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Mystery Of Maha: Hypertension’S Twist Over Cancer’S Shadow, Andrew Takla, Gabriel Vachon, John Hix, Nagesh Jadhav

Advances in Clinical Medical Research and Healthcare Delivery

Microangiopathic hemolytic anemia (MAHA) refers to nonimmune hemolysis resulting from the intravascular fragmentation of red blood cells. The etiology of such disorders can range from primary thrombotic microangiopathic syndromes (TMA) to various systemic conditions, posing a diagnostic challenge. Prompt identification requires a sharp clinical assessment to improve outcomes.

Intractable Hiccups As The Presenting Symptom Of Relapsed Salmonella Bacteremia Complicated By Salmonella Endocarditis, Sahej Arora, Tripti Jain, Hafsa Jawaid, Nada Hafez, Binita Neupane

Advances in Clinical Medical Research and Healthcare Delivery

Salmonella infections are generally acute diarrheal illnesses that uncommonly spread to deeper or endovascular tissues, with key symptoms being nausea, vomiting, diarrhea, abdominal pain and fever. We present a case of a 76-year male who presented chiefly with recurrent intractable hiccups after finishing two weeks of oral ciprofloxacin for a previous episode of Salmonella bacteremia. He was ultimately found to have an aortic root vegetation on transesophageal echocardiogram and focal adenomyomatosis on gallbladder ultrasound. He underwent cholecystectomy, aortic valve replacement and six weeks of antibiotic therapy with resolution of his hiccups. Our case demonstrates an atypical symptom of intractable hiccups …

Mirizzi Syndrome: A Case Report, Elizabeth Barr, Keng Moua, Kavitha Vemuri

Advances in Clinical Medical Research and Healthcare Delivery

Mirizzi syndrome is a rare complication of chronic gallstone disease that occurs when an impacted gallstone at the gallbladder infundibulum or cystic duct causes common extrinsic hepatic or common bile duct obstruction. Contrary to other gallstone pathologies where gallstones affect the respective location in which they are lodged, Mirizzi syndrome is unique in that it is characterized by extrinsic gallstone compression. Chronic gallstone disease most commonly leads to acute cholecystitis, acute cholangitis, or acute pancreatitis. The extrinsic compression of the common hepatic or common bile duct may lead to eventual erosion which increases the risk for a cholecystocholedochal or cholecystohepatic …

Combatting The Mpox Outbreak In Pakistan: An Urgent Public Health Imperative, Abdul Basit Sangah, Shazia Saleem Shaikh, Abdul Karim, Rohait Kumar, Mubashir Hussain

Journal of Community Hospital Internal Medicine Perspectives

No abstract for this article type.

Arcanobacterium Haemolyticum Chronic Osteomyelitis And Bacteremia Complicated By Intraosseous Abscess: A Case Report., Edward Lovering, Michelle Bahrain

Journal of Community Hospital Internal Medicine Perspectives

Arcanobacterium haemolyticum is an anaerobic, gram-positive bacillus most commonly associated with non-streptococcal pharyngitis. However, it is a rare cause of systemic infection and bacteremia. In this report, we present the case of a 39-year-old man diagnosed with A. haemolyticum bacteremia secondary to chronic osteomyelitis and an intraosseous abscess.

Rapidly Developing Bilateral Loculated Streptococcus Pyogenes Empyema In An Immunocompetent Adult: A Case Report, Anish K Shrestha, Matthew Dwumah-Agyen, Boniface Mensah, Yvette Yeboah-Kordieh, Marcos A Wolff, Jennifer A Evans

Journal of Community Hospital Internal Medicine Perspectives

Streptococcus pyogenes is a rare cause of empyema, especially in immunocompetent individuals. The organism expresses various virulence factors leading to rapid progression of the disease. We report a case of rapidly progressing bilateral loculated empyema caused by streptococcus pyogenes in an immunocompetent host without additional risk factors.

A Budding Pancreatic Mass: A Review Of Disseminated Blastomycosis, Tina C. L. Phan, Chloe N. Hundman, Neena Thomas-Gosain, Christopher D. Jackson

Journal of Community Hospital Internal Medicine Perspectives

A 67-year-old male patient presented with anorexia, weight loss, skin masses, and flank pain over the past three months. Imaging revealed a lung mass and a cystic lesion in the pancreatic head. After initial diagnostic work-up and clinical deterioration, broad based budding, seen on pathology, led to a diagnosis of disseminated blastomycosis. After receiving a 14-day course of liposomal amphotericin B followed by itraconazole, the patient showed significant clinical improvement. We reviewed all disseminated blastomycosis cases in the medical literature involving gastrointestinal organs. Although pancreatic involvement is rare, we suggest that it should be suspected in those with a rapidly …

Resolution Of Chronic Urticaria In A Vegan Patient With Vitamin B12 Supplementation: A Case Report, Auda H. Auda, Oluwasegun Shoewu, Ingrid Corredor, Ayrton Bangolo, Mohammad Jurri, John Sotiriadis, Iyad Baker

Journal of Community Hospital Internal Medicine Perspectives

Background Chronic urticaria, characterized by persistent hives and pruritus lasting over six weeks, often presents diagnostic and therapeutic challenges. While its etiology is frequently idiopathic, associations with nutritional deficiencies, such as vitamin B12 deficiency, have been observed. Case Presentation A 24-year-old female with no significant medical history presented with chronic, treatment-resistant hives persisting for several years. Comprehensive evaluations, including allergy testing and autoimmune screenings, were unremarkable. Further investigation revealed a significant vitamin B12 deficiency (serum B12 level of 170 pg/mL), attributed to her long-standing vegan diet without supplementation. Initiation of vitamin B12 supplementation led to the gradual resolution of her …

It Runs In The Family: A Rare Case Of Familial Idiopathic Colonic Varices, Rakahn Haddadin, Ozoemena Akah, Maryam Ameen, George Trad, John Ryan, Hatim Gemil

Journal of Community Hospital Internal Medicine Perspectives

Background: Colonic varices(CV) remain an extremely rare condition, the usual cause of which is portal hypertension due to liver disease, chronic pancreatitis or malignancy. Here we present a case of familial idiopathic CV in a middle-aged female, complicated by a polyp removal during colonoscopy.

Case Presentation: A 57-year-old female with a past medical history of 5 months of melena, polyps and hemorrhoids diagnosed with idiopathic CV during diagnostic colonoscopy. She had no prior history of liver disease, pancreatic disease, non-steroidal anti-inflammatory drugs (NSAID) use, or blood thinner use. She was later found to have a family history of the condition. …

Beyond The Bowel: Lung Cancer Presenting As Complicated Diverticulitis, Ramya Vasireddy, Mariah Malak Bilalaga, Greeshma Gaddipati, Terina S. Chen, Hashroop Gurm

Journal of Community Hospital Internal Medicine Perspectives

Lung cancer is often diagnosed at advanced stages frequently metastasizing to organs like the liver, adrenal glands, brain and bones. However, gastrointestinal metastasis, especially to the small intestine, is rare. We report a patient who presented with a perforated small bowel, requiring emergent laparotomy. Imaging suggested an infectious process, but subsequent workup revealed jejunal perforation and poorly differentiated lung cancer. Despite being a candidate for immunotherapy alone, the patient opted for hospice. This case emphasizes the atypical presentation of lung cancer as a gastrointestinal complication and underscores the

Chorea Hyperglycemia Basal Ganglia (Chbg) Syndrome: A Case Report, Ammad Naeem, Mohamad Omar Beck, Ahsan R. Khan, Ribal Sajjad

Journal of Community Hospital Internal Medicine Perspectives

Chorea, characterized by sudden, involuntary movements of the face and limbs, arises from various causes, including neurodegenerative diseases, metabolic disorders, and structural brain changes, notably in the basal ganglia. Acute lesions in the basal ganglia due to ischemia or vascular pathology can also precipitate chorea. Hyperglycemia-induced basal ganglia changes, termed chorea hyperglycemia basal ganglia, predominantly affect elderly females with type 2 diabetes. We report a 62- year-old female with poorly managed diabetes presenting with involuntary jerking movements, initially in the right leg, progressing to the right arm, face, and lips over three days. Her history included hyperlipidemia and hypertension, and …

Inferior Wall Stemi In A Young Patient- A Sequela Of Phentermine And Smoking, Nismat Javed, Vikram Itare, Emamuzo Obaro Otobo, Yordano Montesano, Preeti Jadhav, Nassim Krim

Journal of Community Hospital Internal Medicine Perspectives

Amphetamine use is associated with increasing rates of cardiovascular risks, such as pulmonary hypertension, arrhythmias, and atherosclerosis. A 47-year-old woman experienced an inferior MI after taking the weight loss drug phentermine. She presented with chest pain, shortness of breath, and vomiting. Initial examination showed low blood pressure and slow heart rate. Subsequent tests revealed elevated cardiac enzyme levels and ST elevations on EKG. A coronary angiogram showed a blockage in the right coronary artery. She underwent a successful procedure to open the artery. The case highlights the heightened cardiovascular risks associated with amphetamine use, even in individuals without existing heart …

A ‘Fluke’ Diagnosis: Suspecting Fascioliasis As A Rare Cause Of Hepatic Abscess, Tharun Shyam, Rosa Lora, Sharanya Kaushik, Jessica Chung, Monica Ghitan, Christina Coyle

Journal of Community Hospital Internal Medicine Perspectives

Hepatic abscess is a rare complication of fascioliasis, with fewer than 50 reported cases worldwide. The diagnosis requires a high degree of suspicion and is often identified after extensive investigation leading to delays in treatment. With this case report, we aim to highlight the need for a higher index of suspicion in non endemic regions like the USA, especially in cities with large immigrant populations. Given the ease and success rates of treatment with oral triclabendazole, the morbidity from unnecessary invasive testing and disease burden is preventable with a thorough evaluation and targeted clinical assessment.

Pneumococcal Endocarditis: Historical Insights And Modern Challenges, Dmytro Bohuslavskyi, Mahesh Bhattarai, Hussam Ammar

Journal of Community Hospital Internal Medicine Perspectives

The patient in this case was a 72-year-old female who presented with altered mental status and was ultimately diagnosed with pneumococcal endocarditis. On physical examination, no abnormal cardiac murmurs were detected. This case highlights an important lesson: pneumococcal endocarditis, though rare, is a life-threatening condition with a high mortality rate and should be a top consideration in patients with S. pneumoniae bacteremia, even when the cardiac exam is relatively unremarkable.

A Rare Discovery Of Neuroendocrine Tumor: Cardiac Mass, Anish K Shrestha, Anirudra Devkota, Terina S Chen, Mahsa Mohebtash

Journal of Community Hospital Internal Medicine Perspectives

Carcinoid tumors are rare, slow-growing neoplasms of neuroendocrine origin commonly affecting the gastrointestinal or respiratory system. They metastasize to lymph nodes and the liver based on their lymphatic and venous drainage of their tissue of origin. Metastasis to the heart is exceedingly rare accounting for

A Rare Case Of Systemic Lupus Erythematosus In An Elderly Male With An Incidental Lung Mass: A Case Report, Harshit Gupta, Rahul Singla, Mahyar Toofantabrizi

Journal of Community Hospital Internal Medicine Perspectives

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology that affects multiple organ systems. This disease primarily affects women of childbearing age but can have severe outcomes and a rare incidence in males. The incidence of SLE in males peak at 45-60 years of age. In this case, we present a rare instance of SLE in a 70-year-old male who presented with progressive shortness of breath, generalized weakness, and weight loss. Laboratory tests revealed anemia, thrombocytopenia, increased creatinine levels, and urine proteinuria. Diagnostic imaging showed an incidental lung mass and bilateral pleural effusion, and serological investigations revealed positive …

Reversible Cerebral Vasoconstriction Syndrome Induced By Sumatriptan: A Case Report And Review Of Literature., Rafi Aibani, Morgan Koontz, James Stephen Harman, Amir Kamran, Khawaja Omar

Journal of Community Hospital Internal Medicine Perspectives

Background

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is characterized by multiple transient cerebral vasoconstrictions that typically resolve within three months, often presenting with sudden thunderclap headaches. Although the cause can be identified in 25% to 60% of cases, RCVS can also occur spontaneously. Common triggers include vasoactive substances and postpartum states, with the latter accounting for 50% to 60% of cases. This report discusses a case of RCVS following sumatriptan use.

Case Report.

A 58-year-old woman with controlled hypertension and obstructive sleep apnea presented with recurrent unilateral pulsating headaches, nausea, and photophobia. Initially diagnosed as migraine, she later developed right …

Post-Myocardial Infarction Associated Ventricular Septal Defect In An Older Female., Nismat Javed, Vikram Itare, Nolberto Bladimir Hernandez, Nisha Ali, Preeti Jadhav

Journal of Community Hospital Internal Medicine Perspectives

Background:

Ventricular septal defect (VSD) is a serious but uncommon complication that can develop 2 days to 2 weeks after a myocardial infarction (MI), particularly if percutaneous coronary intervention (PCI) is delayed.

Case Presentation:

A 91-year-old woman with a history of coronary artery disease had undergone PCI in left anterior descending (LAD) and left circumflex artery (LCX) for a non-ST-elevation myocardial infarction (NSTEMI) 4 weeks prior at another facility, which was complicated by distal wire perforation leading to hemopericardium and the need for pericardiocentesis. She presented with chest pain, and her tests showed ST-segment elevation in leads I, aVL, V2-5, …

Case With Refractory Myasthenia Gravis Caused By Pembrolizumab, Khaled M. Darwesh, Bushra Amer, Lateefah D. Hawshab, Fatima D Hawshab

Journal of Community Hospital Internal Medicine Perspectives

Nowadays, checkpoint inhibitors play a major role in the management of different types of cancers. However, we have seen variants of immune therapy-related adverse events, which usually are variables from fatigue, to neuropathy to severe devastating complications such as respiratory failure due to myasthenia gravis (MG), as we saw in our case. Our patient was started on pembrolizumab, and they developed severe respiratory failure attributed to MG after three weeks from treatment initiation. Also, the patient presented with myositis, mild myocarditis and hepatitis, which were all related to pembrolizumab.

A Rare Case Of Chronic Lymphocytic Leukemia Complicated By Myasthenia Gravis, Eiraj Khan, Rimal Ilyas, Shivani Shah, Rahim Jiwani, Yazan Samhouri, Cyrus Khan

Journal of Community Hospital Internal Medicine Perspectives

About 10-25% of chronic lymphocytic leukemia (CLL) patients experience complications related to autoimmune activity. Although less common, nonhematological autoimmune manifestations have been observed. Myasthenia gravis (MG) is rarely found in association with CLL. Since 1967, only 27 publications have reported the association between CLL and MG, encompassing just 15 cases. Our case is particularly notable for the refractory nature of the patient’s MG. Case Presentation A 56-year-old male with Rai Stage II CLL and myasthenia gravis presented to the emergency department with respiratory distress, dysphagia, and weakness. He was admitted for treatment with intravenous immune globulin, pyridostigmine, and intravenous solumedrol. …

Wild-Type Cardiac Amyloidosis Due To Transthyretin Protein — A Review, Mustafa Shehzad, Muhammad Hasan, Dawood Shehzad, Muhammad Shariq Akram, Muhammad Faiq Akram, Dawlat Khan, Maham Maqsood, Mamoon Ahmed, Humna Younis

Journal of Community Hospital Internal Medicine Perspectives

Transthyretin amyloid cardiomyopathy (ATTR-CM) arises from the accumulation of transthyretin amyloid fibrils in the myocardium, a consequence of instability and misfolding in wild-type or variant transthyretin protein. ATTR-CM should be suspected in older heart failure patients with raised myocardial wall thickness and diastolic dysfunction on echocardiography in the absence of hypertension or other known causes. This diagnosis can be further supported with late gadolinium enhancement on Cardiac MRI which indicates raised myocardial extracellular volume (ECV) hinting at the expansion of interstitial space by amyloid deposits. Diagnostic work up starts with blood and urine tests to rule out AL amyloidosis and …

Iron Deficiency—More Than Just Anemia: A Literature Review, Arianna S Moss, Zahra Pakbaz

Journal of Community Hospital Internal Medicine Perspectives

Iron deficiency (ID) is a global public health concern, as it can be a prodrome of gastrointestinal (GI) malignancies, exacerbate chronic conditions, and lead to an overall decreased quality of life. Despite being the most prevalent nutritional deficiency, it remains underdiagnosed by many healthcare professionals. Misconceptions regarding the clinical and laboratory manifestations of ID lead to delayed or missed diagnoses, contributing to poor patient outcomes. Though anemia is a commonly known consequence of ID, there are additional consequences that remain underrecognized by the medical community, including vague signs and symptoms, such as fatigue, depression, and abnormalities in white blood cell …

Diverticular Abscess And Percutaneous Drainage Outcomes: A Review Of Clinical Practice For The Primary Team, Omer Usman, Abdullah , Imtiaz, Muhammad Abdul Basit, Maham , Tariq, Rehaab , Mujahid, Muhammad Waqas Khan, Vishakh Prakash, Obaid Ur Rehman

Journal of Community Hospital Internal Medicine Perspectives

The inflammation of the diverticular pouch is called acute diverticulitis which can result in abscess formations sometimes. Percutaneous drainage is routinely considered for the management of diverticular abscesses. Being a minimally invasive procedure employed for the removal of large collections of infected fluid from the abscesses, percutaneous drainage emerged as an appealing option. Historically, surgical removal of the abscesses has resulted in multiple hospitalizations and an increased burden on healthcare resources. With the advancement in radiological techniques, CT-guided percutaneous drainage of diverticular abscesses ensured enhanced patient satisfaction and reduced healthcare costs. The choice between surgery or percutaneous drainage of diverticular …

Hollywood And Healthcare: Navigating The Dual Impact Of Movies On Public Health, Fremita Chelsea Fredrick, Anish Kumar Reddy Meda, Mini Virmani, Guntash Kaur, Baltej Singh, Rohit Jain

Journal of Community Hospital Internal Medicine Perspectives

Introduction Synonymous with the American film industry, Hollywood wields considerable influence on public health through its vast global reach and engaging media. This paper explores Hollywood's role and its impacts on public health, primarily driven by its portrayal of healthcare services, illnesses, and related beliefs and provides recommendations to improve “education entertainment” for the future. Methods PubMed was searched using keywords such as hollywood, healthcare, medical dramas, health education, smoking, suicide, and many more. Relevant literature up to June 2024 has been examined and summarized, which consisted of 37 articles with data from various clinical trials, meta-analyses, and literature reviews. …

How Do Polymorphonuclear Counts In Ascitic Fluid Correlate To Hospital Outcome, Rakahn Haddadin, Michael Ghobrial, Tarek Tabbah, George Trad, John Ryan, Robert G. Gish, Pinak Shah

Journal of Community Hospital Internal Medicine Perspectives

Polymorphonuclear neutrophils (PMNs) are critical mediators in the innate immune response, and their levels in ascitic fluid are pivotal for diagnosing spontaneous bacterial peritonitis (SBP), particularly in patients with liver cirrhosis. This retrospective study investigates the association between varying PMN counts in ascitic fluid and hospital outcomes, including mortality, 30-day readmission rates, and length of stay (LOS). We analyzed de-identified data from HCA Healthcare hospitals (July 2013 - December 2023), focusing on patients aged 18 and older with a diagnosis of liver cirrhosis who underwent paracentesis. Patients were categorized based on PMN counts into three groupings to assess their clinical …

Interaction Between Age And Tumor Stage In Survival Outcomes Of Patients With Mantle Cell Lymphoma, Ayrton Bangolo, Behzad Amoozgar, Vignesh K. Nagesh, Kyra Mcgrath, Swapnika Mallipeddi, Samantha Cash, Ankit Sandilya, Rakshanda Banu, Frantz R. Martine, Sarvarinder Gill, Lili Zhang, Shafia Naeem, Pujita Mallampalli, Arun Ram

Journal of Community Hospital Internal Medicine Perspectives

Background:

Mantle Cell Lymphoma (MCL) is a rare and aggressive subtype of non-Hodgkin lymphoma. This study explores the demographic and clinicopathologic characteristics of 746 MCL patients diagnosed in the United States between 2000 and 2015, focusing on the interaction between age and tumor stage.

Methods:

Using SEER database data, this retrospective cohort study analyzes demographic and clinical variables like age, gender, stage, treatment, and marital status. Mortality risks were assessed using Cox proportional hazard regression models to identify predictors of overall mortality (OM) and cancer-specific mortality (CSM), emphasizing age-tumor stage interactions.

Results:

Multivariate Cox regression identified age and advanced Ann …

Endocrinology Expert Witness: Bridging Healthcare And Law To Uphold Standards, Mihail Zilbermint, Stacey B. Lee

Journal of Community Hospital Internal Medicine Perspectives

The role of a medical expert witness is vital in bridging the gap between the healthcare and legal systems, ensuring that justice is served while maintaining high standards of medical care. This perspective highlights the importance of medical professionals engaging in expert witness work, examining both the challenges and rewards of this role. Initially, community physicians may hesitate to participate due to misconceptions about legal risks or potential professional backlash. However, expert witness work provides a unique opportunity to supplement income, contribute to the integrity of the medical profession, and deepen medical knowledge.

The development of legal knowledge, such as …

The Ethics Of Insider Trading, Miles Morgan

Global Tides

In business ethics, insider trading has gone untouched by scholars, as the consensus is that insider trading is morally indefensible, however, questions have emerged regarding the moral responsibility of insiders. This paper engages with Analyzing Insider Trading from the Perspectives of Utilitarian Ethics and Rights Theory by Robert McGee to evaluate the relationship between applied ethics and insider trading. A satisfactory anti-insider trading account must be able to economically or philosophically explain why insider trading is morally wrong. The assumption that this is impossible may be due to a misunderstanding of how we decide what morality is or how economic …

Archaeology By The Book, But Which Book?: Archaeology And Nation Building In Germany And Israel, Verity C. Wray-Raabolle

Classical Mediterranean and Middle East Honors Projects

Archaeology is a powerful tool wielded by nations to tell their own stories. How can two countries in different situations harness archaeology to tell their own national narratives? Through investigation of the archaeological heritage of Israel and Germany, both by their individual archaeologists as well as institutions such as museums, I have discovered the different ways in which nation states can utilize archaeology to their advantage. By choosing to excavate well-known sites, only display certain artifacts, or claim modernity through the science of the discipline, each nation strengthens their national identity via archaeology and related artifacts. Individual archaeologists have more …

A Preliminary Study Of Hilbert–Kunz Functions: Coefficient Behavior In A Normal Affine Semigroup Ring, Jesus A. Mendiola Herrera

Theses and Dissertations

In 1890, David Hilbert published a set of notes on what now constitutes one of the bases of Commutative Algebra; his work would eventually influence the efforts of mathematicians like Ernst Kunz. In 1969, Ernst Kunz introduced a particular mapping regarding modules of regular local rings. His goal was to characterize Noetherian local rings of prime characteristic by computing the length of the composition series under Frobenius power transformations. In this thesis, the focus will be on stating the initial steps on finding the coefficients of the Hilbert-Kunz function of the normal affine semigroup ring of the form R = …