Internal Medicine Commons^™

An Atypical Cause Of Atypical Hemolytic Uremic Syndrome, Abhinav Sharma, Carolina De Elia, Eric Arguelles, Christine L. Gilkerson

Christine Gilkerson, MD

Atypical hemolytic syndrome is an extremely rare, life threatening, progressive disease. Approximately one to two cases per million are seen annually in the US (3,4). It is known to be associated with variety of conditions including infections, drugs, autoimmune conditions, vaccination, malignancy, organ transplantation, pregnancy, and metabolic conditions (11,13).We hereby describe a case of atypical hemolytic uremic syndrome associated with CABG surgery. A 58 year old female presented to the emergency department (ED) with three days of worsening shortness of breath and cold like symptoms including nausea, vomiting and rhinorrhea. Twenty six days prior to presentation she had undergone Coronary …

Left Ventricular Noncompaction Syndrome: A Rare Congenital Cardiomyopathy, Ashwini V. Mallad, Mbbs, Waseem Ahmed, Md, Madhulika Urella, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Mehiar El Hamdani, MD

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance …

Splenic Infarction: An Uncommon Presentation Of Acute Infectious Mononucleosis, Madhulika Urella, Roma Srivastava, Waseem Ahmed, Yehuda Lebowicz

Yehuda Z. Lebowicz, MD

Contrast enhanced CT showing multiple splenic infarcts

Splenic Infarction: An Uncommon Presentation Of Acute Infectious Mononucleosis, Madhulika Urella, Roma Srivastava, Waseem Ahmed, Yehuda Lebowicz

Yehuda Z. Lebowicz, MD

Splenic infarction is a relatively uncommon diagnosis. It occurs when the splenic artery or one of its sub-branches is occluded with an infected or bland embolus or clot. Splenic infarction may be caused by atrial fibrillation, bacterial endocarditis, sickle cell disease, antiphospholipid syndrome, and trauma whereas an infectious etiology is uncommon. It is considered a rare presentation of acute infectious mononucleosis. Currently, its pathogenesis is still unclear. We describe a 24-year-old African American female who was admitted for evaluation of left-sided chest pain. Chest imaging, abdominal ultrasound, and initial laboratory data were normal, followed by a negative hypercoagulability panel. Signs …

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Franklin D. Shuler

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K2 (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation of …

Triple Aim For Clinical Teachers (Tact): Faculty Physician Perceptions On Their Ability To Balance Clinical Quality, Trainee Learning, And Teaching Efficiency, Minuja Muralidharan, Anne Getzin, Kjersti E. Knox, Bonnie L. Bobot, Marie M. Forgie, Nicole P. Salvo, Deborah Simpson

Nicole P. Salvo, MD

Background: A common challenge facing teaching physicians is balancing high-quality student and resident teaching with efficient, high-quality care and patient service. Publicly accessible clinic performance reports increasingly affect where patients seek care and demand that teaching clinics rise to consumer expectations while training future physicians to function in the modern health care workplace. Limited information is available to guide physicians to achieve the triple aim for clinical teachers (TACT): clinical quality/patient experience, trainee learning, and teaching efficiency.

Purpose: To understand clinical teachers’ TACT-related experiences, perceptions and preferences for how to learn TACT-associated skill sets to improve their competence as teachers. …

Why Does Obesity Lead To Hypertension? Further Lessons From The Intersalt Study., Preeya T. Shah, Anna P. Shapiro, Zeid Khitan Md, Prasanna Santhanam Md, Joseph I. Shapiro Md

Joseph I Shapiro MD

Objectives To analyze correlations between major determinants of blood pressure (BP), in efforts to generate and compare predictive models that explain for variance in systolic, diastolic, and mean BP amongst participants of the Intersalt study. Methods Data from the Intersalt study, consisting of nearly 10,000 subjects from 32 different countries, were reviewed and analyzed. Published mean values of 24 hour urinary electrolyte excretion (Na+, K+), 24 hour urine creatinine excretion, body mass index (BMI, kg/m^2), and blood pressure data were extracted and imported into Matlab™ for stepwise linear regression analysis. Results As shown earlier, strong correlations between urinary sodium excretion …

Why Does Obesity Lead To Hypertension? Further Lessons From The Intersalt Study., Preeya T. Shah, Anna P. Shapiro, Zeid Khitan Md, Prasanna Santhanam Md, Joseph I. Shapiro Md

Zeid J. Khitan

Objectives To analyze correlations between major determinants of blood pressure (BP), in efforts to generate and compare predictive models that explain for variance in systolic, diastolic, and mean BP amongst participants of the Intersalt study. Methods Data from the Intersalt study, consisting of nearly 10,000 subjects from 32 different countries, were reviewed and analyzed. Published mean values of 24 hour urinary electrolyte excretion (Na+, K+), 24 hour urine creatinine excretion, body mass index (BMI, kg/m^2), and blood pressure data were extracted and imported into Matlab™ for stepwise linear regression analysis. Results As shown earlier, strong correlations between urinary sodium excretion …

Triple Aim For Clinical Teachers (Tact): Faculty Physician Perceptions On Their Ability To Balance Clinical Quality, Trainee Learning, And Teaching Efficiency, Minuja Muralidharan, Anne Getzin, Kjersti E. Knox, Bonnie L. Bobot, Marie M. Forgie, Nicole P. Salvo, Deborah Simpson

Kjersti Knox, MD

Background: A common challenge facing teaching physicians is balancing high-quality student and resident teaching with efficient, high-quality care and patient service. Publicly accessible clinic performance reports increasingly affect where patients seek care and demand that teaching clinics rise to consumer expectations while training future physicians to function in the modern health care workplace. Limited information is available to guide physicians to achieve the triple aim for clinical teachers (TACT): clinical quality/patient experience, trainee learning, and teaching efficiency.

Purpose: To understand clinical teachers’ TACT-related experiences, perceptions and preferences for how to learn TACT-associated skill sets to improve their competence as teachers. …

Triple Aim For Clinical Teachers (Tact): Faculty Physician Perceptions On Their Ability To Balance Clinical Quality, Trainee Learning, And Teaching Efficiency, Minuja Muralidharan, Anne Getzin, Kjersti E. Knox, Bonnie L. Bobot, Marie M. Forgie, Nicole P. Salvo, Deborah Simpson

Deborah Simpson, PhD

Background: A common challenge facing teaching physicians is balancing high-quality student and resident teaching with efficient, high-quality care and patient service. Publicly accessible clinic performance reports increasingly affect where patients seek care and demand that teaching clinics rise to consumer expectations while training future physicians to function in the modern health care workplace. Limited information is available to guide physicians to achieve the triple aim for clinical teachers (TACT): clinical quality/patient experience, trainee learning, and teaching efficiency.

Purpose: To understand clinical teachers’ TACT-related experiences, perceptions and preferences for how to learn TACT-associated skill sets to improve their competence as teachers. …