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A Case of Monocytic Pleocytosis in West Nile Neuroinvasive Disease Graduate Medical Education Research Journal Volume 1 Issue 1 Article 34 December 2019 A Case of Monocytic Pleocytosis in West Nile Neuroinvasive Disease Brian Villafuerte Trisolini University of Nebraska Medical Center Mohamed Taha University of Nebraska Medical Center Maryam Matloub University of Nebraska Medical Center Thomas Diesing University of Nebraska Medical Center Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Villafuerte Trisolini, B., Taha, M., Matloub, M., , Diesing, T. A Case of Monocytic Pleocytosis in West Nile Neuroinvasive Disease. Graduate Medical Education Research Journal. 2019 Dec 13; 1(1). https://digitalcommons.unmc.edu/gmerj/vol1/iss1/34 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact [email protected]. A Case of Monocytic Pleocytosis in West Nile Neuroinvasive Disease Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol1/iss1/34 *Names in bold type indicate presenting author. Risk of Sleep Disorders in Hospitalized Patients with Obstructive Lung Disease: An Observational Study Nancy H Stewart, Ryan Walters, Babak Mokhlesi, Diane Lauderdale, Vineet M Arora Mentor: Vineet M Arora hospitalized patients with obstructive lung a greater risk of OSA, compared to those disease. without COPD (64.7% vs. 37.9%, p = .002). Program: Sleep Medicine On average, patients with COPD received Methods: During a prospective cohort study Background & Objectives: Obstructive lung 40 minutes less sleep than those without of medical inpatients, participants were disease (OLD) includes chronic obstructive COPD (median sleep duration 284.5 minutes interviewed regarding sleep prior to admission lung disease (COPD) and asthma, and affects (IQR 162.5- 389.5) vs. 324.0 minutes (IQR and inpatient daily sleep. Sleep efficiency over 24 million adults in the US. OLD is the 232.5-413.5). The median sleep efficiency for and duration were measured with actigraphy. 3rd leading cause of morbidity and mortality patients with COPD was 67.4% (IQR 43.0- Within participating subjects, 3 groups were in US, and a significant cost to US healthcare 82.8) vs. 75.9% (IQR 61.6- 85.8) for patients defined: subjects with a primary diagnosis of system. 1 in 4 adults have Obstructive Sleep without a COPD diagnosis. COPD, subjects with COPD as a secondary Apnea (OSA), and 90% are undiagnosed. diagnosis, or those without history of a COPD Conclusions: Patients with obstructive lung Patients with untreated COPD/OSA overlap diagnosis. disease have high odds of insomnia, worse in- have high risk of re-hospitalization and hospital sleep quality and quantity. death. No study yet characterizes risk of Results: OLD patients have 2.5-times higher undiagnosed sleep disordered breathing in odds of insomnia. Patients with COPD, have https://doi.org/10.32873/unmc.dc.gmerj.1.1.033 A Case of Monocytic Pleocytosis in West Nile Neuroinvasive Disease Brian Villafuerte Trisolini, Mohamed Taha, Maryam Matloub, Thomas Diesing Mentor: Thomas Diesing presented to the emergency department for herpes simplex virus, varicella-zoster virus, acute and progressive fever and confusion. cytomegalovirus, enterovirus, syphilis, HIV Program: Neurology Neurological exam was remarkable for and tuberculosis) returned negative. The Background & Objectives: The most lethargy, flaccid quadraparesis and was patient was started on plasma exchange, but commonly reported cerebrospinal fluid (CSF) intubated for management of airway and was discontinued due to a positive result cell counts in West Nile (WN) encephalitis hypercapnic respiratory failure. Magnetic for WN virus specific IgM and negative for is early neutrophilic pleocytosis followed resonance imaging of complete spine showed IgG. With supportive treatment, the patient by lymphocytic pleocytosis. We aimed to contrast enhancement of lower thoracic regained consciousness and strength mildly describe an atypical CSF cell count in a and lumbar ventral roots. Nerve conduction improved, however a tracheostomy and a patient with West Nile acute encephalitis and studies showed an active motor neuronopathy. percutaneous endoscopic gastrostomy tube flaccid quadraparesis. CSF showed 98 white blood cells with 62 were warranted. Methods: We retrospectively review history % monocytes, 25% lymphocytes, 13 % Conclusions: We suggest consideration of present illness, past medical history, polymorphonuclear; and protein 128 mg/dL. of neuroinvasive West Nile Virus despite admission course, laboratory and imaging Pathology review showed monocytes, small a monocytic pleocytosis in the setting of lymphocytes and occasional neutrophils. results of one patient. encephalitis with flaccid paralysis . Infectious etiologies (Gram stain, aerobic Results: A middle-aged patient with a past and fungal cultures, cryptococcal antigen, https://doi.org/10.32873/unmc.dc.gmerj.1.1.034 medical history of controlled hypothyroidism University of Nebraska Medical Center Pressure Ulcer Prevention Initiative Stephan Barrientos, Maria Tecos, Kaeli Samson, Lynette Smith, Chandrakanth Are, Perry Johnson, Jason Miller, Debra Reilly Mentor: Debra Reilly January 2015 – October 2017. Inclusion There are multiple instances where the Braden criteria included: any gender, any ethnicity, Score worsened prior to PU identification. Program: Plastic and Reconstructive Surgery any comorbidity, age >19 and documented There were multiple instances when a PU Background & Objectives: Pressure HAPU development stage II or greater. was identified at the quarterly wound healing ulcers (PUs) are a major health care burden, Data analysis allowed for quarterly HAPU assessment. resulting in increased morbidity, mortality rates. This data was stratified based on PU Conclusion: UNMC has a consistently higher and cost. The Committee of Medicare and location, unit, and comorbidity. Nursing rate of HAPU than the national average. Medicaid Services (CMS) has mandated that compliance was measured in two ways. First, The nursing staff appears to be performing a advanced stage PU’s acquired after hospital by identifying whether a skin assessment skin assessment on most patients. There are admission are “reasonably preventable (Braden Score) was performed each day instances where PUs were not identified by events” and costs related to ulcer management from admission to the initial identification of the nursing staff. There are instances where are not reimbursable. The primary objective the PU and second, by identifying trends in the Braden Score was worsening prior to of this study was to determine the rate of Braden Scores prior to PU development. PU development. Institution wide in-service hospital acquired pressure ulcers (HAPUs) at Results: The incidence of UNMC HAPUs per may be needed to improve pressure ulcer the University of Nebraska Medical Center quarter ranged from (2.18- 4.46%). Eleven prevention at UNMC. (UNMC). A secondary objective was to of the 12 quarters had higher rates than measure nursing compliance with hospital https://doi.org/10.32873/unmc.dc.gmerj.1.1.035 the national average (2.5%). Nursing staff approved PU prevention protocols. performed a Braden assessment the majority Methods: This study was a single site of the time during a patient’s hospitalization. observational retrospective chart review from Dec. 2019 | Vol. 1 | Issue 1 Oral Presentations 46.
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