Physiopathology of Extrapulmonary Tuberculosis: A Literature Review

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Introduction: Extrapulmonary tuberculosis (EPTB) is an infection by mycobacteria in any part of the body other than the lungs. There is information on tuberculosis infection from more than 3,000 years ago, and despite the knowledge that there is about the disease, nowadays, it is estimated that a quarter of the world population is infected and 15% of the cases are extrapulmonary.

Aims: This literature review aims to present the physiopathology of the most common EPTB, update and summarize the current diagnostic and therapeutic advances for the EPTB reviewed, as well as describe the physiopathological implications of coinfection with human immunodeficiency virus (HIV).

Methods: A literature review was performed for which PubMed, Cochrane Library, and Google Scholar databases were consulted using the following keywords: Tuberculosis, Epidemiology, Physiopathology, Diagnosis, and Therapy. Only articles published from 2016 to 2022, evaluated with a score ≥ 10 based on the Scale for the Assessment of Narrative Review Articles (SANRA) score were included, obtaining a total of 38 bibliographic sources.

Discussion: Depending on the system or organ affected, it is how the physiopathological process is carried through as well as how the clinical features manifest and the diagnostic approach is made. The diagnostic and therapeutic strategies of each type of EPTB have been widely studied; however, although technological innovation has contributed to the development of new diagnostic techniques, the treatment of almost all EPTB has remained the same over time, which consists of the same 6-month regimen of therapy as in pulmonary tuberculosis. Furthermore, tuberculosis treatment has been severely affected by rifampicin resistance and concomitant HIV infection.

Conclusion: The physiopathology of the different EPTBs is well described; nevertheless, a better understanding of how the disease spreads and develops will allow us to create new diagnostic resources and improve therapeutic targets for this disease, which still has a substantial presence worldwide.

Impact of Imposter Phenomenon on Medical Learners and Clinicians: A Scoping Review

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Objective: The imposter phenomenon (IP) is the belief that one does not deserve success. Medical students, residents, and physicians experience IP at significant rates, often due to the stress of mastering the extensive diagnostic information and treatment modalities as well as the competitive nature of medicine. We aimed to identify the main factors of IP in medical students, residents, and physicians in the available literature to increase awareness of IP in medical education.

Methods: In this scoping review, PubMed, PsycINFO, Cochrane Library, Embase, Scopus, Web of Science, Google Scholar, Northern Lights Conference Abstracts, and Dissertations & Theses databases were systematically searched for relevant studies published before June 2020. Articles that examined IP in medical students, residents, and attending physicians were retained. References were hand- searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Extracted data were tabulated to summarize characteristics and main findings from each study. Content analysis of this table identified major themes in the available literature.

Results: Twenty-four journal articles published between 1978 and 2020 were included. Three main themes were identified, including specific demographic characteristics of IP (n = 14), the professional impact (n = 10), and the psychological impact (n = 17) of IP. For demographic characteristics, IP was higher in older individuals (n = 3), racial and/or ethnic minorities (n = 2), and women (n = 12). Married individuals experienced less IP (n = 2). For professional impact, IP increased during career transitions or professional challenges (n = 8). For psychological impact, IP was associated with reduced self-esteem (n = 7), a negative self-concept (n = 2), increased self-doubt (n = 3), and perfectionism (n = 3). Depression, anxiety (n = 3), and burnout (n = 6) were also heightened with IP.

Conclusion: Results revealed a multitude of factors influencing IP. Increased awareness of the presence, impact, and severity of IP assists medical educators to combat its negative effects. Further research is needed to improve treatments for IP in this population and to better understand the impact of IP on diversity, career trajectory, and career satisfaction in medicine.

Use of telehealth for cancer screening in primary care during COVID-19: an analysis of the Council of Academic Family Medicine Educational Research Alliance Survey 2022

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Background: The COVID-19 pandemic caused rapid uptake of telemedicine in primary care settings affecting cancer screening.

Objective: This study aimed to understand provider perception of future cancer incidence and telehealth feasibility in cancer screening.

Methods: Data were gathered and analyzed as part of the 2020 Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) survey for primary analysis. The 2020 General Member COVID Survey examined demographics, the impact of faculty isolation, E-learning experience, cancer screening during COVID-19, and outpatient prenatal care. Survey participants were practicing family medicine physicians who were members of one of the CAFM organizations, with a response rate of 14.5%. Descriptive statistics were calculated. Analysis of Variance (ANOVA) was used to evaluate the relationship between telehealth sufficiency and provider age or year they earned their highest degree. Logistic regression evaluated the relationship between telehealth sufficiency and institution type.

Results: 54% of respondents believe that there will be an increase in late-stage cancer. Respondents whose practice settings were not affiliated with medical schools were 1.94 times more likely to feel that telehealth would not be sufficient for cancer screenings in the future (odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.28, 2.93).

Conclusion: While our study shows that in light of the COVID-19 pandemic, primary care physicians believe there will be an increase in later stage cancer; they can also use telehealth to adequately maintain cancer screening practices. This research serves as a starting point to understanding where, in cancer screening, telehealth can be useful and how practitioners can provide high-quality hybrid care.

When Cannabis Use Goes Wrong: An Epidemiologic Study of Cardiopulmonary Symptoms in Patients That Present to Emergency Departments

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Background: Increased availability and use of cannabis in Michigan have led to a marked increase in emergency department (ED) visits associated with the drug’s adverse cardiopulmonary effects. However, few people are aware of these potential cardiopulmonary side effects. Recognition of these presenting symptoms is critical for emergency clinicians to provide timely and effective care, make accurate diagnoses, and safeguard the health of patients who may be experiencing toxic effects from cannabis use.

Study objective: To describe the prevalence, clinical features, and disposition of cannabis cardiopulmonary toxicity in a community- based study.

Methods: This was a retrospective cohort analysis of all patients diagnosed with toxicity related to cannabis use. Patients were seen at eight EDs over a 26-month study period (November 2018–December 2020). Affiliated institutions included three university-affiliated hospitals, a children’s tertiary care facility, and four rural medical centers. Data collected included demographics, clinical features, and treatment outcomes in patients presenting to the ED with cardiopulmonary symptoms (CPS) versus those experiencing other forms of cannabis toxicity.

Results: During the study period, 1,174 patients were evaluated for cannabis toxicity. A total of 318 patients (27.1%) had a cardiopulmonary chief complaint (CPS group) and 856 (72.9%) experienced other forms of cannabis toxicity, predominantly symptoms of intoxication, cannabis hyperemesis syndrome, or neuropsychiatric complaints. The CPS group presented with tachycardia (36.5%), dyspnea (34.3%), chest tightness (28.6%), palpitations (17.9%), and hypertension (8.2%). CPS patients were more likely to be older (32.6 vs. 24.3 years, p < 0.001), ingested edible cannabis (36.8% vs. 9.2%, p < 0.001), and have a history of polysubstance abuse (17.6 vs. 12.0%, p = 0.013). These patients also had a longer ED length of stay (4.9 vs. 3.8 h, p < 0.001) and significantly more hospital admissions (10.1% vs. 6.3%, p = 0.027).

Conclusions: Cardiopulmonary toxicity is common after acute or chronic cannabis exposures, occurring in over one-quarter of ED patients in this community-based study. These troublesome findings highlight the risks associated with using cannabis for recreational or therapeutic purposes.