Internal Medicine Commons^™

Unusual Case Of Obstructive Jaundice., Rajesh Essrani Md, Eric Nellis Md, Patrick Hickey Do, Hiral N. Shah Md

Department of Medicine

Most malignant obstructive jaundice arises from primary periampullary tumors and rarely from metastatic cancer of the head and neck. A 60-year-old male was diagnosed with obstructive jaundice due to metastatic squamous cell carcinoma of the tonsil. Only 12 cases of small bowel metastasis from the head and neck have been reported. Most of them originate from laryngeal squamous cell carcinoma, and only one case reported tonsillar cancer metastasizing to the ileum. Our case is the first one, to the best of our knowledge, to illustrate tonsillar cancer with metastasis to the duodenum causing obstructive jaundice.

A Case Of Flecainide Toxicity In A Young Male, Ifrah Butt, Umair Shaikh, Marlena Fernandez, Sameer Shaharyar, Daniel Heller

Internal Medicine

No abstract provided.

Clinical Features, Survival And Prognostic Factors Of Glycogen-Rich Clear Cell Carcinoma (Grcc) Of The Breast In The U.S. Population, Zhengqiu Zhou, Connor J. Kinslow, Hanina Hibshoosh, Hua Guo, Simon K. Cheng, Chunyan He, Matthew S. Gentry, Ramon C. Sun

Molecular and Cellular Biochemistry Faculty Publications

The World Health Organization (WHO) defines glycogen-rich clear cell carcinoma (GRCC) of the breast as a carcinoma with glycogen accumulation in more than 90% of its tumor cells. Due to the rarity of this disease, its reported survival and clinical associations have been inconsistent due to reliance on case reports and limited case series. As a result, the prognostic implication of this cancer subtype remains unclear. Using the U.S. Surveillance, Epidemiology, and End Results (SEER) program database, we compared the incidence, demographics and prognostic factors of 155 cases of GRCC of the breast to 1,251,584 cases of other (non-GRCC) breast …

Renal Angioplasty Does Not Improve Clinical Outcomes Compared To Standard Medical Therapy In Patients With Atherosclerotic Renal Artery Stenosis, Alexandra Morris

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Cooper CJ, Murphy T, Cutlip D, Jamerson K, Henrich W. Stenting and medical therapy for atherosclerotic renal-artery stenosis. New Eng J Med. 2014;370(1):13-22. doi: 10.1056/NEJMoa1310753.

Massive Hemoptysis Due To Recurrence Of Bronchial To Pulmonary Vascular Malformation: A Case Report, Chelsey White, Pedro Ottaviano, Nancy Munn, Yousef Shweihat, Fuad Zeid

Internal Medicine

Bronchial dieulafoy lesions are quite rare with relatively few case reports in the literature. Symptoms may vary but the lesion is often associated with hemoptysis and may present as massive hemoptysis. We present a case of a 69-year-old male with a recurrent episode of hemoptysis three years after treatment for a bronchial dieulafoy lesion. The bronchoscopy done three years prior during an initial episode of hemoptysis showed a visible dieulafoy deep within a subsegmental branch of the right lower lobe. This case is unique because there are no other reports within the literature of a delayed recurrence several years after …

Pilot Study For Using Fitbit Activity Trackers To Monitor And Predict Onset Of Car-T Cell Immunotherapy Related Adverse Events Including Cytokine Release Syndrome, Cassra Clark, Ms, Bs, Adam Dicker, Md, Phd, Fastro, Margaret Kasner, Md, Msce, Gina Keiffer, Md, Neil Palmisiano, Md, Ms, Pierluigi Porcu, Md, Kaitlin Rancani, Crnp, Vincent Yeung, Md, Lindsay Wilde, Md

Phase 1

Introduction: Immunotherapy using T Cells with engineered chimeric antigen receptors (CAR) is a revolutionary modality for treating cancer, especially B cell malignancies. It also has specific toxicities. The most common toxicities observed are cytokine-release syndrome (CRS) and neurotoxicity. These therapy-related adverse events can range from mild to fatal. If appropriately and timely treated, they have a good prognosis. Thus, further insight into predictive biomarkers can help clinical management of patients and reduce morbidity and mortality.

Objective: One of the constitutional symptoms associated with CRS is fatigue. With the advent of activity tracking digital technology, I propose a pilot study exploring …

Atrial Myxoma Presenting With Palpitations: A Case Report, George Prousi Md, Joseph Moran Do, Ross Biggs Do

Department of Medicine

Abstract

Atrial myxomas are a rare phenomenon and although benign, primary neoplasms of the heart can be burdensome depending on their location. Clinical symptoms are caused through a variety of mechanisms including conduction disturbances, obstruction, and valvular interference. Size and symptom development are strongly correlated and can almost always be detected by the use of echocardiography, magnetic resonance imaging or computed tomography. This is a case of a 62-year-old female with no significant past medical history presented to our facility with complaints of palpitations and associated dizziness for three months.

Introduction

Atrial myxomas are the most common benign primary neoplasm …

Diet And Addiction: Interview With A Former Food, Pornography, And Alcohol Addict, Tro Kalayjian, Brian Lenzkes

Dignity: A Journal of Analysis of Exploitation and Violence

Drs. Tro Kalayjian (Tapan, New York) and Brian Lenzkes (Santee, California) talk to Matt about his struggles with food, pornography, and alcohol addiction, and how changing his diet contributed to his recovery from his addictions. This report is excerpted from the audio podcast LowCarbMD, Episode 13 (https://itunes.apple.com/us/podcast/low-carb-md-podcast/ ), January 30, 2019). This podcast has filled us with immense hope for those struggling with addiction.

Prospective Observational Study In Patients With Obstructive Lung Disease: Novelty Design, Richard Beasley, Richard J Martin, Ian Pavord, David Price, Christina Keen, Asparuh Gardev, Stephen Rennard, Alecka Sveréus, Aruna T Bansal, Lance Brannman, Niklas Karlsson, Javier Nuevo, Fredrik Nyberg, Simon S Young, Jørgen Vestbo

Faculty, Staff and Student Publications

Asthma and chronic obstructive pulmonary disease (COPD) have overlapping clinical features and share pathobiological mechanisms but are often considered distinct disorders. Prospective, observational studies across asthma, COPD and asthma-COPD overlap are limited. NOVELTY is a global, prospective observational 3-year study enrolling ∼12 000 patients ≥12 years of age from primary and specialist clinical practices in 19 countries (ClinicalTrials.gov identifier: NCT02760329). NOVELTY's primary objectives are to describe patient characteristics, treatment patterns and disease burden over time, and to identify phenotypes and molecular endotypes associated with differential outcomes over time in patients with a diagnosis/suspected diagnosis of asthma and/or COPD. NOVELTY aims …

Percutaneous Transluminal Balloon Venoplasty: A Less Invasive Technique For Implantation Of Cardiac Leads In Patients With Limited Venous Access To The Heart, Waiel Abusnina, Zachary O. Curtis, Emilia C. Leigh, Eric Y. Auyoung, Dr. Mehiar El-Hamdani, Esam Baryun

Marshall Journal of Medicine

Since its inception, cardiac pacing has made a significant advancement in cardiology. As new therapies and devices emerge, the number of implantations is steadily increasing which requires up-to-date clinical guidelines for management. Although advanced, these mechanical devices often require maintenance and revisions to achieve optimal performance. One of the most common deteriorations is the lead failure.

In the case of lead failure requiring revision, new lead implant, or upgrading to a more advanced pacing system, venous stenosis resulting in partial or complete obstruction of the vessel can pose a real problem. This case series report introduces the technique of percutaneous …

Cancer Screening For Transgender Patients: An Online Case-Based Module, Devin Oller

Internal Medicine Faculty Publications

Introduction: Guidelines recommend that primary care providers complete organ-based routine cancer screening for all transgender patients. Training on critical transgender health topics like cancer screening, as well as residents' confidence in addressing issues their transgender patients may face, remains limited among graduate medical education (GME) programs. Online case-based modules are an effective tool for skills improvement in GME, but their application to transgender health topics has not been assessed.

Methods: I developed a brief online module on cancer screening for transgender patients using Google Forms and offered it to first-year internal medicine residents. The module was optional and asynchronous with …

Denture Misadventure: The Tooth About Your Colon., Rajesh Essrani Md, Patrick Hickey Do, Hiral N. Shah Md

Department of Medicine

Foreign body ingestion occurs mainly in a mentally impaired person, but rarely in healthy adults. A 48-year-old male was admitted with a recurrence of previously diagnosed right knee septic arthritis and accidentally ingested his dental bridge which was removed from a proximal ascending colon with a colonoscopy.

Growth Dynamics In Naturally Progressing Chronic Lymphocytic Leukaemia, M. Gruber, I. Bozic, I. Leshchiner, D. Livitz, K. Stevenson, L. Rassenti, D. Rosebrock, A. Taylor-Weiner, K. R. Rai, C. J. Wu, +17 Additional Authors

Journal Articles

No abstract provided.

Proportion Of Us Hospitalized Medically Ill Patients Who May Qualify For Extended Thromboprophylaxis, B. Miao, B. Chalupadi, B. Clark, A. Descoteaux, D. Huang, S. Ilham, B. Ly, A. C. Spyropoulos, C. I. Coleman

Journal Articles

© The Author(s) 2019. Extended thromboprophylaxis with oral anticoagulation can reduce the risk of symptomatic venous thromboembolism (VTE) in high-risk patients. We sought to estimate the proportion of medically ill patients in the United States who might qualify for extended thromboprophylaxis according to the criteria used in the Medically-Ill Patient Assessment of Rivaroxaban versus Placebo in Reducing Post-Discharge Venous ThromboEmbolism Risk (MARINER) trial. We analyzed 2014 National Inpatient Sample (NIS) data that provide a 20% weighted annual sample of all discharges from US acute-care hospitals. Hospitalizations for acute medically ill patients were identified as those with a primary discharge diagnosis …

Care Team Perspectives And Acceptance Of Telehealth In Scaling A Home-Based Primary Care Program: Qualitative Study, A. Kozikowski, J. Shotwell, E. Wool, J. C. Slaboda, K. A. Abrashkin, K. Rhodes, K. L. Smith, R. Pekmezaris, G. J. Norman

Journal Articles

No abstract provided.

Outcomes With Ibrutinib By Line Of Therapy And Post-Ibrutinib Discontinuation In Patients With Chronic Lymphocytic Leukemia: Phase 3 Analysis, S. M. O'Brien, J. C. Byrd, P. Hillmen, S. Coutre, J. R. Brown, P. M. Barr, J. C. Barrientos, S. Devereux, T. Robak, J. A. Burger, +8 Additional Authors

Journal Articles

No abstract provided.

Long-Term Studies Assessing Outcomes Of Ibrutinib Therapy In Patients With Del(11q) Chronic Lymphocytic Leukemia, T. J. Kipps, G. Fraser, S. E. Coutre, J. R. Brown, J. C. Barrientos, P. M. Barr, J. C. Byrd, S. M. O'Brien, M. S. Dilhuydy, M. Hallek, +16 Additional Authors

Journal Articles

© 2019 A pooled analysis of 1238 patients with chronic lymphocytic leukemia/small lymphocytic lymphoma from three phase 3 studies found that genomic risk factors were not associated with shorter progression-free survival (PFS) or overall survival for patients treated with ibrutinib. Ibrutinib-treated patients with del(11q) were found to have a longer PFS than those without del(11q). These results suggest less prognostic relevance for certain genomic risk factors with ibrutinib treatment.

It's Not Just Facetime: Core Competencies For The Medical Virtualist, R. Sharma, S. Nachum, K. W. Davidson, M. Nochomovitz

Journal Articles

© 2019 The Author(s). New applications for virtual healthcare have resulted in an expansion of medical care beyond traditional healthcare settings. However, the rapid development of telemedicine as a field has resulted in poor standardization of the care provided through this new medium. The authors outline core competencies to be used in developing training programs for practicing physicians, medical students, and other clinicians using telemedicine as a medium for providing patient care. These competencies aim to provide a framework for defining a standard of care in telemedicine and the ultimate development of a certification in the field.

Comparative Effectiveness, Safety, And Costs Of Rivaroxaban And Warfarin Among Morbidly Obese Patients With Atrial Fibrillation., E. D. Peterson, V. Ashton, Y. Chen, B. Wu, A. C. Spyropoulos

Journal Articles

BACKGROUND: There are limited data regarding clinical outcomes and healthcare resource utilization of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) who are morbidly obese (body mass index >40 kg/m

METHODS: Using data from 2 US healthcare claims databases, we identified patients initiating rivaroxaban or warfarin who had ≥1 medical claim with an AF diagnosis, a diagnostic code for morbid obesity (ICD-9: 278.01, V85.4%; ICD-10: E66.01%, E66.2%, Z68.4%), and a minimum continuous enrollment of 12 months before and 3 months after treatment initiation. Patients were excluded if they had mitral stenosis, a mechanical heart valve procedure, an organ/tissue …

Rivaroxaban Versus Warfarin Treatment Among Morbidly Obese Patients With Venous Thromboembolism: Comparative Effectiveness, Safety, And Costs., A. C. Spyropoulos, V. Ashton, Y. Chen, B. Wu, E. D. Peterson

Journal Articles

INTRODUCTION: Limited data exist on direct-acting oral anticoagulants in morbidly obese patients with venous thromboembolism (VTE). We compared clinical and health/economic outcomes with rivaroxaban versus warfarin for VTE treatment in morbidly obese patients.

MATERIALS AND METHODS: This retrospective 1:1 propensity score matched cohort study analyzed data from 2 US claims databases. VTE patients initiating rivaroxaban or warfarin were identified who had diagnosis codes for morbid obesity (ICD-9:278.01,V85.4; ICD-10:E66.01,E66.2,Z68.4) 12 months pre- or 3 months post-initiation and followed ≥3 months. Intent-to-treat (ITT) and on-treatment (OT) analyses were conducted using conditional logistic regression and generalized linear models to compare recurrent VTE and …

A Pedunculated Skin Lesion In A Case Of Clear Cell Renal Carcinoma, Meghana Kesireddy, Amit Correa, Raoul Correa, Rohit Venkatesan

Faculty & Staff Scholarship

Clear cell type renal carcinoma accounts for about 80% of all renal cell carcinomas. We present a 39-year-old male with clear cell renal carcinoma of the right kidney, stage I: T1 b (5 cm) N0 M0, who developed cutaneous metastases in the right submandibular region 28 months after nephrectomy. Our case is unique as i) the patient with stage I cancer (at the time of nephrectomy) presented with an isolated cutaneous nodule in a location distant from the primary site; ii) cutaneous nodule developed while being treated with pazopanib for metastatic lesions in the lung and adrenal; and iii) nivolumab …

Trial Sequential Analysis Comparing Bleeding And Major Adverse Cardiovascular Events In Patients With Atrial Fibrillation And Acute Coronary Syndrome On Dual Versus Triple Therapy, Muhamad B. Munir, Khansa Osman, Maryam Saleem, Kinjan Patel, Sudarshan Balla

Faculty & Staff Scholarship

Objective To assess efficacy and safety of dual therapy (DT) and triple therapy (TT) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI) and evaluate the quality of evidence with respect to said outcomes based on contemporary randomized trials (RCTs). The efficacy outcome taken was major adverse cardiovascular events (MACE) while safety outcome was major bleeding events. Introduction Appropriate anti-thrombotic therapy is still controversial in patients with AF and concomitant ACS or PCI. We conducted a conventional meta-analysis pooling data from major RCTs to assess the efficacy and safety of DT …

Story Of An Unfortunate Fall: Cardiac Contusion Presenting With An Atrioventricular Block, Maryam Saleem, Fatima Ahmed, Kinjan Patel, Muhamad B. Munir, Mary Warden

Faculty & Staff Scholarship

Blunt cardiac injury (BCI), also referred to in the literature as a cardiac contusion, is a known cause of myocardial injury. It is often challenging to diagnose this condition in the absence of clear diagnostic criteria. Furthermore, its clinical presentation is highly variable depending on the severity, type, and duration of the trauma, as well as the timing from the initial insult. The clinical manifestation of BCI ranges from none to fatal arrhythmias to cardiac wall rupture seen on post-mortem examination. Cardiac biomarkers and electrocardiograms (EKG) are usually helpful in identifying cardiac trauma but are not necessarily abnormal in all …

Adaptive Design Of A Clinical Decision Support Tool: What The Impact On Utilization Rates Means For Future Cds Research, D. Mann, R. Hess, T. Mcginn, R. Mishuris, S. Chokshi, L. Mccullagh, P. D. Smith, J. Palmisano, S. Richardson, D. A. Feldstein

Journal Articles

© The Author(s) 2019. OBJECTIVE: We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: …

Improving Provider Adoption With Adaptive Clinical Decision Support Surveillance: An Observational Study, S. Khan, S. Richardson, A. Liu, V. Mechery, L. Mccullagh, A. Schachter, S. Pardo, T. Mcginn

Journal Articles

© Sundas Khan, Safiya Richardson, Andrew Liu, Vinodh Mechery, Lauren McCullagh, Andy Schachter, Salvatore Pardo, Thomas McGinn. Background: Successful clinical decision support (CDS) tools can help use evidence-based medicine to effectively improve patient outcomes. However, the impact of these tools has been limited by low provider adoption due to overtriggering, leading to alert fatigue. We developed a tracking mechanism for monitoring trigger (percent of total visits for which the tool triggers) and adoption (percent of completed tools) rates of a complex CDS tool based on the Wells criteria for pulmonary embolism (PE). Objective: We aimed to monitor and evaluate the …

Small Septal Branch Artery Thrombus Inducing Ventricular Fibrillation: To Intervene Or Not To Intervene, V. Agarwal, P. C. Olson, J. Mroue, Y. Olkovsky, S. Bekheit, J. Lafferty

Journal Articles

© The Author(s) 2019. A 64-year-old woman presented for chest pain and was diagnosed with anteroseptal ST segment elevation myocardial infarction (STEMI). Emergent angiography showed 95% stenosis at the ostium of the second septal branch, consistent with thrombus, and no other significant lesions. The lesion was not amenable to intervention due to small caliber. Post angiography, the patient’s electrical rhythm deteriorated into ventricular fibrillation. Following resuscitation, repeat angiography confirmed same findings. Electrophysiology study at 3 months was positive for inducing fibrillation. Due to patient risk factors, she had placement of a dual chamber defibrillator. A 5-month follow-up echocardiogram showed a …

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Triggered By Emotional Stress, C. A. Obi, E. Thompson, L. Mordukhaev, I. Khan, N. J. Zhang

Journal Articles

© 2019, Copyright © 2019 Baylor University Medical Center. A 22-year-old woman presented with disorganized behaviors, restlessness, and subacute decline in mental status in the setting of stress. Extensive workup for autoimmune diseases disclosed positive anti-N-methyl-d-aspartate (NMDA) receptor antibodies. We recommend that fertility preservation should be discussed and stress management should be considered in patients with a history of anti-NMDA autoimmune encephalitis because this can help in preventing relapse.

Quantifying Patient Satisfaction With Process Metrics Using A Weighted Bundle Approach., N. B. Riebling, S. Norouzzadeh, G. Reeder, C. Mouradian, A. Hillier, R. Cowan, M. Doerfler

Journal Articles

Background:Current patient satisfaction assessment results are delayed and obtained from select patient surveys. As a result, these assessments may not represent the experience of the entire patient population. This study developed a method to measure and evaluate all patients' experiences while they are within the care episode and link it to processes within the organisation. Methods:Using the Six Sigma methodology, sites assembled diverse teams to categorise and analyse negative experience comments from patients to understand the drivers of dissatisfaction. These customer expectations lead to the development of the four components in the Patient Experience Bundle (PEB): communication, environment, basic needs/comfort …

Medical Education Using Minimal Technology: Achieving Professional Development, K. A. Friedman, S. W. Herman, A. Fornari

Journal Articles

No abstract provided.

A Novel Curriculum To Prepare Internal Medicine Residents For Fellowship Interviews., M. Sinclair, J. Raimo, K. Wong, M. Kline, K. Friedman

Journal Articles

Background:Applications to the Fellowship Match through the National Resident Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high. Data regarding the preparedness of medical residents who go through the interview process is limited. Objective:To assess whether the implementation of an interview curriculum could improve medical resident preparedness for and performance during fellowship interviews. Methods:All third-year internal medicine residents (N = 18) at the Zucker School of Medicine at Hofstra/Northwell (Northwell) applying to subspecialty fellowship participated in an interview curriculum that comprised a didactic session and an Objective Structured Teaching Exercise (OSTE). Participants were surveyed on preparedness before …