Presbyterian Rust Medical Center

We describe two patients with polyglucosan body disease (PBD) with the clinical features of atypical amyotrophic lateral sclerosis (ALS). Patient 1 was demented, and patient 2, of Ashkenazi background, was incontinent of urine. Autopsy of patient 1 revealed diffuse CNS accumulations of polyglucosan bodies (PB) localized primarily in neuronal and astrocytic processes and rarely in neuronal perikarya. PB were present in peripheral nerve and myocardium. Brancher enzyme analysis of nerve and muscle was normal. Patient 2's sural nerve biopsy showed PB. Brancher activity was markedly reduced in nerve but not in leukocytes. Previous reports have shown reduced leukocyte brancher activity in Ashkenazi patients with PBD. Clinically, pathologically, and biochemically, PBD is heterogeneous and may include patients presenting with ALS. Cases in which typical pathologic features of PBD are combined with findings of rare PB in neural perikarya may represent a pathologic variant of PBD. Brancher enzyme activity may be normal or only mildly reduced in leukocytes in Ashkenazi patients with PBD, implying genetic heterogeneity.

BACKGROUND: The ICE3 trial evaluated the safety and efficacy of cryoablation in women aged ≥60 years with low-risk, early-stage breast cancers, aiming to provide a non-operative treatment option and avoid potential surgical risks. This study presents 5-year follow-up trial results. METHODS: The ICE3 trial is an Institutional Review Board-approved, prospective, multicentered, non-randomized trial including women ≥ 60 years of age with unifocal, ultrasound visible, invasive ductal carcinoma ≤ 1.5 cm in size, histologic grade 1-2, hormone receptor (HR)-positive, and human epidermal growth factor receptor 2 (HER2)-negative. The primary study endpoint of 5-year ipsilateral breast tumor recurrence (IBTR) was evaluated based on Kaplan-Meier estimates. RESULTS: Overall, 194 patients meeting eligibility received successful cryoablation treatment per protocol and were included for analysis. The mean age was 74.9 years (55-94) with a mean tumor size of 7.4 mm transverse (2.8-14.0 mm) and 8.1 mm sagittal (2.5-14.9 mm). With a mean follow-up period of 54.16 months, the IBTR rate at 5 years was 4.3% and breast cancer survival was 96.7%. Of the 124 patients who received endocrine therapy only, the IBTR was 3.7%. No serious device-related adverse events were reported. Minor (88.2%) and moderate (9.6%) adverse events were mild in severity and resolved without residual effects. Quality-of-life score demonstrated statistically significant improvement (p < 0.001) in distress at 6 months as compared with baseline. CONCLUSIONS: Breast cryoablation presents a promising alternative to surgery in selected patients, offering the benefits of a minimally invasive procedure with minimal risks. Further studies are encouraged to confirm cryoablation as a viable alternative to surgical excision low-risk patients.

BACKGROUND: Previous studies have reported varying return-to-sport protocols after knee cartilage restoration procedures. PURPOSE: To (1) evaluate the time for return to sport in athletes with an isolated chondral injury who underwent an accelerated return-to-sport protocol after osteochondral autograft plug transfer (OAT) and (2) evaluate clinical outcomes to assess for any consequences from the accelerated return to sport. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: An institutional cohort of 152 OAT procedures was reviewed, of which 20 competitive athletes met inclusion and exclusion criteria. All patients underwent a physician-directed accelerated rehabilitation program after their procedure. Return to sport was determined for all athletes. Clinical outcomes were assessed using International Knee Documentation Committee (IKDC) and Tegner scores as well as assessment of level of participation on return to sport. RESULTS: Return-to-sport data were available for all 20 athletes; 13 of 20 athletes (65%) were available for clinical evaluation at a mean 4.4-year follow-up. The mean time for return to sport for all 20 athletes was 82.9 ± 25 days (range, 38-134 days). All athletes were able to return to sport at their previous level and reported that they were satisfied or very satisfied with their surgical outcome and ability to return to sport. The mean postoperative IKDC score was 84.5 ± 9.5. The mean Tegner score prior to injury was 8.9 ± 1.7; it was 7.7 ± 1.9 at final follow-up. CONCLUSION: Competitive athletes with traumatic chondral defects treated with OAT managed using this protocol had reduced time to preinjury activity levels compared with what is currently reported, with excellent clinical outcomes and no serious long-term sequelae.

An experience of child sexual abuse (CSA) substantially increases women's risk of adult sexual assault (ASA), but the mechanisms underlying this relationship are unclear. Previous research often has not examined the full range of ASA experiences or included the influence of ethnicity, sexual behavior, and sexual attitudes on CSA and severity of ASA. The current study utilized path analysis to explore the relationships among ethnicity, sexual attitudes, number of lifetime sexual partners, CSA, and severity of ASA in emerging adult women. Results indicated a significant relationship between CSA and more severe ASA that was partially explained by having more lifetime sexual partners. Additionally, European American women, relative to Hispanic women, reported more severe victimization, which was fully explained by more positive attitudes toward casual sex and having more lifetime sexual partners. These results have implications in the design and implementation of universal and selective prevention programs aimed at reducing ASA and revictimization among emerging adult women.

1 Background: With rapid community expansion of academic cancer centers, ensuring high-quality delivery of care across all affiliated network sites is critical. Here we report the results of a radiation oncology peer-review system implemented across a large multinational cancer network. Methods: Weekly radiation oncology peer-review conferences were held between network centers and the main campus of a major cancer system; results of standardized peer-review for each case were recorded. Peer-review resulted in each case being scored as concordant or nonconcordant on initial review; nonconcordance was based on institutional guidelines, national standards, and/or expert opinion. Results: Between 2014 and 2018, 28,730 patient radiation treatment plans underwent peer-review at 10 network centers. The peer-review case volume increased over this study period, from 1,420 cases in 2014 to 9,112 in 2018, concomitant with network expansion. Examining cases reviewed in 2018 (N = 9,112), the most-commonly reviewed cases by disease site were breast (28.9%), head and neck (HN; 13.9%), and lung (12.6%). Of all cases in 2018, 452 (5.0%) were deemed nonconcordant. Higher nonconcordance rates were noted for HN cases (14.0%), and lower rates for lung cases (2.3%; p &lt; 0.001). Of nonconcordant HN cases, the majority (69.5%) were deemed nonconcordant based on target volume delineation. Of nonconcordant breast cases, most (67.1%) were nonconcordant based on radiation field design. For centers added to the network during the study period, we observed a significant decrease in the nonconcordance rate over time after joining the network (average annual decrease of 5.4% in nonconcordant cases; p &lt; 0.001). Conclusions: These data demonstrate the feasibility and efficacy of a large-scale multinational cancer network radiation oncology weekly peer-review program. Nonconcordance rates were highest for HN cases, primarily due to target volume delineation. With improved nonconcordance rates for newly-added network centers, these results offer the promise of improving the quality of radiotherapy delivery across an extensive cancer network with a major academic center as the nucleus.

Magnesium sulfate is used for seizure prophylaxis in patients with preeclampsia. It also has significant effects on calcium metabolism and could, therefore, alter the pressor response to calcium-dependent vasoconstrictors. The present in vivo rat study examined the effect of magnesium sulfate to alter the pressor response to norepinephrine (NE) and angiotensin II (A II). Magnesium doses were chosen to approximate those used in treating preeclampsia. NE resulted in a significant rise in mean arterial pressure (delta MAP, 46 +/- 3.7 mmHg; p < 0.001). A II also resulted in a significant rise in MAP (delta MAP, 23 +/- 3.6 mmHg, p < 0.02). Magnesium sulfate alone had no significant effect on MAP but attenuated the pressor response to both NE (delta MAP, 16 +/- 1.5 mmHg) and A II (delta MAP, 12 +/- 2.5 mmHg). After discontinuation of the magnesium sulfate infusion, the control pressor responses to NE and A II were again seen (delta MAP, 39 +/- 3.5 mmHg and delta MAP, 28 +/- 4.2 mmHg, respectively). Although magnesium sulfate is not a primary antihypertensive agent, it may have effects on blood pressure by attenuating the actions of circulating vasoconstrictors.

Background Current guidelines recommend discussion of adjuvant chemotherapy (AC) for stage II colon cancer (CC) with high-risk features despite lacking conclusive randomized trial data. We examined AC administration in this population and its effect on overall survival (OS) for available patient, tumor and treatment characteristics Methods Using National Cancer Data Base, a cohort of 42,971 stage II CC patients diagnosed from 2004-2009, who underwent surgery with curative intent, was identified. Chi-square test and multivariate logistic regression were used to analyze baseline characteristics and to calculate odds of chemotherapy administration, respectively. Survival analysis was conducted using Kaplan Meier survival analysis with log-rank test and Cox proportional hazards regression modelling.. Results AC was administered to 26% patients. The use decreased with advancing age and elderly patients received more single-agent than multi-agent chemotherapy (3% vs 2.4%, p &lt;0.0001). Major predictors of AC use included pT4 status, evaluation of &lt;12 lymph nodes, high grade tumors, positive resection margins, age &lt;65 years, left sided tumors, and low comorbidity score. AC was associated with improved OS regardless of high-risk features (pT4, undifferentiated histology, &lt;12 lymph node evaluation or positive resection margins), tumor location, age, gender, comorbidity index, chemotherapy regimen or type of colectomy (adjusted HR: single-agent 0.55, multi-agent 0.6; p &lt;0.0001). In subgroup analysis, AC use compensated for the survival differences otherwise seen between left and right sided tumors in the non-chemotherapy population. Conclusion AC in stage II CC was associated with improved OS regardless of age, chemotherapy type or high-risk features. It improved 5-year OS irrespective of tumor location and seemed to compensate for the survival difference seen between right and left sided tumors noted in the non-chemotherapy group.

Clinical peer review, a process mandated across all hospitals in the USA, originated as a measure to protect patients by ensuring a standardized level of medical service that is provided by all practicing physicians. The process involves retrospective chart reviewing to assess the quality of patients' care provided by physicians as well as adherence to the most appropriate guidelines. The process of clinical peer review almost entirely serves its ultimate purpose in quality preservation; However, certain laws gave immunity to reviewers resulting in abuse and using the clinical peer review process for secondary gain. Some notable cases of abuse were discussed in the article, we also shed light on two forms of bias that can potentially interfere with the review process and the dreaded outcomes that come along a negative peer review. We also propose methods to overcome these biases to further standardize and improve this crucial process.

PURPOSE: The purpose of this study is to compare lower extremity impairments in persons with systemic sclerosis, rheumatoid arthritis, and healthy controls. METHODS: The participants were a convenience sample of 64 persons with systemic sclerosis, 58 persons with rheumatoid arthritis, and 30 healthy controls. The Keitel Functional Test was used to assess lower extremity joint motion and strength. Demographic information on age, disease duration, employment, and perceived overall health was also collected. RESULTS: Significant differences were found between the healthy control group and both the systemic sclerosis and rheumatoid arthritis groups in rising from a chair, squatting, walking 30 m, walking up and downstairs, and the total score. For hip external rotation, there were significant differences between all three groups for the right hip; for the left hip, the systemic sclerosis group had significantly less motion than the other two groups. For standing on toes, there was only a significant difference between the systemic sclerosis and the healthy control groups. CONCLUSIONS: Persons with systemic sclerosis and rheumatoid arthritis have similar levels of lower extremity impairments but greater impairments compared to the healthy controls. These impairments may lead to decreased mobility paired with difficulties with activities of daily living such as lower extremity dressing, bathing, and feet care. Implications for Rehabilitation Persons with systemic sclerosis and rheumatoid arthritis have similar levels of lower extremity impairments but greater impairments compared to the healthy controls. Findings from this study indicate a need for rehabilitation for persons with systemic sclerosis and rheumatoid arthritis as the lower extremity impairments may lead to decreased mobility paired with difficulties with daily living activities such as lower extremity dressing, bathing, and feet care. The Keitel Functional Test could be used as a quick screening test for lower extremity impairments.

•Tumor lysis syndrome is a rare but deadly complication of solid tumors.•We suggest that tumor lysis syndrome is especially deadly when it results from high grade or metastatic endometrial cancers.•Consider prophylactic measures to prevent tumor lysis syndrome in high risk patients before initiating therapy.

In this first of two articles on new epilepsy guidelines for primary care physicians, the authors present detailed algorithms for the diagnosis and classification of seizure disorders in adults. They discuss the differentiation between generalized and partial seizures and stress that accurate identification is especially important because the type of seizure determines the appropriate treatment. The second article (page 29) looks at the treatment portion of the new guidelines.

Objectives: To assess the adherence to IPC measures among medical staff working in Nineveh governorate during COVID-19 pandemic. Methods: A cross sectional study, using an online survey sent to different medical staff in Nineveh. The questionnaire was composed of two parts, the first included demographic information, and the second covered IPC measures. Survey was completed by medical staff witnessed COVID-19 pandemic in Nineveh governorate. Results: The total sample was 412, of whom, 316 (77%) were males and 142 (35%) were physicians. Overall, the percentage of staff following different IPC measures was ranging from 31 % in wearing head cover, to 97% in keeping clean hands constantly. Main missed points were found in respiratory hygiene, physical distancing and self-isolation. Females were more likely to apply bandages to wounds and wearing gloves before examining patients. Compared to other medical staff, physicians were less compliant to washing hands, putting waste in designated places and wearing protective cloths. Those who work in hospitals were better compliant with sterilizing hands before entering home. Conclusion: The adherence to IPC measures was ranging from less than one-half in wearing sterile head cover, to nearly all respondents in keeping clean hands. There is a great need to provide support as well as training in regards to IPC in Nineveh governorate city.

Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to the hospital with subacute onset of fever, back pain and malaise, and was found to have infectious aortitis secondary to Streptococcus pneumoniae endocarditis. Despite appropriate antimicrobial coverage and surgical repair attempts, she succumbed to aortic perforation after a complicated and prolonged hospitalization.

Organizing pneumonia is a well-known clinical entity resulting in response to noxious stimuli causing lung injury. It is known to occur with infectious disease processes, neoplasms, post lung surgery or radiation therapy and when idiopathic, is called cryptogenic organizing pneumonia. We present an unusual case of a 48-year-old woman who presented with chronic cough and progressive dyspnoea while being on macrolide therapy for Lyme disease. Computerized tomography of chest demonstrated a well-circumscribed nodule in the lingula and bilateral central ground glass opacities. Transbronchial biopsies were consistent with carcinoid tumour in the lingula and organizing pneumonia in bilateral lung fields. Bronchoscopic relief of obstruction was performed by mechanical debulking of the tumour, with subsequent complete resolution of bilateral opacities, consistent with resolution of organizing pneumonia without the need for steroid therapy.

The Pause, an article in the February 2014 issue (Critical Care Nurse. 2014;34[1]:74-75) by Jonathan Bartels, presents a concept that can be used to set a culture of caring and nurturing for patients, their family, and staff. The concept, called The Pause, is a simple time out, 45 seconds to about 1 minute, that recognizes a patient’s death as well as the efforts of the clinical staff when, despite all interventions, the patient dies. This concept, according to Bartels, is not brain surgery or rocket science, but a method for comforting and healing.Hospitals do not need an educational roll-out or check-off list to begin to implement The Pause. Bartels says to just do it; start implementing The Pause right away and begin the healing of taking care of yourself and others on the team.Many departments and disciplines are involved in code blues, including laboratory, radiology, pharmacy, physicians, nurses, technicians, chaplains, respiratory therapists, and paramedics; the list goes on and on. Compassion fatigue can affect those working in health care. It is described as the medical professionals’ posttraumatic stress disorder. Seeing death, trauma, unimaginable injuries, sorrow, and pain on a daily basis can take a toll on human beings and can be emotionally draining. Holding the hand of a patient who is scared, dying, or in pain will catch up with you if you do not take care of yourself and figure out how to deal with your feelings.One way health care workers can intentionally take care of themselves is to implement The Pause. For just a short time, pause and acknowledge what has occurred and recognize that you did the very best you could. Give yourself and your team grace and honor the life that has slipped away. After The Pause you will be more ready to move on to your next task and to recognize that life can be treasured and enjoyed.Bartels, who at the time was an emergency room nurse and palliative care liaison, started The Pause at the University of Virginia Medical Center in the emergency department. The concept and the practice of The Pause spread throughout that hospital.After The Pause was published in Critical Care Nurse, the concept began spreading across the United States. In fact, Bartels has received communication that The Pause has spread to other parts of the world, including Australia and Paraguay. This is tremendous!At the National Teaching Institute &amp; Critical Care Exposition 2014 in Boston, the American Association of Critical-Care Nurses President, Vicki Good, spoke about The Pause. Good reminded critical care nurses that often when we need to be intentional about pausing in our work is when we feel as if we do not have the time or we are not intentional about it. Speaking to this audience yielded great support and encouragement for implementing The Pause in many institutions throughout the United States.After reading Bartels’ article and hearing Good speak, I stepped forward and told anyone and everyone who would listen about The Pause. Now I would like to share how we are “pausing” in New Mexico.We started by sharing the concept of The Pause with our hospital administrator, Angela Ward, RN, MSN. She encouraged me to share the information in our department manager meeting, which leaders from all units in the hospital attend. Those leaders at Presbyterian Rust Medical Center in Rio Rancho, New Mexico, immediately embraced the concept and we implemented it the next day in our emergency department. It was that important and that easy.The response from physicians has blown me away. The first time The Pause was implemented in the emergency department, I thought the emergency department physician would excuse himself and say he was busy, but he did not. He gave me a nod and stood at the bedside in reverence.The word spread to our sister hospital downtown in Albuquerque and I was asked to share The Pause with them. In fact, it was so well received I have been asked to share this information on many other occasions. Similar to my hospital where the results have been overwhelmingly positive, the excitement voiced by many of the units from our sister hospital has been rewarding.It should be noted, in case you have not read the original article yet, that this is not a religious ritual. It is simply a moment, a pause, to honor the life that has slipped away and to honor our efforts to do what we could to preserve life.After the word rippled among nurses in Albuquerque, I was honored to present The Pause at the Transforming Care at the Bedside Annual Conference to nurses from all over the state. Their feedback was very positive.At Presbyterian Rust Medical Center we now include The Pause in our monthly hospital employee orientation, which includes staff from respiratory therapy, laboratory, nursing, pharmacy, radiology, chaplains, paramedics, and more.Thank you Jonathan for this wonderful article and initiative that I will continue to talk about for years to come. One thing I say when talking about The Pause is how beautifully you wrote the article. Your words touched my heart and changed me.As a critical care nurse, hospital supervisor, and member of the rapid response team, I have always tried to take extra time with dying patients and their families, but it never seemed like it was enough. However, with The Pause, we enhance not only the care we take of ourselves but also we show families respect for their loved ones in a significant way. This idea is just so awesome and it has made a difference in my practice and in my team’s practice.

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Study Objective: We sought to assess the factors that are associated with ovarian preservation in the setting of surgically confirmed ovarian torsion, specifically focusing on the time to surgery after the emergency department (ED) presentation. Methods: We conducted a retrospective cohort study at a single tertiary care academic hospital from 2008 to 2021. Patients aged 12–40 with ovarian torsion were identified using diagnosis codes. We compared the outcome of ovarian preservation versus removal based on time to surgery after ED presentation, age, parity, Doppler flow, presence of ovarian mass, detorsion attempt, intraoperative suspicion of necrosis, and time of day. Results: We identified 60 surgical cases of ovarian torsion, with 25 undergoing oophorectomy (58.3% preserved). The median time from ED presentation to surgery was 8.6 hours, and only six surgeries occurred in &lt;4 hours, which was not associated with ovarian preservation. Preservation was associated with Doppler flow (60% vs. 27%, p = 0.019) and was less likely when necrosis was suspected (20% vs. 84%, p &lt; 0.001) and age ≥25 years (34% vs. 68%, p = 0.010). Detorsion attempts resulted in the preservation of 25% of ovaries with suspected necrosis. Parity and presentation time of day were not associated with preservation. Discussion: Time to surgery was not associated with ovarian preservation, possibly because few cases occurred in &lt;4 hours. Setting goal times might improve outcomes. Ovaries are more likely to be preserved when detorsion is attempted despite necrotic appearance and when Doppler flow is present on sonographic exam. The surgical decision for oophorectomy may be based on factors unrelated to functional loss of the ovary.