An investigation of infectious etiologies of sporadic inclusion body myositis

Introduction: Sporadic inclusion body myositis (sIBM) is a rare, debilitating disease that can significantly lower one’s quality of life. Unfortunately, there are no current effective treatments, as the underlying causes are still unknown. We hypothesize that preceding infections do not cause sporadic inclusion body myositis. Methods: The study investigated patients with a diagnosis of inclusion body myositis, with a concurrent or previously documented infection. Men represented a larger proportion of the population as they have an increased preponderance of those affected. The primary objective was to discern which infection, if any, could induce the inflammatory and degenerative changes in muscle tissue observed in patients with sporadic inclusion body myositis. Results: A literature review on 42 primary articles, with HIV being the most studied infectious etiology (n=10). Those results support the notion that the inflammatory and degenerative changes seen in sporadic inclusion body myositis are not directly linked to a preceding infection. Although a causal relationship could not be established for any infection, many of them are being still actively investigated. Discussion: The observed results indicate that there are parallels between the inflammatory changes that take place in sIBM and certain infections. However, there are likely to be other causes that more directly lead to this disease manifestation. Future studies are warranted to further understand the inflammatory and degenerative pathways that take place subsequent to particular infections and inform us of some unknown causes and risk factors

Transition to Psychiatric Residency: Unique Stresses; Unique Rewards

An individual\u27s decision to pursue a psychiatric residency following medical school training is shaped by many factors. Beginning residents are often ill prepared for the relative impact that the shift from medical doctor to psychiatric resident entails. This paper reviews the literature regarding demographic and psychological factors relating to recruitment, dynamic and practical issues confronting the beginning resident, and various coping styles adopted. These factors are considered in the context of an inpatient setting where the majority of residents begin their training. Much of the resident response is seen as adaptive and a number of strategies for coping are suggested

Improving the patient experience through provider communication skills building

The doctor’s interpersonal skills are arguably the most important to clinical outcome and patient experience. A peer-facilitated, communication skills-building course for physicians has been provided twice annually since its inception in 2004. The course was designed to increase personal awareness, as well as to help physicians develop new communication and interpersonal skills. Satisfaction data from 3,561 patient surveys on 80 providers who attended the course between 2006 and 2010 were analyzed one year before and one year after course participation. After completing the course, the proportion of “excellent” ratings of provider service (the highest rating on a 5-point scale) increased by 2% to 5.6%. The most notable improvements in service attributes under the provider’s control and covered in the course content were: involving the patient in care decisions (P \u3c .001), explaining medical condition (P=.002), and the provider’s knowing the patient as a person (P = .004). Other improvements were noted in courtesy (by 3.4%, P=.027), listening (by 3.5%, P=.036), and overall quality of care from the provider (by 3.5%, P=.027). Attributes not directly under the provider’s control – nursing quality, teamwork, spending enough time, and likelihood to recommend – were included in the analysis; year-over-year changes in these were not significant. Further, providers who participated in the course, when compared to those who did not, experienced an 18-percent decrease in patient complaints. Improvements in perception of excellent provider communication and other service-related behaviors suggest this training approach may be useful in improving patient satisfaction, patient experience, and payment in value-based models

Use of Surface-Enhanced Laser Desorption/Ionization with Time of Flight (SELDI-TOF) of the Urine in the Assessment of Acute Kidney Injury (AKI)

Background: Urinalysis is an important component in the assessment of acute kidney injury (AKI). Proteonomics is a rapidly developing approach in the analysis of physiological states. Several techniques have been developed to screen for protein populations. In this regard SELDI-TOF is a technique based on mass spectroscopy that is being utilized in proteonomics research. Methods:For this study, clean catch or catheterized urine was collected from normals (n=18) and patients referred to the renal service with AKI. Based upon urine and serum chemistries, clinical parameters, and microscopic urinalysis, the urines were separated into those consistent with prerenal azotemia (n=17) and acute tubular necrosis (ATN) (n=29). Initially, 5 samples each were chosen from the pre-renal and ATN who had no preexisting renal disease. Other etiologies of AKI were not included in this analysis. The urine specimens were diluted 1:5 and deposited onto an H4 ProteinChip array using 50% acetonitrile as the binding buffer. This system captured the greatest spectral range with the SELDI-TOF evaluation (compared to SAX, WCX2, IMAC, and NP1 ProteinChips). Low (250) and high (300) laser intensities were utilized to ionize and desorb the protein molecules; the spectra were collected in a positive ion mode and analyzed with Ciphergen Peaks software (v 3.0). Results: Five peaks with the high laser power were identified as potential candidates to discriminate between AKI due to prerenal or ATN causes. Those urines from the prerenal subjects were associated with detectable masses at 22.6 and 44.8 kilodaltons (KD); whereas subjects with ATN were noted to have urine with substantial masses at 11, 11.7, and 14.6 KD. The intensity of these peaks were then added together and normalized with the individual components of the discriminate peaks representing a percentage of the total. The prerenal and ATN subjects were then randomized in a training set consisting of 23 subjects and a testing set consisting of 23 subjects. Multiple linear regression was performed on the training set, and this allowed for 65% accuracy when applied to the testing set. Feed forward neural networks with hidden neuron layers ranging from 2-10 achieved similar predictive capability on the training set and testing sets. Conclusions: Although the SELDI-TOF methodology may be a useful adjunct in the assessment of AKI and renal disease, we suggest that larger training sets will be necessary to effectively exploit this strategy

Microangiopathic Occlusion of a Perforating Prepontine Long Circumferential Artery Presenting with Lower Motor Neuron Facial Weakness: Clinical and Radiological Correlation

Case Description: A 79-year old male patient with myelodysplastic syndrome associated with severe neutropenia, thrombocytopenia, anemia, hypertension, and hyperlipidemia was admitted for pneumonia secondary to influenza A. Two weeks later he presented with new symptoms of acute dysarthria, and left facial weakness involving his upper and lower face; the following day he developed left arm weakness. Admission computed tomography (CT) and MRI scans revealed an acute ischemic stroke (AIS) in the right posterior frontal cortex. The initial MRI was reported negative for pontine lesions. Anatomically, the cortical infarct could not explain his left lower motor neuron cranial nerve VII (LMN CN VII) facial weakness distribution because in a cortical lesion the upper half of the face would be expected spared due to contralateral cortical innervation. Upon review of the MRI, the initial hyperintensity seen on Fluid-Attenuated Inversion Recovery (FLAIR) was overlooked and later identified as an acute stroke in the vicinity of the perforating prepontine long circumferential artery affecting the CN VII nucleus. Conclusion: In the absence of earache, active infection, and/or inflammation, a sudden onset facial palsy, lower motor neuron distribution, must poin