As Vertebral Body Tethering Impacts Missouri, New Technology Grows in the Right Direction.

All eleven-year-old girls want to do is play and be active like every other child her age. Yet, the ability to have a normal childhood for one of our patients became a concern when she and her parents noticed an abnormal lateral curvature in her spine, which was later diagnosed as adolescent idiopathic scoliosis. In February 2014, she presented with a 45° thoracic deformity with a high risk of progression.

Falls in Senior Adults: Demographics, Cost, Risk Stratification, and Evaluation.

Falls occur at staggering rates across the country, with 25% of Americans over 65 reporting annual falls. The fall rate in Missourian older adults is 27.3%.

Team Integrated Enhanced Recovery (TIGER) Protocol after Adolescent Idiopathic Scoliosis Correction Lowers Direct Cost and Length of Stay While Increasing Daily Contribution Margins.

Introduction: Posterior spinal fusion (PSF) is the gold standard procedure for curve correction in Adolescent Idiopathic Scoliosis (AIS). Enhanced recovery protocols (ERPs) have been found to decrease pain and hospital length of stay (LOS) resulting in decreased total hospital charges.

Methods: We identified all adolescent idiopathic scoliosis patients treated with a posterior spinal fusion at our children's hospital between 2015-2019.

Innovations in Peripheral Nerve Injury: Current Concepts and Emerging Techniques to Improve Recovery.

Despite the surgical advances in treatment of peripheral nerve injuries, consistent recovery of function is limited suggesting that a multimodal approach is required to optimize nerve regeneration. This approach should include advanced surgical repair techniques, as well as tissue engineering, cellular therapies, and application of local and systemic modulators of neuroregeneration. Further research is needed to advance these therapies from the laboratory to clinical practice, and to further understand how these treatments and techniques can act in concert to optimize functional nerve regeneration.

Falls in Senior Adults Part II: Management, Treatment, Prevention, and Therapy Plans.

In this follow up to our Falls in Senior Adults Part I article,1 we address further management of falls after fall risk has been identified. This review will focus on the current literature on the treatment, therapy plans, and prevention of falls in senior adults.

Yolk sac tumor presenting as a colonic mass in a post-menopausal woman: A case report.

•Yolk sac tumors are quite rare in post-menopausal women.•Yolk sac tumors with endometrial primary origin also may present with abnormal uterine bleeding.•Patients with unclear abdominal symptoms, mass on imaging, and positive tumor markers raises suspicion of yolk sac tumor.

Netarsudil as a Predictor of Response for MicroPulse Transscleral Laser Therapy: A Pilot Study.

Purpose: To investigate the role of netarsudil as an outcome predictor of MicroPulse transscleral laser therapy (MPTLT).

Design: Retrospective comparative study.

Subjects: Forty-seven eyes in 33 adult patients with glaucoma with a minimum of 1 month of follow-up after netarsudil treatment and 3 months of follow-up after MPTLT were included.

Difficulty in diagnosis and management of musculoskeletal nontuberculous mycobacterial infections.

We describe two cases of musculoskeletal nontuberculous mycobacterial (NTM) infection resulting in undesirable outcomes. These organisms can be difficult to identify and treat, potentially leading to significant morbidity. NTM should remain on the differential for culture negative bone and joint infections, especially with a prior surgical history or environmentally-acquired injuries.

Successful Treatment of Epstein-Barr Virus-Induced Necrotizing Retinitis with Intravitreous Ganciclovir, Foscarnet, and Methotrexate.

This is a report of an immunocompromised 49-year-old renal transplant patient with Epstein-Barr virus (EBV)-induced necrotizing retinitis (NR). The patient with NR underwent diagnostic vitrectomy. Polymerase chain reaction (PCR) testing of the vitreous fluid was positive for EBV (25,000 IU/mL) and negative for all other organisms.

Practical strategies to enhance resident engagement in clinical quality improvement.

Background: Engaging residents in meaningful quality improvement (QI) is difficult. Challenges include competing demands, didactics which lack connection to meaningful work, suboptimal experiential learning, unclear accountability, absence of timely and relevant data, and lack of faculty coaches and role models. Various strategies to address these challenges for engagement have been described, but not as a unified approach.

Clinical outcomes after IL-6 blockade in patients with COVID-19 and HIV: a case series.

Background: In hospitalized people with HIV (PWH) there is an increased risk of mortality from COVID-19 among hospitalized PWH as compared to HIV-negative individuals. Evidence suggests that tocilizumab-a humanized monoclonal interleukin (IL)-6 receptor inhibitor (IL-6ri) antibody-has a modest mortality benefit when combined with corticosteroids in select hospitalized COVID-19 patients who are severely ill. Data on clinical outcomes after tocilizumab use in PWH with severe COVID-19 are lacking.

Coronavirus Disease 2019 (COVID-19) Disease Severity: Pregnant vs Nonpregnant Women at 82 Facilities.

Background: Pregnancy has been reported to be a risk factor for severe COVID-19. We evaluated the impact of pregnancy on severe COVID-19 and mortality in an electronic medical record (EMR) database that enabled exclusion of labor and delivery (L&D) encounters.

Methods: In this retrospective cohort study, EMRs from 82 healthcare facilities in the Cerner COVID-19 Datamart were analyzed.

Sources of Vaccine Hesitancy: Pregnancy, Infertility, Minority Concerns, and General Skepticism.

The coronavirus disease 2019 (COVID-19) epidemic continues to evolve, with variants of concern and new surges of COVID-19 noted over the past months. The limited data and evolving recommendations regarding COVID-19 vaccination in pregnancy have led to some understandable hesitancy among pregnant individuals. On social media, misinformation and unfounded claims linking COVID-19 vaccines to infertility are widespread, leading to vaccine skepticism among many men and women of reproductive age.

Transient Cortical Blindness in a Toddler With Heterozygous Ornithine Transcarbamylase Deficiency.

Ornithine transcarbamylase (OTC) deficiency is an incredibly rare disease in the subgroup of urea cycle disorders. Although typically seen in the neonate shortly after initiating high protein feeds (human breastmilk or infant formula), patients with partial/heterozygous deficiencies can often be diagnosed later in life with unique sequelae. One such manifestation is sudden, transient vision loss shortly after an initial episode of hyperammonemia in a patient without a known diagnosis of OTC deficiency.

Pathogenesis of COVID-19 described through the lens of an undersulfated and degraded epithelial and endothelial glycocalyx.

The glycocalyx surrounds every eukaryotic cell and is a complex mesh of proteins and carbohydrates. It consists of proteoglycans with glycosaminoglycan side chains, which are highly sulfated under normal physiological conditions. The degree of sulfation and the position of the sulfate groups mainly determine biological function.

Percutaneous Lymphatic Maceration and Glue Embolization for High-output Chylous Ascites after Robot-assisted Laparoscopic Nephrectomy and Lymphadenectomy.

To propose minimally invasive percutaneous techniques in the management of high output chylous ascites, a known potential complication of retroperitoneal surgery associated with significant morbidity and mortality. Management has traditionally been based on successful treatment reported in the literature. However, refractory or high-output leaks often prove difficult to treat and there is little evidence on superior management.

Ocular Lens Expulsion Secondary to Fusarium Endophthalmitis: A Case Report.

Background: Endophthalmitis is an uncommon yet devastating compilation of Fusarium keratitis. Cases of Fusarium keratitis are seen commonly in tropical regions of the world; however, they have been increasing in frequency in the United States.

Case Report: We present the case of a 36-year-old man who experienced an ocular lens expulsion secondary to Fusarium endophthalmitis.

Diversity begets diversity: Factors contributing to emergency medicine residency gender diversity.

Background: Although the number of women entering medical school and emergency medicine (EM) residencies has increased, female physicians are still proportionally underrepresented in EM. The goal of this study was to determine if there was a relationship between resident gender and program leadership gender.

Methods: A survey of residency leadership and residents was completed, and multivariate factor analysis was performed.

Current Hybrid Interventions in Vascular Surgery: Merging Past and Present.

As the United States population continues to age, the prevalence of vascular disease continues to increase and thus the role of vascular surgeons in disease intervention has become more important than ever. Over the last 30 years, endovascular techniques have become the mainstay for management of vascular disease. However, open operations continue to play a role in management of complex vascular disease.

What Are the Risk Factors for an Upper Extremity Deep Venous Thrombosis After Orthopaedic Irrigation and Debridement and Peripherally Inserted Central Catheter Placement?

Background: Peripherally inserted central catheter (PICC) placement is necessary for delivery of intravenous (IV) antibiotics to treat bone and soft tissue infections. Upper extremity deep venous thrombosis (DVT) after PICC placement is a complication with unknown incidence in the orthopaedic literature. The major objectives of this study are Identifying the rate of upper extremity PICC-associated DVTs after orthopaedic procedures;Which orthopaedic subspecialties are most likely to encounter an upper extremity PICC-associated DVT?What surgeries or medical comorbidities are risk factors for upper extremity PICC-associated DVTs?Does type of DVT chemoprophylaxis decrease the risk of an upper extremity PICC-associated DVT?

Methods: A retrospective review of electronic medical records (EMR) was performed to include all patients undergoing irrigation and debridement (I&D) for treatment of orthopaedic surgery-related infections over a 10-year period.