DigitalCommons@KCU (Kansas City Univ.)
Not a member yet
2803 research outputs found
Sort by
Monkeypox Presenting as Periorbital Cellulitis: A Case Report
Get PDFMonkeypox, a viral disease caused by the monkeypox virus is well known for its characteristic rash with macular, papular, and vesicular stages. Although the skin is one of the most affected organs by monkeypox, the virus can also impact the respiratory, ophthalmologic, genitourinary, and gastrointestinal systems, among others. It is extremely common for the disease to begin with flu-like symptoms in the prodromal phase before cutaneous manifestations emerge. Here, we describe a unique case of monkeypox infection in which a patient first presented with periorbital cellulitis before any characteristic skin findings appeared. The source of the infection was unknown and the patient recovered without any complications to date. This odd presentation of monkeypox reiterates the need for a detailed evaluation of patients with a similar presentation
Zoster Vaccine Lowers Stroke and Myocardial Infarction Risk in Chronic Disease
No full textIntroduction: Herpes zoster increases stroke and myocardial infarction (MI) risk. The objective of this study is to evaluate the impact of live attenuated zoster vaccination on stroke and MI risk in patients at-risk for zoster including persons with hypertension, diabetes mellites, obesity, hypercholesterolemia, chronic kidney disease, chronic obstructive pulmonary disease, emphysema, asthma, and chronic liver disease.
Methods: Retrospective cohort study utilizing continuous de-identified claims data from the IBM MarketScan® Commercial Claims and Encounters Database (collected from 2005-2018) containing data for 200 million commercially insured Americans. Participants included 27,093 adults vaccinated against zoster with at least 5 years continuous enrollment, age and sex-matched 1:5 with unvaccinated controls. Odds ratios, risk difference, and number needed to treat (NNT) evaluated the effect of vaccination on stroke and MI while controlling for relevant comorbidities.
Results: Over five years, proportions of MI (1.29% vs 1.82%; p
Conclusions: Live attenuated zoster vaccination is associated with lower risk stroke and MI in adults with at-risk comorbidities, controlling for age and sex. Vaccination may provide cardiovascular benefits beyond zoster prevention
Diabetes and COVID-19 Outcomes: An Analysis of Freeman Health System Patients
Get PDFBackground: As COVID-19 continues to affect millions of people around the world, it has become vital to understand how comorbidities such as diabetes affect the health outcomes of these patients. While earlier studies have focused on major metropolitan areas, rural settings have been comparatively understudied. The goal of this study is to understand the effect on mortality that these two diseases have in the inpatient setting of a rural population.
Methods: The electronic medical records of all adult patients admitted to Freeman Health System, Joplin, Missouri, United States, between April 1, 2020, and December 31, 2021, were reviewed for the presence of COVID-19 infection and/or diabetes (type I and type II). Freeman Health is a major health system headquartered in Southwest Missouri. Diagnoses were obtained through the use of standard International Classification of Disease, 10th edition (ICD-10) codes. The initial data set consisted of 19,323 admissions. After excluding duplicate admissions and those who had already been infected with COVID-19, 1,729 patients with COVID-19, 172 patients with type I diabetes, and 3,992 patients with type II diabetes were included in the analysis of inpatient all-cause mortality. We hypothesized that patients with type I and type II diabetes would both show an increased risk of all-cause mortality. Mortality in the context of our study results refers to all-cause mortality.
Results: The all-cause mortality rate was 19.94% (137/687, with a 95% confidence interval (CI) of 16.95%22.93%) in patients admitted with both diabetes (the combined type I and type II subsets) and COVID-19 (P1). The mortality rate was 16.03% (167/1042, with 95% CI of 13.80%-18.25%) in patients admitted with COVID-19 who did not have diabetes (P2). Patients admitted with a comorbid diagnosis of diabetes but without COVID-19 (P5) had a much lower mortality rate of 5.98% (249/4164, with a 95% CI of 5.26%-6.70%). The combination of both COVID-19 and diabetes together was associated with a higher mortality rate than either of the two separately. The mortality rate was additionally elevated in patients with both type II diabetes and COVID-19 (P4) (134/663, mortality rate of 20.21% with 95% CI of 17.15%-23.27%) versus those with COVID-19 without diabetes (P2) (167/1042, 16.03% with 95% CI of 13.80%-18.25%), an overall difference of 4.18% (95% CI of 0.40%-7.94%). The subset of patients with type I diabetes with COVID-19 (P3) and type I diabetes without COVID-19 (P6) were too small to accurately power individual analysis. The subset of patients with diabetes (type I and type II) and without COVID-19 (P5) had the lowest mortality rate of any subset adequately powered for analysis at 5.98% (249/41464, CI of 5.26%-6.70%).
Conclusions: The results of this study show that type II diabetes is a significant risk factor for mortality in admitted COVID-19 patients. P4 had the highest overall mortality of any subset studied. The study was underpowered to show if type I diabetes patients, with and without COVID-19, had an increased mortality when analyzed separately. COVID-19 significantly increased mortality in all subsets adequately powered for full analysis
Pattern Recognition of Airway Management Barriers and Associated Troubleshooting Methods
No full textPurpose of Review
Video laryngoscopy (VL) has transformed emergency airway management, offering real-time recording and retrospective analysis. Its rapid adoption in medical education is attributed to superior visualization and identification of anatomical structures. Systematically describing barriers to successful intubation may enhance recognition of these challenges, and articulates troubleshooting options. The purpose of this review is to understand these challenges so that they become recognizable as recurrent barriers to successful intubation, which could enhance education, improve patient safety, and augment provider skills.
Recent Findings
The review of our extensive video database uncovered recurrent challenges that clinicians often encounter during intubation. These challenges include patterns such as sundowning, tongue as a fulcrum, use of Macintosh blade as a Miller blade, and additional items.
Summary
Many barriers to successful intubation are recurrent, recognizable, and reproducible. Description of these barriers augments understanding and highlights avenues to troubleshoot. Through discussion of these barriers and the associated troubleshooting strategies, this work aims to not only enhance patient safety and improve procedural education but also systematically elevate intubation skills
Mortality Rate of COVID-19 With Comorbid Pneumonia in a Rural Area
Get PDFBackground: A myriad of risk factors and comorbidities have been determined to influence COVID-19 mortality rates; among these is pneumonia. This study considers pneumonia as a risk factor for increased mortality in patients admitted with COVID-19 in a rural healthcare system. We predicted that the presence of pneumonia of any kind would increase mortality rates in patients admitted with COVID-19.
Methods: A retrospective observational study was conducted using data collected from hospitals in the Freeman Health System (FHS) located in Joplin and Neosho, Missouri. Data were collected between April 1, 2020, and December 31, 2021. Using International Classification of Diseases, Tenth Revision (ICD-10) codes, the investigators identified five distinct patient populations: patients with COVID-19 and pneumonia due to COVID-19 (P1); patients with COVID-19 but without pneumonia due to COVID-19 (P2); patients with COVID-19 and any type of pneumonia (P3); patients with COVID-19 but without any type of pneumonia (P4); and patients without COVID-19 and with any type of pneumonia (P5). In order to understand how pneumonia influences COVID-19 outcomes, the investigators used Wald’s method and a two-sample proportion summary hypothesis test to determine the confidence interval and to compare the mortality rates between these populations, respectively.
Results: The population of patients with COVID-19 and any type of pneumonia (P3) and the population of patients with COVID-19 and pneumonia due to COVID-19 (P1) showed the highest mortality rates. The population of patients with COVID-19 but without any type of pneumonia (P4) had the lowest mortality rate. The data revealed that having pneumonia combined with COVID-19 in any patient population led to a higher mortality rate than COVID-19 alone.
Conclusion: Mortality rates were higher among COVID-19 patients with pneumonia compared to COVID-19 patients without pneumonia. Additionally, pneumonia, by itself, was found to have a higher mortality rate compared to COVID-19 alone