2548 research outputs found
Sort by
The Optimal Prediction Model for Successful External Cephalic Version.
No full textThe majority of breech fetuses are delivered by cesarean birth as few physicians are trained in vaginal breech birth. An external cephalic version (ECV) can prevent cesarean delivery and the associated morbidity in these patients. Current guidelines recommend that all patients with breech presentation be offered an ECV attempt. Not all attempts are successful, and an attempt does carry some risks, so shared decision-making is necessary. To aid in patient counseling, over a dozen prediction models to predict ECV success have been proposed in the last few years. However, very few models have been externally validated, and thus, none have been adopted into clinical practice. This study aims to use data from a U.S. hospital to provide further data on ECV prediction models.This study retrospectively gathered data from Carle Foundation Hospital and used it to test six models previously proposed to predict ECV success. These models were Dahl 2021, Bilgory 2023, López Pérez 2020, Kok 2011, Burgos 2010, and Tasnim 2012 (GNK-PIMS score).A total of 125 patients undergoing 132 ECV attempts were included. A total of 69 attempts were successful (52.2%). Dahl 2021 had the greatest predictive value (area under the curve [AUC]: 0.779), whereas Tasnim 2012 performed the worst (AUC: 0.626). The remaining models had similar predictive values as each other (AUC: 0.68-0.71). Bootstrapping confirmed that all models except Tasnim 2012 had confidence intervals not including 0.5. The bootstrapped 95% AUC confidence interval for Dahl 2021 was 0.71 to 0.84. In terms of calibration, Dahl 2021 was well calibrated with predicted probabilities matching observed probabilities. Bilgory 2023 and López Pérez were poorly calibrated.Multiple prediction tools have now been externally validated for ECV success. Dahl 2021 is the most promising prediction tool. · Prediction models can be powerful tools for patient counseling.. · The odds of ECV success can estimated based on patient factors and clinical findings.. · Of the six tested models, only Dahl 2021 appears to have good predictive value and calibration.
Endoscopic Removal of a Magnet Retained in the Stomach for Two Years: A Case Report and Literature Review.
No full textForeign body ingestion (FBI) is a common clinical presentation, with most cases occurring in children. While accidental FBI in adults is less frequent, it is often associated with psychiatric conditions or substance use disorders. Magnet ingestion is particularly concerning due to the risk of pressure necrosis, perforation, and fistula formation, yet reports of magnet retention in adults are exceedingly rare. We describe a 45-year-old male with a history of depression and substance use disorder who presented with a three-week history of progressive abdominal pain, nausea, bloating, and foul-smelling belching. Imaging revealed a radiopaque foreign body in the distal gastric antrum, later identified as a 2.5 cm metallic disc-shaped magnet. Notably, a prior CT scan performed two years earlier had documented the same object, which the patient had presumed to be a dental filling and expected to pass spontaneously. Esophagogastroduodenoscopy (EGD) successfully retrieved the magnet using a Roth net, with immediate symptom resolution. This case is unique due to the prolonged asymptomatic retention of a magnet for two years before the onset of gastric outlet obstruction symptoms. While most foreign bodies pass spontaneously, endoscopic retrieval is warranted for magnets to prevent potential complications. The prolonged retention without perforation or obstruction highlights the role of anatomic location and object characteristics in determining outcomes. To our knowledge, this is the first reported case of successful endoscopic removal of a long-retained magnet in an adult using a Roth net. This case underscores the importance of considering FBI in the differential diagnosis of unexplained gastrointestinal symptoms, particularly in high-risk patients. Early recognition and intervention are crucial to prevent severe complications. Endoscopic removal remains a safe and effective strategy even for delayed presentations, emphasizing the need for clinical vigilance in cases of unwitnessed FBI
The High-Flow Holiday: A QI Initiative Using a High-Flow Nasal Cannula (HFNC) Weaning Guide to Optimize Safe HFNC Weaning in Children with Bronchiolitis
Full text linkReduction of Postoperative Tracheostomy Related Pressure Injury in a Neonatal and Pediatric ICU
Full text linkUnlocking Prognostic Potential: Biomarker Predictors of Admission and Length of Stay in Pediatric Sickle Cell Vaso-Occlusive Pain Crisis
Full text linkPrenatal Substance Exposure: Data Trends in a Newborn Clinic at an Urban Academic Medical Center
Full text linkR9Q7AZG796 Performance of A Robotic Assisted Laparoscopic Sleeve Gastrectomy in a Patient With Prior Open Loop Duodenojejunostomy for Duodenal Atresia
No full textEllen Pekar University of Pennsylvania; John Fam Tower Health/Drexel University Introduction: A 45 yo female with a history of duodenal atresia repair presented to the bariatric surgery service with a BMI of 47.44. The patient previously underwent an aborted laparoscopic sleeve gastrectomy at an outside hospital. Method: Preoperative EGD obtained. Loop configuration noted in the first portion of the duodenum with two lumens leading into segments of small bowel. UGI obtained confirming a loop configuration. Decision was made to undergo sleeve gastrectomy. Access obtained in the RUQ with 5mm Optiview trocar. Two 8 mm ports placed in the left lateral abdomen. 12 mm port placed supraumbilically. 8 mm port placed in the right lateral abdomen. Extensive adhesiolysis performed taking down gastric, hepatic, and omental adhesions. Liver retracted with a Stratafix. 5 cm from pylorus measured out. Short gastric vessels ligated with a Harmonic. Moderate sized hiatal hernia primarily repaired. •0 Fr Visi G tube placed. Sleeve created with firing of one blue load and several white loads on a Sureform stapler. Results: Patient doing well postoperatively with 26 lb weight loss 2 weeks after surgery. A month out from surgery she continues to do well. Conclusion: It is safe and feasible to perform a robotic laparoscopic sleeve gastrectomy in a patient with prior open loop duodenojejunostomy
Over the Counter (OTC) Dehydroepiandrosterone-Sulfate Supplementation (DHEA-S): A Potential Cause of Low Cortisol Levels
No full textDescription: Case Report: A 33-year-old woman with subfertility presented with 1 month of fatigue and low cortisol levels. She denied low blood pressure, weight changes, or skin hyperpigmentation. Her reproductive history included failed in vitro fertilization treatments and a miscarriage. Labs showed morning cortisol at 0.4 μg/dL and adrenocorticotropic hormone (ACTH) at 20 pg/mL. She disclosed using over the counter dehydroepiandrosterone (DHEA) (100 mg/d, recently increased to 300 mg/d) to enhance fertility, with DHEA-S levels at 400 μg/dL. After stopping DHEA, her cortisol normalized to 14.2 μg/dL, and ACTH normalized to 27 pg/mL. Discussion: Excessive DHEA-S supplementation suppresses cortisol production through feedback inhibition of the hypothalamic-pituitary-adrenal axis. In this case, high-dose DHEA use elevated serum DHEA-S and suppressed cortisol, resulting in transient adrenal insufficiency. Normalization of cortisol and ACTH after stopping DHEA highlights the reversible nature of this suppression. Conclusion: Prolonged or high-dose DHEA-S can suppress cortisol production through a negative feedback mechanism. Healthcare professionals should carefully review medication histories, including over-the-counter supplements. This case underscores the need for more stringent monitoring of unsupervised supplement use
A Gastroenterologist’s Approach to Improving Metabolic Health in MASLD
No full textGastroenterologists are often the first to encounter patients with metabolic dysfunction-associated steatotic liver disease (MASLD), the most common chronic liver disease worldwide. While MASLD can lead to cirrhosis and hepatocellular carcinoma, cardiovascular disease (CVD) remains the leading cause of mortality in this population. This heightened risk is largely driven by the strong association between MASLD and CVD risk factors, including type 2 diabetes, obesity, and hypertension. Therefore, addressing metabolic health is a fundamental component of MASLD management. Gastroenterologists play a key role in identifying metabolic risk factors, recommending lifestyle, and pharmacologic interventions, in consultation with specialists or multidisciplinary care teams when appropriate. This review provides a practical framework for integrating metabolic health optimization into routine MASLD care, equipping gastroenterologists with the necessary tools to improve both liver-related and overall patient outcomes
Twists of the Gut and Genome: A Case of Intestinal Intussusception Revealing Lynch Syndrome in a Young Adult and Literature Review.
No full textAdult intussusception is a rare clinical entity and often indicates an underlying organic pathology, particularly malignancy. Unlike pediatric cases, adult intussusception necessitates oncologic evaluation and surgical management. We present a case of a 32-year-old woman with no family history of colorectal cancer who presented with a three-month history of intermittent abdominal pain, which had worsened recently. Computed tomography imaging revealed a target-like lesion in the cecum and ascending colon, consistent with ileocolic intussusception. Exploratory laparotomy identified a 10 cm intussuscepted segment with a thickened bowel wall and regional lymphadenopathy. A right hemicolectomy with en-bloc resection and lymphadenectomy was performed. Histopathology confirmed a poorly differentiated tubular adenocarcinoma invading the muscularis propria (T2N0M0) without lymph node involvement. Immunohistochemistry demonstrated loss of MLH1, MSH2, and MSH6, consistent with microsatellite instability-high (MSI-H) phenotype. Genetic testing confirmed Lynch syndrome. The postoperative course was uneventful, and the patient was discharged on postoperative day five without the need for adjuvant chemotherapy. Ileocolic intussusception in young adults may be the initial presentation of colorectal malignancy, including hereditary cancer syndromes. Timely surgical resection and genetic evaluation are crucial for diagnosis, staging, and long-term management