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A Case Report And Literature Review On Argatroban Refractory Heparin-Induced Thrombocytopenia, Imad Ud Deen, Swati Ajay Jha, Sadaf Mustafa

Journal of Community Hospital Internal Medicine Perspectives

Heparin-induced thrombocytopenia (HIT) is characterized by low platelets and thrombosis after exposure to Heparin products. It is classically characterized by a rapid and significant drop in platelets and life-threatening thrombosis. Thrombosis can occur up to 50% of the cases if left untreated. It requires immediate discontinuation of all heparin products and switching to a non-heparin anticoagulant to prevent further thrombosis. Here we present a case of a 56-year-old male who presented to the Emergency Department with sudden onset of severe left leg pain. Duplex study showed arterial thrombosis in the common iliac and distal iliac arteries. He received TPA at …

Use Of Venous Thromboembolism Prophylaxis In Hospitalized Patients: Knowledge And Practice Among Physicians In Nepal., Amit Bhandari, Amit Khanal, Pratikshya Thapa, Ashish Thapa, Kushal Bhattarai, Bibhusan Basnet

Journal of Community Hospital Internal Medicine Perspectives

Despite the importance of Venous Thromboembolism (VTE) prophylaxis in hospitalized patients, audits have shown inadequate use of VTE prophylaxis methods around the world. We aimed to assess knowledge, attitudes, and behaviors regarding VTE prophylaxis among clinicians in Nepal. Methodology: A cross-sectional questionnaire-based survey was conducted using an online survey platform. Results: 199(60.7%) of the respondents were aware of the risk factors-based risk stratification approach to VTE prophylaxis in hospitalized patients. Only 154 (47%) of the physicians reported institute-based protocols for VTE prophylaxis. Conclusion: We found a significant lack of awareness on risk factors-based stratification strategy for VTE prevention practices among …

A Rare Case Of Rectal Squamous Cell Carcinoma Treated With Nigro Protocol, Hunza Chaudhry, Sunny Sandhu, David Tasso, Devang Prajapati

Journal of Community Hospital Internal Medicine Perspectives

Squamous cell carcinoma (SCC) of the rectum is a rare malignancy, and the optimal treatment strategy remains unknown. Cases are limited in the literature, and although historically treated with surgical resection, more recent cases have suggested success with chemotherapy. Although Nigro protocol was initially developed for anal SCC, we present a case of rectal SCC successfully treated with the Nigro protocol. Our case supports the use of chemoradiotherapy as initial treatment for rectal SCC over surgery.

A Case Of Covid-19 Induced Descending Aortic Thrombus And Splenic Infarctions, Srikrishna V Malayala, Syed Bukhari, Rachana Vanaparthy, Ambreen Raza, Ramya Akella

Journal of Community Hospital Internal Medicine Perspectives

Thromboembolic manifestations like pulmonary embolism and deep venous thrombosis are often reported and contribute to a significant mortality from acute and chronic COVID-19 infections. These phenomena are a result of the activation of the coagulation cascade by the COVID-19 induced inflammatory state.

Majority of the thrombotic incidences are reported as a venous thrombosis but extremely rarely, arterial thrombi can be a manifestation of acute COVID-19 infection.

The patient in our case report was an unvaccinated 47-year-old female who presented with fever, nausea, abdominal pain and vomiting. The imaging confirmed the presence of a non-occlusive thrombus in the descending aorta, multiple …

Atraumatic Splenic Rupture On Direct Oral Anticoagulation, Jessica Barnes, Zayd Alhaddad, Robert Paz, Christopher Haas

Journal of Community Hospital Internal Medicine Perspectives

Direct Oral Anticoagulants have become a popular go to treatment option for patients with atrial fibrillation, deep vein thrombosis, or pulmonary embolism. This case report follows a 58 year old woman who developed atraumatic splenic rupture, a rare but recognized complication of direct oral anticoagulation use.

A Fatal Etiology Of Splenic Infarction, David Masterman, Amteshwar Singh, Tanmay Singh, Ashampreet Kaur, Sonal Gandhi

Journal of Community Hospital Internal Medicine Perspectives

Hemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory disorder that is rapidly progressive and carries a poor prognosis. We present a case of HLH caused by undiagnosed B cell lymphoma, presenting initially with splenic infarction. Both HLH and splenic infarction are secondary conditions with a wide range of underlying etiologies. When either condition is identified, a prompt search for the underlying trigger is needed to prevent devastating consequences. We demonstrate the difficulties and barriers that can delay the diagnosis of HLH, and emphasize the importance of early treatment in improving survival rates.

Platypnea Orthodeoxia For Those Who Do Better Lying Low, Rebecca Deboer, Tuoyo Mene-Afejuku, Murtaza Sundhu, Julian Diaz Fraga

Journal of Community Hospital Internal Medicine Perspectives

Platypnea orthodeoxia syndrome (POS) can be a confounding disease. Patients with POS may have already had an extensive and unrevealing evaluation for hypoxia. POS is the worsening of hypoxia when upright compared to supine. The underlying mechanism is a right to left shunt. While there are various causes of this, we focus on intracardiac shunt. The most common of these is patent foramen ovale (PFO). Once this is identified, closure of the PFO can lead to resolution of hypoxia.

5-Fluorouracil-Related Cardiotoxicity With Coronary Vasospasms, Beenish Faheem, Brooke Kania, Hamdallah Ashkar, Leena Bondili, Michael Maroules

Journal of Community Hospital Internal Medicine Perspectives

FOLFIRINOX has been commonly utilized to treat patients with pancreatic cancer; however, it can manifest with rare, significant adverse effects. In particular, 5-FU has been associated with cardiotoxic effects, including but not limited to ischemic events, myocarditis, cardiac arrhythmias, cardiac death, heart failure, as well as coronary vasospasm. Two common thought processes regarding the mechanism of cardiotoxicity with 5-FU include exacerbation of ischemia secondary to coronary vasospasm and direct cell injury to the myocardium. Management of cardiotoxic adverse effects includes discontinuing 5-FU therapy if the patient can tolerate an alternative regimen or initiating prophylactic anti-anginal treatments with very close monitoring …

Level Of Trust In Health Care Systems During Covid-19 Pandemic Among Health Care Workers Of Pakistan, Asmara Ahmed Malik, Sobia Awan, Ali Tahir Rana, Jahanzeb Malik, Uzma Ishaq, Mamoona Zahoor, Syed Muhammad Jawad Zaidi

Journal of Community Hospital Internal Medicine Perspectives

This survey aimed to evaluate the levels of trust and satisfaction among healthcare workers towards the national healthcare delivery system and whether it has been affected by the global disruption created by COVID-19. This was an analytical cross-sectional study that took place from January to October 2021 at a tertiary level health care facility in Rawalpindi, Pakistan, using an online data collection tool. Our sample included 10, 133 healthcare workers of all cadres. Our study found a significant level of distrust of healthcare workers towards multiple aspects of the healthcare delivery system, particularly towards government agencies and other members of …

Pancreatic Cancer With A Skeletal Muscle Metastasis - A Case Presentation And Literature Review, Nicholas Spetsieris, Gayatri Bobba, Priyanka Bhandari, Samir Patel, Zubin Tharayil, Ravi Gupta

Journal of Community Hospital Internal Medicine Perspectives

One-half of patients with newly diagnosed pancreatic cancer will have metastatic disease at the time of diagnosis, mainly due to its non-specific initial clinical presentation which includes abdominal pain, dyspepsia, weight loss, bowel habit changes, jaundice and pruritus. The signs, symptoms and stage of the disease at initial diagnosis depends on the origin of the primary tumor, with tumors of the head presenting earlier with obstructive symptoms while tumors of the body/tail are often diagnosed at an advanced stage due to their non-specific presentation. The most common sites of metastasis are the lymph nodes, liver, lung, and peritoneum. The presence …

A Rare Case Of Pembrolizumab Associated Encephalopathy, Sijan Basnet, Rajanbir Singh, Biswaraj Tharu, Tushar Pawar, Garima Basnet

Journal of Community Hospital Internal Medicine Perspectives

We present a unique case of a 55-year-old man with confusion thought to be due to pembrolizumab which he was receiving for renal cell carcinoma. His workup for other possible etiologies for encephalopathy was negative. He was treated with high dose intravenous methylprednisolone followed by prednisone taper and intravenous immunoglobulin with gradual improvement in his mentation.

Primary Mediastinal B-Cell Lymphoma Presenting As Chest Pain In A Young Woman And Treated With Epoch-R, Chloe Weidenbaum, Akanksha Kushwah, Ariana Geromes, Jonathan A. Abbas

Journal of Community Hospital Internal Medicine Perspectives

Primary mediastinal B-cell lymphoma (PMBCL) is a rare type of diffuse large B-cell lymphoma, constituting 2-4% of non-Hodgkin lymphomas. Here we present a case of PMBCL initially presenting as pleuritic chest pain in an otherwise healthy 33-year-old woman. PMBCL typically presents as a large, fast-growing tumor limited to the mediastinum, making the iliosacral involvement in this case unusual. R-CHOP is the most commonly used chemotherapy regimen, although more aggressive therapies like EPOCH-R can spare the need for consolidative radiation therapy. PMBCL represents one of the greatest diagnostic and therapeutic challenges in malignant hematology.

A National Survey Of The Prevalence Of Anemia And Obesity In Indian School Children, Mithu Banerjee, Brig V.K. Bhatti, Dipayan Roy, Sojit Tomo

Journal of Community Hospital Internal Medicine Perspectives

Background: In India, the socioeconomic shift in the past few decades has led to a sedentary lifestyle with poor dietary habits, leading to an increased incidence of overweight and obesity in children. Furthermore, obesity and anemia share some common links. Objectives: In this study, we have prevalence of anemia and obesity in Indian schoolchildren. Methods: The study was carried out on 1675 children and adolescent participants aged 6-18 years for the prevalence of obesity and anemia. Height, weight, waist and hip circumference were taken. Hemoglobin levels was measured for each participant. Results: Males and females differed in height (p = …

Outcomes Of Corneal Topographical Kmax Readings 3 Months After Corneal Cross Linkage In Keratoconus Patients, Abdul Basit Sangah, Jaya Kumari, Hassan Mumtaz, Mohammad Hasan

Journal of Community Hospital Internal Medicine Perspectives

Background and objective: Collagen protein, which is abundant in the cornea and has a triple helix form, may be found in almost every tissue matrix in the body. Natural cross connections between monomers provide the robustness of the helical protein structure. Wollensak and his colleagues developed the Dresden Protocol, a keratoconus treatment based on Corneal Cross-Linkage. We aimed to analyse and present the findings in individuals with progressive keratoconus using topographic and refractive results after corneal collagen crosslinking treatment (CXL) (KC) after 3 months.

Methods: The study comprises a total of 100 patients who were diagnosed with progressive KC and …

Pocus In Internal Medicine Curriculum: Quest For The Holy-Grail Of Modern Medicine, Devyani Ramgobin, Vasu Gupta, Rea Mittal, Lilly Su, Meet A Patel, Nour Shaheen, Sachin Gupta, Rohit Jain

Journal of Community Hospital Internal Medicine Perspectives

Point of care ultrasound (POCUS) is an essential component of emergency medicine training that has not taken hold in internal medicine training programs. Internal medicine residents can use POCUS to perform focused examinations and aid complicated procedures. However, while there is widespread interest in learning POCUS, training is not standardized amongst residency curriculums. Therefore, more strides are necessary to correctly implement POCUS training during residency training.

Middle Meningeal Artery Embolization: A Paradigm Shift In Approach Of Chronic Subdural Hematoma, Hamza Hanif, Shanza Farook, Sajid S. Suriya, Muhammad Umer Riaz Gondal, Muhammad Ibraiz Bilal, Abu Baker Sheikh

Journal of Community Hospital Internal Medicine Perspectives

Chronic subdural hematoma (SDH) is commonly seen in the aged population. It is hypothesized to occur due to damage to the dural border cells, resulting in an inflammation-proliferation reaction. Inadequate repair leads to the formation of an external layer of cells and fragile capillaries, which are vulnerable to damage, contributing to worsening of the condition. Conventionally, asymptomatic chronic SDH was managed by observation, while symptomatic cases by surgical evacuation. However, the recurrence rate of chronic SDH after surgical evacuation was high. The middle meningeal artery (MMA) provides blood supply to the dura mater and feeds the capillaries of the membranes …

Covid-19 Positive Status Is Associated With Increased In-Hospital Mortality In Patients With Acute Myocardial Infarction: A Systematic Review And Meta-Analysis, Nischit Baral, Waiel Abusnina, Shravya Balmuri, Amith Seri, Soumya Kambalapalli, Prem R Parajuli, Basel Abdelazeem, Krishna P. Bashyal, Niranjan Ojha, Bidhya Timilsina, Timir K Paul

Journal of Community Hospital Internal Medicine Perspectives

Patients hospitalized for acute myocardial infarction (AMI) may have concomitant positive coronavirus disease 2019 (COVID-19). We aimed to compare the risk of in-hospital mortality in patients primarily hospitalized for AMI with or without concomitant COVID-19 positive status. Using the random-effects model, we conducted a systematic review and meta-analysis of published articles from December 1, 2019, to April 1, 2022. There were eight studies with 10128 patients, including 612 patients with COVID and 9516 patients without COVID. A total of 261 patients (42.64%) with COVID-19 positive and 612 patients (6.43%) with negative COVID-19 status died in the hospital. Pooled data showed …

Evidence-Based Role Of Aspirin In Giant Cell Arteritis: A Literature Review, Anum Qureshi, Fatima Halilu, Sam W. Serafi, Howard Hauptman, Tristan Flack

Journal of Community Hospital Internal Medicine Perspectives

Giant cell arteritis (GCA), or temporal arteritis, is a medium to large vessel vasculitis seen in the elderly. Its presentation varies from fever of unknown origin to cranial ischemic complications including complete vision loss. The early initiation of steroids is key to preventing complications of GCA. Here we discuss the role of aspirin in the treatment of GCA, both as an antithrombotic agent and its increasingly utilized antiinflammatory properties. The aim of this review article is to examine the evidence behind the rationale of aspirin use as an adjunct to steroids for the prevention of cranial ischemic complications.

Management Of The Patient With Chronic Critical Illness – Part 2, Arkadiy Finn, Vijairam Selvaraj, Elijah Peterson, Debasree Banerjee, Amos Lal, Himmat Grewal, Edward Martin, Kwame Dapaah-Afriyie

Journal of Community Hospital Internal Medicine Perspectives

Patients with chronic critical illness (CCI) represent a growing segment of the hospitalized population. Key aspects of care in CCI patients including tracheostomy, prolonged mechanical ventilation, nutritional support, wound care, and others require a comprehensive, goal-directed approach. Infectious complications of CCI including pneumonia, tracheobronchitis and urinary tract infection may be caused by nosocomial organisms requiring awareness and adjustment of treatment regimen. Finally, psychiatric, palliative, rehabilitative components of care impact heavily upon outcomes in CCI patients. As care that is typically associated with the intensive care unit is extended to the hospital ward, we aim to increase awareness among providers and …

John R. Brinkley: A Quintessential American Quack, Philip C. Smith

Journal of Community Hospital Internal Medicine Perspectives

The early 20th century was a time of rapid technological innovation and of demanding greater responsiveness of government and society to the needs of the common man. These impulses carried into the field of medicine, where quacks promised to overturn the medical establishment to bring wondrous new cures directly to the people. John Brinkley, among the foremost practitioners of that dark art, made a fortune implanting goat testicles into gullible men to cure sexual dysfunction and other ravages of old age. His medical training was limited, his treatments implausible, and yet, during a career that spanned over a quarter century, …

James Doi, Tina To

Kizuna: Bonds Beyond Incarceration (Summer 2022)

Jimmie balanced farming and homeschool before attending Stockton High; now he’s headed to Berkeley for his PhD.

Faculty Senate Meeting Minutes--September 9, 2022, Faculty Senate

Faculty Senate Minutes

No abstract provided.

The Fierce Green Fire: Vol. 13 Issue 2, Wofford College. Department Of Environmental Studies

The Fierce Green Fire

No abstract provided.

The Beacon, September 9, 2022, Beacon Staff

The Beacon, 2022-2023

Unsung Heroes: Kristin Brouwer; Summer study abroad in Greece; The sweetest rush of the big time reunion; Slapstick humor from beloved despicable minions; The hills were alive with the sound of Acapella; Women's complex reality conveyed with oil on canvas; Students enjoy new ice cream location; Brouwer returns to NW as Faculty; NW institutes new major and minor; Students Study Greece; Who Let the Dogs Out? Kyle Christy; What your Latte Order Says About You; Sport Philosophy: The Magic of Volleyball; First-year Soccer Standout Alexa Johnson; Athlete Mental Health Prioritized at NWC; The wizarding world of Hogwestern; Incoming class continues …

Curricular Changes Proposed For 2023-2025 Morris Catalog Division Of Science And Mathematics,, Curriculum Committee

Curriculum Committee Reports

No abstract provided.

Curricular Changes Proposed For 2023-2025 Morris Catalog Philosophy, Curriculum Committee

Curriculum Committee Reports

No abstract provided.

The Personality And Cognitive Traits Associated With Adolescents’ Sensitivity To Social Norms, Christopher Tate, Rajnish Kumar, Jennifer M. Murray, Sharon Sanchez-Franco, Olga L. Sarmiento, Shannon C. Montgomery, Huiyu Zhou, Abhijit Ramalingam, Erin Krupka, Erik Kimbrough, Frank Kee, Ruth F. Hunter

Economics Faculty Articles and Research

Little is known about the personality and cognitive traits that shape adolescents’ sensitivity to social norms. Further, few studies have harnessed novel empirical tools to elicit sensitivity to social norms among adolescent populations. This paper examines the association between sensitivity to norms and various personality and cognitive traits using an incentivised rule-following task grounded in Game Theory. Cross-sectional data were obtained from 1274 adolescents. Self-administered questionnaires were used to measure personality traits as well as other psychosocial characteristics. Incentivised rule-following experiments gauged sensitivity to social norms. A series of multilevel mixed effects ordered logistic regression models were employed to assess …

Advanced Control Strategies For The Continuous Production Of Monoclonal Antibodies, Markus Kampmann, Thomas Kruse, Johannes Lemke, David Pollard, Jonas Austerjost

Integrated Continuous Biomanufacturing V

Please click Additional Files below to see the full abstract.

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University Presidential Update- September 2022, Academic Affairs

University Updates & Communications from the University President

This is an Otterbein University presidential update to the staff and faculty, informing them on changes to campus.

Energy Price Shocks And Stabilization Policies In A Multi-Agent Macroeconomic Model For The Euro Area, Enrico Turco, Davide Bazzana, Massimiliano Rizzati, Emauele Ciola, Sergio Vergalli

Fondazione Eni Enrico Mattei Working Papers

Soaring energy prices since fall 2021 have prompted European governments to introduce policy measures to support households and businesses. In this paper, we employ the MATRIX model, a multi-sector and multi-agent macroeconomic model calibrated on the Euro Area, to analyze the economic and distributional effects of different types of macro-stabilization policies in response to energy price shocks. Simulation results show that, in the absence of stabilization policies, an increase in fossil fuel price would lead to a sharp growth in price inflation and a severe contraction in real GDP, followed by a slow but steady recovery. We find no significant …