Strict Liability and Informed Consent: Don\u27t Say I Didn\u27t Tell You So!

The purpose of this article is the cogent presentation of the arguments favoring application of contemporary strict tort liability concepts to the doctrine of informed consent. While not a panacea, adoption of this proposal would afford the consumer of medical services the requisite protection to make an effective, informed medical choice, while lending consistency and certainty to the physician, long harrassed, both morally and legally, by doubts as to what constitutes an informed consent. This author will assume, arguendo, for the purpose of this article that all physicians are good-faith, competent practitioners. However, the reader should be forewarned: The existing requirement that medical consumers render an informed consent constitutes a knotty and complex problem, both ethically and legally, for the most conscientious and competent medical practitioner. Entrusting enforcement of the existing informed consent laws to the few physicians who fail to adhere to the high standards promulgated by the medical profession can be likened to deploying the fox to guard the henhouse. Likewise, the reader should note that the proposed standard of strict tort liability applies only to the situation in which the physician has failed to adequately advise the patient of the attendant risks of the proposed treatment, and not to a physician\u27s liability for treatment where informed consent has been obtained

Without a rash! A diagnostic dilemma for VZV vasculopathy

Varicella zoster virus vasculopathy is a condition that can classically present with a dermatomal zoster rash followed by a neurological deficit. The possible neurological manifestations and disease range are extensive. Diagnosis becomes more challenging in patients whose presentation does not include a rash, often causing cognitive errors and delay in treatment. We present a case of an 85-year-old patient, who developed stroke-like symptoms, initially with normal MRI, to later progress to multiple evolving enhancing lesions seen in subsequent MRIs. This case also represents the anchoring, that we as physicians can have when a patient with risk factors for stroke or TIA, presents to the emergency department complaining of unilateral weakness

Quality Improvement in a Hospital Setting: Central Line-Associated Bloodstream Infections at an Acute Care Hospital in South Texas

Background: Central line-associated infections (CLABSI) are life-threatening nosocomial infections that are associated with significant increase in healthcare expenditure, prolonged stays, and risk of mortality. Objective: To identify outcome trends and risk factors that contribute to incidence of CLABSI at an 866-bed acute care hospital in South Texas. Methods: A retrospective chart review was conducted on 38 patients who met the National Healthcare Safety Network criteria for CLABSI during the period of January 2021 to March 2022 Results: There was a total of thirty-two CLABSIs in 2021. Hospital-wide CLABSI rate was 1.76 hospital-wide per 1,000-line days. Half of cases were COVID-19 positive with 59% of the infections occurring between August and October. Overall mortality rate for CLABSI in 2021 was 56%. COVID-19 positive patients with CLABSI had a mortality rate of 87.5% vs 25% in COVID-19 negative patients. From January to March 2022, there was six CLABSIs. Hospital-wide CLABSI incidence rate was 1.09 per 1,000-line days. Half were COVID-19 positive. Overall mortality rate for CLABSI in 2022 is 50%. COVID-19 positive patients with CLABSI had a mortality rate of 66.7% vs 33.3% in COVID-19 negative patients. Conclusions: The COVID-19 pandemic has had a significant impact on incidence of CLABSI this South Texas Hospital. The peak of CLABSI incidence correlates with the trends of COVID cases within the U.S

Antibiotic Stewardship in Skin and Soft Tissue Infections

Introduction: Skin and soft tissue infections (SSTIs) are characterized by microbial invasion of the skin layers and are common in various healthcare settings. A study conducted between 2005-2010 in the United States, found a combined total of 2.3 million cases of SSTIs in ambulatory and inpatient settings. This was higher than the rates of pneumonia and urinary tract infections during the same time period. Another study found that between 2000 and 2012, there was a 40% increase (2.4 million to 3.3 million) in cases of SSTIs. Our aim is to study the primary uses of vancomycin and piperacillin/tazobactam and their average days of therapy in the treatment of SSTIs. Objective: Our aim is to study the primary uses of vancomycin and piperacillin/tazobactam and their average days of therapy in the treatment of SSTIs. Methods: Data was collected for during January of 2019 of all administrations of antimicrobial use in a local hospital, which included the emergency department, inpatient admissions, and intensive care unit. These data points were sorted by antimicrobial, dates administered, and then by their indicated use. Indicated uses were then tallied on a histogram and an average days on therapy was calculated per patient. Discussion: Our analysis illustrates that the top three indicated uses of vancomycin was other, sepsis, and SSTIs, in descending order. The average days of therapy per patient for use of vancomycin in the treatment of SSTIs was 2.97 days. Piperacillin/tazobactam similarly was used primarily for sepsis, gastrointestinal/intra-abdominal infections, and SSTIs, in descending order. Conclusion: Our analysis shows that the average days of therapy for use of vancomycin in the treatment of SSTIs was 2.97. Study limitations include the limited, one-month duration of the data set. Our plan is to expand this work using data from a 12-month period on use of antimicrobials in the same hospital. We intend to compare the average days of therapy for different indications (i.e sepsis) and compare to national averages. We hope to interpret these data in the context of guideline recommendations on duration of intravenous therapy for SSTIs, so as to surmise what differences may exist between guidelines and clinical practice

A Stomach Bug? Not What You May Think: A Case of Post-Viral Gastroparesis Caused by SARS-CoV-2

Gastroparesis has a wide range of etiologies including diabetes, medications, post-surgical, post-viral and idiopathic (1). SARS-CoV-2 can cause gastrointestinal symptoms which typically resolve within the first few weeks of infection (2). However, some sequelae persist beyond the initial infectious period

Impact of Academic Golden Weekend Initiative on Academic Success for an Internal Medicine Clerkship

Background: COVID-19 precautions led to a change in the number of protected weekends for the UTRGV Internal Medicine Clerkship, going from 2 protected weekends to none. The aim of Academic Golden Weekends during a fully inpatient clerkship has been to maximize the student experience by providing enough time to balance all the necessary components of the student experience. Starting April 26, 2021, all cohorts completing their Internal Medicine Clerkship as third-year medical students had 3 protected weekends. Methods: Two surveys were created to compare the pre-intervention and post-intervention cohorts. The surveys focused on student satisfaction regarding the time they had for self-study, accomplishing clerkship requirements, and overall well-being. Furthermore, IM Clerkship NBME grade and clerkship final grade data have been retrieved and deidentified, later analyzed by a blinded party to assess the impact of the Academic Golden Weekend Initiative on academic performance. Results: Prior survey analysis has shown that prior to the implementation of Academic Golden Weekends, students had a higher rate of dissatisfaction regarding time available for self-study, accomplishing clerkship requirements, and self-care. The leading cause for overall dissatisfaction was lack of protected weekends.100% of students in the post-intervention cohort reported feeling that Academic Golden Weekends had a positive impact on their academic performance and self-care and reported increased levels f satisfaction across all categories. However, the preliminary analysis of the impact that this initiative had on academic performance, did not show a significant improvement on average NBME, and clerkship grades. Conclusions: While the Academic Golden Weekends initiative has led to improved student satisfaction for academic performance and self-care, the limited data collected thus far does not reveal a significant improvement in academic performance in terms of NBME and clerkship grades. Once more data is gathered these variables will be re-analyzed for statistical differences

Prevalence of Liver Cirrhosis and Its Association With Obesity Among Mexican Americans: An Evidence Synthesis

Introduction: Chronic liver disease is the 6th and 7th leading cause of death in Hispanic men and Hispanics, respectively.1 In contrast to other causes of liver disease, the prevalence of nonalcoholic liver disease has been growing as is diabetes and obesity.2 Objective: There is a paucity of data regarding the prevalence of cirrhosis for Mexican Americans in South Texas. The aim of this evidence synthesis is to investigate the prevalence of cirrhosis in Hispanic populations and its relationship with obesity. Methods: PubMed was used to perform a thorough literature search on September10, 2020. The terms “liver cirrhosis” and “obesity” were combined with the subheading\u27s “epidemiology,” “genetics,” and “complications.” Five remained after applying criteria. Results: In a cohort of Hispanic patients in South Texas, the prevalence of cirrhosis/fibrosis was estimated to be 3.54%, and central obesity was an independent risk factor for cirrhosis/advanced fibrosis (p=0.04).3 Moderate to severe fibrosis has a statistically significant higher average BMI compared to those with none to mild fibrosis (p\u3c0.001).4 A study in multiple Mexican regions found increased mortality from cirrhosis with statistically significant findings in the South and North regions (p\u3c0.0001).5 Obesity only increased in the Central and Mexico City regions.5 Discussion: Obesity was an independent risk factor for cirrhosis and 65.3% of cirrhosis and advanced fibrosis cases may be attributable to obesity alone in a cohort of Hispanic patients.3Since South Texas has one of the highest rates of obesity in the US, this population is susceptible to high rates of liver disease, obesity and mortality. Conclusions: Hispanic patients that are obese have an increased risk of liver disease and associated mortality.3–6These study findings are limited by the paucity of relevant research and variable methodology of the studies. Further research is needed to evaluate the impact of obesity on liver disease for this population

MRNA-1273 COVID-19 Vaccine Leading To Anti-LGI1 Limbic Encephalitis Flare

Introduction: Here, we discuss a patient with a past medical history of Anti-LGI1 limbic encephalitis that presented with seizure-like activity approximately three weeks after the administration of the mRNA-1273 COVID-19 vaccine. Case Description: A 75-year-old male with a history of Anti-LGI1 limbic encephalitis presented to our hospital with bilateral, truncal myoclonus and lateral nystagmus. EEG showed periodic lateralized epileptiform discharges. Brain MRI was unremarkable. The lumbar puncture was not suggestive of meningoencephalitis and the patient was diagnosed with a clinical relapse of Anti-LG1 limbic encephalitis, started on IVIG, methylprednisolone, azathioprine, and antiseizure medications. After the absence of seizure activity was documented, he was discharged with instructions to follow up with neurology and advised to withhold the second dose of the COVID-19 vaccine. Discussion: Our patient was previously diagnosed with Anti-LGI1 in 2011and had been clinically stable without seizures since 2016. His relapse could have been triggered by an immunological response to the COVID-19 vaccine. Although vaccine administration does not pose a more prominent danger than natural SARS-CoV-2 infection, the temporal association raises the possibility of the vaccine as a trigger for the patient’s autoimmune limbic encephalitis relapse. Unfortunately, little is known about how to predict, prevent or ameliorate these events in certain immunologically predisposed individuals or if the temporal association reported here represents an adverse event of the mRNA-1273 COVID-19 vaccine. Ongoing reporting and further research are warranted to evaluate if this association can be confirmed, and if so, understand if there is a plausible underlying immunological mechanism

Analysis Of Mismatch And Shading Effects In A Photovoltaic Array Using Different Technologies

In this paper, we analyze the performance of a photovoltaic array implemented in the Universidad Politécnica de Valencia which consists of modules of different technologies and power, connected in series, in order to quantify the energy losses due to mismatch and the effect of the shadows. To do this, the performance of the modules was measured in operation under ambient conditions with field measurement equipment (AMPROBE Solar Analyzer, Solar - 4000), which allows the extrapolation of measures to standard conditions STC. For the data validation, measures under controlled conditions were taken to some modules in the flash test laboratory of the Institute of Energy Technology ITE of Valencia in Spain. Subsequently the array curves measured were validated with a photovoltaic array model developed in MATLAB-Simulink for the same conditions and technologies. The results of this particular array are lost up to 20% of the energy supplied due to the modules mismatch. The study shows the curves and the energy loss due to shadows modules. This result opens scenarios for conceivable modifications to the PV field configurations today, chosen during the design stage and unchangeable during the operating stage; and gives greater importance to the energy loss by mismatch in the PV array

Coccidioides immitis presenting with acute hydropneumothorax in an immunocompetent patient from South Texas

Coccidioidomycosis is a disease caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii that predominates in dry climates and it is endemic in Southern California and Arizona. Coccidioides is also found in parts of West Texas and a long the Rio Grande River, however, incidence tends to decrease in areas close to the Gulf of Mexico due to increased humidity. Coccidioidomycosis is more commonly a subclinical and self-limited disease in up to sixty percent of cases. Acute pneumonia (Valley fever), extra thoracic disseminated infection and complications occur more frequently in immunocompromised hosts. We present a case of severe coccidiomycosis in an immunocompetent host who lived in central California for two months, 2 years prior to manifesting severe respiratory compromise. Clinicians should be able to recognize differential diagnoses for cavitary-like lung lesions, paying close attention to social history and CDC epidemiology data