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Management of Asymptomatic Hypertension in the Inpatient Setting.
Get PDFHypertension is common in hospitalized patients and is most often asymptomatic. While there are no guidelines for management of such patients, aggressive blood pressure treatment, including the use of intravenous antihypertensives, is often undertaken. While evidence of benefit is lacking, emerging data suggest that treatment of asymptomatic hypertension in the inpatient setting is associated with adverse outcomes, including acute kidney injury and ischemic stroke. In addition, the intensification of a preexisting antihypertensive regimen at hospital discharge significantly increases the risk of readmission without significant improvement in outpatient hypertension control. Such a combination of a common problem with the demonstrable benefit of a less aggressive approach offers considerable opportunity to improve patient care. This review article will discuss the existent literature and a specific case and make suggestions for improvement of practice
Discontinuation of Routine Postpartum Complete Blood Count in Uncomplicated Vaginal Deliveries
Get PDFIntroduction
The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum CBC testing is not indicated following uncomplicated vaginal delivery if hemoglobin upon admission is \u3e10 g/dL and if estimated blood loss during delivery is \u3c500mL.
Methods
A postpartum complete blood count (CBC) is currently obtained from all obstetric patients at Cabell Huntington Hospital who have had a successful vaginal delivery. A prospective study was performed on 88 consecutive patients presenting to Cabell Huntington Hospital Labor and Delivery. A protocol was instituted whereby a postpartum-day-1 CBC was not indicated on patients undergoing vaginal delivery with an admission hemoglobin of \u3e10 g/dL and an estimated blood loss at the time of delivery of
Results
Analysis of the case series revealed no difference in blood transfusions, symptomatic anemia, postpartum complications, or maternal length of hospital stay before and after the institution of the protocol. There was a significant difference (p=
Conclusion
The findings from this prospective study have the potential to inform evidence-based postpartum care guidelines for low-risk pregnancies. If discontinuing routine CBC testing in uncomplicated vaginal deliveries is proven to be safe and cost-effective, it could lead to more efficient healthcare resource allocation, reduced healthcare costs, and improved patient experience. This study contributes valuable insights to the ongoing efforts in optimizing postpartum care protocols and may influence future clinical practice guidelines for low-risk pregnancies
Return to activity following ACL Reconstruction with the Fertilized ACL: A retrospective study.
Get PDFIntroduction
The objective of this retrospective study is to evaluate outcomes in patients who underwent the fertilized anterior cruciate ligament (ACL) reconstruction procedure. We aim to investigate the return to previous level of activity, safety, and re-rupture rates of the ACL reconstruction augmented with bone marrow concentrate, demineralized bone matrix, autograft bone, and a suture tape (the fertilized ACL).
Methods
A comprehensive review of medical records was conducted for patients treated with the fertilized ACL (FACL). Medical records of all the patients who underwent reconstruction surgery between July 2018 and January 2021 were evaluated. The inclusion criteria for the study were patients with a defined ACL tear based on clinical examination and magnetic resonance imaging testing who received FACL reconstruction between July 2018 and January 2021. Exclusion criteria included revision ACL reconstruction, non FACL reconstruction, and patients that underwent the FACL reconstruction outside of the defined time period. Thirteen patients underwent reconstruction using a Graftlink allograft (Lifenet Virginia Beach, Va) and 38 using quadriceps autografts. All patients received the FACL reconstruction using bone marrow concentrate, demineralized bone matrix, autograft bone, and suture tape. A phone survey was conducted to obtain patient-reported outcome measures including return to previous level of activity, International Knee Documentation Committee (IKDC), ACL Return to Sport After Injury (ACL RSI), and Visual Analogue Scale (VAS) values. A chart review was conducted for complications and questions were asked during the phone survey regarding return to operating room, infections, and re-ruptures.
Results
Data analysis revealed 94% of the patients returned to their previous level of activity. The average IKDC and ACL RSI scores were 94% (SD, 9.0) and 92% (SD,15.3), respectively. The average VAS score was .9/10 (SD, 1.2). One patient required reoperation for pain at 1 year. No re-ruptures were observed.
Conclusion
This retrospective study sheds light on the FACL, which adds biology and an internal brace to an ACL reconstruction, as a reliable and safe option when performing an ACL reconstruction. Very low complication rates were seen in this consecutive series followed for a mean of 2 years. Patients had an extremely high level of return to previous level of sport/activity
Undated Photo of Chuck Yeager in Logan
No full textPhoto of Chuck Yeager with the Civil Aeronautical Association. Photo is undated but the back of the photo describes the individuals in it.https://mds.marshall.edu/yeager/1247/thumbnail.jp
Adolescence, alcohol, and astrocytes: the impact of adolescent alcohol use on astrocyte-synaptic interactions, structure, function, and behavior
Get PDFAlcohol is the third leading cause of preventable death in the United States and has substantial social and economic burdens. Excessive alcohol consumption in the form of binge drinking is highly prevalent among adolescents and emerging adults. Binge drinking is a form of excessive drinking, defined as consuming enough alcohol on a single occasion to result in blood alcohol concentrations above 0.08%. Approximately 55% of full-time college students aged 18- 22 years old have reported consuming alcohol in a binge manner. Furthermore, studies have shown that approximately 20% of college students meet the criteria for an alcohol use disorder (AUD). These statistics are concerning as this period of increased proclivity to participate in binge-type alcohol consumption overlaps with the critical period of adolescent development. During adolescence, the central nervous system (CNS) is undergoing a stage of neurodevelopment in which regions of the brain, such as the prefrontal cortex (PFC) and the hippocampus, which are critical for learning and higher cognitive development, continue to undergo refinement and maturation. Consuming alcohol during early adolescence results in long-term deficits in cognitive function and an increased risk of developing an AUD later in life. There has been a concerted effort to understand the direct contributions of adolescent binge drinking to long-lasting changes in neuronal structure, function, and subsequent cognitive changes that may be associated with the emergence of neuropsychiatric disorders and addiction. However, non-neuronal cells’ contribution to alcohol-induced neuronal dysfunction is just beginning to be elucidated. Astrocytes are highly complex non-neuronal glial cells that serve in developing, refining, and maintaining the CNS. Furthermore, very few studies are dedicated to investigating potential sex differences in the effects of adolescent alcohol exposure on astrocytes. Parallels in findings in human clinical data and laboratory studies using rodent models have allowed our lab and others to use a rat model of adolescent intermittent binge ethanol (EtOH) exposure (AIE) to begin to identify the roles of astrocytes in AIE-induced long-term neuronal dysfunction across multiple brain regions in males and females. This dissertation encompasses the investigation of 1) the short- and long-term effects of AIE on astrocyte morphology and astrocyte-synaptic interactions across multiple subregions of the male PFC, 2) the long-term effects of AIE on astrocyte morphology, astrocyte-synaptic interactions, and astrocyte function at the synapse in the female hippocampus, and 3) the short- and long-term effects of AIE on astrocyte morphology, astrocyte-synaptic proximity and interactions, subsequent astrocyte function at the synapse and hippocampal behaviors in male rodents. Overall, this dissertation aims to fill in gaps of knowledge by identifying how AIE impacts astrocytes across different brain regions undergoing adolescent neurodevelopment and how these effects may vary between sexes
