Medical Specialties Commons^™

Sump Syndrome: The Forgotten Cause Of Painless Jaundice In The Elderly, Mark Ayoub, Amna Anees

Journal of Community Hospital Internal Medicine Perspectives

Painless jaundice is a common presentation of abdominal malignancy seen in elderly patients. While malignancy may be a common cause of obstructive jaundice in that population group, anchor bias should always be avoided. We present a case of an elderly woman who presented with painless jaundice and weight loss. She had a very remote history of cholecystitis. She was found to have Sump syndrome due to a stricture at the Choledochoduodenostomy (CDD) site. She underwent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement which shortly led to resolution of her jaundice. Biopsy from the stricture site came back negative for malignancy.

A Rare Case Of Anca-Negative Rapidly Progressive Glomerulonephritis, Jerry Kenmoe, Elizabeth Mikhail, Fahimeh Talaei, Arvind Kunadi

Journal of Community Hospital Internal Medicine Perspectives

ANCA-negative rapidly progressive glomerulonephritis (RPGN) is a rare condition caused by glomerular injury in the absence of detectable antineutrophil cytoplasmic antibodies (ANCAs). While comprehensive epidemiologic data is limited, ANCAnegative RPGN is known to comprise 5-20% of all glomerulonephritis cases. We report the case of a 43-year-old male who presented to the hospital after a snowmobile accident with symptoms of general malaise along with the emergence of a new-onset rash and tea-colored urine. Further workup with CT-guided kidney biopsy confirmed the diagnosis of RPGN by revealing histopathological findings of crescentic glomerulonephritis and significant glomerular inflammation. Treatment was promptly initiated with prednisone …

Immunotherapy Induced Adrenal Insufficiency: An Underdiagnosed Cause Of Persistent Hypotension In Cancer, Nina H. Cheng, Hannah Lee, Divya Balchander, Remy Mimms, Mahesh Krishnamurthy

Journal of Community Hospital Internal Medicine Perspectives

Endocrinopathies following immunotherapy have infrequently been documented in the literature. Adrenal insufficiency is a rare consequence of pembrolizumab immunotherapy, with incidence reported to be between 0.98 and 1.3%. We present the case of a 34-year-old female with triple negative breast cancer on chemotherapy who presented with generalized weakness with tachycardia, tachypnea and hypotension unresponsive to fluids. Despite initial improvement with intravenous hydrocortisone and midodrine, the patient continued to be symptomatically hypotensive following discharge and required re-admission. AM cortisol level was found to be < 0.5 ug/dl and ACTH was

Ruptured Infectious Pseudoaneurysm Of The Common Carotid Artery In A 14-Year-Old Girl. Management In The Dr Congo, Alphonse Nzomvuama, Jean Jacques Kalongo, Blondel Bayenekene, Stéphane Yanda, M. Jacques Nsuami

School of Medicine Faculty Publications

The infectious pseudoaneurysm of the common carotid artery is a rare observation in children. We present a case of ruptured infectious common carotid aneurysm in a 14-year-old girl managed in the Democratic Republic of Congo. We performed an arterial reconstruction with a saphenous vein patch. Post-operative course was simple. The patient was discharged from the hospital at post-operative day 15. She was doing well and had returned to school. Rupture of an infectious pseudoaneurysm of the common carotid artery constitutes a serious, life-threatening accident. As we have shown in this case report, its management with successful results is indeed possible, …

A Global Perspective On The Treatment And Maintenance Of Mature Skin Using Gentle Cleansers And Moisturizers, Joachim Fluhr, Andrew Alexis, Anneke Andriessen, Olga Barrios, Peter Bjerring, Peter Foley, Michael Gold, Hashim Kaderbhai, Chengfeng Zhang

Internal Medicine, East Africa

Xerosis is highly prevalent in the population aged over 50 years and substantially impacts quality of life due to the associated stigma, related pruritus, and potential sequelae. We propose that the term mature xerosis be used for subjects over 50 who suffer from age-related xerosis and replace senile xerosis to describe the phenomenon. The etiology of xerosis depends on genetic and environmental factors that affect stratum corneum hydration and skin barrier function. Skincare to restore barrier function is essential in xerosis treatment and is relevant for maintaining and preventing its progression. Many moisturizers and cleansers are available for xerosis; however, …

The Impact Of Hearing Impairment On Patient Care And Autonomy, Savannah Baimbridge, Julie Neil, Gabriel M Aisenberg

Faculty, Staff and Student Publications

Sensory deficits, including hypoacusis, can cause a barrier to communication between healthcare providers and patients, which in turn can lead to misdiagnosis and loss of patient autonomy. Such deficits are frequently overlooked in clinical encounters. We present a 92-year-old Spanish-speaking female who presented twice to the Emergency Department for complications of a diabetic foot infection. Limited evaluation, documentation, and accommodations regarding the patient's hypoacusis led to a misinterpretation of her mental status and a transfer of decision-making to surrogates. A two-toe amputation, mechanical intubation, and intensive care unit stay were followed. It was only after these events that the caregivers …

Reproducibility Of Quantitative Myocardial Perfusion And Coronary Flow Capacity By Positron Emission Tomography: 3d Digital Silicon Photomultiplier Solid State Vs Legacy 2d Analogue Systems For Clinical Practice And Trials, Amanda Roby, Lindsey Harmon, Kelly Sander, Linh Bui, Danai Kitkungvan, Monica Patel, Jagat Narula, Nils P Johnson, K Lance Gould

Faculty, Staff and Student Publications

Aims: Quantitative rest-stress myocardial perfusion in millilitres per minute per gram among multiple 2D and 3D positron emission tomography-computed tomography (PET-CT) scanners is essential for personalized cardiac management and clinical trials. Accordingly, this study reports the accuracy and precision of quantitative rest-stress millilitres per minute per gram and coronary flow capacity among 2D and two different digital 3D silicon photomultiplier (SiPM) PET-CT scanners for quantifying the severity of coronary pathophysiology for clinical trials or guiding interventions vs. medical treatment.

Methods and results: One hundred seventy-one participants underwent 748 paired serial rest or stress PET perfusion imaging in the same person …

Use Of Ipsc-Derived Smooth Muscle Cells To Model Physiology And Pathology, Callie S Kwartler, Jose Emiliano Esparza Pinelo

Faculty, Staff and Student Publications

The implementation of human induced pluripotent stem cell (hiPSC) models has introduced an additional tool for identifying molecular mechanisms of disease that complement animal models. Patient-derived or CRISPR/Cas9-edited induced pluripotent stem cells differentiated into smooth muscle cells (SMCs) have been leveraged to discover novel mechanisms, screen potential therapeutic strategies, and model in vivo development. The field has evolved over almost 15 years of research using hiPSC-SMCs and has made significant strides toward overcoming initial challenges such as the lineage specificity of SMC phenotypes. However, challenges both specific (eg, the lack of specific markers to thoroughly validate hiPSC-SMCs) and general (eg, …

Cholesterol-Dependent Lxr Transcription Factor Activity Represses Pronociceptive Effects Of Estrogen In Sensory Neurons And Pain Induced By Myelin Basic Protein Fragments, Swathi K Hullugundi, Jennifer Dolkas, Andrei V Chernov, Tony L Yaksh, Kelly A Eddinger, Mila Angert, Glaucilene Ferreira Catroli, Alex Y Strongin, Patrick M Dougherty, Yan Li, Oswal Quehenberger, Aaron Armando, Veronica I Shubayev

Faculty, Staff and Student Publications

BACKGROUND: A bioactive myelin basic protein (MBP) fragment, comprising MBP

METHODS: In male and female normal and post-CCI rat sciatic nerves, we assessed: (i) cholesterol precursor and metabolite levels by lipidomics; (ii) MBP

RESULTS: CCI regulated LXRα ligand and receptor levels in nerves of both sexes, with cholesterol precursors, desmosterol and 7-DHC, and oxysterol elevated in females relative to males. MBP

CONCLUSION: The injury-released bioactive MBP fragments induce pronociceptive changes by selective inactivation of nuclear transcription factors, including LXRα. By Ncoa1 sequestration, bioactive MBP fragments render LXRα function to counteract pronociceptive activity of estrogen/ESR1 in sensory neurons. This effect of …

Long-Term Weight Loss Effects Of Semaglutide In Obesity Without Diabetes In The Select Trial, Donna H Ryan, Ildiko Lingvay, John Deanfield, Steven E Kahn, Eric Barros, Bartolome Burguera, Helen M Colhoun, Cintia Cercato, Dror Dicker, Deborah B Horn, G Kees Hovingh, Ole Kleist Jeppesen, Alexander Kokkinos, A Michael Lincoff, Sebastian M Meyhöfer, Tugce Kalayci Oral, Jorge Plutzky, André P Van Beek, John P H Wilding, Robert F Kushner

Faculty, Staff and Student Publications

In the SELECT cardiovascular outcomes trial, semaglutide showed a 20% reduction in major adverse cardiovascular events in 17,604 adults with preexisting cardiovascular disease, overweight or obesity, without diabetes. Here in this prespecified analysis, we examined effects of semaglutide on weight and anthropometric outcomes, safety and tolerability by baseline body mass index (BMI). In patients treated with semaglutide, weight loss continued over 65 weeks and was sustained for up to 4 years. At 208 weeks, semaglutide was associated with mean reduction in weight (-10.2%), waist circumference (-7.7 cm) and waist-to-height ratio (-6.9%) versus placebo (-1.5%, -1.3 cm and -1.0%, respectively; P < 0.0001 for all comparisons versus placebo). Clinically meaningful weight loss occurred in both sexes and all races, body sizes and regions. Semaglutide was associated with fewer serious adverse events. For each BMI category (

Dyspneic And Pink, Christian Inchaustegui, Sarvari Yellapragada, Jack Badawy, Ameer Ahmed, Andrew White, Zaven Sargsyan

Faculty, Staff and Students Publications

No abstract provided.

T-Bet Regulates Ion Channels And Transporters And Induces Apoptosis In Intestinal Epithelial Cells, Lang Chen, Hongwei Yi, Qingtian Li, Tianhao Duan, Xin Liu, Linfeng Li, Helen Y Wang, Changsheng Xing, Rong-Fu Wang

Faculty, Staff and Students Publications

T-bet, encoded by TBX21, is extensively expressed across various immune cell types, and orchestrates critical functions in their development, survival, and physiological activities. However, the role of T-bet in non-immune compartments, notably the epithelial cells, remains obscure. Herein, a Tet-O-T-bet transgenic mouse strain is generated for doxycycline-inducible T-bet expression in adult animals. Unexpectedly, ubiquitous T-bet overexpression causes acute diarrhea, intestinal damage, and rapid mortality. Cell-type-specific analyses reveal that T-bet-driven pathology is not attributable to its overexpression in CD4

“To Operate Or Not To Operate”: Peran Internis Dalam Prediksi Risiko Perioperatif Pada Lansia, Ika Fitriana

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Faktor-Faktor Yang Berhubungan Dengan Kualitas Tidur Pasien Dengan Lupus Eritematosus Sistemik, Gestana Andru, Alvina Widhani, Rudi Putranto, Arif Mansjoer, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Sleep disturbances are often found among Systemic Lupus Erythematosus (SLE) patients. Poor sleep may cause low quality of life. Study about sleep quality among SLE patients and related factors in Indonesia is scarce. This study aimed to know factors related to poor sleep quality among SLE patients.

Methods. This cross-sectional study was conducted among SLE patients at Cipto Mangunkusumo Hospital Jakarta Indonesia. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), with global PSQI score >5 indicates poor sleep quality. Factors evaluated were symptoms of depression and anxiety by Hospital Anxiety Depression Scale (HADS), pain by Visual …

Manifestasi Klinis Infeksi Mpox Pada Penderita Hiv: Sebuah Telaah Sistematik Dan Meta-Analisis, Gede Ari Mahendra Mardaningrat, Putu Arya Nugraha, Isabella Soerjanto Putri, Putu Hendri Aryadi

Jurnal Penyakit Dalam Indonesia

Introduction. Mpox is a zoonotic disease caused by the mpox virus. Sexual intercourse is the biggest cause of mpox transmission. Human immunodeficiency virus (HIV) is a viral infection that is also transmitted mostly through sexual routes. This systematic review and meta-analysis was conducted to understand the clinical picture of mpox in relation to HIV infection.

Methods. This meta-analysis followed MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. A systematic search for relevant studies was carried out using the PubMed, EMBASE and Cochrane Library databases covering the period 1 January 2022 to 31 May 2024. The keywords used were …

Model Prediksi Mortalitas Pembedahan Pasien Usia Lanjut Yang Menjalani Pembedahan Elektif Di Rumah Sakit Cipto Mangunkusumo, Fitria Djafar, Noto Dwimartutie, Susilo Chandra, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Introduction. Elderly patients are at high risk of mortality after elective surgery. The aim of this study was to obtain and evaluate the performance of a mortality prediction model for elderly patients undergoing elective surgery.

Methods. The design of this study was a retrospective cohort using medical record data from 747 elderly subjects who underwent elective surgery in the period January 2015–December 2017 at Cipto Mangunkusumo Hospital (RSCM), Jakarta. This study used multivariate analysis with logistic regression to determine significant predictors that were included in the prediction model. The performance of the prediction model was assessed using the …

Prevalensi Dan Karakteristik Pasien Tuberkulosis Paru Resisten Obat (Tb-Ro) Dengan Diabetes Melitus Tipe 2 Di Klinik Tb-Ro Rumah Sakit Umum Pusat Dr. Hasan Sadikin, Bandung, Diva Harnum Maulida, Intan Mauli Warma Dewi, Prayudi Santoso, Adi Imam Cahyadi, Maya Kusumawati, Iceu Dimas Kulsum

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetes mellitus (DM) patients have a higher risk of tuberculosis (TB) infection, including the risk of drug- resistant (DR)-TB infection, compared to those without DM. Data on the characteristics of pulmonary DR-TB with DM in Indonesia are still very limited. The management of pulmonary DR-TB with DM should consider multiple factors, such as drug interactions between DM medication and anti-TB drugs, as well as potential exacerbation of DM complications by anti-TB drugs side effects. Effective management of pulmonary DR-TB patients with DM will improve treatment outcomes. This study aimed to determine the prevalence and characteristics of pulmonary DR-TB …

Peningkatan Leukosit, Neutrofil, Dan Prokalsitonin Persisten Tanpa Bukti Infeksi Pada Kanker Stadium Akhir: Sebuah Laporan Kasus, Santosa Yanuar, Ardhi Rahman Ahani, Andrian Setiabakti, Aulia Rizka, Robert Sinto

Jurnal Penyakit Dalam Indonesia

Elevation of leukocyte, neutrophil, and procalcitonin (PCT) has been known as a marker of bacterial infection independent of the underlying disease. This article will describe a case of end-stage cancer with persistent elevation of leukocyte, neutrophil, and procalcitonin with no evidence of infection. A 45-year-old female presented with abdominal distension for three months prior to hospital admission. The patient was suspected to have breast cancer with hepatic metastasis based on diagnostic tests. Throughout treatment, the patient experienced persistent elevation of leukocytes, neutrophils, and PCT despite no signs or symptoms of infection from history, physical examination, and diagnostic tests. The patient …

Karakteristik Pasien Rinitis Alergi Dengan Hasil Uji Cukit Kulit Positif Yang Berobat Di Poliklinik Tht-Kl Rumah Sakit Umum Daerah Zainoel Abidin Banda Aceh, T. Husni T.R, Cut Murzalina, Elvia Elvia, Dina Alia, Rezania Razali, Siti Nur Annisa, Teuku Romi Imansyah Putra, Rika Farhana

Jurnal Penyakit Dalam Indonesia

Introduction. Allergic rhinitis is an inflammatory disease mediated by IgE in the nasal mucosa, resulting from allergen sensitization and causing various clinical symptoms. The skin prick test is the primary diagnostic technique used to detect specific IgE antibodies against allergenic proteins and peptides. The incidence of allergic rhinitis in Indonesia ranges from approximately 1.5% to 12.4% and increases every year. This study aims to determine the characteristics of allergic rhinitis sufferers with positive skin prick test results who received treatment at the ENT outpatient service of Zainoel Abidin Regional General Hospital (RSUDZA) Banda Aceh from January 2019 to March …

Two-Point Compression Pocus Sebagai Metode Diagnosis Dini Trombosis Vena Dalam Proksimal, Edwin Ti Ramadan, Sausan Hana Maharani, Rahmat Cahyanur, Dimas Priantono, Wulyo Rajabto

Jurnal Penyakit Dalam Indonesia

Deep vein thrombosis (DVT), especially in the proximal part of the lower extremity, might progress to pulmonary embolism and be fatal. Therefore, it is crucial to prompt the diagnosis of DVT in the emergency room (ER). Due to its efficiency and patient convenience, duplex ultrasound has become the preferred diagnostic method for DVT. Point-of-care ultrasonography (POCUS) was known as a simpler and faster way to use ultrasonography at the bedside. The two-point compression method has become frequently used due to its ability to take less time for examination, yet there are still concerns about its accuracy. This study was conducted …

Sindrom Kardiovaskular-Ginjal-Metabolik: Konsep Terkini Untuk Klinisi, Muhammad Yamin, Harits Adi Putra

Jurnal Penyakit Dalam Indonesia

Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic abnormality resulting from complex pathophysiological interactions among cardiovascular disease, chronic kidney disease, and metabolic risk factors, particularly diabetes mellitus and obesity. In clinical practice, the management of CKM syndrome encounters some significant challenges, including the lack of clinicians’ knowledge regarding the most up-to-date therapy, limited drug availability, and restrictions on health insurance. Those issues potentially lead to a rise in morbidity and mortality rates of patients with CKM syndrome. This article elucidates the most updated concept of CKM syndrome regarding its pathophysiology, diagnostic approach, and treatment based on clinical stages ranging from stage 0 …

Severe Febrile Neutropenia And Pancytopenia In A Patient With Advanced Hepatocellular Carcinoma Treated With Atezolizumab And Bevacizumab: A Case Report, Shadi Chamseddine, Michael Lapelusa, Kristen Carter, Van Nguyen, Yehia I Mohamed, Yara Sakr, Cristhiam M Rojas-Hernandez, Rikita I Hatia, Manal Hassan, John A Goss, Khaled M Elsayes, Asif Rashid, Ryan Sun, Hop Sanderson Tran Cao, Hesham M Amin, Ahmed O Kaseb

Faculty, Staff and Student Publications

BACKGROUND: Immune checkpoint inhibitors (ICIs), agents that stimulate T-cell function, have become the standard first-line treatment for unresectable hepatocellular carcinoma (HCC). However, they may also cause immune-related adverse events (irAEs), which are rare and have not been extensively reported. Here, we describe a case of severe febrile neutropenia and pancytopenia after atezolizumab plus bevacizumab (atezo/bev) therapy and its treatment course.

CASE DESCRIPTION: The combination of atezo/bev was initiated as the first-line treatment for a man in his early 50s, who was diagnosed with unresectable HCC. The first treatment cycle was administered in the outpatient setting, and the patient developed a …

The Effects Of The Covid-19 Pandemic On Resident Education And Burnout, Timbre Backen, Oliwier Dziadkowiec, Jeffery S. Durbin, Gregory Guldner, Glenda Quan

HCA Healthcare Journal of Medicine

Background

The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods

We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using …

Aging- And Alcohol-Associated Spatial Transcriptomic Signature In Mouse Acute Pancreatitis Reveals Heterogeneity Of Inflammation And Potential Pathogenic Factors, Rachel R Tindall, Yuntao Yang, Isabella Hernandez, Amy Qin, Jiajing Li, Yinjie Zhang, Thomas H Gomez, Mamoun Younes, Qiang Shen, Jennifer M Bailey-Lundberg, Zhongming Zhao, Daniel Kraushaar, Patricia Castro, Yanna Cao, W Jim Zheng, Tien C Ko

Faculty, Staff and Student Publications

The rapidly aging population is consuming more alcohol, leading to increased alcohol-associated acute pancreatitis (AAP) with high mortality. However, the mechanisms remain undefined, and currently there are no effective therapies available. This study aims to elucidate aging- and alcohol-associated spatial transcriptomic signature by establishing an aging AAP mouse model and applying Visium spatial transcriptomics for understanding of the mechanisms in the context of the pancreatic tissue. Upon alcohol diet feeding and caerulein treatment, aging mice (18 months) developed significantly more severe AAP with 5.0-fold increase of injury score and 2.4-fold increase of amylase compared to young mice (3 months). Via …

Cerebellopontine Angle Meningioma Mimicking Acute Stroke, Milan Terzic, Yash B. Patel

Graduate Medical Education Research Journal

Cerebellopontine angle meningiomas are slow-growing benign tumors of the brain with a largely indolent course until compressive and mass effects occur with adjacent neural structures. Clinical presentations are variable and dependent on the rate of growth and location and tend to progress over a longer period. Acute presentations are less common and require consideration of ubiquitous etiologies. A 62-year-old male with a history of hypertension, benign prostatic hyperplasia, dyslipidemia, and gout presented to the emergency department with a sudden onset of dizziness, loss of balance, and persistently elevated blood pressure. The examination was positive for left dysmetria, dysdiadochokinesia, and tandem …

Small Intestinal Bacterial Overgrowth, Sandesh R. Parajuli, Anish C. Paudel, Anthony Donato

Transformative Medicine

No abstract provided.

Why Medicine Needs The Humanities: An Argument For Arguments, Suraj R. Nyalakonda, Md

The Medicine Forum

As medicine plunges deeper into the 21st century, there appear to be three forces coming together that hold both promise and peril as technology’s march of progress continues unabated through the healing profession.

Musings Of A House Staff Officer On The Wards, Suraj R. Nyalakonda, Md

The Medicine Forum

I am told I am part of the house staff. I am told I am a resident. I am told my predecessors, who are now my teachers, earned the title of resident by residing at their place of work, which was also their place of passion, which was the hospital, that institution that, with the advent of the industrial revolution, came to be a producer of health, a fixer of bodies. I am also now told that we residents are increasingly the sort of thing that can burn out. The other thing I know that can burn out - when …

Shadows And Echoes Of Understanding: A Physician's Reflection On Plato's Allegory Of The Cave And Medicine, Michael Dong, Md, Tamar Wolinsky Md, Benjamin Claxton, Md, Mph, Chantel Venkataraman, Md

The Medicine Forum

Plato's Allegory of the Cave offers a lens through which one can contemplate the complexities of medicine, where the shadows and echoes of illness obscure the true forms of disease. As physicians, we seek to illuminate the shadows that shroud our patients’ understanding of their illnesses and provide clarity to help patients navigate the labyrinth of diagnoses and treatments.

Unmasked, Rehana Persaud, Ms

The Medicine Forum

The world was quiet

A virtual reality

I existed

you lived

in it

We lived

In

a

world,

that was h u s h e d …

A quiet one

The silence was DeafeninG

But

I HEARD what consumed

me