Showing papers in "Southern Medical Journal in 2021"
TL;DR: The role of renin-angiotensin-aldosterone system (RAAS) inhibitors on COVID-19 infections has been discussed in this paper, with the hypothesis that RAAS inhibitors facilitate viral insertion and the alternative hypothesis of the beneficial role of these drugs.
Abstract: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. The angiotensin-converting enzyme 2 (ACE2) has been proven to be used by SARS-CoV-2 for host cell entry. Considering that angiotensin receptor blockers and ACE inhibitors (ACEIs) upregulate the expression of ACE2 in animal studies, there may be a concern about whether these drugs may increase COVID-19 susceptibility and severity. Recently, there has been a debate among clinicians about whether to continue or to stop ACEIs and angiotensin receptor blockers in the context of COVID-19. Also, some media outlets and health systems have called for the discontinuation of these drugs in the context of suspected COVID-19. This has necessitated an urgent release of guidance on the use of such medications in COVID-19 patients. To date, multiple theories relating to the pure effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on COVID-19 infections have been postulated. Favorable effects include blocking the ACE2 receptors, preventing viral entry into the heart and lungs, and protecting against lung injury in COVID-19. Adverse effects include a possible retrograde feedback mechanism that upregulates ACE2 receptors. This review provides greater insight into the role of the RAAS axis in acute lung injury and the effects of RAAS inhibitors on SARS-CoVs. The hypothesis that RAAS inhibitors facilitate viral insertion and the alternative hypothesis of the beneficial role of these drugs are discussed. Up-to-date published data concerning the RAAS inhibitors and COVID-19 are summarized.
13 citations
TL;DR: The response in orthopedic surgery to the coronavirus disease 2019 (COVID-19) pandemic across the United States is investigated by surveying surgeons about their care setting, timing of restrictions on elective surgery, use of telehealth, and estimated economic impact.
Abstract: OBJECTIVES: The purpose of this study was to investigate the response in orthopedic surgery to the coronavirus disease 2019 (COVID-19) pandemic across the United States by surveying surgeons about their care setting, timing of restrictions on elective surgery, use of telehealth, and estimated economic impact. METHODS: A survey was distributed via REDCap through state orthopedic organizations between April and July 2020. The 22-question digital survey collected information regarding restrictions on elective procedures, location of care, utilization of telehealth, and estimated reductions in annual income. RESULTS: In this study, 192 participants responded to the survey (average age 49.9 ± 11.0 years, 92.7% male). Responses primarily originated from Alabama (30.2%), Georgia (30.2%), and Missouri (16.1%). The remainder of the responses were grouped into the category "other." Respondents did not vary significantly by state in operative setting or income type (salary, work relative value units, or collections). Most of the participants documented elective procedure restrictions in hospital and ambulatory settings. The highest frequency of closures occurred between March 18 and 20 (47% in hospital, 51% in ambulatory). Of the participants, financial loss estimates varied across states (P = 0.005), with 50% of physicians claiming >50% losses of income in Alabama (24% Georgia, 10% Missouri, 31% other). Regarding telehealth, practices set up for these services before 2020 varied across states. None of the orthopedic practices in Alabama had telehealth before the COVID-19 pandemic (Missouri 25%, Georgia 9%, other 8%, P = 0.06); however, respondents generally were split when considering the anticipation of implementing telehealth into routine practice. CONCLUSIONS: Most practices did implement restrictions for elective clinic visits and procedures early during the pandemic. COVID-19 ultimately will result in a large revenue loss for elective orthopedic practices. Services such as telehealth may help offset these losses and help deliver orthopedic care to patients remotely.
12 citations
TL;DR: There should be continuous monitoring of the SSNHL Tracing COVID-19 infection is needed to ensure a detailed understanding of this inner ear pathogenesis.
Abstract: Objective: To study the sudden sensorineural hearing loss (SSNHL) in patients with COVID-19 infections Methods: This is a retrospective descriptive study There were 16 COVID-19 patients participated in this study those presented with sudden sensorineural hearing loss (SSNHL) The study was done between March 2020 to August 2020 All these patients were diagnosed with SARS-CoV-2 infection with help of the reverse transcription polymerase chain reaction (RT-PCR) testing Results: Out of 652 COVID-19 patients, 16 (2 45%) patients diagnosed with SSNHL Out of 16 patients with SSNHL, 11 (68 75%) were male and 5 (31 25%) were female with male to female ratio of 2 2:1 The age ranges of the participants were 38 to 72 years with a mean age of 48 42 years There were 14 (87 50%) patients were presented with unilateral and 2 (12 50%) were presented with bilateral SSNHL There were left sided SSNHL in 9 patients (56 25%) and right side SSNHL in 5 patients (31 25%) Conclusion: There should be continuous monitoring of the SSNHL Tracing COVID-19 infection is needed to ensure a detailed understanding of this inner ear pathogenesis © 2020 All rights reserved
12 citations
TL;DR: In the second year clinical skills course at the Florida International University Herbert Wertheim College of Medicine, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions.
Abstract: Objectives Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate. Methods The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions. Results After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses. Conclusions Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula.
10 citations
TL;DR: For URM by URM as mentioned in this paper, a year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund.
Abstract: Objectives The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a "for URM by URM" pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty. Methods A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, which included conference calls and an in-person workshop covering topics related to writing and career advancement. Results The workshop included a mix of prepared programming on how to move from idea to project to manuscript, as well as time for spontaneous mentorship and manuscript collaboration. Key themes that emerged included how to address the high cost of the minority tax, the need for individual passion as a pathway to success, and how to overcome imposter syndrome as a hindrance to writing. Conclusions The "for URM by URM" approach for faculty development to promote writing skills and scholarship for junior URM Family Medicine physicians can address challenges faced by URM faculty. By using a framework that includes the mentors' lived experiences and creates a psychological safe space, we can address concerns often overlooked in traditional skills-based faculty development programs.
10 citations
TL;DR: For instance, this article found that a 1% increase in the proportion of Black individuals in a county would be associated with higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, even after accounting for other high-risk socioecologic factors such as poverty, population density, and household crowding, and uninsured rates.
Abstract: OBJECTIVES: We hypothesized that the proportion of Black individuals in a county would be associated with higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, even after accounting for other high-risk socioecologic factors such as poverty, population density, and household crowding, and uninsured rates. We also expected that counties designated as primary care health professional shortage areas (PCHPSAs) would be associated with higher COVID-19 death rates, and the lack of primary care access would exacerbate racial disparities in death rates. We undertook this study to test these hypotheses and discern the independent effects of racial composition, socioecologic characteristics, and healthcare system factors on COVID-19 cases and deaths in Georgia counties. METHODS: We used county-level COVID-19 cases and deaths on April 23, 2020 from the Johns Hopkins Coronavirus Resource Center and estimates of 2019 county-level populations from the US Census Bureau to calculate the cumulative event rates for the state of Georgia. We used multiple regression models to examine crude and adjusted associations of socioecologic and health system variables with county-level COVID-19 case and mortality rates. RESULTS: After adjustment, a 1% increase in the proportion of Black people in the county resulted in a 2.3% increase in the county COVID-19 confirmed case rate and a 3.0% increase in the death rate (relative risk 1.03, 95% confidence interval 1.01-1.05, P < 0.001). Primary care shortage areas had a 74% higher death rate (relative risk 1.74, 95% confidence interval 1.00-3.00, P = 0.049). CONCLUSIONS: These results highlight the impact of racial disparities on the spatial patterns of COVID-19 disease burden in Georgia, which can guide interventions to mitigate racial disparities. The results also support the need for robust primary care infrastructure throughout the state.
9 citations
TL;DR: In this paper, the effects of a countywide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas were assessed.
Abstract: OBJECTIVES: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. METHODS: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations. RESULTS: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. CONCLUSIONS: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.
8 citations
TL;DR: In this paper, the authors compared the prevalence of second victim experience between supervising physicians and trainees and identified their preferred methods of support, finding that the most common form of desired support for both groups was conversations with their peers.
Abstract: Objectives Physician trainees in obstetrics and gynecology (OBGYN) experience unexpected outcomes similar to those of supervising physicians. A relative lack of experience and perspective may make them more vulnerable to second victim experience (SVE), however. The objectives of our study were to contrast the prevalence of SVE between supervising physicians and trainees and to identify their preferred methods of support. Methods In 2019, the Second Victim Experience and Support Tool, a validated survey with supplemental questions, was administered to healthcare workers caring for OBGYN patients at a large academic center in the midwestern United States. Results The survey was sent to 571 healthcare workers working in OBGYN. A total of 205 healthcare workers completed the survey, including 18 (43.9% of 41) supervising physicians and 12 (48.0% of 25) resident/fellow physicians. The mean scores for the Second Victim Experience and Support Tool dimensions and outcomes were similar between the two groups. Seven (58.3%) trainees reported feeling like a second victim after an adverse patient safety event at some point in their work experience compared with 10 (55.6%) of the supervising physicians. Five (41.7%) trainees identified as a second victim in the previous 12 months compared with 3 (16.7%) supervising physicians (P = 0.21). The most common form of desired support for both groups was conversations with their peers. Conclusions Trainees and supervising physicians are both at risk of SVE after an unexpected medical event and prefer conversations with peers as a desired form of support. Because trainees commonly encounter SVEs early in their careers, program directors should consider implementing a program for peer support after an unexpected event.
8 citations
TL;DR: In this paper, the ability of the Prehospital ABC (PhABC) Score to predict blood transfusions and the need for emergent laparotomy was evaluated by area under the receiver operating characteristic (AUROC) curves and logistic regression.
Abstract: OBJECTIVES Scoring systems, such as the Assessment of Blood Consumption (ABC) Score, are used to identify patients at risk for massive transfusion (MT, ≥10 U red blood cells in 24 hours). Our aeromedical transport helicopter uses ultrasound to perform the Focused Assessment with Sonography for Trauma (FAST) examination. Our objective was to evaluate the ability of the Prehospital ABC (PhABC) Score to predict blood transfusions and the need for emergent laparotomy. METHODS Post hoc analysis of a prospective observational study of trauma patients who underwent an in-flight FAST during aeromedical transport during a 7-month period. PhABC Score was positive if ≥2 of the following were present in flight: penetrating trauma, heart rate >120 bpm, systolic blood pressure <90 mm Hg, or a positive abdominal FAST. The PhABC Score was evaluated by area under the receiver operating characteristic (AUROC) curves and logistic regression. RESULTS A total of 291 trauma patients met inclusion criteria, 23 underwent emergent laparotomy, and 12 received an MT. A positive PhABC Score predicted emergent laparotomy, with a positive predictive value of 48% and a negative predictive value of 95% (sensitivity 46%, specificity 96%, AUROC curve 0.83). A positive PhABC Score also predicted receipt of an MT with a positive predictive value of 28% and a negative predictive value of 94% (sensitivity 33%, specificity 93%, AUROC curve 0.77). Multiple logistic regression identified FAST as the most powerful contributor of the PhABC Score to the prediction of both emergent laparotomy (odds ratio 8.5, P < 0.001) and MT (odds ratio 5.9, P < 0.001). CONCLUSIONS The PhABC Score effectively predicts in-hospital resource utilization. It provides an outstanding undertriage rate from the prehospital setting, and it is helpful to improve trauma team activation, mobilize blood products, and prepare the operating room.
8 citations
TL;DR: Clomiphene citrate and letrozole combined with low dose human menopausal gonadotropin were equally effective for controlled ovarian stimulation in IUI cycles.
Abstract: Objective: To compare the efficacy of clomiphene citrate and letrozole in combination with low dose human menopausal gonadotropin for controlled ovarian stimulation in intrauterine insemination (IUI) cycles. Methods: During January-2018 to December-2019 for intending 496 IUI cycles, controlled ovarian stimulation was performed with either clomiphene or letrozole combined with human menopausal gonadotropin (hMG), in two arms: subjects in one arm (Group A) were with clomiphene and hMG in 222 cycles; those in the second arm (Group B) were with letrozole and hMG in 274 cycles. Pregnancy rate and clinical pregnancy rate of both groups were considered as the primary outcomes. Results: Patient characteristics like female age, indications for IUI, type of IUI (Artificial insemination with husband semen or donor sperm), endometrial thickness and total motile fraction (TMF) of spermatozoa of male partners were seen similar in both groups. The letrozole-hMG group (Group B) had significantly higher numbers of cycles with single dominant follicle (P=0.01) than the other one and human chorionic gonadotropin (hCG) was more frequently used as the ovulation trigger (P=0.03). Pregnancy rate (18.5% vs. 15.3%, P=0.35) and clinical pregnancy rate (18.5% vs. 15.3%, P=0.35) were similar in groups A and B, respectively. Conclusion: Clomiphene citrate and letrozole combined with low dose human menopausal gonadotropin were equally effective for controlled ovarian stimulation in IUI cycles.
8 citations
TL;DR: Attitudes and preferences of students in sports science concerning the use of e-learning and social media at the University of Novi Sad were identified and virtual teaching is not as effective as traditional teaching was shared.
Abstract: Using e-learning and social media has become a common part of students' academic lives in many sciences, including sport sciences. The purpose of this research study was to identify attitudes and preferences of students in sports science concerning the use of e-learning and social media at the University of Novi Sad. The present study was included respondents (N=297) from the Faculty of Sport and Physical Education at the University of Novi Sad from all levels of studies. The attitudes and preferences of the use of e-learning and social media were measured with three separate parts: (1) General information (8 items);(2) use of different genres of social media in teaching (28 items);(3) e-learning in the field of sports studies (13 items), and descriptive statistics (frequencies) were used to describe the basic features of the data. The results showed that participants mostly use Facebook (44.4% of students), Viber (66%), and WhatsApp (56.6%) to contact peer students for study in the context of learning purposes. In comparison, they do not use LinkedIn (1.3%), Twitter (0.3%) or Skype (4%). From another side, the students mostly share their messages via Viber and WhatsApp in the form of various questions (67% via Viber;62.6% via WhatsApp), video messages (20.5%;25.3%), screenshots of their screen (21.2%;27.6%), various links (23.2%;25.3%), comments on a current topic (22.2%;22.2%). In the participants' opinion (81.5%), the teaching process has been set back by the coronavirus pandemic. In contrast, the students experienced the pandemic's positive effect as an improvement in e-learning (51.2% of students). They shared the opinion that virtual teaching is not as effective as traditional teaching (85.2%). The theoretical and practical applications of these results are discussed. © 2021 Montenegrin Sports Academy. All rights reserved.
TL;DR: The COVID-19 associated mucormycosis in the head and neck region of the patients along with patient details, clinical manifestations and management, and diagnosis and treatment of the CAM are studied.
Abstract: Objective: To study the COVID-19 associated mucormycosis in the head and neck region of the patients along with patient details, clinical manifestations and management. Materials and Methods: This is a descriptive and retrospective study of COVID-19 associated mucormycosis (CAM) carried out at a postgraduate teaching hospital. This study was conducted between March 2020 to April 2021. A patient profile such as age, sex, comorbidities, clinical presentations, diagnosis and treatment of the CAM were analyzed.
TL;DR: In this paper, the authors compare access to care, health outcomes, and behavioral risk factors between LGBT and non-LGBT adults in Nashville and Davidson County, Tennessee, using multivariable logistic regression models.
Abstract: Objectives Health disparities for lesbian, gay, bisexual, and transgender (LGBT) adults are well documented, but LGBT health data at the municipal and county levels are lacking, especially in the southern United States. The objective of this study was to compare access to care, health outcomes, and behavioral risk factors between LGBT and non-LGBT adults in Nashville and Davidson County, Tennessee. Methods Data for this study came from a randomly selected, population-based sample of LGBT (n = 128) and non-LGBT (n = 1583) adults in Nashville. Multivariable logistic regression models were used to compare health outcomes between LGBT and non-LGBT Nashvillians while adjusting for demographic characteristics and socioeconomic status. Results LGBT Nashvillians were more likely to be uninsured (odds ratio [OR] 3.96, 95% confidence interval [CI] 1.72-9.10), report unmet medical care needs because of cost (OR 2.20, 95% CI 1.14-4.25), exhibit worse mental health outcomes (eg, frequent mental distress; OR 4.53, 95% CI 2.33-8.80), and report high-risk behaviors for human immunodeficiency virus (OR 9.47, 95% CI 3.96-22.62) compared with non-LGBT Nashvillians. Conclusions To achieve health equity for LGBT individuals at the municipal level, Nashville and Tennessee should consider multifaceted approaches to expanding health insurance coverage and nondiscrimination protections and address mental health and human immunodeficiency virus risks among vulnerable populations.
TL;DR: The results showed that the environmental and health advantages were favourable, but the place advantage indicated a relatively unfavourable situation, which can provide useful solutions for governments to reduce environmental risks and maintain health and physical activity during epidemics.
Abstract: In addition to the environmental problems that have plagued human life in recent decades, the outbreak of the coronavirus epidemic has endangered people's health and adversely affected their lives in other ways Therefore, the present study aimed to investigate the advantage of using shared bicycles (SB) during the outbreak of epidemics For this purpose, 310 male subscribers of an SB system were examined The research tool was a questionnaire taken from studies The results showed that the environmental and health advantages were favourable, but the place advantage indicated a relatively unfavourable situation The results of the structural equation model also showed that the advantages of using an SB based on the highest impact are the motivational advantage, health advantage, environmental advantage, social advantage, financial advantage and place advantage These results can provide useful solutions for governments to reduce environmental risks and maintain health and physical activity during epidemics © 2021 Montenegrin Sports Academy All rights reserved
TL;DR: In this article, the authors describe the demographics, clinical characteristics, and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) in an academic medical center in the southern United States.
Abstract: OBJECTIVES: To describe the demographics, clinical characteristics, and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) in an academic medical center in the southern United States. METHODS: Retrospective, observational cohort study of all adult patients (18 years and older) consecutively admitted with laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 infection between March 13 and April 25, 2020 at the University of Mississippi Medical Center. All of the patients either survived to hospital discharge or died during hospitalization. Demographics, body mass index, comorbidities, clinical manifestations, and laboratory findings were collected. Patient outcomes (need for invasive mechanical ventilation and in-hospital death) were analyzed. RESULTS: One hundred patients were included, 53% of whom were women. Median age was 59 years (interquartile range 44-70) and 66% were younger than 65. Seventy-five percent identified themselves as Black, despite representing 58% of hospitalized patients at our institution in 2019. Common comorbid conditions included hypertension (68%), obesity (65%), and diabetes mellitus (31%). Frequent clinical manifestations included shortness of breath (76%), cough (75%), and fever (64%). Symptoms were present for a median of 7 days (interquartile range 4-7) on presentation. Twenty-four percent of patients required mechanical ventilation and, overall, 19% died (67% of those requiring mechanical ventilation). Eighty-four percent of those who died were Black. On multivariate analysis, ever smoking (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2-28.6) and history of diabetes mellitus (OR 5.9, 95% CI 1.5-24.3) were associated with mortality, and those admitted from home were less likely to die (vs outside facility, OR 0.2, 95% CI 0.0-0.7). Neither age, sex, race, body mass index, insurance status, nor rural residence was independently associated with mortality. CONCLUSIONS: Our study adds evidence that Black patients appear to be overrepresented in those hospitalized with and those who die from COVID-19, likely a manifestation of adverse social determinants of health. These findings should help guide preventive interventions targeting groups at higher risk of acquiring and developing severe COVID-19 disease.
TL;DR: In this article, a large mobile phone manufacturer develops its anti-counterfeit strategy and seizes counterfeit products on the market, focusing on seizure of counterfeit products when consumers' safety is at risk.
Abstract: Research Summary We examine in detail how one large mobile phone manufacturer develops its anti‐counterfeit strategy and seizes counterfeit products on the market. We couple qualitative data (observations from 150 counterfeit sales points worldwide, two focus groups, a survey with 151 respondents, interviews with 90 informants) with econometric analysis of 3,333 fights the focal firm undertook against more than 2,000 counterfeiters in 75 countries over 6 years (2006–2011). We focus on firm's seizure of counterfeit products when consumers' safety is at risk. As the firm is more sensitive to product safety than counterfeiters, we found that the firm generally performs larger seizures when unsafe products are involved, but this is less true in the firm's main market, likely because higher profitability offers higher incentives to counterfeiters. Managerial Summary In companies' fight against counterfeiters, product safety plays a pivotal role. We suggest that companies have a particularly high incentive to seize counterfeit products when the product carries potential safety risks, because the occurrence of safety issues seriously harms its reputation. This research explores the anti‐counterfeit strategy undertaken by a large manufacturer operating in the market of mobile phones and in the market of ancillary products (e.g., batteries and chargers). Results show that larger seizures occur in the ancillary rather than in the mobile phone market because while authentic companies have high incentives to seize mobile phone and accessories, as both involve safety risks, counterfeiters have a greater incentive in the main market and thus put less effort in ancillary markets.
TL;DR: It can be said that nurses tend to show moral behaviors, as the low score of the endurance of threat indicates that operating room nurses do not receive the necessary support from the organization for their courageous behavior.
Abstract: Objective: Moral courage distinguishes real moralists from hypocrites and indicates the commitment of nurses to their patients. Organizational commitment can also influence this commitment. Therefore, the present study aimed to investigate the correlation between moral courage and organizational commitment of operating room nurses working in the teaching hospitals of Arak University of Medical Sciences. Methods: This cross-sectional correlational study was conducted on 136 operating room nurses who were selected using the convenience sampling method. The required data were collected through demographic information form, the organizational commitment questionnaire of Allen and Myer, and the professional moral courage scale by Sekerka and colleagues. The collected data were analyzed using SPSS (version 21) for descriptive and correlational analyses. Results: The mean scores of moral courage of operating room nurses were 62.5±6.5 and in 101.86±13.7 organizational commitment. Moreover, moral courage did not have a statistically significant relationship with organizational commitment (P>0.05). The moral courage and organizational commitment of the participants differed significantly in terms of their type of employment (P<0.05) and age (P<0.05). Conclusion: Given the high mean score of moral courage and organizational commitment in operating room nurses, it can be said that nurses tend to show moral behaviors. On the other hand, the low score of the endurance of threat indicates that operating room nurses do not receive the necessary support from the organization for their courageous behavior. Therefore, the support of senior managers is essential for the occurrence of such behaviors.
TL;DR: This article found that the majority of residents experienced patient macro-and micro-aggression related to race (56%) or gender (59%) and women and residents of color were more likely to experience these types of encounters.
Abstract: Objectives Physicians in training may be particularly vulnerable to the negative effects of discrimination and inappropriate behaviors by patients We sought to determine the frequency of inappropriate behaviors by patients toward Internal Medicine (IM) residents, residents' confidence to manage the behaviors, and differences among demographic characteristics, including race, sex, and level of clinical experience Methods We developed a curricular session to equip IM residents and faculty to respond to discrimination or inappropriate behaviors by patients Before the session, we surveyed residents about their experiences with macroaggressions, microaggressions, and other inappropriate behaviors using a 16-question survey instrument We used descriptive statistics to summarize the participants' characteristics and the χ2 or Fisher exact test for comparison between groups Results Eighty-two percent (27 of 33) of residents who attended the workshop completed the survey We found that the majority of residents experienced patient macro- and microaggressions More than 50% had a personal experience or witnessed experience with a macroaggression related to race (56%) or gender (59%) Seventy percent of residents personally experienced a microaggression by a patient Women and residents of color are more likely to experience these types of encounters, which become more common in residents with higher postgraduate year level Confidence in how to appropriately respond to such encounters is low Conclusions Our study highlights that macro- and microaggressions by patients toward IM residents are common Curricula are needed to equip trainees with tools to appropriately respond during such encounters
TL;DR: The effect of pre-operative vedolizumab treatment on post-operative outcomes in patients with inflammatory bowel disease (IBD) remains unclear as discussed by the authors, however, the authors of this paper aim to determine the relation between pre-operative vedlizumaab and early postoperative complications in patients undergoing abdominal surgery.
Abstract: Objectives The effect of vedolizumab on postoperative outcomes in patients with inflammatory bowel disease (IBD) remains unclear. We aimed to determine the relation between preoperative vedolizumab and early postoperative complications in patients with IBD undergoing abdominal surgery. Methods A search of databases and abstracts from gastroenterology conferences was performed. Primary outcomes included overall and infectious postoperative complication rates as well as surgical site infections. Studies that compared Crohn disease, ulcerative colitis, or patients with IBD-undefined with preoperative vedolizumab treatment undergoing abdominal surgery with controls with preoperative antitumor necrosis factor-α (anti-TNF-α) treatment or no preoperative biologic treatment were included. A meta-analysis was completed using the Mantel-Haenszel and DerSimonian and Laird models. Results Six studies totaling 1201 patients were included; 281 patients were treated preoperatively with vedolizumab, 327 patients were treated preoperatively with anti-TNF-α agents, and 593 patients were not treated preoperatively with any biologics. There was no significant difference in overall complications (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.48-2.24, P = 0.92, I2 =77%) between the vedolizumab and no-biologic groups. There also was no significant difference in infectious complications (OR 1.00, 95% CI 0.37-2.69, P = 1.00, I2 = 78%), which persisted after sensitivity analysis (OR 0.71, 95% CI 0.31-1.60, P = 0.41, I2 = 46%). Furthermore, there was no significant difference in overall complications (OR 0.77, 95% CI 0.24-2.46, P = 0.66, I2 = 85%) and infectious complications (OR 0.89, 95% CI 0.20-3.94, P = 0.87, I2 = 86%) between the vedolizumab and anti-TNF-α groups. After sensitivity analysis, differences in overall and infectious complications remained insignificant (OR 0.54 and 0.50, 95% CI 0.24-1.17 and 0.22-1.15, P = 0.12 and 0.10, I2 = 39% and 18%, respectively). Vedolizumab was also not associated with a significant increase in surgical site infections compared with the no-biologic (OR 1.45, 95% CI 0.33-6.32, P = 0.62, I2 = 75%) and anti-TNF (OR 1.30, 95% CI 0.22-7.60, P = 0.77, I2 = 81%) groups. Conclusions Preoperative treatment with vedolizumab in patients with IBD undergoing abdominal surgery is not associated with increases in overall or infectious postoperative complications compared with preoperative anti-TNF-α treatment and no preoperative biologic treatment. Large, prospective studies are needed to further assess the impact of preoperative vedolizumab treatment on postoperative complications, particularly with respect to IBD subtype.
TL;DR: MyR performed promising effects on testicular and lung tissues following testicular I/R injury according to biochemical parameters, and decreased TOS, MDA, and MPO levels at both high and low doses compared to the I/ R group.
Abstract: Objective: Testicular torsion may lead to testicular atrophy and male infertility if untreated within some hours. Since ischemia reperfusion (I/R) injury is a reason for the harmful effects during testicular torsion, antioxidant agents are among the targets of science to deal with reactive oxygen species (ROS). As a flavonoid member, myricetin (3, 3, 4, 5, 5, 7-hexahydroxyflavone, MYR) has antioxidant, anticancer, anti-inflammatory, antiviral, and antidiabetic activities. Materials and Methods: In this experiment 32 Wistar albino male rats were randomly divided into 4 groups (n=8). Group I was defined as the sham group. In group II, I/R group, testicular torsion detorsion was performed. In group III (MYR 25) and group IV (MYR 50), MYR was administrated intraperitoneally at 25 and 50 mg/kg doses, 30 minutes before detorsion. The testicular and lung tissue samples were examined biochemically. Results: In both testis and lung tissues, MYR decreased TOS, MDA, and MPO levels at both high and low doses compared to the I/R group. Besides, SOD values increased in MYR treatment groups compared to the I/R group. Conclusion: MYR performed promising effects on testicular and lung tissues following testicular I/R injury according to biochemical parameters.
TL;DR: The number of journeys made by public buses, ships, and airplanes in Thailand from January until July 2020 declined by more than 50% from the previous year, and the correlation between theNumber of journeys and COVID-19 cases has been shown in the analysis.
Abstract: Objective: To determine whether there is a relationship between the extent of human travel and the number of COVID-19 cases in Thailand. Materials and Methods: The data set on monthly COVID-19 in Thailand between January and July 2020 were retrieved from the Ministry of Public Health, Thailand. Data regarding people's travel in Thailand during the COVID-19 pandemic and for the same period of 2019 were retrieved from Open Government Data of Thailand. A paired t-test was used to compare the differences between the number of journeys made in each mode of transport in 2019 (January - July) and 2020 (January - July). Pearson's product-moment correlation coefficient was used to examine the relationships among studied variables. Results: A Paired Samples t-test showed that from January until July 2020, the number of journeys made by public buses, ships, and airplanes declined by more than 50% from the previous year (p < 0.05). Pearson correlation coefficients showed that the mean monthly number of COVID-19 cases was significantly and inversely correlated with the number of public bus journeys made (r = -0.897, p < 0.01), the number of train journeys (r = -0.834, p < 0.05), ship journeys (r = -0.890, p < 0.01), and airplane journeys (r = -0.911, p < 0.01). There was no significant relationship between the number of COVID-19 cases and private car journeys (r = -0.405, p = 0.367). Conclusion: During the pandemic, the number of journeys has been decreased. Moreover, the correlation between the number of journeys and COVID-19 cases has been shown in our analysis. © 2021. All Rights Reserved.
TL;DR: In this article, the authors evaluated the concordance between attended automated office blood pressure (AOBP) measurements with an oscillometric device and ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension in adults in a primary healthcare setting.
Abstract: OBJECTIVES As part of the HEARTS in the Americas initiative, Chilean primary healthcare centers have implemented novel hypertension management strategies, including new diagnostic approaches This study evaluated the concordance between attended automated office blood pressure (AOBP) measurements with an oscillometric device and ambulatory blood pressure monitoring (ABPM) METHODS This was an observational cohort study to evaluate and compare attended AOBP and ABPM for the diagnosis of hypertension in adults in a primary healthcare setting RESULTS The study evaluated 309 participants (542 ± 157 years; 505% male) from four primary healthcare centers in Santiago, Chile Attended AOBP measurements were obtained at the clinic on two separate days, followed by ABPM AOBP values indicated that 696% of patients had a systolic blood pressure (SBP) of ≥140 mm Hg and 346% had a diastolic blood pressure (DBP) of ≥90 mm Hg A total of 835% had hypertension, 453% had high SBP, and 560% had high DBP ABPM values indicated that 650% of patients had hypertension The combined AOBP and ABPM analysis showed that 570% of patients had sustained hypertension, 265% had white coat hypertension, 81% had masked hypertension, and 84% were normotensive The concordance between AOBP and ABPM (κ coefficient) was low (κ = 0133; 95% confidence interval 0028-0237) The comparison of AOBP and ABPM measurements (Bland-Altman plots and bias calculations) showed an important bias in BP as measured using the AOBP method, especially for SBP (137 ± 116, 95% confidence interval -91 to 365) CONCLUSIONS Attended AOBP alone may not be sufficient for adequate classification, diagnosis, and management of hypertension in Chile or other countries with similar demographics
TL;DR: In this paper, the authors examined prior studies on maternal and neonatal outcomes with prophylactic compared with emergent blood transfusion in pregnant women with sickle cell disease and found that women who underwent emergent transfusion were more likely to have adverse per-inatal outcomes: preterm delivery, pneumonia, pyelonephritis, pain crises, intrauterine growth restriction, neonatal death, perinatal death and maternal mortality.
Abstract: The objective of this study was to examine prior studies on maternal and neonatal outcomes with prophylactic compared with emergent blood transfusion in pregnant women with sickle cell disease A review of the literature was performed Twenty-one articles were identified and included in the analysis A generalized linear mixed-effects model was used to analyze the outcomes Pregnancy outcomes assessed were preeclampsia, pneumonia, pyelonephritis, pain crises, intrauterine growth restriction, neonatal death, perinatal death, and maternal mortality Women who underwent emergent transfusion were more likely than women who underwent prophylactic transfusion to have the following adverse perinatal outcomes: preterm delivery (adjusted odds ratio [aOR 204], 95% confidence interval [CI] 114-363), pneumonia (aOR 298, 95% CI 144-615), pain crises (aOR 167, 95% CI 118-238), and perinatal death (aOR 184, 95% CI 106-307) Prophylactic transfusion should be reexamined as a potentially beneficial approach to the management of sickle cell disease in pregnancy
TL;DR: In this article, the prevalence and trends of cardiovascular-relevant behaviors and clinical tests among early adolescents using a nationally representative database were assessed and compared by obtaining and comparing measures on physical activity, diet, body mass index, smoking status, cholesterol levels, hemoglobin A1c, sodium intake, and blood pressure.
Abstract: Objectives Lifestyle behaviors relevant to cardiovascular health are learned during childhood and continued into adulthood. Children and adolescents who participate in unhealthy behaviors have a higher lifetime risk of cardiovascular disease in adulthood. Public health institutions publish behavior and clinical recommendations designed for adolescents to reduce their lifetime cardiovascular risk. We assessed the prevalence and trends of cardiovascular-relevant behaviors and clinical tests among early adolescents using a nationally representative database. Methods In 2020, we compared the prevalence of cardiovascular risk factors among 1408 adolescents surveyed from 1988 to 1994 with that of 1812 adolescents surveyed from 2011 to 2016 by obtaining and comparing measures on physical activity, diet, body mass index, smoking status, cholesterol levels, hemoglobin A1c, sodium intake, and blood pressure. Results The prevalence of adherence to the current recommendations regarding physical activity, diet, and body weight declined over time. Conversely, the prevalence of adhering to recommendations to avoid smoking increased. Clinical indicators, including blood pressure control and normal measures of hemoglobin A1c and total serum cholesterol, showed mixed results, with more individuals showing signs of hyperglycemia, fewer showing signs of hypercholesterolemia, and the percentage of individuals with abnormal blood pressure remaining the same. The use of cardiometabolic medications also increased during the study period. Finally, the number of adolescents with all seven cardiovascular protective factors declined significantly during the study period, from 27.6% to 9.6%. Conclusions Modern American teenagers aged 12 to 16 years have more cardiovascular risk factors relating mostly to diet, exercise, and obesity than those of a prior generation; however, smoking rates have also declined precipitously.
TL;DR: A retrospective review of 135 patients who underwent 18F-fluciclovine PET-computed tomography (PET-CT) at a single institution from August 2018 through January 2020 was performed in this article.
Abstract: OBJECTIVES 18F-fluciclovine (fluciclovine) is an amino acid analog approved by the Food and Drug Administration for use as a radiotracer in positron emission tomography (PET) in men with biochemical recurrence of suspected prostate cancer. The purpose of this study was to investigate the initial institutional experience with 18F-fluciclovine in the evaluation of prostate cancer with biochemical recurrence. METHODS This study was a retrospective review of 135 patients who underwent 18F-fluciclovine PET-computed tomography (PET-CT) at a single institution from August 2018 through January 2020. Prognostic information, including prostate-specific level antigen (PSA) at the time of diagnosis, initial risk, initial Gleason score, and initial stage, was reviewed as well as the PSA level at the time of the scan. The images were reviewed by two radiologists with fellowship training in nuclear medicine and additional training to interpret the fluciclovine studies. A minority of studies were reviewed by a third fellowship-trained radiologist under the guidance of the two nuclear medicine-trained radiologists. In cases with abnormal radiopharmaceutical uptake in lymph nodes, the short-axis dimension of the lymph node or largest lymph node with abnormal uptake was noted. If CT or bone scan was performed within 4 months of the 18F-fluciclovine PET-CT, findings on the alternate imaging were compared with the results of the 18F-fluciclovine PET-CT. RESULTS Our institutional positivity rate was 75.6%, with 64 (67.4%) patients with metastatic disease and 71 (52.6%) patients with local recurrence detected by fluciclovine. As expected, the rate of positive examinations increased with increasing PSA values measured at the time of imaging (P < 0.001). Of the 54 patients with nodal disease, 35 had nonpathologically enlarged lymph nodes measuring <1 cm in maximum short-axis dimension. In more than half of the patients in this study, with conventional imaging, fluciclovine either discovered otherwise undetectable metastatic disease or suggested the presence of local recurrence. CONCLUSIONS Our single-institution experience with 18F-fluciclovine PET-CT has the largest number of patients to date in the literature and demonstrates the ability of fluciclovine to help guide clinical management in the detection of early recurrent disease.
TL;DR: The role of physical exercise and the ketogenic diet on epilepsy is explained and neuroprotective effects on oxidative stress, neuroinflammation, potassium channels in the brain, and mitochondrial function are explained.
Abstract: One-third of patients with epilepsy do not respond to antiepileptic drugs and may seek complementary and alternative treatment modalities. Dietary therapies, such as the ketogenic diet (KD), the modified Atkins diet, as well as the medium-chain triglyceride and the low glycaemic index diets, have been successfully implemented with some forms of epilepsy and are growing in utilization. The KD is a high-fat, low-protein, low-carbohydrate diet that has been used for various conditions for over a century. Insights into the mechanism of action of these diets may provide more targeted interventions for patients with epilepsy. Knowledge of these mechanisms is growing and includes neuroprotective effects on oxidative stress, neuroinflammation, potassium channels in the brain, and mitochondrial function. In this review, we explain the role of physical exercise and the ketogenic diet on epilepsy.