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Biopsychosocial Case Report
Get PDFMs. R, a 32-year-old Hispanic female, suffers from severe anxiety exacerbated by a car accident and past struggles with depression and substance use. Evaluation reveals hypothyroidism, mild anemia, and GAD as the primary diagnosis. Factors contributing to her condition include genetic predispositions, medical issues, and social stressors. Treatment involves pharmacotherapy, psychotherapy, and monitoring her physiological health. Research on wearable data for GAD severity offers potential insights for her treatment. A holistic approach, considering biological, psychological, and social factors, guides her tailored treatment plan for overall well-being
BRASH Syndrome: A Deadly Pentad of Symptoms
Get PDFHere we present the case of a male in his 70’s who presented with diarrhea and a syncopal episode and was ultimately diagnosed with BRASH syndrome. The acronym BRASH is a novel way to describe the constellation of symptoms that result in unfortunate synergistic affects that can result in profound bradycardia. In the setting of hyperkalemia and concurrent use of atrioventricular nodal blockers, there is potential for a worsening bradycardia and inevitable cardiovascular collapse if not identified
Case Report: Babesiosis Presenting to the Emergency Department
Get PDFBabesiosis is a tick-borne illness caused by the parasitic protozoa Babesia transmitted by the Ixodes tick. Babesia infect the red blood cell of its host and requires the cell for its replication. It is a disease process that can range from asymptomatic infection to organ failure and death. This case presentation reviews a 68-year-old male who presented to the emergency department with flu like symptoms and was found to have babesiosis
ESG performance and firm risk in the U.S. financial firms
Get PDFThis study examines the association between the environmental, social, and governance (ESG) performance and firm risk in U.S. financial firms. We find a significant negative association between the composite ESG performance and total, idiosyncratic, and systematic risks after controlling for firm and year fixed effects and other risk predictors. We also examine the effect of each pillar of ESG on this relationship and find that “S” and “G” exhibit a significant negative relationship with both systematic and idiosyncratic risks of firms, while “E” is only associated with systematic risk. Lastly, we demonstrate that ESG performance is negatively associated with the extent to which leverage contributes to firm risk, supporting our premise that ESG alleviates financial risk. Overall, we provide empirical evidence of potential risk management benefits of ESG in the financial industr
Chronic Schizophrenia Presenting with Psychogenic Polydipsia Masking Stage IV Uterine Adenocarcinoma
Get PDFBackground: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.
Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien overdose, and multiple ED visits for PPD, each time with complaints of abdominal pain, which were attributed to either PPD or overdose. In 2021 the patient was found to have severe iron deficiency anemia, and an initial abdominal ultrasound was unremarkable. In 2022, tumor marker tests yielded abnormal results including: CA125 85.9/50.1, CA19-9 \u3e10, and CEA 0.3. A pelvic ultrasound was completed after another three ED visits, revealing an infiltrative uterine mass measuring up to 5.6 cm, which was confirmed by CT abdomen and pelvis to be Stage IV Uterine Adenocarcinoma.
Discussion: Several potential opportunities for intervention were missed in this patient including: (1) primary prevention (i.e., no documented/completed cancer screenings), (2) inadequate physical exam and history acquisition, (3) delayed diagnostic imaging from onset of abdominal pain to diagnosis. This case highlights the shortcomings across disciplines to provide early intervention, and the disparities of basic patient care in psychiatric patients
Clinical Outcomes for Cardiac Ablation in Octogenarians, Nonagenarians, and Centenarians: A Retrospective Cohort Study
Get PDFBackground
Cardiac ablation is a therapeutic intervention aimed at correcting abnormal heart rhythms by disrupting electrical pathways in the heart, using techniques such as radiofrequency or cryoablation. Despite its effectiveness, there is a scarcity of data regarding the outcomes of cardiac ablation specifically among elderly patients. Previous studies have highlighted the complexities and challenges associated with managing cardiac arrhythmias in the elderly population, emphasizing the need for further investigation into treatment outcomes in this demographic.1,2 Therefore, this study aimed to investigate in-hospital outcomes among elderly patients who underwent cardiac ablation using data from the National Inpatient Sample (NIS) Database.
Methods
Data from the NIS Database for the years 2019 and 2020 were utilized to identify hospitalizations of adult patients who underwent cardiac ablation based on international classification of diseases 10th revision codes. Patients were stratified into two groups: those aged 80 years or older (≥80 YO) and those younger than 80 years old. Linear regression and multivariate logistic regression were employed to adjust for confounding variables, with inpatient mortality as the primary outcome measure. Statistical analyses were conducted using SPSS software.
Results
The study included 25,754 patients who underwent cardiac ablation, with 3,743 (14.5%) being elderly (≥80 YO). Elderly patients had a significantly higher prevalence of hypertension (66.8% vs. 51%, P
Conclusions
This nationally representative population-based retrospective cohort study underscores the association between cardiac ablation and heightened mortality, as well as worse outcomes, among older patients. These findings highlight the importance of tailored approaches to cardiac arrhythmia management in the elderly population.
References
1. Patel V, et al. Challenges and Considerations in Managing Cardiac Arrhythmias in the Elderly. J Geriatr Cardiol. 2018;15(3):202-207.
2.Smith A, Jones B. Impact of Age on Treatment Outcomes in Patients Undergoing Cardiac Ablation. Aging Med. 2020;3(2):87-95
Community Health Worker: High Risk Stabilization Study
Get PDFIntroduction: Hypertension is a common health concern among Americans of all age groups. Unregulated hypertension can lead to complications such as atherosclerosis that contributes to an increased risk of heart attack and stroke. The identification of individuals with hypertensive blood pressures allows for the targeted distribution of health management advice and resources.
Methods: Blood Pressure measurements are obtained by Community Health Workers at public events through free health screenings
Results: Assessing the efficacy of CHW’s efforts to direct high-risk individuals to proper resources for control of their blood pressure relies on the presence of follow up BP measurements that can be compared over time. This level of consistency proved difficult to obtain since data points were only gathered at community events where attendees are not always consistently the same people.
Discussion: Free health screenings by CHWs provide the foundation for change by identifying individuals with blood pressures that put them at a high risk of dangerous health complications. Comparing BP measurements at different time intervals, such as 30 and 60 days, can help assess the degree of improvement in blood pressures
Cut The Pressure: Blood Pressure Screening in a Community Based Setting
Get PDFThis study addresses the pressing issue of cardiovascular health disparities in African American males through community-based interventions, specifically blood pressure screenings and surveys conducted in a local barbershop setting. Despite a preference among participants for clinical settings, an overwhelming 97.7% expressed high comfort levels in the community-based environment, highlighting the importance of culturally sensitive approaches in healthcare delivery. With 92.5% indicating willingness to return for future screenings, the study underscores the efficacy of non-traditional settings in fostering healthcare engagement. Findings suggest the potential for broader impact through scalable, community-centric initiatives, offering promising avenues for improving health outcomes in underserved populations
Does Strength Training Decrease the Risk of Sports Related Knee Injury?
Get PDFThe knee is the most common joint affected by sports-related injuries, with approximately 2.5 million cases treated annually in the US alone, alongside 2 million worldwide ACL repairs. Among athletes engaged in contact sports like football, soccer, basketball, and volleyball, ACL tears are the primary injury concern. In non-contact sports, particularly running, meniscus tears are commonly experienced. A notable 23% of college athletes encounter knee injuries to varying degrees. Many risk factors have been identified including patient sex, activity type, and body composition, justifying the need for individualized preventive measures.
Various strength training protocols have demonstrated efficacy in reducing the risk of ACL tears, meniscus tears, and patellar tendinopathy pain. Enhancements in muscle activation ratios and biomechanical parameters resulting from strength training contribute to ACL injury risk reduction. Both male and female athletes have benefited in injury risk reduction from strength training, yet the optimal protocol remains undetermined. Nonetheless, diverse training methodologies yield risk reduction benefits, regardless of the onset age of strength training.
While knee injuries pose a significant burden in sports, targeted strength training interventions offer promising avenues for injury prevention. Further research is warranted to find optimal training variety, frequency, and intensity and their effects across different athlete demographics
Examining the Differences in Functional Outcomes for Patients with Traumatic Brain Injury After Acute Rehabilitation and Subacute Rehabilitation: A Review of the Literature
Get PDFBACKGROUND/PURPOSE
Traumatic brain injury (TBI) is one of the major causes of morbidity in the US [1-4]. Studies suggest TBI patients’ enrollment in a rehabilitation program strongly predicts social reintegration. The structure and outcomes of inpatient rehabilitation programs, including acute and subacute rehabilitation, are not well-delineated [5-7].
DESIGN
A structured review of current literature was conducted. Articles were screened using the search string: (post-traumatic brain injury OR post-TBI OR traumatic brain injury OR TBI) AND (acute rehabilitation OR subacute rehabilitation) AND (outcomes OR functional outcomes) NOT (outpatient OR outpatient populations) NOT (pediatric OR pediatric populations). Articles were limited to 1990 – 2023 and excluded outpatient and pediatric populations. Articles were classified into two categories: those addressing either acute or subacute rehabilitation. Outcome measures included disability ratings, physical independence, independence with ADLs, social re-integration inside and outside of home, cognitive recovery, and general mobility, FIM scores, and HSQ-12 scores. Articles examined included meta-analyses, clinical trials, comparative studies, and other literature reviews.
FINDINGS
Sixteen articles addressed outcomes after acute rehabilitation [5, 8-22]. They suggest: 1) improved functional independence, cognition, and odds of discharge to home with earlier intensive acute rehabilitation following TBI, and 2) better FIM scores and HSQ-12 scores compared to those who were discharged from acute care to long term care.
Only one article addressed outcomes after subacute rehabilitation [23].
DISCUSSION/CONCLUSIONS
Acute rehabilitation programs lack uniformity in data collection methods, comprehensive metrics for outcome measurements, and homogenous and well-defined rehabilitation structures [24-27]. Our study suggests there is little-to-no data to support that subacute rehabilitation facilities have improved patient outcomes over acute rehabilitation. In conclusion, current research critically lacks information regarding outcomes after subacute rehabilitation. As trends move towards increased utilization of subacute rehabilitation services, future research must focus on outcomes in patient populations at the subacute rehabilitation level