Sarcopenia of Cirrhosis and the Therapeutic Potential of Transjugular Intrahepatic Portosystemic Shunt Creation

Sarcopenia is a major sequela of cirrhosis, contributing to significant morbidity and mortality. Advances in body composition analysis using medical imaging have begun to identify changes in skeletal muscle and fat that are prognostic of the impact of sarcopenia on medical outcomes in cirrhosis and other pathologies. Recently, observational studies have shown a correlation between transjugular intrahepatic portosystemic shunt (TIPS) creation and a reversal of the progressive muscle loss in cirrhosis. This reversal is also associated with improved clinical outcomes and survival. This review summarizes current understanding of cirrhotic sarcopenia, and discusses the implications of TIPS creation in reversing this process.

Patient Comprehension of Trigger Finger Concepts Based on Distribution Format: A Randomized Controlled Trial of Handout Versus Video

Background: Patient comprehension is an essential part of optimizing medical outcomes. It is unknown which format is most effective in delivering this information. In addition to a face-to-face conversation, a paper handout is often given as an educational supplement at the conclusion of a visit. Secondary to advances in technology and the ubiquity of the Internet, medical videos have gained popularity. The purpose of this randomized controlled trial was to determine whether the educational material format (paper handout vs video) resulted in a difference in either comprehension of the condition or satisfaction with the delivery of the information. Methods: Patients aged ≥18 years with a diagnosis of trigger finger were prospectively enrolled and randomized to receive either a paper handout or video link with information regarding the pathophysiology, diagnosis, and treatment of trigger finger. Survey assessments were then distributed, consisting of 7 questions related to trigger finger and 1 question related to patient satisfaction. Continuous data were compared using 2-sample t tests, and categorical data were compared with χ2 tests. Alpha was 0.05. Results: Seventy-one patients were enrolled, and 60 completed their survey (response rate: 85%). The video group had significantly higher comprehension scores (82% vs 71%, P = .04) and significantly higher satisfaction scores (9.4 vs 8.6, P = .02). Conclusions: Those who received their educational material in a video format had greater comprehension of their condition and higher satisfaction compared with those receiving a paper handout. Medical providers should consider using video formats to provide supplemental educational materials to their patients.

The Different Classification of Hospitals Impact on the Equity of Medical Outcomes of Patients in China

Background: In the context of Healthy China Strategy, the traditional idea that large hospitals provide better medical care is still deeply rooted in people's minds. The characteristics of the medical inverted pyramid structure—higher-level medical institutions are overwhelmed, while lower-level medical institutions are deserted—have existed for a long time. Because of the unreasonable allocation of resources, it is difficult to meet the healthcare needs of citizens and to establish a tiered delivery system. The objective of this paper is to study the effect of different classification of hospitals (COH) on the equity of Medical Outcomes of patients.Methods: The data used was from Urban Employee Basic Medical Insurance (UEBMI) enrolment records of Chengdu. We conducted a retrospective study and used Nested Multinomial Logit Model (NMNL) to estimate the effect of COH on the equity of Medical Outcomes.Results: COH had a significant effect on the equity of Medical Outcomes, but the effectiveness and direction of the hospital level on different outcomes were not consistent. The reimbursement rate, medical expenditures, gender, age, disease type and others factors were associated with the effect(p<0.01); length of stay has a limited effect on health outcomes. It was not the case that the longer the hospital stay was, the higher the quality of care would be. When COH was distinguished, there were significant differences in the effect of different levels of hospitals on the equity of Medical Outcomes. Horizontally speaking, hospitals of the same level had different effects on different the equity of Medical Outcomes(p<0.01). From a longitudinal perspective, different levels of hospitals had different effects on the equity of Medical Outcomes(p<0.01). It was not the case that the higher the level of hospital, the better the medical outcome. When hospital levels and disease types were distinguished, the effect of hospitals of different levels on the medical outcome of different disease types was significantly different.Conclusions: COH made a difference in the equity of Medical Outcomes. Hospitals of different levels should be reasonably selected according to disease types to achieve the optimal medical outcome. Therefore, China should promote the construction of a tiered delivery system.

Quality of life as an indicator of the effects of concomitant hypertensive disease on the state of health of patients with non-alcoholic fatty liver disease

Objective — to determine the effects of concomitant hypertension on the quality of life (QOL) of patients with non‑alcoholic fatty liver disease (NAFLD) using the Medical Outcomes Study Short Form (SF‑36) and The Chronic Liver Disease Questionnaire (CLDQ). Materials and methods. Examinations involved 115 patients with NAFLD at the stage of non‑alcoholic steatohepatitis. The patients were divided into two groups: the main group included 63 patients with NAFLD and hypertension (32 men and 31 women, the mean age 48.4 years) and comparison group consisted of 52 patients with NAFLD (25 men and 27 women, the mean age 48.3 years). The control group consisted of 20 practically healthy people (12 women and 8 men, the mean age 47.1 years). The NAFLD duration did not significantly differ between the groups of comorbid course (6.6 years (95 % confidence interval (CI) — 5.8; 7.3)) and isolated NAFLD (7.8 years (95 % CI 6.7; 8.8)) (p = 0.086). Hypertension duration was 8.4 years (95 % CI 7.3; 9.5). Assessments included body mass index calculation (BMI) and measurements of systolic (SBP) and diastolic (DBP) arterial pressure. The Medical Outcomes Study Short Form (SF‑36) and Chronic Liver Disease Questionnaire (CLDQ) were used to assess the QOL of NAFLD patients. Results. In comparison with the control group and regardless of the presence of concomitant pathology, the significant decrease in QOL scores of almost all SF‑36 scales was established in NAFLD patients. In NAFLD patients with hypertension, decrease in the QOL indicators was observed for all components of health, except for the results on the scale of physical functioning («PF»). Indicators of the total physical («PCS») and mental («MCS») health components were also significantly lower in the group with NAFLD and hypertension and amounted to 25.00 % (95 % CI 21.20; 29.60) and 44.00 % (95 % CI 42.23; 50.47) out of the maximum possible 100 %. There was a significant decrease in indicators for all domains of the CLDQ questionnaire in patients with NAFLD and hypertension compared to the isolated NAFLD and the control group. Significant inverse correlations were determined between the QOL indicators according to both questionnaires and the diseases duration, SBP, DBP levels and BMI. Conclusions. NAFLD is associated with significant deviant changes in patients’ quality of life indicators according to the SF‑36 and CLDQ questionnaires. The presence of concomitant hypertension, the duration of fatty changes in the liver, the experience of hypertension, the levels of SBP, DBP and BMI significantly worsen the QOL of patients with NAFLD. The quantitative variability of QOL components in patients with NAFLD and hypertension can negatively affect the course of the disease and reduce the effectiveness of therapeutic and rehabilitation measures.

PSYChosomatic Medicine in ONcologIc and Cardiac Disease (PSYCHONIC) Study—A Retrospective and Prospective Observational Research Protocol

Psychosocial factors play an important role in non-communicable diseases (NCDs). This observational study is primarily aimed at assessing the relationship of psychological characteristics of patients with the outcomes of different NCDs, and to assess short-term psychotherapy (STP) efficacy in the real world. Methods: One hundred and forty patients with recent acute myocardial infarction, Takotsubo syndrome, or non-metastatic breast cancer and a control group of 140 age and sex-matched healthy subjects, will be enrolled. All subjects will be administered psychometric tests, quality of life tests, a specific body perception questionnaire, a dream questionnaire, and a projective test, the Six Drawing test at baseline and follow-up. All subjects with medical conditions will be asked to freely choose between an ontopsychological STP along with standard medical therapy and, whenever indicated, rehabilitation therapy or medical therapy plus rehabilitation alone. The study endpoints will be to evaluate: the relationship of the psychological characteristics of enrolled subjects with the outcomes of different NCDs, predictors of the choice of psychotherapy, and the efficacy of ontopsychological intervention on psychological and medical outcomes. Conclusion: This study will generate data on distinctive psychological characteristics of patients suffering from different CDs and their relationship with medical outcomes, as well as explore the efficacy of ontopsychological STP in these patients in the real world. (Number of registration: NCT03437642).

Discovering Modality of Cognitive Function Using Clustering Analysis

In this study with Long Life Family Study (LLFS) participants, we aimed to identify patterns of performance on cognitive function assessments as specific cognitive signatures. We hypothesize that such signatures can be correlated with biomarkers and clinical outcomes. More than 4,700 LLFS participants were administered, at enrollment, a series of neuropsychological tests that measure various cognitive domains. We performed a cluster analysis to group LLFS subjects into clusters characterized by combinations of six neuropsychological test scores. The analysis resulted in 10 clusters of varying size with different cognitive signatures that (1) significantly correlated with physical and pulmonary function, and 31 blood biomarkers and (2) predicted mortality and incident medical events such as dementia, cardiovascular diseases, etc. We conclude that cluster analysis of multiple neuropsychological tests discovers cognitive signatures that are more specific than individual cognitive domains and that these can be correlated with blood biomarkers, incident medical outcomes and mortality.

Characteristics and outcomes of patients with COVID-19 with and without prevalent hypertension: a multinational cohort study

ObjectiveTo characterise patients with and without prevalent hypertension and COVID-19 and to assess adverse outcomes in both inpatients and outpatients.Design and settingThis is a retrospective cohort study using 15 healthcare databases (primary and secondary electronic healthcare records, insurance and national claims data) from the USA, Europe and South Korea, standardised to the Observational Medical Outcomes Partnership common data model. Data were gathered from 1 March to 31 October 2020.ParticipantsTwo non-mutually exclusive cohorts were defined: (1) individuals diagnosed with COVID-19 (diagnosed cohort) and (2) individuals hospitalised with COVID-19 (hospitalised cohort), and stratified by hypertension status. Follow-up was from COVID-19 diagnosis/hospitalisation to death, end of the study period or 30 days.OutcomesDemographics, comorbidities and 30-day outcomes (hospitalisation and death for the ‘diagnosed’ cohort and adverse events and death for the ‘hospitalised’ cohort) were reported.ResultsWe identified 2 851 035 diagnosed and 563 708 hospitalised patients with COVID-19. Hypertension was more prevalent in the latter (ranging across databases from 17.4% (95% CI 17.2 to 17.6) to 61.4% (95% CI 61.0 to 61.8) and from 25.6% (95% CI 24.6 to 26.6) to 85.9% (95% CI 85.2 to 86.6)). Patients in both cohorts with hypertension were predominantly >50 years old and female. Patients with hypertension were frequently diagnosed with obesity, heart disease, dyslipidaemia and diabetes. Compared with patients without hypertension, patients with hypertension in the COVID-19 diagnosed cohort had more hospitalisations (ranging from 1.3% (95% CI 0.4 to 2.2) to 41.1% (95% CI 39.5 to 42.7) vs from 1.4% (95% CI 0.9 to 1.9) to 15.9% (95% CI 14.9 to 16.9)) and increased mortality (ranging from 0.3% (95% CI 0.1 to 0.5) to 18.5% (95% CI 15.7 to 21.3) vs from 0.2% (95% CI 0.2 to 0.2) to 11.8% (95% CI 10.8 to 12.8)). Patients in the COVID-19 hospitalised cohort with hypertension were more likely to have acute respiratory distress syndrome (ranging from 0.1% (95% CI 0.0 to 0.2) to 65.6% (95% CI 62.5 to 68.7) vs from 0.1% (95% CI 0.0 to 0.2) to 54.7% (95% CI 50.5 to 58.9)), arrhythmia (ranging from 0.5% (95% CI 0.3 to 0.7) to 45.8% (95% CI 42.6 to 49.0) vs from 0.4% (95% CI 0.3 to 0.5) to 36.8% (95% CI 32.7 to 40.9)) and increased mortality (ranging from 1.8% (95% CI 0.4 to 3.2) to 25.1% (95% CI 23.0 to 27.2) vs from 0.7% (95% CI 0.5 to 0.9) to 10.9% (95% CI 10.4 to 11.4)) than patients without hypertension.ConclusionsCOVID-19 patients with hypertension were more likely to suffer severe outcomes, hospitalisations and deaths compared with those without hypertension.

Racism in medicine: A qualitative study on the impact of discussion among medical students

Background: This study evaluated the impact of the Racism in Medicine Summit on student perceptions of various topics related to racism in medicine. The Summit was organized at the Wayne State University School of Medicine (WSUSOM) to educate students, faculty and staff on how structural racism affects the residents of Detroit and the historical relationship between healthcare and vulnerable populations. The Summit aimed at providing context for what students in Detroit will encounter as physicians-in-training and the skills they will need to master while working within similar communities. Methods: Qualtrics surveys were created and distributed via email to attendees before and after the event. Responses were obtained via Likert scale and open-text questions. Results: A total of 342 out of 445 participants (77%) completed both the pre- and post-survey. Quantitative analysis in post-survey responses revealed more familiarity among participants regarding specific instances of racism in the history of medicine, greater extent of thinking the history of racism impacts present-day Detroit residents, greater extent of thinking that racism influences medical care and/or medical outcomes, and belief that racism is reflected in medical research, compared to pre-survey responses (p < 0.001). Participants also reported more often considering racial or societal influences when studying medicine and more knowledge of what they can do to combat racism as a student and physician (p < 0.001). Qualitative analysis revealed seven themes among participants: the history of racism in medicine, personal reflection, racism in research, bias and microaggression, actions to take against racism, resources for anti-racist education, and racism in medical education. Conclusions: Demonstrable changes in medical student attitude and awareness surrounding topics of racism and healthcare were achieved after the Racism in Medicine Summit. This can serve as a model for other medical schools to raise awareness about racism in medicine.

A Review on Profit, Probable Hazard, and Ecological Impacts of Commonly used Chewing Gum

One of the oldest habits of human beings is to chew gum that was continuing from ancient civilizations to the modern world. Chew the gum could be a quiet pleasure that charming people for a long time. The non-food item chewing gum has a long history. The stepwise progress of its development has given us better flavour and additional medicative values. The stress-releasing properties and different medical outcomes have to make chewing gum popular for everyone. Chew the gum isn’t bring solely stripling pleasure, in near future ‘chewing gum’ perhaps use as a part of the drug delivery system. Unfortunately, it has also produced some negative effects. Modern chewing gum is made by non-biodegradable hydrophobic polymer together with artificial sweetener and flavour. So chew this sort of synthetic materials over a long time could produce some adverse effects. Again, because of our irresponsible attitude to toss the waste part of chewing gum anywhere creates some kind of serious environmental litter known as ‘gum pollution’. Therefore this widespread habit causes some sort of nuisance. Thus it’s the time to think how chewing gum offers us additional pleasure and benefits while not hampering human health and surroundings.