Rare Case of Primary Adenoid Cystic Carcinoma of the Lung With Bilateral Kidney and Liver Metastasis.

Adenoid cystic carcinoma (ACC) is a rare epithelial tumor that is found in the salivary glands. It is typically slow-growing and follows an indolent course. While it can hematogenously spread to the lungs, distant metastases are rarely reported.

Perceptions, Coping Strategies, and Mental Health of Residents during COVID-19.

Objectives: Since the inception of the coronavirus disease 2019 (COVID-19) pandemic, the United States has been the leader in cases and deaths. Healthcare workers treating these severely ill patients are at risk of many deleterious consequences. Residents, in particular, may be affected by physical as well as psychological consequences.

Superfluous Amylase/Lipase Testing at a University-Affiliated Teaching Hospital: A Retrospective Review.

The combination of amylase and lipase tests for diagnosing acute pancreatitis is not better than a lipase test alone; however, both tests are commonly ordered simultaneously. Further, although no data indicate usefulness of monitoring changes in elevated amylase and lipase levels, the tests are often ordered multiple times during the same clinical encounter. We retrospectively reviewed all amylase and lipase tests performed at a university-affiliated teaching hospital during a 6-month period.

Milestones: a rapid assessment method for the Clinical Competency Committee.

Introduction: Educational milestones are now used to assess the developmental progress of all U.S. graduate medical residents during training.

Cardiac papillary fibroelastoma: The need for a timely diagnosis.

Cardiac papillary fibroelastomas (CPFs) are the second most common primary cardiac tumors and the most common cardiac valvular tumors. Although they are histologically benign and usually asymptomatic, CPFs can lead to serious and life-threatening complications like myocardial infarction, stroke, pulmonary embolus, cardiac arrest etc. CPFs represent a rare entity in clinical medicine and literature regarding their management is limited.

Bilirubin in coronary artery disease: Cytotoxic or protective?

Bilirubin has traditionally been considered a cytotoxic waste product. However, recent studies have shown bilirubin to have anti-oxidant, anti-inflammatory, vasodilatory, anti-apoptotic and anti-proliferative functions. These properties potentially confer bilirubin a new role of protection especially in coronary artery disease (CAD), which is a low grade inflammatory process exacerbated by oxidative stress.

Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction: Temporal Trends and Association With In-Hospital Outcomes.

Objectives: The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI).

Background: There are limited data available on the incidence and outcomes of CHB in STEMI patients who undergo contemporary management.

Methods: We used the 2003 to 2012 National Inpatient Sample databases to identify all patients age ≥18 years hospitalized with STEMI.

Coronary Artery Disease in Patients With Disorders of Bilirubin Excretion.

We aimed to determine the predictors of coronary artery disease (CAD) in patients with abnormal bilirubin excretion, that is, Gilbert syndrome, Crigler-Najjar syndrome, Dubin-Johnson syndrome, and Rotor syndrome. We analyzed data from the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality, Rockville, MD for the period 2009 to 2010. All patients ≥18 years of age with a primary diagnosis of "disorders of bilirubin excretion" [International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9CM) code 277.

Autoimmune Hepatitis in Association With Sofosbuvir.

Sofosbuvir in combination with ribavirin was approved by the Food and Drug Administration as a treatment option for hepatitis C (HepC) in 2013. We describe a case of autoimmune hepatitis triggered in a patient on therapy with sofosbuvir and ribavirin. A 65-year-old woman with a medical history of diabetes mellitus, hypertension, and HepC (genotype 2) underwent pretreatment liver biopsy in May 2012, which demonstrated mild chronic active hepatitis with focal piece-meal necrosis and mild stage 1 periportal fibrosis with no increased iron deposition.

Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention.

Background: The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized.

Methods And Results: We queried the 2007-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD.

The management of eosinophilic gastroenteritis.

Eosinophilic gastroenteritis (EG) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal tract. No medication at present is approved by the Food and drug administration of United States for the treatment of EG. The rarity of the disease limits our experience with the different management options.

Outcomes of acute myocardial infarction in patients with hypertrophic cardiomyopathy.

Background: Acute myocardial infarction is a recognized complication in patients with hypertrophic cardiomyopathy. However, limited data are available on outcomes of patients with hypertrophic cardiomyopathy and acute myocardial infarction.

Methods: We analyzed the 2003-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with a principal diagnosis of acute myocardial infarction.

Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States.

Background: Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.

Methods And Results: We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients≥18 years of age who underwent cardiopulmonary resuscitation (International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 99.60 and 99.

Trends in management and outcomes of ST-elevation myocardial infarction in patients with end-stage renal disease in the United States.

Acute myocardial infarction in patients with end-stage renal disease (ESRD) is associated with increased risk of morbidity and mortality. Limited data are available on the contemporary trends in management and outcomes of ST-elevation myocardial infarction (STEMI) in patients with ESRD. We analyzed the 2003 to 2011 Nationwide Inpatient Sample databases to examine the temporal trends in STEMI, use of mechanical revascularization for STEMI, and in-hospital outcomes in patients with ESRD aged ≥18 years in the United States.

Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study.

Background: The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database.

Hypothesis: Pre-HT coagulopathy is associated with increased in-hospital mortality.

Methods: Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes).

Mobile physician reporting of clinically significant events-a novel way to improve handoff communication and supervision of resident on call activities.

Objectives: Reporting of clinically significant events represents an important mechanism by which patient safety problems may be identified and corrected. However, time pressure and cumbersome report entry procedures have discouraged the full participation of physicians. To improve the process, our internal medicine training program developed an easy-to-use mobile platform that combines the reporting process with patient sign-out.

Hyperkalemia among hospitalized patients and association between duration of hyperkalemia and outcomes.

Introduction: The aim of the study was to investigate predictors of mortality in patients hospitalized with hyperkalemia.

Material And Methods: Data among hospitalized patients with hyperkalemia (serum potassium ≥ 5.1 mEq/l) were collected.

Relation of smoking status to outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest.

In-hospital cardiac arrest (IHCA) is common and is associated with poor prognosis. Data on the effect of smoking on outcomes after IHCA are limited. We analyzed the Nationwide Inpatient Sample databases from 2003 to 2011 for all patients aged≥18 years who underwent cardiopulmonary resuscitation (CPR) for IHCA to examine the differences in survival to hospital discharge and neurologic status between smokers and nonsmokers.

Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States.

Background: Limited information is available on the contemporary and potentially changing trends in the incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction (STEMI).

Methods And Results: We queried the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥ 40 years of age with STEMI and cardiogenic shock. Overall and age-, sex-, and race/ethnicity-specific trends in incidence of cardiogenic shock, early mechanical revascularization, and intra-aortic balloon pump use, and inhospital mortality were analyzed.

Operationalizing the internal medicine milestones-an early status report.

Background: The internal medicine milestones were developed to advance outcomes-based residency training and will play an important role in the next accreditation system.

Innovation: As an element of our program's participation in the internal medicine educational innovations project, we implemented a milestones-based evaluation process in our general medicine and pulmonary-critical care rotations on July 1, 2010.

Measures: Outcomes assessed included survey-rated acceptability to participating faculty, residents, and clinical competency committee members.

Predictors of in-hospital mortality and acute myocardial infarction in thrombotic thrombocytopenic purpura.

Background: Despite the widespread availability of plasmapheresis as a therapy, thrombotic thrombocytopenic purpura is associated with significant morbidity and mortality. There is a paucity of data on the predictors of poor clinical outcome in this population. Acute myocardial infarction is a recognized complication of thrombotic thrombocytopenic purpura.

Fecal transplantation for the treatment of recurrent clostridium difficile infection.

Clostridium difficile infection (CDI) is currently a leading cause of antibiotic and health care-related diarrhea. The incidence and the severity of CDI-related diarrhea have increased dramatically in the USA and Europe in the past few decades. The emergence of multidrug-resistant hypervirulent strains of C.

Predictors of mortality, rehospitalization for syncope, and cardiac syncope in 352 consecutive elderly patients with syncope.

Objectives: To investigate the etiologies of syncope and predictors of all-cause mortality, rehospitalization, and cardiac syncope in consecutive elderly patients presenting with syncope to our emergency department.

Participants: Participants were 352 consecutive patients aged 65 years or older with syncope admitted to hospital from the emergency department.

Design: Observational retrospective study.

Etiology of Syncope in Patients Hospitalized With Syncope and Predictors of Mortality and Readmission for Syncope at 17-Month Follow-Up: A Prospective Study.

We investigated the etiologies of syncope and risk factors for mortality and rehospitalization for syncope at 17-month follow-up in a prospective study of 242 consecutive patients, mean age 69 years, hospitalized for syncope. The etiologies of syncope included the following: vasovagal syncope in 49 patients (20%), volume depletion in 39 patients (16%), orthostatic hypotension in 13 patients (5%), primary cardiac arrhythmias in 25 patients (10.3%), structural cardiac disease in 6 patients (2%), and drug overdose in 5 patients (2%).