Jacobs Institute of Women's Health
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The association between nutrient patterns and hospital stay duration and symptoms in COVID-19 in Iranian patients: cross-sectional study
No full textBACKGROUND: An excessively reactive immune system results in the cytokine storm COVID-19. A healthy diet is essential to maintain the balance between the immune system and inflammatory and oxidative stress. Associations between single foods and nutrients and COVID-19 have been examined. However, no prior study has examined associations between nutrient patterns and COVID-19. This study assessed the link between nutrient patterns and the COVID-19 severity and length of hospital stay in Iranian adults. METHODS: This cross-sectional study included 107 Iranian adults aged 20-60 years, who were admitted to Amir Alam Hospital in Tehran, Iran, due to COVID-19. Data on their symptoms were collected through a demographic questionnaire and verified against their hospital records. Three non-consecutive 24-h dietary recalls were used to collect participants\u27 food and beverage intake. Principal component analysis (PCA) was used to derive nutrient patterns. RESULT: A total of 95 Covid patients with a mean age of 46.2 years were included. Four major dietary patterns were identified using the Scree Plot chart, including high carbohydrate and high minerals pattern; high protein and high vitamins pattern; high fat pattern; and poor nutrient pattern. Adherence to the poor nutrient patterns was associated with a higher number of hospitalization days and lower appetite (p \u3c 0.05). The poor dietary patterns were associated with an increased likelihood of headache, fever, and respiratory distress syndrome (RDS). Also, headaches were more common with adherence to the high-fat pattern (p \u3c 0.05). CONCLUSION: The findings of this study show that a poor nutrient pattern is related to longer hospital stays and reduced appetite. It also connected to an increased likelihood of symptoms including headaches, fever, and respiratory distress syndrome. A strong association was found between respiratory distress syndrome, headaches, and a high-fat diet was found. Further studies with prospective designs are needed to better understand and validate these findings
Race and Incident Dementia Among Older Black and Older White Men
No full textThe objective of this study was to determine if racial differences exist between older Non-Hispanic Black (NHB) and White (NHW) men in incident dementia over 11 years (2011-2022) in the National Health and Aging Trends Study (NHATS). The analytic sample included 2395 community-dwelling NHB and NHW men free of dementia at baseline who self-identified as Non-Hispanic Black (NHB) and White (NHW). Dementia was assessed at each visit using a validated algorithm developed by NHATS. After adjusting for demographics, place, and health-related characteristics in the Cox proportional hazard models, older NHB men had an increased risk of dementia (hazard ratio: 1.63, 95% confidence interval: [1.22-2.17]) compared to older NHW men. There may be unique factors such as stressors, patterns of genes, or perhaps nutrition that older NHB men possess and experience throughout their lives that contribute to the increased incident dementia
Use of Midodrine for Intraoperative Hemostasis in Cutaneous and Percutaneous Surgery
No full textOwing to the increasingly high volume of cutaneous and percutaneous procedures performed annually, the demand for local anesthesia has steadily risen. The gold-standard formulations for local anesthesia contain epinephrine at a concentration of 1:100,000 added to lidocaine to aid in hemostasis. Epinephrine, an α-agonist, also exhibits off-target β-adrenergic effects that carry risk of adverse events with these injections. Furthermore, the ongoing global shortage of epinephrine highlights the need for a safer and viable alternative. Midodrine, a targeted a-adrenergic receptor agonist, is utilized as a vasopressor to induce arterial and venous vasoconstriction. We developed a formulation of 2% lidocaine combined with 1:2,000,000 epinephrine and 50 μM midodrine (midodrine/lidocaine/epinephrine formulation), hypothesizing that this combination would exhibit synergism on hemostasis. In a porcine model of blood loss after punch biopsies, our formulation was compared with 2% lidocaine; 2% lidocaine with 1:100,000 epinephrine; 2% lidocaine with 1:2,000,000 epinephrine; and 2% lidocaine with 50 μM midodrine. Our results indicate that 2% lidocaine with 1:100,000 epinephrine and our midodrine/lidocaine/epinephrine formulation were statistically comparable, with both significantly reducing bleeding when compared with the 2% lidocaine (P \u3c .05). The 2% lidocaine with midodrine alone also showed additional promise as an effective hemostatic formulation. Thus, combination of low-concentration epinephrine and midodrine with lidocaine may exhibit synergistic hemostatic effect in cutaneous surgical settings while reducing potential off-target effects of either vasoconstrictor alone at higher concentrations as adjunct monotherapies
Safety Profile of Preoperative Meningioma Embolization: A Meta-Analysis Comparing Embolic Agents and Carotid Systems Embolized
No full textBACKGROUND: Meningiomas can be embolized to facilitate safe tumor resection. However, the procedure may be associated with complications that have not been well-characterized. We aimed to compare the safety of liquid versus particulate agents and to assess the safety of embolization using internal carotid artery (ICA) branches. METHODS: Studies evaluating outcomes of preoperative meningioma embolization from 1974 to 2024 were systematically searched on PubMed, Embase, and Scopus. Data on embolic agents used, feeder arteries embolized, and complication outcomes were extracted. Complication rates were statistically compared using Z-scores calculated from the standard errors of the pooled rates. RESULTS: The meta-analysis encompassed 3,069 patients from 50 studies. Embolization appears safe with an overall complication rate of 3.2% (95% CI: 2.4-4.0%) and a permanent neurological deficit rate of only 1.2% (0.8-1.6%). Overall complication rates were comparable between liquid (4.1%, 1.8-6.5%) and particulate agents (2.7%, 1.7-3.6%) (P = 0.28). The rate of tumor edema causing neurologic deficits was slightly higher for liquid agents (2.4%, 0.6-4.2%) compared to particulate agents (0.5%, 0.2-0.8%) (P = 0.041). No significant differences were observed in hemorrhagic (liquid 2.3%, particulate 0.7%; P = 0.087) or ischemic complications (liquid 1.6%, particulate 1.1%; P = 0.53). For the carotid systems embolized, the pooled complication rate for ICA branches embolization (5.2%, 1.1-9.2%) was comparable to the pooled complication rate of external carotid artery embolization (2.5%, 1.8-3.2%) (P = 0.20). CONCLUSIONS: Preoperative embolization is a safe adjunct for meningioma resection, with similarly low complication rates for liquid and particulate agents. Furthermore, embolization of ICA branches can be as safe as external carotid artery branches in select cases
Plasma Proteomic Signatures of Adiposity Are Associated With Cardiovascular Risk Factors and Type 2 Diabetes Risk in a Multiethnic Asian Population
No full textUNLABELLED: The biomarkers connecting obesity and cardiometabolic diseases are not fully understood. We aimed to 1) evaluate the associations between BMI, waist circumference (WC), and ∼5,000 plasma proteins (SomaScan V4), 2) identify protein signatures of BMI and WC, and 3) evaluate the associations between the protein signatures and cardiometabolic health, including metabolically unhealthy obesity and type 2 diabetes incidence in the Singapore Multi-Ethnic Cohort Phase 1 (MEC1). Among 410 BMI-associated and 385 WC-associated proteins, we identified protein signatures of BMI and WC and validated them in an independent data set across two time points and externally in the Atherosclerosis Risk in Communities (ARIC) study. The BMI and WC protein signatures were highly correlated with total and visceral body fat, respectively. Furthermore, the protein signatures were significantly associated with cardiometabolic risk factors and metabolically unhealthy obesity. In prospective analyses, the protein signatures were strongly associated with type 2 diabetes risk in MEC1 (odds ratio per SD increment in WC protein signature 2.84; 95% CI 2.47-3.25) and ARIC (hazard ratio 1.98; 95% CI 1.88-2.08). Our protein signatures have potential uses in the monitoring of metabolically unhealthy obesity. ARTICLE HIGHLIGHTS: We evaluated the associations between ∼5,000 plasma proteins and BMI and waist circumference (WC) in a multiethnic Asian population. We identified 410 proteins associated with BMI and 385 proteins associated with WC and derived protein signatures of BMI and WC, which we validated externally in a U.S. cohort. Both the BMI and WC protein signatures were strongly associated with cardiometabolic risk factors, metabolically unhealthy obesity, and risk of obesity, metabolic syndrome, and type 2 diabetes. Our protein signatures have potential uses in monitoring metabolically unhealthy obesity
Unveiling Cultural Dynamics and Maternal Nutrition Taboos: A Scoping Review on their Impact on Stunting in Nusa Tenggara, Eastern Indonesia
No full textFather and Son
No full textPhotograph.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1004/thumbnail.jp
Patient-Centered Intervention in Advance Care Planning Across Dialysis Organizations: HIGHWay: Honor Individual Goals and Hopes
No full textBACKGROUND: Patients on dialysis want to discuss their preferences for treatment. The Shared Decision-Making-Renal Supportive Care intervention effectively elicited dialysis patient preferences for end-of-life care. The HIGHWay project updated this intervention to scale it for broader implementation of advance care planning to all patients during their regular dialysis sessions no matter ill-seriousness or time has been in dialysis and to address barriers previously found. METHODS: HIGHWay implemented advance care planning for dialysis patients of participant social workers and nurses, incorporating these conversations into the regular workflow. Participants completed a 6-hour online training course by study investigators focused on motivational interviewing and person-centered approaches. They then received 9-monthly group coaching sessions to strengthen their discussion skills. Data on participant engagement were collected via survey: pre-program, midpoint (6-months), post-implementation (9-months), and weekly surveys over the following 9-months to track conversations conducted. The Consolidated Framework for Implementation Research framework was used to measure implementation outcomes. RESULTS: We enrolled 55 social workers and nurses from 3 dialysis organizations from June 2021 to December 2023 across 61 dialysis clinics in the United States. After a 9-month follow-up period, 1,526 conversations were conducted. Of these, 868 were newly initiated cases. Participants reported an average of 1.7 conversations per week, most 30 minutes or less. The mean feasibility on 12 advance care planning-related activities on a 5-point scale increased from 3.4 (SD = 1.0) pre-training to 4.2 (SD = 0.85) after 9-months of follow-up (p \u3c0.05). Notably, 65% of the respondents felt more skillful addressing patient reluctance and 60% reported being more at ease with advance care planning topics. CONCLUSIONS: HIGHWay enhances confidence and skills in conducting advanced care planning for patients undergoing chronic dialysis. High scores for acceptability, appropriateness, and sustainability suggest that HIGHWay is ready for widespread use across all U.S. dialysis facilities