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Growing evidence suggests patient perceptions of discrimination in healthcare directly affects health outcomes. This research uses the Discrimination in Health Care Survey (DHS) to investigate the perceived quality of healthcare in the geriatric population. The DHS tool assesses a person’s experiences of mistreatment in healthcare attributed to race, ancestry, national origin, sex, disability, and age. Use of the DHS tool, followed by a personal interview may improve provider knowledge so that patients and their families can experience improvement of the quality of care and health outcomes. Combining a standardized screening tool with qualitative patient feedback offers a more comprehensive understanding of discrimination in healthcare.
Over the last decade, videogaming has increased in popularity with some of these gamers turning their hobbies into robust careers. Due to prolonged sitting and repetitive use required, video gamers are prone to injuries of the neck and upper extremity. A variety of conservative treatments may be used for these musculoskeletal injuries, but other treatment options may include injection therapies. Dextrose prolotherapy, an injection therapy, has shown to be effective in various musculoskeletal conditions, most notably, osteoarthritis (OA). Its proposed mechanism is that increasing inflammation prompts a proliferative response, resulting in increased strength and stability at the injection site. In this case, dextrose prolotherapy was used to treat a 34-year-old female hobby gamer who presented with pain in her right thumb. The patient was diagnosed with a sprained first CMC joint, and a dextrose solution was injected into the joint space.
Chagas disease, caused by Trypanosoma cruzi, can lead to heart and digestive issues. While common in South America, kissing bugs are also found in the southern USA, including two species native to North Carolina. Information was analyzed on kissing bug collection dates and locations, along with temperature data from the National Weather Service. PCR testing on 14 bugs found four positive for T. cruzi, indicating potential transmission in North Carolina. Given heart disease is a leading cause of death in the state, Chagas disease should be considered in cardiovascular diagnoses, emphasizing the need for surveillance.
Osteoarthritis (OA) cases have doubled over the last two decades, now exceeding 32 million in the US and over 240 million worldwide. Dextrose prolotherapy is a potential alternative treatment for OA that demonstrates a good safety profile and is less costly than bio-injectables or partial or full joint replacement. This comprehensive review aims to provide background information and summarize findings from dextrose prolotherapy use in clinical trials, from January 2013 to December 2024. Human clinical trials using dextrose prolotherapy show promising clinical outcomes in reducing pain and improving function while maintaining a high degree of safety.
Case: A 9 x 4 cm tumor was found at the rectosigmoid junction during dissection of a 64-year-old man whose cause of death was failure to thrive. Possible metastases to the abdominal and thoracic lymph nodes, lungs, right adrenal gland, and brain were found. Findings: Histology showed a well- to moderately-differentiated adenocarcinoma arising in the mucosa, invading the submucosal lymphatics, and extending through the muscularis externa. The adrenal lesion was morphologically similar to the colorectal tumor. Discussion: Primary treatments for metastatic colorectal cancer include resection and chemotherapy. More recent targeted treatments based on molecular testing have improved survival rates.
Physician Assistant students often have limited exposure to Pediatrics before clinical rotations, leading to knowledge gaps in weight-based dosing, developmental milestones, immunization guidelines, and diagnosing common acute conditions. A 75-minute "What to Know Before You Go: Pediatrics Rotation Preparation" workshop was developed to address these gaps using case-based learning and small-group discussions. Pre- and post-rotation surveys showed significant improvement in self-efficacy (p<0.05), though end-of-rotation scores remained unchanged. Student feedback was highly positive, emphasizing workshop interactivity and helpfulness. Continued implementation and analysis will refine the workshop while exploring additional rotation prep initiatives based on preceptor evaluations and future student performance.
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases. Gross and microscopic evaluation of an 80 y.o. male cadaver showed that the left lung had dilated air spaces and showed notable alveolar wall destruction and dilated airspaces. The right lung was dense and firm, containing macrophages laden with anthracotic pigment and alveoli filled with red blood cells and fibrin. Anthracotic pigment in the lungs indicates long-term exposure to airborne pollutants (e.g. smoke, dust). This profile is aligned with the typical presentation of COPD and demonstrates the risk of comorbid infection with the presence of an organizing pneumonia.
Cadaveric dissection was completed on a 62-year-old female with acute myeloid leukemia (AML) and pancytopenia. The liver and spleen were enlarged; samples taken for histological processing and staining revealed infiltration of numerous abnormal leukemic cells. Due to the aggressive nature of AML and high risk of relapse, post-remission therapies (chemotherapy or bone marrow transplantation) are used to eliminate residual malignant cells. However, since these therapies may not be viable options for older patients, our discussion highlights alternative therapies targeting isocitrate dehydrogenase (IDH) mutations, commonly seen in AML, and their use in older adults to prevent relapse after initial induction therapy.
Case: Gallstones were discovered during dissection of a 104-year-old female whose cause of death was kidney failure. Additionally, white chalky deposits were present in peri-pancreatic fat, suggestive of fat necrosis and saponification seen in cases of pancreatitis. Photographs and samples of the lesions were collected and histologic processing was performed. Findings: The gallstones were consistent with cholesterol stones, and although a common sequela of gallstones, there was no evidence of pancreatitis microscopically. Discussion: Surgery is the primary treatment for gallstones; however, when nonsurgical options warrant consideration, such as in elderly patients, osteopathic manipulative treatment may improve symptoms and relieve pain.
Cadaveric dissection of an 84-year-old woman with history of hypertension revealed intracranial hemorrhage located in the left brain parenchyma, left lateral ventricle, and subarachnoid space of the left parieto-occipital convexity. Microscopic examination of the brain showed no evidence of cerebral amyloid angiopathy and the bleed likely resulted from chronic hypertension. Most likely the hemorrhage originated deep in the left brain and extended to the left lateral ventricle and left parieto-occipital convexity.
Cadaveric dissection of a 59-year-old male revealed adenocarcinoma of the lower lobe of the right lung with right adrenal and right rib metastases. Lung cancer is categorized as either small cell or non-small cell. Adenocarcinoma is the most common subtype of non-small cell lung cancer. Lung adenocarcinoma frequently metastasizes to hilar and mediastinal lymph nodes, adrenal glands, brain, bone, and liver. Early detection of lung cancer is difficult, and the United States Preventive Services Task Force recommends annual screenings using low-dose computed tomography for high-risk individuals.
Breast cancer poses a major challenge due to the potential for metastasis to distant organs. This project examined a case of breast cancer in a 92-year-old female decedent, with metastatic lesions to the liver. Liver metastases, observed during cadaveric dissection, were confirmed through gross examination and histopathological analysis. Despite its relatively lower incidence, liver metastasis in breast cancer patients significantly worsens prognosis. These findings highlight the complex interplay of genetic and environmental factors in the disease's pathogenesis. We additionally underscore the importance of early detection and review the common sites of metastasis originating from primary breast tumors.
Fibromyalgia is a chronic, widespread pain condition affecting the musculoskeletal system, often accompanied by tiredness, decreased mood, and somatic dysfunction. This report aims to: (1) evaluate perineural therapy as a treatment for fibromyalgia, and (2) observe patient outcomes using an osteopathic approach including acupuncture and Osteopathic Manipulative Treatment (OMT). This case highlights a 63-year-old female with fibromyalgia treated with acupuncture, OMT, and perineural therapy (PNT). This report demonstrates the benefits of combining perineural therapy with other osteopathic techniques and treatment modalities. Further studies could evaluate the standalone effectiveness of perineural therapy.
Thyroid nodules are prevalent in the general population and require a systematic approach of evaluation and management. This case focuses on the cadaveric dissection of a 91-year-old female revealing three benign thyroid nodules. Risk factors for the development of thyroid nodules include various lifestyle and environmental factors. Assessment begins with history and physical examination, lab studies, and high-resolution ultrasound. Select individuals with suspected malignancy may undergo additional evaluation via fine-needle aspiration biopsy. Management strategies balance between invasive and non-invasive options. Understanding the etiology, susceptibility, and appropriate interventions ensures optimized care for patients with thyroid nodules.
It is estimated that approximately 25% of women experience symptoms associated with the female reproductive system, including abnormal uterine bleeding, decreased fertility, and pain. These symptoms have many possible etiologies, including leiomyomas, also known as uterine fibroids, which are benign tumors arising from the uterine smooth muscle and connective tissue. Detection and treatment of uterine fibroids can be beneficial for symptom reduction and improved obstetric outcomes. This work highlights a pedunculated subserosal fibroid in a 71-year-old Caucasian woman and explores current screening and diagnostic tools and treatment options. Given the variability in patient age and symptoms at presentation, we will explore how treatment strategies can be individualized to best fit patient needs.
This cadaveric case study examines an 84-year-old female with a brain mass identified as a primary central nervous system lymphoma (PCNSL), discussing its epidemiology, clinical presentation, diagnosis, and treatment. PCNSL is a rare, aggressive lymphoma that primarily affects immunocompromised individuals, the elderly, and males. Diagnosis involves MRI or CT imaging, tumor biopsy, and lumbar puncture. Symptoms include cognitive changes, seizures, incoordination, headaches, papilledema, weight loss, and fever. While the etiology remains unclear, preventive measures include a healthy lifestyle, regular check-ups, and managing immunosuppressive therapy. Raising awareness of at-risk populations can help improve early diagnosis and intervention.
Substance Use Disorder is a chronic condition affecting 10% of the population. Harnett Health Family Medicine Residency identified high screening rates for alcohol and tobacco, but low rates for non-medical prescription drug use and illicit drug use, highlighting the need for standardized screening. The NIDA Quick Screen was chosen for its simplicity and was administered during annual exams. Screening rates improved significantly for non-medical prescription drug use (p=0.02) and illicit drug use (p=0.007). Barriers included inconsistent use and lack of EMR integration. Future efforts will focus on this as well as expanding screening to adolescents and improving treatment follow-up.
Healthcare in America is experiencing its own form of climate change. The arrival of the “silver tsunami” poses a challenge to how we will care for senior adults. Medicare instituted the Annual Wellness Visit (AWV) to improve healthy aging among all seniors. Despite its promise for increasing preventive health services, uptake of AWVs has been low for a variety of reasons. This QI project showed that AWV completion rates increased with a variety of interventions based on outreach, education, EMR implementation, and team-based care. These results have significance on several different levels, mainly infrastructure, personal accountability, and economics.
With an increasing number of women living past menopause, there is a need for research regarding the management of menopausal syndrome. Particularly, there is a need for research regarding the treatment of pain in postmenopausal women. The case described in this report follows a 52-year-old caucasian female who initially presented on February 7th, 2023 with one month of right sided sacroiliac joint pain. An extensive workup did not reveal a clear etiology of pain. Between her initial visit on day 0 and her most recent follow-up on day 435, she was treated with osteopathic manipulative treatment (OMT) on four occasions for various lumbar, sacral, and pelvic somatic dysfunctions. In addition to OMT, the patient was treated with stretches, tizanidine, naproxen, venlafaxine, a right hip injection, and estradiol. Notably, the patient experienced complete pain relief within one week of starting estrogen replacement therapy. This case is unique to existing literature and suggests that estrogen replacement therapy may have a role in sacroiliac pain relief in postmenopausal women.
