HCA healthcare journal of medicine最新文献

{"title":"Implications of COVID-19 On A Rapidly Growing Thymoma Case.","authors":"Neeraja Narayanan, Shoaleh Motamedi, Christian Lalonde, Mikko Tauriainen","doi":"10.36518/2689-0216.1458","DOIUrl":"https://doi.org/10.36518/2689-0216.1458","url":null,"abstract":"<p><strong>Introduction: </strong>Thymomas are a rare form of slow-growing malignancy that originate from thymic epithelial cells presenting as an anterior mediastinal mass. Although most are asymptomatic, they can have a variety of presentations, such as local thoracic symptoms, superior vena cava syndrome, or paraneoplastic syndromes. Local compressive thoracic symptoms include shortness of breath, chest pain, and cough. Superior vena cava syndrome presents with respiratory, vascular, or neurologic symptoms. Paraneoplastic syndromes, such as myasthenia gravis, are due to abnormal T-cell maturation leading to an increased risk of autoimmune conditions.</p><p><strong>Case presentation: </strong>We report a case of a 71-year-old White male with multiple comorbidities presenting to the emergency room after a mechanical fall with an incidental finding of a 3.8 cm x 6.0 cm anterior mediastinal mass. The patient had no local compressive symptoms or paraneoplastic syndromes. Due to the coronavirus disease 2019 (COVID-19) pandemic, the patient did not follow through with the discharge recommendations for surgical consultation. Over a year later, the patient presented to the emergency room for congestive heart failure exacerbation, and chest computed tomography revealed the mass had increased in size to 8.2 cm x 7.7 cm. A multidisciplinary approach was used to determine the patient's course of treatment. Due to the patient's debilitated state and concern for local invasion, radical thymectomy with mediastinal lymph node dissection was planned. Despite medical optimization and coordination with a multidisciplinary team, following surgery, the patient became symptomatically bradycardic with acute hypoxic respiratory failure. The patient ultimately passed away after pulseless electrical activity and the family's decision to discontinue resuscitation.</p><p><strong>Conclusion: </strong>It is imperative to consider the negative impacts of the COVID-19 pandemic. Delay in treatment allowed the thymoma to rapidly grow, thus leading to a decreased chance for cure. An extensive surgery increased perioperative risks that led to unforeseen complications resulting in the untimely death of the patient.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650638","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 Case Report and a Review of Pediatric Hepatoblastoma.","authors":"Anthony D DeRenzi, Audrey Bowen","doi":"10.36518/2689-0216.1095","DOIUrl":"https://doi.org/10.36518/2689-0216.1095","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatoblastoma is a rare pediatric cancer. Approximately 100 cases of hepatoblastoma are reported per year. Due to the limited incidence of this disorder an internationally agreed-upon criteria was developed to classify patients as standard or high-risk. Studies involving chemotherapeutic agents, surgery, and liver transplants have been demonstrated to improve the disease-free survival rate. The combination of chemotherapeutic agents and surgery demonstrated the ability of these regimens to downgrade the initial diagnostic staging of tumors and transform previously unresectable tumors into resectable tumors.</p><p><strong>Case presentation: </strong>The following case of hepatoblastoma presents a 4-year-old male who presented to the emergency department with an upper respiratory infection symptom and was found to have hepatomegaly. The patient was later classified as high-risk, unresectable hepatoblastoma.</p><p><strong>Conclusion: </strong>Hepatoblastoma is a rare liver cancer in children with an annual incidence of 1.5 cases per million. With PRETEXT staging criterion, therapeutic options such as cisplatin/doxorubicin combination, radiotherapy, and lobectomy, have become the standard of care for this condition. Many trials have demonstrated these therapeutic options to successfully improve the survivability rate of patients affected by hepatoblastoma, downgrading tumors from advanced PRETEXT stages and enabling previously unresectable tumors to be considered resectable.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650632","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 Retrospective Cohort Study Assessing the Impact of Statin Therapy on Hospital Length of Stay and Inpatient Mortality in COVID-19 Patients.","authors":"Huy V Ho, Hamish Patel, Mohammed Ahmed, Ahmed Eddib, Olugbenga Oyesanmi, Fagunkumar Modi, Domenick Sorresso, Rahul Mhaskar, David Phrathep","doi":"10.36518/2689-0216.1546","DOIUrl":"https://doi.org/10.36518/2689-0216.1546","url":null,"abstract":"<p><strong>Background: </strong>Coronaviruses, known for their crown-like appearance, cause mild gastrointestinal and respiratory diseases. Some cause outbreaks of respiratory diseases, most recently, SARS-CoV-2, the coronavirus disease 2019 (COVID-19). Individuals with COVID-19 are reported to be in both arterial and venous prothrombotic states. In addition to a lipid-lowering effect, statin also has an anti-inflammatory effect, which addresses one of the underlying causes of thrombosis. An <i>in-silico</i> study revealed that statins could directly interact with the main protease enzyme of SARS-CoV-2 and prevent infectivity. Due to these pleiotropic properties, statins may positively impact the outcome of hospitalized patients with COVID-19 infections.</p><p><strong>Methods: </strong>A total of 26 445 acute COVID-19-infected patients were included in this study. Patients were stratified based on home statin use status: no statins, high-intensity statins (atorvastatin 40-80 mg daily and rosuvastatin 20-40 mg daily), and low-to-moderate intensity statins (all other statins). A multivariate generalized linear model and logistic regression were used to predict the hospital length of stay and inpatient mortality, respectively.</p><p><strong>Results: </strong>The hospital length of stay was compared between low-intensity and high-intensity statin use against no statin therapy. The length of stay was 3.88 days (95% CI, 3.56-4.20; <i>P</i> < .0001) longer among patients with low-dose statin therapy compared to patients without. The length of stay was 4.77 days (95% CI, 4.42-5.13; <i>P</i> <.0001) longer among patients with high-intensity statin therapy than those without. The odds of in-hospital mortality decreased by 24% (OR, 0.76; 95% CI, 0.76-0.97) among those with high-dose statin therapy compared to patients without (<i>P</i> = .02). There was no statistical significance between the low-dose statin group and the no statin group for inpatient mortality.</p><p><strong>Conclusion: </strong>Hospitalized COVID-19 patients on statin therapy, regardless of intensity, are more likely to have a longer length of stay. There may be a mortality benefit in using high-intensity statin in acute COVID-19-infected patients. The results of this study are insufficient to recommend statin therapy for inpatient COVID-19 treatment. However, patients with significant cardiovascular comorbidities, where statins are indicated, should be on these medications, especially amidst the COVID-19 pandemic. Randomized controlled trials are needed to assess the potential in-hospital benefit of statin therapy on COVID-19 patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650633","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":"Atrial Fibrillation: Rate Versus Rhythm Control.","authors":"Carlos E Vargas, Mina Bhatnagar, Haris Ahmed, Michael G Flynn, Thomas Alexander","doi":"10.36518/2689-0216.1564","DOIUrl":"10.36518/2689-0216.1564","url":null,"abstract":"<p><p>Description Atrial fibrillation (AF) remains the most common arrhythmia worldwide and is expected to affect approximately 12 million individuals in the United States alone by 2030. Thromboembolic events remain a feared complication of AF and should be treated and risk-stratified utilizing the CHA₂DS₂-VASc scoring system. Other complications of AF span a wide spectrum from impaired quality of life (QoL) to an increase in all-cause mortality. Rate control strategies consist of controlling the ventricular rate and have been shown to be a safe and effective strategy for asymptomatic AF patients. In patients who are plagued with symptoms leading to impaired QoL or a decrease in exercise capacity, rhythm control with antiarrhythmic drugs or catheter ablation may be suitable options. Mortality benefits when comparing rate versus rhythm control remain equivocal when comparing multiple studies over the past decade.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650634","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":"Primary Care Physician Supply and Population Health Outcomes in Florida, 2010-2019.","authors":"Maxwell E Droznin, Julia Fashner","doi":"10.36518/2689-0216.1528","DOIUrl":"https://doi.org/10.36518/2689-0216.1528","url":null,"abstract":"<p><strong>Background: </strong>Primary care physicians play vital roles in the prevention and management of chronic disease. With increasing rates of chronic disease and a national primary care physician shortage, the role that primary care physician supply has on health outcomes in Florida is not well understood. The objective of this study was to investigate the relationship between primary care physician supply (PCPS) and population health outcomes of obesity, life expectancy, coronary artery disease hospitalization, and death rate as reported by county in the state of Florida for the years 2010, 2013, 2016, and 2019.</p><p><strong>Methods: </strong>This was a retrospective, cross-sectional study. Secondary data was used from the Florida Department of Health. Numerous population health and social determinants of health variables related to PCPS in the literature were selected for analysis. Correlation and linear regression analyses were conducted using STATA14.</p><p><strong>Results: </strong>The association between PCPS and obesity was the strongest association in this analysis and was significant for each year with an average of 9.25 primary care physicians per 100 000 people needed to decrease the obesity rate by 1%. PCPS was positively correlated with life expectancy for years 2013, 2016, and 2019 and negatively correlated with the death rate in 2010 and 2019. In the multiple regression, PCPS was negatively associated with areas having a high rate of uninsured persons, unemployment, decreased education, and age over 65.</p><p><strong>Conclusion: </strong>Increased supply of primary care physicians in Florida is significantly associated with decreased rates of obesity and death and increased life expectancy. Our results also indicate that areas with higher levels of social vulnerability also have inequitable distributions of PCPS. Therefore, PCPS should be increased, particularly in areas with the highest need, as primary care physicians in the state of Florida play an important role in improving the overall health of the populations they serve.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650639","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":"Proton Pump Inhibitor Use and Adverse Effects in South Atlantic Hospitals.","authors":"Nicholas D'Angelo, Ramyar Sigarchy, Anthony Esswein, Sidra Asrar","doi":"10.36518/2689-0216.1450","DOIUrl":"https://doi.org/10.36518/2689-0216.1450","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPI) have transformed the management of acid-related gastrointestinal disorders, becoming one of the top-selling medications in the United States. There is no doubt that PPIs have a significant therapeutic impact on patients with gastroesophageal reflux disease and gastrointestinal bleeding. However, evidence is mounting that PPIs are overprescribed, leading to more patients possibly experiencing adverse effects. There is a great deal of ongoing debate surrounding the significance and impact of these adverse effects.</p><p><strong>Methods: </strong>We conducted a study in 9 HCA hospitals in the southeastern United States to determine the number of patients who started on PPIs during their admission from July 2017 to July 2019 and, of these patients, how many were discharged on PPIs. We also explored whether PPIs were prescribed in conjunction with diagnoses consistent with appropriate use as defined by the National Institute for Health and Clinical Excellence (NICE) guidelines during their admissions. This appropriate use was evaluated based on ICD-10 codes entered during patient stays. Furthermore, we evaluated whether PPI patients had developed some known adverse effects including hypomagnesemia, pneumonia, and <i>Clostridium difficile</i>-associated diarrhea.</p><p><strong>Results: </strong>Our data showed that of the 52 712 patients included in the study, 53.1% (27 993) received PPIs without evidence of an appropriate diagnosis based on ICD-10 codes. Appropriate use ranged between 36.1% and 62.8% for each hospital included.</p><p><strong>Conclusion: </strong>PPIs were being overprescribed at the 9 hospitals included in the study according to the ICD-10 codes documented when compared to NICE guidelines. When compared with a normal, age-matched population, our results found increased rates of pneumonia and hypomagnesemia in patients being prescribed PPIs. This study suggests a need to improve hospital PPI prescribing practices to limit the non-indicated administration of PPIs and the resulting increased incidence of adverse effects.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650640","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":"Coronary Artery Calcium Scoring in Asymptomatic Patients.","authors":"Bilal Hussain, Ahmed Mahmood, Michael G Flynn, Thomas Alexander","doi":"10.36518/2689-0216.1565","DOIUrl":"https://doi.org/10.36518/2689-0216.1565","url":null,"abstract":"<p><p>Coronary artery calcium (CAC) scoring is an important prognostic tool for personalized cardiovascular preventive care and has recently been incorporated into American College of Cardiology/American Heart Association guidelines. CAC provides direct visualization and quantification of CAC burden for risk stratification and primary prevention of cardiovascular events in an asymptomatic population. CAC scoring is recommended for individuals with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and selective populations with borderline ASCVD risk. In this review, we outline the interpretation of CAC scores for predicting the risk of cardiovascular events, and we highlight the guidelines for starting statin and potentially starting aspirin therapy. A CAC score of 0 is the strongest negative predictive factor for cardiovascular disease (CVD), and a 0 score can successfully de-risk a patient. On the contrary, higher CAC scores correlate with worse cardiovascular prognostic outcomes. The CAC scan is a widely available and reproducible means for an early look at the atherosclerotic burden, and it can help strategize early interventions. The CAC interpretation and the decision to start treatment need to be personalized based on individual risk factors. We believe the emerging literature supports our contention that the CAC score can be used more broadly to improve the prophylaxis and treatment of a wider range of apparently healthy patients.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650637","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":"Cârța Monastery.","authors":"Barbara L Gracious","doi":"10.36518/2689-0216.1724","DOIUrl":"10.36518/2689-0216.1724","url":null,"abstract":"<p><p>Description The Cârța Monastery, a former Cistercian monastery, is pictured here from one of its sides, conjuring the romanticism that is beloved in medieval ruins. The photo was taken on a sunny fall afternoon in the Țara Făgărașului region of Romania in southern Transylvania. Cârța Monastery was started around 1202 by a group of Cistercian monks from Egres Abbey in the then-kingdom of Hungary. Cistercian architecture is considered some of the most beautiful of the Middle Ages, and walking the grounds of the Monastery indeed evoked a profound sense of gratitude, awe, and peace in the shadow of its beauty that I can call up to this day. Such experiences contribute to our resilience as individuals, and as communities, and reminds us as global members of society that seeking to consistently better ourselves and our planet is a constant evolution.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10635699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650635","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":"Disabilities and Medicine: From Stairs to Stares.","authors":"Christopher Denham","doi":"10.36518/2689-0216.1410","DOIUrl":"https://doi.org/10.36518/2689-0216.1410","url":null,"abstract":"<p><p>Description The current state of medicine has done little to correct the imbalance of underrepresented groups in the physician workforce. In this editorial, a psychiatric resident physician retells his experience as an individual who is completing his medical training while being affected by a neuromuscular disorder and how it impacts his daily life. The primary goal of this paper is to elucidate the need for greater representation and understanding of the disabled physician workforce.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519626/pdf/26890216_vol4_iss4_321.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164232","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":"And Yet.","authors":"Angelina Hong","doi":"10.36518/2689-0216.1507","DOIUrl":"https://doi.org/10.36518/2689-0216.1507","url":null,"abstract":"<p><p>Description As healthcare workers, invested in the wellbeing of our patients while also hoping to grow as individuals, we sometimes tend to view our jobs as a rigid duality-we are either \"in love\" with our practice and persevere flawlessly through all hardship, or we are \"burnt out,\" coldhearted, and defeated by the heavy workload and expectations of medicine. In reality, we all sit somewhere in the middle of a blurry spectrum, balancing out physical, mental, and emotional pain with the immense honor of saving and cherishing human life, while simultaneously struggling to reconcile our altruistic goals with realistic but necessary human incentives. I want this open-ended work to acknowledge these challenging but critical \"and yet\" moments, and I hope anyone who is reading it can connect to the words personally and find new insight, regardless of where they are in life.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519633/pdf/26890216_vol4_iss4_325.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158102","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}