Medicine and Health Sciences Commons^™

Methotrexate Is Associated With Reduced Cardiovascular Risk In U.S. Veterans With Rheumatoid Arthritis Independent Of Disease Activity Modification, Tate Johnson, Joshua Baker, Punyasha Roul, Harlan Sayles, Grant W. Cannon, Brian Sauer, Ted Mikuls, Bryant England

Graduate Medical Education Research Journal

No abstract provided.

The Impact Of "Meds To Beds" On Postpartum Opioid Use, Kelsie Cabrera, Anna Gorman, Joshua Dahlke, Sonja Kinney, Harlan Sayles

Graduate Medical Education Research Journal

No abstract provided.

Spontaneous Pneumothorax, Pneumomediastinum, And Pneumorrhachis After Choking, Steven Curry, Eric T. Rohe, Daniel J. Wehrmann

Graduate Medical Education Research Journal

No abstract provided.

Accelerated Fractionated Compared To Conventional Fractionated Salvage Radiation Therapy Improves Outcomes In Salvage Chemotherapy Refractory Diffuse Large B-Cell Lymphoma, Brendan Coutu, Avyakta Kallam, Matthew Lunning, Gregory Bociek, Philip Bierman, Julie Vose, James Armitage, Charles Enke

Graduate Medical Education Research Journal

No abstract provided.

Trends In Intraoperative Opioid Analgesic Use Among Patients Undergoing Laparoscopic Cholecystectomy, Allison Bell, Wanying Pei, Blaine Schlawin, Peter Pellegrino, Zhaohui Hu, Apollo Stack, Jason Lau, Katie Berky

Graduate Medical Education Research Journal

No abstract provided.

Nodal Harvest For Right-Sided Colon Cancer: A Case-Matched Assessment Of Laparoscopic Vs. Robotic Approaches, Rishi Batra, Matthew Fuglestad, Herman Hernandez, Kaeli Samson, Jennifer Leinicke, Sean Langenfeld

Graduate Medical Education Research Journal

No abstract provided.

Does Location Of Birth Influence The Outcomes Of Infants With Gastroschisis?, Paul Aylward, Matthew Fuglestad, Stephen Raynor, Robert Cusick

Graduate Medical Education Research Journal

No abstract provided.

Endoscopic Removal Of Fractured 3d-Printed Nasopharyngeal Swabs From The Olfactory Cleft During Covid-19, Matthew Miller, Kristy Carlson, Jayme Dowdall, Christie Barnes, Sam Pate

Graduate Medical Education Research Journal

The severe acute respiratory syndrome SARS-CoV-2 pandemic has posed significant challenges to hospital and public health systems in the United States. In response to a shortage in nasopharyngeal swabs, our institution developed, tested, and deployed 3D-printed swabs to obtain a specimen for testing. A patient was tested in preparation for a scheduled Esophagogastrodeuodenoscopy. During the procedure the swab broke and a portion remained in the superior meatus and olfactory cleft. This case study describes the process of locating and removing the broken sections of the 3D-printed swab. In response to this incident, 3D-printing teams test swabs for sample collection and …

New Onset Murmur Or Hamman’S Sign: Mid-Systolic Click In A Suspected Case Of Connective Tissue Disorder, Amanda Dave, Jodi Cantrell

Graduate Medical Education Research Journal

We present the case of a 15 y/o previously healthy male who presented to CHMC from an OSH with a 3 day history of shortness of breath, audible clicking noise, and chest discomfort after playing at the batting cages 4 days prior. No history of trauma. He was transferred to CHMC for further evaluation after identification of a pneumothorax on chest CT performed at OSH.

With respect to family history, the patient is one of 8 children. Of note, per discussion with family, his older siblings are all tall and have some connective tissue anomalies. Two siblings were noted to …

Laryngeal Histoplasmosis In Patients With Crohn’S Disease Undergoing Treatment With Humira (Adalimumab): A Case Series, Jenna Berg, Jonathan Blecha, Chris Bingcang, Justin Oltman, Jayme Dowdall, Subodh M. Lele

Graduate Medical Education Research Journal

The FDA has advocated for increasing awareness of histoplasmosis for patients undergoing TNF blockers as delay in diagnosis can lead to a poor outcome.¹ Laryngeal histoplasmosis is a rare entity that should be part of the differential diagnosis in patients receiving immune suppression for Crohn’s disease. Patients with laryngeal histoplasmosis often report hoarseness, mucosal ulcerations, dysphagia, and odynophagia. We present a series of two cases of laryngeal histoplasmosis in patients with Crohn’s. These cases illustrate the high index of suspicion required to make the diagnosis of laryngeal histoplasmosis, especially in the Midwestern United States. Diagnosis is made quickly and …

The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High

Graduate Medical Education Research Journal

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate.

Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were …

Irrigation For Cerumen Removal Causing Meningitis – Case Report, Steven Tenny, Pashayar Lookian, Andre Wakim, Daniel Surdell

Graduate Medical Education Research Journal

Introduction: Cerumen impaction is a common problem seen in primary care clinics. There are a variety of methods to deal with impacted cerumen including water irrigation but meningitis after water irrigation cerumen removal has not been previously reported.

Methods: We describe the case of a 59-year-old female with otitis media who developed meningitis with empyema after water-jet irrigation for impacted cerumen.

Results: Our patient presented 24-hours after water-jet irrigation for impacted cerumen with worsening headaches. Workup included positive CSF cultures and empyema on MRI consistent with meningitis. She also had ear drainage from the treated ear which was positive for …

Establishing An Institution-Wide Graduate Medical Education Research Collaborative To Promote Scholarly Activities Among House Officers, Kaeli K. Samson, Lynette M. Smith, Valerie Shostrom, Jeffrey P. Gold, Chandrakanth Are

Graduate Medical Education Research Journal

Background: House officers’ ability to participate in research and quality improvement projects can be hindered by barriers, including lack of time, mentoring, and resources.

Objective: Create a collaborative for house officers that provides readily accessible resources in study design as well as data collection, analysis, interpretation, and presentation.

Methods: In 2017, we established a collaborative comprised of biostatisticians and an Associate Dean for Graduate Medical Research, providing a trove of experience in research and quality improvement. We worked closely with the Institutional Review Board and Electronic Health Records Core to simplify the process for house officers to utilize these research …

Ponv Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance, Karl A. Krieser, John B. Riley Iii, Jospeh E. Baus, Julie T. Hoffman, James N. Sullivan Md, Robert L. Lobato

Graduate Medical Education Research Journal

Objectives: To compare postoperative nausea and vomiting (PONV) prophylaxis treatment and outcomes based on patients’ sex, using a retrospective cohort. The setting was the operating room and post-anesthesia care unit of a tertiary care university medical center.

Patients: A total of 678 adult male and female patients with American Society of Anesthesiologist (ASA) scores of 1-4 underwent surgery with general anesthesia. All patients received preoperative PONV risk assessment. PONV prophylaxis was administered at the discretion of the anesthesia care team members with guidance from a computerized decision support system.

Measurements: Adequacy of prophylaxis was retrospectively determined based on individual patient …

Screen Media Use In Pediatrics: A Qi Project To Promote Behavioral Change, Taylor Kratochvil, Michelle Wineinger Md, Danielle Saner Do, Cristina Fernandez Md

Graduate Medical Education Research Journal

Background: Children are growing up in an increasingly digital world. As mobile devices and digital screens become more accessible, greater attention is being paid to screen media use and its effect on pediatric development. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) have released recommended screen time limits for children of various ages and emphasize the importance of high-quality screen media when used. In 2016, the AAP released the Family Media Plan: an online tool developed for families to create personalized strategies to manage screen media use.

Objective: While a useful tool, the AAP’s Family Media …

Evaluation Of Resident Satisfaction In The Current Era: A Local Perspective On A National Issue, Paul Aylward, Kari L. Nelson, Chandrakanth Are

Graduate Medical Education Research Journal

Background: Mitigating resident burnout is a high priority for medical centers. Monitoring residents’ overall perceptions of their training environments could be a reliable indicator of potential future burnout. Furthermore, recent national studies suggest procedural specialties have a higher burnout rate and lower satisfaction than non-procedural specialties. In the current study, we utilized institutional data from the Accreditation Council for Graduate Medical Education (ACGME) resident survey to better understand trends related to our residency program learning environments over time (2012-2018) and by specialty grouping (procedural versus non-procedural).

Methods: Annual ACGME survey results from 2012 to 2018 were retrospectively analyzed to determine …

Tobacco Cessation And Cancer Patients - Perspective Of An Ent Resident, Lauren Klute

Graduate Medical Education Research Journal

No abstract provided.

Authorship - Perspective Of An Ent Resident, Matthew T. Solverson

Graduate Medical Education Research Journal

N/A due to perspective piece

Life's Adventures, Emily Zurbuchen

Graduate Medical Education Research Journal

No abstract provided.

Complex Reconstruction After Extreme Fournier’S Gangrene; A Case Report, Serban Dumitrache, Leonida A. Goman, Raluca Dutu, Raluca Capatina, Carmen Giuglea, Dan M. Enescu

Journal of Mind and Medical Sciences

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft …

Unexpected Hope For A Multiple Myeloma Patient, Minodora Cezarina Onisâi, Iuliana Iordan, Mihaela Gaman, Horia Bumbea, Ana-Maria Vlădăreanu

Journal of Mind and Medical Sciences

Multiple myeloma (MM) is a plasma cell neoplasm, characterized by periods of remission and relapses. The emergence of novel therapies, with multiple mechanisms of action and fewer adverse reactions, brings more and better options and also a higher survival rate. However, MM is still an incurable disease, and patients eventually become refractory to an extensive range of therapies. We present the case of a patient diagnosed with MM standard risk, who was at first refractory to multiple treatment regimens, and then had an unexpected and stable complete response to a newer drug of the same class.

Immunohistochemical Pattern– A Prognostic Factor For Synchronous Gastrointestinal Cancer, Catalin Alius, Catalin Gabriel Cirstoveanu, Cristinel Dumitru Badiu, Valeriu Ardeleanu, Vasile Adrian Dumitru

Journal of Mind and Medical Sciences

Recent advancements in medical genetics and molecular biology are reflected in the modern understanding and approach to colorectal carcinoma (CRC). Understanding the cellular mechanisms and mutational patterns that promote carcinogenesis could enhance the predictive accuracy of the TNM classification. Furthermore, this will allow for a much more documented stratification and tailored oncological treatment. This paper presents an illustrative case of a relatively young patient (50 years old) with no family history of cancer who was diagnosed with four synchronous gastrointestinal (GI) adenocarcinomas displaying a wild type P53, negative BRAF testing, and mutated MLH1 and PMS2 proteins. This case report contributes …

Paroxysmal Nocturnal Hemoglobinuria: Pandora’S Box?, Mihnea Alexandru Găman, Iulia Ursuleac, Daniel Coriu

Journal of Mind and Medical Sciences

Introduction. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired non-malignant hematological disorder which affects the pluripotent hematopoietic stem cell. The cause of PNH development is the occurrence of somatic mutations in the phosphatidylinositol glycan-A gene which encodes a protein necessary for the biosynthesis of glycosylphosphatidylinositol anchors. The diagnosis of PNH requires the presence of signs of intravascular hemolysis, thrombosis, and (or) bone marrow failure. Case Report. We report the case of a 42-year-old female, diagnosed with PNH at the age of 27, whose evolution was initially characterized predominantly by hemolytic attacks and whose disease pattern evolved towards thromboembolic episodes …

Carbamazepine-Induced Dress Syndrome: A Case Report, Andrada Luciana Lazar, Olga Hilda Orășan, Corina Baican, Nicolae Voicu Rednic, Adela Sitar-Tăut, Bogdan Man, Vasile Negrean, Nicolae Rednic, Angela Cozma

Journal of Mind and Medical Sciences

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, idiosyncratic, acute adverse drug reaction. Fever, morbilliform cutaneous eruption, and eosinophilia are essential features for the diagnosis of this syndrome, along with significant multisystem involvement, hepatitis being the most common, followed by nephritis. The pathogenesis of DRESS syndrome is not yet fully understood. Several hypotheses have been proposed which support the involvement of an intricate interplay of multiple factors. We report a clinical case of DRESS syndrome with renal injury, induced by carbamazepine, in a patient with alcohol abstinence syndrome. In order to define the case, the …

When Myocardial Infarction Is Choosing Young Victims, Cristina Nedelcu, Mihaela Ionescu, Paris Ionescu, Vitalie Morosanu, Gabriel Smarandache, Dumitru Cristinel Badiu, Florentina Gherghiceanu, Vlad Denis Constantin, Emanuele Maria Merlo, Daniel Niţă

Journal of Mind and Medical Sciences

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a “burnout …

Clinical Features, Pathology, And Surgical Management Of Periocular Giant Basal Cell Carcinoma, Oxana Madalina Grosu, Vladimir Poroch, Natalia Velenciuc, Sorinel Lunca

Journal of Mind and Medical Sciences

Objectives. Basal cell carcinomas (BCCs) are malignant tumors which rarely metastasize, are slow-growing, and extensively locally destructive. BCCs more than 5 cm in diameter are defined as giant. Most often they arise as a result of neglect, as the patient avoids, delays, or refuses to see a doctor. The large tumor diameter and consequently of the post-excisional defect make these lesions difficult to treat surgically with respect to selecting the surgical reconstruction technique. Method. We studied a group of 9 patients, aged 60 to 85 years, diagnosed with giant basal cell carcinomas (GBCCs) with periocular location in which surgery was …

The Influence Of Serum Calcium And Magnesium Levels In The Radiological Evolution Of Knee Osteoarthritis, Nicoleta-Bianca Tudorachi, Iuliana Eva, Cristina Gena Dascalu, Rami Al-Hiary, Bogdan Barbieru, Mihai Paunica, Catalina Motofei, Aurelian-Corneliu Moraru

Journal of Mind and Medical Sciences

Calcium and magnesium are minerals with important functions throughout the body. The deficiency has been associated with an increased risk of cardiovascular disease, diabetes, and prostate cancer, and affects the skin and teeth. Some studies have associated it with osteoarthritis. Knee osteoarthritis is a degenerative pathology with a high prevalence that affects the knee joint, and prevention is necessary in the context of the lack of understanding of pathophysiology. The role of serum calcium and magnesium levels was considered in this regard. The study included a group of 371 hospitalized patients for unilateral or bilateral knee pain, of whom 326 …

Covid-19 Outbreak Impact On Plastic Surgery Residents From Romania, Cristina N. Marina, Daniela E. Gheoca-Mutu, Laura Răducu, Adelaida Avino, Lăcrămioara A. Brîndușe, Corina M. Stefan, Razvan V. Scaunasu, Cristian R. Jecan

Journal of Mind and Medical Sciences

The COVID-19 outbreak triggered a global crisis with long-term effects on people’s daily lives. It has altered surgical practice and education and imposed major changes in healthcare systems and resources. In order to analyze the impact the COVID-19 pandemic has had on Romanian Plastic Surgery residents, we carried out an anonymous questionnaire through Google forms. Survey items addressed aspects such as how the pandemic has affected their surgical practice, their exposure to the virus, and the protective measures that have been implemented to minimize risk. Among other results, our study found that nearly 1 in 5 respondents had contact with …

The Use Of Ndyag Laser Combined With Pulsed Light In The Treatment Of Rosacea, Valeriu Ardeleanu, Lavinia Alexandra Moroianu, Vlad Denis Constantin, Petrisor Banu, Florin Silviu Groseanu, Ioana Paunica, Ana Maria Dascalu, Alin Laurentiu Tatu

Journal of Mind and Medical Sciences

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without …

The Quality Of Sexual Life After Vaginal Surgical Interventions, Maria Pană, Romina-Marina Sima, Oana-Denisa Bălălău, Anca-Daniela Stănescu, Liana Pleş, Mircea-Octavian Poenaru

Journal of Mind and Medical Sciences

Introduction. The malfunction of the supporting pelvic system generates signs and symptoms that require various procedures. The aim of our study was to evaluate whether vaginal surgical interventions for genital prolapse or urinary incontinence have an impact on patients’ sexual quality of life. Materials and methods. We studied 40 eligible women who underwent vaginal surgical procedures in Saint John Hospital, Bucharest. Patients completed a questionnaire 6 months after the intervention. Results. Patients who underwent vaginal surgery for prolapse were 50-64 years of age. The most frequent vaginal surgical intervention was vaginal hysterectomy (32.5%), followed by anterior and …