Notes

Case of flexor tenosynovitis due to Mycobacterium arupense.
Older adults commonly face challenges in understanding, obtaining, administering, and monitoring medication regimens after hospitalization. These difficulties can lead to avoidable morbidity, mortality, and hospital readmissions. Pharmacist-led peri-discharge interventions can reduce adverse drug events, but few large randomized trials have examined their effectiveness in reducing readmissions. Demonstrating reductions in 30-day readmissions can make a financial case for implementing pharmacist-led programs across hospitals.

The PHARMacist Discharge Care, or the PHARM-DC intervention, includes medication reconciliation at admission and discharge, medication review, increased communication with caregivers, providers, and retail pharmacies, and patient education and counseling during and after discharge. read more The intervention is being implemented in two large hospitals Cedars-Sinai Medical Center and the Brigham and Women's Hospital. To evaluate the intervention, we are using a pragmatic, randomized clinical trial design with randomization at the patient level. The primary outcome is utilization within 30days of hospital discharge, including unforeseen emergency department visits, observation stays, and readmissions. Randomizing 9776 patients will achieve 80% power to detect an absolute reduction of 2.5% from an estimated baseline rate of 27.5%. Qualitative analysis will use interviews with key stakeholders to study barriers to and facilitators of implementing PHARM-DC. A cost-effectiveness analysis using a time-and-motion study to estimate time spent on the intervention will highlight the potential cost savings per readmission.

If this trial demonstrates a business case for the PHARM-DC intervention, with few barriers to implementation, hospitals may be much more likely to adopt pharmacist-led peri-discharge medication management programs.

ClinicalTrials.gov Identifier NCT04071951.
ClinicalTrials.gov Identifier NCT04071951.
Familial Mediterranean fever (FMF) is the most common interleukin 1 (IL-1)-driven monogenic autoinflammatory disease. Yet published data also suggest that tumor necrosis factor (TNF) may have a role in the pathogenesis of FMF and may serve as a target for treatment. In the present study we evaluate this hypothesis.

To this goal, we studied the incidental effect on FMF of TNF-directed treatment, administered to colchicine-refractory FMF patients for the management of a concurrent inflammatory disease. The rates of FMF patients and of treatments with complete or nearly complete FMF response were determined, based on the number of FMF attacks during TNF-blocker exposures. The possible effect of various FMF and non-FMF features on the outcome was determined using comparative analysis. Patients were identified and data were retrieved using electronic files from the FMF clinic.

Twenty-six patients were identified, each receiving ≥1 of four TNF-blockers for a mean duration of 27.6±16.4months. The TNF-blockers were found to induce complete or nearly complete FMF response in 10 (38.5%) of the patients, and in 13 of 50 (26%) exposures. No clinical, genetic, demographic, or therapeutic feature could predict which FMF patient would respond favorably to TNF-blocker therapy.

This study suggests that TNF-blockers may be beneficial for a small proportion of colchicine-resistant FMF patients.
This study suggests that TNF-blockers may be beneficial for a small proportion of colchicine-resistant FMF patients.Depression constitutes the most frequent comorbid condition associated with rheumatoid arthritis (RA), with prevalence rates ranging from 14% to 48%. This wide range can be explained by several factors including subtypes of depression considered, instrument of measure (i.e. self-questionnaires versus clinical interview), threshold applied but also the overlap of symptoms between the two conditions. Despite being a frequent comorbid condition in RA, depressive states are repeatedly underdiagnosed and thus, often remain untreated. Consequences are dramatic as conclusive evidence show that depression deleteriously impacts just about all outcomes of RA, including disease activity, arthritis-related complications, level of pain, chance of remission, quality of life and mortality. Importantly, links between depression and RA appear to be bidirectional as if RA patients show increased prevalence of depression. Conversely, patients with depression compared to the general population have higher risk to develop RA. Among the factors explaining this strong association between depression and RA, recent advances have underlined the putative role of models based on the inflammatory hypothesis. Pro-inflammatory cytokines such as tumor necrosis factor, interleukin (IL)-1, IL-6, and IL-18 are involved in RA pathogenesis, but also in depression. Furthermore, the connections between the central nervous system, the peripheral system and the immune system are now better understood. As a consequence of the strong comorbidity and the aggravate prognostic, the management of patient showing this dual diagnosis should be carefully monitor. The common physiopathology also opens the path to utilization of RA treatment in severe depression or treatment-resistant depression.This commentary reviews ethics in epidemiology and public health (PH) syllabi collected in 2011 and 2018. The syllabi repository was an American College of Epidemiology (ACE) Ethics Committee project to support institutions and faculty introducing, furthering or improving ethics in epidemiology and public health courses. Of 83 syllabi from 52 accredited public health schools and programs, 80 were reviewed to identify the most common ethics topics. The extracted information was categorized into eight main groups (1) ethical/moral foundations and theories; (2) case studies in epidemiology/PH; (3) ethical issues in PH practice; (4) ethical issues in general epidemiologic/PH research; (5) ethical issues in specific research areas; (6) ethical issues in information technology; (7) ethical issues in other emerging topics in epidemiology/PH; and (8) others. The frequency of topics in each category was computed, and common topics were presented. Ethical issues absent from the syllabi were inferred. This commentary is intended to promote a dialog among those desiring to elevate epidemiology and public health ethics to an educational level commensurate with its importance.
This population-based study explored the associations between childhood adversity and admission to emergency departments (EDs) with non-suicidal self-injury (NSSI) and with a suicide attempt.

A nationally representative cross-sectional sample of 5-17-year-olds admitted to EDs (N=143,113,677) from 2006 to 2015 was utilized to assess the associations between childhood adversities, NSSIs, and suicide attempts.

ED admissions with NSSI and admissions with a suicide attempt were associated with greater odds of exposure to individual childhood adversities (aORs 1.34 to 5.86; aORs 2.37 to 15.69, respectively). ED admissions with a suicide attempt were associated with greater odds of exposure to childhood adversities that might be perceived as less extreme or harmful (separation or divorce aOR 15.69) than other adversities (death of a family member aOR 13.38; history of physical abuse aOR 9.56) as well as greater odds of exposure to three or more childhood adversities (aOR 20.98).

Early detection of childhood adversities is important for identifying potential risk factors for self-harm. ED admission data can provide population-level surveillance to aid in these efforts and lead to more targeted and effective interventions aimed at reducing the negative effects of toxic stress that can result from exposure to childhood adversities.
Early detection of childhood adversities is important for identifying potential risk factors for self-harm. ED admission data can provide population-level surveillance to aid in these efforts and lead to more targeted and effective interventions aimed at reducing the negative effects of toxic stress that can result from exposure to childhood adversities.Because children remained at home throughout the COVID-19 pandemic, the potential existed for an increased rate of ocular injuries. We performed a retrospective chart review of children (≤18 years of age) presenting to an ophthalmology emergency department (ED) at a single institution from March 1 to August 31, 2020, to describe the trends in ocular trauma during the pandemic. Of the 10,738 ED patients, 6% (643) were children. Of these, 156 (24%) sustained ocular trauma. Although the overall number of visits was 44% lower than the same 6-month period in 2019, trauma-related visits were only 34% lower. The mean age was 9.1 ± 5.53 years (range, 4 months to 18 years) and over half (57%) of patients were male. Most closed-globe trauma was due to blunt (48.6%) or sharp (14.4%) objects, foreign bodies (23.3%), or chemical injuries (13.7%). Ten patients (6.4%) presented with an open globe. Blunt trauma was most common regardless of age; however, chemical injuries tended to occur in younger patients compared with all other diagnosis groups (4.7 ± 4.6 vs 9.7 ± 5.4 years; P = 0.0002). Although COVID-19 restrictions limited school, recreational activities, and team sports, ocular injuries remained prevalent in children.We present the case of a 77-year-old woman with adult-onset divergence insufficiency esotropia in which a bifid medial rectus muscle was identified intraoperatively. The patient had no past ocular, medical, syndromic, or traumatic history associated with this isolated horizontal rectus anomaly. Following identification of the bifid muscle, the original surgical plan was altered to asymmetric recession of the superior and inferior medical rectus heads.Abiotic stressors, such as cold exposure, can depolarize insect cells substantially causing cold coma and cell death. During cold exposure, insect skeletal muscle depolarization occurs through a 2-stage process. Firstly, short-term cold exposure reduces the activity of electrogenic ion pumps, which depolarize insect muscle markedly. Secondly, during long-term cold exposure, extracellular ion homeostasis is disrupted causing further depolarization. Consequently, many cold hardy insects improve membrane potential stability during cold exposure through adaptations that secure maintenance of ion homeostasis during cold exposure. Less is known about the adaptations permitting cold hardy insects to maintain membrane potential stability during the initial phase of cold exposure, before ion balance is disrupted. To address this problem it is critical to understand the membrane components (channels and transporters) that determine the membrane potential and to examine this question the present study constructed a mathenerate testable hypotheses of how insects can preserve membrane polarization in the face of stressful cold exposure.Mastitis is a bacterial infection that affects all lactating mammals, and in dairy cattle, it leads to a reduction in their milk production and, in worse cases, it may lead to animal death. One viable therapeutic modality for overcoming bacterial resistance can be photodynamic inactivation (PDI), a therapeutic modality for bacterial infection treatment. One of the main factors that can lead to an efficient PDI process is the association of metallic nanoparticles in the close vicinity of photosensitizers, which has shown promising results due to localized surface plasmon resonance phenomena. In this work, methylene blue (MB) molecules were associated with Ag prismatic nanoplatelets (AgNPrs) to use as PDI photosensitizer against Staphylococcus aureus isolated from bubaline mastitis. The optical plasmonic activity of AgNPrs was tuned to the MB absorption region (600-700 nm) by inducing their growth into prismatic shapes by a seed-mediated procedure, using poly (sodium 4-styrene sulfonate) as the surfactant. A simulation on the plasmonic properties of the nanoprisms, applying particle size within the dimensions determined by TEM image analysis (d = 32 ± 6 nm), showed a 30 % increase of the incident field on the prismatic tips.
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