Laxman Wagle, Dhiraj R Regmi, Alexander Reyes, Rashmita Regmi
{"title":"Type B Aortic Dissection Secondary to Non-typhoidal Salmonella Aortitis: A Case Report and Literature Review.","authors":"Laxman Wagle, Dhiraj R Regmi, Alexander Reyes, Rashmita Regmi","doi":"10.55729/2000-9666.1419","DOIUrl":"10.55729/2000-9666.1419","url":null,"abstract":"<p><p>Infectious aortitis is an uncommon but potentially fatal condition that can lead to aortic dissection or rupture. We describe a case of a 69-year-old female who developed a Stanford type B aortic dissection, presumptively caused by Salmonella, which was successfully managed with thoracic endovascular aneurysm repair (TEVAR) and long-term antibiotics. A literature review of 17 reported cases from 2000 to 2024 of aortic dissection secondary to infectious aortitis was conducted. The most frequently implicated causative organisms were Salmonella and Staphylococcus species. Presenting symptoms were non-specific, such as fever, chest or abdominal pain, and constitutional symptoms. Predisposing factors included hypertension, malignancy, diabetes, atherosclerosis, and hyperlipidemia. The proposed pathogenesis involves bacterial seeding of the aortic wall, leading to enzymatic degradation and structural weakening. Management requires prompt surgical intervention (open or endovascular) based on Stanford dissection type, combined with long-term antibiotic therapy. Early diagnosis is crucial, as infectious aortitis can rapidly progress to life-threatening sequelae like rupture or dissection. Clinicians must maintain a high index of suspicion in at-risk patients presenting with suggestive symptoms or imaging findings.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"66-74"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006451","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}
Sandra Gomez-Paz, Eric Lam, Joshua Fogel, Sofia Rubinstein
{"title":"Clinical Variables Associated With Impaired Consciousness in Hospitalized COVID-19 Patients.","authors":"Sandra Gomez-Paz, Eric Lam, Joshua Fogel, Sofia Rubinstein","doi":"10.55729/2000-9666.1422","DOIUrl":"10.55729/2000-9666.1422","url":null,"abstract":"<p><strong>Background: </strong>Impaired consciousness is associated with complications and mortality in COVID-19 patients. We study factors associated with impaired consciousness as measured by the Glasgow Coma Scale (GCS) in COVID-19 patients.</p><p><strong>Methods: </strong>This is a retrospective study of 604 patients with COVID-19 in the metropolitan New York City area. We study the association of demographics, comorbidity, disease severity, treatment management, and laboratory measurements with both GCS nadir during hospitalization and GCS at discharge.</p><p><strong>Results: </strong>Age was significantly associated with severe GCS nadir during hospitalization and at hospital discharge. Body mass index comorbidity was significantly associated with severe GCS at hospital discharge. Sedation treatment was significantly associated with both moderate and severe GCS nadir during hospitalization. Glucose nadir was significantly associated with severe GCS nadir during hospitalization. Sodium level at admission was associated with decreased relative risk while BUN peak level during hospitalization was associated with increased relative risk for severe GCS on discharge.</p><p><strong>Conclusion: </strong>We found that factors from demographics, comorbidity, treatment management, and laboratory measurements were associated with GCS while disease severity was not significantly associated with GCS. These findings can guide clinicians for treatment approaches for the early identification of impaired consciousness and its degrees of severity in COVID-19 patients.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"43-49"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006397","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}
Golnaz Moradi, Safa S Etehadi, Seyed H Mousavi, Rayeheh Mohammadi
{"title":"Evaluating the Cavitary Lung Lesions on CT Scan of COVID-19 Patients: A Retrospective Study.","authors":"Golnaz Moradi, Safa S Etehadi, Seyed H Mousavi, Rayeheh Mohammadi","doi":"10.55729/2000-9666.1411","DOIUrl":"10.55729/2000-9666.1411","url":null,"abstract":"<p><strong>Background: </strong>It has been shown that cavitary lesions on CT scans of patients with COVID-19 may be related to their clinical symptoms and mortality rate.</p><p><strong>Materials and methods: </strong>The study population included patients diagnosed with COVID-19 based on RT-PCR results from throat samples or typical clinical and chest CT scan findings who were hospitalized at Sina Hospital in Tehran in 2020 and underwent chest CT scans. Chest CT scans were examined for the severity of pulmonary opacities and the presence, number, size, wall thickness, and distribution of cavitary lung lesions.</p><p><strong>Results: </strong>Oxygen saturation was lower in patients with cavitary lesions in the initial state and after treatment than those without cavitation, and a statistically significant relationship was observed (p < 0.05). In terms of gender, a significant correlation was observed, and the prevalence of cavitary lesions was higher in men (p < 0.05). Also, the in-hospital mortality rate was higher in patients with cavitary lesions (p < 0.05).</p><p><strong>Conclusion: </strong>Based on our results, the presence of cavitary lung lesions in COVID-19 patients is related to the mortality rate, severity of pulmonary involvement, and patients' gender.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"23-29"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006413","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":"Game Changer or More of the Same? A Comparative Meta-analysis of Rezafungin and Caspofungin in Treating Candidemia and Invasive Candidiasis.","authors":"Zouina Sarfraz, Zeeshan Nasir, Faheem Javad, Aden Khan, Bushra Shah, Musfira Khalid, Azza Sarfraz, Muzna Sarfraz, Amna Minhas, Suchal A Gondal","doi":"10.55729/2000-9666.1391","DOIUrl":"https://doi.org/10.55729/2000-9666.1391","url":null,"abstract":"<p><p>This meta-analysis assesses the recent Food and Drug Administration (FDA)-approved antifungal, rezafungin, for treating candidemia and invasive candidiasis-both are significant health concerns with limited treatment options. Two randomized controlled trials comparing rezafungin to caspofungin were meta-analyzed, revealing no significant differences in global cure rates and 30-day all-cause mortality. While rezafungin's unique attributes, like a novel mechanism and once-weekly dosing, may enhance patient adherence, concerns arise about its clinical relevance given the substantial investment. The study emphasizes the need for ongoing research, post-marketing surveillance, and real-world data to determine rezafungin's true value in managing these life-threatening fungal infections. Despite FDA approval, further investigation is warranted for a comprehensive understanding of rezafungin's efficacy and safety.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"1-6"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466626","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":"Postpartum Acquired Hemophilia A.","authors":"Khawaja O Omar, William Sebastian, Suzanne Kemper","doi":"10.55729/2000-9666.1382","DOIUrl":"https://doi.org/10.55729/2000-9666.1382","url":null,"abstract":"<p><p>Acquired hemophilia A (AHA) is a bleeding disorder that occurs from aberrant production of autoantibodies that target factor VIII. The underlying cause of AHA is unclear but can present postpartum. Very few cases have reported instances of AHA coexisting with other hematological disorders, such as sickle cell trait (SCT). Although rare and no direct correlation between the two, critical situations involving intractable bleeding can intensify the severity of these disorders. A 31-year-old pregnant female with a medical history significant for SCT presented to the hospital for a C-section. Shortly after the procedure she experienced intractable bleeding from multiple sites. Initial lab work yielded an isolated increase in activated partial thromboplastin time (aPTT). Further investigation showed abnormal mixing studies, reduced factor VIII activity and the presence of factor VIII antibodies. The patient was diagnosed with postpartum AHA (PAH) and treated with activated Factor VII and prednisone. PAH is an uncommon bleeding disorder that commonly occurs one to four months postpartum and presents as excessive bleeding elevated aPTT, abnormal mixing studies, and reduced factor VIII levels with abnormally high inhibitor levels. Despite an unknown identifiable etiology, treatment hinges upon establishing hemostasis and eradicating the aberrant generated factor VIII inhibitors. The association of AHA and other hematological disorders is not yet elucidated.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"85-88"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466630","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}
Abdulahi Hassan, Matthew Simpson, Rahim Jiwani, Abigail Arrigo, Palgun Nisarga, Olukemi A Esan, Anna Koget
{"title":"Blast and Bursts: Unveiling Splenic Rupture in Blastic Plasmacytoid Dendritic Cell Neoplasia.","authors":"Abdulahi Hassan, Matthew Simpson, Rahim Jiwani, Abigail Arrigo, Palgun Nisarga, Olukemi A Esan, Anna Koget","doi":"10.55729/2000-9666.1389","DOIUrl":"https://doi.org/10.55729/2000-9666.1389","url":null,"abstract":"<p><p>Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) is a rare hematologic cancer, accounting for less than 1% of acute leukemias in the U.S. Diagnosis involves detecting markers like CD123, CD4, CD56, TCL1, and TCF4. Treatment typically involved acute leukemia therapies, but Tagraxofusp, a targeted therapy, was recently approved. Despite advancements, prognosis remains grim, with a median survival of around 1 year. Atraumatic splenic rupture (ASR) is a rare complication of this condition, with only five cases reported from 1994 to 2018. Here we present a case of BPDCN complicated by ASR. This case emphasizes the challenges of diagnosing and treating BPDCN, noting its rarity and absence of standard therapy. Tagraxofusp has shown promising results but presents safety concerns like capillary leak syndrome, particularly in elderly patients with comorbidities.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"96-100"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466596","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":"Characterization of Markers in Blood Tests of Patients With Pleural Effusion and Their Correlation to Different Etiologies.","authors":"Raymond Farah, Keren Sidar-Orlin, Adi Sharabi-Nov","doi":"10.55729/2000-9666.1395","DOIUrl":"https://doi.org/10.55729/2000-9666.1395","url":null,"abstract":"<p><strong>Background: </strong>To investigate the etiology of pleural effusion, a variety of examinations are performed, including invasive ones: Thoracentesis is an invasive procedure to remove fluid or air from the pleural cavity for diagnostic or therapeutic purposes. Until now, there are no blood markers that can help us diagnose the type of pleural effusion without the need for pleural puncture or drainage.</p><p><strong>Aims: </strong>The aim of this study was to investigate the relationship and the utility of the new inflammatory markers taken from complete blood count (CBC) to differentiate between the various types of pleural effusion before the invasive procedure decision.</p><p><strong>Material and methods: </strong>This is an observational retrospective study. Data was collected from medical records of patients aged 18-90 admitted in Ziv Medical Center, Safed, Israel that were diagnosed with pleural effusion from 2013 to 2019. Of those patients, of whom inflammatory markers from blood counts and thoracentesis results were obtained, the outcomes were compared with the diagnosis type of pleural effusion.</p><p><strong>Results: </strong>This study involved 391 patients, 256 suffered from exudate type effusion, their median age was 72 years, while 135 suffered from transudate effusion, their median age was 80 years. Those with exudate effusion had higher levels of CRP, platelets, neutrophils, and lymphocytes in blood, whereas those with transudate effusion had higher levels of MPV and RDW in blood. Other blood markers such as NLR and PLR were not statistically significant, but were also higher in the blood of patients with exudate effusion.</p><p><strong>Conclusion: </strong>An evaluation of simple and inexpensive measurements of blood count such as platelets, neutrophils, lymphocytes, MPV, RDW may provide insight into the etiology of pleural effusion.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"30-34"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466598","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}
Mohammed Ahsan, Zackary Anderson, Medjine Jarbath, Maged Bakr, Raymond W Phillips
{"title":"The Impact of Computer-aided Detection Technology in Adenoma Detection Rate Among Experienced Endoscopists in the Community Setting.","authors":"Mohammed Ahsan, Zackary Anderson, Medjine Jarbath, Maged Bakr, Raymond W Phillips","doi":"10.55729/2000-9666.1396","DOIUrl":"https://doi.org/10.55729/2000-9666.1396","url":null,"abstract":"<p><p>Adenoma detection rate (ADR) is a key quality metric in screening colonoscopies. An adenoma detection rate of greater than 30% reduces the incidence of colorectal carcinoma (CRC). Furthermore, studies have demonstrated an inverse relationship between ADR and the incidence of CRC. Computer aided detection (CAD) can improve ADR, but these studies have largely been in major medical centers. In this retrospective single center observational study, screening colonoscopies in average-risk patients were compared among 5 experienced endoscopists in the year before and the year after implementation of the CAD (GI Genius). Training for GI Genius was completed in December 2021 and the technology was implemented the beginning of January 2022. We evaluated the adenoma detection rate (ADR) for 1838 screening colonoscopies in 2021 (before CAD incorporation) and 2629 screening colonoscopies in 2022 (after CAD incorporation) to assess efficacy of AI-assisted colonoscopy. Our study demonstrates that the incorporation of CAD technology in a group of experienced endoscopists in a community setting significantly improved ADR. The ADR of the entire group increased significantly (p < 0.05) following the implementation of CAD technology. The improvement in ADR was attributed to an increased detection of small (<6 mm) polyps. The clinical significance of improved detection of small polyps is uncertain, and further investigation should be done on the economical benefit of incorporating an AI model in the community setting.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"42-48"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466634","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}
Edward Lovering, Ananta Paudel, Christopher J Haas
{"title":"<i>Myroides odoratus</i> Induced Cellulitis and Bacteremia in an Elderly Male.","authors":"Edward Lovering, Ananta Paudel, Christopher J Haas","doi":"10.55729/2000-9666.1386","DOIUrl":"https://doi.org/10.55729/2000-9666.1386","url":null,"abstract":"<p><p><i>Myroides odoratus</i> is a relatively little-known pathogen despite its ubiquitous presence in the environment. It is an opportunistic gram-negative bacillus commonly found in soil and water. Infection by Myroides species is rare, but the spectrum of illness varies from skin and soft tissue infections, urinary tract infections, pneumonia, and, in severe cases, bacteremia and septic shock. Though infection with Myroides species is uncommon and typically limited to immunocompromised individuals, the wide range of antimicrobial resistance it exhibits makes treatment challenging. In this report, we present the case of a 76-year-old male with compensated cirrhosis who presented with cellulitis complicated by bacteremia secondary to <i>M. odoratus</i> and was managed successfully with levofloxacin.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"73-75"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466591","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":"Abnormal TSH Level as a Predictor of Severe Outcomes Among Patients Hospitalized With COVID-19.","authors":"Pinak A Shah, Kartika Shetty, Faraz Rahman, Andrey Manov, Mayesha Sharaf","doi":"10.55729/2000-9666.1400","DOIUrl":"https://doi.org/10.55729/2000-9666.1400","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between thyroid dysfunction and mortality among patients hospitalized with COVID-19. Design: This is a retrospective multi-center study, which examined all patients admitted with Covid-19 diagnoses, and thyroid function results in absence of known thyroid disease.</p><p><strong>Results: </strong>10,933 hospitalized COVID-19 positive patients were included in the study. These patients were without prior diagnosis or treatment of thyroid disease. Outcomes assessed were mortality, ICU admission, Ventilator use, length of stay, readmission and complications during hospital stay. Patients with low TSH and Low free T4 had odds of mortality of 10.07(95% CI [7.44-13.6]) compared to patients with Normal TSH and any free T4 levels. Patients with Low TSH and High free T4 also had odds of mortality of 1.38 (95% CI [1.19-1.59]) compared to patients with Normal TSH and Any free T4 level. Patients with Low TSH and Normal free T4 levels also had an Odds of mortality of 1.46 (95% CI [1.31-1.62]) compared to patients with Normal TSH and any free T4 level. Patients with Low TSH also had higher odds of ICU admission and Ventilator use when compared to patients with normal TSH.</p><p><strong>Conclusions: </strong>This study shows that patients with low TSH, regardless of free T4 level, indicates poor prognosis for hospitalized patients with SARS-CoV-2 infection and offers further insights into possible prognostic value of TSH levels for severe COVID-19 outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 5","pages":"35-41"},"PeriodicalIF":0.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466593","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}