Objective Annually, more than 100,000 US and international military and civilian personnel work in Afghanistan within terrain harboring venomous snakes. Current literature insufficiently supports ...Afghan antivenom treatment and stocking guidelines. We report the clinical course and treatments for snakebite victims presenting to US military hospitals in Afghanistan. Methods All snakebite victims presenting to 3 US military emergency departments between July 2010 and August 2011 in northern and southern Afghanistan were examined via chart review. Case information included patient demographics, snake description, bite details and complications, laboratory results, antivenom use and adverse effects, procedures performed, and hospital course. Results Of 17 cases, median patient age was 20 years (interquartile range IQR, 12–30), 16 were male, and 82% were Afghans. All bites were to an extremity, and median time to care was 2.8 hours (IQR, 2–5.8). On arrival, 8 had tachycardia and none had hypotension or hypoxia. A viper was implicated in 5 cases. Ten cases received at least 1 dose of polyvalent antivenom, most commonly for coagulopathy, without adverse effects. Six received additional antivenom, 6 had an international normalized ratio (INR) > 10, and none developed delayed coagulopathy. Three received blood transfusions. Hospital stay ranged from 1 to 4 days. None required vasopressors, fasciotomy, or other surgery, and none died. All had resolution of marked coagulopathies and improved swelling and pain on discharge. Conclusions We report the largest series of snake envenomations treated by US physicians in Afghanistan. Antivenom was tolerated well with improvement of coagulopathy and symptoms. All patients survived with minimal advanced interventions other than blood transfusion.
Rationale Cystic fibrosis (CF) is a genetic respiratory disease associated with airway obstruction and chronic lung infections. 7-9% of CF cases are complicated by allergic bronchopulmonary ...aspergillosis (ABPA).
Glenohumeral internal rotation deficit has been identified as a significant risk factor for upper-extremity injuries in pitchers across all ages. Humeral retroversion (HR), posterior capsule ...thickness (PCT), and posterior rotator cuff muscle pennation angle (PA) have been independently associated with internal rotation range of motion (IR ROM); however, these anatomic structures have not been collectively measured in baseball pitchers to determine the underlying mechanisms responsible for IR ROM. Therefore, the purpose of this study was to determine the contributions of HR, PCT, and posterior rotator cuff PA on IR ROM during a preseason evaluation in healthy professional baseball pitchers. The authors hypothesized that HR, PCT, and posterior rotator cuff PA would have a significant contribution to IR ROM.
This is a cross-sectional study. Healthy professional pitchers from a single organization were recruited at the beginning of the 2021 Major League Baseball Spring Training. Participants received bilateral IR ROM assessment while laying supine with the shoulder at 90 degrees of abduction and the scapula stabilized. Ultrasound imaging was also performed bilaterally to assess HR, PCT, infraspinatus (superficial + deep) PA, and teres minor (superficial + deep) PA. All ultrasound imaging processes were performed utilizing previously published, highly reliable techniques. A stepwise regression was performed, which included both arms to determine the mechanisms of IR ROM.
Overall, 49 pitchers (88 shoulders) with an average age of 22.5 ± 2.2 years were included in the final data analysis. Stepwise linear regression found that only HR and PCT were associated with the preseason IR ROM. There was a moderate relationship between HR and PCT relative to IR ROM (R = 0.535, P < .001).
HR and PCT were found to be the primary mechanisms responsible for the preseason glenohumeral IR ROM. The posterior rotator cuff was not found to be significantly related to IR ROM. Future research evaluating these anatomic structures longitudinally—both acutely and chronically—will help clinicians optimize ROM management throughout the season. As glenohumeral internal rotation deficit can have harmful effects in baseball pitchers, understanding which anatomic structures are most responsible for IR ROM is important for injury prevention and treatment.
Abstract Background Although single nucleotide polymorphism chromosomal microarrays identify areas of small genetic deletions or duplications, they can also reveal regions of homozygosity indicative ...of consanguinity. As more nongeneticists order single nucleotide polymorphism microarrays, they must prepare for the potential ethical, legal, and social issues that result from revelation of unanticipated consanguinity. Patient We describe an infant with multiple congenital anomalies who underwent single nucleotide polymorphism microarray testing. Results The results of the single nucleotide polymorphism microarray revealed several large regions of homozygosity that indicated identity by descent most consistent with a second-degree or third-degree relative mating (e.g., uncle/niece, half-brother/sister, first cousins). The mother was not aware of the test's potential to reveal consanguinity. When informed of the test results, she reluctantly admitted to being raped by her half-brother around the time of conception. Conclusions During the pretesting consent process, providers should inform parents that single nucleotide polymorphism microarray testing could reveal consanguinity. Providers must also understand the psychological implications, as well as the legal and moral obligations, that accompany single nucleotide polymorphism microarray results that indicate consanguinity.
Background The diagnosis of COPD is made by objectively demonstrating nonreversible airflow obstruction of the lungs. Despite this, rates of pulmonary function testing (PFT) for diagnosis remain low. ...It is still not known why testing is underused. Methods We conducted a population study using the health administrative data of all individuals 35 years of age and older newly diagnosed with COPD in Ontario, Canada, between 2000 and 2010. Receipt of PFT during the peridiagnostic period (between 1 year before and 1 year after a diagnosis of COPD) was determined and related to patient demographic and clinical characteristics as well as primary care physician and health-care system factors. Results Only 35.9% of the 491,754 Ontarians newly diagnosed with COPD during the study period received PFT. Individuals diagnosed before age 50 years or after age 80 years, those living in long-term care, and those with stroke and/or dementia were less likely to receive testing. Patients who had a medical specialist involved in their care and/or had other coexisting pulmonary disease were more likely to receive testing. Finally, older primary care physicians were less likely to order testing for their patients. Conclusions Only about one-third of individuals with COPD in Ontario, Canada, received PFT to confirm their diagnosis; age, comorbidity, and physician factors appear to influence its use. Targeted strategies that address these factors could increase the rate of appropriate testing of people with suspected COPD and improve quality of COPD care.
Background Asthma is a common chronic respiratory condition, the diagnosis of which depends on symptoms and objective evidence of variable airflow obstruction or airway hyperresponsiveness. The ...proportion of people who have had objective pulmonary function testing around the time of diagnosis and factors associated with receiving testing are not well understood. Methods A retrospective cohort study was conducted using the health administrative data of all individuals aged 7 years and older with newly physician-diagnosed asthma living in Ontario, Canada between 1996 and 2007. Receipt of pulmonary function testing in the peridiagnostic period was determined and examined across patient sociodemographic and clinical factors. Results Only 42.7% (95% CI, 42.6%-42.9%) of the 465,866 Ontarians newly diagnosed with asthma received pulmonary function testing between 1 year prior and 2.5 years following the time of diagnosis. In adjusted analyses, individuals 7 to 9 years old and those 70 years or older were less likely to receive testing than younger adults, individuals in the lowest neighborhood income quintile were less likely to receive testing than those in the highest, and individuals seeing a medical specialist were more likely to receive testing than those seeing only a general practitioner. Conclusions Less than one-half of patients with new physician-diagnosed asthma in Ontario, Canada received objective pulmonary function testing around the time of diagnosis. Further study is needed to determine why more pulmonary function testing is not being used to diagnose asthma and how barriers to its appropriate use can be overcome.
Background: Chronic pruritus (CP) is a poorly characterized condition associated with intense pruritus without a primary skin eruption. This condition tends to emerge more commonly in older adults, ...and there is limited research on triggering factors. Objective: To explore the clinical characteristics and pathophysiology of CP following exposure to an immune stimulus. Methods: Clinical characteristics and plasma samples were collected from 15 patients who developed CP following an immune stimulus such as checkpoint inhibitors or vaccination. A multiplex panel was used to analyze plasma cytokine concentrations within these patients. Results: Most immunotherapy-treated patients experienced CP during treatment or after 21 to 60 days of receiving treatment, while vaccine-stimulated patients developed pruritus within a week of vaccination. Plasma cytokine analysis revealed elevated levels of 12 cytokines in patients with immune-stimulated CP compared to healthy controls. Notably, T helper 2 (Th2) related cytokines interleukin (IL)-5 (fold change 2.65; q < 0.25) and thymic stromal lymphopoietin (fold change 1.61 q < 0.25) were upregulated. Limitations: Limitations of this study include limited sample size, particularly in the plasma cytokine assay. Conclusions and Relevance: This study reveals triggers of CP development and describes alterations in blood Th2 markers in patients with CP, including IgE, increased blood eosinophils, and cytokines IL-5 and thymic stromal lymphopoietin.
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