Journal of the National Medical Association最新文献

{"title":"Preoperative Risk Prediction of Futile Surgery in Gastrointestinal Tract Malignancies","authors":"Joshua Lee","doi":"10.1016/j.jnma.2025.08.026","DOIUrl":"10.1016/j.jnma.2025.08.026","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal tract (GI) malignancies remain some of the most common and lethal cancers worldwide. While surgery remains curative, a cohort of patients will succumb to postoperative complications or early recurrence of disease rendering the surgical care futile. A major challenge is identifying patients who may not benefit from surgery i.e. “futile surgery”. The aim of this study was to develop a tool to predict the risk of futile surgery and identify high-risk cohorts for the most common malignancies in eight GI organs.</div></div><div><h3>Methods</h3><div>The National Cancer Database was used to identify patients with GI malignancies of the anus, colorectum, esophagus, gallbladder, liver, pancreas, and extrahepatic and intrahepatic bile ducts (2012 to 2020). The most common histological subtype of the malignancies was investigated for each organ. Futile surgery was defined as death within one year of surgery from any cause. Preoperative clinicopathological features including patient-related factors (e.g. age, sex, socioeconomic status, Charlson comorbidity index, facility type) and tumor-related factors (e.g. American Joint Commission on Cancer [AJCC] clinical T- and N-stage, and grade of tumor differentiation), and history of neoadjuvant therapy were considered as potential predictors. For each cancer type the study population was randomly split into a training (2/3rd) and testing (1/3rd) cohort. Multivariable logistic regression was performed on the training cohort to develop predictive models for each cancer type to predict the risk of futile surgery and high-risk class was defined based on predicted risk. The results were validated in the testing cohort.</div></div><div><h3>Results</h3><div>A total of 111,437 patients were identified and their clinicopathological data were analyzed. The rate of futile surgery ranged from 6.8% to 27.7% across cancer types. Predictors of futile surgery included both patient- and tumor-related factors. Predictive accuracy of the models varied across cancer types with the area under the curve (AUC) ranging from 0.620 to 0.728. High-risk categories were defined and the rate of futile surgery in this cohort ranged from 21.3% to 50.5% across the different types of cancer. The models demonstrated a similar performance in the test cohort.</div></div><div><h3>Conclusions</h3><div>A cohort of patients undergoing resection for GI malignancies experiences futile surgery. A predictive tool was developed to predict an individual’s risk of futile surgery. Integration of this tool in clinical practice could provide objective data to patients and providers to help in shared decision-making resulting in improved healthcare delivery and efficiency.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 12"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Testing of AI-Enhanced pOCUS for Pediatric Wrist and Elbow Fracture Detection","authors":"Cindy Zhang BHSc, MPH, ongoing MD (Presenter),&nbsp;Jarem Jaremko MD,&nbsp;Jessica Kupper PhD,&nbsp;Cassandra Gallant MD","doi":"10.1016/j.jnma.2025.08.077","DOIUrl":"10.1016/j.jnma.2025.08.077","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Artificial intelligence (AI) is transforming medical imaging by enhancing diagnostic accuracy, streamlining workflows, and improving accessibility. Point-of-care ultrasound (pOCUS) has become an essential tool in emergency and clinical settings, offering real-time imaging without radiation exposure. However, its effectiveness is highly dependent on operator expertise, leading to variability in interpretation. AI-driven imaging solutions have the potential to address this challenge by standardizing ultrasound interpretation and augmenting clinical decision-making. This study evaluates the performance of an AI-enhanced pOCUS tool for detecting pediatric wrist and elbow fractures in a high-volume emergency setting. By assessing AI-assisted imaging against traditional radiographic modalities, we aim to determine its diagnostic accuracy, clinical integration, and potential impact on workflow efficiency.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a multi-center, prospective observational study evaluating AI-assisted pOCUS in pediatric patients presenting with suspected wrist or elbow fractures at the Stollery Emergency Room and affiliated clinics. Patients underwent standard clinical imaging, including X-rays, and when clinically indicated, CT or MRI scans. AI-assisted pOCUS was performed by trained healthcare professionals using an AI-powered interpretation tool. The AI model analyzed ultrasound images in real time and generated predictive assessments of fracture presence, severity, and anatomical location. These AI-generated diagnoses were then compared to radiologist-confirmed findings from X-rays and advanced imaging. The study evaluated the diagnostic performance and clinical integration of AI-assisted point-of-care ultrasound (pOCUS) in pediatric fracture detection. Sensitivity and specificity were assessed to determine AI accuracy compared to gold-standard imaging. Agreement between AI predictions and radiologist diagnoses was analyzed for consistency. Usability and integration in clinical settings were explored, considering ease of use, provider confidence, and barriers to implementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Preliminary analysis suggests that AI-enhanced pOCUS demonstrates promising diagnostic performance, with early findings indicating high agreement with radiologist-confirmed diagnoses. The AI model efficiently identified key fracture characteristics, such as displacement and involvement of growth plates, contributing to faster and more standardized image interpretation. Additionally, workflow integration was assessed by measuring the time required for AI-assisted diagnoses compared to conventional imaging workflows. AI-assisted pOCUS showed potential in reducing time-to-diagnosis, particularly in resource-limited settings where access to radiologists may be delayed. Clinicians reported improved confidence in ultrasound-based diagnoses when AI support was available, particularly among les","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 40-41"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Presentation of Peripheral T-Cell Lymphoma as Cause of an Aggressive Primary Left Breast Malignancy","authors":"Dilpreet Singh MD,&nbsp;Raghavendra Kamath MD","doi":"10.1016/j.jnma.2025.08.078","DOIUrl":"10.1016/j.jnma.2025.08.078","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Peripheral T-cell Lymphoma (PTCL) is a subtype of non-Hodgkin lymphoma that generally predominates in the lymph nodes and rarely involves the breasts. Here we present a case where PTCL not only involved the breast but is the primary cause of an aggressive breast cancer, an exceptional rarity with only a few cases ever reported.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Case presentation&lt;/h3&gt;&lt;div&gt;A 76-year-old female with a history of diabetes mellitus, hypertension, hyperlipidemia, and blindness secondary to glaucoma was admitted after suffering a mechanical fall. Incidentally, patient endorsed left breast pain with malodorous, purulent discharge for the past 3 weeks. She had a similar episode two years ago, when a breast surgeon drained the lesion and was given a course of antibiotics. Mammogram obtained in 2021 displayed scattered areas of fibroglandular densities, without any suspicious masses, calcifications or other abnormalities. Physical exam revealed an indurated left breast mass without any active discharge. No focal neuro-deficits, lymphadenopathy, nor hepatosplenomegaly was appreciated. General surgery was consulted for an incision and drainage; however, no drainage was obtained. Breast surgery was then consulted for a biopsy, which revealed T cell markers (BETAF1, CD8, AND TIA1CD3, CD43, CD56, CD15, BCL2, GATA3, CD79a, C-MYC). Further work-up with non-contrast CT scan of head showed small bone lucencies throughout the skull; there were no abnormalities when compared to CT in 2016. MRI of the head revealed left clival expansile lytic lesion and scattered bilateral calvarial lytic enhancing masses without any brain involvement. CBC showed pancytopenia. In depth lab work eventually ruled out various other disorders including Multiple Myeloma, making the likely diagnosis of “Left Breast Peripheral T-cell lymphoma, not otherwise specified” with metastasis to the skull and infiltration of the bone marrow. After discussing the diagnosis and plan with the patient and her son, in collaboration with multiple sub-specialities taking care of the patient, patient decided to be placed in hospice care due to co-morbidities and age, insufficient data on treatment and prognosis, and aggressiveness of the PTCL. Patient refused any further workup and life-saving intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;This case demonstrates the complexity of T-cell lymphoma and its diagnostic and clinical presentation. Breast involvement of PTCL is very rare and usually a manifestation of secondary course of the disease, rather than the primary cause. Patient’s course was already atypical for lymphoma, without obvious nodal or common extra-nodal site involvement; breast symptoms were incidental findings, unrelated to the chief complaint. Diagnosis was further confounded by lytic lesions of the skull and pancytopenia mimicking the presentation of Multiple Myeloma. As there are no specific characteristic immunophenotypes for PTCL, a lengthy work up ","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 41-42"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy and Contraceptive Decision-Making: The Impact of the Dobbs Decision","authors":"Kelly Muller BS,&nbsp;Sernah Essien MS,&nbsp;Karina Vega BS,&nbsp;Brianna Dawson BS,&nbsp;Alexis Carmona BS,&nbsp;Brenda Ross-Shelton MD,&nbsp;Daniel Novak PhD","doi":"10.1016/j.jnma.2025.08.080","DOIUrl":"10.1016/j.jnma.2025.08.080","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Reproductive healthcare in the United States has been shaped by evolving state and federal policies. The 2022 Dobbs v. Jackson ruling marked a pivotal shift in reproductive health. Recent studies suggest an increase in clinician-patient discussions about long-acting reversible contraceptives (LARCs) in the post-Dobbs era. While research has explored some trends, data on the national impact of Dobbs on LARC utilization remains limited. This study aims to analyze LARC usage patterns in the U.S. before and after the ruling. We hypothesize that overall LARC utilization increased at both the 6-month and 1-year post-Dobbs time periods in response to shifting reproductive healthcare policy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using de-identified medical records from 68 healthcare organizations in the electronic health record analysis platform, TriNetX, two cohorts of patients were created. These cohorts were defined as the following: female sex, aged 15-49, with reproductive capacity, and who had an ambulatory care visit within the defined cohort period. The pre-Dobbs cohort was created using the aforementioned criteria occurring between June 23, 2021 and June 23, 2022; similarly, the post-Dobbs cohort was created with the criteria occurring between June 24, 2022 and June 24, 2023. To determine whether differences in LARC utilization were due to initial reactions to the decision, a 6 month cohort was created for comparison, with end dates 6 months after the beginning of the observation period (6 months pre-Dobbs: December 25, 2021 to June 23, 2022; 6 months post-Dobbs: June 24, 2022 to December 21, 2022). After 1:1 propensity-score matching by age and race, four patient cohorts were generated: a 6-month comparison cohort (N=3,525,585) and a 1-year comparison cohort (N=4,739,490). Outcomes included insertion of either an IUD or a subdermal contraceptive implant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The 6 months post-Dobbs cohort showed an increase in IUD insertions from 0.807% to 1.587% (RR=0.511, 95% CI [0.504- 0.519], and an increase in subdermal implant insertions from 0.146% to 0.304% (RR=0.481, 95% CI [0.465-0.497], p&lt;0.0001).&lt;/div&gt;&lt;div&gt;Similarly, the 1-year post-Dobbs cohort showed an increase in IUD insertions from 0.953% to 1.436% (RR=0.664, 95% CI [0.656-0.672], p&lt;0.0001) and an increase in subdermal implant insertions from 0.167% to 0.318% (RR=0.525, 95% CI [0.510-0.539], p&lt;0.0001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;LARC utilization increased markedly in the year following the Dobbs v. Jackson decision. The immediate uptake in LARCs during the initial 6-month period highlights the critical role perceived access plays in individual reproductive healthcare decisions. The 1-year data indicate sustained but tapering demand. While IUDs remain the more commonly used LARC method, demand for subdermal implants during this period also increased significantly, possibly as a result of their less invasive plac","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 42-43"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Fatigue: Unveiling Pancytopenia and Hemolysis Causes","authors":"Tebianne M Abubaker B.A, MD,&nbsp;Lei Lynn MD,&nbsp;Jingxiong Pu MD","doi":"10.1016/j.jnma.2025.08.028","DOIUrl":"10.1016/j.jnma.2025.08.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Case description&lt;/h3&gt;&lt;div&gt;A 33-year-old woman with a history of anemia presented with fatigue, 61 lbs unintentional weight loss, shortness of breath on exertion over the last few months. She denied heavy menses, bleeding, fever, night sweats, pain in her chest, abdomen, or joints. There was no anemia workup or recent labs. She denied family history of malignancy or autoimmune diseases. Physical exam revealed conjunctival pallor, bruising and splenomegaly. Labs showed pancytopenia (WBC 6.8 g/dl, HGB 3.6 g/dl, HCT 12.5 g/dl, Plt 75 × 10e3/mcL, MCV 100 fL.) There was evidence of hemolysis: T bili 2.8 mg/dL (indirect 2.4 mg/dL), undetectable haptoglobin, and LDH 4893 u/L. B12 was undetectable and normal folic acid. Peripheral smear (post transfusion) had dacrocytes, schistocytes, anisocytosis with no blasts. Infectious workups including HIV, parvovirus, EBV, CMV, Hepatitis A, B and C were negative. Pan-CT revealed marked splenomegaly with no lymphadenopathy. Hematology was consulted; bone marrow biopsy showed hypercellular marrow with progressive trilineage hematopoiesis and decreased megakaryocytes with no signs of dysplasia or lymphoma, suggesting pernicious anemia (PA). Intrinsic factor antibodies were positive. Patient received B12 injections with a plan to follow up with hematology outpatient.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;PA is a form of megaloblastic anemia caused by vitamin B12 deficiency due to the destruction of gastric parietal cells leading to intrinsic factor deficiency.1 Hematologic abnormalities were reported in at least two thirds of PA patients; however, pancytopenia and hemolysis in this patient are only seen in 5% and 1.5% of cases, respectively.2,3 This case demonstrates an unusual presentation of PA and highlights the importance of recognizing its varied and often subtle manifestations. Untreated PA can lead to severe and potentially irreversible complications including peripheral neuropathy, subacute combined degeneration of the spinal cord, and cognitive disturbances. PA is also considered a precursor to neoplastic lesions with a 2.84 fold higher risk of developing gastric carcinoma compared to individuals without PA.4,5 Severe cases of B12 deficiency can lead to ineffective hematopoiesis and intramedullary hemolysis, mimicking thrombotic microangiopathy. In those cases, failure to recognize B12 deficiency as the cause has lead to treatment with more aggressive and sometimes unnecessary measures such as steroids, polyvalent immunoglobulins and plasmapheresis.3 Treatment involves high-dose oral or parenteral B12 supplementation, which can lead to rapid hematologic improvement and eventual resolution of neurological symptoms if treated early.6 Regular monitoring of B12 levels and clinical symptoms is essential to ensure adequate management and prevent relapse.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Pancytopenia and hemolysis may be some of the unusual presentations of PA; early recognition and treatment can le","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 13"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric Analysis of HDR Brachytherapy vs. Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer","authors":"Ulysses G. Gardner MD, MBA,&nbsp;Panos Papanikolaou MD,&nbsp;Ardian Latifi MD,&nbsp;Daniel Song MD,&nbsp;Lonny Yarmus MD,&nbsp;Michael Roumeliotis PhD","doi":"10.1016/j.jnma.2025.08.071","DOIUrl":"10.1016/j.jnma.2025.08.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Stereotactic ablative radiotherapy (SABR) is the standard non-surgical treatment for early-stage non-small cell lung cancer (NSCLC), but unintentional irradiation of healthy lung tissue remains a concern. High-dose rate (HDR) bronchoscopic brachytherapy (BT) is a novel approach that may enhance dose conformity while reducing radiation exposure to adjacent normal tissues. To date, a comparative dosimetric analysis between HDR BT and modern SABR in lung cancer has not been performed. We hypothesize that HDR BT will demonstrate superior dose conformity, thereby reducing collateral radiation exposure compared to SABR.</div></div><div><h3>Methods</h3><div>In this study, patients who underwent robotic bronchoscopy between November 2020 and April 2022 at our institution under an IRB- approved protocol were considered. Patients were included if they had biopsy-confirmed stage IA NSCLC and were treated with SABR. Approved SABR plans were extracted from the electronic medical record, and corresponding single-channel HDR BT plans were simulated using identical prescription doses and fractionation schedules. Dose conformity index (CI) was calculated as the ratio of the prescription dose volume to the target volume and compared between both modalities using paired Student’s t-tests (α &lt; 0.05 for statistical significance).</div></div><div><h3>Results</h3><div>Of 182 screened patients, 12 met inclusion criteria after exclusions for advanced disease, non-confirmed histology, or SABR not performed. Of those patients, 8 were excluded for lack of using active breathing control (ABC) to minimize target motion. The mean ± standard deviation (SD) tumor size was 1.4 ± 0.3 cm. SABR plans delivered 50 Gy in 4–5 fractions. Dosimetric analysis revealed that HDR BT achieved higher V95% (volume of target receiving at least 95% of prescription dose), suggesting improved dose coverage within the tumor, while also demonstrating a lower V25 % conformity index, indicating reduced irradiation of surrounding tissues.</div></div><div><h3>Conclusions</h3><div>This is the first dosimetric comparison of HDR BT and SABR for stage IA NSCLC. Our findings suggest that HDR BT offers improved dose conformity and potential for improved dose coverage within the target while minimizing low-dose exposure to adjacent lung tissue, which may reduce radiation-related toxicity. Prospective studies are warranted to further assess the clinical feasibility and therapeutic benefits of HDR BT in early-stage NSCLC.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 37"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectionality in Accredited Orthopaedic Surgery Residency Programs 2010-2020","authors":"Paige E. Cummings MD,&nbsp;Kareme Alder MD,&nbsp;Erick Marigi MD,&nbsp;Jonathan Barlow MD,&nbsp;Sanjeev Kakar MD,&nbsp;Krystin Hidden MD","doi":"10.1016/j.jnma.2025.08.063","DOIUrl":"10.1016/j.jnma.2025.08.063","url":null,"abstract":"<div><h3>Background</h3><div>Among medical specialties, orthopaedic surgery residency consistently has the lowest racial/ethnic and gender diversity. Additionally, orthopaedic surgery has seen the slowest improvements in race/ethnic diversity when compared to other specialties. This study examined whether trends for intersectional race/ethnic and gender minority identity groups mimicked stratified trends for race/ethnicity and gender.</div></div><div><h3>Methods</h3><div>Data was obtained from the Association of American Medical Colleges (AAMC) special report including self-reported race/ethnic and gender identity of active orthopaedic residents from 2010 through 2020. Racial and ethnic groups included American Indian/Alaska Native (AIAN), Asian, Black, Hispanic, Latino, or of Spanish origin (HSLO), Native Hawaiian/Pacific Islander (NHPI), multiracial/other, and unknown. Trends in gender diversity across race/ethnic subgroups were analyzed over time.</div></div><div><h3>Results</h3><div>From 2010 to 2020, the percentage of trainees self-identifying as women in orthopaedic surgery residency programs increased by 4% with a corresponding decrease in trainees self-identifying as men (p &lt; 0.001). Orthopaedic surgery observed a 1.7% increase in non-White residents from 2010 to 2020 (p = 0.009). Over the same period, the proportion of women among White trainees (13.0% to 17.0%; p &lt; 0.001) and non-White trainees (14.2% to 17.5%; p = 0.007) significantly increased. However, the change in the non-White group was driven by Asian trainees who had a significant increase in women (13.1% to 17.8%; p = 0.003) while Black (19.9% to 19.6%; p = 0.306), HLSO (12.7% to 17.3%; p = 0.056), AIAN (12.5% to 16.7%; p = 0.875), NHPI (33.3% to 15.7%; p = 0.138), and Other cohorts (12% to 13.3%; p = 0.547) demonstrated no significant statistical changes</div></div><div><h3>Conclusions</h3><div>Orthopaedic surgery residency programs observed an increase in women trainees from 2010 to 2020, which was largely driven by an increase among White and Asian women. Meanwhile, current efforts to improve racial, ethnic, and gender diversity has not resulted in increased rates for Black, HLSO, AIAN, and NHPI women.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 33"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of Bactrim Desensitization in a Metastatic Breast Cancer Patient","authors":"Kevin E. Cobty Neuroscience and Behavior, BS,&nbsp;Jamil Mashal MD,&nbsp;Gaith Hussein MD","doi":"10.1016/j.jnma.2025.08.029","DOIUrl":"10.1016/j.jnma.2025.08.029","url":null,"abstract":"<div><h3>Introduction</h3><div>A 65-year-old female with metastatic breast cancer involving the lungs presented to the ED with progressive weakness and decreased appetite. She previously underwent a bilateral mastectomy and is now receiving treatment for a nonhealing left breast ulcer infected with Nocardia. Although trimethoprim-sulfamethoxazole (Bactrim) is the first-line treatment, she has a severe sulfa allergy characterized by hives, wheezing, and shortness of breath. This led to her being prescribed Linezolid instead. ED labs showed thrombocytopenia and anemia, suspected to be from Linezolid after ruling out other potential causes. Due to her sulfa allergy and Linezolid intolerance, she underwent a trial of Bactrim desensitization in the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>Bactrim desensitization was performed in the ICU. The patient was started on a lower dose of Bactrim under close observation for any allergic reaction. The dose and frequency gradually increased if tolerated. The patient was monitored for both subjective and objective changes, with frequent bloodwork to assess for abnormal lab results during desensitization.</div></div><div><h3>Results</h3><div>To begin desensitization, the patient was given multiple doses of Bactrim (200-40 mg/5ml) via oral syringe and monitored for adverse reactions. She tolerated the doses well with no severe allergic reactions. She was then transitioned to 800-160 mg of Bactrim twice daily. Her white blood cell count rose from 4.5 to 11.0, but she otherwise tolerated the medication well without significant issues.</div><div>On the second day, she continued the same dose but developed a diffuse, pruritic, erythematous rash across her upper body. She was treated with loratadine and a Medrol dose pack and remained hemodynamically stable with no respiratory distress.</div><div>By the third day, the rash worsened, now including hives, malaise, fatigue, and chills. She also developed a fever of 102.2°F.</div><div>However, she never developed anaphylaxis or respiratory distress. Her labs showed a white blood cell count of 17.6, AST of 224, ALT of 266, and alkaline phosphatase of 462, which later increased to 924 over the next few days. Due to worsening allergic reactions, desensitization of Bactrim was discontinued. The patient was discharged home and refused further antibiotic treatment.</div></div><div><h3>Conclusion</h3><div>Bactrim is first-line treatment against Nocardia, and this case highlights the difficulty of Bactrim desensitization. Despite close monitoring and gradual exposure, the patient could not successfully complete desensitization. This case also highlights the rare side effects of Linezolid, as the patient’s anemia and thrombocytopenia later resolved after discontinuing it.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 13-14"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Actinomycosis Mimicking Lung Malignancy in an Underserved Patient","authors":"Ernest Metelus BS,&nbsp;Ammaar Jan MS4,&nbsp;Amir Rizk MS4,&nbsp;Nigel John MD,&nbsp;Dimas Pineda MD,&nbsp;Omar Francos MD","doi":"10.1016/j.jnma.2025.08.038","DOIUrl":"10.1016/j.jnma.2025.08.038","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction/Background&lt;/h3&gt;&lt;div&gt;Pulmonary actinomycosis is a rare and often misdiagnosed infection that can closely mimic malignancy due to its chronic presentation and radiographic findings. We present a case of a 65-year-old male with a significant smoking history who exhibited progressive weight loss, fatigue, and a productive cough with concerning imaging findings, including spiculated pulmonary nodules, mediastinal adenopathy, and a hepatic lesion. Initial clinical suspicion was high for malignancy; however, biopsy and microbiological studies revealed an Actinomyces odontolyticus infection. This case emphasizes the importance of considering infectious etiologies, particularly actinomycosis, in patients with radiologic and clinical features suggestive of malignancy, thereby preventing unnecessary invasive procedures and ensuring timely antimicrobial therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Presentation&lt;/h3&gt;&lt;div&gt;A 65-year-old male with a 29-pack-year smoking history presented with generalized fatigue, weakness, and unintentional weight loss (10–15 lbs over 4–5 weeks). He reported a productive cough with brown sputum and a decreased appetite, noted by his relatives. He had a recent bicycle accident with possible aspiration. His worsening cough impaired ambulation, but he denied nausea, vomiting, palpitations, fever, or chills. Examination revealed a thin, cachectic man with bilateral lower leg edema. Labs showed hyponatremia, microcytic anemia, leukocytosis, elevated ferritin, low TIBC, and reactive thrombocytosis. Imaging revealed spiculated right upper lobe pulmonary nodules, mediastinal and axillary adenopathy, a hepatic lesion, and a large right-sided loculated pleural effusion. EKG showed rapid atrial flutter. Biopsy revealed fibrosis and inflammatory infiltrates. Blood cultures grew Actinomyces odontolyticus, confirming pulmonary actinomycosis. Thoracentesis drained 220 mL of frank pus, and CT surgery ruled out thoracotomy/decortication. Infectious disease recommended outpatient ceftriaxone or oral penicillin with a favorable prognosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results/Discussion&lt;/h3&gt;&lt;div&gt;This case highlights the diagnostic challenge of differentiating pulmonary actinomycosis from malignancy, particularly in patients with significant smoking histories and radiographic findings that are concerning for cancer. The presence of spiculated pulmonary nodules, mediastinal and axillary adenopathy, and a hepatic lesion initially raised strong suspicion for a neoplastic process. Literature has also discovered that nearly 30% of actinomycosis cases are initially misdiagnosed as lung/hepatic malignancies. Therefore, timely recognition of actinomycosis and a high index of suspicion of infectious pathogens by clinicians can prevent unnecessary invasive procedures and lead to effective treatment with prolonged antibiotic therapy over the course of various weeks, thus ensuring a favorable prognosis.&lt;/div&gt;&lt;div&gt;Pulmonary actinomycosis can closely resembl","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 18-19"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Preeclampsia and Eclampsia in Black Women with Endometriosis","authors":"Calbeth Alaribe DMSc, MPH, PA-C","doi":"10.1016/j.jnma.2025.08.045","DOIUrl":"10.1016/j.jnma.2025.08.045","url":null,"abstract":"<div><h3>Introduction</h3><div>Research indicates women with endometriosis have an increased risk of preeclampsia and eclampsia, the leading cause of maternal mortality in Black women. Unfortunately, Black women are less likely to be diagnosed with endometriosis. This scoping review examines how peer-reviewed literature informs the association between preeclampsia and eclampsia in Black women with endometriosis.</div></div><div><h3>Methods</h3><div>DATA SOURCES: Peer-reviewed articles from medical journals dated from their inception to 2004 and written in English, were generated from PubMed, CINAHL Plus with Full Text, Academic Search Complete, eBook Medical Collection (EBSCOhost), Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, Cochrane Library, Science Direct, Google Scholar, and PROSPERO International Prospective Register of Systematic Reviews. STUDY ELIGIBILITY CRITERIA: Articles examining the association between preeclampsia and eclampsia in Black women between the ages of 15-49 years old with a diagnosis of endometriosis via laparoscopy. Titles and abstracts of the selected studies were reviewed to determine if they met inclusion criteria.</div></div><div><h3>Results</h3><div>After searching nine databases, three articles were identified for the scoping review. Two articles were identified for the review from PROSPERO. None of these articles met the eligibility criteria and were excluded from the review. There was no identified peer- reviewed literature that demonstrates an association between preeclampsia and eclampsia in Black women with endometriosis.</div></div><div><h3>Conclusion</h3><div>This scoping review illuminates the lack of available research investigating the prevalence of endometriosis in Black women and its subsequent adverse impact on pregnancy outcomes. More inclusive endometriosis research is needed to ultimately to expand available data on endometriosis in Black women.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 23"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}