Epidemiology of Craniofacial Injuries from Exercise and Weightlifting: A 10-Year Analysis.

INTRODUCTION: Exercise is the cornerstone of a healthy lifestyle. It is recognized for enhancing cardiovascular health and bolstering mental well-being. While the fitness industry grows, the incidence of exercise-related injuries continues to rise. This study examines craniofacial injuries resulting from exercise and weightlifting over the past decade. The goal is to uncover trends, demographics, diagnoses, and patient dispositions. METHODS AND MATERIALS: A retrospective review was conducted using the National Electronic Injury Surveillance System database. Emergency department visits for craniofacial injuries associated with exercise and weightlifting between 2013 and 2022 were analyzed. One-sample t-tests and the Mann-Kendall test were used to evaluate injury prevalence and significant trends. RESULTS: Over the past decade, 582,972 craniofacial injuries related to exercise and weightlifting were documented. Men accounted for 55.7% of cases. Annual incidence increased by 32.7% between 2013 and 2022. It was statistically significant. Adolescents aged 15 to 19 displayed the highest injury rate. Head injuries were most common (45%), followed by face (26%), neck (21%), mouth (4%), eye (3%), and ear (1%). Diagnoses included internal injury (25.2%), laceration (24.8%), contusions/abrasions (12.9%), and strain/sprain (11.9%). Hospitalization was required for only 8.5% of patients. DISCUSSION: This study elucidates the need for injury prevention strategies. Vulnerable subgroups such as males, adolescents, and the elderly demand targeted prevention efforts. Future research should explore specific mechanisms of injury to identify high-risk exercise. This study promotes the need for safe exercise practices and increases awareness of craniofacial injury risks associated with physical activity.

Cancer caregivers are primarily motivated by love and sense of duty.

Cancer is a debilitating disease for which patients often need caretakers to help them live their lives and complete basic activities. This study aims to characterize the burden of the caretaker. A 14-question survey was sent out to randomly selected United States cancer caretakers to analyze the social, emotional, and physical burden of their caretaking. The results show that a majority of caretakers are direct family to the patient (69.5%). The patients' cancers are often in early stages with about 54.5% having stage 1 cancer and 22.5% having stage 2 cancer while only 8.5% had stage 3 cancer and 17.8% had stage 4 cancer. When asked about their motivation, caretakers most often do it because of love (58.82%) with family responsibilities/duty being the second highest reason (35.56%). When asked about their biggest burden, many caretakers said that grief was the biggest issue (30.50%) with mental health issues also being troublesome (28%). 75.6% of respondents said that being a cancer caretaker has negatively impacted their mental health from either anxiety (37.29%), depression (33.9%), or other conditions (4.41%). When asked about the negative impacts of being a caregiver, 43.5% stated they faced high financial costs to give care, and 35% stated they met a lack of social support or lost friends. In comparison, 33% stated they had negative physical impacts. The number of participants who face overwhelming or high stress nearly quintupled from baseline, from 13% to 59.5%. This cross-sectional survey of US adults demonstrates that there are clear negative impacts on cancer caregivers on their physical, financial, social, and mental health. These data underscore the importance of taking care of patients' caregivers.

Racial disparities in subjective cognitive decline and its implications among Alzheimer's caretakers.

BACKGROUND/OBJECTIVE: Alzheimer's disease is a prominent neurodegenerative disorder characterized by cognitive decline and memory loss. Variations in subjective cognitive decline among Alzheimer's patients, often reported by caregiver, may stem from cultural, socioeconomic, healthcare access, and genetic factors. This study investigates racial disparities in subjective cognitive decline reported by caregivers and their implications. METHODS: In this study, data from 12,627 Alzheimer's caretakers from the CDC's Alzheimer's Disease and Healthy Aging Data Portal were analyzed using JMP software. Caregivers reported patients' cognitive decline for various racial categories: Asian/Pacific Islander, Black, Hispanic, Native American/Native Alaskan, and White. Fit model tests and distribution analyses were employed to assess disparities in symptom severity. The study focused on four key questions regarding symptom prevalence and healthcare communication to assess the degree of symptoms the patients were experiencing. RESULTS: Significant disparities in symptom severity reported by Alzheimer's caretakers were observed among the racial groups analyzed. The symptom severity ranked from least to most severe is the following: White, Asian/Pacific Islander, Black, Native American/Native Alaskan, and Hispanic patients. There was variance when it came to communication with healthcare providers, as the Asian population had the lowest communication rates. These findings underscore the need for targeted interventions considering cultural differences. It is important that tailoring healthcare approaches for different racial backgrounds is happening as a remedy to this gap in communication. CONCLUSION: Due to cultural, socioeconomic, genetic factors, and others, there were significant observed disparities. Tailoring interventions to these diverse populations is crucial to address these inequities.

A Diagnostic Challenge: Periorbital or Orbital Cellulitis?

The authors present the case of a 39-year-old male who presented to the hospital with worsening eye pain, swelling, and blurred vision of the left eye. His symptoms grew worse despite initial over-the-counter medication and a trip to the urgent care center. A physical exam was concerning for a possible orbital cellulitis given the appearance of the eye and the amount of discomfort, as well as their immunocompromised status, necessitating imaging and workup to confirm the diagnosis. The patient was ultimately diagnosed with periorbital cellulitis and bacterial conjunctivitis, and he received intravenous antibiotics for treatment. This case underscores the importance of a comprehensive diagnostic approach to managing ocular infections.

Access to Healthcare in Rural Communities: A Bibliometric Analysis.

Introduction: Access to healthcare is defined by being able to receive regular checkups, specialist appointments, immunizations, procedures, and surgeries within a reasonable timeframe and without restrictive barriers. Methods: The Web of Science database was used to collect 4,745 articles published relating to the keywords "rural", "access", and "healthcare". These articles then underwent bibliometric cataloging by country, journal, and keyword using VOSviewer 1.6.19. Results: Between the years 2015 and 2022, the United States emerged as the predominant publisher in the field. From 2015 to 2019, the United States accounted for 47 percent of the total articles published. However, in the subsequent years of 2020 to 2022, there was a slight decline of 3 percent in the volume of U.S. publications. Australia secured the second position in terms of publications within the aforementioned timeframe of 2015 to 2022. England had the third most publications during the time between 2015 to 2022. The prevalence of articles containing the keyword "disparity" ranged between 7 percent and 12 percent throughout this period. Plus One exhibited prominence by contributing 5.025381 percent of all publications pertaining to access to rural medicine during the years 2015 to 2019 thereby establishing itself as the leading publisher in this domain. However, in 2020, the International Journal of Environment suppressed Plus One by publishing the highest number of articles related to rural healthcare. Subsequently, the BMC Health Services Research claimed the leading position in the years 2021 to 2022. Conclusion: An exploration of who is contributing to the discussion of access to healthcare in rural communities shows that the field and number of publications is growing, and that a focus on disparities is emerging, creating an environment surrounding rural health focused on researching equitable care.

The Doctor-Patient relationship: A bibliometric analysis.

Objective: Doctor-patient communication is an essential clinical practice necessary to improve overall patient experience and their adherence to treatment. This form of communication involves first, listening without interruptions and then, conveying information in a clear and concise manner. Methods: A bibliometric analysis was conducted on publications extracted from the Web of Science database related to doctor-patient communication from 2012 to 2022 using the VOSviewer 1.6.15 software to visualize trends. Results: 20,376 articles were from 2012 to 2022 met the inclusion criteria of being recognized by the search phrase "physician-patient communication." Throughout the defined time period, USA, Canada, and Germany consistently took the top three positions in terms of publishing the most articles regarding the topic. Additionally, the Patient Education and Counseling Journal was the journal with the most publications regarding the topic. Innovation: A bibliometric analysis is a relatively novel way to frame research in a given area. It allows researchers to analyze trends in publication, and capture data from multiple disciplines. Conclusion: The number of articles published annually regarding doctor-patient communication has constantly been increasing from 2012-2022, demonstrating its importance as a crucial component of effective health care.

Subungual Hematoma.

The authors present the case of a 64-year-old male who presented to the emergency department due to foot trauma. He sustained a large subungual hematoma, which was drained. Following the procedure, the patient achieved complete resolution of his pain. He also reported no complications at two-week phone follow-up. The management of subungual hematoma, including the trephination procedure, is discussed. Potential complications, although rare, are reviewed.

Archery-Related Musculoskeletal Injuries: An Epidemiological Study Revealing Injury Sites, Risk Factors, and Implications for Prevention.

Objective: While generally considered a safe sport, archery injuries are often the result of overuse or penetration and largely affect the upper extremities. Studies have shown that during training periods the average risk of injury is 4.4%. By studying mechanisms of injury and their prevalence nationally, this study aims to educate coaches, athletes, and equipment manufacturers on ways the sport can be safer from a clinical perspective. Methods and Materials: The National Electronic Injury Surveillance System Database was queried to analyze archery-related musculoskeletal injuries that occurred between 2013 and 2022. Results: Approximately 43,083 injuries were recorded over a 10-year span, of which 8,038 were women and 35,367 were men. Men were thus 4.4 times more likely to experience injury during archery. Injury sites in men included the finger (66.2%), hand (17.1%), face (6.2%), shoulder (5.4%), and foot (5.1%). All reported injuries in women were finger-related. The most common diagnoses for men were lacerations (58.1%), fractures (12.7%), contusions and abrasions (7.5%), foreign body (5.9%), punctures (4.9%), and strains/sprains (4.9%). Women exclusively experienced lacerations, accounting for 100% of their injuries. Conclusion: The study identifies that lacerations were the most common archery-related injury that was treated in the ED. Additionally, the fingers were the most common site of injury. Findings from this study suggest that improved safety equipment, such as reinforced gloves, finger tabs, and forearm braces should be used by athletes to practice the sport more safely. Future research could involve studying injury rates in archers who use each combination of these safety precautions to investigate which gear is most protective.

Geographic Liver.

The authors present the case of a man with a relatively benign clinical presentation who had a computed tomography scan that revealed a "geographic liver" pattern. The radiologic appearance of hepatic steatosis, its significance, and its association with metabolic syndrome highlight the importance of this radiologic finding.

Acute Cardioembolic Stroke in the Setting of Subtherapeutic Anticoagulation.

Acute ischemic stroke is a sudden neurological deficit secondary to decreased or lack of blood flow (perfusion) due to a thrombus or an embolus. Embolic strokes are ischemic strokes that occur due to a distal clot that results in hypoperfusion upstream. Cardioembolic strokes are embolic strokes due to a cardiac origin. Almost a quarter of ischemic strokes are of cardioembolic etiology. Here, we present the case of an 83-year-old female presenting with right-side weakness and aphasia who arrived 45 minutes after symptom onset. Cardioembolic stroke symptoms, diagnosis, treatment, and risk factors are discussed.

Frykman VIII Fracture Secondary to Falling Onto an Outstretched Hand (FOOSH).

This is the case of a 41-year-old woman who presented with pain in the wrist after a fall from her bicycle, after which she tried to block her fall by outstretching her hand. She sustained a Frykman VIII fracture, with a fracture of the distal radius and ulnar styloid. Her labs were unremarkable, and she had no previous medical history. Her case was an example of a classic fracture due to FOOSH (falling onto an outstretched hand) which can easily be avoided by learning how to break falls properly. The patient's symptoms, diagnosis, treatment, and ways to avoid this injury are presented.

Stercoral Colitis Secondary to Opiate-Induced Constipation.

The authors present the case of a 62-year-old woman who had stercoral colitis secondary to opiate use for rheumatoid arthritis leading to chronic constipation. Computed tomography imaging demonstrated stool along a significant length of the colon. Stercoral colitis is a seldom suspected cause of severe abdominal pain. Although constipation may seem benign, when it gets to the level of a stercoral colitis, mortality due to colonic perforation is a very real concern. The authors review the presentation, risk factors, and management of stercoral colitis.

Impact of Music Therapy on Gait After Stroke.

Music therapy or music-supported therapy is a therapeutic modality sometimes used during the rehabilitation phase after an acute ischemic or hemorrhagic stroke. The intervention suggests that the resulting audio-motor coupling can enhance motor function. Multiple clinical studies have reported various improvements-including cognitive, mood, and limb function. Gait impairment after stroke confers significant morbidity. The authors present a systematic review of randomized controlled trials that have examined the impact of music therapy on patient recovery, specifically on gait and ambulation.

Cost-Effectiveness of Vitamin D Supplementation in Pregnant Woman and Young Children in Preventing Rickets: A Modeling Study.

Background: Literature on the cost of management of rickets and cost-effectiveness of vitamin D supplementation in preventing rickets is lacking. Methods: This study considered the cost-effectiveness of providing free vitamin D supplementation to pregnant women and children <4 years of age with varying degrees of skin pigmentation to prevent rickets in children. Estimates for the prevalence of rickets were calculated using all cases of rickets diagnosed in Central Manchester, UK and census data from the region. Cost of management of rickets were calculated using National Health Service, UK tariffs. The efficacy of vitamin D supplementation was based on a similar programme implemented in Birmingham. Quality of life was assessed using utility estimates derived from a systematic literature review. In this analysis the intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) is below the National Institute for Health and Care Excellence, UK cost-effectiveness threshold of £20,000 per Quality-adjusted life year (QALY). Results: Fifty-seven patients (26 dark, 29 medium and 2 light skin tones) were managed for rickets and associated complications over 4-years. Rickets has an estimated annual incidence of 29·75 per 100,000 children <4 years of age. In the dark skin tone population vitamin D supplementation proved to be cost saving. In a medium skin tone population and light skin tone populations the ICER was £19,295 per QALY and £404,047 per QALY, respectively. Conclusion: Our study demonstrates that a vitamin D supplementation to prevent rickets is cost effective in dark and medium skin tone populations.

Healthcare resource utilization in the management of hypophosphatasia in three patients displaying a spectrum of manifestations.

BACKGROUND: Hypophosphatasia (HPP) is a rare, heterogeneous disease caused by low tissue-nonspecific alkaline phosphatase activity and associated with a range of signs and symptoms, including bone mineralization defects, respiratory problems, seizures, premature tooth loss, and fractures. Data from patients with HPP and their healthcare resource utilization are lacking. We evaluated healthcare utilization for 3 patients with differing severities of HPP. RESULTS: Patient 1 had perinatal HPP (received enzyme replacement therapy asfotase alfa under a compassionate use program), Patient 2 had infantile HPP, and Patient 3 had childhood HPP. Healthcare resources used in the National Health Service, England, were identified from coded activities in the hospital database and detailed medical records. These data showed that healthcare utilization was directly related to disease severity. Patient 1 had respiratory complications necessitating prolonged admission for ventilation from birth. Over 2.5 years, this patient was hospitalized 725 days, with visits from 16 specialists. Patient 2 had HPP-associated signs and symptoms starting in infancy, was treated for craniosynostosis, experienced multiple fractures, and required outpatient management for > 18 years. Patient 3 developed signs and symptoms of HPP in childhood and received outpatient and day case treatment for dental, orthopedic, and cardiovascular problems over 24 years. Healthcare utilization varied with severity and complexity of disease manifestations between these patients. CONCLUSIONS: With the recent approval of asfotase alfa for HPP, data from this analysis may help mobilize multidisciplinary healthcare resources for management of HPP by elucidating healthcare resource needs of patients who show a spectrum of clinical manifestations of HPP.

Anthropometric measurements as predictors of cephalopelvic disproportion: Can the diagnostic accuracy be improved?

OBJECTIVE: We assessed the efficacy of maternal anthropometric measurements and clinical estimates of fetal weight in isolation and in combination as predictors of cephalopelvic disproportion (CPD). DESIGN: Prospective cohort study. SETTING: Tertiary care teaching hospital, two affiliated hospitals with facilities for conducting cesarean delivery and seven affiliated primary care facilities with no operation theaters. SAMPLE: Primigravidae over 37 weeks' gestation attending these facilities during a 20-month period with a singleton pregnancy in vertex presentation. METHODS: Several anthropometric measurements were taken in 249 primigravidae. Fetal weight was estimated. Differences in these measurements between the vaginal delivery and CPD groups were analyzed. The validity of these measurements in predicting CPD was analyzed by plotting receiver operating characteristic curves and by logistic regression analysis. MAIN OUTCOME MEASURE: Mode of delivery. RESULTS: Maternal height, foot size, inter-trochanteric diameter and bis-acromial diameter showed the highest positive predictive values for CPD. Combining some maternal measurements with estimates of fetal weight increased predictive values modestly, which are likely to be greater if the estimates of fetal weight are close to the actual birth weight. Based on multivariate analysis the risk factors for CPD in our population were foot length ≤23cm, inter-trochanteric diameter ≤30cm and estimated fetal weight ≥3 000g. CONCLUSIONS: Maternal anthropometric measurements can predict CPD to some extent. Combining maternal measurements with clinical estimates of fetal weight only enhances the predictive value to a relatively modest degree (positive predictive value 24%).

Environmental tobacco and wood smoke increase the risk of Legg-Calvé-Perthes disease.

BACKGROUND: The etiology of Legg-Calvé-Perthes disease (LCPD) remains unknown. A few studies have suggested passive smoke inhalation may be a risk factor, although the association is not confirmed and a causal relationship has not been established. QUESTIONS/PURPOSES: We therefore undertook this study to confirm an association between environmental tobacco smoke, firewood smoke, and socioeconomic status and the risk of LCPD. METHODS: We prospectively recruited 128 children with LCPD and 384 children attending the hospital for other orthopaedic complaints. The control subjects were frequency-matched with the cases by age and gender. Conditional logistic regression was used to assess the association between the exposures and risk of LCPD. RESULTS: The main risk factors for LCPD were indoor use of a wood stove (adjusted odds ratio [OR], 2.56) and having a family member who smoked indoors (adjusted OR, 2.07). Children from the middle socioeconomic group appeared to be at a greater risk of developing LCPD (adjusted OR, 3.60). CONCLUSIONS: This study provides further evidence that environmental tobacco smoke is associated with an increased risk of LCPD. Exposure to wood smoke also appears to be a risk factor. However, it remains unclear why there are profound differences in the incidence of the disease between regions when the prevalence of smoking is comparable and why bilateral involvement and familial disease are infrequent.

Attitudes Toward Euthanasia Among Doctors in a Tertiary Care Hospital in South India: A Cross Sectional study.

CONTEXT: Advances in expertise and equipment have enabled the medical profession to exercise more control over the processes of life and death, creating a number of moral and ethical dilemmas. People may live for extended periods with chronic painful or debilitating conditions that may be incurable. AIM: This study attempts to study the attitudes of doctors toward euthanasia and the possible factors responsible for these attitudes. SETTINGS AND DESIGN: A cross-sectional survey of 213 doctors working at a tertiary care hospital was conducted to determine their attitudes toward euthanasia. MATERIALS AND METHODS: A self-administered questionnaire was used to assess attitudes and personal perceptions about euthanasia. STATISTICAL ANALYSIS USED: The Chi square test was used to assess factors influencing attitudes toward euthanasia. RESULTS: A majority of the respondents (69.3%) supported the concept of euthanasia. Relief from unbearable pain and suffering was the most commonly (80.3%) cited reason for being willing to consider the option of euthanasia. Majority of those who were against euthanasia (66.2%) felt that the freedom to perform euthanasia could easily be misused. Disapproval of euthanasia was associated with religious affiliation (P<0.001) and speciality (P<0.001). CONCLUSIONS: A majority of the doctors in this study supported euthanasia for the relief of unbearable pain and suffering. Religion and speciality appear to be significant in determining attitudes toward euthanasia.

Prevalence and determinants of tobacco use in a highly literate rural community in southern India.

BACKGROUND: The adverse effects of tobacco use on the health of an individual are well known. It is essential to identify factors leading to tobacco use to plan strategies to limit its use. Education is known to influence the prevalence of tobacco use. We aimed to determine the prevalence and patterns of tobacco use in a rural community with a high literacy rate and to examine the socioeconomic and demographic correlates of tobacco consumption in the area. METHODS: A cross-sectional survey using personal interviews was carried out on 832 individuals > 15 years of age. The prevalence of current daily use of tobacco was used as the outcome measure. The main analytical methods used were chi-square test and multiple logistic regression analysis. RESULTS: The prevalence of tobacco use was 17.5%, being common among older persons, the lower socioeconomic group and those who were less educated. Tobacco was used predominantly in smokeless forms (chewing, snuff or both). The commonest reason cited for initiating tobacco use was to relieve toothache. CONCLUSIONS: Our findings in this rural community suggest that improvement in the educational and socioeconomic status may lead to a decline in the use of tobacco. Health education to improve dental hygiene may also help to reduce tobacco use in this community as it is predominantly used in the chewing form.