Internal Medicine Commons^™

From A Papule To Friable Papillary Projections: A Case Of Old World Cutaneous Leishmaniasis, Zamanali Khakhar, Adil Salyani, Soraiya Manji, Rajiv Patel, Sayed Karar

Internal Medicine, East Africa

This case aims to characterize an unusual cutaneous manifestation in a patient with confirmed cutaneous leishmaniasis, highlighting clinical features that are often underrecognized and may contribute to diagnostic uncertainty. By exploring this atypical presentation, it underscores the potential for misdiagnosis and its implications for patient management. Additionally, it emphasizes the broad spectrum of cutaneous lesions that can mimic Old World cutaneous leishmaniasis, further increasing the risk of diagnostic error.

Ischemic Stroke As The Initial Presentation Of Advanced Pancreatic Adenocarcinoma: A Case Of Marantic Endocarditis., Micah Harris

Ambulatory and Primary Care Articles

Nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, is a rare condition characterized by sterile vegetations on cardiac valves and is often associated with hypercoagulable states such as adenocarcinoma. We describe a patient who presented with multiple embolic cerebrovascular accidents, ultimately found to be secondary to NBTE, which served as the initial manifestation of previously undiagnosed advanced pancreatic adenocarcinoma. This case underscores the importance of considering NBTE in patients with multifocal embolic infarcts, particularly when blood cultures are negative, echocardiography reveals valvular abnormalities without evidence of infection, and clinical suspicion for an underlying malignancy is present.

Investigating The Risk Factors Affecting The Control Of Diabetes And Hypertension In The Refugees Living In Egypt, Noura Seada

Theses and Dissertations

Introduction: Non-Communicable Diseases (NCDs) account for 74% of global deaths, with high prevalence of Diabetes and Hypertension worldwide. Egypt hosts over 1 million registered refugees and asylum seekers, often lacking inclusion in social protection or insurance schemes. This study aimed to assess the factors affecting the control of Type 2 Diabetes (T2D) and Hypertension (HTN) among Syrian and Sudanese refugees in Egypt, focusing on healthcare access, sociodemographic characteristics, lifestyle, and health behaviours.

Methods: This study employed a cross-sectional design using a self-administered questionnaire and BMI measurement. Data were collected from 246 refugees diagnosed with type T2D and/or HTN in the …

Beyond The Rash: Cutaneous Peripheral T-Cell Lymphoma As A Diagnostic Pitfall In Primary Care, Jared Hensley, Aura Calderon, Blake Martin, Cristina Kochi, Andres Suarez Parraga

School of Medicine Publications

Cutaneous manifestations of T-cell lymphomas may resemble common dermatologic or infectious conditions, increasing the risk of delayed recognition. We report a 78-year-old woman with known peripheral T-cell lymphoma (PTCL) who presented with a rapidly progressive, diffuse erythematous rash accompanied by cervical lymphadenopathy. Initial evaluation prioritized more common etiologies; however, inpatient medicine broadened the differential diagnosis, prompting early hematology and oncology consultation. Contrast-enhanced CT of the neck demonstrated multiple enlarged, partially necrotic left cervical lymph nodes consistent with disease progression. After multidisciplinary discussions and consideration of prognosis, the patient elected palliative-focused management with oncology follow-up. This case underscores the importance of …

A Strategy For Surge Management: Senior Residents On The Admitting Frontlines, Hamza Saifuddin, Oliver Yockey, Rachelle Pichot, Gwendolyn Brainard, Samantha Labay, Michael S. Wang

Journal of Community Hospital Internal Medicine Perspectives

Hospitals adapt to surges in a variety of ways, including expediting admitting and discharge procedures, hiring temporary staff and locums to meet increased demand, and temporarily expanding or creating facilities. To mitigate negative effects associated with surges, a small community-based hospital’s Internal Medicine (IM) residency program and hospitalist program collaborated by shifting senior residents into admitting physician roles with indirect supervision to meet increased surge needs. This shift allowed an admitting attending physician to shift to a newly created rounding service and, on average, the number of rounding services was increased from seven to nine. Over a fifteen-month period (five …

Empowering Residents In Community-Based Internal Medicine Programs: A Structured Framework Integrating Simulation Labs, Ai, And Gamification, Nirmay Sonar, Zaynah Sadiq, Bernie Sergent

Journal of Community Hospital Internal Medicine Perspectives

Community-based internal medicine residencies train nearly half of all U.S. IM residents and are essential for staffing underserved areas. These programs often face educational gaps due to limited resources, faculty development, and procedural training opportunities. We designed a 12-month quality initiative for 27 residents at a small community hospital blending new high-fidelity simulation drills (e.g. in-situ rapid-response and procedural labs), restructured didactics (gamified quizzes, NEJM Resident 360™, HumanDx cases), enhanced orientation (“intern survival guide”), research education, wellness retreats, community outreach and AI-driven, individualized case feedback. New interventions were implemented alongside existing activities, with targeted outcomes including clinical competency, board readiness, …

A Case Of Listeria Monocytogenes Bacteremia In A Middle-Aged Woman With A History Of Primary Biliary Cholangitis, Caleb Smack, Jared T. Lausen, Aaron Mills

Eastern Virginia Medical Journal

In this report, we discuss the case of a patient with Listeria monocytogenes bacteremia likely resulting from primary biliary cholangitis (PBC) induced cirrhosis. We aim to bolster the body of literature on Listeria bacteremia and establish PBC as a risk factor for this rare complication. Our patient, who presented with sepsis, was subsequently found to have Listeria bacteremia and received intravenous antibiotic treatment of ampicillin for 3 total weeks with complete resolution of her disease. This is the first case suggesting that cirrhosis as a result of PBC may be an independent risk factor for Listeria bacteremia. In patients at …

Weight-Loss Efficacy Of Glp-1 Receptor Agonists Relative To Lifestyle-Based Interventions, Amy Betterton

Lynchburg Journal of Medical Science

ABSTRACT

This clinical review compares the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with traditional lifestyle modifications in managing obesity. This article also examines barriers to accessing the medications in both civilian and veteran populations. This clinical review was conducted through a wide-ranging review of the published literature, including clinical trials, observational studies, and review articles on lifestyle modifications, GLP-1 receptor agonists, and barriers to obesity treatment. While lifestyle modifications are generally considered a first-line approach and are cost-effective, they tend to yield only modest weight loss. In contrast, GLP-1 RAs offer significantly greater reductions in body weight as …

Rapid Inpatient Methadone Induction In The Fentanyl Era: A Systematic Review Of Safety, Efficacy, And Protocols For Hospitalized Patients With Opioid Use Disorder, Lorik Berisha, Sapan Patel, Charlotte Pirquet, Navina Magesh Kumar, Yousef Soliman, Ahsan Ullah, Daniel M. Matassa

Division of Internal Medicine Faculty Papers & Presentations

Purpose of Review: The potency of illicit fentanyl has rendered standard methadone inductions inadequate for many hospitalized adults with opioid use disorder. Standard protocols often fail to achieve therapeutic doses quickly enough to manage withdrawal and cravings in fentanyl-tolerant individuals, contributing to poor retention and higher self-discharge rates. This review examines emerging evidence on dosing strategies, outcomes, and safety of rapid methadone inductions in acute-care hospitals. Recent Findings: Nine studies (five retrospective cohorts, four case series/reports) encompassing 380 patients met inclusion criteria. Median starting doses were 30–40 mg (range 20–90 mg), with daily or symptom-triggered increases achieving 60–100 mg within …

After Hours, Faster Reperfusion: A Multidisciplinary Quality Improvement Initiative To Reduce Stemi Door-To-Balloon Time, Suhas Tatapudi, Aarohi Parikh, Jeffrey Lesser, Alexander Rhodes, M Daniel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Improving Sepsis Order Set Utilization Through Targeted Resident Education: A Lean Six Sigma Green Belt Quality Improvement Project, Sarah Sheikh, Puneeth Shridhar, Bushra Bangash, Valerie Chukelu, Tonya Meirhofer, Arunima Jose, Zainab Shakir, Shane Jenks, Augusto Sepulveda, Trung Nguyen, Rajeev Raghavan

Gulf Coast Division GME Research Day 2026

No abstract provided.

A Shocking Case Of Wolf Parkinson White (Wpw) Syndrome, Sarah Hendee, Bailey Reale, Tate Higgens, David Taylor, Dmitriy Scherbak

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Unwrapping The Candy Cane: An Underrecognized Cause Of Postoperative Abdominal Pain, Priscilla Itua, Uzma Ali, Mohammad Mahdi, Osamah Salim, Sarib Sultan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Watery Diarrhea And Hypotension: A Missed Clue To Adrenal Crisis In A Patient With Addison's Disease, Wafa Mehboob, Umema Irfan, Keyaben Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Disseminated Mycobacterium Avium Complex (Mac) Infection Presenting With Mycotic Aneurysm And Multisystem Involvement In A Patient With Newly Diagnosed Acquired Immunodeficiency Syndrome (Aids), Hannah Rector, Michael Haddad, Dmitriy Scherbak

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Necrotizing Sweet Syndrome In A Young Male: A Rare Clinical Mimic Of Necrotizing Fasciitis, Evan King, Rawad Radaa, Ryne Peters

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Case Report: Successful Treatment Of Clot In Transit In The Ra And Rv, Venkata Kalyan Byrapogu, Garret D. Olsen, Rati Shirodkar, Brett Hiendylmayr, Pratik Saha

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Survival Following Extreme Metformin-Associated Lactic Acidosis In A Patient With Acute-On-Chronic Kidney Disease Managed With Crrt, Phil Khong, Danielle Sudilovsky, Logan Blackney, Ryan Spilman, Alex Enurah

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Case Reports: A 66-Year-Old Male With Severe Hypocalcemia In The Setting Of Metastatic Prostate Cancer And Denosumab Use, Danielle Sudilovsky, Marissa Patterson, Sophia Eschelbeck, Madeline Whitney, George Issa

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Biliary Obstruction From An Unexpected Source, Max Dinicola, Trevor Link, Derek Welch

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.