BackgroundVarious guidelines exist for female preventative screening tests and medical resident physician adherence to the United States Preventive Services Task Force (USPSTF) guidelines varies. National screening rates for breast cancer and osteoporosis have improved but they are still below the expected target.Material and methodsAmbulatory medical clinic records of female patients from the period July 2015 to December 2017 were reviewed for breast cancer and osteoporosis screening. Resident performance and commitment with regards to ordering the aforementioned screening tests according to the USPSTF guidelines were compared to the most recent national screening rates for mammograms and dual-energy X-ray absorptiometry (DXA) scans.ResultsOf the 1327 charts reviewed, 1025 was included in the study. Of the 545 mammograms performed, 93% of them were indicated according to the USPSTF guidelines (P < 0.0001, 95% CI: 125.9-342.0). A total of 480 mammograms were not ordered, of which 6% were indicated and 93.9% were not indicated. Out of a total of 107 DXA scans performed, 88.7% were correctly indicated (P < 0.0001, 95% CI: 37.11-132.9).ConclusionResident physician adherence to the USPSTF screening guidelines for breast cancer and DXA scans were higher than the national and state screening rates. Our well-structured educational project (strong faculty mentorship, resident to patient continuity of care and the reasonable resident-clinic load) resulted in higher screening rates.
Loperamide (Imodium) is an opioid receptor agonist available over-the-counter and can be used for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain barrier and is reported to produce euphoria, depression of the central nervous system, and cardiotoxicity. It may also be used for its euphoric effects and potentially to alleviate opioid withdrawal. Loperamide has a US boxed warning for torsades de pointes and sudden death. Loperamide has been reported to cause torsades de pointes, cardiac arrest, and death when higher than the recommended dosage is consumed. We report a rare case of ventricular arrhythmia provoked by accidental ingestion of loperamide to treat simple diarrhea.
A rare cause of acute decompensated pulmonary hypertension is pulmonary tumor embolism (PTE), which is an uncommon complication of advanced lung malignancy. Patients diagnosed with PTE typically have a poor prognosis, and so patients with advanced lung tumors who present with signs of right heart failure and respiratory support should be evaluated for PTE. We present a case of a 54-year-old Hispanic female who initially presented with a one-month history of dysphagia, who was found to have acute pulmonary hypertension secondary to invasion of the pulmonary arteries by lung adenocarcinoma.
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