Medical Specialties Commons^™

Newborn Screening Protocols And Positive Predictive Value For Congenital Adrenal Hyperplasia Vary Across The United States, P. W. Speiser, R. Chawla, M. Chen, A. Diaz-Thomas, C. Finlayson, M. M. Rutter, D. E. Sandberg, K. Shimy, J. Cerise, E. C. Délot, +2 Additional Authors

Journal Articles

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Newborn screening for congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency is mandated throughout the US. Filter paper blood specimens are assayed for 17-hydroxyprogesterone (17OHP). Prematurity, low birth weight, or critical illness cause falsely elevated results. The purpose of this report is to highlight differences in protocols among US state laboratories. We circulated a survey to state laboratory directors requesting qualitative and quantitative information about individual screening programs. Qualitative …

Use Of Organ Dysfunction As A Primary Outcome Variable Following Cecal Ligation And Puncture: Recommendations For Future Studies, M. N. Abraham, A. P. Kelly, A. B. Brandwein, T. D. Fernandes, D. E. Leisman, M. D. Taylor, M. R. Brewer, C. A. Capone, C. S. Deutschman

Journal Articles

Outcomes variables for research on sepsis have centered on mortality and changes in the host immune response. However, a recent task force (Sepsis-3) revised the definition of sepsis to "life-threatening organ dysfunction caused by a dysregulated host response to infection." This new definition suggests that human studies should focus on organ dysfunction. The appropriate criteria for organ dysfunction in either human sepsis or animal models are, however, poorly delineated, limiting the potential for translation. Further, in many systems, the difference between "dysfunction" and "injury" may not be clear. In this review, we identify criteria for organ dysfunction and/or injury in …

Quality Of Life Outcomes In Tracheobronchomalacia Surgery, J Mcginn, B Herbert, A Maloney, B Patton, R Lazzaro

Journal Articles

No abstract provided.

Heparin-Induced Thrombocytopenia In Patients Readmitted After Open Cardiac Surgical Procedures: A Case Series, M A. Catalano, V Prasad, A M. Spring, H Cassiere, T Y. Chang, A Hartman, Pj Yu

Journal Articles

No abstract provided.

The Course Of Sars-Cov2 Infection Was Not Severe In A Crohn's Patient Who Administered Maintenance Anti-Tnf Therapy Overlapping The Early Pre-Symptomatic Period Of Infection., F. Okeke, A. Mone, A. Swaminath

Journal Articles

The Inflammatory Bowel Disease (IBD) population, which may require treatment with immunosuppressive medications, may be uniquely vulnerable to COVID-19 infection. In fact, there is some evidence these medications may inhibit the cytokine storm that is theorized to cause a rapid decline seen in COVID-19. In addition, the digestive symptoms of COVID-19 can be difficult to distinguish from the activation of IBD. We present an interesting case of a Crohn's patient inadvertently administering anti-cytokine therapy during the pre-symptomatic period of COVID-19 infection. Immune suppression during early infection with SARS-COV2 risks a poor immune response to the virus and could theoretically result …

Implementation Of The Management Of Anticoagulation In The Periprocedural Period App Into An Electronic Health Record: A Prospective Cohort Study, A. C. Spyropoulos, D. Giannis, J. Cohen, S. John Np, A. Myrka, D. Inlall, M. Qiu, S. Akgul, R. J. Hyman, J. J. Wang

Journal Articles

No abstract provided.

Effect Of Direct Oral Anticoagulant, Patient, And Surgery Characteristics On Clinical Outcomes In The Perioperative Anticoagulation Use For Surgery Evaluation Study., K. Macdougall, J. D. Douketis, N. Li, N. P. Clark, A. Tafur, J. D'Astous, J. Duncan, S. Schulman, A. C. Spyropoulos

Journal Articles

Introduction  The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) Study assessed a standardized perioperative management strategy in patients with atrial fibrillation who were taking a direct oral anticoagulant (DOAC) and required an elective surgery or procedure. The aim of this substudy is to analyze the safety of this management strategy across different patient subgroups, according to four presurgical variables: (1) DOAC type and dose, (2) surgery/procedure bleed risk, (3) patient renal function, and (4) age. Methods  Clinical outcomes analyzed included major bleeding (MB), arterial thromboembolism, any bleeding, and any thromboembolism. We used descriptive statistics to summarize clinical outcomes, where the …

Atypical Presentation Of Panhypopituitarism., H. K. Rai, G. John, M. Anton

Journal Articles

Hypopituitarism is a rare disorder. Hypopituitarism can present as a deficiency of individual anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone) or posterior pituitary hormones (e.g., oxytocin, vasopressin) or as the deficiency of all these pituitary hormones, also known as panhypopituitarism. Here, we discuss a 59-year-old man who presented with two episodes of unwitnessed syncope after an episode of vomiting. On admission, the patient was hypotensive to 88/54 mmHg, afebrile, and with a leukocyte count of 21.43 K/µL (reference range: 3.80 to 10.50 K/µL). CT scan of the head revealed a hyperdensity in …

Erysipelothrix Rhusiopathiae Endocarditis, T. Wang, D. Khan, N. Mobarakai

Journal Articles

© 2020 Erysipelothrix rhusiopathiae is a zoonotic gram positive coccobacillus. It is rarely found in humans as an occupational pathogen that mainly infects animal handlers. There are three forms of human infection: localized erysipeloid, diffuse cutaneous form and lastly, bacteremia that could progress to infective endocarditis. We present a case of a 59-year-old male who was found to have E. rhusiopathiae bacteremia that was diagnosed as aortic valve endocarditis with severe aortic regurgitation. The patient was treated with ampicillin-sulbactam then transitioned to six weeks of intravenous ampicillin. This report summarizes a rare organism that causes a serious human infection and …

Longitudinal Renal Function In Liver Transplant Recipients With Acute-On-Chronic Liver Failure, M. Yazawa, B. Maliakkal, S. Nair, P. S. Podila, U. A. Agbim, S. Karri, S. D. Khan, D. Maluf, J. D. Eason, S. K. Satapathy, +1 Additional Author

Journal Articles

No abstract provided.

Roth Net-Assisted Endoscopic-Guided Manometry Catheter Placement., D. Gurala, J. Philipose, A. D. Polavarapu, Y. El Douaihy, S. M. Mulrooney

Journal Articles

High-resolution esophageal manometry (HRM) has become the gold standard to diagnose esophageal motility disorders. Usually, this procedure is performed by introducing the catheter, which has pressure sensors, into the esophagus and proximal stomach via the nares. Repeated coiling of the catheter and inability to pass through the gastroesophageal junction (GEJ) are common challenges encountered. Endoscopy-guided placement of the catheter can overcome these difficulties. However, sometimes even with the use of endoscopy, it is difficult to advance catheter due to anatomical variants. The extreme fragility of the catheter and sensors and the high cost of this reusable device precludes the use …

Access And Continuity: A Multidisciplinary Education Workshop To Teach Patient-Centered Medical Home (Pcmh) Principles, L. Block, C. Petersen, D. J. Coletti, P. Yalakkishettar, N. Lavine

Journal Articles

No abstract provided.

Predictors Of Bleeding In The Perioperative Anticoagulant Use For Surgery Evaluation Study, A. J. Tafur, N. P. Clark, A. C. Spyropoulos, N. Li, E. Kaplovitch, K. Macdougall, S. Schulman, J. A. Caprini, J. Douketis

Journal Articles

No abstract provided.

Resumption Of Elective Orthopaedic Surgery In The Us Epicenter Of Covid-19, E. S. Krauss, A. Segal, D. Schulman, N. Dengler, T. Bily, M. Cronin, K. Altner

Journal Articles

© 2020 Krauss et al. On March 1, 2020, New York State confirmed its first case of COVID-19. This state has had the largest initial mortality in the United States with more than 479,000 confirmed cases and over 25,000 deaths as of October 10, 2020. All elective surgeries in New York State were suspended on March 23, 2020, due to the national state of emergency. Syosset Hospital is a 75-bed community hospital dedicated primarily to elective surgery. During the COVID-19 surge, the hospital was converted to provide needed beds for the treatment of COVID-19 illness. In anticipation of the resumption …

Pneumothorax In Covid-19 Acute Respiratory Distress Syndrome: Case Series., K. Wong, D. H. Kim, A. Iakovou, S. Khanijo, A. Tsegaye, S. Hahn, M. Narasimhan, G. Zaidi

Journal Articles

Objective The study aims to describe the clinical characteristics and outcomes of patients with COVID-19 related acute respiratory distress syndrome (ARDS) who developed pneumothorax. Design and setting A retrospective chart review was performed of the electronic medical record. Patients were included if they were identified as having confirmed COVID-19 as well as pneumothorax from March 16, 2020 to May 31, 2020. Patients' demographic and clinical characteristics, mechanical ventilator parameters, lung compliance measurements and outcomes during hospitalization were collected. This case series was conducted in intensive care units at two large tertiary care centers within the Northwell Health System, located in …

Evaluating Of Hpv-Dna Ish As An Adjunct To P16 Testing In Oropharyngeal Cancer, J. Chi, I. R. Preeshagul, S. Sheikh-Fayyaz, S. Teckie, N. Kohn, Y. Ziemba, A. Laser, D. Frank, M. Ghaly, D. Kamdar, D. Kraus, D. Paul, N. Seetharamu

Journal Articles

© 2020 Jeffrey Chi. Aim: Current guidelines recommend p16 immunohistochemistry (IHC) for testing human papillomavirus (HPV) in oropharyngeal carcinoma (OPSCC). We evaluated the value of adding DNA in situ hybridization (ISH) to p16 IHC. Methods: Fifty patients with OPSCC were analyzed. Concordance between HPV-DNA ISH and p16 IHC was measured by Gwet's agreement coefficient. Results: p16 IHC was positive in 35/48 (72.9%), negative in 8/48 (16.7%) patients. Wide spectrum DNA-ISH was positive in 9/23 (39%) and negative in 14/23 (60.9%) patients. High-risk 16/18 (HR) HPV DNA-ISH was positive in 11/23 (47.8%) and negative in 12 (52.2%) patients. The agreement between …

Thrombotic Microangiopathy And Acute Kidney Injury Induced After Intravitreal Injection Of Vascular Endothelial Growth Factor Inhibitors Vegf Blockade-Related Tma After Intravitreal Use, R. M. Hanna, N. Tran, S. S. Patel, J. Hou, K. D. Jhaveri, R. Parikh, U. Selamet, L. Ghobry, V. Bijol, I. B. Kurtz, +6 Additional Authors

Journal Articles

No abstract provided.

Continuous Positive Airway Pressure (Cpap) In Nonapneic Asthma: A Clinical Review Of Current Evidence, H. M. Karim, A. M. Esquinas, S. Ziatabar, G. Insalaco, S. Skoczyński, I. Šarc, L. Ferini-Strambi, L. P. Özyiğit, T. Hernández-Gilsoul, B. A. Mina, +17 Additional Authors

Journal Articles

© 2020 by Turkish Thoracic Society-. The use of continuous positive airway pressure (CPAP) in asthma has been a point of debate over the past several years. Various studies, including those on animals and humans have attempted to understand the role and pathophysiology of CPAP in patients with either well controlled or poorly controlled asthma. The aim of this manuscript is to review the currently available literature on the physiologic and clinical effects of CPAP in animal models of asthma and on humans with stable asthma.

Comparison Of A Continuous Noninvasive Temperature To Monitor Core Temperature Measures During Targeted Temperature Management, M. Wagner, K. Lim-Hing, M. A. Bautista, B. Blaber, T. Ryder, J. Haymore, N. Badjatia

Journal Articles

No abstract provided.

Deep Brain Stimulation For Refractory Obsessive-Compulsive Disorder (Ocd): Emerging Or Established Therapy?, H. Wu, M. Hariz, V. Visser-Vandewalle, L. Zrinzo, V. A. Coenen, S. A. Sheth, C. Bervoets, M. Naesstrom, M. Schulder, B. Nuttin, +45 Additional Authors

Journal Articles

No abstract provided.

Author Correction: Noninvasive Sub-Organ Ultrasound Stimulation For Targeted Neuromodulation (Nature Communications, (2019), 10, 1, (952), 10.1038/S41467-019-08750-9), V. Cotero, Y. Fan, T. Tsaava, A. M. Kressel, I. Hancu, T. R. Coleman, S. Zanos, K. J. Tracey, S. S. Chavan, C. Puleo, +10 Additional Authors

Journal Articles

© 2020, The Author(s). This article contained an error in the ordinate axis in Fig. 2d, where the units were reported as nmol/L. The unit should have been reported as pg/ml. This has now been corrected in both the PDF and HTML versions of the Article.

Application Of Multimodal Neuromonitoring In Posterior Inferior Cerebellar Artery Aneurysm Clippings: Review Of Two Cases., J. W. Silverstein, A. Rosenthal, K. Kwan, K. Wagner, J. A. Ellis

Journal Articles

Neurophysiological monitoring is advocated for the prevention of neurological sequelae secondary to the clipping of an aneurysm involved in posterior circulation. Unfortunately, there is a paucity in the literature regarding what neurophysiological monitoring techniques are best employed. The authors here present two cases where multimodal neuromonitoring techniques were used during the clippings of two posterior inferior cerebellar artery (PICA) aneurysms. There is increased neurologic morbidity associated with PICA aneurysm clippings, as a number of eloquent structures live in close proximity to the PICA. The application of a multimodal neuromonitoring paradigm may reduce a poor neurological outcome.

N-Butyl Cyanoacrylate Transvenous Arteriovenous Malformation Embolization With Arterial Balloon Assistance: Defining Parameters For A Transvenous Approach As A Potential Upfront Treatment Option In Managing Cerebral Arteriovenous Malformations., C. Higbie, D. Khatri, B. Ligas, R. Ortiz, D. Langer

Journal Articles

Complete obliteration of arteriovenous malformations (AVMs) using a transvenous approach as the primary and stand-alone treatment modality has been increasingly considered as a useful endovascular approach in the treatment of AVMs. AVMs are typically treated with microsurgery, stereotactic radiosurgery, endovascular embolization, or some combination of the three methods. Preservation of the draining vein is a key requisite common to all treatment modalities. Transvenous embolization (TVE) is conventionally not recommended as a stand-alone treatment for the vast majority of AVMs and has been thought to be best indicated when traditional approaches are considered less safe and when specific evaluation criteria are …

Secondary Encephalocele In An Adult Leading To Subdural Empyema, T. Wang, A. Uddin, N. Mobarakai, R. Gilad, M. Raden, S. Motivala

Journal Articles

© 2020 The Author(s) Brain abscesses are an uncommon but potentially fatal infection. They can spread directly from an adjacent source or hematogenously from a distant source. Encephaloceles represent a rare form of neural tube defects that can potentially be complicated by the development of meningitis or brain abscess. We report a case of a 63-year-old female who presented with bilateral lower extremity weakness and was ultimately found to have a Streptococcus pneumoniae subdural empyema and an associated frontal lobe encephalocele extending through the left frontal sinus. She was treated with surgical drainage, intravenous antimicrobials, and ultimately surgical repair of …

Fusiform Superior Cerebellar Artery Aneurysm Treated With Flow Diversion: A Case Report, Y. Serulle, D. Khatri, J. Fletcher, A. Pappas, A. Heidbreder, D. Langer, R. A. Ortiz

Journal Articles

© 2020 Published by Scientific Scholar on behalf of Surgical Neurology International. Background: Fusiform aneurysms of the distal superior cerebellar artery are rare and challenging to treat. Due to the rarity of these lesions, there is little consensus regarding their management. Treatment options have traditionally included parent artery sacrifice with either an endovascular approach or microsurgical clipping. Given the small diameter of the superior cerebellar artery, flow diversion has not been typically considered as a viable treatment option for these aneurysms. Case Description: A 67-year-old female presented complaining of severe sudden onset headache. Noncontrast head CT demonstrated no intracranial hemorrhage. …

Evaluation Of Concordance Between Original Death Certifications And An Expert Panel Process In The Determination Of Sudden Unexplained Death In Childhood, L. G. Crandall, J. H. Lee, D. Friedman, K. Lear, K. Maloney, J. K. Pinckard, P. Lin, T. Andrew, A. K. Williamson, O. Devinsky, +8 Additional Authors

Journal Articles

Importance: The true incidence of sudden unexplained death in childhood (SUDC), already the fifth leading category of death among toddlers by current US Centers for Disease Control and Prevention estimates, is potentially veiled by the varied certification processes by medicolegal investigative offices across the United States. Objective: To evaluate the frequency of SUDC incidence, understand its epidemiology, and assess the consistency of death certification among medical examiner and coroner offices in the US death investigation system. Design, Setting, and Participants: In this case series, 2 of 13 forensic pathologists (FPs) conducted masked reviews of 100 cases enrolled in the SUDC …

Escape The Trauma Room, M. Podlog, A. Husain, J. Greenstein, S. Sanghvi

Journal Articles

© 2019 by the Society for Academic Emergency Medicine Traditional conference didactics may not be effectively meeting the learning needs of today's emergency medicine (EM) residents, and educators are employing various interactive approaches to engage learners. Escape Room is a popular adventure game in which participants must work together to solve a series of puzzles to escape a locked room. Our aim was to adapt this game design to teach core EM content and procedural aptitude. Upon entering the “locked” room residents were faced with a series of puzzles involving concepts such as toxicology antidotes, ventilator management, echocardiogram interpretations, airway …

Intention To Leave Emergency Medicine: Mid-Career Women Are At Increased Risk, M. D. Lall, S. M. Perman, N. Garg, N. Kohn, K. Whyte, A. Gips, T. Madsen, J. M. Baren, J. Linden

Journal Articles

No abstract provided.

Tdp-43 Is Elevated In Plasma Neuronal-Derived Exosomes Of Patients With Alzheimer’S Disease, N. Zhang, D. Gu, M. Meng, M. L. Gordon

Journal Articles

© Copyright © 2020 Zhang, Gu, Meng and Gordon. Background: Recently, TDP-43 has been recognized as a common proteinopathy in the “oldest old” and a neuropathological comorbidity in patients with Alzheimer’s disease (AD). However, since it has a low concentration in cerebrospinal fluid, the presence of TDP-43 in AD is rarely investigated in vivo. Methods: Twenty-four patients with amyloid PET confirmed AD and 15 healthy controls (HCs) were included in this study. TDP-43 level in plasma neuronal-derived exosomes (NDEs) was measured by enzyme-linked immunosorbent assay. Results: TDP-43 level was elevated in patients with AD compared with HCs (median 1.08 ng/ml, …

Mucocutaneous Disease And Related Clinical Characteristics In Hospitalized Children And Adolescents With Covid-19 And Multisystem Inflammatory Syndrome In Children., S. Rekhtman, R. Tannenbaum, A. Strunk, M. Birabaharan, S. Wright, A. Garg

Journal Articles

Background

Little is known about mucocutaneous disease in acutely ill children and adolescents with COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

Objective

To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C.

Methods

Descriptive cohort study of prospectively and consecutively hospitalized eligible patients between May 11, 2020 and June 5, 2020.

Results

In COVID-19 patients, 4 of 12 (33%) had rash and/or mucositis, including erythema, morbilliform pattern, and lip mucositis. In MIS-C patients, 9 of 19 (47%) had rash and/or mucositis, including erythema, morbilliform, retiform purpura, targetoid and urticarial patterns, along with …