Altered thyroid function in severely injured patients.

BACKGROUND: Hemorrhagic shock profoundly affects the neuroendocrine profile of trauma patients, and we hypothesized that massive resuscitation would negatively impact thyroid function. METHODS: A prospective, observational study investigating thyroid function in hypotensive trauma patients (systolic blood pressure <90 mm Hg × 2) who survived >48 h was conducted at a Level I center over a 6-mo period. Blood samples for thyroid function were collected at time of presentation to the trauma bay and serially for 48 h. Collected data included demographics, injury data, vital signs, transfusion needs, crystalloid use, and vasopressor requirements. Patients receiving >5 units packed red blood cells (PRBC) within 12 h were compared with those receiving ≤5 units. RESULTS: Patients who required >5 units of PRBC/12 h had significantly lower total and free T4 levels on initial presentation, and levels remained significantly depressed over the next 48 h when compared with patients who required a less aggressive resuscitative effort. T3 values were markedly suppressed during the initial 48 h post trauma in all patients, but were significantly lower in patients requiring >5 units PRBC. TSH levels remained within the normal range for all time points. Lower trauma admission T4 levels were associated with the need for greater crystalloid resuscitation within the first 24 h. CONCLUSION: Measurements of thyroid function are significantly altered in severely injured patients on initial presentation, and low T4 levels predict the need for large resuscitation. Further research investigating the profile and impact of thyroid function in trauma patients during resuscitation and recovery is warranted.

Drugs and racial microaggressions: A mediation analysis of racism, mental health, and coping strategies.

INTRODUCTION: Racial microaggressions are daily slights and denigrations perpetrated toward people of color (PoC). These forms of everyday racism are significant stressors for PoC and can insult, invalidate, and assault racial identities. Past findings on discrimination indicate a strong link between engagement in maladaptive behaviors (e.g., substance use and behavioral addictions) and perceived racism. Although the topic of racism is receiving more traction, a dearth of knowledge still persists on racial microaggressions and how these daily interactions can elicit negative coping behaviors, particularly substance use. The current study examined the relationship among microaggressions, substance use, and psychological distress symptoms. Specifically, we aimed to explore if PoC cope with racial microaggressions by using substances. METHODS: We surveyed 557 PoC within the United States using an online platform. Participants answered questions related to their experiences with racial microaggressions, drug and alcohol use as coping strategies for discrimination, and self-reported mental health. Experiences with racial microaggressions was the main predictor variable and the drug and alcohol use as coping strategy was the main outcome variable. The study tested psychological distress as the main mediator for the relationship between racial microaggressions and drug and alcohol use. RESULTS: Findings indicated that microaggressions were a significant predictor of psychological distress symptoms, B = 0.272, SE = 0.046, p < .001, and psychological distress was a significant predictor of coping strategies that involved substance and alcohol use, B = 0.102, SE = 0.021, p < .001. Racial microaggressions were no longer a significant predictor of coping strategies that involved substance and alcohol use after controlling for psychological distress, B = 0.027, SE = 0.024, p = .260. In an exploratory approach, our model was further explained by assessing alcohol refusal self-efficacy, which results suggest be a second mediator in the relation between racial microaggressions and substance use. CONCLUSION: Overall, results suggest that racial discrimination exposes PoC to higher risks for both poorer mental health and the misuse of substances and alcohol. Practitioners treating PoC with substance abuse disorders might also need to assess the psychological impact of experiences with racial microaggressions.

Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial.

OBJECTIVES: Persons with opioid use disorder (OUD) suffer disproportionately from morbidity and mortality related to serious addiction-related infections requiring hospitalization. Long-acting buprenorphine (LAB) is an underused medication for OUD that may facilitate linkage to care and treatment retention when administered before hospital discharge. Transition onto buprenorphine in the inpatient setting is often complicated by pain, active infection management, potential surgical interventions, and risk of opioid withdrawal in transition from full agonists to a partial agonist. METHODS: The COMMIT Trial is a randomized controlled trial evaluating LAB administered by infectious disease physicians and hospitalists compared with treatment as usual for persons with OUD hospitalized with infections. We report a case series of participants on full agonist opioids including methadone who were transitioned to sublingual buprenorphine using low-dose ( microdosing ) strategies followed by LAB injection. RESULTS: Seven participants with current opioid use disorder and life-threatening infections, all with significant concurrent pain and many requiring surgical intervention, underwent low-dose transitions starting at buccal buprenorphine doses ranging from 225 µg to 300 µg 3 times a day on the first day. All were well tolerated with average time to LAB injection of 7.5 days (range, 5-10 days). CONCLUSIONS: Inpatient low-dose buprenorphine transition from full agonist opioids including methadone onto LAB is feasible even in those with complex hospitalizations for concurrent infections and/or surgery. This strategy facilitates dosing of LAB before hospital discharge when risk of opioid relapse and overdose are significant.

The slow violence of racism on Asian Americans during the COVID-19 pandemic.

Racism against people of Asian descent increased by over 300% after the COVID-19 pandemic outbreak in the United States, with one in five Asian Americans reporting direct experiences with overt discrimination. Large-scale efforts and resources initially, and quite understandably, prioritized investigating the physiological impact of the coronavirus, which has partially delayed research studies targeting the psychological effects of the pandemic. Currently, two studies tracked the unique relationships between psychosocial factors, such as experiencing everyday racism, and the self-reported wellbeing of Asian Americans in the United States and compared these associations with Latinx Americans. Study 1 (April 2020-April 2021) examined how Asian and Latinx Americans varied in their levels of wellbeing, fear of the coronavirus, internalized racism, and everyday experiences with racism. Study 2 (September 2021-April 2022) included the same variables with additional assessments for victimization distress. We used the CDC Museum COVID-19 Timeline to pair collected data from our studies with specific moments in the pandemic-from its known origins to springtime 2022. Results highlighted how slow and deleterious forms of racist violence could wear and tear at the wellbeing of targeted people of color. Overall, this research underscores the possible hidden harms associated with slow-moving forms of racism, as well as some of the unseen stressors experienced by people of color living in the United States.

An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study.

BACKGROUND: Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI). METHODS: Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled. Preoperative MDCT scans were classified as indicating the presence (+) or absence (-) of PI and PDI. Operative notes were reviewed and all patients were confirmed as PI (+), and then classified as PDI (+) or (-). As all patients had PI, an analysis of PI specificity was not possible. PI patients formed the pool for further PDI analysis. As sensitivity and specificity data were available for PDI, multivariate logistic regression was performed for PDI patients using the presence or absence of agreement between CT and operative note findings as an independent variable. Covariates were age, gender, Injury Severity Score, mechanism of injury, presence of oral contrast, presence of other abdominal injuries, performance of the scan as part of a dedicated pancreas protocol, and image thickness < or =3 mm or > or =5 mm. RESULTS: Twenty centers enrolled 206 PI patients, including 71 PDI (+) patients. Intravenous contrast was used in 203 studies; 69 studies used presence of oral contrast. Eight-nine percent were blunt mechanisms, and 96% were able to have their duct status operatively classified as PDI (+) or (-). The sensitivity of 16-MDCT for all PI was 60.1%, whereas 64-MDCT was 47.2%. For PDI, the sensitivities of 16- and 64-MDCT were 54.0% and 52.4%, respectively, with specificities of 94.8% for 16-MDCT scanners and 90.3% for 64-MDCT scanners. Logistic regression showed that no covariates were associated with an increased likelihood of detecting PDI for either 16- or 64-MDCT scanners. The area under the curve was 0.66 for the 16-MDCT PDI analysis and 0.77 for the 64-MDCT PDI analysis. CONCLUSION: Sixteen and 64-MDCT have low sensitivity for detecting PI and PDI, while exhibiting a high specificity for PDI. Their use as decision-making tools for the nonoperative management of PI are, therefore, limited.

Incidence of fertility counseling of women of child-bearing age before treatment for colorectal cancer.

BACKGROUND: The incidence of colorectal cancer in women of reproductive age is low. Physicians lack awareness of infertility difficulties in these patients. We studied the frequency of women of child-bearing age with colorectal cancer receiving pretreatment fertility counseling. METHODS: This retrospective review from 1996 to 2004 screened women of reproductive age treated for colorectal cancer for documentation of fertility counseling or referral to fertility specialists before initiating treatment. RESULTS: Twenty-one women met the age criteria (range, 18-45 y). Eight patients were excluded for prior sterilization procedures or tumor involvement of reproductive organs. In the 13 remaining women, 2 had pretreatment fertility counseling documentation. These 2 patients had fewer than 2 children and had rectal tumors. Thirty-eight percent had pregnancy or menses difficulty after treatment. CONCLUSIONS: Few young women with colorectal cancer had pretreatment fertility counseling, whereas several had fertility complications posttreatment. Physicians need to discuss infertility concerns with their female colorectal cancer patients before intervention.