EUS-guided tissue acquisition in patients with solid pseudopapillary neoplasms of the pancreas.

OBJECTIVES: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has been the most common method used for the preoperative cytopathological diagnosis of solid tumors of the pancreas. There are only a few reported cases about the role of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) in the pre-operative diagnosis of solid pseudopapillary neoplasms (SPN). This study aimed to evaluate the diagnostic yield of EUS-TA,including endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) andEUS-FNB, in patients with SPN. METHODS: We performed a retrospective analysis of patients with EUS-TA for SPN diagnosis in 2 referral centers. The primary outcome was the diagnostic yield of EUS-TA compared to the surgical specimen. RESULTS: Seventy-four patients with SPN of the pancreas were identified. Eighteen had a EUS-TA (10 EUS-FNB and 8 EUS-FNA). The median age of the patients was 31 years (IQR 21-38), and all patients were women. The most common presenting symptom was abdominal pain. Most of the tumors were in the head of the pancreas (9/18; 50%). The median tumor size by EUS was 4.5 cm (min-max 2-15 cm). The most common appearance on EUS was a solid lesion (n = 8/18, 44.4%). A definitive presurgical cytopathological diagnosis was obtained in 16/18 patients (88.8%) with EUS-TA. The sensitivity and positive predictive value of the EUS-TA were 94% each. One patient in the EUS-FNB group developed mild acute pancreatitis. CONCLUSION: The diagnostic yield of the EUS-TA in SPN is high. In most cases, the diagnosis was obtained with the first procedure. No differences in the diagnostic yield or AEs between EUS-FNA vs. EUS-FNB needles were seen.

"The Wild West:" Nurse Experiences of Responding to the 2017 Las Vegas Mass Shooting.

OBJECTIVE: The purpose of this study was to explore the experiences of nurses who responded to a public mass shooting in 2017. METHODS: This qualitative study was conducted with a sample of nurses who responded to a mass shooting, recruited purposively from a hospital in Las Vegas, Nevada. Intensive interviews were conducted with a total of 7 nurses, audio-recorded and transcribed for thematic analysis. RESULTS: Six themes were developed from interview data: (1) "The worst night of my life": Overrun and overwhelmed; (2) Unexpected altruism and benevolence of patients and staff; (3) "The Wild West": Giving victim care by improvising beyond rules; (4) Experiencing a range of reactions in the immediate aftermath and in the long term; (5) Shifts in nursing practice and evolving team dynamics; and (6) Defining realistic approaches to support staff mental health and mass casualty preparation. CONCLUSION: Nurses who were involved in responding to the public mass shooting described the event as life-altering. Given the critical role of nurses in responding to mass shootings, it is essential to consider how nurses can be supported in the aftermath of these events and how mass disaster preparation can include attention to the needs of nurses.

Academic Health Centers and Humanitarian Crises: One Health System's Response to Unaccompanied Children at the Border.

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UCH's 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3 to 17 years were cared for. A total of 782 children had COVID-19, most infected before arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH's recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers' capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.

Capsulotomía Nd-Yag Láser en Pseudofáquicos con OCP

Una de las causas de la disminución de la visión es la catarata. El tratamiento es la extracción del cristalino opaco con reemplazo por un lente intraocular (LIO). La opacidad de cápsula posterior (OCP) es una complicación frecuente a largo plazo. Las modificaciones en el diseño del LIO tanto del material y la forma tienen mayor importancia para prevenir la OCP. Como tratamiento está la capsulotomía neodimio YAG láser. Objetivo: identificar la OCP relacionado con el tipo de LIO implantado en pacientes pseudofáquicos en la FBO, entre el periodo de marzo del 2019 hasta febrero del 2022. Métodos: estudio observacional, tipo analítico, subtipo cohorte histórica, retro- prospectiva y longitudinal, con enfoque de análisis estadístico de tipo cuantitativo. Resultados: predominó el género femenino con un 60 % y un 40 % representaba al masculino; un 60,3 % del total tenían entre 65 a 80 años. La OCP en los 3 tipos de lentes intraoculares (acrílico y PMMA) ocasionó una disminución en la agudeza visual: el 37 %, predominó, por el LIO hidrofóbico, 36 % por el LIO PMMA y destacamos que el 27 % fue por el LIO hidrofílico. La incidencia de OCP a 5 años fue del 32 %. No se registró ningún efecto adverso en nuestro estudio. Conclusiones: la OCP provoca una baja de agudeza visual leve a moderada en los 3 tipos de LIOs; con un mínimo predominio de BAV leve para el tipo de LIO hidrofóbico comparado con el hidrofílico. Además después de la capsulotomía un gran porcentaje tiene entre 20/20 a 20/25 de AV mejor corregida.

One of the causes of decreased vision is cataract. Treatment is removal of the cloudy lens with replacement by an intraocular lens (IOL). Posterior capsule opacity (PCO) is a common long-term complication. Modifications in the design of the IOL both in terms of material and shape are of greater importance in preventing PCO. Treatment is neodymium YAG laser capsulotomy. Objective: to identify the PCO related to the type of IOL implanted in pseudophakic patients in the FBO, from March 2019 to February 2022. Methods: observational study, analytical type, historical cohort subtype, retro-prospective and longitudinal, with a quantitative statistical analysis approach. Results: the female gender predominated with 60% and 41% represented the male; 60.3% of the total was between 65 and 80 years old. PCO in the 3 types of intraocular lenses (acrylic and PMMA) caused a decrease in visual acuity: 37%, predominated, due to the hydrophobic IOL, 36% due to the PMMA IOL and we highlight that 27% was due to the hydrophilic IOL. The incidence of PCO at 5 years was 32%. No adverse effect was recorded in our study. Conclusion: PCO causes mild to moderate visual acuity loss in all 3 types of IOLs; with a minimal predominance of mild AVB for the hydrophobic IOL type compared to the hydrophilic one. In addition, after capsulotomy, a large percentage has between 20/20 and 20/25 better corrected visual acuity.

Transcriptomic analyses reveal increased expression of dioxygenases, monooxygenases, and other metabolizing enzymes involved in anthracene degradation in the marine alga Ulva lactuca.

To analyze the mechanisms involved in anthracene (ANT) degradation in the marine alga Ulva lactuca, total RNA was obtained from the alga cultivated without ANT and with 5 µM of ANT for 24 h, and transcriptomic analyses were performed. A de novo transcriptome was assembled, transcripts differentially expressed were selected, and those overexpressed were identified. Overexpressed transcripts potentially involved in ANT degradation were: one aromatic ring dioxygenase, three 2-oxoglutarate Fe (II) dioxygenases (2-OGDOs), and three dienelactone hydrolases that may account for anthraquinone, phthalic anhydride, salicylic acid, and phthalic acid production (pathway 1). In addition, two flavin adenine dinucleotide (FAD)-dependent monooxygenases, four cytP450 monooxygenases, two epoxide hydrolase, one hydroxyphenylpyruvic acid dioxygenase (HPPDO), and two homogentisic acid dioxygenases (HGDOs) were identified that may also participate in ANT degradation (pathway 2). Moreover, an alkane monooxygenase (alkB), two alcohol dehydrogenases, and three aldehyde dehydrogenases were identified, which may participate in linear hydrocarbon degradation (pathway 3). Furthermore, the level of transcripts encoding some of mentioned enzymes were quantified by qRT-PCR are in the alga cultivated with 5 µM of ANT for 0-48 h, and those more increased were 2-OGDO, HGDO, and alkB monooxygenase. Thus, at least three pathways for ANT and linear hydrocarbons degradation may be existed in U. lactuca. In addition, ANT metabolites were analyzed by gas chromatography and mass spectrometry (GC-MS), allowing the identification of anthraquinone, phthalic anhydride, salicylic acid, and phthalic acid, thus validating the pathway 1.

Investigating a Substance Abuse Screening in a Trauma Setting.

INTRODUCTION: Drug and alcohol consumption are often associated with trauma-related injuries. Various studies have been conducted which have shown the benefits of screening and brief intervention (SBI) tools for alcohol consumption. Despite their success, there are few SBI tools utilized for substance use and minimal reports of computerized versions. We hypothesized that a computerized SBI tool for drug use would be effective at identifying patients at risk of substance abuse in a trauma setting. METHODS: This was a prospective evaluation of a computerized alcohol and drug screening and brief intervention survey derived from the National Institute on Drug Abuse. The survey was given to all eligible trauma patients at UCI's Level 1 trauma facility between February 2019 and March 2020. Based on self-reported answers, a substance involvement (SI) score was generated which classified a patient's drug abuse risk as none (0), low (1-3), moderate (4-26), or high (27+). Statistical tests were then used to examine associations between demographic variables and risk categorization. RESULTS: A total of 1801 patients completed the entire survey. Of those, 346 (19.3%) patients reported use of illicit drugs: 10 for non-medical prescription use (.6%), 308 (17.1%) for non-prescription drug use, and 28 (1.6%) for both. Secondary analysis revealed a greater number of males were eligible for further SI assessment (25.1% vs 11.0%, P < .001). Of those, a greater proportion of men were classified as moderate/high risk (81.6% vs 61.5%, P < .001). Further breakdown revealed a greater proportion of patients ≤25 years old reported use of drugs compared to >85 years old (37.0% vs .5%, P < .001). In contrast to the self-reported data, there was an overall positive rate of toxicology of 48.51%. CONCLUSION: The analysis shows that the electronic survey identifies patients at risk of drug abuse, allowing for real-time intervention. Furthermore, it is granular enough to specify at-risk groups. However, a lower self-reported rate, as expected, was elucidated. Further studies to evaluate for improved screening and targeted intervention are warranted.

Serum IL-6: A potential biomarker of mortality among SARS-CoV-2 infected patients in Mexico.

BACKGROUND: The first case of SARS-CoV-2 in Mexico was reported in February 2020, since then, high rates of mortality due to COVID-19 have been found. Cytokine storm is linked to the severity and decreasing the survival among infected patients by COVID-19. The serum levels of Interleukin 6 (IL-6) have been correlated to mortality in COVID-19 cases and could be used as indicator of mortality in COVID-19 cases. The aim of this study was to determine levels of IL-6 and assess its usefulness as indicator of mortality among COVID-19 patients from Mexico. METHODS: A cohort study among 38 adults (28 men, 10 women) was carried out in the Regional High Specialty Hospital of the Yucatan Peninsula in Merida, Yucatan, Mexico. Demographic and clinical biochemistry data were collected. The serum levels of IL-6 were measured in each patient by specific immunoassays. RESULTS: High frequency of mortality (36.84%) was found in the sample. The average age of individuals that non-survive was significantly higher (59.71 ± 13.83 years) than the survival group (43.29 ± 11.80 years). Serum levels of IL-6 were significantly higher in patients that did not survive. A correlation between IL-6 levels with lymphocyte count, LDH, CRP and procaciltonin was found. The optimal cutoff value of IL-6 was 30.95 pg/mL with high sensitivity and specificity. CONCLUSION: Our findings demonstrate that level of IL-6 is an indicator of mortality among hospitalized COVID-19 patients in Mexico.

Pulmonary function and functional capacity in COVID-19 survivors with persistent dyspnoea.

The purpose of this study was to examine the physiological mechanisms of persistent dyspnoea in COVID-19 survivors. Non-critical patients (n = 186) with varying degrees of COVID-19 severity reported persistent symptoms using a standardized questionnaire and underwent pulmonary function and 6-minute walk testing between 30 and 90 days following the onset of acute COVID-19 symptoms. Patients were divided into those with (n = 70) and without (n = 116) persistent dyspnoea. Patients with persistent dyspnoea had significantly lower FVC (p = 0.03), FEV1 (p = 0.04), DLCO (p = 0.01), 6-minute walk distance (% predicted, p = 0.03), and end-exercise oxygen saturation (p < 0.001), and higher Borg 0-10 ratings of dyspnoea and fatigue (both p < 0.001) compared to patients without persistent dyspnoea. We have shown that dyspnoea is a common persistent symptom across varying degrees of initial COVID-19 severity. Patients with persistent dyspnoea had greater restriction on spirometry, lower DLCO, reduced functional capacity, and increased exertional desaturation and symptoms. This suggests that there is a true physiological mechanism that may explain persistent dyspnoea after COVID-19.

Risk Factors for Mortality in Hospitalized Patients with COVID-19: An Overview in a Mexican Population.

BACKGROUND: Currently, Mexico ranks third worldwide in mortality due to coronavirus disease pandemic 2019 (COVID-19) and reliable information is scarce, with the available data focused on epidemiological characteristics. This study aimed to identify the risk factors associated with mortality and outcomes in hospitalized Mexican patients with COVID-19. METHODS: We prospectively assessed patients admitted to a COVID-19 reference center in southeast Mexico between March 28 and June 30, 2020. Mortality was defined as survivors or non-survivors and univariate and multivariate logistic regression analyses were performed to explore the association of the clinical characteristics and laboratory parameters with mortality. RESULTS: We included 200 patients with a mean age of 55 years, 69% were men and 72% had at least one chronic comorbidity. Eighty-six patients required invasive mechanical ventilation (IMV) with an overall mortality rate of 82.5%. Only 51% of the patients with IMV were admitted to the intensive care unit (ICU), with a survival rate of 27.3%, but only 7.2% for patients without ICU admissions (p=0.014). The multivariate analysis found that a neutrophil-to-lymphocyte ratio ≥9 (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.05-10.53) albumin <3.5 g/dL (OR, 3.76; 95% CI, 1.56-9.07), lactate dehydrogenase (LDH) level ≥725 U/L (OR, 5.45; 95% CI, 2.36-12.57), and IMV (OR, 64.7; 95% CI, 15.20-275.39) were independent risk factors associated with mortality. CONCLUSION: Neutrophil-to-lymphocyte ratio, LDH, albumin, and IMV were independent risk factors for mortality in Mexican patients with COVID-19. Also, the availability of ICU resources is invaluable for better outcomes in critically ill patients. Our results could provide clinical information for timely decision-making in low-and-middle income countries to overcome the pandemic.

Bleomycin-Induced Cryptogenic Organizing Pneumonia Manifested as Spontaneous Pneumothorax in a Patient with Classic Seminoma.

Cryptogenic Organizing Pneumonia (COP) can manifest like a collagen disorder or infectious diseases, or be caused by drug induced toxicity. This paper presents the case of a 24 year-old man diagnosed with classic seminoma, treated with chemotherapy scheme that included bleomycin (accumulated dose, 120 units). The patient was admitted at the hospital due to rapidly-progressing dyspnea and thoracic pain. The diagnostic approach revealed the presence of a spontaneous pneumothorax, while a lung biopsy documented COP. Despite treatment, the patient died from disease progression.

Prenatal Screening for Thrombophilias: Indications and Controversies, an Update.

Pregnancy is associated with increased clotting potential and decreased fibrinolysis. Women with thrombophilias have an increased risk of venous thromboembolism during pregnancy. At least 50% of cases of venous thromboembolism in pregnant women are associated with an inherited or acquired thrombophilia. Acquired thrombophilias have also been linked with adverse pregnancy outcomes such as recurrent pregnancy loss, intrauterine fetal demise, early onset severe preeclampsia, placental abruption, and fetal growth restriction. This article addresses indications for thrombophilia testing, the appropriate laboratory tests, and timing of testing to ensure reliability of results.

Correlation of serum fructosamine and recurrent pregnancy loss: Case-control study.

AIM: Pre-gestational diabetes is associated with an elevated risk of pregnancy loss, but it is unclear whether subclinical glucose intolerance is associated with pregnancy loss, especially recurrent pregnancy loss (RPL). The aim of this study was therefore to compare maternal serum fructosamine (a marker of glycemic control) in patients with and without RPL. METHODS: A case-control study was carried out of 117 women with unexplained RPL, defined as two or more pregnancy losses with no more than one live birth, and 117 age-matched controls with at least one full-term uncomplicated pregnancy and no more than one pregnancy loss. No RPL patients or controls had a clinical diagnosis of pre-gestational or gestational diabetes. Maternal serum was analyzed for fructosamine on quantitative spectrophotometry. RESULTS: Mean body mass index (BMI) of RPL patients was 26.0 ± 6.4 kg/m(2) compared with 26.6 ± 5.8 kg/m(2) (P = 0.40). Fructosamine was higher in women with RPL (224.1 ± 28.79 µmol/mL) compared with controls (188.9 ± 19.3 µmol/mL, P < 0.001). This difference persisted when RPL patients and controls were stratified by BMI. The proportion of women with elevated fructosamine considered diagnostic of diabetes (>285 µmol/L) was similar in RPL patients and controls. CONCLUSION: The RPL patients and controls had a similar proportion of women with elevated fructosamine considered diagnostic of diabetes. Serum fructosamine was increased in women with RPL compared with controls. Thus, subclinical glucose intolerance may be associated with an increased risk of RPL. These data support further investigation into the mechanisms of RPL associated with glucose intolerance, but do not support testing for subclinical glucose intolerance in women with RPL.

An extension of the theory of planned behavior to predict pedestrians' violating crossing behavior using structural equation modeling.

This paper aimed to examine pedestrians' self-reported violating crossing behavior intentions by applying the theory of planned behavior (TPB). We studied the behavior intentions regarding instrumental attitude, subjective norm, perceived behavioral control, the three basic components of TPB, and extended the theory by adding new factors including descriptive norm, perceived risk and conformity tendency to evaluate their respective impacts on pedestrians' behavior intentions. A questionnaire presented with a scenario that pedestrians crossed the road violating the pedestrian lights at an intersection was designed, and the survey was conducted in Dalian, China. Based on the 260 complete and valid responses, reliability and validity of the data for each question was evaluated. The data were then analyzed by using the structural equation modeling (SEM). The results showed that people had a negative attitude toward the behavior of violating road-crossing rules; they perceived social influences from their family and friends; and they believed that this kind of risky behavior would potentially harm them in a traffic accident. The results also showed that instrumental attitude and subjective norm were significant in the basic TPB model. After adding descriptive norm, subjective norm was no more significant. Other models showed that conformity tendency was a strong predictor, indicating that the presence of other pedestrians would influence behavioral intention. The findings could help to design more effective interventions and safety campaigns, such as changing people's attitude toward this violation behavior, correcting the social norms, increasing their safety awareness, etc. in order to reduce pedestrians' road crossing violations.

Cervical length screening: a randomized trial assessing the impact on visit length and patient attitudes.

OBJECTIVES: The purpose of this study was to quantify the time required for transvaginal cervical length measurements during a second-trimester anatomy scan and to evaluate patient attitudes regarding cervical length assessment. METHODS: Consenting women were randomly assigned to one of the following: (1) standard arm-cervix visualized, no prespecified cervical length measurement; (2) sequential arm-3 transabdominal cervical length measurements obtained, transvaginal sonography performed if images were inadequate or if any measurement was 3 cm or less; and (3) screening transvaginal sonography arm-3 transvaginal cervical length measurements obtained. Times were recorded for the entire examination and cervical length evaluation. Participants completed a questionnaire at the end of their visits. RESULTS: Sixty of 230 eligible women enrolled. Demographic characteristics were similar across groups except for body mass index, which was greater in the sequential arm than the screening arm (mean ± SD, 28.5 ± 7.75 versus 24.7 ± 3.89 kg/m(2); P = .03). There were no differences in total examination times between the 3 arms (24.8 ± 8.59 versus 27.8 ± 8.75 versus 28.5 ± 7.78 minutes; P= .39). There were no differences across groups in participant attitudes regarding examination discomfort or embarrassment. CONCLUSIONS: Performing screening transvaginal sonography to measure cervical length did not have a statistically significant impact on the amount of time for completion of the entire examination. Participants had positive responses regarding cervical length assessment by transabdominal and transvaginal sonography.

Celiac disease serum markers and recurrent pregnancy loss.

Celiac disease has been associated with numerous unfavorable health outcomes, including pregnancy complications such as infertility, preterm birth, and preeclampsia. However, the association between celiac disease and recurrent pregnancy loss (RPL) remains uncertain. Our purpose was to compare serum markers of celiac disease in women with and without RPL. Therefore, we performed a case-control study of 116 women with unexplained recurrent pregnancy loss and 116 age-matched controls. Maternal sera were analyzed for immunoglobulin A (IgA) and immunoglobulin G (IgG) tissue transglutaminase (tTG) antibodies and endomysial (EM) antibodies. Groups were similar with regard to age, race and ethnicity, and BMI. One case and one control tested positive (≥20 Units) for IgA tTG antibodies and mean levels of IgA tTG antibodies were similar in cases and controls (5.5±2.86 versus 6.0±12.45; p=0.16). No cases or controls were positive for IgG tTG antibodies. However, cases had higher levels of IgG tTG antibody compared with controls (4.0±2.40 versus 3.3±1.30; p=0.0064). One subject (a control) tested positive for IgA EM antibodies and no subjects tested positive for IgG EM antibodies. In conclusion, positive results for tTG and EM antibodies were similar in women with and without RPL. Given these results, testing for occult celiac disease is not recommended in the evaluation of women with idiopathic RPL.

Cesarean delivery on maternal request: a western North Carolina perspective.

Cesarean delivery on maternal request (CDMR), a primary cesarean without medical indication for a singleton, term pregnancy, has been identified by physicians as one factor in the increasing rate of cesarean delivery despite nationwide efforts to the contrary. The purpose of this project was to better understand women's preferences and motivations for their desired mode of delivery. A 62-item survey was administered to pregnant women asking for their delivery preference, their reasons, sources of information, feelings about this pregnancy, and opinions about delivery options. Responses were analyzed for candidates for CDMR or for repeat cesarean section, separately; the standard error of measure is ±4% (95% CI). 396 patients returned surveys (response rate = 63.2%). CDMR was desired by 34/316 (11%) candidates; repeat cesarean was desired by 32/70 (46%) patients. Significant correlates of CDMR included choosing during the first trimester (22% vs. 8.2%; RR = 2.72; P = 0.015), smoking during pregnancy (19.7% vs. 7.6%; RR = 2.60; P = 0.036), and being worried about the delivery (P = 0.004). Desire for CDMR increased as worries increased from unworried (4.4%) to somewhat (11.8%) to very worried (27.6%). Primary reasons included existing medical complications and preventing birth injury. The majority of patients believed CDMR should be an "informed choice"; other opinions varied by delivery preference. The majority of women preferred vaginal deliveries suggesting little contribution of CDMR to the increasing cesarean rate. Contrary to physicians' beliefs, the women's primary objective was their infants' health rather than their own well-being.