Peritonitis in Peritoneal Dialysis

Peritoneal dialysis (PD) involves solute and water transport across a semipermeable membrane that separates fluid compartments. Peritonitis is a serious complication of peritoneal dialysis that results in considerable morbidity and health care costs. It also significantly distorts the normal anatomy of the peritoneal membrane causing transient and long-term adverse events. Bacterial as well as fungal organisms can cause peritonitis and sometimes cultures can be negative. As much as 5–16% of deaths occur in PD even though the rate of infections has been in decline in last few years. Below we will be reviewing risk factors, host’s immune defenses, prevention, diagnosis and evidence-based treatment, types of peritonitis with a role of prophylactic antibiotics for PD peritonitis

Survival rate in acute kidney injury superimposed COVID-19 patients: a systematic review and meta-analysis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155406/1/Yessayan_Survival_Rate.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155406/4/COVID YESSAYAN DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID.docxDescription of Yessayan_Survival_Rate.pdf : ArticleDescription of COVID YESSAYAN DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID.docx : Deep Blue Sharing Agreemen

COVID-19 disparity among racial and ethnic minorities in the US: A cross sectional analysis

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Aim To analyze racial disparities in Coronavirus disease (COVID-19) cases in the United States of America and discuss possible reasons behind this inequality. Subject and methods We obtained estimated case counts of African-American, Caucasian, Native American, Asian and Hispanic individuals with coronavirus disease (COVID-19)infection through May 5, 2020, from publicly available data on state departments of health websites. We calculated race-specific fractions as the percentage of the total population and analyzed the reasons behind this disparity. Results The incident rates of COVID-19 were higher among African Americans and among Latinos disproportionately higher than their representation in 14 states and 9 states, respectively. A similar observation was also reported for New York city. The percentage of deaths reported among African Americans was disproportionately higher than their represented share in the population in 23 out of 35 states. It was reported that 22.4% of COVID-19 deaths in the USA were African American, even though black people make up 13.4% of the USA population. Conclusions The analysis shows the disparity of coronavirus disease outcomes by ethnicity and race. Additional research is needed to determine the factors behind this inequality

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Era of hospitalists

Hospitalists, known as physicians, are an emerging group in the medical field that is focused on the general medical care of hospitalized patients. Specializing in hospital medicine, they often attract a mix of appreciation and criticism. In the present manuscript, we review the pros and cons of a hospitalist in the health-care system. Although experts agree that hospitalists add value to the health-care system by reducing costs, streamlining administrative processes, and contributing to improved health-care outcomes, there is a large degree of disagreement regarding the extent of hospitalist contribution to overall improvements on health-care outcomes. In this paper, new strategies to overcome reported shortcomings and to further improve the quality of health care are discussed. Abbreviations: SHM: Society of Hospital Medicine; BOOST: Better Outcomes by Optimizing Safe Transitions; RED: Re-Engineered Discharge; CHF: chronic heart failure; MI: myocardial infarction; ICU: intensive care unit; PACT: post-acute care transitions; MRSA: methicillin-resistant Staphylococcus aureus; CINAHL: The Cumulative Index to Nursing and Allied Health Literature; PCP: primary care physician

The role of Malaysian university-of-the-future (uotf) in the digital era: international community engagement for improving the wellbeing of youth in India

A humanized education depends on the teaching of educators to impact, navigate and co-occur within the sociocultural environment and implementation of educators, leaders, students, administration, and community members. Creating beliefs and practices around a humanizing education focuses on the cultural and contextual realisms and understandings of the learner. The motivation of this paper was to scout how educators inspire academic change towards a humanizing education and increase employability opportunities for the youth. Educational atmosphere and teaching methods using digital advancements of IR4.0 are explored in this paper as impacts on the elements for humanizing education. Employability is also a major problem to be resolved for the youth in contemplation on an industrial and economical level. Youth have experienced various scenarios of skills mismatch upon trying to be employed in the current industry. The design and system thinking approach has been adapted in this paper to address the wellbeing issues and promote employability skills trainings for the unemployed youth in India through understanding their need, and then followed by building conceptual business models using modelling tools, i.e. Business model canvas (BMC) and Value proposition design canvas (VPC). The approach includes conducting literature review and interviews for understanding the needs, challenges and key problems; formulating and ideating initial business model options in solving the problems; and validation of the initial business model by interviewing the various customer segments. This paper offers validated conceptual UotF business model with focus on international community engagement for a Malaysian-based UotF. The value proposition of the conceptual business model is to enhance the wellbeing of the youth in India through humanizing educational activities by harnessing the digital possibilities in today’s world. This paper also aspires to contemplate the contribution of higher education institutions, in accomplishing the Sustainable Development Goals (SDGs) through employability and digital entrepreneurship skill sets that are essential for a graduate

Non-ST elevation myocardial infarction secondary to carbon monoxide intoxication

Carbon monoxide poisoning has been documented in literature to cause severe neurological and tissue toxicity within the body. However, cardiotoxicity is often overlooked, but not uncommon. Previous research studies and case reports have revealed a significant relationship between carbon monoxide intoxication and myocardial ischemic events. We report a case of a 48-year-old male, who was exposed to severe smoke inhalation due to a house fire and subsequently developed a non-ST elevation myocardial infarction. Ischemic changes were evident on electrocardiogram, which demonstrated T-wave inversion in lead III and ST-segment depression in leads V4-V6. Elevated cardiac enzymes were also present. After standard treatment for an acute cardiac event, the patient fully recovered. This case demonstrates that myocardial ischemic changes due to carbon monoxide poisoning may be reversible if recognized in early stages and treated appropriately, thus reminding physicians that a proper cardiovascular examination and diagnostic testing should be performed on all patients with carbon monoxide poisoning. Abbreviations: NSTEMI: Non-ST elevation myocardial infarctio

Crowd detection and tracking in surveillance video sequences

The importance for video-based monitoring systems is on the rise leading to the growth of interest in the field of computer vision. With the increase of human population, crowd needs to be monitored, be it in a public place or in a building. Human monitoring can be quite tiresome and expensive, making way for the upcoming of automated crowd monitoring systems. Crowd analysis comprises of detection, tracking, behavioral analysis, etc. In this paper a framework for the detection of crowd, tracking and counting is proposed. The goal is to create a robust system with utmost accuracy in its results. Contrasted with sensor-based arrangements and humanbased, the video-based ones take into account more adaptable functionalities, enhanced execution with lower costs. In this work, the dataset PETS2009 was used. The results showed that the proposed system has the capability to count all the people passing through the field of view of the surveillance camera. The system was tested for different types of crowd and the average efficiency of various scenarios is 83.14%

Severe Hyperthyroidism Complicated by Agranulocytosis Treated with Therapeutic Plasma Exchange: Case Report and Review of the Literature

Aim. To present a case of Graves’ disease complicated by methimazole induced agranulocytosis treated with therapeutic plasma exchange (TPE) and review of the literature. Case Presentation. A 21-year-old patient with a history of Graves’ disease presented to the endocrine clinic. His history was significant for heat intolerance, weight loss, and tremors. Upon examination he had tachycardia, smooth goiter, thyroid bruit, and hyperactive reflexes. He was started on methimazole and metoprolol and thyroidectomy was to be done once his thyroid function tests normalized. On follow-up, the patient symptoms persisted. Complete blood count done showed a white blood cell count of 2100 (4000–11,000 cells/cu mm) with a neutrophil count of 400 cells/cu mm, consistent with neutropenia. He was admitted to the hospital and underwent 3 cycles of TPE and was also given filgrastim. He improved clinically and his thyroxine (T4) levels also came down. Thyroidectomy was done. He was discharged on levothyroxine for postsurgical hypothyroidism. Conclusion. Plasmapheresis may be useful in the treatment of hyperthyroidism. It works by removing protein bound hormones and also possibly inflammatory cytokines. Further studies are needed to clarify the role of various modalities of TPE in the treatment of hyperthyroidism

Impact of hospitalists on the efficiency of inpatient care and patient satisfaction: a systematic review and meta-analysis

Background: Over the past 20 years, hospitalists have assumed a greater portion of healthcare service for hospitalized patients. This was mainly due to reducing the length of stay (LOS) and hospital costs shown by many studies. In contrast, other studies suggested increased cost and resources utilization associated with hospitalist-run care models. Aim: We aimed to provide class 1 evidence regarding the effect of hospitalist-run care models on the efficiency of care and patient satisfaction. Design: Meta-analysis. Methods: Four electronic medical databases were searched to retrieve all relevant studies. Two authors screened titles and abstracts of search results for eligibility according to predefined criteria. Initially eligible studies were screened for full text inclusion. Included studies were reviewed for data on LOS, hospital cost, readmission, mortality, and patient satisfaction. Available data were abstracted and analyzed using Comprehensive Meta-Analysis. Results: Sixty-one studies were included for analysis. The overall effect size favored hospitalist-run care models in terms of LOS (MD = −0.67 day, 95% CI [−0.78, −0.56], p < 0.001). There was no significant difference in terms of hospital cost (MD = $92.1, 95% CI [−910.4, 1094.6], p = 0.86) whereas patient satisfaction was similar or even better in hospitalist compared to non-hospitalist (NH) service. Conclusion: Our analysis showed that hospitalist care is associated with decreased LOS and increased patient satisfaction compared to NH. This indicates an increase in the efficiency of care that does not come at the expense of care quality