Primary Care Continuity and Wait Times to Receiving Breast Cancer Chemotherapy: A Population-Based Retrospective Cohort Study Using CanIMPACT Data

(1) Background: Wait times to chemotherapy are associated with morbidity and mortality in breast cancer patients; however, it is unclear how primary care physician (PCP) continuity impacts these wait times, or whether this association is different in immigrants, who experience cancer care inequities. We assessed the association between PCP continuity and the contact-to-chemotherapy interval (wait time from when a patient first presents to healthcare to the first day of receiving breast cancer chemotherapy), with a specific look at the immigrant population. (2) Methods: Population-based, retrospective cohort study of women who were diagnosed with stage I–III breast cancer in Ontario who received surgery and adjuvant chemotherapy. We used quantile regression at the median and 90th percentile to quantify the effect of PCP continuity on the contact-to-chemotherapy interval, performing a separate analysis on the immigrant population. (3) Results: Among 12,781 breast cancer patients, including 1706 immigrants, the median contact-to-chemotherapy interval (126 days) was 3.21 days shorter (95% confidence interval (CI) 0.47–5.96) in symptom-detected patients with low PCP continuity, 10.68 days shorter (95% CI 5.36–16.00) in symptom-detected patients with no baseline PCP visits and 17.43 days longer (95% CI 0.90–34.76) in screen-detected immigrants with low PCP continuity compared to the same groups with high PCP continuity. (4) Conclusions: Higher PCP continuity was not associated with a change in the contact-to-chemotherapy interval for most of our study population, but was associated with a marginally longer interval in our symptom-detected population and a shorter contact-to-chemotherapy interval in screen-detected immigrants. This highlights the importance of PCP continuity among immigrants with positive screening results. Additionally, having no PCP visits at baseline was associated with a shorter contact-to-chemotherapy interval in symptom-detected patients.     

The Evolving Role of Historically Black Pharmacy Schools in a Changing Environment

Objective. To provide a comprehensive review of the contributions of historically Black colleges and universities (HBCUs) to creating a diverse pharmacist workforce and identify opportunities for future contributions. This was accomplished by comparing enrollment at HBCUs to overall US enrollment of African American pharmacy students and then comparing those numbers to national enrollment of pharmacy students, analyzing contributions of HBCUs to underrepresented pharmacy student enrollment, evaluating overall changes to pharmacy school enrollment and impact on enrollment at HBCUs, and identifying areas of opportunity to enhance the future contributions of HBCUs.Findings. There are six HBCU pharmacy schools in the United States. Although HBCU pharmacy schools made up only 4% of the total number of US pharmacy schools, they accounted for an average of 22.8% of the total African American student enrollment in pharmacy schools over a five-year period (2015-2019). An average of 13.8% of the total population of underrepresented people of color (UPOC) enrolled in US pharmacy schools from 2015-2019 attended an HBCU pharmacy school.Summary. Historically Black colleges and universities have consistently made significant contributions to the total pharmacy school population of African Americans, as well as that of Native Hawaiian and other Pacific Islanders and American Indian and Alaska Natives. These institutions have an opportunity to enhance their impact and serve in graduating the diverse pharmacy workforce needed in the future. Historically Black colleges and universities can achieve this goal by making significant efforts to recruit LatinX pharmacy students and by increasing their recruitment of African Americans, Native Hawaiian and other Pacific Islanders, and American Indian and Alaska Natives.     

Prognostic factors for predicting severity and mortality in hospitalized COVID‐19 patients

BackgroundCoronavirus disease 2019, COVID‐19, has reached all the corners of the world and was declared by the WHO as a global pandemic and public health emergency of international concern on the January 31, 2020. Allocating quick and specific biomarkers to predict the disease severity upon admission to hospital became a crucial need. This study, therefore, aimed at exploring the relationship between laboratory results in COVID‐19 patients admitted to hospital and the final outcome in these patients.MethodsRetrospective analysis was performed on the medical records of 310 COVID‐19‐positive patients admitted to Uhod Hospital, the referral hospital in the area of Madinah, Kingdom of Saudi Arabia, between the April 13 and the July 29, 2020. The association of laboratory results with the survival/mortality outcomes was studied.ResultsIt was demonstrated that lymphopenia, prolonged aPTT, high INR, high D. dimer and high CK are valuable prognostic predictors of the severity of the disease at early stages that can determine the outcome. Based on the results of the multiple logistic regression, the variables that are associated with death outcome are aPTT, HR, RR, ALT and CK levelConclusionIt is proposed to perform these tests on admission to hospital for moderate to severe COVID‐19 patients to improve the management of those cases and reduce mortality.     

Custom double tray for a special impression technique for flabby maxillary residual ridge: Case report

The construction of a removable dental prosthesis for patients with compromised residual alveolar ridges is a challenge for prosthodontists. Flabby anterior ridges and hypermobile tissues in completely edentulous arches require special considerations during prosthetic management, especially when natural dentations remain on the opposite side. Previous studies have revealed that the displacement of flabby tissue can be reduced during impressions by controlling the applied forces via changes in factors such as the tray design, scraping of impression trays, impression material, window technique, and seating velocity of the impressions. However, there may still be some forces applied during impression or there is no even space because there are no trays supporting the vinyl polysiloxane (VPS) impression material in the open window area. Using a custom double tray with even gap between these trays and injecting light body impression material may eliminate these forces and provide accuracy due to even space for the impression material. This article is a clinical report of a patient who presented with an anterior flabby maxillary edentulous ridge opposing the remaining anterior natural teeth. A custom double tray was fabricated using the principle of the window technique. The gap between the double trays allows mucostatic impressions of flabby ridge tissue to be made with accuracy. The maxillary single denture, which was made with a custom double tray, satisfied the patient.     

Inflammation Drives Alzheimer's Disease: Emphasis on 5-lipoxygenase Pathways

It is a known fact that inflammation affects several physiological processes, including the functioning of the central nervous system. Additionally, impairment of lipid mechanisms/pathways have been associated with a number of neurodegenerative disorders and Alzheimer’s Disease (AD) is one of them. However, much attention has been given to the link between tau and beta-amyloid hypothesis in AD pathogenesis/prognosis. Increasing evidences suggest that biologically active lipid molecules could influence the pathophysiology of AD via a different mechanism of inflammation. This review intends to highlight the role of inflammatory responses in the context of AD with the emphasis on biochemical pathways of lipid metabolism enzyme, 5-lipoxygenase (5-LO).     

Triple emergencies: Hyperosmolar hyperglycemic state,venous thromboembolism,and huge free‐floating right heart thrombus successfully managed with anticoagulation

A 57‐year‐old man, with type 2 diabetes mellitus, was admitted with a hyperosmolar hyperglycemic state, who developed in‐hospital venous thromboembolism with huge free‐floating right heart thrombus, and there is no available optimal treatment option for the huge free‐floating right heart thrombus, except anticoagulation with warfarin and low molecular weight heparin with successful outcome.     

Investigation of Staphylococcus aureus isolates identified as erythromycin intermediate by the Vitek-1 System: comparison with results obtained with the Vitek-2 and Phoenix systems

We identified 69 Staphylococcus aureus isolates that were erythromycin intermediate as reported by the Vitek-1 system using the GPS-105 card. Of the 57 strains that were available for further testing, all were erythromycin resistant by broth microdilution and the Phoenix system, while the Vitek-2 system identified 55 of 57 strains (96%) as erythromycin resistant. The majority of isolates (54 of 57 [95%]) exhibited the inducible MLS (macrolide-lincosamide-streptogramin family) phenotype, as shown by the double-disk test. We recommend that all S. aureus strains determined as erythromycin intermediate by the Vitek-1 system be interpreted as resistant to erythromycin.     

Uric acid induces inflammatory injury in HK-2 cells via PI3K/AKT/NF-κB signaling pathway

Objective To investigate the effects and underlying mechanisms of phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/NF-κB signaling pathway in human kidney-2 (HK-2) cells of hyperuricemic nephropathy. Methods HK-2 cells were cultured in vitro and randomly divided into control group and experimental group. The experimental group was induced by high uric acid (720 μmol/L) immersion for 48 h to establish a cell model of hyperuricemic nephropathy in vitro and subsequently divided into hyperuricemic group, overexpressed protease activated receptor 2 (PAR2) and knockdown PAR2 group. The expressions of PAR2, PI3K, AKT, NF-κB mRNA were measured by real-time PCR. The expressions of PAR2, PI3K, AKT and NF-κB protein were measured by Western blotting. The expressions of tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1), interleukin-6 (IL-6), pro-interleukin-1β (pro-IL-1β), interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) were detected by enzyme linked immunosorbent assay (ELISA). Results (1) Compared with the control group, the expressions of PAR2, PI3K, AKT and NF-κB mRNA and protein in hyperuricemic group were significantly increased (all P＜0.05), the expressions of TNF-α, MCP-1, IL-6, pro-IL-1β, IL-1β and TGF-β1 in the supernatant in hyperuricemic group were significantly increased (all P＜0.01). (2) Compared with the hyperuricemic group, the expressions of PAR2, PI3K, AKT and NF-κB mRNA and protein in overexpressed PAR2 group were significantly increased (all P＜0.05), the expressions of TNF-α, MCP-1, IL-6, IL-1β and TGF-β1 in the supernatant were significantly increased (all P＜0.05). (3) Compared with the hyperuricemic group, the expression of PAR2, PI3K, AKT and NF-κB mRNA and protein in knockdown PAR2 group were significantly decreased (all P＜0.05), the expressions of IL-6, pro-IL-1β, IL-1β and TGF-β1 in the supernatant were significantly decreased (all P＜0.05). Conclusions In the process of uric acid-induced HK-2 cell damage, uric acid significantly up-regulates the expression of PI3K/AKT/NF-κB signaling pathway by activating PAR2, leading to a marked increase in inflammatory damage. Knocking down PAR2 inhibits the expression of PI3K/AKT/NF-κB signaling pathway, which can effectively reduce the inflammatory damage of HK-2 cells.