West Reading, PA, United States
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PubMed | University of Nebraska at Omaha, University of Nebraska Medical Center and The Reading Health System
Type: Journal Article | Journal: Journal of community hospital internal medicine perspectives | Year: 2014

Although medical publications are frequently used as the source of information, the prevalence of errata remains unclear. The objective of this study was to examine peer-review and publication processes of medical journals as well as to determine the occurrence of reported errata in medical journals and timeliness in identifying and correcting errata.Five medical journals, New England Journal of Medicine, Annals of Internal Medicine, British Medical Journal, Journal of American Medical Association, and Lancet, were evaluated. The characteristics of these journals were obtained from editors survey. All these journals report errata noted in their prior publications. We retrospectively analyzed all errata reported from January 1, 2012, to December 31, 2012. The mean number of reported errata per issue, the most common errata, and the mean time to report errata were calculated.The journals had high impact factors (14-51), received 3,200 to more than 15,000 submissions in 2012, and utilized two or more external reviewers and usually two or more editors for any accepted articles. All the journals edited the accepted articles, including references, figures, and tables for style. A mean of 1.3 articles with 1 errata was reported per issue (a total of 306 articles with errata in 226 issues). Errata in authors information, numeric errata, and errata in the figures and tables were the most common errata. The mean time to report the errata was 122 days.The high-impact journals, with extensive pre-publication review, reported relatively few errata per issue. The delay in reporting errata needs further exploration.


PubMed | Pennsylvania State University and The Reading Health System
Type: Journal Article | Journal: Journal of community hospital internal medicine perspectives | Year: 2015

Compression or irritation of the sciatic nerve and its branches, the common fibular and tibial nerves, causes sciatica which is a common syndrome characterized most often by radiating pain from the lower back down the legs and also manifesting as sensory and motor deficits. Sciatica is a common presentation of lumbosacral disc prolapse and degenerative disease of the lumbar spine in ambulatory settings. Schwannomas rarely cause sciatica; hence, it is seldom considered in evaluation of a patient with radiculopathy. Our patient presented with lumbar radiculopathy, mild degenerative changes on lumbar magnetic resonance imaging (MRI) scan, and failed conservative treatment. Myelopathy was confirmed with electromyogram (EMG). Thoracolumbar spine MRI revealed the schwannoma in the thoracic region. He recovered neurologic function after tumor excision. This case highlights the diagnostic challenge that may arise in evaluating a patient with lumbar radiculopathy, negative lumbosacral spine imaging, and failure of conservative therapy.


Bhatt V.R.,University of Nebraska Medical Center | Aryal M.R.,The Reading Health System | Shrestha R.,Memorial Hospital of Rhode Island | Armitage J.O.,University of Nebraska Medical Center
European Journal of Haematology | Year: 2013

Objectives: Large licensing trials did not find any association between the use of fondaparinux and the development of heparin-induced thrombocytopenia (HIT). Fondaparinux is in fact recommended as an option for the management of HIT. Since the first report of fondaparinux-associated HIT in 2007, additional reports have been published. However, the rarity of these cases, differences in case definition, and lack of larger case series have prevented better understanding of this disease. The objective of this study was to determine the clinical manifestations of fondaparinux-associated HIT, the predictive value of pretest probability (4Ts) scoring system, and the outcomes associated with current management. Methods: Using several search terms, we reviewed all cases of fondaparinux-associated HIT reported and indexed in PubMed till May 2013. All references were also checked for additional reports. We categorized the cases of fondaparinux-associated HIT as confirmed, probable, and possible based on our case definition. Results: A total of eight cases of fondaparinux-associated HIT were identified. Fondaparinux-associated HIT occurred in the setting of pro-inflammatory state, prior HIT, or exposure to heparin products. Bilateral adrenal hemorrhage or infarct, reflecting hypercoagulability or disseminated intravascular coagulation, was seen in 25% of patients. The pretest probability (4Ts) scoring system used for HIT appears to correctly risk stratify all the cases. Although functional assays can be used for the diagnosis, in the presence of recent exposure to heparin products, only the demonstration of fondaparinux-dependent platelet activation should be considered confirmatory. Non-heparin anticoagulants are effective therapy; however, one-third of the patients had poor outcomes. Conclusion: The risk of fondaparinux-associated HIT, although low is real, which along with documented cases of fondaparinux failure mandate its cautious use in the management of HIT. © 2013 John Wiley & Sons A/S.


PubMed | The Reading Health System
Type: | Journal: Journal of community hospital internal medicine perspectives | Year: 2014

A 60 year old male with a medical history of pulmonary sarcoidosis and chronic low testosterone presented to his allergist for excessive lacrimation. Computed tomography (CT) scan of sinuses ordered for possible blocked nasolacrimal duct revealed an abnormal expansion of the sella turcica. Magnetic resonance imaging suggested a homogeneously enhancing 4 cm soft tissue mass enveloping the internal carotid and abutting the optic nerves. Since the patient indicated no symptoms, it was felt to be consistent with a pituitary incidentaloma. Laboratory investigation showed only minimally elevated prolactin. Visual field testing at the office was normal but computed campimetry was suggestive of few minimally depressed points in the supra-temporal quadrant on the right. Even with high suspicion of neurosarcoidosis, the patient had a surgical indication so he underwent transsphenoidal excision of the mass with no complications. Pathology was consistent with a null-cell pituitary adenoma.

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