Special Issue:
Challenges and Opportunities in Metabolic Syndrome
Chun-Man Chen
TaiRx, Inc., Taipei 115602, Taiwan
Yen-Ling Chen
TaiRx, Inc., Taipei 115602, Taiwan
Shu-Min Lin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
Huang-Pin Wu
Division of Pulmonary, Critical Care and Sleep Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204201, Taiwan
Jiun-Nong Lin
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan; Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung 824005, Taiwan
Kai-Huang Lin
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
Chin-Ming Chen
Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan 710402, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
Kuang-Yao Yang
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
Shih-Chi Ku
Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
Fu-Tsai Chung
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan; Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236043, Taiwan; Department of Respiratory Therapy, New Taipei Municipal TuCheng Hospital, New Taipei City 236043, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333423, Taiwan
Chih-His Kuo
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan
Chien Tung Chiu
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan
Chi-Kuei Hsu
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 840203, Taiwan
Hsin-Hui Hsu
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
Chien-Ming Chu
Division of Pulmonary, Critical Care and Sleep Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204201, Taiwan
Han-Chung Hu
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan
Chung-Shu Lee
Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan 333423, Taiwan; Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236043, Taiwan
Shin-Hwar Wu
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
I-Chieh Mao
Division of Critical Care Internal Medicine, Department of Emergency Medicine and Critical Care, Changhua Christian Hospital, Changhua 500209, Taiwan
Ting-Yu Chao
TaiRx, Inc., Taipei 115602, Taiwan
Yi-Wen Chu
TaiRx, Inc., Taipei 115602, Taiwan
Du-Shieng Chien
TaiRx, Inc., Taipei 115602, Taiwan
Abstract
The relationship between serum selenium levels and mortality was investigated in septic patients with severe selenium deficiency (baseline selenium ≤ 80 ng/mL). Eligible patients of sepsis or septic shock were randomized to receive Placebo or High-Dose Selenium (1,000 μg/day) via intravenous injection. Safety, serum selenium, mortality, SOFA, and Glasgow Coma Scale (GCS) scores were monitored. Among all 330 subjects, 27.9% subjects (n=92) had severe selenium deficiency (mean serum selenium = 66.5 ng/mL). Mortality of severe selenium deficiency patients was 27.2%, significantly higher than 17.9% of all subjects. In severe selenium deficiency Placebo group (n=45), 62% subjects showed gradual increase of selenium levels to ~110 ng/mL (mortality ~21.4%), while 38% subjects remained at low selenium ≤ 110 ng/mL throughout study (mortality ~41.2%). Mortality for Placebo subjects with normal baseline selenium ≥ 110 ng/mL was 13.6%. With High-Dose Selenium treatment, 91% of severe selenium deficiency subjects showed quick selenium increase to ~110 ng/mL (mortality 25.5%). Mortality was reduced to 8.6% for High-Dose Selenium subjects with baseline selenium ≥ 110 ng/mL. The odds ratio showed significantly greater survival of High-Dose Selenium subjects with baseline selenium ≥ 110 ng/mL (91.4%) than severe selenium deficiency Placebo subjects (74.1%). Mean baseline SOFA scores for severe selenium deficiency patients were 9.1–9.4, decrease of SOFA scores in High-Dose Selenium subjects was significantly greater than Placebo subjects, along with significant improvement of GCS scores. Repeated infusion of High-Dose Selenium in severe selenium deficiency patients for 14 days was safe and well-tolerated. Mortality for patients with sepsis was clearly affected by serum selenium concentrations. High mortality (41–50%) was observed in the sepsis patients constantly with low selenium £ 80 ng/mL; mortality was reduced to 21–23% if their serum selenium could be increased to ≥ 110 ng/mL. High-Dose Selenium resulted in rapid restoration of serum selenium and improved the survival of severe selenium deficiency septic patients. Low mortality (9–14%) was observed in the sepsis patients starting with baseline selenium ≥ 110 ng/mL. Overall this study demonstrates the significant impact of insufficient selenium levels on the mortality of septic patients. Treatment with high-dose selenium reduced the mortality of severe selenium deficiency septic subjects.
Abstract
Introduction: Low- and middle-income countries (LMICs) face a disproportionate burden of diseases requiring emergency care. In Uganda, road traffic trauma in the context of rapid urbanization, particularly motorcycle accidents, accounts for 48% of medical emergencies. The burden of road traffic accidents, obstetric complications, and non-communicable diseases necessitate robust emergency care, yet Uganda faces systemic challenges in this sector. Following the 60th and 72nd sessions of the World Health Assembly that called for strengthened emergency, critical and operative care to achieve universal health coverage, Uganda committed to strengthening emergency medical services through taking key steps such as developing a national Emergency Medical Services (EMS) Policy. The EMS Policy outlined twelve key focus areas including development of human resources for emergency medical services, key among are emergency physicians. To support these efforts, Seed Global Health, the Ugandan Ministry of Health, Makerere University, and Mbarara University of Science and Technology partnered to strengthen the emergency medicine training between 2019 and 2024.
Methods: We conducted a desk review to evaluate the collaborative effort between Seed Global Health, Ministry of Health, Makerere University and Mbarara University of Science and Technology. We reviewed policy documents, health records, and program reports to assess initiatives by Seed Global Health that were focused on developing human resources for emergency medical services, including emergency physicians training, emergency nurses and the contributions of local and international faculty.
Results: The partnership between Seed Global Health, Ministry of Health, Mbarara University of Science and Technology and Makerere University successfully trained 21 new emergency physicians, with 43 more residents currently in training. It introduced essential clinical resources, enhancing diagnostic and treatment capacities for improved patient care while improving learning environments through skills laboratory support, simulation support and classroom equipment. Additionally, it supported the coordination of emergency services within emergency departments in hospitals as well as enhanced advocacy efforts to improving emergency care in Uganda. However, despite these tremendous milestones, challenges persist including a shortage of specialists relative to the high demand for services, a need for increased investment for emergency medical services and a need for better integration of emergency services within the healthcare system.
Conclusion: This article highlights the value of international collaborations, long term partnership and targeted training in addressing emergency care gaps in LMICs. We recommend expanding emergency medicine programs, increasing government investment in facilities and human resources, and strengthening interdisciplinary emergency response teams. These measures are essential for providing sustainable, quality emergency care to address Uganda’s growing needs.
Anantharaman Venkataraman
Department of Emergency Medicine, Singapore General Hospital, SingHealth Emergency Medicine Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
Steven Hoon Chin Lim
Accident & Emergency Department, Changi General Hospital, SingHealth Emergency Medicine Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre 2 Simei St 3, Singapore 529889, Singapore
Lim Jia Hao
Department of Emergency Medicine, Singapore General Hospital, SingHealth Emergency Medicine Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
Jeremy Choon Peng Wee
Department of Emergency Medicine, Singapore General Hospital, SingHealth Emergency Medicine Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
Abstract
The emergency care systems of most communities around the world have multiple components through which patients move and which are, at best, disjointed and not well coordinated. Illnesses and injuries which begin in the community and frequently preventable often do not have the benefit of bystander assistance or dedicated immediate emergency ambulance care and arrive at Emergency Departments that are crowded. Patients often spend long hours in these Emergency Departments and, if requiring inpatient care, have to wait many hours before an inpatient bed becomes available. Those requiring further convalescent care may often find inadequate arrangements available for them to recover smoothly. The end result is delays and adverse clinical outcomes that are often not measured or even appreciated.
This report discusses each of ten components of the emergency care system as in exists in most communities, including injury and illness prevention, the community burden of emergencies, bystander first responder care, ambulance-based second responder care, emergency department crowding and its contributory factors, transitions of care to the inpatient departments and community convalescent care units, coordination of emergency departments in the community, the patient’s family and, of course, the emergency patient. The effects of fragmentation in each of these components are described and strategies to address each mentioned.
There is a need for a patient-centric, integrated approach to the provision of emergency care in any community which can break down the barriers created by fragmented care and provide the seamless, high-quality care that all our patients deserve.
John R. Richards, MD
University of California, Davis, School of Medicine, Department of Emergency Medicine, Sacramento, California, USA
Aaron R. Danielson, MD
University of California, Davis, School of Medicine, Department of Emergency Medicine, Sacramento, California, USA
Rory P. Stuart, MD
University of California, Davis, School of Medicine, Department of Emergency Medicine, Sacramento, California, USA
Andrew E. Richards
University of California, Davis, School of Medicine, Department of Emergency Medicine, Sacramento, California, USA
Erik G. Laurin, MD
University of California, Davis, School of Medicine, Department of Emergency Medicine, Sacramento, California, USA
Abstract
Methamphetamine (MA) use continues to rise worldwide. The adverse effects of MA on the cardiovascular system include cardiomyopathy, dysrhythmias, coronary arterial vasospasm, and atherosclerosis. Methamphetamine-associated cardiomyopathy (MACM) affects predominantly younger male patients and is responsible for an increasing proportion of heart failure emergency department visits, hospital admissions/readmissions, morbidity, and mortality. Reverse remodeling of MACM and full cardiac recovery is achievable in patients who cease using MA and remain abstinent with self-direction, cognitive behavioral therapy, brief interventions, contingency management, motivational interviewing, and residential rehabilitation. Recovery is further enhanced by the addition of an exercise program and guideline-based pharmacotherapy for heart failure, which includes β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Alternative heart failure treatment with isosorbide dinitrate plus hydralazine, ivabradine, vericiguat, and omecamtiv mecarbil represent further adjuncts which may promote reverse remodeling. Antioxidant compounds such as coenzyme-Q10, omega-3 polyunsaturated fatty acids, resveratrol, and cannabidiol may aid in cardiac restoration. Diet changes, metformin and glucose control, stem cell therapy, melatonin, and sleep quality improvement are further steps on the road to recovery. In this article we review the cardiotoxicity of MA, pathogenesis of MACM, and evidence behind pharmacologic and lifestyle interventions to reverse its progression.
Deborah R. Gustafson
Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
Recai Yucel
Department of Biostatistics, Temple University, Philadelphia, Pennsylvania
Samuel Apple
State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
Gianna Cirrone
State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
Haoyuan Gao
Department of Biostatistics, Temple University, Philadelphia, Pennsylvania
Aaron Huang
State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
Xinrui Ma
Department of Biostatistics, Temple University, Philadelphia, Pennsylvania
Ayesha Saad
State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
Jeremy Wilson
State University of New York Downstate Health Sciences University, College of Medicine, Brooklyn, New York
Sarah Kabariti
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York; Department of Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn New York
Sergey Motov
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York; Department of Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn New York
Abstract
Background. Maintaining good mental health among Emergency Department healthcare workers (ED HCW) is paramount to well-functioning healthcare. We measured mental health and COVID-19 symptoms in ED HCW at a COVID-19 epicenter.
Methods. A cross-sectional, convenience sample of adult (>18 years) ED HCW in Brooklyn, New York, USA, who were employed at >50% of a full-time effort, was surveyed September–December, 2020 with reference period March-May 2020. An anonymous email-distributed survey assessed gender, age, race, healthcare worker status (clinical versus non-clinical), SARS-CoV-2 testing, number of people to talk to, COVID-19-related home problems, mental health care interruption during COVID-19, loneliness, and survey date. Outcomes included symptoms of depression, psychological distress, perceived stress, post-traumatic stress disorder (PTSD), anxiety, and resilience measured using validated scales.
Results. Of 774 HCW, 247 (31.9%) responded (mean age 38.2±10.8 years; 59.4% White; 52.5% men; 80.1% clinical; 61.6% SARS-CoV-2 tested). Average mental health scores were significantly higher among clinical vs non-clinical HCW (P’s<0.0001-0.019). The proportion reporting a clinically-relevant psychological distress symptom burden was higher among clinical vs non-clinical HCW (35.8% vs 13.8%, p=0.019); and suggested for depression (53.9% clinical vs 35.7% non-clinical, p=0.072); perceived stress (63.6% clinical vs 44.8% non-clinical, p=0.053); and PTSD (18.2% clinical vs 3.6% non-clinical, p=0.064). Compared to non-clinical staff, Medical Doctors and Doctors of Osteopathy reported 4.8-fold higher multivariable-adjusted odds of clinically-relevant perceived stress (95%CI 1.8-12.9, p=0.002); Emergency Medical Technicians reported 15.5-fold higher multivariable-adjusted odds of clinically-relevant PTSD (95%CI 1.6-150.4, p=0.018). Increasing age, number of COVID-19-related home problems and people to talk to, loneliness and mental health care interruption were adversely associated with mental health; being male and SARS-CoV-2 testing were beneficial.
Conclusions. COVID-19-related mental health burden was high among ED HCW in Brooklyn. Mental health support services are essential for ED HCW.
Kei Suzuki
Emergency and Critical Care center, Mie University Hospital
Hideo Wada Kaoru Ikejiri
Emergency and Critical Care center, Mie University Hospital
Asami Ito
Emergency and Critical Care center, Mie University Hospital
Takeshi Matsumoto
Department of Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu, Japan
Shine Tone
Departments of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
Masahiro Hasegawa
Departments of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan
Motomu Shimaoka
Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
Toshiaki Iba
Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
Hiroshi Imai
Emergency and Critical Care center, Mie University Hospital
Abstract
Objective: As coronavirus disease 2019 (COVID-19) is frequently associated with thrombotic diseases, the hemostatic abnormalities in cases of COVID-19 have attracted attention. This study examined the hemostatic abnormalities in patients with severe COVID-19.
Methods: Hemostatic abnormalities were examined based on the activated partial thromboplastin time (APTT) and small amount of tissue factor-induced FIX activation (sTF/FIXa) using a clot waveform analysis (CWA). The anti-Xa activity, C5b-9 and ADAMTS 13 values were also examined in these patients.
Results: CWA-APTT and CWA-sTF/FIXa showed that the peak times were prolonged, but peak heights were increased before anticoagulant therapy. The parameters of the CWA-APTT and CWA-sTF/FIXa were not correlated with the anti-Xa activity. The peak times of the CWA-sTF/FIXa were significantly longer in non-survivors than survivors. Although the plasma levels of C5b-9 and ADAMTS13 activity were markedly decreased in severe COVID-19 patients, there were no significant differences in C5b-9 levels or ADAMTS-13 activity between survivors and non-survivors.
Conclusions: The CWA showed the marked hemostatic abnormalities and hypercoagulability in COVID-19 patients, and anticoagulant therapy might not be monitored by routine APTT.
Panagiota Xaplanteri
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Vasileios Zoitopoulos
Department of Microbiology, General Hospital of Eastern Achaia, Aigio, Greece
Vasiliki Diamanti
Department of Microbiology, General Hospital of Eastern Achaia, Aigio, Greece
Athanasia Moutafidi
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Panagiota Masoura
Department of Microbiology, General Hospital of Eastern Achaia, Kalavrita, Greece
Charalampos Potsios
Department of Internal Medicine, University General Hospital of Patras, Greece
Konstantina Filioti
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Angeliki Rapanou
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Zoi Grammenidou
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Aimilios Tzoudas
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Chara Sakarelou
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Tatiana Beqo Rokaj
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Katerina Ntzinia
Department of Primary Healthcare, General Hospital of Eastern Achaia, Kalavrita, Greece
Elsa Kampos Martinez
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Georgios Papachristopoulos
Department of Internal Medicine, General Hospital of Eastern Achaia, Kalavrita, Greece
Constantinos A Letsas
Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece
Abstract
Background: Since December 2019 mankind is agonized over the deadly coronavirus disease 2019 (COVID-19) which is due to the novel coronavirus (2019-nCoV) or Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-cov-2).
Methods: In this retrospective study, laboratory findings and demographic features form all confirmed COVID-19 patients who attended the Emergency Department of both branches of our hospital during the first semester of 2021 were collected and analyzed. The working hypothesis was that initial laboratory data at the time the patients seeked medical assistant for the first time, regardless of comorbidities and day of onset of symptoms, can help predict patients’ outcome. Demographic data and laboratory tests were compared between hospitalized and non-hospitalized patients.
Results: Data of 270 patients were collected and analyzed retrospectively. 31 blood measurement parameters performed in both hospital branches were compared between hospitalized and non-hospitalized patients. Of those, WBC count (p=0.016), neutrophil percentage (p<0.001), lymphocyte percentage (p<0.001), platelet count (p=0.041), glucose (p<0.001), urea (p<0.001), creatinine (p<0.001), SGOT (p=0.024), CK (p<0.053), LDH (p<0.001), GGT (p<0.001), sodium (p<0.001), calcium (p<0.001), high sensitivity Troponin I (p<0.001), and ferritin levels (p<0.001), proved statistically significant. Regarding demographic data, age was significantly linked to patients’ survival.
Conclusion: Our data suggest that common initial laboratory findings of COVID-19 patients who seek for the first-time medical assistant regardless of comorbidities and time from onset of symptoms can give clues to the patient outcome. Age is also important for patients’ survival. Especially in a Primary Health Care Setting, common blood parameters like WBC count, neutrophil and lymphocyte percentage, platelet count, glucose, urea, creatinine, SGOT, CK, LDH, GGT, sodium, calcium, high sensitivity Troponin I, and ferritin levels, could be really helpful to predict disease severity.
Jens J. Christensen
The regional department of clinical microbiology, Zealand University Hospital, Køge, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Christian S. Jensen
The regional department of clinical microbiology, Zealand University Hospital, Køge, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Denmark
Rimtas Dargis
The regional department of clinical microbiology, Zealand University Hospital, Køge, Denmark
Xiaohui C. Nielsen
The regional department of clinical microbiology, Zealand University Hospital, Køge, Denmark
Mia M. Pries- Heje
Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Christoffer Wiingaard
Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Nikolaj Ihlemann
Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Sabine Gill
Department of Cardiology, Odense University Hospital, Denmark
Niels E. Bruun
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
Hanne Elming
Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
Jonas A. Povlsen
Department of Cardiology, Aarhus University Hospital, Denmark
Trine Madsen
Department of Cardiology, Aalborg University Hospital, Denmark
Kaare T. Jensen
Department of Cardiology, Aarhus University Hospital, Denmark
Kurt Fuursted
Department of Bacteria, parasites and fungy, Statens Serum Institut, Denmark
Lauge Østergaard
Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Ulrik Christiansen
Department of Cardiology, Aalborg University Hospital, Denmark
Flemming S. Rosenvinge
Department of Clinical Microbiology, Odense University Hospital, Odense University, Denmark
Jannik Helweg-Larsen
Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
Emil L. Fosbøl
Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Lars Køber
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Christian Torp-Pedersen
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Aalborg University, Denmark; Department of Cardiology, Hillerød Hospital, University of Copenhagen, Denmark
Niels Tønder
The regional department of clinical microbiology, Zealand University Hospital, Køge, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Claus Moser
Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Denmark; Costerton Biofilm Center, Department for Immunology and Microbiology, University of Copenhagen
Kasper Iversen
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology and Emergency Department, Herlev-Gentofte University Hospital, University of Copenhagen, Denmark
Henning Bundgaard
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Denmark
Abstract
The Danish National Partial Oral Treatment of Endocarditis Trial (POET) demonstrated non-inferiority of partly peroral compared to intravenous antibiotic therapy for infective endocarditis (IE) caused by Streptococcus spp, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci. Identifications by whole genome sequencing (WGS) of available streptococcal strains were related to clinical data. Sequences were obtained using Illumina technology (MiseqÒ) followed by core genome analysis and single-nucleotide polymorphism phylogeny examinations. Average nucleotide identification (ANI) calculated using the tool fastANI. Informations on +/- preexisting valve prosthesis, valve surgery and outcome related to obtained identifications. Streptococcal strains (n=123) from 117 patients were WGS examined. Twelve percent were pyogenic group strains and 88% belonged to viridans groups, mainly mitis and bovis groups. Phylogenetic trees were in accordance regarding species and subspecies identifications. High ANI percentages to type strains were found. Respectively 39, 60 and 16 IE cases involved mitral, aortic or both valves. IE caused by pyogenic group or mitis plus bovis group streptococci most frequent affected, respectively, mitral and aortic valves. Thirty-one patients (26%) had a preexisting prosthesis; notably, in 50% of bovis group IE cases. Fifty-six patients had valve surgery done during the current disease; 8% and 93% of patients having, respectively, pyogenic group and mitis group strains as causative agents. Of patients allocated to intravenous or intravenous followed by peroral antibiotic treatment, respectively 26 and 30 had valve surgery done during the current disease. Composite outcome (all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen) at five-year follow-up comprised in total 39 events. In conclusion, molecular examinations adds on substantially by detailing species and subspecies affiliations. A broad spectrum of streptococcal species and subspecies causing IE were identified with mitis- and bovis group strains dominating. Relating strain identifications to clinical data can assist in planning and treating confirmed/suspected IE patients. Adding WGS identification of streptococci in selected patients groups (e.g. IE) in order to expand number of cases characterized in detail seems ideal and advocates for centralized registration of results to reveal important clinical relations.
Jennifer Stahl, MD
East Carolina University, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine. 600 Moye Blvd, 3E-149, Greenville, NC 27834; East Carolina University, Department of Emergency Medicine. 600 Moye Blvd, Mail Stop 625, Greenville, NC 27834
John O’Donnell, DO
East Carolina University, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine. 600 Moye Blvd, 3E-149, Greenville, NC 27834
Abstract
Airway management is both a fundamental skill and resuscitative treatment that has taken a prominent role in emergency medicine. In the past few decades there have been many advancements in airway management particularly in critically ill patients. Technology has been developed and adapted to provide improved visualization for endotracheal intubation as well as supportive strategies for oxygenation and optimization of medications. In this review we will discuss the current practices and literature in airway management of critically ill patients including medication optimization and airway visualization techniques for first pass success.
Kyle M. Hocking, PhD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
Jessica Huston, MD
Department of Medicine, Division of Cardiovascular Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Jeffery Schmeckpeper, MD, PhD
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Monica Polcz, MD
Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
Marisa Case, RN
Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Meghan Breed, MD
Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
Lexie Vaughn, MD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
Dawson Wervey, BS
Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
Colleen Brophy, MD
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
JoAnn Lindenfeld, MD
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
Bret D Alvis, MD
Department of Surgery, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
Abstract
Introduction: A cornerstone of heart failure assessment is the right heart catheterization and the pulmonary capillary wedge pressure measurement it can provide. Clinical and hemodynamic parameters such as weight and jugular venous distention are less invasive measures often used to diagnose, manage, and treat these patients. To date, there is little data looking at the association of these key parameters to measured pulmonary capillary wedge pressure (PCWP). This is a large, retrospective, secondary analysis of a right heart catheterization database comparing clinical and hemodynamic parameters against measured PCWP in heart failure patients.
Methods: A total of 538 subjects were included in this secondary analysis. Spearman’s Rho analysis of each clinical and hemodynamic variable was used to compare their association to the documented PCWP. Variables analyzed included weight, body mass index (BMI), jugular venous distention (JVD), creatinine, edema grade, right atrial pressure (RAP), pulmonary artery systolic pressure (PASP), systemic vascular resistance, pulmonary vascular resistance, cardiac output (thermal and Fick), systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, oxygen saturation (SpO2), and pulmonary artery diastolic pressure (PADP).
Results: Ten out of 17 selected parameters had a statistically significant association with measured PCWP values. PADP had the strongest association (0.73, p<0.0001), followed by RAP and PASP (0.69, p<0.0001 and 0.67, p<0.0001, respectively). Other significant parameters included weight (0.2, p<0.001), BMI (0.2, p<0.001), SpO2 (-0.17, p<0.0091), JVD (0.24, p<0.005) and edema grade (0.2, p<0.0001).
Conclusion: This retrospective analysis clarifies the associations of commonly used clinical and hemodynamic parameters to the clinically used gold standard for volume assessment in heart failure patients, PCWP.
Paige M. Shaffer
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Abigail Helm
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Michael Andre
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Herschelle Reaves
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Kathryn E. Bruzios
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Jennifer Harter
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
David Smelson
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School
Abstract
Background: People with co-occurring substance use and mental health disorders (COD) who experience chronic homelessness often have difficulty engaging in treatment and support services. During the Coronavirus Disease 2019 (COVID-19) pandemic this problem was compounded by community agencies reducing or eliminating in-person care to minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examined the rapid adaptations that were made during COVID-19 to a community-based multicomponent intervention, Maintaining Independence and Sobriety Thorough Systems Integration, Outreach and Networking (MISSION), and how these changes impacted engagement in treatment and fidelity to the intervention prior to and during the COVID-19 pandemic.
Methods: Guided by the Model for Adaptation Design and Impact (MADI) framework, this mixed-methods study (1) qualitatively examines the nature of the rapid adaptations made to the MISSION model with n=4 MISSION clinical program staff and (2) quantitatively examines patterns of engagement and fidelity to the MISSION model prior to and during the pandemic among n=109 people with COD who are experiencing chronic homelessness in an urban region of Massachusetts.
Results: In consultation with the MISSION developers, clinical staff made rapid innovative adaptations to MISSION. These changes, identified through the qualitative interviews, included developing safe in-person session procedures (e.g., shortening sessions, adapting group sessions to individual sessions) and strategies to engage incarcerated individuals to provide continuity of care (e.g., mailing letters and coordinating with jail staff). Despite the adaptations, adherence to the MISSION model remained consistent during COVID-19 and compared to pre-COVID-19. However, there was more adherence to the structured components of care compared to the unstructured components of care during the pandemic. Interestingly, linkages to other needed treatments and community supports increased by 522% despite the pandemic closures.
Conclusions: This mixed-methods study demonstrated that a community-based multicomponent intervention for people experiencing chronic homelessness with COD can be adapted rapidly during a pandemic to help maintain COD treatment and with good fidelity, and that the MADI framework can help document those changes. Thus, these findings provide treatment settings with helpful guidance for community-based COD interventions and public health emergency preparedness.
Mike Astorp
Doctor at Department of Emergency Medicine and Trauma Care, Aalborg University Hospital
Gustav V. Gade
Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
Jeppe Emmersen
Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9000 Aalborg, Denmark
Alexander W. Erbs
Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
Sten Rasmussen
2. Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
Stig Andersen
Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark ; Department of Geriatric Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
Abstract
Background: The covid-19 pandemic hit healthcare systems globally, and demands on healthcare worker resources rose dramatically. Medical students are a potential resource to meet these demands, but to what extent can they be expected to step up, and where can they fill in.
Aims: To evaluate medical students’ contribution as healthcare workers during the pandemic and assess motivation and deterrence factors.
Methods: A cross-sectional survey questionnaire was distributed one year following the lockdown of the country and accessible from March 18th through April 14th 2021. All medical students enrolled at Aalborg University were asked about positions held, number of working hours, and factors of motivation and deterrence.
Results: The response rate was 69% (557 of 806), and 80.4% (448 of 557) of the respondents had performed paid work as healthcare workers during the pandemic. Students took up an array of jobs in the healthcare system, the most prevalent being Covid-19 test-personal (302, 54%), assistant nurse (149, 27%) and locum physician (115, 21%), with 42.2% (235 of 557) of medical students holding more than one position. The majority worked between 11 and 20 hours weekly, and the 448 medical students working in the pandemic reported filling in for 205 full-time jobs. Working students differed from non-working students by giving the most markedly higher scores to taking pride, participating in a historical event, receiving salary and improving job opportunities (all, p<0.001).
Conclusion: Medical students proved to be willing contributors and flexible resources. The 448 medical students worked an estimated 344,000 hours during the first year of the pandemic, and they supported several job types. Differences within domains for motivation and deterrence were identified.
Chiori Kodama
WHO Regional Office for the Eastern Mediterranean, WHO Health Emergencies Programme
Gary Kuniyoshi
WHO Regional Office for the Eastern Mediterranean, WHO Health Emergencies Programme
Basel Abdullah Salem Obaid
WHO Country Office for Yemen
Eudaldo Gonzalez Martinez
WHO Country Office for Yemen
Annette Heinzelmann
WHO Country Office for Yemen
Adham Rashad Ismail Abdel Moneim
WHO Country Office for Yemen
Saeed Mohammed Saeed Baraiah
Ministry of Public Health and Population, Yemen
Ahmed Taha Makki
Faculty of Medicine and Health Sciences, University of Aden
Alaa Hashish
WHO Country Office for Oman
Kamila Al Alawi
WHO Country Office for Oman
Nathalie Khawam
WHO Country Office for Oman
Jean Yaacoub Jabbour
WHO Country Office for Oman
Abdinasir Abubakar
WHO Regional Office for the Eastern Mediterranean, WHO Health Emergencies Programme
Richard John Brennan
WHO Regional Office for the Eastern Mediterranean, WHO Health Emergencies Programme
Abstract
Background: Caring for critically ill patients is challenging in resource-limited and complex emergency settings such as Yemen, where the burden of disease and mortality from potentially treatable illnesses and injuries is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings are numerous and include deficiencies in health systems structure, a limited capable healthcare workforce, insufficient financial resources, and access constraints due to insecurity, among many other factors.
Methods: Potential solutions include the development of focused practical and educational programs for capacity building of national healthcare professionals’ knowledge and skill sets in the care of critically ill patients. This requires adaptation of proven curricula into a national training program to promote implementation of evidence-based critical care.
Results: Yemen successfully introduced a 9-week national critical care training program that targeted both physicians and nurses from 11 of 12 southern governorates from 5th June to 11th August 2022. The procedures for its development and its implementation are described in this report. Successful continued development and implementation are contingent on ongoing adaptation, secured financial resources, and support from academic institutions such as the Faculty of Medicine and Health Sciences University of Aden (Yemen), the Oman Medical Specialty Board (Sultanate of Oman), health care authorities and partners. Technologies utilized included tele-education and a simulation skills center using high fidelity manikins, in addition to the lectures and bed-side training sessions in Intensive Care Unit (ICU).
Conclusion: Critical care training is a vital need and of paramount importance in resource-limited and complex emergency settings such as Yemen and programs should be developed and sustained under country ownership with support from internal and external partners. The current challenges and shortfalls require new approaches such as a comprehensive, focused critical care/ICU national training program to build a cadre of critical care professionals in the country together with the provision of human, material, and financial resources support. Through producing a cadre of critical care/ICU national professionals, this course is contributing to enhancing the emergency preparedness and response capacities in Yemen, as well as building sustainable critical care capabilities within the national health system that will further save many lives in Yemen.
Mohd Azren Hashim
Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia,Pahang, Malaysia.
Mohamed Saufi Awang
Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia,Pahang, Malaysia.
Alarmelu Nithya Ramanathan
Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia,Pahang, Malaysia.
Mohd Ghaddafi Wahab
Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia,Pahang, Malaysia.
Mohd Aidil Mohd Nor
Neurosurgery Department, Hospital Tengku Ampuan Afzan, Pahang, Malaysia.
Edre Mohammad Aidid
Department of Community Medicine, Kulliyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
Abstract
Context: Serum albumin is the major protein of the human plasma, accounting for about 60% of the total plasma protein. Serum albumin levels tend to decline in the plasma due to injury or infection independent of nutritional status. Serum albumin consumption increases in a state of stress. Reduction in serum albumin occurs with intracranial haemorrhages. In a patient with severe head injury, there is a significant decline in serum albumin leading to hypoalbuminemia. Serum albumin can be used as an outcome marker in various critical illnesses, including traumatic brain injury.
Aim: To determine that serum albumin is an independent predictor affecting the outcome of patients with severe traumatic brain injury over a 6-month duration
Settings and design: This was conducted as prospective cohort study in two neurosurgical centres in the East Coast of Malaysia from June 2020 to June 2021
Subjects and methods: A total of fifty-five patients were admitted to our emergency intensive care, or high dependency unit with varying degrees of severe head injuries. Forty patients fulfilled the inclusion criteria of our study and were recruited for data collection and further analysis. Their serum albumin levels were drawn, analysed, and recorded.
Statistical analysis used: Descriptive, univariate and multivariate analyses using Multiple Logistic Regression model were done using SPSS version 26.0.
Results: Average age for patients in this study was 42 years old. 87.5% of patients involved in this study were male, while the remaining 12.5% were female. The ethnicity of the majority of patients were Malays (77.5%) and the other ethnicities involved were Chinese, Indians and Bangladeshi, with a total of 22.5%. Multiple intracranial injuries were suffered by 57.5% of our study population, Subdural Hemorrhage, Extradural Hemorrhage, Contusional bleed, and Diffuse Axonal Injury were seen respectively in 20%, 10% 7.5% and 5% of the study population. At six months, the unfavourable outcome for serial serum albumin in patients with severe head injury patients was 62.5%, while the favourable outcome was 37.5%. Serum albumin of 30 g/L or less than 30g/L at day 1,3 and 5 post-trauma was noted to have unfavourable outcomes compared to serum albumin level of more than 30g/L.
Conclusion: Serum albumin is an independent predictor of outcome in severe TBI patients. However, larger prospective studies are required to verify these findings.
Gintare Valentelyte, PhD MSc (Health Economics)
Healthcare Outcome Research Centre (HORC), School of Population Health, RCSI University of Medicine and Health Sciences, Ireland.
D. A. McNamara
Department of Surgery, Beaumont Hospital, Dublin 9, Ireland.
J. Sorensen
Healthcare Outcome Research Centre (HORC), School of Population Health, RCSI University of Medicine and Health Sciences, Ireland.
Abstract
Background: Emergency abdominal surgery refers to a range of complex intra-abdominal surgical procedures associated with high mortality risk and long length of hospital stay. Length of stay is often used as a proxy measure for hospital resource utilisation in hospital capacity management and planning. Our objective was to explore the heterogeneity in length of stay among emergency abdominal surgery patients admitted at publicly funded hospitals in Ireland.
Methods: We analysed national hospital inpatient data (2014 – 2022) for adults discharged following emergency abdominal surgery. We used quantile regression methods to explore the heterogeneous effects along the length of stay distribution between 10th – 90th percentiles. We compared quantile regression with ordinary least squares estimates, and identified from which point in the length of stay distribution heterogeneous effects were different from ordinary least squares estimates.
Results: From the National Healthcare Quality Reporting System records for 15,408 emergency abdominal surgery adult inpatient episodes were obtained for analysis. We observed significant (p < 0.001) heterogeneous effects across most quantiles of the length of stay distribution. Length of stay was longer for patients with Charlson comorbidity indices of 4 or higher, American Society of Anaesthesiologists physical status scores of 2 and higher, admissions to critical care units, hospital readmissions within 30-days, discharges to nursing home and other hospital, and for patients treated in Model 4 hospitals. Length of stay was shorter for patients with a cancer diagnosis and patients who died during admission. Across these factors, statistically significant heterogeneous effects above ordinary least squares estimates were observed at the 70th to the 90th quantile.
Conclusions: The quantile regression methods identified the presence of significant heterogeneity across the entire length of stay distribution. Relative to ordinary least squares mean estimates, quantile regression is a better method for identifying heterogeneous effects by exploring the entire length of stay distribution. Our results highlight the importance of using appropriate methods for estimating skewed outcomes. This is important to provide valid and relevant empirical analysis to inform policy.
Siddhartha Mani, MD(Medicine), DM(Cardiology)
Consultant Cardiologist, NH- Rabindranath Tagore International Institute of Cardiac Science (NHRTIICS), Kolkata, India
Sujata Sen, DNB(Emergency Medicine)
SR, Emergency Medicine Department, AGMC & GB Pant Hospital, Tripura, India
Kaushik Nag, MD(Community Medicine)
Assistant Professor, Tripura Medical College, Tripura, India
Prof. Sobhan Biswas, MD(Medicine)
Senior Consultant, Emergency Medicine, NH- Rabindranath Tagore International Institute of Cardiac Science (NHRTIICS), Kolkata, India
Abstract
Background: The occurrence of arrhythmias among acute coronary syndrome patients is very common. However, their diagnosis is not considered in contemporary acute coronary syndrome patients. This study investigates the incidence and types of arrhythmias among acute coronary syndrome patients presenting to the emergency department, as well as their association with various factors and patient outcomes.
Methods: The current prospective observational study was conducted at a tertiary care center in Kolkata, India. Data were collected from 76 acute coronary syndrome patients admitted between October 2020 and May 2021 to the emergency department. Information was gathered through semi-structured interviews and relevant investigations.
Results: The majority of the patients were aged 61-70 years, with three-fourths of the study population being male. The incidence of arrhythmia was diagnosed in 77.6% of the patients. The most common arrhythmias were sinus tachycardia, ventricular premature complex, atrial fibrillation, sinus bradycardia, and complete heart block. Arrhythmias were more prevalent among ST-elevation myocardial infarction (62.7%) and unstable angina (8.5%) patients. Patients with Left Ventricular Ejection Fraction ≤ 40% had a higher incidence of arrhythmias (93.5%). The mortality rate during hospital stay was 11.9% among acute coronary syndrome patients with arrhythmias, while all acute coronary syndrome patients without arrhythmia had a 100% survival rate.
Conclusion: This study highlights the incidence and types of arrhythmias in acute coronary syndrome patients presenting to the emergency department. It reveals a higher prevalence of arrhythmias in specific subgroups, such as patients with ST-elevation myocardial infarction and those with a reduction in left ventricular function. These findings contribute to our understanding of arrhythmias in acute coronary syndrome and their association with patient outcomes, emphasizing the importance of appropriate management and monitoring in this population.
Subrata Biswas
Department of General Medicine, Burdwan Medical College, and Hospital, Burdwan, West Bengal, India
Ritwik Ghosh
Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
Arpan Mandal
Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
José Lapeña
Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
Dipayan Roy
Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; Indian Institute of Technology (IIT), Madras, Tamil Nadu, India; School of Humanities, Indira Gandhi National Open University, New Delhi, India
Julián Benito-León
Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain
Abstract
Background and aim: Organophosphate poisoning is a global health burden due to intentional and occupational exposure, particularly in Asian countries. Patients are usually monitored through serum acetylcholinesterase levels. Still, it is non-specific, does not correlate well with the severity of poisoning, and is not widely available in laboratory settings in developing countries. This study aims to assess serum baseline creatine phosphokinase (CPK) levels as a prognostic biomarker in acute organophosphate poisoning.
Materials and methods: We recruited all patients older than 12 years who were admitted to the wards of the Indoor Medicine Ward in Burdwan Medical College and Hospital in West Bengal (India) because of ingestion or inhalation of organophosphorus compounds within the previous 12 hours between May 1, 2019, and November 1, 2020. Clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Serum CPK, pseudocholinesterase levels, and pH were measured. Levels were re-assessed on days three and seven, and patients were followed-up until death or discharge.
Results: 100 patients (68 men and 32 women) were included in the study. Most of them presented with miosis (98%), followed by abdominal pain (96%), diarrhea (78%), and vomiting (52%). In the multivariate analysis, the patients with a higher risk of being intubated were younger. Of the analytical levels, the one that showed a better relationship with the risk of intubation was the pseudocholinesterase level, although without statistical significance. Initial CPK levels, time of admission, or stratification on the POP severity scale offered poor performance after adjustment.
Conclusion: The analytical values of CPK or the POP severity scale at the time the patient presents in the emergency room have limited value to predict the final severity of the picture. The amount of the poison consumed should be collected for future studies to elucidate these differences.
Mairi C. Noverr
Department of Microbiology and Immunology, Tulane University School of Medicine
Junko Yano
Center of Excellence in Oral and Craniofacial Biology, LSU Health School of Dentistry
Michael E. Hagensee
Section of Infectious Diseases, Department of Medicine, LSU Health New Orleans
Hui-Yi Lin
Biostatistics Program, LSU Health School of Public Health
Mary C. Meyaski
Clinical and Translational Research Center, LSU Health New Orleans
Erin Meyaski
Clinical and Translational Research Center, LSU Health New Orleans
Jennifer Cameron
Department of Microbiology, Immunology, and Parasitology, LSU Health New Orleans
Judd Shellito
Section of Pulmonary Medicine, Department of Medicine, LSU Health New Orleans
Amber Trauth
Section of Infectious Diseases, Department of Medicine, LSU Health New Orleans
Paul L. Fidel, Jr.
Center of Excellence in Oral and Craniofacial Biology, LSU Health School of Dentistry
Abstract
Mortality in COVID-19 cases was strongly associated with progressive lung inflammation and eventual sepsis. There is mounting evidence that live attenuated vaccines commonly administered during childhood, also provide beneficial non-specific immune effects, including reduced mortality and hospitalization due to unrelated infections. It has been proposed that live attenuated vaccine-associated non-specific effects are a result of inducing trained innate immunity to function more effectively against broader infections. In support of this, our laboratory has reported that immunization with a live attenuated fungal strain induces a novel form of trained innate immunity which provides protection against various inducers of sepsis in mice via myeloid-derived suppressor cells. Accordingly, we initiated a randomized control clinical trial with the live attenuated Measles, Mumps, Rubella (MMR) vaccine in healthcare workers in the greater New Orleans area aimed at preventing/reducing severe lung inflammation/sepsis associated with COVID-19 (ClinicalTrials.gov Identifier: NCT04475081). Included was an outcome to evaluate the myeloid-derived suppressor cell populations in blood between those administered the MMR vaccine vs placebo. The unanticipated emergency approval of several COVID-19 vaccines in the midst of the MMR clinical trials eliminated the ability to examine effects of the MMR vaccine on COVID-19-related health status. Unfortunately, we were also unable to show any impact of the MMR vaccine on peripheral blood myeloid-derived suppressor cells due to several inherent limitations (low percentages of blood leukocytes, small sample size), that also included a collaboration with a similar trial (CROWN CORONATION; ClinicalTrials.gov Identifier: NCT04333732) in St. Louis, MO. In contrast, monitoring the COVID-19 vaccine response in trial participants revealed that high COVID-19 antibody titers occurred more often in those who received the MMR vaccine vs placebo. While the trial was largely inconclusive, lessons learned from addressing several trial-associated challenges may aid future studies that test the non-specific beneficial immune effects of live attenuated vaccines.
L. Vizer
Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill
N. Charguia
Wellbeing Program, School of Medicine, University of North Carolina, Chapel Hill
K. Adapa
Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill
L. Mazur
Division of Healthcare Engineering, School of Medicine, University of North Carolina, Chapel Hill
Abstract
Healthcare professionals practicing in the Emergency Department (ED) play a critical role in providing care in our societies. They interact with an assortment of sub-systems of the hospital and collaborate with various specialties across inpatient and outpatient settings. Research shows that >60% of ED physicians report burnout and, thus, it is important to understand the key factors contributing to their burnout. Over a ten-week period we used a mixed-method, theory-based, participatory, and data-driven approach based on survey, focus groups, and contextual inquiries to collect and analyze data and prioritize improvement efforts. Key areas of improvement were: i) workflows and patient monitoring that add to high cognitive load and stress levels; ii) low staffing, particularly among sitters, nurses, technicians, secretaries, and security staff; iii) suboptimal therapeutic atmosphere for psychiatric patients; iv) disrespectful and violent patients and visitors; v) communication issues, especially between the ED and other departments; and vi) frequent problems with the telecommunication system. We learned that EDs must take time to rigorously evaluate contributing factors to burnout while engaging their people who best know how to change systems to achieve positive and sustainable results.
Boubaker Charra
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
Yassine Bou-ouhrich
Department of Intensive Care Medicine, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
Abstract
Background: Coronavirus disease of 2019 or COVID-19 is characterised by two main features: the first is the respiratory compromise which corresponds to acute respiratory distress syndrome while the second corresponds to the state of hypercoagulability responsible for thromboembolic complications particularly pulmonary embolism which is the subject of this work. Indeed, a high prevalence of pulmonary embolism has been reported throughout the pandemic period with a significant morbidity and mortality. This reflects the severity of this life-threatening emergency chiefly in the elderly, hemodynamically unstable patients, and patients with severe underlying conditions, mainly cardio-pulmonary comorbidities. The aim of our study is to point out the incidence, the risk factors, the clinical and paraclinical features, the management strategies, and the overall prognosis of pulmonary embolism in critically ill COVID-19 and non-COVID-19 patients.
Patients and methods: It is a retrospective observational study carried out over a two-year-period from January 2019 (non-COVID-19) to December 2020 (COVID-19). Over the study period, 42 cases of COVID-19 and non-COVID-19 pulmonary embolism were collected from an overall set of 611 patients admitted to the medical intensive care unit of the IBN ROCHD university hospital of Casablanca.
Results: The mean age in the COVID-19 group was 64-year-old versus 46-year-old in the non-COVID-19 group. The sex ratio was 1.2 and 0.94 in the non-COVID-19 and COVID-19 group, respectively. Clinical symptomatology was dominated by respiratory failure and chest pain in non-COVID-19 patients while in the COVID-19 group, semiology was dominated by dyspnea, cough, and chest pain. The major sign of severity in both groups was tachypnea.
The chest X-ray was performed in all our patients, it displayed radiological abnormalities in all patients mainly hyper clarity in pulmonary fields. D-dimers were performed in all patients within the two study groups. A chest computed tomography angiogram was performed for all patients and showed unilateral pulmonary embolism in 61% of cases in the non-COVID-19 group versus 61.3% in the COVID-19 group. Cardiac ultrasound was performed for all patients. It showed dilatation of right cavities in both groups (81.8% in non-COVID-19 versus 93.5% in COVID-19 patients). Venous ultrasound of the lower limbs was performed in 96.8% of COVID-19 patients and in 72.7% of non-COVID-19 patients.
With regards to management, all COVID-19 and non-COVID-19 patients received anticoagulation therapy based on standard heparin and anti-vitamin K. Mortality accounted for 54.5% in non-COVID-19 patients versus 74.2% in COVID-19 patients.
Conclusion: COVID-19 pulmonary embolism is often associated with significantly higher morbidity and mortality as compared with non-COVID-19 pulmonary embolism.
Mon Mon Yee
Newcastle University Medicine Malaysia
Myat Kalayar Nyunt
Newcastle University Medicine Malaysia
Aye Mya Thidar
Newcastle University Medicine Malaysia
Myat Soe Khine
Oncology Department, Musgrove Park Hospital, Somerset NHS Foundation Trust, UK
Chong Yau Ong
Sengkang General Hospital, Singapore
Ong Gim Seong
Newcastle University Medicine Malaysia
Abstract
Introduction: Roleplaying is getting popular in modern education. Role-players are trained to act specific roles in clinical situations and interact with medical students in the simulation of real-clinical scenarios. Educators used Role-players wisely especially in restricted situation of Covid Era. There are many opportunities in using Role-players such as creating clinical situation, practicing communication skill, cost-effectiveness, saving the time, comfortable learning environment for learners, encouraging students to learn.
Aim: Current study aims to explore challenges and opportunities in roleplaying in medical education.
Method: This is a reflective writing about the role-play in medical education. The authors reflect on their collective experiences with the review of literatures and describe their educational encounters in various aspects of challenges and opportunities of using role-players in medical education vividly.
All authors have been involved in medical education for at least five years and have used role play to teach undergraduate students. The authors reflect on their role-playing experiences in various phases and modules, such as pre-clinical teaching, clinical case discussion, creative online clinical consultation, and clinical assessment studies. Several identified subject headings were used to group the common experiences, with an emphasis on addressing the challenges and opportunities in advancing the use of role-playing in medical education. The study search engine mage use of key points for its search such as, need for training of role-players, uncertain availability of role-players for certain teaching class and exams, need for specific age of role-players in definite clinical scenarios, some difficulties in recruitment of new role-players, preparation of clinical scenarios, student engagement, further collected information and data are descriptively stated.
Conclusion: Modern educators are trying to improve the roleplaying education. By enhancing opportunities to use Role-players in medical education, the soft skills of medical students such as cooperation in teamwork, negotiation and persuasion can be upgraded. These skills are essential skill for medical students to contribute as a health care provider in community.
The study summarises the numerous ways to overcome the challenges and highlighted that educators has significance role to make sure student receive all information of their task. This study brings out the value attached to clinical scenarios that are well prepared as a real-world event and suggests that reflection taken from role-players and students to improve future roleplaying class. This study contributes to enhancing emergency preparedness and response working as a part of role-playing education. The educators’ effort to improve role-playing education by enhancing opportunities for using role-players in medical education can upgrade the soft skills of medical students, such as cooperation in teamwork, negotiation, and persuasion. These skills are essential for medical students to contribute as health care providers in the community.
Bruce W. Newton, PhD
Department of Anatomy, Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC, USA
Zachary T. Vaskalis, PhD
Department of Medical Education, Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC, USA
Abstract
Background: Establishing an empathic bond of trust with patients is a trait that is important to learn during medical school. There are two types of empathy: affective and cognitive. Being able to partially blunt a detrimental affective response while maintaining cognitive empathy is beneficial for both the patient and the physician.
AIM: To find those students who have partially blunted their affective empathy while maintaining or enhancing their cognitive empathic skills.
Methods: Affective and cognitive empathy was measured using the Balanced Emotional Empathy Scale and the Jefferson Scale of Empathy, respectively. The survey instruments were given during entrance into medical school, at the start of years 3-4, and a final administration just before graduation. Students who fit the aim of the study, had blunted their BEES score by -0.5 to -1.5 s.d. below the male or female population norms, as well as being at or above the 75th percentile for JSE scores as established by the Project in Osteopathic Medical Education and Empathy study. Desired specialty choice and sex was also collected at each timepoint. Five specialties are “people-oriented” and have a large amount of patient contact and continuity of care, and include Family and Internal Medicine, Ob/Gyn, Pediatrics and Psychiatry. Most other specialties are more “procedure- or technical-oriented” and are those with little or no patient contact and/or continuity of care (e.g., Surgery, Emergency Medicine, Anesthesiology).
Results: Only a small subset of students (n = 15/345) fell within the above parameters upon entering medical school. It was a different, small cadre (n = 13) that had these traits upon graduation. Ergo, there was no student who fell within the parameters for all four years of their undergraduate medical education.
Conclusions: Few students had the ability to partially blunt their affective empathic response while maintaining the ability to give a reassuring cognitive empathic response to patients. This indicates an increased emphasis needs to be placed on teaching empathic skills during the basic science years of the curriculum. However, the onus needs to fall upon the physicians who are empathic role-models during the clinical rotation year.
Sebahattin Celik
Department of General Surgery, Van Yüzüncü Yıl University Faculty of Medicine.
İskan Çallı
Department of General Surgery, Van Yüzüncü Yıl University Faculty of Medicine.
Serpil Sevimli Deniz
Department of Computer Technologies, Gevaş Vocational School, Van Yüzüncü Yıl University
M. Kadir Bartin
General Surgery Clinic, Van Training and Research Hospital
Öztekin Çıkman
Department of General Surgery, Van Yüzüncü Yıl University Faculty of Medicine.
Muharrem Duran
General practitionerr in Emergency Depertmant, Van Training and Research Hospital
Serhat Binici
Department of General Surgery, Van Yüzüncü Yıl University Faculty of Medicine.
Abstract
World Health Organization defines obesity as “excessive fat accumulation at a level that may impair health”. Obesity is also officially defined as a “disease” by many surgical and endocrine societies (1,2), and also accepted as a risk factor for some cancers, cardiovascular diseases, chronic kidney disease, diabetes, metabolic syndrome, non-alcoholic fatty liver disease, as well as many chronic diseases (2). Although the degree of accuracy is debated, obesity is still defined as a body mass index (BMI) above 30 (1).
Obesity, which was alarming in western countries in the past, is currently a public health problem that concerns the whole world, except for a few southern African and Asian countries (1). Preventive measures are important in tackling the public health problem. In this context, an active life and low-calorie nutrition are accepted as basic preventive practices.
Ritwick Mondal
Department of Clinical Pharmacology and Therapeutic Medicine
Rahul Manna
Department of Emergency Medicine, IPGMER and SSKM Hospital, Kolkata, India; Neuberg Diagnostics
Emili Banerjee
Neuberg Centre for Genomic Medicine, Neuberg Diagnostics, Gujrat, India
Julián Benito-León
Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) Madrid, Spain; Department of Medicine Complutense University, Madrid, Spain.
Shramana Deb
lnstitute of Neuroscience, University of Kolkata, India
Abstract
Background: Brugada syndrome is generally considered a cardiac channelopathy disorder characterized by syncope or sudden cardiac death. The sodium voltage-gated channel alpha subunit 5 (SCN5A) gene is the most commonly mutated gene associated with Brugada syndrome. Recent discoveries of new variants of this gene, along with current guidance of family screening, have identified several asymptomatic carriers with potentially causative mutations.
Case presentation: We present the case of a 25-year-old female patient without any family history of Brugada syndrome nor related congenital cardiovascular disorders, with an extensive atrioventricular canal defect, who tested positive for a novel heterozygous variant NM_198056.3: c.3169G>C (p. Asp1057 His) in the SCN5A gene. She had no history of syncope or aborted sudden cardiac death except for recurrent chest infections since her early childhood. Intriguingly, she did not show a type I Brugada electrocardiogram pattern.
Conclusions: This report provides a novel heterozygous variant NM_198056.3: c.3169G>C (p. Asp1057 His) in the SCN5A gene, which may have a potential detrimental effect.
Jos P. Noordhuizen
Former Diplomate at EC BHM and VPM, former professor at School of Agriculture and Veterinary Science, Charles Sturt University, Boorooma Street, North Wagga, Australia; Utrecht University, Wageningen University (NL); Nantes Veterinary School (F), Lyon Veterinary School (F); Gand Veternary Faculty (B).
Abstract
In this paper, two main domains of veterinary preventive medicine are addressed: applying vaccines and implementing risk identification & risk management plans. Both should go together on food animal production farms because they appear to be mutually beneficial. Moreover, the potential risk of economic losses is drastically lowered. Both domains are briefly highlighted. A dairy farm is used for illustration purposes. Professional communication plays a paramount role in increasing the compliance of the farmer to these plans. Professional communication is incomparable with emergency risk communication such as should be implemented in highly contagious, notifiable diseases in large regions or such as in a Covid epidemic. Therefore, a discussion text has been added as an Annex I to compare the emergency risk communication outcomes related to Covid-19 in humans in France with the criteria of emergency risk communication addressed in the context of dairy cattle production. Guidelines to set up emergency risk communication plans are provided in an Annex II.
Alan Ducatman, MD, MS
West Virginia University School of Public Health
Lida Chatzi, MD, PHD
Keck School of Medicine, University of Southern California
Abstract
Background: This perspective concerning hepatoxicity of per- and poly-fluoroalkyl substances (PFAS) aims to provide a current understanding of the damage and reasonable clinician responses to the needs of concerned patients and affected communities.
Methods: Search strategy included PFAS and the following: human liver toxicity/disease; relevant biomarkers including transaminases, lipids, uric acid; predictive equations (for liver disease), liver imaging modalities, and histologic findings. Experimental data concerning liver outcomes and disrupted hepatic metabolic pathways was also reviewed. Recommended clinical approaches to patients and communities was sought in both the National Library of Medicine and relevant organizational websites.
Results: Several PFAS reliably cause adverse changes in human liver biomarkers, with strong consistency between human and experimental data. Adverse population changes include human transaminases, cholesterol and LDL cholesterol, and uric acid. This biomarker triad suggests that mechanisms and outcomes are or resemble metabolic associated steatotic liver disease, which is found across species following experimental PFAS exposure. Human imaging studies and sparse human histologic studies mostly support the inference that the toxicant damage is or resembles a pathway that can lead from steatosis to more serious stages of liver disease due to disrupted liver metabolism of fatty acids. Advice to patients and clinicians was reviewed from various agencies and nonprofits organizations including a committee of the US National Academies of Sciences, Engineering, and Medicine, and the nonprofit/university collaboration PFAS REACH.
Discussion: Converging lines of evidence indict PFAS as human (and trans-species) hepatotoxins and mostly support a metabolic associated steatotic liver disease continuum as the nature of the injury. Increases in abnormal transaminases and sparser imaging and biopsy findings support that the damage is clinically important and a contributing cause of a public health problem. It is still challenging to decide which of many definitively disrupted metabolic pathways is/are most important to the injury. Many PFAS in use remain virtually unstudied, a research and public health emergency. Simple clinical responses to the concerns of the most heavily contaminated patients and communities, which are within the capabilities of most clinical offices, are reviewed.
Tiziana Ciarambino
Internal Medicine Department, Hospital of Marcianise, ASL Caserta, Italy
Pietro Crispino|
Emergency Department, Hospital of Latina, ASL Latina, Italy
Pietro Buono
Direzione Generale per la Tutela della Salute ed il Coordinamento del Servizio sanitario regionale Regione Campania
Ugo Trana
Direzione Generale per la Tutela della Salute ed il Coordinamento del Servizio sanitario regionale Regione Campania
Gaetano Patrone
Direzione Generale per la Tutela della Salute ed il Coordinamento del Servizio sanitario regionale Regione Campania
Erika Mastrolorenzo
ASP Potenza, Basilicata, Italy
Ombretta Para
Emergency Department, Hospital of Careggi, University of Florence, Italy
Valentina Camardo
Obstetric and Ginecological Department, A.O. S. Carlo, Hospital Lagonegro, Basilicata, Italy
Mauro Giordano
Internal Medicine Department, University of Campania, L. Vanvitelli, Naples, Italy
Abstract
Coronavirus disease 2019 (Covid-19) is characterized by severe acute respiratory syndrome and is an emerging disease. Considering the changes in maternal physiological and immune function during pregnancy, pregnant women may be at increased risk of being infected with Covid-19 and developing more complicated clinical events. Vertical transmission of the Covid-19 virus is possible although to this day it is still considered a rare event. It is conceivable that most pregnant patients infected with the Covid-19 virus have mild or moderate flu symptoms. More serious symptoms, such as pneumonia, in fact, seem to be more common in the elderly population or in subjects suffering from chronic diseases. As a precaution, pregnant women are considered the most vulnerable and therefore isolation and limitation of contact are recommended. At the moment there are no data to indicate whether spontaneous delivery is preferable in case of coronavirus infection (suspected or confirmed) to a cesarean section. However, in case of breathing difficulties that require delivery as soon as possible, a cesarean section is recommended. There is no evidence that the virus can be transmitted through breast milk. Furthermore, breastfeeding is preferable and has numerous benefits for the newborn’s immune system. Since pregnant people appear to have a high risk of becoming seriously ill if they have an infection, vaccination is particularly important. In addition, there is evidence that vaccinated people have a lower risk of baby problems, such as stillbirth.
Aynur Ozge, MD, PhD
Department of Neurology, Mersin University School of Medicine, Mersin, Türkiye
Reza Ghouri
Department of Neurology, Brain 360 Integrative Center, İstanbul, Türkiye
Derya Uludüz
Department of Neurology, Brain 360 Integrative Center, İstanbul, Türkiye; Department of Neurology, Cerrahpaşa University Medical Faculty, İstanbul, Türkiye
Abstract
This comprehensive review examines the impact of vascular risk factors on the phenotypic expression of migraine in the elderly population. Migraine, particularly migraine with aura, has been established as a risk factor for ischemic lesions of the brain, stroke, and other cardiovascular diseases. The association between migraine and specific vascular events, such as stroke, myocardial infarction, and angina pectoris, underscores the need for a comprehensive understanding of the interplay between migraine and cardiovascular diseases. The challenges in differentiating migraine from vascular insults, especially in the elderly population, highlight the need for improved diagnostic and treatment strategies to address the complexities of managing migraine in this demographic. Patient education and treatment of modifiable risk factors may decrease future vascular events, emphasizing the importance of addressing vascular risk factors in migraine management. The potential impact of prevention and treatment of unfavorable arterial hemodynamics on neurocognitive outcomes underscores the broader implications of addressing vascular risk factors in migraine management. The clinical and public health relevance of understanding the modifiability of vascular risk factors in elderly migraine patients extends to addressing challenges in cancer survivorship, radiological emergency response, and rational person behavior, emphasizing the diverse applications of addressing vascular risk factors in healthcare and public health. Ultimately, the clinical and public health relevance of understanding the impact of vascular risk factors on the phenotypic expression of elderly migraine underscores the need for continued research and clinical vigilance in addressing the complex interplay between migraine and vascular risk factors in the elderly population.
Yousser Mohammad, MD, PhD
Al-Sham Private University, Faculty of Medicine and Pharmacy, Damascus and Latakia, Syria; Centre for Research on Chronic Respiratory Diseases (Director of the Center), Tishreen University, Lattakia, Syria.
Basim Dubaybo
Faculty Affairs and Professional Development, Wayne State University School of Medicine, Detroit, MI, USA
Abstract
The Global Asthma Network (GAN) report issued in 2022 and the Global Initiative for Asthma (GINA) report of 2023 emphasize challenges and difficulties faced by health workers in managing asthma in Low- and Middle-income countries (LMICs). Among the many reasons for these difficulties are insufficient knowledge of health workers of management guidelines, and lack of medical resources especially inhaler medications1,2,3. When available in limited amounts, these resources are prohibitively expensive4,5,6. These reports did not address the impact of disaster on asthma care. In this article, we aim to highlight this issue, hoping that future international asthma reports will take this aspect into consideration.
When disasters such as war and earthquakes occur in LMIC, several aspects of asthma care are negatively impacted. First, challenges in asthma management are compounded by difficulties related to displacement, overcrowding in shelters, immigration of health care workers (HCW), damage to health facilities, limited referral capacity to specialists, and limited availability of expensive inhalers4,5,6. Second, governments face logistical challenges. While the immediate need may be to provide emergency needs,6,7 health facilities should secure medications to provide care according to World Health Organization (WHO) guidelines7. Third, asthma research and data collection are hampered.8 Digital health could be a solution9,10.
It is therefore imperative that we develop suitable asthma management programs applicable to zones in turmoil4,11,12.
We conducted a literature search on challenges in asthma management in zones of turmoil. We used the following search keywords and phrases: asthma and war, asthma and turmoil, asthma and earthquakes, and asthma and disasters. We reviewed all publications that relate to this topic that appeared in the literature between 2014 and 2023. Based on this review and analysis, we list several lessons learned, conclusions and recommendations.
Ingrid Philibert, PhD, MA, MBA
Senior Director, Accreditation, Measurement and Educational Scholarship Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, United States
Danielle Blouin, MD, MHPE, PhD
Professor, Faculty of Health Sciences (Emergency Medicine), Director, MD Program Evaluation, Queen’s University, Kingston, Ontario, Canada
Abstract
Responsiveness to societal needs is an expectation for academic institutions (medical schools and teaching hospitals) that encompasses their three missions – education, research and service to patients and populations. This paper presents a scholarly perspective that proposes practical courses of action for academic institutions to operationalise calls by the World Health Organization and others for medical education institutions to demonstrate societal responsiveness. We offer a pragmatic framework for institutional action to guide societal responsiveness initiatives in all domains of an institution’s academic mission. We point to the history of social accountability as a core role of academic institutions and how these early approaches provide a model for present-day actions and activities. We discuss the importance of engaging individuals and groups who benefit from institutional actions in the service of social accountability in co-determining optimal courses of action. We offer concrete recommendations in each domain of the academic mission to create a practical, institution-specific approach for societal responsiveness, shaped by the given organization’s mission and its role in addressing education, health care and research needs at the level(s) (local, regional or national) at which it operates. We discuss the local, national and global contexts in which individual institutions operate and how they create facilitators and barriers for institutions seeking to meet social responsiveness mandates. We close with discussing how focusing on institution-level priorities for societal responsiveness allows for meaningful actions in a range of settings within an increasingly complex and challenging environment in many regions around the globe.
Natalia Zubieta-DeUrioste
High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia.
Christian Arias-Reyes
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada.; Brain Research Center, High Altitude Research Foundation, La Paz, Bolivia
Lida Sanchez
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada.; Brain Research Center, High Altitude Research Foundation, La Paz, Bolivia
Nestor Freddy Armijo-Subieta
Dirección General de Epidemiología, Ministry of Health, La Paz, Bolivia; Universidad Franz Tamayo, La Paz, Bolivia.
Alfredo Merino-Luna
Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú.
Ivan Solarte
Hospital Universitario San Ignacio Pontificia Universidad Javeriana, Bogotá, Colombia.
Raffo Escalante-Kanashiro
Unidad de Cuidados Intensivos Instituto Nacional de Salud del Niño, Lima, Perú.
Jose Antonio Carmona-Suazo
Hospital Juárez de México, Emergency Department, México City, México.
Enrique Maravi Poma
UCI-B. Hospital Universitario de Navarra, Pamplona, Spain.
Rosalinda Jimenez-Aguilar
Centro Médico Nacional La Raza. Unidad Médica de Alta Especialidad.Hospital General Gaudencia González de la Garza, Mexico City, Mexico.
Jose M. Calle-Aracena
Universidad Autónoma Tomás Frías, Potosí, Bolivia.
Alberto Lopez-Bascope
Hospital Angeles México, México City, México.
Roberto Vera
Universidad Autónoma Tomás Frías, Potosí, Bolivia.
Rafaela Zubieta-DeUrioste
High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia.
Ninoska Rossel
High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia.
Yeshua Peña-Y-Lilio
High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia.
Gary Chambi-Quilla
High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia.
Luis Herrera-Leon
Hospital General Ibarra, Ibarra, Ecuador.
Santiago Garrido-Salazar
Hospital General Ibarra, Ibarra, Ecuador.
Francisco Ney Villacorta Cordova
Universidad Nacional de Chimborazo, Riobamba, Ecuador.
Fausto Vinicio Maldonado Coronel
Escuela Superior Politécnica de Chimborazo, Riobamba Cantón, Ecuador.
Elisabeth Deindl
Walter-Brendel-Centre of Experimental Medicine, University Hospital and Biomedical Center, Institute of Cardiovascular Physiology and Pathophysiology, Ludwig-Maximilians, Universität München, Munich, Germany.
Ricki Sheldon
Arkansas College of Osteopathic Medicine, Arkansas, USA.
Roberto Alfonso Accinelli
Instituto de Investigaciones de la Altura. Facultad de Medicina Alberto Hurtado. Universidad Peruana Cayetano Heredia, Lima, Perú.
Edith M Schneider-Gasser
Institute of Veterinary Physiology, Vetsuisse-Faculty, University of Zurich, Switzerland, and Center for Neuroscience Zurich (ZNZ), Zurich, Switzerland.; Brain Research Center, High Altitude Research Foundation, La Paz, Bolivia
Jorge Soliz
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada.; Brain Research Center, High Altitude Research Foundation, La Paz, Bolivia
Gustavo Zubieta-Calleja
High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), La Paz, Bolivia.
Abstract
The COVID-19 pandemic, caused by the SARS-COV-2 virus, has had devastating consequences worldwide. Remarkably, the incidence, virus transmission capacity, and severity of COVID-19 have been reported to be significantly decreased in high-altitude human populations. The clinical significance of these findings is enormous, as they suggest that permanent inhabitants of high altitudes have developed adaptive protective changes against certain pathologies. However, these observations have been overshadowed by contradictory reports on the COVID-19 mortality rate at high altitude, ascribed to low population densities. These interpretations, however, fail to consider that the environmental conditions of high-altitude regions of the temperate and tropical geographical zones are radically different from each other. Contrary to common thought, the conditions of high-altitude areas of countries within the tropical zone are so benign that they have favored the growth and development of densely populated cities. In this work, we use data from a COVID-19 database covering five Latin American countries in the tropical and subtropical geographic zone that corresponded to the period between the start of the pandemic and the end of 2020, when no vaccine was yet available. Our results reveal that residing above 1,000 m in tropical countries was a protective factor against COVID-19 mortality. Interestingly, this protective effect was independent of population size. The findings presented here, and those from other similar studies, substantiate the need for more research to reveal the secrets of the physiology of permanent high-altitude residents. In conclusion, our findings clearly demonstrate that the high-altitude environment in tropical and subtropical geographic zones significantly contributes to the decreased mortality impact of the SARS-COV-2 virus in high-altitude-exposed populations.
The COVID-19 pandemic, caused by the SARS-COV-2 virus, has had devastating consequences worldwide. Remarkably, the incidence, virus transmission capacity, and severity of COVID-19 have been reported to be significantly decreased in high-altitude human populations. The clinical significance of these findings is enormous, as they suggest that permanent inhabitants of high altitudes have developed adaptive protective changes against certain pathologies. However, these observations have been overshadowed by contradictory reports on the COVID-19 mortality rate at high altitude, ascribed to low population densities. These interpretations, however, fail to consider that the environmental conditions of high-altitude regions of the temperate and tropical geographical zones are radically different from each other. Contrary to common thought, the conditions of high-altitude areas of countries within the tropical zone are so benign that they have favored the growth and development of densely populated cities. In this work, we use data from a COVID-19 database covering five Latin American countries in the tropical and subtropical geographic zone that corresponded to the period between the start of the pandemic and the end of 2020, when no vaccine was yet available. Our results reveal that residing above 1,000 m in tropical countries was a protective factor against COVID-19 mortality. Interestingly, this protective effect was independent of population size. The findings presented here, and those from other similar studies, substantiate the need for more research to reveal the secrets of the physiology of permanent high-altitude residents. In conclusion, our findings clearly demonstrate that the high-altitude environment in tropical and subtropical geographic zones significantly contributes to the decreased mortality impact of the SARS-COV-2 virus in high-altitude-exposed populations.
Elizabeth Armstrong-Mensah
Georgia State University School of Public Health, Atlanta, Georgia.
Maha Karim
Georgia State University School of Public Health, Atlanta, Georgia.
Oluwatoyosi Ogunmuyiwa
Georgia State University School of Public Health, Atlanta, Georgia.
Ernest Alema-Mensah
Morehouse School of Medicine, Department of Community Health and Preventive Medicine, Atlanta, Georgia.
Florence Darko
Georgia State University School of Public Health, Atlanta, Georgia.
Kritika Kolla
Georgia State University School of Public Health, Atlanta, Georgia.
Abstract
Objective: The study examined the mental health conditions experienced by working mothers as caregivers in Georgia, United States during the COVID-19 pandemic, the causes and outcomes of the mental health conditions experienced, and the coping mechanisms they employed.
Methods: A mixed methods cross-sectional study design was used to collect data from 132 working mothers in Georgia across six domains using Qualtrics. Quantitative data was analyzed using SPSS and SAS. Qualitative data was analyzed using a thematic approach.
Results: Working mothers experienced depression and anxiety while providing care during the pandemic. The lack of access to childcare and family support (12.5%), home schooling (18.1%), and juggling work and family (25.6%) contributed to the mental health conditions experienced, which led to anger (12.5%), aggression towards partners (11.3%), and the inability to sleep (18.8%). Coping mechanisms employed were drinking (1.3%), smoking (5.6%) and arguing with a spouse (8%).
Conclusion: While the pandemic affected the mental health of many adults in the US, working mothers providing care were among the population hardest hit. Although the immediate threat of COVID-19 has abated, its impact on mental health cannot be overlooked. By focusing primarily on the mental health of working mothers as caregivers during the pandemic, the study draws attention to, and underscores the need for targeted interventions and policies to be put in place to respond to the mental health needs of this population in the event of a future global health emergency.
Aynur Ozge, MD, PhD
Department of Neurology, Mersin University School of Medicine, Mersin, Türkiye
Reza Ghouri
Department of Neurology, Brain 360 Integrative Center, İstanbul, Türkiye
Derya Uludüz
Department of Neurology, Brain 360 Integrative Center, İstanbul, Türkiye; Department of Neurology, Cerrahpaşa University Medical Faculty, İstanbul, Türkiye
Abstract
This comprehensive review examines the impact of vascular risk factors on the phenotypic expression of migraine in the elderly population. Migraine, particularly migraine with aura, has been established as a risk factor for ischemic lesions of the brain, stroke, and other cardiovascular diseases. The association between migraine and specific vascular events, such as stroke, myocardial infarction, and angina pectoris, underscores the need for a comprehensive understanding of the interplay between migraine and cardiovascular diseases. The challenges in differentiating migraine from vascular insults, especially in the elderly population, highlight the need for improved diagnostic and treatment strategies to address the complexities of managing migraine in this demographic. Patient education and treatment of modifiable risk factors may decrease future vascular events, emphasizing the importance of addressing vascular risk factors in migraine management. The potential impact of prevention and treatment of unfavorable arterial hemodynamics on neurocognitive outcomes underscores the broader implications of addressing vascular risk factors in migraine management. The clinical and public health relevance of understanding the modifiability of vascular risk factors in elderly migraine patients extends to addressing challenges in cancer survivorship, radiological emergency response, and rational person behavior, emphasizing the diverse applications of addressing vascular risk factors in healthcare and public health. Ultimately, the clinical and public health relevance of understanding the impact of vascular risk factors on the phenotypic expression of elderly migraine underscores the need for continued research and clinical vigilance in addressing the complex interplay between migraine and vascular risk factors in the elderly population.
Giorgio Berlot
Dept. of Anesthesia and Intensive Care, University of Trieste, Italy.
Nadia Zarrillo
Dept. of Anesthesia and Intensive Care, Sessa Aurunca Hospital, Italy.
Ludovica Tombolini
Dept. of Emergency Medicine, Macerata Hospital & Marche Polytechnical University, Ancona, Italy.
Abstract
In the last few decades, a number of techniques based on different principles of functioning have been developed to remove from the bloodstream of septic shock patients or those suffering from other clinical conditions characterized by an exaggerated inflammatory response. Yet, their use is based more on personal experience than on the results of clinical trials that often carried contrasting results.
In this review, the rationale for the blood purification procedures, their technical features and the findings of clinical trials are exposed and discussed along with the possible rules of engagement.
James D Hearn, J.D., LL.M, D.Bioethics, MPH, D.Min
Kansas City University of Medicine
Abstract
May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency. COVID-19 resulted in the death of almost seven million people. After such an ordeal, it is normal to feel a sense of relief, the need to relax. Some are afforded this luxury but not so for those who must prepare us for the next pandemic. A pandemic of the same, or greater, magnitude is not statistically expected for some time. Yet, it is a fact that the next pandemic can occur at any time. Thus, we must be ever vigilant and in a state of constant preparation. The benefits of such preparation will be greatly enhanced if the most likely type and magnitude of the next pandemic can be anticipated. The author believes that there are signs pointing to this source.
In pandemic preparation the worst-case scenario employed by many planners is based on the 1918 Spanish influenza. The highest mortality estimates indicate that the pandemic resulted in the death of between 50 and 100 million people. It is difficult to imagine a more intense pandemic. Yet we must. While the 1918 pandemic was the most intense we have experienced, it is certainly not the most intense that we can experience.
“Disease X” is a placeholder name which represents a hypothetical pathogen that the World Health Organization lists as a priority disease on its R&D Blueprint which is a global strategy and preparedness plan. The author believes that it is both naïve and dangerous to employ the 1918 pandemic as a worst-case scenario. It is necessary to think beyond this level. Granted when one does so one is venturing into hypothetical territory. Yet, this must be done to even have a chance at adequately preparing for the next pandemic. This article proposes avian influenza as Disease X. The virus is known but is not currently transmissible between humans. If this becomes possible (and nature is working to make this a reality) the estimated death toll can be expected to exceed a world-changing 1.3 billion.
While this article looks at avian influenza as Disease X it also recommends the preparations necessary to be made for the global society to even hope to survive it.
Christian Pozzi
University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Centre of Competence on Ageing; PhD Student in Public Health, University of Milano Bicocca – Italy
Andrea Staglianò
San Gerardo dei Tintori IRCCS Foundation, Monza – Italy
Claudia Ballabio
Cooperativa “La Meridiana”, Monza
Chiara De Ponti
Cooperativa “La Meridiana”, Monza
Federica Bartoli
Cooperativa “La Meridiana”, Monza
Laura Antolini
Medical Statistics University of Milano Bicocca – Italy
Maria Cristina Ferrara
PhD Student in Public Health, University of Milano Bicocca – Italy; San Gerardo dei Tintori IRCCS Foundation, Monza – Italy
Alessandro Morandi
Azienda Speciale di Cremona Solidale – Italy; Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona – Spain
Stefano Cavalli
University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Centre of Competence on Ageing
Laura N. Gitlin
College of Nursing and Health Professions Drexel University – Philadelphia – USA
Giuseppe Bellelli
San Gerardo dei Tintori IRCCS Foundation, Monza – Italy; School of Medicine and Surgery, University of Milano Bicocca – Italy
Abstract
Background: Nonpharmacological approaches are recommended as first-line treatment for the neuropsychiatric symptoms of persons living with dementia. Tailored Activity Program is a non-pharmacological approach which has shown to reduce neuropsychiatric symptoms and functional dependence of persons living with dementia at the community, as well as caregiver’s distress. The aim of the study is to assess the feasibility of a project in which the Tailored Activity Program is delivered partially at an acute hospital ward and partially at the patient’s home.
Material and Methods: The study is aimed at enrolling 50 dyads (patients/caregivers) from the memory clinic, acute geriatric ward, or short-stay emergency department at the IRCCS San Gerardo dei Tintori, Monza (Italy). Inclusion criteria are: the patient’s clinical diagnosis of dementia, clinically detectable neuropsychiatric symptoms (Neuro Psychiatric Inventory, NPI score >6 in at least one item), the ability to participate in activities of daily living (Katz’s index ≥ 2), the presence of a caregiver (aged ≥ 21 years; minimum 4 hours of daily care), and the willingness of the dyad patient/caregiver to participate in the project. Treatment is delivered both i) in hospital (2 sessions) and ii) at home (6 sessions), including occupational therapy, telemedicine and nursing care provided once a week. The following variables are measured: Neuro Psychiatric Inventory, Time Up and Go Test, Katz’s Index and the level of caregiver’s sense of competence with the Sense of Competence Questionnaire. Data are collected both at baseline, at the end of the treatment, with a follow-up scheduled at 4 months after enrollment. Primary outcome measure is the dyad’s retention rate at 4-month follow-up. Secondary outcomes are the reduction in the patient’s frequency and severity of NPS; the improvement in the patient’s Time Up and Go Test score; the improvement in the patient’s levels of autonomy and participation in activities of daily living and improvement in the caregiver’s Sense of Competence Questionnaire score.
Results and Conclusion: We seek to evaluate whether the Tailored Activity Program is well-received by the patient/caregiver dyad and, consequently, whether our project is feasible. If this objective is achieved, and if we also report some improvement in the secondary outcomes, we can then plan a larger multicenter study aimed at evaluating the effectiveness of this approach, partly delivered at the hospital and partly at patient’s home.
