Maldonadokendall1371

This is the first reported case of a patient presenting with B12 deficiency found to have MM with leptomeningeal carcinomatosis at diagnosis. To the author's knowledge, there is no literature investigating association between B12 deficiency at the time of diagnosis of MM with CNS complications. Furthermore, there are no established guidelines on treatment for leptomeningeal myelomatosis. We present this case with the effort to learn more about this disease in terms of response and overall survival.Patients with diabetes mellitus have diabetic dyslipidemia that occurs due to disturbances in glucose metabolism and can lead to hypertriglyceridemia (HPTG). Severe HPTG is associated with significantly increased risk of developing acute pancreatitis (AP). Acute pancreatitis (AP) is characterized as an inflammatory condition where inactive digestive enzymes become activated causing pancreatic tissue destruction. Hypertriglyceridemia and the inflammatory state that ensues therein also gives rise to a hypercoagulable state in patients with AP. Splenic vein thrombosis (SVT) is a rare complication of both AP and chronic pancreatitis (CP). We report a Case of 55-year-old Filipino male with past medical history of hypertension and uncontrolled type 2 diabetes mellitus (T2D), who presented with abdominal pain and was found to have diabetic ketoacidosis (DKA), and severe HPTG which led to acute pancreatitis, further complicated by SVT requiring anticoagulation. Our case highlights the importance of strict glycemic control among diabetic patients, the prompt management of AP in the setting of HPTG, and treatment of SVT.Wolf-Parkinson-White (WPW) syndrome is a congenital heart condition in which the atrioventricular (AV) node is bypassed by an accessory pathway that connects the atria and ventricle directly. WPW syndrome in patients with a history of peripartum cardiomyopathy (pregnancy-related cardiomyopathy) is associated with a high risk of morbidity and mortality secondary to failure of the pump and the conduction system of the heart. Management of these cases deals with arrhythmia and systolic heart failure, which becomes more challenging in pregnant patients as it requires treatment methods that minimize risks to the fetus. We report a case of a young female patient with WPW syndrome and postpartum cardiomyopathy presenting with symptomatic arrhythmias (tachycardia).Intravascular large B cell lymphoma (IVLBCL), a rare subtype of diffuse large B cell lymphoma (DLBCL), presents with non-specific symptoms and is an extremely difficult diagnosis to make despite extensive workup. It very rarely presents with endocrinologic abnormalities. We present a case of an 81-year-old woman whose predominant presenting manifestation was endocrinopathy, who passed away from multiorgan failure, and was diagnosed to have IVLBCL on post mortem autopsy.Brevibacterium casei is an extremely rare organism that can lead to peritonitis in End-stage renal disease patients of peritoneal dialysis. Out of only five overall Brevibacterium species peritonitis reported worldwide, only two of them had B. casei subspecies peritonitis detected, with both needing peritoneal dialysis catheter removal and change in dialysis modality to hemodialysis. Our patient, an elderly 63-year-old Hispanic male, was on peritoneal dialysis at home and presented with features suggestive of peritonitis. He was diagnosed subsequently with B. casei and started on broad spectrum intraperitoneal antibiotics. However, he did not need dialysis modality change and recovered fully after 3 weeks of appropriate intraperitoneal antibiotics therapy. Longer antibiotics therapy and frequent clinical follow-up plus better clinician awareness are needed to prevent this rare infection.The COVID-19 pandemic has been labeled one of the most lethal pandemics in human history. As a result, there has been a high level of urgency throughout the world to establish successful vaccinations to subdue the effects of the virus and return to a level of normalcy. This study aims to investigate the different COVID-19 vaccines available both in the United States and across the globe. Through exploration of how the vaccines were developed, how they elicit immunity, their efficacy, and their safety profiles, this review has the goal of increasing the amount of knowledge regarding the vaccines available to combat SARS-CoV-2, while also providing an epidemiological and biostatistical approach to interpreting acquired data available on the vaccines.

ACGME requires all Internal Medicine training programs to structure the curriculum to optimize resident educational experiences, including perioperative medicine. Teaching residents about perioperative risk management is challenging in a community hospital with limited resources and low surgical volume.

Our goal was to introduce an interactive educational module on perioperative cardiac risk assessment and management in a community residency training program.

The study was a single-center online education-based intervention from September 2020 to January 2021. 24 categorical internal medicine residents at MetroWest Medical center were included. A self-paced online education program followed by two sessions of a 30-minute, group modulated review and discussion were provided monthly. The pre- and post-evaluation with 20 questions were conducted to assess perioperative cardiac risk assessment and peri-operative cardiac risk management before and after education.

20 out of 24 residents (83%) were included in the analysis. Medicine residents performed significantly better after involvement with the educational module by comparing the pre- and post-evaluation score (10.7 ± 2.7 vs. 13.8 ± 1.8, p < 0.001, respectively). The most significant improvement was noticed in postgraduate year PGY-1 residents (5.1 ± 2.5, p < 0.001), followed by PGY-2 (2.7 ± 1.6, p = 0.004), but not significant in PGY-3 residents (1.6 ± 2.3, p > 0.05).

Implementing an interactive multi-modular curriculum in a community hospital increased residents' awareness and knowledge of perioperative cardiac risk assessment and management. We are confident that this will result in improved performance on the consult services.

Implementing an interactive multi-modular curriculum in a community hospital increased residents' awareness and knowledge of perioperative cardiac risk assessment and management. We are confident that this will result in improved performance on the consult services.Infectious aortitis is an uncommon but life-threatening cause of aortitis. Given the lack of specific symptoms, establishing the diagnosis is often a challenge. When it is associated with an endovascular infection, such as infective endocarditis, blood cultures may be diagnostic although often limited by low positive predictive value. Imaging studies may reveal characteristic findings, with computerized tomography angiography being the most sensitive. Management includes prompt initiation of antimicrobial therapy followed by surgical intervention, keeping in mind that operative mortality is high due to weakened arterial wall integrity. Here we describe a 25-year-old woman without relevant medical history, who presented to the hospital with subacute onset of fever, back pain and malaise, and was found to have infectious aortitis secondary to Streptococcus pneumoniae endocarditis. Despite appropriate antimicrobial coverage and surgical repair attempts, she succumbed to aortic perforation after a complicated and prolonged hospitalization.

Coronavirus disease 2019 (Covid-19) is associated with spontaneous pneumomediastinum (SPM) predominantly in those after positive pressure ventilation (PPV) support. Additionally, many cases of venous thromboembolism (VTE) in COVID-19 patients were described. Our case is the first to describe SPM and VTE present on admission in a patient with Covid -19 pneumonia.

A 53-year-old man presented to the hospital with escalating dyspnea. Two weeks prior to this visit, he had been evaluated in an ambulatory setting and was started on antibiotics and systemic steroids. In the hospital, this patient was found to be in acute hypoxic respiratory failure and was placed on noninvasive PPV. Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) test from nasopharyngeal swab specimen. Chest computed tomography (CT) scan revealed multi-lobar pulmonary emboli (PE) and subcutaneous emphysema with pneumomediastinum. The patient was managed conservatively. He never required closed invasive mechanical ventilation. Subsequent serial imaging displayed the resolution of SPM.

The association between VTE and COVID-19 has been established. This report brings attention to SPM as an additional important complication of COVID-19, even in patients without pre-existing predisposing pathology or exposure to PPV.

The association between VTE and COVID-19 has been established. This report brings attention to SPM as an additional important complication of COVID-19, even in patients without pre-existing predisposing pathology or exposure to PPV.Management of uncontrolled diabetic (DM) patients has always been a challenge across healthcare settings, but recently we noticed a surge in the number of uncontrolled DM patient in our clinic patients' population during the COVID19 pandemic. This in part a combination of disruptions to care, delayed or inaccessible care, and poor diet and physical activity. To address this issue, we formed a multidisciplinary Diabetes Initiative Team consisting of attending physicians, residents, clinical pharmacist, nurse manager, care manager, and coordinator, along with supportive staffs in our Internal Medicine Residency clinic. Our aim was to reengage diabetic patients in the outpatient setting and to overcome barriers limiting diabetic care.Congestive hepatopathy in the setting of chronic heart failure is predominantly cholestatic. Severe hepatocellular injury can be seen in cardiogenic shock, usually in an acute setting with severe reduction in ejection fraction and with significant hypotension. Hepatic ischemia with preserved ejection fraction in the setting of atrial fibrillation has not been widely recognized, although mild elevations of liver enzymes have been seen in such patients in the chronic state. We present a patient with preserved ejection fraction, rapid atrial fibrillation with hypotension who had ischemic hepatitis, with aspartate aminotransferase and alanine aminotransferase over one thousand.

Neuroendocrine neoplasms (NENs) comprise a wide-ranging group of abnormal neoplasms with atypical presentations, from primary localized disease to extensive metastasis, reaching the bone and brain. check details The NENs are divided into two major groups neuroendocrine tumors (NETs), which are well-differentiated tumors of any grade, and neuroendocrine carcinomas (NECs), which are poorly differentiated, high-grade cancers with a high risk of morbidity and mortality. The challenge of diagnosing NENs early, particularly prior to metastasis, highlights the importance of further studying these diseases. We present a case of aggressive metastatic neuroendocrine carcinoma of a gastrointestinal/pancreaticobiliary origin.

A 54-year-old male with a past medical history of hypertension and left total hip replacement presented with generalized weakness, dyspnea on exertion, decreased appetite, and fatigue for one month. Initial laboratory findings noted a hemoglobin level of 3.1 g/dL and a platelet count of 9 × 10

/L. CT scan findings revealed a splenic infarct, lytic bone lesions, and small bilateral occipital hemorrhages.