Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema in an African American Male With Coronavirus Disease 2019 (COVID-19).

Angioedema is a condition characterized by non-pitting swelling of the subcutaneous or submucosal tissues in particular the face, lips, and oral cavity. Angiotensin-converting enzyme (ACE) inhibitors are known to contribute to the development of angioedema by increasing the levels of bradykinin and its active metabolites. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is hypothesized to contribute to the development of angioedema by modifying ACE II levels and further increasing the level of bradykinin in patients taking ACE inhibitors. African Americans may be at particular risk of developing angioedema with concomitant SARS-CoV-2 infection and ACE inhibitor use. This case involves a 31-year-old African American male diagnosed with coronavirus disease 2019 (COVID-19) who developed angioedema while taking an ACE inhibitor.

Spontaneous intercostal herniation of lung and pleural fluid.

Thoracic hernias are characterized by the protrusion of the thoracic contents outside their normal anatomical confines. This case involves a left pleural effusion secondary to a spontaneous lung intercostal hernia (SLIH) in a 52-year-old male. Imaging revealed herniated pleural fluid in the intercostal space. Intra-operatively, there was herniation of the lung parenchyma into an intercostal defect. Pleural effusion secondary to a SLIH is an indication for surgical repair.

Treatment for Constipation-An Online Search. Readability and Quality of Online Patient Resources.

Aim: To evaluate the readability and quality of online patient information regarding treatment for constipation in the English language. Methods: By utilizing the Google © website, the keyword "treatment for chronic constipation" was searched. Each webpage was assessed by 2 authors independently for readability using both the Gunning Fog Index (GFI) and the Flesch Reading Ease Score (FRES). The quality of the information produced on each individual website was assessed using the DISCERN instrument. Other parameters that were recorded included the country of origin, the organization type, and whether or not the website was issued a Health on the Net (HoN) certificate. Results: This study identified a mean GFI score of 13.2 and a mean FRES score of 48.9. This result indicates poor overall readability. A mean DISCERN score of 37.9 was produced, indicating an overall weak quality of online information on this topic. This study indicated that parameters such as website organization type and the presence or absence of HoN certification impacted the quality of the information websites on this topic. Conclusion: This study indicated a poor level of quality and readability of online information on the topic of chronic constipation treatment. Further resources should be directed towards improving website readability and quality. Patients may be advised that if they wish to access online information on this topic, websites that display HoN accreditation will likely produce higher quality information.

Pediatric Burn Care in the Developing World: Where Are the Gaps in Research and What Can Be Done?

Burns are the fourth most common cause of injury worldwide. The burden of burn injury is largely carried by low- and middle-income countries (LMICs) with children in these regions being particularly vulnerable to burns. The purpose of this scoping review is to identify knowledge gaps in global pediatric burn care experience in an effort to help prioritize future research. Using the 6-stage Arksey and O'Malley framework for conducting a scoping review, pediatric burn care literature was reviewed over a 10-year period from 2010 to 2020. Studies from low-resource settings were included and categorized by geographic location, study patient population, study type, type of burn, and level of evidence. Of 107 included studies, 34% and 49% originated from LMICs in South Asia and Sub-Saharan Africa, respectively. Qualitative/observational (73%) and epidemiological single-center (20%) publications comprised the majority of included papers. The majority (95%) of all papers regardless of geographical location were lower levels of evidence (Level 3 or below). Our study identified four primary knowledge gaps: 1) a paucity of high-quality studies to guide burn care in LMICs; 2) an under-representation of articles from certain geographical locations; 3) few therapeutic and economic articles to guide resource allocation; and 4) a lack of articles with long-term patient follow-up. Efforts to address these disparities could help reduce the pediatric burn burden of disease in resource-poor settings.

Arteriovenous Fistula for dialysis - Let's Google it. Readability and quality of online information.

BACKGROUND: This study evaluated the readability and quality of information regarding arteriovenous (AV) fistula for dialysis on the Internet in the English language. STUDY DESIGN: Using Google© search, the keywords "AV Fistula for dialysis" were searched. The top 75 ranking sites were analyzed. One website was excluded due to repetition. Each landing page was assessed independently by two authors (RB, LR) for readability using the Flesch Reading Ease Score (FRES) and Gunning Fog Index (GFI). Web site quality was assessed using the DISCERN instrument. The individual position of the top 15 websites in the search engine ranking order list was noted. The country of origin, organization type and issuance of Health on the Net (HoN) Certification was recorded. Statistical analyses were performed using unpaired t-tests and ANOVA variance. RESULTS: The mean GFI score was 9.2 and the mean FRES score was 50.6, indicating poor readability. The mean DISCERN score was 48.4, indicating weak quality of websites. Website quality was influenced by the academic/healthcare organization type (p = 0.012). Organization type was not found to impact GFI and FRES scores. Presence of a HoN Certification was not found to impact the quality of information. The majority of sites originated from the United States (61%). CONCLUSION: Our study demonstrates that internet information pertaining to AV fistula for dialysis is of poor quality necessitating improvements to readability and overall website quality to improve the patient experience. Further research into how to improve healthcare web information is needed.

18F-fluorodeoxyglucose positron emission tomography/ computed tomography in the diagnosis of suspected paraneoplastic syndromes: A retrospective analysis.

Paraneoplastic syndromes are a rare clinical presentation of tumor thought to affect 0.01% of patients with cancer. Paraneoplastic syndromes present a diagnostic challenge as a wide variety of signs and symptoms may appear. This study examines the use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) as a diagnostic imaging tool for detecting tumor in suspected paraneoplastic syndrome cases. This single-center retrospective study included patients with suspected paraneoplastic syndrome who underwent whole-body 18F-FDG PET/CT scan between December 2005 and December 2016. Associated clinical data were gathered via electronic chart review. Patient records were reviewed for age, sex, clinical signs and symptoms, ancillary diagnostic procedures, date of diagnosis, and follow-up time. Ninety-nine patients met inclusion criteria for this study. Mean follow-up period was 1.8 years. Cancer prevalence was 12.1%. The 18F-FDG PET/CT results are as follows: 10 true positives, 5 false positives, 82 true negatives, and 2 false negatives. The diagnostic values are as follows: sensitivity 83.3%, specificity 94.3%, positive predictive value 66.7%, and negative predictive value (NPV) 97.6%. The high NPV in our study supports the effectiveness of 18F-FDG PET/CT to rule out tumor in suspected paraneoplastic syndrome. Future research aims to analyze which patients with suspected paraneoplastic syndrome would benefit most from 18F-FDG PET/CT.

Heart rate variability in pulmonary hypertension with and without sleep apnea.

OBJECTIVES: Our aims were to evaluate HRV in pulmonary hypertension (WHO Group 1 and 4) compared to control subjects, and to assess whether the presence of sleep apnea in those with pulmonary hypertension would be deleterious and cause greater impairment in HRV. METHODS: This retrospective case-control study analyzed electrocardiogram segments obtained from diagnostic polysomnography. RESULTS: Forty-one pulmonary hypertension patients were compared to 41 age, sex and apnea-hypopnea index matched healthy controls. The pulmonary hypertension group had decreased high frequency, very low frequency, low frequency, and percentage of normal R-R intervals that differ by > 50 ms compared to control subjects. Moderate to severe right ventricle dysfunction on echocardiography was a predictor of lower high frequency in pulmonary hypertension patients. CONCLUSIONS: There were no differences in any HRV measures in pulmonary hypertension patients with or without sleep apnea. Impaired HRV was demonstrated in pulmonary hypertension patients however, the presence of sleep apnea did not appear to further reduce vagal modulation.

Heart rate variability in pulmonary hypertension with and without sleep apnea

Objectives: Our aims were to evaluate HRV in pulmonary hypertension (WHO Group 1 and 4) compared to control subjects, and to assess whether the presence of sleep apnea in those with pulmonary hypertension would be deleterious and cause greater impairment in HRV. Methods: This retrospective case-control study analyzed electrocardiogram segments obtained from diagnostic polysomnography. Results: Forty-one pulmonary hypertension patients were compared to 41 age, sex and apnea-hypopnea index matched healthy controls. The pulmonary hypertension group had decreased high frequency, very low frequency, low frequency, and percentage of normal R-R intervals that differ by > 50 ms compared to control subjects. Moderate to severe right ventricle dysfunction on echocardiography was a predictor of lower high frequency in pulmonary hypertension patients. Conclusions: There were no differences in any HRV measures in pulmonary hypertension patients with or without sleep apnea. Impaired HRV was demonstrated in pulmonary hypertension patients however, the presence of sleep apnea did not appear to further reduce vagal modulation.

The correlation between fundamental characteristics and first-time performance in laparoscopic tasks.

BACKGROUND: The ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure. METHODS: Participants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university. Participants completed four visuospatial, one psychomotor aptitude test and an electronic survey, followed by four laparoscopic tasks on a validated Virtual Reality simulator (LAP Mentor™). RESULTS: Twenty eligible individuals participated with a mean age of 20.8 (±3.8) years. Significant intra-aptitude performance correlations were present amongst 75% of the visuospatial tests. These visuospatial aptitudes correlated significantly with multiple laparoscopic task metrics: number of movements of a dominant instrument (rs ≥ -0.46), accuracy rate of clip placement (rs ≥ 0.50) and time taken (rs ≥ -0.47) (p < 0.05). Musical Instrument experience predicted higher average speed of instruments (rs ≥ 0.47) (p < 0.05). Participant's revised competitive index level predicted lower proficiency in laparoscopic metrics including: pathlength, economy and number of movements of dominant instrument (rs ≥ 0.46) (p < 0.05). CONCLUSION: Multiple visuospatial aptitudes and innate competitive level influenced baseline laparoscopic performances across several tasks in surgically naïve individuals.

Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3.

OBJECTIVES/HYPOTHESIS: To evaluate the changes in health-related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short-Form Survey-36 (SF-36) and the Health Utility Index Mark 3 (HUI-3). To do so, a health utility index was obtained by converting the SF-36 to the Medical Outcome Study Short-Form Survey-6D (SF-6D) to permit comparison with HUI-3 scores in the context of health preference as measured by quality-adjusted life years. STUDY DESIGN: Prospective cohort study. METHODS: Eighty-one postlingually deaf adult patients undergoing cochlear implantation completed the SF-36 and HUI-3 preoperatively and at a median of 1.4 years (range, 11 months-5 years) after cochlear implantation. RESULTS: The SF-36 improvement was statistically significant in two domains. The SF-36 data were converted to SF-6D. Preoperatively, the mean SF-6D utility score was 0.575 ± 0.056. One year postoperatively this score increased to 0.590 ± 0.064. The improvement of 0.015 ± 0.082 was not statistically significant (P = .1118). Of the HUI-3 attributes, two showed improvement between preoperative and postoperative evaluations. The overall HUI-3 score increased from 0.464 ± 0.207 preoperatively to 0.611 ± 0.190 postoperatively. The gain of 0.146 ± 0.19 was statistically significant (P < .0001). The intraclass correlation coefficient between the SF-6D and HUI-3 showed a very small correlation, both pre- and postoperatively. CONCLUSIONS: Against the backdrop of diminishing resources for healthcare, cost-effective analysis is fast becoming an important tool. There remains a strong need for health-related quality-of-life instruments that can truly reflect the benefit of cochlear implantation, in which utility estimates are fundamentally important. The SF-36 scores, when converted to SF-6D, do not correlate well with HUI-3 scores in a cohort of adult cochlear implant recipients. The HUI-3 remains the most appropriate tool for this patient group. LEVEL OF EVIDENCE: 4