Medicine and Health Sciences Commons^™

Complications And Management Of Idiopathic Multicentric Castleman Disease, Kavanya Feustel, Jacob W. Keeling, Olivia Makos, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Background

The pathophysiology of idiopathic multicentric Castleman disease (iMCD) is poorly understood compared to the other subtypes of MCD, which has contributed to limited treatment options and poor prognosis for iMCD patients. The pathogenesis of iMCD is thought to be mediated in part by dysregulation of interleukin (IL)-6.

Case Presentation

We present a case report of a 39-year-old Caucasian man with siltuximab-refractory iMCD. He presented with severe lower extremity lymphedema and wounds. His disease progressed through standard-of-care siltuximab. Due to his severe disease-related morbidity, he contracted recurrent infections, often complicated by sepsis. Ultimately, he required a left lower extremity amputation. …

Long-Term Autoimmune Polyarthritis Due To Covid-19 Vaccine, Ramesh Pandit, Namratha Pallipamu, Trupiti Pandit

HCA Healthcare Journal of Medicine

Background

Vaccinations for COVID-19 have played a pivotal role in controlling the global pandemic, with most adverse events being mild and transient. However, rare post-vaccination autoimmune responses have been reported. The understanding of long-term rheumatologic sequelae, particularly autoimmune polyarthritis following COVID-19 vaccination, remains limited.

Case Presentation

We report the case of a 41-year-old previously healthy man who developed progressive polyarthritis and systemic symptoms following the Johnson & Johnson COVID-19 vaccine. The initial symptoms of joint swelling and arthralgia appeared within a week of the first vaccine dose, subsiding temporarily with medication. After receiving a booster dose, the patient experienced worsening …

Covid-19 Vaccine-Induced Rhabdomyolysis In A 53-Year-Old Woman, Akash Hazari, Jack Chien, Daniel Nunez

HCA Healthcare Journal of Medicine

Introduction

COVID-19-induced rhabdomyolysis is a common complication in COVID-19 infection. However, only a handful of cases have been reported showing links between COVID-19 vaccine and rhabdomyolysis.

Case Presentation

We present the case of a 53-year-old woman, who recently received COVID-19 vaccine and presented to the hospital with progressive extremity weakness. Common reasons for rhabdomyolysis were ruled out as possibility and the patient was found to have rhabdomyolysis induced from COVID-19 vaccine.

Conclusion

Even though COVID-19 vaccine-induced rhabdomyolysis is rare, it should be considered in the differential diagnosis with patients presenting with neuromuscular complaints and a recent COVID-19 vaccine.

Clinical Outcomes After Hospitalization For Acute Coronary Syndrome In Patients Treated With Semaglutide Versus Bariatric Surgery: A Retrospective Multicenter Analysis, Nameer Ascandar, Charles Boadu, Gauthier Stepman, George Skaf, Olugbenga Oyesanmi, Sabry Omar, Rias Ali, Michael Schandorf-Lartey

HCA Healthcare Journal of Medicine

Background

Obesity is a chronic medical condition with a rising prevalence in the United States. A wide range of morbidity and mortality is associated with obesity, with coronary artery disease being among the most common. Ischemic heart disease continues to be the primary cause of death in the United States. Taken together, interventions to minimize the detrimental effects of obesity on patients at risk of heart disease will not only benefit the patient, but the health care system as well.

Methods

In this retrospective study, we used the HCA Healthcare enterprise data warehouse to identify all adult patients who were …

The Prevalence Of Abdominal Compartment Syndrome In The State Of Florida, Jason M. Clark, Laura Mena-Albors, Huazhi Liu, Darwin Ang

HCA Healthcare Journal of Medicine

Introduction

Abdominal compartment syndrome (ACS) is associated with significant mortality. Multiple studies have evaluated the prevalence of ACS at individual institutions and/or for short durations. No study has looked at the change of prevalence over an extended time or included nonresearch institutions. This study aims to evaluate the trend in the prevalence of ACS over time within the state of Florida.

Methods

This is a population-based retrospective study using deidentified data from the Florida’s Agency of Healthcare Database between 2006 and 2021. A total of 16 217 617 patients were evaluated within the intensive care unit (ICU), with 4002 developing …

Care Alert Program In Chronic Emergency Department Using Patients: Expanded Study, Jonathan Leggett, Kaitlyn Phelps, David Nuñez, Brent Wright, Erica Gibbons, Jonathan Bryan, Brian Griggs

HCA Healthcare Journal of Medicine

Introduction

The Care Alert Program (CAP) is designed to help navigate encounters with patients who are high utilizers of Emergency Department (ED) resources. The CAP intends to address the needs of this challenging patient population by designing individualized care plans that are approved by a multidisciplinary committee. The patient populations that frequently use ED resources often have chronic medical conditions, a poor understanding of their conditions, unrealistic expectations regarding treatment, a lack of outpatient resources, and present with multiple complaints when using ED resources.

Methods

The CAP was adopted by our facility in the spring of 2020. The present study …

Automated Dispensing Cabinet Stocking Schedule And Inventory Management Optimization, Daniel Elkes, Victoria Timmons

HCA Healthcare Journal of Medicine

Background

Prior practice in a 523-bed community hospital required automated dispensing cabinets (ADCs) to be replenished daily by early afternoon to ensure accurate drug ordering. Because of the tight time window, technicians frequently refilled ADCs during peak medication administration times. After a positive report from a smaller facility in the health system, the study facility implemented a quality improvement project to optimize the ADCs. This involved new processes of every-other-day ADC replenishment staggered via shift-specific workflows, and a dedicated technician was assigned to optimize ADC inventories.

Methods

Monthly reports of ADC refilling and dispensing transactions were compiled from inpatient, nonprocedural …

Efficacy And Safety Of Lotilaner Ophthalmic Solution 0.25% In Demodex Blepharitis: A Systematic Review, Stephanie P. Fabara, Thalia Fabara, Akankcha Alok, Nausheen Khuddus

HCA Healthcare Journal of Medicine

Demodex blepharitis is a chronic eyelid inflammation caused by Demodex mites, which are ubiquitous skin parasites. Lotilaner, a newly United States Food and Drug Administration (FDA)-approved drug, is an antiparasitic agent that selectively inhibits parasite-specific γ-aminobutyric acid chloride channels, inducing spastic paralysis and death of Demodex mites. It is applied as an ophthalmic solution, 0.25%, twice a day for 6 weeks, and it has a long half-life and high lipophilicity, facilitating the penetration of the drug into the eyelash follicles and meibomian glands where the mites reside. This study systematically reviewed 6 clinical trials that compared lotilaner with placebo for …

Two 55-Word Stories: Reasonable Suspicion And There’S An Art To This, Angel Ogbeide

HCA Healthcare Journal of Medicine

Narrative medicine, specifically the 55-word story, provides clinicians an opportunity to reflect on experiences they encounter and garner significant meaning from them. These 2 stories discuss difficult situations I have experienced in my practice of medicine.

“Reasonable Suspicion” is an internal reflection on the weight of the complex decisions providers are often faced with (mandatory reporting, etc) and are not emphasized enough in health care. Doing the right thing in a clinical situation is taught. How doing the right thing can make a provider feel is not.

“There’s an Art to This” discusses grief. How do you grieve a patient? …

From Molars To Bronchus; The Tale Of An Aspirated Dental Instrument, Yisroel Grabie, Sudeep Acharya, Fasih Sami Siddiqui, Gabriel A. Chavez Reyna, Michel Chalhoub

HCA Healthcare Journal of Medicine

Background

Aspiration of dental instruments is a rare event that carries potentially serious complications when it occurs, especially in older patients, where protective reflexes are diminished. Clinical management may be difficult because of the risk of granulation tissue and different retrieval strategies according to the object’s characteristics. In this report, we describe the case of an 84-year-old man who aspirated a dental bur during a routine dental procedure, necessitating immediate intervention. Timely and precise management was essential to avert severe complications.

Case Presentation

During a routine dental procedure, an 84-year-old man aspirated a bud-shaped cross-cut carbide dental bur. Despite initial …

Using Point-Of-Care Ultrasound For The Medical Management Of Marathoners And Spectators: A Case Series, Jacob D. Pope, Casey Wilson, Kelsey Daller, Jonathan Hardin, Steven Rickett

HCA Healthcare Journal of Medicine

Background

Temporary field hospitals play a crucial role in providing medical care to individuals who experience illnesses and injuries during mass gathering events. Handheld point-of-care ultrasound (POCUS) devices offer an affordable and portable adjunct for emergency care. We present multiple patients from a field hospital during a marathon event in which handheld POCUS devices changed clinical management.

Case Presentation

A 75-year-old man who had fallen was able to be discharged after a lung exam confirmed no rib fractures or pneumothorax. A hypotensive and hypoglycemic 21-year-old man had an echocardiogram confirming volume depletion. He received treatment, and a repeat exam demonstrated …

A Case Of A Massive Right Atrial Thrombus Removal Under Transesophageal Echocardiographic Guidance, Justin Phillips, Max Kabolowsky, Alex M. Hendon, Samantha Arzillo

HCA Healthcare Journal of Medicine

Background

With the advent of catheter guided interventions, practitioners have added another tool alongside chemical lysis and surgical removal to reduce the clot burden of patients with large emboli and thrombi. Due to comorbid conditions, many patients are poor candidates for surgical or chemical clot treatment but may present optimally for catheter-based thromboembolectomy. In this case, we highlight the benefits of mechanical thrombectomy with transesophageal echocardiographic guidance to reduce the clot burden of a patient who would otherwise be considered a poor candidate for surgical or chemical treatment.

Case Presentation

This case follows a 78-year-old man with a past medical …

Pembrolizumab-Associated Acute Esophageal Necrosis: A Case Report And Literature Review, Mark Tawfik, Elie Bou Sanayeh, Stephanie Chain, Ahmed Elfiky, Stephen Mulrooney

HCA Healthcare Journal of Medicine

Background

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. They pose challenges, particularly in the form of immune-related adverse events (irAEs). Although cases of gastrointestinal irAEs have been well-documented, acute esophageal necrosis (AEN) characterized by a circumferential blackening and fragility of the esophagus, weeks after immunotherapy discontinuation, has not been reported.

Case Presentation

A 75-year-old diabetic male who was recently diagnosed with high-grade papillary urothelial cancer with liver and retroperitoneal metastases and had undergone radical cystectomy with ileal conduit urinary diversion, presented to the hospital for sepsis secondary to a urinary tract infection. While in the hospital, he experienced hematemesis, …

Resolution Of Patient’S Anaphylaxis To The Moderna Covid-19 Vaccine By Desensitization, Stefan M. Pienkowski, Marek M. Pienkowski

HCA Healthcare Journal of Medicine

Introduction

Management of patients with rare anaphylaxis to COVID-19 vaccines creates a challenge. Desensitization to medications and vaccines has proven to be effective in managing anaphylactic reactions in selected individuals with a high benefit-to-risk ratio. A previous report described the successful administration of the Moderna modified messenger RNA (MmRNA) COVID-19 vaccine via a graded dose protocol to a patient with previous anaphylaxis to the MmRNA vaccine. Our report describes successful desensitization to the MmRNA vaccine followed by administration of the full dose MmRNA vaccine.

Case Presentation

A patient with a history of chronic allergies and anaphylaxis due to insect sting …

Guillain-Barré Syndrome Following Moderna Spikevax Messenger Rna Covid-19 Vaccine: A Case Analysis, Jamie Lee Aldakkour, Alvin Boyd Newman-Caro, Hector Gonzalez-Montalvo, Usama Bardan, Guruswamy Ramamurthy

HCA Healthcare Journal of Medicine

Background

Guillain-Barré Syndrome (GBS) is an acute autoimmune polyneuropathy. Cases of GBS have been reported following administration of the vaccines for swine influenza, seasonal influenza, hemagglutinin type 1 and neuraminidase type 1, and meningococcal disease. Despite these links, a causal relationship has not been confirmed.

Case Presentation

We present a case of a 70-year-old woman who presented with progressive bilateral ascending weakness and numbness and reported receiving the first dose of the Moderna COVID-19 vaccine 2 weeks prior to presentation.

Conclusion

At the time of writing, this is the first reported case of GBS following the Moderna Spikevax COVID-19 vaccine. …

Intracolonic Migration Of A Dislocated Acetabular Cup Prosthesis, Jack R. Lubka, Cyrus Tamboli, Philip Brunetti, Sarosh Tamboli, Alex Davis, Hamish Patel, Olugbenga Oyesanmi, Michael Strobbe, Shaival Thakore, Subhasis Misra, Jeffrey Mino

HCA Healthcare Journal of Medicine

Background

Acetabular cup migration is a rare complication of hip replacement surgery. If the acetabular socket of the ilium is weak, the prosthesis can erode or pass through it. There have been multiple reports of acetabular cup prosthesis migration to the colon, creating a coloarticular fistula between the hip joint and the cecum, sigmoid colon, or rectum. We report a rare presentation of a complete intracolonic migration of a prosthetic acetabular cup without creating a fistula.

Case Presentation

A 53-year-old female patient with a remote history of a total right hip replacement presented with abdominal pain and rectal bleeding. Computed …

A Rare Instance Of Streptococcus Agalactiae Pyomyoma In A Postmenopausal Patient: A Case Report, Mariah Piazza, Sai V. Nagula, Madeleine Salzberg, Darren Preuninger

HCA Healthcare Journal of Medicine

Background

Pyomyoma is a rare, but potentially fatal, complication of uterine leiomyoma. Most cases occur in postpartum or postmenopausal patients with vascular disease and arise due to infarction and infection of existing fibroids. The proposed diagnostic triad for pyomyoma includes 1) sepsis or bacteremia; 2) uterine leiomyomata; and 3) no other apparent source of infection. We present a case of a postmenopausal patient who presented with the aforementioned triad and was found to have a pyomyoma, positive for Streptococcus agalactiae.

Case Presentation

A 67-year-old woman with no known past medical history presented to the emergency department for altered mental …

An Examination Of Health Coaching As A Developing Profession, Katie Suleta, Jonathan M. Davis

HCA Healthcare Journal of Medicine

Background

Health coaching is a field that is growing in popularity. Health coaching is not regulated and there is no standard for background, education, or training for those acting as health coaches. The purpose of this study was to investigate the burgeoning field of health coaching: who is performing it and common practices.

Methods

A total of 560 health coaching websites were reviewed to record educational backgrounds, recommendations for supplements, and the sale of supplements and/or other wellness products. Multivariable logistic regression was used to test associations between characteristics of health coaches and whether they recommend supplements, sell supplements, or …

Utility Of Incorporating Radiological Findings Of Right Heart Strain In Patients With Acute Pulmonary Embolism For Risk Stratification Of Adverse Outcomes: A Retrospective Analysis, Joshua Amaya, Sameer Allahabadi, Daniel L. Habenicht, John Hunton, Amal M. Khan, Subhash Venigalla, Curran Reddy, Jeremy V. Doan, Grace Wang, Daniel R. Eickenhorst, Shovendra Gautam

HCA Healthcare Journal of Medicine

Background

Right heart (RH) strain in the setting of pulmonary embolisms can significantly increase the risk of mortality. Thus, screening for risk of complications in these patients is crucial. The goal of our study was to assess the strength of specific diagnostic findings of RH strain for predicting adverse outcomes including mortality, hospital length of stay, and the requirement of advanced interventions.

Methods

A single-center, retrospective cohort study of 81 patients diagnosed with acute pulmonary embolism with RH strain on computed tomography pulmonary angiogram (CTPA) from September 12, 2019, to August 30, 2023. Data were collected on patient computed tomography …

Combating Physician Burnout And Fostering Wellness In Graduate Medical Education For Resident Physicians, Abdulaziz Mheir, Zohare Khan, Franklin Hernandez, Alaa Mohamed, Chandan Mitra

HCA Healthcare Journal of Medicine

Background

Over the last 2 decades, there has been a cultural shift in the graduate medical education (GME) space, focusing on an important facet: physician burnout. Burnout is defined as a combination of emotional exhaustion, depersonalization, and a lack of personal accomplishment. With increasing awareness of physician burnout, various wellness initiatives have begun to be implemented throughout training programs, and their results have been measured for effectiveness in reducing burnout rates. Due to the increasing rates of burnout emerging throughout GME programs, an initiative to evaluate our internal medicine (IM) residency on this matter was discussed with all residents at …

Severity Of Sars-Cov-2 Illness In Patients With Type 1 And Type 2 Diabetes Mellitus, Anthony Shadiack, Alexis White, Prasad Munusamy, Jessica Oleske, Parisa Biazar, Serena Mitchell, Michael G. Flynn, Nayda Parisio Poldiak

HCA Healthcare Journal of Medicine

Background

Diabetes is a well-known risk factor for the severity of illness in patients with SARS-CoV-2 infection (COVID-19). However, there is less published data on illness severity differences between patients with type 1 (T1D) and type 2 (T2D) diabetes mellitus.

Methods

We performed a retrospective review of records of patients with COVID-19 (March 2020 - November 2020) extracted from a large, private hospital system database. Of the 76 467 patients with COVID-19, 54 007 (70.6%) did not have a diabetes diagnosis (NON), 22 084 (28.9%) had T2D, and 376 (0.49%) had T1D. We further subgrouped diabetic patients into groups with …

Portable Head Computed Tomography Protocol For Trauma, Christian Quinones, Alexander Bolufer, Cory Hewitt, Sagun Tuli

HCA Healthcare Journal of Medicine

The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols …

Vol6iss2, Hca Healthcare

HCA Healthcare Journal of Medicine Covers

Cover for Volume 6 Issue 2 of the HCA Healthcare Journal of Medicine.

2025 North Texas Gme Research Forum Program, Hca Healthcare

North Texas Research Forum 2025

No abstract provided.

Anatomy In Ink, Gabriel Scally

HCA Healthcare Journal of Medicine

In the intersection of medicine and art lies a profound synergy that nurtures both professional and personal well-being. This piece embodies this connection through a detailed and abstract representation of the human body and its complexities. At the center of the piece, the gross anatomical depiction of the head and neck serves as a nod to the foundational knowledge in medicine. Surrounding this central figure is an intricate conglomeration of medical elements, including the inner ear canal, a fetus, a hand, an eye, the brain, nerves, chemical elements, microbiology, and excerpts from the Hippocratic Oath, tying together aspects from basic …

Harmonizing Innovation: The Beatles, Emi, And The Birth Of Computed Tomography Imaging, Matthew A. Daniel, Alexander Holland, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Computed tomography (CT) imaging has become a cornerstone of modern medical diagnostics, thanks to the groundbreaking work of Sir Godfrey Hounsfield. However, the significant role played by his employer, Electric and Musical Industries (EMI), in providing financial support for his research is often overlooked. In this paper, we explore the connection between EMI's success in the music industry, particularly its signing of the Beatles, and Hounsfield's pioneering work on CT imaging. EMI’s success in the music industry provided the financial stability for Hounsfield's research endeavors. In 1971, he developed the first CT scanner, which revolutionized diagnostic medicine. His collaboration with …

Ethical Considerations Of Percutaneous Endoscopic Gastrostomy Tube Placement In A Patient With Creutzfeldt-Jakob Disease And Advanced Dementia, Toni Habib, Niamh Siobhán Mulrooney, Yisroel Grabie, Mohammad Maruf, Sophia Kasapira

HCA Healthcare Journal of Medicine

Background

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative condition that is not easily diagnosed and has no curative treatments available, essentially requiring palliative measures, including tube feeding. Nonetheless, data shows that the endoscope used for percutaneous endoscopic gastrostomy (PEG) tube insertion can be a vector for CJD transmission.

Case Presentation

We discuss the case of an elderly patient diagnosed with CJD, requiring tube feeding. Multiple specialists were consulted, and they were unable to reach an agreement on the best approach. Eventually, the hospital ethics committee intervened, and the family agreed to comfort measures only. This case report sheds light …

The Black Fungus: A Rare Case Of Pulmonary Mucormycosis, Stephanie Wong, Elsa Lesley Tchouambou Pougoue, Joanna Polanco, Betty Kirimi, Choudhry Poonam

HCA Healthcare Journal of Medicine

Background

Mucormycosis, commonly known as the "black fungus," is a severe infection affecting multiple organ systems, including the skin, brain, lungs, and gastrointestinal tract. This case report is focused on pulmonary mucormycosis, which is frequently observed in organ transplant recipients. Diagnostic challenges arise from nonspecific symptoms.

Case Presentation

Our case involved a 61-year-old male with a history of renal transplantation. The patient initially presented with a persistent cough and bloody sputum and was treated unsuccessfully for a presumed fungal infection. A lung biopsy confirmed pulmonary mucormycosis, emphasizing the heightened vulnerability of immunocompromised individuals.

Conclusion

This case highlights the intricate nature …

Plasma Cell-Rich Lymphoid Neoplasm In An Endocervical Polyp Of The Uterine Cervix In A Perimenopausal 52-Year-Old Woman, Anjali Patel, Jacqueline Haas, Angela Kueck

HCA Healthcare Journal of Medicine

Background

The adaptive immune system consists of T and B lymphocytes, with some B lymphocytes further differentiating into plasma cells that secrete antibodies and make up the humoral immune system. Extramedullary plasmacytoma, mucosa-associated lymphoid tissue (MALT) lymphoma, and plasmablastic lymphoma are all plasma cell-rich lymphoid neoplasms that rarely present in the female genital tract. To date, few case reports of these malignancies arising within the uterine cervix exist.

Case Presentation

This case report describes a 52-year-old perimenopausal woman who presented to her primary obstetrician-gynecologist for an annual exam with the complaint of light spotting following an endometrial ablation that occurred …

Terlipressin-Induced Hyponatremic Seizures In A Patient With Congenital Hepatic Fibrosis, Luca Gauci, Jorge Gafa, Suzanne Cauchi, Jurgen Gerada

HCA Healthcare Journal of Medicine

Introduction

Acute variceal bleeding from portal hypertension is one of the most serious complications with a mortality rate of 15% to 25%. Terlipressin is a vasopressor that controls variceal bleeding by lowering the portal pressure and reducing blood flow to the varices.

Case Presentation

We report a case of a patient with acute variceal bleeding, treated endoscopically and with terlipressin, who developed severe hyponatremia and seizures requiring admission to intensive care. Clinical and biochemical improvements were noticeable upon the cessation of terlipressin, with an eventual discharge from the hospital.

Conclusion

Prompt management of acute variceal bleeding with both endoscopic and …