Browsing by Author "Bittar, Julie M."
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Item Gardnerella vaginalis causing pulmonary infection in a young adult: A novel case(Elsevier, 2019-07-25) Bittar, Julie M.; Gazzetta, Joshua; Surgery, School of MedicineGardnerella vaginalis is an anaerobic, gram-variable bacterium primarily found in vaginal microflora of women. Previous reports of G. vaginalis cultured in men are few and have primarily been limited to the gastrointestinal and genitourinary tract.2-4 Few reports of G. vaginalis causing severe infections have been reported in the literature, including septicemia7 and two cases of perinephric abscess.8,9 There has been one previously reported case of G. vaginalis causing pulmonary complications that occurred in a male alcohol abuser. In our case review, we aim to demonstrate an unusual source of a pulmonary infection and highlight the importance of proper microbial isolation to guide treatment. Our patient is a young male who presented following multiple gunshot wounds including one to his head causing an intracranial hemorrhage, hydrocephalus, and a dural sinus thrombosis. His hospital course was complicated by a decline in neurological status treated with a craniotomy and external drain placement and multiple pulmonary infections. During his fever work-ups, he found to have G. vaginalis on mini-bronchoalveolar lavage and was subsequently treated with metronidazole. After treating his G. vaginalis pneumonia and other infectious sources, namely Haemaphilus influenzae and coagulase-negative staphylococcus pneumonias, his fevers and leukocytosis resolved and he was successfully discharged to a rehabilitation facility for neurologic recovery. To our knowledge, this is the second reported case of G. vaginalis isolated from a pulmonary culture and the first in a previously healthy, immunocompetent young male outside of the urinary tract.Item Systematic Review and Meta-Analysis of Local Recurrence Rates of Head and Neck Cutaneous Melanomas after Wide Local Excision, Mohs Micrographic Surgery, or Staged Excision(Science Direct, 2021-09-01) Bittar, Peter G.; Bittar, Julie M.; Etzkorn, Jeremy R.; Brewer, Jerry D.; Aizman, Leora; Shin, Thuzar M.; Sobanko, Joseph F.; Higgins, Harold W.; Giordano, Cerrene N.; Cohen, Justine V.; Pride, Renee; Wan, Marilyn T.; Leitenberger, Justin J.; Bar, Anna A.; Aasi, Sumaira; Bordeaux, Jeremy S.; Miller, Christopher J.; Dermatology, School of MedicineBackground Prospective trials have not compared local recurrence rates for different excision techniques for cutaneous melanomas on the head and neck. Objective To determine local recurrence rates of cutaneous head and neck melanoma after wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision. Methods A systematic review of PubMed, EMBASE, and Web of Science identified all English case series, cohort studies and randomized controlled trials that reported local recurrence rates after surgery of cutaneous head and neck melanoma. A meta-analysis utilizing a random effects model calculated weighted local recurrence rates and confidence intervals (CI) for each surgical technique and for subgroups of MMS and staged excision. Results Among one-hundred manuscripts with 13,998 head and neck cutaneous melanomas, 51.0% (7138) of melanomas were treated by WLE; 34.5% (4,826) by MMS; and 14.5% (2,034) by staged excision. Local recurrence rates were lowest for MMS (0.61%; 95%CI, 0.1%-1.4%); followed by staged excision (1.8%; 95%CI, 0.1%-2.9%) and WLE (7.8%; 95%CI, 6.4%-9.3%). Limitations Definitions of local recurrence varied. Surgical techniques included varying proportions of invasive melanomas. Studies had heterogeneity. Conclusion Systematic review and meta-analysis show lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS or staged excision compared to WLE.Item Verrucous Plaques of the Buttocks, Perineum, and Umbilicus(Elsevier, 2019) Bittar, Julie M.; Burton, Kyle; Rahnama, Sahand; Dermatology, School of Medicine