Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report

Introduction: Central cord syndrome (CCS) is a clinical syndrome of motor weakness and sensory changes. While CCS is most often associated with traumatic events. There have been few documented cases being caused by abscesses resulting from osteomyelitis.Case Report: A 56-year-old male presented to a regional trauma center complaining of excruciating neck and bilateral upper extremity pain. Computed tomography of the cervical and thoracic regions revealed severe discitis and osteomyelitis of the fourth and fifth cervical (C4-C5) with near-complete destruction of the C4 vertebral body, as well as anterolisthesis of C4 on C5 causing compression of the central canal. Empiric intravenous (IV) antibiotic therapy with ampicillin/sulbactam and vancomycin was initiated, and drainage of the abscess was scheduled. After the patient refused surgery, he was planned to be transferred to a skilled nursing facility to receive a six-week course of IV vancomycin therapy. A month later, patient returned to emergency department with the same complaint due to non-compliance with antibiotic therapy.Discussion: Delayed diagnosis and treatment of osteomyelitis can result in devastating neurological sequelae, and literature supports immediate surgical debridement. Although past evidence has suggested surgical intervention in similar patients with presence of abscesses, this case may suggest that antibiotic treatment may be an alternative approach to the management of CCS due to an infectious etiology. However, the patient had been non-compliant with medication, so it is unknown whether there was definite resolution of the condition.Conclusion: In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging

The relationship of religion, religiosity, and parental communication in the sexual behaviors of Filipinos aged 18-25 years in the United States and the Philippines

This cross-sectional survey research aims to explore and compare the relationship of religion, religiosity, and parental communication to the sexual behaviors of Filipinos aged 18-25 years in the United States and the Philippines. The Duke University Religion Index and Parent-Teen Sexual Risk Communication Scale-III was used to measure religiosity and parental communication. There were 130 participants living in the United States and 247 living in the Philippines included in this study. Among respondents from the Philippines, low levels of parental communication were associated with an increased report for the lack of condom use during the last intercourse. Catholics had a decreased likelihood of alcohol or illicit drug use before intercourse, having had multiple sex partners, and engaging in casual sex. Those who had low levels of religiosity were associated with reports of having had casual sex. Among the United States respondents, those who engaged in alcohol or illicit drug use before sexual intercourse were associated with decreased organizational religious activities. The findings of this study confirmed the need for comprehensive and culturally appropriate approaches to health promotion programs that incorporate religious and familial factors appropriate for Filipinos

Elastic Abdominal Binders Reduce Cesarean Pain Postoperatively: A Randomized Controlled Pilot Trial

Introduction. A potential non-pharmacologic way to reduce postoperativepain and bleeding is using an abdominal binder duringpostoperative recovery. This study aims to determine the effect anelastic abdominal binder has on postoperative pain and hemorrhageafter cesarean delivery. Methods. A randomized, single-site, pilot trial was conducted at twoprenatal care clinics and an academic hospital in Kansas. Beginningin April 2013, 60 patients were enrolled if delivering via cesarean.Participants were randomized to receive an abdominal binder or to acontrol group (did not use binder). Pain levels were reported by questionnaireone day after surgery using a 0 to 10 scale, with 10 being theworst pain. Patient characteristics and blood loss were assessed bymedical record review. Results. Of the 56 patients completing the study, 29 (51.8%) wererandomized to the binder group and 27 (48.2%) were randomizedto the control group. The binder group reported significantly lowerpain score (p = 0.019) and average pain score (p = 0.024). There wasno difference in body mass index, age, previous surgery, infant birthweight, estimated blood loss, and average dose of pain medicationduring the first 24 hours after the cesarean delivery between the twogroups. There was no difference in pre- and post-operative hemoglobinlevels by treatment group (p = 0.406). Conclusions. Abdominal binders may be associated with improvedpostoperative pain scores but did not affect postoperative hemorrhage.Kans J Med 2018;11(2):48-53

Prevalence and Predictors of Social Support Utilization among Cancer Patients Undergoing Treatment

Background. The purpose of this study was to quantify the prevalence of cancer patients utilizing social support services while undergoing treatment and to identify patient and clinical factors associated with utilization of such services. Methods. This was a cross-sectional study. Surveys were distributed to three cancer clinics at 11 locations in the greater Kansas City metropolitan area in 2010. Study inclusion criteria included being at least 18 years old and undergoing treatment for cancer at the time of survey completion. Results. A total of 465 oncology patients completed surveys. Two-thirds (67.5%, n = 314) were undergoing treatment for cancer and were included in the final analysis. More than half (63.7%, n = 198) were female, and the average age was 58.9 ± 13.3 years. More than one-third (37.4%, n = 117) reported using cancer-related social support services. Additionally, 22% (n = 69) reported not using support services but were interested in learning more about those services. Patients had increased odds of having used support services if they were female (OR = 2.67; 95% CI = 1.47, 4.82), were younger adults, or had stage I-III (OR = 2.67; 95% CI 1.32, 5.26) or stage IV cancer (OR = 2.3; 95% CI 1.14, 4.75) compared to those who did not know their cancer stage. Conclusions. More than one-third of patients reported using social support services. A substantial portion of participants reported not using support services but were interested in learning more about those services. Increasing social support service utilization might be especially important to explore for men, those who do not know their cancer stage, and older adults

Evaluation of Protective Equipment Used Among Motorbike Riders

Introduction. This study compared outcomes between patientsinjured at a motorbike track, which requires riders to follow safetyequipment guidelines, and those involved in recreational riding wheresafety equipment usage is voluntary. Methods. A retrospective review was conducted of all patients presentingwith motorbike-related injuries at an American College ofSurgeons verified level-I trauma center between January 1, 2009 andDecember 31, 2013. Data collected included demographics, injurydetails, safety equipment use, hospitalization details, and dischargedisposition. Comparisons were made regarding protective equipmentusage. Results. Among the 115 patients admitted, more than half (54.8%, n =63) were injured on a motorbike track, and 45.2% (n = 52) were injuredin a recreational setting. The majority of patients were male (93.9%),Caucasian (97.4%), and between the ages of 18 to 54 (64.4%). Helmetusage was higher among track riders (95.2%, n = 60) than recreationalriders (46.2%, n = 24, p < 0.0001). Comparisons of injury severity andoutcomes between those who wore protective equipment and thosewho did not were not significant. Conclusions. Even though track riders wore protective equipmentmore than recreational riders, there was no difference between thegroups regarding injury severity or hospital outcomes. These resultssuggested that motocross riders should not rely on protective equipmentas the only measure of injury prevention.Kans J Med 2018;11(2):44-47

Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.Methods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.Results: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).Conclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock

Microstructure evolution and enhanced properties of Cu–Cr–Zr alloys through synergistic effects of alloying, heat treatment and low-energy cyclic impact

In this paper, CuCr–Zr alloys prepared by vacuum melting with adding La and Ni elementswere heat-treated and aged, followed by plastic deformation using low-energy cyclic impact tests, to simultaneously improve their mechanical and electrical properties. Results showed that the grain size of the casted Cu–Cr–Zr alloys was significantly reduced after the solid-solution aging and plastic deformation process. There were a lot of dispersed Cr and Cu5Zr precipitates formed in the alloys, and the numbers of dislocations were significantly increased. Accordingly, the hardness was increased from 78 to 232 HV, and the tensile strength was increased from 225 to 691 MPa. Electrical conductivity has not been significantly affected after these processes. The enhancement of overall performance is mainly attributed to the combined effects of solid-solution hardening, fine grain hardening, and precipitation/dislocation strengthening

C.E. Credit. Assessment of Pre-Doctoral Dental Students’ Knowledge, Attitudes, and Beliefs of HPV-Related Diseases and Vaccination Trends

ABSTRACTBackground The dental team is uniquely positioned to prevent HPV-positive oropharyngeal squamous cell carcinoma (OPSCC-HPV) and other HPV-related diseases. Provider educational interventions may accelerate HPV vaccinations and decrease OPSCC-HPV rates.Methods Surveys before and after educational interventions were deployed. Year 1 – Year 4 students at WesternU College of Dental Medicine completed 129 pre- and 109 posttest surveys. Statistical analyses were conducted utilizing two-sided Crosstab Chi-square tests assessing pre- and post-survey responses. P-value <.05 was considered to be statistically significant.Results Knowledge levels of HPV-related diseases varied amongst cohorts, but improved post – intervention. Knowledge and preparedness for discussing high-risk HPV risk factors and vaccination increased amongst all cohorts. Understanding the importance of oral healthcare providers administering HPV vaccines in the dental office setting (69.8% vs 87.3%, p = .0068) was significant post-intervention.Conclusions After educational interventions, dental students reported they were capable of discussing and administering HPV vaccinations. Dentists should consider administering HPV vaccinations to reduce incidence of OPSCC-HPV and HPV-related diseases.Practical Implications Dental teams can prevent OPSCC-HPV by educating patients about disease’s risk factors and promoting HPV vaccination. HPV vaccinations in dental settings could improve HPV vaccination rates and decrease development of HPV-related diseases including OPSCC-HPV.Continuing Education Credit Available: The practice worksheet is available online in the supplementary material tab for this article. A CDA Continuing Education quiz is online for this article: https://www.cdapresents360.com/learn/catalog/view/20

Management of Multicentric Myopericytoma in the Maxillofacial Region: A Case Report

Myopericytoma (MPC) is a rare kind of benign neoplasm, showing derivation from perivascular myoid cells. About 115 cases have been reported in the English literature; however, most of the literature focuses on the description and classification of pathology. The case presented here is that of a 42-year-old woman with a surgical management experience of multicentric MPC in the maxillofacial region. Although small MPC can be completely and easily excised, large MPC, especially in certain anatomic sites, necessitates careful preoperative preparation