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Mediastinal tissue friability-An unreported complication from Mycobacterium chimaera infection post-cardiac surgery.

by Ahmad, Huzaifa; Molina, Ezequiel J.
Citation: Journal of Cardiac Surgery. 2020 Aug 02.Journal: Journal of cardiac surgery.Published: ; 2020ISSN: 0886-0440.Full author list: Cain CJ; Ahmad H; Molina EJ.UI/PMID: 32740995.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): Case ReportsDigital Object Identifier: https://dx.doi.org/10.1111/jocs.14928 (Click here) Abbreviated citation: J Card Surg. 2020 Aug 02.Abstract: Mycobacterium chimaera can cause disseminated infection following cardiac surgery with cardiopulmonary bypass and contaminated heater-cooler devices. We discuss a 41-year-old man with a disseminated M. chimaera infection following surgery for a type A aortic dissection. His presentation included cachexia and dorsalgia with a work-up revealing vertebral osteomyelitis with an epidural abscess, bone marrow, and pulmonary infiltration, and fluid collection around his aortic graft. He received 1 month of antibiotics before the explantation of infected foreign material, mediastinal debridement, and aortic reconstruction. Complications included septic shock, respiratory and renal failure, mediastinitis, and four distal aortic anastomotic dehiscences from friable tissue and persistent infection. Copyright (c) 2020 Wiley Periodicals LLC.

Hepatotoxicty of Agents Used in the Management of Inflammatory Bowel Disease: a 2020 Update. [Review]

by Barnhill, Michele; Steinberg, Joshua M.
Citation: Current Gastroenterology Reports. 22(9):47, 2020 Jul 15..Journal: Current gastroenterology reports.Published: ; 2020ISSN: 1522-8037.Full author list: Barnhill MS; Steinberg JM; Jennings JJ; Lewis JH.UI/PMID: 32671616.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal Medicine | Medicine/GastroenterologyActivity type: Journal Article.Medline article type(s): Journal Article | ReviewDigital Object Identifier: https://dx.doi.org/10.1007/s11894-020-00781-3 (Click here) Abbreviated citation: Curr Gastroenterol Rep. 22(9):47, 2020 Jul 15.Abstract: PURPOSE OF REVIEW: As treatment options for inflammatory bowel disease (IBD) continue to expand, the opportunity for hepatotoxicity remains a clinical concern. This review looks to update the current literature on drug-induced liver injury (DILI) and liver-related complications from current and emerging treatments for Crohn's disease (CD) and ulcerative colitis (UC).Abstract: RECENT FINDINGS: An extensive literature review on currently used medications to treat IBD and their liver-related side effects that includes mesalamine, thiopurines, certain antibiotics, methotrexate, anti-TNF agents including recently introduced biosimilars, anti-integrin therapy, anti-IL 12/IL 23 therapy, and small molecule JAK inhibitors. Hepatotoxicity remains an important clinical issue when managing patients with IBD. Clinicians need to remain aware of the potential for liver-related adverse events with various medication classes and adjust their clinical monitoring as appropriate based on the agents being used.

Identification of Risk Factors for Testing of Hepatitis C in Non-Birth Cohort Patients: Is Universal Screening Necessary?.

by Basch, Peter; Zeymo, Alexander; Fernandez, Stephen J; Fishbein, Dawn.
Citation: Journal of Addiction Medicine. 2020 Jul 20.Journal: Journal of addiction medicine.Published: ; 2020ISSN: 1932-0620.Full author list: Smart A; Geboy A; Basch P; Nichols W; Zeymo A; Perez I; Hafeez M; Fleisher I; Fernandez S; Fishbein D.UI/PMID: 32732681.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Research Institute | MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): MedStar Institute for Quality and Safety | Medicine/Infectious DiseasesActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1097/ADM.0000000000000702 (Click here) Abbreviated citation: J Addict Med. 2020 Jul 20.Abstract: OBJECTIVES: CDC reported that 45% of Hepatitis C (HCV) infected people denied known risk factors. Electronic health record RF-based, non-Birth Cohort (born outside of years 1945-1965) screening is challenging as risk factors are often input as nonsearchable data. Testing non-Birth Cohort patients solely based on risk factors has the potential to miss a substantial number of HCV infected patients. The aim was to determine the HCV antibody positive prevalence who would have been missed had providers only followed risk factor based screening recommendations.Abstract: METHODS: A 1:3 case-control retrospective nested chart review was conducted. HCV risk factors and opioid prescriptions were manually abstracted from the Electronic Health Record; other variables were collected using Explorys. In July 2015 HCV screening data was collected on non-Birth Cohort patients who were HCV tested across MedStar Health, as a presumptive marker for high risk. Univariate and multivariate logistic regression models were utilized to determine HCV antibody positive predictors.Abstract: RESULTS: Eighteen (23%) HCV antibody positive and 123 (49%) HCV antibody negative had no identified risk factors; 6 (33%) HCV antibody positive reported risk factors only after a positive test result. There was a significant interaction between age over 40 and opioid prescription use; these groups were 11x more likely to be HCV antibody positive (CI95 1.6-74.8).Abstract: CONCLUSIONS: HCV testing solely based on presence of risk factors in non-Birth Cohort patients has the potential to miss a significant number of HCV antibody positive patients. Given patient- and provider-level barriers in elucidating risk factors, universal HCV antibody screening may be warranted.

Cardiovascular complications in COVID-19.

by Butt, Nausharwan; Khalid, Nauman.
Citation: American Journal of Emergency Medicine. 2020 Jul 19.Journal: The American journal of emergency medicine.Published: ; 2020ISSN: 0735-6757.Full author list: Butt N; Arshid A; Ahmad SA; Khalid N; Kayani WT.UI/PMID: 32713605.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): LetterOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.ajem.2020.07.032 (Click here) Abbreviated citation: Am J Emerg Med. 2020 Jul 19.

Intravascular Lithotripsy. [Review]

by Butt, Nausharwan; Khalid, Nauman; Shlofmitz, Evan.
Citation: StatPearls Publishing. 2020 01.Published: ; 2020Full author list: Butt N; Khalid N; Shlofmitz E.UI/PMID: 32809383.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): ReviewAbbreviated citation: StatPearls Publishing. 2020 01.Abstract: Coronary artery calcification (CAC) is an independent predictor for major cardiovascular events.[1][2][3][4] Additionally, coronary calcium deposition can hinder successful percutaneous coronary intervention (PCI) as a result of inadequate stent expansion, difficulty transiting the catheter through a calcified lesion, coated drug separation from a stent, proclivity for in-stent restenosis and stent thrombosis, and a change to the underlying pharmacokinetics. Consequently, PCI of calcified lesions correlates with worse outcomes.[5] Shockwave intravascular lithotripsy (IVL) is a novel technique evolved from the established therapy for renal and ureteral calculi that utilizes a percutaneous device to produce acoustic pressure waves resulting in the delivery of energy to break superficial and deep calcium deposits and aid with the subsequent deployment of a vascular stent.[6][7][8] Guidance with an intravascular imaging device either with intravascular ultrasound or optical coherence tomography is crucial in defining the calcium density and choosing the optimal lesion modification strategy, i.e., rotational atherectomy, orbital atherectomy or IVL.[9][10][11][12][13] The feasibility and safety of IVL in the peripheral vasculature was shown in the Disrupt Peripheral Arterial Disease (PAD) studies and the Disrupt Below the Knee (BTK) study.[14][15][16] The Disrupt PAD III study (ClinicalTrials.gov Identifier: NCT02923193) is currently an ongoing prospective multicenter single-arm observational study assessing treatment of moderate and severely calcified femoropopliteal arteries. The disrupt Coronary Artery Disease studies I and II demonstrated the safety and feasibility of IVL in calcified coronary lesions.[17][6] The Disrupt CAD III (ClinicalTrials.gov Identifier: NCT03595176) is an ongoing prospective, multicenter, single-arm study evaluating the safety and effectiveness of IVL in de novo calcified coronary arteries. Copyright (c) 2020, StatPearls Publishing LLC.

Comprehensive assessment of coronary computed tomography angiography by using Leaman and Leiden score in overweight and obese patients.

by Butt, Nausharwan; Parajuli, Sabin; Ali, Laith; Yacob, Omar; Melaku, Gebremedhin; Hideo-Kajita, Alexandre; Weissman, Gaby; Garcia-Garcia, Hector M.
Citation: The International Journal of Cardiovascular Imaging. 2020 Jul 31.Journal: The international journal of cardiovascular imaging.Published: ; 2020ISSN: 1569-5794.Full author list: Butt N; Parajuli S; Ali L; Yacob O; Melaku GD; Hideo-Kajita A; Weissman G; Garcia-Garcia HM.UI/PMID: 32737708.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): Medicine/General Internal Medicine | Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1007/s10554-020-01938-x (Click here) ORCID: Garcia-Garcia, Hector M http://orcid.org/0000-0001-9642-5182 (Click here) Abbreviated citation: Int J Cardiovasc Imaging. 2020 Jul 31.Abstract: Coronary computed tomography angiography (CCTA) is a non-invasive modality used to assess for coronary artery disease. The CT Leaman and Leiden scores utilize coronary plaque location, composition and severity of stenosis to risk stratify patients for cardiovascular events with remarkable precision. This study compares the CCTA Leaman and Leiden score between overweight and obese populations in addition to their associated baseline characteristics. All patients who underwent CCTA within the last 1 year from a single institution were included for initial analysis. Body mass index (BMI) was used to classify patients who were overweight (25.0 to < 30 kg/m2) or obese (>= 30 kg/m2). Patients with a BMI of < 25 kg/m2 were excluded from further analysis. Patients were divided into overweight and obese groups. CT Leaman and Leiden scores, in addition to baseline characteristics were subsequently compared between the two groups. Overall, a strong correlation between CT Leaman and Leiden scores was found (R2 = 0.9831). Patients classified as obese have more coronary lesions 0.71 +/- 0.12 vs 0.31 +/- 0.50 in overweight patients (p = 0.02) and tended to have a higher positive CT Leiden (5.47 +/- 4.10 vs 3.90 +/- 1.36, p = 0.2) and Leaman (3.45 +/- 2.58 vs 2.35 +/- 0.90, p = 0.1). Furthermore, obese patients with a Leiden score > 5 had significantly higher scores compared to overweight patients (10.22 +/- 2.54 vs 5.87 +/- 0.64, p = 0.016). Obese patients had similar average CT Leaman and Leiden scores compared to overweight individuals but were more likely to have higher CT Leiden scores > 5 which may indicate a higher risk for adverse cardiovascular outcomes.

Monckeberg Medial Calcific Sclerosis of the Temporal Artery Masquerading as Giant Cell Arteritis: Case Reports and Literature Review.

by Chetram, Vishaka K.
Citation: Cureus. 12(7):e9210, 2020 Jul 15..Journal: Cureus.Published: ; 2020ISSN: 2168-8184.Full author list: Cuevas Castillo FJ; Sujanani S; Chetram VK; Elfishawi M; Abrudescu A.UI/PMID: 32754413.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Case ReportsOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.7759/cureus.9210 (Click here) Abbreviated citation: Cureus. 12(7):e9210, 2020 Jul 15.Abstract: Monckeberg medial calcific sclerosis (MCS) is an infrequent finding in the temporal artery and can clinically present almost indistinguishably from giant cell arteritis (GCA). To our knowledge, there have been only two case reports of suspected GCA found to be MCS only after a temporal artery biopsy (TAB). Herein, we present two cases. The first case is a 69-year-old female with hypertension, type-2 diabetes mellitus, and chronic headaches who presented with left temporal headaches and scalp tenderness. She had a prominently dilated, tortuous, and tender left temporal artery. Initial labs showed a leukocyte count of 11.1x103/L, erythrocyte sedimentation rate (ESR) of 29 mm/hr, and C-reactive protein (CRP) of 5.8 mg/L. The patient was started on prednisone 60 mg for presumptive GCA. Left TAB was negative for inflammatory changes, with findings consistent with MCS. Steroids were discontinued, and symptoms resolved. The second case is a 67-year-old male with hypertension, asthma, hyperlipidemia, status-post left eye cataract phacoemulsification, with intraocular lens insertion one-month prior, who presented with left eye blurriness in the inferior visual field and intermittent headache for 15 days. Left ophthalmoscopy showed retinal pallor and edema. Initial labs revealed ESR of 25 mm/hr, CRP of 11.2 mg/L, leukocyte count of 13.01x103/L. The patient was given solumedrol 120 mg once and prednisone 70 mg daily for presumptive GCA. Left TAB was negative for GCA but reported damaged elastic fibers by calcification consistent with MCS. Partial visual blurriness remained, and steroids were discontinued. This report accentuates the importance of MCS as a temporal GCA simulator. Physicians should be aware that TAB potentially changes management and may help surface underlying conditions. Copyright (c) 2020, Cuevas Castillo et al.

Comparison of plaque distribution and wire-free functional assessment in patients with stable angina and non-ST elevation myocardial infarction: an optical coherence tomography and quantitative flow ratio study.

by Dan, Kazuhiro; Garcia-Garcia, Hector M; Yacob, Omar; Kuku, Kayode; Kolm, Paul; Waksman, Ron; Mahmoudi, Michael.
Citation: Coronary Artery Disease. 2020 Aug 19.Journal: Coronary artery disease.Published: ; 2020ISSN: 0954-6928.Full author list: Dan K; Garcia-Garcia HM; Yacob O; Kuku KO; Kolm P; Shah N; Bennett MR; Curzen N; Waksman R; Mahmoudi M.UI/PMID: 32826449.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1097/MCA.0000000000000944 (Click here) Abbreviated citation: Coron Artery Dis. 2020 Aug 19.Abstract: BACKGROUND: Data comparing plaque characteristics and wire-free physiological assessment in the target vessel in patients with stable angina versus acute coronary syndrome are sparse. Therefore, we investigated the difference in plaque distribution between stable angina and non-ST-elevation myocardial infarction (NSTEMI) and explored the relationship between target vessel vulnerability by optical coherence tomography (OCT) and wire-free functional assessment with quantitative flow ratio (QFR).Abstract: METHODS: Patients with stable angina (n = 25) and NSTEMI (n = 24) were in the final prospective study cohort from the DECODE study (ClinicalTrials.gov, NCT02335086). All 5480 OCT frames in the region of interest were analyzed to study plaque morphology in the target vessel. QFR was analyzed from baseline coronary angiography before percutaneous coronary intervention. Vulnerable vessel score (VVS) was calculated from each plaque, and vessel QFR was then compared.Abstract: RESULTS: Out of all frames, thin-cap fibroatheroma was common with NSTEMI compared to stable angina (10.9 versus 6.3%, P < 0.01), while fibrous plaque was more commonly seen with stable angina compared to NSTEMI (19.7 versus 14.4%, P < 0.01). Calcified plaque was similar in both clinical settings (approximately 6%). Regression analysis showed that segments with normal vessel walls were located significantly farther from the other plaque types. Longitudinal distances for plaque-type in NSTEMI were numerically greater than those for stable angina; however, the mean difference was less than 10 mm. The VVS had a significant inverse linear correlation with QFR (r = -0.34, P = 0.009).Abstract: CONCLUSIONS: The plaque distribution by OCT between stable angina and NSTEMI was similar. Target vessel vulnerability was greater in patients with lower QFR value.

Lymphoma survivors have an increased long-term risk of chronic kidney disease.

by Desai, Sanjal; Al-Shbool, Ghassan; Desale, Sameer; Veis, Judith; Malkovska, Vera.
Citation: Leukemia & Lymphoma. :1-8, 2020 Jul 11.Journal: Leukemia & lymphoma.Published: ; 2020ISSN: 1026-8022.Full author list: Desai SH; Al-Shbool G; Desale S; Veis J; Malkovska V.UI/PMID: 32654590.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular Institute | Washington Cancer InstituteDepartment(s): Medicine/Internal Medicine | Medicine/NephrologyActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1080/10428194.2020.1786555 (Click here) ORCID: Desai, Sanjal H https://orcid.org/0000-0002-7892-2625 (Click here) Abbreviated citation: Leuk Lymphoma. :1-8, 2020 Jul 11.Abstract: With improving lymphoma survival, late effects of therapy have emerged. Here, we describe pattern of long-term chronic kidney disease (CKD) in lymphoma survivors. Demographics, comorbidities, lymphoma histology, treatment, and outcome were recorded. Glomerular filtration rate (GFR) was recorded at diagnosis, 1, 2, 5, and 10 years. Rate of GFR decline with time and CKD-free survival were recorded. In 397 patients, median age was 55.3 (18-88), 54% were male, 60% were African Americans, 42% had hypertension (HTN), 15% had DM, 13% had hyperuricemia, 86% received chemotherapy, and 14% had baseline CKD. Total 125 (31%) patients developed CKD in 10 years after lymphoma diagnosis. Probability of CKD development increased significantly with time (23% at 1 year to 41% at 10 years). Rate of GFR decline was 4.6 mL/min/per year. Age, HTN, hyperuricemia, and DM (in young patients) predicted risk of CKD. Thus, lymphoma survivors are at substantial long-term risk of CKD development.

Uncommon Anatomic Predisposition to Myocardial Infarction: A Case of Coronary Artery Ectasia.

by Ghazzal, Amre; Ali, Laith; Radwan, Sohab; Gill, Gauravpal S; Garcia-Garcia, Hector M.
Citation: Cureus. 12(7):e9035, 2020 Jul 06..Journal: Cureus.Published: ; 2020ISSN: 2168-8184.Full author list: Ghazzal A; Ali L; Radwan S; Gill GS; Garcia-Garcia HM.UI/PMID: 32782857.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Case ReportsOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.7759/cureus.9035 (Click here) Abbreviated citation: Cureus. 12(7):e9035, 2020 Jul 06.Abstract: Coronary artery ectasia (CAE) is a recognized cause of acute coronary syndrome (ACS), and can be associated with life-threatening complications, including thrombus formation with consequent distal coronary artery embolization. Several studies have demonstrated a higher incidence of cardiovascular adverse events and cardiac death in patients with CAE or coronary artery aneurysms compared to those without such abnormalities. Management of symptomatic CAE is similar to coronary artery disease (CAD), where guideline-directed medical therapy is indicated due to coexistence of CAD with acquired CAE. Percutaneous coronary intervention can be attempted; however, it is challenging, as it is associated with lower procedural success, higher rates of stent thrombosis, and repeat revascularization. Copyright (c) 2020, Ghazzal et al.

Detection of BRAFV600E in Liquid Biopsy from Patients with Papillary Thyroid Cancer Is Associated with Tumor Aggressiveness and Response to Therapy.

by Gomes-Lima, Cristiane J; Wartofsky, Leonard; Burman, Kenneth D; Bikas, Athanasios.
Citation: Journal of Clinical Medicine. 9(8), 2020 Aug 02..Journal: Journal of clinical medicine.Published: ; 2020ISSN: 2077-0383.Full author list: Jensen K; Thakur S; Patel A; Mendonca-Torres MC; Costello J; Gomes-Lima CJ; Walter M; Wartofsky L; Burman KD; Bikas A; Ylli D; Vasko VV; Klubo-Gwiezdzinska J.UI/PMID: 32748840.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment(s): Medicine/EndocrinologyActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.3390/jcm9082481 (Click here) Abbreviated citation: J. Clin. Med.. 9(8), 2020 Aug 02.Abstract: The detection of rare mutational targets in plasma (liquid biopsy) has emerged as a promising tool for the assessment of patients with cancer. We determined the presence of cell-free DNA containing the BRAFV600E mutations (cfBRAFV600E) in plasma samples from 57 patients with papillary thyroid cancer (PTC) with somatic BRAFV600E mutation-positive primary tumors using microfluidic digital PCR, and co-amplification at lower denaturation temperature (COLD) PCR. Mutant cfBRAFV600E alleles were detected in 24/57 (42.1%) of the examined patients. The presence of cfBRAFV600E was significantly associated with tumor size (p = 0.03), multifocal patterns of growth (p = 0.03), the presence of extrathyroidal gross extension (p = 0.02) and the presence of pulmonary micrometastases (p = 0.04). In patients with low-, intermediate- and high-risk PTCs, cfBRAFV600E was detected in 4/19 (21.0%), 8/22 (36.3%) and 12/16 (75.0%) of cases, respectively. Patients with detectable cfBRAFV600E were characterized by a 4.68 times higher likelihood of non-excellent response to therapy, as compared to patients without detectable cfBRAFV600E (OR (odds ratios), 4.68; 95% CI (confidence intervals)) 1.26-17.32; p = 0.02). In summary, the combination of digital polymerase chain reaction (dPCR) with COLD-PCR enables the detection of BRAFV600E in the liquid biopsy from patients with PTCs and could prove useful for the identification of patients with PTC at an increased risk for a structurally or biochemically incomplete or indeterminate response to treatment.

Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department.

by Goyal, Munish; Magee, Michelle.
Citation: The Western Journal of Emergency Medicine. 21(4):959-963, 2020 Jul 03..Journal: The western journal of emergency medicine.Published: ; 2020ISSN: 1936-900X.Full author list: Nhoung HK; Goyal M; Cacciapuoti M; Day H; Hashemzadeh T; Magee M; Jarris YS.UI/PMID: 32726270.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Emergency Medicine | Medicine/EndocrinologyActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.5811/westjem.2020.4.45918 (Click here) Abbreviated citation: West J Emerg Med. 21(4):959-963, 2020 Jul 03.Abstract: INTRODUCTION: The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter.Abstract: METHODS: This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing.Abstract: RESULTS: Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than non-food insecure patients (relative risk = 1.90 [1.21-2.99], p<.01). Food insecure patients were younger than non-food insecure patients (50.4 vs 57.5 p<.02), and had significantly higher hemoglobin A1c (HgbA1c) levels (11.2% vs 9.9% p = 0.04). Of the 49 patients prescribed insulin, 17 (34.6%) stated they had used less insulin during the prior week than had been prescribed, and 21 (42.9%) stated they had used less insulin during the prior year than had been prescribed. Food insecure patients were more likely to have used less insulin than prescribed in the prior year (odds ratio = 3.60 [1.09-11.9], p = 0.04).Abstract: CONCLUSION: Our exploratory findings suggest almost half of clinically stable adults presenting to our inner-city ED with hyperglycemia experience food insecurity. More than one-third of those prescribed insulin used less than their prescribed amount in the prior year.

Combined stress myocardial CT perfusion and coronary CT angiography as a feasible strategy among patients presenting with acute chest pain to the emergency department.

by Grandhi, Gowtham R.
Citation: Journal of cardiovascular computed tomography. 2020 Jul 29.Journal: Journal of cardiovascular computed tomography.Published: ; 2020ISSN: 1876-861X.Full author list: Grandhi GR; Batlle JC; Maroules CD; Janowitz W; Pena CS; Ziffer JA; Macedo R; Nasir K; Cury RC.UI/PMID: 32807703.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Union Memorial HospitalDepartment(s): MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jcct.2020.06.195 (Click here) Abbreviated citation: J Cardiovasc Comput Tomogr. 2020 Jul 29.Abstract: BACKGROUND: A combined approach of myocardial CT perfusion (CTP) with coronary CT angiography (CTA) was shown to have better diagnostic accuracy than coronary CTA alone. However, data on cost benefits and length of stay when compared to other perfusion imaging modalities has not been evaluated. Therefore, we aim to perform a feasibility study to assess direct costs and length of stay of a combined stress CTP/CTA and use SPECT myocardial perfusion imaging (SPECT-MPI) as a benchmark, among chest pain patients at intermediate-risk for acute coronary syndrome (ACS) presenting to the emergency department (ED).Abstract: METHODS: This is a prospective two-arm clinical trial (NCT02538861) with 43 patients enrolled in stress CTP/CTA arm (General Electric Revolution CT) and 102 in SPECT-MPI arm. Mean age of the study population was 65 +/- 12 years; 56% were men. We used multivariable linear regression analysis to compare length of stay and direct costs between the two modalities.Abstract: RESULTS: Overall, 9 out of the 43 patients (21%) with CTP/CTA testing had an abnormal test. Of these 9 patients, 7 patients underwent invasive coronary angiography and 6 patients were found to have obstructive coronary artery disease. Normal CTP/CTA test was found in 34 patients (79%), who were discharged home and all patients were free of major adverse cardiac events at 30 days. The mean length of stay was significantly shorter by 28% (mean difference: 14.7 h; 95% CI: 0.7, 21) among stress CTP/CTA (20 h [IQR: 16, 37]) compared to SPECT-MPI (30 h [IQR: 19, 44.5]). Mean direct costs were significantly lower by 44% (mean difference: Abstract: CONCLUSION: Combined stress CTP/CTA is a feasible strategy for evaluation of chest pain patients presenting to ED at intermediate-risk for ACS and has the potential to lead to shorter length of stay and lower direct costs. Copyright (c) 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Metastatic Calcinosis of Gastric Mucosa.

by Jhaveri, Khushali.
Citation: Journal of Investigative Medicine High Impact Case Reports. 8:2324709620940482, 2020 Jan-Dec..Journal: Journal of investigative medicine high impact case reports.Published: ; 2020ISSN: 2324-7096.Full author list: Kosuru V; Mohammed A; Kapoor R; Jhaveri K; Medepalli V; Mulloy L; Padala SA.UI/PMID: 32677845.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1177/2324709620940482 (Click here) Abbreviated citation: J. investig. med. high impact case rep.. 8:2324709620940482, 2020 Jan-Dec.Abstract: Calcinosis cutis refers to the deposition of calcium salts in the cutaneous and subcutaneous tissue and is frequently associated with inflammation. Gastric calcinosis can be classified into metastatic, dystrophic, and idiopathic; metastatic calcinosis is the most common type. In metastatic calcification, calcium salts are deposited in normal soft tissues in the setting of altered metabolism of serum calcium and phosphorus and is a rare and serious complication of chronic renal failure. The important factors contributing to the development of metastatic calcinosis are hypercalcemia, hyperphosphatemia, and an elevated calcium-phosphate product. The most striking feature of this diagnosis is the calcification around the large joints. While it mostly involves dermis of small and medium-sized vessels, it can rarely affect the mucosal layers of the gastrointestinal (GI) tract. Calcinosis presents as a marker for the presence of calcifications in other organs, such as heart or lung, which can be life-threatening. Patients rarely present with clinical symptoms of GI upset, dyspepsia, or epigastric pain that are attributed to calcinosis. If patients present with GI symptoms, infectious causes remain to be higher on the differential. We present a case of incidental finding of gastric mucosal calcinosis during the workup and treatment of dysphagia.

The Impact of Clostridium Difficile Infections on In-Hospital Outcomes of Venous Thromboembolism (Deep Vein Thrombosis or Pulmonary Embolism) Hospitalizations.

by Jhaveri, Khushali; Som, Aniruddh.
Citation: Cureus. 12(7):e9195, 2020 Jul 15..Journal: Cureus.Published: ; 2020ISSN: 2168-8184.Full author list: Jhaveri K; Som A; Padala SA; Surani S.UI/PMID: 32685328.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.7759/cureus.9195 (Click here) Abbreviated citation: Cureus. 12(7):e9195, 2020 Jul 15.Abstract: Background Clostridium difficile infection (CDI) is associated with high mortality. Studies have shown an increased rate of venous thromboembolism (VTE) in patients with CDI. However, literature regarding the impact of CDI on outcomes of VTE-related hospitalizations is scarce. Our study aimed to assess the impact of CDI on in-hospital outcomes among VTE hospitalizations. Methods The 2016 National Inpatient Sample (NIS) was used to identify all adult hospitalizations in the United States with a primary discharge diagnosis of acute VTE. Hospitalizations with deep vein thrombosis (DVT) or pulmonary embolism (PE) were included under VTE. The sample was stratified based on the presence or absence of active CDI. Chi-square test and weighted Student's t-test were used to analyze categorical and continuous variables, respectively. The adjusted odds ratio (OR) for clinical outcomes were calculated using multivariate logistic regression analysis. Subgroup analyses for DVT and PE hospitalizations were performed. All analyses were completed in SAS (SAS Institute Inc., Cary, NC), and a p-value of <0.05 was considered statistically significant. Results We identified 382,585 weighted hospitalizations for VTE. Among them, 0.8% had concomitant CDI. The presence of CDI was associated with a statistically significant increase in in-hospital mortality (6% vs. 3%), hospitalization cost (

Characterization of the Demographics and Psychiatric Co-Morbidites Among Clients of a Human Rights Clinic in Miami-Dade County, Florida, United States.

by Kareff, Samuel.
Citation: Cureus. 12(7):e8944, 2020 Jul 01..Journal: Cureus.Published: ; 2020ISSN: 2168-8184.Full author list: Kareff S; Diaz C; Zeigler A; Faulkenberry JG; Utter BF; Barber CM; Symes S.UI/PMID: 32765989.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.7759/cureus.8944 (Click here) Abbreviated citation: Cureus. 12(7):e8944, 2020 Jul 01.Abstract: Miami-Dade County (MDC) represents a major port of entry for people seeking asylum in the United States, and few studies have systematically evaluated the demographic characteristics of this vulnerable population. Moreover, while the burden of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are thought to be higher in this population, the prevalence of these psychiatric conditions in our community is unknown. An analysis of demographics and psychiatric co-morbidities of the Human Rights Clinic (HRC) of Miami's 93 clients between 2010 and 2015 was conducted. The HRC cohort had the following characteristics: median age of 30 years, 52% female, 46% male, 2% transgender or intersex, and 88% originating from Latin America and the Caribbean. The prevalence of PTSD was 67% and MDD was 53% in the HRC population. We conclude that the mental health burden in asylum-seekers in MDC is alarmingly high and that healthcare providers should remain keenly attentive to the unique needs of this population. Copyright (c) 2020, Kareff et al.

COVID-19: associated morbidity and mitigation strategies.

by Mahmood, Syed Nazeer; Woods, Christian J; Chan, Chee Man.
Citation: Infectious Diseases. :1-4, 2020 Jul 29.Journal: Infectious diseases (London, England).Published: ; 2020ISSN: 2374-4243.Full author list: Mahmood SN; Woods CJ; Chan CM.UI/PMID: 32726166.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Pulmonary-Critical CareActivity type: Journal Article.Medline article type(s): LetterDigital Object Identifier: https://dx.doi.org/10.1080/23744235.2020.1799071 (Click here) ORCID: Mahmood, Syed Nazeer https://orcid.org/0000-0002-3037-4084 (Click here) Abbreviated citation: Infect Dis (Lond). :1-4, 2020 Jul 29.

Intermittent left bundle branch block and acute heart failure in trastuzumab-induced cardiotoxicity.

by Masson, Ravi.
Citation: BMJ Case Reports. 13(7), 2020 Jul 28..Journal: BMJ case reports.Published: ; 2020ISSN: 1757-790X.Full author list: Masson R; Bakhshi H; Haddad TM.UI/PMID: 32723779.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1136/bcr-2020-236009 (Click here) Abbreviated citation: BMJ Case Rep. 13(7), 2020 Jul 28.Abstract: A 70-year-old woman with HER2+/ER+ breast cancer on adjuvant trastuzumab therapy without a history of cardiovascular disease presented with respiratory failure from influenza and was found to have intermittent left bundle branch block (LBBB) with new onset systolic heart failure. Her course was complicated by polymorphic ventricular tachycardia and recurrent chest pain. Significant investigations included a normal cardiac MRI and cardiac catheterisation with unobstructed coronaries. It was determined that the aetiology of her heart failure was trastuzumab-induced cardiotoxicity after comprehensive workup. This case highlights an uncommon presentation of LBBB and the steps taken to diagnose a rare cardiomyopathy. Copyright (c) BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

A Rare Presentation of Choledochoduodenal Fistula Due to Ovarian Cancer Metastasis.

by Misra, Deeksha; Mirza, Usman.
Citation: Journal of Investigative Medicine High Impact Case Reports. 8:2324709620934680, 2020 Jan-Dec..Journal: Journal of investigative medicine high impact case reports.Published: ; 2020ISSN: 2324-7096.Full author list: Misra D; Mirza U; Vakiti A; Padala SA.UI/PMID: 32539554.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1177/2324709620934680 (Click here) Abbreviated citation: J. investig. med. high impact case rep.. 8:2324709620934680, 2020 Jan-Dec.Abstract: Choledochoduodenal fistula (CDF) is an abnormal communication between the common bile duct and the duodenum. It accounts for about 5% to 25% of the total biliary fistulas and is usually due to a perforated duodenal ulcer, choledocholithiasis, and complications secondary to tuberculosis or could be iatrogenic. Primary intrabilliary tumors usually cause obstructive jaundice and rarely biliary metastasis arising from other organs like colon, breast, and lungs can cause obstructive jaundice. There has been a case report of metastasis from ovarian cancer to the major papilla of the duodenum but no reported cases of it causing a CDF. We report a rare case of an 83-year-old female with ovarian cancer who developed a metastatic lesion to the duodenum eventually resulting in a CDF.

Pathophysiology and Acute Management of Tachyarrhythmias in Pheochromocytoma: JACC Review Topic of the Week. [Review]

by Nazari, Matthew.
Citation: Journal of the American College of Cardiology. 76(4):451-464, 2020 Jul 28..Journal: Journal of the American College of Cardiology.Published: ; 2020ISSN: 0735-1097.Full author list: Nazari MA; Rosenblum JS; Haigney MC; Rosing DR; Pacak K.UI/PMID: 32703516.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal Article | ReviewOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jacc.2020.04.080 (Click here) Abbreviated citation: J Am Coll Cardiol. 76(4):451-464, 2020 Jul 28.Abstract: Pheochromocytomas, arising from chromaffin cells, produce catecholamines, epinephrine and norepinephrine. The tumor biochemical phenotype is defined by which of these exerts the greatest influence on the cardiovascular system when released into circulation in high amounts. Action on the heart and vasculature can cause potentially lethal arrhythmias, often in the setting of comorbid blood pressure derangements. In a review of electrocardiograms obtained on pheochromocytoma patients (n = 650) treated at our institution over the last decade, severe and refractory sinus tachycardia, atrial fibrillation, and ventricular tachycardia were found to be the most common or life-threatening catecholamine-induced tachyarrhythmias. These arrhythmias, arising from catecholamine excess rather than from a primary electrophysiologic substrate, require special considerations for treatment and complication avoidance. Understanding the synthesis and release of catecholamines, the adrenoceptors catecholamines bind to, and the cardiac and vascular response to epinephrine and norepinephrine underlies optimal management in catecholamine-induced tachyarrhythmias. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Combining Biomarkers and Imaging for Short-Term Assessment of Cardiovascular Disease Risk in Apparently Healthy Adults: A Paradigm-Shifting Approach?.

by Osei, Albert D.
Citation: Journal of the American Heart Association. 9(15):e017790, 2020 Aug 04..Journal: Journal of the American Heart Association.Published: ; 2020ISSN: 2047-9980.Full author list: Osei AD; Blaha MJ.UI/PMID: 32698709.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Union Memorial HospitalDepartment(s): MedicineActivity type: Journal Article.Medline article type(s): EditorialOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1161/JAHA.120.017790 (Click here) Abbreviated citation: J Am Heart Assoc. 9(15):e017790, 2020 Aug 04.

Disrupting the Electrical Circuit: New Onset Atrial Fibrillation in a Patient With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

by Radwan, Sohab; Schwartz, Owen.
Citation: Cureus. 12(7):e9082, 2020 Jul 09..Journal: Cureus.Published: ; 2020ISSN: 2168-8184.Full author list: Radwan S; Schwartz O.UI/PMID: 32670726.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Case ReportsOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.7759/cureus.9082 (Click here) Abbreviated citation: Cureus. 12(7):e9082, 2020 Jul 09.Abstract: In December 2019, an outbreak of pneumonia cases in Wuhan, China was attributed to a novel coronavirus that was eventually recognized as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently identified as coronavirus disease 2019 (COVID-19), it has been declared a pandemic by the World Health Organization given its rapid global transmission. Various cardiovascular complications have been reported, including heart failure, myocarditis, acute coronary syndrome and arrhythmias, both atrial and ventricular. Regarding arrhythmias, onset from time of infection is variable but usually ranges from several days to a week. We hereby present a case of a COVID-19 positive patient presenting with new onset atrial fibrillation. Copyright (c) 2020, Radwan et al.

Air Bubbles in the Heart: A Case of Contrast Media Injection-Induced Venous Air Embolism.

by Radwan, Sohab; Shepperd, Scott.
Citation: Cureus. 12(6):e8708, 2020 Jun 20..Journal: Cureus.Published: ; 2020ISSN: 2168-8184.Full author list: Radwan S; Shepperd S.UI/PMID: 32582502.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Case ReportsOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.7759/cureus.8708 (Click here) Abbreviated citation: Cureus. 12(6):e8708, 2020 Jun 20.Abstract: Venous air embolism (VAE) is more frequently recognized nowadays with the increased use of computed tomography (CT). It may be detected during or even after intravenous contrast media injection. A wide range of clinical manifestations exist, ranging from an incidental finding in a clinically asymptomatic patient to obstructive shock and circulatory failure. Those found incidentally are usually small and have no significant effect on circulatory physiology. Larger air emboli, however, may be potentially fatal, and therefore it is important to recognize such a phenomenon in the setting of intravenous contrast media injection. Copyright (c) 2020, Radwan et al.

Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking.

by Siddiqi, Anees; Chaudhary, Fizah S; Naqvi, Haider A; Saleh, Nahar; Farooqi, Rehan; Yousaf, Muhammad Nadeem.
Citation: BMJ Open Gastroenterology. 7(1), 2020 Aug..Journal: BMJ open gastroenterology.Published: ; 2020ISSN: 2054-4774.Full author list: Siddiqi A; Chaudhary FS; Naqvi HA; Saleh N; Farooqi R; Yousaf MN.UI/PMID: 32788199.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Health Baltimore Residents | MedStar Union Memorial HospitalDepartment(s): MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1136/bmjgast-2020-000466 (Click here) Abbreviated citation: BMJ Open Gastroenterol. 7(1), 2020 Aug.Abstract: Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival. Copyright (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

It Is Not Pneumonia! A Case of Unilateral Pulmonary Edema.

by Stingo, Facundo E; Sallam, Tariq; Ammar, Hussam.
Citation: American Journal of Medicine. 2020 Jul 24.Journal: The American journal of medicine.Published: ; 2020ISSN: 0002-9343.Full author list: Stingo FE; Sallam T; Govindu R; Ammar H.UI/PMID: 32712144.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Case ReportsOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.amjmed.2020.05.050 (Click here) Abbreviated citation: Am J Med. 2020 Jul 24.

Uremic Stomatitis.

by Talish, Mishaal; DiLorenzo, Ashley M.
Citation: New England Journal of Medicine. 382(26):2556, 2020 Jun 25..Journal: The New England journal of medicine.Published: ; 2020ISSN: 0028-4793.Full author list: Talish M; DiLorenzo AM.UI/PMID: 32579815.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/General Internal Medicine | DermatologyActivity type: Journal Article.Medline article type(s): Case Reports | Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1056/NEJMicm1914867 (Click here) Abbreviated citation: N Engl J Med. 382(26):2556, 2020 Jun 25.

The impact of intensive laparoscopic training course with structured assessment and immediate feedback on residents' operative performance in animal lab.

by Tran, Tung.
Citation: Surgical Endoscopy. 2020 Jul 08.Journal: Surgical endoscopy.Published: ; 2020ISSN: 0930-2794.Full author list: Ghaderi I; Tran T; Carton M; Samame J; Galvani C.UI/PMID: 32642846.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1007/s00464-020-07778-z (Click here) Abbreviated citation: Surg Endosc. 2020 Jul 08.Abstract: INTRODUCTION: The objective of this study was to examine the impact of an intensive laparoscopic training course incorporating structured assessment and immediate feedback on residents' operative performance in animal lab.Abstract: METHODS: Surgical residents participated in a 2-day intensive laparoscopic training course. They performed the same procedures on two consecutive days on live pigs. Junior residents (PGY1-2) performed laparoscopic cholecystectomy and incisional hernia repair and the senior residents (PGY3-5) performed laparoscopic Nissen fundoplication, splenectomy, and low anterior colon resection. Assessment tools with proven validity evidence (global and procedure-specific rating tools for operative assessment of laparoscopic skills) were used to assess their operative performance. Faculty assessment and self-assessments were completed immediately after each procedure on both days. The Wilcoxon rank test was used to examine the effect of training on resident performance after one repetition.Abstract: RESULTS: Forty surgical residents (20 junior and 20 senior residents) participated. There was a significant improvement in general laparoscopic skills during incisional hernia repair and Nissen fundoplication using global rating scales (p < 0.05). Moreover, there was an improvement in their performance during cholecystectomy, incisional hernia repair, and low anterior colectomy when procedure-specific skills assessments were used (p < 0.05). There was a positive correlation between residents' self-reported confidences and their operative performance CONCLUSION: Trainees showed significant improvements in performance in general and procedure-specific laparoscopic skills in a wide range of procedures after an intensive training course. This study demonstrates the benefit of a structured training curriculum in improving operative performance in basic and advanced laparoscopic skills in a simulated environment. Future studies are needed to examine the duration of training required to achieve skill retention and competency.

Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology.

by Van Nostrand, Douglas.
Citation: Head & Neck. 2020 Aug 19.Journal: Head & neck.Published: ; 2020ISSN: 1043-3074.Full author list: Singer MC; Marchal F; Angelos P; Bernet V; Boucai L; Buchholzer S; Burkey B; Eisele D; Erkul E; Faure F; Freitag SK; Gillespie MB; Harrell RM; Hartl D; Haymart M; Leffert J; Mandel S; Miller BS; Morris J; Pearce EN; Rahmati R; Ryan WR; Schaitkin B; Schlumberger M; Stack BC; Van Nostrand D; Wong KK; Randolph G.UI/PMID: 32812307.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Nuclear MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1002/hed.26417 (Click here) Abbreviated citation: Head Neck. 2020 Aug 19.Abstract: BACKGROUND: Postoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement.Abstract: METHODS: A multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations.Abstract: RESULTS: Consensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management.Abstract: CONCLUSION: Salivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications. Copyright (c) 2020 Wiley Periodicals LLC.

An Unusual Cause of Acute Pancreatitis: Intraductal Tubulovillous Ampullary Adenoma.

by Vangimalla, Shiva Shankar.
Citation: Journal of the Canadian Association of Gastroenterology. 3(4):153, 2020 Aug..Journal: Journal of the Canadian Association of Gastroenterology.Published: ; 2020ISSN: 2515-2084.Full author list: Vangimalla SS; Dhaliwal A; Singh S; Bhat I.UI/PMID: 32671323.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1093/jcag/gwz042 (Click here) Abbreviated citation: J. Can. Assoc. Gastroenterol.. 3(4):153, 2020 Aug.

Bulla Formation and Tension Pneumothorax in a Patient with COVID-19.

by Yasukawa, Kosuke; Vamadevan, Arathy; Rollins, Rosemarie.
Citation: American Journal of Tropical Medicine & Hygiene. 2020 Jul 08.Journal: The American journal of tropical medicine and hygiene.Published: ; 2020ISSN: 0002-9637.Full author list: Yasukawa K; Vamadevan A; Rollins R.UI/PMID: 32662395.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal Medicine | Medicine/HospitalistActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.4269/ajtmh.20-0736 (Click here) Abbreviated citation: Am J Trop Med Hyg. 2020 Jul 08.

A patient with melanoma that became sensitized to immunotherapy after treatment with a CDK4/6 inhibitor.

by Zaemes, Jacob; Alzeer, Ali.
Citation: Immunotherapy. 12(12):861-867, 2020 Aug..Journal: Immunotherapy.Published: ; 2020ISSN: 1750-743X.Full author list: Zaemes J; Alzeer A; Villa K; Atkins M.UI/PMID: 32640856.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Internal Medicine | PathologyActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.2217/imt-2020-0139 (Click here) Abbreviated citation: Immunotherapy. 12(12):861-867, 2020 Aug.Abstract: Background: Despite the profound effect that checkpoint inhibitors and BRAF/MEK inhibitors have had on survival in patients with metastatic melanoma, treatment options remain limited for those who demonstrate poor response or develop resistance to these modalities. The prospect of tumor sensitization to these treatments is therefore an attractive one. Results: We describe the case of a patient who developed a sustained response to trametinib and pembrolizumab, despite prior resistance to both these therapies, after receiving treatment with a CDK4/6 inhibitor. Discussion: We further outline the preclinical data supporting a possible role for the use of CDK4/6 inhibitors in tumor sensitization to immunotherapy.

Readmission after inferior vena cava filter placement for acute venous thromboembolism in the United States: Impact of a cancer diagnosis.

by Zaghlol, Raja; Barac, Ana.
Citation: Journal of Cardiac Surgery. 2020 Jul 22.Journal: Journal of cardiac surgery.Published: ; 2020ISSN: 0886-0440.Full author list: Guha A; Dey AK; McKinley G; Carter RR; Miller PE; Deshmukh AJ; Zaghlol R; Barac A; Desai NR; Addison D.UI/PMID: 32696998.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Heart & Vascular InstituteDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1111/jocs.14820 (Click here) Abbreviated citation: J Card Surg. 2020 Jul 22.Abstract: BACKGROUND: Inferior vena cava filter (IVCF) use is common after a venous thromboembolic event (VTE). Cancer is associated with higher rates of VTEs and is also seen in a significant proportion of patients requiring IVCF. As hospital readmissions remain a frequently scrutinized metric, we sought to evaluate the impact of cancer on hospital-readmission rates and in-hospital outcomes among patients with VTEs who received an IVCF.Abstract: METHODS: Leveraging the 2013 to 2014 Nationwide Readmission Database, we identified adult patients presenting with a VTE in the United States and evaluated 30-day readmission rates and readmission in-hospital outcomes postindex-admission. Multivariable logistic regression was used to identify factors associated with readmission after an index-procedure, including traditional and nontraditional cardiovascular risk factors, as well as hospital-level characteristics.Abstract: RESULTS: Among the 619 241 patients presenting with a VTE at index-admission, 11.2% of patients received IVCF on index-admission, of which 30.9% had cancer. The 30-day readmission rate amongst IVCF recipients was 15.8% (N = 10 927), and 19.9% amongst those with cancer compared to 13.9% in patients without cancer (P < .001). Moreover, cancer patients had longer lengths of stay in the hospital (4.5 +/- 0.2 vs 4.0 +/- 0.1 days; P = .02), higher cost of care (Abstract: CONCLUSION: Readmission after IVCF placement is common. In patients readmitted after an IVCF implantation, those with cancer have longer hospital stays and higher costs of care. However, in-hospital mortality is similar to those without cancer. Copyright (c) 2020 Wiley Periodicals LLC.

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