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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
Kiranveer Kaur, Abhishek Kalla
Acquired Hemophilia A (AHA) is a bleeding diathesis related to the development of factor VIII inhibitor, which can frequently go undetected. It commonly manifests as spontaneous mucosal bleeds without any known history of a bleeding disorder, but has the potential to cause life threatening bleeding especially in elderly patients with underlying comorbidities. Here we describe a case of AHA in a 78 year old female presenting with spontaneous mucocutaneous bleeding as tongue hematoma and recurrent gastrointestinal (GI) bleeding...
2018: Journal of Community Hospital Internal Medicine Perspectives
Nooreen Hussain, Faiz Hussain, Tulika Chatterjee, Jan N Upalakalin, Teresa Lynch
Enteropathy-associated T-cell lymphoma (EATL) is a rare disease found in the small bowel and is seen most commonly in patients with refractory celiac disease (RCD). We present a case of an elderly male with celiac disease (CD) diagnosed in childhood with months of abdominal pain and diarrhea despite attempting to avoid gluten in his diet. After persistent symptoms for months, the patient was admitted for an acute abdomen and was found to have small bowel perforation due to a jejunal mass that was diagnosed as an EATL...
2018: Journal of Community Hospital Internal Medicine Perspectives
Nooreen Hussain, Faiz Hussain, Danish Haque, Subramanyam Chittivelu
Myasthenia Gravis (MG) is a disorder of the neuromuscular junction (NMJ) that manifests as fluctuating fatiguable weakness of the muscles. There are many factors that can exacerbate myasthenia symptoms including a variety medications and drugs, systemic illness, and pregnancy. A number of medications have been implicated in exacerbating MG symptoms, including aminoglycosides. We present a case of an elderly female with newly diagnosed MG following the use of tobramycin eye drops for 3 days. There have been limited reports in the literature of topical medications that exacerbate MG symptoms...
2018: Journal of Community Hospital Internal Medicine Perspectives
Beenish Fayyaz, Sunita Upreti
Autoimmune inner ear disease is an important yet incompletely understood cause of hearing loss which can present to different medical disciplines. Its diagnostic significance is indicated by the fact that it is a reversible medical condition if recognized early with an excellent response to immunosuppressive agents. Therefore, it should be considered in the differential diagnosis of hearing disorders especially in the context of another autoimmune disease such as Hashimoto's thyroiditis.
2018: Journal of Community Hospital Internal Medicine Perspectives
Nirmal Guragai, Upamanyu Rampal, Rahul Vasudev, Hiten Patel, Hashita Diana Manohar, Pragya Bhandari, Mahesh Bikkina, Fayez Shamoon, Hartaj Virk
Chronic total occlusion (CTO) of coronary artery remains the Achilles heel of the interventional cardiologist and is present in a significant proportion of referrals for coronary artery bypass graft surgery (CABG); however, with the development and standardization of modern CTO recanalization techniques, it has been able to achieve excellent success while coping with lesions of increasing complexity. Nevertheless, failure to recanalize despite the development of new techniques still remains one of the challenges in the field of interventional cardiology...
2018: Journal of Community Hospital Internal Medicine Perspectives
Ramesh K Pandey, Eliza Sharma, Sasmit Roy, Saroj Kandel, Sumit Dahal, Muhammad Rajib Hossain, Marie F Schmidt, Zewge Shiferaw-Deribe
Introduction : Malignant thyroid nodules are clinically euthyroid and appear as cold nodules on scintigraphy. Malignancy in hyper-functioning thyroid nodule is rare. Case report : A 48-year-old male with painless swelling on the right side of his neck for the last 4 months complained of feeling hot all the time, sweating and unintentionally losing about 20 pounds. On physical examination, there was a 3-cm mobile, non-tender mass on the right supra-clavicular area biopsy of which was consistent with metastatic papillary carcinoma of thyroid...
2018: Journal of Community Hospital Internal Medicine Perspectives
Syed Moin Hassan, Ateeq Mubarik, Salman Muddassir, Furqan Haq
Background : Brain metastasis (BM) from colorectal cancer (CRC) is rare with the incidence ranging from 0.6% to 3.2%. There is also an increased incidence of BM with rectal primaries and is consistent with this patient's presentation. Overall, there is scarce literature on the symptoms of patients who present with CRC BMs. Objectives : We present a case of brain metastasis in colorectal cancer presenting with hypertensive urgency and severe headache. Methods and results : This case highlights that neurological deficits are not necessary for BMs in patients with CRC and summarizes and reviews the associated literature regarding BM in CRC...
2018: Journal of Community Hospital Internal Medicine Perspectives
Rashmi Dhital, Sijan Basnet, Prakash Paudel, Yam Prasad Acharya, Dilli Ram Poudel
Rheumatoid arthritis (RA) is being increasingly recognized as an important contributor to chronic obstructive pulmonary disease (COPD). Although smoking is a major risk factor, other factors may play a role. We used National Inpatient Sample (NIS) from 2013 to explore this relationship. We used propensity matching with a 1:3 nearest-neighbor-matching algorithm to match 1 RA hospitalization to 3 age- and-sex-matched comparators. In the age- and-sex-matched population, RA had a higher odds of COPD (OR 1.20, 95% CI: 1...
2018: Journal of Community Hospital Internal Medicine Perspectives
Syed Raza Shah, Palwasha Ghulam Moosa, Mazia Fatima, Rohan Kumar Ochani, Waqas Shahnawaz, Muhammad Ahmed Jangda, Syed Arbab Shah
Congestive Heart Failure (HF) and Atrial Fibrillation (AFIB) often coexist. Catheter ablation is a well-established option for symptomatic AFIB that is resistant to drug therapy in patients with otherwise normal cardiac function. This has been seen in various studies where catheter ablation was associated with positive outcomes in patients with HF. Recently, the study results from the Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial were published...
2018: Journal of Community Hospital Internal Medicine Perspectives
Krishna C Keri, Naga S Samji, Samuel Blumenthal
Diabetic nephropathy (DN is a dreaded consequence of diabetes mellitus, accounting for about 40% of end-stage renal disease (ESRD). It is responsible for significant morbidity and mortality, both directly by causing ESRD and indirectly by increasing cardiovascular risk. Extensive research in this field has thrown light on multiple pathways that can be pharmacologically targeted, to control or reverse the process of DN. Glomerulocentric approach of DN still continues to produce favourable results as evidenced by the recent data on SGLT-2 (sodium glucose co-transporter type 2) inhibitors...
2018: Journal of Community Hospital Internal Medicine Perspectives
Ahmad Ramy Elashery, Kazim Aykent, Hussam Kurdi, Mohammed Ibrahim, Shiquan He, Joann R Petrini, Harvey M Kramer
Background : Heart failure remains one of the highest disease burdens in the USA and worldwide. Heart failure guidelines recommend starting with a higher or equal to home dose of loop diuretics in acute decompensated heart failure admissions. To date, no study has been published assessing the effect of first 24 h loop diuretic dose on length of hospital stay. Objective: We hypothesize that the higher the first 24 h loop diuretic dose to home dose ratio, the shorter the length of hospital stay will be. Design/Methods : Retrospective chart review was conducted in a community teaching hospital and included patients discharged between February, 2015 and April, 2016, with a primary diagnosis of acute decompensated heart failure...
2018: Journal of Community Hospital Internal Medicine Perspectives
Mushabab A Al-Ghamdi
Background : There is limited information about the clinical profile and outcome on patients admitted to a coronary care unit (CCU) in Saudi Arabia is available. Objective : The aim of this study was to evaluate reasons for admission, clinical characteristics, outcome and predictors of outcome in CCU patients. Materials and methods : The data of 392 patients admitted to the CCU of a secondary care centre in southern region of Saudi Arabia from 1 January 2017 to 31 December 2017 were collected. Data that were extracted from the patients included demographics, admission diagnosis and outcome...
2018: Journal of Community Hospital Internal Medicine Perspectives
Maryellen Woodward
2018 Winners at the Maryland Chapter, ACP Mulholland Mohler Residents Meeting.
2018: Journal of Community Hospital Internal Medicine Perspectives
Ahmed Otokiti, Abdelhaleem Sideeg, Paulisa Ward, Merina Dongol, Mohamed Osman, Oloruntobi Rahaman, Syed Abid
Background : Orientation for new medical residents is challenging due to the diversity of prior experiences and cultural backgrounds and is compounded by a lack of orientation curricula that adequately addresses the needs of the medical residents to allow them to perform their duties in an efficient manner from the start. The beginning of residency training is associated with reduced quality of healthcare widely referred to as the 'July effect'. Objective : To assess the impact of a peer-led orientation for new interns on (a) self-reported confidence level, (b) improvement in performance of first-year residents in appropriate clinical documentation and efficient discharge procedures and protocols...
2018: Journal of Community Hospital Internal Medicine Perspectives
Joseph Fanciullo, Jennifer Hsu, Dennis C Stevens
The University of South Dakota Sanford School of Medicine Internal Medicine residency implemented a program to enhance scholarship among residents. This residency is part of a small Mid-Western community-based school. Background : A Director of Research was hired and developed a structured approach consisting of: 1. Independent study regarding research methods and statistical testing and 2. Mentoring of residents and faculty in scholarly pursuits starting in the first months of residency. Methods : Scholarship for two cohorts of residents for years July 2011-2014 and January 2014-2017 were followed...
2018: Journal of Community Hospital Internal Medicine Perspectives
A B O'Connor, C M Williams, B Dalal, M S Sulistio, T K Roth, C K Milne, F A Collichio, E A Muchmore, R Alweis
Background : In May 2017, the Alliance for Academic Internal Medicine (AAIM) published guidelines intending to standardize and improve internal medicine residency program director (PD) letters of recommendation (LORs) for fellowship applicants. Objectives : This study aimed to examine fellowship PDs impressions of the new guidelines, letter writers' adherence to the guidelines, and the impact of LORs that conformed to guidelines compared to non-standardized letters. Methods : The authors anonymously surveyed fellowship PDs from January to March 2018 to gather input about LORs submitted to their programs during the 2017 fellowship application cycle...
2018: Journal of Community Hospital Internal Medicine Perspectives
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