Infectious Aortitis: Case Report and Literature Review.

Aortitis is the inflammation of the aorta secondary to either infectious or non-infectious etiologies. Infectious aortitis is a rare but potentially life-threatening condition. It is more common among older patients with preexisting pathology. Clinical presentation is variable, therefore, a high index of suspicion is required for timely diagnosis and management. We report a case of aortitis which was complicated with the development of a saccular abdominal aortic aneurysm. A 76-year-old male presented to the Emergency Department with two days of right lower quadrant abdominal pain. Clinical evaluation and imaging studies revealed abdominal aortitis, which progressed to a saccular abdominal aortic aneurysm. We highlight a unique presentation of infectious aortitis to raise awareness among physicians. We also reviewed the available literature on infectious aortitis to illustrate the importance of early diagnosis and appropriate treatment to improve the patients' outcomes.

Promoting Healthy Aging During COVID-19.

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID-19.

Preserving Engagement, Nurturing Resilience.

Engagement and resilience constitute 2 psychological aspects of healthy aging that are commonly identified by many individuals as more important than health or longevity. Both of them play a crucial role in healthy aging. Social engagement enhances psychological well-being and improves physical and cognitive health outcomes. In times of adversity, resilience buffers the negative effects of stress and promotes return to baseline health and function. Strong resilience helps individuals become more engaged and active engagement promotes resilience. We discuss the role, health outcomes, and practical implications of these 2 major domains of healthy aging.

Gonococcal epididymo-orchitis in an octogenarian.

Epididymo-orchitis (EO) is inflammation of the epididymis and testicles. In patients older than thirty-five years, it is commonly due to coliform or uropathogenic organisms, whereas younger adults are prone to sexually transmitted infections. We present a relatively infrequent case of gonococcal EO in an octogenarian. This case describes a geriatric male who presented to the emergency department in septic shock. His history was notable for prostate cancer, urinary incontinence and multiple sexual partners. He endorsed perineal pain, localized tenderness with chills and dysuria, and was eventually diagnosed with bilateral EO and hydroceles on repeat ultrasound. PCR was positive for N. gonorrhea. His symptoms responded well to fluid resuscitation and antimicrobial therapy. This case demonstrates that EO secondary to sexually transmitted infections is an important consideration in even the oldest old. It is therefore imperative to obtain a detailed sexual history and identify high-risk sexual behaviors in this population.

Lessons learned about empathy during our interview seasons.

Empathy is one of the most valuable skills sought by patients from their physicians as well as by educators from their trainees. However, in medical education there is a general concern that, if not cultivated among students and residents, empathy may decline. We have assessed empathy self-perception among potential candidates who were applying to our internal medicine residency program. Interestingly, we observed that they have a good understanding and great appreciation of empathy values. Our candidates expressed that as medical students they were sympathetic and with experience, they are becoming more empathetic. They also depicted the different ways in which they learned about empathy. The lessons we learned from them lead us to conclude that the development of empathy is a multifaceted and a lifelong process, which must be cultivated during training years through many different modalities. We suggest that the patient's story, coaching skills and self-reflection, might be the most powerful ways of learning empathy.

Empathy in Internal Medicine Residents at Community-based Hospitals: A Cross-sectional Study.

INTRODUCTION: Many research reports revealed declining empathy in medical schools that continues in postgraduate years of training. OBJECTIVE: The aim of this study is to examine the self-reported empathy levels of internal medicine (IM) residents in 3 community-based teaching hospitals. METHODS: The Jefferson Scale of Physician Empathy, Health Professionals version, is an online, self-administered, questionnaire that was offered to 129 current and incoming residents at 1 osteopathic and 2 allopathic, IM training programs in Flint, Michigan. RESULTS: Forty-five residents responded (35% response rate). Our residents' cumulative mean empathy score was 112.5 with a SD of 12.72, which is comparable with the cumulative empathy scores for IM residents at university hospitals. There was an increase in empathy score from the beginning level of training, postgraduate year 0 (PGY0), to the PGY1 level, and a noticeable, although statistically non-significant, decrease in empathy score for both PGY2 and PGY3 residents. The graduating residents' scores were higher compared with incoming residents. CONCLUSIONS: The cumulative mean empathy score in community-based IM residents showed an increase in the beginning of residents' training and decrease in empathy score by the end of training. There were significant differences in empathy scores by level of training at individual hospitals. This might be related to different targeted curricula.

Empathy Among Internal Medicine Residents in a Community-Based Training Program: A Pilot Study.

This article was migrated. The article was marked as recommended. Background: Empathy in patient care is a highly valuable skill that is promoted in medical education; however, research conducted in academic centers strongly suggests a declining trend in empathy as years of medical education increase. Objective: To assess residents' empathy levels in a community-based internal medicine training program. We hypothesized that empathy in our program did not decrease with years of training. Methods: A cross-sectional, observational study of 22 resident physicians who completed the Jefferson Scale of Physician Empathy between May and October of 2013. The residents were at the end of their first (PGY1), second (PGY2), or third (PGY3) year of training, or were incoming interns (PGY0) at the beginning of their first year. Results: Of 48 eligible residents, responses of 22 (45%) are included in the analysis. The empathy scores for participants ranged from 96 to 136 with a mean of 117.4 and a SD of 10.1. Incoming residents, PGY1, 2 and 3 residents' mean scores were 109.7, 117.2, 114.3 and 124.0 respectively. There was no statistical difference between males and females or between PGY1 and PGY2 residents. A statistically significant difference in mean empathy scores was found between incoming residents and PGY3, with PGY3 residents scoring higher in empathy. Conclusion: The empathy scores in our internal medicine residency program identified higher levels of empathy associated with residents at the end of training. This may be related to our targeted curricula which includes behavioral science and geriatric medicine curriculums.

Chryseobacterium indologenes: an emerging infection in the USA.

Nursing home-associated infections and antibiotic resistant pathogens constitute common and serious problems in the geriatric population.Chryseobacterium indologenes, a non-motile Gram-negative rod, though widely distributed in nature, is an uncommon human pathogen. Typically thought of as an organism of low virulence, it may cause serious infections, particularly among the immunocompromised. The majority of reported cases are nosocomial, often associated with immunosuppression or indwelling catheters. It has been reported as the causative agent in bacteraemia, peritonitis, pneumonia, empyema, pyelonephritis, cystitis, meningitis and central venous catheter-associated infections. We report a rare case of C. indologenesinfection affecting a nursing home resident in the USA and we provide a review of similar cases. This report emphasises the importance of individualised treatment and promotes awareness about this organism as one of several emerging pathogens in immunocompromised adults and in the frail elderly who are often nursing home residents, in the Western Hemisphere.