Unveiling the neglected role of the intensity of acute stress disorder in the prediction of full- and sub-threshold posttraumatic stress disorder: looking beyond the diagnosis.

Purpose: Exposure to traumatic events may lead to the development of Acute Stress Disorder (ASD) within the first month post-trauma in some individuals, while others may not exhibit ASD symptoms. ASD was introduced as a potential early indicator to identify those at higher risk of developing Posttraumatic Stress Disorder (PTSD), however, PTSD can occur in some individuals even without prior ASD. Assessing ASD post-trauma can assist in identifying those who would most benefit from intervention to prevent later PTSD, yet the predictive power of ASD varies across studies, with intensity of ASD symptoms and subthreshold PTSD often less considered.

Vascular Disturbances of the Skin in Critically Ill Patients: Lines, Dots, Patches.

When an understanding of pathogenesis exists, skin lesions that have the appearance of blood in the skin can provide insight into the mechanisms leading to a systemic process that results in cutaneous manifestations. Of the vascular disturbances of the skin that occur in critically ill patients, some result from a non-hemorrhagic process while occurs represent bleeding into the skin. The lesions of livedo, petechiae, purpura, and ecchymoses can be approached from such a perspective.

Understanding Orthopaedic Infections: A Conceptual Approach.

Background: Memorizing mounds of facts without having an effective conceptual framework to store them is often an unsuccessful learning style because memory frequently fails without understanding. To accomplish this goal, we offer a framework of ideas called "concept maps". Of the many strategies for metacognition (that is, thinking about thinking), concept mapping is proven to improve meaningful and independent learning.

The Association of Cognitive Impairment and Depression with Malnutrition among Vulnerable, Community-Dwelling Older Adults: A Large Cross-Sectional Study.

(1) Background: Mental health issues in older adults, particularly cognitive impairment and depression, can affect nutritional status. This study investigates the prevalence of malnutrition among community-dwelling older adults at risk of social exclusion and dependency in Lebanon and its association with cognitive impairment and depression. (2) Methods: This cross-sectional study used secondary data from the TEC-MED project, involving 1410 older adults aged 60 and above in Beirut.

Successful implementation of Medical Education Faculty Development Project at Saint George University of Beirut in the immediate post triple blow to Beirut.

Background: The aim of this study is to explore the efficacy of the Faculty Development Program (FDP) implemented at the Saint George University of Beirut-Faculty of Medicine (SGUB FM) under exceptional circumstances as the triple blow to Beirut.

Methods: The Faculty Development, directed towards a cohort of 35 faculty members, is composed of two major components: methodology of teaching and techniques of assessment. The Kirkpatrick's assessment model, in combination with a specifically designed psychological questionnaire, were chosen to assess the effectiveness of the faculty development initiative.

Predictors and severity of probable acute stress disorder following the Beirut Port Blast.

Background: The Beirut Port Blast on August 4, 2020 is the largest (non-nuclear) explosion on record. St George Hospital University Medical Center (SGHUMC), a leading academic medical centre in Lebanon, adjacent to the Port, sustained a massive loss in lives and infrastructure.

Objective: The current study uses the baseline data of an ongoing longitudinal study to explore the prevalence, severity, and predictors of probable Acute Stress Disorder (ASD) among health workers at SGHUMC following the blast.

Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience.

Introduction: Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum's impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education.

Impact of a national antimicrobial stewardship mentoring program: Insights and lessons learned.

Purpose: The impact of an interprofessional mentoring program to advance antimicrobial stewardship programs (ASPs) in selected U.S. hospitals and lessons learned are described.

TEACHING VALUES IN MEDICINE VIA AWARENESS CREATED THROUGH ART.

The design of a new medical education building sought through art to create awareness of important values in physicians. An antique silk embroidery depicting Aesculapius crowning a man charged to protect the medical profession from quackery is placed at the beginning of the space leading into the simulation laboratories to highlight the importance of competency. A charcoal drawing by an important regional artist conveys the message that trust can arise from vulnerability, with optimal mentoring being the outcome.

Antibiotic strategies in the era of multidrug resistance.

The rapid emergence and dissemination of antibiotic-resistant microorganisms in ICUs worldwide threaten adequate antibiotic coverage of infected patients in this environment. The causes of this problem are multifactorial, but the core issues are clear: the emergence of antibiotic resistance is highly correlated with selective pressure resulting from inappropriate use of these drugs. Because a significant increase in mortality is observed when antibiotic therapy is delayed in infected ICU patients, initial therapy should be broad enough to cover all likely pathogens.

Advances in antibiotic therapy in the critically ill.

Infections occur frequently in critically ill patients and their management can be challenging for various reasons, including delayed diagnosis, difficulties identifying causative microorganisms, and the high prevalence of antibiotic-resistant strains. In this review, we briefly discuss the importance of early infection diagnosis, before considering in more detail some of the key issues related to antibiotic management in these patients, including controversies surrounding use of combination or monotherapy, duration of therapy, and de-escalation. Antibiotic pharmacodynamics and pharmacokinetics, notably volumes of distribution and clearance, can be altered by critical illness and can influence dosing regimens.

Critical Illness in Patients With Asplenia.

The critically ill, asplenic patient presents a variety of management challenges. Historically, the focus of the care of the asplenic population has been the prevention and management of infection, including the often-fatal overwhelming postsplenectomy infection with encapsulated organisms such as Streptococcus pneumoniae. Recently, however, there has been increasing recognition of the spleen's function in areas outside of immunity because the asplenic state has been identified as a risk factor for such vascular complications as thrombosis and pulmonary hypertension resulting from dysregulated inflammation and coagulation.

The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.

Background: Left ventricular diastolic impairment and consequently elevated filling pressure may contribute to stasis leading to left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). We investigated whether transthoracic echocardiographic parameters can predict LAAT independent of traditional clinical predictors.

Methods: We conducted a retrospective cohort study of 297 consecutive nonvalvular AF patients who underwent transthoracic echocardiogram followed by a transesophageal echocardiogram within one year.

B-type natriuretic peptide predicts left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.

Purpose: To investigate whether plasma B-type Natriuretic peptide (BNP), a surrogate of left ventricular filling pressure (LVFP), is predictive of left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (AF) independent of known clinical risk predictors.

Methods: We conducted a retrospective cohort study of 297 consecutive subjects with AF who underwent a clinically indicated transesophageal echocardiogram (TEE) to evaluate for LAAT and spontaneous echo contrast (SEC). Among those, 136 had a clinically indicated BNP level.

Biochemical and pharmacological characterization of human c-Met neutralizing monoclonal antibody CE-355621.

The c-Met proto-oncogene is a multifunctional receptor tyrosine kinase that is stimulated by its ligand, hepatocyte growth factor (HGF), to induce cell growth, motility and morphogenesis. Dysregulation of c-Met function, through mutational activation or overexpression, has been observed in many types of cancer and is thought to contribute to tumor growth and metastasis by affecting mitogenesis, invasion, and angiogenesis. We identified human monoclonal antibodies that bind to the extracellular domain of c-Met and inhibit tumor growth by interfering with ligand-dependent c-Met activation.

Profiling posttransplant circulating antibodies in kidney transplantation using donor endothelial cells.

Background: Pathogenesis of antibody (Ab) responses to transplant are yet not well defined. This study aimed to detect and to analyze posttransplant circulating allo-Abs reacting toward graft endothelial cells (ECs) using primary EC cultures prospectively isolated from the transplant donor at the time of transplantation.

Methods: This study shows a retrospective analysis performed using a dedicated EC crossmatch (ECXM) assay that we developed for the experimental assessment of donor-specific EC-reactive Abs.

Assessment of cholesteryl ester transfer protein inhibitors for interaction with proteins involved in the immune response to infection.

The CETP inhibitor, torcetrapib, was prematurely terminated from phase 3 clinical trials due to an increase in cardiovascular and noncardiovascular mortality. Because nearly half of the latter deaths involved patients with infection, we have tested torcetrapib and other CETPIs to see if they interfere with lipopolysaccharide binding protein (LBP) or bactericidal/permeability increasing protein (BPI). No effect of these potent CETPIs on LPS binding to either protein was detected.

Crystal structure of cholesteryl ester transfer protein reveals a long tunnel and four bound lipid molecules.

Cholesteryl ester transfer protein (CETP) shuttles various lipids between lipoproteins, resulting in the net transfer of cholesteryl esters from atheroprotective, high-density lipoproteins (HDL) to atherogenic, lower-density species. Inhibition of CETP raises HDL cholesterol and may potentially be used to treat cardiovascular disease. Here we describe the structure of CETP at 2.

Expression, purification, crystallization and structure of human adipocyte lipid-binding protein (aP2).

Human adipocyte lipid-binding protein (aP2) belongs to a family of intracellular lipid-binding proteins involved in the transport and storage of lipids. Here, the crystal structure of human aP2 with a bound palmitate is described at 1.5 A resolution.

Inferior vena caval filters: key considerations.

Surgical interruption of the inferior vena cava (IVC) as a means to prevent pulmonary embolism and its consequences has been entertained since the end of the 19th century. Initial methods were crude, however, but their deficiencies led to the development of newer techniques. Despite increasing indications and use of permanent IVC filters there remains controversy regarding their efficacy and complications.

3-(2-carboxyethyl)-4,6-dichloro-1H-indole-2-carboxylic acid: an allosteric inhibitor of fructose-1,6-bisphosphatase at the AMP site.

3-(2-Carboxyethyl)-4,6-dichloro-1H-indole-2-carboxylic acid (MDL-29951), an antagonist of the glycine site of the NMDA receptor, has been found to be an allosteric inhibitor of the enzyme fructose 1,6-bisphosphatase. The compound binds at the AMP regulatory site by X-ray crystallography. This represents a new approach to inhibition of fructose 1,6-bisphosphatase and serves as a lead for further drug design.

Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use.

Context: Previous surveillance studies have documented increasing rates of antimicrobial resistance in US intensive care units (ICUs) in the early 1990s.

Objectives: To assess national rates of antimicrobial resistance among gram-negative aerobic isolates recovered from ICU patients and to compare these rates to antimicrobial use.

Design And Setting: Participating institutions, representing a total of 43 US states plus the District of Columbia, provided antibiotic susceptibility results for 35 790 nonduplicate gram-negative aerobic isolates recovered from ICU patients between 1994 and 2000.