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AbstractAcademic hospitalists play an integral role in the day-to-day care of hospitalized patients, education and research. They are well-positioned to engage in scholarly and research activities and inform clinical practice. Hospital medicine also offers a compelling career path for those seeking to maintain a broad clinical focus while also pursuing opportunities in quality improvement (QI), clinical research, and medical education (MedEd) projects. Participation in these endeavors not only foster scholarly growth but also enhances career satisfaction for hospitalists. Therefore, there is a need to explore and implement feasible strategies to equip hospitalists with the knowledge and resources necessary to generate scholarship and promote academic growth within the field.

It is essential to understand how culture, geography, and environment interact to create water systems that have sustained communities for years in hilly terrains of the globe. In India, Almora, Uttarakhand, is one such example where Naulaand Dhara’s traditional water harvesting systems still persist as a consistent source of fresh drinking water. These systems are valuable due to historical, religious, and architectural importance as they exhibit ancient knowledge about architecture and hydraulics in hills. However, unplanned development and a decline in associated knowledge systems have damaged Naulasand their structures in the city. This paper aims to assess the Naulas in the Almora hill city and propose strategies for conserving traditional water sources and protecting their structures. A comprehensive survey of traditional water sources is carried out based on field surveys for resource mapping, inventories, documentation, visual inspection, and unstructured interviews with local historians and stakeholders. The findings are validated through analysis and condition assessment using non-destructive techniques. The study’s findings indicate that numerous barriers exist to integrating traditional water sources into the current water management system due to lack of expertise and training, persistent conflict and competition between conservation needs and developers’ interests, and lack of funding. There is an immediate need to protect and preserve these traditional water systems and elevate their neglected status to sustain freshwater resources along with associated knowledge systems as a valuable resource for sustainable and inclusive development.

Objectives: This systematic review aims to summarize interventions that effectively reduced hospital readmission rates for African Americans (AAs) aged 65 and older. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were identified by searching PubMed for clinical trials on reducing hospital readmission among older patients published between 1 January 1990 and 31 January 2020. Eligibility criteria for the included studies were mean or median age ≥ 65 years, AAs included in the study, randomized clinical trial or quasi-experimental design, presence of an intervention, and hospital readmission as an outcome. Results: There were 5270 articles identified and 11 were included in the final review based on eligibility criteria. The majority of studies were conducted in academic centers, were multi-center trials, and included over 200 patients, and 6–90% of participants were older AAs. The length of intervention ranged from 1 week to over a year, with readmission assessed between 30 days and 1 year. Four studies which reported interventions that significantly reduced readmissions included both inpatient (e.g., discharge planning prior to discharge) and outpatient care components (e.g., follow-ups after discharge), and the majority used a multifaceted approach. Conclusion: Findings from the review suggest successful interventions to reduce readmissions among AAs aged 65 and older should include inpatient and outpatient care components at a minimum. This systematic review showed limited evidence of interventions successfully decreasing readmission in older AAs, suggesting a need for research in the area to reduce readmission disparities and improve overall health.

Table of Contents Abstract Introduction Case Discussion References Abstract We report a case of temporomandibular joint dislocation during LMA insertion under general anaesthesia, in a 30-years old female patient who [...]

Table of Contents Abstract Introduction Case report Discussion References Abstract Tracheal intubation to secure a patients airway is a fundamental skill in anaesthesia practice. Confirmation of endotracheal intubation in neonates [...]

A 25-year-old male with a background of ulcerative colitis presented with a two-week history of central chest pain. His ECG on presentation showed global T wave inversion with a peak troponin I of 165 ng/mL. Clinical diagnosis of myopericarditis/myocarditis was made. Echocardiography and cardiac magnetic resonance (MR) confirmed the diagnosis. On detailed assessment of his medication history, mesalazine was suspected as an etiological factor, with discontinuation resulting in an improvement in symptoms, inflammatory markers and cardiac enzymes. This is a unique case of mesalazine-induced myopericarditis on a background of inflammatory bowel disease.

76-year-old female presented following an episode of collapse. She was hypotensive with the paramedics and remained refractory despite fluid resuscitation. Her initial baseline tests revealed an elevated troponin; she subsequently underwent a coronary angiogram that showed mild coronary artery disease. Left ventriculogram was performed, which showed abnormal mid-wall ballooning and severely impaired systolic function, characteristic of Takotsubo syndrome. Echocardiogram confirmed the presence of diagnosis and presence of left ventricular outflow tract obstruction with high gradient. She was initiated on medical heart failure therapy and improved. Follow-up investigations after 2 months showed complete resolution of systolic dysfunction and symptoms.

A 73-year-old male was brought into hospital with chest pain and inferior ST elevation on ECG. The patient immediately proceeded to the catheter lab for primary percutaneous coronary intervention. Angiography did not identify any culprit lesions to account for the patient’s electrocardiographic changes and ongoing symptoms of chest pain. Bedside echocardiography revealed critical aortic stenosis. Intra-aortic balloon pump (IABP) was inserted, resulting in resolution of chest pain and ST-segment changes. The patient underwent successful aortic valve (AV) replacement without the need for coronary intervention. This is a rare presentation of critical aortic stenosis (AS) presenting as ST-segment elevation myocardial infarction (STEMI).

This study sought to assess the impact of morbid obesity on outcomes in patients with in-hospital cardiac arrest (IHCA).

AbstractContext: Excess growth hormone (GH) is associated with early mortality.Objectives: We assessed the association of GH with prognosis after acute myocardial infarction (AMI), and the effects of secondary prevention therapies.Methods: GH was measured using a high-sensitivity assay in 953 AMI patients (687 males, mean age 66.1 ± 12.8 years).Results: During 2 years follow-up, there were 281 major adverse cardiac events (MACE). Patients with MACE had higher GH levels (median [range], 0.91 [0.04–26.28] μg/L) compared to event-free survivors (0.59 [0.02–21.6], p < 0.0005). In multivariate Cox survival analysis, GH was a significant predictor of MACE (hazard ratios 1.43, p = 0.026 and 1.49, p = 0.01, respectively) with significant interactions with beta blocker therapy (p = 0.047) and angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACE/ARB) therapy (p = 0.016).Conclusions: GH levels post-AMI are prognostic for MACE and may indicate those patients who benefit from beta blocker and ACE/ARB therapy.

To evaluate anti-anxiety activity of thymol (5, 10, 20 mg/kg. i.p.) in Swiss albino mice.

Background: MRproADM and MRproANP can be used as diagnostic and prognostic markers in heart failure.Aim: The objective was to identify confounding factors for the interpretation of plasma MRproADM and MRproANP concentrations.Methods: A total of 518 healthy volunteers with a mean age of 60.84  ±±  7.41 years were analyzed. We evaluated the influence of demographic factors, renal function and echocardiographic indices on the candidate peptides.Results: Multivariate analysis revealed that age (P  <  0.001), BMI (P  <  0.001) and eGFR (P  <  0.001) were independent predictors for MRproADM concentrations in healthy subjects. The independent predictors for MRproANP were age (P  <  0.001), female gender (P  <  0.001), heart rate (P  <  0.001) and eGFR (P  =  0.039).Conclusion: The interpretation of both peptides is multifaceted due to confounders. Knowledge of these factors will further our understanding of how these peptides behave in health and in disease.

We describe a patient who suffered a cardiac arrest preceded by bradyarrhythmia in the immediate postoperative period and further episodes in the high dependency unit (HDU) that was secondary to a low cortisol level. The patient was managed with hydrocortisone replacement following which the condition of the patient improved with no further cardiac arrests. There are few documented cases of cardiac arrest in the peri‐operative period secondary to undiagnosed cortisol deficiency.

The benefit of statins in the prevention of cardiovascular disease is well founded, derived from their lipid lowering and pleiotropic effects. The concept of lipoproteins as lipid transporters has evolved to encompass functions in coagulation, inflammation, and redox reactions due to their unique protein cargo. The aim of this study was to determine the effect of statin therapy on lipoproteins and their protein cargo by use of an unbiased bottom-up proteomics approach in people with hypercholesterolaemia.