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Influence of Epidemiological Factors on Eye Injuries in Texas: A Five-Year Retrospective Analysis
Get PDFBackground: Eye injuries in the United States represent a significant public health concern with their potential to cause long-term disability, economic burden, and reduced quality of life. Injuries to the eye can range from minor abrasions to severe contusions, lacerations, and fractures, with some leading to permanent vision loss. Preliminary data also suggests disparities in the availability of ophthalmologists across Texas cities which raises the question of whether cities with higher rates of eye injuries are staffed with enough specialists. In Texas, where the population is both geographically and demographically diverse, understanding the epidemiological factors behind eye injuries is crucial for further prevention, treatment, and identifying areas where access to care is most needed.
Methods: Using the Texas Department of State Health Services (DSHS) Database data from 2018 - 2022, we performed a retrospective analysis of eye injury cases reported statewide using the ICD-10 codes for injury of eye and orbit (S05) and fracture of the orbital floor (S02.3). The key variables included demographic information (sex, age), severity, cause of injury, and incident location by ZIP codes and population density organized by Public Health Regions (PHR). Statistical analyses were conducted using R software. This included chi-square tests and frequency analysis. A p-value below 0.05 was considered significant.
Results: We identified 9,243 patients with eye injuries in our dataset. Within this population, young adults accounted for the highest frequency of eye injuries (29.9%); however, the elderly had significantly higher proportions in the Minor severity category (17.43%). Eye injuries were more frequent in males (69%) compared to females (31%). Despite this, the severity distribution was similar between sexes, with males experiencing Moderate (7.5%) and Severe (2.0%) injuries, compared to females with Moderate (5.4%) and Severe (1.7%) injuries. The distribution of orbital fractures across Texas was not random, with PHR 10 – El Paso showing the highest density of eye injuries at 759 per 100,000 people (59.2%), followed by PHR 1 with 55 per 100,000 people, accounting for 9% of the distribution. Additionally, assaults leading to eye injuries were more frequent than motor vehicle accidents, with a difference of 2.1% in frequency.
Conclusion: Overall, we found that males and young adults exhibited the highest frequency of eye injuries; this could be due to increased exposure to high-risk activities. Additionally, assault accounted for more eye injuries than motor vehicle accidents. Further investigation is necessary to assess the availability of specialists in regions with high rates of eye injuries. Cross-referencing this data can help allocate ophthalmic care to areas that need it most
Who Leaves Orthopedics? Analyzing Attrition Among Texas Orthopedic Surgeons
Get PDFBackground: Nationally, attrition rates in surgical specialties have been reported to be as high as 20-26%. As of 2019, women comprised only 6.5% of the 29,613 orthopedic surgeons. Female residents showed significantly higher overall attrition rates compared to males (5.96% vs. 2.79%, p \u3c 0.001), with unintended attrition nearly twice as high (2.09% vs. 1.01%, p \u3c 0.001). Attrition can result from a wide array of variables, including sex, ethnicity, education, and background. The aim of this study was to evaluate the demographic and educational factors associated with career longevity beyond training among orthopedic surgeons, with a focus on identifying patterns of attrition in underrepresented groups.
Methods: Data from the Texas Medical Board Physician Database as of September 2024 was evaluated using Microsoft Excel. To determine length of practice, the date of license issuance was subtracted from the date of license expiration. Surgeons with license expirations after 2024 were excluded to maintain a focus on physicians that are no longer practicing. Entries with missing or blank data fields were excluded from the analysis. Demographic variables, including sex, medical degree type (MD v. DO), and medical school origin (International Medical Graduate (IMG) vs. U.S. medical graduate (US, Canada, Puerto Rico) were reviewed and were examined.
Results: This study examined factors influencing orthopedic surgeons’ career longevity, with comparisons made using chi-square analysis. Key variables included gender, race, and educational background. Attrition was highest in the first 10 years post-licensure across all demographics. Only 10% of surgeons in this range were non-white minorities. Female surgeons had a 10-year attrition rate of 80.8% (p \u3c 0.001), compared to 40.9% (p = 0.154) for males. White surgeons displayed no significant deviations across practice duration, especially in the first ten years of practice (884 observed vs. 913 expected, p=0.332). Minorities exhibited greater attrition earlier in their careers (Asian, p \u3c 0.001; Black, p = 0.007). This trend reversed after 20 years when comparing IMGs at 19.4% (p \u3c 0.001) versus U.S. graduates at 12.2% (p = 0.280).
Conclusion: Female orthopedics experience disproportionately high attrition rates within the first 10 years of practice, underscoring systemic challenges such as family planning pressures, workplace discrimination and lack of support. Similarly, racial minorities show high early-career attrition rates, pointing to barriers such as discrimination and isolation within the field. IMG surgeons exhibited lower long-term attrition rates than their U.S. counterparts, potentially reflecting the resilience cultivated through more challenging training and licensure pathways. This study is limited by its inclusion of recent graduates who may inflate attrition rates and its lack of data on geographic and employment transitions. Addressing these gaps could provide a more comprehensive understanding of the factors influencing career longevity
Influence of Epidemiological Factors on GCS Score of Traumatic Brain Injury Cases in Texas: A Five-Year Retrospective Analysis
Get PDFBackground: Traumatic brain injury (TBI) is caused by an external force and can result in temporary or permanent brain function impairment. In 2019 and 2020, it was estimated that TBI resulted in ~220,000 hospitalizations and ~64,000 deaths in the United States making TBI a significant public health concern. Of note, patients living in the southern states have been shown to have the highest TBI related fatalities per 100,000 population, with Texas ranking second for the number of TBIs in the United States. Limited epidemiological studies have evaluated possible causes for the increased prevalence and severity of TBI in southern states. As a first step, here we sought to understand the relationship between Glasgow Coma Scale (GCS) and demographic factors from a large cohort of TBI cases in Texas to better assess different risk factors associated with TBI incidence.
Methods: Using publicly available data from the Department of State Health Services (DSHS) trauma database from 2018 to 2022, we collected data for subjects that were diagnosed using ICD10 code S06 for TBI. All TBI cases in our data set were assessed for multiple variables including age, sex, ethnicity, cause of injury, and total Glasgow Coma Scale (GCS) scores. Classifications for Injury Type and Consciousness Status were derived from the S06 ICD10 code information. Data analyses were conducted using R (version 4.4.1) (R Core Team, 2024). A p value below 0.05 was considered significant.
Results: We identified 66,431 cases of TBI in our dataset. We first evaluated the relationship between GCS and age. We found that age was a significant predictor of the GCS score (r = .21, p \u3c .001; F(1, 52069) = 2386, p \u3c .001), with older populations showing an increased GCS score. Furthermore, GCS scores were significantly different between male and female patients, with female patients having a higher GCS score (χ²(1, N = 52075) = 476.88, p \u3c .001). The mean GCS score for male patients was 12.49 (SD = 4.27), while the mean for female patients was 13.40 (SD = 3.42). We assessed GCS scores across six ethnic groups and found significant differences among some (χ²(5, N = 49,740) = 203.99, p \u3c .001). Specifically, Black patients had lower GCS scores compared to Asian, Hispanic, Other/Mixed, and White patients (p \u3c .05), while Hispanic patients had higher scores than both Black and White patients (p \u3c .05).
Conclusion: Our results suggest that epidemiological differences in GCS scores exist in TBI patients in the state of Texas. We found that women and older individuals had more protection from the impact of TBI with higher GCS scores. Interestingly, Hispanics had significantly higher GCS scores than other ethnicity groups. Our data suggests that certain populations may have less severe TBI at presentation, exhibiting a delayed onset of symptoms. Future work will evaluate the influence of cause of injury and injury severity score (ISS) on our observed trends
Investing in Limb Preservation: A Case Report in Avoiding Bilateral Amputation in a Vasculopathy Patient
Get PDFBackground: Limb salvage and prosthetics play vital roles in restoring function and mobility for patients with severe injuries or metabolic conditions. Limb salvage involves surgical techniques aimed at preserving a limb rather than resorting to amputation, while prosthetics provide artificial devices to replace lost limbs. Key considerations for limb salvage include restoring a functional foot, maintaining patient independence, minimizing hospitalizations, and avoiding bilateral lower limb amputations.
Case Presentation: The patient, already at single-limb status, presented with a necrotic heel ulcer, exposed calcaneus, and necrotic Achilles tendon. After vascular optimization, the risks and benefits of final aggressive measures were discussed, leading to consent for a partial calcanectomy. The procedure utilized a silo-technique with triple antimicrobial bone cement for the residual heel, including curettage of an aneurysmal bone tumor and evacuation of necrotic tissue. Exposed, tunneled structures were covered with collagen wound matrix*, followed by meshed bilayer wound matrix** to support dermal coverage of exposed heel. Negative pressure wound therapy (NPWT) and a modified external fixation device “SALSAstand” were employed to offload the heel [1]. Inpatient spot grafting addressed compromised tissue viability due to central bleeding at the bone site, using dehydrated flaked fish-skin graft. Throughout the postoperative period, careful management of bleeding risks guided local wound care before frame removal. Multiple grafts were applied due to wound size and depth of vital structures, resulting in gradual healing, with notable improvements in tissue tone and turgor. The wound fully healed over approximately six months, initiating rehabilitation followed by two months of prosthetic gait training through physical therapy. After nearly two years of frequent hospitalizations, the patient has regained functional independence.
Conclusion: This case study illustrates the successful management of a vasculopathic patient at high risk for below-knee amputation (BKA) after already experiencing one within the past year. Following bypass surgery, aggressive measures were essential to salvage the remaining limb without compromising the vascular graft. Once healed, the patient transitioned to rehabilitation focused on strength and mobility, primarily for prosthetic gait training on the contralateral limb. This case highlights the critical importance of multidisciplinary management in limb salvage, emphasizing meticulous surgical techniques, surgical offloading, comprehensive rehabilitation strategies, and effective resource allocation for successful limb salvage outcomes
Anti-NMDA Receptor Encephalitis Associated with Ovarian Teratoma in a Pediatric Patient: A Case Report
Get PDFBackground: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rare autoimmune condition caused by antibodies targeting NMDA receptors in the brain. The condition was first described in association with ovarian teratomas in 2005; however, it was in 2007 that the condition was further identified as an anti-NMDA receptor-mediated encephalitis. These antibodies disrupt synaptic function by internalizing NMDA receptors, leading to a wide range of neuropsychiatric symptoms such as mood changes, seizures, and autonomic dysfunction. The incidence of autoimmune encephalitis, including anti-NMDAR variants, has increased from 0.4 to 1.2/100,000 person-years over the past two decades due to improved detection of antibody-positive cases. Although the condition primarily affects young women, pediatric cases are increasingly recognized; however, the novelty of this condition in children, in association with a nonspecific presentation, can lead to delays in diagnosis and treatment. Early intervention with tumor resection and immunotherapy significantly improves prognosis and reduces long-term complications.
Case Presentation: A 12-year-old Hispanic female presented with acute mood changes, insomnia, and a generalized tonic-clonic seizure. Initial evaluation in the emergency department resulted in a misdiagnosis of psychogenic seizures. Persistent symptoms prompted further evaluation at a major medical center. Cerebrospinal fluid analysis revealed elevated antiNMDAR antibodies, confirming the diagnosis. Pelvic ultrasound and MRI revealed a 2.1 cm dermoid cyst in the right ovary, clarifying the association. The patient underwent a laparoscopic oophorectomy, which successfully removed the teratoma. She also received high-dose corticosteroids and symptomatic management with anti-seizure medications. Post-operatively and prior to discharge, the patient\u27s neuropsychiatric symptoms, including mood and speech disturbances, were completely resolved. At a follow-up with her primary care physician, just two months after the initial presentation of symptoms, the patient demonstrated sustained recovery with no recurrence of symptoms.
Conclusion: Anti-NMDAR encephalitis is a rare yet treatable condition that requires prompt recognition and comprehensive management. This case underscores the importance of practitioners having heightened clinical awareness of this condition and considering it in the differential diagnosis of pediatric patients with unexplained, nonspecific neuropsychiatric symptoms. The rising incidence of cases due to improved diagnostic capabilities also emphasizes the importance of clinical awareness. This case contributes to the growing body of evidence demonstrating the variability in the presentation of this condition in pediatric patients and that early intervention, including tumor removal and immunotherapy, described in this case, demonstrates that the patient can reach a complete resolution of symptoms
Impact of Diabetes Mellitus on Shoulder Arthroplasty Outcomes: A Systematic Review of Postoperative Complications
Get PDFBackground: In modern day, diabetes is one of the most common chronic diseases in the United States and worldwide, ranking as the seventh leading cause of death in the United States. Worldwide, 1 in 11 adults have diabetes mellitus and the prevalence is expected to increase from 415 to 642 million by the year 2040. Diabetes mellitus (DM) may also increase the risk of complication in various surgeries, such as shoulder arthroplasty. Shoulder arthroplasty is increasing in popularity; however, various pre-existing medical comorbidities can increase the risk of complications from this procedure such as DM. The primary objective of this study is to gather information from current literature to best summarize the effects on DM on shoulder arthroplasty outcomes, specifically deep vein thrombosis (DVT), infection, and length of stay. We hypothesized that diabetes would increase the rates of the analyzed shoulder arthroplasty outcomes. Methods: To conduct a literature review, a PubMed search was performed using the keywords “Diabetes” and “Shoulder Arthroplasty.” Only studies published between 2015 to 2024 were considered, yielding 170 articles. Articles that did not address both diabetes and shoulder arthroplasty were excluded. The search was then refined to focus specifically on post-operative complications such as DVT, general infections, and extended length of stay (LOS). Ultimately, 26 research papers were selected for analysis, examining how these complications affect diabetic patients undergoing shoulder arthroplasty. Results: Diabetes mellitus is associated with an increased risk of postoperative complications following shoulder arthroplasty (TSA), particularly DVT, extended hospital stays, and infections. DM and obesity increased the risk of postoperative DVT following TSA, with DM showing a higher risk (OR: 1.38; p = 0.007) and obesity linked to increased 90-day complications (p = 0.02). Metabolic syndrome did not significantly affect DVT incidence (p = 0.991), highlighting the need for preoperative optimization in diabetic and obese patients. Most studies also highlighted diabetes as a risk factor in patients who had increased length of stay. Other cohort studies found significantly longer stays for diabetic patients compared to non-diabetic patients\u27 post-shoulder arthroplasty. Regarding infection, it is unclear whether DM increases the risk of various infections following shoulder arthroplasty as some studies show an increased risk while others show no effect. However, studies have shown that obesity increases the risk for infections following shoulder arthroplasty which may be worth considering as diabetic individuals tend to have a higher BMI than nondiabetic individuals. Conclusion: The present systematic review concerning the impact of diabetes on peri- and post-procedural shoulder arthroplasty outcomes has yielded an overwhelming majority of studies that suggest diabetics are at higher risk for postoperative complications like DVT and infection, as well as an increased length of stay. These complications also potentially result in an increased cost of care which could be taken into consideration when treating diabetic patients
An Enigmatic Manteño Burial from Buen Suceso, Ecuador, AD 771–953
No full textBurial 10 is a unique Manteño (AD 650–1532) burial from Buen Suceso, Ecuador, dating between AD 771 and 953. This burial included the remains of a young female, pregnant at the time of death and buried with an elaborate array of goods, including anachronistic spondylus ornaments, green stones, and shell eye coverings. Perimortem trauma, including a cranial fracture and cutmarks on hand bones, perimortem removal of the hands and left leg, and other body manipulation suggest she was sacrificed, a rare event for coastal Ecuadorian peoples.
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El Entierro 10 se ubica en el sitio Buen Suceso, Ecuador que pertenece a la tradición Manteño (650–1532 dC). El entierro data entre 771 y 953 dC. Incluía los restos de una mujer joven, embarazada en el momento de la muerte y enterrada con una elaborada variedad de bienes que incluyen adornos de spondylus, piedras verdes, y ojos cubiertos por conchas. Además, algunos de los adornos de spondylus se produjeron originalmente durante la tradición Valdivia (3800–1450 aC), vinculando este entierro con un pasado más profundo. El trauma perimortem y otras manipulaciones corporales, incluida la amputación de ambas manos y la pierna izquierda, sugieren que el individuo fue sacrificado
Macrowire for intracranial thrombectomy: An early experience of a new device and technique for anterior circulation large vessel occlusion stroke
Get PDFBackground and Purpose
Mechanical thrombectomy (MT) has become the standard of care for treatment of acute ischemic stroke secondary to large vessel occlusion up to 24 h from the last known normal time. With ADAPT and SOLUMBRA techniques, classically, a large bore aspiration catheter is delivered over a microcatheter and microwire crossing the clot to perform thrombectomy. Recently, a novel macrowire (Colossus 035 in.) has been introduced as a potential alternative to the use of microwire-microcatheter to allow the delivery of the aspiration catheter (ID = 0.070 in. up to 0.088 in.) over a macrowire alone. Objective
To test the feasibility of delivering an aspiration catheter to clot interface over a macrowire alone. Materials and Methods
A retrospective evaluation of prospectively maintained Macrowire for Intracranial Thrombectomy (MINT) Registry where this novel technique was utilized for thrombectomy. Consecutive patients undergoing MT using the MINT technique were included. We collected baseline demographics, imaging and clinical characteristics, rate of procedural success, conversion to traditional MT, and complications. Results
Fifty consecutive patients were recruited during the initial 4 months of the larger study duration. The aspiration catheter was able to be advanced to the clot interface successfully in 46/50 (92%) using the MINT technique. Median time from vascular access to the first pass was 11.30 min (IQR = 7.45–14.30 min) and successful thrombectomy was 14 min (IQR = 10–22.15). The modified first-pass effect with this procedure was 71%. One vasospasm was reported as a procedural complication. Conclusions
MINT is safe and feasible for large vessel occlusion recanalization based on our initial clinical experience in this multicenter study
Editorial Insights: Reflections on the Volume and Charge to the Field
Get PDFIn this, the final chapter of Section 3, the authors document an interview that took place in June of 2024, as the editorial team wrapped up reviews of the chapters submitted to this volume. The interview was led by two of the advisory board members, Meghan Shaughnessy and Barbara Stengal, and included the editorial group, Heather Howell, Carrie Wilkerson Lee, Liza Bondurant, and Bima Sapkota, and other members of the advisory board, Greg Benoit and Yvonne Lai. The motivation to create this interview-based chapter was to capture some of the authors\u27 own learning and reflection as they brought the volume together
Critical appraisal of multidrug therapy in the ambulatory management of patients with COVID-19 and hypoxemia Part I. Evidence supporting the strength of association
Get PDFThis critical appraisal is focused on three published case series of 119 COVID-19 patients with hypoxemia who were successfully treated in the United States, Zimbabwe, and Nigeria with similar off-label ivermectin-based multidrug treatments that may include ivermectin, nebulized nanosilver, doxycycline, zinc, Vitamins C, and Vitamin D, resulting in rapid recovery of oxygen levels. We used a simplified self-controlled case series method to investigate the association between treatment and the existence of hospitalization rate reduction. External controls of hospitalized patients were compared against the subgroup of patients with baseline room air SpO2 ≤ 90% to investigate the association between treatment and the existence of mortality rate reduction. No deaths were reported in any of the three case series. One case series reported 5 hospitalization equivalent events (2 ventilations and 3 uses of supplemental oxygen). Combined, the three case series comprised 119 patients of which 61 patients presented with baseline room air SpO2 ≤ 90%. All appropriate external controls were lower-bounded by 12% case fatality rate for hospitalized patients. The existence of hospitalization rate reduction was statistically significant and resilient against both random and systemic selection bias for two out of three case series with the most aggressive treatments. The existence of mortality rate reduction was statistically significant when at least the two case series with the most aggressive treatments were combined. It is more likely than not that random selection bias alone cannot explain this reduction in mortality. These results established an association between the two most aggressive ivermectin-based multidrug treatment protocols and reduction in hospitalization and mortality for hypoxemic COVID-19 patients