Bone mineral density and content during weight cycling in female rats: effects of dietary amylase-resistant starch

<p>Abstract</p> <p>Background</p> <p>Although there is considerable evidence for a loss of bone mass with weight loss, the few human studies on the relationship between weight cycling and bone mass or density have differing results. Further, very few studies assessed the role of dietary composition on bone mass during weight cycling. The primary objective of this study was to determine if a diet high in amylase-resistant starch (RS₂), which has been shown to increase absorption and balance of dietary minerals, can prevent or reduce loss of bone mass during weight cycling.</p> <p>Methods</p> <p>Female Sprague-Dawley (SD) rats (n = 84, age = 20 weeks) were randomly assigned to one of 6 treatment groups with 14 rats per group using a 2 × 3 experimental design with 2 diets and 3 weight cycling protocols. Rats were fed calcium-deficient diets without RS₂(controls) or diets high in RS₂(18% by weight) throughout the 21-week study. The weight cycling protocols were weight maintenance/gain with no weight cycling, 1 round of weight cycling, or 2 rounds of weight cycling. After the rats were euthanized bone mineral density (BMD) and bone mineral content (BMC) of femur were measured by dual energy X-ray absorptiometry, and concentrations of calcium, copper, iron, magnesium, manganese, and zinc in femur and lumbar vertebrae were determined by atomic absorption spectrophotometry.</p> <p>Results</p> <p>Rats undergoing weight cycling had lower femur BMC (p < 0.05) and marginally lower BMD (p = 0.09) than rats not undergoing weight cycling. In comparison to controls, rats fed RS₂had higher femur BMD (p < 0.01) and BMC (p < 0.05), as well as higher values for BMD and BMC measured at the distal end (p < 0.001 and p < 0.01) and femoral neck (p < 0.01 and p < 0.05). Consistent with these findings, RS₂-fed rats also had higher femur calcium (p < 0.05) and magnesium (p < 0.0001) concentrations. They also had higher lumbar vertebrae calcium (p < 0.05) and magnesium (p < 0.05) concentrations.</p> <p>Conclusion</p> <p>Weight cycling reduces bone mass. A diet high in RS₂can minimize loss of bone mass during weight cycling and may increase bone mass in the absence of weight cycling.</p

Updated guidance on the management of COVID-19:from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.status: Published onlin

A 55 Year-old Man With Mental Status Change and Severe Anemia

Case Presentation A 55 year-old male with past medical history significant for mentalretardation, a stage IV sacral decubitous ulcer, iron deficiencyanemia and gastrointestinal bleeding presented from a long termcare facility for acute onset of respiratory distress and change inmental status. On presentation the patient was found to have aGCS of three, and he was emergently intubated in the emergencydepartment for airway protection. Following intubation his vitalsigns were stable

A 19 Year-Old Man With Chest Pain

Case Report A 19-year-old man with no past medical history presented tothe ER with a sore throat, cough, and pleuritic chest pain. Thepatient had been well until 1 month before admission, whenhe developed a sore throat and felt ill. He presented to theemergency department twice for these symptoms. On the first visit, the patient had a positive rapid strep test. He was diagnosedwith strep throat and treated with penicillin IM. However, hissore throat persisted. Five days before admission, the patientdeveloped a non-productive cough. One day prior to admissionhe developed severe right sided chest pain that was throbbing,pleuritic, and radiated to his right shoulder. The pain, whichwas initially relieved by sitting forward and with Ibuprofen,continued to worsen, prompting the patient’s mother to bringhim back to be re-evaluated. Upon presentation, the patient denied shortness of breath, fevers,or chills. He had no personal history of prenatal or childhooddisease, and denied family history of early heart disease, lungdisease, cancer or bleeding disorders. He denied tobacco,alcohol, or illicit drug use. He reported being heterosexual with4-5 lifetime sexual partners, and one new partner in the priortwo months

Beyond the Individual: A Multidisciplinary Model for Critical Thinking in the Intensive Care Unit.

Health profession educators readily identify with the goal of fostering healthcare providers who are critical thinkers focused on quality patient care. In the following paper, we aim to delve into critical thinking at the team level and help educators begin the process of creating a shared mental model focusing on cognition to identify gaps and opportunities for growth in their trainees. We will distinguish between microcognition (an individuals own critical thinking process in a controlled environment), macrocognition (critical thinking process in a real-world environment), and team cognition (the interaction and relationship among team members to augment macrocognition). A common case example will be used to guide the discussion as well as provide a model framework to be used for clinician educators in the future

Critical Care Teamwork in the Future: The Role of TeamSTEPPS^® in the COVID-19 Pandemic and Implications for the Future

At our institution, we observed inconsistency in the application of structural facilitators for interprofessional teamwork such as handoffs and communication of contingency planning, complete formation and engagement of teams on interprofessional rounds, regular situation monitoring, interprofessional huddles, use of “check back” during code situations, and standard debriefings after codes and procedures (TeamSTEPPS®). To enhance team performance, we piloted TeamSTEPPS® training and reinforcement for all healthcare team members in the medical intensive care unit (MICU), inclusive of trainees, advanced practice providers (APPs), nurses, and respiratory therapists rotating through the unit. Seven months after the training launch, the initial COVID-19 surge interrupted the reinforcement stage of the pilot providing an opportunity to study the retention of TeamSTEPPS® principles and its potential role in response to a crisis. We conducted interprofessional focus groups after a year of crisis management during the pandemic. Themes revealed how TeamSTEPPS® training impacted teamwork and communication, as well as factors that influenced the use of TeamSTEPPS®. This work points to the value of team training in unexpected scenarios. Additional studies at multiple sites are needed to determine scalability for all MICU teams or for onboarding new team members

Risk Factors and Clinical Outcomes of Candidemia Associated with Severe COVID-19

COVID-19 can cause serious illness requiring multimodal treatment and is associated with secondary infections. Studies have suggested an increased risk of fungal infections, including candidemia following severe COVID-19 though understanding of risk factors and clinical outcomes remains unclear. OBJECTIVES: To describe clinical characteristics, outcomes and risk factors of candidemia among patients hospitalized with severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, case-control study of patients with severe COVID-19 was conducted to evaluate risk factors and clinical outcomes in patients who developed candidemia between August 2020 and August 2021. MAIN OUTCOMES AND MEASURES: Chart review evaluating institutional and patient demographics, clinical and mycological characteristics, concomitant interventions (antibiotics, immunosuppressive agents, parenteral nutrition, degree of oxygen support, mechanical ventilation, surgery), treatment regimens, and outcomes (length of stay and discharge disposition) RESULTS: A total of 275 patients were enrolled in the study, including 91 patients with severe COVID-19 and subsequent candidemia and 184 with severe COVID-19 without candidemia. Most patients received antibiotics prior to candidemia episode (93%), while approximately one-quarter of patients received biologic for COVID-19. In-hospital mortality was significantly higher in the cases compared with the controls (68% vs 40%; p < 0.01). Candida albicans was the most common (53%), followed by C. glabrata (19%). Use of central lines, biologic, and paralytics were independent risk factors for candidemia. CONCLUSIONS AND RELEVANCE: Candidemia following COVID-19 infection is a concern that requires clinical consideration and patient monitoring. Risk factors for the development of candidemia in the setting of COVID-19 infection are largely consistent with traditional risk factors for candidemia in hospitalized patients