The Psychological Well-Being of Medical Versus Dental GME Residents During the COVID 19 Pandemic: A Cross-Sectional Study.

PURPOSE: Trainees are facing isolation and burnout, due to the fear of contracting and transmitting novel coronavirus-19 (COVID-19). There has been a reduction in clinical activities of residents. The purpose of this paper is to measure and compare the psychological well-being of dental versus medical residents during the COVID-19 outbreak. METHODS: This is a cross-sectional study whereby trainees of a hospital in New York City were sent a questionnaire. Participants were from the dental and medical departments. Psychological measures of depression and post traumatic stress disorder were assessed utilizing the Patient Health Questionnaire-9 (PHQ-9) and The Impact of Event Scale-Revised (IES-R) questionnaire. Other variables compared were age, gender, smoking status, living situation and comorbidities. Data analysis utilized chi-squared (X2) and t-tests. Bivariate correlation and linear regression analyses were also utilized. RESULTS: The survey was sent to 19 dental (Dental) and 171 medical (MD) residents. There were 66 participants. The response rate was 63.16 and 35.09% for the Dental and MD residents, respectively. The mean age for the Dental and MD residents, respectively, was 29.62 ± 2.09 and 34.82 ± 9.32 (P = .014). Eighty-one percent of the Dental respondents were male and 33.3% of the MD respondents were male (P < .001). The mean PHQ-9 score was 18.29 ± 2.88 vs 7.24 ± 7.41 for Dental and MD residents, respectively (P < .001). A higher score represents increased severity of depression. The Dental residents scored 61.9 ± 3.90 on the IES-R vs 30.36 ± 24.67 (P < .001). A higher score indicates a greater frequency of intrusive thoughts and avoidance. Forty-two percent of Dental and 13.3% of MD residents tested positive; 25% of Dental and 28.9% of MD residents self-reported symptoms for COVID-19. Being positive or symptomatic resulted in statistically significant higher IES-R and PHQ-9 scores. CONCLUSIONS: Dental residents and being positive or symptomatic for COVID-19 resulted in higher PHQ-9 and IES-R scores. Being aware of the impact of COVID-19 is an important step in providing intervention.

Transcranial Dopplers Revisited: Development of Novel Markers for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage.

Background Cerebral vasospasm has been monitored by conventional angiography or transcranial Doppler (TCD). While angiography is the most accurate and reliable method for detection, TCDs are a noninvasive alternative to monitor onset and resolution of vasospasm. We aim to determine whether alternative TCD parameters rather than Lindegaard ratio lead to an improved method to diagnose and potentially prevent cerebral vasospasm. Methods A total of 103 consecutive patients with subarachnoid hemorrhage (SAH) were retrospectively reviewed and TCD studies were performed during the first 14 days post-bleed or longer if indicated. Multivariate logistic regression models were developed using significant univariate characteristics. Receiver operating characteristic (ROC) curves evaluated the mean middle cerebral artery (MCA), peak systolic MCA (PSV MCA), and end diastolic MCA (EDV MCA) velocities as well as ratios when compared to the ipsilateral extracranial internal carotid artery (ICA). The area under the curve was calculated to compare accuracy for symptomatic vasospasm. Results Thirteen patients (12.6%) were observed to develop cerebral vasospasm. Aneurysm location (p = 0.51), Hunt and Hess grade (p = 0.44), Fischer grade (p = 0.87), comorbidities, age (p = 0.67), or gender (p = 0.41) did not appear to have any effect in predicting the presence of vasospasm. ROC curves demonstrated that MCA EDV appeared to be slightly better compared to MCA velocity in predicting symptomatic vasospasm. PSV MCA/extracranial ICA and the EDV MCA/extracranial ICA ratios appeared to be an improvement to the Lindegaard ratio in the prediction of symptomatic vasospasm. Conclusion The utility of peak systolic and end diastolic velocities, instead of the classically referenced mean velocities and Lindegaard ratio, may improve diagnostic sensitivity of cerebral vasospasm after subarachnoid hemorrhage.

Traumatic Pneumothorax in a 58-Year-Old Man: A Case Report of a Rare Post-Acupuncture Adverse Event.

BACKGROUND The prevalence of chronic medical conditions continues to rise, as does the number of patients seeking alternative treatments for them. Chronic pain is a prevalent medical complaint and acupuncture often is used to treat it. The Chinese literature documents several adverse events (AEs) associated with acupuncture, including cardiac tamponade, pneumothorax, infection, and nerve injuries. These complications are rare and may be associated with anatomical characteristics of the patients and deep insertion of the acupuncture needles. Differences in body type, weight, height, sex, and muscle mass contribute to anatomical differences and the depth at which vital organs lie. Having a better understanding of these anatomical differences may alter the occurrence of such AEs. CASE REPORT A slim 58-year-old man who was treated for neck pain with acupuncture presented with 2-day history of moderate-severity pleuritic and sharp pain radiating from the left scapula to the midaxillary and retrosternal area. A left-sided pneumothorax was diagnosed on chest X-ray and the patient was treated with a chest tube. CONCLUSIONS This case underscores that acupuncture can result in complications such as a pneumothorax from puncture of the pleura. These types of AEs from acupuncture can be avoided with a better understanding of anatomical differences, including body mass index and variations in depth associated with body size, musculature, or skeletal structure. When placing the needles, it is crucial for practitioners to know that the depth at which vital organs lie may differ between patients.

Coinfection with SARS-CoV-2 and Influenza A Virus in a 32-Year-Old Man.

BACKGROUND There was a growing presumption that coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and another viral respiratory illness was nonexistent. Although there has been an increasing number of coinfection cases since the beginning of the SARS-CoV-2 pandemic, there is still a significant lack of information regarding the symptomatology, treatment, prognosis, and reasoning behind coinfection. This raises concern of the possibility of misdiagnosis or delay in treatment. CASE REPORT This case report discusses a coinfection of SARS-CoV-2 and Influenza A in a 32-year-old man to highlight that these viruses can coexist within the same patient. This patient unfortunately died of persistent respiratory failure after several days in the ICU. CONCLUSIONS Coinfection of SARS-CoV-2 and Influenza A can occur and lead to a poor prognosis.

Leukocyte filtration and postoperative infections.

BACKGROUND: Leukocyte filtration has been hypothesized to reduce the risk of postoperative infections by alleviating the immunosuppressive effect of whole blood. However, the literature regarding the clinical efficacy of leukocyte filtration remains conflicted. This meta-analysis investigates the impact of allogeneic and autologous leukocyte-filtered blood transfusions on the incidence of postoperative infections in adult surgical patients. METHODS: A comprehensive literature search of PubMed, Google Scholar, and Cochrane Central Registry of Controlled trials (1966-2016) was completed for all published randomized controlled trials. Postoperative infections under "as-per-protocol" (APP) and "intention-to-treat" (ITT), length of stay, and mortality were analyzed. RESULTS: Sixteen randomized controlled trials involving 6586 randomized (ITT) patients (4615 APP patients) in various clinical settings were evaluated. The leukocyte-filtered blood group demonstrated an overall 26% risk reduction in postoperative infections when analyzed by APP (relative risk [RR] = 0.74; 95% confidence interval [CI, 0.60-0.92]; P = 0.007) and a 22% risk reduction when analyzed by ITT (RR = 0.78; 95% CI [0.65-0.94]; P = 0.009). Leukocyte-filtered blood was also associated with a significant reduction in length of stay (standardized difference of mean [SDM] = -0.74; 95% CI [-1.32 to -0.15]; P = 0.014) and all-cause mortality (RR = 0.74; 95% CI [0.57-0.95]; P = 0.018). CONCLUSIONS: Leukocyte-filtered blood transfusions are associated with significantly lower postoperative infection rates in both the APP and ITT populations. Leukocyte filtration also shortens length of stay and decreases all-cause mortality in surgical patients and should be considered in all surgical patients.

Risk of Metabolic Complications in Patients with Solid Tumors Treated with mTOR inhibitors: Meta-analysis.

BACKGROUND/AIM: Numerous trials have described a wide variation of metabolic complications associated with the mammalian target of rapamycin inhibitors (mTORi). This analysis aimed to report and critically analyze the risks of mTORi-associated metabolic complications. MATERIALS AND METHODS: A comprehensive search of all published phase II or III randomized controlled trials were investigated. Outcomes included were adverse effect profiles of hyperglycemia (HGC), hypertriglyceridemia (HTG), and hypercholesterolemia (HCE). RESULTS: Sixteen phase II/III clinical trials were identified. The overall incidence of all-grade (AG) and high-grade (HG) metabolic complications associated with mTORi were 39.7% and 4.1% respectively. mTORi use was associated with an increased risk of AG (2.97 [2.25-3.92]) and HG HGC (4.08 [2.71-6.14]), AG (2.22 [1.70-2.89]) and HG HTG (1.88 [1.10-3.20]), and AG (2.48 [1.83-3.36]) and HG HCE (4.26 [2.30-7.90]). CONCLUSION: mTORi are associated with a significantly increased risk of AG and HG HGC, HTG, and HCE. Clinicians should be aware of these risks, perform regular monitoring, and consider alternative anti-neoplastic treatments or adjunctive pharmacological intervention if necessary.