Increasing Trends in the Pancreatitis Risk With Tumor Necrosis Factor Inhibitor Use.

Tumor necrosis factor (TNF) inhibitors are a class of pharmacologic agents used to treat a wide range of immunologic diseases. We present a systematic study of the pancreatitis risk with TNF inhibitor use through a retrospective case-control design disproportionality analysis of the U.S.

Flecainide toxicity with pill-in-pocket approach from accidental overdose: a case report.

Background: The Pill-in-the-Pocket (PiP) approach may be used in highly selected patients to achieve acute pharmacological cardioversion into sinus rhythm. Flecainide toxicity is rarely reported, especially with patients who take flecainide as PiP, and only limited evidence exists in its management. We present a case of accidental flecainide overdose for a patient who is on PiP and the acute management strategy.

Pancreatitis Associated With Teduglutide: A Disproportionality Analysis via the Food and Drug Administration Adverse Event Reporting System (FAERS) Database.

Introduction Teduglutide is a glucagon-like peptide-2 analog that is indicated for the treatment of short bowel syndrome (SBS) by reducing patient dependence on parenteral support. Due to the rarity of SBS as well as the recent timeline of the adoption of teduglutide, the safety of teduglutide is relatively poorly understood. Several recent clinical case reports have highlighted elevated pancreatic enzymes and pancreatitis as a concerning complication of teduglutide.

Empagliflozin-Associated Pancreatitis in the Setting of Hyperglycemic Hyperosmolar Syndrome.

Acute pancreatitis is a prevalent gastrointestinal condition in the United States, with approximately 130,000 new cases annually, displaying a rising incidence. Severe cases, constituting 20% of instances, necessitate intensive care unit admission, associated with elevated mortality rates. While gallstones and chronic alcohol use are primary causes, certain medications, including ACE inhibitors, statins, hormone-replacement therapies, diuretics, hypoglycemic agents, and steroids, can induce pancreatitis.

Dietary Effects of Fasting on the Lipid Panel.

Introduction: Dietary habits, such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH), have been shown to improve cardiac health. Another more recent popular form of dieting incorporates periods of fasting known as intermittent fasting. The two main forms are alternate-day fasting and time-restricted eating.

A Rare Multilevel Spinal Epidural Abscess With Streptococcus agalactiae in an Adult With Uncontrolled Diabetes: A Case Report.

Spinal epidural abscess (SEA) is a rare, life-threatening infection that typically presents with fever, back pain, and neurologic deficits. Although most commonly caused by , this case reviews a rare occurrence of a multilevel SEA caused by in a 62-year-old female with uncontrolled type II diabetes mellitus. The patient initially presented with lower back pain and was subsequently diagnosed with a SEA complicated by hyperglycemia.

From Studio to Rehab: A Debilitating Form of Anti-HMGCR Myopathy.

Immune-mediated necrotizing myopathy is a subtype of immune-mediated myopathy associated with or without statin use. Statins, or HMG-CoA reductase inhibitors, are the most prescribed medications for dyslipidemia. The statin-associated myopathic syndromes range from asymptomatic elevations in creatine kinase to severe debilitating muscle weakness with associated rhabdomyolysis and elevated liver enzymes.

SARS-CoV-2-Induced Autoimmune Hepatitis.

Few case reports discuss the incidences of autoimmune hepatitis (AIH) in patients after SARS-CoV-2 infection. Here, we present a case of SARS-CoV-2-induced AIH in a male patient who came into the emergency department with complaints of weight loss, poor oral intake, nausea, dark-colored urine, clay-colored stools, and scleral icterus, which began two weeks after he tested positive for SARS-CoV-2 PCR. Liver biopsy and subsequent histology confirmed the diagnosis of AIH with the most probable etiology being SARS-CoV-2 infection.

Effectiveness of Hospital-directed Wellness Interventions in COVID-19: A Cross-sectional Survey.

Introduction: Hospitals have implemented various wellness interventions to offset the negative effects of coronavirus disease 2019 (COVID-19) on emergency physician morale and burnout. There is limited high quality evidence regarding effectiveness of hospital-directed wellness interventions, leaving hospitals without guidance on best practices. We sought to determine intervention effectiveness and frequency of use in the spring/summer 2020.

A Case of COVID-19-Associated Focal Segmental Glomerulosclerosis.

This case report details a 43-year-old female diagnosed with the collapsing variant of focal segmental glomerulosclerosis (FSGS) post-infection with coronavirus disease 2019 (COVID-19). The patient contracted COVID-19 after returning from a trip to Florida and initially presented to the emergency department with gastrointestinal symptoms. Thereafter, the patient was diagnosed with COVID-19 and was admitted for acute kidney injury and worsening COVID-19 infection.

The First Known Documented Case of Ewingella Americana Urinary Tract Infection.

We present a 73-year-old male with a history of end-stage renal disease (ESRD) on dialysis, type 2 diabetes mellitus, coronary artery disease status post stents, prostate carcinoma status post radiation, and prostatectomy, with recurrent bladder neck contracture requiring suprapubic catheter, left urethral stricture with nephrostomy tube placement, penile implant, and recurrent urinary tract infections, who presented to the emergency room complaining of constant bilateral groin pain for one day. Physical exam was significant for suprapubic tenderness and a chronic suprapubic catheter and left-sided nephrostomy tube. An initial examination of the patient's urine revealed turbid, yellow-colored fluid, positive for white blood cells, leukocyte esterase, and bacteria.

Barriers to research opportunities among osteopathic medical students.

Context: Despite the increase of importance placed on research, both by residency program directors and the medical field at large, osteopathic medical students (OMS) have significantly fewer research experiences than United States (U.S.) allopathic medical students and non-U.

Implementation of Vertical Split Flow Model for Patient Throughput at a Community Hospital Emergency Department.

Background: Hospitals have implemented innovative strategies to address overcrowding by optimizing patient flow through the emergency department (ED). Vertical split flow refers to the concept of assigning patients to vertical chairs instead of horizontal beds based on patient acuity.

Objective: Evaluate the impact of vertical split flow implementation on ED Emergency Severity Index (ESI) level 3, patient length of stay, and throughput at a community hospital.

Calciphylaxis in a Biopsy of Pyoderma Gangrenosum in a Patient Without End-Stage Kidney Disease.

Calciphylaxis is a rare condition characterized by calcification of the blood vessels in the subcutaneous tissue with tissue ischemia. Calcium deposition is observed within scarred and occluded blood vessels of the subcutaneous tissue when a biopsy of the lesion is performed. Calciphylaxis is usually associated with end-stage kidney disease.

Physiologic Response to Exercise or Rhabdomyolysis? Creatine Phosphokinase Elevation in 16 Asymptomatic Firefighters.

BACKGROUND We present a case series of 16 trainee firefighters who presented to the Emergency Department with elevated creatine phosphokinase levels of greater than 14 000 units per liter 3 days after the initiation of intense aerobic exercise. All 16 patients were diagnosed with exercise-induced rhabdomyolysis and were mostly asymptomatic. While exercise-induced rhabdomyolysis often affects untrained individuals who abruptly initiate strenuous exercises, our patients were all physically well-trained and maintained an active training regimen.

Looks Like Neurosyphilis, Feels Like Guillain-Barre: At the Confluence of Infection and Immunology.

We present a 51-year-old male, with a past medical history of type 2 insulin-dependent diabetes mellitus (T2IDDM) without neuropathy, coronavirus disease 2019 (COVID-19) in April 2020 without residual symptoms, Raynaud's, and recent occupational outdoor exposure to insects as a construction manager who came to the emergency room complaining of a three-week history of bilateral progressive numbness and weakness beginning in his lower extremities and ascending toward his pelvis. Notably, he received the second dose of his Moderna COVID-19 vaccine one week prior to symptom onset and four weeks prior to admission. He also reported a recent appearance of a maculopapular rash on his upper extremities and flanks.

A Tale of Two Twins: Discordant Presentation of COVID-19 in Identical Twins.

Coronavirus disease 2019 (COVID-19) is a highly contagious viral illness caused by the RNA virus Coronaviridae subtype severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Rapid infection caused by this virus became overwhelming and resulted in millions of deaths worldwide. The effects of smoking have been heavily studied and lead to increased occurrence of COVID-19 viral infections and mortality.

New-Onset Heart Failure in the Setting of T4-Conversion Disorder.

Thyroid hormone is essential in accomplishing the appropriate metabolism of the body. Achieving euthyroidism is of importance due to the deadly ramifications of being hypothyroid, such as multiple organ failure, profound decrease in mentation and even death. We present a case of an 80-year-old female with a history of hypertension, coronary artery disease, chronic kidney disease, hypothyroidism due to total thyroidectomy, and a cerebral vascular accident who presented with slurred speech, decreased appetite, dizziness and lethargy with new-onset weakness.

Discordance among Belief, Practice, and the Literature in Infection Prevention in the NICU.

This study evaluates practices of infection control in the NICU as compared with the available literature. We aimed to assess providers' awareness of their institutional policies, how strongly they believed in those policies, the correlation between institution size and policies adopted, years of experience and belief in a policy's efficacy, and methods employed in the existing literature. An IRB-approved survey was distributed to members of the AAP Neonatal Section.

Impact of COVID-19 on Emergency Medicine Residency Programs: A Cross-Sectional Study in New York State.

Introduction: The 2019 novel coronavirus pandemic has caused significant disruptions in the clinical operations of hospitals as well as clinical education, training, and research at academic centers. New York State was among the first and largest epicenters of the pandemic, resulting in significant disruptions across its 29 emergency medicine (EM) residency programs. We conducted a cross-sectional observational study of EM residency programs in New York State to assess the impact of the pandemic on resident education and training programs.

Community Hospital Response to COVID-19 Outbreak.

Since early 2020, the world has been living through coronavirus disease 2019 (COVID-19). Westchester County, New York, was one of the hardest and earliest hit places in the United States. Working within a community emergency department amid the rise of a highly infectious disease such as COVID-19 presented many challenges, including appropriate isolation, adequate testing, personnel shortages, supply shortfalls, facility changes, and resource allocation.

Critical Point-of-care Ultrasound Diagnosis of Fournier's Gangrene: A Case Report.

Introduction: Fournier's gangrene is a severe, necrotizing, and potentially fatal, soft tissue infection of the perineum that can be difficult to diagnose clinically. Point-of-care ultrasound (POCUS) has established a critical role in emergency medicine as a quick diagnostic tool due to its safety, accuracy, and cost effectiveness.

Case Report: We present a case in which POCUS was used to rapidly confirm diagnosis in an unstable, severely septic patient presenting to the emergency department with Fournier's gangrene.

Staphylococcus lugdunensis Urinary Tract Infection With Associated Neutropenic Fever.

We present a 62-year-old woman with a history of uterine cancer status post-total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) on paclitaxel, who presented to the emergency department febrile at 101.7 Fahrenheit and complaining of fatigue and urinary incontinence. Laboratory testing revealed neutropenia and urinalysis showed elevated bacteria with minimal white blood cells, and negative leukocyte and negative nitrites.