2548 research outputs found
Sort by
Factors Associated with Prolonged Length of Intensive Unit Stay Following Mechanical Thrombectomy for Acute Ischemic Stroke
No full textObjective: The objective of the study was to investigate factors affecting the length of stay (LOS) in the intensive care unit (ICU) following mechanical thrombectomy (MT) for acute ischemic stroke. Background: NA Design/Methods: We identified patients undergoing MT from a prospective registry at a comprehensive stroke center between January 2021 and June 2023. ICU stay for more than 48 hours was defined as prolonged ICU stay. Results: Out of 363 patients, 41.6% (n=151) required a prolonged ICU stay. Prolonged ICU stay were more likely to have higher baseline median NIHSS score (19 vs. 14%, p \u3c 0.0001), posterior circulation stroke (12.6% vs. 5.7%, p = 0.0200), intubation for the procedure (86.7% vs. 69.3%, p = 0.0001), complications including pneumonia (18.5% vs. 6.1%, p = 0.0002), deep vein thrombosis (7.3 vs. 2.3, p = 0.0242), urinary tract infection (12.6% vs. 6.1%, p = 0.0326), and symptomatic intracerebral hemorrhage (7.3% vs. 1.9%, p = 0.0109). Patients receiving thrombolysis prior to thrombectomy were less likely to have a prolonged LOS (27.8% vs. 41.7%, p = 0.0086). Independent predictors for prolonged ICU LOC included higher NIHSS (odds ratio [OR] 2.7, p = 0.0002), intubation prior to the procedure (OR 2.7, p = 0.0002), not receiving IV thrombolysis (OR 2.3, p = 0.0069), thrombolysis in cerebral infarction (TICI) score ≥ 2B (OR 0.458, p = 0.0754), composite ICU complications (OR 2.4, p = 0.0027), and symptomatic intracranial hemorrhage (OR 5.2, p = 0.0157). Conclusions: Almost one-third of the acute ischemic stroke patients required a prolonged ICU stay following MT. A better understanding of the factors associated with prolonged ICU stay may assist in appropriate allocation of resources
When Elevated Creatinine Is Not What It Seems: Intraperitoneal Urinary Leak Mimicking Acute Kidney Injury.
No full textAcute kidney injury (AKI) is typically classified as prerenal, renal, or postrenal in etiology, with postrenal often referring to obstructive causes. However, certain uncommon conditions, such as intraperitoneal urinary leaks, may not fit clearly into these categories. In patients with a recent history of pelvic procedure, a complication such as intraperitoneal urinary leak can mimic AKI due to urine reabsorption across the peritoneum. When these leaks present beyond the immediate postoperative period, they can be challenging to diagnose, potentially leading to delayed management and complications. We report the case of a male patient who presented with lower abdominal pain and dysuria four weeks after undergoing radical prostatectomy. His initial evaluation, including urinalysis and imaging, suggested a urinary tract infection (UTI), and he was discharged with antibiotics. Three days later, he returned to the emergency room with persistent symptoms, new-onset diarrhea, and elevated creatinine compared to baseline. He was diagnosed with AKI, presumed to be secondary to dehydration, and received intravenous (IV) fluids. Despite undergoing treatment, his symptoms worsened, with further deterioration in renal function in the absence of a clear cause. An abdominal MRI ultimately revealed a fluid collection behind the bladder, indicative of a urinoma. His symptoms and renal function improved significantly after the Foley catheter placement. Intraperitoneal urinary leaks should be considered in post-pelvic surgery patients with unexplained serum creatinine elevations, as delayed recognition can lead to significant morbidity. This report underscores the importance of including intraperitoneal urinary leaks in the differential diagnosis for patients presenting with AKI following recent pelvic surgeries or procedures
Ascending Colon Ulcerative Mass: An Unusual Manifestation of Ischemic Colitis
No full textIntroduction: Ischemic colitis refers to vascular pathology of the gastrointestinal tract involving vessels like superior mesenteric artery (SMA), inferior mesenteric artery (IMA) and internal iliac arteries. It may include thrombosis, embolic arterial occlusion or non-occlusive colitis often affecting \u27watershed\u27 regions such as hepatic and splenic flexure. It commonly presents as moderate to severe pain, tenderness, and bloody stools. Presentation as a colonic mass is rare and can be mistaken for cancer. We present a case with this unusual presentation. Case Description/Methods: 75-year-old woman with medical history of coronary artery disease with stents, smoking, hypertension, presented with 3 days of right sided abdominal pain with no diarrhea, nausea or vomiting. She had no pain with food intake, no recent illnesses or weight loss. She spiked a low-grade fever of 100.4 F but stable vitals. Physical examination revealed right lower quadrant tenderness only. Laboratory tests showed white cell count of 12.4; all other tests, including lactic acid, were normal. Computed tomography scan of abdomen showed ascending colon wall thickening and adjacent wall stranding, with no enlarged lymph nodes. Gastroenterology performed colonoscopy which showed circumferential ulcerated malignant appearing mass in the proximal and mid ascending colon with biopsies sent. Colorectal surgery was consulted and she was tentatively scheduled for surgical resection. Pathology results showed fibrinopurulent exudate with necrotic colonic mucosa and no malignancy. Surgery was cancelled. A CTA abdomen revealed partial improvement of inflammatory changes in ascending colon and mild to moderate stenosis of SMA and IMA. She was discharged with instructions for adequate hydration and seen by Gastroenterology in outpatient. Follow up colonoscopy in 6 weeks showed complete resolution of the mass. Discussion: Ischemic colitis should be considered as a differential diagnosis in patients with a colonic mass. Notably, about 20% of ischemic colitis cases have coexisting colonic carcinoma [1]. Hence, follow up with imaging and colonoscopy is imperative to assess improvement of ischemia after conservative management. No established guidelines for the timing of follow-up colonoscopy exist. Recommendations suggest repeating the scope within 7-10 days [2], adjusted based on the level of suspicion for cancer. This approach ensures timely detection of potential malignancies and avoidance of unnecessary surgical interventions, which carry long term complications (see Figure 1)
Prevalence and Characteristics of Delusional Infestation in Individuals With Opiate Use Disorders Within One Health System: A Retrospective Cross-Sectional Study.
No full textOBJECTIVE: The recent development of xylazine adulteration of the illicit opiate supply has been associated with necrotic extremity wounds of unclear pathogenesis. This study sought to understand the prevalence and characteristics of delusional infestation (DI) among patients with opiate use disorders who also carried a diagnosis of cellulitis.
METHODS: A retrospective cross-sectional study was performed in one health system to identify patients with opiate use disorder and cellulitis over the past three years who also described symptoms of DI. We collected demographics, comorbid substance use disorder, and psychiatric diseases and calculated the likelihood of association with drug use by applying the Naranjo Adverse Drug Reaction scale.
RESULTS: Fifteen patients (3.2% of all opiate-dependent individuals) were identified as also having DI. All patients had recurrent symptoms of DI, persisting over 18.3 ± 16 months with 4.6 ± 2.3 different health system contacts. The mean age was 44.4 years (range: 25 to 63 years). Twelve were female (80%, chi-square 5.4, p = 0.02). All had open wounds. Psychiatric comorbidities were common, but only two were schizophrenic, and none were actively psychotic during contact with the health system. Symptoms were either definitely (n = 1) or probably (n = 14) associated with drug exposure, according to the Naranjo Adverse Drug Reaction scale. Thirteen (87%) were also abusing other stimulants. All workups were negative for parasites and eosinophilia.
CONCLUSIONS: The prevalence of DI in patients with opiate use disorder was identified as significantly higher than reported in other populations. The role of DI in the formation of skin wounds deserves further study
Association between food insecurity and metabolic dysfunction-associated steatotic liver disease/significant fibrosis measured by fibroscan.
No full textPURPOSE: Studies evaluating food insecurity and metabolic dysfunction-associated steatotic liver disease (MASLD) and significant hepatic fibrosis are currently scarce. We evaluated the characteristics of food insecure individuals and whether food insecurity was associated with MASLD and significant hepatic fibrosis in the US population.
METHODS: In this cross-sectional study from the National Health and Nutrition Examination Survey 2017-2018, 3441 participants with complete data were enrolled. We defined MASLD and significant hepatic fibrosis (≥ F2) by transient elastography in the absence of other causes of liver disease. The detailed questionnaire assessed and categorized food security as high, marginal, low, and very low food security.
RESULTS: Food-insecure subjects were more likely to be female, younger, more impoverished, non-Hispanic blacks, Hispanics, and less likely to be educated, married, and physically active. Food insecurity increased the odds of the prevalence of MASLD by 42% (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.12-1.78) after adjustment for demographic, lifestyle, and metabolic risk factors. The addition of diabetes and obesity did not change this association (OR: 1.36, 95% CI: 1.03-1.78). The multivariable model showed an independent relationship between food insecurity and significant hepatic fibrosis (OR: 1.40, 95% CI: 1.04-1.88) after adjustment for demographic, lifestyle, and metabolic risk factors, although the association was attenuated and changed insignificantly after adjustment for diabetes and obesity.
CONCLUSIONS: Food insecurity was associated with higher odds for MASLD. While there is a relationship between food insecurity and significant hepatic fibrosis, this relationship changed insignificantly after adjustment of diabetes and obesity
Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review.
No full textFertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: \u27transgender persons\u27 and \u27fertility preservation\u27 and \u27adolescents\u27 was conducte
Advancements in gene therapy approaches for atrial fibrillation: Targeted delivery, mechanistic insights and future prospects.
No full textAtrial fibrillation (AF) remains a complex and challenging arrhythmia to treat, necessitating innovative therapeutic strategies. This review explores the evolving landscape of gene therapy for AF, focusing on targeted delivery methods, mechanistic insights, and future prospects. Direct myocardial injection, reversible electroporation, and gene painting techniques are discussed as effective means of delivering therapeutic genes, emphasizing their potential to modulate both structural and electrical aspects of the AF substrate. The importance of identifying precise targets for gene therapy, particularly in the context of AF-associated genetic, structural, and electrical abnormalities, is highlighted. Current studies employing animal models, such as mice and large animals, provide valuable insights into the efficacy and limitations of gene therapy approaches. The significance of imaging methods for detecting atrial fibrosis and guiding targeted gene delivery is underscored. Activation mapping techniques offer a nuanced understanding of AF-specific mechanisms, enabling tailored gene therapy interventions. Future prospects include the integration of advanced imaging, activation mapping, and percutaneous catheter-based techniques to refine transendocardial gene delivery, with potential applications in both ventricular and atrial contexts. As gene therapy for AF progresses, bridging the translational gap between preclinical models and clinical applications is imperative for the successful implementation of these promising approaches
Metformin Continuation Versus Holding Pre and Post Coronary Angiography with Normal Renal Function: A Systematic Review and Meta-Analysis
Get PDFBackground
It is common practice to withhold metformin prior to cardiac catheterization due to fear of developing lactic acidosis in the setting of contrast-associated acute kidney injury (AKI). The evidence behind this recommendation is currently weak.
Methods
We collected 851 articles from PubMed and Embase, of which 3 met our inclusion criteria. Inclusion criteria were age \u3e 18 years, baseline use of long-term metformin with continued or interrupted metformin use in patients during diagnostic or interventional cardiac catheterization. The outcomes studied were differences between post-catheterization and pre-catheterization serum creatinine (SCr) and glomerular filtration rate (GFR). We excluded studies dealing with patients not on long-standing metformin and those in which contrast exposure was through contrast enhanced computerized tomography. We used Hedges’s g with inverse variance method to pool standard mean difference with a random effects model using meta-cont module in CRAN-R software with 95% confidence interval (CI) for statistical significance. Higgins I-squared (I²) statistic was used to evaluate heterogeneity.
Results
. Post-catheterization serum creatinine (Hedges’s g = -0.12 mg/dL; CI = -0.83 to +0.6, p = 0.75, I2 = 95%), post-catheterization GFR (Hedges’s g = +0.18 mL/min; CI = -0.76 to +1.11, p = 0.71, I2 = 97%) and post-catheterization lactate levels (Hedges’s g = +0.03 mg/dL; CI = -0.66 to +0.72, p = 0.75, I2 = 95%) failed to reach statistical significance.
Conclusions
There is no statistically significant difference in SCr or GFR between patients who held metformin prior to cardiac catheterization and those who continued taking the medication
Impact of the COVID-19 pandemic on hospitalizations with hepatocellular carcinoma in the United States.
No full textBACKGROUND: We studied the temporal trends of hepatocellular carcinoma (HCC)-related hospitalizations and potential predictors of in-hospital mortality around the COVID-19 pandemic.
RESEARCH DESIGN AND METHODS: Using the International Classification of Diseases code, we used the National Inpatient Sample 2019-2020 and defined HCC and its underlying etiology. To assess the impact of the COVID-19 pandemic on hospitalization and in-hospital mortality, the study period was divided into the pre-COVID-19 era (2019 Q1-2020 Q1) and the COVID-19 era (2020 Q2-2020 Q4). Quarterly trends in etiology-based hospitalizations with HCC and predictors of in-hospital mortality among hospitalizations with HCC were determined.
RESULTS: Hospitalization rates for HCC, as well as viral hepatitis-related HCC hospitalization rates, remained stable, while hospitalizations with alcohol-related liver disease (ALD, quarterly percentage change [QPC]: 2.1%; 95% confidence interval [CI]: 0.1%-4.2%) increased steadily. Hospitalization related to nonalcoholic fatty liver disease (NAFLD)-related HCC increased significantly steeper in the COVID-19 era (QPC: 6.6%; 95% CI: 4.0%-9.3%) than in the pre-COVID-19 era (QPC: 0.7%; 95% CI: 0.2%-1.3%). COVID-19 infection was independently associated with in-hospital mortality among hospitalizations with HCC (odds ratio: 1.94, 95% CI: 1.30-2.88).
CONCLUSION: Hospitalization rates for viral hepatitis-related HCC remained stable, while those for HCC due to ALD and NAFLD increased during the COVID-19 pandemic
