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

Introduction: The use of hydroxychloroquine for treating malarial infections and certain autoimmune diseases is well established, but data on hydroxychloroquine overdose and management are relatively scarce. Given its increased use in recent years and because life-threatening symptoms can occur within hours of ingestion, it is important to understand its potential for toxicity and available treatment options.

Case presentation: We present a case of a 43-year-old male with intentional overdose of 6 grams hydroxychloroquine, along with 6 grams trazodone and 30 grams metformin. He presented in respiratory failure, later developing severe hypokalemia and electrocardiogram abnormalities. He was managed with activated charcoal, intravenous 20% lipid emulsion, intravenous epinephrine, intravenous diazepam, and intravenous sodium bicarbonate, which resulted in clinical improvement. Unfortunately, aspiration pneumonia and severe hypotension led to fatal multiorgan failure.

Discussion: This case highlights the potential treatment options for hydroxychloroquine overdose, given its more recent use in the treatment of COVID-19 and increased incidence of toxicity.

Introduction: In the traditional 4-year medical school model, the final 2 years are the clinical years. These years bear challenges and experiences distinct from the preclinical part of medical school.

Methods: We implemented a longitudinal, multifaceted, 2-year course involving advising, Objective Structured Clinical Examination, and discussions to help students at a private, Midwestern medical school navigate the clinical years, ensure graduation competencies are met, and prepare for residency. Participants were third- and fourth-year medical students from 2013 to 2022. The course, titled "Continuous Professional Development," was run by a core group of faculty representing a variety of specialties.

Results: At the end of each academic year, students completed evaluations on the components of the course and the course as a whole. Feedback was generally positive, with students rating the one-on-one advising and short sessions related to clerkship and residency transitions particularly beneficial.

Conclusions: Students value educational content specifically tailored to their clinical experience. While having a single course responsible for multiple programs and sessions appears to be uncommon for undergraduate medical education, our course shows that it is possible and can be done effectively with a relatively small cohort of faculty.

Introduction: Chlamydia and gonorrhea are the most commonly reported bacterial communicable diseases in Wisconsin, with rising incidence rates despite effective treatments. Examining demographic trends can inform public health strategies.

Methods: We analyzed Wisconsin Electronic Disease Surveillance System data (2010-2022) to assess chlamydia and gonorrhea incidence by sex, age, and race.

Results: From 2010 through 2022, chlamydia rates in Wisconsin rose 4.9% (415.5 to 435.9 per 100 000), while gonorrhea rates increased 62.8% (90.7 to 147.7 per 100 000). Among females 15 to 24 years old, chlamydia rates declined 12.0% (3308.5 to 2912.8 per 100 000) but increased 30.1% (203.1 to 264.2 per 100 000) among females 25 years old and older. Gonorrhea rates rose 6.3% (574.7 to 610.6 per 100 000) in females 15 to 24 years old but nearly doubled (47.4 to 82.0 per 100 000) for those 25 and older. Among males 15 to 24 years old, chlamydia rates increased 10.7% (1046.4 to 1158.8 per 100 000) and increased 47.7% in males 25 years old and older (130.7 to 193.1 per 100 000). Gonorrhea rates rose 52.2% in males 15 to 24 years old (295.7 to 450.1 per 100 000) and rose 226.8% in males 25 years old and older (40.7 to 133.0 per 100 000). In 2010, chlamydia rates were 14 times higher and gonorrhea rates nearly 40 times higher among Black individuals compared to White individuals, narrowing to 11 and 30 times higher, respectively, by 2022.

Conclusions: Chlamydia and gonorrhea incidence rates have risen across most populations in Wisconsin but disproportionately affect Black individuals, with the largest racial disparities seen in the nation. While chlamydia rates remained stable among young females, they increased among males and older adults. Gonorrhea rates surged across nearly all groups. These findings highlight the need for targeted interventions to expand screening, address structural barriers to health care, and reduce disparities.

Introduction: Community paramedicine (CP) is an expanding area of interest within the field of emergency medical services. Few studies have established operational metrics and outcome measures for CP programs. We aimed to evaluate change in 911 use and operational metrics among patients enrolled in a pilot, fire department-based, CP program.

Objective: The purpose of this study was to determine if the ongoing CP program decreased unscheduled emergency health care utilization among high utilizers. It was hypothesized that the implementation of community paramedicine visits would reduce 911 calls among this cohort.

Methods: A retrospective cohort study of adults enrolled in a CP program during 2016 to 2020 was performed. Patients were enrolled in the CP program if they frequently used a community emergency department or 911 services. This was defined as greater than 4 uses in the past 12 months. A select group of experienced paramedics received targeted training in relevant concepts. Paramedics frequently contacted patients via both in-home visits and phone calls based on perceived clinical need. Through a review of electronic medical records, we collected patient demographic and clinical information and program operational metrics. The primary outcome of interest was the change in 911 use after enrollment. These 2 groups were compared using a paired t test.

Results: Of 33 patients who met inclusion criteria, 29 were successfully enrolled. Pre-enrollment 911 calls averaged 31.8 calls per month. Post-enrollment 911 calls averaged 14.2 calls per month. Average calls per month decreased by 54.2% (P = .003) post-enrollment, a reduction of 207 calls per year across the cohort. Length of program enrollment also was found to have a greater impact on 911 call reduction.

Conclusions: A fire-department based CP program effectively reduced 911 calls for high utilizer emergency medical services and emergency department patients by 54.2%. Program participation for 6 months or longer was associated with greater reductions in 911 calls, regardless of the number of existing comorbidities.

Introduction: EXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a rare disease caused by somatic mutations in the UBA1 gene, first identified in 2020. Prevalence is unclear, and there are no established treatment guidelines, highlighting the need for disease recognition.

Case presentation: We report the case of a 34-year-old African American man with a prior diagnosis of rheumatoid arthritis who developed migratory arthritis, pustular acne, and hidradenitis suppurativa. Despite suggestive clinical features, delayed access to biologic therapy contributed to disease progression and resulted in hospitalization. After extensive genetic and clinical evaluation, he was diagnosed with PAPASH syndrome.

Discussion: VEXAS syndrome results from dysregulation in the ubiquitylation pathway, causing autoinflammatory and hematologic symptoms. Diagnosis is challenging due to variable presentation. Bone marrow biopsy and genomic testing for UBA1 mutation are crucial for diagnosis. Treatment focuses on controlling inflammation with steroids and IL-6 receptor antagonists such as tocilizumab.

Conclusions: We present this case to raise awareness of this recently established condition. Further understanding will aid in optimizing management and improving clinical outcomes.

Introduction: Many patients and health care providers believe that barometric pressure drops increase the incidence of premature rupture of membranes (PROM). To test this, we studied high risk women living near a weather station.

Methods: This cohort chart review study investigated 189 PROMs, diagnosed between 24 and 42 weeks gestation, at Wheaton Franciscan-St Joseph Campus, Milwaukee, Wisconsin. National Oceanic and Atmospheric Administration (NOAA) data from the 24 hours preceding each PROM occurrence were analyzed. The sample provided 91% power to detect a two-fold increase in the PROM rate.

Results: The PROM rate, 9.5%, within the 24 hours following a NOAA-defined substantial pressure drop, was similar to that predicted using the percentage of the total study period time within 24 hours after a substantial pressure drop, 10.8%, (P= .64). The findings for within 3, 6, and 12 hours after a substantial pressure drop were similar.

Conclusions: The incidence of PROM does not increase following substantial atmospheric pressure drops.

Introduction: Climate change, a global crisis, affects health through changes such as more intense and longer lasting heatwaves. Some populations are more vulnerable to such events, including those with certain medical conditions, like heart failure. This study aimed to improve understanding of heat-related vulnerabilities and opportunities to enhance adaptive capacity of patients within an ambulatory heart failure clinic.

Methods: Heart failure clinic patients at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin, voluntarily completed a 25-question multiple-choice survey. We present descriptive statistics of the survey responses with count and percentage for categorical responses.

Results: We found that out of 60 survey respondents, 46.55% agreed or strongly agreed they would benefit from discussing heat illness risks with their physician, and 31.58% were not aware their heat illness risk is higher on days hotter than 90 °F (32.2 °C). Several vulnerability factors were common: 70.69% follow a prescribed fluid restriction, 33.33% live alone, 20.34% lack a car with air conditioning, and 20.00% worry about their ability to pay electric bills. Notable knowledge gaps included 65% do not check forecasted temperatures, 60% do not plan activities for the coolest times of day, 43.10% lacked awareness of cooling centers, 33.33% were unsure of heat illness symptoms, and 27.12% lacked awareness of Wisconsin's Focus on Energy program.

Conclusions: A sizable portion of survey respondents indicated they would benefit from discussing their heat illness risk with their clinicians, and many underestimated their personal risk of heat illness. Additionally, multiple vulnerability factors were highly prevalent and knowledge gaps were demonstrated in this population. Our findings support adaptive capacity opportunities through heat illness education, anticipatory guidance, and increased resource awareness for patients with heart failure in an ambulatory setting.

Introduction: Fibrocartilaginous embolism causing spinal cord infarct is rare, and a high index of clinical suspicion is needed for accurate diagnosis.

Case presentation: A 65-year-old woman presented to our hospital with back pain, paraparesis, and neurogenic bladder. Magnetic resonance imaging showed a T4-T7 signal abnormality that was misdiagnosed initially and treated as autoimmune myelitis.

Discussion: Fibrocartilaginous spinal cord infarction is rare and remains a clinical diagnosis with supportive imaging findings. The imaging findings may be nonspecific, and other etiologic diagnostic considerations must be excluded.

Conclusion: Fibrocartilaginous embolism causing spinal cord infarct can be mistaken for transverse myelitis. A high index of clinical suspicion with clinical and radiologic correlation is necessary to make accurate diagnosis and avoid unnecessary treatment.