Baylor University Medical Center Proceedings最新文献

Background: For most patients with hypertrophic cardiomyopathy (HCM), the clinical course is considered relatively benign, similar to hypertensive heart disease (HHD). We compared the long-term outcomes in patients with HCM versus HHD from a large healthcare system database.

Methods: Data from SSM Virtual Data Warehouse were used to identify patients with a new diagnosis of either HCM or HHD who followed up in our system for at least 6 months. HCM patients were matched 1:1 to HHD patients based on age, sex, and race. Outcomes examined included heart failure (HF) admission, ventricular tachyarrhythmia (ventricular fibrillation or sustained ventricular tachycardia), and need for pacemaker or defibrillator implantation. We identified 1904 HCM patients along with HHD controls.

Results: After adjusting for demographic characteristics and relevant comorbidities, HCM had higher odds of HF admission (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.43-2.10), ventricular tachyarrhythmias (OR: 2.31, CI: 1.60-3.33), pacemaker implantation (OR: 2.14, CI: 1.29-3.57), and defibrillator implantation (OR: 3.77, CI: 1.82-7.83). Survival analysis confirmed the difference in outcomes early on from the time of diagnosis.

Conclusion: In this retrospective study from a large healthcare system database, HCM patients had significantly higher incidences of HF admission, ventricular tachyarrhythmias, and pacemaker or defibrillator implantation compared to HHD patients.

Background: Screening for Barrett's esophagus (BE) remains controversial, even for high-risk populations. Our study aimed to evaluate the proportion of patients diagnosed with esophageal adenocarcinoma (EAC) who were not screened for BE or did not receive recommended BE surveillance screening. We then evaluated the relationship between cancer staging and screening/surveillance opportunities.

Methods: This single-center retrospective study included 187 patients from January 2016 to January 2022 with newly diagnosed EAC. Data extracted from patient charts included BE risk factors, and BE, endoscopic, and histologic history.

Results: A total of 187 patients had a new diagnosis of EAC. Among this group, 44% had appropriate BE surveillance adherence, and 47% of patients met the criteria for BE screening but had not been screened prior to EAC diagnosis. Adherence to BE surveillance was associated with earlier stages of cancer on biopsy. No significant difference in cancer staging was found in those with missed BE screening opportunities.

Discussion: Patients with a diagnosis of BE who adhered to surveillance guidelines had earlier stage EAC at diagnosis, which emphasizes the importance of surveillance. Most of those with an initial diagnosis of EAC had not received any BE screening.

Background: We hypothesized that implementation of a labor epidural management algorithm would increase the labor epidural catheter replacement rate at our hospital.

Methods: Our institutional review board approved this study and waived the requirement for informed consent. Patients who had labor epidural analgesia and delivered vaginally or had replacement of an epidural catheter prior to vaginal delivery from August 1, 2022 to December 31, 2022 and from August 1, 2023 to December 31, 2023 were included in the study. Study investigators entered data from the electronic medical record into REDCap.

Results: A total of 530 and 740 patients received labor epidural analgesia and met inclusion criteria before and after implementation of the algorithm, respectively. Patients who received labor epidural analgesia after implementation of the protocol had an absolute increase of 1.0% in the catheter replacement rate, which was not statistically significant (P = 0.34). A multivariate logistic regression found that the number or rescue analgesia boluses (odds ratio 2.68; 95% confidence interval 2.092, 3.434; P < 0.001) and operator level of training (odds ratio 0.41; 95% confidence interval 0.226, 0.743; P = 0.003) were associated with catheter replacement.

Conclusion: After implementation of a labor epidural catheter management algorithm, patients had an increase in labor epidural catheter replacement that was not statistically significant.

Contrast-associated acute kidney injury (CA-AKI) is an abrupt decline in kidney function occurring after a recent exposure to iodinated radiocontrast media. CA-AKI presents as elevated serum creatinine level or decreased urine output. CA-AKI is the third leading cause of inpatient AKI. The incidence of CA-AKI varies according to patient population characteristics, ranging from 5% in the general population to as high as 30% in special populations with preexisting comorbidities such as diabetes mellitus, cardiovascular disease, and chronic kidney disease. The development of CA-AKI places a heavy toll on patients and the healthcare system secondary to increased patient morbidity, mortality, hospital length of stay, readmission risk, and healthcare cost. Patients undergoing cardiac catheterization are of special interest, since they have higher risk of developing CA-AKI and its associated complications. The recognition, prevention, and management of CA-AKI has improved over the past few years with the introduction of fluid management guidelines, using less nephrotoxic radiocontrast media, and preprocedural CA-AKI risk assessment. Future advancements in patients' CA-AKI risk stratification and early detection will facilitate prompt initiation of mitigation treatment plans and decrease associated complications.

An erector spinae plane block (ESPB), in which a local anesthetic is injected into the plane anterior to the erector spinae muscles, is a relatively new technique for delivering regional anesthesia and is typically performed in the mid-thoracic region. ESPBs demonstrate great potential to control regional neuropathic pain, and, accordingly, may be particularly effective at the T1 level for controlling pain in patients undergoing first rib resections for thoracic outlet syndrome (TOS). Four patients undergoing first rib resections for TOS were administered an ultrasound-guided ESPB at the T1 level. Two patients received the injection sitting upright without general anesthesia; the other patients received the block in the lateral decubitus position while under general anesthesia. Each patient's postoperative pain was adequately controlled, and no complications were observed. T1 ESPBs offer the potential to mitigate postoperative pain. Better pain management may decrease the need for opioids and shorten recovery times. As such, further investigation to establish the safety and efficacy of T1 ESPBs in this patient population can greatly improve patient outcomes.

Background: A new intervention called high-intensity focused ultrasound (HIFU) targets fibroids with high-intensity ultrasound pulses using ultrasound probes. This noninvasive method, which can be carried out with either magnetic resonance imaging or ultrasound guidance, results in immediate coagulated necrosis within a clearly defined area a few millimeters in diameter.

Methods: This systematic review evaluated the safety of HIFU in the treatment of uterine fibroids regardless of site or size. We specifically aimed to determine the incidence of side effects that can occur during and after HIFU. We searched the PubMed, Scopus, ScienceDirect, and Mendeley archive using only the terms HIFU and fibroid. After identifying 1077 studies of different types from 2014 to March 2024, 300 studies were screened and 60 included.

Results: According to Society of Interventional Radiology guidelines, class A adverse events (AEs) showed no significant results, and individuals with these AEs required no treatment and had no long-term consequences. Similarly, there were no class B significant results. However, 3943 of 10,204 patients (38%) complained of lower abdominal pain after the procedure, a class B AE, which resolved by analgesics. Further, 153 of 24,700 patients (0.6%) had skin burns, blisters, or nodules, and these issues resolved with conservative treatment. Additionally, 74 of 23,741 patients (0.3%) had hematuria; 882 of 5970 patients (14.7%) had abnormal vaginal discharge; 414 of 23,449 (1.7%) had vaginal bleeding; and 267 of 7598 (3.5%) had leg paresthesia. Major AEs (class C and D) were almost nonexistent, and the incidence of death in our study was zero.

Conclusion: HIFU ablation of uterine fibroids is generally safe, causing mostly mild side effects and very few severe complications. The relative safety of HIFU compared to other minimally invasive techniques, such as uterine artery embolization, still needs further evaluation.

Measles is a highly contagious viral illness mainly affecting the younger population worldwide despite the availability of a safe and effective vaccine. The disease is caused by measles virus, a member of the Paramyxoviridea family, which is transmitted through aerosols and respiratory droplets. Widespread vaccination has led to a significant decline in morbidity and mortality worldwide; however, recent years have witnessed a resurgence of outbreaks in the United States, highlighting barriers in achieving and sustaining elimination goals. The measles and rubella elimination initiative, under Immunization Agenda 2030, required at least 5 World Health Organization regions to achieve measles elimination by 2020, but none of the regions met these goals. Vaccine hesitancy, virus importation via international travel, and waning immunity are considered contributing factors to the recent surge of measles outbreaks. This review highlights the challenges in the pursuit of measles eradication and the importance of a multidimensional approach involving public health interventions.

Background: The primary aim of our study was to determine which patient characteristics were associated with opioid consumption following cesarean delivery.

Methods: The Baylor Scott & White Research Institute institutional review board approved this study (024-178). Patients who underwent cesarean delivery at Baylor Scott & White Medical Center - Temple with single injection or combined spinal epidural anesthesia in 2023 were eligible for inclusion. We examined the medical records of 300 patients, calculated the 24-hour opioid consumption for each, and compared the top third to the low group in a bivariate analysis and then performed a multivariate logistic regression.

Results: One hundred thirty-one patients had no opioid consumption in the first 24 postoperative hours, and 100 patients had a morphine milligram consumption of 30 to 117.5 mg. A multivariate logistic regression determined that patients in the higher opioid consumption cohort were more likely to have received combined spinal epidural anesthesia (odds ratio 2.079; 95% confidence interval 1.149, 3.762; P = 0.02) and administration of intravenous dexmedetomidine in the intraoperative period (odds ratio 2.542; 95% confidence interval 1.038, 6.224; P = 0.04).

Conclusion: Intraoperative administration of intravenous dexmedetomidine and combined spinal epidural anesthesia was associated with increased postoperative opioid consumption following cesarean delivery.