Journal of community hospital internal medicine perspectives
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J Community Hosp Intern Med Perspect · Sep 2020
An interfaith dialogue with Sir William Osler: crossing the divide of COVID-19 pandemic.
With the recent COVID-19 pandemic and George Floyd protests, the USA (US) has become extensively polarized across social and political divides. The COVID-19 pandemic has left tens of thousands dead and several million American citizens without work. Furthermore, the months of quarantine and uncertainty with the COVID-19 virus impacted the economic stability and health of Americans. ⋯ A physician that exemplified many aspects interfaith dialogue in his clinical practice and personal life was the late Sir William Osler. This will be accomplished through a fictional dialogue between Sir William Osler and Dr. Mark Webb.
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J Community Hosp Intern Med Perspect · Sep 2020
Case ReportsDiagnostic dilemma, an incidental diagnosis of COVID 19.
COVID 19 or SARS-CoV-2 infection was first reported in December 2019 in Wuhan City of China. Since then, it continues to spread globally and has been declared a pandemic. These patients present predominantly with respiratory complaints; however, in this article, we describe a case that was detected incidentally during workup of another suspecting diagnosis. We also elaborate on the benefits and importance of rapid testing.
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J Community Hosp Intern Med Perspect · Jan 2019
Reducing substance abuse in patients receiving prescription opioids for chronic non-cancer pain: a quality improvement and patient safety study in a primary care setting.
Background: Chronic non-cancer pain is a common cause of primary care physicians' office visits. Objective: To determine the impact of adopting screening and monitoring measures in primary care settings on the illicit substance use behavior of patients receiving opioid analgesic prescriptions. Methods: This was a retrospective analysis of data on patients who were prescribed opioid analgesics for chronic non-cancer pain between 2014 and 2017 Q1 (i.e., first quarter of 2017). ⋯ Conclusion: Adopting a system-wide screening and monitoring measures in a primary care setting can significantly reduce the amount of illicit drug use among patients receiving an opioid prescription for non-cancer pain. This has important implications for patient safety and the current opioid epidemic in the USA. Further studies are needed to evaluate similar interventions in other settings such as a pain clinic.
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J Community Hosp Intern Med Perspect · Jan 2019
Case ReportsEruptive xanthoma associated with severe hypertriglyceridemia and poorly controlled type 1 diabetes mellitus.
Eruptive xanthoma is characterized by yellowish skin papules encircled by an erythematous halo and associated with severe hypertriglyceridemia above 2,000 mg/dl. Hypertriglyceridemia can be caused by primary genetic mutations, secondary causes, such as uncontrolled diabetes, obesity, alcohol overuse, or combinations of both. Eruptive xanthoma can serve as an important clinical indicator of underlying systemic conditions (e.g. hypertriglyceridemia and uncontrolled diabetes mellitus). It is important for clinicians to recognize it to prevent further complications such as pancreatitis and cardiovascular disease.
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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.