Wisconsin Medical Journal最新文献

Introduction: Blastomycosis is a rare pyogranulomatous infection that most commonly involves the lungs and sometimes the skin. Other manifestations are much less common. Diagnosis relies on biopsy, histopathology, and culture of suspicious lesions.

Case presentation: In this case, a healthy 42-year-old male from Wisconsin presented to the emergency department with a chief complaint of 2 weeks of knee pain without a clear mechanism of injury. Upon further examination, he was found to have lesions on his abdomen, which he had first noticed over 3 years prior and had been treated with antibiotics as cellulitis for nearly 18 months. Biopsy of these lesions was consistent with blastomycosis infection, and further work-up and examination was notable for brain and laryngeal lesions without any pulmonary involvement. Intense anti-fungal treatment was immediately initiated with dramatic improvement in his symptoms.

Discussion: This case highlights the importance of a thorough physical exam and consideration of rare infections in cases without clear answers. To our knowledge, this is the first published example of a blastomycosis infection involving brain, laryngeal, skin, and knee lesions without pulmonary infection.

Introduction: Massive transfusion may cause ionized hypocalcemia, a complication that, when severe, causes hemodynamic instability. Extant literature fails to provide effective guidance on replacement strategies to avoid severe ionized hypocalcemia in the most extreme situations.

Case presentation: We discuss a liver transplant in which our empiric calcium replacement strategy resulted in no critically low ionized calcium values during the pre-reperfusion phase of a liver transplant with over 140 000 mL of bank blood transfusion, with an average of 10 000 mL per hour for 14 hours.

Discussion: Few comparable reports exist. Most rely upon monitoring with subsequent replacement, but these have not been effective at avoiding severely low ionized calcium values.

Conclusions: Our empiric calcium replacement strategy of 1 gram of calcium chloride per liter of citrated bank blood transfused, in 200 mg/200 mL increments, resulted in successful maintenance of ionized calcium during the anhepatic phase of liver transplantation while on continuous veno-venous hemofiltration.

Background: Monitoring suicide rates is an important public health strategy to inform prevention efforts. We describe rates of adult suicide in Milwaukee County, Wisconsin, over a 19-year period.

Methods: Data on all adult suicides from 2002 through 2020 (n = 981) were obtained from the Milwaukee County Medical Examiner's Office. Subpopulation rates were identified using the Wisconsin Interactive Statistics on Health System.

Results: Suicide rates increased significantly over the study period, with disproportionate increases among Black and Latinx residents.

Discussion: Expanded prevention efforts are needed to reverse this concerning trend. Further research should guide development of culturally relevant interventions, provide data for the equitable allocation of limited resources.

Background: Uterine fibroid diagnosis and management can be delayed by a lack of access to care. To combat this barrier, this study aimed to determine gaps in knowledge and investigate areas of education interest.

Methods: Obstetrics-gynecology, family medicine, and internal medicine resident and attending physicians received an electronic survey via RedCap. Descriptive statistics were performed in Mintab and Excel.

Results: Seventy of the 316 physicians (22%) who received the survey completed it. Most participants answered questions regarding diagnosis timing, instruments for validated reported outcomes, and risk factors incorrectly. Seventy-six percent of respondents desired more education about treatment options and guidelines.

Discussion: This study provides insight regarding current knowledge of uterine fibroids and areas of educational interest among different physicians.

Objective: Health At Every Size is a paradigm that encourages body acceptance, intuitive eating, and other principles to increase healthy, peaceful living. The model is accepted by many in the mental health field, but in order for its principles to become standard in clinical (medical) care, clinician perspectives on Health at Every Size should be sought and understood.

Methods: Ten clinicians were interviewed (4 physicians, 2 nurse practitioners, and 4 physician assistants). Participants reviewed the HAES principles, and identified facilitators and barriers to respectful, weight-inclusive care.

Results: Most clinicians felt that body mass index is a useful, standard metric, but it is inadequate and can be a cause of distress. Providing non-weight-focused care was identified as the primary facilitator to respectful care.

Discussion: Participants viewed body mass index as useful in some scenarios but do not think it encompass a patient's well-being and has the potential to cause the patient distress (eg, perpetuating weight stigma). Barriers to using Health At Every Size in clinical practice included the need for clinician education, bias/stigma, and a focus on weight.

Introduction: The importance of the inclusion of sex and gender medicine (SGM) in medical education has been recognized formally by both the American Association of Medical Colleges and the Department of Health and Human Services since 1995. Yet, few medical schools, including the Medical College of Wisconsin, have a standard SGM curriculum. This work mapped the SGM health topics taught in the Medical College of Wisconsin preclinical curriculum.

Methods: Seven medical students audited 16 basic science preclinical courses in 2020-2021. SGM characterizations, including epidemiology, diagnosis, presentation, treatment, prognosis, pharmacology, and disparity, were captured by an online survey tool. Comparisons were made to 38 high-yield topics presented in the textbook "How Sex and Gender Impact Clinical Practice: An Evidence-Based Guide to Patient Care."

Results: Of the 604 preclinical sessions audited, 54% contained some SGM content. Epidemiology was the most common characterization (23% of total). Thirty-four of the 38 high-yield clinical SGM topics received mention in the basic science sessions. Breast cancer, stroke, osteoporosis, sex and gender considerations in therapeutic response, and systemic lupus erythematosus had the most frequent SGM-specific coverage (representation in at least 4 of the 16 preclinical courses).

Conclusions: Utilizing a medical student cohort to thoroughly audit courses was an effective way to document that Medical College of Wisconsin preclinical curriculum introduces many clinically relevant SGM topics. However, the audit also discovered varying levels of detail among the high-yield topics with concern that students may not be adequately prepared to treat all patients. These results establish the groundwork for a more formalized and integrated approach to include SGM in preclinical curriculum.

Trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine are individually associated with methemoglobinemia through a series of altered reduction-oxidation reactions. We report a case of methemoglobinemia associated with concurrent use of TMP/SMX and phenazopyridine in a 70-year-old woman with recurrent urinary tract infections. She presented to the emergency department for worsening back pain in the setting of recurrent urinary tract infections, concerning for pyelonephritis. During her workup, she became acutely hypoxic. The emergency department provider suspected the presence of abnormal hemoglobin. An arterial blood gas showing elevated levels of methemoglobinemia confirmed the suspicion. The combined use of TMP/SMX and phenazopyridine was thought to be the likely etiology of hypoxia. This case highlights the importance of medication management in the geriatric population, as well as the judicious use of antibiotics for urinary tract infections-a common chief complaint in the primary care setting.

Background: Primary care physicians are often the first to identify signs and symptoms concerning for cancer. An important aspect of cancer screening is thorough skin examinations and subsequent referral to a dermatologist for atypical cutaneous presentations, which may be associated with an underlying visceral malignancy. Diagnostic considerations for pruritus without dermatitis ("itch without rash") in adults include senile pruritus, medication reaction, and paraneoplastic syndrome. Recognition of cutaneous manifestations of cancer should prompt cancer screening by primary care providers.

Objective: To update practicing physicians on current cancer screening guidelines with a specific focus on cutaneous clues to prompt further workup.

Methods: American Cancer Society and United States Preventive Services Task Force guidelines were systematically reviewed using PubMed and organizational websites during August and September, 2021, with review of Task Force Guidelines during October, 2022.

Results: Colorectal, cervical, breast, lung, skin, prostate, ovarian, hematologic, pancreatic, thyroid, testicular, bladder, oral, and gastric cancer screening guidelines are summarized.

Conclusions: Primary care physicians can recognize atypical cutaneous conditions and facilitate referral to a dermatologist for evaluation and/or directly order tests themselves to initiate appropriate cancer screening.