Crystals and biomarker analysis via synovial fluid sampling in patients with knee effusion with radiographic correlation

Purpose: Synovial fluid biomarker analysis is a developing modality for subcategorizing arthritis type. We examined radiographic evidence of chondrocalcinosis and osteoarthritis severity in relation to their respective biomarker levels or detection on the Synovasure® RISC panel. Methods and Study Design: This is a monocentric, cross-sectional, non-controlled, and non-randomized, case series study. Patients with a knee effusion and planned arthrocentesis were included. 800 synovial fluid samples were obtained from consenting eligible patients as part of standard of care and sent via Synovasure specimen kits for analysis. Samples were further categorized based on biomarker results. Results: A total of 800 synovial fluid samples were analyzed. Crystals were found to be present in 166 (N= 20.8%) of samples. Isolated crystals included calcium pyrophosphate (N=148; 18.5%) and monosodium urate (N= 17; 2.13%), with one sample screening positive for both (N=1; 0.13%). The mean Cartilage Oligomeric Matrix Protein (COMP)/Interleukin-8 (IL-8) ratio was 30.6 (SD = 26). 305 subjects (38.3%) had a Kellgren-Lawrence (KL) grade of 4 representing a plurality for the total cohort. The COMP/IL-8 ratio was found to increase with ascending KL-grade (p-value \u3c 0.001). Chondrocalcinosis was found on radiographic review in 144 subjects (18.1%), 100 samples (60.2%) of which were noted also to be positive for intracellular and/or extracellular crystals (p-value \u3c 0.001). A subset of the cohort (N=210) was analyzed for comorbid history of gout, with 29 (13.8%) being identified via retrospective chart review. Among the subjects with crystal positivity, 24 (14.5%) also had comorbid gout (p=0.766). Conclusions: This study demonstrates statistically significant findings with respect to the presence of radiographic chondrocalcinosis and crystal detection positivity rates via synovial fluid analysis. It also demonstrates a significant correlation between arthritis severity, as qualified by radiographic KL grade, and the ratio of COMP to IL-8. Calcium pyrophosphate crystals were predominant in subjects with radiographic chondrocalcinosis. Significance: This study highlights the relationship between crystals, biomarkers, and their associated conditions, emphasizing the crucial role of synovial fluid analysis in diagnosing and treating arthritis. Acknowledgements: The study group would like to acknowledge Zimmer Biomet for its role in sample processing and data collation

Comparative Functional Outcomes for Ischemic Stroke Patients with and without COVID-19

Background: COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. This study examines how COVID-19 affects functional outcomes of ischemic stroke patients. Methods: Ischemic stroke patients admitted to our Joint Commission-certified primary stroke center were retrospectively analyzed from March 1, 2020, to March 1, 2022. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022). Patients were included if they were ≥18 years old and had a stroke on admission or during hospitalization. Univariate and multivariable analyses were used, with a significance threshold of p\u3c 0.05. Results: Out of 1,171 patients, those who tested positive for COVID-19 had significantly worse outcomes. Demographics, clinical data, and outcomes are found in Table 1. COVID-19 Positive patients experienced fewer days between stroke and death (4 days vs. 25 days, p=0.047), higher modified Rankin Scale (mRS) scores at discharge (3 vs. 1, p=0.001), and increased rates of altered consciousness (41.46% vs. 21.86%, p=0.03). In the vaccination period subgroup, COVID-positive patients had fewer days from stroke to death (4 days vs. 42 days, p=0.047), worse mRS scores (3 vs. 1, p=0.009), longer delays in discharge placement (0 vs. 1 day, p=0.020), and higher rates of altered consciousness (57.89% vs. 23.71%, p=0.001). Additionally, COVID-negative patients were more likely to be discharged home (49.52% vs. 36.84%, p=0.021). Multivariable analysis identified higher NIHSS at admission (OR: 1.028 [1.003–1.053], p=0.027), older age (OR: 1.027 [1.011–1.045], p=0.001), and a history of diabetes (OR: 1.596 [1.056–2.413], p=0.027) as increased mortality risks. Discussion & Conclusion: COVID-19 is associated with worse recovery outcomes and discharge delays for ischemic stroke patients compared to those without COVID-19. Further research is needed to explore these differences and their implications for stroke management amid the ongoing global health crisis

Acculturation, Self-Esteem, Family Norms, and Disordered Eating Behaviors in South Asian Women

This study investigated the relationships among acculturation, self-esteem, family norms, and disordered eating behaviors among South Asian women living in the United States. Although research suggests culture plays a role in the etiology of eating disorders, little information on the experiences of South Asian women exists. This study sought to fill this gap in the literature. Using a cross-sectional, quantitative survey-based design, 151 South Asian women provided insight into their experiences with family norms, acculturation, self-esteem, and eating behaviors. Results indicated that acculturation was not significantly associated with disordered eating. However, self-esteem was found to be negatively associated with disordered eating behaviors. Likewise, traditional family norms and expectations were found to be significantly associated with healthier eating habits. This study highlights the need for further exploration of the role of cultural factors, self-esteem, and family systems in terms of the development and maintenance of eating disorders

Exploring Psychological Impacts, Coping, and Conflict Resolution of Transnationalism on Parent-Child Relationships

The number of immigrants migrating to the United States has increased over the past 30 years. Many of these immigrants leave behind their spouses and children, creating transnational families. Researchers have focused on the experiences of transnational families, but there is a need for continued research to further explore the psychological impact of separation and reunification. The purpose of this study was to identify the possible psychological impact of the separation and reunification process experienced by transnational families, and the coping strategies used during the process. This study used a qualitative design to explore the experiences of transnational families who experienced separation due to parental migration. The participants included four Hispanic adolescents between the ages of 14 and 20 years old, and their parents. A semi-structured interview was used to interview the participants about the parent-child relationship, their experiences, and methods of coping. A qualitative method of grounded theory was used to analyze the interview transcripts. The following themes emerged from the interviews with the adolescents: psychological impacts of separation on children, reunification process, using their support system, and coping. The following themes emerged from the interviews with the parents: reason for migration, communication attempts, parental perception of children’s reactions to parental migration and reunification, parental coping, parents’ reactions to reunification, and the parent-child relationship. A better understanding of this population’s experiences can guide clinicians toward improving client care and identifying best practices for this population

Pediatric Anxiety Disorders: Therapy Process Predictors of Response to CBT

CBT is moderately effective in the treatment of youth anxiety, yet there remains a sizeable number of youth who remain nonresponsive at posttreatment, and less than half achieve remission. Various patient-level variables have been examined concerning differential treatment outcomes for anxious youth, but fewer studies have examined therapy process variables. Using archival data, this study aimed to identify predictors of treatment response in youth with primary anxiety disorders who completed 16-weeks of CBT at a university-based clinic. Four samples of anxious youth, aged 7-17 were included in the analysis. Regression analyses revealed that increased skill acquisition and greater change in parent-reported coping efficacy were associated with disorder-specific improvement (CGI-I), while only change in parent-reported coping efficacy was associated with posttreatment symptom severity (CGI-S), degree of clinical significance and functional impairment of anxiety symptoms (CSR), and overall anxiety level (MASC). The results of the study suggest that mastery of therapeutic skills and more reliably, growth in a patient’s confidence to navigate anxiety-provoking situations are important for treatment response, though there may be additional processes contributing to favorable outcomes. Our findings add to a relatively small body of youth process-outcome literature that examines differential outcomes for anxious youth and contributes new insights into the relationship between process variables and youth treatment outcomes. Implications for future youth process-outcome studies are also provided

A pilot study of a manualized cognitive-behavioral intervention for opioid use disorder delivered in a community-based public health organization

This pilot study evaluated a previously untested cognitive-behavioral therapy (CBT) intervention designed specifically to treat opioid use disorder (OUD). Adults (N = 20) taking medication for OUD were recruited from a public health organization providing harm reduction and treatment services to people who use drugs in Philadelphia. Outcomes collected at baseline and 12 weeks included urinalysis-confirmed use of illicit drugs and surveys of mood (Patient Health Questionnaire-9; Generalized Anxiety Disorder-7), recovery capital (Brief Assessment of Recovery Capital-10), and cravings (Brief Substance Craving Scale). Feasibility and acceptability were assessed via retention rates, the Client Satisfaction Questionnaire-8, and the number of CBT sessions attended. The twelve, 50-minute modules followed standard CBT format (e.g., agenda, action plans) and applied the foundational tenets of CBT to reduce the behavior of illicit opioid use (e.g., cognitive restructuring, functional analysis). Change in outcomes and effect sizes were calculated using paired t-tests, McNemar’s tests, and Cohen’s d. Enrolled participants (N = 20, 66.7% male, 8.3% Black) were a mean age of 41.8 years, SD = 9.0. In total, 12 participants completed pre- and post-treatment study visits and were included in analyses (60%). From baseline to week 12, completers (n = 12) reported improvements in recovery capital (t [11] = -1.83, p = .047, Cohen’s d = -.53), reductions in anxiety (t [11] = 2.22, p = .024, Cohen’s d = .64), and reductions in depression (t [11] = 3.58, p = .002, Cohen’s d = 1.0). No changes were observed in positive urine screenings for illicit opioid use specifically (OR = 1.0). Participants attended the majority of CBT sessions (M = 10.8, SD = 1.6) and reported high satisfaction with the program (M = 31.3, SD = 1.4). Overall, satisfaction ratings were high and moderate effect sizes observed for most of the survey-based psychosocial outcomes. Utilizing measures that quantify reductions in opioid use versus abstinence only, and that assess for behaviors that can increase the risk of overdose, may better capture the impact of psychosocial interventions on opioid use in this population

The Different Effects Between Trimethylamine and Trimethylamine N-oxide on H9c2 Myoblast Cells

Background: Trimethylamine (TMA) is a gut-derived metabolite of choline and L-carnitine that is converted to trimethylamine N-oxide (TMAO) in the liver. Elevated plasma TMAO levels are strongly associated with an increased risk of cardiovascular disease. Previous studies suggest that TMA and TMAO promote inflammation, oxidative stress, and dysregulation of cholesterol metabolism, contributing to pro-atherosclerotic changes in blood vessels. We hypothesize that high levels of TMA and TMAO induce cardiac cell damage through oxidative stress and mitochondrial dysfunction. Goals/Methods: This study utilizes H9c2 myoblast cells to investigate the effects of TMA and TMAO on cardiac cell function. Cells were treated with different concentrations of TMA or TMAO (0.001uM-500mM) to assess dose-dependent effects on cell viability using the colorimetric Cell Counting Kit-8. Additionally, mitochondrial membrane potential (MMP) and intracellular reactive oxygen species (ROS) levels were measured using MT-1 and DCFDA fluorescence assays, respectively. All data were presented as means ± SE. The data was analyzed by student t-test. p\u3c 0.05 are considered to be statistically significant. Results: Higher concentrations (10-500 mM) of TMA or TMAO dose-dependently reduced cell viability. TMA (80 mM) significantly attenuated H9c2 cell viability to 25.3 ± 2.1% (n=8) compared to the control. In contrast, TMAO exerted similar effects (26.9 ± 7.3%, n=5) at a higher concentration (250 mM). The ROS levels remained unchanged in TMA-treated cells at 80 mM (104 ± 20.7%, n=3), whereas TMAO (250 mM) showed a 44.53 ± 0.78 fold increase in ROS production. Additionally, TMA (80 mM) slightly reduced MMP to 94.0 ± 5.1% (n=2), while TMAO (250 mM) significantly reduced MMP to 74.8 ± 2.8% (n=2). Conclusion: The data suggest that higher doses of TMA and TMAO reduced H9c2 cell viability. In contrast to TMAO, TMA showed higher potency. TMAO-induced cell damage is mediated by increased ROS production and MMP reduction. However, TMA\u27s mechanism of cell damage remains unclear, as ROS levels and MMP were not significantly altered. Further studies are needed to elucidate the precise mechanisms underlying TMA-mediated cytotoxicity

Stretch-Induced Hip Injury Causing Septic Arthritis: A Case Report

Introduction: Septic arthritis is a serious bacterial condition commonly affecting kids through hematogenous spread. It is frequently caused by organisms such as Staphylococcus Aureus and Kingella Kingae. The joint space of bones, such as the hips and knees of children, is a common location for septic arthritis to form. Monitoring the ESR and CRP are important in diagnosing and treating the infection. We present a rare case that highlights septic arthritis in a child that was caused by a stretching incident that was not evident due to normal lab values and was considered to be a muscle strain. Case Report: A 10-year-old girl presents with a hip injury from stretching three days after experiencing upper respiratory symptoms. The child had been to the emergency room and physician\u27s office but did not show any signs of septic arthritis. A couple of days later, the child presented three out of the four symptoms in the Kocher criteria, which led to a high suspicion of septic arthritis. The patient was then admitted into the hospital, and underwent a surgical incision & drainage, followed by administration of a PICC Line. The patient had to undergo rehabilitation services and is on her way to recovery. Results: Successful treatment of the patient was obtained, and the patient is undergoing multiple forms of rehabilitation to regain normal function. Conclusion: This case demonstrates an infection that was not suspected due to the injury and no clinical evidence of septic arthritis in the beginning. This case report is designed to bring awareness to how septic arthritis can present in different ways than may be expected. The rare nature of this case led to a delayed presentation of septic arthritis, which should be expected in children who experience any injuries in their musculoskeletal system and report joint pain following the injury

Racial and geographic disparities in opioid use disorder (OUD) during pregnancy in Georgia: A systematic review

BACKGROUND The opioid crisis remains a significant public health challenge in the United States, with opioid use disorder (OUD) during pregnancy posing serious health risks for both mom and baby. In Georgia, Black individuals face disproportionately high opioid-related mortality rates, exacerbated by systemic inequities in healthcare access, pain management, and maternal health services. Rural communities experience additional barriers, including limited healthcare infrastructure and socioeconomic constraints. Despite existing research on opioid use disorder in pregnancy, limited studies have examined how racial and geographic factors uniquely intersect to impact maternal and neonatal health outcomes in Georgia. Understanding these intersections is crucial to developing equitable interventions. OBJECTIVE This study aims to examine racial and geographic disparities in OUD during pregnancy in Georgia by examining existing literature on opioid-related health outcomes, systemic inequities, and social determinants of health. The findings will aid in the development of strategies needed to improve maternal and neonatal health while addressing these disparities. METHODS A systematic literature review will be conducted using peer-reviewed articles, government reports, and publicly available datasets from sources such as PubMed, Scopus, Cochrane Library, the Healthcare Cost and Utilization Project (HCUP), and the U.S. Census Bureau. A thematic analysis will be employed to identify key themes, including racial disparities in opioid misuse and mortality, rural-urban differences in opioid-related health outcomes, and the impact of social determinants of health on opioid use in Georgia. Findings will be synthesized to highlight gaps in existing research and potential policy implications. RESULTS & CONCLUSION This project is currently in progress. Preliminary findings will be analyzed to identify actionable strategies for reducing disparities in maternal and neonatal health outcomes. These insights will contribute to policy recommendations and future interventions targeting opioid use disorder in pregnancy. Final conclusions will be drawn upon the completion of the review, with an emphasis on translating findings into equitable and effective healthcare strategies

Combined CRVO + CLRAO – A Case Report

Introduction This case report presents a patient diagnosed with central retinal vein occlusion (CRVO) concomitant with cilioretinal artery occlusion (CLRAO) in their right eye. The diagnosis was established through a dilated fundus examination, fluorescein angiography, optical coherence tomography (OCT), and fundus photography. The occurrence of CRVO in conjunction with CLRAO is rare, representing a unique and noteworthy clinical presentation. The clinical manifestation of CRVO typically includes optic disc hyperemia, dilation and tortuosity of veins, and extensive retinal edema and hemorrhage. Disruption of the blood-retinal barrier consequently leads to edema and disruption of the vascular endothelium leads to hemorrhages, which can ultimately be seen on fluorescein angiography as leakage of dye from capillaries. The central retinal artery, the cilio-retinal artery, and the central retinal vein all share a common exit point through the optic nerve. An associated CLRAO with CRVO has been hypothesized and attributed to the rapid increase in intraluminal pressure within the retinal capillary network from the venous stasis following a CRVO, subsequently surpassing the pressure within the cilioretinal artery and resulting in the obstruction of blood flow in the cilioretinal artery. Methods Case Report and Literature Review Results The clinical presentation of this patient’s painless, sudden loss of vision was consistent with a diagnosis of CRVO with CLRAO, confirmed with OCT and fluorescein angiography. Initially, it appeared nonischemic due to non-severe hemorrhage, vision greater than 20/200, absence of afferent pupillary defect, and absence of cotton wool spots. At his 2-week follow up visit, his vision had decreased, and OCT revealed severe macular edema with outer retina disruption, raising concern for ischemic conversion. Intravitreal injections of 1.25mg bevacizumab was initiated. Conclusion Healthy blood circulation is vital for efficiently circulating oxygen and nutrients to all parts of the body, including to the eye. The main vessels of the inner retina are the central retinal artery and the central retinal vein, which supply and drain the retina. With the compromised blood, oxygen, and nutrient flow, the retina becomes ischemic. This leads to damage at a cellular level, leading to an upregulation of cytokines, and angiogenic factors including vascular endothelial growth factors (VEGF). VEGF, a very potent angiogenic protein, leads to retinal and choroidal neovascularization, as well as vascular permeability resulting in retinal edema. With prolonged obstruction in retinal perfusion, permanent ganglion cell death can occur leading to irreversible vision loss. For this reason, prompt treatment is recommended. The occurrence of CRVO in conjunction with CLRAO is rare, representing a unique and noteworthy clinical presentation