Medicine and Health Sciences Commons^™

Unraveling The Threads: A Case Report On Confusional Migraine And The Intricate Dance Between Psychiatry And Neurology, Mabit C. Gonzalez, Manjula Kottapalli

HCA Healthcare Journal of Medicine

Background

Migraine affects about 1 billion people worldwide and is associated with a significant negative impact on personal and occupational functioning. Migraine accompanied by aura is seen in about 15% of migraineurs. Visual aura is the most common type of aura. Much less common though are auras that involve higher mental function, such as confusional state. The confusional state may manifest with a wide variety of cortical dysfunction, such as speech impairment, increased alertness, agitation, and amnesia, often lasting longer than a typical migraine aura.

Case Presentation

The authors present the unique case of a 29-year-old patient with episodic and …

Unique Presentation Of Vertebral Artery Dissection: A Case Report, Rossen I. Kirkov, Daniel Fisher

HCA Healthcare Journal of Medicine

Background

Vertebral artery dissection (VAD) is a common cause of stroke within the younger patient population. It is usually associated with headache or neck pain, as well as signs and symptoms of a posterior circulation stroke, such as vertigo, dysarthria, and ataxia. However, there are very scarce reports of patients with this pathology presenting with focal neurologic deficits, which are more indicative of a cerebral stroke.

Case Presentation

This case involves a 46-year-old woman who presented to the emergency department (ED) with complaints of right-sided headache and neck pain, which had been ongoing for 1 week, with newly developed right …

Complications And Management Of Idiopathic Multicentric Castleman Disease, Kavanya Feustel, Jacob W. Keeling, Olivia Makos, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Background

The pathophysiology of idiopathic multicentric Castleman disease (iMCD) is poorly understood compared to the other subtypes of MCD, which has contributed to limited treatment options and poor prognosis for iMCD patients. The pathogenesis of iMCD is thought to be mediated in part by dysregulation of interleukin (IL)-6.

Case Presentation

We present a case report of a 39-year-old Caucasian man with siltuximab-refractory iMCD. He presented with severe lower extremity lymphedema and wounds. His disease progressed through standard-of-care siltuximab. Due to his severe disease-related morbidity, he contracted recurrent infections, often complicated by sepsis. Ultimately, he required a left lower extremity amputation. …

Long-Term Autoimmune Polyarthritis Due To Covid-19 Vaccine, Ramesh Pandit, Namratha Pallipamu, Trupiti Pandit

HCA Healthcare Journal of Medicine

Background

Vaccinations for COVID-19 have played a pivotal role in controlling the global pandemic, with most adverse events being mild and transient. However, rare post-vaccination autoimmune responses have been reported. The understanding of long-term rheumatologic sequelae, particularly autoimmune polyarthritis following COVID-19 vaccination, remains limited.

Case Presentation

We report the case of a 41-year-old previously healthy man who developed progressive polyarthritis and systemic symptoms following the Johnson & Johnson COVID-19 vaccine. The initial symptoms of joint swelling and arthralgia appeared within a week of the first vaccine dose, subsiding temporarily with medication. After receiving a booster dose, the patient experienced worsening …

Covid-19 Vaccine-Induced Rhabdomyolysis In A 53-Year-Old Woman, Akash Hazari, Jack Chien, Daniel Nunez

HCA Healthcare Journal of Medicine

Introduction

COVID-19-induced rhabdomyolysis is a common complication in COVID-19 infection. However, only a handful of cases have been reported showing links between COVID-19 vaccine and rhabdomyolysis.

Case Presentation

We present the case of a 53-year-old woman, who recently received COVID-19 vaccine and presented to the hospital with progressive extremity weakness. Common reasons for rhabdomyolysis were ruled out as possibility and the patient was found to have rhabdomyolysis induced from COVID-19 vaccine.

Conclusion

Even though COVID-19 vaccine-induced rhabdomyolysis is rare, it should be considered in the differential diagnosis with patients presenting with neuromuscular complaints and a recent COVID-19 vaccine.

Clinical Outcomes After Hospitalization For Acute Coronary Syndrome In Patients Treated With Semaglutide Versus Bariatric Surgery: A Retrospective Multicenter Analysis, Nameer Ascandar, Charles Boadu, Gauthier Stepman, George Skaf, Olugbenga Oyesanmi, Sabry Omar, Rias Ali, Michael Schandorf-Lartey

HCA Healthcare Journal of Medicine

Background

Obesity is a chronic medical condition with a rising prevalence in the United States. A wide range of morbidity and mortality is associated with obesity, with coronary artery disease being among the most common. Ischemic heart disease continues to be the primary cause of death in the United States. Taken together, interventions to minimize the detrimental effects of obesity on patients at risk of heart disease will not only benefit the patient, but the health care system as well.

Methods

In this retrospective study, we used the HCA Healthcare enterprise data warehouse to identify all adult patients who were …

The Prevalence Of Abdominal Compartment Syndrome In The State Of Florida, Jason M. Clark, Laura Mena-Albors, Huazhi Liu, Darwin Ang

HCA Healthcare Journal of Medicine

Introduction

Abdominal compartment syndrome (ACS) is associated with significant mortality. Multiple studies have evaluated the prevalence of ACS at individual institutions and/or for short durations. No study has looked at the change of prevalence over an extended time or included nonresearch institutions. This study aims to evaluate the trend in the prevalence of ACS over time within the state of Florida.

Methods

This is a population-based retrospective study using deidentified data from the Florida’s Agency of Healthcare Database between 2006 and 2021. A total of 16 217 617 patients were evaluated within the intensive care unit (ICU), with 4002 developing …

Care Alert Program In Chronic Emergency Department Using Patients: Expanded Study, Jonathan Leggett, Kaitlyn Phelps, David Nuñez, Brent Wright, Erica Gibbons, Jonathan Bryan, Brian Griggs

HCA Healthcare Journal of Medicine

Introduction

The Care Alert Program (CAP) is designed to help navigate encounters with patients who are high utilizers of Emergency Department (ED) resources. The CAP intends to address the needs of this challenging patient population by designing individualized care plans that are approved by a multidisciplinary committee. The patient populations that frequently use ED resources often have chronic medical conditions, a poor understanding of their conditions, unrealistic expectations regarding treatment, a lack of outpatient resources, and present with multiple complaints when using ED resources.

Methods

The CAP was adopted by our facility in the spring of 2020. The present study …

Automated Dispensing Cabinet Stocking Schedule And Inventory Management Optimization, Daniel Elkes, Victoria Timmons

HCA Healthcare Journal of Medicine

Background

Prior practice in a 523-bed community hospital required automated dispensing cabinets (ADCs) to be replenished daily by early afternoon to ensure accurate drug ordering. Because of the tight time window, technicians frequently refilled ADCs during peak medication administration times. After a positive report from a smaller facility in the health system, the study facility implemented a quality improvement project to optimize the ADCs. This involved new processes of every-other-day ADC replenishment staggered via shift-specific workflows, and a dedicated technician was assigned to optimize ADC inventories.

Methods

Monthly reports of ADC refilling and dispensing transactions were compiled from inpatient, nonprocedural …

Efficacy And Safety Of Lotilaner Ophthalmic Solution 0.25% In Demodex Blepharitis: A Systematic Review, Stephanie P. Fabara, Thalia Fabara, Akankcha Alok, Nausheen Khuddus

HCA Healthcare Journal of Medicine

Demodex blepharitis is a chronic eyelid inflammation caused by Demodex mites, which are ubiquitous skin parasites. Lotilaner, a newly United States Food and Drug Administration (FDA)-approved drug, is an antiparasitic agent that selectively inhibits parasite-specific γ-aminobutyric acid chloride channels, inducing spastic paralysis and death of Demodex mites. It is applied as an ophthalmic solution, 0.25%, twice a day for 6 weeks, and it has a long half-life and high lipophilicity, facilitating the penetration of the drug into the eyelash follicles and meibomian glands where the mites reside. This study systematically reviewed 6 clinical trials that compared lotilaner with placebo for …

The Relationship Between Fast Food Consumption And Physical Activity With Primary Dysmenorrhea In Adolescents, Wahyuni Wahyuni

Jurnal Vokasi Indonesia

Background: Menstruation is a bleeding event that occurs when the inner lining of the uterus, known as the endometrium, sheds. Dysmenorrhea is one of the symptoms that teenage girls often feel during menstruation. Dysmenorrhea can affect women's comfort and quality of life. There are two types of dysmenorrhoea, namely primary dysmenorrhea and secondary dysmenorrhoea. Primary dysmenorrhoea refers to the condition of menstrual pain that adolescent girls often experience, with a prevalence rate of 60-90%. Risk factors for primary dysmenorrhoea are influenced by several factors, including fast food intake, physical activity level, stress level, age at first menstruation (menarche), and nutritional …

A Review Of Medications Listed In The 2023 Beers Criteria, Hanh Motilall, Kelley Maberry, Connor Quinter

Transformative Medicine

The American Geriatrics Society’s (AGS) 2023 Beers Criteria identifies potentially inappropriate medications (PIMs) to use in geriatric patients defined as greater than or equal to 65 years of age. This population experiences pharmacokinetic and pharmacodynamic changes, which raise the risk of potentially harmful side effects. The Beers Criteria were developed as a clinical tool to help healthcare providers improve medication safety in this vulnerable population. The main focus of this article is on commonly seen medications and the rationale for recommended avoidance in geriatric patients. Additionally, a table of potentially clinically important drug-drug interactions that should be avoided in older …

"What Is Causing This Sinus Tachycardia?", Muhammad Asad Hanif, Nayab Mirza, Jaswanth Jasti

Transformative Medicine

No abstract provided.

Neurosarcoidosis Presenting As Cauda Equina Syndrome: Case Report And Review Of The Literature, Benjamin Millar, Lauren Carmody, Fnu Naintara, Tara Dutta, Abhinav Hoskote

Transformative Medicine

Background

Sarcoidosis is a systemic immune disease with an unknown trigger, identified histologically by non-caseating granulomas. Neurosarcoidosis is a subset in which granulomatous inflammation infiltrates the central or peripheral nervous system. Sarcoid myelopathy affects a very small fraction of sarcoidosis patients. We present here the case of a 35 year old male who presented primarily for cauda equina symptoms.

Case Presentation

A 35-year-old Caucasian male with past history of hypertension, Hashimoto's thyroiditis, and type II diabetes mellitus presented to the emergency department complaining of a headache with left sided face numbness and periorbital swelling. He reported two months of gradual, …

Bilateral Patellar Tendon Rupture: Obesity As A Risk Factor, Alyssa Ison, Adam Sigal Md, Gary Canner Md

Transformative Medicine

Introduction
Bilateral patellar tendon rupture is an uncommon presentation in the Emergency Department but can occur in the setting of certain risk factors. Obesity is an independent predisposing condition in which early identification can expedite diagnosis and treatment.

Case Description
We report a case of bilateral patellar tendon rupture in a young male with obesity as the sole risk factor following a low-energy trauma. The patient ruptured his bilateral patellar tendons while jumping up during a basketball game. The diagnosis was made on exam and confirmed with plain radiographs and Magnetic Resonance Imaging. Because of the bilateral involvement and inability …

Retrospective Analysis Of Bleeding And Wound Complications After Preoperative Administration Of Ketorolac In Acute Appendicitis, Kate Yurick Md, Jahan Aslami Ms, John Lemoine Bs, Luke Rovenstine Bs, Tan Tran Bs, Traci Deaner Msn, Rn, Thomas Wasser Phd, Adam Sigal Md

Transformative Medicine

ABSTRACT:

Introduction:

Opioids are a mainstay of acute pain management and provide excellent analgesia for severe pain. However, their side effect profile and complication rates raise concerns regarding routine administration.

Methods:

This study is a retrospective cohort study of 1415 patients in a single tertiary care center comparing bleeding and operative complications in patients administered ketorolac prior to appendectomy.

Results:

There was no difference between the ketorolac and non-ketorolac groups regarding blood loss (0.7% vs 0.6%, p=0.572) and hemoperitoneum (0.4% vs 0.6%, p = 0.43) There was no difference between the groups regarding need for re-exploration (0.6% vs 0.6%, …

Impacts Of Fasting Holy Month Of Ramadan During Pregnancy On Pregnancy/Birth Outcomes: An Umbrella Review, Md Estiar Rahman, May Salama, Abdullah Al-Taiar

Graduate Student Government Association Research Conference

Fasting during the holy month of Ramadan is one of the obligatory duties in Islam, which includes refraining from consuming food and drinks and engaging in sexual activity from dawn to sunset. Though pregnant women are exempted from this practice, approximately 80-90% of Muslim pregnant women choose to fast during Ramadan as part of their religious and cultural beliefs. The impact of fasting holy month of Ramadan during pregnancy on pregnancy/birth outcome remains under debate, despite several primary research studies and literature reviews. Up to date, no guidelines or recommendations have been formulated regarding fasting holy month of Ramadan for …

Phytochemical Analysis And Antimicrobial Activity Of Micromeria Barbata Leaf And Stem Extracts Against Pseudomonas Aeruginosa: Insights From Molecular Docking And In Vitro Assays, Shiraz Rawas, Dalia El-Badan, Nawal Al Hakawati

BAU Journal - Science and Technology

The present study provides the characterization of the phytochemical content and the antibacterial activity of ethanolic extracts from the leaves (LM) and stems (SM) of Micromeria barbata (M.barbata) against Pseudomonas aeruginosa . Important functional groups were determined by analyzing the FTIR spectra of LM and SM. The phytochemical profiles were analyzed by GC-MS, and these characterized the chemicals according to retention periods and peak regions. The binding affinities of discovered compounds with the P. aeruginosa LasR and PqsD proteins were evaluated using molecular docking approach. Assays for biofilm formation, MIC, MBC, and agar well diffusion were used to assess the …

Hubungan Penggunaan Jenis Bahan Bakar Untuk Memasak Dengan Kejadian Ispa Pada Balita Di Provinsi Kalimantan Utara Tahun 2017, Maharani Karina Setiawan, Salwa Zalfa Elyanto, Aisyah Muthia Darajat, M. Nanda Putra Pratama Sm

Jurnal Nasional Kesehatan Lingkungan Global

Acute respiratory infections (ARI) in toddlers are certainly still a significant public health problem with environmental factors affecting them, such as air pollution from the burning of the fuels used, namely charcoal, wood and kerosene. This study aims to analyze the relationship between household fuel use and the incidence of ISPA in toddlers, especially in North Kalimantan Province (Kaltara) using data from the Indonesian Health Demographic Survey (SDKI) in 2017. The research design used a cross-sectional study, data analysis was carried out descriptively using a table then followed by chi square data analysis to determine the relationship between the variable …

Assessment Of Dry Mouth In A Palliative Population: A Comparison Between Patient-Reported Symptoms And Clinical Oral Dryness Scale Measurements, Emir Murphy Dourieu, Dominika Lisiecka, William Evans, Patricia Sheahan

Publications

The severity and impact of dry mouth in patients receiving palliative care is underreported, and assessment methods for this condition are lacking consensus. This study aimed to examine the severity of dry mouth in a palliative population as rated on a visual oral dryness scale and to compare these findings with the actual symptoms experienced by patients, as reported through both a symptom scale measure and a bother questionnaire. 40 participants took part in this cross-sectional study. The results indicated that xerostomia is a significant and debilitating symptom for many patients receiving palliative care. Daily activities such as speaking and …

Mortalitas Pada Pasien Hemodialisis: Masih Menjadi Tantangan Globa, Anandhara Indriani Indriani Khumaedi, Dina Elita

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Faktor-Faktor Yang Berhubungan Dengan Massa Otot, Kekuatan Otot, Dan Performa Fisik Pada Lansia, Nur Riviati, Taufik Indrajaya, Rukiah Chodilawati, Ridzqie Dibyantari, Bima Indra

Jurnal Penyakit Dalam Indonesia

Introduction. Despite its high prevalence and significant impact on health, comprehensive studies are still needed to explore the factors affecting sarcopenia parameters, such as muscle mass, muscle strength, and physical performance. This study aimed to identify the factors influencing sarcopenia parameters in the elderly, including muscle mass, muscle strength, and physical performance.

Methods. A cross-sectional study was conducted from July to December 2022 on elderly individuals (>60 years old) at the Geriatric Polyclinic, Moh. Hoesin General Hospital, Palembang, selected through consecutive sampling. Muscle mass was measured using bioimpedance analysis, expressed in ASMI values; muscle strength was measured …

Faktor Risiko Yang Berhubungan Dengan Kematian Pasien Penyakit Ginjal Kronis Pada Usia Dewasa Yang Menjalani Hemodialisis Reguler Di Provinsi Lampung, Joue Abraham Trixie Latupeirissa, Mondastri Korib Sudaryo, Muhamad Zulfikar Hadiaturahman, Steven Sapta Putra Sinaga

Jurnal Penyakit Dalam Indonesia

Introduction. Although mortality among adult chronic kidney disease (CKD) patients on regular hemodialysis remains infrequent within the first three months, it is still a potential outcome. Given that hemodialysis is required for life, identifying risk factors for mortality is critical. This study aims to examine risk factors associated with mortality in adult CKD patients undergoing regular hemodialysis.

Methods. A case-control study, without matching, was conducted using medical record data from adult CKD patients (≥18 years) receiving regular hemodialysis between 2022 and 2024 at three hospitals (types A, B, and C) in Lampung Province. The case group consisted of …

Gejala Neuropsikiatri Pasien Hiv Setelah Menjalani Transisi Antiretrovirus Nevirapin Ke Dolutegravir Di Rumah Sakit Cipto Mangunkusumo, Jakarta, Metra Adi Pratama, Rudi Putranto, Herqutanto Herqutanto, Aisyah Syahrani, Aljira Fitya Hapsari, Veritea Natali, Meivina Ramadhani Pane, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

Introduction. Dolutegravir (DTG) is one of the effective antiretroviral therapies (ART) for suppressing HIV replication and has a favorable safety profile. However, reports regarding neuropsychiatric side effects, especially in patients transitioning from a nevirapine (NVP) regimen to dolutegravir, have started to emerge. This study aimed to describe the changes in neuropsychiatric symptoms before and after the transition from a NVP-based ARV regimen to DTG in HIV patients at Cipto Mangunkusumo Hospital (RSCM), Jakarta.

Methods. This study employed a prospective cohort design involving 292 HIV patients at Cipto Mangunkusumo Hospital who were transitioning from NVP to DTG regimen. Participants …

Peran Prediktif Il-6, Il-10, Dan Tnf-Α Plasma Terhadap Gagal Ginjal Akut Pada Pasien Dengan Covid-19 Derajat Sedang Dan Berat, Dewi Gathmyr, Maruhum Bonar H Bonar, Adityo Susilo, Kuntjoro Harimurti, Ginova Nainggolan, Alvin Tagor, Hamzah Shatri, Cosmas Rinaldi Adithya Lesmana, Zulkifli Amin

Jurnal Penyakit Dalam Indonesia

Introduction. Acute kidney injury (AKI) is associated with higher mortality rate in COVID-19 patients due to inflammation and immune dysregulation. This study aimed to correlate serum levels of IL-6, IL-10, and TNF-α with serum creatinine changes and their roles to predict incidence of acute kidney injury (AKI) in patients with moderate and severe COVID-19.

Methods. This prospective cohort study was conducted among patients with moderate to severe COVID-19 in Pertamina Central Hospital Jakarta, Indonesia during November 2020 to January 2021. All serum levels of cytokines (IL-6, IL-10, and TNF-α) and creatinine were collected on the first day and …

Korelasi Stenosis Penyakit Arteri Perifer Di Bawah Lutut Dengan Kecepatan Hantar Saraf Pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2, Akbarbudhi Antono, Dono Antono, Birry Karim, Manfaluthy Hakim, Kuntjoro Harimurti, Dyah Purnamasari Sulistianingsih, Eka Ginanjar, Erni Juwita Nelwan, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN.

Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 …

Laporan Kasus Hipokalemi Periodik Paralisis Pada Pasien Dengan Graves’ Disease, Anggi Cahaya Millenia S Sirait, Borries Foresto Buharman, Adinda Zhafira Dyanti Putri, Derby Ayudhia Utami Iskandar Putri

Jurnal Penyakit Dalam Indonesia

Hypokalemia periodic paralysis (HPP) characterized by episodes of flaccid weakness or paralysis that may be associated with abnormalities of the serum potassium level. HPP often associated with hyperthyroidism and Graves’ disease. HPP prevalence is 1 in 100.000. Each individual has different clinical manifestations, so it’s necessary to adjust therapy based on the etiology. This case report was developed to provide more information regarding Graves’ disease, considering lack of information about management and description of HPP with Graves’ disease. A 27-year-old male with sudden weakness in both legs radiating to upper extremity, shortness of breath, palpitations, and sweating. Over the last …

Pemberian Asupan Kalori Terestriksi Vs. Asupan Kalori Standar Yang Berlanjut Pada Pasien Penyakit Kritis Dengan Refeeding Syndrome: Laporan Kasus Berbasis Bukti, Sukma Hapsari, Rabbinu Rangga Pribadi

Jurnal Penyakit Dalam Indonesia

Refeeding syndrome is a different clinical symptom and metabolic disorder that occur during the reintroduction of nutrition in chronically malnourished patients. Calorie restriction can increase survival and reduce mortality rates. This evidence-based case report was developed to examine the influence of caloric restriction on mortality, morbidity, and duration of critical illness. A literature search was performed using PubMed, EBSCOHost, ScienceDirect, and Cochrane with the keywords: “critically ill,” “restricted caloric intake,” “standard caloric intake,” “mortality,” “morbidity,” and “duration”. Articles were appraised using the University of Oxford Centre for Evidence-Based Medicine (CEBM) tools. Two studies met the inclusion criteria. The first was …

Tata Laksana Fraktur Panggul Pada Geriatri: Sudut Pandang Internis, Laila M. Jannah, Noto Dwimartutie

Jurnal Penyakit Dalam Indonesia

Hip fracture are a common issue in geriatric patients, associated with increased risk of morbidity and mortality. The complex and multimorbid characteristics of geriatric patients presents significant challenge in their management. Optimal outcomes require a comprehensive interdisciplinary approach to care, aiming to restore functional status and reduce postoperative complications. A holistic strategy, grounded in thorough Comprehensive Geriatric Assessment (CGA), is essential to guide individualized treatment and ensure effective, patient-centered management.

Spatially Resolved Transcriptomic Profiles Of Placental Cell Populations In Placental Malaria, Corina A. Mong

Undergraduate Honors Theses

Malaria remains a prevalent infectious disease that continues to cause disease-related morbidity and mortality. Despite preventative efforts, malarial pregnancies still cause birth complications, therefore emphasizing the necessity to study these adverse outcomes in malarial pregnancy. Malaria in pregnancy can lead to placental malaria (PM), which is the presence and accumulation of Plasmodium-infected red blood cells in the placental intervillous space (IVS). Even after treatment, past PM (presence of hemozoin crystals from the parasite in the placenta) can cause a chronic inflammatory response. We predicted that the activation states of the maternal monocytes and fetal macrophages differ within the placenta and …