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Discolored Claw Symptoms: In a situation Presentation plus a Overview of Supervision Options.
Introduction Patients infected with SARS-Cov-2, the causative virus behind the coronavirus disease-19 (COVID-19) pandemic, have been increasing rapidly in New York City. New York City has the highest incidence in the United States and fully 45% of all deaths from COVID-19. Our medical center is located within a high-density region of cases in south Brooklyn and, in fact, three of our neighborhood zip codes are in the top seven in New York in incidence. As a result, our center has experienced a dramatic increase in hospitalizations, particularly respiratory distress secondary to COVID-19, which rapidly exceeded the capacity of our internal medicine service. This necessitated the formation of new COVID-19 units throughout the hospital, replacing all former service lines. These units employed management teams composed of residents from many medical and surgical disciplines, including general surgery residents. Methods Our general surgery residency program established a surgical COVID-19 (SCOVID) management team. Initially, 4 surgical residents (2 senior and 2 junior), 1 attending surgeon, and 1 attending internal medicine physician were allocated to the initial SCOVID team. On day 3 of implementation, to achieve more rapid competence in the complex management of these patients, a senior medicine resident with direct experience in the care of COVID-19 patients was added in an advisory capacity. Results The addition of an experienced senior medical resident and attending allowed for the quick adoption of uniform management protocols by surgical residents and attendings. Discussion We describe a protocol for the establishment of COVID-19 management teams staffed with general surgical residents, as well as a strategy for the achievement of rapid increases in competency. The addition of a senior internal medicine resident and attending to our SCOVID team allowed for rapid achievement of competency in the care of COVID-19 patients in our large institution at the epicenter of the COVID-19 pandemic.Purpose The aims of the current study were to better understand, from the perspective of adolescents and young adults (AYAs) with sarcoma, parents, and providers, the friendship support needs of AYAs with bone and soft tissue sarcoma and the role of social media in facilitating social support for AYAs with sarcoma. Methods Semistructured interviews were conducted with 21 participants. AYA (n = 10) ranged in age from 14 to 23 years (mean 19.3, standard deviation 3.4 years; 50% female). All AYAs reported a current or past diagnosis of sarcoma, except for one patient who had another cancer diagnosis but was receiving treatment through the sarcoma clinic. Five parents of the adolescent participants were interviewed, as well as six health care providers. Data analysis was conducted using theory-driven immersion/crystallization, incorporating the Resilience in Illness Model as a framework to guide interpretation of the data. Results Four main themes associated with social support from friends and social media were identified (1) Social media provides a way to feel normal and connected to friends; (2) Social media accentuates the frustration of being left behind; (3) Social media facilitates the need to be understood by peers who have experienced sarcoma, and (4) Social media can lead to despair, and also provide hope for the future. Conclusions Connecting with peers through social media can play an important role in providing support for AYAs with sarcoma, but it may also amplify feelings of frustration and anxiety. Future work is needed to determine intervention components that can maximize the benefits of social media for social support of AYAs with sarcoma. Clinical Trial Registration number NCT03130751.Metabolism is essential for a living-organism to sustain life. It provides energy to a cell by breaking down compounds (catabolism), and supplies building blocks for the synthesis of macromolecules (anabolism). Signal transduction pathways tightly regulate mammalian cellular metabolism. Simultaneously, metabolism itself serves as a signaling pathway to control many cellular processes such as proliferation, differentiation, cell death, gene expression, and adaptation to stress. see more Considerable progress in the metabolism field has come from understanding how cancer cells co-opt metabolic pathways for growth and survival. Recent data also show that several metabolic pathways may participate in the pathogenesis of lung diseases, some of which could be promising therapeutic targets. In this translational review, we will outline the basic metabolic principles learned from the cancer metabolism field as it applies to the pathogenesis of pulmonary arterial hypertension and fibrosis with an emphasis on therapeutic potential.
Interpreting the radiological data in conjunction with an objective clinical score could help to harmonize IPF diagnostic and improve accuracy.

We sought to establish and validate a multivariable objective scoring model based on clinical parameters, by stratifying the risk for patients to be diagnosed as IPF versus other forms of interstitial lung disease (ILD).

A clinical score was derived from review of patients evaluated at the Inova Fairfax ILD program and validated in three distinct cohorts. Based on known IPF clinical characteristics, a multivariable model was created and assessed by receiver operator curve (ROC) characteristics.

There were 844 ILD patients diagnosed as either IPF (n=347, 41%) or non-IPF ILD (n=497, 59%). Based on calculated odds ratios, a score was assigned to each of the following clinical parameters age, sex, smoking history, ethnicity, ILD family history, exposures, presence of CTD signs or symptoms, and Velcro crackles. The final Fairfax IPF clinical score (FICS) ranged from 1 to 25. The clinical diagnostic score system was accurate in predicting IPF, as measured by the area under the curve (AUC 0.88) in the derivation cohort with similar AUCs of 0.91, 0.81 and 0.71 in the respective validation cohorts.

The FICS appears to be an accurate tool for estimating the pretest probability of IPF in patients with ILD. How the FICS performs in conjunction with the various HRCT patterns remains to be determined. This model could ultimately be useful for increasing the degree of confidence in the final diagnosis and help to obviate the need for lung biopsy in cases of non-UIP patterns on HRCT.
The FICS appears to be an accurate tool for estimating the pretest probability of IPF in patients with ILD. How the FICS performs in conjunction with the various HRCT patterns remains to be determined. This model could ultimately be useful for increasing the degree of confidence in the final diagnosis and help to obviate the need for lung biopsy in cases of non-UIP patterns on HRCT.Background Surgical site infections (SSIs) represent an economic burden to healthcare systems. The use of negative pressure wound therapy (NPWT) for SSI prophylaxis remains uncertain. Methods A systematic literature search was conducted in Medline/PubMed, CINAHL, and Web of Science for relevant studies. The primary outcome was the evaluation of the effectiveness of NPWT for prophylaxis of SSI rates in general abdominal surgery. Secondary outcomes were rates of seroma and wound dehiscence, length of hospital stay, and re-admission rates. The statistical analysis was performed with random effect models. Results A total of 3,193 patients from 20 articles (six randomized controlled trials [RCT], three prospective, eight retrospective, and three ambispective studies) were analyzed. Negative pressure wound therapy was associated with decreased rate of SSIs compared with standard dressing in a pooled analysis of non-randomized studies and RCTs (0.57; 95% confidence interval [CI], -0.4 to 0.8; p  less then  0.001). This result, however, needs to be challenged because of a significant statistical heterogeneity of the included studies (I2 = 71%; p  less then  0.01). A separate analysis of the six RCTs failed to confirm the superiority of NPWT (0.64; 95% CI, -0.4 to 1.04; p = 0.07), also disclosing significant heterogeneity. The analysis of secondary outcomes was only possible in combination of randomized and non-randomized studies because of incomplete datasets in RCTs. Re-admission rates were lower after NPWT and no difference was observed for the incidence of seroma, wound dehiscence, and length of hospital stay. Conclusions Based on available evidence, the routine use of NPWT for SSI prophylaxis after laparotomy in general abdominal surgery cannot be generally recommended.Purpose Malnutrition is commonly observed during cancer treatment, while some cancer survivors are at risk of overweight and obesity. This study investigated nutritional status during and after treatment in adolescents and young adults (AYA) with cancer. Methods A retrospective chart review of AYA diagnosed with cancer was conducted. Data were collected monthly during treatment, then annually for 3 years of follow-up. Results Of 93 AYA, 8% were underweight at diagnosis versus 20% during treatment (p = 0.012). Forty-four percent experienced ≥5% loss of weight (LOW) during treatment, and 23% of those were not referred to a dietitian. While 47% were referred to a dietitian at some point during treatment, 77% did not have dietetic involvement in the month after reaching greatest percentage LOW. Different tumor types were associated with different risks of LOW. Eighty-six percent with acute lymphoblastic leukemia (ALL)/lymphoblastic lymphoma (LL) and 86% with acute myeloid leukemia had ≥5% LOW during treatment, compared with 17% with Hodgkin lymphoma (p  less then  0.0001). In year 3 of follow-up, 36% of all AYA were overweight or obese versus 25% at diagnosis (p = 0.2). Overweight/obesity was more common in ALL/LL survivors than other tumor types (67% vs. 14%, p = 0.037). No patients had dietitian involvement in year 3 of follow-up. Conclusions AYA, particularly those with ALL/LL, are at risk of significant weight loss during treatment and overweight and obesity during survivorship. Dietetic involvement was inconsistent in this cohort. These data may guide which diagnoses warrant preemptive dietetic input during treatment and highlight the importance of dietetic involvement in survivorship.Objective Are education materials available online appropriate for patients seeking information before rhinoplasty? Study Design Google.com and YouTube.com were searched for patient education information on rhinoplasty procedures. Of the first 100 results, 75 articles and 75 videos met the inclusion criteria. Each article's readability was scored using six previously validated readability scores to determine patient's ability to comprehend the text, while each video was scored using the Journal of the American Medical Association (JAMA) benchmark criteria and the Global Quality Score (GQS) to measure source reliability and educational value, respectively. Results Analysis of the readability of the 75 articles yielded an average grade reading level of 10.31 (range 5-20; 95% confidence interval, 9.83-10.79), while video analysis found videos authored by physicians were significantly more reliable (PJAMA less then 0.001) and had a significantly higher educational value (PGQS less then 0.001). Patient education videos were found to be more reliable than patient experience videos (PJAMA = 0.
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