52426 research outputs found
Sort by
mpact Of Systemic Hypertension On Cardiovascular Outcomes and Mortality in Cardiac Sarcoidosis Patients: A Real-World Analysis
No full textOnce, twice, three times a bite victim: recidivism in snake envenomation.
No full textINTRODUCTION: We believe there are certain behaviors that may predispose people to being bitten by a snake. The purpose of this study was to describe cases reported to the North American Snakebite Registry in which the snakebite victim acknowledged multiple lifetime snakebites and to test the hypothesis that male sex, intentional handling of the snake, alcohol consumption, and maintaining snakes in captivity are associated with sustaining multiple snakebites in a lifetime.
METHODS: This was a retrospective review of de-identified patient information reported to the snakebite registry between January 1, 2013 and December 31, 2023. Data regarding the circumstances of the snake encounter, patient demographics, previous snakebites, antivenom administration, and clinical outcomes were reviewed.
RESULTS: Of the 2,140 snakebites reported during the study period, 94 (4.4%) involved patients with a history of one or more previous snakebites. Males accounted for 80 (85.1%) victims. Sixty-one (64.9%) bites followed intentional interaction with the snake. Alcohol use was reported in 15 (24.6%) of these cases. Captive snakes were responsible for 18 (29.5%) bites. Of the bites that resulted from unintentional snake interaction, alcohol was implicated in three (9.1%) cases. One (3%) bite was from a captive snake. Acute hypersensitivity reactions were observed in six (7.5%) patients who received antivenom.
DISCUSSION: Most patients with multiple lifetime snakebites were intentionally interacting with the snake just prior to being bitten. Maintaining snakes in captivity was reported more frequently in patients with previous bites than among the general snakebite population. Although alcohol use was more common among patients who intentionally interacted with snakes, most patients with multiple lifetime snakebites did not report preceding alcohol use.
CONCLUSIONS: Male sex, intentionally handling snakes, and maintaining snakes in captivity are more common in patients with multiple lifetime snakebites than those who have experienced only one bite
Letter: the hidden cost of robotic spine surgery: real-world adverse events cause 58-minute delays and undermine economic viability.
No full textMetrics for Perioperative Exercise in Patients Undergoing Lung Cancer Resection: A Systematic Review.
No full textPerioperative exercise interventions have been shown to mitigate morbidity associated with lung resection. While these interventions have established a role in this patient population, there has been little discussion regarding which metrics are used to standardize perioperative exercise interventions. A better understanding of these metrics is needed to define best practices and ensure interventions are reproducible. A systematic review of the literature was performed using CINAHL, PubMed/MEDLINE, and SCOPUS. The initial review yielded a total of 3456 results. After review of titles and abstracts, 119 studies remained. The included studies underwent detailed review of the manuscript and 29 were found to meet the inclusion criteria for the review. A total of 29 studies were selected for inclusion. Included studies were completed on adult patients with diagnosis of lung cancer who underwent lung resection surgery and participated in a standardized exercise intervention before or after their surgery. The most common metrics used to grade exercise interventions were percent maximal workload (%Wmax) based on preoperative cardiopulmonary exercise testing (CPET), which was used in 41% of included studies, and symptom limited Borg rating of perceived exertion, which was used in 38% of included studies. There was significant variation in metrics used for tracking perioperative exercise interventions. Standardization of validated metrics for perioperative exercise interventions, specifically using percent of maximal workload and the Borg scale, would impact the ability to compare future studies and the effectiveness of exercise interventions
Daily light exposure habits of youth with migraine: A prospective pilot study.
No full textBACKGROUND: Eighty percent of youth with migraine report photophobia. It is unknown if photophobia leads to light avoidant behavior, and if such behaviors worsen light sensitivity and disrupt sleep. Recently developed wearable, continuous light loggers allow us to address these open questions. We conducted a pilot study to determine the feasibility of measuring light exposure using wearable light loggers in youth with migraine.
METHODS: Youth 10 - 21 years old with a headache-specialist confirmed ICHD-3 diagnosis of migraine were recruited from CHOP headache clinics. Each participant recorded 7 consecutive days of light logging data from the ActLumus device worn as a pendant around the neck paired with a text-based daily migraine symptom diary during a typical school week between November and March 2024. Validated questionnaires were used to capture any headache and bad headache frequency, headache-related disability, visual sensitivity, fear-of-pain, and sleep disturbance and impairment. Percent time spent within recommended light exposure levels was calculated for the day, 3 hours prior to bedtime, and night. Power analysis was calculated to determine sample size needed for group comparison of baseline characteristics across light intensity and light timing metrics to aid in the design of larger studies.
RESULTS: Twenty youth with a median age 17 years [IQR 16, 19], 70% of whom were female completed 7 days of continuous light logger recording and daily headache diary. Data completion rates were high with 136/140 (97.1%) useable days of light logger data, and 100% compliance on the daily headache diary. Participant feedback on the study was positive; 85% would recommend the study to others. On average, participants received recommended light exposure during only 14.5% +/- SD 7.0 of daylight hours. By contrast, participants were more consistently below the recommended maximum light levels 3 hours prior to bed (77.5% +/- 21.6 of the time), and at night (99.1% +/- 2.9 of the time). Youth with chronic migraine (i.e., at least 15 headache days and 8 bad headache days per month) had daily light exposure patterns that were phase shifted 60 minutes later as compared to participants with non-chronic migraine. Power analyses suggest that future tests for differences in light exposure between migraine-characteristic groups (e.g., differing by headache frequency, severity, or disability) will require sample sizes on the order of 50 to 150 to reach 80% power with an alpha of 0.05.
CONCLUSION: Measuring daily light exposure is feasible in pediatric populations with photophobia and reveals intriguing trends in youth with migraine that warrant further study
Sex-related differences in cognition after severe murine traumatic brain injury: A Morris water maze study evaluating learning and memory.
No full textBACKGROUND: A number of sex-related outcomes following severe traumatic brain injury (TBI) appear to principally favor females. However, sex-related differences in post-TBI learning and memory remain underexplored. We hypothesized that females realize greater cognitive recovery than males following severe TBI.
METHODS: CD1 male (n = 12) and female (n = 12) mice were randomized to controlled cortical impact (severe TBI: impactor tip diameter, 3 mm; impact velocity, 6 m/s; depth, 1 mm; dwell time, 100 milliseconds) or sham craniotomy and followed for 14 days. Body weight loss recovery was measured daily as a surrogate of neuroclinical recovery. Mice underwent Morris water maze testing to evaluate learning (locating submerged escape platform) with cued and spatial trials and to recall (remembering platform location after it was removed) with probe trials.
RESULTS: Compared with uninjured male mice, male mice with TBI failed to recover lost weight for the first 7 postinjury days (i.e., day 5: MTBI: -3.7% ± 1.5% vs. MSh: +4.1% ± 1.4% body weight; p \u3c 0.01), while female mice with TBI recovered the same lost weight and at the same rate as sham female mice (FTBI: -1.6% ± 1.0% vs. FSh: -1.8% ± 0.9%, -0.02% ± 0.01%; p \u3e 0.9). Learning (cued and spatial) after TBI was significantly worse in males but not in females. In probe trials, impaired memory after injury was only observed in females.
CONCLUSION: Severe TBI worsens cued and spatial learning and impairs weight loss recovery in male but not female mice. Female, but not male, mice sustain memory impairment after identical severe TBI. While the mechanism(s) that underpin these observations remain unclear, sex-related neurocognitive outcome differences question the universal applicability of trial-based evidence for clinical care
Vitiligo: Ruxolitinib and Other Oral Treatment Options Beyond Ruxolitinib.
No full textBACKGROUND: Vitiligo is a chronic autoimmune disorder marked by the loss of melanocytes, causing depigmented patches across the skin. Affecting up to 2% of the global population, vitiligo presents significant psychological impacts, particularly in those with darker skin types. Current hypotheses attribute its etiology to autoimmune destruction, genetic predisposition, and environmental triggers like trauma and stress.
MATERIALS AND METHODS: A comprehensive review of recent studies was conducted using PubMed and Google Scholar, focusing on systemic treatments for vitiligo, particularly JAK inhibitors (ruxolitinib, upadacitinib, tofacitinib, ritlecitinib, and baricitinib). Eligible studies included trials and case reports on adults with vitiligo evaluating treatment efficacy, safety, and tolerability.
RESULTS: Topical ruxolitinib has achieved the highest efficacy in repigmenting facial and sun-exposed areas, particularly when combined with phototherapy. Emerging evidence supports oral Janus kinase (JAK) inhibitors, especially upadacitinib and tofacitinib, for their repigmenting effects in refractory cases, though side effects like acne and neutropenia warrant monitoring. Limited evidence supports methotrexate and minocycline as adjunct therapies, with minor repigmentation observed.
CONCLUSION: Advances in systemic and topical JAK inhibitors have shown promising repigmentation effects in vitiligo, particularly for localized facial lesions. Ruxolitinib cream, the first FDA-approved therapy, and other JAK inhibitors highlight a growing therapeutic approach, with ongoing trials needed to optimize efficacy and evaluate long-term safety. Combination therapy with phototherapy shows enhanced repigmentation outcomes
PREVALENCE OF ABNORMAL ECG FINDINGS IN ADOLESCENT FEMALE ATHLETES: A CROSSSECTIONAL STUDY
No full textThe Impact of Climate, Aeroallergens, Pollution, and Altitude on Exercise-Induced Bronchoconstriction.
No full textExercise-induced bronchoconstriction (EIB) with or without underlying asthma is a condition with complex pathophysiology, where many factors play a role in its development and clinical presentation. EIB can be impacted by various environmental factors including climate, environmental allergens, air pollution, and altitude. Although it might be hard to escape one\u27s environment, patients should nevertheless be counseled on how the environment could impact their symptoms. Patient education regarding environmental factors could help overcome impediments to exercise and improve performance