Wayne Memorial Hospital

Real-time RT-PCR is considered the gold standard confirmatory test for coronavirus disease 2019 (COVID-19). However, many scientists disagree, and it is essential to understand that several factors and variables can cause a false-negative test. In this context, cycle threshold (Ct) values are being utilized to diagnose or predict SARS-CoV-2 infection. This practice has a significant clinical utility as Ct values can be correlated with the viral load. In addition, Ct values have a strong correlation with multiple haematological and biochemical markers. However, it is essential to consider that Ct values might be affected by pre-analytic, analytic, and post-analytical variables such as collection technique, specimen type, sampling time, viral kinetics, transport and storage conditions, nucleic acid extraction, viral RNA load, primer designing, real-time PCR efficiency, and Ct value determination method. Therefore, understanding the interpretation of Ct values and other influential factors could play a crucial role in interpreting viral load and disease severity. In several clinical studies consisting of small or large sample sizes, several discrepancies exist regarding a significant positive correlation between the Ct value and disease severity in COVID-19. In this context, a revised review of the literature has been conducted to fill the knowledge gaps regarding the correlations between Ct values and severity/fatality rates of patients with COVID-19. Various databases such as PubMed, Science Direct, Medline, Scopus, and Google Scholar were searched up to April 2021 by using keywords including "RT-PCR or viral load", "SARS-CoV-2 and RT-PCR", "Ct value and viral load", "Ct value or COVID-19". Research articles were extracted and selected independently by the authors and included in the present review based on their relevance to the study. The current narrative review explores the correlation of Ct values with mortality, disease progression, severity, and infectivity. We also discuss the factors that can affect these values, such as collection technique, type of swab, sampling method, etc.

Although many observations indicate that bile acids and their derivatives may be bound by serum proteins, little information upon the quantitative aspects of this reaction is available. Lecomte du Nofiy (1) observed that the activity of bile salts

Journal Article The Susceptibility of Bacteroides fragilis to 24 Antibiotics Get access Jay Ward Kislak Jay Ward Kislak From the Infectious Disease and Immunology Division, Department of Medicine, New York University School of Medicine; the Medical Service, Goldwater Memorial Hospital; and the Infectious Disease Research Laboratory, French Hospital Division of the French and Polyclinic Medical School and Health Center, New York, New York Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 125, Issue 3, March 1972, Pages 295–299, https://doi.org/10.1093/infdis/125.3.295 Published: 01 March 1972 Article history Received: 26 January 1971 Revision received: 30 September 1971 Published: 01 March 1972

Lack of specific analytic methods has hitherto prevented exact studies of the effect of liver dis- ease upon the concentration of bile acids in the serum. Until recently it has not been possible to measure the serum concentration of bile acids other than cholic acid. Various modifications-of the Pettenkofer reaction have been employed to deter- mine the serum concentration of cholic acid. Re- ports of "normal" serum cholic acid concentrations of 0.0 mg. per cent (1), 0.4 mg. per cent (2), 0.6 to 2.2 mg. per cent (3), and 3 to 6 mg. per cent (4) reflect the non-specific nature of this reaction.

A derivative of quinine formed in minced rabbit liver has been isolated by Kelsey et al. (I), and identified by Mead and Koepfli (2) as a carbostyril.Hence quinine is oxidized in liver with replacement of the hydrogen atom in position 2 of the quinoline ring by a hydroxy group.Analogous oxidation products are excreted by men receiving the four principal cinchona alkaloids.This change is important in the chemotherapy of malaria, because the oxidation of these compounds markedly reduces their antimalarial activity (3).The activity of some quinoline compounds can be greatly enhanced if this oxidation is prevented by appropriate substitution (4).The nature of the metabolic system able to perform this oxidation is consequently of considerable pharmacological interest, and it was hoped that its biochemical function as well could be approached by studying the reaction with a series of quinoline derivatives.By the use of such compounds as substrates, the enzyme responsible for their oxidation has been prepared in about 5 per cent purity.It specifically acts on unsaturated heterocyclic compounds with an active a-hydrogen and is intimately associated with the flavoprotein, liver aldehyde oxidase. MethodsReagent-The synthetic antimalarials used were supplied by various laboratories cooperating with the malaria program of the Office of Scientific Research and Development.These * 'SN number" compounds are described fully elsewhere (4), but were generally of a high degree of purity.Isoquinoline, quinaldine, quinoline, and crotonaldehyde were redistilled in uacuo, and the bases recrystallized as the acid salts before use.Coenzyme I (5) and diaphorase (6) were prepared by the standard methods.Other compounds were used as obtained commercially.Propamidine was kindly

Aggressive natural killer cell leukemia (ANKL) is a systemic NK-cell neoplasm, almost always associated with Epstein-Barr virus (EBV). Rare cases of EBV-negative ANKL have been described, and some reports suggested more indolent behavior. We report the clinicopathologic, immunophenotypic, and molecular characteristics of 7 EBV-negative ANKL. All patients were adults, with a median age of 63 years (range 22 to 83 y) and an M:F ratio of 2.5:1. Five patients were White, 1 Black, and 1 Asian. All patients presented acutely, with fever (6/7), cytopenias (6/7), and splenomegaly (4/7). Four patients had lymphadenopathy, 4 had extranodal disease. Bone marrow involvement was present in 5, with hemophagocytosis in 3. Peripheral blood was involved in 5 with the neoplastic cells containing prominent azurophilic granules. By immunohistochemistry and/or flow cytometry, the tumor cells lacked surface CD3 and were positive for CD56 (7/7), CD2 (5/5), CD8 (3/7), CD30 (4/5), and granzyme-B (6/6). They were negative for CD4, CD5, βF1, TCRγ, LMP1, and EBV-encoded RNA. Polymerase chain reaction for TCRG clonality was polyclonal. Mutational analysis revealed missense mutations in the STAT3 gene in both cases studied. Median survival was 8 weeks from the onset of disease. One patient received allogeneic bone marrow transplant and is alive with no disease (follow-up 15 mo). EBV-negative ANKL exists but is rare. It tends to occur in older patients and is indistinguishable clinically and pathologically from EBV-positive ANKL, with a similar fulminant clinical course. The high prevalence of Asian patients seen with EBV-positive disease seems less evident with EBV-negative cases.

UNLABELLED: Delayed closure of foot ulcers is a primary factor leading to lower extremity amputation in patients with diabetes, creating great demand for products or therapies to accelerate the rate of wound closure in this population. This study (ClinicalTrials.gov Identifier: NCT02209051) was designed to evaluate dehydrated amniotic membrane allograft (DAMA) (AMNIOEXCEL, Derma Sciences Inc, Princeton, NJ) plus standard of care (SOC) compared to SOC alone for the closure of chronic diabetic foot ulcers (DFUs). MATERIALS AND METHODS: This prospective, open-label, randomized, parallel group trial was implemented at 8 clinical sites in the United States. Eligibility criteria included adults with type 1 or type 2 diabetes mellitus who have 1 or more ulcers with a Wagner classification of grade 1 or superficial 2 measuring between 1 cm2 and 25 cm2 in area, presenting for more than 1 month with no signs of infection/osteomyelitis; ABI > 0.7; HbA1c Less than 12%; and serum creatinine less than 3.0 mg/dL. Eligible subjects were randomized (1:1) to receive either SOC alone (n = 14) or DAMA+SOC (n = 15) until wound closure or 6 weeks, whichever occurred first. The endpoint was the proportion of subjects with complete wound closure (defined as complete reepithelialization without drainage or need for dressings). RESULTS: Thirty-five percent of subjects in the DAMA+SOC cohort achieved complete wound closure at or before week 6, compared with 0% of the SOC alone cohort (intent-to-treat population, P = 0.017). There was a more robust response noted in the per protocol population, with 45.5% of subjects in the DAMA+SOC cohort achieving complete wound closure, while 0% of SOC-alone subjects achieved complete closure (P = 0.0083). No treatment-related adverse events were reported. CONCLUSION: The results suggest DAMA is safe and effective in the management of DFUs, but additional research is needed.

Sodium acetate-1-C 14 was administered to anesthetized rats by continuous intravenous infusion, with simultaneous administration of d,l-α-amino-γ-phenylbutyric acid. Radioactivity measurements were made of respiratory CO 2 , cholesterol, fatty acids and urinary acetylamino acid. From the radioactivity data, calculations were made of rates of acetate turnover and of synthesis of cholesterol and fatty acids from acetate. Data on these metabolic functions are given for normal rats on a stock diet and for animals on a lipid-free ration. Similar experiments were carried out in rats fed thyroid powder and thiouracil. The rate of acetate turnover, and rates of synthesis of cholesterol and fatty acids from acetate, were found to be directly proportional to the basal oxygen consumption rates of the animals. The altered rates of lipid synthesis from acetate resulted, in the main, from absolute changes in rates of the reactions involved, and only to a small extent from shifts in the relative magnitudes of different pathways of acetate metabolism.

Pamaquine (6-methoxy-8-amino [N-diethylaminoisopentyl] quinoline) is recognized to be a potentially dangerous drug. However, a definitive appraisal of its hazard had not been achieved at a time when the further exploration of the antima- larial activity of the 8-aminoquinolines was con- sidered advisable. Pamaquine toxicity can in- volve the gastro-intestinal tract, the central nerv- ous system, and the circulating blood. Symptoms referable to the gastro-intestinal tract and the cen- tral nervous system may be annoying, but there is no evidence that they constitute a hazard to life or persist beyond the termination of therapy. Effects on the blood do constitute a serious hazard and are considered in this paper.

The purpose of this quasi-experimental study was to determine the effects of a nurse-directed self-management program on dyspnea and self-efficacy levels in patients with chronic obstructive pulmonary disease (COPD). The Health Belief Model and the Theory of Self-Efficacy provided the theoretical framework for the study. The sample included 10 COPD patients from rural North Carolina who attended a 6-week nurse-directed self-management program. Dyspnea and self-efficacy were measured before and after the program by using a vertical visual analogue scale for dyspnea and the COPD Self-Efficacy Scale. A single-group quasi-experimental design that incorporated a pretest and a posttest was used. Paired t tests were used to compare the pretest and the posttest levels of dyspnea and self-efficacy. The findings revealed no significant change in levels of dyspnea after the program. Levels of self-efficacy, however, were found to have increased at a statistically significant level (p < .001) following the program. This study indicates that using a group teaching method to teach self-management skills improved self-efficacy levels.

Haag and Larson (1) demonstrated in 1942 that in the case of nicotine the extent of urinary ex- cretion of a chemical may be related to the reac- tion of urine. They emphasized the importance of taking into consideration the dissociation con- stant of a drug and the relative reabsorbability of the free and dissociated base. Extending these studies to the urinary excretion of quinine in man, Haag, Larson and Schwartz (2) found in 1943 that the urinary output could be doubled by passing from an alkaline to an acid urine and they ascribed the difference to greater resorption of quinine from the urinary tract when the urine is alkaline.

Journal Article The Arterial Wall. Aging, Structure, and Chemistry Get access The Arterial Wall. Aging, Structure, and Chemistry, edited by Albert I. Lansing, The Williams & Wilkins Co., Baltimore, 1959, 259 pages, $7.50. J. Murray Steele, M.D. J. Murray Steele, M.D. Goldwater Memorial Hospital New YorkNew York Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Gerontology, Volume 15, Issue 3, July 1960, Pages 280–281, https://doi.org/10.1093/geronj/15.3.280 Published: 01 July 1960

Granulocytic sarcoma is an unusual form of tumefaction caused by acute granulocytic leukemia. On rare occasions, the lesion precedes the leukemic phase and presents as a mass with a normal peripheral white cell count. This report describes the initial manifestation of granulocytic sarcoma by vaginal cytology in a 39-year-old female with Down's syndrome. Six days after admission, the patient died of acute peritonitis following spontaneous perforation of the bowel. Autopsy revealed involvement of cervix, vagina, bowel wall and one pelvic lymph node by granulocytic sarcoma. Bone marrow examination confirmed the preleukemic stage of the disease. Cytologically, the malignant cells occurred singly. No nucleoli were seen. The differential diagnosis between malignant lymphoma and granulocytic sarcoma rests upon a positive naphtol AS-D chloroacetate esterase stain in granulocytic sarcoma. This stain may be performed on paraffin-embedded sections or on smears.

PRINZMETAL and Kennamer1 first reported on the use of ACTH in 1954 to correct complete heart block secondary to myocardial infarction. They believed that, in incomplete septal infarction or in infarctions near the septum, the interference with atrioventricular conduction that often culminates in complete heart block may be due in many cases not to destruction but only to inflammation of the atrioventricular node and the specialized conductive tissue in the septum. If this is true, anything that reduces inflammation in body tissues should help re-establish normal conduction in these cases. The anti-inflammatory action of hormones elaborated by the adrenal cortex . . .

OBJECTIVE: To determine whether a skills laboratory for corneal foreign body and rust ring removal improves self-assessed skill and confidence. METHODS: A prospective trial was conducted as part of the didactic curriculum of a university-based residency program in emergency medicine (EM). A convenience sample of 26 EM residents and five fourth-year medical students participated. The skills laboratory used model corneas made by coating 3.2-cm glass spheres with a 1-2-mm film of paraffin. Foreign bodies were simulated by embedding small pieces of metal into the paraffin. Rust rings were simulated by dipping a hot, straightened paper clip into a rust-colored crayon and then into the paraffin. The model eyes fit into a life-sized model of a human head. Participants removed the foreign bodies and rus rings under supervision, using the slit lamp. Each participant anonymously completed a questionnaire before and after participating in the skills laboratory. The questionnaire recorded educational level, previous experience, and self-assessed comfort and skill levels (0 = lowest, 10 = highest). RESULTS: Most (66%) of the participants had not previously removed a corneal foreign body; 86% had not previously removed a rust ring. On a ten-point scale, the median comfort level for removing a foreign body rose from 2 to 7, and the self-assessed skill level rose from 1 to 7 (p = 0.0001). Similar improvements in self-assessed comfort and skill levels were seen for rust ring removal. CONCLUSIONS: Participation in this skills laboratory significantly improved the self-reported comfort and self-assessed skill levels in removing corneal foreign bodies and rust rings. This technique provides useful practice of a fine-motor procedural skill requiring eye-hand coordination prior to supervised application of these skills in clinical practice.

Journal Article The Peril of Deprofessionalization Get access R. David Anderson, B.S. R. David Anderson, B.S. Director of Pharmacy Waynesboro Community Hospital, Waynesboro, VA Address correspondence to Mr. Anderson at 6 Pelham Green, West, Waynesboro, VA 22980- 1561 rdandy1@cfw.com. Search for other works by this author on: Oxford Academic Google Scholar American Journal of Health-System Pharmacy, Volume 61, Issue 22, 15 November 2004, Pages 2373–2379, https://doi.org/10.1093/ajhp/61.22.2373 Published: 15 November 2004

Chronic regional pain syndrome refers to a class of disorders thought to involve common neuropathic and clinical features. These disorders usually are caused by injury, and they manifest in pain and sensory changes that are disproportionate in intensity, distribution, and duration to the underlying pathology. The result of these injuries is significant impairment of motor function over time. This article is divided into two parts. Part I discusses background information such as pain, pathophysiology, diagnosis, clinical stages, and the most common treatment modality, sympathetic nerve blocks. Part II, discusses alternate treatment modalities, such as sympathectomy, physical therapy, stimulators, trigger point injections, acupuncture, tourniquet effects, placebo effects, and amputation.

Many hematologic disorders are accompanied by coagulation defects which, in women of childbearing age, can lead to severe menorrhagia. We have found it desirable and possible to render and maintain such patients amenorrheic. Twenty-nine patients were treated by one of three drug regimens: A = norethynodrel + mestranol, B = depo-medroxyprogesterone acetate, and C = depo-medroxyprogesterone acetate + conjugated estrogens. Acute leukemia and immune thrombocytopenic purpura were the most frequent diagnoses. Significant breakthrough bleeding occurred in 7 women (24%). Two were in group A (22%), 3 in B (38%), and 2 in C (17%). Although not statistically significant, these differences suggest that concurrent administration of estrogen and progestin is attended by less breakthrough bleeding than the administration of progestin alone.

Objective. To compare academic performance in and students' perceptions of an outpatient pharmacy practice laboratory course taught in a traditional laboratory setting vs by virtual facilitation. Methods. An outpatient pharmacy practice laboratory course was taught in a traditional live laboratory setting to 69 students on two campuses in 2016. A year later, the same course was taught via synchronous virtual (ie, remote) facilitation using an internet-based video and chat conference room for communication across two campuses to 91 students. Students' academic performance was evaluated based on major assessments, individual test questions, and final course grades. A course and instructor evaluation were administered to each group of students at the conclusion of each course offering. Results. Students who completed the live traditional laboratory (2016) had a mean final course grade of 90.1%, while students who completed the virtually facilitated laboratory course (2017) had a mean final course grade of 89.6%. The mean score on course evaluations completed by students in the virtually facilitated course was lower. The difference in scores between individual course and instructor evaluations between 2016 to 2017 was not significant. There was no significant difference found between students' grades on the midterm and final objective structured clinical examinations (OSCEs) and written assessment questions between 2016 and 2017. Conclusion. Students who completed the live traditional laboratory course and those who completed the course in the virtually facilitated setting performed well. Course evaluations revealed student satisfaction with the course and instructor in both settings. These findings suggest that a virtually facilitated laboratory course does not hinder student performance and provides a similar experience as a traditional classroom.

Malignant hyperthermia (MH) is a medical emergency that all perioperative nurses should be prepared to handle. Patients with the inherited MH trait have a rare skeletal muscle disease that causes them to develop life-threatening hyperthermia (ie, body temperatures of 43.3 degrees C [110.0 degrees F] or higher) at the time MH-triggering agents are administered to induce general anesthesia or shortly thereafter. The incidence of MH episodes is reported to be 1 in every 12,000 pediatric anesthetic procedures and 1 in every 40,000 adult anesthetic procedures. The MH syndrome also is characterized by continuous skeletal muscle rigidity, hypermetabolism, hypercapnia, tachypnea, and tachycardia that result in cardiac arrest and death if left untreated. Perioperative staff members' knowledge of MH, the care of MH-susceptible patients, and adequate preparation for MH crises are the cornerstones of successful patient outcomes to this life-threatening syndrome.