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Comparing experiences of WIC participants and non-participants in navigating family food choices during the COVID-19 pandemic: A qualitative study
Get PDFBack to bedside: Renal point-of-care ultrasonography (POCUS) by internal medicine resident physicians for identification of hydronephrosis in patients with acute kidney injury.
No full textBACKGROUND: Point-of-care ultrasonography (POCUS) has rapidly emerged as a valuable diagnostic tool in various medical conditions, including acute kidney injury (AKI) in the Western healthcare system. Its utility in the Middle East and Asian healthcare setups remains under-explored. This study aimed to assess the effectiveness of POCUS, performed by internal medicine residents (IMRs), in diagnosing hydronephrosis in AKI patients at a tertiary care training hospital in Qatar.
METHODS: We conducted a pilot prospective cross-sectional study from June 2021 to September 2021, enrolling adult patients admitted with AKI in the acute medical assessment unit (AMAU) via convenience sampling. IMRs received mandatory POCUS training (including a 30-minute didactic teaching session and supervised performance of renal POCUS scans). The primary outcome was the detection of hydronephrosis, with findings compared to departmental renal ultrasound scans performed by the radiologists.
RESULTS: Fifty patients were included, with POCUS identifying hydronephrosis in five out of nine patients with confirmed hydronephrosis via official departmental renal ultrasound, demonstrating a sensitivity of 83.3% and specificity of 93% for POCUS performed by IMRs. Hydronephrosis via bedside POCUS scans had clinically reliable positive and negative predictive values (55.6% and 98%, respectively). Cohen\u27s kappa was 0.7 (0.45-0.94), indicating substantial agreement. One patient whose renal POCUS was reported as normal by IMR was identified to have hydronephrosis on an official departmental renal ultrasound.
CONCLUSION: This study demonstrated the effectiveness of adequate training in improving the diagnostic skills of residents using POCUS for bedside detection of hydronephrosis in patients with AKI in a residency program from the Middle East. Residency programs that include POCUS training have the potential to significantly increase bedside diagnostic capabilities with improved quality of training and patient care
Patterns and implications of missed injuries on computed tomography imaging in older blunt trauma patients.
No full textBACKGROUND: Older adults sustain disproportionately morbid injuries from low energy mechanisms, yet guidance around computed tomography imaging is lacking for this demographic. We hypothesize that current imaging practices may lead to potentially missed injuries, increasing morbidity and mortality.
METHODS: A secondary analysis of a prospective multicenter study (11/2020-12/2021) of older blunt trauma patients was performed. Suboptimal imaging was defined as a mismatch between final injury diagnosis and initial computed tomography imaging. We compared optimally vs not optimally imaged patients to determine factors associated with suboptimal imaging and examined mortality, hospital length of stay, and critical care use with a multivariable logistic regression.
RESULTS: Among 5,496 patients from 18 trauma centers (median age 79), 5,023 (91.4%) were optimally imaged, and 473 (8.6%) were suboptimally imaged initially. Falls (75.1%) were the predominant injury mechanism. Computed tomography imaging was performed in 95% of cases. Most potentially missed injuries were in the thoracic and lumbar spine. Suboptimally imaged patients had higher mortality and longer median hospital stays. Patients imaged prior to transfer (odds ratio 1.39, 95% confidence interval 1.04-1.87, P = .027) or not triggering full or limited trauma activations (odds ratio 1.64, 95% confidence interval 1.09-2.45, P = .017) were more likely to have missed injuries.
CONCLUSIONS: More than 1 in 12 older blunt trauma patients received suboptimal computed tomography imaging initially. Our findings suggest that clinicians should maintain heightened awareness when evaluating older trauma patients as consults, those transferred from other facilities, or those facing language barriers, as these factors were associated with suboptimal imaging practices
Comprehensive Gynecologic Care of the Transfeminine Patient.
No full textAs visibility of transfeminine individuals increases, so does the need for inclusive and competent gender-affirming health care. Regardless of a patient\u27s stage during their transition, gynecologists are essential health care providers for transfeminine patients. With the proper education and training, gynecologists can provide gender-affirming hormone therapy, assess and manage postoperative complications, and conduct routine health screening. The goal of this article is to provide an overview of available feminizing hormone therapies and effects, review feminizing surgical procedures, discuss the management of their complications, and highlight evidence-based screening recommendations for transfeminine patients
Actinomyces Odontolyticus Cavitary Pneumonia in a Vape Smoker
No full textBackground Actinomyces species are facultative anaerobes that naturally inhabit the human oral cavity, colon, and vagina. Actinomycosis, a rare chronic granulomatous infection, typically arises in immunocompromised individuals. It\u27s classified by the anatomical site involved, with the 3 main subtypes being cervicofacial (60%), abdominal (20%), and pulmonary (15%). Risk factors for pulmonary actinomycosis include poor oral hygiene, aspiration risk, underlying lung disease, and immunocompromise.A recent report by Massey et al. linked marijuana vaping to pulmonary actinomycosis. Here, we describe a case of cavitary pneumonia caused by A. Odontolyticus in an otherwise healthy young woman who underwent a recent dental procedure and does nicotine vaping.Case PresentationWe\u27re presenting a case of a 48-year-old female with a history of obesity, opioid abuse on methadone therapy and a 5-year history of vape smoking who presented to the hospital for an evaluation of dry cough and shortness of breath that started 1 week prior to her presentation. Patient didn\u27t have signs of respiratory distress, was Afebrile and saturating 87% on room air. Chest x-ray showed bibasilar opacities so, a CT angiography of the chest was done showing patchy ground-glass opacification suggestive of pneumonia with a left lower lobe cavitary lesion with air-fluid level suggestive of an abscess. She was started on broad-spectrum antibiotics and underwent bronchoscopy with bronchoalveolar lavage with brush. Culturing the lavage grew a pure Actinomyces Odontolyticus. The patient was started on penicillin V for 3 months. Upon further history taking, the patient stated that she underwent a recent root canal treatment. She denied dental pain and there was no discharge up on examination.DiscussionThis case illustrates a rare instance of pulmonary actinomycosis caused by Actinomyces Odontolyticus in an otherwise healthy young woman following dental work and vape smoking. While it can rarely present as a pulmonary infection in immunocompromised individuals, A. Odontolyticus infection in this patient suggests that a recent dental manipulation and vaping may have facilitated bacterial entry and lung infection.Risk factors are crucial when considering Actinomyces pulmonary involvement because of its propensity to mimic other pulmonary inflammatory or neoplastic conditions. While the treatment is readily available, the diagnosis remains a challenge with a correct diagnosis on initial presentation being as low as 4%. While smoking is a known risk factor for respiratory infections this case adds to emerging evidence that vaping may similarly predispose healthy individuals to commensal oral flora causing pulmonary infections
Exploring nationwide trends in multiple myeloma (MM), autologous stem cell transplants (ASCTs), chimeric antigen receptor T-cell (CAR-T) therapy and coronavirus disease 2019 (COVID-19) in hospitalizations from 2017 to 2021.
No full textBackground:MMrepresents approximately 17% of hematologic malignancies. Several newMM treatments have been approved over the years. This study explores trends in MM hospitalizations. Methods: This retrospective cross-sectional study utilizes the National Inpatient Sample data for 2017 to 2021. We included hospitalizations of adults with MM identified by ICD10 codes. We used chi-square test, Kruskal-Wallis H test, Cochran Armitage trend test and other tests as appropriate. The results are statistically weighted. Results: From 2017 to 2021, 598510 hospitalizations had a diagnosis of MM. Annual hospitalizations were 117040, 122325, 127140, 114410, and 117595 for 2017, 2018, 2019, 2020, and 2021 respectively. Results are reported chronologically. Median length of stay(LOS) was 5 days for all years. Median total hospitalization charges(TOTCHG) (in ≥) trended up: 44935, 46869, 49365, 53895, and 59447 (P,0.001). Inpatient Deaths (IPD) trended up: 5455 (4.7%), 5795 (4.7), 6175 (4.9), 6500 (5.7), and 7115 (6.1) (P,0.001). In 2020 and 2021, 1170 and 1665 deaths were COVID-19 positive. 5360 (4.7%) and 7690 (6.5) hospitalizations in 2020 and 2021 were COVID-19 positive. Treatmentassociated pancytopenias trended up: 14350 (12.3%), 15710 (12.8), 15335 (12.1), 14615 (12.8) and 15525 (13.2) (P,0.001). Intensive Care Unit (ICU) requirements trended up: 5205 (4.4%), 5920 (4.8), 6135 (4.8), 6610 (5.8) and 6420 (5.5) (P,0.001). Hypogammaglobulinemia (HG) trended up: 1970 (1.7%), 2290 (1.9), 2605 (2.0), 2205 (1.9) and 2570 (2.2) (P,0.001). Transfusions trended down: 21210 (18.1%), 20145 (16.5), 19755 (15.5), 18795 (16.4) and 18885 (16.1) (P,0.001). Pathologic fractures remained stable at 1.1% (6415 over 5 years). Hospitalizations for ASCTs trended up: 6185, 6625, 6410, 6425, and 6415 (P = 0.011). IPD during ASCT remained stable: 60 (1%), 50 (0.8), 50 (0.8), 40 (0.6), and 60 (0.9) (P = 0.586). In 2020 and 2021, 5 and 20 deaths were COVID-19 positive (P,0.001). 15 (0.2%) and 45 (0.7) ASCT hospitalizations were COVID-19 positive in 2020 and 2021. The median LOS for ASCT was 16 days. Median TOTCHG (≥) stayed relatively stable: 168602, 164636, 169490, 165354, and 168591. In 2021, 145 hospitalizations noted administration of CAR-T therapy. IPD was 0.COVID-19 positivity was 0. Median LOS was 10 days. Median TOTCHG was ≥1700293. Conclusions: With newer treatments, MM outcomes have improved. Outcomes in hospitalized MM patients present a more complex picture, as demonstrated by rising IPD, ICU, and HG. TOTCHG trended up forMMbut was stable for ASCT. LOS remained stable. Transfusion requirements declined over time. These results may represent the impact of COVID-19 and of newer treatments, requiring higher-acuity care
Disparities During Family-Centered Rounds for Families Using Languages Other Than English.
No full textBACKGROUND/OBJECTIVE: Patient- and family-centered rounds (PFCR) have become a pediatric standard of care. However, rounds experiences of families using languages other than English (LOE)-particularly languages other than English or Spanish (LOES; eg, Arabic)-receive less focus. We aimed to identify differences in PFCR communication and engagement by language.
METHODS: We analyzed postintervention data from a 21-center structured PFCR study, assessing communication practices, quality, and family and nurse engagement during PFCR. Logistic regression adjusted by site compared PFCR between families using (1) LOE vs English, (2) Spanish vs English, and (3) LOES vs English.
RESULTS: Among 3051 PFCR encounters, 348 (11.4%) involved LOE (Spanish = 260; LOES = 85). Interpretation was not used in 7.2%, 5.8%, and 9.4% of encounters using LOE, Spanish, and LOES, respectively. PFCR in the following groups had lower adjusted odds (adjusted odds ratio [95% CI]) for the following domains: (1) LOE vs English: including providing verbal patient summaries (0.66 [0.46-0.95]), explaining diagnoses and differentials (0.62 [0.44-0.88]), family engagement (0.34 [0.20-0.57]), nursing inclusion (0.75 [0.60-0.93]), and nursing engagement (0.69 [0.52-0.90]). (2) Spanish vs English: diagnoses/differentials being explained (0.56 [0.37-0.85]), family engagement (0.35 [0.18-0.67]), nursing inclusion (0.77 [0.59-1.00]), and nursing engagement (0.68 [0.52-0.89]). (3) LOES vs English: families sharing concerns (0.66 [0.47-0.93]), family engagement (0.30 [0.16-0.54]), and nursing inclusion (0.74 [0.55-0.99]).
CONCLUSION: Even after implementing a PFCR intervention, families using LOE-especially LOES-experienced significant disparities in communication and engagement. Future approaches to improving PFCR should emphasize language access and promote nurse and family engagement for families using LOE, particularly LOES
Giant Prolactinoma: Challenges in Management
No full textBackground/Objective: Prolactinomas are the most common form of pituitary adenomas, 90% of which are microprolactinomas measuring \u3c 1 cm. A giant prolactinoma is defined as a prolactinoma measuring \u3e4 cm with a serum prolactin level of \u3e1000 ng/mL. We report a case of giant prolactinoma causing optic nerve compression that initially responded well to cabergoline and later developed intratumoral hemorrhage requiring transsphenoidal resection. Case Report: A 47-year-old man presented with blurry vision and intermittent headaches for 6 months. Visual field (VF) testing demonstrated bitemporal VF defect, which prompted magnetic resonance imaging of brain that showed a 4.1 × 3.1 × 3.1–cm pituitary macroadenoma with suprasellar extension compressing the optic chiasm. Laboratory evaluation revealed an increased prolactin level, low testosterone level, inappropriately normal luteinizing hormone level, and follicle-stimulating hormone level consistent with central hypogonadism. Cabergoline 0.5 mg twice weekly was started. Repeat VF testing and prolactin level in 4 weeks after starting cabergoline showed improvement. Nine months later, his symptoms worsened, and repeat magnetic resonance imaging showed intratumoral hemorrhage and that the size of the tumor had increased. He underwent an emergent transsphenoidal resection. After surgery, he developed central adrenal insufficiency and central hypothyroidism requiring steroid and thyroid hormone replacement. Discussion: Only a few cases of giant prolactinomas have been reported, and no clear guidelines for management of giant prolactinomas have been established. First-line medical management includes dopamine agonists such as cabergoline and bromocriptine. Conclusion: The dilemma between medical management and surgical management occurs during initial presentation of giant prolactinoma with VF defect. Our case report highlights the challenges and complications encountered in the treatment of a patient with giant prolactinoma
