Adventist HealthCare

We report the first confirmed record of Sibon canopy (Arteaga & Batista, 2023) in Portobelo National Park, Colón, Panama, expanding its known geographical distribution by 106.13 km to the northeast and lowering its altitudinal range from 543 m to 119 m a. s. l. Additionally, we document the presence of a pair during the dry season, suggesting possible reproductive behavior. Our observations increase the number of snail-eating snake species in the park to six and the total reptile species richness to 59. Furthermore, we extend the known range of Sibon irmelindicaprioae (Arteaga & Batista, 2023) by 132.72 km northeast of its previously reported locality. These findings reinforce the importance of continued field surveys in protected areas and support the prediction that reptile diversity in Portobelo is still underestimated.

We report a case of a 92-year-old elderly male with Stage IVA oligometastatic prostate adenocarcinoma to the pelvic nodes managed successfully with stereotactic body radiotherapy (SBRT) alone. The patient declined androgen deprivation therapy (ADT) with concerns about quality of life and reported side effects. He was treated with weekly SBRT targeting the prostate and pelvic lymph nodes without a rectal spacer, experiencing only Grade 1 urinary toxicity. The prostate-specific antigen (PSA) significantly declined from 12.05 to 0.16 ng/ml at the six-month follow-up. This case shows the feasibility and tolerability of SBRT as monotherapy in select elderly patients with regional risk node-positive prostate cancer.

Clinicians are expected to make use of data to reflect on their practice; this is reflected in its accepted role in mandatory Continuing Professional Development (CPD). One potentially valuable form of relevant data that hospitals routinely collect is clinical indicators (CI), such as readmissions and complications. This paper describes our design and qualitative evaluation of SeeCI, an interface to enable clinicians to use CI data to see, understand, and reflect on their practice. Our think-alouds with ten hospital staff indicate that SeeCI enabled meaningful insights, despite the challenging nature of repurposed data, notably for valuable peer comparisons. Our key contributions: (1) SeeCI, a new interface to support individuals’ reflection on their clinical practice, based on data from a set of repurposed CIs; and (2) demonstration of the value of SeeCI for individuals to gain insights and perspectives, including making use of peer comparison.

Sleep is the most significant factor for keeping young adults healthy and active. Sleep deprivation increases the risk of depression, anxiety, and low self-esteem. Sleep is essential for the mental, physical, social, and emotional development of young adults. Sleep deprivation may cause impairment in cognition and emotions among young adults. A case study is used to illustrate cognitive factors related to poor sleep quality in a young adult. The participant was a healthy patient outside of his sleep disturbance. Changes in cognitive functioning were evaluated with the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). RBANS is a series of 12 subtests that provide a broad selection of tasks that measure neuropsychological impairment. The RBANS was administered during intake, one month and at six months following the eight weeks of Cognitive Behavior Therapy. The profile of performance for the participant was similar to that previously reported for mild cognitive impairment due to head trauma. The implication to health (i.e., cognitive functioning) for sleep disturbance is presented. The outcome shows cognitive abilities such as language skills improved as sleep efficiency increased, whereas other cognitive abilities such as immediate and delayed memory did not show improvement. The implication is that sleep disturbance and poor quality of sleep can impact one’s cognitive functioning and are related to overall health and well-being.

SummaryBackgroundSince the 1990’s attempts to favorably modulate nitric oxide (NO) have been unsuccessful. We hypothesized that because NO is lipophilic it would preferentially localize into intravascularly infused hydrophobic nanoparticles, thereby reducing its bioavailability and adverse effects without inhibiting its production. We aimed to determine the efficacy and safety of intravenous infusion of a fluid comprised of hydrophobic phospholipid nanoparticles (VBI-S) that reversibly absorb NO in the treatment of hypotension of patients in severe septic shock.MethodsThis is a multicentre, open-label, repeated measures, phase 2a clinical pilot trial done at six hospital centers in the USA. Patients in severe septic shock were enrolled after intravenous fluid therapy had failed to raise mean arterial blood pressure (MAP) to at least the generally accepted level of 65 mmHg, requiring the use of vasopressors. The primary endpoint of this study is the proportion of patients in whom MAP increased by at least 10 mmHg. VBI-S was administered intravenously to patients as boluses of 100 ml, 200 ml, 400 ml, and 800 ml at 999 ml/min until the blood pressure goal was reached after which the infusion was stopped, and the MAP was recorded. All patients who received any volume of VBI-S were included in the primary and safety analysis. The study is registered with ClinicalTrials.gov, NCT04257136.FindingsBetween February 17, 2020 and January 3, 2023, 20 eligible patients were enrolled in the study. In all 20 (100%) patients, the goal of increasing MAP by at least 10 mmHg using VBI-S was achieved (p = 0.0087, effect size = 0.654). Mean VBI-S volume required to meet the primary goal was 561.0 ± 372.3 ml. The goal of lowering vasopressor dose was also achieved (p = 0.0017). Within 48 h or less after VBI-S, there was a statistically significant improvement in oxygenation, serum creatinine, clotting variables, procalcitonin, lactic acid, and the sequential organ failure assessment (SOFA) score. At 24 h and 48 h following administration of VBI-S, 12/15 (80%) and 9/12 (75%) patients developed hyperlipidemia, respectively. No severe adverse events of VBI-S were observed, and there were no treatment-related deaths.InterpretationThese preliminary findings suggest the safety and efficacy of VBI-S in treating hypotension in patients with septic shock. However, a definitive mortality benefit cannot be demonstrated without a randomized controlled study.FundingThe Naval Medical Research Command—Naval Advanced Medical Development program via the 10.13039/100021976Medical Technology Enterprise Consortium.