Internal Medicine Commons^™

Severe Febrile Neutropenia And Pancytopenia In A Patient With Advanced Hepatocellular Carcinoma Treated With Atezolizumab And Bevacizumab: A Case Report, Shadi Chamseddine, Michael Lapelusa, Kristen Carter, Van Nguyen, Yehia I Mohamed, Yara Sakr, Cristhiam M Rojas-Hernandez, Rikita I Hatia, Manal Hassan, John A Goss, Khaled M Elsayes, Asif Rashid, Ryan Sun, Hop Sanderson Tran Cao, Hesham M Amin, Ahmed O Kaseb

Faculty, Staff and Student Publications

BACKGROUND: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course.

CASE DESCRIPTION: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a …

The Effects Of The Covid-19 Pandemic On Resident Education And Burnout, Timbre Backen, Oliwier Dziadkowiec, Jeffery S. Durbin, Gregory Guldner, Glenda Quan

HCA Healthcare Journal of Medicine

Background

The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods

We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using …

Aging- And Alcohol-Associated Spatial Transcriptomic Signature In Mouse Acute Pancreatitis Reveals Heterogeneity Of Inflammation And Potential Pathogenic Factors, Rachel R Tindall, Yuntao Yang, Isabella Hernandez, Amy Qin, Jiajing Li, Yinjie Zhang, Thomas H Gomez, Mamoun Younes, Qiang Shen, Jennifer M Bailey-Lundberg, Zhongming Zhao, Daniel Kraushaar, Patricia Castro, Yanna Cao, W Jim Zheng, Tien C Ko

Faculty, Staff and Student Publications

The rapidly aging population is consuming more alcohol, leading to increased alcohol-associated acute pancreatitis (AAP) with high mortality. However, the mechanisms remain undefined, and currently there are no effective therapies available. This study aims to elucidate aging- and alcohol-associated spatial transcriptomic signature by establishing an aging AAP mouse model and applying Visium spatial transcriptomics for understanding of the mechanisms in the context of the pancreatic tissue. Upon alcohol diet feeding and caerulein treatment, aging mice (18 months) developed significantly more severe AAP with 5.0-fold increase of injury score and 2.4-fold increase of amylase compared to young mice (3 months). Via …

Cerebellopontine Angle Meningioma Mimicking Acute Stroke, Milan Terzic, Yash B. Patel

Graduate Medical Education Research Journal

Cerebellopontine angle meningiomas are slow-growing benign tumors of the brain with a largely indolent course until compressive and mass effects occur with adjacent neural structures. Clinical presentations are variable and dependent on the rate of growth and location and tend to progress over a longer period. Acute presentations are less common and require consideration of ubiquitous etiologies. A 62-year-old male with a history of hypertension, benign prostatic hyperplasia, dyslipidemia, and gout presented to the emergency department with a sudden onset of dizziness, loss of balance, and persistently elevated blood pressure. The examination was positive for left dysmetria, dysdiadochokinesia, and tandem …

Small Intestinal Bacterial Overgrowth, Sandesh R. Parajuli, Anish C. Paudel, Anthony Donato

Transformative Medicine

No abstract provided.

Why Medicine Needs The Humanities: An Argument For Arguments, Suraj R. Nyalakonda, Md

The Medicine Forum

As medicine plunges deeper into the 21st century, there appear to be three forces coming together that hold both promise and peril as technology’s march of progress continues unabated through the healing profession.

Musings Of A House Staff Officer On The Wards, Suraj R. Nyalakonda, Md

The Medicine Forum

I am told I am part of the house staff. I am told I am a resident. I am told my predecessors, who are now my teachers, earned the title of resident by residing at their place of work, which was also their place of passion, which was the hospital, that institution that, with the advent of the industrial revolution, came to be a producer of health, a fixer of bodies. I am also now told that we residents are increasingly the sort of thing that can burn out. The other thing I know that can burn out - when …

Shadows And Echoes Of Understanding: A Physician's Reflection On Plato's Allegory Of The Cave And Medicine, Michael Dong, Md, Tamar Wolinsky Md, Benjamin Claxton, Md, Mph, Chantel Venkataraman, Md

The Medicine Forum

Plato's Allegory of the Cave offers a lens through which one can contemplate the complexities of medicine, where the shadows and echoes of illness obscure the true forms of disease. As physicians, we seek to illuminate the shadows that shroud our patients’ understanding of their illnesses and provide clarity to help patients navigate the labyrinth of diagnoses and treatments.

Unmasked, Rehana Persaud, Ms

The Medicine Forum

The world was quiet

A virtual reality

I existed

you lived

in it

We lived

In

a

world,

that was h u s h e d …

A quiet one

The silence was DeafeninG

But

I HEARD what consumed

me

Quantum Of Solace, Jeffrey White, Md

The Medicine Forum

Dr. R was back on 3 West and looking the worse for wear. Colon cancer, partial resection, bowel obstruction, ischemia, second surgery, bleeding, third surgery, infectious colitis, four days in the ICU—this 90-year-old man, who his wife assured us was bright and vibrant before his admission, was not long for this world. His baseline dementia had begotten daily delirium. He had had heart failure and COPD before his admission, and his fluid retention had swelled his already substantial body habitus to uncomfortable proportions.

Cadaver Dissection — A Reminder Of Humanity, Samuel De Matte, Ms

The Medicine Forum

I wash my hands, pick up a pair of purple forearm gloves, and gown up in an apron. The large overhead lights flood the room with sterile illumination, reflecting off the metal cabinets onto the white walls. I approach one of the thirty-four body bags with a group of classmates. The slow growl of the zipper fills the otherwise silent room. We pull back the formaldehyde-soaked sheet to reveal our cadaver. We all notice the rose tattoo on her chest.

A Curious Case Of Ards, Normonique Dyer, Do

The Medicine Forum

Acute respiratory distress syndrome (ARDS) is a well-known description of progressive respiratory decline. ARDS can be suspected in patients that meet the following criteria: (1) progressive dyspnea with onset within 1 week of a suspected clinical insult, (2) reduction in arterial oxygen saturation, and (3) bilateral alveolar infiltrates not due to a primary cardiogenic process.¹ The management of ARDS is largely unchanged regardless of the etiology and thus will not be within the scope of discussion for this report. However, the etiology of ARDS is of significance given that the cause of a patient’s respiratory failure has prognostic implications. …

A Case Of Reactivation Tuberculosis, Edwin Perez, Md, Avish Patel, Md, Taha Awan, Md, Amman Bhasin, Md, Gautam George, Md

The Medicine Forum

Approximately 22 percent of the world population is estimated to be infected with Mycobacterium tuberculosis. The largest number of cases are seen in Sub-Saharan Africa, India, and the islands of Southeast Asia, while North America and Western Europe are “low incidence” regions.¹ In the US, most cases are seen in foreign-born individuals who emigrate from high-incidence countries. Despite the low incidence in the US, prevention and control of Tuberculosis (TB) remain an important component of Public Health.² Here we present a case of a patient of Vietnamese origin with reactivation TB and rare manifestations of TB.

Nodular Al Amyloidosis — An Unusual Etiology Of A Solitary Pulmonary Nodule, Benjamin B. Claxton, Md, Mph, Shruti Nanivadekar, Md, Stacey Gargano, Md, Prarthna C. Kulandaisamy, Md

The Medicine Forum

Solitary pulmonary nodules (SPN) are defined as single intraparenchymal opacities less than 3 centimeters. The differential diagnosis of the SPN is broad. AL amyloidosis is a protein conformational disease which occurs when certain monoclonal light chains develop an unstable tertiary structure with resultant polymerization of insoluble amyloid fibrils that deposit in the extracellular space of sundry tissues. In the lung, diffuse interstitial amyloid deposition is the most common form of the disease.

When Obstruction Meets Infection: A Case Of Multi- Drug Resistant (Mdr) E. Coli Community Acquired Pneumonia In A Patient With Metastatic Melanoma, Victor Diaz, Ms, David Saeed, Ms

The Medicine Forum

Multidrug resistant Escherichia Coli (MDR E. Coli) is a less common cause of bacterial community-acquired pneumonia as compared to Streptococcus pneumoniae and Staphylococcus aureus. We present a case of MDR E. Coli community-acquired pneumonia diagnosed on culture of bronchoalveolar lavage specimens (BAL) after bronchoscopic debulking of a metastatic melanoma mass completely obstructing the left main stem bronchus (LMSB).

Renal Cell Carcinoma Manifesting As A Tumor Thrombus Identified On Transthoracic Echocardiography & Ct Scan, Kashka Mallari, Md

The Medicine Forum

This is a 60 year old male who presented with increased lower extremity edema for a month and right upper quadrant abdominal pain for a week. A CT of his abdomen showed a right renal mass consistent with renal cell carcinoma (Figure 1, red arrow), along with a tumor thrombus extending into the inferior vena cava (IVC) to the level of the junction with the right atrium (Figure 1, blue arrow, and Figure 2). An echocardiogram revealed an enlarged IVC with an increased echogenicity likely representative of an extensive tumor (Figure 3). Subsequently, he underwent a right radical nephrectomy, vena …

Case Study: Diagnosis Of Acute Myeloid Leukemia In A Middle-Aged Patient With A History Of Aplastic Anemia, Umma Fatemam Md, Marc Yorker, Md

The Medicine Forum

The clinical and diagnostic landscape of hematologic disorders such as Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukemia (AML) is complex and multifaceted, with particular challenges arising in the identification and differentiation of related conditions like aplastic anemia and hypoplastic MDS.¹ MDS, a heterogeneous group of clonal marrow disorders, is typified by dysplasia and ineffective hematopoiesis, which often culminate in cytopenias. A subset of MDS patients may experience leukemic transformation, marked by the proliferation of undifferentiated blasts, ultimately progressing to AML, a malignancy characterized by rapid growth and accumulation of these cells.² Aplastic anemia shares the clinical hallmark of …

Primary Care Provider Awareness And Attitudes Regarding Updated Brca1/2 Screening Recommendations And Genetic Testing, Emily Foecke Munden, Ms, Maria Poluch, Ms, Jennifer S. Zeiger, Ms, Maya Rosenberg, Md, Swati Shroff, Md

The Medicine Forum

Detection of BRCA1/2 gene mutations opens the door for breast cancer prevention; however, many high-risk individuals are not screened until after their first cancer diagnosis. The United States Preventive Services Task Force (USPSTF) updated its BRCA1/2 screening recommendations in 2019. This study explores provider awareness of this update and attitudes towards BRCA1/2 genetic testing. A survey was sent to Obstetrics/ Gynecology (Ob/Gyn), Internal Medicine (IM), and Family Medicine (FM) providers at Thomas Jefferson University Hospitals (TJUH). 66% of responders felt familiar with BRCA1/2 screening guidelines, and 38% were aware of the 2019 USPSTF update. Ob/Gyn providers were more familiar with …

Looking For The Unseen: Application Of Wood’S Lamp In The Ambulatory Clinic, Alexandros Grivas, Md, John Caruso, Md

The Medicine Forum

A 56-year-old female patient with a personal medical history of class III obesity and uncontrolled DM presented to the ambulatory clinic with a pruritic rash behind her knees. The rash was of 4 weeks duration and did not improve with topical application of nystatin powder. Examination revealed an erythematous patch in the intertriginous area behind the knees bilaterally, associated with mild desquamation and clear demarcation from the normal skin. No satellite lesions were noticed. (figure 1A) The patient was evaluated for an intertriginous skin rash. The differential diagnosis included intertrigo, fungal infection, psoriasis, and lichen planus. Wood’s lamp examination was …

Minocycline-Induced Hyperpigmentation In A Patient With Multiple Causes Of Skin Discoloration, Jeffrey White, Md, Amman Bhasin, Md, Gregary Marhefka, Md

The Medicine Forum

Minocycline-induced hyperpigmentation is a well-documented but poorly understood adverse effect of the popular tetracycline antibiotic minocycline, mainly affecting patients who use it for a prolonged duration. When patients develop dark skin lesions, the etiology may be clouded if a patient on minocycline has other risk factors. We describe a patient on suppressive minocycline therapy as well as anticoagulation and a history of chronic venous stasis who developed ecchymosis after an invasive procedure.