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Examining the Role of Corticosteroids in the Management of Acute Interstitial Pneumonia: A Systematic Review.
Get PDFBACKGROUND: Acute interstitial pneumonia (AIP), also known as Hamman-Rich syndrome, is a rapidly progressive interstitial lung disease. In addition to being challenging to diagnose, AIP is also difficult to treat. The mortality rate of AIP is greater than 70% due to the disease\u27s rapid progression. Furthermore, survivors are likely to develop chronic interstitial lung disease as a sequela. Treatment primarily focuses on supportive care, which consists of oxygenation through mechanical ventilation, administration of broad-spectrum antibiotics, and the use of corticosteroids. Although the use of steroids as empiric treatment is controversial and results on its mortality benefit are variable, some studies have shown high-dose pulse steroid therapy to be associated with better health outcomes. This review aimed to evaluate cases of AIP to better understand the role of corticosteroids in the management plan of these cases.
METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Outcomes of interest included patient age, sex, autoimmune condition, corticosteroid use, survival or expiration of patients, and time from hospitalization to expiration.
RESULTS: Initial querying of the five databases yielded 376 articles. Following a thorough review, only 30 articles remained, comprising 42 patient cases. Of these cases, 62% of the patients survived, 36% expired, and 2% were unknown. The average stay from hospitalization to death was 20.2 days, and corticosteroid pulse doses were used as a first- or second-line treatment in 31% of patients.
CONCLUSION: The limitations of the evidence used in this study highlight the need for a greater output of higher-level evidence in the form of controlled trials and retrospective studies to help further elucidate the proper role and dosage of corticosteroids in the management plan of AIP with the ultimate goal of enhancing clinical decision-making and patient care. The findings of this systematic review, primarily based on observational data from case reports, highlight the critical need for treatment guidelines for this condition. The compilations of these cases also illustrated the diverse strategies employed by clinicians globally to save patients afflicted by this condition. While specific recommendations cannot be made based solely on these results, we anticipate that this comprehensive overview of varied clinical approaches from around the world will serve as a valuable resource for healthcare providers navigating the complexities of managing this condition
A Narrative Review of Military Reverse Triage.
Get PDFINTRODUCTION: Military reverse triage has been described at several points in the literature. However, an extensive review of the concept and any gaps that may exist has not been conducted. This narrative review seeks to understand how reverse triage is used in the military literature and how it might be implemented in practice, as well as the documented historical applications of reverse triage.
MATERIALS AND METHODS: Four databases were searched manually for English-language articles: PubMed, SCOPUS, JSTOR, and Worldwide Political Science Abstracts. In addition, a manual search of references, U.S. DoD, and NATO doctrine, as well as other published works that the investigator was familiar with that are not cataloged in databases (such as print volumes) was performed.
RESULTS: After duplicates were removed, 15 articles were located from the database search. An additional 14 records were located from the manual search, resulting in 29 records that were screened for eligibility. After reviewing the abstracts of the records, 11 were excluded as not specifically discussing military reverse triage, resulting in 18 records for this review. Recurrent themes in the records reviewed include (1) military necessity, (2) reverse triage from physician, patient, and unit perspective, (3) fiduciary duties, (4) international humanitarian law (IHL), (5) military doctrine, and (6) moral injury. Reverse triage has been described as rare but historically significant, with only 3 documented potential instances identified in this review. These include its use by the German Army in World War II to prioritize lightly wounded soldiers for rapid return to duty, the selective use of penicillin during World War II, and a reported instance during the Falklands conflict. Despite these examples, current literature offers limited practical guidance on implementing reverse triage, raising questions about decision-making authority, criteria for implementation, and ethical considerations such as prioritization based on military occupational specialty, rank, or demographic factors. These uncertainties highlight the need for further exploration of the operational and ethical dimensions of reverse triage.
CONCLUSIONS: Reverse triage has evolved with a focus on military necessity but remains absent in U.S. military doctrine and rare in practice. Limited historical documentation and scant discussion in doctrine leave uncertainty about whether and how the U.S. military would implement reverse triage in future large-scale combat operations. Addressing these gaps requires further empirical investigation into the perspectives of key stakeholders to guide ethical and operational decision-making
4-Strand Hamstring Versus Single-Bundle Quadriceps Tendon Grafts in Anterior Cruciate Ligament Reconstruction at 2 years: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
Get PDFPURPOSE: To compare the 2-year postoperative outcomes of hamstring tendon (HT) grafts to quadriceps tendon (QT) grafts in anterior cruciate ligament (ACL) reconstruction. We hypothesised no significant differences between the two methods.
METHODS: A systematic review and meta-analysis were conducted following the 2020 PRISMA guidelines. Five online databases (Cochrane, Embase, PubMed, Scopus and Web of Science) were screened for prospective randomised controlled trials (RCT). IKDC, Lysholm, Tegner, side-to-side KT-1000 scores and ages were collected. Statistical analysis was conducted with SPSS v29. Between the two groups, a test of between-subgroup homogeneity
RESULTS: Five RCTs were included in the final analysis. The HT group included 87 patients, and the QT group included 93 patients. The mean ages for the HT and QT groups were 28.3 ± 6.6 and 26.5 ± 8.4 years, respectively. HTs yielded clinically higher IKDC scores (
CONCLUSIONS: Compared with the use of the QT graft, the HT graft for ACL reconstruction may result in greater knee function and stability, while QT ACL reconstruction may be associated with increased levels of postsurgical activity in terms of return to sports and work. Future long-term RCTs are needed to confirm our findings.
LEVEL OF EVIDENCE: Level I
Stability Analysis & Analytic Solutions to Unforced Kinematic Property Equations
Get PDFWe present analytic solutions and a stability analysis for a system of nonlinear coupled differential equations that describe the time evolution of kinematic properties of geophysical fluids. Solution curves in phase space are interestingly hyperbolic, elliptical, or parabolic in nature, depending on the initial conditions we input and have interesting geometrical properties
Exploring Sense of Belonging Among Neurodivergent Students in Higher Education
Get PDFPositive academic experiences for university students are hard to come by when non-academic experiences are negative (Gidley et al., 2010; Sandhu et al., 2022; Tinto, 1975). This issue has become increasingly important for neurodivergent students in higher education as more of this population is enrolling in university (Cox et al., 2002; Edwards et al., 2022; Gurbuz et al., 2018; Lubin & Brooks, 2021; Izzo et al., 2008; Mamiseishvili & Koch, 2011; Yssel et al., 2016). The purpose of this study is to listen to neurodivergent student voices to learn about their university experience and sense of belonging. Research questions include: How do neurodivergent students describe sense of belonging? (RQ1), What academic and non-academic experiences shape sense of belonging for neurodivergent students? (RQ2) and how do neurodivergent students navigate academic and non-academic challenges in a college environment? (RQ3). This study is significant because outcomes can help education professionals understand what changes are necessary to improve the university experience for neurodivergent students. The researcher conducted an interpretative phenomenological analysis where students were interviewed, and their perspectives coded. Major themes became apparent which led the researcher to conclude that students at Blue University developed sense of belonging, which lead to persistence through academic and non-academic challenges
RELATIONS AMONG RACISM-RELATED STRESS, ANXIETY, SPIRITUALITY AND MINDFULNESS IN BLACK SEXUAL MINORITY MEN
Get PDFAbstract Kainaat Anwar RELATIONS AMONG RACISM-RELATED STRESS, ANXIETY, SPIRITUALITY AND MINDFULNESS IN BLACK SEXUAL MINORITY MEN 2021-2022 Jonathan Mathias Lassiter, Ph.D. Master of Arts in Clinical Psychology Black sexual minority men’s experiences of racism and anxiety have not been documented extensively in the literature. There is also a paucity of research exploring protective factors that can mitigate the effects of racial stress on anxiety in BSMM. Therefore, this study looked at the potential moderating effects of spirituality and mindfulness on the relationship between racism-related stress and anxiety in BSMM. Participants completed measures regarding socio-demographics, racism-related stress, anxiety symptoms, mindfulness and spirituality. Utilizing frameworks of intersectionality and optimal conceptual theory (OCT), results were analyzed using Hayes PROCESS Macro Model 2 (Two-Way Moderation). Based on our findings, we found full support for Hypothesis 1: racism-related stress was significantly positively associated with anxiety while spirituality and mindfulness were significantly negatively associated with anxiety. Regression analyses also found racism-related stress and mindfulness to independently predict anxiety in BSMM. Due to significant lack of power in the study, we did not find support for Hypothesis 2 (moderation). Clinical and research implications of the findings are discussed
ATTITUDE ABOUT CAMPUS DIVERSITY IN A POST ANTI-AFFIRMATIVE ACTION ERA
Get PDFAbstract Robert Shawn Chester ATTITUDES ABOUT CAMPUS DIVERSITY IN A POST ANTI-AFFIRMATIVE ACTION ERA 2024-2025 Stephanie Lezotte, Ph.D. Master of Arts in Higher Education This thesis examines the implications of the recent Supreme Court ruling that deemed race-based Affirmative Action policies unconstitutional, focusing on its impact on diversity in higher education. Since the 1960s, Affirmative Action has been a pivotal tool in promoting racial equity and diversity in American colleges and universities, yet legal challenges have led to its dismantling in several states and now nationwide. This research explores Rowan University staff perspectives on the challenges and strategies for maintaining diversity without Affirmative Action, investigating how they prioritize diversity, the obstacles they face, and adaptations made following the ruling. Findings provide insights into how institutions can foster inclusive student bodies amid shifting legal frameworks. The focus on a single institution in a liberal region may limit generalizability to broader national trends. While Rowan staff strongly value diversity, the removal of race-based policies has created major challenges in outreach, financial aid, and clarity, prompting a shift to race-neutral strategies like socioeconomic targeting and holistic admissions. This research contributes to ongoing discussions about diversity and inclusion in higher education, offering actionable recommendations aligned with evolving legal and societal expectations and emphasizing the urgency of innovative, race-neutral strategies to preserve campus diversity progress
Exploring Intracellular Signaling Responses to KS18, a Potent Mcl-1 Inhibitor, in Multiple Myeloma
Get PDFMultiple myeloma (MM), a cancer of plasma B cells, is a hematological malignancy in which patients inevitably relapse and develop drug resistance. Mcl-1, a member of the anti-apoptotic subgroup of Bcl-2 family proteins, plays a critical role in the progression of multiple myeloma and contributes significantly to drug resistance. Elevated Mcl-1 expression is observed in approximately 52% of MM patients at diagnosis, increasing to 81% at relapse. Given its driving role in disease progression and therapy resistance, Mcl-1 inhibition has emerged as a promising therapeutic target, prompting ongoing research into the development and clinical evaluation of Mcl-1 inhibitors, particularly for patients with refractory or relapsed MM. Here, we show that KS18 is a potent and selective Mcl-1 inhibitor in both sensitive and chemo-resistant MM cells in vitro, and it outperforms other clinically tested Mcl-1 inhibitors such as S63845, VU661013, and AZD5991 in resistant cells. Given the many intracellular interactions of Mcl-1, inhibition can result in signaling changes that can either promote or compensate for the intended apoptotic effect. Our research indicates that KS18 causes a decreased p-ERK ½ expression, a kinase which phosphorylates and stabilizes Mcl-1. However, inhibition of p-ERK ½ via Trametinib, an FDA approved MAPK inhibitor, does not affect Mcl-1. Additionally, KS18 upregulates LC3, a key protein of autophagy, and this is not observed in other Mcl-1 inhibitors. Autophagic induced cell death has been observed in response to chemotherapeutic agents. Cells resistant to Mcl-1 inhibitor S63845 still responded to KS18 and exhibited similar upregulation in LC3. These observations provide valuable insights into effects of potent Mcl-1 inhibition and ways to enhance its apoptotic effects while minimizing chemotoxicity in patients
Outcomes of Left Atrial Appendage Occlusion in Patients with Obstructive Sleep Apnea: A Comprehensive National Study
Get PDFWe sought to explore a sample of the inpatient population with OSA with AF who underwent LAAO
Case Report: Pulmonary Infarction Following Recent Pulmonary Embolism
Get PDFA 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and a recent pulmonary embolism (PE) on anticoagulation presented with acute pleuritic chest pain and worsening dyspnea. Computed tomographic angiography (CTA) of the chest revealed a small distal segmental PE in the left lower lobe and an adjacent irregular consolidation, raising concern for pulmonary infarction versus pneumonia. The patient was empirically started on antibiotics for possible pneumonia and admitted for anticoagulation and supportive care. He left the hospital against medical advice (AMA) before completing treatment, but returned days later with exacerbated symptoms. This case highlights the diagnostic challenge of differentiating pulmonary infarction from pneumonia in the context of acute PE. The patient’s course underscores the importance of recognizing imaging and laboratory clues suggestive of infarction, ensuring adequate treatment, and the risks associated with premature discontinuation of care. We discuss the pathophysiology of pulmonary infarction, its clinical and radiologic presentation, and discuss recent literature on management strategies. The case emphasizes the need for high clinical suspicion of pulmonary infarction in PE patients who develop pulmonary opacities, as timely diagnosis can direct appropriate therapy and avoid mismanagement