Alzheimer's Disease and SARS-CoV-2: Pathophysiological Analysis and Social Context.

The COVID-19 pandemic has proven to be a challenge for healthcare systems, especially in terms of the care of patients with Alzheimer's disease (AD). Age is one of the major risk factors for severe forms of COVID-19, most probably due to the presence of comorbidities and inflammations. It is known that SARS-CoV-2 invades nerve endings and olfactory nerves through the binding of the spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor. This interaction triggers an inflammatory cascade that results in cognitive impairment. In turn, the isoform of apolipoprotein-E4 (APOE-4ε) in AD is a risk factor for increased neuroinflammation through microglia activation, increased oxidative stress, and neurodegeneration. AD and SARS-CoV-2 are associated with increases in levels of inflammatory markers, as well as increases in levels of APOE-4ε, ACE2 and oxidative stress. Thus, there is a synergistic relationship between AD and SARS-CoV-2. In addition, the social isolation and other health measures resulting from the pandemic have led to a higher level of anxiety and depression among AD patients, a situation which may lead to a decline in cognitive function. Therefore, there is a need to develop strategies for keeping the patient calm but active.

A Brief Overview of Recurrent Pericarditis Management and the Potential of Rilonacept as a New Therapeutic Option.

Recurrent pericarditis affects 15-30% of patients after acute pericarditis. A large number of the patients with recurrent pericarditis can become corticosteroid dependent, leading to disease chronicity and drug dependence, with additional morbidity from long-term steroid use. Recent randomized trials indicate the efficacy of the interleukin-1 inhibitors anakinra and rilonacept in recurrent pericarditis, including colchicine-resistant and corticosteroid-dependent cases. In particular, rilonacept was assessed in the RHAPSODY clinical trial and found to be a potential treatment option that would decrease recurrent episodes, enabling patients to be weaned off steroids. Additionally, new data indicate that rilonacept should be considered as an option for patients with recurrent pericarditis, as add-on therapy to colchicine and nonsteroidal anti-inflammatory drugs, in place of steroids. We review the current management options for recurrent pericarditis as well as rilonacept as a prospective new addition to our armamentarium.

In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017.

Introduction:Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM).Methods:This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. Hospitalizations of adults >/ = 18 years old with a principal diagnosis of DKA were obtained using ICD-10 codes and divided into groups based on a secondary diagnosis of PEM. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), and system-based complications.Results:Patients with PEM had a statistically significant difference in the adjusted odds for in-hospital mortality compared to patients without PEM (aOR 1.73, 95% CI: 1.20-2.49, p = 0.004). Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49-3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31-4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17-1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83-2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43-2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42-3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000-22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96-2.57, p < 0.001) in days when compared to patients without PEM.Conclusion:Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality.

Outcomes of atrial fibrillation hospitalizations in patients with systemic lupus erythematosus: a report from the national inpatient sample.

This study compares outcomes of patients admitted for atrial fibrillation (AF) with and without coexisting systemic lupus erythematosus (SLE). The primary outcome was inpatient mortality. Hospital length of stay (LOS), total hospital charges, odds of undergoing ablation, pharmacologic cardioversion and electrical cardioversion were secondary outcomes of interest. Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for adult hospitalizations with AF as principal diagnosis with and without SLE as secondary diagnosis using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 821,630 hospitalizations were for adult patients, who had a principal diagnosis of AF, out of which, 2645 (0.3%) had SLE as secondary diagnosis. Hospitalizations for AF with SLE had similar inpatient mortality (1.5% vs 0.91%, adjusted OR (AOR): 1.0, 95% CI 0.47 to 2.14, p=0.991), LOS (4.2 vs 3.4 days, p=0.525), total hospital charges ($51,351 vs $39,121, p=0.056), odds of undergoing pharmacologic cardioversion (0.38% vs 0.38%, AOR: 0.90, 95% CI 0.22 to 3.69, p=0.880) and electrical cardioversion (12.9% vs 17.5%, AOR 0.87, 95% CI 0.66 to 1.15, p=0.324) compared with those without SLE. However, SLE group had increased odds of undergoing ablation (6.8% vs 4.2%, AOR: 1.9, 95% CI 1.3 to 2.7, p<0.0001). Patients admitted for AF with SLE had similar inpatient mortality, LOS, total hospital charges, likelihood of undergoing pharmacologic and electrical cardioversion compared with those without SLE. However, SLE group had greater odds of undergoing ablation.

Obesity Impacts Mortality and Rate of Revascularizations Among Patients With Acute Myocardial Infarction: An Analysis of the National Inpatient Sample.

Background Obesity is now a recognized chronic comorbid condition which is highly prevalent in the United States. Obesity poses several health risks, affecting multiple organ systems. The cardiovascular system is particularly affected by obesity including its role in atherosclerotic disease and hence myocardial infarction (MI) from atheromatous plaque events. However, multiple population-based studies have shown mixed outcomes in obese patients who have acute MI. This study aimed to determine if obesity paradoxically improved outcomes in patients with acute myocardial infarction (AMI) as well as compare outcomes of mild to moderately obese patients and morbidly obese patients to non-obese patients. Materials and methods Data was obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study included adult patients with a principal discharge diagnosis of AMI. This group was divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment myocardial infarction (NSTEMI). Obese patients were subdivided into two groups: mild-moderate obesity and morbid obesity. Primary outcome compared inpatient mortality. Secondary outcomes included rate of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), composite revascularization, mean length of hospitalization, total hospital charges, and rates of complications. Results In patients with STEMI, mild to moderately obese patients had lower odds of mortality (aOR: 0.80, 95% CI: 0.715-0.906, p < 0.001) compared to non-obese patients. However, morbidly obese patients had higher odds of mortality (aOR: 1.26, 95% CI: 1.100-1.446, p < 0.001) compared to non-obese patients. Mild to moderately obese patients had higher odds of composite revascularization (aOR: 1.24, 95% CI: 1.158-1.334, p < 0.001), PCI (aOR: 1.08, 95% CI: 1.054-1.150, p = 0.014), and CABG (aOR: 1.46, 95% CI: 1.313-1.626, p < 0.001). Conclusion The degree of obesity affects outcome of patients with AMI. Cardiovascular interventions during hospitalizations for AMI also varied with degree of obesity. This may have affected the outcome, especially among morbidly obese patients.

Neurofobia en estudiantes de postgrado en Medicina Interna

RESUMEN Introducción: la neurofobia es la percepción hacia la neurología como difícil y desagradable. Objetivos: determinar la frecuencia de neurofobia en estudiantes de postgrado de Medicina Interna del Hospital de Clínicas, Hospital Nacional de Itauguá, Hospital Militar Central e Instituto de Previsión Social. Materiales y métodos: diseño observacional y descriptivo de corte transversal. La herramienta utilizada fue un cuestionario diseñado para identificar la afinidad o aversión hacia las diferentes subespecialidades que componen la medicina interna y posteriormente, re interrogar sobre las eventuales causas subjetivas de la misma. Resultados: se incluyeron 56 estudiantes. Se encontró que 54% presenta neurofobia, 63,3% identificó la falta de conocimientos en neurología básica como la causa más importante, seguido por 50% que refiere la complejidad propia de la anamnesis y examen físico asociado a las patologías neurológicas. Conclusiones: más de la mitad de los estudiantes de postgrado de Medicina Interna presenta neurofobia, lo cual es alarmante debido a que una tercera parte de la patología humana es de orden neurológico y por tanto será parte de su ejercicio médico diario.

ABSTRACT Introduction: Neurophobia is the perception of neurology as difficult and unpleasant. Objective: To determine the frequency of neurophobia in internal medicine postgraduate students of the Clinical Hospital, National Hospital of Itauguá, Central Military Hospital and Institute of Social Security. Materials and methods: This was an observational descriptive cross-sectional study. The tool used was a questionnaire designed to identify the affinity or aversion towards the different subspecialties that compose the internal medicine and later, to interrogate on the possible subjective causes of the aversion. Results: Fifty six students were included. It was found that 54% presented neurophobia, 63.3% identified the lack of knowledge in basic neurology as the most important cause, followed by 50% that referred to the complexity of the anamnesis and physical examination associated with neurological pathologies. Conclusions: More than half of the internal medicine postgraduate students present neurophobia, which is alarming because one-third of human pathology is neurological and therefore will be part of their daily medical practice.

Del levantamiento de demandas y necesidades a la declaración del "perfil intermedio del ciclo básico" / About the collection of demands and needs to the declaration of the "intermedium profile from de basic cycle"

Está muy arraigado en Ciencias Básicas, un modelo de estudiante aprendiz: con el objetivo de proveerle conocimientos enciclopédicos y memorísticos. Los departamentos son independientes entre sí, con un control absoluto de sus materias, y desarrollo de programas fragmentados. Es evidente una separación entre las básicas y las clínicas. Probablemente por ello las ciencias básicas están desintegradas con la práctica profesional, y hace difícil la aplicación del conocimiento. La oportunidad brindada por el PIC, no es solo plasmar el análisis y reflexión, sino hacer propuestas reales que se vinculen con la atención médica, la docencia e investigación, a través de intervenciones educativas, para obtener mejores resultados en la formación de los médicos en general. Se abre así la posibilidad de una instancia de identificación y reflexión de la problemática en la formación del ciclo básico, con el propósito de fortalecer líneas de acción, desde la experiencia y perspectiva de cada docente y estudiante. Entre los principales retos formativos estaría: 1. Definir el rol de las ciencias básicas en la formación médica, 2. Integrar las materias del ciclo básico: transitar de un plan de estudios fragmentado a una propuesta formativa orientada en competencias. Para ello las actividades deberían estar enfocadas a: articular el ciclo Basico con el ciclo clínico, mejorar la competencia docente, estimular la capacidad de autogestión del estudiante, integrar los saberes, e incentivar la investigación. Para ello, se comenzó con los Lineamientos del Proyecto de Innovación curricular (PIC) de la FCM-UNA, estructurado y asesorado en el modelo de la profesora Karenina Troncoso, sobre las bases de las tendencias actuales de la Educación Superior. Esta primera fase del proyecto consistió en: - El levantamiento de las demandas y necesidades de formación desde el punto: político, teórico, científico, tecnológico a partir de referentes significativos. - La Sistematización y análisis de la información para la determinación de los compromisos formativos. Para concluir con: - La descripción de las dimensiones o dominios del Ciclo Básico. - La Declaración del perfil del Perfil del Ciclo Básico (Perfil Intermedio).

A learner model is deeply rooted in Basic Sciences: in order to provide encyclopedic and factual knowledge. The departments are independent from each other, with absolute control of their subjects and fragmented development of the programs. The separation between the basic and clinical is manifest. That is probably why basic sciences are disintegrated with professional practice, making difficult the application of knowledge. The opportunity provided by the Curricular Innovation Project involves not only analysis and reflections, but also making real proposals that are linked to medical care, teaching and research, through educational interventions, for best results in the training of doctors in general. Thus, there is a possibility of an instance of identification and reflection of the problems in the formation of the basic cycle, with the aim of strengthening lines of action, from the experience and perspective of each teacher and student. The main formative challenges would be: 1. Defining the role of basic science in medical training, 2. Integrating the subjects of the basic cycle: move from a fragmented curriculum to a competency-oriented training proposal. To do so, the activities should be focused on: articulating the basic cycle with clinical training, improving teaching skills, encourage student self-management skills, integrate knowledge, and encourage research. To do this, it began with the Guidelines of the Curricular Innovation Project (CIP) of the FCM-UNA, structured and advised on the model of Professor Karenina Troncoso, on the basis of current trends of the Superior Education. This first phase of the project consisted of: - The lifting of the demands and training needs from the political, theoretical, scientific and technological point of view of significant references. - The systematization and analysis of information for the determination of formative commitments. To conclude with: - The description of the dimensions or domains of the Basic Cycle. - The Declaration of the Basic Cycle Profile (Intermediate Profile).