Neuro-ophthalmic challenges and multi-morbidity in vasculitis among the older adults

INTRODUCTION

Vasculitides are a heterogeneous group of disorders producing inflammation of blood vessels (e.g. arteries or veins). All major vasculitides potentially have ophthalmological symptoms and signs including visual loss. Co-morbidity, multimorbidity, polypharmacy, and geriatric syndromes all play important roles in patient outcomes for these rheumatic conditions in the elderly. This monograph reviews the NCBI PubMed database (Feb 2023) literature on the neuro-ophthalmic and geriatric considerations in vasculitis.

AREAS COVERED

Cogan Syndrome, Granulomatosis with Polyangiitis, Giant Cell Arteritis, Polyarteritis Nodosa, Takayasu Arteritis, Vasculitis epidemiology, and neuro-ophthalmological symptoms.

EXPERT OPINION

Geriatric patient care for vasculitis with neuro-ophthalmological manifestations can be complicated by the interplay of multiple co-morbidities, polypharmacy, and specific geriatric syndromes. The valuation and treatment of vasculitis and the complications associated with the disease can negatively impact patient care. Advances in noninvasive imaging and updates in diagnostic criteria have enabled increased identification of patients at earlier stages with less severe disease burden. Novel therapeutic agents can be glucocorticoid sparing and might reduce the adverse effects of chronic steroid use. Holistic care models like the 5 M geriatric care model (mind, mobility, medications, multicomplexity, and matters most) allow patients' needs to be in the forefront with biopsychosocial aspects of a patient being addressed.

Mechanisms of pain in aging and age-related conditions: Focus on caregivers

Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.

Associations Between Vitamin D Deficiency/Insufficiency and Depression Expose Health Disparities in Older Rural West Texans: A Project FRONTIER Study

OBJECTIVE

To determine associations between Vitamin D (VD) levels and clinical depression through the Geriatric Depression Scale (GDS) and its questions and subdomains, stratified by demographics and Hispanic/Latino ethnicity (HLE).

DESIGN, SETTING, AND PARTICIPANTS

A cohort of 299 Project FRONTIER participants aged 62.6 ± 11.7 years old, 70.9% female, and 40.5% HLE were used. Standard correlation and regression analyses were employed.

MEASUREMENTS

The main outcome measures were VD (serum 25(OH)-VD) level, GDS-30 (30-item questionnaire), GDS-30 subfactors and questions, and HLE status. VD categories were defined as VD deficiency (VDD; ≤20 ng/mL), VD insufficiency (VDI; 21-29 ng/mL), VD sufficiency (30-38 ng/mL) and high VD sufficiency (>38 ng/mL).

RESULTS

The majority (61.5%) of samples fell into VDD/VDI categories. A significant negative association was found between VD level and GDS-30 total score. VD level was negatively correlated with Dysphoria and Meaninglessness GDS-30 subfactors. Although GDS subfactors were similar between HLE and non-HLE groups, VD levels were significantly lower in HLE samples. Finally, HLE/non-HLE groups were differentially stratified across VD categories. Only 4% of HLEs fell into the high VD sufficient category, suggesting low VD supplementation.

CONCLUSION

A significant negative association between VD level and depressive symptoms was revealed in our aging Project FRONTIER participants. HLE individuals were overrepresented in VDD/VDI samples, and VDD/VDI was associated primarily with the Dysphoria GDS subdomain. Regression analysis predicted high VD sufficiency (95.5 ng/mL) to be associated with no depressive symptoms (GDS=0). Our results underscore troubling disparities in VD-related depressive symptoms between HLE and non-HLE populations.

Lessons From an MD PhD - From SLC13A5 to Neurology

The journey towards becoming a physician scientist is a long, arduous, and uncertain journey. Few medical students pursue a career as a physician scientist. Even those that do, the path towards maintaining a robust research career and clinical training can be difficult given the personal and social pressures to focus solely on research or clinical work. Despite the long history of science and medicine, there is question concerning the role that physician scientist in modern medicine. As a recent physician scientist graduate, physician scientists are greatly needed in the medical profession. The ability to overlap science, medicine, and the humanities together is an essential part of the producing a well-rounded and effective physician for a rapidly changing profession and world. Through my journey as a physician scientist in training, the lessons I've learned through my training in both the basic science and clinical portions can be helpful for medical students traversing both sides of the divide.

Alzheimer's disease and its related dementias in US Native Americans: A major public health concern

Alzheimer's disease (AD) and Alzheimer's related dementias (ADRD) are growing public health concerns in aged populations of all ethnic and racial groups. AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Studies of postmortem brains have revealed multiple cellular changes implicated in AD and ADRD, including the accumulation of amyloid beta and phosphorylated tau, synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss. These changes occur in both early-onset familial and late-onset sporadic forms. Two-thirds of women and one-third of men are at life time risk for AD. A small proportion of total AD cases are caused by genetic mutations in amyloid precursor protein, presenilin 1, and presenilin 1 genes, and the APOE4 allele is a risk factor. Tremendous research on AD/ADRD, and other comorbidities such as diabetes, obesity, hypertension, and cancer has been done on almost all ethnic groups, however, very little biomedical research done on US Native Americans. AD/ADRD prevalence is high among all ethnic groups. In addition, US Native Americans have poorer access to healthcare and medical services and are less likely to receive a diagnosis once they begin to exhibit symptoms, which presents difficulties in treating Alzheimer's and other dementias. One in five US Native American people who are 45 years of age or older report having memory issues. Further, the impact of caregivers and other healthcare aspects on US Native Americans is not yet. In the current article, we discuss the history of Native Americans of United States (US) and health disparities, occurrence, and prevalence of AD/ADRD, and shedding light on the culturally sensitive caregiving practices in US Native Americans. This article is the first to discuss biomedical research and healthcare disparities in US Native Americans with a focus on AD and ADRD, we also discuss why US Native Americans are reluctant to participate in biomedical research.

Urgent needs of caregiving in ageing populations with Alzheimer's disease and other chronic conditions: Support our loved ones

The ageing process begins at birth. It is a life-long process, and its exact origins are still unknown. Several hypotheses attempt to describe the normal ageing process, including hormonal imbalance, formation of reactive oxygen species, DNA methylation & DNA damage accumulation, loss of proteostasis, epigenetic alterations, mitochondrial dysfunction, senescence, inflammation, and stem cell depletion. With increased lifespan in elderly individuals, the prevalence of age-related diseases including, cancer, diabetes, obesity, hypertension, Alzheimer's, Alzheimer's disease and related dementias, Parkinson's, and other mental illnesses are increased. These increased age-related illnesses, put tremendous pressure & burden on caregivers, family members, and friends who are living with patients with age-related diseases. As medical needs evolve, the caregiver is expected to experience an increase in duties and challenges, which may result in stress on themselves, and impact their own family life. In the current article, we assess the biological mechanisms of ageing and its effect on body systems, exploring lifestyle and ageing, with a specific focus on age-related disorders. We also discussed the history of caregiving and specific challenges faced by caregivers in the presence of multiple comorbidities. We also assessed innovative approaches to funding caregiving, and efforts to improve the medical system to better organize chronic care efforts, while improving the skill and efficiency of both informal and formal caregivers. We also discussed the role of caregiving in end-of-life care. Our critical analysis strongly suggests that there is an urgent need for caregiving in aged populations and support from local, state, and federal agencies.

Trends in transgender healthcare curricula in graduate medical education

Background

Recent studies have shown deficiencies in resident knowledge concerning transgender healthcare. However, there has not been an updated survey examining transgender healthcare training by medical residency directors. We assessed whether accredited residency programs in the United States and Canada were providing education on the healthcare needs of transgender patients.

Methods

We performed an exploratory descriptive survey study in 2022 of residency programs in the United States and Canada to assess residency education on transgender health using program directors listed in the website directory of the Accreditation Council for Graduate Medical Education.

Results

Out of 1680 residency program directors, 160 programs responded (response rate, 10%). Among the residency programs, education in transgender health was taught periodically throughout the curriculum (52.5%), in discrete modules (34.4%), or not taught at all (10.6%). However, 60% of residency program directors who responded reported that their program lacked any clinical rotation in which residents directly work with transgender patients. The most common areas of transgender care omitted from residency education on transgender health were barriers associated with chronic illness and mental health.

Conclusion

There remains a need for robust transgender medical training in residency programs through clinical rotations on transgender health.

The Influence of Religious Affiliation and Attitudes of Clinical Genetic Testing Among Medical Students in the West Texas Region

Background

Genetic counseling is an essential and pertinent field in any society to lower the prevalence of hereditary disorders. However, the desire to undergo counseling and genetic testing varies widely depending on the cultural background and level of scientific literacy of the individual. In this survey, we examine the perspectives of medical students on clinical genetic testing based upon their religious tradition.

Methods

The total number of participants in the study was 257 (122 male and 135 female) second year medical students at Texas Tech University Health Sciences Center (TTUHSC). The distribution of religious identification (Atheist, Christian, Hindu, Jewish, Muslim, Spiritual/not Affiliated, and Other) among the second-year medical students. The survey was available to students through TTUHSC's Omnibus survey program for a period of two weeks.

Results

Most of the second-year medical students interviewed identified as being Christian (67%) with the next highest religious identification being Spiritual/not Affiliated (9%), Atheist (8%), and Muslim (6%). With regards to genetic tests, most of the students (95%), regardless of religious identification, have not used any commercial genetic testing services. Most second year medical students regardless of religious affiliation had similar agreement with questions regarding clinical genetic testing. However, there was a similar drop in agreement when it came on where students would want genetic screening to be performed regularly in clinics/hospitals.

Conclusion

Given the numerous factors that must be considered, such as the patient's attitudes, knowledge, and beliefs towards the counseling process and genetic testing, genetic counseling is a challenging problem. Each target population's history, relevant exposure to, and domain expertise must be considered while promoting decision-making in genetic testing.

Pomegranate peel extract is an effective agent against MDR bacteria

Multidrug-resistant (MDR) bacteria are one of the major public health threats facing humanity. Infections with MDR strains are difficult or impossible to treat with standard antibiotics leading to severe illnesses and even deaths. The spread of MDR bacteria has necessitated the search for alternative approaches that tackle MDR pathogens. Natural plants can be utilized as alternative therapeutic agents against the rise of MDR bacteria. In this study, we aimed to assess the antimicrobial activity of pomegranate peel extracts (PPE) against MDR clinical isolates. A total of 9 clinical isolates (8 MDR and 1 non-MDR clinical isolates) were collected and examined for their susceptibility to PPE. Using the zone of inhibition assay, 4 isolates (S. aureus, three MRSA isolates, Vancomycin-resistant Enterococci (VRE), and Acinetobacter baumannii) were sensitive to PPE. In Broth assay, 4 mg/ml PPE significantly reduced the growth (S. aureus, three MRSA isolates, Vancomycin-resistant Enterococci (VRE), and Acinetobacter baumannii), while 40 mg/ml PPE either significantly reduced or completely inhibited the growth of the isolates. The minimum bactericidal concentration (MBC) of PPE against S. aureus and MRSA-88 was 10 mg/ml. This study showed the potential of PPE as an alternative compound for treating infections caused by PPE-sensitive MDR bacteria.

Analyzing and Improving the Utilization of Statin Drugs in Family Medicine Patients with Type II Diabetes

Background

Statins are the primary drug used to reduce morbidity and mortality for cardiovascular disease. However, many type II diabetes mellitus (T2DM) patients who are currently not on a statin would otherwise qualify. Therefore, we investigated the proportion of T2DM patients on a statin compared to the total number of T2DM patients eligible to be on a statin. We also examined potential barriers that prevent T2DM patients from being prescribed statins by physicians.

Methods

A retrospective chart study on family medicine patients was collected data on age, race, cholesterol readings, blood pressure, and whether the patient was on blood pressure medications, aspirin, and/or a statin. The information gathered was used to determine the patients' 10-year risk of cardiovascular disease. A survey was given to residents and faculty to assess the cost, side effects, and other behavioral factors had on a patients' choice to be on a statin.

Results

Among the 706 T2DM patients, we found that a large proportion (75.2%) were both eligible and prescribed a statin according to the American Heart Association Guidelines. In addition, over 58% of the patients had a 0%-25% 10-year risk of cardiovascular disease risk. Among the 14 family medicine physicians surveyed, the fear of or history of side effects with statin medications were the greatest barriers to starting statins.

Conclusion

The large proportion of family medicine patients that were eligible were prescribed a statin. According to the survey, physicians Believed that the greatest barrier for a patient starting on a statin is the fear of or history of side effects with statin medications.

COVID-19 and Gastrointestinal Disease: Current Insights and Future Management

The first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan, Hubei Province, China, in December 2019, marking a pivotal moment in human history [...].

Male Victims of Sexual Assault: A Review of the Literature

Compared to female rape victims, the literature addressing male rape victims remains a growing area of interest for counselors and scholars. This article aims to review the growing literature on male sexual assault victims. Specifically, the review will examine the literature on male victims of sexual assault in nine sections: (a) an overview of male sexual assault, (b) male rape myths, (c) prevalence, (d) responses to male victimization, (e) populations and perpetrators of male victimization, (f) risk factors, (g) reporting, (h) the impact of sexual assault on men, (i) help-seeking, and (j) implications for counseling. Empirical studies, case reports, and books are included in the review.

Anti-Pseudomonas aeruginosa Vaccines and Therapies: An Assessment of Clinical Trials

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes high morbidity and mortality in cystic fibrosis (CF) and immunocompromised patients, including patients with ventilator-associated pneumonia (VAP), severely burned patients, and patients with surgical wounds. Due to the intrinsic and extrinsic antibiotic resistance mechanisms, the ability to produce several cell-associated and extracellular virulence factors, and the capacity to adapt to several environmental conditions, eradicating P. aeruginosa within infected patients is difficult. Pseudomonas aeruginosa is one of the six multi-drug-resistant pathogens (ESKAPE) considered by the World Health Organization (WHO) as an entire group for which the development of novel antibiotics is urgently needed. In the United States (US) and within the last several years, P. aeruginosa caused 27% of deaths and approximately USD 767 million annually in health-care costs. Several P. aeruginosa therapies, including new antimicrobial agents, derivatives of existing antibiotics, novel antimicrobial agents such as bacteriophages and their chelators, potential vaccines targeting specific virulence factors, and immunotherapies have been developed. Within the last 2-3 decades, the efficacy of these different treatments was tested in clinical and preclinical trials. Despite these trials, no P. aeruginosa treatment is currently approved or available. In this review, we examined several of these clinicals, specifically those designed to combat P. aeruginosa infections in CF patients, patients with P. aeruginosa VAP, and P. aeruginosa-infected burn patients.

Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in African Americans: Focus on Caregivers

Alzheimer’s disease (AD) and Alzheimer’s Disease-Related Dementias (ADRD) are chronic illnesses that are highly prevalent in African Americans (AA). AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Histopathological, morphological, and cellular studies revealed how multiple cellular changes are implicated in AD and ADRD, including synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss, in addition to the accumulation of amyloid beta and phosphorylated tau in the brain. The contributions of race, ethnicity, location and socioeconomic status all have a significant impact on the care and support services available to dementia patients. Furthermore, disparities in health care are entangled with social, economic, and environmental variables that perpetuate disadvantages among different groups, particularly African Americans. As such, it remains important to understand how various racial and ethnic groups perceive, access, and experience health care. Considering that the mounting data shows AA may be more susceptible to AD than white people, the demographic transition creates significant hurdles in providing adequate care from family caregivers. Furthermore, there is growing recognition that AD and ADRD pose a significant stress on AA caregivers compared to white people. In this review, we examine the current literature on racial disparities in AD and ADRD, particularly concerning AA caregivers.

Optimum duration of hyperventilation during electroencephalography

Hyperventilation (HV) is carried out for 3 minutes as a standard activation procedure in most routine electroencephalographic (EEG) procedures. The cerebral blood flow (CBF) reduction and the accompanying cerebral vasoconstriction caused by HV is believed to be the mechanism of EEG activation during HV. Some advocate for 5 minutes of HV, although the optimum duration is unknown. In this study, we measured the CBF continuously over the anterior temporal lobes using subdural probes, which use thermal diffusion flowmetry to measure CBF directly from the cerebral cortex. We sought to determine the duration of HV that produces the maximum reduction in CBF during routine HV in our epilepsy monitoring unit and prolonged the procedure for an additional 2 minutes for this study. Flowtronics^® CBF probes were placed over the anterior temporal lobes in addition to the standard subdural strip placement for localization of their seizure focus in six patients who were candidates for epilepsy surgery. CBF was measured continuously for 2 minutes before and 5 minutes during HV for each patient. Time to reach maximum reduction of CBF for each attempt (11 temporal lobes) was computed. At 3 minutes, CBF reduction ranged from 11.6% to 40.0% from the pre-HV CBF level (mean 23.9%). At 5 minutes, CBF ranged from 14.3% to 42.0% (mean 25.7%). Six of the 11 measurements were steady or decreased slightly, and in the five other measurements, CBF showed a reverse trend after 3 minutes. A significant CBF reduction was attained in 3 minutes of HV in all trials. Continued HV after 3 minutes resulted in only a marginal (mean 1.8%) additional CBF reduction after 3 minutes. Thus, we propose that 3 minutes of HV is sufficient for EEG activation by the CBF criterion.

Fatty acids, esters, and biogenic oil disinfectants: novel agents against bacteria

For hundreds of years, disinfectants have comprised a variety of active chemical agents that destroy microorganisms through a wide spectrum of mechanisms. In recent years, there has been growing interest in novel disinfectants. One novel method for disinfectant is aerosols. Since the beginning of the 20th century, aerosols produced by the volatilization and subsequent recondensation of oil vapors have been utilized as obscurants (smoke) screens during military operations. Specifically, a petroleum middle distillate, known as the FOG oil, has been used in the US military battlefield to create obscurant smoke screens. Biogenic oils are non-petroleum-based oils that resemble FOG oil in terms of their physical characteristics. Furthermore, FOG and biogenic oils have characteristics that make them preferable to other disinfectants that are frequently employed. In this review, we examine the antimicrobial activities of mineral oils and biogenic oil esters aerosols/vapors as novel disinfectants against bacteria and other microorganisms.

Pain and aging: A unique challenge in neuroinflammation and behavior

Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.

The in vitro efficacy of betadine antiseptic solution and colloidal silver gel combination in inhibiting the growth of bacterial biofilms

INTRODUCTION

Betadine (Povidone-Iodine) solution is a topically applied antiseptic, which has been used routinely used in wound care and general surgery to prevent skin and wound infections. However, several studies have documented the ineffectiveness of betadine. Other topical antimicrobial dressings, including those that contain silver, have been used in the management of infected wounds. The present study was undertaken to determine if the combination of 5% betadine solution and silver colloidal gel (Ag-gel) is more effective than either substance alone in inhibiting the growth gram-negative and gram-positive bacteria.

METHODS

The effectiveness of 5% betadine solution and Ag-gel as anti-microbial agents were assessed using both colony forming unit (CFU) assay and confocal laser scanning microscopy (CLSM).

RESULTS

Ag-gel showed complete inhibition on all the bacteria species examined except the Klebsiella pneumoniae clinical isolate (CL) strain while 5% betadine concentrations did not completely kill any of the tested bacteria. In contrast, K. pneumoniae was completely eliminated in the presence of both 5% betadine solution and Ag-gel together. The CLSM showed similar findings to the CFU results examining the 5% betadine solution and Ag-gel combination.

CONCLUSIONS

This study demonstrated that while the individual treatments using either 5% betadine solution and Ag-gel alone were infective antimicrobial agents, the combination of 5% betadine solution and Ag-gel was superior at eliminating all tested bacteria, including K. pneumoniae CL.

Two-muscle surgical treatment of a compensatory head tilt in an adult with acquired downbeat nystagmus

Kestenbaum-Anderson-like operations have proven beneficial in treatment of compensatory head tilt in patients with infantile nystagmus. However, their use in acquired vertical nystagmus in adults with head tilt has rarely been reported. Presented here is a case of a 52-year-old woman with acquired downbeat nystagmus with a significant head tilt who responded to a simple two-muscle surgery involving the superior recti. Cyclovertical muscle surgery should be considered a viable option in such patients who are refractory to medical intervention. Additionally, it appears that four-muscle vertical muscle recessions (two muscles per eye) may not be necessary to dampen vertical nystagmus since good results can be obtained with a single muscle recession bilaterally.

Case report: Medical student types journals during ketamine infusions for suicidal ideation, treatment-resistant depression, post-traumatic stress disorder, and generalized anxiety disorder

Suicide is the most common cause of death in male resident physicians and the second most common cause of death in resident physicians overall. Physicians also experience high rates of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and burnout. These conditions frequently develop during medical school, and threaten not only physicians but the patients they care for. A 30-year-old medical student presented to our clinic with a history of treatment-resistant depression (TRD), generalized anxiety disorder (GAD), PTSD, and 5 years of daily suicidal ideation. Previous treatments included therapy, lifestyle modifications, and various combinations of six antidepressants. These interventions had little effect on the patient's mental health. The patient was treated at our clinic with an 8-month regimen of IV ketamine infusions and ketamine-assisted psychotherapy (KAP). The patient achieved remission from suicidality and PTSD within 1 month; and TRD and GAD within 7 months. The patient's Patient Health Questionnaire (PHQ-9) score decreased from 25 (severe depression) to 1 (not depressed). These findings suggest that ketamine and KAP may represent effective interventions for mental health applications in healthcare professionals. The patient made the unique decision to attempt to type narrative journals during four of his ketamine infusions (doses ranged from 1.8 to 2.1 mg/kg/h IV). The patient successfully typed detailed journals throughout each 1-h ketamine infusion. To our knowledge, these journals represent the first independently typed, first-person, real-time narratives of ketamine-induced non ordinary states of consciousness. The transcripts of these journals may provide useful insights for clinicians, particularly in the context of KAP.

An Assessment of the In Vitro Models and Clinical Trials Related to the Antimicrobial Activities of Phytochemicals

An increased number antibiotic-resistant bacteria have emerged with the rise in antibiotic use worldwide. As such, there has been a growing interest in investigating novel antibiotics against antibiotic-resistant bacteria. Due to the extensive history of using plants for medicinal purposes, scientists and medical professionals have turned to plants as potential alternatives to common antibiotic treatments. Unlike other antibiotics in use, plant-based antibiotics have the innate ability to eliminate a broad spectrum of microorganisms through phytochemical defenses, including compounds such as alkaloids, organosulfur compounds, phenols, coumarins, and terpenes. In recent years, these antimicrobial compounds have been refined through extraction methods and tested against antibiotic-resistant strains of Gram-negative and Gram-positive bacteria. The results of the experiments demonstrated that plant extracts successfully inhibited bacteria independently or in combination with other antimicrobial products. In this review, we examine the use of plant-based antibiotics for their utilization against antibiotic-resistant bacterial infections. In addition, we examine recent clinical trials utilizing phytochemicals for the treatment of several microbial infections.

The Potential Antiviral Effects of Selenium Nanoparticles and Coated Surfaces

Modern epidemics quickly spread across borders and continents with devastating effects on both human health and the world economy. This issue is made worse by the various ways that infections are spread, including through aerosol, droplets, and fomites. The antibacterial qualities of various surface materials and coatings have been the subject of much research. However, the antiviral activity of metal coatings can be heavily influenced by imbalances in metal distribution and the presence of other metal impurities. As such, there is interest in developing novel surface coatings that can reduce the transmission of active viral particles in healthcare facilities. In recent years, the non-metals, such as selenium and nanoparticles, have acquired greater interest from the medical and scientific community for their antiviral surface activity. In this review, we will discuss the cellular and physiological functions of selenium in mammalian cells and against viral infections. We then discuss the mechanism behind selenium coated surfaces and their efficacy against bacterial infections. Lastly, we examine the antiviral activity of selenium, and the potential antiviral activity of selenium nanoparticles and coatings.

Amyloid Beta in Aging and Alzheimer’s Disease

Alzheimer’s disease (AD), is a progressive neurodegenerative disease that affects behavior, thinking, learning, and memory in elderly individuals. AD occurs in two forms, early onset familial and late-onset sporadic; genetic mutations in PS1, PS2, and APP genes cause early onset familial AD, and a combination of lifestyle, environment and genetic factors causes the late-onset sporadic form of the disease. However, accelerated disease progression is noticed in patients with familial AD. Disease-causing pathological changes are synaptic damage, and mitochondrial structural and functional changes, in addition to increased production and accumulation of phosphorylated tau (p-tau), and amyloid beta (Aβ) in the affected brain regions in AD patients. Aβ is a peptide derived from amyloid precursor protein (APP) by proteolytic cleavage of beta and gamma secretases. APP is a glycoprotein that plays a significant role in maintaining neuronal homeostasis like signaling, neuronal development, and intracellular transport. Aβ is reported to have both protective and toxic effects in neurons. The purpose of our article is to summarize recent developments of Aβ and its association with synapses, mitochondria, microglia, astrocytes, and its interaction with p-tau. Our article also covers the therapeutic strategies that reduce Aβ toxicities in disease progression and discusses the reasons for the failures of Aβ therapeutics.

Central diabetes insipidus and burn trauma

Diabetes insipidus (DI) is characterized by polyuria and polydipsia. In most cases, the condition results from either an inadequate release or resistance to the activity of antidiuretic hormone in the renal collecting tubules. The underlying pathophysiology may be related to destruction the destruction or degeneration of neurons from inflammatory, autoimmune diseases, vascular diseases, Langerhans cell histiocytosis, sarcoidosis, or trauma. However, a large majority of diabetes insipidus cases (50%) are considered idiopathic. An exceedingly rare cause of idiopathic central DI occurs in burn injuries, which has only been reported in eight cases. We present an extremely rare case of idiopathic DI in a 15-year-old male with 76% total body surface area (TBSA) burns with the development of idiopathic central DI. An extensive literature review was accomplished to compare this case with the small number of previously reported case reports of idiopathic DI in burn patients.

Lay Summary

Diabetes insipidus (DI) is a rare complication of burn injuries that results from the destruction of neurons involved in the secretion of antidiuretic hormone from the pituitary gland. Only eight cases of DI have been reported in the literature in association to burn injuries. The patient in this case report received immediate fluid resuscitation, burn treatment, and intensive observation after the initial burn injury. The rapid response was likely the main reason for the absence of neurological damage as reported in the CT image. Therefore, the treatment of burn injuries remains an important step for reducing neurological damage and hormonal dysregulation leading to diabetes insipidus.

Binding of Citrate-Fe3+ to Plastic Culture Dishes, an Artefact Useful as a Simple Technique to Screen for New Iron Chelators

NaCT mediates citrate uptake in the liver cell line HepG2. When these cells were exposed to iron (Fe³⁺), citrate uptake/binding as monitored by the association of [¹⁴C]-citrate with cells increased. However, there was no change in NaCT expression and function, indicating that NaCT was not responsible for this Fe³⁺-induced citrate uptake/binding. Interestingly however, the process exhibited substrate selectivity and saturability as if the process was mediated by a transporter. Notwithstanding these features, subsequent studies demonstrated that the iron-induced citrate uptake/binding did not involve citrate entry into cells; instead, the increase was due to the formation of citrate-Fe³⁺ chelate that adsorbed to the cell surface. Surprisingly, the same phenomenon was observed in culture wells without HepG2 cells, indicating the adsorption of the citrate-Fe³⁺ chelate to the plastic surface of culture wells. We used this interesting phenomenon as a simple screening technique for new iron chelators with the logic that if another iron chelator is present in the assay system, it would compete with citrate for binding to Fe³⁺ and prevent the formation and adsorption of citrate-Fe³⁺ to the culture well. This technique was validated with the known iron chelators deferiprone and deferoxamine, and with the bacterial siderophore 2,3-dihydroxybenzoic acid and the catechol carbidopa.

A Reappraisal of Oxandrolone in Burn Management

Objective: Burn injuries remain among the most severe traumatic injuries globally. With the discovery of cortisol, the use of steroids has become an essential therapy for the management of inflammatory and metabolic conditions. Several studies have shown the steroid oxandrolone improves burn injuries through stimulating anabolic and reducing catabolic processes. In this review, we examine the efficacy and applications of oxandrolone with regard to burn management and treatment. Data Sources: A literature search was performed using the PubMed database from January 1990 to May 2020 to identify articles on oxandrolone and burn management. A total of 18 studies were included in our review. Study Selection and Criteria: The keywords used in our search strategy for PubMed included “oxandrolone” and “burns.” Data Synthesis: The main benefit of oxandrolone is the improved long-term lean body, protein, and bone mineral mass of burn patients. In addition, 3 separate meta-analyses showed oxandrolone shortened length of hospital stay, donor-site healing time, reduced weight loss, and net protein loss. However, oxandrolone therapy did not affect mortality, infection, or liver function. Conclusion: Oxandrolone remains an effective therapy for reducing the hypermetabolic response and comorbidities from burn injuries. Future clinical trials are needed using larger sample sizes and long-term follow-up to determine whether oxandrolone in the context of rehabilitation programs can reduce mortality, lower treatment costs, and improve function outcomes among burn patients.

Perspectives on Consumer and Clinical Genetic Testing Education among Medical Students in West Texas

There is a popular trend for genetic test companies to market genetic screenings to identify detrimental mutations directly to consumers. As a result, there has been an increase in the number of patients wanting to discuss the results of their personal genetic tests with their physician. In turn, the medical education community has recognized a need to provide medical staff and patients with resources to interpret and act on personal genetic data. Most medical students and residents lack the requisite knowledge to interpret and manage patient-provided individualized genetic testing. This has prompted a growing interest among medical students in learning more about genetic testing and how to counsel their patients on this information. Consequently, early educational exposure to clinical genetic testing and counseling would benefit medical education training programs. In this study, we examine the perceptions of medical students in West Texas with regard to clinical genetic testing.

Effects of Dexamethasone on DNA Synthesis in Lens Epithelial Cells are Dependent on Cell Type and Growth Factor

PURPOSE

To determine the factors that influence the ability of dexamethasone (dex) to inhibit or stimulate the growth of lens epithelial cells.

METHOD

Different growth factors with or without dex (10^-6 M) were added to quiescent cultures of two clones of Nakano mouse lens epithelial cells (NK11) in serum-free medium. DNA synthesis was then measured after 8 to 12 hours by the incorporation of tritiated thymidine.

RESULTS

Dex was found to both stimulate and inhibit mitogen-induced ³H-thymidine incorporation into the DNA of cultured mouse lens epithelial cells. Enhancement or repression by dex was found to depend on the growth factor used to stimulate the quiescent cell. EGF and insulin were consistently inhibited with dex. Basic fibroblast growth factor (bFGF) and retinoblastoma-derived growth factor (RbDGF) were both enhanced and inhibited by dex, depending on the growth factor concentration and the cell clone used for the experiment. Additionally, RbDGF protects against the dex inhibition of insulin stimulation, but not the inhibition of EGF stimulation. Progesterone, an inhibitor of the activation of the glucocorticoid receptor, blocks the dex inhibitory effect on the EGF and insulin stimulation of DNA synthesis.The ability of progesterone to affect the dex inhibition is consistent with the dex receptor modulating DNA synthesis. The dex effect on DNA synthesis, either stimulatory or inhibitory, was still seen if dex was added as late as 10 hours after the growth factor.

CONCLUSIONS

The study demonstrated that dex reduces the overall growth and activity of lens epithelial cells in vitro. This result provides insight into the risk of developing posterior subcapsular cataracts (PSC) in patients on oral glucocorticoid therapy. Understanding the basic mechanisms by which steroids mediate lens cell growth may provide the ability to more accurately predict who will develop PSC. The present studies show the difference in the effect of dex from lens cell to lens cell, but, more importantly, suggest a pattern of dependent variables that might prove useful in such predictions.

Case report of recurrent fibromatosis with laryngeal involvement: Treatment based on network analyses of NGS data

Aggressive fibromatosis (AF) is a rare, benign neoplasm originating from musculoaponeurotic stromal structures characterized by aggressive growth and infiltration of local tissues. To date, only six previous cases of AF involving the larynx have been reported. The present case was that of a 70-year-old female patient with a 5-year history of hoarseness and an enlarging neck mass consistent with aggressive recurrent fibromatosis. MRI displayed a large, solid mass arising from the left anterior cervical space displacing the trachea and upper airway to the right. At one year after the initial radical resection, the patient presented with recurrence. A second radical excision was performed not including a laryngectomy. Radiation therapy was considered for possible local treatment to prevent subsequent tumor recurrence. According to the literature, AF has recurrence rates of up to 40-70% within 18 months. There is only sparse literature to guide treatment. Using the mutations detected in the patient's AF tissue, an Ingenuity Pathway Analysis (IPA) was used to guide treatment of the recurrence. In the present case, the IPA analysis indicated the use of pazopanib to treat the patient's cancer. In general, surgery appears to be the treatment of choice for head and neck AF, but the management of recurrence is controversial.

Global Impact of COVID-19 on Colorectal Cancer Screening: Current Insights and Future Directions

The coronavirus disease 2019 (COVID-19) pandemic has brought significant challenges to many aspects of healthcare delivery since the first reported case in early December 2019. Once in the body, SARS-CoV-2 can spread to other digestive organs, such as the liver, because of the presence of ACE2 receptors. Colorectal cancer (CRC) remains the second-leading cause of death in the United States (US). Therefore, individuals are routinely screened using either endoscopic methods (i.e., flexible sigmoidoscopy and colonoscopy) or stool-based tests, as per the published guidelines. At the beginning of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) recommended that all non-urgent surgical and medical procedures, including screening colonoscopies, be delayed until the pandemic stabilization. This article aims to review the impact of COVID-19 on CRC screening.

Suffering and divine impassibility

Many theologians believe in the doctrine of divine impassibility: that God does not experience pain or pleasure from the actions of creation. However, the question inevitably touches upon our personal relationship and journey with God, a journey involving deep joys and pains. This discussion of divine impassibility relates to the medical profession, which seeks to heal the sick and comfort the dying.

A reflection from a polio patient at the Texas Scottish Rite Hospital for Children in Dallas

Similar to the current coronavirus pandemic, the polio pandemic during the early 20th century impacted the entire world, leaving many children permanently disabled. The Texas Scottish Rite Hospital for Children was created to address this need. In this article, Dewain Collins tells his story of being treated for polio by Dr. William Beall Carrell at Scottish Rite in the 1930s.

Anticancer Activity of Ω-6 Fatty Acids through Increased 4-HNE in Breast Cancer Cells

Simple Summary

Epidemiological evidence suggests that breast cancer risk is lowered by Ω-3 and increased by Ω-6 polyunsaturated fatty acids (PUFAs). Paradoxically, the Ω-6 PUFA metabolite 4-hydroxynonenal (4-HNE) inhibits cancer cell growth. This duality prompted us to study whether arachidonic acid (AA) would enhance doxorubicin (dox) cytotoxicity towards breast cancer cells. We found that supplementing AA or inhibiting 4-HNE metabolism potentiated doxorubicin (dox) toxicity toward Her2-dependent breast cancer but spared myocardial cells. Our results suggest that Ω-6 PUFAs could improve outcomes of dox chemotherapy in Her2-overexpressing breast cancer.

Abstract

Her2-amplified breast cancers resistant to available Her2-targeted therapeutics continue to be a challenge in breast cancer therapy. Dox is the mainstay of chemotherapy of all types of breast cancer, but its usefulness is limited by cumulative cardiotoxicity. Because oxidative stress caused by dox generates the pro-apoptotic Ω-6 PUFA metabolite 4-hydroxynonenal (4-HNE), we surmised that Ω-6 PUFAs would increase the effectiveness of dox chemotherapy. Since the mercapturic acid pathway enzyme RALBP1 (also known as RLIP76 or Rlip) that limits cellular accumulation of 4-HNE also mediates dox resistance, the combination of Ω-6 PUFAs and Rlip depletion could synergistically improve the efficacy of dox. Thus, we studied the effects of the Ω-6 PUFA arachidonic acid (AA) and Rlip knockdown on the antineoplastic activity of dox towards Her2-amplified breast cancer cell lines SK-BR-3, which is sensitive to Her2 inhibitors, and AU565, which is resistant. AA increased lipid peroxidation, 4-HNE generation, apoptosis, cellular dox concentration and dox cytotoxicity in both cell lines while sparing cultured immortalized cardiomyocyte cells. The known functions of Rlip including clathrin-dependent endocytosis and dox efflux were inhibited by AA. Our results support a model in which 4-HNE generated by AA overwhelms the capacity of Rlip to defend against apoptosis caused by dox or 4-HNE. We propose that Ω-6 PUFA supplementation could improve the efficacy of dox or Rlip inhibitors for treating Her2-amplified breast cancer.

Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis

Background:

Pulmonary embolism (PE), depending on the severity, carries a high mortality and morbidity. Proper evaluation, especially in patients with low probability for PE, is important to avoid unnecessary diagnostic testing.

Objective:

To review the diagnostic utility of conventional versus age-adjusted D-dimer cutoff values in patients 50 years and older with suspected pulmonary embolism.

Methods:

Systematic review with univariant and bivariant meta-analysis.

Data sources:

We searched PubMed, MEDLINE, and EBSCO for studies published before September 20th, 2020. We cross checked the reference list of relevant studies that compares conventional versus age-adjusted D-dimer cutoff values in patients with suspected pulmonary embolism.

Study selection:

We included primary published studies that compared both conventional (500 µg/L) and age-adjusted (age × 10 µg/L) cutoff values in patients with non-high clinical probability for pulmonary embolism.

Results:

Nine cohorts that included 47 720 patients with non-high clinical probability were included in the meta-analysis. Both Age-adjusted D-dimer and conventional D-dimer have high sensitivity. However, conventional D-dimer has higher false positive rate than age-adjusted D-dimer.

Conclusion:

Age-adjusted D-dimer cutoffs combined with low risk clinical probability assessment ruled out PE diagnosis in suspected patients with a decreased rate of false positive tests.

Teaching methods fostering enjoyment and creativity in medical education

The journey towards becoming a physician has always been a test of diligence and patience in perfecting the science and art of treating patients. This learning continues well-beyond medical school, requiring a life-long pursuit for acquiring and refining medical knowledge with advances in science and technology. After completing medical school and residency, however, many clinicians report feelings of dissatisfaction and disillusionment with their career path citing lack of autonomy, increased government regulations, and long hours. Although a complex challenge, encouraging creativity and enjoyment during medical education can provide future physicians new skills to advance their medical knowledge while maintaining their personal satisfaction and enjoyment. In this article, we examine examples of how empowering medical education to be enjoyable provides the foundation for producing healthier and more engaged clinicians in the workforce and beyond.

President William Howard Taft's Trowel: spreading the cementing of unity and tolerance in public health

President William Howard Taft is remembered as being the largest US president and a Freemason. However, Taft’s work and legacy in public health are often overlooked by his predecessor, Theodore Roosevelt, and the ensuing political scuffle both held towards each other at the end of Taft’s presidency. Taft’s many chronic illnesses, most notably his obesity, made visitations and long-distance communication with over 30 physicians, including Sir William Osler, a regular occurrence through this life. Yet Taft’s struggles with his health and his beliefs as a freemason were deeply rooted in his appreciation for health care and public health measures. This article aims to explore the motivations and contributions of Taft to public health initiatives to explore the impact public health has had in the past and continues to have in the modern COVID-19 pandemic.

Application of beta-blockers in burn management

Severe burn injuries cause chronic inflammation, which produces a subsequent hypermetabolic response that starts immediately and persists for at least 3 years. The hypermetabolic state, which is thought to be due to postburn elevations of endogenous catecholamines and cortisol, is associated with a number of harmful physiologic derangements including immunosuppression, impaired wound healing, muscle catabolism, and hepatic dysfunction. Beta-blockers have become first line agents for reducing these adverse effects of hypermetabolism in severe burns. This review discusses the underlying pharmacological mechanisms demonstrated by clinical studies evaluating the safety and efficacy of beta-blockers in the management of burn injuries. A literature search was performed using the PubMed database to identify articles on beta-blockers and burn management. The review yielded 33 relevant results consisting of randomized controlled trials, original research articles, and meta-analyses in pediatric and adult burn patients. Propranolol administration reduced insulin resistance, lipolysis, proteolysis, cardiac work, and bone loss resulting from burn-associated hypermetabolism. Propranolol also effectively reduced myocardial stress, resting energy expenditure, and central deposition of fat. Recent studies have begun to evaluate incorporation of anabolic agents and rehabilitative exercise therapy. However, at this time propranolol continues to be the most effective therapy for reducing the hypermetabolic response and other morbidities resulting from burn injuries.

A PheWAS Model of Autism Spectrum Disorder

Children with Autism Spectrum Disorder (ASD) exhibit a wide diversity in type, number, and severity of social deficits as well as communicative and cognitive difficulties. It is a challenge to categorize the phenotypes of a particular ASD patient with their unique genetic variants. There is a need for a better understanding of the connections between genotype information and the phenotypes to sort out the heterogeneity of ASD. In this study, single nucleotide polymorphism (SNP) and phenotype data obtained from a simplex ASD sample are combined using a PheWAS-inspired approach to construct a phenotype-phenotype network. The network is clustered, yielding groups of etiologically related phenotypes. These clusters are analyzed to identify relevant genes associated with each set of phenotypes. The results identified multiple discriminant SNPs associated with varied phenotype clusters such as ASD aberrant behavior (self-injury, compulsiveness and hyperactivity), as well as IQ and language skills. Overall, these SNPs were linked to 22 significant genes. An extensive literature search revealed that eight of these are known to have strong evidence of association with ASD. The others have been linked to related disorders such as mental conditions, cognition, and social functioning.Clinical relevance- This study further informs on connections between certain groups of ASD phenotypes and their unique genetic variants. Such insight regarding the heterogeneity of ASD would support clinicians to advance more tailored interventions and improve outcomes for ASD patients.

The pancreas and COVID-19: a clinical conundrum

With the progression of the COVID-19 pandemic, the classic manifestations of COVID-19 (e.g., persistent fever, dry cough, pneumonia, and acute respiratory distress syndrome in the severe disease) have expanded to include less common complications of the extrapulmonary organs. Recent evidence has shown that COVID-19 patients with concomitant presence of GI symptoms are at higher risk of developing severe disease and have poor clinical outcomes. Recently, multiple SARS-CoV-2-induced acute pancreatitis (AP) cases have been reported. This literature review aims to provide an insight into SARS-CoV-2-directed invasion of the pancreas. We will also review the currently available literature on the clinical effects of SARS-CoV-2, including AP and mild elevation of lipase levels in patients with COVID-19. In addition, we will discuss plausible mechanisms that underly SARS-CoV-2-induced pancreatitis.

Medical views on the death by crucifixion of Jesus Christ

The death of Jesus Christ remains a pivotal moment in world history and a symbol of love, mercy, and courage across the globe. Yet for centuries, the manner of Jesus' death has remained a subject of controversy in academic and medical circles. Forensic pathologists and clinicians have argued for several hypotheses concerning Jesus' death, including pulmonary embolism, cardiac rupture, suspension trauma, asphyxiation, fatal stab wound, and shock. This article surveys a broad range of medical and other specialist views regarding Jesus' experience on the cross, concluding that asphyxiation or asphyxiation-dominant theories have emerged as the consensus position regarding the cause of Jesus' death. Two features of this article are significant. First, it provides a rich resource of different medical opinions regarding the effects of Jesus' crucifixion. Second, and more importantly, the survey results show that, perhaps less similar to crucifixion in general, there is a growing consensus regarding Jesus' cause of death by medical professionals. A table maps these results, summarizing for those in the medical field as well as historians and theologians what medical professionals consider to be the cause of Jesus' death.

Comparison of 30-day mortality and readmission frequency in women versus men with acute myocardial infarction

This study aimed to assess gender differences in hospitalization incidence, 30-day mortality, and 30-day readmission rates for acute myocardial infarction (AMI) in a Southwestern US medical center. Hospital billing records for AMI admissions were compiled from January 2013 to June 2019, resulting in a sample size of 2394. Billing data included gender, age, principal procedure, insurance status, principal diagnosis, and race/ethnicity. Multivariate logistic regression was used to estimate gender differences in mortality after adjustment for the aforementioned factors. Men were hospitalized for AMI over twice as frequently, yet women had higher AMI mortality than men (9.3% vs. 6.1%, P < 0.01). Female AMI patients were older on average and slightly less likely to undergo percutaneous transluminal coronary angioplasty than men. Thirty-day readmission rates did not differ by gender. In absolute terms, AMI hospitalizations and deaths are larger in number in men, but AMI hospitalizations more frequently end in death in women.

Emerging Role of Fascin-1 in the Pathogenesis, Diagnosis, and Treatment of the Gastrointestinal Cancers

Simple Summary

Gastrointestinal (GI) cancers, including esophageal, gastric, colorectal, liver, and pancreatic cancers, remain as one of the leading causes of death worldwide, with a large proportion accounting for fatalities related to metastatic disease. The active involvement of fascin-1 in forming membrane protrusions crucial for cellular movement has been identified as an important molecular mechanism behind the phenotypic switch from the localized to the metastatic tumor. Thus, fascin-1 expression status in the malignant tissue has been utilized as an important component in determining the patient’s clinicopathological outcomes. In this review, we provide an up-to-date literature review of the role of fascin-1 in the initiation and metastatic progression of GI tract cancers, its involvement in patients’ clinical outcomes, and its potential as a therapeutic target.

Abstract

Gastrointestinal (GI) cancers, including esophageal, gastric, colorectal, liver, and pancreatic cancers, remain as one of the leading causes of death worldwide, with a large proportion accounting for fatalities related to metastatic disease. Invasion of primary cancer occurs by the actin cytoskeleton remodeling, including the formation of the filopodia, stereocilia, and other finger-like membrane protrusions. The crucial step of actin remodeling in the malignant cells is mediated by the fascin protein family, with fascin-1 being the most active. Fascin-1 is an actin-binding protein that cross-links filamentous actin into tightly packed parallel bundles, giving rise to finger-like cell protrusions, thus equipping the cell with the machinery necessary for adhesion, motility, and invasion. Thus, fascin-1 has been noted to be a key component for determining patient diagnosis and treatment plan. Indeed, the overexpression of fascin-1 in GI tract cancers has been associated with a poor clinical prognosis and metastatic progression. Moreover, fascin-1 has received attention as a potential therapeutic target for metastatic GI tract cancers. In this review, we provide an up-to-date literature review of the role of fascin-1 in the initiation of GI tract cancers, metastatic progression, and patients’ clinical outcomes.