The effect of obesity on venous impedance and outflow measured by ultrasound

Obesity has been identified epidemiologically as a risk factor for development of chronic venous disease. To examine whether abdominal adiposity obstructs venous outflow from the legs, 26 females aged 34-49 years with no clinical venous disease and body mass index (BMI) between 20.9 – 46.7 kg/m$^2$ were studied. A novel measurement of the extent of abdominal fat along the legs when seated correlated well with BMI and other measures of central fat (sagittal-abdominal diameter, ultrasound fat thickness, % truncal fat by DEXA scan). On sitting, inguinal tissue pressure recorded by needle manometry increased more in obese (BMI > 30) than normal weight (BMI 20-25) subjects (8.2 vs 1.5 mmHg, p<0.01) as did the femoral vein cross-sectional area (129 vs 60%, p<0.05). Both measures correlated with increasing abdominal fat but were not associated with each other. In the lower leg, saphenous vein distensibility and compliance correlated positively with abdominal fat and BMI, but there was no such association for the popliteal vein. Female sex hormones, physical activity levels and insulin status did not affect venous haemodynamics. Thus, increased abdominal fat can potentially hinder venous return when sitting, leading to distension and changes in vein biomechanics, which could over time contribute to venous disease

Cryptocurrencies Are Taxable and Not Free From Fraud

In this report, the authors discuss cryptocurrencies — especially bitcoin — and argue that because the IRS lists them as property, they are taxable, and because they are not as anonymous as once thought, they are not free from fraud. Cryptocurrencies are digital assets used as a medium of exchange, but they are not really coins. They can be sent electronically from one entity to another almost anywhere in the world with an internet connection. There are many cryptocurrencies in the market, including bitcoin, ethereum, ethereum classic, litecoin, nem, dash, iota, bitshares, monero, neo, and ripple. Many of the cryptocurrency networks are not controlled by a single entity or company; instead, a decentralized network of computers keeps track of the currency using a token ID. A ledger maintains a continuously growing list of date stamped transactions in real time called “blocks.” This technology is known as blockchain, which records, verifies, and stores transactions without a trusted central authority. The network instead relies on decentralized autonomous organizations (DAOs) with uncertain legal standing

Infectious complications of abortion

This article reviews the infectious complications of abortion (both spontaneous and induced) and the management of this condition. The key points are: (1) Making abortion illegal does not reduce its incidence or prevalence; rather, it only makes abortions unsafe, increasing the likelihood of infectious complications. (2) Timely recognition of developing sepsis in the pregnant patient is critical. This requires constant vigilance and a high index of suspicion. (3) Rapid intravenous administration of broad-spectrum antibiotics targeted to the likely intrauterine source of infection as soon as sepsis is diagnosed is critical to prevent severe sepsis, septic shock, and multisystem organ failure. (4) The mainstay of treatment is prompt evacuation of any residual products of conception from within the uterine cavity under broad-spectrum antibiotic cover targeting the likely intrauterine source of infection. (5) Prompt engagement of specialists in both critical care and obstetrics-gynecology is necessary to optimize outcomes in patients with septic abortion

Impact of a double catastrophe, war and COVID-19, on health service utilization of a tertiary care hospital in Tigray: An interrupted time-series study

BACKGROUND: In developing nations with fragile healthcare systems, the effect of war is likely to be much worse than it would be in more developed countries. The presence of COVID-19 will also likely exacerbate the war\u27s impact. This study set out to determine the effect of armed conflict and the COVID-19 pandemic on health service utilization at Ayder Comprehensive Specialized Hospital, in the Tigray region of Ethiopia. METHODS: An interrupted time-series study design was used to analyze patient visits over forty-eight consecutive months (from July 2017 to June 2021) at inpatient, outpatient, and emergency departments. Data were analyzed using segmented regression analysis with a defined outcome of level and trend changes in the number of patient visits. In addition, negative binomial regression analysis was also used to estimate the impact of both COVID-19 and the war on patient flow. RESULTS: There were 59,935 admissions, 876,533 outpatient visits, and 127,872 emergency room visits. The effect of COVID-19 was seen as soon as the Tigray regional government imposed comprehensive restrictions. Immediately after COVID-19 appeared, all the service areas exhibited a significant monthly drop in visits; [-35.6% (95% CI: -48.2%, -23.1%)] for inpatient, [-60.6% (95% CI: -71.6%, -49.5%)] for outpatient, and [-44.1% (95% CI: -59.5%, -28.7%)] for emergency department visits. The impact of the war became apparent after a lag time of one month. Controlling the effects of time and COVID-19, the war led to a significant fall in inpatient visits [-44.3% (95% CI: -67.2%, -21.5%)], outpatients [-52.1% (95% CI: -82.7%, -21.5%)], and emergency-room attendances [-45.0% (95% CI: -74.8%, -15.2%)]. An upward trend in outpatient flow was observed after the war [1,219.4 (95% CI: 326.1, 2,112.8)]. CONCLUSIONS: The present study has clearly indicated that the war and COVID-19 have led to a large reduction in admissions, outpatient attendance, and emergency department visits. The evidence from this study suggests that due to this double catastrophe, thousands of patients could not gain access to healthcare, with probable negative consequences. Governments and organizations should implement measures to buttress the healthcare system to maintain pre-war status of service

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy\u27s landfall to utilization before the disaster in 2012. RESULTS: In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS: We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks

Foam fractionation for removal of per- and polyfluoroalkyl substances: Towards closing the mass balance

Foam fractionation has recently attracted attention as a low-cost and environmentally benign treatment technology for water contaminated with per- and polyfluoroalkyl substances (PFAS). However, data on the mass balance over the foam fractionation process are scarce and when available, gaps in the mass balance are often identified. This study verified the high treatment efficiency of a pilot-scale foam fractionation system for removal of PFAS from industrial water contaminated with aqueous film-forming foam. ΣPFAS removal reached up to 84 % and the removal of perfluorooctane sulfonic acid (PFOS) up to 97 %, but the short-chain perfluorobutanoic acid (PFBA) was only removed with a mean efficiency of 1.5 %. In general, mobile short-chain PFAS were removed less efficiently when the perfluorocarbon chain length was below six for carboxylic acids and below five for sulfonic acids. Fluctuations in treatment efficiency due to natural variations in the chemistry of the influent water were minor, confirming the robustness of the technology, but significant positive correlations between PFAS removal and influent metal concentration and conductivity were observed. Over all experiments, the mass balance closure did not differ significantly from 100 %. Nonetheless, PFAS sorption to the walls of the reactor was measured, as well as high PFAS emissions by the air exiting the reactor. PFAS emissions in aerosols correlated positively with mass balance closure. The elevated aerial PFAS concentrations measured in the experimental facility have implications for worker safety and prevention of PFAS-emissions to the atmosphere, and demonstrate the importance of installing appropriate filters on the air outlet of foam fractionation systems

Dialysis service in the embattled Tigray region of Ethiopia: A call to action

Haemodialysis is extremely limited in low-income countries. Access to haemodialysis is further curtailed in areas of active conflict and political instability. Haemodialysis in the Tigray region of Ethiopia has been dramatically affected by the ongoing civil war. Rapid assessment from the data available at Ayder Hospital\u27s haemodialysis unit registry, 2015-2021, shows that enrollment of patients in the haemodialysis service has plummeted since the war broke out. Patient flow has decreased by 37.3% from the previous yearly average. This is in contrary to the assumption that enrollment would increase because patients could not travel to haemodialysis services in the rest of the country due to the complete blockade. Compared to the prewar period, the mortality rate has doubled in the first year after the war broke out, i.e., 28 deaths out of 110 haemodialysis recipients in 2020 vs. 43 deaths out of 81 haemodialysis recipients in the year 2021. These untoward outcomes reflect the persistent interruption of haemodialysis supplies, lack of transportation to the hospital, lack of financial resources, and the unavailability of basic medications due to the war and the ongoing economic and humanitarian blockade of Tigray in Northern Ethiopia. In the setting of this medical catastrophe, the international community should mobilize to advocate for resumption of life-saving haemodialysis treatment in Ethiopia\u27s Tigray region and put pressure on the Ethiopian government to allow the passage of life-saving medicines, essential medical equipment, and consumables for haemodialysis into Tigray

Muscle-derived precursor cells isolated on the basis of differential adhesion properties respond differently to capillary flow

Capillary shear stress can improve osteogenic differentiation in muscle-derived precursor cells (MDPCs). This has implications for large-scale bioprocessing of cell therapies where capillary transfer is needed. The recovery, viability, and osteogenic differentiation potential of two subsets of MDPCs, early-adherent pre-plate 1 (PP1) and late-adherent PP3 populations, have been examined: PP1 MDPCs produced a greater degree of osteogenic differentiation than PP3 MDPCs, quantified by Alizarin Red S staining intensity (P < 0.05). For both cell populations, capillary flow-induced significant increases in Alizarin Red S staining (P < 0.05). However, PP1 cells were more susceptible to capillary flow-induced damage than PP3 cells and this was dependent on duration of exposure. Overall, results indicate that different cell subsets, even from within a single tissue, can respond variably to capillary shear stress, necessitating its precise monitoring and control

Impact of mechanical stretch on the cell behaviors of bone and surrounding tissues

Mechanical loading is recognized to play an important role in regulating the behaviors of cells in bone and surrounding tissues in vivo. Many in vitro studies have been conducted to determine the effects of mechanical loading on individual cell types of the tissues. In this review, we focus specifically on the use of the Flexercell system as a tool for studying cellular responses to mechanical stretch. We assess the literature describing the impact of mechanical stretch on different cell types from bone, muscle, tendon, ligament, and cartilage, describing individual cell phenotype responses. In addition, we review evidence regarding the mechanotransduction pathways that are activated to potentiate these phenotype responses in different cell populations