Reminder to all residents about the upcoming Dia De Los Muertos Event on Friday 10/29, 5-7:30pm
- 5:00-5:30pm Remembrance Ceremony: set up altar and place pictures/keepsakes
- 5:30-6:15pm Dinner/Potluck (Outdoors) + Intros (UCSD SOM and JEDI)
- 6:15-7:30pm Movie Screening (Lower MET Auditorium)
If you are planning on attending, please click here to RSVP by Monday, 10/25/2021!!
There will be food available so we need an accurate headcount. You can still bring potluck items but this is optional!
This is a great opportunity to spend quality time with one another, learn more about a cultural tradition, and meet/mentor medical students!
UC San Diego is hosting its inaugural Physician Family Day at Petco Park on Sunday, November 7th from noon to 4 PM.
There will be lots of family-friendly fun on the field, with activities like face painting, batting cages, ping pong, corn hole and more. Plus, enjoy delicious treats like cotton candy, tacos, nachos and kettle corn.
This event is free for all physicians and their families, in appreciate of all your hard work!
Click here to register for the event!
VA Morning Teaching Conference 10/25/21
Today, our fabulous R2 Anjali Kumar presented a hot case of a patient admitted for an empyema, but also had a rapidly worsening AKI (Cr of 0.8 to 8 in one week)! We discussed how we approach AKI on the wards, what focused history/exam to perform, what labs to order, and more importantly – how to interpret them! Here are some takeaway points:
- The FENa (fractional excretion of sodium in the urine) is most helpful when a patient has oliguric AKI. A lower FENa (<1%) is suggestive of hypovolemic state where the body is trying to retain sodium and water. However, the FENa can be <1% in many cases of AKI unrelated to a “pre-renal” etiology such as in sepsis, CKD, contrast-associated nephropathy. Administration of IVF can also skew your FENa results.
- The spot urine protein to urine creatinine ratio is a very practical tool to estimate the amount of protein a patient is excreting in a day. Example: [uPr] / [uCr] = [60 mg/dL] / [30 mg/dL] = 2. This ratio of 2 suggests that the patient is urinating 2 grams of protein in 24 hours! As convenient as it may be, the spot ratio is not as accurate as a 24 hour urine collection and can be dependent on time of day urine was collected, recent exercise, patient’s body size and baseline creatinine production, etc.
- Normal urinary protein excretion is less than 150 mg / day.
- Normal urinary creatinine excretion is about 20 mg/kg / day. Calculating someone’s “normal” urinary creatinine excretion and comparing it to their 24 hour urine collection of creatinine can help you determine if the 24 hour collection was adequate.
We then wrapped up with my personal method of thinking about nephrotic/nephritic syndrome by anatomy!
Dear UC San Diego Colleagues and Friends,
We cordially invite you to celebrate the 15th Anniversary Native American Heritage Month (NAHM) celebration at UC San Diego. This is a hybrid FREE event (including both live and pre-recorded components) that will kick off Native American Heritage Month. Our keynote speaker, Kali “KO Mequinonoag” Reis, is a Native American and Cape Verdean professional boxer from the Cherokee, Nipmuc and Seaconke Wampanoag tribes. She is an outspoken advocate for Native American rights, bringing awareness to the Missing and Murdered Indigenous Women and Girls (MMWIG) movement and continuously striving to utilize her knowledge and status to educate those around her and using her platform to elevate Native voices. In addition, you don’t want to miss our amazing entertainer performing live, Paul Cannon, a singer/song-writer from the San Pasqual Band of the Kumeyaay Nation. He is a member of the acoustic group, Iron Sage Wood, representing the heart and soul of Southern California.
Please join us as we recognize Native American Heritage Month in support of equity, diversity, and inclusion at UC San Diego. REGISTER SOON! The first 100 registrants will receive the 2021 NAHM gift bag.
Date: Thursday, November 4, 2021
Time: 10:00 AM – 11:30 AM PDT
Location: Price Center Ballrooms A/B
If you have any questions or concerns about the UC San Diego Native American Heritage Month celebration, please contact: NAHM@ucsd.edu .
2021 NAHM PLANNING COMMITTEE
This morning senior resident Nick Flores presented a case of a middle-aged gentleman who presented after his 4th episode of syncope in the last year. We reviewed the diagnostic schema for syncope and then went through the patient’s HPI and exam. Patient was found to have evidence of volume overload with elevated JVP and lower extremity edema. Also reported DOE. We then had residents compile a list of labs/tests/studies they would order to further evaluate the patient.
We then reviewed his EKG, CXR, and initial labs. Noted to have low voltage EKG with elevated Cr, troponin, and BNPP. We then reviewed several views of his echocardiogram. With the help of our expert discussant we analyzed the imaging and found a pattern concerning for an infiltrative process noting the restrictive filling, LVH, bi-atrial dilation, and hyper-echoic septum.
Dr. Urey then explained what aspects of the patient’s history and presentation raised his suspicion for cardiac amyloidosis. We reviewed common clinical manifestations and test results seen in amyloidosis, highlighting the ones our patient had. We discussed the differing characteristics of the 3 types of amyloidosis that cause >90% of cardiac amyloidosis: AL, ATTRwt, ATTRm. Finally we went through the initial work up for patients with suspicion for cardiac amyloidosis: immunofixation/SPEP and serum free light chain ratio to assess for AL amyloidosis, if negative then Pyrophosphate Scan to evaluate for both forms of ATTR amyloidosis.
Take Home Points:
- Cardiac amyloidosis is under diagnosed and requires high level of suspicion
- Consider amyloidosis in patients presenting with unexplained LVH, especially if heart failure, syncope, or angina present
- Evaluate for non-cardiac signs and symptoms of amyloidosis: carpel tunnel, renal impairment, proteinuria, peripheral neuropathy, GI issues, etc.
- Imaging with echo +/- cardiac MRI can show characteristic findings
- Work-up the type of cardiac amyloidosis with SPEP, Serum Free Light Chain ratio, and 99mTechnetium Pyrophosphate Scan
So proud of you Cris and Ana Lucia! You guys rock!!
The following interest group meetings have been arranged to give you the opportunity to meet and talk with the program directors and fellows within UCSD’s program. All are welcome to attend! We encourage you to attend as many meetings as you’d like! Feel free to reach out to the program directors or chief residents, if you have any questions! We will continue to update this post as meetings are arranged.
- PCCM (CMR: Susan Seav)
- Date/Time: Monday, October 25th at 7:00 PM
- Zoom ID: 972 2664 1969
- GI (CMR: Lizzy Hastie)
- Date/Time: Thursday, November 18th at 6:00 PM
- Zoom ID: 983 6187 1212
- Primary Care
- ID/Global Health
- Hospital Medicine
- Palliative Care
This afternoon was full of great kidney talk! Our senior residents started out the afternoon working through cases of both nephrotic and nephritic syndromes with Dr. Cunard. Once our interns joined the group, we moved on to a discussion of CKD management with Dr. Woodell. He did note the current controversy surrounding the role of Race in calculating eGFR – more to come next week! Finally, Dr. Carreira from Family Medicine/Psych, taught us about healthcare for patients experiencing homelessness and about the resources available in San Diego. She reminded us that “just being homeless is trauma,” and we took time to share our own stories of the barriers we see our patients face when accessing healthcare. The best thing we can do is be human and connect with this population.
Cited in the Washington Post today, Dr. Mandel (Chief of Pulmonary and Critical Care) explains why we should not let our unused vaccines expire when we can contribute to the global immunity to COVID-19! His international efforts in reducing COVID-19 rates exemplifies our mission as a health institution to treat patients regardless of their nationality or socioeconomic status!