Acute Deep Vein Thrombosis Involving the Inferior Vena Cava: Interventional Perspectives

Extension of an iliofemoral thrombosis into the inferior vena cava (IVC), or from the IVC descending into the iliofemoral segments, can confer significant morbidity and mortality. Interventional management of acute deep vein thrombosis (DVT) has been controversial, but there is little doubt that certain subpopulations benefit, such as those with symptomatic IVC thrombosis. When considering an intervention, caval involvement introduces technical difficulties due to its larger diameter, high thrombus burden, bilateral limb clot extension and need for dual access. The frequent coexistence of an IVC filter increases the complexity even more. This review summarises the current indications and treatment modalities available for the management of acute DVT involving the vena cava

Radiocarbon Analyses Quantify Peat Carbon Losses With Increasing Temperature in a Whole Ecosystem Warming Experiment

Climate warming is expected to accelerate peatland degradation and release rates of carbon dioxide (CO2) and methane (CH4). Spruce and Peatlands Responses Under Changing Environments is an ecosystem-scale climate manipulation experiment, designed to examine peatland ecosystem response to climate forcings. We examined whether heating up to +9 °C to 3 m-deep in a peat bog over a 7-year period led to higher C turnover and CO2 and CH4 emissions, by measuring 14C of solid peat, dissolved organic carbon (DOC), CH4, and dissolved CO2 (DIC). DOC, a major substrate for heterotrophic respiration, increased significantly with warming. There was no 7-year trend in the DI14 C of the ambient plots which remained similar to their DO14 C. At +6.75 °C and +9 °C, the 14C of DIC, a product of microbial respiration, initially resembled ambient plots but became more depleted over 7 years of warming. We attributed the shifts in DI14 C to the increasing importance of solid phase peat as a substrate for microbial respiration and quantified this shift via the radiocarbon mass balance. The mass-balance model revealed increases in peat-supported respiration of the catotelm depths in heated plots over time and relative to ambient enclosures, from a baseline of 20%–25% in ambient enclosures, to 35%–40% in the heated plots. We find that warming stimulates microorganisms to respire ancient peat C, deposited under prior climate (cooler) conditions. This apparent destabilization of the large peat C reservoir has implications for peatland-climate feedbacks especially if the balance of the peatland is tipped from net C sink to C source. Plain Language Summary Since the end of the last glacial period, about 20 thousand years ago, peatlands have taken up carbon and now store an amount nearly equivalent to the quantity in the atmosphere. Microorganisms consume and respire that peat C releasing it back to the atmosphere as CO2 and CH4. Until now, many studies have shown that microorganisms prefer to consume the most recently fixed carbon and that the deeply buried ancient peat carbon reservoir is relatively stable. However, climate warming is expected to upset that balance. The Spruce and Peatlands Responses Under Changing Environments is large-scale experimental warming of a Minnesota peatland designed to study these effects. We conducted radiocarbon analysis of the peat and the microbially produced CO2 and dissolved organic carbon in ambient and heated areas of the peatland and show that at warmer temperatures more of the ancient peat carbon is being mobilized and respired to CO2. This is troubling as it signifies a positive feedback loop wherein warming stimulates peat to produce more CO2 which further exacerbates climate change

Soil Metabolome Response to Whole-Ecosystem Warming at the Spruce and Peatland Responses Under Changing Environments Experiment

While peatlands have historically stored massive amounts of soil carbon, warming is expected to enhance decomposition, leading to a positive feedback with climate change. In this study, a unique whole-ecosystem warming experiment was conducted in northern Minnesota to warm peat profiles to 2 m deep while keeping water flow intact. After nearly 2 y, warming enhanced the degradation of soil organic matter and increased greenhouse gas production. Changes in organic matter quality with warming were accompanied by a stimulation of methane production relative to carbon dioxide. Our results revealed increased decomposition to be fueled by the availability of reactive carbon substrates produced by surface vegetation. The elevated rates of methanogenesis are likely to persist and exacerbate climate warming

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Sleeves Up and STICK IT: Vaccinations Among Undergraduate Students

Introduction Recent studies have shown that the level of vaccine knowledge is directly correlated with the willingness of individuals to receive a vaccine. The purpose of this study is to evaluate whether a student\u27s focus of study would influence their decision to receive one of the COVID-19 vaccines as they become available. Material and Methods A causal-comparative approach was utilized. A multivariate analysis of variance was conducted among undergraduate students (n=365) enrolled at the University of South Florida. The independent variable is the student\u27s field of study. The dependent variables included students\u27 reports of 1) worker status; 2) knowledge of persons who tested positive; 3) knowledge of a person who passed; 4) trusting the vaccine offered protection; 5) vaccination status; 6) booster compliance; and 7) COVID testing accessibility at USF. Results This study identified two statistically significant findings. (1) The proportion of students (83%) who report that the COVID-19 vaccine offered protection (p\u3c0.02); and (2) the proportion of students (89%) who report receiving the COVID-19 vaccine (p\u3c0.03). Conclusion Findings identified differences among the fields of study within the university regarding willingness to receive the vaccine, as well as trust in the vaccine\u27s efficacy. Students who identified their major as public health and nursing were more likely to believe in the importance of vaccination for protection in contrast to students who reported other majors. Nursing students reported being vaccinated more frequently than other majors. Students who identified themselves as education majors were the least compliant with CDC recommendations about obtaining a vaccination

Sleeves Up and STICK IT: Vaccinations Among Undergraduate Students

Introduction Recent studies have shown that the level of vaccine knowledge is directly correlated with the willingness of individuals to receive a vaccine. The purpose of this study is to evaluate whether a student\u27s focus of study would influence their decision to receive one of the COVID-19 vaccines as they become available. Material and Methods A causal-comparative approach was utilized. A multivariate analysis of variance was conducted among undergraduate students (n=365) enrolled at the University of South Florida. The independent variable is the student\u27s field of study. The dependent variables included students\u27 reports of 1) worker status; 2) knowledge of persons who tested positive; 3) knowledge of a person who passed; 4) trusting the vaccine offered protection; 5) vaccination status; 6) booster compliance; and 7) COVID testing accessibility at USF. Results This study identified two statistically significant findings. (1) The proportion of students (83%) who report that the COVID-19 vaccine offered protection (p\u3c0.02); and (2) the proportion of students (89%) who report receiving the COVID-19 vaccine (p\u3c0.03). Conclusion Findings identified differences among the fields of study within the university regarding willingness to receive the vaccine, as well as trust in the vaccine\u27s efficacy. Students who identified their major as public health and nursing were more likely to believe in the importance of vaccination for protection in contrast to students who reported other majors. Nursing students reported being vaccinated more frequently than other majors. Students who identified themselves as education majors were the least compliant with CDC recommendations about obtaining a vaccination

Predictors of intensive care unit admission in adult cancer patients presenting to the emergency department with COVID-19 infection: A retrospective study.

BackgroundAdult cancer patients with COVID-19 were shown to be at higher risk of Intensive Care Unit (ICU) admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. Therefore, this study aimed to identify predictors of ICU admission (demographic, clinical, and COVID-19 targeted medications) in cancer patients with active COVID-19 infection presenting to the Emergency Department (ED).MethodsThis is a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the American University of Beirut Medical Center ED from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data were extracted from electronic medical records. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. A p-value less than 0.05 was considered significant.ResultsEighty-nine distinct patients were included. About 37% were admitted to the ICU (n = 33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage above 22 breaths per minute, oxygen saturation less than 95%, and a higher c-reactive protein upon presentation to the ED. After adjusting for confounding variables, only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission.ConclusionPhysicians need to be vigilant when taking care of COVID-19 infected cancer patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission

Epidemiology of substance use and mental health disorders among forced migrants displaced from the MENAT region: A systematic review and meta-analysis protocol.

BackgroundUnderstanding the epidemiology of substance use disorders (SUDs) and mental health disorders (MHDs) among forced migrants from the Middle East and North Africa and Türkiye (MENAT) region is of utmost importance given their distinct challenges and vulnerabilities. Existing research on the topic is substantial; however, comprehensive systematic reviews are limited. We aim to conduct a systematic literature review to bridge this gap, providing a thorough understanding of SUDs and MHDs epidemiology among this population.MethodsThe systematic review will include original, peer-reviewed research articles published in English or Arabic between 2013 and 2023. It will encompass qualitative, quantitative, and mixed-methods studies focusing on SUDs and/or MHDs among forced migrants from the MENAT region. A Medline (via Ovid) search strategy was developed and will be translated into databases of EMBASE (via Ovid), Web of Science Core Collection (as licensed at Yale), and CINAHL. Risk of Bias in the included studies will be assessed using the Joanna Briggs Institute (JBI) checklist for observational studies and the Cochrane Risk of Bias (ROB) 2 tool for intervention studies. Meta-analysis using random-effects models will be conducted and subgroup analyses based on studies' data will be performed. The systematic review will be conducted based on the framework introduced by the Joanna Briggs Institute. Additionally, the PRISMA-P extension for systematic reviews was used to report the present protocol. The present systematic review protocol has been registered with PROSPERO, an international prospective register of systematic reviews. The review's registration ID is CRD42021286882.DiscussionThe systematic review aims to explore, identify and synthesize the evidence to reveal the epidemiology of SU and/or MH of forced migrants of the MENAT region as described in this protocol. In sum, the review will provide evidence to fill the gap in the literature and help the stakeholders, policymakers, and health providers to expand current knowledge of the prevalence and risk factors of SU and/or MH in humanitarian settings

Association of vital signs and ED treatment of COVID oncology patients with in-hospital mortality.

Association of vital signs and ED treatment of COVID oncology patients with in-hospital mortality.</p