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Although all age groups are at risk of contracting Covid-19 disease, older people are facing the highest risk due to ageing and underlying health conditions. According to the US Centers for Disease Control and Prevention report, 8 out of 10 deaths reported in the US have been of adults 65 years old and older. Therefore, the global recommendation for older populations includes social isolation, which involves staying at home and avoiding contact with other people, possibly for an extended period of up to three or four months. Such distancing presents serious challenges to the health and well-being of older adults, more so those who are frail or have multiple chronic conditions..Covid-19 has been one of the worst public health calamities faced by humankind in over a century. As of July 23, 2020, there have been 15,633,159 confirmed cases and 635,422 deaths reported, worldwide (1). We are six months into the pandemic, and yet we know little about the disease. The role of medicines is far from optimal, and vaccines are still under trials. Therefore, we have little to defend ourselves against this novel virus..The Indian Council of Medical Research Consensus Guidelines on 'Do Not Attempt Resuscitation' (DNAR) were published in the April 2020 issue of the Indian Journal of Medical Research (1), and simultaneously in the National Medical Journal of India (2). It is a timely effort at resolving a long-standing clinical dilemma. .Training in medical ethics has been made mandatory in the undergraduate curriculum (1). The Medical Council of India (MCI) in 2002 released its revised Code of Ethics, a regulatory document on professional conduct, etiquette, and ethics of doctors (2)..
Differences in outcomes of hepatocellular carcinoma (HCC) between countries have been largely attributed to variation in the conduct of surveillance and subsequent HCC treatment eligibility. However, differences in outcomes among those detected under surveillance have not been well described. We compared characteristics and prognosis between patients with surveillance-detected HCC from the United States (US) and Japan.
Patients in whom initial HCC was detected under surveillance between January 2006 and December 2015 from two centers in the US and two from Japan were included. Survival was compared between patients from the US and Japan using multivariable Cox regression analysis and propensity-score matched analysis. We performed subgroup analyses by liver disease etiology, tumor stage, and type of HCC treatment.
Of 3788 HCC patients, 1797 (47.4%) were diagnosed under surveillance, 715 from the US and 1082 from Japan. Patients from the US diagnosed under surveillance had worse liver dysfunction and larger tumor burden than those from Japan. In multivariate analysis, US patients with surveillance-detected HCC had significantly worse survival than those from Japan (HR 1.17, 95% CI 1.00-1.35), which was also observed in propensity-score matched analysis. However, this difference was no longer significant after adjusting for treatment type (HR 1.07, 95% CI 0.92-1.25). When stratified by treatment type, survival was comparable between the two countries except lower survival among patients who underwent resection in the US versus Japan.
Prognosis of patients with surveillance-detected HCC is poorer in the US than Japan, primarily driven by differences in treatment delivery. Studies are necessary to elucidate reasons for these differences.
Prognosis of patients with surveillance-detected HCC is poorer in the US than Japan, primarily driven by differences in treatment delivery. Studies are necessary to elucidate reasons for these differences.
Sleep research has grown substantially in recent decades, producing a large amount of data and an increasing number of meta-analyses. This study sought to establish the volume of meta-analyses in this area and assess how this level of material has developed over time.
A bibliographic search of the Web of Science database was conducted (1945-2019). The total number of articles and the total number of meta-analyses were extracted for both sleep medicine and a combination of 6 other medical specialties (cardiology, neurology, psychiatry, pulmonology, otorhinolaryngology, and pediatrics).
A total of 262,384 articles and 1,152 meta-analyses related to sleep medicine were identified. Considering the whole period under analysis, meta-analyses represented 0.44% of the total number of sleep medicine-related articles. Throughout this period, the proportion of meta-analyses published has been increasing in both sleep medicine and the other fields, but it is greater in the other fields. In 2019, meta-analyses in slectives.
Narcolepsy is a chronic neurological sleep disorder, debuting before age 15 years in one-third of patients. Narcolepsy has a negative influence on quality of life, with daily functioning being affected by concomitant cognitive, behavioral, and social problems. In December 2019, a new coronavirus emerged worldwide, causing the severe respiratory disease COVID-19. In the Netherlands, a partial lockdown was implemented that included the closure of schools. Here we present 3 illustrative case reports that teach important lessons for the treatment of pediatric narcolepsy. EGFR signaling pathway We observed significant consequences of the partial lockdown measures on daytime functioning, well-being, and school performance, both negative and positive. The consequences of the lockdown led to valuable insights for further treatment, substantiating the importance of personalizing education. Involvement of specialized student counselors, flexibility in the way that education is delivered, and enhancement of environmental factors could help ion is delivered, and enhancement of environmental factors could help in guiding young patients with narcolepsy through challenges at school.
Upper airway stimulation (UAS) is an innovative surgical treatment for obstructive sleep apnea; however, the treatment failure rate is approximately 22%. Easy arousability may limit the tolerability of stimulation and, by extension, its effectiveness. The odds ratio product (ORP) is a continuous electroencephalographic metric of arousal propensity (range 0 [deep sleep] to 2.5 [full wakefulness]), and its rate of decline after arousal (ORP-9) is a risk factor for susceptibility to arousal in the presence of frequent arousal stimuli. We hypothesized that individuals with deeper sleep (low average ORP and low ORP-9) are more likely to respond to UAS.
ORP and ORP-9 were calculated from 126 baseline polysomnograms of participants in the STAR Trial. These values were compared between responders and nonresponders. Adjusted linear modeling was performed to determine the association between ORP-derived variables and treatment response.
No differences were found between responders and nonresponders in unadjusted comparisons of ORP-derived variables.
