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Selective Androgen Receptor Modulators Leading to Liver Injury: A Case Report
Get PDFSelective androgen receptor modulators (SARMs) have gained popularity for their alleged ability to selectively target androgen receptors, potentially offering muscle-building benefits with fewer side effects than traditional steroids. However, the safety profile of SARMs, including RAD-140, is not fully understood. This case report presents a 29-year-old male who developed liver injury after taking RAD-140. The patient experienced jaundice and elevated liver enzymes after three months of RAD-140 use. A liver ultrasound revealed hepatic steatosis and a hyperechoic lesion. Symptoms resolved after discontinuing RAD-140. Similar cases of liver injury associated with RAD-140 have been reported, highlighting the potential hepatotoxicity of this SARM. Discontinuation of RAD-140 appears to reverse liver injury, but the long-term effects and risks of SARM use remain unclear. This case highlights the need for caution and monitoring when considering SARMs for performance enhancement
Body Armor and Lumbar Disc Herniation in Young Military Veterans: A Case Series
No full textIntroduction: Soldiers on the battlefield are affected by heavy body armor and excessive march load. It is well known, but the long-term effects of this extra weight on the musculoskeletal system of military veterans, specifically the lumbar spine, are unclear. In Iraq and Afghanistan, most body armors weighed over 33 pounds (15 kg). These armors were 3 times heavier than those used in Vietnam. Chiropractors at the Fargo VA Hospital are seeing more young veterans with non-traumatic lower back pain. This article presents a perspective on the impact of body armor weight and excessive carry load on lumbosacral disc herniation with radicular pain in military veterans.
Materials and methods: This study is a retrospective case series. We used a convenient sampling method. We selected the first 10 military veterans who came to a Fargo VA chiropractor in late fall 2023. Each veteran filled out a VA Form 10-5345 to give us permission to access their electronic health records. All 10 veterans also completed a survey. The survey asked about their active combat status, the type and weight of their body armor, how long they wore the armor each day, how much weight they carried, and their opinion on the cause of their lower back pain (service related or not). The Fargo VA does not require an institutional review board for a case series.
Results: This study found that military veterans experience lower back pain at an average age of 35 years. This is at least 5 years earlier than non-service men. Lower back pain with disc herniation typically occurs at the L4-L5 and L5-S1 disc levels. All 10 veterans in the study believe that their lower back pain is related to their service. Sixty percent of the participants in the study have a service-connected disability because of back pain.
Conclusions: For military veterans, onset of lower back pain from a disc herniation at a young age may be linked to carrying heavy body armor and loads. However, the small sample size of this case series limits causal relationship inferences
Fear of Falling and Common Symptoms of Multiple Sclerosis: Physical Function, Cognition, Fatigue, Depression, and Sleep – A Systematic Review
No full textBackground: Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions.
Objective: To synthesize the correlational and predictive relationships between FOF and common symptoms of MS.
Methods: Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies.
Results: Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF.
Conclusion: Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies
Misplaced Evidence, Missed Opportunities: Protocols for Handling Ballistic Evidence in Pediatric Patients
No full textBackground: Gun-related injury is now the number one cause of death in pediatric trauma patients. Many hospitals lack dedicated forensic nurses or updated protocols for handling ballistic evidence. Evidence not collected, handled improperly, or misplaced may deny a victim the basic human right to justice.
Objective: This article aims to describe an initiative to highlight the importance of proper management of ballistic evidence and to educate medical providers on best practices for the documentation, handling, removal, and transfer of ballistic evidence.
Methods: After discovering 24 orphaned bullets and bullet fragments in our hospital that had not been turned over to law enforcement, we sought to turn in evidence to the proper authorities and implement protocols to prevent this error in the future. New protocols were written by forensic staff, and education on new protocols was provided via in-person training, grand rounds, emails, and other collaborative initiatives.
Results: Evidence was matched to police reports using the patient name and date of birth on evidence labels. The median (interquartile range [IQR]) time of lost ballistic evidence was 1,397 (903, 1604) days, with the oldest bullet removed in 2015. All bullets were successfully returned to law enforcement with a median (IQR) time from bullet discovery to collection of 78 (78, 174) days.
Conclusions: Ballistic evidence handling protocols are essential for all hospitals. Dedicated, trained forensic staff should be employed to ensure proper evidence handling
The Contribution of Rural/Urban Residence to Incidence and Survival in Thymoma and Thymic Carcinoma, A Retrospective Cohort Study of the SEER 2000-2020 Database
No full textObjective: Rural-urban healthcare disparities have been demonstrated throughout the United States, particularly in acquiring oncologic care. In this study, we aim to discern the role of rural-urban health disparities in thymic cancer incidence and uncover potential survival disparities.
Methods: The Surveillance, Epidemiology, and End Results (SEER) 17-State database was queried for all cases of thymoma (ICD-O-3/3 codes: 8580-8585) and thymic carcinoma (8586) located in the thymus (primary site code C37.9) diagnosed between 2000 and 2020. Residence was established using SEER Rural-Urban Continuum Codes. Incidence trend modeling for rural versus urban patients was completed using Joinpoint Regression Software. Chi-square, Kaplan-Meier with log-rank testing, and Cox proportional hazards was completed using SPSS, with significance set to p \u3c0.05.
Results: Joinpoint analysis revealed a significant growth in incidence in the urban population compared to a stagnant incidence among the rural population. Disease specific survival was higher among urban patients on univariate modeling (p = 0.010), and confirmed on multivariate analysis, whereby rural living conferred an adjusted hazard ratio of 1.263 (95 % CI 1.045-1.527; p = 0.016) in comparison to urban patients.
Conclusions: These findings demonstrate differences between thymic cancer incidence and outcomes in patients living in urban versus rural environments and demonstrate an important disparity
Transiliac-Shortening Osteotomy to Treat Ischial Pressure Injury due to Fixed Pelvic Obliquity: A Case Report
No full textCase: A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely. At the 1-year follow-up visit, there were no further signs of pressure injury.
Conclusion: This case report describes transiliac-shortening osteotomy as a viable treatment option for non-healing ischial pressure injuries secondary to fixed pelvic obliquity
Educating Teachers on Selective Mutism: A Pilot Study on the Effects of Professional Development
No full textSelective Mutism (SM) is a rare mental health disorder that usually has an onset when children are entering school. It often presents as a lack of speech in a setting where speech is expected, however, the child can and does speak freely in other settings. Given its rare prevalence rate, many school professionals are unfamiliar with the disorder. This can lead to children not being identified and getting the treatment they need. This dissertation was a pilot study designed to measure the effect of professional development on teachers’ understanding of SM. The professional development seminar focused on three key areas in which research suggests teachers need support. 1) Recognition of SM symptoms in students and how to refer them for services, 2) distinguishing between acculturation and SM in English language learners, and 3) knowledge of technology-based interventions and comfort in implementing them. The researcher recruited 41 teachers from schools in various states and districts. Data was collected using a pre-test, post-test, and three-month follow-up questionnaire. The items asked teachers to rate their prior knowledge of SM, their confidence in working with ELL students with SM, and their comfort in implementing technology-based classroom interventions. Using both qualitative and quantitative data, the results from this study found statistically significant findings that can aid in providing future recommendations for research and supporting educators in working with students with SM. These findings suggest that professional development trainings are effective in increasing teachers’ knowledge and confidence in working with SM students. Specifically, teachers reported increased knowledge of SM traits, increased comfort in working with ELL students with SM, and increased confidence in utilizing technology-based interventions. Lastly, the study revealed that initially reported misconceptions about children with SM changed to more accurately reflect the anxiety disorder
Hypoxia-inducible Factor-1α Inhibition in Renal Cell Carcinoma
Get PDFThe tumorigenesis of clear cell renal cell carcinoma (ccRCC), an aggressive variant of renal cell carcinoma (RCC), is primarily attributable to the mutational inactivation of the Von Hippel–Lindau (VHL) gene. This mutation causes VHL syndrome, which is associated with tumor growth in various body parts, including the brain, spinal cord, eyes, adrenal glands, pancreas, kidney, and reproductive tract. RCC is the leading cause of death in patients with VHL syndrome. The VHL gene acts as a tumor suppressor that prevents the proliferation of various oncogenes by controlling the hypoxia-inducible factor (HIF). The HIF pathway is directly linked to the control of metabolic adaptation, cell proliferation, migration, angiogenesis, and apoptosis, which, in turn, is linked to ccRCC tumorigenesis. Consequently, many treatments have been developed to directly or indirectly inhibit HIF1α. Direct inhibition of HIF-1α was briefly explored but has not yet resulted in any treatment strategy approved by the Food and Drug Administration. Most prevalent are the indirect inhibitors targeting vascular endothelial growth factor receptors (VEGFR), the mammalian target of rapamycin (mTOR), and heat shock protein 90 (Hsp90). The VEGFR inhibitor category has the most FDA-approved drugs as they have been proven to be the most efficacious and safe early on. Thus, VEGFR inhibitors, along with mTOR inhibitors, have become the mainstay in RCC treatment. Most recently, therapies targeting HIF-2α inhibition have gained traction with FDA approval, whereas emerging therapies targeting direct inhibition of hsp90 have shown promise
Malnutrition and Obesity in Patients with COPD Exacerbation, Insights from the National Inpatient Sample
Get PDFBackground: The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes.
Objective: This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE.
Methods: Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis.
Results: The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs. 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs. 0.61%, P \u3c0.01; adjusted odds ratio (aOR) 2.36, P\u3c0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs. 2.82%, P\u3c0.01, aOR 4.9, P\u3c0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge.
Conclusion: Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation