Family chaos and adolescent inflammatory profiles: the moderating role of socioeconomic status.

OBJECTIVE: To test whether family chaos influences adolescents' inflammatory profiles and whether adolescents from low socioeconomic status (SES) environments are at higher risk for experiencing adverse inflammatory profiles from living in chaotic family environments. METHODS: A total of 244 families with an adolescent aged 13 to 16 years participated. Parents completed measures of family SES and family chaos. Both systemic inflammation and stimulated proinflammatory cytokine production in response to bacterial challenge were assessed in adolescents. RESULTS: Our results suggest that SES moderates the detrimental effect of family chaos on systemic inflammation and interleukin-6 (B = -0.010, standard error [SE] = 0.004, p = .026), but not C-reactive protein (B = 0.009, SE = 0.006, p = .11), and on stimulated proinflammatory cytokine production (B = -0.098, SE = 0.044, p = .026) in adolescents, such that a chaotic family environment is positively associated with greater systemic inflammation and greater stimulated proinflammatory cytokine production in adolescents as family SES declines. CONCLUSIONS: These findings indicate that living in chaotic family environments places youth who may be vulnerable based on socioeconomic factors at a potentially higher risk for inflammation-related diseases.

Trends and Factors Associated With Extremity Fractures and Post-Acute Care Utilization of Nevada Older Adults: Insights of Age-Friendly State Planning in U.S.

Along with the trend of a steady utilization decline in the U.S. nursing home beds, post-acute care (PAC) utilization at the skilled nursing facilities has declined. This study was a cross-sectional, retrospective review of hospital discharge-based claim data. We evaluate the factors associated with utilizing post-acute care at rehabilitation facilities among those with extremity fractures in the state of Nevada. All Nevada hospital discharges of aged ≥65 years with extremity fractures between 2018 and 2021 were divided to post-acute care locations by (1) rehabilitation facilities (skilled nursing facility and inpatient rehabilitation facility) and (2) homes (with and without services). PAC utilization at facilities declined from 55.1% in 2018 to 49.7% in 2021 (P < .001). In response, PAC utilization at homes continuously upwards, particularly, homes with services from 18.8% in 2018 to 24.5% in 2021 (P < .001). Older age, female, lower extremity fractures, comorbidities, and Medicare beneficiaries were associated with higher probabilities of utilizing post-acute rehabilitation facilities. Racial minorities, COVID-19 pandemic, upper extremities, Medicaid beneficiaries, rural hospitals, and prolonged hospital length of stay were associated with lower probabilities of PAC utilization at facilities. Caregiver burdens and workforce training is urgently warranted to respond to this utilization shift. Effective geriatrics workforce training might advance care efficiency of older adults with extremity fractures and guide to the insights of establishing the age-friendly state of Nevada in response to this utilization shift trends.

Trends of emergency department visits for cannabinoid hyperemesis syndrome in Nevada: An interrupted time series analysis.

Cannabis-related emergency department visits have increased after legalization of cannabis for medical and recreational use. Accordingly, the incidence of emergency department visits due to cannabinoid hyperemesis syndrome in patients with chronic cannabis use has also increased. The aim of this study was to examine trends of emergency department visit due to cannabinoid hyperemesis syndrome in Nevada and evaluate factors associated with the increased risk for emergency department visit. The State Emergency Department Databases of Nevada between 2013 and 2021 were used for investigating trends of emergency department visits for cannabinoid hyperemesis syndrome. We compared patients visiting the emergency department due to cannabinoid hyperemesis syndrome with those visiting the emergency department due to other causes except cannabinoid hyperemesis and estimated the impact of cannabis commercialization for recreational use. Emergency department visits due to cannabinoid hyperemesis syndrome have continuously increased during the study period. The number of emergency department visits per 100,000 was 1.07 before commercialization for recreational use. It increased to 2.22 per 100,000 (by approximately 1.1 per 100,000) after commercialization in the third quarter of 2017. Those with cannabinoid hyperemesis syndrome were younger with fewer male patients than those without cannabinoid hyperemesis syndrome. A substantial increase in emergency department visits due to cannabinoid hyperemesis syndrome occurred in Nevada, especially after the commercialization of recreational cannabis. Further study is needed to explore factors associated with emergency department visits.

Cost-Effectiveness Analysis of Telehealth and In-Person Primary Care Visits for People Living with Alzheimer's Disease-Related Disorders in the State of Nevada.

To people living with Alzheimer's Disease-Related Disorders (ADRD), timely and coordinated communication is essential between their informal caregivers and healthcare providers. In provider shortage areas, for example, the state of Nevada, telehealth can be an effective primary care delivery alternative to in-person visits. To evaluate the cost-effectiveness of telehealth visits for people living with ADRD in the state of Nevada, a decision-analytic Markov model was developed from healthcare system perspectives with a 10-year horizon/1-year cycle. To estimate the effects of demographic and geographic parameters on the Markov model, race parameters were divided into non-Hispanic White individuals vs. others and location parameters were divided into urban vs. rural. A 12-item short-version Zarit Burden Interview (ZBI-12) was applied to measure the informal caregiver burdens of non-institutionalized people living with ADRD. The values of mortality rate and healthcare utilization were obtained from healthcare systems' publicly available payor administrative data and Nevada State Inpatient/Emergency Department datasets. Among urban-residing non-Hispanic White individuals, the Incremental Cost-Effectiveness Ratio (ICER) per modified ZBI-12 indicated a cost saving of USD 9.44 with telehealth visits; among urban-residing racial minorities, the ICER per modified ZBI-12 indicated a cost saving of USD 29.26 with in-person visits; and among rural residents, the ICER per modified ZBI-12 indicated a cost-saving of USD 320.93 with telehealth visits. Distributional differences in the cost-saving effects of telehealth primary care were noted in line with racial and geographic parameters. Workforce and caregiver training is necessary for reducing distributional differences, especially among urban-residing racial monitories living with ADRD in the provider shortage area of the state of Nevada.

Oculogyric Crisis in the Setting of Low Dose Risperidone and Benztropine Mesylate Use in a Patient With Schizophrenia: A Case Report and Review of Literature.

In this case report, we describe a rather unique case of a 37-year-old male patient suffering from schizophrenia who presented with a fixed upwards gaze diagnosed as oculogyric crisis (OGC). This presentation was attributed to the effects of risperidone, a second-generation antipsychotic, while concomitantly taking benztropine mesylate. The latter is a medication commonly used to prevent dystonia in this type of patient population. Interestingly, the dose of risperidone was minimal, and side effects were not expected, making this presentation rare and not often cited or represented in the medical literature, given that second-generation antipsychotics are known to have a safer side effect profile when compared to their counterparts. We also aim to provide a review of the literature on this topic and describe the approach to diagnosis and treatment of such.

Metastasis of Melanoma to the Adrenal Glands: A Case Report and Literature Review.

Immune checkpoint inhibitors have significantly improved the prognosis of metastatic melanoma, but metastases to the adrenal glands remain highly resistant to these new treatments. Adrenal gland metastases from melanoma can present in an unusual manner, such as in this report, making it diagnostically and therapeutically challenging. In this case report, we present a patient with histologically confirmed metastatic melanoma to the adrenal glands, a large intracardiac mass suspicious for metastatic disease, and an inferior vena cava thrombus. We review the existing literature to explain the unique characteristics, clinical relevance, pathogenesis, diagnosis, and treatment of adrenal gland metastases from melanoma.

A Rare Presentation of Undiagnosed Systemic Syphilis: A Case Report and Review of Literature.

Within the specialties of infectious diseases and dermatology, few rashes involve the palms and soles. The syphilitic rash has a pathognomonic association with these body surfaces and signals physicians to investigate this disease. However, the distinct presentations and symptoms associated with syphilis and the various stages of the disease make it diagnostically challenging. We herein report a rather intricate and unusual case of a patient who presented with a new-onset headache and blurred vision and a two-month history of diffuse pruritic maculopapular rash sparing the palms and soles. Several physicians had not established a diagnosis in the outpatient setting. Inpatient workup eventually revealed that the patient was suffering from secondary syphilis with neurological and ocular involvement. Management included a prolonged course of intravenous penicillin G leading to a complete recovery. We share images of the skin findings and the details of the intricate workup and hospital course, as well as a review of the literature.

A Rare Colon Polypectomy Diagnosis: Description of a Unique Investigational Journey and Literature Review of Burkitt Lymphoma.

The presentation of Burkitt lymphoma (BL) is variable and highly dependent on its subtype. It often presents with non-specific symptoms and may appear in the jaw, bone marrow, liver, spleen, kidneys, ovaries, and gastrointestinal tract. This case describes a 50-year-old male who presented with abdominal pain and was eventually found to have Burkitt lymphoma, diagnosed by biopsy of a cecal polyp. Herein, we explore the diagnostic journey to BL and review the literature regarding its unique manifestations and thus the diagnostic challenge it can present.

Third-Degree Heart Block Associated With Saddle Pulmonary Embolism: A Rare Sequelae of COVID-19-Induced Hypercoagulable State.

The pathophysiology of coronavirus disease 2019 (COVID-19) involves multi-organ dysfunction, particularly involving the respiratory, cardiovascular and hematological systems. This dysfunction is partly due to systemic inflammation causing a wide array of pathological sequelae thus posing a significant challenge to management despite the advances in treatment made thus far. In this report, we present a COVID-19 patient who developed a transient complete heart block and was temporarily paced as a complication of a saddle pulmonary embolus (PE). The mechanism of complete heart block is unclear, may be related to strain, ischemia, or vagal response. We believe that this is a unique sequence of events in a COVID-19 patient and, to our knowledge, is the first of its kind to be reported.

Marked Elevation of Carcinoembryonic Antigen Without an Identified Primary Gastrointestinal Tumor.

Whether profound carcinoembryonic antigen (CEA) elevations, such as > 20 times the upper limit of normal, are of diagnostic use remain unknown. Herein, we present a case of a 55-year-old female with profound serum CEA elevation and multiple pelvic masses but with no evidence of a primary gastrointestinal tumor following upper endoscopy and colonoscopy. Subsequent immunostaining of resected pelvic masses confirmed adenocarcinoma of colorectal origin. This case report highlights the possible diagnostic role of profound CEA elevation, particularly in cases of unknown primary tumors.

Barriers and facilitators to recruitment of South Asians to health research: a scoping review.

OBJECTIVES: People of South Asian ethnicity are under-represented in health research studies. The objectives of this scoping review were to examine the barriers and facilitators to recruitment of South Asians to health research studies and to describe strategies for improving recruitment. DESIGN: Scoping review METHODS: Using the Arksey and O'Malley framework for scoping reviews, we comprehensively searched electronic databases (MEDLINE via PubMed, Cochrane Library, CINAHL and PsycINFO). Studies that identified barriers and facilitators to recruitment, or recruitment strategies for South Asian populations were included. Recruitment barriers, facilitators and strategies were grouped thematically and summarised narratively. SYNTHESIS: Of 1846 potentially relevant articles, 15 met the inclusion criteria and were included in the thematic synthesis. Multiple facilitators and barriers to enrolment of South Asians in health research studies were identified; these most commonly related to logistical challenges, language and cultural barriers, concerns about adverse consequences of participating and mistrust of research. Several actionable strategies were discussed, the most common being engagement of South Asian communities, demonstration of cultural competency, provision of incentives and benefits, language sensitivity through the use of translators and translated materials and the development of trust and personal relationships. CONCLUSION: There is a growing awareness of the barriers and facilitators to recruitment of South Asian participants to health research studies. Knowledge of effective recruitment strategies and implementation during the grant funding stages may reduce the risk of poor recruitment and representation of South Asians.