Impacts of A Taste of African Heritage: A Culinary Heritage Cooking Course.

OBJECTIVE: To examine changes in cooking and dietary behaviors and health outcomes following participation in A Taste of African Heritage, a culinary heritage cooking course. DESIGN: One group, pre-post program design, surveys, and physical assessments. SETTING: Community centers, churches, health care settings, homes, and housing complexes. PARTICIPANTS: Participants (n = 586, 84% women) were recruited by partner organizations from 2013-2018 across 21 states and the District of Columbia. INTERVENTION(S): A 6-week cooking curriculum that teaches history, nutrition, and cooking techniques to reconnect participants with the vibrant, healthy traditions of the African Diaspora. MAIN OUTCOME MEASURE(S): Weekly frequency of cooking, food group intake, and exercise assessed by surveys, measured weight, waist circumference, and blood pressure. ANALYSIS: Linear and logistic mixed-effects models with random intercepts for participant and teacher, sex and site type as covariates comparing pre-post physical measurements and binary behavioral outcomes, P < 0.0033 for statistical significance after Bonferroni correction. RESULTS: Intake frequencies of fruit, vegetable, and greens and exercise frequency were improved from preprogram to postprogram (all P < 0.0021). Weight, waist circumference, and systolic blood pressure were also improved from preprogram to postprogram (all P <0.0001). CONCLUSIONS AND IMPLICATIONS: Participation in A Taste of African Heritage was associated with positive behavior changes and health outcomes. Integrating cultural heritage and behaviors are positive components to connect participants to healthy old ways or traditions.

Clinical and economic outcomes associated with hospitalizations for acute idiopathic pericarditis in the United States.

BACKGROUND: Outcomes-based data regarding the management of hospitalized U.S. patients with acute idiopathic pericarditis (AIP) are lacking. OBJECTIVES: This study sought to elucidate the clinical and economic outcomes associated with the inpatient care of AIP. METHODS: Cohort study of adults with AIP; multivariable analyses of clinical and economic outcomes (inpatient mortality, surgical or medical complications, length of stay, and medical charges). RESULTS: Surgical or medical complications, pericardiocentesis, and pericardiotomy were each independently associated with a significantly higher odds of inpatient mortality (p<0.05). Pericardiocentesis, pericardiotomy, and pericardiectomy were also independently associated with significantly higher odds for complications (p<0.001) and, overall, surgical or medical complications were associated with longer lengths of stay and higher charges (p < 0.001). A higher odds of inpatient mortality was associated with micropolitan or rural patient residence, Medicaid payor, and African American race (p<0.05). CONCLUSIONS: U.S. inpatient cases of AIP are associated with significant use of healthcare resources, disparities, morbidity, and mortality.

When You Cannot Go With the Flow: A Case Report of May-Thurner Syndrome.

INTRODUCTION: May-Thurner syndrome (MTS) is caused by extrinsic compression of the left iliac venous system, most commonly between an overlying right iliac artery and fifth lumbar vertebra, and is seen mainly in women between 20 and 50 years of age. This compression may be asymptomatic but can lead to the formation of venous thrombi causing left lower extremity pain and swelling. CASE PRESENTATION: We report a case of MTS in a patient who initially presented with back and left lower extremity pain and swelling whose initial duplex venous ultrasound was negative for deep venous thrombus. Subsequent computed tomography (CT) revealed a venous thrombus of the left common, internal, and external iliac veins. DISCUSSION: In the case of unilateral lower extremity swelling with a negative initial duplex venous ultrasound, consider further investigation with CT venography to evaluate for possible MTS.

Effect of Tobacco Cessation on Weight in a Veteran Population.

INTRODUCTION/OBJECTIVES: Weight gain concerns remain a barrier to tobacco cessation. Literature suggests that weight gain can occur after stopping tobacco, but continuing tobacco can have far worse outcomes. Limited information is available regarding weight gain in military personnel. The objective of this study was to evaluate weight change in veterans that stopped tobacco for a minimum of 12 months enrolled in a pharmacist managed telephone tobacco cessation clinic (PMTTCC). METHODS: A retrospective analysis of veterans who had been tobacco-free for 12 months enrolled in a PMTTCC were included in this analysis. Primary outcomes were change in weight (kg) and body mass index (BMI) from baseline. Descriptive data were utilized where appropriate and paired t-tests were utilized for the primary outcomes. RESULTS: Seventy-seven patients were screened and 10 were excluded. Sixty-seven veterans met inclusion criteria and were mostly male (91%, n = 61) and Caucasian (74.6%, n = 50). At 12 months post cessation, the mean weight gain was (1.81 kg ± 6.83, P = .03) and BMI (0.51 ± 2.23 kg/m2, P = .06). CONCLUSIONS: Veterans appeared to have minimal weight gain despite statistical significance and no statistical change with BMI after 12 months of being tobacco-free. Results suggest that the long-term weight gain is minimal, and a comprehensive tobacco cessation program can be helpful to improve weight outcomes.

Autonomic Neuromodulation Acutely Ameliorates Left Ventricular Strain in Humans.

Low-level transcutaneous vagus nerve stimulation at the tragus (LLTS) is anti-adrenergic. We aimed to evaluate the acute effects of LLTS on left ventricular (LV) function and autonomic tone. Patients with diastolic dysfunction and preserved LV ejection fraction were enrolled in a prospective, randomized, double-blind, 2 × 2 cross-over study. Patients received two separate, 1-h sessions, at least 1 day apart, of active LLTS (20 Hz, 1 mA below the discomfort threshold) and sham stimulation. Echocardiography was performed after LLTS or sham stimulation to assess cardiac function. A 5-min ECG was performed to assess heart rate variability (HRV). Twenty-four patients were enrolled. LV global longitudinal strain improved by 1.8 ± 0.9% during active LLTS compared to sham stimulation (p = 0.001). Relative to baseline, HRV frequency domain components (low frequency, high frequency, and their ratio) were favorably altered after LLTS compared to sham stimulation (all p < 0.05). We concluded that LLTS acutely ameliorates cardiac mechanics by modulating the autonomic tone. Trial registration: NCT02983448.

Outcomes of Direct-to-Consumer Hearing Devices for People with Hearing Loss: A Review.

As the population of those with mild to moderate hearing loss increases the need remains for amplification solutions. There is a trend to offer alternative amplification options beyond traditional hearing aids. Due to reduced medical risk associated with the most common types of hearing loss (i.e., presbycusis and noise induced), many individuals with such audiological configurations may have success with direct-to-consumer hearing devices (DCHD). The current paper presents a literature review of studies focused on the outcomes of DCHDs for people with hearing loss. Search of electronic databases were used to identify relevant articles for review. Studies on outcomes of DCHDs mainly focused on older adults and reported consistently positive results in clinical and self-reported outcome measures. Improvements in auditory ability, communicative function, social engagement, quality of life, and reduction of self-reported hearing disability were observed. The nature of the direct-to-consumer method makes it challenging to design studies that will accurately represent outcomes for patients due to the extensive dissimilarities in patient journey and device selection options. Accordingly, a majority of the studies conducted on this topic are of low quality of evidence and only provide short-term (i.e., less than one year) outcomes. In addition, results may have been influenced by researcher and/or clinician involvement in choosing the devices and by provision of additional support (i.e., incorporation of a communication partner and communication strategies training). Overall, the literature suggests positive outcomes and self-reported benefit of DCHDs in older adults with hearing loss. However, additional research is needed in this area to verify outcomes.

Applications of direct-to-consumer hearing devices for adults with hearing loss: a review.

BACKGROUND: This systematic literature review is aimed at investigating applications of direct-to-consumer hearing devices for adults with hearing loss. This review discusses three categories of direct-to-consumer hearing devices: 1) personal sound amplification products (PSAPs), 2) direct-mail hearing aids, and 3) over-the-counter (OTC) hearing aids. METHOD: A literature review was conducted using EBSCOhost and included the databases CINAHL, MEDLINE, and PsycINFO. After applying prior agreed inclusion and exclusion criteria, 13 reports were included in the review. RESULTS: Included studies fell into three domains: 1) electroacoustic characteristics, 2) consumer surveys, and 3) outcome evaluations. Electroacoustic characteristics of these devices vary significantly with some meeting the stringent acoustic criteria used for hearing aids, while others producing dangerous output levels (ie, over 120-dB sound pressure level). Low-end (or low-cost) devices were typically poor in acoustic quality and did not meet gain levels necessary for most adult and elderly hearing loss patterns (eg, presbycusis), especially in high frequencies. Despite direct-mail hearing aids and PSAPs being associated with lower satisfaction when compared to hearing aids purchased through hearing health care professionals, consumer surveys suggest that 5%-19% of people with hearing loss purchase hearing aids through direct-mail or online. Studies on outcome evaluation suggest positive outcomes of OTC devices in the elderly population. Of note, OTC outcomes appear better when a hearing health care professional supports these users. CONCLUSION: While some direct-to-consumer hearing devices have the capability to produce adverse effects due to production of dangerously high sound levels and internal noise, the existing literature suggests that there are potential benefits of these devices. Research of direct-to-consumer hearing devices is limited, and current published studies are of weak quality. Much effort is needed to understand the benefits and limitations of such devices on people with hearing loss.

Supplementation with 80,000 IU vitamin D3/month between November and April corrects vitamin D insufficiency without overdosing: Effect on serum 25-hydroxyvitamin D serum concentrations.

INTRODUCTION: Vitamin D insufficiency, defined by a 25-hydroxyvitamin D (25OHD) serum concentration<20ng/mL, is highly frequent in the French general population, especially between November and April. The aim of this study was to evaluate whether 80,000 IU vitamin D3 every month during this period of the year was able to maintain a 25OHD level between 20 and 60ng/mL in apparently healthy subjects whatever their basal vitamin D status. METHODS: Ninety-eight subjects volunteered to receive an 80,000 IU vitamin D3 dose every month between November 2014 and April 2015. Serum 25OHD, calcemia and calciuria were measured just before the first dose (Month 0), just before the 4th dose (M4), and one month after the 6th dose (M7). RESULTS: At M0, 25OHD was 17.5±9.5ng/mL. Sixty subjects (61.2%) had a 25OHD<20ng/mL and 25 (25.5%) had a 25OHD<10ng/mL. 25OHD increased significantly at M4 (35.3±8.0ng/mL) and M7 (40.1±8.5) without change in calcemia and calciuria. At M4, 2 subjects had a 25OHD slightly below 20ng/mL (17.6 and 19.7ng/mL), and none had a concentration>60ng/mL. At M7, all had a serum 25OHD>20ng/mL and 2 subjects had a value slightly above 60ng/mL (62.1 and 63.2ng/mL). CONCLUSION: A monthly supplementation with 80,000 IU vitamin D3 between November and April corrected vitamin D insufficiency in subjects in whom it was initially very frequent, without overdosing. This protocol is simple, safe and costless, and can be easily implemented when physicians detect risk factors for hypovitaminosis D in patients for whom a 25OHD measurement is not indicated.

Non-Steroidal Anti-Inflammatory Drugs and Aspirin Therapy for the Treatment of Acute and Recurrent Idiopathic Pericarditis.

Aspirin (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for the treatment of idiopathic pericarditis (IP). A comprehensive review consisting of pertinent clinical literature, pharmacokinetic, and pharmacodynamic considerations, has not been released in recent years. This review will facilitate the clinician's understanding of pharmacotherapeutic considerations for using ASA/NSAIDs to treat IP. Data were compiled using clinical literature consisting of case reports, cohort data, retrospective and prospective studies, and manufacturer package inserts. ASA, ibuprofen, indometacin, and ketorolac relatively have the most evidence in the treatment of IP, provide symptomatic relief of IP, and should be tapered accordingly. ASA is the drug of choice in patients with coronary artery disease (CAD), heart failure (HF), or renal disease, but should be avoided in patients with asthma and nasal polyps, who are naïve to ASA therapy. Ibuprofen is an inexpensive and relatively accessible option in patients who do not have concomitant CAD, HF, or renal disease. Indometacin is not available over-the-counter in the USA, and has a relatively higher incidence of central nervous system (CNS) adverse effects. Ketorolac is an intravenous option; however, clinicians must be mindful of the maximum dose that can be administered. While ASA/NSAIDs do not ameliorate the disease process of IP, they are part of first-line therapy (along with colchicine), for preventing recurrence of IP. ASA/NSAID choice should be dictated by comorbid conditions, tolerability, and adverse effects. Additionally, the clinician should be mindful of considerations such as tapering, high-sensitivity CRP monitoring, bleeding risk, and contraindications to ASA/NSAID therapy.

Safety and economic considerations of argatroban use in critically ill patients: a retrospective analysis.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) causes thromboembolic complications which threaten life and limb. Heparin is administered to virtually every critically ill patient as a protective measure against thromboembolism. Argatroban is a promising alternative anticoagulant agent. However, a safe dose which still provides effective thromboembolic prophylaxis without major bleeding still needs to be identified. METHODS: Critically ill patients (n = 42) diagnosed with HIT at a tertiary medical center intensive care unit from 2005 to 2010 were included in this retrospective analysis. Patient records were perused for preexisting history of HIT, heparin dosage before HIT, argatroban dosage, number of transfusions required, thromboembolic complications and length of ICU stay (ICU LOS). Patients were allocated to Simplified Acute Physiology Scores above and below 30 (SAPS >30, SAPS <30), respectively. For calculations, patients (n = 19) without previous history of HIT were compared to patients (n = 23) with a history of HIT before initiation of argatroban. RESULTS: The mean initial argatroban dosage was below 0.4 mcg/kg/min regardless of SAPS score. Maintenance dosage had to be increased in patients with SAPS <30 to 0.54 ± 0.248 mcg/kg/min (p >0.05) to achieve effective anticoagulation. No thromboembolic complications were encountered. Argatroban had to be discontinued temporarily in 16 patients for a total of 57 times due to diagnostic or surgical procedures, supratherapeutic aPTT and bleeding without increasing the number of transfusions. A history of HIT was associated with a shorter ICU LOS and significantly reduced transfusion need when compared to patients with no history of HIT. Cost calculation favour argatroban due to increased transfusion needs during heparin administration and increase ICU LOS. CONCLUSION: Argatroban can be used at doses < 0.4 mcg/kg/min without an increase in transfusion requirements and at a reduced overall treatment cost compared to heparin.

Lone atrial fibrillation is associated with pectus excavatum.

BACKGROUND: Pectus excavatum is a skeletal abnormality that may have cardiac manifestations. OBJECTIVE: To determine whether pectus excavatum is associated with lone atrial fibrillation (AF). METHODS: The pectus severity index (PSI) is the ratio of the lateral diameter of the chest to the distance between the sternum and the spine on computed tomography scan. A normal PSI is ≤2.5 whereas patients with severe pectus excavatum have a PSI >3.25. We calculated the PSI of 220 consecutive patients with AF who underwent radiofrequency catheter ablation from September 2008 to 2012 and compared this to the PSI of 225 controls without a history of AF undergoing chest computed tomography. RESULTS: Mean PSI was higher in patients with lone AF (2.72 ± 0.07) compared to patients with nonlone AF (2.25 ± 0.03) or controls (2.26 ± 0.03) (P < .001). The likelihood of mild, moderate, or severe pectus excavatum was higher in patients with lone AF compared to patients with nonlone AF and controls (P < .001). Patients with lone AF were more than 5 times as likely to have severe pectus excavatum compared to patients with nonlone AF or controls (P < .001) even after adjustment for potential confounders. CONCLUSIONS: Nearly two-thirds of the patients with lone AF have at least mild pectus excavatum and 17% have severe pectus, which is significantly higher than in patients with nonlone AF or controls. This association suggests a potential genetic or mechanical abnormality may be common to the 2 disorders. Our study may provide insight into the pathogenesis of lone AF.

Ultrastructure of cell contacts of fetal and adult Leydig cells in the rat: a systematic study from birth to senium.

Differentiation, development, and function of Leydig cells in the testis are regulated also by macrophages, vascular endothelial cells, and peritubular cells in the testis. The aim of the present study was to investigate the possible morphological substrates for communication between these cells. The cell contacts between adjacent Leydig cells, and between Leydig cells and other interstitial cells were studied electron microscopically in the rat testis of various age groups from birth to senium. Intercellular bridges with continuous cytoplasm were observed between fetal Leydig cells (FLCs) in the early postnatal period. Gap junctions were present in nearly every age group. A structural diversity as well as an increased occurrence of gap junctions with the maturity of the Leydig cells was noted. Coated pits were observed initially on pnd 30. From pnd 50 onwards, macrophages and Leydig cells were attached very closely to each other, when the cell processes of Leydig cells protruded either into the coated pits or into the deep invaginations of macrophages. To conclude, this is the first report on the presence of intercellular bridges between FLCs suggesting a possible functional synchronization of interconnected Leydig cells. The cell contacts observed here are possibly required for a precise communication between the Leydig cells and other interstitial cells.