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Leukocytoclastic Vasculitis in Cefazolin and Nafcillin Antibiotic Treatment

Jon Richards and Josip Divic

Publication Date: 5-9-2025

Autologous free flap (AFF) microsurgical outcomes have been well studied in adult populations, but have yet to be extensively studied in children, likely due to the relatively fewer number of microsurgical cases in this population. This study will investigate the relationship between pediatric health factors, demographics, insurance payor status, hospital characteristics and how they contribute to post surgical AFF transfer complications.
Treatment of Marjolin's Ulcer Arising from Hidradenitis Suppurativa and Reconstructive Methods: A Review

Morgan Sainsbury, Peter Granger, and Travis Holcombe

Publication Date: 5-9-2025

Hidradenitis Suppurativa (HS) is an inflammatory disorder of the skin characterized by the presence of painful deep-seated nodules, abscesses, or fistula tracts at intertriginous regions that follow a chronic, recurrent course1-3.HS is often challenging to treat, with surgical excision typically reserved for advanced, refractory disease. Marjolin's Ulcer, a type of Squamous Cell Carcinoma, is a rare complication that can arise from longstanding HS. Formal treatment guidelines for Marjolin Ulcer arising from HS are currently undefined.
Physical Activity Counseling in MSU Network Family Medicine Clinics

Karyn Schmidt Veerman and Harland Holman

Publication Date: 5-9-2025

Chronic disease is a global health concern, with physical inactivity being a major risk factor. The WHO recommends at least 150 minutes of moderate-intensity exercise weekly, but only half of US adults meet this goal. Physicians are key to addressing physical inactivity through activity prescriptions. While effective and cost-efficient, counseling on physical activity is underutilized by physicians. Primary care physicians face challenges in prescribing physical activity due to time constraints, limited education, and patient commitment. While brief counseling and written prescriptions can be effective, physicians often lack training and only address the first two steps of the 5 A's counseling method - assess, advise, agree, assist, and arrange- a known method for counseling patients toward behavior change.
Evaluation of Epidural Anesthesia on Neonates Undergoing Abdominal or Thoracic Surgery

Sejad Skokic, Shewar Ibadat, Ann Shupe, Lucas Leffler, and Jodi Garvin

Publication Date: 5-9-2025

Epidural analgesia use is common in adult and pediatric patients, but there is limited use in the neonatal world due to inexperience among neonatologists and pediatric anesthesiologists. Epidural analgesia can reduce postoperative opioid use and improve recovery in adults and children, yet data on neonates is limited1. Neonates endure 7.5 to 17.3 painful procedures daily, altering pain responses and potentially having long-term neurocognitive effects due to the developing brain2,3. Opioid use is common in neonates; however, neurotoxic effects and respiratory depression highlight a need for alternatives4. In 2020, the HDVCH perioperative committee implemented a protocol for epidural analgesia in postoperative neonates undergoing major thoracic and abdominal surgery to improve pain management and reduce opioid side effects such as apnea, respiratory distress and delayed bowel function.
Incidence of Invasive Group A Streptococcus Infection in Relation to the COVID-19 Pandemic (GASCO) - A Pilot Study

Jacob Stremers, Hannah Bray, Adam Caulfield, Robert Fulmer, Zachary Ciochetto, and Gordana Simeunovic

Publication Date: 5-9-2025

Group A Streptococcus (GAS) is a known cause of invasive infections in humans leading to significant morbidity and mortality. During the COVID-19 pandemic the incidence of respiratory infections had decreased, likely due to pandemic interventions. Previous studies found a correlation between the rates of viral respiratory infections and a predisposition to invasive GAS infections (iGAS). We hypothesize that the incidence of iGAS among adults may have been affected by the COVID-19 pandemic, but evidence is lacking. GASCO compares the rate of iGAS infections before, during and after the COVID-19 pandemic, and evaluates factors that may affect the incidence and outcomes. In this pilot study, we describe the incidence of total GAS infection (tGAS) and iGAS in relation to the COVID-19 pandemic.
Persistent Endofilling of Frozen Elephant Trunk

Christina Supino, Jake Nicholson, and Eanas Yassa

Publication Date: 5-9-2025

A 67-year-old male presented in 2021 with an acute type A aortic dissection. He underwent ascending aorta and hemiarch replacement with a frozen elephant trunk and stent placement into the left subclavian artery. On follow up imaging he was found to have an increase in his maximal aortic diameter with persistent filling of the false lumen from a fenestration between the innominate and left carotid artery on interval diagnostic aortogram (see image 1). The patient elected not to undergo redo arch replacement given the risks associated and instead opted for great vessel debranching followed by zone 0 thoracic branch stent graft.
Self-induced Dermatosis in Adolescence: A Great Imitator

Emma Syrek, Christian Kolacki, and Andrea Reeder

Publication Date: 5-9-2025

Self-induced dermatoses refer to skin conditions in which an individual deliberately creates skin lesions on their own body, often as a manifestation of underlying psychological distress. These dermatoses constitute about 2% of dermatology patient visits and can mimic and coexist with primary dermatologic disease. We present the case of a 13-year-old adolescent who was evaluated by multiple providers and specialties for recurrent "rash" before the determination that the lesions were all self-inflicted.
Beware of Feeding Chickens: A Case of Salmonella Endocarditis

Ajith Thomas and Jorgelina De Sanctis

Publication Date: 5-9-2025

Infective endocarditis (IE) is a common cause of bacteremia, though the most common offending microorganisms tend to be from the staphylococcus, streptococcus, and enterococcus species. Salmonella is a very rare cause of endocarditis accounting for less than 0.01-2.9% of all reported cases of bacterial endocarditis from the known literature. Though fairly uncommon, Salmonella endocarditis has a high mortality rate in complicated or inadequately treated cases, and thus greater effort must be taken to fully treat such rare infections.
Management of Intercostal Artery Pseudoaneurysm after Stab Wound to Chest

Kyle Thompson

Publication Date: 5-9-2025

Intercostal artery pseudoaneurysms are extremely rare, with recorded cases being approximately 10. The management of intercostal pseudoaneurysms has not been standardized given their low incidence. With the anatomical location and difficulty of access, the potential morbidity with rupture could be devastating. The indications for interventional management have not been established. This case gives an insight into the diagnosis and potential management of intercostal artery pseudoaneurysms.