Validating the use of body mass index with computed tomography in a racially and ethnically diverse cohort of patients admitted with SARS-CoV-2.

BACKGROUND: Body mass index (BMI) is criticized for being unjust and biased in relatively healthy racial and ethnic groups. Therefore, the current analysis examines if BMI predicts body composition, specifically adiposity, in a racially and ethnically diverse acutely ill patient population. METHODS: Patients admitted with SARS-CoV-2 having an evaluable diagnostic chest, abdomen, and/or pelvic computed tomography (CT) study (within 5 days of admission) were included in this retrospective cohort. Cross-sectional areas (centimeters squared) of the subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT) were quantified. Total adipose tissue (TAT) was calculated as sum of these areas. Admission height and weight were applied to calculate BMI, and self-reported race and ethnicity were used for classification. General linear regression models were conducted to estimate correlations and assess differences between groups. RESULTS: On average, patients (n = 134) were aged 58.2 (SD = 19.1) years, 60% male, and racially and ethnically diverse (33% non-Hispanic White [NHW], 33% non-Hispanic Black [NHB], 34% Hispanic). Correlations between BMI and SAT and BMI and TAT were strongest revealing estimates of 0.707 (0.585, 0.829) and 0.633 (0.534, 0.792), respectively. When examining the various adiposity compartments across race and ethnicity, correlations were similar and significant differences were not detected for TAT with SAT, VAT, or IMAT (all P ≥ 0.05). CONCLUSIONS: These findings support the routine use of applying BMI as a proxy measure of total adiposity for acutely ill patients identifying as NHW, NHB, and Hispanic. Our results inform the validity and utility of this tool in clinical nutrition practice.

Two-dimensional dilute Baxter-Wu model: Transition order and universality.

We investigate the critical behavior of the two-dimensional spin-1 Baxter-Wu model in the presence of a crystal-field coupling Δ with the goal of determining the universality class of transitions along the second-order part of the transition line as one approaches the putative location of the multicritical point. We employ extensive Monte Carlo simulations using two different methodologies: (i) a study of the zeros of the energy probability distribution, closely related to the Fisher zeros of the partition function, and (ii) the well-established multicanonical approach employed to study the probability distribution of the crystal-field energy. A detailed finite-size scaling analysis in the regime of second-order phase transitions in the (Δ,T) phase diagram supports previous claims that the transition belongs to the universality class of the four-state Potts model. For positive values of Δ, we observe the presence of strong finite-size effects, indicative of crossover effects due to the proximity of the first-order part of the transition line. Finally, we demonstrate how a combination of cluster and heat-bath updates allows one to equilibrate larger systems, and we demonstrate the potential of this approach for resolving the ambiguities observed in the regime of Δ≳0.

An aperture in the sagittal plane of the dorsal wall of the sacrum.

The dorsal wall of the sacrum presents various anatomical variations, while the dorsal bony wall of the sacral canal suffers more. We report a case of a sacrum with a series of variants in the midline due to abnormal ossification and a bizarre aperture on the sagittal plane between the 1st and the 2nd sacral spinous processes. A failure of the ossification patter during embryological life, or an ossification of the supraspinous ligament may result in such an aperture. Sacrum variety is of great importance for the daily proper medical practice.

Insomnia and burnout in Greek Nurses.

BACKGROUND/AIM: Sleep disturbances and burnout are possibly related to each other, although the exact nature of this relationship is still under investigation.  The purpose of the study was to investigate the prevalence of insomnia and its relation with burnout levels in a group of nurses working in psychiatric, pediatric, internal medicine and surgery departments in the public hospitals of central Greece. METHODS: One hundred and seventy four nurses working in internal medicine, surgery, psychiatric and pediatric sector in public hospitals of Central Greece were enrolled in the study. Maslach's burnout inventory and Athens Insomnia Scale were used to evaluate burnout and insomnia respectively. Statistical significance was set at p=0.05. RESULTS: Mean age of the nurses was 35.19 ± 7.07 (22-56). One hundred and fifteen (95.8%) nurses were women and 71 nurses (59.2%) were married. Mean insomnia score was 10.00. Approximately 3 out of 4 nurses exhibited high burnout levels.  Nurses working in the department of surgery and those with more than 4.5 night shifts per month exhibited higher insomnia scores. Insomnia score was correlated with burnout subscales, positively with emotional exhaustion and depersonalization and negatively with personal achievements scale. CONCLUSIONS: Insomnia and burnout scales are linearly related to each other. Younger nurses are particular vulnerable to insomnia. Job reform should target at younger nurses and those working on surgical departments who might also benefit from additional education and training to reduce insomnia and burnout. Hippokratia 2014; 18 (2):150-155.

Tazarotene plus UVB phototherapy in the treatment of psoriasis.

BACKGROUND: The addition of oral retinoids to phototherapy may accelerate and enhance antipsoriatic efficacy, but can result in systemic adverse events and additional laboratory monitoring costs. OBJECTIVE: Our purpose was to determine whether the topical addition of tazarotene to UVB phototherapy improves efficacy without problems related to photosensitivity. METHODS: Bilateral target plaques were randomized to receive two of the following, one on each plaque once daily for 14 days: tazarotene 0.1% gel, vehicle gel, or no treatment. Thereafter, the same treatments were continued 3 times per week, plus UVB phototherapy 3 times per week, for an additional 67 days. RESULTS: Tazarotene plus UVB phototherapy achieved faster and significantly greater reductions in plaque elevation and scaling throughout treatment and achieved at least 50% improvement from the pretreatment baseline with a significantly lower median cumulative UVB exposure than vehicle gel plus UVB light or UVB phototherapy alone. No case of unusual photosensitivity was noted in the tazarotene plus UVB treatment group. CONCLUSION: The addition of tazarotene to UVB phototherapy improves and accelerates efficacy and maintains acceptable safety and tolerability.

Air leaks from the respiratory tract in mechanically ventilated children with severe respiratory disease.

Our objectives were to evaluate the frequency of air leaks (AL) from the respiratory tract (pneumothorax, pneumomediastinum, pneumoperitoneum, subcutaneous emphysema) in critically ill children on mechanical ventilation (MV) for severe respiratory diseases, and to examine whether AL could be correlated with specific clinical events or ventilator settings. The study constitutes a retrospective cohort of 80 consecutive critically ill children receiving MV for severe respiratory diseases between 1986 and 1993. Patients (mean age 2.9 +/- 0.6 years, 49 males and 31 females), were admitted to the Pediatric Intensive Care Unit (PICU) with acute respiratory syndrome (ARDS) (27%), asthma (15%), bronchiolitis (10%), pneumonia (21%), pulmonary congenital diseases (9%), or foreign body aspiration (18%). Patients were divided into two groups; those with AL (n=22) and those without air-leaks (non-AL) (n = 58). Air leaks developed in 22 of 80 patients or in 27.5%. Survival was significantly lower in the AL group, compared to the non-AL group (41% vs. 76%, P < 0.01). The odds ratio that a patient with multiple organ system failure (MOSF) or infection would develop AL was 2.96 and 2.19, respectively. Candida and Pseudomonas species were recovered with significantly higher frequency in the AL group compared with the non-AL group (P < 0.025). There was a strong positive correlation between the incidence of AL and high ventilatory pressures (PIP 36 vs. 29.7 cm H(2)O, P < 0.001), or large tidal volumes (V(T) 12 vs. 9 mL/kg, P < 0.05), suggesting that large volumes might elicit injury to the pulmonary epithelium. Multiple logistic regression analysis showed that only V(T) was independently associated with the development of AL in children with primary severe respiratory disease (r(2) = -0.38, P = 0.01). In conclusion, MV will produce AL, particularly when high peak airway pressures (barotrauma) or large tidal volumes (volotrauma) are delivered by the ventilator. Sepsis, MOSF, and lung superinfection with Pseudomonas or Candida species may be also important factors in the development of AL in critically ill children.