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BACKGROUND: As the landscape of medical education evolves with emerging technologies and the COVID-19 pandemic, e-learning platforms continue to gain popularity. Orthopaedic podcasts, a burgeoning e-learning platform, continue to gain traction; however, there is a paucity of information regarding their coverage of topics and their distribution over time. Therefore, our analysis sought to (1) characterize podcast content related to orthopaedic surgery, and (2) evaluate the changes in the prevalence of orthopaedic podcasts over the past 15 years. METHODS: Three common podcasting platforms (Apple Podcasts, Google Podcasts, and Spotify) were queried using the key terms "orthopaedic," "orthopedic," and "ortho" in order to identify a list of podcasts that are related to orthopaedic surgery. For each unique orthopaedic podcast, the title, the show description, the number of episodes, the date of the first episode, the date of the most recent episode, and episode frequency were collected. Podcasts were then classified based on a predetermined list of podcast domains. The number of existing active (released within the last 3 months) orthopaedic podcasts was then trended on a monthly basis from 2011 to 2020. RESULTS: Ninety-four unique podcasts met inclusion criteria, 62 of which remained active as of October 25, 2020. The most common podcast domains were "general" (38 [40.4%]) and "clinical knowledge" (20 [21.3%]). Among the assessed podcasts, 90 (95.7%) utilized an exclusively audio format. The majority of podcasts were based in the United States (89.4%), included introductory music (72.3%), and included interviews (63.8%). Most podcast hosts were practicing orthopaedic surgeons (52.1%). Between January 2016 and October 2020, the number of active orthopaedic surgery podcasts grew more than twelvefold (1,240%) at an average rate of roughly 1 new podcast each month (average, 1.0 podcast; standard deviation, 1.8). DISCUSSION: The past decade has seen sizable growth in the number of readily available podcasts related to orthopaedic surgery. Additional research is required to independently assess the quality of these resources and their implications for remote trainee education.

In the context of change in global scenario of terrorism and economic competition, the risk of deliberate attack on agriculture is increasing. In a country, like India, whose economy is largely dependent on agriculture produce and exports, any such malicious attack can grossly destabilise the socio-economic structure. Additionally, an attack on major food crops can lead to potential threat to food security, subsequently, leading to destabilised law and order situation of a state. It is therefore very important to understand the risks and threats of agroterrorism for a given country in order to be prepared for any such circumstance. In this review we discuss different aspects of agroterrorism, its history, possibilities of such incidences in Indian scenario and mitigation strategies, which can be achieved through regular surveillance of pathogens in vulnerable crop ecosystems. We also describe a recent episode of outbreak of cotton leaf curl disease in the Northwest Indian cotton growing region and discuss it from the perspective of a possible threat on one of the most important economic crops of our country.

Objective: To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil. Methods: A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests. Results: A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03). Conclusions: Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care.

Context: Neuroleptic malignant syndrome (NMS) has been introduced as a rare but lethal and idiosyncratic reaction to neuroleptics/antipsychotics. The most obvious risk of this syndrome is the use of neuroleptics, especially high-potency ones. Metoclopramide is also known as an anti-nausea medication administered before surgery to manage digestive problems. Evidence Acquisition: Formerly, it had been assumed that metoclopramide was a type of chlorobenzamide that was not in the phenothiazine group but free of extrapyramidal side effects (EPSs). The sequential reports of complications indicate that metoclopramide can cause EPSs and drug-induced motor side effects. A total number of 5044 articles were obtained after the initial search. Then, two researchers independently screened out their titles, and abstracts and 20 articles were finally selected based on the inclusion criteria. Results: Of the 20 articles reporting metoclopramide-induced NMS, treatments had been successful in 16 (80%) cases, but it had led to death in four (20%) patients. There were 11 and 8 male and female patients, respectively, and gender was not mentioned for a patient in one article. The age range of the patients was from six months to 84 years, and the mean age was 50.92 years. Conclusions: Although NMS following metoclopramide intake is reported very rarely, it should be considered for any psychiatric symptoms with unexpected mental changes, muscle rigidity, and fever after being treated with metoclopramide. The neuroleptic malignant syndrome can occur following multiple doses or just one dose of metoclopramide. Also, metoclopramide use in patients affected with kidney failure is accompanied by a higher risk of NMS. A previous history of NMS, a recent episode of catatonia, and severe agitation are all taken into account as risk factors in this domain.

A 78 year-old woman has experienced multiple episodes of transient right third nerve palsy over the course of 15 years and has undergone multiple imaging studies as well as investigations for myasthenia gravis and giant cell arteritis in search for the diagnosis. When seen after the most recent episode, MRI with contrast and Fast-Imaging Employing Steady-State Acquisition protocol revealed a subtle enlargement and enhancement of the cisternal and proximal cavernous portions of the right third cranial nerve. An empiric diagnosis of schwannoma intrinsic to third cranial nerve was made. All patients with cyclical third nerve palsies should have appropriate neuroimaging to rule out subtle structural lesions before other investigations are undertaken.

Objective: To determine whether the time lag between blood culture draw and the start of shaking chills is associated with blood culture positivity. Methods: A prospective observational study was undertaken from January 2013 to March 2015 at a referral center in Okinawa, Japan. All enrolled patients were adults with an episode of shaking chills who were newly admitted to the division of infectious diseases. The study exposure was the time lag between blood culture draw and the most recent episode of shaking chills. Results: Among patients whose blood cultures were obtained within 2 h after shaking chills started, the blood culture positivity was 53.6% (52/97), whereas among patients whose blood cultures were obtained after more than 2 h, the positivity was 37.6% (44/117) (p = 0.019). The adjusted odds ratio of blood culture positivity for samples drawn within 2 h after shaking chills was 1.88 (95% confidence interval 1.01–3.51, p = 0.046). Escherichia coli were the most frequently detected bacteria (58/105). Conclusions: The positivity of blood cultures obtained within 2 h after the start of the most recent shaking chills was higher than that for blood cultures obtained after 2 h. Keywords: Blood culture, Shaking chills, Bacteremia, Sepsis, Shivering

The yellow fever 17D vaccine contains live-attenuated virus. Initial efficacy and safety reports were favorable. Recently, however, neurologic and viscerotropic adverse events (AE) were described. We managed a 61-year-old man who experienced meningomyeloradiculitis 18 days after receiving the yellow fever 17D vaccine. The manifestations were atypical. The cerebrospinal fluid contained high titers of anti-yellow fever immunoglobulins M and G and of anti-flavivirus immunoglobulins G. After methylprednisolone (1 g/day for 3 days), intravenous human immunoglobulins (140 g over 5 days), and two plasma exchanges, the symptoms improved only slightly. Neurological adverse events after yellow fever vaccination are rare or underestimated. To our knowledge, this is the first reported case of meningomyeloradiculitis after yellow fever vaccination. A remarkable feature is the intrathecal production of yellow fever antibodies, which probably played a pathogenic role and may have been related to a recent episode of influenza.

Several studies have shown that a considerable proportion of horses are eliminated from endurance rides due to lameness and metabolic problems. Limited information is available on specific veterinary issues in endurance horses and there are no descriptive data on veterinary problems in a large population of endurance horses. The aim of this study was to describe veterinary problems occurring in endurance horses in England and Wales, the regions of the United Kingdom where endurance rides are organised and regulated by Endurance Great Britain (Endurance GB). A comprehensive online self-completed questionnaire was used for data collection (30th December 2015-29th February 2016) All members of Endurance GB who were the main rider of one or more endurance horses were eligible to participate. From the target population of 1209 horses, 190 questionnaires were completed by riders, resulting in a 15.7% response rate. The most common rider-reported veterinary problem was lameness, affecting 152/190 (80.0%) of endurance horses at some point during their careers and 101/190 (53.2%) of horses in the previous 12 months. Detailed information on the most recent episode of lameness was available for 147 horses. Seventy-six percent of these lameness episodes (112/147) had been initially identified by a veterinarian, but only 52% of these lameness episodes were investigated further by a veterinarian, despite the high proportion of horses affected by lameness and the proportion of horses with recurrent lameness episodes. The second most common veterinary problem was thoracolumbar region pain, followed by non-specific cough, skin disease and colic. Education of endurance riders may improve the number, quality and timing of veterinary investigations, especially for lameness and thoracolumbar region pain.

Case summary A 9-year-old male neutered Maine Coon cat presented with a 6-month history of polyphagia and one recent episode of tremors and weakness. Blood work revealed profound hypoglycemia and results of a paired insulin glucose test were consistent with an insulinoma. Abdominal ultrasound revealed a solitary pancreatic mass, and results of a fine-needle aspirate (FNA) gave further support for the location of the neuroendocrine tumor. After unsuccessful medical management of the hypoglycemia, the mass was surgically removed. Immunohistochemistry confirmed that it was an insulinoma. At the time of writing, the patient had been in clinical remission for 9 months. Relevance and novel information Feline insulinomas are rare and there is very little information on their behavior, clinical course and histologic characteristics. This is the first reported case of an insulinoma in a Maine Coon cat and the first to describe results of an ultrasound-guided FNA of the mass. In addition, the progression of disease, histopathology and immunohistochemistry results add to the currently minimal database for feline insulinomas.

Introduction Macroscopic hematuria is considered a significant risk factor for urologic disease, and it is highly prevalent in people with hemophilia. Aim To determine whether prophylactic factor replacement therapy is associated with reduced occurrence of macroscopic hematuria in people with hemophilia in a post hoc analysis using data from a cross‐sectional study conducted by the Age‐Related Developments and Comobordities in Hemophilia (ADVANCE) Working Group that included males with hemophilia ≥40 years of age. Methods Data from 16 contributing centers, in 13 European countries and Israel, were analyzed using logistic regression. Of 532 recruited individuals, this analysis included 370 patients with moderate or severe hemophilia who received on‐demand or prophylactic therapy. Results For patients with a history of macroscopic hematuria, we analyzed the association between prophylaxis and reoccurrence of macroscopic hematuria within the past 5 years (n = 235 patients). Frequent (≥3 times/wk) prophylaxis was negatively associated with a recent episode of macroscopic hematuria (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.18‐0.76). We also analyzed whether prophylaxis corresponded to a lower lifetime number of macroscopic hematuria episodes (n = 285 patients). Frequent prophylaxis for >15 years was associated with a lower number of episodes compared to on‐demand treatment (OR, 0.29; 95% CI, 0.16‐0.54), whereas nonsteroidal anti‐inflammatory drugs (NSAIDs) and severe hemophilia were associated with a higher number. There was no association of prophylaxis

Background Many self-harmers do not present in hospitals due to the self-harm. It is still unclear on the differences between medically treated and untreated self-harm in China. This study described the differences of the two groups of self-harmers using the largest psychological aid hotline data. Methods The present observational study recruited 3,403 hotline callers who reported episodes of self-harm before the call. In routine assessment, information about the most recent episode of self-harm was collected, including the method of self-harm, the wish to die, goals of the self-harm, and any medical treatment (irrespective of psychological services) in the hospital. The callers were divided into two groups: those who received hospital-based medical treatment due to the most recent self-harm (treated self-harm callers) and those who did not (untreated self-harm callers). Results In the most recent episode of self-harm, 65% (n = 2,217) of callers were untreated and 55% (1,226/2,217) of the untreated self-harm callers reported a wish to die. A total of 67% of the callers reported that their main goal of self-harm was to relieve suffering. The most common self-harm methods were using instruments (knife or rope) and overdosing on medicines. Compared with treated self-harm callers, the untreated self-harm callers were less likely to have a wish to die (OR = 0.57), engage in self-harm outside the home (OR = 0.71 and 0.78), and attribute their self-harm to romantic relationship problems (OR = 0.76); however, they were more likely to use instruments, to jump, or to choose other methods (OR = 3.73, 3.83, and 7.71, respectively). Conclusions Among hotline callers, many episodes of self-harm did not receive medical treatment, despite over half reporting a wish to die. Characteristics of self-harm behaviors were different between treated and untreated self-harm callers. Our findings suggest that more strategies should improve access to hospital-based medical treatment and coverage for post-intervention for self-harmers who are not presented in hospitals.

We report the case of a 36 year old male who demonstrated extensive high attenuation in the muscles of the chest wall and neck on a noncontrast chest CT. The high attenuation in the musculature was due to calcium, sequela from a recent episode of rhabdomyolysis. Although the diagnosis of rhabdomyolysis is made on clinical grounds, the imaging appearance can be confusing given the variability in appearance of rhabdomyolysis depending on the severity and the timeline of disease.

Aim To explore the prevalence of residual symptoms (both depressive and manic) and their correlates in subjects with bipolar disorder in clinical remission. Methodology This multicentric cross-sectional study included patients in clinical remission recruited across the 14 centers. The patients were evaluated on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) for the prevalence of residual symptoms. A score of ≤7 on both scales defined the presence of residual symptoms. Results Four-fifth (79.8%) of the participants had residual symptoms, with 130 (16.8%) having only residual depressive symptoms, 74 (9.6%) having only residual manic symptoms, and 413 (53.4%) having both depressive and manic residual symptoms, on HDRS and YMRS. The residual symptoms were related to the polarity of the most recent episode and the lifetime predominant polarity. Higher numbers of lifetime depressive episodes are associated with higher residual depressive symptoms, and higher numbers of lifetime manic episodes are associated with higher chances of having residual manic symptoms. Conclusions A large proportion of patients with bipolar disorder have residual symptoms during the remission phase. Clinicians need to make efforts to identify and address the same to improve the treatment outcome.

A 7-year-old girl presented with severe pallor, cough, and massive hemoptysis. She had been previously hospitalized twice within the time span of 2 years for severe pallor and hemoptysis, each time requiring 2U of blood transfusion. In the recent episode, blood examination was suggestive of iron deficiency anemia, chest radiograph yielded bilateral pulmonary infiltrate, computed tomography scan of lungs showed ground glass pattern, and bronchoalveolar lavage revealed hemosiderin-laden macrophages. Investigations to exclude any secondary causes of pulmonary hemosiderosis were negative. The child was diagnosed as a case of idiopathic pulmonary hemosiderosis and treated with prednisolone.

The current study examined event-level characteristics (e.g., contextual factors, risk behaviors) during the most recent episode of Molly use among a sample of college students who reported previously using Molly. Participants ( N = 151; 66.7% female) were drinkers aged 18 to 25 years. Data were collected from October to November 2014, February to April 2015, and September to November 2015. Participants completed measures regarding typical Molly use and items related to context and behaviors during their most recent episode of Molly use. Findings revealed that our sample most commonly reported using Molly earlier in the evening while hanging out with friends or at a party. In addition, sexual and other drug use behaviors commonly occurred when using Molly. Findings provide preliminary information in guiding future work exploring Molly use and potential substance-related issues associated with the context of when and how Molly is consumed.

A perimenopausal woman presented with a single recent episode of heavy vaginal bleeding and low hemoglobin level. She has been, however, spotting off and on for the last several years. On examination an ulcerated polypoid lesion was identified protruding through the external os. The lesion raised a clinical suspicion of an adenosarcoma in this perimenopausal patient. The current report describes this rare entity, documents the gross and microscopic features which may mimic adenosarcoma of the mullerian system. Keywords: Giant endocervical polyp, Adenosarcoma

In this paper we investigate the impact of changes in proved reserves on U.S. stock returns using firm level data of the largest U.S. oil and gas companies. The selected sample covers the period 2009 to 2018 incorporating the recent episode of the shale oil and gas revolution. In contrast to previous studies, our results show that changes in proved oil and gas reserves have no significant effect on stock returns. We also give evidence of the impact of reserves on financial returns being dependent on the level of oil prices. Since oil prices fell abruptly after 2014, we show a significantly lower effect of oil reserves in stock returns in this subperiod and, thus, partly explain the overall insignificant effect.

This study explores the most recent episode in the evolution of audit technology, namely the incorporation of Big Data and Data Analytics (BDA) into audit firm approaches. Drawing on twenty-two interviews with individuals with significant experience in developing, implementing or assessing the impact of BDA in auditing, together with publicly available documents on BDA published within the audit field, the paper provides a holistic overview of BDA-related changes in audit practice. In particular, the paper focuses on three key aspects, namely: the impact of BDA on the nature of the relationship between auditors and their clients; the consequences of the technology for the conduct of audit engagements; and the common challenges associated with embedding BDA in the audit context. The study’s empirical findings are then used to establish an agenda of areas suitable for further research on the topic. The study is one of the first empirical accounts providing a perspective on the rise of BDA in auditing.

Background Although the influence of genetics on chronic low back pain (LBP) has been previously examined, few studies have investigated whether the impact of genetic factors on LBP depends on how the condition is assessed. Methods We investigated the contribution of genetics and environment on chronic LBP: lifetime prevalence, pain intensity (recent and worst) and activity limitation (anytime and recent) in a cross-sectional study with 1,598 adult twins. All twins answered a self-reported questionnaire about health-related questions. We conducted classic twin analyses using structural equation models to estimate the genetic and environmental influences in LBP phenotypes. Results We found a heritability of 26% (95%CI: 0.09-0.42) for lifetime chronic LBP; 36% (95%CI: 0.18-0.52) and 25% (95%CI: 0.03-0.46) for activity limitation due to chronic LBP, related to lifetime and most recent episode, respectively; and heritability of 35% (95%CI: 0.11-0.55) for pain intensity associated with the most recent episode. Genetics showed no significant influence in pain intensity experienced during the worst LBP episode. Conclusions Genetic factors appear to significantly contribute to the variance in chronic LBP including lifetime chronic LBP, activity limitation and pain intensity associated with more recent episodes of LBP, but not for pain intensity associated with people's report of the worst pain episode. Heritability estimates was fairly similar across different LBP outcomes in a population-based twin sample, and not dependent on how it is assessed or experienced. However, we could not detect any significant heritability for a report of intensity experienced during the worst LBP episode experienced. Significance Heritability estimates were similar for different low back pain definitions, and therefore not dependent on how chronic low back pain is experienced or assessed, in the same population-based sample.

Precise risk stratification in heart failure (HF) patients enables clinicians to tailor the intensity of their management. The Seattle Heart Failure Model (SHFM), which uses conventional clinical variables for its prediction, is widely used. We aimed to externally validate SHFM in Japanese HF patients with a recent episode of acute decompensation requiring hospital admission.SHFM was applied to 2470 HF patients registered in the West Tokyo Heart Failure and National Cerebral And Cardiovascular Center Acute Decompensated Heart Failure databases from 2006 to 2016. Discrimination and calibration were assessed with the use of the c-statistic and calibration plots, respectively, in HF patients with reduced ejection fraction (HFrEF;40%) and preserved ejection fraction (HFpEF; ≥40%). In a perfectly calibrated model, the slope and intercept would be 1.0 and 0.0, respectively. The method of intercept recalibration was used to update the model. The registered patients (mean age 74 ± 13 y) were predominantly men (62%). Overall, 572 patients (23.2%) died during a mean follow-up of 2.1 years. Among HFrEF patients, SHFM showed good discrimination (c-statistic = 0.75) but miscalibration, tending to overestimate 1-year survival (slope = 0.78; intercept = -0.22). Among HFpEF patients, SHFM showed modest discrimination (c-statistic = 0.69) and calibration, tending to underestimate 1-year survival (slope = 1.18; intercept = 0.16). Intercept recalibration (replacing the baseline survival function) successfully updated the model for HFrEF (slope = 1.03; intercept = -0.04) but not for HFpEF patients.In Japanese acute HF patients, SHFM showed adequate performance after recalibration among HFrEF patients. Using prediction models to tailor the care for HF patients may improve the allocation of medical resources.

For more than a decade, the Veterans Health Administration (VHA) has offered MOVE!, a comprehensive lifestyle intervention for weight management. However, there is limited knowledge to inform resource allocation decisions at the health system level—for example, the choice between reaching new veterans with weight management treatment, re-engaging veterans who have stopped attending, and/or increasing contact with current MOVE! participants. To inform VHA policy and planning, this VHA-wide study examines the relationship between MOVE! participation and weight outcomes. A longitudinal observational study of veterans across VHA who participated in MOVE!. Veterans who initiated their most recent episode of MOVE! care between 2004 and 2014. Weight measurements were abstracted from VHA electronic health records. The primary outcome was the proportion of veterans with clinically relevant weight loss. The predictor of interest was number of MOVE! contacts during the 12 months following MOVE! initiation. The cohort consisted of 237,577 veterans (87.4% male; mean age 54.4 years), who had 5.3 contacts on average in the 12 months following initiation. Veterans with 2–5 contacts had the same odds of achieving clinically relevant weight loss as veterans with only one contact (adjusted OR: 1.00, 95% CI: 0.98–1.03). Veterans with 6–9, 10–13, 14–17, and 18 or more contacts had significantly higher odds of clinically relevant weight loss (adjusted OR: 1.17, 95% CI: 1.13–1.20; adjusted OR: 1.53, 95% CI: 1.47–1.59; adjusted OR: 1.84, 95% CI: 1.74–1.94; adjusted OR: 2.21, 95% CI: 2.12–2.31, respectively). Veterans with ≥6 MOVE! contacts in the year following treatment initiation were significantly more likely to achieve clinically relevant weight loss than those with one contact, with greater participation further increasing the odds of clinically relevant weight loss. While further characterization of weight loss predictors is needed, the VHA should provide policy guidance that supports increasing participation among veterans who have initiated MOVE!.

The U.S.-based Financial Accounting Standards Board (FASB) emphasizes that accounting standard-setting is not and should not be regarded as a �political process.� Employing the case of accounting for stock compensation, I examine a recent debate in which FASB appears to have successfully established and maintained a boundary between a technical accounting process and politics. This case is interesting because an earlier, failed effort to expense stock compensation was described as highly politicized. However, the boundary between technical and political processes was maintained in the more recent episode. I find that a focus on due process, characterizations of existing accounting requirements as anomalous and available measurement methods as reliable, and warnings about the dangers of injecting �politics� into standard-setting were important to this boundary work. I also find that the boundary work required considerable interpretive flexibility in selecting (or ignoring) the evidence to be used in justifying the standard-setting project and its conclusions. I conclude by suggesting that a different understanding of what it means to be involved in a �political process� might help all parties understand more fully what is taking place during the accounting standard-setting process. Attention could be turned to developing processes to facilitate debates over which values should guide decisions occurring throughout the standard-setting process. To this end, an enhanced standard-setting process might allow for increased participation in agenda setting, in framing and scoping standard-setting projects, and in providing opportunities for nonexperts to participate.

Objectives: In the Indian social structure, as in many other countries and regions across the globe, housewives form the nucleus of their family. They have a nonstop hectic full day assignment in the home, and yet their contribution has neither been adequately acknowledged, nor has it received due attention of researchers. The aim and objective of this study is to determine the prevalence of Low Back Pain (LBP) in non-working women of Kanpur city. Also, an attempt has been made to find the amount of social burden and its impact on LBP present in housewives of Kanpur city.Method: A sample of 300 non-working women of Kanpur city, aged 25 to 70 years, was selected. The Nordic Musculoskeletal Questionnaire, Oswestry Disability Index, and Zarit Burden Interview measuring musculoskeletal discomfort, low back disability and social burden respectively were given to all the women.Results: Descriptive analysis data reveal the recent episode of LBP were present in 93% of the women, 82% had chronic LBP and 71...

La reacción adversa más frecuentemente asociada al tratamiento con inhibidores del cotransportador sodio-glucosa es la infección micótica genital y en menor proporción la infección urinaria, esto no es dosis dependiente. Es más común en mujeres y en hombres antes de los 50 años de edad. Es infrecuente la necesidad de suspender el tratamiento por estas infecciones. Se recomienda evitar el uso en pacientes con historia de infecciones urinarias recurrentes o con episodio reciente de infección urinaria alta y especial cuidado al indicarla en aquellos con historia de hipertrofia prostática porque se han descripto casos de pielonefritis.

Purpose: We administered olanzapine to 24 outpatients with bipolar disorder who had experienced a depressive or mixed episode as their most recent episode to evaluate the efficacy and safety of olanzapine in clinical practice. Methods: The duration of study treatment was 8 weeks. Symptoms in each subject were assessed using the Montgomery Asberg Depression Rating Scale (MADRS) and the Clinical Global Impressions-Severity of Illness, Bipolar Version (CGI-BP) at the start of treatment with olanzapine and at Week 4 and Week 8 of treatment. Results: A total of 17 subjects underwent the assessments at Week 4, and 13 subjects completed the 8-week treatment regimen and the assessments at Week 8. The mean total score and each individual item score of the MADRS were significantly improved at Week 4 and Week 8 compared to those at the start of treatment. The mean CGI-BP Depression and CGI-BP Overall scores were significantly improved at Week 4 and Week 8, while the mean CGI-BP Mania score was not significantly different at Week 4 or Week 8 compared to that at the start of treatment. Adverse drug reactions were reported in 3 subjects during the study: hyperphagia in 2 subjects and light-headed feeling in 1 subject. No manic switches were observed. Discussion: The results of this study confirmed the efficacy and safety of olanzapine in outpatients with bipolar depression in clinical practice.

Federal Communications Commission (FCC) v. FOX Television Stations (FOX II, 2012) marked the most recent episode in the Supreme Court’s consideration of the regulation of indecency in the public broadcast medium. The Court’s decision in FOX II has given the FCC permission to revise, but not necessarily to abandon, its policies that interpret indecency in light of public interest and other legal requirements. We argue that the FCC should switch from a passive listener rationale to an active-listener/invited-guest rationale as a philosophical approach to the regulation of indecency. Consistent with such philosophy, the FCC should extend its rationale for exempting coverage of live public and news events to exempting live coverage of private events, while defining indecency as constitutive of a violation of principles pertaining to fair warning.

An elderly man had a recent episode of acute pancreatitis. A pancreatic mass was seen during evaluation of the pancreatitis.

56-old man with new onset diabetes mellitus and a history of alcohol abuse and two prior episodes of acute pancreatitis. The most recent episode of pancreatitis was 3 months ago.

We assessed sexually transmitted infection risk behaviours and desire to discuss mental health, as reported by 426 HIV-infected men who have sex with men receiving HIV care in eight urban clinics. Most of these patients (90%) had begun HIV care >1 year ago. In the past year, 74% had multiple sexual partners, 75% engaged in anal intercourse, 48% had >1 HIV-uninfected partner and 82% used illegal psychoactive drugs. Among those reporting anal intercourse, approximately 61 % reported using a condom during the most recent episode. Among all patients, 70% wanted to talk with their clinicians about how they felt mentally or emotionally. Using a two-tailed chi-squared test, we found that patients who engaged in unprotected receptive anal sex were more likely to want such a conversation than those who did not (80% versus 62%, P < 0.01); and those who engaged in unprotected insertive anal sex were also more likely to want such a conversation (81 % versus 63%, P < 0.01). The findings highlight the prevalence of risky sexual behaviour and of mental health concerns in the participating patient population. Patients reporting risky sexual behaviour were more likely to want to discuss how they felt mentally or emotionally than those not reporting such behaviour.

Background: Patients with acute pulmonary embolism (APE) with concomitant chronic heart failure (CHF) are characterized by higher mortality rates than APE patients without CHF. The aim of this study is to evaluate the potential impact of APE on early and long-term prognosis in patients with CHF. Methods: This study included 87 patients with CHF with suspected APE. Patients were divided into two groups according to spiral computed tomography results: one group with confirmed APE and one with excluded APE. Total and cardiovascular mortality in patients of both groups during a 6- and 36-month follow up period was assessed. Potential risk factors for mortality in patients with CHF in short and long-term observations were identified. Results: APE was diagnosed in 35 patients, and excluded in the remaining 52 patients. Total and cardiovascular 6-month mortality was higher in APE patients than in patients without APE: 34.3% and 28.5% vs. 13.4% and 11.5%, p = 0.02, p = 0.02, respectively. In 6-month follow-up the only independent risk factor for mortality was the presence of APE (HR = 2.7, 95% CI 1.1–24.4, p = 0.04). However, in the 36-month follow-up APE had no effect on mortality. Conclusions: Patients with CHF and acute episode of PE are characterized by a higher 6-month total and cardiovascular mortality rate following discharge from hospital compared to patients hospitalized due to acute CHF decompensation. Moreover, recent episode of PE in patients with CHF is an independent risk factor for early mortality in a 6-month follow-up.

During the recent financial crisis dedicated short bias (DSB) hedge funds exhibited extremely strong results while many other hedge fund strategies suffered badly. This article, prompted by this recent episode, investigates DSB hedge fund performance over an extended sample period, from January 1994 to December 2008. Performance and risk evaluation are carried out on an equally weighted DSB hedge fund portfolio using three different factor model specifications and both linear and nonlinear estimation techniques. The authors conclude that DSB hedge funds are a significant source of diversification for equity market investors and produce statistically significant levels of alpha. Their findings are robust to the specification of traditional and alternative risk factors, nonlinearity, and the omission of the crisis periods, which are particularly favorable for the DSB strategy.

We report the case of a patient with a long history of dysthymia and major depressive episodes requiring repeated hospitalization. We describe the most recent episode, associated with catatonia symptomatology and features suggestive of cognitive impairment. The absence of a clear initial psychopharmacological response alongside the clinical severity made the patient a potential candidate for electroconvulsive therapy (ECT). A regional cerebral blood flow SPECT (SPECT-rCBF), performed to rule out concomitant Alzheimer disease (AD), revealed a markedly decreased neocortical uptake, with no definitive pattern of concomitant primary cognitive impairment. Because a gradual clinical improvement was observed in the patient, with evidence of enhanced cerebral reperfusion in a second SPECT-rCBF study at two weeks after admission, the application of ECT was discounted and an expectant attitude was adopted.

Long–short hedge funds are often very highly levered, despite the costs of leverage that became apparent during the LTCM crisis in 1998 and the more recent episode in 2008. This note explores potential market imperfections that may explain the use of leverage.

The influence of patient age on various features of ocular toxoplasmosis has been a subject of study for many years. The age at which Toxoplasma gondii infection occurs in different populations is related to socioeconomic factors and studies suggest that ocular toxoplasmosis is a more severe disease at the extremes of age. The prevalence of ocular involvement is markedly different between individuals with congenital and those with post-natally acquired infections. Even among those with post-natally acquired infections, age influences the risk and timing of ocular involvement. The severity of toxoplasmic retinochoroiditis (in terms of lesion size, location and associated inflammation) is also affected by patient age at the time of initial infection or recurrence. The risk of recurrent toxoplasmic retinochoroiditis is influenced by age at the time of initial infection and age at most recent episode of active disease. Understanding of relationships between ocular toxoplasmosis and patient age is incomplete; evidence has often been indirect and in some cases conflicting. The influence of patient age on ocular toxoplasmosis should be studied in a systematic manner to provide a better understanding of disease mechanisms and to provide clinical information that can used to establish better strategies for disease treatment and prevention.

To assess the long-term risk of developing permanent AF in relation to the signal-averaged P wave duration (SAPWD) and clinical and echocardiographic characteristics.In an observational study design we studied 131 patients with earlier ECG-documented AF and successfully restored sinus rhythm attending a long-term, follow-up visit at hospital or at home. Established permanent AF was examined in relation to primary clinical, echocardiographic, and electrophysiological parameters.Only prolonged SAPWD (p=0.006) was associated with an increased risk of development of permanent AF. The risk of permanent AF after 3 years follow-up was 0.72 with an SAPWD equal to 180 ms versus 0.39 with a normal SAPWD (130 ms). We found no prognostic effect of age, gender, dilated left atrium, long duration of AF history, or long duration of the most recent episode of AF. Co-existing hypertension reduced the risk of permanent AF; this could be explained by concomitant treatment with angiotensin-converting-enzyme-inhibitors.Prolonged SAPWD (a marker of atrial remodelling) appears to be a risk factor for long-term development of permanent AF.

The recent episode in Flint, Michigan, has brought the issue of lead in water into the public eye. But the dangers of lead exposure have been recognized for millennia, and we have the knowledge required to redress this social crime — if only we had the political will.

We present the case of a 63-year-old woman with heterotaxy syndrome and polysplenia who presented with clinical signs and symptoms of recurrent acute pancreatitis in which the biliary origin had been seen in the most recent episode. This syndrome is rare in adult patients because it is associated with congenital heart defects. It is important to know the visceral anomalies that are common in this syndrome to avoid confusing them with pathological processes.

Young injectors are a group with high-risk behaviours, particularly with respect to HIV infection and hepatitis C. A leading strategy to prevent these infections could be the prevention of injection, especially among the youngest individuals. We report analyses on initiation into drug injection from a prospective cohort study of street youth conducted in Montreal, Canada. Among 118 non-injector participants under 18 years of age followed for an average of 1.31 years, we estimated an incidence rate of injection of 22.7 per 100 person-years. Independent predictors of initiation were: a lifetime history of use of ≥4 types of drugs, recent daily alcohol drinking, a recent episode of homelessness, a lifetime history of rape, and recent involvement in survival sex. The observed high rate of initiation into injection clearly indicates that interventions to prevent injection should target especially adolescent street youth. These interventions should address simultaneously individual and structural factors, such ...

This investigation assessed the relationships among recalled, expected, and actual muscle pain intensity and unpleasantness during a period of 48 hours. We hypothesized that (1). specific expectations of pain after 24 hours would account for a significant amount of variance in actual pain, (2). recalled pain from the most recent episode of naturally occurring muscle pain would be significantly associated with expected pain, and (3). the accuracy of expectations (ie, the difference between expected and actual pain) would increase across time as the onset of muscle pain occurred. Ninety-five students completed 3 sessions. In Session 1, recalled muscle pain and expected muscle pain in the next 24 hours were collected before exercise. In Sessions 2 and 3, muscle pain during movement and expected pain in the next 24 hours were collected. Recalled muscle pain was associated with expectations at baseline, r values [equals].26 to.47, P [lt ].05. The accuracy of expected intensity increased during the study, t [equals] 3.20, P [lt ].01, and the accuracy of expected unpleasantness was associated with change in expected unpleasantness, r values [equals] [minus ].28, P [lt ].01. The amount of variance in actual intensity and unpleasantness accounted for by expectations increased up to 55% and 52%, respectively, during the study. Expected unpleasantness did not account for variance in actual intensity. Expected intensity accounted for 3% of the variance in actual unpleasantness, but only in the second 24-hour period. Thus, our hypotheses were generally supported, but unanticipated findings regarding changes across time in the relationships among recalled, expected, and actual muscle pain were also detected.

Acute otitis media (AOM) is the most frequent bacterial disease and leading cause of antibacterial prescriptions in infants and children. Although AOM resolves spontaneously in most patients, antibacterial treatment is believed to be indicated in most industrial countries, particularly for infants, to prevent severe complications and relieve symptoms more rapidly. The classical duration of oral antibacterial therapy has been 10 days. During the last decade, the efficacy of shortened course antibacterial therapy has been demonstrated in many trials. Advantages of shorter treatment periods include less expense, better compliance, and potentially less impact on the commensal flora. However, short course antibacterial therapy may not be appropriate for children

The patient was a single, 36year-old white man. He was admitted to our institution due to agitated behavior and psychosis, with a diagnosis of bipolar I disorder from his most recent episode, which was mixed and severe with moodincongruent psychotic features. He presented with depressed mood of 3 weeks’ duration, associated with early and intermittent insomnia, decreased energy, racing thoughts, and psychomotor agitation. Furthermore, he exhibited persecutory delusions, believing that people were “out to get him,” and was thus physically aggressive to those he encountered. He denied any suicidal or homicidal ideations, and substance abuse screens returned with negative results. The patient was diagnosed with myasthenia gravis at 19 years, but because he was “living on the streets,” he failed to receive adequate treat

A 50-year-old male presented with recurrent effusion around the left knee joint. There was no history of trauma to the knee or recent episode of fever. On clinical examination, suprapatellar fullness with decreased range of movement was noted. However, there was no tenderness or redness of the overlying skin. There were no complaints in other joints of the body or a similar family history. He was advised X-ray of the knee joint (anteroposterior and lateral view) which showed advanced degenerative changes in the form of reduced tibiofemoral joint space, osteophyte formation with subchondral sclerosis, and cystic changes. A large suprapatellar fullness was also seen (Fig. 1). He was advised magnetic resonance imaging (MRI) to look for any synovial or intraarticular pathology (Figs. 2, 3 and 4).

1. History A 13-year-old boy was admitted for intermittent diarrhea and a recent episode of sharp, well localized pain in the left thigh. Blood tests, blood cultures and stool specimens were obtained during the intestinal work-up and the results were pending at time of radiological examination. The patient was referred for radiological work-up of the unspecific pain of the left femur. Conventional radiographs and fine focus magnification radiographs of the left femur were done. Because the findings on the conventional radiographs were inconclusive an MRIscan of both thighs was obtained.

SummaryThe object of this study was to analyse the results of laparoscopic cholecystectomy (LC) without previous endoscopic retrograde cholangiopancreatography (ERCP) in mild acute biliary pancreatitis (ABP) patients once the acute attack had resolved. Seventy-six patients were operated on after a recent episode of mild ABP, as determined by the presence of three or less positive Ranson-Imrie criteria (ABP-Group). Depending on the proximity of LC to the ABP attack, the ABP-Group was further divided into two subgroups. Forty patients were operated on during the first 2 weeks after the onset of pancreatic symptoms (early-LC subgroup), and 36 were operated on between 16 and 60 days (delayed-LC subgroup). The results are compared with 411 patients who underwent LC for uncomplicated cholelithiasis (Control-Group) during the same period. The operative time and incidence of common bile duct stones were significantly superior in the ABP-Group (p

Purpose: To determine predisposing factors, best method of treatment, and the final outcome in cases of Descemet's membrane detachment. Setting: A tertiary care teaching eye hospital. Methods: All cases of Descemet's detachment from January 1986 to May 1994 were retrospectively reviewed. Twelve eyes of 11 patients with partial or total detachment of Descemet's membrane were identified. Patients with small localized detachments at the incision area were excluded. Results: All but one patient had surgical repair. Ten eyes had successful reattachment after up to four attempts at repair. Methods of repair included intracameral air or sulfur hexafluoride (SF 6 ) 20% gas, with or without corneal sutures. After a followup of 3 to 79 months, eight eyes retained clear corneas, four eyes developed corneal edema and scarring, and two required penetrating keratoplasty. No definite predisposing factor could be identified, although four eyes had preoperative diagnoses of glaucoma and recent corneal edema. Conclusion: Surgical repair with injection of intracameral air or SF 6 20% was successful in most cases of Descemet's membrane detachment. A preoperative diagnosis of glaucoma and a recent episode of corneal edema may increase the risk of detachment.

W i d c l YOUR PATIENTS will be asking you about awareness under anesthesia quite a bit more in the near future. That’s because the subject has been a popular point of discussion in Hollywood. A recent episode of the TV series Nip/ Tuck dealt with awareness and, of course, the big blockbuster movie Awake (Fig 1) will be coming out in the fall. Anyone who has watched the medical dramas ER or Grey’s Anatomy knows that sometimes certain liberties are taken with the facts; however, many of our patients do not know that. The bloggers are already complaining that anesthesia healthcare providers have engaged in a conspiracy of keeping the problem of anesthetic awareness secret from the general public.

Purpose – The aim is to review developments on the internet, especially those of general cybernetic interest.Design/methodology/approach – A recent episode involving a hoax paper is reviewed, along with discussions of the implications for paper refereeing and information dissemination generally. Some sources of information on nanotechnology, with applications in medicine, are reviewed.Findings – That a hoax paper was accepted casts doubt on the review process, but the situation is not clear‐cut and the usefulness of mammoth conferences is also questioned. Nanotechnology is shown to be poised for major advances.Practical implications – The generation of a convincing hoax paper is an interesting technical achievement in itself. Implications for the review process are explored. Sources of information on nanotechnology are indicated.Originality/value – It is hoped this is a valuable periodic review.

Little literature exists addressing the risk of performing percutaneous coronary intervention (PCI) in patients who have had recent gastrointestinal bleeding (GIB). This study analyzed mortality, re-infarction and further GIB rates among patients who had PCI within 30 days of a GIB event. ICD-9

During a recent episode of procrastinating on the Internet, I came across an advertisement for Thudguard, a protective helmet for babies learning to walk. I'm not making this up: its motto is “You take the first step and protect your toddler's brain.” It turns out that not only does a walking helmet for normal toddlers exist, but Thudguard has a lot of competition on eBay.

ObjectivesBipolar I most recent episode-manic (BP-I-M) is an important cause of morbidity and mortality in hospitalized patients. While BP-I-M has been extensively studied in the past, the contemporary data for impact of BP-I-M on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 10,875 patients were analyzed; 57.13% were female and 42.87% were male (P < 0.0001); 74.78% were white, 14.51% black and 10.71% of other race (P < 0.0001). Rate of hospitalization increased from 528.71/million to 588.76/million from 1998–2011. Overall mortality was 0.42% and mean cost of hospitalization was 22,215.77$. The in-hospital mortality increased from 0.37% to 0.82% (P < 0.0001) and mean cost of hospitalization increased from 10,580.54$ to 40,737.65$. Total spending on BP-I-M related admissions have increased from $44.24 million/year to $187.00 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $44.24 million/year to $187.00 million/year, which leads to an estimated $ 142.76 million/year additional burden to US health care system from. In the era of cost conscious care, preventing BP-I-M related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for BP-I-M related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.