Is There a Role for Plant-Based “Meat” in Cardiovascular Disease Prevention?

Diet is an established risk factor for cardiovascular disease. The American Heart Association recommends following a whole-food, minimally processed diet emphasizing fruit and vegetables to reduce cardiovascular mortality. Recently, processed plant-based meat substitutes, such as Beyond Meat® and Impossible™ foods have become easily accessible to consumers and are advertised as a healthful addition to a plant-based diet. However, these products are highly processed and contain high amounts of saturated fat and sodium. The purpose of this research is to investigate the effect of processed plant-based meat diets on adverse cardiovascular events compared to animal-based meat diets and minimally processed healthful plant-based diets. Health outcomes are dependent on micronutrient content Plant-based diets with the highest levels of serum beta-carotene and other micronutrients are associated with lower overall cardiovascular disease and mortality, as well as better metabolic markers.1,7,8 Plant-base meats reduce TMAO levels and improve cardiovascular disease risk factors Animal-based diets are associated with higher serum levels of trimethylamine N-oxide (TMAO), which is associated with an increased risk of heart attacks, vascular disease, and stroke. 2,9,10 Consumption of plant-based meat alternatives has been shown to reduce TMAO levels by 31.9% while reducing LDL and blood pressure and increasing HDL levels. Many studies found that highly processed diets are associated with negative health outcomes, regardless of plant-based content. Unhealthful plant-based diets are associated with greater cardiovascular disease risk factors and mortality compared to healthful plant-based diets. Lastly, it was found that computer modeling predicts adherence to a minimally processed diet containing animal products will result in lower rates of cardiovascular disease, ischemic heart disease, and diabetes, compared to a moderately processed plant-based diet

Mesenchymal Stem Cell Therapy for Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, is a fatal neurodegenerative disease affecting motor neurons in the brain and spinal cord. Progressive muscle weakness, atrophy, and spasticity characterize the condition, which eventually leads to paralysis and respiratory failure. There is currently no cure for ALS, and the standard of care is supportive, with riluzole being the only approved medication that has been shown to slightly slow disease progression (1). However, the use of mesenchymal stem cells (MSCs) in the treatment of ALS is a new area of research in regenerative medicine. MSCs are multipotent stem cells that have the ability to differentiate into a variety of cell types, including neurons, and have immunomodulatory and anti-inflammatory properties, making them an appealing therapy for neurodegenerative diseases such as ALS (2). This review examines the safety and efficacy of MSC therapy for ALS in four randomized controlled trials. The trials involved administering MSCs via various routes, including intrathecal and intravenous, and assessing outcomes such as survival, disease progression, and quality of life. The findings of these trials shed light on the potential of MSC therapy as a novel approach to treating ALS

Wide Awake Local Anesthesia No Tourniquet (WALANT) Is More Effective at Decreasing Pain Compared to Distal Nerve Block With a Tourniquet During Carpal Tunnel Release Surgery: A Systematic Review and Pooled Analysis

Background: Carpal tunnel release (CTR) is one of the most common upper extremity procedures, reaching 400,000 - 600,000 procedures yearly in the United States. With such a common procedure, it is pertinent that every step is as comfortable for the patient as possible. Many patients report discomfort due to the usage of a tourniquet during the anesthesia process. However, a growing number of physicians are beginning to use the wide awake local anesthesia no tourniquet (WALANT) approach. WALANT utilizes a distal nerve block (commonly Ropivacaine), Lidocaine, Epinephrine, but no tourniquet. The more commonly used approach utilizes the same distal nerve block, in combination with a tourniquet. To date, there have been no systematic reviews or meta-analyses evaluating whether the WALANT approach yields lower pain than a distal nerve block with a tourniquet during CTR. Purpose: We conducted a systematic review and pooled analysis comparing the WALANT technique to using a tourniquet with a distal nerve block on the pain experienced by patients during carpal tunnel release. Methods: This systematic review and pooled analysis followed the 2020 PRISMA guidelines. Five online databases (Cochrane, Embase, Scopus, Web of Science, Pubmed) were screened for studies that included intraoperative Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) scores of patients having CTR with either the WALANT approach or a tourniquet with a distal nerve block. After the screening process, 2 randomized controlled trials (RCTs) were included in the final analysis, yielding a total of 90 distinct patient evaluations. Results: The results portray a strong clinical significance (Cohen’s d = 1.03, 95% CI 0.59-1.47) on pain reduction, in favor of utilizing the WALANT technique. Conclusion: Our systematic review and pooled analysis serves as a preliminary study in the exploration of the WALANT technique, specifically for CTR. The results illustrate that WALANT is a promising method in reducing patient pain during this procedure, portrayed by the large effect size between using a tourniquet with a distal block, and WALANT. Future RCTs are needed to control for the drug and dose of nerve block used, and to increase the sample size

Cardiovascular Disease Prediction Modelling: A Machine Learning Approach

The objective of this project is to utilize the UCI Heart Disease dataset to identify physiological biomarkers that are highly correlated with heart disease incidence. A predictive model can then be developed using these biomarkers to estimate the likelihood of someone having or developing a heart-related condition. This study compares the efficacy of predicting cardiovascular disease as an outcome using three machine learning algorithms: Support Vector Machine, Gaussian Naive Bayes, and logistic regression. Support Vector Machine works by creating hyperplanes between data points to conduct classification. Gaussian Naive Bayes works by using the conditional probabilities of events to classify the target. In logistic regression, the independent variables included all features in the data set except for “target,” which is a categorical variable that indicates whether the patient has cardiovascular disease. The dependent variable included the “target” variable. The findings suggest that the logistic regression model had the highest accuracy in predicting cardiovascular disease. The results of this study can be beneficial to healthcare professionals in developing new preventative protocols for assessing and treating cardiovascular disease

Effects of Income and Language on Health Literacy: A Study Between a Student-Run Free Clinic and a Family Medicine Office

Background: Over one-third of the US population exhibit limited health literacy, leading to negative health outcomes and lifestyle choices. By employing the NVS assessment, RCHC sought to compare the health literacy levels of uninsured patients at their facility with those of insured patients at the Rowan Family Medicine office in Hammonton, NJ. This study aimed to assess specific factors that may influence health literacy levels. Methods: This is an IRB-approved study which surveyed patients enrolled at the RCHC and Rowan Family Medicine Office between February 2021 and March 2023. Patients were given a nutrition label and verbally answered the NVS Assessment. Data was recorded via Qualtrics forms, and analysis was conducted with Fisher’s Exact Test in IBM SPSS Statistics. Results: A statistically significant increase in prevalence of limited literacy compared to adequate literacy among patients below the poverty line (p=0.038) and Spanish speaking patients (p=0.041). No significant difference between limited literacy and adequate literacy based on location of care, insurance status, gender, or education level. Conclusions: Income below the poverty line and Spanish as a primary language played a significant role in health literacy in our patient population. Since limited health literacy is highly prevalent in the US, it is important that physicians allot more time to explain medical terms to patients whose primary language is not English or who are from a low socioeconomic status. In the future, the RCHC hopes to design and implement a health literacy course for patients

Factors Affecting Caregiver Burden in Informal Caregivers of Patients with Autism Spectrum Disorder

Individuals with Autism Spectrum Disorder (ASD) often require lifelong care to meet their daily needs, which is typically provided by informal sources like family members as well as formal caregivers from home health agencies. The persistent stress of raising a child with ASD can potentially lead to parental burnout, highlighting the importance of understanding the struggles faced by these caregivers. Clinicians must prioritize the well-being of both the individuals with ASD and their dedicated caregivers by gaining a comprehensive understanding of the challenges they encounter. Our research aims to investigate and comprehend the specific challenges faced by caregivers of individuals diagnosed with ASD. By utilizing the Caregiver Burden Inventory (CBI; Novak & Guest, 1989), we sought to pinpoint the primary elements that contribute to caregiver burden and evaluate how it affects the wellbeing of caregivers. These findings can ultimately lay the foundation for targeted interventions and strategies aimed at lessening the burden on caregivers, ensuring they receive the necessary support to provide optimal care for their loved ones with ASD while maintaining their own well-being

Variables Contributing to The Psychosocial Strain on Caregivers of Patients with Autism Spectrum Disorder

This research, conducted at the Rowan-Virtua Integrated Special Needs (RISN) Center, Sewell, New Jersey, explores the psychosocial strain on caregivers of patients with Autism Spectrum Disorder (ASD). Utilizing the Caregiver Burden Inventory (CBI), we assessed multiple psychosocial dimensions, including time dependency, emotional health, development, social relationships, and physical health. Data was extracted from a total of 295 patient charts; this poster analyzes the initial sample of 99 patients by incorporating demographic variables and caregiver burden scores into a tailored database for comprehensive analysis. Our findings reveal a statistically significant correlation between the age of patients and increased developmental scores in the CBI, suggesting that older patients tend to impose higher developmental demands on caregivers. Gender analysis showed no significant correlation with CBI scores. The study underscores the persistent psychosocial challenges faced by caregivers, pointing to the necessity for enhanced supportive measures and further research into the factors influencing caregiver burden. This ongoing project continues to expand with the aim of contributing to better-informed care strategies for both ASD patients and their caregivers

Auriculotemporal Nerve Block for TMJ: A Systematic Review

The purpose of this systematic review is to evaluate auriculotemporal nerve blocks for temporomandibular joint (TMJ) disorder management. 583 articles reviewed from five databases, selected four studies for pooled analysis on visual analog scale (VAS) and maximum mouth opening (MMO) outcomes. Pooled analysis showed significant improvement in VAS (-2.27, p \u3c 0.001) and MMO (0.94, p = 0.03) post-auriculotemporal nerve blocks for TMJ disorder. Auriculotemporal nerve blocks demonstrate potential effectiveness in TMJ disorder treatment, warranting further research on long-term effects and side effects

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research