Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]S...Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.展开更多
Dear editor,Intussusception is the invagination of one portion of the intestines into another, and is the most common form of intestinal obstruction in infants.^([1]) The vast majority of cases of intussusception are ...Dear editor,Intussusception is the invagination of one portion of the intestines into another, and is the most common form of intestinal obstruction in infants.^([1]) The vast majority of cases of intussusception are idiopathic, and are thought to be due to hyperplasia of the lymphoid tissue in the Peyer’s patches of the terminal ileum. The展开更多
Background:Parkinson’s disease(PD)is often accompanied by clinically identified depression.Providing effective pharmacotherapies that concomitantly treat both motor and psychological symptoms can pose a challenge to ...Background:Parkinson’s disease(PD)is often accompanied by clinically identified depression.Providing effective pharmacotherapies that concomitantly treat both motor and psychological symptoms can pose a challenge to physicians.For this reason,alternatives to standard anti-depressant treatments,such as repetitive transcranial magnetic stimulation(rTMS),have been evaluated within the Parkinson’s population.Methods:A literature search was conducted on the PubMed database for all studies that evaluated rTMS as a treatment in patients with both depression and PD.A meta-analysis was performed on all studies that reported mean pre-and post-rTMS depression inventory scores.Widely used depression inventories included both self-report and clinician-administered measures.Effect size for individual study groups and across all studies was calculated.Results:Six of 7 studies meeting inclusion criteria reported significantly improved depression scores,large effect sizes,and significant p-values.Total weighted average effect size was calculated at 1.32 across all study groups that applied rTMS.Conclusions:Across all but one study,rTMS appears to effectively reduce depression scores among self-reported and clinician administered inventories.The total weight average effect size showed that,when considering study sample sizes and degree of findings,this form of neurostimulation can relieve PD patients of their depressive symptoms.Further,rTMS is a promising alternative to traditional anti-depressant therapies when treating refractory depression in patients with PD.展开更多
Despite improved survival outcomes across many cancer types,the prognosis remains grim for certain solid organ cancers including glioblastoma and pancreatic cancer.Invariably in these cancers,the control achieved by t...Despite improved survival outcomes across many cancer types,the prognosis remains grim for certain solid organ cancers including glioblastoma and pancreatic cancer.Invariably in these cancers,the control achieved by time-limited interventions such as traditional surgical resection,radiation therapy,and chemotherapy is short-lived.A new form of anti-cancer therapy called therapeutic alternating electric fields(AEFs)or tumor treating fields(TTFields)has been shown,either by itself or in combination with chemotherapy,to have anti-cancer effects that translate to improved survival outcomes in patients.Although the pre-clinical and clinical data are promising,the mechanisms of TTFields are not fully elucidated.Many investigations are underway to better understand how and why TTFields is able to selectively kill cancer cells and impede their proliferation.The purpose of this review is to summarize and discuss the reported mechanisms of action of TTFields from pre-clinical studies(both in vitro and in vivo).An improved understanding of how TTFields works will guide strategies focused on the timing and combination of TTFields with other therapies,to further improve survival outcomes in patients with solid organ cancers.展开更多
文摘Myocarditis is a disease process that every emergency physician fears missing.Its severity can be mild to life-threatening,and many cases are likely undetected because they are subclinical with nonspecifi c signs.[1]Subtle cardiac signs may be overshadowed by systemic symptoms of the underlying infectious process.Fever,myalgias,lethargy,symptoms commonly associated with viral syndrome,can mask the life-threatening myocarditis that may be present.In fact,in the United States Myocarditis Treatment Trial,almost 90%of patients reported symptoms consistent with a viral prodrome.[2]Ammirati et al[3]reported that 27%of patients with myocarditis had either reduced left ventricular ejection fraction,ventricular arrhythmias,or low cardiac output.Here,we present a case report,in which handheld point-of-care ultrasound was utilized at the bedside to aid in the critical diagnosis of myocarditis.With the additional information provided through this imaging modality,this patient was able to be transferred to the appropriate tertiary care facility in an expeditious manner and receive possible defi nitive treatment.
文摘Dear editor,Intussusception is the invagination of one portion of the intestines into another, and is the most common form of intestinal obstruction in infants.^([1]) The vast majority of cases of intussusception are idiopathic, and are thought to be due to hyperplasia of the lymphoid tissue in the Peyer’s patches of the terminal ileum. The
文摘Background:Parkinson’s disease(PD)is often accompanied by clinically identified depression.Providing effective pharmacotherapies that concomitantly treat both motor and psychological symptoms can pose a challenge to physicians.For this reason,alternatives to standard anti-depressant treatments,such as repetitive transcranial magnetic stimulation(rTMS),have been evaluated within the Parkinson’s population.Methods:A literature search was conducted on the PubMed database for all studies that evaluated rTMS as a treatment in patients with both depression and PD.A meta-analysis was performed on all studies that reported mean pre-and post-rTMS depression inventory scores.Widely used depression inventories included both self-report and clinician-administered measures.Effect size for individual study groups and across all studies was calculated.Results:Six of 7 studies meeting inclusion criteria reported significantly improved depression scores,large effect sizes,and significant p-values.Total weighted average effect size was calculated at 1.32 across all study groups that applied rTMS.Conclusions:Across all but one study,rTMS appears to effectively reduce depression scores among self-reported and clinician administered inventories.The total weight average effect size showed that,when considering study sample sizes and degree of findings,this form of neurostimulation can relieve PD patients of their depressive symptoms.Further,rTMS is a promising alternative to traditional anti-depressant therapies when treating refractory depression in patients with PD.
基金supported by the McNair Medical Institute at The Robert and Janice McNair Foundation.
文摘Despite improved survival outcomes across many cancer types,the prognosis remains grim for certain solid organ cancers including glioblastoma and pancreatic cancer.Invariably in these cancers,the control achieved by time-limited interventions such as traditional surgical resection,radiation therapy,and chemotherapy is short-lived.A new form of anti-cancer therapy called therapeutic alternating electric fields(AEFs)or tumor treating fields(TTFields)has been shown,either by itself or in combination with chemotherapy,to have anti-cancer effects that translate to improved survival outcomes in patients.Although the pre-clinical and clinical data are promising,the mechanisms of TTFields are not fully elucidated.Many investigations are underway to better understand how and why TTFields is able to selectively kill cancer cells and impede their proliferation.The purpose of this review is to summarize and discuss the reported mechanisms of action of TTFields from pre-clinical studies(both in vitro and in vivo).An improved understanding of how TTFields works will guide strategies focused on the timing and combination of TTFields with other therapies,to further improve survival outcomes in patients with solid organ cancers.
