Internal medicine

BACKGROUND: Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described. OBJECTIVES: Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children...

A multiple sleep latency test (MSLT) with occurrence of sleep onset REM periods (SOREMP) is considered one of the central diagnostic criteria for narcolepsy according to the International Classification of Sleep Disorders, but its sensitivity and specificity have been questioned. This study aims to describe MSLT and polysomnography (PSG) findings, including frequency and distribution of SOREMP during the day, in a large cohort of patients with central disorders of hypersomnolence (CDH). We retrospectively analyzed electrophysiological data from MSLT and PSG in 370 consecutive patients with narcolepsy type 1 (NT1, n = 97), type 2 (NT2, n = 31), idiopathic hypersomnia (IH, n = 48), nonorganic hypersomnia (NOH, n = 116) and insufficient sleep syndrome (ISS, n = 78)...

Photodynamic inactivation (PDI) is a novel sterilization technology that has proven effective in medicine. This study focused on applying PDI to food packaging, where chitosan (CS) films containing photosensitizing riboflavin (RB) were prepared via solution casting. The CS-RB composite films exhibited good ultraviolet (UV)-barrier properties, and had a visually appealing highly transparent yellow appearance. Scanning electron microscopy (SEM) confirmed even dispersion of RB throughout the CS film. The addition of RB led to improved film characteristics, including the thickness, mechanical properties, solubility, and water barrier properties...

OBJECTIVE: Sarcopenia is highly prevalent in hospitalized older patients and associated with short-term mortality. This study aimed to investigate whether sarcopenia and its measures handgrip strength (HGS) and muscle mass at hospital admission were associated with long-term mortality in a cohort of hospitalized older patients. DESIGN: Observational, prospective, longitudinal inception cohort study. SETTING AND PARTICIPANTS: Academic teaching hospital; patients age ≥70 years admitted to the internal medicine, acute admission, trauma, or orthopedic wards...

The General European Official Medicines Control Laboratory (OMCL) Network (GEON), co-ordinated by the European Directorate for the Quality of Medicines & HealthCare (EDQM), regularly organises market surveillance studies on specific categories of suspected illegal or illegally traded products. These studies are generally based on a combination of retrospective and prospective data collection over a defined period of time. This paper reports the results of the most recent study in this context with the focus on health products containing non-Anatomical Therapeutic Chemical-International Nonproprietary Name (ATC-INN) molecules...

BACKGROUND: The development of large data sets, including genomic data, coupled with rapid advances in personalized medicine where citizens increasingly face complex choices about the use of their genomic information implies that citizens are essential stakeholders in genomics. They should be engaged in the ethical, legal and societal issues to produce a framework that fosters trust and allows them to guide the technology based on their values. OBJECTIVE: This article highlights that citizens' conceptions of the human genome inform about and make sense of their main values regarding the use of genomic information, which is critical for policymakers, experts and stakeholders to understand to maintain the public support in genomics...

BACKGROUND: Mitochondria play an important role in cellular metabolism and their dysfunction is postulated to be involved in metabolic disturbances. Mitochondrial DNA is present in multiple copies per cell. The quantification of mitochondrial DNA copy number (mtDNA-CN) might be used to assess mitochondrial dysfunction. OBJECTIVES: We aimed to investigate the cross-sectional association of mtDNA-CN with type 2 diabetes and the potential mediating role of metabolic syndrome...

BACKGROUND: Frailty complicates management and worsens outcomes. We assessed the prevalence, determinants and consequences of frailty among elderly patients in a hospital setting. DESIGN: Retrospective observational study in a Swiss university hospital. METHODS: 22,323 patients aged ≥65 years hospitalized between January 2009 and December 2017 at the internal medicine ward were included. Frailty was defined by the Hospital Frailty Risk Score (HFRS) and patients were categorized as low (HFRS<5), intermediate (HFRS 5-15) and high (HFRS>15) risk...

BACKGROUND It is challenging to entirely show the anterior talofibular ligament (ATFL) and accurately diagnose ATFL injury with traditional 2-dimensional (2D) magnetic resonance imaging (MRI). With the introduction of 3.0T MRI, a 3-dimensional (3D) MRI sequence can achieve images with high spatial resolution. This study aimed to evaluate the accuracy of 3D MRI and compare it with 2D MRI in diagnosing ATFL injury. MATERIAL AND METHODS This was a prospective study in which 45 patients with clinically suspected ATFL injury underwent 2D MRI, 3D MRI, and 3D model reconstruction followed by arthroscopic surgery between February 2018 and April 2019...

Lower respiratory tract infections (LRTIs) due to bacterial pneumonia are common among hospitalized patients and are frequently treated with antibiotics. Viral illnesses and exacerbations of heart failure or COPD may present with symptoms mimicking a LRTI, resulting in unnecessary antibiotic utilization. Procalcitonin testing may be useful in these clinical scenarios. We attempted to assess the utility of procalcitonin testing versus not testing, and positive versus negative results among hospitalized patients with suspected LRTI...

The COVID-19 pandemic has led to increased staffing needs in emergency departments. The question quickly arose as to whether it was appropriate to offer medical students the opportunity to assist this staff. The dilemma stems in part from the potential impact on their psychological well-being as well as their academic and clinical performances. We sought to determine the level of anxiety of medical students during the COVID-19 outbreak, and whether it was higher among the students who chose to return to the clinical setting, especially in first-line units (i...

SARS-CoV2-induced direct cytopathic effects against type II pneumocytes are suspected to play a role in mediating and perpetuating lung damage. The aim of this study was to evaluate serum KL-6 behavior in COVID-19 patients to investigate its potential role in predicting clinical course. Sixty patients (median age IQR, 65 (52-69), 43 males), hospitalized for COVID-19 at Siena COVID Unit University Hospital, were prospectively enrolled. Twenty-six patients were selected (median age IQR, 63 (55-71), 16 males); all of them underwent follow-up evaluations, including clinical, radiological, functional, and serum KL-6 assessments, after 6 (t1) and 9 (t2) months from hospital discharge...

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease which has had a rapid surge in cases and deaths since it is first documented in Wuhan, China, in December 2019. COVID-19 is caused by the Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 uses angiotensin-converting enzyme 2, which is highly expressed in the human lower respiratory tract but also in other tissues, as the cellular entry receptor. Thus, COVID-19 mainly affects the respiratory system but can cause damage to other body systems, including the cardiovascular, gastrointestinal, hepatobiliary, renal, and central nervous systems...

No abstract text is available yet for this article.

Using postmortem MRI, we studied the features of the development of internal cadaveric hypostasis in dead newborns. Postmortem radiological and pathoanatomical examination of 62 bodies of newborns and infants who died at the age of 1.5 h to 49 days was carried out. After the death was ascertained, prior to MRI, the bodies were stored in a refrigerator at 4°C in the supine position. Depending on the duration of the postmortem period (2-72 h), all observations were divided into eight groups. Prior to autopsy, an MRI scan was performed in T1 and T2 standard modes, followed by analysis of the presence and severity of the gradient line of the intensity of the MR signal in the liver and lung tissue in the ventral (overlying) and dorsal (underlying) areas, as well as the presence of a gradient of the intensity of the blood signal in the heart cavity and in the aortic lumen...

No abstract text is available yet for this article.

OBJECTIVES: To explore the current evidence on interventions to influence antibiotic prescribing behavior of health professionals in outpatient settings in low-income and lower-middle-income countries, an underrepresented area in the literature. METHODS: The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low-income and lower-middle-income countries...

BACKGROUND: There is limited data on the characteristics of 30-day readmission after hospitalization with coronavirus disease 2019 (COVID-19). OBJECTIVES: To examine the rate, timing, causes, predictors, and outcomes of 30-day readmission after COVID-19 hospitalization. METHODS: From March 13 to April 9, 2020, all patients hospitalized with COVID-19 and discharged alive were included in this retrospective observational study. Multivariable logistic regression was used to identify the predictors of 30-day readmission, and a restricted cubic spline function was utilized to assess the linearity of the association between continuous predictors and 30-day readmission...

l-Tetrahydropalmatine (l-THP), an active alkaloid compound isolated from Rhizoma Corydalis-yanhusuo, has been reported to possess biological activity for treating cocaine use. To enhance both oral bioavailability and brain penetration, three formulations of l-THP suspension, mixture of l-THP-puerarin and self-microemulsifying drug delivery systems (SMEDDS) were prepared. A sensitive and reliable ultra-high-performance liquid chromatography with tandem mass spectrometry method was developed and validated for the simultaneous determination of l-THP and its active metabolite l-isocorypalmine (l-ICP) in rat brain...

BACKGROUND: Marked strong ion (metabolic) acidosis in neonatal diarrheic calves usually is corrected by IV administration of NaHCO3 . The distribution space for IV-administered bicarbonate, called the apparent bicarbonate space (ABS), appears to depend on initial plasma bicarbonate concentration (cHCO3 ) and varies considerably in calves. OBJECTIVE: To determine whether ABS was associated with initial plasma cHCO3 and other acid-base variables. ANIMALS: Twenty-five neonatal diarrheic calves with acidemia and metabolic acidosis...