Hahnemann University Hospital

Pelvic inflammatory disease (PID) is a genital tract infection that affects a predominantly young and sexually active population. While its exact pathogenesis has yet to be determined, it appears to be caused by several micro-organisms that develop in response to one or more of the following: foreign bodies, such as intrauterine contraceptive devices, retained tampons and douching solutions, and surgery, such as endometrial biopsy and hysterosalpingography. The most common risk factor for PID is multiple sexual partners. The disease is associated with infertility, sterility and adverse pregnancy outcomes. Management calls for aggressive antibiotic therapy and the temporary suspension of sexual activity.

Introduction: Atrial fibrillation (Afib) is a common cardiac manifestation of hyperthyroidism. The data regarding outcomes of A fib with and without hyperthyroidism are lacking. Hypothesis: We hypothesized that patients with Afib and hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism. Methods: We queried National Inpatient Sample database for years 2015 - 2017 using Validated International Classification of Diseases and Clinical Modification (ICD-10-CM) codes for atrial fibrillation and hyperthyroidism. Patients were separated into 2 groups- A fib with hyperthyroidism and A fib without hyperthyroidism. Results: Study was conducted on 68,095,278 pateints. A total of 9,727,295 Afib patients were identified, out of which 90,635(0.9%) had hyperthyroidism. The prevalence of hyperthyroidism was higher in patients with Afib (0.9% vs 0.4%, p value <0.001), compared with patients without A fib. Using multivariate regression analysis after adjusting for various confounding factors, the odds ratio of Afib with hyperthyroidism was 2.08 (CI 2.07 - 2.10 P<.0001). Afib patients with hyperthyroidism were younger, (70.9 vs75.1 years, p<0.0001) and more likely to be female (63.9% vs 47% p<0.0001) as compared with Afib patients without hyperthyroidism. Afib patients with hyperthyroidism had lower prevalence of CAD (36.4% vs 43.8%,p<0.0001), cardiomyopathy(24.1% vs 25.9%,p<0.0001), valvular disease (6.9% vs 7.4%,p<0.0001), hypertension(60.7% vs 64.4%,p<0.0001) , and diabetes mellitus (28.9% vs 31.8%,p<0.0001). Afib with hyperthyroidism group had lower all-cause mortality (3.3% vs 4.8%, p<0.0001), shorter mean length of stay (5.7 ±6.6 vs 5.9±6.6 days,p<0.0001) and hospitalization cost ($14968±21871 vs $15955±22233, p<0.0001). The disposition to home was higher in Afib with hyperthyroidism patients (50.6% vs 41.8 p<0.0001). Conclusions: Presence of hyperthyroidism is associated with Afib in both univariate and multivariate analysis. Afib patients with hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism.

In the last 200 years, religion and psychiatry had an ambivalent relationship. The introduction of “religious or spiritual problems” in 1994 DSM-IV as a new diagnostic category invited professionals to respect the patient’s beliefs and rituals. More than nine in ten Americans (92%) believe in the existence of God or a universal spirit. And 63% of American women and 44% of American men say that religion is very important to their lives. But research on religion and coping suggests that the benefits of religion have to do more with how you are religious – your religious style or orientation – than whether one is religious. Neurobiological sub-neocortical limbic brain regions; dopamine systems utilizing opiate and GABA receptors in the ventral striatum, amygdala, and orbital frontal cortex; and various neuropeptides mediate homeostatic satisfactions in belief systems of religion, spirituality, and positive emotions.

There are different kinds of visa with which you can travel and stay in the United States during your exams or for the purpose of interviews. Having a brief idea about the different kinds of visa might enable you to plan ahead and obtain your visa on time. However, there are limited options in visa for pursuing a residency in the United States. It is essential to know the differences between the available visa types, in order to make a proper decision while creating your rank order list.

Degloving injuries of the foot involve the management of extensive soft tissue and osseous damage secondary to significant forced avulsion of soft tissue, which can present a major challenge for the surgeon. Surgical procedures on pediatric foot degloving involving split-thickness and/or full-thickness skin grafts and rotational flaps can result in negative consequences, such as donor site comorbidities and psychosocial implications when the pediatric patient returns to daily life. The authors report the case of a 16-year-old girl with no past medical history who sustained an extensive degloving injury to her right foot involving severe subcutaneous and muscular soft tissue disruption and contamination. The initial treatment consisted of debridement, copious irrigation, primary wound closure at several sites, and application of an extracellular matrix (ECM) substitute graft. Shortly thereafter, secondary treatment consisted of application of primary musculoskeletal repair, negative pressure wound therapy (NPWT), and application of a dermal regeneration template. Over the 5-month course of treatment, an additional 3 trips to the operating room occurred, involving serial irrigation and debridement, NPWT application, and dermal/ECM substitute graft applications, leading to full epithelialization. To the best of the authors' knowledge, this is the first reported case in which an instance of pediatric foot degloving is presented with serial debridement, NPWT, and biological dressings, resulting in no additional plastic surgical techniques needed to provide return to functional outcome.

Abstract Fetal head entrapment by a uterine scar or adhesion is a rare obstetric complication. We present a case of a uterine constriction diagnosed in pregnancy that resulted in confinement of the fetal head to the lower uterine segment. The developing fetus ultimately suffered growth restriction of the head and was delivered after the mother experienced preterm premature rupture of membranes (PROM). Severe adhesions of the lower uterine segment were confirmed during the patient’s classical cesarean section.

Brivaracetam is a new antiepileptic drug with limited data in children. The objective of this study was to assess the efficacy/tolerability of brivaracetam. This is a retrospective chart review of children/adolescents with refractory epilepsy treated with brivaracetam from 2016 to 2018. The primary outcome was seizure reduction (decrease in seizure frequency >50%). Twenty-three patients were identified. Mean age at initiation was 12.5 years. Fourteen were females. Epilepsy was focal in 11, generalized in 6, and mixed in 3. Average dose was 3.9 mg/kg/d. The mean duration of treatment was 8.2 months. Eight had greater than 50% decrease in seizure frequency, of which 7 had focal epilepsy, and 1 had Lennox-Gastaut/mixed epilepsy. Two had drowsiness and 3 behavioral complaints. One experienced tingling and dizziness. Our retrospective review suggests that brivaracetam is an effective therapy for refractory focal epilepsy in children older than 4 years of age.

INTRODUCTION: Although rare, pylephlebitis should be included on the differential for any patient with CT imaging showing thrombosis in the portal vasculature, with a recent intraabdominal infection. Although there are not yet guidelines for management of this potential deadly complication, patients who received early antibiotics and anticoagulation have been associated with better outcomes. CASE DESCRIPTION/METHODS: A 59-year-old female presented with worsening abdominal pain two days after being discharged for uncomplicated diverticulitis, for which she was receiving a course of ciprofloxacin and metronidazole. Initial CBC was significant for a leukocytosis of 19.5 K/uL, and CT imaging revealed an inferior mesenteric vein (IMV) thrombosis extending up to her portal vein. She was continued on her antibiotics and started on unfractionated heparin for systemic anticoagulation. Despite these interventions, the patient continued to experience worsening abdominal pain, with physical exam revealing significant rebound tenderness. Interventional radiology (IR) guided aspiration on hospital day (HD) 6 as well as endoscopic aspiration on HD 9 were attempted. However, the location of the infectious process was prohibitively difficult to access. Repeat CT imaging done on HD 10 showed progressive septic thrombophlebitis with evidence of bowel ischemia. She underwent emergent washout with left colectomy and end colostomy. Throughout her admission, her course had been complicated by perforated diverticulitis and candida dubliniensis fungemia. The patient eventually improved and was discharged on HD 29. She was discharged to complete piperacillin-tazobactam (4 weeks of therapy), anidulafungin (6 weeks of therapy) and Coumadin (6 months of therapy). DISCUSSION: Pylephlebitis is a grave condition that can arise from common infections adjacent to the portal venous system. Diagnosis is now commonly made by imaging showing thrombosis in the portal vasculature. The mortality rate is significant, estimated to be 11-25%. Repeat imaging should be considered if there is lack of clinical improvement. Broad spectrum antibiotic therapy is a mainstay of treatment. Lower mortality rates and improved outcomes have been shown in those who were anticoagulated. Complications can be seen in up to 20% of patients, the most common of which are chronic thrombosis or extension of the thrombus, bowel ischemia and abscess formation. Surgery is not required for the initial management but can be used to obtain source control and manage complications.

The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after an extensive review of all aspects of their electronic medical records. Climate data were compiled from monthly norms based on location, as well as specific data regarding temperature, dew point, and humidity from dates of surgery. Rigorous statistical analysis was performed. We found that penile prosthesis infections occurred more commonly in June (n = 24) and less frequently during the winter months (n = 39), with the lowest number occurring in March (n = 11). One-hundred thirty-nine infections occurred at average daily temperatures greater than 55 °F, compared to 72 infections at less than 55 °F. The incidence rate ratio for this trend was 1.93, with a p-value of <0.001. Humidity results were similar, and fungal infections correlate with daily humidity. Infected implants performed in the fall and summer were over 3 and 2.3 times, respectively, more likely to grow Gram-positive bacteria compared to implants performed in spring (p = 0.004; p = 0.039). This was consistent across geographic location, including in the Southern hemisphere. We found trends between climate factors and IPP infection like those seen and proven in other surgical literature. To our knowledge these data represent the first exploration of the relationship between temperature and infection in prosthetic urology.