Monkeypox-induced proctitis: a case report of an emerging complication.

PURPOSE: At the outset of the 2022 human monkeypox virus outbreak, the World Health Organization described the self-limited disease as a rash illness associated with nonspecific symptoms such as fever, myalgias, and lymphadenopathy. Historically, the infection caused by this zoonotic virus has presented with rashes primarily on the face, palms, and soles of feet. However, emerging case report literature from the 2022 recent outbreak highlighted more atypical presentations ranging from ocular manifestations to myocarditis. CASE DESCRIPTION: We present a case of a 32-year-old African American male with a past medical history of poorly controlled acquired immunodeficiency syndrome and external hemorrhoids that presented for worsening rectal pain. The patient was afflicted with diffuse skin lesions even present on his hemorrhoids. Initial imaging significant circumferential rectal thickening consistent with proctitis. Subsequent polymerase chain reaction testing confirmed active monkeypox infection, and a 14-day course of twice daily tecovirimat 600 mg was initiated to treat disseminated monkeypox infection. After improved pain control and starting antiviral treatment, the patient was discharged two days later. CONCLUSION: As more cases of monkeypox-associated proctitis emerge, clinicians should keep this disease in their differential due to the growing atypical presentations that have diverged from previous patterns to avoid the risk of misdiagnosing another sexually transmitted infection. Additionally, appropriate medical management is still not definitive and requires further development of evidence-based protocols to treat such patients.

Identifying network structure similarity using spectral graph theory.

Most real networks are too large or they are not available for real time analysis. Therefore, in practice, decisions are made based on partial information about the ground truth network. It is of great interest to have metrics to determine if an inferred network (the partial information network) is similar to the ground truth. In this paper we develop a test for similarity between the inferred and the true network. Our research utilizes a network visualization tool, which systematically discovers a network, producing a sequence of snapshots of the network. We introduce and test our metric on the consecutive snapshots of a network, and against the ground truth. To test the scalability of our metric we use a random matrix theory approach while discovering Erdös-Rényi graphs. This scaling analysis allows us to make predictions about the performance of the discovery process.

A comparison of congestive heart failure readmissions among teaching and nonteaching hospital services.

OBJECTIVES: Heart failure (HF) is a leading cause of hospitalization in the United States. With the population trend shifting to a higher volume of elderly adults, the efficient management of HF will become increasingly essential. The development and implementation of The Patient Protection and Affordable Care Act and subsequent changes in reimbursement practices have made 30-day readmission rates a topic of much interest and relevance. The aim of the study was to compare rates of readmission among teaching and nonteaching hospitals. METHODS: The authors gathered retrospective data on HF quality measures and readmission rates between August 2011 and July 2012, extracted from the institution's managerial accounting database. These data were compared among teaching and nonteaching hospitals. Patient demographics, readmission rates, readmission diagnoses, severity of illness, patient disposition, medications prescribed, cost of services, and mortality were reviewed. Analysis of variance was used for continuous variables; χ(2) analysis was used for evaluating categorical variables. RESULTS: A higher proportion of patients on the cardiology teaching service were men than on either the medicine teaching service or the medicine nonteaching service. Length of stay, case costs, and care costs were lowest for the cardiology teaching service; however, patient illness severity was lower on this service than on the other two services. Overall, readmissions and mortality were similar among all groups, but readmission for the same diagnosis was more likely on the cardiology service than on the medicine teaching and nonteaching services. CONCLUSIONS: Studies comparing teaching and nonteaching providers for an HF diagnosis are needed. Hospital readmission and mortality rates were similar across services and compared favorably with national data. Opportunities that target cost reduction and length of stay may be leveraged.

Hospital bed utilization by teaching and nonteaching medical services.

A study was undertaken to determine whether hospital bed utilization is different between teaching and nonteaching hospitalist services. During a 2-year period, the average length of stay (ALOS), case-mix index, readmissions within 30 days of discharge, and percentage of 1-day stays were compared between these services. To ameliorate confounders, the ALOS was recalculated (ALOS revised) after excluding patients with length of stay of more than 20 days and those originally admitted to the intensive care unit. Six thousand ninety-nine patients were discharged by the teaching service (group 1), 14 348 by the corporate hospitalist (group 2), and 2634 by the community-based practitioner group (group 3). The mean ALOS revised was significantly lower for the teaching service (3.64 ± 2.22 days) compared with the other 2 services (4.53 ± 1.48 and 4.73 ± 1.02, respectively [P < .001]), although the mean case-mix index was significantly higher for the teaching service compared with the other services. The mean percentage of readmissions within 30 days of discharge and 1-day stays were not significantly different between group 1 and groups 2 and 3. Hospital bed utilization in the teaching service was superior to the nonteaching hospitalist services. Further research should explore the reasons for the differences between these models of care.

Resource-based relative value scale analysis between teaching and nonteaching hospitalist services.

BACKGROUND: Resource-based relative value scale is an objective estimate of physician work that allows comparisons of physician productivity, yet few studies have explored its use to compare the productivity between teaching faculty and nonteaching hospitalists. METHODS: Demographic and billing data of patients assigned either to a resident-staffed teaching service or a hospitalist service, the number of encounters per provider, relative value units (RVUs) generated, and total charges were obtained from billing records (November 2006-April 2007). Age, race, sex, insurance status, case mix index, and length of stay were also analyzed. RESULTS: The mean RVUs generated per unit of encounter and the mean charges generated per unit of encounter were not significantly different between the 2 services. However, mean RVUs generated per full-time equivalent provider and mean charges generated per clinical full-time equivalent were significantly higher in the teaching service. CONCLUSIONS: Based on a resource-based relative value scale analysis, the clinical productivity of teaching faculty was superior to that of nonteaching hospitalists. The difference may be attributable to lower time requirements of the teaching attendings compared with full-time hospitalists.

Sandostatin causing reversible thrombocytopenia.

Esophageal variceal bleeding can be serious or life threatening. Drug-induced thrombocytopenia can further complicate such bleeding episodes. Thrombocytopenia because of sandostatin has been reported in the literature only once previously. We describe a case of sandostatin-induced reversible thrombocytopenia with a positive rechallenge. Platelet count decreased during administration of sandostatin and recovered only when the infusion was halted. The proposed mechanism of thrombocytopenia during both episodes is immunologic. Physician awareness of sandostatin-induced thrombocytopenia can prevent unnecessary complication during episodes of esophageal variceal bleeding and is rapidly reversed with discontinuation of the drug.

A comparative study of unscheduled hospital readmissions in a resident-staffed teaching service and a hospitalist-based service.

BACKGROUND: The rate of unscheduled readmissions is an important quality indicator with financial implications for hospitals. OBJECTIVE: To determine if resident-staffed services have more favorable outcomes compared to hospitalist services, predictors of readmissions were determined within an academic hospital. METHODS: From November 1, 2006 to April 30, 2007, 5943 admissions were assigned to a resident-staffed teaching service (n = 2244) or to a hospitalist-based service (n = 3699). Data on age, race, sex, insurance status, case mix index (CMI), length of stay (LOS), and unscheduled hospital readmission within 30 days were analyzed. RESULTS: Patients admitted to the hospitalist service were older and more likely to be female compared with those admitted to the teaching service. There were no significant differences in the health care insurance carrier of the patients admitted to the two services. The rate of unscheduled hospital readmissions within 30 days was significantly higher in the teaching service compared to the hospitalist service (14.1% vs 10.4%; P < 0.001). LOS was significantly higher (4.95 +/- 7.77 vs 4.14 +/- 5.95; P < 0.001), and the CMI was significantly lower (1.04 +/- 0.94 vs 1.14 +/- 1.02; P < 0.001) in the hospitalist service compared to the resident-staffed service. Probability of readmission was significantly reduced with increasing LOS and discharge home with self care. CONCLUSIONS: The modestly increased unscheduled readmission rate to the resident-staffed service compared to the hospitalist service may be related to lower LOS. Increased CMI of patients in the resident service may have contributed to the increased rate of readmissions.