Browsing by Author "Patel, Arpan"
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Item A Case of Pediatric Tracheal Stenosis Secondary to Chronic Retching in the Setting of Bulimia Nervosa(2024-03-21) Patel, Arpan; Joshi, Eeshan; Srikalyani, Sathvik; Lal, Kevin; Saadeh, CharlesBackground: Tracheal stenosis is an important life threatening pathology in the pediatric population. The prompt diagnosis and management of tracheal stenosis is crucial to prevent complications of airway obstruction. Common etiologies include congenital anomalies, traumatic injury, complications of infection, and autoimmune disorders. Diagnosis is made with a combination of cross sectional imaging and rigid bronchoscopy. Endoscopic assessment and intervention will generally relieve acquired tracheal stenosis, with more severe cases requiring open surgical approaches. Historically, pediatric tracheal stenosis has had a poor prognosis; however, notable advances in endoscopic and open surgical treatments have led to a decline in morbidity and mortality. Case Information: A 14 year old female presented to the Emergency Department at Cook Children’s Medical Center with biphasic stridor and evidence of airway obstruction. The patient had never been tracheally intubated, and had no other significant medical history except for one year of frequent retching in the setting of bulimia nervosa. Symptoms were gradual in onset over the course of several weeks, with an initial working diagnosis of asthma with no improvement with inhaled steroids. A CT scan was obtained that revealed severe tracheal stenosis involving the cervical trachea. Initial lab work revealed an elevated WBC of 16.7, Potassium of 2.8mmol/L, Normal c-reactive protein, erythrocyte sedimentation rate, and procalcitonin. Her initial assessment was concerning for impending airway obstruction and she was taken to the operating room for emergent rigid bronchoscopy. She was found to have an irregular circumferential scar extending for 1.5cm, starting 2cm distal to the glottis involving the second through fourth tracheal rings. The initial stenosis was grade three with pinpoint 2-3mm patency. The scar was biopsied, and the stenosis easily dilated to normal caliber. Circumferential submucosal Kenalog was applied and the patient ultimately did very well clinically and was discharged on postoperative day 1 in stable condition. Her workup included anti-neutrophil cytoplastic antibodies, myeloperoxidase antibodies, serine proteinase 3 antibodies which were all normal. Her pathology revealed chronic tracheitis without evidence of bacterial tracheitis or vasculitis. Intraoperative cultures were unremarkable. She was taken back to the operating room six weeks later with findings of a normal lumen trachea with no evidence of restenosis or granulation. Of note, she had refrained from further retching since her initial presentation. At the time of this report, the patient was doing well with no concern for recurrent stenosis and compliant with avoidance of retching. Conclusions: This case emphasizes the diverse etiologies of tracheal stenosis and, specifically, the potential development of acquired tracheal stenosis related to self-induced retching in patients with eating disorders. Furthermore, this case underscores the need to consider the systemic effects of mental health disorders in pediatric patients, and helps add to our fund of knowledge regarding aerodigestive complications of bulimia nervosa.Item Resources and Opportunities Available for Allopathic and Osteopathic Medical Students Pursuing Otolaryngology: A Comprehensive Analysis(2024-03-21) Stucki, Brenton; Patel, Arpan; Judd, Dallin; Bruner, WilliamIntroduction: Otolaryngology, commonly known as Ear, Nose, and Throat (ENT), is a surgical subspecialty dedicated to addressing conditions of the head and neck. It is no surprise that matching into surgical subspecialties such as otolaryngology - head and neck surgery becomes more and more competitive each year. Data indicates that each year on average, students are performing at higher levels than years previous. This increase in competitiveness prompts the development of resources including specialty-specific information to be made more readily available to students. This review aims to identify key ENT organizations in the United States that may provide pivotal tools for medical students. Through an analysis of these organizations, this study reveals opportunities available to medical students through organizations such as research opportunities, conference scholarships, mentorship programs, and avenues for leadership roles. Furthermore, emphasizes the significance of research experience, leadership roles, academic performance, and compelling letters of recommendation, which are crucial in the application process. By focusing on these critical aspects, the primary aim is to highlight resources that can equip medical students with the necessary skills and experiences to apply for an ENT residency successfully.Methods:147 organizations were identified by the University of North Texas Health Science Center (UNTHSC) Gibson Library. A search conducted then by three independent researchers via Google Search contributed an additional 30 organizations. The combination of these sources resulted in a preliminary list of 177 organizations. Three duplicates were eliminated, thus decreasing the list to 174 unique organizations. The next stage of screening was predicated on the relevance of these organizations to the field of Otolaryngology. Three independent researchers excluded 129 entities sourced from the UNTHSC Gibson Library. Further reviews were conducted and a finalized cohort of fourteen national otolaryngology - head and neck surgery organizations were selected for comprehensive evaluation. Information regarding the following information was gathered and compiled for review and comparison: Organization Focuses on a Subspecialty of Otolaryngology, Organization Allows Both MD and DO Student Membership, Medical Student Cost to Join Organization, Annual Meeting, Research Presented at Annual Meeting, Medical Students can Present at Annual Meeting, Medical Student Registration Fee for Annual Meeting, Annual Meeting Registration / Travel Scholarships Available for Medical Students, Mentorship Available Within the Organization for Medical Students, Leadership Opportunities Available for Medical Students, Scholarships/Grants Available for Medical Students, Educational Material Available to Medical Students. Results: The comprehensive analysis highlighted resources and opportunities available for allopathic and osteopathic medical students pursuing otolaryngology. These entities offer numerous benefits, including research opportunities, educational materials, annual meetings, and access to subspecialties. These organizations can provide a competitive edge to medical students who take advantage of these benefits. Conclusion: In conclusion, this analysis underscores the vital support that professional organizations offer to medical students pursuing otolaryngology, highlighting the significance of mentorship, research opportunities, and educational materials. It urges medical students to actively engage with these organizations to enhance their career prospects in this field. However, identified gaps in mentorship, travel financial aid, and leadership roles point towards areas needing enhancement.Item Trigger Point Injections as a Potential First Line Therapy for Persistent Myofascial Pain Syndrome(2024-03-21) Srikalyani, Sathvik; Clearfield, Daniel; Patel, ArpanBackground Myofascial pain syndrome (MPS), characterized by pain from myofascial trigger points in skeletal muscles, often responds to conservative treatments. However, in this case, the patient's persistent symptoms resisted conservative methods but found relief only with trigger point injections. Using trigger point injections as the primary treatment method for MPS is unique. While trigger point injections are documented, their role as a first-line treatment for MPS is underexplored. This case reinforces the potential of trigger point injections for patients unresponsive to conventional treatments and underscores the importance of personalized management for myofascial pain. Teaching points in this case highlight the significance of clinical expertise in the diagnosis and the role of advanced diagnostic tools like ultrasonography, emphasizing meticulous diagnosis in cases where traditional treatments fall short. Case Summary A 58 year old male ex-Army Ranger presented with persistent bilateral posterior leg pain and tightness after failed conservative treatments such as massages, stretching, and NSAIDs for more than a year. A preliminary differential diagnosis included chronic exertional compartment syndrome, vascular claudication, as well as myofascial trigger points. Ultrasound-guided trigger point injections were administered, significantly reducing pain, increasing function, and improving their range of motion. This success highlights the efficacy of trigger point injections in treating MPS that resists conservative methods. Conclusion Literature on MPS primarily focuses on non-invasive treatments and explores trigger point injections as an adjuvant to other treatments. However, this case is different because it features a patient with chronic lower extremity MPS unresponsive to conventional therapies. The case challenges the traditional view that non-invasive methods suffice for MPS and highlights trigger point injections as a potential first-line treatment. For similar unresponsive MPS cases, future management should consider the early use of trigger point injections, particularly with ultrasound guidance for safety and precision. This case stresses the importance of individualized care, encouraging healthcare practitioners to explore alternative treatments when conventional ones fall short.