Journal of Clinical Medicine

Background: Lymphedema is a debilitating condition with high morbidity, yet despite advances in management, diagnostic ambiguity and fragmented referral patterns continue to delay appropriate care. We evaluated predictors of accurate diagnosis, microsurgical reconstruction candidacy, and secondary referrals generated during consultation with a lymphatic microsurgeon to highlight the need for a coordinated model of care. Methods: A retrospective chart review was performed for all outpatient referrals for ‘lymphedema’ from September 2020 to September 2021. Patient demographics, diagnostics, referral patterns, and lymphedema-related clinical data were collected. Results: 94 patients were referred for evaluation of possible lymphedema; lymphoscintigraphy confirmed diagnosis in 69. Following consultation, 23 patients received referrals for physical therapy, 17 for vascular surgery, and 8 for bariatric surgery or medical weight loss. Patients without lymphedema were more often referred to vascular surgery than those with lymphedema. Non-surgical candidates were more frequently referred to therapy or weight loss. Conclusions: Incorporating microsurgical reconstructive expertise into the evaluation of limb swelling improves diagnostic accuracy and refers patients- regardless of lymphedema status or surgical candidacy- to appropriate specialists. We propose a pathfinder model for patient flow that streamlines triage, improves access to accurate diagnosis and treatment, and prevents overburdening microsurgical practices with non-surgical patients.

Objectives: Nasal obstruction is a common presenting symptom in otolaryngology practice. Frequent etiologies include allergic and non-allergic rhinitis, inferior turbinate hypertrophy (HIT), and nasal septal deviation (DNS). This study aimed to evaluate the relationship between major causes of nasal obstruction and their effect on patient-reported quality of life (QoL). Methods: We conducted a retrospective analysis of patients presenting with nasal obstruction who completed the 22-item Sino-Nasal Outcome Test (SNOT-22), the Nasal Obstruction Symptom Evaluation (NOSE) scale, and a visual analog scale (VAS). Patients were categorized into three groups based on etiology: rhinitis, anatomical obstruction, or combined pathology. Results: The study included 170 patients (62% male), with a mean age of 38.4 years. Mean SNOT-22, NOSE, and VAS scores were 38, 61, and 6.5, respectively, with no statistically significant differences observed among the three etiologic groups. QoL outcomes were also comparable across anatomical subgroups, including isolated DNS, HIT, or combined findings. Among SNOT-22 domains, rhinologic symptoms demonstrated the highest burden. Patients with rhinitis exhibited significantly higher rhinologic and ear/facial symptom scores compared with patients with isolated anatomical obstruction (p = 0.04 and p = 0.005, respectively). Strong correlations were observed between SNOT-22, NOSE, and VAS scores across the entire cohort. Conclusions: Nasal obstruction is associated with substantial impairment in multiple domains of quality of life, independent of the underlying etiology. These findings highlight the broad impact of nasal obstruction on patient well-being. Larger prospective studies are warranted to further assess changes in quality of life following medical and surgical interventions.

Background/Objectives: The study evaluated whether the cumulative burden of multiple, modifiable risk factors worsened cardiovascular disease (CVD) mortality in West Virginia. Methods: This retrospective observational study looked at all CVD mortality rates per county of West Virginia between 2011 and 2020 and each county’s modifiable risks. Income, ratio of people per PCP (PCP Ratio), and Food Desert Status (FDS), and the death rate from the Census Bureau, AMA, US Department of Agriculture, and the West Virginia Department of Health and Human Services (WV HHS) were collected, respectively. Multiple linear regression and ANOVA analyses were performed for each combination of factors towards the death rate. Results: Multiple linear regression demonstrated that combined risk factors were more strongly associated with CVD mortality than any single factor alone. Over the 10-year period, West Virginia’s population aged overall. Each individual risk factor was significantly associated with CVD mortality (Income: F(1,537) = 53.39, p < 0.0001; PCP Ratio: F(1,537) = 21.49, p < 0.0001; FDS: F(1,537) = 5.13, p = 0.024). Two two-way interactions were significant (PCP Ratio:Income: F(1,537) = 22.03, p < 0.001; FDS:Income: F(1,537) = 5.23, p = 0.022), while the PCP Ratio:FDS interaction and the three-way interaction were not. Conclusions: Counties burdened by several modifiable risk factors experienced disproportionately elevated CVD mortality, exceeding what would be predicted by the additive effects of each risk factor individually. These findings highlighted the importance of addressing cumulative socioeconomic and healthcare access factors at the county level.