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  PEG Tube: Dealing With Transcolonic Misplacement

  Marko Kozyk, Kateryna Strubchevska, and Mihaela Batke

  Publication Date: 10-2022

  Introduction

  Percutaneous endoscopic gastrostomy (PEG) tube acts as the favorable route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition, generally beyond 4 weeks. As PEG tube provides direct percutaneous access to the stomach, another indication for PEG placement includes stomach decompression. PEG tube placement is a relatively safe procedure; however, complications sometimes occur.

  Discussion

  Complications of PEG: • Hemorrhage • Aspiration • Inflammation • Infections • Misplacement • Formation of fistulas Misplacement results from juxtaposition of the colon between the stomach and the skin during the PEG insertion, resulting in a feeding tube passing through the colon, usually the transverse colon, before being anchored in the stomach.

  Prevention of PEG-tube misplacement: • Adequate air insufflation of the stomach can help prevent this complication by displacing the colon away from the path of the PEG tube

  Management of PEG tube misplacement: • Surgical (in the presence of peritonitis) • Endoscopic (in the absence of peritonitis) • Percutaneous removal of the tube may result in stercoral peritonitis or colocutaneous fistula.

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  Investigating the Effects of a Mindfulness Based Stress Reduction Course on a Grouping of Oncology Patients, Health Care Workers and their Families on Measures of Stress and Burnout in Health Care Workers: A Randomized Control Trial

  Michael Moussa, Patrick Herndon, Alyssa Heintschel, Scott Sabbagh, and Ruth Lerman

  Publication Date: 5-2-2022

  INTRODUCTION
  Mindfulness Based Stress Reduction (MBSR) can improve the mental health of health care workers (HCW). How will the inclusion of oncology patients (OP) in MBSR classes for HCW affect the mental health of HCW?

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  Acquired Acrodermatitis Enteropathica Presenting as Confusion and Desquamating Maculopapular Rash

  Nazli Begum Ozturk, Ali Khreisat, Luai Madanat, and Lynda Misra

  Publication Date: 10-2022

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  Mindfulness-Based Stress Reduction for Pre-Clinical Medical Students: Exploring Efficacy and Benefit

  Scott Sabbagh, Alyssa Heintschel, Patrick Herndon, Michael Moussa, and Ruth Lerman

  Publication Date: 5-2-2022

  INTRODUCTION
  Studies suggest that healthcare-affiliated populations are at an increased risk of experiencing chronic stress and burnout. Mindfulness meditation has become an established method to address and alleviate their effects, though it has not been extensively studied in the medical student population. The primary goals of this study are to assess the feasibility and efficacy of an 8-week, 30 contact hour MBSR course for first and second year medical students, and to assess its impact on their reported levels of stress, burnout, fear of compassion, and mindfulness.

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  Urinary cytokines as potential biomarkers of mild cognitive impairment and Alzheimer’s disease: a pilot study

  Nazia Saiyed, Ali Yilmaz, Sangeetha Vishweswariah, Sarah Bartolone, Tammy Osentoski, Stacey Ruff, Amita Pai, Michael Maddens, Khaled Imam, and Stewart F. Graham

  Publication Date: 10-21-2022

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  HIV-associated nephropathy presenting as the first manifestation of HIV 2 infection

  Kamil Sardarli, Rania Daboul Daboul, Sumesh Khanal, and Sami Zarouk

  Publication Date: 4-2022

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  Dual Paraneoplastic Syndrome in Small Cell Lung Cancer

  Kamil Sardarli, Austin Morris, and Jamal AbuKhaled

  Publication Date: 11-2022

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  A Rare Case of Subcutaneous Panniculitis-Like T-cell Lymphoma

  Blake Seelbinder, Angela Kim, Marcos Rosado, Mohamed Musheinesh, Amanda Cimino, John Pui, Armen Korkigian, and Craig Gordon

  Publication Date: 5-2022

  Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and typically slow growing variant of T-cell lymphoma. The clinical course usually mimics infectious panniculitis. It characteristically affects the subcutaneous adipose tissue of the trunk or extremities without resultant lymph node involvement. It comprises

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  Primary Carnitine Deficiency Induced Ventricular Fibrillation

  Andrew Sherman, Luai Madanat, Timothy Pow, and Akhil Gulati

  Publication Date: 5-13-2022

  Background: Children with primary carnitine deficiency (PCD) frequently develop cardiomyopathy; however it is not commonly seen in adults. Arrhythmias are less common and include forms of long QT-syndrome and ventricular fibrillation. ECG findings commonly involve peaked T-waves and short QT intervals that may resolve with supplementation of L-carnitine. Case presentation: An 18-year-old female with a family history of sudden cardiac death (SCD) presented to the emergency department following a witnessed out-of-hospital cardiac arrest. She was initially noted to be in ventricular fibrillation (VF) and was subsequently defibrillated twice on presentation. Her rhythm converted to supraventricular tachycardia at which time adenosine 6 mg IV was administered twice with reversion to sinus rhythm. ECG on presentation demonstrated peaked T waves and short QT interval. She was admitted to the cardiac intensive care unit for targeted temperature management. Carnitine level on admission was subtherapeutic at 1 nmol/mL (normal: 34-78 nmol/mL) due to suboptimal dosing at home. She was loaded with L-carnitine 12 g/day with repeat levels improving to 41 nmol/mL. Echocardiogram revealed an ejection fraction (EF) of 35% with a dilated right ventricle and global left ventricular hypokinesis. The patient later regained consciousness and was transferred out of the cardiac intensive care unit. Repeat echocardiogram two weeks later revealed no significant change in EF. Her hospital course was complicated by methicillinsensitive staphylococcus aureus pneumonia, for which ICD placement was delayed until completion of antibiotics. She was discharged home in stable condition with plans for 4 weeks of IV antibiotic therapy and close follow-up. Discussion: Primary carnitine deficiency can present as ventricular fibrillation with or without pre-existing cardiomyopathy in adults. Strategies for primary prevention of SCD should be considered in these patients, especially in those with a known family history of SCD.

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  Case of Leptospirosis in Urban Settings With Perplex Clinical Presentation

  Kateryna Strubchevska, Marko Kozyk, and Brian Nadeau

  Publication Date: 10-2022

  Introduction

  Leptospirosis is a zoonosis with variable clinical manifestations caused by pathogenic spirochetes of the genus Leptospira. It occurs in both temperate and tropical regions. A systematic review and modeling exercise estimated that there were 1.03 million cases worldwide annually with 58,900 deaths. Leptospirosis stays among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of hemorrhagic fever.

  Discussion

  Leptospirosis has unusual symptoms which make the diagnosis challenging. There is a need for a comprehensive approach when the disease is suspected. • Liver and kidney involvement represent life-threatening manifestations of the disease. • Antibiotic treatment is usually recommended as it shortens the clinical course and prevents the spread of the disease.

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  Diabetic Ketoacidosis Precipitated by COVID-19 Induced Acute Pancreatitis

  Tamera Tennant and Bhavinkuma Dalal

  Publication Date: 5-13-2022

  Gastrointestinal manifestations of COVID-19 infection are increasingly being recognized, such as nausea, vomiting, and diarrhea. Research into the pathophysiology is ongoing. I present a case of a 52-year-old female without a history of diabetes who presented to the emergency room with progressive lethargy and altered mental status. Her tests results were consistent with diabetic ketoacidosis with glycemia 1440 mg/dL, venous pH 7.23, beta hydroxybutyrate of 7.53 mmol/L, bicarbonate 14 mmol/L, and anion gap 32. COVID-19 (SARSCoV- 2) testing by nucleic acid amplification was positive on admission. She was admitted to the intensive care unit and started on an insulin drip. Her severe abdominal pain led to the diagnosis of acute pancreatitis with lipase >1200 U/L and computed tomography of the abdomen showed inflammatory changes around the head of the pancreas and second portion of the duodenum. Workup for the cause of her pancreatitis was unrevealing. A right upper quadrant ultrasound negative for evidence of cholelithiasis, common bile duct dilation or liver abnormalities. She denied alcohol and drug use, which was confirmed with a negative blood alcohol level and urine drug screen on admission. Furthermore, she was not taking any medications prior to arrival, specifically those known to cause pancreatitis. She was diagnosed with diabetes mellitus during this admission and DKA was the presenting situation precipitated by COVID-19 pancreatitis. She was treated with intravenous fluids and supportive care. The remainder of her hospital stay was unremarkable. She was discharged home with an insulin regimen, and her HbA1C two months later was 8.3%. Follow-up CT of the abdomen one month after discharge showed no abnormalities. Literature review revealed a study in China reported an elevated incidence of pancreatic injury with few exhibiting hyperglycemia, and without a diagnosis of acute pancreatitis (1). There are few cases of acute pancreatitis that are classified as being caused by COVID-19 infection (2). However, none of these reported a complication of DKA. This case demonstrates pancreatitis and DKA as rare, yet possible, complications of COVID-19 and emphasizes the importance of thorough history-taking and diagnostic evaluation.

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  A Case of Pancreatic Squamous Cell Cancer

  Bijaya Thapa, Ujjwal Jung Karki, Bipin Ghimire, Ashbita Pokharel, Shailesh Niroula, and Mohammad Muhsin Chisti

  Publication Date: 10-2022

  Introduction

  Primary Squamous Cell Carcinoma of the pancreas is a rare entity that comprises 0.05% of all exocrine pancreatic carcinomas. The main differential diagnoses of primary SCC of the pancreas are adenosquamous carcinoma- another rare primary tumor of the pancreas and metastatic SCC from another primary site.

  Discussion

  Squamous cell carcinoma of the pancreas is a controversial entity of uncertain origin, as the pancreas is entirely devoid of squamous cells[1] • Adenosquamous carcinomas may be misdiagnosed in case of inadequate sampling of adenocarcinoma component. • Literature is limited to a few case reports, and has shown pancreatic SCC to be an aggressive cancer with a poor prognosis. • Isolated reports are available on the use of gemcitabine and newer taxane formulations, but the response to chemotherapy or radiotherapy is sub-optimal. • Similar to breast, ovarian, and endometrial cancers; pancreatic cancers can be genetically inherited. • As with all pancreatic cancers, surgical resection of the tumor has been the most effective modality, however treatment with targeted immunotherapy could be promising in unresectable tumors with targetable mutations.

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  Prediabetes as a risk factor for major adverse cardiovascular events

  Muhammad A. Waheed, Ramy Mando, Adrian Michel, and Alexandra Halalau

  Publication Date: 5-2-2022

  INTRODUCTION
  Major adverse cardiac events (MACE) have been shown to be associated with Type II diabetes mellitus (DM) as it is a proinflammatory process. Some DM inflammatory markers may be present in prediabetes (pDM). Yet, the clinical relationship between pDM and MACE has not been well studied. Thus, this study’s primary goal is to see if pDM increases one’s risk for MACE.

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  Patient Perceptions of their Health Care Teams and Preferences for Making Decisions regarding Medical Care

  Veronica F. Williams and Nelia Afonso

  Publication Date: 5-2-2022

  INTRODUCTION
  Beaumont Hospital values patient and family-centered care, but a clear understanding of how patients perceive their health care teams and prefer to make decisions regarding their medical treatment have not been well-described. It is necessary to understand patients’ preferences regarding various factors that impact their medical care in order to foster an effective health care environment. The primary goal of this study is to determine how patients’ care teams impact the ways in which they make decisions regarding their medical treatment. A secondary goal is to determine the individuals, both inside and outside of the health care setting, that make up patients’ care team

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  Standardizing Ambulatory Blood Pressure Measurement

  Alan Zakaria, Julia Tullio, Nicholas Maddens, and Alexandra Halalau

  Publication Date: 4-28-2022

  Objectives

  - Quality improvement project conducted for more accurate BP readings to improve the management of HTN

  - Undergo PDSA cycles to implement proper blood pressure measuring techniques