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Infrapatellar Branch of Saphenous Nerve: From Anatomy, Sonoanatomy to its Clinical Implications
No full textThe infrapatellar branch of the saphenous nerve (IPBSN) is implicated in nerve injury from different knee surgeries because of its intimate course relative to the knee joint capsule. Pain physicians encounter patients in their practice for the management of neuralgia of this nerve or in the context of advanced management of knee osteoarthritis. This article aims to provide a comprehensive review of the anatomy, sonoanatomy, and the intervention of the IPBSN in pain management of infrapatellar neuralgia and chronic knee pain
Determining the Effects of Social Media Engagement on Surgery Residents within the American College of Osteopathic Surgeons
Get PDFContext: The widespread adoption of social media has transformed how individuals connect in medicine. This study explores how social media can be utilized as a conduit to connect osteopathic medical students and residents. By examining how these digital connections can support professional development, this study investigates social media\u27s role as a potential foundation for a mentorship program, fostering guidance, support, and career insights for osteopathic medical students within the surgical field.
Objectives: This study aimed to evaluate the effectiveness of X (formerly Twitter) in networking between osteopathic medical students and surgical residents, specifically assessing engagement rates and the potential of social media as a tool for mentorship in the osteopathic surgical community.
Methods: The Accreditation Council on Graduate Medical Education (ACGME)-approved surgical programs that the American College of Osteopathic Surgeons (ACOS) represents were identified online. Doctor of Osteopathic Medicine (DO) residents were identified retrospectively through an online search of publicly available data. Residents and programs were searched through X, and account handles were collected. Residents were contacted through X by direct messaging and subsequently directly commented in the initial ACOS Medical Student Section (ACOS-MSS) message. Descriptive statistics along with the chi-square and Fisher\u27s exact statistical tests were utilized for demographic and categorical variable analysis, respectively.
Results: There are 1179 DO surgical residents in ACGME programs, with 84.8 % of those being General Surgery residents. Among residents, 75 % of Cardiothoracic (CT) Surgery, 46.4 % of Urology, 28.6 % of Neurosurgery, 17.3 % of General Surgery, and 11.11 % of Plastic Surgery residents have X accounts. Specific surgical subspecialties are more likely to have an X account in comparison to General Surgery, including CT Surgery (odds ratio [OR], 11.13; p=0.02), Urology (OR, 4.13; p\u3c0.0001), and Neurosurgery (OR, 0.842; p=0.047). After multiple attempts, 0 % of Plastic Surgery, 2.9 % of General Surgery, 7.8 % of Urology, 18.8 % of Neurosurgery, and 33.3 % of CT Surgery residents signed up for the mentorship program, totaling 13 residents.
Conclusions: The study reveals low social media engagement via X among osteopathic surgical residents, with notable variation across surgical specialties. This limited engagement suggests exploring and refining social media strategies that foster mentorship connections within the osteopathic surgical community. Future studies should examine other social media platforms and alternative engagement approaches to enhance the reach and impact of mentorship initiatives, ultimately supporting osteopathic medical students as they navigate career paths in surgery
Program Directors\u27 Selection Criteria for Urology Residency Match in a United States Medical Licensing Examination Step 1 Pass/Fail Era
No full textIntroduction: Program directors of urology residencies have historically weighted the United States Medical Licensing Examination Step 1 heavily to select interview candidates. In January 2022, the 3-digit Step 1 score changed to pass/fail, aiming to reduce the burden of examination preparation and promote more holistic review, yet, in doing so, abolished a key objective metric. This study examines the criteria now prioritized in the selection of urology candidates to interview.
Methods: A survey was distributed to program directors of 150 nationally accredited urology residency programs, consisting of 26 factors across 4 domains: (1) academics, (2) extracurriculars, (3) virtual etiquette, and (4) applicant diversity. Respondents rated each factor on a 1 to 10 scale (from no importance to most important), with free-text options for additional input.
Results: Forty-six program directors completed the survey. The top 5 factors were (1) urology letters of recommendation (mean ± SD, 8.58 ± 1.57), (2) signaling (8.56 ± 1.69), (3) virtual professionalism (7.33 ± 2.71), (4) completion of a subinternship at the director\u27s program (7.22 ± 2.20), and (5) camera on during virtual meetings (7.04 ± 2.75). Notably, a Step 2 score ≥ 250 (5.84 ± 2.45) ranked sixth among 9 academic factors.
Conclusions: The shift to a pass/fail Step 1 has reshaped urology applicant selection, where Step 2 scores do not seem to replace Step 1 as a primary metric. The implications of these changes, including their impact on holistic application review and candidate selection, remain to be determined
Quadriostial Origin of the Coronary Arteries: A Case Report
Get PDFA 75-year-old male, with a history of hypertension and peripheral vascular disease, presented to the cardiac catheterization lab for an elective coronary angiogram after an abnormal cardiac stress test. The coronary angiogram results showed a total of four separate coronary artery ostia. Within the right coronary cusp, there were two separate ostia as opposed to a single ostia that supplies the right coronary artery (RCA). The additional ostia gave rise to the left anterior descending artery (LAD). Further, as opposed to the single ostia in the left coronary cusp, there were two separate ostia creating a left circumflex (LCX) and marginal artery. Despite this anomalous anatomy, the patient was asymptomatic and instructed to continue to follow up with outpatient cardiology. Our case report discusses this unique quadriostial coronary anatomy, the complications that can arise from anomalous coronary arteries, diagnoses, and management of such cases
A Rare Case of Pott\u27s Puffy Tumor in an Adult With Paranasal Osteoma and Pachymeningitis
Get PDFPott\u27s puffy tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, most commonly seen in children and adolescents. We report an unusual case of PPT in a 63-year-old man with a history of intranasal cocaine use, complicated by pachymeningitis. The patient presented with severe right eye pain, periorbital swelling, erythema, and purulent discharge. Initial imaging revealed right orbital cellulitis and erosive paranasal sinus disease, with a suspected frontal subgaleal abscess. Brain MRI confirmed the diagnosis of PPT, demonstrating acute-on-chronic pansinusitis, frontal bone osteomyelitis, subperiosteal phlegmon, and associated pachymeningitis.
The patient was managed with broad-spectrum intravenous antibiotics, with surgical intervention considered. Notably, he demonstrated clinical improvement with medical management alone, including the resolution of periorbital edema. This case underscores the evolving epidemiology of PPT in the adult population and highlights the role of risk factors such as cocaine use and sinus osteoma. It also emphasizes the critical importance of early recognition and a multidisciplinary approach in managing PPT to prevent serious intracranial complications. Despite the anatomical complexity, conservative medical therapy can be effective in selected cases without immediate surgical indications
Variation in Morphology of the Suprascapular Nerve and Vessels at the Suprascapular Notch: Clinical Implications for Suprascapular Nerve Release
No full textPurpose: This study aimed to classify variation in morphology of the suprascapular nerve (SSN), suprascapular artery (SSA), and suprascapular vein (SSV) in relation to the superior transverse scapular ligament (STSL) at the suprascapular notch (SN) to evaluate the risk of vascular injury during SSN release.
Methods: Dissections were performed on 104 shoulders to analyze the morphology of the SSN, SSA, and SSV at the SN. The superior transverse scapular ligament (STSL) was evaluated for dimensions, ossification, and impact on SN morphology. Configurations of the nerve and vessels were categorized, and vascular injury risk was stratified as low, moderate, or high.
Results: The SSN passed beneath the STSL in 99% of shoulders, while the SSA and SSV configurations varied. Low vascular injury risk was identified in 82% of shoulders, moderate risk in 10.6%, and high risk in 7.4%, with female cadavers demonstrating higher risk anatomy (13.3%) compared to males (2.0%). Ossified STSLs were significantly associated with smaller SN dimensions, including reduced height and width (p \u3c 0.001).
Conclusion: Anatomical variations at the SN play a critical role in determining the risk of vascular injury during SSN release. Surgeons should consider these morphological differences, particularly in cases involving ossified STSLs or higher-risk configurations, to optimize surgical planning. This study underscores the importance of precise anatomical knowledge for minimizing complications in suprascapular procedures at the SN
Epigenetic Insights into Substance Use Disorder and Associated Psychiatric Conditions
Get PDFBackground: Substance use disorder (SUD) is closely associated with epigenetic modifications that significantly impact mental health outcomes. Alcohol and drug misuse induce widespread changes in the epigenome and transcriptome of the central nervous system, disrupting critical processes such as reward signaling and emotional regulation. These alterations in epigenetic regulation and gene expression often persist even after substance cessation, potentially contributing to the onset or worsening of psychiatric conditions, including schizophrenia, depression, stress, and anxiety.
Summary: This review delves into key epigenetic mechanisms underlying SUD and its comorbid psychiatric disorders, with a focus on DNA methylation, histone modifications, and noncoding RNA regulation. Additionally, it examines the influence of environmental and biological factors on the epigenome and evaluates emerging epigenetic-based therapeutic strategies aimed at treating SUD and related psychiatric conditions.
Key messages: Gaining a deeper understanding of the epigenetic mechanisms driving SUD and its associated psychiatric disorders is crucial for the development of effective therapeutic interventions. This review highlights the potential of epigenetic-based pharmacological strategies to mitigate the societal and personal burdens linked to SUD and its mental health complications
The Role of Urinary Microbiome Analysis in the Diagnostic Approach and Management of Urinary Incontinence: A Systematic Review
Get PDFUrinary incontinence (UI) is a significant global health issue that impacts mainly middle-aged women, severely affecting their quality of life. Emerging research highlights the urinary microbiome\u27s complex role in the etiology and management of UI, with microbial dysbiosis potentially influencing symptom severity and treatment outcomes. This systematic review aimed to evaluate the current evidence on the urinary microbiome\u27s role in diagnosing and managing UI, focusing on variations in microbial composition across UI subtypes. We identified 21 studies, mostly employing 16S rRNA sequencing to characterize urinary microbiota and their associations with various UI subtypes, including urgency urinary incontinence (UUI), overactive bladder (OAB), and stress urinary incontinence (SUI). The findings revealed distinct microbial patterns, such as reduced Lactobacillus levels and increased Gardnerella prevalence, particularly in UUI. Altered microbiome profiles correlated with symptom severity, with reduced Lactobacilli suggesting a protective role in maintaining urinary health. Specific microbial species, including Actinotignum schaalii and Aerococcus urinae, emerged as potential biomarkers for UI diagnosis. Despite promising findings, limitations such as small sample sizes, variability in microbiome profiling methods, and insufficient causal evidence underscore the need for further research
Farm Progress Show Attendees\u27 Use, Knowledge and Attitudes Regarding Off-Road Vehicles on Public Roads
No full textMost deaths due to all-terrain vehicles (ATVs) and utility task vehicles (UTVs) occur on public roads, despite manufacturers\u27 warnings that they are not designed for roadway use. Our study objective was to determine rural residents\u27 use, knowledge, and attitudes regarding ATVs/UTVs on public roads. A convenience sample of 2022 Farm Progress Show attendees were surveyed (N = 361). Over 90% and over 75% of ATV/UTV users had driven on unpaved and paved public roads, respectively. Respondents from farms had higher proportions riding more frequently on roadways. A majority of participants stated it was safe to drive on both unpaved and paved public roads. Around 60% and more than 40% agreed with statements that ATVs/UTVs were designed for riding on unpaved and paved public roads, respectively. Only 26% and 31% agreed that most ATV and most UTV deaths occur on public roads. Moreover, just 8-29% disagreed with the incorrect assertion that manufacturers state ATVs/UTVs are safe to ride on public roads. In conclusion, many participants frequently drove ATVs/UTVs and had false beliefs related to the safety of these vehicles on public roadways. Efforts to educate users about the dangers of riding off-road vehicles on public roads and how to decrease associated risks are sorely needed
Use of Hearing Aids Embedded with Inertial Sensors and Artificial Intelligence to Identify Patients at Risk for Falling
No full textObjective: To compare fall risk scores of hearing aids embedded with inertial measurement units (IMU-HAs) and powered by artificial intelligence (AI) algorithms with scores by trained observers.
Study design: Prospective, double-blinded, observational study of fall risk scores between trained observers and those of IMU-HAs.
Setting: Tertiary referral center.
Patients: Two hundred fifty participants aged 55-100 years who were at risk for falls.
Interventions: Fall risk was categorized using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test battery consisting of the 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests. Performance was scored using bilateral IMU-HAs and compared to scores by clinicians blinded to the hearing aid measures.
Main outcome measures: Fall risk categorizations based on 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests obtained from IMU-HAs and clinicians.
Results: Interrater reliability was excellent across all clinicians. The 4-Stage Balance and TUG showed no statistically significant differences between clinician and HAs. However, the IMU-HAs failed to record a response in 12% of TUG trials. For the 30-Second Chair Stand test, there was a significant difference of nearly one stand count, which would have altered fall risk classification in 21% of participants.
Conclusions: These results suggest that fall risk as determined by the STEADI tests was in most instances similar for IMU-HAs and trained observers; however, differences were observed in certain situations, suggesting improvements are needed in the algorithm to maximize accurate fall risk categorization