DigitalCommons@KCU (Kansas City Univ.)
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Intrinsic Hand Deformity
No full textMuch of the hand\u27s inherent functionality can be attributed to a delicate balance between the intrinsic and extrinsic musculature. Injury to or compromise of the intrinsic musculature can lead to the development of an intrinsic minus (claw) or intrinsic plus (contracture) hand. If left untreated, these deformities may cause profound functional limitations, including digital and wrist stiffness, impaired grip strength, an inability to grip objects properly, and challenges with personal hygiene. A thorough history and physical examination are typically sufficient to diagnose intrinsic hand deformity. Additional imaging, laboratory tests, and neurological studies may be indicated to establish an underlying etiology. While nonoperative management, such as bracing, therapy, and injections, may be adequate interventions in milder cases, more advanced deformities may require operative treatment
Author Correction: Location and Function of TDP-43 in Platelets, Alterations in Neurodegenerative Diseases and Arising Considerations for Current Plasma Biobank Protocols
Get PDFLocation and Function of TDP-43 in Platelets, Alterations in Neurodegenerative Diseases and Arising Considerations for Current Plasma Biobank Protocols
Get PDFThe TAR DNA Binding Protein 43 (TDP-43) has been implicated in the pathogenesis of human neurodegenerative diseases and exhibits hallmark neuropathology in amyotrophic lateral sclerosis (ALS). Here, we explore its tractability as a plasma biomarker of disease and describe its localization and possible functions in the cytosol of platelets. Novel TDP-43 immunoassays were developed on three different technical platforms and qualified for specificity, signal-to-noise ratio, detection range, variation, spike recovery and dilution linearity in human plasma samples. Surprisingly, implementation of these assays demonstrated that biobank-archived plasma samples yielded considerable heterogeneity in TDP-43 levels. Importantly, subsequent investigation attributed these differences to variable platelet recovery. Fractionations of fresh blood revealed that ≥ 95% of the TDP-43 in platelet-containing plasma was compartmentalized within the platelet cytosol. We reasoned that this highly concentrated source of TDP-43 comprised an interesting substrate for biochemical analyses. Additional characterization of platelets revealed the presence of the disease-associated phosphoserine 409/410 TDP-43 proteoform and many neuron- and astrocyte-expressed TDP-43 mRNA targets. Considering these striking similarities, we propose that TDP-43 may serve analogous functional roles in platelets and synapses, and that the study of platelet TDP-43 might provide a window into disease-related TDP-43 dyshomeostasis in the central nervous system
A Systematic Review of Tablet-Based Interactive Distraction as a Preoperative Anxiolytic in Pediatric Patients Undergoing Same-Day Procedures
Get PDFEvidence shows tablet-based interactive distraction (TBID) is effective as a preoperative anxiolytic in pediatric patients. TBID involves age-appropriate video games that have been preloaded onto a tablet (TAB) and subsequently given to a pediatric patient before the administration of anesthesia. The purpose of this study is to provide a comprehensive analysis of previous studies that have investigated the use of TBID to minimize preoperative anxiety. The literature criteria for this systematic review included randomized controlled trials and prospective studies that used TBID as a method to reduce preoperative anxiety in pediatric patients aged 1-12 years. Data extraction concentrated on the patient population to which the TABs were introduced, the method of TAB administration, how anxiety was evaluated, who completed the evaluations, and the results of each publication. This chosen data set is to systematically understand if TBID is effective and to identify the most practical ways to implement TBID. Collected data from the selected publications were entered into a table. For this systematic review, 27 publications from 2006 to 2023 were screened for eligibility. These studies were selected using a combination of MeSH terms and a Title-Abstract filter in PubMed, Embase, and Scopus. These data represented 475 total patients (T) and 249 patients who implemented TAB use. The other 226 patients were used as various control groups. The outcome of each study is summarized and placed into a table. This study is expected to provide an overall assessment of the effectiveness of TBID and proposed guidelines for clinicians to incorporate TAB use into preoperative protocols. The time to give the TAB to the children impacts its efficiency. This review accentuates the effectiveness of utilizing TBID to mitigate preoperative anxiety in pediatric patients based on a comprehensive analysis of multiple prior studies conducted in diverse healthcare settings, including pediatric hospitals and surgical centers. TAB use demonstrated an effective reduction in perioperative anxiety, emergence of delirium, and time to discharge, increasing parental satisfaction compared to midazolam. These results are likely replicable across a broader range of clinical settings, provided the intervention parameters, such as the timing of TAB introduction and the personalization of content to patient interests, are carefully adapted to each situation. The anxiety evaluations of patients using TBID varied based on the evaluator. Therefore, future research should analyze if perceived anxiety in patients using TABs is consistent or not among the evaluators. The impact of this TBID review has the potential to set a new benchmark for managing pediatric preoperative anxiety, with significant implications for healthcare quality and patient satisfaction
Integration of Osteopathic Manipulative Treatment for Patients with Chronic Pain
Get PDFThe Five Models of Osteopathic Medicine offers guidance on creating a treatment plan that includes OMT for patients with chronic pain. Using OMT on one body region or system has numerous downstream effects and can influence multiple models. This paper describes this therapeutic modality
Haloperidol-Induced Neuroleptic Malignant Syndrome: A Case Report
Get PDFNeuroleptic malignant syndrome (NMS) is a severe reaction to antipsychotic medications characterized by fever, muscle rigidity, altered mental status, and autonomic dysfunction. Here, we describe the case of a 58year-old female who presented with altered mental status two days after open reduction and internal fixation of the hip. A rapid response team was called when the patient appeared agitated with increased respiratory demand. After being intubated and moved to the ICU, she became febrile and rigid. A preliminary diagnosis of metabolic encephalopathy of unknown origin was made. Before being transported to the ICU, the patient was given multiple haloperidol doses in addition to her continued at-home medication, paroxetine, for major depressive disorder. The differential diagnosis included a workup for NMS, serotonin syndrome, and infectious processes. Once NMS was determined as the most likely etiology, all antipsychotic and serotonergic medications were discontinued. Then dantrolene and amantadine were administered, which resulted in clinically significant improvement. This case report demonstrates the importance of early identification of and intervention for NMS
Pandemic-Related Stress Increases PTSD and Depression Risk in Traumatic Injury Patients: A Comparative Study of Pre- and Peri-Pandemic Trauma Cases
No full textThe COVID-19 pandemic significantly impacted the psychological well-being of the general population. However, there are limited studies that examine its mental health effects on patients who have experienced traumatic injuries and tracked their recovery over time. This study aimed to: (1) compare the rates and severity of post-traumatic stress disorder (PTSD) and depression between patients who sustained traumatic injuries before the COVID-19 pandemic (pre-pandemic) and those injured during the pandemic (peri-pandemic); and (2) assess whether the degree of pandemic-related stress (e.g., worry about infection, social isolation, loss of home/job) predicted the severity of PTSD or depression symptoms. Participants (N = 198) were recruited from a Level 1 Trauma Centre in Southeastern Wisconsin following admission for a single-incident traumatic injury. Symptoms of PTSD and depression were assessed during hospitalisation and at three additional points within the subsequent 6 months. Self-report measures were used to evaluate PTSD and depression severity among patients injured before (pre-pandemic; n = 126) and during (peri-pandemic; n = 73) the pandemic. Peri-pandemic participants also completed a modified version of the COVID-19 Family Stress Screener to measure pandemic-related stress. Exploratory factor analysis was conducted to identify the dimensions of pandemic-related stress in our sample. The findings indicated that participants injured during the pandemic exhibited higher symptoms of PTSD and depression compared to those injured before the pandemic. Additionally, greater pandemic-related stress correlated with elevated levels of depression and PTSD at baseline. Our results highlight that the broader context in which patients recover from injuries can intensify the negative mental health consequences of traumatic injury. This underscores the need for enhanced access to psychological services for trauma patients, particularly during major societal stressors like a global pandemic