Jejunal Intussusception: A Rare Adult Presentation of Lymphoid Hyperplasia

A 21-year-old African-American male presented to the emergency room with a sudden diffuse onset abdominal pain of one day duration. CT findings revealed mild telescoping of loops of small bowel and mesenteric fat in the left mid abdomen with no apparent masses. The patient underwent an exploratory laparoscopy revealing intussusception of the mid jejunum. As a fair amount of distention compromised safe navigation of the bowel, laparoscopic resection was not warranted at this time. Open approach allowed for segmental resection of the affected segment of the small bowel. This was followed by primary anastomosis. Pathological findings revealed focal reactive lymphoid hyperplasia with marked congestion in the lamina propria of the jejunum. The patient had an unremarkable postoperative period and recovered with no further complications

Pathophysiology and Neuroimmune Interactions Underlying Parkinson’s Disease and Traumatic Brain Injury

Parkinson’s disease (PD) is a progressive neurodegenerative disorder clinically defined by motor instability, bradykinesia, and resting tremors. The clinical symptomatology is seen alongside pathologic changes, most notably the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and the accumulation of α-synuclein and neuromelanin aggregates throughout numerous neural circuits. Traumatic brain injury (TBI) has been implicated as a risk factor for developing various neurodegenerative diseases, with the most compelling argument for the development of PD. Dopaminergic abnormalities, the accumulation of α-synuclein, and disruptions in neural homeostatic mechanisms, including but not limited to the release of pro-inflammatory mediators and the production of reactive oxygen species (ROS), are all present following TBI and are closely related to the pathologic changes seen in PD. Neuronal iron accumulation is discernable in degenerative and injured brain states, as is aquaporin-4 (APQ4). APQ4 is an essential mediator of synaptic plasticity in PD and regulates edematous states in the brain after TBI. Whether the cellular and parenchymal changes seen post-TBI directly cause neurodegenerative diseases such as PD is a point of considerable interest and debate; this review explores the vast array of neuroimmunological interactions and subsequent analogous changes that occur in TBI and PD. There is significant interest in exploring the validity of the relationship between TBI and PD, which is a focus of this review

The catalytic role of Mystery Patient tools in shaping patient experience: A method to facilitate value co-creation using action research.

Improving patients' experience in hospitals necessitates the improvement of service quality. Using mystery patients as a tool for assessing and improving patients' experience is praised for its comprehensiveness. However, such programs are costly, difficult to design and may cause unintended negative consequences if poorly implemented. Following an Action Research theoretical framework, the aim of this study is to utilize the Mystery Patient (MP) for engaging the patient in co-creating valuable non-clinical services and producing guidance about future managerial interventions. This was operationalized at the Outpatient Clinics at a large Academic Hospital in the Middle East region whereby 18 Mystery Patients conducted 66 visits to clinics and filled out 159 questionnaires. The results indicated higher scores on hard criteria or skills (technical), such as personal image and professionalism, and lower scores on soft criteria (interpersonal), including "compassion" and "courtesy". The data also demonstrated how the MP tool could provide targeted information that can point to future interventions at any one of the patient experience core pillars, namely: process, setting, and employees. This paves the way for another cycle of spiral learning, and consequently, a continuous process of organizational learning and development around service provision. The MP tool can play the role of the catalyst that accelerates the value co-creation process of patient experience by directing management to necessary interventions at the three pillars of patient experience: employees, processes, and setting

Salmonella aortitis successfully treated with antibiotics without surgery

Aortitis is an inflammation of the aorta that is linked to large vessel vasculitis and other rheumatologic cases. Less often, an infectious etiology of aortitis is diagnosed. Aortitis is associated with high mortality and morbidity and requires a high index of suspicion. Here we present a rare case of aortitis secondary to Salmonella Septicemia treated with six weeks of antibiotics in the hospital without and remained asymptomatic and inflammatory markers normalized at 2 weeks follow up (ESR, CRP, and WBCs)