Digital Commons Network^™

Metachronous And Synchronous Triple Primary Lung Cancers In A Chronic Smoker, Xin Ya See, Ahmed Omer, Zhiting Tang, Fahad Eid, Margaret Zambon

Journal of Community Hospital Internal Medicine Perspectives

Multiple primary lung cancers (MPLCs), characterized by the presence of more than one distinct primary lung tumors, may develop either synchronously (simultaneously) or metachronously (after initial cancer treatment). This case describes a rare occurrence of three primary lung cancers in a chronic smoker. After a lobectomy for right middle lobe adenocarcinoma (ADC), the patient was diagnosed with synchronous small cell carcinoma (SCLC) in the right upper lobe and squamous cell carcinoma (SCC) in the right lower lobe. Notably, the ADC and subsequent lung cancers were metachronous. Due to her unsuitability for surgery, the patient pursued a treatment regimen involving radiation …

Survival And Vision Restoration Following Severe Metformin-Associated Metabolic Acidosis With Transient Blindness: A Case Report And Review Of The Literature, Elizabeth Mikhail, Matthew Jankowski, Dheeraj Alexander, Dhwani Pandya, Arvind Kunadi

Journal of Community Hospital Internal Medicine Perspectives

Metformin-associated lactic acidosis (MALA) is a life-threatening condition that may occur as a side effect of biguanides. This condition has a mortality rate of approximately 55% depending on the severity. Typical symptoms include abdominal pain, nausea, vomiting, and diarrhea, but may also manifest with severe symptoms such as blindness, distributive shock, and renal failure requiring ICU level care. We present the case of a female in her early 70s who arrived at the emergency department with altered mental status and new-onset blindness, later diagnosed with severe acidosis (pH 6.607). She was intubated for hemodynamic instability and continuous renal replacement therapy …

Streptococcus Canis Native Aortic Valve Endocarditis Linked To Cat Exposure: A Case Report And Review, Michael S. Wang, Maria Huaringa, Lauren Feld, Ken Ochiai, Tiffany Whelan, Nicholas M. Frazier

Journal of Community Hospital Internal Medicine Perspectives

Streptococcus canis is an uncommon human pathogen, but documented infections have been mostly associated with exposure to dogs. There are only five documented cases of endocarditis secondary to streptococcus canis, with all cases except one documenting exposure to a canine. We present a 74-year-old male with a history of Type 2 diabetes mellitus, CKD 3, moderate aortic stenosis and remote exposure to agent orange, who was found to have Streptococcus canis native valve endocarditis without exposure to a dog. To the best of our knowledge this case is the first case of endocarditis linked to feline exposure.

When Diagnosis Curls A Little: Partial Bowel Obstruction Due To Ascaris. L In A Young Man, Hanieh Radkhah, Mehrnia Omidali, Sadaf Parvin, Bahareh Shateri Amiri

Journal of Community Hospital Internal Medicine Perspectives

Ascaris lumbricoides is a helminth commonly infecting humans, particularly in developing countries. It causes a range of clinical symptoms; However, many patients are asymptomatic. This article presents a case study of a young man who experienced diffuse abdominal pain and constipation, eventually being diagnosed with partial bowel obstruction due to Ascaris lumbricoides infection. The article emphasizes the importance of considering helminthic infections like ascariasis as a potential cause of intestinal obstruction, especially in endemic areas. Early diagnosis and intervention, including conservative management and anthelminthic drugs, can lead to a full recovery and avoid unnecessary surgery.

Pituitary Apoplexy: Pitfalls In Diagnosis, Victor Rivera-Hernandez, Emiliya Zareva, Santh Silparshetty

Journal of Community Hospital Internal Medicine Perspectives

Headache is a common presenting complaint in the emergency department. A rare cause is pituitary apoplexy – a complication of pituitary adenoma consisting of hemorrhage or infarction of the primary tumor accounting for approximately 1% of headaches. A 44-year-old female presented with intractable headache, nausea, photophobia and later – signs of meningeal irritation. Initial imaging demonstrated no mass or hemorrhage, labs showed only leukocytosis and elevated CRP. Patient was started on empiric acyclovir and methylprednisolone. CSF analysis was negative for meningitis, therefore MRI of the brain was performed which demonstrated a 2.5 cm suprasellar mass. Initial Pituitary hormone evaluation demonstrated …

A Tale Of Two Diagnoses; Gout Vs Chronic Osteomyelitis. A Case Report, Mashal Imtiaz Khan, Wajiha , Ali, Ali Javed, Saadia Haleema, Yasir . Ahmed

Journal of Community Hospital Internal Medicine Perspectives

Gout can potentially be diagnosed clinically and treated, if classical symptoms are present. In some cases, gout and osteomyelitis can have similar presenting signs and symptoms and it may be difficult to differentiate just on clinical presentation, routine laboratory workup and imaging like radiography or ultrasound. Arthrocentesis can be crucial in such scenarios to differentiate the two entities as missed opportunity to treat infectious etiology can have detrimental outcomes. We present a case of patient with ankle pain and swelling treated as recurrent gout, as there were no risk factors for osteomyelitis. Arthrocentesis confirmed the diagnosis of osteomyelitis and patient …

Multiple Anomalous Coronary Arteries With Right Sinus Of Valsalva Origin: A Case Report, Abraheim Al-Nasseri, Nathaniel Leavitt, Usman Kazi, Aakash Patel, Hari Kannam

Journal of Community Hospital Internal Medicine Perspectives

Coronary artery anomalies (CAA) define a wide array of congenital abnormalities that stem from the origin, course, and distribution of coronary arteries. CAAs can lead to severe complications such as arrhythmias, myocardial ischemia, and even sudden cardiac death. We describe the case of a 58-year-old female who presented to the emergency department with chest discomfort and shortness of breath and received a workup for acute coronary syndrome. She underwent a cardiac catheterization, which incidentally found an anomalous left anterior descending artery with a right sinus of Valsalva origin, an absent left circumflex coronary artery, and a dominant right coronary artery …

A Rare Case Of Right Atrial Thrombus In A Patient With Recurrent Classical Hodgkin Lymphoma., Ayrton , Bangolo, Shraboni Dey, Amulya Upendram, Indris A Yesuf, Candice Small, Chrishanti A. Joseph, Amadu Bangura, Anushka Dekhne, Adarshpreet Singh, Nkechinyere Mary Harry, Hiba Alkeal, Aditya Gajera, Soobee Kim, Deepti Kansal, Simcha Weissman

Journal of Community Hospital Internal Medicine Perspectives

Patients with cancer are at risk for thrombotic complications due to a hypercoagulable state. However, the benefit of prophylactic anticoagulation is unclear in many subsets of these patients. For the first episode of acute thromboembolic disease (VTE) in patients with active cancer, anticoagulant therapy is administered for at least three to six months. Herein, we present a 31-year-old female with active, recurrent stage IIIa classical Hodgkin lymphoma (CHL) (nodular sclerosis), previously treated for proximal upper extremity deep vein thrombosis (DVT), presenting for evaluation of shortness of breath and eventually diagnosed with bilateral pulmonary embolism (PE) secondary to a right atrial …

Uremic Pericarditis And Cardiac Tamponade Resolving With Intensive Hemodialysis, Mayuri Patel, Shiavax J. Rao, Abhinandan R. Chittal, Khalid Al-Talib, Sriram Padmanabhan

Journal of Community Hospital Internal Medicine Perspectives

We present an interesting and complex case of cardiac tamponade due to uremic pericarditis (UP), resolving with intensive hemodialysis (HD). HD should be considered as first line management for patients with UP and pericardial effusion. Intensification of HD should be considered based on clinical presentation and severity of presentation.

Global Perspective On Covid-19 Therapies, Cardiovascular Outcomes, And Implications For Long Covid: A State-Of-The-Art Review, Azza Sarfraz, Zouina Sarfraz, Shehar Bano, Muzna Sarfraz, Ali Jaan, Amna Minhas, Aminah Abdul Razzack, Gaurav Patel, Manish Kc, Sarabjot Singh Makkar, Radhika Garimella, Krunal Pandav, Jose Almonte, Trissa Paul, Tahlianna Almonte, Lissandra Jimenez, Juan C Pantoga, Nada El Mazboudi, George Yatzkan, George Michel, Jack Michel

Journal of Community Hospital Internal Medicine Perspectives

The COVID-19 pandemic has resulted in many therapies, of which many are repurposed and used for other diseases in the last decade such in Influenza and Ebola. We intend to provide a robust foundation for cardiovascular outcomes of the therapies to better understand the rationale for the clinical trials that were conducted during the COVID-19 pandemic, and better understand the steps moving forward should the repurposing provide clinical benefit in pandemic situations. With this state-of-the-art review, we aim to improve the understanding of the cardiovascular involvement of the therapies prior to, during, and after the COVID-19 pandemic to provide meaningful …

Gastric Cancer: Clinical Features, Screening, Diagnosis, Treatment, And Prevention, Rajarajeshwari Ramachandran, Tyler Grantham, Swetha Parvataneni, Deepa Budh, Sindhu Gollapalli, Madhavi Reddy, Vinaya Gaduputi

Journal of Community Hospital Internal Medicine Perspectives

The objective of this article is to highlight the clinical features, screening, diagnosis, treatment, and prevention of gastric cancer (GC). Early GC is often asymptomatic leading to frequent delays in diagnosis. Weight loss and persistent abdominal pain are the most common symptoms at initial diagnosis. The diagnosis of GC typically involves a combination of endoscopy, biopsy, and imaging studies. Endoscopic resection techniques are emerging as successful treatment options for early GC. Treatment options for advanced GC include surgery and chemotherapy. The first line chemotherapy for advanced GC consists of doublet therapy with a combination of platinum and fluoropyrimidines. Trastuzumab, a …

Efficacy And Safety Of Bempedoic Acid In Patients With Hyperlipidemia And Non-Alcoholic Fatty Liver Disease, Sibtain Nisar, Sidra Sohail, Saman Fatima, Muhammad Talha Akhtar, Muhammad Ahmad, Muhammad Waqar Hanif, Masood Khan, Amin Mehmoodi, Jahanzeb Malik

Journal of Community Hospital Internal Medicine Perspectives

Hyperlipidemia and its association with cardiovascular diseases have been significant public health concerns for many decades. Statins have long been the primary therapeutic option for lowering cholesterol levels and reducing cardiovascular mortality. However, a substantial number of patients either do not achieve optimal lipid goals with maximally tolerated statin doses or experience statin intolerance. In recent years, there have been remarkable developments in the field of hyperlipidemia management, leading to the approval of novel hypolipidemic drugs in North America and Europe. This article reviews the clinical development of bempedoic acid, a promising new drug, alone and in combination with ezetimibe, …

Outcomes Of Upper Gastrointestinal Bleeding In Hospitalized Covid-19 Patients In The United States: A Propensity-Score Matched Analysis Of A Large National Database, Moon Ryu, Mohammed Quazi, Niloy Ghosh, Karthik Gangu, Amir H Sohail, Asif Farooq, Babu Sriram , Maringanti, Aman Goyal, Anupa Patel, Muhammad Salman Khan, Abu Baker Sheikh

Journal of Community Hospital Internal Medicine Perspectives

Patients with cirrhosis that are hospitalized with COVID-19 infection have been found to have worse outcomes. No comparative study has been conducted between gastrointestinal (GI) bleeding in patients with cirrhosis who are diagnosed with COVID-19. We utilized the National Inpatient Sample (NIS) database to perform a retrospective analysis of 24, 050 patients diagnosed with cirrhosis and COVID-19. The identified patients were separated into variceal bleeding, nonvariceal bleeding, and no (or neither) GI bleeding groups. After performing propensity sample matching and multivariate analysis of mortality, we found no significant differences in mortality among the three groups. However, the variceal bleed group …

Outcome Comparison In Hospitalized Covid-19 Patients With And Without Aki, Sanjivani Shrestha, Yani Zhang, Wajehe Najafi, Abraham Halik, Jiling Chou, Man Kit Michael Siu, Monika Dhillon, David S. Weisman

Journal of Community Hospital Internal Medicine Perspectives

Aim: Patients hospitalized with COVID-19 have a higher incidence of Acute Kidney Injury (AKI) compared with non-COVID patients. Previous observational studies showed AKI in hospitalized patients with COVID-19 was associated with significant increased mortality rate. We conducted a retrospective cohort study in a large mid- Atlantic health system to investigate whether COVID-19 associated AKI during hospitalization would lead to worse outcomes in a predominant Black patient population, compared to COVID-19 without AKI. Methods: We reviewed health records of patients (aged≥18 years) admitted with symptomatic COVID-19 between March 5, 2020, and Jun 3, 2020, in 9 acute care facilities within MedStar …

The Latest Evidence On Bempedoic Acid: Meta-Analysis Of Safety And Efficacy In High Cardiovascular Risk Patients With Hypercholesterolemia, Muhammad Adil Afzal, Noman Khalid, Muhammad Abdullah, Ata Ul Haiy, Mubariz Ahmed Hassan, Hania Sana, Sherif Elkattawy, Ahmad Azam Malik, Patrick Michael, Rahul Vasudev, Fayez Shamoon

Journal of Community Hospital Internal Medicine Perspectives

Background: Bempedoic Acid (BA) is a novel drug that has a potential to serve as an alternative to statins to decrease lipid levels and improve cardiovascular disease (CVD) outcomes, particularly for statin-intolerant individuals. However, insufficient statistical power has limited our understanding of the efficacy and safety of BA. This meta-analysis utilizes the latest data to improve our knowledge of BA's effects on lipids and CVD with increased statistical power.

Methods: MEDLINE, Embase, Cochrane Central, Clinicaltrials.gov, abstracts of national and international conferences, and reference lists of studies were searched for relevant studies. Rayyan was used to screen the search results, and …

Effect On Diabetes Control In A Resident Clinic Following The Integration Of A Clinic Pharmacist, Febronia Dawoud, Madeline Fitzpatrick, Kajal Jain, Jonathan Hughes, Tracey Doering, Melissa Scalise

Journal of Community Hospital Internal Medicine Perspectives

The impact of a pharmacist has been evaluated within the primary care setting but not within a resident-managed internal medicine clinic. This retrospective study found that the integration of a clinical pharmacist within a resident clinic improved the mean HbA1c of a high-risk patient group by 3% in 3 months and 2.6% in 6 months. None of the residents surveyed reported that the presence of a clinical pharmacist hindered their learning experience. The study also found the residents perceived the clinical pharmacist to be helpful with co-management of diabetes. This data supports the addition of a clinical pharmacist into a …

Impact Of The Covid-19 Pandemic On Hospital Admission Rate, Length Of Stay, And Mortality Rate For Patients With Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Study., Omar Abdulfattah, Akshay Kohli, Peter White, Cynthia Michael, Zainab Alnafoosi

Journal of Community Hospital Internal Medicine Perspectives

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospital admissions. Coronavirus disease 2019 (COVID-19) has large impact on patients with pulmonary diseases. The purpose of the study is to evaluate the impact of COVID-19 on patients with AECOPD. METHOD: Retrospective study with two cohorts, the first period included patients with AECOPD before COVID-19 pandemic; the second period included patients with AECOPD since the beginning of COVID-19 pandemic. The length of stay (LOS), number of patients requiring mechanical ventilation, and allcause mortality were calculated. RESULTS: There was a total of 55 (44.72%) patients in the pre-COVID …

Book Reviews, Florida Historical Society

Florida Historical Quarterly

Thulman and Garrison, eds., New Directions in the Search for the First Floridians. by Shawn Joy; Sledge, The Gulf of Mexico: A Maritime History. by Deanne Stephens; Smith, ed., Submerged History: Underwater Archaeology in Florida. by John J. Bertalan; Clavin, The Battle of Negro Fort: The Rise and Fall of a Fugitive Slave Community. by Uzi Baram; Nelson, How The New Deal Built Florida Tourism: The Civilian Conservation Corps and State Parks. by Tara Mitchell Mielnik; Odom and Waling, eds., NASA and the Long Civil Rights Movement. by Amy E. Foster; Delerme, Latino Orlando: Suburban Transformation and Racial Conflict. by …

Amnesia, Anamnesis, And Myth-Making In Florida: A Case Study Of Chipco, Eric Hannel

Florida Historical Quarterly

History often finds ways of retaining information deemed "valuable," while discarding information no longer of interest or importance to its scrivener. During this process, those who recount history intentionally or unintentionally forget some details while retaining others, perhaps even embellishing them for later generations. At the nexus of this amnesia and purposeful anamnesis (the way history is remembered), rests American mythmaking. Each layer of mythmaking connects with place or geography representing forgotten as well as recollected details, a reclamation of past events and altered memories that aggrandize, justify, and construct out of messy, complex, and often brutal reality, a sanitized …

Free Blacks, Citizenship, And The Constitution In Florida Courts, 1821-1846, Craig Buettinger

Florida Historical Quarterly

In 1829, George J. F. Clarke of St Augustine called on the St. Johns County tax assessor to make a return (itemization) of his taxable properties and those of each of his five adult sons. Clarke was one of the city's leading men, born in St. Augustine to Scottish parents during Florida's British period. Clarke's sons, born once Florida had returned to Spanish rule, were his children by his mistress, Flora Leslie, a slave he had purchased in 1793 and emancipated in 1797. In November 1828, the Legislative Council for the Florida Territory had enacted a revenue law that taxed …

Florida Historical Quarterly, Volume 98, Number 1, Florida Historical Society

Florida Historical Quarterly

Free Blacks, Citizenship, and the Constitution in Florida Courts, 1821-1846 by Craig Buettinger
"The Women of Florida Are Wide Awake": The National Association of Colored Women's Clubs in Florida, 1897-1930 by Cynthia Patterson
The Happiest Place on Earth?: South Africa, Divestment, and Anti-Aparteid Movements in Orlando, Florida in the 1980s by Jacob Ivey
End Notes

The Making Of Florida's "Criminal Class": Race, Modernity, And The Convict Leasing Program, 1877-1919, Connon Donegan

Florida Historical Quarterly

"To degrade a white man by physical punishment is to make a bad member of society and a dangerous political element," so declared the report ofthe three person committee appointed by the delegates to Florida's 1865 constitutional convention. Their charge was to facilitate the drafting of a new legal code in conformity with the Thirteenth Amendment to the United States Constitution, abolishing slavery and involuntary servitude except as punishment for a duly convicted crime. The criminal code enacted in the legislative sessions of 1865 and 1866 embodied the conviction of the formerly-Confederate lawmakers that the State of Florida would continue …

Volusia And Vibilia: Companion Plantations On The St. Johns River In Spanish And Territorial East Florida, Lani Friend

Florida Historical Quarterly

The names Volusia and Vibilia are mellifluous, "soft and pleasing to the ear." These are words used by Horatio Dexter to describe the Seminole language, but they are well suited to the names of these Spanish land grant plantations on the St.Johns River. Volusia and Vibilia seem to belong together because they do-they share a semantic affinity; they originate from a common cultural source; they were likely bestowed by the same person/s; and the lands bearing the names are closely linked in their history and development. Volusia and Vibilia were companion plantations in Spanish and Territorial East Florida.

Florida Historical Quarterly, Vol. 97, Number 4, Florida Historical Society

Florida Historical Quarterly

Volusia and Vibilia: Companion Plantations on the St. Johns River in Spanish and Territorial East Florida, Lani Friend
The Making of Florida's "Criminal Class": Race, Modernity, And the Convict Leasing Program, 1877-1919, Connor Donegan
Covert Cross-Racial Mobilization, Black Activism, and Political Participation Pre-Voting Rights Act, Loren Collingwood and Benjamin Bonzales-O'Brien
Book Reviews
End Notes
Index for Volume 97

All Disquiet On The Home Front: World War I And Florida, 1914-1920, Gary R. Mormino

Florida Historical Quarterly

On the eve of the First World War, the United States viewed events in Europe through a filter of isolationism and neutrality. Two vast oceans had reinforced an inclination toward internal affairs and paranoia, while engendering suspicion of diplomatic alliances and foreign revolutions. But events in faraway places-Sarajevo, St. Petersburg, and the Somme-made isolation impossible and neutrality improbable.

Florida Historical Quarterly, Volume 97, Number 3, Florida Historical Society

Florida Historical Quarterly

All Disquiet on the Home Front: World War I and Florida, 1914-1920, Gary R. Mormino
War, Fear, and Bread in Tampa, 1917-1918, Andy Huse
The Sunshine State in Darkness: A Digital Approach to Florida and World War I, Michael Burke, Tyler Campbell, Kayla Campana
Book Reviews
End Notes

Painting A Landscape Of Acute Care Nurse Scientist Work, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Hospitals are increasingly hiring nurse scientists, motivated in part by nursing excellence designations such as Magnet. Magnet designation requires at least three, nurse-led, Institutional Review Board-approved research studies to be conducted in the hospital every four years and for nurses to be actively implementing evidence-based practice (EBP) projects using research evidence. However, clinical nurses often lack the specialized knowledge and training necessary to engage in well-designed research or EBP. Nurse scientists are PhD-prepared individuals with expertise to mentor clinical nurses to navigate the rigor and complexity of creating, implementing, analyzing, and disseminating research and EBP projects. Yet, due …

Nurse Engagement In Clinical Scholarship Linked To A Hospital-Based, Virtual Nursing Research Course, Trisha Saul, Frances Chu, Rose Timmerman, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background:

Clinical scholarship is a multifaceted concept in nursing that embodies building and disseminating knowledge within the professional environment. This requires conducting practice-based research, discovering the best available evidence for clinical practice, and translating findings into nurse-led interventions. An environment of clinical scholarship involves creating opportunities for nurse engagement in research, evidence-based practice (EBP) projects, and quality improvement initiatives. This must be supported by education and training centered on the principles of clinical scholarship. A course was developed with the curriculum design focusing on its attributes and application in the clinical setting and cultural milieu.

Purpose:

To examine hospital-based nurses’ …

Acute Care Staff Interactions With Chaplains To Discuss Team Or Personal, Non-Work-Related Stressors, Gary Weisbrich, Sarah Sumner, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Healthcare staff experience stress from the workplace when providing complex patient care and often may lean on specially trained spiritual support caregivers, or chaplains, for support navigating patient-related stressors. Yet, healthcare staff can also suffer from team-related or personal stressors that, if unresolved, could negatively impact care delivery. Little is known about whether, how often, and which staff may interact with chaplains for emotional support when experiencing non-patient-related stressors originating from work or personal lives.

Purpose: To describe the proportion of individuals who report discussing team-related or personal stressors with chaplains in the past 12 months, and to …

Alleviating Health Professionals' Moral Distress Through Hospital-Based Chaplain Care, Karen Colorafi, Sarah Sumner, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Healthcare workers frequently experience occupational stressors that negatively impact their emotional well-being. Recent evidence suggests that healthcare workers’ occupational stressors may translate to moral distress, defined as emotional turmoil occurring over an ethical dilemma secondary to a patient care or team-related issue. Following the COVID-19 pandemic, moral distress and a wide range of psychological and physical issues have been linked to high rates of healthcare worker burnout. Increased occupational stressors significantly augment turnover intentions and behaviors and negatively impact well-being. The resultant turnover rates have reached an all-time high among professional registered nurses. Some evidence suggests that the …