For Atrial Fibrillation, DOACs Outperform Warfarin in Patients with Reduced Kidney Function.

At standard doses, direct oral anticoagulants (DOACs) were associated with a reduced risk of systemic embolism and intracranial hemorrhage (ICH) when compared with warfarin, with a greater derived benefit at lower creatinine clearance (CrCl-down to 25 mL/min). Lower doses of DOACs were associated with increased overall mortality without a significant decrease in ICH and incident bleeding when compared with standard dose DOACs and warfarin, across all CrCl down to 25 mL/min..

Antimicrobial susceptibility and epidemiological types of Legionella pneumophila human isolates from Italy (1987-2020).

Background: Although antimicrobial resistance has not yet emerged as an overarching problem for Legionella pneumophila (Lp) infection, the description of clinical and environmental strains resistant to fluoroquinolones and macrolides is a cause of concern. This study aimed to investigate the antimicrobial susceptibility of Lp human isolates in Italy.

Methods: A total of 204 Lp clinical isolates were tested for sensitivity to nine antibiotics using the broth microdilution assay (BMD).

Dysuria: Evaluation and Differential Diagnosis in Adults.

Dysuria, a feeling of pain or discomfort during urination, is often caused by urinary tract infection but can also be due to sexually transmitted infection, bladder irritants, skin lesions, and some chronic pain conditions. History is most often useful for finding signs of sexually transmitted infection, complicated infections, lower urinary symptoms in males, and noninfectious causes. Most patients presenting with dysuria should have a urinalysis performed.

Laparoscopic jejunostomy during McKeown minimally invasive esophagectomy: a propensity score analysis.

Background: Nutrition is a key factor limiting the rapid recovery of patients undergoing esophagectomy, but there is as yet no consensus on the optimal route of nutritional support. This study aimed to evaluate the potential benefits of laparoscopic jejunostomy (Lap-J) in comparison to conventional nasoenteral tube (NT) feeding in patients who underwent McKeown minimally invasive esophagectomy (MIE).

Methods: A total of 577 consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown MIE were included in this single-center retrospective study.

Operation Baby Drop: Lessons Learned From Military International Air Transport of Critically Ill Neonate.

Military medical transport is unique due to its frequent long-distance travel with limited supplies and capabilities. Military neonatal transport is perhaps even more niche, and descriptions in the literature are rare. A military neonatal team transported a 1-month-old former 26-week infant from a forward-deployed non-combat setting.

Navigating Medical Device Product Liability in Obstetrics and Gynecology.

Medical devices are an essential component of the practice of obstetrics and gynecology. These devices may, at times, suffer from a defect or failure, which could result in a product liability lawsuit when associated with patient harm. Medical device product liability lawsuits are directed toward the device manufacturer when a patient suffers harm because of a device.

Differential diagnosis in immune checkpoint inhibitors neurotoxicity.

Background: Neurologic symptoms seen in patients receiving immune checkpoint inhibitors (ICI) may not be entirely caused by immunotoxicity. We aim to highlight these confounding conditions through clinical cases to encourage early recognition and management.

Methods: We describe a series of seven cases from our institution that were treated with ICI and presented with Neurologic symptoms and were diagnosed with superimposed conditions beyond immunotoxicity.

Economic Evaluation of a Novel Lung Cancer Diagnostic in a Population of Patients with a Positive Low-Dose Computed Tomography Result.

Early detection of lung cancer is crucial for improving patient outcomes. Although advances in diagnostic technologies have significantly enhanced the ability to identify lung cancer in earlier stages, there are still limitations. The alarming rate of false positives has resulted in unnecessary utilization of medical resources and increased risk of adverse events from invasive procedures.

Algorithmic Audits in Sports Medicine: An Examination of the SpartaScienceTM Force Plate System.

Introduction: Force plate systems are increasingly utilized in the armed forces that claim to identify individuals at risk of musculoskeletal injury. However, factors influencing injury risk scores from a force plate system (SpartaScienceTM), and the effects of experimental perturbations on these scores, remain unclear.

Methods: Healthy males (n = 823; 22.

Pediatric Bone Sarcoma Biopsy Tract Excision: Is it Safe to Resect Separately?

Background: Biopsy is an essential part of proper diagnostic workup in pediatric bone sarcomas impacting surgical planning, chemotherapeutic treatments, and prognostic determination. Two main biopsy techniques are currently used: closed biopsy (core needle or fine needle aspiration) and open biopsy. Historical oncologic teaching is for resection of the biopsy tract with the tumor specimen due to the theoretical risk for biopsy tract tumor contamination; however, this can restrict surgical planning and increase morbidity.

Emergency medicine updates: Sympathetic crashing acute pulmonary edema.

Introduction: Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition.

Objective: This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician.

Global research trends and emerging hotspots in nano-drug delivery systems for lung cancer: a comprehensive bibliometric analysis (1998-2024).

Purpose: Nano-drug delivery systems (NDDS) have become a promising alternative and adjunctive strategy for lung cancer (LC) treatment. However, comprehensive bibliometric analyses examining global research efforts on NDDS in LC are scarce. This study aims to fill this gap by identifying key research trends, emerging hotspots, and collaboration networks within the field of NDDS and LC.

Best Practice Recommendations for Endometrial Intraepithelial Neoplasia/Atypical Endometrial Hyperplasia in the Military Health System.

Endometrial cancer is the most prevalent gynecologic cancer in the United States and has rising incidence and mortality. Endometrial intraepithelial neoplasia or atypical endometrial hyperplasia (EIN-AEH), a precancerous neoplasm, is surgically managed with hysterectomy in patients who have completed childbearing because of risk of progression to cancer. Concurrent endometrial carcinoma (EC) is also present on hysterectomy specimens in up to 50% of cases.

Surgical Management of a Traumatic Mainstem Bronchus Avulsion.

Traumatic tracheobronchial tree injuries are rarely survivable. We present the case of a 31-year-old male patient who had a delayed discovery of a complete right mainstem bronchus avulsion following a motor vehicle collision. Despite initial respiratory stability, the patient rapidly deteriorated on hospital day 4.

Analysis of Disparities in Diagnosis of Autism Spectrum Disorder in the Military Health System Pediatrics Population.

There have been disparities reported in prevalence of autism by gender, race, and socioeconomic status with older ages of diagnosis in non-White and in female children. Possible disparities in the ages of autism diagnosis are not well-established within the Military Health System (MHS) pediatric population, where we hypothesized less disparities given universal Tricare coverage for active-duty military families and theoretically equal access to the military treatment facility (MTF). We conducted retrospective cross-sectional analysis using deidentified database repository records from the MHS.

Small Bowel Obstruction Secondary to Partial Malrotation of the Gut: A Case Report.

This case report presents a unique clinical presentation of small bowel obstruction secondary to congenital partial malrotation of the gut in adults. Partial malrotation may have variable clinical presentations and this case highlights a constellation of patient history, radiographic signs, and operative findings leading to appropriate diagnosis and successful surgical management. A 56-year-old female patient presented with severe abdominal pain, nausea, and anorexia.

Assessing Physician Assistant Students' Ability to Accurately Identify the Regional Landmarks of the Fascia Iliaca Compartment With Point of Care Ultrasound After a Brief Training Session.

Introduction: Regional anesthesia, specifically fascia iliaca compartment blocks (FICB), is highly effective in managing pain, especially in military settings. However, a significant barrier to its implementation is the lack of provider confidence in performing ultrasound-guided procedures. This study evaluates the ability of physician assistant (PA) students, who are often first-line providers in austere locations, to identify the fascia iliaca compartment (FIC) using point-of-care ultrasound (POCUS) after a brief training session and assesses their retention of this skill over a 60- to 90-day period.

Impact of Dobbs v. Jackson Women's Health Organization on Female Sterilization Rates at a Texas Military Medical Center, a Retrospective Cohort Study.

Objective: Female sterilization is a common form of contraception in the United States. On June 24, 2022, the United States Supreme Court eliminated the federal standard protecting a woman's right to abortion via Dobbs v. Jackson Women's Health Organization.

An Analysis of the Association of Whole Blood Transfusion With the Development of Acute Respiratory Distress Syndrome.

Objectives: To determine the association of whole blood and other blood products (components, prothrombin complex concentrate, and fibrinogen concentrate) with the development of acute respiratory distress syndrome (ARDS) among blood recipients.

Design: Retrospective cohort study.

Setting: American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2020 and 2021.

Utilization and Outcomes of Epidural Anesthesia Versus Regional Anesthesia for Thoracic Surgery: An ACS-NSQIP Analysis.

Objectives: To determine the use of epidural anesthesia compared with regional anesthesia as an adjunct to general anesthesia in thoracic surgery over time, and compare length of stay, overall morbidity, serious morbidity, and mortality between epidural and regional anesthesia when utilized as adjuncts to general anesthesia in thoracic surgery.

Design: Retrospective data analysis from the American College of Surgeons National Surgical Quality Improvement Project data registry, years 2014 to 2022.

Setting: Over 800 U.