Two decades of influenza and pneumonia mortality trends: Demographics, regional shifts and disparities in the United States: 1999 to 2020.

BACKGROUND: In the 20th century, influenza and pneumonia constituted the largest proportion of infectious disease deaths in the United States. Despite progress in management, US mortality trends for these diseases have not been thoroughly investigated. OBJECTIVES: We aim to examine the patterns of influenza and pneumonia-related deaths among US residents. METHODS: Crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using influenza and pneumonia mortality data (International Classification of Diseases, 10th revision codes: J09-J18) from the CDC WONDER database. Annual percentage changes with a 95% confidence interval were determined using joinpoint regression analysis. Average annual percentage changes were computed as the weighted average of annual percentage changes. RESULTS: From 1999 to 2020, US influenza and pneumonia deaths totaled 1,257,088 (AAMR: 17.09), with a significantly decreasing AAMR (-2.94). Males had a higher AAMR (20.13) than females (15.02). Non-Hispanic American Indians had the highest AAMR (20.44), while Hispanics had the lowest AAMR (13.91). The Northeast had the highest AAMR (18.02). All other regions had similar AAMRs. Rural regions had a consistently higher AAMR (19.80) than urban regions (AAMR: 16.51). CONCLUSION: Tailoring interventions toward high-risk groups can enhance the effectiveness of preventive measures, vaccination, and health care access.

Graphene Nanocomposite Ink Coated Laser Transformed Flexible Electrodes for Selective Dopamine Detection and Immunosensing.

Novel and flexible disposable laser-induced graphene (LIG) sensors modified with graphene conductive inks have been developed for dopamine and interleukin-6 (IL-6) detection. The LIG sensors exhibit high reproducibility (relative standard deviation, RSD = 0.76%, N = 5) and stability (RSD = 4.39%, N = 15) after multiple bendings, making the sensors ideal for wearable and stretchable bioelectronics applications. We have developed electrode coatings based on graphene conductive inks, poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (G-PEDOT:PSS) and polyaniline (G-PANI), for working electrode modification to improve the sensitivity and limit of detection (LOD). The selectivity of LIG sensors modified with the G-PANI ink is 41.47 times higher than that of the screen-printed electrode with the G-PANI ink modification. We have compared our fabricated bare laser-engraved Kapton sensor (LIG) with the LIG sensors modified with G-PEDOT (LIG/G-PEDOT) and G-PANI (LIG/G-PANI) conductive inks. We have further compared the performance of the fabricated electrodes with commercially available screen-printed electrodes (SPEs) and screen-printed electrodes modified with G-PEDOT:PSS (SPE/G-PEDOT:PSS) and G-PANI (SPE/G-PANI). SPE/G-PANI has a lower LOD of 0.632 µM compared to SPE/G-PEDOT:PSS (0.867 µM) and SPE/G-PANI (1.974 µM). The lowest LOD of the LIG/G-PANI sensor (0.4084 µM, S/N = 3) suggests that it can be a great alternative to measure dopamine levels in a physiological medium. Additionally, the LIG/G-PANI electrode has excellent LOD (2.6234 pg/mL) to detect IL-6. Also, the sensor is successfully able to detect ascorbic acid (AA), dopamine (DA), and uric acid (UA) in their ternary mixture. The differential pulse voltammetry (DPV) result shows peak potential separation of 229, 294, and 523 mV for AA-DA, DA-UA, and UA-AA, respectively.

Comparison of the Prevalence of Body Dysmorphic Disorder in Rhinoplasty Patients and its Influence on its Surgical Outcomes.

Introduction: Body dysmorphic disorder (BDD) in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, is defined as one of pseudo-obsessive disorders; a class of obsessive-compulsive disorders. Whereas BDD has been weakly investigated among the Middle east population and there are little data about the prevalence of BDD in Iran especially in the northern part, in this study we tend to investigate the prevalence rate of BDD and its relationship with demographic factors and post-operative satisfaction in a sample of candidates for cosmetic and non-cosmetic surgery in Rasht. Method: During an analytical cross-sectional study, we investigated the prevalence of BDD in 100 applicants for cosmetic surgery (rhinoplasty) and 100 applicants for non-cosmetic surgery (including septoplasty and FESS) who were referred to Amir Al-Momenin Hospital in 2022. The modified Yale-Brown Obsessive Compulsive Questionnaire was used to examine BDD. Also, postoperative satisfaction (3 months later) was evaluated and compared in these two groups through telephone calls. SPSS software version 22, Fisher's test, chi-square test, independent t-test, and multiple logistic regression analysis were used for statistical analysis of the collected data. Results: The frequency of BDD in rhinoplasty applicants is significantly higher than the non-cosmetic surgery applicants (P-value = 0.005). The chance of BDD in rhinoplasty applicants is 4 times more than in non-cosmetic surgery applicants (P-value = 0.001, OR = 4.03). There is no significant difference in post-operative satisfaction between cosmetic and non-cosmetic surgery applicants (P-value = 0.975). Conclusion: It is recommended that all applicants for cosmetic surgeries be examined with appropriate tools in terms of mental health before being accepted by surgeons so that they can be referred to psychiatrists if needed and unnecessary cosmetic surgery should be avoided. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04355-3.

Dual Antitubercular and Antileishmanial Profiles of Quinoxaline Di-N-Oxides Containing an Amino Acidic Side Chain.

We present a new category of quinoxaline di-N-oxides (QdNOs) containing amino acid side chains with dual antituberculosis and antileishmanial activity. These compounds were synthesized by combining a regioselective 2,5-piperazinedione opening and a Beirut reaction and were screened for their activity against Mycobacterium tuberculosis and the promastigote and amastigote forms of representative species of the Leishmania genus. Most QdNOs exhibited promising antitubercular activity with IC50 values ranging from 4.28 to 49.95 µM, comparable to clinically established drugs. Structure-activity relationship analysis emphasized the importance of substituents on the aromatic ring and the side chain. Antileishmanial tests showed that some selected compounds exhibited activity comparable to the positive control miltefosine against promastigotes of Leishmania amazonensis and Leishmania donovani. Notably, some compounds were found to be also more potent and less toxic than miltefosine in intracellular amastigote assays against Leishmania amazonensis. The compound showing the best dual antitubercular and leishmanicidal profile and a good selectivity index, 4h, can be regarded as a hit compound that opens up new opportunities for the development of integrated therapies against co-infections.

Mortality patterns in older adults with infective endocarditis in the US: A retrospective analysis.

BACKGROUND: Infective Endocarditis (IE) has become a significant cause of morbidity and mortality over the last two decades. Despite management advancements, mortality trends in the USA's geriatric population are unexplored. The aim of this study was to assess the trends and regional differences in IE related mortality among geriatric patients in the USA. METHODS: We analyzed death certificates sourced from the CDC WONDER database spanning 1999 to 2020. The research targeted individuals aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC), along with 95% CI, were calculated through joinpoint regression analysis. RESULTS: From 1999 to 2020, infective endocarditis caused 222,573 deaths, showing a declining trend (APC: -0.8361). Males had higher AAMR (26.8) than females (22.2). NH White had the highest AAMR (25.8), followed by NH American Indians or Alaska Natives (19.6). Geographically, the Midwest had the highest AAMR (27.4), followed by the Northeast (25.8). Rural areas consistently had higher AAMRs (26.6) than urban areas (23.6), while 80.16% of deaths occurring in urban settings. North Dakota, Nebraska, and Montana had the highest state AAMRs, approximately double than the states with the lowest mortality rates: Mississippi, Hawaii, California, and Massachusetts. Those aged 85 and above accounted for 42.9% of deaths. CONCLUSION: IE mortality exhibited a clear pattern: rising till 2004, declining from 2004 to 2018, and increasing again till 2020. Key risk factors were male gender, Midwest residence, NH White ethnicity, and age ≥85.Targeted interventions are essential to reduce IE mortality, especially among vulnerable older populations.

Gender and racial disparities in obesity-related cardiovascular-induced mortality in the USA, 1999-2020.

Obesity is closely linked to various cardiovascular diseases, leading to increased mortality rates. This study examines the trends in cardiovascular-induced obesity associated mortality among individuals aged 15 years and older in the United States. Data were sourced from the CDC WONDER for the years 1999-2020, encompassing fatalities where cardiovascular disease was the underlying cause of death and obesity was a contributing factor. The dataset was analyzed, considering annual patterns, gender, and ethnic origins. A total of 280,992 deaths were reported, with 56.35 % attributed to males and 43.64 % to females. The age-adjusted mortality rate was 5.8 for males and 4 for females. Non-Hispanic white individuals accounted for 71.049 % of total deaths, while non-Hispanic Black individuals contributed 19.510 %. The highest mortality rate was observed among non-Hispanic Black individuals, with non-Hispanic American Indian or Alaska Native individuals following. Non-Hispanic Asian or Pacific Islander individuals had the lowest mortality rate. The average annual percentage change (AAPC) was 6.1 for males and 4.4 for females. A significant increase in the overall mortality rate was observed from 2018 to 2020, with Hispanics/Latinos exhibiting the highest increase. The elevated AAMR among males as compared to females may be attributed to the cardio-protective properties of estrogen in women. Furthermore, the COVID-19 pandemic introduced unfavorable lifestyle changes, including weight gain and reduced exercise, potentially exacerbating CVD mortality trends after 2019. Further timely and targeted efforts are needed to control obesity and cardiovascular-related mortality in the USA.

Prevalence of Postoperative Hypothermia in the Post-anesthesia Care Unit.

Background: Unwanted postoperative hypothermia is an unpleasant event that can cause various complications. Objectives: As this serious complication and its provoking causes have not been investigated sufficiently, this study was designed and conducted to determine the prevalence of hypothermia and its associated factors in the post-anesthesia care unit after elective surgery. Methods: Four hundred patients undergoing elective surgeries were enrolled in the present cross-sectional research after termination of surgery and at the time of arrival at the post-anesthesia care unit of Poursina Public University Hospital. The tympanic membrane temperature was measured and recorded at the time of arrival at the post-anesthesia care unit and every 30 minutes after arrival. The required data were collected in a researcher-made checklist and analyzed after entering the SPSS software version 25. Results: Considering the 5% error, it can be said that the prevalence of hypothermia in patients undergoing elective surgery ranges from 20 to 28% at the time of arrival at the post-anesthesia care unit and 18.5 to 26% 30 minutes after arrival. Conclusions: More than a quarter of patients experienced hypothermia following elective surgery. Therefore, appropriate treatment and control measures are necessary to manage this complication, particularly in patients with predisposing risk factors and comorbidities.

Positive End-Expiratory Pressure in Rhinoplasty Surgery; Risks and Benefits.

Aims: The aim of this study is to evaluate the effect of Positive End Expiratory Pressure (PEEP) on surgical field bleeding and its respiratory and hemodynamic consequences in rhinoplasty surgeries. Materials and methods: This single-blind clinical trial performed in Amir Al-Momenin university Hospital in 2018. Seventy cases of rhinoplasty surgery patients Enrolled and were randomized into two groups; intervention (PEEP = 5) and comparison group (PEEP = 0). Surgical field bleeding and arterial oxygen saturation pulmonary dynamics and hemodynamic parameters were evaluated during operation and in post anesthesia care unit. Data were analyzed by SPSS software using descriptive and analytical statistics. Results: PEEP applying had no negative effect on surgical bleeding as well as surgeon satisfaction, heart rate and blood pressure were similar in two groups. Pulmonary dynamics and oxygenation were stable and within normal values in all cases. The mean peak airway pressure was 17.87 ± 2.24 in the PEEP group and 16.08 ± 3.37 in the ZEEP group (P = 0.029). Conclusion: applying low level PEEP during anesthesia improved recovery oxygen saturation but had no negative effects on the patient`s hemodynamics, and did not aggravate bleeding and visual clarity. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03854-7.

Genotoxicity of Copper, Silver and Green Synthetic Gold Nanoparticles in Fish (Ctenopharyngodon idella).

Grass carp (Ctenopharyngodon idella) was exposed to nanoparticles of different concentrations, i.e., copper oxide nanoparticles (CuO-NPs), silver nanoparticles (Ag-NPs), and green synthetic gold nanoparticles (Au-NPs).The administered doses of the three concentration groups were 20mg L-1, 30 mg L-1, and 40mg L-1 each for a period of 14 and 28 days, respectively. The DNA damage in the erythrocytes of grass carp was detected through a comet assay technique. The values of total comet score (TCS) were noted for the exposed concentrations with a significant increasing trend (p < 0.05) and ordered as CuO-NPs > Ag-NPs > Au-NPs. The highest TCS value of the exposed erythrocytes was recorded for CuO-NPs at 40 mg L-1 after 14 days of exposition period. Comparatively, TCS values of erythrocytes exposed to green synthetic Au-NPs at all the concentrations and exposed time were less as compared to the Ag-NPs and CuO-NPs. The study confirmed the adverse effects of nanoparticles on the genetic material of fish cells.

A Facile Graphene Conductive Polymer Paper Based Biosensor for Dopamine, TNF-α, and IL-6 Detection.

Paper-based biosensors are a potential paradigm of sensitivity achieved via microporous spreading/microfluidics, simplicity, and affordability. In this paper, we develop decorated paper with graphene and conductive polymer (herein referred to as graphene conductive polymer paper-based sensor or GCPPS) for sensitive detection of biomolecules. Planetary mixing resulted in uniformly dispersed graphene and conductive polymer ink, which was applied to laser-cut Whatman filter paper substrates. Scanning electron microscopy and Raman spectroscopy showed strong attachment of conductive polymer-functionalized graphene to cellulose fibers. The GCPPS detected dopamine and cytokines, such as tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) in the ranges of 12.5-400 µM, 0.005-50 ng/mL, and 2 pg/mL-2 µg/mL, respectively, using a minute sample volume of 2 µL. The electrodes showed lower detection limits (LODs) of 3.4 µM, 5.97 pg/mL, and 9.55 pg/mL for dopamine, TNF-α, and IL-6 respectively, which are promising for rapid and easy analysis for biomarkers detection. Additionally, these paper-based biosensors were highly selective (no serpin A1 detection with IL-6 antibody) and were able to detect IL-6 antigen in human serum with high sensitivity and hence, the portable, adaptable, point-of-care, quick, minute sample requirement offered by our fabricated biosensor is advantageous to healthcare applications.

Development of pullulan/chitosan/salvianolic acid ternary fibrous membranes and their potential for chemotherapeutic applications.

This study investigates the feasibility of centrifugal spinning for producing fibrous membranes containing pullulan, chitosan, and danshen extract. The danshen extract is composed of 20 wt% salvianolic acid B (SA). Citric acid was added to the mixture as a crosslinking agent to promote its use in the aqueous medium. The influence of the danshen concentration (25 wt% and 33 wt%) on fiber morphology, thermal behavior, and the biochemical effect was analyzed. Developed fiber-based membranes consist of long, continuous, and uniform fibers with a sparse scattering of beads. Fiber diameter analysis shows values ranging from 384 ± 123 nm to 644 ± 141 nm depending on the concentration of danshen. The nanofibers show adequate aqueous stability after crosslinking. Thermal analysis results prove that SA is loaded into nanofibers without compromising their structural integrity. Cell-based results indicate that the developed nanofiber membranes promote cell growth and are not detrimental to fibroblast cells. Anticancer studies reveal a promising inhibition to the proliferation of HCT116 colon cancer cells. The developed systems show potential as innovative systems to be used as a bioactive chemotherapeutic drug that could be placed on the removed tumor site to prevent development of colon cancer microdeposits.

The effect of physical activity level on the severity of diastolic dysfunction.

BACKGROUND: Diastolic dysfunction (DD) is a risk factor for cardiovascular events in patients undergoing non-cardiac surgeries. Investigators aimed to assess the effect of physical activity level on the diastolic function of the left ventricle (LV) in patients attending the preoperative visit. METHODS: This analytic cross-sectional study was conducted on 228 patients referred to Poursina hospital from November 2021 to March 2022. To define the physical activity level, we used the short form of the International Physical Activity Questionnaire (IPAQ). We categorized patients into inactive, minimally active, and health-enhancing physical activity groups. We also divided participants into three groups based on their daily sitting time. Also, echocardiographic parameters were calculated. The diastolic function of LV was evaluated, and its grading was defined from mild (grade1) to severe (grade 3). RESULTS: Results showed that patients with DD had significantly higher age and lower levels of education (P < 0.001 and P = 0.005, respectively). After assessing echocardiographic parameters, we found that E/e', TR Velocity, left atrial volume index, and pulmonary artery pressure had a statistically significant inverse relationship with physical activity level (P < 0.001 for all). Comparing physical activity level of subgroups showed that in HEPA (health-enhancing physical activity), the chance of developing grade 2 or 3 DD was reduced by 97% compared to the inactive group (OR = 0.03, P < 0.001). Still, there was no significant difference between the inactive and minimally active groups (P = 0.223). CONCLUSIONS: This study showed an inverse relationship between physical activity level and DD of the LV in a sample of 228 individuals attending the Anesthesia Clinic, independent of potentially confounding variables.Therefore, due to lower rate of DD in patients who are physically active, we can expect lower occurrence rate of cardiovascular events during surgery.

Double Trouble Co-Infections: Understanding the Correlation Between COVID-19 and HIV Viruses.

A global outbreak of coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mounted a substantial threat to public health worldwide. It initially emerged as a mere outbreak in Wuhan, China, in December 2019 and quickly engulfed the entire world, evolving into a global pandemic, consuming millions of lives and leaving a catastrophic effect on our lives in ways unimaginable. The entire healthcare system was significantly impacted and HIV healthcare was not spared. In this article, we reviewed the effect of HIV on COVID-19 disease and the ramifications of the recent COVID-19 pandemic over HIV management strategies. Our review highlights that contrary to the instinctive belief that HIV should render patients susceptible to COVID-19 infection, the studies depicted mixed results, although comorbidities and other confounders greatly affected the results. Few studies showed a higher rate of in-hospital mortality due to COVID-19 among HIV patients; however, the use of antiretroviral therapy had no consequential effect. COVID-19 vaccination was deemed safe among HIV patients in general. The recent pandemic can destabilize the HIV epidemic control as it hugely impacted access to care and preventive services and led to a marked reduction in HIV testing. The collision of these two disastrous pandemics warrants the need to materialize rigorous epidemiological measures and health policies, but most importantly, brisk research in prevention strategies to mitigate the combined burden of the two viruses and to battle similar future pandemics.

Automatic dispersion, defect, curing, and thermal characteristics determination of polymer composites using micro-scale infrared thermography and machine learning algorithm.

Infrared thermography is a non-destructive technique that can be exploited in many fields including polymer composite investigation. Based on emissivity and thermal diffusivity variation; components, defects, and curing state of the composite can be identified. However, manual processing of thermal images that may contain significant artifacts, is prone to erroneous component and property determination. In this study, thermal images of different graphite/graphene-based polymer composites fabricated by hand, planetary, and batch mixing techniques were analyzed through an automatic machine learning model. Filler size, shape, and location can be identified in polymer composites and thus, the dispersion of different samples was quantified with a resolution of ~ 20 µm despite having artifacts in the thermal image. Thermal diffusivity comparison of three mixing techniques was performed for 40% graphite in the elastomer. Batch mixing demonstrated superior dispersion than planetary and hand mixing as the dispersion index (DI) for batch mixing was 0.07 while planetary and hand mixing showed 0.0865 and 0.163 respectively. Curing was investigated for a polymer with different fillers (PDMS took 500 s while PDMS-Graphene and PDMS Graphite Powder took 800 s to cure), and a thermal characteristic curve was generated to compare the composite quality. Therefore, the above-mentioned methods with machine learning algorithms can be a great tool to analyze composite both quantitatively and qualitatively.

Graphene-Coated PVDF/PAni Fiber Mats and Their Applications in Sensing and Nanogeneration.

Forcespinning is a powerful technique to produce fiber systems with suitable properties for a vast array of applications. This study investigates the sensing and energy generation performance of PVDF/PAni fiber mat systems made by the forcespinning method with and without graphene coating. The developed fiber mats were coated with graphene nanoflakes by drop-casting. The graphene-coated nanocomposites show an average output voltage of 75 mV (peak-to-peak), which is 300% higher compared to bare fiber mats, and an output current of 24 mA (peak-to-peak) by gentle finger pressing. Moreover, graphene-coated PVDF/PAni showed a volume conductivity of 1.2 × 10-7 S/cm and was investigated as a promising system for temperature (5 times better sensitivity than normal fiber mat), vibration (2 times better voltage generation), and airflow sensing. The graphene-coated composite has been further investigated as a water tide energy harvesting piezoelectric nanogenerator, with the system generating ∼40 mV for a synthetic ocean wave with a flow rate of 30 mL/min. In the future, graphene-coated nanofiber mats can be a solution for low-powered sensors and to harvest blue energy and vibration energy.

Evaluation of applying topical tranexamic acid to control septorhinoplasy - induced hemorrhage.

OBJECTIVES: Hemorrhagic events related to surgical field is a common disturbing complication which could worsen the outcomes of operation. This study aimed to evaluate how applying of topical tranexamic acid (TXA) could affect bleeding related to septorhinoplasty operation. MATERIAL AND METHODS: This double-blind controlled trial study finally evaluated 198 candidates for septorhinoplasty repair who were randomly allocated to two groups: TXA receivers (5 mg/kg) and control group (received 5 mg/kg of saline 0.9 %). Then cumulative volume of hemorrhage was calculated by adding total volume of suctioned blood and numbers of fully blood-filled surgical gauzes (15 mL in each). Additionally postoperative 24 h volume of hemorrhage was measured by counting number of bloody surgical gauzes. RESULTS: Of all participants, 90 % were female. The mean age was 26 ± 7 years. Total cumulative volume of hemorrhage during surgery was significantly diminished when topical TXA was applied (p < 0.0001). Additionally drier field of operation was illustrated postoperatively in patients received topical TXA (2 % & 28 % in TXA and saline 0.9 % receivers, respectively) (p < 0.001). CONCLUSION: Using topical TXA could decrease bleeding volume and make surgical field of septorhinoplasty drier either during surgery or postoperatively.

Clinical Characteristics of COVID-19-Infected Cancer Patients in Pakistan: Differences Between Survivors and Non-Survivors.

BACKGROUND: Cancer patients are considered as highly vulnerable individuals in the current COVID-19 pandemic. We studied the clinical characteristics of survivor and non-survivor COVID-19-infected cancer patients in Pakistan. PATIENTS AND METHODS: We did a retrospective study of 70 cancer patients with PCR-confirmed COVID-19 infection from Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore and Peshawar, Pakistan between April 13 and July 09, 2020. These patients were discharged from the hospital or had died by July 09, 2020. Clinical, pathological and radiological characteristics were compared between survivors and non-survivors by fisher's exact test and chi-square test. Univariable and multivariable logistic regression models were performed to explore the risk factors of mortality. RESULTS: Seventy cancer patients with SARS-CoV-2 infection were enrolled and the majority were males 38 (54.3%). 57 (81.4%) had solid tumors and 13 (18.6%) had hematological malignancies. Dyspnea (44 cases) was the most common symptom (62.9%). Complications were reported in 51 (72.9%) patients during the course of disease. 19 (27.1%) patients were admitted to an intensive care unit (ICU). A significant increase in the C-reactive protein level and neutrophil count was observed in the deceased patients as compared to the surviving patients. D-dimer values of ≥0.2 mg/L were significantly associated with mortality (P=0.01). We identified two independent risk factors associated with death, ICU admission (P=0.007) and D-dimer (P=0.003). CONCLUSION: Pakistani cancer patients with COVID-19 infection reported poor prognosis. Intensive surveillance of clinicopathological characteristics of cancer patients infected with COVID-19 especially D-dimer values may play a pivotal role in the outcome of the disease.

The Correlation between Head of Bed Angle and Intra-Abdominal Pressure of Intubated Patients; a Pre-Post Clinical Trial.

INTRODUCTION: The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position. However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done to evaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensive care unit. METHODS: In this clinical trial, seventy-six critically ill patients under mechanical ventilation were enrolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three different degrees of the head of bed (HOB) elevation (0 ° , 15 ° , and 30 ° ). Bland-Altman analysis was performed to identify the bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Compartment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limits of agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19), and the significance level was considered as 0.05. RESULTS: The prevalence of intra-abdominal hypertension was 18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0°, 9.58 ± 4.52 for HOB angle 15 ° , and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0°and HOB angle 15° was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0° and HOB angle 30°. CONCLUSION: Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement of IAP at HOB angle 15° was more reliable than 30°.

Resisted adduction sit-up test (RASUT) as a screening tool for pelvic versus hip pathology.

Groin pain is a common symptom in hip and pelvic pathology and differentiating between the two remains a challenge. The purpose of this study was to examine whether a test combining resisted adduction with a sit-up (RASUT) differentiates between pelvic and hip pathology. The RASUT was performed on 160 patients with complaints of hip or groin pain who subsequently had their diagnosis confirmed by magnetic resonance imaging (MRI) or surgery. Patients were categorized as having pelvic pathology (athletic pubalgia or other) or hip pathology (intra-articular or other). Athletic pubalgia was defined as any condition involving the disruption of the pubic aponeurotic plate. Sensitivity, specificity, positive predictive accuracy, negative predictive accuracy and diagnostic odds ratios were computed. Seventy-one patients had pelvic pathology (40 athletic pubalgia), 81 had hip pathology and 8 had both. The RASUT was effective in differentiating pelvic from hip pathology; 50 of 77 patients with a positive RASUT had pelvic pathology versus 29 of 83 patients with a negative test (P < 0.001). RASUT was diagnostic for athletic pubalgia (diagnostic odds ratio 6.08, P < 0.001); 35 of 45 patients with athletic pubalgia had a positive RASUT (78% sensitivity) and 73 of 83 patients with a negative RASUT did not have athletic pubalgia (88% negative predictive accuracy). The RASUT can be used to differentiate pelvic from hip pathology and to identify patients without athletic pubalgia. This is a valuable screening tool in the armamentarium of the sports medicine clinician.

The environment contributes more than genetics to smaller hippocampal volume in Posttraumatic Stress Disorder (PTSD).

BACKGROUND: Studies using structural magnetic resonance imaging (MRI) volumetrics showed smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD). These studies were cross-sectional and did not address whether smaller volume is secondary to stress-induced damage, or whether pre-existing factors account for the findings. The purpose of this study was to use a co-twin case control design to assess the relative contribution of genetic and environmental factors to hippocampal volume in PTSD. METHODS: Monozygotic (N = 13 pairs) and dizygotic (N = 21 pairs) twins with a history of Vietnam Era military service, where one brother went to Vietnam and developed PTSD, while his brother did not go to Vietnam or develop PTSD, underwent MR imaging of the brain. Structural MRI scans were used to manually outline the left and right hippocampus on multiple coronal slices, add the areas and adjust for slice thickness to determine hippocampal volume. RESULTS: Twins with Vietnam combat-related PTSD had a mean 11% smaller right hippocampal volume in comparison to their twin brothers without combat exposure or PTSD (p < .05). There was no significant interaction by zygosity, suggesting that this was not a predisposing risk factor or genetic effect. CONCLUSIONS: These findings are consistent with smaller hippocampal volume in PTSD, and suggest that the effects are primarily due to environmental effects such as the stress of combat.