Awareness of the Importance of Cardiopulmonary Resuscitation Skills Following the Sudden Cardiac Arrest of Damar Hamlin during a Buffalo Bills Game

Background: Cardiopulmonary resuscitation (CPR) is a life-saving skill that is often overlooked until a tragic event occurs. A popular NFL player, Damar Hamlin, safety for the Buffalo Bills, suffered a cardiac arrest on January 2, 2023. Due to prompt intervention and CPR, Hamlin survived the arrest and is playing again. This research sought to understand how people respond to this event on the internet. It also seeks to understand how this response can be used to raise CPR awareness. Design and Methods: Using Google Trends and Twitter data, we searched, downloaded, and retrospectively analyzed search interests relative to Hamlin’s cardiac arrest for a one-year duration. We searched for related keywords in the United States from March 2022 to March 2023, including “Damar Hamlin”, “sudden cardiac death”, “heart attack”, and “CPR”. Results: There was a significant rise in post-event Google searches that combined the terms “Damar Hamlin” and “SCD” (M = -28898.88, SE = 1537.66;t = 1.62, p Conclusion: Based on the analytics of these platforms, it can be concluded that there were active discussions and an awareness of life-saving skills such as CPR along with Hamlin’s cardiac event by his fans, as demonstrated by the data gathered from these platforms. This can provide us with valuable insight into human behavior and help us leverage this knowledge to promote health.

Modulation of Respiratory Neural Drive by Physiological Loads in COVID-19 Patients with Dyspnea

COVID-19 patients often experience dyspnea due to several factors. The underlying unique pathophysiology of dyspnea in COVID-19 is not yet fully understood, but it is believed to be related to a combination of respiratory, cardiovascular, and neuromuscular factors. Hypoxemia is considered one of the key symptoms of COVID-19. This affects the respiratory drive, which determines the rate, depth, and pattern of breathing. The relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and chemosensitivity, has gained significant attention following the COVID-19 pandemic. The ACE2 receptors allow viral entry into the lungs, leading to the loss of surfactant, hypoxic vasoconstriction, and intrapulmonary shunting that may result in a V/Q mismatch. Additionally, acidosis, hypercapnia, elevated 2,3-diphosphogly-cerate levels and fever may shift the oxygen diffusion curve rightward, lowering arterial oxygen saturation levels and triggering ventilatory responses. This paper examines how physio pathological factors such as altered gas diffusion, chemosensory feedback, V/Q ratios, altered compliance, arterial blood gases, and respiratory muscle dysfunction in these patients affect ventilatory drive. A review of the published literature was also conducted to determine the mechanism of dyspnea. To ensure appropriate gas exchange, individuals need to augment their minute ventilation (VE) when physiological dead space is elevated. This serves as a compensatory mechanism to counteract the effects of compromised gas exchange and keep adequate oxygenation throughout the body. The respiratory centers may experience dysregulation due to the impact of the virus on the respiratory system, which could affect the rhythm-generating and pattern-generating signals that are vital for regulating the respiratory rate and depth of breathing effort. The cerebral cortex, in conjunction with the brain stem centers, plays a crucial role in regulating ventilation during prolonged hypoxemia. This interaction between these two components may help elucidate the conscious respiratory sensation (or dyspnea) experienced by patients. It is hypothesized that neuroventilatory decoupling acts as a mechanism to prevent sensory signals from translating into mechanical or ventilatory responses. This decoupling phenomenon is believed to have a notable impact on the intensity of breathlessness. By understanding the relationship between increased ventilatory neural drive and abnormal gas exchange, particularly in the context of ventilation/perfusion (V/Q) mismatches and altered chemosensitivity, healthcare professionals can develop strategies to optimize respiratory support for COVID-19 patients.

Fear of missing out: A brief overview of origin, theoretical underpinnings and relationship with mental health

Fear of missing out(FoMO)is a unique term introduced in 2004 to describe a phenomenon observed on social networking sites.FoMO includes two processes;firstly,perception of missing out,followed up with a compulsive behavior to maintain these social connections.We are interested in understanding the complex construct of FoMO and its relations to the need to belong and form stable interpersonal relationships.It is associated with a range of negative life experiences and feelings,due to it being considered a problematic attachment to social media.We have provided a general review of the literature and have summarized the findings in relation to mental health,social functioning,sleep,academic performance and productivity,neuro-developmental disorders,and physical well-being.We have also discussed the treatment options available for FoMo based on cognitive behavior therapy.It imperative that new findings on FoMO are communicated to the clinical community as it has diagnostic implications and could be a confounding variable in those who do not respond to treatment as usual.

Cancer and comorbidity:The role of leptin in breast cancer and associated pathologies

Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine(or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.

Bitter gourd (Momordica charantia): A potential mechanism in anti-carcinogenesis of colon

TO THE EDITORBitter gourd (Momordica charantia), has received widespread attention in the scientific community due to its beneficial effects, including antidiabetic, anti-cancer and anti-inflammatory effects in laboratory studies[1]. However, a well-defined mechanism by which this important plant food exerts its beneficial effects has not been elucidated. We present some of the latest findings on the plant’s effects against colon cancer.

Colo-renal fistula:An unusual cause of hematochezia

A 76 year old woman with bloody stools and symp-tomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell car-cinoma on her left posterior kidney. The patient was initially prepped for a colonoscopy to view possible causes of lower gastrointestinal bleeding. However, the patient had a CT with PO contrast that revealed a variation of a renoalimentary fistula. The patient was subsequently brought to the operating room, and it was discovered that a colo-renal fistula had formed, with transmural perforation of the posterior descending colon. A left nephrectomy, left colectomy with colostomy and Hartmann's pouch was performed.

Unilateral 6-OHDA <i>th-fgfr1</i>(<i>tk-</i>) mouse model supports the role of FGFs in Parkinson’s disease and the effects of nicotine and L-DOPA on spontaneous motor impairments

In the developing and adult brain, neurotrophic growth factors support the growth and protec tion of dopaminergic neuronal systems. Recently, links between impaired neurotrophin support of dopamine (DA) neurons has been described in Parkinson’s Disease (PD). Fibro- blast growth factor (FGF) has a unique association with DA neurons in that FGF signaling is vitally important for the development and protection of adult DA neurons. We assessed the role of substantia nigra (SN)-expressed FGFs in the nigrostriatal dopaminergic system using a transgenic mouse, th-fgfr1(tk-). In these mice, generated by expression of dominant negative FGFR1(TK-) from the tyrosine hydroxylase (TH) gene promoter, reduced FGF signaling results in smaller and less dense adult nigrostriatal DA neurons, similar to what is observed in PD. With unilateral 6-hydroxydopamine (6-OHDA) lesions, th-fgfr1(tk-) mice exhibited extensive unilateral nigrostriatal damage with robust spontaneous (non-drug induced) asymmetrical turning and a decreased latency to remain on the accelerating rotarod. L-DOPA remains the gold standard for PD therapy despite debilitating hyperkinetic and dyskinetic side effects. The nicotinic acetylcholine system has recently been targeted as an alternative system to combat PD motor symptoms. Nicotine effectively stimulates dopaminergic transmission in the nigrostriatal pathway and mediates movement. Using unilaterally lesioned th-fgfr1(tk-) mice, long term (11 day) oral administration of nicotine increased spontaneous bidirectional turning and increased the latency before falling from the accelerating rotarod. In a separate analysis, L-DOPA treatment reversed directionality of rotation and further deepened motor discoordination, suggesting activation of hypersensitive postsynaptic DA receptors in the denervated striata. These results in a transgenic model of PD provide insights into the cellular mechanisms underlying L-DOPA and nicotinic therapies and offer further evidence of nicotine’s capacity to facilitate movement and enhance motor coordination in PD.

Brain Rattled, Heart Shackled: Ictal Asystole in a Patient without Prior History of Epilepsy or Arrhythmia

We present a case of ictal asystole in an 81-year-old female, with no prior history of epileptic activity, or cardiac history suggestive of arrhythmia, who suffered several seemingly unrelated epileptic and asystolic episodes prior to finally having a witnessed seizure followed by an asystolic event. Following this event, all atrioventricular (AV) nodal blockers, and medications with potential seizure threshold lowering activity were stopped, and anti-epileptic medication was optimized. Due to the wishes of the patient’s family, no invasive interventions were pursued.However, the patient continued to be medically treated with anti-epileptic therapy and had no further asystolic events. Unfortunately, the patient’s overall clinical status deteriorated, and she subsequently passed during her hospital stay after being made do not resuscitate and do not intubate (DNR/DNI) by the family and then subsequently comfort care. Prior to her passing, however, she had remained free of epileptic events for 10 days and free of asystolic events for 21 days.

An Atypical Cause of Abdominal Pain in an Elderly Patient

Background: Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. HSP does occur in older patients at a much lower frequency. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. Biopsies demonstrated leukocytoclastic vasculitis in the skin and acute inflammation and hemorrhage in the gastrointestinal tract. The diagnosis was confirmed as IgA vasculitis following the renal biopsy. The patient’s symptoms improved with the administration of methylprednisolone. Conclusion: In adults with HSP there is greater concern regarding renal involvement and a greater risk of developing end-stage renal disease compared to children. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage.

ADHD儿童家庭环境与成人早期疾病结局及共患人格障碍的关系

目的:探讨儿童期家庭环境是否会影响儿童注意缺陷多动障碍(ADHD)患者在成人早期的功能缓解及伴发人格障碍的发生情况。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)ADHD诊断标准的儿童286例,用家庭环境量表中文版(FES-CV)评估儿童期家庭环境,在成人早期随访ADHD的功能缓解情况及人格障碍的伴发情况。采用logistic回归分析儿童期家庭环境与儿童ADHD成人早期结局的关系。结果:平均随访6.2年后,符合成人ADHD诊断的134例(46.9%),符合人格障碍诊断的116例(40.6%)。Logistic回归结果显示,FESCV矛盾性因子分与儿童ADHD持续到成人早期呈正向关联(OR=1.14,95%CI:1.01~1.28,P<0.05),与成人早期人格障碍呈正向关联(OR=1.17,95%CI:1.03~1.31,P<0.05),成功性因子分与成人早期人格障碍负向关联(OR=0.85,95%CI:0.73~0.99,P<0.05)。结论:儿童期家庭环境中的矛盾性表达越强,儿童ADHD持续到成人早期的风险越高,成人早期出现人格障碍的风险越高;成功性表达越强,成人早期出现人格障碍的风险越低。

Esophageal liposarcoma:Well-differentiated rhabdomyomatous type

Rhabdomyomatous well-differentiated esophageal liposarcomas are extremely rare. As of August 2016, only one other such case has been reported in the Englishlanguage medical literature. Liposarcomas in general are one of the most common soft tissue neoplasms in adults, but the incidence of primary esophageal liposarcomas is exceptionally low. There have been only 42 reported cases of primary liposarcoma of the esophagus worldwide thus far. These malignancies are harbored within giant fibrovascular polyps, which slowly grow within the esophageal lumen causing obstructing symptoms. We hereby present the case of a 68-year-old male patient who came in with a 2-mo history of worsening intermittent dysphagia, persistent cough, and postprandial retrosternal pain. After an esophagogastroduodenoscopy, a computed tomographic scan, and a diagnostic endoscopy, complete endoscopic resection was performed of the 13 cm×6 cm×2.6 cm fibrovascular polyp. A literature review was done and results are presented herein.

Postpartum psychosis in a non-native language-speaking patient: A perspective on language barriers and cultural competency

SUMMARY Postpartum psychosis is a condition characterised by rapid onset of psychotic symptoms several weeks after childbirth. Outside of its timing and descriptions of psychotic features, minimal research exists due to its relative rarity (1 to 2 per 1000 births in the USA), with greater emphasis on postpartum sadness and depression. With the existi叩 literature, cultural differences and language barriers previously have not been taken into consideration as there are no documented cases of postpartum psychosis in a non-English-speaki叩 patient. Correctly differentiating postpartum psychosis from other postpartum psychiatric disorders requires adeptly evaluating for the presence of psychotic symptoms with in-depth history taking.

Perceptions of the osteopathic profession in New York City’s Chinese Communities

Objective The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Chinese immigrant communities in New York City(NYC).Design A cross-sectional study was designed in which a culturally appropriate survey in Chinese and English versions was administered anonymously to measure immigrant perceptions and knowledge of osteopathic medicine.setting Data collection occurred in the municipal delineations for the Chinatown neighbourhood within the New York,New York borough of Manhattan.Participants Community members were selected using convenience sampling from high-density areas to participate.Information gathered from the survey included demographics,education level,healthcare habits and knowledge of the osteopathic profession.results 120 surveys were conducted with 68 males and 52 females,with an average age=40.Respondents in the age range of 18-29 years,those with fluent English-language proficiency,and participants with graduate-level education status demonstrated a higher proportion of knowledge of osteopathic manipulative medicine and osteopathic physicians(doctors of osteopathic medicine)among the study variables.Conclusion Compared with research on the general US population,a general lack of knowledge of osteopathic medicine exists within NYC’s Chinese immigrant community.Although this difference may be ascribed to linguistics and ethnosociological factors,greater outreach and education is needed in urban minority communities to make immigrants aware of all healthcare resources available during the current shortage of US primary care physicians.

Leukocytoclastic Vasculitis Following Ceftriaxone Exposure

Leukocytoclastic vasculitis (LCV) is an immune-complex mediated inflammation of dermal capillaries and venules that can occur after infections, drugs, autoimmune disorders, neoplasms, or idiopathically. We present the case of a 59-year-old male who was treated with ceftriaxone for an abscess, S. aureus cellulitis, and osteomyelitis of his right second toe. Biopsy confirmed the diagnosis of LCV and symptoms resolved after ceftriaxone was discontinued and systemic corticosteroids were introduced.

The phytochemical, biological, and medicinal attributes of phytoecdysteroids: An updated review

The phytoecdysteroids(PEs)comprise a large group of biologically-active plant steroids,which have structures similar to those of insect-molting hormones.PEs are distributed in plants as secondary metabolites that offer protection against phytophagus(plant-eating)insects.When insects consume the plants containing these chemicals,they promptly molt and undergo metabolic destruction;the insects eventually die.Chemically,ecdysteroids are a group of polyhydroxylated ketosteroids that are structurally similar to androgens.The carbon skeleton of ecdysteroids is termed as cyclopentanoperhydro-phenanthrene with aβ-side chain at carbon-17.The essential characteristics of ecdysteroids are a cis-(5β-H)junction of rings A and B,a 7-en-6-one chromophore,and a trans(14α-OH)junction of rings C and D.Plants only synthesize PEs from mevalonic acid in the mevalonate pathway of the plant cell using acetyl-CoA as a precursor;the most common PE is 20-hydroxyecdysone.So far,over 400 PEs have been identified and reported,and a compilation of 166 PEs originating from 1998 has been previously reviewed.In the present review,we have summarized 212 new PEs reported between 1999 and 2019.We have also critically analyzed the biological,pharmacological,and medicinal properties of PEs to understand the full impact of these phytoconstituents in health and disease.

A Review of Double Kissing Crush Stenting in Coronary Bifurcation Lesions

Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinical trials and studies.It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios.Among all the available evidence,the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion.DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions.Future direction of how to make this DK crush technique better is also proposed.

Clinical utility of whole genome sequencing for the detection of mitochondrial genome mutations

Genetic mitochondrial disorders are a heterogenous group of multi-system disorders caused by an imbalance in mitochondrial function(Moggio et al.,2014;Wallace,2018).In contrast to the nuclear genome,each cell contains hundreds,or even thousands,of mtDNA molecules(Veltri et al.,1990;Calvo et al.,2006).Thus,a mixture of different mtDNA sequences can co-exist within the same individual,a situation referred to as he terop las my.The level of heteroplasmy in an individual often affects the penetrance and phenotypic severity of the diseases.Consequently,detection of sequence heteroplasmy is essential for the proper clinical interpretation of mitochondrial diseases(Stewart and Chinnery,2015).