Clinical Medicine & Research最新文献

{"title":"Air Embolism-Induced Ischemic Stroke Following Orthognathic Surgery in a Patient With Goldenhar Syndrome.","authors":"Apurva Popat, Sweta Yadav","doi":"10.3121/cmr.2024.1882","DOIUrl":"10.3121/cmr.2024.1882","url":null,"abstract":"<p><p>Goldenhar syndrome, a rare congenital anomaly, manifests as craniofacial malformations often necessitating intricate surgical interventions. These procedures, though crucial, can expose patients to diverse postoperative complications, including hemorrhage or infection. A noteworthy complication is stroke, potentially linked to air embolism or local surgical trauma. We highlight a case of a male patient, aged 20 years, who experienced a significant postoperative complication of an ischemic stroke, theorized to be due to an air embolism, after undergoing orthognathic procedures for Goldenhar syndrome. The patient was subjected to LeFort I maxillary osteotomy, bilateral sagittal split ramus osteotomy of the mandible, and anterior iliac crest bone grafting to the right maxilla. He suffered an acute ischemic stroke in the left thalamus post-surgery, theorized to stem from an air embolism. Advanced imaging demonstrated air pockets within the cavernous sinus, a rare and concerning finding suggestive of potential air embolism. This case underscores the intricate challenges in treating Goldenhar syndrome patients and the rare but significant risk of stroke due to air embolism or surgical trauma. Limited literature on managing air embolism complications specific to Goldenhar syndrome surgeries exists. Generally, management includes immediate recognition, positional adjustments, air aspiration via central venous catheters, hyperbaric oxygen therapy, hemodynamic support, and high-flow oxygen administration to expedite air resorption. Our patient was conservatively managed post-surgery, and at a 3-month neurology follow-up, he showed significant improvement with only residual right arm weakness. It emphasizes the imperative of a comprehensive, multidisciplinary approach.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"22 1","pages":"44-48"},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872943","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 Injections for Musculoskeletal Conditions: A Narrative Review.","authors":"John Kiel, Andres I Applewhite, Tais G O Bertasi, Raphael A O Bertasi, LaRae L Seemann, Lorena M C Costa, Haytham Helmi, George G A Pujalte","doi":"10.3121/cmr.2024.1847","DOIUrl":"10.3121/cmr.2024.1847","url":null,"abstract":"<p><p>Musculoskeletal conditions of the upper and lower extremities are commonly treated with corticosteroid injections. Ketorolac, a parenteral nonsteroidal anti-inflammatory drug, represents an alternative injectant for common shoulder, hip, and knee conditions. A review of the current literature was conducted on the efficacy of ketorolac injection in musculoskeletal diseases. Several studies support the use and efficacy of ketorolac injection in subacromial bursitis, adhesive capsulitis, and hip and knee osteoarthritis. Given the systemic effects of glucocorticoid injections, ketorolac may be a safe and effective alternative in patients with musculoskeletal disease. However, more evidence is required to better understand the effects ketorolac has on the human body during inflammatory processes.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"22 1","pages":"19-27"},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870446","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":"A National Survey of Neonatologists' Perspectives on Probiotics Use in Neonatal Intensive Care Units in the U.S.A.","authors":"Mariha Khan, Brooke Delgoffe, Rachel Gabor, Nageshwar Chauhan, Nirzar Parikh, Noor Ketana, Aditya Joshi","doi":"10.3121/cmr.2024.1848","DOIUrl":"10.3121/cmr.2024.1848","url":null,"abstract":"<p><p><b>Introduction:</b> Most recent clinical reports from the American Academy of Pediatrics (AAP) concluded current evidence does not support routine universal administration of probiotics to preterm infants, particularly those with birth weight <1000 grams. Despite this, the use of probiotics is increasing in US neonatal intensive care units (NICU).<b>Objectives:</b> Collaborating with the Perinatal Neonatal Medicine of AAP, we conducted a national survey to obtain neonatologist opinion on probiotics use.<b>Methods:</b> Survey questionnaires were sent to 3000 neonatologists via email.<b>Results:</b> Of 3000 potential respondents, 249 (8.3 %) completed the survey. Seventy-five (30%) neonatologists working in 23 different NICUs reported using probiotics in their practice, while 168 (70%) neonatologists working in 54 different NICUs reported not using probiotics. Of those not currently use probiotics, 49% indicated they would consider using probiotics in the future vs. 12% indicating they would not use probiotics. The most common indication for probiotics use was average gestational age < 32 weeks and mean birth weight < 1500 grams. Probiotics were discontinued at mean gestational age of 35 weeks. Respondents who prescribe probiotics were more likely to work in a setting without fellowship or residency training (48% vs 20%). Probiotics users were more often from the West (29 % vs 7%) and less often from Northeast (5% vs 34%) compared to non-users. The proportion of those using probiotics did not significantly differ by NICU size, NICU level, or years working in a NICU. Similac Tri-Blend, Evivo, and Culturelle were the top three probiotics used in the respondent's NICU.<b>Conclusion:</b> Though a majority of respondents are not currently using probiotics in their NICU, a large number of nonusers are interested in using probiotics in the future. Differences continue to exist in the brand of probiotics used in US NICUs.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"22 1","pages":"1-5"},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872706","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":"A Systematic Review and Meta-Analysis of the Predictive Power of China-PAR Against Cardiovascular Disease.","authors":"Qiongfang Cao, Huan Li, Xinyu Pan, Yuhan Wang, Peng Zhang, Lanying He, Jian Wang, Min Huang, Fan Xu","doi":"10.3121/cmr.2024.1846","DOIUrl":"10.3121/cmr.2024.1846","url":null,"abstract":"<p><p><b>Background and Purpose:</b> To evaluate the predictive power of the China-PAR model for cardiovascular disease (CVD).<b>Methods:</b> Dominate databases, including PubMed, Web of Science, CNKI, Wanfang Data Knowledge Service Platform, Chinese Biomedical Literature Service System, and VIP self-built database, were searched from January 1, 2016 to February 22, 2022. The primary outcome included observed events and predicted events by China-PAR. Meta-analysis was performed using RevMan 5.3 software. Stroke, arteriosclerotic cardiovascular disease (ASCVD), male, and female were divided into subgroup analyses. Funnel plots were used to assess publication bias.<b>Results:</b> A total of nine studies, which included 221,918 participants, were analyzed. Meta-analysis showed the combined observed incidence of CVD was 3.97%, and the combined predicted incidence was 9.59% by China-PAR. There was no significant difference between the observed and the predicted events. Subgroup analysis showed there was no statistical significance between the observed and the predicted events for stroke or for ASCVD. The difference between the observed and the predicted events by China-PAR was not statistically significant in either males or females.<b>Conclusions:</b> China-PAR model has important public health significance to further improve the primary prevention strategy of CVD.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"22 1","pages":"28-36"},"PeriodicalIF":1.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872924","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":"Perinatal Prognosis of Pregnancies with Single Umbilical Artery in a Romanian Third-Level Unit.","authors":"János Levente Turos, Emmanuel Ladanyi, Tamás Szabó, Béla Szabó","doi":"10.3121/cmr.2023.1775","DOIUrl":"10.3121/cmr.2023.1775","url":null,"abstract":"<p><p><b>Objectives:</b> Single umbilical artery (SUA) is considered the most common abnormality of the umbilical artery. The objective of the study was to evaluate the perinatal prognosis of fetuses with SUA and to describe the associated malformations. The significance of the study is represented by examining whether our findings are in correlation with data already described.<b>Methods:</b> We performed a prospective cohort study on singleton pregnancies complicated with SUA. The study population was composed of women with singleton pregnancies who were examined at the Department of Obstetrics and Gynecology of the Târgu Mures County Emergency Clinical Hospital between 2012 and 2021.<b>Results:</b> The incidence of SUA in the study population was 0.48%. C-section was performed in 40 cases with SUA and in 5258 cases with no SUA (RR:1.56, <i>P</i><0.05.) From the total number of 2249 premature deliveries, 23 newborns were diagnosed with SUA (RR:2.12, <i>P</i><0.05.) From the total number of 869 deliveries with low birth weight (LBW) newborns, 13 were associated with SUA (RR: 3.12, <i>P</i><0.05.) There were 206 pregnancies noted with antenatal fetal demise after 24 weeks of gestation, and only 2 of them were with SUA (RR:2.01, <i>P</i>>0.05.) Fetal and neonatal malformations were described in 290 cases, and 28 were associated with SUA (R:21.96, <i>P</i><0.05.) In 57 of 85 cases (67.05%), we found iSUA, and 28 newborns (32.95%) had minor, major, or other associated pathologies. We found two cases of trisomy 18 and one case with trisomy 13 associated with SUA. Investigating the malformations associated with SUA, the most common were cardiac and great vessels malformations (12), followed by limb malformations (8), urogenital malformations (7), digestive tract malformations (7), central nervous system malformations (4), and in one case we found cleft palate.<b>Conclusions:</b> Perinatal prognosis regarding SUA is significantly poorer than in cases without this pathology. One-third of fetuses with SUA were associated with fetal anomalies. The most common pathologies associated with SUA were cardiovascular, limb, urogenital, and digestive system malformations. Our data are similar to those described in other studies; therefore, we conclude, we can implement the general recommendations in our region regarding counselling patients.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"192-195"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651805","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":"Compliance of Prone Positioning in Non-Intubated COVID-19 Patients.","authors":"Christopher G Bargoud, Tingyu Jih, Danika Baskar, Lindsay Volk, Sheraz Siddiqui, Mafudia Suaray, Rory Ulloque, Sara Khalil, Rachel L Choron","doi":"10.3121/cmr.2023.1830","DOIUrl":"10.3121/cmr.2023.1830","url":null,"abstract":"","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"171-176"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651891","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":"\"Dialogue Between Franklin and the Gout\" Reexamined.","authors":"Mary Mikhael, Chokkalingam Siva","doi":"10.3121/cmr.2023.1833","DOIUrl":"10.3121/cmr.2023.1833","url":null,"abstract":"<p><p>Benjamin Franklin, one of the founding fathers of the United States, was not just a politician and a political philosopher but an inventor with a scientific temperament. He was overweight and likely suffered from the consequences of metabolic syndrome including gout. He woke up with a gout attack on October 22, 1780 and wrote the \"Dialogue Between Franklin and the Gout.\" His observations on the risk factors for gout are re-examined in the modern context 243 years later.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"196-200"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651889","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":"Investigating the Effect of Temperature Therapy on the Severity of Restless Legs Syndrome: Systematic Review and Meta-Analysis.","authors":"Mohammad Mehdi Mohammadi, Ali Akbar Vaisi Raygani","doi":"10.3121/cmr.2023.1824","DOIUrl":"10.3121/cmr.2023.1824","url":null,"abstract":"<p><p><b>Background:</b> Restless legs syndrome (RLS) is a sensorimotor disorder leading to disturbance of resting, discomfort, stress, and impaired daytime activity in the sufferers. The present systematic review and meta-analysis was conducted to determine the effect of temperature therapy on the severity of RLS.<b>Methods:</b> The electronic databases of Google Scholar, ProQuest, Scopus, PubMed, Web of Science, and State Inpatient Databases (SID) were searched from inception to August 2022. The Cochrane Collaboration's Risk of Bias Tool was used to check the quality of included studies. Meta-analysis was performed by calculating standardized mean differences (SMDs), using random effects model, and running Comprehensive Meta-Analysis (CMA) software version 2.<b>Results:</b> The included studies (n=6) comprised 177 participants, whose mean age was 49.85 years old. The results of the meta-analysis showed temperature therapy could reduce the severity of RLS (SMD=-1.520, 95% CI: -2.122 to -0.918). Regarding the source of heterogeneity, meta-regression results indicated the efficacy of the intervention in reducing the severity of RLS enhanced significantly by increasing the duration of the intervention in each session (β=-0.039, 95% CI -0.076 to -0.002, <i>P</i><0.001). The results also showed increasing the duration (β=-0.039, 95% CI -0.076 to -0.002, P<0.001) and the temperature of the intervention in each session (β=-0.016, 95% CI -0.028 to -0.003, <i>P</i><0.05) significantly enhanced the efficacy of the intervention in reducing the severity of RLS. The results also indicated that, among patients with underlying clinical conditions, the effectiveness of temperature therapy was higher in hemodialysis patients (β=-2.006, 95% CI -2.736 to -1.276, <i>P</i><0.05).<b>Conclusion:</b> The present study findings suggested temperature therapy could mildly reduce the severity of RLS symptoms. It was also found that the highest efficacy of this intervention could be achieved when the higher temperature was used in fewer treatment sessions in hemodialysis patients. Based on our findings, this intervention can be included in the care plan of patients with RLS considering the settings described to achieve the highest efficacy.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"216-225"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651893","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":"Meningitis in the Guise of Dementia: Lyme-Induced Normal Pressure Hydrocephalus.","authors":"Ryan Liu, Matheus Polly, Robert P Lennon, Alexis Reedy-Cooper","doi":"10.3121/cmr.2023.1829","DOIUrl":"10.3121/cmr.2023.1829","url":null,"abstract":"<p><p>While the cause of altered mentation in the elderly may be multifactorial, infectious etiologies may be missed. This case report aims to detail an account of a patient with dementia, found to have Lyme meningitis in the setting of a normal pressure hydrocephalus (NPH). The patient smelled of urine and presented with ambulatory dysfunction, fitting the \"wet, wacky, and wobbly\" triad of NPH while also having subjective chills and leukocytosis. Non-contrast brain CT scan showed dilated ventricles. Cerebrospinal fluid (CSF) studies suggested aseptic meningitis. Serum studies using a modified two-tiered algorithm confirmed the diagnosis of Lyme disease. Treatment of the underlying condition with a prolonged course of doxycycline improved symptoms and clinical course. Review of the literature on the association between Lyme meningitis and NPH reveals that few cases of Lyme-related NPH have been reported worldwide and further research into the pathophysiology, diagnostic approach, treatment modalities, and management of NPH secondary to Lyme meningitis may be warranted.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"226-229"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651804","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":"Distance Matters: Investigating No-Shows in a Large Rural Provider Network.","authors":"Abdul Shour, Adedayo A Onitilo","doi":"10.3121/cmr.2023.1853","DOIUrl":"10.3121/cmr.2023.1853","url":null,"abstract":"<p><p><b>Background/Objective:</b> No-shows have a negative effect on healthcare outcomes. It is unclear, however, whether patients' distance from the clinic is associated with higher no-show rates. To fill this knowledge gap, we examined the relationship between patients' distance from the clinic and no-shows in a rural provider network.<b>Methods:</b> Data from Marshfield Clinic Health System's scheduling system, including 263,464 recent patient appointments in 2021 were analyzed. The outcome was no-shows, defined as when patients missed an appointment (categorized as yes/no). The exposure was the distance to the clinic, measured in miles as a straight-line distance from the clinic in the patient's zip code to the facility where the appointment was held (classified as <5 miles, 5-10, 10-20; >20, and used as continuous). Covariates were patient demographics, appointments, providers, and insurance status. Chi-square and logistic regression were used with p-values ≤.05 considered statistically significant.<b>Results:</b> The no-show rate was 8.0%. Patients who lived <5 miles (8.3%) and >20 miles (8.2%) from the clinic had higher no-show rates than those who lived between 10-20 miles (8.0%) and 5-10 miles (7.6%), at <i>P</i>=0.001. In the adjusted model, the odds of no-show were similar between patients who did not show and those who did (OR:1.00,95%CI:1.00-1.00). No-shows were more likely among male patients compared to females (OR:1.14,95%CI:1.11-1.18), Spanish compared to English speakers (OR:1.34,95%CI:1.20-1.50), prior no-show compared to no prior no-show (OR:4.42,95%CI:4.27-4.48), >4 weeks lead time compared to <1 day (OR:5.45,95%CI:4.98-5.97), and Medicaid compared to non-Medicaid patients (OR:1.56,95%CI:1.49-1.63).<b>Conclusion:</b> Our analysis showed patients who lived <5 miles and >20 miles from the clinic had higher no-show rates. The odds of a no-show were comparable between patients who showed up and those who did not. Male patients, Spanish-speaking patients, patients with a history of no-shows, and Medicaid beneficiaries were more likely to miss their appointments. Understanding the impact of these variables on no-show rates can assist healthcare providers in developing strategies to improve patient access and reduce no-show rates. These findings imply that rural patients may face a variety of barriers when seeking healthcare, necessitating a comprehensive approach to addressing this issue.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"21 4","pages":"177-191"},"PeriodicalIF":1.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139651892","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}