Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients.

Background: The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.

Objective: Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.

Methods: We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities.

Interaction of breast cancer-relevant DNA repair genes and air pollution in relation to breast cancer risk in UK biobank.

We investigated if selected polymorphisms in DNA repair genes modify the association between exposure to particulate matter ≤ 10 micron in diameter (PM) and breast cancer (BCa) risk. We included 150,929 postmenopausal women (5,969 with BCa) from UK Biobank, a population-based prospective cohort. Cancer diagnoses were ascertained through the linkage to the UK National Health Service Central Registers.

Cutaneous Basal Cell Carcinoma In Situ: A Review of the World Literature.

Cutaneous basal cell carcinoma (BCC) in situ is a recently recognized subtype of the skin neoplasm in which the abnormal cells are confined to the epidermis. BCC in situ of the skin was previously referred to as a superficial BCC. A review of the world literature has revealed 10 cutaneous BCCs in situ that have been described in nine patients but likely reflect a more general phenomenon.

Search for medical information for chronic rhinosinusitis through an artificial intelligence ChatBot.

Objectives: Artificial intelligence is evolving and significantly impacting health care, promising to transform access to medical information. With the rise of medical misinformation and frequent internet searches for health-related advice, there is a growing demand for reliable patient information. This study assesses the effectiveness of ChatGPT in providing information and treatment options for chronic rhinosinusitis (CRS).

Racing to disaster: A 10-year retrospective analysis of pediatric competitive motocross injuries.

Objectives: In competitive motocross, children as young as 4 years old race in groups on motorized off-road bikes on uneven terrain. We aimed to describe pediatric injuries occurring during an annual week-long certified amateur motocross competition between 2011 and 2021. Secondarily, we compared injury characteristics and medical evaluation by age.

TOGA Therapeutic Oxygen for Gastrointestinal Atony.

Background And Aims: Ileus, mechanical bowel obstruction, and acute colonic pseudo-obstruction are characterized by distension of the intestines with accumulated bowel gas. Current treatments are not completely satisfactory.

Methods: By manipulating the partial pressures of oxygen and nitrogen in the trapped air with a novel 6-hour treatment with 100% oxygen via nonrebreather mask, the bowel can be successfully decompressed, facilitating resolution of the underlying condition.

Impact of an enteral nutrition protocol in critically ill patients with burn injuries.

Objectives: The objective of this study is to characterize the University of Florida (UF) Health Shands Burn Centers enteral nutrition protocol as it relates to total protein intake and clinical outcomes.

Methods: This retrospective chart review study included 99 adult patients admitted to the UF Health Shands Burn Center from January 2012 through August 2016 with burns of twenty percent or greater TBSA and required enteral nutrition supplementation.

Results: Patients received an average of 137.

A Hemoglobinopathy That Produces an Array of Different Hemoglobin A1c Values.

Hemoglobin A1c (HbA1c) refers to non-enzymatically glycated hemoglobin and reflects the patient's glycemic status over approximately 3 months. An elevated HbA1c over 6.5% National Glycohemoglobin Standardization Program (NGSP) (48 mmol/mol the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)) can be used to diagnose diabetes mellitus.

A perfectly imperfect engine: Utilizing the digital twin paradigm in pulmonary hypertension.

Pulmonary hypertension (PH) is a severe medical condition with a number of treatment options, the majority of which are introduced without consideration of the underlying mechanisms driving it within an individual and thus a lack of tailored approach to treatment. The one exception is a patient presenting with apparent pulmonary arterial hypertension and shown to have vaso-responsive disease, whose clinical course and prognosis is significantly improved by high dose calcium channel blockers. PH is however characterized by a relative abundance of available data from patient cohorts, ranging from molecular data characterizing gene and protein expression in different tissues to physiological data at the organ level and clinical information.

Assessing Fall Mortality by Field-Relevant Categories at an Urban Level I Trauma Center.

Introduction: Little research has focused on assessing the mortality for fall height based on field-relevant categories like falls from greater than standing (FFGS), falls from standing (FFS), and falls from less than standing.

Methods: This retrospective observational study included patients evaluated for a fall incident at an urban Level I Trauma Center or included in Medical Examiner's log from January 1, 2015, to June 31, 2017. Descriptive statistics characterized the sample based on demographic variables such as age, race, sex, and insurance type, as well as injury characteristics like relative fall height, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), traumatic brain injury, intensive care unit length of stay, and mortality.

Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education.

Introduction: Generation Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape.

Methodology: The Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG-EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM.

Paving the Way for Medical Students: How Smooth Should the Road Be?

Clerkship directors must balance the mental wellbeing of their medical students with the demanding schedule that rotations in procedural specialties such as surgery and obstetrics and gynecology require. In this paper, the Undergraduate Medical Education Committee of the Association of Professors of Obstetrics and Gynecology argues the importance of maintaining adequate clinical exposure for learners. Involving students in overnight call provides additional clinical involvement, improved relationships with the clinical team, and a better perspective on specialist lifestyle.

Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital.

Objectives: This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED).

Methods: We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible.

Rapid recognition and optimal management of hemophilia in the emergency department: A quality improvement project.

Objectives: This study aimed to assess the effectiveness of a continuous quality improvement initiative at the University of Florida Health Physicians practice in reducing the time to administer factor replacement therapy (FRT) for hemophilia patients presenting with bleeding in the emergency department (ED).

Methods: The study, a quasi-experimental, interventional design, was conducted between January 2020 and January 2023. The intervention, implemented in September 2021, involved training ED physicians, creating a specialized medication order set within the electronic health record (EHR), and a rapid triage system.

Use of artificial intelligence in critical care: opportunities and obstacles.

Background: Perhaps nowhere else in the healthcare system than in the intensive care unit environment are the challenges to create useful models with direct time-critical clinical applications more relevant and the obstacles to achieving those goals more massive. Machine learning-based artificial intelligence (AI) techniques to define states and predict future events are commonplace activities of modern life. However, their penetration into acute care medicine has been slow, stuttering and uneven.

Fasting to stop suffering in advanced dementia.

Many healthcare providers think withholding food and fluids from advance dementia patients, even if those patients requested that when competent, is immoral. This means such patients suffer unnecessarily long. Patients have the ethical right when capacitated to specify that they want assistance with food and drink stopped when they have advanced dementia.

Dysregulation of kidney proteases in the pathogenesis of hypertension following unilateral nephrectomy in juvenile mice.

Background: Unliteral nephrectomy (UNX) results in the reduction of kidney mass. The remaining kidney undergoes compensatory renal growth via hypertrophy of the glomeruli and renal tubules to maintain a normal glomerular filtration rate (GFR). These compensatory mechanisms result in increased capillary pressure and glomerular hyperfiltration to increase single nephron GFR.

Complement C1q-dependent engulfment of alpha-synuclein induces ENS-resident macrophage exhaustion and accelerates Parkinson's-like gut pathology.

Deposition of misfolded α-synuclein (αsyn) in the enteric nervous system (ENS) is found in multiple neurodegenerative diseases. It is hypothesized that ENS synucleinopathy contributes to both the pathogenesis and non-motor morbidity in Parkinson's Disease (PD), but the cellular and molecular mechanisms that shape enteric histopathology and dysfunction are poorly understood. Here, we demonstrate that ENS-resident macrophages, which play a critical role in maintaining ENS homeostasis, initially respond to enteric neuronal αsyn pathology by upregulating machinery for complement-mediated engulfment.

Examination of disparities in prehospital encounters for pediatric asthma exacerbations.

Introduction: There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma.

Methods: This is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2-18 years.

Hyperinsulinemia is a probable trigger for weight gain and hyperphagia in individuals with Prader-Willi syndrome.

Objective: Prader-Willi syndrome (PWS) is the most frequently diagnosed genetic cause of early childhood obesity. Individuals with PWS typically progress through 7 different nutritional phases during their lifetime. The main objective of this study was to assess potential factors, particularly insulin, that may be responsible for the weight gains in sub-phase 2a and their role in the subsequent increase in fat mass and obesity in sub-phase 2b and insatiable appetite in phase 3.

Small Bowel Obstruction and Enterococcus Meningitis: Rare Complications of Ventriculoperitoneal Shunt Placement.

A ventriculoperitoneal (VP) shunt is a commonly used mechanical device indicated for congenital and acquired hydrocephalus in children. Although VP shunt failure is not uncommon, the symptomatology and cause of failure can vary. In this case, we describe intestinal obstruction in a three-year-old Caucasian female with a history of Pilomyxoid Astrocytoma and VP shunt placement for the management of hydrocephalus.