Impact of the COVID-19 Global Pandemic on the Otolaryngology Fellowship Application Process

On March 11, 2020, the World Health Organization declared coronavirus disease 2019 a global pandemic. In addition to massive social disruption, this pandemic affected the traditional fellowship interview season for otolaryngology subspecialties, including head and neck surgical oncology, facial plastic and reconstructive surgery, laryngology, rhinology, neurotology, and pediatric otolaryngology. The impact on the fellowship interview process, from the standpoint of the institution and the applicant, necessitated the use of alternative interview processes. This change may alter the future of how interviews and the match proceed for years to come, with nontraditional methods of interviewing becoming a mainstay. While the impact this pandemic has on the fellowship match process is not yet fully realized, this commentary aims to discuss the challenges faced on both sides of the equation and to offer solutions during these unprecedented times

Tuning Photo-Sensitive Intramolecular Electron Transfers in Rhenium Coordination Compounds

To investigate photo-sensitive intramolecular electron transfers in supramolecular coordination compounds, three covalently linked donor ligand acceptor (CLDA) complexes were proposed with the general formula: [dmbRe(CO)₃-μ-L-μ-Re(CO)₃deb]2+, where L=bpa, t-bpe, and 4,4’-bpy. The donor substituent is a rhenium dimethyl polypyridyl linked through a bridging ligand to an acceptor rhenium diester polypyridyl. These three CLDA complexes were broken into six intermediate complexes, which consisted of the donor or acceptor ligand attached to the rhenium (I) center and one of the four bridging ligands. In the CLDA with L= t-bpe, we observe emission only at 600 nm, from the metal-to-ligand charge transfer (MLCT) band of the acceptor deb ligand regardless of which MLCT band was excited. In the CLDA with L=bpa, a wavelength-depedent luminescence is observed depending on which MLCT band was irradiated. Excitation of the Re (I) to the donor dmb ligand MLCT had an emission at 552 nm, while excitation of the Re (I) to the acceptor deb ligand MLCT had an emission at 600 nm. This suggests a lack of conjugation in the bridging ligand which prevents pure electronic communication across the complex

Tuning the Photo-Sensitive Intramolecular Electron Transfers in a Rhenium Supramolecular Coordination Compound

To investigate photo-sensitive intramolecular electron transfers and spatially large charge-separated states in a supramolecular coordination compound, a covalently linked donor bridge acceptor complex was synthesized with the general formula: [dmbRe(CO)₃-μ-L-Pt(NH₃)₂-μ-L-Re(CO)₃deb]4+, where L=4,4-bpy. The donor substituent is a rhenium dimethyl polypyridyl linked through a square planar Pt(II) moiety to an acceptor rhenium diester polypyridyl. Emission of a photon is observed at 612 nm on the acceptor polypyridyl when the compound is irradiated at 338 nm, the wavelength of excitation from the Re(I) metal to the donor 4,4’-dmbpy ligand. It is hypothesized that this excitation of the metal-to-ligand charge transfer (MLCT) band from the donor Re leads to a Re(II) excited state with the electron in a π* molecular orbital of the donor 4,4’dmbpy ligand. Through a Förster resonance type mechanism due to the length of the molecule, the electron then undergoes a series of energetically downhill intramolecular electron transfers to lead to a spatially large charge-separated state with the electron lying on the diester polypyridyl ligand, the acceptor complex. We theorize that communication occurs from the conjugation in the 4,4’-bpy bridging ligands on either side of the Pt(II) moiety, which allows electrons to transfer from the donor complex to the acceptor complex. To tune these photo-sensitive intramolecular electron transfers, we are adapting the bridging ligand to have 3,3’-dimethyl-4,4’-bipyridine ligands on either side of the Pt(II) moiety. Since the dihedral angle between the two pyridine rings is 81.1°, this non coplanar conformation should slow the electron transfer or inhibit the transfer all together. We are currently working on a proper synthesis for this ligand, which will then allow us to analyze the absorption and fluorescence properties of the molecule

Autophagy and Apoptosis: Current Challenges of Treatment and Drug Resistance in Multiple Myeloma

Over the past two decades, the natural history of multiple myeloma (MM) has evolved dramatically, owing primarily to novel agents targeting MM in the bone marrow microenvironment (BMM) pathways. However, the mechanisms of resistance acquisition remain a mystery and are poorly understood. Autophagy and apoptosis are tightly controlled processes and play a critical role in the cell growth, development, and survival of MM. Genetic instability and abnormalities are two hallmarks of MM. During MM progression, plasma malignant cells become genetically unstable and activate various signaling pathways, resulting in the overexpression of abnormal proteins that disrupt autophagy and apoptosis biological processes. Thus, achieving a better understanding of the autophagy and apoptosis processes and the proteins that crosslinked both pathways, could provide new insights for the MM treatment and improve the development of novel therapeutic strategies to overcome resistance. This review presents a sufficient overview of the roles of autophagy and apoptosis and how they crosslink and control MM progression and drug resistance. Potential combination targeting of both pathways for improving outcomes in MM patients also has been addressed

Risk Factors Associated With Atrial Fibrillation in Elderly Patients.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia with a growing prevalence worldwide, especially in the elderly population. Patients with AF are at higher risk of serious life-threatening events and complications that may lead to long-term sequelae and reduce quality of life. The aim of our study was to examine the association of additional risk factors and comorbid medical conditions with AF in patients 65 years, or older. METHODS: We performed a retrospective electronic medical record review of patients aged 65 years and older, who visited our internal medicine office between July 1, 2020 and June 30, 2021. RESULTS: Among 2,433 patients, 418 patients (17.2%) had AF. Our analysis showed that for each unit increased in age, there was a 4.5% increase in the odds of AF (95% confidence interval (CI) 2.2-6.9%; P \u3c 0.001). Compared to patients of Caucasian descent, African-American patients had significantly decreased odds of AF (odds ratio (OR) 0.274, 95% CI 0.141 - 0.531; P \u3c 0.001). Patients with hypertension had 2.241 greater odds of AF (95% CI 1.421 - 3.534; P = 0.001). Additional comorbidities with significantly greater odds of AF included other cardiac arrhythmias (OR 2.523, 95% CI 1.720 - 3.720; P \u3c 0.001), congestive heart failure (OR 3.111, 95% CI 1.674 - 5.784; P \u3c 0.001), osteoarthritis (OR 3.014, 95% CI 2.138 - 4.247; P \u3c 0.001), liver disease (OR 2.129, 95% CI 1.164 - 3.893; P = 0.014), and colorectal disease (OR 1.500 95% CI 1.003 - 2.243; P = 0.048). Comorbidities with significantly decreased odds of AF included other rheumatological disorder (OR 0.144, 95% CI 0.086 - 0.243; P \u3c 0.001), non-steroidal anti-inflammatory drugs (NSAIDs) use (OR 0.206, 95% CI 0.125 - 0.338; P \u3c 0.001), and corticosteroid use (OR 0.553, 95% CI 0.374 - 0.819; P = 0.003). CONCLUSIONS: Increasing age, hypertension, presence of other cardiac arrhythmias, congestive heart failure, osteoarthritis, liver disease, and colorectal disease are associated with increased odds of having AF

Association of Risk Factors and Comorbidities With Chronic Pain in the Elderly Population

Introduction/Objective: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older. Methods: Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups. Results: Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P  = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P  = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P  < .001), anxiety (27.0% vs 17.1%; P  < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P  = .036), obstructive sleep apnea (16.8% vs 11.6%; P  = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P  < .001), osteoarthritis (49.3% vs 26.1%; P  < .001), other rheumatologic diseases (24.9% vs 19.4%; P  = .006), and peripheral neuropathy (14.4% vs 5.3%; P  < .001). Conclusion: Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder

Comorbidities and Risk Factors Associated With Insomnia in the Elderly Population

Introduction/Objectives: Sleep disorders affect around 50 to 70 million Americans, with chronic insomnia being the most common, especially in the elderly population. With an 11-fold increase in the US office visits due to insomnia, from 0.8 to 9.4 million, between 1993 and 2015, it is imperative to identify the modifiable risk factors. The aim of our study was to examine the association of risk factors and comorbid medical conditions with insomnia in patients 65 years, and older. Methods: We performed a retrospective electronic medical record review of the patients aged 65 years and older, who visited our suburban internal medicine office between July 1, 2020 and June 30, 2021. Patients were divided into insomnia group, and the group without insomnia. The associated variables were compared. Results: Among 2431 patients, 247 patients (10.2%) had insomnia. Mean ages of the patients in the insomnia group and the group without insomnia were comparable (77 ± 8.1 year vs 76 ± 7.5 year; P  = .211). There was a significantly greater frequency of women in the insomnia group compared to the group without insomnia (63.2% vs 55.5%; P  = .022). In the insomnia group, there were significantly higher frequencies of association of certain comorbidities compared to the group without insomnia, such as dementia (6.5% vs 3.4%; P  = .015), depression (30.8% vs 14.9%; P  < 0.001), anxiety disorder (34.4% vs 17.4%; P  < .001), atrial fibrillation (19.4% vs 13.4%; P  = .01), and chronic pain disorders (32.8% vs 18.9%; P  < .001). Logistic regression analysis showed significantly greater odds of insomnia in patients who had depression (OR = 1.860, 95% CI 1.342–2.576; P  < .001), anxiety (OR = 1.845, 95% CI 1.342-2.537; P  < .001), and chronic pain disorders (OR = 1.901, 95% CI 1.417-2.549; P  < .001). Conclusions: Female sex, dementia, depression, anxiety, chronic pain disorders, and atrial fibrillation are associated with insomnia in the elderly patients. Presence of depression, anxiety, and chronic pain disorders are associated with greater odds of having insomnia in the elderly patients