Showing papers by "Ochsner Medical Center published in 2022"
01 Jan 2022
3 citations
TL;DR: In this article, a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.
2 citations
TL;DR: In this article , the authors compare the specimen quality, complication rates and recovery times in EUS-LB vs percutaneous (PC-LB) and transjugular (TJ-LB), and show that EUSLB produces better or similar specimens with fewer needle passes and lesser postprocedural recovery time when compared with PC-LB and TJ-LB.
Abstract: Background and Aims Endoscopic ultrasound guided fine needle biopsy of the liver (EUS-LB) has emerged as a safe technique to obtain liver tissue for diagnosis of parenchymal liver disease. In this study, we compare the specimen quality, complication rates and recovery times in EUS-LB vs percutaneous (PC-LB) and transjugular (TJ-LB) routes. Methods This is a single center retrospective study comparing EUS-LB (19-G core needle) to PC-LB (16-G needle) and TJ-LB (19-G needle). Primary outcome was the number of complete portal tracts (CPT). Secondary outcomes were: aggregate specimen length (AL), mean length of longest intact core (LIC), postprocedure recovery time, and adverse events. Results A total of 92 procedures were included in this study. Fewer needle passes were performed in EUS-LB group and PC-LB group compared to TJ-LB group (P < 0.001). EUS-LB produced more CPTs than PC-LB (P < 0.001) and similar number of CPT to TJ-LB (P > 0.05). EUS-LB produced significantly higher AL than both PC-LB (P = 0.03) and TJ-LB (P = 0.02). LIC with EUS-LB was higher than TJ-LB (P = 0.04) but similar to PC-LB (P = 0.23). Postprocedural recovery time was less after EUS-LB compared to PC-LB (P < 0.001) and TJ-LB (P = 0.04). Postprocedure adverse events were rare, and similar across the 3 groups. Conclusion EUS-LB produced better or similar specimens with fewer needle passes and lesser postprocedural recovery time when compared with PC-LB and TJ-LB. EUS-LB should be the preferred technique for liver biopsy when patients also need an upper endoscopy.
2 citations
TL;DR: In a large integrated healthcare system, patients with a P2Y12 reaction units (PRU) test were identified. as mentioned in this paper found that HPR was more common in the cardiovascular patient population than previously appreciated.
Abstract: "Clopidogrel resistance," also defined as heightened platelet reactivity (HPR) while on clopidogrel therapy, may lead to a sub-optimal antiplatelet effect and a potential thrombotic event. There is limited literature addressing the prevalence of HPR in a large cohort of patients receiving either coronary or endovascular interventions.In a large integrated healthcare system, patients with a P2Y12 reaction units (PRU) test were identified. HPR was defined as a PRU ≥ 200 during clopidogrel therapy. Vascular and coronary interventions were identified utilizing CPT codes, HPR prevalence was calculated, and Fischer's exact test was used to determine significance.From an initial cohort of 2,405,957 patients (October 2014 to January 2020), we identified 3301 patients with PRU tests administered. Of these, 1789 tests had a PRU ≥ 200 (HPR overall prevalence, 54%). We then identified 1195 patients who underwent either an endovascular or coronary procedure and had a PRU measurement. This corresponded to 935 coronary and 260 endovascular interventions. In the coronary cohort, the HPR prevalence was 54% (503/935). In the vascular cohort, the HPR prevalence was 53% (137/260); there was no difference between cohorts in HPR prevalence (p = 0.78)."Clopidogrel resistance" or HPR was found to be present in nearly half of patients with cardiovascular disease undergoing intervention. Our data suggest HPR is more common in the cardiovascular patient population than previously appreciated. Evaluating patients for HPR is both inexpensive ($25) and rapid (< 10 min). Future randomized studies are warranted to determine whether HPR has a clinically detectable effect on revascularization outcomes.
2 citations
TL;DR: In this paper , the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is considered for patients with nonprotective Streptococcus pneumoniae titers.
Abstract: Background Pneumococcal antibody deficiency has been the subject of limited study in chronic rhinosinusitis (CRS) and has not been studied in recurrent acute rhinosinusitis (RARS). The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is considered for patients with nonprotective Streptococcus pneumoniae titers. We hypothesized that both RARS and CRS patients with deficient S pneumoniae titers and subsequent PPSV23 vaccination would have reduced health-care encounters for sinusitis and fewer prescriptions for antibiotics or steroids. Methods A retrospective cohort study was performed of patient encounters between January 2011 and December 2019. All patients included were ≥18 and ≤65 years old with a diagnosis of CRS or RARS and pneumococcal titer data. Patients with immunodeficiency and comorbid conditions requiring PPSV23 vaccination before 65 years of age were excluded. Results A total of 938 patients were included in the study. Nonprotective antibody titers were present in 75.8% of CRS and 74.8% of RARS patients. A total of 306 patients with deficient antibody titers received the PPSV23 vaccine. Eighty-nine percent of CRS and 90.1% of RARS patients had protective responses. Among the 217 patients with continuous data from 2 years before through 2 years after PPSV23 vaccination, a decrease in the number of encounter diagnoses of CRS (p < 0.0001) and RARS (p = 0.0006) was observed. Decreases in the frequency of antibiotic (p = 0.002) and corticosteroid (p = 0.04) prescriptions were also appreciated. Conclusion Most patients with CRS and RARS have nonprotective antibody titers. PPSV23 administration significantly decreases health-care utilization.
2 citations
TL;DR: In this paper , the authors compared the efficacy and safety of the combination of warfarin and dual-antiplatelet therapy (DAT) in patients with left ventricular assist devices (LVAD).
2 citations
TL;DR: In this article , a multi-input and multiscale (MIMS) U-Net with a two-stage recurrent training strategy was proposed for the automatic vessel segmentation, which generated a refined prediction map with the following two training stages: (i) stage I coarsely segmented the major coronary arteries from preprocessed single-channel ICAs and generated the probability map of arteries; and during the stage II, a three-channel image consisting of the original pre-processed image, a generated probability map, and an edge-enhanced image generated from the pre-processing image was fed to the proposed MIMS U-net to produce the final segmentation result.
Abstract: Purpose: In stable coronary artery disease (CAD), reduction in mortality and/or myocardial infarction with revascularization over medical therapy has not been reliably achieved. Coronary arteries are usually extracted to perform stenosis detection. As such, developing accurate segmentation of vascular structures and quantification of coronary arterial stenosis in invasive coronary angiograms (ICA) is necessary. Approach: A multi-input and multiscale (MIMS) U-Net with a two-stage recurrent training strategy was proposed for the automatic vessel segmentation. The proposed model generated a refined prediction map with the following two training stages: (i) stage I coarsely segmented the major coronary arteries from preprocessed single-channel ICAs and generated the probability map of arteries; and (ii) during the stage II, a three-channel image consisting of the original preprocessed image, a generated probability map, and an edge-enhanced image generated from the preprocessed image was fed to the proposed MIMS U-Net to produce the final segmentation result. After segmentation, an arterial stenosis detection algorithm was developed to extract vascular centerlines and calculate arterial diameters to evaluate stenotic level. Results: Experimental results demonstrated that the proposed method achieved an average Dice similarity coefficient of 0.8329, an average sensitivity of 0.8281, and an average specificity of 0.9979 in our dataset with 294 ICAs obtained from 73 patients. Moreover, our stenosis detection algorithm achieved a true positive rate of 0.6668 and a positive predictive value of 0.7043. Conclusions: Our proposed approach has great promise for clinical use and could help physicians improve diagnosis and therapeutic decisions for CAD.
1 citations
TL;DR: In this paper , the authors discuss three patients with challenging LAA anatomy that underwent successful Watchman FLX implantation and discuss their case series of 3 patients with atrial fibrillation who underwent successful implantation.
1 citations
TL;DR: Scombroid poisoning, systemic mastocytosis, and hereditary alpha tryptasemia all present with episodes that resemble allergic reactions as mentioned in this paper, and key differences are described between these events and allergic reactions.
1 citations
TL;DR: In this article , the authors explored purdah in Bangladeshi society through an ethnographic study in one of Dhaka's low income communities and argued that while new employment opportunities allow women to enter spaces that were hitherto not accessible to them, these employment opportunities are, in reality, often extensions of existing exploitative, patriarchal systems.
Abstract: In many countries, women's movements continue to be dictated by gendered spaces, including social practices such as purdah. At the same time, globalisation and increased urbanisation in recent years have transformed women's lives, bringing about a significant increase in opportunities for women to work outside their homes. This article explores purdah in Bangladeshi society through an ethnographic study in one of Dhaka's low income communities. It will be argued that while new employment opportunities allow women to enter spaces that were hitherto not accessible to them, these employment opportunities are, in reality, often extensions of existing exploitative, patriarchal systems. Furthermore, women must manage their movements in specific ways in order to maintain a positive identity and moral status. These negotiations are an integral part of the day-to-day experiences of women as they navigate their relationships and employment in the changed context of their lives.
TL;DR: In this article, a patient with acute anaphylactic reaction should be observed in the ED for at least 24 hours, depending on their clinical course, risk factors, and social support.
TL;DR: In this paper , Nijst et al. measured renin and aldosterone levels at day-1 and at discharge in patients with acute heart failure and showed that renin/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis.
05 Jul 2022
TL;DR: In this article , the authors look at the history and pros and cons of TIF when it comes to community redevelopment and how it has benefited and benefits CRED, and discuss the advantages and disadvantages of using tax increment financing in community development.
Abstract: One of the most important aspects of community development is the notion of private public partnerships in which a government entity partners with a private sector developer to complete a development that neither could have done on their own. One of the most widely used forms of public-private partnership development agreements is tax increment financing, better known as TIF. This chapter looks at the history and pros and cons of TIF when it comes to community redevelopment and how it has benefited and benefits CRED.
09 May 2022
TL;DR: In this paper , a case report of an unusual presentation of retropharyngeal abscess in a 3 month old infant with fever and irritability was presented, which was later confirmed to be a case of colic.
Abstract: Case report of an unusual presentation of retropharyngeal abscess in a 3 month old infant with fever and irritability.
14 Sep 2022
TL;DR: In this paper , the applicability of vertical temperature profile (VTP) for hydrological simulations through several experimental sets was investigated and further enhanced by using Web-DHM-S to simulate the hydrology of a snowfed river basin in Japan.
Abstract: The use of the Japanese 55-year Reanalysis (JRA55) vertical temperature profile (VTP) has been suggested in previous studies for estimating gridded air temperatures at high elevations in data-scarce regions to conduct hydrological simulations. In this study, we investigate and further enhance the applicability of VTP for hydrological simulations through several experimental sets using a distributed hydrological model with improved snow physics (WEB-DHM-S) based on water and energy budget to simulate the hydrology of a snowfed river basin in Japan, Kurobe Basin, while simultaneously correcting the snow precipitation estimates through optimization. We examined the simulated discharge, point snow depth, and snow cover, finding that the snow processes were highly sensitive to the individual station used with VTP for extrapolating air temperature to higher elevations, with corrected snowfall estimates differing by as much as 18%. We further compared this with simulations based on linear regression-based lapse rates derived from station observations (scarce and often distributed at low elevations). It was found that the use of VTP improved discharge simulations but deteriorated point snow depth simulations at low elevations, compared with linear regression-based lapse rates. A hybrid of the two methods led to better discharge and point snow depth simulations with reasonable snow cover simulations. The study advances the application of snow-process models in data-scarce regions by enhancing our understanding about the usage of VTP.
22 Jun 2022
TL;DR: In this article , the human blood-brain barrier was studied using C. elegans as a model organism and the effects of L-Cysteine and methylmercury on C- elegans were studied using three metrics: viability, locomotive disability, and time for locomotive effects to occur.
Abstract: Methylmercury is a neurotoxin present in fish tissues that permeates the blood-brain barrier after consumption. Previous research has shown that methylmercury is harmful to neurons, causing pH alterations, oxidative stress, excitotoxicity, and parenchymal damage. Methylmercury is a known factor of neurological disorders including Alzheimer's and Parkinson's. The method by which methylmercury passes through the blood-brain barrier is largely unknown. According to preliminary studies, one way methylmercury crosses the blood-brain barrier is by creating a complex with L-Cysteine, which facilitates its passage by the LATs system through mimicking another amino acid existing in the body. The human blood-brain barrier was studied using C. elegans as a model organism. It was hypothesized that if methylmercury passes through the blood-brain barrier of C. elegans faster with L-Cysteine present than without L-Cysteine present, the methylmercury's adverse effects (death and locomotive difficulty) will occur sooner. Each of the four experimental groups contained one C. elegans: the control, the L-Cysteine group, the methylmercury group, and the methylmercury and L-Cysteine combination group. The effects of L-Cysteine and methylmercury on C. elegans were studied using three metrics: viability, locomotive disability, and time for locomotive effects to occur. The group that received both methylmercury and L-Cysteine had reduced viability rates and a decreased time for locomotive difficulty to develop, supporting the hypothesis. These findings suggest that L-Cysteine aids methylmercury permeation through the blood-brain barrier. Because the experiment indicates how methylmercury penetrates the blood-brain barrier, these results aid in finding a therapeutic solution to reverse methylmercury neurotoxicity in the brain. Additionally, this study further opens channels into potential therapeutic and preventative measures for dementia, improving morbidity and mortality in neurodegenerative diseases.
23 Jun 2022
TL;DR: In this article , the human blood-brain barrier was studied using C. elegans as a model organism and the effects of L-Cysteine and methylmercury on C- elegans were studied using three metrics: viability, locomotive disability, and time for locomotive effects to occur.
Abstract: Methylmercury is a neurotoxin present in fish tissues that permeates the blood-brain barrier after consumption. Previous research has shown that methylmercury is harmful to neurons, causing pH alterations, oxidative stress, excitotoxicity, and parenchymal damage. Methylmercury is a known factor of neurological disorders including Alzheimer's and Parkinson's. The method by which methylmercury passes through the blood-brain barrier is largely unknown. According to preliminary studies, one way methylmercury crosses the blood-brain barrier is by creating a complex with L-Cysteine, which facilitates its passage by the LATs system through mimicking another amino acid existing in the body. The human blood-brain barrier was studied using C. elegans as a model organism. It was hypothesized that if methylmercury passes through the blood-brain barrier of C. elegans faster with L-Cysteine present than without L-Cysteine present, the methylmercury's adverse effects (death and locomotive difficulty) will occur sooner. Each of the four experimental groups contained one C. elegans: the control, the L-Cysteine group, the methylmercury group, and the methylmercury and L-Cysteine combination group. The effects of L-Cysteine and methylmercury on C. elegans were studied using three metrics: viability, locomotive disability, and time for locomotive effects to occur. The group that received both methylmercury and L-Cysteine had reduced viability rates and a decreased time for locomotive difficulty to develop, supporting the hypothesis. These findings suggest that L-Cysteine aids methylmercury permeation through the blood-brain barrier. Because the experiment indicates how methylmercury penetrates the blood-brain barrier, these results aid in finding a therapeutic solution to reverse methylmercury neurotoxicity in the brain. Additionally, this study further opens channels into potential therapeutic and preventative measures for dementia, improving morbidity and mortality in neurodegenerative diseases.
TL;DR: In this article , the authors summarize the pathophysiological processes linking HTN to heart failure with preserved ejection fraction (HFpEF) and highlight novel concepts in medical and device-based management of HTN and HTN.
Abstract: Hypertension (HTN) remains the most common and strongest contributing factor to the development of heart failure with preserved ejection fraction (HFpEF). In this review, we aim to summarize the pathophysiological processes linking HTN to HFpEF and highlight novel concepts in medical and device-based management of HFpEF and HTN.Despite the global increase in the prevalence of HFpEF, there has been limited benefit in current medication and device-based therapy for this complex syndrome. The hallmark of HFpEF is an elevated left intra-atrial and ventricular pressure and exertional dyspnea. Traditional medications used for treating HTN in patients with reduced left ventricular ejection fraction have unclear benefits in patients with HFpEF. Careful analysis of emerging medications such as angiotensin receptor-neprilysin inhibitor and sodium-glucose co-transporter-2 inhibitors showed benefit in reducing not only blood pressure but also hospitalizations in patients with HFpEF. Current data on device-based therapy aims to reduce left intra-atrial pressure, ventricular pressure and stimulate baroreceptors to lower blood pressure; however, needs further investigation.The nexus of HTN and HFpEF remains strong and complex. Although traditional medications for treating HFrEF did not affect long-term outcomes, novel therapies with angiotensin receptor neprilysin-inhibitor and sodium-glucose co-transporter-2 inhibitor offer promising results. Many device-based interventions in the HFpEF population are being developed with the aim to reduce left intra-atrial and ventricular pressure; however, their role in HFpEF hypertensive patients needs to be further investigated.
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TL;DR: The weakest areas in the Liberian education system is that of technical/vocational education as discussed by the authors , and during the nineteenth century practically nothing was accomplished in this area, since the Christian missions which dominated education in the country were so preoccupied with Christianising and "civilising" that they neglected vocational education.
Abstract: The Liberian nation usually traces its beginnings to settlement in the 1820s by blacks from the New World under the auspices of the American Society for Colonizing the Free People of Colour of the United States of America and the various state colonisation societies which sprang up in relation to it. As might be expected, the initial emphasis was on elementary (primary) education and from 1822 to 1839 only elementary schools existed. They were run by individual settlers who were already members of Christian churches. From 1833 the church missions began to work directly in Liberia and to play a dominant role in education. One of the weakest areas in the Liberian education system is that of technical/vocational education. During the nineteenth century practically nothing was accomplished in this area. The Christian missions which dominated education in the country were so preoccupied with Christianising and ‘civilising’ that they neglected vocational education.
01 Jun 2022
TL;DR: In this article , the authors discuss the protections afforded by international human rights law to the right to liberty and security of the person and right to a fair trial for those suspected of having committed a criminal offence.
Abstract: This chapter discusses the protections afforded by international human rights law to the right to liberty and security of the person and the right to a fair trial. The right to liberty regulates powers of detention and provides safeguards against ill-treatment of detainees. An extreme form of arbitrary detention is enforced disappearance. The right to a fair trial sets out how court proceedings should be conducted and court systems organized. In addition, there are specific protections for those who are suspected of having committed a criminal offence.
01 Jan 2022