A case of appendiceal neuroendocrine tumor with metastatic spread in a young patient.

Appendiceal neuroendocrine tumors are a rare subset of well-differentiated neuroendocrine tumors, comprising <1% of all malignancies. Appendiceal cancer is particularly rare, affecting approximately one to two individuals per one million annually in the United States. Appendiceal neuroendocrine tumors have an estimated incidence of 7/100,000 person-years in the United States.

A Retrospective Comparative Study of Sex-Based Risk Variations in Heart Failure With Preserved Ejection Fraction (HFpEF) Versus Heart Failure With Reduced Ejection Fraction (HFrEF).

Introduction/objectives: The prevalence of heart failure (HF) in the United States is currently at an all-time high and is predicted to rise to 8.5 million by 2030. Development of HF differs between men and women.

Comorbidities and Risk Factors Associated with Inflammatory Vasculitis in the Adult Population.

Introduction/objectives: Inflammatory vasculitis (IV) is characterized by blood vessel inflammation, leading to vessel damage and potential organ failure. This study aimed to identify the risk factors and comorbidities in adults with IV.

Methods: A retrospective review of adult patients receiving outpatient care was conducted.

Risk Factors and Comorbidities Associated With Vitamin B Deficiency in an Adult Population.

Introduction/objectives: Vitamin B deficiency (B12D) is associated with multiple risk factors and comorbidities; however, there are no firm guidelines regarding screening for B12D in the population at risk. We aimed to identify the risk factors and comorbidities associated with B12D in an adult population.

Methods: Retrospective review of entire cohort of adult patients who received outpatient medical care in our large urban tertiary healthcare system between January 1, 2011, and December 31, 2020.

Risk Factors in Optimal Management of Hypertension in Elderly Patients Following 2017 American College of Cardiology-American Heart Association Guidelines.

Introduction/objectives: The 2017 American Heart Association hypertension management guidelines recommended optimal control of blood pressure under 130/80 mmHg. We aimed to study the factors associated with suboptimal and uncontrolled hypertension in the elderly patients.

Methods: We performed a retrospective review of suburban outpatient records of patients with hypertension, aged 65 years and older, and grouped into optimally controlled (OC; BP <130/80 mmHg), sub-optimally controlled (SOC; BP 130-139/80-89 mmHg), and uncontrolled (UC; BP≥140/90 mmHg) groups; and compared the associations of variables.

Association of Atrial Fibrillation with Insomnia in the Elderly Population.

Introduction/objectives: Insomnia is a common sleep disorders that affects most individuals in the United States, and worldwide. Insomnia is linked with an increased risk of atrial fibrillation (AF) in adults, although the strengths of association were weak, especially in the elderly population. AF is estimated to affect approximately 3 to 6 million people in the United States.

The 2021 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and the outpatient management: Examining physician adherence and its effects on patient outcome.

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable illness that carries a large global economic and social burden. The global initiative for chronic obstructive lung disease (GOLD) guidelines has been utilized as a global strategy for the continued COPD diagnosis, assessment, and treatment. We aimed to determine if the adherence to the 2021 GOLD guideline directed management influenced outcomes.

Association of Risk Factors and Comorbidities With Chronic Pain in the Elderly Population.

Introduction/objective: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors.

Healthcare Costs and Healthcare Utilization Outcomes of Vitamin D3 Supplementation at 5000 IU Daily during a 10.9 Month Observation Period within a Pragmatic Randomized Clinical Trial.

Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization.

A Mysterious Recurrent Urticarial Rash and a Life-Altering Metal.

Allergic contact dermatitis is a common manifestation in individuals who have a contact hypersensitivity to nickel. Direct exposure to nickel triggers an adaptive immune response that mediates a localized inflammatory reaction of the skin, typically resulting in an erythematous and pruritic rash at the site of contact. We present a distinct case in which nickel was systemically introduced via a carotid stent into an individual with an unidentified allergy to nickel.

Remote and semi-automated methods to conduct a decentralized randomized clinical trial.

Introduction: Designing and conducting clinical trials is challenging for some institutions and researchers due to associated time and personnel requirements. We conducted recruitment, screening, informed consent, study product distribution, and data collection remotely. Our objective is to describe how to conduct a randomized clinical trial using remote and automated methods.

Faint of Heart: A Case of Atrial Myxoma Presenting With Atypical Syncope.

Syncope is a frequent reason for elderly patients to present to an outpatient office. The underlying cause of syncope can range from benign to serious. Although serious cases of syncope are rare, appropriate workup can help detect and address potentially fatal pathologies.

Comorbidities and Risk Factors Associated With Insomnia in the Elderly Population.

Introduction/objectives: Sleep disorders affect around 50 to 70 million Americans, with chronic insomnia being the most common, especially in the elderly population. With an 11-fold increase in the US office visits due to insomnia, from 0.8 to 9.

Risk Factors Associated With Atrial Fibrillation in Elderly Patients.

Background: Atrial fibrillation (AF) is the most common arrhythmia with a growing prevalence worldwide, especially in the elderly population. Patients with AF are at higher risk of serious life-threatening events and complications that may lead to long-term sequelae and reduce quality of life. The aim of our study was to examine the association of additional risk factors and comorbid medical conditions with AF in patients 65 years, or older.

Vitamin D3 Supplementation at 5000 IU Daily for the Prevention of Influenza-like Illness in Healthcare Workers: A Pragmatic Randomized Clinical Trial.

Vitamin D supplementation has been shown to reduce the incidence of acute respiratory infections in populations at risk. The COVID-19 pandemic has highlighted the importance of preventing viral infections in healthcare workers. The aim of this study was to assess the hypothesis that vitamin D3 supplementation at 5000 IU daily reduces influenza-like illness (ILI), including COVID-19, in healthcare workers.

Drug-Induced Liver Injury Secondary to Enobosarm: A Selective Androgen Receptor Modulator.

Selective androgen receptor modulators (SARMs) are compounds that bind to androgen receptors and have similar anabolic properties to anabolic steroids. Unlike anabolic steroids, which bind to androgen receptors in many tissues all over the body, individual SARMs selectively bind androgen receptors in certain tissues, but not in others. This selectivity has attracted researchers due to the possibility of using SARMs for the potential benefits of androgen receptor stimulation, such as increased muscle mass and increased bone density, while minimizing the adverse effects, such as erythrocytosis and hepatotoxicity.

Impact of Correcting Nutritional Deficiency Anemias in the Elderly on Hospitalizations, Falls, and Mortalities.

Background: The incidence and prevalence of anemia increase with age, particularly in adults older than 65 years, and it is associated with a number of adverse health outcomes (AHO), particularly hospitalizations, falls and mortalities. Given that approximately one-third of these anemias are due to reversible causes, we studied whether the treatment of nutritional deficiency anemia (NDA), namely iron deficiency anemia (IDA), cobalamin deficiency anemia (CDA), and folate deficiency anemia (FDA), improves AHO; and explored whether each NDA had different AHO.

Methods: We reviewed electronic medical records of our internal medicine office patients aged 65 years or older, who had a diagnosis of anemia in a non-acute setting.

Do Outpatient Podiatry Evaluations Reduce the Risk of Falls in Elderly Patients With Diabetes Mellitus?

Background: Elderly patients with diabetes mellitus (DM) are faced with potential changes in their lower extremities, such as peripheral neuropathy and peripheral arterial disease, making them vulnerable to falls. We hypothesized that evaluations by podiatrists would lower the events of falls.

Methods: A retrospective chart review of a cohort of patients with DM, 65 years or older, was performed, who visited our primary care office between January 1, 2019 and June 30, 2019.

Risk Factors and Comorbidities Associated with Diabetic Kidney Disease.

Introduction/objectives: Diabetic Kidney Disease (DKD) is the leading cause of end-stage kidney disease. Despite optimal glycemic control and blood pressure management, progression to DKD cannot be halted in some patients. We aimed to find the association of modifiable and non-modifiable risk factors and comorbid conditions in patients with DKD.

Association Between Obesity and Cancer Mortality: An Internal Medicine Outpatient Clinic Perspective.

Background: Obesity is one of the leading preventable causes of cancer that has a causal relationship with cancers of esophagus, breast and colon. Paradoxically, there are studies demonstrating that obesity is associated with improved survival in cancer patients. The aim of our study was to investigate the association of obesity and cancer mortality in adult patients.

High-Sensitivity Troponin for Suspected Acute Coronary Syndrome in Patients With Chronic Kidney Disease Versus Patients Without Chronic Kidney Disease.

Background: Heart disease is the leading cause of death in the United States. Patients with acute coronary syndrome (ACS) who have chronic kidney disease (CKD) have a twofold increase in mortality compared to patients with normal kidney function. Patients with CKD tend to have elevated baseline high-sensitivity cardiac troponin-T (hs-cTnT) levels.

Recurrent chronic thromboembolic disease despite optimal anticoagulation in setting of recent COVID-19 infection.

We present a case of a 38-year-old man with a history of chronic thromboembolic pulmonary hypertension on therapeutic anticoagulation and recent hospitalisation for COVID-19 disease who was hospitalised for recurrent acute pulmonary embolism despite therapeutic anticoagulation with warfarin (International Normalized Ratio (INR) of 3.0). Our case highlights the hypercoagulable state associated with COVID-19 disease and the absence of standardised approaches to anticoagulation treatment for this population.

Association of Elevated Levels of Inflammatory Marker High-Sensitivity C-Reactive Protein and Hypertension.

Introduction: The correlation between inflammation and vascular disease is widely accepted. High levels of C-reactive protein (CRP) have been shown to play a role in the process of endothelial dysfunction. Hypertension is described as an inflammatory vascular disease, and is 1 of the most commonly encountered diseases in the outpatient setting.

Outpatient Management of Bronchial Asthma: A Comparative Analysis Between Guideline-Directed Management and Usual Management.

Background: Bronchial asthma is a common controllable disease that causes a serious economic and social burden. The Global Initiative for Asthma (GINA) was developed to help guide clinicians in appropriate management of asthma. Despite the existence of published guidelines, common practice in many primary care clinics follows usual care based on clinical gestalt.