HCA healthcare journal of medicine最新文献

{"title":"Is it Retaliation or Remediation? Educating Our Learners on the Difference.","authors":"France M Leandre, Almari Ginory","doi":"10.36518/2689-0216.2048","DOIUrl":"10.36518/2689-0216.2048","url":null,"abstract":"<p><p>Description 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.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"493-495"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497588","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":"Rectal Fidaxomicin as Salvage Therapy in Fulminant <i>Clostridioides difficile</i> Infection After Total Colectomy: A Case Report.","authors":"Akankcha Alok, Mohamed Ismail, Stephanie P Fabara, Mohammed Al Said, Vidya Sagar Kollu","doi":"10.36518/2689-0216.1843","DOIUrl":"10.36518/2689-0216.1843","url":null,"abstract":"<p><strong>Introduction: </strong><i>Clostridioides difficile</i> 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 <i>C difficile</i> and spares the normal intestinal microbiota, which may contribute to its favorable outcomes.</p><p><strong>Case presentation: </strong>Our case study involves a 79-year-old man with worsening symptoms post-amoxicillin/clavulanic acid use. Diagnosed with septic shock from <i>C difficile</i> and toxic megacolon, the patient started on oral vancomycin and metronidazole, followed by rectal vancomycin, per guidelines, also requiring vasopressors and renal replacement therapy. Despite initial treatment, his condition deteriorated, after which he underwent a sub-total colectomy without improvement. He was eventually started on rectal fidaxomicin and loperamide, resulting in rapid improvement. This case introduces rectal fidaxomicin as a novel approach for FCDI treatment with unique preparation and administration methods.</p><p><strong>Conclusion: </strong>An extensive review of the literature found only a few instances of rectal fidaxomicin use for FCDI, suggesting its novelty and rarity. The successful outcome prompts further studies to validate its efficacy and its possible inclusion in future treatment guidelines. In summary, this case underscores the complexity of FCDI management and highlights the potential of rectal fidaxomicin as a salvage therapy. Further research is warranted to elucidate its role in treating FCDI and incorporating it into clinical practice guidelines.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"429-433"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497622","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 MAHEC Research Certificate Program: A Brief and Introductory Exposure to Key Research Topics for Diverse Learners.","authors":"Grace E Flinchum, Emily S Mazure, Chelsea C Atkins, Wendy Nuzzo, C Micha Belden, Edward C Jauch, Jacqueline R Halladay","doi":"10.36518/2689-0216.1966","DOIUrl":"10.36518/2689-0216.1966","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 for interdisciplinary learners that avoided costs to the user, kept learning sessions under 30 minutes, could be fully completed online, and could be incorporated into larger research courses. We created 8 modules by vetting freely available online resources or produced original content if existing resources were deemed inadequate. Additionally, we developed our evaluation processes.</p><p><strong>Results: </strong>The MAHEC Research Certificate Curriculum was implemented, and several GME programs, and other educational programs, incorporated the modules into their research curriculum. Preliminary results demonstrate that learner confidence on all 8 research topics improved after module completion. Overall, participants were highly satisfied with the curriculum and were likely to recommend the modules to peers.</p><p><strong>Conclusion: </strong>This research curriculum fills a need for a free, brief, accessible, and asynchronous online research training program for learners. The curriculum can be used to supplement existing research didactic training in professional programs, to support researchers reviewing specific research topics, and/or to introduce research concepts to inexperienced researchers, all of whom can receive an automatically generated certificate of completion.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"485-492"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497650","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":"Rapid Percutaneous Nephrostomy Stent Encrustation in Pregnancy: Navigating Your Stone Challenge.","authors":"Victor M Feldbaum, Roberto Morales, Shawn R Ramsey, Michael L Douso","doi":"10.36518/2689-0216.1949","DOIUrl":"10.36518/2689-0216.1949","url":null,"abstract":"<p><strong>Background: </strong>Surgical management of kidney stones in pregnancy can be a serious problem for both mother and fetus.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusion: </strong>At the time of writing, this was the first case to describe a stent encrustation remnant in pregnancy. This case illustrates the need for timely follow-up after interventional radiology procedures and the potential complications a pregnant patient can encounter with surgical interventions, such as a nephrostomy tube. This case highlights stone challenges that obstetricians, internists, urologists, and radiologists should be aware of when managing the most common nonobstetrical cause of admission in pregnancy.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"435-439"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497609","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":"Spontaneous Pneumomediastinum Following Ingestion of Bleach, Dish Soap, and Laundry Detergent and Inhalation of Methamphetamines.","authors":"Marshall Johnson, Matthew Boss, Alayna S Buzzetta, Barbara L Gracious","doi":"10.36518/2689-0216.2060","DOIUrl":"10.36518/2689-0216.2060","url":null,"abstract":"<p><strong>Introduction: </strong>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 can be further divided into primary and secondary causes; the main difference is that secondary SPM requires a preexisting condition (ie, lung disease). Primary SPM is considered when trauma or any iatrogenic causes are ruled out. Secondary SPM, which is more common, is usually seen with esophageal perforation. Few case reports have been published connecting the inhalation of marijuana, cocaine, and the use of opioids to SPM, and, until now, no published data links the ingestion of cleaning products to SPM.</p><p><strong>Case presentation: </strong>This case report presents a 28-year-old White man who developed a SPM following the ingestion of bleach, dish soap, and laundry detergent and the inhalation of methamphetamines. This case report highlights the potential for chemical-induced pneumomediastinum and emphasizes the importance of considering unusual etiologies in patients presenting with acute chest pain and respiratory distress after chemical exposures with a suicide attempt.</p><p><strong>Conclusion: </strong>Spontaneous pneumomediastinum is due to a pressure change within the thoracic cavity as a result of air leakage. This has been commonly seen with certain risk factors, such as cystic fibrosis, chronic obstructive pulmonary disease, and, most commonly, Boerhaave's syndrome. However, there are other less commonly known risk factors that can predispose a patient to or contribute to them developing SPM, including methamphetamine use and inhalation of laundry chemicals.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"469-477"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497619","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":"Nonglomerular Hypocomplementemic Interstitial Nephritis.","authors":"Tyler Hemphill, Yogesh Sanghvi","doi":"10.36518/2689-0216.2067","DOIUrl":"10.36518/2689-0216.2067","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case presentation: </strong>A woman in premenopause, with no significant past medical history, other than a remote history of seizures, presented to the emergency department (ED), in cardiac arrest, via emergency medical services (EMS). When EMS arrived, she was noted as hypotensive and tachycardic with agonal respirations, having received 3 rounds of defibrillation in the field. Per rapid assessment, the patient received CPR from a bystander for an unknown amount of time. Upon arrival at the ED, the patient again went into cardiac arrest, requiring 5 rounds of CPR, with 3 separate administrations of epinephrine, followed by intubation with mechanical ventilation. Initial labs presented significant results for acute respiratory acidosis without renal compensation, leukocytosis, elevated troponin consistent with myocardial infarction, mild normocytic anemia, and intrarenal AKI. Imaging was significant for a suprarenal mass, later confirmed to be pheochromocytoma. Over the next few days, the patient developed anuric kidney failure requiring dialysis, and a kidney biopsy was obtained for confirmation of AIN. However, she was also noted to have decreased complement, which is not typically found in interstitial nephritis.</p><p><strong>Conclusion: </strong>We encountered a patient with interstitial nephritis and low complement level. The reason behind this rare phenomenon remains unclear in recent literature. As of 2024, only 11 other known cases of AIN have been found to have hypocomplementemia, making it a rare and curious pathophysiological process. More research and data are needed for further investigation into this exciting new pathology, its fundamental process, and potential treatment variations aside from those already used in AIN.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 5","pages":"479-483"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12600042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497668","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":"Ovarian Dysgerminoma With Tubo-Ovarian Torsion in an 11-Year-Old Child: A Rare Occurrence but a Significant Differential Diagnosis in Acute Abdomen.","authors":"Charu Chandra, Keeranmayee Mishra, Rahul Mangal, Chirag Doshi, Apurba Anshuman Mishra","doi":"10.36518/2689-0216.1992","DOIUrl":"10.36518/2689-0216.1992","url":null,"abstract":"<p><strong>Background: </strong>Ovarian tumors are quite uncommon in the premenarchal age group, with the majority being functional cysts. Malignant tumors are unusual in this age group, making the diagnosis of ovarian malignancy in children quite challenging. Dysgerminoma is the most common malignant ovarian germ cell tumor in females. The clinical symptoms often include abdominal pain, distension, a palpable mass, reduced appetite, nausea, and vomiting.</p><p><strong>Case presentation: </strong>We discuss the case of an 11-year-old premenarchal girl who was brought to the emergency department with abdominal pain persisting for 3-4 days, which had intensified over the 24 hours before she arrived at the emergency department. The pain was accompanied by vomiting. On examination, her lower abdomen showed tenderness, guarding, and rigidity, and a firm mass approximately 10 x 8 cm in size was palpable in the midline. Ultrasonography of the abdomen and pelvis revealed a large hypoechoic mass lesion, approximately 99 x 56 x 92 mm, in the right adnexa. A magnetic resonance imaging with contrast of the abdomen and pelvis was performed for confirmation, which substantiated the diagnosis of the right ovarian lesion with torsion. Following the patient's exploratory laparotomy, a right salpingo-oophorectomy and left oophoropexy were performed. The histopathological report confirmed the diagnosis of dysgerminoma.</p><p><strong>Conclusion: </strong>Malignant ovarian tumors are quite rare in the premenarchal age group, and the primary goal should be to offer fertility-preserving surgeries. This allows the individual to retain reproductive functions. However, close monitoring is essential, and if needed, radical surgery should be considered to save the patient's life.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"367-372"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066246","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":"Educational Point-of-Care Ultrasound Discovers Adrenal Cortical Carcinoma, a Case Report: Clinical Implications and Review of the Literature.","authors":"Minh Q Ngyuyen, Moshe Bengio, Vu H Tran","doi":"10.36518/2689-0216.1944","DOIUrl":"10.36518/2689-0216.1944","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) has become an indispensable tool for emergency physicians in assessing intra-abdominal pathology due to its real-time visualization, portability, and cost-effectiveness. While POCUS is not traditionally focused on adrenal gland assessment, incidental findings of adrenal masses during examinations have been reported. Our patient presented with a chronic obstructive pulmonary disease (COPD) exacerbation and was found to have a large adrenal mass, discovered incidentally, during thoracic ultrasound.</p><p><strong>Case presentation: </strong>This case report presents the discovery of an adrenal mass in a patient with respiratory distress due to a COPD exacerbation, emphasizing the importance of sonographers' ability to identify abnormal imaging within their POCUS framework. The clinicians promptly communicated the incidental finding to the patient, leading to further imaging and labs while in the emergency department and subsequent hospital admission. Traumatic arteriovenous fistulas and visceral vascular injuries are rare.</p><p><strong>Conclusion: </strong>Although adrenal glands are not the primary focus for emergent pathology, the identified mass prompted a comprehensive evaluation, ultimately revealing a nonhormone-secreting adrenal cortical carcinoma. The rarity of this malignancy and the discrepancy between imaging and laboratory results underscore the need for a thorough investigation, with the focus suggesting that POCUS, despite its limitations, can play a crucial role in prompting additional imaging for accurate diagnosis and informed patient management. This case also highlights the significance of transparent communication while empowering patients and guiding further investigations for a comprehensive understanding of the pathology.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"349-354"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066551","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 Hard Problem: Managing Constipation in the Geriatric Population.","authors":"William G Jones, Veeraen Jonnalagadda, Alexandra E Thomson, Victoria Grumbles, Chase Cottle, Christian Robertson, Maulikkumar Patel","doi":"10.36518/2689-0216.1955","DOIUrl":"10.36518/2689-0216.1955","url":null,"abstract":"<p><p>Description Constipation is a common condition among geriatric patients with different presenting symptoms and potential serious complications. Additionally, the condition causes a significant burden on our healthcare system. Here, we summarized recommendations from several societies, including the American College of Gastroenterology, American Geriatrics Society, and American Academy of Family Physicians to provide guidance on managing constipation with geriatric patients. Our aim was to emphasize the importance of prevention of constipation in this population and methods to do so. We also give recommendations on how to manage constipation when it does develop and how to manage it across different healthcare settings. These recommendations should aid providers in managing this prevalent and burdensome condition.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"303-309"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066508","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":"An Acknowledgement to the <i>HCA Healthcare Journal of Medicine</i>'s Reviewers and Editors for the First Half of 2025.","authors":"Juan A Sanchez, Graig Donini","doi":"10.36518/2689-0216.2333","DOIUrl":"10.36518/2689-0216.2333","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":"6 4","pages":"299-301"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066482","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}