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PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257687
Author(s):  
Chun Ting Siu ◽  
Zachary Wolfe ◽  
Martin DelaTorre ◽  
Erafat Rehim ◽  
Robert Decker ◽  
...  

Background Thrombophilia workup is typically inappropriate in the inpatient setting as testing may be skewed by anticoagulation, acute thrombosis, or acute illness. Objective To determine adherence of inpatient thrombophilia testing with institutional guidelines. Patients and methods A retrospective study to evaluate thrombophilia testing practices of adult patients who were admitted to Lehigh Valley Hospital at Cedar Crest with either venous thromboembolism or ischemic stroke in 2019. Testing included inherited and acquired thrombophilia. Patient charts were individually reviewed for three measured outcomes: 1) the number of appropriate thrombophilia testing in the inpatient setting; 2) the indications used for thrombophilia testing; 3) the proportion of positive thrombophilia tests with change in clinical management. Results 201 patients were included in our study. 26 patients (13%) were tested appropriately in accordance with institution guidelines and 175 (87%) patients were tested inappropriately. The most common reason for the inappropriate testing was testing during acute thrombosis. 28 of the 201 patients had positive thrombophilia tests, but the reviewers only noted 7 patients with change in clinical management—involving anticoagulation change. Conclusion Our study revealed that a majority of inpatient thrombophilia testing did not follow institutional guidelines for appropriate testing and did not change patient management. These thrombophilia tests are often overutilized and have minimal clinical utility in the inpatient setting.


2021 ◽  
pp. 074880682110437
Author(s):  
Nalin Dayal ◽  
Joseph Castellano

Mastopexy has become a widely popularized procedure across the country over the last 20 years. Women have seen the benefits of various forms of breast lifts to correct breast ptosis. While older teachings focused on mastopexy and augmentation as separate, staged procedures, many centers now perform both simultaneously. Our center primarily performs mastopexy procedures with simultaneous augmentation with implants, and we reviewed 260 patient charts to examine complications when compared to mastopexy alone. Complications reviewed include the following: hematoma formation, incision openings, and revision surgeries. Our data showed only minor rates of hematoma formation, incision openings, and revision surgeries with a negligible difference between the 2 groups. Patients in both groups overall had few surgical complications. Patients undergoing mastopexy with simultaneous augmentation had similar rates of complications when compared to patients with mastopexy alone. Many previously believed that simultaneous augmentation with mastopexy would place too much tension on the mastopexy incisions due to the rapid breast volume increase. However, with no significant changes in complications between the groups, it is clear that surgical technique and planning has improved to allow this to be a safely performed single-staged procedure. Overall, we had minimal complications and show that mastopexy with simultaneous augmentation is safe for patients who desire these procedures.


SLEEP ◽  
2021 ◽  
Author(s):  
Debbie Stultz ◽  
Savanna Osburn ◽  
Tyler Burns ◽  
Thomas Gills ◽  
Darrell Welch ◽  
...  

2021 ◽  
Vol 62 (9) ◽  
pp. 1167-1171
Author(s):  
In Choel Shin ◽  
Sang Duck Kim

Purpose: In the present study, we introduced and evaluated the effectiveness of partial lid margin excision including hair follicles in diffuse trichiasis and distichiasis. Methods: A retrospective review of medical records was performed on 21 eyelids of 14 patients with diffuse trichiasis and distichiasis. The patients had trichiasis of more than 1/3 of the eyelid margin and received lid margin excision including hair follicles at our hospital. The patients were followed up for more than 3 months after surgical correction. A telephone survey of the surgical outcomes, including recurrence and cosmetic satisfaction, was conducted for patients who were unable to visit the clinic. Success was defined as complete resolution of symptoms, no recurrence of abnormal cilia, and acceptable cosmesis. Results: The patients included five males (6 eyes) and nine females (15 eyes) with an average age of 61.9 years (range, 39.8-82.4 years). The surgical success rate was 90.5%. Two eyelids showed a recurrence of trichiasis requiring additional electrolysis treatment, and one eyelid exhibited skin pigmentation. Conclusions: For patients with diffuse trichiasis and distichiasis, partial lid margin excision including hair follicles showed excellent results with respect to resolving irritating symptoms, with minimal complications, low recurrence, and an easy procedure.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ji Soo Kim ◽  
Seungheon Lee ◽  
Jin Young Kim ◽  
Eoi Jong Seo ◽  
Ju Byung Chae ◽  
...  

AbstractTo investigate the visual/anatomical outcome of diabetic macular edema (DME) patients lost to follow-up (LTFU) for more than 1 year during intravitreal anti-VEGF treatment. A retrospective review of 182 treatment-naïve DME patients was performed. Among them, we identified patients LTFU for more than 1 year during anti-VEGF treatment. Visual acuity and anatomic outcomes at the first visit, last visit before being LTFU, return visit, and after re-treatment were analyzed and compared with those of DME patients with regular follow-up. Patients who had continuous follow-up visits were assigned to the control group. Sixty patients (33%) with DME were LTFU for more than 1 year during anti-VEGF treatment. Multivariate analysis revealed that the ratio of male (p = 0.004), diabetes mellitus (DM) duration less than 5 years (p = 0.015), and poor early anatomic response (p = 0.012) were higher compared to the control group. Eighteen patients returned to the clinic and received re-treatment. After re-treatment with anti-VEGF, central subfield thickness (CST) was significantly improved to the CST of before LTFU. However, visual acuity did not recover to the level before LTFU (0.63 ± 0.26 vs. 0.45 ± 0.28, p = 0.003). About thirty percent of DME patients were LTFU for more than 1 year. Permanent visual loss was observed in these LTFU patients. Patients with a high risk of LTFU such as male, early DM, and poor response after initial injections should be treated more aggressively to improve the visual outcomes.


2021 ◽  
Author(s):  
Huda Badri ◽  
Imran Satia ◽  
Vikas Bansal ◽  
Muhammad Asif Mangi ◽  
Anupong Tangaroonsanti ◽  
...  

Abstract Purpose: Gastro-oesophageal reflux disease (GORD) is commonly thought to play an important role in chronic cough and patients are often empirically treated with acid suppression therapy. We sought to investigate the response rate to acid suppression treatment in patients with and without heartburn attending two specialist cough clinics. Methods: A retrospective review of 558 consecutive patients referred to two specialist cough clinics was performed (UK and US). Patients who were treated with acid suppression were included and their documented response to treatment collected. Binary logistic regression was used to ascertain the value of reported heartburn in predicting the response of chronic cough to acid suppression therapy. Results: Of 558 consecutive referrals, 238 patients were excluded due to missing data or cough duration of <8weeks. The remaining 320 patients were predominantly female (76%), mean age 61yrs (±13), 96.8% non-smokers, with chronic cough for 36 (18-117) months. Of 72 patients with heartburn, 20 (28%) noted improvement in their cough with acid suppression, whereas of 248 without heartburn, only 35 (14%) responded. Patients reporting heartburn were 2.7 (95% C.I. 1.3-5.6) times more likely to respond to acid suppression therapy (p=0.007).Conclusion: In specialist cough clinics, few patients report a response of their chronic cough to acid suppression therapy. Nonetheless, heartburn is a useful predictor substantially increasing the likelihood of benefit.


2021 ◽  
Author(s):  
Virgilio Galvis ◽  
Alejandro Tello ◽  
Jaime Larrea ◽  
Carlos J. Rodríguez ◽  
Sergio E. Serrano ◽  
...  

Abstract Purpose To describe the results of topical atropine 1% weekly combined with a fixed combination of ocular hypotensives (dorzolamide + timolol), versus ocular hypotensives alone, in children and adolescents. Methods A retrospective review of medical records of myopic children and adolescents from September 2003 to June of 2019. The unit of analysis of the data was the change in the magnitude of myopia in a given eye between two consecutive visits (CMCV) and were divided in three groups: “non-adherent”, “hypotensive” and “atropine”, and classified according to the magnitude of myopia progression. Results There were statistically significant differences in the percentages of the CMVC analysis units included in the “completely controlled myopia” classification (higher for the “Atropine” group) and in the “moderate progression” and “severe progression” classifications (lower for the “Atropine” group). Mean progression rate of the CMCV analysis units included in the “atropine” group was significantly lower (-0.13 ± 0.41 Diopters/year) than in the “hypotensives” group (-0.41 ± 0.54 Diopters/year), and in the “non-adherent” group (-0.59 ± 0.57 Diopters/year). Conclusions In a group of myopic children and adolescents in Colombia during the periods of time in which they received 1% atropine, one drop weekly, in combination with dorzolamide + timolol, every 12 hours, showed better control of the progression of myopia, than in the time periods in which they received only ocular hypotensives or were not adherent to pharmacological treatment. Further research is warranted.


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