Diabetes Mellitus como factor de riesgo para síndrome de manguito rotador en pacientes atendidos en el Hospital I La Esperanza EsSalud.

Determinar si la diabetes mellitus es un factor de riesgo para el desarrollo de síndrome de manguito rotador. Material y métodos: Se realizó un estudio retrospectivo de casos y controles sobre una población de 160 pacientes de consultorios externos de Medicina Física y Rehabilitación del Hospital I La Esperanza EsSalud. Se incluyeron en el grupo de casos a quienes tengan un diagnostico imagenológico confirmado de síndrome de manguito rotador, contemplando tendinopatías o desgarros de los tendones del mismo. Se recolectaron datos de diagnóstico de diabetes mellitus, niveles de glicemia, colesterol, triglicéridos y diagnostico de hipertensión arterial. Resultados: El diagnóstico de diabetes mellitus estuvo presente en el 80% y 45% de pacientes con y sin síndrome de manguito rotador respectivamente con un OR de 4.89 (IC 95% 2.42 – 9.87), la hipercolesterolemia estuvo presente en un 65% y 40% de pacientes con y sin síndrome de manguito rotador respectivamente con un OR de 2.79 (IC 95% 1.47 – 5.29), la hipertrigliceridemia estuvo presente en un 51.3% y 33.8% de pacientes con y sin síndrome de manguito rotador respectivamente con un OR de 2.06 (IC 95% 1.09 – 3.91) y la hipertensión arterial estuvo presente en un 35% y 16.3% de pacientes con y sin síndrome de manguito rotador respectivamente con un OR de 2.78 IC (95% 1.31 – 5.88); todos con significancia estadística (p<0.05). Conclusión: La diabetes mellitus, hipercolesterolemia, hipertrigliceridemia e hipertensión arterial se posicionaron como factores de riesgo para síndrome de manguito rotador. Nivel de evidencia: 2+To determine if diabetes mellitus is a risk factor for the development of rotator cuff syndrome. Material and methods: A retrospective case-control study was carried out on a population of 160 patients from physical medicine and rehabilitation outpatient clinics at Hospital I La Esperanza EsSalud. Those who will have a confirmed imaging diagnosis of rotator cuff syndrome were included in the group of cases, contemplating tendinopathies or tears of the tendons of the same. Diagnosis data of diabetes mellitus, blood glucose levels, cholesterol, triglycerides and diagnosis of arterial hypertension were collected. Results: The diagnosis of diabetes mellitus was present in 80% and 45% of patients with and without rotator cuff syndrome respectively with an OR of 4.89 (95% CI 2.42 - 9.87), hypercholesterolemia was present in 65% and 40 % of patients with and without rotator cuff syndrome respectively with an OR of 2.79 (95% CI 1.47 – 5.29), hypertriglyceridemia was present in 51.3% and 33.8% of patients with and without rotator cuff syndrome respectively with an OR of 2.06 (95% CI 1.09 - 3.91) and arterial hypertension was present in 35% and 16.3% of patients with and without rotator cuff syndrome respectively with an OR of 2.78 CI (95% 1.31 – 5.88); all with statistical significance (p<0.05). Conclusion: Diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and arterial hypertension were positioned as risk factors for rotator cuff syndrome Level of evidence : 2+.Tesi

Being More Realistic about the Public Health Impact of Genomic Medicine

Wayne Hall and colleagues discuss the limitations of genomic risk prediction for population-level preventive health care

A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa

Background: Diabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. The aim of this study was to explore patients’ current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change. Methods: The study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status. Results: The concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients’ perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings of this study indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients’ motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care. Conclusions: In accordance with other similar studies, most of the hypertensive and diabetic patients interviewed for this study were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers. In order to enable healthcare providers in South Africa to adopt a more patient-centred approach and to better assist and motivate patients to become effective partners in their care, training, resources and tools are needed. In addition, providers need to be supported by policy and organisational change

The Crossroads of Interprofessionalism: Four Avenues of Collaboration at the Wegmans School of Pharmacy

Objective: The utilization of interprofessional education and collaborative practice delivers optimal health services and improves patient outcomes. Training future healthcare providers in an integrated environment promotes a “collaborative practice-ready” workforce. The aim of this study was to identify ongoing specific interprofessional collaborative projects and promote their awareness among faculty at the St. John Fisher College Wegmans School of Pharmacy. Methods: Faculty members were surveyed to identify the ongoing interprofessional collaborative initiatives among pharmacy faculty. Results: A total of four collaborative practices were identified among faculty: ambulatory care, assisted-living, didactic, and assessment. The ambulatory care setting at an osteoporosis clinic provides patient-centered care with a clinical component. Each patient with a new diagnosis or change in medication therapy receives education/counseling from a pharmacist, a registered nurse for medication administration and a physician for a physical exam. In the assisted-living setting, pharmacy and nursing students are paired to conduct a high-level health assessment in their respective disciplines. Didactic interprofessional efforts are being conducted to create a flexible and comprehensive pain education curriculum. Physicians, dentists, nurses, pharmacists, psychologists, chiropractors, and oriental medicine practitioners will develop the curriculum. The pain module will be adaptable for interprofessional education activities. Finally, recognizing the similarities in accreditation standards for communication and professionalism, the School of Pharmacy and the NY Chiropractic School are sharing strategies and rubrics for assessing these outcomes. Implications: The survey revealed a broader range of interprofessional collaborations than was originally suspected. The school will continue to foster and support interprofessional education and collaborative practice

Elevating Voices, Addressing Depression, Toxic Stress, and Equity through Group Prenatal Care: A pilot study

INTRODUCTION: Elevating Voices, Addressing Depression, Toxic Stress and Equity (EleVATE) is a group prenatal care (GC) model designed to improve pregnancy outcomes and promote health equity for Black birthing people. This article outlines the foundational community-engaged process to develop EleVATE GC and pilot study results. METHODS: We used community-based participatory research principles and the Ferguson Commission Report to guide creation of EleVATE GC. The intervention, designed by and for Black birthing people, centers trauma-informed care, antiracism, and integrates behavioral health strategies into group prenatal care to address unmet mental health needs. Using a convenience sample of patients seeking care at one of three safety-net health care sites, we compared preterm birth, small for gestational age, depression scores, and other pregnancy outcomes between patients in individual care (IC), CenteringPregnancy™ (CP), and EleVATE GC. RESULTS: Forty-eight patients enrolled in the study ( DISCUSSION: Our findings model a systematic approach to design a feasible, patient-centered, community-based, trauma-informed, antiracist intervention. Further study is needed to determine whether EleVATE GC improves perinatal outcomes and promotes health equity

LMNA variants cause cytoplasmic distribution of nuclear pore proteins in Drosophila and human muscle

Mutations in the human LMNA gene, encoding A-type lamins, give rise to laminopathies, which include several types of muscular dystrophy. Here, heterozygous sequence variants in LMNA, which result in single amino-acid substitutions, were identified in patients exhibiting muscle weakness. To assess whether the substitutions altered lamin function, we performed in vivo analyses using a Drosophila model. Stocks were generated that expressed mutant forms of the Drosophila A-type lamin modeled after each variant. Larvae were used for motility assays and histochemical staining of the body-wall muscle. In parallel, immunohistochemical analyses were performed on human muscle biopsy samples from the patients. In control flies, muscle-specific expression of the wild-type A-type lamin had no apparent affect. In contrast, expression of the mutant A-type lamins caused dominant larval muscle defects and semi-lethality at the pupal stage. Histochemical staining of larval body wall muscle revealed that the mutant A-type lamin, B-type lamins, the Sad1p, UNC-84 domain protein Klaroid and nuclear pore complex proteins were mislocalized to the cytoplasm. In addition, cytoplasmic actin filaments were disorganized, suggesting links between the nuclear lamina and the cytoskeleton were disrupted. Muscle biopsies from the patients showed dystrophic histopathology and architectural abnormalities similar to the Drosophila larvae, including cytoplasmic distribution of nuclear envelope proteins. These data provide evidence that the Drosophila model can be used to assess the function of novel LMNA mutations and support the idea that loss of cellular compartmentalization of nuclear proteins contributes to muscle disease pathogenesis

Novel pathogenic COX20 variants causing dysarthria, ataxia, and sensory neuropathy.

COX20/FAM36A encodes a mitochondrial complex IV assembly factor important for COX2 activation. Only one homozygous COX20 missense mutation has been previously described in two separate consanguineous families. We report four subjects with features that include childhood hypotonia, areflexia, ataxia, dysarthria, dystonia, and sensory neuropathy. Exome sequencing in all four subjects identified the same novel COX20 variants. One variant affected the splice donor site of intron-one (c.41A&gt;G), while the other variant (c.157+3G&gt;C) affected the splice donor site of intron-two. cDNA and protein analysis indicated that no full-length cDNA or protein was generated. These subjects expand the phenotype associated with COX20 deficiency

A population of red candidate massive galaxies ~600 Myr after the Big Bang

Galaxies with stellar masses as high as roughly 1011 solar masses have been identified1,2,3 out to redshifts z of roughly 6, around 1 billion years after the Big Bang. It has been difficult to find massive galaxies at even earlier times, as the Balmer break region, which is needed for accurate mass estimates, is redshifted to wavelengths beyond 2.5 μm. Here we make use of the 1–5 μm coverage of the James Webb Space Telescope early release observations to search for intrinsically red galaxies in the first roughly 750 million years of cosmic history. In the survey area, we find six candidate massive galaxies (stellar mass more than 1010 solar masses) at 7.4 ≤ z ≤ 9.1, 500–700 Myr after the Big Bang, including one galaxy with a possible stellar mass of roughly 1011 solar masses. If verified with spectroscopy, the stellar mass density in massive galaxies would be much higher than anticipated from previous studies on the basis of rest-frame ultraviolet-selected samples.The Cosmic DAWN Center is funded by the Danish National Research Foundation. K.W. wishes to acknowledge funding from Alfred P. Sloan Foundation grant no. FG-2019-12514. M.S. acknowledges project no. PID2019-109592GB-I00/AEI/10.13039/501100011033 from the Spanish Ministerio de Ciencia e Innovacion - Agencia Estatal de Investigacion.Peer reviewe

What can state medical boards do to effectively address serious ethical violations?

State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team\u27s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians