Medicine and Health Sciences Commons^™

Emicizumab-Kxwh: A Critical Review, Kiera O'Leary

International Undergraduate Journal of Health Sciences

The first descriptions of haemophilia A were reported in the second century AD, with the first modern description by John Conrad Otto in 1803. Historically, the natural history of haemophilia A was associated with very high rates morbidity and mortality, often following trivial accidents. Although treatment options for haemophilia A have been revolutionised in recent decades, haemophilia A remains a hereditary disease of concern and factor replacement products remain the mainstay of treatment.

As such, patients with haemophilia can carry huge burdens, particularly when a complication such as a FVIII inhibitor is present. A recently approved novel therapeutic, Emicizumab-kxwh, has …

Haematological Tests: Important Tools For Covid-19 Prognosis?, Kevin D'Arcy

International Undergraduate Journal of Health Sciences

SARS Co-V2 virus outbreak has resulted in a worldwide pandemic causing the death of approximately 5 million across the globe. The virus particle is transmitted via air droplets or by direct contact with surfaces. Infected individuals may present with moderate flu-like symptoms or may remain asymptomatic. While most cases of SARS Co-V2 resolve, some patients may progress to acute respiratory distress syndrome. The onset of ARDS is associated with a broad range of complications leading to increased morbidity and mortality. Sepsis induced coagulopathy is a clinically significant complication associated with the development of ARDS. Approximately 3% of Covid-19 patients will …

A Review Of The Pathogenesis, Clinical Features And Diagnostic Indicators Of The Novel Condition Vaccine-Induced Thrombotic Thrombocytopenia, Ada Fleming

International Undergraduate Journal of Health Sciences

The introduction of vaccination against SARS-CoV-2 infection was a welcome and significant event in the COVID-19 pandemic. While vaccine administration was for the most part successful, it did come with the emergence of a novel condition, Vaccine-Induced Thrombotic Thrombocytopenia (VITT). This condition presents after the administration of adenoviral vector-based vaccines against COVID-19, causing thrombocytopenia and thrombosis in affected individuals. There have been 10 suspected cases of VITT in Ireland. While its mechanism is not fully understood, the condition is characterised by the presence of Platelet Factor 4 (PF4) antibodies. There are several laboratory indicators which may suggest that a patient …

Full Issue: The International Undergraduate Journal Of Health Sciences, Volume 2, Issue 1, June 2022, Sword Mtu

International Undergraduate Journal of Health Sciences

Full Issue: The International Undergraduate Journal of Health Sciences, Volume 2, Issue 1, June 2022

Tattoos In Medicine, Marcus Ibrahim

HCA Healthcare Journal of Medicine

I am a second-year family medicine resident with a rather large arm-sleeve tattoo. As you can probably deduce by reading the title of this editorial, it will focus on how tattoos in healthcare may be perceived by others. My goal is to illustrate some of my perspectives, opinions, and experiences regarding making my tattoos visible in the clinical setting.

Covid: Health Inequities Exposed And How We Can Do Better, Timothy Mcnamara, Kara Mann, Josephin Mathai

HCA Healthcare Journal of Medicine

If a fair and just healthcare system is the goal, then the COVID-19 pandemic proves America still has a long way to go in its effort to achieve health equity for all. Inequalities in the healthcare landscape have been amassing for decades. Lack of access to quality care, underfunded public health programs, and the rising cost of treatment are just a few of the proposed origins of systemic inequity—all of which were apparent long before COVID-19’s arrival. Will observing these deep-seated issues under the lens of an ongoing pandemic shine a brighter light on these enduring disparities? More importantly, what …

Starting The Conversation About Healthcare Disparities, Melissa D. Mendez, Sandra Lopez, John H. Washington Iv

HCA Healthcare Journal of Medicine

The Accreditation Council for Graduate Medical Education (ACGME) put forth institutional requirements to implement healthcare disparity education in resident and fellow curricula in an effort to decrease these inequities. Healthcare disparities stem from many different factors. These may include access to care, insurance status, socioeconomic status, health literacy, language barriers, and the way healthcare systems function. These factors may have interactions that lead to poor health outcomes. As researchers and educators, we need to find a way to research these issues in more depth as well as teach these concepts to our resident physicians. Here, we discuss El Paso, Texas, …

Unearthing Historical Trauma To Advance Health Equity For Survivors Of Human Trafficking, Sandy Woo-Cater

HCA Healthcare Journal of Medicine

In the last decade, the public health field has grown a strong interest in responding to issues related to human trafficking. This specific concentration in healthcare has made efforts to ensure this work includes culturally appropriate tools to serve patients. While curricula to guide health professionals in areas such as cultural competency, cultural responsiveness, or cultural humility exist, historical trauma is not often integrated in the understanding of health outcomes for patients experiencing human trafficking. This paper asserts that advancing health equity for these patients necessitates a deeper historical perspective.

Identifying, Addressing, And Eliminating Microaggressions In Healthcare, Tracy Macintosh, Michelle Hernandez, Anuja S. Mehta

HCA Healthcare Journal of Medicine

Microaggressions are pervasive throughout society, including in healthcare and academic institutions. They are often unconscious but accumulate over time, and they negatively impact the recipients' productivity and achievement by creating a sense of inadequacy as well as a lack of belonging. We outline several evidence-based strategies and teaching frameworks that institutions and training programs can adopt to reduce the prevalence and impact of microaggressions against trainees from historically marginalized groups, and that can promote psychological safety for everyone.

Doctors And Disability: Improving Inclusion In Medical Education, Mary Alice Keller

HCA Healthcare Journal of Medicine

Disability is extremely common in the United States with 26% of adults identifying as having some type of disability. Oftentimes, people with disabilities need to access health care services frequently in order to receive adequate care and support. However, despite this need, medical students receive limited, if any, education about people with disabilities and how to appropriately provide medical care and interact with them. This lack of education exacerbates health care disparities experienced by people with disabilities. This article highlights these disparities as well as the history of disability and health care. Current advancements in medical education regarding people with …

Delayed Diagnosis Of Klippel-Trénaunay Syndrome In A 23-Year-Old African American Male, Daniel A. Nguyen, Pranav Patel, Stephen E. Weis

HCA Healthcare Journal of Medicine

Klippel-Trénaunay syndrome is a rare genetic disorder that typically presents as a triad of symptoms consisting of venous malformations (varicosities), capillary malformations (port-wine stain), and limb overgrowth. We followed a 23-year-old African American male with a past medical history of peripheral vascular disease, who was visiting the dermatology clinic for a persistent skin lesion on his thigh. During physical examinations, we noted a subtle port-wine stain on his right leg, right leg hypertrophy, and peripheral vascular disease. Skin findings were difficult to observe on his darker skin tone, Fitzpatrick skin type VI, which may have led to the delayed diagnosis …

Gender Dysphoria Versus Acute Psychosis: Can One Properly Diagnose Gender Dysphoria Solely During Acute Psychosis?, Kristy A. Fisher, Samantha Scemla, Clara L. Alvarez Villalba, Jessica Kroin

HCA Healthcare Journal of Medicine

Gender dysphoria occurs when a discrepancy between one’s sex assigned at birth and one’s gender identity causes distress or impairment in function, which can lead ultimately to seeking treatment in the forms of psychotherapy, hormonal therapy, and/or gender-affirming surgery. Clinical care guidelines also recommend pharmacological treatment of psychiatric comorbidities if indicated. A review of the current literature demonstrates comorbidity between gender dysphoria and psychosis, including cases of gender dysphoria with schizophrenia and the occurrence of gender dysphoria symptoms during manic or psychotic episodes. The existing literature has yet to specifically examine gender dysphoria amongst individuals with schizoaffective disorder. The authors …

Free Silicone-Induced Granulomatosis And Hypercalcemia In A Transgender Female, Brian L. Pando, Benjamin Goldsmith, Adam Lane Webb, Komal Kinger, Brian Helmly

HCA Healthcare Journal of Medicine

Introduction

Vitamin D derangements are a rare but important cause of hypercalcemia. Granulomatous disease is a primary cause of vitamin D derangements and is frequently associated with sarcoidosis, tuberculosis, and in the present case, foreign body granulomatosis. Liquid or injectable silicone is used as a filler for cosmetic body contouring. Transgender patients may seek silicone injections as part of gender affirmation surgeries. Granuloma formation is a rare but well-described complication of injectable silicone.

Case Description

A 40-year-old, assigned male at birth (AMAB) transgender female patient, with a history of HIV and chronic kidney disease (CKD) stage 3b, was admitted to …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Cutaneous Abscesses, Christopher M. Wong, Christian J. Scheufele, Sandhya Bodapati, Daniel A. Nguyen, Ashleigh E. Hermann, Jean Elizze M. Charles, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Cutaneous abscesses are collections of pus resulting from skin and soft tissue bacterial infections. They clinically exhibit the four cardinal inflammatory signs of pain, warmth, swelling, and erythema. In patients with darkly pigmented skin, classically-associated erythema may be challenging to appreciate and can lead to missed or delayed diagnosis. We compare abscess presentations in different skin types. Recognition of varying presentations of cutaneous abscesses in diverse skin colors will help clinicians utilize additional clues to identify and diagnose this entity correctly.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Inverse Psoriasis, Daniel A. Nguyen, Henry Lim, Christopher M. Wong, Christian J. Scheufele, Ashleigh E. Hermann, Jean Elizze M. Charles, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Inverse psoriasis is a clinical variant of psoriasis involving flexural or intertriginous areas of the body. Inverse psoriasis may be present in 3 to 36% of psoriasis patients. Lesions are clinically characterized as smooth, well-demarcated, erythematous plaques (raised, >1 cm) without the typical silvery scales of classic psoriasis. Differential diagnosis includes tinea infection, candidiasis, seborrheic dermatitis, or bacterial streptococcal infection. The clinical images in this review focus on identifying inverse psoriasis along the full spectrum of skin tones.

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Plaque Psoriasis, Ashleigh E. Hermann, Daniel A. Nguyen, Christopher M. Wong, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Recent studies estimate that more than 8 million Americans have psoriasis. The prevalence of psoriasis in African Americans is 1.5% compared to 3.6% of Caucasians. Psoriasis is likely to be underdiagnosed among African Americans and other individuals with darker pigmented skin due to variations in clinical presentation in addition to disease distribution and severity. We present images of psoriasis vulgaris in a variety of Fitzpatrick skin types. Differences in the biology of skin pigmentation may explain the clinical masking of erythema in darker-skinned individuals. Recognition of this important difference will help clinicians utilize additional clues to identify and diagnose this …

Pilot Mental Health Offender Program Improves Participant Outcomes And Lowers Costs In A Large Urban County, Colleen Bell, Mohsin Raza, David Kilcrease, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Mass incarceration, particularly of the mentally ill, continues to pervade our criminal justice system. Jails in many areas have become the largest mental health facilities, especially in large urban communities, despite increasing societal recognition that those with mental illness are not best served behind bars. Misdemeanors are an often-overlooked contributor to mass incarceration, and may be preventable for those with chronic severe mental illness.

Methods

This Northeast Florida pilot program, the Mental Health Offenders Program (MHOP), is based on the successful Miami Eleventh Circuit Court Criminal Mental Health Project. MHOP provided pretrial release from custody, through diversion with a …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: An Introduction, Christian J. Scheufele, Delfin Weis, Stephen E. Weis

HCA Healthcare Journal of Medicine

Dermatological disease has historically been dependent on photography as a primary modality for education. Previously, photographs used for medical education were representative of the regional patient populations at that time; however, they have not proportionally reflected the rapidly changing demographics in the United States. Education on the diagnosis of cutaneous disease has, therefore, primarily relied on photographs of lighter skin tones. There is a need for a better representation of darker skin tones in dermatologic medical education. This article introduces a clinical series that highlights dermatological diseases in various skin pigmentations, which are commonly seen in the primary care office. …

Care Alert Program In Chronic Recurrent Ed Utilizing Patients, Kaitlyn Phelps, Jonathan Bryan, Jonathan Leggett, Erica Gibbons, Brian Griggs

HCA Healthcare Journal of Medicine

The Care Alert program is designed to help navigate encounters with patient populations that are high utilizers of emergency department (ED) resources. These populations often have chronic medical conditions, have a poor understanding of their conditions, are unfamiliar with the EDs’ role in the management of these conditions, and commonly lack outpatient resources. The Care Alert program intends to address the needs of this challenging patient population by designing individualized care plans that are approved through a multidisciplinary committee. Data from this study showed a 37% decrease in ED visits and a 47% decrease in hospitalizations during the initial 8 …

Examining Racial, Ethnic, And Gender Disparities In The Treatment Of Pain And Injury Emergencies, Laurel A. Wimbish, Janelle R. Simpson, Lauren R. Gilbert, Andria Blackwood, Emily A. Grant

HCA Healthcare Journal of Medicine

Background

Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers’ use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender.

Methods

This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in …

Covid-19 And Mental Health Disparities In The Black American Population, Israel Taylor

HCA Healthcare Journal of Medicine

The current COVID-19 pandemic has amplified health disparities that have long existed for minoritized groups in the United States. There have been disproportionate effects on the mental and physical health of the Black American population, specifically because of longstanding racial, social, and economic injustices. To fully understand the current state of Black mental health and the extent to which COVID-19 has impacted it, we examine historical examples of unjust mental health practices throughout generations. We then explore why depression, suicidality, and other mental illnesses may have a profound effect on a community that has been made vulnerable to socioeconomic shifts. …

The Impact Of Covid-19 In The Latinx Community, Laura Pedraza, Ricardo Villela, Vikki Kamatgi, Kaitlyn Cocuzzo, Ricardo Correa, Miriam Zylberglait Lisigurski

HCA Healthcare Journal of Medicine

The COVID-19 pandemic has intensified the existing health and social disparities that affect minority groups in the United States (US), including the Latinx community. This situation has been reflected in many aspects of health, including increased morbi-mortality and reduced adherence to medical and scientific recommendations. Limited access to health care, financial challenges, migrant status, and health literacy, or lack thereof, have all hampered the Latinx community's ability to seek aid quickly and to be tested or treated effectively for this disease. This pandemic has shown that the Latinx community's socioeconomic status correlates with greater mortality rates when compared to other …

Conscious And Unconscious Bias: The Hidden Pandemic Of Biases In Healthcare Exacerbated By Covid-19, Ibtisam Rauf, Abigail Hartmann, Alexandre Koumtchev, Syed Anjum Khan, Rahul Kashyap

HCA Healthcare Journal of Medicine

Background

There are limited data on unconscious bias in healthcare, but there is consistent evidence that it alters clinical decision-making. COVID-19 exacerbated many pre-existing disparities, and this paper seeks to identify, deconstruct, and propose mitigation strategies for a few of them.

Discussion

Five of the largest disparities amplified by the pandemic are discussed in this paper. Older people, Black people, uninsured people, rural communities, and people with lower education levels have been disproportionally affected in both morbidity and mortality.

Conclusions

The disparities discussed above did not occur in a vacuum but are the result of systemic issues. Equity starts with …

Through The Cracks: The Disposition Of Patients With Schizophrenia Spectrum Disorders In The Post-Asylum Era, Briana Tillman, Erin Smith, Alicia Cho, Colt Kennington, Alexandra Kreis

HCA Healthcare Journal of Medicine

This paper aims to explore current disposition options for patients with psychosis in light of shifts toward community care and changes in mental healthcare funding in the post-asylum era and to propose systemic-level improvements based upon local successes. It evaluates critiques of long-term psychiatric care programs, claims of transinstitutionalization to incarceration, shelters, and emergency rooms, and programs initiated to address deinstitutionalization. The authors conclude that while Assertive Community Treatment, Partial Hospitalization Programs, intermediate-level care, and housing interventions can improve outcomes for many persons with psychotic illness, a significant portion of these patients would still be best served in long-term psychiatric …

Is There A Bias Toward Unvaccinated Covid-19 Patients?, Abbas B. Jama, Anwar Khedr, Hisham Mushtaq, Nitesh K. Jain, Thoyaja Koritala, Syed Anjum Khan

HCA Healthcare Journal of Medicine

With more than 22% of the United States still not vaccinated for COVID-19, we are trying to shed some light on whether there is any bias when treating unvaccinated COVID-19 patients. We highlight several reports where some individuals or organizations displayed possible bias, whether implicit or explicit. We examine the legal and ethical implications of these biases and offer a general overview of how to tackle them.

Health Equity In Medicine, Tracy Macintosh, Barbara L. Gracious, Jeremy R. Brooks, Graig Donini

HCA Healthcare Journal of Medicine

Healthcare disparities exist when, due to racial, ethnic, or gender identity differences linked to social, economic or environmental factors, certain populations lack equitable access to quality healthcare and insurance coverage. Such disparities across history carry profound future implications that we have only begun to contemplate as a profession. This special issue of the HCA Healthcare Journal of Medicine examines the critical issue of health equity in medicine and how the medical community can advance health equity through inclusive behavior and interactions in clinical and educational settings, and our communities.

The Influence Of Blue Light On Melatonin Levels, Nagarathna .

Manipal College of Health Professions, Manipal Theses and Dissertations

No abstract provided.

A Narrative Review On The Diagnostic Ability Of Dry Eye Questionnaires, Shonal D'Souza

Manipal College of Health Professions, Manipal Theses and Dissertations

No abstract provided.

Short Term Ocular Effects Among Swimmers: (A Scoping Review), Anvitha Shetty

Manipal College of Health Professions, Manipal Theses and Dissertations

No abstract provided.

Effects Of Blue Enriched Light On Metabolism: A Scoping Review, Supraja Supraja

Manipal College of Health Professions, Manipal Theses and Dissertations

No abstract provided.