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Objectives: Parkinsonian signs are frequent in Alzheimer disease (AD) and are associated with a faster cognitive decline, worse quality of life, and early nursing home admission. Cross-sectional studies in AD reported a significant association between parkinsonism and apathy. The aim of this study was to assess the chronological association between apathy and parkinsonism in AD.Design: Longitudinal study of a consecutive series of patients with AD.Setting: Dementia clinic from a tertiary clinical center.Participants: One hundred sixty-nine patients meeting diagnostic criteria for AD.Intervention: A consecutive series of 169 patients with probable AD were assessed for the presence of parkinsonism, cognitive deficits, apathy, and depression with the Unified Parkinson's Disease Rating Scale and a comprehensive neuropsychiatry assessment. One hundred thirty-six (80%) of the patients had a follow-up assessment between 1 and 4 years after the baseline evaluation.Measurements: Scores on apathy, parkinsonism, and depression scales at follow-up were the main outcome measures.Results: Patients with apathy at baseline or those who developed apathy during follow-up had a significant increase in parkinsonism at follow-up when compared with patients with no apathy at both assessments. The association between apathy and increasing parkinsonism was unrelated to age, gender, the severity of cognitive deficits, the presence of depression, or use of psychotropic medications. On the other hand, neither the presence of parkinsonism nor depression at baseline was significantly associated with more severe apathy at follow-up.Conclusion: Apathy may be an early manifestation of a more aggressive AD phenotype characterized by loss of motivation, increasing parkinsonism, a faster cognitive and functional decline, and more severe depression. [ABSTRACT FROM AUTHOR]

A combined postero-anterior and antero-posterior approach to the Bell's palsy patient, with removal of the incus, produces visualization of the Fallopian canal anteriorly from the geniculate ganglion to as far posteriorly as the stylomastoid foramen. This is not feasible by the posteroanterior approach alone. With a dehiscence of the horizontal portion of the Fallopian canal, it is not always necessary to decompress the vertical portion of the facial nerve. Surgical intervention is still indicated in non-resolving Bell's palsy. [ABSTRACT FROM AUTHOR]

Six identical experiments (3 in Devon and 3 in Suffolk) investigated the effect of 200, 300 and 400 lb N/ac (224, 336 and 448 kg/ha), given in 1, 2, 4 or 8 equal applications, on the yield and seasonal production of perennial ryegrass swards cut every 25 days. Each rate of N increased DM and N yieIds. Giving the N in 4 or 8 dressings gave higher DM, but rather lower N yields, than applying the N in I or 2 dressings. The effect on DM yield of splitting the N was most marked at 400 lb N/ac (448 kg/ha). Seasonal production was closely related to the time of N application and most uniform where N was given in 8 dressings. Differences between Devon and Suffolk were most evident where the N was given in 4 or 8 dressings and occurred in the second half of the season when the low rainfall in Suffolk apparently restricted N uptake and DM yield. The efficiency with which N taken up by the plant was used for DM production was affected by sunshine. It is concluded that rainfall and sunshine will limit the extent to which fertilizer N can be used to control herbage production. [ABSTRACT FROM AUTHOR]

A brief summary of methods for reconstruction of the external auditory meatus for whatever reason, which have been recommended and used by a number of authors, is presented. Recurrence of the atretic problem occurs in a great percentage of individuals necessitating further attempts with an even greater failure rate. In 13 ases with this problem, including congenital agenesis and/or atresia of the external auditory canal, exostectomies, and postsurgical stenosis, I have fund that surgery with concomitant use of Merocel wicks has given a "cure rate" of better than 90%. The first patient in this group has been followed for approximately two years. [ABSTRACT FROM AUTHOR]

Lower genital tract specimens and endometrial biopsies from 147 women with pelvic inflammatory disease (PID) and surgical specimens (fallopian tubes, ovaries, or both) from 22 women with PID and 37 women without PID were cultured for cytomegalovirus (CMV) and herpes simplex virus (HSV), as well as for organisms commonly associated with PID. CMV was isolated from 39 cervical or endometrial samples from 30 (20.4%) of 147 women with PID and from ovaries or fallopian tubes from 5 (22.7%) of 22 women with PID, but CMV was not recovered from surgical specimens obtained from 37 women undergoing surgery for tubal ligation, ectopic pregnancy, or other gynecologic conditions (P = .005). HSV was isolated from cervical samples obtained from 5 (3.4%) of 147 women with PID but not from any endometrial or surgical specimens. These data suggest that CMV, but not HSV, may contribute to the pathogenesis of PID in some patients. [ABSTRACT FROM AUTHOR]

Background: Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions., Objective: To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout., Design: A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland., Participants: Participants included 724 physicians and 971 nurses providing direct clinical care to patients., Main Measures and Approach: Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses., Key Results: Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing., Conclusions: More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout., (© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.)

Objective: To describe our contemporary experience with aspiration and sclerotherapy (AS) as a non-surgical alternative for patients with symptomatic hydrocele and spermatocele who prefer non-surgical treatment., Materials and Methods: Patients were identified by billing diagnosis code for hydrocele or spermatocele from 2015 to 2019. Patients underwent AS with doxycycline (200-400 mg). Physical examination, ultrasound and aspirate microscopy were used to differentiate hydrocele from spermatocele. Baseline and follow-up data were recorded., Results: In total, 65 patients underwent AS, 54/65 (83%) for hydrocele and 11/65 (17%) for spermatocele with mean aspirate volumes 307 mL (SD 238 mL) and 138 mL (SD 112 mL), respectively. Follow-up data was available for 38/54 (70%) hydroceles and 8/11 (73%) spermatoceles with median follow-up 28 (IQR 23-41) and 22 (IQR 18.5-30.5) months respectively. Relief of patient reported bother associated with scrotal size occurred in 29/38 (77%) hydroceles and 8/9 (89%) spermatoceles. 2/54 (4%) hydrocele patients developed hematoma managed with in-office aspiration. Immediate post-procedural pain occurred in 2/56 (4%) hydroceles and 2/10 (20%) spermatocele. Post-procedural pain requiring more than 5 tablets of hydrocodone/acetaminophen 5mg/325mg occurred in 2/57 (3%) hydroceles and 2/10 (20%) spermatoceles. Surgical repair was ultimately pursued in 3/38 (8%) and 1/9 (11%) patients with persistent hydrocele and spermatocele respectively., Conclusion: AS is a safe and effective treatment alternative for hydrocele and spermatocele for patients wishing to avoid surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)