Internal Medicine Commons^™

A Multimodal Approach To Decreasing Hesitancy Of The Influenza Vaccine In The Family Care Setting, Carley J. Ellenberger

Evidence-Based Practice Project Reports

The uptake of the influenza vaccine is the most effective and proactive action an individual can take to defend themselves against the influenza outbreak each season; therefore, it is recommended that everyone at least six months of age and older should receive the annual flu vaccine (CDC, 2022; WHO, 2023). Unfortunately, influenza vaccine hesitancy is demonstrated on a global level affecting the uptake compliance annually each influenza season despite the millions of people that experience influenza symptoms annually (CDC, 2022, WHO, n.d.; Healthy People 2030, n.d.). The PICOT question for this project was in adults, over the age of 18, …

Relationship Between Food Security, Nutrition Security, And Diabetes: The Role Of Supplemental Nutrition Assistance Program Participation, Maha Almohamad, Jayna M Dave, Eric E Calloway, Ruosha Li, Shreela Sharma

Faculty, Staff and Student Publications

BACKGROUND: Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood.

OBJECTIVES: This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers.

METHODS: …

Intrabiliary Metastasis Of Colorectal Mucinous Adenocarcinoma Mimicking Choledocholithiasis 18 Years After The Primary Tumor, Sumaya Abdul Ghaffar, David Pfau, Nikhil Madhuripan, Robert Christopher Harmon, Antonio Galvao Neto, Ana Luiza Gleisner

Faculty, Staff and Student Publications

This case report presents a 62-year-old male who had previously undergone curative colectomy and neoadjuvant chemotherapy in 2005 for colorectal cancer. He presented with jaundice, which was initially attributed to choledocholithiasis. After cholecystectomy and repeat ERCPs, hyperbilirubinemia persisted. There was persistent dilation of the right posterior duct on imaging, concerning for biliary stricture, possibly due to cholangiocarcinoma or intraductal papillary neoplasm. During a right posterior hepatectomy, a peripheral liver lesion was found in association with the dilated bile duct. On frozen evaluation, the lesion was found to be invasive adenocarcinoma. The final pathology was compatible with a metastatic mucinous adenocarcinoma …

Guidance For Assessment Of The Inflammation Etiologic Criterion For The Glim Diagnosis Of Malnutrition: A Modified Delphi Approach., Tommy Cederholm, Gordon L Jensen, Maria D Ballesteros-Pomar, Renee Blaauw, M Isabel T D Correia, Cristina Cuerda, David C Evans, Ryoji Fukushima, Juan Bernardo Ochoa Gautier, M Cristina Gonzalez, Andre Van Gossum, Leah Gramlich, Joseph Hartono, Steven B Heymsfield, Harriët Jager-Wittenaar, Renuka Jayatissa, Heather Keller, Ainsley Malone, William Manzanares, M Molly Mcmahon, Yolanda Mendez, Kris M Mogensen, Naoharu Mori, Maurizio Muscaritoli, Guillermo Contreras Nogales, Ibolya Nyulasi, Wendy Phillips, Matthias Pirlich, Veeradej Pisprasert, Elisabet Rothenberg, Marian De Van Der Schueren, Han Ping Shi, Alison Steiber, Marion F Winkler, Rocco Barazzoni, Charlene Compher

Ambulatory and Primary Care Articles

BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the …

Practice Facilitation And Peer Coaching For Uncontrolled Hypertension Among Black Individuals: A Randomized Clinical Trial, Monika M Safford, Doyle M Cummings, Jacqueline R Halladay, James M Shikany, Joshua Richman, Suzanne Oparil, James Hollenberg, Alyssa Adams, Muna Anabtawi, Lynn Andreae, Elizabeth Baquero, Joanna Bryan, Debra Sanders-Clark, Ethel Johnson, Erica Richman, Orysya Soroka, Jimmy Tillman, Andrea L Cherrington

Faculty, Staff and Student Publications

IMPORTANCE: Rural Black participants need effective intervention to achieve better blood pressure (BP) control.

OBJECTIVE: Among Black rural adults with persistently uncontrolled hypertension attending primary care clinics, to determine whether peer coaching (PC), practice facilitation (PF), or both (PCPF) are superior to enhanced usual care (EUC) in improving BP control.

DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized clinical trial was conducted in 69 rural primary care practices across Alabama and North Carolina between September 23, 2016, and September 26, 2019. The participating practices were randomized to 4 groups: PC plus EUC, PF plus EUC, PCPF plus EUC, and EUC alone. …

Coronary Pathophysiology Underlying The Obesity Paradox, Linh Bui, Monica Patel, K Lance Gould

Faculty, Staff and Student Publications

No abstract provided.

Obstacles To Optimal Antenatal Corticosteroid Administration To Eligible Patients, Kara M Rood, Lynda G Ugwu, William A Grobman, Jennifer L Bailit, Ronald J Wapner, Michael W Varner, John M Thorp, Steve N Caritis, Alan T N Tita, George R Saade, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa

Faculty, Staff and Student Publications

Background

Administration of antenatal corticosteroids (ANCS) is recommended for individuals expected to deliver between 24 and 34 weeks of gestation. Properly timed administration of ANCS achieves maximal benefit. However, more than 50% of individuals receive ANCS outside the recommended window.

Objective

To examine maternal and hospital factors associated with suboptimal receipt of ANCS among individuals who deliver between 24–34 weeks gestation.

Study Design

Secondary analysis of the Assessment of Perinatal Excellence (APEX), an observational study of births to 115,502 individuals at 25 hospitals in the US from March 2008–February 2011. Data from 3123 individuals who gave birth to a non-anomalous …

Coronary Stenosis And Cardiogenic Shock Secondary To Aortitis Following Aortic Root Support Procedure, Alexander Carpenter, Stephanie Connaire, Nitin Chandra Mohan, Stephanie L Curtis, Serban C Stoica, Massimo Caputo, Julian W Strange

Faculty, Staff and Student Publications

A woman with recent personalized external aortic root support implant presented in cardiogenic shock with bilateral coronary ostial occlusion and aortic inflammation requiring emergency coronary angioplasty. Subsequent computed tomography with positron emission tomography scanning demonstrated aortitis with extensive inflammation adjacent to the personalized external aortic root support mesh, the first report of this important complication.

When Intervention Becomes Imperative: A Case Report Of Spontaneous Vulvar Edema During Pregnancy, Vo Anh Vinh Trang, Thao-Ngan Nguyen Pham, Bao Huy Le, Thien Tan Tri Tai Truyen, Hoang Kim Tu Trinh, Kieu-Minh Le, Huu Doan Pham, Ngoc Minh Tam Nguyen, Quoc Kha Tran, Phuc Cam Hoang Nguyen, Vinh Hung Tran

Faculty, Staff and Student Publications

Spontaneous idiopathic vulvar edema during the second trimester is a rare condition. The approach to managing this condition involves relieving symptoms, identifying underlying causes, and implementing appropriate treatment. Managing such cases during pregnancy is challenging because of concerns for potential adverse fetal outcomes. Conservative management expects the condition to be relieved spontaneously postpartum, whereas invasive treatment offers a more rapid resolution. Treatment choices are controversial because each method has its pros and cons and influences the delivery process to a certain extent. Surgical drainage becomes a viable option when patients are not responsive to medications. We report a case of …

Nationwide Outcomes In Intermediate To High-Risk Pulmonary Embolism Treated With Catheter-Based Therapies, Chukwuemeka Umeh, Rahul Gupta, Priya Hotwani Md, Sabina Kumar, Mark A. Zainea, Jay Mohan

Internal Medicine Residency

Background

Methods

Gender Disparities In Outcomes Of Left Atrial Appendage Occlusion Device Placement, Manoj Kumar, Shafaqat Ali, Faryal Farooq, Priya Hotwani Md, Sanjay Kumar

Internal Medicine Residency

Background

Objective

Methods

Propensity Matched In-Hospital Outcomes Of Acute St Elevation Myocardial Infarction Of Left Anterior Descending (Lad) Coronary Artery In Patients With & Without Chronic Total Occlusion Of Coronaries, Manoj Kumar, Shafaqat Ali, Faryal Farroq, Sanchit Duhan, Priya Hotwani Md, Bijeta Keisham, Sanjay Kumar, Mahin R. Khan

Internal Medicine Residency

Background

Methods

Results

Intravascular Ultrasound In Percutaneous Coronary Interventions: A Nationwide Overview Of Its Use And Outcomes, Priya Hotwani Md, Chukwuemeka Umeh Md, Rahul Gupta, Gagan Kaur Md, Raghav Dhawan, Benson Eghreriniovo, Tamanna Mohta, Payaam Mahdavian Md, Jessica Ekomerei Obi, Eseosa Sanwo, Sabina Kumar Do, Mark A. Zainea Md Fscai, Jay Mohan Do Fscai

Internal Medicine Residency

Background

Methods

Results

Outcomes Of Mechanical Circulatory Support In Stemi Patients With Cardiogenic Shock: Insights From The National Inpatient Sample, Rahul Gupta, Chukwuemeka Umeh, Priya Hotwani Md, Gagan Kaur, Raghav Dhawan, Benson Eghreriniovo, Tamanna Mohta, Payaam Mahdavian, Eseosa Sanwo, Sabina Kumar, Mark A. Zainea, Jay Mohan

Internal Medicine Residency

Background

Methods

Results

Metachronous Mucinous Breast Carcinoma And Mucinous Pancreatic Cystadenoma In A Patient With Metabolic Comorbidities; Case Report And A Literature Review, Teodora Gabriela Alexescu, Irina Obada, Angela Cozma, Mirela Georgiana Perne, Olga Hilda Orasan, Vasile Negrean, Iacob Domsa, Victoria Ruta, Simina Felicia Țărmure

Journal of Mind and Medical Sciences

Mucinous breast carcinoma is a rare subtype of mammary neoplasm encountered in medical practice. It represents approximately 1-6% of all breast cancers and is more common in postmenopausal women. There are two subtypes of mucinous breast carcinoma: pure and mixed. We report the case of a 73-year-old Caucasian woman diagnosed with mucinous pancreatic cystadenoma in 2007. She underwent a surgical procedure involving pancreatectomy of the body and tail, along with multiple known cardiovascular and metabolic comorbidities. In November 2019, during a clinical-biological evaluation for associated diseases, a mucinous carcinoma of the right breast was accidentally detected and later confirmed through …

Management Of Macrovascular Diabetic Complications: A Single-Center Case Series Analysis Of Consecutively Attending Patients In Primary Care, Sanda Maria Crețoiu, Mihaela Adela Iancu, Laura Maria Condur, Teodor Salmen, Andreea Steriu, Ana Maria Alexandra Stănescu, Irina Anca Eremia, Cristina Mihaela Olariu, Eliza Elena Cinteză, Camelia Cristina Diaconu

Journal of Mind and Medical Sciences

Introduction. The prevalence of diabetes mellitus is increasing, with type 2 diabetes (T2DM) being a major health priority for any public health system. Increased arterial stiffness in patients with diabetes will lead to the appearance of vascular complications. Increased arterial stiffness in patients with diabetes usually leads to vascular complications. Any earlier diagnosis of impaired macrovascular evidence may lead to improved outcomes in patient care. The objective of our study was to assess and evaluate the finger-toe pulse wave velocity (ftPWV), as a measure of arterial stiffness, in order to assist with early detection of macrovascular diabetic complications. Materials and …

Effect Of Continuous Renal Replacement Therapy On Serum Levels Of Inflammatory Cytokines/Interleukin-17 In Severe Acute Pancreatitis, Diana Iosif, Adrian Paul Suceveanu, Marius Prazaru, Iulia Cindea, Viorel Gherghina, Anca Mihaela Pantea Stoian, Laura Mazilu, Dragos Serban, Alina Nicoara, Andra Iulia Suceveanu

Journal of Mind and Medical Sciences

Despite continuous investigations in the diagnosis and treatment of severe acute pancreatitis (SAP), this disease still remains a critical condition with a mortality rate of up to 35%. The pathophysiology of SAP involves an important inflammatory reaction of the pancreas (mediated by inflammatory cytokines and immune system activation), causing severe local tissue damage as well as important systemic imbalances. IL-17 is an inflammatory mediator that have a pivotal role in SAP evolution, generating multiple interactions between inflammatory cytokines and significantly influencing the immune system response. Consequently, continuous renal replacement therapy/CRRT was added to the conventional therapy, leading to improved treatment …

A Case Series Of Unusual Iga Vasculitis, Jared Bradley, Ian Whitaker, Brittany Lyons, Amy Mangla

HCA Healthcare Journal of Medicine

Introduction

Immunoglobulin A vasculitis (IgA)is a rare condition characterized by palpable purpura, often involving the skin, gastrointestinal tract, joints, and kidneys. Presentation is usually acute and is more common in children and adolescents of Southeast Asian and European descent. In the adult population, it is less common and therapies are not as well-established.

Case Presentation

Disease prevalence of IgA vasculitis outside Southeast Asian and European populations is not well-documented. In this case series, we present 2 cases of IgA vasculitis in 2 older adult males, one of Native American descent and one of African American descent.

Conclusion

IgA vasculitis must …

Acute Bilateral Pyelonephritis In The Setting Of Newly Diagnosed Diabetes Mellitus: A Case Report, Jessenia Ariana Contreras, Satwinder Singh, Ramesh Alwarappan

HCA Healthcare Journal of Medicine

Introduction

Acute pyelonephritis is a bacterial infection that starts in the bladder and ascends to the kidneys, causing inflammation of the renal parenchyma. Women are more likely to get infected compared to men, with diabetics being at higher risk. The pathophysiology of how diabetics are more prone to getting urinary tract infections/pyelonephritis has been studied, particularly the difference between bilateral pyelonephritis and unilateral pyelonephritis.

Case Presentation

This case presentation follows a 51-year-old Spanish-speaking woman with a past medical history of prediabetes, bilateral tubal ligation, and perimenopause. She presented to the hospital for abdominal and back pain, fevers, and weakness that …

Mpox-Induced Proctitis, Saif Ghias, Niyati Joshi, Dzenana Cabaravdic, Ramesh Nathan, Jasprit Takher

HCA Healthcare Journal of Medicine

Introduction

Mpox, formerly known as monkeypox, is a zoonotic virus in the genus Orthopoxvirus, which has a variable incubation period and an extensive array of symptoms. While those infected with Mpox have displayed generalized viral prodromal symptoms, atypical symptoms such as proctitis have also been seen. Proctitis associated with Mpox is a relatively infrequent initial presenting symptom with a reported incidence of 14-32.9% that has seen an uptick in prevalence since the 2022 global endemic.

Case Presentation

We present a confirmed case of Mpox in a 27-year-old male who presented with 3 days of intermittent anorectal bleeding and various forms …