Internal Medicine Commons^™

Gastrointestinal Bleeding As Initial Manifestation Of Injection Drug Use-Associated Amyloidosis, Mohammed Rifat Shaik, Nishat Anjum Shaikh, Elvina Yunasan, Erika Wheeler, Robert T Chow

Journal of Community Hospital Internal Medicine Perspectives

Systemic amyloidosis has been reported in the context of injection drug use, usually related to ongoing chronic inflammation and persistent cutaneous infections. The kidneys are almost always the first organs affected in that setting. Involvement of the gastrointestinal tract is less common and rarely the initial site of presentation. We present a case of systemic amyloidosis that primarily manifested in the gastrointestinal tract, occurring in the setting of chronic injection drug use. The patient's hemoglobin level dropped progressively over time due to ongoing, slow gastrointestinal bleeding, prompting an endoscopic examination that ultimately confirmed the presence of gastrointestinal amyloidosis. As the …

Prevalence And Impact Of Gastrointestinal Manifestations In Covid-19 Patients: A Systematic Review, Bassam Hossain, Shoreh Qazi, Sumair Ahmad, Atif Saleem, Amanke Oranu, Fahad Malik

Journal of Community Hospital Internal Medicine Perspectives

Background and Objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken …

Home Oxygen And Monitoring For Covid-19 Patients: A Multidisciplinary Team Approach, Mahta Salehi, Shehrose Chaudry, Rebecca B. Newman, Josette Hartnett, Suzanne J. Rose, Forugh Homayounrooz

Journal of Community Hospital Internal Medicine Perspectives

Introduction: During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety.

Methods: A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies …

Reply To The Letter To The Editor Titled “Before Blaming Legionella For Severe Rhabdomyolysis, Consider Alternative Triggers”, Harish Gopalakrishna, Ahmad Al-Abdouh, Gayatri Nair, Vinod Solipuram, Ammer Bekele

Journal of Community Hospital Internal Medicine Perspectives

No abstract provided.

Getting Ahead: A Resident Led Quality Improvement Project To Increase Diabetic Nephropathy Screening In An Underserved Hispanic-Predominant Population, Stephanie Luu, Jose Rivera, Daniel Aragon, Victor Zamora, Irma Huayanay, Reham Majzoub, Andreina Baird, Cristina Escobar, Eric Sanchez, Juan Carlos Lopez-Alvarenga, Daniela Hernandez, Chelsea Chang

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.

Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year.

Methods: We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and …

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 …

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.

Recurrence Of Thrombotic Thrombocytopenic Purpura After Vaccination With Mrna-1273 Covid-19 Vaccine, Spyridon Ntelis, Kathryn Champ

Journal of Community Hospital Internal Medicine Perspectives

Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by thrombocytopenia, microangiopathic hemolytic anemia, and ischemic organ damage. Several cases of TTP associated with administration of COVID-19 vaccines have been reported. We report a case of a 63-year-old woman with a past medical history of hypertension, diabetes mellitus, chronic kidney disease, HIV infection, and remote history of TTP who presented with several days of shortness of breath on exertion, chest tightness, low-grade fever, and bruising thirty-three days after receiving the second dose of the mRNA-1273 COVID-19 vaccine. Thrombocytopenia and hemolytic anemia with schistocytes were noted on testing, and ADAMTS13 activity …

Assessment Of Predictive Factors Of Hepatic Steatosis Diagnosed By Vibration Controlled Transient Elastography (Vcte) In Chronic Hepatitis C Virus-Infected Patients, Singh Y, Gogtay M, Gurung S, Trivedi N, Abraham Gm

Journal of Community Hospital Internal Medicine Perspectives

This retrospective, cross-sectional study aimed to evaluate the predictive factors of moderate/severe hepatic steatosis diagnosed by vibration-controlled transient elastography (VCTE). It included 158 adult patients with suspected non-alcoholic fatty liver disease (NAFLD) evaluated by VCTE in an outpatient setting of a community-based teaching hospital. Patients with significant alcohol consumption, oral contraceptive use, hepatitis B disease, autoimmune hepatitis, and primary biliary cirrhosis were excluded. Steatosis was categorized as S0-S1 (mild) and S2-S3 (moderate/severe) based on the controlled attenuation parameter (CAP) score. Results demonstrated the mean values of BMI (p=0.001), kiloPascals [kPa] (fibrosis) raw score (p=0.009), obesity (p=0.001), diabetes mellitus [DM] (p=0.014), …

Gastrointestinal Hemorrhage Due To Duodenal Varix: A Case Report, Bassam Hossain, Fahad Malik, Ali Khan, Mohammad Abidi, Ali Marhaba, Amanke Oranu, Mark Shumeyko, Amine Hila, Shoreh Qazi, Shehryar Shaikh

Journal of Community Hospital Internal Medicine Perspectives

We report a case of a 72-year-old female with a past medical condition of non-alcoholic steatohepatitis who presented in the emergency department with altered mentation. An Esophagogastroduodenoscopy was performed which showed a normal esophagus and stomach, but revealed grade III varices which were appreciable in the second portion of the duodenum. Her colonoscopy report revealed multiple small and large mouthed diverticula in the sigmoid colon along with hematin throughout the colon, yet no evidence of active bleeding,mass or inflammation. We discuss the patient's rarity of the clinical entity, clinical development, and elements used for diagnosis along with the treatment modalities …

A Case Of Adult Multisystem Inflammatory Syndrome Following Covid-19 Vaccine, Meghan Brown, Nika Zorko Garbajs, Simon Zec, Hisham Mushtaq, Anwar Khedr, Abbas Bashir Jama, Ibtisam Rauf, Mikael Mir, Aishwarya Reddy Korsapati, Shikha Jain, Thoyaja Koritala, Ramesh Adhikari, Amos Lal, Ognjen Gajic, Juan Pablo Domecq, Sarah Goksoy, Brian Bartlett, Amit Sharma, Nitesh Kumar Jain, Syed Anjum Khan

Journal of Community Hospital Internal Medicine Perspectives

Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has been reported after severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) in children and adults; recently it has been described in some post-COVID-19 vaccinated individuals. The prognosis with supportive care and immunomodulatory therapy is good, although some individuals may require treatment in the intensive care unit (ICU). Here we report a case of a 58-year-old man who developed multi-organ failure after receiving the second dose of the Moderna mRNA-1273 COVID-19 vaccine. He required critical organ support in the …

Angiotensin Receptor Blockers Associated Enteropathy- Brief Report, Falgun Gosai, Neha Gosai

Journal of Community Hospital Internal Medicine Perspectives

The current literature has shown equivocal results regarding the association of Olmesartan and other angiotensin receptor blockers (ARBs) use and the presence of Celiac sprue-like enteropathy (CSLE). Various factors affecting the association are- patient population under study, geographic area, and duration of use of medication. Various case reports/ case series and observational studies have shown the mixed results regarding an association. We have tried to answer a question what exists in the literature regarding the angiotensin receptor blockers related sprue like enteropathy.

The Racial Divide: A Follow Up Study On Racial Disparity Amongst Covid-19 Survivors In An Urban Community, Christopher Millet, Emily Racoosin, Spandana Narvaneni, George Horani, Sherif Roman, Alisa Farokhian, Arslan Chaudhry, Sohail Chaudhry, Yezin Shamoon, Humberto Jimenez, Patrick Michael, Jin Suh

Journal of Community Hospital Internal Medicine Perspectives

Background Studies have shown that COVID-19 has had a disproportionate effect on minority groups in both the clinical and social settings in America. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups.

Methods This was a prospective cohort study consisting of patients who had recovered from COVID-19 one year prior. The patients included in the study had a confirmed COVID-19 diagnosis …

Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md

Journal of Community Hospital Internal Medicine Perspectives

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous system at any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called “The Great Pretender” or “The monkey among diseases” (12). This is a case report of an 83-year-old female with a history of multiple …

Development Of A Community Hospital Medicine Affiliated Inpatient Rotation For Family Medicine Residents - A Collaborative Success, David M. Gallagher, Anthony J. Viera, William E. Bynum, Poonam Sharma, John W. Ragsdale, Jeffrey Eschbach, Lalit Verma

Journal of Community Hospital Internal Medicine Perspectives

Background: Hospitalists perform key roles as inpatient educators for family medicine residents. For the past decade, Duke University Family Medicine Residency Program had its inpatient family medicine resident rotation at non-Duke facilities.

Objective: The authors describe the steps taken in 2020 to develop an inpatient Duke family medicine rotation at a North Carolina community hospital, Duke Regional Hospital, and provide outcomes data.

Methods: Duke Family Medicine Residency and Duke Regional Hospital Medicine collaborated in addressing key issues to develop an inpatient rotation for family medicine residents. Performance metrics of patients cared for by both the family medicine inpatient resident team …

Pulmonary Evaluation Of Post-Covid-19 Patients: An Ecuadorian Experience, Ivan Cherrez-Ojeda, Efraín Sanchez-Angarita, Emanuel Vanegas, María José Farfán Bajaña, Karla Robles-Velasco, María F. Osorio, Azza Sarfraz, Zouina Sarfraz, Juan C. Calderón, Jorge Cáneva, Laura Gochicoa-Rangel, Matías Panchana Lascano, Juan Carlos Fernández Cadena, Derly Madeleiny Andrade Molina, Amado X Freire, Miguel Felix

Journal of Community Hospital Internal Medicine Perspectives

Background: Despite the growing concerns related to the potential of long-term pulmonary sequelae due to COVID-19, data about intermediate and long-term changes in the respiratory function of patients who recover is relatively sparse, particularly in developing countries. Objectives: To assess the characteristics and pulmonary function at follow-up in a sample of Ecuadorian patients that recovered from the virus. Methods: We conducted a cross-sectional study that included 43 patients after symptomatic COVID infection, who were evaluated by spirometry, single breath DLCO, and 6MWT. For statistical analysis we performed point biserial correlations, and chi squared tests. Results: Overall, 30.3% of patients (n=13) …

Dronedarone For Atrial Fibrillation Prophylaxis In Patients Undergoing Open Heart Surgical Interventions: A Case Series, Jay D. Patel, Mrhaf Alsamman, Dewansh Goel, Sai Gudduru, Rakesh Prashad

Journal of Community Hospital Internal Medicine Perspectives

Atrial fibrillation (a-fib) is one of the most frequently encountered and studied arrhythmias in medicine. The presence of A-fib in the post-operative period of coronary artery bypass graft (CABG) surgery is of particular concern for clinicians as this presents risks of post-operative stroke, hospital readmission, or anticoagulation dilemmas depending on the patient’s comorbidities. In this case study, we present 5 patients who were treated with dronedarone prior to undergoing open heart procedures. We subsequently followed each patients clinical course paying close attention for any evidence of post-operative a-fib.

Extranodal Rosai-Dorfman Disease- A Review Of Diagnostic Testing And Management., Imad Ud Deen, Abhinandan Chittal, Nabil Badro, Robert Jones, Christopher Haas

Journal of Community Hospital Internal Medicine Perspectives

Rosai-Dorfman disease (RDD) is a rare, benign histiocytic proliferative disorder primarily occurring in the lymph nodes. Extranodal disease can occur in skin and soft tissue, central nervous system, gastrointestinal tract, and breast. Here we present a case of a 55-year-old female with a history of hypertension, hyperlipidemia, and diabetes mellitus who presented with a fixed solid mass localized to the right medial thigh. Excision revealed S100 and CD 68 positive scattered lymphoid aggregates and emperipolesis, hallmark molecular and cytopathologic features of RDD. RDD is a nonmalignant, classically sporadic histiocytosis. Clinical outcome in terms of mortality seems to be favorable in …

Catastrophic Perforation In Streptococcus Pneumoniae Aortitis: Complications Of Infective Endocarditis In The Current Antimicrobial Era, Sana Shaikh, Jorge Isaac Peña Garcia, Michelle Shieh, Alexandre Lacasse

Journal of Community Hospital Internal Medicine Perspectives

Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to …