Aim: Prostate cancer (PCa) is one of the most common cancer among men in the world. Prostate specific antigen is the most used biomarker for PCa diagnosis. In this study we aimed to measure the procalcitonin(PCT) and C-reactive protein (CRP) levels in patients with PCa. Methods: The patients who underwent transrectal prostate biopsy and transurethral prostate surgery in the last 4 years were included in the study. The patients were divided into two groups according to the pathology reports, group1; benign prostate hyperplasia and group2; prostate cancer. MedCalc Statistical Software version 17.6 was used for statistical analyses. Results: The current study includes 149 patients. There were 118 patients in group1 and 31 patients in group 2. The mean age of the patients was 66.85 and 69.41 years in groups respectively. Serum CRP and PCT levels was 3.33 and 0.01 in group 4.07 and 0.04 in group 2. Serum PCT levels was significantly higher in patients with PCa. Conclusion: We found that elevated procalcitonin levels was associated with prostate cancer. Further studies are needed to define the relationship between procalcitonin and prostate cancer. What’s Known: Prostate cancer is the second most common cancer among elderly men. Prostate specific antigen testisng is usually used in screening and diagnosis. Unfortunately PSA is not cancer specific and new biomarkers are needed for prostate cancer management. What’s New: Procalcitonin is a precursor of calcitonin which is produced by thyroid C-cells and some neuroendocrine cells. The elevated level of procalcitonin is associated with bacteremia and sepsis. In this study e investigated the procalcitonin levels in prostate cancer.
An increasing number of COVID-19 cases worldwide has overwhelmed the healthcare system. Physicians are struggling to allocate resources and to focus their attention on high-risk patients, partly because early identification of high-risk individuals is difficult. This can be attributed to the fact that COVID-19 is a novel disease and its pathogenesis is still partially understood. However, machine learning algorithms have the capability to correlate a large number of parameters within a short period of time to identify the predictors of disease outcome. Implementing such an algorithm to predict high-risk individuals during the early stages of infection, would be helpful in decision making for clinicians. Here, we propose recommendations to integrate machine learning model with electronic health records so that a real-time risk score can be developed for COVID-19.
Aim: We compared the efficacy and safety of insulin degludec/insulin aspart co-formulation (IDegAsp) twice-daily to a free combination of basal insulin degludec and GLP-1 receptor agonist liraglutide (IDeg+Lira) once-daily for patients with inadequately controlled type 2 diabetes on insulin therapy and oral antidiabetic drugs. Subjects and Methods: Eligible patients were randomly allocated at a 1:1 ratio to receive either the once-daily dual-injection of IDeg+Lira (n=24) or twice-daily single-injection of IDegAsp (n=28). The primary endpoints were: HbA1c changes over 52 weeks of treatment and the percentage of participants achieving HbA1c<7.0% at week 52. Results: After 52 weeks, HbA1c decreased by 0.3% in the IDegAsp group and by 0.7% in the IDeg+Lira group. The HbA1c reduction was greater in the IDeg+Lira group than in the IDegAsp group. 19% of patients on IDegAsp versus 40% on IDeg+Lira achieved HbA1c<7.0%. Pre-breakfast and pre-dinner blood glucose at 52 weeks were significantly lower in the IDeg+Lira group than in the IDegAsp group. The reduction in body mass index (BMI) was greater in the IDeg+Lira group than in the IDegAsp group throughout the study period. The confirmed hypoglycemia rates were 1.32 and 0.69 per patient/year of exposure to IDegAsp and IDeg+Lira, respectively. Conclusions: In patients with inadequately controlled type 2 diabetes on insulin therapy and oral antidiabetic drugs, treatment with the once-daily dual-injection of IDeg+Lira compared to the twice-daily single-injection of IDegAsp showed no significant difference in glycemic control, but with a slightly larger reduction in HbA1c at 52 weeks, and statistically superior weight loss.
Introduction: We aim to determine the influence of lower gastrointestinal bleeding (LGIB) on mortality, morbidity, length of hospital stay, and resource utilization in end-stage renal disease (ESRD) patients. Material and Methods: The National Inpatient Sample database (2016 &2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of ESRD and LGIB. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS), and total costs between propensity-matched groups of ESRD patients with LGIB versus ESRD patients. Results: We identified 2187954 ESRD patients, of whom 242075 has LGIB, and 1945879 were ESRD patients. The in-hospital mortality was higher in ESRD with LGIB (OR 2.5, 95% CI 1.5-2.2; P=0.00). ESRD with LGIB has higher odds of mechanical ventilation (OR 1.4, 95% CI 6.4-16.4; P=0.00), and shock requiring vasopressor (OR 1.2, 95% CI 4.9-5.4; P=0.002). Advanced age (OR 1.02 CI 1.02-1.03 P=0.00), anemia (OR 1.04 CI 1.59-1.91 P=0.006), acute coronary syndrome (OR 1.8 CI 1.6-2.1, P=0.00), acute respiratory failure (OR 1.29 CI 2.0-2.6, P=0.00), mechanical ventilation (OR 1.9, CI 3.5-4.4, P=0.00), and sepsis (OR 1.5, CI 4.1-5.08, P=0.00) were identified as predictors of mortality in ESRD with LGIB. Mean LOS (10.8±14.9 vs. 6.3±8.5, P<0.01) and mean total charges (37054 $ vs. 18080 $, P<0.01) were also higher. Conclusions: In this propensity-matched analysis, ESRD with LGIB was associated with higher odds of in-hospital mortality, mechanical ventilation, and shock requiring vasopressor. Mean LOS and resource utilization were also higher.
More than 1.2 million people died from chronic kidney damage (CKD) globally, in 2017. Anemia is a common complication of CKD. Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates iron metabolism. Roxadustat is often used to treat anemia caused by renal diseases. Its adverse effects include high blood pressure, myocardial infarction, heart failure, high potassium, and dizziness; however, there are no reports about rhabdomyolysis associated with roxadustat. One of our patients developed rhabdomyolysis after he was administered roxadustat to treat anemia caused by chronic renal failure. Physicians should be alert about the occurrence of rhabdomyolysis when roxadustat is used.
Aim: To describe the pattern of paediatric soft tissue sarcomas with emphasis on the grade and stage at the first surgical or medical oncologic intervention. Methods: We retrospectively reviewed all cases of histologically confirmed paediatric Soft Tissue Sarcomas in the Department of Pathology, University College Hospital (UCH), Ibadan, Nigeria in children age 0-14 years. The study period was January 1991 to December 2016. Information obtained included age, gender, morphology and site of the tumours. The tumour grade and pathologic/clinical staging of all cases that had surgical biopsy or surgical resection were also obtained and verified from the clinical records. Tumour grading was carried out using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) Sarcoma group grading system and staging was done using TNM. Results: One hundred and twelve cases were seen with an almost equal male-to-female ratio and age range from 5 months to 14 years (median 8.5 years). The peak age group was 5-9 years. Rhabdomyosarcoma was by far the most common histological type (73.2%). Other types were undifferentiated sarcomas (6.3%), fibrosarcoma (5.4%), Kaposi sarcoma (4.5%), and 2.7% each for synovial sarcoma, dermatofibrosarcoma protuberans. The common primary sites were the head and neck (including the orbit) 51(45.5%), and the abdominopelvic 27(24.1%) regions. Other sites included the lower limb 13(11.6%), trunk 12(10.7%), upper limb 6(5.4%). Majority (67.9%) had histologic grade 3 at presentation based on the FNCLCC grading system. About 48.2% had Stage T2b while 9.8% were stage T2a based on American Joint Committee on Cancer Staging (AJCC) system. Conclusion: Rhabdomyosarcoma, undifferentiated sarcomas and Kaposi sarcoma are the commonest paediatric malignant soft tissue tumours in our practice. Majority of our patients present with late stage tumour and with high histologic grade thereby conferring poor prognosis at presentation/first surgical or medical oncologic intervention.
Background: Arteriovenous access (AV) thrombosis is important and preventable problem among chronic hemodialysis (HD) patients. On the other hand, systolic blood pressure (SBP) alteration relates with higher cardiovascular mortality among these patients. In this study, we investigated the relation between SBP changes and arteriovenous access (AV) thrombosis. Methods: 50 HD patients with thrombosis and 50 HD patients without thrombosis were included in the study. Odds ratios and 95% confidence intervals were estimated with multivariate adjusted logistic regression models to determine the association between potential thrombosis-related risk factors and thrombosis risk. Results: Elder adults, women, and patients with arteriovenous grafts, lower intradialytic SBP and higher SBP variations during dialysis sessions had higher incidence of AV access thrombosis. Chronic inflammation and mineral metabolism related parameters were also found to be abnormal at the time of AV access thrombosis. Conclusions: Close monitoring and management of intra-dialytic hypotension, SBP variation in every dialysis session and correction of biochemical parameters are critical for earlier identification and prevention of AV access thrombosis in HD patients.
Aims: Accumulating evidence links COVID-19 incidence and outcomes with vitamin D status. We investigated if an interaction existed between vitamin D levels and social deprivation in those with and without COVID-19 infection. Methods: Upper- or lower-respiratory tract samples from 104 patients were tested for SARS-CoV-2 RNA in accordance with Public Health England criteria (January–May 2020) using RT-PCR. The latest serum total 25-hydroxyvitamin D(25-OHD) levels, quantified by LC-MS/MS, was obtained for each patient (September 2019–April 2020). Index of Multiple Deprivation (IMD) was generated for each patient. Univariate and logistic regression analyses examined associations between age, gender, 25-OHD, IMD score and SARS-CoV-2 result in the total cohort and subgroups. Results: In the total cohort, a positive SARS-CoV-2 test was significantly associated with lower 25-OHD levels and higher IMD. A positive test was associated with higher IMD in the male subgroup and with lower 25-OHD levels in those aged >72 years. Low 25-OHD and IMD quintile 5 were separately associated with positive COVID-19 outcome in the cohort. Patients in IMD quintile 5 with vitamin D levels ≤34.4 nmol/L were most likely to have a positive COVID-19 outcome, even more so if aged >72 years (OR: 19.07, 95%CI: 1.71–212.25; p=0.016). Conclusions: In this cohort, combined low vitamin D levels and higher social deprivation were most associated with COVID-19 infection. In older age, this combination was even more significant. Our data supports the recommendations for normalising vitamin D levels in those with deficient / insufficient levels and in groups at high-risk for deficiency.
Since the beginning of the 21st century, three coronaviruses have crossed the species barrier and caused serious human disease: severe acute respiratory syndrome coronavirus (SARS-CoV) in November 2002 [1, 2], Middle-East respiratory syndrome coronavirus (MERS-CoV) in 2012 [3, 4], and SARS-CoV-2 in 2019 [5, 6]. SARS-CoV-2 , initially called 2019-nCoV, is the etiological agent of COVID-19, a highly contagious infectious illness that was first reported in December 2019 in Wuhan, China and subsequently spread globally . As of May 24, 2020, COVID-19 has caused >5,370,000 infections and >343,000 deaths worldwide .Unfortunately, nearly 20 years after the SARS outbreak, and despite many attempts for vaccines and therapeutic agents directed against SARS and MERS, no approved prophylactics or therapeutics exist. As a result, the management of COVID-19 largely relies on supportive care [10, 11] and on hopes surrounding compounds that appeared promising against previous coronaviruses [12, 13]. This lost opportunity, in itself, offers a valuable lesson for current and future outbreaks, and the need for new experimental rationales to accelerate discovery.The cellular entry of coronaviruses is fairly conserved across members of the Coronaviridae family and is mediated by the transmembrane spike (S) glycoprotein , a homotrimer [15, 16] that is often heavily glycosylated  and protrudes from the viral surface. Each of the three monomers of the spike glycoprotein consists of two functional subunits, S1, involved in membrane attachment, and S2, required for membrane fusion [15, 18]. In many coronaviruses, the spike glycoprotein is cleaved at the S1/S2 interface by host cell proteases . Within the S1 domain, the receptor binding domain (RBD) attaches to the cellular receptor, which in the case of both SARS-CoV and SARS-CoV-2 is the angiotensin-converting enzyme 2 (ACE2) [19-21]. Another cleavage site, S2’, is located within S2 [17, 19]. The spike glycoproteins of SARS-CoV and SARS-CoV-2 share 76% identity at the amino acid level [22, 23], although biophysical assays indicate that SARS-CoV-2 binds their common receptor, ACE2, with a 10-20 fold higher affinity than SARS–CoV .As we contemplate the dynamics of COVID-19 and the development of prophylactic and therapeutic interventions, one of the key considerations is the emergence and potential relevance of viral mutations. In the short time since the pandemic started, several missense mutations have been observed in various SARS-CoV-2 isolates . One of these, the 23403A>G variant, substitutes the aspartic acid at position 614 of the viral spike glycoprotein with glycine (D614G), and is frequently documented in European countries but rarely observed in China .In the current issue of the IJCP , Becerra-Flores and Cardozo interrogate the impact of this mutation on pathogenicity and offer a structural correlate for their findings . Their analysis includes confirmed COVID-19 cases and deaths as reported by the European CDC during the first week of April 2020 and examines the viral spike genomic sequences deposited in the GISAID database over that period, correlating the prevalence of the D614G mutation with fatality rates in the same regions. The authors then use cryo-electron microscopy data andin silico mutagenesis of this key residue to predict conformational preferences of the two variants of the spike protein.The analysis indicates that viruses isolated from European patients predominantly expressed a glycine at position 614 of the spike glycoprotein, while a high percentage of the isolates collected from Far East patients favored aspartic acid at the same position. The proportion of viral isolates having a glycine at this position significantly correlated with higher average and median case fatality rates across geographic areas. Interestingly, their data also imply a rationale for divergence in the behavior of the disease between the East and West coasts of the United States, based upon the provenance of the viral ‘founders’ in these regions, from the European and Asian variants, respectively.Surprisingly, the authors’ molecular modeling indicates that the presence of a glycine at position 614 diminishes binding to the cellular receptor when replacing the aspartic acid at that residue, mainly by reducing the spike protein’s occupancy of the “up” or liganded state, when it is most amenable to receptor interaction. While seemingly counterintuitive, this finding opens at least two fascinating scenarios. As the authors hypothesize, a spike glycoprotein that harbors glycine at this position might be better protected from immune recognition, elicit the production of harmful antibodies, flood the host with ineffective antibodies, or some combination of all three. A delay in immune recognition may impact viral transmission by delaying symptomatic presentation or allowing unfettered infection without effective immune response. An aberrant response, suited to the viral conformation at large but not the infective conformation, could equally allow for an increased—but poorly targeted—inflammatory cascade. The possibility of a harmful immune response is particularly thought provoking, as antibody-dependent enhancement, the phenomenon by which antibodies facilitate viral entry into host cells that do not necessarily have viral receptors [27, 28], has been reported for many viruses, including coronaviruses [27, 29], dengue virus [30, 31], feline infectious peritonitis virus  , Ebola virus , and HIV . Another possibility, not mutually exclusive, is that the D614G mutation creates or exposes a novel cleavage site in the spike glycoprotein.Delving into these molecular mechanisms with confirmatory in vitro studies will hopefully reap the benefits of decades of scientific strides while simultaneously highlighting deficiencies in key areas that can guide our approach to the current pandemic. One of the immediate questions involves the impact of this and other mutations on vaccine efficiency and the potential need to develop multiple candidate vaccines that cover a range of epitopes and their variants. In all likelihood, there is a lengthy and tortuous road ahead, but characterizing significant variants will allow us to better understand many elusive aspects of this virus’ success – the latent/incubation period, immune evasion and hyper-response, variable receptor binding, replication dynamics, and organ-specific pathogenesis—and discover host vulnerabilities that mutations such as D614G seem to exploit.The D614G mutation appears to become more common as the pandemic unfolds . That this phenomenon is simply the result of a founder effect is possible but unlikely, and rather may be explained by this variant’s selective advantage allowing more efficient spread. Whether this advantage is conferred by infectivity, immune evasion, or pathogenicity—or some combination of these—is yet to be understood. Interestingly, this mutation is now known to travel simultaneously with other mutations, including one that affects the RNA-dependent RNA polymerase, with implications for proofreading, replication efficiency (and thus viral titer), and the emergence of drug-resistant viral phenotypes .Addressing these molecular questions relies heavily on widespread efforts to assemble accurate and comprehensive data on population infection rates and mortality, and frequent sampling of the genotypes of circulating isolates on a global basis. So far, this feat has been challenging and continued deficiencies will translate into missed singular opportunities to link molecular findings with population-level consequences, ultimately leaving us less prepared to address both this and future pandemics.The valuable and timely experimental strategy used by Becerra-Flores and Cardozo serves as an important analytic model that should be employed routinely to understand the ‘molecular strategy’ of this virus in the context of the evolving pandemic. This approach will also prove to be an indispensable instrument if also employed routinely at the onset of future outbreaks, which are all but guaranteed in the coming years, given the only recently appreciated ease of global spread of viruses in the modern world. In summary, this set of tools allows us to perform active surveillance, monitor the emergence of deleterious mutations prior to their widespread distribution, and use informed in silico and structural data to make informed decisions guiding molecular research and epidemic preparedness.
Social disparity in magnifying glass: the inequality among the vulnerable people during COVID-19 pandemicKeywords: COVID-19; SARS-COV-2; social disparity; vulnerable peopleThe editorial written by Stein and Ometa, (2020)  about the dilemma between health system and socioeconomic conditions created by the Covid-19 pandemic has called our attention as a very appropriated topic. Indeed, there are different repercussion in all aspects in unequal societies, which goes from financial issues to the chances to adhere of the current recommended measures of the WHO. For instance, social distancing and basic personal hygiene without proper social, economic and healthcare support may contribute to exacerbate disparity in fragile societies.In Brazil, the virus SARS-COV-2 is spreading fast and crashing our healthcare system and economy. The government is struggling to pay the financial supporting defined by the congress of 600 Brazilian real per month (about 100USD) for all the living costs and only reached around 15% of the population.Demographic data show that 48% of Brazilians live in places without sewage and 35 million do not have access to running water in their homes . Furthermore, 5-10% live in slum-like areas known as “favelas” , where most residences accommodate an average of 5 individuals per room with a housing density 10x higher than the rest of the city . Finally, 40.6% of the Brazilian working-age population are in the informal economy, living without social protection . Keeping these in mind, how can these vulnerable people protect themselves in times of COVD-19? How can they keep basic hygiene without regular running water and sewage? How to accomplish social distancing living in over-crowded places?If the COVID-19 wasn´t challenging enough, Brazil still struggles with other important infectious diseases, such as Dengue fever, Zika e Chikungunya. These viral mosquito-borne infections (Aedes aegypti mosquito) are endemic in Brazil and can show initial similar signs and symptoms to COVID-19. The rainy season is the most favourable time for mosquito proliferation and disease spread , which this year the seasonality (usually peaks in April) is coinciding with the spread of SARS-COV-2 in Brazil . Socially vulnerable people are more prone to acquire Aedes aegypti-related infections due to poor housing, poor sanitation and high-density population housing in “favelas”  .Current recommendations for people with COVID-19 mild illness is to stay at home. However, the panic-state created by the COVID-19 pandemic is taking these vulnerable people, which may be suffering of mosquito-borne infections, to health units and exposing them to SARS-COV-2. Thus, the overlapping of infections is overburdening even more the health system and increasing the transmission rate of COVID-19 in Brazil. Furthermore, many people in the informal market don´t have bank accounts and are agglomerating in huge lines in bank branches to get the financial aid. While many developed countries have struggled to give assistance to COVID-19 patients, Brazil must battle against two powerful enemies. So, the hard question to answer is: how many extra souls will be lost due to Brazil´s chronic problems?Brazil was used as an example we know well, but many other non-developed countries, especially the African ones may be struggling with some of these problems as well.
BACKGROUND: Initially identified in December 2019 in China, the 2019 Coronavirus disease (COVID-19) is now affecting more than 200 countries and territories around the world. Given the current unavailability of an effective medical cure for COVID-19, a public health strategy of reduced social contact and shelter in place has been adopted worldwide. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, determining loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines an insurmountable obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS: In this paper we discuss the potential role of telepsychiatry and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine advantages and risks related to the massive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS: Telemental health services are particularly feasible and appropriate for the support of patients, family members and health-care providers during this COVID-19 pandemic. The integration of telepsychiatry with other technological innovations (e.g., mobile apps, virtual reality, big data and artificial intelligence) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION: The COVID-19 pandemic situation shows us how vast the amount of untreated mental illnesses can be. The pandemic crisis can contribute to spread, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.
Aims: Opioid misuse and overuse has contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five-step modified Delphi process, we aimed to develop consensus-based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids, and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids. Results: In patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid-related complications, despite psychological or physical interventions. There was consensus observed to initiate with a CBD-predominant oral extract in the daytime and consider adding THC. When adding THC, start with 0.5–3 mg, and increase by 1–2 mg once or twice weekly up to 30–40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as-needed medication to control pain, and/or the cannabis dose has been optimized. The opioid tapering schedule may be 5%–10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥ 30% reduction in pain intensity, a ≥ 25% reduction in opioid dose, a reduction in opioid dose to < 90 mg MED, and/or reduction in opioid-related adverse events. Conclusions: This five-stage modified Delphi process led to the development of consensus-based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids.
BACKGROUND Hypoalbuminemia is frequently observed in patients with SARS-CoV-2 infection although its underlying mechanism and relationship with clinical outcome still need to be clarified. METHODS We retrospectively evaluated in patients with COVID-19 hospitalized at the Fatebenefratelli-Sacco Hospital in Milan, the prevalence of hypoalbuminemia, its association with the severity of COVID-19, with the levels of C-reactive protein, d-dimer and interleukin-6 and with clinical outcome over a follow-up period of 30 days. Urinalysis was evaluated in a subgroup of patients. RESULTS Serum albumin levels < 30 g/L were found in 105/207 (50.7%) patients at hospital admission. Overall, the median albumin value was 29.5 g/L (IQR 25-32.8). A negative association was found between albumin levels and severity of COVID-19 (p<0.0001) and death (p=0.003). An inverse correlation was observed between albumin and both C-reactive protein and D-dimer at hospital admission (r = -0.487 and r = -0.479, respectively; p< 0.0001). Finally, a positive correlation was found between albumin levels and eGFR (r= 0.137; p=0.049). Proteinuria was observed in 75% of patients with available data and it did not differ between patients with hypoalbuminemia and those with albumin > 30 g/L (81% and 67%, respectively; p=0.09). CONCLUSION In patients with COVID-19 hypoalbuminemia is common and observed in quite an early stage of pulmonary disease. It is strictly associated with inflammation markers and clinical outcome. The common finding of proteinuria, even in the absence of creatinine increase, indicates protein loss as a possible biomarker of local and systemic inflammation worthwhile to evaluate disease severity in COVID-19.
Background: The rapid spread of COVID-19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well-being of or changes to training for American resident physicians during the COVID-19 pandemic. We aim to study predictors of trainee well-being and changes to clinical practice using an anonymous survey of American urology residents. Methods: An anonymous, voluntary, 47-question survey was sent to all ACGME-accredited urology programs in the United States. We executed a cross-sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals. Results: Among approximately 1,800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID-19 severity, and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children, and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training. Conclusions: Several potential actions, which could be taken by urology residency program directors and hospital administration, may optimize urology resident well-being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency program and institutional levels, instituting telehealth education programs, and fostering a sense of shared responsibility of COVID-19 patients.
Physical/social distancing, handwashing, respiratory hygiene, and face-masking have been recommended as realistic counterstrategies to control the COVID-19 pandemic. These strategies have been critical in the fight against the present pandemic in many countries. Here, we detail the background to such countermeasures, present some examples in different settings, and finally emphasize that they should remain in place worldwide as a cultural and behavioral “new normal” until a vaccine or a decisive treatment for COVID-19 is developed and made available globally.
Background: Hypertension and sarcopenia are commonly seen in older adults. The renin-angiotensin system and the therapeutic use of angiotensin converting enzyme (ACE) inhibitors have been on the agenda of sarcopenia in different perspectives. Our aim was to explore the frequency of sarcopenia in patients with hypertension and to investigate the association between the use of ACE inhibitors and sarcopenia. Methods: A total of 233 community dwelling adults were recruited. Anterior thigh muscle thickness was measured by ultrasound. Handgrip strength, gait speed and chair stand test were evaluated. Presarcopenia was diagnosed in the presence of low sonographic thigh adjustment ratio (STAR) values and sarcopenia was diagnosed if low STAR values were coupled with low functional tests. Results: 109 subjects (46.8%) had no comorbid disease; 93 (75.0%) had one, 21 (16.9%) had two, eight (6.5%) had three and two (1.6%) had four comorbid diseases. Both presarcopenia (48.3% vs. 21.1%) and sarcopenia (33.3% vs. 7.0%) were more commonly seen in hypertensive when compared to normotensive older adults. Subgroup analysis of older adults with hypertension revealed that sarcopenia was less prevalent (p=0.020) in patients using ACE inhibitors (9.1%) than those using angiotensin receptor blockers (ARBs) (40.5%) and other antihypertensive drugs (42.9%). After binary logistic regression analyses; only the presence of hypertension seemed to independently predict the development of sarcopenia in older adults [OR=7.9 (95% CI: 2.6-24.5, p<0.001)]. Conclusions: Sarcopenia is highly prevalent in hypertensive older adults. Among many antihypertensive medications, ACE inhibitors seem to have favorable effects on both disorders.
The worldwide outbreak of coronavirus disease-19 (COVID-19) has already put healthcare workers (HCWs) at a high risk of infection. The question of how to give HCWs the best protection against infection is a priority. Our literature review has indicated that the degree of protection required in looking after people with COVID-19 infection, is dependent on the particular environment to which the HCW is exposed. Covering more of the body could provide better protection for HCWs. Of importance, it is not just the provision of PPE but the skills in donning and doffing of PPE that are important, this being a key time for potential transmission of pathogen to the HCW and in due time from them to others. In relation to face masks, the evidence indicates that a higher-level specification of face masks (N95) seems to be essential to protect HCWs from Coronavirus infection. Evidence specifically around PPE and protection from the COVID-19 virus is minimal and at the level of anecdotal reports only.
Objective: A correct examination is essential during a differential diagnosis of neck pain patients. Therefore, the objective of this study was to provide an update on the properties considered most important by PTs when conducting accessory and physiological movement tests during the cervical spine physical examination. Methods: A total of 84 private physiotherapy centres participated in this online cross-sectional survey including 415 active physiotherapists and members of one autonomous Spanish Physiotherapists School. The main outcome measures were the frequency and the importance of mobility and pain responses assessed during cervical spine examination and the most commonly utilized reference to make a judgement. Results: Pain responses are most frequently used by physiotherapists at a rate of 79.8% and also rated as important by 42.65% respondents mobility aspects such as quality of end-feel (17.3%), quantity of translation (16.4%) and quality of resistance (13.3%) during passive accessory intervertebral movement tests. During passive and active physiological movement tests, the most frequent properties assessed were the quality of motion path (80,5% and 84.3% respectively) and quantity of angle bending (81,7% and 77.6% respectively). Pain responses are used as reference by 54.7% to make a clinical judgement during passive accessory intervertebral movement tests. Conclusion: Physical therapists face validity in relation to passive accessory intervertebral movement test for assessing spinal segmental motion aspects has been decreasing with more attention devoted to pain responses. The current skepticism regarding the motion properties assessed with these tests is associated with utility aspects such as validity, sensitivity, accuracy and specificity.