HCA healthcare journal of medicine最新文献

{"title":"An Acknowledgement to the <i>HCA Healthcare Journal of Medicine</i>'s Reviewers and Editors for the First Half of 2024.","authors":"Bruce Deighton, Graig Donini","doi":"10.36518/2689-0216.2041","DOIUrl":"https://doi.org/10.36518/2689-0216.2041","url":null,"abstract":"<p><p>Description The <i>HCA Healthcare Journal of Medicine</i> would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Complexity of Nocardia Septic Arthritis in an Immunocompromised Patient: A Case Report.","authors":"Steven A Kessler, Meghan R Mansour, Ali Khreisat, Mamon Tahhan","doi":"10.36518/2689-0216.1694","DOIUrl":"https://doi.org/10.36518/2689-0216.1694","url":null,"abstract":"<p><strong>Background: </strong>Nocardiosis is the systemic manifestation of <i>Nocardia</i> infection, often found in immunocompromised individuals. <i>Nocardia</i> are transmitted via inhalation or skin wounds, disseminating hematogenously to organs and rarely, joints. We present a patient with immunosuppression who developed gout of the knee with superimposed Nocardial septic arthritis and a possible subsequent systemic infection.</p><p><strong>Case presentation: </strong>A 74-year-old man presented with left lower extremity swelling and pain. He was taking immunosuppressive medication for antineutrophilic cytoplasmic antibody-positive vasculitis. A week prior, an arthrocentesis test was positive for gout. He received prednisone without improvement. A repeat arthrocentesis was positive for <i>Nocardia farcinica</i> septic arthritis. Chest imaging showed subpleural nodules. After failed antibiotics, a susceptibilities test yielded results that favored linezolid. The patient exhibited acute anemia from hematomas intramuscularly above the infection, which resolved with transfusions. Immunosuppression was stopped, and the patient recovered appropriately after the correct antibiotics were administered.</p><p><strong>Conclusion: </strong>This case involves septic arthritis with possible pulmonary nodule involvement, showcasing the complexity of infections in immunocompromised individuals. Clinicians should maintain adequate suspicion for an infectious cause of arthritis in patients with immunosuppression. In our case, the hematomas are a curious finding, without known etiology. The question of when and how to reintroduce immunosuppressive agents while preventing the recurrence of nocardiosis remains a complex consideration.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrower's Fracture With Subsequent Compartment Syndrome Requiring Emergent 2 Compartment Upper Extremity Fasciotomy.","authors":"Andrew Wise, Darwin Ang","doi":"10.36518/2689-0216.1727","DOIUrl":"https://doi.org/10.36518/2689-0216.1727","url":null,"abstract":"<p><strong>Introduction: </strong>A thrower's fracture is a mid-to-distal third humerus fracture that commonly presents as an audible pop with severe arm pain sustained during the throwing motion. Although thrower's fracture has been described previously in the literature, this report is the first to demonstrate compartment syndrome as its potential sequel.</p><p><strong>Case presentation: </strong>A 25-year-old semi-professional pitcher presented to the emergency department with severe right arm pain following a pitch. He described hearing an audible pop with subsequent severe pain. He was found to have elevated compartment pressures in his upper arm and was rushed to the operating room for a 2 compartment fasciotomy. The thrower's fracture classically presents as an audible pop with subsequent arm pain in male patients aged 20-30 years during the acceleration phase of throwing. A potential well-known sequel is radial nerve palsy, which occurs in roughly 5-11% of patients. A sequel which has not been previously described is the subsequent development of compartment syndrome.</p><p><strong>Conclusion: </strong>Compartment syndrome should be monitored in patients with thrower's fractures, as it is a limb-threatening condition that can subsequently develop.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Patients Hospitalized to Community Hospitals With Malignant Brain Tumors and Factors Associated With Discharge Destination.","authors":"Se Won Lee, Thanapath D Thantacheva, Denny Mack","doi":"10.36518/2689-0216.1698","DOIUrl":"https://doi.org/10.36518/2689-0216.1698","url":null,"abstract":"<p><strong>Background: </strong>Our main objective was to compare the characteristics and hospital outcomes of patients with primary and metastatic brain malignancies and to investigate the associated factors related to hospital outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective, cross-sectional study of 1628 patients with brain malignancies from 8 community hospitals between 2017 and 2022 who were identified using International Classification of Disease codes. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge.</p><p><strong>Results: </strong>The median age was 65 years old, with 72.5% of patients having metastatic brain malignancies. After 7.2 days of hospital stay, 49.2% were discharged home, and 102 patients expired during hospitalization. Increased age, medical coverage by Medicare, hemiplegia or paraplegia, lower initial hemoglobin level, increased length of stay, and the use of electrolyte replacement, antibiotics, laxatives, heparin, and anticonvulsants were associated with a decreased likelihood of discharge to home. No medical insurance, Medicaid insurance coverage, comorbidities of cerebrovascular disorder, the need to stay in the intensive care unit, patient safety indicator events, and the use of antibiotics, oral analgesics, and ipratropium-albuterol were associated with increased odds of in-hospital mortality.</p><p><strong>Conclusion: </strong>We identified several predictor variables that delineate differences between both mortality risk and home discharge in patients with primary and metastatic brain tumors. Understanding these predictor variables can be helpful in improving the acute and post-acute care of this population.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Hemolytic Uremic Syndrome Following Influenza B: A Case Report.","authors":"Kathryn E McGraw, Amanda P Porter, Alyssa M Moffitt, Marina E M Golden, Heather Stewart","doi":"10.36518/2689-0216.1669","DOIUrl":"https://doi.org/10.36518/2689-0216.1669","url":null,"abstract":"<p><strong>Background: </strong>Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy that presents with a triad of hemolytic anemia, thrombocytopenia, and acute kidney impairment. It can be attributed to mutations in an array of different complement proteins leading to the overactivation of the complement system, the most impacted being the alternative pathway. Though rare, influenza B has been documented as a potential trigger to the development of aHUS.</p><p><strong>Case presentation: </strong>We discuss a 10-year-old girl with a history of aHUS who was found to have a repeat episode of aHUS following an influenza B infection. There have only been a few reports of aHUS triggered by influenza B, making this a unique case. Given the recurrence and atypical features present in this case, a genetic workup was obtained, which showed a heterozygous mutation of complement protein CD46. The presence of mutations in CD46 is a known predisposing factor to aHUS, but influenza B infection is rarely implicated as a trigger to aHUS. The prognosis of aHUS varies and is dependent on the complement mutation specific to the individual.</p><p><strong>Conclusion: </strong>Patients with CD46 mutations have been shown to have high rates of relapse but less long-term kidney damage, as seen in this case. Clinicians should be aware of the association between influenza B and aHUS to improve patient outcomes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Targeted Genetic Evaluation of an Idiopathic Neuropathy Cohort Through ATTRv Amyloidosis Screening.","authors":"Kristy A Fisher, Santiago Diaz, Jeffrey Gelblum, Charles Brock, Niraja Suresh, Meghan Towne","doi":"10.36518/2689-0216.1557","DOIUrl":"https://doi.org/10.36518/2689-0216.1557","url":null,"abstract":"<p><strong>Background: </strong>While the reported prevalence of polyneuropathies is 1%-3%, the incidence of hereditary transthyretin amyloidosis in the United States is estimated to be 1 in 100 000 individuals. Polyneuropathies are known to be difficult to treat and lead to significant morbidity. The aim of pain management is symptomatic treatment, with varying approaches to progression prevention being based on the causative pathophysiology.We assessed the prevalence of hereditary amyloid transthyretin variant (ATTRv) amyloidosis, a progressive autosomal dominant multisystem disease caused by the abnormal formation and extracellular deposition of transthyretin protein fibrils in various tissues, in an idiopathic polyneuropathy population by using genetic analysis.</p><p><strong>Methods: </strong>Individuals aged 18 and over with an established diagnosis of polyneuropathy, via electromyography testing that was deemed to be idiopathic, at a large, urban neurology clinic consented to an institutional review board-approved protocol for genetic testing. No further exclusions were made regarding age of onset, family history, axonal neuropathy subtype, comorbidities suggestive of ATTRv amyloidosis, etc. Clinical genetic testing was performed on 134 participants via an 81-gene panel associated with inherited neuromuscular disorders or targeted <i>TTR</i> gene sequencing with deletion and duplication analysis.</p><p><strong>Results: </strong>Within our cohort, 38.06% had at least one reportable finding in one of 38 distinct genes, for a total of 76 reported alterations. Four individuals were identified as having a single pathogenic alteration in an autosomal recessive gene, consistent with carrier status for the 4 following disorders: congenital insensitivity to pain with anhidrosis (NTRK1), Charcot-Marie-Tooth disease type IIP (LRSAM1), Brown-Vialetto-Van Laere syndrome type II (SLC52A2), hereditary sensory and autonomic neuropathy type III (IKBKAP). One individual was found to have a variant of uncertain significance (VUS) (p.G103D) in the <i>TTR</i> gene.</p><p><strong>Conclusion: </strong>Precision medicine on the molecular level with genetic testing in the identification of specific neuropathies may provide clinicians with more detailed information for developing a more direct therapeutic and treatment modality for better-targeted management. Further investigation is needed to expand on the knowledge and understanding of the clinical relevance surrounding the alterations found in the genetic evaluation of idiopathic neuropathy.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Right-Sided Posterolateral Diaphragmatic Hernia in an Adult Presenting as an Incarcerated Large Bowel Obstruction: A Case Report.","authors":"Tanya J T Starr, Andrew G Nicholson, Maximilian J H Starr, Jessica A Traxler, Peter Y Chu","doi":"10.36518/2689-0216.1735","DOIUrl":"https://doi.org/10.36518/2689-0216.1735","url":null,"abstract":"<p><strong>Introduction: </strong>A diaphragmatic hernia (DH) is a defect within a part of the diaphragm that allows intra-abdominal contents to enter the thoracic cavity. Diaphragmatic hernias can be congenital or acquired later in life. The most common congenital DH is the Bochdalek hernia (posterolateral hernia), but the most commonly acquired DH is due to traumatic injury. These hernias are rare in adults and are typically diagnosed incidentally. Surgical repair is the standard of care; however, data regarding the surgical approach is scarce. We report a case of a rare right posterolateral DH in an adult female patient who presented with acute abdominal pain.</p><p><strong>Case presentation: </strong>A 69-year-old female presented with recurrent epigastric pain that had acutely worsened, nausea, vomiting, and food intolerance. A computed tomography (CT) scan demonstrated a right posterolateral DH containing the hepatic flexure of the colon. The patient was taken urgently to surgery due to concern for strangulation. Reduction of the hernia was attempted laparoscopically but was converted to an open procedure with a subcostal incision due to poor visualization. This approach revealed adequate exposure of the defect and subsequent reduction of the herniated abdominal contents. The defect was easily closed without tension or the use of mesh. The patient was discharged on postoperative day 3.</p><p><strong>Conclusion: </strong>Chronic DH can have severe life-threatening sequelae when left untreated. This case demonstrates the importance of thorough history-taking and raises awareness of missed diaphragmatic injuries in trauma situations. Since patients who present with a symptomatic DH often need urgent repair, it is important for surgeons working in the acute care setting to understand the surgical options available and when mesh placement may benefit the situation. Our case outlines a successful primary defect repair, without mesh, of a right-sided DH in which a minimally invasive technique was attempted but converted to laparotomy for patient safety.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Infinite Corridor.","authors":"Houyar Moghaddas","doi":"10.36518/2689-0216.2037","DOIUrl":"https://doi.org/10.36518/2689-0216.2037","url":null,"abstract":"<p><p>Description This photograph was chosen as a visual representation of the poem \"Theory of a Well Mind\" to capture the essence of the poem's exploration of the human psyche and the journey toward mental wellness. The corridor, with its repeating arches and vanishing point, symbolizes the cyclical nature of thoughts, emotions, and actions that the poem delves into. Just as the corridor seems to stretch into infinity, the poem reflects on the seemingly endless and challenging process of personal growth and self-discovery. The contrast between light and shadow within the image mirrors the poem's themes of introspection, uncertainty, and the pursuit of clarity amidst the complexities of the mind. The light that filters through the arches and windows represents moments of insight and hope, while the shadowed areas evoke the difficulties and unknowns that one encounters on the path to wellness.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Post-Suicide Survey: The Perspective We Have Been Missing.","authors":"Matthew Larsen, Cassandra Sauther, Ryan Sauther, Justin Solomon","doi":"10.36518/2689-0216.1674","DOIUrl":"https://doi.org/10.36518/2689-0216.1674","url":null,"abstract":"<p><strong>Background: </strong>Suicide is a major problem in the United States and in the state of Idaho. Prevention data are lacking for suicide primarily because information about those who completed suicide is not attainable. There are no published data from surveying the family members of the deceased. Our objective was to learn more about those who died by suicide by surveying family members or close contacts of the deceased.</p><p><strong>Methods: </strong>We conducted a descriptive study using a 77-question survey to obtain information about those who died by suicide, with the survey being completed by their loved ones. Survey questions addressed the deceased's demographics, employment, mental health, substance use, access to lethal means, cultural and religious beliefs, relationships, etc. The survey was distributed in Southeast Idaho for 3 months.</p><p><strong>Results: </strong>Results showed that those who died by suicide in Southeast Idaho were predominantly: White (95%), male (77%), had no previous hospitalization for mental illness (76%), had a firearm in their home (66%), their religious beliefs matched those in their family and community (73%), they did not alert others or seek medical help (79%), had attempted suicide before (55%), had high stress in their most recent relationship (55%), or had current legal issues (54%). Firearms were the most common means of death (51%).</p><p><strong>Conclusion: </strong>In Southeast Idaho, our data suggested those at the highest risk of suicide were White men who previously attempted suicide, were experiencing a relationship change, had legal trouble, and had quick access to a firearm in their home. Suicide prevention efforts should be focused on these risk factors.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Granulomatous Lobular Mastitis: A Case Report.","authors":"Wendy M Timirau, Esra Sari, Maham Shahid, Nilmarie Guzman, Augusto Villegas","doi":"10.36518/2689-0216.1684","DOIUrl":"https://doi.org/10.36518/2689-0216.1684","url":null,"abstract":"<p><strong>Introduction: </strong>Idiopathic granulomatous mastitis (IGM), also known as nonpuerperal mastitis or granulomatous lobular mastitis, is a rare, benign, chronic inflammatory breast disease first characterized in 1972. IGM is characterized by sterile noncaseating lobulocentric granulomatous inflammation, usually affecting parous premenopausal women with a history of lactation.</p><p><strong>Case presentation: </strong>We present a 38-year-old African American woman presenting to our continuity clinic complaining of a painful right breast mass discovered during a self-breast examination. An initial right breast ultrasound demonstrated an area of concern with asymmetry, architectural distortion, and a questionable mass correlating to a 5.1 cm hypoechoic mass at the 12:30 position. Additionally, a mammogram showed a suspicious, indeterminate, large hypoechoic region or mass with angular margins measuring 5.1 x 1.7 x 3.7 cm with slight internal vascularity. An ultrasound-guided stereotactic biopsy revealed extensive mixed inflammatory and focal granulomatous lobular mastitis.</p><p><strong>Conclusion: </strong>Idiopathic granulomatous mastitis is a rare disorder that often mimics breast malignancies and infectious processes. This case highlights the need for further research on IGM pathogenesis to prevent unnecessary life-altering therapeutic procedures and bring awareness to the medical community.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}