A Rare Case of Hemolysis Secondary to Severe Vitamin B12 Deficiency.

An 80 year old female with a past medical history of hypertension, hyperlipidemia, hypothyroidism, and chronic back pain presented to the hospital with fatigue and was found to have a severe macrocytic anemia. Blood work showed pancytopenia and positive markers of hemolysis. Additional work up was consistent with severe vitamin B12 deficiency and pernicious anemia.

1-Minute Pearls/Pitfalls for the Clinician.

This article describes some pearls/pitfalls pertinent to empty sella and levothyroxine dose adjustment with certain medications/conditions.

Telemetry Practices Among Physicians and Nurses at an Academic Tertiary Medical Center.

Background: Cardiac telemetry is an integral part of inpatient medicine, although it is also costly, labor-intensive, and a limited resource. In this quality improvement initiative, we surveyed nurses, residents, and attending physicians regarding their knowledge and application of the American Heart Association (AHA) guidelines for telemetry usage.

Methods: Our study included developing and implementing a survey among nurses, residents, and attendings in a major academic teaching hospital.

Update in Hyperferritinemic Syndromes: Recognition and Management - A Scoping Review.

Elevated serum ferritin is a marker of macrophage activation and is associated with increased mortality. The hyperferritinemic syndromes which include hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS), catastrophic antiphospholipid syndrome (CAPS), septic shock, adult-onset Still's Disease (AOSD), and multi-inflammatory syndrome related to COVID-19 (MIS-C/A) are characterized by intense inflammation and its sequalae. Prompt recognition and management of these heterogenous disorders is required to improve patient outcomes.

Inpatient Management of Monkeypox.

Monkeypox is a viral zoonosis with symptoms that appear similar to smallpox patients seen in the past, although it is clinically less severe. Since eradicating smallpox in 1980, monkeypox has become the most important orthopoxvirus for public health. The virus is primarily transmitted by close contact with respiratory secretions, skin lesions of an infected person, or contaminated objects.

Rapid (7-Day) Readmissions to an Inpatient Medical Service at a Tertiary, Academic Medical Center.

Background: Rapid readmissions, occurring within 7 days of hospital discharge, are associated with significant morbidity and mortality. Objectives: Identify causes of rapid readmissions with a focus on clinical judgement errors and improve discharge practices.

Methods: Records of 371 patients discharged from an inpatient medical service and readmitted within 7 days were reviewed.

Lessons Learned When Discharging Older Adults to Skilled Nursing Facilities.

Background: When patients transition from an inpatient hospital stay to a skilled nursing facility (SNF), the information that is sent with them is essential to proper care in the facility.

Methods: Records of hospital-to-SNF transfer were reviewed for opportunities for improvement in providing accurate or complete information. SNF staff were asked about their experiences caring for these patients and the effects that the inadequate documentation had on the patient's medical care.

Progressive Encephalomyelitis with Rigidity and Myoclonus Treated with Rituximab: Case Report and Review of the Literature.

A woman in her 50s presented with hyper-religiosity, auditory hallucinations, episodes of staring associated with unresponsiveness and stiffening of her entire body. A broad workup excluded autoimmune encephalitis, sarcoidosis, and prion disease. She was diagnosed with PERM (progressive encephalomyelitis with rigidity and myoclonus) syndrome which was supported by elevated cerebrospinal fluid (CSF) autoantibodies against glutamic acid decarboxylase (GAD) glutamic acid decarboxylase.

Metastatic Merkel Cell Carcinoma.

Merkel cell carcinoma is a rare, aggressive skin cancer that affects mainly the sun exposed areas in the elderly, especially the head and neck. Immunohistochemical analysis is necessary to establish diagnosis. We describe an elderly male who presented with hematochezia and was incidentally noted to have liver lesion on abdominal imaging, which was subsequently diagnosed as Merkel cell carcinoma.

Esophageal necrosis and obstruction after esophageal variceal banding.

A 78-year-old woman with a history of liver cirrhosis related to non-alcoholic steatohepatitis presented to the hospital with abdominal pain and distention. She was diagnosed with abdominal ascites and underwent paracentesis without evidence of infection. Esophagogastroduodenoscopy identified Grade 2 esophageal varices that were treated with band ligature.