Journal of community hospital internal medicine perspectives
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J Community Hosp Intern Med Perspect · Jan 2018
Morbidity pattern and outcome of patients admitted in a coronary care unit: a report from a secondary hospital in southern region, Saudi Arabia.
Background: There is limited information about the clinical profile and outcome on patients admitted to a coronary care unit (CCU) in Saudi Arabia is available. Objective: The aim of this study was to evaluate reasons for admission, clinical characteristics, outcome and predictors of outcome in CCU patients. Materials and methods: The data of 392 patients admitted to the CCU of a secondary care centre in southern region of Saudi Arabia from 1 January 2017 to 31 December 2017 were collected. ⋯ Conclusion: The reasons for admission to the CCU were acute coronary syndrome, heart failure and cardiac arrest. Mortality among CCU patient was comparable to reports elsewhere. Cardiac arrest and age greater than 50 years were independent predictors of death.
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J Community Hosp Intern Med Perspect · Jan 2018
Case ReportsDaptomycin associated eosinophilic pneumonia: case report and differential diagnoses.
Daptomycin is a bactericidal antibiotic approved for treatment of gram-positive skin and soft tissue infections. We present a case of an 89-year-old man who presented with fever, shortness of breath and nonproductive cough on week 4 of starting daptomycin for infective endocarditis. Computerized tomography scan showed bilateral interstitial infiltrates predominantly affecting the lower lobes. ⋯ He was diagnosed with eosinophilic pneumonia secondary to daptomycin use. His symptoms improved with discontinuation of daptomycin and initiation of corticosteroids. Clinical correlation of pneumonia-like presentation with recent use of daptomycin should make physicians rule out this rare adverse effect for early institution of correct treatment.
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J Community Hosp Intern Med Perspect · Jan 2018
Internal medicine fellowship directors' perspectives on the quality and utility of letters conforming to residency program director letter of recommendation guidelines.
Background: In May 2017, the Alliance for Academic Internal Medicine (AAIM) published guidelines intending to standardize and improve internal medicine residency program director (PD) letters of recommendation (LORs) for fellowship applicants. Objectives: This study aimed to examine fellowship PDs impressions of the new guidelines, letter writers' adherence to the guidelines, and the impact of LORs that conformed to guidelines compared to non-standardized letters. Methods: The authors anonymously surveyed fellowship PDs from January to March 2018 to gather input about LORs submitted to their programs during the 2017 fellowship application cycle. ⋯ Fellowship PDs felt that letters that followed the AAIM guidelines were more helpful than letters that did not, especially for differentiating between applicants from the same institution and for understanding residents' performance across the six core competency domains. Fellowship PDs provided several suggestions for residency PDs to make the LORs even more helpful. Conclusion: Fellowship PD respondents indicated that LORs that followed the new AAIM guidelines were more helpful than letters that did not.
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J Community Hosp Intern Med Perspect · Jan 2018
Case ReportsA case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male - an increasingly recognized rare disease.
Background: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. ⋯ He underwent an emergent percutaneous transluminal coronary angiography which revealed a total occlusion of the left anterior descending artery at its origin with an evidence of spontaneous dissection as the cause of the occlusion, which was subsequently treated with placement of a drug-eluting stent and thrombectomy from the distal occluded portion. This case highlights the importance of including spontaneous coronary artery dissection as a cause of ischemic cardiac insults and illustrates the approach to treatment. Conclusion: Internists should have a low threshold of clinical suspicion for SCAD especially in a young patient with no known risk factors and should know the importance of emergency in management.
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J Community Hosp Intern Med Perspect · Jan 2018
Case ReportsIdiopathic thyroid storm mimicking SIRS in a patient with hypothyroidism- a diagnostic dilemma.
Thyroid storm, defined as an endocrine emergency in 1926, remains a challenge for physicians in the 21st century. The mortality rate of untreated thyroid storm is very high. Hence, if a thyroid storm is suspected, treatment should not be delayed. ⋯ The clinical features of thyroid storm may be related to other co-morbidities which makes diagnosis a clinical challenge. Nonetheless, it is important to be aware of the possibility of development of a thyroid storm in patients with a history of subclinical hypothyroidism. In addition, patients, if diagnosed with a thyroid storm, should be treated immediately with appropriate medications since thyrotoxicosis is life threatening.