Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"First Reported Case of <i>Actinomyces oris</i> Endocarditis and Bacteremia in the United States: A Case Report.","authors":"Hajra Nosheen, Josephine R Pitasari, Khaled Almorsy, Shagufta N Ali","doi":"10.55729/2000-9666.1469","DOIUrl":"https://doi.org/10.55729/2000-9666.1469","url":null,"abstract":"<p><strong>Introduction: </strong><i>Actinomyces</i> are Gram-positive bacilli found as normal flora in the oral, urogenital, and gastrointestinal tracts. <i>Actinomyces</i> causing endocarditis is extremely rare, with only one prior case of <i>Actinomyces oris</i> endocarditis reported in 2020 in Thailand. We present the first case ever reported in the United States.</p><p><strong>Case description: </strong>We present a 58-year-old African American woman with multiple comorbidities, including end-stage renal disease, on hemodialysis who presented with altered mentation. On investigations, she had <i>A. oris</i> bacteremia, with echocardiography revealing mitral valve vegetation. She was treated with IV antibiotics followed by oral amoxicillin-clavulanic acid.</p><p><strong>Discussion: </strong>Our case highlights the diagnostic challenges posed by slow-growing organisms like <i>A. oris</i> in patients with comorbidities, especially on hemodialysis. Blood cultures and transesophageal echocardiography were critical in diagnosing this case. Advanced microbial diagnostic techniques are crucial in identifying the pathogen and the pathogen's susceptibility-guided treatment. This case highlights the importance of early recognition and tailored therapy for rare pathogens like <i>A. oris</i>.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"76-80"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026947","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":"Managing the Complexity of Thrombotic and Bleeding Risks: Case Report of Factor VII Deficiency and Factor V Leiden Mutation in a Patient With Bi-valvular Infective Endocarditis Undergoing Open-heart Surgery.","authors":"Tharun Shyam, Soe P Winn, Vallabh Shet, Saumya Nanda, Momna Noor, Vahagn Tamazyan, Palvi S Jindal, Kamlesh Kumar, Alina Zatsepina, Stephen Peeke, Mariya Astashkevich","doi":"10.55729/2000-9666.1463","DOIUrl":"https://doi.org/10.55729/2000-9666.1463","url":null,"abstract":"<p><p>Factor VII deficiency (FVIID) is a rare autosomal dominant disorder that occurs in approximately 1 in 500,000 individuals. Paradoxically, 3-4 percent of cases of FVIID result in thrombosis. The etiology behind this clotting predilection is thought to be multifactorial, possibly due to an associated pro-coagulant mutation. We hereby describe a case of FVIID with a heterozygous Factor V Leiden mutation (FVLM) in a patient with bivalvular infective endocarditis undergoing open-heart surgery. This case highlights the complexity of managing patients with concomitant bleeding and thrombotic tendencies, especially in the context of major surgery. We recommend tailoring anticoagulation strategies on a case by case basis to manage these risks.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"71-75"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998503","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":"Subcutaneous Insulin Aspart Every 4 Hours in the Treatment of COVID-19 Patients With Mild-to-Moderate Diabetic Ketoacidosis: A Case Series.","authors":"Dararat Chiewchalermsri, Chayanin Wanittansirichok, Chutintorn Sriphrapradang","doi":"10.55729/2000-9666.1456","DOIUrl":"https://doi.org/10.55729/2000-9666.1456","url":null,"abstract":"<p><p>This case series evaluates the efficacy and safety of subcutaneous (SC) insulin Aspart administered every 4 h for managing mild-to-moderate diabetic ketoacidosis (DKA) in COVID-19 patients, addressing a current evidence gap. We conducted a retrospective review of confirmed COVID-19 patients over 15 years old who developed mild to moderate DKA between July 2020 and October 2021. Insulin Aspart was administered at 0.4 units/kg SC every 4 h, reduced to 0.2 units/kg when blood glucose (BG) decreased to <250 mg/dL, and SC basal insulin was initiated at 0.15-0.2 units/kg at DKA diagnosis. A total of seven patients, with a mean age of 67.4 ± 13.2 years, predominantly female (71.4 %), and all with pre-existing type 2 diabetes mellitus, were analyzed. Initial biochemical parameters included BG of 449 ± 157.3 mg/dL, HbA1c of 10.6 ± 2.8 %, pH of 7.34 (range, 7.26-7.45), beta-hydroxybutyrate of 4.0 ± 1.5 mmol/L, and bicarbonate of 15.5 ± 2.2 mmol/L. The time to resolution of hyperglycemia (BG < 250 mg/dL) and DKA was 8.0 ± 3.1 and was 12.7 ± 5.8 h, respectively. During DKA resolution, one patient experienced hypoglycemia (47 mg/dL) and later developed recurrent DKA as COVID-19 infection worsened. Three deaths occurred due to COVID-19-related complications following DKA recovery. While SC insulin Aspart administered every 4 h shows promise, careful monitoring for recurrent DKA and septic shock is essential for optimal management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"66-70"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968242","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":"Accelerated Ischemic Disease Presenting as Ventricular Fibrillation.","authors":"Nismat Javed, Vikram Itare, Nisha Ali, Nassim Krim, Preeti Jadhav","doi":"10.55729/2000-9666.1460","DOIUrl":"https://doi.org/10.55729/2000-9666.1460","url":null,"abstract":"<p><strong>Introduction: </strong>Ventricular fibrillation (VF) is often associated with underlying structural heart disease and occurs in a small percentage of acute myocardial infarction (MI) cases. Specific conditions such as complete coronary occlusion, anterior wall infarction, and pre-existing conditions like atrial fibrillation or congenital abnormalities increase the risk of VF. In this report, we present the case of a 64-year-old male with a history of hypertension, HIV, and opioid dependence who developed VF during stress testing despite having no prior structural heart disease. This case supports the hypothesis that ongoing ischemia may trigger VF in the absence of structural heart disease.</p><p><strong>Case presentation: </strong>A 64-year-old male with a medical history of hypertension, HIV, and opioid dependence presented with chest pain and dyspnea. The patient's ECG showed changes suggestive of an inferior myocardial infarction. During a dobutamine stress test, the patient developed VF and was successfully resuscitated. Subsequent coronary angiography revealed severe triple vessel disease, and the patient underwent coronary artery bypass surgery. He recovered well postoperatively and was discharged on dual antiplatelet therapy.</p><p><strong>Conclusion: </strong>VF occurs in a significant percentage of MI patients and is often associated with coronary artery disease and acute thrombotic lesions. This case illustrates that even in the absence of structural heart disease, ischemia can trigger VF. Early identification and invasive management, such as coronary angiography and mechanical circulatory support, are critical for improving survival outcomes in these patients.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"56-60"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973389","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 Vulnerability of the Heart During Diarrhea: A Case Report on Pericarditis Linked to Inflammatory Bowel Disease.","authors":"Phani B Cherukuri, Jayasree Ravilla, Siva N S Yarrarapu, Penny Turtel, Du Doantrang","doi":"10.55729/2000-9666.1465","DOIUrl":"https://doi.org/10.55729/2000-9666.1465","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease, often involves extraintestinal manifestations, affecting up to 40% of patients. Cardiovascular complications, although rare, can include pericarditis, the most common cardiac manifestation in IBD.</p><p><strong>Case presentation: </strong>We report the case of a 34-year-old male with a long-standing history of UC who presented with pleuritic chest pain, shortness of breath, and worsening colitis symptoms. This case is particularly noteworthy due to the complexity added by the patient's 24-year history of UC, diverse treatment modalities (including mesalamine, 6-mercaptopurine, infliximab, vedolizumab, upadacitinib, and ustekinumab), and the patient not being on any 5-aminosalicylic acid (5-ASA) medications known to cause pericarditis at the time of presentation. The pericarditis episodes were temporally associated with UC flare-ups, complicating the distinction between disease-induced and medication-induced pericarditis. The patient experienced two recurrent episodes within 14 weeks, and comprehensive investigations excluded other common causes, narrowing down the potential etiologies. Clinical evaluation revealed pericarditis with a moderate pericardial effusion, elevated inflammatory markers, and normal cardiac biomarkers. The patient's pericarditis was managed with corticosteroids and colchicine, leading to rapid symptom resolution. This case underscores the challenge of distinguishing between disease-induced and medication-induced pericarditis in IBD patients.</p><p><strong>Conclusion: </strong>Pericarditis, although a rare extraintestinal manifestation of IBD, should be considered in patients with UC presenting with chest pain. This report highlights the need for heightened awareness and careful management of pericarditis in UC patients. Clinicians should maintain a high index of suspicion for cardiovascular complications in IBD, ensuring timely diagnosis and intervention.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"85-89"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973484","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":"Rare Case of Intragastric Balloon Induced Acute Pancreatitis.","authors":"Islam Rajab, Nagihan Orhun, Mina F Alkomos, Yana Cavanagh, Walid Baddoura","doi":"10.55729/2000-9666.1464","DOIUrl":"https://doi.org/10.55729/2000-9666.1464","url":null,"abstract":"<p><p>Intragastric balloon (IGB) placement, a minimally invasive intervention for obesity, can lead to a range of complications from mild gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and gastroesophageal reflux (GERD) to more severe and life-threatening conditions, including perforation, balloon migration, and pancreatitis. IGB-related pancreatitis is a rare complication, but it is being reported in the literature. This case report presents a rare cause of pancreatitis induced by IGB, with complete resolution achieved following balloon removal.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"61-65"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026711","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":"IVIG-induced Aseptic Meningitis in an Adult Patient With Acute Inflammatory Demyelinating Polyneuropathy: A Case Report and Literature Review.","authors":"Brock J Malatches, Ayman Alsaadi, Jemeera Jeyamuhunthan, Sarmad Pirzada, Stefan Odabasic","doi":"10.55729/2000-9666.1466","DOIUrl":"https://doi.org/10.55729/2000-9666.1466","url":null,"abstract":"<p><p>Intravenous immunoglobulins (IVIG) therapy is used to treat various autoimmune, immunodeficiency, and inflammatory conditions. One of the rare, but serious, side effects is aseptic meningitis. In this case report, we present a 55-year-old female who experienced IVIG-induced aseptic meningitis for treatment of acute inflammatory demyelinating polyneuropathy (AIDP).</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"94-98"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009451","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":"Navigating Thyroid Crises: A Nationwide Analysis of the Weekend Effect and Mortality Trends in Myxedema Coma (2016-2020).","authors":"Mariam Hashmi, Zubair H Bodla, Fatima Niaz, Umer Farooq, Zahra Niaz, Christopher L Bray, Peters Okonoboh","doi":"10.55729/2000-9666.1423","DOIUrl":"https://doi.org/10.55729/2000-9666.1423","url":null,"abstract":"<p><p>Our objective was to utilize the National Inpatient Sample (NIS) database for analyzing the outcomes of myxedema coma based on the day of admission and explore five-year mortality trends. This retrospective cohort study examined in-patient mortality and secondary outcomes of patients with myxedema coma from 2016 to 2020 using the NIS database. Patients were selected using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and divided into weekday and weekend admission groups. From 174,776,205 discharges, 5095 patients were included. Mean age of admitted patients was higher on weekdays (67.1 year) than weekends (66.5), with females constituting 69.4% and 67.4% of admissions, respectively. Weekend admissions had higher odds of inpatient mortality compared to weekdays [adjusted odds ratio (aOR): 1.9, p = 0.01]. The overall mortality rate for myxedema coma rose from 6.8% in 2016 to 13.4% in 2020 (p-value = 0.01). No significant difference in the length of stay, hospitalization cost, and charges, blood transfusion, acute kidney injury requiring dialysis, acute respiratory failure requiring intubation and parenteral nutrition was noted between weekday and weekend admissions. Further studies are needed to identify factors contributing to this disparity and to confirm the findings of increasing mortality related to myxedema.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"6-13"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994737","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":"Rapidly Progressing Secondary Organizing Pneumonia in a Case of Systemic Sclerosis Sine Scleroderma - A Diagnostic Urgency: A Case Report and Literature Review.","authors":"Anish K Shrestha, Jyotsna Gummadi, Basem Al Achras, Nicholas E Ghionni","doi":"10.55729/2000-9666.1442","DOIUrl":"10.55729/2000-9666.1442","url":null,"abstract":"<p><p>Systemic sclerosis sine (latin: without) scleroderma (ssSSc), also called visceral scleroderma, is characterized by internal organ involvement and abnormal serologic abnormalities in the complete or partial absence of cutaneous manifestations of systemic sclerosis.1,2 Pulmonary involvement in scleroderma consists of interstitial lung disease and pulmonary hypertension. Usual interstitial pneumonia (45.4%), followed by nonspecific interstitial pneumonia (36.4%) represents the predominant interstitial lung disease in scleroderma.3 Rarely, organizing pneumonia has been described with scleroderma and seldom with systemic sclerosis sine scleroderma in literature.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"93-97"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046842","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":"Primary Raynaud's Phenomenon.","authors":"Eliana A Alweis, Richard L Alweis","doi":"10.55729/2000-9666.1443","DOIUrl":"10.55729/2000-9666.1443","url":null,"abstract":"<p><p>The authors present a clinical image of primary Raynaud's phenomenon and briefly review its pathophysiology, differential diagnosis, and need for longitudinal follow up.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"49-50"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046901","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}