Optimizing routine screening for cardiac sarcoidosis through use of commonly available studies.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder with unclear etiology. Morbidity and mortality vary based on organ involvement, with cardiac sarcoidosis (CS) associated with higher mortality; despite this, CS remains underdiagnosed. The Heart Rhythm Society (HRS) expert consensus statement recommends screening sarcoidosis patients for CS utilizing a symptom screen, EKG, and echocardiogram (TTE), while the American Thoracic Society (ATS) guideline recommends only EKG and symptom screening. These recommendations, however, are based on limited data with recommendations for further studies. RESEARCH QUESTION: The purpose is to evaluate the prevalence of abnormal screening tests in patients with sarcoidosis and the correlation of these tests with the subsequent diagnosis of CS. A specific emphasis was placed on evaluating the sensitivity of the recommendations versus the sensitivity of a modified criteria. STUDY DESIGN: and Methods: This study retrospectively evaluated a database of prospectively enrolled patients from a tertiary military academic center. All patients who underwent imaging with cardiac MRI and/or FDG-PET were identified. These results were correlated with screening studies (symptom screen, EKG, TTE, and ambulatory rhythm monitoring (ARM)) and used to calculate sensitivity, specificity, and positive and negative predictive values for each test. Using a clinical diagnosis of CS as the reference standard, the sensitivity and specificity of the HRS criteria were calculated and compared to a modified screening rubric developed a priori, consisting of minor changes to the criteria and the addition of ARM. RESULTS: This study evaluated 114 patients with sarcoidosis with 132 advanced imaging events, leading to a diagnosis of CS in 36 patients. Utilizing HRS screening recommendations, the sensitivity for CS was 63.9%, while the modified criteria increased sensitivity to 94.4%. INTERPRETATION: This study suggests that the HRS guidelines lack sensitivity to effectively screen for CS and that a modified screening model which includes ARM may be more effective.

An Editorial Review of Mobile Health: Implications for the US Military Health System.

INTRODUCTION: The United States Military Health System provides healthcare to a diverse patient population throughout the world. There are three distinct challenges that the Military Health System faces. (1) Providers have varying degrees of clinical training expertise and may be called upon to practice outside their usual scope of care. (2) There is geographic isolation of patients and providers with limited resources while stationed overseas. (3) Patients are at higher risk of breaks in continuity of care because of permanent change of duty stations, deployments, and retirement. MATERIALS AND METHODS: In this article we review the history of mobile health in both the civilian and military sectors, and how mobile health may be used to address the challenges unique to the United States Military Health System. RESULTS: There are many good initiatives in military mobile health, however they are decentralized and different across the services and military treatment facilities. We describe some military specific success stories with improving patient access to care and disease specific mobile health applications implemented. CONCLUSIONS: Mobile health is a powerful platform which can help deliver standardized care in missions around the world and improve access to care for patients at military treatment facilities in the United States. The United States Military Health System would benefit greatly from creating universal mobile health applications to assist providers in patient access to care, military mission readiness, and disease specific modules. Future resources should be dedicated to the development of a mobile health application pool that is universally implemented across services to improve quality of care delivered at home and in theater by military providers.

Puerperal Complications of a Retroplacental Uterine Leiomyoma.

Leiomyoma can be found concomitant with pregnancy and can cause complications during labor, delivery, and postpartum management. In the present case, a 26-year-old nulliparous patient at 39.4 weeks gestational age with a 12×9-cm retroplacental leiomyoma underwent a spontaneous vaginal delivery. Nine weeks after delivery, the patient presented with acute pain and vaginal bleeding. Immediate manual removal of the bulk of the leiomyoma tissue via vaginal approach was performed. Four weeks later, the patient returned for removal of the remaining tissue via hysteroscopic excision. This case demonstrates that a large retroplacental leiomyoma can be associated with both immediate and delayed postpartum complications, and it can be managed in a minimally invasive way.