Widget and Mobile Technologies a Forcing Function for Acquisition Change: Paradigm Shift Without Leaving Bodies Behind

Naval Postgraduate School Acquisition Research Progra

Large endocardial rheumatoid nodules: a case report and review of the literature

Rheumatoid nodules occur frequently in patients with rheumatoid arthritis and are the most common cutaneous manifestation of the disease. Although uncommon, rheumatoid nodules may also occur on cardiac valves, where they may be large and clinically significant. They may embolize and cause stroke. They may cause regurgitant murmurs, or they may result in valvular destruction. Echocardiographically, they may mimic an atrial myxoma or appear as a vegetation. We present a patient with seronegative rheumatoid arthritis who developed an acute embolic stroke; he had peripheral stigmata of infective endocarditis on physical examination and echocardiography revealed a mitral valve vegetation. We illustrate that these findings were due to a large, highly destructive mitral valve rheumatoid nodule. We review the literature on macroscopic endocardial nodules and emphasize their diverse clinical behavior

Case Report and Literature Review: HHV-6-Associated Meningoencephalitis in an Immunocompetent Adult

Human herpesvirus type 6 (HHV-6) has been well described as an agent of meningoencephalitis in post-haematopoietic stem cell transplantation patients, but is a rare cause of meningoencephalitis in immunocompetent adults. We report an immunocompetent adult with HHV-6-associated meningoencephalitis. The patient was an elderly diabetic man who presented with fever and confusion, with cerebrospinal fluid (CSF) pleocytosis. HHV-6 DNA was amplified from CSF by polymerase chain reaction. In our review of the medical literature we examine clinical presentations, laboratory findings, neuroimaging studies, treatments and clinical outcomes in immunocompetent patients with HHV-6 meningoencephalitis

An interventional pilot study on obesity among low-income patients using a computer-based weight management module

Primary care physicians infrequently address lifestyle modification with their obese patients, among whom those of lower economic means are disproportionately represented. To enhance patients’ access to education on lifestyle modification, a clinic-based computer kiosk was installed at our residency clinic for the purpose of healthy lifestyle education. While posttest scores improved and were maintained after completion of lifestyle modification education, body mass index (BMI) was essentially unaffected. Computer-based education without intensive counseling on lifestyle modification appears ineffective in reducing BMI amongst obese patients of lower economic means. Accountable care organization-sponsored health coaching may represent a potential means by which intensive counseling is accomplished among such patients

Hepatitis C: The Complications of Immune Dysfunction

Hepatitis C virus (HCV) infection has been linked to numerous diseases of immune dysfunction, including, but not limited to, essential mixed cryoglobulinemia and non-Hodgkin\u27s lymphoma. Clinical studies support these associations and treatment of the underlying HCV infection has been variably successful. Recent studies, focusing on the role of HCV gene products, have discovered evidence of dysregulated responses in multiple aspects of host immunity that may be contributing to the genesis of these diseases. Novel treatments that target these areas of dysregulation offer hope for improved therapy for the diseases associated with immunodysregulation by HCV

Influenza Vaccine Failure Associated With Age and Immunosuppression

Abstract Background The influenza vaccine is one of the best ways to prevent influenza infection, but little is known about influenza vaccine failure. Methods This study evaluated patients admitted for acute respiratory illness during 2015–2019 influenza seasons to compare vaccinated influenza-negative to vaccinated influenza-positive patients. Statistical analyses were performed with STATA and R using Pearson χ 2, Kruskal-Wallis, Wilcoxon rank-sum tests, and multivariate logistic regression. Results Of 1236 enrolled patients vaccinated for influenza, 235 (19%) tested positive for influenza. Demographics, vaccines, and comorbidities were similar between groups except for morbid obesity (13% influenza negative vs 8%, P = .04), and immunosuppression (63% influenza positive vs 54%, P = .01). Logistic regression analysis demonstrated older patients (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.03–2.10) and immunosuppressed patients (OR, 1.56; 95% CI, 1.15–2.12) were at increased risk for influenza despite immunization. When evaluated by influenza subtype, immunosuppression increased the risk for influenza A/H3N2 (OR, 1.86; 95% CI, 1.25–2.75). Conclusions Our study demonstrated increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of patients against influenza illnesses, more effective vaccines and strategies are needed. </jats:sec