Journal of Community Hospital Internal Medicine Perspectives最新文献

Necrotizing Fasciitis (NF) is a severe, potentially fatal soft tissue infection leading to death of muscles, fascia, and surrounding tissue. Perforated colon cancer (CC) is an exceedingly uncommon cause of NF. Here, we present a case of NF secondary to perforated colon cancer. This case emphasizes the significance of prompt identification, aggressive surgical excision of affected tissue, and consideration of rare, yet potentially fatal underlying etiologies in the management of NF as well as underscores the importance of CC screening to prevent devastating complications and mortality.

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease characterized by the presence of circulating autoantibodies. The spectrum of disease manifestations extends from asymptomatic cases to mild symptoms and, in rare instances, acute liver failure. AIH is a diagnosis of exclusion, supported by the detection of autoantibodies such as anti-smooth muscle antibody (ASMA). This case describes a 43-year-old female with myasthenia gravis, receiving monthly intravenous immunoglobulin (IVIG) infusions, who presented with persistently elevated liver enzymes and mildly elevated ASMA titers across multiple clinical encounters. A liver biopsy revealed severe acute hepatitis. While drug-induced liver injury (DILI) secondary to IVIG was initially considered the leading diagnosis, the persistence of elevated liver enzymes over two months despite discontinuation of IVIG made the diagnosis of AIH more likely and brought attention to the diagnostic challenges associated with AIH. Although ASMA is a hallmark serologic marker for AIH, it only has a moderate sensitivity of 59 %. Furthermore, IVIG administration may interfere with autoimmune testing, potentially leading to false-negative results. This case illustrates the complexity of interpreting autoimmune serologies and emphasizes the need for comprehensive diagnostic approach. It also highlights the importance of recognizing cognitive biases, such as premature diagnostic closure, that can hinder accurate diagnosis.

Background: Atherosclerosis, a major cause of cardiovascular morbidity and mortality, involves lipid accumulation, endothelial dysfunction, inflammation, and oxidative stress. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, initially developed for type 2 diabetes mellitus (T2DM), have demonstrated cardiovascular benefits beyond glycemic control. Emerging evidence suggests their potential role in slowing atherosclerosis progression and enhancing plaque stability.

Methods: A systematic review of PubMed, Scopus, Embase, and Cochrane Library databases was conducted to identify preclinical and clinical studies on SGLT2 inhibitors and atherosclerosis. Studies published in English up to December 2024 were screened using predefined criteria. Data on mechanisms, lipid metabolism, endothelial function, vascular inflammation, and plaque stability were extracted, and study quality was assessed.

Results: A total of 16 animal and 4 human studies were included. SGLT2 inhibitors (empagliflozin, dapagliflozin, and canagliflozin) improved glycemic control, lipid metabolism, and atheroma reduction while enhancing plaque stability. They modestly reduced triglycerides and LDL-C while increasing HDL-C. SGLT2 inhibitors also decreased vascular inflammation and enhanced plaque stability by increasing fibrous cap thickness. Cardiovascular outcome trials demonstrated reductions in major adverse cardiovascular events (MACE) and heart failure hospitalizations, indirectly supporting their atheroprotective role.

Conclusion: SGLT2 inhibitors offer a multifaceted approach to atherosclerosis management by improving lipid metabolism, endothelial function, vascular inflammation, and plaque stability. While evidence is promising, further research is needed to confirm direct anti-atherosclerotic effects, optimize their role in cardiovascular care.

We present a rare case of a patient diagnosed with both primary biliary cholangitis (PBC) and secondary syphilis during hospitalization. While the coexistence of these two conditions is uncommon, distinguishing between syphilitic hepatitis and autoimmune liver disease is critical. This case highlights the importance of thorough history-taking, a comprehensive workup for cholestatic liver disease, and the potential diagnostic overlap between infectious and autoimmune processes.

Cardiac rehabilitation programs are offered in two major formats: Conventional Cardiac Rehab (CCR), which is primarily based on exercise interventions, and Intensive Cardiac Rehabilitation (ICR), which is a holistic approach including dietary modifications with a plant-based diet and wellness counseling. We performed a retrospective cohort study to compare the CCR and ICR groups for the primary composite outcome of Major Adverse Cardiac Event (MACE) at two years. The MACE outcome was 2-year mortality, unstable angina requiring hospitalization, Myocardial Infarction (MI), Coronary Artery Bypass Graft (CABG), Percutaneous Coronary Intervention (PCI), and stroke. Secondary outcomes were overall mortality, and number of readmissions. There were 2104 patients included in the statistical analysis with 963 in the CCR group and 1141 in the ICR group. We found that there were no significant differences in MACE events between ICR and CCR (OR = 1.10; 95 % CI = 0.81-1.49; p = 0.55). Readmissions were higher in the ICR group than the CCR group, with 34.1 % vs 28.6 % (p = 0.006), respectively. Additionally, older age was associated with more MACE events (OR = 1.16; 95 % CI = 1.07-1.25; p < 0.001). Overall, our study did not demonstrate a difference in the composite MACE outcome between ICR and CCR.

Introduction: Research on digital health tools (DHT) use in rheumatologic disease (RD) patients is lacking.

Method: Data from the 2017 and 2018 Health Information National Trends Survey (HINTS) were used to compare DHT ownership and perceived usefulness between individuals with and without RD and to evaluate how health applications usage influenced health behaviors in RD patients.

Results: No significant differences in smartphone or health applications ownership were found between the groups. Among RD patients, older males and those with lower incomes were less likely to use DHT. DHT users reported better communication with healthcare providers, but no significant impact on health behaviors.

Conclusions: Females, individuals <65 years, and those with higher annual income had higher odds of health applications usage. DHT facilitated better communication between patients with RD and healthcare providers. DHT tailored for RD are readily available but remain underutilized and warrant further exploration to improve health outcomes in this population.

Familial hypocalciuric hypercalcemia (FHH) is a rare autosomal dominant condition caused by mutations in the calcium-sensing receptor gene (CASR), leading to asymptomatic hypercalcemia. Here, we report a case of hypercalcemia in a patient with acute pancreatitis, subsequently diagnosed with FHH. A 41-year-old male presented with abdominal pain and elevated pancreatic enzymes. Imaging revealed changes consistent with acute pancreatitis. Surprisingly, serum calcium was elevated, which is uncommon in acute pancreatitis. Further work-up demonstrated normal parathyroid hormone (PTH), PTH-related peptide (PTHrp), and vitamin D levels. A 24-h urinary calcium excretion of 24 mg/24 h and a calcium to creatinine clearance ratio (CCCR) of 0.002 confirmed the diagnosis of FHH. This condition is typically asymptomatic, with few complications, and is managed conservatively with patient education and genetic counselling.

Immunoglobulin A (IgA) nephropathy is the most common glomerulonephritis worldwide. While IgA nephropathy mainly presents with renal manifestations, systemic symptoms associated with vasculitis are uncommon. Oftentimes, creatinine is used as a serum marker for renal dysfunction; however, it may not always be sensitive, especially in patients with low muscle mass. In such cases, cystatin C may prove to be a better indicator of renal function. Here, we present a case of IgA nephropathy with a normal serum creatinine and elevated cystatin C, highlighting the utility of cystatin C in the setting of a normal creatinine and high suspicion for renal dysfunction.

Transesophageal echocardiography is a relatively safe procedure; however, there are rare complications associated with it. Multiple attempts during TEE can lead to injury of hypopharyngeal or parapharyngeal wall leading to an infection. Here, we describe a case of hypopharyngeal-parapharyngeal abscess resulting from multiple TEE attempts during cardioversion leading to a prolonged hospital course.

We report a 69-year-old with a past medical history of prostate cancer, and arsenic poisoning, who was incidentally found to have multiple pulmonary nodules and hepatosplenic lesions on CT imaging. He denied respiratory symptoms, but was noted to have significant weight loss. A bronchoscopy revealed mycobacterium kumamotonense on culture. He was treated presumptively for pulmonary and disseminated infection with azithromycin and ethambutol for 16 months, and 12 months of rifabutin after four months of rifampin which was discontinued due to resistance. Patient's weight loss resolved and CT imaging appeared significantly improved.