A Case of Sarcoidosis Disseminated to Skeletal Tissues

Sarcoidosis is a systemic granulomatous disease of unknown etiology that typically affects young adults. Diagnostic criteria for sarcoidosis include involvement of two or more of the following organ systems: 1) pulmonary infiltrates; 2) bilateral hilar adenopathy; and 3) skin and/or eye lesions. Musculoskeletal system is less commonly involved. For that reason potential presenting symptoms can vary and make the diagnosis very challenging; particularly if a patient has symptoms that mimic other conditions. Musculoskeletal involvement for example can mimic malignancy. The following case describes a patient with known history of primary metastatic mediastinal Germ Cell Tumor (GCT) with teratomatous elements who is diagnosed with sarcoidosis involving skeletal tissues

Effect of birthplace on cardiometabolic risk among blacks in the Metabolic Syndrome Outcome Study (MetSO)

BACKGROUND: Metabolic syndrome poses an increased global burden of disease and causes immense financial burden, warranting heightened public health attention. The present study assessed the prevalence and severity of cardiometabolic risk among foreign-born versus US-born blacks, while exploring potential gender-based effects. METHODS: A total of 1035 patients from the Metabolic Syndrome Outcome Study (Trial registration: NCT01946659) provided sociodemographic, medical history, and clinical data. General Linear Model (GLM) was used to assess the effects of birthplace and gender on cardiometabolic parameters, adjusting for age differences in the sample. RESULTS: Of the sample, 61.6 % were foreign-born blacks (FBB) and 38.4 % were US-born blacks (USB). FBB had significantly lower BMI compared with USB (32.76 ± 0.35 vs. 35.41 ± 0.44, F = 22.57), but had significantly higher systolic blood pressure (136.70 ± 0.77 vs. 132.83 ± 0.98; F = 9.60) and fasting glucose levels than did USB (146.46 ± 3.37 vs. 135.02 ± 4.27; F = 4.40). Men had higher diastolic BP (76.67 ± 0.65 vs. 75.05 ± 0.45; F = 4.20), glucose (146.53 ± 4.48 vs. 134.95 ± 3.07; F = 4.55) and triglyceride levels (148.10 ± 4.51 vs. 130.60 ± 3.09; F = 10.25) compared with women, but women had higher LDL-cholesterol (109.24 ± 1.49 vs. 98.49 ± 2.18; F = 16.60) and HDL-cholesterol levels (50.71 ± 0.66 vs. 42.77 ± 0.97; F = 46.01) than did men. CONCLUSIONS: Results showed that birthplace has a significant influence on cardiometabolic profiles of blacks with metabolic syndrome. Patients’ gender also had an independent influence on cardiometabolic profile

IgA Monoclonal Gammopathy of Undetermined Significance and Complication of Streptococcus mitis Bacteremia

This case presents a patient with bacteremia of an unusual organism with a history of monoclonal gammopathy of undetermined significance (MGUS). MGUS is typically thought to be asymptomatic until potential progression of the disease. This case reports a patient with a history of MGUS who does not show disease progression, however, may be showing symptoms, such as immunodeficiency. This case displays bacteremia with Streptococcus mitis within a two-week period of an invasive procedure. Recent studies parallel this case by showing MGUS patients may have two times the risk of infections compared to the unaffected population. This report brings up the question of taking prophylactic measures for this patient population to prevent future complications

Promoting tobacco cessation utilizing pre-health professional students as research associates in the emergency department

OBJECTIVE: The objective of this study was to investigate the extent to which volunteer research associates (RAs) can be utilized to screen emergency department patients and their visitors for tobacco use and effectively refer tobacco users requesting help to state Tobacco Quitlines. METHODS: A sample of 19,149 individuals in 10 emergency departments around the country was enrolled into a prospective, interventional study on tobacco cessation by pre-health professional RAs. Participants who screened positive for tobacco use were provided a brief description of Tobacco Quitline programs and then offered a faxed referral to their respective state Quitline. RESULTS: A total of 10,303 (54%) participants reported tobacco use for more than one month during their lives, with 3861 (20%) currently using every day and an additional 1340 using on some days (7%). Most importantly, 2151 participants requested a faxed Tobacco Quitline referral (36% of individuals who used tobacco in the past month). DISCUSSION: Pre-health professional RAs were shown to be an effective and cost-efficient resource for providing a strongly recommended service in the emergency department. Patient care (and the care of their visitors) was supplemented, emergency department personnel were not provided with additional burden, and RAs were provided with valuable experience for their futures in the health professions

Patient-Centered Communication Behaviors That Correlate With Higher Patient Satisfaction Scores

Background: With increased emphasis on improving the patient experience, clinicians are being asked to improve their patient-centered communication behaviors to improve patient satisfaction (PS) scores. Local Problem: The relationship between clinician communication behaviors and PS is poorly studied in the emergency department (ED) setting. The purpose of this study was to identify whether specific communication behaviors correlate with higher PS scores in the ED setting. Methods: During a quality improvement project, we performed 191 bedside observations of ED clinicians during their initial interaction with patients and recorded the frequency of 8 positive communication behaviors as defined by the PatientSET tool. Interventions: The frequency of use of the PatientSET communication behaviors was compared between known high performers in Press Ganey PS scores versus low performers. Results: Being a high Press Ganey performer was associated with a significantly higher frequency of performance in 6 of the 8 PatientSET communication behaviors. Conclusions: Positive communication behaviors such as those in the PatientSET tool occurred more frequently in ED clinicians with higher PS scores

Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection.

BackgroundCharacterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function.Methods and findingsThis prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p ConclusionsCOVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services