Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders.
Aged; Humans; Male; Adult; Female; Prospective Studies; Middle Aged; Treatment Failure; Prognosis; Quality of Life; Follow-Up Studies; Proton Pump Inhibitors/therapeutic use; Esophagus; Esophageal pH Monitoring; Gastroesophageal Reflux; Heartburn; Impedance Test; Proton Pump Inhibitor; Regurgitation; Electric Impedance; Endoscopy Digestive System; Esophagus/diagnostic imaging/physiopathology; Gastroesophageal Reflux/diagnosis/drug therapy/physiopathology
BACKGROUND & AIMS: As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. METHODS: Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. RESULTS: Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group. CONCLUSIONS: We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
Abdallah J; George N; Yamasaki T; Ganocy S; Fass R
Clinical Gastroenterology and Hepatology
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.cgh.2018.06.018" target="_blank" rel="noreferrer noopener">10.1016/j.cgh.2018.06.018</a>
Effectiveness of computed tomography scanning to detect blunt bowel and mesenteric injuries requiring surgical intervention: A systematic literature review
Abdominal computed tomography; Computed tomography performance; Diagnostic accuracy; Hollow viscus injury; Mesenteric injury
BACKGROUND: Computed tomography (CT) diagnostic accuracy for blunt bowel and mesenteric injuries (BBMI) is controversial. DATA SOURCES: A literature review to compute aggregate CT performance and individual CT sign sensitivity, specificity, and positive predictive value (PPV) for operative BBMI. CONCLUSIONS: Sensitivity, specificity, and PPV were: overall CT performance 85.3%, 96.1%, 51.4%; abnormal wall enhancement 30.1%, 95.7%, 64.0%; bowel wall discontinuity 22.3%, 99.0%, 87.9%; bowel wall hematoma 22.5%, 100%, 19.5%; bowel wall thickening 35.2%, 96.5%, 32.1%; free air 32.0%, 98.7%, 57.1%; free fluid 65.6%, 85.0%, 25.5%; mesenteric air 27.6%, 99.1%, 85.3%; mesenteric extravasation 22.9%, 99.6%, 73.9%; mesenteric hematoma/fluid 33.9%, 98.7%, 52.8%; mesenteric stranding/streaking 34.3%, 91.8%, 31.6%; mesenteric vessel beading 32.1%, 97.2%, 60.4%; mesenteric vessel termination 31.6%, 97.2%, 63.5%; oral contrast extravasation 10.0%, 100%, 100%; retroperitoneal air 9.4%, 94.9%, 55.6%; and retroperitoneal fluid 44.2%, 49.4%, 38.5%. Sensitivity, specificity, and PPV vary substantially among known signs. Other clinical factors are necessary for comprehensive BBMI identification.
Abdel-Aziz Hiba; Dunham C Michael
American Journal of Surgery
2019
2019-07
<a href="http://doi.org/10.1016/j.amjsurg.2018.08.018" target="_blank" rel="noreferrer noopener">10.1016/j.amjsurg.2018.08.018</a>
Neuropathological Findings in Susac Syndrome: An Autopsy Report
Cerebral vasculitis; Deafness; Encephalopathy; Susac syndrome; Visual loss
A 24-year-old woman developed encephalopathy, branch retinal artery occlusion, hearing loss, and had "snowball" lesions in the corpus callosum, classic findings of Susac syndrome (SuS). Despite intensive immunosuppressive therapy, she lapsed into a coma, and died 7 months after the onset of her illness. Neuropathological examination, revealed perivascular inflammation and vasculitis involving small vessels, associated with vascular narrowing and occlusion, and numerous microinfarcts diffusely throughout the brain. The findings establish SuS as a neuroinflammatory condition that can include vasculitis. This represents the most comprehensive report of the neuropathological findings in SuS.
Agamanolis Dimitri P; Klonk Collin; Bigley Kim; Rennebohm Robert M
Journal of Neuropathology and Experimental Neurology
2019
2019-06
<a href="http://doi.org/10.1093/jnen/nlz031" target="_blank" rel="noreferrer noopener">10.1093/jnen/nlz031</a>
Brain microvascular pathology in Susac syndrome: an electron microscopic study of five cases
hearing loss; Susac syndrome; electron microscopy; encephalopathy; branch retinal artery occlusion; cerebral vasculitis; corpus callosal lesions
Susac syndrome is a rare, immune-mediated disease characterized by encephalopathy, branch retinal artery occlusion, and hearing loss. Herein, we describe the electron microscopic findings of three brain biopsies and two brain autopsies performed on five patients whose working clinical diagnosis was Susac syndrome. In all five cases, the key findings were basement membrane thickening and collagen deposition in the perivascular space involving small vessels and leading to thickening of vessel walls, narrowing, and vascular occlusion. These findings indicate that Susac syndrome is a microvascular disease. Mononuclear cells were present in the perivascular space, underlining the inflammatory nature of the pathology. Though nonspecific, the changes can be distinguished from genetic and acquired small vessel diseases. The encephalopathy of Susac syndrome overlaps clinically with degenerative and infectious conditions, and brain biopsy may be used for its diagnosis. Its vascular etiology may not be obvious on light microscopy, and electron microscopy is important for its confirmation.
Agamanolis Dimitri P; Prayson Richard A; Asdaghi Negar; Gultekin Sakir H; Bigley Kim; Rennebohm Robert M
Ultrastructural Pathology
2019
2019-11-16
Journal Article
<a href="http://doi.org/10.1080/01913123.2019.1692117" target="_blank" rel="noreferrer noopener">10.1080/01913123.2019.1692117</a>
PMID: 31736417
IMPERATORIN, A PLANT DERIVED SMALL MOLECULE, INHIBITS OXIDATIVE STRESS AND PREVENTS MITOCHONDRIAL DAMAGE IN HUMAN OA CHONDROCYTES
Rheumatology; Orthopedics
Ahmad N; Ansari M; Haqqi T
Osteoarthritis and Cartilage
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.joca.2019.02.790" target="_blank" rel="noreferrer noopener">10.1016/j.joca.2019.02.790</a>
A randomized, controlled trial for transurethral treatment of bladder tumors using PlasmaButton vaporization electrode or monopolar loop electrocautery
Introduction: The use of an electrocautery device (monopolar loop) for patients undergoing transurethral resection of bladder tumors (TURBT) is standard of care. The aim of this study is to establish non-inferiority of complication rates for a bipolar energy device, the PK PlasmaButton (PK Button), when compared to the monopolar loop. Materials and methods: Seventy-eight subjects (41 monopolar loop and 37 PK Button), were enrolled in a single-center, prospective, randomized study with cystoscopically detected bladder tumors that were judged endoscopically resectable with only one trip into the operating room. Intra and postoperative data on complication rates, operative time, catheterization time and disease recurrence rates at 3 month follow up were collected. Results: Overall complication rates after TURBT with the monopolar loop or PK Button were similar, (56% versus 38% respectively, p = 0.107), however there were more bladder perforations in the monopolar loop arm compared to the PK Button arm (12.2% versus 0%, respectively, p = 0.028). There was no difference in overall operative time (p = 0.170), catheterization time (p = 0.709) and disease recurrence (p = 0.199). Conclusion: The results of this study demonstrated no difference between the monopolar loop and PK Button in regard to overall complications; however, there was a higher rate of bladder perforation with monopolar TURBT. PK Button vaporization for bladder tumors represents a promising alternative to traditional monopolar TURBT without compromising short term (3 month) cancer recurrence rates.
Alemozaffar Mehrdad; Ogan Kenneth; Filson Christopher P; Patil Dattatraya; Lee Grace; Canter Daniel J; Hong Gordon; Master Viraj A
Canadian Journal Of Urology
2019
2019-10
Journal Article
<a href="https://www.ncbi.nlm.nih.gov/pubmed/31629439" target="_blank" rel="noreferrer noopener">https://www.ncbi.nlm.nih.gov/pubmed/31629439</a>
MICRONEEDLING ASSISTED AND MICROINJECTION DELIVERY OF TRANEXAMIC ACID FOR THE TREATMENT OF MELASMA
Dermatology; Surgery
Almukhtar R; Stevens J; Lee B
Lasers in Surgery and Medicine
2019
2019-02
Journal Article or Conference Abstract Publication
<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23059" target="_blank" rel="noreferrer noopener">https://onlinelibrary.wiley.com/doi/epdf/10.1002/lsm.23059</a>
TRACHEOBRONCHIAL ASPIRATION IN ADULTS: A RARE BUT LIFE THREATENING CONDITION.
ADULTS; ASPIRATION & aspirators; FOREIGN bodies (Surgery); THERAPEUTICS
Amin A; Kwatra S; Bautista M; Khalid U; Sharma G
CHEST
2019
2019-04
<a href="http://doi.org/10.1016/j.chest.2019.02.110" target="_blank" rel="noreferrer noopener">10.1016/j.chest.2019.02.110</a>
AN EXTREMELY RARE CASE OF DIFFUSE ALVEOLAR HEMORRHAGE IN A PATIENT WITH SCLERODERMA AND PREVIOUSLY UNDIAGNOSED GRANULOMATOSIS WITH POLYANGITIS.
BRONCHOALVEOLAR lavage; EXTRACORPOREAL membrane oxygenation; HEMORRHAGE; THERAPEUTICS
Amin A; Kwatra S; Sharma G; Goldstein L; Bautista M; Anthony B
CHEST
2019
2019-04
<a class="doi" href="https://doi.org/10.1016/j.chest.2019.02.109" target="_blank" title="Persistent link using digital object identifier" rel="noreferrer noopener">https://doi.org/10.1016/j.chest.2019.02.109</a>
STRONGYLOIDES HYPERINFECTION SYNDROME: A RARE BUT COMMONLY FATAL CASE.
OBSTRUCTIVE lung diseases; SYNDROMES
Amin A; Thiruveety P; Ibrahim A; Elahee M; Bautista M; Boulos A
CHEST
2019
2019-04
<a href="http://doi.org/10.1016/j.chest.2019.02.078" target="_blank" rel="noreferrer noopener">10.1016/j.chest.2019.02.078</a>
INHIBITION OF LYSOSOMAL FUNCTION ENHANCES INFLAMMATORY GENE EXPRESSION, INDUCE OXIDATIVE STRESS AND APOPTOSIS IN HUMAN CHONDROCYTES
Rheumatology; Orthopedics
Ansari M Y; Ball H C; Wase S; Novak K; Haqqi T M
Osteoarthritis and Cartilage
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.joca.2019.02.233" target="_blank" rel="noreferrer noopener">10.1016/j.joca.2019.02.233</a>
PARKIN DEFICIENCY IMPAIRS THE CLEARANCE OF DYSFUNCTIONAL MITOCHONDRIA AND AUGMENTS IL-1B INDUCED INFLAMMATION IN HUMAN ARTICULAR CHONDROCYTES
Rheumatology; Orthopedics
Ansari M Y; Novak K; Haqqi T M
Osteoarthritis and Cartilage
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.joca.2019.02.232" target="_blank" rel="noreferrer noopener">10.1016/j.joca.2019.02.232</a>
Genetic Inactivation of ZCCHC6 Suppresses Interleukin‐6 Expression and Reduces the Severity of Experimental Osteoarthritis in Mice.
ANIMAL experimentation; CARTILAGE; CARTILAGE cells; DACTINOMYCIN; DNA-binding proteins; GENE expression; GENETIC aspects; IN vivo studies; INTERLEUKINS; MICE; MICRORNA; OSTEOARTHRITIS; PREVENTION; SEQUENCE analysis; SEVERITY of illness index; SYNOVITIS; TRANSCRIPTION factors
Objective: Cytokine expression is tightly regulated posttranscriptionally, but high levels of interleukin‐6 (IL‐6) in patients with osteoarthritis (OA) indicate that regulatory mechanisms are disrupted in this disorder. The enzyme ZCCHC6 (zinc‐finger CCHC domain–containing protein 6; TUT‐7) has been implicated in posttranscriptional regulation of inflammatory cytokine expression, but its role in OA pathogenesis is unknown. The present study was undertaken to investigate whether ZCCHC6 directs the expression of IL‐6 and influences OA pathogenesis in vivo. Methods: Human and mouse chondrocytes were stimulated with recombinant IL‐1β. Expression of ZCCHC6 in human chondrocytes was knocked down using small interfering RNAs. IL‐6 transcript stability was determined by actinomycin D chase, and 3′‐uridylation of microRNAs was determined by deep sequencing. Zcchc6−/− mice were produced by gene targeting. OA was surgically induced in the knee joints of mice, and disease severity was scored using a semiquantitative grading system. Results: ZCCHC6 was markedly up‐regulated in damaged cartilage from human OA patients and from wild‐type mice with surgically induced OA. Overexpression of ZCCHC6 induced the expression of IL‐6, and its knockdown reduced IL‐6 transcript stability and IL‐1β–induced IL‐6 expression in chondrocytes. Reintroduction of Zcchc6 in Zcchc6−/− mouse chondrocytes rescued the IL‐1β–induced IL‐6 expression. Knockdown of ZCCHC6 reduced the population of micro‐RNA 26b (miR‐26b) with 3′‐uridylation by 60%. Zcchc6−/− mice with surgically induced OA produced low levels of IL‐6 and exhibited reduced cartilage damage and synovitis in the joints. Conclusion: These findings indicate that ZCCHC6 enhances IL‐6 expression in chondrocytes through transcript stabilization and by uridylating miR‐26b, which abrogates repression of IL‐6. Inhibition of IL‐6 expression and significantly reduced OA severity in Zcchc6−/− mice identify ZCCHC6 as a novel therapeutic target to inhibit disease pathogenesis. [ABSTRACT FROM AUTHOR]
Ansari Mohammad Y; Khan Nazir M; Ahmad Nashrah; Green Jonathan; Novak Kimberly; Haqqi Tariq M
Arthritis & Rheumatology
2019
2019-04
<a href="http://doi.org/10.1002/art.40751" target="_blank" rel="noreferrer noopener">10.1002/art.40751</a>
The large protein 'L' of Peste-des-petits-ruminants virus exhibits RNA triphosphatase activity, the first enzyme in mRNA capping pathway.
Acid Anhydride Hydrolases/*metabolism; Animals; Baculoviridae/genetics; Cercopithecus aethiops; Cloning; Conventional mRNA capping; Enzyme Activation; Gene Expression; Genetic Vectors/genetics; Messenger/*genetics/*metabolism; Molecular; Morbillivirus; mRNA capping; Peste-des-petits-ruminants virus L protein; Peste-des-petits-ruminants virus/*physiology; Peste-des-Petits-Ruminants/*virology; PPRV; RNA; RNA Caps/*metabolism; RNA triphosphatase; Vero Cells; Viral Proteins/*metabolism
Peste-des-petits-ruminants is a highly contagious and fatal disease of goats and sheep caused by non-segmented, negative strand RNA virus belonging to the Morbillivirus genus-Peste-des-petits-ruminants virus (PPRV) which is evolutionarily closely related to Rinderpest virus (RPV). The large protein 'L' of the members of this genus is a multifunctional catalytic protein, which transcribes and replicates the viral genomic RNA as well as possesses mRNA capping, methylation and polyadenylation activities; however, the detailed mechanism of mRNA capping by PPRV L protein has not been studied. We have found earlier that the L protein of RPV has RNA triphosphatase (RTPase), guanylyltransferase (GTase) and methyltransferase activities, and unlike vesicular stomatitis virus (VSV), follows the conventional pathway of mRNA capping. In the present work, using a 5'-end labelled viral RNA as substrate, we demonstrate that PPRV L protein has RTPase activity when present in the ribonucleoprotein complex of purified virus as well as recombinant L-P complex expressed in insect cells. Further, a minimal domain in the C-terminal region (aa1640-1840) of the L protein has been expressed in E. coli and shown to exhibit RTPase activity. The RTPase activity of PPRV L protein is metal-dependent and functions with a divalent cation, either magnesium or manganese. In addition, RTPase associated nucleotide triphosphatase activity (NTPase) of PPRV L protein is also demonstrated. This work provides the first detailed study of RTPase activity and identifies the RTPase domain of PPRV L protein.
Ansari Mohammad Yunus; Singh Piyush Kumar; Rajagopalan Deepa; Shanmugam Purnima; Bellur Asutosh; Shaila Melkote Subbarao
Virus Genes
2019
2019-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s11262-018-1617-5" target="_blank" rel="noreferrer noopener">10.1007/s11262-018-1617-5</a>
How Should Health Care Professionals Address Social Determinants of Refugee Health?
In the case scenario, RJ is a resettled refugee teenager who presents to his physician with vitamin B12 deficiency, anemia, and symptoms of mental illness. This commentary considers social determinants of refugee health and the moral importance of freedom to achieve well-being. The capabilities framework is used to analyze this case because it offers an ethical framework for understanding and evaluating social determinants of refugee health that either promote or diminish freedom to achieve well-being. By using this framework to consider social isolation as a negative social determinant of refugee health, clinicians and institutions can be caregivers as well as advocates for social justice, fulfilling 2 core ethical obligations to refugee communities.
Aultman Julie M
AMA journal of ethics
2019
2019-03
<a href="http://doi.org/10.1001/amajethics.2019.223" target="_blank" rel="noreferrer noopener">10.1001/amajethics.2019.223</a>
Moving Beyond Moral Revulsion: A Deeper Analysis of Social Justice Within Clinical Ethics Training.
AT-risk people; CITIZENSHIP; CONCEPTUAL structures (Information theory); DECISION making; ETHICAL decision making; ETHICISTS; HEALTH services accessibility; MEDICAL ethics; PSYCHOSOCIAL factors; PUBLIC health; RESPONSIBILITY; SOCIAL justice; UNDOCUMENTED immigrants
The article offers information on social justice within clinical ethics training. Topics discussed include with a more deliberative effort toward a deeper understanding of justice as it relates to care, efficiency, and public health; mentions no theoretical approach or framework may resolve ethical dilemmas affecting undocumented patients; and also mentions medical education has emphasized the importance of justice and the fair treatment of patients.
Aultman Julie; Whipkey Andrew J
American Journal of Bioethics
2019
2019-04
<a href="https://doi.org/10.1080/15265161.2019.1572821">10.1080/15265161.2019.1572821</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic
medical education; clinical; medications; pharmacy; interventions; Pharmacology & Pharmacy; impact; academic detailing; ambulatory care; community practice; prescribing patterns; prior authorization
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of beta-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's chi(2) and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and beta-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad M H; Ulbrich T R; Furdich K M; Schneider S R; Gothard M D
Journal of Pharmacy Technology
2019
2019-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
The Effect of Pharmacy-Led, Small-Group Academic Detailing on Prescribing Patterns in an Ambulatory Care Clinic.
Adrenergic Beta-Antagonists -- Therapeutic Use; Adult; Ambulatory Care Facilities; Chi Square Test; Descriptive Statistics; Diabetes Mellitus; Education; Essential Hypertension -- Drug Therapy; Fisher's Exact Test; Human; Hyperlipidemia -- Drug Therapy; Medically Underserved Area; Metformin -- Therapeutic Use; Non-Traditional; Outcomes of Education; Pharmacy Service; Physicians -- Education; Prescribing Patterns -- Education; Statins -- Therapeutic Use; Type 2 -- Drug Therapy
Background: While academic detailing seems to be the most promising intervention to improve prescribing patterns, implementation could be challenging for small community practices. Objective: A pharmacy-led, interactive, and tailored small-group academic detailing in a federally qualified health center is described. The primary objective of the study was to determine if the small-group academic detailing improved the prescribing patterns of the medical providers for select disease states: type 2 diabetes mellitus (T2DM), hyperlipidemia (HLD), and essential hypertension (HTN). Methods: Prescribing patterns in a federally qualified health center were examined in relation to small-group academic detailing sessions from April 2010 to March 2015. The markers for improvement were the increase in utilizing metformin and statins in patients diagnosed with T2DM and HLD, respectively, and the reduction of β-blocker use in patients diagnosed with essential HTN. Changes in prescribing patterns were evaluated using Pearson's χ2 and Fisher's exact tests. Results: The average number of active, adult patients with T2DM, HLD, and essential HTN was 839, 1768, and 2547, respectively. Utilization of metformin in T2DM increased from 5.5% at baseline to 37.7%, statin utilization in HLD increased from 77.1% to 86.9%, and β-blocker use in HTN decreased from 17.9% to 13.8% (P < .005). Conclusions: A pharmacy-led, small-group academic detailing program improved and maintained appropriate prescribing patterns in an underserved community practice. This study serves as a successful pilot emphasizing the pharmacist's role as an educator and a resource to medical providers regarding appropriate medication use.
Awad Magdi H; Ulbrich Timothy R; Furdich Kenneth M; Schneider Stacy R; Gothard M David
Journal of Pharmacy Technology
2019
2019-04
<a href="http://doi.org/10.1177/8755122518818826" target="_blank" rel="noreferrer noopener">10.1177/8755122518818826</a>
Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee.
BACKGROUND: Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. METHODS: A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and EMBASE was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to perform a systematic review and create recommendations. RESULTS: We reviewed seven articles relevant to trauma center care and nine articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients. CONCLUSIONS: As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay; however, inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma. LEVEL OF EVIDENCE: Systematic review/guideline, level III.
Aziz Hiba Abdel; Lunde John; Barraco Robert; Como John J; Cooper Zara; Hayward Thomas 3rd; Hwang Franchesca; Lottenberg Lawrence; Mentzer Caleb; Mosenthal Anne; Mukherjee Kaushik; Nash Joshua; Robinson Bryce; Staudenmayer Kristan; Wright Rebecca; Yon James; Crandall Marie
The journal of trauma and acute care surgery
2019
2019-04
<a href="http://doi.org/10.1097/TA.0000000000002155" target="_blank" rel="noreferrer noopener">10.1097/TA.0000000000002155</a>
Recurrent pseudoaneurysm after carotid endarterectomy
Angioplasty; aortic endograft infection; Bovine patch; Carotid endarterectomy; Complication; experience; false aneurysm; Infection; pasteurella-multocida; patch infection; Pseudoaneurysm; Surgery
Pseudoaneurysms and patch infections are known complications of carotid endarterectomy with patch angioplasty. Although they are rare occurrences, they carry high morbidity and almost uniformly require surgical intervention. Infectious pathogens are often gram-positive bacteria, most commonly Staphylococcus species, whereas gram-negative infections are less frequently observed. We present a case of recurrent pseudoaneurysm in a patient who had a carotid endarterectomy with bovine pericardial patch angioplasty complicated by Pasteurella multocida infection. This case demonstrates the need for recognition and consideration of a broad differential of pathogens in evaluating and treating vascular infections.
Azouz V; Fahmy J N; Kornbau C; Petrinec D
Journal of Vascular Surgery Cases and Innovative Techniques
2019
2019-06
<a href="http://doi.org/10.1016/j.jvscit.2018.12.010" target="_blank" rel="noreferrer noopener">10.1016/j.jvscit.2018.12.010</a>
Recurrent pseudoaneurysm after carotid endarterectomy
Angioplasty; Bovine patch; Carotid endarterectomy; Complication; Infection; Pseudoaneurysm
Pseudoaneurysms and patch infections are known complications of carotid endarterectomy with patch angioplasty. Although they are rare occurrences, they carry high morbidity and almost uniformly require surgical intervention. Infectious pathogens are often gram-positive bacteria, most commonly Staphylococcus species, whereas gram-negative infections are less frequently observed. We present a case of recurrent pseudoaneurysm in a patient who had a carotid endarterectomy with bovine pericardial patch angioplasty complicated by Pasteurella multocida infection. This case demonstrates the need for recognition and consideration of a broad differential of pathogens in evaluating and treating vascular infections.
Azouz Vitali; Fahmy Joseph N; Kornbau Craig; Petrinec Drazen
Journal of Vascular Surgery Cases and Innovative Techniques
2019
2019-06
<a href="http://doi.org/10.1016/j.jvscit.2018.12.010" target="_blank" rel="noreferrer noopener">10.1016/j.jvscit.2018.12.010</a>
Open Access Medical Journals: Promise, Perils, and Pitfalls
The number of both print and electronic open access (OA) journals has increased dramatically. Although electronic availability of information on the Internet may offer greater potential for information sharing, it also gives rise to "predatory" journals and deceptive publishers. In this Invited Commentary, the authors describe both the opportunities and potential perils that come with OA publications.Definitions for four models of legitimate OA are provided: the gold model, the green model, the platinum model, and the hybrid model. Benefits and risks of each model are discussed. The authors also distinguish between legitimate OA journals and predatory journals, highlighting several existing tools and resources for distinguishing between the two.Finally, the authors provide a checklist to help authors evaluate the policies and processes of journals and thereby avoid predatory publications.
Baker Eileen F; Iserson Kenneth V; Aswegan Andrew L; Larkin Gregory L; Derse Arthur R; Kraus Chadd K; of Emergency Physicians Ethics Committee American College
Academic Medicine: Journal of the Association of American Medical Colleges
2019
2019-05
<a href="http://doi.org/10.1097/ACM.0000000000002563" target="_blank" rel="noreferrer noopener">10.1097/ACM.0000000000002563</a>
Measles
Balu Bharath; Mostow Eliot N
JAMA dermatology
2019
2019-12-01
Journal Article
<a href="http://doi.org/10.1001/jamadermatol.2019.2663" target="_blank" rel="noreferrer noopener">10.1001/jamadermatol.2019.2663</a>
PMID: 31825476
Just Because There is a Button Doesn't Mean it is Appropriate to Use or That it will Give Accurate Information
ultrasound; Acoustics; Radiology; safety; Nuclear Medicine & Medical Imaging
Barr R G
Journal of Ultrasound in Medicine
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1002/jum.14990" target="_blank" rel="noreferrer noopener">10.1002/jum.14990</a>
A Clinical Study Comparing the Diagnostic Performance of Assist Strain Ratio Against Manual Strain Ratio in Ultrasound Breast Elastography
breast cancer; elastography; cancer; guidelines; Radiology; elasticity; strain; Nuclear Medicine & Medical Imaging; us; recommendations; society; strain ratio; fat-to-lesion ratio; FLR
Objective Strain ratio (SR) is a semiquantitative parameter in differentiating benign from malignant tumors in breast ultrasound elastography. Currently, SR is computed manually and, thus, user dependent. The objective of this study was to evaluate the performance of a new tool assist strain ratio (ASR) and determine how it performs compared with an expert sonologist. Methods Ninety-one patients scheduled for breast biopsy were included in this institutional review board-approved/Health Insurance Portability and Accountability Act-compliant study. For manual strain ratio (MSR), fat and lesion were manually outlined, whereas for ASR, the clinician indicated the lesion center and the fat-to-lesion ratio is computed automatically. Three measurements were obtained for each lesion. The same raw data were used to calculate the MSR and ASR. Results The SR thresholds to differentiate benign from malignant tumors were determined using the Youden index. For MSR, the cutoff was 2.7, and for ASR was 2.8. The MSR showed a sensitivity of 88%, specificity of 64%, accuracy of 77%, positive predictive value of 72%, and negative predictive value of 92.1%. Corresponding ASR showed a sensitivity of 86%, specificity of 76%, accuracy of 81%, positive predictive value of 79%, and negative predictive value of 84%. The areas under the curve for the MSR and ASR were 0.83 and 0.85, respectively. The average coefficients of variation for the MSR and ASR measurements were 43% and 30%, respectively. Conclusion Assist strain ratio demonstrated similar diagnostic performance compared with MSR. In addition, the coefficient of variation of ASR is lower, implying lower intraoperator dependency. Thus, ASR may aid less-experienced scanners in obtaining improved results.
Barr R G; Managuli R A
Ultrasound Quarterly
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ruq.0000000000000398" target="_blank" rel="noreferrer noopener">10.1097/ruq.0000000000000398</a>
Letter to the Editor
Barr Richard G
Ultrasound Quarterly
2019
2019-05
<a href="http://doi.org/10.1097/RUQ.0000000000000460" target="_blank" rel="noreferrer noopener">10.1097/RUQ.0000000000000460</a>
Breast Elastography: How to Perform and Integrate Into a "Best-Practice" Patient Treatment Algorithm
breast cancer; breast; elastography; shear wave elastography; strain elastography; breast tumors; sonoelastography
Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively steep learning curve, and variability in methods between vendors. This article describes our protocol for performing breast elastography using both strain elastography and shear wave elastography, which produces high sensitivity and specificity. Additionally, we will describe the most commonly known false-positive and false-negative lesions as well as how to detect them.
Barr Richard G
Journal Of Ultrasound In Medicine: Official Journal Of The American Institute Of Ultrasound In Medicine
2019
2019-10-16
Journal Article
<a href="http://doi.org/10.1002/jum.15137" target="_blank" rel="noreferrer noopener">10.1002/jum.15137</a>
PMID: 31617225
Can Accurate Shear Wave Velocities Be Obtained in Kidneys?
artifacts; kidney; renal; shear wave elastography
OBJECTIVES: There are conflicting results in the literature on the use of shear wave elastography of the kidney parenchyma to determine whether renal stiffness values are related to a disease process. This study was conducted to evaluate the raw data from 3 ultrasound systems and determine whether adequate displacement curves are obtained to accurately estimate shear wave speeds. METHODS: Shear wave elastography was performed on 5 healthy volunteers with 3 ultrasound systems. The raw data were collected and evaluated for the shear wave propagation quality to determine whether accurate estimates of renal shear wave speeds could be determined. RESULTS: Results from the 3 machines demonstrate that accurate shear wave displacement curves are not obtained with renal elastography on existing systems (as of June 2018). One vendor has recently released software that appears to acquire accurate shear wave displacements. CONCLUSIONS: Elastographic studies performed on the kidney to date are likely to be inaccurate. A new algorithm that appears to acquire accurate shear wave displacements in the kidney has been developed. Additional studies are needed to confirm that the new algorithm provides accurate clinical results. This study demonstrates that although the system provides a shear wave speed, it is important to confirm the accuracy of that number by evaluating the raw data.
Barr Richard G
Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
2019
2019-12-03
Journal Article
<a href="http://doi.org/10.1002/jum.15190" target="_blank" rel="noreferrer noopener">10.1002/jum.15190</a>
PMID: 31797411
Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis
breast; breast cancer; breast tumors; elastography; sonoelastography
There are 3 methods of interpreting breast strain elastography: the elastographic-to-B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy.
Barr Richard G; De Silvestri Annalisa; Scotti Valeria; Manzoni Federica; Rebuffi Chiara; Capittini Cristina; Tinelli Carmine
Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
2019
2019-06
<a href="http://doi.org/10.1002/jum.14849" target="_blank" rel="noreferrer noopener">10.1002/jum.14849</a>
Use of a Real-Time Stress Map for Assessment of Applied Stress for Strain Elastography-Utility in Training and Computation of Strain Ratios.
Training; strain elastography; Strain ratio; strain index
OBJECTIVES: There is a significant learning curve in strain elastography. Uniform appropriate levels of stress must be applied for accurate elastograms. If the stress is not applied appropriately, inaccurate results will be obtained, particularly when strain ratios are being estimated. This paper describes a new technique which allows the real-time visualization of the applied stress with a color-coded stress map. The potential use of this map is discussed. METHODS: Ten patients (5 breast, 5 thyroid) and phantoms were scanned using the stress map. The stress applied was varied and the resultant change in the strain image evaluated. RESULTS: The stress map was able to document if appropriate stress was applied when performing strain elastography. When inappropriate stress was applied or physiological process effected the strain image the stress map demonstrated the areas of inaccurate measurements in the stress map. CONCLUSIONS: The display of a stress map that depicts the degree and uniformity of applied stress would be helpful both for training of the appropriate technique, for confirming that the elastogram is appropriate for evaluation, and that strain ratio estimates are accurate.
Barr Richard G; Nikolov Svetoslav Ivanov
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
2019
2019-04
<a href="http://doi.org/10.1002/jum.15006" target="_blank" rel="noreferrer noopener">10.1002/jum.15006</a>
Future of breast elastography.
Strain; Breast; Shear wave; Breast neoplasms; *Elasticity Imaging Techniques; Strain ratio
Both strain elastography and shear wave elastography have been shown to have high sensitivity and specificity for characterizing breast lesions as benign or malignant. Training is important for both strain and shear wave elastography. The unique feature of benign lesions measuring smaller on elastography than B-mode imaging and malignant lesions appearing larger on elastography is an important feature for characterization of breast masses. There are several artifacts which can contain diagnostic information or alert to technique problems. Both strain and shear wave elastography continue to have improvements and new techniques will soon be available for clinical use that may provide additional diagnostic information. This paper reviews the present state of breast elastography and discusses future techniques that are not yet in clinical practice.
Barr Richard Gary
Ultrasonography (Seoul, Korea)
2019
2019-04
<a href="http://doi.org/10.14366/usg.18053" target="_blank" rel="noreferrer noopener">10.14366/usg.18053</a>
Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope.
STUDY OBJECTIVE: Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients. METHODS: From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (>/=60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of
Bastani Aveh; Su Erica; Adler David H; Baugh Christopher; Caterino Jeffrey M; Clark Carol L; Diercks Deborah B; Hollander Judd E; Malveau Susan E; Nicks Bret A; Nishijima Daniel K; Shah Manish N; Stiffler Kirk A; Storrow Alan B; Wilber Scott T; Yagapen Annick N; Weiss Robert E; Sun Benjamin C
Annals of emergency medicine
2019
2019-03
<a href="http://doi.org/10.1016/j.annemergmed.2018.10.032" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2018.10.032</a>
Antibiotics and adverse events: the role of antimicrobial stewardship programs in 'doing no harm'
PURPOSE OF REVIEW: Antimicrobial resistance (AMR) is a global threat worldwide, with deaths associated with AMR infections projected to exceed 10 million per year by the year 2050. The overuse and misuse of antibiotics is the primary driver of this resistance, with up to 50% of antibiotics prescribed in the hospital setting being either unnecessary or inappropriate. Antimicrobial stewardship (AMS) programs (ASPs) can mitigate some of this resistance, with the benefits well recognized; however, if we are to truly advance the state of AMS, the principles and practices should align with patient safety. RECENT FINDINGS: In a recent evaluation, among 1488 adult patients receiving systemic antibiotic therapy, 298 (20%) experienced at least one antibiotic-associated adverse drug event (ADE). Fifty-six (20%) nonclinically indicated antibiotic regimens were associated with an ADE. It is also well recognized that besides ADEs, the inappropriate use of antibiotics is associated the development of multidrug-resistant infections and Clostridium difficile infection. SUMMARY: Currently, there is a significant gap in ASPs correlating initiatives with patient safety goals, including reductions in antibiotic-associated ADEs and multidrug-resistant infections. Therefore, in this article, we provide the rationale for why ASPs are best suited to lead a collaborative effort to prevent antibiotic-associated ADEs and multidrug-resistant infections.
Bauer Karri A; Kullar Ravina; Gilchrist Mark; File Thomas M
Current Opinion In Infectious Diseases
2019
2019-12
Journal Article
<a href="http://doi.org/10.1097/QCO.0000000000000604" target="_blank" rel="noreferrer noopener">10.1097/QCO.0000000000000604</a>
PMID: 31567566
Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments
Advance directives; African Americans; CONFIDENCE intervals; Gerontology And Geriatrics; Judgments; Nurses; Nursing; Quality of care; Quality of life; Race; Racism; Research design; Residential segregation; Rural areas; Rural education; Rural urban differences; Segregation; Social science research; Social workers; Urban education
Background and Objectives Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions Research Design and Methods Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. Results Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78) Discussion and Implications Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.
Baughman Kristin R; Ludwick PhD R N-B C C N S F A A N Ruth; Jarjoura PhD David; Kropp BS Denise; Shenoy BS Vimal
The Gerontologist
2019
2019-04
<a href="http://doi.org/10.1093/geront/gnx129" target="_blank" rel="noreferrer noopener">10.1093/geront/gnx129</a>
PREVALENCE OF MYOCARDITIS AND PERICARDITIS AMONG CHEST PAIN PATIENTS WITH A NORMAL ISCHEMIC EVALUATION
Cardiovascular System & Cardiology
Background Although stress-echo (SE), nuclear myocardial stress perfusion imaging (MPI) and coronary arteriography are used to detect atherosclerosis, they are not well suited for diagnosing inflammatory heart disease. Cardiac MRI (CMR) is uniquely capable of detecting myocardial and pericardial edema, a hallmark of inflammation. As the myocardium and pericardium are contiguous, myocarditis and pericarditis often coexist. This study assessed the prevalence of myocarditis and pericarditis in patients with chest pain and a negative ischemic evaluation, using CMR. Methods An institutional cardiac imaging database was queried for patients with chest pain who underwent CMR after a normal ischemic evaluation. CMR criteria for inflammation included myocardial/pericardial enhancement on T2 STIR, early gadolinium enhancement, increased T1 mapping relaxation time, increased T2 mapping relaxation time, and delayed gadolinium enhancement. At least 2 of these findings were required for a diagnosis of myocarditis or pericarditis. The prevalence of myocarditis/pericarditis was computed for patients with a negative SE, MPI or CMR stress study separately. Results There were 1,476 patients with chest pain and negative ischemic evaluation. Of 149 patients with a normal SE, 10 (6.8%) had evidence of myocarditis. Of these 10 patients, nine (90%) were female. These same 10 patients (100%) also had coexisting pericarditis (10% male, 90% female). Of 403 patients with a normal MPI, 29 (7.2%) had myocarditis. 22 of these 29 (75.9%) also had CMR findings of pericarditis. Of 924 patients with a normal CMR stress perfusion study, 63 (6.8%) had myocarditis on CMR. Of these 63 patients, 48 (76.2%) had CMR evidence of pericarditis as well. Conclusion This study suggests a 7% prevalence of underlying myocarditis in patients presenting with chest pain and a negative ischemic evaluation. Additionally, 78% of these patients had evidence of coexisting pericarditis. Females with normal stress-echo results are more likely to have a missed diagnoses of acute myocarditis and pericarditis. These data emphasize the value of CMR for diagnosing underlying myocarditis and pericarditis, after a negative ischemic evaluation.
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Poster Contributions Poster Hall, Hall F Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: MR 3
Abstract Category: 29. Non Invasive Imaging: MR Presentation Number: 1227-338
Behbahani-Nejad O; Boland S; Raghavendran R; Mikolich B; Tondapu V; Mikolich J R
Journal of the American College of Cardiology
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0735-1097(19)32182-5" target="_blank" rel="noreferrer noopener">10.1016/s0735-1097(19)32182-5</a>
Level of scientific evidence underlying the current American College of Cardiology/American Heart Association clinical practice guidelines.
Humans; United States; Data Accuracy; Cardiology/standards; consensus; standard of care; Practice Guidelines as Topic/standards; Evidence-Based Medicine/standards; American Heart Association; cardiology; malpractice
Bevan GH; Kalra A; Josephson RA; Al-Kindi SG
Circulation. Cardiovascular quality and outcomes
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1161/CIRCOUTCOMES.118.005293" target="_blank" rel="noreferrer noopener">10.1161/CIRCOUTCOMES.118.005293</a>
PMID: 30755028
Exercise-Induced Dyspnea in Children and Adolescents: Differential Diagnosis
Pediatrics; adults; asthma; induced bronchoconstriction; hyperventilation; vocal-cord dysfunction
Exercise-induced dyspnea in children and adolescents can occur for many reasons. Although asthma is the common cause, failure to prevent exercise-induced asthma by pretreatment with a bronchodilator, such as albuterol, indicates that other etiologies should be considered. Other causes of exercise-induced dyspnea include exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, chest wall restrictive abnormalities, cardiac causes, and normal physiologic limitation. When exercise-induced dyspnea is not from asthma, cardiopulmonary exercise testing with reproduction of the patient's dyspnea is the means to identify the other causes. Cardiopulmonary exercise testing monitors oxygen use, carbon-dioxide production, end-tidal pCO(2) (partial pressure of carbon dioxide), and electrocardiogram. Additional components to testing are measurement of blood pH and pCO(2) when symptoms are reproduced, and selective flexible laryngoscopy when upper airway obstruction is observed to specifically identify vocal cord dysfunction or laryngomalacia. This approach is a highly effective means to identify exercise-induced dyspnea that is not caused by asthma.
Bhatia R; Abu-Hasan M; Weinberger M
Pediatric Annals
2019
2019-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3928/19382359-20190219-02" target="_blank" rel="noreferrer noopener">10.3928/19382359-20190219-02</a>
Patiromer Acetate Induced Hypercalcemia: An Unreported Adverse Effect.
Hyperkalemia, a potential life threating condition, is a commonly encountered problem in chronic kidney disease (CKD) patients. Patiromer acetate, a nonabsorbable cation exchange polymer, is a gastrointestinal agent for chronic therapy in patients with persistent hyperkalemia. Patiromer is generally well tolerated in patients; common side effects are gastrointestinal, such as diarrhea, constipation, flatulence, and vomiting. Hypercalcemia, although a theoretical possibility, has not been reported in any major clinical trials. We present a case of hypercalcemia associated with patiromer acetate used for treatment of hyperkalemia in a stage IV CKD patient. Clinicians should be aware of the possibility of hypercalcemia while taking patiromer.
Bhattarai Shreeyukta; Pupillo Stephen; Man Singh Dangol Gulshan; Sarac Erdal
Case reports in nephrology
2019
2019
<a href="http://doi.org/10.1155/2019/3507407" target="_blank" rel="noreferrer noopener">10.1155/2019/3507407</a>
Rising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic Pancreatitis.
Aged; Humans; Male; Adult; Female; Hospitalization; Middle Aged; Adolescent; Young Adult; Length of Stay; Retrospective Studies; Prevalence; Health Resources; Opioid-Related Disorders/epidemiology; Pancreatitis Chronic/drug therapy
OBJECTIVES: We aimed to evaluate the prevalence, impact, and predictors of opioid use disorder (OUD) in hospitalized chronic pancreatitis (CP) patients. METHODS: A retrospective cohort study was performed using the National Inpatient Sample database from 2005 to 2014. Patients with a primary diagnosis of CP and OUD were included. The primary outcome was evaluating the prevalence and trend of OUD in patients hospitalized with CP. Secondary outcomes were to (1) assess the impact of OUD on health care resource utilization and (2) identify predictors of OUD in hospitalized CP patients. RESULTS: A total of 176,857 CP patients were included, and OUD was present in 3.8% of patients. The prevalence of OUD in CP doubled between 2005 and 2014. Patients with CP who had OUD were found to have higher mean length of stay (adjusted mean difference, 1.2 days; P < 0.001) and hospitalization costs (adjusted mean difference, US $1936; P < 0.001). Independent predictors of OUD in CP patients were obesity, presence of depression, and increased severity of illness. CONCLUSIONS: Opioid use disorder-related diagnoses are increasing among CP patients and are associated with increased health care resource utilization. Our study identifies patients at high-risk for OUD whose pain should be carefully managed.
Bilal M; Chatila A; Siddiqui MT; Al-Hanayneh M; Shah AR; Desai M; Wadhwa V; Parupudi S; Casey BW; Krishnan K; Hernandez-Barco YG
Pancreas
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/mpa.0000000000001430" target="_blank" rel="noreferrer noopener">10.1097/mpa.0000000000001430</a>
A Retrospective Cohort Study of Narrow Band UVB Phototherapy for the Treatment of Uremic Pruritus in Aging Patients at an Academic Tertiary Care Center
Geriatrics & Gerontology
Meeting abstract D99 presented at the 2019 Annual Scientific Meeting of the American-Geriatrics-Society (AGS)
Binod J; Araoye E; Kim N
Journal of the American Geriatrics Society
2019
2019-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
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