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Characterization of Social Determinants of Health in Patients with Anti-NMDAR Encephalitis (P6-14.007)
No full textObjective:
To characterize the social determinants of health (SDOH) impacting anti-NMDAR encephalitis patients.
Background:
Anti-NMDAR encephalitis is a rare autoimmune neurologic condition characterized by complex neuropsychiatric symptoms including psychosis, behavioral changes, memory deficits, seizures, abnormal movements, and autonomic dysregulation. Preliminary analysis of population databases by our group showed that many of our patients encountered multiple SDOH inequities, having lived in disadvantaged areas compared to both the state and national average.
Design/Methods:
This is a patient-reported outcome study of 24 anti-NMDAR encephalitis patients from the University of Utah Health seen between January 2012 – August 2022. We captured SDOH related to economic stability, educational access, healthcare access, neighborhood environment, and community support via telephone interview, while correlating this with retrospectively collected clinical outcomes.
Results:
58.3% (n=14) were male and 50% (n=12) were white/non-Hispanic. Average age of diagnosis was 24.8 [5–82]. The median time from symptom onset to confirmatory NMDAR IgG Antibody Assay was 25.5 days. Distribution of insurance revealed 37.5% (n=9) had private insurance, 45.8% (n=11) had government insurance, 4.2% (n=1) had a combination of private and government insurance, and 12.5% (n=3) of patients were uninsured. Further sensitivity analysis will be conducted to understand the correlation between individual SDOH and clinical outcomes.
Conclusions:
We have previously determined that patients with anti-NMDAR encephalitis in this cohort represent the moderately to moderate-to-most disadvantaged populations within a large catchment area. This study will further categorize specific SDOH related to economic stability, educational access, healthcare access, neighborhood environment, and community support in this patient population through one-on-one phone interviews. Identification of the SDOH obstacles encountered by this population will enable us to identify modifiable factors which can promote timely diagnosis and to direct interventions informed by patient reported SDOH
A Random Sampling Method for Radiobiological Modeling
No full textVarious radiobiological models have been proposed to describe the clonogenic cell survival after radiation. Least square model fitting to match experimental survival data can be tedious and sometimes difficult for complex models with multiple parameters. In this work, a random sampling method is developed to optimize the model parameters automatically to achieve best fitting with the experimental data. A computer program is developed to read the experimental data and to calculate the cell survival fractions based on a given mathematical model. Model parameters are randomly sampled, and the model predictions are compared with the experimental data. The mean square error (MSE) is used as an objective function to drive the iterative process. The goodness-of-fit of the linear quadratic (LQ), multitarget (MT), universal survival curves (USC) and multimode (MM) model was compared between the new method and previous studies for melanoma and non–small-cell lung cancer (NSCLC) cell lines. Good fitting was obtained for the MM model with the NSCLC data (MSE = 0.0005), which was better than the fits to the LQ, MT and USC models (MSE = 0.0019, 0.0082, 0.0024, respectively). The parameters used for the LQ, MT and USC models were α = 0.33Gy, α/β = 10Gy, D0 = 1.25Gy, n = 4.22 and DT = 6.2Gy. The parameters for the MM model (n = 4) were D1 = 3.0Gy, D2 = 8.27Gy, and D3 = 2.93Gy and D4 = 10.6Gy. It is concluded that the random sampling method provides a useful tool for the parameterization of radiobiological models for radiation research and clinical applications
Managing Cow\u27s Milk Protein Allergy During the 2022 Formula Shortage: Decision-Making Among Pediatric Healthcare Providers
Get PDFIntroduction: Cow\u27s milk protein allergy (CMPA) affects 2%-7% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding healthcare providers\u27 (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices.
Methods: This study utilized US HCPs\u27 de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages.
Results: 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1\u27s safety and effectiveness.
Discussion: Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care
Use of Sea Buckthorn Oil in the Treatment of Skin Disease: Anti-Inflammatory Benefits, Clinical Applications, and Formulary Challenges
Get PDFSkin diseases such as psoriasis, atopic dermatitis, burns, and other barrier insults pose ongoing therapeutic challenges, often requiring treatments that address both inflammation and skin barrier repair. The primary aim of this review is to provide a comprehensive overview of the potential benefits of sea buckthorn oil, derived from Hippophae rhamnoides, as a treatment for various skin diseases, detailing its anti-inflammatory properties, reporting benefits across several skin conditions, and highlighting challenges in formulation as well as preservation of the oil’s nutritional benefits. Drawing from a wide array of existing literature, this review investigates sea buckthorn oil’s rich composition of omega fatty acids, vitamins, and antioxidants, which may contribute to its therapeutic effects by modulating inflammatory pathways and enhancing skin barrier function. Clinical trials and patient case studies indicate that sea buckthorn oil shows promise in reducing erythema, inflammation, and improving skin sensitivity. However, challenges such as formulation stability, sourcing of quality oil, and variability in response to treatment across conditions need to be addressed. Future research should focus on optimizing formulations and conducting large-scale clinical trials to validate the therapeutic efficacy of sea buckthorn oil in the management of skin diseases. Additionally, further exploration of the regulatory mechanisms underlying its ability to modulate inflammation and repair the skin barrier is needed to fully elucidate its clinical potential. Sea buckthorn oil offers a novel and promising adjunctive treatment for psoriasis, atopic dermatitis, and wound-healing with significant potential to enhance therapeutic options for additional skin diseases
Tensile Strength of the Achilles Tendon Allograft: A Comparative Study of Graft Preparation Technique
Get PDFBackground/Objectives: The Achilles tendon is a popular allograft option for anterior cruciate ligament (ACL) reconstruction. Structurally, the tendon is known to have a 90-degree rotational fiber track. Preparation techniques, with this consideration, may influence the strength of the graft. This study aims to assess the tensile strength of a novel Achilles tendon allograft harvest procedure following the rotational fiber track.Methods: Both Achilles tendons were harvested from formalin-embalmed cadavers [(n = 20), male n = 13, female n = 7, average age = 70]. Ten cadavers had the right Achilles as the control and the left Achilles as the fiber track sample; 10 cadavers had the opposing designation. Tensile strength was tested utilizing a Bose machine. An unpaired t-test was used to compare data across groups.Results: The average ultimate load for the control group was 874.17 N, with an average elastic stiffness of 76.01 N/mm. The ultimate load for the fiber track group was 807.84 N, with an average elastic stiffness of 64.75 N/mm. No statistically significant difference (p = 0.21) was determined between the average ultimate loads or elastic loads (p = 0.18) across groups.Conclusions: These data suggest that the rotational fiber track method of Achilles allograft has consistent tensile strength and elastic stiffness as compared to the common harvest procedure. The rotational fiber track method for ACL harvesting is a viable alternative option to the common harvest procedure for usage in an ACL reconstruction
Samuel Frank Clarendon Ghouralal (1925-1991): Pioneering Neurosurgeon in Trinidad
No full textBackground: Dr. Samuel Frank Clarendon Ghouralal emerged not only as a pioneer in neurosurgery but as a community leader in Trinidad and Tobago, contributing significantly to a region where neurosurgical care was scarce. This historical account aims to shed light on the remarkable life and career of Dr. Ghouralal, emphasizing the critical role he played in establishing and advancing neurosurgery in Trinidad and Tobago.
Methods: The writing of this project was sparked by the discovery of original scientific and biographical information about Dr. Ghouralal.
Results: Dr. Ghouralal revolutionized Trinidad and Tobago\u27s medical landscape, pioneering neurosurgery in a region where it was previously nonexistent. Despite initial challenges, his exceptional skills and dedication established the field, earning him the title the Guru. His groundbreaking surgeries, including the successful brain tumor removal from an American soldier in 1957 and the critical operation on Indian cricket captain Nari Contractor in 1962, cemented his reputation as a trailblazer. Dr. Ghouralal\u27s visionary leadership extended beyond borders, influencing neighboring countries and formalizing training programs, earning recognition from prestigious institutions like the Royal College of Surgeons in England. His service as President of the Trinidad and Tobago Medical Association and Assistant Hospital Medical Director showcased his commitment to medical governance. Having been conferred the Scroll of Honour and the Chaconia Medal (Gold), his enduring legacy persists posthumously.
Conclusions: Dr. Ghouralal\u27s life and achievements stand as a testament and inspiration to the transformative impact dedicated individuals can have on the advancement of neurosurgery throughout the world
Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Labral Repair and Patient-Reported Outcomes: A Systematic Review
Get PDFBackground: Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality.
Purpose/Hypothesis: The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs.
Study Design: Systematic review; Level of evidence, 4.
Methods: A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscop*) AND (reconstruction OR repair) in PubMed, Cochrane, and Scopus in August 2023 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, yielding 2002 initial records. Only studies comparing PROMs between revision labral reconstruction or revision labral repair after primary hip arthroscopy for labral tear were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, PROMs, psychometric thresholds, and secondary surgeries. Secondary surgery in our study was defined as any open or arthroscopic hip surgery secondary to the initial revision surgery. Forest plots were created for pre- and postoperative outcomes present in ≥3 studies. Heterogeneity was calculated using I2 values.
Results: Four studies, including 215 revision labral reconstructions and 115 revision labral repairs of the hips, were included in this systematic review. All studies were level 3 evidence, and study periods ranged between 2009 and 2019. Mean follow-up for the reconstruction and repair groups ranged from 26.3 to 36.6 months and 30.7 to 56.4 months, respectively. The mean age for the reconstruction and repair groups varied between 27 to 34.6 years and 27.5 to 30 years, respectively. Mean postoperative modified Harris Hip Scores for the reconstruction and repair cohorts ranged from 72.0 to 81.2 and 70.8 to 84.1, respectively (I2 = 0%). Mean visual analog scale for pain scores for the reconstruction and repair cohorts ranged from 3 to 3.5 and 2.3 to 3.9 (I2 = 33%). Overall secondary surgery rates ranged from 10.0% to 26.7% in the labral reconstruction cohort, compared with 10.0% to 50.0% in the labral repair cohort. One study reported superior outcomes in the revision labral repair group, with 3 studies finding no statistically significant difference in outcomes between the groups.
Conclusion: Our systematic review showed that patients undergoing revision hip arthroscopy with labral reconstruction demonstrated significant improvement in postoperative outcome measures. Postoperative outcomes were similar to those of a benchmark control group of patients undergoing revision hip arthroscopy and labral repair. Labral reconstruction in the revision setting appears to be an effective treatment in clinically indicated patients