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

Introduction: People experiencing homelessness are more likely than the general population to have chronic health conditions and often encounter significant barriers to health care access. Many of these barriers can be affected by community-based factors, such as availability of reliable transportation, past experiences with health care systems, and community attitudes toward the unhoused population. This project aims to assess the needs and barriers to health care identified by people experiencing homelessness in a rural Midwestern city.

Methods: The survey used was adapted from a survey previously conducted to assess the needs of the homeless population in Milwaukee, Wisconsin. Surveys were distributed during outreach around the city of Wausau, Wisconsin. Data were transcribed and reviewed, and descriptive statistics were calculated.

Results: A total of 45 surveys were completed. Most participants identified as White, non-Hispanic males (n = 24, 53%) and were 46 to 55 years old (n = 14, 31%). Barriers to health care included lack of housing, cost, transportation, lack of a mailing address, inadequate hours, and disrespectful care. Eighty-six percent of participants (n = 38) reported having a mental health diagnosis, yet only 26% (n = 12) stated that they see a mental health professional.

Conclusions: Individuals experiencing homelessness in a rural community have broad and complex barriers to accessing health care. Given limited resources in smaller communities, innovative and holistic solutions should be considered when aiming to make care more equitable.

Introduction: The recreational use of nitrous oxide is surging in popularity, with nearly 13 million Americans aged 12 and older reported to have misused it, according to a 2019 survey by the Substance Abuse and Mental Health Services Administration. Prolonged use has been linked to significant neurological deficits, potentially leading to lifelong issues if not treated early.

Case presentation: We present a case of a 38-year-old male with significant neurologic deficits attributed to prolonged nitrous oxide abuse, resulting in subacute combined degeneration of the spinal cord. This condition is characterized by demyelination of dorsal and lateral columns.

Discussion/conclusions: The growing recreational use of nitrous oxide, facilitated by its easy availability and lack of regulation, highlights the importance of clinician vigilance in managing associated risks. Neurological symptoms from vitamin B12 deficiency are particularly worrisome. Early intervention is crucial to prevent potential long-term consequences.

Background: Individuals who donate their bodies to academic, whole-body donation programs support health science education, training, and research. This is the first report on Wisconsin whole-body donor demographics and the extent to which donors represent the state population.

Methods: Donor demographic data from 2016 through 2021 were collected from death certificate worksheets and compared with Wisconsin population data from the US Census Bureau and state health statistics.

Results: Most donors were non-Hispanic White individuals, did not have a college degree, and did not work in health care. The median age at death was 86 years. Twenty-eight percent of donors served in the armed forces. Donors were not representative of the Wisconsin population in age, race, ethnicity, or military service.

Discussion: Whole-body donors provide an invaluable resource for health science education and research. Understanding donor demographics is an important first step in examining diversity and representation within Wisconsin's body donation programs.

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare critical outcome of breast implantation that typically presents 8 to 10 years after textured-implant placement with periprosthetic seroma. Treatment consists of implant removal and capsulectomy, which is typically curative. But in rare case, malignant infiltration through the capsule results in disseminated disease, necessitating aggressive treatment with systemic chemotherapy. Sarcoidosis, a chronic systemic granulomatous disease characterized by noncaseating granulomas, is another rare cause of periprosthetic seroma.

Case presentation: A 61-year-old female with a history of invasive ductal carcinoma of the breast status post textured implant-based reconstruction presented with late periprosthetic seroma and overlying rash. Cytology of seroma aspirate was suggestive of BIA-ALCL, and positron emission tomography-computed tomography was concerning for invasive disease. Surgical specimen pathology of the implant-capsule complex and skin punch biopsy of the overlying rash revealed only granulomatous inflammation. The patient was diagnosed with sarcoidosis and spared systemic chemotherapy treatment for disseminated BIA-ALCL.

Conclusions: BIA-ALCL should be ruled out in all cases of late periprosthetic seroma. Definitive surgical pathology is necessary to prevent misdiagnosis and inappropriate treatment of masquerading entities, such as sarcoidosis.

Introduction: Pembrolizumab is an immune checkpoint inhibitor (ICI) used to treat many types of advanced cancer. ICIs can cause encephalopathy, a severe immune-related adverse event, which is a diagnosis of exclusion. Pembrolizumab immune-related adverse events typically develop early (within a few months) in treatment; presentation after a year is extremely rare.

Case presentation: A 70-year-old White female with metastatic endometrial cancer treated with pembrolizumab for 19 months presented with generalized weakness that rapidly progressed to confusion, delusions, and hallucinations.

Discussion: After ruling out other causes of encephalopathy via broad-based testing of blood and cerebrospinal fluid and imaging, her neurologic status improved after treatment with high-dose glucocorticoids and intravenous immunoglobulin.

Conclusions: Pembrolizumab is an ICI that can cause encephalopathy, which is challenging to diagnose. While immune-related adverse events typically emerge soon after starting treatment, pembrolizumab-induced encephalopathy can be delayed significantly.

Introduction: The Centers for Disease Control and Prevention recommends HIV screening for all patients aged 13 to 64. We sought to improve the health of our patient population by enacting universal HIV screening in our emergency departments.

Methods: Universal opt-out HIV screening was implemented in 7 southeastern Wisconsin emergency departments and included linkage to care for those diagnosed with HIV.

Results: In the first year of this initiative, 57 565 patients were screened for possible testing and 24 417 patients did not opt out (42.4%). In total, 12 406 HIV tests were performed in the first year of the program.

Discussion: Our emergency department opt-out HIV screening initiative identified 23 new cases of HIV, approximately 10% of the average number of incident HIV cases in Wisconsin. We linked 96% of persons newly diagnosed with HIV to HIV medical care.