UCSD Internal Medicine Residency on Social Media!!

Our residency’s twitter following continues to grow! Our handle @ucsdim is becoming THE place for bite-sized medical education. Make a twitter and join the hundreds of followers checking out our account to:
– See COMPACT key takeaways from teaching conferences DAILY
– Get connected with the DEI shift, Dr. Pooja Jaeel and Dr. DJ Gaines to expand your perspective on diversity, equity, & inclusion (DEI) in medicine
– Get your hard work featured by us, shown off to fellowship programs (UCSD Cardiology, PCCM, and Heme-Onc and key figures from every department are all on twitter and follow us daily!!) or other great Medical Education venues such as the Human Diagnosis Project (who feature FIVE of our residents over the last week!)

– We even had our residency featured by ‘The Internal Medicine Applicant‘, an account dedicated to helping medical students find the right place to match during the pandemic!!

Join us! If you have questions or need help making an account, ask your friendly neighborhood Chiefs!! We want to show you off and help your careers thrive!!

Congratulations Dr. Mahmud!

Dr. Ehtisham Mahmud, Chief of the Division of Cardiovascular Medicine, has recently been named the Interim Chair of the Department of Medicine! Dr. Mahmud, a UCSD internal medicine residency alumnus, is a world-renowned cardiologist, researcher, and educator. He recently completed his term as the President of the Society for Cardiovascular Angiography and Interventions and has authored over 200 publications.

Congratulations Dr. Mahmud!

Residency Alumna Shout Out: Sydney Ramirez!

Shout out to residency and PSTP program alumna and current UCSD infectious diseases fellow Sydney Ramirez! She was recently interviewed for a radio segment on PRI’s The World in which she explains what we have learned so far about the SARS-CoV-2 virus. Listen to the full segment here:

https://www.pri.org/file/2020-07-03/scientists-study-immunity-novel-coronavirus

Separately, her groundbreaking research tracking CD-4+ and CD-8+ T-cell responses in convalecent COVID-19 patient serum was published in Cell in May. She was interviewed by Popular Science about her findings in May.

Read the report in Cell here: DOI: 10.1016/j.cell.2020.05.015

Read the interview in Popular Science here: https://www.popsci.com/story/health/covid-19-coronavirus-immunity-vaccine/

Amazing work Sydney!

Jacobs Hospital Med Conference

Today we were lucky to have 2 great EBM presentations from our Hospital Medicine residents at Jacobs! Dr. Neena Iyer investigated the use of steroids vs pentoxifylline in alcoholic hepatitis, while Dr. Lauren Haggerty took use through the brief history of steroid use in patients with COVID-19. Two key points for each of them!

Alcoholic Hepatitis
1. Many providers use Maddrey’s Discriminant Score to determine whether or not they would treat Alcoholic Hepatitis patients with steroids.
2. The key concern is that when patients develop infection in alcoholic hepatitis their survival rates decrease substantially. The data for whether or not steroids increase the risk for infection in these patients isn’t clear.

Steroids in COVID-19
1. Recent pre-published data (pdf *here*) from the UK showed a significant mortality benefit in patients with COVID-19 who were treated with Dexamethasone.
2. This benefit was primarily seen in patients with severe enough disease to require oxygenation. Benefits were limited in patients >70 years old and in the first 7 days of infection.

Morning Teaching Conference on “Acute Heart Failure” with Dr Tran

Teaching Points

Differential for ACUTE onset heart failure can be broken down into rhythm, endocardial, myocardial and pericardial causes

Cardiac MRI can be used to diagnose myocardial causes of acute heart failure by identifying certain tissue characteristics, such as edema and hyperemia in a non-ischemic distribution

Indication for endomyocardial biopsy for patients with acute onset heart failure are (1) cardiogenic shock, given high concern for Giant Cell Myocarditis (2) AV block or life threatening arrhythmias (3) refractory heart failure despite appropriate goal directed medical therapy

Morning Teaching Conference with Dr. Wardi

Today we discussed sepsis with Dr. Wardi and our amazing resident Anna Silverman! We went over code sepsis criteria at UCSD. Code sepsis can be called by any member of the care team. It should be called in a patient with 2 or more SIRs criteria + suspected infection + either a lactate >2 or hypotension. Early recognition and treatment of sepsis is key in improving patient mortality.

Tips for how to approach a code sepsis:

  • See the patient! Give your senior a heads up!
  • Evaluate for stability: ABCs, vitals trend
  • Assess level of care needs
  • Evaluate for possible infectious sources, but also think about non infectious causes.
  • Consider labs such as blood cultures, UA, CXR, CBC, CMP and lactate
  • Determine if fluids are needed and resuscitate appropriately with crystalloids.
  • Assess for the need for antibiotics.
  • Remember to document (.sepsisinitialnote)
  • Follow-up with patient to evaluate for improvement or change in status and document (.sepsisreassess)

Resident Kudos!

Kudos to Anna Silverman who, as our awesome Hillcrest Team 1 senior, got a shout-out from one of our nurses, Bella Gulkarov! Bella said “working with her is a great experience. She is not only a smart young lady, but she also has a beautiful heart and she takes care of her patients like they are her family! Very professional and incredible!”

We could not agree more! Congratulations Anna!

Morning Teaching Conference with Dr Wooten

This morning we discussed a case of subacute fever and headache in a HIV/AIDS patient with signs/symptoms of elevated ICP (positional headache, vomiting, lethargy and Cushing’s Triad)! We were lucky to have one of our Owen Clinic physicians, Dr Darcy Wooten, help us build our differential for headache and fever in an HIV/AIDS patient.

Teaching Points!

  1. Signs of elevated ICP: AMS, papilledema, positional headache/vomiting, CN VI palsy, Cushing’s Triad (HTN, bradycardia and respiratory depression)
  2. Gold standard for differentiating between active Cryptococcal Meningits v IRIS is a positive fungal culture, as CSF CrAg can be reflective of dead Cryptococcus
  3. Patients at risk for IRIS are patients (1) recently started on ARVs; (2) low CD4 and high viral load prior to initiation of ARV; (3) associated recent increase in CD4 and decrease in HIV viral load after initiation of ARV