JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION最新文献

{"title":"Eosinopenia and COVID-19.","authors":"Fahmina Tanni, Eleonora Akker, Muhammad M Zaman, Nilka Figueroa, Biju Tharian, Kenneth H Hupart","doi":"10.7556/jaoa.2020.091","DOIUrl":"10.7556/jaoa.2020.091","url":null,"abstract":"<p><strong>Context: </strong>Early diagnosis of coronavirus disease 2019 (COVID-19) and patient isolation are important for both individual patient care and disease containment. The diagnosis is confirmed by testing for the presence of nasopharyngeal viral RNA with a polymerase chain reaction assay, which has limited availability, variable turnaround time, and a high false-negative rate. The authors report that a rapid laboratory test, the eosinophil count, readily obtained from a routine complete blood cell count (CBC), may provide actionable clinical information to aid in the early recognition of COVID-19 in patients, as well as provide prognostic information.</p><p><strong>Objective: </strong>To investigate the diagnostic and prognostic value of eosinopenia in COVID-19-positive patients.</p><p><strong>Methods: </strong>The eosinophil results of routine CBC from the first 50 admitted COVID-19-positive patients were compared with the eosinophil results of 50 patients with confirmed influenza infection at the time of presentation to the emergency department at Coney Island Hospital in Brooklyn, New York. The number of patients with 0 eosinophils on the day of presentation was also compared between the 2 groups. Furthermore, the eosinophil counts in the 50 COVID-19 patients were reviewed for the first 5 days of their hospital stay and before discharge, along with the outcome (deceased vs discharged), and trends in eosinophil data were compared based on the outcome.</p><p><strong>Results: </strong>On the day of presentation, 30 patients in the COVID-19 group (60%) and 8 patients in the influenza group (16%) had an eosinophil count of 0. An additional 14 patients in the COVID-19 group had 0 eosinophils during the following 2 days; the total number of patients in the COVID-19 group who had 0 eosinophils on admission or during the ensuing 2 days was 44 (88%). In addition, 18 of 21 deceased patients in the COVID-19 group (86%) who initially presented with eosinopenia remained eosinopenic compared with 13 of 26 survivors (50%).</p><p><strong>Conclusion: </strong>The absence of an eosinophil count in a CBC can aid in early diagnosis of COVID-19. It may be a useful tool in deciding whether to promptly isolate a patient and initiate specific therapies while waiting for confirmatory test results. Persistent eosinopenia after admission correlated with high disease severity and low rates of recovery.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38161506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteopathic Response to the COVID-19 Pandemic.","authors":"Eric Martinez, David Redding","doi":"10.7556/jaoa.2020.081","DOIUrl":"10.7556/jaoa.2020.081","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38153263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Dual-Fluorescent Mitophagy Reporter Reveals a Reduced Mitophagy Flux in Type 1 Diabetic Mouse Heart.","authors":"Satoru Kobayashi,&nbsp;Joy Patel,&nbsp;Fengyi Zhao,&nbsp;Yuan Huang,&nbsp;Tamayo Kobayashi,&nbsp;Qiangrong Liang","doi":"10.7556/jaoa.2020.072","DOIUrl":"https://doi.org/10.7556/jaoa.2020.072","url":null,"abstract":"<p><strong>Context: </strong>Patients with diabetes are susceptible to heart failure. Defective mitochondria can cause cardiac damage. Mitochondrial autophagy or mitophagy is a quality control mechanism that eliminates dysfunctional mitochondria through lysosome degradation. Mitophagy is essential for maintaining a pool of healthy mitochondria for normal cardiac function. However, the effect of diabetes on the functional status of cardiac mitophagy remains unclear.</p><p><strong>Objective: </strong>To determine and compare cardiac mitophagy flux between diabetic and nondiabetic mice.</p><p><strong>Methods: </strong>Using a novel dual fluorescent mitophagy reporter termed mt-Rosella, we labeled and traced mitochondrial fragments that are sequestered by the autophagosome and delivered to and degraded in the lysosome.</p><p><strong>Results: </strong>Mitophagic activity was reduced in high-glucose-treated cardiomyocytes and in the heart tissue of type 1 diabetic mice.</p><p><strong>Conclusions: </strong>Mitophagy was impaired in the heart of diabetic mice, suggesting that restoring or accelerating mitophagy flux may be a useful strategy to reduce cardiac injury caused by diabetes.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"446-455"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LETTER TO THE EDITOR.","authors":"Monique Cherrier,&nbsp;Gregory Terman,&nbsp;Danny Shen,&nbsp;Laura Shireman,&nbsp;Andrew Saxon,&nbsp;Tracy Simpson","doi":"10.7556/jaoa.2020.070","DOIUrl":"https://doi.org/10.7556/jaoa.2020.070","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"434-435"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fitz-Hugh-Curtis Syndrome.","authors":"Michelle Mersch,&nbsp;Daniel Martingano","doi":"10.7556.jaoa.2020.077","DOIUrl":"https://doi.org/10.7556.jaoa.2020.077","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"483"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Straight Back Syndrome.","authors":"Julio C Perez-Downes,&nbsp;Amie Leon,&nbsp;Pramod Reddy","doi":"10.7556/jaoa.2020.078","DOIUrl":"https://doi.org/10.7556/jaoa.2020.078","url":null,"abstract":"","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"485"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Opioid Prescribing Education for Obstetrics and Gynecology Residents in a Safety-Net Hospital.","authors":"Casey Evans, Deanna McCullough, Kelly Best, Brian K Yorkgitis","doi":"10.7556/jaoa.2020.073","DOIUrl":"10.7556/jaoa.2020.073","url":null,"abstract":"<p><strong>Context: </strong>The number of deaths due to opioid overdose has steadily increased in the United States since the early 2000s. The US opioid epidemic calls for an urgent need to evaluate physician prescribing habits.</p><p><strong>Objective: </strong>To educate obstetrics and gynecology residents about opioid abuse, the quantity typically prescribed postoperatively, and strategies to decrease adverse outcomes.</p><p><strong>Methods: </strong>Obstetrics and gynecology residents at an urban safety-net hospital were given a preintervention evaluation to understand their opioid prescribing patterns and use of resources like prescription drug monitoring programs and opioid risk tool. Residents then attended a didactic session reviewing rates of adverse outcomes from overprescribing, resources to reduce adverse outcomes, and the number of opioids considered appropriate postoperatively. Residents completed an immediate postintervention evaluation to reevaluate prescribing patterns.</p><p><strong>Results: </strong>Pre- and postintervention evaluations were completed by 13 residents. In the preintervention evaluation, all participants reported that they would prescribe at least 30 opioid pills for patients after cesarean delivery, but in the postintervention evaluation, none reported that they would prescribe more than 20 opioid pills (P=<.0001). Similar but less distinct shifts can be seen in laparoscopic hysterectomy and the use of preoperative gabapentinoids (ie, gabapentin and pregabalin). Before the intervention, 7 residents (54%) reported that they currently prescribed 20 opioid pills or more for patients after laparoscopic hysterectomy, whereas after the intervention, 1 resident (7.7%) reported that he or she would prescribe more than 20 opioid pills in (P=.0382). Before the intervention, 2 residents (15.4%) reported that they would consider gabapentinoids compared with 13 residents (100%) after the intervention.</p><p><strong>Conclusion: </strong>Focused opioid education can reduce the intended number of opioid pills prescribed in a postoperative setting. This study highlights the effect that educational curricula can have on physician prescribing patterns to help mitigate the current epidemic and help optimize stepwise multimodal analgesia to avoid overprescribing opioids.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"456-461"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Osteopathic Manipulative Therapy Improves Postoperative Pain and Reduces Opioid Consumption After Total Knee Arthroplasty: A Prospective Comparative Study.","authors":"Pierre Barral,&nbsp;Shahnaz Klouche,&nbsp;Nathalie Barral,&nbsp;Yves-Pierre Lemoulec,&nbsp;André Thés,&nbsp;Thomas Bauer","doi":"10.7556/jaoa.2020.071","DOIUrl":"https://doi.org/10.7556/jaoa.2020.071","url":null,"abstract":"<p><strong>Context: </strong>Pain is a therapeutic challenge after total knee arthroplasty (TKA), and it could lead to the overuse of opioids. Few methodologically robust clinical studies have been performed to assess the effectiveness of osteopathic manipulative therapy (OMTh; manipulative care performed by non-US-trained osteopaths) for postsurgical pain.</p><p><strong>Objective: </strong>To evaluate the effectiveness of standardized preoperative OMTh on early postoperative pain and opioid consumption after TKA.</p><p><strong>Methods: </strong>This comparative, nonrandomized study took place from 2013 to 2015 and included patients who had primary unilateral TKA for osteoarthritis in a knee that had not undergone any previous surgery. Patients were divided into 2 consecutive groups: 1 group received traditional preoperative management, and the other group received associated preoperative OMTh (general OMTh [rhythmic mobilization of all the body joints, from the ankles to the skull, using long-lever manipulation] and myofascial relaxation). The primary evaluation criterion was knee pain at rest 1 month after surgery: 0 (no pain) to 100 (the worst imaginable pain). The secondary evaluation criteria were: (1) knee pain while walking 1 month after surgery, (2) average weekly knee pain during the first month after surgery, (3) the presence of night pain and the consumption of sleeping pills and opioids or morphine at least once per week, (4) the International Knee Society scores and the Western Ontario and McMaster University Osteoarthritis index at postoperative 6 months and 1 year. The number of patients needed for a superiority trial was determined.</p><p><strong>Results: </strong>No eligible patient refused OMTh when proposed. Seventy patients were evaluated (mean [SD] age, 75 [8] years; 47 women and 23 men). The 2 treatment groups contained 35 patients each. At postoperative month 1, the OMTh group had significantly less pain at rest (mean [SD], 6.8 [6] vs 20.9 [17.3]; P=.00001) and while walking (7.9 [9.4] vs 23.5 [20.6]; P=.0001) compared with the group that received traditional preoperative management. The consumption of opioids during the first postoperative week was significantly lower in the OMTh group (P=.0001). No statistically significant difference was found in the International Knee Society or Western Ontario and McMaster University Osteoarthritis scores between the 2 groups at 6 months and 1 year of follow-up.</p><p><strong>Conclusion: </strong>Standardized preoperative OMTh was found to be effective in reducing pain in the first month after TKA for osteoarthritis and significantly reduced opioid consumption during the first postoperative week.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"436-445"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7556/jaoa.2020.071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Financial Conflicts of Interest Among Contributors to Clinical Practice Guidelines of the American College of Obstetricians and Gynecologists.","authors":"Micah R Wright,&nbsp;Lance Frye,&nbsp;Luanne Vo Solis,&nbsp;Jake X Checketts,&nbsp;Carlos Guevara,&nbsp;Larissa Smith,&nbsp;Matt Vassar","doi":"10.7556/jaoa.2020.059","DOIUrl":"https://doi.org/10.7556/jaoa.2020.059","url":null,"abstract":"<p><strong>Context: </strong>Patient care is an essential part of the practice of obstetrics and gynecology, and patient care is directed by clinical practice guidelines. To increase the validity of these guidelines, we must make sure that there is no outside influence by financial conflicts of interest.</p><p><strong>Objective: </strong>To investigate the existence of and reporting patterns regarding payments received by contributors to guidelines from the American College of Obstetricians and Gynecologists (ACOG), ACOG executive committee members, and companies making these payments and to examine the compliance of those receiving payments to ACOG's conflict of interest policies.</p><p><strong>Methods: </strong>The Center for Medicare and Medicaid's Open Payments database was used to search practice bulletin committee members and practice bulletin collaborators from 2014-2016, as well as current executive committee board members. Open Payments was also used to evaluate companies that provided payments, and amounts were totaled. The main outcome measure was the monetary values of payments received and the compliance with disclosure statements enforced by ACOG. Manufacturer payments to physicians in the database were analyzed descriptively.</p><p><strong>Results: </strong>General and research payments were calculated among 65 physicians in the Open Payments database: 44 physician members of both the obstetrics and the gynecology practice bulletin committees, 4 2016 ACOG executive board physician members, and 17 contributing physician authors. Research payments accounted for greater than 78% of all payments. Consulting, travel and lodging, and speaking fees totaled greater than $90,000 and contributed to more than 90% of the total amount of general payments. Food and beverage payments contributed to 10% of all general payments. Three covered members were noncompliant with the financial conflicts of interest guidelines, receiving industry payments exceeding $5000.</p><p><strong>Conclusion: </strong>A small number of companies provide the majority of contributions; however, there is no evidence to suggest bias toward manufactures within ACOG practice bulletins. Future investigations into pharmaceutical manufacturer payments, specifically for consulting fees, may be warranted. (Clinical Trial Registry UMIN-CTR, UMIN000029165).</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"462-470"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sister Mary Joseph Nodule in a Patient With Advanced Prostate Cancer.","authors":"Michael Chahin,&nbsp;William Kogler,&nbsp;Anthony Stack,&nbsp;Brittany Lyons","doi":"10.7556/jaoa.2020.075","DOIUrl":"https://doi.org/10.7556/jaoa.2020.075","url":null,"abstract":"<p><p>Prostate cancer is the second most common cause of cancer death among US men. Metastasis typically occurs in the bone, lymph nodes, liver, and thorax. This case highlights a patient who was suspected of having prostate cancer several years before presenting to the emergency department with back pain and an umbilical hernia of increasing size. Gross examination revealed fixed masses on the abdominal wall that appeared malignant on computed tomographic imaging. The umbilical mass was a Sister Mary Joseph nodule (SMJN), which is sometimes found in patients with advanced, metastatic abdominal cancer. An SMJN is most commonly suggestive of gastrointestinal or gynecologic cancer, but it is a rarely reported finding in the context of prostate cancer. SMJN is a frequently missed finding that may delay further investigation for malignant neoplasms. This case reinforces the importance of this physical examination finding and provides evidence for adding prostate cancer to the list of possible diagnoses for patients who have an SMJN.</p>","PeriodicalId":47816,"journal":{"name":"JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION","volume":"120 7","pages":"476-478"},"PeriodicalIF":1.1,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38095274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}