6501 research outputs found
Sort by
The Role of ECT in OCD: A 10-Year Review (2014-2024)
Full text linkBackground: Obsessive-compulsive disorder (OCD) affects up to 2.5% of the population with significant impacts on everyday functioning and relationships. First-line treatment includes selective serotonin reuptake inhibitors (SSRI) and cognitive behavioral therapy; however, studies have found that up to 40-60% of patients do not respond to SSRIs. ECT is an alternative approach that has demonstrated limited efficacy in OCD.
Objective: The current review aims to summarize the results of published work between 2014-2024 to assess the efficacy of ECT in the treatment of OCD.
Methods: A literature review was conducted using eight studies from 2014-2024 to assess the effectiveness of ECT in the treatment of OCD as measured by the Yale-Brown Obsessive–Compulsive Scale (Y‐BOCS). ECT was administered adjunctively with medications, not as a standalone treatment.
Results: Y-BOCS scores decreased by an average of 16.75 after ECT treatment. 77.7% participants reported a positive response immediately after ECT. 13.3% reported side effects including headaches, memory disturbances, emesis and post-treatment agitation. 20% reported recurrence of symptoms or a deteriorating disease course after ECT at different time periods and to varying magnitudes.
Conclusion: Although decreased Y-BOCS scores were statistically significant and 77.7% of participants reported a positive response to ECT, limited long-term efficacy and adverse effects limit the effectiveness of ECT. Variable long-term effects were reported across all studies, highlighting the importance of assessing individual benefit-to-risk ratios. ECT may have greater benefit in those with comorbid psychiatric diagnoses, possibly due to more severe courses and resistance to medications
Personalizing Intermittent Fasting: The Role of Microbiome Diversity and Fiber Intake in Shaping Health Outcomes
Full text linkBACKGROUND: Intermittent fasting (IF) has been linked to improved metabolic health, reduced inflammation, and increased longevity in animal models. These effects are thought to be mediated through changes in the gut microbiome. Murine studies consistently show that IF enhances microbial diversity and promotes beneficial species like Lactobacillus and Bifidobacterium, improving metabolic profiles and gut barrier function. However, human studies reveal inconsistent results, suggesting that individual-level factors such as baseline microbiome composition and fiber intake may influence response to IF.
HYPOTHESIS: Baseline gut microbiome diversity and habitual dietary fiber intake modulate the metabolic and inflammatory benefits of intermittent fasting in humans.
METHODS: A systematic literature review was conducted to identify peer-reviewed research articles and clinical trials involving intermittent fasting, gut microbiome outcomes, and metabolic parameters in murine and human models.
RESULTS:
•Murine models: Consistent increase in microbial diversity and improvement in metabolic markers •Human studies: Highly variable outcomes; benefits more likely in individuals with diverse microbiomes and higher fiber intake •Few human trials stratify participants by microbiome composition or diet, limiting interpretation
CONCLUSIONS: Individual variability in human IF outcomes may stem from differences in gut microbiome diversity and dietary fiber intake. A threshold model is proposed, in which individuals with favorable gut conditions are more responsive to IF. This supports the need for personalized dietary interventions
A Rare Case of Cardioversion-Induced Ventricular Fibrillation in a 62 Year Old Male Due to Inappropriate Timing: A Case Report
Full text link•Atrial fibrillation (AF) is a common arrythmia of the heart due to the atria beating irregularly. AF has a national burden of over 30 million. AF is commonly managed in the outpatient clinic with pharmaceutical interventions. In a minority of cases, medications are unable to restore normal sinus rhythm of the heart, requiring further interventions such as cardiac ablation or trans-esophageal echocardiogram(TEE)/ cardioversion. This arrythmia can frequently leads to blood clots, stroke, and other cardiac complications. •This patient has recurrent paroxysmal AF for 3 years with resistance to multiple medication trials and presents for an outpatient TEE/cardioversion to restore normal sinus rhythm. Synchronized electrical cardioversion is a cardiac procedure to shock the heart to resolve arrythmias, but carries risks including skin irritation, stroke, heart damage, arrythmias such as ventricular fibrillation, and heart failure. This patient experienced an unsuccessful cardioversion, resulting in a new arrythmia of ventricular fibrillation following inappropriate timing of synchronized cardioversion. The purpose of this case report is to encourage awareness and further research on the complications of electric cardioversion. It is intended for others to learn the potential complications of a commonly performed procedure with a very low complication rate
Mapping Fat Embolism as a Complication of Liposuction and Fat Grafting: A Systematic Review of Anatomical and Technical Risk Factors
Full text linkFat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). Embolic locations included ocular (27.0%), pulmonary (26.3%), and cerebral (18.2%) arteries. All 16 reported deaths occurred following intramuscular gluteal injection; none occurred in non-gluteal cases, (X² = 14.13, p = 0.0002) or subcutaneous-only injection. 35 cases of liposuction-associated fat embolism were reviewed. The abdomen was the most frequent site (n=19), followed by the thigh (n=3), with remaining cases involving axilla/back, buttocks, waist/xiphoid, lower-leg, and flanks. 68.6% of these cases involved large-volume or high-force techniques. Across both procedural categories, 76% of patients developed symptoms within 24 hours, and overall mortality-rate was 9.54%, all occurring within 5 days post-op. Fat embolism risk is strongly influenced by anatomical site and technique. All deaths occurred after intramuscular gluteal FG, while subcutaneous injection and non-gluteal sites were not associated with mortality. Abdominal liposuction was most frequently implicated, especially after high-force techniques
Patient Perspectives on the Role of Healthcare Providers in Addressing Food Insecurity in a NJ Primary Care Setting
Full text linkBackground:
Food insecurity is a critical social determinant of health, yet is rarely discussed with patients in primary care settings. The objective of this project is to explore patient perspectives on the physician role in addressing food insecurity as well as to identify factors associated with food insecurity among patients in family medicine clinics.
Methods:
A cross-sectional survey was distributed to patients (n=250) across two academic family medicine clinics in South New Jersey between May 2023 and December 2024. Demographics, self-reported health status, and comfort with discussing food insecurity were collected. Additionally, food insecurity status was determined based on the standard 2 question screen, the Hunger Vital Screen. Results were analyzed through ANOVA and probit regression.
Results:
17.2% of all respondents (n=43) were identified as food insecure. Despite 83% of respondents (n=186) feeling ‘very comfortable’ or ‘somewhat comfortable’ discussing food insecurity with their PCP, only 3 had ever done so. Interestingly, only 10.5% of respondents who felt it was ‘very important’ to discuss food insecurity with their PCP were themselves food insecure, compared to 89.5% who were food secure.
Conclusion:
While most respondents support family physicians addressing food insecurity, discussions around the topic remain limited, especially among those most impacted. These findings highlight a disconnect between patient openness and physician engagement, underscoring the need for more systematic screening and clearer physician roles
The Presence of Cardiac Arrhythmias Impacts Hospitalized Patients With Celiac Disease
Full text linkBackground
Celiac disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and sarcoidosis. The latter 3 also have cardiovascular manifestations associated with them. However, there are limited studies on the in-hospital outcomes of Celiac disease with cardiac manifestations. Therefore, the aim of this study was to evaluate the hospital outcomes of Celiac disease with concomitant arrhythmias.
Methods
Patients aged 18 years with Celiac disease and arrhythmias (atrial fibrillation, atrial flutter, ventricular tachycardia, and supraventricular tachycardia) versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, average length of hospital stays, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Weighted analysis utilizing Stata 17 MP was performed.
Results
This study identified approximately 82304 patients with Celiac Disease from the years 2019 to 2020. Of these patients, 15% had concomitant arrhythmia. Mean age of patients with Celiac disease was 56.27. The mean age of Celiac disease patients with arrhythmias was 73.79. The mean length of stay for Celiac disease patient was 4.5 days. The analysis revealed that mortality (OR 1.625, pand total hospital charges (THC) were increased ($19,504.09, pThe rate of total hospitalization death was 4%. The rate of death of Celiac disease patient with no arrhythmias was 1.42% while Celiac disease patients with arrhythmias was 3.42%.
Discussion
Celiac disease is a systemic immune-mediated disorder that is triggered by an abnormal immune response to gliadin, a component of gluten1. Hallmark inflammatory response to gluten could further augment atherosclerosis, a major contributor to cardiovascular diseases1,2. Evidence shows an increased risk of atrial fibrillation in Celiac disease patients2. Gluten free diet has also shown to notably improve arrhythmias2. However, the association of arrhythmias and Celiac disease remain understudied and further research in this area could yield better patient outcomes.
Conclusion
Our study shows that patients with Celiac disease with arrhythmias when hospitalized had increased mortality, hospital LOS, and THC. Based on our study results, patients with cardiac arrhythmias need closer monitoring and there needs to be a focus on improved treatment and management approaches through further research. Future studies should explore the impact of each type of cardiac arrhythmia on outcomes and then there can be further risk stratification based on type of cardiac arrhythmias present for Celiac disease patient
Early Celiac Plexus Block in Metastatic Pancreatic Cancer
Full text linkBoth Early and Delayed Celiac Plexus Blocks (CPBs) have been used in pancreatic cancer. Early CPB is completed when criteria for CPB is initially met, whereas Delayed CPB is implemented only after recalcitrant pain persists. We describe the benefit of early CPB in pancreatic cancer management
Reviewing The Effect of Antiplatelet Therapy on Lumbar Puncture Complications
Full text linkReviewing The Effect of Antiplatelet Therapy on Lumbar Puncture Complications aims to assess literature that discusses the possible risks of undergoing lumbar puncture while on antiplatelet therapy. Lumbar punctures offer vital information that can help guide making accurate diagnosis and creating appropriate treatment plans. However, a large portion of the population is on antiplatelet therapy for cardiovascular and cerebrovascular disease prevention. While there are many benefits to being on these medicines, patients are at increased risk for bleeding. Thus the clinical question as to whether or not proceed with lumbar puncture on patients taking antiplatelet therapy involves weighing risks and benefits. This study aims to assess the difference in traumatic lumbar punctures in patients taking antiplatelet therapy and those who are not and how this may contribute to negative outcome such as the development of spinal hematomas. Studies included were all articles published past 2000 involving human subjects that fit the PICO format and provided important background information. Results section analyzed studies comparing participants on antiplatelet therapy and those who were not and the difference in outcomes following lumbar puncture. Differences between groups were minimal and it was seen that antiplatelet therapy before lumbar punctures was not associated with traumatic taps. This review adds to the discussion on whether or not lumbar punctures should be delayed in emergent situations due to risk of bleeding and possible hematoma development. Studies assessed in this review suggest that it may be safe to proceed with lumbar puncture while on antiplatelet therapy
Efficacy of Platelet Rich Plasma on Thumb Basal Joint Osteoarthritis: A Narrative Review
Full text linkPlatelet-rich plasma (PRP) has emerged as a potential treatment for carpometacarpal (CMC) joint osteoarthritis, with studies suggesting it may offer more durable symptom relief compared to corticosteroids. A comprehensive review of four studies, including two randomized controlled trials (RCTs), a retrospective study, and a pilot study, revealed that both PRP and corticosteroid injections led to short-term improvements in pain and function. However, PRP demonstrated significantly better long-term outcomes, with VAS scores decreasing from 75 to 20 in the PRP group at 12 months, compared to a modest reduction from 70 to 65 in the corticosteroid group. Additionally, PRP showed a significantly lower DASH score at 12 months (20.4 vs. 43, P = 0.025). The pilot study indicated short-term improvements in pain and function, but some rebound in symptoms was observed at six months. Despite the promising results, variability in PRP protocols and study designs limits direct comparisons, and further large-scale, standardized trials are necessary to confirm these findings and establish optimal treatment protocols for CMC joint osteoarthritis
Patient Education and Health Literacy Effects on Statin Use and Adherence
Full text linkBackground: While the use of statins (HMG-CoA reductase inhibitors) plays a significant role in the prevention of cardiovascular disease, it is estimated approximately 60% of patients who would benefit from a statin are receiving these medications. Current research suggests that a preference for life-style intervention over medical management, concern over medical adverse reactions, and a lower perceived risk of cardiovascular events is associated with statin non-adherence.
Methods: An IRB-approved paper survey was administered to patients aged 18 to 89 at an ambulatory primary care clinic for non-acute visits. Qualtrics was utilized to collect, store, and process data. Information elicited from study participants included demographic information and cardiovascular history. Additional questions focused on patient education provided by a physician, and beliefs about cardiovascular disease. Information was submitted anonymously.
Results: Nineteen (19) responses were analyzed. Participants included 7 males and 12 females, and reported age of participants ranged from 30 to 79. Data demonstrated that 6 participants were currently using statin medications, 11 participants were never prescribed a statin, and 2 participants declined or discontinued statin use. Data demonstrated that males more so than females more strongly agreed with “If someone needs to use a statin they have failed go make good choices” (p=0.06).
Conclusion: Pilot study data collected did not capture enough participants who declined or stopped statin use to sufficiently examine how patient education might have influenced these choices. Data does suggest male participants have stronger beliefs regarding the effect of personal choice on health outcomes