WMJ : official publication of the State Medical Society of Wisconsin最新文献

{"title":"A Case of Autoimmune Thyroiditis Presenting as Apraxia.","authors":"Thomas Kolman, Noor Bhatti, Shruti Narayan, Akorfa Adobor, Pinky Jha","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune thyroiditis, commonly referred to as Hashimoto's thyroiditis, is the leading cause of hypothyroidism in iodine-sufficient regions. Neurologic manifestations are uncommon.</p><p><strong>Case presentation: </strong>A 20-year-old female with no significant medical history presented with aphasia and episodes of nonsensical speech. Initial workup was unremarkable, and she was discharged. She subsequently returned with recurrent neurologic symptoms, including apraxia and headache. Further evaluation revealed an elevated thyroid-stimulating hormone (TSH) level and markedly elevated antithyroid peroxidase (anti-TPO) antibodies. A diagnosis of autoimmune thyroiditis was made, and treatment with levothyroxine led to improvement in symptoms.</p><p><strong>Discussion: </strong>Autoimmune thyroiditis can have atypical presentations, particularly in younger individuals. Genetic predisposition and family history may increase susceptibility. Early recognition is critical in identifying cases such as Hashimoto's encephalopathy, which may resolve completely with appropriate treatment.</p><p><strong>Conclusions: </strong>We present a case of autoimmune thyroiditis that manifested solely with neurological symptoms. It is crucial to consider hypothyroidism when treating complex, undifferentiated patients.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 2","pages":"290-293"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207512","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":"Drug-Induced Thrombocytopenia in an Immunosuppressed Renal Transplant Recipient: A Diagnostic and Therapeutic Challenge.","authors":"Mureed Abbas, Hasaan Salman Shafi, Muhammad Talha Sohail, Mobeen Ud Din","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-induced thrombocytopenia (DITP) is a rare but life-threatening disorder, particularly in immunosuppressed patients; it can occur via immune and nonimmune mechanisms. β-lactam antibiotics are infrequently known to cause immune DITP.</p><p><strong>Case presentation: </strong>We present the case of a 30-year-old woman with a history of renal transplantation who developed severe thrombocytopenia while receiving ganciclovir for cytomegalovirus, and meropenem and cefoperazone/sulbactam for sepsis. Despite discontinuing ganciclovir, she developed thrombocytopenia, which worsened upon switching to cefoperazone. Her platelet count improved only after discontinuing both β-lactam antibiotics and the administration of eltrombopag.</p><p><strong>Discussion: </strong>While ganciclovir is a well-known myelosuppressive agent, β-lactam antibiotics such as meropenem and cefoperazone have also been implicated in DITP, particularly via immune-mediated mechanisms. Similar case reports are limited, especially involving immunosuppressed patients requiring complex antimicrobial regimens.</p><p><strong>Conclusions: </strong>Clinicians should monitor patients receiving antibiotics for DITP, particularly those on immunosuppressive therapy. This case underscores the need for close monitoring, early drug discontinuation, and consideration of thrombopoietin receptor agents in severe cases of DITP.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 2","pages":"302-304"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207313","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":"By the Students, for the Students: Operation Conversation Enhances Preclinical Students' Confidence in Challenging Communication Skills.","authors":"Anika Agrawal, Allison Dentice, April Zehm","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Effective communication improves outcomes, yet communication skills training remains underrepresented in preclinical medical education. Operation Conversation, a student-designed and mentored program focused on difficult conversations, was integrated into the core curriculum to address this gap.</p><p><strong>Methods: </strong>Preclinical medical students participated in small-group experiential learning sessions using personally selected, simulated scenarios. Each session included facilitator observation and feedback. Anonymous qualitative comments and quantitative feedback were collected to assess learner satisfaction and changes in self-confidence.</p><p><strong>Results: </strong>Eighty-one percent of participants reported being \"extremely satisfied\" with the program and said they would recommend it to peers. Self-confidence increased across all program objectives, and participants said the exercises were realistic and timely.</p><p><strong>Conclusions: </strong>This student-championed program builds communication confidence through experiential learning and feedback. Learners valued the program and appreciated its relevance. Future work will examine participants' longitudinal communication performance through standardized assessments.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 1","pages":"95-99"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694629","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":"Three-Year Outcomes of a Longitudinal Department of Medicine Fellow as Medical Educator Training Program Pilot.","authors":"Jessica Tischendorf, Christine Sharkey, Kara Westmas, Amy B Zelenksi, Fauzia Hollnagel, Elizabeth Chapman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Health science educators often receive little formal training in teaching methods, which may limit the adoption of evidence-based strategies. Synchronous, less flexible development programs are also difficult for many interprofessional educators to access.</p><p><strong>Methods: </strong>We designed Education Essentials, a modular, asynchronous curriculum to support foundational teaching skill development across health professions. Guided by growth mindset and experiential learning frameworks and informed by our needs assessment, we developed 9 modules aligned with core teaching domains.</p><p><strong>Results: </strong>As of April 2025, 185 unique learners had enrolled in at least 1 of the first 6 modules, with 110 modules completed.</p><p><strong>Discussion: </strong>This curriculum addresses an institutional need and supports scalable, accessible educator development across clinical, basic science, and interprofessional settings.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 1","pages":"221-224"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694646","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":"Assessing Human Papillomavirus Knowledge and Vaccination Intentions Following a Virtual Educational Intervention for Parents and Guardians.","authors":"Lalee Lo, Cristin Marchese, Julia Prajdic, Timika Robertson, Angela Saber, Destiny Self, Lisa Dinkins","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Human papillomavirus (HPV) is the most common sexually transmitted infection globally, with high-risk strains contributing to cancers of the cervix, penis, anus, vulva, vagina, and oropharynx. Despite the availability of an effective vaccine (Gardasil-9) and broad support from public health organizations, vaccination rates remain suboptimal due to parental hesitancy and misinformation. This study assessed the impact of an educational intervention on HPV knowledge and vaccination intent among parents and guardians of children aged 8 to 17 years.</p><p><strong>Methods: </strong>Pharmacy students conducted virtual educational sessions via Zoom for parents of children aged 8 to 17 years. Sessions covered HPV transmission, associated risks, and benefits of Gardasil-9. Participants completed presession and postsession surveys assessing knowledge and willingness to vaccinate.</p><p><strong>Results: </strong>A total of 50 participants attended the sessions; 48 completed the presurvey and 39 completed the postsurvey. Knowledge improved significantly following the intervention (53% vs 90% correct; P<.001). Willingness to vaccinate daughters increased from 68% to 89% reporting \"very willing,\" while willingness to vaccinate sons increased from 70% to 91%. Parents were 1.2 times more likely to report being \"very willing\" to vaccinate their children against HPV after the intervention.</p><p><strong>Conclusions: </strong>A virtual educational intervention significantly improved parental knowledge and positively influenced their intent to vaccinate against HPV. Addressing vaccine hesitancy through structured, accessible educational programs may help increase HPV vaccination rates and reduce the burden of HPV-related cancers.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 3","pages":"349-353"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803967","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":"Clinical Presentation and Diagnostic Patterns of Multisystem Inflammatory Syndrome in Children in a Pediatric Emergency Department.","authors":"Alexander B Rosiejka, Danny G Thomas, Mark Nimmer, Patrick S Walsh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Multisystem inflammatory syndrome in children (MIS-C) is a severe postinfectious complication of COVID-19, and diagnosis remains challenging because of overlapping features with other illnesses. We sought to describe emergency department (ED) evaluations of children with suspected MIS-C at a southeast Wisconsin pediatric referral center and to identify factors that distinguish MIS-C from alternative diagnoses.</p><p><strong>Methods: </strong>This retrospective study included children evaluated for MIS-C in the Children's Wisconsin ED from July 2020 through December 2022. We compared clinical and laboratory characteristics of children diagnosed with MIS-C with those of children with alternative diagnoses and used logistic regression to identify factors associated with MIS-C.</p><p><strong>Results: </strong>Among 792 children evaluated, 86 (11%) were diagnosed with MIS-C; case counts declined over time. Children with MIS-C were older (median age, 7.4 vs 2.9 years; P < .001) and had greater odds of cardiac (OR, 50.4; 95% CI, 27.4-96.4), mucocutaneous (OR, 3.57; 95% CI, 2.18-6.04), gastrointestinal (OR, 2.36; 95% CI, 1.36-4.36), and hematologic (OR, 8.81; 95% CI, 5.41-14.4) system involvement than children with other diagnoses. Odds of MIS-C were reduced among children with a positive non-COVID-19 viral test (OR, 0.12; 95% CI, 0.02-0.41), but alternative diagnoses made before the ED visit were not associated with MIS-C risk.</p><p><strong>Conclusions: </strong>In this cohort of children evaluated for MIS-C in southeast Wisconsin, specific symptoms aligned with MIS-C diagnostic criteria were associated with increased odds of MIS-C, whereas positive non-COVID-19 viral tests were associated with alternative diagnoses. These findings may assist clinicians in risk stratification and diagnostic decision-making for children with suspected MIS-C in the emergency department setting.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 2","pages":"257-262"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207272","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":"Starvation Ketosis Versus Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report Highlighting the Diagnostic Overlap.","authors":"Divya Sai Vunnam, Samantha E Moore, Ram D Pathak","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Starvation ketosis in pregnancy, though rare, is increasingly recognized, underscoring the need for a better understanding of its pathophysiology. Prolonged fasting or inadequate carbohydrate intake leads to elevated ketone levels, which can adversely affect maternal and fetal health. Early diagnosis via ketone monitoring and clinical assessments, is essential. The clinical presentation and laboratory profile of starvation ketosis overlap with euglycemic diabetic ketoacidosis (DKA), often creating a diagnostic dilemma.</p><p><strong>Case presentation: </strong>A 28-year-old female with gestational diabetes presented at 37 weeks of gestation with a 3-day history of nausea, vomiting, and abdominal pain. She had been unable to eat for 60 hours, consuming only small sips of water. Laboratory workup revealed high-anion gap metabolic acidosis with elevated β-hydroxybutyrate. Other causes of high-anion gap metabolic acidosis were ruled out, leading to a diagnosis of starvation ketosis versus euglycemic DKA. The patient was treated with dextrose supplementation to meet caloric needs, along with an insulin infusion. As her nausea improved, she tolerated an oral diet and was gradually weaned off intravenous dextrose. She recovered well and delivered a healthy infant at 38 weeks of gestation via spontaneous vaginal delivery.</p><p><strong>Discussion: </strong>During starvation, the body transitions from glucose to lipid metabolism, producing ketone bodies as an alternative energy source. While ketoacidosis typically develops after 10 to 14 days in nonpregnant individuals, pregnancy-induced insulin resistance increases susceptibility, allowing ketoacidosis to develop within 24 hours, particularly in the third trimester.</p><p><strong>Conclusions: </strong>Treatment of starvation ketosis in pregnancy involves aggressive caloric replacement through dextrose infusions and insulin supplementation. Early intervention and maintaining a high index of clinical suspicion are crucial to prevent adverse complications for both mother and fetus.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 2","pages":"323-326"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207411","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":"Phlegmasia Cerulea Dolens With Compartment Syndrome.","authors":"Aryan Shiari, Ryan Bailey, Jason Beckerman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Phlegmasia cerulea dolens (PCD) is a rare, severe form of deep vein thrombosis (DVT) characterized by extensive venous thrombosis and significant venous congestion, leading to swelling, cyanosis, and severe pain. Unlike typical DVT, PCD causes secondary arterial compromise via small arteriole collapse, resulting in critical limb ischemia and potential venous gangrene. This compromise, coupled with increased compartment pressures and fluid sequestration, makes PCD a true emergency requiring immediate intervention to prevent irreversible damage and limb loss.</p><p><strong>Case presentation: </strong>A 58-year-old woman with a complex medical history presented with severe left hip and lumbar pain following trauma. Examination revealed a swollen, cold, cyanotic, and painful left leg with weak pulses indicating compromised blood flow. Computed tomography confirmed extensive DVT from the left common iliac to the tibial veins, consistent with PCD and concerning for compartment syndrome. Given the critical presentation, fasciotomy was performed without obtaining compartment pressure measurements. The patient received anticoagulation and underwent inferior vena cava filter placement, attempted thrombectomy, and subsequent fasciotomy. Despite these measures, persistent ischemia necessitated a left above-the-knee amputation. Incidental cholangiocarcinoma was subsequently diagnosed, likely contributing to her thrombotic condition.</p><p><strong>Conclusions: </strong>This case highlights the need for prompt diagnosis and intervention in PCD and its progression to compartment syndrome. Underlying malignancy can complicate the clinical course, necessitating a multidisciplinary approach to care. Immediate anticoagulation, thrombus removal, and supportive measures are essential in preventing further complications and improving outcomes.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 2","pages":"316-319"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207442","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":"Severe Morbidity and Mortality From Coronavirus Disease 2019 in Hmong Individuals With Gout.","authors":"Kari Falaas, Michael Schnaus, Elie Gertner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Given the disproportionate impact of coronavirus disease 2019 (COVID-19) on patients with comorbidities -  including gout - and on diverse populations such as the Hmong community, it remains unclear whether a combination of these factors lead to more severe COVID-19 outcomes.</p><p><strong>Methods: </strong>We reviewed the outcomes of 21 Hmong patients with coexisting gout and COVID-19 admitted to 2 tertiary care centers from March 1, 2020, through December 31, 2021.</p><p><strong>Results: </strong>Seven patients required low-flow nasal cannula oxygen, 3 required high-flow nasal cannula, 1 required noninvasive ventilation, and 10 (48%) required mechanical ventilation. The 30-day mortality rate was 57% (n=12).</p><p><strong>Discussion: </strong>The findings highlight a potentially disproportionate burden of severe COVID-19 outcomes among Hmong patients with gout. The high observed mortality raises questions about the role of comorbidities, vaccination disparities, and structural factors contributing to poor outcomes in this population.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 2","pages":"273-275"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207456","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":"Simulation in Medical Education: History, Applications, and Effectiveness.","authors":"Jeffery Northway, Emily Patula, Kaydon Morgan, Farzana Hoque","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based training (SBT) has long played a role in health care education, evolving from rudimentary anatomical models to sophisticated digital platforms. Over time, simulation to include life-like mannequins, standardized patients, and immersive virtual environments, significantly enhancing the ability to teach clinical skills, communication, and decision-making in safe, controlled settings. As medical education continues to adapt to new challenges, simulation remains a cornerstone for preparing health care professionals through realistic and experiential learning.</p><p><strong>Objectives: </strong>This review examines the evolution and current applications of simulation in medical education, highlighting its integration within military and civilian training environments. It describes major simulation modalities, reviews evidence supporting their effectiveness, and evaluates commonly used assessment tools. The review also outlines potential future directions for simulation-based education in response to the evolving needs of modern health care.</p><p><strong>Methods: </strong>Relevant literature was identified through searches of PubMed and other academic databases. Articles were selected based on their relevance to the review objectives, including the historical development of simulation, its applications in diverse educational settings, and emerging technologies shaping the field.</p><p><strong>Results: </strong>SBT has been widely adopted across all levels of health care education - from medical and nursing schools to residency programs and continuing professional development. It enhances technical skills, clinical reasoning, teamwork, and communication in structured environments. Civilian and military programs alike benefit from simulation's ability to replicate complex, high-stakes clinical scenarios. However, measuring its direct impact on clinical performance and patient outcomes remains challenging.</p><p><strong>Conclusions: </strong>SBT is an essential component of modern medical education, enhancing clinical skills and helping bridging the gap between knowledge and practice. As technology advances, simulation offers new opportunities for personalized and scalable learning. Moving forward, educators must implement these innovations thoughtfully, maintaining a focus on empathy and patient-centered care.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":"125 1","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694542","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}