Possible Long-Term Cardiovascular Effects of COVID-19.

Coronavirus Disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has become a worldwide pandemic. Since 2019, the virus has mutated into multiple variants that have made it harder to eradicate and have increased the rate of infection. This virus can affect the structure and the function of the heart and can lead to cardiovascular symptoms that can have long-lasting effects despite recovery from COVID-19. These symptoms include chest pain, palpitations, fatigue, shortness of breath, rapid heartbeat, arrhythmias, cough and hypotension. These symptoms may persist due to myocardial injury, cardiac inflammation or systemic damage that may have been caused during infection. If these symptoms persist, the patient should visit their cardiologist for diagnosis and treatment plan for any type of cardiovascular disease that may have developed Post-COVID 19.

POCUS in Internal Medicine Curriculum: Quest for the Holy-Grail of Modern Medicine.

Point of care ultrasound (POCUS) is an essential component of emergency medicine training that has not taken hold in internal medicine training programs. Internal medicine residents can use POCUS to perform focused examinations and aid complicated procedures. However, while there is widespread interest in learning POCUS, training is not standardized amongst residency curriculums. Therefore, more strides are necessary to correctly implement POCUS training during residency training.

Associations of Use of Social Media and Psychopathology and Body Image in Pre- and Post-surgical Bariatric Samples: a Cross-sectional Analysis.

PURPOSE: Interest has grown regarding the impact of social media platforms on mental health including body image and internalized weight bias (IWB) in those who have struggled with weight issues. However, few studies have addressed social media usage in bariatric patient samples. The objective of this study was to understand how the amount of time spent on social media could serve as a predictor for IWB in both pre- and post-operative bariatric patients. MATERIALS AND METHODS: Pre- and post-operative patients at one academic medical center completed self-report measures assessing patients' IWB, depression, anxiety, body dissatisfaction, sociodemographic variables, and social media usage. Data were collected from March 2019 to April 2020. Statistical methods that included correlations, logistical regression models, and ANOVA analysis were used to determine the relationship between time spent on social media and other covariates. RESULTS: A total of 148 responses were collected from the pre-surgical population, with 81 responses from the post-surgical sample. At baseline, the majority of respondents used social media for approximately 1 h per day (n = 37; 27.82%). Time spent on social media was negatively associated with age (r = - 0.24 [- 0.40, - 0.08]), and positively associated with IWB (r = 0.20 [0.02, 0.36]) and anxiety (r = 0.21 [0.01, 0.39]). In the post-operative group, only the 6-month BMI (r = 0.29 [0.05, 0.49]) was positively associated with time spent on social media. CONCLUSION: Given this study's findings, providers are encouraged to become aware of patients' use of social media, and to understand the impact social media usage can have on the mental well-being of patients.

A concerning trend in geriatric pharmacy that merits evidence-based intervention.

The effects of polypharmacy on geriatric populations are an emerging concern that merits more exploration. The primary goal of this review was to evaluate the current body of knowledge on polypharmacy and explore the preventive and corrective measures to avoid negative outcomes. Even if a medication has an appropriate indication, polypharmacy in the geriatric population is associated with an increased risk of drug-drug or drug-condition interactions. Recent efforts to prevent polypharmacy include the development of interprofessional teams in clinics dedicated to medication review and reconciliation, deprescription plans aimed to safely discontinue potentially inappropriate medications, and inpatient screening tools that provide prescribing recommendations. In conclusion, polypharmacy affects a high percentage of the geriatric population. Current efforts to address and prevent polypharmacy are ongoing but have not been widely adopted.

Effects of chronically skipping meals on atrial fibrillation risk.

Atrial fibrillation is the most common form of arrhythmia and can result in significant morbidity and mortality. While there are many potential causes of atrial fibrillation that have been well studied, this work considers the potential effect of chronically skipping meals on the development of atrial fibrillation. The authors discuss the various processes that skipping meals initiates in the body that may ultimately result in atrial fibrillation. Through a better understanding of the various disease pathophysiologies that can contribute to the development of atrial fibrillation, this narrative review may help lead to more advanced therapeutic and preventive approaches.

Arrhythmias are conditions of the heart that cause it to beat abnormally. When the heart beats abnormally, this can result in disturbances in the functioning of the body in many ways. Symptoms can range from very minimal to severe and even death. Although there are various types of abnormal heart rhythms, atrial fibrillation is the most common form, and it originates in the upper chambers of the heart. Chronically skipping meals may increase the risk that one may develop atrial fibrillation through various processes. In this narrative review, the authors discuss these various processes in the hopes that this may help lead to more advanced therapeutic and preventive approaches.

The Upsurge of Impact Factors in Pediatric Journals Post COVID-19 Outbreak: A Cross-Sectional Study.

Background: Impact factor (IF) is a quantitative tool designed to evaluate scientific journals' excellence. There was an unprecedented upsurge in biomedical journals' IF in 2020, perhaps contributed by the increased number of publications since the COVID-19 outbreak. We conducted a cross-sectional study (2018-2020) to analyze recent trends in standard bibliometrics (IF, Eigenfactor, SNIP) of pediatric journals. We also estimated reference and publication counts of biomedical journals since publication volume determines the number of citations offered and IF. Methods: Various bibliometrics of pediatric journals and reference/publication volumes of biomedical journals were compared between 2020 vs. 2019 and 2019 vs. 2018. We also compared open access (OA) and subscription journals' trends. Finally, we estimated IF changes in the journals of a different specialty, pulmonology. Results: The study included 164 pediatric and 4,918 biomedical journals (OA = 1,473, subscription = 3,445). Pediatric journals' IFs had increased significantly in 2020 [median (IQR) = 2.35 (1.34)] vs. 2019 [1.82 (1.22)] (Wilcoxon: p-value < 0.001). IFs were unchanged between 2018 and 2019. Eigenfactor remained stable between 2018 and 2020, while SNIP increased progressively. Reference/publication volumes of biomedical journals escalated between 2018 and 2020, and OA journals experienced faster growth than subscription journals. IFs of pulmonary journals also increased considerably in 2020 vs. 2019. Conclusions: We report an upsurge in pediatric journals' IF, perhaps contributed by a sudden increase in publication numbers in 2020. Therefore, considering this limitation, IF should be cautiously used as the benchmark of excellence. Unlike IF, Eigenfactor remained stable between 2018 and 2020. Similar changes in IF were also observed among the journals of another specialty, pulmonology.

A narrative review of chronic alcohol-induced atrial fibrillation.

Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.

Lay abstract Alcohol use disorder (AUD) affects many people and can lead to many cardiovascular consequences, including arrhythmias. Higher alcohol intake (>3 drinks a day) is associated with higher risk of atrial fibrillation (AF). Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of AF in AUD populations is abstinence.

Sociodemographic predictors of COVID-19 vaccine acceptance: a nationwide US-based survey study.

OBJECTIVES: Acceptance of COVID-19 vaccination is attributable to sociodemographic factors and their complex interactions. Attitudes towards COVID-19 vaccines in the United States are changing frequently, especially since the launch of the vaccines and as the United States faces a third wave of the pandemic. Our primary objective was to determine the relative influence of sociodemographic predictors on COVID-19 vaccine acceptance. The secondary objectives were to understand the reasons behind vaccine refusal and compare COVID-19 vaccine acceptance with influenza vaccine uptake. STUDY DESIGN: This was a nationwide US-based survey study. METHODS: A REDCap survey link was distributed using various online platforms. The primary study outcome was COVID-19 vaccine acceptance (yes/no). Sociodemographic factors, such as age, ethnicity, gender, education, family income, healthcare worker profession, residence regions, local healthcare facility and 'vaccine launch' period (pre vs post), were included as potential predictors. The differences in vaccine acceptance rates among sociodemographic subgroups were estimated by Chi-squared tests, whereas logistic regression and neural networks computed the prediction models and determined the predictors of relative significance. RESULTS: Among 2978 eligible respondents, 81.1% of participants were likely to receive the vaccine. All the predictors demonstrated significant associations with vaccine acceptance, except vaccine launch period. Regression analyses eliminated gender and vaccine launch period from the model, and the machine learning model reproduced the regression result. Both models precisely predicted individual vaccine acceptance and recognised education, ethnicity and age as the most important predictors. Fear of adverse effects and concern with efficacy were the principal reasons for vaccine refusal. CONCLUSIONS: Sociodemographic predictors, such as education, ethnicity and age, significantly influenced COVID-19 vaccine acceptance, and concerns of side-effects and efficacy led to increased vaccine hesitancy.

Current Management Guidelines on Hyperlipidemia: The Silent Killer.

Given the high incidence of cardiovascular events in the United States, strict control of modifiable risk factors is important. Pharmacotherapy is helpful in maintaining control of modifiable risk factors such as elevated lipids or hypercholesterolemia. Hypercholesterolemia can lead to atherosclerotic disease which may increase the risk of acute coronary events. Statin therapy has long been a mainstay in the treatment of hypercholesterolemia, but while highly regarded, statin therapy also has side effects that may lead to patient noncompliance. Therefore, various medicines are being developed to manage hypercholesterolemia. This paper will discuss the role that lipids play in the pathophysiology of atherosclerotic disease, review the current lipid management guidelines, and discuss new treatment options that are alternatives to statin therapy.

COVID-19 mental health consequences on medical students worldwide.

Background: The COVID-19 epidemic has impacted medical education for medical students worldwide. As medical students are already vulnerable to poor psychological well-being, the mental health of medical students may be significantly affected by the changes caused by COVID-19. Objective: In this article, we discuss the curriculum and mental health ramifications of the COVID-19 epidemic on the international medical school population Methods: In this review, we analyzed 13 studies evaluating the impact of COVID-19 on medical school curriculum, medical student mental health, and subsequent medical student coping strategies. Results: Early in the COVID-19 outbreak, the Association of American Medical Colleges recommended to pause all student clinical rotations, while in-person curriculum moved to virtual modalities. Students expressed concern over their abilities to explore specialties of interest and their confidence in becoming a competent doctor. Medical students also reported higher levels of anxiety, stress, and exhaustion, with female students reporting this more than male students. Students have been coping with these challenges in quarantine through engaging in physical activity, spending time outdoors, and video chats. Conclusion: Medical education institutions must address the effects of COVID-19 on the mental health of their students in order to mitigate related consequences.

Systemic dendrimer-drug nanomedicines for long-term treatment of mild-moderate cerebral palsy in a rabbit model.

BACKGROUND: Neuroinflammation mediated by microglia plays a central role in the pathogenesis of perinatal/neonatal brain injury, including cerebral palsy (CP). Therapeutics mitigating neuroinflammation potentially provide an effective strategy to slow the disease progression and rescue normal brain development. Building on our prior results which showed that a generation-4 hydroxyl poly(amidoamine) (PAMAM) dendrimer could deliver drugs specifically to activated glia from systemic circulation, we evaluated the sustained efficacy of a generation-6 (G6) hydroxyl-terminated PAMAM dendrimer that showed a longer blood circulation time and increased brain accumulation. N-acetyl-L-cysteine (NAC), an antioxidant and anti-inflammatory agent that has high plasma protein binding properties and poor brain penetration, was conjugated to G6-PAMAM dendrimer-NAC (G6D-NAC). The efficacy of microglia-targeted G6D-NAC conjugate was evaluated in a clinically relevant rabbit model of CP, with a mild/moderate CP phenotype to provide a longer survival of untreated CP kits, enabling the assessment of sustained efficacy over 15 days of life. METHODS: G6D-NAC was conjugated and characterized. Cytotoxicity and anti-inflammatory assays were performed in BV-2 microglial cells. The efficacy of G6D-NAC was evaluated in a rabbit model of CP. CP kits were randomly divided into 5 groups on postnatal day 1 (PND1) and received an intravenous injection of a single dose of PBS, or G6D-NAC (2 or 5 mg/kg), or NAC (2 or 5 mg/kg). Neurobehavioral tests, microglia morphology, and neuroinflammation were evaluated at postnatal day 5 (PND5) and day 15 (PND15). RESULTS: A single dose of systemic 'long circulating' G6D-NAC showed a significant penetration across the impaired blood-brain-barrier (BBB), delivered NAC specifically to activated microglia, and significantly reduced microglia-mediated neuroinflammation in both the cortex and cerebellum white matter areas. Moreover, G6D-NAC treatment significantly improved neonatal rabbit survival rate and rescued motor function to nearly healthy control levels at least up to 15 days after birth (PND15), while CP kits treated with free NAC died before PND9. CONCLUSIONS: Targeted delivery of therapeutics to activated microglia in neonatal brain injury can ameliorate pro-inflammatory microglial responses to injury, promote survival rate, and improve neurological outcomes that can be sustained for a long period. Appropriate manipulation of activated microglia enabled by G6D-NAC can impact the injury significantly beyond inflammation.

Cerebellar injury and impaired function in a rabbit model of maternal inflammation induced neonatal brain injury.

Cerebellum is involved in higher cognitive functions and plays important roles in neurological disorders. Cerebellar injury has been detected frequently in patients with preterm birth resulting in cognitive dysfunction later in life. Maternal infection and inflammation is associated with preterm birth and in neonatal brain injury. We have previously shown that intrauterine lipopolysaccharide (LPS) exposure induces white matter injury and microglial activation in the cerebral white matter tracts of neonatal rabbits, resulting in motor deficits consistent with the clinical findings of cerebral palsy (CP). Here we investigated whether intrauterine LPS exposure induced cerebellar inflammation and functional impairment. Timed-pregnant New Zealand white rabbits underwent a laparotomy on gestational day 28 (G28) and LPS (3200 EU, endotoxin group) was injected along the wall of the uterus as previously described. Controls did not receive surgical intervention. Kits born to control and endotoxin treated dams were euthanized on postnatal day (PND)1 (3 days post-injury) or PND5 (7 days post-injury) and cerebellum evaluated for presence of inflammation. The microglial morphology in cerebellar white matter areas was analyzed using Neurolucida and Neurolucida Explorer. mRNA expression of inflammatory cytokines was quantified by real-time-PCR. We found that intrauterine exposure to LPS induced intensive microglial activation in cerebellar white matter areas, as evidenced by increased numbers of activated microglia and morphological changes (amoeboid soma and retracted processes) that was accompanied by significant increases in pro-inflammatory cytokines. The Purkinje cell layer was less developed in endotoxin exposed kits than healthy controls. In kits that survived to PND 60, soma size and cell density of Purkinje cells were significantly decreased in endotoxin exposed kits compared to controls. The findings of altered Purkinje cell morphology were consistent with impaired cerebellar function as tested by eye-blink conditioning at 1 month of age. The results indicate that the cerebellum is vulnerable to perinatal insults and that therapies targeting cerebellar inflammation and injury may help in improving outcomes and function.

Sirtuin 1 (SIRT1) Deacetylase Activity and NAD⁺/NADH Ratio Are Imperative for Capsaicin-Mediated Programmed Cell Death.

Capsaicin is considered a chemopreventive agent by virtue of its selective antigrowth activity, commonly associated with apoptosis, against cancer cells. However, noncancerous cells possess relatively higher tolerance to capsaicin, although the underlying mechanism for this difference remains unclear. Hence, this study aimed to elucidate the differential effects of capsaicin on cell lines from lung tissues by addressing the signal pathway leading to two types of cell death. In MRC-5 human fetal lung cells, capsaicin augmented silent mating type information regulation 1 (SIRT1) deacetylase activity and the intracellular NAD(+)/NADH ratio, decreasing acetylation of p53 and inducing autophagy. In contrast, capsaicin decreased the intracellular NAD(+)/NADH ratio, possibly through inhibition of tumor-associated NADH oxidase (tNOX), and diminished SIRT1 expression leading to enhanced p53 acetylation and apoptosis. Moreover, SIRT1 depletion by RNA interference attenuated capsaicin-induced apoptosis in A549 cancer cells and autophagy in MRC-5 cells, suggesting a vital role for SIRT1 in capsaicin-mediated cell death. Collectively, these data not only explain the differential cytotoxicity of capsaicin but shed light on the distinct cellular responses to capsaicin in cancerous and noncancerous cell lines.