Activity

We aimed to assess associations between depressive symptoms, lifestyle, and somatic symptoms during the COVID-19 pandemic.

A prospective, observational study using a self-designed questionnaire.

Three general practitioners’ (GP) offices in rural Germany.

271 adult patients without manifest cardiovascular or pulmonary disease with (n = 82) and without (n = 189) hypertension reporting to our GP offices.

The reported increase of depressive symptoms (loneliness, sleeplessness, joylessness, listlessness) prior to the first documented case in Germany on 27.01.2020 (t

) as opposed to patients’ health perception during the Corona pandemic (t

) was the primary outcome measure. The secondary outcome measures were changes in physical activity (PA), dyspnea and angina in the two groups.

Out of 271 patients (50.8 ± 16.8 years, 55.1% females), 1.5% were tested positive for COVID-19. Overall, listlessness (8.5%, p = 0.001), sleeplessness (5.2%, p = 0.001) and joylessness (4.2%, p = 0.003) were increased. Dyspnis no driver of symptom deterioration during the pandemic. The trial was registered in the German Clinical Trials Registry (DRKS00022157).

Variation in breast cancer stage at initial diagnosis (including racial disparities) is driven both by tumor biology and healthcare factors.

We studied women age 67-74 with initial diagnosis of breast cancer from 2006 through 2014 in the SEER-Medicare database. We extracted variables related to tumor biology (histologic grade and hormone receptor status) and healthcare factors (screening mammography [SM] utilization and time delay from mammography to diagnostic biopsy). We used naïve Bayesian networks (NBNs) to illustrate the relationships among patient-specific factors and stage-at-diagnosis for African American (AA) and white patients separately. After identifying and controlling confounders, we conducted counterfactual inference through the NBN, resulting in an unbiased evaluation of the causal effects of individual factors on the expected utility of stage-at-diagnosis. An NBN-based decomposition mechanism was developed to evaluate the contributions of each patient-specific factor to an actual racial disparity in stage-at-diagnosis. 2000 bootstrap samples from our training patients were used to compute the 95% confidence intervals (CIs) of these contributions.

Using a causal-effect contribution analysis, the relative contributions of each patient-specific factor to the actual racial disparity in stage-at-diagnosis were as follows tumor grade, 45.1% (95% CI 44.5%, 45.8%); hormone receptor status, 5.0% (4.5%, 5.4%); mammography utilization, 23.1% (22.4%, 24.0%); and biopsy delay 26.8% (26.1%, 27.3%).

The modifiable mechanisms of mammography utilization and biopsy delay drive about 49.9% of racial difference in stage-at-diagnosis, potentially guiding more targeted interventions to eliminate cancer outcome disparities.

The online version contains supplementary material available at 10.1007/s13755-021-00165-5.

The online version contains supplementary material available at 10.1007/s13755-021-00165-5.Background Opioids prescribed for the management of chronic noncancer pain are associated with nausea, vomiting, and constipation. Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, has demonstrated robust efficacy and was well-tolerated in treating opioid-induced constipation without affecting central analgesia. Our objective was to assess changes in the frequency of adverse events after the first or second dose of methylnaltrexone or placebo. Methods This post hoc analysis pooled data from two randomized, placebo-controlled clinical trials assessing methylnaltrexone for opioid-induced constipation in the outpatient setting. click here Patients received subcutaneous methylnaltrexone (12 mg once daily or 12 mg once every other day), oral methylnaltrexone (150, 300, or 450 mg daily), or placebo. Adverse events, opioid withdrawal symptoms, pain intensity, and rescue-free bowel movements (RFBMs) within 4 hours of the first dose (i.e., RFBM responders) were assessed. Associations between adverse event frequencies and RFBM response were also evaluated. Results The analysis included 1263 adult patients with chronic noncancer pain. Treatment-emergent adverse event rates declined from treatment day 1 to 2 (methylnaltrexone 16.2%-5.3%; placebo 6.6%-5.4%). Among methylnaltrexone-treated patients, significantly greater proportions of RFBM responders versus nonresponders reported gastrointestinal adverse events on day 1. No associations between RFBM response and the frequency of adverse events were observed in the placebo group. No meaningful changes in opioid withdrawal symptoms or pain intensity were observed. Conclusions Early-onset adverse events following methylnaltrexone treatment, particularly gastrointestinal adverse events, are at least partially due to laxation. Methylnaltrexone treatment effectively relieves opioid-induced constipation without affecting the central analgesic effects of opioids.Background There are three methods for renal replacement therapy for end stage chronic kidney disease; dialysis, continuous ambulatory peritoneal dialysis, and renal transplantation which is the best because of the least morbidity rate, the best survival rates, the best quality of life, and the best improvement in activities of daily living. In the field, flow cytometry serves a well-established role in pre- and post-transplant crossmatching, and if it is combined with human leukocyte antigen (HLA) immunophenotyping based on DNA, it will produce a more sensitive prediction of the chronic graft rejection compared to complement-dependent cytotoxicity crossmatching and can eliminate irrelevant antibody (IgM). This is the first experience using this method in our hospital. The survival rate at one, five and ten years has been shown to be 99%, 97% and 96%, respectively; therefore, we wanted to find out the five year follow up of the patient. Case presentation We evaluated a 20-year-old female with a history of pediatric renal transplantation five years previously due to end stage renal disease caused by bilateral parenchymatous renal disease. She had a history of hypertension since December 2014 and underwent hemodialysis for three months. The transplantation took place in March 2015. A kidney from her mother was transplanted to recipient using end-to-side anastomoses. After five years, the patient was routinely monitored at the urology clinic, with creatinine serum results between 1.5 and 2 mg/dL, urea and electrolyte serum levels within normal limits and she could resume normal life. Conclusions Survival five years after the procedure showed a beneficial outcome of the method used.Increases in lung vascular permeability is a cardinal feature of inflammatory disease and represents an imbalance in vascular contractile forces and barrier-restorative forces, with both forces highly dependent upon the actin cytoskeleton. The current study investigates the role of Ena-VASP-like (EVL), a member of the Ena-VASP family known to regulate the actin cytoskeleton, in regulating vascular permeability responses and lung endothelial cell barrier integrity. Utilizing changes in transendothelial electricial resistance (TEER) to measure endothelial cell barrier responses, we demonstrate that EVL expression regulates endothelial cell responses to both sphingosine-1-phospate (S1P), a vascular barrier-enhancing agonist, and to thrombin, a barrier-disrupting stimulus. Total internal reflection fluorescence demonstrates that EVL is present in endothelial cell focal adhesions and impacts focal adhesion size, distribution, and the number of focal adhesions generated in response to S1P and thrombin challenge, with the focal adhesion kinase (FAK) a key contributor in S1P-stimulated EVL-transduced endothelial cell but a limited role in thrombin-induced focal adhesion rearrangements. In summary, these data indicate that EVL is a focal adhesion protein intimately involved in regulation of cytoskeletal responses to endothelial cell barrier-altering stimuli. Keywords cytoskeleton, vascular barrier, sphingosine-1-phosphate, thrombin, focal adhesion kinase (FAK), Ena-VASP like protein (EVL), cytoskeletal regulatory protein.

Diagnosis of pollen allergies is mainly based on test allergens for skin prick testing. In the minimum battery of test inhalant allergens recommended by the Global Allergy and Asthma European Network 10 pollen allergens are included. Complementary other pollen allergens may need to be considered; however, respective awareness may not always be granted. Furthermore, at least in Germany, the situation may be even more complicated by the fact that test allergens need regulatory approval. A decline in commercially available test allergens may result in a diagnostic gap regarding patients with non-frequent allergies. How many patients with non-frequent pollen allergies would be affected by this gap? The data presented here partly answer this question.

The study consisted of a descriptive and an analytical part. In the descriptive part, sensitization to frequent pollen allergens (alder, hazel, birch, sweet grasses; according to the German Therapy Allergen Ordinance) and to respective non-frequent pollen allergesidered when examining patients with respective seasonal symptoms, and test (and respective therapy) allergens for non-frequent pollen allergies need to be available. Further prerequisites for adequate patient management would be a nationwide pollen monitoring system giving continuous pollen data and a systematic sensitization monitoring at patient level.

Sensitization to non-frequent pollen allergens have to be considered when examining patients with respective seasonal symptoms, and test (and respective therapy) allergens for non-frequent pollen allergies need to be available. Further prerequisites for adequate patient management would be a nationwide pollen monitoring system giving continuous pollen data and a systematic sensitization monitoring at patient level.Infective endocarditis is an important cause of morbidity and mortality, which classically presents with fevers and nonspecific symptoms. Afebrile infective endocarditis with negative blood cultures makes diagnosis more challenging and delays in treatment can occur increasing the likelihood of complications. The presence of prosthetic heart valves places patients at an increased risk of infective endocarditis and the case described below highlights the importance of considering this diagnosis even if classic clinical features such as fever and raised inflammatory markers are not present, as well as discussing an unusual complication of infective endocarditis; coronary artery embolism leading to myocardial infarction.Ocular injuries carry a significant morbidity worldwide. Visual outcomes vary depending on the mechanism of injury, the damage on arrival and the surgical technique used. The presence of an intraocular foreign body further complicates matters, due to its constituents, the infectious potential, and/or damage to intraocular structures. Another described problem is the inadvertent cataract formation due to contact with the natural lens during removal of the foreign body. The purpose of this paper is to describe a case with a mechanical foreign body lodging in the posterior chamber without harming the lens. The surgical challenge was to remove it without causing cataractous changes. Therefore, a soft contact lens was used to form a protective layer between the foreign body and the natural lens of the eye allowing successful removal of the foreign body.