Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines Reviewed.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report is an essential resource for all clinicians who strive to provide optimal care to patients with chronic obstructive lung disease (COPD). The annual report of GOLD makes few revisions and updates besides including data from the preceding year. At an interval, GOLD comes up with a significant modification in its guidelines, which is generally a major overhaul of the pre-existing guidelines.

Sarcoidosis presenting as multiple osseous lesions.

Sarcoidosis is a multisystem inflammatory condition presenting with the formation of noncaseating granulomas. These granulomas can be found in nearly every organ of the body, but in 90% of cases the lungs are involved. Osseous manifestations are seen in only 3% to 13% of cases and are typically seen alongside the more common pulmonary manifestations.

Hepatic infarction in pregnancy: a systematic review.

Objective: Hepatic infarction is a rare complication of pregnancy most often associated with hemolysis, elevated liver enzymes, and low platelets syndrome. The objective of this review is to identify risk factors, present signs and symptoms, identify methods of diagnosis, and identify best management practices on the basis of published case reviews.

Data Sources: PubMed and MEDLINE (Ovid) databases were searched for citations regarding hepatic infarction in pregnancy or the postpartum period from database inception until the study date of December 18, 2023.

Intimate Partner Violence and Depression Screening of Mothers with Infants in the Neonatal Intensive Care Unit.

Objective:  This study aimed to determine the prevalence of partner violence and depression in neonatal intensive care unit (NICU) mothers.

Study Design:  This was a descriptive study. Mothers were screened in a safe room away from their partner with the Edinburgh Postnatal Depression Scale (EPDS) and the Abuse Assessment Screen Tool (AAS) within 2 days of the newborn's admission.

Idiopathic toxic epidermal necrolysis in a pediatric patient.

Stevens-Johnson syndrome and toxic epidermal necrolysis are potentially life-threatening cutaneous diseases that are rarely seen in the pediatric population. We describe a case of a 7-year-old female who presented with fever, cough, mucosal erosions, and a widespread maculopapular eruption with flaccid bullae for 4 days. She had no sick contacts and no new medications, supplements, or vitamins.

An eruption of basal cell carcinoma after ibrutinib.

Ibrutinib is a therapy targeting tyrosine kinase that has been used for various hematologic malignancies. It is associated with a variety of adverse effects, several of which are dermatologic. While there are few discussions of basal cell carcinoma as an adverse event, there have not yet been reports of a significantly increased incidence.

The Pattern of Admission, Clinical Characteristics, and Outcomes Among Patients Admitted to the Intensive Care Unit of a Tertiary Hospital in Tanzania: A 5-Year Retrospective Review.

Introduction: Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality.

Sclerodermatous Graft-Versus-Host Disease: A Rare Sequela of Hematopoietic Stem Cell Transplantation.

Although graft-versus-host disease (GVHD) is a common immunologic reaction after an allogeneic hematopoietic stem cell transplant (HSCT), progression into sclerodermatous GVHD is a rare sequela. It can present locally or generalized with various cutaneous and mucocutaneous manifestations, resulting in loss of skin elasticity and reduced functional capabilities. One of the most debilitating consequences of sclerodermatous GVHD is its effect on a range of motion due to fibrosis of the skin and subcutaneous fat.

Obesity Increases Risk for Wound Complications After Pediatric Foot Surgery: A Retrospective Cohort Review Using the NSQIP-Pediatric Database.

Background: As the incidence of childhood obesity continues to rise, so too does the number of obese children who undergo foot surgery. As the childhood obesity epidemic rolls on, pediatric orthopaedic surgeons will encounter obese patients with even greater frequency. Therefore, a comprehensive understanding of the risks associated with obesity is valuable to maximize patient safety.

Utility of multimodal sampling and testing during advanced bronchoscopy for diagnosing atypical respiratory infections in a -endemic region.

Background: The role of advanced diagnostic bronchoscopy (ADB) for assessing atypical respiratory infections is unclear. The purpose of this study was to ascertain: (I) the diagnostic utility of ADB-tissue sampling in patients with focal thoracic lesions due to atypical respiratory infections; (II) how multimodal bronchoscopic sampling and testing enhance diagnosis in a -endemic region.

Methods: A retrospective observational cohort study analyzing all ADBs performed over a 10-year period in patients with focal thoracic lesions diagnosed with a non-malignant disorder.

Gastrointestinal Bleeding Caused by Large Intestine Amyloidosis.

Background: Amyloidosis is a rare disorder caused by abnormal folding of proteins, leading to the dysfunction of normal tissues. Amyloid deposition can affect several organs, but deposition in the large intestine is rare.

Case Presentation: A 79-year-old man presented with gastrointestinal bleeding and nonspecific symptoms of weight loss, dry heaves, dysphagia, and weakness.

A 24-year-old multiparous woman with apparent subdural epidural catheter: diagnosis and management of an uncommon obstetric anesthesia complication.

We present a multiparous woman who received labor epidural analgesia and later developed signs and symptoms of a subdural block. Spontaneous resolution occurred after supportive care and monitoring. After we replaced the epidural catheter, successful labor analgesia was subsequently achieved and the patient had an uncomplicated vaginal delivery.

Formalizing the curbside: digitally enhancing access to specialty care.

Asynchronous medical care has increased in utilization, patient interest, and industry demand. While E-consults have been discussed extensively in the literature, there are rare examples of a multispecialty implementation within a large health system. Here, we describe our experience in implementing an internal E-consult program for asynchronous, nonurgent communication between ambulatory specialists and primary care providers in our large multispecialty regional health system.

Systemic Venous Congestion Reviewed.

Accurate determination of intravascular volume status is challenging in acutely ill patients. Favorable patient outcome is vital to correctly identify intravascular volume depletion and avoid systemic venous congestion. Most of the conventional means of hemodynamic monitoring in the acute healthcare setting are geared toward addressing the cardiac output and maintaining an optimum mean arterial pressure.

Proximal humerus fracture management and outcomes are distinctly different for individuals 60 years of age or younger: a systematic review.

Background: Proximal humerus fractures (PHFs) occur most commonly in an elderly and osteoporotic population, but a considerable proportion of these injuries occur in relatively younger individuals. Differences in treatment principles and outcomes in this younger population remain poorly understood. The purpose of this review was to characterize the treatment algorithms and outcomes for patients less than or equal to 60 years of age with PHFs.

Many pediatric patients with gastroparesis do not receive dietary education.

Background: Gastroparesis is delayed gastric emptying in the absence of obstruction; dietary modifications are first-line treatment. However, we do not know the factors related to provision of dietary recommendations.

Methods: We sought to determine how often pediatric patients with gastroparesis receive dietary education (from a gastroenterology provider vs dietitian), the recommendations given, and factors related to these outcomes.

Feasibility and Outcomes of Simultaneous Gastric Bypass with Paraesophageal Hernia Repair in Elderly Patients.

Background: Paraesophageal hernias (PEH) have a higher incidence in patients with obesity. Roux-en-Y gastric bypass (RYGB) with concomitant PEH repair is established as a valid surgical option for PEH management in patients with obesity. The safety and feasibility of this approach in the elderly population are not well elucidated.

Vaccination with HepB-CpG vaccine in individuals undergoing immune suppressive drug therapy.

Background: Immunosuppressed patients are a targeted group for HBV vaccination but suboptimal antibody responses occur when traditional recombinant vaccines are used.

Methods: We tested an FDA approved immune adjuvanted HBV vaccine (HEPLISAV--B® or HepB-CpG) in medically immune suppressed individuals. HepB-CpG was given to 10 patients taking biologic agents or anti-rejection therapy.

Low rate of secondary surgery and implant removal following superior, precontoured plating of midshaft clavicle fractures.

Background: Surgical fixation of midshaft clavicle fractures with a single 3.5 mm superior clavicular plate has been associated with a high rate of hardware removal due to symptomatic hardware. Because of this, dual-plating techniques with lower-profile implants have been proposed.