Alzheimer's Disease in Diabetic Patients: A Lipidomic Prospect.

Diabetes Mellitus (DM) and Alzheimer's disease (AD) have been two of the most common chronic diseases affecting people worldwide. Type 2 DM (T2DM) is a metabolic disease depicted by insulin resistance, dyslipidemia, and chronic hyperglycemia while AD is a neurodegenerative disease marked by Amyloid ß (Aß) accumulation, neurofibrillary tangles aggregation, and tau phosphorylation. Various clinical, epidemiological, and lipidomics studies have linked those diseases claiming shared pathological pathways raising the assumption that diabetic patients are at an increased risk of developing AD later in their lives. Insulin resistance is the tipping point beyond where advanced glycation end (AGE) products and free radicals are produced leading to oxidative stress and lipid peroxidation. Additionally, different types of lipids are playing a crucial role in the development and the relationship between those diseases. Lipidomics, an analysis of lipid structure, formation, and interactions, evidently exhibits these lipid changes and their direct and indirect effect on Aß synthesis, insulin resistance, oxidative stress, and neuroinflammation. In this review, we have discussed the pathophysiology of T2DM and AD, the interconnecting pathological pathways they share, and the lipidomics where different lipids such as cholesterol, phospholipids, sphingolipids, and sulfolipids contribute to the underlying features of both diseases. Understanding their role can be beneficial for diagnostic purposes or introducing new drugs to counter AD.

The Impact of Travel Distance on Rhegmatogenous Retinal Detachment Presentation and Outcomes.

BACKGROUND AND OBJECTIVE: Rhegmatogenous retinal detachment (RRD) requires urgent surgical intervention. The effect of travel distance on RRD outcomes is unclear. PATIENTS AND METHODS: This retrospective cohort study included 642 patients who underwent RRD repair at Cole Eye Institute from 2012 to 2020. Google Maps was used to calculate the travel distance in miles from the residential zip code to the presenting and surgery location addresses. Multivariable logistic and bivariate linear regressions were used to compare macula-off status and best-corrected visual acuity (BCVA) in ETDRS letters at presentation and at 6-month follow-up, with patient travel distance divided into < 25 miles, 25 to 50 miles, and > 50 miles. RESULTS: Four hundred sixty-two patients were examined in the final cohort. The retinal reattachment rate was 94.3% for less than 25 miles, 96.3% for 25 to 50 miles, and 95.9% for greater than 50 miles (P = 0.63). In multivariable analysis, distance to presenting location was not associated with macula-off status (P = 0.69) or BCVA at follow-up (P = 0.27). Oneway analysis of distance and time from presentation to surgery in days revealed that distance to surgical site was associated with longer time to surgery (P = 0.003). Subset analysis of patients with income less than $25,520 (n = 18) revealed greater distance to presenting and surgical location was associated with longer time to surgery (P < .0001), but was not associated with BCVA at follow-up (P = 0.53). CONCLUSIONS: This data suggests that patients who live further from the hospital achieve equivalent outcomes from RRD repair, despite delays in surgery. [Ophthalmic Surg Lasers Imaging Retina 2022;53:666-672.].

Rhegmatogenous Retinal Detachment: Variations in Clinical Presentation and Surgical Outcomes by Socioeconomic Status and Race.

BACKGROUND AND OBJECTIVE: To characterize rhegmatogenous retinal detachment (RRD) presentation and repair outcomes by race and socioeconomic status. MATERIALS AND METHODS: Retrospective cohort one-center study of adults with a new RRD repair from 2012 to 2020. Logistic and linear regression analyses were conducted. RESULTS: 61.7% were male, 84.5% White and 9.4% Black (total n = 1092). 95.8% White and 94.2% Black patients had retinal reattachment (P = .234). Macula-off status was more likely with Medicare/Medicaid than private insurance (OR 1.63, 95% CI 1.11 to 2.41, P = .014); and less likely with higher income (OR 0.88, CI 0.81 to 0.96, P = .003). Black patients had worse best visual acuity (BVA) at presentation and follow-up (follow-up -6.93 letters, CI -13.19 to -0.64, P = .031), and higher odds of postoperative ocular hypertension (OHTN) (OR 2.41, CI 1.28 to 4.60, P = .007). CONCLUSIONS: Despite equivalent retinal reattachment rates, Black patients have worse BVA, and are more likely to develop OHTN than White patients. Macula-off status is less likely in patients with higher income or private insurance. [Ophthalmic Surg Lasers Imaging Retina 2022;53:538-545.].

Lost in translation: A qualitative analysis of facilitators and barriers to collecting patient reported outcome measures for surgical patients with limited English proficiency.

BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly being used throughout surgical disciplines, but their use is limited in multilingual patient populations. We aimed to investigate facilitators and barriers to PROMs collection for patients with limited English proficiency (LEP). METHODS: Semi-structured interviews were performed with providers from multiple surgical disciplines across six academic medical centers until thematic saturation was achieved. RESULTS: Among 24 interviews, respondents noted either systematic exclusion of patients with LEP or significant barriers to implementation. Barriers included lack of valid and translated PROMs, lack of multi-lingual electronic medical record integration, and insufficient time and resources to accommodate patients with LEP. Facilitators to collection included institutional leadership and funding support for validating translations. CONCLUSION: These barriers may result in inadvertent but systematic exclusion of patients with LEP from outcomes datasets as well as clinical decision making. Future implementation projects should consider these themes when developing initiatives for more equitable PROMs collection and utilization.

Liquid biopsy for therapy monitoring in early-stage non-small cell lung cancer.

Liquid biopsy is now considered a valuable diagnostic tool for advanced metastatic non-small cell lung cancer (NSCLC). In NSCLC, circulating tumor DNA (ctDNA) analysis has been shown to increase the chances of identifying the presence of targetable mutations and has been adopted by many clinicians owing to its low risk. Serial monitoring of ctDNA may also help assess the treatment response or for monitoring relapse. As the presence of detectable plasma ctDNA post-surgery likely indicates residual tumor burden, studies have been performed to quantify plasma ctDNA to assess minimal residual disease (MRD) in early-stage resected NSCLC. Most data on utilizing liquid biopsy for monitoring MRD in early-stage NSCLC are from small-scale studies using ctDNA. Here, we review the recent research on liquid biopsy in NSCLC, not limited to ctDNA, and focus on novel methods such as micro RNAs (miRNA) and long non-coding (lncRNA).

Differences in outcomes after emergency general surgery between Hispanic subgroups in the New Jersey State Inpatient Database (2009-2014): The Hispanic population is not monolithic.

BACKGROUND: Our aim was to examine differences in clinical outcomes between Hispanic subgroups who underwent emergency general surgery (EGS). METHODS: Retrospective cohort study of the HCUP State Inpatient Database from New Jersey (2009-2014), including Hispanic and non-Hispanic White (NHW) adult patients who underwent EGS. Multivariable analyses were performed on outcomes including 7-day readmission and length of stay (LOS). RESULTS: 125,874 patients underwent EGS operations. 22,971 were Hispanic (15,488 with subgroup defined: 7,331 - Central/South American; 4,254 - Puerto Rican; 3,170 - Mexican; 733 - Cuban). On multivariable analysis, patients in the Central/South American subgroup were more likely to be readmitted compared to the Mexican subgroup (OR 2.02; p < 0.001, respectively). Puerto Rican and Central/South American subgroups had significantly shorter LOS than Mexican patients (Puerto Rico -0.58 days; p < 0.001; Central/South American -0.30 days; p = 0.016). CONCLUSIONS: There are significant differences in EGS outcomes between Hispanic subgroups. These differences could be missed when data are aggregated at Hispanic ethnicity.

Associations of physician burnout with organizational electronic health record support and after-hours charting.

In 2017, 43.9% of US physicians reported symptoms of burnout. Poor electronic health record (EHR) usability and time-consuming data entry contribute to burnout. However, less is known about how modifiable dimensions of EHR use relate to burnout and how these associations vary by medical specialty. Using the KLAS Arch Collaborative's large-scale nationwide physician (MD/DO) data, we used ordinal logistic regression to analyze associations between self-reported burnout and after-hours charting and organizational EHR support. We examined how these relationships differ by medical specialty, adjusting for confounders. Physicians reporting ≤ 5 hours weekly of after-hours charting were twice as likely to report lower burnout scores compared to those charting ≥6 hours (aOR: 2.43, 95% CI: 2.30, 2.57). Physicians who agree that their organization has done a great job with EHR implementation, training, and support (aOR: 2.14, 95% CI: 2.01, 2.28) were also twice as likely to report lower scores on the burnout survey question compared to those who disagree. Efforts to reduce after-hours charting and improve organizational EHR support could help address physician burnout.

Disparities in the Geographic Distribution of Neurosurgeons in the United States: A Geospatial Analysis.

OBJECTIVE: Large disparities in access to neurosurgical care are known, but there are limited data on whether geographic distribution of the neurosurgery workforce potentially plays a role in these disparities. The goal of this study was to identify the geographic distribution of neurosurgeons in the United States and to study the association of the per capita workforce distribution with socioeconomic characteristics of the population. METHODS: The number of practicing neurosurgeons in the United States in 2016 was obtained from the 2017-2018 American Medical Association Masterfile contained within the Area Health Resource File. The association of the number of neurosurgeons per 100,000 population with socioeconomic characteristics was assessed through linear regression analysis at Hospital Referral Region (HRR) level. RESULTS: The median number of neurosurgeons per capita across all HRRs was 1.47 neurosurgeons per 100,000 population (interquartile range, 1.02-2.27). Bivariable analysis showed that greater supply of neurosurgeons was positively associated with regional levels of college education, median income, and median age. The number of neurosurgeons per capita at the HRR level was negatively associated with unemployment, poverty, and percent uninsured. CONCLUSIONS: Regions characterized by low socioeconomic status have fewer neurosurgeons per capita in the United States. Low income, low number of college graduates, and high unemployment rate are associated with fewer numbers of neurosurgeons per capita. Further research is needed to determine if these geographic workforce disparities contribute to poor access to quality neurosurgical care.

The PEGASUS Games: Physical Exam, Gross Anatomy, phySiology and UltraSound Games for Preclinical Medical Education.

Introduction: Gamification engages learners and has successfully taught point-of-care ultrasound (POCUS) to residents and fellows. Yet ultrasound (US) curricula in undergraduate medical education remains limited. This study assessed a gamification model integrating US, anatomy, physiology, physical examination, and radiology created for preclinical medical students as compared with traditional didactic education. Methods: Twenty first-year medical students participated in a session on neck and thyroid material. Students were randomly assigned to a game or non-game group. Game students participated in games incorporating thyroid US with exam maneuvers, other imaging modalities, physiology, and pathology. Non-game students were taught the same material with an instructor. Students were assessed with a pretest and immediate and delayed post-tests. Group differences and scores were assessed using t-tests. A Likert scale evaluated learners' opinions of the educational experience. Results: The game group performed better than the non-game group on the immediate post-test (p = 0.007, CI = [0.0305, ∞]). There was no significant difference between the groups on the delayed post-test (p = 0.726, CI = [-0.120, ∞]). Students in both groups felt more confident in their knowledge of the material, and all students in the game group agreed that the games encouraged teamwork. Most (9/10) stated the games allowed them to learn the material more effectively and would like to see more gamification (8/10). Conclusion: This US education model incorporating gamification for preclinical medical students promotes teamwork and is as effective for learning material than a traditional learning model. Students additionally convey a positive attitude towards gamification.

The Impact of Virtual Interviews on the Geographic Distribution of Ophthalmology Match Results in the 2020-2021 Cycle.

Background Instead of the traditional in-person interviews, the 2020 to 2021 ophthalmology application cycle was conducted with virtual interviews due to coronavirus disease 2019 (COVID-2019). Little is known about differences between the results of this application cycle with previous years. Objectives The aim of this study was to determine the effect of virtual interviews on the geographic distribution of matched ophthalmology residency applicants. Methods Information was collected on the medical school location and matched residency program location for 2020 to 2021 applicants as well as applicants during the 2016 to 2017, 2017 to 2018, and 2018 to 2019 cycles from publicly available Web sites. Pearson chi-squared tests were conducted to determine whether there was a significant difference in the proportion of applicants matching in the same region, state, and institution as their medical schools in the 2020 to 2021 interview cycle when compared with past cycles. Results Three-hundred seventy-five applicants from 2020 to 2021 and 1,190 applicants from 2016 to 2019 application cycles were analyzed. There was no difference in the type of medical school attended (allopathic vs. osteopathic vs. international medical graduate) ( p = 0.069), the likelihood of attending a residency program in the same region as the home medical school (54% for 2020-2021 vs. 57% for 2016-2019 applicants, p = 0.3), and the likelihood of attending a residency program in the same state as the home medical school (31 vs. 28%, p = 0.2). There was a higher likelihood of applicants during the 2020 to 2021 cycle matching at a residency program affiliated with their home medical school than previous cycles (23 vs. 18%, p = 0.03). Conclusions Virtual interviews did not increase the likelihood of medical students staying in the same region or state as their medical school, while there was a higher likelihood of applicants matching at residency programs at institutions affiliated with their medical schools. A hybrid approach to maintain geographic diversity of applicants' final residency programs involving virtual interviews with the addition of in-person away rotations is suggested.

A Social-Ecological Framework to Understand Barriers to HIV Clinic Attendance in Nakivale Refugee Settlement in Uganda: a Qualitative Study.

The social-ecological model proposes that efforts to modify health behaviors are influenced by constraints and facilitators at multiple levels. We conducted semi-structured interviews with 47 clients in HIV care and 8 HIV clinic staff to explore how such constraints and facilitators (individual, social environment, physical environment, and policies) affect engaging in HIV clinical care in Nakivale Refugee Settlement in Uganda. Thematic analysis revealed that participants were motivated to attend the HIV clinic because of the perceived quality of services and the belief that antiretroviral therapy improves health. Barriers to clinic attendance included distance, cost, unemployment, and climate. Those that disclosed their status had help in overcoming barriers to HIV care. Nondisclosure and stigma disrupted community support in overcoming these obstacles. Interventions to facilitate safe disclosure, mobilize social support, and provide more flexible HIV services may help overcome barriers to HIV care in this setting.

Aspirin-Exacerbated Respiratory Disease: Association Between Patient-Reported Sinus and Asthma Morbidity.

BACKGROUND: The association between sinonasal and pulmonary symptoms in aspirin-exacerbated respiratory disease is not fully established. OBJECTIVE: To characterize sinonasal and asthma symptomatology, and to determine whether reported sinonasal symptoms predict asthma severity. METHODS: Prospectively collected data from an aspirin-exacerbated respiratory disease registry cohort were included from 2013 to 2018. Sinonasal symptomatology measured by Sino-Nasal Outcomes Test (SNOT) 22-item total scores was used as the predictor variable, with Asthma Control Test (ACT) scores and percent predicted FEV1 (FEV1% predicted) as primary outcomes. All instances of paired data on the same date were used. ACT score was also evaluated with FEV1% predicted as the outcome. Mixed effects regression was completed. RESULTS: From 1065 aspirin-exacerbated respiratory disease registry subjects (mean age, 48.1 ± 12.8 years; 68.0% females, 29.8% males), mean SNOT-22 score was 42.3 ± 24.12 (n = 1307 observations from 869 subjects), mean ACT score was 19.4 ± 5.2 (n = 1511 observations from 931 subjects), and mean FEV1% predicted was 82.8 ± 19.6 (n = 777 observations from 307 subjects). SNOT-22 score significantly predicted ACT scores (P < .0001, 1185 paired observations from 845 subjects) and FEV1% predicted (P = .018, 485 observations from 246 subjects). Any 10-point increase in SNOT-22 score was associated with a 0.87-point decrease in ACT score and a 0.75% decrease in FEV1% predicted. Any 1-point increase in ACT score was associated with a 1.0% increase in FEV1% predicted (P < .0001, 616 observations from 269 subjects). The most severe SNOT-22 symptoms were sense of smell/taste and blockage/congestion of nose. CONCLUSIONS: SNOT-22 scores significantly predict ACT scores and FEV1% predicted, and ACT scores significantly predict FEV1% predicted. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity.

Gut microbiome and response to checkpoint inhibitors in non-small cell lung cancer-A review.

The gut microbiome is a collection of diverse bacteria that normally reside within the gastrointestinal tract. In recent years, the relationship between the gut microbiome, and fluctuations in it, and overall health has been an intense area of interest in medical research. In addition to having a barrier role in the gastrointestinal tract, there appears to be an immune function of gut microbiota, with a correlation between dysbiosis of gut microbiota and certain inflammatory and malignant disease states of the gastrointestinal system. We have also seen evidence that the gut microbiome can impact response to immunotherapy in melanoma patients. Evidence has also emerged to show that the lung has a microbiome of its own. In this review we will explore the relationship between the gut and lung microbiomes, known as the gut-lung axis, and the potential effects of this axis on anticancer therapy in lung cancer, including checkpoint inhibitors.

Linking world bank development indicators and outcomes of congenital heart surgery in low-income and middle-income countries: retrospective analysis of quality improvement data.

OBJECTIVE: Many low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies. DESIGN: Retrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment. Spearman correlation coefficients were calculated. SETTING AND PARTICIPANTS: The International Quality Improvement Collaborative (IQIC) keeps a volunteer registry of outcomes of CHD surgery programmes in low-resource settings. Inclusion in the IQIC is voluntary enrolment by hospital sites. Patients in the registry underwent congenital heart surgery. Sites that actively participated in IQIC in 2013, 2014 or 2015 and passed a 10% data audit were asked for permission to share data for this study. 31 sites in 17 countries are included. OUTCOME MEASURES: In-hospital mortality: standardised mortality ratios were calculated. Risk adjustment for in-hospital mortality uses the Risk Adjustment for Congenital Heart Surgery method, a model including surgical risk category, age group, prematurity, presence of a major non-cardiac structural anomaly and multiple congenital heart procedures during admission. RESULTS: The IQIC registry includes 24 917 congenital heart surgeries performed in children<18 years of age. The overall in-hospital mortality rate was 5.0%. Country-level congenital heart surgery standardised mortality ratios were negatively correlated with gross domestic product (GDP) per capita (r=-0.34, p=0.18), and health expenditure per capita (r=-0.23, p=0.37) and positively correlated with under-five mortality (r=0.60, p=0.01) and undernourishment (r=0.39, p=0.17). Countries with lower development had wider variation in mortality. GDP per capita is a driver of the association between some other measures and mortality. CONCLUSIONS: Results display a moderate relationship among wealth, healthcare investment and malnutrition, with significant variation, including superior results in many countries with low GDP per capita. These findings provide context and optimism for investment in CHD procedures in low-resource settings.

Circumscribed interests in adolescents with Autism Spectrum Disorder: A look beyond trains, planes, and clocks.

Adolescence is a unique developmental period, characterized by physical and emotional growth and significant maturation of cognitive and social skills. For individuals with Autism Spectrum Disorder (ASD), it is also a vulnerable period as cognitive and social skills can deteriorate. Circumscribed interests (CIs), idiosyncratic areas of intense interest and focus, are a core symptom of ASD that may be associated with social development. Yet, relatively little is known about the expression of CIs in adolescents with ASD. Many studies investigating CIs have used images depicting items of special interest; however, it is not clear how images should be customized for adolescent studies. The goal of this study was to gain insight into the types of images that may be appropriate for studies of CIs in adolescents with ASD. To this end, we used a mixed methods design that included, 1) one-on-one interviews with 10 adolescents (4 with ASD and 6 TD), to identify categories of images that were High Autism Interest ('HAI') or High Typically Developing Interest ('HTD'), and 2) an online survey taken by fifty-three adolescents with ASD (42 male) and 135 typically developing (TD) adolescents (55 male) who rated how much they liked 105 'HAI' and 'HTD' images. Although we found a significant interaction between 'HAI' and 'HTD' categories and diagnosis, neither group significantly preferred one category over the other, and only one individual category ('Celebrities') showed a significant group effect, favored by TD adolescents. Males significantly preferred 'HAI' images relative to females, and TD adolescents significantly preferred images with social content relative to adolescents with ASD. Our findings suggest that studies investigating affective or neural responses to CI-related stimuli in adolescents should consider that stereotypical ASD interests (e.g. trains, gadgets) may not accurately represent individual adolescents with ASD, many of whom show interests that overlap with TD adolescents (e.g. video games).

High-risk human papillomavirus in the oral cavity of women with cervical cancer, and their children.

BACKGROUND: Association of High-risk Human Papillomavirus (HR-HPV) with oral cancer has been established recently. Detecting these viruses in oral cavity is important to prevent oral lesions related to them. The purpose of this study was to evaluate the prevalence of HR-HPV in the oral cavity of women with cervical cancer, and their children. A total of 70 women, previously diagnosed with cervical cancer, and 46 children of these women, born by vaginal delivery only, were selected for this study. Buccal swabs were collected from their oral cavity and HPV detection was carried out using Hybrid Capture 2 high-risk HPV (HC2 HR-HPV) detection system. RESULTS: Out of 70 women with cervical cancer, four (5.71%) were found to be positive for HR-HPV in their oral cavity. No association of HR-HPV was found with sociodemographic profile, marital status, reproductive history, tobacco and alcohol usage, contraceptive pills usage, and presence of oral lesions (p>0.05). Among children, HR-HPV in the oral cavity was detected in only 1 of the 46 subjects examined (2.17%). Clinically healthy oral mucosa, without any oral lesions, was observed in all the HR-HPV positive subjects. CONCLUSION: The result of this study showed that there is low, if any, risk of HR-HPV infection in the oral cavity of women with cervical cancer. Further, our study suggests that there is very low risk for children of women with cervical cancer, to acquire and sustain HR-HPV in their oral cavity until childhood or adolescence.