American journal of hospital medicine, volume 7, issue 4 (2023 October-December)
Permanent URI for this collection
Browse
Recent Submissions
Item Thrombus formation within a left ventricular apical aneurysm in hypertrophic cardiomyopathy with midcavity obstruction : a case report(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2023-12) Jagadish, Ashwin; Hiremagalur, Shobha; Khan, AhmedMidcavity left ventricular (LV) hypertrophy is a less common form of hypertrophic cardiomyopathy (HCM). It is associated with apical aneurysms, arrhythmias, and sudden cardiac death. Apical aneurysms can lead to the development of thrombi, and anticoagulation may be needed for individuals with this condition. Our case involves a 76-year-old female with HCM who had midcavity LV hypertrophy with obstruction and LV apical aneurysm formation. She developed a thrombus within the aneurysm, which was successfully treated with oral apixaban.Item Plasmapheresis for hyperbilirubinemia and bile cast nephropathy after terbinafine therapy(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2023-12) Hung, Justine T.; Fass, Lucas F.; Karim, Muhammad S.; Rose, William N.We report a 62-year-old Caucasian female who was treated with plasmapheresis for hyperbilirubinemia that was triggered by cholestatic liver injury that likely developed from terbinafine therapy. She initially presented with fatigue, pruritus, and jaundice. Her peak serum total bilirubin level was 66.5 mg/dL. She also had an acute kidney injury with an initial urinalysis that showed 30 proteins, 4+ bilirubin, 0-2 red blood cells, 0-5 white blood cells, 0-2 hyaline casts, and 3-5 granular casts with suspicion for bile cast nephropathy. During her hospitalization, hemodialysis and plasmapheresis were performed, and her total bilirubin decreased to 3.1 mg/dL at the time of transfer to another facility about two months after her initial presentation.Item Physician and patient perspectives on inpatients’ understanding of their care and mixed messages during hospitalization(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2023-12) To, C; Schnipper, Jeffrey; Cimino, Jenica; Bambury, Elizabeth; Harrison, James D.; Atkinson, Mariam K.Patient understanding, improved communication between providers and patients, and patient engagement have been linked to improved patient health outcomes. However, factors such as the complexity and ever-changing nature of the hospital environment as well as complex patient conditions limit the above communication, in turn decreasing patient understanding and engagement. We wish to elucidate clinician views on patients’ understanding of their care during hospitalization, as well as patient and clinician perspectives on possible solutions for improving patients’ understanding.Item Cranial impalement : a late discovery of a non-metal foreign object(University of Missouri, Department of Medicine, Division of Hospital Medicine, 2023-12) Rincón-Gallardo, Francisco J. Lugo; Mendoza-Gaona, Ana P.A 64-year-old farmer was brought to the emergency department after he was found lying on the ground. He had been herding sheep in the fields prior to being found. He was disoriented, and left facial edema was seen, as well as a small laceration on the left side of his upper lip and hematic traces in the oral cavity. Head computed tomography (CT) revealed a 122- Hounsfield-unit (HU) linear foreign body that penetrated the base of the skull (Figure 1). Seven days later, a new CT scan revealed an increase in density (137 HU) of the penetrating body (Figure 2). Infectious complications developed, and despite antibiotic therapy, progressed to septic shock and death. The material of the penetrating foreign body was never identified. Detection of head-penetrating foreign bodies remains a challenge, mainly because they may not be visible on clinical examination, and some materials, like wood, are barely visible on CT scans. Wooden foreign bodies demonstrate increasing HU over time (within approximately one week), probably caused by the gradual absorption of blood and liquid into porous dry wood. We hypothesize that the farmer had a wooden walking stick with a sharpened tip. Somehow, he tripped and as he fell, he got stabbed with the cane in the face, penetrating the base of the skull. The impact caused the tip of the cane to break off. As soft tissue swelled, the remains of the cane became embedded in the soft tissue, leaving no trace of the foreign body on clinical examination.