HCA healthcare journal of medicine最新文献

{"title":"Beyond the Norm: Decoding Spontaneous Coronary Artery Dissection as an Unusual Cause of Acute Coronary Syndrome.","authors":"Holden Zimmerman, Himanshi Banker, Inder P Kaur, Jaskaran Munjal, Vasu Gupta, Ayushi Garg, Nikita Garg, Meet Patel, Rohit Jain","doi":"10.36518/2689-0216.2070","DOIUrl":"10.36518/2689-0216.2070","url":null,"abstract":"<p><p>Description Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of myocardial infarction among young women, particularly during pregnancy. As the name suggests, SCAD is caused by the spontaneous formation of the false lumen within the coronary artery wall, thus compromising the blood flow to the myocardium. Unlike atherosclerotic acute coronary syndromes, SCAD is not directly associated with diabetes or hypertension; moreover, underlying connective tissue defects and inflammation are considered more contributory towards its etiology. Although its pathophysiology is not well understood, multiple theories have been proposed. Clinically, SCAD has a similar presentation to acute coronary syndromes, including substernal chest pain, elevated cardiac enzymes, ST-segment elevation myocardial infarction, and T wave changes on the ECG. Due to its elusive etiology, variable clinical presentation, and potential for catastrophic outcomes, it is essential to make a proper diagnosis using tools such as coronary angiography, optical coherence tomographic imaging, intravascular ultrasound, and cardiac magnetic resonance imaging. In this article, we review the current understanding of SCAD, encompassing its epidemiology, pathophysiology, clinical presentation, and diagnostic and management options.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"395-401"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497263","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":"Can the Combination of White Blood Cell Count and C-Reactive Protein Rule Out Pediatric Appendicitis, a Retrospective Analysis?","authors":"Scott Gutovitz, Samantha Stoner, Jarrett Koper, Sarah Kleist","doi":"10.36518/2689-0216.2137","DOIUrl":"10.36518/2689-0216.2137","url":null,"abstract":"<p><strong>Background: </strong>Pediatric appendicitis (PA) is the most frequent cause of pediatric emergency surgery. Standard PA scoring systems incorporate inflammatory biomarkers (white blood cell count [WBC] or C-reactive protein [CRP]); however, the individual biomarker sensitivities have not been reported beyond single-center sites. We aimed to measure the individual and combined sensitivities of WBC and CRP to rule out PA in a large multicenter hospital system.</p><p><strong>Methods: </strong>We did a retrospective study of pediatric emergency department patients (age <18) with abdominal pain, using a deidentified electronic health database from a 175-hospital system in the United States, comparing PA versus non-PA patients. Pediatric appendicitis patients were identified by ICD-10 diagnosis codes and had advanced imaging, whereas non-PA patients had advanced imaging and were discharged home with the ICD-10 code for abdominal pain. Using matched propensity matching, we calculated receiver operator characteristics and Youden's index to find the optimal cutpoints. Sensitivity was calculated at the optimal and traditional cutpoints for each biomarker, also combined in parallel fashion.</p><p><strong>Results: </strong>We identified 7414 subjects (3707 PA matched to 3707 controls). The WBC in PA patients was 14.99 ± 5.00 k/mm³ versus 9.63 ± 3.83 k/mm³ in non-PA patients (<i>P</i> < .001). The CRP in PA patients was 5.13 ± 6.43 mg/dL versus 1.22 ± 2.17 mg/dL in controls (<i>P</i> < .001). The optimal cutpoints (Youden's index) were 11.5 k/mm³ for WBC and 1.11 mg/dL for CRP. The sensitivity of WBC to rule out PA varied between 75.6%-83.9%, depending on the cutpoint (10.0-11.5 K/mm³). Similarly, the sensitivity of CRP to rule out PA varied from 64.9%-66.7%, depending on the cutpoint (1.0-1.11 mg/dL). Combined analysis showed that low WBC and CRP had a sensitivity of 90.0%-93.0%, yielding a negative predictive value of 99.2%-99.4% to rule out PA.</p><p><strong>Conclusion: </strong>The PA patients in our study had significantly higher inflammatory biomarkers than the non-PA patients. Combining WBC less than 10.0 k/mm³ and CRP less than 1.0 mg/dL was 93.0% sensitive to rule out PA. Researchers should consider this combination of biomarkers to rule out PA in future prospective studies.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"403-413"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497266","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":"Use of Topical Hemostatic Agents in a Gynecologic Patient With Coagulopathy.","authors":"Alexis O'Connell, Syeda Zainab Shah","doi":"10.36518/2689-0216.2029","DOIUrl":"10.36518/2689-0216.2029","url":null,"abstract":"<p><strong>Introduction: </strong>The use of topical hemostatic agents has become common during surgical interventions. There is a wide variety of substances available to augment clotting, ranging from physical agents to topical thrombin combinations. Application of these agents in gynecologic surgery in patients with existing coagulopathies has not been studied.</p><p><strong>Case presentation: </strong>A 62-year-old woman with an inferior vena cava filter and a history of multiple deep vein thromboses presented to the clinic with pelvic pain, stress urinary incontinence, and uterovaginal prolapse. She underwent a total vaginal hysterectomy, sacral colpopexy, tension-free vaginal tape sling, and cystourethroscopy. Warfarin was cross titrated to enoxaparin prior to surgery. Patient had a 10-week sized uterus, normal appearing adnexa, and postoperatively bleeding was identified at the vaginal cuff. Preoperative hemoglobin was 9.0, and postoperative hemoglobin was 8.0 with normal coagulation factors. Several hemostatic techniques were used intraoperatively including combined gelatin-thrombin and gelatin-based agents. The procedure was complicated by a cystotomy which was repaired intraoperatively. The patient had postoperative bleeding from the incision site within the first 2 hours of recovery requiring a revision procedure. Exploration laparotomy was performed identifying the source of hemorrhage as a vaginal cuff hematoma. Suture and additional gelatin-thrombin sealant was applied to the pedicles and thrombin-soaked packing was placed in the vagina. Total estimated blood loss was 800 mL. The patient was transfused 2 units of packed red blood cells, 1 unit of platelets, and 1 unit of fresh frozen plasma. The patient made an uneventful recovery, and routine follow-up was conducted with no apparent complications.</p><p><strong>Conclusion: </strong>This case illustrates special considerations for intraoperative topical hemostatic agent use for gynecologic patients taking chemoprophylaxis for history of thrombosis and the value of the material composition for timely activity. Fibrin sealants have more rapid hemostasis than an oxidized regenerated dry matrix of cellulose. Because of the proximity of the reproductive organs to the bladder and urinary system, procedures complicated by cystotomy may result in mild leakage of sanguineous urine. This leakage can reduce the efficacy of combined gelatin-thrombin spray by disrupting its chemical components, compared with other hemostatic agents.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"463-467"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497571","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":"Upper Respiratory Tract Infection Leading to a New Diagnosis of Sweet Syndrome and Monoclonal Gammopathy of Unknown Significance.","authors":"Nidhi Rawat, Meron Gebrehiwot, Jason Raw, Jeyaprakash Ramachandran","doi":"10.36518/2689-0216.2001","DOIUrl":"10.36518/2689-0216.2001","url":null,"abstract":"<p><strong>Background: </strong>We present a rare case of Sweet syndrome with underlying monoclonal gammopathy of unknown significance (MGUS) which initially presented as upper respiratory tract infection.</p><p><strong>Case presentation: </strong>A 52-year-old woman presented with a complaint of sore throat for 6 days, productive cough and fever for 5 days, and red, pruritic, circular, tender rashes on face, arms and trunk for 2 days. There was a past history of similar self-limiting rashes presenting intermittently for 1.5 years. She also reported to be taking tablet ibuprofen, as required for the past 1-2 years, for cervical spondylosis. On integumentary examination, widespread, red, tender, annular plaques (2.5-5 cm in diameter) were noted over the face, back, and arms, with old, healed lesions having hyper-pigmented margins. A blood test revealed leukocytosis (13.6 x 10⁹/L), high neutrophil count (9.6 x 10⁹/L), elevated C-reactive protein of 108.7 mg/dL, abnormal monoclonal protein level (1.9 g/dL), high immunoglobulin G count (19.78 g/L) and high erythrocyte sedimentation rate (64 mm/hr). A histological examination showed skin with hyperkeratosis, parakeratosis and acanthosis of the epidermis, and scattered intra-epidermal neutrophils with occasional eosinophils and florid interstitial infiltrate of neutrophil in dermis. A diagnosis of Sweet syndrome due to possible use of ibuprofen and underlying MGUS was suspected, and the patient was started on a tapering dose of prednisolone. At a 2-week follow-up, the patient reported significant improvement in her health, which confirmed our diagnosis of Sweet syndrome.</p><p><strong>Conclusion: </strong>It is crucial to investigate Sweet syndrome patients for malignant and premalignant conditions due to their common association. In this case, the patient was diagnosed with MGUS, a clinical condition with 1% risk of conversion into lymphoma or myeloma.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"447-454"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497616","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":"Response: Letter to the Editor, Exercise Is a Vital Sign.","authors":"Megan Dannemiller, Anthony Shadiack, Marvin Sineath, Andrew Baird, Marc Poirier, Kevin Thomas, Michael G Flynn","doi":"10.36518/2689-0216.2390","DOIUrl":"10.36518/2689-0216.2390","url":null,"abstract":"<p><p>Description This letter is submitted in response to the letter to the editor regarding the authors' article \"Exercise Is a Vital Sign.\"</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"393-394"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497625","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":"Clinical Characteristics Associated With Hospital Mortality and Length of Stay Among Older Adults Admitted With Delirium: Retrospective Analysis.","authors":"Se Won Lee, Jeff J Kim, Cole Kretchmar, Napatkamon Ayutyanont, Mooyeon Oh-Park","doi":"10.36518/2689-0216.2239","DOIUrl":"10.36518/2689-0216.2239","url":null,"abstract":"<p><strong>Background: </strong>Limited information exists on the characteristics of older adults admitted with delirium at risk of poor hospital outcomes. This study aims to identify risk factors present on admission that are associated with hospital mortality and length of stay (LOS) among older adults admitted with delirium.</p><p><strong>Methods: </strong>This is a retrospective study of 5598 patients 65 years of age or older who were admitted to acute care units at 8 community hospitals with an <i>International Statistical Classification of Diseases, Tenth Revision</i> code of delirium.</p><p><strong>Results: </strong>Multivariate regression analyses revealed that in-hospital mortality increase was associated with increased age, Asian race, various medical comorbidities, abnormal agitation-sedation score, abnormal blood urea nitrogen level, intensive care unit admission, and opioid use. Increased LOS was associated with male sex, Asian race, Black race, Medicaid insurance, chronic lung disease, renal disease, and antipsychotic use.</p><p><strong>Conclusion: </strong>This study identified a subgroup with specific demographic and clinical characteristics associated with an increased risk of hospital mortality and increased LOS among older patients admitted with delirium. This subgroup would likely benefit from targeted interventions that may address potential health care inequalities among older adults with delirium.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"415-423"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497171","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":"Exercise Promotes Health but Is Not a Vital Sign.","authors":"Jacob Draves, Halil Tekiner, Steven H Yale, Eileen S Yale","doi":"10.36518/2689-0216.2005","DOIUrl":"10.36518/2689-0216.2005","url":null,"abstract":"<p><p>Description The term \"vital sign\" has been attached to at least 83 conditions, symptoms, or phenomena in the literature to highlight their role and importance in overall health and well-being. This has created considerable confusion and overlapping terms in the medical literature. The 4 time-honored vital signs include temperature, pulse, blood pressure, and respiration. Two other measurements, blood oxygen saturation, and capnography (end-tidal CO2) are considered the fifth and sixth vital signs, respectively. The authors argue that exercise should be named a vital sign, and several authors have designated it as the fifth vital sign. However, not all symptoms or phenomena, such as exercise, are essential for life. This article traces the origins of the term \"vital sign,\" reports on the various conditions named the fifth through eighth vital signs, and proposes an objective definition that describes the requirements for designating something as a vital sign.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"389-391"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497575","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":"Clinical Images of Cutaneous Horns in Patients Presenting to a Family Medicine Residency Practice.","authors":"Julia Fashner, Tillie Schumann","doi":"10.36518/2689-0216.2017","DOIUrl":"10.36518/2689-0216.2017","url":null,"abstract":"<p><p>Description We detail 2 cases of cutaneous horn, also referred to as cornu cutaneum, which is a hard-compacted linear outgrowth of keratin that projects above the skin. We present these images to increase awareness for all medical specialties who may see a patient with this skin lesion.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"425-427"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497300","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":"Utilizing Femoral Metaphyseal Sleeves in Primary Total Knee Arthroplasty for Post-Traumatic Osteoarthritis: A Case Report.","authors":"Zachary Sukin, Adam Dentinger, Jeremiah Earl","doi":"10.36518/2689-0216.2009","DOIUrl":"10.36518/2689-0216.2009","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty in younger patients presents a heightened risk of postoperative complications and implant failures compared to older populations, particularly in those with posttraumatic arthritis. These challenges necessitate careful consideration and specialized approaches to optimize the outcomes in this patient demographic.</p><p><strong>Case presentation: </strong>A 43-year-old man presented with left knee pain resulting from a traumatic lawn mower injury, causing an intraarticular distal femur, at the age of 6. The injury led to a limb-length discrepancy for which he underwent 2 limb-lengthening procedures in his early 20s. Radiographs demonstrated advanced posttraumatic osteoarthritis, and the patient elected to proceed with surgical intervention. Intraoperatively, significant deficiencies of the medial femur and anterodistal femur were noted, making cement, a bone graft, or a combination of both, less viable options. He underwent a left total knee arthroplasty, with the utilization of a femoral metaphyseal sleeve, due to severe bone loss in the distal femur. Postoperatively, the patient progressed well and returned to his activities of daily living, and, at about 3 months, had a pain-free left knee, without a disturbance of his prior limb-length discrepancy.</p><p><strong>Conclusion: </strong>This is a rare case of a metaphyseal sleeve being used in a younger patient, revealing the potential for this procedure to be used in cases of primary total knee arthroplasty in patients with posttraumatic osteoarthritis.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"455-462"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497641","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":"Capacity Over Cognition: A Case of High-Risk Disease and Homelessness.","authors":"Mikalah E Maury, Avery M Duncan, Rebecca A Taylor, Mary Ann Beil, Maulikkumar A Patel","doi":"10.36518/2689-0216.1952","DOIUrl":"10.36518/2689-0216.1952","url":null,"abstract":"<p><strong>Background: </strong>Medical decision-making in indigent patients with baseline cognitive deficits and lack of supportive resources is a difficult problem that reveals many ethical issues. Performing high-level medical procedures (eg, invasive surgery, chemotherapy, radiation therapy) on these patients without supportive resources brings into question the efficacy and necessity of treatment if it places the patient at higher risk of additional complications and mortality.</p><p><strong>Case presentation: </strong>In this article, we present a case of a 62-year-old indigent man with a long history of encephalopathy secondary to alcohol abuse, presenting with an aggressive head and neck cancer impacting his quality of life.</p><p><strong>Conclusion: </strong>Determining a patient's cognition level, capacity, and ability to give informed consent can be challenging as all these factors can be ever-changing in patients with baseline cognitive deficits. In this report, we examine the complexities involved in deciding not to offer advanced treatment to a patient who has decreased cognitive function and lacks social and financial resources due to his experiencing homelessness.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"441-445"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497174","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}