The Home Sleep Apnea Test (HSAT) has good diagnostic performance for patients with a high pretest probability of moderate to severe obstructive sleep apnea (OSA). However, the false negative rate has been reported as high as 17
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease that may be refractory to conventional medical and surgical therapies. Advances in the understanding of type 2 inflammatory mechanisms have led to the development of targeted biologic therapies. This review examines clinical trial evidence, and real-world data supporting biologic use in CRSwNP. Four biologics (dupilumab, omalizumab, mepolizumab, tezepelumab) are FDA approved in the United States for the management of refractory CRSwNP. Randomized controlled trials and multiple additional studies have demonstrated the efficacy of biologics in reducing nasal polyp burden and nasal congestion in patients who are refractory to traditional medical/surgical therapy or are poor surgical candidates. Guidelines for implementing these drugs into daily practice emphasize the importance of identifying appropriate patient subgroups, considering patient inflammatory profiles and comorbid conditions to select the best agent, and reassessing drug response to optimize resources and ensure patient safety. Biologics uniquely contribute to CRSwNP management by modulating the underlying type 2 inflammatory pathway cascade in patients who are otherwise refractory to conventional medical and surgical therapy. Ongoing and future trials will refine biomarker-guided therapy and define the role of biologics alongside surgery in comprehensive CRSwNP care.
BACKGROUND: Maternal mortality rates in the United States have steadily risen over the past two decades, despite being largely preventable with timely and appropriate care. Obstetric Life Support (OBLS) is an evidence-based, interdisciplinary simulation curriculum designed to train prehospital and hospital-based healthcare workers (HCWs) in recognizing, preventing, and managing maternal medical emergencies. However, its implementation has primarily been limited to high-resource settings with access to optimal training infrastructure. Rural settings often face unique challenges that hinder the translation of evidence-based health practices. This manuscript outlines a protocol to identify barriers and facilitators to OBLS implementation and develop and evaluate an adapted curriculum tailored to rural communities in New England. METHODS: This study represents a collaboration between the University of Connecticut Health, the New England Rural Health Association, and the Dartmouth Health Center for Rural Emergency Services and Trauma (CREST). Surveys and focus groups will be conducted with prehospital and hospital-based administrators and HCWs in rural settings to explore elements of the consolidated framework for implementation research that may influence implementation outcomes. Using an implementation mapping process, the OBLS curriculum will be adapted for rural contexts. The revised curriculum will be evaluated at four rural-serving sites (two hospital-based and two prehospital-based) in New England. Participants will complete surveys at baseline, immediately post-course, and at 6- and 12-month intervals to assess the impact of the training on their knowledge, self-efficacy, and clinical skills to managing maternal medical emergencies. DISCUSSION: Equitable scale-up of OBLS necessitates an implementation plan that addresses the unique contextual challenges, resource limitations, and delivery mechanisms for rural healthcare settings. This study aims to create an ‘implementation roadmap’ to guide healthcare institutions in rural and other low-resource healthcare settings, where education on maternal medical emergencies is urgently needed. Findings on knowledge and skill retention will inform strategies for targeted refresher courses, helping HCWs retain critical skills and maintain readiness to manage high-stakes maternal medical emergencies over time.
Latent autoimmune diabetes in adults (LADA) is an underrecognized form of autoimmune diabetes that is commonly misdiagnosed as type 2 diabetes mellitus (T2DM) because of its indolent progression and overlapping features with metabolic syndrome. We present a case of a 60-year-old woman with an initial diagnosis of T2DM who persistently had elevated hemoglobin A1c (HbA1c) despite optimal treatment and lifestyle modifications. After subsequent hospitalization and an episode of euglycemic diabetic ketoacidosis (DKA), further evaluation unmasked the diagnosis of LADA. This case emphasizes the need for a high index of suspicion for adults with poor glycemic control or unexplained DKA, as a timely diagnosis can significantly alter management and improve outcomes.
Purpose: To report a rare case of bilateral tractional retinal detachments (TRDs) in an infant with a pathogenic KIF11 mutation, describe the surgical management, and evaluate the anatomic and neurodevelopmental outcomes over 2 years of follow-up. Methods: A single case was reviewed. Results: A female neonate with microcephaly and bilateral TRDs diagnosed on day 2 of life underwent bilateral pars plana vitrectomy and lensectomy at 3 weeks of age. This represents one of the earliest and most severe presentations of KIF11 -related retinopathy documented to date and one of the earliest reported surgical interventions for this condition. The retinas remained attached at 2 years of follow-up, and the patient demonstrated favorable neurodevelopmental progress, including motor development. Conclusions: Early surgical intervention resulted in a favorable anatomic outcome in this infant with severe KIF11 -related retinopathy. Prompt restoration of visual input during a critical neurodevelopmental window may have contributed to favorable motor development. However, further studies are required to determine whether early visual rehabilitation influences neurodevelopmental outcomes in this condition.
