Medical Specialties Commons^™

Amoxicillin-Clavulanate Related Liver Injury, Devin Vaishnani Md, Pratikkumar Vekaria Md, Ravish Patel Md, Megan White Md, Marvin Vaishnani Md

Gastroenterology

Introduction: Recognition of Drug-induced Liver Injury (DILI) may be challenging as it is often diagnosis of exclusion, unavailability of diagnostic test and variability in presentation. Many antibiotics can cause DILI but Amoxicillin-Clavulanate has rare adverse reaction causing mixed cholestatic-hepatocellular injury. Since amoxicillin alone does not induce liver injury, combination of amoxicillin and clavulanic acid could be responsible for this adverse reaction. It can be due to metabolic idiosyncrasy or hypersensitivity mechanism. Case Report: 64-year-old female with no pertinent PMH presented to ER with abdominal pain and jaundice. She had abdominal pain for 4-5 days. Abdominal pain was constant and located …

The Palpitations That Thumped Us All:, Carolyn Falk Tran Do, Gurmanpal Sandhu Md, Daniel Robitshek Md, Tejas Raiyani Md

Internal Medicine

No abstract provided.

Rare Infective Endocarditis Caused By Dental Source Due To Streptococcus Bovis Masquerading As Cardiac Failure, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Asif Shah

Internal Medicine

No abstract provided.

Guillain Barre Syndrome In A Patient With Sickle Cell Anemia, Kunjan Udani Md, Pooja Patel, Dveet Patel, Hajra Awwab, Nino Balanchivadze

Internal Medicine

No abstract provided.

Intestinal Tuberculosis In An Immunocompetent Patient, Reema M. Vaze Md, Anam Malik Md, Ricky Buckshaw Do, Michal Kloska Md, Abdul Aleem Md, Frederic Stelzer Md

Department of Medicine

No abstract provided.

Small Bowel Variceal Bleeding Successfully Treated With Percutaneous Coil Embolization, Anam Malik Md, Reema M. Vaze Md, Ricky Buckshaw Do, Michal Kloska Md, Eric Nellis Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

A Case Of Cmv Colitis Seen In Dress, Anam Malik Md, Reema M. Vaze Md, Ricky Buckshaw Do, Eric Nellis Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Spitting Blood And Casts With Mud: A Rare And Unusual Presentation Of C3 Glomerulonephritis, Gerardo Mederos, Harsh Patel, Menalee Hapuarachchi, Som Aftabizadeh, Prashanth Reddy, Ranjit Nair, Dana Ciobanu, Machaiah Madhrira

Internal Medicine

C3 glomerulonephritis (C3GN) is a rare disease that falls under the umbrella of C3 glomerulopathy. It is manifested by abnormal activation of the alternate pathway resulting in complement deposition in the glomeruli. Kidney biopsy with characteristic findings of electron-dense deposits in the mesangial and capillary wall confirms the diagnosis. Until recently, C3GN presenting with primarily lung involvement had not been reported. We present a unique case of initial pulmonary manifestation C3GN.

Metastatic Renal Cell Carcinoma To The Small Bowel: A Rare Cause Of Gastrointestinal Hemorrhage, Ricky Buckshaw Do, Anam Malik Md, Reema M. Vaze Md, Michal Kloska Md, Robert Andrews Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Can We Predict Low Quality Colonoscopy? Establishing Open Access Colonoscopy At A Fellow-Run Gastroenterology Clinic, Matthew Sullivan Do, Abdul Aleem Md, Rajesh Essrani Md, Patrick Hickey Do, Robert Andrews Md, Anam Malik Md, Hiral N. Shah Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Safety Climate, Safety Climate Strength, And Length Of Stay In The Nicu, Daniel S Tawfik, Eric J Thomas, Timothy J Vogus, Jessica B Liu, Paul J Sharek, Courtney C Nisbet, Henry C Lee, J Bryan Sexton, Jochen Profit

Faculty, Staff and Student Publications

BACKGROUND: Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs).

METHODS: Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU's respondents, i.e., safety climate strength, was determined via intra-unit standard deviation …

Fostering Productive Conversations In A Kenyan Tertiary Intensive Care Unit: Lessons Learnt, Sayed Karar, Jamila Nambafu, Feroza Daroowalla

Internal Medicine, East Africa

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.

Concurrent Catastrophic Antiphospholipid Syndrome And Heparin-Induced Thrombocytopenia, Brian J. Holahan Do, Kareem Godil Md, Nathan Brewster Do, Jonaid Aslam Md

Department of Medicine

No abstract provided.

Management Of Incidental Aortic Mural Thrombus In The Setting Of Heparin-Induced Thrombocytopenia, Mal P. Homan Do, Brian J. Holahan Do, Soorya N. Aggarwal Do, Robert V. Decker Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Pleural Effusion With Trapped Lung Associated With Methimazole Induced Hypothyroidism, Nathan Brewster Do, Michal Kloska Md, Alaynna C. Kears Do, Brian J. Holahan Do, Waqas Adeel Md

Department of Medicine

No abstract provided.

Anti-Synthetase Syndrome Presenting As Rapidly Progressive Interstitial Lung Disease, Nathan Brewster Do, Amogh M. Joshi Do, Alaynna C. Kears Do, Kareem Godil Md, Jessica Boehmler Md, Andres Zirlinger Md

Department of Medicine

No abstract provided.

Flare Of Rheumatoid Arthritis Associated Interstitial Lung Disease Secondary To Lung Biopsy, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Ethan S. Stern Do, Jessica Boehmler Md

Department of Medicine

No abstract provided.

Rash Provokes Catastrophic Antiphospholid Syndrome, Alaynna C. Kears Do, Nathan Brewster Do, Breanna S. Goldner Do, Kareem Godil Md, Aaron J. Czysz Md

Department of Medicine

No abstract provided.

Rapidly Progressive Rheumatoid Lung Disease, Alaynna C. Kears Do, Nathan Brewster Do, Andrea M. Soliman Do, Stacey Smith Md, Facp, James Ross Md, Facp

Department of Medicine

No abstract provided.

Using Education To Increase Compliance With Heart Failure Medications, Kara Stout Do, Isaac Navarro Dmd

Internal Medicine

• Approximately 5.7 million adults in the United States have heart failure.
• 25% of individuals die within one year of diagnosis and more than 80% die within 8 years.
• Full adherence to medications may be as low as 30% in heart failure patients.
• Non-compliant patients are two times more likely to be readmitted to the hospital and have a three times higher mortality rate.

Choking On Adenocarcinoma, Andre Sahakian Md, Rajesh Gulati Md

Internal Medicine

No abstract provided.

Moyamoya Disease Presenting With Stroke, Timothy Collins, Chimezie Ubbaonu, Phuong Vo

Internal Medicine

No abstract provided.

So Much Soma, Satvir Dhillon Md, Gregory Shimizu Md

Internal Medicine

No abstract provided.

Primary Hyperparathyroidism Can Generate Recurrent Pancreatitis And Secondary Diabetes Mellitus – A Case Report, Nicoleta Mîndrescu, Georgeta Văcaru, Emil Ștefănescu, Loreta Guja, Rucsandra Elena Dănciulescu Miulescu

Journal of Mind and Medical Sciences

Introduction. Acute or recurrent pancreatitis may be a complication of primary hyperparathyroidism and patients with previous episodes of pancreatitis may develop secondary diabetes mellitus. Case report. We describe the clinical case of a 52-year old Caucasian man diagnosed with chronic recurrent pancreatitis in 2007. The first episode of acute pancreatitis occurred in 2002, followed by another 4 episodes in 2004 and 2007. In 2004, papilosfincterectomy was implemented with a stent mount that was removed one month later. In 2005, the patient underwent a surgical intervention for the diagnosis of chronic lithiasis, and cholecystectomy was performed. Additional investigations on the etiology …

Therapeutic Alternatives With Cpap In Obstructive Sleep Apnea, Corina E. Budin, Lorena Ciumarnean, Anca Maierean, Ruxandra Rajnovean, Bianca D. Gergely, Milena Man, Maria Aluas, Angela Cozma, Roxana I. Bordea

Journal of Mind and Medical Sciences

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, …

Impact Of Ivig Vs. Scig On Igg Trough Level And Infection Incidence In Primary Immunodeficiency Diseases: A Systematic Review And Meta-Analysis Of Clinical Studies., Pragya Shrestha, Paras Karmacharya, Zhen Wang, Anthony Donato, Avni Y Joshi

Reading Hospital Internal Medicine Residency

Background: Monthly intravenous immunoglobulin (IVIG) and weekly subcutaneous immunoglobulin (SCIG) have been regarded as therapeutically equivalent treatments for primary immunodeficiency diseases (PIDD). Immunoglobulin G (IgG) trough level is used as a monitoring measure for infection prevention.

Objective: A systematic review and meta-analysis were performed to elucidate the relationship between IgG dosing, trough IgG levels with overall infection incidence in patients with PIDD receiving IVIG and SCIG therapy.

Methods: Medline, EMBASE, Cochrane, Central, and Scopus were searched for studies published from Jan 2010-June 2018, fulfilling the inclusion criteria. DerSimonian and Laird random-effects method were used to pool the difference of IgG …

Nocardia Beijingensis: A Rare And Unusual Cause Of Intracranial Abscess, Lakshpaul Chauhan Md, Nirali Vassa Md, Elizabeth Henderson Md, Ateeq Mubarik Md, Danish M. Siddiq Md, Abdulmagid Eddib Md

Infectious Disease

Background : Nocardia species are thin, aerobic, filamentous, gram-positive bacilli that are ubiquitous in soil worldwide. Nocardia infections are divided into three main categories: pulmonary nocardiosis, disseminated nocardiosis, and cutaneous nocardiosis.

Methods : We present a case of cerebral nocardiosis in an immunocompetent patient caused by Nocardia beijingensis (NB).

Results : A 60-year-old Caucasian lady from Florida with type 2 diabetes mellitus, hypertension, hyperlipidemia, presented to the emergency room with complaints of altered mentation. Per husband, she was having episodes of emesis and diarrhea three days prior to admission that resolved however, her mentation significantly deteriorated to where she was …

Which Student Characteristics Are Most Important In Determining Clinical Honors In Clerkships? A Teaching Ward Attending Perspective., Lauren Nicholas Herrera, Ryan Khodadadi, Erinn Schmit, James Willig, Andrew Hoellein, Christopher Knudson, Karen Law, Nina Mingioni, Katherine Walsh, Carlos Estrada, Winter Williams

Division of Internal Medicine Faculty Papers & Presentations

PURPOSE: To explore faculty perspectives on which characteristics of high-performing clerkship students are most important when determining an honors or top grade designation for clinical performance.

METHOD: In 2016-2017, the authors surveyed faculty (teaching ward attendings) for internal medicine clerkships and 1 pediatrics clerkship in inpatient settings at 5 U.S. academic medical centers. Survey items were framed around competencies, 24 student characteristics, and attitudes toward evaluation. Factor analysis examined constructs defining high-performing students.

RESULTS: Of 516 faculty invited, 319 (62%) responded. The top 5 characteristics as rated by respondents were taking ownership, clinical reasoning, curiosity, dependability, and high ethical standards …

Multiple Sclerosis Outcomes After Cancer Immunotherapy, Catherine R. Garcia, Rani Jayswal, Val R. Adams, Lowell B. Anthony, John L. Villano

Markey Cancer Center Faculty Publications

INTRODUCTION: Neurological immune-related adverse events are a rare but potentially deadly complication after immune checkpoint inhibitor (ICI) treatment. As multiple sclerosis (MS) is an immune-mediated disease, it is unknown how ICI treatment may affect outcomes.

METHODS: We analyzed the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database for pembrolizumab, atezolizumab, nivolumab, ipilimumab, avelumab, and durvalumab 2 years prior their FDA approval until December 31, 2017, to include all cases with confirmed diagnosis/relapse of MS. We also included cases reported in the literature and a patient from our institution.

RESULTS: We identified 14 cases of MS …

A Study To Assess The Relationship Between Attention Deficit Hyperactivity Disorder And Obstructive Sleep Apnea In Adults, Sean Hesselbacher, Akshar A. Aiyer, Salim R. Surani, Alishah A. Suleman, Joseph Varon

Internal Medicine, East Africa

The association between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD) is well-established in children. However, there is a paucity of literature regarding this association in adults. The aim of this study was to determine if ADHD is more common in adult patients with OSA. All patients referred to a sleep center for sleep evaluation were administered the Adult ADHD Self-Report Scale and diagnostic polysomnogram. The ADHD screen is considered positive if 4 of 6 questions in part A of the screening questionnaire were answered abnormally. The study population consisted of 194 participants, predominantly male (62%), Caucasian (54%), …