Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Relationship Between Lower Esophageal Sphincter Muscles Thickness and Their Response to Pneumatic Dilation in Patients With Achalasia.","authors":"Foroogh A Avanaki, Mahdi Saravi, Nader Roshan, Razman A Bahri, Parnian Shobeiri, Faeze Salahshour, Hanieh Radkhah","doi":"10.55729/2000-9666.1381","DOIUrl":"https://doi.org/10.55729/2000-9666.1381","url":null,"abstract":"<p><strong>Background: </strong>Prognostic factors play a major role in managing achalasia patients treated with pneumatic dilatation (PD) and understanding the pathophysiology of the disease. In this regard, the muscular thickness of the lower esophageal sphincter (LES) has drawn attention in recently published studies.</p><p><strong>Methods: </strong>Patients with newly diagnosed achalasia were included consecutively in this study, and Endoscopic Ultrasound (EUS) was used to determine the thickness of longitudinal and circular muscles of LES. To determine the recurrence of symptoms, patients were followed up for one year using the Eckardt questionnaire. The relationship between pre-treatment LES muscle thickness and symptom recurrence was investigated.</p><p><strong>Results: </strong>Seventeen of nineteen treated patients were enrolled in this study and the data of sixteen patients was analyzed. Although not statistically significant, those with thinner LES had recurrent symptoms ( <i>p-value</i> = 0.08). Patients with a thicker LES (5.1 mm vs. 4.6 mm) initially responded better to pneumatic dilatation ( <i>p-value</i> = 0.03). After initial therapy, severe pain (daily pain) was strongly associated with symptom recurrence.</p><p><strong>Conclusions: </strong>Severe retrosternal chest pain and a thin LES appear to be surrogate markers for advanced disease and poor outcomes. Pre-treatment integrated relaxation pressure (IRP) seems to be a promising predictor of PD prognosis. Due to the study's heterogeneous population, the findings cannot be generalized to all achalasia patients, and larger-scale studies are necessary to confirm these findings.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466632","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":"Symptomatic Valvular and Subvalvular Stenosis: A Case Report.","authors":"Jesus Romero, Sherif Elkattawy, Ana L Romero, Murad Aldarayseh, Omar Elkattawy, Meherwan Joshi","doi":"10.55729/2000-9666.1367","DOIUrl":"https://doi.org/10.55729/2000-9666.1367","url":null,"abstract":"<p><p>Aortic stenosis is a common valvular disease that is expected to become more prevalent with the aging population. It is often undiagnosed in socioeconomically deprived groups. Diagnosis relies on echocardiography, and additional imaging techniques such as cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) are increasingly used. Surgical aortic valve replacement is the standard treatment, except for high-risk cases where TAVR is recommended. Subvalvular aortic stenosis (SAS) is the second most common cause of left ventricular outflow tract obstruction. This case report highlights a 72-year-old Hispanic lady with both valvular and subvalvular aortic stenosis, emphasizing the need for specialized care and surgical intervention. Early identification, accurate assessment, and appropriate intervention are crucial for improving outcomes in aortic stenosis and subvalvular stenosis cases.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466633","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":"Viscous Vengeance: A Case Report of Hyperviscosity Syndrome in IgA Lambda Multiple Myeloma.","authors":"Afoma Onyechi, Jessica Ohemeng-Dapaah, Ayesha Kang, Alexandre Lacasse, Ranju Kunwor","doi":"10.55729/2000-9666.1397","DOIUrl":"https://doi.org/10.55729/2000-9666.1397","url":null,"abstract":"<p><p>Multiple myeloma (MM) is a relatively uncommon neoplastic proliferation of monoclonal plasma cells. Common manifestations are related to infiltration of plasma cells into bones and other organs, causing an increased total serum protein concentration, hypercalcemia, kidney injury, and anemia. The most common type of MM is IgG Kappa, and the second most common type is the IgA subtype. Hyperviscosity (HVS) is a rare presentation of MM and management includes prompt plasmapheresis, resulting in significant reduction of serum viscosity and symptomatic relief. We present a case of IgA Lambda MM presenting with HVS.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466635","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":"An Unlikely Cause of Chest Pain: Recurrent Takotsubo Cardiomyopathy.","authors":"Mark Colantonio, Maan Awad, Marcelino M Liriano, Matthew Santer, Abdul Murshid, Affan Haleem","doi":"10.55729/2000-9666.1394","DOIUrl":"https://doi.org/10.55729/2000-9666.1394","url":null,"abstract":"<p><p>Takotsubo cardiomyopathy is described as transient, ventricular dysfunction. A relatively rare pathology accounting for 0.02% of hospitalizations, recurrent episodes are even less common, occurring at 1-6%. Here, we present a case of an elderly woman presenting with multiple, recurrent episodes of takotsubo cardiomyopathy. Similarities and differences between our case and others presented in literature are compared. Our case highlights the importance of maintaining a broad differential when presented with multiple episodes of recurrent, acute heart failure in the setting of chest pain and ST segment elevations.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485615","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":"An Unusual Case of Metronidazole-induced Encephalopathy in a Patient with Hereditary Hemorrhagic Telangiectasia.","authors":"Tina H Dao, Kinza Khan, Christopher D Jackson","doi":"10.55729/2000-9666.1398","DOIUrl":"https://doi.org/10.55729/2000-9666.1398","url":null,"abstract":"<p><p>Metronidazole-induced encephalopathy (MIE) is a rare toxic encephalopathy. We describe a reversible MIE case in a patient with hereditary hemorrhagic telangiectasia (HHT), treated with metronidazole for brain abscess, who developed dizziness, weakness, dysarthria, and severe dysmetria. His Magnetic Resonance Imaging (MRI) brain revealed bilateral, symmetric lesions in bilateral symmetrical regions of increased intensity in the medullary olives, cerebellar dentate nuclei, and the dorsal pons, all characteristic of MIE. Upon metronidazole discontinuation, the patient experienced significant symptom improvement, with subsequent MRI showing resolution of the lesions.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466595","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":"Gastric and Rectal Phytobezoar From Sunflower Seed Ingestion: A Case Report and Review of the Literature.","authors":"Joseph O Atarere, Sakthi S Gautham, Jennifer A Evans, Haider A Naqvi","doi":"10.55729/2000-9666.1392","DOIUrl":"https://doi.org/10.55729/2000-9666.1392","url":null,"abstract":"<p><p>Seed bezoars are a subcategory of phytobezoars caused by undigested vegetable seeds or fruit pits. We report the case of a 48-year-old woman who was admitted due to severe constipation and rectal pain. Rectal examination was notable for numerous sunflower seeds at the anal verge. Initial CT imaging revealed fecal impaction with a rectal bezoar which was managed with manual evacuation. Repeat CT imaging was notable for a gastric bezoar which was successfully managed by dissolution therapy with Coca-Cola. Most seed bezoars can be managed conservatively and life-threatening complications are rare.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466627","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":"Acute Renal Failure Secondary to <i>Vibrio cholera</i> Gastroenteritis in a United States Citizen, Corrected With Renal Replacement Therapy.","authors":"Meng Xie, Angelina Hong, Mayuri Gupta, Dusan Dragovic","doi":"10.55729/2000-9666.1387","DOIUrl":"https://doi.org/10.55729/2000-9666.1387","url":null,"abstract":"<p><p>Cholera is an acute gastroenteritis that can lead to fatal dehydration and metabolic derangements. Cases of cholera in the United States are typically associated with international travel. Patients who are persistently dehydrated despite aggressive rehydration and antibiotic therapy may require hemodialysis until symptom resolution and stabilization of renal function. We present a case of a 47-year-old male who recently returned from a trip to Haiti and presented with intractable abdominal pain, nausea, vomiting, and watery diarrhea. He was found to be in acute renal failure with a high anion gap metabolic acidosis of an unclear etiology. Abdominal imaging was consistent with enterocolitis, and his stool culture grew <i>Vibrio cholerae</i>. In addition to aggressive fluid resuscitation, he underwent two intermittent hemodialysis sessions and received sodium bicarbonate and antibiotic therapy. Renal function normalized by hospital day 6. This is a novel case of severe renal failure and high anion gap metabolic acidosis in a US patient with cholera; our review of the literature did not find any case reports regarding cholera in the past decade involving a US citizen.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466594","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":"Percutaneous Coronary Intervention in Patients with Coronary Artery Ectasia: A Retrospective Single-center Study.","authors":"Shoaib Subhan, Muhammad Shehram, Malik F Iftikhar, Abdullah B Munir, Ali Al-Ansari, Haysum Khan, Syeda S Sultana, Jahanzeb Malik, Amin Mehmoodi","doi":"10.55729/2000-9666.1368","DOIUrl":"https://doi.org/10.55729/2000-9666.1368","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective single-center study aimed to compare the outcomes of ad-hoc versus planned percutaneous coronary intervention (PCI) in patients with coronary ectasia. We investigated baseline characteristics, primary and secondary outcomes, and predictors of mortality in a cohort of patients who underwent PCI procedures.</p><p><strong>Methods: </strong>Data from 3,179 patients (ad-hoc PCI, n = 1,286; planned PCI, n = 1,893) with coronary ectasia were analyzed. Baseline characteristics, including age, gender, comorbidities, and lesion characteristics, were compared between the two groups. Primary outcomes included technical success and stent deployment success, while secondary outcomes encompassed major adverse cardiovascular events (MACE), all-cause mortality, recurrent angina, and target lesion revascularization. Logistic regression was utilized to identify predictors of mortality.</p><p><strong>Results: </strong>The ad-hoc PCI group exhibited a higher prevalence of comorbidities, including hypertension, diabetes mellitus, smoking history, and multi-vessel disease (all p < 0.05). While technical success and stent deployment success rates were lower in the ad-hoc PCI group (p < 0.05), patients undergoing planned PCI demonstrated significantly lower rates of MACE, all-cause mortality, recurrent angina, and target lesion revascularization (all p < 0.05). Logistic regression analysis identified older age, male gender, hypertension, diabetes mellitus, smoking history, and multi-vessel disease as independent predictors of mortality (all p < 0.05). Importantly, coronary ectasia emerged as an additional predictor of mortality (p = 0.002).</p><p><strong>Conclusion: </strong>Our study indicates that planned PCI is associated with improved procedural outcomes and lower rates of mortality and adverse events compared to ad-hoc PCI in patients with coronary ectasia.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466629","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":"Internal Jugular Vein Thrombosis as the Initial Presentation of Antiphospholipid Antibody-positive Vascular Behçet Disease: A Clinical Image.","authors":"Hidetaka Katoh, Mitsunaga Iwata, Teruhiko Terasawa","doi":"10.55729/2000-9666.1403","DOIUrl":"https://doi.org/10.55729/2000-9666.1403","url":null,"abstract":"<p><p>Internal jugular vein (IJV) thrombosis is a rare and potentially life-threatening condition commonly caused by central venous catheter insertion, malignant tumors, and neck infections. A 45-year-old woman with an unremarkable medical history presented with left neck pain. Imaging studies of a suspected mediastinal tumor revealed IJV thrombosis. No malignancy was identified by imaging or upper gastrointestinal endoscopy. Despite suspicion of antiphospholipid antibody syndrome (APS) and treatment with warfarin, subsequent testing did not provide conclusive evidence for a definitive diagnosis of APS. Later, genital ulcers, right scleritis, folliculitis-like lesions on the trunk and femor, and hand arthritis developed. Based on her clinical findings and positive human leukocyte antigen A26, the patient was diagnosed with vascular Behçet disease one year after the initial presentation. While IJV is rare, its differential diagnosis is diverse. This includes uncommon causes, such as deep venous thrombosis secondary to vascular Behçet disease.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485617","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":"Eustachian Valve Endocarditis: A Case Report and Literature Review.","authors":"Danna Reyes, Gamal Musleh, Sherif Elkattawy, Muhammad Noori, Jesus Romero, Ana L Romero, Omar Elkattawy, Omran Ahmed, Gabriel Zaverucha, Razan Shamoon","doi":"10.55729/2000-9666.1353","DOIUrl":"https://doi.org/10.55729/2000-9666.1353","url":null,"abstract":"<p><p>Infective endocarditis (IE) is a well-known condition, but certain manifestations, such as Eustachian valve endocarditis (EVE), remain rare. This report presents a case of EVE in a 66-year-old male with no apparent risk factors. EVE is a form of right-sided endocarditis, often associated with intravenous drug use, yet it can occur in patients without traditional risk factors. The patient presented with a constellation of symptoms, including lightheadedness, dyspnea, generalized weakness, and fever. Diagnostic workup revealed multiple complications, including liver abscesses, pulmonary nodules, and spinal osteomyelitis. EVE was confirmed through transesophageal echocardiography (TEE), highlighting multiple Eustachian valve vegetations. Blood cultures identified <i>Bacteroides fragilis</i> as the causative agent. The patient received appropriate antimicrobial therapy, underwent drainage of liver abscesses, and was started on therapeutic anticoagulation for thrombophlebitis. A favorable clinical response was observed, and the patient was discharged for continued outpatient follow-up. This case underscores the importance of considering atypical forms of endocarditis, such as EVE, even in patients lacking traditional risk factors. The diagnostic utility of TEE and the management of complications, including liver abscesses and thrombophlebitis, are discussed. Awareness of such presentations is essential for timely diagnosis and effective treatment.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466601","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}