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1.
JPGN Rep ; 5(2): 166-169, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38756140

RESUMEN

Patients with esophageal atresia and tracheoesophageal fistula (EA-TEF) are at increased risk of conditions including gastroesophageal reflux, peptic esophagitis, gastric metaplasia, anastomotic strictures, eosinophilic esophagitis, and dysphagia. Patients with TEF-EA may need serial endoscopy in their lifetime given the known short- and long-term GI complications. There has been increased interest in pediatric unsedated transnasal endoscopy (TNE) as an endoscopic alternative as it is lower cost, has shorter recovery time, and eliminates potential risks associated with anesthesia. We report on the use of TNE with EA-TEF in four patients: One patient had gastroesophageal reflux disease, one patient had eosinophilic esophagitis and TNE was used for surveillance in two patients. Use of TNE allowed for close endoscopic monitoring and changes in medication management. The third and fourth patients underwent TNE as part of routine EA-TEF screening which is recommended by societal guidelines (Krishnan et al, J Pediatr Gastroenterol Nutr. 2016;63(5):550-570). Unsedated TNE is an alternative endoscopic approach in the management of patients with EA-TEF.

2.
Am J Hosp Palliat Care ; 41(5): 468-470, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38556759

RESUMEN

The United States (US) has one of the highest rates of incarceration in the world. Due to the aging of the US population as a whole and limited opportunities for early release, the proportion of older people in prison continues to rise. Some correctional health systems have adopted geriatric and palliative care principles to better care for this aging population, many of whom die in prison. However, not everyone who grows old in prison will die behind bars. In this article, we explore existing literature that highlights the unique physical, cognitive, and psychosocial challenges that formerly incarcerated patients face. We proceed to argue that palliative care providers should screen for a history of incarceration to identify and address the needs of this patient population. We also offer strategies to create a safe, welcoming environment to discuss past traumas related to these patients' time in prison.


Asunto(s)
Cuidados Paliativos , Prisioneros , Humanos , Estados Unidos , Anciano , Prisiones , Encarcelamiento
3.
J Viral Hepat ; 2024 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-38654623

RESUMEN

In Vietnam and the Philippines, viral hepatitis is the leading cause of cirrhosis and liver cancer. This study aims to understand the barriers and enablers of people receiving care for hepatitis B and C to support both countries' efforts to eliminate viral hepatitis as a public health threat by 2030. Retrospective, semi-structured interviews were conducted with a purposive, quota-based sample of 63 people living with hepatitis B or C in one province of Vietnam and one region of the Philippines. A rapid deductive approach to thematic analysis produced key findings among the three phases of care: (1) pre-awareness and testing, (2) linkage and treatment initiation and (3) ongoing treatment and recovery. The research found that participants followed five typical journeys, from a variety of entry points. Barriers during the pre-awareness and testing phase included limited awareness about hepatitis and its management, stigma and psychological impacts. Enablers included being familiar with the health system and/or patients benefiting from social connections within the health systems. During the linkage and treatment initiation phase, barriers included difficult physical access, complex navigation and inadequate counselling. In this phase, family support emerged as a critical enabler. During the ongoing treatment and recovery phase, the cost of care and socially and culturally informed perceptions of the disease and medication use were both barriers and enablers. Exploring peoples' journeys with hepatitis B and C in Vietnam and the Philippines revealed many similarities despite the different cultural and health system contexts. Insights from this study may help generate a contextualized, people-centred evidence base to inform the design and improvement of primary care services for hepatitis in both research sites.

4.
Poult Sci ; 103(3): 103408, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38320393

RESUMEN

High oleic (HO) soybeans may serve as a value-added feed ingredient; providing amino acids and estimating their dietary energy value for broilers is essential. In this study, we determined the apparent metabolizable energy (AME), AME corrected for zero nitrogen retention (AMEn), digestibility, and nitrogen (N) retention of HO full-fat (HO-FF) soybean as compared to solvent-extracted soybean meal (SE-SBM), normal oleic full-fat (NO-FF) and extruded expeller (NO-EE) soybean. A total of 240 Ross-708 male broilers were selected, with 8 replicates per treatment and 6 chicks per cage. The AME and AMEn were estimated using the difference method with a 30% inclusion of test ingredients using a corn-soy reference diet with partial and total excreta collection. The index method with partial excreta collection used titanium dioxide as an inert marker. The same starter diet was provided for all birds for 14 d, followed by the reference and assay diets for the next 6 adaptation days. Total excreta were collected twice a day for 3 d. The AME and AMEn values determined for the HO-FF and NO-FF were higher (P < 0.001) than the NO-EE and SE-SBM. The AME of SE-SBM and NO-EE were similar with both methods, but the AMEn of SE-SBM was lower than the NO-EE only with the partial collection method. The agreement between AME and AMEn values determined by partial and total excreta collection analysis was 98%. Data from the total excreta collection method yielded higher AME and AMEn values (P < 0.001) than those from the partial collection method. In summary, HO-FF and NO-FF soybean meals had similar AME and AMEn values. The HO-FF soybean had 39 and 24% higher AME and AMEn than SE-SBM. Hence, high oleic full-fat soybean meal could serve as a valuable alternative feed ingredient to conventional SE-SBM meals in broiler diets, providing additional energy while providing amino acids and more oleic acid to enrich poultry meat products.


Asunto(s)
Pollos , Glycine max , Animales , Masculino , Pollos/metabolismo , Harina , Nitrógeno/metabolismo , Alimentación Animal/análisis , Metabolismo Energético , Fenómenos Fisiológicos Nutricionales de los Animales , Aminoácidos/metabolismo , Ácidos Oléicos/metabolismo
5.
Am J Trop Med Hyg ; 110(3): 444-447, 2024 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-38350139

RESUMEN

Anopheles darlingi is the primary malaria vector in the Amazon region and is highly susceptible to both Plasmodium vivax and Plasmodium falciparum parasites. Although anopheline mosquitoes may develop melanotic encapsulation in response to Plasmodium parasites, there is no record of An. darlingi exhibiting a melanization response to P. vivax, the main malaria parasite in the Americas. Here, we report the occurrence of P. vivax sporozoite melanization in An. darlingi mosquitoes.


Asunto(s)
Anopheles , Malaria Vivax , Malaria , Animales , Humanos , Plasmodium vivax , Anopheles/parasitología , Esporozoítos , Mosquitos Vectores/parasitología , Glándulas Salivales
6.
Poult Sci ; 103(3): 103399, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38281331

RESUMEN

The effects of high oleic oil full-fat (HO-FF) soybean meal (SBM) on broiler meat quality could lead to value-added food products. This experiment evaluated the effects of dietary normal oleic extruded expelled (NO-EE), normal oleic full-fat (NO-FF), or HO-FF SBM on live performance, carcass and parts yield, and breast fatty acid composition. Diets were formulated to be isoenergetic and isonitrogenous. A total of 540 Ross-708 male broilers were raised on floor pens with 18 broilers/pen and 10 replicates/treatment. Data were analyzed in a completely randomized design. Chickens were fed with a starter (0-14 d), grower (15-35 d), or a finisher diet (36-47 d) up to 47 d. Chickens were weighed at 7, 14, 35, and 47 d. At 48 d, 4 broilers per pen were processed. Breast samples were collected and evaluated for quality and fatty acid content. Broilers fed diets with NO-EE were heavier (P < 0.05) than chickens fed diets with full-fat SBM (NO-FF and HO-FF) at d 7, 14, 35 while feed conversion ratio (FCR) of NO-EE was best (P < 0.05) at 7 and 47 d. Carcass yield was also higher for broilers fed NO-EE than the other treatments. Diet did not affect parts yield, breast meat color, cooking, drip loss, white stripping, or SM quality parameters. More breast fillets without wooden breast (score 1) were observed (P < 0.05) for NO-FF than the other 2 treatments. The breast meat fatty acid profile (g fatty acid/100 g of all fatty acids) was significantly affected (P < 0.001) by diet. Broilers fed the HO-FF SBM diet had 54 to 86% more oleic acid, 72.5% to 2.2 times less linoleic acid, and reduced stearic and palmitic acid levels in the breast meat than NO-FF and NO-EE. In conclusion, feeding HO-FF to broilers enriched the oleic acid content of their breast meat while reducing the saturated fatty acid content relative to the NO-FF and NO-EE treatment groups.


Asunto(s)
Pollos , Ácidos Grasos , Animales , Masculino , Dieta Alta en Grasa , Harina , Glycine max , Ácido Oléico
7.
Lancet Reg Health West Pac ; 44: 100990, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38204496

RESUMEN

Chronic viral hepatitis is a significant public health concern in the Western Pacific, including in Vietnam and the Philippines. To accelerate progress toward meeting the 2030 elimination goals, the World Health Organization (WHO) encourages countries to adopt an integrated, people-centered health sector response to hepatitis, grounded in Primary Health Care (PHC). A review of the academic and grey literature, along with policy documents, was conducted to describe the national health system and PHC response to hepatitis B and C in Vietnam and the Philippines. Information was analyzed against the four strategic levers of the WHO Operational Framework for PHC to identify challenges and opportunities. The findings suggest that both countries have relatively robust policy frameworks, with some room for improvement. Vietnam may have stronger political commitment and funding than the Philippines, while the Philippines appears to be stronger in community engagement. Both countries share challenges and opportunities for learning to actualize viral hepatitis elimination utilizing a PHC approach.

8.
Emotion ; 24(3): 676-686, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37707484

RESUMEN

Although the effects of different emotion regulation strategies are well-documented, most studies to date have focused on the selection and implementation of broad strategies, while overlooking the selection and implementation of specific tactics to enact those strategies. The present research investigated the strategy of cognitive reappraisal and the differences in selection frequency and affective outcomes that are associated with the implementation of different reappraisal tactics to enact that strategy. Participants completed a laboratory task in which they were instructed to reappraise or not to reappraise negative images and reported on their use of specific reappraisal tactics for every trial. Using established reappraisal tactic coding, we assessed how people selected from among common tactics for each image (Study 1) and all tactics (Study 2) and implemented those tactics to reappraise negative images. We compared reappraisal tactic selection and implementation when used during instructed reappraisal versus during spontaneous reappraisal, in the nonreappraise condition. Results of both studies indicate that tactics were used more often when instructed to reappraise versus when spontaneously reappraising. Participants used some tactics (e.g., reality challenge) more frequently compared to the rest of the tactics in both conditions. Negative affect was lower following instructed versus spontaneous reappraisal. Some tactics (e.g., change current circumstances) were more effective at decreasing negative affect in both conditions. Knowing which reappraisal tactics are most frequently selected, and their affective outcomes when used when prompted or spontaneously, may help us better understand how to improve people's ability to use reappraisal to achieve their emotional goals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Asunto(s)
Regulación Emocional , Emociones , Humanos , Emociones/fisiología , Regulación Emocional/fisiología , Proteínas Represoras
10.
Poult Sci ; 102(12): 103152, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37967503

RESUMEN

High-oleic (HO) soybean may serve as a value-added feed ingredient to enrich poultry meat due to its fatty acid content. However, the amino acid (AA) nutrient digestibility of soybean meal (SBM) made from these soybeans has yet to be determined. The objective of this study was to determine apparent ileal AA digestibility (AID) and standardized ileal AA digestibility (SID) of high-oleic full-fat (HO-FF) SBM compared to normal oleic full-fat (NO-FF), normal oleic extruded expeller (NO-EE), and solvent-extracted SBM (SE-SBM) in broilers. A nitrogen-free basal diet (NFD) was fed to 1 treatment group with 10 chicks/cage to determine basal endogenous losses (BEL). Titanium dioxide was used as an inert marker. The test diets contained 57.5% of the basal NFD and 42.5% of 1 of the 4 soybean sources. A total of 272 Ross-708 male broilers were placed in 40 battery cages with 5 treatments and 8 replicates per treatment. A common starter diet was provided to all the chickens for 14 d. Experimental diets were provided as a mash for 9 d before sample collection. Chickens were euthanized with CO2 on d 23, and contents of the distal ileum were collected, frozen, and freeze-dried. The BEL were similar to the values found in the literature. At d 23, broilers fed the SE-SBM had the highest body weight gain and best FCR compared to chickens fed the HO-FF and NO-FF treatments (P < 0.001). Broilers fed the SE-SBM and NO-EE experimental diets had (P < 0.001) higher apparent ileal AA digestibility and AA SID than broilers fed the HO-FF and NO-FF treatments. In conclusion, the SID of AA from HO-FF is similar to the digestibilities of other full-fat soybeans found in the literature and is lower than that of NO-EE and SE-SBM.


Asunto(s)
Aminoácidos , Glycine max , Animales , Masculino , Aminoácidos/metabolismo , Pollos/metabolismo , Harina , Digestión , Dieta/veterinaria , Nutrientes , Íleon/metabolismo , Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales
11.
JAMA Surg ; 158(12): 1265-1273, 2023 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-37870954

RESUMEN

Importance: Oral tamoxifen citrate benefits women with ductal carcinoma in situ (DCIS), but concern about toxic effects has limited acceptance. Previous pilot studies have suggested transdermal 4-hydroxytamoxifen gel has equivalent antiproliferative efficacy to oral tamoxifen, with low systemic exposure. Objective: To demonstrate that 4-hydroxytamoxifen gel applied to the breast skin is noninferior to oral tamoxifen in its antiproliferative effect in DCIS lesions. Design, Setting, and Participants: This randomized, double-blind, phase 2 preoperative window trial was performed at multicenter breast surgery referral practices from May 31, 2017, to January 27, 2021. Among 408 women with estrogen receptor-positive DCIS who were approached, 120 consented and 100 initiated study treatment. The most common reasons for nonparticipation were surgical delay, disinterest in research, and concerns about toxic effects. Data were analyzed from January 26, 2021, to October 5, 2022. Intervention: Random assignment to oral tamoxifen citrate, 20 mg/d, and gel placebo or 4-hydroxytamoxifen gel, 2 mg/d per breast, and oral placebo, for 4 to 10 weeks, followed by DCIS resection. Main Outcomes and Measures: The primary end point was absolute change in DCIS Ki-67 labeling index (Ki67-LI). Secondary end points included 12-gene DCIS Score, breast tissue tamoxifen metabolite concentrations, tamoxifen-responsive plasma protein levels, and patient-reported symptoms. Noninferiority of Ki67-LI reduction by 4-hydroxytamoxifen gel was tested using analysis of covariance; within- and between-arm comparisons were performed with paired t tests for mean values or the Wilcoxon rank sum test for medians. Results: Of 90 participants completing treatment (mean [SD] age, 55 [11] years; 8 [8.9%] Asian, 16 [17.8%] Black, 8 [8.9%] Latina, and 53 [58.9%] White), 15 lacked residual DCIS in the surgical sample, leaving 75 evaluable for the primary end point analysis (40 in the oral tamoxifen group and 35 in the 4-hydroxytamoxifen gel group). Posttreatment Ki67-LI was 3.3% higher (80% CI, 2.1%-4.6%) in the 4-hydroxytamoxifen gel group compared with the oral tamoxifen group, exceeding the noninferiority margin (2.6%). The DCIS Score decreased more with oral tamoxifen treatment (-16 [95% CI, -22 to -9.4]) than with 4-hydroxytamoxifen gel (-1.8 [95% CI, -5.8 to 2.3]). The median 4-hydroxytamoxifen concentrations deep in the breast were nonsignificantly higher in the oral tamoxifen group (5.7 [IQR, 4.0-7.9] vs 3.8 [IQR, 1.3-7.9] ng/g), whereas endoxifen was abundant in the oral tamoxifen group and minimal in the 4-hydroxytamoxifen gel group (median, 13.0 [IQR, 8.9-20.6] vs 0.3 [IQR, 0-0.3] ng/g; P < .001). Oral tamoxifen caused expected adverse changes in plasma protein levels and vasomotor symptoms, with minimal changes in the transdermal group. Conclusions and Relevance: In this randomized clinical trial, antiproliferative noninferiority of 4-hydroxytamoxifen gel to oral tamoxifen was not confirmed, potentially owing to endoxifen exposure differences. New transdermal approaches must deliver higher drug quantities and/or include the most potent metabolites. Trial Registration: ClinicalTrials.gov Identifier: NCT02993159.


Asunto(s)
Carcinoma Intraductal no Infiltrante , Humanos , Femenino , Persona de Mediana Edad , Carcinoma Intraductal no Infiltrante/tratamiento farmacológico , Carcinoma Intraductal no Infiltrante/cirugía , Antígeno Ki-67 , Método Doble Ciego , Tamoxifeno/uso terapéutico , Tamoxifeno/efectos adversos , Proteínas Sanguíneas/uso terapéutico
12.
Am J Bioeth ; 23(10): 58-60, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37812118

Asunto(s)
Bioética , Humanos
13.
BMJ Case Rep ; 16(8)2023 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-37562859

RESUMEN

Inferior scapula avulsion fractures are rare injuries, with few cases reported and only a small number managed operatively discussed in the literature. We report the case of a man in his 40s who fell from a height and presented with right-sided scapular winging and point tenderness at the inferior pole of his right scapula with no neurological deficit. Radiographs and CT diagnosed avulsion fracture of the inferior scapula. The patient underwent surgical fixation and, following a course of physiotherapy, successfully recovered with no residual winging and full range of movement.


Asunto(s)
Fracturas por Avulsión , Fracturas del Hombro , Traumatismos Torácicos , Masculino , Humanos , Fracturas por Avulsión/diagnóstico por imagen , Fracturas por Avulsión/cirugía , Escápula/cirugía , Radiografía
14.
Am J Public Health ; 113(10): 1086-1088, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37499199

RESUMEN

Schools of public health have increasingly adopted programs, praxis, and competencies for antiracist work. Fighting Oppression, Racism and White Supremacy through Action, Research and Discourse (FORWARD) was founded to accelerate antiracist work at the Columbia University Mailman School of Public Health in New York City. Seven action corps reporting to an accountability cabinet were established with 183 participants. FORWARD achieved progress across five core pillars. We describe how an iterative, dynamic structure and explicit framework for accountability can guide future antiracism work. (Am J Public Health. 2023;113(10):1086-1088. https://doi.org/10.2105/AJPH.2023.307356).


Asunto(s)
Trastornos Mentales , Racismo , Humanos , Salud Pública , Antiracismo , Racismo/prevención & control , Responsabilidad Social
15.
Neuroimage ; 274: 120119, 2023 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-37068719

RESUMEN

INTRODUCTION: Poor quality T1-weighted brain scans systematically affect the calculation of brain measures. Removing the influence of such scans requires identifying and excluding scans with noise and artefacts through a quality control (QC) procedure. While QC is critical for brain imaging analyses, it is not yet clear whether different QC approaches lead to the exclusion of the same participants. Further, the removal of poor-quality scans may unintentionally introduce a sampling bias by excluding the subset of participants who are younger and/or feature greater clinical impairment. This study had two aims: (1) examine whether different QC approaches applied to T1-weighted scans would exclude the same participants, and (2) examine how exclusion of poor-quality scans impacts specific demographic, clinical and brain measure characteristics between excluded and included participants in three large pediatric neuroimaging samples. METHODS: We used T1-weighted, resting-state fMRI, demographic and clinical data from the Province of Ontario Neurodevelopmental Disorders network (Aim 1: n = 553, Aim 2: n = 465), the Healthy Brain Network (Aim 1: n = 1051, Aim 2: n = 558), and the Philadelphia Neurodevelopmental Cohort (Aim 1: n = 1087; Aim 2: n = 619). Four different QC approaches were applied to T1-weighted MRI (visual QC, metric QC, automated QC, fMRI-derived QC). We used tetrachoric correlation and inter-rater reliability analyses to examine whether different QC approaches excluded the same participants. We examined differences in age, mental health symptoms, everyday/adaptive functioning, IQ and structural MRI-derived brain indices between participants that were included versus excluded following each QC approach. RESULTS: Dataset-specific findings revealed mixed results with respect to overlap of QC exclusion. However, in POND and HBN, we found a moderate level of overlap between visual and automated QC approaches (rtet=0.52-0.59). Implementation of QC excluded younger participants, and tended to exclude those with lower IQ, and lower everyday/adaptive functioning scores across several approaches in a dataset-specific manner. Across nearly all datasets and QC approaches examined, excluded participants had lower estimates of cortical thickness and subcortical volume, but this effect did not differ by QC approach. CONCLUSION: The results of this study provide insight into the influence of QC decisions on structural pediatric imaging analyses. While different QC approaches exclude different subsets of participants, the variation of influence of different QC approaches on clinical and brain metrics is minimal in large datasets. Overall, implementation of QC tends to exclude participants who are younger, and those who have more cognitive and functional impairment. Given that automated QC is standardized and can reduce between-study differences, the results of this study support the potential to use automated QC for large pediatric neuroimaging datasets.


Asunto(s)
Imagen por Resonancia Magnética , Neuroimagen , Humanos , Niño , Reproducibilidad de los Resultados , Neuroimagen/métodos , Imagen por Resonancia Magnética/métodos , Encéfalo/diagnóstico por imagen , Control de Calidad
16.
Clin Dermatol ; 41(2): 280-283, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37105502

RESUMEN

Dermatology in the United States is among the global leaders in advancing scientific discovery and practicing evidence-based medicine; however, many patients face limited access to dermatologic care due to a national shortage of dermatologists, provider clustering, and the interplay of sociodemographic and socioeconomic factors. These intertwined barriers have created a landscape where race, ethnicity, insurance subtype, education, and socioeconomic status negatively impact access to dermatologic services. Leveraging the utilization of technology and community engagement provides inroads to improve access to care. We outline how teleconsultations, telementoring, specialty care extension for community health outcomes (Project ECHO), community health centers, donated specialty care models, and community health workers can be bolstered to create more equitable access to care.


Asunto(s)
Dermatología , Humanos , Estados Unidos , Pandemias , Clase Social , Etnicidad , Accesibilidad a los Servicios de Salud
17.
Schizophr Bull ; 49(6): 1518-1529, 2023 11 29.
Artículo en Inglés | MEDLINE | ID: mdl-36869812

RESUMEN

BACKGROUND AND HYPOTHESIS: Neurocognitive and social cognitive abilities are important contributors to functional outcomes in schizophrenia spectrum disorders (SSDs). An unanswered question of considerable interest is whether neurocognitive and social cognitive deficits arise from overlapping or distinct white matter impairment(s). STUDY DESIGN: We sought to fill this gap, by harnessing a large sample of individuals from the multi-center Social Processes Initiative in the Neurobiology of the Schizophrenia(s) (SPINS) dataset, unique in its collection of advanced diffusion imaging and an extensive battery of cognitive assessments. We applied canonical correlation analysis to estimates of white matter microstructure, and cognitive performance, across people with and without an SSD. STUDY RESULTS: Our results established that white matter circuitry is dimensionally and strongly related to both neurocognition and social cognition, and that microstructure of the uncinate fasciculus and the rostral body of the corpus callosum may assume a "privileged role" subserving both. Further, we found that participant-wise estimates of white matter microstructure, weighted by cognitive performance, were largely consistent with participants' categorical diagnosis, and predictive of (cross-sectional) functional outcomes. CONCLUSIONS: The demonstrated strength of the relationship between white matter circuitry and neurocognition and social cognition underscores the potential for using relationships among these variables to identify biomarkers of functioning, with potential prognostic and therapeutic implications.


Asunto(s)
Trastornos del Conocimiento , Esquizofrenia , Sustancia Blanca , Humanos , Esquizofrenia/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Cognición Social , Estudios Transversales , Cognición , Pruebas Neuropsicológicas
18.
BJR Case Rep ; 9(2): 20220120, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36998335

RESUMEN

Necrotizing fasciitis of the breast is a rare, life-threatening entity characterized by a rapidly aggressive infection of the soft tissue. There are few literature reports on necrotizing fasciitis at the level of the breast tissue as the most common locations are within the abdominal wall or extremities, but this entity can lead to sepsis and systemic multiorgan failure if not adequately managed. Here, we report a case that highlights the course of a 68-year-old African American female with a past medical history of hypertension, hyperlipidemia, and poorly controlled diabetes mellitus, who presented with the complaint of a painful right breast abscess with intermittent, purulent drainage. An initial point-of-care ultrasound displayed an area of induration of the right breast as well as soft tissue edema with no identifiable fluid collection. A subsequent CT abdomen and pelvis was obtained given new onset abdominal pain, which demonstrated incidental findings of inflammatory changes and subcutaneous emphysema along with colonic diverticulosis. Surgical intervention was immediately sought for which she underwent debridement and exploration of the right breast with findings that were consistent with necrotizing transformation. The patient was sent back to the OR for an additional surgical debridement the next day. Of note, the patient had post-op atrial fibrillation with rapid ventricular response and had to be admitted to the ICU for conversion to sinus rhythm. She returned to sinus rhythm and was transferred back to medicine before application of a negative pressure wound dressing on discharge. The patient was transitioned from Enoxaparin to Apixaban for anticoagulation control in the setting of atrial fibrillation before being discharged to a Skilled Nursing Facility with long-term antibiotics. This case highlights the difficulty and significance in establishing a prompt diagnosis for necrotizing fasciitis.

19.
NPJ Digit Med ; 6(1): 19, 2023 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-36737642

RESUMEN

Triage is a system used to prioritise patients as they enter the emergency department (ED) based on their need for urgent care. In recent decades, EDs have becoming increasingly overcrowded, leading to longer pre-triage waiting times for patients. E-triage interventions like kiosks have been proposed as a solution to overcrowding. We conducted a literature review into the effectiveness of kiosks in improving triage efficiency. After rigorously searching five biomedical databases and screening candidate articles in Endnote, we identified nine papers pertaining to the introduction of kiosks in emergency departments. Six articles had positive findings-with E-triage interventions improving some aspect of the triage process-such as reducing pre-triage times. Conversely, only three articles reported negative findings, such as low uptake. Consequently, EDs should consider introducing kiosks to complement the current nurse-led triage process and thereby promote better patient outcomes.

20.
Poult Sci ; 102(4): 102486, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-36736139

RESUMEN

This study was conducted to understand the impact of including full fat high-oleic soybean meal in layer hen diets on nutrient digestibility and added nutritional value in eggs. Forty-eight layers (∼36 wk old) were randomly assigned to one of 4 isonitrogenous (18.5% crude protein) treatment diets with 12 replicate birds per treatment in a 3-wk study. Treatments were 1) solvent extracted defatted soybean meal + corn diet, 2) dry extruded defatted soybean meal + corn, 3) full-fat soybean meal + corn, 4) high-oleic full-fat soybean meal + corn diet. Apparent ileal digestibility of crude fat (CF) and crude protein (CP) were determined using celite (∼2%) as an indigestible marker. Tibia strength and egg quality parameters (egg weight, shell strength, Haugh unit, shell color, and yolk color) were recorded during the study. Fatty acid profiles, including the monounsaturated fatty acid, oleic acid (C18:1, cis), in eggs and adipogenic tissue (liver, muscle, and fat pad) were measured using gas chromatography (GC-FID). Digestibility values of CF ranged from 71 to 84% and CP varied from 67 to 72% for treatment diets, with treatment mean values being no different (P > 0.05) between treatment diets. No differences between treatment diets in tibia strength or egg quality parameters (egg weight, shell strength, and Haugh unit) were observed (P > 0.05) except for yolk color. Similarly, there were no differences in the total lipids in egg yolk (P > 0.05) between treatment diets. However, oleic acid percentage of total lipid in egg and tissue was significantly higher (P < 0.001) in hens given the high-oleic full-fat soybean meal diet than in other treatment groups. No difference was observed in oleic acid percentage of total lipid in egg between the other 3 treatment diets (P > 0.05). Overall, the results exhibited that the eggs and tissue of layer hens fed the full-fat high-oleic acid soybean meal diet were higher in oleic acid while the CF and CP digestibility remained similar to the digestibility of the other diets.


Asunto(s)
Pollos , Ácido Oléico , Animales , Femenino , Pollos/fisiología , Ácido Oléico/farmacología , Harina , Dieta/veterinaria , Nutrientes/fisiología , Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales
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