Overall, much progress has been made in automatic detection and characterization of polyps in real time. Barring ethical or mass adoption setbacks, it is inevitable that AI will be involved in the field of GI, especially in colorectal polyp detection and identification.
Background: Cardiovascular disease (CVD) is the major cause of mortality and morbidity among the adult USA population. Major cardiovascular risk factors include age, obesity, hypertension, hypercholesterolemia, diabetes, and chronic kidney disease (CKD) with both diabetes and CKD being considered CVD risk equivalent. Psychological distress is known to be associated with diverse health outcomes. We aim to assess the relationship between psychological distress and cardiovascular disease among adult USA population. Materials & Methods: Data was analyzed from National Health Interview Survey (NHIS) administered by the CDC’s National Center for Health Statistics (NCHS). The NHIS samples non-institutionalized American civilians by household following a multi-stage area probability design. The survey included Kessler 6, a standardized psychological distress scale. SPSS® version 26 was used for analysis which included utilizing both the t-test and ANOVA for continuous variables and the Chi-squared analysis for categorical variables. A logistic regression model was developed to estimate the odds ratio and the strength of association between psychological distress and cardiovascular risk factors, coronary heart disease and stroke. Data is presented as the mean value ±SEM unless otherwise specified. Results: The analysis included 284,497 respondents with 3.6% of the US representative sample reporting psychological distress with a mean age of 48.09 ±0.16. Psychological distress was more common among age group 45-64 years, women, Hispanics and Blacks, alcoholic drinkers, those without a high school diploma, and those below the poverty level. The unadjusted odds ratio for myocardial infarction among those with psychological distress was 2.6 (2.45-2.83 95% CI), p<0.01. The unadjusted odds ratio for stroke among those with psychological distress was 3.1 (2.88-3.34 95% CI), p<0.01. After adjusting for age, BMI, diabetes, hypertension, hypercholesterolemia, smoking and chronic kidney disease, the odds ratio of myocardial infarction among the psychologically distressed was 1.96 (1.66-2.31 95% CI), p<0.01. The adjusted odds ratio for stroke was 2.56 (2.18-3.01 95% CI) p<0.01. Conclusion: Psychological distress is associated with a substantially higher risk of myocardial infarction and stroke independent of the traditional cardiovascular disease risk factors and is highly prevalent among ethnic minorities and disadvantaged socioeconomic groups. Further research is needed to develop effective interventions to manage psychological distress and decrease the disproportionately higher rates of cardiovascular disease among vulnerable populations.
INTRODUCTION:The American Stroke Association estimates that stroke is the fifth leading cause of death in the United States. According to the Center for Disease Control and Prevention someone in the United States has a stoke every 40 seconds, affecting more than 795,000 people of which 140,000 result in death [1]. Emerging evidence suggests that obstructive sleep apnea (OSA) is a strong risk factor for stroke. This study using The Metabolic Syndrome Outcome (MetSO) registry explored whether blacks at risk for obstructive sleep apnea (OSA) are at greater risk for a stroke. METHOD:The present study utilized data from the MetSO study, an NIH-funded cohort study of blacks with metabolic syndrome (MetS). Patients were diagnosed with MetS using standard criteria articulated in the joint interim statement for harmonizing the MetS. The study assessed OSA risk using the Apnea Risk Evaluation System (ARES); defining high risk as a total ARES score ≥6. Data was coded and analyzed by an experienced statistician using SPSS 20.0. RESULTS:A total of 1035 participants were screened for MetS in the MetSO registry. During the data collection period 875 participants were enrolled during the time of analysis. The average age of the sample was 62±14 years (range: 20-97); 71% were female, and all were of black race/ethnicity. Seventy-one percent reported finishing high school, and 43% reported annual income <10K. Descriptive analyses showed 93% of the participants were diagnosed with hypertension; 61%, diabetes; 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease and 10% had a stroke history. Using the ARES screener, we estimated that 48% were at high risk for OSA. Logistic regression analysis, adjusting for age and gender, showed that patients at high risk for OSA had a nearly three-fold increase in the odds of having a stroke (OR = 2.79, 95% CI: 1.64-4.73). CONCLUSION:In the MetSO registry, a cohort of blacks with MetS, the prevalence of stroke is greater than in the general US population. Blacks at risk for OSA are particularly vulnerable to experiencing a stroke.
Novel coronavirus disease (COVID-19) is a pandemic affecting over 10 million people in 160 countries. Its spread, and the medical communities’ response, cast light on an important deficiency in the speed and effectiveness for evidence-based recommendations to reach the bedside in academic medical practice. We built a clinical decision support tool on the avoMD platform that systematizes and personalizes the treatment of COVID-19 by bringing point-of-care access to the guidelines specific to individual cases to the clinician’s hands. This app has the potential to improve the mortality for COVID-19.
Introduction: Among the reported cases of valproic acid - induced pleural effusion, recurrence of pleural fluid accumulation has scarcely been presented in the literature. Case presentation: This case study reports a 51-year-old man under treatment with valproic acid, who presented with recurrent pleural effusion characterized by transition from eosinophilic to lymphocytic predominance. The recurrence of the effusion upon re-administration of the drug, along with its resolution upon discontinuation of treatment with valproic acid, is strongly indicative of a causative association. Conclusion: This is the first reported case of recurrent valproic acid - induced pleural effusion presenting with transition from eosinophilic to lymphocytic predominance. We aim to highlight the importance of taking into consideration the causative role of valproic acid in inducing pleural effusion, even when the pleural fluid demonstrates alteration in the predominant cell type.
Echocardiography can be a useful tool to evaluate athlete's heart in various sports. In this scoping review, we discuss some of the structural and functional changes of the right ventricle across different echocardiographic modes and techniques among individuals engaging in extreme athletic activity. We highlight the role of imaging in the evaluation of athlete's heart and describe similarities and differences between echocardiographic and cardiac MRI features related to acute and chronic athletic activity. We will also review novel echocardiographic parameters including speckle tracking and strain/strain rate imaging. Overall, we aim to present common echocardiographic parameters in elite sports population in order to facilitate better interpretation of their interpretations that may not necessarily be a distinct digression from these common features.
The incidence of CICM in African Americans and Afro-Caribbean is higher than reported in the general population. Dyslipidemia and baseline ejection fraction were seen as the major risk factors associated with the higher incidence of CICM.
Background: Over half of women who present with angina are found to have negative coronary angiographic assessments. Of these patients, up to 50% are diagnosed with coronary microvascular dysfunction (CMD), which refers to pathologic changes within the small vessels of the coronary circulation. The hallmark of the pathophysiology of CMD is that endothelial damage, which occurs due to a multitude of conditions and risk factors, is the inciting event for the development and progression of CMD. CMD leads to a mismatch in myocardial demand and perfusion, leading to signs and symptoms of cardiac ischemia in the absence of obstructive lesions in the major vessels. CMD can be diagnosed through a variety of both invasive methods that allow a more specific evaluation of the microvasculature and non-invasive imaging techniques, such as cardiac positron emission tomography (PET) and magnetic resonance imaging (MRI). Risk factors for CMD overlap significantly with those of obstructive coronary artery disease (CAD) - hypertension, hypercholesterolemia, and diabetes remain salient predictors. However, these conditions only account for 20% of CMD cases in females. Findings: Women have sex-specific risk factors such as menopause, pregnancy, polycystic ovarian syndrome (PCOS), and a higher proclivity toward chronic inflammatory disorders. Estrogen has a cardioprotective effect by increasing production of nitric oxide, a potent vasodilator released by endothelial cells. As a result, the hormonal changes of menopause may accelerate endothelial damage, and in turn, CMD. Current treatments focus on addressing the risk factors of cardiovascular disease, such as anti-hypertensive drugs, weight loss, and glucose control. Conclusion: Given the multifactorial nature of CMD in women, and the extensive atypical risk factors for cardiac disease, a more nuanced approach is needed that addresses the varied pathophysiology of CMD.
Background: Asthma represents a potential threat to students when the school nurse or trained personnel are not available. When teachers need to assist asthmatic students, they need to have a sufficient level of knowledge to be effective until medical help arrives. This study used a sample of convenience to examine the level of teacher asthma knowledge for educators in Middle Tennessee and the effects of four demographic factors on their understanding of asthma using a sample of convenience. Methods: Teachers completed a 13-question online survey (n= 218) which evaluated their knowledge of asthma and the effects of demographic factors such as gender, school level taught, teachers’ own asthma status, and educational attainment on knowledge of asthma. Results: Teachers scored positively on the overall assessment of asthma knowledge with a mean score of correctness was 78% (Likert 3.90). This is above the asthma knowledge efficacy threshold set at 70% (Likert 3.50) by an expert panel. In the demographic analysis, only teachers with a history of asthma had demonstrated a higher level of asthma knowledge (M= 4.09) as compared to teachers without asthma (M= 3.87). Other demographic factors such as gender, educational attainment, or school grade taught had no effect on asthma knowledge. Conclusions: Teachers and educators held a level of asthma knowledge which was above the knowledge level threshold (Likert > 3.5). Teachers with a history of asthma held a higher overall knowledge of asthma than non-asthmatic teachers. No other demographic factors yielded a statistically significant effect. It is recommended public school systems regularly evaluate teacher asthma knowledge to ensure teachers are well prepared to assist students in an asthma emergency.
Objectives: A lot of prolonged jaundice patients may undergo many tests before confirmed diagnosis. Liver biopsy is an effective way in final stage of the course. This article aims to evaluate the accuracy of liver biopsy to diagnose biliary atresia (BA) in infants with cholestasis. Methods: We searched Pubmed, EMBASE and the Web of Science databases for articles evacuated the accuracy of liver biopsy to diagnose BA to obtain the sensitivity, specificity, TN, FN, FP, TP. The methodological quality of liver biopsy was assessed with version 2 of the Quality Assessment of Diagnostic Accuracy Studies tool. Screening, data extraction, and quality assessment were done in duplicated. Results: A total of 20 articles were included. The whole data results the Diagnostic Odds Ratio of liver biopsy was 170.39 (84.90 to 341.97), with a pooled sensitivity of 92% (90%-94%), pooled specificity of 95% (93%-95%). Conclusion: Quantitative analysis demonstrated liver biopsy to be high sensitivity, high specificity, high accuracy in diagnosing BA. The data analysis provides evidence of liver biopsy is a reliable diagnosis method to confirm diagnosis.
Sepsis is a commonly encountered diagnosis affecting nearly 1.7 million adults in the USA annually. According to Center for Disease Control (CDC), over 270,000 Americans die of sepsis each year and 1 in 3 hospital mortalities is attributed to sepsis. The Surviving Sepsis Campaign (SSC) Guidelines for management of severe sepsis and septic shock published in 2004 provide key elements in the treatment of sepsis that are organized into two bundles of care, the "resuscitation" and "management" bundles, including interventions to be accomplished within specified timeframes. In this quality improvement study, we implemented a sepsis intervention protocol (SIP) intended to increase adherence to 3-hour and 6-hour bundles, and to examine the impact on mortality of patients presenting with severe sepsis and septic shock in our emergency department. We analyzed data from our emergency department as reported to the New York State Department of Health (NYSDOH) from 2017Q2 to 2018Q2 (April 2017 -June 2018), the period prior to implementation of SIP, compared to data from 2018Q3 to 2019Q2 (July 2018 to June 2019) after implementation of SIP. The implementation of SIP resulted in increased3-hour and 6-hour bundle adherence and showed a clinically significant reduction of the mean pre-intervention hospital percent mortality of 40.3% to a mean post-intervention hospital percent mortality of 28.7%. A t-test analysis of the pre and post intervention mean hospital percent mortality revealed a reduction in mortality outcomes that was also statistically significant (p <0.05). Our study demonstrates that a well-designed and implemented SIP can increase bundle adherence and is highly effective in reducing mortality among high-risk population.
The severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, is the most serious pandemic in modern times. The disease was first reported in January of 2020 in China's city of Wuhan, Hubei province, and since then it has spread worldwide. Given the rapid spread of the virus and the burden it has taken on the healthcare systems it has swept through, there is the need for a concise description of current understanding of the pathogenesis of organ failure in SARS-CoV-2 infection while acknowledging that more is yet to be uncovered. This review will not only inform decision making at the bedside but will also help illustrate potential therapeutic targets for research. We searched the available literature to-date, and present the pathophysiology underlying increased morbidity and mortality of SARS-CoV-2 infection in the lungs, heart and kidneys in a highly illustrated presentation that is easy-to-understand for the clinician, researcher, and student alike.
Background Rheumatoid arthritis (RA) patients have an increased risk of malignancy with postulated risk factors that include chronic inflammation, smoking and the use of immunosuppressants have been postulated as drivers of higher malignancies rates. Our study aimed to describe the prevalence and type of malignancies encountered in an urban, predominantly Black RA patient population. Methods Cross sectional analysis of 1142 patients with RA diagnosis by ICD-codes of which 501 cases met the inclusion criteria for the study. Blacks accounted for 88.4% of the study population. Fifty-six patients had cancer recorded in their medical records and these cases were further reviewed for tumor type, timing of diagnosis and patient clinical characteristics. Results The cancer prevalence was 11.2% (56/501) in our Black RA population being studied. Mean age at cancer diagnosis was 59.9 ± 5.2 for the patients who developed cancer before RA diagnosis and 58.25 ± 16.02 for those who developed malignancy after RA diagnosis. There were 18 breast cancers, 4 colon and 4 cervical cancers; for lung, multiple myeloma, thyroid, squamous cell carcinoma and pancreas there were 3 cases each; for endometrial, Non-Hodgkin's lymphoma, meningioma and prostate, 2 cases each and 1 each for urinary bladder, esophageal adenocarcinoma, lymphoma, glioblastoma, liver, Hodgkin's lymphoma, sarcoma, ovary and renal cell carcinoma. No differences were found in years of RA duration, joint erosion, joint space narrowing or SENS score except for significantly higher ESR among the cancer group and RF seropositivity in the non-cancer group.Therapeutic modalities were not significantly different between the cancer and no cancer groups. Conclusion Breast cancer was the most prevalent malignancy among our Black RA population. Further studies are needed to identify the contributing factors to the malignancy risk of breast cancer in our Black RA population and whether it is gender-related since RA is more prevalence in women.
Heart Failure (HF) is a major public health problem and a major cause of morbidity and mortality worldwide. Thyroid hormones (TH) have multiple effects on the heart and cardiovascular system. In recent years, studies have shown that hypothyroidism, including subclinical hypothyroidism, is associated with an increased risk for developing and worsening of HF. This review addresses the relationship between HF and hypothyroidism by highlighting the epidemiology, pathophysiology and management.
Background FDA is considering to establish a product standard to reduce nicotine in cigarettes to make them “minimally addictive or nonaddictive.” FDA has funded many clinical studies where smokers are switched to smoking low nicotine cigarettes to determine a nicotine ceiling that is appropriate for the protection of the public health. Unlike typical clinical trials involving pharmaceuticals or medical devices, ambulatory studies with low nicotine cigarettes face a unique challenge in that conventional nicotine non-study cigarettes are readily available to participants when protocols require them to exclusively use study cigarettes. As a consequence, protocol deviation in non-study product use is a major limitation common in such ambulatory studies, with up to 80 percent of participants using non-study cigarettes during the study. There is no published method for estimating the magnitude of such protocol deviation, i.e., the number of non-study cigarettes smoked by participants, in such studies.Methods We present a method for estimating the magnitude of noncompliance based on the proposition that the level of biomarker of exposure to a smoke constituent is proportional to the amount of the constituent per cigarette and the number of cigarettes smoked by participants. The method estimates the number of non-study cigarettes smoked by participants based on the discrepancies between the yield of smoke constituents (e.g., nicotine) and the level of the corresponding biomarkers measured in a study.Results Data from a confined study confirmed the validity of this method. Under-reporting on the magnitude of non-study cigarette use is widespread across studies using different low nicotine cigarettes. Participants in one of the largest published studies under-reported the number of non-study cigarette used by 79-90%.Conclusions Controlling and accurately estimating non-study cigarette use is critical for ambulatory low nicotine cigarette switching studies to ensure the resulting data can be appropriately evaluated to support science-based regulatory decision-making. In planning future studies, researchers should consider incorporating specific biomarkers that would enable objective assessment of both the prevalence and the magnitude of non-study cigarette use.
The prevalence of obesity and its related comorbidities continues to rise in the United States and worldwide. Insulin resistance, increased inflammation and oxidative stress are the major pathogenic mechanisms involved in obesity-associated co-morbid conditions. Major efforts to curb the rising tide of obesity, including lifestyle modifications, anti-obesity medications and surgical interventions have shown minimal success. Therefore, introducing new methods to combat obesity, diabetes and associated disorders are desperately needed. , a natural, non-caloric sweetener has generated significant interest in the scientific community due to its effects on glucose homeostasis, blood pressure and inflammation, all known consequences of obesity. In this review, we assess the effects of Stevia on these parameters in humans as well as in animal models, highlighting its potential role as an effective intervention for the major cardiovascular risk factors associated with obesity.
Heart Failure (HF) is one of the leading hospital readmission diagnoses in the United States. It is a major challenge in today's healthcare environment to reduce hospital readmissions for HF and much of the expenditure on HF is on in-hospital treatment. In the USA, risk factors for readmission with HF include being African American, low-socioeconomic status, Medicare, Medicaid, self-pay/no insurance and drug abuse. The Transitional Care Clinic (TCC) model established at our institution integrated multiple facets of chronic HF management, including early post-discharge follow-up, phone call reminders as well as clinical pharmacists and nurse practitioner's integration into the treatment team. Of 488 HF admissions to our institution from March 2015 until May 2017, mean age = 65 years (SD 13.03), 262 patients were males (53.6%) and 463 patients (94%) were Blacks. There was a total of 121 readmissions within 30 days after discharge (24.8%) and 43 readmissions 7 days after discharge (8.81%) during our study period. 159 patients (32.58%) followed up in our TCC, while 329 patients (67.41%) did not at TCC. Within 7 days post discharge, there was 3 (1.9%) Vs 40 (12.2%) readmissions for TCC and non-TCC groups respectively, P<0.01. There was 18 (11.32%) Vs 103(31.31%) readmissions within 30 days post discharge for TCC and non-TCC groups respectively P<0.01. Among high readmission risk and predominantly black population with HF, TCC resulted in significantly lower hospital readmission rate within 7 days and within 30 days of initial discharge. These data help inform policy makers regarding the effectiveness of TCC model for resource allocation and broader implementation, particularly among high risk population with the potential of cost saving and better patient outcomes.
CRISPR is a powerful new biochemical tool that can be used to edit the DNA of somatic cells or the germline. It can be used for good ends such as the treatment or prevention of illness or disability, or for bad ends. All its uses for good ends can be sorted out into six kinds of cases: editing somatic cells to treat or prevent disease-a therapeutic use; editing somatic cells to enhance a living thing; editing the germline to prevent future disease-a second therapeutic use; editing the germline to enhance future living things; editing somatic cells for research to understand nature and unlock its secrets; and editing the germline for the same research purposes. Recent discussions by various experts, in the science, ethics, and governance of gene editing, show confidence in the first kind of case-that it is a good use provided the editing is safe and effective; and hesitation, doubts, and calls to stop editing in the next three cases. The paper explores the basis of our confidence in the somatic therapeutic case, and compares it systematically to the enhancement cases, while using the research cases for what they teach us about good ends. The center of this approach is that our confidence in the therapeutic somatic case is based on our agreement that health is a fundamental good, and the paper suggests an analogy between the ethics of therapy and the ethics of enhancement, which throws some light on the difficult cases of human enhancement.
While rheumatoid arthritis (RA) typically presents with synovitis of the small and medium joints of the hands, ocular manifestations of the disease are generally overlooked and largely underdiagnosed. These complications usually present in longstanding RA population and occasionally represents the first manifestation of the disease and generally affect the anterior chamber of the eye, leading to keratoconjunctivitis sicca, episcleritis, scleritis, peripheral ulcerative keratitis and anterior uveitis. In this review, we present the current understanding of the pathophysiologic mechanisms for ocular disease in RA, including the role of oxidative stress, cytokine imbalance, chronic inflammation, vascular permeability, immune complex deposition and the role of T-cells as well as the contribution of tear hyperosmolarity among other factors. We also discuss the clinical presentation and diagnosis of each of the ocular disease entities highlighting the latest strategies in the management of this serious disorders that could potentially lead to blindness and the implications of recently completed and ongoing clinical trials in the field. While RA disease control is the cornerstone in the management of RA-associated ocular manifestations, early recognition of ocular pathology with prompt referral to ophthalmology is of paramount importance in order to prevent blindness and improve the quality of life in this patient population.
