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Journal of Community Hospital Internal Medicine Perspectives

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https://www.readbyqxmd.com/read/29686797/porencephalic-cyst-a-rare-cause-of-new-onset-seizure-in-an-adult
#1
Anam Qureshi, Asad Jehangir, Eugene P York
We present a case of a 56-year-old male with a history of perinatal intracerebral hemorrhage who presented to the emergency department after a witnessed new-onset generalized tonic-clonic seizure. Computerized tomography and magnetic resonance imaging of the head revealed a large frontal lobe porencephalic cyst, with encephalomalacia in the right parietal lobe and temporal lobe (the patient did not have any prior cranial imaging). The patient has subsequently remained seizure-free on levetiracetam. Porencephalic cyst is a rare condition of cerebrospinal fluid accumulation in the brain parenchyma that is usually related to perinatal vascular events...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686796/rapidly-progressive-dyspnea-in-gastrointestinal-stromal-tumor-gist-with-imatinib-cardiac-toxicity
#2
Adnan Asif Parvez Ghias, Shahzeem Bhayani, David J Gemmel, Sudershan K Garg
Gastrointestinal stromal tumors (GISTs) are rare and current estimates range from 4,000 to 6,000 number of GIST cases in the USA annually. Imatinib, a tyrosine kinase inhibitor, has shown a survival benefit in GISTs, and the presence of KIT mutation status is predictive of response. The current case discusses rapidly progressive dyspnea and heart failure in an elderly male with metastatic GIST who was started on imatinib. Although reported as a rare and sporadic side effect of imatinib, the current case illustrates rapidity and the clinical significance of cardiotoxicity, with onset at 2 weeks...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686795/rare-cause-of-gastric-outlet-obstruction
#3
Sonal Gandhi, Niraj Jani
Bouveret's syndrome is a rare cause of gastric outlet obstruction. The stones enter the small bowel via cholecysto-enteric fistula. The most common presenting symptoms are abdominal pain, nausea and vomiting. The gold standard diagnostic test isesophagogastroduodenoscopy (EGD). Rigler's triad on abdominal x-ray is classic. CT scan findings are pneumobilia, cholecystoduodenal fistula and a gallstone in the duodenum. We present a case of a 75-year-old female who presents with 3 week history of nausea, vomiting, and diffuse abdominal pain...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686794/risperidone-induced-angioedema-with-concurrent-eps-symptoms-a-case-report-and-review-of-literature
#4
Gursharan Singh Samra, Saumitra Kant, Robert Chow
Angioedema has recently been reported as a side effect associated with the antipsychotic risperidone. We report a case of dystonia with concurrent angioedema due to risperidone. A 40-year-old male with a history of schizophrenia was started on 3 mg of risperidone BID and developed perioral and periorbital edema along with increased muscle rigidity and hand tremor within 24 h of initial administration. His symptoms abated after cessation of risperidone and intravenous administration of corticosteroids and antihistamine...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686793/invasive-group-b-streptococcus-multiloculated-perinephric-abscesses-treated-with-percutaneous-drainage
#5
J Isaac Peña-Garcia, Sana Shaikh, Alexandre Lacasse
Group B streptococcus infections (GBSI) are commonly associated with neonates and pregnant women, but may also affect nonpregnant adults. Among its spectrum of manifestations, perinephric abscess (PA) is exceedingly rare. Comorbid conditions such as diabetes mellitus (DM) and immunosuppression increase the risk of GBSI. We describe a 61-year-old Vietnamese man with compensated alcoholic cirrhosis, who presented with acute encephalopathy following subacute, progressive abdominal pain. He was afebrile and hemodynamically stable...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686792/beating-the-urine-drug-test-a-case-report-on-niacin-toxicity
#6
Beenish Fayyaz, Hafiz J Rehman, Sunita Upreti
Niacin is a form of vitamin B3 which is used for the medical treatment of hyperlipidemia and niacin deficiency. However, within the last few years, it is being advertised on the Internet as a quick way to detoxify the human body in an attempt to evade urine drug tests. This claim is without any medical or scientific evidence and as a result, many cases have been reported where young adults have ended up with niacin toxicity. In this case report, we discuss a rare presentation of niacin toxicity and the effects Internet has had on the healthcare being practised by both the physicians and the patients themselves...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686791/lung-consolidation-as-a-rare-presentation-of-lymphoplasmacytic-lymphoma-with-extramedullary-waldenstr%C3%A3-m-s-macroglobulinemia
#7
Omar Abdulfattah, Ebad Ur Rahman, Bikash Bhattarai, Sumit Dahal, Zainab Alnafoosi, David Trauber, Danilo Enriquez, Frances Schmidt
Objectives : Lymphoplasmacytic lymphoma (LPL) is a mature B cell lymphoma that usually involves the bone marrow, spleen and lymph nodes. Extramedullary involvement, including the lung, is rarely reported. Case description : A 73-year-old female initially presented to our hospital complaining of productive cough of white-colour sputum for three weeks duration. She reported unintentional weight loss of ten pounds over the last five months. There was no history of haemoptysis, fever, night sweats, chills, recent infections or hospitalization...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686790/adult-idiopathic-hypertrophic-pyloric-stenosis-a-common-presentation-with-an-uncommon-diagnosis
#8
Syed Moin Hassan, Ateeq Mubarik, Salman Muddassir, Furqan Haq
Background and Objectives: Adult Idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare but well-defined entity in adults with only 200-300 cases reported so far in the literature.We describe a case of AIHPS and the relevant literature review. Methods and Results: The patient presented with acute onset upper abdominal pain associated with nausea, vomiting, foul-smelling black tarry stools, and anorexia. On the Esophagogastroduodenoscopy (EGD), pylorus demonstrated a unique "cervix sign." The patient had multiple endoscopic dilations with minimal relief...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686789/a-case-of-spontaneous-coronary-artery-dissection-presenting-with-acute-anterior-wall-myocardial-infarction-in-a-young-adult-male-an-increasingly-recognized-rare-disease
#9
Mohamed Taha, Htun Latt, Jaafar Al-Khafaji, Mohamed Ali, Richard Seher
Background : Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. In men, however, risk factors for atherosclerosis are more prevalent in cases of SCAD Case report : We report a case of a 43-years-old healthy male, with no known risk factors, who presented with ischemic chest pain and elevated troponin levels...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686788/pyoderma-gangrenosum-in-primary-care-setting-the-challenges-involved
#10
REVIEW
Beenish Fayyaz
This article aims at raising clinical awareness about pyoderma gangrenosum especially when presenting in primary care settings. Due to its initial manifestation as a nonspecific ulcer, physicians with relatively less dermatology experience usually misdiagnose PG as cutaneous infection or vascular disease. This usually leads to inappropriate treatment with subsequent worsening of condition and devastating effects on patients' lives.
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686787/pattern-duration-of-stay-and-outcomes-of-medical-admissions-a-report-from-teaching-community-hospital-in-assir-region-saudi-arabia
#11
Mushabab A Al-Ghamdi, Aref A Bin Abdulhak
Background : Population-based studies are the gold standard to understand the burden of different diseases, plan health care policy and resource allocation, and provide an accurate estimate of disease several disease indices including mortality. However, population-based studies are difficult to undertake in a resource-limited situation where no robust data bases and disease registries are available. Therefore, hospital-based cohorts may be used to inform about the community health. Objectives: We sought to study the pattern of disease causing admission, hospital stay, and outcomes of medical admissions to King Abdullah Hospital in Bisha in order to inform clinicians, public health professionals, and policymakers about the current status of diseases within the community in Bisha...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686786/predictors-and-outcome-of-invasive-mechanical-ventilation-in-hospitalized-patients-with-sepsis-data-from-national-inpatient-sample
#12
Rashmi Dhital, Sijan Basnet, Dilli Ram Poudel
Background: Sepsis is a significant cause of mechanical ventilation in hospitalized patients. Objective: The aim of our study was to recognize the demographic and clinical characteristics associated with an increased need for invasive mechanical ventilation in hospitalized sepsis patients. Methods: We used National Inpatient Sample database from the years 2009-2011 to identify sepsis patients requiring invasive mechanical ventilation. We compared demographic and clinical characteristics of sepsis patients requiring and not requiring ventilator support and conducted univariate and multivariate analyses to determine odds ratio (OR) of association...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686785/primary-thyroid-maltoma-a-rare-diagnosis-of-an-unassuming-thyroid-nodule
#13
Pragya Shrestha, Kimberly Aderhold, Sharon Swierczynski, Catherine Lin, Ronald Herb
Primary thyroid lymphoma, although a rare malignancy, can arise in common chronic inflammatory conditions such as Hashimoto's thyroiditis. Incidental finding of a thyroid nodule with chronic thyroid inflammation warrants further investigation. Early detection of malignancy can play a vital role in improved outcomes. We report a case of a 60-year-old male who presented to the clinic for a routine visit. An enlarged, firm, non-tender thyroid gland was appreciated on exam with high thyroid stimulating hormone (TSH) level...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29686784/primary-malignant-melanoma-of-the-lung-a-case-report-of-a-rare-tumor-and-review-of-the-literature
#14
Muharrem Yunce, Stephen Selinger, William Krimsky, Daniel P Harley
Primary malignant melanoma of the lung (PMML) is a rare malignancy that exhibits aggressive behavior and has a very poor prognosis. We are reporting on a case of PMML in an otherwise healthy 22-year-old Caucasian male with no significant past medical history and an unremarkable family history. The patient initially presented with a 2-month history of a cough and an unexplained 22-lb weight loss. His initial chest X-ray demonstrated opacification of the right lower lobe (RLL) of his lung and a subsequent computerized tomography scan (CT scan) of his lung revealed a large mass occupying most of his RLL (Figure 1)...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29441167/is-this-a-worrisome-red-eye-episcleritis-in-the-primary-care-setting
#15
Amr Salama, Arwa Elsheikh, Richard Alweis
Episcleritis is the inflammation of the thin, loose, highly vascular connective tissue layer that lies between the conjunctiva and sclera. Incidence is less than 1/1000. It is more common in women and those between 40 and 50 years of age. Most cases are idiopathic. It is classified into simple and nodular. Most attacks resolve within 1-3 months. The nodular type tends to be more recurrent and painful. It presents with acute onset of redness, lacrimation, and photophobia. The diagnosis of is essentially clinical, and eye pain or tenderness should raise the concern for scleritis...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29441166/a-case-of-madness-resulting-in-a-fortunate-outcome-case-report-of-a-psychotic-break-as-a-result-of-cortisol-secreting-thymic-neuroendocrine-thymic-tumor
#16
Jibran Durrani, Faizan Malik, Naveed Ali, Syed Imran Mustafa Jafri, Mohsin Hamid
Representing a mere 2-5% of the total thymic malignancies and 0.4% of total carcinoid tumors, primary thymic neuroendocrine tumors (NETs) are the zebras of the thymic neoplasms. They were initially characterized as 'epithelial thymomas'; later, the term carcinoid tumors was coined by Rosai and Higa. These tumors are highly unpredictable in their presentation and prognosis. Coupled with variable clinical presentation, rare pathologic diagnosis and absence of diagnostic and prognostic parameters, it is a challenge for both patients and clinicians...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29441165/propylthiouracil-induced-anca-negative-cutaneous-small-vessel-vasculitis
#17
Aliaksandr Trusau, Michael L Brit
Propylthiouracil (PTU) is a commonly used medication for the treatment of hyperthyroidism. PTU is known to cause different adverse reactions including autoimmune syndromes. PTU-induced autoimmune syndromes can be classified into drug-induced lupus or drug-induced vasculitis. Differential diagnoses could be very challenging. PTU-induced vasculitis is more common than PTU-induced lupus, and has a higher risk of morbidity and mortality. Usually it is limited to the skin in a form of cutaneous leukocytoclastic vasculitis, but may also affect organs including kidneys and lungs...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29441164/rare-case-of-mycobacterium-nebraskense-presenting-as-asymptomatic-cavitary-lung-lesion
#18
Omar Abdulfattah, Antony Lixon, Saroj Kandel, Ebad Ur Rahman, Sasmit Roy, Sumit Dahal, Zainab Alnafoosi, Frances Schmidt
Introduction : Mycobacterium Nebraskense is a rare nontuberculous mycobacterial infection. The first isolate of the species was from human sputum at University of Nebraska Medical Center. There are only a few cases have been reported and the exact behavior of the disease is not clearly described. Here, we present a case from New York City incidentally found to have a cavitary lung lesion due to M . nebraskense. Case report : An 82-year-old female with a history of diabetes mellitus, hypertension, and dementia presented with constipation and urinary retention for 1 day...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29441163/in-with-acute-bronchitis-out-with-duodenal-perforation-the-potentially-harmful-cascade-of-over-testing-a-case-report
#19
Karamjit Dhaliwal, Victoria Malkhasyan, Mohammed Elhassan
Overutilization of diagnostic imaging can lead to unnecessary interventions and subsequently can jeopardize patient safety. When ordered, the results of these images should always be interpreted in the appropriate clinical context taking into consideration the patient clinical presentation and the natural history of the diseases which are being investigated. We presented a case that demonstrates for the practicing physicians how violating these two notions can lead ultimately to patient harm.
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29441162/a-multimodal-high-value-curriculum-affects-drivers-of-utilization-and-performance-on-the-high-value-care-component-of-the-internal-medicine-in-training-exam
#20
Tom Chau, Laura Loertscher
Background : Teaching the practice of high-value care (HVC) is an increasingly important function of graduate medical education but best practices and long-term outcomes remain unknown. Objective : Whether a multimodal curriculum designed to address specific drivers of low-value care would affect resident attitudes, skills, and performance of HVC as tested by the Internal Medicine In-Training Exam (ITE). Methods : In 2012, we performed a baseline needs assessment among internal medicine residents at a community program regarding drivers of healthcare utilization...
2018: Journal of Community Hospital Internal Medicine Perspectives
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