Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States and the largest in North Texas in terms of inpatients and outpatients served. The health system includes Texas Health Physicians Group and hospitals under the banners of Texas Health Presbyterian, Texas Health Arlington Memorial, Texas Health Harris Methodist and Texas Health Huguley. Texas Health has affiliated with numerous organizations — from all aspects of the health care industry — to better serve the more than 7 million residents of North Texas. These relationships, along with other major initiatives and quality programs, are supported by Texas Health's more than 350 points of access, 24,000 employees and 6,000 physicians with active staff privileges, with the collective aim to provide employers and consumers in North Texas with more affordable, high-quality and better-coordinated care. Their vision is "partnering with you for a lifetime of health and well-being."Texas Health has 29 hospital locations - including acute-care, short-stay, behavioral health, rehabilitation and transitional care facilities - that are owned, operated or joint-ventured with Texas Health Resources along with more than 350 outpatient facilities, satellite emergency rooms, surgery centers, fitness centers, imaging centers and other community access points including Texas Health Physician Group clinics, doctors' offices, sleep medicine clinics, and Minute Clinics. In 2020, Fortune magazine ranked Texas Health Resources at number 15 on their Fortune List of the Top 100 Companies to Work For in 2020 based on an employee survey of satisfaction, rising to #7 in 2021.
ABSTRACT:Total joint arthroplasty (TJA) is increasingly performed in a global patient population that includes individuals observing prolonged daily fasting during Ramadan, a lunar calendar-based observance occurring over 29 to 30 consecutive days. Daily fasting may exceed 14 to 18 hours depending on geography and season, producing measurable alterations in hydration, glycemic variability, circadian rhythm, and sleep architecture that intersect with perioperative safety in TJA. This article synthesizes the physiologic and perioperative considerations, examines the implications for patients and surgeons, and proposes a framework for risk stratification, shared decision-making, and perioperative management. Elective TJA during Ramadan is not inherently contraindicated but requires structured assessment, perioperative planning, and patient counseling.
BACKGROUND:ImmunoglobulinG4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory condition affecting various organs, mimicking other inflammatory or neoplastic processes. Neurological manifestations, although uncommon, are recognized, with hypertrophic pachymeningitis being the most frequent. OBSERVATIONS:This case is notable for several differences. First, the patient's age and sex (23-year-old female) contrasts sharply with the typical demographic of middle-aged to elderly males. Second, while spinal involvement is known, this case highlighted involvement of the vertebral disc alongside vertebral bodies, leading to a discitis/osteomyelitis with a mass effect, which is a less common finding in neurological IgG4-RD. Most critically, the case was uniquely complicated by a superimposed methicillin-sensitive Staphylococcus aureus infection, resulting in a psoas abscess and discitis/osteomyelitis. This transpired after initial improvement with glucocorticoids and subsequent worsening despite rituximab treatment. LESSONS:This case broadens the known spectrum of IgG4-RD, emphasizing its protean manifestations and the importance of considering it across a broader demographic and atypical spinal involvement. It underscores that clinical deterioration in IgG4-RD patients on immunosuppressive therapy necessitates a thorough re-evaluation, ruling out concurrent infections rather than considering primary disease progression or relapse. A comprehensive diagnostic approach, including repeat biopsies and cultures, and a multidisciplinary management, is vital for optimal patient outcomes. https://thejns.org/doi/10.3171/CASE25789.
PURPOSE To compare cancer survival in the United States during the past half century in adolescent and young adult (AYA) patients of age 15-39 years with younger and older patients. METHODS Annual survival data were obtained from 8 US SEER regions during 1975-2017 for AYAs, younger (age 0-14 years), and older (age 40-59 and ≥65 years) populations. The average annual percent change (AAPC) in 5-year relative survival was determined with and without deaths from HIV/AID-associated malignancies that compromised overall cancer survival in males during the HIV/AIDS epidemic of 1981-1998. Joinpoint analysis identified time trends and statistical significances. RESULTS During 1975-1997, the AAPC in 5-year relative survival in AYAs was 0.66 (95% CI, 0.63 to 0.69), which was less than that in both younger, age <15 years, 0.93 (95% CI, 0.82 to 1.05) and older, age 40-64 years, 1.12 (95% CI, 0.10 to 1.14) patients. Subsequently, the 2000-2017 AAPC in AYAs was 0.47 (95% CI, 0.45 to 0.49), which was greater than that in both younger, age <15 years, 0.40 (95% CI, 0.34 to 0.45) and older, age 40-64 years, 0.43 (95% CI, 0.42 to 0.44) patients. In males, whose overall cancer survival was seriously compromised by the HIV epidemic in the 1980s and 1990s, much of the overall progress occurred as a result of the epidemic's cessation. Excluding HIV-associated cancers, however, showed even greater progress than the results for males and females considered together. CONCLUSION While compared with younger and older patients with cancer, American AYAs had the slowest improvement in 5-year relative survival before 1998, they since have had a greater improvement rate. Much of this progress can be attributed to national efforts led by NCI-funded cooperative groups to focus on AYA oncology.
