Category Archives: VA

VA Resident Report: What is the distribution of arthritis associated with systemic infection?

The Bottom Line: Staphylococcus aureus is the main cause of septic arthritis involving native joints, although many other organisms are encountered also. In our center, neither the distribution nor the antibiotic susceptibility profiles of the causative organisms changed significantly over … Continue reading

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VA Resident Report: How to properly remove a tick

How to remove a tick Centers for Disease Control and Prevention June 1, 2015 Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible. Pull upward with steady, even pressure. Don’t twist or jerk the tick; … Continue reading

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VA Resident Report: What is the management strategy of Kaposi Sarcoma and pneumocystis pneumonia in a HIV positive patient?

The Bottom Line: The management of pulmonary KS is challenging. There is a risk of precipitating IRIS upon initiating cART. Chemotherapy can also cause further immunosuppression and increase the risk of further infections. In many of these patients, initiation of … Continue reading

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VA Resident Report: What is the effectiveness of POEM for achalasia?

Available data suggests POEM is very effective in the relief of symptoms in patients with achalasia. However, POEM is associated with a very high incidence of pathologic reflux. The clinical sequalae of the increase in pathologic reflux are currently incompletely … Continue reading

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VA Resident Report: Review of Fournier’s gangrene

The Bottom Line: Fournier’s gangrene is a progressive necrotizing soft-tissue infection (NSTI) of the external genitalia and/or perineum. It is a urological emergency requiring prompt diagnosis and treatment — even with administration of parenteral broad-spectrum antibiotics and expedited aggressive surgical debridement, the disease … Continue reading

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VA Resident Report: What is the mechanism of metabolic alkalosis with villous adenoma?

The Bottom Line: When diarrhea is the cause of metabolic alkalosis, rather than acidosis, the mechanism is determined by measuring the electrolyte content in stool. Large losses of chloride may occur in patients who have villous adenomas or other secretory … Continue reading

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VA Resident Report: What are the adverse effects of PPI use on B12 levels?

The Bottom Line: Studies of PPI use and vitamin B12 deficiency have yielded mixed results. Absorption decreased from 3.2 to 0.9% (P ¼ 0.031) in patients on omeprazole 20 mg daily, and from 3.4 to 0.4% in patients on higher … Continue reading

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