A Rare Case of Cord Compression From Extra-Medullary Hematopoiesis (EMH) in Beta Thalassemia.

Cord compression can arise from many different etiologies -- including trauma, degenerative changes, growths, neoplasms, or even abscesses. While some etiologies can cause symptoms such as weakness or motor deficits, others can simply present as pain. A rare cause of cord compression is extramedullary hematopoiesis (EMH), or the growth of blood cells outside the bone marrow. This rare, abnormal growth of cells can result in severe complications such as increased intracranial pressure and motor and sensory impairment. General clinicians should strive for early and prompt diagnosis of cord compression whenever possible, especially in patients who present with acute neurological deficits. We present a case of a 27-year-old female with beta thalassemia major (BTM) and transfusional hemosiderosis, who came in with progressive lower extremity weakness, numbness and urinary retention, and was diagnosed with acute cord compression from EMH.

Correction: A Rare Case of Cord Compression From Extra-Medullary Hematopoiesis (EMH) in Beta Thalassemia.

[This corrects the article DOI: 10.7759/cureus.38520.].

Analysis of clinical risk models vs. clinician's assessment for prediction of coronary artery disease among predominantly female population.

INTRODUCTION: Multiple risk models are used to predict the presence of obstructive coronary artery disease (CAD) in patients with chest pain. We aimed to compare the performance of these models to an experienced cardiologist's assessment utilizing coronary angiography (CA) as a reference. MATERIALS AND METHODS: We prospectively enrolled patients without known CAD referred for elective CA. We assessed pretest probability of CAD using the following risk models: Diamond-Forrester (original and updated), Duke Clinical score, ACC/AHA, CAD consortium (basic and clinical) and PROMISE minimal risk tool. All patients completed self-administrative Rose angina questionnaire. Independently, an experienced cardiologist assessed the patients to provide a binary prediction of obstructive CAD prior to CA. Obstructive CAD was defined as >80% stenosis in epicardial coronary arteries by visual assessment, or fractional flow reserve <0.80 in intermediate lesions (30-80%). RESULTS: A total of 150 patients were recruited (100 women, 50 men). Mean age was 58 (32-78) years. Obstructive CAD was found in 31 patients (21%). The area under the curve (AUC) for all the clinical risk prediction models (except the Duke Clinical Score, AUC 0.73, P = 0.07) was significantly lower compared with the clinician's assessment (AUC 0.51-0.65 vs. 0.81, respectively, P < 0.01). The clinician's assessment had sensitivity comparable to the Duke Clinical score, which was higher than all other clinical models. There was no difference in prediction performance on the basis of sex in this predominantly female population. DISCUSSION/CONCLUSION: In stable patients with chest pain and suspected CAD, current clinical risk models which are universally based upon the characteristics of the chest pain, show suboptimal performance in predicting obstructive CAD. These findings have important clinical implications, as current appropriateness criteria for recommending CA are on the basis of these risk models.

Development and preliminary evaluation of ilearnKAS: An animated video about kidney allocation to support transplant decision-making.

BACKGROUND: We aimed to develop and feasibility test an educational video culturally targeted to African American (AA) patients regarding kidney allocation. METHODS: We iteratively refined an animated video for AAs with multiple stakeholder input and conducted a one-group, pre-post study with 50 kidney transplant candidates to assess video feasibility and acceptability. A mixed population was chosen to obtain race-specific acceptability data and efficacy estimates for a larger study. RESULTS: Median participant age was 56 years, and 50% were AA. Comparing pre-post video scores, large knowledge effect sizes were found for the cohort (r = 0.7) and in the context of AA race (r = 0.8), low health literacy (r = 0.6), low educational achievement (r = 0.7), age >55 years (r = 0.6), dialysis vintage ≥1 year (r = 0.8), low income (r = 0.7) and low technology access (r = 0.8). Over 87% of participants provided positive ratings on each of the seven acceptability items. The frequency of positive responses increased pre-post video for kidney allocation understanding (78% vs 94%, P = 0.008), decisional self-efficacy (64% vs 88%, P < 0.001) and belief in fairness (76% vs 90%, P = 0.02). CONCLUSIONS: In collaboration with key stakeholders, a culturally targeted educational video was developed that was well received. Results are promising to impact kidney allocation knowledge among AA and non-AA kidney transplant candidates.

Kidney Transplant Evaluation: Inferences from Qualitative Interviews with African American Patients and their Providers.

BACKGROUND: Completing pre-transplant evaluation is often a barrier to kidney waiting list placement among African American (AA) patients. Interventions are needed to provide AAs with culturally sensitive, understandable information that increases their capacity to achieve placement on the kidney transplant waiting list. Research about enabling and constraining factors for patients to complete the waitlisting process is necessary to inform such interventions; however, few such studies have been conducted specific to AA patient needs. METHODS: Semistructured qualitative focus groups and interviews were conducted with 24 AA listed or transplanted patients (along with their caregivers when available) and 14 transplant providers to explore thoughts, feelings, and assumptions about transplant evaluation. Questions also probed participants' perceptions of enabling and constraining factors to wait-listing. Interviews were recorded and transcribed and inductive thematic analysis was performed to inform message content for a future educational video intervention. RESULTS: Three themes emerged from thematic content analysis: (1) transplant center support in navigating steps to wait-listing, (2) provider attitude and messaging, and (3) education about evaluation and the waiting list. Enabling factors for evaluation completion included staff assistance with completing testing, frequent communication, and positive staff messaging. Constraining factors were staff inaccessibility, patient scheduling difficulties, and misunderstanding/misinformation regarding the role of the transplant coordinator, process of and requirements for listing, and understanding allocation. CONCLUSIONS: We identified information based on patients' expressed needs and experiences managing evaluation completion. These findings are valuable in efforts going forward to empower AAs to achieve placement on the waiting list.