Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Determinants of Mortality Among US Patients Diagnosed With Malignant Pleural Mesothelioma Over the Past Decade.","authors":"Ayrton Bangolo, Pierre Fwelo, Amer Jarri, Sai P Pulipaka, Vignesh K Nagesh, Nikita Wadhwani, Budoor Alqinai, Sidra Sohail, Geetha Keshav, Angel A Chacko, Aiswarya Menon, Luis Periel, Zuhair S Siddiqui, Bibek Pyakurel, Sandra Kunnel, Matthew Maturasingh, Gillan Quirequire, Jerusha Gudapati, Ashfi Hoque, Zubair Habib, Varun Rao, Jasmine K Grewal, Abraham Lo, Simcha Weissman","doi":"10.55729/2000-9666.1384","DOIUrl":"https://doi.org/10.55729/2000-9666.1384","url":null,"abstract":"<p><strong>Background: </strong>Malignant Pleural Mesothelioma (MPM) is a primary pleural tumor with scarce prognostic data estimates given its rarity. This study aims to explore the epidemiologic and survival predictors amongst patients with MPM, extending from the largest and most recent study conducted between 1973 and 2009.</p><p><strong>Methods: </strong>3384 patients diagnosed with MPM between 2010 and 2017 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographics, clinical characteristics, overall mortality (OM), and cancer-specific mortality (CSM) estimates were analyzed. Multivariate Cox model was used to identify independent prognostic factors, where a hazard ratio (HR) greater than 1 denotes adverse prognostic factors.</p><p><strong>Results: </strong>Our cohort revealed a male predominance (77.16%), with over 80% diagnosed after age 59, peaking between 60 and 79 years old (60.17%). Epithelioid mesothelioma (41.78%), non-Hispanic whites (78.13%), and diagnosis at distant stage (71.60%) were the most common subgroups in their respective categories. 365 patients (10.79%) lacked pleural effusion at diagnosis. In multivariate analyses, higher overall mortality (OM) was associated with male gender (HR = 1.24, 95% CI 1.14-1.37, p < 0.01), age >80 years (HR = 2.17, 95% CI 1.41-3.35, p < 0.01), fibrous mesothelioma (HR = 2.21, 95% CI 1.95-2.51, p < 0.01), and distant stage (HR = 1.55, 95% CI 1.34-1.81, p < 0.01). Higher cancer-specific mortality (CSM) was associated with male gender (HR = 1.25, 95% CI 1.13-1.38, p < 0.01), age >80 years (HR = 2.02, 95% CI 1.29-3.15, p < 0.01), fibrous mesothelioma (HR = 2.24, 95% CI 1.97-2.55, p < 0.01), and distant stage (HR = 1.59, 95% CI 1.36-1.87, p < 0.01). Lower OM and CSM was observed in patients who underwent any type of treatment. Nonmalignant pleural effusion, based on histology, was associated with higher CSM (HR = 1.22, 95% CI 1.05-1.4, p < 0.05).</p><p><strong>Conclusion: </strong>Fibrous mesothelioma, older age, and distant disease were associated with increased mortality. All intervention strategies were associated with improved survival outcomes. Earlier diagnosis may improve outcomes, as available interventions are associated with lower mortality when feasible at diagnosis. The study paves the way for further prospective and retrospective studies to focus on the identification of patient subsets that may benefit from early mesothelioma screening.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"14-20"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466600","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":"14 5","pages":"106-109"},"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":"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":"14 5","pages":"120-123"},"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":"14 5","pages":"92-95"},"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":"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":"14 5","pages":"110-113"},"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":"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":"14 5","pages":"49-51"},"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":"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":"14 5","pages":"114-119"},"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":"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":"14 5","pages":"52-54"},"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":"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":"14 5","pages":"7-13"},"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":"COVID-19-related Pneumonitis in Immunocompromised Patients: Reviewing Clinical Features and Management Approaches.","authors":"Adeel Nasrullah, Hassan Shakir, Eiraj Khan, Muhammad I Bilal, Abu B Sheikh, Khalid Malik, Tariq Cheema","doi":"10.55729/2000-9666.1399","DOIUrl":"https://doi.org/10.55729/2000-9666.1399","url":null,"abstract":"<p><p>In this case series, we explore persistent SARS-CoV-2 infection and its resultant pneumonitis within a cohort of immunocompromised patients. We elucidate the complex interplay between immunosuppression and COVID-19 by examining four patients who experienced prolonged viral shedding and recurrent respiratory failure due to their compromised immune systems. This series elucidates the clinical presentation, diagnostic challenges, and therapeutic strategies. We also summarize existing literature regarding persistent SARS-CoV-2 infection in immunocompromised individuals. Our findings support the use of a tailored treatment approach using a proposed diagnostic and management algorithm to standardize care and optimize outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"63-72"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466599","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}