Disparities in infertility workup costs across the United States.

Objective: To investigate cost disparities of infertility diagnostic tests across the United States.

Design: Cross-sectional study analyzing costs for recommended infertility diagnostic tests, including hormone tests (follicle stimulating hormone, luteinizing hormone, estradiol, and progesterone), semen analysis, transvaginal ultrasound, and hysterosalpingogram. Data were sourced from consumer cost claims repositories for five most populous cities per state, categorized into four regions (Midwest, South, West, and Northeast) as per US Census Bureau classifications.

Complete Heart Block in a Patient Declining Pacemaker Implantation: A Discussion on Patient-Centered Care and Shared Decision-Making.

Permanent pacemaker (PPM) implantation is the standard of care in patients with complete heart block (CHB) and second-degree type II atrioventricular (AV) block irrespective of patient symptoms when the conduction abnormality is irreversible. CHB generally constitutes a medical emergency that can be fatal if not urgently treated. This is in contrast to first-degree AV block and second-degree type I AV block, which require PPM implantation only in very special circumstances.

Intraventricular baclofen for the treatment of pediatric spasticity in cerebral palsy: technique and outcomes.

Objective: Intraventricular baclofen (IVB) administration is used for the treatment of secondary dystonia associated with cerebral palsy (CP), but it has not been reported as a first-line infusion technique for spasticity. In this study, the authors report outcomes of patients with mixed or isolated spasticity treated with IVB administration.

Methods: A retrospective analysis was performed of consecutive patients treated with IVB between 2019 and 2023.

Categorizing Stigma as a Barrier to Support Following Nonfatal Overdose: A Qualitative Study.

Objectives: Stigma is known to be a major barrier to treatment for people who use drugs (PWUD). This study uses the Stigma and Health Discrimination Framework to analyze how different forms of stigma shape experiences in the wake of an overdose incident, and perceptions of the efficacy and utility of postoverdose interventions among a sample of PWUD in Dayton, Ohio-a location with a high overdose rate.

Methods: Interviews were conducted with 23 individuals who self-reported past-month illicit opioid, crack/cocaine, or methamphetamine use who had experienced or witnessed a drug overdose in the past 6 months.

Teaching Preclinical Medical Students Lifestyle Counseling Skills for Patients' Health Behavior Change.

Introduction: Physicians face barriers to counseling patients regarding lifestyle, specifically, low perceived importance of and confidence in counseling, leading to underuse. There is a dearth in the literature evaluating educational interventions for counseling skills among preclinical medical students. Closing this gap is crucial to taking advantage of critical opportunities early in training.

Preserving and expanding the pipelines of surgeons.

Presidential address delivered at the 2024 Annual meeting of the Midwest Surgical Association, Mackinac Island, MI on August 6th 2024.

Anticancer Effects of Arsenic Compounds in Non-Small Cell Lung Cancer.

Non-small cell lung cancer (NSCLC) is the most common and prevalent subtype of lung cancer and continues to be one of the leading causes of cancer-related deaths worldwide. Despite various treatment options, a majority of NSCLC patients continue to experience disease progression and associated side effects, which are largely attributed to drug resistance, indicating the need for alternative strategies to combat this deadly disease. Among various applicable alternative approaches, repurposed drugs such as arsenic compounds have been shown to exert anticarcinogenic properties against NSCLC and possess the ability to overcome drug resistance mechanisms.

A Case of Aquagenic Syringeal Acrokeratoderma in a Male Patient Undergoing Treatment With an Angiotensin-Converting Enzyme Inhibitor.

Aquagenic syringeal acrokeratoderma (ASA) is a rare dermatological condition characterized by the transient appearance of edematous, white, translucent papules on the palms following water exposure. While the condition is most commonly associated with cystic fibrosis (CF) and predominantly affects young women, this report presents a unique case in a 24-year-old man without a history of cystic fibrosis. The patient reported a 10-month history of painful, pruritic eruptions on the hands following exposure to water.

Relevance of the Platelet-activating factor system in chemical warfare agents-induced effects.

The threats to chemical warfare-associated agents (CWA), including nitrogen mustard, are increasing, and no direct antidote is currently available to mitigate the deleterious cutaneous and systemic responses to prevent mortality. Though most of these agents act as alkylating agents, a significant knowledge gap exists in the molecular mechanisms of how these vesicants cause toxic effects. Studies, including ours, have shown that exposure to reactive oxygen species (ROS)-generating stimuli, including alkylating chemotherapeutic agents, and thermal burn injuries with ethanol produce the potent family of lipid mediators, Platelet-activating factor (PAF) agonists that induce local inflammation, and multi-system organ dysfunction (MOD).

A 24% Decline in the Utilization of Epidural Procedure Visits for Chronic Spinal Pain Management in the Medicare Population from 2019 to 2022: Updated Analysis of the Effect of Multiple Factors.

Background: The analysis of epidural procedure utilization has revealed several notable trends over recent years. Utilization increased significantly until 2004, then rose minimally until 2011, followed by gradual declines up to 2019 in the Medicare population. The COVID-19 pandemic led to a marked 19% decline in usage from 2019 to 2020.

Escalating Growth to Rapid Decline of Utilization Patterns of Facet Joint Interventions in Managing Spinal Pain in the Medicare Population: Updated Analysis of the Effect of Multiple Factors from 2000 To 2022.

Background: The use of facet joint interventions for spinal pain management experienced rapid growth between 2000 and 2010, with an annual increase of 14.2%. However, this trend slowed significantly from 2010 to 2019, with a reduced growth rate of just 2.

Development and psychometric testing of an instrument for team-based learning assessment.

Background: In team-based learning (TBL), students actively participate in the learning process and are responsible for their learning through preclass studying and team work with other classmates. Evaluation of the TBL method by students provides information for its better implementation. Due to extensive use of TBL method in medical curriculum at medical universities, we aimed to develop a questionnaire for its evaluation from the viewpoints of students.

Demographic and Treatment Analysis of Periosteal Osteosarcoma.

Background And Aims: Periosteal osteosarcoma (PO) is a rare bone cancer that makes up between 1% and 6% of osteosarcomas. No epidemiological survey of the United States has been conducted to study this disease, and most of the literature is limited to single-center analyses and case reports. We seek to perform the first such assessment.

Immunomodulatory Effects of Modified Colostrum, Whey, and Their Combination With Other Natural Products: Effects on Natural Killer Cells.

Objectives: Natural killer (NK) cells are important immune system effector cells providing innate defenses against intracellular infections, including viral infections, immune surveillance, and cancer immunoediting. The primary purpose of this study was to investigate whether modified ultra-filtrated colostrum (UC) and hydrolyzed whey (W) products or their combinations with other natural products with reported immunomodulatory properties will stimulate NK cell cytotoxic activity by activation of granzyme B and IFN-γ production.

Methods: The ability of study products to stimulate the cytotoxic activity of human-purified CD56 NK cells and the production of granzyme B and IFN-γ by activated NK cells was evaluated in the cytotoxic assay.

A Moving Target: Firearm Deaths, Mental Health, and the Role of Physicians.

Purpose Of Review: This review aims to provide an updated overview of trends in firearm- related deaths, the mental health impact on communities, and clinical and legislative interventions. We examine existing interventions and highlight lesser-known yet impactful strategies, such as incorporating appropriate training in medical education on firearm safety. Additionally, we explore the broader impacts of firearm violence on community mental health and address the disputed topic of whether mental illness is a driving factor behind mass shootings.

Cervical spine injuries in professional judo: a cross-sectional analysis of prevalence, risk factors, and preventive measures.

Introduction: Judo, a martial art created by Jigoro Kano in 1882, is a martial art promoting physical and spiritual development. Despite its "gentle way" philosophy, it poses a significant risk for cervical spine injuries, often resulting from throws and ground techniques.

Methods: This cross-sectional study analyzed cervical injuries among professional judo athletes from January to July 2024.

Optimal Dosing Recommendations of Clonidine in Pediatrics Using Physiologically Based Pharmacokinetic Modeling.

Objective: Clonidine has been widely used in the pediatric population to treat neonatal abstinence syndrome (NAS), attention deficit hyperactivity disorder (ADHD), sedation, and Tourette's syndrome; however, there is no consensus on dosing. This research aims to recommend optimal dosing of clonidine in the pediatric population using physiologically based pharmacokinetic (PBPK) modeling.

Methods: The pediatric PBPK model was developed from an adult model by scaling the clearance processes from adults to pediatrics using ontogeny equations.

Standardization of Narcotic Prescriptions in Minimally Invasive General Surgery Procedures.

Introduction: The opioid crisis is a major public health issue, and postoperative opioids play a unique role. Many institutions have implemented standardized protocols to decrease excess opioids available. The objective of this study was to establish a standardized pain protocol for common surgical procedures and assess postoperative pain control.

Batteries Included: A Case of Multiple Self-Inflicted Foreign Bodies in the Lower Genitourinary Tract.

Self-insertion of foreign objects into the lower urinary tract is an uncommon presentation with diverse underlying motivations, including psychiatric illness, sexual gratification, intoxication, and perceived contraception. A wide variety of objects may be inserted, leading to varied symptom presentations. We report the case of a 51-year-old male with a history of post-traumatic stress disorder, antisocial personality disorder, and prior self-mutilation, who presented to the ED following self-insertion of multiple foreign objects into the lower urinary tract.

Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties.

Background: In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.

Methods: The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018-July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report.

Resident Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Academic Curriculum.

Background The goals of the annual Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) are to provide residents with an assessment of their knowledge and program directors an assessment of their residency programs. Research has shown that a score greater than 200 is correlated with passing the qualifying board examination. We observed a substantial number of our residents were not performing well on the exam, which prompted the implementation of a new academic program aimed at determining the impact of an academic curriculum addition on CREOG-ITE scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program.