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Carotid and Vertebrobasilar Manifestations of COVID-19
No full textCoronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome with spikelike proteins projecting from the surface of the virus, hence the name of the virus. Most coronaviruses that affect humans typically cause self-limited mild symptoms. These viruses have the capacity to jump between species triggering emergence of new viruses such as the Middle East respiratory syndrome (MERS) coronavirus and severe acute respiratory syndrome (SARS-CoV-1 and SARS-CoV-2) (Umakanthan S et al., Postgrad Med J 96:753–8, 2020). The latter is the infectious agent responsible for coronavirus disease 2019 or COVID-19. This clinical syndrome is thought to have emerged in December 2019 in Wuhan, China. Within months, it spread around the world, becoming a pandemic and leading to one of the biggest health and economic challenges humanity has faced in the last century. According to the World Health Organization (WHO), by mid-2024, over 760 million cases and 6.9 million deaths have been recorded worldwide since its discovery, although the actual number is thought to be higher. Over 13 billion vaccines have been administered as of June 2023
Patient- vs Technologist-Controlled Mammography Compression: A Prospective Comparative Study of Patient Discomfort and Breast Compression Thickness
No full textOBJECTIVE: We assess whether mammographic patient-assisted compression (PAC) has an impact on breast compression thickness and patient discomfort compared with technologist-assisted compression (TAC).
METHODS: A total of 382 female patients between ages 40 and 90 years undergoing screening mammography from February 2020 to June 2021 were recruited via informational pamphlet to participate in this IRB-approved study. Patients without prior baseline mammograms were excluded. The participating patients were randomly assigned to the PAC or TAC study group. Pre- and postmammogram surveys assessed expected pain and experienced pain, respectively, using a 100-mm visual analogue scale and the State-Trait Anxiety Inventory. Breast compression thickness values from the most recent mammogram were compared with the patient\u27s recent prior mammogram.
RESULTS: Between the 2 groups, there was no significant difference between the expected level of pain prior to the mammogram (P = .97). While both study groups reported a lower level of experienced pain than was expected, the difference was greater for the PAC group (P \u3c .0001). Additionally, the PAC group reported significantly lower experienced pain during mammography compared with the TAC group (P = .014). The correlation of trait/state anxiety scores with pre- and postmammogram pain scores was weak among the groups. Lastly, the mean breast compression thickness values for standard screening mammographic views showed no significant difference in the PAC group when compared with the patient\u27s prior mammogram.
CONCLUSION: Involving patients in compression reduces their pain independent of the patient\u27s state anxiety during mammography while having no effect on breast compression thickness. Implementing PAC could improve the mammography experience
Photodynamic Therapy: Clinical Applications in Dermatology
No full textPhotodynamic therapy (PDT) is a non-invasive treatment modality that uses photosensitizers in conjunction with a light source to induce therapeutic effects mediated in part through reactive oxygen species. PDT can be used as monotherapy or in combination with other treatments. In the United States, PDT is approved by the Food and Drug Administration for the treatment of actinic keratoses and is utilized off-label for other dermatologic conditions. Studies show that PDT has a favorable safety profile and, in order of level of evidence, has been used to treat actinic keratoses, basal cell carcinoma, cutaneous squamous cell carcinoma in situ, acne, port wine stains, cutaneous infections, photoaging, actinic cheilitis, mycosis fungoides, rosacea, alopecia areata, and Extramammary Paget disease. Part II of this CME provides a comprehensive overview of dermatologic clinical applications of PDT. Understanding the expanding evidence-based applications of PDT is crucial for dermatologists to ensure patient safety and optimize patient outcomes through tailored treatment protocols. Herein, we provide clinical descriptions of how to treat various dermatologic diseases using PDT so that clinicians may incorporate PDT into their practice
Utility of N-Terminal Pro-B-Type Natriuretic Peptide -to-Troponin and BNP-to-Troponin Ratios for Differentiating Type 1 from Type 2 Myocardial Infarction: A HIGH-US Sub-Study
No full textBACKGROUND: Differentiating type 1 myocardial infarction (T1-MI) from type 2 MI (T2-MI) remains a diagnostic challenge, even with the availability of high-sensitivity cardiac troponin assays. This study explored whether NT-proBNP, BNP, and their respective ratios to troponin could enhance the ability to distinguish between these MI subtypes.
METHODS: As a HIGH-US sub-study, we examined data from 280 patients diagnosed with non-ST elevation myocardial infarction (172 with T1-MI and 108 with T2-MI). We assessed NT-proBNP, BNP, hs-cTnI, and their ratios as potential discriminative biomarkers. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curves.
RESULTS: NT-proBNP levels were markedly elevated in T2-MI patients compared to those with T1-MI (mean 10,327±12,923 vs 4,675±11,740 ng/L; P=0.006). Conversely, hs-cTnI concentrations were higher in T1-MI (1.4±5.1 vs 0.5±1.1 ng/L; P=0.030). Notably, the NT-proBNP-to-troponin ratio was more than three times greater in T2-MI cases (94,880±152,648 vs 24,209±78,727; P=0.007). NT-proBNP alone demonstrated fair discriminatory capacity (AUC 0.717, 95% CI 0.578-0.856), closely matching the NT-proBNP-to-troponin ratio (AUC 0.720, 95% CI 0.566-0.873). In contrast, BNP and the BNP-to-troponin ratio offered lower diagnostic values. Mean BNP levels were 505.4 ±576.6 ng/L for those with T2-MI and 437.1 ±738.8 ng/L for patients with T1-MI. BNP-to-troponin ratio showed a poor discrimination for the 2 MI types (AUC, 0.660; 95% CI, 0.532-0.789).
CONCLUSIONS: Both NT-proBNP and its ratio to troponin show potential in differentiating T1-MI from T2-MI, reflecting distinct underlying pathophysiological processes. Given its comparable performance to the ratio, NT-proBNP alone may serve as a practical and cost-effective standalone marker. These findings support the hypothesis that incorporating NT-proBNP testing into routine clinical workflows may better informs the management of patients with suspected MI
Comparative outcomes of percutaneous coronary intervention in ST-elevation myocardial infarction: an analysis by infarct-related coronary artery
No full textImpact of Coronary Dominance on Atrioventricular Node Ablation Approach
No full textPersistent atrial fibrillation often requires atrioventricular node (AVN) ablation when conventional rhythm - or rate-control strategies are unsucessful, but procedural outcomes may be influenced by anatomic variability. We hypothesized that coronary artery dominance affects AVN positioning and the preferred ablation approach. In this retrospective study, 132 patients who underwent AVN ablation and coronary CTA were analyzed. Right coronary dominance was present in 78.8% of patients, left in 13.6% and co-dominant in 7.6%. Patients with left or co-dominant circulation had significantly higher odds of requiring a left-sided approach compared with right-dominant patients (21.4% vs 1.9%, p\u3c 0.001), and demonstrated longer mean procedure time (50 vs 34 minutes, p = 0.044). These findings suggest that coronary dominance may influence AVN localization and ablation strategy. Incoroporating coronary dominance assessment into preprocedural imaging may enhance procedural planning, shorten duration and reduce radiation exposure
To build a better VAD: What is needed to make MCS truly competitive with cardiac transplantation for long-term outcomes?
No full textWhile average survival in patients undergoing durable left ventricular assist device (dLVAD) support now approximate 6 years, the application of therapy remains limited across the globe. Herein we highlight important deficiencies common to present technology and propose device innovations and field corrections that will be necessary to improve acceptance of dLVAD support by both patients and medical providers caring for patients with end-stage heart failure. Pragmatic trials will also be needed to help identify the therapeutic strategy (permanent dLVAD support vs heart transplant vs dLVAD as a bridge to transplant) that affords the best outcomes for a patient\u27s risk profile and total survival goals
Birth outcomes among pregnant people with treated and untreated perinatal mood and anxiety disorder (PMAD)
No full textSocioenvironmental factors associated with shrimp allergy and shrimp sensitization in a large and diverse patient population and cohort study from metropolitan Detroit
No full textBACKGROUND: Earlier studies have demonstrated significant differences in food allergy by race and ethnicity, particularly for seafood and shrimp. Shrimp allergy is particularly interesting given the potential for cross-reactive sensitization from other arthropods.
OBJECTIVES: We characterized risk factors for shrimp allergy and shrimp sensitization.
METHODS: Data from electronic health records were abstracted for food allergies among patients who sought care at a large health system between October 1, 2010, and April 1, 2024. Geocoded addresses were linked to US Census data to identify characteristics associated with shrimp allergy. Non-Hispanic Black participants from the Study of Asthma-Related Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE) were assessed for allergic sensitization using an IgE array, and survey data collected from participants were evaluated for association with shrimp, cockroach, and dust mite sensitization.
RESULTS: Among 2,975,183 health system patients, 4,709 individuals reported shrimp allergy. Compared to White individuals, rates of shrimp allergy were significantly higher in Black, Asian/Pacific Islander, Native American, and Latino individuals. Shrimp allergy was higher with increasing age, female sex, and asthma, and it was inversely related to median household income. Among SAPPHIRE participants, sensitization to shrimp, cockroach, and dust mite was positively associated with total IgE levels and proportion of African ancestry, but inversely associated with head of household level of education.
CONCLUSIONS: Both shrimp allergy and sensitization were associated with sociodemographic factors, suggesting that environmental exposures leading to cross-reactive sensitization may be important risk factors. Nevertheless, sensitization was also associated with ancestry, highlighting the potential importance of group-specific genetic risk factors
Delphi consensus on melasma management by international experts and pigmentary disorders society
No full textBACKGROUND: Melasma, an acquired hyperpigmentation disorder, affects individuals of all ethnicities. Its multifactorial aetiology, high recurrence rates and psychosocial impact complicate management and necessitate comprehensive, evidence-based recommendations.
OBJECTIVES: The objective was to develop an international consensus on the diagnosis and management of melasma by synthesizing expert opinions and the latest scientific evidence.
METHODS: This consensus was developed using a modified Delphi approach. A core group of two senior dermatologists who were experts in pigmentary disorders guided the process, and a diverse panel of 38 dermatologists with a special interest in pigmentary disorders from 11 countries (Australia, Brazil, France, India, Italy, Mexico, Philippines, South Africa, South Korea, Taiwan and the USA) participated in three rounds of surveys and discussions, under the aegis of the Pigmentary Disorders Society (PDS). A literature search of articles published between 2014 and 2024 identified key studies that were graded using the Oxford levels of evidence (2009). Consensus statements were drafted, refined and finalized based on expert feedback. Responses were assessed using a 5-point Likert scale, with predefined thresholds for high (≥75%), moderate (55%-74%) and low (\u3c 55%) agreement.
RESULTS: The consensus development process started with 34 statements, and at the end of the third round of the Delphi process, 21, 4 and 1 statement reached high, moderate and low consensus, respectively. Key recommendations highlighted photoprotection with broad-spectrum sunscreens as essential, regulated and supervised use of hydroquinone-based triple combination creams as the gold standard, and alternatives such as topical azelaic acid, kojic acid and oral tranexamic acid. Adjunctive procedural therapies, such as chemical peels and microneedling, were suggested to enhance topical efficacy, while lasers were reserved for refractory cases.
CONCLUSION: These recommendations aim to improve the outcomes of melasma patients globally by integrating expert opinion and evidence-based strategies. Future research should focus on evaluating emerging therapies and optimizing long-term maintenance strategies