Clinical Medicine & Research最新文献

{"title":"Cinema's Terrifying Realities: Pandemics, Zombification, and SARS-COV-2.","authors":"Dennis Henkel, Eelco F M Wijdicks","doi":"10.3121/cmr.2022.1742","DOIUrl":"10.3121/cmr.2022.1742","url":null,"abstract":"<p><p>Contagion is a function of the properties of the pathogen, social interactions, and personal relationships in the society it attacks. Filmmakers in the horror genre were inspired by the idea of rabies as a virus that could mutate into something more dangerous. Fictional epidemics of scavenging undead were often attributed to encephalitis caused by rabies or a mutated rabies virus. During the early months of the SARS-COV-2 pandemic, there was a spike in streaming of <i>Contagion</i> that portrays a viral infectious disease modeled after a bat virus that spreads at an alarming rate, unleashing a global public panic and a clueless governmental response. We wanted to trace how filmmakers used rabies pathology as source material for their plots. We searched internet film databases and reviewed fictional films that utilized this plot device. Many dystopic, rabies-induced pandemic scenarios - mostly from the zombie genre - reveal parallels to the COVID-19 pandemic. Many zombie films, despite their absurd premise, anticipated the realities of future pandemics.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544194/pdf/0200121.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10455930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Vasoconstrictor-Induced Non-Occlusive Mesenteric Ischemia of Colon: A Systematic Review.","authors":"Umer Farooq, Daniel Alcantar, Zahoor Ahmed, Ayokunle T Abegunde","doi":"10.3121/cmr.2022.1726","DOIUrl":"10.3121/cmr.2022.1726","url":null,"abstract":"<p><strong>Background: </strong>Nonocclusive mesenteric ischemia (NOMI) is due to mesenteric arterial hypoperfusion from several causes, such as hypovolemia, heart failure, shock, vasoconstrictors, and severe liver or renal disease. Vasoconstrictor-induced NOMI is usually iatrogenic or associated with cocaine use.</p><p><strong>Objectives: </strong>Anecdotal reports suggest that cocaine-induced NOMI has the highest mortality among vasoconstrictors. This review aims to compare the outcomes of colonic NOMI secondary to cocaine versus other vasoconstrictors.</p><p><strong>Methods: </strong>We conducted a systematic search of MEDLINE from inception through October 2016 to find articles on colonic NOMI. The study's primary outcomes were mortality and hospital length of stay (LOS), while secondary outcomes included the need for surgery. We reported descriptive statistics as percentages or median and interquartile range (IQR). We compared continuous data with the Mann-Whitney test and categorical data with Fisher's exact test; <i>P</i> < 0.05 was statistically significant.</p><p><strong>Results: </strong>Of the 59 studies, 20 case reports and 3 case series (n= 27 patients) met the inclusion criteria. There was no difference in mortality between cocaine-induced NOMI and non-cocaine NOMI (<i>P</i>=1.0). There were statistically significant differences between cocaine and non-cocaine vasoconstrictor-induced colonic NOMI regarding surgery (60% vs. 5.8%, <i>P</i>=0.03) and median LOS (7 days vs. 4 days, <i>P</i>=0.04).</p><p><strong>Conclusion: </strong>Cocaine-induced NOMI and non-cocaine NOMI both appear to have a relatively high but similar mortality rate, but the former is associated with increased requirement for surgery and LOS; prompt recognition of this clinical entity is required to improve outcomes.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544191/pdf/0200164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10456210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Health Care Costs in Understanding Patient Preferences of Providers.","authors":"Anna Breiburg,&nbsp;Ware G Kuschner","doi":"10.3121/cmr.2022.1762","DOIUrl":"https://doi.org/10.3121/cmr.2022.1762","url":null,"abstract":"","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":" ","pages":"69"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242730/pdf/0200069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40409061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications Associated with Polydek Sutures Used in Eyelid Lateral Tarsal Strip Procedures.","authors":"Lin Chen,&nbsp;Robert B Penne","doi":"10.3121/cmr.2021.1661","DOIUrl":"https://doi.org/10.3121/cmr.2021.1661","url":null,"abstract":"<p><p>Suture-related complications can occur in response to a patient's immune system activation regardless of surgical site. However, there is minimal literature describing complications related to commonly used Polydek sutures. We report the diagnosis, treatment, and follow up of four cases of Polydek suture-related complications post-eyelid lateral tarsal strip procedures, including an early wound healing problem/infection and later granuloma formation and/or suture extrusion that only resolved after removal of the Polydek suture or granuloma tissue. Use of non-Polydek sutures may reduce the likelihood for post-operative suture complications.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 2","pages":"107-110"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242731/pdf/0200107.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39794904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance of Fluoroquinolone Resistance in Wisconsin: Geographic Variation and Impact of Revised CLSI Breakpoints.","authors":"Giovanna Lazzerini,&nbsp;Stephen C Lavey,&nbsp;Barry C Fox,&nbsp;Erik Munson","doi":"10.3121/cmr.2021.1718","DOIUrl":"https://doi.org/10.3121/cmr.2021.1718","url":null,"abstract":"<p><p><b>Objective:</b> Many clinical microbiology laboratories procure antimicrobial susceptibility testing data using guidelines established by Clinical and Laboratory Standards Institute (CLSI). When necessary, CLSI revises interpretive breakpoints in efforts to improve clinical correlation, with two revisions relative to fluoroquinolone agents occurring in 2019. The purpose of this investigation was to determine the impact of fluoroquinolone breakpoint revisions on Wisconsin clinical isolates of <i>Escherichia coli, Proteus mirabilis,</i> and <i>Pseudomonas aeruginosa.</i><b>Design:</b> Multi-center laboratory surveillance, with testing at a single location utilizing standardized media and susceptibility testing protocols.<b>Methods:</b> From the Surveillance of Wisconsin Organisms for Trends in Antimicrobial Resistance and Epidemiology (SWOTARE) program, levofloxacin and ciprofloxacin minimum inhibitory concentration (MIC) values for 1911, 1521, and 1463 Wisconsin isolates of <i>E. coli, P. mirabilis,</i> and <i>P. aeruginosa,</i> respectively, were determined by broth microdilution testing. In separate data analyses, all MIC data were interpreted using CLSI breakpoints published prior to 2019, then secondarily by using CLSI breakpoints published since 2019 (which reflect lower breakpoints for both levofloxacin and ciprofloxacin resistance). Findings were further stratified by Wisconsin Department of Health Services region.<b>Results:</b> Up to 3.2% decreased statewide fluoroquinolone susceptibility was observed for <i>E. coli</i> isolates, while 5.1% and 6.3% decreases in levofloxacin susceptibility were noted for <i>P. aeruginosa</i> and <i>P. mirabilis</i> isolates, respectively, when revised breakpoints were applied. <i>E. coli</i> isolates from the Western region and <i>P. mirabilis</i> isolates from the Southeastern region demonstrated significant shifts toward decreased fluoroquinolone susceptibility upon application of revised breakpoints. Northern region <i>P. mirabilis</i> isolates exhibited consistently decreased fluoroquinolone susceptibility.<b>Conclusions:</b> Fluoroquinolone resistance has been underreported in Wisconsin as a whole, yet geographic variability continues to exist. Targeted annual surveillance is important to identify and monitor resistance trending. Compilations of SWOTARE surveillance data can be utilized to predict the impact of future CLSI interpretive breakpoint revisions in Wisconsin.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 2","pages":"81-88"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242736/pdf/0200081.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39865034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Opioid Analgesia after Surgery: Assessing Postoperative Prescriptions from a Patient and Surgeon Perspective.","authors":"Roshini J Ramwani,&nbsp;Jessica A Wernberg","doi":"10.3121/cmr.2021.1630","DOIUrl":"https://doi.org/10.3121/cmr.2021.1630","url":null,"abstract":"<p><p><b>Purpose:</b> Nonmedical use of prescription opioids continues to be a public health crisis in the United States that disproportionately affects rural communities with diversion of pills from friends and family being the most common source. The primary goal of the study was to identify current opioid prescription practices, and to assess the discrepancy in amount of opioids prescribed by surgeons versus the amount needed post-operatively by patients. Patient factors that may influence postoperative analgesia needs and their management of leftover prescription opioids were also evaluated<b>Methods:</b> Patients ≥18 years-of-age who underwent a surgery between July and December 2018 by the subspecialty departments of Acute Care and General Surgery at a tertiary care facility in the rural Midwest were surveyed at their first post-operative visit to assess their postoperative analgesic needs. Resident and attending surgeons in the above departments were also surveyed to identify different factors that influenced their narcotic prescription practices.<b>Results:</b> Surveys from 252 patients, 12 attending surgeons, and 14 general surgery residents met inclusion criteria. Of patients who received a narcotic prescription, 19.9% did not fill their prescription, 64.1% of whom were >60 years old, and 72.1% resided within an hour of the hospital. Average reported prescription size was 11-40 pills; however, most used more than 5 pills regardless of the type of operation (<i>P</i>=0.59) and history of chronic pain (<i>P</i>=0.07). Inability to call in narcotic prescriptions and patients' distance from care influenced providers' prescription practices, with 77.9% of resident physicians and 68.3% of attending surgeons stating they would prescribe fewer if given the ability to call in a narcotic prescription.<b>Conclusions:</b> Regardless of the operation complexity, a majority of patients required fewer than five opioid pills after discharge and would be willing to return leftover pills. Development of opioid stewardship programs within the healthcare sector may reduce the number of opioids available for diversion and misuse.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 2","pages":"89-94"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242732/pdf/0200089.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39865036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketorolac and Predicted Severe Acute Pancreatitis: A Randomized, Controlled Clinical Trial.","authors":"Zahra Vahdat Shariatpanahi,&nbsp;Shaahin Shahbazi,&nbsp;Erfan Shahbazi","doi":"10.3121/cmr.2021.1663","DOIUrl":"https://doi.org/10.3121/cmr.2021.1663","url":null,"abstract":"<p><p><b>Objective:</b> We evaluated the effect of ketorolac on reducing the severity of acute pancreatitis.<b>Design and Setting:</b> Randomized clinical trial performed in a University hospital.<b>Participants:</b> There were 56 adult patients, with predicted severe acute pancreatitis, randomly divided into two groups.<b>Methods:</b> The patients in the study group received intravenous ketorolac, 10 mg, three times daily from the time of enrollment for a maximum of 5 days, as needed, along with standard medical treatment. Primary outcome measure was the change in the serum level of high sensitive C-reactive protein (hs-CRP). Patients were also followed up in terms of hospitalization duration, need for intensive care unit (ICU), organ failure development, persistent organ failure, pancreatic necrosis, nutritional assessment, and mortality. The study continued to gather clinical follow-up information up to 4 months.<b>Results:</b> Serum level of hs-CRP was significantly lower in the ketorolac group compared with the control group on days 3, 4, and 5. There were no significant differences in organ failure, pseudocyst formation, acute necrotic collection, mortality, and ICU transfer between groups. Days of hospitalization were significantly lower in the study group. The feeding start time was significantly shorter in the study group with no need for tube feeding in the ketorolac group. Frequency of NPO (not per oral) was significantly lower in the ketorolac group.<b>Conclusion:</b> The use of ketorolac may improve feeding outcomes and shorten length of hospitalization in predicted severe acute pancreatitis.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 2","pages":"74-80"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242735/pdf/0200074.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39796792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Thyroid Disorders Among Resistant Hypertension Patients: Are We Doing Enough?","authors":"Nikos Pappan,&nbsp;Mian Tanveer Ud Din,&nbsp;Divya Venkat,&nbsp;Patrick Wedgeworth,&nbsp;Sheng Fu","doi":"10.3121/cmr.2021.1676","DOIUrl":"https://doi.org/10.3121/cmr.2021.1676","url":null,"abstract":"Objective: To perform a quality assurance study assessing if hypo- and hyperthyroidism are appropriately screened for in patients with resistant hypertension. Design: Data was collected from patients diagnosed with resistant hypertension, defined as being on four or more different classes of anti-hypertensive medications. These patients were filtered to determine if thyroid stimulating hormone (TSH) measurement occurred within 90 days of the addition of a fourth medication class. Setting: Two internal medicine residency clinics in Pittsburgh, PA. Participants: Patients were selected who had a diagnosis of hypertension and were seen in clinic between January 1, 2018 and December 23, 2020. Methods: A single center retrospective review was performed. Results: A total of 1,125 patients were identified as having resistant hypertension. Of these, only 74 patients were found to have a TSH measurement taken within 90 days of having a fourth medication class prescribed. Seven TSH values were found to be abnormal with one patient being diagnosed with hyperthyroidism, demonstrating a screening rate of 6.6%. There were statistically significant differences in age, body mass index, and diastolic blood pressure in those screened versus not. Conclusions: Thyroid disease is under-screened as an etiology for resistant hypertension, particularly given the ease of diagnosis and reversibility of these conditions.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 2","pages":"70-73"},"PeriodicalIF":1.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9242733/pdf/0200070.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39796793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Osteoporosis and Spinal Fractures: Contemporary Guidelines and Evolving Paradigms","authors":"Nasvin Imamudeen, A. Basheer, A. Iqbal, Nihal Manjila, N. Haroon, S. Manjila","doi":"10.3121/cmr.2021.1612","DOIUrl":"https://doi.org/10.3121/cmr.2021.1612","url":null,"abstract":"Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying diminished bone mineral density, as worldwide fracture prevention campaigns are trailing behind in meeting their goals. This is a narrative review exploring the various imaging and laboratory tests used to diagnose osteoporotic fractures and a comprehensive compilation of contemporary medical and surgical management. We have incorporated salient recommendations from the Endocrine Society, the American Association of Clinical Endocrinology (AACE), and the American Society for Bone and Mineral Research (ASBMR). The use of modern scoring systems such as Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk in osteoporosis with a 10-year probability of hip fracture and major fractures in the spine, forearm, hip, or shoulder is highlighted. This osteoporosis risk assessment tool can be easily incorporated into the preoperative bone health optimization strategies, especially before elective spine surgery in osteoporotic patients. The role of primary surgical intervention for vertebral compression fracture and secondary fracture prevention with pharmacological therapy is described, with randomized clinical trial-based wisdom on its timing and dosage, drug holiday, adverse effects, and relevant evidence-based literature. We also aim to present an evidence-based clinical management algorithm for treating osteoporotic vertebral body compression fractures, tumor-induced osteoporosis, or hardware stabilization in elderly trauma patients in the setting of their impaired bone health. The recent guidelines and recommendations on surgical intervention by various medical societies are covered, along with outcome studies that reveal the efficacy of cement augmentation of vertebral compression fractures via vertebroplasty and balloon kyphoplasty versus conservative medical management in the elderly population.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"53 1","pages":"95 - 106"},"PeriodicalIF":1.4,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90081024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Low Grade Follicular Lymphoma of the Conjunctivae Mimicking Nodular Anterior Scleritis: A Case Report","authors":"Hui Yin Goh, Che Mahiran Binti Che Daud, Chandramalar T. Santhirathelagan, Shamala Retnasabapathy","doi":"10.3121/cmr.2022.1674","DOIUrl":"https://doi.org/10.3121/cmr.2022.1674","url":null,"abstract":"Conjunctival lymphomas are rare entities and may present with non-specific ocular signs that resemble inflammation. They may mimic common ocular pathologies, leading to a delay in diagnosis and treatment. The treatment options of conjunctival lymphomas should be tailored to individuals due to their indolent nature compared to other adnexal lymphomas. Herein, the authors report a case of a primary follicular conjunctival lymphoma in a patient who presented with signs and symptoms of nodular anterior scleritis. The final histology of the conjunctiva lesion revealed primary follicular lymphoma. The patient was managed conservatively with active surveillance.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"51 1","pages":"111 - 113"},"PeriodicalIF":1.4,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90548838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}