Journal of Community Hospital Internal Medicine Perspectives最新文献

{"title":"Rapid Neurological Decline due to Creutzfeldt-Jakob Disease.","authors":"Nicole Tesoro, David Blackwood, Robert Reif, Samuel Miller, Kalyan Paudel, Christopher Haas","doi":"10.55729/2000-9666.1446","DOIUrl":"10.55729/2000-9666.1446","url":null,"abstract":"<p><p>Creutzfeldt-Jakob Disease (CJD) is an exceedingly rare condition with an incidence of one case per million people worldwide. It is diagnosed with symptoms of rapid neurological decline, positive CSF biomarkers, and diagnostic findings on MRI and EEG. There is no known effective therapy for CJD and prompt diagnosis is required to prepare for the expected disease prognosis and goals of care discussions.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"51-53"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046908","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":"Arrhythmogenic Right Ventricular Cardiomyopathy Presenting With VT Electrical Storm.","authors":"Shon Thomas, Jaclynn Jackubowski, Kevin Ismair, Jeremiah Chang, Jerome Kuhnlein","doi":"10.55729/2000-9666.1432","DOIUrl":"10.55729/2000-9666.1432","url":null,"abstract":"<p><p>Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a right ventricular disease caused by desmosomal gene mutations leading to fibro-fatty replacement of the myocardium causing ventricular arrhythmias such as ventricular tachycardia (VT). A 59-year-old female presented with new onset VT manifesting as shortness of breath and chest discomfort. Diagnostic workup revealed right ventricular dilation/dysfunction on echocardiogram, VT with left bundle branch block (LBBB) and diffuse T wave inversions (TWIs) on EKG. She was discharged with a diagnosis of ARVC. Later, she developed VT storm, treated with epi-endocardial ablation for complete resolution of recurrent VT. Our case demonstrates the rare presentation of ARVC as ventricular storm and the various management strategies such as anti-arrhythmics, automated implantable cardioverter-defibrillator (AICD) and ablation procedures.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"70-74"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046825","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":"Effectiveness of Abdominal Breathing Exercise to Control Gastroesophageal Reflux Disease, a Randomized Controlled Trial.","authors":"Maryam Sadiq, M Shazan Raza, Noman Sadiq, Anum Sadiq, Muniba Zafar, Syed Muhammad B Zaidi, Saima Ambreen","doi":"10.55729/2000-9666.1438","DOIUrl":"10.55729/2000-9666.1438","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effect of actively training the crura of diaphragm which is a part of lower esophageal sphincter using abdominal breathing exercises to treat gastroesophageal reflux disease.</p><p><strong>Methodology: </strong>With a randomized controlled study design, a total of 22 (11 in each group) clinically diagnosed patients of GERD presenting to the gastroenterology outpatient department at Holy Family Hospital in Pakistan were assessed using GERD related \"quality of life index (QoLI)\" questionnaire and their on-demand proton pump inhibitors (PPI) usage. Single blinding technique will be used. Patients ages 18-60 years with GERD were included. However, those with hiatal hernia > 2 cm, previous surgeries on LES and those with who could not undergo the breathing exercise training were excluded. The data was collected via interviews. The intervention group was trained to do a 5-min breathing exercise and advised to perform it 5 times a day for 4 continuous weeks. On demand PPI usage was self-recorded. The control group was also trained to perform a breathing exercise that had no effect on LES and was asked to self-record on demand PPI usage. After 4 weeks the data was collected from both groups and compared quality-of-life index and PPI usage. Data was retrieved and analyzed using SPSS version 22. Descriptive analysis was used for describing the study variables. Paired t-test was used for in group comparison before and after intervention and independent t test was used for between group comparison, p value of <0.05 was taken as significant. Mean PPI usage of the two groups was also compared.</p><p><strong>Results: </strong>An improved QoLI and reduced PPI usage was seen in the intervention group as compared to control group. Paired t test confirmed a statistically significant difference, but the independent t test did not. Linear regression test showed that F (1,20) = 32.822, p = 0.000. Adjusted R value is 0.603. y = 13.182x +2.812. The beta value is 0.789 and p value is 0.000.</p><p><strong>Conclusion: </strong>The study concludes that abdominal breathing exercises can improve the GERD symptoms as assessed by QoLI score and on demand PPI usage. It advocates for an alternative treatment option for GERD patients that is more efficacious as compared to no breathing exercises and has less potential side effect as compared to continuous PPI use, enabling us to lead our way towards revolution in medicine providing more effective and less invasive treatment options to facilitate our patients.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"30-35"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046870","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":"Poor Outcome of Rare Lactobacillus Bacteremia and Endocarditis in a Patient With Frequent Consumption of Live Culture Yogurts.","authors":"Paul Wasuwanich, Logan B Brickner, Mark S Rasnake, Rebecca J Witherell","doi":"10.55729/2000-9666.1448","DOIUrl":"10.55729/2000-9666.1448","url":null,"abstract":"<p><p><i>Lactobacillus rhamnosus</i> is a gram-positive bacterium commonly found in dairy products and used as a probiotic due to its resistance to acid and bile. While generally considered safe, rare cases of <i>L. rhamnosus</i> bacteremia and endocarditis have been reported, primarily in individuals with significant risk factors. This report discusses an elderly male with a history of cardiovascular diseases, diabetes, and asthma, who developed <i>L. rhamnosus</i> bacteremia and endocarditis after consuming large quantities of Greek yogurt. The patient initially presented with fatigue, myalgias, and fever, and was treated empirically with cefepime and vancomycin. On that occasion, blood cultures recovered <i>L. rhamnosus</i> which was treated with a short course of oral antibiotics. Despite initial improvement, the patient was re-hospitalized with a transient cerebral ischemic attack. Subsequent investigations again revealed <i>L. rhamnosus</i> in blood cultures raising suspicion for subacute bacterial endocarditis. Antibiotic therapy with ampicillin resulted in the clearance of bacteremia; unfortunately, the patient experienced a non-ST elevation myocardial infarction leading to cardiac arrest and death. This case highlights the potential pathogenicity of <i>L. rhamnosus</i> in susceptible individuals and underscores the need for caution in consuming probiotic products among those with severe or multiple comorbidities.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"98-102"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046896","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":"Marginal Zone Lymphoma in a Case of Hidradenitis Suppurativa Treated With Adalimumab Therapy.","authors":"Anish K Shrestha, Rojina Pokherel, Greeshma N Gaddipati, Pankti S Desai","doi":"10.55729/2000-9666.1444","DOIUrl":"10.55729/2000-9666.1444","url":null,"abstract":"<p><p>Marginal zone lymphoma has seldom been described in relation to adalimumab used for treatment of hidradenitis suppurativa. Although studies have shown an increased risk of lymphoma with adalimumab, most of these studies were done in patients with underlying inflammatory bowel disease or rheumatoid arthritis where the disease itself presents as a confounder for lymphoma. Our case described adds to the role of chronic anti-TNF alpha therapy as a possible etiology of lymphoma.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"58-62"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046887","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 Case of Infective Endocarditis Caused by <i>Aerococcus urinae</i>.","authors":"Benjamin Ossai, Shadan Mehraban, Jonathan London, Nicholas Spetsieris, Zubin Tharayil, Manoj Trehan, Balaji Pratap","doi":"10.55729/2000-9666.1433","DOIUrl":"10.55729/2000-9666.1433","url":null,"abstract":"<p><p><i>Aerococcus urinae</i> is an alpha-hemolytic gram-positive catalase-negative coccus that typically causes urinary tract infections. It has been rarely implicated in other invasive infections such as endocarditis, bacteremia, peritonitis, meningitis, and vertebral osteomyelitis. There are approximately 50 reported cases of <i>A. urinae</i> infective endocarditis in literature. We present a rare case of a 64-year-old male who was found to have a urinary tract infection, bacteremia, and endocarditis caused by <i>A. urinae</i>.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"66-69"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046818","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":"Hyperhomocysteinemia-associated Thrombosis in Patients With Pernicious Anemia.","authors":"Thura W Htut, Kyaw Z Thein, Thein H Oo","doi":"10.55729/2000-9666.1437","DOIUrl":"10.55729/2000-9666.1437","url":null,"abstract":"<p><strong>Introduction: </strong>Cobalamin deficiency (CD) due to pernicious anemia (PA) leads to hyperhomocystinemia, a risk factor for thrombosis. However, the clinical presentations and outcomes of hyperhomocystinemia-associated thrombosis (HAT) are not fully understood.</p><p><strong>Methods: </strong>We undertook a literature search using PUBMED, SCOPUS and WEB OF SCIENCE databases for the terms \"pernicious anemia AND thrombosis\", \"pernicious anemia AND embolism\", \"pernicious anemia AND thromboembolism\", \"autoimmune gastritis AND thrombosis\", \"autoimmune gastritis AND embolism\", \"autoimmune gastritis AND thromboembolism\" through January 2024 and reviewed the published literature. Our aim was to illustrate the clinical features of PA-related HAT.</p><p><strong>Results: </strong>Of 20 patients, the median age was 54.5 years (60 % males). 35 % of patients were elderly. The median serum homocysteine level was 67.75 umol/L. 35 % of patients developed thromboses at multiple locations while 20 % had thromboses at unusual sites. 45 % of patients had co-existing neuropsychiatric symptoms. 80 % of patients were positive for anti-IF (anti-intrinsic factor) antibodies. All patients received cobalamin replacement and the median duration of antithrombotic therapy was 6.5 months for reported cases. None developed recurrent thromboembolism.</p><p><strong>Conclusion: </strong>This rare condition is associated with high incidence of thromboses at unusual sites, multiple-site thromboses, co-existing neuropsychiatric symptoms, high positivity rate for anti-IF antibodies and low recurrent thrombosis rate.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"22-29"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046875","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":"Inpatient Versus Outpatient MRI? Outcomes for Hospitalized Patients With New Liver Masses.","authors":"Ho-Man Yeung","doi":"10.55729/2000-9666.1435","DOIUrl":"10.55729/2000-9666.1435","url":null,"abstract":"<p><p>No guidelines exist to guide hospitalists on whether inpatient MRI should be pursued for incidental liver masses. Here, we compare outcomes between patients who receive an inpatient MRI and those who did not, following detection of suspicious liver masses during hospitalization. A retrospective study of hospitalized patients with new HCC from Jan 1st, 2020 through Dec 31st, 2021 was conducted. Patients for hospice or with known HCC were excluded. Out of 34 unique subjects, 22 received MRI inpatient (IP) and 12 did not (non-IP). Time to inpatient MRI averaged 2.2 days. Inpatient LOS between the two groups were similar (6 v 7 days). IP group had lower lost-to-follow-up rates (4% v 42%). Median time to cancer treatment was similar (31 v 34 days), however IP group had higher treatment rate (68% v 42%). Obtaining inpatient MRI may benefit select high-risk patients, with increased follow-up rate and treatment rate for HCC.</p>","PeriodicalId":15460,"journal":{"name":"Journal of Community Hospital Internal Medicine Perspectives","volume":"15 1","pages":"5-7"},"PeriodicalIF":0.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046876","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 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}