Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Diagnostic Challenges in Concurrent Primary Biliary Cholangitis and Secondary Syphilis: A Case Report.","authors":"Rakahn Haddadin, Danny Aboujamra, Emon Javadi, Humzah Iqbal, Pinak Shah, Homayon Iraninezhad","doi":"10.55729/2000-9666.1500","DOIUrl":"10.55729/2000-9666.1500","url":null,"abstract":"<p><p>We present a rare case of a patient diagnosed with both primary biliary cholangitis (PBC) and secondary syphilis during hospitalization. While the coexistence of these two conditions is uncommon, distinguishing between syphilitic hepatitis and autoimmune liver disease is critical. This case highlights the importance of thorough history-taking, a comprehensive workup for cholestatic liver disease, and the potential diagnostic overlap between infectious and autoimmune processes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"43-45"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775531","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":"Mortality and Readmission Outcomes for Intensive and Conventional Cardiac Rehabilitation (MR-OFICR) Study.","authors":"Yash B Patel, Agara Kumar, Marianne Huebner, Mohammed El Nayir, Anupam Suneja, Frank Smith","doi":"10.55729/2000-9666.1514","DOIUrl":"10.55729/2000-9666.1514","url":null,"abstract":"<p><p>Cardiac rehabilitation programs are offered in two major formats: Conventional Cardiac Rehab (CCR), which is primarily based on exercise interventions, and Intensive Cardiac Rehabilitation (ICR), which is a holistic approach including dietary modifications with a plant-based diet and wellness counseling. We performed a retrospective cohort study to compare the CCR and ICR groups for the primary composite outcome of Major Adverse Cardiac Event (MACE) at two years. The MACE outcome was 2-year mortality, unstable angina requiring hospitalization, Myocardial Infarction (MI), Coronary Artery Bypass Graft (CABG), Percutaneous Coronary Intervention (PCI), and stroke. Secondary outcomes were overall mortality, and number of readmissions. There were 2104 patients included in the statistical analysis with 963 in the CCR group and 1141 in the ICR group. We found that there were no significant differences in MACE events between ICR and CCR (OR = 1.10; 95 % CI = 0.81-1.49; p = 0.55). Readmissions were higher in the ICR group than the CCR group, with 34.1 % vs 28.6 % (p = 0.006), respectively. Additionally, older age was associated with more MACE events (OR = 1.16; 95 % CI = 1.07-1.25; p < 0.001). Overall, our study did not demonstrate a difference in the composite MACE outcome between ICR and CCR.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"8-13"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775537","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":"Ownership and Perceived Usefulness of Digital Health Tools (DHT) for Health Promotion Among Individuals with Rheumatologic Disease in the United States.","authors":"Ufuoma N Mamoh, Soziema J Salia, Joseph O Atarere, Andrew K Ndakotsu, Alejandro Jaller, David S Weisman","doi":"10.55729/2000-9666.1506","DOIUrl":"10.55729/2000-9666.1506","url":null,"abstract":"<p><strong>Introduction: </strong>Research on digital health tools (DHT) use in rheumatologic disease (RD) patients is lacking.</p><p><strong>Method: </strong>Data from the 2017 and 2018 Health Information National Trends Survey (HINTS) were used to compare DHT ownership and perceived usefulness between individuals with and without RD and to evaluate how health applications usage influenced health behaviors in RD patients.</p><p><strong>Results: </strong>No significant differences in smartphone or health applications ownership were found between the groups. Among RD patients, older males and those with lower incomes were less likely to use DHT. DHT users reported better communication with healthcare providers, but no significant impact on health behaviors.</p><p><strong>Conclusions: </strong>Females, individuals <65 years, and those with higher annual income had higher odds of health applications usage. DHT facilitated better communication between patients with RD and healthcare providers. DHT tailored for RD are readily available but remain underutilized and warrant further exploration to improve health outcomes in this population.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775538","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 Familial Hypocalciuric Hypercalcemia in Patient With Pancreatitis.","authors":"Muhammad I Khan, Tanvi Jain, Muhammad M Abid, Samra Israr, Muhammad H Khan","doi":"10.55729/2000-9666.1497","DOIUrl":"10.55729/2000-9666.1497","url":null,"abstract":"<p><p>Familial hypocalciuric hypercalcemia (FHH) is a rare autosomal dominant condition caused by mutations in the calcium-sensing receptor gene (CASR), leading to asymptomatic hypercalcemia. Here, we report a case of hypercalcemia in a patient with acute pancreatitis, subsequently diagnosed with FHH. A 41-year-old male presented with abdominal pain and elevated pancreatic enzymes. Imaging revealed changes consistent with acute pancreatitis. Surprisingly, serum calcium was elevated, which is uncommon in acute pancreatitis. Further work-up demonstrated normal parathyroid hormone (PTH), PTH-related peptide (PTHrp), and vitamin D levels. A 24-h urinary calcium excretion of 24 mg/24 h and a calcium to creatinine clearance ratio (CCCR) of 0.002 confirmed the diagnosis of FHH. This condition is typically asymptomatic, with few complications, and is managed conservatively with patient education and genetic counselling.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"66-68"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775522","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 Presentation of IgA Vasculitis and IgA Nephropathy: A Case Report.","authors":"Mark A Colantonio, Nicholas Condiles, Alan P Lim, Khaled Shawwa","doi":"10.55729/2000-9666.1502","DOIUrl":"10.55729/2000-9666.1502","url":null,"abstract":"<p><p>Immunoglobulin A (IgA) nephropathy is the most common glomerulonephritis worldwide. While IgA nephropathy mainly presents with renal manifestations, systemic symptoms associated with vasculitis are uncommon. Oftentimes, creatinine is used as a serum marker for renal dysfunction; however, it may not always be sensitive, especially in patients with low muscle mass. In such cases, cystatin C may prove to be a better indicator of renal function. Here, we present a case of IgA nephropathy with a normal serum creatinine and elevated cystatin C, highlighting the utility of cystatin C in the setting of a normal creatinine and high suspicion for renal dysfunction.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"61-65"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775527","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":"Deep Neck Space Infection as a Complication of Transesophageal Echocardiogram for Atrial Flutter Ablation.","authors":"Anish K Shrestha, Naffa Faisal, Kanchana Bali, Nadine Safi, Maria E Mesalles, Nahar Saleh","doi":"10.55729/2000-9666.1520","DOIUrl":"10.55729/2000-9666.1520","url":null,"abstract":"<p><p>Transesophageal echocardiography is a relatively safe procedure; however, there are rare complications associated with it. Multiple attempts during TEE can lead to injury of hypopharyngeal or parapharyngeal wall leading to an infection. Here, we describe a case of hypopharyngeal-parapharyngeal abscess resulting from multiple TEE attempts during cardioversion leading to a prolonged hospital course.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"108-111"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775530","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":"Pulmonary <i>Mycobactetrium kumamotonense</i> With Hepatosplenic Dissemination in an Immunocompetent Patient: A Case Report and Review.","authors":"Michael S Wang, Jeremiah Chang, Tiffany Whelan, Bo Liu, Katie Fitton, Jeffrey J Grondin","doi":"10.55729/2000-9666.1503","DOIUrl":"10.55729/2000-9666.1503","url":null,"abstract":"<p><p>We report a 69-year-old with a past medical history of prostate cancer, and arsenic poisoning, who was incidentally found to have multiple pulmonary nodules and hepatosplenic lesions on CT imaging. He denied respiratory symptoms, but was noted to have significant weight loss. A bronchoscopy revealed <i>mycobacterium kumamotonense</i> on culture. He was treated presumptively for pulmonary and disseminated infection with azithromycin and ethambutol for 16 months, and 12 months of rifabutin after four months of rifampin which was discontinued due to resistance. Patient's weight loss resolved and CT imaging appeared significantly improved.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"37-42"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775539","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":"First Report of Successful Rituximab Therapy in Idiopathic Sclerosing Mesenteritis.","authors":"Indira Acharya, Carey Field, Mary E Clark","doi":"10.55729/2000-9666.1504","DOIUrl":"10.55729/2000-9666.1504","url":null,"abstract":"<p><p>Sclerosing mesenteritis (SM) is a rare idiopathic fibroinflammatory disorder of the bowel mesentery adipose tissue. While the use of rituximab has been documented in IgG4-related SM, its effectiveness in idiopathic, IgG4-unrelated SM remains unknown. We present a case of idiopathic SM successfully managed with rituximab, suggesting that this treatment may be an option for patients who either have contraindications to or have not responded to current first-line therapies.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"100-103"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775533","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 Heart of the Matter: A Case of Massive Pedal Edema Erroneously Attributed to Liver Cirrhosis.","authors":"Ankita Nekkanti, Harishankar Gopakumar, Kaneez Zainab, Teresa Lynch, Sonu Dhillon","doi":"10.55729/2000-9666.1452","DOIUrl":"10.55729/2000-9666.1452","url":null,"abstract":"<p><p>Liver cirrhosis is commonly diagnosed with etiologies such as viral hepatitis, alcohol-related liver disease, and metabolic dysfunction-associated steatotic liver disease (MASLD). However, less common causes should be considered, especially in atypical presentations or suboptimal treatment responses. A 67-year-old man presented with massive bilateral pedal edema unresponsive to furosemide. He had well-controlled diabetes and hypertension but no history of alcohol use. Laboratory tests showed normal renal function, mild transaminitis, and mild thrombocytopenia. Imaging revealed liver morphology suggestive of cirrhosis, which prompted the presumptive diagnosis of metabolic-associated steatohepatitis (MASH). Despite diuretic therapy, the patient's edema worsened, necessitating repeated hospital admissions for intravenous diuresis. Measurement of transhepatic pressures showed findings consistent with portal hypertension, but the degree of edema was disproportionate to the hepatic venous pressure gradient. Liver biopsy showed sinusoidal congestion suggesting cardiac causes of portal hypertension. Subsequent cardiac evaluation, including left and right heart catheterization and cardiac MRI, revealed constrictive pericarditis. The patient then underwent pericardiectomy, leading to substantial improvement in symptoms allowing cessation of diuretic therapy. The overlap of symptoms between cardiopulmonary and hepatic diseases can complicate diagnosis. Cardiac cirrhosis, though often asymptomatic, should be considered in patients with unexplained peripheral edema. Diagnostic challenges include normal echocardiograms and the need for advanced imaging. Careful evaluation and consideration of atypical presentations are crucial, with gastroenterologists playing a vital role in identifying cardiac conditions masquerading as primary liver disease.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"46-49"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775542","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 Association of Non-invasive Ventilation and Mortality in COVID-19 Induced Acute Respiratory Distress Syndrome.","authors":"Chahat Puri, Akshay Duddu, Gina Patel, Sahib Singh, Juan Negrin, Lauren Greenburg, David Vitberg, Elisabeth M Carr","doi":"10.55729/2000-9666.1499","DOIUrl":"10.55729/2000-9666.1499","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic caused a major burden on the healthcare system. Since the beginning of the pandemic, the timing of intubation in patients with COVID-19 induced acute respiratory distress syndrome (ARDS) remained an area of debate.</p><p><strong>Research question: </strong>Does a trial of non-invasive ventilation (NIV) in COVID-19 patients worsen mortality in patients intubated due to ARDS?</p><p><strong>Study design and methods: </strong>A single-center, retrospective cohort study of all adult patients (n = 161) with COVID-19 admitted to the ICU between March 2020 through September 2022 with acute hypoxic respiratory failure were included. The group was divided into patients intubated after a trial of NIV (N = 100) and patients intubated without a trial of NIV (N = 61). The primary outcome was to compare the mortality rates between the two groups.</p><p><strong>Measurements and main results: </strong>ICU mortality (defined as death during ICU admission) was higher in patients intubated after a trial of the NIV group compared to those without a trial of NIV (69% vs 52%, p = 0.044). Patients initially treated with a trial of NIV had an odds ratio (OR) of 2.17 for mortality compared to those intubated without a trial of NIV (95% CI 1.04-4.54). ICU length of stay was higher in the intubation after a trial of the NIV group, 11.9 vs 7.7 days (p = 0.001). Patients intubated after a trial of NIV had a longer hospital Length of stay (LOS) (IRR 1.39, 95% CI 1.05-1.85, p = 0.022). However, the duration of mechanical ventilation was similar in the two groups (IRR 1.23, 95% CI 1.93-4.68, p = 0.35). The incidence of pneumothorax, ventilator associated pneumonia (VAP), and venous thromboembolism (VTE) were similar in the two groups.</p><p><strong>Conclusion: </strong>In ARDS, a lung protective strategy with low TV has been proven to improve patient outcomes. The use of a trial of NIV prior to intubation is associated with an increase in mortality.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 4","pages":"14-20"},"PeriodicalIF":0.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775540","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}