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1.
Endocr Pract ; 29(6): 465-470, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36906069

RESUMEN

OBJECTIVE: The World Professional Association for Transgender Health Standards of Care Version 7 recommended that before initiating gender-affirming hormone therapy (GAHT), patients should seek a psychosocial evaluation from a mental health professional documenting a diagnosis of persistent gender dysphoria. The Endocrine Society published guidelines in 2017 recommending against an obligatory psychosocial evaluation, which was affirmed in the recently published World Professional Association for Transgender Health Standards of Care Version 8 from 2022. Little is known about how endocrinologists ensure appropriate psychosocial assessment for their patients. This study assessed the protocols and characteristics of U.S.-based adult endocrinology clinics that prescribe GAHT. METHODS: An anonymous electronic survey sent to members of a professional organization and the "Endocrinologists" Facebook group was responded by 91 practicing board-certified adult endocrinologists who prescribe GAHT. RESULTS: Thirty-one states were represented by the respondents. Overall, 83.1% of GAHT-prescribing endocrinologists reported accepting Medicaid. They reported working in university practices (28.4%), community practices (22.7%), private practices (27.3%), and other practice settings (21.6%). Overall, 42.9% of the respondents reported that their practice required documentation of a psychosocial evaluation from a mental health professional before initiating GAHT. CONCLUSION: Endocrinologists who prescribe GAHT are divided about requiring a baseline psychosocial evaluation before prescribing GAHT. Further work is needed to understand the impact of psychosocial assessment on patient care and facilitate the uptake of new guidelines into clinical practice.


Asunto(s)
Disforia de Género , Personas Transgénero , Adulto , Humanos , Estados Unidos , Endocrinólogos , Personas Transgénero/psicología , Identidad de Género , Disforia de Género/tratamiento farmacológico , Hormonas
2.
Endocr Pract ; 29(5): 341-348, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37150580

RESUMEN

OBJECTIVE: This 2023 updated protocol summarizes the American Association of Clinical Endocrinology's (AACE's) new framework for the development of clinical practice guidelines and other guidance documents that includes changes to methodology, processes, and policies. METHODS: AACE has critically reviewed its development processes for guidance documents over the last several years against the National Academy of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines and the Council of Medical Specialty Societies Principles for Development of Specialty Society Clinical Guidelines to determine areas for improvement. RESULTS: The new AACE framework for development of guidance documents incorporates many changes, including a revised conflicts of interest (COI) policy; strengthened commitment to collection of disclosures and management of relevant COI during development; open calls to membership for authors; new requirements for authors; new diversity, equity, and inclusion (DEI) policy; new empanelment process that incorporates consideration of DEI; and adoption of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to increase the quality of evidence assessment and standardize recommendation grades and statements, among other improvements. CONCLUSIONS: AACE has revised its policies and adopted a completely new methodology for guideline development in support of the mission to elevate the practice of clinical endocrinology to improve patient care. With the use of an evidence-based medicine framework and by continually assessing and improving its processes for development of guidance, AACE strives to deliver trustworthy, unbiased, and up-to-date information that ensures clinician and patient confidence in AACE content. Further, AACE hopes that these enhancements foster a more collaborative approach to development and increase engagement with the worldwide medical community to improve global health.


Asunto(s)
Endocrinología , Estados Unidos , Humanos , Sociedades Médicas
3.
Endocr Pract ; 28(3): 310-314, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34965450

RESUMEN

OBJECTIVE: Counseling patients about nutrition significantly improves chronic disease outcomes. Endocrinologists are uniquely positioned to educate patients regarding nutrition. The purpose of this study was to define the current state of nutrition education in endocrinology fellowship programs in the United States and assess the needs for future nutrition training. METHODS: Endocrinology program directors were surveyed via an online questionnaire between February and April 2021. RESULTS: Thirty-eight program directors responded (25% response rate) to the survey. Twenty-two (58%) programs offered nutrition education. Existing nutrition education offerings were 1 to 5 total hours (13, 34%), primarily didactic (20, 53%), and often led by registered dietitian nutritionists (15, 39%). Only 3 (8%) programs rated their current nutrition education as extremely effective; 95% of respondents believed that further nutrition education was needed. According to respondents, the ideal nutrition education for endocrine trainees should be 1 to 5 total hours (19, 50%) over multiple sessions (25, 66%), be interactive (24, 63%), and be led by registered dietitian nutritionists (26, 68%). The most important topics for independent practice included diet-related behavior modification (21, 55%), components of a healthful diet (19, 50%), and energy expenditure/intake (18, 47%). CONCLUSION: Although the majority of the program directors believe that further nutrition education is needed, almost half of the surveyed programs do not offer such training. Programs that offer nutrition education primarily rely on a didactic format. There is an unmet need for interactive, multidisciplinary nutrition education in these programs.


Asunto(s)
Endocrinología , Becas , Consejo , Curriculum , Educación de Postgrado en Medicina , Humanos , Encuestas y Cuestionarios , Estados Unidos
4.
Endocr Pract ; 24(6): 512-516, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29624097

RESUMEN

OBJECTIVE: Thyrotropin (TSH) receptor antibody (TRAb) testing is considered accurate for the diagnosis of Graves disease (GD) and has been identified rarely in thyrotoxic patients without GD. We describe 4 patients with transient thyrotoxicosis and positive TRAb to highlight this clinical possibility. METHODS: Patient demographics, symptoms, laboratory findings, and time to resolution of thyrotoxicosis are summarized. TRAb testing was performed by either a third-generation thyrotropin-binding inhibitory immunoglobulin (TBII) competitive-binding assay or a thyroid-stimulating immunoglobulin (TSI) bioassay from either Mayo Clinic Laboratory or Quest Diagnostics. RESULTS: Four patients with transient thyrotoxicosis and positive TRAb testing were identified. Of these, three were female, and the median age was 44 years (range, 25 to 49 years). Median symptom duration at evaluation was 6.5 weeks (range, 3 to 12 weeks). No patient had any clinical manifestations unique to GD or exposure to biotin, thyroid hormone, supplements, iodine, or relevant medications. The TSH was <0.1 mIU/L in all patients. Three patients had a positive TSI, which was elevated less than twice the upper limit of the reference range in all cases, and 1 patient had a strongly positive TBII. None of the patients were treated with thionamides or radioactive iodine. Spontaneous resolution occurred in all patients at a median of 5.5 weeks (range, 2 to 14.4 weeks). CONCLUSION: These cases demonstrate that TSI or TBII may be present in thyrotoxic patients with transient thyrotoxicosis. For clinically stable patients presenting without pathognomonic evidence of GD, mildly elevated TRAb results may require cautious interpretation, and alterative diagnostic testing or close monitoring should be considered. ABBREVIATIONS: cAMP = cyclic adenosine monophosphate; FT4 = free thyroxine; GD = Graves disease; TBII = thyrotropin-binding inhibitory immunoglobulin (also known as TBI); TRAb = thyrotropin receptor antibody; TSH = thyrotropin; TSHR = thyrotropin receptor; TSI = thyroid-stimulating immunoglobulin; TT3 = total triiodothyronine; TT4 = total thyroxine.


Asunto(s)
Autoanticuerpos/sangre , Enfermedad de Graves/diagnóstico , Receptores de Tirotropina/inmunología , Tirotoxicosis/inmunología , Adulto , Femenino , Humanos , Inmunoglobulinas Estimulantes de la Tiroides/sangre , Masculino , Persona de Mediana Edad
5.
Transfusion ; 57(12): 3026-3034, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28960322

RESUMEN

BACKGROUND: Major bleeding in orthotopic liver transplantation is associated with significant morbidity and mortality. Limited literature exists regarding comparative effectiveness of prothrombin complex concentrate and fibrinogen concentrate during orthotopic liver transplantation on blood product utilization. STUDY DESIGN AND METHODS: This retrospective, single-institution study evaluated the impact of prothrombin complex concentrate and fibrinogen concentrate on blood product utilization during orthotopic liver transplantation from December 2013 to April 2016. This study included patients age 18 years or older and excluded patients who received simultaneous heart or lung transplantation or did not meet documentation criteria. A propensity score matching technique was used to match patients who were exposed to prothrombin complex concentrate with unexposed patients, at a 2 to 1 ratio, to control for selection bias. RESULTS: During this study, 212 patients received orthotopic liver transplantation with 39 prothrombin complex concentrate exposures. The matched study population included 39 patients who were exposed to prothrombin complex concentrate and 78 unexposed patients. Overall, 84.6% of patients who were exposed to prothrombin complex concentrate also received concomitant fibrinogen concentrate, whereas only 2% of patients in the control group received fibrinogen concentrate. After propensity score matching, no other factors that were included in the model differed significantly or had a standardized mean difference of 0.11 or greater. There was no statistical difference in the utilization of red blood cells or fresh frozen plasma for the exposed group versus the unexposed group after matching (mean ± standard deviation: red blood cell units, 12.4 ± 8.0 units vs. 9.7 ± 5.6 units [p = 0.058]; fresh-frozen plasma units, 10.0 ± 6.3 vs. 12.7 ± 9.7 units [p = 0.119], respectively). CONCLUSION: The intraoperative use of prothrombin complex concentrate and fibrinogen concentrate during orthotopic liver transplantation did not reduce intraoperative blood product requirements at a single institution.


Asunto(s)
Factores de Coagulación Sanguínea/administración & dosificación , Transfusión Sanguínea/estadística & datos numéricos , Fibrinógeno/administración & dosificación , Cuidados Intraoperatorios/métodos , Trasplante de Hígado/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos
6.
Med Teach ; 39(2): 147-152, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28024434

RESUMEN

The authors share twelve practical tips on writing a case that engages learners in active learning and discussion. They first advise that, during the initial preparation of the case, authors should (1) identify the case goals and objectives, and (2) identify the level of the learners. When writing the case, authors should (3) use active and colorful language; (4) use patients' own descriptions rather than medical language; (5) allow the learners to interpret data themselves; (6) allow for natural discovery rather than presenting information chronologically; and (7) be realistic about interruptions in patient care. In addition, case authors should pay attention to methods that enhance discussion by (8) creating barriers to diagnostic or treatment options; (9) promoting questions and discussion over answers; (10) using cues to assure discussion flow and knowledge exploration; and (11) omitting details or inserting informational distractors. Finally, well-crafted questions are essential during the case presentation to engage learners in higher-order thinking; and to (12) stimulate curiosity and reflection.


Asunto(s)
Educación Médica/organización & administración , Aprendizaje , Enseñanza/organización & administración , Escritura/normas , Educación Médica/normas , Objetivos , Humanos , Enseñanza/normas
7.
Laryngoscope ; 133(2): 317-326, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-35560997

RESUMEN

OBJECTIVES: Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM. METHODS: The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan-Meir and Cox regression analyses were used to determine variables associated with survival. RESULTS: The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five-year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01-1.06]), N-stage (1.94 [1.10-3.42]), M-stage (10.13 [3.33-30.86]), male sex (1.79 [1.06-3.03]), and African-American race (2.63 [1.14-6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004). CONCLUSIONS: Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:317-326, 2023.


Asunto(s)
Melanoma , Neoplasias de la Boca , Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Disección del Cuello , Ganglios Linfáticos/patología , Neoplasias de la Boca/patología , Pronóstico , Estadificación de Neoplasias , Estudios Retrospectivos
8.
J Contin Educ Health Prof ; 43(1): 68-71, 2023 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-36070405

RESUMEN

INTRODUCTION: Medical educators in residency programs have unique opportunities to teach health inequities, social determinants of health (SDOH), and implicit bias. However, faculty are not adequately trained to effectively teach these topics. The aim is to assess the effectiveness of a faculty-level workshop to teach health inequity. METHODS: An interactive workshop was designed by an interprofessional faculty from a major urban teaching hospital, addressing SDOH, implicit bias, an "Enhanced Social History," and the benefits of interprofessional care. Before and after completion, workshop participants completed surveys regarding comfort in teaching these concepts. Survey results were analyzed to assess benefits of the intervention. RESULTS: Sixty-four percent of participants completed preworkshop and postworkshop surveys. Participants reported increased contemplation and improved comfort in teaching SDOH, barriers to medical care, and implicit bias. CONCLUSION: Faculty comfort in teaching health inequity increased after this workshop. This may help bridge the gap between the expectation of clinical faculty to evaluate trainee practice of patient-centered, culturally competent care, and faculty possession of and confidence in health inequity teaching skills in clinical settings. Future research should focus on learner- and patient-based outcomes, including teaching time and impact on delivery of care.


Asunto(s)
Docentes , Internado y Residencia , Humanos , Encuestas y Cuestionarios , Enseñanza , Docentes Médicos/educación
9.
Laryngoscope ; 133(8): 1938-1942, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-36214517

RESUMEN

BACKGROUND: Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty. METHODS: The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis. RESULTS: A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p = 0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p = 0.016), and had chronic steroid use (25.9% vs. 12.9%, p = 0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p = 0.020) and chronic steroid use (OR: 3.81, p = 0.018). CONCLUSIONS: This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1938-1942, 2023.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Mejoramiento de la Calidad , Humanos , Masculino , Femenino , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Esteroides , Estudios Retrospectivos , Factores de Riesgo
10.
Clin Chem ; 63(8): 1330, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28751322
11.
Medicine (Baltimore) ; 101(7): e28839, 2022 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-35363178

RESUMEN

ABSTRACT: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2, has claimed 5,587,549 lives worldwide as of January 20, 2022. Fortunately, large-scale vaccination can mitigate the impact of COVID-19 by making the disease milder and less common. Although 75.2% of the United States population has received at least 1 dose of a COVID-19 vaccines thus far, concerns regarding vaccine side effects have contributed to vaccine hesitancy. Furthermore, nearly 50% of adults in the United States are concerned not only about side effects, but about their downstream impact, including missed work.The goal of this cross-sectional study was to investigate the effect of messenger RNA vaccine adverse effects on the propensity to miss work among employees associated with a single, large academic health center.Using Qualtrics, all employees, including faculty, staff, and trainees, of 5 large departments were surveyed to determine whether they received the COVID-19 vaccine and which type, and any symptoms they experienced after receipt of either vaccine dose. We hypothesized that vaccine recipients would be more likely to miss work or feel sick enough to miss work following the second dose.Thirty-seven percent of respondents experienced events severe enough that they needed to miss work from either of the doses, with the majority (27.8%) related to the second dose. These findings are consistent with and expand on the results from the phase 3 trials for Pfizer-BionTech and Moderna, which showed that vaccine side effects were more common after the second dose than after the first dose. Our statistically significant finding was more common among Asians, women, trainees/house staff, and nonphysician clinical employees.With an increasing number of individuals taking the vaccine, employers will need to account for the impact of adverse effects on their employees' ability to work. These findings will further help organizations better plan for staffing as vaccinations increase to mitigate the spread of COVID-19.


Asunto(s)
COVID-19 , Vacunas contra la Influenza , Gripe Humana , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Estudios Transversales , Atención a la Salud , Femenino , Humanos , Gripe Humana/prevención & control , ARN Mensajero , Estados Unidos/epidemiología , Vacunas Sintéticas , Vacunas de ARNm
12.
J Contin Educ Health Prof ; 42(3): 164-173, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-36007516

RESUMEN

INTRODUCTION: Faculty development in the clinical setting is challenging to implement and assess. This study evaluated an intervention (IG) to enhance bedside teaching in three content areas: critical thinking (CT), high-value care (HVC), and health care equity (HCE). METHODS: The Communities of Practice model and Theoretical Domains Framework informed IG development. Three multidepartmental working groups (WGs) (CT, HVC, HCE) developed three 2-hour sessions delivered over three months. Evaluation addressed faculty satisfaction, knowledge acquisition, and behavior change. Data collection included surveys and observations of teaching during patient care. Primary analyses compared counts of post-IG teaching behaviors per hour across intervention group (IG), comparison group (CG), and WG groups. Statistical analyses of counts were modeled with generalized linear models using the Poisson distribution. RESULTS: Eighty-seven faculty members participated (IG n = 30, CG n = 28, WG n = 29). Sixty-eight (IG n = 28, CG n = 23, WG n = 17) were observed, with a median of 3 observation sessions and 5.2 hours each. Postintervention comparison of teaching (average counts/hour) showed statistically significant differences across groups: CT CG = 4.1, IG = 4.8, WG = 8.2; HVC CG = 0.6, IG = 0.9, WG = 1.6; and HCE CG = 0.2, IG = 0.4, WG = 1.4 ( P < .001). DISCUSSION: A faculty development intervention focused on teaching in the context of providing clinical care resulted in more frequent teaching of CT, HVC, and HCE in the intervention group compared with controls. WG faculty demonstrated highest teaching counts and provide benchmarks to assess future interventions. With the creation of durable teaching materials and a cadre of trained faculty, this project sets a foundation for infusing substantive content into clinical teaching.


Asunto(s)
Atención a la Salud , Pensamiento , Humanos , Encuestas y Cuestionarios , Enseñanza
13.
Postgrad Med ; 133(sup1): 3-10, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33618595

RESUMEN

This review aims to describe the epidemiology, pathophysiology, risk factors, presentation, complications, evaluation/diagnosis, and treatment of upper extremity deep vein thrombosis (UEDVT). Upper extremity deep vein thrombosis (UEDVT) accounts for 6% of cases of deep vein thrombosis (DVT). It can lead to swelling and discomfort in that extremity and can be complicated by pulmonary embolism, post-thrombotic syndrome, and recurrence of DVT. Evaluation can begin with a dichotomized Constans score and fibrin degradation product testing. Diagnosis is typically made with compression ultrasound. Anticoagulation is the mainstay of therapy. Primary UEDVT is known as Paget Schroetter Syndrome (PSS) which occurs due to venous thoracic outlet syndrome (vTOS). Anticoagulation, thrombolysis, and decompression of the venous thoracic outlet are used for treatment but the optimal strategy remains to be elucidated. Secondary UEDVT are most commonly caused by indwelling catheters and malignancy. There is an ongoing realization that UEDVT are more than simply 'leg clots in the arm.' Given the increasing incidence, research needs to be done to further our understanding of this disease state, its evaluation, and its treatment.


Asunto(s)
Síndrome del Desfiladero Torácico/complicaciones , Trombosis Venosa Profunda de la Extremidad Superior , Anticoagulantes/farmacología , Descompresión Quirúrgica/métodos , Humanos , Terapia Trombolítica/métodos , Ultrasonografía/métodos , Extremidad Superior/irrigación sanguínea , Extremidad Superior/diagnóstico por imagen , Trombosis Venosa Profunda de la Extremidad Superior/sangre , Trombosis Venosa Profunda de la Extremidad Superior/etiología , Trombosis Venosa Profunda de la Extremidad Superior/fisiopatología , Trombosis Venosa Profunda de la Extremidad Superior/terapia
15.
Heart Views ; 21(4): 276-280, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33986927

RESUMEN

Social media use has dramatically increased in the past two decades. This growth has been seen in the health-care field as well. Social media is being used for a variety of activities including networking, education, public health, and marketing. Health-care professionals in cardiology participate in social media to varying degrees and in different ways. Current studies have focused primarily on physicians who have an established presence on social media. To learn more about the social media habits of community-based cardiology providers, we queried attendants at a cardiovascular conference held by our health-care system. The purpose of this article is to: Highlight the social media habits of a range of community-based cardiology providers and distinguish between producing and consuming social media. There is a predominance of social media content consumers compared to producersOutline important considerations when assessing the risks and benefits of social media use and the perceived concerns of cardiology health-care professionalsEmphasize the need to incorporate guidelines for social media use into institutional policies and provide training on social media use to the health-care community.

16.
Am J Surg Pathol ; 44(6): 793-798, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31934919

RESUMEN

Colon polypectomy can require an injection of a submucosal lifting agent to fully visualize and completely remove the polyp. To the best of our knowledge, this is the largest morphologic series on the novel lifting agents Eleview and Orise. The study consisted of 1 polypectomy and 8 colon resections from 9 patients: 6 women, 3 men (mean age=64 y); Orise=6, Eleview=3; the median time interval between injection and resection=16 weeks. Pathologic diagnoses of the polyps included tubular adenoma (n=4), tubulovillous adenoma (n=4), and sessile serrated adenoma/polyp (n=1). We report that a histologically processed Orise aliquot from the manufacturer showed similar histology to that seen in the specimens from patients with confirmed Orise injection. The morphology of the agents in the patient specimens changed with time status postinjection: immediate resection of the lifting agent showed basophilic, amorphous, and bubbly-extracellular material with prominent hemorrhage, and resection ∼3 months after lifting agent injection showed prominent hyalinized, pink-amorphous ribbons and globules with a foreign body giant cell reaction and fibrosis. The epicenter of the lifting agents was in the submucosa, and the agents were neither refractile nor polarizable. Because of the morphologic overlap with amyloid, 5 cases were stained with Congo Red, and all cases were negative. In conclusion, awareness of the morphology of these new lifting agents is important for accurate diagnosis and to avoid the diagnostic pitfall of amyloid. These lesions can be definitively distinguished from amyloid by their nonreactivity on a Congo Red and familiarity with their characteristic clinicopathologic presentation.


Asunto(s)
Amiloidosis/patología , Pólipos del Colon/patología , Pólipos del Colon/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Poloxámero , Amiloidosis/diagnóstico , Pólipos del Colon/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Poloxámero/efectos adversos
17.
Am J Med ; 132(8): e631-e633, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30878544

RESUMEN

Anticoagulation-related nephropathy might just be the most common diagnosis you've never heard of. It was formerly known as warfarin-induced nephropathy, until it was observed with numerous other anticoagulants and broadened to anticoagulation-related nephropathy. It is a potentially devastating disorder with serious and life-changing consequences if not recognized and diagnosed swiftly. As the clinician is faced with new acute renal failure, it is important to appreciate those factors that place patients at greater risk of anticoagulation-related nephropathy: conditions such as underlying chronic kidney disease patients and supratherapeutic international normalized ratio. Through greater understanding of this common yet under-recognized condition, we become better equipped to diagnose and prognosticate potential patients. Currently, there are no specific guidelines to follow regarding anticoagulation-related nephropathy identification and management; however, it is an entity that is important to remember, especially given the number of patients requiring anticoagulation for numerous conditions.


Asunto(s)
Anticoagulantes/efectos adversos , Insuficiencia Renal Crónica/etiología , Anticoagulantes/uso terapéutico , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Humanos , Relación Normalizada Internacional/clasificación , Insuficiencia Renal Crónica/fisiopatología , Factores de Riesgo
18.
Algorithmica ; 81(4): 1699-1727, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31007327

RESUMEN

Singleton arc consistency is an important type of local consistency which has been recently shown to solve all constraint satisfaction problems (CSPs) over constraint languages of bounded width. We aim to characterise all classes of CSPs defined by a forbidden pattern that are solved by singleton arc consistency and closed under removing constraints. We identify five new patterns whose absence ensures solvability by singleton arc consistency, four of which are provably maximal and three of which generalise 2-SAT. Combined with simple counter-examples for other patterns, we make significant progress towards a complete classification.

19.
Orthopedics ; 31(5): 441, 2008 05.
Artículo en Inglés | MEDLINE | ID: mdl-19292325

RESUMEN

This biomechanical study compared suture anchors versus transosseous sutures for repair of quadriceps tendon ruptures using a force of 150 N at a frequency of 0.5 Hz. No significant difference in displacement was found between the 2 techniques with initial loading or with load or no load after 1000 cycles. Displacement after 1000 cycles for suture anchors and bone tunnels was 4.65 and 4.50 mm, respectively. These findings suggest a possible role for suture anchors in repairing quadriceps tendon ruptures. Suture anchors are relatively expensive but require less dissection over the patella and do not involve suture placement about the patella tendon.


Asunto(s)
Anclas para Sutura , Técnicas de Sutura/instrumentación , Suturas , Traumatismos de los Tendones/fisiopatología , Traumatismos de los Tendones/cirugía , Tendones/fisiopatología , Tendones/cirugía , Cadáver , Módulo de Elasticidad , Humanos , Rotura/fisiopatología , Rotura/cirugía , Estrés Mecánico , Resistencia a la Tracción , Muslo , Resultado del Tratamiento
20.
Postgrad Med ; 135(sup1): 1-2, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-37061930
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