Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Predictors of Escalation to Intensive Care Unit Level of Care Among Admissions for Alcohol Withdrawal.","authors":"Gaurav Mohan,&nbsp;Poorva Bhide,&nbsp;Amer Abu-Shanab,&nbsp;Medha Ghose,&nbsp;Adhithya Rajamohan,&nbsp;Tayyeb Muhammad,&nbsp;Anosh A Khan,&nbsp;Mahrukh Khan,&nbsp;Farhan Khalid,&nbsp;Rana P Padappayil,&nbsp;Doantrang Du","doi":"10.55729/2000-9666.1241","DOIUrl":"10.55729/2000-9666.1241","url":null,"abstract":"<p><p>According to the 2019 National Survey on Drug Use and Health, 14.5 million people ages 12 and older had alcohol abuse disorder. Alcohol withdrawal syndrome (AWS) can be defined as a collection of physical symptoms experienced due to abrupt cessation of alcohol after long-term dependence. In instances where regular inpatient management fails to control AWS symptoms, patients are shifted to intensive care units (ICUs) for closer monitoring and prevention of life-threatening complications like withdrawal seizures and delirium tremens (DTs), labeled as severe alcohol withdrawal syndrome (SAWS). Although this represents a significant healthcare burden, minimal studies have been conducted to determine objective predictors. In this study, we aim to determine the effect of patient demographics, socio-economic status, biochemical parameters, and clinical factors on the need for escalation to ICU level of care among admissions for AWS. Our study showed that factors such as a history of DTs or alcohol-related seizures, the initial protocol of management, degree of reported alcohol usage, activation of rapid response teams, mean corpuscular value, alcohol level on admission, highest Clinical Institute Withdrawal Assessment Alcohol Revised (CIWA-Ar) scored during the hospital stay, and the total amount of sedatives used were significantly associated with escalation to ICU level of care. Clinicians must use these objective parameters to identify high-risk patients and intervene early. We encourage further studies to establish a scoring algorithm incorporating biochemical parameters to tailor management algorithms that might better suit high-risk patients.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 5","pages":"8-14"},"PeriodicalIF":1.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/26/54/jchim-13-05-008.PMC10589036.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690768","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 Critical Care Standpoint in the Diagnosis of Scleroderma Renal Crisis.","authors":"Ariana Tagliaferri,&nbsp;Brooke Kania,&nbsp;Abraam Rezkalla,&nbsp;Ruth Lamm","doi":"10.55729/2000-9666.1226","DOIUrl":"10.55729/2000-9666.1226","url":null,"abstract":"<p><p>Typical or atypical presentations of rare diseases may be confounded by co-morbidities in critically-ill patients. It is imperative to diagnose and treat appropriately, despite this difficulty. Scleroderma renal crisis mimics many other conditions, and can be potentially fatal if not caught early enough. Particularly, in critically-ill patients with multiple pathologies, it can be difficult to distinguish scleroderma renal crisis from other diseases, such as thrombotic thrombocytopenic purpura (TTP), hypertensive emergency, posterior reversible encephalopathy syndrome (PRES), or atypical hemolytic uremic syndrome (HUS). Herein, a patient who presented with encephalopathy and seizures was initially treated for thrombotic thrombocytopenic purpura, but was ultimately diagnosed with scleroderma renal crisis. Given her numerous laboratory abnormalities, such as thrombocytopenia, hemolytic anemia, kidney and liver dysfunction, and elevated inflammatory markers, various differentials were considered. During her hospitalization, she suffered a cardiac arrest, seizures, nosocomial infections and worsening kidney disease requiring dialysis, making the final diagnosis of scleroderma renal crisis a diagnosis of exclusion. Subsequently, the management of a patient with multiple co-morbidities and confounding laboratory abnormalities difficult to treat. This article highlights these intricacies and formulates the thought process behind the diagnosis of Scleroderma Renal Crisis.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 5","pages":"72-76"},"PeriodicalIF":1.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/ec/jchim-13-05-072.PMC10589050.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690761","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":"Hemophagocytic Lymphohistiocytosis and Pancreatic Cancer: A Rare Association.","authors":"Ali Jaan,&nbsp;Farhan Khalid,&nbsp;Abdullah M Firoze Ahmed,&nbsp;Ahmed Salman,&nbsp;Trisha Meghal,&nbsp;Doantrang Du","doi":"10.55729/2000-9666.1225","DOIUrl":"10.55729/2000-9666.1225","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Hemophagocytic lymphohistiocytosis (HLH) or hemophagocytic syndrome (HPS) is a life-threatening and relatively rare condition that usually presents as a multisystem febrile illness. It is associated with excessive activation of the immune system and hypercytokinemia, leading to an unregulated aggregation of macrophages and lymphocytes. Here, we present the first likely case of HLH with metastatic pancreatic carcinoma being the underlying etiology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case: &lt;/strong&gt;A 44-year-old male with past medical history significant for heart transplant for which he was on tacrolimus, End-Stage Renal Disease (ESRD) on hemodialysis, recently treated CMV viremia, and necrotizing pancreatitis presented to the emergency with complaints of chills, decreased appetite, worsening non-bloody emesis, and dull left upper quadrant abdominal pain with radiation to the back for four days. No shortness of breath, fever, diarrhea, or blood in the stool was reported. Vitals on admission were blood pressure of 90/61 mmHg, a heart rate of 110 beats per minute, temperature of 98.1 °F, and respiratory rate of 18 per minute. Physical exam was significant for scleral icterus, decreased bibasilar breath sounds, moderate abdominal tenderness in the left flank and left upper abdominal quadrant without any palpable mass, and 1+ bilateral pedal edema. The remainder of the physical examination was benign. Electrocardiogram (EKG) showed sinus tachycardia without any ischemic changes, and chest x-ray showed mild pulmonary edema. Initial blood workup revealed WBC at 8.3 k/uL, hemoglobin of 10.2 g/dL, platelet count of 90 k/uL, and BUN/creatinine of 45/5.8 (baseline 40/5.0). Cardiac workup showed an elevated high sensitivity troponin level of 2479 pg/mL and brain natriuretic peptide (BNP) of 600 (0-100 pg/mL). The hepatobiliary profile showed an aspartate transaminase (AST) level of 2645 U/L, an alanine transaminase (ALT) of 2935 U/L, alkaline phosphatase (ALP) of 106 U/L, and lipase of 61 U/L, with total and conjugated bilirubin of 3.5 mg/dL and 2.1 mg/dL, respectively. Transthoracic echocardiogram (TTE) showed reduced left ventricular size with hyperdynamic systolic function. Computerized tomography (CT) scan of the abdomen (Fig. 1) revealed numerous new pulmonary nodules, ring-enhancing lesions within the liver, hyperenhancement of the pancreas with walled-off necrosis, and splenomegaly. Microbiological work-up was positive for cytomegalovirus (CMV) serologies (IgM and IgG) but absent viral load on Polymerase Chain Reaction (PCR). The initial diagnosis was systemic inflammatory respiratory syndrome (SIRS), likely septic versus distributive in the setting of pancreatitis, demand mediated non-ST segment elevation myocardial infarction (NSTEMI), and shock liver. Tacrolimus was held, and the patient was started on broad-spectrum antibiotics including vancomycin and cefepime for sepsis of unknown origin along with vasopressors for hypotension, requ","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 5","pages":"68-71"},"PeriodicalIF":1.0,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/79/jchim-13-05-068.PMC10589035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690764","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 Frequently Overlooked Contaminant: A Case of Staphylococcus lugdunensis Bacteremia.","authors":"Nicole Hunter,&nbsp;Alexander Kusnik,&nbsp;Laurie Proia","doi":"10.55729/2000-9666.1201","DOIUrl":"10.55729/2000-9666.1201","url":null,"abstract":"","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 4","pages":"107-108"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/61/jchim-13-04-107.PMC10589021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690747","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 Influence of Religious Affiliation and Attitudes of Clinical Genetic Testing Among Medical Students in the West Texas Region.","authors":"Jonathan Kopel","doi":"10.55729/2000-9666.1212","DOIUrl":"10.55729/2000-9666.1212","url":null,"abstract":"<p><strong>Background: </strong>Genetic counseling is an essential and pertinent field in any society to lower the prevalence of hereditary disorders. However, the desire to undergo counseling and genetic testing varies widely depending on the cultural background and level of scientific literacy of the individual. In this survey, we examine the perspectives of medical students on clinical genetic testing based upon their religious tradition.</p><p><strong>Methods: </strong>The total number of participants in the study was 257 (122 male and 135 female) second year medical students at Texas Tech University Health Sciences Center (TTUHSC). The distribution of religious identification (Atheist, Christian, Hindu, Jewish, Muslim, Spiritual/not Affiliated, and Other) among the second-year medical students. The survey was available to students through TTUHSC's Omnibus survey program for a period of two weeks.</p><p><strong>Results: </strong>Most of the second-year medical students interviewed identified as being Christian (67%) with the next highest religious identification being Spiritual/not Affiliated (9%), Atheist (8%), and Muslim (6%). With regards to genetic tests, most of the students (95%), regardless of religious identification, have not used any commercial genetic testing services. Most second year medical students regardless of religious affiliation had similar agreement with questions regarding clinical genetic testing. However, there was a similar drop in agreement when it came on where students would want genetic screening to be performed regularly in clinics/hospitals.</p><p><strong>Conclusion: </strong>Given the numerous factors that must be considered, such as the patient's attitudes, knowledge, and beliefs towards the counseling process and genetic testing, genetic counseling is a challenging problem. Each target population's history, relevant exposure to, and domain expertise must be considered while promoting decision-making in genetic testing.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 4","pages":"109-112"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/8e/jchim-13-04-109.PMC10589017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690757","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":"Dry Beriberi Post Roux-en-Y Gastric Bypass Surgery.","authors":"PokharelAshik, AcharyaIndira, AkhiwuTed O, HaasChristopher J","doi":"10.55729/2000-9666.1210","DOIUrl":"10.55729/2000-9666.1210","url":null,"abstract":"<p><p>Bariatric surgery is an effective strategy for achieving substantial weight loss, prolonging survival, and improving the comorbidities associated with obesity. Nutritional deficiency is a commonly recognized post-procedural complication. Here, we present a case of a patient with paresthesia, lower extremity weakness, and altered mental status one year following Roux-en-Y gastric bypass, who was found to have multiple vitamin and micronutrient deficiencies and was diagnosed with beriberi in the setting of profound thiamine deficiency.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 1","pages":"58-64"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10589022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70739039","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":"Anaphylaxis to Lumason Contrast Agent in Echocardiography after Immune Sensitization: A Case Report and Literature Review.","authors":"Elizabeth S Mikhail,&nbsp;Joseph B Ghaly,&nbsp;Bilal Malik,&nbsp;Abhijeet G Ghatol","doi":"10.55729/2000-9666.1207","DOIUrl":"10.55729/2000-9666.1207","url":null,"abstract":"<p><p>With the continued evolution of echocardiography techniques, novel contrast agents have been introduced to aid in evaluating cardiac structure and function. Lumason is an FDA-approved ultrasound-enhancing agent made of Sulfur hexafluoride lipid-type A microspheres. We report a case of Lumason-induced immune sensitization and subsequent anaphylaxis on re-exposure in a middle-aged male patient presenting with symptoms concerning for a cerebrovascular accident. The patient was successfully treated with steroids and antihistamines. Providers, including physicians, echocardiography technicians, and mid-level providers should be aware of and be prepared to respond to the possibility of anaphylaxis to contrast-enhancing agents used in echocardiography.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 4","pages":"74-78"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/32/jchim-13-04-074.PMC10589027.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690749","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":"Syncope as the Sole Presentation of Multi-Vessel Coronary Artery Disease.","authors":"Mostafa R Mostafa,&nbsp;Mostafa Najim,&nbsp;Alexander Kusnik,&nbsp;Mohammad A Sheikha,&nbsp;Mohamed Magdi,&nbsp;Mostafa M Fahmy,&nbsp;Sanjay Shah,&nbsp;David C M Corteville","doi":"10.55729/2000-9666.1214","DOIUrl":"10.55729/2000-9666.1214","url":null,"abstract":"<p><p>Defining the etiology of syncope can be occasionally challenging. We present a case with no history of coronary artery disease (CAD) who presented exclusively with exertional syncope, and was found to have mildly reduced left ventricular systolic dysfunction on echocardiogram and severe multi-vessel CAD with chronic total occlusion (CTO) of the right coronary artery (RCA). Syncope as the initial presentation of advanced CAD in the absence of classic ischemic symptoms is rather an uncommon presentation in clinical practice.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 4","pages":"9-12"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/df/jchim-13-04-009.PMC10589011.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690756","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 Utility of Fecal Calprotectin in the Diagnosis and Management of Microscopic Colitis.","authors":"Busara Songtanin,&nbsp;Abbie Evans,&nbsp;Kenneth Nugent,&nbsp;Vanessa Costilla","doi":"10.55729/2000-9666.1215","DOIUrl":"10.55729/2000-9666.1215","url":null,"abstract":"<p><strong>Background: </strong>The incidence of microscopic colitis has increased over time. To date, there is no specific biomarker for microscopic colitis, and the diagnosis relies on histopathological tissue obtained during colonoscopy which is an invasive and costly procedure. Unlike Crohn's disease and ulcerative colitis, the utility of fecal calprotectin in diagnosing or monitoring microscopic colitis has not been established, and studies on the role of fecal calprotectin in microscopic colitis are limited. In this retrospective study, we analyzed the utility of this biomarker in the diagnosis of microscopic colitis.</p><p><strong>Methods: </strong>The medical records of patients who have been diagnosed with collagenous colitis and lymphocytic colitis aged 18-89 years old were retrospectively reviewed. Patient characteristics were recorded in those who had fecal calprotectin measured.</p><p><strong>Results: </strong>There were 198 patients who were diagnosed with collagenous colitis and lymphocytic between October 1, 2015, and July 31, 2022. Twenty-three patients had fecal calprotectin levels measured and were included in this study. The mean age was 51.7 ± 7.8 years in all groups. Thirteen patients were female. Six patients (26.1%) were diagnosed with collagenous colitis, and 17 patients (73.9%) were diagnosed with lymphocytic colitis. The fecal calprotectin cut-off in this lab is 50 μg/g stool. Median fecal calprotectin levels were 30.1 μg/g (15.6, 122.5), 19.5 μg/g (16.5, 64.6), and 33.2 μg/g (15.6, 134.9) in all groups, collagenous colitis, and lymphocytic colitis, respectively.</p><p><strong>Conclusion: </strong>The utility of fecal calprotectin in diagnosing microscopic colitis is limited. Our study suggests the diagnosis should be based on histopathology tissue obtained during colonoscopy.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 4","pages":"71-73"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/a4/jchim-13-04-071.PMC10589029.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690758","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":"Cardioembolic Stroke Secondary to Massive Stress-Induced Apical Thrombosis: A Clinical Conundrum Relating to Anticoagulation Initiation.","authors":"Siva N S Yarrarapu,&nbsp;Parth Shah,&nbsp;Vikramaditya S Venkata,&nbsp;Jayasree Ravilla,&nbsp;Gaurav Mohan,&nbsp;Poorva Bhide,&nbsp;David Anwar","doi":"10.55729/2000-9666.1205","DOIUrl":"10.55729/2000-9666.1205","url":null,"abstract":"<p><p>Takotsubo cardiomyopathy or stress cardiomyopathy is a condition characterized by acute and transient left ventricular systolic dysfunction in the absence of coronary heart disease, occurring after an acute emotional or physical stressful event. Cardiac dysfunction in these patients is suspected to be secondary to catecholamine induced cardiac myocyte injury via cyclic AMP-mediated calcium overload or due to endothelial dysfunction. Even though left ventricular dysfunction in takotsubo cardiomyopathy is transient, it can lead to acute complications. Left ventricular thrombus formation is a widely reported complication and has an incidence of around 5-14% in Takotsubo cardiomyopathy patients and can lead to thromboembolic events like stroke. We report a case of takotsubo cardiomyopathy with an apical LV thrombus, complicated by a large cardioembolic stroke. This case constitutes a clinical conundrum, as LV thrombus would warrant prompt initiation of anticoagulation, while the severe ischemic stroke would be a contraindication for immediate anticoagulation.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"13 4","pages":"101-106"},"PeriodicalIF":1.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/1f/jchim-13-04-101.PMC10589025.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690751","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}