Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Home Treatment for Low-risk Pulmonary Embolism: Is it Happening?","authors":"Faria A Nitol, Holman Li, Mohammad Raja, Andrew Miele, Craig Thurm","doi":"10.55729/2000-9666.1418","DOIUrl":"10.55729/2000-9666.1418","url":null,"abstract":"<p><p>Patients with pulmonary embolus (PE) can be stratified into low, intermediate, and high risk based on such factors as hemodynamics and the status of the right ventricle. Low risk patients who meet appropriate criteria can potentially be discharged home with oral anticoagulation, avoiding unnecessary hospitalization and associated complications and costs. However, limited data suggest early discharge of low-risk patients has not gained widespread traction. This retrospective study reviewed 138 patients seen in a high-volume emergency department (ED), 29 of whom were considered low-risk. Of these, 24 (82.7%) were still admitted to the hospital despite meeting appropriate criteria for early discharge. This suggests early discharge of low-risk PE patients is underutilized. A variety of quality improvement measures can be implemented to increase adoption of this approach.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"30-34"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006421","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":"Recurrent Hypoglycemia in a Patient with Advanced Hepatocellular Carcinoma.","authors":"Balpreet Chouhan","doi":"10.55729/2000-9666.1406","DOIUrl":"10.55729/2000-9666.1406","url":null,"abstract":"<p><strong>Background: </strong>Nonislet cell tumor hypoglycemia (NICTH) is a rare but serious complication of malignancy. Various causes of this type of hypoglycemia include excessive tumor burden resulting in destruction of the liver or adrenal glands, production of autoantibodies against insulin and tumoral production of incompletely processed IGF-2.</p><p><strong>Objectives: </strong>Objective of this case report is to explore pathogenic mechanisms for hypoglycemia in hepatocellular carcinoma (HCC), and evidence-based treatment options.</p><p><strong>Methods: </strong>We present a case of recurrent symptomatic hypoglycemia, despite conservative management, in a patient with extensive hepatocellular carcinoma.</p><p><strong>Results: </strong>Patient developed recurrent hypoglycemia despite attempting treatment with therapies based on limited evidence available on literature review.</p><p><strong>Conclusion: </strong>Management of hypoglycemia is usually challenging given patients are usually not good candidates for aggressive therapies given advanced cancer stage and/or poor general condition. Paraneoplastic hypoglycemia is usually a poor prognostic indicator. Experimental treatment options for hypoglycemia include steroids, glucagon and growth hormone.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"94-96"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006429","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":"Review of Attributes and Outcomes of Hospitalized Patients with Alcohol Withdrawal.","authors":"Harsh R Desai, Joan S Hyland, Erica Paulos, Eric Shaw, Nayda Parisio-Poldiak, Maulikkumar Patel","doi":"10.55729/2000-9666.1420","DOIUrl":"10.55729/2000-9666.1420","url":null,"abstract":"<p><strong>Background: </strong>Alcohol abuse leads to millions of hospital admissions each year in the United States. Alcohol withdrawal syndrome (AWS) is associated with several serious complications, including seizures, delirium tremens, and death. Benzodiazepines have been the mainstay of treatment for hospitalized patients with alcohol withdrawal.</p><p><strong>Objective: </strong>To compare hospital length of stay (LOS) among different protocols for the management of AWS in hospitalized patients.</p><p><strong>Methods: </strong>We conducted a retrospective study of 49,125 adult patients admitted over 4 years (2018-2022) to HCA Healthcare hospitals across the USA with a diagnosis of alcohol use disorder or alcohol withdrawal. Hospital LOS was the primary outcome examined across various treatment groups (chlordiazepoxide, diazepam, gabapentin, lorazepam, phenobarbital). Secondary outcomes included the initial Clinical Institute Withdrawal Assessment (CIWA) score, intensive care unit (ICU) admission rates, readmission rates, and mortality.</p><p><strong>Results: </strong>The average age of patients admitted was 48 years, and the majority (72%) were White males. Lorazepam was the most frequently used protocol and was associated with the lowest LOS (3.96 days). Patients treated with lorazepam had relatively higher initial CIWA scores. Only 11% of patients were admitted to the ICU during their hospitalization, and only 2% were intubated or ventilated. There were no 30-day readmissions, and less than 1% of patients admitted with a diagnosis of AWS died. Other protocols, such as gabapentin, diazepam, phenobarbital, and chlordiazepoxide, were less commonly used and had variable impacts on the outcomes studied.</p><p><strong>Conclusions: </strong>The results of this retrospective study support lorazepam as an effective treatment for AWS management. Future research should focus on comparing the effectiveness of alcohol withdrawal assessment tools in patients with baseline psychiatric disorders.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"35-42"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006432","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":"Decreased Duration of Hospital Stays in Uncomplicated Diverticulitis With Initiation of Enteral Feeds Within 24 Hours.","authors":"Rakahn Haddadin, Matthew Brockway, Pinak Shah, Reed Hansen, Christian Stone, Kartika Shetty","doi":"10.55729/2000-9666.1409","DOIUrl":"10.55729/2000-9666.1409","url":null,"abstract":"<p><p>Diverticulitis is a complication of a mostly benign condition called diverticulosis. Diverticulitis is a common illness that medical staff see in emergency departments and hospital inpatient services. The thought process behind this study was looking at the treatment of other diseases like pancreatitis or other critical illnesses and the data supporting timing of feeds. Our study concludes that starting a diet within 24 h of uncomplicated diverticulitis is associated with reduced length of stay without increasing readmission rates and mortality.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"18-22"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006408","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":"Dieulafoy's Lesion in the Esophagus Causing Gastrointestinal Bleeding: A Concise Review.","authors":"Lefika Bathobakae, Joseph Russo, Devina Adalja, Malina Mohtadi, Tyler Wilkinson, Nader Mekheal, Ruhin Yuridullah, Kamal Amer, Yana Cavanagh, Walid Baddoura","doi":"10.55729/2000-9666.1425","DOIUrl":"10.55729/2000-9666.1425","url":null,"abstract":"<p><p>Dieulafoy's lesion (DL) is an uncommon cause of life-threatening gastrointestinal (GI) bleeding. It can occur in any part of the GI tract, including the stomach, duodenum, colon, and esophagus. Dieulafoy's lesion in the esophagus (DLE) is an exceedingly rare entity, with only 23 case reports/series (27 patients) reported to date. We performed a systematic search of published case reports on DLE in PubMed, Google Scholar, and Embase, from inception through January 2024. The search terms for the review were \"Dieulafoy's lesion,\" \"esophagus,\" \"oesophagus,\" \"hematemesis,\" \"melena,\" \"hematochezia,\" and \"gastrointestinal bleeding.\" Articles were eligible for inclusion in the study if they were published in English, described a case of DLE noted on endoscopy or histopathology, and were available as full text. Our literature search yielded 23 articles consisting of 27 patients. Of the 27 patients, eight (30%) were female and 19 (70%) were male. The patients' age ranged from 13 years to 87 years, with an average age of 54.1 years. Twenty-five patients (92.6%) presented with hematemesis and melena as chief complaints. DLE was found in the distal esophagus in 19/27 (70.4%) of the patients and the mid-esophagus in 6/27 (22.2%) of the patients. Two patients had no information about the lesion site. Endoscopic hemoclips were employed in 12 (44.4%) patients, endoscopic band ligation (EBL) in six and electrocautery was used in one patient. Early diagnosis and prompt treatment are crucial for managing DLE, as they can cause recurrent bleeding and potentially lead to complications or death.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"82-88"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006410","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":"Outcomes of Low Barrier Hepatitis C Treatment in High Risk Populations From Primary Care.","authors":"Scarlett Austin, Kristi Seemiller, Brittany Nolton, Emily Hobart, Bruce Ling, Jonathan Ghobrial, Thomas Robertson","doi":"10.55729/2000-9666.1404","DOIUrl":"10.55729/2000-9666.1404","url":null,"abstract":"<p><p>Hepatitis C (HCV) can be treated in the primary care setting; however, most patients are referred to subspecialists. Marginalized populations may be refused treatment due to stigma or substance use. We aimed to treat HCV in these high-risk patients, and prevent a delay in time from diagnosis to the time of treatment and sustained virologic response (SVR), by utilizing a multidisciplinary treatment team in a primary care clinic. Outcomes assessed included achieving SVR at 3 months, time from diagnosis to treatment initiation, and liver fibrosis stage compared between cohorts with previous subspecialty referral and those treated initially from primary care. Among the 32 patients who initiated treatment, 29 (90.6%) completed the regimen and 27 (84.3%) had documented SVR. Patients treated in a primary care setting without prior referral had a significantly shorter median time from viral load testing to treatment initiation (161 days), compared to those who were previously referred (median time of 954 days). Aggregated fibrosis scores suggest those referred to subspecialists had significantly higher scores. We demonstrate successful HCV treatment in primary care achieving SVR, and a decrease in the median days between viral load and treatment initiation, with lower fibrosis scores.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"10-17"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006368","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":"Lymphocytic Gastritis in a Patient With Microscopic Colitis: A Case Report.","authors":"Saba Ahmed, Jewel Estrella, Khaleeq Siddiqui, Fahad Malik, Karen Avgush, Yasir Ahmed","doi":"10.55729/2000-9666.1421","DOIUrl":"10.55729/2000-9666.1421","url":null,"abstract":"<p><p>Lymphocytic gastritis (LG) is a rare form of gastritis characterized by lymphocytosis in the gastric mucosa, while microscopic colitis (MC) is the chronic inflammatory disease of the large intestine with lymphocytic or collagenous colitis as two distinct histologic forms. These lymphocytic disorders of the gastrointestinal tract (GIT) have various associations, commonly gluten-sensitive enteropathy, <i>Helicobacter pylori</i> infection and while others are less commonly associated. We report a case of a 24-year-old patient with concomitant lymphocytic gastritis and microscopic colitis diagnosed via histopathologic analysis of tissue specimens from stomach and colon. The presence of a lymphocytic disorder in GIT should prompt workup for associated disorders. There is also an association between lymphocytic disorders of the lower GIT with the upper GIT, and vice versa. Endoscopy is important to diagnose comorbid lymphocytic conditions, and subsequently, guiding treatment.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"115-119"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006426","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":"Sevelamer-induced Gastrointestinal Mucosal Injury: A Critical Review for Clinicians.","authors":"Lefika Bathobakae, Phenyo Phuu, Saif Yasin, Rammy Bashir, Jessica Escobar, Ruhin Yuridullah, Gabriel Melki, Mohamed Elagami, Kamal Amer, Yana Cavanagh, Walid Baddoura","doi":"10.55729/2000-9666.1424","DOIUrl":"10.55729/2000-9666.1424","url":null,"abstract":"<p><p>Sevelamer is a non-absorbable polymer used to treat hyperphosphatemia in individuals with end-stage renal disease (ESRD) undergoing hemodialysis. The deposition of sevelamer crystals in the gastrointestinal (GI) tract, especially in the colon, can cause mucosal inflammation, pseudopolyps, ulceration, ischemia, or necrosis. Owing to its rarity and lack of physician awareness, the actual incidence and prevalence of sevelamer-induced gastrointestinal mucosal injury (SIGMI) remain unknown. The current evidence is retrospective, in the form of observational studies. This systematic review of case reports provides an overview of SIGMI, with a focus on its etiology, signs and symptoms, pathogenesis, diagnosis, and management. Electronic databases, including PubMed, Embase, and Google Scholar, were searched for published case reports, case series, and abstracts from inception to August 2023. The search yielded 1239 articles that were filtered using the study design, English language, and human subjects. After screening for duplicates and irrelevant articles, only 28 articles were included in the final review. Melena and abdominal pain were the most common complaints. Sevelamer was discontinued in all patients, and 27 (75%) experienced clinical improvement or symptom resolution. Eight patients (22%) required colectomy due to colonic perforation, malignant obstruction, or extensive necrosis. SIGMI is a unique complication of sevelamer use in patients undergoing hemodialysis. Prompt diagnosis and management are crucial to prevent life-threatening complications.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"58-65"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006449","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":"Neuropsychiatric Manifestations of Syphilis.","authors":"Nadim Ojaimi, Aida Metri, Christopher J Haas","doi":"10.55729/2000-9666.1416","DOIUrl":"10.55729/2000-9666.1416","url":null,"abstract":"<p><p>Neurosyphilis is a condition characterized by insidious onset of encephalopathy and delirium. The infrequency with which it is encountered makes neurosyphilis a formidable diagnostic challenge. We present a rare case of a 71-year-old male with ischemic cardiomyopathy, chronic obstructive pulmonary disease (COPD), undifferentiated arthritis and alcohol use disorder who was brought to the emergency department after he was found altered, confused, and paranoid. His hospital stay was eventful for multiple episodes of agitation that were difficult to control despite benzodiazepines and high doses of antipsychotics. After an extensive workup, he was found to have neurosyphilis and his delirium resolved following a brief period of treatment. This case illustrates the importance of early suspicion for neurosyphilis as a cause of delirium, especially in endemic areas and in patients with focal neurologic findings.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"111-114"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006357","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":"Atypical Thyroid Stimulating Hormone Levels in Myxedema Coma Complicated by Severe Sepsis.","authors":"Nazmul Hasan, Daniel Yang, Thaer Othman, Jenny Dai-Ju","doi":"10.55729/2000-9666.1412","DOIUrl":"10.55729/2000-9666.1412","url":null,"abstract":"<p><p>Most cases of Myxedema Coma are associated with primary hypothyroidism characterized by significantly elevated thyroid stimulating hormone (TSH) levels. However, this case presents an atypical manifestation of myxedema coma with low TSH levels despite severe hypothyroidism. The rarity of this presentation lies in the absence of central lesions typically responsible for such TSH suppression. This highlights a critical consideration: the profound impact of severe sepsis on thyroid hormone regulation and the hypothalamus-pituitary-thyroid axis.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"120-123"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006386","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}