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Effect of Disease Modifying Therapy on Erythropoietin Levels in Patients with Sickle Cell Disease
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Receipt of Services for Transition from Pediatric to Adult Health Care Among Youth with Chronic Medical Conditions: A Cross-Sectional Analysis of the 2022 National Survey of Children’s Health
Get PDFBarriers to Pediatric Emergency Care in Low-Resource Settings: A Narrative Review.
No full textPediatric emergency care in low- and middle-income countries (LMICs) faces critical challenges, leading to preventable morbidity and mortality. Limited resources, inadequate infrastructure, workforce shortages, and socioeconomic disparities strain the healthcare system. This narrative review identifies key barriers, including insufficient healthcare infrastructure, a lack of trained professionals, and restricted access to essential medical supplies and emergency services. Financial constraints, caregiver health literacy gaps, and technological limitations, such as poor EMR systems and limited telemedicine, further hinder care. Geographical barriers delay interventions, especially in rural areas with poor transportation. Weak healthcare policies contribute to fragmented care, necessitating urgent reform. Solutions include strengthening infrastructure, expanding pediatric emergency training, leveraging digital health technologies, and reducing out-of-pocket expenses. Community engagement and caregiver education are crucial for timely access, whereas global collaboration is vital for resource mobilization and sustainable improvements in LMICs\u27 pediatric emergency care
Crisis within a crisis: A CDC WONDER analysis of the pandemic\u27s impact on cancer and cardiovascular mortality
No full textBackground: Cancer and cardiovascular disease (CVD) are leading global causes of mortality, often coexisting and worsening outcomes. This study examines how the pandemic impacted mortality rates in individuals with cancer and CVD, comparing pre- and post-COVID-19 periods. By analyzing mortality patterns, we explore the interplay of these diseases during the global health crisis. Methods: Using CDC WONDER data (2018-2023), we analyzed adults ≥25 with cancers (ICD-10: C00-D48) and CVD (ICD-10: I00-99). Age-adjusted mortality rates (AAMRs) were calculated for pre-COVID (2018-2019), during COVID (2020-2021), and post- COVID (2022-2023), with percent changes stratified by demographics and geography. Results: We observed a 12.1% rise in CVD mortality in adults with cancer during COVID, followed by a 2.3% increase post-COVID, resulting in a 14.6% net rise from pre-COVID levels. Females (16.5%) had a higher mortality increase than males (13%). Non-Hispanic (NH) American Indians experienced the largest increase during COVID (14.8%), followed by NH Whites (12.6%), NH Blacks (12.6%), NH Asians (12.4%), and Hispanics (11.7%). Post-COVID, NH American Indians saw a decline (-6.4%), while NH Asians (-0.9%) and Hispanics (-0.6%) were stable; NH Blacks (2.4%) and NH Whites (3%) had a modest increase. Adults ≥65 years were most impacted, with a 15.5% rise in mortality compared to 45-64 years (11%) and ,45 years age groups (10.8%). All census regions experienced increases during COVID (Northeast: 7.6%, West: 11.1%, South: 14.1%, Midwest: 14.4%). Post-COVID, mortality declined in the Northeast (-0.1%) and Midwest (-0.2%) but rose in the South (5.7%) and West (1.3%). States with the highest AAMRs before, during, and post-COVID remained consistent: Oklahoma, Nebraska, and Mississippi. Conclusions: The COVID-19 pandemic contributed to rising cancer and CVD mortality rates, especially among females, NH Whites, older adults, and the South. These trends emphasize the need to address disparities, strengthen preventive care, and build resilient healthcare
The Silent Tension: A Case of Pheochromocytoma
No full textDescription: Background/Objective: Pheochromocytoma is a rare endocrine disease, with incidence rates per 100 000. Classic findings include hypertension, palpitations, and headaches. Typical signs can be absent in some cases. Case Report: A 51-year-old woman with a history of anxiety with depression on buspirone and aripiprazole presented for follow-up of adrenal nodule. Prior imaging of 2017 showed a nodule 1.1 cm, which had grown to 2.2 cm in 2022. She denied prior history of hypertension and is not on any antihypertensive medications. She has reported episodes of orthostatic hypotension but denies episodes of sweating, palpitations, or chest pain. She reported intermittent headaches but denied cushingoid symptoms. Physical examination showed stable vitals and no abnormalities to palpation or vision. Laboratory results obtained showed a dehydroepiandrosterone sulfate level of 26.6 mcg, total metanephrine level of 1289 mg, urine metanephrine level of 819 mg (greater than 2 times the upper limit), and plasma metanephrine level of \u3e5 times the upper limit (although the medication could induce high levels, this would not induce 5 times the limit). The urine norepinephrine level was 37 mcg, and the urine epinephrine level was 11 mcg. For reference, the normal dehydroepiandrosterone sulfate level in a woman aged 50 to 60 years is 26 to 200 mcg, The normal urine metanephrine level for that same age range is 400 mcg, and the plasma metanephrine level for that same age range is 400 to 600 mcg. The norepinephrine level in urine is 10 to 35 mcg, and the urine epinephrine level is 0 to 20 mcg. Computed tomography of the abdomen with adrenal protocol (HU) showed a right adrenal mass shadowing an absolute washout value of 46.5% and a relative washout value of 27%. An absolute washout of \u3c 60% and relative of \u3c 45% indicate benign adrenal masses. Repeat urine studies continued to slow metanephrine levels greater than 2 times the upper limit. Based on these studies, patients were placed on appropriate alpha- and beta-blocker regimen and referred for surgery. Discussion: Pheochromocytoma is usually observed in patients with hypertension. However, patients can have normal pressures or episodes of orthostatic hypotension. With the advent of routine use of imaging, presymptomatic diagnosis of pheochromocytoma occurs in greater than 60% of patients. Conclusion: For patients with a family history or personal history of hypertension, if cardinal symptoms of pheochromocytoma are absent but mood disorders, diaphoresis, and tachycardia during panic attacks occur, this should prompt imaging and workup for pheochromocytoma. Case Report: Identifying Pheochromocytoma in a woman with normotension, history of anxiety disorder, and episodes of orthostatic hypotension. Discussion: A diagnosis of normotension or hypotension does not rule out pheochromocytoma. Conclusion: With high suspicion for pheochromocytoma, prompt workup should be initiated
