Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"A Rare Presentation of <i>Pseudomonas Putida</i> Bacteremia Secondary to Skin and Soft Tissue Infection.","authors":"Danielle Rowe, Sachi Patel, Varun Lakhmani, Harsh Patel","doi":"10.55729/2000-9666.1451","DOIUrl":"10.55729/2000-9666.1451","url":null,"abstract":"<p><p><i>Pseudomonas putida</i> is a rod-shaped, flagellated, non-lactose fermenting, gram negative bacterium, usually found in water and soil habitats. <i>P. putida</i> generally causes nosocomial infections in immunocompromised patients. Increased infection rates are seen in those patients with medical devices inserted, due to this organism's innate ability to attach to moist and inanimate objects. In this case report we present a 63-year-old male patient with a past medical history of type II diabetes mellitus, chronic kidney disease stage 5, and hypertension who presented with <i>P. putida</i> cellulitis and bacteremia. This patient had no exposure to contaminated water sources or soil; however, had immunocompromising comorbidities such as diabetes and chronic kidney disease. The patient was treated with intravenous (IV) antibiotics with vancomycin and cefepime which was de-escalated within 48 hours after obtaining sensitivity data from the blood cultures. The patient had an uneventful recovery and was discharged home in a stable condition. This case highlights the importance of considering <i>P. putida</i> as a potential pathogen in immunocompromised patients with no direct exposure to typical environmental sources. Prompt identification and targeted antimicrobial therapy is necessary for a favorable outcome.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"115-117"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046822","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":"Cocaine-induced Vasculitis: Uncommon Manifestations in the Lower Extremities - A Case Report.","authors":"Israel Umoh, Elizabeth Mikhail, Mahmoud Ibrahim, Arvind Kunadi","doi":"10.55729/2000-9666.1441","DOIUrl":"10.55729/2000-9666.1441","url":null,"abstract":"<p><p>Levamisole-induced vasculitis is a recognized dermatopathologic phenomenon frequently observed in individuals engaged in illicit substance use, particularly cocaine. Levimasole's structural resemblance to cocaine leads to its utilization as a cutting or bulking agent, creating an illusion of unaltered purity. While this vasculitis typically manifests in cartilaginous areas such as the ears and nose, it can also occur, though less commonly, in the lower extremities. At the time of writing, our case is the 3^rd case of levamisole induced vasculitis to affect the lower extremities. The primary therapeutic approach involves discontinuing the use of the implicated agent, as repeated exposure to levamisole tends to exacerbate skin lesions with subsequent use. In this report, we present the case of a 30-year-old female with a history of cocaine use, who presented with extensive bilateral chronic leg wounds affecting her ambulation. Histopathological analysis of the skin biopsy confirmed signs of levamisole-induced vasculitis. Our objective is to raise awareness among both the public and healthcare providers, emphasizing the consideration of cocaine-induced vasculitis in patients presenting with chronic non-healing wounds, even in less common anatomical regions. Encouraging substance use cessation is crucial in the management of such cases.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"89-92"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046867","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":"Urine Retention Versus Post-obstructive Diuresis as a Potential Cause of Acute Hyponatremia: A Case Report.","authors":"Akram M Eraky, Sean Hickey, Adnan Khan","doi":"10.55729/2000-9666.1427","DOIUrl":"10.55729/2000-9666.1427","url":null,"abstract":"<p><p>Acute urine retention is a common urologic emergency that is frequently seen in the Emergency room (ER). Standard treatment includes placing a urinary catheter or a suprapubic catheter with outpatient urologic follow-up. Urine retention can cause complications, such as hyponatremia and post-obstructive diuresis. It is crucial to diagnose and manage these life-threatening complications appropriately. Herein, we present a case of urine retention-induced hyponatremia. The patient's urine sodium level and osmolality were consistent with the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH). In this patient, sodium autocorrection started after a urinary catheter placement. Hypotonic saline was administered to prevent rapid autocorrection. This type of hyponatremia is unique as autocorrection occurs after catheter placement; however, monitoring is needed to ensure fast autocorrection does not occur. Potential fast autocorrection is concerning in those patients. Treating those patients with hypertonic fluids or normal saline can exacerbate the fast autocorrection and lead to severe complications. Hypotonic fluid administration should be considered when developing rapid autocorrection.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"103-106"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046982","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":"<i>Proteus mirabilis</i>: An Unlikely Device-related Infection.","authors":"Mark A Colantonio, Michelle Hartzell, Brooke Shannon","doi":"10.55729/2000-9666.1440","DOIUrl":"10.55729/2000-9666.1440","url":null,"abstract":"<p><p>Implantable cardiac devices, including cardiac pacemakers, are not without risk for infection, carrying a mortality and morbidity of around 5-15%. Gram positive organisms are most common in 91% of cases, whereas gram negative organisms are less common, found in 2% of cases secondary to gram negative organisms other than <i>Pseudomonas aeruginosa</i>. Here, we present a rare case of the gram-negative organism <i>Proteus mirabilis</i> leading to a pacemaker site infection.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"84-88"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046812","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":"Home Treatment for Low-risk Pulmonary Embolism: Is it Happening?","authors":"Faria A Nitol, Holman Li, Mohammad Raja, Andrew Miele, Craig Thurm","doi":"10.55729/2000-9666.1418","DOIUrl":"10.55729/2000-9666.1418","url":null,"abstract":"<p><p>Patients with pulmonary embolus (PE) can be stratified into low, intermediate, and high risk based on such factors as hemodynamics and the status of the right ventricle. Low risk patients who meet appropriate criteria can potentially be discharged home with oral anticoagulation, avoiding unnecessary hospitalization and associated complications and costs. However, limited data suggest early discharge of low-risk patients has not gained widespread traction. This retrospective study reviewed 138 patients seen in a high-volume emergency department (ED), 29 of whom were considered low-risk. Of these, 24 (82.7%) were still admitted to the hospital despite meeting appropriate criteria for early discharge. This suggests early discharge of low-risk PE patients is underutilized. A variety of quality improvement measures can be implemented to increase adoption of this approach.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"30-34"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006421","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":"Recurrent Hypoglycemia in a Patient with Advanced Hepatocellular Carcinoma.","authors":"Balpreet Chouhan","doi":"10.55729/2000-9666.1406","DOIUrl":"10.55729/2000-9666.1406","url":null,"abstract":"<p><strong>Background: </strong>Nonislet cell tumor hypoglycemia (NICTH) is a rare but serious complication of malignancy. Various causes of this type of hypoglycemia include excessive tumor burden resulting in destruction of the liver or adrenal glands, production of autoantibodies against insulin and tumoral production of incompletely processed IGF-2.</p><p><strong>Objectives: </strong>Objective of this case report is to explore pathogenic mechanisms for hypoglycemia in hepatocellular carcinoma (HCC), and evidence-based treatment options.</p><p><strong>Methods: </strong>We present a case of recurrent symptomatic hypoglycemia, despite conservative management, in a patient with extensive hepatocellular carcinoma.</p><p><strong>Results: </strong>Patient developed recurrent hypoglycemia despite attempting treatment with therapies based on limited evidence available on literature review.</p><p><strong>Conclusion: </strong>Management of hypoglycemia is usually challenging given patients are usually not good candidates for aggressive therapies given advanced cancer stage and/or poor general condition. Paraneoplastic hypoglycemia is usually a poor prognostic indicator. Experimental treatment options for hypoglycemia include steroids, glucagon and growth hormone.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"94-96"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006429","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":"Review of Attributes and Outcomes of Hospitalized Patients with Alcohol Withdrawal.","authors":"Harsh R Desai, Joan S Hyland, Erica Paulos, Eric Shaw, Nayda Parisio-Poldiak, Maulikkumar Patel","doi":"10.55729/2000-9666.1420","DOIUrl":"10.55729/2000-9666.1420","url":null,"abstract":"<p><strong>Background: </strong>Alcohol abuse leads to millions of hospital admissions each year in the United States. Alcohol withdrawal syndrome (AWS) is associated with several serious complications, including seizures, delirium tremens, and death. Benzodiazepines have been the mainstay of treatment for hospitalized patients with alcohol withdrawal.</p><p><strong>Objective: </strong>To compare hospital length of stay (LOS) among different protocols for the management of AWS in hospitalized patients.</p><p><strong>Methods: </strong>We conducted a retrospective study of 49,125 adult patients admitted over 4 years (2018-2022) to HCA Healthcare hospitals across the USA with a diagnosis of alcohol use disorder or alcohol withdrawal. Hospital LOS was the primary outcome examined across various treatment groups (chlordiazepoxide, diazepam, gabapentin, lorazepam, phenobarbital). Secondary outcomes included the initial Clinical Institute Withdrawal Assessment (CIWA) score, intensive care unit (ICU) admission rates, readmission rates, and mortality.</p><p><strong>Results: </strong>The average age of patients admitted was 48 years, and the majority (72%) were White males. Lorazepam was the most frequently used protocol and was associated with the lowest LOS (3.96 days). Patients treated with lorazepam had relatively higher initial CIWA scores. Only 11% of patients were admitted to the ICU during their hospitalization, and only 2% were intubated or ventilated. There were no 30-day readmissions, and less than 1% of patients admitted with a diagnosis of AWS died. Other protocols, such as gabapentin, diazepam, phenobarbital, and chlordiazepoxide, were less commonly used and had variable impacts on the outcomes studied.</p><p><strong>Conclusions: </strong>The results of this retrospective study support lorazepam as an effective treatment for AWS management. Future research should focus on comparing the effectiveness of alcohol withdrawal assessment tools in patients with baseline psychiatric disorders.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"35-42"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006432","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":"Decreased Duration of Hospital Stays in Uncomplicated Diverticulitis With Initiation of Enteral Feeds Within 24 Hours.","authors":"Rakahn Haddadin, Matthew Brockway, Pinak Shah, Reed Hansen, Christian Stone, Kartika Shetty","doi":"10.55729/2000-9666.1409","DOIUrl":"10.55729/2000-9666.1409","url":null,"abstract":"<p><p>Diverticulitis is a complication of a mostly benign condition called diverticulosis. Diverticulitis is a common illness that medical staff see in emergency departments and hospital inpatient services. The thought process behind this study was looking at the treatment of other diseases like pancreatitis or other critical illnesses and the data supporting timing of feeds. Our study concludes that starting a diet within 24 h of uncomplicated diverticulitis is associated with reduced length of stay without increasing readmission rates and mortality.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"18-22"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006408","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":"Dieulafoy's Lesion in the Esophagus Causing Gastrointestinal Bleeding: A Concise Review.","authors":"Lefika Bathobakae, Joseph Russo, Devina Adalja, Malina Mohtadi, Tyler Wilkinson, Nader Mekheal, Ruhin Yuridullah, Kamal Amer, Yana Cavanagh, Walid Baddoura","doi":"10.55729/2000-9666.1425","DOIUrl":"10.55729/2000-9666.1425","url":null,"abstract":"<p><p>Dieulafoy's lesion (DL) is an uncommon cause of life-threatening gastrointestinal (GI) bleeding. It can occur in any part of the GI tract, including the stomach, duodenum, colon, and esophagus. Dieulafoy's lesion in the esophagus (DLE) is an exceedingly rare entity, with only 23 case reports/series (27 patients) reported to date. We performed a systematic search of published case reports on DLE in PubMed, Google Scholar, and Embase, from inception through January 2024. The search terms for the review were \"Dieulafoy's lesion,\" \"esophagus,\" \"oesophagus,\" \"hematemesis,\" \"melena,\" \"hematochezia,\" and \"gastrointestinal bleeding.\" Articles were eligible for inclusion in the study if they were published in English, described a case of DLE noted on endoscopy or histopathology, and were available as full text. Our literature search yielded 23 articles consisting of 27 patients. Of the 27 patients, eight (30%) were female and 19 (70%) were male. The patients' age ranged from 13 years to 87 years, with an average age of 54.1 years. Twenty-five patients (92.6%) presented with hematemesis and melena as chief complaints. DLE was found in the distal esophagus in 19/27 (70.4%) of the patients and the mid-esophagus in 6/27 (22.2%) of the patients. Two patients had no information about the lesion site. Endoscopic hemoclips were employed in 12 (44.4%) patients, endoscopic band ligation (EBL) in six and electrocautery was used in one patient. Early diagnosis and prompt treatment are crucial for managing DLE, as they can cause recurrent bleeding and potentially lead to complications or death.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"82-88"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006410","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":"Lymphocytic Gastritis in a Patient With Microscopic Colitis: A Case Report.","authors":"Saba Ahmed, Jewel Estrella, Khaleeq Siddiqui, Fahad Malik, Karen Avgush, Yasir Ahmed","doi":"10.55729/2000-9666.1421","DOIUrl":"10.55729/2000-9666.1421","url":null,"abstract":"<p><p>Lymphocytic gastritis (LG) is a rare form of gastritis characterized by lymphocytosis in the gastric mucosa, while microscopic colitis (MC) is the chronic inflammatory disease of the large intestine with lymphocytic or collagenous colitis as two distinct histologic forms. These lymphocytic disorders of the gastrointestinal tract (GIT) have various associations, commonly gluten-sensitive enteropathy, <i>Helicobacter pylori</i> infection and while others are less commonly associated. We report a case of a 24-year-old patient with concomitant lymphocytic gastritis and microscopic colitis diagnosed via histopathologic analysis of tissue specimens from stomach and colon. The presence of a lymphocytic disorder in GIT should prompt workup for associated disorders. There is also an association between lymphocytic disorders of the lower GIT with the upper GIT, and vice versa. Endoscopy is important to diagnose comorbid lymphocytic conditions, and subsequently, guiding treatment.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"14 6","pages":"115-119"},"PeriodicalIF":0.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006426","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}