Is It Time to Revisit Remdesivir Use for Severe COVID-19?

How to cite this article: Taggarsi DA. Is It Time to Revisit Remdesivir Use for Severe COVID-19? Indian J Crit Care Med 2022;26(9):983–984.     

Evidence-Based Medicine: What Is It and How Does It Apply to Athletic Training?

OBJECTIVE: To introduce the concept of evidence-based medicine (EBM) to athletic trainers. This overview provides information on how EBM can affect the clinical practice of athletic training and enhance the care given to patients. DATA SOURCES: We searched the MEDLINE and CINHAL bibliographic databases using the terms evidence-based medicine and best practice and the online Index to Abstracts of Cochrane Reviews by group (injury, musculoskeletal injuries, and musculoskeletal) to identify reviews on topics pertinent to athletic training. DATA SYNTHESIS: Evidence-based medical practice has 5 components: defining a clinically relevant question, searching for the best evidence, appraising the quality of the evidence, applying the evidence to clinical practice, and evaluating the process. Evidence-based medicine integrates the research evidence, clinician's expertise, and patient's preferences to guide clinical decision making. Critical to this effort is the availability of quality research on the effectiveness of sports medicine techniques. Athletic training outcomes research is lagging behind that of other health care professions. RECOMMENDATIONS: Athletic trainers need to embrace the critical-thinking skills to assess the medical literature and incorporate it into their clinical practice. The profession should encourage more clinically related research and enhance the scientific foundation of athletic training. Evidence-based medicine provides an important next step in the growth of the athletic training profession.     

Genetic and Environmental Vulnerabilities Underlying Adolescent Substance Use and Problem Use: General or Specific?

Are genetic and environmental risks for adolescent substance use specific to individual substances or general across substance classes? We examined this question in 645 monozygotic twin pairs, 702 dizygotic twin pairs, 429 biological sibling pairs, and 96 adoptive (biologically unrelated) sibling pairs ascertained from community-based samples, and ranging in age from 12 to 18 years. Substance use patterns and symptoms were assessed using structured psychiatric interviews. Biometrical model fitting was carried out using age- and sex-specific thresholds for (a) repeated use and (b) problem use, defined as one or more DSM-IV symptoms of abuse or dependence. We hypothesized that problem use would be more heritable than use in adolescence, and that both genetic and environmental risks underlying tobacco, alcohol, and marijuana use and problem use would be significantly correlated. Results of univariate analyses suggested significant heritable factors for use and problem use for all substances with the exception of alcohol use. Shared environmental factors were important in all cases and special twin environmental factors were significant for tobacco use, tobacco problem use, and alcohol use. Multivariate analyses yielded significant genetic correlations between each of the substances (for both levels studied), and significant shared environmental correlations among use variables only. Our results suggest that tobacco, alcohol, and marijuana problem use are mediated by common genetic influences, but shared environmental influences may be more substance-specific for problem use.     

Was It There All the Time?

The complement system is old, yet it may still have something new to teach us. For many years, research has existed which shows that C3d, in addition to its established role as an adjuvant, could have an immunosuppressive activity. Being true, it suggests that a common mechanism may be used both by organisms and by their pathogens to prevent unwanted immune responses.     

Antibiotic Use in Crohn’s Disease

On the assumption that bacteria in the gut may be a cause of symptoms and/or complications of Crohn's disease, various antibiotics are efficaciously employed in some affected patients. However, we do not know exactly why and how they are helpful. A possible explanation is that one or several bacterial species may have a primary role in the aetiology of Crohn's disease, but this is not supported by the data in our possession. Another hypothesis is that intestinal bacteria may cause flare-up of the disorder, either by inducing intestinal lesions or by an interaction with the immune system, but we know today that specific pathogens can cause flares only in a minority of cases. On the contrary, there is considerable evidence that the intestinal microflora and its products may amplify and perpetuate inflammation in Crohn's disease. Despite the fact that few controlled trials have been conducted, and have shown inconclusive results, antibiotics are widely employed for improving symptoms and for inducing remission of active phases. At present, a combination of metronidazole and ciprofloxacin, active against many enteric bacteria, has proved to be effective in the treatment of Crohn's disease complications. This therapy also seems to be effective in acute flares as an alternative to, or in combination with, corticosteroids.     

It oughtta be a crime? Criminalizing HIV

The case of Nushawn Williams, who had unprotected sex with at least 48 women after finding out his HIV status, has led to laws criminalizing HIV transmission. Critics state that the new laws are unnecessary, and that existing laws are adequate to deal with rare individuals like Williams. One possible law would create a new offense, called aggravated reckless endangerment, which would be a Class C felony. This law is described, and the likelihood of it reducing HIV transmission is discussed.     

Malnutrition in Obesity: Is It Possible?

BackgroundThe World Health Organization (WHO) classifies malnutrition as the biggest threat to public health worldwide, and this condition is observed in 20–60% of hospitalized patients. Malnutrition is a state of the body in which due to insufficient supply or incorrect absorption of essential nutrients, the body composition changes and the body''s functions are impaired. Malnutrition is associated not only with reduced body mass index but also with obesity.SummaryObesity is defined as a paradoxical state of malnutrition, which despite excessive energy consumption is associated with a shortage of individual microelements. Deficiency or lack of homeostasis of essential micronutrients can significantly affect daily performance, intellectual and emotional state, but also the physical state of the body. Food deficiency can also contribute to further weight gain or the development of other metabolic diseases. Micronutrient deficiency may include not only incorrect dietary choices and insufficient access to nutrient-rich foods but also changes in the absorption, distribution or excretion of nutrients, and altered micronutrient metabolism resulting from systemic inflammation caused by obesity. An effective therapy method recommended for people with morbid obesity is bariatric surgery aimed at both weight loss and improving quality of life. Unfortunately, the effects of these treatments are often medium- and long-term complications associated with micronutrient deficiency as a result of reduced consumption or absorption. Therefore, the use of bariatric surgery in patients with extreme obesity can affect the metabolism of microelements and increase the risk of nutritional deficiencies.Key MessagesStudies by many authors indicate a higher incidence of food deficiency among people with excessive body weight, than in people with normal body weight of the same age and same sex. Monitoring the concentration of minerals and vitamins in blood serum is a good practice in the treatment of obesity. The proper nutritional status of the body affects not only the state of health but also the effectiveness of therapy. The aim of the review was to present the issue of malnutrition in the context of obesity.     

To Use or Not to Use – Practitioners’ Perceptions of an Open Web Portal for Young Patients With Diabetes

Background

Health care professionals'' attitudes can be a significant factor in their acceptance and efficient use of information technology, so they need to have more knowledge about this resource to enhance their participation.

Objective

We explored practitioners’ perceptions of using an open-access interactive Web portal tailored to young diabetes type 1 patients and their guardians or significant others. The portal offered discussion forums, blog tools, self-care and treatment information, research updates, and news from local practitioners.

Methods

Eighteen professionals who were on pediatric diabetes care teams each wrote an essay on their experience using the portal. For their essays, they were asked to describe two situations, focusing on positive and negative user experiences. The essays were analyzed using qualitative content analysis.

Results

Based on our analysis of the respondents essays, we identified three categories that describe perceptions of the Web portal. The first category - to use or not to use - included the different perspectives of the practioners; those who questioned the benefits of using the Web portal or showed some resistance to using it. The frequency of use among the practitioners varied greatly. Some practitioners never used it, while others used it on a daily basis and regularly promoted it to their patients. Some respondents in this category reflected on the benefits of contributing actively to online dialogues. In the second category - information center for everyone – practitioners embraced the site as a resource for scientifically sound information and advice. As part of their practice, and as a complement to traditional care, practitioners in this category described sending information through the portal to patients and their significant others. Practitioners felt safe recommending the site because they knew that the information provided was generated by other practitioners. They also assumed that their patients benefited from actively using the Web portal at home: peers brought the site to life by exchanging experiences through the discussion forums. In the third category – developing our practice – practitioners reflected upon the types of information that should be given to patients and how to give it (ie, during in-person appointments or through the Web portal). They perceived meeting with various professionals at other hospitals to update information on the portal and develop content policies as constructive teamwork. Practitioners expressed interest in reading patients’ dialogues online to learn more about their views. They also thought about how they could use the portal to adapt more to patients’ needs (eg, creating functions so patients could chat with the diabetes nurses and doctors).

Conclusions

Practitioners expressed positive perceptions toward a tailored open Web portal. They suggested that future benefits could be derived from systems that integrate factual information and online dialogues between practitioners and patients (ie, exchanging information for everyone’s benefit).     

共聚聚酯应用互动技术平台Tritan Mold It

<正>近年来,美国伊士曼化工公司推出新一代共聚聚酯——Tritan TM。由于它具有优良的机械物理性能,如高抗冲击强度;优良的耐化学性,不含BPA,如良好的生物相容性;高透明度与良好的加工成型性,自推出市场以来,已经在家居用品、小家电中的耐用品以及医疗器械(留置针、透析器)等领域得到广泛应用。然而,Tritan TM材料在加工工艺与模具设计、加工方面有一定的特殊要求,为了帮助用户顺利地采用     

Toll-like Receptor 9, What O'Clock Is It?

In this issue of Immunity, Silver et al. (2012) provide evidence that murine Toll-like receptor 9 (TLR9) expression and function in innate and adaptive immunity is controlled by the circadian cycle.     

Development and Evaluation of an Interactive CD-ROM Refusal Skills Program to Prevent Youth Substance Use: “Refuse to Use”

An interactive CD-ROM program designed to reduce adolescent substance use was developed and evaluated. The program uses video vignettes to teach refusal skills and socially acceptable responses to substance use situations, specifically offers of marijuana. In a randomized pretest-to-posttest experiment with 74 public school students from six classes in three high schools, significant changes were observed at posttest on (1) the adolescent's personal efficacy to refuse the offer of marijuana, (2) the adolescent's intention to refuse marijuana if offered, and (3) the adolescent's perceptions of the social norms associated with substance use and the importance of respecting another's decision to refuse a drug offer. In addition, adolescents in the treatment condition were able to recall approximately 50% of the portrayed refusal strategies. Findings are discussed with regard to the potential benefits of an interactive multimedia approach for conducting substance use interventions.     

It’s a Cell-Eat-Cell World: Autophagy and Phagocytosis

The process of cellular eating, or the phagocytic swallowing of one cell by another, is an ancient manifestation of the struggle for life itself. Following the endosymbiotic origin of eukaryotic cells, increased cellular and then multicellular complexity was accompanied by the emergence of autophagic mechanisms for self-digestion. Heterophagy and autophagy function not only to protect the nutritive status of cells, but also as defensive responses against microbial pathogens externally or the ill effects of damaged proteins and organelles within. Because of the key roles played by phagocytosis and autophagy in a wide range of acute and chronic human diseases, pathologists have played similarly key roles in elucidating basic regulatory phases for both processes. Studies in diverse organ systems (including the brain, liver, kidney, lung, and muscle) have defined key roles for these lysosomal pathways in infection control, cell death, inflammation, cancer, neurodegeneration, and mitochondrial homeostasis. The literature reviewed here exemplifies the role of pathology in defining leading-edge questions for continued molecular and pathophysiological investigations into all forms of cellular digestion.

“Life is cell activity; its uniqueness is the uniqueness of the cell.” –Rudolf Virchow¹

     

Is paranoid status prognostic of good outcomes? It depends

Better outcomes for psychiatric inpatients classified as paranoid rather than nonparanoid could be due to group differences in disability levels created by traditional classification approaches. Paranoid functioning, per se, may not predict good institutional outcomes. The authors retrieved community outcome data for 469 inpatients from 19 wards, a subsample of participants that had been previously examined during their inpatient stay. Paranoid groups showed better community outcomes as an artifact of differences in disability levels when classifications were based on the traditional approach that requires a predominance of paranoid over nonparanoid behavior. No differential outcomes appeared when classifications were based on dimensionally measured paranoid functioning alone. In fact, dispositions of patients suggest that staff view paranoid behavior as a negative rather than positive prognostic indicator.     

Beef from the United States: Is It Safe?

1). Various embargos between countries were established prohibiting the import of meat products, and there continues to be much embroiled debate regarding the matter. Some countries continue to ban import of international beef, going so far as question political leadership based on the status of trading relations, despite the lack of data to support a need for such hyper vigilance (2).BSE is a progressive neurodegenerative disease in cattle that ultimately leads to degeneration of the central nervous system. It is believed to spread via a conformational change of susceptible proteins, known as "prions," which is an abbreviation for "proteinaceous infectious particle" (3). The infectious agent is believed to be abnormally misfolded protease-resistant proteins, which trigger a conformational change of other normal cellular prions that normally exist in the plasma membrane of mammalian neurons (3). A study published in January 2007 questions whether the infective agent in transmissible spongiform encephalopathies (TSE) is a virion particle, rather than a protein (4). There remains much to be determined regarding the potential susceptibility due to possible mutations of these prion sequences, what physiologic purpose they normally serve, and what role the proteins play in the pathogenesis of TSE.The analogous disease in humans, known as variant Creutzfeldt-Jakob disease (vCJD), is believed to be caused by exposure to the abnormal prions found in cattle infected with BSE. Transmission to humans is thought to occur via ingestion of cattle products contaminated with BSE (5). Similarly to BSE, vCJD has an incubation time lasting years, and those affected undergo a similar spongiform transformation of their central nervous system ultimately leading to death (3).The United Kingdom epidemic was largely due to the practice of making livestock feed out of mammalian byproducts, a practice which was then banned by the European Union in 1994 (1). Due to the availability and relatively low cost of soy products, using mammalian byproducts for ruminant feed was not as common a practice in the United States. In 1997, the United States Food and Drug Administration instituted a ruminant to ruminant feed ban (6). The profound number of infected cattle found in the United Kingdom (180,000+) and nearby countries (Republic of Ireland, 1,600+, France 1,000+, Portugal 1,000+, Spain 700+, Switzerland 400+, Germany 300+) far outnumber the 4 confirmed cases found in the United States, of which one was found to be an animal that had been imported from Canada (7,8).In 2014, the United States was the fifth highest consumer of beef and veal per capita, fifth to Hong Kong, Argentina, Uruguay, and Brazil. In that year, the per capita consumption of beef in the United States was found to be 53.84 kg (9). As reported by the National Cruetzfeldt-Jakob Disease Surveillance Unit from the University Edinburgh, there have been a total of three reported cases of vCJD in the United States. However, there are strong evidence supporting two of three were exposed to the BSE agent while they were in United Kingdom (10). Third case was an immigrant who had been raised in Saudi Arabia, and had then moved to the United States in late 2005. According to the case report, the patient had most likely been infected while living in Saudi Arabia (10). In 2014, the United States was second-largest exporter after Australia in terms of beef export value. Beef export value of the United States in 2014 was $7.13 billion, which is the increase of nearly $1 billion compared to the previous year. Export volume also increased by 2% from the previous year (11). While some countries such as Japan and South Korea continue to restrict the beef that is imported from the United States after the first case of BSE was reported in the United States in 2003, other countries reopened their borders in a matter of months (2). Beef exports to Mexico rebounded within a year, and export to Canada increased as well (2).In April of 2006, the United States Department of Agriculture released an analysis of 7 years of BSE surveillance data, which concluded that the prevalence of BSE is less than 1 case per 10 million adult cattle (12). The analysis further stated that the most likely number of cases is 4 to 7 infected animals out of 42 million cattle, or 0.000017% (13). The USDA continues to test for BSE via a surveillance program which complies with the science-based international guidelines set forth by the World Animal Health Organization, testing at a level far exceed higher than the recommended level (14).If one were to exclude vegetarians who are thought to compose 3.4% of the population which is currently believed to be 320 million, one can roughly conclude that the number of meat consumers in the United States is just shy of 309 million (15,16). Our voracious appetites are reflected by our staggering ability to consume beef as measured per capita, yet reported cases of vCJD in the United States are in essence very rare. With the stringent surveillance of cattle reared in the United States and the miniscule rate of possible BSE infection as noted above, one can therefore conclude that the United States is in effect a safe exporting source of international beef.