Assessing the Threat of Violent Employees

Conflict in the workplace is not a new phenomenon. Almost every worker, anywhere in the world will have encountered a colleague who is unfriendly, unpleasant and even hostile. However, there are occasions when an employee goes beyond those levels and they are aggressive, menacing and dangerous. This paper will explore the very rare incidents of work-related murder as well as the much more common low levels of violence, sexual harassment and workplace bullying. It will discuss the importance of good risk assessment and actions to be taken when such behaviour occurs.

Stress on Human Health Resources as A Result of The COVID-19 Virus

The world has been paralyzed by a new pandemic, efforts to mitigate the spread, the necessary medical intervention in infected patients, the problems of health systems have shown the value of the personnel working in the health sector. The objective is to reflect on the implications of the Human Resource of health in the care of COVID-19. Arguing that health work in the urgent situation of the pandemic can generate stress as a consequence. The intervention to temper the spread of the virus makes human resources vulnerable to health, these repercussions are exalted by working hours and overwork. It delves into the problem of stress as part of mental health and the daily work of human resources. It concludes with a series of suggestions that could contribute to the phenomenon of stress in human health resources.

Budesonide-Formoterol as Needed for The Treatment of Mild Persistent Asthma

Objective: To summarize literature assessing the safety and efficacy of budesonide/formoterol, a low dose inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) used as needed for the treatment of adult patients with mild persistent asthma requiring step 2 therapy compared to low dose inhaled corticosteroid (ICS) plus short-acting beta agonist (SABA) and SABA monotherapy. Data Sources: A literature search of PubMed (1966-October 2020), EMBASE (1973-October 2020) and clinicaltrials.gov was conducted using the following search terms: budesonide, formoterol, as needed, and mild asthma. Study selection and data extraction: Randomized, controlled trials with data describing as needed use of budesonide-formoterol in the treatment of mild, persistent asthma were included. Data synthesis: Current trials demonstrate a reduced risk of exacerbation and an improvement in symptom control in patients receiving budesonide/formoterol as needed when compared to as needed SABA alone. However, when compared to scheduled budesonide maintenance, patients receiving budesonide/formoterol as needed experienced worse symptom control and mixed exacerbation results. Relevance to patient care and clinical practice: This review evaluates the efficacy and safety of budesonide/formoterol as needed for patients with mild asthma. The Global Initiative for Asthma (GINA), a global strategy for asthma management and prevention adopted this change in 2019, and the most recent updated Expert Panel Report 4 of the National Asthma Education and Prevention Program (NAEPP) did not address this area. Conclusions: Based on this review of the literature, further study is needed to determine the place in therapy for budesonide/formoterol as needed in the treatment of mild persistent asthma. Low-dose ICS should remain the standard of therapy in patients with mild asthma requiring Step 2 therapy.

Methicillin Susceptible Staphylococcus aureus is the predominant Organism in Septic Bursitis with the Majority Involving the Olecranon Bursa: A Study of 65 Cases

Bursae are fluid filled structures between mobile parts of the musculoskeletal system to reduce friction by lubrication. Repeated trauma to bursae results in bursitis which are usually aseptic initially, which may be followed by infection. Many cases are related to occupational or recreational activities. We present an analysis of cases of Staphylococcus aureus septic bursitis admitted to 10 hospitals over a 3-year period. The olecranon bursa was the most common site involved 42/65 (64.6%) followed by prepatellar bursa 17/65 (26.1%). The mean age was 61.2 years. Fifty five out of Sixty-five (84.6%) were male. The majority were caused by methicillin susceptible Staphylococcus aureus 52/65 (80%). The occupational history was missing for most patients. The occupations reported in few of the patient charts were floor worker, construction worker and roofer. Sixty one out of sixty-five (92.4%) of cases involved the elbow and knee. Avoidance of activities that result in repeated friction or trauma to elbows and knees would prevent majority of cases of septic bursitis.

Alpha-Synuclein aggregation in Parkinson’s Disease

The ability of polypeptides to fold into a functional, three-dimensional structure forms the basis of normal cellular and organ function, however, when this fundamental process goes awry it forms the basis of neurodegenerative diseases. Nearly 1 in 6 people have a neurological condition and these diseases can be debilitating and incurable. Parkinson’s Disease (PD) is the second most common neurodegenerative disease that is known as a movement disorder, but that is also characterized by additional non-motor associated symptoms. The pathophysiological hallmark of PD is the misfolding and aggregation of the protein α-synuclein (α-Syn) and the accompanying loss of neurons that produce dopamine in the brain. There are currently no proven therapies for PD and management options consist of symptom relief. Through the development of multidisciplinary approaches (including nuclear magnetic resonance, high-resolution imaging and animal models of disease), scientists have made great strides in our understanding of the chemical, genetic and molecular basis of PD. Although it is commonly accepted that aggregation of α-Syn is key in the pathogenesis of PD, the extent to which its aggregation plays a causal role in neurodegeneration is still a matter of intense investigation. This review will provide a critical assessment of the importance of α-Syn aggregation in PD and discuss the experimental approaches and current and future therapies for this neurodegenerative disease. Expanding our knowledge of the role of protein aggregation in the pathophysiology of PD is critical for the identification of biomarkers for early disease detection, as well as for the development of novel and specific therapeutic approaches.

COVID-19 as Viewed by The Pathologist: A Rapid Literature Review

The current coronavirus outbreak represents a severe threat to public health worldwide. Finding measures to properly manage and prevent the epidemic is ongoing, right now practitioners and public health authorities need immediate, actionable information. Basic science and medical scientific disciplines have quickly produced a quantity of publications never seen with other emergencies, with a risk of exaggerated information and non-evidence-based measures. This rapid literature review of PubMed®/MEDLINE publications from January 20 to April 20, 2020 using COVID-19 as main key-word resulted in over 6.000 articles, with around 600 reviews. The contributions were subsequently clustered in subgroups according to journal sources and preselected areas of reference. Results were aggregated into 4 categories: supported, promising controversial and critical data. This Review has revealed a major criticality: only seven pathology articles were based on post-mortem material (minimally invasive autopsies/biopsies) . Dealing with an unknown disease, autopsies are indispensable to understand pathogenetic mechanisms, in order to rationalize therapeutic interventions. Even more important is to adopt a dedicated protocol aimed at correlating pathological findings with disease duration, patient location (home, hospital ward, ICU), and, for each period, symptoms, and treatment. Autopsy reports should not be released before a multidisciplinary discussion by hospital Root Cause Analysis or Morbidity/Mortality conferences. Telepathology is not a suitable means for such studies.

COVID-19 Pandemic and Yoga practice -New prescription for Stress Reduction?

The emergence of COVID 19 pandemic since December 31 2019, and isolation of novel SARS-CoV-2 changed the world. Since then, cases have spread all over the globe including 213 Countries/ territories. As the coronavirus spreads throughout the world, so has the ramifications of its spread impacted every aspect of our daily lives. While the physical, economic and social consequences of this pandemic have been enormous, its toll on the mental health and stress level of the general public is especially significant and should be addressed. Mandatory stay at home orders, social distancing measures, the closure of schools, parks, visitation in nursing homes, while necessary to contain the spread, may additionally lead to declining mental health. The latest statistics show that a whopping 264 million individuals worldwide suffer from clinical depression. We propose the use of some simple Yoga practices to cope with this stressful situation and also to address the immune boosting effect of this practice. Proper practice of Yoga assists in mental clarity as well as emotional and physical control. It also helps with stress relief and increases one’s awareness of the physical body rhythms. In this article we address simple Yoga and how to practice it with illustrations. We discuss the available literature regarding Yoga and its benefit in stress and immune-boosting.

Improved Pancreaticoduodenectomy Outcomes after Starting a Specialized Community Hospital Pancreatic Surgery Program

Background: Recent trends in centralization of pancreatic surgery happened as a response to improved outcomes in tertiary care institutions. The volume-outcome relationship is true for high volume hospitals and surgeons. Obstacles to patient travelling to high volume institutions and widespread quality care in community hospitals led to establishing a quality specialized pancreatic surgery program in the community. Methods: Two pancreatic surgery specialists relocated their program from a tertiary care center to a community hospital. Results of the first sixty-two pancreaticoduodenectomy and total pancreatectomy procedures were studied. Results: One hundred and seventeen pancreatic surgery cases were analyzed, sixty-two pancreaticoduodenectomy and total pancreatectomy cases were included. Patient demographics were not different in regard to the median age (67 vs. 62 years), gender (65 vs. 62% males), median BMI (26.2 vs. 26 kg/m2), or American Society of Anesthesiologists class, in between the two hospitals. There was a significant decrease in the operative time (350 vs. 281 minutes, p=0.0001), estimated blood loss (409 vs. 156 milliliters, p=0.003), and length of hospital stay (7.2 vs. 5.2 days, p=0.0001). Most patients were operated on for a diagnosis of malignancy (74.2%), and the R0 resection rate was better at the community hospital reaching 95.2%. Transfusions, delayed gastric emptying and leaks tended to be better at the community hospital but did not reach statistical significance. Conclusion: With dedicated institutional support and careful program design, complex procedures such as PD can be successfully relocated to the community where superior results can be achieved.

The Effect of Selective Serotonin Reuptake Inhibitor Antidepressants on Bruxism: A Systematic Review

The aim of this research was to perform a systematic review of the literature using the Cochrane Library criteria to establish whether there is a relationship between the use of selective serotonin reuptake inhibitor (SSRI) antidepressants and bruxism. We performed a review of randomised clinical trials studies that compared individuals treated with SSRI antidepressants to those treated with a placebo to detect an association between treatments with SSRIs the clinical and/or polysomnographic diagnosis of sleep bruxism. Studies were excluded from the review if the methods used were unclear or if they presented results that were inconsistent with their stated aims. In addition, descriptive and observational studies, literature reviews, case reports, and case series were not included. In the selection process, there were no requirements with regard to the language of the study or the source of the information. The MEDLINE, LILACS, CENTRAL, Embase and PsycINFO databases were examined using pre-established electronic search strategies. None of the 48 selected articles met the criteria for the present review. Thus, we were not able to perform a systematic review using the Cochrane Library criteria. There are no studies that have been conducted using consistent, validated methods that elucidate the relationship between sleep bruxism and the use of SSRIs. Studies should be conducted using appropriate methods to validate this relationship.