The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.
The University of South Dakota Sanford School of Medicine Internal Medicine residency implemented a program to enhance scholarship among residents. This residency is part of a small Mid-Western community-based school.Background: A Director of Research was hired and developed a structured approach consisting of: 1. Independent study regarding research methods and statistical testing and 2. Mentoring of residents and faculty in scholarly pursuits starting in the first months of residency.Methods: Scholarship for two cohorts of residents for years July 2011–2014 and January 2014–2017 were followed. Products included papers accepted/published and papers accepted/presented at national or international meetings.Results: 7 (14.8%) of 47 residents in the first cohort published 12 papers (0.25 papers/resident) with 18 faculty as co-authors (1.5/paper). 20 (43.4%) of 46 residents in the second cohort (structured program) published 39 papers (0.85 papers/resident) with 80 faculty as co-authors (2.1/paper). The difference in papers was significant by chi-square analysis.Conclusion: A structured program requiring independent study in conjunction with individualized mentoring of scholarship starting early in the first postgraduate year was successful in significantly increasing the scholarly activity of our community-based internal medicine residents and faculty. With this program, the percentage of residents publishing exceeds national statistics recently reported.
Rheumatoid arthritis (RA) is a multisystem inflammatory disease which can involve many organ systems including the central nervous system (CNS). Though not very common, the results can be severely debilitating. The spectrum of the CNS involvement includes meningitis, encephalitis and occasionally rheumatoid nodules. Its presentation is variable, though very rarely it can present as focal neurological deficits. Imaging can be suggestive, but diagnosis usually requires tissue biopsy. Treatment consists of high-dose steroids and immunosuppressants. We describe the case of a 55-year-old male patient with a history of RA presenting with a third nerve palsy and headache who was found to have rheumatoid nodules on biopsy. CNS involvement in RA should be considered in anyone with rheumatoid arthritis who presents with focal neurological deficits, though infections and space-occupying lesions should also be ruled out.
Crowned dens syndrome (CDS) is a rare syndrome of calcium pyrophosphate dihydrate (CPPD) deposition on the odontoid process of the second cervical vertebra leading to unique clinical presentation and radiographical findings. Symptoms usually overlap with more common etiologies, including meningitis, stroke, and giant cell arteritis. Thus, patients struggle with extensive evaluation before diagnosing this uncommon condition. There are few case reports and case series of CDS in the literature. Patients respond well to treatment, but unfortunately, there is a high rate of relapse. Here we present an interesting case of a 78-year-old female patient who presented with acute onset headache and neck pain.
West Nile virus (WNV) neuroinvasive disease is associated with substantial morbidity and mortality. Clinical suspicion is usually confirmed with cerebrospinal (CSF) immunoglobulin M (IgM) detection using enzymelinked immunoassay (ELISA) techniques. CSF polymerase chain reaction (PCR) is rarely used to confirm the disease and is not widely available. We present a detailed report of false-negative WNV IgM in a patient receiving rituximab therapy for rheumatoid arthritis. She was exposed to the virus during peak immunosuppression and strong clinical suspicion was confirmed with WNV PCR, illustrating the importance of such consideration with the recent incremental use of rituximab therapy. Despite the lack of specific antiviral treatment for WNV, delayed consideration and diagnosis of WNV in those who are immunosuppressed would expose them to a wide panel of testing, with a subsequent increase in the cost of medical care.
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