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Perry C, Budweg JB, Stein AP, Harder J, Gupta S, Nusbickel AJ, Smoot M, Patel K, Winchester DE. Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities. Am J Med 2023; 136:350-354. [PMID: 36566899 DOI: 10.1016/j.amjmed.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.
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Affiliation(s)
| | | | | | | | - Shishir Gupta
- University of Florida College of Medicine, Gainesville
| | | | | | - Keval Patel
- University of Florida College of Medicine, Gainesville
| | - David E Winchester
- University of Florida College of Medicine, Gainesville; Cardiology Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, Fla.
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2
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Smoot M, Jaber JF, Saha BK, Austin A. A Woman With Progressive Dyspnea and Seronegative Rheumatoid Arthritis. Chest 2023; 163:e63-e67. [PMID: 36759119 DOI: 10.1016/j.chest.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/18/2022] [Indexed: 02/09/2023] Open
Abstract
CASE PRESENTATION A 66-year-old woman with a medical history of seronegative rheumatoid arthritis on long-standing methotrexate and adalimumab therapy was referred to the pulmonary clinic for abnormal chest imaging. The patient was also under evaluation by rheumatology physicians for increased fatigue, nonproductive cough, and recurrent sinus infections. At the time of the initial pulmonary visit, the patient complained of acute onset of bilateral blurry vision and subsequently was diagnosed with anterior uveitis and received ophthalmic steroids with significant improvement. The patient's biologic therapy was discontinued because of a concern for possible drug toxicity. Over the course of 4 months, the patient experienced worsening dyspnea with exertion. She was a lifelong nonsmoker and had no history of recent travel. However, on review of possible environmental exposures, patient stated using feather pillows and bedding for several decades.
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Affiliation(s)
- Madeline Smoot
- Department of Medicine, University of Florida, Gainsville, FL
| | - Johnny F Jaber
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainsville, FL
| | - Biplab K Saha
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainsville, FL
| | - Adam Austin
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainsville, FL.
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Vahdatpour C, Epstein S, Jones K, Smoot M, Parker A, Ryan J, Bryant A. A review of cardio-pulmonary microvascular dysfunction in pulmonary hypertension. Am Heart J Plus 2023; 26:100255. [PMID: 38510189 PMCID: PMC10946046 DOI: 10.1016/j.ahjo.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 03/22/2024]
Abstract
Microvascular dysfunction progressing to pulmonary hypertension can be a primary cause of right ventricular failure or a secondary cause because of an underlying systemic illness. Little is known regarding the etiology and epidemiology of coronary microvascular dysfunction in pulmonary hypertension. Despite this limitation, its presence has been described in patients with pulmonary hypertension. This review focuses on the pathogenesis of cardiac and pulmonary microvascular dysfunction in pulmonary hypertension. Additionally, this review provides a contemporary assessment on the diagnosis and treatment of microvascular dysfunction in patients in pulmonary hypertension. This topic is important to raise awareness of microvascular dysfunction in the coronary and pulmonary circulation, so that future studies will investigate its impact on the pulmonary hypertension patient cohort.
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Affiliation(s)
- Cyrus Vahdatpour
- Department of Pulmonary Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Samuel Epstein
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Kirk Jones
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Madeline Smoot
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Alex Parker
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - John Ryan
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrew Bryant
- Department of Pulmonary Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Smoot M, Reinoso JL, Austin A. Fixed right ventricular collapse: A loculated pericardial effusion due to metastatic pulmonary adenocarcinoma. Respir Med Case Rep 2022; 42:101805. [PMID: 36793923 PMCID: PMC9923221 DOI: 10.1016/j.rmcr.2022.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Pericardial effusions can occur as either circumferential or loculated when referencing their anatomic distribution in the pericardium. These effusions can result from multiple different etiologies, including malignancy, infection, trauma, connective tissue disease, acute pericarditis drug induced, or idiopathic. Loculated pericardial effusions can be difficult to manage. Even small loculated effusions can result in hemodynamic compromise. Oftentimes in the acute setting, point of care ultrasound can be used to evaluate pericardial effusions directly at the bedside. We present a case of a malignant loculated pericardial effusion and offer insight into management and clinical evaluation using point of care ultrasound.
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Affiliation(s)
- Madeline Smoot
- Department of Medicine, University of Florida, Gainesville, FL, USA,Corresponding author. Department of Medicine, University of Florida, Gainesville, FL, 32610, USA.
| | - Jean Luis Reinoso
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Adam Austin
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Smoot M, Ward MA, Arviso L, Sanchez CE, Leeds SG. Hiatal hernia repair and magnetic sphincter augmentation to treat laryngopharyngeal reflux aiding the prevention of recurrent laryngeal cancer. Proc (Bayl Univ Med Cent) 2020; 34:148-150. [PMID: 33456181 DOI: 10.1080/08998280.2020.1818167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Laryngopharyngeal reflux (LPR) is a difficult disease to treat and can result in mucosal injury in the pharynx and larynx. This typically results in symptoms such as cough, hoarseness, and globus sensation, but the manifestation of cancer is a possibility. We present a patient with a squamous cell cancer of the larynx who was diagnosed with gastroesophageal reflux disease (GERD) and found to have LPR. The cancer was treated locally and GERD was eradicated with magnetic sphincter augmentation. After 15 months of follow-up, there was no residual cancer. This case highlights the role that untreated LPR may play in patients' risk of developing laryngeal cancer.
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Affiliation(s)
| | - Marc A Ward
- Texas A&M College of Medicine, Bryan, Texas.,Center for Advanced Surgery, Baylor University Medical Center, Dallas, Texas.,Division of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, Texas
| | - Lindsey Arviso
- Division of Otolaryngology, Baylor University Medical Center, Dallas, Texas
| | - Christine E Sanchez
- Division of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, Texas.,Baylor Scott & White Research Institute, Dallas, Texas
| | - Steven G Leeds
- Texas A&M College of Medicine, Bryan, Texas.,Center for Advanced Surgery, Baylor University Medical Center, Dallas, Texas.,Division of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, Texas
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Hammack TS, Amaguaña RM, Andrews WH, Al-Hasani SM, Asmundson R, Battista K, Beatty SJ, Berges-Soubies VA, Bozicevich T, Brooks D, Case J, Coles C, Copeland F, Davis-Debella PE, Entis P, Feldsine P, Fourcade L, Garcia GR, Goins DG, Jackson T, Koch S, Lafogiannis JA, Lee J, Lerner I, McIntyre D, McKee B, McNally S, Muchnik V, Mui L, Pfundheller R, Raghubeer EV, Rains D, Ruscica G, Schmieg J, Sellers R, Smoot M, Sobol R, Thunberg R, Torres S, Trinidad LF, Tuncan E, Watson JM. Rappaport-Vassiliadis Medium for Recovery of Salmonellaspp. from Low Microbial Load Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.1.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Twenty-three laboratories participated in a collaborative study to compare the relative effectiveness of Rappaport-Vassiliadis (RV) medium incubated at 42°C, selenite cystine (SC) broth (35°C), and tetrathionate (TT) broth (35 and 43°C) for recovery of Salmonella from the following foods with a low microbial load: dried egg yolk, dry active yeast, ground black pepper, guar gum, and instant nonfat dry milk. For dry active yeast, lauryl tryptose (LT) broth, incubated at 35°C, was used instead of SC broth. All of the foods were artificially inoculated with single Salmonella serovars, that had been lyophilized before inoculation, at high and low target levels of 0.4 and 0.04 colony forming units/g food, respectively. For analysis of 870 test portions, representing all of the foods except yeast, 249 Salmonella-positive test portions were detected by RV medium, 265 by TT broth (43°C), 268 by TT broth (35°C), and 269 by SC broth (35°C). For analysis of 225 test portions of yeast, 79 Salmonella-positive test portions were detected by RV medium, 79 by TT broth (43°C), 84 by TT broth (35°C), and 68 by LT broth (35°C). RV medium was comparable to, or even more effective than, the other selective enrichments for recovery of Salmonella from all of the foods except guar gum. It is recommended that RV (42°C) and TT (35°C) be used with foods that have a low microbial load, except for guar gum for which SC (35°C) and TT (35°C) are recommended.
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Affiliation(s)
- Thomas S Hammack
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, HFS-516, 200 C St, SW, Washington, DC 20204
| | - R Miguel Amaguaña
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, HFS-516, 200 C St, SW, Washington, DC 20204
| | - Wallace H Andrews
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, HFS-516, 200 C St, SW, Washington, DC 20204
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Smoot M, Volkmer R, Roth C, Cornelius B. Intrapartum leprosy. Proc (Bayl Univ Med Cent) 2019; 32:431-432. [DOI: 10.1080/08998280.2019.1616520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - Casey Roth
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Brandon Cornelius
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
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Abstract
Common maxims about beauty suggest that attractiveness is not important in life. In contrast, both fitness-related evolutionary theory and socialization theory suggest that attractiveness influences development and interaction. In 11 meta-analyses, the authors evaluate these contradictory claims, demonstrating that (a) raters agree about who is and is not attractive, both within and across cultures; (b) attractive children and adults are judged more positively than unattractive children and adults, even by those who know them; (c) attractive children and adults are treated more positively than unattractive children and adults, even by those who know them; and (d) attractive children and adults exhibit more positive behaviors and traits than unattractive children and adults. Results are used to evaluate social and fitness-related evolutionary theories and the veracity of maxims about beauty.
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Affiliation(s)
- J H Langlois
- Department of Psychology, University of Texas at Austin 78712, USA.
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