Medicine and Health Sciences Commons^™

Medicaid Reimbursement For Total Joint Arthroplasty In The United States: Implications For Patient Access To High-Quality Arthroplasty Care, Lamiah Hall

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Introduction: While recent American Association of Hip and Knee Surgeons (AAHKS) advocacy efforts have focused on Medicare physician fee schedule cuts for total hip arthroplasty (THA) and total knee arthroplasty (TKA), few studies have evaluated Medicaid reimbursement. Substantial variability among Medicaid payments between states may have implications for equitable access to quality orthopaedic care. The purpose of this study was to evaluate differences in physician reimbursements by state between patients undergoing TKA or THA with Medicaid insurance compared to Medicare insurance. Methods: Individual states were queried for publicly available Medicaid physician fees and the Centers for Medicaid and Medicare Services …

Orthopaedic Infections: A Primer, Gregory Laborde

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Background: In a 1992 Internal Medicine Grand Rounds presentation that focused on medical education, Dr. Frank Griffin, Jr. made the comment that “understanding is the key to learning” (Griffin, 1992). His contention was that for information to be effectively retrieved, it must first be efficiently stored. Griffin said that the focus is usually on acquiring a “morass of details,” which precludes the commitment of time to consider concepts. Memorizing mounds of facts without having an effective conceptual framework to store them is often an unsuccessful learning style because memory frequently fails without understanding. To accomplish this goal, we offer a …

Investigating An Adaptive Target Biofeedback Paradigm To Reduce Gait Asymmetry In Older Adults Post-Stroke, John Macaulay

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Background: Stroke is one of the most common causes of long-term disability in the United States and can present with debilitating motor impairment. Asymmetric walking patterns due to hemiparesis are energetically costly and impair walking performance. For this reason, gait asymmetry is an important target of clinical gait training and post stroke rehabilitation research. Visual gait biofeedback training is an effective, well-studied way to alter walking patterns in people with chronic stroke. However, there exists large methodological variability between studies with discrepancies in feedback target and feedback structure. The objective of this study was to determine the utility of a …

Does Preoperative Antibiotic Timing Prior To Incision And Drainage Procedures For Severe Odontogenic Infections Affect Length Of Stay Or Reoperation, Dylan Mire

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Background: An odontogenic infection can be a life-threatening medical condition which requires incision and drainage (I&D) in the operating room. Prior to these procedures, many patients are started on antibiotics; however, the effects of the timing of starting the antibiotics prior to surgery is not known. Methods: The authors conducted a retrospective cohort study consisting of all adult patients treated in the OR with I&D for odontogenic infections from 1/1/2015 to 7/30/2021 at a large, urban academic hospital. The primary predictor variable was preoperative antibiotic timing—the amount of time between when the antibiotic was given before surgery and incision time. …

Food For Thought: The Cognitive Effects Of Mediterranean, High-Fat Low Carbohydrate, And Traditional American Diets – Study Design, Audrey Smets

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Background Dietary patterns have long been associated with a range of health outcomes. Findings from cross-sectional studies suggest that dietary patterns can affect cognitive function. Mediterranean diets, rich in fruits, vegetables, olive oil, and fish, have been associated with improved cognitive function and reduced risk of cognitive decline. Conversely, the standard American diet, rich in saturated fats and sugars, has been linked with adverse cognitive outcomes. Findings regarding the effects of low-carb diets are mixed. However, some studies have reported potential cognitive benefits. Hypothesis A two-week consumption of high-fat diets, such as the standard American diet and high-fat, low-carbohydrate diets, …

Update: Ascertaining Barriers To Anal Cancer Prevention In People Living With Hiv From The Patient Perspective, Amber Trauth

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Background: The general population in the U.S. has a 1 in 500 lifetime risk of developing anal cancer. There is 19-fold increase in anal cancer risk among all HIV positive people and a 37-fold increase in risk for HIV+ MSMs. Despite modest improvements in access to anal pap smears and high resolution anoscopy (HRA) in the U.S., these screening modalities remain underutilized by at-risk groups. To date, few studies have explored the factors contributing to non-adherence to anal cancer screening recommendations among HIV positive at-risk people. No studies have focused on HIV positive people living in Louisiana despite the state …

Complexity Of Chronic Suppurative Otitis Media In The Setting Of Immunodeficiency And Drug-Reactions, Bryce Arata

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A 9-year-old female was admitted to the pediatric hospital medicine service for bilateral otalgia, postauricular pain, and blood-tinged otorrhea from the left ear concerning for acute mastoiditis. Relevant past medical history included chronic suppurative otitis media with conductive hearing loss, recurrent upper respiratory infections, and a nonspecific B-cell immunodeficiency. Surgical and social histories respectively included 10 tympanoplasties in the past 5 years and 42 missed school days in the last academic year. She was followed by ENT and Allergy-Immunology with plan for mastoidectomies in 4-6 months as well as IVIG. Upon further review, the patient had been hospitalized multiple times …

A Tail Of A Pancreatic Duct Fistula, Nikki Arceneaux

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Introduction: Pancreatic duct fistulas are characterized by an abnormal communication between the pancreatic duct and surrounding tissues or organs. This pathological entity poses significant challenges in clinical management due to its diverse etiology, variable clinical presentations, and potential for serious complications. Understanding the underlying mechanisms and clinical implications of pancreatic duct fistulas are essential for improving diagnostic accuracy, optimizing treatment strategies, and enhancing patient outcomes. Case: A 70-year-old male with a past medical history of hypertension, alcohol use, and cataracts presented to the Emergency Department for one week of abdominal pain as well as decreased appetite for two weeks. Upon …

Under The Collarbone: A Case Of Primary Sternal And Clavicular Osteomyelitis, Nikki Arceneaux

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Introduction: Primary sternal osteomyelitis (PSO) is a rare but life-threatening condition. This case underscores the diagnostic challenges of PSO, highlighting the significance of early culture-based pathogen identification and the potential success of conservative management when patients respond well to antibiotics. Case: A 41-year-old female with a past medical history of obesity, uncontrolled type 2 diabetes, hypertension, and intravenous drug use complicated by necrotizing fasciitis of the left forearm presented to the Emergency Department for acute left chest pain and purulence of left forearm wounds for two days. Her exam was significant for tenderness to palpation to the anterior chest, left …

Surreptitious Diuretic Abuse In A Patient With Severe Hypokalemia And Long Qt Syndrome, Claire Carr

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The patient in question was a 45 year old female with past medical history of long QT syndrome who presented to the emergency department with a chief complaint of chest pain and shortness of breath for 3 days. The patient was in her usual state of health until 3 days prior to admission, when she began experiencing a pressure-like chest pain associated with progressively worsening dyspnea. At baseline, the patient does not experience dyspnea and walks one mile every day without difficulty. Her new-onset dyspnea was present both with exertion and at rest. Her symptoms continued to progress and prompted …

Jaundice With Markedly Elevated Carbohydrate Antigen 19-9 (Ca 19-9): Biliary Stones Or Malignancy?, Brianna Bourgeois

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A 59-year-old male with past medical history of untreated type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the UMC family medicine clinic for a follow up for chronic conditions after being lost to follow up for about 2.5 years. On initial observation, the patient appeared jaundiced. The jaundice is not associated with nausea, vomiting, diarrhea, or constipation. The patient does have generalized pruritus. He denied having pain in spite of questioning during the first two family medicine visits and the first visit with gastroenterology. However, on the 3rd Family Medicine visit, the patient admitted to the medical student that …

Surreptitious Diuretic Abuse In A Patient With Severe Hypokalemia And Long Qt Syndrome, Claire Carr

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Surreptitious Diuretic Abuse in a Patient with Severe Hypokalemia and Long QT Syndrome Claire Carr, MS3, LSU School of Medicine- New Orleans, Kyle Hoppens, MD, LSUHSC The patient in question was a 45 year old female with past medical history of long QT syndrome who presented to the emergency department with a chief complaint of chest pain and shortness of breath for 3 days. The patient was in her usual state of health until 3 days prior to admission, when she began experiencing a pressure-like chest pain associated with progressively worsening dyspnea. At baseline, the patient does not experience dyspnea …

Case Report: A Case Of Coccidiomycosis Confounding A Systemic Lupus Erythematosus Diagnosis, Lily Chen

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Lily Chen, Sidney Mejia, Lydia Rewers and Seema Walvekar Introduction: Systemic Lupus Erythematosis is a rare autoimmune disease with prevalence of 20-150 cases per 100,000 in the United States. Despite increased awareness among physicians and improvements in serologic testing, the time to diagnosis from symptom onset is still delayed for many patients, with one study estimating the average time to diagnosis of 6 years. One significant cause of diagnostic delay is due to the heterogeneity in the disease presentation, with symptoms that can present similarly to many other autoimmune, infectious, or hematologic diseases. Many of the symptoms of SLE are …

Jaundice With Markedly Elevated Carbohydrate Antigen 19-9 (Ca 19-9): Biliary Stones Or Malignancy, Brianna Bourgeois

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A 59-year-old male with past medical history of untreated type 2 diabetes mellitus, hypertension, and hyperlipidemia presents to the UMC family medicine clinic for a follow up for chronic conditions after being lost to follow up for about 2.5 years. On initial observation, the patient appeared jaundiced. The jaundice is not associated with nausea, vomiting, diarrhea, or constipation. The patient does have generalized pruritus. He denied having pain in spite of questioning during the first two family medicine visits and the first visit with gastroenterology. However, on the 3rd Family Medicine visit, the patient admitted to the medical student that …

A Case Of Recurrent Head And Neck Dermatofibrosarcoma Protuberans, Kathryn Dillman

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Title: A Case of Recurrent Head and Neck Dermatofibrosarcoma Protuberans Authors and Affiliations: Kathryn Dillman, BS; Nicholas Culotta, MD; Christopher Haas, MD; LSU School of Medicine New Orleans and LSU Department of Dermatology Patient Initials: DF History of Present Illness: Personal Data: 68 y.o. M Patient is a 68-year-old male with a history of dermatofibrosarcoma protuberans (DFSP) of the left cheek who presented to dermatology clinic for follow-up skin exam. He noted a few concerning lesions on the trunk and the face that he would like examined, but denied any bleeding, ulceration, enlarging, or non-healing lesions. He initially reports a …

An Ironic Electrolyte Imbalance: A Hyperkalemic Emergency In Primary Hyperaldosteronism, Amded-Fazal-Ur Rehman

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Title: An Ironic Electrolyte Imbalance: A Hyperkalemic Emergency in Primary Hyperaldosteronism Ahmed Fazul-ur-rehman, Asad Mussarat MD, Luke Yesbeck DO, Angus Harper MD, Ashley Van MD, Sumrita Bindra DO, Rebecca Maitski, Brian Mackel MD, Seth Vignes, MD Department of Internal Medicine, LSU Health Sciences Center Introduction: Hyperkalemia is a common medical emergency that can lead to life-threatening complications, including muscle weakness, paralysis, and worst arrhythmias due to cardiac membrane instability. Primary hyperaldosteronism is a disorder where excess aldosteronism promote intravascular volume expansion and renal loss of serum potassium. When treated, however, patients’ electrolyte imbalance overcompensates and can presents with hyperkalemia. We …

Aseptic Meningitis As The Sole Symptom Of Legionnaire’S Disease, Michael Forte

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Aseptic Meningitis as the Sole Symptom of Legionnaire’s Disease • Michael Forte (LSU HSC School of Medicine) mfort1@lsuhsc.edu • William Benton, M.D. (LSU HSC Department of Internal Medicine, Baton Rouge) wbento@lsuhsc.edu CASE PRESENTATION A 41-year-old incarcerated male with a history of migraines and prior tobacco use presented in late summer with fevers, headaches, neck stiffness, and body aches for four days. He was sent to the ED for further evaluation after recording a temperature of 104° at the prison’s infirmary. On evaluation in the ED, his temperature was 99.5°F, and his heart rate was 105 bpm. He was diaphoretic, and …

Gabapentin To Cyclobenzaprine: A Case Of Acute Reversible Iatrogenic Psychosis Influenced By Schedule V Classifications, Grant Collins

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Clinical guidelines within psychiatric therapeutics continuously evolve, leading to varying exposure of specific population subgroups to particular therapeutic classes of medication. Such shifts are crucial, as these subgroups might be more susceptible to adverse reactions not common in the broader population. One pertinent example of this occurrence is the classification of Gabapentin as a Schedule V drug such as in Kentucky; which will likely lead to increased prescription rates of alternatives such as cyclobenzaprine (Flexeril®) in subgroups prone to recreational drug use. We present a case of a young incarcerated individual who developed acute mania after switching from gabapentin to …

Chronic Osteomyelitis Predictors With Pattern Of Care And Health Services, Thuc Truong

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Background: Chronic osteomyelitis is an infection of the bone presenting at a point in time after an acute injury or trauma. The infection may occur due to a multitude of reasons, but a couple would be open wounds or biofilms created by pathogens on implanted hardware. Commensal staphylococci are the most common cause of osteomyelitis1 . Management of chronic osteomyelitis can either be surgical with irrigation and debridement, a course of antibiotics ranging from four to six weeks, or a combination of both2 . Chronic osteomyelitis can complicate the healing process, but also place a burden on the patient if …

An Atypical Case Of Sweet Syndrome, Samuel Halle

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Title: An Atypical Case of Sweet Syndrome

Authors and Affiliations: Samuel Halle, LSU School of Medicine MD Candidate; Michael Olejniczak, LSUNO Comprehensive Medicine House Officer; Mohammed Ziada, LSUNO Assistant Professor; Daniel Provenzano, LSUNO Anesthesiology; Peyton Hopkins, LSUNO Comprehensive Medicine

Case Presentation: A 68-year-old female with a PMH of progressive CKD5, and Type II Diabetes Mellitus bounces back to the UMC ED with blurry vision, ocular disturbances, abdominal pain, and progressive weakness. Things have just been getting worse for her. Two days ago she was discharged with a large conjunctival mass with instructions to seek treatment at an Ophthalmology center, but …

Vaping-Related Pneumomediastinum In The Younger Patient Population, Andrew Hoang

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Title: Vaping-related pneumomediastinum in the younger patient population Authors: Andrew Hoang BS, Arash Ataei MD, Paul Videau MD, Michael Olejniczak MD, Victoria Lulich MD, Hunner Luke MD, Briggs Welch MD, Taylor Sanders MD, Najy Masri MD

Introduction: Herein, we describe a case of a young patient presenting with pneumomediastinum (PM) associated with vaping use. PM is due to air leaking within the mediastinal tissues that can travel to associated structures, often classified as spontaneous or traumatic. PM is an uncommon complication of asthma and often presents with acute chest pain or shortness of breath.1 While relatively rare, it is more …

A Case Of Malignant Melanoma In A Fitzpatrick Type Iii Male Patient, Lisa Kam

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Title: A Case of Malignant Melanoma in a Fitzpatrick Type III Male Patient

Authors and Affiliations: Dr. Deborah C. Hilton, MD, LSUHSC New Orleans; Lisa Kam, BS, MS, LSUHSC New Orleans.

Case Presentation: We present a 36-year old African American patient with a slow growing lesion on his left ear since he was 10 years old. The patient denied symptoms of fever, chills, nausea, vomiting, weight loss, and myalgias. He stated that the lesion was “burned off” in childhood, and observed recurrence of the nodule two years before visiting our clinic. The lesion measured 9mm in diameter upon presentation. Tangential …

Multifocal Pneumonia With Complications Secondary To Aspiration Of Rare Anaerobe, Emma James

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MULTIFOCAL PNEUMONIA WITH COMPLICATIONS SECONDARY TO ASPIRATION OF RARE ANAEROBE

Emma James, BS, Keyur Patel, MD, Michael Brands, MD, Nali Gillespie, MD, Chantal Wickman, MD, Kyle Hoppens, MD, Jorge Martinez, MD Department of Medicine, LSUHSC, New Orleans, LA

Introduction: In the United States, pneumonia is the most common infectious cause of death and the second most common cause of hospitalizations. Factors such as age, comorbidities, infections, and smoking can predispose individuals to getting pneumonia. This case presents an unusual case of severe pneumonia in an individual with no known risk factors. Case Description: A 42-year-old-male with no past medical history …

Rare Adverse Reaction To Nexplanon, Breyanah Graham

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Title: Rare adverse reaction to Nexplanon

Authors and affiliations: Breyanah Graham1, Rachel Denneny2 MD, Nicole Freehill2 MD MPH 1LSU Health Sciences Center, School of Medicine, New Orleans, LA 2LSU Health Sciences Center, Department of Obstetrics and Gynecology, New Orleans, LA

Case Presentation: A 23 y.o. G1P1001 with a past medical history of stage 1A mucinous borderline ovarian tumor presented in clinic for removal of her Nexplanon implant site 42 days after standard placement due to concerns for possible reaction or infection. The patient reported that the site where Nexplanon was placed never healed, and she had noticed escalating pain and …

Glp-1 Agonists And Gastroparesis: Ozempic Initiation In A Case Of Chronic Gi Issues, Landon Krone

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GLP-1 Agonists and Gastroparesis: Ozempic Initiation in a Case of Chronic GI Issues

Landon Krone, BS; Lara Boudreaux, MD; Catherine Hudson, MD Louisiana State University Section of Gastroenterology

Gastroparesis is a chronic disorder involving delayed emptying of the stomach after a meal. Symptoms include nausea, vomiting, belching, bloating, and early satiety. Glucagon-like peptide-1 (GLP-1) receptor agonists function like the incretin hormone GLP-1 that is released into the intestine after consumption of food. GLP-1 agonists can serve as pharmacologic agents to treat type 2 diabetes, as they increase insulin sensitivity, decrease glucagon secretion, and slow gastric emptying. At this time, there …

Calciphylaxis: An Unusual Course Of A Rare Condition, Michelle Livitz

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Calciphylaxis: an unusual course of a rare condition

Michelle Livitz, Maren Bell, Mohammed Ziada Department of Internal Medicine, LSU Health Sciences Center, New Orleans, Louisiana

INTRODUCTION Calciphylaxis is a rare disorder, mostly seen in those with End-Stage Renal Disease (ESRD). It is characterized as calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue, leading to local ischemia and necrosis of the affected tissue. It is associated with a high mortality and morbidity with no definitive treatment or cure. CASE 35 y/o F with history of ESRD on hemodialysis (HD), HTN, STEMI s/p DES, and Mitral Valve Replacement …

Anaphylactic Reaction To Chlorhexidine After Plantar Fasciitis Injection, Chad Hobbs

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Anaphylactic Reaction to Chlorhexidine After Plantar Fasciitis Injection

Brandon M. Savage, M.D., Casey A. Murphy, M.D., F.A.A.P.M.R., D.A.A.P.M, Chad Hobbs, D.O., DPT LSU PM&R and VA Medical Center of New Orleans

We performed a chart review and patient interview. A 48-year-old male presented to his podiatrist’s clinic for a therapeutic injection into his foot to manage plantar fasciitis. The patient had no known allergies to medications or topical agents and had no history of adverse reactions during previous medical procedures. Prior to injection, chlorohexidine with alcohol was used at the injection site as part of routine preparation. A mixture containing …

Milk-Alkali Syndrome, An Udder Failure Of Acid Control, Michelle Livitz

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Milk-Alkali syndrome, an udder failure of acid control

Michelle Livitz DO, Asad Mussarat MD, William Gibson MD, Daniel Holmes MD Department of Internal Medicine, Louisiana State University- New Orleans

Introduction: Milk-Alkali syndrome is characterized by a triad of lab findings: elevated calcium levels, metabolic alkalosis, and acute kidney injury. This is found in the setting of substantial intake of calcium and an absorbable alkali. It now accounts for more than 10% of hypercalcemia cases and is the third most common cause of hypercalcemia in hospitalized patients, after hyperparathyroidism and malignancy. In Milk-Alkali syndrome, the hypercalcemia is caused due to the …

Membranoproliferative Glomerulonephritis In Primary Sjogren’S Syndrome, Michelle Livitz, Maria Rodrigues

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Membranoproliferative Glomerulonephritis in primary Sjogren’s Syndrome

Michelle Livitz DO1 , Maria Rodriguez DO1 , Nahida Baigam MD2 , Farshid Yazdi MD2 1. Department of Internal Medicine, LSUHSC- NO, 2. Department of Nephrology, LSUHSC-NO

Introduction: Primary Sjogren’s syndrome (pSS) is an autoimmune disease that causes lacrimal and salivary gland dysfunction via lymphocytic infiltration, resulting in xerophthalmia and xerostomia. Extraglandular features can be exhibited, including renal involvement, which is noted in only 5% of pSS patients. The most common histological pattern of renal disease in pSS is tubulointerstitial nephritis, while glomerular disease in these patients is uncommon. Of the glomerular diseases that …

Macrofocal Multiple Myeloma: A Special Subgroup Of Multiple Myeloma, Catherine Loehr

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Case Report: A 45-year-old Honduran man with no prior medical history presented to clinic for left-sided rib pain radiating to his back. Pain first began after falling off a truck onto his back 6 years ago, previously relieved with pain medicine. However, he recently moved to the US and ran out of medicine. Spine x-ray showed compression fracture at T10-T11. Biopsy was performed at a T11 lytic lesion showing plasma cell neoplasm with no involvement in the bone marrow. There was successful treatment with focal radiation to the spine, thus no indication for chemotherapy or surgery. PET scan noted a …