Ochsner Journal最新文献

{"title":"Case Illustration of the Natural History of Left Dominant Arrhythmogenic Cardiomyopathy","authors":"Corry B. Sanford, Jerry Fan, Yinan Hua, Lazaros Nikolaidis, Whitney Edmister, Sarah Payne, Hari Dandapantula, Manik Veer, Vinh Nguyen","doi":"10.31486/toj.23.0057","DOIUrl":"https://doi.org/10.31486/toj.23.0057","url":null,"abstract":"<h3></h3> <b>Background:</b> Arrhythmogenic left ventricular cardiomyopathy is an increasingly recognized cause of recurrent myocarditis, a mimicker of acute coronary syndrome, and an important cause of malignant ventricular arrythmias and heart failure. Desmoplakin is a protein that is critical to maintaining the structural integrity of the myocardium. Disruption of desmoplakin leads to fibrofatty infiltration of the myocardium which leads to congestive heart failure, cardiac arrhythmias, and sudden cardiac death. However, desmoplakin cardiomyopathy is often misdiagnosed, resulting in significant morbidity and mortality. We report 2 contrasting cases illustrating the natural history—hot and cold phases—of arrhythmogenic left ventricular cardiomyopathy. <b>Case Series:</b> The first case demonstrates a common phenotypic presentation of desmoplakin cardiomyopathy manifested as recurrent myocarditis and myocardial injury representing the hot phase. The second case is an undulating course of chronic systolic heart failure and ventricular arrhythmias representing the cold phase. <b>Conclusion:</b> Arrhythmogenic cardiomyopathy manifests as a spectrum of disease processes that involve the right, left, or both ventricles. Mutations in the desmoplakin gene are often associated with a left dominant ventricular cardiomyopathy. Diagnosis remains difficult as the condition has no signature clinical presentation, and imaging findings are variable.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136136907","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":"Brain Calcifications Secondary to Idiopathic Hyperthyroidism and Hypoparathyroidism","authors":"Bushra Zafar Sayeed, Faiza Zafar Sayeed, Muhammad Nashit, Shaheen Bhatty","doi":"10.31486/toj.23.0004","DOIUrl":"https://doi.org/10.31486/toj.23.0004","url":null,"abstract":"<h3></h3> <b>Background:</b> Thyroid and parathyroid hormones are essential components of the metabolic system and its regulation. Concurrent hyperthyroidism with hypoparathyroidism is an extremely rare finding and is not considered a common etiology of brain calcifications seen on imaging. Brain calcifications can cause a range of neurologic symptoms, including movement disorders, cognitive impairment, and seizures. Prompt recognition and treatment of hypoparathyroidism are essential to prevent or minimize the development of brain calcifications and associated neurologic symptoms. <b>Case Report:</b> A 39-year-old female presented to the emergency department in an unconscious state with generalized weakness and tonic-clonic seizures for 1 day. On clinical examination, she had jerky movements of her upper limbs, and her Glasgow Coma Scale score was 4/15. Supporting hypoparathyroidism, she had low levels of serum parathyroid hormone, calcium, and vitamin D and a high level of serum phosphorus. Her magnesium level was normal. Thyroid profile revealed hyperthyroidism. Noncontrast-enhanced computed tomography scan at the midbrain level showed multiple bilateral hyperintense areas in the basal ganglia and thalami suggestive of calcifications. The patient was treated with calcium and vitamin D supplements and antithyroid agents that successfully resolved her symptoms. <b>Conclusion:</b> This case provides important documentation for including hypocalcemia as a result of hypoparathyroidism in the differential diagnosis of patients with seizures. The treatment approach used with our patient can be considered for managing seizures in cases where the underlying cause is challenging to identify. This case highlights the importance of a thorough evaluation and individualized treatment plan for patients with seizures.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"218 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135153630","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":"Misdiagnosis of Acute Appendicitis in the Emergency Department: Prevalence, Associated Factors, and Outcomes According to the Patients' Disposition","authors":"Hila Weinberger, Abdel-Rauf Zeina, Itamar Ashkenazi","doi":"10.31486/toj.23.0051","DOIUrl":"https://doi.org/10.31486/toj.23.0051","url":null,"abstract":"<h3></h3> <b>Background:</b> Although abdominal pain is one of the most common complaints of patients presenting to the emergency department (ED), and acute appendicitis is a leading surgical differential diagnosis of patients presenting with abdominal pain, the diagnosis of acute appendicitis remains challenging. We examined the missed diagnosis rate of acute appendicitis in one ED and evaluated the association between disposition (discharge home or hospitalization in the wrong department) and complicated appendicitis. <b>Methods:</b> We retrospectively evaluated the medical records of patients with acute appendicitis and periappendicular abscess from January 1, 2013, to December 31, 2016. <b>Results:</b> The diagnosis of acute appendicitis was missed in 7.1% of patients (90/1,268) at their first ED encounter: 44 were discharged, and 47 were hospitalized with a wrong diagnosis (1 female patient was both discharged and then hospitalized with an incorrect diagnosis). Compared to the patients who were correctly diagnosed, patients with a missed diagnosis were older (median age 29 years vs 23 years, <i>P</i>=0.022), their time between ED first encounter and surgery was longer (median 29.5 hours vs 9.3 hours, <i>P</i><0.001), and their rate of complicated appendicitis was higher (54.4% vs 27.5%, <i>P</i><0.001). Missed females were more commonly hospitalized (26/39), while missed males were more commonly discharged from the ED (31/52) (<i>P</i>=0.019). No differences in the time between the first ED encounter and surgery (29.6 hours vs 29.6 hours, <i>P</i>=0.29) and the rate of complicated appendicitis (63.8% vs 43.2%, <i>P</i>=0.06) were noted between hospitalized patients with a wrong diagnosis and those discharged from the ED. Of the 25 patients with periappendicular abscesses, only 3 could be related to missed diagnoses during their first encounter in the ED. <b>Conclusion:</b> We found that 7.1% of patients were missed during their first encounter in the ED. Hospitalization in departments other than general surgery was not protective against delay in surgery or the development of complicated appendicitis. Periappendicular abscess was attributable to late referral rather than a missed diagnosis in most patients<b>.</b>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135396325","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":"Carotid Web as a Source of Thromboembolism in a Young African American Female","authors":"Eric Assid, Chad Hall, Mawadah Samad, Richard Zweifler","doi":"10.31486/toj.23.0082","DOIUrl":"https://doi.org/10.31486/toj.23.0082","url":null,"abstract":"<h3></h3> <b>Background:</b> Carotid webs are nonatherosclerotic fibrous bands that may alter hemodynamic flow and increase the risk of platelet aggregation, leading to thromboembolism in young, otherwise healthy individuals. Although rare, carotid webs are important causes of thromboembolic strokes and are often overlooked in the routine workup for a stroke. Treating physicians and radiologists must recognize and properly manage patients who present with carotid webs to prevent recurrent thromboembolism. <b>Case Report:</b> A healthy 30-year-old female presented with slurred speech and unilateral left upper and lower extremity numbness. Imaging modalities showed an acute infarction of the right middle cerebral artery and bilateral carotid webs. The patient was managed operatively with a right carotid endarterectomy and discharged on day 3 of admission on a regimen of ticagrelor, amlodipine, and aspirin. The patient was asymptomatic at 1-year follow-up. <b>Conclusion:</b> Our case highlights the clinical relevance of considering carotid web as a potential etiology for ischemic stroke in young, otherwise healthy patients and emphasizes the importance of timely diagnosis and appropriate management to prevent recurrent cerebrovascular events.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134912004","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":"Successful Percutaneous Ultrasonic Lithotripsy of Gallstones","authors":"Adam Ostergar, Muhammad Hassan Alkazemi, Hayden Hill, Michael M. Awad, Alexander Ushinsky, Michael Darcy, Alana C. Desai, Robert Sherburne Figenshau","doi":"10.31486/toj.23.0071","DOIUrl":"https://doi.org/10.31486/toj.23.0071","url":null,"abstract":"<h3></h3> <b>Background:</b> Acute calculous cholecystitis is the obstruction of the cystic duct by a gallstone that leads to inflammation of the gallbladder necessitating cholecystectomy. <b>Case Series:</b> We present the cases of 2 patients with acute calculous cholecystitis who were deemed ineligible candidates for cholecystectomy because of their complicating medical histories. Both patients initially underwent cholecystostomy and drain placement with interventional radiology for management of acute calculous cholecystitis. Their large gallstones remained refractory to attempts at removal by electrohydraulic lithotripsy via the cholecystostomy access. The patients’ gallstones were successfully removed via percutaneous ultrasonic lithotripsy during a collaborative procedure with interventional radiology and urology. <b>Conclusion:</b> An interdisciplinary approach using percutaneous cholecystolithotomy with rigid ultrasonic lithotripsy is an effective method for removing challenging gallstones in patients for whom traditional approaches fail.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734016","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":"Season of Gratitude.","authors":"Ronald G Amedee","doi":"10.31486/toj.23.5038","DOIUrl":"https://doi.org/10.31486/toj.23.5038","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"23 4","pages":"267"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10741808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032755","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":"Efficacy and Safety of Psychedelics in Treating Anxiety Disorders.","authors":"Leah Feulner, Thanpicha Sermchaiwong, Nathan Rodland, David Galarneau","doi":"10.31486/toj.23.0076","DOIUrl":"https://doi.org/10.31486/toj.23.0076","url":null,"abstract":"<p><p><b>Background:</b> Anxiety disorders are commonly diagnosed and cause substantial functional impairment. A mixture of pharmacologic and psychosocial treatments currently exists, but these treatments are not always tolerable and effective. For patients with anxiety resistant to standard therapy, psychedelics may be a promising alternative. This review assesses the therapeutic benefits and safety of psychedelics in treating anxiety disorders. <b>Methods:</b> We searched PubMed, Embase, PsycInfo, and CINAHL for clinical trials investigating psychedelics in patients with clinician-diagnosed generalized anxiety disorder, social anxiety disorder, specific phobia, separation anxiety disorder, selective mutism, panic disorder, agoraphobia, and anxiety attributable to another medical condition. We analyzed data from 9 independent psychedelic-assisted trials testing ayahuasca (1 study), ketamine (4 studies), lysergic acid diethylamide (LSD) (2 studies), 3,4-methylenedioxymethamphetamine (MDMA) (1 study), and psilocybin (1 study). Efficacy was assessed by measuring the change in outcome measures and the quality of life from baseline. <b>Results:</b> The reviewed studies demonstrated encouraging efficacy in reducing anxiety symptoms, increasing self-perception, and increasing social function in patients with generalized anxiety disorder, social anxiety disorder, or anxiety attributable to another medical condition while establishing feasibility and evidence of safety. For many patients, the therapeutic effects of the psychedelic treatment lasted weeks, and no severe adverse events were reported. <b>Conclusion:</b> Based on the evidence of symptom reduction and safety, the current literature (2011 to 2021) shows that psychedelics could be considered for treating clinician-diagnosed anxiety disorders. Psychedelics may provide an alternative therapeutic option for patients resistant to current standard treatments.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"23 4","pages":"315-328"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10741816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032754","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":"Trends in Cigarette Smoking Among United States Adolescents.","authors":"Maria C Mejia, Adedamola Adele, Robert S Levine, Charles H Hennekens, Panagiota Kitsantas","doi":"10.31486/toj.23.0113","DOIUrl":"https://doi.org/10.31486/toj.23.0113","url":null,"abstract":"<p><p><b>Background:</b> Cigarette smoking remains the leading avoidable cause of premature death in the United States, accounting for approximately 500,000, or 1 in 5, deaths annually. We explored trends in cigarette smoking among US adolescents. <b>Methods:</b> We used data for adolescents in grades 9 through 12 from 1991 to 2021 from the Youth Risk Behavior Survey provided by the US Centers for Disease Control and Prevention. We explored trends overall as well as by sex, race/ethnicity, and school grade. <b>Results:</b> All cigarette use-assessed as ever, occasional, frequent, or daily-among adolescents declined markedly from 1991 to 2021. Specifically, ever use significantly decreased from 70.1% in 1991 to 17.8% in 2021 (<i>P</i><0.05), an almost 4-fold decline. Occasional use significantly decreased from 27.5% in 1991 to 3.8% in 2021 (<i>P</i><0.05), a greater than 7-fold decline. Frequent use significantly decreased from 12.7% to 0.7%, a greater than 18-fold decline. Daily use declined from 9.8% in 1991 to 0.6% in 2021, a greater than 16-fold decline. Cigarette smoking significantly decreased from 1999 to 2021 across sex, race/ethnicity, and school grade (<i>P</i><0.05). In 2021, daily use was higher in boys vs girls; Hispanic/Latino and White youth vs Black and Asian youth; and 12th graders vs 9th, 10th, and 11th graders. <b>Conclusion:</b> These data show large and significant decreases in cigarette use among US adolescents in high school grades 9 through 12 from 1991 to 2021. Nonetheless, the data also suggest residual clinical and public health challenges that will require targeted interventions.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"23 4","pages":"289-295"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10741819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032769","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 Summer of Our Discontent: Facing the Challenge of Increasing Heat-Related Illness.","authors":"Kevin Conrad","doi":"10.31486/toj.23.5039","DOIUrl":"https://doi.org/10.31486/toj.23.5039","url":null,"abstract":"","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"23 4","pages":"268-270"},"PeriodicalIF":1.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10741821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032756","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 Source of a Disease Outbreak Based on Risk Estimation: A Simulation Study Comparing Risk Estimates Obtained From Logistic and Poisson Regression Applied to a Dichotomous Outcome","authors":"Chanapong Rojanaworarit, Jason J Wong","doi":"10.31486/toj.18.0166","DOIUrl":"https://doi.org/10.31486/toj.18.0166","url":null,"abstract":"Background: In epidemiologic investigations of disease outbreaks, multivariable regression techniques with adjustment for confounding can be applied to assess the association between exposure and outcome. Traditionally, logistic regression has been used in analyses of case-control studies to determine the odds ratio (OR) as the effect measure. For rare outcomes (incidence of 5% to 10%), an adjusted OR can be used to approximate the risk ratio (RR). However, concern has been raised about using logistic regression to estimate RR because how closely the calculated OR approximates the RR depends largely on the outcome rate. The literature shows that when the incidence of outcomes exceeds 10%, ORs greatly overestimate RRs. Consequently, in addition to logistic regression, other regression methods to accurately estimate adjusted RRs have been explored. One method of interest is Poisson regression with robust standard errors. This generalized linear model estimates RR directly vs logistic regression that determines OR. The purpose of this study was to empirically compare risk estimates obtained from logistic regression and Poisson regression with robust standard errors in terms of effect size and determination of the most likely source in the analysis of a series of simulated single-source disease outbreak scenarios. Methods: We created a prototype dataset to simulate a foodborne outbreak following a public event with 14 food exposures and a 52.0% overall attack rate. Regression methods, including binary logistic regression and Poisson regression with robust standard errors, were applied to analyze the dataset. To further examine how these two models led to different conclusions of the potential outbreak source, a series of 5 additional scenarios with decreasing attack rates were simulated and analyzed using both regression models. Results: For each of the explanatory variables—sex, age, and food types—in both univariable and multivariable models, the ORs obtained from logistic regression were estimated further from 1.0 than their corresponding RRs estimated by Poisson regression with robust standard errors. In the simulated scenarios, the Poisson regression models demonstrated greater consistency in the identification of one food type as the most likely outbreak source. Conclusion: Poisson regression with robust standard errors proved to be a decisive and consistent method to estimate risk associated with a single source in an outbreak when the cohort data collection design was used.","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"19 1","pages":"220 - 226"},"PeriodicalIF":1.2,"publicationDate":"2019-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47975274","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}