Utilization of Romosozumab in Primary Care.

The objective of the study is to highlight the role and safety of romosozumab in patients at high risk of fractures in primary care. A systemic database search of PubMed/MEDLINE, ClinicalTrials.gov, and Cochrane Library was conducted for articles with keywords romosozumab, osteoporosis, and safety between inception and July 2022.

Massive hemoptysis with end stage renal disease (ESRD): An initial symptom of rare disease.

Microscopic polyangiitis is a rare autoimmune vasculitis, that could present with renal-pulmonary symptoms, posing diagnostic challenges in patients with preexisting kidney disease. Timely diagnosis is crucial to improve patient outcomes.

Selective Depletion of Staphylococcus aureus Restores the Skin Microbiome and Accelerates Tissue Repair after Injury.

Our skin is home to a diverse community of commensal microorganisms integral to cutaneous function. However, microbial dysbiosis and barrier perturbation increase the risk of local and systemic infection. Staphylococcus aureus is a particularly problematic bacterial pathogen, with high levels of antimicrobial resistance and direct association with poor healing outcome.

An enigmatic presentation of endocarditis: Emphasizing the role of brain magnetic resonance imaging.

Key Clinical Message: Infective endocarditis should be considered in any febrile individual with acute onset neurological symptoms. If suspicion is high, a negative brain computed tomography does not virtually exclude embolism, and magnetic resonance imaging is warranted.

Abstract: A diagnosis of infective endocarditis (IE) is often delayed, particularly in those infected with unusual organisms.

A multicenter retrospective comparison of trauma in toy breeds versus giant breeds: A Veterinary Committee on Trauma registry study.

Objective: To retrospectively evaluate and stratify the differences in signalment, mechanisms, and severity of injury between toy and giant breed dogs.

Design: Retrospective, observational cohort study.

Setting: Multicenter, university veterinary teaching hospital, and private referral hospitals contributing to Veterinary Committee on Trauma (VetCOT) patient registry.

Genome assembly of two nematode-resistant cotton lines (Gossypium hirsutum L.).

Upland cotton (Gossypium hirsutum L.) is susceptible to damage by the root-knot and the reniform nematodes, causing yield losses greater than 4% annually in the United States. In addition, these nematodes are synergistic with seeding disease and root rot pathogens that exacerbate diseases and subsequent yield losses.

Real-Time Learning Through Telemedicine Enhances Professional Training in Rural Emergency Departments.

The low volume and the intermittent nature of serious emergencies presenting to rural emergency departments (EDs) make it difficult to plan and deliver pertinent professional training. Telemedicine provides multiple avenues for training rural ED clinicians. This study examines how telemedicine contributes to professional training in rural EDs through both structured and unstructured approaches.

Successful xenotransfusion in a domestic ferret with spontaneous hemoperitoneum using feline packed red blood cells.

Objective: To describe the diagnosis, management, and outcome of a ferret with spontaneous hemoperitoneum with surgical intervention and xenotransfusion of type A feline packed red blood cells (pRBCs).

Case Summary: A domestic ferret diagnosed with a spontaneous hemoperitoneum secondary to a hepatic mass received isotonic crystalloids, hypertonic saline, and an allogenic blood transfusion perioperatively. Postoperatively, the ferret developed progressive anemia and tachycardia refractory to fluid therapy and, given a lack of additional allogenic blood sources, received a xenotransfusion of feline pRBCs.

The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest.

Aim: In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0-20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge.

Paediatric tele-emergency care: A study of two delivery models.

Introduction: Tele-emergency models have been utilized for decades, with growing evidence of their effectiveness. Due to the variety of tele-emergency department (tele-ED) models used in practice, however, it is challenging to build standardized metrics for ongoing evaluation. This study describes two tele-ED programs, one specialized and one general, that provide care to paediatric populations.

The Business Case for Tele-emergency.

Background: Tele-emergency is an expanding telehealth service that provides real-time audio/visual consultation delivered by an emergency medicine team to a remote, often rural, emergency department (ED). Financial analyses of tele-emergency in the literature are limited. This article expands the tele-emergency literature to describe the business case for tele-emergency.

Tele-emergency utilization: In what clinical situations is tele-emergency activated?

Introduction: Tele-emergency provides audio/visual communication between a central emergency care centre (tele-emergency hub) and a distant emergency department (remote ED) for real-time emergency care consultation. The purpose of this mixed methods study is to examine how often tele-emergency is activated in usual practice and in what circumstances it is used.

Methods: Tele-emergency log data and merged electronic medical record data from Avera Health (Sioux Falls, SD) were analysed for 60,193 emergency department (ED) encounters presenting over a two-and-a-half year period at 21 critical access hospitals using the tele-emergency service.

Effects of reduced dietary protein and supplemental rumen-protected essential amino acids on the nitrogen efficiency of dairy cows.

When fed to meet the metabolizable protein requirements of the National Research Council, dairy cows consume an excess of N, resulting in approximately 75% of dietary N being lost to the environment as urine and feces. Reductions in environmental N release could be attained through an improvement in N efficiency. The objective of this study was to determine if the predicted reduction in milk yield associated with feeding a low-protein diet to lactating dairy cows could be avoided by dietary supplementation with 1 or more ruminally protected (RP) AA.

A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status.

Objectives: The aims of this study were to investigate the extent of MRI-determined joint disease (erosion and synovitis) in SLE and to link this to autoantibody profiles known to be relevant to SLE, including ACPA, RF and anti-RA33 antibodies.

Methods: Contrast-enhanced MRI of the hand and wrist was performed in 34 symptomatic SLE patients and in 15 RA patients with similar disease duration. Images were scored by two observers using the OMERACT rheumatoid arthritis MRI scoring (RAMRIS) system.

Plasma IL-6 levels correlate with clinical and ultrasound measures of arthritis in patients with systemic lupus erythematosus.

Objective: The objective of this paper is to elucidate the role of specific cytokines in lupus (SLE) arthritis.

Methods: Fifty SLE and 40 RA patients had an ultrasound (US) scan of their hand as per standardized protocols. US scores were expressed per joint and as a total 'US activity' score, (sum of power Doppler (PD) and grey-scale synovial hypertrophy scores in all joints) and a total erosion score.

Childhood eye examination.

Vision screening in children is an ongoing process, with components that should occur at each well-child visit. The purpose is to detect risk factors and visual abnormalities that necessitate treatment and to identify those patients who require referral to an ophthalmologist skilled in examining children. Screening can reveal conditions commonly treated in primary care and can aid in discussion of visual concerns with parents or caregivers.

Lupus arthritis--do we have a clinically useful classification?

Joint disease in SLE is common and has a significant impact on patients in terms of their burden of disease and quality of life. Despite this it remains largely understudied in comparison with the other inflammatory arthropathies. Newer imaging techniques are challenging the traditional concepts of a non-erosive arthropathy that is outlined in the ACR diagnostic criteria for SLE.

Herpes zoster and postherpetic neuralgia: prevention and management.

Herpes zoster (shingles) is diagnosed clinically by recognition of the distinctive, painful vesicular rash appearing in a unilateral, dermatomal distribution. An estimated 1 million cases occur in the United States each year, and increasing age is the primary risk factor. Laboratory testing, including polymerase chain reaction, can confirm atypical cases.

Essential amino acids regulate both initiation and elongation of mRNA translation independent of insulin in MAC-T cells and bovine mammary tissue slices.

Current nutrient requirement models assume fixed efficiencies of absorbed amino acid (AA) conversion to milk protein. Regulation of mammary protein synthesis (PS) potentially violates this assumption by changing the relationship between AA supply and milk protein output. The objective of this study was to investigate the effects of essential AA (EAA) and insulin on cellular signaling and PS rates in bovine mammary cells.

Colour Doppler ultrasound of the ocular circulation in patients with systemic lupus erythematosus identifies altered microcirculatory haemodynamics.

We assessed whether quantitative analysis of Doppler flow velocity waveforms is able to identify subclinical microvascular abnormalities in SLE and whether eigenvector analysis can detect changes not detectable using the resistive index (RI). Fifty-four SLE patients with no conventional cardiovascular risk factors, major organ involvement or retinopathy were compared to 32 controls. Flow velocity waveforms were obtained from the ophthalmic artery (OA), central retinal artery (CRA) and common carotid artery (CA).

Noncontact ultrasound therapy for adjunctive treatment of nonhealing wounds: retrospective analysis.

Background And Purpose: The optimal adjunctive therapy for wounds that fail to heal despite conventional wound care has not been established. Clinical evidence suggests improved healing in wounds treated with noncontact ultrasound therapy (NCUT). Although existing evidence supports the use of NCUT for enhanced wound healing, the total number of participants studied remains modest.

Enhancement of undergraduate rheumatology teaching through the use of musculoskeletal ultrasound.

Objectives: Musculoskeletal ultrasound (MSUS) is increasingly being used by rheumatologists in routine clinical practice to aid with diagnosis and therapy monitoring in the rheumatic conditions. Undergraduate teaching in anatomy is often regarded as problematic and various approaches are in use in UK medical schools. To our knowledge no study to date describes the use of MSUS to facilitate understanding of pathology in the musculoskeletal system at undergraduate level.

A randomised interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosus.

Objective: To determine the clinical effect of dietary supplementation with low-dose omega-3-polyunsaturated fatty acids on disease activity and endothelial function in patients with systemic lupus erythematosus.

Methods: A 24-week randomised double-blind placebo-controlled parallel trial of the effect of 3 g of omega-3-polyunsaturated fatty acids on 60 patients with systemic lupus erythematosus was performed. Serial measurements of disease activity using the revised Systemic Lupus Activity Measure (SLAM-R) and British Isles Lupus Assessment Group index of disease activity for systemic lupus erythematosus (BILAG), endothelial function using flow-mediated dilation (FMD) of the brachial artery, oxidative stress using platelet 8-isoprostanes and analysis of platelet membrane fatty acids were taken at baseline, 12 and 24 weeks.