Refractory Hypocalcemia Following Total Thyroidectomy in an Adult Patient With Bariatric Surgery.

Obesity poses a global health challenge with significant individual and societal impacts. Bariatric surgery, including Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion/duodenal switch (BPD/DS), is effective for long-term weight management but can lead to serious nutritional deficiencies, particularly hypocalcemia. This report presents the rare case of a 35-year-old woman with severe, recurrent hypocalcemia following BPD/DS surgery, complicated by iatrogenic hypoparathyroidism from prior thyroidectomy.

2023 Inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Introduction: This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Methods: The symposium brought together esteemed experts from various disciplines to explore models for translating evidence-based interventions into practice.

Results: The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi-stakeholder engagement, and the significance of family and community involvement in healthcare interventions.

A Quality Improvement Project to Reduce Rapid Response System Inequities for Patients with Limited English Proficiency at a Quaternary Academic Medical Center.

Background: Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts.

Objective: To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations.

Dedifferentiated liposarcoma with heterologous rhabdomyosarcomatous differentiation in the bone marrow.

We present a case of advanced well-differentiated liposarcoma transforming to dedifferentiated liposarcoma in the bone marrow.Our patient presented with 5 weeks of worsening flank pain. He was found to have profound leukocytosis, thrombocytopenia, and normocytic anemia.

A Rare Case of Hydralazine-Induced Diffuse Alveolar Hemorrhage.

Hydralazine-induced anti-neutrophil cytoplasmic antibody (ANCA) vasculitis may occur any time after hydralazine initiation. General internists should recognize diffuse alveolar hemorrhage (DAH) as a rare complication of this condition, as early treatment reduces the associated high risk of mortality. We describe the case of an 82-year-old female with diastolic heart failure who presented with a one-month history of worsening dyspnea on exertion and a one-week history of scant hemoptysis and fatigue.

A Rare Case of Olmesartan-Associated Enteropathy Successfully Managed With Steroid Taper.

Olmesartan is a commonly used antihypertensive medication belonging to the class of angiotensin II receptor blockers. Though generally well-tolerated, olmesartan can rarely cause olmesartan-associated enteropathy (OAE) with non-bloody diarrhea, weight loss, abdominal pain, and vomiting. Patients may develop enteropathy months to years after drug initiation.

Food Insecurity Leading to Superior Mesenteric Artery Syndrome Managed Successfully with Endoscopic Gastrojejunostomy Stent.

BACKGROUND Food insecurity describes the lack of adequate and reliable access to food due to insufficient resources. The condition affects over one-quarter of the world's population and is exacerbated by factors such as conflicts, climate variability, rising costs of nutritious food, and economic slumps; these challenges are amplified by poverty and inequality. Food insecurity is associated with many negative health outcomes, such as iron deficiency anemia, poor oral health, and stunting of growth in children.

The role of language barriers on efficacy of rapid response teams.

Objectives: Rapid response (RR) systems are associated with decreased hospital mortality. Systemic biases and inequities can negatively impact RR outcomes. Language barriers between patients and providers are associated with worse outcomes, but it is unknown if language barriers are associated with RR outcomes.

Building High-Performance Team Dynamics for Rapid Response Events in a US Tertiary Hospital: A Quality Improvement Model for Sustainable Process Change.

Hospital rapid response systems are designed to reduce unmet patient needs and prevent clinical deterioration. Rapid response teams are the principal component of a rapid response system and require teamwork to function optimally; poor communication among team members can result in substandard patient care. The authors describe a process for developing and implementing standardized communication and a teamwork structure for rapid response events (RREs) at a large academic hospital.

Comparative outcomes between COVID-19 and influenza patients placed on veno-venous extracorporeal membrane oxygenation for severe ARDS.

Background: ECMO is an established supportive adjunct for patients with severe, refractory ARDS from viral pneumonia. However, the exact role and timing of ECMO for COVID-19 patients remains unclear.

Methods: We conducted a retrospective comparison of the first 32 patients with COVID-19-associated ARDS to the last 28 patients with influenza-associated ARDS placed on V-V ECMO.

Time to Cannulation after ICU Admission Increases Mortality for Patients Requiring Veno-venous ECMO for COVID-19 Associated Acute Respiratory Distress Syndrome.

Objective: COVID-19 can cause ARDS that is rapidly progressive, severe, and refractory to conventional therapies. ECMO can be used as a supportive therapy to improve outcomes but evidence-based guidelines have not been defined.

Summary Background Data: Initial mortality rates associated with ECMO for ARDS in COVID-19 were high, leading some to believe that there was no role for ECMO in this viral illness.

Pulmonary Perfusion Scan Mimicking Hepatobiliary Scintigraphy in a Patient With an Uncommon Manifestation of Granulomatosis With Polyangiitis.

A 36-year-old man with known granulomatosis with polyangiitis underwent quantitative ventilation-perfusion pulmonary scintigraphy as part of an initial evaluation for lung transplant candidacy. Radiotracer uptake on the perfusion study has the appearance of the hepatic silhouette, drawing initial concern that there may have been a misadministration of Tc with a hepatobiliary agent. Comparison CT reveals extensive cystic bronchiectasis, parenchymal destruction, and volume loss involving the entire left lung and basal portions of the right lung, with the residual portions of functional lung parenchyma conforming to a shape similar to the liver.

Variability of CT Attenuation Measurements in Virtual Unenhanced Images Generated Using Multimaterial Decomposition from Fast Kilovoltage-switching Dual-energy CT.

Rationale And Objectives: To compare Hounsfield unit (HU) data obtained from true-unenhanced (TUE) and virtual-unenhanced (VUE) imaging obtained with a fast kv-switching dual-energy computed tomography (CT) scanner using multimaterial decomposition algorithm.

Materials And Methods: In this Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective cohort study, CT scans of 19 patients undergoing multiphasic renal protocol abdominal CT on a fast kv-switching dual-energy CT scanner were reviewed. CT numbers were measured on the matched TUE and VUE generated using a multimaterial decomposition algorithm with selective iodine suppression, and postcontrast images at predefined locations in seven organs.

Alcoholic liver disease presents at advanced stage and progresses faster compared to non-alcoholic fatty liver diseas.

Background And Objective: Steatohepatitis is a common cause of liver disease due to alcohol (ALD) or non-alcoholic fatty liver disease (NAFLD). We performed this study to compare natural history of ALD and NAFLD.

Material And Methods: Retrospective analysis of ALD or NAFLD patients managed at our center (2007-2011).

Diabetes Mellitus Predicts Occurrence of Cirrhosis and Hepatocellular Cancer in Alcoholic Liver and Non-alcoholic Fatty Liver Diseases.

Background And Aims: Alcohol abuse and nonalcoholic fatty liver disease (NAFLD) are common causes of liver disease. Diabetes mellitus (DM) is a common comorbidity among NAFLD patients. We performed this study with the specific aim to examine the impact of DM on progression of alcoholic liver disease (ALD) liver and NAFLD.

Autoimmune Markers Do Not Impact Clinical Presentation or Natural History of Steatohepatitis-Related Liver Disease.

Background And Aim: Autoimmune (AI) markers are reported in patients with steatohepatitis-related liver disease. However, their clinical significance is unclear.

Methods: Charts of patients due to alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) were stratified for antinuclear antigen (ANA > 1:80), antismooth muscle antibody (ASMA > 1:40), or antimitochondrial antibody (AMA > 1:20).

PNPLA3 Gene Polymorphism Is Associated With Predisposition to and Severity of Alcoholic Liver Disease.

Objectives: The genetic polymorphism with an isoleucine-to-methionine substitution at position 148 (rs738409 C>G) in the patatin-like phospholipase domain protein 3 (PNPLA3) gene confers risk of steatosis. PNPLA3 polymorphism is shown to be associated with alcoholic liver disease (ALD). We performed a systematic review and meta-analysis to examine association of this genetic polymorphism with ALD spectrum and its severity.

Use of a covered stent modification to produce a transcatheter valve: laboratory and animal testing.

Stent-based transcatheter valves continue to require large sheaths inappropriate for deployment in children. Low-profile covered stent valves (CSVs) were constructed by removing triangular sections from two sides of partially expanded Palmaz P308 stents before covering the stents with 0.1 mm polytetrafluoroethylene.