Impact of pulmonary artery catheterization in patients with acute myocardial infarction cardiogenic shock.

Acute myocardial infarction (AMI) remains one of the most common causes for cardiogenic shock (CS), with high inpatient mortality (40-50 %). Studies have reported the use of pulmonary artery catheters (PACs) in decompensated heart failure, but contemporary data on their use to guide management of AMI-CS and in different SCAI stages of CS are lacking. We investigated the association of PACs and clinical outcomes in AMI-CS.

Rectovaginal Fistula Repair Following Vaginoplasty in Transgender Females: A Systematic Review of Surgical Techniques.

Rectovaginal fistula (RVF) remains a complex complication following gender-affirming vaginoplasty. This review aims to evaluate RVF repair techniques and outcomes following vaginoplasty. A systematic review was performed per PRISMA guidelines.

The Posterior Ligamentous Complex: Anatomic and Biomechanical Considerations in Injury Classification and Management.

The posterior ligamentous complex (PLC) provides critical structural support in the thoracolumbar spine. Its role in resisting progressive flexion is particularly important at the thoracolumbar junction due to the transition from the rigid thoracic spine to the more mobile lumbar region. Each component of the PLC contains anatomic features that contribute to both the structure and function of the PLC as a whole.

Effects of Isoproterenol Administration in Dobutamine Stress Echocardiography.

Objective: This study evaluated the safety and efficacy of isoproterenol administration as an adjunct for achievement of target heart rate (HR) during dobutamine stress echocardiography (DSE).

Background: In DSE, optimal accuracy is achieved when a target HR of 85% of maximal predicted heart rate (MPHR) is attained. Although rarely studied, intravenous isoproterenol has been used as an adjunct therapy to dobutamine and atropine to increase chronotropic response during pharmacologic stress testing.

Engaging older adults in diagnostic safety: implementing a diagnostic communication note sheet in a primary care setting.

Introduction: Adults over the age of 65 are at a higher risk for diagnostic errors due to a myriad of reasons. In primary care settings, a large contributor of diagnostic errors are breakdowns in information gathering and synthesis throughout the patient-provider encounter. Diagnostic communication interventions, such as the Agency for Healthcare Research and Quality's "Be the Expert on You" note sheet, may require adaptations to address older adults' unique needs.

Assessing online chat-based artificial intelligence models for weight loss recommendation appropriateness and bias in the presence of guideline incongruence.

Background And Aim: Managing obesity requires a comprehensive approach that involves therapeutic lifestyle changes, medications, or metabolic surgery. Many patients seek health information from online sources and artificial intelligence models like ChatGPT, Google Gemini, and Microsoft Copilot before consulting health professionals. This study aims to evaluate the appropriateness of the responses of Google Gemini and Microsoft Copilot to questions on pharmacologic and surgical management of obesity and assess for bias in their responses to either the ADA or AACE guidelines.

Transient Ischemic Attack in Women: Real-World Hospitalization Incidence, Outcomes, and Risk of Hemorrhage and Stroke.

Background: Sex-specific differences in stroke risk factors, clinical presentation, and outcomes are well documented. However, little is known about real-world differences in transient ischemic attack (TIA) hospitalizations and outcomes between men and women.

Methods: This was a retrospective cohort study of the 2016 to 2021 Nationwide Readmissions Database in the United States.

Prophylactic Irradiation for the Prevention of Heterotopic Ossification After Foot Amputation: A Case Series.

Background: The formation of heterotopic ossification (HO) is a common complication after transosseous partial foot amputation. Development of HO in weightbearing and/or superficial areas can lead to increased pressures, which increases the likelihood of wound formation and pain. Current treatment modalities for HO of the foot include mechanical off-loading and surgical resection; however, prophylactic measures such as nonsteroidal anti-inflammatory drugs, bisphosphonates, and other medical therapies have been attempted previously with mixed efficacy.

Rapid Neurological Decline due to Creutzfeldt-Jakob Disease.

Creutzfeldt-Jakob Disease (CJD) is an exceedingly rare condition with an incidence of one case per million people worldwide. It is diagnosed with symptoms of rapid neurological decline, positive CSF biomarkers, and diagnostic findings on MRI and EEG. There is no known effective therapy for CJD and prompt diagnosis is required to prepare for the expected disease prognosis and goals of care discussions.

Comparison of 12- to 24-Hour Versus 72-Hour Intravenous Terlipressin in Patients With Acute Esophageal Variceal Bleeding: A Systematic Review and Meta-analysis.

To compare the efficacy and safety of 12-24 hours versus 72 hours of intravenous terlipressin therapy in patients with acute esophageal variceal bleeding (AVB). A systematic search was conducted using PubMed, Scopus, Cochrane Library, Google Scholar, Web of Science, VHL, and ClinicalTrials.gov for studies published up to February 24, 2024.

Limited health literacy in shoulder and elbow patients.

Background: The aim of this study was to evaluate health literacy in orthopedic shoulder and elbow patients.

Methods: This retrospective cross-sectional study included all new English-speaking adult patients presenting to two fellowship-trained shoulder and elbow surgeons from October 2020-July 2021. Patients who did not complete the Brief Health Literacy Screen Tool (BRIEF) were excluded, leaving 594 patients.

Consumer-grade wearable devices in arrhythmia diagnostics for clinicians: where we are and where we are going.

Atrial arrhythmias, including atrial fibrillation (AF), are a major contributor to cardiovascular morbidity and mortality. Early detection and effective management are critical to mitigating adverse outcomes such as stroke, heart failure, and overall mortality. Wearable devices have emerged as promising tools for monitoring, detecting, and managing atrial arrhythmias near-continuously.

Rotating Hinge Revision Total Knee Arthroplasty With and Without Porous Cone Adjunct Fixation.

Introduction: As the number of revision total knee arthroplasties (rTKA) continues to rise, there is increasing interest in the use of contemporary rotating hinge prostheses. These devices often incorporate porous cones to fill bone defects and enhance long-term fixation. This study evaluated the clinical and functional outcomes and survivorship in rTKA patients utilizing a rotating hinge prosthesis with flexible titanium (FT) cones, porous tantalum (PT) cones, or no cones.

Understanding the Prevalence of Medial Arterial Calcification Among Complex Reconstructive Patients: Insights from a Decade of Experience at a Tertiary Limb Salvage Center.

: Medial arterial calcification (MAC), a distinct form of vascular pathology frequently coexisting with peripheral arterial disease (PAD), poses unique challenges in limb salvage among patients with diabetes, chronic kidney disease, and end-stage renal disease. This study examines the incidence of MAC and its impact on limb salvage outcomes over a decade of experience at a tertiary limb salvage center. : A retrospective review of all complex lower extremity (LE) reconstructions using local flap (LF) or free tissue transfer (FTT), performed from July 2011 to September 2022, was conducted.

Transesophageal echocardiography monitoring for liver transplantation: where are we now?

Intraoperative hemodynamic monitoring is crucial for managing patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT) due to their complex cardiovascular and pulmonary abnormalities. Traditionally, pulmonary artery catheterization (PAC) has been the standard for hemodynamic monitoring during OLT. However, the use of transesophageal echocardiography (TEE) has increased due to its real-time visualization of cardiac and vascular structures, which aids in managing hemodynamic instability during the three surgical phases of OLT: pre-anhepatic, anhepatic, and neo-hepatic.

Outcomes of Cochlear Implantation in Adolescents With Auditory Neuropathy Spectrum Disorder: Scoping Review and Case Report.

Objective: To assess outcomes of CI in adolescent patients with ANSD, a population which has not yet been comprehensively reviewed through a scoping review.

Methods: A scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of MEDLINE, EMBASE, Cochrane DSR, Cochrane CENTRAL, CINAHL, and Web of Science was performed.

Decay in Physiologic Knowledge since Medical School among Critical Care Fellows (DIP Study).

Rapid accumulation of knowledge and skills by trainees in the intensive care unit assumes prior mastery of clinically relevant core physiology concepts. However, for many fellows, their foundational physiology knowledge was acquired years earlier during their preclinical medical curricula and variably reinforced during the remainder of their undergraduate and graduate medical training. We sought to assess the retention of clinically relevant pulmonary physiology knowledge among pulmonary and critical care medicine (PCCM) and critical care medicine (CCM) fellows.

Neuropsychiatric Manifestations of Syphilis.

Neurosyphilis is a condition characterized by insidious onset of encephalopathy and delirium. The infrequency with which it is encountered makes neurosyphilis a formidable diagnostic challenge. We present a rare case of a 71-year-old male with ischemic cardiomyopathy, chronic obstructive pulmonary disease (COPD), undifferentiated arthritis and alcohol use disorder who was brought to the emergency department after he was found altered, confused, and paranoid.

Beneath the Surface: Diagnosing Gastric Linitis Plastica.

Gastric Linitis plastica is characterized by extensive infiltration of gastric wall by poorly differentiated tumor cells, creating a "leather-bottle stomach" appearance. We describe a case involving a 71-year-old male presenting with globus sensation, early satiety and weight loss. Recent EGD had revealed chronic gastritis with polypoid mucosa at the GE junction, and subsequent FDG-PET indicated asymmetric FDG localization.

Palovarotene in fibrodysplasia ossificans progressiva: review and perspective.

Introduction: Palovarotene is a retinoic acid receptor gamma agonist that was studied in phase-2 and phase-3 clinical trials for the inhibition of new heterotopic ossification (HO) in fibrodysplasia ossificans progressiva (FOP). Despite numerous setbacks and regulatory delays, palovarotene is now the first approved FOP treatment in the U.S.

Eye metrics are a marker of visual conscious awareness and neural processing in cerebral blindness.

Damage to the primary visual pathway can cause vision loss. Some cerebrally blind people retain degraded vision or sensations and can perform visually guided behaviors. These cases motivate investigation and debate on blind field conscious awareness and linked residual neural processing.