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Photo Distributed Gray-Blue Hyperpigmentation Due to Kratom Use
Get PDFGray-blue hyperpigmentation due to Kratom use in sun exposed areas is a side effect of the herb not commonly discussed. The mechanism by which this happens is not fully understood but can present in users, particularly those taking high doses. The hyperpigmentation occurs most commonly the face, back of the neck, and back of the hands and arms. We describe a 30-year-old Caucasian male who experienced this after approximately five years of Kratom use
Population-Based Study of the Epidemiology of Stiff Person Syndrome in a Large Colorado-Based Health System
Get PDFBackground and objectives: Stiff person syndrome spectrum disorder (SPSD) is a rare autoimmune disorder characterized by progressive muscle stiffness and painful spasms with an estimated prevalence of 1-2 cases per million people. Population-based epidemiologic studies are lacking because of both poor patient capture and the lack of standardized diagnostic criteria. Objectives of this study were to describe the incidence and prevalence of SPSD within the University of Colorado Health (UCH) system and apply previously proposed published criteria for SPSD within this population.
Methods: We queried Health Data Compass, an electronic health data repository for a large academic health care system, from 2012 through 2022 for all patients older than 18 years with International Classification of Diseases, 10th Revision (ICD-10) codes pertaining to stiff person syndrome. Records were reviewed for diagnostic confirmation. We calculated yearly and period prevalence and incidence rates based on observable person-time exposure of our cohort. We applied previously published Mayo Clinic and Johns Hopkins criteria for SPSD and compared period prevalence based on each criterion and evaluated for agreement.
Results: Two hundred and seventy-three patients met the initial inclusion criteria using ICD-10 codes; 59 were confirmed to have SPSD. The mean age was 49.7 years (SD = 12.9), 59.3% were female, 59.3% were considered antibody positive. The total database population over the interval was 2,801,674 persons. The estimated prevalence of SPSD based on our UCH cohort was 2.11 (95% CI 1.57-2.64) per 100,000 persons. The average yearly incidence was 0.35 per 100,000 person-years (95% CI 0.27-0.46). Applying different clinical diagnostic criteria, the estimated prevalence ranged from 1.36 (95% CI 0.93-1.79) to 1.82 (95% CI 1.32-2.32) per 100,000 persons.
Discussion: We describe a prevalence of SPSD of 2.11 per 100,000 persons in our UCH cohort. Prevalence estimates differed depending on which clinical diagnostic criteria were applied and whether possible SPSD cases were included. Using the most stringent criteria for diagnosis, we report a prevalence of 1.36 per 100,000 persons. While our study uniquely captures many US demographic groups, limitations remain because this is a retrospective review of a single system. Additional studies are needed to determine whether these results are representative of a national or global population
Carpal Ligament Instability
No full textCarpal instability resulting from ligamentous injury is a broad and complex topic with several potential etiologies. Acute or repetitive wrist trauma can cause tearing or progressive insufficiency of key intercarpal ligaments, which can lead to static or dynamic carpal instability. Without appropriate treatment, carpal ligament injury may alter the intrinsic mechanics of the wrist and lead to painful and possibly debilitating complications. Carpal instability should be differentiated from carpal misalignment, wherein carpus alignment may show deviation from normal radiographic parameters, but the joints remain stable when loaded under physiologic conditions.
This activity for healthcare professionals discusses the most common carpal instabilities and their sequelae, focusing on dorsal intercalated segment instability characterized by scapholunate dissociation and volar intercalated segment instability due to lunotriquetral dissociation. This activity reviews the anatomy, pathophysiology, clinical characteristics, evaluation, and treatment of these causes of carpal instability while highlighting the role of the interprofessional team in improving outcomes for patients with these potentially debilitating disorders
Surgical Time and Complication Risk in Conversion Total Hip Arthroplasty With Implant Removal: Finding an Optimal Surgical Duration
No full textBackground: Although longer surgical times in primary total hip arthroplasty (THA) are associated with higher complication rates, this has yet to be explored in conversion THA. The purpose of this study is to investigate the relationship between surgical time and complications in the setting of conversion THA with implant removal. We aim to establish a length of surgery after which the risk of complications increases.
Methods: This was a retrospective study conducted at a single institution. A total of 260 conversion THAs performed between 2015 and 2021 were included. An area under the curve (AUC) was constructed to determine a surgery time that increased the likelihood of complications. Logistic regressions were run to determine predictors for longer surgical times and complications.
Results: The overall complication rate of conversion THA involving implant removal was 25.8% (67 patients). Surgical times greater than 114 minutes were found to be a predictor of complications (AUC: 0.700, 95% Confidence Interval [CI]: 0.630 to 0.771), with complications 6 times as likely in these cases (9.57% vs. 34.9%, P \u3c 0.001). Regression analysis revealed that index implants of cephalomedullary nails (P \u3c 0.001, odds ratio [OR]: 17.47) and dynamic hip screw plates (P \u3c 0.001, OR: 10.9) were notable predictors of surgical times greater than 114 minutes along with higher body mass index (P = 0.005, OR: 1.10). Higher body mass index and surgical times greater than 114 minutes were also found to be predictors of complications (P = 0.035, OR: 0.93; P \u3c 0.001, 6.37).
Conclusion: Conversion THA cases involving implant removal that are longer than 114 minutes are associated with higher complication rates and revision surgeries. Conversion THA requiring implant removal of cephalomedullary nails or dynamic hip screw plates were predictors for longer surgical times. Improved surgical planning and perioperative patient optimization may be viable options to limit surgical times. This information can be used to counsel patients on the risk of complications and the possibility of a staged procedure if appropriate
Autologous Matrix-Induced Chondrogenesis for the Treatment of Hip Acetabular Chondral Lesions Demonstrates Improved Outcomes: A Systematic Review
No full textPurpose: To systematically investigate the outcomes of patients who underwent autologous matrix-induced chondrogenesis (AMIC) during hip arthroscopy for the treatment of acetabular chondral lesions due to femoroacetabular impingement syndrome (FAIS).
Methods: PubMed and Cochrane were queried in June 2022 to conduct this systematic review using the following keywords: femoracetabular impingement, arthroscopy, microfracture, and autologous matrix-induced chondrogenesis. Articles were included if they reported on patient-reported outcomes of AMIC during hip arthroscopy to treat chondral lesions of the hip. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Each study was queried for demographics, lesion classification, surgical treatment, patient-reported outcome scores, revision arthroscopy, and conversion to THA. A qualitative sub-analysis was performed to compare patients undergoing AMIC to patients undergoing microfracture alone if included studies also assessed results of microfracture alone.
Results: Four studies met inclusion criteria and assessed 209 hips undergoing AMIC. The included studies consisted of 99 male and 110 female patients. Mean postoperative follow-up ranged from 1 to 8 years, and mean patient age ranged from 34.3 to 45 years. Three of the four included studies reported the modified Harris Hip Scores (mHHS) and all three of these studies reported statistically significant improvement in the mHHS at final follow-up (p
Conclusion: Patients who underwent hip arthroscopy and AMIC for the treatment of FAIS and acetabular chondral lesions demonstrated improved patient reported outcomes and low rates of secondary surgeries at short-term follow-up
Rehabilitation Clinicians’ Use of Mainstream Wireless Technologies in Practice: A Scoping Review
No full textPurpose
This scoping review was conducted to understand the barriers, facilitators, and education and training needs of rehabilitation clinicians in their use of mainstream wireless technologies (MWT) to support people with disabilities and older adults. It was also conducted to understand the functional skills of clients that were targeted with MWT use.
Materials and methods
This scoping review was reported using PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) and the Population (or Participants)/Concept/Context) framework. We searched PubMed; ProQuest to access APA PsycINFO; Web of Science Core Collection; and EBSCOhost to access Cumulated Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE ALL, and Education Resources Information Center (ERIC). Articles published between 2015–2022 were retrieved.
Results
A total of 90 articles were included. Most interventions were apps, smartphones, and tablets; were geared toward adults; and targeted motor, cognitive and speech skills. An infographic on barriers and facilitators was generated as a decision support tool for clinicians when implementing MWT. The topic, format, timing, and source of information clinicians need are also delineated.
Conclusion
MWT such as apps, smartphones and tablets are being used by rehabilitation clinicians to address motor, cognitive, and speech skills, most commonly in adults. Clinicians voice a need for more education and training. Barriers and facilitators exist at the clinician-, technology-, client-, institution-, and policy levels
Opioid Use Disorder in Missouri: An Evidence-Based, Public Health-Oriented Approach
No full textOpioid use disorder (OUD) represents a growing public health crisis in Missouri and nationwide. Reversing the trend of rising OUD-associated morbidity and mortality will require implementing evidence-based approaches grounded in public health principles. Key evidence-based interventions include medications for opioid use disorder, naloxone distribution, overdose education, and syringe services programs. The increasing presence of fentanyl and xylazine in the drug supply represent new challenges to the OUD crisis in Missouri. Optimal implementation of evidence-based interventions will require action at the individual physician, community, and state policy level
Corrigendum: Navigating Formula Shortages: Associations of Parental Perspectives on Transitioning to Alternative Infant Formulas for Cow\u27s Milk Protein Allergy During the 2022 National Formula Shortage
No full text[This corrects the article DOI: 10.3389/falgy.2023.1333570.]
A Prognostic Model for Schistosoma japonicum Infection-Associated Liver Hepatocellular Carcinoma: Strengthening the Connection Through Initial Biological Experiments
No full textBackground: Numerous studies have shown that Schistosoma japonicum infection correlates with an increased risk of liver hepatocellular carcinoma (LIHC). However, data regarding the role of this infection in LIHC oncogenesis are scarce. This study aimed to investigate the potential mechanisms of hepatocarcinogenesis associated with Schistosoma japonicum infection.
Methods: By examining chronic liver disease as a mediator, we identified the genes contributing to Schistosoma japonicum infection and LIHC. We selected 15 key differentially expressed genes (DEGs) using weighted gene co-expression network analysis (WGCNA) and random survival forest models. Consensus clustering revealed two subgroups with distinct prognoses. Least Absolute Shrinkage and Selection Operator (LASSO) and Cox regression identified six prognostic DEGs, forming an Schistosoma japonicum infection-associated signature for strong prognosis prediction. This signature, which is an independent LIHC risk factor, was significantly correlated with clinical variables. Four DEGs, including BMI1, were selected based on their protein expression levels in cancerous and normal tissues. We confirmed BMI1\u27s role in LIHC using Schistosoma japonicum-infected mouse models and molecular experiments.
Results: We identified a series of DEGs that mediate schistosomiasis, the parasitic disease caused by Schistosoma japonicum infection, and hepatocarcinogenesis, and constructed a suitable prognostic model. We analyzed the mechanisms by which these DEGs regulate disease and present the differences in prognosis between the different genotypes. Finally, we verified our findings using molecular biology experiments.
Conclusion: Bioinformatics and molecular biology analyses confirmed a relationship between schistosomiasis and liver hepatocellular cancer. Furthermore, we validated the role of a potential oncoprotein factor that may be associated with infection and carcinogenesis. These findings enhance our understanding of Schistosoma japonicum infection\u27s role in LIHC carcinogenesis
