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

Background: This pre-specified analysis of a randomized controlled trial compared electronic fetal monitoring patterns among participants with and without amnioinfusion.

Methods: Data from the parent randomized trial included 26 term singleton nulliparous participants who developed risk factors for fetal neurologic injury. For this secondary analysis, the primary outcome was total deceleration area-a pattern predictive of neonatal acidemia and morbidity. Secondary outcomes included electronic fetal monitoring patterns (eg, variability).

Results: There were no differences in total deceleration area between the no amnioinfusion group and the amnioinfusion group (28 550 [8800-57 400] mm² [IQR] vs 31 500 [21 700-47 785] mm² [IQR], respectively; P = .84). Specific secondary outcomes differed by amnioinfusion.

Conclusions: These results highlight the need for prospective data to identify the optimal amnioinfusion administration technique that reduces morbidity.

Introduction: Periorbital dermatitis can be due rarely to an adverse drug reaction. We present a case of a patient whose periorbital dermatitis was caused by apixaban.

Case presentation: A 76-year-old female presented with severe periorbital dermatitis 3 weeks after starting apixaban. Varying potencies of antihistamines, topical steroids, calcineurin inhibitors, and emollients were used over a 20-month span with no relief of symptoms. Upon discontinuing apixaban and switching to rivaroxaban, she experienced complete resolution of her symptoms.

Discussion: Periorbital dermatitis is a lesser-known adverse effect of apixaban. To our knowledge, there has only been 1 other reported case of periorbital dermatitis induced by apixaban.

Conclusions: We report this case to increase awareness among clinicians of adverse effects of apixaban and to encourage consideration of drug side effects as part of the differential diagnosis for new skin complaints.

Introduction: Self-orchiectomy is a rare occurrence primarily documented in the context of psychosis. We present the case of a nonbinary individual without psychotic symptoms who performed self-orchiectomy to alleviate gender dysphoria.

Case presentation: An adult nonbinary individual who was assigned male sex at birth presented to the emergency department after removing their testicles several hours earlier. Psychiatry was consulted to assess capacity to refuse testicle reattachment. There was no psychosis, substance use, or suicidal ideation. The patient verbalized all necessary criteria for decision-making capacity. Urology performed wound closure, and the patient was discharged.

Discussion: Few similar cases in the existing literature discuss capacity assessment following self-orchiectomy in nonbinary patients.

Conclusions: While our patient recovered, self-surgery is dangerous. This case illustrates that self-orchiectomy is not limited to cases of psychosis or substance use and emphasizes the importance of broad access to gender-affirming care.

Introduction: HIV remains a significant public health concern. In Wisconsin, new cases increased by 36% during 2020 through 2022, and 22% were 13 to 24 years old. Despite recommendations for routine HIV screening, youth testing remains inadequate. This study aimed to understand HIV screening practices among youth receiving care in pediatric primary care clinics in southeastern Wisconsin.

Methods: Clinic HIV testing rates were measured in patients aged 12 to 26 undergoing gonorrhea and/or chlamydia testing at pediatric primary care clinics affiliated with a not-for-profit children's hospital.

Results: Youth HIV testing rates at all clinic sites were low (median 19.7%) ranging from 13.2% to 36.1%. Higher rates were seen in clinics with higher rates of sexually transmitted infections.

Conclusions: Interventions are needed to enhance HIV testing rates in pediatric primary care clinics.

Introduction: Rubber band ligation (RBL) is a common treatment for internal hemorrhoids. Although generally safe, complications such as delayed bleeding can occur, particularly in patients taking anticoagulants, antiplatelets, or nonsteroidal anti-inflammatory drugs (NSAIDs).

Case presentation: A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids. She was not taking anticoagulants, antiplatelets, or NSAIDs and had no history of bleeding disorders. Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray. She recovered without further complications.

Discussion: Massive bleeding following RBL is rare, especially in patients without traditional bleeding risk factors. Literature review identified only one similar case. Most reported cases involve patients on aspirin or other blood-thinning agents. This case adds to the limited data on severe post-RBL bleeding in low-risk individuals and highlights the potential for delayed presentation.

Conclusions: This case highlights the potential for delayed and significant bleeding post-RBL, even in patients without traditional bleeding risk factors. Vigilance beyond the immediate postoperative period is essential, and patients should be counseled on signs of delayed complications.

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.