Acute anosmia in neuromyelitis optica spectrum disorder.

The cardinal features of neuromyelitis optica spectrum disorder (NMOSD) are optic neuritis, longitudinal extensive transverse myelitis and area postrema syndrome. Olfactory dysfunction is not listed as a feature in the NMOSD diagnostic criteria. Here, we present an aquaporin-4 antibody positive patient who, in addition to classical features of NMOSD, developed acute anosmia with magnetic resonance imaging (MRI) evidence of olfactory bulb abnormalities. While the association of anosmia and NMOSD has been rarely noted previously, to our knowledge, no prior cases have found this to be one of the presenting features of a relapse nor have they identified acute radiological correlates.

Afro-Caribbean Heart Failure in the United Kingdom: Cause, Outcomes, and ATTR V122I Cardiac Amyloidosis.

BACKGROUND: It has been reported that subjects of African descent present with heart failure at a younger age and because of different causes than whites. We present contemporary data from UK Afro-Caribbean patients in London. METHODS AND RESULTS: All patients with heart failure presenting to St George's Hospital Heart Failure clinic between 2005 and 2012 were included (n=1392). Patients were predominantly white (71%) and male (67%), and median age at presentation was 73 years (range, 18-100 years). In 211 Afro-Caribbean patients, the most common cause of heart failure was nonischemic dilated cardiomyopathy in 27.5% (whites, 19.9%; P<0.001). Lower rates of ischemic cardiomyopathy were observed (13% versus 41%; P<0.001). The fourth most common cause of heart failure in Afro-Caribbeans was cardiac amyloidosis (11.4%). The prevalence may have been even higher as not all patients were tested for amyloidosis. Patients with ATTR V122I had the worst prognosis compared with other causes of Afro-Caribbean heart failure and white patients. To better understand this condition, we analyzed data from the largest international cohort of ATTR V122I patients, followed up at the UK National Amyloidosis Center (n=72). Patients presented with cardiac failure (median age, 75 [range, 59-90] years). Median survival was 2.6 years from diagnosis. CONCLUSIONS: In London, the cause of heart failure varies depending on ethnicity and affects age of presentation and outcomes. In Afro-Caribbean patients, ATTR V122I is an underappreciated cause of heart failure, and cardiomyopathy is often misattributed to hypertension. As promising TTR therapies are in development, increased awareness and proactive detection are needed.

A second opinion: response to 100 professors.

Induced abortion is a controversial topic among obstetricians. "100 Professors" extolled the benefits of elective abortion in a Clinical Opinion published in AJOG. However, scientific balance requires the consideration of a second opinion from practitioners who care for both patients, and who recognize the humanity of both. Alternative approaches to the management of a problem pregnancy, as well as short and long term risks to women as published in the peer reviewed medical literature are discussed. Maintaining a position of "pro-choice" requires that practitioners also be given a right to exercise Hippocratic principles in accordance with their conscience.

Medical students' involvement in outpatient clinical encounters: a survey of patients and their obstetricians-gynecologists.

PURPOSE: To study women's prior exposure to medical students during office visits, and the association between this and other factors in the likelihood of patients consenting to medical students' involvement in obstetrical-gynecological (ob-gyn) care. Physicians also were surveyed regarding their perceptions of patients' preferences. METHOD: In 1999-2000, an anonymous questionnaire was distributed for one week to all women scheduled for an ob-gyn visit and to their providers at six community campuses of Michigan State University College of Human Medicine. The questionnaire asked for patients' demographic information and prior experience with medical students, factors important when deciding to allow medical students to participate in their care, and how knowledge of medical students' involvement influences patients' choice of an ob-gyn. RESULTS: Seventy-two physicians and 1,059 patients returned the questionnaire. Four hundred eighty-eight (49%) patients reported prior experience with medical students. Patients and physicians rated interpersonal skills as most important when deciding about medical students' participation. Forty-three (63%) physicians thought students should participate in the history and physical examination compared to 299 (31%) patients. Prior experience with medical students was a major facilitating factor for medical students' involvement while patients' needs were a limiting factor. Patients' age and medical students' gender also predicted patients' attitudes. CONCLUSIONS: Most women would allow medical students to participate in their care, a finding moderated by a number of factors. A small proportion of women were biased against participation of male medical students. Physicians overestimated patients' ratings and might themselves be a source of bias regarding medical students' involvement.

Female patients' preferences related to interpersonal communications, clinical competence, and gender when selecting a physician.

PURPOSE: In obstetrics and gynecology (ob-gyn), a physician's gender can affect patients' access to care as well as medical education curricula and career counseling. The authors focused on the importance that female patients place on various physician characteristics, and how this importance varied by patients' characteristics and compared for family practitioners, obstetrician-gynecologists, and surgeons. METHOD: In 1999-2000, an anonymous questionnaire was distributed for one week to all women scheduled for an ob-gyn visit at six community campuses of Michigan State University College of Human Medicine. The first section of the questionnaire listed 16 physician characteristics and asked patients to rate the importance of each using a six-point scale (1 = not at all important, to 6 = very important). The items were presented three times, in reference to the patients' choice of a family physician, ob-gyn, and surgeon. The questionnaire also asked for patients' demographic information. Descriptive statistics were used to summarize patient demographics and ratings. Multivariate relationships were tested using analyses of variance (repeated-measures analysis of variance [ANOVA]) and multiple regression. RESULTS: In the 1,059 completed questionnaires, items related to physician gender were among the lowest rated, regardless of specialty. A factor analysis resulted in a three factor solution: Interpersonal Communications, Clinical Competence, and Gender. Interpersonal Communications ratings varied least by physician specialty and patient characteristics; Gender ratings varied most. Physician behaviors rather than physician attributes play an important role in women's choices. CONCLUSIONS: For most women, physician gender was one of the least important characteristics, regardless of specialty. Excellent skills might give all physicians an edge in patients' choice decisions, a finding contrary to widely held beliefs about more limited future opportunities for men in some specialties.

What influences medical students to pursue careers in obstetrics and gynecology?

OBJECTIVES: The purpose of this study was to identify factors that influence medical students to choose of obstetrics/gynecology as a career specialty. STUDY DESIGN: A Web-based survey of medical students was conducted that included demographics, desire to enter the obstetrics and gynecology specialty, factors that influence selection of the obstetrics and gynecology specialty, perceptions about the obstetrics and gynecology specialty, and incidents of encouragement and discouragement toward entering the obstetrics and gynecology specialty. Analysis included parametric and nonparametric testing. RESULTS: Fifty-one percent of the students (n=205) returned the survey: 131 women (64%) and 72 men (35%); 2 respondents did not specify gender. Various factors influenced a medical student to pursue a career in obstetrics and gynecology, which revealed some specific areas of significant difference between genders, particularly in relation to lifestyle issues and practice trends. CONCLUSIONS: This study amplifies the importance of understanding the role of student gender when exploring the obstetrics and gynecology specialty as a career choice. Appreciating factors that influence decisions to enter the obstetrics and gynecology specialty provides opportunities to impact the experiences and decisions of students toward considering the obstetrics and gynecology specialty as a career choice.