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Journal of Community Hospital Internal Medicine Perspectives

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https://www.readbyqxmd.com/read/27802866/point-of-care-ultrasonography-as-a-training-milestone-for-internal-medicine-residents-the-time-is-now
#1
Bruce F Sabath, Gurkeerat Singh
Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution - a community hospital - in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802865/contralateral-compartment-syndrome-inoculated-by-invasive-group-a-streptococcus
#2
Huiwen Chen, Sean Thomas Mcphillips, Vishnu Chundi
Compartment syndrome is a rare but a well-documented complication in patients with trauma-induced group A streptococcus infection. Here, we present a case of a male who developed compartment syndrome on the left lower extremity after an injury inoculated by group A streptococcus on the right lower extremity. The patient was resuscitated with antibiotics, urgent fasciotomy, and immunoglobulin. The patient was eventually transferred to a burn center for further care.
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802864/glucokinase-mutation-a-rare-cause-of-recurrent-hypoglycemia-in-adults-a-case-report-and-literature-review
#3
Oluremi N Ajala, David M Huffman, Ibrahim I Ghobrial
BACKGROUND: Hypoglycemia occurs frequently in patients both in the inpatient and outpatient settings. While most hypoglycemia unrelated to diabetes treatment results from excessive endogenous insulin action, rare cases involve functional and congenital mutations in glycolytic enzymes of insulin regulation. CASE: A 21-year-old obese woman presented to the emergency department with complaints of repeated episodes of lethargy, syncope, dizziness, and sweating. She was referred from an outside facility on suspicion of insulinoma, with severe hypoglycemia unresponsive to repeated dextrose infusions...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802863/adrenal-incidentalomas-are-they-being-worked-up-appropriately
#4
Pooja Sahni, Apoorva Trivedi, Abdulkadir Omer, Nitin Trivedi
INTRODUCTION: Adrenal incidentalomas are defined as masses picked up on imaging studies that were done for apparently different reasons. With frequent use of imaging modalities, incidental adrenal masses are commonly encountered in clinical practice. Guidelines are currently available for the diagnosis and management of adrenal incidentalomas, but the appropriateness of initial work-up and subsequent follow-up of incidental adrenal masses in the community hospital setting is unknown. OBJECTIVE: We studied the appropriateness of initial work-up and follow-up of incidental adrenal masses discovered on abdominal computerized tomography (CT)...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802862/isolated-pulmonary-valve-endocarditis-masquerading-as-community-acquired-pneumonia
#5
Salik Nazir, Saroj Lohani, Niranjan Tachamo, Anam Siddiqui, Nitin Patel
Isolated pulmonary valve endocarditis in intravenous drug users is a rarely reported phenomenon. We present the case of a 25-year-old male with history of intravenous drug use who presented with respiratory symptoms after failing outpatient treatment for community-acquired pneumonia. Further investigations identified multiple lung lesions with early cavitation, concerning for septic pulmonary embolism on computerized tomography scan, positive blood cultures with methicillin-susceptible staphylococcus aureus, and isolated vegetation of the pulmonic valve on transthoracic echocardiography...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802861/financial-impact-of-a-targeted-reduction-in-cardiac-enzyme-testing-at-a-community-hospital
#6
Li Zhang, Anne M Sill, Ilene Young, Sabreen Ahmed, Maria Morales, Sapna Kuehl
OBJECTIVES: Nearly one-third of healthcare costs are potentially avoidable and would not compromise medical care if eliminated. Therefore, we sought to evaluate the financial impact of reduction in use of creatinine kinase (CK)-MB and myoglobin tests after removing them from the cardiac enzyme order set at a community hospital. METHODS: Grand rounds were held, and an email notification was sent to de-emphasize the use of CK, CK-MB, myoglobin, SGOT (glutamic-oxaloacetic transaminase), and SGPT (serum glutamic-pyruvic transaminase) in acute coronary syndrome (ACS) work up...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802860/hemifacial-spasm-in-a-patient-with-basilar-artery-dolichoectasia-caused-by-uncontrolled-hypertension
#7
Gordon S Crabtree, David Gish, David Goldberg
A 47-year-old male presented with a 2-year history of hemifacial spasm. Magnetic resonance imaging performed showed his tortuous basilar artery with nerve compression, and the patient was treated conservatively with botulinum toxin injections with complete resolution of symptoms. This rare disease was caused by his long history of hypertension, which led to his major basilar artery dolichoectasia.
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802859/emerging-infectious-diseases-1970s
#8
Robert Ferguson
Forty years ago is not ancient history in the medical field. However, being an eye witness to the emergence of three new infectious diseases in the northeastern United States in the 1970s left a deep impression on this author. I will relate a small portion of the amazing events that caught the attention of the medical establishment and the general public in a roughly 5-year period of medical discovery.
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802858/rash-that-itches-and-is-all-over-look-beyond-the-skin
#9
Saroj Lohani, Niranjan Tachamo, Salik Nazir
Generalized pruritic rash in Hodgkin's disease is most commonly due to paraneoplastic manifestation. It can sometimes precede other manifestations of Hodgkin's disease by weeks or months. Hence, if other possible causes have been ruled out, Hodgkin's disease should be considered a possible cause of generalized pruritic rash. Consideration of Hodgkin's disease as a cause of generalized pruritic rash can help in early identification of Hodgkin's disease. We present a case of a 71-year-old female who presented to the hospital with generalized pruritic rash for 4 days...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802857/adoption-of-electronic-health-records-and-barriers
#10
REVIEW
Venkataraman Palabindala, Amaleswari Pamarthy, Nageshwar Reddy Jonnalagadda
Electronic health records (EHR) are not a new idea in the U.S. medical system, but surprisingly there has been very slow adoption of fully integrated EHR systems in practice in both primary care settings and within hospitals. For those who have invested in EHR, physicians report high levels of satisfaction and confidence in the reliability of their system. There is also consensus that EHR can improve patient care, promote safe practice, and enhance communication between patients and multiple providers, reducing the risk of error...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802856/when-life-threatening-conditions-appear-clinically-silent-an-atypical-presentation-of-spontaneous-coronary-artery-dissection-in-a-60-year-old-female
#11
Yenal Harper, Manyoo Agarwal, Krishna Gannamraj, Sneha Parmar, Inyong Hwang, Shadwan Alsafwah
Spontaneous coronary artery dissection is a poorly understood phenomenon that usually affects women during pregnancy or the immediate post-partum period. We present the case of a 60-year-old female with chronic obstructive pulmonary disease who presented with vague complaints of shortness of breath, dizziness, and weakness with a mildly elevated troponin. She denied any anginal symptoms. As part of her initial workup, a nuclear stress test revealed inferior wall reversible changes. Coronary angiography revealed spontaneous right coronary artery dissection which was treated with a drug-eluting stent...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802855/a-remarkable-case-of-rhabdomyolysis-associated-with-ingestion-of-energy-drink-neon-volt
#12
Praneet S Iyer, Rishitha Yelisetti, Varun Miriyala, Waqas Siddiqui, Anand Kaji
Rhabdomyolysis is defined as a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. We present a case of a 35-year-old male who exercised for 2 h after ingesting energy drink and subsequently presented with rhabdomyolysis. After excluding common and uncommon causes of rhabdomyolysis, we reached the conclusion that the likely cause was the ingestion of energy drink 'NEON VOLT' in a setting of mild dehydration. Increasing physical activity and intense exercise is becoming a trend in many countries, due to its many health-related benefits such as prevention of obesity...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802854/syphilis-an-atypical-case-of-sepsis-and-multiple-anogenital-lesions-in-secondary-syphilis
#13
Nichole Smith, Sonu Dhillon, John G Cotter, Zohair Ahmed
The incidence of syphilis has historically been cyclical in nature, often in relation to the rise and fall of public health initiatives directed toward eradication along with social attitudes toward sexual practices. The incidence of syphilis has increased by 15% in the last 6 years in the United States, with similar increases worldwide. Herein, we present an atypical case of syphilis presenting with severe septic shock and multiple anogenital lesions in an immunocompetent host. A 22-year-old male with no significant past medical history presented with fevers, chills, sore throat, diaphoresis, and diarrhea...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802853/large-volume-paracentesis-with-indwelling-peritoneal-catheter-and-albumin-infusion-a-community-hospital-study
#14
Daniel K Martin, Saqib Walayat, Ren Jinma, Zohair Ahmed, Karthik Ragunathan, Sonu Dhillon
BACKGROUND: The management of ascites can be problematic. This is especially true in patients with diuretic refractory ascites who develop a tense abdomen. This often results in hypotension and decreased venous return with resulting renal failure. In this paper, we further examine the risks and benefits of utilizing an indwelling peritoneal catheter to remove large-volume ascites over a 72-h period while maintaining intravascular volume and preventing renal failure. METHODS: We retrospectively reviewed charts and identified 36 consecutive patients undergoing continuous large-volume paracentesis with an indwelling peritoneal catheter...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802852/glioblastoma-management-challenges-in-the-elderly-population
#15
Niranjan Tachamo, Salik Nazir, Saroj Lohani, Brian Le, Richard Alweis
Glioblastoma is a highly aggressive and generally lethal brain tumor despite aggressive treatment. Treatment to ensure prolonged survival while maintaining quality of life has always been challenging, as glioblastoma occurs mostly in elderly population who already have multiple comorbidities. We present the case of a 75-year-old male who was evaluated for complaints of recurrent falls due to gait abnormalities and weakness, and was found to have multifocal glioblastoma. Despite rapid initiation of chemo radiation, he did not respond to therapy and died within 4 months of diagnosis...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802851/throbbing-headache-is-not-always-migraine-it-can-be-serious
#16
Marcelle G Meseeha, Maximos Attia
Cerebral venous thrombosis (CVT) is a rare but serious venous thrombotic disorder in the general population. It has an estimated annual incidence of about 4-5 cases per 1 million persons. It is more common in females than males. We describe below a case of a 49-year-old female patient who presented to the emergency room with 1 day history of right-sided throbbing headache associated with vomiting. Computed tomography (CT) scan of the head without contrast showed venous sinus thrombosis involving the posterior sagittal sinus, extending into the dominant right transverse sinus, which was confirmed by CT head with intravenous contrast...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802850/impending-aortic-aneurysm-rupture-a-case-report-and-review-of-the-warning-signs
#17
David S Gish, J Austin Baer, Gordon S Crabtree, Bilal Shaikh, Shoaib B Fareedy
Abdominal aortic aneurysm (AAA) may present with subtle clinical findings. Recognition of the imaging features of an impending rupture is key for timely diagnosis. This report reviews the classic computed tomography findings of impending AAA rupture and presents a recent case which illustrates the key features.
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802849/miliary-tuberculosis-and-acquired-immunodeficiency-syndrome-a-cursed-duet
#18
Atif Tatari, Sahana Ramanujam, Suja Mathai, Nigahus Karabulut, Robert L Moser, Sara L Wallach
Tuberculous osteomyelitis is rare and usually involves the vertebrae but is seldom found in the foot. The uncommon site and ability to mimic other disorders clinically and radiographically leads to diagnostic and therapeutic delays. We report a case of a 40-year-old man who initially presented to his podiatrist with intermittent pain and swelling of his right ankle and foot that lasted for a year. He also started to exhibit significant weight loss and unexplained fevers and was subsequently hospitalized for cellulitis of his right foot...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27802848/a-case-of-renal-cell-carcinoma-with-an-extensive-inferior-vena-cava-thrombosis
#19
Majd Alfreijat
Renal cell carcinoma (RCC) is the most prevalent primary renal malignant neoplasm in adults. Most of the cases are usually found incidentally. It is commonly associated with venous thrombosis. We demonstrate a case of a RCC which was associated with an extensive thrombus that reached the upper part of the inferior vena cava (IVC). We also perform a brief literature review about the association between RCC and IVC thrombosis.
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27609736/utilization-of-4t-score-to-determine-the-pretest-probability-of-heparin-induced-thrombocytopenia-in-a-community-hospital-in-upstate-new-york
#20
Yazan Samhouri, Mohammad Telfah, Ruth Kouides, Timothy Woodlock
BACKGROUND: Thrombocytopenia is common in hospitalized patients. Heparin-induced thrombocytopenia (HIT) is a life-threatening condition which can lead to extensive thrombosis. Diagnosis of HIT relies on clinical suspicion determined by 4T score and immunoassays through testing for anti-PF4/heparin antibodies. Clinical practice guidelines published by the American Society of Hematology in 2013 recommended use of the 4T score before ordering the immunoassays as a measure of pretest probability...
2016: Journal of Community Hospital Internal Medicine Perspectives
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