Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Slipping Through the Chasm of Multicenter Hand-offs-Rare Incidence of Nintedanib Induced Renal Failure: Case Report.","authors":"Muhammad Mohsin Abid, Muhammad Ijaz Khan, Tanvi Jain, Amrita Daniel, Tristan M Flack, Jeffrey N Posner","doi":"10.55729/2000-9666.1561","DOIUrl":"10.55729/2000-9666.1561","url":null,"abstract":"<p><strong>Introduction: </strong>Nintedanib, a receptor tyrosine kinase inhibitor (TKI), is approved for idiopathic pulmonary fibrosis (IPF). While its common adverse effects include gastrointestinal symptoms and elevated liver enzymes, renal toxicity is rare. We report a case of nintedanib-induced kidney failure.</p><p><strong>Case: </strong>An 82-year-old man with IPF and no prior kidney disease developed acute kidney injury (AKI), nephrotic-range proteinuria, volume overload, metabolic acidosis, and hyperkalemia 10 days after starting nintedanib. Extensive serologic investigations were unremarkable. Kidney biopsy showed acute tubular injury, minimal change disease (MCD), focal global glomerulosclerosis, and interstitial fibrosis. Nintedanib and other potential nephrotoxins were stopped, and the patient was started on hemodialysis. Kidney function recovered within six weeks. Five months later, the patient was unintentionally restarted on nintedanib during a phone follow-up. He presented five weeks later with worsening edema, anuria, and weakness. Renal ultrasound was normal. Repeat biopsy revealed MCD, global glomerulosclerosis, extensive tubular necrosis, and 60 % interstitial fibrosis-worse than prior findings. Immunofluorescence was negative, and no other nephrotoxins were involved. Hemodialysis was reinitiated. By three months, kidney function and urine output returned to baseline.</p><p><strong>Discussion: </strong>FDA-approved in 2014 for IPF, nintedanib exemplifies multi-kinase TKIs; renal toxicity, particularly with it, is uncommon. To date, only four post-marketing cases of nintedanib-induced renal injury exist. Histologic findings such as MCD and glomerular sclerosis, previously noted with other VEGF inhibitors, have not been reported with nintedanib.</p><p><strong>Conclusion: </strong>This case underscores the need for vigilance regarding nintedanib's nephrotoxicity and highlights the value of interdisciplinary care to prevent medicationrelated harm.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"40-44"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433224","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":"Losartan-induced Angioedema: A Case Report and Review of Literature.","authors":"Leila C Tou, Audrey Nourse, Rachel Cox, Spencer Stanford","doi":"10.55729/2000-9666.1571","DOIUrl":"10.55729/2000-9666.1571","url":null,"abstract":"<p><p>Angiotensin receptor blockers (ARBs) are frequently prescribed as alternatives to angiotensin-converting enzyme inhibitors (ACEIs), particularly in patients who experience ACEI-induced adverse effects including cough. Although ARBs are associated with a lower incidence of angioedema, rare cases have been reported in patients without prior ACEI exposure. Here, we describe a 58-year-old Black male who developed lip and facial swelling six months after starting losartan. His symptoms did not improve with antihistamines or corticosteroids but resolved after discontinuation of losartan, which was replaced with amlodipine without recurrence. This case emphasizes the need for clinician awareness of ARB-induced angioedema and the importance of balancing this rare risk against the established cardiovascular and renal benefits of ARB therapy.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"45-51"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433205","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":"Statin Induced New-onset Diabetes Mellitus - A Narrative Review.","authors":"Jasvin K Manha, Sumanth K Bandaru","doi":"10.55729/2000-9666.1563","DOIUrl":"10.55729/2000-9666.1563","url":null,"abstract":"<p><p>Statins are widely used to lower LDL cholesterol and prevent cardiovascular disease. Although generally safe, there is increasing evidence that they may increase the risk of new-onset diabetes mellitus (NODM). Recent studies show a modest but consistent rise in diabetes risk associated with statin use, especially among individuals with prediabetes, obesity, or other metabolic risk factors. High-intensity statins like atorvastatin and rosuvastatin carry a greater risk compared to agents such as pravastatin or pitavastatin. Proposed mechanisms include increased insulin resistance, impaired insulin secretion, and changes in hepatic glucose production. Despite the diabetes risk associated with statins, their well-established cardiovascular benefits generally outweigh this concern. This review discusses the current evidence on the association between statin use and NODM, explores potential biological mechanisms, compares the diabetogenic effects of different statins, assess the impact of statin dose and intensity, and outlines implications for clinical practice.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"24-31"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432491","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 Comparison of Biological Therapies vs Traditional Immunosuppressant in the Management of Inflammatory Bowel Diseases: A Narrative Review.","authors":"Umme F Tahir, Sadaf Noureen, Fnu Partab, Muhammad W Afzal, Maham Afzal, Asad Mehmood, Fatima Afzal, Kaynat Hasan, Fnu Sameeha, Seerat Riaz, Sumyya Tariq, Abida Perveen","doi":"10.55729/2000-9666.1566","DOIUrl":"10.55729/2000-9666.1566","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic immune-mediated condition requiring long-term management. Traditional immunosuppressants, such as corticosteroids, thiopurines, and methotrexate, have been widely used but are associated with broad immunosuppressive effects and significant adverse events. The advent of biological therapies, including tumor necrosis factor (TNF) inhibitors, integrin inhibitors, and interleukin (IL)-12/23 inhibitors, has revolutionized IBD treatment by offering targeted immune modulation. Biologics have demonstrated superior efficacy in achieving and maintaining remission compared to traditional immunosuppressants, particularly in moderate to severe IBD. They provide targeted immune suppression, reducing systemic side effects, but are associated with risks such as infections, immunogenicity, and high costs. Traditional immunosuppressants remain relevant for milder cases and as combination therapy but are limited by delayed onset of action and toxicity concerns. Despite these advances, challenges such as treatment accessibility, high costs, and loss of response persist. The introduction of biosimilars and novel small-molecule drugs may improve treatment affordability, while personalized medicine approaches, including biomarker-driven therapy selection and therapeutic drug monitoring, are emerging as crucial strategies to optimize treatment outcomes. While biological therapies have transformed IBD management, future research should focus on refining treatment strategies, improving long-term safety, and enhancing accessibility to ensure better patient outcomes.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"32-39"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433153","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":"Hidden Malignancy: Ileocecal Intussusception as an Atypical First Presentation of Diffuse Large B-cell Lymphoma in Adulthood.","authors":"Komal Harisinghani, Parth Adrejiya, Mohammad Abubaker, Oluchi Idenyi, Raman Babayeuski, Noor Qureshi, Ashok Kanugula, Sara Assaf, Daniel Assaf, Srikanth Maddika","doi":"10.55729/2000-9666.1567","DOIUrl":"10.55729/2000-9666.1567","url":null,"abstract":"<p><p>Intussusception is predominantly a pediatric condition, with only about 5 % of all intussusception cases occurring in adults with primary intestinal lymphomas comprising 1 %-4 % of gastrointestinal malignancies, 90 % of which are B-cell non-Hodgkin lymphomas (NHL). Diffuse large B-cell lymphoma (DLBCL), the most common subtype of NHL, often leads to intussusception without classical B symptoms. We present the case of a 33-year-old male with ileocolonic intussusception caused by a 4.8 × 5.3 × 5.5 cm enhancing mass. Histopathology and FISH confirmed DLBCL without MYC, BCL2, or BCL6 rearrangements, ruling out double- or triple-hit lymphoma. Following a right ileo-colectomy, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy was initiated. This case underscores the role of malignancy in intussusception and highlights the importance of timely diagnosis and management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"56-59"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433179","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":"Remembrance of our Founder and Editor Emeritus.","authors":"Surendra Marur","doi":"10.55729/2000-9666.1572","DOIUrl":"https://doi.org/10.55729/2000-9666.1572","url":null,"abstract":"","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"1-2"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433177","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":"Short Term Outcomes and Resource Utilization in Patients Admitted for Infective Endocarditis Who Develop Pericardial Effusion: A Retrospective Cohort Study.","authors":"Nameer Ascandar, Sajog Kansakar, Waqas Qureshi, Aakash Patel, Ahmed O Farooq, Brett Milford, Suman Pasupuleti, Eduardo J Lazaro","doi":"10.55729/2000-9666.1564","DOIUrl":"10.55729/2000-9666.1564","url":null,"abstract":"<p><strong>Background: </strong>Pericardial effusion (PCE) development in the context of infective endocarditis (IE) may negatively impact clinical outcomes leading to intense resource utilization. Limited contemporary studies exist that examine clinical outcomes, resource utilization and readmission rates in patients admitted for IE who develop PCE.</p><p><strong>Methods: </strong>We utilized the Nationwide Readmissions Database years 2016-2022 to tabulate all adult admissions for IE. We compared clinical outcomes in patients who developed PCE to those who did not. Survey weighted logistic and linear regression analysis was performed to predict in-hospital mortality, clinical outcomes, costs, and 30-day non-elective readmission in association with PCE.</p><p><strong>Results: </strong>Of an estimated 162,694 total patients with IE, 2859 (1.8 %) had PCE and 159,835 (98.2 %) did not. Following risk adjustment, PCE was associated with higher odds of in-hospital mortality, acute heart failure, cardiogenic shock, acute kidney injury, and need for temporary mechanical circulatory support. Additionally, PCE was associated with longer duration of hospital stay and hospitalization costs. Interestingly, PCE cohorts who received drainage during index admission had lower odds of 30-day non-elective readmission.</p><p><strong>Conclusion: </strong>PCE after IE admission was linked with inferior outcomes including in-hospital mortality, and several other outcomes, as well as longer hospital stay and accrued costs. Notably, 30-day non-elective readmission was lower among patients with PCE who underwent intervention to drain the effusion during index hospitalization.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"16 1","pages":"16-23"},"PeriodicalIF":0.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433173","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":"Gastric Adenocarcinoma With Enteroblastic Differentiation Presenting as Lung Nodules: A Diagnostic Dilemma.","authors":"Jain Evani, Yadav Devvrat, Sainatham Chiranjeevi, Kc Manisha, Jain Anirudh, Jindal Vishal","doi":"10.55729/2000-9666.1548","DOIUrl":"10.55729/2000-9666.1548","url":null,"abstract":"<p><strong>Background: </strong>Gastric Adenocarcinoma with enteroblastic differentiation (GAED) is a rare subtype of alpha fetoprotein-producing gastric cancers characterized by a tubulo-papillary pattern resembling fetal gastrointestinal epithelium. It expresses at least one of the following enteroblastic markers (EMs): glypican-3 (GPC3), spalt-like transcription factor 4 (SALL4), and α-fetoprotein (AFP).</p><p><strong>Case report: </strong>A 78-year-old man with a history of chronic dry cough was found to have multiple lung nodules on Chest X-ray and CT, suspicious for a malignancy. Therefore, percutaneous biopsy of the lung nodule was performed which showed CDX-2 positivity on immunohistochemistry (IHC). Next Generation Sequencing (NGS) and Caris GPSai were inconclusive. Therefore, a search for the primary site was initiated. Endoscopy revealed a fungating mass at the gastroesophageal junction while colonoscopy was unrevealing. Histology revealed well-differentiated adenocarcinoma with mucinous features. IHC was positive for SALL-4 and GPC3. HER2 expression returned a 3+ score. Alpha-fetoprotein (AFP) level was elevated. The patient was started on capecitabine and oxaliplatin in addition to trastuzumab with subsequent clinical and radiological improvement.</p><p><strong>Conclusion: </strong>Lung malignancy, primary or metastatic, can present as chronic cough. It is imperative for patients to undergo a thorough workup for a timely diagnosis. IHC plays a vital role in delineating the origin of the malignant cells. GPC3 expression is the most sensitive marker for GAED. High serum AFP levels directly correlate with the strength of immunostaining and are associated with a poor prognosis. High HER2 expression and PDL-1 immunostaining is commonly seen in GAED cases with the most common mutation being p53. Currently, there are no set guidelines for management of GAED. Unresectable, metastatic HER2 positive conventional adenocarcinoma is being managed using platinum-fluoropyrimidine doublet therapy with anti-HER2 monoclonal antibody trastuzumab. This case report calls for aggressive IHC staining for prompt diagnosis where necessary as well as proper guidelines for management.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 6","pages":"61-65"},"PeriodicalIF":0.6,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142487","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":"JCHIMP 15th Anniversary Issue: Peer Review, Authorship and Scholarly Activity.","authors":"Surendra Marur, Lucien J Cardinal, Gillian Junker","doi":"10.55729/2000-9666.1558","DOIUrl":"10.55729/2000-9666.1558","url":null,"abstract":"<p><p>JCHIMP's Editor-in-Chief and a member of the Editorial Board acknowledge the importance of authors and peer reviewers to the success of JCHIMP in 2024. They discuss the value of peer review and how it satisfies ACGME directives for scholarship. Publication costs, and sources for publication funding are also examined.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 6","pages":"1-5"},"PeriodicalIF":0.6,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141975","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 not too Fragile Bacteroides.","authors":"Siddartha Guru, Nadim Jaafar, Rahul Sharma, Poonam Bai","doi":"10.55729/2000-9666.1554","DOIUrl":"10.55729/2000-9666.1554","url":null,"abstract":"<p><p>We present a rare case of <i>Bacteroides fragilis</i> vertebral osteomyelitis, in a 20-year-old female with no underlying medical conditions. She presented with a three-week history of lower back pain, myalgias, rigors, and night sweats. The patient was febrile and tachycardic, with borderline low blood pressures. Her initial labs showed elevated inflammatory markers with no leukocytosis. MRI of the thoracic and lumbar spine demonstrated T12/L1 discitis/osteomyelitis with phlegmonous changes and concerns for epidural abscess, causing mild to moderate spinal stenosis. <i>Bacteroides fragilis</i> grew in an anaerobic bottle, and a CT-guided biopsy of the T12/L1 lesion grew <i>Bacteroides fragilis</i>. E-test sensitivities revealed sensitivity to metronidazole. The source of bacteremia was thought to be from gut translocation thus concerned about possible co-infection with <i>E. coli</i> from the gastrointestinal tract. Another source of <i>E. coli</i> could have been from her recent <i>E. coli</i> urinary tract infection, whose growth from blood cultures could have been suppressed from recent course of cephalexin. She was treated with six weeks of metronidazole for the <i>Bacteroides fragilis</i> and ceftriaxone for possible co-infection with <i>E. coli</i>, resulting in improvement of her back pain and down-trending inflammatory markers on clinic follow-up after six weeks.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 6","pages":"45-48"},"PeriodicalIF":0.6,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142518","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}