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Articles 1 - 30 of 68
Full-Text Articles in Medicine and Health Sciences
A Vista Of Kahana Bay, Haryashpal Bhullar
A Vista Of Kahana Bay, Haryashpal Bhullar
HCA Healthcare Journal of Medicine
This is a picture of Kahana Bay in Honolulu, HI I took when I was visiting my friend stationed at Tripler Army Medical Center last year. Like me, he is a Psychiatry resident and I had not seen him in over a year, so meeting him was quite meaningful to me as we had so much more to talk about. Having this vista behind us while we climbed and shared stories made for one of the best hikes of my life. I often look at this photo and realize the freedom we had to fly to all sorts of beautiful …
Corona, Syed Anjum Khan
Corona, Syed Anjum Khan
HCA Healthcare Journal of Medicine
We all are witnessing unprecedented pain and suffering, enduring unsurpassed tribulations. As a doctor working in an intensive care unit each day, I carry the burden of my patients and their families, my coworkers, my own family and friends. I never think about myself, the burden on my soul.
Yet I believe there will be a better tomorrow. A new day, where COVID times will be remembered with tears in our eyes yet a comfort in our smile that it’s past.
Primary Care Practices In Western North Carolina: Adaptation To The Covid-19 Pandemic And Ongoing Challenges, Hannah R. Friedman, Joseph Konstanzer, Erica Richman, Brian Cass, Bryan Hodge, Sheri Denslow, Jacqueline Halladay
Primary Care Practices In Western North Carolina: Adaptation To The Covid-19 Pandemic And Ongoing Challenges, Hannah R. Friedman, Joseph Konstanzer, Erica Richman, Brian Cass, Bryan Hodge, Sheri Denslow, Jacqueline Halladay
HCA Healthcare Journal of Medicine
Introduction
The COVID-19 pandemic has created unique challenges for primary care practices while also highlighting their importance in the pandemic response. To understand primary care practice needs, a survey was conducted of practices in Western North Carolina.
Methods
Phase 2 of a primary care needs assessment was administered to 63 practices in Western North Carolina over the course of six weeks, from July 23 to August 31, 2021.
Results
Most practices were operating with normal hours, though some still operated with reduced hours. Many practices reported insufficient personal protective equipment (PPE) supplies. While most practices provided at least some care …
An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont
An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont
HCA Healthcare Journal of Medicine
Background
Patients with syncope often undergo costly testing, despite current guidelines and data supporting the contrary.
Objective
To determine the diagnostic value through positivity rate of electrocardiogram (EKG), computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain, transthoracic echocardiogram, nuclear and pharmacologic cardiac stress test, tilt table test and carotid ultrasound in patients diagnosed with syncope.
Methods
This is a retrospective study of 10,036 adults presenting to the emergency department or hospitalized with a primary diagnosis of syncope at 8 acute care facilities in the southwest United States from January 1, 2019, to December 31, 2019. …
Pharmacy-Led Medication Reconciliation Program Reduces Adverse Drug Events And Improves Satisfaction In A Community Hospital, L. Hayley Burgess, Joan Kramer, Carley Castelein, Joseph M. Parra, Victoria Timmons, Samantha Pickens, Sarah Fraker, Christopher Cameron Skinner
Pharmacy-Led Medication Reconciliation Program Reduces Adverse Drug Events And Improves Satisfaction In A Community Hospital, L. Hayley Burgess, Joan Kramer, Carley Castelein, Joseph M. Parra, Victoria Timmons, Samantha Pickens, Sarah Fraker, Christopher Cameron Skinner
HCA Healthcare Journal of Medicine
Background
Pharmacy-led medication reconciliation identifies and corrects medication errors that can potentially cause moderate to severe harm. This research sought to identify the impact of pharmacy-led medication reconciliation on patient outcomes and describe the changes in healthcare workers’ perceptions of the program.
Methods
A pharmacy-led admission medication reconciliation program pilot started in July 2019, and a discharge medication reconciliation proof of concept was tested in September 2020 at a 432-bed hospital. The following periods were compared: August 2018 to February 2019 (pre-program implementation) and August 2019 to February 2020 (post-program implementation). Endpoints included patient outcomes, workforce productivity and interdisciplinary healthcare …
Jacuzzi-Induced Pneumoperitoneum: Case Report And Literature Review, Obteene Azimi-Ghomi, Dieter Brummund, Vasiliy Ovakimyan, Gerardo Kahane
Jacuzzi-Induced Pneumoperitoneum: Case Report And Literature Review, Obteene Azimi-Ghomi, Dieter Brummund, Vasiliy Ovakimyan, Gerardo Kahane
HCA Healthcare Journal of Medicine
Radiographically-detected pneumoperitoneum in the setting of acute onset abdominal pain is a classic case among surgical emergencies. The spectrum of etiology ranges from benign to catastrophic, and the ability to differentiate depends in large part on the history and physical exam findings. Included among non-surgical types of pneumoperitoneum are (1) post-operative, (2) diagnostic/experimental, (3) gynecologic tract air entry, (4) the difference in intra- and extra-alveolar pressures, pneumothorax-associated and (5) miscellaneous. Jacuzzi-induced pneumoperitoneum is an extremely rare form of non-surgical pneumoperitoneum. We discuss a case of a 32-year-old female presenting with pneumoperitoneum and acute onset abdominal pain secondary to vaginal insertion …
Epidural Anesthesia For Cesarean Section For Parturient With Recently Diagnosed Asymptomatic Chiari Malformation Type I: A Case Report, Ashie Kapoor, Jon Halling
Epidural Anesthesia For Cesarean Section For Parturient With Recently Diagnosed Asymptomatic Chiari Malformation Type I: A Case Report, Ashie Kapoor, Jon Halling
HCA Healthcare Journal of Medicine
Chiari malformations (CMs) are congenital defects of the brain and skull that result in inferior displacement of the cerebellum. There are four types of CMs distinguished by the severity of the anatomic defects and parts of the brain that protrude beyond the foramen magnum. Of these types, CM Type I (CMI) is the least severe. It is characterized by the downward displacement of the cerebellar tonsils beyond the foramen magnum by more than 5 millimeters and goes into the cervical spinal canal. CMI is the most common type with an incidence of 0.1-0.5% in the general population and a predominance …
Steroid-Refractory Lichenoid Eruption Associated With Pembrolizumab In A Patient With Non-Small Cell Lung Cancer, Leon Kou, Sanjay Agarwal, Alyssa Miceli, Logan Kolb, Karthik Krishnamurthy, Shawn Schmieder
Steroid-Refractory Lichenoid Eruption Associated With Pembrolizumab In A Patient With Non-Small Cell Lung Cancer, Leon Kou, Sanjay Agarwal, Alyssa Miceli, Logan Kolb, Karthik Krishnamurthy, Shawn Schmieder
HCA Healthcare Journal of Medicine
Programmed cell death receptor 1 (PD-1) inhibitors are promising and effective treatments for various cancers. Cutaneous adverse events, such as lichenoid drug eruptions, are well-known common side effects associated with PD-1 inhibitors. Lichenoid drug eruptions associated with PD-1 inhibitors show rapid improvement with high potency topical steroids and do not require cessation of the offending drug. We present the case of an 84-year-old female with progressive pembrolizumab therapy-associated lichenoid eruption that was resistant to several treatments and ultimately required discontinuation of pembrolizumab and treatment with methotrexate to resolve. This report includes histological findings of the pembrolizumab-associated lichenoid eruption.
The Role Of Physical Activity In Older Adults And Practical Intervention, Se Won Lee, Rebecca Patel, Bryan Werner, Ji Won Yoo, Timothy Tiu
The Role Of Physical Activity In Older Adults And Practical Intervention, Se Won Lee, Rebecca Patel, Bryan Werner, Ji Won Yoo, Timothy Tiu
HCA Healthcare Journal of Medicine
Physical inactivity (PI), defined as not meeting guidelines for physical activity beyond baseline daily living activities, is common among older adults (age 65 and older) and contributes to increased morbidity, increased mortality and increased health care spending. Understanding the clinical impact of PI on common medical conditions among older adults will help primary care physicians (PCPs) to educate these patients successfully. Physical activity and exercise are effective in the primary and secondary prevention of chronic diseases that can lead to physical impairments, disability and/or premature death. Physical activity and exercise have been shown to improve cognitive dysfunction and painful musculoskeletal …
Music And Medicine, Sanjana Sundara Raj Sreenath
Music And Medicine, Sanjana Sundara Raj Sreenath
HCA Healthcare Journal of Medicine
This digital artwork, titled “Music and Medicine”, explores the role of holistic patient care as well as the important role of music as a therapeutic tool. Patients often seek connection and belonging during illness, and music serves as a powerful tool in healing. The important role of music in minimizing anxiety and improving mental wellbeing has been brought to the forefront during the Covid pandemic, given the drastic increases in depression and anxiety levels during this time.
Hand Hygiene And Hospital-Acquired Infections During Covid-19 Increased Vigilance: One Hospital’S Experience, Alexander Kong, Carlos S. Botero Suarez, Bebe Rahamatalli, Jennifer Shankweiler, Olga Karasik
Hand Hygiene And Hospital-Acquired Infections During Covid-19 Increased Vigilance: One Hospital’S Experience, Alexander Kong, Carlos S. Botero Suarez, Bebe Rahamatalli, Jennifer Shankweiler, Olga Karasik
HCA Healthcare Journal of Medicine
Background
Hospital-acquired infections are associated with increased morbidity, mortality, costs and length of stay. Prior studies have linked increased hand hygiene compliance with reduced hospital-acquired infection rate. With the increased vigilance for personal and institutional hygiene practices during the COVID-19 pandemic, we hypothesized increased hand hygiene compliance and, as a result, decrease in hospital-acquired infections in our hospital.
Methods
Hand hygiene compliance data was provided by the hospital’s Quality Department. We queried and empirically analyzed local hospital-acquired infection data obtained from our Quality Department and the National Healthcare Safety Network. We compared local hand hygiene compliance rates before and after …
Characteristics Contributing To A Pharmacy Services Excellence Model In A Large Health System, L. Hayley Burgess, Sara Fletcher, Mandelin K. Cooper, Elizabeth Wiggins, Susan S. Horton, Joan S. Kramer
Characteristics Contributing To A Pharmacy Services Excellence Model In A Large Health System, L. Hayley Burgess, Sara Fletcher, Mandelin K. Cooper, Elizabeth Wiggins, Susan S. Horton, Joan S. Kramer
HCA Healthcare Journal of Medicine
Objective
To identify characteristics that contribute to and promote a pharmacy services center of excellence model in a large health system.
Methods
In 2019, a survey was conducted of 161 acute care pharmacy departments of health system-affiliated hospitals. Information captured included pharmacy practice models, pharmacist resource allocation, training of pharmacy residents, postgraduate training and pharmacist certifications. Results were combined with clinical pharmacy metric performance and centralized electronic data to identify features of top performing pharmacy departments.
Results
Survey results were received from 141 of 161 affiliated hospitals (88%). Hospitals with 100 to 299 beds comprised 54% (n = 16 of …
Patient Characteristics And Emergency Treatment Orders In Three Florida Inpatient Psychiatric Units, France M. Leandre, Hong Liang, Sarah Fayad, Michael Johnson
Patient Characteristics And Emergency Treatment Orders In Three Florida Inpatient Psychiatric Units, France M. Leandre, Hong Liang, Sarah Fayad, Michael Johnson
HCA Healthcare Journal of Medicine
Background
Florida law defines emergency treatment orders (ETOs) as an immediate administration of psychotropic medications to a person to expeditiously treat symptoms that may present an immediate danger to the safety of the person or others.1 There is currently little information on who receives ETOs. In this study, we aim to explore correlations between patients’ demographics and administering ETOs in order to understand this cohort, which could allow for improved services and alternative interventions.
Methods
This retrospective study examined data from 1,460 adult patients who were admitted to an acute inpatient psychiatric unit from January 2015 to December 2017 and …
The Influence Of Hospital Site On Emergency Physician Press Ganey Scores, Dietrich Jehle, Brian Doherty, Lexus Dickson, Melville C. O'Brien, Casey Wilson, Scott Gutovitz
The Influence Of Hospital Site On Emergency Physician Press Ganey Scores, Dietrich Jehle, Brian Doherty, Lexus Dickson, Melville C. O'Brien, Casey Wilson, Scott Gutovitz
HCA Healthcare Journal of Medicine
Background
The use of physician satisfaction scores to evaluate emergency medicine physicians’ performance and compensation is controversial. Prior studies have shown that the clinical environment may influence scores. This study compared satisfaction scores for the same physician at different emergency departments (ED). Differences in their individual score may indicate the ED environment could be as important as the physician’s interaction.
Methods
Press Ganey satisfaction scores were obtained for physicians at three EDs—Grand Strand, South Strand and North Strand—between July 2018 and June 2019. Included physicians worked at all 3 facilities and had at least 6 patient satisfaction surveys at each …
Ecthyma Gangrenosum And Panniculitis Secondary To Acute Pseudomonas Myositis Without Bacteremia, Heather Gosnell, Matthew Burke, Joseph Shnouda
Ecthyma Gangrenosum And Panniculitis Secondary To Acute Pseudomonas Myositis Without Bacteremia, Heather Gosnell, Matthew Burke, Joseph Shnouda
HCA Healthcare Journal of Medicine
Introduction
Ecthyma gangrenosum (EG) is a relatively uncommon cutaneous manifestation of an underlying Pseudomonas aeruginosa infection and is clinically described as necrotic with gangrenous ulcers surrounded by erythematous halos. Cases of EG may occur in the absence of bacteremia and have been increasingly reported in literature. Here we present a patient with features of both EG and panniculitis, despite the lack of underlying bacteremia.
Clinical Findings
A 57-year-old male presented to the emergency department with unrelenting right-sided lower back pain and an “itchy and painful” rash of four to five day duration. The patient had an extensive history of intravenous …
A Case Report Of Dissociative Amnesia Involving “Detective Work”, Muhammad Sharifi, Ana Turner, Traci Fuglestad, Colleen Bell
A Case Report Of Dissociative Amnesia Involving “Detective Work”, Muhammad Sharifi, Ana Turner, Traci Fuglestad, Colleen Bell
HCA Healthcare Journal of Medicine
Dissociative amnesia is a rare psychiatric disorder presenting with sudden retrograde memory impairment and inability to recall autobiographical information that is inconsistent with normal forgetting. This case report discusses dissociative amnesia with dissociative fugue in a middle aged male that led to him becoming homeless. Because of his autobiographical forgetting, he was unable to access services, and we present here the distinctive “detective work” needed to not only help treat his symptoms, but also help him legally establish who he is and gain access to housing. This patient is unique in that he only began psychiatric treatment in his late …
Induction Of Hypopituitarism Following Ipilimumab/ Nivolumab Therapy Followed By Radiation In The Treatment Of Metastatic Scalp Melanoma, Joshua K. Salabei, Dhaval Upadhyay, Sripal A. Padam
Induction Of Hypopituitarism Following Ipilimumab/ Nivolumab Therapy Followed By Radiation In The Treatment Of Metastatic Scalp Melanoma, Joshua K. Salabei, Dhaval Upadhyay, Sripal A. Padam
HCA Healthcare Journal of Medicine
Immune checkpoint inhibitors (ICI) are antagonistic antibodies that block specific immune checkpoint molecules, such as cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1) and its ligand PD-L1. With FDA approval, the use of these checkpoint inhibitors has led to long-lasting tumor responses. However, by stimulating the immune system, checkpoint inhibitors can cause immune-related adverse events involving the endocrine organs, among others. Pituitary dysfunction (hypophysitis) leading to secondary adrenal insufficiency, or primary adrenal insufficiency caused by immune checkpoint inhibitors, have been documented. In this report, we present a case of a 70-year-old man with scalp melanoma with metastasis to …
A Rare Diagnosis Of Strongyloides Stercoralis In The Pleural Cavity, Fatemeh Rhana Mousavi, Emon Alavi, Nick A. Hirad
A Rare Diagnosis Of Strongyloides Stercoralis In The Pleural Cavity, Fatemeh Rhana Mousavi, Emon Alavi, Nick A. Hirad
HCA Healthcare Journal of Medicine
Strongyloides stercoralis is a soil-transmitted helminth that causes strongyloidiasis, a chronic parasitic infection in humans. S. stercoralis is one of several worm species that cause soil-transmitted helminthiasis, a neglected tropical disease. Herein, we discuss a 78-year-old female residing in a nursing home presenting with abdominal pain and shortness of breath. During a thoracentesis, physicians found multiple rhabditoid larvae consistent with S. stercoralis. However, before the procedure, a serial assessment of stool sample was performed and failed to demonstrate a parasitic infestation. Many of those infected with S. stercoralis are asymptomatic. Lack of symptoms and low sensitivity in traditional parasitological …
A Rare Presentation Of An Acute Type A Aortic Dissection Obscured Due To The Simultaneous Presence Of Acute Pancreatitis, Amrin M. Kharawala, Nirav Brahmbhatt, Huzefa Bhopalwala, Nakeya Dewaswala, Adnan Bhopalwala, Waqas Ghumman, Robert Dean Chait
A Rare Presentation Of An Acute Type A Aortic Dissection Obscured Due To The Simultaneous Presence Of Acute Pancreatitis, Amrin M. Kharawala, Nirav Brahmbhatt, Huzefa Bhopalwala, Nakeya Dewaswala, Adnan Bhopalwala, Waqas Ghumman, Robert Dean Chait
HCA Healthcare Journal of Medicine
Introduction
Acute pancreatitis (AP) and acute aortic dissection (AAD) are medical emergencies that must be promptly recognized to avoid the development of life-threatening complications. Both of these diseases can present with chest or epigastric pain which can radiate to the back, thus, early suspicion based on clinical presentation and risk factors is essential. We present the case of a 56-year-old patient initially diagnosed with AP who was later found to have an AAD.
Clinical Findings
A 56-year-old man with a history of alcohol abuse presented with 1 day of diffuse abdominal pain, nausea and vomiting. His lipase was 3,909 U/L …
Conservative Management Of Low Back Pain, Se Won Lee, Dan Nguyen, Denny Mack, Eric Aguila, Mary Thomas, Karyn Doddy
Conservative Management Of Low Back Pain, Se Won Lee, Dan Nguyen, Denny Mack, Eric Aguila, Mary Thomas, Karyn Doddy
HCA Healthcare Journal of Medicine
Low back pain (LBP) is frequently encountered in outpatient clinics and affects individual patients and society in general with decreased physical function, quality of life, disability, and/or economic burden. Although most acute LBP resolves on its own, recurrent and chronic LBP is a common reason for outpatient clinic visits. This review explores pragmatic approaches to LBP in the clinical setting, focusing on recognizing prognostic factors, initial approaches to evaluation, including selective imaging, and conservative management including patient education, therapeutic exercises and bracing.
Residency Support During A Natural Disaster: Hurricane Ida, Tiffany Chang, Elizabeth W. Kelly, Chi Dola
Residency Support During A Natural Disaster: Hurricane Ida, Tiffany Chang, Elizabeth W. Kelly, Chi Dola
HCA Healthcare Journal of Medicine
Natural disasters can have extraordinary impacts on a community and its infrastructure. Disasters can weaken systems that provide crucial resources, such as shelter, food security, water and health care. Recently, southeast Louisiana sustained devastating damage from Hurricane Ida on the 16th anniversary of Hurricane Katrina. Our medical workforce faced challenges caring for patients in a facility without potable water and powered by a generator. With the support of corporate entities and our academic institution, however, these barriers were quickly overcome and thus highlights the importance of collective resilience in the face of a natural disaster.
Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe
Utilization Of Patient-Controlled Analgesia Reduces Length Of Stay Of Sickle Cell Crisis Hospitalizations, Brett M. Prestia, Talha Ramzan, Catherine Waldron, Ameer Malik, Robert M. Pallay, Candace R. Murbach, Mike Flynn, Eric Shaw Phd, Abdullah Kutlar, Daniel Lowe
HCA Healthcare Journal of Medicine
Background
Sickle cell crisis hospitalizations are emotionally and financially burdensome to patients and healthcare systems, and processes to decrease the frequency or length of stay of these crises should be examined.
Methods
This is a multicenter retrospective hospital record review of sickle cell crisis hospitalizations as defined by ICD-10 codes (D57.1-4), from January 2016 through December 2019, examining inpatient medication administration records and length of stay among admitted adults aged 18–65 years. Patient controlled analgesia orders using morphine, hydromorphone, fentanyl and/or merperidine at any point of an admission (n=188) were compared to admissions without any patient-controlled analgesia orders (n=2,159). The …
Medical Imaging Stewardship And Healthcare Savings: Utilization Of Age Adjusted D-Dimer To Rule Out Acute Pulmonary Embolism, Phillip Bloodworth, Casey Morris, Kenneth Cail, Brian L. Pando, Brian Helmly
Medical Imaging Stewardship And Healthcare Savings: Utilization Of Age Adjusted D-Dimer To Rule Out Acute Pulmonary Embolism, Phillip Bloodworth, Casey Morris, Kenneth Cail, Brian L. Pando, Brian Helmly
HCA Healthcare Journal of Medicine
Introduction
Acute pulmonary embolism (PE) is a common diagnosis that can lead to death if left untreated. Computerized tomography pulmonary angiogram scan (CTPA) is the gold standard for diagnosis of PE. Utilization of CTPA is increasing in the emergency setting even when suspicion for PE is very low. While CTPA is helpful, radiation exposure, contrast reactions, and cost must be considered. D-dimer is a well-established, high sensitivity and low specificity laboratory test that can effectively rule out PE in low-risk patients when negative. The ADJUST-PE trial showed that there is a natural rise of D-dimer levels with age. This age …
Obesity, Race, And Covid-19 Mortality: Results From A Large Cohort Early In The Pandemic, Eric K. Shaw, Anyul Ferez-Pinzon, Micah Mabe, Mike Flynn, Christopher K. Senkowski
Obesity, Race, And Covid-19 Mortality: Results From A Large Cohort Early In The Pandemic, Eric K. Shaw, Anyul Ferez-Pinzon, Micah Mabe, Mike Flynn, Christopher K. Senkowski
HCA Healthcare Journal of Medicine
Background
Obesity has increased progressively in the United States and is a known risk factor for several diseases such as type 2 diabetes, coronary artery disease, stroke and hypertension. Amid the current pandemic, concerns have been raised about obesity as a risk factor for COVID-19 positive patients. The primary goal of this study was to explore the association between obesity and hospital mortality in COVID-19 patients. Our secondary objective was to explore the relationship between obesity and race on hospital mortality in COVID-19 patients.
Methods
This was a cross-sectional, retrospective analysis using data from 186 hospitals from across the United …
Car Ratings Take A Back Seat To Vehicle Type: Outcomes Of Suv Versus Passenger Car Crashes, Dietrich Jehle, Albert Arslan, Chirag Doshi, Clay O'Brien
Car Ratings Take A Back Seat To Vehicle Type: Outcomes Of Suv Versus Passenger Car Crashes, Dietrich Jehle, Albert Arslan, Chirag Doshi, Clay O'Brien
HCA Healthcare Journal of Medicine
Background
Car safety ratings are routinely utilized in making automobile purchase decisions. These 1- to 5-star ratings are based on crash test data comparing vehicles of similar type, size and weight.
Objectives
We hypothesized that car safety ratings are less important than vehicle factors such as vehicle type and weight in predicting outcomes of head-on crashes.
Methods
A retrospective study was conducted on severe head-on motor vehicle crashes entered into the FARS (Fatality Analysis Reporting System) database between 1995 and 2010. This database includes all US motor vehicle crashes that resulted in a death within 30 days of the accident. …
Ossifying Fibromyxoid Tumor: A Rare Subcutaneous Tumor, Karla C. Guerra, Luke Godwin, Chad Johnston, Maggie Noland, David Rowe
Ossifying Fibromyxoid Tumor: A Rare Subcutaneous Tumor, Karla C. Guerra, Luke Godwin, Chad Johnston, Maggie Noland, David Rowe
HCA Healthcare Journal of Medicine
The following case study demonstrates a 26-year-old male that presented to the dermatology clinic with an enlarging, raised skin nodule located on the left inferior lateral lower back. The patient reported it had persisted for two years, and he had not received prior treatment. He noted a family history of nonmelanoma skin cancer but had no other dermatological issues in the past. Physical examination revealed a pink, firm and well-circumscribed subcutaneous mass with a prominent follicular pore. It was assumed the lesion was an epidermal inclusion cyst, and surgical excision was performed. Histopathology revealed lobules of epithelioid cells with indistinct …
Classical Findings Of Infantile Hepatic Hemangiomas, Senayit Demie, Michael Bossak
Classical Findings Of Infantile Hepatic Hemangiomas, Senayit Demie, Michael Bossak
HCA Healthcare Journal of Medicine
Introduction
Hemangiomas are benign vascular tumors that are common during infancy. They are most commonly noted as superficial bright red lesions on the skin but can also be found deeper as subcutaneous lesions. Patients with multifocal cutaneous hemangiomas are at risk of visceral involvement with the liver being most commonly affected. Most hemangiomas can be monitored clinically as they are self-limiting. Despite this, hepatic hemangiomas can have serious complications including large arteriovenous shunts leading to cardiac compromise as well as severe hepatomegaly which can cause abdominal compartment syndrome, impaired ventilation and renal vein compression.
Clinical Findings
A six-month-old female, born …
Lymphoproliferative Disease In A Non-Transplant Patient And Spironolactone’S Activity Against Epstein Barr Virus, Anthony Derenzi, Jessie Penico
Lymphoproliferative Disease In A Non-Transplant Patient And Spironolactone’S Activity Against Epstein Barr Virus, Anthony Derenzi, Jessie Penico
HCA Healthcare Journal of Medicine
Epstein Barr Virus (EBV) may cause lymphoproliferative disorder that can cause malignancies in patients who are immunosuppressed. These malignancies may be suppressed or reversed by antiviral therapy including spironolactone.
We present a case of a 66-year-old female who had been immunosuppressed through use of interferon and tumor necrosis factor (TNF)-active agents for multiple sclerosis (MS). She met the criteria for idiopathic CD4 T-lymphocytopenia or non-human immunodeficiency syndrome (HIV) acquired immunodeficiency syndrome (AIDS). She developed a reactivation of EBV due to the immunosuppression which caused a subset of Non-Hodgkin’s lymphoma. The patient was initially treated with valacyclovir but she developed brain …
Use Of Ultrasound-Guided Platelet-Rich Plasma In The Treatment Of Carpometacarpal Osteoarthritis, Manuel Britto, Siraaj Dawood, Siyang Lu, Martin Canillas
Use Of Ultrasound-Guided Platelet-Rich Plasma In The Treatment Of Carpometacarpal Osteoarthritis, Manuel Britto, Siraaj Dawood, Siyang Lu, Martin Canillas
HCA Healthcare Journal of Medicine
Introduction
Osteoarthritis (OA) is the most common form of arthritis and can severely affect function and quality of life. Platelet-rich plasma (PRP) is derived from a patient’s own blood and has potential as an adjunct to treat OA. However, research has been limited for small joints such as the carpometacarpal (CMC) joint.
Clinical Findings
A 65-year-old Caucasian male complained of bilateral wrist and neck pain after a motor vehicle accident. His initial exam noted swelling, tenderness and pain with movement at the bilateral thumb CMC joints and anatomic snuffboxes. However, there was no strength, range of motion or tactile deficits …
The Role Of The Pharmacist In The Treatment Of Infantile Botulism, Rachel E. Huntsman, Abigail Schauble
The Role Of The Pharmacist In The Treatment Of Infantile Botulism, Rachel E. Huntsman, Abigail Schauble
HCA Healthcare Journal of Medicine
Infantile botulism is a potentially devastating disease caused by ingestion of Clostridium botulinum spores through food products or dust particles. The toxin produced by the spores can lead to descending paralysis requiring hospitalization for supportive care which sometimes includes mechanical ventilation. Human Botulism Immune Globulin-Intravenous (BIG-IV or BabyBIG) from the Infant Botulism Treatment and Prevention Program (IBTPP) has been shown to greatly improve outcomes. A previously healthy 5-month-old infant was admitted to her regional hospital for poor feeding and lethargy. When the weakness progressed and she had trouble with protecting her airway, she was intubated and transferred to our institution. …