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Journal of Community Hospital Internal Medicine Perspectives

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https://www.readbyqxmd.com/read/29915663/bouveret-s-syndrome-sense-and-sensitivity
#1
John Ong, Carla Swift, Sharon Ong
Bouveret's syndrome is an uncommon disease characterised by gastro-duodenal obstruction caused by an impacted gallstone in the upper gastrointestinal tract. Here we submit a letter to the editor in response to an article published by Gandhi and Jani (2018) entitled 'Rare cause of gastric outlet obstruction' where we raise three points of contention that readers should take into consideration.
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915662/an-unfortunate-failure-multifocal-hepatocellular-carcinoma-in-a-non-cirrhotic-patient-with-chronic-hepatitis-c-treated-with-ledipasvir-sofosbuvir
#2
Megan Sue Soliman, Youssef Yousry Soliman, Qamar Ahmad, Roopa Yarlagadda
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the third highest cause of cancer mortality worldwide. Risk factors include chronic liver disease and cirrhosis of various causes including chronic hepatitis B and C. In cases of chronic hepatitis C virus (HCV), HCC usually does not manifest unless the liver has become cirrhotic. Fortunately, novel treatments for hepatitis C including ledipasvir/sofosbuvir can cure patients from their disease and as a result, may never develop cirrhosis and therefore, be at much lower risk of developing HCC...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915661/multifactorial-aetiology-for-non-uremic-calciphylaxis-a-case-report
#3
Sijan Basnet, Niranjan Tachamo, Rashmi Dhital, Biswaraj Tharu
Calciphylaxis is commonly associated with end-stage renal disease patients on haemodialysis. We present a rare case of calciphylaxis in a non-uremic patient. The diagnosis was made clinically and confirmed with skin biopsy showing calcification of the dermal and subcutaneous tissues in the von Kossa stain. We believe that the combination of uncontrolled diabetes mellitus, a non-functioning paraganglioma and vitamin D deficiency in a susceptible female patient was responsible for causing calciphylaxis in our patient...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915660/a-rare-case-of-peritonitis-due-to-brevundimonas-vesicularis
#4
Colin Bolzon, Binh Hoa Nguyen
Healthcare associated infections due to gram negative bacilli are a major concern among healthcare institutions. While Pseudomonas and Escherichia coli species are known major organisms; other lesser known species can also cause primary infection. We present a case of peritonitis in a patient on a peritoneal dialysis regimen due to Brevundimonas vesicularis.
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915659/a-case-report-anti-nmda-receptor-encephalitis
#5
Pavan Bhat, Ameer Ahmed, Preetam Jolepalem, Charmian Sittambalam
N -methyl-d-aspartate receptor (NMDAR) antibody encephalitis is a potentially fatal autoimmune syndrome in which there is antibody production against the NMDAR causing profound dysregulation of neurotransmission. The syndrome is frequently associated with ovarian teratomas and women are disproportionately affected. Patients most often present with a constellation of neuropsychiatric signs and symptoms, including memory loss, hallucinations, and decreased level of consciousness. This condition is lethal if left untreated...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915658/why-now-delayed-drug-induced-pancreatitis-due-to-dapsone-for-dermatitis-herpetiformis
#6
Youssef Yousry Soliman, Megan Sue Soliman, Farrukh Abbas
Drug-induced pancreatitis can be caused by a wide array of medications. In fact, the diagnosis is likely commonly missed due to the difficulty in diagnosing one agent as the sole cause. We present a case of dapsone-induced pancreatitis in a 75-year-old male with history of celiac disease. He presented with abdominal pain and was found to have acute pancreatitis. Interestingly, he had been on dapsone for 5 years and had no other recent medication changes, significant alcohol use, or gallbladder disease. It was determined this was an episode of delayed acute pancreatitis due to dapsone...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915657/daptomycin-associated-eosinophilic-pneumonia-case-report-and-differential-diagnoses
#7
Sijan Basnet, Niranjan Tachamo, Rashmi Dhital, Biswaraj Tharu
Daptomycin is a bactericidal antibiotic approved for treatment of gram-positive skin and soft tissue infections. We present a case of an 89-year-old man who presented with fever, shortness of breath and nonproductive cough on week 4 of starting daptomycin for infective endocarditis. Computerized tomography scan showed bilateral interstitial infiltrates predominantly affecting the lower lobes. He also had peripheral eosinophilia of 6%. He was diagnosed with eosinophilic pneumonia secondary to daptomycin use...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915656/a-deadly-prescription-combination-of-methotrexate-and-trimethoprim-sulfamethoxazole
#8
Mohsin Hamid, Bilal Lashari, Irfan Ahsan, Ida Micaily, Usman Sarwar, Joseph Crocetti
Methotrexate (MTX) is a chemotherapeutic synthetic(s) phase cell cycle inhibitor, and its role has evolved as an immunological agent in autoimmune diseases like rheumatoid arthritis, psoriasis, and systemic lupus erythematosus, etc. Trimethoprim-sulfamethoxazole (TS) is one of the most widely prescribed antibiotics commonly used for urinary tract infections, exacerbations of chronic bronchitis, traveler's diarrhea, and pneumocystis pneumonia. Both MTX and TS can have significantly overlapping side effects involving dermatologic, renal, and hematological systems, and the combination of these can be deadly...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915655/to-be-or-not-to-be-a-case-of-heparin-resistance
#9
Jibran Durrani, Faizan Malik, Naveed Ali, Syed Imran Mustafa Jafri
Heparin resistance can be defined as high doses of unfractionated heparin (UFH), greater than 35,000 IU/day, required to raise the activated partial thromboplastin time (aPTT) and activated coagulation time (ACT) to within therapeutically desired ranges or the impossibility of doing so. The most common pathology responsible is the deficiency of anti-thrombin III (ATIII) deficiency. Other clinically relevant conditions that can present with heparin resistance are congenital deficiencies; use of high doses of heparin during extracorporeal circulation, use of asparaginase therapy and disseminated intravascular coagulation (DIC)...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915654/a-dramatic-recovery-in-a-patient-initially-expected-to-die-of-ttp-its-complications
#10
Jennifer Ogilvie, Jaskeerat Singh
Thrombotic thrombocytopenic purpura (TTP) has a high fatality rate if not caught early and treated with plasmapheresis. When TTP patients present late in their sequelae with neuro symptoms, an elevated lactate dehydrogenase and systemic symptoms, there is a high mortality rate. This report describes the case of a young female who had no significant medical problems and presented to our hospital after several days of hematuria, new onset blurry vision and dizziness. She was found to have thrombocytopenia and microangiopathic hemolytic anemia consistent with TTP and was thus started on plasmapheresis...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915653/coagulation-in-chronic-liver-disease-and-the-use-of-prothrombin-complex-concentrate-for-an-emergent-procedure-a-case-report-and-review-of-literature
#11
Matthew Laubham, Eric Kallwitz
Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915652/case-report-giant-cell-arteritis-in-a-patient-with-carotid-atherosclerosis-a-diagnostic-dilemma
#12
Beenish Fayyaz
Carotid atherosclerosis and giant cell arteritis (GCA) are two distinct medical conditions with an overlapping clinical spectrum of vascular symptoms such as vision loss and ischemic stroke. This is because both diseases cause arterial ischemia with a predilection for carotid vasculature. In addition, high-vascular risk individuals who are diagnosed with GCA are usually elderly with age >55 years with high-vascular risk and thus can have underlying atherosclerosis. All these factors can pose a diagnostic dilemma for the physicians as GCA is a medical emergency which if left untreated can result in significant morbidity and mortality...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915651/posterior-reversible-encephalopathy-syndrome-pres-after-bevacizumab-therapy-for-metastatic-colorectal-cancer
#13
Mohsin Hamid, Ali Ghani, Ida Micaily, Usman Sarwar, Bilal Lashari, Faizan Malik
Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognizable neuro-clinical syndrome. Clinical and neurological manifestations of PRES include hypertension, headache, encephalopathy, seizures, and symmetrical white matter changes on brain MRI. Most common precipitants of PRES are acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy, and chemotherapy. Bevacizumab is a monoclonal antibody that halts angiogenesis by inhibiting vascular endothelial growth factor...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915650/a-case-of-recurrent-obscure-gastrointestinal-bleeding-heyde-s-syndrome-case-report-and-review
#14
Rajarajeshwari Ramachandran, Hakim Uqdah, Niraj Jani
Gastrointestinal bleeding from angiodysplasias in patients with aortic stenosis is termed as 'Heyde's syndrome'. We report a case of Heyde's syndrome successfully treated with trans-catheter aortic valve replacement.
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915649/cytomegalovirus-infection-in-a-patient-with-systemic-lupus-erythematosus-and-acute-myocardial-infarction-cause-or-causal-relationship
#15
Anum Asif, Maria Del Pilar Morales
The possible role of infectious and inflammatory states in the pathogenesis of atherosclerotic disease has been a matter of debate in the literature. There are case reports of active cytomegalovirus (CMV) infection unmasking underlying dormant systemic lupus erythematosus (SLE). CMV infection has also been postulated to be associated with atherosclerosis development in the coronaries. We present a unique case where a patient with newly diagnosed SLE and acute myocardial infarction was found to have high anti-CMV titers suggesting concomitant active CMV infection...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915648/acute-eosinophilic-pneumonia-associated-with-smoking-a-case-report
#16
Beenish Fayyaz
Acute eosinophilic pneumonia (AEP) is commonly misdiagnosed as infectious pneumonia due to presence of fever and radiological features. However, development of peripheral eosinophilia within days of presentation should raise the concern of AEP especially in previously heathy adults with history of recent tobacco smoking.
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915647/recurrent-spontaneous-pneumothorax-in-pregnancy-a-case-report-and-review-of-literature
#17
Noman Lateef, Mustafa Dawood, Karn Sharma, Abubakar Tauseef, Muhammad Asadullah Munir, Erin Godbout
Spontaneous pneumothorax in pregnancy is a rare and life-threatening condition. In this report, a case of spontaneous pneumothorax occurring at 34 weeks' gestation in a healthy 34-year-old primigravida is described. She had typical complaints of chest pain and dyspnoea and diagnosis was made by chest X-ray which showed an extensive pneumothorax in the right side. Pneumothorax recurred twice over approximately three weeks. A caesarean section secondary to small pelvic parameters was scheduled with the chest tube in situ and a healthy 2...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915646/spinal-gout-causing-reversible-quadriparesis-a-case-report-and-literature-review
#18
Jaspreet Kaler, Osama Mukhtar, Mazin Khalid, Shivani Thapa, Ravinder Kaler, Brandon Ting, Vijay Gayam
Gout commonly affects peripheral joints and is rarely found in axial joints, such as the spine and sacroiliac joints. We report a case of a patient that presented with quadriparesis who was empirically treated for spinal gout and a review of relevant literature. A 77-year-old male presented with new-onset quadriparesis that developed over 3 days. MRI imaging was suggestive of tophaceous gout of the cervical spine, but our patient refused a spinal biopsy. He was empirically treated with high-dose steroids and his upper and lower extremities weakness started improving within 3 days and resolved completely...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915645/kratom-a-dangerous-player-in-the-opioid-crisis
#19
Khadija Tayabali, Colin Bolzon, Paul Foster, Janki Patel, Mohammad Omar Kalim
Kratom use as a herbal supplement is on the rise in the United States, with reported medical outcomes and lethal effects suggesting a public health threat. Even though the Drug Enforcement Administration has included kratom on its drugs of concern list and the FDA has published a press release to identify it as an opioid with a potential for abuse, its therapeutic and side effects are still not well defined in the literature. Here, we present a case of a 32-year-old man with a history of kratom use who became acutely ill with a brief prodromal illness, followed by jaundice and elevated liver enzymes showing a cholestatic picture, and his successful treatment...
2018: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/29915644/right-ventricular-dysplasia-management-and-treatment-in-light-of-current-evidence
#20
REVIEW
Amr Idris, Syed Raza Shah, Ki Park
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiovascular disease that predisposes to ventricular arrhythmias potentially leading to sudden cardiac death (SCD). ARVC varies considerably with multiple clinical presentations, ranging from no symptoms to cardiac arrhythmias to SCD. ARVC prevalence is not well known, but the estimated prevalence in the general population is 1:5000. Diagnosis of ARVC can be made by using the Revised European Society of Cardiology criteria for ARVC that includes ventricular structural and functional changes, ECG abnormalities, arrhythmias, family and genetic factors...
2018: Journal of Community Hospital Internal Medicine Perspectives
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