Journal of academic hospital medicine, volume 7, issue 2 (2015 April-June)

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https://hdl.handle.net/10355/65712

Table of Contents
Review Articles
- Antibiotic De-escalation in Culture-negative Healthcare-associated Pneumonia / Christian Rojas-Moreno, MD
Case Reports
- Rheumatoid Pleural Effusions and Trapped Lung: An Uncommon Complication of Rheumatoid Arthritis / Jessica Stout, D.O, David Hayes, M4, Christian Rojas-Moreno, M.D, Kevin Clary, M.D, F.A.A.P, William M See, M.D., F.A.C.S
- Non-traumatic Muscle Pain in a Diabetic / Monalisa Mullick, MD, Cheryl McDonough, MD
- Case Analysis: Ethical Issues in Predictive Genetic Testing of Minors for Adult-Onset Hereditary Conditions / Lila S. Wahidi, BS, Lea Brandt, OTD, MA, OTR/L, Jan Sherman, PhD, Michael Sherman, MD
- Widespread Rash in an Immunocompromised 31-year-old Female: Case Report and Literature Search / Adam Grumke, Christian Rojas-Moreno, MD
Image of the Month / Meghan Kelly, MS3, Christian Rojas-Moreno, MD
Ask a Specialist
- Ask a Pathologist / Emily Coberly, MD

[Collection created September 4, 2018]

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Case analysis : Ethical issues in predictive genetic testing of minors for adult-onset hereditary conditions
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-04) Wahidi, Lila; Brandt, Lea; Sherman, Jan; Sherman, Michael
Introduction: Predictive genetic testing for adult-onset conditions in children is an issue that has initiated ethical discussions and polarized views. Case Presentation: A genetic counselor is contacted by a mother requesting predictive genetic testing of her young son for Hereditary Nonpolyposis Colorectal Cancer (HNPCC) due to an extensive family history of the condition. The ethics team subsequently worked to balance professional guidelines and ethical considerations to evaluate whether to comply with the parental request. It was necessary to consider the importance preserving the child's future right to exercise his autonomy in participating in such testing, preserving the confidentiality of the test result, and considering the possibility of potential psychological harm. Conclusion: Determining whether to perform predictive genetic testing in a minor for conditions of adult-onset should be guided by the potential outcomes that indicate that medical benefits obtained will outweigh the risks of testing.
Case Report : Widespread rash in an immunocompromised 31-year-old female : Case report and literature search
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-04) Grumke, Adam; Rojas-Moreno, Christian
A 31-year-old female presents with a widespread vesicular and papular rash involving her anterior and posterior trunk, proximal extremities, neck, and face with sparing of soles and palms. Her past medical history is significant for Philadelphia chromosome and BCR-ABL positive chronic myelogenous leukemia (CML) diagnosed in 2011 and now s/p allogenic hematopoietic stem-cell transplant (HSCT) and subsequent CNS recurrence. Five days before presenting, the rash initially began around her vagina and coccyx and spread laterally to the left and onto her medial buttock and is associated with significant pernineal swelling.
Image of the month
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-04) Kelly, Meghan; Rojas-Moreno, Christian
The most likely diagnosis is: 1. Toxic megacolon -- 2. Colonic obstruction secondary to adhesions -- 3. Colonic pseudo-obstruction -- 4. Shigellosis.
Case Reports : Non-traumatic muscle pain in a diabetic
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-04) Mullick, Monalisa; McDonough, Cheryl
The prevalence of diabetes in the adult population in United States is approximately 10[percent] and is expected to rise. The myriad of complexities of this entity, both microvascular and macrovascular is anticipated to follow suit, adding to the morbidity and mortality. Diabetic muscle infarction (DMI) is one such incompletely understood complication of long-standing uncontrolled diabetes and seems to play a crucial role in risk stratification in those with microvascular involvement. DMI has shown to be a poor prognosticator of long-term survival, a grim reality given the mean age of presentation is only 43 years. Further investigation into improving this outlook and whether tighter glycemic control changes outcome would be of significant interest and benefit.
Antibiotic de-escalation in culture-negative healthcare-associated pneumonia
(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2015-04) Rojas-Moreno, Christian
The guidelines from the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) recommend "early, appropriate antibiotics inadequate doses, while avoiding excessive antibiotics by de-escalation of initial antibiotic therapy,based on microbiologic cultures and the clinical response of the patient, and shortening the duration of therapy to the minimum effective period"1. But they offer no recommendations on how to de-escalate when the cultures are negative. They do mention that if lower respiratory tract cultures obtained before antibiotics are negative at 48-72 hours, discontinuation of antibiotics can be considered. However, unless the patient is intubated (i.e. intensive care setting), we are usually unable to obtain lower respiratory tract cultures.

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