Ventura County Medical Center

Farmworkers are at high risk of heat-related illness, especially those working in polytunnels. There is a gap in knowledge regarding working conditions inside polytunnels. Polytunnels are prevalent in California's Central Coast region. Recommendations to reduce the risk of heat-related illness among workers in polytunnels were formulated. Polytunnels-also known as hoop houses-are used worldwide to grow certain crops year-round, primarily to protect plants from precipitation and cool temperatures. Farmworkers may be at increased risk in polytunnels due to higher temperatures and relative humidity. In the Central Coast region of California, polytunnels are commonly used to grow berries and other crops, but information on measures used to reduce heat stress in farmworkers working in polytunnels or how many workers are potentially exposed to these conditions is scarce. The purpose of this study was to: (1) estimate the area under polytunnels and the number of workers in them in California's Central Coast region; (2)assess current practices to manage heat and protect workers in polytunnels; and (3)use this information to develop proposed best practices for protecting farmworkers in polytunnels. Using satellite imagery and crop production records, the area under polytunnels in the region was estimated at 5,162 ha with a conservatively estimated 46,000 farmworkers. Through key informant interviews, we found that farms are generally following OSHA worker safety regulations. However, additional measures may be needed to protect workers because environmental conditions inside polytunnels are variable and difficult to predict. For instance, wet bulb globe temperature would be a more accurate measure of heat stress risk than temperature alone. We propose recommendations that follow the hierarchy of controls to reduce the risk of heat-related illness among workers inside these structures.

IntroductionThis work aims to determine the effect on nerve fiber layer (NFL) and ganglion cell complex (GCC) thickness trends in eyes with open-angle glaucoma (OAG) treated with Vision Protection Therapy™ (VPT).MethodsA retrospective analysis of spectral-domain optical coherence tomography (OCT) measured NFL and GCC thickness trends was performed, excluding eyes with poor-quality scans and principal diagnoses other than OAG. This study compares eyes with OAG managed conventionally with IOP control alone (controls) to eyes managed with the addition of VPT (VPT eyes). The direction (+ or −) and magnitude (microns/year) of the OCT trends were the study endpoints.ResultsSeventy-eight control eyes of 40 patients and 61 VPT-treated eyes of 39 patients were included in the study. Positive NFL trends were noted in 5% of control eyes vs. 71% of VPT eyes (p < 0.0001). Positive GCC trends were noted in 8% of control eyes vs. 43% of VPT eyes (p < 0.0001). Mean NFL trends (µm/year) were − 0.692 for controls vs. 0.347 for VPT (p < 0.0001). Mean GCC trends (µm/year) were − 0.554 for controls vs. − 0.148 for VPT (p = 0.0175).ConclusionsThe addition of VPT to the conventional management of OAG resulted in highly significant improvements in NFL and GCC trends, indicating a reversal of key indicators of glaucoma severity and progression.

Abdominal hernia surgeries are commonly performed with many different approaches, and mesh utilization has become a cornerstone in hernia repair, ensuring durable outcomes with minimal recurrence risk. However, managing contaminated hernia repairs presents unique challenges due to the heightened risks of mesh infection. Recent advancements in lightweight macroporous polypropylene meshes offer promising solutions. Studies have highlighted the superiority of macroporous polypropylene meshes compared to primary suture repair and other mesh types in terms of reduced surgical site infection rates and lower hernia recurrence rates. Moreover, utilizing macroporous polypropylene mesh in the retrorectus plane is associated with a favorable salvage rate, underscoring its efficacy in contaminated hernia repairs. At the same time, contrary evidence suggests higher postoperative complications with mesh use in settings of clean-contaminated or contaminated fields. Most significant complications are increased infection rates and similar recurrence rates compared to mesh-free repairs. New synthetic mesh that is being marketed as having better outcomes than other types of mesh and potentially primary repair need to be carefully assessed as biologic mesh once used to also be touted as the mesh to use in such fields, but more research is showing higher complication rates. The risk of infection and consequent morbidity might outweigh the benefit of less recurrence risk with mesh use. Further research, including prospective studies with long-term follow-up, is warranted to elucidate optimal hernia repair strategies in contaminated fields and inform evidence-based practice guidelines.

Abstract Introduction: Due to concerns over potential interactions between some hepatitis C direct-acting antivirals (DAAs) and opioids, we describe adverse event (AE) reports of concomitant use of opioids and DAAs. Methods: AEs reported (July 28, 2017 to December 31, 2021) with the administration of the DAAs glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir/voxilaprevir, and elbasvir/grazoprevir as suspect products were downloaded from the US Food and Drug Administration AE Reporting System Public Dashboard. The number of AE reports containing opioids (fentanyl, hydrocodone, oxycodone) as co-suspect products/concomitant products were counted and summarized by severity, reporting country and whether an outcome of death was reported. Overdose AEs were counted irrespective of opioid use, and changes over time were assessed. Results: In total 40 AEs were reported for DAAs and concomitant fentanyl use, 25 were in the USA, 14 resulted in death and 13 were considered serious; and 626 were reported with concomitant oxycodone/hydrocodone use, 596 were in the USA, 28 resulted in death an 296 were considered serious. There were 196 overdose AEs (32 deaths) declining from 2018 (N=56) to 2021 (N=29). Conclusions: Treating people with HCV infection who use drugs is key to achieving HCV elimination. Low numbers of DAA AE reports with opioids may provide reassurance to prioritize HCV treatment in this population.

An unsafe injection practice is one of the major contributors to new hepatitis C virus (HCV) infections; thus, people who inject drugs are a key population to prioritize to achieve HCV elimination. The introduction of highly effective and well-tolerated pangenotypic direct-acting antivirals, including glecaprevir/pibrentasvir (GLE/PIB), has revolutionized the HCV treatment landscape. Glecaprevir is a weak cytochrome P450 3A4 (CYP3A4) inhibitor, so there is the potential for drug-drug interactions (DDIs) with some opioids metabolized by CYP3A4, such as fentanyl. This study estimated the impact of GLE/PIB on the pharmacokinetics of intravenous fentanyl by building a physiologically based pharmacokinetic (PBPK) model. A PBPK model was developed for intravenous fentanyl by incorporating published information on fentanyl metabolism, distribution, and elimination in healthy individuals. Three clinical DDI studies were used to verify DDIs within the fentanyl PBPK model. This model was integrated with a previously developed GLE/PIB PBPK model. After model validation, DDI simulations were conducted by coadministering GLE 300mg + PIB 120mg with a single dose of intravenous fentanyl (0.5µg/kg). The predicted maximum plasma concentration ratio between GLE/PIB + fentanyl and fentanyl alone was 1.00, and the predicted area under the curve ratio was 1.04, suggesting an increase of only 4% in fentanyl exposure. The administration of a therapeutic dose of GLE/PIB has very little effect on the pharmacokinetics of intravenous fentanyl. This negligible increase would not be expected to increase the risk of fentanyl overdose beyond the inherent risks related to the amount and purity of the fentanyl received during recreational use.

Background: Craniofacial injuries are thought to be commonly associated with traumatic brain injury (TBI), but there is conflicting evidence in the literature. This retrospective cohort study aims to evaluate the incidence of TBI in patients with craniofacial trauma. Methods: The study included 2982 consecutive patients with either solitary or concurrent diagnoses of TBI and facial fractures, seen and evaluated at a single level II trauma center between 1 January 2010 and 31 December 2020. Continuous variables were compared against whether the patient had one or both diagnoses. Results: Of the target population, 55.8% had a solitary diagnosis of TBI; 30.28% had a solitary diagnosis of facial fractures; and 13.92% had concurrent diagnoses of both TBI and facial fractures. Patients with concurrent diagnoses had a significantly longer mean length of stay (LOS) compared to those with solitary diagnoses (9.92 ± 16.33 days vs. 6.21 ± 10.96 days, p &lt; 0.01), but age (p = 0.68) and ICU LOS (p = 0.09) did not differ significantly between the two groups. Conclusions: Trauma to the face should be given special attention due to the increased chance of TBI with craniofacial fractures. Patients with concurrent diagnoses of TBI and facial fractures had worse hospital outcomes than those with solitary diagnoses of either TBI or facial trauma.