Ben Taub Hospital

Calf pain can result from various causes, including rare conditions such as common peroneal nerve entrapment (CPNE) and chronic exertional compartment syndrome (CECS), both requiring careful evaluation for accurate diagnosis. We present a rare case of leg pain caused by concurrent CPNE and CECS in a middle-aged recreational athlete with a history of bilateral popliteal fasciotomies. We hypothesized that fasciotomy scar tissue decreased compartmental mechanical compliance, transiently increasing intracompartmental pressure. Ultrasound imaging and electrodiagnostic testing confirmed bilateral common peroneal neuropathies. After bilateral peroneal nerve decompression, the patient's left leg pain resolved, but he continued to experience residual right calf pain. A selective motor tibial nerve block with hydrodissection provided temporary symptom relief, leading to a diagnosis of CECS. This case underscores the complexity of leg pain in athletes, arising from two concomitant conditions, and demonstrates the use of a selective motor block as a diagnostic tool for CECS.

BackgroundAnterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain condition characterized by irritation or compression of abdominal wall intercostal nerve branches called the anterior cutaneous nerves. Peripheral nerve stimulation (PNS) has become an effective treatment option for painful sensory neuropathic conditions, including mononeuropathies and nerve entrapment syndromes. This report describes a successful case of using temporary PNS to treat ACNES and reviews the available literature on the use of PNS for the treatment of ACNES.Case presentationA 38-year-old female with a complex abdominal medical and surgical history presented to the pain medicine clinic for intractable burning pain and pressure in the left upper quadrant of the periumbilical region. Given the patient's clinical history and the nature of her presenting symptoms, ACNES was considered as a potential diagnosis. The diagnosis was confirmed through a series of successful diagnostic rectus sheath nerve blocks. A two-month temporary peripheral nerve stimulator trial targeting the left anterior cutaneous nerve was completed, and it resulted in 80 % pain reduction at 3 and 6-month follow-up evaluations, with returning pain at the 8-month assessment.ConclusionChronic abdominal pain in patients with a complex history of abdominal surgery should alert pain specialists to consider the possibility of an ACNES diagnosis. Current evidence supporting PNS for ACNES is limited to a small number of case reports showing successful treatment; however, larger-scale and more robust studies are needed to determine the effectiveness and safety of this method. This study contributes to the existing body of literature, highlighting that PNS may serve as a valuable treatment option for individuals with chronic abdominal wall pain secondary to ACNES whose pain is refractory to conservative management strategies.

Background: Hypercalcemia is a common and serious complication of malignancy, often contributing to morbidity and mortality. In patients with paraproteinemia, elevated total calcium with normal ionized calcium, termed pseudohypercalcemia, can complicate diagnosis and lead to inappropriate treatment. While this phenomenon has been described in case reports, its prevalence and clinical impact in routine practice remain poorly defined. Methods: We report a case of pseudohypercalcemia in a patient with IgG κ multiple myeloma and conducted a retrospective review of de-identified data to assess the prevalence and biochemical associations of pseudohypercalcemia in paraproteinemia. Available data included serum protein electrophoresis (SPEP), total calcium, albumin, total protein, creatinine, and parathyroid hormone (PTH). Associations between calcium status, paraprotein levels, and the gamma globulin gap were examined. Results: The index case demonstrated pseudohypercalcemia, with elevated total calcium (13.5 mg/dL) but normal ionized calcium (1.22 mmol/L), in the setting of IgG κ paraproteinemia (4.4 g/dL). In the retrospective cohort of 2537 samples, 986 (39%) had a single monoclonal paraprotein. Gamma globulin gap showed a moderate correlation with paraprotein concentration for IgG (r = 0.56, p < 0.0001) and IgA (r = 0.44, p < 0.0001), but a weaker relationship for IgM (r = 0.49, p < 0.0001). In contrast, total calcium showed no significant correlation with paraprotein concentration in the overall cohort. Among samples with elevated calcium (>10.5 mg/dL), the association between calcium and IgG paraprotein levels remained weak (r = 0.34, p = 0.23), and was similar for IgG κ (r = 0.61, p = 0.12) and IgG λ (r = 0.09, p = 0.87). Hypercalcemia was uncommon, occurring in only ~2% of IgG-positive samples, and rarely at paraprotein levels ≥ 1.5 g/dL. Conclusions: Pseudohypercalcemia in paraproteinemia is uncommon but clinically important, as total calcium may be artifactually elevated due to paraprotein-related assay interference, either from assay precipitation effects or calcium binding by paraproteins. Paraprotein burden correlates with gamma globulin gap but not with true calcium status. Reliance on total calcium alone may lead to diagnostic misclassification; ionized calcium should be measured in patients with monoclonal gammopathies to distinguish true hypercalcemia from analytical interference and avoid unnecessary treatment.

Objective: The current study sought to explore the impact of a novel noninvasive treatment called transcranial photobiomodulation (PBM) on resting-state functional connectivity (rsFC) of the cerebellum in individuals with a history of repetitive head acceleration events (RHAEs). Background: RHAEs are associated with cumulative neurological compromise, including chronic alterations in rsFC; however, few treatments have been investigated to mitigate these effects. A recent study by our team demonstrated that PBM treatment led to improvements in measures of balance and motor function in adults with RHAE exposure. Due to the cerebellum's role in motor functioning and its connectivity with cerebral regions targeted by PBM, we sought to examine changes in the rsFC of the cerebellum following PBM treatment. Methods: Thirty individuals with RHAE used an at-home PBM headset with an intranasal cannula for 20 min every other day for a period of 8-10 weeks. A total of 240 J/cm2 of red and near-infrared light was administered to cortical nodes of the default mode network (DMN) and subcortical structures in each session. Using resting-state functional magnetic resonance imaging, rsFC was measured before and after treatment in 11 cerebellar seed regions associated with the DMN, salience network (SN), and frontoparietal network (FPN). Results: We observed an overall decrease in between-network connectivity and an increase in within-network connectivity after PBM treatment, particularly in the SN and FPN. Conclusions: These results suggest that PBM may improve network efficiency of the cerebellum by regulating overactive connections and increasing network segregation.

This study investigated the prevalence of implicit racial associations among academic physiatrists and trainees. We administered the Harvard Implicit Association Test on race (Black/White) to 71 participants from a national academic physiatry association. The survey gathered demographic data (age, gender, ethnicity, race, professional role, and years of experience) and Harvard Implicit Association Test results, where participants reported a preference for Black race, White race, or no race preference. The majority of respondents (54.5%) displayed a preference for White race, with regression analysis revealing that participant race was the only significant predictor of this bias ( P = 0.03), No associations were found between age, gender, ethnicity, or trainee status and the Harvard Implicit Association Test results. The results indicated a significant pattern of implicit bias favoring White race among academic physiatrists and trainees, consistent with findings in other medical fields. The study emphases the need for ongoing efforts to be aware of and manage implicit biases in the field of physician medicine and rehabilitation, aiming to enhance patient outcomes and reduce healthcare disparities.

BackgroundThe incidence of early-onset colorectal cancer (EOCRC) has been rising at an alarming rate in the USA, and EOCRC disproportionately affects racial/ethnic minorities. Here, we construct comprehensive profiles of EOCRC DNA methylomes at base-pair resolution for a cohort of Hispanic and African American patients.ResultsWe show the epigenetic landscape of these EOCRC patients differs from that of late-onset colorectal cancer patients, and methylation canyons in EOCRC tumor tissue preferentially overlapped genes in cancer-related pathways. Furthermore, we identify epigenetic alterations in metabolic genes that are specific to our racial/ethnic minority EOCRC cohort but not Caucasian patients from TCGA. Top genes differentially methylated between these cohorts included the obesity-protective MFAP2 gene as well as cancer risk susceptibility genes APOL3 and RNASEL.ConclusionsIn this study, we provide to the scientific community high-resolution DNA methylomes for a cohort of EOCRC patients from underrepresented populations. Our exploratory findings in this cohort highlight epigenetic mechanisms underlying the pathogenesis of EOCRC and nominate novel biomarkers for EOCRC in underrepresented populations.

Oligosaccharidoses are a group of lysosomal storage disorders characterized by abnormal storage and excretion of incompletely processed glycan structures. As with other inherited metabolic disorders, early diagnosis and initiation of treatment are essential for optimizing outcomes. Biochemical investigation of suspected oligosaccharidoses has traditionally included thin layer chromatography to detect the presence of disease-specific free oligosaccharides in urine; however, this qualitative method has long been known to have limited sensitivity and specificity. In this unit, a quantitative technique for measuring oligosaccharides utilizing high-performance liquid chromatography-tandem mass spectrometry is described, which provides substantial improvements over other methods, in terms of sensitivity and specificity; moreover, it is relatively inexpensive, accessible, and requires significantly less time, effort, sample volume, and reagents to perform. © 2024 Wiley Periodicals LLC. Basic Protocol: Analysis of urinary FOS by HPLC-MS/MS.

BackgroundNatriuretic peptide testing is guideline recommended as an aid to the diagnosis of heart failure (HF). We sought to evaluate the performance of the ADVIA Centaur (Siemens Healthcare Diagnostics, Tarrytown, NY) NT-proBNPII assay (PBNPII) in emergency department (ED) dyspneic patients. MethodsEligible patients presented to the ED with dyspnea, with their gold standard diagnosis determined by up to 3 cardiologists blinded to the PBNPII results. Patients were stratified into 3 groups based on PBNPII resultsa rule out group of NT-proBNP<300 pg/mL, an age-specific rule in group using cutoffs of 450, 900, and 1800 pg/mL, for <50, 50–75, and > 75 years respectively, and an intermediate cohort for results between the rule out and rule in groups. ResultsOf 3128 eligible patients, 1148 (36.7 %) were adjudicated as acute heart failure (AHF). The gold standard AHF diagnosis rate was 3.7, 24.3, and 67.2 % for patients with NTproBNPII in the negative, indeterminate, and positive groups, respectively. Overall likelihood ratios (LR) were 0.07 (95 % CI: 0.05,0.09), 0.55 (0.45,0.67), and 3.53 (3.26,3.83) for the same groups, respectively. Individual LR+for age dependent cutoffs were 5.01 (4.25,5.91), 3.71 (3.25,4.24), and 2.38 (2.10,2.69), respectively. NTproBNPII increased with increasing severity of HF when stratified by NYHA classification. ConclusionsThe ADVIA Centaur PBNPII assay demonstrates acceptable clinical performance using the recommended single rule out and age dependent rule in cutoffs for an AHF diagnosis in dyspneic ED patients.

In order to understand abnormal gait, this article will first review normal gait, discuss how neuromuscular diseases disturb gait patterns and review orthotic interventions. In normal gait, concentric contractions accelerate and eccentric contractions decelerate the limb. Neuromuscular gait disorders can be grouped into (1) proximal weakness, (2) distal weakness, (3) nonlength-dependent or generalized weakness, (4) asymmetric weakness, and (5) sensory disorders. Identification of gait disturbance type in neuromuscular diseases leads to the appropriate orthotic prescription since orthotic strategies are grouped into (1) proximal weakness, (2) distal weakness, and (3) sensory disturbances. Orthotics is not indicated in all types of gait disturbance. Weakness in proximal hip musculature can be managed with gait aids such as walkers. In contrast, distal muscle weakness can be managed with orthotics. Preservation of gait assists in maintenance of daily function and integration in society.