Still Scholarworks (A.T. Still University)
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The Relationship between Eating Disorders, Disordered Eating, and Injury in Athletes: A Critically Appraised Topic
No full textClinical Scenario: Eating disorders (EDs) and disordered eating (DE) result in numerous physical and psychological complications for female and male athletes. Besides bone-related injury, little research exists investigating what injuries EDs and/or DE contribute to. Clinical Question: Are EDs and/or DE a risk factor for injury incidence in athletes? Summary of Key Findings: We searched for prospective studies assessing EDs or DE as a risk factor for injury in female or male athletes high school age and older. Our search returned 5 studies. One study found Eds, or DE were not a risk for any type of injury in female cross-country and track-and-field athletes. Two studies found a possible relationship between EDs or DE, as one contributing factor of others, in the incidence of bone stress injuries (BSIs) in female athletes who compete in various sports. One study found female, but not male, cross-country and track-and-field athletes with a history of EDs were more at risk for stress fractures than those without a history. One study found Eds, or DE were not a risk for BSI in female runners and triathletes. Clinical Bottom Line: Large and important gaps in the literature exist investigating injuries related to EDs or DE outside of BSIs. There is low–moderate evidence that EDs and/or DE are either a sole, or contributing, risk factor for BSIs in female athletes. Strength of Recommendation: Grade B evidence exists to support the idea that EDs and/or DE are a risk factor for a specific type of injury (BSI) in female athletes only
A narrative review of nine commercial point of care influenza tests: An overview of methods, benefits, and drawbacks to rapid influenza diagnostic testing
No full textContext: Rapid influenza diagnostic tests (RIDTs) are becoming increasingly accurate, available, and reliable as the first line of testing when suspecting influenza infections, although the global burden of influenza infections remains high. Rapid diagnosis of influenza infections has been shown to reduce improper or delayed treatment and to increase access to diagnostic measures in public health, primary care, and hospital-based settings. Objectives: As the use of RIDTs continues to expand in all healthcare settings, there is a multitude of molecular techniques being employed by these various testing platforms. With this in mind, we compare the sensitivity, specificity, and time to diagnosis for nine highly utilized commercial RIDTs. Methods: Nine commercially available RIDTs were identified from the US Centers for Disease Control and Prevention (CDC) website, which were also referenced on PubMed by name within the title or abstract of peer-reviewed publications examining the sensitivity and specificity of each test against a minimum of three influenza A virus (IAV) strains as well as seasonal influenza B virus (IBV). Data from the peer-reviewed publications and manufacturers\u27 websites were combined to discuss the sensitivity, specify, and time to diagnosis associated with each RIDT. Results: The sensitivity and specificity across the examined RIDTs were greater than 85.0% for both IAV and IBV across all platforms, with the reverse transcriptase-polymerase chain reaction (RT-PCR) assays maintaining sensitivity and specificity greater than 95.0% for all viruses tested. However, the RT-PCR platforms were the longest in time to diagnosis when compared to the other molecular methods utilized in the examined RIDTs. Conclusions: Herein, we discussed the benefits and limitations of nine commercially available RIDTs and the molecular techniques upon which they are based, showing the relative accuracy and speed of each test for IAV and IBV detection as reported by the peer-reviewed literature and commercial manufacturers
Unmasking structural racism in US medical education: advancing equity for underrepresented medical students
No full textThe COVID pandemic cast a harsh light on the structural and systemic health inequalities that exist in American society and in U.S. medical education. Black and Brown communities were disproportionately affected, and the pandemic highlighted the need for a diverse physician and healthcare workforce. Both the lack of equitable, high-quality healthcare in underrepresented communities and the obstacles that students who are underrepresented in medicine (URiM) experience in medical school are direct consequences of the structural racism that flourishes in U.S. medical schools and healthcare institutions. In this article, we explain structural racism and how it has manifested itself in medical education, including the lack of diversity among faculty and leadership, implicit biases and stereotypes about people of color, and discriminatory language used in evaluations of URiM students. We conclude with potential solutions for addressing structural racism in medical education. These include increasing diversity among faculty and leadership, implementing antiracist curricula, and providing mentorship and support for URiM students. Ultimately, we aim to promote discussion and action to eliminate structural racism in medical education in America
Esthetical Properties of Single-Shade and Multishade Composites in Posterior Teeth
No full textThis study aimed to compare the aesthetic properties of posterior composite restorations made with a multishade (MS) or single-shade (SS) material. For that, 23 extracted human molars were used. The shade determination was performed, and the occlusal anatomy was registered by a custom-made stamp. Then, class I preparations were made, and each tooth was restored twice, using two different composites of MS/opacity layering material (Admira Fusion - Voco) and an SS/opacity bulk-fill composite (Admira Fusion X-tra - Voco). After finishing the first restoration with the MS material, a standardized picture was taken, and the restoration was removed. Then, the preparation was restored again with the other composite, obtaining a new picture. The pictures were randomly analyzed by 10 calibrated evaluators regarding color match using the FDI criteria. The evaluators were blinded to the restorative material used. Data were analyzed using an unpaired t-test and Wilcoxon test. The significance level adopted in the study was 5%. As a result, there were nonsignificant differences between the composites evaluated for color match, as well nonsignificant differences were obtained related to which restorative technique produced the best aesthetic results. Only for darker shades (A4, B4, and C4), most of the evaluators considered the restorations made with the MS material more aesthetic than with the SS, while for the other shades, nonsignificant differences were observed. Therefore, the choice of the SS and the MS/opacity composites does not influence the aesthetic outcome of posterior restorations for the lighter shades. However, the use of bulk fill material for dark shades is less favorable than the MS layering ones
Is there any association between genetically predicted periodontitis and ischemic stroke?
No full textDesign: Mendelian randomization study. Case selection: Using a Mendelian randomization framework, the causal relationship between periodontitis [chronic periodontitis (CP) and aggressive periodontitis (AgP)] and ischemic stroke and its subtypes [cardioembolic (CE) stroke, large artery atherosclerosis (LAA), and small vessel occlusion (SVO)], were studied. Data analysis: Data from three large databanks, namely, UK Biobank, genome-wide association study of European ancestry, and MEGASTROKE consortium of European ancestry were used to obtain genetic variant information of CP, AgP, and ischemic stroke, respectively. UK Biobank contributed 950 cases of CP and 455,398 controls. Genome-wide association study of European ancestry contributed 851 AgP cases and 6836 controls. MEGASTROKE consortium of European ancestry contributed 34,217 cases of ischemic stroke and its subtypes and 406,111 controls. Statistical tests including inverse variant weighted method and sensitivity analyses were performed to analyse the causal inference and to verify the strength of the results. Results: A total of 15 single nucleotide polymorphisms (SNPs) for CP was obtained as genetic instruments. No causal inference of CP on ischemic stroke was found. Among the ischemic stroke subtypes, with the exception of CE stroke, no significant causal inference of CP on LAA or SVO was found. A total of 9 single nucleotide polymorphisms (SNPs) for AgP was obtained as genetic instruments. No causal inference of AgP on ischemic stroke and its subtypes were found. Conclusions: Neither CP nor AgP was found to have a causal inference on ischemic stroke and most of its subtypes. A probable causal effect of CP on CE stroke was noted
Recognizing postural orthostatic tachycardia syndrome in primary care
No full textAbstract
Postural orthostatic tachycardia syndrome (POTS) is a complex autonomic disorder characterized by abnormal tachycardia on standing. This disorder predominantly affects young women, with a peak incidence between ages 20 and 30 years. POTS often is associated with a variety of symptoms, including dizziness, palpitations, fatigue, generalized weakness, anxiety, and exercise intolerance, which can significantly impair patient quality of life. Primary care providers (PCPs) often are the first healthcare professionals to whom patients present. This article provides an overview of POTS, including diagnostic criteria and the importance of a thorough clinical evaluation to rule out other causes of symptoms. PCPs play a critical role in the comprehensive approach to care, involving patient education, lifestyle modifications, and treatment to improve outcomes and enhance patient quality of life
Scedosporium infection disseminated from toe to head in allogeneic stem cell transplant recipient: a case report
No full textAbstract
Background: Scedosporium is a lesser-known non-Aspergillus genus of mold that can present in unsuspecting ways. If overlooked, it may disseminate and cause high mortality in high-risk allogeneic stem cell transplant recipients.
Case presentation: This case report describes a 65-year-old patient with Acute Myeloid Leukemia who underwent an allogeneic hematopoietic stem cell transplant after a period of prolonged neutropenia with fluconazole prophylaxis. She suffered severe debility with altered mentation from a S. apiospermum infection which likely disseminated from a toe wound to the lung and central nervous system. She was successfully treated with liposomal amphotericin B and voriconazole, but faced a prolonged recovery from physical and neurologic sequela.
Conclusions: The case highlights the importance of adequate anti-mold prophylaxis in high-risk patients, and the value of a thorough physical examination in this patient population, with particular attention to skin and soft tissue findings