Carilion Clinic

Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity but remains substantially underutilized. Limited data exist on outpatient counselling patterns preceding surgical uptake. Using electronic health record data, we conducted a 10-year retrospective cohort study of adults with body mass index ≥ 40 kg/m2. The primary outcome was documentation of the MBS discussion. Secondary outcomes included MBS receipt and demographic factors associated with documented discussion. Among 60 574 eligible patients, only 7.6% had documented MBS discussion. Overall, 1.2% underwent MBS. Surgery occurred in 12.1% of patients with documented discussion compared with 0.3% without discussion. Patients with documented discussion were younger (median, 42 vs. 47 years), had higher BMI (median, 46.8 vs. 42.0 kg/m2), and were more often female. Eligible women were more likely than men to have documented discussion (8.7% vs. 5.5%). Black patients had higher discussion rates than White patients, despite known downstream disparities in MBS utilization. Documented MBS discussion is rare but represents a critical inflection point in surgical uptake. Demographic differences in counselling suggest clinician- and system-level factors influence access before referral, highlighting outpatient counselling as a key target to improve equitable MBS utilization.

A ressurgência comportamental é definida como o reaparecimento de uma resposta previamente aprendida e depois suprimida, quando os reforços para uma resposta alternativa mais recentemente reforçada são eliminados ou reduzidos. Estudos anteriores que investigaram os efeitos da exposição repetida na magnitude da ressurgência demonstraram que a ressurgência é um fenômeno replicável, porém, os resultados são divergentes quanto a mudança na sua magnitude. O objetivo do presente estudo foi investigar o efeito da exposição repetida ao procedimento convencional de ressurgência sobre a magnitude de ressurgência da resposta-alvo. Para isso, seis ratos foram expostos ao procedimento de ressurgência que consistiu em três fases: 1) Treino da resposta-alvo; 2) Extinção da resposta-alvo simultânea ao treino da resposta alternativa; 3) Extinção de ambas as respostas/Teste de Ressurgência. Todas as fases foram realizadas três vezes para todos os animais. Os resultados indicam que a ressurgência ocorreu repetidamente para todos os ratos e que a magnitude da resposta-alvo aumentou no decorrer das exposições ao procedimento. Por fim, foram discutidas as possíveis variáveis que influenciaram esses resultados, suas semelhanças com outras investigações de ressurgência

Retrospective cohort study. To evaluate the influence of smoking on 30-day postoperative complications following anterior cervical discectomy with fusion (ACDF) surgery. Although smoking can have significant negative effects on bone healing in orthopaedic surgery, there is currently conflicting literature regarding the effect of smoking on patients undergoing ACDF surgery. Patients who underwent an ACDF procedure between 2011 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database by CPT code 22551 from 2011 to 2021. The study population was divided into 2 groups: smokers and nonsmokers. Chi-square tests for categorical variables and t-tests for continuous variables were used to identify differences in perioperative variables between groups. Multivariable logistic regression analysis assessed smoking status effect on postoperative outcomes after adjusting for these factors. A total of 85,758 patients who underwent ACDF surgery were identified, of whom 22,223 (25.9%) were smokers and 63,535 (74.1%) were non-smokers. Smokers were younger than the non-smoker cohort (51.84 vs. 56.74 years, p<0.001). Smokers had a significant odds ratio (OR) for extended length of hospital stay (OR: 1.240, 95% CI: 1.114-1.380, p<0.001) and reoperation (OR: 1.144, 95% CI: 1.007-1.298, p=0.038), following a multivariate logistic regression analysis. Patients with a history of smoking within the past year were at an increased risk for reoperation and extended length of stay after ACDF. These findings can enhance informed consent for patients with a smoking history. Future studies should evaluate patient-reported outcomes and pseudoarthrosis rates to further elucidate the role of smoking in cervical spine surgery.

Pediatric sepsis remains a leading cause of child mortality worldwide. Early risk stratification using organ dysfunction scores may improve management. Bangladesh bears a high burden of pediatric infectious disease and sepsis, particularly in children under 5. This study compared the predictive performance of admission PELOD-2, pSOFA, and Phoenix Sepsis Scores for in-hospital mortality among pediatric sepsis patients. We conducted a secondary analysis of an observational study at a tertiary hospital in Dhaka, Bangladesh (February-December 2022). Of 100 enrolled children aged 2 months to 18 years with sepsis, 96 had sufficient data for score calculation. Median age was 8 months (IQR 5-18), and in-hospital mortality was 23%. Admission PELOD-2 >3 and pSOFA >6 were associated with increased mortality. AUCs for mortality were 0.83 (pSOFA), 0.82 (PELOD-2), and 0.79 (Phoenix). All 3 scores showed good mortality discrimination. pSOFA and Phoenix may be more feasible in low-resource settings.

Spinal cord ischemia (SCI) in the pediatric population is rare and not well characterized. Initial diagnosis is often delayed, and there are no standardized, evidence-based management strategies. Risk factors and etiologies vary and include trauma, thrombotic or embolic disease, infection, vasculitis, cerebellar herniation, arteriovenous malformation, cardiovascular interventions, scoliosis correction, sickle cell disease, and idiopathic causes. We present a case of an 11-year-old girl with anterior spinal artery (ASA) syndrome who presented four days after a fall with back pain, bilateral lower extremity weakness, and numbness. On examination, she demonstrated objective weakness and decreased pain and temperature sensation (worse on the left than the right) in her lower extremities. Diagnostic workup revealed a thoracic ASA infarction, thoracic transverse process fracture, lumbar paraspinal muscle strain, and elevated intracranial and intraspinal pressure potentially resulting from the recent fall. Notably, the patient's opening pressure during a fluoroscopy-guided lumbar puncture was markedly elevated, a finding not previously documented in the literature or followed clinically. Owing to the rarity of SCI and its imaging similarities with early-phase myelitis, considerable workup is required for patients presenting with objective weakness to ensure accurate diagnosis and prevent adverse outcomes. Unfortunately, accurate diagnosis of SCI is frequently delayed until irreversible damage has occurred. The ASA infarct and paraspinal muscle strain presented here were diagnosed by MRI.