HCA healthcare journal of medicine最新文献

Introduction: While male breast carcinoma is a relatively uncommon occurrence, its incidence is on the rise, potentially attributed to sporadic pathophysiological mechanisms, primarily involving hormonal imbalances. Invasive apocrine carcinoma represents a small fraction of global breast malignancies, with limited instances reported among male patients in the literature. The clinical presentation of an apocrine breast carcinoma closely resembles that of other breast cancer subtypes, as it is most often described as a solitary ulcerative nodular lesion occupying a retro-areolar region of the breast. Herein, we describe a novel case of an apocrine male breast carcinoma metastasizing to the skin, given that past cases had presented ab initio in the subcutaneous breast tissue. Furthermore, we discuss the unusual histopathology encountered in this entity such as the presence of psammoma bodies.

Case presentation: In this case report, we outline the clinical presentation of an 80-year-old male with a history of prior breast cancer and mastectomy, performed 9 years before this dermatologic consultation. Upon a physical examination, a singular nodular lesion on his right breast was discovered, leading to a biopsy. Subsequent histological analysis identified an apocrine cell carcinoma characterized by numerous psammoma bodies, an unusual occurrence in breast tissue. Consequently, the patient received a diagnosis of relapsing breast apocrine carcinoma.

Conclusion: Cutaneous metastases arising from apocrine breast carcinoma are infrequent in male patients. The precise diagnosis of invasive apocrine breast carcinoma hinges on the accurate identification of immunohistochemical markers and a clear morphological profile. A notable correlation has been observed, particularly in positive expressions of gross cystic disease fluid protein-15 (GCDFP-15) and androgen receptor. However, due to the rarity of this presentation, there is limited data on treatment modalities. Ongoing studies are investigating the potential role of anti-androgens in the treatment of apocrine breast carcinomas.

Background: Nitrofurantoin is a prevalent antibiotic used to treat urinary tract infections. Despite nitrofurantoin's general safety, it can cause serious side effects, including acute pulmonary toxicity, fulminant hepatitis, and severe systemic inflammatory responses, which may mimic conditions such as ischemia and infection. However, reports of acute systemic inflammatory response syndrome after nitrofurantoin ingestion are uncommon in medical literature.

Case presentation: This case describes a severe systemic inflammatory response syndrome in an 85-year-old woman presenting with hypoxia, altered mental status, and profound leukocytosis after exposure to a single dose of nitrofurantoin.

Conclusion: Herein we report on a patient with suspected bacteremia and urosepsis. Who was treated with broad-spectrum antibiotics. However, the antibiotic used to treat the patient's urinary tract infection caused an altered mental status and systemic inflammatory response. Therefore, it is crucial for clinicians to consider iatrogenic and medication-induced etiologies for altered mental status.

Background: With increasing numbers of human-animal interactions, there has been an increase in animal-related injuries. While canine bites are the most commonly reported animal injury, little data exists in regard to the other classes of animals, particularly marine life. The last comprehensive report on injuries related to noncanine bites and stings seen in emergency departments (EDs) across the US was between 2011 and 2015.

Methods: We performed a retrospective analysis from 2014-2019 on marine injuries from a large hospital network with over 180 hospitals, 100 freestanding EDs, and 170 urgent care centers to provide an update on the volume and greatest contributors to these types of injuries being treated in US hospital EDs. We used existing, de-identified data from HCA's EDW using Teradata SQL. All data were descriptive. Of the 4092 patients aged 18 and older included in this study; 2692 were male (65.8%) and 1400 were female (34.2%).

Results: Of the total, 4010 (98.0%) patients were discharged home, 15 (0.4%) were admitted, 66 (1.6%) were classified as other, and 1 (0.02%) was referred to long-term care. The majority of injuries were caused by stingrays (1196, 29.23%), catfish (974, 23.8%), jellyfish (421, 10.3%), and other fish (541, 13.2%). The majority of injuries from all encounters occurred on the foot (1449, 35.4%) and hand (1181, 28.9%). The second and third quarters of each year were found to have the highest number of injuries (1290, 31.5% and 1742, 42.5%, respectively).

Conclusion: Our results demonstrated that the majority of injuries were due to stingrays, jellyfish, and small fish, specifically catfish. As expected, the majority of injuries occurred on hands and feet. They occurred mostly during the summer.

Description When someone is given the opportunity to utilize creative liberty, they have access to an infinitely diverse palette of colors, mediums, patterns, and shapes to form a unique amalgamation of artistic styles that conveys different ideas and stories. This painting has been created using watercolor paint, permanent markers, acrylic paint, and multicolored glitter to portray a dream-like, tropical bird in flight. The background of the painting is not as detailed as the prominent, avian figure in question, and that is to leave some ambiguity as to the exact whereabouts of this majestic creature, which is to be determined solely by the observer.

Background: Addiction affects millions of people, often resulting from a complex interplay between genetic and environmental factors, and is frequently linked to mental health disorders. Many experts agree there is no cure for addiction, but there are effective treatments available. Many patients continue to succumb to addiction despite treatment. Therefore, more research is needed to develop new therapies in addiction medicine.

Case presentation: This is the case of a 63-year-old woman with an extensive smoking history who suffered an acute stroke affecting her left-sided basal ganglia, including the caudate nucleus and nucleus accumbens. The patient presented with bilateral strokes to the basal ganglia, previously having had a stroke affecting the contralateral basal ganglia. The new stroke resulted in moderate cognitive impairment and personality changes while also resulting in interesting changes to her cigarette addiction. Since the onset of her symptoms, the patient developed an aversion to cigarettes and a curious change in beverage preferences.

Conclusion: This case presents an incidental outcome that highlights what some authors have concluded in their research, which is local ablation to the addiction pathways in the brain can result in decreased rates of addiction in humans.

Description "Lyrical Stillness" is a poem I wrote during my radiation oncology rotation, during which I was provided the opportunity to learn more about multidisciplinary cancer care while delving deeper into radiotherapy. Cancer can be an overwhelming disease process physically, psychologically, and emotionally. Patients undergoing treatment often experience stress and anxiety with the uncertainty of their prognoses. In this poem, I describe a patient receiving radiation therapy whom I enjoyed speaking to about his favorite hobby: bird watching. During his subsequent radiation treatment sessions, I decided to play a CD of mockingbirds singing in a tropical forest, in the hopes it would remind him of fond memories and ease his anxiety with the treatment process. The poem emphasizes the importance of listening, having empathy, and treating others as whole human beings.

Background: Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case presentation: A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was remarkable for persistent hypertension despite multiple antihypertensive medications. A computed tomography angiography (CTA) of the abdomen and pelvis showed a superior mesenteric arteriovenous fistula (AVF) with pseudoaneurysm. He underwent endovascular repair of this traumatic visceral AVF and pseudoaneurysm. This rare case illustrates the presentation, diagnosis, and treatment of a traumatic visceral arterioportal fistula with pseudoaneurysm.

Conclusion: Traumatic AVF and visceral vascular injuries are rare. A CTA of the abdomen can be diagnostic, and we demonstrate that endovascular techniques can be diagnostic and therapeutic. Further studies are needed to compare the long-term outcomes of open versus endovascular techniques.

Background: Second-generation antipsychotic medications (SGAs) are often used by primary care physicians (PCPs) to treat multiple psychiatric diagnoses. SGAs have been connected to a number of adverse effects, including cardiovascular disease. Currently, there are no published evidence-based recommendations addressing SGAs and cardiotoxicity that are directed toward PCPs. This project aims to fill this gap.

Methods: Relevant search terms related to SGAs and cardiovascular disease were identified and then used to search databases (PubMed, PubMed Central, and AccessMedicine). Research studies obtained from the searches were narrowed to include systematic reviews and meta-analyses. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool was utilized by 2 investigators to evaluate the quality of the research independently. Research rated by both investigators to be of high and moderate quality using the AMSTAR-2 system was employed to develop recommendations for PCPs when using SGAs with their patients.

Results: Seven systematic reviews and meta-analyses were found to be of high or moderate quality by AMSTAR-2 evaluations. The studies identified associations between SGAs and a number of adverse cardiac conditions, including corrected QT interval (QTc) prolongation, arrhythmias, myocardial infarction, tachycardia, and other cardio-metabolic associated morbidities.

Conclusion: Our project indicated that cardiovascular risks can be associated with SGAs and that screening and monitoring for cardiac toxicities are indicated when treating patients with this class of medications. These risks, however, do not appear to override benefits in most patients. Furthermore, it appears that when using SGAs, methods of risk reduction can be applied effectively in the primary care setting.

Description This letter to the editor addresses limitations to holding COVID vaccines responsible for the diagnosis of thrombotic thrombocytopenic purpura and discusses the potential differential diagnoses that must be considered.

Background: Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods: Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive format and included all staff members directly involved in fall-related incidents. Protocols for implementing an evidence-based prevention program were developed to (1) address environmental concerns, (2) educate clinical workers and patients' families, (3) enforce interventions, (4) conduct weekly non-punitive, round table discussions, and (5) provide leadership support. Measures were implemented to proactively prevent falls. Data was collected and reported to all departments monthly.

Results: Following implementation of the program, results showed a statistically significant decrease in average fall rates per 1000 patient days from pre-intervention (4.05) to post-intervention (2.54) (P = .0001). Results showed improvement below the national average (3-5 falls per 1000 patient days), resulting in cost savings for the institution due to fewer falls. Inpatient medical-surgical and progressive care units had a noteworthy decline in the total number of falls, with notable estimated cost savings.

Conclusion: Preventative interventions have shown effective results with compassionate, non-punitive leadership, an interdisciplinary team, and continuous follow-up education. Heeding to the Just Culture Algorithm as the foundation of weekly reviews, staff were empowered to engage in fall reduction strategies. A comprehensive weekly fall review program with ongoing staff education and transparent data reporting yielded a significant, sustained reduction in patient falls, with a substantial cost savings in excess of $1.6 million dollars over the life of the program.