A Case of Acute Liver Failure Due to Artemisinin-Derived Herbal Supplements

A 49-year-old female presented with malaise, nausea, vomiting, and discolored urine. She was found to have an acute liver failure with labs significant for aspartate aminotransferase (AST) of 2164, alanine aminotransferase (ALT) of 2425, alkaline phosphatase (ALP) of 106, total bilirubin of 3.6, and lactate dehydrogenase (LDH) of 2269. The international normalized ratio (INR) was also elevated at 1.9. All workup for acute liver failure was negative and it was found that she had started taking a new supplement called Gut Health , which contained artemisinin, for weight loss and menopausal symptoms. After discontinuing the supplements and symptomatically treating her for acute liver failure, her transaminitis resolved

A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis

A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence since September 2021. One month after quitting alcohol, she experienced a sudden deterioration in bilateral extremity neuropathy, forgetfulness, difficulty writing, and severe mood swings, which continued to worsen until her presentation in July 2022. Laboratory tests, including complete blood count and electrolyte levels, were within normal ranges. A previous MRI performed during the investigation for alcoholic neuropathy a few months before she quit drinking showed no abnormalities. However, a subsequent MRI during work-up for the current acute symptoms revealed significant signal abnormalities involving the central pons, bilateral cerebral peduncles, and medullary pyramids, consistent with chronic central pontine myelinolysis (CPM) with extrapontine myelinolysis (EPM) extending into the peduncles. The patient received treatment with folate and multivitamins and was scheduled for outpatient follow-up with physical therapy for rehabilitation. This case highlights CPM as a consequence of alcohol withdrawal and emphasizes the importance of timely diagnosis and appropriate management in such patients

BREAKING DOWN BARRIERS FOR CERVICAL CANCER SCREENING USING SECURE GROUP TEXTING

STATEMENT OF PROBLEM/QUESTION: Is a secure messaging system an effective tool to address barriers of time constraints and patient preference for a female provider in order to improve cervical cancer screening (CCS)? In the past 40 years, CCS has significantly reduced the incidence of cervical cancer in the United States 1. However, the proportion of patients without up-to-date CCS increased from 14.4% in 2005 to 23.0% in 20192. One barrier we identified to CCS is patient preference for a female provider to complete their pap smear. DESCRIPTION OF PROGRAM/INTERVENTION: Our clinic has approximately 20 senior staff physicians and 118 residents. We have an underserved population of patients who are all insured. We use a team-based care model where our medical assistants will prepare patients who are overdue for a CCS at the beginning of the office visit if they are willing to complete their pap smear. We piloted a HIPAA-compliant secure messaging group chat with 10 of our female primary care attending physicians. This group chat is available for any provider or support staff to use when a patient is due for a pap smear, and is willing to obtain it at their visit. This includes scenarios when a patient of a male physician prefers a female provider, or time constraints prevent a provider from doing the pap smear. When a message is sent, all 10 female providers will receive it, and if someone is available to help, they will respond to the group message. If no one is available, no response will be sent. MEASURES OF SUCCESS: A positive outcome is defined as a message sent accompanied by a response; a negative outcome is a message sent with no response. Quantitative metrics to evaluate this tool include measuring the time elapsed between provider request and provider response, and number of responses. FINDINGS TO DATE: We piloted this project in 2021. Of 21 provider requests in 1 year, there was an 86% response rate. Average time to response was 2.3 minutes with median time 1 minute. Average number of responding physicians was 1. KEY LESSONS FOR DISSEMINATION: This intervention conveniently meets patients at the point-of- care clinic setting to improve CCS by addressing barriers, which include time constraints, and patient preference for a female provider. In addition, we have broadened this tool to include interested residents in order to allow them the opportunity to gain procedural experience. This custom yet cost-effective tool can be used for similar preventative health screenings and other sensitive procedures/exams