Industry payments to hospitalist physicians: a 5-year analysis of the Open Payments programme from 2014 to 2018.

We analysed Open Payments programme data (https://openpaymentsdata.cms.gov) on industry-to-physician payments to hospitalists for the years 2014 to 2018.

Recurrent Cholangiocarcinoma Presenting as Sister Mary Joseph Nodule After Liver Transplantation.

Hilar cholangiocarcinoma, also known as Klatskin tumor, is the most common type of cholangiocarcinoma. It usually has a lymphatic spread and is rarely associated with an umbilical nodule, also known as Sister Mary Joseph nodule. We report a case of a 53-year-old Caucasian man with hilar cholangiocarcinoma.

Guillain-Barre Syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Secretion as Paraneoplastic Syndromes in Splenic Marginal B-cell Non-Hodgkins Lymphoma: A Rare Presentation.

Splenic marginal zone lymphoma (SMZL), a rare sub-type of non-Hodgkin lymphoma (NHL) presents with abdominal discomfort, lymphocytosis, cytopenias along with B symptoms including fatigue, night sweats, night fevers, weight loss. NHLs rarely present with paraneoplastic neurological syndromes like Guillain-Barre (GB) syndrome, myelopathy causing paraplegia, chorea, neuromyotonia, vasculitic neuropathy and dermatomyositis. Here, we present a 85-year old caucasian lady presenting with GB syndrome and Syndrome of Inappropriate Antidiuretic Hormone (SIADH) who eventually got diagnosed with SMZL.

Coronavirus Disease 2019-Induced Rhabdomyolysis.

Rhabdomyolysis is caused by necrosis of muscles and leakage of intracellular contents into blood circulation. It is most commonly caused by trauma, crush injuries, drugs, toxins, immobilization, compartment syndrome, prolonged surgical procedures, and less likely by infections. Infection-related rhabdomyolysis is rare, but not uncommon, and is seen in both viral and bacterial infections.

Staphylococcus warneri: Skin Commensal and a Rare Cause of Urinary Tract Infection.

Coagulase negative Staphylococci often grow in cultures and form one of the most abundant flora among skin microbiome. It is important and challenging to identify and treat clinically significant infections caused by these organisms. Prosthetic devices, catheters and conditions causing immunocompromised states are the risk factors for such infections.

Albuterol-Induced Type B Lactic Acidosis: Not an Uncommon Finding.

Lactic acidosis (LA) is usually a medical emergency diagnosed by laboratory evaluation in emergency rooms (ERs) and hospital settings in critically ill patients. LA is classified into two major types based on pathophysiology; type A results from tissue hypoxia and/or hypoperfusion and type B results from deranged metabolic activity in the cells in the absence of hypoxia/hypoperfusion. Prompt evaluation and treatment are essential to prevent morbidity and mortality, especially in patients with type A LA.

Gastric schwannoma.

Gastric Schwannomas are rare benign slow-growing tumors and warrant treatment/resection only when symptomatic. Watchful waiting is recommended for incidental or asymptomatic schwannomas.

Severe Respiratory Alkalosis in Acute Ischemic Stroke: A Rare Presentation.

Respiratory alkalosis is a rare but severe complication of acute ischemic stroke (AIS). In ischemic stroke, respiratory alkalosis results from hyperventilation due to the effect of stroke on the respiratory center. We report a case of a young male who presented with acute encephalopathy.

Gallbladder Neuroendocrine Carcinoma: A Rare Endocrine Tumor.

Gallbladder neuroendocrine neoplasms (GB-NEN) are very rare neuroendocrine tumors (NETs). GB-NEN can present as carcinoid or typical/atypical carcinoid or small cell carcinoma. Most of the GB-NENs present as gall bladder polyps or stones with right upper quadrant pain, nausea and non-specific symptoms which leads to clinical misdiagnosis.

Corona Virus Disease 2019 (COVID-19) Presenting as Acute ST Elevation Myocardial Infarction.

Patients with Covid-19 disease commonly present with symptoms related to respiratory illness, and less commonly they develop cardiovascular complications either on presentation or during the course of the disease. The mortality/morbidity is high in these patients with cardiovascular involvement. Acute ST-elevation myocardial infarction (STEMI) is a medical emergency which needs immediate coronary re-perfusion for better patient outcomes.

Euglycemic Diabetic Ketoacidosis in a Young Pregnant Woman Precipitated by Urinary Tract Infection.

Diabetic ketoacidosis (DKA) is a life-threatening diabetic complication and medical emergency. Euglycemic DKA (EKDA) is a variant of DKA with normal range glucose levels. The condition can be difficult to diagnose due to the misleading euglycemic levels.

Multiple Intracranial Tuberculomas with an Intra-medullary Spinal Cord Tuberculoma in a Pediatric Patient.

Central nervous system (CNS) tuberculosis (TB), caused by Mycobacterium tuberculosis (MT), is a severe form of TB, which presents as meningitis, cerebritis, abscesses, spinal tuberculous arachnoiditis, and rarely tuberculomas. CNS TB is prevalent in the underdeveloped or developing world and is common in malnourished, alcoholics, children, young adults, immunocompromised, and cancer patients. Intracranial tuberculomas (ICT) can present with symptoms and signs of focal neurological deficits with or without systemic manifestations.

Sweet syndrome in a patient with Hidradenitis Suppurativa.

Neutrophilic Dermatoses should be considered in the differential diagnosis, if a patient with abrupt onset of painful erythematous plaques/nodules and elevated erythrocyte sedimentation rate is not responding to antibiotics.

New Delhi Metallo-beta-lactamase-producing Enterobacter Cloacae - A Rare Multidrug Resistance Strain in a Caucasian Woman.

New Delhi metallo-beta-lactamase (NDM-1) is a novel metallo-beta-lactamase (MBL) gene carried by some Enterobacteriaceae that induces resistance to most of the antibiotics. First described in a Swedish patient hospitalized in India with an infection due to Klebsiella pneumoniae. NDM-1 makes bacteria resistant to a broad range of beta-lactam antibiotics.

A Case of Histoplasmosis with Central Nervous System Relapse after Itraconazole Therapy Needs Further Research.

Central nervous system (CNS) histoplasmosis occurs in 5-20% of all cases and is most commonly seen in immunosuppressed patients who have acquired immunodeficiency syndrome (AIDS) or have received organ transplant. The prevalence of histoplasmosis in patients greater than 65 years old between the years of 1999-2008 in the state of Texas was about 2-3 cases per 100,000 patients year. Since 1990 with the discovery of Triazoles, itraconazole (ICZ) has become the standard initial and suppressive therapy in patients with mild-moderate histoplasmosis without CNS involvement.

Isolated Area Postrema Syndrome Presenting as Intractable Nausea and Vomiting.

Neuromyelitis optica (NMO) is a disease of central nervous system, characterized by demyelination and axonal damage mostly involving optic nerves and spinal cord. Usually these patients present with symptoms related to optic neuritis or myelitis with a typical relapsing course. Some patients present with less common symptoms involving brain stem like nausea and vomiting, especially those involving area postrema (AP) located in dorsal medulla.

Granulomatous Myositis Associated with Extremely Elevated Anti-striated Muscle Antibodies in the Absence of Myasthenia Gravis.

Granulomatous myositis is a rare disease that predominantly results in proximal muscle weakness in the upper and/or lower extremities. As it can resemble other inflammatory myopathies, it is important to obtain a muscle biopsy to make the underlying diagnosis. We report the first case of granulomatous myositis associated with extremely elevated anti-striated muscle antibodies in a 69-year-old Caucasian woman.

Hemichorea Induced by Non-ketotic Hyperglycemia in a Caucasian Woman.

Chorea is a disorder characterized by irregular, involuntary, hyperkinetic movements and has various causes. One unusual cause is hyperglycemia. This case involves a 76-year-old diabetic Caucasian female who developed gait disturbances, hemichorea of the face and limbs, and slurred speech over two to three weeks.

Dahl's Sign: An Indicator of Severe Chronic Obstructive Pulmonary Disease.

Dahl's sign, a clinical sign in which areas of thickened and darkened skin seen on the lower thighs and/or elbows, is seen in patients with severe chronic respiratory disorders such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, congestive heart failure (CHF), and chronic moderate to severe persistent asthma. The aim of our present report is to create awareness and encourage providers to lay emphasis on physical examination in every medical examination that can give clues to the severity of the underlying disorder.

Terry's nails.

Terry's nails can be manifested in systemic diseases like cirrhosis, congestive heart failure, diabetes mellitus, renal failure, and other conditions which emphasizes the importance of physical examination in every clinical encounter.

Intrahepatic Cholangiocarcinoma Associated with High Procalcitonin, Hypercalcemia, Polycythemia and Leukocytosis.

Intrahepatic cholangiocarcinomas or bile duct cancers comprise approximately 10-20% of all cholangiocarcinomas and may present with right upper quadrant pain, weight loss, liver enzyme abnormalities or they may be completely asymptomatic and be picked incidentally on routine abdominal imaging. Typically, hepatocellular carcinomas have been associated with various paraneoplastic syndromes such as hypercalcemia, erythrocytosis, hypoglycemia, diarrhea and skin changes though paraneoplastic syndromes in the setting of cholangiocarcinoma do occur as well. Cholangiocarcinomas are usually associated with dermal paraneoplastic syndromes (Sweet syndrome, porphyria cutanea tarda, acanthosis nigricans, necrotic migratory erythema, erythema multiforme, bullous pemphigoid), hypercalcemia, leukocytosis and limbic encephalitis.

Calciphylaxis: A Deceiving Cellulitis.

Calciphylaxis is a rare and serious disorder seen most in end-stage renal disease (ESRD) patients on dialysis. It is associated with the calcium deposits in small and medium blood vessels of the skin and subcutaneous tissues resulting in painful skin lesions, plaques, ulcerations, gangrene, and secondary infections. The aim of our present report is to create awareness and encourage providers to consider calciphylaxis in the differential diagnosis of cellulitis in the appropriate clinical setting.

Gastric Emphysema Induced by Severe Vomiting.

Gastric emphysema or air in the stomach wall is a rare condition resulting from the disruption of gastric mucosa and entry of air into the stomach wall which could be from severe vomiting, instrumentation or endoscopy, gastric ischemia, and dissection of air from the mediastinum. Treatment is usually conservative and supportive. We report the case of a 70-year-old woman with a three-day history of nausea and vomiting who presented with gastric emphysema on computed tomography (CT) imaging; she responded very well with conservative treatment and was discharged in a stable condition.

Metoclopramide-induced Serotonin Syndrome.

Serotonin syndrome is a clinical diagnosis characterized by a constellation of autonomic and neurological physical examination findings due to the use of one or more serotonergic agents. Due to high morbidity and mortality associated with this condition, high index of suspicion is required in making this diagnosis. Treatment is aimed at discontinuation of the offending agent and supportive care.