Read by QxMD icon Read

Journal of Community Hospital Internal Medicine Perspectives

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
Venkateswara K Kollipara, Patrick L Brine, David Gemmel, Sisham Ingnam
Pernicious anemia is an autoimmune disease with a variety of clinical presentations. We describe a case of pernicious anemia presenting with pancytopenia with hemolytic features. Further workup revealed very low vitamin B12 levels and elevated methylmalonic acid. It is important for a general internist to identify pernicious anemia as one of the cause of pancytopenia and hemolytic anemia to avoid extensive workup. Pernicious anemia can present strictly with hematological abnormalities without neurological problems or vice versa as in our case...
2016: Journal of Community Hospital Internal Medicine Perspectives
Chirag Sheth, Amandeep Gill, Sumeet Sekhon
Acquired factor VIII deficiency (acquired hemophilia A) is a rare condition characterized by the acquisition of autoantibodies that affect the clotting activity of factor VIII (fVIII). The most common manifestation in affected patients is a hemorrhagic diathesis. This disorder is associated with autoimmune diseases, pregnancy, postpartum period, drugs, and malignancy. Management of this condition begins with attempts to arrest an acute bleed based on the site and severity of bleeding and inhibitor titer. The next priority is eradication of the fVIII antibodies using immunosuppressive therapies...
2016: Journal of Community Hospital Internal Medicine Perspectives
Shruti Bhandari, Katrina Agito, Esther I Krug
Bilateral adrenal hemorrhage (BAH) is a rare complication typically seen in critically ill patients, which can lead to acute adrenal insufficiency and death unless it is recognized promptly and treated appropriately. We describe the case of a 64-year-old man with polycythemia vera found to be unresponsive with fever, hypotension, tachycardia, and hypoglycemia. Electrocardiogram showed ST-elevation with elevated troponin, hemoglobin, prothrombin time, and partial thromboplastin time. He required aggressive ventilator and vasopressor support...
2016: Journal of Community Hospital Internal Medicine Perspectives
Vinuta Mohan, Robert Lind
Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease...
2016: Journal of Community Hospital Internal Medicine Perspectives
Dongyan Liu, Thomas Bateman, Elisabeth Carr, Paul Foster
An 87-year-old Caucasian woman with hypertension, diabetes mellitus type 2, and COPD was admitted with 1-week duration of back pain and weight gain. The physical examination revealed jugular venous distention, rales in the left lower lung field, and severe pitting edema over lower extremities. As workup for leukocytosis, blood cultures grew Gemella haemolysans. Subsequently, a transthoracic echocardiogram revealed vegetation on the non-coronary aortic leaflet and mild aortic stenosis. She was treated with ampicillin and gentamicin...
2016: Journal of Community Hospital Internal Medicine Perspectives
Jaymon Patel, Preeti Patel, Zohair Ahmed
Thrombotic thrombocytopenic purpura (TTP) is a life-threatening medical emergency which may be difficult to recognize given the wide spectrum in which it presents. A delay in treatment may be catastrophic as untreated cases of TTP have a mortality rate exceeding 90%. Given the high fatality rate of untreated TTP and its range of presenting symptoms, we present our unusual case of TTP in a post-splenectomy patient with early treatment and positive outcome. This case describes a 54-year-old female who presented with hematuria and gingival bleeding, followed by the development of a bilateral lower extremity petechial rash...
2016: Journal of Community Hospital Internal Medicine Perspectives
Md Basunia, Samir A Fahmy, Frances Schmidt, Chidozie Agu, Bikash Bhattarai, Vikram Oke, Danilo Enriquez, Joseph Quist
BACKGROUND: Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) present with a variety of sleep-related symptoms. In polysomnography, sleep architecture is almost always abnormal, but it is not known which of the sleep-stage abnormalities are related to symptoms. Finding key sleep-stage abnormality that cause symptoms may be of therapeutic importance to alleviate symptoms. So far the mainstay of treatment is continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BIPAP) therapy, but many patients are non-compliant to it...
2016: Journal of Community Hospital Internal Medicine Perspectives
Ali Alfahan, Samia Alhabib, Imad Abdulmajeed, Saeed Rahman, Samira Bamuhair
BACKGROUND: Hand hygiene is one of the essential means to prevent the spread of infections. The aim of this study was to assess the knowledge, attitudes, and practice (KAP) of hand hygiene in primary care settings. METHODS: A cross-sectional study using a self-reported questionnaire was conducted in primary care settings located in Riyadh, Kingdom of Saudi Arabia, under the service of King Abdulaziz Medical City (KAMC). The Institutional Review Board of KAMC Research Centre approved the study...
2016: Journal of Community Hospital Internal Medicine Perspectives
Michael H K Nguyen, Krista M Isaac, Rebecca Dougherty
Gastrointestinal perforations are a complication of 2-10% of duodenal ulcers. There are a variety of etiologies associated with duodenal ulcer formation and its complications. Corticosteroid use is associated with an increased risk of duodenal ulcer perforation, with the first documented case in 1950. Other important medications associated with perforation include NSAIDS and opioids. Beyond medication, one of the most common disease processes, chronic obstructive pulmonary disease (COPD), has been found to be associated with peptic ulcer disease...
2016: Journal of Community Hospital Internal Medicine Perspectives
Niranjan Tachamo, Salik Nazir, Saroj Lohani, Paras Karmacharya
Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis. Most cases are asymptomatic; however, symptomatic patients may present with a wide range of non-specific cutaneous, pulmonary, or gastrointestinal symptoms posing a diagnostic dilemma and delay in diagnosis. We report a case of a 58-year-old female who presented with months of generalized pruritus and abdominal discomfort along with persistent eosinophilia due to strongyloidiasis, which completely resolved with treatment.
2016: Journal of Community Hospital Internal Medicine Perspectives
Abdul S Mohammed, Prajwal Boddu, David Mael, Mohammed Samee, Dana Villines
Healthcare providers use antinuclear antibodies (ANAs) to screen and diagnose patients with autoimmune diseases. In the recent years, commercial multiplex ANA kits have emerged as a convenient and fast diagnostic method. Diagnostic testing should follow sequenced algorithms: initial screen followed by specific antibody analysis. Second-level testing as an initial screen for autoimmune disease is inappropriate. We reviewed 68 patients with ANA comprehensive panels over a 6-month period from May 2015 to October 2015...
2016: Journal of Community Hospital Internal Medicine Perspectives
Swe Zin Mar Win Htut Oo, Koroush Khalighi, Archana Kodali, Cho May, Thein Tun Aung, Richard Snyder
Wellens' syndrome is characterized by T-wave changes in electrocardiogram (EKG) during pain-free period in a patient with intermittent angina chest pain. It carries significant diagnostic and prognostic value because this syndrome represents a pre-infarction stage of coronary artery disease involving proximal left anterior descending (LAD) artery, which can subsequently lead to extensive anterior myocardial infarctions (MIs) and even death without coronary angioplasty. Therefore, it is crucial for every physician to recognize EKG features of Wellens' syndrome in order to take appropriate immediate intervention to reduce mortality and morbidity for MI...
2016: Journal of Community Hospital Internal Medicine Perspectives
Paul N Foster, Julie R Klein
The Institute of Medicine (IOM) released its report on diagnostic errors in September, 2015. The report highlights the urgency of reducing errors and calls for system-level intervention and changes in our basic clinical interactions. Using the report's controversial definition of diagnostic error as a starting point, we introduce the issues and the potential impact on practicing physicians. We report a case used to illustrate this in an academic conference. Finally, we turn to the challenge of integrating these ideas into the traditional peer-review process...
2016: Journal of Community Hospital Internal Medicine Perspectives
Katherine Wong, Sam W Serafi, Abhijit S Bhatia, Irene Ibarra, Elizabeth A Allen
An 81-year-old woman with a history of malignant melanoma who presented with dyspnea and fatigue was found to have metastases to the stomach detected on endoscopy. Primary cutaneous malignant melanoma with gastric metastases is a rare occurrence, and it is often not detected until autopsy because of its non-specific manifestations.
2016: Journal of Community Hospital Internal Medicine Perspectives
Faiz Hussain, Nina Yedavalli, David Loeffler, Andre Kajdacsy-Balla
Renal cell carcinoma is a common cancer, known for its aggressive behavior and ability to metastasize nearly every organ system in the body. While the cancer commonly spreads to a select few organs and metastasis usually develops within 5 years of diagnosis, there have been numerous case reports of atypical sites of metastasis and cases of relapse up to decades after treatment. We present a case a 65-year-old male who presented with right preauricular swelling 8 years after the initial diagnosis and right nephrectomy for clear cell renal cell cancer...
2016: Journal of Community Hospital Internal Medicine Perspectives
Brianna A da Silva, Mahesh Krishnamurthy
CASE DESCRIPTION: A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. DISCUSSION: Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up...
2016: Journal of Community Hospital Internal Medicine Perspectives
Raafia Memon, WuQiang Fan, Richard Snyder, Mahesh Krishnamurthy
INTRODUCTION: While extremely uncommon, diabetic ketoacidosis (DKA) and thyroid storm (TS) are endocrine emergencies that can coexist. We describe a case with a confounding clinical presentation that identifies these two emergencies within the setting of sepsis and influenza. CASE: A 69-year-old diabetic female was found by the paramedic staff to be disoriented. She demonstrated tachycardia and had a foul-smelling abdominal wound. Laboratory evaluation revealed DKA, leukocytosis, influenza B, and urinary tract infection...
2016: Journal of Community Hospital Internal Medicine Perspectives
Bikram Shrestha, Bernard Kim, Alison Huffstetler
MALT: Mucosa-associated lymphoid tissue (MALT)-type lymphoma is a relatively rare disease; nevertheless, it is the third most common lymphoma type, accounting for 5-7% of all non-Hodgkin lymphomas. Case series and retrospective analysis published in the literature have suggested that extra gastrointestinal (GI) MALT-type lymphoma can occur simultaneously with MALT-type lymphoma involving the GI tract. We report the case of a healthy, 64-year-old Caucasian male who presented with progressive fatigue, non-productive cough, and worsening exertional shortness of breath for 3 months who was subsequently diagnosed with gastric extra-nodal marginal zone B-cell lymphoma or MALToma with simultaneous metastasis to the lung (bronchi) based on biopsy reports...
2016: Journal of Community Hospital Internal Medicine Perspectives
Jose Orsini, Christa Blaak, Salil Rajayer, Vikash Gurung, Eric Tam, Joaquin Morante, Ben Shamian, Ryan Malik
Recreational substance use and misuse constitute a major public health issue. The annual rate of recreational drug overdose-related deaths is increasing exponentially, making unintentional overdose as the leading cause of injury-related deaths in the United States. Marijuana is the most widely used recreational illicit drug, with approximately 200 million users worldwide. Although it is generally regarded as having low acute toxicity, heavy marijuana usage has been associated with life-threatening consequences...
2016: Journal of Community Hospital Internal Medicine Perspectives
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"