Coexistence of systemic lupus erythematosus and thrombotic thrombocytopenic purpura: a case report.

Systemic Lupus Erythematosus (SLE) and Thrombotic Thrombocytopenic Purpura (TTP) are two different clinical entities that can have overlapping features. Early recognition of either disease is vital since therapy differs. The exact incidence of coexistence of SLE and TTP is unclear. Rituximab has recently been used in the treatment of plasmapheresis-resistant TTP and is effective when SLE and TTP present together. We report a case of a 52-year-old female who presented with both SLE and TTP, years after she had initially presented with TTP alone. During this episode she did not respond to the conventional treatment with plasmapheresis and steroids. She was subsequently started on rituximab and responded well.

Hiding in plain sight: H1N1 influenza presenting with respiratory failure and normal chest radiography.

Sepsis and respiratory failure are uncommon complications of infection with H1N1 influenza. In the majority of cases of H1N1-associated sepsis and respiratory failure found in the literature, evidence of pneumonia or the acute respiratory distress syndrome was seen on chest radiography. This case report describes the clinical characteristics of a patient who presented with septic shock and multi-system organ failure due to H1N1 influenza, but had normal chest radiography. Beyond describing a unique presentation of H1N1-related sepsis, this report highlights the need for clinicians to maintain a high index of suspicion for infection with H1N1 influenza in patients with sepsis and respiratory distress.

Accounting for professionalism: an innovative point system to assess resident professionalism.

BACKGROUND: Professionalism is a core competency for residency required by the Accreditation Council of Graduate Medical Education. We sought a means to objectively assess professionalism among internal medicine and transitional year residents. INNOVATION: We established a point system to document unprofessional behaviors demonstrated by internal medicine and transitional year residents along with opportunities to redeem such negative points by deliberate positive professional acts. The intent of the policy is to assist residents in becoming aware of what constitutes unprofessional behavior and to provide opportunities for remediation by accruing positive points. A committee of core faculty and department leadership including the program director and clinic nurse manager determines professionalism points assigned. Negative points might be awarded for tardiness to mandatory or volunteered for events without a valid excuse, late evaluations or other paperwork required by the department, non-attendance at meetings prepaid by the department, and inappropriate use of personal days or leave. Examples of actions through which positive points can be gained to erase negative points include delivery of a mentored pre-conference talk, noon conference, medical student case/shelf review session, or a written reflection. RESULTS: Between 2009 and 2012, 83 residents have trained in our program. Seventeen categorical internal medicine and two transitional year residents have been assigned points. A total of 55 negative points have been assigned and 19 points have been remediated. There appears to be a trend of fewer negative points and more positive points being assigned over each of the past three academic years. CONCLUSION: Commitment to personal professional behavior is a lifelong process that residents must commit to during their training. A professionalism policy, which employs a point system, has been instituted in our programs and may be a novel tool to promote awareness and underscore the merits of the professionalism competency.