In other words, non-White patients— Black patients in particular—were significantly more likely to experience the “double whammy” of delayed diagnosis and lower quality of care after diagnosis. ......let us not overlook that all patients in Kalva et al.’s study received care at one of approximately 1500 Commission on Cancer-accredited cancer programs that report to the NCDB. Efforts to eradicate inequity and elevate the management of MTC will undoubtedly require a multifaceted approach, balancing a deep understanding of the complex interplay of race, ethnicity, gender, and socioeconomic factors with scientific advancements in MTC research to reinforce the provision of guideline-concordant care.
Extranodal natural killer (NK)/T-cell lymphoma, nasal type (NNKTL) is a rare and highly aggressive non-Hodgkin lymphoma originating from NK or γδ T cells infected by Epstein-Barr virus (EBV). In the ...United States, NNKTL is usually noted in people of Asian or Hispanic descent. Natural killer/T-cell lymphoma, nasal type commonly involves the upper aerodigestive tract, including the nasopharynx, nasal cavity, Waldeyer’s ring, and oropharynx. Extensive local destruction and invasion has been noted, especially of the paranasal sinuses, hard palate, and central nervous system; involvement of the nasolacrimal duct with dacryocystitis is yet to be reported. We report a rare case of a Hispanic man with extranodal NNKTL masquerading as persistent dacryocystitis and necrotizing sinusitis unresponsive to antibiotics and surgical intervention. An extensive background of necrosis and inflammation was noted on pathology, and additional analysis with immunohistochemistry and in situ hybridization after repeat biopsy were necessary for accurate diagnosis.
Impact of gun violence Eze, Anthony Nnaemeka
Trauma surgery & acute care open,
12/2023, Letnik:
8, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In our societal focus on gun mortality, we lose sight of the long-term effects of these injuries, including the cost and treatment burden that victims and their families incur and, in fact, the ...nation at large. Measuring the impact of gun violence by mortality rate alone is a gross underestimation of its true impact. While the debate on how to reduce rate of gun violence continues, it is imperative that we make every endeavor to ensure that victims of gun violence receive the care they need to reduce disability and morbidity. It is crucial that we prevent firearm-related deaths, and we must address the sequelae of these injuries and the casualties that these injuries bring the opportunities and livelihoods of the survivors of gun violence.
Introduction: Neonatal appendicitis is extremely rare and lacks specific clinical signs. Given its rarity, lack of specific physical signs and the subsequent low index of suspicion; diagnosis and ...surgical intervention are often delayed in neonates resulting in significant morbidity and mortality. Case presentation: We describe the case of a premature twin male born via spontaneous vaginal delivery at 22 weeks of gestation. Due to hypoxic respiratory failure and sepsis at birth, he required prolonged ventilator support and intermittent vasopressor support. On the 26th day of life, he developed feeding intolerance with hypotension and was found to have abdominal distension and significant pneumoperitoneum on plain radiograph without signs of peritonitis on physical exam. During an emergent laparotomy with ileocecectomy, he was found to have acute gangrenous appendicitis with large perforation at the base. Pathology examination demonstrated transmural necrosis of the appendix with perforation and an abundance of ganglion cells throughout the length of the examined bowel, excluding the possibility of Hirschsprung's disease. Conclusion: While neonatal appendicitis is historically considered rare, given improved survival of premature babies due to medical advances in perinatal care, it is expected that the incidence of neonatal appendicitis will continue to rise. Our case report describes the unusual presentation of neonatal appendicitis without peritonitis despite significant pneumoperitoneum and it highlights the importance of having a thorough understanding of the nonspecific signs of neonatal appendicitis and a higher index of suspicion with a comprehensive differential diagnosis to facilitate a timely diagnosis and initiate urgent surgical intervention.
Megaduodenum is a rare clinical syndrome characterized by significant duodenal dilation, elongation, and hypertrophy. Given its rarity and nonspecific clinical manifestations, megaduodenum may be ...misdiagnosed, leading to delays in surgical care and increased morbidity. We describe a case of idiopathic megaduodenum in a teenage Caucasian female, who presented with a five-year history of halitosis, recurrent belching, bloating, nausea and vomiting, and postprandial epigastric abdominal pain. She was diagnosed with megaduodenum by dramatic findings on contrast radiography. She developed a duodenal volvulus necessitating emergency exploratory laparotomy, during which a duodenal plication and a side-to-side duodenojejunostomy were performed. Exploratory laparotomy and histopathological analysis were unrevealing of any definitive abnormalities to explain her megaduodenum. Postoperatively, she developed two early small bowel obstructions, both from subsequent adhesions requiring repeat laparotomy with adhesiolysis. She has subsequently recovered without incident. Diagnosis and accurate classification of megaduodenum requires surgical exploration with a full-thickness biopsy and subsequent histopathologic analysis to rule out obstructive or functional disorders of the duodenum. Treatment of megaduodenum depends on the underlying cause and degree of duodenal distention. It is crucial that clinicians are knowledgeable of the various surgical options, their indications, and the potential postoperative complications that may arise.
IntroductionDozens of multivariable prediction models for atrial fibrillation after cardiac surgery (AFACS) have been published, but none have been incorporated into regular clinical practice. One of ...the reasons for this lack of adoption is poor model performance due to methodological weaknesses in model development. In addition, there has been little external validation of these existing models to evaluate their reproducibility and transportability. The aim of this systematic review is to critically appraise the methodology and risk of bias of papers presenting the development and/or validation of models for AFACS.MethodsWe will identify studies that present the development and/or validation of a multivariable prediction model for AFACS through searches of PubMed, Embase and Web of Science from inception to 31 December 2021. Pairs of reviewers will independently extract model performance measures, assess methodological quality and assess risk of bias of included studies using extraction forms adapted from a combination of the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and the Prediction Model Risk of Bias Assessment Tool. Extracted information will be reported by narrative synthesis and descriptive statistics.Ethics and disseminationThis systemic review will only include published aggregate data, so no protected health information will be used. Study findings will be disseminated through peer-reviewed publications and scientific conference presentations. Further, this review will identify weaknesses in past AFACS prediction model development and validation methodology so that subsequent studies can improve upon prior practices and produce a clinically useful risk estimation tool.PROSPERO registration numberCRD42019127329.
Oral sex, a risky sexual behaviour, is now a common sexual behaviour in Nigeria. Nigerian clinicians play crucial roles in the promotion of healthy sexual behaviours among the lay public. This study ...seeks to identify those factors that determine the willingness of Nigerian clinicians to recommend protected oral sex to patients with history of oral sex practice. This study surveyed 330 clinicians in Nigeria, using an e-questionnaire circulated via WhatsApp and Telegram. The collected data were analysed using SPSS version 21 software. The majority (89.1%) of the respondents were willing to recommend protected oral sex for patients engaging in oral sex. Amidst all of the factors (sociodemographic factors, sexual history, etc.) investigated, only one factor (which was the uncertainty about the risk level of oral sex) was found to predict the willingness to recommend protective measures to patients on oral sex (OR = 3.06, p = 0.036). In conclusion, only few factors were found to influence Nigerian clinicians in engaging in patient education on safer oral sex practices.
Aortic dissection (AD) presents a critical medical emergency characterized by a tear in the aortic wall, necessitating prompt recognition and management to mitigate catastrophic complications. ...Despite advancements in medical technology and therapeutic interventions, AD remains a formidable challenge, often resulting in severe morbidity and mortality. This narrative review provides a comprehensive overview of AD, encompassing its clinical presentation, diagnostic modalities, and management strategies, while also exploring emerging trends and innovations in its management. Genetic predispositions significantly influence AD pathogenesis, with over 30 contributory genes identified, emphasizing the importance of genetic screening and counseling. Classification systems such as Stanford and DeBakey, alongside their revised counterparts, aid in categorizing AD and guiding treatment decisions. Advancements in diagnostic imaging, including transesophageal echocardiography and computed tomography angiography, have enhanced diagnostic precision, augmented by artificial intelligence and machine learning algorithms. Pharmacological innovations focus on optimizing medical therapy, while surgical and endovascular approaches offer minimally invasive treatment options. Hybrid procedures and aortic valve-sparing techniques broaden treatment avenues, while bioresorbable stent grafts hold promise for tissue regeneration. Collaborative efforts and ongoing research are essential to address remaining challenges and improve outcomes in managing AD. This review contributes to the understanding of AD's complexity and facilitates informed decision-making in clinical practice, underscoring the imperative for continued innovation and research in AD management.
Firearm injury is a public health crisis. Most victims are minorities in underserved neighborhoods. Measuring firearm injury by mortality underestimates its impact, as most victims survive to ...discharge. This study was done to determine if race and insurance status are associated with discharge disposition for gunshot wound (GSW)-related trauma.
Using the 2019 Trauma Quality Improvement Program database, we identified GSW patients with Abbreviated Injury Scale (AIS) = 1-3. Exclusion criteria included patients who died in hospital and routine home discharge. We compared discharge patterns of patients based on demographics (age, gender, race, ethnicity, payor, AIS, hospital designation, and length of stay LOS) and injury severity. Multivariable logistic regression models identified factors associated with discharge disposition.
Our sample included 2437 patients with GSWs. On univariable analysis, Black patients were more likely to discharge to home with home health (64.1% Black versus 34.7% White; P < 0.001). White patients were more likely to discharge to skilled nursing facility (SNF) (51.4% White versus 44.6% Black; P < 0.001). Controlling for age, race, Latin ethnicity, primary payor, LOS, AIS severity, and injury severity score factors independently associated with discharge to SNF included age (0.0462, P < 0.001), Medicaid (1.136, P < 0.0003), Medicare (1.452, P < 0.001), and LOS (0.03745, P < 0.001).
Postacute care following traumatic injuries is essential to recovery. Black GSW victims are more likely to be discharged to home health than White patients, who are more likely to be discharged to SNF. Targeted programs to reduce barriers to appropriate aftercare are necessary to eliminate this bias and improve the care of underserved populations.
Chronic kidney disease (CKD) is a progressive condition characterized by gradual loss of kidney function, necessitating timely monitoring and interventions. This systematic review comprehensively ...evaluates the application of artificial intelligence (AI) and machine learning (ML) techniques for predicting CKD progression. A rigorous literature search identified 13 relevant studies employing diverse AI/ML algorithms, including logistic regression, support vector machines, random forests, neural networks, and deep learning approaches. These studies primarily aimed to predict CKD progression to end-stage renal disease (ESRD) or the need for renal replacement therapy, with some focusing on diabetic kidney disease progression, proteinuria, or estimated glomerular filtration rate (GFR) decline. The findings highlight the promising predictive performance of AI/ML models, with several achieving high accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve scores. Key factors contributing to enhanced prediction included incorporating longitudinal data, baseline characteristics, and specific biomarkers such as estimated GFR, proteinuria, serum albumin, and hemoglobin levels. Integration of these predictive models with electronic health records and clinical decision support systems offers opportunities for timely risk identification, early interventions, and personalized management strategies. While challenges related to data quality, bias, and ethical considerations exist, the reviewed studies underscore the potential of AI/ML techniques to facilitate early detection, risk stratification, and targeted interventions for CKD patients. Ongoing research, external validation, and careful implementation are crucial to leveraging these advanced analytical approaches in clinical practice, ultimately improving outcomes and reducing the burden of CKD.
