Journal of Investigative Medicine High Impact Case Reports, 2020
An 80-year-old male patient presented with sepsis secondary to infected central line which was pl... more An 80-year-old male patient presented with sepsis secondary to infected central line which was placed for native aortic valve endocarditis. He also had melena and abdominal pain prior to his presentation. Abdominal computed tomography (CT) was done, which showed cholelithiasis. Esophagogastroduodenoscopy was also done with no source of bleeding identified. Later, he developed hemodynamic instability requiring aggressive fluid resuscitation and multiple packed blood cell transfusions. In view of his hemodynamic instability, a repeat abdominal CT scan showed air droplets within the gallbladder pneumobilia, ascites, diverticulosis, and a bleeding infrahepatic hematoma measuring 6 × 10 cm, which was not on his prior scan 2 days prior. A mesenteric arteriogram was performed that identified an aneurysm of the right hepatic artery with no active bleeding; therefore, it was coiled. Due to his continued clinical decompensation, he underwent an urgent open cholecystectomy, in which serosangui...
Understanding the resource limitations in developing countries, a community health worker (CHW) p... more Understanding the resource limitations in developing countries, a community health worker (CHW) project was developed to help educate, provide materials, and prevent the spread of COVID-19 in Haiti. CHWs have shown to be an evidence-driven alternative in resource-limited settings. Pwojé Bon Vwazen (The Good Neighbor Project) took place from May 2020 to September 2020 in Port-au-Prince, Haiti. Through the project, 9 CHWs were trained. The project had two coordinators in Haiti. The CHWs, over the period of 4 months, were able to reach 1350 individuals and provide them with education regarding spread and prevention of COVID-19 and distribute materials including soap, hand sanitizers, and masks which were sewn in Haiti. Access to affordable health care presents a unique challenge in resource-limited countries. Training of CHWs and implementation of a CHW program can be an alternative in certain situations.
Journal of Investigative Medicine High Impact Case Reports, 2020
A 76-year-old Caucasian male with a history of rheumatoid arthritis, Raynaud’s phenomenon, pulmon... more A 76-year-old Caucasian male with a history of rheumatoid arthritis, Raynaud’s phenomenon, pulmonary embolism on warfarin, and a previous amputation of his left partial ring and fifth finger presented with acute onset of rash in bilateral lower extremities. He was recently started on trimethoprim-sulfamethoxazole due to concern for cellulitis. Differential diagnosis for acute-onset rash with the patient’s history presented as a challenge to the internist, as the differential is broad. Our case goes through the differential diagnosis to contrast the different presentations of rash in a patient with vasculitis. Ultimately skin biopsy in conjunction with a past positive cryoglobulinemic level helped confirm the diagnosis of cutaneous vasculitis, following which he was started on appropriate treatment and recovered.
Background In the US, pneumonia is the most common cause of a hospital admission. Prior analysis ... more Background In the US, pneumonia is the most common cause of a hospital admission. Prior analysis has shown that nearly one in six patients will have an all-cause 30-day readmission. Given the disparities in access to healthcare between rural and urban settings, we sought to see if patient location influenced the incidence rate for 30-day readmission after treatment for Gram Positive Pneumonia. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify index admissions with a principal diagnosis of Gram Positive Pneumonia (ICD-9 codes 482.3, 482.31, 482.32, and 482.39 for streptococcus and 482.40, 482.41, 482.42, and 482.49 for staphylococcus). The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. Applicable admissions were all adults (age >= 18) from January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates we...
Journal of Investigative Medicine High Impact Case Reports, 2020
A 28-year-old female presented to the emergency room with epigastric pain, nausea, and vomiting; ... more A 28-year-old female presented to the emergency room with epigastric pain, nausea, and vomiting; her lipase was elevated, and computed tomography of abdomen showed evidence of acute pancreatitis. Her past medical history was significant for poorly controlled insulin requiring type 2 diabetes mellitus and 2 previous admissions for hypertriglyceridemia-induced pancreatitis. Due to the severity of her pancreatitis presentation, she was admitted to the intensive care unit. She received aggressive intravenous fluid hydration and was started on an insulin drip. Apheresis was strongly considered given the degree of her hypertriglyceridemia (11 602 mg/dL), but there was no timely access to this treatment option. She, however, significantly improved with insulin therapy alone. Her triglyceride levels decreased rather quickly to 4783 mg/dL within 24 hours and by the fourth day of admission were comfortably <1000 mg/dL with insulin infusion along with clinical improvement. She was discharge...
Journal of Investigative Medicine High Impact Case Reports, 2020
Tick-borne illness has been increasingly on the rise, since the first human case was reported in ... more Tick-borne illness has been increasingly on the rise, since the first human case was reported in the late 1980s. Ehrlichia chaffeensis is one of the most common reported causes of tick-borne illness, particularly in the southern states of the United States. The clinical picture presents as a paradigm to the clinician, often missing the diagnosis without an appropriate history being taken and sometimes mistreated for other conditions. With the number of cases on the rise, new manifestations and clinical presentations due to E chaffeensis continue to be reported. Our case report is one such case in a 46-year-old male from Arkansas, with known exposure to multiple tick bites who presented with classical symptoms and laboratory values of tick-borne illness leading to atrial flutter. This unusual manifestation of atrial flutter due to tick-borne illness is rare and poorly understood. Further studies on tick-borne illness due to E chaffeensis may be needed to understand the systemic cause...
Journal of Investigative Medicine High Impact Case Reports, 2020
Dyspnea in a HIV patient often warrants an extensive workup. The most common etiology of this pre... more Dyspnea in a HIV patient often warrants an extensive workup. The most common etiology of this presentation is likely due to an infectious etiology. However, with the introduction of antiretroviral treatment, non–AIDS-defining illness including malignancies are increasingly being reported. We report the case of a 46-year-old African American female, nonsmoker who presented with dyspnea and found to have pericardial effusion. In patients with HIV presenting with dyspnea, pericardial effusion should be considered among the differential diagnosis, more so in patients in whom infectious etiologies have been ruled out. Further workup, including imaging and biopsy, revealed that our patient had metastatic lung adenocarcinoma. The introduction of antiretroviral treatment has significantly reduced mortality for those with AIDS from AIDS-defining illness and malignancies. However, the incidence of non–AIDS-defining malignancies like lung adenocarcinoma (most common non–AIDS-defining malignanc...
Journal of Investigative Medicine High Impact Case Reports, 2020
An 80-year-old male patient presented with sepsis secondary to infected central line which was pl... more An 80-year-old male patient presented with sepsis secondary to infected central line which was placed for native aortic valve endocarditis. He also had melena and abdominal pain prior to his presentation. Abdominal computed tomography (CT) was done, which showed cholelithiasis. Esophagogastroduodenoscopy was also done with no source of bleeding identified. Later, he developed hemodynamic instability requiring aggressive fluid resuscitation and multiple packed blood cell transfusions. In view of his hemodynamic instability, a repeat abdominal CT scan showed air droplets within the gallbladder pneumobilia, ascites, diverticulosis, and a bleeding infrahepatic hematoma measuring 6 × 10 cm, which was not on his prior scan 2 days prior. A mesenteric arteriogram was performed that identified an aneurysm of the right hepatic artery with no active bleeding; therefore, it was coiled. Due to his continued clinical decompensation, he underwent an urgent open cholecystectomy, in which serosangui...
Understanding the resource limitations in developing countries, a community health worker (CHW) p... more Understanding the resource limitations in developing countries, a community health worker (CHW) project was developed to help educate, provide materials, and prevent the spread of COVID-19 in Haiti. CHWs have shown to be an evidence-driven alternative in resource-limited settings. Pwojé Bon Vwazen (The Good Neighbor Project) took place from May 2020 to September 2020 in Port-au-Prince, Haiti. Through the project, 9 CHWs were trained. The project had two coordinators in Haiti. The CHWs, over the period of 4 months, were able to reach 1350 individuals and provide them with education regarding spread and prevention of COVID-19 and distribute materials including soap, hand sanitizers, and masks which were sewn in Haiti. Access to affordable health care presents a unique challenge in resource-limited countries. Training of CHWs and implementation of a CHW program can be an alternative in certain situations.
Journal of Investigative Medicine High Impact Case Reports, 2020
A 76-year-old Caucasian male with a history of rheumatoid arthritis, Raynaud’s phenomenon, pulmon... more A 76-year-old Caucasian male with a history of rheumatoid arthritis, Raynaud’s phenomenon, pulmonary embolism on warfarin, and a previous amputation of his left partial ring and fifth finger presented with acute onset of rash in bilateral lower extremities. He was recently started on trimethoprim-sulfamethoxazole due to concern for cellulitis. Differential diagnosis for acute-onset rash with the patient’s history presented as a challenge to the internist, as the differential is broad. Our case goes through the differential diagnosis to contrast the different presentations of rash in a patient with vasculitis. Ultimately skin biopsy in conjunction with a past positive cryoglobulinemic level helped confirm the diagnosis of cutaneous vasculitis, following which he was started on appropriate treatment and recovered.
Background In the US, pneumonia is the most common cause of a hospital admission. Prior analysis ... more Background In the US, pneumonia is the most common cause of a hospital admission. Prior analysis has shown that nearly one in six patients will have an all-cause 30-day readmission. Given the disparities in access to healthcare between rural and urban settings, we sought to see if patient location influenced the incidence rate for 30-day readmission after treatment for Gram Positive Pneumonia. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify index admissions with a principal diagnosis of Gram Positive Pneumonia (ICD-9 codes 482.3, 482.31, 482.32, and 482.39 for streptococcus and 482.40, 482.41, 482.42, and 482.49 for staphylococcus). The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. Applicable admissions were all adults (age >= 18) from January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates we...
Journal of Investigative Medicine High Impact Case Reports, 2020
A 28-year-old female presented to the emergency room with epigastric pain, nausea, and vomiting; ... more A 28-year-old female presented to the emergency room with epigastric pain, nausea, and vomiting; her lipase was elevated, and computed tomography of abdomen showed evidence of acute pancreatitis. Her past medical history was significant for poorly controlled insulin requiring type 2 diabetes mellitus and 2 previous admissions for hypertriglyceridemia-induced pancreatitis. Due to the severity of her pancreatitis presentation, she was admitted to the intensive care unit. She received aggressive intravenous fluid hydration and was started on an insulin drip. Apheresis was strongly considered given the degree of her hypertriglyceridemia (11 602 mg/dL), but there was no timely access to this treatment option. She, however, significantly improved with insulin therapy alone. Her triglyceride levels decreased rather quickly to 4783 mg/dL within 24 hours and by the fourth day of admission were comfortably <1000 mg/dL with insulin infusion along with clinical improvement. She was discharge...
Journal of Investigative Medicine High Impact Case Reports, 2020
Tick-borne illness has been increasingly on the rise, since the first human case was reported in ... more Tick-borne illness has been increasingly on the rise, since the first human case was reported in the late 1980s. Ehrlichia chaffeensis is one of the most common reported causes of tick-borne illness, particularly in the southern states of the United States. The clinical picture presents as a paradigm to the clinician, often missing the diagnosis without an appropriate history being taken and sometimes mistreated for other conditions. With the number of cases on the rise, new manifestations and clinical presentations due to E chaffeensis continue to be reported. Our case report is one such case in a 46-year-old male from Arkansas, with known exposure to multiple tick bites who presented with classical symptoms and laboratory values of tick-borne illness leading to atrial flutter. This unusual manifestation of atrial flutter due to tick-borne illness is rare and poorly understood. Further studies on tick-borne illness due to E chaffeensis may be needed to understand the systemic cause...
Journal of Investigative Medicine High Impact Case Reports, 2020
Dyspnea in a HIV patient often warrants an extensive workup. The most common etiology of this pre... more Dyspnea in a HIV patient often warrants an extensive workup. The most common etiology of this presentation is likely due to an infectious etiology. However, with the introduction of antiretroviral treatment, non–AIDS-defining illness including malignancies are increasingly being reported. We report the case of a 46-year-old African American female, nonsmoker who presented with dyspnea and found to have pericardial effusion. In patients with HIV presenting with dyspnea, pericardial effusion should be considered among the differential diagnosis, more so in patients in whom infectious etiologies have been ruled out. Further workup, including imaging and biopsy, revealed that our patient had metastatic lung adenocarcinoma. The introduction of antiretroviral treatment has significantly reduced mortality for those with AIDS from AIDS-defining illness and malignancies. However, the incidence of non–AIDS-defining malignancies like lung adenocarcinoma (most common non–AIDS-defining malignanc...
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Papers by Anthony Kunnumpurath