Obesity and Viral Infections.

The 2019 novel coronavirus disease (COVID-19) triggered a rapidly expanding global pandemic. The presence of obesity in patients with COVID-19 has been established as a risk factor for disease severity, hospital admission, and mortality. Thus, it is imperative those living with obesity be vaccinated against COVID-19. Although there is a timeframe COVID-19 vaccines are efficacious in those living with obesity, more studies need to be conducted to ensure that those long-lasting protection is maintained, as obesity has implications on the immune system.

Primary hyperparathyroidism in the geriatric population: A case report and mini literature review.

We report a case of a 93-year-old woman with PHPT secondary to a left inferior parathyroid adenoma. The patient met criteria to be a surgical candidate; however, literature about parathyroidectomy in the elderly was limited and controversial. The patient remained stable through medical management for the next 5 years.

Internal Medicine Resident Adherence to Evidence-Based Practices in Management of Diabetes Mellitus.

OBJECTIVE: Diabetic preventative health maintenance involves (1) adherence to guidelines and (2) appropriate documentation. This study evaluates the frequency with which internal medicine (IM) residents met these two outcomes. We also evaluated if there were differences in outcomes between resident classes. METHODS: In this retrospective analysis, 234 diabetic outpatient visits were analyzed. Guidelines were derived from the American Diabetes Association (ADA). The outcomes for each guideline were averaged and stratified by resident class. Averages within and between classes were compared using the student's paired t-test and one-way ANOVA respectively. RESULTS: Classes were most adherent to A1c testing guidelines (PGY-1 96.1%, PGY-2 97.6%, and PGY-3 95.9%). PGY-1 and PGY-2 classes were least adherent to podiatry (27.5% and 17.6% respectively), whereas PGY-3 had equal least adherence rates to podiatry and lifestyle modification guidelines (36.7%). All classes had highest rates in documenting A1c findings (PGY-1 92.2%, PGY-2 97.6%, and PGY-3 85.7%) and lowest rates in documenting relevant podiatry information (PGY-1 5.9%, PGY-2 5.9%, and PGY-3 11.2%). Comparing sequential resident classes, there was a decline in lifestyle counselling and documentation from PGY-1 to PGY-2. From PGY-2 to PGY-3, there was improvement in adherence to statin, podiatry, microalbuminuria, and monofilament guidelines. There was also improvement in documenting statin and monofilament usage, however, A1c reporting declined. CONCLUSION: The findings of the study suggest disproportionate levels of care in diabetes preventative management. Additionally, program directors should take caution in assuming linear improvement with sequential resident classes.

A case-control study of length of stay outliers.

OBJECTIVES: Inpatients with extended length of stay (LOS), referred to as LOS outliers, pose a challenge to health systems by contributing to high costs while assuming all the risks associated with hospital-acquired conditions. Limited research has been conducted within the US health system to better define LOS outliers and the risk factors for becoming an outlier in the setting of inpatient medicine stays. STUDY DESIGN: This was a retrospective study on adult inpatient admissions to the general medicine service of a university hospital from September 2015 to August 2016. Cases were defined as patients with observed LOS 3 SD above predicted. Controls were defined as those who stayed within 3 SD of predicted LOS. METHODS: A total of 108 LOS outliers were identified through the University Health System Consortium, and 72 were matched with inlier controls by principal diagnosis and disease severity. RESULTS: Compared with their inlier controls, outliers stayed 32.41 days longer and cost $77,228 more per stay. There were higher odds of being an outlier observed for patients with a history of smoking (odds ratio [OR], 29.5; 95% CI, 2.9-301.3), in-hospital complications (OR, 17.6; 95% CI, 3.5-88.6), hospital-acquired infections (OR, 7.2; 95% CI, 1.7-31.4), and discharge to a facility (OR, 11.5; 95% CI, 2.6-50.0). CONCLUSIONS: In-hospital complications, hospital-acquired infections, and discharge to a facility are all predictors of not only increasing hospital days for patients but also increasing the risk of becoming LOS outliers, who stay disproportionately longer and use disproportionately more resources than predicted.

Plasma cell leukemia.

We present a rare case report of a patient diagnosed with primary plasma cell leukemia (PCL) who presented with atypical signs and symptoms which acutely evolved into life-threatening multi-organ failure. This case raises questions regarding the latest diagnostic guidelines and therapeutic options in the management of acute PCL and reinforces the need for prompt treatment after diagnosis.