General Medicine

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    Residents/Fellows’ Perception on Primary Prevention of Premature Cardiovascular Disease
    (2018-03-14) Kediyal, Jaya; Sivoravong, Jon; Muzina, Rubina; Lee, Jenny; Trinh, Jennifer
    Purpose: Cardiovascular disease is the leading cause of death globally with 6.3 million premature deaths annually. Minimal research has been done on the perception of physicians on primary prevention that may or may not lead to improved disease outcomes. The purpose of this study was to evaluate the perceptions of residents/fellows from different specialities and levels of training. Our hypothesis is that perception of family medicine (FM) and internal medicine (IM) residents on the role of primary prevention in premature cardiovascular disease is greater than surgery and medicine subspecialty (MS). Methods: Residents/fellows (30 FM, 30 IM, 12 surgery, 6 gastroenterology, & 10 cardiology) from Medical City Fort Worth (MCFW) Hospital were recruited to complete a voluntary, anonymous survey including health care opinions. Inclusion criteria were new/returning residents & fellows at MCFW who consented to participation. Exclusion criteria included those who opted to not participate. Chi square test and logistic regression yielded odds ratio (OR), confidence intervals, and p-values. Results: There were 56 participants (39% FM, 32% IM, 11% surgery, & 18% MS). The remaining 32 met the exclusion criteria, resulting in a smaller sample size that may affect statistical significance. A confounding factor was the predominance of osteopathic physicians; allopathic residents included: FM (1 PGY2, 1 PGY3) and IM (1 PGY2, 7 PGY1). IM (OR .97), surgery (OR .50), and MS (OR .69) were less likely to identify primary prevention as the best way to eradicate premature cardiovascular disease than FM (p Conclusion: FM residents practice primary & disease (premature cardiovascular disease) prevention and patient involvement than other specialties. Further research is needed to investigate how perceptions of physicians-in-training, regardless of specialty, directly affect patient lifestyle management & preventive counseling; and whether implementing a lifestyle curriculum can influence perceptive outcomes & primary care.
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    Do Mental Health Levels Differ by Activity Limitations and Physical Activity in Arthritic Males Ages 50-79?
    (2018-03-14) Evans, Ashley; Jones, Camille; Lemke, Henry; Hartos, Jessica; Tran, Mary; Morgan, Samantha
    Purpose: Depressive symptoms are a common comorbidity seen with arthritis. Despite previous research showing the effect of activity on depression levels, there has been a lack of research within the older arthritic male population. The purpose of this study was to evaluate whether activity limitations and physical activity are related to mental health levels in arthritic males ages 50 -79. Methods: This cross-sectional analysis used BRFSS 2015 data for males ages 50-79 from Alabama, Arkansas, Kentucky, Tennessee, and West Virginia. Multiple logistic regression analysis was used to assess the relationship between activity limitations and physical activity with mental health, while controlling for general health, health care access, weight status, race, educational level, and income level. Results: Less than one-third participants reported less than good mental health (27-31%), approximately half reported activity limitations (47-53%), and over half of participants reported their activity level as inactive/insufficiently active (52-58%). Adjusted results indicated that activity limitations were significantly related to mental health (moderate effect sizes) in all five states, but physical activity was only significant in one state. In addition, cost precluding seeing a provider was found to be significant. Conclusions: Overall, mental health was found to be significantly related to activity limitations and healthcare access in all five states, but not to physical activity levels. Therefore, male arthritic patient ages 50-79 in a primary care setting should be screened for both mental health issues and activity limitations if they present with symptoms of either. In addition, primary care clinics that are in lower socioeconomic (SES) areas should take into account the effect that cost has on mental health and activity limitations in arthritic patients when developing treatment plans.
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    Cirrhotic Portal Hypertension: A Case Report
    (2018-03-14) Nguyen, Nghia; Wong, Long; Schmaus, William
    Background: Portal hypertension (PH) is defined as an abnormal increase of the blood pressure in the hepatic portal vein system. PH can result from pre-hepatic, intra-hepatic, and post-hepatic causes with 90% of cases in the United States being due to the intrahepatic cause of cirrhosis. Prognosis of PH is made through calculation of the Hepatic Venous Pressure Gradient (HVPG) via hepatic vein catheterization. Once PH is identified, bleeding and fluid status must be appropriately managed using pharmacological and surgical therapy to avoid complications such as ascites and splenomegaly. In this report, we offer a summary of the diagnosis and management of PH, and present the case of a 59-year-old male diagnosed with the cirrhotic form of PH. Case Information: This case was selected and assembled using electronic medical records and imaging results. A 59-year old male presented to a family medicine clinic with a chief complaint of abdominal pain for 2 months. Past medical history was significant for chronic hepatitis C, alcohol abuse, and cirrhosis of the liver. An abdominal ultrasound was ordered and revealed morphologic changes of cirrhosis present with evidence of portal venous hypertension with moderate splenomegaly present. Laboratory blood works showed ALT to be 56 U/L (9-46 normal), AST 57 U/L (10-35 normal), GGT 151 U/L (3-85 normal). Otherwise, blood cell counts were within normal limits. Conclusions: Portal Hypertension (PH) is a serious chronic hepatic illness that can occur due to a variety of pre-hepatic, intrahepatic, and post-hepatic causes. The patient’s PH etiology comes from the most common cause of PH, cirrhosis, which causes around 90% of PH in the United States. In this case, the patient’s cirrhosis was due to hepatic remodeling due to alcohol abuse and hepatitis C. While the definitive way of diagnosing PH remains HVPG, the patient’s symptoms coupled with abdominal ultrasound evidence were enough to make the diagnosis. The patient risks complications involving ascites, further problems with existing splenomegaly, and development of varices. To effectively prevent these complications, careful interdisciplinary medical management must be followed.
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    A Case of Valentino's Syndrome Presenting as Possible Appendicitis
    (2018-03-14) Patel, Denish D.O.; Ronaghan, Joseph M.D. FACS; Cherry, Brandon H.
    Background: One of the most common causes of right lower quadrant abdominal pain is acute appendicitis. The most frequent symptoms observed are periumbilical pain that radiates to the right lower quadrant, anorexia, nausea and vomiting. Other conditions which mimic acute appendicitis at presentation include ovarian torsion, ruptured ectopic pregnancy, pseudomembranous colitis, and perforated cholecystitis. Here, we present a unique case of Valentino’s syndrome, wherein a perforated duodenal ulcer manifested the same constellation of symptoms as acute appendicitis. Case Information: When computed tomography and ultrasound were not definitive for the diagnosis, the decision was made to perform a laparoscopic appendectomy. The appendix showed no gross signs of inflammation, so intraoperative esophagogastroduodenoscopy was used to examine for a perforated peptic ulcer. When no perforations were found, exploratory laparotomy was performed and revealed purulent fluid in the right colic gutter and a pinhole perforation in the first part of the duodenum. The defect was repaired and the abdominal space was washed thoroughly and closed. The patient recovered well and was discharged from the hospital in good health. Conclusion: Valentino’s syndrome is an uncommon cause of RLQ pain and symptoms mimicking acute appendicitis.
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    Would Guidelines for Maturity Onset Diabetes in Youth (MODY) Be Useful in Clinical Practice?
    (2018-03-14) Wilson, Don; Hamilton, Luke; Hamby, Tyler; Crenshaw, Aubrey
    Purpose: Maturity Onset Diabetes in Youth (MODY) is a rare form of diabetes mellitus (DM) caused by a single gene mutation inherited in an autosomal dominant fashion. There are approximately 13 different gene mutations that can cause the MODY phenotype. MODY is typically diagnosed in Caucasian adolescents; the incidence is similar in males and females. Approximately 80-95% of MODY cases are misdiagnosed as T1D or T2D. Currently no algorithm is available to facilitate clinic decision making to assure proper diagnosis and treatment of affected youth. Methods: An online survey was conducted to better understand common approaches in the diagnosis of DM in youth and the need for a clinical algorithm to help guide testing for MODY. The survey was sent via email to PESTOLA providers (Pediatric Endocrinologists of Texas, Oklahoma, Louisiana, and Arkansas). Results: The survey was sent out to 188 providers; 32 responded (17% response rate). In establishing a diagnosis of MODY, a majority of providers agreed or strongly agreed that they needed more education (53%) and that they needed and algorithm (64%). Responses to the survey allowed us to construct a cost-effective diagnostic algorithm to assist in clinical decision-making in youth with diabetes. Conclusion: Confirming a diagnosis of MODY requires proper knowledge of the key features of the disease and its genetic mode of inheritance, a reliable family history, and predilection of race and phenotype. Because treatment options, outcomes, and genetic counseling differ in MODY compared to T1D and T2D, whenever appropriate clinicians should consider performing genetic testing. Using a diagnostic algorithm for children presenting with dysglycemia will provide physicians a cost-effective way to decide which patients may benefit from genetic testing and, hopefully, reduce the frequent misdiagnosis of MODY. Further studies are needed to determine the utility of the proposed model.
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    LAM- A Post-Op Hypoxia Dilemma
    (2018-03-14) Cota, Donna; Nguyen, Thao
    Background/Abstract: Lymphangioleiomyomatosis (LAM) is a rare multisystem disease that mostly affects young women. It is estimated that approximately 3 to 5 out of every 1 million women are affected. The primary histopathological abnormality is the proliferation of atypical smooth muscle-like cells. The most common presentation of LAM is signs and symptoms of lung disease, however, patients can also present with extrapulmonary manifestations such as renal and lymphatic disease. Lymphangioleiomyomas are lymphatic fluid filled benign tumors found in the pelvic, retroperitoneum, and mediastinum that occur in 16 to 38 percent of patients with LAM. Here we present a case of a young female with no past medical history who presented for elective surgical removal of a pelvic mass. The hypoxia present during the postoperative course led to the diagnosis of LAM. Case Report: A 31 yo Caucasian female with no significant past medical history presented to our hospital for elective surgical removal of a pelvic mass. The operative course was unremarkable. Patient was extubated to nasal cannula after the surgery, but was unable to maintain oxygen saturation on room air. She was found to be hypoxic, requiring at least 2L nasal cannula to maintain saturation levels in the low to mid 90s. Initial chest X-ray was remarkable for bilateral mild interstitial opacities and bibasilar atelectasis. Despite aggressive incentive spirometry use, patient could not overcome the hypoxemia without supplemental oxygen. CT chest was obtained and showed cystic changes diffusely throughout both lungs. The diagnosis of LAM was considered high on the differential at this point. The patient was discharged on supplemental oxygen and advised to follow up in the pulmonology clinic. Two days after discharge, the pathology from the pelvic mass resulted and was consistent with lymphangioleiomyoma. Discussion/Conclusion: This case was unique in the fact that it presented as an extrapulmonary manifestation of LAM that eventually led to the diagnosis of the pulmonary disease. Due to the postoperative nature, atelectasis was initially implicated for the hypoxia in this young female with essentially no prior past medical history, clouding the possibility of other differentials such as LAM. However, in a female with pelvic mass of unknown etiology and pulmonary symptoms, LAM should stay at the top of the differential, despite the rarity of the condition.
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    Is Obesity a Risk Factor for Depression in Males 55 and Older?
    (2018-03-14) Border, Rebecca; Jou, Melody; Milson, Christine; Hartos, Jessica; Way, Kristen
    Purpose: Obesity has been associated with many health conditions, including an increased risk of depression. In the U.S., middle aged and older adults are more likely to be obese; however, the relationship between depression and obesity in older adult males is not well understood. Thus, the purpose of this study was to assess the relationship between depression and obesity in elderly men. Methods: This cross-sectional analysis used 2015 BRFSS data for males aged 55 and older from Oklahoma, Oregon, Tennessee, and West Virginia. Multiple logistic regression analysis was used to assess the relationship between depression and obesity while controlling for: health conditions, activity limitations, age, ethnicity/race, education level, marital status, and metropolitan status. Results: Overall, approximately one-fifth of participants reported ever being diagnosed with depression or dysthymia (15-20%) and about one-third reported being obese (31-38%). After controlling for health and sociodemographic factors, depression was not significantly related to obesity in three out of four states. However, depression was significantly related to activity limitations (large effect size) and having two or more health conditions in all four states (large effect size). Conclusions: Depression was not related to obesity in men aged 55 and older, but was significantly related to activity limitations and having two or more health conditions. Limitations to this study include self-reported BMI which is subject to reporting error. Additionally, depression data was measured as lifetime incidence of depression or dysthymia, whereas BMI reflected current weight status. Clinicians should be informed on both depression and obesity in order to screen and educate elderly male patients. Because the two conditions are not related in this population, it is not indicated that practitioners evaluate for one due to the presence of the other. However, if a patient presents with activity limitations or two or more health conditions, it is recommended the practitioner screens for depression, and vice versa.
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    Diagnosing Autism Spectrum Disorder in Adolescents: The Value of Screening in Late Infancy into Early Adulthood
    (2018-03-14) Hager, Nicole
    Diagnosing Autism Spectrum Disorder in Adolescents: The Value of Screening in Late Infancy into Early Adulthood 1Nicole Hager, MS, Dr. Priya Bui, DO From the 1University of North Texas Health Science Center Pediatrics Department, Fort Worth, Texas, United States Abstract Autism Spectrum Disorder (ASD) is a complex neurological disorder that affects a patient’s ability to interact and socialize with others due to challenges they face with communication and behavior. ASD has become increasingly popular in the healthcare community but still, pediatricians find themselves lacking a standardized screening tool for their patients. At UNTHSC Pediatrics clinic, ASD is screened for at 18 months and 24 months of age by having the parents fill out a form called the MCHAT, or Modified Checklist for Autism in Toddlers. These questions specifically look for behaviors of social misconduct, abrupt reactions to environmental stimuli, situational overreaction and decreased emotionality, speech or eye contact issues, or the occurrence of repetitive behaviors. However, after 24 months of age, children with negative MCHATs are no longer screened for ASD even though as a child ages they can present more clearly with signs of ASD. ASD is commonly mistaken for multiple other psychological or neurodevelopmental disorders including but not limited to ADHD, OCD, anxiety, and depression. In this case study, we address the importance of screening in late infancy up through early adulthood by showing a case of misdiagnosis of ADHD in a patient with ASD. We will present tools and recommendations for pediatricians to use in evaluating patients for possible ASD.
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    Are Patients with Adrenal Insufficiency and X-linked Adrenoleukodystrophy Substrate-Limited?
    (2018-03-14) Hamilton, Luke; Hamby, Tyler; Wilson, Don; Jack, Benjamin
    BACKGROUND X-linked adrenoleukodystrophy (X-ALD) results from inherited defects in the ATP-Binding Cassette Subfamily D Member 1 gene (ABCD1), which encodes adrenoleukodystrophy protein (ALDP), a peroxisomal protein involved in intracellular lipid transport. X-ALD phenotypes include various combinations of cerebral, neurological, and adrenal abnormalities, with up to 70% of affected males demonstrating primary adrenocortical insufficiency (AI). The pathogenesis of X-ALD is largely attributed to the accumulation of very long chain fatty acids (VLCFAs). It has been suggested that impaired intracellular transport of cholesterol may also play a role in the pathogenesis of AI in X-ALD. The objective of this case study is to review the mechanisms of cholesterol transport and availability in steroidogenic cells in patients with X-ALD who develop AI. CASE INFORMATION A 27-month-old male was referred for evaluation of adrenal function following a diagnosis of X-ALD. Serial laboratory results revealed progressive decline of both baseline and stimulated adrenal function. DISCUSSION In steroidogenic cells, cytosolic free cholesterol is incorporated into the outer mitochondrial membrane (OMM) by a complex of proteins, including mitochondrial transport protein TSPO. Steroidogenic acute regulatory protein transports cholesterol from the OMM to the inner mitochondrial membrane (IMM) where the initial steps of steroidogenesis occur. If cholesterol isn’t available at the IMM, no steroid hormones are produced. Because cholesterol is critical for steroid hormone synthesis, adrenal cortical cells have redundant mechanisms of cholesterol acquisition to ensure an adequate supply, including from circulating lipoproteins, intracellular stores, and de novo synthesis. Disorders affecting lipid and lipoprotein metabolism—as well as lipid lowering treatments, such as use of statins—could potentially alter adrenocortical function. However, there are few reports of AI in these disorders. CONCLUSION Because cortisol is essential for health and the body’s response to stress, redundant mechanisms of acquiring cholesterol allow steroidogenic cells to acquire cholesterol in spite of ALDP deficiency. The inability to process VLCFAs and accumulation of lipids in X-ALD, however, appears to overwhelm the adrenal cortical cells, resulting in cell death and primary AI.
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    Neuroleptic Malignant Syndrome caused by Cyclobenzaprine
    (2018-03-14) Aftabizadeh, Som; Patel, Harsh; Herekar, Amar; Machaiah, Madhrira; Reddy, Prashanth
    Background/Abstract: Neuroleptic malignant syndrome is a disorder characterized by a triad of fever, muscle rigidity and altered mental status and classically associated with dopamine antagonists. It is rare and potentially fatal if not diagnosed and treated in the correct manner. There is no specific diagnostic test to rule in the disorder and a high suspicion and detailed list of home medications are needed as it is essentially a clinical diagnosis. A patients course usually begins with muscle rigidity followed by a fever within several hours, as well as mental status changes that range from drowsiness, agitation, or confusion to a severe delirium or coma. Here we present a unique case of a patient with NMS secondary to cyclobenzaprine. To our knowledge, it is only the third case reported in literature.1-3 Case Report: A 70 year old male with a past medical history of left-sided ischemic stroke, hypertension, type II diabetes, and chronic back pain presented to our emergency department with altered mental status (AMS). His last known normal was the previous evening around 10pm where the wife admitted to a verbal argument over the patient’s frequent overuse of prescribed Norco and Flexeril for his chronic back pain. Upon waking up the following morning the patient’s wife immediately noticed AMS, unsteady gait, and loss of bladder control. Upon arrival to our ED the patient was febrile with a max temperature of 104.9, profusely diaphoretic, tachypneic, tachycardic, with muscle rigidity. Pupils were equal and reactive and reflexes were intact. The patient’s altered mentation and labored breathing continued to decline requiring intubation and mechanical ventilation. Computed tomography and magnetic resonance imaging of the brain were normal. Continuous EEG was negative for seizure activity. CSF analysis, blood, and urine cultures were negative for infection. Creatine kinase was elevated at 1,963 U/L and WBC elevated at 21.9 k/mm3. Urine triage screen was positive for opiates. The patient was treated with dantrolene and lorazepam with good response in temperature. Slowly, over the course of the next few days, the patient’s symptoms resolved and he was weaned of the ventilator and eventually discharged with no complications. Discussion/Conclusion: Our patient’s clinical presentation and diagnostic work-up were classic for NMS. Treatment is largely supportive including cessation of the offending agent and pharmacologic interventions in more severe cases such as ours. NSM is thought to be caused by abrupt dopamine receptor blockage and the typical causative agents are antipsychotics. NMS caused by cyclobenzaprine is extremely rare and to the best of our knowledge only two other case reports have been reported in literature. While our case points to an overdose as the most likely pathogenesis, other reports have described a possible idiosyncratic reaction, i.e., immune-mediated reactions that occur rarely and in unpredictable fashion among the population. This case questions if medications other than antipsychotics such as muscle relaxers should be kept in mind when working up a cause for NMS. The fact that a muscle relaxant can actually potentiate muscle rigidity makes this a unique phenomenon and we feel it should be further investigated. References: Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalists. Neurohospitalist. 2011;1(1):41-7. Fink M. Response to "Neuroleptic malignant-like syndrome due to cyclobenzaprine?". J Clin Psychopharmacol. 1996;16(1):97-9.
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    A Rare Case of Superior Vena Cava Syndrome caused by long-term indwelling Hemodialysis Catheter Placement
    (2018-03-14) Aftabizadeh, Som; Iyamu, Ikponmwosa; Nguyen, Thao; Madhrira, Machaiah; Reddy, Prashanth; Patel, Aman
    Title: A Rare Case of Superior Vena Cava Syndrome caused by long-term indwelling Hemodialysis Catheter Placement First Authors: Dr. Som Aftabizadeh, DO, PGY-1 Co-authors: Dr. Thao Nguyen, DO, PGY-2; Dr. Aman Patel, DO, PGY-3; Dr. Prashanth Reddy, MD, PGY-1 Attendings: Dr. Ikponmwosa Iyamu, MD; Dr. Machaiah Madhrira, MD; Dr. Balamurugan Sankarapandian, MD Name of Institution- Medical City Fort Worth Name of institutional department, division or other administrative unit- Internal Medicine City, State, Zip Code: Fort worth, Texas, 76104 Background/Abstract: End-stage renal disease (ESRD) cases continue to rise at approximately 21,000 cases per year in the US.1 During the past decade there has been a trending increase in use of central venous catheters (CVC) for hemodialysis (HD).2-3 When inserted into the superior vena cava (SVC), these catheters have been shown to be associated with thrombosis. While malignancy is the most common cause of superior vena cava syndrome (SVCS), an increasing incidence of benign causes are appearing. A portion of these benign causes are associated with the increasing use of intravascular catheters.2,4 Case Report: A 51-year-old african american female with past medical history of ESRD on HD, type II diabetes mellitus, coronary artery disease, paroxysmal atrial fibrillation who presented to our emergency department with acute neck swelling associated with hoarseness and headache. She states she woke up on the morning of admission with diffuse bilateral neck swelling that increased in size throughout the day. She denied difficulty with swallowing solids or liquids. She also denied difficulty with respiratory effort, chest pain, or shortness of breath. Her Vitals were stable. Clinical exam showed minimal facial edema but prominent superficial veins of the chest wall and neck region. Chest x-ray showed widening of the mediastinum. Our initial clinical impression was cellulitis, angioedema, or allergic reaction. Chest CT showed a thrombus partially occluding the SVC with severe stenosis at the cavoatrial junction. The patient was diagnosed with SVCS and underwent recanalization with angioplasty and stenting of SVC. The symptoms of superior vena cava syndrome began to improve immediately after the angioplasty and she continued to be free of symptoms and was subsequently discharged home. Of note, the patient had a long history of CVC access with repeated and prolonged placement after failed AVGs. Discussion/Conclusion: SVC syndrome is a medical emergency and can be fatal if resulting in severe cerebral edema and cerebellar herniation. A slower development of SVC is often better tolerated as many patients develop collateralization of vessels.4 It is thought that approximately half of central vein stenosis remain asymptomatic with clinical manifestations presenting due to eventual local upstream hypertension. In addition to risk of thrombosis of all CVCs, hemodialysis related CVCs are believed to have increased risk of thrombosis due to having longer, thicker lumens and longer length of placement.5-6 Therapy is generally endovascular or surgical with the former fairing better in hemodialysis patients with multiple comorbidities.7 This case illustrates the unusual manner in which SVC can present along with the potential for iatrogenic causes of SVC syndrome. Given the increasing frequency of intravascular catheter placement, it’s important to identify iatrogenic causes. Avoiding long term use of hemodialysis catheters and timely creation of AVFs may help prevent these complications. References: Lok CE, Foley R. Vascular access morbidity and mortality: trends of the last decade. Clin J Am Soc Nephrol. 2013;8(7):1213-9. A rare complication of hemodialysis catheters: superior vena cava syndrome. Akoglu H, Yilmaz R, Peynircioglu B, Arici M, Kirkpantur A, Cil B, Altun B, Turgan C Hemodial Int. 2007 Oct; 11(4):385-91. Warren P, Burke C. Endovascular management of chronic upper extremity deep vein thrombosis and superior vena cava syndrome. Semin Intervent Radiol. 2011;28(1):32-8. Quaretti P, Galli F, Moramarco LP, et al. Dialysis catheter-related superior vena cava syndrome with patent vena cava: long term efficacy of unilateral Viatorr stent-graft avoiding catheter manipulation. Korean J Radiol. 2014;15(3):364-9. Seelig MH, Oldenburg WA, Klingler PJ, Odell JA. Superior vena cava syndrome caused by chronic hemodialysis catheters: autologous reconstruction with a pericardial tube graft. J Vasc Surg. 1998;28(3):556-60.
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    Does Physical Activity Level Differ Between Those With and Without Diagnosed Arthritis in Middle Aged Females?
    (2018-03-14) Hartos, Jessica; DeBerry, Sara; Welch, Jayton; Carroll, Amanda
    Purpose: Current clinical guidelines regarding the recommended physical activity levels for middle aged females with arthritis are unclear. Therefore, the purpose of this study was to assess whether physical activity levels differ between those with and without diagnosed arthritis in middle-aged females. Methods: This cross-sectional analysis used 2015 BRFSS data for females ages 45-64 from Arkansas, Mississippi, and Alabama. Multiple logistic regression was used to assess the relationship between physical activity levels and arthritis while controlling for weight status, fruit consumption, vegetable consumption, activity limitations, heart disease, depression, educational level, and ethnicity/race. Results: Approximately half of females 45-65 years-old reported a diagnosis of arthritis (44-49%) and less than half reported being physically inactive (38-45%). Overall, physical activity levels did not significantly differ between those with and without arthritis. However, arthritis was significantly related to activity limitations, heart disease, and depression. Conclusion: Overall, physical activity levels did not differ between those with and without arthritis in females ages 45-64 years old. Across 2 or 3 states, an arthritis diagnosis was significantly related to activity limitations, a diagnosis of angina or coronary heart disease, and a diagnosis of depression. However, no information was available regarding patient medications, compliance, or current management of arthritis. Based on the results of this study, it is recommended that if a patient presents with arthritis, activity limitations, coronary heart disease, or depression, primary care providers should screen for all four conditions, provide education, and treat accordingly.