Journal of Community Hospital Internal Medicine Perspectives最新文献

Systemic sclerosis sine (latin: without) scleroderma (ssSSc), also called visceral scleroderma, is characterized by internal organ involvement and abnormal serologic abnormalities in the complete or partial absence of cutaneous manifestations of systemic sclerosis.1,2 Pulmonary involvement in scleroderma consists of interstitial lung disease and pulmonary hypertension. Usual interstitial pneumonia (45.4%), followed by nonspecific interstitial pneumonia (36.4%) represents the predominant interstitial lung disease in scleroderma.3 Rarely, organizing pneumonia has been described with scleroderma and seldom with systemic sclerosis sine scleroderma in literature.

The authors present a clinical image of primary Raynaud's phenomenon and briefly review its pathophysiology, differential diagnosis, and need for longitudinal follow up.

Lymphogranuloma venereum (LGV) is a sexually transmitted infection typically caused by serovars L1-L3 of Chlamydia trachomatis. These serovars are tissue-invasive with a preponderance for lymphatic spread and can be acquired via unprotected oral, anal, or vaginal sex. We present the case of a 23-year-old with a prior history of syphilis admitted with four weeks of progressively enlarging painful right cervical lymphadenopathy. Extensive testing, including oropharyngeal swabs and microbiological testing, did not yield a diagnosis, nor did extensive pathological and microbial testing of the lymph node biopsy tissue. Serological test of lymphogranuloma venereum revealed positive Chlamydia trachomatis L1 serovar antibodies. The patient had a complete resolution of his symptoms after three weeks of doxycycline therapy.

Pancreatic carcinoma has remained one of the leading causes of cancer-related mortality worldwide. Cancer originating in the head of pancreas is often detected early in the disease due to biliary obstruction resulting in jaundice. In contrast, cancer of the pancreatic body and tail remains indolent, presenting late with significantly increased tumor burden and distant metastasis. Unfortunately, a single laboratory screening study is neither sensitive nor specific for early detection of pancreatic cancer. In this report, we present a patient with longstanding diabetes incidentally detected to have pancreatic tail carcinoma while presenting with pulmonary embolism, emphasizing the need for pancreatic cancer screening studies in population with longstanding diabetes.

Objective: To determine risk factors, clinical and microbiological characteristics of infections in a single-center systemic lupus erythematosus (SLE) cohort.

Methods: All hospital patients in The First Affiliated Hospital of Zhengzhou University from 2019 to 2021 who meet ≥4 ACR-97 SLE criteria were identified. Patients with infection and without infection were included with a ratio of 1:2.

Results: 687 SLE patients were identified and 224 patients with infection and 448 patients without infection were included. The most common microorganisms in the infection group were Escherichia coli, Herpes zoster and Aspergillus, respectively. In the cox regression analysis, nephritis (OR 1.785; 95% CI: 1.156-2.756), diabetes(OR 6.507; 95% CI: 2.692-15.725), CD4+ T cell (OR 1.003; 95% CI: 1.002-1.004), prednisone>10 mg/day (OR 1.879; 95% CI: 1.112-3.175), immunosuppressants (OR 0.465; 95% CI: 0.310-0.697) and SLEDAI score (OR 0.866; 95% CI: 0.837-0.896) were risk factors associated with infection.

Conclusions: Bacteria was the most common infection in SLE patients with the respiratory tract being the most common site. Nephritis, diabetes, SLEDAI score were associated with infection. Monitoring CD4+ T cell can predict the infection incidence. Prednisone (>10 mg/day) and immunosuppressants increase the occurrence of infection.

Background and aims: Acute pancreatitis (AP) frequently presents in emergency departments and poses challenges in predicting severity and mortality. Established scoring systems like Ranson criteria, Acute Physiology And Chronic Health Evaluation II (APACHE) II, and Bedside Index of Severity in Acute Pancreatitis (BISAP) have varying effectiveness. Lactate dehydrogenase (LDH), an enzyme released during tissue damage, shows promise as a marker for organ injury in AP. This study aimed to evaluate LDH's potential to predict mortality risk and hospital stay duration in AP patients.

Methods: A retrospective cohort study analyzed AP cases at HCA Healthcare facilities from January 2011 to January 2021. Among 514 patients with LDH data at admission, groups were categorized based on LDH levels. Outcomes included hospital and ICU stay lengths, mortality rates, and factors such as age, gender, race, BMI, and medical history.

Results: Patients were stratified into three groups: Group 1 (<300 IU/L), Group 2 (300-600 IU/L), and Group 3 (>600 IU/L) based onLDHlevels. Patients withLDH>600 IU/L experienced an average hospital stay extension of 4.5 days,were 3.2 times more likely to require ICU admission, and faced a 12.1 times higher mortality risk compared to those with LDH <300 IU/L.

Conclusion: This study highlights LDH as a potentially valuable predictor of hospital stay duration, ICU requirements, and mortality rates in AP patients. Its cost-effectiveness and accessibility suggest LDH testing could aid clinical decision-making in AP management. Future prospective studies should further explore LDH's role in optimizing AP patient care.

Acute pancreatitis is a frequent cause of hospital admission, managed with intravenous (IV) fluids, analgesia, and oral feeding when tolerated. In patients with hypertriglyceridemia-induced pancreatitis, insulin and other therapies may be necessary for disease resolution. We present a case of a patient with severe acute pancreatitis and euglycemic diabetic ketoacidosis (DKA) with known lipase maturation factor 1 (LMF1) gene mutations, which can impact insulin efficacy on triglyceride metabolism through altered lipoprotein lipase activity, successfully treated with intravenous insulin. This case highlights the effectiveness of insulin therapy even in those with LMF1 gene mutations.

Purpose: The diagnosis and management of hypercalcemia in hospitalized patients can be challenging. Hypercalcemia is often associated with significant morbidity and end-organ damage which may delay a patient's recovery.

Methods: We report a case series of three patients who underwent orthopedic procedures with intraoperative placement of vancomycin-loaded calcium sulfate beads. Patients had no known history of malignancy or excess intake of calcium, vitamin A or vitamin D. Laboratory workup showed low parathyroid (PTH) levels and normal PTH-related peptide levels. The temporal nature of the non-PTH mediated hypercalcemia in relation to implantation of the antibiotic beads suggests causality of exogenous calcium sulfate with the patients' subsequent hypercalcemia.

Results: Patients were treated with aggressive intravenous saline and zoledronic acid resulting in resolution of hypercalcemia in all cases. The antibiotic impregnated beads did not require explantation.

Conclusion: Hypercalcemia following calcium sulfate antibiotic bead implantation may contribute to patient morbidity and increased length-of-stay. We recommend serum calcium and creatinine be closely monitored during the early postoperative period in patients who receive calcium sulfate antibiotic beads.

Nitrous oxide (N₂O) has been increasingly used for recreational purposes due to its dissociative and euphoric properties. Exposure to N₂O results in the deactivation of in vivo vitamin B₁₂, leading to subsequent neurological sequelae due to vitamin B₁₂ deficiency.7 Current management focuses on cessation of exposure and replacement therapy, yet patients may continue to suffer from permanent neurological damage.12 We report a case of a 50-year-old woman who presented with impaired balance, a subacute decline in mental status, multiple falls, and back pain. She was hospitalized for evaluation of her presenting symptoms and for pain management. The patient's sister helped uncover the patient's misuse of N₂O via "Whip-it!" cartridges. Physical examination, along with magnetic resonance imaging of the cervical and thoracic spine, confirmed the diagnosis of subacute combined degeneration (SCD), and appropriate treatment was initiated. Our case aims to bring attention to this seemingly harmless recreational drug that continues to regain popularity and its association with brain and nerve damage.13.

An examination of recent developments related to CRISPR technology, ethical considerations of the application of such technologies, and future directions for germline editing.