Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"How Do Polymorphonuclear Counts in Ascitic Fluid Correlate to Hospital Outcome.","authors":"Rakahn Haddadin, Michael Ghobrial, Tarek Tabbah, George Trad, John Ryan, Robert G Gish, Pinak Shah","doi":"10.55729/2000-9666.1475","DOIUrl":"10.55729/2000-9666.1475","url":null,"abstract":"<p><p>Polymorphonuclear neutrophils (PMNs) are critical mediators in the innate immune response, and their levels in ascitic fluid are pivotal for diagnosing spontaneous bacterial peritonitis (SBP), particularly in patients with liver cirrhosis. This retrospective study investigates the association between varying PMN counts in ascitic fluid and hospital outcomes, including mortality, 30-day readmission rates, and length of stay (LOS). We analyzed de-identified data from HCA Healthcare hospitals (July 2013-December 2023), focusing on patients aged 18 and older with a diagnosis of liver cirrhosis who underwent paracentesis. Patients were categorized based on PMN counts into three groupings to assess their clinical outcomes. Our findings suggest that lower PMN counts correlate with increased mortality, particularly in groups with counts ≤100 and ≤200 cells/mm³. Conversely, higher PMN counts (201-249 cells/mm³) were associated with reduced odds of mortality. While 30-day readmissions demonstrated complex associations, higher counts also linked to increased readmission risk in the highest subgroup. Interestingly, LOS showed no significant differences across PMN levels. This study underscores the nuanced role of PMN counts in prognostication and treatment decisions for cirrhotic patients. Given emerging literature questioning the strict PMN diagnostic threshold for SBP, our results advocate for reconsideration of current guidelines to optimize patient management and outcomes. Further investigation is warranted to delineate the implications of PMN levels in the context of antimicrobial therapy and broader clinical strategies in liver disease management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"15-22"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775510","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":"Combatting the Mpox Outbreak in Pakistan: An Urgent Public Health Imperative.","authors":"Abdul B Sangah, Shazia S Shaikh, Abdul Karim, Rohait Kumar, Mubashir Hussain","doi":"10.55729/2000-9666.1478","DOIUrl":"10.55729/2000-9666.1478","url":null,"abstract":"","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"125-127"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775506","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":"Interaction Between Age and Tumor Stage in Survival Outcomes of Patients With Mantle Cell Lymphoma.","authors":"Ayrton Bangolo, Behzad Amoozgar, Vignesh K Nagesh, Kyra McGrath, Swapnika Mallipeddi, Samantha Cash, Ankit Sandilya, Rakshanda Banu, Frantz R Martine, Sarvarinder Gill, Lili Zhang, Shafia Naeem, Pujita Mallampalli, Arun Ram, Dessislava Papantoniou, Shallot Nareeba, Kwangha Baek, Urveesh Sharma, Gopal Mondal, Kausar Bano, Mary Gad, Priya R Rokade, Monica M Kharat, Aditya Dodhia, Snehal Goud, Sahiti Gavva, Eyasu G Aduna, Zaed S Siddiqui, Aadi R Palvia, Arjuninder Singh, Akaash Nayak, Krishna P Jakkula, Achint Jethi, Neeharika Thota, Simcha Weissman","doi":"10.55729/2000-9666.1480","DOIUrl":"10.55729/2000-9666.1480","url":null,"abstract":"<p><strong>Background: </strong>Mantle Cell Lymphoma (MCL) is a rare and aggressive subtype of non-Hodgkin lymphoma. This study explores the demographic and clinicopathologic characteristics of 746 MCL patients diagnosed in the United States between 2000 and 2015, focusing on the interaction between age and tumor stage.</p><p><strong>Methods: </strong>Using SEER database data, this retrospective cohort study analyzes demographic and clinical variables like age, gender, stage, treatment, and marital status. Mortality risks were assessed using Cox proportional hazard regression models to identify predictors of overall mortality (OM) and cancer-specific mortality (CSM), emphasizing age-tumor stage interactions.</p><p><strong>Results: </strong>Multivariate Cox regression identified age and advanced Ann Arbor stage (II, III, and IV) as critical predictors of increased OM and MCL-specific mortality. Patients aged 80+ had the highest mortality risks (OM HR = 3.93, 95 % CI 1.33-11.64; CSM HR = 4.02, 95 % CI 1.36-11.88). Marital status was significant, with widowed individuals experiencing elevated mortality (OM HR = 1.85, 95 % CI 1.28-2.68; CSM HR = 1.81, 95 % CI 1.26-2.61). Advanced staging combined with older age showed significant risk interactions, except for Stage III, which lacked age-related significance.</p><p><strong>Conclusion: </strong>Age, tumor stage, and marital status strongly influence MCL outcomes, highlighting the need for personalized management strategies. Widowed status underscores the role of social support in survival. Tailored interventions, accounting for these factors, can improve patient outcomes. Further research is essential to clarify age-stage interactions and refine therapeutic approaches.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"5-14"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775512","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":"Rapidly Developing Bilateral Loculated Streptococcus Pyogenes Empyema in an Immunocompetent Adult: A Case Report.","authors":"Anish K Shrestha, Matthew Dwumah-Agyen, Boniface Mensah, Yvette Yeboah-Kordieh, Marcos A Wolff, Jennifer A Evans","doi":"10.55729/2000-9666.1489","DOIUrl":"10.55729/2000-9666.1489","url":null,"abstract":"<p><p><i>Streptococcus pyogenes</i> is a rare cause of empyema, especially in immunocompetent individuals. The organism expresses various virulence factors leading to rapid progression of the disease. We report a case of rapidly progressing bilateral loculated empyema caused by streptococcus pyogenes in an immunocompetent host without additional risk factors.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"116-119"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775517","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 Discovery of Neuroendocrine Tumor: Cardiac Mass.","authors":"Anish K Shrestha, Anirudra Devkota, Terina S Chen, Mahsa Mohebtash","doi":"10.55729/2000-9666.1488","DOIUrl":"10.55729/2000-9666.1488","url":null,"abstract":"<p><p>Carcinoid tumors are rare, slow-growing neoplasms of neuroendocrine origin commonly affecting the gastrointestinal or respiratory system. They metastasize to lymph nodes and the liver based on their lymphatic and venous drainage of their tissue of origin. Metastasis to the heart is exceedingly rare accounting for <2 % of cases. Exceedingly rare is the incidental detection of cardiac carcinoid metastasis as the initial presentation of carcinoid syndrome. Here, we describe a case of metastatic cardiac carcinoid detected during a routine echocardiogram done for evaluation of a systolic murmur.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"76-79"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775502","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":"Post-myocardial Infarction Associated Ventricular Septal Defect in an Older Female.","authors":"Nismat Javed, Vikram Itare, Nolberto B Hernandez, Nisha Ali, Preeti Jadhav","doi":"10.55729/2000-9666.1472","DOIUrl":"10.55729/2000-9666.1472","url":null,"abstract":"<p><strong>Background: </strong>Ventricular septal defect (VSD) is a serious but uncommon complication that can develop 2 days to 2 weeks after a myocardial infarction (MI), particularly if percutaneous coronary intervention (PCI) is delayed.</p><p><strong>Case presentation: </strong>A 91-year-old woman with a history of coronary artery disease had undergone PCI in left anterior descending (LAD) and left circumflex artery (LCX) for a non-ST-elevation myocardial infarction (NSTEMI) 4 weeks prior at another facility, which was complicated by distal wire perforation leading to hemopericardium and the need for pericardiocentesis. She presented with chest pain, and her tests showed ST-segment elevation in leads I, aVL, V2-5, and ST-depression on III, avF, and high troponin levels which were concerning for stent thrombosis. Due to her age and multiple comorbidities, she was managed medically and her code status was changed to do-not-resuscitate/do-not-intubate (DNR/DNI) after family discussion. Echocardiogram revealed a severely reduced ejection fraction and a new mid-inferoseptal VSD detected on readmission. The patient died 4 days later, highlighting the critical importance of timely PCI to prevent severe complications like VSD.</p><p><strong>Conclusions: </strong>VSD lesions although uncommon with the advent of PCI should always be considered in cases with septal lead STEMI and new onset murmur. VSD remains a late complication of STEMI in patients who are managed medically and not offered PCI.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"63-67"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775516","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":"Case With Refractory Myasthenia Gravis Caused by Pembrolizumab.","authors":"Bushra Amer, Fatima D Hawshab, Lateefah D Hawshab, Khaled M Darwesh","doi":"10.55729/2000-9666.1486","DOIUrl":"10.55729/2000-9666.1486","url":null,"abstract":"<p><p>Nowadays, checkpoint inhibitors play a major role in the management of different types of cancers. However, we have seen variants of immune therapy-related adverse events, which usually are variables from fatigue, to neuropathy to severe devastating complications such as respiratory failure due to myasthenia gravis (MG), as we saw in our case. Our patient was started on pembrolizumab, and they developed severe respiratory failure attributed to MG after three weeks from treatment initiation. Also, the patient presented with myositis, mild myocarditis and hepatitis, which were all related to pembrolizumab.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"59-62"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775504","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":"Iron Deficiency-More Than Just Anemia: A Literature Review.","authors":"Arianna S Moss, Zahra Pakbaz","doi":"10.55729/2000-9666.1481","DOIUrl":"10.55729/2000-9666.1481","url":null,"abstract":"<p><p>Iron deficiency (ID) is a global public health concern, as it can be a prodrome of gastrointestinal (GI) malignancies, exacerbate chronic conditions, and lead to an overall decreased quality of life. Despite being the most prevalent nutritional deficiency, it remains underdiagnosed by many healthcare professionals. Misconceptions regarding the clinical and laboratory manifestations of ID lead to delayed or missed diagnoses, contributing to poor patient outcomes. Though anemia is a commonly known consequence of ID, there are additional consequences that remain underrecognized by the medical community, including vague signs and symptoms, such as fatigue, depression, and abnormalities in white blood cell and platelet counts. A thorough understanding of the pathophysiology connecting ID to white blood cell and platelet dyscrasias is essential for accurate diagnosis and effective treatment. This review aims to highlight existing gaps in physicians' ability to diagnose ID and the underrecognized laboratory presentations of ID without anemia.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 3","pages":"38-45"},"PeriodicalIF":0.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775513","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 Effect of Atrial Fibrillation on Mortality Outcomes in Patients Admitted With Diabetic Ketoacidosis.","authors":"Ajay Mishra, Umabalan Thirupathy, Anil Jha, Anu A George, Douglas Laidlaw","doi":"10.55729/2000-9666.1461","DOIUrl":"https://doi.org/10.55729/2000-9666.1461","url":null,"abstract":"<p><p>This study aims to identify the effect of atrial fibrillation on mortality in patients admitted with DKA. We used the National Inpatient Sample Database for the year 2018 and 2019 to identify patients hospitalized with DKA. Association of atrial fibrillation was confirmed using the International Classification of Disease, Tenth Edition (ICD 10 CM). We performed a retrospective analysis on this database using STATA (Stata Corp, College Station, TX). The primary outcome was mortality in DKA. Length of stay (LOS) and total hospitalization charge were the secondary outcomes. There was a total of 447,570 DKA patients out of which 12,770 had associated atrial fibrillation in the year 2018-2019. The mean age of patients with DKA and AFIB was 62 years. Approximately 46% of patients were female in DKA with AFIB group. The multivariate logistic analysis showed increased mortality in patients with DKA and AFIB (OR = 1.4, p = 0.048). Predictors of increased mortality were older age and in metropolitan areas (OR = 1.0, p < 0.001 and OR = 1.4, p = 0.031 respectively). LOS was lower in patients with DKA and AFIB compared to DKA alone (3.1 day and 5.2 days respectively, OR = 0.82, p < 0.001). Total hospitalization charge was higher for patient in DKA with AFIB (USD 53,576 and USD 32,533 respectively, coefficient = 10,513, p < 0.001). Patients hospitalized with DKA and AFIB had higher mortality compared to patients without AFIB, while they showed lower LOS but increased hospitalization cost. Further research in this direction would be helpful to better understand this association.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"14-20"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020199","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":"Pseudogout in an Acute-care Hospital: Hospitalists as the Key to Optimized Care.","authors":"Taku Harada, Takashi Watari, Mori Nakai","doi":"10.55729/2000-9666.1455","DOIUrl":"https://doi.org/10.55729/2000-9666.1455","url":null,"abstract":"<p><p>Acute calcium pyrophosphate crystal arthritis (CPP) or pseudogout commonly affects older adults and may manifest as fever during hospitalization. However, its recognition as a cause of fever remains under-investigated, and diagnostic delays have been reported in approximately 27% of cases. This study evaluated the diagnostic and treatment accuracies of acute CPP in acute-care hospitals over a decade. Out of 47 cases, effective treatment was administered within 24 h in only 40.4% of cases. When managed by hospitalists, the likelihood of a timely and appropriate diagnosis increases, with a reduction of about half in the unnecessary use of computed tomography scans and antibiotics.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"21-24"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009158","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}