American journal of hospital medicine, volume 3, issue 2 (2019 April-June)
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Item Importance of HIV screening(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-04) Rojas-Moreno, Christian"Although it can be challenging to think about screenings while trying to fix potentially life-threatening conditions, hospitalists need to actively screen for HIV infection. According to the Centers for Disease Control and Prevention (CDC), 1.1 million people aged 13 and older had HIV infection in the United States at the end of 2016, including an estimated 162,500 (14%) people with undiagnosed infection. The number of new HIV diagnoses in the United States was 38,281 in 2017."Item ECG dilemma(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-04) Balla, Sudarshan; Vasudevan, Archana"A 48-year-old white male presented to the emergency room (ER) with 5-day history of fever and chills. He also reported chest pain, which he described as heaviness and radiating to the left arm. He reports generalized weakness. He has no significant past medical history. He was told to have a murmur since childhood. He does not have orthopnea nor paroxysmal nocturnal dyspnea. Vitals on examination were: Heart rate 30 bpm, blood pressure 100/60 mm Hg. Physical examination: Ejection systolic murmur grade 3/6 heard at the right upper sternal border and radiating to both carotids, lungs were clear to auscultation, skin and extremity examination was normal. Laboratory studies obtained in the ER: WBC 26, 900 /[mu]l, hemoglobin 12.2 g/dl, BUN 23 mg/dl creatinine 0.97 mg/dl, troponin I 0.3 ng/ml, hemoglobin A1c 9.2[percent]. Blood culture results obtained the next day showed 4 of 4 cultures positive for Gram positive cocci in chains. Electrocardiogram obtained is shown below. Transthoracic echocardiogram was performed – valves were not adequately visualized due to poor imaging windows but showed mild mitral and tricuspid regurgitation, aortic valve was calcified with moderate stenosis."Item Conference calendar (AJHM, volume 3, issue 2, 2019)(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-04)Item Gabapentin and buprenorphine nasal insufflation in a patient on buprenorphine for opiod use disorder(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-04) Embers, David; Ravishankar, Dheepthi Arakonam; Sethi, RoopaUpon introduction into the market, gabapentin was not thought to be a drug with abuse potential. Newer research is showing this to be possible, especially in the population of patients with a history of opioid addiction. Clinicians should pay special attention to the use of gabapentin in clinic settings and be wary of the abuse potential it carries, especially in high-risk populations.Item Ask a pathologist : warm autoantibodies(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2019-04) Coberly, EmilyThis article answers the question: My patient is anemic and I ordered a type and screen, and the blood bank told me they are unable to find compatible units due to a warm autoantibody. What is the next step?