HIV/STI/HCV Risk Clusters and Hierarchies Experienced by Women Recently Released from Incarceration.

This study examines cross-sectional clusters and longitudinal predictions using an expanded SAVA syndemic conceptual framework-SAVA MH + H (substance use, intimate partner violence, mental health, and homelessness leading to HIV/STI/HCV risks)-among women recently released from incarceration (WRRI) (n = 206) participating in the WORTH Transitions (WT) intervention. WT combines two evidence-based interventions: the Women on the Road to Health HIV intervention, and Transitions Clinic. Cluster analytic and logistic regression methods were utilized. For the cluster analyses, baseline SAVA MH + H variables were categorized into presence/absence. For logistic regression, baseline SAVA MH + H variables were examined on a composite HIV/STI/HCV outcome collected at 6-month follow-up, controlling for lifetime trauma and sociodemographic characteristics. Three SAVA MH + H clusters were identified, the first of which had women with the highest overall levels of SAVA MH + H variables, 47% of whom were unhoused. Hard drug use (HDU) was the only significant predictor of HIV/STI/HCV risks in the regression analyses. HDUs had 4.32-fold higher odds of HIV/STI/HCV outcomes than non-HDUs (p = 0.002). Interventions such as WORTH Transitions must differently target identified SAVA MH + H syndemic risk clusters and HDU to prevent HIV/HCV/STI outcomes among WRRI.

The Impact of Surgical Scheduling on Outcomes in Lumbar Laminectomy.

Objective The purpose of this study was to determine whether surgical scheduling affected patient outcomes following lumbar laminectomy. Physician fatigue caused by prolonged work hours has been shown to worsen outcomes. Previous research has also established a relationship between surgical scheduling and outcomes. Methods This was a retrospective chart review of single-level lumbar laminectomy patients at the Penn State Milton S. Hershey Medical Center between 1992 and 2019. Patients who underwent a one-level laminectomy between 1992 and 2019 were included in the study. Patients with procedures defined as complex (>1 level, tumor or abscess removal, discectomy, implant removal) were excluded. The surgical complication rate [cerebrospinal fluid (CSF) leak, 30-day redo, 30-day ED visit, weakness, sensation loss, infection, urinary retention] was compared across surgical start times, day of the week, proximity to a holiday, and procedure length. Results Procedures that started between 9:01-11:00 were more likely to have a complication than those between 7:01-9:00 (p=0.04). For every 60-min increase in surgery length, odds of having a complication increased by 2.01 times (p=0.0041). Surgeries that started between 11:01-13:00 had a significantly longer median surgery length than those between 7:01-9:00. Conclusion The time of the day when the procedure was started was predictive of worse outcomes following laminectomy. This may be attributed to several factors, including fatigue and staff turnover. Additionally, increased surgical length was predictive of more complications. It remains unclear whether increased surgical time results from correction of noticed errors or a fatigue-related decline in speed and performance. These findings on one-level laminectomy warrant further investigations since they have implications for reducing systemic failures that impact patient outcomes.

Innervation of taste buds revealed with Brainbow-labeling in mouse.

Nerve fibers that surround and innervate the taste bud were visualized with inherent fluorescence using Brainbow transgenic mice that were generated by mating the founder line L with nestin-cre mice. Multicolor fluorescence revealed perigemmal fibers as branched within the non-taste epithelium and ending in clusters of multiple rounded swellings surrounding the taste pore. Brainbow-labeling also revealed the morphology and branching pattern of single intragemmal fibers. These taste bud fibers frequently innervated both the peripheral bud, where immature gemmal cells are located, and the central bud, where mature, differentiated cells are located. The fibers typically bore preterminal and terminal swellings, growth cones with filopodia, swellings, and rounded retraction bulbs. These results establish an anatomical substrate for taste nerve fibers to contact and remodel among receptor cells at all stages of their differentiation, an interpretation that was supported by staining with GAP-43, a marker for growing fibers and growth cones.

Risperidone and lorazepam concomitant use in clonazepam refractory catatonia: a case report.

The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. Atypical antipsychotics may be a new alternative in the treatment of catatonia. Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.

Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience.

BACKGROUND: Long-term results of Roux-en-Y gastric bypass (RYGB) are nonexistent in the veterans affairs (VA) population. We compare excess weight loss (EWL) success and medical comorbidity changes between the VA and non-VA population after RYGB. METHODS: Retrospective review of consecutive subjects undergoing RYGB from 1997 to 2002 at the Los Angeles VA. Weight and comorbidity data were collected every 6 and 12 months, respectively. RESULTS: Fifty-nine subjects were included; 54%, 58%, 46.8%, and 44.1% of subjects achieved EWL >50% at years 1 to 4. Hypertension resolved in 23%, 30%, and 32% at months 12 to 36. Obstructive sleep apnea resolved in 37%, 48%, 48%, 44%, and 60% at months 12 to 60. Diabetes mellitus resolved in 86%, 84%, 79%, and 80% at months 12 to 48. Improvements in the lipid panel were observed by month 12 and maintained thereafter. CONCLUSIONS: EWL and proportion of subjects with resolved hypertension and obstructive sleep apnea are inferior to the non-VA population. Nevertheless, improvements in measures of success are maintained in the VA population.