Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"The Effect of Atrial Fibrillation on Mortality Outcomes in Patients Admitted With Diabetic Ketoacidosis.","authors":"Ajay Mishra, Umabalan Thirupathy, Anil Jha, Anu A George, Douglas Laidlaw","doi":"10.55729/2000-9666.1461","DOIUrl":"https://doi.org/10.55729/2000-9666.1461","url":null,"abstract":"<p><p>This study aims to identify the effect of atrial fibrillation on mortality in patients admitted with DKA. We used the National Inpatient Sample Database for the year 2018 and 2019 to identify patients hospitalized with DKA. Association of atrial fibrillation was confirmed using the International Classification of Disease, Tenth Edition (ICD 10 CM). We performed a retrospective analysis on this database using STATA (Stata Corp, College Station, TX). The primary outcome was mortality in DKA. Length of stay (LOS) and total hospitalization charge were the secondary outcomes. There was a total of 447,570 DKA patients out of which 12,770 had associated atrial fibrillation in the year 2018-2019. The mean age of patients with DKA and AFIB was 62 years. Approximately 46% of patients were female in DKA with AFIB group. The multivariate logistic analysis showed increased mortality in patients with DKA and AFIB (OR = 1.4, p = 0.048). Predictors of increased mortality were older age and in metropolitan areas (OR = 1.0, p < 0.001 and OR = 1.4, p = 0.031 respectively). LOS was lower in patients with DKA and AFIB compared to DKA alone (3.1 day and 5.2 days respectively, OR = 0.82, p < 0.001). Total hospitalization charge was higher for patient in DKA with AFIB (USD 53,576 and USD 32,533 respectively, coefficient = 10,513, p < 0.001). Patients hospitalized with DKA and AFIB had higher mortality compared to patients without AFIB, while they showed lower LOS but increased hospitalization cost. Further research in this direction would be helpful to better understand this association.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"14-20"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020199","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":"Pseudogout in an Acute-care Hospital: Hospitalists as the Key to Optimized Care.","authors":"Taku Harada, Takashi Watari, Mori Nakai","doi":"10.55729/2000-9666.1455","DOIUrl":"https://doi.org/10.55729/2000-9666.1455","url":null,"abstract":"<p><p>Acute calcium pyrophosphate crystal arthritis (CPP) or pseudogout commonly affects older adults and may manifest as fever during hospitalization. However, its recognition as a cause of fever remains under-investigated, and diagnostic delays have been reported in approximately 27% of cases. This study evaluated the diagnostic and treatment accuracies of acute CPP in acute-care hospitals over a decade. Out of 47 cases, effective treatment was administered within 24 h in only 40.4% of cases. When managed by hospitalists, the likelihood of a timely and appropriate diagnosis increases, with a reduction of about half in the unnecessary use of computed tomography scans and antibiotics.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"21-24"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009158","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":"What We May not Know: Torsades de Pointes Induced by Cannabinoid Use.","authors":"Leen Othman, Niloo Jalaly","doi":"10.55729/2000-9666.1468","DOIUrl":"https://doi.org/10.55729/2000-9666.1468","url":null,"abstract":"<p><p>The use of THC (Tetrahydrocannabinol) and related products have been increasing. It is estimated that 3.9 % of the world's population between 15 and 64 years have used THC. We report the case of a 66-year old female who presented with syncope and was later found to have polymorphic ventricular tachycardia on inpatient telemetry. The patient had significantly prolonged QTc on her EKG despite adequate electrolyte correction. An extensive cardiac workup including catheterization was nonrevealing. The patient was advised to abstain from cannabinoid use and was started on nadolol 10 mg daily with return of her QTc to normal. This case corresponds to the rising evidence linking cannabinoid use to arrhythmias with some proposed mechanisms mimicking drug induced long QT syndromes. In conclusion, there is rising evidence linking cannabinoid product use to arrhythmogenic properties. The lack of proven long-term safety of cannabinoid products underscores the need for caution while using them.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"99-102"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993794","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 Use of Corticosteroids in Patients With Pleural and Pericardial Tuberculosis.","authors":"Julie Sang, Arunee Motes, Kenneth Nugent","doi":"10.55729/2000-9666.1453","DOIUrl":"https://doi.org/10.55729/2000-9666.1453","url":null,"abstract":"<p><p>Tuberculous (TB) pleural effusions and pericarditis are relatively common extrapulmonary complications associated with this infection. Corticosteroids have been studied with standard antituberculous medications in the management of tuberculous pleural effusion and pericarditis due to their anti-inflammatory effect and their potential to modulate host inflammatory responses. However, current studies have reported conflicting results and inconsistent benefits of adjunctive corticosteroids with TB drug treatment. In TB pleural effusion, corticosteroids have reduced the duration of symptoms and accelerated the reabsorption of pleural fluid, but their long-term benefits, such as less residual pleural thickening and improved lung function, remain inconsistent across studies. Similarly, studies on TB pericarditis have shown mixed results, with some indicating faster resolution of symptoms and reduced incidence of constrictive pericarditis, while others found no difference in mortality and other complications. Although corticosteroids may offer some benefits in managing pleural or pericardial tuberculosis, the current evidence is not sufficient to support their routine use. Key questions include the optimal corticosteroid dosage, the timing of corticosteroid initiation during the infection, and the duration of corticosteroid treatment. More research is needed to determine which cases benefit from corticosteroids as adjunctive therapy in patients with pleural and pericardial tuberculosis.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"35-47"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013056","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":"Results of Lung Cancer Screening at a Rural Hospital Network in the United States.","authors":"Sugam Gouli, Mariam Mostafa, Yodsuwan Ratnadai, Myla Strawderman, Anush Patel, Eric Bravin","doi":"10.55729/2000-9666.1458","DOIUrl":"https://doi.org/10.55729/2000-9666.1458","url":null,"abstract":"<p><strong>Introduction and background: </strong>Lung cancer is the second most common cancer in the world. United States Preventive Services Task Force (USPSTF) has specific guidelines for lung cancer screening in high-risk individuals. Multiple studies including National Lung Cancer Screening trial (NLST) trial has shown reduction in lung cancer mortality with lung cancer screening. Most of these studies focus on the urban population and there are very few studies that have studied lung cancer screening in the rural US population.</p><p><strong>Materials and methods: </strong>This is a retrospective study reviewing patients that were diagnosed with lung cancer after undergoing lung cancer screening in a rural hospital network.</p><p><strong>Results: </strong>In our study, lung cancer detection rate was 2.96 % (74 cases out of 2500 cases screened). 63.3 % of cancer patients were diagnosed on stage I. The median household income was $50,262 which was below the average median household income for United States. The median pack years of the cancer patients was 50. Significant proportion of cancer patients were referred by either Nurse Practitioners or Physician Assistants (43 %) compared to physicians (57 %).</p><p><strong>Conclusion: </strong>Lung Cancer Screening can play a pivotal role in detection of lung cancer at early stages in rural population.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"1-5"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026553","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":"New Onset Atrial Fibrillation in Hospitalized Patients.","authors":"Arafat A Farooqui, Syed M Mazhar Uddin, Sanjay K Maheshwari, Kevin Clements, Rabiah Ashraf, Jay Keith, Neha Sharma, Haris Bilal, Naira Saleem, Vijay S Shetty","doi":"10.55729/2000-9666.1467","DOIUrl":"https://doi.org/10.55729/2000-9666.1467","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate different factors precipitating new onset atrial fibrillation (AF) in hospitalized patients and their effect on in-patient mortality.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Setting: </strong>Urban tertiary care center in New York City.</p><p><strong>Measurements: </strong>Primary outcomes:Determine different factors precipitating new onset atrial fibrillation in hospitalized patients and their effect on in-patient mortality.Secondary outcomes:Determine the duration of hospital stay after admission precipitating new onset atrial fibrillation and its effect on mortality.Evaluate different factors in COVID-19 patients with new onset atrial fibrillation.</p><p><strong>Results: </strong>Out of 464 patients; 62.3 % were males and 37.72 % were females. Evaluation of patients before developing new onset AF showed that 75.86 % had hypertension, 41.38 % had heart failure and 42.67 % had ischemic heart disease (IHD). Younger patients were noted to be treated with more rhythm control as compared to rate control (52.38 % vs 38.1 %) for their management while opposite was observed with patients >50 years of age (70.88 % vs 52.6 %; rate control vs rhythm control respectively). In terms of mortality, female gender (<i>OR</i> = 2.63, 95 % CI: 1.03-6.94, <i>p</i> = 0.045), presence of infection (<i>OR</i> = 6.00, 95 % CI: 2.23-18.08, <i>p</i> <0.001), use of vasopressors (<i>OR</i> = 6.71, 95 % CI: 2.58-19.42, <i>p</i>< 0.001), and a history of CVA (<i>OR</i> = 6.98, 95 % CI: 1.99-24.58, <i>p</i> = 0.002) all significantly increased the odds for mortality. Majority of the patients; 54.31 %, developed new onset AF after the third day of admission but it did not increase the mortality (OR 0.93, 95 % CI 0.37-2.45, p = 0.884). Majority of the patients (67 %) had enlarged left atrium (>35 ml/m²). However, it was not associated with higher mortality (OR 0.53, 95 % CI 0.19-1.48, p = 0.223). Patients that were tested positive for COVID-19 were more likely to have sepsis (75 % vs 31.46 %, <i>p</i>< 0.001).</p><p><strong>Conclusion: </strong>This study finds that four factors i.e., female gender, presence of infection, use of vasopressors, and a history of CVA all precipitate new onset atrial fibrillation with resultant increase in mortality during the same admission. Study concludes that longer hospital stay of more than three days increases the likelihood of developing new onset atrial fibrillation without increasing the mortality. Study found that patients who were positive forCOVID-19 were more likely to have sepsis.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"25-32"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021143","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 Unusual Suspect - Herpes Zoster as the Culprit for Severe Abdominal Pain. A Case Report.","authors":"Edward Lovering, Ahmad Asif, Sean Sheih, Samuel B Holzman, Yani Zhang","doi":"10.55729/2000-9666.1462","DOIUrl":"https://doi.org/10.55729/2000-9666.1462","url":null,"abstract":"<p><p>Reactivation of herpes zoster leading to disseminated and visceral organ involvement is an uncommon phenomenon and almost always associated with immunocompromised patients. Visceral herpes zoster is a challenging diagnosis to make as patients typically present with severe abdominal pain which precedes the typical rash of herpes zoster. We describe the case of a 68-year-old female who presented to the emergency department with abdominal pain and was subsequently diagnosed with disseminated herpes zoster and found to have underlying monoclonal gammopathy.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"81-84"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013053","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":"Unexpected Twists: Intussusception as a Long Term Sequalae of Bariatric Surgery.","authors":"Mohamed A M Amer, Ramya Vasireddy, Dimitrios Ladakis, Adhvithi Pingili, Ahmed Aly, Christopher Haas","doi":"10.55729/2000-9666.1459","DOIUrl":"https://doi.org/10.55729/2000-9666.1459","url":null,"abstract":"<p><p>Bowel intussusception is rare in adults and accounts for less than 5 % of all cases, occurs in only 1 % of patients with bowel obstruction and in 0.64 % of patients following Roux-en-y bypass surgery with a female predominance. Our case underscores the unusual size and configuration of intussusception, wherein the distal segment telescopes into the proximal segment, defying the conventional presentation. Notably, the rarity of observing intussusception following Roux-en-Y gastric bypass surgery is also highlighted. It is important to be clinically vigilant and keep long term sequalae of bariatric surgery on the differential. A 56-year-old female with a remote history of Roux-en-Y gastric bypass surgery presented with epigastric pain radiating to the lower left and right quadrants, nausea, and vomiting of 1-day duration. She was on a prolonged outpatient course of non-steroidal anti-inflammatory drugs and steroids for pain management following recent orthopedic procedure. In the emergency department, she was afebrile, saturating well on two liters of oxygen, and normotensive with sinus tachycardia. Labs showed leukocytosis with mildly elevated lipase, alkaline phosphatase, and lactic acid. Initial CT abdomen pelvis with contrast was unremarkable. The patient continued to experience abdominal pain with worsening lactic acid. Repeat imaging revealed a 10 cm enteroenteric intussusception containing proximal jejunum with the gastric bypass Roux limb acting as the intussuscipiens. No obvious mass or lead point was identified. Ulceration/stricture at the jejunojejunal anastomosis was thought to be contributory to this. The patient underwent successful laparoscopic surgery.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"33-34"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023111","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":"Risk Factors, Pathogenesis, Prevention and Clinical Features of Cardiovascular Implantable Electronic Device (CIED) Infections.","authors":"Mustafa Shehzad, Humna Younis, Rohail Azhar, Dawood Shehzad, Noor Z Usman","doi":"10.55729/2000-9666.1457","DOIUrl":"https://doi.org/10.55729/2000-9666.1457","url":null,"abstract":"<p><p>Cardiac implantable electronic devices (CIEDs) are essential therapeutic tools for managing various cardiac conditions but are also associated with the risk of infections, leading to significant morbidity, mortality, and healthcare costs. Risk factors include patient comorbidities, procedural aspects, and device characteristics. Prompt intervention and early recognition of CIED infections, including pocket and systemic infections, are essential for preventing complications. Advanced imaging modalities aid in accurate diagnosis, while a multidisciplinary approach involving infectious disease specialists and cardiologists guide treatment strategies. This article emphasizes risk factors, pathogenesis, and the development of preventive measures to address the growing challenge of CIED-related infections and improve patient outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"48-55"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987875","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 Rare Case of Isolated Metastasis to the Pleura in the Setting of Newly Diagnosed Pancreatic Adenocarcinoma.","authors":"Rakahn Haddadin, Humzah Iqbal, Danny Aboujamra, George Trad, John Ryan, Hatim Gemil","doi":"10.55729/2000-9666.1454","DOIUrl":"https://doi.org/10.55729/2000-9666.1454","url":null,"abstract":"<p><p>In the landscape of pancreatic cancer, extra-pancreatic manifestations like pleural effusion are infrequent. Our case spotlights a 78-year-old female with a recent diagnosis of pancreatic adenocarcinoma with isolated metastasis to the pleura. The patient presented with exacerbated dyspnea and cough, shedding light on the uncommon link between pancreatic adenocarcinoma and pleural effusion. Pancreatic cancer typically exhibits nonspecific symptoms, and its association with pleural effusion significantly complicates diagnosis, often leading to delayed recognition and management challenges. This case underscores the diagnostic complexities and the need for heightened vigilance when faced with atypical presentations in pancreatic cancer, emphasizing the intricacies of managing such rare extra-pancreatic manifestations.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"90-93"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012959","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}