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Journal of Community Hospital Internal Medicine Perspectives

Youssef Soliman, Megan Soliman, Qamar Ahmad, Laura vonDoenhoff
Stress cardiomyopathy or Takotsubo cardiomyopathy (TCM) is transient left ventricular apical akinesis in the absence of angiographic evidence of corresponding obstructive coronary artery disease. A classic presentation is of chest pain following intense emotional or physical stress. Reports of stress-inducing triggers include acute respiratory failure, sudden death of a loved one, sympathomimetic drugs, pheochromocytoma crisis, diabetic ketoacidosis, and even earthquakes. We report three cases of intra-abdominal etiologies precipitating Takotsubo cardiomyopathy: two with small bowel obstruction, and one with Clostridium difficile colitis...
2018: Journal of Community Hospital Internal Medicine Perspectives
Dariush Shahsavari, Bryan Zoll
Hyperthyroidism is associated with increased risk of cardiovascular conditions. We report a case of a 50-year-old woman with no prior cardiac history who presented to the emergency department with shortness of breath, chest pain, lower extremity swelling, and generalized fatigue. She was found to have Graves' Disease (GD) and extensive coronary artery disease (CAD), suggesting the possibility of increased risk of de novo CAD in patients with GD in the absence of other risk factors.
2018: Journal of Community Hospital Internal Medicine Perspectives
Corbin Pagano, Ana Cios, Stefan David
Cutaneous angiosarcoma (CA) is a rare form of cancer with limited treatment options and has a very severe prognosis. In this case report, a differential diagnosis, ranging from infection and neoplasia to autoimmune disease, was attributed to recurrent cellulitis centered on a purple lesion. The continuous pursuit of a diagnosis and treatment plan had to be tailored in accordance with patient goals of care. Careful anticipation of disease progression and complications was required following the diagnosis of CA and involved careful transition from palliation to hospice care...
2018: Journal of Community Hospital Internal Medicine Perspectives
Omar Abdulfattah, Ebad Ur Rahman, Zainab Alnafoosi, Frances Schmidt
Introduction : Unhealthy use of alcohol can be associated with serious adverse events. Patients with alcoholism and malnutrition are at high risk for electrolyte disturbances, commonly hypokalemia. Here in we describe a case of alcohol use disorder presented with weakness and subsequently developed cardiac arrest secondary to severe hypokalemia. Case description : A 51-year-old lady presented to our emergency department because of generalized body ache and marked weakness in both lower extremities for two days duration...
2018: Journal of Community Hospital Internal Medicine Perspectives
Stephen Melnick, Priya Rajagopalan, Theresa Lynn, Anthony Donato
Context : Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a novel treatment approved for type 2 diabetes mellitus to lower hyperglycemia, systolic blood pressure, and promote weight loss. Commonly reported serious adverse events include increased mycotic urogenital infections, orthostatic hypotension, and normoglycemic ketoacidosis. Case report : We present a case of a 47-year old man with a history of type 2 diabetes mellitus initiated on the SGLT-2 inhibitor canagliflozin preoperatively before a penile implant, who presented with late postoperative MRSA bacteremia and scrotal abscess requiring implant extraction...
2018: Journal of Community Hospital Internal Medicine Perspectives
Benjamin Chaucer, Dustin Whelan, Dronacharya Lamichhane
Myasthenia gravis is an autoimmune disorder that effects an estimated 20 people per 100,000 in the USA per year. Pyridostigmine is a common drug used in the symptomatic treatment of myasthenia gravis. While generally safe and effective, a rare set of patients treated with pyridostigmine encounter cardiac conduction disorders. Here, we report a rare presentation of an adverse drug reaction due to pyridostigmine, which is important for its implications in the acute care setting.
2018: Journal of Community Hospital Internal Medicine Perspectives
Syed Raza Shah, Najla Issa Najim, Zainab Abbasi, Mazia Fatima, Ayesha Altaf Jangda, Waqas Shahnawaz, Maira Shahid, Syed Arbab Shah
Canagliflozin is a new novel oral antidiabetic agent belonging to the class of sodium-glucose co-transporter 2 (SGLT2) inhibitors, inhibiting glucose reabsorption in the proximal tubule, leading to increased urinary glucose excretion and subsequently to reduction in plasma glucose concentration, in individuals with hyperglycemia. Before the approval of canagliflozin by the Food and Drug Administration (FDA) in 2013, a pair-wise meta-analyses of trials involving canagliflozin did not differ from control in terms of all-cause mortality, cardiovascular death, myocardial infarction, and stroke...
2018: Journal of Community Hospital Internal Medicine Perspectives
Syed Raza Shah, Sue-Wei Luu, Matthew Calestino, John David, Bray Christopher
The term 'flutter' and 'fibrillation' were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary...
2018: Journal of Community Hospital Internal Medicine Perspectives
Abbas Ali, Abhishek Kalla
Burkitt lymphoma is a late complication of HIV, and bilateral cranial nerve palsies are extremely rare in patients with AIDS. A twenty year old Caucasian male with known congenital HIV who had been non-adherent with anti-retroviral therapy presented with multiple cranial nerve palsies and was eventually diagnosed with Burkitt lymphoma. Before chemotherapy, he was started on radiation therapy to the brain, meninges, and base of skull with the intent of improving cranial nerve palsies and preventing further neurological sequelae since the cranial nerve palsies were dense and there was concern that intrathecal chemotherapy would have less penetration than radiation...
2018: Journal of Community Hospital Internal Medicine Perspectives
Jennifer Williams, Shumona Ima, Charles Milrod, Mahesh Krishnamurthy
Splenic infarct is an incredibly rare diagnosis for abdominal pain. One study involving two hospitals over ten years describes only 0.0037% of all hospital admissions presenting with splenic infarction. Our report describes a case of massive splenomegaly causing pain in a different location compared to the normal anatomical location of the spleen with an unexpected cause, lymphoma. High clinical suspicion for lymphoma as a cause of splenic infarction is critical because this disease can otherwise be clinically silent...
2018: Journal of Community Hospital Internal Medicine Perspectives
Ahsan Wahab, Ahmad Ali, Sarah Nazir, Lisa Ochoa, Hafiz Khan, Mahin Khan, Siddique Chaudhary, Susan J Smith
Introduction : Only 12% of Americans have proficient health literacy (HL). Patients hide this fact from others including physicians. This quality improvement (QI) project was developed to compare internal medicine (IM) resident physicians' (RPs) ability to accurately predict patients with low HL and to improve IM-RPs' understanding of low HL and its impact on patients. Aim statement : Over six-months, our aim was to increase the IM residents' HL-knowledge by 30% as measured by an HL-Knowledge-Based-Survey. Methods : After IRB exemption, patients visiting the residency-clinic within a two-week period were screened for low HL with the REALM-R, a validated tool...
2018: Journal of Community Hospital Internal Medicine Perspectives
M Singal, A Zafar, B Tbakhi, N Jadhav, R Alweis, H Bhavsar
Background : Resident physicians are known to be infrequent reporters of patient safety events (PSE). Previous studies assessing barriers to resident PSE reporting have not considered possible cultural barriers faced by international medical graduates (IMG). This study aimed to assess the knowledge and attitudes of residents regarding PSE and possible barriers contributing to poor resident reporting. Methods : A cross sectional survey of all house staff undergoing post-graduate residency training at two independent community hospital based academic medical centers was conducted through an online questionnaire...
2018: Journal of Community Hospital Internal Medicine Perspectives
Chisom Ikeji, Charmian D Sittambalam, Lyn M Camire, David S Weisman
Synthetic cathinones represent the latest genre of new drugs of abuse, which are increasing in popularity in part because they are readily available and because they are not detected by routine drug testing. They provide a cheaper substitute to stimulants such as methamphetamine and cocaine and are sold on the internet and in retail establishments as 'bath salts,' 'plant food,' or 'research chemicals.' We report a case involving a 21-year-old male who suffered arrest-related death due to intoxication with N -ethylpentylone, a new cathinone derivative...
2018: Journal of Community Hospital Internal Medicine Perspectives
Juan J Gonzalez, Ahsan Wahab, Mohamed Elgamal, Kavitha Kesari
Takotsubo cardiomyopathy (TTC) is a syndrome characterized by transient regional systolic dysfunction of the left ventricle in the absence of angiographic evidence of obstructive coronary artery disease (CAD). A variety of stress-related triggers, including malignancies, have been reported in patients with TTC. However, to our knowledge, a recent diagnosis of a colon mass preceding the development of TTC has not been reported. We report on a female patient who was recently diagnosed with a colon mass by colonoscopy who was then scheduled to undergo robotic hemicolectomy, but was subsequently admitted to our hospital for intractable nausea and abdominal pain...
2018: Journal of Community Hospital Internal Medicine Perspectives
Vijay Gayam, Amrendra Kumar Mandal, Mazin Khalid, Binav Shrestha, Pavani Garlapati, Mowyad Khalid
Valproic acid (VPA) is a commonly used agent in the management of seizures and psychiatric disorders. Hyperammonemia is a common complication of VPA with 27.8% of patients having elevated levels - that is unrelated to hepatotoxicity and normal transaminases. Common side effects include obesity, insulin resistance, metabolic disorder and severe forms of hepatotoxicity. Other rare and idiosyncratic reactions have been reported, one of which is presented in our case. A 27-year old patient presented with hyperammonemia and encephalopathy as a consequence of idiosyncratic VPA reaction causing drug-induced liver injury (DILI) with severely elevated transaminases...
2018: Journal of Community Hospital Internal Medicine Perspectives
Ahsan Wahab, Bilal Nasir
A 47-year-old female with a history of chronic alcoholism presented with nausea, vomiting and mild epigastric tenderness. She reported subjective fever, abdominal fullness and loose, watery stools and had stable vitals on arrival. Examination was positive for mild epigastric tenderness with hepatic enlargement. Computed tomography of the abdomen showed circumferential thickening of the stomach wall, lower esophagus and the first part of the duodenum in addition to peritoneal ascites. She was admitted for alcohol-related gastritis, acute alcoholic hepatitis, and acute kidney injury...
2018: Journal of Community Hospital Internal Medicine Perspectives
Sonal Gandhi, Niraj Jani
No abstract text is available yet for this article.
2018: Journal of Community Hospital Internal Medicine Perspectives
Van T La, Michael Diatte, Johnathan Gaston, Dallas Dick, Raed Sweiss, Zahra Pakbaz
Extramedullary hematopoiesis (EMH) in individuals with thalassemia is often the result of undertreated severe anemia. Radiation or surgery is often the chosen approach to handle spinal cord compression due to these paraspinal EMH elements. Our patient is a 28-year-old male with E-beta-thalassemia who presented with both upper thoracic and lower extremity symptoms of spinal cord compression and was successfully managed with the combination of transfusion and hydroxyurea. Given the variation in symptoms as a result of the sporadic location as well as the extent of these EMH elements along the spinal canal, the hematological communities will continue to benefit from case reports that offer treatment therapy...
2018: Journal of Community Hospital Internal Medicine Perspectives
Oreoluwa Oladiran, Rashmi Dhital, Anthony Donato
Autoimmune hemolytic anemia (AIHA) is a condition associated with an extensive differential diagnosis that includes lymphoid malignancies. Although AIHA occurs in about 10-25% of patients with chronic lymphocytic leukemia, it is also reported to occur in all of the other lymphoid subtypes. In this article, we report a case of recurrent AIHA in a 67-year-old woman with two acute episodes of hemolysis separated by 3 years of hematologic remission. Both episodes were severe enough to require blood transfusion, oral steroids, and rituximab...
2018: Journal of Community Hospital Internal Medicine Perspectives
Khalil I Bourji, T Newsome, John Meyerhoff
A 49-year-old man, who presented with new onset dyspnea on exertion and fatigue without clear history of a typical erythema migrans rash, was found to have complete atrioventricular (AV) heart block with positive serology for Lyme disease. A complete stepwise reversal of the AV block was achieved shortly after the initiation of intravenous antibiotic treatment.
2018: Journal of Community Hospital Internal Medicine Perspectives
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