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Psychiatric Sequelae of Chronic Pruritic Dermatoses
Get PDFThis comprehensive review investigates the significant psychological impact and profound psychological comorbidities found in individuals suffering from chronic pruritic dermatoses, including atopic dermatitis, chronic urticaria, and prurigo nodularis. Highlighting the complex, reciprocal relationship between pruritus and psychiatric conditions such as depression, anxiety, and sleep disturbances, this paper elucidates the comprehensive impact of dermatological disorders on the skin in addition to the far-reaching effects on an individual’s psychological well-being. By evaluating the efficacy of integrated psychodermatological interventions, including cognitive behavioral therapy, mindfulness practices, pharmacological treatments, and innovative telepsychiatry and digital health solutions, this review aims to lay the foundation for a more holistic approach to treatment of concurrent dermatological and psychiatric conditions. Future research endeavors should delve deeper into the mechanistic foundation of the pruritus-psychiatry interface, the refinement of tailored treatment strategies, and the evaluation of long-term patient outcomes. In doing so, this review seeks to contribute to the optimization of patient care and well-being, underscoring the pivotal role of addressing both dermatological and psychological needs in achieving comprehensive health outcomes
Contraindications to Tissue Plasminogen Activator Thrombolysis for Acute Lower Extremity Ischemia
No full textObjective: Previous randomized prospective trials have demonstrated the effectiveness of transcatheter tissue plasminogen activator (tPA) thrombolysis in treating acute limb ischemia (ALI) compared to conventional surgery. These pivotal trials have also highlighted contraindications for these procedures. Given recent advancements in techniques and technology, our aim is to reassess the relevance of these contraindications in contemporary practice.
Methods: A retrospective chart analysis was performed utilizing the inpatient medical records of consecutive individuals who underwent tPA treatment for acute limb ischemia (ALI) from September 2016 to April 2022. Inclusion criteria encompassed patients aged 18 and above displaying clinical symptoms and imaging evidence of ALI within 14 days. All patients received tPA with suction thrombectomy following the fast-track thrombolysis protocol. In cases where a persistent thrombus or stenosis was detected, catheter-directed thrombolysis was considered overnight, and patients underwent angiography and reassessment in the operating room subsequently.
Results: Patients were classified into two groups based on the STILE trial\u27s established contraindications for endovascular treatment in acute limb ischemia (ALI). If a patient had any of these contraindications, they were placed in the contraindicated group. This resulted in 24 patients (32%) in the contraindicated group and 52 patients (68%) in the non-contraindicated group. No statistically significant demographic variations were observed between these groups. Contraindications in our study included uncontrolled hypertension (12/24, 50%), recent invasive procedures (7/27, 29%), history of cerebrovascular accident (CVA) within 6 months (3/24, 12%), and intracranial malformation/neoplasms (2/24, 8%). Three patients within the non-contraindicated group experienced bleeding complications: two with puncture site bleeds and one with nasal bleeding. In contrast, one patient in the contraindicated group had transient postoperative hematuria. There were no significant differences in bleeding complications observed between the two groups (p = .771). Additionally, no amputations were observed within our population.
Conclusions: In light of our study results and advancements in endovascular therapies, we can now safely and efficiently treat patients who were previously considered contraindicated for such treatments. It is essential to individualize treatments and carefully balance the risks and benefits of endovascular versus open surgical revascularization for these patients. Additionally, we believe that the nearly 30-year-old guidelines for endovascular therapies need to be revisited and updated to align with modern technology
Staff and Providers\u27 Perceptions of Patients\u27 PrEP Candidacy, Acceptability, and Adherence in Methadone Clinic Settings
No full textBackground: People who use drugs and patients in substance use treatment may be placed at high risk for HIV due to mixing sex and drugs, potential engagement in sex work, and injection drug use. However, pre-exposure prophylaxis (PrEP) adoption among these populations remains low. Methadone clinics, a main point of contact with the healthcare system for this population, are a missed opportunity to offer biomedical HIV prevention. Understanding provider and staff perceptions of patients\u27 PrEP-related candidacy, acceptability, and adherence is a critical first step to informing PrEP implementation in substance use treatment settings.
Methods: Thirty semistructured interviews were conducted at 2 methadone clinics in Northern New Jersey between January and April 2019. Participants included methadone counselors, medical providers, front desk staff, intake coordinators, and other clinic staff members.
Results: Three major themes were identified: (1) provider and staff\u27s perceptions of who would benefit most from PrEP, (2) perceptions of patients\u27 acceptability of PrEP, and (3) perceptions of patients\u27 ability to take a pill every day. Broadly, staff perceived younger patients to be better PrEP candidates than older patients, expressed cautious optimism that PrEP would be acceptable to their patient populations, and were mixed in terms of their perceptions of patients\u27 ability to adhere to PrEP. Notably, staff largely did not mention patients who inject drugs as potential PrEP candidates, suggesting a missed opportunity.
Conclusion: To promote PrEP implementation in methadone clinics, staff and providers should receive training around screening for PrEP eligibility in order to maximize the benefits of PrEP for various subpopulations, especially those who inject. Importantly, discussions around sexual behavior and injection drug use must be approached in an open, non-stigmatizing manner. These findings can be used to inform future interventions to integrate PrEP services into substance use treatment settings
Genetic and Environmental Influence on Alcohol Intent and Alcohol Sips Among U.S. Children-Effects Across Sex, Race, and Ethnicity
Get PDFIntroduction: Alcohol intent (the susceptibility to initiating alcohol use) and alcohol sips (the initiation of alcohol) in youth are a multifactorial puzzle with many components. This research aims to examine the connection between genetic and environmental factors across sex, race and ethnicity.
Methods: Data was obtained from the twin hub of the Adolescent Brain Cognitive Development (ABCD) study at baseline (2016-2018). Variance component models were conducted to dissect the additive genetic (A), common (C) and unique environmental (E) effects on alcohol traits. The proportion of the total alcohol phenotypic variation attributable to additive genetic factors is reported as heritability (h2).
Results: The sample (n = 1,772) included an approximately equal male-female distribution. The 886 same-sex twin pairs were 60.4% dizygotic (DZ), 39.6% monozygotic (MZ), 65.4% non-Hispanic Whites, 13.9% non-Hispanic Blacks, 10.8% of Hispanics with a mean age of 121.2 months. Overall, genetic predisposition was moderate for alcohol intent (h2 = 28%, p = .006) and low for alcohol initiation (h2 = 4%, p = 0.83). Hispanics (h2 = 53%, p \u3c .0001) and Blacks (h2 = 48%, p \u3c .0001) demonstrated higher alcohol intent due to additive genetic factors than Whites (h2 = 34%, p \u3c .0001). Common environmental factors explained more variation in alcohol sips in females (c2 = 63%, p = .001) than in males (c2 = 55%, p = .003). Unique environmental factors largely attributed to alcohol intent, while common environmental factors explained the substantial variation in alcohol initiation.
Conclusion: Sex and racial/ethnic disparities in genetic and environmental risk factors for susceptibility to alcohol initiation can lead to significant health disparities. Certain populations may be at greater risk for alcohol use due to their genetic and ecological factors at an early age
Ethnic Differences in Ascending Aorta Dimensions and Dilatation Rates: A Systematic Review
Get PDFEthnic differences may substantially influence the morphological characteristics of the ascending aorta, with potential implications for clinical assessment and management of aortic dilatation. This systematic review evaluated the impact of ethnicity on ascending aorta diameter and dilatation rates, highlighting the need for more tailored, ethnicity-specific care in cardiovascular practice. We identified 11 studies that measured ascending aorta dimensions using transthoracic echocardiography (TTE), computed tomography (CT), or magnetic resonance imaging (MRI). Most investigations focused on Asian, Caucasian, African American, and Hispanic populations. Data extraction revealed notable variability in baseline aortic diameters across ethnic groups. Some studies found no significant differences between Asian and Caucasian participants, whereas others reported consistently larger diameters in Chinese ethnicities compared to Caucasians and smaller diameters in African American groups. One investigation, for instance, showed that Chinese participants had ascending aorta diameters approximately 1.5 mm larger than their Caucasian counterparts. Dilatation rates also diverged: one study observed that non-White race was linked to earlier or more rapid aortic root dilation in younger populations. At the same time, another reported that Vietnamese individuals had nearly twice the annual growth rate of ascending aorta dilatation when compared to other ethnicities. Available data on prevalence varied, with some studies suggesting ascending aorta dilatation ranged from about 1.2% to 7.5% in Caucasians, 0.9% to 6.4% in African Americans, and 0.8% to 5.9% in Asians. These findings potentiate the role of ethnicity in shaping aortic dimensions, possibly through a combination of genetic predisposition, environmental factors, and lifestyle influences. Incorporating ethnic background into risk stratification may improve the accuracy of clinical assessments and help guide personalized management strategies for ascending aorta dilatation. Future research should address heterogeneity in measurement techniques, more consistently defining ethnic groups, and explore long-term outcomes to clarify whether these observed morphological differences translate into variations in morbidity and mortality
Mid- to Long-Term Outcomes in Patients After Hip Arthroscopy With Labral Reconstruction: A Systematic Review
Get PDFBackground: There is a paucity of aggregate data documenting mid- to long-term outcomes of patients after hip arthroscopy with labral reconstruction.
Purpose: To report mid- to long-term outcomes in patients after undergoing either primary or revision hip arthroscopy with labral reconstruction for the treatment of irreparable labral tears.
Study design: Systematic review; Level of evidence, 4.
Methods: A systematic review of the PubMed, Cochrane, and Scopus databases in May 2022 was conducted with the following keywords: hip arthroscopy, labral reconstruction, irreparable, labrum, reconstruction, five-year, midterm, 5 year, long-term, 10 year, ten-year, and femoroacetabular impingement using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Midterm was defined as mean 5-year follow-up, and long-term was defined as mean 10-year or longer follow-up. For each included article, the demographic, radiographic, intraoperative, and surgical variables, as well as patient-reported outcomes (PROs), psychometric thresholds, and secondary surgeries were recorded. Forest plots were created for PROs that were reported in ≥3 studies; heterogeneity was assessed using I2 values.
Results: Out of 463 initial articles, 5 studies including 178 hips with primary and 41 hips with revision surgeries were included. One study had an average 5-year follow-up, three studies had a minimum 5-year follow-up and one study had a minimum 10-year follow-up. The most common indications for hip arthroscopy with labral reconstruction were irreparable labral tears. The most common PRO was the modified Harris Hip Score (mHHS), which was reported in all 5 studies. The mean preoperative mHHS ranged from 58.9 to 66, and the mean postoperative mHHS at minimum 5-year follow-up ranged from 80.2 to 89. The preoperative and postoperative mHHSs for the single long-term follow-up study were 60 and 82, respectively. All 5 studies demonstrated significant improvements in reported PROs. All 5 studies reported secondary surgery rates, with 1 study reporting rates at both 5- and 10-year follow-up. Conversion to total hip arthroplasty ranged from 0% to 27%, while overall secondary surgery rates ranged from 0% to 36%.
Conclusion: Findings demonstrated that patients undergoing primary and revision hip arthroscopy with labral reconstruction experienced favorable outcomes and high rates of clinical benefit and survivorship at mid- to long-term follow-up
Lakeside Hospital, Kansas City, MO.
Get PDFColor postcard depicting Lakeside Hospital in Kansas City, Missouri.
The hospital opened in December 1924 at 2801 Flora Ave. overlooking Troost Lake. George Conley, D.O., put up his own funds to build a teaching hospital for the students of Kansas City College of Osteopathy and Surgery (now Kansas City University). It was the first hospital in the area to provide internships for osteopathic physicians.https://digitalcommons.kansascity.edu/postcards/1023/thumbnail.jp
Gateway B.B. Springs Hotel and Bath House, Bowling Green, Mo.
Get PDFTinted postcard depicting a man and woman standing at the gateway to the B. B. Springs Hotel & Bathhouse in Bowling Green, Missouri.
The hotel was purchased by three osteopaths, R.H. Williams, C.H. Downing, and H.S. Hain, and opened in 1923 as the Bowling Green Sanitarium and Mineral Water Company, specializing in osteopathic and hydrotherapy. Dr. R.H. Williams also marketed Bowling Green Mineral Water.https://digitalcommons.kansascity.edu/postcards/1025/thumbnail.jp
Tigua General Hospital
Get PDFUndated color postcard depicting the Tigua General Hospital in El Paso, Texas.
The back of the postcard reads: An Osteopathic Institution and lists the address as 7722 North Loop Road, El Paso, Texas.https://digitalcommons.kansascity.edu/postcards/1028/thumbnail.jp