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aliaa E M K El-Mosallamy
- Department of Pharmacology, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Samira H Aljuaydi
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
| | - Huda O AbuBakr
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Cairo University, Giza, 12211, Egypt
- Department of Biochemistry, Faculty of Veterinary Medicine, Egyptian Chinese University, Cairo, Egypt
| | - Rabab Ahmed Rasheed
- Department of Medical Histology and Cell Biology, Faculty of Medicine, King Salman International University, El Tor, 46511, South Sinai, Egypt.
| | - A S Sadek
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
- Department of Anatomy and Embryology, Faculty of Medicine, King Salman International University, El Tor, 46511, South Sinai, Egypt
| | - R T Khattab
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Wael Botros Abualyamin
- Department of Medical Physiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Department of Natural and Physical Sciences, Blinn College, Brenham, TX, USA
| | - Shereen E Abdelaal
- Department of Pathology, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Amy F Boushra
- Department of Medical Physiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Saatchi D, Oh S, Yoo H, Kim JS, Lee MJ, Khan M, Wicklein B, Mahato M, Oh IK. Dynamic Schwarz Meta-Foams: Customizable Solutions for Environmental Noise Reduction. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2402872. [PMID: 38946604 DOI: 10.1002/advs.202402872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/26/2024] [Indexed: 07/02/2024]
Abstract
In an era marked by increasing environmental challenges affecting human well-being, traditional acoustic materials struggle to effectively handle the diverse and multi-frequency nature of harmful environmental noises. This has spurred a demand for innovative acoustic metamaterial solutions by utilizing sustainable design strategies. This research introduces tunable Schwarz metamaterial capable of transforming into a soft meta-foam to solve the complex problems of varying environmental noises. This study primarily focuses on adjusting single to multiple sound-blocking bandgaps mechanism using a multi-layered approach, incorporating the Schwarz P-type triply periodic minimal surface (TPMS) and its elective soft foam counterpart, known as tunable Schwarz meta-foams (TSMF-x). The tunable design parameters of the unit cell, multi-layered TPMS, and soft programmable TSMF-lichen version are comprehensively explored including a fire-safety test. The results demonstrate these enhanced flame retardant meta-foam families have the potential to be used for mid-to-high-frequency environmental noises in industrial equipment and smart homes for sustainable architecture and environmental health applications.
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Affiliation(s)
- Daniel Saatchi
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Saewoong Oh
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Hyunjoon Yoo
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Ji-Seok Kim
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Myung-Joon Lee
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Mannan Khan
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Bernd Wicklein
- Materials Science Institute of Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
| | - Manmatha Mahato
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Il-Kwon Oh
- National Creative Research Initiative for Functionally Antagonistic Nano-Engineering, Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
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214
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Ahn JH, Jung DH, Kim DY, Lee TS, Kim YJ, Lee YJ, Seo IS, Kim WG, Cho YJ, Shin SJ, Park JH. Impact of IL-1β on lung pathology caused by Mycobacterium abscessus infection and its association with IL-17 production. Microbes Infect 2024; 26:105351. [PMID: 38724000 DOI: 10.1016/j.micinf.2024.105351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
Mycobacterium abscessus (MAB), a non-tuberculous mycobacterium (NTM), causes chronic pulmonary inflammation in humans. The NLRP3 inflammasome is a multi-protein complex that triggers IL-1β maturation and pyroptosis through the cleavage of caspase-1. In this study, we investigated the roles of NLRP3 and IL-1β in the host's defense against MAB. The IL-1β production by MAB was completely abolished in NLRP3, but not NLRC4, deficient macrophages. The NLRP3 inflammasome components, which are ASC and caspase-1 were also found to be essential for IL-1β production in response to MAB. NLRP3 and IL-1β deficiency did not affect the intracellular growth of MAB in macrophages, and the bacterial burden in lungs of NLRP3- and IL-1β-deficient mice was also comparable to the burden observed in WT mice. In contrast, IL-1β deficiency ameliorated lung pathology in MAB-infected mice. Notably, the lung homogenates of IL-1β-deficient mice had reduced levels of IL-17, but not IFN-γ and IL-4 when compared with WT counterparts. Furthermore, in vitro co-culture analysis showed that IL-1β signaling was essential for IL-17 production in response to MAB. Finally, we observed that the anti-IL-17 antibody administration moderately mitigated MAB-induced lung pathology. These findings indicated that IL-1β production contribute to MAB-induced lung pathology via the elevation of IL-17 production.
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Affiliation(s)
- Jae-Hun Ahn
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea; Department of Experimental Animal Research, Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Do-Hyeon Jung
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Dong-Yeon Kim
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Tae-Sung Lee
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Yeong-Jun Kim
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Yun-Ji Lee
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - In-Su Seo
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Wan-Gyu Kim
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Young Jin Cho
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jong-Hwan Park
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, Gwangju 61186, Republic of Korea; NODCURE, INC., 77 Yongbong-ro, Buk-gu, Gwangju 61186, Republic of Korea.
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215
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Trotta RL, Shoemaker AE, Greysen SR, Boltz M. Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach. J Healthc Qual 2024; 46:e26-e39. [PMID: 38743004 DOI: 10.1097/jhq.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
ABSTRACT Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.
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216
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Nagarakanti S, Vegunta S, David PS. Migraine Management in Women: Exploring the Impact of Combined Hormonal Contraceptives on Menstrual Migraine. J Womens Health (Larchmt) 2024; 33:991-992. [PMID: 38301122 DOI: 10.1089/jwh.2023.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Sindhu Nagarakanti
- Temple University Honors Program, Undergraduate in Neuroscience, Philadelphia, Pennsylvania, USA
| | - Suneela Vegunta
- Division of Women's Health-Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Paru S David
- Division of Women's Health-Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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217
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Shimosato M, Kada S, Yase E, Sakane N. Oral candida lesions and Candida tropicalis: Potential prognostic markers in end-of-life cancer patients. SPECIAL CARE IN DENTISTRY 2024; 44:1097-1106. [PMID: 38168741 DOI: 10.1111/scd.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
AIMS Oral candidosis is common in patients with end-of-life cancer; however, its prognosis is unclear. We aimed to assess oral candidosis and Candida species as prognostic indicators in palliative care for these patients. METHODS We consecutively included palliative care patients, assessed for candidosis via microbiological techniques, and classified into three groups by the extent of oral lesions. The association between oral candidosis and overall survival was assessed using a Cox proportional hazards model adjusted by performance status (PS). RESULTS We studied 142 patients (median age 77; 52.8% women) with a 76.1% oral candidosis prevalence. Candida albicans (80.6%) was the most common species. Oral lesions were classified as none, grade 1 (28.7%), or ≥ grade 2 (14.8%). During follow-up, Cox models identified ≥grade 2 lesions (aHR = 2.04; 95% CI: 1.18-3.54; p = .011) and Candida tropicalis (aHR = 2.38; 95% CI: 1.03-5.55; p = .044) as predictors. CONCLUSION The extent of oral candidosis lesions or the presence of C. tropicalis may serve as prognostic indicator in patients with end-of-life cancer. Therefore, solely concentrating on the prevalence and frequency of fungal species may be insufficient for predicting life prognosis; it is advisable to assess these parameters through both visual examination and culture.
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Affiliation(s)
- Maiko Shimosato
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shinpei Kada
- Department of Otolaryngology-Head and Neck Surgery, Otsu Red Cross Hospital, Otsu, Shiga, Japan
- Division of Clinical Research Planning and Management, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eriko Yase
- Department of Pharmacy, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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218
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Shamad M, Al-Mutairi N. Successful Treatment of Cutaneous Larva Migrans With Combined Albendazole and Ivermectin Therapy: A Report of Two Cases From Sudan. Cureus 2024; 16:e64665. [PMID: 39021742 PMCID: PMC11253558 DOI: 10.7759/cureus.64665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 07/20/2024] Open
Abstract
Cutaneous larva migrans (CLM), caused by third-stage filariform larvae of cat and dog hookworms, presents as pruritic, serpiginous tracks upon skin penetration by larvae from contaminated soil. Herein, we report the successful treatment of two CLM patients using albendazole and ivermectin combination therapy. A 42-year-old man from Kordofan and a 38-year-old man from White Nile State presented with characteristic lesions on their lower extremities, resolving completely within one week post-treatment without recurrence. This report highlights the potential of combined albendazole-ivermectin therapy in managing CLM amid emerging antihelminthic resistance, suggesting that its broader application warrants further investigation.
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Affiliation(s)
- Mahdi Shamad
- College of Medicine, University of Bahri, Khartoum, SDN
- Faculty of Medicine, Kuwait University, Kuwait City, KWT
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219
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He Y, Liu J, Wei S, Chen J. Super-refractory status epilepticus in a woman with Aeromonas caviae meningitis: a rare case report and review of the literature. Front Med (Lausanne) 2024; 11:1410762. [PMID: 39011456 PMCID: PMC11246960 DOI: 10.3389/fmed.2024.1410762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
Currently, there is a lack of knowledge regarding Aeromonas caviae meningitis. We report the first case of super-refractory status epilepticus (SRSE) in a woman with Aeromonas caviae meningitis. The case report demonstrates that this condition can lead to severe SRSE. Effective treatment for epilepsy is crucial for improving the prognosis for similar patients. According to Gomes et al.'s consensus protocol for SRSE, using a combination of up to one anesthetic drug and three non-anesthetic anti-epileptic drugs may be helpful and important in managing SRSE that is caused by Aeromonas caviae meningitis.
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Affiliation(s)
- Yanlang He
- Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jia Liu
- Department of Geriatrics, Shaoyang Central Hospital, Shaoyang, China
| | - Sheng Wei
- Medical College of Nanchang University, Nanchang, China
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jianyong Chen
- Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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220
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Michelson JD. Considerations Regarding Vitamin D in Foot and Ankle Treatment and Surgery. Orthop Clin North Am 2024; 55:383-392. [PMID: 38782509 DOI: 10.1016/j.ocl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans. There should be a low threshold for assessing vitamin D levels in such patients.
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Affiliation(s)
- James D Michelson
- Orthopaedic Surgery, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Stafford Hall 418, 95 Carrigan Drive, Burlington, VT 05401, USA.
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221
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Gao Q, Ma Y, Qu X, Zheng X. Risk factors in patients with acute fatty liver of pregnancy: the role of abortion, total bilirubin and serum creatinine. Arch Gynecol Obstet 2024; 310:153-159. [PMID: 37910196 DOI: 10.1007/s00404-023-07234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Acute fatty liver of pregnancy (AFLP) is a relatively rare obstetric emergency usually accompanied by fatal complications. Numerous studies have evaluated the potential risk factors for outcomes in patients with AFLP. But rare studies evaluated the predictive ability, sensitivity and specificity of the risk factors for maternal mortality. Thus, in this multicenter research, we aimed to further prove the predictive ability of the MELD model, investigated the prognostic value of history of abortion (HOA), total bilirubin (TBiL) and serum creatinine (SCr) and explored new predictive models for predicting maternal mortality in patients with AFLP. METHODS We performed a retrospective cohort study of 133 hospitalised patients with AFLP in four Chinese tertiary hospitals between January 2009 and April 2014. RESULTS The maximal AUC amongst three independent risk factors for maternal death was TBiL with a cut-off point of > 131.9 μmol/L, showing a sensitivity of 100% and a specificity of 55.9%. The threshold of the RF model for maternal mortality was - 1.629 and the AUC was 0.876, with an 81.8% sensitivity and an 80.2% specificity. The AUC for MELD model to predict maternal death was 0.894, and the best cut-off point was 28 with a sensitivity of 81.8% and a specificity of 84.7%. CONCLUSIONS Both the MELD model and the RF model showed good efficacy in predicting the maternal mortality in patients with ALFP (AUC = 0.894 and 0.876, respectively).
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Affiliation(s)
- Qiang Gao
- Department of Critical Care Medicine, Dazhou Central Hospital, NO.56 Nanyuemiao Street, Tongchuan District, Dazhou, 635000, Sichuan, China
| | - Yujie Ma
- Department of Cardiovascular Medicine, Dachuan People's Hospital, Dazhou, Sichuan, China
| | - Xin Qu
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xiangde Zheng
- Department of Critical Care Medicine, Dazhou Central Hospital, NO.56 Nanyuemiao Street, Tongchuan District, Dazhou, 635000, Sichuan, China.
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222
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Wang K, Shafique S, Wang N, Walter SM, Xie X, Piamjariyakul U, Winstanley EL. Early-onset alcohol, tobacco, and illicit drug use with age at onset of hypertension: a survival analysis. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1129-1141. [PMID: 38104055 DOI: 10.1007/s00127-023-02596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To examine the associations of age when first substance use and early-onset substance use before age 18 with age at onset (AAO) of hypertension. METHODS This study included 19,270 individuals with AAO of hypertension from the 2015-2019 National Survey on Drug Use and Health. Age when first use of 10 substance use variables included alcohol, daily cigarettes, cigars, smokeless tobacco, marijuana, cocaine, hallucinogens, lysergic acid diethylamide (LSD), inhalants, and methamphetamine use. The outcome was AAO of hypertension and variable cluster analysis was used to classify the exposures and outcome. Substance use status was classified into three categories: early-onset substance use (first used substance before age 18), late-onset substance use (first used substance after age 18), and never used. RESULTS The mean AAO of hypertension was 42.7 years. Age when first use of 10 substance use variables had significant correlations with AAO of hypertension (all p values < 0.001). Individuals with early-onset alcohol, cigars, smokeless tobacco, marijuana, hallucinogens, inhalants, cocaine, LSD, and methamphetamine use revealed significantly earlier onset of hypertension than those never used. Compared with never used substances, the Cox regression model showed that early-onset alcohol, smokeless tobacco, marijuana, inhalants, and methamphetamine use had an increased risk of AAO of hypertension [hazard ratio (HR) (95%CI) = 1.22 (1.13, 1.31), 1.36 (1.24, 1.49), 1.85 (1.75, 1.95), 1.41 (1.30, 1.52), and 1.27 (1.07,1.50), respectively]. CONCLUSION These findings suggest that intervention strategies or programs focusing on preventing early-onset substance use before age 18 may delay the onset of adult hypertension.
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Affiliation(s)
- Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Saima Shafique
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
- Office of Research and Scholarly Activities, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Nianyang Wang
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Suzy Mascaro Walter
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Xin Xie
- Department of Economics and Finance, College of Business and Technology, East Tennessee State University, Johnson City, TN, 37614, USA
| | - Ubolrat Piamjariyakul
- Office of Research and Scholarly Activities, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
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223
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Akuri MC, Bencardino JT, Peixoto JB, Sato VN, Miyahara LK, Kase DT, Dell'Aquila AM, do Amaral E Castro A, Fernandes ARC, Aihara AY. Fungal Musculoskeletal Infections: Comprehensive Approach to Proper Diagnosis. Radiographics 2024; 44:e230176. [PMID: 38900682 DOI: 10.1148/rg.230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Fungal musculoskeletal infections often have subacute or indolent manifestations, making it difficult to distinguish them from other diseases and infections, given that they are relatively uncommon. Fungal infections occur by hematogenous spread, direct inoculation, or contiguous extension and may be related to different risk factors, including immunosuppression and occupational activity. The infection can manifest in isolation in the musculoskeletal system or as part of a systemic process. The fungi may be endemic to certain regions or may be found throughout the world, and this can help to narrow the diagnosis of the etiologic agent. Infections such as candidiasis, cryptococcosis, aspergillosis, and mucormycosis are often related to immunosuppression. On the other hand, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and blastomycosis can occur in healthy patients in geographic areas where these infections are endemic. Furthermore, infections can be classified on the basis of the site of infection in the body. Some subcutaneous infections that can have osteoarticular involvement include mycetoma, sporotrichosis, and phaeohyphomycosis. Different fungi affect specific bones and joints with greater prevalence. Imaging has a critical role in the evaluation of these diseases. Imaging findings include nonspecific features such as osteomyelitis and arthritis, with bone destruction, osseous erosion, mixed lytic and sclerotic lesions, and joint space narrowing. Multifocal osteomyelitis and chronic arthritis with joint effusion and synovial thickening may also occur. Although imaging findings are often nonspecific, some fungal infections may show findings that aid in narrowing the differential diagnosis, especially when they are associated with the patient's clinical condition and history, the site of osteoarticular involvement, and the geographic location. ©RSNA, 2024.
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Affiliation(s)
- Marina C Akuri
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Jenny T Bencardino
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Júlia B Peixoto
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Vitor N Sato
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Lucas K Miyahara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adriana M Dell'Aquila
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adham do Amaral E Castro
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
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Mallon WT, Cox N. Promotion and Tenure Policies and Practices at U.S. Medical Schools: Is Tenure Irrelevant or More Relevant Than Ever? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:724-732. [PMID: 38489477 DOI: 10.1097/acm.0000000000005689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
ABSTRACT Promotion and tenure (P&T) have been common mechanisms to support and nurture faculty at higher education institutions and, therefore, have been of continual interest to medical school faculty and administrators. In the last decade, significant changes in the academic medicine sector have occurred, including new medical schools, mergers and acquisitions of academic hospitals and health systems, and institutional and societal efforts to address systemic racism and inequality. In addition, societal controversies have revived long-dormant concerns about academic freedom for medical school faculty, a bedrock principle of U.S. higher education for more than a century. These developments raise the question of whether tenure at medical schools is increasingly irrelevant for large numbers of full-time faculty or more relevant than ever.Using a 2022 survey of 118 medical schools, a review of P&T policies at 37 other medical schools, and an analysis of Association of American Medical Colleges Faculty Roster data, the authors review the prevalence of tenure systems at U.S. MD-granting medical schools; trends in the use of such systems for full-time basic science and clinical faculty; models of including diversity, equity, and inclusion (DEI) criteria in P&T standards; and alterations to introduce greater flexibility into the P&T process.The authors' analysis shows that, although tenure systems remain well established at U.S. MD-granting medical schools, the percentage of full-time faculty on tenured or tenure-eligible tracks declined over the last 4 decades. Troubling gaps in tenure-eligible appointments persist between men and women faculty and among faculty by race and ethnicity. Medical schools have begun to deploy a variety of tactics in P&T processes focused on DEI to address these systemic inequities. To adapt the traditional tenure system to meet the needs of academic medicine, medical schools have altered their policies, including tenure financial guarantees, probationary period extensions, and post-tenure review.
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Gottlieb M, Chien N, Long B. Managing Alcohol Withdrawal Syndrome. Ann Emerg Med 2024; 84:29-39. [PMID: 38530674 DOI: 10.1016/j.annemergmed.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
| | - Nicholas Chien
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX
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226
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Chavan K, Chhablani J, Jalali S, Padhy SK. Understanding the relationship between pachychoroid spectrum disorders and retinitis pigmentosa: A review of the evidence. Indian J Ophthalmol 2024; 72:956-961. [PMID: 38622849 DOI: 10.4103/ijo.ijo_2909_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 04/17/2024] Open
Abstract
This study aims to investigate the relationship between pachychoroid spectrum disorders and retinitis pigmentosa (RP) or rod-cone dystrophy through a comprehensive literature review. The purpose is to explore the association between these disorders, understand their underlying mechanisms, and summarize the existing hypotheses and opinions. A thorough review of the literature was conducted using PubMed, focusing on articles related to central serous chorioretinopathy (CSC), RP, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, peripapillary pachychoroid neovasculopathy, and peripheral exudative hemorrhagic chorioretinopathy. Relevant studies were selected for a detailed narrative review and analysis. Several studies have reported the coexistence of CSC and RP, indicating a potential association between the two conditions. The dysfunction of the retinal pigment epithelium is proposed as a common factor. Choroidal thinning is observed in RP, but conflicting results exist regarding choroidal thickness (CT). While some studies support choroidal thinning in RP, others suggest preserved or increased thickness. Additionally, cases of pachychoroid neovasculopathy and polypoidal choroidal vasculopathy in RP have been reported, suggesting an overlap between these conditions. The literature suggests conflicting reports on CT changes in RP. Future research should focus on large-scale studies using comprehensive imaging techniques, genetic analysis, and long-term follow-up to uncover the underlying mechanisms and determine the prevalence of pachychoroid spectrum disorders in RP patients.
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Affiliation(s)
- Kasturi Chavan
- Vitreoretina Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Subhadra Jalali
- Vitreoretina Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta Kumar Padhy
- Vitreoretina Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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227
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Rungsinaporn V, Innarkgool S, Kongmalai P. Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial. Clin Orthop Relat Res 2024; 482:1201-1207. [PMID: 38059761 PMCID: PMC11219141 DOI: 10.1097/corr.0000000000002936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. QUESTIONS/PURPOSES Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? METHODS Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. RESULTS There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. CONCLUSION The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Visit Rungsinaporn
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Sirasit Innarkgool
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Pinkawas Kongmalai
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
- Department of Orthopedics, Faculty of Medicine, Kasetsart University, Bangkok, Thailand
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Shah M, Green J, Hudacko R, Cohen AJ. Clinical Response to Olaparib in a Patient With Leptomeningeal Carcinomatosis in Newly Diagnosed Breast Cancer With Germline BRCA2 Mutation. JCO Precis Oncol 2024; 8:e2400063. [PMID: 38991180 DOI: 10.1200/po.24.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/18/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024] Open
Abstract
Case of LMC in a BRCA2-mutated breast cancer patient shows clinical improvement with Olaparib therapy.
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Affiliation(s)
- Manali Shah
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Jeremy Green
- Department of Radiology, Newark Beth Israel Medical Center, Newark, NJ
| | - Rachel Hudacko
- Department of Pathology, Newark Beth Israel Medical Center, Newark, NJ
| | - Alice J Cohen
- Frederick B. Cohen Comprehensive Cancer & Blood Disorders Center, Newark Beth Israel Medical Center, Newark, NJ
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Grande E, Alicandro G, Vichi M, Pompili M, Frova L. Suicide After Partner's Death in the Elderly Population: Results From a Nationwide Cohort Study in Italy. Am J Geriatr Psychiatry 2024; 32:825-831. [PMID: 38342662 DOI: 10.1016/j.jagp.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE This study aims to investigate the effect of partner loss on suicide mortality for surviving partners in the elderly Italian population and to explore differences according to sex and time elapsed since the loss. DESIGN This was a historical cohort study. SETTING All Italian residents registered by the 15th Italian Population Census (9 October 2011) were linked to emigration records and death certificates for 2012-2017 to track migration, vital status, and cause of death. PARTICIPANTS 5,068,414 individuals living as a couple, as registered in the census, and aged ≥69 years on January 1, 2012. MEASUREMENTS Mortality rate ratios (MRR) estimated through Poisson regression models were used to compare suicide mortality at age ≥75 years between subjects who experienced partner loss and those who did not. RESULTS Among people who experienced partner loss, there were 383 suicide deaths in men and 90 in women. Suicide mortality was higher in older men and women who experienced the loss compared to those who did not, and the impact of the spouse loss on mortality was stronger in men (age-adjusted MRR=2.83) than in women (1.41). Among men the excess risk was particularly high during the first year following the loss; in women, no substantial differences in the excess risk were observed over the follow-up period. CONCLUSION Study findings provide evidence of the sex differences in the impact of spouse loss based on data from a large national cohort and reinforce the need for monitoring suicide risk in recently widowed older people.
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Affiliation(s)
- Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics (EG, LF), Rome, Italy.
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano (GA), Milano, Italy; Department of Paediatrics, Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (GA), Milano, Italy
| | - Monica Vichi
- Statistical Service, Istituto Superiore di Sanità (MV), Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome (MP), Italy
| | - Luisa Frova
- Integrated System for Health, Social Assistance and Welfare, National Institute of Statistics (EG, LF), Rome, Italy
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Berkalieva A, Kelly NR, Fisher A, Hohmann SF, Abul-Husn NS, Greally JM, Horowitz CR, Wasserstein MP, Kenny EE, Gelb BD, Ferket BS. Physician and informal care use explained by the Pediatric Quality of Life Inventory (PedsQL) in children with suspected genetic disorders. Qual Life Res 2024; 33:1997-2009. [PMID: 38743313 DOI: 10.1007/s11136-024-03677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To examine associations between Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL Infant Scales with formal health care resource utilization (HCRU) and informal caregiver burden. METHODS We studied a pediatric cohort of 837 patients (median age: 8.4 years) with suspected genetic disorders enrolled January 2019 through July 2021 in the NYCKidSeq program for diagnostic sequencing. Using linked ~ nine-month longitudinal survey and physician claims data collected through May 2022, we modeled the association between baseline PedsQL scores and post-baseline HCRU (median follow-up: 21.1 months) and informal care. We also assessed the longitudinal change in PedsQL scores with physician services using linear mixed-effects models. RESULTS Lower PedsQL total and physical health scores were independently associated with increases in 18-month physician services, encounters, and weekly informal care. Comparing low vs. median total scores, increases were 10.6 services (95% CI: 1.0-24.6), 3.3 encounters (95% CI: 0.5-6.8), and $668 (95% CI: $350-965), respectively. For the psychosocial domain, higher scores were associated with decreased informal care. Based on adjusted linear mixed-effects modeling, every additional ten physician services was associated with diminished improvement in longitudinal PedsQL total score trajectories by 1.1 point (95% confidence interval: 0.6-1.6) on average. Similar trends were observed in the physical and psychosocial domains. CONCLUSION PedsQL scores were independently associated with higher utilization of physician services and informal care. Moreover, longitudinal trajectories of PedsQL scores became less favorable with increased physician services. Adding PedsQL survey instruments to conventional measures for improved risk stratification should be evaluated in further research.
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Affiliation(s)
- Asem Berkalieva
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA
| | - Nicole R Kelly
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ashley Fisher
- Center for Advanced Analytics, Vizient, Chicago, IL, USA
| | | | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- 23andMe Inc, Sunnyvale, CA, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Division of Genomics, Department of Genetics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eimear E Kenny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bart S Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA.
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Slanovic L, Arwas N, Aviram M, Gatt D, Lazar I, Feinstein Y, Yafit D, Goldbart A, Alkrinawi S, Golan-Tripto I, Neeman E. Pediatric thermal epiglottitis: insights from a tertiary center experience. Eur J Pediatr 2024; 183:2913-2919. [PMID: 38613577 DOI: 10.1007/s00431-024-05555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
Thermal epiglottitis, a non-infectious cause of epiglottitis, is a rare entity that shares some clinical features with infectious epiglottitis. This study presents 16 years of experience in diagnosing and managing thermal epiglottitis. A retrospective descriptive study in a tertiary center in southern Israel included confirmed cases of thermal epiglottitis in children (0-18 years) between 2004 and 2020 by endoscopy. Of approximately 600,000 pediatric ER admissions between 2004 and 2020, seven children were diagnosed by endoscopy with thermal epiglottitis (mean age 24 months, 71% males). Clinical presentation included stridor, respiratory distress, and drooling. Four children had fever and elevated inflammatory markers at presentation and were treated with systemic antibiotics. All were treated with systemic steroids. The median length of stay in the PICU was five days, and four patients required intubations. All fully recovered without experiencing any sequelae. Conclusion: Thermal epiglottitis stands as a potential contributor to acute upper airway obstruction. Although it's rarity, it should be discussed in any child with acute upper airway obstruction. It is essential to inquire directly about the accidental intake of hot beverages, particularly in cases lacking fever or elevated inflammatory markers. What is Known: • Thermal epiglottitis is a rare, non-infectious condition sharing clinical features with infectious epiglottitis. • Common presentations include stridor, respiratory distress, and drooling. What is New: • Thermal epiglottitis is a potential contributor to acute upper airway obstruction, urging consideration even in the absence of fever or elevated markers. • Direct inquiry about hot beverage intake for diagnosis is essential for diagnosis.
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Affiliation(s)
- Leonel Slanovic
- Pediatric Cardiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Arwas
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Pediatric Pulmonary Unit, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University, PO box 151, Beer Sheva, Israel.
| | - Micha Aviram
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvir Gatt
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Isaac Lazar
- Pediatric Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yael Feinstein
- Pediatric Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Daniel Yafit
- Department of ENT Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Aviv Goldbart
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Soliman Alkrinawi
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eitan Neeman
- Pediatric Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
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232
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Yaghoobi A, Abiri R, Alvandi A, Manouchehri I, Arkan E, Jalalvand AR. A novel biosensing strategy for identification of three important bacteria causing meningitis. J Microbiol Methods 2024; 222:106954. [PMID: 38754480 DOI: 10.1016/j.mimet.2024.106954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/11/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
Bacterial meningitis is an acute infection which requires rapid diagnosis and treatment due to the high mortality and serious consequences of the disease. The purpose of this study was to design a homemade multiplex PCR and a novel fluorescence biosensor on chip (FBC) to detect three important agents of meningitis including Streptococcus pneumoniae (S. pneumoniae), Neisseria meningitidis (N. meningitidis), and Haemophilus influenzae (H. influenzae). The homemade multiplex PCR can diagnose three bacterial species simultaneously. Fabrication of FBC was carried out based on the deposition of lead nanoparticles on a quartz slide using the thermal evaporation method. Then, the SH-Cap Probe/Target ssDNA /FAM-Rep probe was loaded on lead film. The evaluation of the fluorescence reaction when the probes bind to the target ssDNA was assessed by a Cytation 5 Cell Imaging Multimode Reader Bio-Tek. The limit of detections (LOD) in homemade PCR and FBC to identify S. pneumoniae were 119 × 102 CFU/mL (0.27 ng/μL) and 380 CFU/mL (9 pg/μL), respectively. The LODs of homemade PCR and FBC for detection of N. meningitidis were 4.49 CFU/mL (1.1 pg/μL) and 13 × 103 CFU/mL (30 pg/μL), respectively. Our results confirmed the LODs of homemade PCR and FBC in detection of H. influenzae were 15.1 CFU/mL (30 fg/μL) and 41 × 102 CFU/mL (90 pg/ μL), respectively. Both techniques had appropriate sensitivity and specificity in detection of S. pneumoniae, N. meningitidis and H. influenzae.
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Affiliation(s)
- Azam Yaghoobi
- Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Abiri
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Amirhoushang Alvandi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Iraj Manouchehri
- Department of Physic, Faculty of Sciences, Kurdistan University, Sanandaj, Iran
| | - Elham Arkan
- Nano Drug Delivery Research Center, Research Institute for Health Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali R Jalalvand
- Pharmaceutical Sciences Research Center, Health institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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233
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Huang X, Shen Y, Liu Y, Zhang H. Current status and future directions in pediatric ventricular assist device. Heart Fail Rev 2024; 29:769-784. [PMID: 38530587 DOI: 10.1007/s10741-024-10396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
A ventricular assist device (VAD) is a form of mechanical circulatory support that uses a mechanical pump to partially or fully take over the function of a failed heart. In recent decades, the VAD has become a crucial option in the treatment of end-stage heart failure in adult patients. However, due to the lack of suitable devices and more complicated patient profiles, this therapeutic approach is still not widely used for pediatric populations. This article reviews the clinically available devices, adverse events, and future directions of design and implementation in pediatric VADs.
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Affiliation(s)
- Xu Huang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yi Shen
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China
| | - Yiwei Liu
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
- Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, No. 1678, Dongfang Rd, Pudong District, Shanghai, 200127, China.
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234
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McCarthy MM, Del Giudice I, Wong A, Fletcher J, Dickson VV, D'Eramo Melkus G. Cardiovascular Health in Black and Latino Adults With Type 2 Diabetes. Nurs Res 2024; 73:270-277. [PMID: 38498851 PMCID: PMC11192611 DOI: 10.1097/nnr.0000000000000730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The incidence of type 2 diabetes (T2DM) among U.S. adults has been rising annually, with a higher incidence rate in Black and Hispanic adults than in Whites. The American Heart Association (AHA) has defined cardiovascular health according to the achievement of seven health behaviors (smoking, body mass index [BMI], physical activity, diet) and health factors (total cholesterol, blood pressure, fasting glucose). Optimal cardiovascular health has been associated with a lower risk of cardiovascular disease, and awareness of this risk may influence healthy behaviors. OBJECTIVES This study aimed to assess cardiovascular health in a sample of Black and Hispanic adults (age: 18-40 years) with T2DM and explore the barriers and facilitators to diabetes self-management and cardiovascular health. METHODS This was an explanatory sequential mixed-method design. The study staff recruited adults with T2DM for the quantitative data followed by qualitative interviews with a subsample of participants using maximum variation sampling. The seven indices of cardiovascular health as defined by the AHA's "Life's Simple 7" were assessed: health behaviors (smoking, BMI, physical activity, diet) and health factors (total cholesterol, blood pressure, A1C). Qualitative interviews were conducted to explore their results as well as the effects of the pandemic on diabetes self-management. Qualitative and quantitative data were integrated into the final analysis phase. RESULTS The majority of the sample was female, with 63% identifying as Black and 47% as Hispanic. The factor with the lowest achievement of ideal levels was BMI, followed by a healthy diet. Less than half achieved ideal levels of blood pressure or physical activity. Themes that emerged from the qualitative data included the impact of social support, the effects of the pandemic on their lives, and educating themselves about T2DM. DISCUSSION Achievement of ideal cardiovascular health factors varied, but the achievement of several health factors may be interrelated. Intervening on even one factor while providing social support may improve other areas of cardiovascular health in this population.
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235
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Xu J, Wu W, Zhang X, Ren Y, Yao M, Liu M, Zou K, Wang W, Sun X. The Use of Real-World Evidence for Regulatory Decisions in China. Clin Pharmacol Ther 2024; 116:82-95. [PMID: 38566457 DOI: 10.1002/cpt.3257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
There is a growing demand for the use of high-quality real-world evidence (RWE) to support regulatory decision-making worldwide and in China, which highlights the need for conducting literature reviews to evaluate the available data and evidence. This study aims to review the use of RWE in Chinese regulatory decisions and to summarize relevant regulatory and methodological considerations to inform the future use of RWE in China. We identified policy documents, technical guidance documents, and cases on official Chinese government websites and extracted their contents separately. We consulted experts from the National Medical Products Administration (NMPA) and academic institutes and searched case-related articles for enrichment. We also searched and included articles related to the use of RWE/Real-world data in Chinese regulatory decisions. Six trial versions of technical guidance documents, 7 case studies, and 40 articles related to the Chinese regulatory decisions were included in this study. Based on the technical guidance, data quality, and appropriate study design and statistical analysis are the main concerns for RWE generation. The cases and articles related to regulatory decisions revealed 9 main concerns, including data sources and applicability, data quality, strength of existing evidence, appropriate study design and statistical analysis, regulated and transparent process for analysis and evidence generation, product safety and efficacy, product characteristics and clinical needs, ethical considerations and data security, and communicate adequately with regulatory authorities. Among these concerns, data issues are central. Preliminary attempts have been made by the NMPA to promote the use of RWE, but substantial challenges still remain.
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Affiliation(s)
- Jiayue Xu
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Wenkai Wu
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Xia Zhang
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Yan Ren
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Minghong Yao
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mei Liu
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Kang Zou
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Wen Wang
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Xin Sun
- Chinese Evidence-based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
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236
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Al‐Qahtani AA. Improving outcomes of type 2 diabetes mellitus patients in primary care with Chronic Care Model: A narrative review. J Gen Fam Med 2024; 25:171-178. [PMID: 38966652 PMCID: PMC11221057 DOI: 10.1002/jgf2.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 07/06/2024] Open
Abstract
Designed and implemented over two decades ago, the Chronic Care Model is a well-established chronic disease management framework that has steered several healthcare systems in successfully improving the clinical outcomes of patients with type 2 diabetes mellitus. Research evidence cements the role of the Chronic Care Model (with its six key elements of organization of healthcare delivery system, self-management support, decision support, delivery system design, clinical information systems, and community resources and policies) as an integrated framework to revamp the type 2 diabetes mellitus-related clinical practice and care that betters the patient care and clinical outcomes. The current review is an evidence-lit summary of importance of use of Chronic Care Model in primary care and their impact on clinical outcomes for patients afflicted with one of the most debilitating metabolic diseases, type 2 diabetes mellitus.
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Affiliation(s)
- Arwa Ahmed Al‐Qahtani
- Department of Family Medicine, College of MedicineAl‐Imam Mohammed Ibn Saud Islamic UniversityRiyadhSaudi Arabia
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237
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Alexander RW, Yang S, Peterson CJ, Nugent K. Analysis of the Types of Retracted COVID-19 Articles Published in PubMed-Listed Journals. South Med J 2024; 117:358-363. [PMID: 38959961 DOI: 10.14423/smj.0000000000001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVES Periodically, medical publications are retracted. The reasons vary from minor situations, such as author attributions, which do not undermine the validity of the data or the analysis in the article, to serious reasons, such as fraud. Understanding the reasons for retraction can provide important information for clinicians, educators, researchers, journals, and editorial boards. METHODS The PubMed database was searched using the term "COVID-19" (coronavirus disease 2019) and the term limitation "retracted publication." The characteristics of the journals with retracted articles, the types of article, and the reasons for retraction were analyzed. RESULTS This search recovered 196 articles that had been retracted. These retractions were published in 179 different journals; 14 journals had >1 retracted article. The mean impact factor of these journals was 8.4, with a range of 0.32-168.9. The most frequent reasons for retractions were duplicate publication, concerns about data validity and analysis, concerns about peer review, author request, and the lack of permission or ethical violation. There were significant differences between the types of article and the reasons for retraction but no consistent pattern. A more detailed analysis of two particular retractions demonstrates the complexity and the effort required to make decisions about article retractions. CONCLUSIONS The retraction of published articles presents a significant challenge to journals, editorial boards, peer reviewers, and authors. This process has the potential to provide important benefits; it also has the potential to undermine confidence in both research and the editorial process.
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Affiliation(s)
- Robert W Alexander
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Shengping Yang
- the Department of Biostatistics, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | - Kenneth Nugent
- From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
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238
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Mohammad A, Laboulaye MA, Shenhar C, Dobberfuhl AD. Mechanisms of oxidative stress in interstitial cystitis/bladder pain syndrome. Nat Rev Urol 2024; 21:433-449. [PMID: 38326514 DOI: 10.1038/s41585-023-00850-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/09/2024]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder and/or pelvic pain, increased urinary urgency and frequency and nocturia. The pathophysiology of IC/BPS is poorly understood, and theories include chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of the glycosaminoglycan (GAG) barrier and urine cytotoxicity. Multiple treatment options exist, including behavioural interventions, oral medications, intravesical instillations and procedures such as hydrodistension; however, many clinical trials fail, and patients experience an unsatisfactory treatment response, likely owing to IC/BPS phenotype heterogeneity and the use of non-targeted interventions. Oxidative stress is implicated in the pathogenesis of IC/BPS as reactive oxygen species impair bladder function via their involvement in multiple molecular mechanisms. Kinase signalling pathways, nociceptive receptors, mast-cell activation, urothelial dysregulation and circadian rhythm disturbance have all been linked to reactive oxygen species and IC/BPS. However, further research is necessary to fully uncover the role of oxidative stress in the pathways driving IC/BPS pathogenesis. The development of new models in which these pathways can be manipulated will aid this research and enable further investigation of promising therapeutic targets.
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Affiliation(s)
- Ashu Mohammad
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mallory A Laboulaye
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chen Shenhar
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA.
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239
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Bentivegna K, Saba NJ, Shinder R, Grant-Kels JM. Ocular and orbital tumors in childhood. Clin Dermatol 2024; 42:396-405. [PMID: 38301859 DOI: 10.1016/j.clindermatol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Pediatric tumors of the eye and orbit can be benign or malignant as well as congenital or acquired and are usually distinctively different than those seen in adults. Although most of these neoplasms are benign (eg, dermoid cyst, chalazion, molluscum), their location near and within a vital organ can result in serious dermatologic and ophthalmologic sequelae. Lesions discussed include vascular lesions, retinoblastomas (the most common primary pediatric intraocular malignancy), rhabdomyosarcoma (the most common primary pediatric orbital malignancy), Langerhans cell histiocytosis, and metastatic lesions to the orbit (neuroblastoma, Ewing sarcoma). Although cysts and ocular melanoma can occur within the pediatric population, these conditions are covered in other contributions in this issue of Clinics in Dermatology.
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Affiliation(s)
- Kathryn Bentivegna
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nicholas J Saba
- Department of Ophthalmology, SUNY Downstate, Brooklyn, New York, USA
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate, Brooklyn, New York, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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Prabhakarrao Doke P, Paresh Chutke A, Hemant Palkar S, Sachin Gothankar J, Dnyandeo Pore P, Vasantrao Patil A, Vinayakrao Deshpande A, Kumar Bhuyan K, Vaman Karnataki M, Nishikant Shrotri A, Gopal Chaudhari R, Sitaram Bacchav M, Bajirao Patil M, Balasaheb Deshmukh R. Implementation of preconception care for preventing adverse pregnancy outcomes in rural and tribal areas of Nashik District, India. Prev Med Rep 2024; 43:102796. [PMID: 39026568 PMCID: PMC11257142 DOI: 10.1016/j.pmedr.2024.102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction The World Health Organization has suggested preconception care to improve pregnancy outcomes. Hence, the study aimed to compare the effect of preconception care on pregnancy outcomes, particularly prematurity and low birth weight. Methods We carried out interventions in one tribal and one non-tribal block. For comparison, one adjacent tribal block and one non-tribal block were included in Nashik district, India. The total study period was from April 2018 to July 2021. All reproductive age group women desiring pregnancy within one year in selected four blocks participated in the study. The services included clinical examination, laboratory investigations, treatment, six-monthly deworming, anemia management, folic acid supplementation, family planning services, and behavioral change communication using different media. The existing healthcare workers provided services to the women until they became pregnant or until the end of the follow-up period (27 months). We monitored pregnancy outcomes, including abortion, stillbirth, and live birth; among live births, low birth weight, preterm birth, congenital physical anomaly, and neonatal death. Results The study enrolled 7,875 women, and 3,601 had outcomes. The proportion of preterm births in the intervention and comparison block was 11.18 % and 14.99 %, respectively (p = 0.001), and the proportion of low-birth-weight babies was 9.23 % and 11.25 %, respectively (p = 0.01). The adjusted prevalence ratio showed that the risk of preterm births in the absence of intervention was 1.3 (CI: 1.1-1.6). Preterm birth was a mediator between preconception care and low birth weight. Conclusion Reduction in proportion of low birth weight and preterm babies can be achieved through preconception care using minimal additional resources.
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Affiliation(s)
- Prakash Prabhakarrao Doke
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Amruta Paresh Chutke
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Sonali Hemant Palkar
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Jayashree Sachin Gothankar
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
| | - Prasad Dnyandeo Pore
- Bharati Vidyapeeth (Deemed to be University) Medical College, Department of Community Medicine, Pune 411043, India
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McCarthy MM, Fletcher J, Wright F, Del Giudice I, Wong A, Aouizerat BE, Vaughan Dickson V, Melkus GD. Factors Associated With the Cardiovascular Health of Black and Latino Adults With Type 2 Diabetes. Biol Res Nurs 2024; 26:438-448. [PMID: 38448370 DOI: 10.1177/10998004241238237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
AIMS The purpose of this study was to assess the levels of cardiovascular health (CVH) of Black and Latino adults with type 2 diabetes (T2D) and examine the association of individual and microsystem level factors with their CVH score. METHODS This was a cross-sectional design in 60 Black and Latino Adults aged 18-40 with T2D. Data were collected on sociodemographic, individual (sociodemographic, diabetes self-management, sleep disturbance, depressive symptoms, quality of life, and the inflammatory biomarkers IL-6 and hs-CRP) and microsystem factors (family functioning), and American Heart Association's Life's Simple 7 metrics of CVH. Factors significantly associated with the CVH score in the bivariate analyses were entered into a linear regression model. RESULTS The sample had a mean age 34 ± 5 years and was primarily female (75%) with a mean CVH score was 8.6 ± 2.2 (possible range of 0-14). The sample achieved these CVH factors at ideal levels: body mass index <25 kg/m2 (8%); blood pressure <120/80 (42%); hemoglobin A1c < 7% (57%); total cholesterol <200 mg/dL (83%); healthy diet (18%); never or former smoker > one year (95%); and physical activity (150 moderate-to-vigorous minutes/week; 45%). In the multivariable model, two factors were significantly associated with cardiovascular health: hs-CRP (B = -0.11621, p < .0001) and the general health scale (B = 0.45127, p = .0013). CONCLUSIONS This sample had an intermediate level of CVH, with inflammation and general health associated with overall CVH score.
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Affiliation(s)
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Inés Del Giudice
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Agnes Wong
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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242
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Carvey MMT, Omidvar AA, Wan EE, Hynes AM, Lentz SA. Effectiveness of the Introduction to Critical Care in Emergency Medicine Curriculum's Implementation Among Trainees Interested in Intensive Care. J Emerg Med 2024; 67:e80-e88. [PMID: 38806349 DOI: 10.1016/j.jemermed.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/11/2024] [Accepted: 03/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Emergency physicians and trainees provide the initial care for critically ill patients. In times of emergency department boarding, this care may extend beyond the first few hours. To meet the needs of this population, a standardized novel critical care curriculum targeting third- and fourth-year medical students was developed. OBJECTIVES We hypothesized that the institution of such a curriculum is feasible and will provide an increased understanding of the underlying critical care principles within this learner population. METHODS We developed a 2-month-long critical care curriculum (February-April) and carried out the course twice from 2022-2023. Our pilot study deployed this curriculum to medical students interested in critical care through the American Academy of Emergency Medicine/Resident and Student Association. The primary outcome included was the overall composite score comparison of the pre- and post-course evaluations, with a higher score indicating that the student improved their comprehension. Secondary outcomes included the individual factors of the pre- and post-course surveys. RESULTS Fifty-one trainees completed the pilot course, including 11/51 (21.6%) third-year medical students and 40/51 (78.4%) fourth-year medical students. Overall, 39 had "no experience" in critical care and 12 indicated that they had "previous experience." The students' baseline pre-course from the pooled 2022 and 2023 Introduction to Critical Care in Emergency Medicine (ICCEM) curriculum data was 3 (interquartile range 4-3) and their post-course score was 9 (interquartile range 9-9), p-value 0.015 for the 51/54 students who completed the course. CONCLUSIONS The novel curriculum was found to be effective during its implementation in third- and fourth-year medical students. As such, it indicated that a critical care fundamentals course improves confidence in these topics for students with and without prior experience. Further work is necessary to understand the generalizability and knowledge retention of the proposed pilot curriculum.
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Affiliation(s)
- Matthew M T Carvey
- Department of Emergency Medicine, MetroHealth/Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ava A Omidvar
- St. George's University, School of Medicine, St. George, Grenada
| | - Elias E Wan
- Department of Surgery, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Allyson M Hynes
- Department of Emergency Medicine; Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Skyler A Lentz
- Department of Emergency Medicine and Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
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243
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Neaves BI, Coop CA. Imported fire ant immunotherapy. Ann Allergy Asthma Immunol 2024; 133:28-32. [PMID: 38281676 DOI: 10.1016/j.anai.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
Imported fire ants (IFAs) permeate many areas of the United States. The IFA allergy is a significant health problem for children and adults. Stings from IFAs cause pustules, localized reactions, and anaphylaxis. There have been at least 32 deaths attributed to IFA stings. Because of the difficulty with the extraction of venom from the fire ants, whole body extracts are the only commercially available serum for immunotherapy. Fortunately, whole body extract immunotherapy given conventionally or through the rush method has proven to be efficacious and safe. It is recommended for the treatment of IFA hypersensitivity. Maintenance immunotherapy is typically given at 4-week intervals. However, more recent research has revealed that these intervals can gradually be extended up to 12 weeks similar to flying Hymenoptera venom immunotherapy. Long-term adherence to IFA immunotherapy remains an obstacle for many patients despite its potential as a life-saving treatment.
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244
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Catella J, Guillot N, Nader E, Skinner S, Poutrel S, Hot A, Connes P, Fromy B. Controversies in the pathophysiology of leg ulcers in sickle cell disease. Br J Haematol 2024; 205:61-70. [PMID: 38867511 DOI: 10.1111/bjh.19584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
Patients with sickle cell disease (SCD) often experience painful vaso-occlusive crises and chronic haemolytic anaemia, as well as various acute and chronic complications, such as leg ulcers. Leg ulcers are characterized by their unpredictability, debilitating pain and prolonged healing process. The pathophysiology of SCD leg ulcers is not well defined. Known risk factors include male gender, poor social conditions, malnutrition and a lack of compression therapy when oedema occurs. Leg ulcers typically start with spontaneous pain, followed by induration, hyperpigmentation, blister formation and destruction of the epidermis. SCD is characterized by chronic haemolysis, increased oxidative stress and decreased nitric oxide bioavailability, which promote ischaemia and inflammation and consequently impair vascular function in the skin. This cutaneous vasculopathy, coupled with venostasis around the ankle, creates an ideal environment for local vaso-occlusive crises, which can result in the development of leg ulcers that resemble arterial ulcers. Following the development of the ulcer, healing is hindered as a result of factors commonly observed in venous ulceration, including venous insufficiency, oedema and impaired angiogenesis. All of these factors are modulated by genetic factors. However, our current understanding of these genetic factors remains limited and does not yet enable us to accurately predict ulceration susceptibility.
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Affiliation(s)
- Judith Catella
- Service de Médecine Interne et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique (LBTI UMR 5305), CNRS/Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Guillot
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Elie Nader
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Sarah Skinner
- Clinical Research and Epidemiology Unit, Montpellier University, Montpellier, France
| | - Solène Poutrel
- Service de Médecine Interne et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Philippe Connes
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, Paris, France
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Berengère Fromy
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique (LBTI UMR 5305), CNRS/Université Claude Bernard Lyon 1, Lyon, France
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245
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Seeber P, Trentino KM, Murray K, Lucas M. A further update on mortality and morbidity in patients with very low hemoglobin levels who decline blood transfusion. Transfusion 2024; 64:1198-1206. [PMID: 38716878 DOI: 10.1111/trf.17867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND In the past two decades, researchers have published mortality and morbidity rates in patients with very low hemoglobin levels declining blood transfusion. The clinical knowledge and tools available for the management of patients who decline transfusions have grown since these publications. The aim of our study was to provide a further update on outcomes associated with severe anemia in these patients. STUDY DESIGN AND METHODS A retrospective observational study of patients declining allogeneic blood transfusions with nadir hemoglobin levels ≤8 g/dL treated at The Institute for Blood Management, HELIOS Klinikum Gotha, Germany. Outcomes were in-hospital mortality within 30 days and composite morbidity or mortality, with morbidity events defined as acute myocardial infarction, cardiac failure, wound infection, arrhythmia, and pneumonia. RESULTS Between June 2008 and June 2021, The Institute for Blood Management treated 2841 admissions of which 159 (5.6%) recorded nadir hemoglobin levels ≤8 g/dL. Of these, five (3.1%) patients died in hospital within 30 days, including four (4.8%) patients admitted for surgical procedures and one (1.4%) medical admission. There was a significant increase in the unadjusted proportion of composite morbidity or mortality events with severity of nadir hemoglobin, with each gram decrease in hemoglobin associated with a 1.48 (95% confidence interval = 1.05-2.09; p = .025) times increase. CONCLUSION Our comparatively lower proportion of patients reaching hemoglobin levels ≤8 g/dL and lower mortality rates suggest outcomes in patients with severe anemia is modifiable with the application of current patient blood management and bloodless medicine and surgery strategies.
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Affiliation(s)
- Petra Seeber
- The Institute for Blood Management, Gotha, Germany
| | - Kevin M Trentino
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Habachi G, Sahli S, Ammar SB, Aziza B, Jouini R. Methicillin-resistant Staphylococcus aureus-associated empyema necessitans in a child: A case report and a literature review. Qatar Med J 2024; 2024:35. [PMID: 39036320 PMCID: PMC11258561 DOI: 10.5339/qmj.2024.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/01/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Empyema is a known complication of severe pleuropneumonia. In rare cases, if poorly treated, it could result in dissemination and fistulization and transformation into empyema necessitans. The manifestation may appear as a superficial abscess. However, as management highly differs, the recognition of potentially severe phenomenon is required. Case Presentation We describe a case of empyema necessitans on a 4-year-old girl secondary to methicillin-resistant Staphylococcus aureus. It represents the sixth pediatric case reported in the literature. It was managed by open drainage and prolonged antibiotherapy. The outcome was favorable as guidelines were extracted from similar reported cases. Conclusion Empyema necessitans remains a rare complication with significant morbidity. Prompt diagnosis and adapted management have relied on limited literature. As such, further reports are necessary to establish proper guidelines.
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Affiliation(s)
- Ghada Habachi
- Department of Pediatric Surgery "A", Children's Hospital of Tunis, Tunis, Tunisia *
| | - Sondes Sahli
- Department of Pediatric Surgery "A", Children's Hospital of Tunis, Tunis, Tunisia *
| | - Sabrine Ben Ammar
- Department of Pediatric Surgery "A", Children's Hospital of Tunis, Tunis, Tunisia *
| | - Bochra Aziza
- Department of Pediatric Surgery "A", Children's Hospital of Tunis, Tunis, Tunisia *
| | - Riadh Jouini
- Department of Pediatric Surgery "A", Children's Hospital of Tunis, Tunis, Tunisia *
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247
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Kofman K, D’Alessandro LCA, Yilmaz Furtun B. Practical Tips for Paediatricians: Precordial catch syndrome. Paediatr Child Health 2024; 29:205-207. [PMID: 39045476 PMCID: PMC11261817 DOI: 10.1093/pch/pxad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2024] Open
Affiliation(s)
- Karina Kofman
- Faculty of Science, York University, Toronto, Canada
| | - Lisa C A D’Alessandro
- Pediatric Cardiology, Trillium Health Partners, Mississauga, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Betul Yilmaz Furtun
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
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248
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Parghane RV, Basu S. Triple Tumors (Neuroendocrine Tumor, Schwannoma, and Papillary Thyroid Carcinoma) With Brain Lesions in a Single Patient Demonstrating Avidity on 68 Ga-DOTATATE PET/CT and Their Characterization With FDG-PET/CT and Brain MRI. Clin Nucl Med 2024; 49:e329-e330. [PMID: 38778465 DOI: 10.1097/rlu.0000000000005273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT Neuroendocrine tumor (NET) typically spreads to the liver, lymph nodes, lungs, and skeleton. Brain metastasis in NET is uncommon. Therefore, each case of detected brain metastases in NET is crucial for the development of treatment guidelines for these types of tumors. We present a unique case of triple tumors (NET, papillary thyroid carcinoma, and schwannoma) in a single patient who presented with neurological symptoms and somatostatin receptor-avid T2 hyperintense multiple metastatic brain lesions from NET on 68 Ga-DOTATATE-PET/CT scan and brain MRI. Despite the rarity of brain metastases in NET, we conclude that the presence of neurological sign or symptoms and/or the detection of somatostatin receptor-avid brain lesions in patients with NET should raise suspicion of brain metastases.
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249
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Lin S, Sproul D, Agarwal A, Harris AB, Golladay GJ, Thakkar SC. Risk Factors Associated With Quadriceps Tendon Extensor Mechanism Disruption Following Total Knee Arthroplasty. J Arthroplasty 2024; 39:1840-1844.e1. [PMID: 38331356 DOI: 10.1016/j.arth.2024.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Quadriceps tendon extensor mechanism disruption is an infrequent but devastating complication after total knee arthroplasty (TKA). Our knowledge of specific risk factors for this complication is limited by the current literature. Thus, this study aimed to identify potential risk factors for quadriceps tendon extensor mechanism disruption following TKA. METHODS A retrospective cohort analysis was performed using the PearlDiver Administrative Claims Database. Patients undergoing TKA without a prior history of quadriceps tendon extensor mechanism disruption were identified. Quadriceps tendon extensor mechanism disruption included rupture of the quadriceps tendon, patellar tendon, or fracture of the patella. Patients who had a minimum of 5 years of follow-up after TKA were included. A total of 126,819 patients were included. Among them, 517 cases of quadriceps tendon extensor mechanism disruption occurred (incidence 0.41%). Hypothesized risk factors were compared between those who had postoperative quadriceps tendon extensor mechanism disruption and those who did not. RESULTS On multivariate analysis, increased Charlson Comorbidity Index (odds ratio (OR): 1.10, 95% confidence interval (CI) [1.07 to 1.13]; P < .001), obesity (OR: 1.49, 95% CI [1.24 to 1.79]; P < .001), and fluoroquinolone use any time after TKA (OR: 1.24, 95% CI [1.01 to 1.52]; P = .036) were significantly associated with quadriceps tendon extensor mechanism disruption. CONCLUSIONS Our study identified the incidence of quadriceps tendon extensor mechanism disruption following TKA as 0.41%. Identified risk factors for quadriceps tendon extensor mechanism disruption after TKA include an increased Charlson Comorbidity Index, obesity, and use of fluoroquinolones postoperatively.
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Affiliation(s)
- Shu Lin
- Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - David Sproul
- Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Amil Agarwal
- Department of Orthopedic Surgery, George Washington Hospital, Washington, District of Columbia
| | - Andrew B Harris
- Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Savyasachi C Thakkar
- Adult Reconstruction Division, Johns Hopkins Department of Orthopaedic Surgery, Columbia, Maryland
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250
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Kantrowitz DE, Colvin A. Comprehensive Clinical Examination of ACL Injuries. Clin Sports Med 2024; 43:311-330. [PMID: 38811112 DOI: 10.1016/j.csm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
A comprehensive clinical examination of the potentially anterior cruciate ligament (ACL)-deficient knee should proceed as follows: inspection; palpation; range of motion; varus and valgus stress; neurovascular status; and finally provocative maneuvers. The Lachman, anterior drawer, Lever, and pivot shift tests are all greater than 90% specific for ACL pathology. Due to the relatively high coincidence of ACL injuries and those to the posterior cruciate ligament, posterolateral corner , posteromedial corner , and menisci, it is critical that the examiner perform provocative maneuvers to evaluate the integrity of these structures as well.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA.
| | - Alexis Colvin
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA
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