SD Number Research Articles

Prevalence of Potentially Inappropriate Medications Among Older People in Qom, Iran Based on STOPP Criteria and Its Association With the Health-Related Quality of Life

Objectives: Aging is associated with an increased prevalence of chronic diseases and multidrug therapy, which increases the risk of drug side effects and changes in quality of life. With the increase of the world’s aging proportion, the quality and safety of prescribing drugs has become a global health concern. This study aims to determine the prevalence of Potentially Inappropriate Medications (PIMs) in the elderly in Qom, Iran according to STOPP (Screening Tool of Older Persons’ Prescriptions) criteria and its association with their Health-Related Quality of Life (HRQOL). Methods & Materials: In this cross-sectional and descriptive-analytical study, participants were 783 older patients hospitalized in internal and surgical wards of selected hospitals affiliated to Qom University of Medical Sciences who were selected using a convenience sampling method. The instruments were a demographic/ health information form, Charlson Comorbidity Index (CCI), STOPP version 2, and the 15 D HRQOL questionnaire. The data were analyzed in SPSS v. 20 software using descriptive statistics and logistic regression analysis. Results: The Mean±SD number of medications used by the elderly was 7.21±3.16, and 79.57% of patients had multidrug use. The CCI score of 29.9% was 4. The prevalence of PIM was 46.10% and the most common category of PIM were Drugs that adversely affect those prone to falls (13.79%), Duplicate Drug Class (12.39%), Central Nervous System and Psychotropics (5.36%). The Mean±SD score of HRQOL was 0.85± 0.12. Logistic regression analysis results showed that HRQOL (95%CI: 0.030-0.307, OR= 0.096), multidrug use (95%CI: 4.780-14.966, OR=8.46), and CCI (95%CI: 1.36-3.17, OR=2.079) had significant association with PIM use by the elderly (P<0.001). Conclusion: The use of PIM is a common health problem among the elderly and is associated with HRQOL, multidrug use, and CCI. Nurses should evaluate the elderly’s medication regimen to identify PIMs.

Outcome assessment of medical education fellowships in emergency medicine.

Medical education fellowships in emergency medicine (EM) provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. Our objective was to characterize the career outcomes of medical education fellowship graduates. We solicited curriculum vitae (CV) from graduates of U.S. EM education fellowships by email. We abstracted data from CVs with a standard instrument that included program characteristics, employment history, leadership positions, awards, and scholarly productivity. We calculated and reported descriptive statistics. A total of 71 of 91 (78%) graduates participated. Thirty-three completed a 1-year fellowship and 38 completed a 2-year fellowship. Nineteen (27%) completed an advanced degree during fellowship. Median (range) graduation year was 2016 (1997-2020). The majority, 63 of 71 (89%), work in an academic setting. Graduates held leadership positions in continuing medical education, graduate medical education, and undergraduate medical education. Forty-eight (68%) served on national medical education committees. The mean±SD number of national medical education awards was 1.27±2.03. The mean±SD number of national medical education presentations was 7.63±10.83. Graduates authored a mean±SD of 3.63±5.81 book chapters and a mean±SD of 4.99±6.17 peer-reviewed medical education research publications. Ten (14%) served on journal editorial boards, 34 (48%) were journal reviewers, and 31 (44%) had received a medical education grant. EM medical education fellowship graduates are academically productive and hold education leadership positions.

Effects of ambient pressure on the frequency characteristics of self-excited cavitating waterjet

The effects of ambient pressure on the self-excited cavitating waterjet(SECJ)’s frequency characteristics were experimentally studied under different operating conditions and nozzle resonant chamber geometries. The frequency characteristics were obtained by analyzing the waterjet’s dynamic pressure fluctuation and noise. Experimental results indicate that the fundamental self-excited frequency and its harmonics increase as ambient pressure rises from 0 to 5.5 MPa (corresponding 0 - 500 m water depth) under constant pressure drop ΔP=25MPa, which results in a higher-order resonance mode of the jet. The dimensionless parameters, including the Strouhal number Sd and cavitation number σ, were introduced to uncover ambient pressure’s influence mechanism. Dimensional analysis results indicate that the ambient pressure alters the self-excited frequency and modulates the frequency characteristics by changing the Strouhal number. The relationship between SdN and σ can be fitted as a power function SdN=Naσb (N is harmonic order, a and b are constant-coefficient). Based on this law and the mechanism of SECJ, the ambient pressure’s effects on the frequency characteristics can be predicted, which may be used to guide the optimization of SECJ system under a high ambient environment.

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures.

Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures. Diagnostic test, level IV.

O-001 Delay in IVF treatment up to 180 days does not affect pregnancy outcomes in women with diminished ovarian reserve

textIn clinical practice, infertility treatment delays can occur due to medical, logistical, or financial reasons. Concerns over treatment delays were brought to the forefront in March 2020 when the SARS-CoV-2 pandemic prompted both the ESHRE and ASRM to recommend the suspension of new infertility treatment cycles. At the time, little was known about the risk of viral transmission on reproductive health and necessary medical resources urgently needed to be reallocated to the front lines of the pandemic. These society recommendations were met with resistance from some clinicians and patients that raised valid concerns about whether delaying IVF treatment for a few months could negatively affect pregnancy outcomes.To help answer this question, we designed a retrospective cohort study to assess whether a delay up to 180 days in initiating IVF treatment affects pregnancy outcomes in infertile women with diminished ovarian reserve. This population was selected because their treatment outcomes were the most likely to affected by treatment delays due to the continuous decline in ovarian reserve over time. Infertile women treated at our IVF center were included if they had diminished ovarian reserve and started an ovarian stimulation cycle within 180 days of their initial consultation that resulted in an oocyte retrieval with planned fresh embryo transfer between 1 January 2012 and 31 December 2018. Diminished ovarian reserve was defined as an anti-Mŭllerian hormone (AMH) < 1.1 ng/mL.In total, 1,790 patients met inclusion criteria (1,115 immediate and 675 delayed treatment). Each patient had one included cycle and no subsequent data from additional frozen embryo transfer cycles were included. Since all cycle outcomes evaluated were from fresh embryo transfers, no genetically tested embryos were included. Patients were grouped by whether their cycle started 1-90 days after presentation (immediate) or 91-180 days (delayed). The primary outcome was live birth (≥24 weeks of gestation). A subgroup analysis of more severe forms of diminished ovarian reserve was performed to evaluate outcomes for patients with an AMH < 0.5 and for patients >40 years old with an AMH < 1.1 ng/mL (Bologna criteria for diminished ovarian reserve). Logistic regression analysis, adjusted a priori for patient age, was used to estimate the odds ratio (OR) with a 95% CI. All pregnancy outcomes were additionally adjusted for the number of embryos transferred.The mean ± SD number of days from presentation to IVF start was 50.5 ± 21.9 (immediate) and 128.8 ± 25.9 (delayed). After embryo transfer, the live birth rate was similar between groups (immediate: 23.9%; delayed: 25.6%; OR 1.08, 95% CI 0.85-1.38). Additionally, a similar live birth rate was observed in a subgroup analysis of patients with an AMH < 0.5 ng/mL (immediate: 18.8%; delayed: 19.1%; OR 0.99, 95% CI 0.65-1.51) and in patients >40 years old with an AMH < 1.1 ng/mL (immediate: 12.3%; delayed: 14.7%; OR 1.21, 95% CI 0.77-1.91).Overall, we observed that a delay in initiating IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation. This observation persisted for patients who in the highest-risk categories for poor response to ovarian stimulation. Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistical, or financial reasons, treatment outcomes will not be negatively affected.

Comparison of percent adjusted versus predefined incremental argatroban dosing nomograms in patients with heparin induced thrombocytopenia

IntroductionHeparin-induced thrombocytopenia (HIT) necessitates initiation of non-heparin based anticoagulation to prevent long-term sequelae. Optimal anticoagulation needs to be reached safely and rapidly. The optimal adjustment of argatroban dosing has remained unclear. Materials and methodsThis retrospective cohort study at UI Health screened patients between 1/1/2011 to 3/21/2017. Patients were included if argatroban was administered for 24 h or more for suspected or confirmed HIT. The primary outcome was to compare time to reach 2 consecutive activated partial thromboplastin time within 60 to 100 s (stable therapeutic aPTT) between pre-guideline (dose incremental adjusted) and post-guideline (percent adjusted) nomograms. Secondary outcomes were to characterize safety events and analyze the effect of covariates on the primary outcome. ResultsA total of 231 patients were screened, 29 patients pre-guideline and 24 patients post-guideline were included. The mean ± SD time to reach stable therapeutic aPTT was 17.3 ± 14.4 h pre-guideline and 27.4 ± 23.5 h post-guideline (p=0.08). The mean ± SD number of dose adjustments was 1.5 ± 2.2 pre-guideline and 1.7 ± post-guideline (p = 0.89). ICU admission, hepatic impairment, albumin level, total bilirubin level, weight, and starting argatroban dose did not statistically affect time to stable therapeutic aPTT. There were 3 major bleed events and 3 thrombotic events, all occurred in pre-guideline cohort. ConclusionsNo statistically significant difference in time to reach therapeutic anticoagulation between dosing nomograms or in any safety or clinical outcomes was found. Less stringent, provider-driven argatroban dosing nomograms may have similar efficacy and safety to more aggressive dosing.

Amputation versus Primary Nonoperative Management of Chronic Osteomyelitis Involving a Pedal Digit in Diabetic Patients.

The preferred primary treatment of toe osteomyelitis in diabetic patients is controversial. We compared the outcome of primary nonoperative antibiotic treatment versus digital amputation in patients with diabetes-related chronic digital osteomyelitis. We conducted a retrospective medical record review of patients treated for digital osteomyelitis at a single center. Patients were divided into two groups according to initial treatment: 1) nonoperative treatment with intravenous antibiotics and 2) amputation of the involved toe or ray. Duration of hospitalization, number of rehospitalizations, and rate of below- or above-the-knee major amputations were evaluated. The nonoperative group comprised 39 patients and the operative group included 21 patients. The mean ± SD total duration of hospitalization was 24.05 ± 15.43 and 20.67 ± 15.97 days, respectively (P = .43). The mean ± SD number of rehospitalizations after infection recurrence was 2.62 ± 1.63 and 1.67 ± 1.24, respectively (P = .02). During follow-up, the involved digit was eventually amputated in 13 of the 39 nonoperatively treated patients (33.3%). The rate of major amputation (above- or below-knee amputation was four of 39 (10.3%) and three of 21 (14.3%), respectively (P = .69). Despite a higher rate of rehospitalizations and a high failure rate, in patients with mild and limited digital foot osteomyelitis in the absence of sepsis it may be reasonable to offer a primary nonoperative treatment for digital osteomyelitis of the foot.

Breed differences in the pharmacokinetics of orally administered meloxicam in domestic chickens (Gallus domesticus).

To determine the pharmacokinetics of meloxicam in Wyandotte hens and duration and quantity of drug residues in their eggs following PO administration of a single dose (1 mg of meloxicam/kg [0.45 mg of meloxicam/lb]) and compare results with those previously published for White Leghorn hens. 8 healthy adult Wyandotte hens. Hens were administered 1 mg of meloxicam/kg, PO, once. A blood sample was collected immediately before and at intervals up to 48 hours after drug administration. The hens' eggs were collected for 3 weeks after drug administration. Samples of the hens' plasma and egg whites (albumen) and yolks were analyzed with high-performance liquid chromatography. Mean ± SD terminal half-life, maximum concentration, and time to maximum concentration were 5.53 ± 1.37 hours, 6.25 ± 1.53 μg/mL, and 3.25 ± 2.12 hours, respectively. Mean ± SD number of days meloxicam was detected in egg whites and yolks after drug administration was 4.25 ± 2 days and 9.0 ± 1.5 days, respectively. Compared with White Leghorn hens, meloxicam in Wyandotte hens had a longer terminal half-life, greater area under the plasma concentration-versus-time curve from time 0 to infinity, a smaller elimination rate constant, and a longer mean residence time-versus-time curve from time 0 to infinity, and drug persisted longer in their egg yolks. Therefore, the oral dosing interval of meloxicam may be greater for Wyandotte hens. Results may aid veterinarians on appropriate dosing of meloxicam to Wyandotte hens and inform regulatory agencies on appropriate withdrawal times.

A Cross-Sectional Survey on Medication Management Practices for Noncommunicable Diseases in Europe During the Second Wave of the COVID-19 Pandemic.

Maintaining healthcare for noncommunicable diseases (NCDs) is particularly important during the COVID-19 pandemic; however, diversion of resources to acute care, and physical distancing restrictions markedly affected management of NCDs. We aimed to assess the medication management practices in place for NCDs during the second wave of the COVID-19 pandemic across European countries. In December 2020, the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) conducted a cross-sectional, web-based survey in 38 European and one non-European countries. Besides descriptive statistics of responses, nonparametric tests and generalized linear models were used to evaluate the impact on available NCD services of the number of COVID-19 cases and deaths per 100,000 inhabitants, and gross domestic product (GDP) per capita. Fifty-three collaborators from 39 countries completed the survey. In 35 (90%) countries face-to-face primary-care, and out-patient consultations were reduced during the COVID-19 pandemic. The mean ± SD number of available forms of teleconsultation services in the public healthcare system was 3 ± 1.3. Electronic prescriptions were available in 36 (92%) countries. Online ordering and home delivery of prescription medication (avoiding pharmacy visits) were available in 18 (46%) and 26 (67%) countries, respectively. In 20 (51%) countries our respondents were unaware of any national guidelines regarding maintaining medication availability for NCDs, nor advice for patients on how to ensure access to medication and adherence during the pandemic. Our results point to an urgent need for a paradigm shift in NCD-related healthcare services to assure the maintenance of chronic pharmacological treatments during COVID-19 outbreaks, as well as possible future disasters.

Persistent fontanelles in Chihuahuas. Part I. Distribution and clinical relevance.

BackgroundThe Chihuahua dog breed is known for frequent occurrence of a bregmatic fontanelle on the dorsal skull. A common conception is that this skull defect is a clinically irrelevant finding. No studies, however, describe its prevalence or whether it is accompanied by other persistent fontanelles (PFs). Although Chihuahuas are predisposed to Chiari‐like malformation (CM) and syringomyelia (SM), it is unknown whether PFs occur more commonly in dogs with clinical signs that are caused by CM or SM.Hypothesis/ObjectivesTo describe the number and location of PFs at cranial sutures (CSs) and to compare the occurrence of these PFs in dogs with and without CM/SM‐related clinical signs. We hypothesized that PFs also occur commonly at lateral and caudal cranial surfaces, affect a higher number of CSs, and are larger in dogs with CM/SM‐related clinical signs.AnimalsFifty client‐owned Chihuahuas with or without CM/SM‐related clinical signs.ResultsOf the 50 dogs evaluated, 46 (92%) had either 1 or several PFs. The mean ± SD number of PFs was 2.8 ± 3.0 (range, 0‐13). A total of 138 PFs occupied 118 CSs with 57 (48%) located dorsally, 44 (37%) caudally, and 17 (14%) laterally. The number of CSs affected by PFs was significantly higher (P ≤ .001) and total PF area was significantly larger (P = .003) in dogs with CM/SM‐related clinical signs.Conclusions and Clinical ImportancePersistent fontanelles are very common in this group of Chihuahuas and appear at dorsal, lateral, and caudal cranial surfaces. They are more numerous and larger in Chihuahuas with CM/SM‐related clinical signs.

Analysing online Twitter discussions of bedwetting via a condition-specific hashtag (#Bedwetting).

Bedwetting is a common paediatric condition. #Bedwetting has been established as the official hashtag to structure Twitter discussions about the condition. We analysed online Twitter discussions for #Bedwetting. Symplur, a Twitter analytics service was employed to aggregate Twitter activity, users and content including #Bedwetting, between October 2013 and November 2018. Activity was analysed via tweet volume and user adoption. Users were assorted using geographic location, occupation and affiliation data. Content in #Bedwetting Tweets was undertaken by retrieving information about retweets, links, frequently used words and hashtags. A total of 101 412 tweets and 9957 users utilising #Bedwetting were identified. Most tweets were sent with links (93%). The average ± SD number of tweets using #Bedwetting per month increased from 96 ± 87 in 2013 to 2935 ± 1644 in 2015. Tweet volume decreased to 1960 ± 257 in 2016 and subsequently increased to 2901 ± 1110 in 2017. New users increased from 4 in 2013 to 9957 users in 2018. Users tweeted from 69 countries. Advocacy organisations comprised 35% of the top 100 influencers. Common words in #Bedwetting tweets were 'potty', 'best' and 'training'. Popular associated hashtags were #Pottytraining, #Solutions and #Moms. Hyperlinks in #Bedwetting tweets included advocacy, academic and commercial websites. Our analysis of #Bedwetting highlights that Twitter is frequently used to discuss the condition's diagnosis and management. Various stakeholders in health care are utilising the platform to build awareness about bedwetting. We identified that Twitter is being employed to drive web traffic to other internet websites.

Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator Intervention.

Integration of general medical care and mental health care is a high priority for individuals with serious mental illnesses because of their high risk of morbidity and early mortality. The Bridge is a peer-led, health navigator intervention designed to improve access to and use of health care and self-management of medical services by individuals with serious mental illnesses. This study expands on a previous study in which the authors examined participants' self-reported outcomes from a 12-month randomized controlled trial of the Bridge. In the study reported here, Medicaid data were used to assess the impact of the intervention on service use during that trial. Medicaid data on use of general medical services (emergency room, outpatient, and inpatient) for 6 months were compared for 144 individuals with serious mental illnesses-Bridge participants (N=72) and a waitlist control group (N=72). An intent-to-treat approach was used, with regression models controlling for general medical services in the 6 months before baseline. Zero-inflated negative binomial analyses, controlling for service use 6 months before baseline, found that the intervention group used the emergency room significantly less frequently, compared with the control group (adjusted mean±SD number of visits, 0.72±0.19 versus 1.59±0.42). No between-group differences were found in use of general medical inpatient or outpatient services. The Bridge was effective in decreasing emergency room use among individuals with serious mental illnesses.

Leucovorin as an Antidepressant Adjunct in Elderly Inpatients With Treatment-resistant Depression.

To assess the safety and tolerability of folinic acid as an augmentation agent among geriatric inpatients with depression and to determine whether this augmentation was associated with decreased days of clinically needed hospitalization. A retrospective chart review was conducted of the medical records of patients > 60 years of age discharged from a geriatric psychiatry unit between June 1, 2014, and February 1, 2016. Two groups were compared: those with depression who received folinic acid (leucovorin) supplementation (n = 35) and those with depression who did not receive leucovorin (n = 80). The primary outcome measure was number of clinically needed days of hospitalization. The mean ± SD number of days (logged) of clinically needed hospitalization in the leucovorin group was 2.0 ± 0.7 compared with 2.4 ± 0.6 in the nonintervention group. Unpaired t group analysis yielded the following: t115 = 3.47, P < .0001 (2-tailed). The patients who received leucovorin had a significantly reduced requirement of days of hospitalization, which translates to reduced cumulative cost of treatment during hospitalization. Further studies, including randomized controlled trials, are recommended to explore this treatment option.

Influential and Highest Cited Shoulder Instability Articles: A Bibliometric Analysis.

Background:In orthopaedic surgery and other fields, the effect of influential journal articles has been evaluated by their citation counts and their correlation with methodological quality.Purpose:To identify and characterize the 50 most cited articles on shoulder instability, examine trends in publication characteristics, and evaluate the correlation of citations with quality of evidence.Study Design:Cross-sectional study.Methods:The Web of Science and Scopus online databases were searched to identify the top 50 most cited articles on shoulder instability, based on the average number of citations from each database. Article characteristics were recorded, and level of evidence and methodological quality were assessed using the modified Coleman Methodology Score (mCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate relationships between citations or citation density (citations/y) and level of evidence or methodological scoring. Top cited articles from recent years were also aggregated.Results:The top 50 most cited papers had a mean ± SD number of citations of 381.5 ± 166.7, with a mean of 15.0 ± 8.8 citations/y. Overall, 15 articles (30%) were biomechanical/cadaveric studies, and 15 (30%) were case series. Only 3 (6%) were considered to have level 1 evidence. The mean ± SD mCMS was 54.4 ± 12.7, mean ± SD Jadad score was 3.1 ± 1.4, and mean ± SD MINORS score was 10.5 ± 3.3. There were no significant correlations between citation rank or density and methodological assessments. There were weak correlations between citation rank and publication year (rs = 0.32; P = .022) and between rank and level of evidence (rs = –0.38; P = .047). The correlation between citation density and publication year was moderate (rs = 0.70; P < .0001). There was no difference in citation density of the top 10 articles from 2010 to 2020 compared with the top 10 from the overall list (23.8 ± 5.3 vs 28.8 ± 9.5; P = .16).Conclusion:Influential articles in shoulder instability included a high proportion of biomechanical/cadaveric studies. The majority of top cited articles had lower evidence levels and poorer methodological quality without strong correlation with citations or citation density. There was a moderate correlation between citation density and year of publication.

The Linton A. Whitaker Legacy: Cultivating Craniofacial Surgeon Leaders.

Linton A. Whitaker is a pioneer of craniofacial surgery. He served as chief of plastic surgery at the Children's Hospital of Philadelphia and University of Pennsylvania and director of the craniofacial training program. Herein, the authors reflect on his legacy by studying the accomplishments of his trainees. Dr Whitaker's trainees who completed (a) craniofacial fellowship training while he was director of the program or (b) residency training while he was chief were identified. Curricula vitae were reviewed. Variables analyzed included geographic locations, practice types, academic leadership positions, scholarly work, and bibliometric data. Between 1980 and 2011, 34 surgeons completed craniofacial fellowship training under Dr Whitaker, and 11 completed plastic surgery training under his chairmanship and subsequent craniofacial fellowship. The majority had active craniofacial practices after training (83.3%) and practice in an academic setting (78.0%). Most settled in the northeast (31.1%) and south (31.1%) but across 24 states nationally. Overall, the mean ± SD number of publications was 76 ± 81 (range, 2-339); book chapters, 23 ± 29 (0-135); H-index, 18 ± 12 (1-45); and grants, 13 ± 16 (0-66). Of those who pursued academia, 53.1% were promoted to full professor, 46.9% had a program director role, 75.0% directed a craniofacial program, and 53.1% achieved the rank of chief/chair. Equally important to Dr Whitaker's clinical contributions in plastic and craniofacial surgery is the development and success of his trainees who will undoubtedly continue the legacy of training the next generation of craniofacial surgeon leaders.

Baseline urinalysis results in 32 healthy Antillean manatees (Trichechus manatus manatus).

To describe results of analysis of free-catch urine samples collected from Antillean manatees (Trichechus manatus manatus) under human care in the Caribbean. 32 Antillean manatees in 5 Caribbean oceanaria and rescue centers. Urine samples were obtained by opportunistic free catch during physical examination or through the use of operant conditioning procedures. Urinalyses consisted of macro- and microscopic evaluations, biochemical analyses with test strips, and refractometry. Results were compared for manatees grouped on the basis of age, sex, and habitat. Urine samples were typically clear, straw colored, and alkaline (mean pH, 8.0); had a urinoid odor and low specific gravity (mean, 1.010); and had results on qualitative test strips that were consistently negative for the presence of glucose, bilirubin, ketones, proteins, nitrites, RBCs, and WBCs. Microscopically, the mean ± SD number of RBCs and WBCs/hpf was 0.5 ± 0.3 RBCs/hpf and 1.1 ± 1.5 WBCs/hpf. The presence of some epithelial cells and crystals was typical. Spermatozoa were found in urine from 1 of 15 sexually mature males, and parasite larvae and eggs were found in urine from 2 manatees. Results of the present study yielded the first compilation of baseline urinalysis values in healthy Antillean manatees under human care, which, when combined with physical examination and other diagnostic procedures, can help in monitoring the health of these animals. We encourage the use of free-catch urine collection methods, as used in the present study, for routine urinalyses of manatees under human care in zoos, aquaria, or rescue centers.

The effect of school feeding programme on class absenteeism and academic performance of schoolchildren in Southern Ethiopia: a prospective cohort study.

Ethiopia recently scaled up the implementation of a school feeding programme (SFP). Yet, evidence on the impact of such programmes on academic outcomes remains inconclusive. We evaluated the effect of the SFP on class absenteeism and academic performance of primary school students (grade 5-8) in Sidama zone, Southern Ethiopia. This prospective cohort study enrolled SFP-beneficiary (n 240) and non-beneficiary (n 240) children 10-14 years of age from sixteen public schools and followed them for an academic year. School absenteeism was measured as the number of days children were absent from school in the year. Academic performance was defined based on the average academic score of the students for ten subjects they attended in the year. Data were analysed using multivariable mixed effects negative binomial and linear regression models. Food insecure districts in Sidama zone, Southern Ethiopia. SFP-beneficiary and non-beneficiary children 10-14 years of age. The mean (sd) number of days children were absent from school was 4·0 (sd 1·5) and 9·3 (sd 6·0), among SFP beneficiaries and non-beneficiaries, respectively. Students not covered by the SFP were two times more likely to miss classes (adjusted rate ratio = 2·30; 95 % CI 2·03, 2·61). Pertaining to academic performance, a significant but small 2·40 (95 % CI 0·69, 4·12) percentage point mean difference was observed in favour of SFP beneficiaries. Likewise, the risk of school dropout was six times higher among non-beneficiaries (adjusted rate ratio = 6·04; 95 % CI 1·61, 22·68). SFP promotes multiple academic outcomes among socio-economically disadvantaged children.

Efficacy and Safety of the Susanna Glaucoma Drainage Device After 1 Year of Follow-up.

This study found a rate of failure of 13.6% of the new Susanna Glaucoma Drainage Device (SGDD) after 1 year of follow-up. Severe complications occurred in 1 patient (4.5%). The purpose of this study was to determine the success and complications rates of the SGDD implant in refractory glaucoma. This is a retrospective study. Medical records from all consecutive refractory glaucoma patients (failed trabeculectomies with the use of adjunctive mitomycin) followed in a private clinical practice were included in the study. All patients had undergone SGDD implant surgery from September 2016 to July 2019 were included. All surgeries were done by the same surgeon (R.S.). Primary outcome was surgical failure, defined as intraocular pressure (IOP) >18 mm Hg and/or <20% IOP reduction from baseline, IOP<5 mm Hg, reoperation for glaucoma, need of implant removal or loss of light perception vision. Secondary outcomes included mean IOP, use of supplemental medical therapy, and complications. In all, 22 eyes were analyzed. Mean patient age was 63±15 years (range: 27 to 87 y). Mean IOP decreased from 23±7 to 11±8 mm Hg (P<0.001, paired t test) at an average of 18±9 months after the tube implant. The mean SD number of glaucoma medications was reduced from 3.3±1 to 1.5±1.2 at the last postoperative visit (P<0.01, paired t test). No early postoperative complications occurred. There was 1 case of late persistent hypotony in a patient with previous endocyclophotocoagulation that was solved with tube ligature with silk 8-0. Failure because of high IOP occurred in 2 cases. There was no extrusion or erosion of the tube and the plate. The SGDD presented a 13.6% failure rate (86.4% success rate) with very few complications, being an efficient and safe alternative for refractory glaucoma.

Decrease in Antibiotic Use and Radiographic Sinus Severity after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis and Antibody Immunodeficiencies

Antibody immunodeficiencies are common in patients with chronic rhinosinusitis (CRS) and are associated with recurrent sino-pulmonary infections. The role of functional endoscopic sinus surgery (FESS) has not been established in the management of these infections and clinical guidelines suggest caution with surgery. This study evaluates number of antibiotic courses for sino-pulmonary infections and radiographic sinus disease severity after FESS in patients with CRS and antibody immunodeficiencies. Patients with CRS and antibody immunodeficiencies undergoing FESS at Northwestern Medicine between 2007-2017 were identified using an automated review of electronic medical records. A manual chart review of 35 randomly selected patients was performed. The number of antibiotic courses prescribed annually for sino-pulmonary infections was determined, 1 year before and up to 5 years after FESS. Lund-Mackay scores were calculated in patients who had sinus CT scans available before and after FESS. The 35 patients identified were 51.4% male, 82.9% white, and had an average age of 52.9±8 years. There was a reduction in the mean±SD number of antibiotics prescribed per year for sino-pulmonary infections after FESS (2.8±2.2 pre vs. 1.5±1.2 post, P=0.001) in patients with CRS and antibody immunodeficiencies. There was a reduction in Lund-Mackay scores with FESS (N=21, 10.2±5.3 pre vs. 7.5±3.2, P=0.009). FESS is associated with a reduction in antibiotic prescriptions for sino-pulmonary infections and improvement in radiographic sinus disease severity in patients with CRS and antibody immunodeficiencies. This suggests that FESS can be an effective strategy for reducing sino-pulmonary infections and disease burden in these patients.

Functional Effects of Intervening Illnesses and Injuries After Critical Illness in Older Persons.

Intervening illnesses and injuries have pronounced deleterious effects on functional status in older persons, but have not been carefully evaluated after critical illness. We set out to evaluate the functional effects of intervening illnesses and injuries in the year after critical illness. Prospective longitudinal study of 754 nondisabled community-living persons, 70 years old or older. Greater New Haven, CT, from March 1998 to December 2018. The analytic sample included 250 ICU admissions from 209 community-living participants who were discharged from the hospital. None. Functional status (13 activities) and exposure to intervening illnesses and injuries leading to hospitalization, emergency department visit, or restricted activity were assessed each month. Comprehensive assessments (for covariates) were completed every 18 months. In the year after critical illness, recovery of premorbid function was observed for 169 of the ICU admissions (67.6%), and the mean (sd) number of episodes of functional decline (from 1 mo to the next) was 2.2 (1.6). The adjusted hazard ratios (95% CI) for recovery were 0.18 (0.09-0.39), 0.46 (0.17-1.26), and 0.75 (0.48-1.18) for intervening hospitalizations, emergency department visits, and restricted activity, respectively. For functional decline, the corresponding odds ratios (95% CI) were 2.06 (1.56-2.73), 1.78 (1.12-2.83), and 1.25 (0.92-1.69). The effect sizes for hospitalization and emergency department visit were larger than those for any of the covariates. In the year after critical illness, intervening illnesses and injuries leading to hospitalization and emergency department visit are strongly associated with adverse functional outcomes, with effect sizes larger than those of traditional risk factors. To improve functional outcomes, more aggressive efforts will be needed to prevent and manage intervening illnesses and injuries after critical illness.