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

Background: The transition from youth to adult health care is a complex process, and only 25% of all youth and less than 35% of youth with special health care needs in Wisconsin receive support.

Objectives: This article describes the process and results from the Wisconsin Youth Health Transition Initiative's assessment of transition support provided in health care.

Methods: Key informant interviews were undertaken with clinicians from several Wisconsin health care systems.

Results: Fifty percent of health care systems interviewed had a formal policy or guideline supporting health care transition. Additionally, several barriers consistent with national trends were confirmed.

Conclusions: Health care transition for Wisconsin youth remains suboptimally supported in practice. Continued funding and work towards this important maternal and child health objective are needed.

Introduction: Every year, children are poisoned with lead with irreversible effects. This exposure most often occurs in older housing built before 1978 with chipping paint from windowsills where children play and ingest the lead particulates. Exposure to lead can cause neurological and psychological dysfunction, among other health issues.

Objective: This quality improvement study aims to evaluate our knowledge of at-risk children through a public health approach by analyzing the current public health data and possible barriers to lead screening, testing follow-up, and identifying at-risk children.

Methods: We received data on lead-poisoned children and inspected properties from the City of Milwaukee Health Department. We analyzed each child's initial blood lead level, as well as follow-up tests recorded, ZIP code of residence, and family renter versus home ownership.

Results: Over 90% of children in the database had recorded follow-up blood lead testing following an initial elevated blood lead level. There was no difference in initial recorded blood lead levels between children with recorded follow-up blood lead levels and children without (21.40, SD = 11.26); t[1.17], P = 0.24). Most affected children were from economically disadvantaged ZIP codes (53206, 53208, 53215), and 94% lived in rented properties.

Conclusions: Over 90% of children in the database had recorded follow-up blood lead testing following an initial elevated blood lead level. There was no difference in initial recorded blood lead levels between children with recorded follow-up blood lead levels and children without (21.40, SD = 11.26); t[1.17], P = 0.24). Most affected children were from economically disadvantaged ZIP codes (53206, 53208, 53215), and 94% lived in rented properties.

Introduction: In this report, we describe a case of a large, full-thickness traumatic cornea laceration that was managed nonsurgically.

Case presentation: A 22-year-old male presented with a red, painful right eye 4 days after a work-related injury. He was found to have a 6.5 mm full-thickness corneal laceration. The wound was Seidel negative, so the decision was made to manage the laceration nonsurgically. The patient did not develop endophthalmitis or wound complications, and his corrected visual acuity recovered to 20/25.

Discussion: Full-thickness cornea lacerations and lacerations larger than 3 mm routinely necessitate surgical intervention in a sterile environment, while medical management is typically reserved for partial-thickness or small, self-sealing lacerations. Surgical repair of lacerations can lead to resultant astigmatic problems, even when performed in ideal conditions and, therefore, should be avoided when possible. Through careful examination and close follow-up, our patient with a large full-thickness laceration was successfully treated nonsurgically and able to avoid associated complications.

Conclusions: This report expands the literature of the appropriate management of cornea lacerations.

Introduction: Actinomycosis is a rare, chronic, progressive bacterial infection caused by Actinomyces species with a reported incidence of 1 in 300 000. Actinomycosis has variable presentations and is commonly mistaken for malignancy and other infections, leading to delays in diagnosis and appropriate treatment. Actinomyces is a commensal bacteria found in the mouth, gut, and genitourinary tract. Actinomycosis tends to take advantage of anatomical defects for contiguous spread and can cause fistulas, sinus tracts, abscesses, and intrauterine device-associated infections.

Case presentation: A 78-year-old White male with known dental caries came to a primary care clinic 2 days after noticing a painless, nonbleeding mass eroding from his hard palate. After a tissue biopsy of the mass showed a diagnosis of actinomycosis and advanced imaging showed no intracranial involvement, he was treated with a 6-month course of antibiotics, including oral amoxicillin, oral amoxicillin-clavulanate, and intravenous ertapenem.

Discussion: There are several case reports of actinomycosis with variable presentations, such as cutaneous nodules and sinus tracts. These cases frequently are associated with dental infections and procedures, trauma, oral surgery, or prior head and neck radiation. The condition is often mistaken for other infections or malignancy, which can delay appropriate treatment and increase the risk of complications.

Conclusions: Actinomycosis is a rare bacterial infection with variable presentations occurring throughout the body. This patient responded well to a prolonged course of intravenous and oral antibiotics and had complete healing of his hard palate defect. Actinomycosis is frequently misdiagnosed, leading to delays in appropriate treatment.

Introduction: COVID-19 can have severe consequences for immunocompromised individuals, including those with hematological malignancies. Prolonged infections causing pneumonia and lung injury are rare in patients with diffuse large B-cell lymphoma (DLBCL) treated with chimeric antigen receptor T-cell (CAR-T).

Case presentation: A 43-year-old male with a history of DLBCL, in remission for 2 years after CAR-T therapy, developed a persistent COVID infection, as confirmed via positive polymerase chain reaction. This slowly progressed to symptomatic hypoxemic pneumonitis and biopsy-proven diffuse alveolar damage, which responded to corticosteroid treatment.

Discussion: COVID-19 poses increased risks to patients with a history of hematologic malignancies and can lead to severe respiratory distress and mortality. Studies have shown prolonged pneumonitis may require corticosteroids for improvement. However, data on appropriate regimen for managing prolonged COVID-19 pneumonitis are lacking.

Conclusions: This case highlights challenges of the treatment of COVID-19 infections in immunocompromised individuals with hematological malignancies. Corticosteroid treatment shows benefits, but dosing and duration should be based on individual patient response. Extended monitoring, individualized treatment plans, and research are crucial for optimizing outcomes in this vulnerable population.

Salivary gland carcinomas are a heterogeneous group of rare tumors. There is no established standard of care therapy for metastatic disease. We describe the case of a patient with metastatic salivary gland adenocarcinoma harboring STRN-ALK translocation, with tumor response and clinical benefit from anaplastic lymphoma kinase (ALK) inhibition. Our patient experienced clinical benefit from first and second generation ALK inhibition in a chemotherapy refractory tumor. Tumor mutation profiling can identify mutations that may render tumors sensitive to targeted therapy with tyrosine kinase inhibitors.

Introduction: Genitourinary tract injuries have been reported to account for 3% to 10% of trauma patients, and scrotal injuries have been reported to comprise 71% of male genital trauma. Scrotal trauma is particularly prevalent in males 10 to 30 years of age, thus posing a potential threat to fertility. Scrotal trauma can be blunt or penetrating in nature, and the mechanism of trauma can have an impact on the management and outcomes of this type of injury.

Methods: A retrospective chart review of adult patients who presented with scrotal trauma to a single large level I trauma center from January 1, 2000, to June 1, 2022, was conducted to assess the relative occurrence and type of trauma (blunt vs penetrating), as well as differences in the management, duration of hospital stay, and need for orchiectomy between these 2 types of injury.

Results: There were 102 patients included in this study, with an average age of 39.5 years (18.7-77.2 years). Fifty-six patients had blunt scrotal trauma, and 46 had penetrating scrotal injury. There was not a statistically significant difference in the percentages of blunt versus penetrating trauma (P < = 0.3729). Patients with penetrating trauma were more likely to be inpatient than those with blunt trauma (69.6% vs 42.9%; P < = 0.013; 95% CI, 0.062-0.473). A total of 61 patients were treated conservatively (44 and 17 patients in the blunt and penetrating trauma groups, respectively). Overall, 41 patients required surgical intervention: 12 who had blunt trauma and 29 who suffered penetrating injury. Surgical treatment was more common for penetrating trauma than for blunt trauma (63.0% vs 21.4%; P <0.0001; 95% CI, 0.220-0.612). Eleven patients underwent orchiectomy - 4 from the blunt trauma group and 7 from the penetrating trauma group; the rate of orchiectomy was not significantly different between the 2 groups.

Conclusions: In this study, blunt scrotal trauma was slightly more common than penetrating injury, but the difference did not reach statistical significance. Blunt scrotal trauma was associated with a higher rate of conservative treatment. Further study is needed to better understand the impact of scrotal trauma on future fertility.

Background: Patients living with chronic pain may feel frustrated with and neglected by clinicians who care for them, leading to negative health care experiences. Clinicians may struggle to find new ways to engage and connect with patients experiencing chronic pain. Both patients and clinicians may benefit from expressive writing by potentially improving communication and creating a deeper sense of connection within medical visits.

Methods: An expressive writing activity, the Three-Minute Mental Makeover (3MMM), was conducted with 15 patients living with chronic pain during primary care visits with 5 UW Health family medicine physicians. Patient and physician experience using the 3MMM was measured using pre- and post-visit surveys and individual interviews.

Results: Both physicians and patients viewed the experience of doing the 3MMM together positively. We identified 8 key themes from individual follow-up interviews with patients and physicians: (1) opening the door, (2) insight into the doctor/patient as a person, (3) peer-to-peer communication, (4) closeness and connection, (5) comfort and relaxation, (6) unexpected learning, (7) unexpected value to patients, and (8) vulnerability and self-disclosure. The most commonly reported barriers to physicians using the activity in practice were lack of time and persuading other physicians to do the activity.

Dsicussion: Patients with chronic pain and the clinicians who care for them may benefit from an expressive writing exercise, such as the 3MMM, in the key realms of building relationships, communication, and trust.

Background: Probiotics are synthetic oral supplements containing live bacterial and fungal species hypothesized to help with various gastrointestinal conditions. However, they can cause infection if the organism spreads outside of the gastrointestinal tract. The aim of this study was to identify and describe patients who experienced systemic infections caused by probiotic use.

Methods: This study was a retrospective chart review of pediatric and adult patients at academic medical centers who received probiotics and subsequently developed positive cultures from a sterile site for probiotic-related species. Two individuals completed the chart reviews to determine if the probiotic was the true cause of the infection.

Results: Lactobacillus, Bifidobacterium, and Saccharomyces cultures were reviewed, with a total of 71, 8, and 2 cultures isolated from sterile sites for each organism, respectively. Further review revealed 23 Lactobacillus cultures from 13 unique patients who were taking Lactobacillus-containing probiotics. Four patients without gastrointestinal tract compromise were included in the final analysis, including 1 patient whose culture was confirmed as identical to the probiotic. Types of infections included meningitis and bacteremia. Targeted antimicrobial therapy included ampicillin, ampicillin-sulbactam, and piperacillin-tazobactam, with total durations of therapy ranging from 10 to 22 days. No patients had mortality attributed to Lactobacillus infection.

Conclusions: Probiotics are not harmless supplements as they come with risk of serious infection as demonstrated in this review. Before use, the risks of probiotics should be considered carefully for each individual patient. Clinicians should consider avoiding probiotics in hospitalized patients, especially those with vascular or extra-ventricular access devices.