Browsing by Author "Duncan, Francesca"

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    An Abscessed Tooth that Wasn't: An Unusual Case of Mumps in an Elderly Patient
    (2020-03) Lin, Jenny; Willhite, Sydney; Moore, Hannah; Smith, Maddie; Duncan, Francesca
    Case: A 62-year-old African American female with history of self-resolving parotitis initially presented with progressive neck and bilateral facial swelling. She attributed this to an abscessed tooth. CT revealed parotitis with inflammatory changes and mass effect on the hypopharynx and larynx, although the patient denied breathing difficulty. Antibiotics were administered for two days, discontinuing due to lack of abscess. Six days later, the patient presented with worsening facial swelling, sore throat, and dysphagia. She remained afebrile but with a WBC count of 12.8. Antibiotics and steroids were given. MRI displayed retropharyngeal space involvement of 2.6 cm in thickness. ENT performed surgical debridement and culture collection. Upon return from the OR, respiratory distress and inability to manage secretions resulted in intubation via an upright awake fiberoptic approach given concern for impending airway compromise. Finally, a positive IgM antibody to mumps virus was detected from the debridement culture. Discussion: The differential for nonsuppurative parotitis includes viruses, autoimmune disorders, and granulomatous inflammation. Paramyxovirus, specifically mumps, is the most common viral cause, with EBV, HSV, CMV, and HIV as other concerns. Autoimmune causes are Sjogren syndrome and SLE. Mycobacterium species are the likely granulomatous culprit. Though mumps is the most common viral cause of parotitis, it typically occurs in children and young adults, not fitting of the patient described. However, mumps cases have increased recently. MMR vaccination began in 1967 and cases decreased more than 99%; yet, since 2006 there have been outbreaks. Vaccine-induced protection may wane over time. Mumps is highly contagious and complications include meningitis, encephalitis, pancreatitis, and deafness, occurring more commonly in elderly patients. Patients with nonsuppurative parotitis should thus be surveyed for vaccination history and examined for MMR titers.
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    Acute Heart Failure in the Setting of Post-Covid MIS-C: A Case Report
    (2023-03-24) Luster, Taylor; Sloat, Brittany; Mederos, Alexa; Karam, Marie; Pavlik, Lauren; Duncan, Francesca
    Introduction: Multi-inflammatory Syndrome in Children (MIS-C) has emerged as a rare, but severe complication of SARS-CoV-2 infection. Patients present with persistent fever, abdominal pain, diarrhea, vomiting, rash, mucocutaneous lesions, and in severe cases, shock. The diagnostic criteria are age < 21, fever, laboratory evidence of inflammation, multi-organ involvement, and a positive COVID-19 test or known exposure 4 weeks prior to symptoms onset. Case Description: A 17-year-old female with a history of prior COVID-19 infection presented complaining of chest pain, shortness of breath, headache, and fevers with a Tmax of 105F for 4 days. The patient was hypotensive, tachycardic, tachypneic, and hypoxic. Pertinent labs included: Na 126, BUN 48, Creatinine 2.1, ALT 62, AST 86, WBC 27.4, Hg 10.5, Troponin 0.96, Lactate 3.3, CRP 60, ESR 85, Procalcitonin 75, D-dimer 2.02, Fibrinogen >1000, COVID PCR negative, and COVID Ig-G reactive. CT chest was notable for bibasilar pulmonary opacites, cardiomegaly, and bilateral pleural effusions. Echocardiogram showed left ventricular ejection fraction of 21% and global hypokinesis. She was ultimately intubated due to respiratory failure and started on milrinone and vasopressors. She was treated with IVIG, aspirin, and methylprednisolone for MIS-C. She clinically improved and repeat echo showed an improved EF of 57% and was discharged after 10 days with a prolonged prednisone taper. Clinical Significance: The incidence of MIS-C is 316 per 1 million pediatric SARS-CoV-2 infections. This case demonstrates need for increased awareness of potential acute cardiac failure in adolescents with a recent history of COVID-19 infection, elevated inflammatory markers, and signs of multi-organ failure so that IVIG, aspirin and corticosteroids can be started immediately to avoid progression of MIS-C into acute cardiac failure. Conclusion: Pediatric presentation of SARS-CoV-2 infection can be mild, but there is a subset of patients that have been reported to develop MIS-C, a more severe post viral syndrome.
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    “I Didn't Know What to Say”: Responding to Racism, Discrimination, and Microaggressions With the OWTFD Approach
    (Association of American Medical Colleges, 2020-07-31) Sotto-Santiago, Sylk; Mac, Jacqueline; Duncan, Francesca; Smith, Joseph; Medicine, School of Medicine
    Introduction Academic medicine has long faced the challenge of addressing health inequities, reflecting on how these contribute to structural racism, and perpetuating negative social determinants of health. Most recently, we have constructed opportunities for dialogues about racism, discrimination, and microaggressions (RDM). As such, we created a professional development program that encouraged participants to (1) openly discuss RDM and the impact they have in academia, (2) learn about tools to address and respond to RDM, and (3) move towards the creation of inclusive environments. The target audience included institutional leaders, faculty, trainees, professional staff, and health care teams. Methods We sought to meet workshop goals by integrating anti-racist dramaturgical teaching, introducing concepts knowledge, and practicing communication tools. To assess learning and evaluate our workshops, participants completed a pre- and postsurvey. Results Results showed that 30 participants were more comfortable with discussing issues related to race/ethnicity, gender identity/expression, sexual orientation, and spirituality after participating in the workshops. Prior to the two workshops, the percentage of learners who felt confident initiating conversations ranged from 29% to 54%. After the workshops, the percentage of learners who felt confident ranged from 58% to 92%. The greatest increase, 100%, was observed in the levels of confidence in initiating conversations related to race/ethnicity. Discussion Despite medical education's commitment to cultural competence and institutional mission statements that value diversity, equity, inclusion, and justice, professional development opportunities are limited. Participants strongly agreed their participation in such a workshop was relevant and important to their professional work.
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    Novel Presentation of Pulmonary Atypical Carcinoid Tumor as Acute Pancreatitis
    (Cureus Inc, 2020-10) Bharat, Anchit; Duncan, Francesca; Williams, Mark; Medicine, School of Medicine
    Pulmonary neuroendocrine tumors (NETs) are a group of rare tumors that pose a high financial burden on patients and the United States healthcare system. The usual presenting symptoms include cough or wheezing, hemoptysis, or chest pain. Due to bronchial obstruction, patients may also present with recurrent pneumonia. Acute pancreatitis has yet to be documented as the initial manifestation of this disease. Atypical carcinoids - a subtype of NETs - are heterogeneous regarding their site of origin, biological behavior, and malignant potential. Studies show that the most common primary tumor site varies by race, with the lung being the most common in white patients and the rectum being the most common in Asian/Pacific Islander, American Indian/Alaskan Native, and African American patients. Certain carcinoid tumors, such as those of the rectum, are over-represented among the Black and Asian populations within the United States, suggesting the role of genetics in the development of this intriguing disease. Furthermore, the pancreas is not a usual site of metastasis for primary lung NET. Our case study describes the rare occurrence of a primary pulmonary NET (atypical carcinoid) metastasizing to the pancreas and presenting as acute pancreatitis.
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    Student-Led Effort to Incorporate Social and Structural Determinants of Health into Undergraduate Medical Education: Civic Engagement, Advocacy, and Anti-Racism
    (2022-04-28) Fazle, Trilliah; Feliciano, Anna; Brown, Lucy; Roberts, Faith; Owens, Jourdan; Duncan, Francesca
    Background: The recent wave of student and physician activism created a space to discuss racism in healthcare with a more critical lens. Students are interrogating the environment in which they will provide healthcare and the social and structural determinants of health—one being the lack of anti-racist education in undergraduate medical education (UME). Objective: The Black History Month Speaker Series (BHMSS) was formulated to highlight racism in healthcare. Participants learned about race and healthcare policy (RHP), maternal mortality (MM), racial health equity (RHE), voting barriers and civic engagement (CE), distrust of medical institutions among communities of color (D), and health disparities (HD). A list of national and local partner organizations was provided after the series to all participants with contact information and volunteer resources to encourage active community engagement and apply what they had learned. Methods: Students organized a five-lecturer series for February 2021. Pre-BHMSS and post- BHMSS Qualtrics surveys assessed overall knowledge and comfort measured on a 4-point scale (1=very uncomfortable/no knowledge and 4=very comfortable/knowledgeable). Two-tailed unpaired t-test was utilized. Results: The pre-BHMSS population (n=247) included primarily medical students (49%); post- BHMSS respondents (n=61) were majority female (80%) and Caucasian (63%). Post-BHMSS reported increased “knowledge” for RHP, MM, RHE, CE, D, and HD (μ difference=0.71 [95% CI=0.47, 0.95] p<0.001; 0.58 [0.32, 0.84] p<0.001; 0.49 [0.21, 0.77] p<0.001; 0.61 [0.20, 1.0] p<0.01; 0.64 [0.40, 0.87] p<0.001; 0.22 [0.057, 0.38] p<0.01). Post-BHMSS exhibited increased “comfort” addressing RHP, MM, RHE, CE, and D (0.55 [0.30, 0.80] p<0.001; 0.40 [0.14, 0.66] p<0.01; 0.46 [0.18, 0.74] p<0.01; 0.47 [0.053, 0.87] p<0.05; 0.35 [0.09, 0.61] p<0.01); however, there was no change in HD “comfort.” Conclusion: Comfort and knowledge significantly increased across nearly all topics, suggesting insufficient prior awareness and the urgent need for integration of anti-racism education in UME. BHMSS represents an innovative option for the incorporation of historical racial context that influences current medical practices and education. Knowledge acquired may foster valuable relationships between providers and patients and represents a potential solution to improved care for marginalized groups.
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    Student-Led Effort to Incorporate Social and Structural Determinants of Health into Undergraduate Medical Education: Civic Engagement, Advocacy, and Anti-Racism.
    (2021-10) Brown, Lucy; Fazle, Trilliah; Roberts, Faith; Feliciano, Anna; Owens, Jourdan; Duncan, Francesca
    Background: The recent wave of student and physician activism created a space to discuss racism in healthcare with a more critical lens. Students are interrogating the environment in which they will provide healthcare and the social and structural determinants of health—one being the lack of anti-racist education in undergraduate medical education (UME). Objective: The Black History Month Speaker Series (BHMSS) was formulated to highlight racism in healthcare. Participants learned about race and healthcare policy (RHP), maternal mortality (MM), racial health equity (RHE), voting barriers and civic engagement (CE), distrust of medical institutions among communities of color (D), and health disparities (HD). A list of national and local partner organizations was provided after the series to all participants with contact information and volunteer resources to encourage active community engagement and apply what they had learned. Methods: Students organized a five-lecturer series for February 2021. Pre-BHMSS and post- BHMSS Qualtrics surveys assessed overall knowledge and comfort measured on a 4-point scale (1=very uncomfortable/no knowledge and 4=very comfortable/knowledgeable). Two-tailed unpaired t-test was utilized. Results: The pre-BHMSS population (n=247) included primarily medical students (49%); post- BHMSS respondents (n=61) were majority female (80%) and Caucasian (63%). Post-BHMSS reported increased “knowledge” for RHP, MM, RHE, CE, D, and HD (μ difference=0.71 [95% CI=0.47, 0.95] p<0.001; 0.58 [0.32, 0.84] p<0.001; 0.49 [0.21, 0.77] p<0.001; 0.61 [0.20, 1.0] p<0.01; 0.64 [0.40, 0.87] p<0.001; 0.22 [0.057, 0.38] p<0.01). Post-BHMSS exhibited increased “comfort” addressing RHP, MM, RHE, CE, and D (0.55 [0.30, 0.80] p<0.001; 0.40 [0.14, 0.66] p<0.01; 0.46 [0.18, 0.74] p<0.01; 0.47 [0.053, 0.87] p<0.05; 0.35 [0.09, 0.61] p<0.01); however, there was no change in HD “comfort.” Conclusion: Comfort and knowledge significantly increased across nearly all topics, suggesting insufficient prior awareness and the urgent need for integration of anti-racism education in UME. BHMSS represents an innovative option for the incorporation of historical racial context that influences current medical practices and education. Knowledge acquired may foster valuable relationships between providers and patients and represents a potential solution to improved care for marginalized groups.