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The Role of Socioeconomic Status in Financial Socialization Practices of African American Women in the United States
No full textHeart Failure and Impaired Cognitive Function: Findings From the National Health and Nutrition Examination Survey (NHANES)
No full textBackground The relationship between heart failure (HF) and cognitive impairment has not been clearly delineated. The primary objective of this analysis was to determine whether patients with HF have greater cognitive impairment compared with those without HF using the NHANES continuous dataset (n=111,797) from 1999 to 2021. Methods A total of 5951 patients aged ≥60 years were identified with cognition scores from the Digit Symbol Substitution Test (DSST), a measure of range of cognitive functions. Univariate correlation between HF and cognitive function as measured by the DSST was performed. A multivariate model was constructed to examine the effect of potential predictors: HF, sex, age, race, education, diabetes, body mass index, smoking, hypertension, cholesterol, coronary artery disease, depression, stroke and alcohol use. Propensity score adjustment (PSA) was performed using inverse probability treatment weighting in a third linear model. Results Mean DSST scores were significantly lower (P\u3c 0.0001) for those with HF (35.2) than for those without (43.8), with a mean difference of 8.5 (95% confidence interval: 6.7-10.3). After adjustment for baseline covariates using PSA, patients with HF had a leastsquares mean difference of approximately 4.2 points lower than those without HF (P=0.0009). Conclusion A significant reduction was found in cognitive function in patients with HF after adjusting for potential confounders and baseline covariates. The lower score in patients with HF is within the range of mild cognitive impairment
Nuchal-type Fibroma Induced by Repetitive Trauma from Weightlifting: Case Report and Comprehensive Review of Literature
No full textA nuchal-type fibroma (NTF) is a rare, benign, subcutaneous nodule that most frequently occurs in the posterior neck along the midline. It is characterized histologically by bundles of thick collagen fibers confined to the dermis and subcutaneous tissue of the posterior neck. Few trauma-related NTF cases have been published. We present a biopsy-proven case of NTF that is likely to have developed as a result of weightlifting activity in the gym, including repetitive trauma to the area of the lesion during the exercise known as the barbell back squat. During this exercise, a heavy barbell was repeatedly rested on the patient\u27s vertebral prominence at the level of C7/T1, the location where the NTF developed. Our 25-year old patient reported that he had been doing this exercise on a weekly basis for about 10 years. We believe that repetitive trauma at this location from specific weightlifting exercises may attribute to the incidence of NTF. A description of key magnetic resonance imaging characteristics and the surgical pathology of this case are provided, along with a review of current literature on trauma-related NTFs
Acute Kidney Injury in Subarachnoid Hemorrhage: Exploring Its Clinical Significance and Prognostic Implications
No full textObjectives: Subarachnoid hemorrhage (SAH) from spontaneous aneurysm rupture is a debilitating condition with high morbidity and mortality. Patients with SAH remain understudied, particularly concerning the evaluation of incidence and consequences of subsequent acute kidney injury (AKI). In this study, we aim to explore the risk factors and outcomes of AKI in SAH patients. Materials and Methods: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to query the National Inpatient Sample (NIS) for patients with a diagnosis of SAH between 2010-2019. Subgroup analysis was stratified by AKI diagnosis during the same hospitalization. AKI and non-AKI groups were assessed for baseline clinical characteristics, interventions, complications, and outcomes. Descriptive statistics, multivariate regressions, and propensity score-matching were performed using IBM SPSS 28. Results: Of 76,553 patients diagnosed with nontraumatic SAH between 2010-2019, 10,634 (13.89 %) had a comorbid diagnosis of AKI. SAH patients with AKI were older (p \u3c 0.01) and more often obese (p \u3c 0.01) compared to the non-AKI group. A multivariate regression found the diagnosis of AKI to be independently correlated with poor functional outcome (p \u3c 0.001), above average length of stay (p \u3c 0.001), and in-hospital mortality (p \u3c 0.001) when controlling for age, SAH severity, and other comorbidities. Conclusions: This study showed significant association between AKI and adverse outcomes in SAH patients, and a correlation between AKI and heightened complication rates, poor functional outcome, extended hospital stays, and elevated mortality rates. Early detection of AKI in SAH patients is vital to improve their chances of recovery
Responsive Neurostimulation of the Frontal Lobe for the Detection and Treatment of Seizures in Intractable Epilepsy Due to Tuberous Sclerosis Complex: Illustrative Case
No full textBACKGROUND Responsive neurostimulation (RNS) is often considered to be a palliative therapy for drug-resistant epilepsy (DRE) and is generally not considered to be a treatment for patients with tuberous sclerosis complex (TSC). Here, the authors present the case of a 24-year-old male with TSC who obtained seizure freedom following RNS device implantation. OBSERVATIONS Prior to RNS device implantation, the patient underwent tuberectomies, subependymal giant cell astrocytoma resection, vagus nerve stimulator placement, and left frontal lobe resection but continued to have frequent seizures. An RNS device was implanted, which initially led to a decrease in seizures, but he continued to have 12 seizures per month. He then underwent lead revision for stimulation via a different electrode. After that lead change, he had no seizures for almost 3 years. In the following 3 years, he had two episodes of breakthrough seizures, both of which occurred with medication weans. Although the patient still requires antiseizure medication, he has had years of seizure freedom with RNS therapy. LESSONS This study exhibits the potential effectiveness of RNS therapy for patients with TSC and DRE. RNS should be considered for patients with TSC when other therapies have not sufficiently treated their epilepsy
Transcriptome Wide Changes in Long Noncoding Rnas in Diabetic Ischemic Heart Disease
No full textMore than 10% of adults in the United States have type 2 diabetes mellitus (DM) with a 2–4 times higher prevalence of ischemic heart disease than the non-diabetics. Despite extensive research approaches to limit this life-threatening condition have proven unsuccessful, highlighting the need for understanding underlying molecular mechanisms. Long noncoding RNAs (lncRNAs), which regulate gene expression by acting as signals, decoys, guides, or scaffolds have been implicated in diverse cardiovascular conditions. However, their role in ischemic heart disease in DM remains poorly understood. We provide new insights into the lncRNA expression profile after ischemic heart disease in DM mice. We performed unbiased RNA sequencing of well-characterized type 2 DM model db/db mice or its control db/+ subjected to sham or MI surgery. Computational analysis of the RNA sequencing of these LV tissues identified several differentially expressed lncRNAs between (db/db sham vs. db/db MI) including Gm19522 and Gm8075. lncRNA Gm-19522 may regulate DNA replication via DNA protein kinases, while lncRNA Gm-8075 is associated with cancer gene dysregulation and PI3K/Akt pathways. Thus, the downregulation of lncRNAs Gm19522 and Gm8075 post-MI may serve as potential biomarkers or novel therapeutic targets to improve cardiac repair/recovery in diabetic ischemic heart disease
Surgery Clerkship Directors’ Perceptions of the COVID-19 Pandemic’s Impact on Medical Student Education
No full textBACKGROUND: This study assessed the national impact of the coronavirus disease 2019 (COVID-19) pandemic on the education of medical students assigned to surgery clerkship rotations, as reported by surgery clerkship directors (CDs). STUDY DESIGN: In the spring of 2020 and 2021, the authors surveyed 164 CDs from 144 Liaison Committee on Medical Education-accredited US medical schools about their views of the pandemic’s impact on the surgery clerkship curriculum, students’ experiences, outcomes, and institutional responses. RESULTS: Overall survey response rates, calculated as number of respondents/number of surveyed, were 44.5% (73 of 164) and 50.6% (83 of 164) for the spring 2020 and 2021 surveys, respectively. Nearly all CDs (more than 95%) pivoted to virtual platforms and solutions. Most returned to some form of in-person learning by winter 2020, and prepandemic status by spring 2021 (46%, 38 of 83). Students’ progression to the next year was delayed by 12% (9 of 73), and preparation was negatively impacted by 45% (37 of 83). Despite these data, CDs perceived students’ interest in surgical careers was not significantly affected (89% vs 77.0%, p = 0.09). During the 1-year study, the proportion of CDs reporting a severe negative impact on the curriculum dropped significantly (p \u3c 0.0001) for most parameters assessed except summative evaluations (40.3% vs 45.7%, p = 0.53). CDs (n = 83) also noted the pandemic’s positive impact with respect to virtual patient encounters (21.7%), didactics (16.9%), student test performance (16.9%), continuous personal learning (14.5%), engagement in the clerkship (9.6%), and student interest in surgery as a career (7.2%). CONCLUSIONS: During the pandemic, the severe negative impact on student educational programs lessened, and novel virtual curricular solutions emerged. Student interest in surgery as a career was sustained. Measures of student competency and effectiveness of new curriculum, including telehealth, remain areas for future investigation
Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology: A Systematic Review
No full textImportance: Unlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known. Objective: To systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties. Evidence Review: A systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes. Findings: A total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention. Conclusions and Relevance: This study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment
The Impact of Artificial Intelligence on Large Vessel Occlusion Stroke Detection and Management: A Systematic Review Meta-Analysis
No full textIntroduction: Stroke remains the second leading cause of death worldwide, with many survivors facing significant disabilities. In acute stroke care, the timeless adage \u27Time is brain\u27 underscores the vital need for quick action. Innovative Artificial Intelligence (AI) technology potentially enables swift detection and management of acute ischemic strokes, revolutionizing acute stroke care towards enhanced automation. Methods: The study is registered with Prospero under CRD42024496716 and adheres to the Problem, Intervention, Comparison, and Outcomes framework (PICO). The analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Embase, PubMed, DBLP, Google Scholar, IEEE Xplore, Cochrane database, IEEE, Web of Science, ArXiv, MedRxiv, and Semantic Scholar. The articles included were published between 2019 and 2023. Out of 1528 articles identified, thirty-seven met the inclusion criteria. Results: We compared AI-augmented Large Vessel Occlusion (LVO) detection and non-AI LVO detection in various patient processing times related to emergent endovascular therapy in acute ischemic strokes. Triage Time, Door-to-Intervention Notification Time (INR), and Door-to -Arterial Puncture Time revealed an odds ratio (OR) of 0.39 (95 % CI: 0.29–0.54, p \u3c 0.001), 0.30 (95 % CI: 0.21–0.42, p \u3c 0.001), and 0.50 (95 % CI: 0detection 0.30–0.82, p = 0.007), respectively – all of which had negligible heterogeneity (I^2 = 0). CT-to-Puncture-Time and Door-to-CTA-Time yielded an OR of 0.57 (95 % CI: 0.31–1.04, p = 0.065) and 0.77 (95 % CI: 0.37–1.60, p = 0.489), respectively – both of which had negligible heterogeneity (I^2 = 0). The Last Known Well (LWK) to Time of Arrival resulted in an OR of 1.15 (95 % CI: 0.83–1.59, p = 0.409, I^2 = 0). AI stroke detection sensitivity OR of 0.91 (95 % CI: 0.88–0.95, p \u3c 0.001) should be interpreted with potential heterogeneity in mind (I^2 = 69.3). National Institute of Health score (NIHSS) mean of 16.20 (95 % CI: 14.96–17.45, p = 0.001, I^2 = 0). Patient Transfer-Times between primary and comprehensive stroke centers generated an OR of 0.98 (95 % CI: 0.73–1.32, p = 893, I^2 = 0). Similarly, Door-in-Door-Out Time (DIDO) had an OR of 1.19 (95 % CI: 0.21–6.88, p = 0.848) and low heterogeneity (I^2 = 5.1). The results indicated significant differences across several parameters between the AI augmentation and non-AI groups. Conclusion: Our findings highlight how AI augments healthcare providers\u27 ability to detect and manage strokes swiftly and accurately within acute care settings. As these technologies progress, healthcare organizations mature, and AI becomes more integrated into healthcare systems, longitudinal studies are critical in evaluating its impact on workflow efficiency, cost-effectiveness, and clinical outcomes
Aortic Pseudoaneurysm After Pancreatic Transplant: Case Report and Review of the Literature
No full textPseudoaneurysm (PSA) is a rare complication of pancreatic transplantation and can present with gastrointestinal (GI) bleeding. We present a case of a 61-year-old male, who had a history of a pancreas transplant for type I diabetes mellitus 12 years ago, who presented with GI bleeding. He had a CT scan that showed a small PSA in the distal aorta near the arterial anastomosis of his previous pancreas transplant. He underwent an angiogram showing a distal aortic PSA with a wide sac. The patient was initially treated with observation and had recurrent bleeding. The patient had a repeat CT scan showing an increase in the size of the aortic pseudoaneurysm with contrast into the GI tract. He underwent an emergent endovascular stent placement with good recovery. Pancreatic transplantations have a low incidence of PSA; however, patients can present with sentinel gastrointestinal bleeding followed by more massive bleeding. These patients should undergo a CT scan with contrast and angiogram for accurate diagnosis and treatment