Search

Introduction/Objectives: Insomnia is a common sleep disorders that affects most individuals in the United States, and worldwide. Insomnia is linked with an increased risk of atrial fibrillation (AF) in adults, although the strengths of association were weak, especially in the elderly population. AF is estimated to affect approximately 3 to 6 million people in the United States. We studied the association of AF with insomnia in the elderly population. Methods: We reviewed the electronic medical records of elderly patients who received care in an internal medicine office from July 1, 2020 through June 30, 2021. Patients were grouped into AF group, and a group without AF (NOAF). Association of insomnia and other variables were compared between the 2 groups. Results: Among 2428 patients, 341 (14%) had AF. Patients in the AF group were significantly older compared to no-AF group (80.3 ± 7.9 vs 76.1 ± 7.4 years; P

Infections due to drug-resistant Acinetobacter baumannii strains are increasing and cause significant morbidity and mortality, especially in hospitalized and critically ill patients. A. baumannii rapidly develops resistance to numerous antibiotics, and antibiotics traditionally used against this deadly pathogen have been failing in recent years, highlighting the need to identify new treatment strategies. Treatment options that have shown promise include revisiting common antibiotics not typically used against A. baumannii, evaluating new antibiotics recently introduced to market, and identifying combinations of antibiotics that display synergistic interactions. In this study, we characterized the antibiotic susceptibility profiles of extensively (XDR) and pandrug-resistant (PDR) A. baumannii patient isolates. We examined the potency of 22 standard-of-care antibiotics and the newer antibiotics eravacycline, omadacycline, and plazomicin against these strains. Furthermore, we examined combinations of these antibiotics against our collection to identify synergistic effects. We found that this collection is highly resistant to most or all standard-of-care antibiotics, except for minocycline and rifampin. We show that eravacycline and omadacycline are effective against these strains based on minimum inhibitory concentrations. We also identified two highly effective combinations, cefepime and amikacin and cefepime and ampicillin–sulbactam, which exhibited high rates of synergy against this collection. This information is valuable in our battle against highly drug resistant and virtually untreatable A. baumannii infections.

Introduction/Objective: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older. Methods: Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups. Results: Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has risen in popularity as the contemporary treatment-of-choice for end-stage ankle osteoarthritis. INFINITY™ Total Ankle System (Stryker, Kalamazoo, MI) is one of the most frequently used ankle prostheses. Prior studies established positive functional outcomes; however, aseptic baseplate loosening has reported to occur in approximately one-third of patients. Aseptic baseplate loosening is seen radiographically either as shift in talar or tibial components or evidence of periprosthetic lucency. Aseptic baseplate loosening with persistent pain defines prosthesis failure, thus an indication for early surgical revision. Implementing bone cement may fixate and stabilize prostheses, potentially reducing incidence of aseptic baseplate loosening. This study aimed to determine if patients with cemented INFINITY total ankle prostheses had different incidence of aseptic baseplate loosening than those with cementless prostheses. Methods: Patients who underwent total ankle arthroplasty using the INFINITY total ankle prosthesis system between January 2016 and May 2022 (n = 28) were retrospectively identified using keyword search for “infinity” and Current Procedural Terminology (CPT) code 27702. Fourteen patients had prostheses affixed with cement, and fourteen patients had prostheses that were not cemented. Preoperative, immediate postoperative, and most recently available anteroposterior (AP), mortise, and lateral ankle X- rays were reviewed. Tibiotalar angle, talar tilt, and presence of visible postoperative lucency were assessed independently by two reviewers. Wilcoxon rank-sum test on quantitative variables and chi-square test on categorical variables were performed with 0.05 significance level. Results: Inter-rater reliability was above 94% for all measurements. Comparing the cemented to cementless sample group, difference in average age (59.5 years vs. 56.5 years, p=0.32) and sex (57.1% vs. 50.0% female, p=0.70) were not statistically significant. Pre-operative and immediate post-operative tibiotalar and talar tilt angles were not statistically significantly different between cement and cementless groups (p>0.31 for all comparisons). Only one patient in the cement group had evidence of periprosthetic lucency in the immediate postoperative period. Median follow-up was 362.5 days and 544.5 days in the cement and cementless group, respectively (p=0.52). Follow-up tibiotalar angles and talar tilt angle between cement and cementless groups were not significantly different (p>0.51 for all comparisons). Periprosthetic lucency occurred in 50% of both groups in the follow- up period (p=1.0). Conclusion: Patients with cemented INFINITY total ankle prostheses had equal incidence of aseptic baseplate loosening compared to patients with cementless prostheses. Continuing to examine methods for reducing incidence of baseplate loosening is significant for potentially reducing rate of early prosthesis revision and prosthesis failure, consequently improving quality of life for patients.

Introduction/Objectives: Sleep disorders affect around 50 to 70 million Americans, with chronic insomnia being the most common, especially in the elderly population. With an 11-fold increase in the US office visits due to insomnia, from 0.8 to 9.4 million, between 1993 and 2015, it is imperative to identify the modifiable risk factors. The aim of our study was to examine the association of risk factors and comorbid medical conditions with insomnia in patients 65 years, and older. Methods: We performed a retrospective electronic medical record review of the patients aged 65 years and older, who visited our suburban internal medicine office between July 1, 2020 and June 30, 2021. Patients were divided into insomnia group, and the group without insomnia. The associated variables were compared. Results: Among 2431 patients, 247 patients (10.2%) had insomnia. Mean ages of the patients in the insomnia group and the group without insomnia were comparable (77 ± 8.1 year vs 76 ± 7.5 year; P = .211). There was a significantly greater frequency of women in the insomnia group compared to the group without insomnia (63.2% vs 55.5%; P = .022). In the insomnia group, there were significantly higher frequencies of association of certain comorbidities compared to the group without insomnia, such as dementia (6.5% vs 3.4%; P = .015), depression (30.8% vs 14.9%; P