There is an epidemic of obesity in adults in rural America. It is estimated that about 19% of the population resides in rural areas, which encompasses 97% of America's total landmass. Although rural America makes up a fraction of America's total population, it has been estimated that the prevalence of obesity is approximately 6.2 times higher than in urban America. This illustrates an apparent disparity that exists between the rural population and urban populations that needs to be examined.The prevalence of obesity, especially in rural America, is a growing concern in the medical community in recent years. Obesity has been identified as a significant risk factor for cardiovascular disease, cancer, and type 2 diabetes mellitus, which are leading causes of morbidity and mortality in the US. To better understand the disparity in the prevalence of adult obesity between rural and urban America, researchers have identified risk factors that are associated with the high incidence and prevalence of obesity in the rural American adult population. Low income and lack of physical activity have been identified as factors that predispose rural Americans to increased risk of obesity, arguing that low-income Americans may not have access to the resources available to assist them in weight reduction. With rural Americans being at an income disadvantage, it creates a risk for obesity, which further predisposes them to chronic diseases such as hypertension, obstructive sleep apnea (OSA), diabetes, and coronary artery disease.As obesity continues to rise among the American population, the burden on the rural population is incredibly evident. Despite ongoing efforts by the US government and strategies implemented by the Common Community Measures for Obesity Prevention, there is still much to be done to tackle the epidemic. With an existing strategy in place, such as the 12 Common Community Measures for Obesity Prevention (COCOMO) strategies to fight obesity with physical activity, Americans are a step closer to conquering this epidemic. However, until other disparities such as income are addressed, rural Americans may continue to be severely impacted by the rising incidence of obesity and subsequent higher mortality rates from associated diseases.

Inflammatory bowel disease (IBD) is a term that encompasses conditions characterized by chronic inflammation of the gastrointestinal tract (GIT). It includes Crohn's disease and ulcerative colitis. Major scientific organizations interested in gastrointestinal systems or GIT-focused organizations worldwide release guidelines for diagnosing, classifying, managing, and treating IBD. However, there are subtle differences among each of these guidelines. This review evaluates four evidence-based guidelines in the management of IBD and seeks to highlight the differences and similarities between them. The main differences in the evaluated guidelines were in diagnosis and treatment recommendations. The diagnosing recommendations were comparable amongst the four guidelines; however, some were more specific about limiting the number of interventions necessary to confirm a diagnosis. Regarding treatment options, each guideline had clear suggestions about what was considered ideal. Although the treatment options were identical, the main differences existed in the recommended diets and initial therapy in patients with moderate disease. Clinical practice guidelines (CPGs) recommend evidence-based practice from opinion leaders in clinical decision-making. Rather than dictating a one-size-fits-all approach in IBD management, reviewing various guidelines can enhance the cross-pollination of ideas amongst clinicians to improve decision-making. Clearly describing and appraising evidence-based reasoning for scientific recommendations remain driving factors for quality patient care. The effectiveness of CPGs in improving health and the complexities of their formation requires constant review to maximize constructive criticisms and explore possible improvements.

Pancreatic cancer remains the third leading cause of death amongst men and women in the United States. Pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer maintains its reputation of being the most aggressive with a poor prognosis. One of the contributing factors to the high mortality of PDAC is the absence of biomarkers for early detection of disease and the complexity of tumor biology and genomics. In this review, we explored the current understanding of epigenetics and diagnostic biomarkers in PDAC and summarized recent advances in molecular biology. We discussed current guidelines on diagnosis, prognosis, and treatment, especially in high-risk individuals. We also reviewed studies that have touched on identifying biomarkers and the role they play in making early diagnosis although there are currently no screening tools for PDAC. We explored the recent understanding of epigenetic alterations of PDAC and the future implications for early detection and prognosis. In conclusion, the new and emerging advances in the detection and treatment of PDAC can lead to an improvement in the current outcome of PDAC.

Background and objectiveThe role of the antibiogram in reducing hospital length of stay (LOS), mortality rate, health care costs, and, by extension, patients' social, physical, and emotional wellness has a significant impact on the medical community. Hospitals in large cities serve a dynamic population of diverse ethnic groups. Many scholarly works and publications have shown that the antimicrobial pattern in rural settings has significant variability annually. Over the last two years, the spread of coronavirus disease 2019 (COVID-19) has brought about many unknowns in the sphere of healthcare. The pattern of pathology accompanying COVID-19 has affected hospital policies and direct patient management, leading to a paradigm shift in approaches, policies, and resource utilization. The years 2019 to 2021 were marked by many admissions due to COVID-19, and the effects of COVID-19 are still being studied. In light of this, this study examined the changes in sensitivity patterns, new trends, and nature of bacteria isolates, antimicrobial rates, and susceptibility based on a rural hospital's annual antibiogram pertaining to its central departments: the intensive care unit (ICU), patient care unit (PCU), the outpatient unit, and emergency department (ED). MethodsThis five-year retrospective antibiogram review compared antibiogram patterns two years before the first case of COVID-19 was reported in the hospital and those two years after the initial outbreak. ResultsThe organism comparative susceptibility tests for Escherichia coli (E. coli) were not significant except for increased susceptibility toward nitrofurantoin (p=0.003); Klebsiella pneumoniae (K. pneumoniae) was also not significant except for the increased susceptibility to ciprofloxacin (p=0.003). Pseudomonas aeruginosa (P. aeruginosa) had no changes in susceptibility patterns, while Proteus mirabilis (P. mirabilis) had increased susceptibility to imipenem (p=0.05), aztreonam (p=0.00), and meropenem (p=0.004), with reduced susceptibility to gentamicin (97.47% vs. 88.24%, p=0.006). There was a whopping decrease in the sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) to clindamycin (75.93% vs. 50.7%, p=0.000), linezolid (99.54% vs. 88.73, p=0.004), trimethoprim/sulfamethoxazole (92.59% vs. 74.65%, p=0.001), and vancomycin (99.54% vs. 88.73%, p=0.004). Staphylococcus aureus (S. aureus) had no significant variation except an increase in susceptibility to nitrofurantoin (p=0.023), and perhaps ironically, Streptococcus pneumoniae (S. pneumoniae) had no significant changes in susceptibility pattern.