Ochsner Journal最新文献

{"title":"Management of Spontaneous Renal Arteriovenous Fistula in Pregnancy.","authors":"Comfort S Tamakloe, Conner Davey, Kaitlyn Dorn, Patrick Gilbert, Frank B Williams","doi":"10.31486/toj.24.0062","DOIUrl":"10.31486/toj.24.0062","url":null,"abstract":"<p><strong>Background: </strong>A renal arteriovenous fistula (RAVF) is an abnormal connection between the artery and vein of the kidney and can result from idiopathic, congenital, or traumatic causes. In the general population, this pathology is rare and has the potential to be life-threatening. The incidence in pregnancy is even rarer.</p><p><strong>Case report: </strong>A pregnant 33-year-old gravida 5, para 4 patient presented with gross hematuria and passage of clots and was diagnosed with a right renal lower pole arteriovenous fistula at 36 weeks, 6 days' gestation. The patient developed gestational hypertension but did not demonstrate severe features of preeclampsia She underwent labor induction, uncomplicated spontaneous vaginal delivery, and subsequent endovascular embolization of the fistula. Hematuria and hypertension resolved postembolization.</p><p><strong>Conclusion: </strong>Because RAVF presents with nonspecific symptoms that mimic other causes of hematuria and hypertension in pregnancy, this rare vascular anomaly poses challenges in diagnosis and management in pregnant patients. Our case was also challenging because of the late-stage pregnancy diagnosis. The case highlights the challenges of diagnosing and managing RAVF during pregnancy and underscores the importance of a multidisciplinary approach.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"59-63"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693733","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":"Evaluation of the Diagnostic Accuracy of the T2Resistance Panel (Research Use Only) in Patients With Possible Bacterial Bloodstream Infections.","authors":"Deborah Ashcraft, Jesse St Pierre, Heather Davis, Susan Scariano, Maria Latsis, Royanne Vortisch, Samantha Smith, George Pankey","doi":"10.31486/toj.24.0101","DOIUrl":"10.31486/toj.24.0101","url":null,"abstract":"<p><strong>Background: </strong>Early identification and antimicrobial susceptibility testing (AST) of bloodstream pathogens are important for promptly determining the appropriate therapy. Currently, positive blood culture results (identification and AST) are reported in 2 to 4 days. The T2Resistance (T2R) Panel (T2 Biosystems, Inc) uses DNA amplification with magnetic resonance from 3 mL of whole blood for direct detection of 13 antibiotic resistance genes: <i>bla</i> _KPC, <i>bla</i> _NDM, <i>bla</i> _VIM, <i>bla</i> _IMP, <i>bla</i> _OXA-48, <i>bla</i> _CTX-M-14/15, AmpC <i>bla</i> _CMY/DHA, <i>van</i>A/B, and <i>mec</i>A/C. We compared the accuracy of T2R testing to AST for positive blood cultures.</p><p><strong>Methods: </strong>This investigator-sponsored, single-center study prospectively enrolled 802 patients with a standard of care blood culture. Five hundred forty-seven patients had adequate blood for culture and T2R testing. Blood cultures with positive isolates were identified, and AST was performed. Blood samples with positive blood cultures were tested with the T2R Panel.</p><p><strong>Results: </strong>Blood cultures were positive for 58/547 (10.6%) patients. Contaminants (18/547 [3.3%]) were excluded. T2R testing results (n=31) showed 2 <i>bla</i> _CTX-M-14/15 genes with 100% sensitivity; the remaining gram-negative resistance genes were not detected, so sensitivity could not accurately be determined. Specificity was 100% for the 16 gram-negative bacilli. Three enterococci and 2 <i>Staphylococcus aureus</i> showed 100% sensitivity/specificity. However, 10 coagulase-negative staphylococci showed 17% sensitivity/100% specificity. Antibiotic resistance genes identified were 2 <i>bla</i> _CTX-M-14/15, 2 <i>mec</i>A/C, and 1 <i>van</i>A/B. T2R testing results were obtained in an average of 7 hours.</p><p><strong>Conclusion: </strong>T2R testing is highly specific (100%) for the 13 antibiotic resistance genes on the panel. Sensitivity was 100% for the genes detected but was low (17%) for coagulase-negative staphylococci. T2R testing has the potential to diagnose certain antibiotic resistance genes from bacterial bloodstream infections in hours vs the days required for a positive blood culture with AST. Additional studies that include larger numbers of samples with antimicrobial resistance genes are needed.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"24-33"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694113","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":"Evidence for Combining Conservative Treatments for Adhesive Capsulitis.","authors":"Jordan L Hill","doi":"10.31486/toj.23.0128","DOIUrl":"10.31486/toj.23.0128","url":null,"abstract":"<p><p><b>Background:</b> Adhesive capsulitis, also known as frozen shoulder, is a challenge to treat clinically. Common first-line treatment options are suprascapular nerve block (SSNB), intra-articular corticosteroid (IACS) injection, hydrodilatation, and physical therapy. This literature review summarizes each of these conservative treatments and discusses the evidence base for combining treatment options for potential additive benefits to improve patient outcomes (ie, pain, range of motion [ROM], and shoulder function). <b>Methods:</b> The PubMed and Google Scholar databases were searched using the search terms \"adhesive capsulitis,\" \"frozen shoulder,\" \"corticosteroids,\" \"physical therapy,\" \"suprascapular nerve block,\" \"hydrodilatation,\" and \"conservative care.\" Pertinent articles were identified and synthesized to provide a comprehensive review of 4 common conservative treatments for adhesive capsulitis. <b>Results:</b> Combining SSNB with physical therapy and/or IACS injection and combining IACS injection with physical therapy have support in the literature for improving shoulder pain, ROM, and function, while hydrodilatation and physical therapy seem to offer some additive benefits for improving shoulder ROM when used as adjunct treatments for adhesive capsulitis. <b>Conclusion:</b> Adhesive capsulitis remains a challenge to treat clinically with much still unknown regarding treatment optimization. For the foreseeable future, first-line conservative management will continue to be the mainstay of managing adhesive capsulitis. Thus, knowing how to best use and optimize these various options-both individually and in combination-is vital for effective treatment.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 1","pages":"47-52"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177098","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":"Comment: Trends in Cigarette Smoking Among United States Adolescents.","authors":"Muhammad Hasham Khawaja, Omna Daulat Khawaja","doi":"10.31486/toj.23.0145","DOIUrl":"10.31486/toj.23.0145","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 1","pages":"5"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177096","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 Fourth Trimester: Embracing the Chaos of the Postpartum Period.","authors":"Tabitha M Quebedeaux, Stacey Holman","doi":"10.31486/toj.24.5043","DOIUrl":"10.31486/toj.24.5043","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 2","pages":"93-95"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11192216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443527","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 Xavier Ochsner College of Medicine - \"The Time Is Always Right To Do What Is Right\".","authors":"Yvens Laborde","doi":"10.31486/toj.24.5049","DOIUrl":"10.31486/toj.24.5049","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 4","pages":"242-244"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886164","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":"Happy Holidays and Happy New Year.","authors":"Ronald G Amedee","doi":"10.31486/toj.24.5051","DOIUrl":"https://doi.org/10.31486/toj.24.5051","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 4","pages":"239"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885771","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":"Beta-Blocker Usage in Patients With Heart Failure With Reduced Ejection Fraction During Acute Decompensated Heart Failure Hospitalizations.","authors":"Matthew T Brennan, Khaled M Harmouch, Jawad Basit, M Chadi Alraies","doi":"10.31486/toj.24.0011","DOIUrl":"https://doi.org/10.31486/toj.24.0011","url":null,"abstract":"<p><p><b>Background:</b> Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States every year. Beta-blockers are a first-line agent for patients experiencing heart failure with reduced ejection fraction, but beta-blocker use in patients hospitalized for acute decompensated heart failure remains low. We conducted an analysis of the existing evidence and guidelines to determine the conditions for prescribing beta-blockers to patients with acute decompensated heart failure. <b>Methods:</b> We searched the PubMed database for studies from 2004 to 2024 that included the search terms \"beta blockers\" and \"acute decompensated heart failure.\" We included studies in which beta-blockers were used in patients with heart failure with reduced ejection fraction and excluded studies that did not study beta-blockers directly. We compiled recommendations from professional societies regarding beta-blocker usage-both for outpatients with heart failure with reduced ejection fraction and for patients hospitalized with acute decompensated heart failure. <b>Results:</b> Studies consistently demonstrated lower rates of mortality and rehospitalization when beta-blocker therapy was maintained for patients with heart failure with reduced ejection fraction who were already on beta-blocker therapy. Conversely, withdrawal of beta-blocker therapy was associated with increased in-hospital and short-term mortality. We summarized our findings in a guideline-based flowchart to help physicians make informed decisions regarding beta-blocker therapy in patients with acute decompensated heart failure. Based on the evidence, beta-blockers should be initiated at a low dose in patients with heart failure with reduced ejection fraction who have never been on beta-blockers, provided the patient is hemodynamically stable. <b>Conclusion:</b> Our research and our guideline-based flowchart promote guideline-directed use of beta-blockers to improve the outcomes of patients with heart failure with reduced ejection fraction.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 3","pages":"198-203"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298636","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":"So What?","authors":"Bobby D Nossaman","doi":"10.31486/toj.24.5046","DOIUrl":"https://doi.org/10.31486/toj.24.5046","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 3","pages":"169-170"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298642","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":"Alcohol Misuse and Sexually Transmitted Infections: Using the CAGE Questionnaire as a Screening Tool.","authors":"Leah Feulner, Kelly Kossen, Jill Lally, Montana Ellis, Jeff Burton, David Galarneau","doi":"10.31486/toj.23.0141","DOIUrl":"10.31486/toj.23.0141","url":null,"abstract":"<p><p><b>Background:</b> While the connection between alcohol and risky behavior is well known, a clear correlation between alcohol misuse and contracting sexually transmitted infections (STIs) has not been determined. The 4-question CAGE questionnaire-the acronym stands for attitudes and activities related to alcohol use-is often administered at primary care annual visits to screen patients for alcohol abuse. This study assessed the relationship between CAGE scores and STI results to determine if the CAGE questionnaire could help determine the need for STI screening at annual visits. <b>Methods:</b> All patients who received a CAGE screening from 2015 to 2022 at a Gulf South health system were included in the analysis. The primary outcome of the study was the relationship between a positive CAGE score (a score ≥2) and a positive STI result. STIs included in the primary analysis were human immunodeficiency virus (HIV), hepatitis B, syphilis, chlamydia, gonorrhea, and trichomoniasis. The correlation between a positive CAGE score and hepatitis C was examined as a secondary outcome. <b>Results:</b> A total of 40,022 patients received a CAGE screening during the study period, and 757 (1.9%) scored ≥2 on the CAGE questionnaire. Significant associations were found between a positive CAGE score and hepatitis B (odds ratio [OR]=2.69, 95% CI 1.91, 3.80; <i>P</i><0.001), gonorrhea (OR=5.43, 95% CI 1.80, 16.39; <i>P</i>=0.003), and hepatitis C (OR=2.10, 95% CI 1.57, 2.80; <i>P</i><0.001). No associations were found between a positive CAGE score and HIV, chlamydia, or trichomoniasis. No patients with a CAGE score ≥2 had a syphilis diagnosis; therefore, no syphilis analysis was possible. <b>Conclusion:</b> Based on the results of this study, patients with a CAGE score ≥2 may benefit from screening for hepatitis B, hepatitis C, and gonorrhea at their primary care annual visit. Early STI detection could lead to prompt treatment and prevent further transmission and complications.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"24 2","pages":"96-102"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11192223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443524","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}