Journal of the National Medical Association最新文献

{"title":"Telomere Length Variation by Ancestry in Multiple Myeloma: Insights into Racial Differences in Disease Presentation and Prognosis","authors":"Zania Johnson MS, Louis Williams MD","doi":"10.1016/j.jnma.2025.08.091","DOIUrl":"10.1016/j.jnma.2025.08.091","url":null,"abstract":"<div><h3>Introduction</h3><div>Telomere shortening, a marker of genomic instability, has been observed in multiple myeloma (MM) and is thought to contribute to disease progression (Dratwa et al., 2023). Interestingly, longer leukocyte telomere length (LTL) has been associated with an increased risk of MM, suggesting that inherited telomere biology may influence disease susceptibility (Campa et al., 2014). Large clinical datasets indicate that the natural history and prognosis of newly diagnosed MM (NDMM) differ by ancestry, with patients of African ancestry (AA) often presenting at a younger age and, in some studies, experiencing worse outcomes. Although next-generation sequencing (NGS) has revealed ancestry-related genomic differences in MM, most studies have focused on patients of European descent. Notably, Black individuals generally exhibit longer LTL in healthy states, potentially reflecting germline variation in telomere regulation (Zhu et al., 2010). These inherited differences, along with varying telomere attrition under disease stress, may contribute to ancestry-specific MM biology. Here, we investigate the genomic features and outcomes of a large cohort of Black and White MM patients, with a focus on LTL and total telomere length (TTL).</div></div><div><h3>Methods</h3><div>Subjects were selected from the MMRF CoMMpass SM trial, a study that includes 1,154 patients with updated outcome data as of March, 2020. Within this data set, 760 patients had information on race and ethnicity. Among these, 55 HL patients and 478 NHW patients possessed complete clinical and genomic information. We analyzed baseline whole exome sequencing (WES) and long insert whole genome sequencing (WGS) as previously described (Walker, et al. <em>Blood</em> 2019). Our analysis focused on 63 known driver mutations in multiple myeloma and 39 sites of common copy number variation across the study population. Complex structural variants and tumor telomere length were called using previously described bioinformatic tools (Boyle et al. <em>Leukemia</em> 2021). Survival analysis was undertaken using the Kaplan-Meier method with hazard ratios determined by the Cox proportional hazards model.</div></div><div><h3>Results</h3><div>In our study, we observed a statistically significant difference in leukocyte telomere length (LTL) between Black and White individuals (F = 4.13, p = 0.042), indicating ancestry-related variation in baseline telomere length. More strikingly, a highly significant difference was found in total telomere length (TTL) between the two groups (F = 80.99, p = 2.42 × 10⁻¹⁸). Black individuals exhibited substantially shorter average TTL (mean = 2.40, variance = 29.67) compared to White individuals (mean = 6.86, variance = 21.12) in this cohort. This significant difference suggests distinct telomere biology across ancestral groups, which may contribute to disparities in multiple myeloma pathogenesis and clinical outcomes. The magnitude of the TTL difference h","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 50"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989957","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":"High-Risk Clinical Target Volume Deformation in MRI-Guided HDR Brachytherapy for Cervical Cancer","authors":"Ulysses G. Gardner MD, MBA,&nbsp;Gayoung Kim PhD,&nbsp;Khadija Sheikh PhD,&nbsp;Majd Antaki ME,&nbsp;Ehud Schmidt PhD,&nbsp;Michael Roumeliotis PhD,&nbsp;Junghoon Lee PhD,&nbsp;Akila Viswanathan MD","doi":"10.1016/j.jnma.2025.08.074","DOIUrl":"10.1016/j.jnma.2025.08.074","url":null,"abstract":"<div><h3>Purpose</h3><div>This study quantitatively evaluates high-risk clinical target volume (HR-CTV) deformation using magnetic resonance imaging (MRI) done before and after applicator placement, in order to consider the reliability of pre-brachytherapy MR imaging to reflect tumor volume and shape at the time of treatment.</div></div><div><h3>Materials &amp; Methods</h3><div>A retrospective analysis of 54 cervical cancer patients who underwent MRI-guided HDR brachytherapy between January 2019 and December 2023 was conducted under an institutional review board–approved protocol. All patients received tandem/ring or tandem/ring/interstitial applicator insertions and underwent same-day pre- and post-applicator placement T2-weighted MRI in a dedicated 1.5T MR simulator (Siemens Sola). HR-CTVs were segmented, and quantitative shape descriptors—including elongation, flatness and roundness—were analyzed using 3D Slicer (v5.6.2). Paired Student’s t-tests (α &lt; 0.05) were performed to assess statistically significant changes in tumor morphology.</div></div><div><h3>Results</h3><div>Analysis revealed a significant increase in MR HR-CTV volume from 53.1 cm³ pre-insertion to 62.8 cm³ post-insertion (p=0.048), with a Pearson correlation coefficient (r=0.72) indicating a strong volumetric relationship. However, shape descriptor analysis demonstrated statistically significant geometric changes, including differences in roundness (p=0.002), flatness (p=0.047), and elongation (p=0.002), suggesting that applicator placement induces substantial tumor deformation beyond simple volumetric expansion.</div></div><div><h3>Conclusion</h3><div>This study provides the first quantitative evidence that pre-brachytherapy MRI alone may not adequately represent HR-CTV geometry at the time of treatment. The significant post-insertion deformation underscores the critical need for post-applicator insertion MRI to ensure accurate target delineation and optimal dose delivery. These findings challenge conventional imaging workflows and highlight the necessity of adaptive treatment planning strategies in MRI-guided brachytherapy to improve clinical outcomes for cervical cancer patients.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 39"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989419","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":"Effect of and Interventions in Prevention and Management of Maternal Anemia in the Advent of COVID-19","authors":"John Kyalo PhD","doi":"10.1016/j.jnma.2025.08.079","DOIUrl":"10.1016/j.jnma.2025.08.079","url":null,"abstract":"<div><h3>Background</h3><div>There were many unknowns for pregnant women during the COVID-19 pandemic. Most of these could have been silent however lethal and anemic conditions could escalate the worsening of pregnancy outcomes. Existing evidence indicate that, array of factors is associated with the ability of compromising maternal anemia, some directly and others indirectly.</div></div><div><h3>Objective</h3><div>This review aimed at ascertaining the pooled effect of several anemia interventions. Specifically, the aim of this study was to establish if pregnancy status is associated with COVID-19 severity characterized by a cytokine storm.</div></div><div><h3>Methods</h3><div>We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to studies suitable for inclusion in this meta-analysis. Studies examining women of reproductive age on any maternal anemia intervention were included. The risk of bias was assessed using the Cochrane risk of bias tool. Review Manager 5.4.1 was used to calculate rate ratios (RRs) with 95% CIs, which were depicted using forest plots. Quantitative variables were summarized in total numbers and percentages. The effect on prevention, control, management and or treatment of anemia was calculated and compared between the intervention and the comparator arms. Heterogeneity was evaluated with the Cochran Q statistic and Higgins test.</div></div><div><h3>Results</h3><div>A total of 11 articles including data for 6,129 were included. With sensitivity analysis, the interventions had a utility of 39% on maternal anemia prevention and management (random effects model RR 0.61, 95% CI 0.43, 0.87; P = 0.006) (χ26=286.98, P&lt;.00001; I2=97%). All the interventions against maternal anemia showed an effect of 17% (fixed-effect model RR 0.83, 95% CI 0.79-0.88; P&lt;.00001) (χ24=2.93, P=0.57; I2=0%). Education to pregnant women showed a 28% effect (RR 0.72 95% CI 0.58, 0.89), medicinal administration 19% (RR 0.81 95% CI 0.73, 0.90), iron supplementation 17% (RR 0.83 95% CI 0.75, 0.92) and I.V Ferric Carboxy-maltose 15% (RR 0.85 95% CI 0.74, 0.97) (I2 = 0%). Interventions in African region had a higher (16%) and significant effect compared to other regions (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P&lt;.001) (χ25=176.53, P&lt;.00001; I2=97%). Multiple center studies had a significant predictive effect (16%) compared to single center studies (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P&lt;.00001)(χ25=176.53, P&lt;.00001; I2=97%). The year 2020 recorded the highest effect of maternal anemia interventions at 28% (random-effects model RR 0.72, 95% CI 0.67-0.78; P&lt;.00001) (χ23=167.34, P&lt;.00001; I2=98%)</div></div><div><h3>Conclusion</h3><div>In the advent of COVID-19, maternal anemia interventions were compromised demonstrated by a low effectiveness trend from the year 2020 to the year 2022. During this period, even the most effective and recommended interventions against maternal anemia were someho","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 42"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989426","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":"Double Trouble: Drug-Induced AIH-PBC Overlap Syndrome Triggered by Hydralazine","authors":"Urmimala Chaudhuri DO,&nbsp;Forrest Jonathan BS,&nbsp;Agrawal Sangeeta MD","doi":"10.1016/j.jnma.2025.08.031","DOIUrl":"10.1016/j.jnma.2025.08.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Autoimmune liver disease comprises a spectrum of conditions, notably autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). When features of multiple autoimmune diseases overlap, the condition is termed overlap syndrome with AIH-PBC being the most common. However, its etiology remains complex and not fully understood. This case highlights drug-induced liver injury (DILI) as a potential trigger for AIH-PBC overlap syndrome in a patient with initially elevated liver function tests (LFTs) attributed to hydralazine use.</div></div><div><h3>Case description</h3><div>A 51-year-old male with a medical history of hypertension (HTN), type 2 diabetes mellitus, and a prior cerebrovascular accident presented with elevated LFTs after starting hydralazine. Initial labs showed aspartate aminotransferase (AST) 456 U/L, alanine aminotransferase (ALT) 779 U/L, alkaline phosphatase 250 U/L, and total bilirubin 1.4 mg/dL. Additional workup included testing for antimitochondrial antibody (AMA), antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA) and an iron profile. While AMA, ANA, and ASMA were elevated, a diagnosis of AIH or PBC was not made due to the absence of diagnostic histologic findings. Liver biopsy showed mixed portal and lobular inflammation with lymphocytes, plasma cells, and eosinophils, without interface hepatitis or bile duct lesions.</div><div>Despite discontinuing hydralazine, the patient returned one month later with persistently elevated LFTs. Further workup was notable for an antimitochondrial antibody (AMA) titer greater than 1:320 and an anti-smooth muscle antibody (ASMA) level of 39, indicating an autoimmune etiology, specifically pointing toward AIH-PBC overlap syndrome. A repeat liver biopsy showed florid duct lesions and interface hepatitis, supporting the diagnosis of AIH-PBC overlap syndrome.</div><div>The patient was treated with prednisone and ursodiol (13 mg/kg/day in two divided doses). Statin therapy was discontinued, and a 30- day prednisone course at 40 mg daily was initiated. Follow-up LFTs demonstrated marked improvement, with AST 26 U/L, ALT 77 U/L, and alkaline phosphatase 89 U/L. A steroid taper was initiated in response to the significant improvement.</div></div><div><h3>Discussion</h3><div>The clinical presentation of AIH-PBC overlap syndrome is often non-specific, including symptoms such as fatigue, abdominal pain, myalgias, and arthralgias. Diagnosis is based on the Paris criteria: Patients with PBC must have two of the following (1) ALP ≥ 2x the upper limit or GGT ≥ 5x the upper limit; (2) positive anti-mitochrondrial antibody; and (3) floral duct lesion on biopsy [1]. A comprehensive history is essential to assess the multifactorial etiologies commonly underlying AIH-PBC overlap syndrome. When the etiology remains uncertain, our case suggests evaluating the patient’s medication history, as DILI may trigger AIH-PBC overlap syndrome. Common drugs associated with DILI inc","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 14-15"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989934","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":"Obesity in the U.S.: Temporal Shifts and Emerging Gastrointestinal and Hepatologic Consequences","authors":"Ibukunoluwa Oshobu MD ,&nbsp;Eunice Aregbesola MD ,&nbsp;Chima Amadi ,&nbsp;Adedeji Okikiade MD PhD","doi":"10.1016/j.jnma.2025.08.086","DOIUrl":"10.1016/j.jnma.2025.08.086","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity is a chronic complex disease that can be defined as excessive fat deposits which impairs health. It is noted by measuring weight and height to ensure calculation of the BMI. Although BMI has been utilized in with management or predicting good health, studies have shown that it is not an accurate predictor of health status in African Americans.</div><div>Obesity is an important driver in a lot of gastrointestinal pathology which can influence the prevalence and the severity of several GI conditions. This study highlights the trend of obesity by region and in African Americans from 2011- 2023 in correlation the clinical impact on GI disorders.</div></div><div><h3>Methods</h3><div>Data was obtained from NHANES. The obesity analysis was then contextualized with peer reviewed literature to further portray the impacts of obesity on GI disorders such as GERD, MAFLD, and colorectal cancer.</div></div><div><h3>Results</h3><div>Our study found that obesity has a high prevalence in the South and Midwest areas with females having slightly higher median values of obesity 40.4% vs. 29.5% compared to men. From about 2018 onward, females consistently show a slightly higher obesity rate than males. Results showed no significant difference in between males (M = 30.63, SD = 4.00) and females (M = 30.84, SD = 4.92), t (1336.05) = -0.90, p = .37, 95% CI [-0.69, 0.25]. This gap widens around 2020–2021 and then stabilizes. This change takes into consideration the biological, behavioral and sociocultural factors.</div><div>Together with showing the regions affected, non-Hispanic black individuals generally have the highest rates of obesity with Hawaiian/Pacific Islanders recording also an elevated rate of obesity in the region. Non-Hispanic blacks in the South have been found to have higher prevalence of obesity. This is attributed to systemic issues such as structural inequalities, limited access to healthcare, cultural dietary contribution, and lower educational attainment.</div></div><div><h3>Discussion</h3><div>Obesity has a lot of clinical implications, It is associated with GERD and Barrett’s esophagus especially in younger adults that are African Americans. Obesity increases the risk of MAFLD with a growing indication for liver transplant across the country. However, there is lesser indication for liver transplant in AA (HR 0.56, 95% CI 0.50-0.62). Obesity is an independent factor that increases the risk of pancreatitis and colorectal neoplasia in the African American population.</div></div><div><h3>Conclusions</h3><div>With the ongoing rise of obesity prevalence, it is important to redefine GI screening, management, and prevention strategies. Such strategies will include weight reduction interventions such as pharmacologic, dietary counseling that should be incorporated into workflow of physicians. Providers particularly those serving the high-risk minority populations like the African Americans must adopt these practices i","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 46"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989961","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":"Long-Term Outcomes of Laparoscopic vs Open Vesicovaginal Fistula Repair","authors":"Nurupa Ramkissoon BS,&nbsp;Azure Erskine BS, MD (Candidate),&nbsp;Mikal Abraha BS, MD (Candidate),&nbsp;Kiara Lowery BS, MD (Candidate),&nbsp;Kamdili Ogbutor BS, MD (Candidate),&nbsp;Elijah McMillan BS, DPT, MD (Candidate),&nbsp;Da’Jhai Monroe BS, MD (Candidate),&nbsp;Ryan Mitchell BS, MD (Candidate),&nbsp;Tajah Lewter BS, MD (Candidate),&nbsp;Samwarit Zinabu MD,&nbsp;Miriam Michael MD","doi":"10.1016/j.jnma.2025.08.050","DOIUrl":"10.1016/j.jnma.2025.08.050","url":null,"abstract":"<div><h3>Introduction</h3><div>Vesicovaginal fistula (VVF) is a debilitating condition that can lead to urinary incontinence and impaired quality of life. Laparoscopic repair has emerged as a minimally invasive alternative to traditional approaches, but its impact on postoperative continence remains unclear. This study evaluates the one-year outcomes of incontinence in patients undergoing laparoscopic versus non-laparoscopic VVF repair.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on 768 propensity-matched patients who underwent VVF repair, with 384 receiving laparoscopic repair and 384 undergoing non-laparoscopic repair. Groups were matched by age and race. Risk analysis, Kaplan-Meier survival analysis, and t-tests were performed to compare incontinence rates, time-to-incontinence, and severity between cohorts.</div></div><div><h3>Results</h3><div>Patients in the laparoscopic group had a significantly lower incontinence rate (3.6%) compared to the non-laparoscopic group (10.2%) (p = 0.000). The risk ratio (0.359) and odds ratio (0.335) indicated a substantial reduction in incontinence risk with laparoscopic repair. Kaplan-Meier analysis showed a significantly higher continence survival probability (96.1% vs. 88.98%, p = 0.000). The hazard ratio (0.353) suggested a 65% lower risk of incontinence over time, though proportionality testing was non-significant (p = 0.466). Incontinence severity was also significantly lower in the laparoscopic group (p = 0.007).</div></div><div><h3>Conclusion</h3><div>Laparoscopic VVF repair is associated with a significantly lower risk and severity of incontinence, with prolonged continence survival. These findings suggest that laparoscopic repair should be considered the preferred approach when feasible. Further studies are needed to assess long-term outcomes and patient quality of life.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 26"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989658","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":"Physical Activity's Role in Waist Circumference and Heart Failure Risk","authors":"Garrett Jordan BS, MS,&nbsp;Walker Benjamin PhD, MS,&nbsp;Abigail Gamble PhD,&nbsp;Elizabeth Heitman PhD,&nbsp;Michael Hall MD,&nbsp;Wondwosen Yimer PhD","doi":"10.1016/j.jnma.2025.08.019","DOIUrl":"10.1016/j.jnma.2025.08.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) affects approximately 6.2 million adults in the United States, presenting a major public health concern. Waist circumference (WC) is a well-established risk factor for HF, while moderate-to-vigorous physical activity (MVPA) has been suggested as a potential protective factor. This study investigates the relationship between WC and the incidence of heart failure hospitalization (HFH) and assesses whether MVPA modifies this association using data from the Jackson Heart Study (JHS).</div></div><div><h3>Methods</h3><div>Our preliminary analysis used JHS data to examine the association of WC (continuous, cm) and incidence of HFH. Self- reported MVPA was categorized as poor (0 minutes/week), intermediate (1-149 minutes/week), and ideal (150 minutes/week).</div><div>Descriptive statistics were used for demographic characteristics and distributions of WC, MVPA, and covariates (e.g. sedentary behavior, diabetes). Cox proportional hazards models were used to examine the association between WC and the incidence of HFH and whether this association was moderated by MVPA.</div></div><div><h3>Results</h3><div>Among 3,397 participants (median follow-up: 12.0 years), 280 HFH events occurred. The median WC was 103 cm (IQR: 96– 111 cm) for men and 98 cm (IQR: 89–106 cm) for women. Higher WC was associated with increased HFH risk (hazard ratio [HR] per cm = 1.013, 95% CI: 1.005, 1.023). MVPA was not independently associated with HFH after adjustment for covariates. Interaction terms for intermediate (HR = 1.01, 95% CI: 0.99, 1.03) and ideal MVPA levels (HR = 1.01, 95% CI: 0.99, 1.04) with WC suggest no effect modification.</div></div><div><h3>Conclusions</h3><div>Increased WC is linked to a greater risk of HFH, independent of MVPA levels. These findings suggest that physical activity alone may not be sufficient to lower HF risk, particularly for individuals with abdominal obesity. Further research will incorporate restricted cubic splines and time-varying covariates to gain deeper insights into these associations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 7"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989936","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":"Ultrasound Guided Detection of Diabetic Retinopathy Complications in Cadavers","authors":"Jacob B. Morgan BS,&nbsp;Cassandra Henderson MD","doi":"10.1016/j.jnma.2025.08.054","DOIUrl":"10.1016/j.jnma.2025.08.054","url":null,"abstract":"<div><h3>Introduction</h3><div>To utilize cadavers as models for point-of-care ultrasound education to identify intraocular pathologies such as retinal detachments and vitreous hemorrhages. Training with cadaveric donors, coupled with ocular ultrasound education, will offer an innovative approach for medical instruction. Both vitreous hemorrhages and retinal detachments can limit long-term vision and are diagnosable with ultrasound. Although there are many ocular offenses which lead to detachment and hemorrhage, a primary offender is diabetic retinopathy. In all cases, these disorders require rapid diagnosis and treatment for visual health.</div></div><div><h3>Methods</h3><div>Cadaveric tissue is used to simulate retinal detachments. A lateral canthotomy and sclerotomy is performed to access the choroidal and retinal layers in the posterior pole of the eye. A normal saline solution is then injected with a micropipette into the subretinal space, leading to retinal detachment. An agar-based solution is used to create a soft tissue mass in the vitreous chamber simulating hemorrhage.</div></div><div><h3>Results</h3><div>The techniques described are capable of creating the desired models. It is hypothesized that this training model will be an effective tool to simulate ocular ultrasound pathology for healthcare professionals. In academic medical centers, this model can be implemented due to the availability of the materials and donors.</div></div><div><h3>Conclusion</h3><div>Clinically, point-of-care ultrasound is regarded as a reliable, cost-effective tool for prompt diagnosis of retinal detachments and vitreous hemorrhage improving the overall prognosis. Use of this ocular training model can facilitate the creation of large groups of healthcare professionals trained in ocular ultrasonography which will expedite time to diagnosis in underserved populations, mitigating permanent visual loss.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 28"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989665","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":"Assessing Healthcare Inequities in Shoulder Dislocation Management and Outcomes","authors":"Tia Clay BS,&nbsp;Sylvester Okoro MS,&nbsp;Kyle Smith MS,&nbsp;Kyra Robinson BS,&nbsp;Onais Tariq,&nbsp;Cleo Stafford II MD, MS,&nbsp;Edward R. Jackson II MD","doi":"10.1016/j.jnma.2025.08.057","DOIUrl":"10.1016/j.jnma.2025.08.057","url":null,"abstract":"<div><h3>Introduction</h3><div>The inherent instability of the glenohumeral joint and the lesions it produces are major contributors to shoulder pain. As one of the most commonly treated sports injuries, shoulder dislocations have benefited from significant advancements in arthroscopic techniques and rehabilitative approaches to restore joint function. However, despite these improvements, research on disparities in the management and outcomes of shoulder dislocations remains limited. Our objective was to comprehensively analyze the existing health inequities related to shoulder dislocation to better understand the complex interplay between healthcare access barriers and disparities in treatment outcomes.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using PubMed, including studies published between 2000 and 2023 examining disparities in shoulder dislocation management. Keywords included “shoulder dislocation,” “shoulder instability,” “healthcare disparities,” “insurance status,” “race/ethnicity,” and “access to care.” Of 233 initially identified studies, 12 met inclusion criteria. Data were extracted on patient demographics, surgical rates, time to surgery, and post-surgical outcomes.</div></div><div><h3>Results</h3><div>Barriers to surgical management, prolonged time to surgery, and delays in diagnosis and access to care for shoulder dislocation were associated with public insurance status and racial minority groups. Additionally, publicly insured patients were more likely to be readmitted or experience postoperative complications. Shoulder instability was associated with minority race, male sex, and older age, with Black and Asian patients experiencing more significant pathology and lower post-surgical baseline activity levels. At the same time, socioeconomic factors like insurance status and community distress influenced preoperative severity.</div></div><div><h3>Discussion/Conclusion</h3><div>Systemic inequities in healthcare access continue to impact the management and outcomes of shoulder dislocations, particularly among patients with public insurance and lower socioeconomic status. Despite Medicaid expansion, access to orthopedic care remains limited due to low provider reimbursement rates, administrative burdens, and higher appointment refusal rates for Medicaid patients. Expanding Federally Qualified Health Centers (FQHCs) and increasing Medicaid reimbursement have shown potential to address these barriers, but more systemic reforms should be considered. Standardized treatment protocols and improved access to specialty care may help close the gap in surgical intervention rates and postoperative outcomes. Addressing such disparities requires further research into targeted policy solutions and healthcare models that improve accessibility, streamline treatment pathways, and ensure equitable care for all patients.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 29-30"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989580","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":"The Cost of Social Disadvantage: Increased Postoperative Risk in TKA Patients","authors":"Colby McClaugherty BS,&nbsp;Caleb Casanova,&nbsp;Aruni Areti,&nbsp;Lorenzo Deveza MD","doi":"10.1016/j.jnma.2025.08.065","DOIUrl":"10.1016/j.jnma.2025.08.065","url":null,"abstract":"<div><h3>Introduction</h3><div>Social Determinants of Health (SDOH) contribute to disparities in healthcare delivery and patient outcomes. Previous studies have demonstrated that factors related to social vulnerability, including socioeconomic status, education, and access to care significantly impact outcomes following orthopedic surgical procedures. The CDC's 2018 Social Vulnerability Index (SVI), developed using 16 U.S. Census variables, serves as a tool to approximate social disparity. While prior studies have associated a high SVI score with poor postoperative outcomes in total joint arthroplasty, regional differences in healthcare infrastructure and population demographics are hypothesized to influence this relationship. Houston, Texas serves as a valuable model to evaluate this relationship due to the diverse patient population and high surgical caseload. This study aims to investigate the relationship between patient SVI score and postoperative outcomes following TKA at a large academic medical center in Houston, Texas.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 9,191 patients who underwent primary TKA between January 1, 2013 and December 31, 2023 at a private medical center in Houston, Texas. Patients who underwent primary TKA during this period were identified using International Classification of Diseases (ICD) codes. Those who underwent revision TKA or unicondylar knee arthroplasty were excluded. Postoperative complications evaluated include prolonged length of stay (≥5 days post-op), incidence of 30-day infection and 90-day infection, as well as 90-day incidence of sepsis, readmission, pulmonary embolism (PE), deep vein thrombosis (DVT), myocardial infarction (MI), and cerebrovascular accident (CVA). Given the baseline rarity of complications following primary TKA, Firth Logistic regression was used to evaluate associations between SVI scores and complications. Odds ratios and 95% confidence intervals were reported for significant associations. A p-value of &lt;0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>After adjusting for confounders, each 1% increase in SVI score was associated with a 0.9% increase in the odds of PE within 90 days (OR = 1.009, 95% CI = 1.002-1.016, p-value = 0.013) and a 0.9% increase in the odds of infection within 30 days following surgery (OR = 1.009, 95% CI = 1.0002-1.017, p-value=0.044). No significant associations were identified for sepsis, postoperative readmission, DVT, MI, CVA, 90-day infection, or prolonged length of stay.</div></div><div><h3>Conclusion</h3><div>Higher Social Vulnerability Index scores are associated with increased risk of postoperative pulmonary embolism (within 90 days)and new infection (within 30 days) following TKA. The elevated risk of PE in socially vulnerable patients may warrant closer perioperative monitoring and consideration of more aggressive anticoagulant prophylaxis. Higher infection rates may be at","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 34"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989501","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}