Medicine and Health Sciences Commons^™

Is It Retaliation Or Remediation? Educating Our Learners On The Difference, France M. Leandre, Almari Ginory

HCA Healthcare Journal of Medicine

The goal of this article is to discuss 1 of the questions in the Accreditation Council for Graduate Medical Education Resident/Fellow Survey, which assesses the fear of retaliation in a program. To better understand the needs of residents and facilitate the reporting of concerns, programs must evaluate and educate residents on the difference between remediation and retaliation.

The Mahec Research Certificate Program: A Brief And Introductory Exposure To Key Research Topics For Diverse Learners, Grace E. Flinchum, Emily S. Mazure, Chelsea C. Atkins, Wendy Nuzzo, C Micha Belden, Edward C. Jauch, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background

Research is a core component of health profession training programs, but few efficient training resources exist that provide introductory research training that is brief, freely accessible, and supportive of learners with varying levels of research experience.

Methods

We set out to create the Mountain Area Health Education Center (MAHEC) Research Certificate program to support Graduate Medical Education (GME) residents and other learners. We initially explored existing curricula used to instruct medical and doctor of pharmacy students in order to identify foundational research topics to include in our introductory research program. We were guided by stakeholders to create a curriculum …

Nonglomerular Hypocomplementemic Interstitial Nephritis, Tyler Hemphill, Yogesh Sanghvi

HCA Healthcare Journal of Medicine

Background

Acute interstitial nephritis (AIN) is the most common cause of acute kidney injury (AKI) with subsequent renal impairment and is often underdiagnosed. Acute interstitial nephritis presents with a decline in kidney function and is characterized by an inflammatory infiltrate in the kidney interstitium. It is most often induced by drug therapy and is sometimes followed by infections with unknown causes. In a typical presentation of AIN, there is no evidence of hypocomplementemia; low complement is associated most commonly with autoimmune etiologies. Renal biopsy serves as the most definitive test for both the diagnosis and prognosis of AIN.

Case Presentation …

Spontaneous Pneumomediastinum Following Ingestion Of Bleach, Dish Soap, And Laundry Detergent And Inhalation Of Methamphetamines, Marshall Johnson, Matthew Boss, Alayna S. Buzzetta, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Spontaneous pneumomediastinum (SPM) is a rare condition defined by the presence of air in the mediastinum in patients without an observable traumatic cause. Pneumomediastinum is a somewhat rare condition that occurs 1 in every 25 000 individuals, aged 5 to 34 years old, with 76% occurring in men. Pneumomediastinum can further be divided into 2 categories: SPM and traumatic pneumomediastinum. Traumatic pneumomediastinum is most commonly seen with blunt force trauma or any iatrogenic procedures to the chest wall. Spontaneous pneumomediastinum frequently occurs due to air leaking through small alveolar sacs, which rupture within the surrounding bronchovascular sheath. Spontaneous pneumomediastinum …

Use Of Topical Hemostatic Agents In A Gynecologic Patient With Coagulopathy, Alexis O'Connell, Syeda Zainab Shah

HCA Healthcare Journal of Medicine

Introduction

The use of topical hemostatic agents has become common during surgical interventions. There is a wide variety of substances available to augment clotting, ranging from physical agents to topical thrombin combinations. Application of these agents in gynecologic surgery in patients with existing coagulopathies has not been studied.

Case Presentation

A 62-year-old woman with an inferior vena cava filter and a history of multiple deep vein thromboses presented to the clinic with pelvic pain, stress urinary incontinence, and uterovaginal prolapse. She underwent a total vaginal hysterectomy, sacral colpopexy, tension-free vaginal tape sling, and cystourethroscopy. Warfarin was cross titrated to enoxaparin …

Utilizing Femoral Metaphyseal Sleeves In Primary Total Knee Arthroplasty For Post-Traumatic Osteoarthritis: A Case Report, Zachary Sukin, Adam Dentinger, Jeremiah Earl

HCA Healthcare Journal of Medicine

Background

Total knee arthroplasty in younger patients presents a heightened risk of postoperative complications and implant failures compared to older populations, particularly in those with posttraumatic arthritis. These challenges necessitate careful consideration and specialized approaches to optimize the outcomes in this patient demographic.

Case Presentation

A 43-year-old man presented with left knee pain resulting from a traumatic lawn mower injury, causing an intraarticular distal femur, at the age of 6. The injury led to a limb-length discrepancy for which he underwent 2 limb-lengthening procedures in his early 20s. Radiographs demonstrated advanced posttraumatic osteoarthritis, and the patient elected to proceed with …

Upper Respiratory Tract Infection Leading To A New Diagnosis Of Sweet Syndrome And Monoclonal Gammopathy Of Unknown Significance, Nidhi Rawat, Meron Gebrehiwot, Jason Raw, Jeyaprakash Ramachandran

HCA Healthcare Journal of Medicine

Background

We present a rare case of Sweet syndrome with underlying monoclonal gammopathy of unknown significance (MGUS) which initially presented as upper respiratory tract infection.

Case Presentation

A 52-year-old woman presented with a complaint of sore throat for 6 days, productive cough and fever for 5 days, and red, pruritic, circular, tender rashes on face, arms and trunk for 2 days. There was a past history of similar self-limiting rashes presenting intermittently for 1.5 years. She also reported to be taking tablet ibuprofen, as required for the past 1-2 years, for cervical spondylosis. On integumentary examination, widespread, red, tender, annular …

Capacity Over Cognition: A Case Of High-Risk Disease And Homelessness, Mikalah E. Maury, Avery M. Duncan, Rebecca A. Taylor, Mary Ann Beil, Maulikkumar A. Patel

HCA Healthcare Journal of Medicine

Background

Medical decision-making in indigent patients with baseline cognitive deficits and lack of supportive resources is a difficult problem that reveals many ethical issues. Performing high-level medical procedures (eg, invasive surgery, chemotherapy, radiation therapy) on these patients without supportive resources brings into question the efficacy and necessity of treatment if it places the patient at higher risk of additional complications and mortality.

Case Presentation

In this article, we present a case of a 62-year-old indigent man with a long history of encephalopathy secondary to alcohol abuse, presenting with an aggressive head and neck cancer impacting his quality of life.

Conclusion …

Rapid Percutaneous Nephrostomy Stent Encrustation In Pregnancy: Navigating Your Stone Challenge, Victor M. Feldbaum, Roberto Morales, Shawn R. Ramsey, Michael L. Douso

HCA Healthcare Journal of Medicine

Background

Surgical management of kidney stones in pregnancy can be a serious problem for both mother and fetus.

Case Presentation

A 20-year-old woman with a second trimester pregnancy presented to the emergency room with renal calculi. She required surgical intervention and a left nephrostomy tube after consultation with urology. Five weeks later, her tube was solidified in place unbeknownst to her care team. She required several surgeries, dealt with encrustation remnants, infections, radiation exposure, persistent infection requiring antibiotic management, and, ultimately, an early delivery at 37 weeks.

Conclusion

At the time of writing, this was the first case to describe …

Rectal Fidaxomicin As Salvage Therapy In Fulminant Clostridioides Difficile Infection After Total Colectomy: A Case Report, Akankcha Alok, Mohamed Ismail, Stephanie Pino Fabara, Mohammed Al Said, Vidya Sagar Kollu

HCA Healthcare Journal of Medicine

Introduction

Clostridioides difficile infection (CDI) is a significant cause of antibiotic-associated diarrhea and colitis, ranging from mild to severe and potentially life-threatening conditions, like fulminant colitis with toxic megacolon and bowel perforation. The 2021 guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommend vancomycin and metronidazole for fulminant CDI (FCDI), with consideration of rectal vancomycin for cases with ileus. Fidaxomicin, though preferred for initial and recurrent CDI treatment, is not the first line for FCDI due to limited evidence. Fidaxomicin has a narrow spectrum of activity only targeting C difficile and …

Clinical Images Of Cutaneous Horns In Patients Presenting To A Family Medicine Residency Practice, Julia Fashner, Tillie Schumann

HCA Healthcare Journal of Medicine

We detail 2 cases of cutaneous horn, also referred to as cornu cutaneum, which is a hard-compacted linear outgrowth of keratin that projects above the skin. We present these images to increase awareness for all medical specialties who may see a patient with this skin lesion.

Clinical Characteristics Associated With Hospital Mortality And Length Of Stay Among Older Adults Admitted With Delirium: Retrospective Analysis, Se Won Lee, Jeff J. Kim, Cole Kretchmar, Napatkamon Ayutyanont, Mooyeon Oh-Park

HCA Healthcare Journal of Medicine

Background

Limited information exists on the characteristics of older adults admitted with delirium at risk of poor hospital outcomes. This study aims to identify risk factors present on admission that are associated with hospital mortality and length of stay (LOS) among older adults admitted with delirium.

Methods

This is a retrospective study of 5598 patients 65 years of age or older who were admitted to acute care units at 8 community hospitals with an International Statistical Classification of Diseases, Tenth Revision code of delirium.

Results

Multivariate regression analyses revealed that in-hospital mortality increase was associated with increased age, Asian race, …

Can The Combination Of White Blood Cell Count And C-Reactive Protein Rule Out Pediatric Appendicitis, A Retrospective Analysis?, Scott Gutovitz, Samantha Stoner, Jarrett Koper, Sarah Kleist

HCA Healthcare Journal of Medicine

Background

Pediatric appendicitis (PA) is the most frequent cause of pediatric emergency surgery. Standard PA scoring systems incorporate inflammatory biomarkers (white blood cell count [WBC] or C-reactive protein [CRP]); however, the individual biomarker sensitivities have not been reported beyond single-center sites. We aimed to measure the individual and combined sensitivities of WBC and CRP to rule out PA in a large multicenter hospital system.

Methods

We did a retrospective study of pediatric emergency department patients (age <18) with abdominal pain, using a deidentified electronic health database from a 175-hospital system in the United States, comparing PA versus non-PA patients. Pediatric appendicitis patients were identified by ICD-10 diagnosis codes and had advanced imaging, whereas non-PA patients had advanced imaging and were discharged home with the ICD-10 code for abdominal pain. Using matched propensity matching, we calculated receiver operator characteristics and Youden’s index to find the optimal cutpoints. Sensitivity was calculated at the optimal and traditional cutpoints for each biomarker, also combined in parallel fashion.

Results

We identified 7414 subjects (3707 PA matched to 3707 controls). The WBC in PA patients was 14.99 ± 5.00 k/mm³ versus 9.63 …

Beyond The Norm: Decoding Spontaneous Coronary Artery Dissection As An Unusual Cause Of Acute Coronary Syndrome, Holden Zimmerman, Himanshi Banker, Inder P. Kaur, Jaskaran Munjal, Vasu Gupta, Ayushi Garg, Nikita Garg, Meet Patel, Rohit Jain

HCA Healthcare Journal of Medicine

Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of myocardial infarction among young women, particularly during pregnancy. As the name suggests, SCAD is caused by the spontaneous formation of the false lumen within the coronary artery wall, thus compromising the blood flow to the myocardium. Unlike atherosclerotic acute coronary syndromes, SCAD is not directly associated with diabetes or hypertension; moreover, underlying connective tissue defects and inflammation are considered more contributory towards its etiology. Although its pathophysiology is not well understood, multiple theories have been proposed. Clinically, SCAD has a similar presentation to acute coronary syndromes, including substernal chest …

Response: Letter To The Editor, Exercise Is A Vital Sign, Megan Dannemiller, Anthony Shadiack, Marvin Sineath Jr, Andrew Baird, Marc Poirier, Kevin Thomas, Michael G. Flynn

HCA Healthcare Journal of Medicine

This letter is submitted in response to the letter to the editor regarding the authors’ article “Exercise Is a Vital Sign.”

Exercise Promotes Health But Is Not A Vital Sign, Jacob Draves, Halil Tekiner, Steven H. Yale, Eileen S. Yale

HCA Healthcare Journal of Medicine

The term “vital sign” has been attached to at least 83 conditions, symptoms, or phenomena in the literature to highlight their role and importance in overall health and well-being. This has created considerable confusion and overlapping terms in the medical literature. The 4 time-honored vital signs include temperature, pulse, blood pressure, and respiration. Two other measurements, blood oxygen saturation, and capnography (end-tidal CO2) are considered the fifth and sixth vital signs, respectively. The authors argue that exercise should be named a vital sign, and several authors have designated it as the fifth vital sign. However, not all symptoms or phenomena, …

The Art Of Movement, Payton Hedderman

Journal of Undergraduate Research at Minnesota State University, Mankato

I wanted to do this project for my Interdisciplinary Studies Capstone to showcase some of my skills and to articulate what I want to do with my degree. I want to go into Medical Illustration, and I want to make science easier for people to learn. To do this I want to take complicated subjects and remake them into simpler terms. For my capstone, I decided to take anatomy of the arm, leg, and abdominal organs and draw them on professional women athletes. I thought that expressing this anatomy in less of a clinical way is one strategy to make …

Art Therapy In Social Work Practice, Laura Gebur

Journal of Undergraduate Research at Minnesota State University, Mankato

Art therapy is an emerging practice among mental health professionals looking for new ways to engage with their clients and encourage nonverbal communication. Creativity is a means of processing memories, improving relationships, and strengthening the mind-body connection across a variety of age groups and practice settings. The efficacy of art therapy has led to its integration into social work practice, benefitting a diverse range of client populations within the field. While a lack of macro-level research studies has prevented the implementation of standardized art therapy techniques in social work, clinical research trials have examined art therapy across several areas of …

Circulating Inflammatory Biomarkers And Endometriosis Lesion Characteristics In The Wise Consortium, Kathryn L. Terry, Amy Shafrir, Ashley Laliberte, Allison F. Vitonis, Kurtis Garbutt, Mary Depari, Christian Becker, Naoko Sasamoto, Krina T. Zondervan, Stacey A. Missmer

Health Sciences Faculty Publications

Endometriosis is a chronic inflammatory condition requiring surgical or imaging visualization for definitive diagnosis. How endometriotic lesion characteristics relate to circulating inflammatory markers remains unclear. We evaluated 11 inflammatory biomarkers, including interleukin (IL)-1β, -6, -8, -10, -16, tumor necrosis factor (TNF)-α, thymus and activation regulated chemokine (TARC), monocyte chemotactic protein (MCP)-1, -4, and Interferon gamma-induced protein (IP)-10, in 566 participants with endometriosis from the Women’s Health Study: From Adolescence to Adulthood (A2A), Endometriosis Oxford Care & Research (CaRe) study (ENDOX) and Endometriosis: Natural History, Diagnosis, and Outcome (ENDO) study to evaluate associations with endometriosis characteristics, including macrophenotype (superficial lesions only, …

Atypical Abdominal Pain: Uncovering Malignant Peritoneal Mesothelioma In Suspected Crohn's Disease: A Case Report, Catherine Loehr, Lara Boudreaux, Ann Porter Uhlhorn, Nisha Loganantharaj

School of Medicine Faculty Publications

BACKGROUND: Malignant peritoneal mesothelioma (MPM) is a rare and aggressive cancer from the serosal membranes of the abdominal cavity. In the United States, MPM accounts for about 10-15% of all mesothelioma cases, and translates into approximately 600 new cases diagnosed annually. It is typically diagnosed in Caucasian individuals, and while asbestos exposure is a well-established risk factor for pleural mesothelioma, its association with peritoneal mesothelioma remains less clear. Clinical symptoms of MPM, such as abdominal pain, bloating, and weight loss, overlap with other gastrointestinal disorders, which often leads to delayed diagnosis. This case report presents a unique instance of MPM …

Supporting Clinical Identification Of Children With Sensory Integration Challenges: A Decision Guide For Primary Care Providers, Shelly J. Lane, Sarah A. Schoen, Roseann Schaaf, Anita Bundy, Zoe Mailloux, Susanne Smith Roley, Teresa A. May-Benson, L. Diane Parham

Department of Occupational Therapy Faculty Papers

Background: Children and youth often have challenges processing and integrating sensory information. These increasingly common challenges and can significantly impact development, learning, behavior, well-being, and participation in everyday activities. Since children with sensory integration challenges, with or without other concerns, are likely to present first to their primary care provider (PCP), it is important that they have resources about sensory integration challenges and their impact on the child or the need to refer these children for further assessment and intervention. Our aim is to assist PCPs in their clinical decision-making.

Methods: We conducted a narrative review of CINAHL, PsychInfo, and …

Sleep And Sleep Disorders: Much More Than How Long You Sleep, What Truly Matters Is How You Sleep, Teresa Arora, Claudia R.C. Moreno

All Works

Since the discovery of electroencephalography to measure brain activity in 1924, sleep research has rapidly advanced. Contemporary sleep research no longer focuses on the length of sleep and the consequences of sleep loss. Instead, a multitude of sleep parameters, such as sleep duration, quality, irregularity, health, and disordered sleep, now inform the sleep science community about the importance of sleep in relation to health, performance, cognitive, cultural, and clinical outcomes through diverse study designs, equipment, and across a range of populations. This special issue on sleep and its disorders has shown us how diverse and widespread the study of sleep …

The Link Between Depression And Bone Fractures In Rural Regions, Blake C. Martin, Kristina Vatcheva, Bharathi Gadad, Kelsey Baker

School of Medicine Publications

The prevalence of depression has increased throughout the 21st century. Recent evidence has suggested that depression may be linked with changes in bone health. In this descriptive study, we sought to evaluate the connection between depression and bone fractures to increase awareness and enable possible improvement in the prevention of bone fractures in medically underserved areas such as the Rio Grande Valley (RGV). We conducted a retrospective chart review of electronic medical records within the University of Texas Health RGV database from 2019 to 2022. We analyzed medical records and separated charts into groups that had: a dual diagnosis of …

Impact Of Fasting On Granulocyte Chemotactic Protein-2 Chemokine And Lactate Dehydrogenase Enzyme Activity In The Development Of Dental Caries, Ghada I. Taha

Sultan Qaboos University Medical Journal

Objectives: This study aimed to evaluate the impact of fasting on the innate defence mechanism by measuring the granulocyte chemotactic protein-2 levels and the enzymatic activity of the lactate dehydrogenase enzyme in individuals diagnosed with dental caries. Methods: This longitudinal observational study included male and female college students attended teaching dentistry clinics in Baghdad, Iraq. The study took place between November 2023 and May 2024. Unstimulated saliva samples were collected from all participants and the biomarkers granulocyte chemotactic protein-2 and lactate dehydrogenase were detected by enzyme-linked immunosorbent assay kits. Every subject under study underwent a clinical examination by a dentist. …

Induction Of Myelopoiesis By Candida Dubliniensis Drives Protective Trained Immunity Against Sepsis In A Card9-Dependent Manner, Shannon Esher Righi, Elizabeth A. Lilly, Amanda J. Harriett, Patrick W. Daly, Maryjane Jones, Chad Steele, Mairi C. Noverr, Paul L. Fidel

School of Dentistry Faculty Publications

Trained immunity is a long-term functional reprogramming of innate cells that allows for the formation of immune memory akin to adaptive responses, but with a more rapid nonspecific response. We recently identified an anti-inflammatory trained immunity response, termed trained tolerogenic immunity (TTI), induced by low virulence Candida dubliniensis, that protects against acute lethal polymicrobial sepsis via myeloid-derived suppressor cells (MDSCs). Trained immunity and MDSCs arise following hematopoietic stem and progenitor cell (HSPC) expansion in the bone marrow. Here, we show that C. dubliniensis induces inoculum-dependent protection and HSPC expansion, whereas depletion of HSPCs following C. dubliniensis immunization abrogates protection. We …

Assessment Of Vector Control Strategies Based On Mass Aedes (Stegomyia) Mosquito Trapping (Agos Traps) Pilot Study In A Us-Mexico Border Region Of South Texas, Jesús A. Aguilar-Durán, Josue Ramírez, Mario A. Rodríguez-Pérez, Christopher J. Vitek, Nadia A. Fernández-Santos, José Guillermo Estrada-Franco

School of Integrative Biological & Chemical Sciences Faculty Publications

Background: Aedes (Stegomyia) aegypti and Ae. (Stegomyia) albopictus mosquitoes are major vectors of diseases including dengue, Zika, chikungunya, and yellow fever. The excessive use of chemical insecticides has caused resistance in mosquito populations, along with negative environmental impacts and harm to non-target organisms. In this regard, mosquito control strategies, such as passive mass trapping interventions with autocidal gravid ovitraps (AGO) offer a promising alternative. Here we report the results of a pilot study evaluating a passive mass trapping treatment using AGOs against Ae. aegypti in the city of Harlingen, Texas, USA, during the peak mosquito season.

Methodology: Three treatments were …

Safety And Efficacy Of Liver-Directed Radiotherapy After Chemoimmunotherapy For Advanced Cholangiocarcinoma: An Early Report From A Large Tertiary Cancer Center, Abdulmoiz Asif, Abdulmoid Asif, Michael K Rooney, Enoch Chang, Felicity Namayanja, Kimana Quentin, Sunyoung Lee, Ian Hu, Vincent Bernard, Prajnan Das, Emma B Holiday, Sonal Noticewala, Grace L Smith, Albert C Koong, Ethan B Ludmir, Milind Javle, Lianchun Xiao, Eugene J Koay

Faculty, Staff and Student Publications

BACKGROUND: Recent randomized controlled trials have established chemoimmunotherapy as the standard of care for patients with advanced biliary cancers with a median overall survival (OS) of about thirteen months. No data exist to demonstrate the safety and efficacy of liver-directed radiotherapy (RT) for extrahepatic and intrahepatic cholangiocarcinoma (CCA) in the era of chemoimmunotherapy. The purpose of this study is to report our early experience treating patients with CCA using RT and chemoimmunotherapy.

METHODS: Twenty-eight patients with CCA who received chemoimmunotherapy sequentially and/or concurrently with RT were retrospectively analyzed. The median biologic equivalent dose (BED) of RT was 84.0 [interquartile range …

Causal Predictive Modeling Of Survival Of Lung And Bronchus Cancer Patients Diagnosed During 2010–2011 In Texas, Zeinab Mohamed, Sidketa Fofana, Everardo Cobos, Manish K. Tripathi, Tamer Oraby

School of Mathematical & Statistical Sciences Faculty Publications

Background: Lung and Bronchus cancer is the most fatal type of cancer in the United States. According to the American Cancer Society, there were more than 127,000 deaths from lung cancer in 2023. Lung cancer care cost 23.8 billion dollars in 2020. In Texas, only 22.8% of lung cancer patients survived 5 years or more past diagnosis based on 2012-2018 data.

Aim: This study evaluates the survival length of lung and bronchus cancer patients in Texas using advanced statistical and machine learning methods applied to an 11-year cohort study from Surveillance, Epidemiology, and End Results Program. It also quantifies the …

Understanding Tobacco Use Among Bangladeshi Men: A Socio-Demographic Analysis Of Risk Factors, Md. Rashedus Salekin Sabbir, Helal Uddin, Md Shazid Hossain Shohan

Indonesian Journal of Public Health Nutrition (IJPHN)

Tobacco consumption remains a major public health concern in Bangladesh, where adult males represent the most affected group. Despite existing bans on public smoking, cultural norms, media influence, and limited awareness continue to sustain high prevalence. The objective of this study was to examine the socio-demographic determinants of tobacco use among Bangladeshi men, focusing on regional variation, education, media exposure, and family influence. A cross-sectional survey was conducted among 275 adult males in Dhaka Division using a structured questionnaire. Data was analyzed through descriptive statistics, chi-square tests, and binary logistic regression to identify significant predictors of tobacco consumption. Findings reveal …

The Relationship Between Anemia, Chronic Energy Deficiency, Knowledge, And Other Factors And Anc Attendance Among Pregnant Women In Bogor City And Regency 2025, Winfried Ichtussend Hartnajaya Chrisna, Ratu Ayu Dewi Sartika, Nurul Dina Rahmawati, Daden Setiawan

Indonesian Journal of Public Health Nutrition (IJPHN)

Antenatal Care (ANC) is a comprehensive health service to optimize pregnancy outcomes. In 2023 in Bogor City, the ANC K6 coverage rate has reached the target (98.63%), but this is not the case with the coverage in Bogor Regency (62.25%). ANC visits that do not reach the standard can be influenced by predisposing factors, supporting factors, and health needs factors. The inequality that occurs can hinder efforts to reduce maternal mortality. This study aims to determine the relationship between knowledge and other factors with ANC visits in Bogor City and Regency in 2025. This study is quantitative with a cross-sectional …