ABSTRACT Introduction Coronavirus disease 2019 (COVID-19) infection is characterized by a dysregulated inflammatory response, which may result in severe hemodynamic instability and septic shock. The Seraph-100® Microbind® Affinity Blood Filter commercially available extracorporeal pathogen absorbent device with the ability to bind pathogens cytokines present within blood. Our study aimed evaluate efficacy of for patients acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Materials Methods...

OBJECTIVES: A significant proportion of patients with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation at our institution demonstrated heparin resistance, which in combination a shortage resulted the transition to argatroban or without aspirin as an alternative anticoagulation strategy. The optimal strategy for is unknown, and therefore, we sought evaluate efficacy safety this patient population. DESIGN: Retrospective cohort. SETTING: Single-center...

Virtual care (VC) and remote patient monitoring programs were deployed widely during the COVID-19 pandemic. Deployments heterogeneous evolved as pandemic progressed, complicating subsequent attempts to quantify their impact. The unique arrangement of US Military Health System (MHS) enabled direct comparison between facilities that did not implement a standardized VC program. program enrolled patients symptomatic for or at risk severe disease. Patients' vital signs continuously monitored home...

Many bacteria regulate gene expression in response to phosphate availability using a two-component signal transduction system, the activity of which is controlled by interaction with Pst specific transporter and cytoplasmic protein PhoU. Mycobacterium tuberculosis, causative agent requires its sensing system for virulence antibiotic tolerance, but molecular mechanisms remain poorly characterized. smegmatis serves as model studying mycobacterial pathogens including M. tuberculosis. encodes...

Introduction Proton pump inhibitors (PPI) are commonly prescribed in the primary care setting. While generally considered to be safe, there is growing evidence suggesting that PPI misuse associated with a variety of significant adverse outcomes and unnecessary cost. The goal this quality improvement project was identify patients non-guideline recommended prescriptions our internal medicine residency clinics implement process de-prescribe or reduce dose PPIs across patient population. Methods...

Statin-induced immune-mediated necrotizing myopathy, also known as anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) is an inflammatory myopathy that triggered by statin exposure and persists after discontinuation. It a rare side effect of statins, distinct from the more commonly recognized statin-induced myalgia, challenging to diagnose treat. We describe case anti-HMGCR in 59-year-old male with prior history intolerance presenting markedly elevated creatinine kinase,...

Introduction The American Board of Internal Medicine (ABIM) requires that trainees receive procedural training for certification; however, (IM) residents perform a variable number procedures throughout residency training. This results in differences confidence levels as well competence. For active-duty military trainees, this is especially problematic, these skills are often required during deployment soon after graduation. deficit can be improved through standardized simulation-based...

Introduction The coronary artery disease-reporting and data system (CAD-RADS) was developed to standardize communication of per-patient maximal stenosis provide treatment recommendations that may affect downstream testing. Methods Downstream testing, cardiology referral, cost were abstracted for 1,796 consecutive patients undergoing CT angiography (CCTA) before after the adoption CAD-RADS reporting template at a single-center closed referral hospital system. Cost analysis based on direct...

Introduction Coronary artery calcification (CAC) scoring is typically performed utilizing non-contrast, electrocardiogram- (ECG) gated CT and offers an estimation of cardiovascular (CV) prognosis risk stratification beyond previously established cardiac factors. can also be assessed during non-gated chest CT, which significant given the recent recommendations for lung cancer screening by low-dose CT. Methods We retrospectively reviewed 4,953 non-contrast scans in a single, closed referral...

Erythrodermic psoriasis is a rare and potentially fatal skin condition. We present the case of 68-year-old woman, with no prior dermatologic history, who was treated steroid injection for an insect bite one month to presentation subsequently developed diffuse erythematous rash. She presented military medical center in shock, weeping, coalesced plaques covering majority her skin. Skin biopsies revealed pustular psoriasis, treatment infliximab initiated erythrodermic psoriasis. After six weeks...

Deployed military personnel may be at risk for developing acute and chronic lung disease. Prior studies of this patient population have revealed that unexplained exertional dyspnea is the most common diagnosis despite an extensive evaluation. There a concern occult disorder affecting population. This study evaluated role bronchoalveolar lavage (BAL) fluid analysis in evaluation deployment-associated dyspnea.

ABSTRACT Hemoptysis is a rare presenting symptom in pediatric and young adult patients with highly variable outcome ranging from an isolated mild occurrence to severe illness death. Exercise-induced pulmonary hemorrhage (EIPH) has several reports literature but not previously been reported patients. A 12-year-old female history of trisomy X (47, XXX), obesity, depression, anxiety, obstructive sleep apnea presented the pulmonology clinic after episodes hemoptysis. Spirometry, imaging,...

ABSTRACT Introduction Asthma is the most common diagnosis in military personnel who endorse chronic dyspnea. Service members have unique occupational risk factors, and there concern that airborne exposures deployed environment as well other may contribute to development of asthma or exacerbate pre-existing disease. phenotyping with clinical biomarkers such serum immunoglobulin E (IgE) levels eosinophil (EOS) counts useful defining treatment strategies for management asthma. This study sought...

Background Coronary artery calcium (CAC) scoring based on gated non-contrast cardiac computed tomography (CT) is a validated risk marker of major adverse cardiovascular events (MACE). Reporting CAC non-gated CT chest (NGCT) scans and the impact medical therapy not well studied. Methods A retrospective cohort 5,043 NGCT was reviewed for presence CAC. The radiology report to determine whether mentioned in either body or final impression. Electronic records (EMR) were abstracted baseline...

A 33-year-old male with severe COVID-19 required prolonged veno-venous extracorporeal membrane oxygenation (ECMO) support. Following decannulation, he developed an Enterococcus faecium empyema. Tube thoracostomy and broad-spectrum antibiotics were initiated, followed by unsuccessful attempt at pleural irrigation saline, given the patient had increased risk of bleeding due to concomitant requirement for systemic anticoagulation. Subsequently, intrapleural tissue plasminogen activator (tPA)...

High-affinity hemoglobinopathies are a rare clinical entity that commonly presents as an isolated erythrocytosis in asymptomatic individuals. We report such case involving 18-year-old active duty military trainee who presented to the hematology clinic after was incidentally discovered during flight physical. The patient but did family history of his mother and maternal grandmother which intermittently required venesection. Initial physical exam were unremarkable. P50 RBC Oxygen Dissociation...

Actinomycosis is an uncommon bacterial infection that presents as indolent, progressive disease can affect multiple organ systems. We describe the case of a 66-year-old female with end-stage renal who presented to emergency department after developing acute dyspnea and chest pain two weeks undergoing diagnostic esophagogastroduodenoscopy (EGD). A CT scan was obtained revealed large mediastinal mass, which initially concerning for potential malignancy. Biopsy mass Gram stain consistent...

ABSTRACT Introduction Pulmonary embolism (PE) is associated with significant rates of morbidity and mortality. Management PE complex, adverse patient events are not uncommon. Brooke Army Medical Center (BAMC) among several select institutions that have implemented multidisciplinary pulmonary response teams (PERTs) to improve outcomes. PERT structure varies often involves specialty expertise from a variety departments within the hospital. aim diagnosis treatment for patients acute PE. Here,...