Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins (recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.

Giant ovarian cysts, which are described in the literature as measuring more than 10 cms in size in their largest diameter, are rare in occurrence. With the availability of multiple imaging modalities and routine physical examinations, it has become even rarer to find such cases. Ovarian serous cystadenomas, which are benign tumors arising from the ovarian epithelium, represent the most common type. We present a case of a 58-year-old female who came to establish primary care in our clinic. She reported ongoing symptoms of constipation, abdominal discomfort, bloating, as well as intermittent postmenopausal bleeding for the past few months. The patient reported taking over-the-counter medications for her predominant gastrointestinal symptoms with no improvement at all. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) of the pelvis revealed the presence of giant bilateral ovarian masses measuring more than 17 X 10cms each. Further testing revealed highly elevated levels of tumor markers cancer antigen 125 (CA-125) and human epididymis protein 4 (HE-4). The patient subsequently underwent total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Her histopathology report revealed the presence of bilateral benign cystadenomas. From a primary care physician's perspective, this case highlights the importance of possible rare pathologies that can present with symptoms of a completely unrelated organ system. Even with the rarity of these cases, a clinician may encounter such a case in their everyday practice. Patients can endorse a plethora of vague complaints, often masquerading other entities seen commonly in the clinic.

Nonalcoholic fatty liver disease (NAFLD) is a rapidly increasing cause of chronic liver disease with excess fat deposition in the liver, without an identifiable cause. NAFLD's benign form is called nonalcoholic fatty liver (NAFL), which can progress to nonalcoholic steatohepatitis (NASH) with or without fibrosis. Over time, NASH can progress to cirrhosis and eventually hepatocellular carcinoma (HCC) or progress to HCC without cirrhosis. Its incidence and prevalence are increasing to epidemic proportions, making it the most common cause of chronic liver disease in the western world. This review article attempts to understand the epidemiology, pathophysiology, evaluation, and management, and, most importantly, to generate awareness of this disease process.

Cognitive decline is a common issue seen in older adults in the primary care setting. Assessment of cognitive decline in primary care includes a detailed history, physical examination, labs, imaging, and a formal cognitive assessment. Various tools are available for cognitive assessments. However, a short screening tool is more practical for cognitive evaluation. A decline in cognition should be correlated with the broader clinical picture, and a detailed cognitive assessment should be performed. This article focuses on some of the cognitive assessment tools used in clinical settings to assess cognition.

Food insecurity is a complex public health problem affecting millions of people globally. It leads to negative health outcomes in the afflicted population and the society at large. There is a self-perpetuating vicious cycle between food insecurity and chronic health conditions like diabetes. It is important for healthcare professionals to be aware of its existence, to be able to recognize it, and to work with their patients to find solutions for it. Simultaneously, the providers should advocate for their patients and make program administrators, policymakers, and legislatures aware of this crisis. During the current coronavirus disease 2019 (COVID-19) pandemic, when economies have been badly affected and many people have lost their jobs, this subject has arguably assumed much greater importance. In this article, we discuss the magnitude of the problem, its relation to diabetes mellitus, and the role that a Federally Qualified Health Center (FQHC) can play in mitigating this problem. Categories: Family/General Practice Keywords: food insecurity, food insecurity and diabetes, federal nutrition programs, role of federally qualified health centers, cycle of food insecurity and health, hunger, food insecurity and chronic disease, food assistance, feeding america, southern illinois university center for family medicine Open Access Review Article