19043 research outputs found
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Silencing the Noise: State-Of-The-Art Neuroendovascular and Cardiology Management of Pulsatile Tinnitus
No full textPulsatile tinnitus (PT) is a unique clinical condition often attributed to various vascular anomalies, making it of increasing interest to specialists outside the traditional realms of otolaryngology and neurology. Endovascular treatment has recently emerged as a key management tool for patients suffering from PT, particularly in cases associated with venous sinus stenosis or arteriovenous shunting. Understanding the indications, procedural risks, and long-term outcomes associated with endovascular treatment is important to ensure timely referral and comprehensive care for patients presenting with PT. Cardiologists should be vigilant for signs and symptoms of PT, as PT can be an early indicator of vascular abnormalities and other cardiovascular conditions. Once identified, cardiologists can play an essential role in the timely diagnosis and treatment of PT, differentiating the etiology and ensuring that the patient receives the proper prompt referrals for imaging and endovascular assessment if needed
The Challenge of Diagnosing Intracranial Pressure Elevations as an Otolaryngologist
No full textPurpose: This article addresses the complex clinical scenario where patients present to otolaryngologists with symptoms typically ascribed to chronic rhinosinusitis (CRS) or migraines which may in fact stem from elevations in intracranial pressure. We aim to clarify the diagnostic challenges and emphasize the importance of considering elevated intracranial pressure (eICP) as its symptoms overlap with both CRS and migraines. Methods: This narrative review synthesizes clinical experiences and literature to discuss the differential diagnoses involving CRS, facial pain/pressure, migraines, and eICP. Key discussion points include symptomatology of eICP and its management in otolaryngological practice. Results: Patients presenting with symptoms of CRS or migraine may exhibit overlapping signs that makes diagnosis challenging. Patients with symptoms of facial pain and pressure, or other findings such as ear fullness, muffled hearing, and tinnitus, that do not resolve with conventional topical intranasal therapies or migraine management should be worked up for eICP. Conclusion: The overlap in clinical presentations among patients with concern for CRS, migraines, and ICP elevations poses a diagnostic challenge. It is crucial for otolaryngologists and neurologists to collaborate closely to ensure accurate diagnoses and appropriate management. Enhanced awareness and understanding of the broader spectrum of symptoms associated with eICP can prevent misdiagnosis and promote better patient outcomes
Lumbar Spinal Fusion in Postmenopausal Women With a History of Hormone Replacement Therapy
No full textIntroduction: Recent re-evaluation of the Women\u27s Health Initiative Hormone Therapy Trials has established that hormone replacement therapy (HRT) can be beneficial for patients, if begun shortly after menopause. This study investigates the impact of a history of postmenopausal HRT on patient demographics and perioperative complications in women undergoing lumbar spinal fusion. Methods: The National Inpatient Sample was queried from 2016 to 2020 for postmenopausal women (\u3e55 years old or applicable diagnosis) undergoing lumbar spinal fusion for degenerative etiologies, using International Classification of Disease Tenth Revision diagnostic and procedural codes. Patient characteristics and perioperative complications were evaluated for history of HRT versus non-HRT patients undergoing lumbar spinal fusion surgery. Results: Of the 202,945 postmenopausal patients undergoing lumbar spinal fusion, 2645 (1.3 %) had a history of receiving HRT. Analysis demonstrated that HRT was a negative predictor of acute kidney injury (OR: 0.672; p = 0.006), pneumonia (OR: 0.320; p = 0.010), and anemia (OR: 0.887; p = 0.020). It was a positive predictor of bowel/bladder dysfunction (OR: 1.371; p \u3c 0.001). Conclusions: The findings of this study highlight the unique demographics, comorbidities, and perioperative complications of postmenopausal women with a history of HRT undergoing lumbar spinal fusion surgery. While HRT history was associated with a favorable inpatient course, including reduced risk of acute kidney injury, pneumonia, deep venous thrombosis and myocardial infarction, these findings should be interpreted with caution due to limitations in coding accuracy and lack of long-term follow-up. HRT status may reflect broader differences in baseline health and healthcare access
Expanding Buprenorphine Prescribing in Primary Care: A Qualitative Study of the Experiences of Primary Care Providers and Nurse Care Managers Participating in the New York City Buprenorphine Nurse Care Manager Initiative
No full textBackground: Improving access to and retention in evidence-based treatment for opioid use disorder, including buprenorphine, is a critical response to the opioid overdose crisis. To increase the availability of buprenorphine treatment in primary care settings, the New York City Department of Health and Mental Hygiene implemented the Buprenorphine Nurse Care Manager Initiative in safety-net primary care clinics. The initiative funds nurse care managers to coordinate ongoing buprenorphine care and provides clinical support and technical assistance for implementation. Methods: As part of a process evaluation of the initiative, we conducted in-depth interviews with 18 primary care providers new to prescribing buprenorphine and five nurse care managers across six organizations in New York City that participated in the Buprenorphine Nurse Care Manager Initiative between 2017 and 2019. We aimed to understand participating providers’ views on the successes and challenges of the initiative. Thematic and trajectory analytic approaches were used to capture major themes and changes over time. Results: Findings show that participating providers valued many aspects of the initiative, suggesting that integrating buprenorphine treatment with the support of a nurse care manager into safety-net primary care clinics can effectively expand access to buprenorphine and quality of care for people with opioid use disorder in New York City. Conclusions: Findings from this process evaluation can inform future primary care-based buprenorphine treatment initiatives. Recommendations include ensuring ample nurse care manager support for primary care providers, robust mentorship structures, and organizational buy-in for initiative sustainability
Pharmacokinetic Evaluation of Aripiprazole Monohydrate as a Once Every 2-Months Long-Acting Injectable Antipsychotic for Schizophrenia
No full textIntroduction: Long-acting injectable (LAI) antipsychotics are often considered preferable to their oral counterparts for the long-term maintenance treatment of schizophrenia. One goal of LAI drug development is to extend the dose interval between injection visits. Aripiprazole Monohydrate (AM, Abilify Maintena®) was approved in 2013 as a monthly formulation, but a 2-month interval formulation (Ari2M, Abilify Asimtufii®) was approved by the FDA in 2023 for the treatment of schizophrenia in adults and maintenance monotherapy of bipolar I disorder in adults, and by the EMA as Abilify Maintena® 960 mg in 2024 with the indication of maintenance treatment of schizophrenia in adult patients stabilized with oral aripiprazole. Areas covered: This review covers the development and pharmacokinetics of the 2-month formulation and provides data on the safety and pharmacokinetic modeling which informed its regulatory approval. Expert opinion: Ari2M 960 mg Q2M can be safely substituted for AOM 400 mg Q1M and Ari2M 720 mg Q2M for AOM 300 mg Q1M as per clinician and patient preference. The new formulation employs a ready-to-use prefilled syringe, must be administered in the gluteal muscle, and can be given within ± 2 weeks of the scheduled injection date. Reinitiation is only necessary if ≥ 14 weeks have passed since the prior injection
EDTA Treatment of Serum Reduces T Cell and B Cell False Positivity in Flow Cytometry Crossmatching: A Multicenter Study
No full textFalse positive T or B cell flow cytometry crossmatching (FCXM) results present a significant challenge in transplantation decisions. In this multicentre study, we investigated the efficacy of ethylenediaminetetraacetic acid (EDTA) treatment of serum samples to enhance the quality of FCXM results by reducing false positivity at two independent laboratories. Our findings indicate that EDTA treatment of serum effectively eliminated false positivity in B cell non-pronased (NP) FCXM compared with untreated samples, possibly by lowering aggregated IgG formation from in vitro storage of patient sera. In B cell NP FCXM, EDTA-treated serum from both sensitised and non-sensitised patients exhibited comparable efficacy to B cell pronase treated (PT) FCXM, with a sensitivity of 94% and specificity of 96%. Moreover, EDTA-treated serum samples demonstrated superior performance to T cell PT FCXM, effectively reducing false positivity. In addition, EDTA-treated sera performed in par with sera pre-treated with 2-mercaptoethanol, and superior to sera treated with Dithiothreitol or with heat inactivation, in removing false B cell positivity in NP FCXM. Importantly, our analysis of 124 FCXM underscores the simplicity and effectiveness of EDTA treatment, which can be seamlessly integrated into both NP and PT FCXM. Consequently, the adoption of EDTA-treated patient serum in B cell NP FCXM reduces the need for B cell PT FCXM
Prognostic Effect of Frailty in Cerebral Venous Thrombosis
No full textIntroduction: Few studies have evaluated the role of frailty in cerebral venous thrombosis (CVT), perhaps due to the relative rarity of the pathology and its predominance in younger populations. We aim to do so using a large, nationally representative sample. Methods: Hospitalization records for CVT were identified in the National Inpatient Sample (2016–2020) and the cohort was stratified by increasing frailty thresholds, quantified by the Risk Analysis Index (RAI). Effect sizes of frailty tiers for poor outcome (defined as non-routine discharge disposition) produced from multivariable logistic regression models and discrimination (c-statistic) were evaluated. Results: This analysis identified 3265 CVT hospitalizations (median age 56 years, 59.6 % female). Following cohort stratification, 465 (14.2 %) were frail and 160 (4.9 %) were very frail. A poor outcome was experienced by 58.7 %, and the rate of poor outcome as well as mean baseline NIHSS score increased as a function of increasing frailty tier. Following multivariable logistic regression analysis, all frailty tiers of the categorical RAI were significantly associated with poor outcome. A combined RAI-NIHSS model achieved a c-statistic of 0.828 (95 % CI 0.796, 0.860). Conclusion: Concomitant consideration of frailty quantified by the RAI and baseline NHSS score reliably predicts short-term outcome in CVT
