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Beta-Blockers as an Immunologic and Autonomic Manipulator in Critically Ill Patients: A Review of the Recent Literature
Get PDFThe autonomic nervous system plays a key role in maintaining body hemostasis through both the sympathetic and parasympathetic nervous systems. Sympathetic overstimulation as a reflex to multiple pathologies, such as septic shock, brain injury, cardiogenic shock, and cardiac arrest, could be harmful and lead to autonomic and immunologic dysfunction. The continuous stimulation of the beta receptors on immune cells has an inhibitory effect on these cells and may lead to immunologic dysfunction through enhancing the production of anti-inflammatory cytokines, such as interleukin-10 (IL-10), and inhibiting the production of pro-inflammatory factors, such as interleukin-1B IL-1B and tissue necrotizing factor-alpha (TNF-alpha). Sympathetic overstimulation-induced autonomic dysfunction may also happen due to adrenergic receptor insensitivity or downregulation. Administering anti-adrenergic medication, such as beta-blockers, is a promising treatment to compensate against the undesired effects of adrenergic surge. Despite many misconceptions about beta-blockers, beta-blockers have shown a promising effect in decreasing mortality in patients with critical illness. In this review, we summarize the recently published articles that have discussed using beta-blockers as a promising treatment to decrease mortality in critically ill patients, such as patients with septic shock, traumatic brain injury, cardiogenic shock, acute decompensated heart failure, and electrical storm. We also discuss the potential pathophysiology of beta-blockers in various types of critical illness. More clinical trials are encouraged to evaluate the safety and effectiveness of beta-blockers in improving mortality among critically ill patients
An Abnormal Presentation of Rocky Mountain Spotted Fever: A Case Report
Get PDFThe intracellular coccobacilli Rickettsia rickettsii causes Rocky Mountain Spotted Fever, a potentially fatal illness. This bacterium is transmitted to humans through a tick vector. Patients classically present with a triad of symptoms, including fever, headache, and a rash that begins on the extremities and spreads proximally to the trunk. Diagnosis of this disease can prove difficult when patients have unusual symptoms, such as hypertensive crisis. In this case report, we present a 29-year-old male who arrived at the emergency room with altered mental status and a hypertensive crisis after his family reported one week of changes in his behavior. The patient had no evidence of ticks, tick bites, fever, or rash. Positive findings in the emergency room included a WBC of 14.9 × 109. All other physical exams, imaging, and laboratory findings were non-contributory. The patient was promptly given IV hydralazine to control his blood pressure and empiric IV ceftriaxone for potential infection, and he was admitted for observation. Over the course of three days, WBC levels decreased, and his altered mental status improved. On day 3, the patient remembered a tick crawling across his hand, and this prompted the ordering of immunoglobulin levels for tick-borne illnesses. IgM for RMSF was positive. This case presentation illustrates the need for clinicians to keep the potential diagnosis of RMSF high on the differential, even in the presence of a paucity of symptoms, as prompt treatment with doxycycline can be lifesaving. This case may also be one of the first reported in the literature of hypertension being a symptom of Rocky Mountain Spotted Fever. It is plausible, however, that this patient’s hypertension was due to an acute stress response
The Impact of Exercise on Food-related Inhibitory Control— Do Calories, Time of Day, and BMI Matter? Evidence From an Event-related Potential (ERP) Study
No full textA growing body of research suggests exercise improves inhibitory control functions. We tested if exercise-related inhibitory control benefits extend to food-related inhibitory control and differ by calorie content, time of day, and weight status. One hundred thirty-eight individuals were pseudo-randomly assigned to a morning or evening group. Each subject participated in two lab sessions where they completed questionnaires (rest session) or walked on a treadmill at 3.8mph (exercise session) for 45 min. After each session, participants completed both a high-calorie and low-calorie go/no-go task while N2 and P3 event-related potentials (ERP), both neural indicators of inhibitory control, were measured. Participants also rated food images for valence and arousal. While N2 and P3 difference amplitudes were larger to high-calorie than low-calorie foods, neither exercise nor time of day affected results. Individuals had faster response times after exercise without decreases in accuracy. Arousal and valence for high-calorie foods were lower after exercise and lower for all foods after morning compared to evening exercise. In a subset of individuals with obesity and normal-weight individuals, individuals with obesity had larger N2 difference amplitudes after morning exercise, while normal-weight individuals had larger P3 difference amplitudes to high-calorie foods after exercise. Results suggest moderate exercise did not affect food-related inhibitory control generally, although morning exercise may be beneficial in improving early recruitment of food-related inhibitory control in individuals with obesity. Moderate exercise, particularly in the morning, may also help manage increased attention allocated to food
Epithelial Barrier Hypothesis: A Systematic Review
Get PDFBackground
The epithelial barriers, which include the skin, the gut, and the respiratory lining, play a crucial role in protecting the body from pathogens and environmental threats. Many harmful toxins are increasingly part of modern life. The increase in usage of these damaging agents in conjunction with the increase in allergic inflammatory conditions suggests that the “epithelial barrier hypothesis”—the concept that damage to the epithelia by external agents can result in dysbiosis, inflammation, and allergy—may explain the rise in these conditions seen in the developed world.
Objective
We sought to assess the evidence for the epithelial barrier hypothesis, with particular focus on the skin.
Methods
A systematic search of PubMed and Embase was performed using search terms relating to epithelial barriers and damaging agents.
Results
Our initial search yielded 25 results with 7 studies meeting inclusion criteria.
Limitations
Lack of studies.
Conclusions
The epithelial barrier hypothesis provides an understanding of mechanisms affecting the integrity of the skin, gut, and respiratory barriers that may lead to inflammation and allergic disease throughout the body
Expanding Insurance Coverage to Include Newly Available Over-the-Counter Contraceptives in the United States
No full textEstablishing the Patient Acceptable Symptoms State for the Boston Carpal Tunnel Questionnaire in a Postoperative Carpal Tunnel Surgery Population
No full textPurpose: Threshold scores for patient acceptable symptom state (PASS) represent the score beyond which a patient considers themselves well. We aimed to determine PASS thresholds for the symptom severity scale (SSS) and functional status scale (FSS) of the Boston Carpal Tunnel Questionnaire in a sample of patients 1 year following carpal tunnel release.
Methods: Adults (≥ 18 years) from a single, tertiary-care academic institution were contacted 12 ± 1 months after carpal tunnel release. The Boston Carpal Tunnel Questionnaire and two PASS anchor questions were administered via REDCap-one queried acceptability of their current symptoms, and the other queried function. Participants were classified as being in an acceptable symptom state ( PASS(+) ) if they answered very satisfied or somewhat satisfied, whereas those responding neither satisfied nor dissatisfied, somewhat dissatisfied, or very dissatisfied were classified as PASS(-). Threshold values were calculated using three methods: (1) the mean score for PASS(+) participants, (2) the 75th percentile score for PASS(+) patients, and (3) the Youden Index determined using receiver operating curve (ROC) analysis to maximize sensitivity and specificity.
Results: The 153 patients included in the study had a mean age of 60 ± 15 years and 60% (94/153) were women. At a mean follow-up of 1.0 ± 0.1 years, SSS and FSS scores were significantly lower (better) for PASS(+) than PASS(-) patients for both anchor questions. PASS estimates ranged from \u3c1.4 to \u3c1.8 for the SSS and from \u3c1.3 to \u3c1.5 for the FSS. All ROC curves produced excellent discrimination (area under the curve \u3e 0.8).
Conclusions: We propose PASS thresholds of 1.8 for the SSS and 1.5 for the FSS, derived by the Youden or ROC method, which showed excellent discrimination between PASS(+) and PASS(-) patients.
Clinical relevance: These threshold values can be used to assess whether patient populations have achieved an adequate symptom and functional state
Otolaryngological Presentations of Klippel-Feil Syndrome: A Systematic Review
Get PDFKlippel-Feil syndrome (KFS) is a rare congenital condition characterized by the fusion of cervical vertebrae. It classically presents with a triad of symptoms: limited cervical range of motion, a low posterior hairline, and a short neck. Common otolaryngological manifestations include hearing loss, dysphagia, cleft palate, jaw disorders, thyroid abnormalities, and ear malformations, highlighting the importance of KFS awareness in the field of otolaryngology. Recognizing these symptoms can enhance patient care and outcomes. This systematic review analyzed all case reports on KFS published in the last 10 years on PubMed. Cases were classified using the Samartzis classification, Mallampati score, and Cormack-Lehane grade. Symptoms were then identified, and common imaging techniques were noted to provide clinical recommendations for treating KFS patients. The study found that more severe vertebral fusions are linked to more serious symptoms. Otolaryngologists should consider KFS in their differential diagnosis, especially in patients presenting with neck masses and pain, hearing loss, dysphagia, scoliosis, Sprengel\u27s deformity, or other musculoskeletal abnormalities
Needle Arthroscopy in Orthopedics
No full textArthroscopy is a minimally invasive diagnostic and operative tool in orthopedics that yields speedy recovery and decreased morbidity compared to open surgery. First described in the early 1990s, the use of needle arthroscopy has increased due to improved image quality and technique. The rapid expansion in use of needle arthroscopy is reflected by the increased incidence in publications assessing the indications, surgical techniques, outcome and complication profiles for both diagnostic and operative management of joint pathology. This narrative review aimed to provide an insight into the current literature about the use and development of needle arthroscopy in orthopedic surgery and to identify knowledge gaps as input for further research