Medicine and Health Sciences Commons^™

Can Anemia Be A Prognostic Indicator To Scope For Gastroesophageal Junction Adenocarcinoma?, Ryan Tam, Neha Narayanan, Evan Basha, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Gastroesophageal junction adenocarcinoma is a rapidly progressive disease that has a poor prognosis with a 5-year survival rate of 20%. It commonly presents with major symptoms of dysphagia and weight loss in addition to a long-standing history of reflux. As of now, screening for esophageal adenocarcinoma (EAC) is dependent on identifying risk factors which include a family history of Barrett’s esophagus and esophageal adenocarcinoma or patients with gastroesophageal reflux disease and at least one other risk factory for EAC such as age greater than 50 years, obesity or central adiposity, history of smoking, or male gender. Here, we present a …

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.

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 …

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 …

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.

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.

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 …

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 …

Healthcare Leadership In Western Societies: Religion, Politics, And Rhetoric, Nelly D. Figueroa-Herrera

Pepperdine Journal of Communication Research

No abstract provided.

Post-Discharge Telephone Intervention With A Clinical Pharmacy Specialist For Gastrointestinal Medical Oncology Patients, Jane E. Rogers, Michael Leung, Amanda Sirisaengtaksin, Jennifer Zadlo, Van Nguyen, Morgan Mace, Wendy Covert, Makenna Smack, Stacy Diao, Zhou Fang, Andrea Landgraf, Mariela Blum Murphy

Advances in Cancer Education and Quality Improvement

Background: Oncology patients are a vulnerable population with medication-related problems spanning across care settings. Gastrointestinal medical oncology (GIMO) patients often have unique medication challenges due to extensive treatment history. High-quality medication reconciliation aids in preventing medication discrepancies and potential adverse events during transitions of care. We conducted a pilot post-hospital discharge intervention with clinical pharmacy specialists for GIMO patients.

Objective: The primary objective was to identify the frequency of medication discrepancies.

Methods: GIMO patients discharged from our hospital were identified and called within 7 days of discharge. Clinical pharmacy specialist telephone encounters occurred between December 2021 and February 2022.

Results: …

Factors Associated With Emergency Difficult Tracheal Intubation And Difficult Airway Management In A Non–Operating Room Setting At A Cancer Treatment Center, Jackson Su, Neil Bailard, Jens Tan, Jeffrey Lim, Catherine Vu, Wenli Dong, Gang Zheng

Advances in Cancer Education and Quality Improvement

Difficult tracheal intubations are reported more often in the emergency non−operating room setting than in the operating setting. To identify the factors associated with emergency difficult intubation (DI) and difficult airway (DA) management in hospitalized patients with cancer, we conducted a single-center retrospective study in hospitalized patients who underwent emergency intubations in a non−operating setting from 2016 to 2019 at a cancer treatment center. Cases of DI (inability to visualize the vocal cords and/or >2 intubation attempts) and DA (DI, advanced airway device use, and/or need for a surgical airway) were included. We reviewed 763 cases; the DI and DA …

Evaluating The Impact Of A Renal Dosing Refreshable Sidebar Report On Appropriateness Of Antimicrobial Dosing At A Large Acute Care Cancer Hospital, Emily Fox, Jovan Borjan, Nancy Vuong, Hannah Aune, Claire Marten, Joshua Hendrickson

Advances in Cancer Education and Quality Improvement

Background: Appropriate antimicrobial dosing is vital in the treatment of patients with infectious diseases, though adherence to guideline recommended doses is often suboptimal.

Outcomes: This study was conducted to evaluate the impact of a renal dosing refreshable sidebar report, which displayed recommendations from a previously developed institutional antimicrobial dosing guide at the time of antimicrobial order entry. The primary outcome was adherence to daptomycin dosing guideline recommendations before and after implementation.

Methods: This was a pre- and post-quasi-experimental study at a 600-bed acute care cancer hospital. Adult patients (≥18 years old) that received daptomycin from February-April 2021 (pre-intervention phase) and …

Volume 11 Full Text, Bjur Staff

Butler Journal of Undergraduate Research

No abstract provided.

Beyond Liver Function: Albuminuria And A Novel Child-Turcotte-Pugh-Albu Score Improve Mortality Prediction In Medical Intensive Care Unit Patients With Hepatic Encephalopathy, Ahmed Alwassief, Said A. Al-Busafi, Khalid Al Shamousi, Ashraf Elbahrawy, Hossam Shahba, Hafez Abdelhafeez

Sultan Qaboos University Medical Journal

Objective: This study aimed to evaluate whether incorporating albuminuria (Alb) into the Child-Turcotte-Pugh (CTP) score improves the prediction of mortality in patients with hepatic encephalopathy (HE). Methods: This prospective study was conducted between January 2013 and January 2015 at Al-Azhar University, Cairo, Egypt. Patients who were diagnosed with HE at the time of admission to the medical intensive care unit (MICU) were included. Upon admission, patients underwent HE grading, CTP classification, and an albumin-to-creatinine ratio (ACR) assessment. A novel scoring system, CTP-AlbU, was calculated by combining existing CTP scores with the admission degree of ACR. The primary outcome …

Coexisting Dual Mechanisms Of Ischaemic Stroke: Frequency And Outcomes In A University Hospital-Based Stroke Registry, Arunodaya R Gujjar, Darshan Lal, Sunil Kumar, Shyam S Ganguly, Sameer Raniga, Faizal Al-Azri, Abdullah Rashid Al-Asmi

Sultan Qaboos University Medical Journal

Objectives: Ischaemic stroke (IS) is a heterogeneous condition with varied mechanisms. Some patients have more than 1 stroke mechanism coexisting, irrespective of the mechanism of the incident stroke. This study aimed to examine the association of coexisting dual stroke mechanisms among IS patients with risk factors and clinical outcomes. Methods: This retrospective study included adult patients with IS diagnosed using the TOAST criteria in Sultan Qaboos University Hospital's stroke registry who were admitted and treated from January 2011 to December 2020. The records were reviewed for the presence of dual IS mechanisms (combinations involving small vessel disease [SVD], …

Enhancing Mortality Data Accuracy: Outcomes From A Collaborative National Workshop In Oman, Salim Al-Busaidi, Eman Aly, Mohammed Al-Abri, Salim Al-Salmi, Abdullah Al-Hinai, Omar Al-Naqabi, Jawaher Al-Maskari, Marwa Al-Mahroqi, Alaa Hashish, Henry Doctor, Arash Rashidian, Jean Jabbour, Abdullah Al-Alawi

Sultan Qaboos University Medical Journal

Objectives: Mortality data is essential for global health policy and sustainable development goals, yet errors in death notifications, often exceeding 50%, challenge its accuracy. This is largely due to the lack of formal training among physicians and medical coders in issuing death notifications. This study conducting a national educational intervention and aimed to assess the outcomes of the intervention Methods: A 2-day workshop was held in Oman in June 2023 for physicians and medical coders, employing a pre- and post-assessment design. The training, developed by both international and national experts, covered aspects of mortality data quality, based on …

Disconnected Pancreatic Duct Syndrome In Complicated Necrotising Pancreatitis, Nasiba Al Maqrashi, Noor Al Wahaibi, Salim Al Busaidi, Abdullah Al Alawi

Sultan Qaboos University Medical Journal

No abstract provided.

Effectiveness And Safety Profile Of Fingolimod In Treating Omani Patients With Multiple Sclerosis: A Single Tertiary Centre Experience, Ghaida K. H. Al-Hashmi, Abdullah Al-Asmi, M. Mazharul Islam, Ibrahim Al-Zakwani, Mehwish Butt, Ahmed Al-Qassabi, Haifa Al-Abri, Arunodaya R. Gujjar

Sultan Qaboos University Medical Journal

Objectives: This study aimed to evaluate the effectiveness and safety of fingolimod in Omani multiple sclerosis (MS) patients. Fingolimod is one of the oral drugs used to treat MS. However, there is limited information on its effectiveness and safety among the Omani population. Methods: This retrospective real-world study included 65 Omani MS patients who received fingolimod therapy from 2012 to 2021 at a single tertiary centre in Oman. Data were collected between August and November 2021. Various measures were used to evaluate the effectiveness and safety of fingolimod. Results: Out of 65 MS patients included in the …

The Diagnostic Utility Of Bronchoalveolar Lavage In Pulmonary Infections: Study From A Tertiary Care Hospital In Oman, Masoud Kashoub, Al-Baraa Al-Jabri, Mohammed Al Rashdi, Jamal Al-Aghbari

Sultan Qaboos University Medical Journal

Objectives: Bronchoalveolar lavage (BAL) is an important diagnostic tool. Despite advancements in microbiological strategies, BAL's yield remains inconsistent. Hence, this study aimed to evaluate the yield of BAL in terms of microbial detection and correlate these results with computed tomography (CT) findings and antimicrobial usage duration before bronchoscopy. Methods: This retrospective cohort study included all adult patients who underwent bronchoscopy with BAL at Sultan Qaboos University Hospital, Muscat, Oman, from January 2021 to December 2022. Results: A total of 203 patients underwent bronchoscopy. The primary indication for bronchoscopy was lung infiltrates in patients with haematological malignancies (49.3%). The …

Healthcare-Associated Infections Secondary To Multidrug-Resistant Organisms In Hospitalised Patients With Covid-19 Pneumonia: A Single-Centre Experience, Yahyia Al Hanashi, Abdullah Balkhair

Sultan Qaboos University Medical Journal

Objectives: Hospitalisations related to COVID-19 pneumonia have increased the risk of healthcare-associated infections (HCAIs), including those caused by multidrug-resistant organisms (MDROs). This study aimed to investigate the epidemiology of HCAIs secondary to MDROs among hospitalised patients with COVID-19 pneumonia. Methods: This retrospective study population included patients with COVID-19 pneumonia aged 18 years and older who were admitted to Sultan Qaboos University Hospital, Muscat, Oman, for more than 48 hours between March 2020 and December 2021. Results: A total of 486 patients were included in this study. Among the cohort, 76 patients (15.6%) were diagnosed with concurrent HCAIs …

Incidence And Predictors Of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement: Two-Centre Experience From Oman, Mohamed N. Al Rawahi, Adil Al Kindi, Ahmed Al Yarubi, Ahmed Shams, Adil Al Riyami, Hatim Al Lawati, Ahmed El Said, Mohamed Al Riyami, Khalid Al Saidi, Ismail Al Abri, Najib Al Rawahi, Abdullah Al Ismaili, Fahad Al Kindi, Muhammad A. Sadiq, Sunil K. Nadar

Sultan Qaboos University Medical Journal

Objectives: This study aims to evaluate the predictors and rate of permanent pacemaker (PPM) implantation among patients undergoing transcatheter aortic valve replacement (TAVR) at two institutions in Oman. TAVR has become the standard of care for patients with severe aortic stenosis at high risk for surgery. However, it is associated with a high PPM implantation rate. Methods: This was a retrospective study involving all patients undergoing TAVR at two leading cardiac centres in Oman over seven years, from May 2013 to September 2020. We included patients who survived the procedure to discharge and those who were followed-up for …

Pseudomyxoma Peritonei: Exploring An Unusual Clinical Presentation – A Case Report, Mallak Al Naabi, Salim Al Busaidi, Amwaj Al Shahi, Maha Al Shaibi, Khalid Al Shamousi, Abdullah Al Alawi, Mohammed Al Hosni

Sultan Qaboos University Medical Journal

Pseudomyxoma peritonei (PMP) is a rare clinicopathological condition characterised by mucin-producing peritoneal and omental deposits with an estimated incidence of 1--2 cases per million per year. We report a 42-year-old female patient who presented to a tertiary care hospital in Muscat, Oman, in 2023 due to a 7-year history of chronic diarrhoea associated with progressive abdominal distension over the past 2 years. Her assessment was significant for ascites. No neoplastic lesions were found on the upper and lower gastrointestinal scopes. A diagnostic ascitic tapping revealed a free flow of gel-like thick, yellowish fluid. A diagnostic laparoscopy showed a perforated appendicular …

Utility Of Routine 24-Hour Electrocardiographic Holter Monitoring For Detecting Atrial Fibrillation In Patients Admitted With Acute Stroke Syndromes, Salim Al-Busaidi, Hatim Al-Lawati, Nasiba Al-Maqrashi, Arunodaya R. Gujjar

Sultan Qaboos University Medical Journal

Objectives: This study aimed to assess the operating characteristics of standard 12-lead electrocardiogram (ECG) and 24-hour Holter studies in detecting atrial tachyarrhythmia in patients with acute stroke syndromes. The study's objective was to determine the potential factors that increased the likelihood of detecting atrial fibrillation (AF) and its impact on management. Methods: This retrospective cohort study included adults (aged ≥18 years) admitted at Sultan Qaboos University Hospital from January 2010 to December 2019, with ischaemic stroke or transient ischaemic attack and had undergone a 24-hour Holter study. The hospital stroke registry was used to screen patients. Results: A …

Dengue Fever: Clinical Features And Health Outcomes In Patients Presenting To A Tertiary Care Hospital, Khalfan Al Zeedy, Sheikha Al Shibli, Jawahar H. Al Noumani, Mohammed Al Azri, Abdullah Al Alawi

Sultan Qaboos University Medical Journal

Objectives: This study aimed to assess the mortality rate and related factors in dengue fever (DF) patients. Additionally, it will outline the clinical and biochemical characteristics and treatments administered to confirmed cases. Methods: This retrospective cross-sectional study included DF patients who presented to Sultan Qaboos University Hospital between January 2022 and July 2023. Data were extracted from the hospital's electronic system into a pre-designed Excel data collection sheet and analysed. Results: The study identified 319 confirmed DF cases with male predominance. The overall mortality rate was 3.8% (n = 12). Mortality was significantly higher among those with …

Clinical And Autoimmune Profiles Of Omani Patients With True Versus False Positive Autoimmune Encephalitis Antibodies Panels, Ahmed Al-Qassabi, Haifa Al-Abri, Mahmood Al Kindi, Abdullah Al-Asmi, Jalila Alshekaili, Said Al Farsi, Rawan Al Hinai, Ikram Al Lawati, Arunodaya R. Gujjar

Sultan Qaboos University Medical Journal

Objective: This study aimed to explore the clinical profiles of Omani patients with true-positive autoimmune encephalitis (AE) autoantibodies and compare them with those having false-positive autoantibodies. The incidence of AE is rising due to growing awareness and the detection of new autoantibodies. Coinciding with this rise are false positive autoantibodies without clinical correlates. Methods: The medical records of all patients who tested positive for AE antibodies in Sultan Qaboos University Hospital, Muscat, Oman, from May 2016 to December 2022 were reviewed. Cases were verified by three neurologists based on the existing criteria for AE. Results: The participants comprised …