Objective: Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment, and may originate during medical school. The objective of this study is to determine the prevalence of burnout and contributing factors in medical students. Methods: A survey was administered to 249 medical students using…
Influenza occurs worldwide as a seasonal infection. The influenza virus is enclosed in an envelope containing the glycoproteins hemagglutinin and neuraminidase. It has been known for many decades that the virus mutates to form new subtypes and strains, which are named according to the antigenic types of hemagglutinin and neuraminidase,…
Vascular invasion is not uncommon histologically in patients with urothelial carcinoma (UC) arising from the renal pelvis or ureter, while tumor thrombus affecting the main renal vein or the inferior vena cava (IVC) is rare. Herein, we report a unique case of renal pelvic UC with extended IVC thrombus manifested…
Takotsubo (stress induced) cardiomyopathy is also known as broken heart syndrome or transient left ventricular apical ballooning syndrome. The clinical presentation, which mimics acute myocardial infarction, is preceded by intense emotional or physical stress. Recurrence of apical ballooning syndrome seems to be rare. We present a case of recurrent takotsubo…
Objectives: The impact of chronic poor quality sleep on immunity as seen in obstructive sleep apnea (OSA) has not been evaluated. We aim to explore the relationship between lymphocytes, neutrophil, and total leukocyte counts with severity stratified apnea hypopnea index (AHI) in patients with OSA. Methods: A retrospective review of…
Objectives: Knowledge of the contribution of race to irritable bowel syndrome (IBS) -associated morbidity helps not only with health care policy decisions but also may provide important clues to the pathophysiologic interactions involved. Methods: We conducted a survey at 9 different sites in our metro area. Subjects filled a questionnaire…
The number of Americans who are overweight, grossly overweight, and morbidly obese has been increasing rapidly. Of greatest concern is the growing incidence of childhood obesity. Multiple reasons are given for these increases: overeating, high caloric fast food, inactivity, and lack of exercise. It is, though, a matter of numbers—…
A case of an extramedullary plasmacytoma (EMP), which presented with a solitary pelvic tumor, is reported. Complete tumor resection was performed, followed by radiation therapy. Our experience demonstrates a satisfactory short-term oncological outcome.
To the Editor: A 62-year-old Caucasian woman with a history of multiple myeloma diagnosed one year ago presented with chief complaints of lower extremity rash of two weeks’ duration and severe burning pain in the same area for the past four days. The patient had no known drug allergies and…
The unusual and unprecedented occurrence of a patient with hereditary hemorrhagic telangiectasia (HHT) and a polymicrobial abscess with three different organisms, including fungi, is reported. The patient was a 48-year-old woman with human immunodeficiency virus (HIV) infection and HHT who was brought to the hospital after a motor vehicle accident…
Rickets, characterized by the failure of growing bones to mineralize, is now known to be caused by vitamin D deficiency. During the Industrial Revolution, rickets was noted to be rampant among underprivileged infants in the northern United States and several large cities in Europe. An autopsy study done in 1909…
Chest computed tomography showed pericardial effusion and bilateral small pleural effusion in a 19-year-old patient. Nine hundred mL of yellow purulent fluid was drained by pericardiocentesis. Culture of the fluid grew methicillin resistant Staphylococcus aureus (MRSA). Our patient denied history of previous hospitalization, surgical procedures, or illicit drug use and…
Acute adult supraglottitis can be a serious, life-threatening disease because of its potential for sudden upper airway obstruction. Symptoms and signs of this disease may be nonspecific and may resemble those of upper respiratory tract infection. Unexplained sore throat with tenderness of the anterior neck over the hyoid bone warrant…
Objective: Inconsistent findings from epidemiological studies have continued the controversy over the role of oral vitamin D supplementation in reducing blood pressure in normotensive or hypertensive populations. Methods: We performed a literature search up to December 2009, with no restrictions. Only double-blind randomized controlled trials (RCTs) of oral vitamin D…
The Currarino triad is a complex genetic disorder characterized by multiple caudal anomalies. Currarino et al first described this syndrome in 1981 as a sacral bony defect, presacral mass, and an anorectal malformation. Patients with this disorder usually present with constipation and characteristic radiological findings. Early diagnosis is vital for…
Cisplatin was the first platinum compound to be introduced as a chemotherapeutic agent with antineoplastic activity against a wide variety of solid tumors. Renal impairment with a decline in glomerular filtration has been the classical nephrotoxicity of cisplatin. Renal salt wasting syndrome is yet another, though it is not common….
To the Editor: A thirteen-year-old female was admitted to Children’s Hospital of Michigan with abdominal pain, vomiting, and a diagnosis of acute pancreatitis. Laboratory studies were remarkable for hypochromic microcytic anemia, elevated amylase, and lipase levels. Past medical history included iron deficiency anemia, depression, obsessive compulsive disorder, pica, and trichotillomania….
Management of obesity-associated comorbidities costs about $60 billion/year, about 5% of total US healthcare expenditure. Bariatric surgery is the only proven effective weight loss therapy for severely obese patients with a BMI ≥35 kg/m2. Bariatric surgery produces long-term weight loss, improves quality of life, and reduces the number of sick…
Myositis is a complication of many infectious and noninfectious processes. Secondary syphilis is an uncommon cause of myositis, and, therefore, the diagnosis may be delayed. We describe a man with human immunodeficiency virus infection presenting with diffuse muscle injury secondary to syphilis. He had complete resolution of all signs and…
Objectives: Helicobacter pylori (H pylori) infection induces chronic inflammation that can progress to gastric atrophy, intestinal metaplasia, and gastric adenocarcinoma. We have examined oxidative damage caused by Helicobacter pylori, metaplasia, and atrophy of gastric mucosal cells in patients with chronic gastritis by measuring their urinary 8-hydroxydeoxyguanosine (8-OHdG) levels. Methods: We…
A 58-year-old man was seen with complaints of fevers, night sweats, weight loss, and multiple bilateral cavitary lung lesions. Mycobacterium szulgai with nearly identical antibiograms grew from separate sputum specimens 9 years apart. He was treated with a combination of clarithromycin and ethambutol with clinical, microbiologic, and radiographic resolution of…
To the Editor: A 52-year-old white female was diagnosed with clinical stage IIIB invasive ductal carcinoma of the right breast and was started on neo-adjuvant chemotherapy with doxorubicin and cyclophosphamide every 3 weeks. The first cycle was administered through peripheral veins before indwelling catheter placement.
Young adults, especially pregnant woman and patients with pre-existing medical conditions, appear to be at risk for the development of severe acute respiratory distress syndrome (ARDS) from influenza A (H1N1) infection, leading to critical hypoxemia. This may require high ventilator settings, the use of nonconventional modes, and extracorporeal membrane oxygenation…
Hallucinations are common among patients with Parkinson disease (PD). Hallucinations, typically transitory and occurring at night, are classically visual and occur in 30% of treated patients; auditory hallucinations are rare. A musical hallucination (MH) is a rare type of complex auditory hallucination reported in only six PD patients so far….
Kulchitsky cells represent the cells of origin of small cell lung cancer (SCLC). They display an antigenic makeup characteristic of both the neural crest and epithelium and have been shown to secrete both polypeptide hormones and enzymes. The coexistence of two or more (concomitant or sequential) paraneoplastic endocrine syndromes is…
Diagnosis of myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) and chronic lymphocytic leukemia (CLL) in the same patient is extremely rare. We describe a 69-year-old CLL patient who developed MDS with ring sideroblasts 1 year after diagnosis of CLL and without any previous treatment. Diagnosis was based on flow cytometry, bone marrow…
To the Editor: A 59-year-old Hispanic female with a medical history of diabetes mellitus type 2 and coronary artery disease was nine days’ postcardiac catheterization when she presented to the emergency department (ED). The patient had a two-day history of nausea and vomiting, with diarrhea starting on the day of…
To the Editor: Malignant pericardial effusions are not uncommon and are usually secondary to metastatic pericardial disease. There is, however, a relative lack of emphasis on primary cardiac malignancies as a cause of pericardial effusion due to extreme rarity of these tumors. These malignancies need to be considered in the…
Objective: Daptomycin is a novel antibiotic with activity against many Gram-positive organisms that has demonstrated efficacy in the management of skin and soft tissue infections (SSTIs). However, data regarding the use of daptomycin for the management of burn wound infections are lacking. We assessed the efficacy and safety of daptomycin…
Objectives: Chronic pain is a serious public health problem and is treated by diverse health care providers. In order to enhance policies and programs to improve pain care, we collected information about the distribution of pain patients among four major groups of pain management providers: primary care physicians (PCPs), pain…
We report a patient with carcinomatous meningitis secondary to known transitional cell carcinoma of the bladder. The patient presented with multiple focal neurological signs and symptoms. Diagnosis was suggested by magnetic resonance imaging and confirmed by analysis of the cerebrospinal fluid. He received whole brain radiotherapy despite a poor prognosis….
To the Editor: Ethylene glycol (EG) poisoning is uncommon, yet if unrecognized, potentially fatal. Treatment options for EG toxicity include correction of metabolic acidosis, fomepizole, hemodialysis, and supportive care.1 We present a unique case of severe metabolic acidosis secondary to EG and use of continuous venovenous hemodiafiltration (CVVHDF) over traditional…
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