Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Disguised and Dangerous: A Case of Cervicofacial Actinomycosis Presenting With Hemoptysis.","authors":"Tharun Shyam, Shamanth M Reddy, Saumya Nanda, Yan N Tun, Rohan Pinto, Navjot Somal, Ravi K Patti","doi":"10.55729/2000-9666.1569","DOIUrl":"https://doi.org/10.55729/2000-9666.1569","url":null,"abstract":"<p><p>Actinomycosis is a rare, chronic, suppurative bacterial infection caused by <b><i>Actinomyces spp</i></b> with an incidence of 0.3 cases per million people annually. The cervicofacial area is the most common site of infection and accounts for approximately 50 percent of all cases. Most cases of cervicofacial actinomycosis are odontogenic in origin. Hemoptysis in the setting of actinomycosis commonly occurs from pulmonary involvement. Hemoptysis secondary to isolated cervicofacial actinomycosis has seldom been documented in literature. We hereby present a case of cervicofacial actinomycosis presenting with hemoptysis likely secondary to an oro-cervical fistula. We aim to highlight the challenges in diagnosis of this relatively rare clinical entity and the potential for life threatening complications if not detected and managed appropriately.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"52-55"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering Residents in Community-based Internal Medicine Programs: A Structured Framework Integrating Simulation Labs, AI, and Gamification.","authors":"Nirmay Sonar, Zaynah Sadiq, Bernie Sergent","doi":"10.55729/2000-9666.1570","DOIUrl":"https://doi.org/10.55729/2000-9666.1570","url":null,"abstract":"<p><p>Community-based internal medicine residencies train nearly half of all U.S. IM residents and are essential for staffing underserved areas. These programs often face educational gaps due to limited resources, faculty development, and procedural training opportunities. We designed a 12-month quality initiative for 27 residents at a small community hospital blending new high-fidelity simulation drills (e.g. in-situ rapid-response and procedural labs), restructured didactics (gamified quizzes, NEJM Resident 360™, HumanDx cases), enhanced orientation (\"intern survival guide\"), research education, wellness retreats, community outreach and AI-driven, individualized case feedback. New interventions were implemented alongside existing activities, with targeted outcomes including clinical competency, board readiness, communication skills, and well-being. Over one year, the mean In-Training Examination (ITE) scores rose from 56.7 % to 59.9 % (p = 0.025) and percentile rank by 11.8 points, CAHPS patient communication scores improved from the 66th to 97th percentile (p < 0.05), and resident satisfaction (ACGME survey) increased from 70 % to 84 %. 78 % of residents found simulation \"very useful,\" while 74 % felt supported by wellness initiatives. Gamified learning was highly relevant to 44 %. Sustained impact needs continued leadership and formal GME integration. Investing in resident education directly improves patient care, creating a continuous cycle of clinical excellence.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"3-9"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Shocking Case of a Bleeding Heart.","authors":"Muhammad I Khan, Samra Israr, Muhammad H Khan, Nadim Jaafar, Rahul Sharma, Shilpi Ahmed","doi":"10.55729/2000-9666.1568","DOIUrl":"https://doi.org/10.55729/2000-9666.1568","url":null,"abstract":"<p><p>Hemopericardium is a rare but life-threatening complication of anticoagulation therapy. Although bleeding complications are well documented with direct oral anticoagulants (DOACs), apixaban-induced hemopericardium is exceedingly rare. We report a case of a 56-year-old female with multiple comorbidities, including end-stage renal disease (ESRD) on hemodialysis, paroxysmal atrial fibrillation, cerebral vascular accident with residual right-sided weakness, and coronary artery disease, who presented with progressive dyspnea over two months. Imaging revealed a massive pericardial effusion without tamponade Physiology. Despite initial conservative measures, the patient developed hemodynamic instability following fluid removal during dialysis, necessitating urgent pericardiocentesis, which drained 1560 mL of hemorrhagic fluid. Pericardial fluid analysis was negative for malignancy or infection, and apixaban was identified as the likely culprit. DOAC-associated hemopericardium is an underrecognized but serious complication, particularly in patients with renal impairment and concurrent use of p-glycoprotein or CYP3A4 inhibitors, such as amiodarone. Given the increased risk of supratherapeutic drug accumulation in ESRD, clinicians must exercise caution when administering DOACs. This case highlights the importance of recognizing spontaneous hemopericardium as a potential adverse effect of apixaban, especially in high-risk populations. Early echocardiographic evaluation and swift intervention are crucial for preventing catastrophic outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"60-63"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Strategy for Surge Management: Senior Residents on the Admitting Frontlines.","authors":"Hamza Saifuddin, Oliver Yockey, Rachelle Pichot, Gwendolyn Brainard, Samantha Labay, Michael S Wang","doi":"10.55729/2000-9666.1565","DOIUrl":"https://doi.org/10.55729/2000-9666.1565","url":null,"abstract":"<p><p>Hospitals adapt to surges in a variety of ways, including expediting admitting and discharge procedures, hiring temporary staff and locums to meet increased demand, and temporarily expanding or creating facilities. To mitigate negative effects associated with surges, a small community-based hospital's Internal Medicine (IM) residency program and hospitalist program collaborated by shifting senior residents into admitting physician roles with indirect supervision to meet increased surge needs. This shift allowed an admitting attending physician to shift to a newly created rounding service and, on average, the number of rounding services was increased from seven to nine. Over a fifteen-month period (five quarters), there was a substantial increase in patient census and rounding physicians, paired with minimal differences in individual physician loads, suggesting that this approach helped alleviate strain on the hospital system. Additionally, this approach was well-received by residents, with residents reporting that the workload during the surge was appropriate, that the balance between service and education was appropriate, and that the surge experience was beneficial for their education and ability to practice independently. In summary, this innovative surge management technique has the potential to help mitigate the risk of burnout among hospitalists, while prioritizing resident wellness and education. Importantly, this novel approach may be reproducible in other community hospitals and scalable in larger institutions with residency programs.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"10-15"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Losartan-induced Angioedema: A Case Report and Review of Literature.","authors":"Leila C Tou, Audrey Nourse, Rachel Cox, Spencer Stanford","doi":"10.55729/2000-9666.1571","DOIUrl":"https://doi.org/10.55729/2000-9666.1571","url":null,"abstract":"<p><p>Angiotensin receptor blockers (ARBs) are frequently prescribed as alternatives to angiotensin-converting enzyme inhibitors (ACEIs), particularly in patients who experience ACEI-induced adverse effects including cough. Although ARBs are associated with a lower incidence of angioedema, rare cases have been reported in patients without prior ACEI exposure. Here, we describe a 58-year-old Black male who developed lip and facial swelling six months after starting losartan. His symptoms did not improve with antihistamines or corticosteroids but resolved after discontinuation of losartan, which was replaced with amlodipine without recurrence. This case emphasizes the need for clinician awareness of ARB-induced angioedema and the importance of balancing this rare risk against the established cardiovascular and renal benefits of ARB therapy.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"45-51"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Slipping Through the Chasm of Multicenter Hand-offs-Rare Incidence of Nintedanib Induced Renal Failure: Case Report.","authors":"Muhammad Mohsin Abid, Muhammad Ijaz Khan, Tanvi Jain, Amrita Daniel, Tristan M Flack, Jeffrey N Posner","doi":"10.55729/2000-9666.1561","DOIUrl":"https://doi.org/10.55729/2000-9666.1561","url":null,"abstract":"<p><strong>Introduction: </strong>Nintedanib, a receptor tyrosine kinase inhibitor (TKI), is approved for idiopathic pulmonary fibrosis (IPF). While its common adverse effects include gastrointestinal symptoms and elevated liver enzymes, renal toxicity is rare. We report a case of nintedanib-induced kidney failure.</p><p><strong>Case: </strong>An 82-year-old man with IPF and no prior kidney disease developed acute kidney injury (AKI), nephrotic-range proteinuria, volume overload, metabolic acidosis, and hyperkalemia 10 days after starting nintedanib. Extensive serologic investigations were unremarkable. Kidney biopsy showed acute tubular injury, minimal change disease (MCD), focal global glomerulosclerosis, and interstitial fibrosis. Nintedanib and other potential nephrotoxins were stopped, and the patient was started on hemodialysis. Kidney function recovered within six weeks. Five months later, the patient was unintentionally restarted on nintedanib during a phone follow-up. He presented five weeks later with worsening edema, anuria, and weakness. Renal ultrasound was normal. Repeat biopsy revealed MCD, global glomerulosclerosis, extensive tubular necrosis, and 60 % interstitial fibrosis-worse than prior findings. Immunofluorescence was negative, and no other nephrotoxins were involved. Hemodialysis was reinitiated. By three months, kidney function and urine output returned to baseline.</p><p><strong>Discussion: </strong>FDA-approved in 2014 for IPF, nintedanib exemplifies multi-kinase TKIs; renal toxicity, particularly with it, is uncommon. To date, only four post-marketing cases of nintedanib-induced renal injury exist. Histologic findings such as MCD and glomerular sclerosis, previously noted with other VEGF inhibitors, have not been reported with nintedanib.</p><p><strong>Conclusion: </strong>This case underscores the need for vigilance regarding nintedanib's nephrotoxicity and highlights the value of interdisciplinary care to prevent medicationrelated harm.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"40-44"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin Induced New-onset Diabetes Mellitus - A Narrative Review.","authors":"Jasvin K Manha, Sumanth K Bandaru","doi":"10.55729/2000-9666.1563","DOIUrl":"https://doi.org/10.55729/2000-9666.1563","url":null,"abstract":"<p><p>Statins are widely used to lower LDL cholesterol and prevent cardiovascular disease. Although generally safe, there is increasing evidence that they may increase the risk of new-onset diabetes mellitus (NODM). Recent studies show a modest but consistent rise in diabetes risk associated with statin use, especially among individuals with prediabetes, obesity, or other metabolic risk factors. High-intensity statins like atorvastatin and rosuvastatin carry a greater risk compared to agents such as pravastatin or pitavastatin. Proposed mechanisms include increased insulin resistance, impaired insulin secretion, and changes in hepatic glucose production. Despite the diabetes risk associated with statins, their well-established cardiovascular benefits generally outweigh this concern. This review discusses the current evidence on the association between statin use and NODM, explores potential biological mechanisms, compares the diabetogenic effects of different statins, assess the impact of statin dose and intensity, and outlines implications for clinical practice.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"24-31"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Biological Therapies vs Traditional Immunosuppressant in the Management of Inflammatory Bowel Diseases: A Narrative Review.","authors":"Umme F Tahir, Sadaf Noureen, Fnu Partab, Muhammad W Afzal, Maham Afzal, Asad Mehmood, Fatima Afzal, Kaynat Hasan, Fnu Sameeha, Seerat Riaz, Sumyya Tariq, Abida Perveen","doi":"10.55729/2000-9666.1566","DOIUrl":"https://doi.org/10.55729/2000-9666.1566","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic immune-mediated condition requiring long-term management. Traditional immunosuppressants, such as corticosteroids, thiopurines, and methotrexate, have been widely used but are associated with broad immunosuppressive effects and significant adverse events. The advent of biological therapies, including tumor necrosis factor (TNF) inhibitors, integrin inhibitors, and interleukin (IL)-12/23 inhibitors, has revolutionized IBD treatment by offering targeted immune modulation. Biologics have demonstrated superior efficacy in achieving and maintaining remission compared to traditional immunosuppressants, particularly in moderate to severe IBD. They provide targeted immune suppression, reducing systemic side effects, but are associated with risks such as infections, immunogenicity, and high costs. Traditional immunosuppressants remain relevant for milder cases and as combination therapy but are limited by delayed onset of action and toxicity concerns. Despite these advances, challenges such as treatment accessibility, high costs, and loss of response persist. The introduction of biosimilars and novel small-molecule drugs may improve treatment affordability, while personalized medicine approaches, including biomarker-driven therapy selection and therapeutic drug monitoring, are emerging as crucial strategies to optimize treatment outcomes. While biological therapies have transformed IBD management, future research should focus on refining treatment strategies, improving long-term safety, and enhancing accessibility to ensure better patient outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"32-39"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hidden Malignancy: Ileocecal Intussusception as an Atypical First Presentation of Diffuse Large B-cell Lymphoma in Adulthood.","authors":"Komal Harisinghani, Parth Adrejiya, Mohammad Abubaker, Oluchi Idenyi, Raman Babayeuski, Noor Qureshi, Ashok Kanugula, Sara Assaf, Daniel Assaf, Srikanth Maddika","doi":"10.55729/2000-9666.1567","DOIUrl":"https://doi.org/10.55729/2000-9666.1567","url":null,"abstract":"<p><p>Intussusception is predominantly a pediatric condition, with only about 5 % of all intussusception cases occurring in adults with primary intestinal lymphomas comprising 1 %-4 % of gastrointestinal malignancies, 90 % of which are B-cell non-Hodgkin lymphomas (NHL). Diffuse large B-cell lymphoma (DLBCL), the most common subtype of NHL, often leads to intussusception without classical B symptoms. We present the case of a 33-year-old male with ileocolonic intussusception caused by a 4.8 × 5.3 × 5.5 cm enhancing mass. Histopathology and FISH confirmed DLBCL without MYC, BCL2, or BCL6 rearrangements, ruling out double- or triple-hit lymphoma. Following a right ileo-colectomy, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy was initiated. This case underscores the role of malignancy in intussusception and highlights the importance of timely diagnosis and management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"56-59"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Term Outcomes and Resource Utilization in Patients Admitted for Infective Endocarditis Who Develop Pericardial Effusion: A Retrospective Cohort Study.","authors":"Nameer Ascandar, Sajog Kansakar, Waqas Qureshi, Aakash Patel, Ahmed O Farooq, Brett Milford, Suman Pasupuleti, Eduardo J Lazaro","doi":"10.55729/2000-9666.1564","DOIUrl":"https://doi.org/10.55729/2000-9666.1564","url":null,"abstract":"<p><strong>Background: </strong>Pericardial effusion (PCE) development in the context of infective endocarditis (IE) may negatively impact clinical outcomes leading to intense resource utilization. Limited contemporary studies exist that examine clinical outcomes, resource utilization and readmission rates in patients admitted for IE who develop PCE.</p><p><strong>Methods: </strong>We utilized the Nationwide Readmissions Database years 2016-2022 to tabulate all adult admissions for IE. We compared clinical outcomes in patients who developed PCE to those who did not. Survey weighted logistic and linear regression analysis was performed to predict in-hospital mortality, clinical outcomes, costs, and 30-day non-elective readmission in association with PCE.</p><p><strong>Results: </strong>Of an estimated 162,694 total patients with IE, 2859 (1.8 %) had PCE and 159,835 (98.2 %) did not. Following risk adjustment, PCE was associated with higher odds of in-hospital mortality, acute heart failure, cardiogenic shock, acute kidney injury, and need for temporary mechanical circulatory support. Additionally, PCE was associated with longer duration of hospital stay and hospitalization costs. Interestingly, PCE cohorts who received drainage during index admission had lower odds of 30-day non-elective readmission.</p><p><strong>Conclusion: </strong>PCE after IE admission was linked with inferior outcomes including in-hospital mortality, and several other outcomes, as well as longer hospital stay and accrued costs. Notably, 30-day non-elective readmission was lower among patients with PCE who underwent intervention to drain the effusion during index hospitalization.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"16-23"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}