Jacobs Institute of Women's Health
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Treatment for a rare case of phenazopyridine-induced methemoglobinemia: a case report and mini-review
No full textMethemoglobinemia is a condition caused by elevated levels of methemoglobin (MetHb) in the blood, a reduced form of hemoglobin that cannot properly bind to oxygen, interfering with delivery to tissues. If left untreated, this condition can be fatal. Phenazopyridine, an over-the-counter urinary tract analgesic, has been reported to cause methemoglobinemia in rare instances. In the present case, a 67-year-old patient demonstrated hypoxia and oral cyanosis in the setting of chronic phenazopyridine use and chronic obstructive pulmonary disease (COPD). A chocolate-brown coloration of his blood and an elevated MetHb level of 14.5% confirmed the diagnosis of methemoglobinemia. He was treated with methylene blue, ascorbic acid, bronchodilators, steroids, and supportive oxygen. This regimen led to a gradual improvement in the patient\u27s clinical condition, including his hypoxia, cyanosis, and MetHb levels. This report illustrates a rare, unique case of phenazopyridine-induced methemoglobinemia and acute hypoxic respiratory failure in a patient with pre-existing COPD. In such patients, effective management requires a careful treatment approach directed at both methemoglobinemia and COPD
A Retrospective Review of Tracheal Intubation of Obstetrical Patients, Incidence and Associated Factors
No full textTracheal intubation (TI) of an obstetrical patient around the time of delivery can be an upsetting event for involved providers. It can also cause an unpredictable use of intensive care resources. Its incidence is currently poorly characterized in the literature. We analyzed the 2019 National Inpatient Sample (NIS) to assess the incidence rate and associated risk factors. Patients were identified by International Classification of Diseases, 10th edition codes for delivery of a child. Measured endpoints were the incidence of TI and factors associated. Categorical variables were compared using Chi squared or Fisher\u27s Exact. Continuous variables were compared using the Student T-test or the Mann Whitney rank sum U-test. A logistic regression model was created to determine the odds for each variable contributing to TI. A P value of 0.05 was considered the minimum standard for significance. There was a low rate of TI (0.03%). Mortality was rare (0.004%) and there was a higher rate of mortality among patients who underwent tracheal intubation (5.5% vs 0.003% among patients not intubated, P \u3c .001). The majority of intubations occurred among patients who delivered via CD. Pneumonia, cardiomyopathy, eclampsia, and postpartum hemorrhage were all independently associated with increased odds for TI. There are risk factors which may increase the likelihood for tracheal intubation. The diagnosis of a cardiomyopathy was strongly associated with an increased odds for TI and may result from acute respiratory failure. PPH and eclampsia were also associated with a greater odds for intubation
Insights From Seven Communities Improving Eldercare for Their Populations
No full textBACKGROUND: Older adults\u27 experiences when living with disabilities largely depend upon fragmented, uncoordinated arrangements for medical and supportive services in their community. Many separate organizations provide these services in the U.S., but no overarching entity is responsible for assessing quality, equity, continuity, supply or cost - or for addressing shortcomings. METHODS: We initially aimed to aggregate data from care plans across local provider organizations; but inadequate care planning and digital documentation, and non-existent interoperability of records across providers, made this impossible. We proceeded to partner with seven communities to test improving eldercare community-wide through collaborative efforts guided by data. We provided a readiness assessment, technical assistance, and eventually insights from Medicare administrative data and other national datasets. RESULTS: Descriptive narrative data elucidated overarching themes, lessons learned, challenges, and areas for future research. From 57 applicants, seven selected organizations developed local collaborations and improved some aspect of eldercare. Organizations faced challenges in finding useful whole-population data and faced uncertain authority and limited sustainability of their coalitions and interventions. We ultimately developed geographic eldercare metrics from Medicare data and other sources to support these communities and future efforts. CONCLUSIONS: Implementing eldercare improvement for geographically defined populations is possible. Future demonstrations should test this approach more broadly, and those demonstrations should facilitate data access to guide interventions and should establish the authority of a respected entity, broadly representative of stakeholders, to take responsibility for the performance of local arrangements
Letter to the Editor: New Current Procedural Terminology Codes for Radiofrequency Ablation of Thyroid Nodules Will Negatively Affect American Patients According to the Executive Council of the North American Society for Interventional Thyroidology
No full textTreatment of focal anaplastic Wilms tumor: A report from the Children\u27s Oncology Group AREN0321 and AREN03B2 studies
No full textBACKGROUND: In the fifth National Wilms Tumor Study, patients received vincristine and dactinomycin (VA) without radiation for stage I focal anaplastic Wilms tumor (FAWT) and VA plus doxorubicin (DD4A) and radiation for stage II-IV FAWT. Four-year event-free survival (EFS) and overall survival (OS) for stage I FAWT were 67.5% and 88.9% and for stage IV FAWT were 61.4% and 71.6%, respectively. Therapy intensification for stage I and IV FAWT was evaluated as secondary objectives in AREN0321. METHODS: Central review in the AREN03B2 Renal Tumors Classification, Biology, and Banking Study confirmed patient stage and tumor histology. Patients were then enrolled in AREN0321 and received DD4A with radiation for stage I-III FAWT and vincristine, doxorubicin, cyclophosphamide, carboplatin, and etoposide (UH-1/revised UH-1) with radiation for stage IV FAWT. Outcomes of patients with FAWT who were treated in AREN0321 (n = 25) and in AREN03B2 (n = 20) treated as per AREN0321 were analyzed. RESULTS: In the pooled data analysis from AREN0321 and AREN03B2, 4-year EFS and OS were both 100% for stage I-II FAWT (n = 21), 82.4% (95% CI, 66.1%-100%) and 87.8% (95% CI, 73.4%-100%) for stage III FAWT (n = 17), respectively, and both 85.7% (95% CI, 63.3%-100%) for stage IV FAWT (n = 7). Four patients enrolled in AREN0321 had events: treatment failure occurred in three patients with stage III FAWT, and one treatment-related death was observed in a patient with stage IV FAWT following revised UH-1. No EFS or OS events occurred in patients with FAWT enrolled in AREN03B2 only. CONCLUSIONS: Patients with stage I and II FAWT have outstanding survival when treated with DD4A and radiation. Intensification of therapy may have improved survival for stage IV FAWT, albeit with an increased toxicity risk
Time to weight plateau with tirzepatide treatment in the SURMOUNT-1 and SURMOUNT-4 clinical trials
No full textThe rate of weight reduction during obesity treatment declines over time and eventually reaches a weight plateau. We investigated factors associated with time to weight plateau (TTWP) in tirzepatide-treated participants with obesity or overweight in a post-hoc analysis of SURMOUNT-1 and SURMOUNT-4 trials. Participants adherent to tirzepatide treatment and achieving ≥5% weight loss by primary endpoint (week 72 SURMOUNT-1; week 88 SURMOUNT-4) were included. Weight plateau was defined as a weight change \u3c5% over a 12-week interval and all subsequent 12-week intervals. TTWP was time from randomization to the start of the first 12-week interval. Association between baseline characteristics and TTWP was assessed. Overall, 1438 participants in SURMOUNT-1 and 259 in SURMOUNT-4 were included. Across BMI categories (overweight, class I, II, and III), median TTWP in SURMOUNT-1 was 24.3, 26.0, 36.1, and 36.1 weeks, respectively (p \u3c.05, class II and III vs. overweight). By week 72%, 90.2%, 88.9%, 87.6%, and 87.8% of participants in SURMOUNT-1 had reached a weight plateau across respective BMI categories. Higher doses of tirzepatide (10/15 mg), younger age, and female sex were more likely to reach a weight plateau later. Results in SURMOUNT-4 were similar. In this post-hoc analysis, most participants reached a weight plateau by week 72. Higher doses of tirzepatide, younger age, and female sex were associated with a longer TTWP. Further research into modifiers of weight reduction phases with tirzepatide may inform treatment decisions for its use in chronic weight management. Clinical Trial Registration: ClinicalTrials.gov, identifiers NCT04184622 (SURMOUNT-1) and NCT04660643 (SURMOUNT-4), available at http://www.clinicaltrials.gov/
Cannabis use characteristics and associations with problematic use outcomes, quitting-related factors, and mental health among US young adults
No full textOBJECTIVE: Given the changes in trends of cannabis use (e.g., product types), this study examined latent classes of young adult use and associations with use-related outcomes. METHODS: We analyzed 2023 survey data among 4,031 US young adults (M=26.29, 59.4% female, 19.0% Hispanic, 13.5% Black, 13.6% Asian). Among those reporting past-month use (48.8%), latent class analysis (LCA) indicators included: days used (1-5; 6-20; 21-30), use/day (1; 2-4; ≥5), and type usually used (herb/flower; edibles; oils/vape; concentrates/other). Multivariable regressions examined class in relation to problematic use, quitting-related factors, and mental health, controlling for sociodemographics and state non-medical cannabis laws. RESULTS: LCA identified 4 classes of cannabis use frequency and types used: \u27infrequent-herb/edibles\u27 (41.4%), \u27frequent-herb\u27 (16.8%), \u27moderate-herb\u27 (28.0%), and \u27moderate-oil/other\u27 (13.8%). In multivariable analyses (referent group: \u27moderate-herb\u27 class), \u27frequent-herb\u27 reported less problematic use (B=-0.18, 95%CI=-0.30, -0.07), while \u27moderate-oil/other\u27 reported greater (B = 0.39, 95%CI = 0.27, 0.51). \u27Infrequent-herb/edibles\u27 had lower odds of driving post-use of cannabis (aOR = 0.28, 95%CI = 0.22, 0.37) and cannabis/alcohol (aOR = 0.52, 95%CI = 0.35, 0.76), whereas \u27frequent-herb\u27 (aOR = 1.52, 95%CI = 1.02, 2.28) and \u27moderate-oil/other\u27 (aOR = 3.98, 95%CI = 2.72, 5.82) reported greater odds of driving post-cannabis/alcohol use. \u27Moderate-oil/other\u27 reported higher quitting importance (B = 0.59, 95%CI = 0.17, 1.01), while \u27frequent-herb\u27 reported lower (B=-0.33, 95%CI=-0.99, -0.18). \u27Infrequent-herb/edibles\u27 reported higher quitting confidence (B = 0.56, 95%CI = 0.20, 0.92), whereas \u27frequent-herb\u27 (B=-1.01, 95%CI=-1.45, -0.57) and \u27moderate-oil/other\u27 (B=-1.27, 95%CI=-1.74, -0.81) reported lower. \u27Infrequent-herb/edibles\u27 reported fewer mental health symptoms (B=-0.55, 95%CI=-0.93, -0.17), while \u27moderate-oil/other\u27 reported more (B = 1.03, 95%CI = 0.53, 1.52). CONCLUSIONS: Preventing frequent and moderate use of cannabis, particularly of oils/concentrates, is crucial given the potential negative implications for problematic use, quitting, and mental health
Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients
No full textBACKGROUND: Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability. This study aimed to compare the 30-day perioperative outcomes of frail patients undergoing OIHR with either GA or LA. METHODS: Patients who underwent initial OIHR were identified in the ACS-NSQIP database from 2005-2021. Patients with a Modified Frailty Index (mFI)≥2 were included. Patients were divided based on GA or LA administered. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients undergoing OIHR under GA or LA. RESULTS: Among 20,129 frail patients who underwent initial OIHR, 13,473 had GA, and 3686 had LA. The 30-day mortality rates for LA and GA were low. However, frail patients who underwent LA had a lower risk of bleeding (aOR 0.282, P=0.04), superficial surgical site infection (aOR 0.450, P=0.03), and discharge not to home (aOR 0.792, P\u3c0.01). In addition, frail patients who underwent LA had shorter operation time (58.42±25.26 vs 67.60±37.17 mins, P\u3c0.01) and a shorter length of stay (0.45±2.30 vs 0.57±2.96 days, P\u3c0.01). CONCLUSION: Although GA is the dominant anesthesia use (4:1) in OIHR among frail patients, LA emerges as a safe alternative to GA for these patients, offering potential benefits such as reduced complications and increased day-case surgery volume, which may be associated with decreased healthcare costs