Medicine and Health Sciences Commons^™

Goblet Cell Carcinoma Of The Appendix: A Case Report On Goblet Cell Carcinoid, Sheliza Kabani, Aubtin Saedi, Austin Lehr, Lina O'Brien

HCA Healthcare Journal of Medicine

Goblet cell carcinoid of the appendix is a rare neoplasm with histological features of both neuroendocrine and adenocarcinomas. The combination of its aggressive behavior, infrequent occurrence, and variable clinical presentation convolutes the management of this tumor. We report the case of a 75-year-old female presenting with acute appendicitis. A laparoscopic appendectomy was performed. The pathology report showed goblet cell carcinoid at the base of the appendix with involvement of the proximal surgical margins. At her postoperative visit, the patient’s pathology report and options for management were reviewed, and the patient agreed to proceed with a right hemicolectomy 8-10 weeks after …

A Rare Case Of C3 Glomerulonephritis Presenting As Pulmonary Renal Syndrome, Gerardo Mederos, Harsh Patel, Menalee Hapuarachchi, Machaiah Madhrira, Ranjit Nair, Dana Ciobanu

HCA Healthcare Journal of Medicine

C3 glomerulonephritis (C3GN) is a rare disease that falls under the umbrella of C3 glomerulopathy (C3G). Classic manifestations of C3G include acute renal failure, proteinuria, and hematuria. In some cases, extrarenal manifestations can include ocular drusen. Until recent reports, C3G manifesting with pulmonary symptoms has not been reported. In this report, we describe a patient that initially presented with hemoptysis and acute renal failure, eventually leading to a diagnosis of pulmonary renal syndrome. Renal biopsy showed C3GN. The patient’s symptoms improved with pulse dose steroids, plasmapheresis and mycophenolate mofetil. C3G presenting with pulmonary symptoms is rare. Further research is needed …

Cutaneous Malignant Melanoma: A Synthesis On Updated Guidelines For The Primary Care Perspective, Seetha Venkateswaran, Nicholas D'Angelo

HCA Healthcare Journal of Medicine

Cutaneous malignant melanoma (CMM) is a condition wherein malignant cells form in the melanocytic cells. CMM is a potentially lethal form of skin cancer, commonly found in sun-exposed areas of the body. There are multiple risk factors for disease development, such as genetic mutation and UV radiation among others. Diagnosis and staging is important in determining disease morbidity and mortality. The United States Preventive Services Task Force (USPSTF) and the American Academy of Dermatology (AAD) have their respective guidelines and consensus on diagnosis, staging and treatment. It is imperative to delineate and educate primary care physicians on CMM, as they …

Importance Of Awareness Of Adverse Drug Reaction Reporting During The Covid-19 Pandemic, Heather Ellis, Hale Z. Toklu

HCA Healthcare Journal of Medicine

Health care professionals hold the responsibility of reporting any adverse drug reactions in order to learn about new therapy and how best to safely care for our patients. The information derived from case publications and FDA MedWatch reports are essential to accumulate information and increase awareness for the possible risks of new drugs.

The Management Of Seborrheic Dermatitis 2020, Sandra Widaty, Kusmarinah Bramono, Muhammad Yulianto Listiawan, Ariyati Yosi, Eliza Miranda, Githa Rahmayunita, Herwinda Brahmanti, Henry W. Lim

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Seborrheic dermatitis (SD) is a chronic relapsing dermatitis manifesting in the seborrheic area, affecting infants or adults. In Indonesia, the prevalence of SD is 0.99–5.8% of all dermatology cases from 2013 to 2015. SD has been known to be a prominent manifestation among HIV patients, but there is an increasing trend in the general population. Therefore, in 2017, the Indonesian Society for Dermatology and Venereology proposed a consensus for the management of SD in Indonesia based on the discussion from 12 dermatological centers. Concurrent with the development of new drugs, this study aims to evaluate and develop a …

Lucio’S Phenomenon: A Report On Six Patients In A Tertiary Referral Hospital In Indonesia, Melani Marissa, Rahadi Rihatmadja, Denny Surya, Henry W. Lim, Sri Linuwih Menaldi

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Lucio's phenomenon (LP) is a rare variant of leprosy reaction, with the clinical manifestation of “necrotizing erythema.” LP was observed in patients with lepromatous leprosy who have not received or completed the treatment, and it is especially evident in patients with diffuse lepromatous leprosy (DLL), known as Lucio-Latapi’s leprosy. LP occurs due to M. leprae invading the blood vessels, causing endothelial damage that leads to thrombosis, ischemia, infarction, and tissue necrosis. The clinical features of the disease are erythematous lesions that can be accompanied by vesicles or bullae, with ulcers forming scar tissues. Histopathological examination can help establish …

Correlation Between Clinical And Histopathological Findings Of Five Puzzling Cases Of Cutaneous Tuberculosis, Eliza Miranda, Sandra Widaty, Sondang Pandjaitan Sirait, Luddwi Achmad Rizky, Sri Linuwih Menaldi, Henry W. Lim

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings. …

Prevalence Of Nail Changes In Patients Infected With Hiv - A Cross Sectional Study, Seethalakshmi Ganga Vellaisamy, Priya Jeyaraman, Kannan Gopalan

Journal of General - Procedural Dermatology & Venereology Indonesia

Introduction: The spectrum of nail changes is wider and their frequency is higher among HIV patients. These changes magnify the range and multiplicity of AIDS manifestations. Their systematic examination is a non-invasive method of possible diagnostic value.

Objective: The present study was conducted to study the frequency and types of nail changes in HIV infected individuals and to correlate the severity of nail changes with CD4 count.

Material and Method: This was a cross sectional study, conducted in Skin & STD Out-Patient department in a tertiary care hospital between March 2018 and April 2019. A total of …

Efficacy Of 3d-Pore Sanitary Napkin On Mild-To-Moderate Irritant Contact Dermatitis In The Female Genital Area, Srie Prihianti Gondokaryono, Hanny Nilasari, Inge Ade Krisanti, Tia Febrianti, Herliyani Purba, Haruko Toyoshima, Danang Agung Yunaidi

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Women worldwide have their own strategies to cope with menstruation, and unhygienic menstrual practices often cause vaginal diseases. During menstruation, the skin is irritated by the remaining unabsorbed menstrual flow and sweat on sanitary pads. Irritation of vulvar skin by an external agent could cause contact dermatitis, which is an important contributor to vulvar diseases. Various sanitary napkins available today share similar materials. This study compared commonly used sanitary napkin among Indonesian women with 3D-pore sanitary napkin in terms of efficacy.

Methods: A randomized, controlled, single blind, crossover study of 72 participants who met the inclusion and …

Cutaneous Candidiasis Mimicking Inverse Psoriasis Lesion In A Type 2 Diabetes Mellitus Patient, Steven Philip Surya, Kardiana Purnama Dewi, Regina Regina

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Type 2 diabetes mellitus (T2DM) condition could affect the skin. The disease is among the greatest risk factors of skin infection such as cutaneous candidiasis and is also associated with autoimmune skin diseases such as psoriasis, which lesion morphologies and predilection areas are quite similar. These similarities are a source of confusion to clinicians.

Case illustration: We present a 60-year-old female patient with uncontrolled T2DM and multiple erythematous plaques in the form of shiny lesions at the intertriginous area that developed 1 week prior to her hyperglycemic state. The lesions had recurred at the same site for …

Purpuric Lesion In A Patient With Leprosy: Was It A Lucio’S Phenomenon Or An Epiphenomenon?, Sri Linuwih Menaldi, Melani Marissa, Inadia Putri Chairista, Henry W. Lim, Rahadi Rihatmadja

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: Lucio’s phenomenon (LP) is a severe necrotizing cutaneous reaction that occurs in patients with Lucio’s leprosy. The exact pathomechanism is not fully understood, but typically abundant acid-fast bacilli in the walls of blood vessels point to direct perturbation of blood supply to the epidermis. We report a case of LP where epidermal necrosis occurred in the absence of vascular invasion by mycobacteria, raising the question whether this was an epiphenomenon or a true LP.

Case Illustration: A 34-year-old male was referred for an episodic swelling of his hands and feet that persisted for two years. There were …

Reversal Reaction With Nodules Clinical Manifestations That Initially Diagnosed As Erythema Nodosum Leprosum In Borderline Lepromatous Leprosy, Laila Tsaqilah, Pati Aji Achdiat, Hendra Gunawan

Journal of General - Procedural Dermatology & Venereology Indonesia

Background: The reversal leprosy reaction generally manifest as larger, swollen, red and shiny the pre-existing skin lesions which are accompanied with pain. This reaction can be manifest as infiltration and nodules which resembles the features of erythema nodosum leprosum (ENL) leprosy reaction.

Case Illustration: We present a case of 26-year-old woman with erythematous nodules on almost all the body since two weeks ago. She had pre-existing erythema plaque on the right elbow became more erythematous and arouse with partially felt pain, fever, and malaise. Nodule lesions in BL leprosy with reaction need to be distinguished between ENL and …

Acupuncture And Its Effects On Chronic Pain, Pavan Patel, Michael Sabia, Jashen Patheja, Rohan Kapoor, Tiffany Mathias, Tameem Murtaza

Cooper Rowan Medical Journal

Abstract

Acupuncture is an complementary form of medicine that has relatively recently become a component of traditional Chinese medicine (TCM). It involves the application of thin needles at specific points throughout the body, although initially, general areas instead of points were used. There are estimated to be about 395 different points that can be utilized, and the technique behind using these points can vary widely between practitioners. In addition to acupuncture points, TCM is said to use meridians or pathways along with qi, or energy flows. In terms of acupunctures’ utility, it has been known to treat a variety of …

Transfer Of Patients With St Elevation Myocardial Infarction For Primary Percutaneous Coronary Intervention During Ordinary & Pandemic Times Position Statement Of The Saudi Arabian Cardiac Intervention Society, Shukri M. Al Saif, Owayed Al Shammeri, Abdullah Alkhushail, Ramzi Almohammadi, Mohamed Kurdi

Journal of the Saudi Heart Association

Primary percutaneous coronary intervention is the most effective therapy in the management of acute ST Elevation Myocardial Infarction. Evidence recommends keeping the period from symptom onset to reperfusion to a minimum in order to preserve left ventricular function, improve outcome, and reduce mortality. The position statement describes the recommendations of the the Saudi Arabian Cardiac Intervention Society for optimal conditions and timing for the acute management of patients presenting with ST Elevation Myocardial Infarction during ordinary and pandemic times.

An Australian Conundrum: Genomic Technology, Data, And The Covidsafe App, David Morrison, Patrick T. Quirk

Pace International Law Review

This paper examines the difficulties that have arisen in Australia in the use of its contact-tracing app. We examine the privacy implications around the use of the app, the wider economic imperative, and the balancing of those concerns against the health threat of the COVID-19 pandemic. We posit that default options are superior in times of emergency and rather than begging for the adoption of lifesaving technology, we suggest that the evidence gathered by behavioral economists provides an apposite and powerful alternative worthy of consideration.

Atypical Presentation Of Acute Appendicitis: A Case Report, Yudhistira Pradnyan Kloping, R. Cita Resti Anantia Putri

The New Ropanasuri Journal of Surgery

Despite the fact that acute appendicitis is one of the most common surgical emergencies worldwide, delays in establishing a diagnosis still occur. We report a case of acute appendicitis with an atypical presentation based on the patient’s clinical and laboratory findings. A 25-year-old male was brought with pain in his right lower quadrant. Pain migration, fever, anorexia, nausea, vomiting, or dysuria were denied. Laboratory results were within normal limits. USG examination was not able to visualize the appendix. An abdominal CT-Scan showed a sign of acute appendicitis. The patient was planned for appendectomy. It is important to not immediately rule …

The Crossroads Of Wellness And Second Victim Syndrome: Identifying Factors That Alter The Pathway Of Caregiver Recovery Following An Unanticipated Adverse Patient Outcome, Kimia Zarabian, A. Katharine Hindle, Ivy Benjenk, Anita Vincent, Jamil M. Kazma, Benjamin Shambon, Raymond Pla, Eric Heinz

Journal of Wellness

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery.

Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The …

Low-Dose Psoralen–Uv-A Maintenance Therapy Prolongs Disease-Free Remission Rates In Mycosis Fungoides Patients, Joshua M. Brady

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using Vieyra-Garcia P, Fink-Puches R, Porkert S, et al. Evaluation of Low-Dose, Low-Frequency Oral Psoralen–UV-A Treatment With or Without Maintenance on Early-Stage Mycosis Fungoides. JAMA Dermatology. 2019;155(5):538. https://doi.org/10.1001/jamadermatol.2018.5905 for a patient weighing whether to continue treatment in light of socioeconomic circumstances.

Spare Parts Surgery For Oncologic Reconstruction To Preserve Local Advancement Flap For Decubitus Ulcer Reconstruction: A Case Report, Emily Zurbuchen, Nathan Foje, Sean Figy

Graduate Medical Education Research Journal

A 58-year-old male presented to our institution with synchronous large left thigh sarcoma and sacral decubitus ulcer requiring oncologic resection and reconstruction. Due to extensive tumor involvement, use of local flap for reconstruction was not feasible. Therefore, a spare parts free fillet flap from the disarticulated lower leg was utilized for reconstruction following oncologic resection. The benefits of this spare parts approach include no donor site morbidity, sufficient tissue padding for later use of prosthesis, and preservation of other flaps for future reconstruction of his sacral decubitus ulcer.

Multi-Digit Auto-Amputation In Setting Of Mixed Connective Tissue Disease, Kishan P. Patel, Jennifer L. Medlin, Michelene Hearth-Holmes

Graduate Medical Education Research Journal

Raynaud’s disease is a cutaneous manifestation often present in various connective tissue and vascular diseases. Depending on the age of onset and acuity of symptoms, the phenomenon can provide clinicians with some insight as to the severity of underlying disease, including the distinction between primary and secondary Raynaud’s. However, this diagnostic approach seems to have its limitations regarding efficacy and timing of treatment. Traditionally, treatment of Raynaud’s has focused on reestablishing blood perfusion to affected tissue, which has previously been achieved with vasodilatory medications and site-specific surgical intervention. In lieu of the severe sequelae of Raynaud’s in the setting of …

Costs Associated With Recurrent Epistaxis In A Patient With A Ventricular Assist Device, Eric T. Rohe, Evan M. Ryan, Jayme R. Dowdall, Dwight T. Jones

Graduate Medical Education Research Journal

Mucosal bleeding is a well-known complication of having a ventricular assist device and commonly presents with epistaxis. Although the frequency of epistaxis as a complication in patients with a ventricular assist device has been documented in the literature, to our knowledge the cost of this complication has not been reported. This case report examines the financial burden of ventricular assist device-associated epistaxis in a single patient from September 2018 to December 2019 using ICD 10 diagnostic codes. The patient was found to have accumulated $138,020 in costs over 38 encounters. This case report not only highlights the recurrent nature and …

Customized Blister Packaging For Patients Living With Hiv: Assessment Of Patient Attitudes And Satisfaction, Holly Groteluschen, Harlan Sayles, Rebecca Osborn, Joshua P. Havens, Sara Bares, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Adherence to antiretroviral medication results in reduced HIV transmission and improved health outcomes, yet challenges with medication adherence remain. A Collaborative Care Program was developed with a community pharmacy integrating a multi-dose adherence packaging service. We surveyed program participants to assess their satisfaction with this program and found an overall positive sentiment toward the program, that the program helped with reducing missed doses, and all patients would recommend the program to others.

Assessing The Vulnerability Of Monterey Bay Area Seniors To Covid-19, Ethan A. Quaranta, Gerhard L. Gross

Culture, Society, and Praxis

This paper assesses the vulnerability of seniors residing in the Monterey Bay Tri-County Region to the COVID-19 pandemic. Due to weakened immune systems, seniors are the most at-risk members of our community to COVID-19, and have a death rate that is three times higher than the overall death rate to COVID-19. Using standard ambulance response times from each hospital throughout the area, our objective is to determine what proportion of Tri-County seniors aged 65 and over, including those who are in nursing homes, are living independently, and cannot afford health care, were within an adequate travel time to the hospital. …

Supporting Evidence-Based Practices And Standardization Of Care Through Implementation Of Outpatient, Emergency Department, And Hospital Covid-19 Order Sets In A Large Healthcare System, Timothy P. Gauthier, Erika Gonzalez

Nursing & Health Sciences Research Journal

No abstract provided.

The Outstanding Service Of A Nurse Supervisor During Covid-19, Judy Bowling

Nursing & Health Sciences Research Journal

Nurses are heroes but are often hesitant to use this title. Nurses stand at the center of the public health crises with the coronavirus pandemic, demonstrating courage, bravery, knowledge, and commitment, often putting themselves in harms’ way while caring for and guarding their patients. Nurses respond to the call to care at every level, from the direct care nurses in hospitals to board members shaping national policies. One special category of nurses on the front line, administrative nursing supervisors, are experienced and dedicated nurses who exemplify the finest characteristics of nurses. This article relates the exploits of one nursing supervisor …

Efficacy Of The Nutritional Supplement, Evenflo, In The Management Of Sickle Cell Disease: A Randomized Controlled Trial, Richard Muga, Arthur Ajwang, James Ouma, Josephine Ojigo, Juliana Otieno, Peter Okoth, Caroline Wafula, Sophia Ajwang, David Ogolla, Abraham Hollist, James Adefisoye

Nursing & Health Sciences Research Journal

Background: In this study, we investigated if a combination of the nutraceutical supplement, EvenFlo and folic acid will be superior to the standard stand-alone use of folic acid.

Methods: We conducted a randomized double-blind, active-controlled, clinical trial. A total of 70 subjects with SCD ages 5-12 years were enrolled into the study with 35 in the intervention group and 35 in the control group; 61 completed the trial (32 from the intervention group and 29 from the control group).

Results: Participants in the intervention group were significantly less likely to experience crises compared to subjects in the control group. None …

A Collaborative Approach To Reduce The Spread Of Covid-19 In A Large Urban Hospital In South Florida, David Schneider, Roberto L. Roman Laporte

Nursing & Health Sciences Research Journal

The novel Coronavirus has proven challenging for many healthcare organizations. Hospitals are pressed to secure sufficient personal protective equipment to ensure the safety of their healthcare personnel and various strategies have been implemented to stop the spread of the virus. There are still many unknowns about COVID-19 and hospitals are rapidly adapting to new information while trying to maintain the safety and wellbeing of healthcare personnel. Baptist Hospital of Miami developed a collaborative data driven plan to monitor, disseminate vital information, and implement various strategies to protect employees and patients during the pandemic.

A Healthcare Organization’S Response To Challenges During A Pandemic, Debora O'Cathey, Judy Bowling

Nursing & Health Sciences Research Journal

The pandemic of 2020 has added many new challenges for healthcare organizations. Front-line nurses have borne the brunt of these challenges and were tested as never before to deliver excellent patient care during such arduous time. This story details the efforts of one hospital to rise above the chaos and overcome the challenges presented during this time.

A Drive-Thru Anticoagulation Testing Clinic During Covid-19 Pandemic, Tina Hyman, Nohemi Sadule Rios, Robert P. Ramirez

Nursing & Health Sciences Research Journal

As COVID-19 started to spread rapidly in their community, a team of nurses at South Miami Hospital initiated a drive-thru anticoagulation testing process to provide safe access to care for patients on anticoagulation therapy, requiring Internationalized Ratio (INR) testing. This article describes the implementation of a drive-thru anticoagulation testing process and implications for best practices during a pandemic crisis.

A Collaborative Effort To Establish A Convalescent Plasma Program In South Florida, Roberto L. Roman Laporte, Edwina Brathwaite

Nursing & Health Sciences Research Journal

On March 11, 2020, Miami-Dade County had its first diagnosed case of COVID-19 and quickly became the top hotspot of COVID-19 cases in Florida. Hospitals were challenged to find effective treatments to combat the virus. A collaborative effort between Doctors Hospital and Boca Raton Regional Hospital established a robust convalescent plasma program for critically ill patients diagnosed with COVID-19 within Baptist Health South Florida.