J Natl Med Assoc
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Left ventricular hypertrophy (LVH) is recognized as a cardiovascular risk factor and is a known consequence of sickle cell anemia (SCA). Abnormal left ventricular geometric patterns have been described but the determinants have not been well elucidated. ⋯ Sickle cell anemia predisposes to abnormal LV geometric patterns, especially eccentric LVH. There may be a need to review the electrocardiographic cut off points for defining eccentric LVH in the SCA populace.
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After the murder of George Floyd, many professions, organizations, and institutions have begun to confront the long and persistent legacy of racism in the United States. Within that context, it is critically important for the medical education community to address the question of whether medical education is systemically racist, and if so, what should be done to address this problem. ⋯ Analysis leads the author to the conclusion that medical education clearly meets the definition of systemic racism and that recent attempts to increase the racial and ethnic diversity of medical students have largely failed. The author then outlines a three-pronged approach to address this problem with interventions at the admissions, medical school, and graduate medical education levels.
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We present a case report of a patient who is a non-cirrhotic with portal cavernous transformation secondary to previous trauma. The patient presents with portal biliopathy requiring ERCP/EUS with biliary stenting. ⋯ The patient underwent a novel technique of transplenic access with portal vein recanalization via a gunsight technique, ultimately receiving a direct intrahepatic portocaval shunt (DIPS). Subsequently, his symptoms resolved, and the biliary stent was successfully removed.
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Advanced age and comorbidities have been described to increase the risk of mortality associated with COVID-19 infection. However, the degree to which comorbidities influence mortality among younger and older adults with and without comorbidity in COVID-19 infection has not been clearly elucidated. ⋯ A total of 62 patients had adverse outcome while in the hospital (10%). Risk factors independently associated with adverse outcome included advanced age (OR(CI) 9.21 (2.29-37.06), p=.002), male sex (OR(CI) 2.6(1.34-5.16), p=.005), living in most disadvantaged area (OR(CI) 2.42(1.8-5.42), p=.03), history of diabetes (OR(CI) 2.35(1.12-4.95), p=.023), and history of heart failure (OR(CI) 4.00(2.09-7.63), p<.001). Further analysis after creating risk groups based on participants age and the presence of diabetes and / or heart failure was performed. The probability of adverse outcome was highest among older male participants with comorbidities (Pr =0.315 (CI: 0.176-0.454)). The probability of adverse outcome among older participants without diabetes and heart failure (Pr =0.081 (CI: .010 -0.152) was less than the probability for younger patients with diabetes and heart failure (Pr: 203 (CI: 0.103 - 0.303) CONCLUSIONS: While older adults with comorbidities were the most vulnerable for adverse outcome, the risk of adverse outcome among older adults without comorbidities was less than that of younger adults with comorbidities.