Tag: nevin manimala

Trop Med Infect Dis. 2023 Feb 24;8(3):137. doi: 10.3390/tropicalmed8030137.

ABSTRACT

The prevalence of colonization by Pneumocystis jirovecii (P. jirovecii) has not been studied in Mexico. We aimed to determine the prevalence of colonization by P. jirovecii using molecular detection in a population of Mexican patients with chronic obstructive pulmonary disease (COPD) and describe their clinical and sociodemographic profiles. We enrolled patients discharged from our hospital diagnosed with COPD and without pneumonia (n = 15). The primary outcome of this study was P. jirovecii colonization at the time of discharge, as detected by nested polymerase chain reaction (PCR) of oropharyngeal wash samples. The calculated prevalence of colonization for our study group was 26.66%. There were no statistically significant differences between COPD patients with and without colonization in our groups. Colonization of P. jirovecii in patients with COPD is frequent in the Mexican population; the clinical significance, if any, remains to be determined. Oropharyngeal wash and nested PCR are excellent cost-effective options to simplify sample collection and detection in developing countries and can be used for further studies.

PMID:36977138 | DOI:10.3390/tropicalmed8030137

Toxins (Basel). 2023 Mar 1;15(3):186. doi: 10.3390/toxins15030186.

ABSTRACT

Algal blooms consisting of potentially toxic cyanobacteria are a growing source water management challenge faced by water utilities globally. Commercially available sonication devices are designed to mitigate this challenge by targeting cyanobacteria-specific cellular features and aim to inhibit cyanobacterial growth within water bodies. There is limited available literature evaluating this technology; therefore, a sonication trial was conducted in a drinking water reservoir within regional Victoria, Australia across an 18-month period using one device. The trial reservoir, referred to as Reservoir C, is the final reservoir in a local network of reservoirs managed by a regional water utility. Sonicator efficacy was evaluated through qualitative and quantitative analysis of algal and cyanobacterial trends within Reservoir C and surrounding reservoirs using field data collected across three years preceding the trial and during the 18-month duration of the trial. Qualitative assessment revealed a slight increase in eukaryotic algal growth within Reservoir C following device installation, which is likely due to local environmental factors such as rainfall-driven nutrient influx. Post-sonication quantities of cyanobacteria remained relatively consistent, which may indicate that the device was able to counteract favorable phytoplankton growth conditions. Qualitative assessments also revealed minimal prevalence variations of the dominant cyanobacterial species within the reservoir following trial initiation. Since the dominant species were potential toxin producers, there is no strong evidence that sonication altered Reservoir C’s water risk profiles during this trial. Statistical analysis of samples collected within the reservoir and from the intake pipe to the associated treatment plant supported qualitative observations and revealed a significant elevation in eukaryotic algal cell counts during bloom and non-bloom periods post-installation. Corresponding cyanobacteria biovolumes and cell counts revealed that no significant changes occurred, excluding a significant decrease in bloom season cell counts measured within the treatment plant intake pipe and a significant increase in non-bloom season biovolumes and cell counts as measured within the reservoir. One technical disruption occurred during the trial; however, this had no notable impacts on cyanobacterial prevalence. Acknowledging the limitations of the experimental conditions, data and observations from this trial indicate there is no strong evidence that sonication significantly reduced cyanobacteria occurrence within Reservoir C.

PMID:36977077 | DOI:10.3390/toxins15030186

Toxics. 2023 Mar 6;11(3):247. doi: 10.3390/toxics11030247.

ABSTRACT

Background: Patients on chronic hemodialysis therapy are at high risk of disturbances in trace element status due to both the underlying disease and the hemodialysis process itself. Data on iodine and bromine levels in these patients are scarce. Methods: Using an ICP-MS analytical procedure, serum iodine and bromine levels were determined in a cohort (n = 57) of end-stage renal disease patients on chronic hemodialysis. The results were compared with those of a control group (n = 59). Results: Hemodialysis patients presented serum iodine levels within the normal range, slightly lower than in controls, but without reaching a statistically significant difference (67.6 ± 17.1 µg/L vs. 72.2 ± 14.8 µg/L; p = 0.1252). In contrast, serum bromine levels were much lower in patients (1086 ± 244 µg/L vs. 4137 ± 770 µg/L; p < 0.0001), at values only about 26% of the values observed in controls. Conclusions: Hemodialysis patients had normal serum iodine levels, but highly decreased serum bromine levels. The clinical significance of this finding requires further investigation, but it may be associated with sleep disturbances and fatigue that affect hemodialysis patients.

PMID:36977012 | DOI:10.3390/toxics11030247

Toxics. 2023 Feb 25;11(3):217. doi: 10.3390/toxics11030217.

ABSTRACT

Laboratory experiments were carried out to analyze 39 soil samples collected from four industrial areas in Xuzhou City using inductively coupled plasma mass spectrometry and atomic fluorescence spectrometry. The descriptive statistics of heavy metals (HMs) in the soil profiles showed that the HM content at three depths was highly variable, and most coefficients of variation (CVs) showed moderate variability. The enrichment of Cd at all depths exceeded the risk screening value, and Cd pollution occurred in four plants. The enrichment of the other HMs at three depths was mainly concentrated in the pharmaceutical plant A and chemical plant C. It was found that the different HMs had different vertical distribution characteristics. For the different industrial plants, the raw materials and products not only made the spatial distribution characteristics of the HMs different, but also caused the HM types and contents to differ. The average single pollution indices of Cd in plant A, iron-steel plant B, and plant C indicated a slight pollution level. The other seven HMs in A, B, and C and all HMs in chemical plant D belonged to the safe category. The mean values of the Nemerow pollution index in the four industrial plants belonged to the warning category. The analysis showed that none of the HMs posed potential noncarcinogenic health risks, and only the carcinogenic health risks of Cr in plants A and C were unacceptable. The carcinogenic effect of Cr through the inhalation intake of resuspended soil particulates and that of Cd, Ni, and As via direct oral ingestion were the main exposure pathways.

PMID:36976982 | DOI:10.3390/toxics11030217

J Nutr Gerontol Geriatr. 2023 Mar 28:1-13. doi: 10.1080/21551197.2023.2192186. Online ahead of print.

ABSTRACT

This cross-sectional study assessed the nutrition and physical activity (PA) needs, practices, and programming preferences of adults ages 40+ years from seven states (n = 1,250). Respondents were mostly educated, White, food-secure, adults ages 60+ years. Many were married, suburban-residing, and interested in health programming. By self-report most respondents were “at nutritional risk” (59.3%), in “somewhat good health” (32.3%), and sedentary (49.2%). One-third reported PA intention in the next two months. Desired programs were less than four weeks and under 4 h weekly. Respondents preferred to attend self-directed online lessons (41.2%). Program format preference varied by age (P < 0.05). More respondents aged 40-49 years and 70+ years reported a preference for online group sessions compared to those aged 50 to 69 years. Respondents ages 60 to 69 years reported the highest preference for interactive apps. More older respondents (60 years and older) preferred asynchronous online lessons compared to the younger respondents (age 59 years and younger). There were significant program participation interest differences by age, race, and location (P< 0.05). These results revealed a need and preference for self-directed, online health programming for middle-aged and older adults.

PMID:36976616 | DOI:10.1080/21551197.2023.2192186

West J Emerg Med. 2023 Feb 27;24(2):363-367. doi: 10.5811/westjem.2022.11.57574.

ABSTRACT

INTRODUCTION: There are more than 80,000 emergency department (ED) visits for non-fatal bullet-related injuries (BRI) per year in the United States. Approximately half of these patients are discharged home from the ED. Our objective in this study was to characterize the discharge instructions, prescriptions, and follow-up plans provided to patients discharged from the ED after BRI.

METHODS: This was a single-center, cross-sectional study of the first 100 consecutive patients who presented to an urban, academic, Level I trauma center ED with an acute BRI beginning on January 1, 2020. We queried the electronic health record for patient demographics, insurance status, cause of injury, hospital arrival and discharge timestamps, discharge prescriptions, and documented instructions regarding wound care, pain management, and follow-up plans. We analyzed data using descriptive statistics and chi-square tests.

RESULTS: During the study period, 100 patients presented to the ED with an acute firearm injury. Patients were predominantly young (median age 29, interquartile range 23-38 years), male (86%), Black (85%), non-Hispanic (98%), and uninsured (70%). We found that 12% of patients did not receive any type of written wound care instruction, while 37% received discharge paperwork that included instructions to take both an NSAID and acetaminophen. Fifty-one percent of patients received an opioid prescription, with a range from 3-42 tablets (median 10 tablets). The proportion of patients receiving an opioid prescription was significantly higher among White patients (77%) than among Black patients (47%).

CONCLUSION: There is variability in prescriptions and instructions provided to survivors of bullet injuries upon ED discharge at our institution. Our data indicates that standardized discharge protocols could improve quality of care and equity in the treatment of patients who have survived a BRI. Current variable quality in discharge planning is an entry point for structural racism and disparity.

PMID:36976600 | DOI:10.5811/westjem.2022.11.57574

West J Emerg Med. 2023 Feb 25;24(2):210-217. doi: 10.5811/westjem.2022.11.58766.

ABSTRACT

INTRODUCTION: In 2021, a large Midwestern university began selling alcohol to spectators within the football stadium for the first time. The stadium routinely hosts >65,000 spectators, and drinking alcohol is highly prevalent at pre-game tailgating events. Our goal in this study was to determine the impact of in-stadium alcohol sales on the incidence of alcohol-related emergency department (ED) visits and local emergency medical services (EMS) calls. We hypothesized that the availability of alcohol throughout the stadium would lead to an increase in alcohol-related patient presentations.

METHODS: This was a retrospective study including patients who used local EMS and presented to the ED on football Saturdays in the 2019 and 2021 seasons. There were 11 Saturday games with seven home games each year. The 2020 season was excluded due to the impact of COVID-19- related restrictions on attendance. Trained extractors using predefined criteria reviewed records for each patient to determine whether the visit was alcohol related. Using logistic regression analysis we examined the odds of an EMS call and ED visit being alcohol-related before and after the start of stadium alcohol sales. We compared characteristics of visits before and after the onset of stadium alcohol sales using Student’s t-test for continuous variables and chi-square test for categorical variables.

RESULTS: In 2021, after the onset of in-stadium alcohol sales, there were a total of 505 emergency calls to local EMS on football Saturdays (home and away), and 29% of them were for alcohol-related incidents down from 36% of 456 calls in 2019. After adjustment for covariates, the odds of a call being alcohol-related were lower in 2021 than 2019, but this difference was not significant (adjusted odds ratio [aOR] 0.83, 95% CI 0.48-1.42). Looking specifically at the seven home games each season, the difference was more pronounced (31% of calls in 2021 compared to 40% in 2019) but not statistically significant after adjustment for covariates (aOR 0.54, 95% CI 0.15-2.03). In the ED, 1,414 patients were evaluated on game days in 2021 and 8% of them for alcohol-related reasons. This is similar to 2019, when 9% of the 1,538 patients presented due to alcohol-related complaints. After adjustment for covariates, the odds of an ED visit being alcohol-related were similar in 2021 and 2019 (aOR 0.98, 95% CI 0.70-1.38).

CONCLUSION: There was a decrease in alcohol-related EMS calls on home game days in 2021, although the result was not statistically significant. In-stadium alcohol sales had no significant impact on the frequency or proportion of alcohol-related ED visits. The reason for this outcome is unclear, but it is possible that fans drank less at tailgate parties knowing they could consume more once the game started. Long lines and a two-beverage limit at stadium concessions may have kept patrons from consuming excessively. The results of this study may inform similar institutions regarding the safe implementation of alcohol sales during mass-gathering events.

PMID:36976589 | DOI:10.5811/westjem.2022.11.58766

West J Emerg Med. 2023 Mar 6;24(2):119-126. doi: 10.5811/westjem.2023.1.58366.

ABSTRACT

INTRODUCTION: Emergency medicine (EM) residency programs have variable approaches to educating residents on recognizing and managing healthcare disparities. We hypothesized that our curriculum with resident-presented lectures would increase residents’ sense of cultural humility and ability to identify vulnerable populations.

METHODS: At a single-site, four-year EM residency program with 16 residents per year, we designed a curriculum intervention from 2019-2021 where all second-year residents selected one healthcare disparity topic and gave a 15-minute presentation overviewing the disparity, describing local resources, and facilitating a group discussion. We conducted a prospective observational study to assess the impact of the curriculum by electronically surveying all current residents before and after the curriculum intervention. We measured attitudes on cultural humility and ability to identify healthcare disparities among a variety of patient characteristics (race, gender, weight, insurance, sexual orientation, language, ability, etc). Statistical comparisons of mean responses were calculated using the Mann-Whitney U test for ordinal data.

RESULTS: A total of 32 residents gave presentations that covered a broad range of vulnerable patient populations including those that identify as Black, migrant farm workers, transgender, and deaf. The overall survey response was 38/64 (59.4%) pre-intervention and 43/64 (67.2%) post-intervention. Improvements were seen in resident self-reported cultural humility as measured by their responsibility to learn (mean responses of 4.73 vs 4.17; P < 0.001) and responsibility to be aware of different cultures (mean responses of 4.89 vs 4.42; P < 0.001). Residents reported an increased awareness that patients are treated differently in the healthcare system based on their race (P < 0.001) and gender (P < 0.001). All other domains queried, although not statistically significant, demonstrated a similar trend.

CONCLUSION: This study demonstrates increased resident willingness to engage in cultural humility and the feasibility of resident near-peer teaching on a breadth of vulnerable patient populations seen in their clinical environment. Future studies may query the impact this curriculum has on resident clinical decision-making.

PMID:36976587 | DOI:10.5811/westjem.2023.1.58366

JAMA Netw Open. 2023 Mar 1;6(3):e235002. doi: 10.1001/jamanetworkopen.2023.5002.

ABSTRACT

IMPORTANCE: Stroke may be a first manifestation of an occult cancer or may be an indicator of an increased cancer risk in later life. However, data, especially for younger adults, are limited.

OBJECTIVES: To assess the association of stroke with new cancer diagnoses after a first stroke, stratified by stroke subtype, age, and sex, and to compare this association with that in the general population.

DESIGN, SETTING, AND PARTICIPANTS: This registry- and population-based study included 390 398 patients in the Netherlands aged 15 years or older without a history of cancer and with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) between January 1, 1998, and January 1, 2019. Patients and outcomes were identified through linkage of the Dutch Population Register, the Dutch National Hospital Discharge Register, and National Cause of Death Register. Reference data were gathered from the Dutch Cancer Registry. Statistical analysis was performed from January 6, 2021, to January 2, 2022.

EXPOSURE: First-ever ischemic stroke or ICH. Patients were identified by administrative codes from the International Classification of Diseases, Ninth Revision, and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

MAIN OUTCOMES AND MEASURES: The primary outcome was the cumulative incidence of first-ever cancer after index stroke, stratified by stroke subtype, age, and sex, compared with age-, sex- and calendar year-matched peers from the general population.

RESULTS: The study included 27 616 patients aged 15 to 49 years (median age, 44.5 years [IQR, 39.1-47.6 years]; 13 916 women [50.4%]; 22 622 [81.9%] with ischemic stroke) and 362 782 patients aged 50 years or older (median age, 75.8 years [IQR, 66.9-82.9 years]; 181 847 women [50.1%]; 307 739 [84.8%] with ischemic stroke). The cumulative incidence of new cancer at 10 years was 3.7% (95% CI, 3.4%-4.0%) among patients aged 15 to 49 years and 8.5% (95% CI, 8.4%-8.6%) among patients aged 50 years or older. The cumulative incidence of new cancer after any stroke among patients aged 15 to 49 years was higher among women than men (Gray test statistic, 22.2; P < .001), whereas among those aged 50 years or older, the cumulative incidence of new cancer after any stroke was higher among men (Gray test statistic, 943.1; P < .001). In the first year after stroke, compared with peers from the general population, patients aged 15 to 49 years were more likely to receive a diagnosis of a new cancer after ischemic stroke (standardized incidence ratio [SIR], 2.6 [95% CI, 2.2-3.1]) and ICH (SIR, 5.4 [95% CI, 3.8-7.3]). For patients aged 50 years or older, the SIR was 1.2 (95% CI, 1.2-1.2) after ischemic stroke and 1.2 (95% CI, 1.1-1.2) after ICH.

CONCLUSIONS AND RELEVANCE: This study suggests that, compared with the general population, patients aged 15 to 49 years who have had a stroke may have a 3- to 5-fold increased risk of cancer in the first year after stroke, whereas this risk is only slightly elevated for patients aged 50 years or older. Whether this finding has implications for screening remains to be investigated.

PMID:36976557 | DOI:10.1001/jamanetworkopen.2023.5002

JAMA Netw Open. 2023 Mar 1;6(3):e235187. doi: 10.1001/jamanetworkopen.2023.5187.

ABSTRACT

IMPORTANCE: While epinephrine has been widely used in prehospital resuscitation for pediatric patients with out-of-hospital cardiac arrest (OHCA), the benefit and optimal timing of epinephrine administration have not been fully investigated.

OBJECTIVES: To evaluate the association between epinephrine administration and patient outcomes and to ascertain whether the timing of epinephrine administration was associated with patient outcomes after pediatric OHCA.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included pediatric patients (<18 years) with OHCA treated by emergency medical services (EMS) from April 2011 to June 2015. Eligible patients were identified from the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective OHCA registry at 10 sites in the US and Canada. Data analysis was performed from May 2021 to January 2023.

EXPOSURES: The main exposures were prehospital intravenous or intraosseous epinephrine administration and the interval between arrival of an advanced life support (ALS)-capable EMS clinician (ALS arrival) and the first administration of epinephrine.

MAIN OUTCOMES AND MEASURES: The primary outcome was survival to hospital discharge. Patients who received epinephrine at any given minute after ALS arrival were matched with patients who were at risk of receiving epinephrine within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions.

RESULTS: Of 1032 eligible individuals (median [IQR] age, 1 [0-10] years), 625 (60.6%) were male. 765 patients (74.1%) received epinephrine and 267 (25.9%) did not. The median (IQR) time interval between ALS arrival and epinephrine administration was 9 (6.2-12.1) minutes. In the propensity score-matched cohort (1432 patients), survival to hospital discharge was higher in the epinephrine group compared with the at-risk group (epinephrine: 45 of 716 [6.3%] vs at-risk: 29 of 716 [4.1%]; risk ratio, 2.09; 95% CI, 1.29-3.40). The timing of epinephrine administration was also not associated with survival to hospital discharge after ALS arrival (P for the interaction between epinephrine administration and time to matching = .34).

CONCLUSIONS AND RELEVANCE: In this study of pediatric patients with OHCA in the US and Canada, epinephrine administration was associated with survival to hospital discharge, while timing of the administration was not associated with survival.

PMID:36976555 | DOI:10.1001/jamanetworkopen.2023.5187