7/19 VA MTC: Primary Care Series- Workup and Treatment of Hypertension

This morning we went through a case where a patient presented to clinic to establish care and was found to have an elevated blood pressure in the office. With the help of our awesome primary care expert discussant, Dr. Joseph Diaz, we reviewed initial evaluation in patients with suspected hypertension. We discussed the importance of confirming diagnosis with home blood pressures or ambulatory monitoring.

We also reviewed initial physical exam and work up once diagnosis is made. This includes listening for abdominal bruit, cardiac exam, thyroid, and considering fundoscopic exam if concerned HTN is long-term or malignant. The goal of labs and studies are to determine if there is evidence of end organ damage and to characterize the patient’s overall cardiovascular risk profile.

Lastly we discussed treatment including specific lifestyle modifications that have been proven to help lower blood pressure. We reviewed options for monotherapy initiation and in small groups went over additional benefits, side effects, and contraindications for ACE, ARB, CCB, and thiazides.

MTC 7/19: “Leuk” out for these causes of an elevated white count!

Today, at our inaugural Hillcrest Primary Care Morning Report, we discussed the case of an elderly woman who presented with night sweats and splenomegaly and was found to have a significant leukocytosis. A peripheral blood smear revealed increased bands, metamyelocytes, myelocytes, and basophils. A BCR/ABL1 PCR was sent and returned positive, confirming the diagnosis of chronic myelogenous leukemia. She improved with initiation of imatinib.

With the help of our primary care expert, Dr. Lawrence Ma, a proud alumnus of the residency program, we talked about the most common etiologies of leukocytosis in the outpatient setting. Non-malignant causes of leukocytosis include stress (e.g., trauma), exercise, smoking, medications, acute/chronic infection, chronic inflammation, bone marrow activation, and asplenia. Malignant causes of leukocytosis include chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL), other myeloproliferative/lymphoproliferative disorders, and various solid tumors.

The peripheral blood smear can offer important diagnostic clues. At UCSD and the VA, you can digitally view blood smears using CellaVision. The appearance of blasts should raise concern for an acute leukemia, whereas an increase in more mature blood cells of the myeloid or lymphoid lineage could signal the presence of CML or CLL, respectively. As Dr. Ma pointed out, the decision to refer a patient to Hematology/Oncology is contingent upon a number of factors, including severity/duration of leukocytosis, B symptoms (fevers, night sweats, weight loss), hepatosplenomegaly, lymphadenopathy, bleeding, bruising, and petechiae. Presence of blasts, other immature forms, increased basophils, monomorphic lymphocytosis, and other cell line abnormalities are all suggestive of a hematologic disorder.

Remember, CML is a diagnosis that any primary care physician can make! Classified as a myeloproliferative neoplasm, CML is associated with the t(9;22) translocation (Philadelphia chromosome) and BCR/ABL1 fusion. Diagnosis is confirmed by FISH (for the translocation) and/or PCR (for the BCR/ABL1 fusion transcript). Treatment is with BCR/ABL1-specific tyrosine kinase inhibitors, which include imatinib and dasatinib.

Thank you, Dr. Ma, for everything you do for your patients and for being part of UCSDIM history!

Medical Spanish Word of the Day: el bazo = spleen

Fellowship Opportunity at University of Chicago in Primary Care Research

See below regarding a University of Chicago Fellowship opportunity for graduating residents who are interested in pursuing an academic career as a clinical investigator in internal medicine, pediatrics, ID/HIV, or geriatrics.

The goal of the HRSA T32 Primary care Investigators Training in Chronic disease & Health disparities (PITCH) Fellowship is to train the next generation of primary care clinical investigators to improve health outcomes and care delivery for patients with chronic diseases from underserved backgrounds. The PITCH Fellowship will recruit fellows from diverse backgrounds and train four (two first-year and two second-year) primary care fellows each year. Research projects will be aimed primarily at transforming the health care system through value-based care delivery and quality improvement initiatives, as well as improving mental health access and care, ending the crisis of opioid use disorder and overdose in America, and ending the HIV epidemic

Fellows will attain the core competencies for health services research and formal education addressing responsible conduct of research, oral and written presentation, manuscript and grant writing, leadership skills, and project management. Fellows will be offered the opportunity to complete Master of Science for Clinical Professionals or Master of Public Health, in addition to receiving dedicated, aligned mentorship with at least biweekly meetings and quarterly mentorship reviews. Through these activities, our fellows will become experts in the key principles of primary care research affecting vulnerable populations, the communication of their findings, leveraging policy to improve equity, and gain the fundamental skills that are required for rigorous academic research careers.

Eligibility:

All primary care clinicians with a commitment to a clinical investigator career will be considered for this two-year fellowship. Priority will be given to physician candidates from the specialties of internal medicine, geriatrics, pediatrics, and infectious disease (HIV) and/or those from underrepresented backgrounds.  For those individuals pursuing ID/HIV or geriatrics, acceptance into the PITCH fellowship and the clinical fellowships can be coordinated.

Applicants must be board-eligible or board-certified in internal medicine and/or pediatrics and eligible for licensure in the state of IL by July 1 of their first fellowship year. In addition, due to federal regulations based on our funding, applicants are required to be U.S. citizens or have permanent U.S. residence status at the time of the application.

Application Process:

Applying requires a 1) CV, 2) personal statement, and 3) brief Redcap survey.  The personal statement should explain why you are interested in this fellowship, your general area of research, name potential mentors, and describe your long-term goals including the position you think you would want after completing the fellowship.  The Fellowship has a particular interest in recruiting fellow from diverse backgrounds, so please also include information about your personal background.

If applicants move to the interview stage, then applicants will be asked to submit 3 letters of recommendation and an example of their research writing, if available.

Important dates:

Call for Applications: 4/1/2021-8/1/2021

Application Deadline: 8/1/2021

Invitation to Interview: 7/1/2021-8/22/2021

2nd Call for Applications (if necessary): 8/1/2021-8/31/2021

Applicant Interviews: 7/1/2021-9/30/2021

Deadline for Acceptance: 10/20/2021

Fellowship start date: 7/1/2022

To apply or if you have questions, please contact Morgan Ealey (Administrative Director) at mealey@medicine.bsd.uchicago.edu, Neda Laiteerapong, MD, MS (Program Director) at nlaiteer@medicine.bsd.uchicago.edu, and/or Elbert Huang, MD, MPH (Co-Director) at (ehuang@medicine.bsd.uchicagoe.du).

Final Reminder: TONIGHT is the Primary Care Career Panel!

Please join us TONIGHT for the virtual primary care career panel! We encourage you to attend even if you are not certain whether you are interested in a career in primary care. This is a great opportunity to talk to representatives from many local healthcare organizations including UCSD, VA San Diego, Sharp Rees-Stealy, Kaiser, Scripps, SharpCare Medical Group, Family Health Centers of San Diego, and more!

Thursday, April 29th at 5:30pm

https://uchealth.zoom.us/j/5427861524

Please RSVP to Stacy Charat (scharat@health.ucsd.edu) if you plan to attend, but an RSVP is not necessary for attendance.

Reminder: Primary Care Career Panel!

Please mark your calendar for the virtual primary care career panel! We encourage you to attend even if you are not certain whether you are interested in a career in primary care. This is a great opportunity to talk to representatives from many local healthcare organizations including UCSD, VA San Diego, Sharp Rees-Stealy, Kaiser, Scripps, SharpCare Medical Group, Family Health Centers of San Diego, and more!

Thursday, April 29th at 5:30pm

https://uchealth.zoom.us/j/5427861524

Please RSVP to Stacy Charat (scharat@health.ucsd.edu) if you plan to attend, but an RSVP is not necessary for attendance.

Save the Date: Primary Care Career Panel

Please save the date for a virtual primary care career panel! We encourage you to attend even if you are not certain whether you are interested in a career in primary care. This is a great opportunity to talk to representatives from many local healthcare organizations including UCSD, VA San Diego, Sharp Rees-Stealy, Scripps, SharpCare Medical Group, Family Health Centers of San Diego, and more!

Thursday, April 29th at 5:30pm

https://uchealth.zoom.us/j/5427861524

Please RSVP to Stacy Charat (scharat@health.ucsd.edu) if you plan to attend, but an RSVP is not necessary for attendance.

New Pathway Participants 2020-21

Congratulations to all our pathway participants for our upcoming academic year!

Primary Care

  • Stacy Han (R1)
  • Jessica Hansen (R1)
  • Allison Yip (R1)

Hospital Med

  • Nick Flores (R1)
  • Thejas Kamath (R1)

Global Health

  • Jed Bell (M/P R1)
  • Randall Blankers (R1)
  • Elena Cutting (R1)
  • David Hibbert (R1)
  • Samara Sorus (M/P R1)

RACE Track

  • Tally Buckstaff (R1)
  • Soumya Kurnool (R1)
  • Mehul Trivedi (R1)
  • Edward Wang (R1)
  • Kendel Flegenheimer (R2)
  • Erin Roberts (R2)
  • Revathy Sampath-Kumar (R2)

Integrative Med

  • Anna Armitage (R1)
  • Amy Guzdar (R1)
  • Allison Ibarra (R1)
  • Annie Ondracek (M/P R1)
  • Kevin Sung (R1)
  • Allison Yip (R1)
  • Neena Iyer (R2)
  • Ambika Munaganuru (R3)