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The current management of COVID-19 is mostly limited to general supportive care and symptomatic treatment. Ivermectin is a broad-spectrum anti-parasitic drug used widely for the treatment of onchocerciasis and lymphatic filariasis. Apart from its anti-parasitic effect it also exhibits antiviral activity against a number of viruses both in vitro and in vivo. Hence, we conducted this systematic review and meta-analysis to assess the currently available data on the therapeutic potential of ivermectin for the treatment of COVID‐19 as add on therapy. A total of 629 patients were included in the 4 studies and all were COVID-19 RT-PCR positive. Among them, 397 patients received ivermectin along with usual therapy. The random effect model showed the overall pooled OR to be 0.53 (95%CI: 0.29 to0.96) for the primary outcome (all-cause mortality) which was statistically significant (P=0.04). Similarly, the random effect model revealed that adding ivermectin led to significant clinical improvement compared to usual therapy (OR=1.98, 95% CI: 1.11 to 3.53, P=0.02). However, this should be inferred cautiously as the quality of evidence is very low. Currently, many clinical trials are on-going, and definitive evidence for repurposing this drug for COVID-19 patients will emerge only in the future.

The New Mexico Department of Health (NMDOH) conducted a matched case-control study to compare 315 persons (cases) with and 945 persons (controls) without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) secondary detection (ie, positive SARS-CoV-2 test ≥90 days after first detection as of December 10, 2020). Compared with controls, cases had greater odds of higher SARS-CoV-2 testing frequency (adjusted odds ratio [aOR] = 1.2), being female (aOR = 1.6), being non-Hispanic American Indian/Alaska Native (aOR = 2.3), having diabetes mellitus (aOR = 1.8), and residing and/or working in detention and/or correctional facilities (aOR = 4.7). Diagnostic tools evaluating infectiousness at secondary detection are urgently needed to inform infection control practices., Individuals positive for SARS-CoV-2 ≥90 days after first detection received tests more frequently and were more often female, non-Hispanic American Indian/Alaska Native, diabetic, and associated with detention/correctional facilities compared with individuals without a positive test ≥90 days after first detection.

Background and objectives Although gaming disorder is increasingly recognized, there has been limited consideration of the impact of free-to-play games with in-game purchases, also called microtransactions. Methods Case report (n = 1). Results A patient with posttraumatic stress disorder, major depressive disorder in remission, polysubstance use disorders in remission, and opioid use disorder on buprenorphine/naloxone developed gaming disorder (based on International Classification of Diseases, 11th revision) and spent up to 40% of his monthly income on microtransactions within a smartphone game. Treatment consisted of relinquishing access to electronic payment mechanisms, motivational interviewing, and couples therapy. Discussion and conclusions The case highlights how in-game purchases may cause patients with gaming disorder to experience financial consequences, and the need for further characterization of the clinical ramifications of microtransactions. Scientific significance To the best of our knowledge, this is the first report in the medical literature of a patient with gaming disorder developing excessive in-game spending from expenditures on microtransactions. (Am J Addict 2020;29:528-530).

AIM: Patients are asking health care providers about e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME). SETTING: A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social). PARTICIPANTS: From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/student/other; 41% were international. PROGRAM DESCRIPTION: The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units. PROGRAM EVALUATION: A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias. DISCUSSION: Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches.

Many anti-inflammatory drugs like, tocilizumab, N-acetylcystiene and etolizumab has been repurposed for the management of COVID-19 with variable success. Colchicine exhibits anti-inflammatory activity by tubulin disruption and inhibition of leucocyte-mediated inflammatory activities like production of superoxide and release of various cytokines which are central to the pathophysiology of COVID-19. So, this systematic review and meta-analysis assessed the currently available data on the use of colchicine for the treatment of COVIDLJ19. A total of 3 studies (2 RCTS and 1 observational study) including 402 patients were included out of which 194 patients received colchicine. The random effect model showed the overall pooled OR to be 0.32 (95%CI: 0.18 to 0.56) for the primary outcome (Clinical deterioration) which was statistically significant (p

Este artículo se encuentra disponible en la siguiente URL: https://journals.sagepub.com/doi/pdf/10.1177/1098612X211028834 En este artículo de investigación también participan: Elvin Kulendra, Hannah Clarke, Jessica McCarthy, Nuria Fernandez-Salesa, Sorrel Langley-Hobbs, Josep Aisa, Timothy Parkin, Elena S. Addison. Objectives The aim of the study was to describe traumatic stifle injury in cats and report complications and longterm outcome. Methods The medical records from seven veterinary hospitals of cats treated for traumatic stifle injury were reviewed. Long-term follow-up data were collected from referring veterinarians and using the Feline Musculoskeletal Pain Index, collected from owners. Results Seventy-two cats were included in the study. The most common combination of ligament injury involved both cruciate ligaments and the lateral collateral ligament (25.4%). Medial meniscal injury was more common (66.2%) than lateral meniscal injury (59.4%). A temporary transarticular pin was used intraoperatively to aid reduction in 23/73 (31.5%) surgeries. Postoperative immobilisation was applied in 41/72 (56.9%) cats with a mean duration of 4.8 weeks. Short-term complications occurred in 40/64 (62.5%) cats. Long-term complications occurred in seven (17.5%) cats. Overall outcome was excellent in 25/61 (41%) cats, good in 13/61 (21.3%) cats, fair in 11/61 (18%) cats and poor in 12/61 (19.7%) cats. Mean length of follow-up was 29.6 months (range 0.5–204). A significantly poorer outcome was observed in cats with medial meniscal injury and those undergoing revision surgery. Use of a transarticular pin when left in situ for postoperative immobilisation was associated with a poorer outcome (P = 0.043) and a higher risk of complications (P = 0.018). Postoperative immobilisation was not related to outcome. Conclusions and relevance Traumatic stifle injury in cats can lead to rupture of multiple ligaments causing significant instability of the joint. Surgical treatment is associated with a high rate of short-term complications, although longterm outcome may still be good to excellent in the majority of cats (62.3%). In cats where follow-up was available, postoperative immobilisation had no positive effect on outcome and may not be required. Leaving a transarticular pin for postoperative immobilisation is not recommended as it was significantly associated with a poorer outcome and a higher complication rate.

Case summary A 15-year-old neutered male domestic shorthair cat presented with a 4-week history of dysphonia and reluctance to chew hard food. Oral examination revealed a mass lesion on the caudal soft palate. Biopsy was performed and histopathology with immunohistochemistry was most consistent with histiocytic sarcoma. CT of the head identified a discrete, left-sided, soft tissue mass lesion cranial to the tonsil with bilaterally symmetrical regional lymph nodes. CT of the thorax was unremarkable. Surgical removal achieved cytoreduction but not complete removal. Adjuvant chemotherapy with lomustine 10 mg (30 mg/m2) was initiated. The patient developed suspected pancreatitis 2–3 weeks postoperatively, so further chemotherapy treatment was discontinued, but supportive treatment with pain relief and appetite stimulants was provided. Three months postoperatively, the patient developed recurrent dysphonia, and oral examination revealed a suspicion of local recurrence. Confirmation of diagnosis (cytopathology or histopathology) was not obtained. Supportive treatment to maintain a good quality of life was continued and the patient was euthanased 6 months after diagnosis owing to progressive disease. Relevance and novel information Only a few reports have been published describing histiocytic diseases of cats. To our knowledge, this is the first report of a feline histiocytic sarcoma of the oral cavity. Therefore, histiocytic sarcoma should be considered as a differential diagnosis in feline patients with an oral mass, especially if histopathology suggests a pleomorphic and poorly differentiated sarcoma. Immunohistochemistry for the confirmation of cell line origin would be strongly recommended.

Introduction Individuals with substance use disorders and/or mental health (MH) conditions have higher rates of cigarette smoking than the general population. Electronic nicotine delivery systems (ENDS) while gaining popularity pose health risks. Herein we investigate risk perceptions and attitudes toward e-cigarettes in military Veterans with MH conditions. Materials and Methods Participants included U.S. Veterans receiving services from Veterans Administration MH/substance use disorder clinics in the San Francisco Bay Area (N = 98; 95% male, 44% White, 34% Black/African American), who completed a survey on smoking and health. Results compare attitudes and perceptions regarding e-cigarette use between ever and never e-cigarette users. The study was reviewed by the Institutional Review Board at both the Veterans Administration and University. Results Most respondents reported being current/past cigarette smokers (91%) and over a third reported having ever used an e-cigarette (38%). Most believed that e-cigarettes are not safe, are potentially dangerous, are potentially addictive if they use every day and are tempting and appealing to youth. Fifty-one percent of ever-users agreed with a statement that e-cigarettes can help people quit smoking regular cigarettes completely, and there was a significant difference in this belief when comparing them with never-users (23% agreed); χ2 = 9.259, P = 0.010. Conclusions Proportion of e-cigarette use in this Veteran sample is greater than the general population. We observed high risk perception about e-cigarettes among all respondents and differences in perceived helpfulness of e-cigarettes for quitting in ever-users versus never-users in this sample. More consistent assessment of tobacco use among Veterans, with inclusion of ENDS use, would help inform prevention and treatment priorities, especially as information on health impacts of ENDS surfaces.

Tobacco use remains a global problem, and options for consumers have increased with the development and marketing of e-cigarettes and other new nicotine and tobacco products, such as "heat-not-burn" tobacco and dissolvable tobacco. The increased access to these new products is juxtaposed with expanding public health and clinical intervention options, including mobile technologies and social media. The persistent high rate of tobacco-use disorders among those with psychiatric disorders has gathered increased global attention, including successful approaches to individual treatment and organizational-level interventions. Best outcomes occur when medications are integrated with behavioral therapies and community-based interventions. Addressing tobacco in mental health settings requires training and technical assistance to remove old cultural barriers that restricted interventions. There is still "low-hanging fruit" to be gained in educating on the proper use of nicotine replacement medications, how smoking cessation can change blood levels of specific medications and caffeine, and how to connect with quitlines and mobile technology options. Future innovations are likely to be related to pharmacogenomics and new technologies that are human-, home-, and community-facing.El uso de tabaco sigue siendo un problema mundial, y las opciones para los consumidores han aumentado con el desarrollo y comercialización de cigarrillos electrónicos y otros nuevos productos de la nicotina y del tabaco, como el tabaco que “calienta pero no quema” y el tabaco soluble. El aumento del acceso a estos nuevos productos está yuxtapuesto con el desarrollo de la salud pública y de las opciones de intervenciones clínicas, incluyendo las tecnologías móviles y los medios de comunicación social. El persistente aumento en la frecuencia de los trastornos por uso de tabaco entre los pacientes con trastornos psiquiátricos ha atraído una mayor atención mundial, incluyendo intervenciones exitosas a nivel de los tratamientos individuales y en las organizaciones. Los mejores resultados se obtienen cuando se combinan medicamentos con terapias conductuales e intervenciones a nivel de la comunidad. El tratamiento del tabaquismo en los ambientes de salud mental requiere entrenamiento y asistencia técnica para remover las antiguas barreras culturales que restringen las intervenciones. Todavía hay posibilidades fáciles para enseñar la utilización correcta de medicamentos que reemplacen a la nicotina, para saber que el dejar de fumar puede modificar los niveles plasmáticos de determinados fármacos y de cafeína, y para conocer cómo conectarse con aplicaciones de tecnologías móviles y líneas telefónicas orientadas a dejar de fumar. Es probable que las futuras innovaciones estén relacionadas con la farmacogenómica y con nuevas tecnologías orientadas a los humanos, a la casa y a la comunidad.L'usage du tabac reste un problème mondial, de nouvelles options se présentant aux consommateurs avec le développement et la commercialisation des cigarettes électroniques et d'autres nouveaux produits dérivés du tabac et de la nicotine, comme le tabac « qui chauffe mais ne brûle pas » et le tabac soluble. L'accès accru à ces nouveaux produits se juxtapose au développement de la santé publique et aux options d'intervention clinique, telles que les technologies mobiles et les médias sociaux. L'attention générale s'est focalisée sur le taux élevé persistant des troubles liés au tabac parmi les patients qui ont des troubles psychiatriques, et notamment sur le succès des traitements individuels et des interventions organisationnelles. Les résultats sont meilleurs quand les traitements sont intégrés à des thérapies comportementales et à des interventions de proximité. Le traitement du tabagisme dans le cadre de la santé mentale nécessite une formation et une assistance technique pour supprimer les barrières culturelles qui restreignent les interventions. Il existe encore des solutions faciles à mettre en oeuvre pour éduquer les patients à l'utilisation correcte des substituts nicotiniques, leur expliquer comment l'arrêt du tabac change les taux sanguins de certains médicaments spécifiques et de la caféine et leur apprendre à se connecter aux applications mobiles et aux lignes téléphoniques dédiées à l'arrêt du tabac. De futures innovations seront probablement liées à la pharmacogénomique et à de nouvelles technologies qui seront tournées vers l'humain, la maison et la population.

Author(s): Das, Smita; Hickman, Norval J; Prochaska, Judith J | Abstract: ObjectivesTobacco use is undertreated in individuals with psychiatric and substance use disorders (SUDs), with concerns that quitting smoking may compromise recovery. We evaluated outcomes of a tobacco intervention among psychiatric patients with co-occurring SUDs.MethodsData from 2 randomized tobacco treatment trials conducted in inpatient psychiatry were combined; analyses focused on the subsample with co-occurring SUDs (n = 216). Usual care provided brief advice to quit and nicotine replacement therapy during the smoke-free hospitalization. The intervention, initiated during hospitalization and continued 6 months after hospitalization, was tailored to readiness to quit smoking, and added a computer-assisted intervention at baseline, and 3 and 6 months; brief counseling; and 10 weeks of nicotine replacement therapy after hospitalization. Outcomes were 7-day point prevalence abstinence from 3 to 12 months and past 30-day reports of alcohol and illicit drug use.ResultsThe sample consisted of 34% women, among which 36% were Caucasian, averaging 19 cigarettes/d prehospitalization; the groups were comparable at baseline. At 12 months, 22% of the intervention versus 11% of usual care participants were tobacco-abstinent (risk ratio 2.01, P = 0.03). Past 30-day abstinence from alcohol/drugs did not differ by group (22%); however, successful quitters were less likely than continued smokers to report past 30-day cannabis (18% vs 42%) and alcohol (22% vs 58%) use (P l 0.05), with no difference in other drug use.ConclusionsTobacco treatment in psychiatric patients with co-occurring SUDs was effective and did not adversely impact recovery. Quitting smoking was associated with abstinence from alcohol and cannabis at follow-up. The findings support addressing tobacco in conjunction with alcohol and other drugs in psychiatric treatment.

Background: Thirst is reported as a troublesome symptom in patients with heart failure (HF), and very few studies have been done to assess thirst in these patients. Therefore, this study aims to assess thirst intensity, thirst distress, and practices of HF patients to manage thirst. Methods: A descriptive, cross-sectional study was conducted on 75 HF patients admitted to the cardiology department. Purposive sampling technique was used for collecting data from July 2019 to November 2019. Visual analog scale (0–100 mm) was used to assess thirst intensity, and 8-item thirst distress scale was used to assess thirst distress. The practices of the participants were assessed using a self-developed questionnaire. Results: The mean age of the participants was 44.83 ± 15.51 years and the majority (72%) was male. The majority of the participants (82.7%) had fluid restriction, and almost 97.3% of all of the participants were receiving diuretics. The median (interquartile range) thirst intensity was 33 (16–50) mm. About 66.7% of the participants had moderate-to-severe thirst distress. Both thirst intensity and thirst distress were associated with fluid restriction, New York Heart Association functional class, and serum urea level. The participants reported that they drink a small amount of water frequently, gargle with water, eat cucumber, drink buttermilk, lemon juice, and coconut water. Very few participants had made changes in their food habits and lifestyle. Conclusion: Two-thirds of the participants had moderate-to-severe thirst distress. Fluid restriction was associated with both thirst intensity and thirst distress. Thus, nurses are responsible to assess thirst among HF patients and help them to manage their thirst effectively.

Tobacco use disorder is the most common substance use disorder among individuals with any other psychiatric disorder, resulting in enormous health disparities, shorter lifespan, increased suicide risk, and reduced quality of life compared with others, due in part to general medical conditions caused or worsened by tobacco use. Tobacco use can have financial, employment, relationship, and other personal consequences. Mental health and addiction treatment settings have historically ignored tobacco use; however, psychiatrists and others have recently recognized their crucial role in helping patients to quit. A culture change is needed that values addressing tobacco use in behavioral treatment settings to support the integration of evidence-based practices for assessing and treating tobacco use disorder. This clinically focused article provides up-to-date information for practicing psychiatrists on how to increase screening, assessment, and treatment of tobacco use disorder. Clinical tools, such as the carbon...

Aims: The prevalence of alcohol use disorders (AUDs) among hospitalized medically ill patients exceeds 40%. Most AUD patients experience uncomplicated alcohol withdrawal syndrome (AWS), requiring only supportive medical intervention, while complicated AWS occurs in up to 20% of cases (i.e. seizures, delirium tremens). We aimed to prospectively test and validate the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), a new tool to identify patients at risk for developing complicated AWS, in medically ill hospitalized patients. Methods: We prospectively considered all subjects hospitalized to selected general medicine and surgery units over a 12-month period. Participants were assessed independently and blindly on a daily basis with PAWSS, Clinical Institute Withdrawal Assessment—Alcohol, Revised (CIWA-Ar) and clinical monitoring throughout their admission to determine the presence and severity of AWS. Results: Four hundred and three patients were enrolled in the study. Patients were grouped by PAWSS score: Group A (PAWSS < 4; considered at low risk for complicated AWS); Group B (PAWSS ≥ 4; considered at high risk for complicated AWS). The results of this study suggest that, using a PAWSS cutoff of 4, the tool’s sensitivity for identifying complicated AWS is 93.1% (95%CI[77.2, 99.2%]), specificity is 99.5% (95%CI[98.1, 99.9%]), positive predictive value is 93.1% and negative predictive value is 99.5%; and has excellent inter-rater reliability with Lin’s concordance coefficient of 0.963 (95% CI [0.936, 0.979]). Conclusion: PAWSS has excellent psychometric characteristics and predictive value among medically ill hospitalized patients, helping clinicians identify those at risk for complicated AWS and allowing for prevention and timely treatment of complicated AWS.

Diabetes Mellitus (DM) is a metabolic disorder characterized by relative or absolute deficiency of insulin, resulting in hyperglycemia. Subcutaneous insulin and Oral Hypoglycaemic Agents (OHA) constitute the main treatment option for DM. Insulin is administered by injection or continuous infusion to control glucose levels mainly in Type I diabetes. Newer routes both oral and non oral, for insulin administration are current direction of insulin research as insulin injection therapy is burdensome and painful for many patients. Inhalational insulin is an attractive alternative for systemic administration of insulin given its accessibility and large alveolar-capillary network of lungs for drug absorption. Afrezza, inhaled insulin has been recently approved by Food and Drug Administration (FDA). It is a new, quicker acting inhalable insulin with a different and safer pharmacokinetic profile in comparison to previously failed inhaled form of insulin.

Tobacco use remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of “the host” (e.g., tobacco user characteristics), the “agent” (e.g., nicotine product characteristics), the “vector” (e.g., tobacco industry), and the “environment” (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness.

The medical records of cats receiving surgical treatment for unilateral patellar ligament rupture between 1999 and 2012 at 12 referral centres in the UK and Ireland were reviewed. Seven cases were identified: six were caused by trauma and one was iatrogenic, occurring as a complication following surgical stabilisation of a tibial fracture. All cases were treated by sutured anastomosis of the ruptured ligament, with six of the repairs protected by a circumpatellar and/or transpatellar loop of suture. The stifle was immobilised by transarticular external skeletal fixation in three cases. No cases required revision surgery. No complications were reported. Final evaluation, performed at a median time of 31 days, determined five patients to have returned to acceptable or good limb function; two cases were lost to follow-up. The data suggest that, in cats, the current surgical techniques extrapolated from their canine counterparts for repair of a completely or partially ruptured patellar ligament are successfully used and result in acceptable limb function.

Background: Adverse drug reactions (ADRs) are one of the prime causes of morbidity and mortality, increase in hospital stay and socioeconomic burden on the patients. Periodic monitoring aids in formulating methods for safe usage of medicines in hospitals. This study was undertaken to study the patterns, assessment of causality, severity, preventability, body systems affected from ADRs received by the Pharmacovigilance cell, Department of Pharmacology between April 2018 to June 2019.Methods: The present study is an observational, retrospective, non-interventional analysis of voluntarily reported ADRs. Demography of patients, causative drugs, reactions, outcome, and severity are recorded. Data were analysed and expressed in numbers, percentages.Results: A total of 180 ADRs were spontaneously reported. Dermatology (42.8%), psychiatry (23.9%) and general medicine (18.3%) are the major departments reporting ADRs in our hospital. 60.6% reports were in males. The body system with maximum reactions is dermatological (51.1%). Drug class most commonly affected is anti-microbials (36.1%). Paracetamol (8.9%) is the most common drug with reactions. Causality assessment stated that 41.7% ADRs are probable and 58.3% were possible. Severity assessment showed 86.7% as mild and 13.3% as moderate. Preventability assessment stated that 93.3% ADRs not preventable, 5.6% probably preventable and 1.1% definitely preventable.Conclusions: The study provides a valuable insight with regards to the pattern of ADRs in our hospital. This will be useful in initiating a reporting culture, increase awareness, reducing under-reporting of ADR in our set up.

Background: Nursing staffs spend most time in patient care and are bedside caregivers. To expect voluntary reporting of adverse reactions, it is essential that they possess proper knowledge, right attitude and practice reporting. Therefore, the present study was aimed to assess the Knowledge, Attitude and Practice of Pharmacovigilance towards ADRs reporting.Methods: A prospective, cross sectional, observational, questionnaire-based survey was conducted among nurses in a tertiary care teaching hospital in Eastern India. Questionnaire containing 15 questions was used to assess knowledge, attitude and practice. The questionnaire was administered to 150 nurses. Analysis of data was done using statistical software..Results: The response rate in our study was 86.67%. Nurses have good knowledge of pharmacovigilance and adverse reaction. However, only 10% have reported an adverse reaction in our study. This shows that in spite of having a good knowledge of reporting, nurses have poor attitude, which is reflected by a low reporting rate. Nurses opined that taking patient care is of prime importance than report an adverse reaction. This corroborates the low reporting rate in our set up.Conclusions: Majority of nurses have good knowledge on pharmacovigilance and adverse drug reaction. The concern remains on the low reporting rate. Continuous training programmes, and reminders likely to enhance the voluntary reporting from the nursing staffs.

Background: Diabetes mellitus is a common chronic disease. One of the pathophysiology is found to be oxidative stress. This study aims to evaluate the effect of resveratrol on oxidative stress in high fat diet (HFD)/streptozotocin induced diabetic rats.Methods: Wistar albino rats, fed with HFD rendered diabetic with streptozotocin, were divided into 6 groups, namely the diabetic control treated with vehicle (DC), standard control which received metformin (SC), test groups treated with 5,10, and 20 mg/kg b.w. of resveratrol and combination of half dose of metformin and resveratrol (10 mg/kg)(TC). A group of six normal animals served as normal control (NC), another six as HFD control. Fasting blood glucose, lipid profile and serum MDA and SOD were measured one week after induction of diabetes. The animals were then treated orally for 2 weeks after which the same parameters were repeated. The in-vivo results were analysed by one way ANOVA followed by Tukey’s multiple comparison test.Results: The DC group demonstrated a increase in the fasting blood glucose compared to NC, HFD control while a significant decrease in the fasting blood glucose was observed with SC, Test groups (p

Background: The prognostic implications and significance of hypoalbuminemia after surgical intervention is significant. In this study, we assess the predictive value of preoperative serum albumin level on postoperative morbidity and mortality following surgical intervention in acute abdomen. Methods: In this retrospective study, Medical records of 110 patients with estimated preoperative serum albumin level undergoing exploratory laparotomy with acute abdominal conditions in a tertiary health care centre were reviewed. Patients with record of preoperative serum albumin level were reviewed. Albumin less than 3.2 g/dL was recognized as hypoalbuminemia. Types of surgery, postoperative complications, and mortality rates were collected. The association between preoperative serum albumin level and postoperative morbidity and mortality was assessed. Results: Preoperative serum albumin level of 3.2g/dl was found in 33 (30%) cases and 77 (70%) patients had same or less than 3.2g/dl albumin. Patients with preoperative serum albumin less than 3.2 g/dL had complications in 50 (45.5%) cases than that of normal preoperative albumin levels (07: 5.5%; p= 3.2g/dl and 28 cases with less than 3.2g/dl (p= 3.2g/dl serum albumin against 20 cases (25%) with less than 3.2g/dl. (p=0.0187; 95% CI=0.066-0.997). Conclusions: Preoperative hypoalbuminemia is an independent risk factor for postoperative complications after emergency laparotomy.

Tobacco use disorders (TUDs) continue to be overly represented in patients treated in mental health and addiction treatment settings. It is the most common substance use disorder (SUD) and the leading cause of health disparities and increased morbidity/mortality amongst individuals with a psychiatric disorder. There are seven Food and Drug Administration (FDA) approved medications and excellent evidence-based psychosocial treatment interventions to use in TUD treatment. In the past few years, access to and use of other tobacco or nicotine emerging products are on the rise, including the highly publicized electronic cigarette (e-cigarette). There has also been a proliferation of technology-based interventions to support standard TUD treatment, including mobile apps and web-based interventions. These tools are easily accessed 24/7 to support outpatient treatment. This update will review the emerging products and counter-measure intervention technologies, including how clinicians can integrate these tools and other community-based resources into their practice.

World of sports have been rocked by doping scandals every now and then and World Anti-Doping Agency(WADA) has banned several offending drugs at different times to counter this menace. Meldonium is the recent addition to the long list of drugs banned by WADA to prevent its misuse among the athletes. Meldonium is a carnitine synthesis inhibitor and has been approved by some European countries for the management of cardiac diseases like angina pectoris and congestive cardiac failure. Apart from these, it has numerous other indications like bronchial asthma, bronchitis and retinopathies. It had also been used by athletes across the world because of its presumptive role in increasing the performance.

Congenital leukemia is a rare but a well-documented disease in which leukemic process is detected at birth or very shortly thereafter (Philip McCoy and Roy Overton, Commun Clin Cytom 22:85–88, 1995). These leukemias represent approximately 0.8 % of all childhood leukemias. We present a case of congenital acute myeloid leukemia manifesting from the very first day of birth. Diagnosis of acute myeloid leukemia was suspected by the presence of blasts in the peripheral blood smear and was confirmed on bone marrow by flowcytometry. Karyotyping revealed Trisomy 21.

Background Both providers and payors bear the financial risk associated with complications of poor quality care. But the stakeholder who bears the largest burden of this risk has a strong incentive to support quality improvement activities. The goal of the present study was to determine whether hospitals or payors incur a larger burden of increased hospital costs associated with complications. Study design We merged clinical data for 1,008 surgical patients from the private sector National Surgical Quality Improvement Program to the internal cost-accounting database of a large university hospital. We then determined the marginal costs of surgical complications from the perspective of both hospitals (changes in profit and profit margin) and payors (increase in reimbursement paid to the hospital). In our analyses of cost and reimbursement, we adjusted for procedure complexity and patient characteristics using multivariate linear regression. Results Reimbursement for patients without complications ($14,266) exceeded hospital costs ($10,978), generating an average hospital profit of $3,288 and a profit margin of 23%. When complications occurred, hospitals still received reimbursement in excess of their costs, but the profit margin declined: reimbursement ($21,911) exceeded hospital costs ($21,156), yielding an average profit of $755 and a profit margin of 3.4%. Complications were always associated with an increase in costs to health-care payors: complications were associated with an average increase in reimbursement of $7,645 (54%) per patient. Conclusions Hospitals and payors both suffer financial consequences from poor-quality health care, but the greater burden falls on health-care payors. Strong incentives exist for health-care payors to become more involved in supporting quality improvement activities.

The present study aimed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases. Using a nonrandomized, observational design, we recruited six hospitals to participate in the study. The research team helped implement the program during the first year of participation (implementation) and then withdrew from active involvement during the second year (institutionalization). The mean 6-month self-reported cessation rates were 26.3% (range = 17.6%-52.8%) for the implementation phase and 22.7% (range = 12.9%-48.2%) for the institutionalization phase. Hospitals with paid professionals providing the program had the best outcomes. Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25%.

The medical records of dogs receiving surgery for unilateral patellar ligament rupture between 1999 and 2012 at 12 multidisciplinary referral centres were reviewed. Forty-three cases were identified; 26 were traumatic in origin; almost one-third were iatrogenic, of which over three-quarters occurred as a complication following surgical stabilisation of patellar luxation. Treatment involved primary reapposition of the ligament (36 cases). The repair was protected by circumpatellar and/or transpatellar loop(s) of orthopaedic wire, nylon, polypropylene or polydioxanone suture (34 cases). Wire loops were more likely to require surgical removal compared with loops of other materials (P=0.0014). The stifle joint was immobilised postoperatively by the applications of a transarticular external skeletal fixator (taESF) in 17 cases and by external coaptation (EC) in 8 cases; in 18 cases, no postoperative joint immobilisation was provided. Complications specific to the method of immobilisation occurred in seven of the cases with taESF and six of the cases with EC. Revision surgery to address failure of repair was required in five cases. Outcome was classified as acceptable or good in over three-quarters of the cases (31/40) and poor in less than a quarter (9/40). These data highlight patellar ligament rupture as a complication of surgical stabilisation of patellar luxation.

Srikanth Vallurupalli1, Smita Das21Division of General Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA; 2Department of Kinesiology and Community Health, University of Illinois College of Medicine, Champaign, IL, USABackground: Beta1 (B1) selective blockers have been widely used for the treatment of neurocardiogenic syncope though clinical trials have shown conflicting degrees of efficacy.Objective: To study the clinical efficacy of B1 selective blockers compared to placebo in the treatment of neurocardiogenic syncope.Methods: Four placebo controlled randomized studies were identified after search of existing English language literature. Review Manager (RevMan version 5, Oxford, England) was used for statistical calculations. Both random and fixed effects models were used for analysis.Results: There was no demonstrable efficacy of B1 blockers compared to placebo even after a pre-specified sensitivity analysis. There was a trend towards more adverse events in the beta blocker group compared to placebo (OR = 2.03 CI = 0.83–3.95,P = 0.12).Conclusion: There is no clinical evidence for justifying the use of B1 selective blockers in the treatment of adult neurocardiogenic syncope. These agents may in fact lead to a higher rate of adverse events compared to placebo.Keywords: beta1 selective blockers, neurocardiogenic syncope