An Unlikely Guest With an Overstayed Welcome: Cyclospora-Induced Postinfectious Irritable Bowel Syndrome.

INTRODUCTION: Postinfectious irritable bowel syndrome is a phenomenon that can occur following bouts of acute gastroenteritis. While bacterial pathogens are typically implicated in the development of postinfectious irritable bowel syndrome, viral and parasitic infections should also be considered as inciting pathogens. CASE PRESENTATION: An immunocompetent, 65-year-old woman presented with several weeks of watery diarrhea, which polymerase chain reaction testing confirmed to be a Cyclospora infection. Resolution of diarrhea was achieved with antibiotic treatment, however, months later she presented to the gastroenterology service with persistence of loose stools and abdominal cramping consistent with a diagnosis of postinfectious irritable bowel syndrome. DISCUSSION: Postinfectious irritable bowel syndrome has a similar presentation to sporadic irritable bowel syndrome, with diagnosis aided by the identification of an inciting pathogen. To our knowledge, this is the first documented case of Cyclospora-induced postinfectious irritable bowel syndrome. While parasitic infections typically aren't implicated in cases of postinfectious irritable bowel syndrome, this case highlights the value of considering this condition as a cause of protracted diarrhea in patients previously diagnosed with Cyclospora.

Perception of Burnout and Its Impact on Academic Hospitalists During COVID-19 and Institutional Strategies to Combat Burnout and Improve Wellness.

INTRODUCTION: Physician burnout has been alarmingly high, particularly among general internal medicine, which displays some of the highest rates. A recent study of academic hospitalists reported a higher level of burnout (62%) than the rates found in similar studies, but with agreement about factors leading to burnout, consequences of burnout, and importance of steps to prevent burnout. This study seeks to expand upon these results by investigating the impact of COVID-19 on burnout among hospitalists and uncovering the perspectives of frontline clinicians to formulate effective mitigation strategies. METHODS: Academic hospitalists were recruited to participate in a series of focus group interviews. The questions focused on contributors to burnout, the impact of COVID-19, and strategies to improve wellness and reduce burnout. The focus groups were audio-recorded, transcribed, and coded for emergent themes using Taguette, an open-source qualitative data analysis software. RESULTS: Burnout-inducing themes included workload, bureaucratic hurdles, and lack of control. COVID-19-specific themes included fear of exposing family and social isolation. The most common mitigation strategy was to increase social interactions to foster a sense of community. Additional solutions included adhering to a census cap of patients, streamlining clinical work, and providing avenues for two-way communication between leadership and clinicians to share concerns and elicit feedback. CONCLUSIONS: Streamlining clinical work allows more time for patient care. Enhancing community and fostering collaboration in decision-making allows clinicians to feel more empowered. A crucial first step to combat burnout is to encourage a work environment that values clinician well-being and proactively works to increase job satisfaction.

A Complex Case of Aspergillus Infection of the Brain and Its Future Medical Implications.

Aspergillus is a fungal genus found worldwide, which causes infection most commonly in the respiratory system and in other systems, including the central nervous system. Fungal species, such as Aspergillus fumigatus or flavus, are more common in immunocompromised patient populations, such as those taking immunosuppressants post-transplantation, those on long-term corticosteroids, or those with immunodeficiencies such as AIDS. In this paper, we describe a rare case of aspergillosis that occurred due to a history of taking corticosteroids to treat arthritis pain in a patient with type 2 diabetes. Given the rise in antifungal-resistant species and environmental changes, it is noteworthy for further research to be conducted on new treatment plans and the management of such fungal infections to prepare against opportunistic infections caused by Aspergillus in the future.

Peri-Operative Method of Applying Chlorhexidine and Iodine as Skin Preparation Solutions: Does It Matter? A Literature Review.

Background: Surgical site infection (SSI) is an adverse event that can lead to increased pain, increased cost, risk of death, and decreased patient satisfaction. Studies have investigated the best solutions to prevent SSI. Chlorhexidine has been suggested as the most efficacious antiseptic. However, scant data exist on application of antiseptic solutions and effectiveness of concentric versus back-and-forth strokes. Because a specific method may result in better outcomes, we aimed to review the literature to compare these two techniques. Methods: PubMed-indexed articles were reviewed using specific keywords, including "back-and-forth," "concentric circle," "chlorhexidine," "iodine," "surgical site infection," "antiseptic," and "skin preparation." Because data showing the correlation between SSI and application method of skin preparation solutions were scant, studies that described skin preparation method but analyzed other types of infection, bacteremia, or colonization were also included in this review. Results: No consensus was found regarding the application method. Two articles showed the superiority of chlorhexidine applied using the back-and-forth technique, whereas one demonstrated the superiority of iodine applied in concentric circles. Conclusions: The method of applying antiseptic solution may be just as important as the choice of solution. More studies are needed to assess method of antiseptic application.

Medication non-adherence as a cause of apixaban failure in venous thromboembolism: The importance of pharmacist medication reconciliation.

Venous thromboembolism is often treated with direct oral anticoagulants. In order for direct oral anticoagulants to be effective, patients must adhere to a specific dosing strategy. We report a case of apixaban failure, the clinical workup that ensued, and the eventual discovery of unsuccessful medication adherence as the cause.

Women's Health Information Survey: Common Health Concerns and Trusted Sources of Health Information Among Different Populations of Female Patients.

Background: Women are more likely to search for information on behalf of both themselves and others, thus making them a valuable target for health information research. The purpose of this project was to identify and compare the most important medical concerns and sources of health information trusted by women in relationship to demographic differences in two different clinical settings within the same geographic area (Mayo Clinic Department of Family Medicine and Beaches Community Health care-a Sulzbacher Center Clinic). Methods: A novel survey tool was developed to obtain information regarding the age, race, and socioeconomic demographics of patients as well as the patients' personal significant medical concerns and trusted sources of health information. Results: Despite the huge development of health care information delivery through online resources, in our study, the majority of patients from both clinics still used and viewed their primary care provider as the most trusted source of health information. The health concerns most reported by both populations included cardiac health, breast and other cancers, and obesity; meanwhile, mental health was significantly more reported by patients from the free clinic. Conclusions: Education level may be an important factor of the awareness and ultimate treatment and prevention of these prevalent diseases. Furthermore, our study results may help improve patient satisfaction, knowledge, and health outcomes.

Sensorineural Hearing Loss and Wernicke Encephalopathy: A Case Report and Literature Review.

Sensorineural hearing loss (SNHL) is seldom associated with Wernicke encephalopathy (WE) or thiamine deficiency. While thiamine deficiency and repletion are often considered prior to dextrose infusions in patients with chronic alcohol abuse to prevent WE, they are often overlooked in non-alcoholic patients who are also at risk for malnutrition. In this paper we describe a case of a non-alcoholic 28-year-old female status post-sleeve gastrectomy who developed SNHL in the setting of thiamine deficiency and WE, with ongoing hearing impairment requiring hearing aids despite thiamine repletion.