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A Simple Intervention Improves Access to Telemedicine for Spanish-Speaking Families in an Outpatient Pediatric Epilepsy Clinic.
No full textTelemedicine has become an established modality of care in pediatric neurology since the COVID-19 pandemic made it a necessity. However, prominent barriers have persisted for socially vulnerable families, including non-English-speaking families. In a cohort of Spanish-speaking families, we assessed the effect of an educational intervention in improving patient portal activation and use of telemedicine by doing a retrospective observational study. Among the 69 families assessed, 42 did not receive intervention, including 74% who already had patient portals and 26% without portal activation, and none of those 11 families subsequently activated the portal or underwent telemedicine. Among 27 families who received the intervention, 85% activated the portal, including 87% who participated in telemedicine visits. Results did not achieve statistical significance for accessing telemedicine but did for activating the portal. We postulate that a simple, brief educational intervention was effective in increasing access to neurologic telemedicine care in non-English-speaking families
Association of Body Surface Area versus Body Mass Index on Outcomes in Peripheral Arterial Disease.
No full textBACKGROUND: Numerous studies have indicated that increased obesity in patients with established peripheral artery disease (PAD) is inversely associated with disease prognosis, a phenomenon coined as the obesity paradox . A major cause of criticism in studies investigating the obesity paradox is the use of body mass index (BMI) as a surrogate marker in defining and quantifying the degree or severity of obesity. We conducted a retrospective review to verify whether the obesity paradox persists in patients with PAD when using body surface area (BSA) as an alternative anthropometric measure.
METHODS: Patients undergoing surgery (open or endovascular) for PAD between January 2009 and March 2020 were identified from the Vascular Quality Initiative (VQI) national database. The association between BSA or BMI and risk of postoperative complications was evaluated using logistic regression and restricted cubic spline analysis, both of which were adjusted for demographic and comorbid risk predictors. When analyzing BSA and BMI as categorical variables, patients were grouped according to BSA quintiles and the World Health Organization (WHO) BMI categories.
RESULTS: A total of 130,428 patients were included based on our eligibility criteria, of which 85,394 (65.5%) were men. Patients were typically hypertensive (87.8%), diabetic (50.4%), and overweight (63.0% over 25 kg/m
CONCLUSIONS: Our data suggests that the obesity paradox persists in patients with PAD when using either BMI or BSA as anthropometric measures. Future studies with a prospective design and utilizing newer anthropometric indices should be conducted to fully verify the presence of this phenomenon
THE ROLE OF CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY IN THE TREATMENT OF PERITONEAL METASTASIS FROM COLON AND RECTAL CANCER
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Optimizing palatal fistula repair: CLAPP Hospital\u27s institutional experience tracking success and recurrence in 510 cases over 3 years.
No full textBACKGROUND: Palatal fistula repair remains a persistent challenge in cleft care, with recurrence rates ranging from 10% to 30% globally. Despite the numerous techniques described, outcomes remain variable. Therefore, identifying predictors of recurrence is critical to guide individualized, evidence-based surgical strategies.
METHODS: This retrospective observational cohort included 510 patients who underwent palatal fistula repair over a three-year period at a high-volume cleft center (CLAPP Hospital, Lahore, Pakistan). Patients were categorized as presenting with either primary or recurrent fistulae. Demographic, anatomical, and surgical variables were recorded. Predictors of recurrence were evaluated using univariate and multivariate logistic regression, with outcomes reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI).
RESULTS: Among 510 patients, 345 had primary fistulae and 165 had recurrent fistulae. The overall recurrence rate was 12.5%. Older age was significantly associated with recurrence on univariate analysis (median 12 vs. 7 years; p \u3c 0.001) but did not remain significant after adjustment. Recurrent fistula at presentation independently predicted further recurrence (aOR 1.83, 95% CI: 1.01-3.30; p = 0.045). The Bardach two-flap repair, employed in 72.4% of the cases, was associated with higher recurrence compared to flap-based techniques (aOR 0.50, 95% CI: 0.24-0.96; p = 0.047). Larger size and greater anatomical extent were significant only in univariate analysis, indicating that appropriate surgical technique selection mitigated risk.
CONCLUSION: Recurrent fistulae and Bardach repair independently predicted recurrence, whereas flap-based approaches reduced failure rates. These findings reinforce the importance of risk-adapted surgical planning, intraoperative decision-making, and standardized treatment pathways. Multicenter registries and longer-term follow-up are needed to further optimize outcomes in palatal fistula repair
Prospective COPD Case Finding in a Lung Cancer Screening Program: A Pilot Study.
No full textBACKGROUND: Chronic obstructive pulmonary disease (COPD) remains underdiagnosed and undertreated. Because screening asymptomatic individuals for COPD is not recommended, several case-finding tools have been explored. The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) questionnaire and peak expiratory flow (PEF) rate (CAPTURE tool) have been tested in the primary care setting, with disappointing results. We hypothesized that these tools could yield better results in a computed tomography lung screening (CTLS) program, where individuals have a history of cigarette smoking and higher prevalence of COPD.
METHODS: We recruited 67 patients referred to a CTLS program at a single institution. Participants completed the CAPTURE and COPD Assessment Test (CAT) questionnaires. Spirometric testing was completed with a portable device and low-dose chest computed tomography (CT) was performed according to a standard protocol.
RESULTS: The group\u27s mean age was 66 ±7 years, 43% were male, with a 37 pack-year smoking history. Eighteen (27%) had COPD (forced expiratory volume in 1 second of 60 ±22% predicted) and a higher CAT score (12 [interquartile range (IQR) 6-15]) compared to the nonobstructed group (CAT=7 [IQR 3-10]),
CONCLUSIONS: The CAPTURE tool is an effective method to find COPD cases in lung cancer screenings. A CT diagnosis of emphysema can substitute peak flow in this population
Pheochromocytoma in a Patient With Chronic Hypotension: A Case Report.
No full textPheochromocytomas are neuroendocrine tumors that commonly present with hypertension, headache, palpitations, perspiration, and facial flushing. The diagnosis is typically made with imaging demonstrating an adrenal mass and elevated metanephrines and normetanephrines. The recommended treatment is medical optimization and adrenalectomy. Here, we present the case of a patient referred to our surgical oncology clinic with diagnostic challenges due to chronic hypotension and only heart palpitations. She was found to have a peripherally located adrenal mass extending over the renal hilum with an otherwise normal adrenal gland. Elevated plasma and urine normetanephrines were found, so the patient underwent complete resection of the tumor with en bloc adrenalectomy and was ultimately found to have a pheochromocytoma. After surgery, she has no evidence of disease and has had resolution of palpitations