Background: Despite a large amount of evidence evaluating elevated troponin I levels and adverse clinical outcomes, little is known about the role of a normal (negative) troponin I during the first 24 h of admission for risk stratification in patients with Coronavirus Disease 2019 (COVID-19). This study aims to evaluate the utility and negative predictive value of a serum troponin I level to predict in-hospital mortality.Methods: We retrospectively analyzed all adult patients (>18 years of age) with COVID-19 admitted to an HCA Healthcare facility between March 2020 and March 2021 who had a troponin I level drawn at admission. Patients were initially stratified into two groups based on their cardiac troponin I value in the first 24 h of admission (elevated vs negative).Results: A total of 65,580 patients were included in the final analysis. A negative troponin I value was associated with lesser odds of death during admission (OR = 0.32, 95 % CI 0.31-0.34, p < 0.01) and cardiac complications (OR = 0.38, 95 % CI 0.37-0.40, p < 0.01). The negative predictive value of a negative troponin value for allcause in-hospital mortality was 85.7 %.Conclusions: Our study found a significant association between a negative troponin I value in the first 24 h of admission and decreased odds of death during admission in patients with confirmed COVID-19 infection, in addition to decreased odds of cardiac complications but no significant difference in hospital length of stay. Therefore, the authors suggest that the absence of troponin I elevation may serve as an indicator of a more benign hospital course.

Emergency department (ED) and intensive care unit (ICU) staff experience significant and ongoing exposure to mental health trauma due to the extremely high number of tragic cases consistently seen. Despite awareness of the magnitude of this problem, there is a scarcity of clinical efforts directed toward reducing and managing secondary traumatic stress and vicarious trauma. In an effort to promote resiliency in these frontline workers, we describe development and implementation of the Adapted Peer Support Resiliency Program (APSRP), a psychoeducational and cognitive reframing behavioral-based program equipped with peer support professionals who are trained in cognitive-behavioral strategies specifically tailored toward the needs of this population. The APSRP is an adaption of concepts and coping skills utilized by the Penn Resilience Program, which has previously demonstrated efficacy in combating a range of psychological problems (e.g., anxiety, depression, substance abuse, eating disorders, and severe mental illness). The APSRP incorporates a range of cognitive-behavioral strategies inclusive of cognitive reframing skills, role-playing, and behavior rehearsal. This proposed program was facilitated and supervised by a licensed mental health professional and implemented by fellow ED and ICU peer professionals. Components of the APSRP model are discussed. Suggestions for directing future efforts within this needed area are offered.

Introduction The amount of peri- and post-operative use of opioids for pain management, and the duration in which they are used following surgery, are positively associated with the likelihood of subsequent opioid use and addiction. Aware of this issue, many clinicians are seeking ways to reduce opioid use while maintaining adequate pain management. Recent evidence suggests that peripheral nerve block utilization may present a viable mechanism by which clinicians can accomplish this goal. Methods Ovid MEDLINE and Pubmed databases were searched to identify relevant articles. Using the advanced search option, the key terms "opioid," "morphine," "nerve block," "peripheral anesthesia," "pain management," "preoperative,", "intraoperative," and "postoperative" were used and combined with the Boolean terms "AND" and "OR." This review examines the extant literature surrounding the use of peripheral nerve blocks in relation to patient-reported pain scores, intraoperative opioids, postoperative opioids, patient-controlled analgesic with opioids, and opioid consumption once the patient has left the hospital. Further, the effect peripheral nerve blocks have on postoperative physical therapy, surgery related complications, and overall patient satisfaction are briefly discussed. Results The use of perioperative peripheral nerve blocks decreases opioid consumption not only in the postoperative period, but also intraoperatively as well. The most significant decrease in opioid consumption is seen in the first 24-72 hours postoperatively. Patient reported pain scores were also lower in patients who received peripheral nerve blocks. Discussion Despite relatively robust efficacy data, utilization of peripheral nerve blocks is not ubiquitous; the potential reasons for which are also discussed. Lastly, clinical recommendations based on the available data are provided.

>Alzheimer 's disease(AD) has a multifactorial etiology that has eluded scientists and clinicians for decades. This incomplete understanding of the causal factors likely contributes to the dearth of effective therapeutics available to treat this growing pandemic. Cholinesterase inhibitors such as galantamine, rivastigmine and donepezil are considered frontline treatments but these medications merely treat some of the symptoms associated with AD,

The World Health Organization refers to Alzheimer’s disease (AD) as a global health priority. As the average age of the world’s population is increasing, so too is the rate of AD. There are an estimated 47 million people globally who have been diagnosed with AD dementia, and researchers have yet to figure out the root cause. All misfolded aggregate proteins that are involved in neurodegenerative disorders (amyloid-β, Huntington’s tau, α-synuclein) induce oxidative stress. It is that oxidative stress that leads to inflammation and, in conjunction with amyloid protein and tau hyperphosphorylation, progresses to and exacerbates AD. The consumption of antioxidants and nutrients, specifically vitamin E, caffeine, and turmeric, may slow the progression of AD and can be found in a wide variety of dietary foods. This review explores the role of inflammation on AD, the antioxidants that can potentially combat it, and future directions of how the treatment of the disease can be better understood.

The Body Shape Questionnaire (BSQ) is a widely used measure of body shape concerns that was originally designed for use with women but has more recently been used with boys and men. The latter use may be problematic, given that no previous study has demonstrated sex invariance for BSQ scores. To determine the extent to which BSQ scores are sex invariant, we asked Portuguese-speaking women (n = 1,613) and men (n = 871) to complete the full BSQ (34 items). Confirmatory factor analysis indicated that a hypothesized 32-item model of BSQ scores and shorter versions had acceptable fit indices in women and men, separately. However, multigroup confirmatory factor analysis showed that these BSQ model scores had configural but not metric, scalar, or strict sex invariance. Differential item analysis indicated significant item-functioning differences on 19 of the 32 retained BSQ items. Thus, BSQ scores are not sex invariant, making problematic the results of previous studies that have compared latent BSQ scores across sex.

Entamoeba histolytica is the responsible parasite of amoebiasis and remains one of the top three parasitic causes of mortality worldwide. With increased travel and emigration to developed countries, infection is becoming more common in nonendemic areas. Although the majority of individuals infected with E. histolytica remain asymptomatic, some present with amoebic colitis and disseminated disease. As more is learned about its pathogenesis and the host's immune response, the potential for developing a vaccine holds promise. This narrative review outlines the current knowledge regarding E. histolytica and E. dispar and insight in the development of a vaccine.

OBJECTIVES:To refine the biobehavioral markers of binge eating disorder (BED).METHODS:We conducted fMRI brain scans using images of high energy processed food (HEPF), low energy unprocessed food (LEUF), or non-foods (NF) in 42 adults (obese with BED [obese -BED; n=13] and obese with no BED [obese non-BED; n=29]) selected via ads. Two blood oxygenated level dependent (BOLD) signal contrast maps were examined: food versus nonfood, and HEPF versus LEUF. In addition, score differences on the disinhibition scale were correlated with BOLD signals.RESULTS:food versus nonfood showed greater BOLD activity for BED in emotional, motivational and somatosensory brain areas: insula, anterior cingulate cortex (ACC), Brodmann areas (BA) 19 & 32, inferior parietal lobule (IPL), posterior cingulate cortex (PCC), and lingual, postcentral, middle temporal and cuneate gyri (p≤0.005; k≥88). HEPF versus LEUF showed greater BOLD activity for BED in inhibitory brain regions: BA 6, middle and superior frontal gyri (p<0.01; k≥119). The groups also differed in the relationships between disinhibition and BOLD activity in the postcentral gyrus (PCG; p=0.04) and ACC-BA 32 (p=0.02). For all participants jointly, PCG BOLD amplitude predicted greater disinhibition (p=0.04).DISCUSSION:Food images elicited neural activity indicating attention bias (cuneate & PCG), emotion dysregulation (BA 19 & 32), and disinhibition (MFG, BA6 & SFG) in obese with BED. These may help tailor a treatment for the obesity with BED phenotype.

Obesity is a multifactorial, chronic disease that has proven difficult to treat. An increased understanding of aetiological mechanisms is critical to the development of more effective obesity prevention and treatment strategies. A growing body of empirical evidence has demonstrated parallels between obesity, overeating and substance abuse, including shared behavioural, psychological and neurophysiological factors implicated in the excessive intake of both food and substances of abuse. Several different lines of research have recently emerged that hold the potential to shed light on the connection between obesity, food reward and addiction, with studies examining changes in alcohol use/misuse after weight loss surgery providing a particularly interesting perspective on these interrelationships. However, these lines of investigation have proceeded in relative isolation, and relevant research findings have yet to be integrated in a synthesized, comprehensive manner. To provide an opportunity to achieve such a synthesis, a scientific symposium was convened at the Radcliffe Institute in Cambridge, Massachusetts. Invited participants were researchers working in diverse domains related to the intersection between obesity and addiction. Extensive discussion was generated suggesting novel research directions. In this article, we summarize and synthesize the symposium participants' ongoing research in this area, incorporating additional relevant research holding potential clues regarding the connections between obesity, weight loss surgery and addiction.

MAP (MUTYH-associated polyposis) is a syndrome, described in 2002, which is associated with colorectal adenomas, with enhanced colorectal carcinogenesis. This review synthesizes the available literature on MAP and outlines its pathogenesis, association with colorectal tumorigenesis, screening, treatment, and the subtle differences between it and its close cousins—FAP and AFAP. The preponderance of data is collected using MAP guidelines. However, although AFAP and MAP appear similar, potentially important distinctions exist, warranting targeted diagnostic criteria and treatment approaches. We suggest that it may be prudent to screen for MAP earlier than in current clinical practice, as it has been shown that sequence variants are associated with more severe disease, presenting with an earlier onset of colorectal cancer. Finally, we issue a call-to-action for much-needed further data to establish clear clinical and diagnostic criteria.

To evaluate the psychometric properties of the male body dissatisfaction scale (MBDS) in Brazilian and Portuguese university students; to present a reduced model of the scale; to compare two methods of computing global scores for participants’ body dissatisfaction; and to estimate the prevalence of participants’ body dissatisfaction.

Study Objective: The increasing prevalence of adolescent obesity has led to consideration of the potential effect of obesity on risky sexual behaviors. In the current study we examined whether body mass index (BMI) was related to age at sexual debut, type of sexual behavior, partner number, and condom use in a population of adolescent women at high risk for obesity and risky sexual behaviors.Design, Setting, and Participants: Cross-sectional examination of 860 sexually active, predominantly minority, adolescent women who received medical care at an urban health center from 2007 through 2013.Intervention and Main Outcome Measures: Self-reported age at sexual debut, types of sexual intercourse, number of partners and condom use was compared with clinically assessed BMI.Results: BMI was positively associated with number of sexual partners (P = .001) and history of attempted anal intercourse (P = .002). An inverse association was observed with age at first anal intercourse (P = .040).Conclusion: In this sample of adolescent women, increased BMI was associated with riskier sexual practices at a younger age. Results of this study suggest that overweight and obese adolescents are a vulnerable population who might need targeted sexual health counseling.

Sexually transmitted infections and unintended pregnancies are highly prevalent among adolescents and disproportionately affect young adults and ethnic minorities. Previous literature has established a relationship between self-esteem and safer sex practices (e.g. contraception use); however, studies that examine the relationship between self-esteem and motivation for contraception use are lacking. The purpose of this study was to evaluate the relationship between a marker of self-esteem and self-reported use of contraception for protection against pregnancy vs. protection against sexually transmitted infections (STIs).

Many clinicians are not adequately aware of the reasons that individuals with obesity struggle to achieve and maintain weight loss, 1 Colbert JA Sushrut J Training clinicians to manage obesity—back to the drawing board. N Engl J Med. 2013; 369: 1389-1391 Crossref PubMed Scopus (26) Google Scholar and this poor awareness precludes the provision of effective intervention. 2 Puhl RM Heuer CA Obesity stigma: important considerations for public health. Am J Public Health. 2010; 100: 1019-1028 Crossref PubMed Scopus (984) Google Scholar Irrespective of starting weight, caloric restriction triggers several biological adaptations designed to prevent starvation. 3 Ochner CN Barrios DM Lee CD Pi-Sunyer FX Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013; 120: 106-113 Crossref PubMed Scopus (107) Google Scholar These adaptations might be potent enough to undermine the long-term effectiveness of lifestyle modification in most individuals with obesity, particularly in an environment that promotes energy overconsumption. However, they are not the only biological pressures that must be overcome for successful treatment. Additional biological adaptations occur with the development of obesity and these function to preserve, or even increase, an individual's highest sustained lifetime bodyweight. For example, preadipocyte proliferation occurs, increasing fat storage capacity. In addition, habituation to rewarding neural dopamine signalling develops with the chronic overconsumption of palatable foods, leading to a perceived reward deficit and compensatory increases in consumption. 4 Kenny PJ Reward mechanisms in obesity: new insights and future directions. Neuron. 2011; 69: 664-679 Summary Full Text Full Text PDF PubMed Scopus (469) Google Scholar Importantly, these latter adaptations are not typically observed in individuals who are overweight, but occur only after obesity has been maintained for some time. 3 Ochner CN Barrios DM Lee CD Pi-Sunyer FX Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013; 120: 106-113 Crossref PubMed Scopus (107) Google Scholar Thus, improved lifestyle choices might be sufficient for lasting reductions in bodyweight prior to sustained obesity. Once obesity is established, however, bodyweight seems to become biologically stamped in and defended. Therefore, the mere recommendation to avoid calorically dense foods might be no more effective for the typical patient seeking weight reduction than would be a recommendation to avoid sharp objects for someone bleeding profusely. Reversible biological adaptations in obesityChristopher Ochner and colleagues address the very important issue of whether reversal of the neurohormonal adaptations associated with obesity is physiologically possible. They suggest that these changes are irreversible and thus prevent the possibility of designing successful strategies using lifestyle interventions. They argue that any treatment of obesity should include direct biological intervention.1 Full-Text PDF Reversible biological adaptations in obesity – Authors' replyWe thank Per Södersten and colleagues for their thoughtful commentary, and appreciate the contribution of their research.1 However, its description primarily argues against contentions that were not made in our Comment,2 which necessitates some clarification. We state that the neurohormonal adaptations to sustained obesity often persist indefinitely, but we do not suggest that is it not physiologically possible to reverse them. Further, the increased ghrelin following low-calorie diet described by Södersten and colleagues is an example of an adaptation to caloric restriction, which differs from biological adaptations to sustained obesity that serve to maintain or even increase an individual's adipose storage capacity. Full-Text PDF

Substance abuse in adolescence is related to many psychosocial and environmental factors, family structure being one that has received considerable attention. However, little data exists about how living arrangements may be related to substance use. This study sought to examine the relationship between living situation and substance use in an urban adolescent population. Data for this study was obtained from evaluation survey of the largest freestanding comprehensive-care adolescent health center in the world, conducted by an independent agency (ICF International). The Mount Sinai Adolescent Health Center (MSAHC) sees nearly 12,000 patients a year, of whom > 95% were minority and approximately 65% low socioeconomic status. The sample in this study had a total of 1368 male and female adolescents. Of the total sample, 702 were current MSAHC patients and 700 were non-MSAHC patients recruited from the local community and matched for age and gender. Data was collapsed across these groups and enrollment group was included as a control variable in all analyses. The mean sample age was 19.5 ± 2.2 [SD] years. 47.3% of the sample was Hispanic, 54.4% was African American. Survey data was gathered via a self-reported, 20-minute phone survey for all participants. We performed a cross-sectional analysis of baseline data. Multinomial logistic regressions were performed, controlling for age, recruitment group, gender, and zip code. 1099 (80.3%) patients reported living in their parents' home, 190 (13.9%) reported living in another person's home, and 79 (5.8%) reported living in their own place. Eighty-four (6.1%) of patients reported that they had ever used illegal drugs or pills without a prescription. Of the prior 30 days, patients reported smoking cigarettes on 2.5 ± 7.5 days, drinking 5 or more drinks of alcohol 1.0 ± 3.0 days, and using marijuana 3.3 ± 8.1 times. Regression analyses indicated that adolescents who have their own place vs. living with their parents were at 0.75 increased log odds of having (ever) abused prescription drugs Exp(B) = 2.12, p = 0.048. However, living in their own place or in another person's home relative to with parents was not associated with increased odds of smoking cigarettes, excessive alcohol use, or marijuana use (all p's > 0.13). A post hoc power analyses revealed power > 0.9 to detect even a small effect. Living situation in an urban adolescent population significantly affects illegal prescription drug abuse. This information may be useful to aid providers in targeting counseling to more vulnerable patients.

In the face of worldwide obesity epidemics that is associated with a myriad of adverse health consequences, numerous dietary regimens have been designed to prevent weight gain by modifying the amount and type of the calorie intake. Dietary protein is the least studied macronutrient regarding the nutritional manipulations recommended for weight loss however, despite the initial skepticism of many investigators, high-protein (HP) diets have received attention as a strategy for weight control and obesity management. From the thermodynamics point of view, a calorie is a calorie is a calorie, regardless of the macronutrient composition of the diet. However, not opposing but adding to this; a weight loss diet that is also increasing energy expenditure would result in a greater negative energy balance than the mere effects of hypocaloric intake, leading to a greater weight loss. In support; it has been shown that individuals given (HP) diets accompanied by carbohydrate restriction, increased energy expenditure, attenuating muscle loss, and improving blood lipids. Within this review, we present evidence from well designed randomized control trials showing that an HP diet regimen can lead to a greater feeling of satiety, decreased caloric intake during and at a subsequent meal, increased resting energy expenditure and greater overall weight loss especially from fat depots as well as less weight regain following weight loss than an isocaloric low-protein (LP) diet regimen. We will also discuss the safety concerns raised against protein-laden food intake for the general public; current research on the safety issues have mostly been regarded as inconclusive, and the associated harmful effects seem to be contingent upon the former health status (e.g. existing kidney dysfunction), the specific content of the overall diet, and possibly the type of dietary protein. Finally, a calorie is a calorie, however this comprises one half of the energy balance equation; thus the effects of dietary protein on energy expenditure may lead to greater weight loss benefits of a hypocaloric HP diet than the other macronutrients.

Background. Sexually transmitted infections (STIs) are common among adolescents, and multiple STIs over one's lifetime can increase health risks. Few studies have assessed lifetime STI prevalence. This study evaluates minority, underserved adolescents' self-reported lifetime STI history and objective STI rates. Methods. Lifetime STI rates of female patients at an urban adolescent health center were obtained from self-administered questionnaires. Additionally, STI test results were retrieved from electronic medical records. Results. Patients reported a high lifetime prevalence of STIs. By comparing self-report and objective data, underreporting was identified for chlamydia, gonorrhea, and herpes. Conclusions. STI rates in at-risk adolescent females are higher than in the general population and remain elevated over time. Lifetime STI reports could expand our understanding of sexual health and should be further studied. Underreporting, which may increase health risks and hinder health care delivery, requires further investigation. Improvements in STI screening and prevention targeting at-risk populations are warranted.

Objective: Review evidence for dietary interventions for Alzheimer's disease (AD) and mild cognitive impairment (MCI) prevention and treatment. Background: Evidence suggests nutrition may be a preventative and/or therapeutic option for AD/MCI. Grading the existing research via evidence-based review may augment current AD/MCI management plans via low-risk, non-pharmacological interventions, while also clarifying research gaps. Methods: PubMed, PsychINFO and Medline were used to identify clinical trials and additional studies addressing the relation between diet and AD/MCI. Based on the 2011 AAN Clinical Practice Guidelines manual criteria, evidence surrounding the use of dietary interventions for prevention and treatment of AD and MCI is rated as: Strong, Moderate, Weak or Insufficient. Results: Although clinical trials are lacking, the Mediterranean-style diet has the strongest data to support reduced risk of AD/MCI. Studies have also shown a positive relationship between low-carbohydrate, lower daily caloric intake (<2143), and higher antioxidant intake (e.g., flavonoid-rich berries) and memory function. However, one clinical trial found that neither a combination of Vitamin E, C, and alpha-lipoic acid nor CoQ-10 had an effect on AD. Trials demonstrated enhanced cognitive performance in MCI patients given omega-3 supplements, with some preliminary data suggesting pharmacogenomic considerations (APOE4+/-). Preliminary evidence supports disease modifying and/or therapeutic effects of B-complex vitamins and cocoa flavinols. To date, no trial/study has been conducted to assess the relation between coconut oil intake and the progression or treatment of AD/MCI. Conclusion: There is sufficient evidence to recommend the use of specific dietary modification in clinical practice for risk reduction and management of AD/MCI. Adherence to a Mediterranean-style diet (strong), low-carbohydrate/caloric intake (moderate), omega-3 fatty acid intake (moderate), and B-vitamins (moderate) may lower the risk of AD. Antioxidants (moderate/weak) and coconut oil (insufficient) are less convincing. While further studies are warranted, certain low-risk dietary strategies should be considered as part of a multi-faceted therapeutic approach for AD/MCI.

The purpose of this narrative review was to discuss the most compelling empirical evidence pertaining to the potential relation between coffee consumption, cognitive function, and Alzheimer’s disease (AD). Sixteen studies were identified and selected based on cognitive outcomes (performance, decline, dementia and AD). The majority of retrospective studies suggest a positive association between coffee intake and cognitive performance, implying a possible therapeutic strategy for those affected with AD. Similarly, most prospective cohort studies suggest that coffee consumption is associated with reductions in cognitive decline, and onset of dementia and AD. Unfortunately, few human studies differentiate between the effects of caffeinated vs. decaffeinated coffee. Recent studies in animals suggest that the presumed neuroprotective effect of coffee is not completely accounted for by caffeine, but may be due to a combinatory effect of caffeine with other bioactive compounds in coffee (e.g., eicosanoyl-5-hydroxytryptamide). As such, additional research in humans is warranted, particularly regarding the effects of caffeinated vs. decaffeinated coffee on cognitive function and AD. Despite the lack of evidence of a causal relation, coffee consumption in the morning carries few known risks and may be associated with improvements in cognitive function.