Wisconsin Medical Journal最新文献

{"title":"Can Metronidazole Cause a Disulfiram-Like Reaction? A Case-Control Study Propensity Matched by Age, Sex, and Ethanol Concentration.","authors":"Ryan Feldman,&nbsp;Rachael Jaszczenski","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There is controversy over the existence of a metronidazole-induced disulfiram-like reaction. Uncontrolled case reports suggest metronidazole can cause a severe disulfiram-like reaction in combination with ethanol. Criticism of these cases suggest the observed effects appear to be as likely caused by ethanol as by a drug interaction. Controlled experimental data refute these reports, demonstrating metronidazole does not increase acetaldehyde and cannot reliably produce disulfiram-like reactions. The purpose of this study is to retrospectively assess the incidence of clinical effects consistent with a disulfiram-like reaction in a population of patients with confirmed ethanol use who received metronidazole. As alcohol may also be responsible for the effects seen, the incidence of effects is assessed against a control group matched for age, sex, and ethanol concentration.</p><p><strong>Methods: </strong>A retrospective chart review was performed from December 1, 2010, through December 31, 2020 on emergency department patients with ethanol use confirmed via detectable ethanol concentration who received metronidazole while ethanol was predicted to still be present in the serum. A matched comparator group with the same ethanol concentrations, as well as sex and age, was generated for comparison. The incidence of disulfiram-like reaction symptoms documented in the medical record was compared between groups.</p><p><strong>Results: </strong>Thirty-six patients were included in the study: 18 in the metronidazole group and 18 in the ethanol concentration matched control group. The mean age in both groups was 46 years. The metronidazole group was 50% male, and the mean ethanol concentration was 0.21 g/dL. The control group was 44.4% male. There was significantly less hypertension in the metronidazole group compared to the control group (16.7% vs 61.1%, <i>P</i> $lt;  0.0001). There were no other significant difference in disulfiram-like effects between the two groups. No patients who received metronidazole and had a detectable ethanol concentration had a suspected disulfiram-like reaction documented in the medical record.</p><p><strong>Conclusions: </strong>This data set further supports the lack of a disulfiram-like reaction when metronidazole is used in patients with recent ethanol use in the acute care setting. Additionally, it highlights that the clinical effects of a disulfiram-like reactions may be present at baseline from ethanol ingestion or underlying disease regardless of metronidazole use. These findings are consistent with well-controlled human and animal data demonstrating no increase in acetaldehyde concentrations or disulfiram-like symptoms when metronidazole is co-administered with ethanol. In patients where metronidazole is indicated as the superior agent, its use should not be avoided due to concern about an interaction with ethanol.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9872628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Findings Aid in Diagnosis of West Nile Virus.","authors":"Brandon K Winward,&nbsp;Justin L Gottlieb,&nbsp;Jonathan S Chang,&nbsp;Luke Bradbury,&nbsp;Nenita Maganti,&nbsp;Chintan Pathak,&nbsp;Benjamin J Fowler","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>West Nile virus disease, which is endemic to the United States, is a rarely reported systemic infection that can be difficult to diagnose. Chorioretinitis is an uncommon manifestation of West Nile virus but has pathognomonic ocular findings that can aid in diagnosis.</p><p><strong>Case presentation: </strong>A 66-year-old man presented with acute onset fever, chills, and dyspnea. He underwent an extensive but nondiagnostic workup during hospitalization. New visual complaints prompted ophthalmology consultation. Funduscopic examination showed macular hemorrhages and midperipheral chorioretinal lesions. Fluorescein angiography revealed target-like lesions in a radial distribution, which is pathognomonic for West Nile virus chorioretinitis. Serology confirmed the diagnosis of West Nile virus disease. Systemic and ocular symptoms improved with supportive care.</p><p><strong>Discussion: </strong>West Nile virus disease has many nonspecific manifestations. History of recent mosquito exposure is not always readily elicited. In patients with visual symptoms, eye examination can help in its diagnosis.</p><p><strong>Conclusions: </strong>West Nile virus should be considered in patients with acute febrile or neurological illness during mosquito season.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10258308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unlikely Guest With an Overstayed Welcome: <i>Cyclospora</i>-Induced Postinfectious Irritable Bowel Syndrome.","authors":"Matthew Aiken,&nbsp;Trisha Jethwa,&nbsp;Muhammad Bilal Abid","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Postinfectious irritable bowel syndrome is a phenomenon that can occur following bouts of acute gastroenteritis. While bacterial pathogens are typically implicated in the development of postinfectious irritable bowel syndrome, viral and parasitic infections should also be considered as inciting pathogens.</p><p><strong>Case presentation: </strong>An immunocompetent, 65-year-old woman presented with several weeks of watery diarrhea, which polymerase chain reaction testing confirmed to be a Cyclospora infection. Resolution of diarrhea was achieved with antibiotic treatment, however, months later she presented to the gastroenterology service with persistence of loose stools and abdominal cramping consistent with a diagnosis of postinfectious irritable bowel syndrome.</p><p><strong>Discussion: </strong>Postinfectious irritable bowel syndrome has a similar presentation to sporadic irritable bowel syndrome, with diagnosis aided by the identification of an inciting pathogen. To our knowledge, this is the first documented case of <i>Cyclospora</i>-induced postinfectious irritable bowel syndrome. While parasitic infections typically aren't implicated in cases of postinfectious irritable bowel syndrome, this case highlights the value of considering this condition as a cause of protracted diarrhea in patients previously diagnosed with <i>Cyclospora</i>.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10258307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Acute Q Fever in Rural Wisconsin: A Case Report.","authors":"Taylor Boland Rigby,&nbsp;Tyler Grunow,&nbsp;Jillian Landeck,&nbsp;Kathryn M Scmitt,&nbsp;Jennifer Lochner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Q fever is a zoonotic disease with a variable clinical presentation and potentially fatal complications. While rare, it is more common in rural areas due to its transmission from animals, including cattle.</p><p><strong>Case presentation: </strong>A 3-year-old boy presented in December 2020 with intermittent fevers, headache, rash, and lymphadenopathy. After several months of symptoms, he was diagnosed with acute Q fever.</p><p><strong>Discussion: </strong>This case demonstrates the importance of considering Q fever in the differential diagnosis when a patient presents with nonspecific infectious symptoms and an epidemiological link that places them at risk.</p><p><strong>Conclusions: </strong>While rare, Q fever is a potentially serious infection that can affect people living in Wisconsin's rural farming communities.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Database Tracking in Gender-Affirming Surgery: Are Patients Falling Through the Cracks?","authors":"Ton C Doan,&nbsp;Kasey Leigh Wood Matabele,&nbsp;Peter J Nicksic,&nbsp;Katherine M Gast,&nbsp;Samuel O Poore","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>This study sought to examine risk factors for venous thromboembolism in transfeminine vaginoplasty. Secondarily, the authors outline reasons why patients are not adequately classified for research purposes despite using relevant queried codes.</p><p><strong>Methods: </strong>Transgender patients undergoing vaginoplasty were identified with diagnostic and procedure-specific codes using a national surgical database from 2010 through 2019.</p><p><strong>Results: </strong>There were 457 transgender vaginoplasties performed, with 24 wound dehiscences, 17 unplanned reoperations, and 12 surgical site infections. With zero cases of venous thromboembolism, risk factor analysis was deferred.</p><p><strong>Conclusions: </strong>Heterogeneity in coding practices for gender-affirming surgery led to an uncharacteristically small cohort of transfeminine vaginoplasty patients captured in the database. Current diagnostic and procedure-specific codes are nonspecific and unbundled, hindering accurate assessment of the incidence of standard surgical complications.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Internal Medicine Advanced Practice Providers Perceive a Benefit in Mentorship?","authors":"Andrea Bequest,&nbsp;Paige Gioia,&nbsp;Sanjay Bhandari,&nbsp;Pinky Jha","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Join the Conversation: Talking About the Health Consequences of Global Heating/Climate Destabilization.","authors":"Bruce Krawisz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Global heating/climate destabilization is likely to be the most serious public health problem in this century. This article encourages health care workers to discuss climate change and provides a short summary of climate change/health information. There are talking points with references that may be of practical use. Although climate change is a global crisis that requires global solutions, by conversing with others, an individual may be able to take effective climate action.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient Pediatric Care and Clinician Workforce in Wisconsin: The State of the State.","authors":"Samantha Busch,&nbsp;Ann Allen,&nbsp;Jen Birstler,&nbsp;Andrea Ildiko Martonffy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Availability of inpatient pediatric services declined across the United States from 2008 through 2018, with rural areas experiencing steepest declines. Despite the movement of pediatric care to children's centers, most children are still cared for in community hospitals nationally. Assessing the availability and providers of inpatient pediatric care in Wisconsin is an important step in ensuring the health care needs of children in the state continue to be met.</p><p><strong>Methods: </strong>A cross-sectional survey was distributed to Wisconsin hospitals to determine pediatric services and physician workforce. The response rate was 130/138 (94%), including 56/58 (97%) critical access hospitals. Results of specific inpatient pediatric subdivisions were analyzed by descriptive statistics.</p><p><strong>Results: </strong>Hospitals that provide inpatient newborn care are mostly staffed by pediatricians and family physicians, while critical access hospitals are staffed by family physicians. Hospitals with neonatal intensive care units are staffed by neonatologists, with telemedicine utilized in critical access hospitals. Hospitals with general pediatric admissions are staffed by pediatricians or family physicians, while critical access hospitals are staffed by family physicians. Hospitals with pediatric intensive care units are staffed by pediatric intensivists.</p><p><strong>Conclusions: </strong>Despite workforce disparities and shortages, hospitals across Wisconsin, including many critical access hospitals, continue to provide inpatient pediatric services. Family physicians play a major role in the pediatric health care delivery in Wisconsin hospitals. Robust inpatient pediatric training of family physicians may enable rural health authorities to continue addressing the gaps that persist in inpatient pediatric care accessibility.</p>","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Health Equity Through the Integration of Mental Health Services Within Primary Care.","authors":"Jeffrey D Shahidullah,&nbsp;Rachel A Petts","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9872624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuing to Address the Shortage of Family Medicine Physicians.","authors":"Joseph E Kerschner","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38747,"journal":{"name":"Wisconsin Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}