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Ren T, Afaq S, Vaziri A, Oyesanmi O, Muddassir S. Ogilvie's Syndrome in a Young Female With Chronic Constipation. Cureus 2024; 16:e56557. [PMID: 38646298 PMCID: PMC11028015 DOI: 10.7759/cureus.56557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, is often encountered in post-surgical patients or those with serious comorbidities requiring intensive care. For this reason, it has rarely been reported in patients younger than 50 years without any predisposing risk factors. Our case report highlights a unique case of Ogilvie's syndrome in a young female with no recent trauma or surgical history. To that extent, we discuss risk factors that predisposed her to this condition, including her history of chronic constipation. We also emphasize the need for outpatient workups for such patients to prevent the worsening of their symptoms.
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Affiliation(s)
- Tong Ren
- Internal Medicine, Florida State University College of Medicine, Hospital Corporation of America (HCA) Healthcare Oak Hill Hospital, Brooksville, USA
| | - Shaikh Afaq
- Internal Medicine, Florida State University College of Medicine, Hospital Corporation of America (HCA) Healthcare Oak Hill Hospital, Brooksville, USA
| | - Ali Vaziri
- Internal Medicine, Florida State University College of Medicine, Hospital Corporation of America (HCA) Healthcare Oak Hill Hospital, Brooksville, USA
| | - Olu Oyesanmi
- Internal Medicine, Florida State University College of Medicine, Hospital Corporation of America (HCA) Healthcare Oak Hill Hospital, Brooksville, USA
| | - Salman Muddassir
- Internal Medicine, Florida State University College of Medicine, Hospital Corporation of America (HCA) Healthcare Oak Hill Hospital, Brooksville, USA
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Yang TJ, Patel AA, Singh J, Jahagirdar V, Solanki D, Nikhare B, Harwani N, Goswami R, Devani H, Maiyani P, Moradiya DV, Desai M, Muddassir S. Increasing Trends of Clostridium difficile Infection in Hospitalized Young Patients: A Study of the National Inpatient Sample From 2007 to 2017. Cureus 2022; 14:e29497. [PMID: 36299947 PMCID: PMC9588299 DOI: 10.7759/cureus.29497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background Clostridium difficile infection (CDI) is one of the rising public health threats in the United States. It has imposed significant morbidity and mortality in the elderly population. However, the burden of the disease in the young population is unclear. This study aimed to identify hospitalization trends and outcomes of CDI in the young population. Methodology We obtained data from the National (Nationwide) Inpatient Sample (NIS) for hospitalizations with CDI between 2007 and 2017. We used the International Classification of Diseases Ninth Edition-Clinical Modification (ICD-9-CM) and ICD-10-CM to identify CDI and other diagnoses of interest. The primary outcome of our study was to identify the temporal trends and demographic characteristics of patients aged less than 50 years old hospitalized with CDI. The secondary outcomes were in-hospital mortality, length of hospital stay (LOS), and discharge dispositions. We utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends and outcomes. Results From 2007 to 2017, CDI was present among 1,158,047 hospitalized patients. The majority (84.04%) of the patients were ≥50 years old versus 15.95% of patients <50 years old. From 2007 to 2017, there was a significant increase in CDI among <50-year-old hospitalized patients (12.6% from 2007 to 18.1% in 2017; p < 0.001). In trend analysis by ethnicities, among patients <50 years old, there was an increasing trend in Caucasians (63.9% versus 67.9%; p < 0.001) and Asian females (58.4% versus 62.6%; p < 0.001). We observed an increased trend of discharge to home (91.3% vs 95.8%; p < 0.001) in association with a decrease in discharge to facility (8.3% vs 4%; p < 0.001). The average LOS from 2007 to 2017 was 5 ± 0.03 days, which remained stable during the study period. Conclusions The proportion of young (<50 years old) hospitalized patients with CDI has been steadily increasing over the past decade. Our findings might represent new epidemiological trends related to non-traditional risk factors. Future CDI surveillance should extend to the young population to confirm our findings, and the study of emerging risk factors is required to better understand the increasing CDI hospitalization in the young population.
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Shah H, Ali A, Patel AA, Abbagoni V, Goswami R, Kumar A, Velasquez Botero F, Otite E, Tomar H, Desai M, Maiyani P, Devani H, Siddiqui F, Muddassir S. Trends and Factors Associated With Ventilator-Associated Pneumonia: A National Perspective. Cureus 2022; 14:e23634. [PMID: 35494935 PMCID: PMC9051358 DOI: 10.7759/cureus.23634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is a hospital-acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Studies showing temporal trends, predictors, and outcomes of VAP are very limited. Objective: We used the National database to delineate the trends and predictors of VAP from 2009 to 2017. Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) for adult hospitalizations who received mechanical ventilation (MV) by using ICD-9/10-CM procedures codes. We excluded hospitalizations with length of stay (LOS) less than two days. VAP and other diagnoses of interest were identified by ICD-9/10-CM diagnosis codes. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze the data. Results: Out of a total of 5,155,068 hospitalizations who received mechanical ventilation, 93,432 (1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with a 5% decrease. Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25 days vs. 12 days; p<0.001). In multivariable regression analysis, we identified that males, African Americans, teaching hospitals and co-morbidities like neurological disorders, pulmonary circulation disorders and electrolyte disorders are associated with the increased odds of developing VAP. VAP was also associated with higher rates of discharge to facilities and increased LOS. Conclusion: Our study identified the trends along with the risk predictors of VAP in MV patients. Our goal is to lay the foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to reduce the incidence of VAP among MV patients.
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Bazigh I, Asfour M, Muddassir S, Mughni S. Acute Pancreatitis After the Use of Belimumab in a Patient With Systemic Lupus Erythematosus: Case Report and Review of Literature. Cureus 2022; 14:e22540. [PMID: 35345744 PMCID: PMC8956404 DOI: 10.7759/cureus.22540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Belimumab is a B-cell depletion therapy that has emerged as an effective and safe treatment option for Systemic Lupus Erythematosus (SLE), but ongoing phase IV trials continue to report its common and rare adverse effects. Our case report seeks to add data to the existing literature on the safety profile of belimumab. We report an interesting and complicated case of a 30-year-old female with a 12-year history of SLE and multiple treatment failures who developed acute pancreatitis in the context of the initiation of belimumab. The temporal link between the two events made us undertake a review of literature on the efficacy and safety of belimumab. We used PubMed and Medline to shortlist eight studies that included phase III parent and extension clinical trials of belimumab that had been conducted in the past 10 years and illustrated the results in a tabulated form. The United States Food and Drug Administration has approved belimumab as a safe and effective treatment option for SLE. The BLISS-52, BLISS-76, and BLISS-SC trials along with their extension trials showed that SRI (SLE Responder Index) was higher in the patient cohorts that were treated with IV (intravenous) or SC (subcutaneous) belimumab. According to the website “eHealthMe.com”, which tracks the incidence of adverse events from drugs by allowing people to report events, 14100 people reported side effects when taking belimumab and among them, 29 people (0.21%) reported acute pancreatitis. Time on belimumab when patients had acute pancreatitis was 1-2 years for 52% of the patients and 1-6 months for 40% of the patients; 96% of the patients were females. The age group at which it was most reported was 40-49 years. Additional data is needed to enable a better characterization of the pathophysiology and nature of acute pancreatitis as a possible side effect of belimumab.
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Iqbal AM, Mohammed SK, Zubair N, Mubarik A, Ahmed A, Jamal SF, Hassan SM, Haq F, Muddassir S. The Impact of Door to Diuretic Time in Acute Heart Failure on Hospital Length of Stay and In-Patient Mortality. Cureus 2021; 13:e12742. [PMID: 33643721 PMCID: PMC7884126 DOI: 10.7759/cureus.12742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Acute heart failure (AHF) can be life-threatening if not treated promptly and can significantly increase the number of annual emergency department (ED) encounters in the United States. Achieving adequate and prompt euvolemic state in AHF patients using intravenous (IV) diuretics is the cornerstone of treatment, which not only reduces in-hospital stay and mortality but also decreases healthcare expenditures. Surprisingly, the door to diuretic (D2D) time in AHF patients has always been a debatable issue among physicians worldwide, and so far, there are no set guidelines. This study examines a large cohort of AHF patients to determine the association between diuretics use within 90 minutes of ED admission and hospital length of stay (LOS) and patient mortality. Methods Retrospective institutional data of AHF patients receiving IV diuretics following ED admission were extracted from 2016 to 2017. A total of 7,751 patients treated for AHF exacerbation were included, which were further divided into two groups based on the timing of diuretics administration (<90 minutes vs. ≥90 minutes). The primary outcomes were LOS between the two groups and hospital mortality. The standard statistical methodology was used for data analysis. Results A total of 7,751 AHF cases receiving IV diuretics were identified. Almost 1,432 patients (18.5%) received IV diuretics within 90 minutes of ER admission (group 1) while 6,319 patients (81.5%) patients received IV diuretics after 90 minutes (group 2). Furthermore, among group 1 patients, average LOS was noted to be associated with shorter hospitalization (average of 1.423 days less as compared to group 2 patients (confidence interval (CI) =1.02-1.82; p<0.05). Finally, after controlling for other mortality risk factors, patients in group 2 were 1.435 times more likely to have died compared to patients in group 1 (CI=1.03-1.98; p<0.05). Conclusions D2D time in AHF patients has always been a crucial judgmental decision. The current study successfully demonstrated the relation between IV diuretics administration within 90 minutes of ED admission, favorable clinical outcomes, and decreased mortality rates. More adequately powered studies are needed to validate the results of our current study further.
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Affiliation(s)
- Arshad Muhammad Iqbal
- Internal Medicine, University of South Florida Morsani College of Medicine Graduate Medical Education (GME) Oak Hill Hospital, Brooksville, USA
- Cardiology/Electrophysiology, University of Missouri School of Medicine, Columbia, USA
| | - Sohaib K Mohammed
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Nida Zubair
- Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK
| | - Ateeq Mubarik
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
- Sleep Medicine, New York Sleep Disorder Center, Brooksville, USA
- Internal Medicine, Ascension St. Michael's Hospital, Stevens Point, USA
| | - Adnan Ahmed
- Internal Medicine, Saint Joseph Hospital, Chicago, USA
| | | | | | - Furqan Haq
- Miscellaneous, Hospital Corporation of America West Florida, Tampa, USA
| | - Salman Muddassir
- Internal Medicine, University of South Florida Morsani College of Medicine Graduate Medical Education (GME) Oak Hill Hospital, Brooksville, USA
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Lambird E, Patel D, Amble A, Henderson E, Muddassir S. A Rare Case of Hypereosinophilic Syndrome-Induced Shower Thrombus Responsive to Nilotinib. Cureus 2020; 12:e8341. [PMID: 32617216 PMCID: PMC7325400 DOI: 10.7759/cureus.8341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hypereosinophilic syndrome (HES) is a rare clinical disease that affects 0.036/100,000 patients, with a minority of patients having associated genetic markers which can encompass PDGFRA/B or FGFR1 mutations. The prognosis is dependent on the timing of diagnosis and early treatment, with a mortality rate ranging from 48% to 75% if there is a delayed diagnosis. Eosinophilic myocarditis is characterized by invasion of the myocardium with eosinophils. Myeloid neoplasms are a rare, but known cause of HES induced myocarditis. Signs and symptoms can range from being asymptomatic to retrosternal pain, arrhythmias, and even sudden death. HES myocarditis is a diagnosis of exclusion that is made via endomyocardial biopsy. Peripheral eosinophilia is the only specific sign to suggest eosinophilic myocarditis with traditional biomarkers, electrocardiogram, and echocardiogram. Treatment modalities include systemic corticosteroids and symptomatic management. Complications from HES myocarditis may include embolic events, eosinophilic vegetations, and dysrhythmias, or conduction disturbances. We present a case of a 62-year-old male who initially presented with epigastric pain, and then suffered a myocardial infarction. After testing, the probable diagnosis of eosinophilic myocarditis was made. His clinical course was complicated by the development of shower thrombus associated with acute encephalopathy. Although HES has classically been treated with imatinib, in this case, an alternative biologic agent was used, resulting in a good prognosis and ultimate patient survival. This case details the importance of early clinical suspicion, diagnosing the condition, and early initiation of treatment to prevent worsening clinical status.
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Abstract
Non-small cell lung cancer is one of the leading causes of mortality in the United States. The BRAF mutation, which has been associated with malignant melanoma, has been documented in only 3.5-5% of the non-small cell lung cancer (NSCLC) patient population.The involvement of the BRAF mutation in NSCLC and the treatment for tumors with such mutations is still an evolving topic of interest, which is why more in depth information is warranted. We present a rare case of stage IV non-small cell lung adenocarcinoma, who presented first with a complicated pericardial effusion with evidence of malignant effusion. He had genetic testing done, revealing he had a positive BRAF V600E mutation. He was put on multiple chemotherapy regimens, but was most responsive to Vemurafenib. This case will shed light into the importance of the BRAF V600E gene and its importance in NSCLC for better prognosis value.
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Affiliation(s)
- Dharti Patel
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Ateeq Mubarik
- Internal Medicine, Ascension St. Michael's Hospital, Stevens Point, USA.,Internal Medicine, Oak Hill Hospital, Brooksville, USA.,Sleep Medicine, New York Sleep Disorder Center, Brooksville, USA
| | | | - Ali Vaziri
- Internal Medicine, Oak Hill Hospital, Broooksville, USA
| | - Salman Muddassir
- Internal Medicine, Hospital Corporation of America West Florida GME Consortium / Oak Hill Hospital, Brooksville, USA
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Abstract
Patient: Male, 70 Final Diagnosis: Acute interstitial nephritis Symptoms: Dark color urine, difficult voiding Medication: Rivaroxaban Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Fahad Zafar
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | | | - Ateeq Mubarik
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | - Melanie Rojas
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | - Salman Muddassir
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
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Patel D, Iqbal AM, Mubarik A, Zafar F, Siddiqui SM, Jupalli A, Mitzov NP, Muddassir S. Spontaneous Fungal Peritonitis as a Rare Complication of Ascites Secondary to Cardiac Cirrhosis: A Case Report. Am J Case Rep 2019; 20:1526-1529. [PMID: 31619662 PMCID: PMC6818645 DOI: 10.12659/ajcr.917757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spontaneous fungal peritonitis (SFP) is a life-threatening infection which occurs more commonly in patients with liver failure. SFP is not as common as spontaneous bacterial peritonitis (SBP) and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. Spontaneous fungal peritonitis is extremely uncommon in patients with cardiac ascites due to a high protein content, which predisposes to a low risk of infections. CASE REPORT This report presents a rare case of spontaneous fungal peritonitis in a patient with cardiogenic ascites. To the best of our knowledge, this is the second known case of SFP occurring in a patient with cardiac cirrhosis. The patient did not respond to initiation of SBP treatment and after ascitic fluid grew Candida glabrata, the diagnosis of SFP was made. The patient's clinical status improved after initiation of intravenous caspofungin. CONCLUSIONS SFP should be a differential diagnosis in patients who have cardiac or liver cirrhosis, who are not improving with empirical antibiotic therapy for spontaneous bacterial peritonitis.
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Mubarik A, Siddiqui S, Iqbal AM, Hassan SM, Chauhan L, Muddassir S, Eddib A. THE INCIDENCE OF GI BLEED AMONG DIFFERENT NOVEL ORAL ANTICOAGULANTS: RESULTS FROM A LARGE INSTITUTIONAL DATABASE. Chest 2019. [DOI: 10.1016/j.chest.2019.08.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Chauhan L, Mubarik A, Eddib A, Eid M, Vaziri A, Muddassir S. Complete Eye Ophthalmoplegia: the unusual initial presentation of Leptomeningeal Carcinomatosis. J Community Hosp Intern Med Perspect 2019; 9:355-357. [PMID: 31528289 PMCID: PMC6735305 DOI: 10.1080/20009666.2019.1640016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/28/2019] [Indexed: 11/02/2022] Open
Abstract
Ophthalmoplegia is a paralysis or weakness of extraocular muscles that have a variety of different etiologies including and not limited to Leptomeningeal Carcinomatosis (LC). LC is caused mainly by metastatic cancers and can cause a wide variety of symptoms. We present a case of LC with no preexisting condition who presented with a unilateral ophthalmoplegia as initial presentation who was found to have LC secondary to large B-cell lymphoma.
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Affiliation(s)
- Lakshpaul Chauhan
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Ateeq Mubarik
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Abdulmagid Eddib
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Mohammad Eid
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Ali Vaziri
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
| | - Salman Muddassir
- Graduate Medical Education, Oak Hill Hospital, Brooksville, Florida, USA
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Talbot Z, Amble A, Delva G, Eddib A, Muddassir S. Severe Sepsis and Wet Gangrene Requiring Foot Amputation Caused by an Emerging Human Pathogen - Shewanella algae. Cureus 2019; 11:e5668. [PMID: 31720144 PMCID: PMC6823033 DOI: 10.7759/cureus.5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 69-year-old woman with type 2 diabetes mellitus, peripheral vascular disease, and other comorbidities presented with recurrent syncopal episodes. Cellulitic skin changes in her right lower extremity were noted, as well as a large hemorrhagic bulla on the dorsum of her right foot. Severe sepsis was determined to be the reason for her syncopal episodes. Blood cultures and the bulla aspirate culture were positive for Shewanella algae that was pan-sensitive to antibiotics. Her clinical status was stabilized with a regimen of intravenous fluids and broad-spectrum antibiotics. However, due to the development of right foot gangrene, she underwent debridement and eventually required transmetatarsal open amputation.
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Affiliation(s)
- Zuzana Talbot
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Arun Amble
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Guesly Delva
- Internal Medicine, Oak Hill Hospital, Brookville, USA
| | - Abdulmagid Eddib
- Internal Medicine: Critical Care, Oak Hill Hospital, Brooksville, USA
| | - Salman Muddassir
- Internal Medicine, Hospital Corporation of America West Florida GME Consortium / Oak Hill Hospital, Brooksville, USA
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Abstract
Patient: Male, 27 Final Diagnosis: Sick sinus syndrome Symptoms: Syncope Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
| | - Ateeq Mubarik
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
| | | | | | - Salman Muddassir
- Department of Internal Medicine, Oak Hill Hospital, Brooksville, FL, USA
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Abstract
Cardiac myxoma is an uncommon diagnosis but presents with common manifestations. There is a wide range of symptomatology from non-specific fever and weight loss to stroke-like symptoms. It is also one of the rare causes of cardiac syncope and thromboembolic events. We present a case of a 67-year-old female who presented with seemingly benign vertigo symptoms which she ignored for years before seeking medical attention. An echocardiogram revealed a 3.5 x 3.0 x 1.0 cm atrial myxoma which was surgically excised. Her symptoms have resolved entirely with no recurrence since surgery.
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Affiliation(s)
| | - Ateeq Mubarik
- Internal Medicine, Ascension St. Michael's Hospital, Stevens Point, USA
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Mohammed SK, Mubarik A, Nadeem B, Khan K, Muddassir S. Atypical Hemolytic Uremic Syndrome: A Case Report. Cureus 2019; 11:e4634. [PMID: 31312560 PMCID: PMC6623993 DOI: 10.7759/cureus.4634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Patel D, Iqbal AM, Mubarik A, Vassa N, Godil R, Saad M, Muddassir S. Delftia acidovorans: A rare cause of septic pulmonary embolism from catheter-related infection: Case report and literature review. Respir Med Case Rep 2019; 27:100835. [PMID: 31011526 PMCID: PMC6462758 DOI: 10.1016/j.rmcr.2019.100835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 11/01/2022] Open
Abstract
Septic pulmonary emboli is a rare condition due to the dislodgement of an infected thrombus traveling to the pulmonary vasculature via the venous system. Staphylococcus spp. and Candida spp. are the most common causative agents. The most common risk factor is intravenous drug abuse, but there has been an association with intravenous catheters. Delftia acidovorans (DA) is a rare organism causing catheter-related infection, which has a tendency to embolize and clog up major vessels. It is highly resistant to all available aminoglycoside agents. There are only a few cases reported in children showing DA as a cause of septic emboli with none of the cases reported in a young patient. We report a similar case but in a young adult who developed septic emboli due to DA that was caused by an infected peripherally inserted central catheter (PICC) line. Since the organism is highly susceptible to recurrent embolization, the PICC line was removed and the patient was treated successfully with an appropriate antibiotic regime.
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Affiliation(s)
| | | | | | | | - Rania Godil
- Oak Hill Hospital, Brooksville, FL, 34613, USA
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Mubarik A, Jupalli A, Iqbal AM, Mohammed SK, Muddassir S, Abdulmagid E. Mycoplasma pneumonia with hydropneumothorax: A case report. Respir Med Case Rep 2019; 26:299-300. [PMID: 30859064 PMCID: PMC6396097 DOI: 10.1016/j.rmcr.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/26/2022] Open
Abstract
Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia in adults. Mycoplasma pneumoniae pneumonia (MPP) presents with pulmonary and extrapulmonary manifestations. Pneumothorax is a rare MPP complication in children. But, we reported a case of MPP with hydropneumothorax in an adult. The association of MPP, hydropneumothorax, and empyema is extremely rare.
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Mubarik A, Jupalli A, Iqbal AM, Muddassir S, Eddib A. Isolated Starvation Ketoacidosis: A Rare Cause of Severe Metabolic Acidosis Presenting with a pH Less than 7. Cureus 2019; 11:e4086. [PMID: 31019864 PMCID: PMC6467431 DOI: 10.7759/cureus.4086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Anion gap metabolic acidosis (AGMA) occurs when an anion gap exists along with metabolic acidosis, most commonly due to diabetic ketoacidosis (DKA) and lactic acidosis (LA). Isolated starvation ketoacidosis (ISK) is one of the rare causes of AGMA; however, it usually presents with a mild disturbance in pH. We report a rare case of a 45-year-old female with previously diagnosed squamous cell cancer (SCC) of the larynx. She presented to the emergency department complaining of difficulty in breathing following laryngectomy and tracheostomy for SCC. Her laboratory results on admission were consistent for isolated starvation ketoacidosis and the patient responded quickly to the appropriate treatment.
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Affiliation(s)
- Ateeq Mubarik
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
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Hassan M, Mubarik A, Patel C, Haq F, Muddassir S. Atheroma of the Innominate Artery Presenting as a Transient Ischemic Attack. Cureus 2019; 11:e3961. [PMID: 30956913 PMCID: PMC6436674 DOI: 10.7759/cureus.3961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Supra-aortic atherosclerotic lesions, including innominate artery atheromas, are an uncommon but established cause of transient ischemic attacks, stroke, upper extremity ischemia, and vertebrobasilar insufficiency. We present a patient with a transient ischemic attack admitted with right hemispheric symptoms who was found to have a severe ulcerated innominate artery atheroma. The patient underwent an aortic arch angiogram with stenting of the innominate artery. The proper diagnosis, treatment, and management of innominate artery atheromas are imperative to prevent further cardiovascular morbidity and mortality in patients. Currently, both endovascular and surgical options are available for revascularization, and there have been no randomized controlled trials comparing endovascular versus open repair to standardize one as the standard of care over the other. No randomized controlled trials are examining the benefit of dual versus single antiplatelet therapy post-stenting in supra-aortic atherosclerotic lesions. We believe that this topic warrants further research and needs evidence-based guidelines to help direct physicians about treatment and management.
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Affiliation(s)
- Moin Hassan
- Internal Medicine, North Shore Medical Center, Salem, USA
| | - Ateeq Mubarik
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Chirag Patel
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
| | - Furqan Haq
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
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Rojas M, Mubarik A, Henderson EA, Agha F, Chauhan L, Iqbal AM, Vaziri A, Muddassir S. Pulmonary arterial hypertension: A rare yet fatal complication of Neurofibromatosis Type 1. Respir Med Case Rep 2019; 27:100832. [PMID: 30997327 PMCID: PMC6451192 DOI: 10.1016/j.rmcr.2019.100832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
| | - Ateeq Mubarik
- Corresponding author. Chief Resident Internal Medicine Oakhill Hospital, 11375 Cortez Blvd, Brooksville, FL, 34613, USA.
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Mubarik A, Hassan SM, Felix M, Muddassir S, Haq F. A confusing manifestation: a case report of neurosarcoidosis presenting with confusion. J Community Hosp Intern Med Perspect 2018; 8:363-367. [PMID: 30559946 PMCID: PMC6292345 DOI: 10.1080/20009666.2018.1536239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction: Sarcoidosis is an inflammatory granulomatous multisystem disease with an unknown etiology. Neurosarcoidosis is a cryptogenic neuroinflammatory manifestation of sarcoidosis. Case report: We describe a case of neurosarcoidosis with initial presentation as confusion. Our patient fits the picture of probable neurosarcoidosis as per the Zajicek et al criteria, with the clinical presentation of neurosarcoidosis, evidence of inflammation in the CNS, evidence of systemic sarcoidosis and exclusion of other diseases. He was started on steroids with subsequent improvement in mental status. Discussion and conclusion: The diagnosis of neurosarcoidosis becomes challenging when neurosarcoidosis presents as isolated clinical neurological symptoms. We want to highlight the highly variable nature of neurosarcoidosis and underscore the fact that for cryptogenic neuroinflammatory diseases, neurosarcoidosis should be considered after excluding common infections and autoimmune causes. Abbreviations: CXR: Chest X-ray; CTA: Computed tomography angiography; PCR: Polymerase chain reaction; DNA: Deoxyribonucleic acid; MRI: Magnetic resonance imaging; ACE: Angiotensin converting enzyme; HRCT: High Resolution computed tomography
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Affiliation(s)
- Ateeq Mubarik
- Department of Internal Medicine, Graduate Medical Education, Oak Hill Hospital, Brooksville, FL, USA
| | - Syed Moin Hassan
- Oak Hill Hospital, Graduate Medical Education, Internal Medicine Residency, Brooksville, FL, USA
| | - Monicka Felix
- Department of Internal Medicine, Graduate Medical Education, Oak Hill Hospital, Brooksville, FL, USA
| | - Salman Muddassir
- Department of Internal Medicine, Graduate Medical Education, Oak Hill Hospital, Brooksville, FL, USA
| | - Furqan Haq
- HCA-West Florida Division, Tampa, FL, USA
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Hassan SM, Mubarik A, Muddassir S, Haq F. Brain metastasis in colorectal cancer presenting as refractory hypertension. J Community Hosp Intern Med Perspect 2018; 8:215-219. [PMID: 30181829 PMCID: PMC6116300 DOI: 10.1080/20009666.2018.1490138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Brain metastasis (BM) from colorectal cancer (CRC) is rare with the incidence ranging from 0.6% to 3.2%. There is also an increased incidence of BM with rectal primaries and is consistent with this patient’s presentation. Overall, there is scarce literature on the symptoms of patients who present with CRC BMs. Objectives: We present a case of brain metastasis in colorectal cancer presenting with hypertensive urgency and severe headache. Methods and results: This case highlights that neurological deficits are not necessary for BMs in patients with CRC and summarizes and reviews the associated literature regarding BM in CRC. A 57-year-old female with a past medical history of recently diagnosed stage IV moderately differentiated distal rectal adenocarcinoma with liver and lung metastasis was admitted with the primary complaint of hypertensive urgency, severe headache, intractable nausea and vomiting, and diarrhea. Magnetic resonance imaging brain showed a left cerebellar lesion measuring 3.6 × 3.2 × 2.9 cm, ipsilateral transtentorial herniation, and obliteration of the fourth ventricle. The patient was started on steroids and transferred for an urgent neurosurgical intervention to a tertiary care center. Conclusions: Even though BMs are rare in CRC, clinicians should have a high index of suspicion with complaints like hypertensive urgency, headache, nausea, vomiting, vertigo, and blurring of vision triggering imaging studies to rule out BM. The approach to BM has become increasingly individualized as surgical and radiosurgical therapies have continued to evolve Abbreviations: CRC: Colorectal cancer; BM: Brain metastasis; FOLFOX: Folinic acid, fluorouracil and oxaliplatin; CT: Computed tomography; IV: Intravenous; PO: By mouth; BAER: Brain auditory evoked response hearing testing; SSEP’s: Somatosensory evoked potentials; BMFI: Brain metastasis free interval; WBRT: Whole-brain radiation therapy; SRS: Stereotactic radiosurgery.
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Affiliation(s)
- Syed Moin Hassan
- Internal Medicine Resident, Oak Hill Hospital, Brooksville, FL, USA
| | - Ateeq Mubarik
- Internal Medicine Resident, Oak Hill Hospital, Brooksville, FL, USA
| | - Salman Muddassir
- Internal Medicine Resident, Oak Hill Hospital, Brooksville, FL, USA
| | - Furqan Haq
- Hospital Corporation America (HCA), West Florida Division, Tampa, FL, USA
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Hassan SM, Mubarik A, Muddassir S, Haq F. Adult idiopathic hypertrophic pyloric stenosis - a common presentation with an uncommon diagnosis. J Community Hosp Intern Med Perspect 2018; 8:64-67. [PMID: 29686790 PMCID: PMC5906761 DOI: 10.1080/20009666.2018.1444905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/15/2018] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Adult Idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare but well-defined entity in adults with only 200-300 cases reported so far in the literature.We describe a case of AIHPS and the relevant literature review. Methods and Results: The patient presented with acute onset upper abdominal pain associated with nausea, vomiting, foul-smelling black tarry stools, and anorexia. On the Esophagogastroduodenoscopy (EGD), pylorus demonstrated a unique “cervix sign.” The patient had multiple endoscopic dilations with minimal relief. She then underwent a distal partial gastrectomy with a Billroth 1 gastroduodenostomy with considerable improvement in her symptoms on follow up. Conclusion: Adult Idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare disease which is also underreported due to a difficulty in diagnosis. The most common symptoms of AIHPS are postprandial nausea, vomiting, early satiety, and epigastric pain as seen in our patient. Endoscopy usually shows ?Cervix sign? a unique sign showing a fixed, markedly narrowed pylorus with a smooth border. Multiple treatments have been proposed for AIHPS, including endoscopic dilation, pyloromyotomy with or without pyloroplasty, gastrectomy with a Billroth 1 gastroduodenostomy. Currently, there is no evidence of one surgical technique being superior to another. Further research needs to be done on AIHPS before one technique can be standardized as the standard of care.
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Affiliation(s)
- Syed Moin Hassan
- Internal Medicine Residency, Oak Hill Hospital, Brooksville, FL, USA
| | - Ateeq Mubarik
- Internal Medicine Resident, Oak Hill Hospital, Brooksville, FL, USA
| | - Salman Muddassir
- Internal Medicine Resident, Oak Hill Hospital, Brooksville, FL, USA
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Alperstein A, Fertig RM, Feldman M, Watford D, Nystrom S, Delva G, Muddassir S. Septic thrombophlebitis of the internal jugular vein, a case of Lemierre's syndrome. Intractable Rare Dis Res 2017; 6:137-140. [PMID: 28580216 PMCID: PMC5451747 DOI: 10.5582/irdr.2017.01021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 18-year-old gentleman with a history of recurrent tonsillitis presented to the emergency room complaining of worsening sore throat. He was found to have a peritonisillar abscess, and imaging revealed a non-occlusive left internal jugular vein thrombosis. Lemierre's syndrome is a rare, potentially fatal condition characterized by internal jugular vein thrombosis with septicemia following an acute oropharyngeal infection. While anticoagulation is the mainstay of treatment of deep venous thromboembolism (DVT) and pulmonary embolism (PE), the use of therapy is controversial in septic thrombophlebitis. This is counterintuitive since a common reported complication is pulmonary emboli. Early in the course of thrombophlebitis, while the thrombus is firmly attached, antibiotics may be all that is necessary to treat the condition.
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Affiliation(s)
- Adam Alperstein
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Raymond M. Fertig
- University of Miami, Miller School of Medicine, Miami, FL, USA
- Address correspondence to: Dr. Raymond Fertig, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, 1475 NW 12th Ave, 2nd Floor Miami Florida, 33136, USA. E-mail:
| | - Matthew Feldman
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Daniel Watford
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan Nystrom
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Guesly Delva
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
| | - Salman Muddassir
- Oak Hill Hospital, Graduate Medical Education, Department of Internal Medicine, Brooksville, FL, USA
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Siddiqui WJ, Iyer P, Amba S, Muddassir S, Cheboterav O. Ventricular septal defect: early against late surgical repair. J Community Hosp Intern Med Perspect 2016; 6:30460. [PMID: 26908387 PMCID: PMC4763561 DOI: 10.3402/jchimp.v6.30460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/09/2016] [Accepted: 01/18/2016] [Indexed: 11/14/2022] Open
Abstract
Ventricular septal defect (VSD) is a rare complication of right ventricular infarction (RVI) which is associated with significant mortality, if not treated appropriately. It typically occurs within the first 10-14 days after myocardial infarction. Surgical repair has been shown to reduce in-hospital mortality from 90% to 33-45%. Early surgical VSD repair has also been associated with high 30-day operative mortality of 34-37%. Furthermore, after an acute MI the friable myocardium enhances the risk of recurrent VSD with early surgical repair. We present a case of a middle-aged woman who developed VSD after an RVI. Her surgical repair was delayed by 2 weeks due to development of Staphylococcus aureus bacteremia. During this period, she was managed medically and later on underwent percutaneous repair with an amplatzer VSD occluder device. Keeping this patient encounter in mind, we would like to emphasize on the limited recommendations available for early against late surgical repair of VSD.
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Affiliation(s)
- Waqas J Siddiqui
- Internal Medicine Department, Saint Francis Medical Center, Trenton, NJ, USA
| | - Praneet Iyer
- Internal Medicine Department, Saint Francis Medical Center, Trenton, NJ, USA;
| | - Samridhi Amba
- Internal Medicine Department, Saint Francis Medical Center, Trenton, NJ, USA
| | - Salman Muddassir
- Department of Internal Medicine, Oak Hill Medical Center, Jacksonville, FL, USA
| | - Oleg Cheboterav
- Department of Cardiology, Saint Francis Medical Center, Trenton, NJ, USA
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Osgood E, Muddassir S, Jaju M, Moser R, Farid F, Mewada N. Starvation marrow - gelatinous transformation of bone marrow. J Community Hosp Intern Med Perspect 2014; 4:24811. [PMID: 25317270 PMCID: PMC4185148 DOI: 10.3402/jchimp.v4.24811] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/14/2022] Open
Abstract
Gelatinous bone marrow transformation (GMT), also known as starvation marrow, represents a rare pathological entity of unclear etiology, in which bone marrow histopathology demonstrates hypoplasia, fat atrophy, and gelatinous infiltration. The finding of gelatinous marrow transformation lacks disease specificity; rather, it is an indicator of severe illness and a marker of poor nutritional status, found in patients with eating disorders, acute febrile illnesses, acquired immunodeficiency syndrome, alcoholism, malignancies, and congestive heart failure. We present a middle-aged woman with a history of alcoholism, depression, and anorexia nervosa who presented with failure to thrive and macrocytic anemia, with bone marrow examination demonstrative of gelatinous transformation, all of which resolved with appropriate treatment. To our knowledge, there are very few cases of GMT which have been successfully treated; thus, our case highlights the importance of proper supportive management.
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Affiliation(s)
- Eric Osgood
- St. Francis Medical Center, Department of Internal Medicine, Seton Hall University School of Graduate Medical Sciences, South Orange, NJ, USA
| | - Salman Muddassir
- St. Francis Medical Center, Department of Medicine, Seton Hall University School of Graduate Medical Sciences, South Orange, NJ, USA
| | - Minal Jaju
- St. Francis Medical Center, Department of Internal Medicine, Seton Hall University School of Graduate Medical Sciences, South Orange, NJ, USA
| | - Robert Moser
- St. Francis Medical Center Department of Pathology, Johns Hopkins University, South Orange, NJ, USA
| | - Farwa Farid
- Rawalpindi Medical College, Department of Radiology, Holy Family Hospital, Rawalpindi, Pakistan
| | - Nishith Mewada
- St. Francis Medical Center, Department of Internal Medicine, Seton Hall University School of Graduate Medical Sciences, South Orange, NJ, USA
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Tariq S, Muddassir S, Patel JK. Single coronary artery anomaly: branching of left coronary artery from right coronary artery with 2 distinct patterns. J Invasive Cardiol 2012; 24:E67-E71. [PMID: 22477760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Normal coronary vasculature has a left coronary artery arising from the left coronary cusp and a right coronary artery arising from the right coronary cusp. In about 0.024% of cases in the general population, there is no left main coronary artery. In fact, there is a single coronary artery, which arises from the right coronary cusp. We encountered 2 such cases with distinct patterns. The first case was a patient with angina who had an abnormal stress test for which he underwent coronary angiography. This revealed a single coronary artery arising from the right coronary cusp. This vessel gave rise to the right coronary artery, which had a varicose anatomy, with a critical lesion in the posterior descending artery. The left coronary artery passed anteriorly to the pulmonary artery with a critical lesion in the circumflex artery. In the second case, the patient also had angina with a normal noninvasive work-up but due to his persistent symptoms, coronary angiography was performed. This revealed a single coronary artery arising from the right coronary cusp. Subsequent CT angiography revealed that the left coronary artery coursed in between the aorta and pulmonary artery without critical lesions. In both cases, the patients underwent coronary artery bypass grafting.
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Affiliation(s)
- Saad Tariq
- St. Francis Medical Center, Trenton, New Jersey, USA.
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