Inlaws, Outlaws, and State Formation in Nineteenth-Century Oklahoma

While much of the federal Department of Justice’s policing bureaucracy was in retrenchment from the 1880s and 1890s, the Indian Territories was the site of some of the most aggressive policing in the nation’s history. Specifically, a series of reforms in US-Indian relations permitted a high level of federal involvement in policing and the management of local order. Using original demographic data on US deputy marshals and criminal gangs active in the Indian Territories, as well as an analysis of media coverage of Oklahoma crime, this article shows that this explosion of state-building was due, in part, to the ways in which kinship rules in Oklahoma allowed racially ambiguous inhabitants to be castigated as “outlaws.” This, in turn, opened up space for the federal marshal apparatus—which was primarily white—to expand its role as the purveyors of local law and order in a manner that had never been possible in the South.

Intermediate Risk of Choledocolithiasis: Are We on the Right Path?

Background Choledocolithiasis is the presence of stones in the bile duct, commonly associated with cholelithiasis, with an incidence of 5-18%. Risk of choledocolithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step, which can be either surgical or endoscopic. The American Gastroenterology Society (ASGE) proposed a predictor scale of choledocolithiasis based on ultrasound findings, liver function tests, and the presence of pancreatitis and/or cholangitis. Therefore we aim to describe our experience managing patients with intermediate risk of choledocolithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. MethodsA retrospective observational study with a prospective database was conducted. Patients over 18 years old who complied with inclusion criteria between January and December 2019, were registered. Descriptive statistics of all study parameters were provided. Analysis included socio demographic data, laboratory values ​​and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients with biliary disease were classified as having intermediate risk for choledocolithiasis. Half the patients were at least 65 years old (iqr 20). All patients underwent MRI cholangiography. 24.77% were diagnosed with choledocolithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocolithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation < 6 mm OR: 14.65 (p 0.00). ConclusionsThere is a high proportion of patients classified as intermediate risk who did not have choledocolithiasis by colangioresonance. There is a persistently high variability in accuracy of imaging techniques in intermediate risk patients. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.

The association between serum vitamin D and mood disorders in a cohort of lipedema patients

Objectives The association between serum Vitamin D (Vit. D) and mood disorders in lipedema patients has not been investigated. Therefore, the main aim of this study is to investigate the correlation between serum Vit. D, depression and anxiety risk. Methods A cross-sectional cohort of lipedema patients were investigated by collecting the clinical and demographic data. The Hamilton Depression Scale (HAM-D) and the Hamilton of Anxiety Scale (HAM-A) were used to evaluating the risk of depression and anxiety. Serum concentrations of Vit. D were measured. The association between Vit. D levels and both HAM-A and HAM-D scores were statistically examined by bivariate and partial correlations. Results Forty lipedema patients were enrolled in this study. Around two-thirds of them had a higher depression or anxiety risk, and 77.5% were under the normal serum Vit. D levels. A significant and inverse correlation was observed between serum Vit. D levels and both HAM-D (r=−0.661, p<0.001), and HAM-A (r=−0.496, p=0.001) scores. This strong association was sustained after the statistical model adjusted for the main potential confounding factors (age, body mass index (BMI), disease duration, and lipedema stages). Additionally, serum Vit. D correlated significantly and inversely with BMI (r=−0.647, p<0.001). Moreover, BMI significantly correlated with HAM-D: r=0.560, p<0.001, and HAM-A: r=0.511, p=0.00. Conclusions This study suggests a strong correlation between Vit. D levels, depression scores, and anxiety scores in lipedema patients. Our results also demonstrate a strong and direct relationship between BMI, Vit. D levels, depression, and anxiety.

Simultaneous septic arthrodesis of the tibiotalar and subtalar joints with the Ilizarov external fixator—an analysis of 13 patients

Purpose Treatment of joint destruction of the tibiotalar and subtalar joints caused by acute or chronic infections in compromised hosts is a challenging problem. In these cases, simultaneous septic arthrodesis with the use of the Ilizarov external fixator represents a possible alternative to amputation. This case series presents the results and complications of patients with acute or chronic infection of the tibiotalar and subtalar joints. Methods Between 2005 and 2015, 13 patients with acute or chronic infections were treated by simultaneous single-stage debridement/arthrodesis of the tibiotalar and subtalar joints. In seven patients, there was a florid infection with fistula formation and soft tissue defects, and in six patients, there was chronic osteomyelitis with closed soft tissue. In addition to the demographic data, the time spent in the fixator, the major and minor complications and the endpoint of consolidation were reviewed. Results The mean time spent in the fixator was 18 (min 15, max 26) weeks. The mean follow-up time for nine patients was 100 (min 3, max 341) weeks. Complete osseous consolidation of both the tibiotalar and subtalar joints was achieved in 10 patients (77%). In three (23%) patients, there was complete consolidation of one of the joints and partial consolidation of the other joint. Conclusion The Ilizarov external fixator allows for simultaneous arthrodesis of the tibiotalar and subtalar joints in septic joint destruction. However, the healing rates are below the rates reported in the literature for isolated tibiotalar or tibiocalcaneal arthrodesis in comparable clinical situations.

Oxidant and Antioxidant Balance in Children with Community-Acquired Pneumonia

Objective The balance between oxidant and antioxidant defense mechanisms is crucial. We aimed to evaluate the role of this balance in community-acquired pneumonia (CAP) in children. Methods We analyzed serum oxidant and antioxidant stress parameters according to the clinical and demographic data of children with CAP and compared them with healthy controls. Serum total antioxidant status (TAS) and total oxidant status (TOS) were evaluated and compared between the groups, along with levels of ischemia-modified albumin (IMA), antioxidant enzymes, nonenzymatic antioxidant factors, and plasma thiol. Results Of 160 children evaluated, 106 had CAP (54 outpatients and 52 inpatients), and the other 54 were healthy (control group). Total thiol and native thiol levels were significantly lower in the inpatient group compared with the outpatient group (p = 0.004 and p = 0.005, respectively). Serum IMA differed significantly among the groups (p = 0.001), with inpatients showing the highest level. A positive correlation was found between serum IMA and C-reactive protein levels in patients with pneumonia (r = 0.351; p = 0.001). Conclusion Parameters that provide information about antioxidant capacity may be useful in the diagnosis and prognosis of pneumonia. Our results suggest that plasma thiol levels and IMA may be good candidate biomarkers to predict hospitalization for CAP in children.

Combination Use of Antibiotic-Loaded Calcium Sulfate Beads in Spinal Surgery for Patients with Spondylodiscitis：A Clinical Retrospective Study

Background. Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after infection site debrided by Quadrant channel combined with percutaneous fixation through a single-stage posterior approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure. Methods. This study collected 32 patients’ clinical data of whom had spine spondylodiscitis treated in our department from July of 2015 to August of 2020. The Demographic data included age, gender, involved segment and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded. Results. The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65–10%. Cobb angle was significantly improved and could be maintained at final follow-up. Solid bone fusion was achieved in all patients. There were no recurrences of infection in our study. Conclusions. The procedure we proposed is effective in the treatment of spondylodiscitis, the infection site can be debrided and controlled exactly, and spinal stabilization can also be achieved.

Predisposing Factors for Severe Complications after Cataract Surgery: A Nationwide Population-Based Study

We conducted a retrospective group study to evaluate the potential systemic risk factors for major postoperative complications of cataract surgery. Individuals diagnosed with (n = 2046) and without (n = 8184) serious complications after cataract surgery were matched 1:4 for age, sex, and index date obtained using Taiwan’s National Health Insurance Research Database. The outcome was defined as at least one new inpatient or outpatient diagnosis of systemic disease one year before the index date. The effect of demographic data on postoperative complications was also analyzed in the multivariable model. Data were analyzed using univariate and multivariate conditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals of the risk of developing serious complications. After the entire study interval, the major postoperative complications of cataract surgery were associated with the following systemic diseases: hypertension (adjusted OR (aOR) = 2.329, p < 0.001), diabetes mellitus (aOR = 2.818, p < 0.001), hyperlipidemia (aOR = 1.702, p < 0.001), congestive heart failure (aOR = 2.891, p < 0.001), rheumatic disease (aOR = 1.965, p < 0.001), and kidney disease needing hemodialysis (aOR = 2.942, p < 0.001). Additionally, demographic data including old age, higher urbanization level, higher level of care, and more frequent inpatient department visits were associated with a higher rate of postoperative complications. In conclusion, metabolic syndrome, chronic heart failure, end-stage renal disease, rheumatic disease, older age, and frequent inpatient department visits are correlated with the development of severe postoperative complications of cataract surgery. Therefore, cataract surgery patients should be informed about a higher possibility of postoperative complications.

Antiviral Therapeutic Approaches for SARS-CoV-2 Infection: A Systematic Review

Background: Due to the lack of an etiologic treatment for SARS-CoV-2 and the difficulties involved in developing new drugs, some drugs already approved for other diseases or with efficacy against SARS and MERS, have been used in patients with COVID-19. This systematic review aims to summarize evidence on the efficacy and safety of five antivirals applied to patients with COVID-19, that have proven to be effective either in vitro studies or in studies on SARS-CoV and MERS.; Methods: An intensive search of different databases (Pub Med, WoS, MEDLINE and Cochrane COVID-19 Study Register) has been carried out until the end of April 2021. This systematic review has been conducted according to the PRISMA statement. From each of the included studies, the characteristics of the intervention and comparison groups, demographic data and results were extracted independently; Results: Remdesivir is well tolerated and helps to accelerate clinical improvement but is ineffective in reducing mortality. Favipiravir is safe and shows promising results regarding symptom resolution but does not improve viral clearance. The use of lopinavir/ritonavir has been associated with an increased risk of gastrointestinal adverse events and it has not proven to be effective. No significant differences were observed between patients treated with ribavirin or umifenovir and their respective control groups; Conclusions: Remdesivir and favipiravir are well tolerated and effective in accelerating clinical improvement. This systematic review does not support the use of lopinavir/ritonavir, ribavirin and umifenovir in hospitalized patients with COVID-19.

High sedation needs of critically ill COVID-19 ARDS patients—A monocentric observational study

Background Therapy of severely affected coronavirus patient, requiring intubation and sedation is still challenging. Recently, difficulties in sedating these patients have been discussed. This study aims to describe sedation practices in patients with 2019 coronavirus disease (COVID-19)-induced acute respiratory distress syndrome (ARDS). Methods We performed a retrospective monocentric analysis of sedation regimens in critically ill intubated patients with respiratory failure who required sedation in our mixed 32-bed university intensive care unit. All mechanically ventilated adults with COVID-19-induced ARDS requiring continuously infused sedative therapy admitted between April 4, 2020, and June 30, 2020 were included. We recorded demographic data, sedative dosages, prone positioning, sedation levels and duration. Descriptive data analysis was performed; for additional analysis, a logistic regression with mixed effect was used. Results In total, 56 patients (mean age 67 (±14) years) were included. The mean observed sedation period was 224 (±139) hours. To achieve the prescribed sedation level, we observed the need for two or three sedatives in 48.7% and 12.8% of the cases, respectively. In cases with a triple sedation regimen, the combination of clonidine, esketamine and midazolam was observed in most cases (75.7%). Analgesia was achieved using sufentanil in 98.6% of the cases. The analysis showed that the majority of COVID-19 patients required an unusually high sedation dose compared to those available in the literature. Conclusion The global pandemic continues to affect patients severely requiring ventilation and sedation, but optimal sedation strategies are still lacking. The findings of our observation suggest unusual high dosages of sedatives in mechanically ventilated patients with COVID-19. Prescribed sedation levels appear to be achievable only with several combinations of sedatives in most critically ill patients suffering from COVID-19-induced ARDS and a potential association to the often required sophisticated critical care including prone positioning and ECMO treatment seems conceivable.

A comparative study: Dr. APJ Abdul Kalam amrut ahar yojana and take home ration scheme, Armori block, Gadchiroli, Maharashtra

Background: Even after forty-five years of ICDS, nutrition, still, continues to be a major public health challenge in India. The impact of ICDS on child growth and development has been rather slow. The present study is a comparison of Dr. A. P. J. Abdul Kalam amruta ahar yojana and take home ration scheme.Methods: The study adapts a combination approach, i.e. qualitative and quantitative method. Qualitative method is used to study the perception of beneficiaries as well as the providers while quantitative method is conducted among 80 beneficiaries with an aim to identify the utilisation pattern of food and level of satisfaction with both the schemes.Results: A total of 80 pregnant women and lactating mothers participated in this study. This study used a questionnaire containing socio-demographic data and utilisation pattern of one-time square meal and dry ration; socio-demographic questions including concerned age group, their education, religion, employment status and income.Conclusions: The findings depict that the provision of amruta ahar is in demand compared to the dry ration of Take-Home Ration Scheme. According to the beneficiaries, amruta ahar yojana is more advantageous as it leads healthy eating practices which are essential during pregnancy and lactation.