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Assessing Post-Operative Complications in Pediatric Cochlear Implant Surgery
Get PDFCochlear implantation (CI) surgery is the standard of care treatment for pediatric patients diagnosed with severe-to-profound sensorineural hearing loss. There is compelling evidence that supports the use of CIs to improve hearing, language comprehension, and speech development significantly in children of all ages. While the operation is considered relatively safe, invasive procedures involving the skull can put patients at risk of adverse events.
This study aims to help pediatric otolaryngologists identify high risk patients and take preventative measures to ensure minimal complications.
The specific objectives include the following:
1) To determine the incidence of postoperative complications in pediatric patients undergoing CI surgery.
2) To identify the risk factors associated with postoperative complications in pediatric CI surgery
3) To perform a sub-analysis of complication rates among different pediatric age cohorts.
A full-text retrospective chart review was conducted for all pediatric patients that underwent CI surgery at Children’s Hospital of Michigan between August 2016 and June 2021. This cohort study included 72 patients that were presented to this urban pediatric surgery unit. Each patient\u27s comorbidities and complications were then classified as a qualitative variable and SPSS was used to investigate the statistical significance between these variables and demographics such as age cohorts, and postoperative complication risk was calculated using Pearson Chi Squared testing. As surgical techniques, medical devices, and patient guidelines continue to evolve, new data is necessary to understand how complication rates change over time. Pediatric otolaryngologists must be knowledgeable about evidence-based risk factors and complication rates related to CI surgery
Interplay Between Biliary Cyst and Sarcoidosis to Sinusoidal Dilatation with Venous Outflow Impairment
Get PDFIntroduction: Sinusoidal dilatation in liver biopsy has been found to be associated with venous outflow impairment, however, may be caused by different factors. Such observations may be related to systemic issues such as biliary cyst and sarcoidosis. Case Presentation: Lobulated shrunken hepatic morphology may indicate hepatic cirrhosis. Sinusoidal We present a case 65-year-old African American female with a history of elevated liver enzymes, elevated liver enzymes, sarcoidosis, and portal hypertension. Patient has had a past surgical history of cholecystectomy, esophagogastroduodenoscopy, and mastectomy. Liver biopsy was performed showing venous outflow obstruction and sinusoidal dilation with no fibrosis. MRI done showed question of lobulation and 1.7cm liver mass most likely representing a hemangioma. MRI/MRCP showed a biliary structure. Subsequent ERCP and cholangioscopy showed stricture in the common hepatic duct, found to be related to extrinsic compression, likely from the portal vein. Biliary epithelium appeared normal. The patient was treated by performing a biliary sphincterotomy and placement of a biliary stent. No evidence of stricture, mass, or abnormality was noted on the cholangioscopy in the left and right main hepatic ducts. 1-year post-procedure, patient’s MRI showed similar to slight improvement in mild-to-moderate intrahepatic biliary dilation which may relate to a known central stricture. Portal hypertension can result from disrupted hepatic venous outflow, which may have progressed to patient’s indication of cirrhosis. Prior portal vein thrombus may also have been involved, causing portal hypertension and consequent gastrointestinal bleeding. Conclusion: This case highlights venous outflow obstruction and sinusoidal dilatation, in the presence of sarcoidosis and biliary cyst
FLASH Radiation Ultra-High Dose Rate Radiation with Potential for Sensitization by Platinum
No full textExternal beam radiation therapy, a cornerstone in cancer treatment for 50% of patients, poses challenges due to its toxicity to both cancer and healthy cells. Seeking to mitigate side effects, the emerging FLASH radiation technology employs ultra-high dose rates, promising quicker treatments with reduced impact on surrounding normal tissue. Platinum, recognized as a radiation sensitizer, enhances the effectiveness of radiation therapy by increasing sensitization at higher energy levels through pair-production. This study explores the hypothesis that Cisplatin, a platinum-based chemotherapy agent, will exhibit a synergistic effect when combined with FLASH radiation. Using A549 cells from non-small cell lung cancer, the research involves four conditions (conventional with and without cisplatin, FLASH with and without cisplatin) across at least five doses. Intriguingly, results show no obvious platinum sensitization with FLASH, contrary to conventional results. The unique conditions of FLASH radiation, where energy is rapidly deposited and potentially less influenced by the environment, prompt further investigation. Confirmatory studies are underway, aiming to understand the pathophysiology of non-sensitization in FLASH and explore the timing and effectiveness of other known sensitizers and radiation protectors. The end goal is to unravel the sensitization dynamics of FLASH radiation, enabling the maximization of therapeutic effects with minimal side effects in cancer patients
Trauma and Anxiety: The Narratives of Syrian Youth Resettled as Refugees
Get PDFBackground
Civilian war trauma and forced migration are among the most traumatic life experiences. There are approximately 36.4 million refugees worldwide; 40% are children. There is a paucity of mixed methods approaches that quantify properties of trauma narratives of refugee youth. This approach could assist in identifying individuals who could benefit from early clinical care.
Methods
Participants were 68 youth resettled as refugees of Syria in Southeast Michigan ages 7-17 (31F, Mage = 12.85), originally recruited from clinics during health screenings within one month of arrival in the United States. Those enrolled in this study consented to additional data collection and were assessed 1-2 years post-migration. Linguistic Inquiry and Word Count tools analyzed the narratives of youth’s experiences. Participants were asked to recall the overall most hurtful or terrifying event they had ever experienced, and then under their current living situation. Mixed methods approaches were employed to derive thematic elements from trauma narratives.
Results
Pre-migration narratives consisted of violence and loss from experiences in both Syria and Jordan. The top three most frequent word categories were social references, perception, and spatial language. Post-migration narratives consisted of discrimination and bullying, namely at school and in communities. The top three most frequent word categories were social references, perception, and cognition.
Conclusion
Most social interactions children have are at school or school-related functions. Schools have a unique opportunity to mitigate traumatic social experiences. Further funds and teaching are needed to positively shape the social experiences of young people, especially youth resettled as refugees
Investigating Arab American perspectives on barriers to mental health treatment
Get PDFPurpose: Compared to the general population, Arab Americans experience higher rates of mental illness and lower rates of mental health treatment. While some causes of this discrepancy have been suggested, there are many gaps in the literature since Arab Americans are not recognized as an ethnic group in the United States. This study aims to analyze Arab-Americans’ outlook on mental health by identifying and addressing the barriers to receiving mental health treatment.
Methods: An anonymous bilingual Qualtrics survey was conducted and responses were collected from Arab and non-Arab participants (n=294, ages 18+). The participants’ viewpoints on barriers between Arabs and non-Arabs, as well as among Arabs (i.e gender and religion) were assessed.
Results: Arabs were less likely than non-Arabs to seek mental health treatment from a primary care provider or therapist. Cultural stigmas unique to the Arab community were found. For example, Arabs were more likely to endorse the fear of being labeled as crazy as an obstacle in seeking treatment. Treatment cost was another barrier Arabs and non-Arabs faced.
Conclusion: The results provide unique understandings into Arab-American perspectives on mental health, especially relating to treatment barriers. This study also provides a new facet on the mental health preferences of subgroups, such as gender, religion, and age, within the Arab population. This study’s goal is to magnify the importance of identifying the Arab American population as a distinct group and show the value in conducting future studies for a deeper understanding of Arab American cultural effects on health
Improvement of Total Body Weight Loss in a Comprehensive Weight Loss Program at a Community Gastroenterology Practice with Consistent Support Group Attendance
Get PDFIntroduction
Obesity-related gastrointestinal disorders, including non-alcoholic fatty liver disease (NAFLD), account for over 30% of visits to GI practices. Total body weight loss (TBWL) of 10% or more is associated with reversal of NAFLD-associated fibrosis and steatosis. Support groups have proven to help individuals recover from other lifestyle diseases. This study assesses the impact of support group attendance on a patient achieving 10% TBWL while enrolled in a community-based weight loss program.
Methods
Patients participated in a 6-month support group with weekly meetings. TBWL was calculated by taking the difference between the patient’s starting weight and their 6-month weight divided by starting weight. Data was collected retrospectively through chart review. By April 2023, 95 patients completed the support group program. Statistical analysis was performed using ANOVA and Tukey-Kramer post-hoc tests.
Results
The mean percent weight loss was 6.18% for patients with 0-49% attendance, 8.78% for patients with 50-74% attendance, and 13.24% for patients with 75-100% attendance. The ANOVA test revealed a statistically significant difference in mean percent weight loss across the three groups (F(2,92) = 10.299, p \u3c0.001). The Tukey-Kramer test revealed a statistically significant difference in mean percent weight loss between the 0-49% and 75-100% attendance groups (p\u3c0.001) and between the 50-74% and 75-100% attendance groups (p=0.003).
Discussion
The results indicate that patients with at least 75% support group attendance reported significantly higher percent weight loss than patients with lower attendance. This study supports the efficacy of support groups toward achieving weight loss
The Utility of Non-Specific ECG Findings in the Setting of Low High-Sensitivity Cardiac Troponin Levels
Get PDFObjective: Our objective was to assess the relationship between non-specific ischemic electrocardiogram (nsi-ECG) findings and the occurrence of major adverse cardiac events (MACE) within a 30-day timeframe among patients in the Emergency Department (ED) with low high-sensitivity cardiac troponin (hs-cTnI) levels.
Methods: We conducted a secondary analysis of the RACE-IT trial, a randomized trial performed across 9 EDs from July 2020 through March 2021 that looked at the effectiveness of hs-cTnI in evaluating the risk for acute myocardial infarction (AMI). Our study assessed the association between nsi-ECG findings (left bundle branch block, ST-segment changes, or T-wave inversions) and 30-day MACE (death, AMI, heart failure hospitalization, or coronary revascularization) in patients who had AMI ruled out based on low hs-cTnI levels.
Results: 16,606 patients were included in this analysis. Combined, there were 3345 patients with potentially ischemic ECG findings. Thirty-day death or AMI occurred in 66 patients. Death within 30 days occurred in 47 patients, of whom 38 were adjudicated as non-cardiac. There was no difference in MACE events based on potentially ischemic findings (OR 1.38, 95% CI 0.79 - 2.39, p=0.257). The presence of ST-segment changes, however, had a trend towards greater odds of MACE (OR 2.53, 95% CI 0.92 - 6.99).
Conclusion: Non-specific ischemic ECG findings in the setting of low hs-cTnI are not associated with greater MACE events within 30 days of discharge for patients with possible AMIs. The use of nsi-ECG findings should be considered in the context of hs-cTnI levels when evaluating risk for coronary disease
Dwoskin and Me: Halting the Flow of Time
No full textIn this article, I discuss the three experimental autobiographical films that Stephen Dwoskin made between 1994 and 2003: Trying to Kiss the Moon (1994), Some Friends (Apart) (2002), and Francis in Memorium (2003). I first met Dwoskin at the Royal College of Art (RCA) film school in London, England, where I was a student in the 1970s and he was a part-time tutor. We were both Jewish with very different personal histories and experiences, but after I left the RCA, he became a close personal friend. As a disabled American expatriate, he spent most of his adult life looking at the world through a camera lens, filming his friends and lovers, and building an archive of footage that form part of these films supplemented by the extensive home movie footage filmed by his father Henry Dwoskin, a carpenter. My analysis of his films is therefore colored by my own personal recollections of him
The First Insight into Mitochondrial DNA Haplogroup Prediction for the Population Originating from Medieval Bosnia
No full textPopulation genetic studies have shown that the Bosnian-Herzegovinian (B&H) population is a part of the European gene pool, but until now there is limited information about the genetic structure of ancient B&H populations. In this regard, the aim of our study was to determine the frequency and distribution of mitochondrial DNA (mtDNA) haplogroups for medieval Bosnian population. Thirty-four samples, excavated from medieval necropolises located in the B&H according to the borders of medieval Bosnia, were subjected to analysis in this study. Sequencing of the mtDNA HVS1 region and RFLP analysis were performed for haplogroup determination. In our study, all 32 samples were identified as haplogroup H, with subhaplogroups H2a and H5 determined in 30 and 2 samples, respectively. The frequency of H haplogroup was significantly different between the studied samples and previous studies of contemporary populations in B&H, where the H haplogroup frequency was approximately half of that determined in the current study. A significant difference in H haplogroup frequency was also observed in comparison with other medieval populations outside of B&H, where the ancient B&H population is most similar to ancient Italians. Our results provide insight into the mitochondrial landscape of populations that inhabited the territory of present day B&H in the Middle Ages. Our study reveals that inhabitants of Medieval Bosnia carried genetic lineages that exist today in B&H populations suggesting continuity of mtDNA haplogroup over a long period of time, regardless of various historical demographic events that shaped the genetic structure of the modern B&H population