Baylor University Medical Center Proceedings最新文献

Background: Erector spinae plane blocks (ESPB), a new and increasingly popular technique for controlling thoracic pain, have typically been performed around the T5 level. Using a T1 ESPB for first rib resections in patients with thoracic outlet syndrome (TOS) might offer better pain control relative to the current standard of intravenous multimodal pain management alone.

Methods: All first rib resections for patients with TOS during an 18-month period (n = 380) were analyzed. In-hospital opioid consumption, the number of patients discharged with an opioid prescription, and hospital admission length were compared between patients receiving ESPBs and multimodal pain management alone.

Results: ESPB patients received 26.18% less morphine milligram equivalents on postoperative day 1 (P < 0.001) and were 13.23% less likely to be discharged with an opioid prescription (P < 0.001). Admission length between the two groups was not meaningfully different (P = 0.84).

Conclusion: T1 ESPBs offer effective regional pain control for TOS patients undergoing first rib resections while mitigating the potential for opioid dependence and abuse. No increased risk of complication with ESPB was observed relative to multimodal pain management alone.

Rosacea and seborrheic dermatitis are both chronic inflammatory skin conditions with facial distributions. Using the TriNetX database, we investigated the concomitance of rosacea and seborrheic dermatitis. After propensity score matching, rosacea patients had an increased risk of seborrheic dermatitis (odds ratio 6.456; 95% confidence interval, 6.155-6.772; P < 0.0001). This significant correlation emphasizes the importance of clinicians remaining observant for signs of both conditions when diagnosing and managing patients with either disease.

Background: Restless leg syndrome (RLS) is a common neurological condition that can affect the quality of life. Iron is one of the available options for the treatment of RLS.

Methods: This systematic review and meta-analysis assessed the efficacy and safety of different iron regimens in treating RLS. We searched EMBASE, SCOPUS, Web of Science, PubMed, and Cochrane databases for studies that assessed the effects of different iron supplements compared to placebo on the International RLS score (IRLS), RLS-Quality of Life (QOL) score, sleep visual analog score (VAS), and adverse events (AEs).

Results: Twelve randomized controlled trials with 511 patients were included. Iron improved the IRLS score (mean difference [MD] = -5.28; 95% confidence interval [CI] - 7.66, -2.90; P < 0.0001), the number of patients with improved IRLS score (risk ratio [RR] = 2.06; 95% CI 1.49, 2.84; P < 0.0001), RLS-QOL (MD = 7.42; 95% CI 1.32, 13.51; P = 0.02), and sleep VAS score (MD = -24.83; 95% CI -40.08, -9.58; P = 0.001), but yielded more overall AEs (RR = 2.04; 95% CI 1.46, 2.85; P < 0.0001), with no difference in serious AEs or those leading to drug discontinuation (RR = 2.04; 95% CI 0.39, 10.81; P = 0.40 and RR = 6.25; 95% CI 0.79, 49.54; P = 0.08), respectively.

Conclusion: Iron, especially ferric carboxymaltose, is a valuable option for RLS, which showed improvement in several indices.

Mucormycosis is a fungal infection most commonly affecting severely ill patients, with increasing incidence in the setting of the COVID-19 pandemic. Due to its ability to involve multiple structures including the paranasal sinuses, orbit, and brain, mucormycosis infections present with variable clinical signs. All previously reported cases of mucormycosis in the literature involved paranasal sinus involvement, most commonly the ethmoid sinus. Herein we present the first reported case of isolated orbital mucormycosis without histologic evidence of paranasal sinus infection. Prompt recognition of atypical mucormycosis infections in the absence of paranasal sinus involvement in critically ill patients is necessary in order to initiate early and aggressive treatment due to the high fatality rate and rarity of this presentation.

Background: This study analyzes the costs associated with treatment strategies for acute coronary syndrome: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and medical management (MM).

Methods: This is a substudy of a previous analysis showing improved outcomes with CABG compared to PCI and MM, now focusing on variation in charges based on the type of treatment, hospital length of stay (LOS), and the occurrence of hospital readmission. We extracted total reimbursements, LOS, and readmissions for acute coronary syndrome patients (4267) between 2018 and 2022 from the electronic health record.

Results: Expenses related to total charges were higher for CABG patients than PCI patients (+$106,047); however, average daily charges were lower for CABG patients compared to PCI patients (+$14,957). LOS was a primary driver for total charges, as CABG patients stayed 8.35 ± 0.50 days longer than PCI patients on average. The average difference between the total charge amount for readmitted and nonreadmitted patients was $22,765 ± $11,820. Even though readmission increases total charges, the charge per day was still less in patients with readmission due to their longer LOS.

Conclusion: The higher total charge amount and lower charge per day in CABG patients compared to PCI patients, as well as readmitted patients, highlights the importance of employing strategies to reduce LOS and minimize charges for CABG and readmissions.

This scoping review explored the literature about weight stigma in healthcare education and patient care and how it may impact individuals living in larger bodies. Two databases, MGH OneSearch and PubMed, were utilized, focusing on research published from 2013 to 2023 in English. A total of 18 articles were identified and used for this review. Evidence indicated that healthcare providers stigmatize patients living in larger bodies, both implicitly and explicitly. Studies found that medical students preferred thin patients and had strong anti-fat bias (P < 0.001). Weight bias in healthcare can lead to discrimination, impacting patients' mental and physical well-being, including heightened stress, altered caloric intake, fluctuations in body size, and declining overall health. The impact of weight stigma in healthcare is recognized but understudied. This review suggests that believing weight is within patient control fosters blame and stigma. Learning about weight stigma and developing nonstigmatizing education for healthcare students and providers should be a priority. Understanding how weight stigma may delay healthcare and increase chronic illness risk could encourage more compassionate care for patients in larger bodies.

We report the case of a 62-year-old man who experienced intraoperative anaphylaxis following intravenous morphine administration during head and neck surgery. Immediate resuscitation was successful, and subsequent allergy workup demonstrated a positive skin prick test to morphine. This case underscores the diagnostic complexity of perioperative anaphylaxis and emphasizes the critical role of guideline-directed allergy evaluation in identifying the offending agent and ensuring safe future anesthetic management.