Hepatic encephalopathy complicated by decompensated alcoholic liver cirrhosis in a Hispanic male

Introduction: Alcohol can directly affect the brain via neuroinflammation or alter the gut microbiome which concomitantly results in hepatic encephalopathy. Hepatic encephalopathy can cause altered mental status from liver dysfunction with or without portal-systemic blood shunting. Chronic alcohol use has been associated with dementia, cirrhosis, and hepatic encephalopathy. This case report highlights the prognosis of hepatic encephalopathy in the setting of decompensated liver cirrhosis complicated by acute alcohol intoxication. Case report: A 35-year-old Hispanic man with history of alcohol use disorder, decompensated alcoholic liver cirrhosis with ascites, severe anemia secondary to upper GI bleeding with underlying esophageal varices who was accompanied to the ED via EMS after being found obtunded and nonresponsive on the floor. Upon arrival to ED, ethanol level was 178. The patient was intubated for airway protection due to two episodes of large volume hematemesis. Two units of PRBCs were ordered and an upper EGD showed two nonbleeding varices which were banded; however, the source of bleeding was not confirmed or arrested. The patient’s ICU course included eleven units of PRBCs, two units of cryoprecipitate and ten units of fresh frozen plasma. Despite emergent dialysis and intensive care interventions, the patient has not been able to be extubated despite being off sedation and paralytics. Conclusion: Alcohol can directly affect the brain via neuroinflammation or alter the gut microbiome which concomitantly results in hepatic encephalopathy. In patients with acute alcohol intoxication, prompt assessment of ammonia levels and gastroenterology recommendations are warranted to improve patient outcome

Assessing function and endurance in adults with spinal and bulbar muscular atrophy: validity of the adult myopathy assessment tool.

Purpose. The adult myopathy assessment tool (AMAT) is a performance-based battery comprised of functional and endurance subscales that can be completed in approximately 30 minutes without the use of specialized equipment. The purpose of this study was to determine the construct validity and internal consistency of the AMAT with a sample of adults with spinal and bulbar muscular atrophy (SBMA). Methods. AMAT validity was assessed in 56-male participants with genetically confirmed SBMA (mean age, 53 ± 10 years). The participants completed the AMAT and assessments for disease status, strength, and functional status. Results. Lower AMAT scores were associated with longer disease duration (r = -0.29; P \u3c 0.03) and lower serum androgen levels (r = 0.49-0.59; P \u3c 0.001). The AMAT was significantly correlated with strength and functional status (r = 0.82-0.88; P \u3c 0.001). The domains of the AMAT exhibited good internal consistency (Cronbach\u27s α  = 0.77-0.89; P \u3c 0.001). Conclusions. The AMAT is a standardized, performance-based tool that may be used to assess functional limitations and muscle endurance. The AMAT has good internal consistency, and the construct validity of the AMAT is supported by its significant associations with hormonal, strength, and functional characteristics of adults with SBMA. This trial is registered with Clinicaltrials.gov identifier NCT00303446

Small area analysis methods in an area of limited mapping : exploratory geospatial analysis of firearm injuries in Port-au-Prince, Haiti

Background: The city of Port-au-Prince, Haiti, is experiencing an epidemic of firearm injuries which has resulted in high burdens of morbidity and mortality. Despite this, little scientific literature exists on the topic. Geospatial research could inform stakeholders and aid in the response to the current firearm injury epidemic. However, traditional small-area geospatial methods are difficult to implement in Port-au-Prince, as the area has limited mapping penetration. Objectives of this study were to evaluate the feasibility of geospatial analysis in Port-au-Prince, to seek to understand specific limitations to geospatial research in this context, and to explore the geospatial epidemiology of firearm injuries in patients presenting to the largest public hospital in Port-au-Prince. Results: To overcome limited mapping penetration, multiple data sources were combined. Boundaries of informally developed neighborhoods were estimated from the crowd-sourced platform OpenStreetMap using Thiessen polygons. Population counts were obtained from previously published satellite-derived estimates and aggregated to the neighborhood level. Cases of firearm injuries presenting to the largest public hospital in Port-au-Prince from November 22nd, 2019, through December 31st, 2020, were geocoded and aggregated to the neighborhood level. Cluster analysis was performed using Global Moran’s I testing, local Moran’s I testing, and the SaTScan software. Results demonstrated significant geospatial autocorrelation in the risk of firearm injury within the city. Cluster analysis identified areas of the city with the highest burden of firearm injuries. Conclusions: By utilizing novel methodology in neighborhood estimation and combining multiple data sources, geospatial research was able to be conducted in Port-au-Prince. Geospatial clusters of firearm injuries were identified, and neighborhood level relative-risk estimates were obtained. While access to neighborhoods experiencing the largest burden of firearm injuries remains restricted, these geospatial methods could continue to inform stakeholder response to the growing burden of firearm injuries in Port-au-Prince

Clinical features of spinal and bulbar muscular atrophy

Spinal and bulbar muscular atrophy is an X-linked motor neuron disease caused by a CAG repeat expansion in the androgen receptor gene. To characterize the natural history and define outcome measures for clinical trials, we assessed the clinical history, laboratory findings and muscle strength and function in 57 patients with genetically confirmed disease. We also administered self-assessment questionnaires for activities of daily living, quality of life and erectile function. We found an average delay of over 5 years from onset of weakness to diagnosis. Muscle strength and function correlated directly with serum testosterone levels and inversely with CAG repeat length, age and duration of weakness. Motor unit number estimation was decreased by about half compared to healthy controls. Sensory nerve action potentials were reduced in nearly all subjects. Quantitative muscle assessment and timed 2 min walk may be useful as meaningful indicators of disease status. The direct correlation of testosterone levels with muscle strength indicates that androgens may have a positive effect on muscle function in spinal and bulbar muscular atrophy patients, in addition to the toxic effects described in animal models

Virologic and immunologic outcomes in HIV-infected Cambodian children after 18 months of highly active antiretroviral therapy (HAART)

This observational cohort study was conducted among HIV-infected, antiretroviral therapy (ART) naive children in Phnom Penh, Cambodia, to evaluate the feasibility and efficacy of highly active antiretroviral therapy (HAART) delivered using a modified directly observed therapy (MDOT) protocol. From August 2004 to March 2006, 26 children were enrolled and started on a first-line HAART regimen, which was continued for 18 months. The study included a directly observed therapy phase (months 1-3) and a medication self-administration phase (months 4-18). CD4 percentage (CD4%) and HIV-1 RNA plasma viral load (PVL) were measured at baseline and at months 6, 12, and 18. At baseline, the median age was 5.5 years (range: 13 months-12 years), the median CD4% was 4, and the median PVL was 7.5x10(5) copies/ml. At 18 months, 23 (88%) children were alive and participating in the study. Of these children, 20 (87%) had a PVL /ml and 12 (52%) had PVL \u3c 50 copies/ml. The median CD4% increased to 23, while the median change in height-for-weight z-score was 0.64. Genotypic resistance typing in 2 children with PVL \u3e 400 copies/ml at 18 months demonstrated mutations associated with resistance to lamivudine (M184V) and non-nucleoside reverse transcriptase inhibitors (Y181C and G190A). The virologic and immunologic outcomes achieved in this study compare favorably with those reported by other pediatric HIV treatment programs worldwide. The study results suggest that MDOT may be effective for HAART administration in limited-resource settings like Cambodia

sj-docx-2-hss-10.1177_15563316231199493 – Supplemental material for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis

Supplemental material, sj-docx-2-hss-10.1177_15563316231199493 for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis by Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane and Troy B. Amen in HSS Journal®</p

sj-docx-1-hss-10.1177_15563316231199493 – Supplemental material for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis

Supplemental material, sj-docx-1-hss-10.1177_15563316231199493 for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis by Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane and Troy B. Amen in HSS Journal®</p

sj-jpg-3-hss-10.1177_15563316231199493 – Supplemental material for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis

Supplemental material, sj-jpg-3-hss-10.1177_15563316231199493 for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis by Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane and Troy B. Amen in HSS Journal®</p

sj-docx-4-hss-10.1177_15563316231199493 – Supplemental material for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis

Supplemental material, sj-docx-4-hss-10.1177_15563316231199493 for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis by Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane and Troy B. Amen in HSS Journal®</p

sj-pdf-5-hss-10.1177_15563316231199493 – Supplemental material for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis

Supplemental material, sj-pdf-5-hss-10.1177_15563316231199493 for Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis by Samuel S. Rudisill, Alexander L. Hornung, Nathan H. Varady, Christian A. Pean, Joseph M. Lane and Troy B. Amen in HSS Journal®</p