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Objective: To compare the rates of selected nervous system, cardiovascular, and otologic abnormalities in patients with and without Treacher Collins Syndrome (TCS). Design: Retrospective TriNetX platform cohort study. Setting: Aggregated and deidentified electronic health record (EHR) data from across the United States. Patients, Participants: Patients with TCS (n = 1,114) and a propensity matched control cohort without TCS (n = 1,114 matched from n = 110,368,585). Main Outcome Measured: Prevalence and relative risk (RR) of selected diagnoses in a propensity-matched cohort. Results: The RR of congenital malformations of the circulatory system in patients with TCS was 8.5 (95% CI 4.44-16.28). Patients with TCS also had higher rates of otologic abnormalities including conductive hearing loss (RR 44, 95% CI 24-83) and nervous system disorders including movement disorders (RR 2.60, 95% CI 1.27-5.50) and recurrent seizures (RR 4.2, 95% CI 2.12-8.33). Conclusions: We found a significantly elevated risk in TCS patients within all three systems. We postulate that the nervous system effects may be the result of one of the TCS-linked genes, for which a mutation has also been associated with progressive ataxia, cerebellar atrophy, hypomyelination, and seizures. As the previously-identified causal genes influence neural crest cells that form the head and face, these cells may also populate cardiac structures, resulting in cardiovascular abnormalities. Finally, the characteristic craniofacial abnormalities identified in TCS impair hearing and are associated with increased risk of otitis media. Our findings may help researchers to hypothesize the function of the genes underlying TCS, as well as to inform the care of affected individuals. [ABSTRACT FROM AUTHOR]

Objective: The study was aimed at comparing intrapartum and postpartum outcomes between pregnant patients with and without antenatal COVID‐19 infection using aggregated, deidentified electronic health record (EHR) data. Design and Setting: This retrospective cohort study included data from over 80 health care organizations within the TriNetX Analytics Research Network. Population: Individuals admitted for delivery from Jan 2020 to May 2023 were studied. Methods: We studied individuals with ICD‐10 codes for delivery, COVID‐19 diagnosis, and primary outcomes. We compared the incidence of adverse intrapartum and 30‐day postpartum outcomes in those with and without antenatal COVID‐19. Main Outcome Measures: The main outcomes compared were obstetric, cardiovascular, neurovascular, and respiratory outcomes within 30 days postpartum. Results: Twenty‐six thousand nine hundred seventy‐four of 369,923 (7%) birthing parents with a delivery encounter had an antenatal COVID‐19 diagnosis. Compared to matched controls, having COVID‐19 was associated with an increased risk of postpartum hemorrhage (RR—1.24 (CI—1.16–1.33)), gestational hypertension (RR—1.27 (CI—1.27–1.34)), preeclampsia (RR—1.25 (CI—1.18–1.32)), eclampsia (RR—1.66 (CI—1.29–2.32)), preterm labor (RR—1.21 (CI—1.21–1.34)), cerebral infarction (RR—1.74 (CI—1.04–2.90)), cardiomyopathy (RR—2.08 (CI—1.30–3.32)), heart failure (RR—1.55 (CI—1.04–2.31)), sepsis (RR—2.21 (CI—1.54–3.19)), DVT (RR—2.32 (CI—1.45–3.71)), and pulmonary embolism (RR—2.68 (CI—1.74–2.90)). Conclusion: Individuals with antenatal COVID‐19 were more likely to have intrapartum and postpartum obstetric, cardiovascular, neurovascular, and respiratory complications. This data will inform risk stratification and screening for prenatal care providers. [ABSTRACT FROM AUTHOR]

Summary: Anti‐Müllerian hormone (AMH) is commonly used as a marker of ovarian reserve. Although obesity is associated with decreased fertility, the relationship between body mass index (BMI) and AMH remains uncertain, hindering the accurate interpretation of AMH. We sought to assess the relationship between serum AMH and BMI in patients with and without polycystic ovarian syndrome (PCOS). This study analysed 500 patients at a single centre between 2020 and 2021. Patients were divided into cohorts: those with BMI <40 kg/m2 and those with BMI >40 kg/m2. Patients with and without PCOS were included. Chi‐square tests, Fisher's exact tests, multiple linear regression analysis and independent t‐tests were performed as appropriate. In the general study population, serum AMH was not significantly different in the BMI >40 kg/m2 group compared to the BMI <40 kg/m2 group (4.3 ± 5.6 vs. 4.3 ± 5.6, p =.35). Patient ages between these two groups differed, with an average age of 35.4 ± 5.4 years in the BMI <40 kg/m2 group and 33.7 ± 5.4 years in the BMI <40 kg/m2 group (p =.031). Our multivariate regression analysis, which adjusted for age, demonstrated a significant interaction effect between BMI and PCOS diagnosis, indicating that the relationship between BMI and AMH is dependent on PCOS status (β = −.03, 95% confidence interval [CI]: −0.05, 0.00, p =.044). In patients without PCOS, we found a non‐significant relationship between AMH and BMI (β =.00, 95% CI −0.01, 0.01, p =.7); however, in patients with PCOS, AMH significantly decreased as BMI increased (β = −.03, 95% CI −0.06, 0.00, p =.034). BMI has an inverse association with AMH levels in patients with PCOS, indicating a need for future research to determine if that interaction represents a clinically significant negative effect on reproductive function. [ABSTRACT FROM AUTHOR]

Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research. Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools. Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations. Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities. [ABSTRACT FROM AUTHOR]

Objective: To compare the rates of selected nervous system, cardiovascular, and otologic abnormalities in patients with and without Treacher Collins Syndrome (TCS)., Design: Retrospective TriNetX platform cohort study., Setting: Aggregated and deidentified electronic health record (EHR) data from across the United States., Patients, Participants: Patients with TCS (n = 1,114) and a propensity matched control cohort without TCS (n = 1,114 matched from n = 110,368,585)., Main Outcome Measured: Prevalence and relative risk (RR) of selected diagnoses in a propensity-matched cohort., Results: The RR of congenital malformations of the circulatory system in patients with TCS was 8.5 (95% CI 4.44-16.28). Patients with TCS also had higher rates of otologic abnormalities including conductive hearing loss (RR 44, 95% CI 24-83) and nervous system disorders including movement disorders (RR 2.60, 95% CI 1.27-5.50) and recurrent seizures (RR 4.2, 95% CI 2.12-8.33)., Conclusions: We found a significantly elevated risk in TCS patients within all three systems. We postulate that the nervous system effects may be the result of one of the TCS-linked genes, for which a mutation has also been associated with progressive ataxia, cerebellar atrophy, hypomyelination, and seizures. As the previously-identified causal genes influence neural crest cells that form the head and face, these cells may also populate cardiac structures, resulting in cardiovascular abnormalities. Finally, the characteristic craniofacial abnormalities identified in TCS impair hearing and are associated with increased risk of otitis media. Our findings may help researchers to hypothesize the function of the genes underlying TCS, as well as to inform the care of affected individuals.

Objective: In patients undergoing elective thoracic surgery, frailty is associated with worse outcomes. However, the magnitude by which frailty influences outcomes of urgent thoracic surgery (UTS) is unknown., Methods: We identified patients admitted with a UTS condition from January to September 2017 in the National Readmissions Database. UTS conditions were classified as esophageal perforation, hemo/pneumothorax, rib fracture, and obstructed hiatal hernia. Outcome of interest was mortality within 90 days of index admission. Frailty score was calculated using a deficit accumulation method. Cox proportional hazard modeling was used to calculate a hazard ratio for each combination of UTS disease type and frailty score, adjusted for sex, insurance payor, hospital size, and hospital and patient location, and was compared with the effect of frailty on elective lung lobectomy., Results: We identified 107,487 patients with a UTS condition. Among UTS conditions overall, increasing frailty elements were associated with increased mortality (hazard ratio, 2270; 95% CI, 1463-3523; P  < .001). Compared with patients without frailty undergoing elective lobectomy, increasing frailty demonstrated trending toward increased mortality in all diagnoses. The magnitude of the effect of frailty on 90-day mortality differed depending on the disease and level of frailty., Conclusions: The effect of frailty on 90-day mortality after admission for urgent thoracic surgery conditions varies by disease type and level of frailty. Among UTS disease types, increasing frailty was associated with a higher 90-day risk of mortality. These findings suggest a valuable role for frailty evaluation in both clinical settings and administrative data for risk assessment., Competing Interests: Dr Towe is a consultant for Atricure and Zimmer Biomet. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2023 The Author(s).)