Digital Health Literacy and Social Determinants of Health Affecting Telehealth Use by Athletic Trainers.

CONTEXT: While increasing telehealth use throughout sports medicine has improved patients' access to health care, some communities may not have the same opportunities to connect with a provider. Barriers to telehealth implementation can be influenced by internal (eg, provider's digital health literacy and resources) and external (eg, community's social determinants of health or "SDOH") factors. This study aimed to assess the impact of internal and external factors on telehealth use by athletic trainers (ATs). DESIGN: Cross-sectional survey. METHODS: In total, 767 ATs participated in the study. Participants (age = 39 [13] y) completed a survey containing the electronic health literacy scale and digital health literacy instrument, reported professional use of telehealth as a provider (yes/no), provided resources at their clinical site, and provided the zip code for the community they served. After data collection, the researchers extracted SDOH information using the zip code data from 2 US databases, including population density, median household income, poverty index, education level, and technology access. Chi-square or independent samples t tests were conducted to compare telehealth use by each SDOH factor. RESULTS: In total, 62.3% (n = 478/767) of ATs reported using telehealth, and 81.6% of ATs (n = 626) had a dedicated facility to offer health care services. We identified a significant difference in digital health literacy scores between users and nonusers of telehealth (P = .013). We did not identify any significant differences between telehealth users by community type (P = .957), population density (P = .053), income (P = .462), poverty index (P = .073), and computer (P = .211) or broadband internet access (P = .295). CONCLUSIONS: Our data suggest that internal factors such as digital health literacy and clinical site resources may have contributed to an AT's previous telehealth use in clinical practice. However, the SDOH data extracted from the community zip code where the AT provided clinical services were similar for those with and without previous telehealth use.

Inhaled Organophosphorus Poisoning Presenting as Superior Laryngeal Nerve Palsy: A Rare Case.

Poisoning by organophosphorus (OP) is a major clinical issue affecting many nations worldwide, especially developing nations. In this case report, we have highlighted organophosphate poisoning syndrome that resulted in paralysis of the vocal cords. A 28-year-old male patient with a history of accidental inhalation of the OP compound reported to our hospital with symptoms of vomiting and hoarseness of voice. He had nasal regurgitation and hoarseness having both 9th and 10th cranial nerve palsies on admission, which improved after administration of atropine.

Role of Zinc and Clinicopathological Factors for COVID-19-Associated Mucormycosis (CAM) in a Rural Hospital of Central India: A Case-Control Study.

Introduction Coronavirus disease 2019 (COVID-19)has been a difficult enemy to beat for healthcare professionals around the world. However, even before the end of the COVID-19 pandemic, there has been an emergence of a new combatant in the form of opportunistic fungal infections with a high rate of morbidity and mortality, creating havoc throughout the globe. Methods A case-control single-center study was conducted in Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra. All the subjects who were included in the study were tested positive for COVID-19 through the reverse transcriptase-polymerase chain reaction (RT-PCR) method and the cases were defined as patients with biopsy-proven mucormycosis, whereas control were subjects who did not develop mucormycosis. The duration of the study was three months, from June 2021 to August 2021. Result A total of 55 cases and 50 controls were enrolled in the study. The use of zinc was found to be significantly associated with COVID-19-associated mucormycosis, with 89.1% of the cases having a history of zinc intake and only 52% of controls having a history of zinc intake( p-value <0.001). Diabetes mellitus was found to be significantly associated with COVID-19-associated mucormycosis with 83.6% of the cases and 16% of the controls having diabetes mellitus (p-value <0.001). Although the use of steroids in cases was more with 98.2% of the cases and 54% of the control receiving steroids; this difference was not significant statistically (p-value of 1.00). Conclusion We conclude that apart from diabetes mellitus and other immunosuppressive states, zinc might be the hidden culprit behind the sudden surge of COVID-19-associated mucormycosis worldwide owing to the self-administration of zinc by the patients to acquire innate immunity and over-prescription of multivitamins by the treating clinicians. However, this association required further studies in order to be proved.

Lightning Strike Presenting as Fatal Lung Contusion: A Case Report.

Electrical injuries to humans from a lightning strike are associated with significant rates of morbidity and fatality. High-voltage injuries including those caused by lightning strikes are pulmonary edema, pulmonary contusion, acute respiratory distress syndrome, and pulmonary hemorrhages. Patients who get injured experience secondary trauma in addition to direct and indirect injury. In this report, we present the case of a 62-year-old male patient with complaints of shortness of breath, vomiting, and hoarseness of voice. The patient's treatment included airway protection, antibiotics, corticosteroids, and supportive care; however, the patient did not survive due to a severe lung contusion.

Spine and lower extremity kinematics during gait in patients with cervical spondylotic myelopathy.

BACKGROUND CONTEXT: Cervical spondylotic myelopathy (CSM) typically manifests with a slow, progressive stepwise decline in neurologic function, including hand clumsiness and balance difficulties. Gait disturbances are frequently seen in patients with CSM, with more advanced cases exhibiting a stiff, spastic gait. PURPOSE: To evaluate the spatiotemporal parameters and spine and lower extremity kinematics during the gait cycle of adult patients with CSM before surgical intervention. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: Twenty-eight subjects with symptomatic CSM who have been scheduled for surgery and 30 healthy controls (HC). OUTCOME MEASURES: Spine and lower extremity kinematics and spatiotemporal parameters. METHODS: Clinical gait analysis was performed for patients with CSM and HC. The data were analyzed with a one-way analysis of variance. RESULTS: Patients with CSM have significantly more anterior pelvis tilt (CSM: 13.97°, HC: 5.56°), larger lumbar lordosis (CSM: 8.59°, HC: 2.7°), smaller cervical lordosis (CSM: 6.02°, HC: 11.35°), and less head flexion (CSM: 0.69°, HC: 8.66°) at the beginning of the gait cycle. There was a decrease in knee range of motion in patients with CSM compared with controls (CSM: 36.31°, HC: 50.17°). Furthermore, patients with CSM presented with slower walking speed (CSM: 0.81 m/s, HC: 1.05 m/s), decreased cadence (CSM: 95.57 step/m, HC: 107.64 step/m), increased double support time (CSM: 0.40 s, HC: 0.28 s) and stride time (CSM:1.28 s, HC: 1.13 s), shorter stride length (CSM: 1.04 m, HC: 1.18 m) and step length (CSM:0.51 m, HC: 0.58 m), and wider width (CSM: 0.14 m, HC:0.11 m). CONCLUSIONS: Our study shows that patients with CSM enter the gait cycle with a larger anterior pelvic tilt and lumbar lordosis as well as less cervical lordosis and head flexion. As a consequence of these abnormal spinal parameters at the onset of the gait cycle, lower extremity biomechanics are also altered. Our study is the first to demonstrate the relationship between aberrant spinal alignment and lower extremity function. Identification of this interrelationship as well as the specific gait and biomechanical disturbances seen in myelopathic patients can both inform our understanding of the disease and tailor rehabilitation protocols.

Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients.

OBJECTIVE: Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and VTE. SUMMARY BACKGROUND DATA: The prevalence of prophylactic placement of IVC filters has increased among trauma patients. However, there exists little data on the overall efficacy of prophylactic IVC filters with regard to outcomes. METHODS: Trauma quality collaborative data from 2010 to 2014 were analyzed. Patients were excluded with no signs of life, Injury Severity Score <9, hospitalization <3 days, or who received IVC filter after occurrence of VTE event. Risk-adjusted rates of IVC filter placement were calculated and hospitals placed into quartiles of IVC filter use. Mortality rates by quartile were compared. We also determined the association of deep venous thrombosis (DVT) with the presence of an IVC filter, accounting for type and timing of initiation of pharmacological VTE prophylaxis. RESULTS: A prophylactic IVC filter was placed in 803 (2%) of 39,456 patients. Hospitals exhibited significant variability (0.6% to 9.6%) in adjusted rates of IVC filter utilization. Rates of IVC placement within quartiles were 0.7%, 1.3%, 2.1%, and 4.6%, respectively. IVC filter use quartiles showed no variation in mortality. Adjusting for pharmacological VTE prophylaxis and patient factors, prophylactic IVC filter placement was associated with an increased incidence of DVT (OR = 1.83; 95% CI, 1.15-2.93, P-value = 0.01). CONCLUSIONS: High rates of prophylactic IVC filter placement have no effect on reducing trauma patient mortality and are associated with an increase in DVT events.

Management strategies for total hip arthroplasty in sickle cell patients.

Sickle cell anemia is an inherited hemoglobinopathy in which there is a structural change to the erythrocyte from round to crescent shaped or sickled. These abnormally shaped cells can block small vessels resulting in compromise of vascular supply, pain, and end-organ damage. These patients are particularly susceptible to hip osteonecrosis, which in late stages may require a total hip arthroplasty. Historically, total hip arthroplasty had inferior outcomes in this patient population due to poorer clinical outcomes and higher perioperative complications. During recent decades, however, there have been some improvements in the medical management of these patients, which has potentially improved the clinical outcomes of this procedure. In this article, we review all reported management strategies for the perioperative care of sickle cell anemia patients undergoing total hip arthroplasty.

Outcomes of primary total knee arthroplasty in the morbidly obese patients.

The purpose of this study was to assess the clinical and radiographic outcomes of primary total knee arthroplasty (TKA) in morbidly obese patients compared to a cohort who had a normal body mass index (BMI). We reviewed 105 knees in 84 patients who had a minimum BMI of 40 kg/m2 who underwent a primary TKA between 2006 and 2010. There were 17 men and 67 women who had a mean age of 59 years and a mean follow-up of 52 months. Outcomes evaluated included implant survivorship, Knee Society scores, activity scores, and complications. Kaplan-Meier analysis demonstrated statistically similar overall implant survivorship between the morbidly obese and the comparison groups (96 vs 97%). However, the mean Knee Society objective (85 vs 91 points) and functional scores (84 vs 89 points), as well as activity scores (4.2 vs 6.1 points) were lower and complications were higher in morbidly obese patients at final follow-up. It is encouraging that in the morbidly obese patients, total knee arthroplasty can have acceptable results at midterm follow-up, however, these patients may benefit from preoperative counseling to have realistic expectations from their surgery.

Laparoscopic cholecystectomy in pregnancy.

PURPOSE: Since the start of laparoscopic cholecystectomy, a debate about its use in the gravid patient has remained controversial. Concerns about the morbidity and mortality in the mother and fetus through all trimesters have been expressed. The objective of this retrospective review was to further evaluate the safety of laparoscopic cholecystectomy in the pregnant patient. METHODS: At Covenant Health Care-Cooper Campus and Harrison Campus in Saginaw, Michigan, 10 cholecystectomies in pregnant patients were performed from 1995 to April 1998. Eight of these patients were done with laparoscopy, and 2 were done through the open technique. RESULTS: No mortality or significant morbidity occurred in the laparoscopic group. However, the open group did have a fetal mortality. CONCLUSIONS: Our study showed that laparoscopic cholecystectomy can be performed safely in the pregnant patient in the first 2 trimesters. This is consistent with the findings in the current world literature.