Browsing by Author "Jones, Jenna"

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    Myocarditis in an 18-Year-Old with Ulcerative Colitis
    (2021-03-27) Asdell, Stephanie M.; Prabhakar, Mira; Jones, Jenna; Frick, William; Tolliver, Kevin
    CASE DESCRIPTION: An 18-year-old woman with recently-diagnosed ulcerative colitis (UC) on mesalamine presented with chest pain worsened by inspiration and exertion, dyspnea, and subjective fever for 6 hours. She had a self-limited dry cough 2 weeks prior. SARS-CoV-2 PCR was negative. At presentation, her hemoglobin was 7.1 g/dL. EKG showed sinus tachycardia. Peak troponin was 0.21 ng/mL. Transthoracic echocardiogram showed a possible mildly hypokinetic apex, and vasodilator stress test was normal. Due to persistent hematochezia and the possibility of mesalamine-induced myocarditis, mesalamine was changed to sulfasalazine for her UC. The patient was otherwise treated supportively and referred for outpatient cardiac MRI, but declined the study. Subsequently, Coxsackie B Virus Antibody Type 3 titer was strongly positive at > 1:640, confirming viral myocarditis. CONCLUSIONS: This case describes the work-up of an 18-year-old female patient with UC presenting with acute onset chest pain and fever. Differential diagnosis included viral myocarditis, mesalamine-induced myocarditis, pericarditis, pulmonary embolism, acute coronary syndrome (ACS), and multisystem inflammatory syndrome in children secondary to SARS-CoV-2. CLINICAL SIGNIFICANCE: Global incidence of viral myocarditis is 22 cases per 100,000 individuals annually; though significantly more common in males, female patients often present with more severe disease. Suspected myocarditis warrants an initial EKG and cardiac biomarkers followed by echocardiography, and when indicated, testing for ACS. While acute myocarditis is most commonly caused by coxsackievirus B3 and adenovirus in the U.S. and is treated supportively, several case reports of mesalamine-induced myocarditis prompted specific management for this patient with newly diagnosed UC. Thus, the acuity and incidence of myocarditis present a learning opportunity for differential diagnosis building and workup for young female patients with acute onset chest pain.
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    Plating versus Intramedullary Nailing of OTA/AO 43C1 and C2 Intra-articular Distal Tibia Fractures: A Propensity Score and Multivariate Analysis
    (Wolters Kluwer, 2024-01) Jang, Yohan; Wilson, Nathaniel; Jones, Jenna; Alchaide, Doriann; Szatkowski, Jan; Sorkin, Anthony; Slaven, James E.; Natoli, Roman; Orthopaedic Surgery, School of Medicine
    OBJECTIVE: To compare rates of reduction loss, nonunion, and infection in intra-articular distal tibia fractures (IADTF) treated with limited open reduction internal fixation and intramedullary nailing (IMN) as compared to open reduction internal fixation with plate and screws (plate fixation [PF]). METHODS: Design: Retrospective review. Setting: Level-I academic trauma center. Patient Selection Criteria: Patients age ≥ 18 with OTA/AO 43C1 and C2 IADTF treated with IMN or PF between 2013-2021. Outcome Measures and Comparisons: Loss of reduction, surgical site infection (SSI), nonunion, and patient-reported outcomes (PROs) were compared for IMN versus PF treatments. RESULTS: One hundred ten patients met the inclusion criteria (IMN 33 and PF 77). There was no loss of reduction found. Seventeen nonunions (15% overall; IMN 4/33 and PF 13/77) and 13 SSIs (12% overall; IMN 2/33 and PF11/77) were identified. Despite several risk factors being identified for nonunion and SSI in bivariate analysis, only open fracture remained significant as a risk factor for both nonunion (odds ratio 0.09 for closed fracture, 95% confidence interval, 0.02–0.56, P = 0.009) and SSI (odds ratio 0.07 for closed fracture, 95% confidence interval, 0.06–0.26, P = 0.012) in the multivariate model. Propensity scoring based on presurgical variables was significantly different between patients who received IMN versus PF (P = 0.03); however, logistic regression incorporating the propensity score revealed no significant association with nonunion and SSI. Adjusting for the propensity score, there remained no association comparing IMN versus PF with nonunion and SSI (P = 0.54 and P = 0.17, respectively). There was also no difference in PROs between IMN and PF (physical function: P = 0.25 and pain interference: P = 0.21). CONCLUSIONS: Overall nonunion and SSI prevalence was 15% and 12%, respectively, in operatively treated OTA/AO 43C1 and C2 IADTF. An open fracture was a significant risk factor for nonunion and SSI. Metaphyseal fixation through IMN or PF did not affect loss of reduction, nonunion, SSI, or PROs. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.