Explore the vast range of titles available.

BackgroundAn estimated 10–30% of people with COVID-19 experience debilitating long-term symptoms or long covid. Underlying health conditions associated with chronic inflammation may increase the risk of long covid.MethodsWe conducted a systematic review and meta-analysis to examine whether long covid risk was altered by pre-existing asthma or chronic obstructive pulmonary disease (COPD) in adults. We identified studies by searching the PubMed and Embase databases from inception to 13 September 2024. We excluded studies that focused on children or defined long covid only in terms of respiratory symptoms. We used random-effects, restricted maximum likelihood models to analyse data pooled from 51 studies, which included 43 analyses of asthma and 30 analyses of COPD. The risk of bias was assessed using a ROBINS-E table.ResultsWe found 41% increased odds of long covid with pre-existing asthma (95% CI 1.29 to 1.54); pre-existing COPD was associated with 32% increased odds (95% CI 1.16 to 1.51). Pre-existing asthma, but not COPD, was associated with increased odds of long covid-associated fatigue. We observed heterogeneity in the results of studies of asthma related to hospitalisation status. Potential confounding and inconsistent measurement of exposure and outcome variables were among the identified limitations.ConclusionsOur findings support the hypothesis that pre-existing asthma and COPD increase the risk of long covid, including chronic fatigue outcomes in patients with asthma. Because COVID-19 targets the respiratory tract, these inflammatory conditions of the lower respiratory tract could provide mechanistic clues to a common pathway for the development of long-term sequelae in patients with long covid.

ObjectiveTo compare clonidine versus phenobarbital as adjunctive therapy in infants who failed monotherapy with morphine for neonatal abstinence syndrome (NAS).Study designProspective, randomized, open-label study of infants ≥ 35 weeks’ gestation. Infants received clonidine or phenobarbital per protocol. Primary outcome was morphine treatment days. Secondary outcomes were inpatient adjunctive days, length of stay (LOS), triple therapy, safety, and readmission rates.ResultsA total of 25 infants were treated with clonidine (n = 14) or phenobarbital (n = 11). Mean morphine treatment duration was significantly longer with clonidine (34.4 days, SD = 10.6) compared with phenobarbital (25.5 days, SD = 7.3, p = 0.026). The clonidine group also had higher inpatient adjunctive days (mean: 33.8 days [SD = 14.3] vs. 22 days [SD = 12.6], p = 0.042) and LOS (mean: 41.8 days [SD = 10.9] vs. 31 days [SD = 10]; p = 0.018) compared with phenobarbital.ConclusionsPhenobarbital, as adjunctive therapy, led to significantly shorter duration of morphine therapy, inpatient adjunctive days, and length of stay compared with clonidine.

Background Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. Methods A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. Results A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days (P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. Conclusion After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.

Objective: In order to determine the status of scholarly efforts on health literacy by librarians, researchers examined the characteristics of health literacy publications authored by librarians from 2000 to 2020. Methods: Bibliometric analysis was used to assess the indicators of productivity, affiliation, collaboration, and citation metrics of librarians in health literacy–related research. Data were collected using the Scopus database; articles were screened for inclusion before importation into Microsoft Excel for analysis. SPSS software was used to run basic descriptive statistics. Results: Of 797 search results, 460 references met the inclusion criteria of librarian authorship. There was a significant linear trend upward in publications since 2001 with an average increase of 1.52 papers per year. The number of publications per year peaked in 2019 (n=59). Journal of Consumer Health on the Internet was the most prolific journal. The majority of references were authored by at least two authors and by multidisciplinary teams. Nineteen percent (n=107) of the librarian authors were responsible for more than one publication, and 84.1% of publications were cited at least once. Conclusions: In the last two decades, librarian involvement in health literacy publications has exponentially increased, most markedly in the years following 2014. The productivity, multidisciplinary collaboration efforts, and consistent growth in literature indicate that librarians are engaged in health literacy scholarship. Further research is needed to explore the work of librarians whose impacts on health literacy may not be reflected within well-indexed, peer-reviewed publications.

Background Research indicates that stigma impacts the care provided to individuals with Substance Use Disorders (SUDs), but perceptions of SUDs in various healthcare training programs are not well known. We aimed to characterize perceptions of faculty, staff, and students about SUD stigma in professional healthcare training programs. Methods We conducted a cross-sectional survey of faculty, staff, and students employed at or enrolled in one of six health-related colleges at one Mid-South health science center in the United States, including medicine, pharmacy, dentistry, nursing, health professions, and graduate health sciences. Data collection occurred between February and March 2021. We used descriptive and frequency statistics to assess the constructs within the survey instrument. Results A total of 572 respondents participated in this study (response rate = 9%; students, n  = 428, 75%; faculty, n  = 107, 19%; staff, n  = 32, 6%). Most respondents reported interacting with persons with a SUD, cited challenges with the interaction, and perceived SUDs to be mental health condition ( n  = 463) or biological disease ( n  = 326). Most respondents believed that their college: emphasizes learning about SUDs; promotes an accurate perception of SUDs; and fosters respect for persons with. Few respondents reported they hear faculty, staff, or students express negative comments about persons with SUDs, but they were sometimes expressed by students. Conclusions Most faculty, staff, and students reported experiencing challenges when interacting with a person with a SUD, mainly communication, but few recalled hearing negative comments from their peers. Whether interventions tailored towards improving communication in academic healthcare training settings could minimize challenges experience by faculty, staff, and students when serving individuals with SUDs should be further evaluated.

Polyprenyl immunostimulant (PI) was, at the time of this study, a USDA-licensed veterinary biologic for the treatment of feline rhinotracheitis. In two previous controlled challenge trials, PI administration reduced the severity of acute feline rhinotracheitis in specific pathogen-free (SPF) cats (1). We replicated the oral PI challenge-treatment protocol to evaluate humoral and virologic outcomes, measured by serum virus-neutralizing antibody titers and virus isolation, and to assess clinical ocular disease after conjunctival rechallenge. During the study, the frequency of virus isolation and the virus-neutralizing antibody (VN) titers did not vary significantly between the treatment and placebo groups. After the rechallenge, all placebo controls (8/8) developed ocular disease, whereas 10/16 PI-treated cats developed conjunctivitis/ocular disease, and 6/16 remained asymptomatic. PI treatment was associated with a 37.5% reduction in the incidence of ocular disease after conjunctival rechallenge. We hypothesize that PI may reduce the likelihood of clinical ocular disease after FeHV-1 rechallenge by priming innate cell-mediated immune responses.

Amyloid-specific antibodies have been shown to opsonize and enhance amyloid clearance in systemic amyloidosis mouse models. However, the immunological mechanisms by which amyloid is removed have not been clearly defined. Previous reports from preclinical studies suggest polymorphonuclear cells ( , neutrophils) can affect amyloid removal. Therefore, we sought to analyze how neutrophils may contribute to the clearance of human AL amyloid extracts, using a murine amyloidoma model. Immunocompromised nude mice injected subcutaneously with patient-derived AL amyloid extract (generating a localized \"amyloidoma\") were used to circumvent confounding factors contributed by the adaptive immune system and served as the model system. Two representative AL amyloid extracts were used, ALλ(CLA), which is refractory to clearance, and ALκ(TAL), which is readily cleared in mice. Neutrophil recruitment to the amyloid masses, cellular activation, and propensity to engulf amyloid were assessed. Immunophenotyping of amyloidomas from animals implanted with 2 mg of either ALλ or ALκ revealed that more neutrophils were recruited to ALκ amyloid masses as compared to the ALλ material, which was generally devoid of neutrophils. analyses indicated neutrophils do not efficiently phagocytose amyloid directly. However, histological evaluation of the ALκ amyloidoma revealed the abundant presence of neutrophil extracellular traps, which were absent in the ALλ amyloidomas. Using neutrophil depletion experiments in mice, we determined that mice devoid of neutrophils cleared the human amyloid lesions less efficiently. Moreover, mice devoid of neutrophils also had significantly reduced intra-amyloid expression of inflammatory cytokines. Neutrophils may not directly mediate amyloid clearance through phagocytosis; however, these cells can be stimulated by the amyloid and may function to facilitate phagocytosis and amyloid clearance by professional phagocytes ( , macrophages).

Incorporating gum disease assessment into epidemiologic studies would facilitate investigations of disease etiology. We evaluated the accuracy and inter-rater reliability of experienced dental health professionals' visual assessments of digital photographs to determine inflammatory gum disease. Raters viewed anonymized photographs of the teeth and gums of 30 adult patients and were asked to distinguish \"healthy\" gingiva from \"gum disease\" and to assess disease severity. Frequency, percentage, and cross-tabulation statistics were used to perform diagnostic calculations including sensitivity, specificity, and overall accuracy. Fleiss' Kappa, with a 95% confidence interval, was used to test for interrater reliability amongst the four raters. Cohen's Kappa was then calculated for each potential pairing of the four raters. The accuracy of determining active inflammatory gum disease from digital photographs ranged from 76.7% to 96.7% (mean 85.9%) across the four raters. Sensitivity ranged from 70% to 95% (mean 82.5%), and specificity ranged from 80% to 100% (mean 92.5%). However, inter-rater reliability for disease severity was only fair, with Fleiss's Kappa for gingivitis and periodontitis 0.25 (0.00-0.51) and 0.28 (0.03-0.54), respectively. Our findings show that digital photographs could be useful for assessing inflammatory gum disease in epidemiologic studies of inflammation-mediated chronic systemic diseases.

Abstract Background Acute decompensated heart failure (ADHF) can be confused with other conditions that cause dyspnea. Patients with ADHF are often simultaneously treated for community-acquired pneumonia (CAP), even when evidence for infection is lacking. We hypothesized that the fluid and sodium content of potentially unnecessary intravenous antibiotic (IVAB) therapy could worsen outcomes of ADHF patients. Methods We reviewed 144 ADHF patients at low risk of pneumonia based on diagnostic findings and clinical documentation. The primary end point was length of stay. Secondary outcomes were mortality, readmission rates, amount of diuretic received, and fluid volume and quantity of sodium administered as part of IVAB therapy. Results Of the 144 admissions reviewed, 88 did not and 56 did receive IVAB. IVAB-treated patients received an average of 1.7 L of additional fluid (230 mL/d) and 9311 mg of additional sodium (1381 mg/d) as a result of IVAB therapy. Length of stay was longer in the IVAB arm (6.6 days) compared with the no-IVAB arm (3.0 days; P < .001). Patients required more furosemide in the IVAB arm (930 mg) compared with the no-IVAB arm (320 mg; P < .001). Patients who received IVAB were also 2.51 times more likely to be readmitted compared with patients who did not receive IVAB (P = .04). Conclusions ADHF patients who received IVAB without evidence of infection had longer lengths of stay, required more diuretics, and were more likely to be readmitted compared with ADHF patients not exposed to IVAB. ADHF patients are a promising target of antibiotic stewardship interventions. Patients admitted with a diagnosis of heart failure often receive intravenous antibiotic therapy, even when there is a low likelihood of concurrent infection. This article describes potential adverse effects of the excess fluid and sodium administered as part of intravenous antibiotic therapy in this patient population.

Monoclonal free light chain (LC) proteins are present in the circulation of patients with immunoproliferative disorders such as light chain (AL) amyloidosis and multiple myeloma (MM). Light chain-associated amyloid is a complex pathology composed of proteinaceous fibrils and extracellular matrix proteins found in all patients with AL and in ~10-30% of patients who presented with MM. Amyloid deposits systemically in multiple organs and tissues leading to dysfunction and ultimately death. The overall survival of patients with amyloidosis is worse than for those with early stage MM. We have developed a sensitive binding assay quantifying the recruitment of full length, patient-derived LC proteins by synthetic amyloid fibrils, as a method for studying their amyloidogenic potential. In a survey of eight urinary LC, both AL and MM-associated proteins were recruited by synthetic amyloid fibrils; however, AL-associated LC bound significantly more efficiently (p < 0.05) than did MM LCs. The LC proteins used in this study were isolated from urine and presumed to represent a surrogate of serum free light chains. The binding of LC to synthetic fibrils in this assay accurately differentiated LC with amyloidogenic propensity from MM LC that were not associated with clinical amyloid disease. Notably, the LC from a MM patient who subsequently developed amyloid behaved as an AL-associated protein in the assay, indicating the possibility for identifying MM patients at risk for developing amyloidosis based on the light chain recruitment efficacy. With this information, at risk patients can be monitored more closely for the development of amyloidosis, allowing timely administration of novel, amyloid-directed immunotherapies-this approach may improve the prognosis for these patients.