Medical Specialties Commons^™

Invasive Liver Abscess Syndrome Caused By Klebsiella Pneumoniae: First Tanzanian Experience, Nadeem Kassam, Omar Aziz, Samina Somji, Zainab Yusuf Fidaali, Salim Ramzan Surani

Internal Medicine, East Africa

Over the past 20 years there has been growing awareness of community-acquired primary liver abscess caused by strains of Klebsiella pneumoniae (K. pneumoniae) especially in patients of Asian descent, a minority of which are characterized by metastatic spread. A common and frequent destructive complication is endophthalmitis as well as the involvement of the central nervous system (CNS), causing suppurative meningitis or brain abscess. Here we report a case of invasive liver abscess caused by K. pneumoniae in an Asian patient who presented to our hospital in Tanzania with bilateral lower limb swelling for 6 weeks with acute onset of difficulty …

Efficacy Of Argon Plasma Coagulation Treatment In Radiation Colitis Patients And Its Confounding Factors, Aru Ariadno, Dadang Makmun, Andri S. Sulaiman, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Introduction. Argon plasma coagulation (APC) is widely used in the treatment of radiation colitis among patients with gynecology, colorectal and urology malignancy. This study aimed to measure the result of APC conducted on radiation colitis patients and its counfounding factors. Methods. An analytic descriptive study with retrospective cohort design was conducted among radiation colitis patients received APC treatment in Cipto Mangunkusumo Hospital, Jakarta. Data were collected from medical record database between April 2012 until October 2019. Results. As much as 180 radiation colitis patients received APC treatment fulfilled inclusion criteria with characteristics female patients (89.4%) and age >50 years old …

Pengelolaan Predialisis Pasien Penyakit Ginjal Kronik, Ni Made Hustrini

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Factors Associated With Late Referral In End Stage Renal Disease Patients At Dr. Cipto Mangunkusumo Hospital, Aida Lydia, Grecia Rachmaningrum, Hamzah Shatri, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Relationship Between Total Session Of Hyperbaric Oxygen Therapy As Adjuvant Therapy With Diabetic Foot Ulcers Improvement In Dr. Mintohardjo Naval Hospital In The Year 2016−2018, Naufal Hilmi Andrisha, Pritha Maya Savitri, Nurfitri Bustamam

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetic foot ulcers (DFU) are a common complication of diabetes mellitus (DM). High rates of amputation risk and mortality in DM patients with DFU as well as the use of conventional therapies that often fail to improve the DFU condition cause an adjuvant therapy such as hyperbaric oxygen therapy (HBOT) to be used. HBOT is known can facilitate wound bed closure and reduce the amputation rates in diabetic gangrene foot. This study aimed to determine the relationship between total sessions of HBOT as adjuvant therapy with an improvement of DFU patients. Method. A cross-sectional study was conducted among DFU …

The Correlation Between Transforming Growth Factor-Beta (Tgf- Β) Serum Level And Beck Depression Inventory (Bdi) Score In Colorectal Cancer Patients At Rsmh Palembang, Muhammad Ali Apriansyah, Mediarty Syahrir, Muhammad Rosyidi Kgs, Ahmad Faisyar

Jurnal Penyakit Dalam Indonesia

Introduction. Depression not only increase the mortality rate, but also can interfere the quality of life of colorectal cancer patients during treatment. Low levels of systemic inflammation may contribute to the development of depression. The inflammatory process can be seen by measuring serum transforming growth factor-β (TGF-β) levels and depressive symptoms using the beck depression inventory (BDI) score. This study aimed to determine the correlation between TGF-β serum levels with depression in colorectal cancer patients. Methods. Analytical observational research with cross sectional design was conducted among colorectal cancer patients who underwent chemotherapy with a BDI score ≥10 (depression) in the …

Prediction Model Of 30-Day Mortality In Elderly Patients Admitted To Geriatric Acute Ward Using Comprehensive Geriatric Assessment Domain, Noto Dwimartutie, Slti Setiati, Edy Rizal Wahyudi, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Advanced Directives In Palliative Care, Hamzah Shatri, Edward Faisal, Rudi Putranto, Budi Sampurna

Jurnal Penyakit Dalam Indonesia

Initially palliative care is emphasized at the end of life, but the right thing is to begin identifying palliative care needs when the disease is diagnosed. Palliative care is the treatment needed to improve the quality of life of patients and their families that suffering from life threatening and progressive disease such as cancer, non-cancer diseases, and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). Palliative care decision must be in place from the beginning of treatment, so the patient’s preferences are met. The goals of this care are to reduce physical, social, psychological, and spiritual suffers. Further treatment plan is based …

Anti-Dfs70 As Nonsystemic Autoimmune (Primary Billiar Cholangitis) Concomitant Disease Marker In Systemic Lupus Erythematosus, Yasjudan Rastrama Putra, Deshinta Putri Mulya, Fahmi Indrarti

Jurnal Penyakit Dalam Indonesia

Anti-dense fine speckled 70 (DFS70) is known as a non-systemic autoimmune marker. It is only found in 1% of systemic autoimmune patients and 2–22% in healthy population. To the best of our knowledge, no anti-DFS70 positive has been reported in systemic lupus erythematosus (SLE) patients with primary billiary cholangitis (PBC) comorbidities. We reported a 40-year-old woman that was diagnosed with SLE 1-month before, came to the hospital due to seven days of fatigue, loss of appetite, icteric, arthralgia, hair loss, and unexplained fever. Total bilirubin was 9.46 mg/dl, direct bilirubin 7.73 mg/dl, gamma-glutamyl transferase (GGT) 503 U/L, alkaline phosphatase (ALP) …

The Proportion Of Acute Transfusion Reaction At Outpatient Blood Transfusion Unit In Tertiary Hospital In Indonesia, Ahmad Fariz Malvi Zamzam Zein, Lugyanti Sukrisman

Jurnal Penyakit Dalam Indonesia

Introduction. Acute transfusion reaction (ATR) is an important issue related to patient safety. The prevalence of ATR at tertiary hospital in Indonesia is 0.5%. This study was aimed to determine the proportion of ATR in outpatient blood transfusion unit at tertiary hospital. Method. This retrospective study implemented data from medical records of adult patients who underwent blood transfusion in outpatient blood transfusion unit, Cipto Mangunkusumo Hospital between August – October 2014. The blood components included packed red cells (PRC), thrombocyte concentrate (TC), fresh frozen plasma (FFP), and cryoprecipitate. We recorded the administration of premedication and ATR-related symptoms/signs. The ATR report …

Towards Effective Management Protocols: A Transnational Review Of The State-Of-The-Art Of Coronavirus Disease 2019 (Covid-19) In Pakistan And The United Arab Emirates, Maryam Ehtesham, Talal Almas, Absam Akbar, Muhammad Ali Niaz, Noreen Zia

Medical College Documents

Coronavirus disease 2019 (COVID-19) has proliferated rapidly in Pakistan, adversely affecting every province. The grave repercussions that the pandemic has elicited in Pakistan have evoked a dire need for drastic measures to be employed at both the governmental and provincial levels. Due to the inequitable appropriation of healthcare resources with respect to the various provinces, however, a stark contrast in terms of morbidity and mortality persists. Furthermore, considering that Pakistani citizens constitute a noteworthy proportion of expatriates residing in the United Arab Emirates (UAE) and the close proximity of the two countries, due consideration of the situation in the UAE …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Differences In Angiographic Profile And Immediate Outcome Of Primary Percutaneous Coronary Intervention In Otherwise Risk-Free Young Male Smokers, Salik Ahmed, Sanam Khowaja, Saher Khowaja, Tariq Ashraf, Kanwal Aamir, Mahesh K. Batra, Musa Karim, Muhammad Anis M. Ahmedani, Syed Z. Jamal

Section of Internal Medicine

Introduction: Cigarette smoking is a well-established risk factor for the development and progression of coronary artery disease (CAD) and it is strongly related to cardiac morbidity and mortality. Therefore, this study aimed to compare the angiographic profile and immediate clinical outcomes in young male smokers and non-smokers without any other cardiac risk factors presented with ST-elevation myocardial infarction (STEMI).
Methods: This study includes young (≤40 years) male patients presented without cardiac risk factors other than smoking. Angiographic profile and immediate outcome of primary percutaneous coronary intervention (PCI) were collected from the hospital database.
Results: A total of 580 young male …

A Silent Fatal Presentation Of Pulmonary Embolism: Reflection And Discussion., Qian Zhang, Zain U. Abideen, Khine S. Shan, Thomas Yoon, Muhammad Farooq

Abington Jefferson Health Papers

Acute pulmonary embolism is a common medical condition that clinicians face in practice. It is important to have a prompt diagnosis with proper management as it is associated with high morbidity and mortality. However, a timely diagnosis is often difficult to obtain especially when the presenting symptoms are atypical, but the consequence could be fatal. We present an 80-year-old gentleman who presented with a near-syncope episode who subsequently was found to have acute extensive bilateral pulmonary embolisms after a code blue event.

A Mysterious Paratracheal Mass: Pulmonary Agenesis., Qian Zhang, Khine S. Shan

Abington Jefferson Health Papers

A 35-year-old lady with a history of possible tuberculosis infection 15 years ago presented to the clinic with the chief complaint of cough. Incidental chest CT showed a right paratracheal and medial right apical heterogeneous soft tissue mass with central areas of calcification that warranted further investigation. A routine endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) discovered isolated lobar pulmonary agenesis as the underlying cause of the mass without findings of malignancy on pathology reports.

Tension Pneumocephalus After Right Dacryocystorhinostomy: A Rare But Potential Serious Complication, Sher Sethi, Syed Ahsan Ali

Section of Internal Medicine

Tension pneumocephalus is a phenomenon in which air enters through dural injury in the brain and then expands and causes a mass effect. The injury can be due to any neurosurgical procedure, trauma, infection and/or neoplasm. A 63-year-old female known case of diabetes and hypertension had an elective procedure of right dacryocystorhinostomy present to the emergency department the very next day with a loss of consciousness. Urgent CT of the head showed air in the cranium (pneumocephalus). A radiological sign named "Mount Fuji" is classical for tension pneumocephalus. She was closely monitored and shows good clinical improvement allowing the neurosurgery …

Takotsubo Cardiomyopathy: A Rare Complication Of Acute Viral Gastroenteritis, Ammar Ashfaq, Waqas Ullah, Shristi Khanal, Muhammad Abdullah Zain, Nishanth Thalambedua, Faisal Inayat, Muhammad Umair Atiq

Division of Internal Medicine Faculty Papers & Presentations

Takotsubo Cardiomyopathy (TCM) is characterized by a transient but reversible ventricular dysfunction in post-menopausal females following, but not always, a recent emotional or physical stress. Typically, chest pain is reported as a presenting symptom in the majority of patients. The severe diarrheal illness secondary to acute viral gastroenteritis is not commonly reported as the stressor event prior to TCM. We report a unique case of a middle-aged male presented with syncope shortly after loose bowel movements. He was diagnosed with TCM and was successfully managed with supportive care. The purpose of this case is to make clinicians aware of this …

An Exceedingly Rare Presentation Of Severe Folate Deficiency-Induced Non-Immune Hemolytic Anemia., Qian Zhang, Khine S. Shan, Babatunde A. Ogunnaike, Atsoufi Amewuame-Kpehor, Travis Nace

Abington Jefferson Health Papers

Macrocytic anemia is usually associated with vitamin B12 or folate deficiency. However, folate deficiency was rarely reported as a cause of hemolytic anemia. We present a case of a young man with a history of alcohol abuse who initially presented with an acute on chronic abdominal pain and was found to have jaundice and scleral icterus. His liver enzymes were unremarkable, and his abdominal imaging did not reveal any acute pathology. However, he was found to have a severe non-immune hemolytic anemia secondary to folate deficiency.

Efficacy Of Allopurinol In Cardiovascular Diseases: A Systematic Review And Meta-Analysis, Waqas Ullah, Shristi Khanal, Rozi Khan, Bikash Basyal, Samavia Munir, Artem Minalyan, M. Chadi Alraies, David L. Fischman

Abington Jefferson Health Papers

Background: Given current evidence, the use of allopurinol for the prevention of major cardiovascular events (acute cardiovascular syn-drome (ACS) or cardiovascular mortality) in patients undergoing cor-onary artery bypass graft (CABG), after index ACS or heart failure remains unknown.

Methods: Multiple databases were queried to identify studies com-paring the efficacy of allopurinol in patients undergoing CABG, after ACS or heart failure. The unadjusted odds ratio (OR) was calculated using a random effect model.

Results: A total of nine studies comprising 850 patients (allopurinol 480, control 370) were identified. The pooled OR of periprocedural ACS (OR: 0.25, 95% confidence interval (CI): 0.06 …

Impact Of Order Set Use On Stroke Care, Bilal Nadeem, Edward Waseleski, Meryem Maras-Casey, Sabih Alam, Adnan Faruqui, Michael Gutierrez, Maruthsakhi Molugu, Christina Oricompil, Ashar Mahmood, Katherine Torralba, Fatima Agha, Nour Tlimat, Olu Oyesanmi, Irina Davis, Salman Muddassir, Nikolay Mitzov

West Florida Division GME Research Day 2020

• A case control study on stroke patients was recently completed for a quality improvement (QI) investigation.
• The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations

A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel, Ravi Patel, Marek Krysztofiak, K V. Sundaresh

West Florida Division GME Research Day 2020

Pott’s disease (PD), also known as tuberculosis spondylitis, is a rare disease of the spine which is typically caused by extraspinal infection. The basic lesion in Pott's disease is a combination of osteomyelitis and arthritis, usually affecting more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is commonly involved. Spinal TB can include any of the following: progressive bone destruction leading to vertebral collapse and kyphosis, cold abscess formation (due to extension of infection into adjacent ligaments and soft tissues), spinal canal narrowing by abscesses, granulation tissue or direct dural invasionresulting in spinal …

Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu, Andrea Hernandez, Bassem Zeidan, John T. Young, Johnathan Frunzi

West Florida Division GME Research Day 2020

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses ^{(1, 2)}. Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin ^(3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state ^(3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive care unit …

Kounis Syndrome, Charles Doerner, Mark Sawh, Tamer A. Amer, Konstantinos Marmagkiolis

West Florida Division GME Research Day 2020

Kounis syndrome, also known as allergic vasospastic angina, is a type of acute coronary syndrome caused by an allergic reaction or immune response to a substance.[1] It is essentially an “allergic angina” which is believed to be caused by mast cell activation and release of cytokines and histamine causing spasm of the artery leading to acute coronary syndrome and acute myocardial infarction. Stress cardiomyopathy (Takotsubo syndrome), which predominantly affects post-menopausal women, may also occur in anaphylaxis where transient ventricular dysfunction associated with regional ventricular wall abnormalities extending beyond the regions of coronary blood supply ensues.[2] The suspected prevalence of Kounis …

Initial Evaluation Of A Wellness Game, Bing Parkinson, Bruce St. Amour

Capital Division GME Virtual Research Day 2020

Physician wellness has recently been a topic of significant national interest.^1-8 The term “wellness” has many definitions, and was best defined by Around et al. ¹ as “one’s personal recipe for thriving and not just surviving.” Wellness refers to interconnected dimensions of physical, mental, and social well-being that extend beyond the absence of illness. Wellness has traditionally been measured in the negative sense by assessing rates of burnout, emotional exhaustion, and depersonalization. It is known that physician burnout is at its highest point during residency^{1, 4, 5} and burnout is linked to many negative outcomes including: substance abuse …

Axillary Artery Pseudoaneurysm Following Percutaneous Transaxillary Access For Impella Device Placement During Percutaneous Coronary Intervention, Anas A. Alharbi, Fahad S. Alqahtani, Peter Farjo, Jason A. Moreland

Internal Medicine Faculty Publications

Percutaneous transaxillary access is currently considered an acceptable alternative to transfemoral approach for large-bore access, especially in the setting of hostile iliofemoral arteries. Few published reports exist concerning complications of upper extremity access. We describe development of an axillary artery pseudoaneurysm and its management following transaxillary access. (Level of Difficulty: Advanced.)

Reliability And Validity Of Watch: Warwick Assessment Instrument For Clinical Teaching, Sonia Ijaz Haider, Khalid Masood Gondol, Muhammed Tariq, Muhammad Furqan Bari, Iqbal Azam Syed

Department for Educational Development

Objective: To determine the reliability, validity, feasibility, acceptability and perceived educational impact of WATCH: Warwick Assessment insTrument for Clinical teacHing among doctors in Pakistan.
Study design: Cross-sectional research study.
Place and duration of study: The College of Physicians and Surgeons, Pakistan, from September 2018 to August 2019.
Methodology: Postgraduate trainees were asked to rate the clinical teaching sessions, using WATCH, which consists of 15 items. Percentage was used to calculate gender and participation from different specialties. Inter-item correlations of 15 items with individual mean scores, standard deviations and Cronbach's Alpha were reported, including Friedman test, in order to observe the …

Role Of Micro-Rna For Pain After Surgery: Narrative Review Of Animal And Human Studies, Juan P Cata, Aysegul Gorur, Xiaoyi Yuan, Nathaniel K Berg, Anil K Sood, Holger K Eltzschig

Faculty, Staff and Student Publications

One of the most prevalent symptoms after major surgery is pain. When postoperative pain treatment is unsatisfactory, it can lead to poor surgical recovery, decreased quality of life, and increased health care costs. Current analgesics, single or in combination, have limited efficacy due to low potency, limited duration of action, toxicities, and risk of addiction. The lack of nonaddictive strong analgesics along with the over prescription of opioids has led to an opioid epidemic in the United States. Therefore, there is an urgent need for the development of newer analgesics. Microribonucleic acids (miRNAs) are small noncoding RNA molecules that modulate …

Hypoxia-Inducible Factor (Hif)-2Α Reprograms Liver Macrophages To Protect Against Acute Liver Injury Via The Production Of Interleukin-6, Rachel Y Gao, Meng Wang, Qihui Liu, Dechun Feng, Yankai Wen, Yang Xia, Sean P Colgan, Holger K Eltzschig, Cynthia Ju

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Acetaminophen (APAP) overdose represents the most frequent cause of acute liver failure, resulting in death or liver transplantation in more than one third of patients in the United States. The effectiveness of the only antidote, N-acetylcysteine, declines rapidly after APAP ingestion, long before patients are admitted to the clinic with symptoms of severe liver injury. The direct hepatotoxicity of APAP triggers a cascade of innate immune responses that may exacerbate or limit the progression of tissue damage. A better understanding of this complex mechanism will help uncover targets for therapeutic interventions.

APPROACH AND RESULTS: We observed that …

Impact Of Cardiopulmonary Resuscitation On Survival In Cancer Patients: Do Not Resuscitate Before Or After Cpr?, Dana E Giza, Jordan Graham, Teodora Donisan, Dinu V Balanescu, John Crommet, Gregory Botz, Cristina Gutierrez, Mariberta Vidal, Rodrigo Mejia, Cezar Iliescu

Faculty, Staff and Student Publications

No abstract provided.

Beyond An Updated Graded Prognostic Assessment (Breast Gpa): A Prognostic Index And Trends In Treatment And Survival In Breast Cancer Brain Metastases From 1985 To Today, Paul W Sperduto, Shane Mesko, Jing Li, Daniel Cagney, Ayal Aizer, Nancy U Lin, Eric Nesbit, Tim J Kruser, Jason Chan, Steve Braunstein, Jessica Lee, John P Kirkpatrick, Will Breen, Paul D Brown, Diana Shi, Helen A Shih, Hany Soliman, Arjun Sahgal, Ryan Shanley, William Sperduto, Emil Lou, Ashlyn Everett, Drexell Hunter Boggs, Laura Masucci, David Roberge, Jill Remick, Kristin Plichta, John M Buatti, Supriya Jain, Laurie E Gaspar, Cheng-Chia Wu, Tony J C Wang, John Bryant, Michael Chuong, James Yu, Veronica Chiang, Toshimichi Nakano, Hidefumi Aoyama, Minesh P Mehta

Faculty, Staff and Student Publications

PURPOSE: Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts.

METHODS AND MATERIALS: A multi-institutional (19), multinational (3), retrospective database of 2473 …