Search

Background. The SARS-CoV-2 virus caused the global COVID-19 pandemic, with waxing and waning course. This study was conducted to compare outcomes in the first two waves, in mechanically ventilated patients. Methods. This retrospective observational study included all mechanically ventilated COVID-19 patients above 18 years of age, between March 2020 and January 2021. Patients were grouped into first wave from March 2020 to July 2020, and second wave from August 2020 to January 2021. Outcome measures were mortality, the development of acute kidney injury (AKI), and need for renal replacement therapy (RRT). Univariate and multivariate cox regression analysis were used to delineate risk factors for the outcome measures. Results. A total of 426 patients, 285 in the first wave and 185 in the second wave, were included. The incidence of AKI was significantly lower in the second wave (72% vs. 63%; p = 0.04). There was no significant difference in mortality (70% vs. 63%; p = 0.16) and need for RRT (36% vs. 30%; p = 0.1). Risk factors for mortality were increasing age and AKI in both waves, and chronic kidney disease (CKD) (adj. HR 1.7; 95% CI 1.02–2.68; p = 0.04) in the second wave. Risk factors for AKI were CKD in both the waves, while it was diabetes (adj. HR 1.4; 95% CI 1.02–1.95; p = 0.04) and increasing age in the first wave. Remdesivir (adj. HR 0.5; 95% CI 0.3–0.7; p < 0.01) decreased the risk of AKI, and convalescent plasma (adj. HR 0.5; 95% CI 0.3–0.9; p = 0.02) decreased the risk of mortality in the first wave, however, such benefit was not observed in the second wave. Conclusions. Our study shows a decrease in the incidence of AKI in critically ill patients, however, the reason for this decrease is still unknown. Studies comparing the waves of the pandemic would not only help in understanding disease evolution but also to develop tailored management strategies. [ABSTRACT FROM AUTHOR]

Postoperative polyuria due to diabetes insipidus (DI) is commonly reported complication of pituitary surgery. However, central DI postabdominal surgery is rare and related to unmasking of pre‐existing DI or prolonged surgery with significant intraoperative blood loss. A thorough workup needs to be performed to exclude central DI in such patients. [ABSTRACT FROM AUTHOR]

Police receive extensive training due to the complexity and challenges of their work. Surprisingly, most police officers receive minimal training on how to understand and interact with adolescents. The current study included data from 1,030 law enforcement officers from 24 police departments evaluating perceived readiness to interact and work with adolescents in the community. We examined overall training needs, and then tested how experience in law enforcement and position or rank impacted self-identified training needs. Rank was associated with police officer perceptions of adolescents and related training needs. Compared with patrol officers, school resource officers indicated that they believed they had the skills needed to effectively work with adolescents [ P = 0.001, odds ration (OR) = 2.5]. Beat or area patrol officers were significantly less likely than school resource officers to report feeling equipped to work with adolescents who have experienced trauma compared with new recruits (P < 0.001, OR  =  0.3) and other non-patrol police officers (P = 0.001, OR  =  0.6). School resource officers were significantly more likely to view adolescents as positive assets to the community (P = 0.003, OR  =  2.8), and were significantly less likely to understand why Black adolescents or other adolescents of colour might mistrust police compared with both new recruits (P < 0.001, OR  =  0.2) and patrol officers (P < 0.001, OR  =  0.5). Overarching training needs are illuminated by these unique data. [ABSTRACT FROM AUTHOR]

Background: Pregnancy causes a physiological increase in renal blood flow and glomerular filtration rate, which leads to a transient increase in urinary protein excretion. Up to 300 mg/d proteinuria is known to occur in pregnancy due to physiological changes. Proteinuria of greater than 3 g/d is categorized as being within the nephrotic range, and the most common cause of nephrotic range proteinuria in the later stages of pregnancy is preeclampsia. Minimal change disease (MCD) as a cause of nephrotic syndrome is rare in pregnancy and is rarer still after abortion. Here, we report a patient who presented with nephrotic syndrome due to MCD after elective surgical abortion. Case Report: A 21-year-old woman presented with shortness of breath, worsening anasarca, abdominal distension, and weight gain 3 weeks after undergoing elective surgical abortion at 7 weeks of gestation. There was no hematuria and no past medical history or family history of kidney disease. Investigations revealed normal serum creatinine with hypoalbuminemia, dyslipidemia, nephrotic range proteinuria, and negative serology for autoimmune diseases. Renal biopsy showed podocyte effacement with normal glomeruli and intact tubulointerstitium, confirming the diagnosis of MCD. The patient was treated with steroids, antidiuretics, statins, and angiotensin receptor blockers. She responded well, showing symptomatic improvement and resolution of proteinuria, hypoalbuminemia, and dyslipidemia. She was gradually tapered off steroids during subsequent follow-up visits. Conclusions: Only a single case of a patient presenting with acute renal failure and MCD after a missed abortion has been reported. To the best of our knowledge, this is the second case report of MCD after abortion and the first report of a patient with MCD without acute renal failure after elective termination of pregnancy. [ABSTRACT FROM AUTHOR]

The gun violence restraining order (GVRO) is a new tool for preventing gun violence. Unlike traditional approaches to prohibiting gun purchase and possession, which rely on a high threshold (adjudication by criminal justice or mental health systems) before intervening, the GVRO allows family members and intimate partners who observe a relative's dangerous behavior and believe it may be a precursor to violence to request a GVRO through the civil justice system. Once issued by the court, a GVRO authorizes law enforcement to remove any guns in the respondent's possession and prohibits the respondent from purchasing new guns. In September 2014, California's governor signed AB1014 into law, making California the first U.S. state to enact a GVRO law. This article describes the GVRO and the rationale behind the concept, considers case examples to assess the potential impact of the GVRO as a strategy for preventing gun violence, and reviews the content of the California law. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Administration of the Miranda Warnings to deaf suspects poses many legal issues. If police officers, judges, attorneys and psychologists are unaware of these, evidence obtained as a consequence of deaf suspects waiving their Miranda Rights may be inadmissible in court. These issues include the importance of videotaping the police interview, the use of sign language interpreters, the determination of the deaf defendant's reading level and communication capacity, the limitations of lipreading, and other psycholinguistic factors. Recommendations age offered to aid in determining whether a deaf suspect is capable of understanding the Miranda Warnings and how these warnings should be administered. [ABSTRACT FROM AUTHOR]

Laryngeal sequelae following prolonged endotracheal intubation are being observed with increasing frequency as this technique of airway management is being employed for extended periods of time. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. After reviewing the records of 372 consecutive patients intubated over an 18-month period, we have observed an increased frequency of these complications in the diabetic female patient and suggest that early tracheostomy should be considered in these individuals when the use of prolonged intubation is anticipated. The possible pathophysiology of this problem in the diabetic, as well as the non-diabetic intubated patient, and its possible prevention will be discussed. [ABSTRACT FROM AUTHOR]

Opportunistic infection and reactivation of latent infection has been reported with use of monoclonal TNF alpha antibodies used for treatment of severe rheumatoid arthritis. We present a case of peritoneal tuberculosis (TB) causing renal failure secondary to ureteral constriction in a patient who had been treated with infliximab for rheumatoid arthritis. We suggest that physicians should be aware of the increased risk of false negative and false positive TST and IGRA among patients treated with monoclonal TNF alpha antibodies and should regularly look for usual and unusual symptoms of TB in this patient population. [ABSTRACT FROM AUTHOR]

Determines the effect of trimethoprim-sulfamethoxazole on serum potassium concentration. Progressive increase in serum potassium during therapy; Danger of hyperkalemia in high dose therapy for HIV-infected patients.

Objective: Our study examined officers' attitudes and perceptions of adolescents in general (and challenges in policing adolescents) and the degree to which community variables affect those perceptions., Hypotheses: Our examinations of officers' descriptions of adolescents and challenges in policing adolescents were exploratory. We hypothesized that community characteristics would significantly influence officers' perceptions of adolescents, such that working in more impoverished, higher crime, and more proportionally Black communities would be associated with more negative perceptions of adolescents., Method: Data were obtained from 1,112 active law enforcement officers representing 30 police agencies/departments across the United States. Participating officers completed a survey about adolescents and challenges in policing adolescents. Publicly available data sets were used to measure select community and police agency/departmental characteristics. We examined qualitative data using an inductive methodological approach., Results: Police officers' descriptions of adolescents were significantly more negative than positive. Negativity was observed in the relative frequency of negative versus positive comments about adolescents as well as the use of inherently problematic descriptors. Police officers working in more impoverished, higher crime, and more proportionally Black communities displayed significantly more problematic attitudes and significantly fewer positive attitudes compared with those in less proportionally Black communities. The findings related to race were partially-but not completely-explained by other community variables., Conclusions: Officers' negative descriptors, their occasional use of inherently problematic terms, and the intensification of those tendencies when working in communities with more poverty, higher crime, and a larger proportion of Black residents suggest an urgent need for intervention to help officers better understand youth. Training that would help police officers better understand youth, recognize developmental influences, and see each youth individually rather than as a representative of a group could help officers interact more supportively with youth, be less likely to inadvertently create confrontation, and more effectively de-escalate situations involving distressed or activated youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Acute renal infarction is a rare and often underdiagnosed condition with estimated incidence of 0.5-1.5%. Coronavirus disease 2019 (COVID-19) has been shown to cause a hypercoagulable state in patients leading to arterial and venous thromboembolism. Renal infarction as a consequence of COVID-associated coagulopathy has been reported, sometimes resulting in acute kidney injury. Most of the patients so far reported had other existing comorbidities and risk factors that compounded the risk of precipitating an infarction. Here, we present a 37-year-old, the youngest patient reported so far, with no pre-existing comorbidities or risk factors, who developed bilateral renal infarction with COVID-19 pneumonia. The patient was treated with anticoagulation for renal infarction and discharged on apixaban. Anticoagulation is an important part of current treatment strategies for COVID-19 pneumonia and should extend beyond the acute phase of the disease to prevent long-term sequelae, especially in young patients., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Antineutrophil cytoplasmic antibodies (ANCA) vasculitis is common after the age of 50 years but it can occur at any age. There is a slight male preponderance and it is more common in Whites than Blacks but the black race confers a worse prognosis. The clinical features of ANCA vasculitis vary considerably. The manifestation of the disease depends on the organs affected, the chronicity of the disease, and how quiescent it is. Non-specific symptoms of malaise, fatigue, fever, and weight loss are common. Crescentic glomerulonephritis with focal necrosis is usually the pathology underlying renal disease. Manifestations of renal disease include hematuria and proteinuria which may progress to renal failure. We present a case of a 75-year-old female who presented with acute worsening of renal function and nephrotic-range proteinuria with positive testing for p-ANCA after the recent commencement of treatment with tofacitinib. This prompted a suspicion of ANCA-vasculitis. The patient was started on pulse dose steroids and rituximab after kidney biopsy confirmation of ANCA-vasculitis with crescentic glomerulonephritis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Asemota et al.)

Competing Interests: Competing interests: None declared.