Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Rare Case of Intragastric Balloon Induced Acute Pancreatitis.","authors":"Islam Rajab, Nagihan Orhun, Mina F Alkomos, Yana Cavanagh, Walid Baddoura","doi":"10.55729/2000-9666.1464","DOIUrl":"https://doi.org/10.55729/2000-9666.1464","url":null,"abstract":"<p><p>Intragastric balloon (IGB) placement, a minimally invasive intervention for obesity, can lead to a range of complications from mild gastrointestinal symptoms such as nausea, vomiting, abdominal pain, and gastroesophageal reflux (GERD) to more severe and life-threatening conditions, including perforation, balloon migration, and pancreatitis. IGB-related pancreatitis is a rare complication, but it is being reported in the literature. This case report presents a rare cause of pancreatitis induced by IGB, with complete resolution achieved following balloon removal.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"61-65"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026711","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":"Accelerated Ischemic Disease Presenting as Ventricular Fibrillation.","authors":"Nismat Javed, Vikram Itare, Nisha Ali, Nassim Krim, Preeti Jadhav","doi":"10.55729/2000-9666.1460","DOIUrl":"https://doi.org/10.55729/2000-9666.1460","url":null,"abstract":"<p><strong>Introduction: </strong>Ventricular fibrillation (VF) is often associated with underlying structural heart disease and occurs in a small percentage of acute myocardial infarction (MI) cases. Specific conditions such as complete coronary occlusion, anterior wall infarction, and pre-existing conditions like atrial fibrillation or congenital abnormalities increase the risk of VF. In this report, we present the case of a 64-year-old male with a history of hypertension, HIV, and opioid dependence who developed VF during stress testing despite having no prior structural heart disease. This case supports the hypothesis that ongoing ischemia may trigger VF in the absence of structural heart disease.</p><p><strong>Case presentation: </strong>A 64-year-old male with a medical history of hypertension, HIV, and opioid dependence presented with chest pain and dyspnea. The patient's ECG showed changes suggestive of an inferior myocardial infarction. During a dobutamine stress test, the patient developed VF and was successfully resuscitated. Subsequent coronary angiography revealed severe triple vessel disease, and the patient underwent coronary artery bypass surgery. He recovered well postoperatively and was discharged on dual antiplatelet therapy.</p><p><strong>Conclusion: </strong>VF occurs in a significant percentage of MI patients and is often associated with coronary artery disease and acute thrombotic lesions. This case illustrates that even in the absence of structural heart disease, ischemia can trigger VF. Early identification and invasive management, such as coronary angiography and mechanical circulatory support, are critical for improving survival outcomes in these patients.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"56-60"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973389","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":"Subcutaneous Insulin Aspart Every 4 Hours in the Treatment of COVID-19 Patients With Mild-to-Moderate Diabetic Ketoacidosis: A Case Series.","authors":"Dararat Chiewchalermsri, Chayanin Wanittansirichok, Chutintorn Sriphrapradang","doi":"10.55729/2000-9666.1456","DOIUrl":"https://doi.org/10.55729/2000-9666.1456","url":null,"abstract":"<p><p>This case series evaluates the efficacy and safety of subcutaneous (SC) insulin Aspart administered every 4 h for managing mild-to-moderate diabetic ketoacidosis (DKA) in COVID-19 patients, addressing a current evidence gap. We conducted a retrospective review of confirmed COVID-19 patients over 15 years old who developed mild to moderate DKA between July 2020 and October 2021. Insulin Aspart was administered at 0.4 units/kg SC every 4 h, reduced to 0.2 units/kg when blood glucose (BG) decreased to <250 mg/dL, and SC basal insulin was initiated at 0.15-0.2 units/kg at DKA diagnosis. A total of seven patients, with a mean age of 67.4 ± 13.2 years, predominantly female (71.4 %), and all with pre-existing type 2 diabetes mellitus, were analyzed. Initial biochemical parameters included BG of 449 ± 157.3 mg/dL, HbA1c of 10.6 ± 2.8 %, pH of 7.34 (range, 7.26-7.45), beta-hydroxybutyrate of 4.0 ± 1.5 mmol/L, and bicarbonate of 15.5 ± 2.2 mmol/L. The time to resolution of hyperglycemia (BG < 250 mg/dL) and DKA was 8.0 ± 3.1 and was 12.7 ± 5.8 h, respectively. During DKA resolution, one patient experienced hypoglycemia (47 mg/dL) and later developed recurrent DKA as COVID-19 infection worsened. Three deaths occurred due to COVID-19-related complications following DKA recovery. While SC insulin Aspart administered every 4 h shows promise, careful monitoring for recurrent DKA and septic shock is essential for optimal management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"66-70"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968242","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 Vulnerability of the Heart During Diarrhea: A Case Report on Pericarditis Linked to Inflammatory Bowel Disease.","authors":"Phani B Cherukuri, Jayasree Ravilla, Siva N S Yarrarapu, Penny Turtel, Du Doantrang","doi":"10.55729/2000-9666.1465","DOIUrl":"https://doi.org/10.55729/2000-9666.1465","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease, often involves extraintestinal manifestations, affecting up to 40% of patients. Cardiovascular complications, although rare, can include pericarditis, the most common cardiac manifestation in IBD.</p><p><strong>Case presentation: </strong>We report the case of a 34-year-old male with a long-standing history of UC who presented with pleuritic chest pain, shortness of breath, and worsening colitis symptoms. This case is particularly noteworthy due to the complexity added by the patient's 24-year history of UC, diverse treatment modalities (including mesalamine, 6-mercaptopurine, infliximab, vedolizumab, upadacitinib, and ustekinumab), and the patient not being on any 5-aminosalicylic acid (5-ASA) medications known to cause pericarditis at the time of presentation. The pericarditis episodes were temporally associated with UC flare-ups, complicating the distinction between disease-induced and medication-induced pericarditis. The patient experienced two recurrent episodes within 14 weeks, and comprehensive investigations excluded other common causes, narrowing down the potential etiologies. Clinical evaluation revealed pericarditis with a moderate pericardial effusion, elevated inflammatory markers, and normal cardiac biomarkers. The patient's pericarditis was managed with corticosteroids and colchicine, leading to rapid symptom resolution. This case underscores the challenge of distinguishing between disease-induced and medication-induced pericarditis in IBD patients.</p><p><strong>Conclusion: </strong>Pericarditis, although a rare extraintestinal manifestation of IBD, should be considered in patients with UC presenting with chest pain. This report highlights the need for heightened awareness and careful management of pericarditis in UC patients. Clinicians should maintain a high index of suspicion for cardiovascular complications in IBD, ensuring timely diagnosis and intervention.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"85-89"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973484","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":"IVIG-induced Aseptic Meningitis in an Adult Patient With Acute Inflammatory Demyelinating Polyneuropathy: A Case Report and Literature Review.","authors":"Brock J Malatches, Ayman Alsaadi, Jemeera Jeyamuhunthan, Sarmad Pirzada, Stefan Odabasic","doi":"10.55729/2000-9666.1466","DOIUrl":"https://doi.org/10.55729/2000-9666.1466","url":null,"abstract":"<p><p>Intravenous immunoglobulins (IVIG) therapy is used to treat various autoimmune, immunodeficiency, and inflammatory conditions. One of the rare, but serious, side effects is aseptic meningitis. In this case report, we present a 55-year-old female who experienced IVIG-induced aseptic meningitis for treatment of acute inflammatory demyelinating polyneuropathy (AIDP).</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"94-98"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009451","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":"Navigating Thyroid Crises: A Nationwide Analysis of the Weekend Effect and Mortality Trends in Myxedema Coma (2016-2020).","authors":"Mariam Hashmi, Zubair H Bodla, Fatima Niaz, Umer Farooq, Zahra Niaz, Christopher L Bray, Peters Okonoboh","doi":"10.55729/2000-9666.1423","DOIUrl":"https://doi.org/10.55729/2000-9666.1423","url":null,"abstract":"<p><p>Our objective was to utilize the National Inpatient Sample (NIS) database for analyzing the outcomes of myxedema coma based on the day of admission and explore five-year mortality trends. This retrospective cohort study examined in-patient mortality and secondary outcomes of patients with myxedema coma from 2016 to 2020 using the NIS database. Patients were selected using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and divided into weekday and weekend admission groups. From 174,776,205 discharges, 5095 patients were included. Mean age of admitted patients was higher on weekdays (67.1 year) than weekends (66.5), with females constituting 69.4% and 67.4% of admissions, respectively. Weekend admissions had higher odds of inpatient mortality compared to weekdays [adjusted odds ratio (aOR): 1.9, p = 0.01]. The overall mortality rate for myxedema coma rose from 6.8% in 2016 to 13.4% in 2020 (p-value = 0.01). No significant difference in the length of stay, hospitalization cost, and charges, blood transfusion, acute kidney injury requiring dialysis, acute respiratory failure requiring intubation and parenteral nutrition was noted between weekday and weekend admissions. Further studies are needed to identify factors contributing to this disparity and to confirm the findings of increasing mortality related to myxedema.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 2","pages":"6-13"},"PeriodicalIF":0.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994737","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 Progressing Secondary Organizing Pneumonia in a Case of Systemic Sclerosis Sine Scleroderma - A Diagnostic Urgency: A Case Report and Literature Review.","authors":"Anish K Shrestha, Jyotsna Gummadi, Basem Al Achras, Nicholas E Ghionni","doi":"10.55729/2000-9666.1442","DOIUrl":"10.55729/2000-9666.1442","url":null,"abstract":"<p><p>Systemic sclerosis sine (latin: without) scleroderma (ssSSc), also called visceral scleroderma, is characterized by internal organ involvement and abnormal serologic abnormalities in the complete or partial absence of cutaneous manifestations of systemic sclerosis.1,2 Pulmonary involvement in scleroderma consists of interstitial lung disease and pulmonary hypertension. Usual interstitial pneumonia (45.4%), followed by nonspecific interstitial pneumonia (36.4%) represents the predominant interstitial lung disease in scleroderma.3 Rarely, organizing pneumonia has been described with scleroderma and seldom with systemic sclerosis sine scleroderma in literature.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"93-97"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046842","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":"Primary Raynaud's Phenomenon.","authors":"Eliana A Alweis, Richard L Alweis","doi":"10.55729/2000-9666.1443","DOIUrl":"10.55729/2000-9666.1443","url":null,"abstract":"<p><p>The authors present a clinical image of primary Raynaud's phenomenon and briefly review its pathophysiology, differential diagnosis, and need for longitudinal follow up.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"49-50"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046901","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":"Oropharyngeal Lymphogranuloma Venereum: A Clinical Reasoning Challenge and Literature Review.","authors":"Andrew D Vogel, Anthony Asta, Hussam Ammar","doi":"10.55729/2000-9666.1439","DOIUrl":"10.55729/2000-9666.1439","url":null,"abstract":"<p><p>Lymphogranuloma venereum (LGV) is a sexually transmitted infection typically caused by serovars L1-L3 of <i>Chlamydia trachomatis</i>. These serovars are tissue-invasive with a preponderance for lymphatic spread and can be acquired via unprotected oral, anal, or vaginal sex. We present the case of a 23-year-old with a prior history of syphilis admitted with four weeks of progressively enlarging painful right cervical lymphadenopathy. Extensive testing, including oropharyngeal swabs and microbiological testing, did not yield a diagnosis, nor did extensive pathological and microbial testing of the lymph node biopsy tissue. Serological test of lymphogranuloma venereum revealed positive <i>Chlamydia trachomatis</i> L1 serovar antibodies. The patient had a complete resolution of his symptoms after three weeks of doxycycline therapy.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"79-83"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046892","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 Embolism in Long Standing Diabetes: A Hint Towards Pancreatic Carcinoma.","authors":"Anish K Shrestha, Christopher Haas","doi":"10.55729/2000-9666.1429","DOIUrl":"10.55729/2000-9666.1429","url":null,"abstract":"<p><p>Pancreatic carcinoma has remained one of the leading causes of cancer-related mortality worldwide. Cancer originating in the head of pancreas is often detected early in the disease due to biliary obstruction resulting in jaundice. In contrast, cancer of the pancreatic body and tail remains indolent, presenting late with significantly increased tumor burden and distant metastasis. Unfortunately, a single laboratory screening study is neither sensitive nor specific for early detection of pancreatic cancer. In this report, we present a patient with longstanding diabetes incidentally detected to have pancreatic tail carcinoma while presenting with pulmonary embolism, emphasizing the need for pancreatic cancer screening studies in population with longstanding diabetes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"118-122"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046903","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}