Braswellclay2895

Background Physician shortage and healthcare access are serious issues in rural states like Kentucky and further worsened during the coronavirus disease 2019 (COVID-19) pandemic. International Medical Graduates (IMGs) serve the underserved communities of Kentucky to fill in the physician gap. However, uncertainties surrounding immigration policies added significant challenges to physicians and the rural communities served by them during the pandemic. Methods A survey was created using the data collection platform "SurveyMonkey" and sent to IMG physicians practicing on a visa to understand their role and their immigration-related challenges. Only the physicians practicing in Kentucky were included in this study. Results It was found that 84% practice in primary care specialties like internal medicine, pediatrics, or family medicine, 92.9% practice in Medically Underserved Areas or Health Professional Shortage Areas, and 71.4% practice in rural settings. Also, 61.5% practice in a "frontline" COVID-19 specialty and 92.3% were involved in direct care of COVID-19 infected or suspected patients. Of the physicians, 88.5% were in an "immigration backlog"; 92.6% of them were the primary visa holders of their families and 88.9% expressed concern that their families face hardship if they have a disability during the pandemic. It was reported by 92.3% of them that visa-related restrictions limited them from providing additional coverage in these places. Conclusions Lack of physician access is a critical issue facing many rural states in America like Kentucky, and IMG physicians play a valuable role in taking care of this underserved population and fighting the COVID-19 pandemic. The challenges surrounding the immigration backlog are contributing to significant hardships and remain a hurdle to expand healthcare access to the rural and medically underserved communities.Calciphylaxis is a rare but highly fatal vascular calcification disorder with a predilection for patients with end stage renal disease (ESRD). The pathogenesis of calciphylaxis is unknown, however, several risk factors have been identified such as hypercalcemia, hyperphosphatemia, hyperparathyroidism, low serum albumin, and history of warfarin therapy. This article presents a case of calciphylaxis induced by warfarin in a COVID-19 patient.Introduction/Objectives Women with high-risk pregnancies require careful follow-up, management, and efficient allocation of resources to achieve optimal pregnancy outcomes. This study investigated the association between an updated, validated antenatal risk index score and neonatal mortality and morbidity in a tertiary care center in Saudi Arabia. Methods This retrospective cohort study included pregnant women delivered at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between June 2016 and December 2018. Pregnant women who delivered before arrival, delivered in another hospital, or without an antenatal risk score because of missing data were excluded. The study cohort was recruited by simple random selection. Data of mothers and neonates were extracted from electronic health records. The pregnancy risk was assigned using a validated antenatal risk score index, creating low, moderate, and high-risk pregnancy categories. The association between antenatal risk scores, maternal and neonatal outcomes was invede a North American system. The higher scores were associated with maternal complications as well as neonatal mortality and morbidity. This is the first study to report maternal demographics, mortality, stillbirths, male gender, and congenital anomalies and their associations with categories of pregnancy level of risk. The clinical and economic benefits of antenatal risk screening in Saudi Arabia warrant further large population-based study that includes multi-domain socioeconomic determinants of health specific to our region.Introduction Cerebral venous sinus thrombosis (CVST) is an acute cerebrovascular disease diagnosed nowadays more frequently. Magnetic resonance venogram (MRV) is the modality of choice for accurate diagnosis. Young females in their childbearing age are prone to develop CVST. Clinical presentation is mainly with headache, focal neurologic deficits, and seizures. Around one third of the patients have altered sensorium at presentation. Prognosis of CVST is good if diagnosed and treated early. Long-term deficits may remain in one quarter of patients. The aim of our study was to do clinical profiling and prognosis of CVST patients. Materials and methods This is a descriptive study conducted at the department of Neurology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Study duration was one year. Patients fulfilling inclusion and exclusion criteria were included in the study. Patients confirmed to have CVST on magnetic resonance imaging (MRI)/MRV were included in final analysis. Ethical approval was taken from the Institutional Review Board. Results Thirty three out of 54 patients were included in the final analysis. Out of them, 29 (87.8%) were females and four (12.1%) were males. The mean age at the time of presentation was 31.36 ± 9.61. Of the 29 females, only three were pregnant and 26 were in the postpartum period at the time of presentation. Twelve (41.4%) females were primigravida. Focal deficits were present in 30 (90.9%) patients; headache was present in 26 (78.8%) patients; seizures were present in 24 (72.7%) patients on presentation; and anemia was present in 20 (60.6%) patients. Conclusion CVST is an important cause of intracranial hypertension, seizures, and stroke in young people. Clinical presentation is extremely variable, and a high index of suspicion is needed. Magnetic resonance imaging brain with MRV is the current diagnostic modality of choice. Medical management with anticoagulants and supportive measures has excellent clinical outcomes.The complications resulting from aortic dissections are often devastating. Historically, when a Stanford B aortic dissection extended into the visceral abdominal aorta, only surgical management was considered to limit visceral organ malperfusion. Complications of surgical management for Stanford B aortic dissections are as high as 50%. The inherently high complication and mortality rate for any acute aortic dissection, in addition to the complication rates resulting from surgical management, have demonstrated poor outcomes. This is especially true when aortic dissections involve the visceral segment, where thoracic endovascular aortic repair (TEVAR) becomes limited or contraindicated. NXY-059 in vivo In the last two decades, various approaches for TEVAR have improved in both endograft design and interventional technique. The current literature demonstrates improved outcomes for patients that receive TEVAR for Stanford B aortic dissections, including those that involve the visceral segment. Despite favorable prognostic advancement in TEVAR, the proven management complexity of Stanford B aortic dissections continue to reflect the pitfalls of the endovascular devices that are currently available.