Lightning Can Strike Twice: Management of an Infant With Anomalous Left Coronary Artery from the Pulmonary Artery Complicated by Coccidioidomycosis Infection.

Cardiac disease in young children can be unrecognized until symptoms are unmasked by a precipitating event, such as an infection. We present a case of anomalous left coronary artery from the pulmonary artery causing clinically significant disease in a four-month-old male with concomitant mitral regurgitation and pulmonary coccidioidomycosis who required modification of his surgical management due to the infection. This case highlights how timely diagnosis and perioperative management and recovery can be affected by concurrent infections in patients with congenital heart disease.

Assessing asymmetric enhancement on breast MRI: Besting the diagnostic challenge with imaging and clinical clues.

Breast magnetic resonance imaging (MRI) has the highest sensitivity for breast cancer detection compared to other breast imaging modalities such as mammography and ultrasound. As a functional modality, it captures the increased angiogenic activity of breast cancer through gadolinium-based contrast enhancement. Normal breast tissue also enhances, albeit in distinct patterns termed background parenchymal enhancement (BPE).

Diagnostic Laboratory Stewardship in a Growing Integrated Delivery Network.

Background: Many organizations institute laboratory diagnostic stewardship (DS) programs to improve the utilization of laboratory resources.

Methods: In this paper, we describe the road to implementing laboratory DS in a large, not-for-profit integrated delivery network located in the western United States.

Results: Program structure, projects, challenges, and future opportunities are discussed, providing tactics and opportunities that facilities can employ to maximize their initial foray into the DS landscape.

Evaluating multiplicity reporting in analgesic clinical trials: An analytical review.

Background And Objectives: Analgesia trials often demands multiple comparisons to assess various treatment arms, outcomes, or repeated assessments. These multiple comparisons risk inflating the false positive rate. Multiplicity correction in recent analgesic randomized controlled trials (RCTs) remains unclear despite statistical method advancements and regulatory guidelines.

Infant and parent heart rates during a babywearing procedure: Evidence for autonomic coregulation.

Babywearing is the practice of carrying an infant in a baby carrier, which may provide an inexpensive, nonpharmacological intervention for the parent-infant dyads to handle mental stressors, such as pain and anxiety, especially among vulnerable infants. This study investigated the influence of babywearing on parent-infant autonomic coregulation based on the changes in the HR of mother-infant and father-infant dyads for infants with neonatal abstinence syndrome (NAS). Guided by the Calming Cycle Theory as the framework, the correlation between parent HR and infant HR and the difference in the mother-infant dyad (n = 17) compared to the father-infant dyad (n = 8) were examined.

Subacute Combined Degeneration of the Spine: A Case Study of Delayed Diagnosis in the Emergency Department.

Subacute combined degeneration of the spine (SCDS) is a well-known disease that classically presents with progressive sensory and motor deficits and characteristic magnetic resonance imaging (MRI) findings, leading to its use as a key diagnostic tool. However, clinical and MRI findings in SCDS may be diverse, and thus, a high index of suspicion should be maintained for this disease, which can cause irreversible neurological damage if left untreated. In this article, we report the case of a 29-year-old female with significant recent life stressors and otherwise unremarkable medical history who presented with progressive weakness of the bilateral lower extremities who previously had unremarkable computed tomography (CT) and MRI completed at an outside hospital for the same symptoms, which had since continued to worsen.

Intergenerational transmission of the structure of the auditory cortex and reading skills.

High-level cognitive skill development relies on genetic and environmental factors, tied to brain structure and function. Inter-individual variability in language and music skills has been repeatedly associated with the structure of the auditory cortex: the shape, size and asymmetry of the transverse temporal gyrus (TTG) or gyri (TTGs). TTG is highly variable in shape and size, some individuals having one single gyrus (also referred to as Heschl's gyrus, HG) while others presenting duplications (with a common stem or fully separated) or higher-order multiplications of TTG.

Heart Failure Mortality in Chronic Kidney Disease: The Fatal Crossover.

Background: Real-world mortality data regarding heart failure in patients with comorbid chronic kidney disease remains limited, especially following the advent of advanced heart failure therapies.

Methods: Using the CDC WONDER database, we included patients ≥ 25 years old who died primarily from heart failure (2011-2020) with comorbid chronic kidney disease. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals.

Survival trends in heart transplant patients supported on ECMO and IABP: A 10-year UNOS database analysis.

The United Network for Organ Sharing (UNOS) heart transplant allocation policy was changed in 2018. This study examines the impact of the change in UNOS heart transplant allocation policy on the use of temporary mechanical circulatory support (MCS) devices and post-transplant survival. The analysis included a total of 26,481 patients listed and transplanted between January 2013 and June 2022.

Association of Metal Cations with the Anti-PF4/Heparin Antibody Response in Heparin-Induced Thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is an antibody-mediated immune response against complexes of heparin and platelet factor 4 (PF4). The electrostatic interaction between heparin and PF4 is critical for the anti-PF4/heparin antibody response seen in HIT. The binding of metal cations to heparin induces conformational changes and charge neutralization of the heparin molecule, and cation-heparin binding can modulate the specificity and affinity for heparin-binding partners.

Preemptive Impella 5.5 insertion to reduce operative risk in high-risk cardiac surgery: A case report.

Introduction And Importance: Society of thoracic surgery (STS) risk score has been used as a tool to gauge operative risk of cardiac surgery patients. High-risk patients, with STS risk score > 8 %, are considered as having prohibitive risk and are not offered surgery. There is no established strategy to minimize postoperative hemodynamic instability using mechanical circulatory support (MCS), despite growing interest in utilizing MCS prior to hemodynamic instability.

MRI in Patients with Cardiovascular Implantable Electronic Devices and Fractured or Abandoned Leads.

Purpose To examine the clinical effect of lead length and lead orientation in patients with cardiac implantable electronic devices (CIEDs) and lead fragments or abandoned leads undergoing 1.5-T MRI. Materials and Methods This Health Insurance Portability and Accountability Act-compliant retrospective study included patients with CIEDs and abandoned leads or lead fragments undergoing 1.

Development and preliminary validation of the personalized cystic fibrosis medication questionnaire (PCF-MQ).

Background: A personalized approach to assessing medication knowledge may identify opportunities for education to support self-management of cystic fibrosis (CF). This project describes the development, scoring, and preliminary validity of the Personalized CF Medication Questionnaire (PCF-MQ), designed to assess knowledge of prescribed CF medication purpose, administration, and dose and frequency.

Methods: Participants completed the PCF-MQ, the Knowledge of Disease Management (KDM-CF), and the Cystic Fibrosis-Medication Beliefs Questionnaire (CF-MBQ).

Hush, little baby: The role of C-tactile afferents in babywearing infants with neonatal opioid withdrawal.

Social touch through infant holding, skin-to-skin contact, and infant carrying (babywearing) decreases infant distress and promotes secure attachment. Unknown is the extent to which these effects are the result of the activation of C-Tactile afferents (CTs), the constellation of nerve fibers associated with affective touch, primarily located in the head and trunk of the body. The purpose of the present study was to compare dynamic touch (CTs activated) to static touch (CTs less activated) during a babywearing procedure among infants experiencing Neonatal Opioid Withdrawal Syndrome (NOWS).