"GatorSign" for severe lumbar spinal canal stenosis: Magnetic resonance imaging evidence of lumbar perineural edema in the central canal.

Lumbar spinal stenosis is one of the most commonly diagnosed pathological conditions of the spine. Patients with lumbar spinal stenosis can be symptomatic or asymptomatic. Regardless of the clinical presentation, a combination of radiological imaging modalities including magnetic resonance imaging, CT, and dynamic X-rays can be used to evaluate the severity. An often underrecognized aspect of severe lumbar spinal stenosis is its effect on nerve roots. We propose coining the term "GatorSign" to describe nerve root edema above the area of severe central canal stenosis. This radiological finding can help identify patients with severe central canal stenosis in patients who would likely be neurologically symptomatic, requiring an invasive intervention such as epidural injections or surgical decompression for relief as conservative treatments such as physical therapy and/or medications are less likely to be effective.

Large Aerodigestive Tract Foreign Body Extraction Complicated by End-Stage Dementia.

A foreign body in the upper aerodigestive tract can be life-threatening. It is especially challenging for surgeons and anesthesiologists working in a limited shared workspace. A case is presented of an 83-year-old woman with end-stage dementia afflicted with oral fixation as defined as overeating or putting objects in the mouth other than food. She appeared asymptomatic although she had altered baseline mentation and was found to have ingested a large foreign object. This case provides an opportunity to discuss the unique challenges of performing anesthesia on patients undergoing the extraction of a large upper aerodigestive tract foreign body, complicated by end-stage dementia.

Family Medicine Clerkship Teaching About Contraception: Meeting a Need.

INTRODUCTION: Women's healthcare including preventive care, obstetric care, and family planning and counseling are important medical education topics that student physicians frequently encounter during their Family Medicine Clerkship in medical training; however, despite its brief emphasis, many students feel underprepared to counsel patients in a clinical setting. With this in mind, a case-based curriculum focused on women's health was developed for students enrolled in the Family Medicine Clerkship. METHODS: During the 2018-2019 academic year, 127 students on the Family Medicine Clerkship at the Florida International University Herbert Wertheim College of Medicine (HWCOM) participated in three two-hour sessions on the topics of adolescent preventive health care, obstetric care, and contraceptive counseling. These sessions incorporated cases, role-play activities, and pre-session readings. An optional, anonymous, paper-based pre-session survey of Likert-type questions was administered prior to the first session and a post-session survey of Likert-type questions was given following the final session. IRB exemption was obtained. RESULTS: The pre-session survey showed that 41.67% of students agreed or strongly agreed that they were confident in their ability to perform female contraceptive counseling. After the sessions, 92.68% of students agreed or strongly agreed that the case addressing contraceptive counseling was of clinical value to their learning needs. CONCLUSION: Given that less than half of the students felt confident in their counseling abilities prior to these sessions, this curriculum is potentially addressing an unmet educational need. Students found this session to be relevant, indicating that a case-based discussion curriculum that incorporates both pre-session reading materials and role-play interactions may be a promising educational approach.

Mixed Bullous-Eczematous Contact Dermatitis From a Black Henna Tattoo in an African American Female With Sickle Cell Disease With Post-Dermatitis Pain.

Traditionally practiced in East Asian and Southeast Asian countries, Henna tattooing has gained western popularity in creating temporary decorative patterns on the skin. Derived from the Lawsonia inermis shrub prevalent in Asia/Southeast Asia, the leaves of this plant are ground to create a paste with a brown pigment commonly called Mehndi or Henna which have deep-rooted cultural values/practices. The pure organic form of these compounds has few reported side effects. However, with gaining western popularity, synthetic additives to the natural paste to create color variation, shorten application times, and increase shelf-life have led to an increase in the incidence of adverse reactions. Namely attributed to synthetic compounds like para-phenylenediamine (PPD) or para-toluylenediamine, this synthetic type of mixture is called black henna. Although multiple types of adverse reactions with black henna have been documented as an eczematous type of reaction, few if any cases of adverse reactions of black henna affecting patients with sickle cell disease (SCD) have been documented. In this case, we aim to present an atypical mixed bullous-eczematous contact dermatitis reaction secondary to a PPD containing black henna dye applied to the skin of a patient with homozygous SCD. We intend to raise awareness of the deleterious cosmetic sequelae and chronic post-dermatitis pain manifestations which may arise in patients with SCD, as the popularity of black henna tattooing grows in the United States where SCD is one of the most prevalent hemoglobinopathies amongst black Americans.

Medical Ethics and the Biopsychosocial Model for Patient Care: A Case Analysis for Improved Communication, Clinical Time, and Error Avoidance.

The practice of interdisciplinary medicine is one of the most effective and cooperative forms of medical management, which optimizes clinical care and outcomes for a patient. This model of care affords the patient the benefit of receiving the best available therapeutic options from specialists who are experts in their respective disciplines, which would otherwise be limited when compared with the clinical expertise from a single provider managing multiple co-morbidities. However, poor communication between each specialized team managing a patient's care can result in redundancies and superfluous treatment that can have deleterious clinical outcomes that impede the physician-patient relationship and question the bioethical principles of clinical practice. Having a medical provider like an internist who is the primary medical provider for a patient anchors reinforces the physician-patient relationship through familiarity and continuous involvement in the gross clinical course of a patient. Specialty care provides a very focused and limiting scope of practice. However, whether practicing specialty care or being a generalist, utilizing clinical tools, such as the biopsychosocial model and routinely using bioethical principles during clinical encounters, not only help extract pertinent information from the patient's medical history but also furthers the continuity of clinical care by understanding the global context of the patient's medical history. This is a case analysis that exemplifies sub-optimal outcomes in patient care due to undermining the critical role of an internist in patient care and clinical management in addition to challenging several bioethical principles of clinical care. It also highlights the importance of how using the biopsychosocial model of care can avoid clinical errors, improve interdisciplinary and patient communication, and, ultimately, optimize the patient-physician relationship and clinical care.

Demographic Variation in the Frequency of Gliomas in Florida.

Background and objectives: Glial brain cancers affect nearly 20,000 individuals in the United States (USA) annually. SEER database data exploring the relationship between race and gliomas is now available and have shown that cerebral gliomas occur at a higher frequency in Caucasian men. However, such analyses did not include demographic data specific to the state of Florida. This study assessed the association between race and glial vs. non-glial Central Nervous System (CNS) cancers in Florida, USA. Materials and Methods: This case-control study utilized the Florida Cancer Data Registry (FCDS), in which race was considered the exposure and development of glioma as the measured outcome. The sample was comprised of patients in Florida diagnosed with brain tumors from 1981 to 2013. Relative racial frequencies were compared between patients with glial brain tumors and those with other CNS tumors. Data was analyzed using logistic regression in order to determine any associations between race and frequency of diagnosis adjusting for several confounders (age, sex, smoking status, year of diagnosis, and insurance status). Results: Between 1981 and 2013 a total of 14,092 patients meeting the inclusion and exclusion criteria were diagnosed in Florida with a primary brain tumor. Being of non-white race was associated with 60% decreased odds of glioma diagnosis compared to the reference white population (adjusted OR 0.4, 95% CI 0.34⁻0.47). Secondary findings include associations between increasing age and male sex with increased odds of glioma diagnosis. Decreased adjusted odds of glioma diagnosis were found with former smoking status (reference non-smokers), diagnosis between 2001 and 2010 (reference 1981⁻1990), and Medicaid or Medicare insurance (reference private insurance). Hispanic ethnicity, current smoking status, no insurance/self-pay, and geographical location (urban vs. rural) all had no association with glioma diagnosis. Conclusions: These findings are consistent with and help reinforce previous studies utilizing national databases (SEER) which also showed increasing odds of glioma diagnosis in older white males. Various potential explanations for these findings include genetic predisposition, lifestyle and behavioral factors, and socioeconomic status, including access to healthcare. Future research aims at identifying potential genetic etiologies.

Beyond JNC 8: implications for evaluation and management of hypertension in underserved populations.

In the United States, hypertension is a significant medical problem that affects nearly 1 in 3 adults, causes thousands of deaths annually, and costs the nation billions of dollars annually for medical management in terms of hospitalisations, lost wages, and pharmacotherapy. The management guidelines of hypertension have greatly varied between different healthcare organisations including the American College of Cardiology (ACC), the European Society of Cardiology (ESC) and the Joint National Committee (JNC-7, 8). One of the points of contention is the generalisability of the guidelines to all individuals despite empirical evidence suggesting racial sensitivities to pharmacotherapy and high clinical adversities with elevations in blood pressure (BP). This manuscript will aim to review a brief history of the guidelines, the adjustment of the BP goals with pharmacotherapy for the management of hypertension, and discuss several socioeconomic factors attributing to higher clinical risks for certain minority racial groups susceptible to the new BPs goals for management under the JNC-8.

Disparities in Brain Cancer in the United States: A Literature Review of Gliomas.

In the human body, the central regulatory system of homeostasis is maintained by the brain. Its complexity is mesmerizing and many of its functions are largely uncharted. Unfortunately, its functionality is often impaired through neoplastic growths, like gliomas, which are devastating to patients and their families. Annually, gliomas are the most common primary brain tumours affecting over 20,000 people in the United States. However, despite their status as the third most common cause of cancer related death for individuals between ages 20 and 39, the aetiology of gliomas remains unknown. This paper aims to review the latest information regarding the 2016 World Health Organization (WHO) 4th edition classifications of gliomas, their malignant effects, and disparities within these classifications, as well as identify areas for further research. These suggestions for future inquiry may contribute to a better understanding of the pathology of these cancers enabling improvement in prevention, screening, and treatment.

Biocompatibility Assessment of Novel Bioresorbable Alloys Mg-Zn-Se and Mg-Zn-Cu for Endovascular Applications: In- Vitro Studies.

Previous studies have shown that using biodegradable magnesium alloys such as Mg-Zn and Mg-Zn-Al possess the appropriate mechanical properties and biocompatibility to serve in a multitude of biological applications ranging from endovascular to orthopedic and fixation devices. The objective of this study was to evaluate the biocompatibility of novel as-cast magnesium alloys Mg-1Zn-1Cu wt.% and Mg-1Zn-1Se wt.% as potential implantable biomedical materials, and compare their biologically effective properties to a binary Mg-Zn alloy. The cytotoxicity of these experimental alloys was evaluated using a tetrazolium based- MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay and a lactate dehydrogenase membrane integrity assay (LDH). The MTS assay was performed on extract solutions obtained from a 30-day period of alloy immersion and agitation in simulated body fluid to evaluate the major degradation products eluted from the alloy materials. Human foreskin fibroblast cell growth on the experimental magnesium alloys was evaluated for a 72 hour period, and cell death was quantified by measuring lactate dehydrogenase concentrations. Both Mg-Zn-Se and Mg-Zn-Cu alloys exhibit low cytotoxicity levels which are suitable for biomaterial applications. The Mg-Zn-Cu alloy was found to completely degrade within 72 hours, resulting in lower human foreskin fibroblast cell viability. The Mg-Zn-Se alloy was shown to be less cytotoxic than both the Mg-Zn-Cu and Mg-Zn alloys.

Mechanical Properties and Tensile Failure Analysis of Novel Bio-absorbable Mg-Zn-Cu and Mg-Zn-Se Alloys for Endovascular Applications.

In this paper, the mechanical properties and tensile failure mechanism of two novel bio-absorbable as-cast Mg-Zn-Se and Mg-Zn-Cu alloys for endovascular medical applications are characterized. Alloys were manufactured using an ARC melting process and tested as-cast with compositions of Mg-Zn-Se and Mg-Zn-Cu, being 98/1/1 wt.% respectively. Nanoindentation testing conducted at room temperature was used to characterize the elastic modulus (E) and surface hardness (H) for both the bare alloys and the air formed oxide layer. As compared to currently available shape memory alloys and degradable as-cast alloys, these experimental alloys possess superior as-cast mechanical properties that can increase their biocompatibility, degradation kinetics, and the potential for medical device creation.

In Vitro Degradation Behavior of Ternary Mg-Zn-Se and Mg-Zn-Cu Alloys as Biomaterials.

In this study, the corrosion behavior of Mg-Zn-Se and Mg-Zn-Cu alloys was investigated to evaluate their corrosion behavior related to use as implantable biomaterials. The corrosion behavior of these alloys and a commercially available Mg-Zn alloy were examined using static solution electrochemical testing, dynamic solution gravimetric testing, ion leaching testing, and microscopic evaluation. Fluctuations in the pH of the Dulbecco's Modified Eagles Medium (DMEM) used for the gravimetric and ion leaching immersion testing were also recorded over the 30-day duration to assess whether the media conditions induced by the alloy degradation would permit for cellular survival. Weight loss experimentation and electrochemical tests revealed the Mg-Zn-Cu alloy to have the greatest corrosion rate.

Electro and Magneto-Electropolished Surface Micro-Patterning on Binary and Ternary Nitinol.

In this study, an Atomic Force Microscopy (AFM) roughness analysis was performed on non-commercial Nitinol alloys with Electropolished (EP) and Magneto-Electropolished (MEP) surface treatments and commercially available stents by measuring Root-Mean-Square (RMS), Average Roughness (Ra), and Surface Area (SA) values at various dimensional areas on the alloy surfaces, ranging from (800 × 800 nm) to (115 × 115µm), and (800 × 800 nm) to (40 × 40 µm) on the commercial stents. Results showed that NiTi-Ta 10 wt% with an EP surface treatment yielded the highest overall roughness, while the NiTi-Cu 10 wt% alloy had the lowest roughness when analyzed over (115 × 115 µm). Scanning Electron Microscopy (SEM) and Energy Dispersive Spectroscopy (EDS) analysis revealed unique surface morphologies for surface treated alloys, as well as an aggregation of ternary elements Cr and Cu at grain boundaries in MEP and EP surface treated alloys, and non-surface treated alloys. Such surface micro-patterning on ternary Nitinol alloys could increase cellular adhesion and accelerate surface endothelialization of endovascular stents, thus reducing the likelihood of in-stent restenosis and provide insight into hemodynamic flow regimes and the corrosion behavior of an implantable device influenced from such surface micro-patterns.

Biodegradable Magnesium Alloys: A Review of Material Development and Applications.

Magnesium based alloys possess a natural ability to biodegrade due to corrosion when placed within aqueous substances, which is promising for cardiovascular and orthopedic medical device applications. These materials can serve as a temporary scaffold when placed in vivo, which is desirable for treatments when temporary supportive structures are required to assist in the wound healing process. The nature of these materials to degrade is attributed to the high oxidative corrosion rates of magnesium. In this review, a summary is presented for magnesium material development, biocorrosion characteristics, as well as a biological translation for these results.