Interfaith Medical Center is a hospital located in Brooklyn, New York. With facilities in Crown Heights, Bedford-Stuyvesant, and Prospect Heights, it is a full-service non-profit community hospital that has 287 beds and serves more than 11,000 inpatients each year. It also has more than 200,000 outpatient visits and services and 50,000 emergency department visits annually. Interfaith is also a teaching hospital, with four graduate medical education residency programs, and fellowship programs in Pulmonary Medicine, Cardiology and Gastroenterology. Interfaith continues to serve as a safety-net hospital for its surrounding community since it emerged from bankruptcy in 2014.In addition to its main campus at 1545 Atlantic Avenue, Interfaith has other buildings which house specialists who provide care and offer community education and physician referrals to several other areas in Central Brooklyn. The largest is the Bishop Orris G. Walker, Jr. Healthcare Center, located at 528 Prospect Place and serving Prospect Heights and Crown Heights. The Bishop Orris G. Walker Center houses most outpatient specialties along with an internal medicine clinic and Atlantic Urgent Care.
There is little research on the subject, despite the rising prevalence of concurrent Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) infections. We present the case of a 48-year-old immunocompetent man diagnosed with pulmonary tuberculosis with simultaneous sputum cultures positive for NTM. Chest imaging revealed bilateral upper-lobe cavitary lesions, and serial sputum studies demonstrated persistent MTB on acid-fast bacilli smears and MTB polymerase chain reaction. Standard four-drug antituberculous therapy was initiated. However, concurrent sputum cultures subsequently grew Mycobacterium abscessus and later Mycobacterium avium complex, prompting the addition of amikacin, cefoxitin, and azithromycin based on infectious disease consultation. This case illustrates the diagnostic and therapeutic challenges inherent to MTB-NTM coinfection, where distinguishing true NTM disease from colonization is critical, and underscores the importance of multidisciplinary management.
Background Decompensated cirrhosis carries a high symptom burden, frequent hospitalizations, and unpredictable disease progression [1,2]. While inpatient palliative care (PC) provides symptom relief and facilitates care alignment, its effect on readmissions at the population level remains underexplored. This study evaluates the association between inpatient PC encounters and 30- and 90-day unplanned readmissions in decompensated cirrhosis. Methods Using the 2017–2021 Nationwide Readmissions Database (NRD), adults hospitalized with decompensated cirrhosis who survived to discharge were identified. Separate weighted cohorts were analyzed for 30- and 90-day outcomes, consistent with the NRD’s design. Multivariate survey-weighted logistic regression assessed the association between inpatient PC and 30- or 90-day readmissions, adjusting for demographics, comorbidities, and hospital characteristics. Results Among 202,903 weighted hospitalizations, 5.14% included an inpatient PC encounter. Thirty-day readmission occurred in 23.46% of patients, with an in-hospital mortality rate of 8.46%. PC was associated with reduced odds of 30-day readmission (adjusted odds ratio [aOR] 0.50, 95% confidence interval [CI] 0.47–0.54, p< 0.01).In a separate 152,059 weighted hospitalizations, 5.1% received PC. Ninety-day readmission occurred in 35.94% of patients, with an in-hospital mortality rate of 8.0%. PC was associated with reduced odds of 90-day readmission (aOR 0.42, 95% CI 0.39–0.45, p< 0.01).PC recipients were older (by ∼5 years, p< 0.01), more frequently Medicare-insured (p< 0.01), of lower income (p< 0.01), and more often treated at large teaching hospitals (p< 0.01).Leading causes of readmission included alcoholic cirrhosis with ascites, sepsis, and hepatic failure. Conclusion Inpatient palliative care was consistently associated with lower 30- and 90-day readmissions in patients with decompensated cirrhosis, independent of patient and hospital factors. These findings highlight the potential of palliative care as a critical adjunct in cirrhosis management, improving care quality while reducing avoidable hospital utilization.
Wunderlich syndrome is a rare urological emergency characterized by spontaneous, nontraumatic renal hemorrhage into the subcapsular and perirenal spaces. We present the case of a 37-year-old male with end-stage renal disease on hemodialysis, hypertension, and bilateral inguinal hernias who presented with acute chest and abdominal pain, nausea, and vomiting after missing a dialysis session. The initial assessment identified severe anemia necessitating a massive transfusion, and he was subsequently treated for suspected uremic coagulopathy. Imaging with computed tomography angiography (CTA) demonstrated a massive left retroperitoneal hemorrhage. The patient also tested positive for COVID-19, potentially contributing to a complex coagulopathic state. Given ongoing bleeding, he underwent successful renal artery embolization, achieving hemostasis without surgical intervention. This case highlights the importance of early recognition of Wunderlich syndrome in high-risk patients, the diagnostic value of CTA, and the critical role of interventional radiology in management.
Isolated superior mesenteric artery (SMA) dissection is a rare vascular condition that is increasingly recognized due to the widespread use of advanced imaging modalities. It may present with abdominal pain or remain asymptomatic and be detected incidentally. We report the case of a 62-year-old male with end-stage renal disease (ESRD) on hemodialysis who presented with hypertensive emergency and acute pulmonary edema, in whom SMA dissection was incidentally identified on computed tomography angiography (CTA). The patient was successfully managed conservatively with blood pressure control, antithrombotic therapy, and close monitoring. This case highlights the importance of individualized management strategies in asymptomatic SMA dissection and supports the role of conservative therapy in stable patients without evidence of bowel ischemia.
Pernicious anemia (PA) represents a significant diagnostic challenge in neuropsychiatric patients due to its subtle and variable presentation. While PA is traditionally associated with clinical and biochemical manifestations of anemia, many patients, particularly those with neuropsychiatric symptoms, may have normal hematologic parameters, delaying recognition and appropriate treatment. Neurological and psychiatric symptoms, ranging from cognitive impairment and mood disorders to subacute combined degeneration (SCD) of the spinal cord, can precede hematologic abnormalities, leading to misdiagnosis or inappropriate management. The lack of a definitive gold standard test for cobalamin deficiency (CD) further complicates identification. Commonly used biomarkers, such as serum cobalamin, methylmalonic acid (MMA), homocysteine (Hcy), intrinsic factor antibodies (IFAs), and parietal cell antibodies (PCAs), each have limitations in diagnosing PA, especially in the absence of overt anemia. The variability in diagnostic criteria and cutoff values across studies adds to the challenge of achieving early and accurate diagnosis. This article reviews the complexities of diagnosing PA in neuropsychiatric patients, evaluates the limitations of current diagnostic methods, and emphasizes the need for a more comprehensive, standardized approach to early detection and treatment. Combining clinical awareness with improved biomarker interpretation is essential for preventing irreversible neurological damage and improving patient outcomes. Improved diagnostic protocols and further research are essential to optimize detection and minimize the risk of long-term neurological damage.
