Baylor University Medical Center Proceedings最新文献

We report a case of a 63-year-old man with a history of numerous basal cell carcinomas (BCCs) on vismodegib who developed a pink subcutaneous nodule that was thought to be either a BCC or an epidermal inclusion cyst. Sections displayed a dome-shaped lesion composed of large dermal nodules of epithelioid cells with variable cytology. Some of the dermal nodules demonstrated squamatization of the epithelioid cells while others had a predominantly basaloid phenotype. Central necrosis was present in the majority of the large dermal nodules, but the lesion did not stain with CK7 or CK20, helping to rule out internal metastases. The epithelial nodules stained strongly with pancytokeratin (AE1/AE3), p40, and stained lightly with BCL-2, supporting the diagnosis of BCC. However, Ber-EP4 being negative and the presence of significant squamatization suggest vismodegib can alter both the histological and immunophenotype of BCCs. This phenomenon has rarely been reported in literature.

Background: Risk assessment tools are used by clinicians to predict which patients might have excessive bleeding. We studied the association between a peripartum hemorrhage risk assessment score using peripartum quantified blood loss (QBL) among those with vaginal deliveries who are often at lower risk for peripartum hemorrhage.

Methods: In this retrospective analysis of 1221 patients with term vaginal deliveries at a public New York City hospital, the Association of Women's Health, Obstetric and Neonatal Nurses (AWOHNN) risk assessment tool was used to categorize patients as low risk, medium risk, or high risk for postpartum hemorrhage.

Results: Low-risk scores were present in 925 (75.8%) patients, medium-risk scores in 268 (21.9%) patients, and high-risk scores in 28 (2.3%) patients. Outcome variables consisted of QBL (M = 213.8, SD = 215.00 mL), QBL ≥ 500 mL (n = 89, 7.3%), and ratio of postdelivery hematocrit to predelivery hematocrit (M = 0.9, SD = 0.08). High-risk score (B = 0.14, SE = 0.07, P = 0.04) but not medium-risk score was significantly associated with increased QBL as compared to low-risk score. Body mass index (BMI) measured as a continuous variable was significantly associated with increased QBL (B = 0.004, SE = 0.002, P = 0.049). However, BMI measured as a categorical variable using the AWOHNN cutoff score of >35 was not significantly associated with QBL. AWOHNN score was not significantly associated with QBL ≥ 500 mL or with the ratio of postdelivery hematocrit with predelivery hematocrit.

Conclusion: We recommend revising the AWOHNN measure to better reflect medium risk and to consider a different approach for BMI use as part of the AWOHNN risk score.

Background: We hypothesized that patients who received a lower dose of intrathecal morphine (ITM) would have higher postoperative opioid consumption following cesarean delivery.

Methods: Patients who had cesarean deliveries from February 15, 2022, through February 14, 2024 at Baylor Scott & White Medical Center - Temple with single injection spinal or combined spinal epidural anesthesia who did not have labor epidural anesthesia were included. Morphine milligram equivalent (MME) opioid consumption in the first 24 postoperative hours was recorded along with patient demographic, physical, and clinical characteristics.

Results: A total of 535 and 502 patients received 0.2 and 0.15 mg ITM, respectively. Patients who received 0.15 mg ITM had higher rates of depression, scheduled cesarean deliveries, and acetaminophen administration compared to patients who received 0.2 mg ITM. Patients who received 0.2 mg ITM and 0.15 mg ITM had median (interquartile range) 24-hour MME consumption of 10.0 mg (0-30.0 mg) and 10.0 mg (0-40.0 mg), respectively (P = 0.97).

Discussion: MME consumption for 24 hours following cesarean delivery was similar between patients who received 0.2 and 0.15 mg ITM.

Background: This study aimed to determine whether surgical multiple-choice questions generated by ChatGPT are comparable to those written by human experts (surgeons).

Methods: The study was conducted at a medical school and involved 112 fourth-year medical students. Based on five learning objectives in general surgery (colorectal, gastric, trauma, breast, thyroid), ChatGPT and surgeons generated five multiple-choice questions. No change was made to the ChatGPT-generated questions. The statistical properties of these questions, including correlations between two group of questions and correlations with total scores (item discrimination) in a general surgery clerkship exam, were reported.

Results: There was a significant positive correlation between the ChatGPT-generated and human-written questions for one learning objective (colorectal). More importantly, only one ChatGPT-generated question (colorectal) achieved an acceptable discrimination level, while other four failed to achieve it. In contrast, human-written questions showed acceptable discrimination levels.

Conclusion: While ChatGPT has the potential to generate multiple-choice questions comparable to human-written ones in specific contexts, the variability across surgical topics points to the need for human oversight and review before their use in exams. It is important to integrate artificial intelligence tools like ChatGPT with human expertise to enhance efficiency and quality.

Takayasu arteritis is a rare vasculitis commonly seen in young women. Amaurosis fugax and headache are visual presentations of Takayasu arteritis. Migraine with visual aura is a common condition affecting young women, and differentiating migraine from Takayasu presenting with visual symptoms and headache can be challenging. We present a case of a young woman initially misdiagnosed with migraine with aura, who was later found to have amaurosis fugax as an early manifestation of Takayasu arteritis.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Social determinants of health (SDH) significantly impact HCC outcomes, yet comprehensive insights into these effects are lacking. This scoping review aimed to examine the influence of SDH on HCC outcomes.

Methods: Following PRISMA-ScR guidelines, we searched 10 databases, including PubMed and Scopus, using terms related to HCC and SDH. We included studies published between 1994 and 2024, focusing on human participants and various study designs. A total of 20 studies were selected, including cross-sectional, cohort, and case-control studies.

Results: The review identified disparities in HCC outcomes linked to socioeconomic status, health care access, and racial and ethnic differences. Patients in disadvantaged socioeconomic conditions and marginalized racial groups faced delays in treatment and worse outcomes. United States-based studies highlighted pronounced disparities compared to studies in Argentina, France, and Australia. Various SDH metrics provided inconsistent results, illustrating a need for standardized measures.

Conclusions: SDH significantly shapes HCC outcomes, revealing gaps in current research. Future studies should integrate various SDH factors using consistent metrics to improve HCC care and reduce health disparities.

Immune checkpoint inhibitors (ICIs) are novel treatment modalities that have revolutionized the field of oncology. Their widespread use in various cancers and prolonged survival of patients led to the identification of a wide range of side effects associated with the therapy, known as immune-related adverse effects (irAEs). IrAEs are presumed to arise from immunologic enhancement and frequently result in endocrine disorders. Thyroid dysfunction is not uncommon during therapy with pembrolizumab and affects up to 13% to 14% of patients. Thyroid storm associated with ICIs is extremely rare. We present a case of a 34-year-old woman with metastatic ovarian carcinoma who developed thyroid storm shortly after an addition of pembrolizumab.

Background: Endoscopic bariatric interventions are viable alternatives to traditional weight loss surgeries for patients with a body mass index between 30 and 40 kg/m². While studies have explored the impact of intragastric balloons on obesity and weight reduction, comprehensive data on real-world device-related complications and failures are limited. This study aimed to investigate mechanical failures leading to patient adverse events reported to the US Food and Drug Administration.

Methods: A retrospective analysis using the Manufacturer and User Facility Device Experience (MAUDE) database examined device-related events and patient outcomes associated with various intragastric balloons from July 2017 to October 2023. Data analysis was performed using SPSS software to assess the reported events and their associations with specific types of intragastric balloons.

Results: Our review included 1393 cases, revealing 1758 device malfunctions and 1760 patient complications. Deflation problems (25.31%) and balloon leakage or rupture (21.90%) were the most common device-related complications. Patient complications were primarily linked to the Orbera balloon, with implant failure (24.30%), abdominal pain (21.92%), and vomiting (21.26%) as leading adverse events.

Conclusion: Our findings highlight the need for continuous surveillance, rigorous monitoring, and enhanced safety protocols for intragastric balloons.