Towards Standardized, Safe and Efficacious Screening Approaches to Patients with Lower Extremity Peripheral Arterial Disease in the setting of Lower Extremity Arthroplasty

INTRODUCTION: Peripheral arterial disease (PAD) impedes recovery from lower extremity arthroplasties (LEA) and increases risk of complications/mortality, yet there aren’t standards for screening PAD patients pre-LEA. This review proposes some. METHODS: This review searched databases for articles containing relevant terms. Non-English articles, those unrelated to LEA, and duplicates were excluded. Articles were cross-referenced to find other relevant papers for a total of 111. RESULTS: Up to 49.2% of PAD patients have CAD. Wagner grade III/IV ulcers increase amputations and decrease wound closures. The Wound, Ischemia, and Foot Infection (WIfI) system provides more accurate, and therefore actionable, assessment. Overlooking PAD in surgery patients is linked to sequelae from tourniquets. Arterial calcification increases risk of perioperative blood loss from vascular compression, anemia, and critical limb ischemia. Compounding risk factors for PAD (diabetes, smoking, etc.) increase likelihood of future PAD diagnosis. If SBP\u3e180 or DBP\u3e110 mmHg, forgo elective surgery. Non-cardiac surgery patients with hypertension should receive a beta-blocker one day pre-surgery and perioperatively. Smoking cessation four weeks preoperatively and abstinence four weeks postoperatively may halve wound complications. Absent/asymmetrical pulses should prompt vascular referral pre-LEA. ABI may be falsely normal in asymptomatics with moderate aortoiliac stenosis. Risk of hematoma formation and LEA infection suggests waiting one year while continuing antiplatelet therapy. DISCUSSION/CONCLUSIONS: Adequate blood flow is imperative peri- and postoperatively for optimal healing from LEA. Before orthopedic surgery, we suggest meticulous history and assessment to identify PAD risk factors and determine tolerance for surgical intervention. Patients should be stratified for amputation risk and revascularization benefit using the WIfI system. ABI should be performed to assess severity of vascular stenosis. Patients \u3c0.9 should receive vascular consultation, then reassessment. These recommendations could help clinicians assign vascular intervention pre-LEA, minimize complications/reoperations, truncate spending, and improve patient satisfaction/well-being

The Effects of Different Antihypertensives, Steroids, and Beta Blockers on COVID-19 Outcomes in a CKD and Non-CKD Cohort in Detroit, Michigan

Initial studies during the COVID-19 pandemic reported angiotensin converting enzyme 2 inhibitors (ACE2i) could be associated with worse disease course due to potential increase in ACE2 receptors which SARS-CoV2 virus uses for cellular entry. Subsequent studies refuted such concerns, reporting that continued use of ACEis and angiotensin receptor blockers (ARBs) in hypertensive individuals is protective. However, there remains a paucity of data evaluating effects of various antihypertensive medications, steroids, and beta blockers in chronic kidney disease (CKD) populations and in individuals with normal kidney function. This study was designed to evaluate the potential risks associated with antihypertensive medications and COVID-19 outcomes in a cohort of mostly Black and Caucasian patients admitted to the Detroit Medical Center for COVID-19. We collected data from 330 patients using inclusion criteria of age \u3e 18 years and a positive SARS-CoV2 PCR test. We used the mean, standard deviation/standard error of mean, and percentages when appropriate for the description of patient characteristics. Group differences (CKD vs. non-CKD) were compared using the Pearson χ2 test. P-values of \u3c0.05 were regarded as significant. On regression analyses, the odds of death during hospitalization for COVID-19 infection was not significantly associated with either biological sex, race, or CKD status in our sample population. The odds of dying in the hospital were higher in patients who were on calcium channel blockers (OR 2.99, 95% CI 1.29-6.93) and steroids (OR 4.23, 95% CI 1.17-15.31). The only significance for ICU admission was obtained for steroid use (OR 1.872, 95% CI 1.059-3.311)

Wealth Essentialism in Adults and Children

Psychological essentialism is the idea that certain categories, such as male" or "wealthy," are defined by underlying, innate, and non-obvious features. In other words, essentialist reasoning posits that someone is born with a particular quality, that they will always possess the quality, and that it may be used to categorize the individual. Our study will focus on wealth, specifically the qualities of richness and poorness, and assess the degree to which adults and children alike think about these characteristics. Being able to reliably essentialize certain qualities may be helpful in constructing categories and predicting characteristics of novel concepts or objects. That said, essentialist reasoning about people may be conducive to harmful stereotypes and premature judgments. Understanding how we categorize others could one day reduce the harm inflicted by negative stereotypes and encourage a more inclusive society. The adult portion of the present study is unique in that we will be testing for possible relationships between essentialism scores, socioeconomic status, and political affiliation. This is a multidisciplinary project which incorporates concepts from a variety of fields.LSA Honorshttps://deepblue.lib.umich.edu/bitstream/2027.42/148868/1/Khoury.ppt

Characteristics and distribution of obesity in the Arab-American population of southeastern Michigan

Abstract Background Arab-Americans constitute ~ 5% of Michigan’s population. Estimates of obesity in Arab-Americans are not up-to-date. We aim to describe the distribution of and factors associated with obesity in an Arab-American population in Southeastern Michigan (SE MI). Methods Retrospective medical record review identified n = 2363 Arab-American patients seeking care at an Arab-American serving clinic in SE MI, located in a city which is home to a large proportion of Arab-Americans in the United States (US). Body mass index (BMI) was the primary outcome of interest. Distribution of BMI was described using percentages, and logistic regression models were constructed to examine the association between obesity, other comorbid conditions and health behaviors. This cohort was compared to Michigan’s Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 (n = 9589) and to a cohort seeking care between 2013 and 2019 from a free clinic (FC) located in another city in SE MI (n = 1033). Results Of the 2363 Arab-American patients, those who were older or with HTN, DM or HLD had a higher prevalence of obesity than patients who were younger or without these comorbidities (all p-value < 0.001). Patients with HTN were 3 times as likely to be obese than those without HTN (95% CI: 2.41–3.93; p < 0.001). Similarly, the odds of being obese were 2.5 times higher if the patient was diabetic (95% CI: 1.92–3.16; p < 0.001) and 2.2 times higher if the patient had HLD (95% CI: 1.75–2.83; p < 0.001). There was no significant difference in obesity rates between Arab-Americans (31%) and the BRFSS population (32.6%). Compared to Arab-Americans, patients seen at the FC had a higher obesity rate (52.6%; p < 0.001) as well as significantly higher rates of HTN, DM and HLD (all p < 0.001). Conclusion Overall obesity rates in Arab-Americans were comparable to the population-based BRFSS rates, and lower than the patients seen at the FC. Further studies are required to understand the impact of obesity and the association of comorbidities in Arab-Americans.http://deepblue.lib.umich.edu/bitstream/2027.42/173488/1/12889_2020_Article_9782.pd