A patient with progressive disseminated histoplasmosis was noted to have an increase in urine Histoplasma antigen level during monitoring of her disease. The patient revealed she had inadequately hydrated, and her urine volume was low and subjectively concentrated. Following hydration, urine antigen was retested and became undetectable. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Background In the USA cancer is the second leading cause of mortality, as such, primary prevention of cancer is a major public health concern. Vitamin D supplementation has been studied as a primary prevention method for multiple diseases including cardiovascular disease, osteoporosis, diabetes mellitus and cancer. The role of Vitamin D as primary prevention of cancer is still controversial. With fast emergence of large randomized controlled trials (RCTs) in that regards, we aimed to evaluate the efficacy of Vitamin D supplementation as primary prophylaxis for cancer. PKI 14-22 amide,myristoylated PKA peptide Methods A comprehensive electronic database search was conducted for all RCTs where comparison of Vitamin D supplementation versus placebo for the prevention of any type of disease with at least 3 years of Vitamin D supplementation was used and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality and cancer incidence. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-er.Background Potassium (K+) homeostasis is closely related to acid – base disorders. The aim of this study is to analyze the possible causes of hypokalemia non-surgical critically ill patients including acid – base disorders and its relationship with response to K+ supplementation. Methods We performed a retrospective cohort study of 122 consecutive non-surgical patients admitted to the Intensive Care Unit during July 2016 Patients were classified according to the presence of hypokalemia or not. Demographic data, morbidities associated with hypokalemia, with emphasis in acid-base disorders and response to treatment were described and analyzed. Results Hypokalemia was observed in 32,7% (n = 40) of the patients included. Hypokalemic group had a higher value of base excess (median of -0.65 [IQR -3.3-5.2] Vs -3.2 [IQR -5.1–1.4]; p less then 0.001). The patients with hypokalemia that achieved normal serum K+ in more than 25 h had a higher value of excess base than those who did so in less than 24 h (median of 4.3 [IQR -2.1-5.5] vs -1.9 [IQR -4.8-3]; p less then 0.05). Neither the degree of hypokalemia, the time to development, route of administration or solution concentration, speed of infusion, the amount of K+ administered per day per kg of weight were related with the response of treatment. Conclusions Hypokalemia is a common disorder in non-surgical critically ill patients. Hypokalemic patients had a higher incidence of metabolic alkalosis. Patients with hypokalemia and metabolic alkalosis needed a higher amount of potassium administration and higher time to achieve correction. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Background Great saphenous vein (GSV) grafts are used for coronary artery bypass surgeries, but the remaining stump of the GSV may be the nidus for superficial and deep vein thrombosis. This study aims to determine the risk of thrombosis in the GSV stump in patients who developed lower extremity swelling following coronary artery bypass graft (CABG). Methods We conducted a single-center retrospective analysis at Abington Jefferson Hospital of 100 patients who underwent CABG with GSV. Patients were monitored via follow-up for seven days for the development of saphenous vein thrombosis without any prophylactic anticoagulation for venous thrombosis. Risk factors including age, diabetes, hypertension, smoking, familial thrombophilia’s, family history of thrombosis, malignancy, and confounding factor-like early mobilization that may potentially alter the results were recorded. Results The mean age of included patients was 70 years, and 65% of participants were men, 35% were women. Fourteen percent of the patients 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Quality improvement projects are an important part of education for residents and outcome-based projects, and data are required by ACGME. Our resident clinic conducted a quality improvement project regarding screening and treatment for hepatitis C. We improved our screening rate per CDC guidelines and found a prevalence of 1.9% in our clinic population, higher than the national prevalence. We, as internal medicine specialists, have also successfully treated several patients with Tenncare (the equivalent of Medicaid) and uninsured through improvement in our case identification, follow-up and use of specialty pharmacies and standardized order sets. © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.Background Platelet distribution width (PDW) has demonstrated clinical significance in populations with specific disorders; its prognostic significance in internal medicine wards has not been investigated. Methods Demographic, clinical and laboratory data were collected prospectively for 1036 internal medicine inpatients. The primary outcome was 90-day mortality, secondary outcomes were treatment with mechanical ventilation, prolonged hospital stay, in-hospital death, and all-cause mortality following discharge. Data were assessed according to PDW values on admission ≤16.7% (group A) and >16.7% (group B). Results Compared to group A patients (n = 273), group B patients (n = 763) were more likely to be older, admitted for cardio-cerebrovascular disorder, to present with comorbidities, to be mechanically ventilated, to have prolonged hospital stay and to die during the current hospitalization. The respective 90-day and total (median follow-up of 5 months) mortality rates were significantly higher in group B (13.