RESUMO
BACKGROUND: People experiencing homelessness (PEH) are recognized as members of a vulnerable population with significant health and social disparities. Due to the COVID-19 pandemic, these populations are at risk for increased morbidity and mortality. The Herbert Wertheim College of Medicine (HWCOM) of Florida International University (FIU) in collaboration with the Miami-Dade County Homeless Trust presents this case series based on the results of the Telemedicine Homeless Monitoring Project, launched in April 2020. METHODS: Utilizing a faculty-student educational model, medical students at FIU HWCOM called PEH patients residing in isolation hotels on a daily basis to monitor their symptoms using a COVID-19 risk assessment template. Thirty-one PEH patients were followed for the duration of 12 weeks between April 2020 and August 2020. A retrospective chart review was then conducted, and four exemplar patients were chosen, highlighting common themes. Variables in the risk assessment included demographics, comorbidities, past medical history, indications for isolation or quarantine, length of stay, clinical and social needs identified, and qualitative data regarding barriers or successes of the telehealth platform. RESULTS: Thirty-one patients, between the ages of 20 and 84 and with an average age of 50.74, were followed in the program. There were eight females and 23 males in the study. Four exemplar PEH patients were discussed, highlighting the common themes identified; the lack of basic necessities that PEH face, the burden of chronic medical illnesses, a lack of health literacy, the burden of mental illnesses, and the acute stress caused by COVID-19 itself. CONCLUSION: Our research identified numerous characteristics of the homeless population that providers should pay special attention to during the pandemic. The relationship between the Homeless Trust and FIU HWCOM provided medical students with an excellent learning opportunity by letting them participate in clinical care while under lockdown due to the COVID-19 outbreak. Based on the results of the study, we believe that models like this will be useful in the event of a future epidemic.
RESUMO
As the most common cause of low back pain, the cascade of intervertebral disc (IVD) degeneration is initiated by the disappearance of notochordal cells and progressive loss of proteoglycan (PG). Limited nutrient supply in the avascular disc environment restricts the production of ATP which is an essential energy source for cell survival and function such as PG biosynthesis. The objective of this study was to examine ATP level and PG production of porcine IVD cells under prolonged exposure to hypoxia with physiological glucose concentrations. The results showed notochordal NP and AF cells responded differently to changes of oxygen and glucose. Metabolic activities (including PG production) of IVD cells are restricted under the in-vivo nutrient conditions while NP notochordal cells are likely to be more vulnerable to reduced nutrition supply. Moreover, provision of energy, together or not with genetic regulation, may govern PG production in the IVD under restricted nutrient supply. Therefore, maintaining essential levels of nutrients may reduce the loss of notochordal cells and PG in the IVD. This study provides a new insight into the metabolism of IVD cells under nutrient deprivation and the information for developing treatment strategies for disc degeneration.
