Highlights Herpes zoster results from the reactivation of dormant varicella zoster virus. Risk factors include older ages and immunosuppression. Lumbosacral plexopathy is a complication of disseminated herpes zoster. Early treatment even in immunocompetent patients can decrease morbidity. Awareness of the complications is crucial to provide early treatment.
Herpes zoster is an infection resulting from the reactivation of dormant varicella zoster virus (VZV) in a posterior dorsal root ganglion. It affects 50% of immunocompromised patients and, when the viral infection persists, it can lead to a process known as disseminated varicella zoster virus (dVZV). Here we discuss a case of a bullous presentation of VZV with a rapid evolution of disseminated herpes zoster in an immunocompromised patient. Maintaining a broad differential diagnosis is necessary for early diagnosis and treatment of atypical presentations of herpes zoster, which is imperative to avoid increasing morbidity and mortality.
BackgroundThe Centers for Medicare and Medicaid Services enacted the Hospital Readmissions Reduction Program to impose penalties for diagnoses with high readmission rates. Despite several elective orthopedic procedures being included in this program, readmission rates have not declined, and associated costs have reached critical levels for total knee and total hip arthroplasty. Readmissions drastically impact patient outcomes. There are many known contributors to patient readmission rates, including infection, pain, and hematomas. However, evidence is inconclusive regarding other aspects, such as demographics, insurance, and discharge disposition. The purpose of this manuscript is to 1) measure hospital readmission rates for total knee and total hip arthroplasty, 2) evaluate the causes of readmissions, and 3) provide a predictive profile of risk factors associated with hospital readmissions. MethodsPatients who underwent total knee or total hip arthroplasty were identified through a retrospective database review. An electronic chart review extracted data concerning patient demographics, comorbidities, surgical information, 30-day outcomes, and reasons for 30-day readmissions. Continuous and categorical variables were assessed with the Wilcoxon rank-sum test and the Chi-square test, respectively. ResultsA total of 6,065 patients were included, with 269 (4.4%) having at least one surgery-related 30-day readmission. No differences in readmission were noted with age, sex, or ethnicity; however, differences were found in weight and body mass index. Statistically significant comorbidities were heart failure, chronic obstructive pulmonary disease, dialysis, and alcohol use or abuse. ConclusionOur research indicated that surgery type, length of stay, and heart failure most significantly impacted 30day readmission rates. By assessing readmission rates, we can take steps to optimize care for non-elective surgeries that will improve patient outcomes and cost-effectiveness.
BackgroundElbow conditions and pathology are commonly seen in the outpatient clinic. Telephone and video visits can allow for expeditious assessment of elbow complaints, without the added challenges of commuting for a clinic-based evaluation. In the setting of a pandemic, the benefits of telemedicine are apparent, but the time and effort saved from being able to remotely evaluate musculoskeletal conditions are also useful in a nonpandemic situation. In this modern era of telemedicine, protocols need to be developed to provide guidance for a remote elbow evaluation. As with all musculoskeletal conditions, the history about the elbow complaint allows the clinician to develop a differential diagnosis, which is either supported or refuted based on physical examination and diagnostic studies. Appropriate questions asked over a telephone call can provide answers that lead the clinician to a specific diagnosis and treatment plan. Furthermore, responses to these same questions can be further supported by a video assessment of the affected elbow, which may provide additional evidence to support a diagnosis and plan of care. AimsTo outline possible questions, responses, and video examination techniques to aid the clinician in elbow examinations conducted via telemedicine. MethodsWe have created a pathway for step-by-step evaluation to help physicians direct their patients through the typical elements of a thorough elbow examination via telehealth. ResultsWe have created tables of questions, answers, and instructions to help guide the physician through different aspects of a telehealth elbow examination. We have also included a glossary of descriptive images that demonstrate each maneuver. ConclusionThis article provides a structured guide to efficiently extracting clinically relevant information during telemedicine examinations of the elbow.
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