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Connecticut Medicine

Michael M Deren
No abstract text is available yet for this article.
May 2017: Connecticut Medicine
Rachel R Comito, Kelly Richard
No abstract text is available yet for this article.
May 2017: Connecticut Medicine
Dylan Duchen, Andrew T Boyd, Aniyizhai Annamalai
There is a high prevalence of latent tuberculosis infection (LTBI) and risk of reactivation among refugees. This study describes LTBI prevalence, treatment initiation, and completion rates in refugee patients seen at one urban Connecticut hospital. This retrospective chart review includes 248 adult refugee patients screened between January 2009 and April 2012. Demographics, tuberculin skin test (TST) results, treatment initiation and completion rates, and treatment-related variables were collected. Ninety-eight percent of adult refugees received TST screening and 44...
May 2017: Connecticut Medicine
Sam Awan, Ranadeep Mandhadi, Aryeh M Abeles
Human immunodeficiency virus (HIV) infection can result in several autoimmune illnesses, including psoriasis, psoriatic arthritis (PsA), and polyarteritis nodosa (PAN). We describe a patient who presented with PsA refractory to both synthetic and biologic disease-modifying antirheumatic drugs (DMARDs), who then developed PAN while on antitumor necrosis factor (TNF) therapy. The onset ofvasculitic disease led to the discovery of the HIV infection, and manifestations of both PsA and PAN remitted with the introduction of highly active antiretroviral therapy...
May 2017: Connecticut Medicine
Emanuel Jose Saad, Diego De Goycoechea, Maria Kurpis, Ricardo Arturo Albertini
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma that selectively affects small and medium-sized bloodvessels in the absence oflymph-adenopathy. The central nervous system (CNS) and skin are the organs most commonly affected. We describe the case of a 64-year-old male who presented to the emergency department (ED) complaining of asthenia and bilateral lower extremity edema that progressed rapidly to anasarca. On presentation, laboratory results were significant for elevated erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) levels...
May 2017: Connecticut Medicine
Christopher Steele, Jane Ungemack, Marie Mormile-Mehler, William Rabitaille
OBJECTIVES: Integrated primary and behavioral health care models are emerging to improve access to care; however, the effect they have on utilization and expenditure has yet to be studied. METHODS: A retrospective, longitudinal review of all patients (N = 343; 97% Medicaid) enrolled in our primary and behavioral health care program looked at hospital utilization up to a year before and after enrollment and estimated spending from Medicaid reimbursement data. RESULTS: There was a significant decrease in emergency department (ED) visits per person before enrollment vs after enrollment (2...
May 2017: Connecticut Medicine
Michael J Payette
OBJECTIVE: To investigate the lost revenue associated with Medicaid patients in a university-based dermatology practice over a one-year period compared to non-Medicaid patients. Specifically, the goal was to investigate the change in revenue if Medicaid visits were associated with a range of copayments. RESULTS: The total billed across all encounters for the 2014 -2015 fiscal year was $31017159, of which $3715393 (13.61%) was for Medicaid. 'he total revenue for all encounters was $12267832, of which $420230 (3...
May 2017: Connecticut Medicine
Abigail Cutler, Jonathan D Black, Sangini S Sheth, Shefali Pathy
OBJECTIVE: To examine the frequency with which obstetrics and gynecology (OBGYN) residents experience critical incidents (CIs) during residency and participate in postincident debriefing. METHODS: A survey was conducted to examine the frequency of CIs during training, abilities of residents to cope with CIs, and the impact of postincident debriefing. RESULTS: Among the 27 residents who responded (93.1%), 82.6% reported involvement in one ormore CIs during residency...
May 2017: Connecticut Medicine
Dhruv K Modi, Khusbboo Sheth, Stefanie Wade, Rochelle Castillo, Sukrut Nanavaty, Syed Salman Ali
Giant cell arteritis (GCA) is the most common form of primary vasculitis and it mainly involves large to medium sized vessels. It is also referred to as temporal arteritis as it primarily affects the temporal artery. Ocular involvement frequently occurs in GCA; if not promptly diagnosed, it can cause devastating ocular complications including complete vision loss and permanent blindness. In the majority of cases, it is unilateral; however, there are rare instances where bilateral ocular involvement is reported...
April 2017: Connecticut Medicine
Gregory R Madden, John J Chang
Pseudo-atrial flutter is an EKG artifact that mimics a true atrial flutter. We report a case of pseudo-atrial flutter in a 67-year-old male with quadriplegia and ventilator dependence due to amyotrophic lateral sclerosis (ALS) who was hospitalized for respite care. Ihe pseudo-atrial flutterwas found to be due to percussions from a built-in chest wall percussion device in a hospital mattress used for chest physiotherapy.
April 2017: Connecticut Medicine
Shuo Li, Neeraj Bhatt, Nishant Gupta, Yogesh Kumar, Mark A Rosovsky
Although magnetic resonance imaging (MRI) excels in a number of medical imaging utilities, one of its particular attraction is the lack of ionizing radiation. However, MRI scans are associated with their own unique safety concerns. We encountered two cases of lost tragus piercings presenting as a novel risk factor in MRI safety. The lost tragus piercings caused temporary discomfort and pain but were able to be removed without complication. Heightened awareness for this potential source of patient harm, particularly with more individuals obtaining body piercings, is necessary for appropriate patient screening...
April 2017: Connecticut Medicine
Michael Del Rosario, Henry Tsai, Constantin A Dasanu
People aging with human immunodeficiencyvirus (HIV) present a unique set of challenges for their providers. Cardiovascular, metabolic, neurodegenerative, and renal disorders, and certain cancers are more common in this cohort, which is attributed to elevated rates of inflammation. Although survival remains compromised, integration of efficacious antiretrovirals and high-dose methotrexate (HD-MTX) was shown to improve clinical results in HIV-infected patients with primary central nervous system lymphoma (PCNSL)...
April 2017: Connecticut Medicine
Nidharshan S Anandasivam, Glenn S Russo, Andre M Samuel, Ryan Grant, Daniel D Bohl, Jonathan N Grauer
Of 92030 patients with subdural hematoma (SDH) in the National Trauma Data Bank (NTDB), 55729 had fall mechanisms of injury (61%), while 36301 had other traumatic mechanisms (nonfall, 39%). For nonfall mechanisms, the three associated injuries with the highest incidence were: skull fractures (43.3%), rib/sternum injuries (25.0%), and thoracic organ injuries (24.0%). For fall mechanisms, the three associated injuries with the highest incidence were: skull fractures (19.0%), spinal injuries (7.1%), and upper extremity fractures (6...
April 2017: Connecticut Medicine
Katie Propst, Haylie Butler, David M O'Sullivan, Elena Tunitsky Bitton
OBJECTIVE: To evaluate the success rate and patient satisfaction ofperipheral tibial nerve stimulation (PTNS) therapy. METHOD: Retrospective cohort study assessing PTNS treatment success and patient satisfaction. RESULTS: Data from 34 women were included. On average, patients were 70.2 (± 12) years of age, had a BMI of 29.9 (± 8.9) kg/M², and traveled 11.2 (± 12.3) miles to receive weekly PTNS treatments. Overall, 22 patients (64.7%) were satisfied, four (11...
April 2017: Connecticut Medicine
Shefali Thaker, Matthew Anderson, James Fezio, Christine Rader, Meghna V Misra
BACKGROUND: Pectus carinatum is a congenital chest wall deformity characterized by protrusion ofthe sternum and ribs. External bracing has been the gold standard treatment for this condition for the past 20 years. PURPOSE: The primary purpose of the study was to identify factors that contribute to treatment success of bracing for patients with pectus carinatum. The secondary aim was to identify the optimal age to recommend bracing for pectus carinatum. METHODS: 176 patients who were evaluated for a brace for pectus carinatum were contacted to participate in an online survey about their experience...
April 2017: Connecticut Medicine
Vinay Gulati, Ossama Elsaid, Matthew W Parker, Michael Thorns, Thea Ling, Steven Zweibel
BACKGROUND: We hypothesize that data-entry errors within the National Cardiovascular Data Registry® (NCDR) ICD Registry™ may be an important reason behind labeling many cases as nonevidence-based. OBJECTIVE: To describethe frequency of data-entry errors in implantable cardioverter-defibrillator (lCD) implant data from our institution and develop a plan for quality improvement using the Deming cycle. METHODS AND RESULTS: We assessed data of patient report forms from2007to 2010 and compared these data with forms submitted from 2011 to 2012 after implementation of a continuous multicomponent staff education and training program...
April 2017: Connecticut Medicine
Alyssa Boutin, Corinne Ewing
No abstract text is available yet for this article.
March 2017: Connecticut Medicine
Olurotimi Adekolu, Constantine A Manthous
BACKGROUND: The impact of fluid ri suscitation on hematologic parameters and function has been well studied in hemorrhagic shock. Similar research has not been conducted in resuscitation of septic shock. HYPOTHESIS: In the absence of accompanying hemorrhage, resuscitation of patients with sepsis should be marked by hemodilution, followed by hemoconcentration during recovery. METHODS: Records of patients with primary diagnoses of severe sepsis or septic shock treated in a community hospital intensive care unit (ICU) between 2009 and 2012 were extracted from an electronic d tabase for analysis...
March 2017: Connecticut Medicine
James M Clark, Michael P Hopkins, Emilia Krol, Daniel Chase, Dorothy Sparks
In recentyears, theincidence ofvul- var carcinoma has increased over 400%, specifically in the population of young women. We present a patient with an extensive history of recurrent vulvar carcinoma in situ who underwent multiple surgi- cal procedures and subsequent reconstruction with a skin graft, who then returned with a rare recur- rence in the graft. Multiple hypotheses have been proposedto explain the recurrence ofthis type ofcar- cinoma; however, none provides a solid explanation. It has been noted that the increase in the incidence of vulvar cancer correlates with the increased incidence of HPV infection; the relationship between the two has been well-established...
March 2017: Connecticut Medicine
Matthew C Katz
No abstract text is available yet for this article.
March 2017: Connecticut Medicine
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