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Pryor EK, Tyre M, Brands S, Flinn RE, Stepleman LM, Holt NR. Barriers to Mental Health Care Identified by Sexual and Gender Minority Individuals in Georgia and South Carolina. South Med J 2023; 116:264-269. [PMID: 36863045 DOI: 10.14423/smj.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Geographic location can affect access to appropriate, affirming mental health care for sexual and gender minority (SGM) individuals, especially for those living in rural settings. Minimal research has examined barriers to mental health care for SGM communities in the southeastern United States. The objective of this study was to identify and characterize perceived barriers to obtaining mental health care for SGM individuals living in an underserved geographic area. METHODS Drawing from a health needs survey of SGM communities in Georgia and South Carolina, 62 participants provided qualitative responses describing barriers they encountered to accessing mental health care when needed in the previous year. Four coders used a grounded theory approach to identify themes and summarize the data. RESULTS Three themes of barriers to care emerged: personal resource barriers, personal intrinsic factors, and healthcare system barriers. Participants described barriers that can inhibit access to mental health care regardless of one's sexual orientation or gender identity, such as finances or lack of knowledge about services, but several of the identified barriers intersect with SGM-related stigma or may be magnified by participants' location in an underserved region of the southeastern United States. CONCLUSIONS SGM individuals living in Georgia and South Carolina endorsed several barriers to receiving mental health services. Personal resource and intrinsic barriers were the most common, but healthcare system barriers were present as well. Some participants described simultaneously encountering multiple barriers, illustrating that these factors can interact in complex ways to affect SGM individuals' mental health help seeking.
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Affiliation(s)
| | - Margaret Tyre
- From the Medical College of Georgia, Augusta University, Augusta
| | - Susan Brands
- From the Medical College of Georgia, Augusta University, Augusta
| | - Ryan E Flinn
- From the Medical College of Georgia, Augusta University, Augusta
| | - Lara M Stepleman
- From the Medical College of Georgia, Augusta University, Augusta
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Ali Amghaiab IF, Abozguia K, Brewer L, Pryor EK, Boykin R, Ali FI. Inferior ST-Elevation Myocardial Infarction (STEMI) with Heart Block: Can We Always Trust External Pacemakers? Ann Emerg Med 2023; 81:73-75. [PMID: 36543487 DOI: 10.1016/j.annemergmed.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 12/23/2022]
Affiliation(s)
| | - Khalid Abozguia
- Marshall University Joan C. Edwards School of Medicine, Huntington, WV
| | | | | | | | - Fathi I Ali
- Tri-Star Southern Hills Medical Center, Nashville, TN
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Ullah A, Khan J, Waheed A, Sharma N, Pryor EK, Stumpe TR, Velasquez Zarate L, Cason FD, Kumar S, Misra S, Kavuri S, Mesa H, Roper N, Foroutan S, Karki NR, Del Rivero J, Simonds WF, Karim NA. Parathyroid Carcinoma: Incidence, Survival Analysis, and Management: A Study from the SEER Database and Insights into Future Therapeutic Perspectives. Cancers (Basel) 2022; 14:cancers14061426. [PMID: 35326576 PMCID: PMC8946517 DOI: 10.3390/cancers14061426] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction: Parathyroid carcinoma (PC) is an extremely rare entity, with a frequency of 0.005% of all malignancies. Most data related to this rare disease are limited to case series and a few database studies. We present a large database study that aims to investigate the demographic, clinical, and pathological factors, prognosis, and survival of PC. Methods: Data of parathyroid carcinoma were extracted from the Surveillance, Epidemiology, and End Results (SEER) diagnosed between 1975 and 2016. Results: PC had a slightly higher incidence in men (52.2%, p < 0.005), the majority of cases affected Caucasians (75.4%, p < 0.005), and the mean age at diagnosis was 62 years. Histologically, 99.7% were adenocarcinomas not otherwise specified (p < 0.005), well-differentiated (p < 0.005), and 2−4 cm (p < 0.001) in size among the patients with available data. In cases with staging provided, most PC were organ-confined (36.8%, p < 0.001). Lymph nodes were positive in 25.2% of cases where lymph node status was reported. The main treatment modality was surgery (97.2%), followed by radiation alone (2%), and very few received chemotherapy alone (0.8%), p < 0.005. Five-year follow-up was available for 82.7% of the cases. Those who underwent surgery only or radiation alone had 5-year survivals of 83.8% and 72.2%, respectively (p < 0.037). Multivariable analysis identified tumor size >4 cm, age > 40 years, male sex, Caucasian race, distant spread, and poorly differentiated grade as independent risk factors for mortality (p < 0.001). Conclusion: PC is a very rare tumor mostly affecting Caucasian individuals in the fifth decade. Older age, poor histologic differentiation, and distant metastasis are associated with a worse prognosis. Surgical resection offers the best survival outcome. To better understand the pathogenesis and factors affecting survival, all PC patients should be enrolled in national and international registries.
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Affiliation(s)
- Asad Ullah
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.K.); (H.M.)
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Nitasha Sharma
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Elizabeth K. Pryor
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Tanner R. Stumpe
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Luis Velasquez Zarate
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Frederick D. Cason
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Suresh Kumar
- National Cancer Institute, NIH, Bethesda, MD 20892, USA; (S.K.); (N.R.); (J.D.R.)
| | - Subhasis Misra
- Department of Surgery, Brandon Regional Hospital, Brandon, FL 33511, USA;
| | - Sravan Kavuri
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Hector Mesa
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (J.K.); (H.M.)
| | - Nitin Roper
- National Cancer Institute, NIH, Bethesda, MD 20892, USA; (S.K.); (N.R.); (J.D.R.)
| | - Shahin Foroutan
- Department of Surgery, San Joaquin General Hospital, French Camp, CA 95231, USA; (A.W.); (N.S.); (F.D.C.); (S.F.)
| | - Nabin Raj Karki
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
| | - Jaydira Del Rivero
- National Cancer Institute, NIH, Bethesda, MD 20892, USA; (S.K.); (N.R.); (J.D.R.)
| | - William F. Simonds
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA;
| | - Nagla Abdel Karim
- Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (A.U.); (E.K.P.); (T.R.S.); (L.V.Z.); (S.K.); (N.R.K.)
- Correspondence: ; Tel.: +513-375-2554
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Pryor EK, Sinkler MA, Ullah A, Martin E, Homlar K. Rare Lower Extremity Fibrosarcomatous Variant of Dermatofibrosarcoma With Myxoid Features Treated With Transtibial Amputation. Cureus 2021; 13:e18079. [PMID: 34692297 PMCID: PMC8523476 DOI: 10.7759/cureus.18079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor originating from the dermis, with high rates of local recurrence and invasive growth but low likelihood of distant metastasis. Fibrosarcomatous transformation (FS-DFSP) of DFSP accounts for approximately 5-15% of DFSP tumors, is a higher-grade tumor, with higher chances of metastasis and poorer prognosis. We present a case of a 66-year-old female presented with a large fungating mass on the left dorsal foot. Ultrasound-guided core needle biopsy with immunohistochemistry suggested a spindle cell neoplasm, favoring myxofibrosarcoma with intermediate grade. The patient elected for below-knee amputation over limb salvage with wide resection and free flap reconstruction. Based on clinical presentation, radiologic, histologic features and fluorescence in situ hybridization (FISH) studies confirmed the diagnosis of fibrosarcomatous variant of dermatofibrosarcoma protuberans with myxoid change. FS-DFSP with myxoid change is a rare soft tissue tumor that requires aggressive treatment due to its high rates of recurrence. This case presents a rare tumor in a unique location that was successfully treated with limb amputation, which is not documented in current literature.
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Affiliation(s)
- Elizabeth K Pryor
- Orthopedics, Medical College of Georgia - Augusta University, Augusta, USA
| | - Margaret A Sinkler
- Orthopedics, Medical College of Georgia - Augusta University, Augusta, USA
| | - Asad Ullah
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Elizabeth Martin
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Kelly Homlar
- Orthopedic Surgery, Medical College of Georgia - Augusta University, Augusta, USA
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Sumner MD, Beard S, Pryor EK, Das I, McCully KK. Near Infrared Spectroscopy Measurements of Mitochondrial Capacity Using Partial Recovery Curves. Front Physiol 2020; 11:111. [PMID: 32116804 PMCID: PMC7033681 DOI: 10.3389/fphys.2020.00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Near-infrared spectroscopy (NIRS) has been used to measure muscle mitochondrial capacity (mVO2max) as the recovery rate constant of muscle metabolism after exercise. The current method requires as many as 50 short ischemic occlusions to generate two recovery rate constants. Purpose To determine the validity and repeatability of using a 6-occlusion protocol versus one with 22 occlusions to measure muscle mitochondrial capacity. The order effect of performing multiple Mito6 test was also evaluated. Method In two independent data sets (bicep n = 7, forearm A n = 23), recovery curves were analyzed independently using both the 6 and 22 occlusion methods. A third data set (forearm B n = 16) was generated on the forearm muscles of healthy subjects using four 6-occlusion tests performed in succession. Recovery rate constants were generated using a MATLAB routine. Results When calculated from the same data set, the recovery rate constants were not significantly different between the 22 occlusion and 6 occlusion methods for the bicep (1.43 ± 0.33 min–1, 1.43 ± 0.35 min–1, p = 0.81) and the forearm A (1.97 ± 0.40 min–1, 1.97 ± 0.43 min–1, p = 0.90). Equivalence testing showed that the mean difference was not different than zero and the 90% confidence intervals were within 5% of the average rate constant. This was true for the Mito6 and the Mito5∗ approaches. Bland–Altman analysis showed a slope of 0.21 min–1 and an r of 0.045 for the bicep dataset and a slope of −0.01 min–1 and an r of 0.045 for the forearm A dataset. When performing the four 6-occlusion tests; recovery rate constants showed no order effects (1.50 ± 0.51 min–1, 1.42 ± 0.54 min–1, 1.26 ± 0.41 min–1, 1.29 ± 0.47 min–1, P > 0.05). Conclusion The Mito6 analysis is a valid and repeatable approach to measure mitochondrial capacity. The Mito6 protocol used fewer ischemic occlusion periods and multiple tests could be performed in succession in less time, increasing the practicality of the NIRS mitochondrial capacity test. There were no order effects for the rate constants of four repeated 6-occlusion tests of mitochondrial capacity, supporting the use of multiple tests to improve accuracy.
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Affiliation(s)
- Maxwell D Sumner
- Non-Invasive Exercise Muscle Physiology Lab, Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Samuel Beard
- Non-Invasive Exercise Muscle Physiology Lab, Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Elizabeth K Pryor
- Non-Invasive Exercise Muscle Physiology Lab, Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Indrajit Das
- Non-Invasive Exercise Muscle Physiology Lab, Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Kevin K McCully
- Non-Invasive Exercise Muscle Physiology Lab, Department of Kinesiology, University of Georgia, Athens, GA, United States
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