Wisconsin Medical Journal最新文献

Introduction: Neurologic complications of hyperglycemia are common. Cases of seizures and hemianopia related to nonketotic hyperglycemia have been reported but are rare with diabetic ketoacidosis.

Case presentation: We present clinical, laboratory, and radiologic findings in a patient with diabetic ketoacidosis associated with generalized seizure and homonymous hemianopia, with a literature review of reported cases.

Discussion: Neurologic complications of hyperglycemia are many, but seizure with hemianopia is most commonly associated with nonketotic hyperosmolar hyperglycemia rather than diabetic ketoacidosis.

Conclusions: Generalized seizure and retrochiasmal visual field defect are known neurological complications of diabetic ketoacidosis. Like nonketotic hyperosmolar hyperglycemia, these neurological symptoms are transient, and the structural changes in magnetic resonance imaging are usually reversible.

Introduction: Fremanezumab is a humanized monoclonal antibody administered through a subcutaneous injection. It is used for treatment of migraines, and occasional injection site reactions have developed after usage.

Case presentation: This case report describes a nonimmediate injection site reaction on the right thigh of a 25-year-old female patient after starting treatment with fremanezumab. The injection site reaction presented as 2 warm, red annular plaques 8 days following a second injection of fremanezumab and about 5 weeks following the first injection. She was prescribed a 1-month course of prednisone that relieved her symptoms of redness, itching, and pain.

Discussion: Similar nonimmediate injection site reactions have been reported before, but this particular injection site reaction was significantly more delayed.

Conclusions: Our case illustrates that injection site reactions to fremanezumab can be delayed after the second dose and may require systemic therapy to alleviate symptoms.

Background: This study aimed to assess the incidence of and risk factors for mountain bike injuries among users of a local mountain bike trail system.

Methods: An email survey was sent to 1,800 member households, and 410 (23%) responded. Exact Poisson test was used to calculate rate ratios, and a generalized linear model was used for multivariate analysis.

Results: The injury incidence rate was 3.6 injuries per 1,000 person-hours of riding, with beginners at a significantly higher risk compared to advanced riders (rate ratio = 2.6, 95% CI, 1.4-4.4). However, only 0.4% of beginners required medical attention, compared to 3% of advanced riders.

Conclusions: More injuries occur among beginning riders, but the injuries are more severe with experienced riders, suggesting higher risk-taking or less attention to safety measures.

Introduction: The management of young infants with skin and soft tissue infection is not well-defined.

Methods: We performed a survey study of pediatric hospital medicine, emergency medicine, urgent care, and primary care physicians to assess the management of young infants with skin and soft tissue infection. The survey included 4 unique scenarios of a well-appearing infant with uncomplicated cellulitis of the calf with the combination of age ≤ 28 days vs 29-60 days and the presence vs absence of fever.

Results: Of 229 surveys distributed, 91 were completed (40%). Hospital admission was chosen more often for younger infants (≤ 28 days) versus older infants regardless of fever status (45% vs 10% afebrile, 97% vs 38% febrile, both P < 0.001). Younger infants were more likely to get blood, urine, and cerebrospinal fluid studies (P < 0.01). Clindamycin was chosen in 23% of admitted younger infants compared to 41% of older infants (P < 0.05).

Conclusions: Frontline pediatricians appear relatively comfortable with outpatient management of cellulitis in young infants and rarely pursued meningitis evaluation in any afebrile infants or older febrile infants.

Introduction: Kwashiorkor is a malnutrition syndrome most commonly seen in the United States among patients with malabsorptive conditions. While it is rare in otherwise healthy individuals, cases can develop where low nutritional literacy or unorthodox diets are a factor.

Case presentation: We present an 8-month-old infant who developed kwashiorkor after transitioning to homemade infant formula.

Discussion: This patient developed severe malnutrition due to consumption of homemade formula that did not meet nutritional standards. The recipe was promoted by an alternative health organization as a healthy option, and the difficulty in identifying reliable health information online also played a significant role.

Conclusions: Families of young children face many challenges, particularly during the recent infant formula shortage. Maintaining strong relationships and open communication with trusted health care professionals is vital to combating health misinformation and helping patients and families navigate these challenges safely.

Introduction: E-cigarette use has been increasing for years with a limited understanding of how to help users quit. Quit lines are a potential resource for e-cigarette cessation. Our objective was to characterize e-cigarette users who call state quit lines and to examine trends in e-cigarette use by callers.

Methods: This retrospective study examined data from adult callers to the Wisconsin Tobacco Quit Line from July 2016 through November 2020, including demographics, tobacco product use, motivations for use, and intentions to quit. Descriptive analyses were performed by age group with pairwise comparisons.

Results: A total of 26,705 encounters were handled by the Wisconsin Tobacco Quit Line during the study period. E-cigarettes were used by 11% of callers. Young adults aged 18-24 had the highest rates of use at 30%, and their use rose significantly from 19.6% in 2016 to 39.6% in 2020. E-cigarette use among young adult callers peaked at 49.7% in 2019, coinciding with an outbreak of e-cigarette-related lung injury. Only 53.5% of young adult callers used e-cigarettes to "cut down on other tobacco," compared to 76.3% of adult callers aged 45-64 (P <0.05). Of all callers using e-cigarettes, 80% were interested in quitting.

Conclusions: E-cigarette use among callers to the Wisconsin Tobacco Quit Line has increased, driven largely by young adults. Most e-cigarette users who call the quit line want to quit. Thus, quit lines can serve an important role in e-cigarette cessation. A better understanding of strategies to help e-cigarette users quit is needed, particularly in young adult callers.

Introduction: Naloxone reverses opioid overdose, but it is not universally prescribed. With increases in opioid-related emergency department visits, emergency medicine providers are in a unique position to identify and treat opioid-related injury, but little is known about their attitudes and practices around naloxone prescribing. We hypothesized that emergency medicine providers would identify multifactorial barriers to naloxone prescribing and report varying levels of naloxone-prescribing behaviors.

Methods: A survey designed to assess attitudes and behaviors regarding naloxone prescribing practices was emailed to all prescribing providers at an urban academic emergency department. Descriptive and summary statistics were performed.

Results: The response rate was 29% (36/124). Nearly all respondents (94%) expressed openness to prescribing naloxone from the emergency department, but only 58% had actually done so. Most (92%) believed that patients would benefit from greater access to naloxone, however 31% also believed that opioid use would increase as access to naloxone increases. Time was the most frequently identified barrier (39%) to prescribing, followed by a perceived inability to properly educate patients on naloxone use (25%).

Conclusions: In this study of emergency medicine providers, the majority of respondents were amendable to prescribing naloxone, yet almost half had not done so and some believed that doing so would increase opioid use. Barriers included time constraints and perceived self-reported knowledge deficits regarding naloxone education. More information is needed to gauge the impact of individual barriers to prescribing naloxone, but these findings may provide information that can be incorporated in provider education and potential clinical pathways designed to increase naloxone prescribing.

Introduction: Scurvy is a deadly disease caused by a lack of vitamin C in the diet. Although frequently considered a disease from the past, it still occurs in modern-day society, including in developed countries.

Case report: We report a case of an 18-year-old male who was admitted with bleeding into his legs, prolonged prothrombin time and partial thromboplastin time, and anemia requiring a blood transfusion. His history included congenital deafness and a restrictive eating pattern primarily consisting of fast food. He was deficient in folic acid, vitamin K, and vitamin C. Scurvy best explained the bleeding, and he improved with vitamin supplementation.

Discussion: Scurvy is a collagen production disorder that can cause bleeding on the skin and mucous membranes. Although rare in industrialized nations, scurvy is typically the result of a restrictive diet or malnutrition. Those who are at a particularly high risk are the elderly, alcohol abusers, and those with eating disorders.

Conclusions: Scurvy is easily treatable but can be missed; therefore, a high level of suspicion should be present in patients at risk for malnutrition. Those diagnosed with scurvy should be screened for concomitant nutritional deficiencies.