Medical avoidance among marginalized groups: the impact of the COVID-19 pandemic

Journal of Behavioral Medicine - Medical avoidance is common among U.S. adults, and may be emphasized among members of marginalized communities due to discrimination concerns. In the current study,...     

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019 (COVID-19) for surgeons is not quantified which may be affected by their risk of exposure and individual factors. The objective of this review is to quantify the risk of COVID-19 among surgeons, and explore whether facemask can minimise the risk of COVID-19 among surgeons. A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers (HCWs) especially those work in surgical specialities including surgical nurses and intensivists. Additionally, systematic reviews that assessed the effectiveness of facemask against viral respiratory infections, including COVID-19, among HCWs were identified. Data from identified articles were abstracted, synthesised and summarised. Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask (and other personal protective equipment) were summarised. Although the risk of COVID-19 could not be quantified precisely among surgeons, about 14% of HCWs including surgeons had COVID-19, there could be variations depending on settings. Facemask was found to be somewhat protective against COVID-19, but the HCWs’ compliance was highly variable ranging from zero to 100%. Echoing surgical societies’ guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.     

Implantable Cardioverter‐Defibrillator Shock: Appropriate or Inappropriate?

A 76‐year‐old female with a single chamber implantable cardioverter‐defibrillator implanted for secondary prevention was referred due to multiple discharges. The device was programmed for ventricular tachycardia (VT) detection at 400 ms, fast VT detection at 280 ms, and ventricular fibrillation detection at 320 ms. Antitachycardia pacing (ATP) during charge was enabled. Interrogation revealed a VT episode with a mean cycle length of 270 ms, which was successfully terminated with ATP during charge. Seconds later, the device delivered a shock. This case illustrates the importance of understanding programming algorithms as part of troubleshooting when facing a scenario of device discharge. Ann Noninvasive Electrocardiol 2010;15(2):181–183     

PLA nanoparticles coated with a β-cyclodextrin polymer shell: Preparation, characterization and release kinetics of a hydrophobic compound

The aim of this work was to incorporate a hydrophobic compound benzophenone (BP) into core-shell nanoparticles (NPs) and to study its release. The core of these NPs is based on polylactic acid (PLA) and serves as a nanocontainer to accommodate BP. The shell is constituted of a β-cyclodextrin polymer (Poly-β-CD) which ensures the control of BP release through non-covalent host-guest interactions. Studies were focused on the preparation, physico-chemical analysis of the BP-loaded NPs and on the elucidation of the release mechanisms. The main features which are the slow kinetics, the dilution-induced release and the total release of encapsulated BP are in good agreement with a mechanism mainly controlled by diffusion of BP and by its binding with the β-CDs cavities present at the surface of NPs.     

The role of positron emission tomography in the management of non–small cell lung cancer

The potential use of positron emission tomography (PET) imaging in patients with non–small cell lung cancer (NSCLC) is broadly divided into 5 categories: management of solitary pulmonary nodule, mediastinal lymph node evaluation, detection of metastases, evaluation of response to chemoradiation and detection of recurrence. The purpose of this review is to discuss the current clinical applications of ¹⁸F-fluorodeoxyglucose PET in patients with NSCLC and to discuss future applications and developments of this technology.     

Are Infertile Men Less Healthy than Fertile Men? Results of a Prospective Case-Control Survey

Background

An association between either subfertility or infertility and an elevated risk of certain male cancers has been previously reported. Nothing is known about abnormalities in infertility and general health conditions.

Objective

To assess whether men with male factor infertility (MFI) are overall less healthy than fertile men, regardless of the reasons for infertility.

Design, setting, and participants

From September 2006 to September 2007, 344 consecutive European Caucasian men with MFI were enrolled in this prospective case-controlled study. Patients were compared with a control group of 293 consecutive age-comparable fertile men. Infertile men were consecutively attending the outpatient male reproductive clinic at a tertiary academic center. Fertile controls were consecutively recruited by use of advertisements posted within our hospital.

Measurements

Comorbidities of patients and fertile men were objectively scored with the Charlson Comorbidity Index (CCI) according to the International Classification of Diseases modified ninth version (ICD-9-CM) codes. Multivariate linear regression models tested the association between predictors and CCI score, as a proxy of general health status.

Results

According to the CCI scores, infertile men had a significantly higher rate of comorbidities compared with the fertile controls (CCI: 0.33 [0.8] vs 0.14 [0.5]; p < 0.001; 95% CI: 0.08–0.29). Linear regression analyses showed that although educational status did not have an impact on CCI (β: 0.035; p = 0.365), while CCI linearly increased with age (β: 0.196; p < 0.001) and body mass index (BMI; β: 0.161; p < 0.001). After adjusting for age, BMI, and educational status, a significantly lower CCI was calculated for fertile men and compared with MFI patients (β: −0.199; p < 0.001).

Conclusions

These results show that MFI accounts for a higher CCI, which may be considered a reliable proxy of a lower general health status.     

Long-term graft outcome in patients with chronic allograft nephropathy after immunosuppression modifications

Background/aim  This retrospective study was conducted to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy (CAN). Methods  One-hundred and seventy-four cyclosporin (CsA)-treated renal transplant recipients were studied. Patients were included if they had a biopsy-proven CAN (mild to moderate) with serum creatinine ≤3.5 mg/dL. Patient treatment was switched to either: (A) MMF/reduced dose CsA (MMF for azathioprine (Aza); n = 132); or (B) Aza/Tac for CsA (n = 42). Patient records were checked for graft function and survival, and for co-morbidities after conversion. Results  Mean follow-up before conversion was 52.2 ± 31.1 and 47.9 ± 27.4 months for groups A and B, respectively. There was significant deterioration of graft function in group B after five years (P < 0.5). Ten-year actuarial graft survival was 38% in group A and 19% in group B (P = 0.04). Nine patients (five patients and four patients in groups A and B, respectively) started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P = 0.05), but a significantly higher incidence of diabetes mellitus (P = 0.04).There was no significant change or difference in blood pressure between groups. Conclusions  Our results suggest that in patients with CAN and deteriorating allograft function, CsA minimization and addition of MMF achieved favorable efficacies in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.     

Does posttransplant anemia at 6 months affect long-term outcome of live-donor kidney transplantation? A single-center experience

Background/Aims  Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia at 6 months of transplantation in patients under different protocols of immunosuppression, and to determine the impact of anemia on long-term patient and graft survival. Methods  We included 832 renal transplant recipients who were categorized at 6 months according to hemoglobin (Hb) level into two groups: the first group, with Hb >13 g/dl in males and >12 g/dl in females (group I, 385 cases); and the second group, with Hb <13 g/dl in males and <12 g/dl in females (group II, 447 cases). We compared the two groups regarding posttransplant complications as well as patient and graft survival. Results  Although there was no significant difference between the two groups regarding acute rejection episodes, chronic allograft nephropathy was significantly higher in the anemic group. Other posttransplant medical complications were comparable in both groups. Graft survival was significantly higher in the nonanemic group. However, no difference in patient survival was detected. Conclusion  From this study, we can conclude that prevalence of PTA is high, especially in females and those receiving calcineurine inhibitors (CNI) and mycophenolate mofetil (MMF), and that it was associated with poorer graft outcome but with no effect on patient survival.     

Obesity does not increase the risk of lymph node metastases in patients with clinically localized prostate cancer undergoing radical prostatectomy and extended pelvic lymph node dissection

Objectives: Several studies have shown that obesity is associated with more aggressive prostate cancer (PCa) variants. We hypothesized that obesity, quantified as body mass index (BMI), is associated with a higher risk of lymph node invasion (LNI) in patients undergoing extended pelvic lymph node dissection (ePLND). Methods: Clinical and pathological data were available for 994 consecutive men with PCa treated with radical prostatectomy (RP) and ePLND at a single European tertiary academic centre. Univariable and multivariable logistic regression analyses addressed the rate of LNI. Covariates consisted of pre‐treatment prostate specific antigen (PSA), biopsy Gleason sum, clinical stage history of diabetes mellitus as well as BMI coded as either continuous or categorized (<25, 25.0–29.9, 30 kg/m² or more) variable. Predictive accuracy was assessed with area under curve estimates. Results: Overall LNI was diagnosed in 105 patients (10.6%). Mean number of removed lymph nodes was 18.3 (range 7–60). Of all 994 patients, 372 (37.4%) were normal weight, 518 (52.1%) overweight, and 104 (10.5%) were clinically obese. Prevalence of LNI did not significantly differ across different BMI categories (<25, 25.0–29.9 and 30 kg/m² or more; 9.9, 10.6 and 12.5%, respectively; P = 0.75). In logistic regression models, neither continuously coded nor categorized BMI was a significant predictor of LNI at univariable or multivariable analyses (all P‐values ≥0.1). Moreover, inclusion of BMI with PSA, clinical stage, biopsy Gleason sum and presence of DM did not increase the ability of these variables to predict LNI (82.2% without BMI vs 82.5% and 82.9% with BMI coded as continuous and categorized variable, respectively; all P ≥ 0.4). Conclusions: In men undergoing RP and ePLND, increased BMI was not associated with increased risk of lymph node metastases. Therefore, routinely considering patient BMI in risk stratification schemes or prognostic LNI models may not be warranted.