Delayed Presentation of Hemothorax and Mediastinal Hematoma Requiring Surgical Intervention After Linear Endobronchial Ultrasound

A 55-year-old male with coronary artery disease status post drug-eluting stents in 2009, maintained on dual antiplatelet therapy (DAPT) with clopidogrel 75 mg daily and aspirin (ASA) 325 mg daily, and an 80 pack-year history of tobacco dependence was referred for evaluation of a right upper lobe lung nodule. No additional risk factors for bleeding were identified. Computed tomography of the chest showed a 29.0 mm spiculated right upper lobe nodule with right hilar and paratracheal lymphadenopathy. Poor functional status excluded him from possible curative intent surgery by previous thoracic surgery consultation

Ethnomedical and Biomedical Health Care and Healing Practices Among the Rathwa Adivasi of Kadipani Village, Gujarat State, India

The Rathwa of Kadipani village are adivasi (original inhabitants, tribe) residing in a rural part of Gujarat State, India. Primarily farmers, the Rathwa live in an area where development-related projects, such as mineral mining and damming on the Narmada River, are increasingly impacting their livelihood, health status, and quality of life. The local economy is impacted by uncertainty regarding access to water from the Narmada River, concerns related to the extraction of minerals from a mine in Kadipani, and economic issues that arise when the primary wage earner of the household becomes ill. This dissertation addresses Rathwa health care practices, relying primarily on social constructivism and a political economy framework. I also discuss feminist theory when I analyze women, health care, and spirituality, and modernization theory when I consider the impact of development on health. This study examines the intersection of ethnomedical health care practices (e.g., indigenous/folk medicine/faith healing, Ayurveda and homeopathy) with biomedical/allopathic health care practices. The pluralistic health care system available to the Rathwa in both Kadipani and Kawant villages offers services from private and public sectors, resulting in individuals and families in search of treatment frequently accessing multiple health care providers of both the ethnomedical and/or biomedical categories simultaneously. Treatments for illness may include a visit to a Bhoua (faith healer), a public clinic provided by the government, and home remedies prepared from locally available medicinal plants. This junction of ethnomedical and biomedical health care practices impacts family health care seeking behavior and decision making in a number of ways. With a variety of health care providers available, people will go from one provider to the next until they receive the treatment they are requesting (e.g., antibiotics, injections, etc.), or their symptoms dissipate and they are healed. This practice may result in conflict with certain aspects of Rathwa history, tradition, and cultural practices, such as forgoing a visit to the indigenous healer, a practice which is considered part of Rathwa tradition, and going straight to the public clinic for prescription medications, or giving birth in the public hospital instead of using a traditional birth attendant at home

Ethnomedical and Biomedical Health Care and Healing Practices Among the Rathwa Adivasi of Kadipani Village, Gujarat State, India

The Rathwa of Kadipani village are adivasi (original inhabitants, tribe) residing in a rural part of Gujarat State, India. Primarily farmers, the Rathwa live in an area where development-related projects, such as mineral mining and damming on the Narmada River, are increasingly impacting their livelihood, health status, and quality of life. The local economy is impacted by uncertainty regarding access to water from the Narmada River, concerns related to the extraction of minerals from a mine in Kadipani, and economic issues that arise when the primary wage earner of the household becomes ill. This dissertation addresses Rathwa health care practices, relying primarily on social constructivism and a political economy framework. I also discuss feminist theory when I analyze women, health care, and spirituality, and modernization theory when I consider the impact of development on health. This study examines the intersection of ethnomedical health care practices (e.g., indigenous/folk medicine/faith healing, Ayurveda and homeopathy) with biomedical/allopathic health care practices. The pluralistic health care system available to the Rathwa in both Kadipani and Kawant villages offers services from private and public sectors, resulting in individuals and families in search of treatment frequently accessing multiple health care providers of both the ethnomedical and/or biomedical categories simultaneously. Treatments for illness may include a visit to a Bhoua (faith healer), a public clinic provided by the government, and home remedies prepared from locally available medicinal plants. This junction of ethnomedical and biomedical health care practices impacts family health care seeking behavior and decision making in a number of ways. With a variety of health care providers available, people will go from one provider to the next until they receive the treatment they are requesting (e.g., antibiotics, injections, etc.), or their symptoms dissipate and they are healed. This practice may result in conflict with certain aspects of Rathwa history, tradition, and cultural practices, such as forgoing a visit to the indigenous healer, a practice which is considered part of Rathwa tradition, and going straight to the public clinic for prescription medications, or giving birth in the public hospital instead of using a traditional birth attendant at home

Outcomes for type C proximal humerus fractures in the adult population: comparison of nonoperative treatment, locked plate fixation, and reverse shoulder arthroplasty

BackgroundThis study compares patient-reported outcomes and range of motion (ROM) between adults with an AO Foundation/Orthopaedic Trauma Association type C proximal humerus fracture managed nonoperatively, with open reduction and internal fixation (ORIF), and with reverse shoulder arthroplasty (RSA).MethodsThis is a retrospective cohort study of patients >60 years of age treated with nonoperative management, ORIF, or RSA for AO Foundation/Orthopaedic Trauma Association type 11C proximal humerus fractures from 2015 to 2018. Visual analog scale pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, ROM values, and complication and reoperation rates were compared using analysis of variance for continuous variables and chi square analysis for categorical variables.ResultsA total of 88 patients were included: 41 nonoperative, 23 ORIF, and 24 RSA. At the 2-week follow-up, ORIF and RSA had lower visual analog scale scores and lower PROMIS pain interference scores (P < .05) than nonoperative treatment. At the 6-week follow-up, ORIF and RSA had lower visual analog scale, PROMIS pain interference, and PF scores and better ROM (P < .05) than nonoperative treatment. At the 3-month follow-up, ORIF and RSA had better ROM and PROMIS pain interference and PF scores (P < .05) than nonoperative treatment. At the 6-month follow-up, ORIF and RSA had better ROM and PROMIS PF scores (P < .05) than nonoperative treatment. There was a significantly higher complication rate in the ORIF group than in the non-operative and RSA groups (P < .05).ConclusionThe management of AO Foundation/Orthopaedic Trauma Association type 11C proximal humerus fractures in older adults with RSA or ORIF led to early decreased pain and improved physical function and ROM compared to nonoperative management at the expense of a higher complication rate in the ORIF group