A Cross-Sectional,Correlational Study Comparing Individual Characteristics of Younger and Older Nursing Home Residents using Western Canadian Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0

ObjectiveTo compare characteristics of nursing home (NH) residents by age categories in Western Canada.DesignA cross-sectional, correlational analysis of secondary data.Setting and Participants89,231 residents living in Western Canada NHs in the provinces of Alberta, Manitoba, and British Columbia in 2016 and 2017.MethodsResident characteristics (age, sex, marital status, body mass index, medical diagnoses, cognitive function, physical function, depressive symptoms) came from the Resident Assessment Instrument–Minimum Data Set 2.0 and were analyzed using chi-square, analysis of variance, and post hoc pairwise tests. Human developmental stage age categories were used to create 5 age groups: 18-34, 35-50, 51-64, 65-80, and 81 years and older.ResultsThe demographics, medical diagnoses, cognitive function, and physical function characteristics of NH residents among 5 age groups differed considerably (all P < .001). Residents aged 18-34 years were predominately male, never married, with a higher incidence of paralysis and traumatic brain injury. Residents aged 35-50 years had a higher incidence of stroke and multiple sclerosis, and residents aged 51-64 years mainly were morbidly obese and more prone to depression. Residents aged 65-80 years were predominately married and more prone to diabetes, and residents aged 81 years and older were predominately widowed, with a higher incidence of dementia compared with others.Conclusions and ImplicationsFindings describe the uniqueness of younger NH age groups and indicate that the youngest NH residents often have the severe disability and a modest support system (as defined by partnered status) compared to older residents in NHs. Future studies must analyze longitudinal data that track the growth of, and changes in, residents’ health and functional status.     

Prevalence of Coxiella-infections in ticks - review and meta-analysis

Q fever is a global zoonotic infection caused by the intracellular Gram-negative bacterium Coxiella burnetii. Historically, it is considered a vector-borne disease, but the role of ticks in transmission has not fully been elucidated yet. Excretion of C. burnetii in tick feces and saliva is well documented but the role of these findings or the epidemiological context is discussed controversially. Thus, the aim of this study was to determine the prevalence of C. burnetii DNA in ticks to clarify the potential role of tick species for maintenance of C. burnetii infection. A literature review was performed using Google scholar, Agora, Science Direct, PubMed and Scopus to identify original studies on C. burnetii DNA presence in ticks. The search was limited to literature published from 2009 to 2020 in English and French and focused on data obtained by molecular detection of C. burnetii DNA in ticks. Overall, the prevalence of C. burnetii in ticks collected in Africa varied from 2.91% to 13.97%, in Europe from 2.46% to 10.52% and the Middle East from 4.76% to 12.53%. Ticks collected from animals showed a prevalence of 8% (95% CI: 6%–10%), followed by ticks collected from the environment and animals of 7% (95% CI: 5%–10%). C. burnetii DNA has been found in samples of many tick species with the highest prevalence in Rhipicephalus evertsi and Amblyomma variegatum. However, most of these studies did not include a differentiation between C. burnetii and Coxiella-like endosymbionts making it finally difficult to estimate the potential role that ticks play in the epidemiology of Q fever. Therefore, it is necessary to analyze the vector competence of different tick species to transmit C. burnetii. Knowledge of the vector and reservoir competence of ticks is important for taking adequate preventive measures to limit infection risks.     

Accuracy of diagnostic clinical tests and questionnaires in screening for carpal tunnel syndrome among workers- A systematic review

ObjectiveTo synthesize and appraise the evidence on the diagnostic accuracy of the clinical examination tests and questionnaires for screening carpal tunnel syndrome (CTS) among workers.DesignSystematic review of diagnostic test accuracyMethodsElectronic search of 3 online databases (CINAHL, Embase, Medline) was done on August 31, 2020. Studies reporting the diagnostic accuracy of clinical examination tests in workers, compared to a reference standard test, were included. Diagnostic accuracy measures such as sensitivity (Sn) and specificity (Sp) were extracted and reported for different clinical examination tests. The risk of bias and applicability concerns were rated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool by 2 independent reviewers. Diagnostic tests accuracy extension of the PRISMA guidelines were followed.ResultsTwelve studies reporting on the diagnostic accuracy of the clinical examination tests for workers suspected of CTS were included. Fourteen different clinical examination tests were evaluated in the studies, including sensorimotor, provocative maneuvers, questionnaires, and hand symptom diagrams (HSD). Ten of the included studies had an either unclear or high risk of bias. The most accurate tests to diagnose CTS in workers were the Katz HSD (with Sn ranging from 38%-93%, and Sp ranging from 25%-89%) and Kamath and Stothard questionnaire (Sn and Sp = 100%). Combination of Katz HSD with either the Phalen’s maneuver or the Tinel’s sign resulted in excellent Sp (83% and 89%, respectively).ConclusionsLow to moderate quality evidence indicates variability in individual clinical examination tests used to screen for CTS in workers. Diagnostic self-report tools consisting of hand diagrams and/or diagnostic questions provide low burden and high accuracy. Still, they require more rigorous investigation about their value alone or in combination with clinical assessment tests.     

Comparing 3 Suture Techniques After Muscle Laceration Repair

Background: Skeletal muscle lacerations are a relatively common injury. Compared with nonrepaired lacerations, surgically repaired muscle lacerations regenerate faster, develop less scar tissue, have a higher return to baseline strength, and have lower incidence of hematomas. Despite the benefits of repair, the optimal repair technique is still unknown. The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the optimal repair. Methods: Forty-two fusiform porcine muscle specimens were dissected and used for this study. Three suture techniques were used for comparative analysis: Figure-eight, Mason Allen, and Perimeter. Each muscle was transected and then repaired using one of the 3 techniques. Fourteen muscle-tendon specimens were prepared for each group and tested for tensile failure using a material testing system. Biomechanical properties, including peak failure point and stiffness, were compared for differences between the suture groups by 1-way analysis of variance. The average time per repair technique was also recorded. Results: The Perimeter technique showed a statistically significant higher peak failure point than the Mason Allen technique (P = .03). Both the Figure-eight (P = .047) and Perimeter techniques (P < .001) were significantly stiffer than the Mason Allen technique. The repair time was comparable across all 3 techniques. Conclusions: The Figure-eight and Perimeter repairs were found to be similar in peak failure point and stiffness, whereas the Mason Allen technique showed significantly lower stiffness and peak failure point. The Figure-eight was the quickest repair to perform. The Figure-eight technique may be strongly considered for muscle laceration repairs due to its simplicity and efficiency.     

From the archives of MD Anderson Cancer Center Castleman disease involving the thymus gland: Case report and literature review

Castleman disease is a nodal based disease and very rarely involves the thymus gland. We report a 52-year-old man who was found incidentally to have a single thymic mass by computerized tomography scan. Thymectomy was performed, and the gross specimen showed a well-circumscribed, multi-loculated cystic mass. Histologic examination showed thymus involved by Castleman disease, hyaline-vascular variant. The lesion was characterized by lymphoid follicles with wide mantle zones, variably lymphocyte-depleted germinal centers with sclerotic radial blood vessels, and prominent interfollicular/stromal changes including numerous endothelial venules with sclerotic walls and hyaline sclerosis, scattered and frequent dysplastic follicular dendritic cells and foci of dystrophic calcification. Immunohistochemical analysis showed that the follicle mantle zones were composed of numerous B-cells positive for CD20, PAX5, and IgD. Antibodies specific for CD21 and CD23 highlighted prominent follicular dendritic cell networks within follicles. There was no evidence of human herpes virus 8. We searched the literature and could identify only 10 additional cases of thymic CD. Previously reported cases included 8 unicentric and 2 multicentric, classified pathologically as plasma cell variant (n = 4), hyaline vascular variant (n = 3), and mixed (n = 3). Thymectomy, as was done in the currently reported case, most often leads to the diagnosis of Castleman disease and was a mainstay of treatment in other reported cases.     

Genotype-phenotype correlations in RHOBTB2-associated neurodevelopmental disorders

PurposeMissense variants clustering in the BTB domain region of RHOBTB2 cause a developmental and epileptic encephalopathy with early-onset seizures and severe intellectual disability.MethodsBy international collaboration, we assembled individuals with pathogenic RHOBTB2 variants and a variable spectrum of neurodevelopmental disorders. By western blotting, we investigated the consequences of missense variants in vitro.ResultsIn accordance with previous observations, de novo heterozygous missense variants in the BTB domain region led to a severe developmental and epileptic encephalopathy in 16 individuals. Now, we also identified de novo missense variants in the GTPase domain in 6 individuals with apparently more variable neurodevelopmental phenotypes with or without epilepsy. In contrast to variants in the BTB domain region, variants in the GTPase domain do not impair proteasomal degradation of RHOBTB2 in vitro, indicating different functional consequences. Furthermore, we observed biallelic splice-site and truncating variants in 9 families with variable neurodevelopmental phenotypes, indicating that complete loss of RHOBTB2 is pathogenic as well.ConclusionBy identifying genotype-phenotype correlations regarding location and consequences of de novo missense variants in RHOBTB2 and by identifying biallelic truncating variants, we further delineate and expand the molecular and clinical spectrum of RHOBTB2-related phenotypes, including both autosomal dominant and recessive neurodevelopmental disorders.     

Thiopentone inhibits beta-adrenergic responses in myocardial tissue

The purpose of this study was to determine the importance of inhibition of beta-adrenergic function in thiopentone-induced myocardial depression. Using an isolated, electrically stimulated rat left atria model, contractile dose-response curves to thiopentone (200 μM, 400 μM, 600 μM, 800 μM) were shifted to the right in preparations treated with 10^{− 3} M dibutyryl cyclic adenosine monophosphate (cAMP) compared with atria stimulated with 10^{− 6} M isoprenaline, demonstrating that inhibition of beta-adrenergic mechanisms by thiopentone is physiologically important. Depression by thiopentone was similar in atria treated with 10^{− 5} M forskolin compared with preparations stimulated with 10^{− 6} M isoprenaline, indicating that thiopentone does not block beta-adrenergic receptors. It is concluded that thiopentone depresses myocardial function by several mechanisms, one of which involves inhibition of the adenyl cyclase cascade. The adenyl cyclase enzyme is a likely site where thiopentone inhibits the system; however, other components of the cascade may also be involved. L’objectif de cette étude consiste à déterminer l’influence de l’inhibition de l’activité β-adrenergique sur la dépression myocardique induite par le thiopentone. A l’aide d’un modèle constitué d’une oreillette gauche de rat stimulée électriquement, la relation dose-effet du thiopentone sur la contractilité (200 μM, 400 μM, 600 μM, 800 μM) se déplace vers la droite dans des préparations traitées avec de l’adénosine monophosphorique cyclique (cAMP) 10^{− 3} M comparativement à des oreillettes stimulées avec de l’isoprénaline 10^{− 6} M, ce qui démontre que l’inhibition β-adrénergique provoquée par le thiopentone est physiologiquement importante. La dépression de l’oreillette provoquée par le thiopentone est identique à celle que produit la forskoline 10^{− 5} M comparativement à celle de l’isoprénaline 10^{− 6} M, ce qui indique que le thiopentone n’inhibe pas les récepteurs β-adrénergiques. Les auteurs concluent que le thiopentone déprime la fonction myocardique par plusieurs mécanismes qui impliquent l’inhibition de la cascade de l’adényl cyclase. L’inhibition du système se produit vraisemblablement au niveau de l’enzyme adényl cyclase; cependant, il est possible que d’autres éléments de la cascade de l’adényl cyclase soient impliqués.     

Awake intubation of the adult trachea using the Bullard laryngo-scope

Awake intubation using the Bullard laryngoscope can be comfortably and easily performed in the adult. Five cases are presented in which tracheal intubation was performed under topical anaesthesia with light intravenous sedation. In each case, topical anaesthesia was performed by insertion of a Guedel oral airway, with lidocaine ointment applied to the inferior and posterior surfaces. In one case, Bullard intubation was successful where direct laryngoscopy and multiple attempts at bronchoscopic intubation by three different operators had failed. We conclude that the Bullard laryngoscope can be easily used in awake patients and may be a useful alternative where other methods for awake intubation have failed.