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Cureus Mar 2024Diabetes has reached epidemic levels in the United States (US). This review compared two nationwide diabetes prevention policies: the National Diabetes Prevention... (Review)
Review
Diabetes has reached epidemic levels in the United States (US). This review compared two nationwide diabetes prevention policies: the National Diabetes Prevention Program (DPP) and the Penny-per-Ounce Excise (POE) tax policy on sugar-sweetened beverages (SSBs) based on their efficiency and efficacy in reducing the number of new cases of diabetes in the US. The study made a recommendation for the implementation of one or both policies based on the comparison. The national DPP focuses on screening for prediabetes in overweight/obese individuals and having positive subjects participate in a potentially insured one-year weight loss program with CDC-approved coaches. The POE tax on SSBs on the other hand is based on taxing SSBs with the objective that it will reduce new cases of diabetes due to a lower consumption of these beverages, or a switch to healthier alternatives. Studies that predicted the impact of either policy at the national level were used to compare both policies. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference in net costs saved by the difference in net effectiveness (diabetes cases prevented per year); thereby comparing both policies in terms of costs saved for each diabetes case prevented per year. Using only nationwide US predictions, it has been estimated that the POE tax on SSB will produce the most cost savings with a greater impact on reducing new cases of diabetes if implemented; therefore, this tax should be recommended, in addition to the already implemented DPP.
PubMed: 38595899
DOI: 10.7759/cureus.55866 -
EuroIntervention : Journal of EuroPCR... Mar 2024
Topics: Humans; Hemorrhage
PubMed: 38506740
DOI: 10.4244/EIJ-E-23-00063 -
Journal of Mental Health (Abingdon,... Feb 2024
PubMed: 38354332
DOI: 10.1080/09638237.2023.2278103 -
Fertility and Sterility May 2024To demonstrate the surgical techniques for improving safety in robotic-assisted abdominal cerclage in patients with bicornuate uteri complicated by recurrent pregnancy...
OBJECTIVE
To demonstrate the surgical techniques for improving safety in robotic-assisted abdominal cerclage in patients with bicornuate uteri complicated by recurrent pregnancy loss and cervical insufficiency.
DESIGN
Stepwise demonstration with narrated video footage.
SETTING
An academic tertiary care hospital.
PATIENTS
Our patient is a 22-year-old G2P0020 with a history of recurrent pregnancy loss. During her first pregnancy, she was asymptomatic until 19 weeks and delivered because of a preterm premature rupture of membranes. A transvaginal cerclage was performed for her second pregnancy at 14 weeks, which ended at 16 weeks because of preterm premature rupture of membranes. The final magnetic resonance imaging report noted a "bicorporeal uterus with duplication of the uterine body, resulting in two markedly divergent uterine horns that are fused at the isthmus... unlike a typical didelphic uterus, a single, non septated cervix is noted, which shows normal appearances, measuring 3.8 cm in length." Given her history of a uterine anomaly and recurrent pregnancy loss in the absence of other biochemical factors, her maternal-fetal medicine specialist referred her to us as the patient strongly desired future viable pregnancies. The patient was counseled on multiple alternatives, including different methods of performing the cerclage, and ultimately decided on the robotic-assisted (Da Vinci Xi) prophylactic abdominal cerclage.
INTERVENTIONS
The bicornuate uterus is a rare class IV mullerian duct anomaly caused by the impaired fusion of the mullerian ducts in the uterus, classically appearing in imaging studies as a heart-shaped uterus. This patient demographic reports a high incidence of obstetric complications. Pregnancy in such a uterus causes complications like first- and second-trimester pregnancy loss, preterm labor, low-birthweight infants, and malpresentation at delivery. Researchers have postulated that there is an abnormal ratio of muscle fibers to connective tissue in a congenitally abnormal cervix. During pregnancy, an inadequate uterine volume may lead to increased intrauterine pressure and stress on the lower uterine segment, which can lead to cervical incompetence. To address cervical incompetence, cervical cerclages are a commonly utilized procedure, as recent studies demonstrate that the incidence of term pregnancies in the group with documented cervical incompetence treated with cerclage placement increased from 26% to 63%. One observational study noted improved obstetrical outcomes occurred with interval placement, a cerclage placed in between pregnancies in the nongravid uterus, compared with cerclage placement between 9 and 10 weeks gestation, with the mean gestational age for delivery at 32.9 weeks and 34.5 weeks when a cerclage was placed in gravid and nongravid women, respectively. In addition, another retrospective study was done, which demonstrated a lower incidence of neonatal death with prophylactic cerclages. Operating on a nonpregnant uterus offers several benefits, including its reduced size, fewer and smaller blood vessels, and simplified handling. Moreover, there are clearly no concerns regarding the fetus. In the decision to use a robotic-assisted platform vs. laparoscopic, a systematic review showed the rates of third-trimester delivery and live birth (LB) using laparoscopy during pregnancy were found to be 70% and 70%-100%, respectively. The same review demonstrated slightly improved outcomes via the robotic route regarding gestational age at delivery (median, 37 weeks), rates of LB (90%), and third-trimester delivery (90%). Additional factors contributing to the preference for robotics in surgical procedures include incorporating advanced tools, which can enhance the robotic system's advantages compared with traditional laparoscopy. An invaluable tool in this context is the simultaneous utilization of Firefly mode, which employs a near-infrared camera system, achieved through injecting indocyanine green dye or integrating other light sources concurrently. The intravenous administration of indocyanine green is acknowledged widely for its safety and efficacy as a contrast agent in the evaluation of microvascular circulation and organ vascularization. This property equips surgeons with heightened precision when guiding the needle, proving especially advantageous when faced with challenges in visualizing vascular anatomy. In our specific case, we harnessed the capabilities of Firefly mode in conjunction with hysteroscopic light, enabling us to vividly illustrate the contours of a bicornuate uterus from both external and internal perspectives. We demonstrate a simplified technique of the abdominal cerclage, one cerclage around the internal cervical os of the uterus, using a robotic-assisted platform in a nongravid patient. The surgery began with the eversion of the umbilicus, and a 15-mm skin incision was made in the umbilicus. A Gelpoint mini advanced access site laparoscopy device was inserted into the incision, and CO was allowed to insufflate the abdominal cavity with careful attention given to intraabdominal pressure. Once the DaVinci was docked, the surgeon began the creation of a bladder flap. The bladder was carefully dissected from the lower uterine segment and both uteri using monopolar scissors. The anatomical differences of a bicornuate uterus prompted the surgeon to dissect a wider circumference for safety reasons, where a wider dissection offers a better view of the uterine vessels and ease of introducing the Mersilene tape later on. Bilateral uterine vessels were further skeletonized and exposed anteriorly using blunt dissection and monopolar scissors. After further dissection and lateralization, the final result creates a landmark medial to the right uterine vessels at the level of the internal cervical os with which the needle of the Mersilene tape will be able to pass through. The Mersilene tape was guided from anterior to posterior via a previously straightened needle. Similarly, a landmark was created on the left, and the Mersilene tape was directed from anterior to posterior. The Mersilene tape was placed circumferentially around the internal cervical os of the bicornuate uterus, medial to the uterine vessels. Both ends of the Mersilene tape were then gently pulled, ensuring that the tape was lying flat on the anterior of the internal cervical os with no bowels or uterine vessels within it. The tape was then tied posteriorly at the 6 o'clock position with appropriate tension. A 2-0 silk was then sutured to the tails of the tape using the purse-string technique to ensure that it would remain securely tied and in the correct position. Hemostasis was assured. Both a hysteroscopy and a cystoscopy were done after the completion of the cerclage to ensure that no tape or sutures were seen within the cervical canal or the uterine cavity. None were observed.
MAIN OUTCOMES MEASURES
The success criteria for the surgery were identified as the patient's ability to attain a viable pregnancy after the cerclage placement, along with achieving LB.
RESULTS
Subsequently, a spontaneous pregnancy was achieved. An infant weighing 3 pounds and 16 ounces was delivered by cesarean section at 36 weeks because of an oligohydramnios. The infant is currently healthy at 13 pounds.
CONCLUSION
Robotic-assisted abdominal cerclage around the internal cervical os in a bicornuate uterus offers a possibly feasible and straightforward technique for surgeons seeking to reduce risks, although further research is needed.
Topics: Female; Humans; Pregnancy; Young Adult; Abortion, Habitual; Bicornuate Uterus; Cerclage, Cervical; Robotic Surgical Procedures; Treatment Outcome; Urogenital Abnormalities; Uterine Cervical Incompetence; Uterus
PubMed: 38316208
DOI: 10.1016/j.fertnstert.2024.01.036 -
Clinical Infectious Diseases : An... Jun 2024
Topics: Humans; Fellowships and Scholarships; COVID-19
PubMed: 38267210
DOI: 10.1093/cid/ciad788 -
British Dental Journal Jan 2024
PubMed: 38225316
DOI: 10.1038/s41415-024-6730-3 -
Food & Function Feb 2024Osteoporosis, a condition that is characterized by low bone mineral density (BMD), is a serious health concern worldwide. This study aims to explore the relationship...
Osteoporosis, a condition that is characterized by low bone mineral density (BMD), is a serious health concern worldwide. This study aims to explore the relationship between whole egg consumption and BMD levels in the US population. This study involves 19 208 participants with valid BMD and egg consumption data from the National Health and Nutrition Examination Survey (NHANES) during 2005-2006, 2007-2008, 2009-2010, 2013-2014 and 2017-2018. Linear regression analysis was conducted to evaluate the association between whole egg consumption and BMD levels. Mediation analysis was used to investigate the role of serum alkaline phosphatase (ALP) in the above relationship. After multivariate adjustment, participants consuming whole eggs over 3.53 ounce per day in their diet were found to have elevated BMD levels in the femur (0.013 g cm with 95% CI: 0.004, 0.022) and lumbar spine (0.013 g cm with 95% CI: 0.002, 0.024) ( < 0.05). The additive interaction of egg consumption and body mass index (BMI) on the BMD of both the femur and lumbar spine ( < 0.05) was also analyzed. The association between whole egg consumption and BMD of both the femur and lumbar spine were significantly mediated by ALP with 71.8% and 83.3% mediation proportion, respectively. In general, higher whole egg consumption is positively related to an increase in the BMD scores of both the femur and lumbar spine among the US population.
Topics: Humans; Bone Density; Nutrition Surveys; Absorptiometry, Photon; Cross-Sectional Studies; Femur Neck; Lumbar Vertebrae
PubMed: 38206082
DOI: 10.1039/d3fo04248k -
JAMA Health Forum Jan 2024Sugar-sweetened beverage (SSB) taxes are promoted as key policies to reduce cardiometabolic diseases and other conditions, but comprehensive analyses of SSB taxes in the...
IMPORTANCE
Sugar-sweetened beverage (SSB) taxes are promoted as key policies to reduce cardiometabolic diseases and other conditions, but comprehensive analyses of SSB taxes in the US have been difficult because of the absence of sufficiently large data samples and methods limitations.
OBJECTIVE
To estimate changes in SSB prices and purchases following SSB taxes in 5 large US cities.
DESIGN, SETTING, AND PARTICIPANTS
In this cross-sectional study with an augmented synthetic control analysis, changes in prices and purchases of SSBs were estimated following SSB tax implementation in Boulder, Colorado; Philadelphia, Pennsylvania; Oakland, California; Seattle, Washington; and San Francisco, California. Changes in SSB prices (in US dollars) and purchases (volume in ounces) in these cities in the 2 years following tax implementation were estimated and compared with control groups constructed from other cities. Changes in adjacent, untaxed areas were assessed to detect any increase in cross-border purchases. Data used for this analysis spanned from January 1, 2012, to February 29, 2020, and were analyzed between June 1, 2022, and September 29, 2023.
MAIN OUTCOMES AND MEASURES
The main outcomes were the changes in SSB prices and volume purchased.
RESULTS
Using nutritional information, 5500 unique universal product codes were classified as SSBs, according to tax designations. The sample included 26 338 stores-496 located in treated localities, 1340 in bordering localities, and 24 502 in the donor pool. Prices of SSBs increased by an average of 33.1% (95% CI, 14.0% to 52.2%; P < .001) during the 2 years following tax implementation, corresponding to an average price increase of 1.3¢ per oz and a 92% tax pass-through rate from distributors to consumers. SSB purchases declined in total volume by an average of 33.0% (95% CI, -2.2% to -63.8%; P = .04) following tax implementation, corresponding to a -1.00 price elasticity of demand. The observed price increase and corresponding volume decrease immediately followed tax implementation, and both outcomes were sustained in the months thereafter. No evidence of increased cross-border purchases following tax implementation was found.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, SSB taxes led to substantial, consistent declines in SSB purchases across 5 taxed cities following price increases associated with those taxes. Scaling SSB taxes nationally could yield substantial public health benefits.
Topics: Cross-Sectional Studies; Sugar-Sweetened Beverages; Taxes; Cities; Paclitaxel; Philadelphia
PubMed: 38180765
DOI: 10.1001/jamahealthforum.2023.4737 -
Pediatric Blood & Cancer Mar 2024Extracorporeal photopheresis (ECP) has proven effective in the treatment of several diseases, including acute and chronic graft-versus-host disease (GVHD) after...
Extracorporeal photopheresis (ECP) has proven effective in the treatment of several diseases, including acute and chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation. In its standard version, ECP requires leukapheresis to obtain a fraction of mononuclear cells. The possibility of using leukapheresis is limited by the requirements for vascular access and the somatic status of the patient. We have developed a new ECP method that does not require leukapheresis. This paper presents a description of two clinical cases of severe refractory GVHD treated by micro-ECP.
Topics: Humans; Photopheresis; Hematopoietic Stem Cell Transplantation; Graft vs Host Disease; Transplantation, Homologous; Chronic Disease
PubMed: 38105463
DOI: 10.1002/pbc.30800 -
Annals of Surgical Oncology Apr 2024
Topics: Humans; Hyperthermic Intraperitoneal Chemotherapy; Financial Stress; Hyperthermia, Induced; Cytoreduction Surgical Procedures
PubMed: 38087135
DOI: 10.1245/s10434-023-14768-7