Overcoming Anatomical Challenges: Epidural Blood Patch and Plica Mediana Dorsalis Case Report.

The efficacy of epidural blood patch (EBP) is highly variable, and often, clinicians are unable to identify the underlying reasons for treatment failure. A 36-year-old parturient underwent a "blind" epidural blood patch (EBP) without image guidance but failed to obtain relief from a postural headache related to the labor epidural. During the second EBP, an intact plica mediana dorsalis (PMD) was visualized in the anterior-posterior fluoroscopic view after injection of contrast, and autologous blood was injected on both sides of the PMD, leading to the complete resolution of headache symptoms.

A Comprehensive Review of the Role of GLP-1 Agonists in Weight Management and Their Effect on Metabolic Parameters Such as Blood Glucose, Cholesterol, and Blood Pressure.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been developed to manage type 2 diabetes mellitus. Although, in the last 10 years, the use of GLP-1 RAs, especially semaglutide and liraglutide, has increased, its clinical implications and how it affects metabolic parameters have yet to be fully consolidated. This narrative review explores the metabolic effects of GLP-1 RAs in weight management, blood glucose, cardiovascular health, lipid profiles, and blood pressure.

Addressing Sleep Disorders in Psychiatry: Comparing the Use of Melatonin, Trazodone, and Doxepin.

Introduction Sleep disorders are prevalent among psychiatric patients, and pharmacological treatments such as melatonin, trazodone, and doxepin are commonly prescribed. This study aimed to assess the efficacy and acceptability of these three medications in improving sleep quality and reducing daytime drowsiness in psychiatric patients. Methodology A total of 175 psychiatric patients with sleep disturbances participated in this cohort study at the Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan.

Early transcriptomic changes at the skin interface during Powassan virus transmission by ticks.

Introduction: Powassan virus (POWV), a vector-borne pathogen transmitted by ticks in North America, is the causative agent of Powassan encephalitis. As obligate hematophagous organisms, ticks transmit pathogens like POWV at the tick bite site, specifically during the initial stages of feeding. Tick feeding and salivary factors modulate the host's immunological responses, facilitating blood feeding and pathogen transmission.

IGF-1 Assessment During Weekly Somatrogon Treatment in Pediatric Patients With GH Deficiency.

Context: In patients with GH deficiency (GHD) receiving GH treatment, IGF-1 concentrations are used by physicians to monitor treatment safety and efficacy and guide dosing decisions. Somatrogon is a long-acting GH approved as a once-weekly treatment for pediatric GHD. Somatrogon administration results in characteristic changes in the IGF-1 profile, with values measured at 96 hours postdose representing mean IGF-1 concentrations that best reflect overall somatrogon exposure.

Chronobiology in breathlessness across 24 h in people with persistent breathlessness.

https://bit.ly/3WVbCrF.

Recent Updates in the Diagnosis and Management of Kidney Diseases in Multiple Myeloma.

Multiple myeloma (MM) represents a difficult-to-treat plasma cell malignancy and the second most common hematologic malignancy in adults, significantly impacting kidney function. The spectrum of kidney involvement in MM is broad, encompassing electrolyte imbalances, tubular injury, and even rare glomerular diseases. The evolution of MM treatment modalities has led to notable improvements in the long-term survival of patients experiencing kidney-related complications.

Environment scan of generative AI infrastructure for clinical and translational science.

This study reports a comprehensive environmental scan of the generative AI (GenAI) infrastructure in the national network for clinical and translational science across 36 institutions supported by the CTSA Program led by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) at the United States. Key findings indicate a diverse range of institutional strategies, with most organizations in the experimental phase of GenAI deployment. The results underscore the need for a more coordinated approach to GenAI governance, emphasizing collaboration among senior leaders, clinicians, information technology staff, and researchers.

Supporting contraceptive self-care and reproductive empowerment with a digital health game in Barbados: Development and Pre-implementation study for What's My Method?

Effective contraceptive education is essential to reducing unwanted pregnancy, increasing uptake of modern contraceptive methods, and thoughtfully planning desired births. New World Health Organization (WHO) and family planning organization guidelines recommend situating contraceptive education and counseling within a broader context of self-care that emphasizes individual agency and reproductive empowerment. Digital health interventions, and games for health specifically, have been validated as effective and scalable tools for self-guided and interactive health education, especially among younger tech-savvy individuals.

Impact of liver cirrhosis on morbidity and mortality of patients admitted to the hospital with necrotizing fasciitis.

Background: Necrotizing fasciitis (NF) is a potentially fatal bacterial infection of the soft tissues. Liver cirrhosis appears to be a contributing factor to higher morbidity and mortality in patients with NF. This research article explores the relationship between these two conditions.

Key factors associated with oral health services at Federally Qualified Health Centers.

Objective: This study aimed to investigate changes in oral health services from 2012 to 2021 and identify factors influencing the number of different types of services directly provided by all Federally Qualified Health Centers (FQHCs).

Methods: Data from the 2012-2021 Uniform Data System were analyzed using multilevel mixed-effect negative binomial regression models. These models explored associations between oral health staffing, federal grant revenue, and state Medicaid dental policies for adults, and the number of different types of oral health services provided at FQHCs.

Population-Based Analysis of the Risk of Mycobacterial Infections Associated With Immune Checkpoint Inhibitors.

In this population-based study, we examined the risk of nontuberculous mycobacterial disease associated with immune checkpoint inhibitors among people with cancer. Using a nested case-control design, we identified 184 cases and 714 matched controls; there was no significant association on conditional logistic regression (adjusted odds ratio, 0.51 [95% confidence interval, .

Physiology of bridging stent grafts after fenestrated/branched endovascular aortic repair: Where translational science meets the clinical profile.

Fenestrated/branched endovascular aortic repair emerges as the primary therapeutic modality for intricate aortic pathologies encompassing the paravisceral and thoracoabdominal segments, where bridging stent grafts (BSGs) play a vital role in linking the primary aortic endograft with target vessels. Bridging stent grafts can be categorized mainly into self-expanding stent grafts (SESGs) and balloon-expandable stent grafts (BESGs). Physiological factors significantly influence post-complex endovascular aortic repair BSG behaviour, impacting clinical outcomes of SESGs and BESGs in different but overlapping ways.

Race and Ethnicity, Neighborhood Social Deprivation and Medicare Home Health Agency Quality for Persons Living With Serious Illness.

Objective: Examine the relationship between race and ethnicity and area-level social deprivation and Medicare home health care (HHC) agency quality for seriously ill older adults receiving HHC.

Methods: A linear probability fixed effects model analyzed the association between patient-level predictors and HHC agency quality (star-rating), controlling for neighborhood level fixed effects. Linear mixed regression modeled the relationship between area-level social deprivation and receiving care from a high-quality HHC agency.

A descriptive analysis of nurses' self-reported mental health symptoms during the COVID-19 pandemic: An international study.

Aim: To describe the self-reported mental health of nurses from 35 countries who worked during the COVID-19 pandemic.

Background: There is little occupationally specific data about nurses' mental health worldwide. Studies have documented the impact on nurses' mental health of the COVID-19 pandemic, but few have baseline referents.

Continuous risk monitoring and management of heart failure: Rationale and design of the ALLEVIATE-HF trial.

Aims: Early identification and management of worsening heart failure (HF) is necessary to prevent disease progression and hospitalizations. The ALLEVIATE-HF (Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure) trial is a prospective, randomized, controlled, double-blind, multicentre trial that aims to assess the safety and efficacy of using the Reveal LINQ™ insertable cardiac monitor (ICM) in patients with HF to continuously monitor and evaluate HF risk status and guide timely interventions.

Methods: The ICM algorithm uses parameters derived from electrocardiogram (atrial fibrillation [AF], ventricular rate during AF, heart rate variability, and night heart rate), three-axis accelerometer (patient activity duration), and subcutaneous bioimpedance (fluid volume, respiration rate).

Health-related quality of life across heart failure categories: associations with clinical characteristics and outcomes.

Aims: The study aims to examine characteristics and outcomes associated with health-related quality of life (HRQoL) in patients with heart failure (HF) with preserved, mildly reduced and reduced ejection fraction (EF) (HFpEF, HFmrEF and HFrEF).

Methods And Results: Data on HRQoL were collected in the Swedish Heart Failure Registry (SwedeHF; 2000-2021) using the EuroQoL 5-dimensional visual analogue scale (EQ 5D-vas). Baseline EQ 5D-vas scores were categorized as 'best' (76-100), 'good' (51-75), 'bad' (26-50) and 'worst' (0-25).

Are More Adults Bleeding After Tonsillectomy Than in the Past?

Objective: Post-tonsillectomy hemorrhage (PTH) rates have increased in children over the last decade. This study aimed to determine whether PTH incidence in adults had also increased over the last 15 years.

Study Design: Retrospective study.

Exploring the clinical profiles and management of juvenile dermatomyositis in Africa: a survey of African rheumatology care providers.

Background: There are limited studies of juvenile dermatomyositis (JDM) in low and middle-income countries (LMIC). Many demonstrate delays to care, high prevalence of severe manifestations, and high mortality. Given the disease-associated damage with JDM, understanding JDM in Africa further is critical.

Relationship between meteorological factors and the incidence of severe fever with thrombocytopenia syndrome: a systematic review and meta-analysis.

Objective: Although meteorological factors are connected with severe fever with thrombocytopenia syndrome (SFTS) incidence, available findings have been inconsistent. This study was performed to systematically evaluate the correlation between meteorological factors and SFTS incidence.

Methods: We performed a thorough literature search in PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases from databases initiatives to November 30, 2024.

Number of children and dementia risk: a causal mediation analysis using data from the HUNT study linked with national registries in Norway.

Background: Childlessness, as well as having a high number of children, has been reported to be associated with an elevated risk of dementia compared to having 2-3 children. The mechanisms underlying these relationships are not well understood and may be mediated by different midlife risk factors. We examined the mediating role of various factors on the relationship between the number of children and dementia risk.

Penalized landmark supermodels (penLM) for dynamic prediction for time-to-event outcomes in high-dimensional data.

Background: To effectively monitor long-term outcomes among cancer patients, it is critical to accurately assess patients' dynamic prognosis, which often involves utilizing multiple data sources (e.g., tumor registries, treatment histories, and patient-reported outcomes).

Promoting Health Equity, Diversity, and Inclusion in Medical and Scientific Writing and Publishing of Research: A Statement from the Inaugural Diversity, Equity, and Inclusion (DEI) Advocacy Team of the Journal of General Internal Medicine.

The Journal of General Internal Medicine (JGIM) has a long-standing history of publishing manuscripts focused on health equity and is committed to diversity, equity, and inclusion (DEI) in scientific writing and publishing. This is extremely important in the current climate where false narratives and attacks on DEI and health equity are rampant. To demonstrate their commitment to DEI and health equity, the JGIM Editors-in-Chief created an inaugural DEI Advocacy Team.

Respiratory and Cardiovascular Medical Emergency Calls Related to Indoor Heat Exposure through a Case-Control Study in New York City.

Understanding when and where heat adversely influences health outcomes is critical for targeting interventions and adaptations. However, few studies have analyzed the role of indoor heat exposures on acute health outcomes. To address this research gap, the study partnered with the New York City Fire Department Emergency Medical Services.