Association of Primary Care providers Health Habits with Lifestyle Counseling to Hypertensive Elderly Patient: Results of a National Survey

We were interested in studying the association between personal health habits of healthcare providers and their beliefs and practices of lifestyle counseling to elderly hypertensive patients. We conducted a national anonymous cross sectional survey of physicians and nurse practitioners providing primary care. The survey was developed to assess providers’ beliefs and practices of lifestyle counseling as well as personal habits. Beliefs about counseling were assessed by (a) perceived available time, (b) perceived skill, and (c) perceived effectiveness of lifestyle counseling. Reported lifestyle counseling practice were assessed by reported frequency of (a) obtaining lifestyle habits and (b) providing lifestyle counseling to elderly hypertensive patients. We mailed 7,500 mailed surveys and received 774. Providers who reported healthier lifestyle habits reported that they more frequently obtain lifestyle history (p=.004) and provide lifestyle counseling (

Vaginal birth after caesarean section in a woman with twin reversed arterial perfusion sequence

Twin reversed arterial perfusion (TRAP) sequence results from aberrant and asymmetrical twinning. It is a rare but serious complication of monozygotic twin pregnancies. It is characterized by a normally formed fetus that shows features of heart failure, and an acardiac twin. A 26-year-old pregnant woman, gravida 6, para 5, with mono-chorionic di-amniotic twin pregnancy at her 20th week of gestation, was diagnosed with TRAP sequence. Both the pump twin and the acardiac co-twin did not display any cardiac activity. Termination of pregnancy was accomplished by a successful vaginal birth after cesarean section (VBAC) following five prior cesarean sections. Proper and early diagnosis of TRAP sequence can aid in treatment selection and pump twin salvage. Induction of labor by both misoprostol and intracervical balloon catheter showed to be safe and effective in a woman with a uterine scar resulting from five prior cesarean sections

Sex differences in etiology and short-term outcome in young ischemic stroke patients receiving mechanical thrombectomy

BACKGROUND: Although there are well known sex differences in older patients with ischemic stroke receiving acute reperfusion treatments, there is paucity of data in younger patients. METHODS: We investigated sex-related differences in clinical presentation, stroke etiology and short-term outcomes in consecutive young patients with acute ischemic stroke (AIS) below the age of 50 years receiving mechanical thrombectomy (MT) between January 2011 and May 2021 in a tertiary stroke center. RESULTS: We identified a total of 202 young ischemic stroke patients with MT, with 51% being female. Young female AIS patients were significantly younger (39 ± 8 vs. 43 ± 7 years, p < 0.001), and presented with a trend for more severe stroke on admission (median NIHSS 12 vs. 9, p = 0.065), compared to males, respectively. Young female AIS patients had higher rates of embolic strokes of determined or undetermined sources in the anterior circulation, while young male AIS patients suffered more often strokes of arterio-arterial embolism. Complete reperfusion (TICI score 3) was achieved significantly less often in young female AIS patients (69% vs. 83%, p = 0.006), and in-hospital mortality was 2-times higher (5% vs. 2%, p = 0.271) compared to males. CONCLUSIONS: Young female AIS patients receiving MT have higher rates of severe embolic strokes and less often complete reperfusion due to different occlusion sites and stroke etiology compared to males

The effect of short-chain fatty acids on glycemic control in humans: A systematic review and meta-analysis

Background: Non-communicable disease development is related to impairments in glycaemic and insulinemic response, which can be modulated by fiber intake. Fiber's beneficial effect upon metabolic health can be partially attributed to the production of short-chain fatty acids (SCFAs) via microbial fermentation of fiber in the gastrointestinal tract. Objective: We aimed to determine the effect of the SCFAs, acetate, propionate, and butyrate on glycemic control in humans. Methods: CENTRAL, Embase, PubMed, Scopus and Web of Science databases were searched from inception to the 07/12/2021. Papers were included if they reported a randomized, controlled trial measuring glucose and/or insulin compared to a placebo in adults. Studies were categorized by the type of SCFA and intervention duration. Random effects meta-analyses were performed for glucose and insulin for those subject categories with ≥3 studies, or a narrative review was performed. Results: We identified 43 eligible papers, with 46 studies within those records (n = 913), 44 studies were included in the meta-analysis. Vinegar intake decreased acute glucose response, standard mean difference (SMD) and (95% CI) –0.53 (–0.92, –0.14) (n = 67) in individuals with impaired glucose tolerance or type 2 diabetes and in healthy (SMD) –0.27 (–0.54, 0.00) (n = 186). The meta-analyses for acute acetate as well as acute and chronic propionate studies had no significant effect. Conclusions: Vinegar decreased glucose response acutely in healthy and non-healthy. Acetate, propionate, butyrate, and mixed SCFAs had no effect on blood glucose and insulin in humans. Significant heterogeneity, risk of bias, and publication bias were identified in several study categories, including acute vinegar glucose response. As evidence was very uncertain, caution is urged when interpreting these results. Further high-quality research is required to determine the effect of SCFAs on glycemic control

The data not collected on community forestry

Conservation and development practitioners increasingly promote community forestry as a way to conserve ecosystem services, consolidate resource rights, and reduce poverty. However, outcomes of community forestry have been mixed; many initiatives failed to achieve intended objectives. There is a rich literature on institutional arrangements of community forestry, but there has been little effort to examine the role of socioeconomic, market, and biophysical factors in shaping both land-cover change dynamics and individual and collective livelihood outcomes. We systematically reviewed the peer-reviewed literature on community forestry to examine and quantify existing knowledge gaps in the community-forestry literature relative to these factors. In examining 697 cases of community forest management (CFM), extracted from 267 peer-reviewed publications, we found 3 key trends that limit understanding of community forestry. First, we found substantial data gaps linking population dynamics, market forces, and biophysical characteristics to both environmental and livelihood outcomes. Second, most studies focused on environmental outcomes, and the majority of studies that assessed socioeconomic outcomes relied on qualitative data, making comparisons across cases difficult. Finally, there was a heavy bias toward studies on South Asian forests, indicating that the literature on community forestry may not be representative of decentralization policies and CFM globally

Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials

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cardiovascular manifestations in patients infected with the human immunodeficiency virus

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