Medical Specialties Commons^™

Access And Continuity: A Multidisciplinary Education Workshop To Teach Patient-Centered Medical Home (Pcmh) Principles, L. Block, C. Petersen, D. J. Coletti, P. Yalakkishettar, N. Lavine

Journal Articles

No abstract provided.

Predictors Of Bleeding In The Perioperative Anticoagulant Use For Surgery Evaluation Study, A. J. Tafur, N. P. Clark, A. C. Spyropoulos, N. Li, E. Kaplovitch, K. Macdougall, S. Schulman, J. A. Caprini, J. Douketis

Journal Articles

No abstract provided.

Estimating The Predictive Value Of Negative Sars-Cov-2 Results: A Prospective Study, D. Hirschwerk, M. Foley, M. Lesser, B. Farber, J. M. Crawford, K. W. Davidson, G. J. Berry, E. Smith, C. Kast, T. Mcginn, +1 Additional Author

Journal Articles

© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved. We performed a prospective study of 501 patients, regardless of symptoms, admitted to the hospital, to estimate the predictive value of a negative Nasopharyngeal swab for SARS-CoV-2. At a positivity rate of 10.2%, the estimated Negative Predictive Value (NPV) was 97.2% and NPV rose as prevalence decreased during the study.

Do Not Fall To The Vape Trap!, S. Acharya, S. I. Ali, S. Anwar, A. Glaser

Journal Articles

© 2020 The Author(s) Introduction: Whilst the use of combustible tobacco products continues to decline in the United States, the use of e-cigarettes has seen an explosive rise in recent years. In 2019 an outbreak on EVALI was seen across the country, highlighting the fact that e-cigarettes may not be as harmless as previously perceived. Case description: A 22-year-old male came to the emergency department complaining of vomiting and shortness of breath. Patient reported using a “pod” a day of a “JUUL” e-cigarette. Patient's oxygen requirement continued to increase and was eventually shifted to the intensive care unit and mechanically …

A Rare But Reversible Cause Of Lithium-Induced Bradycardia., B. Ataallah, R. Al-Zakhari, A. Sharma, M. Tofano, G. Haggerty

Journal Articles

Lithium is a well-known medication that has been used for many years to treat mood disorders. One of its side effects is cardiotoxicity, which usually occurs at serum lithium levels > 1.5 mEq/L but rarely occurs when therapeutic levels of lithium are used. Other causes of bradycardia should be eliminated by performing a detailed workup that includes calcium level, thyroid function, and cardiac workup, with consideration of any medication interactions. Lithium-induced bradycardia is reversible upon discontinuation of lithium, but irreversible sinus node can occur and may warrant permanent insertion of a pacemaker to maintain sinus rhythm when long-term lithium therapy is …

Erratum: A Large Right Ventricle And Severe Hypoxemia. Use Of Bedside Transesophageal Echocardiography To Assess Cardiopulmonary Failure (Annals Of The American Thoracic Society (2020) 17 (112-115) Doi: 10.1513/Annalsats.201904-316cc), A. Agrawal, M. Frank, A. Tsegaye

Journal Articles

Copyright © 2020 by the American Thoracic Society. The authors would like to make a correction to the legends of Videos 1 and 3 in their article published in the January 2020 issue of AnnalsATS (1). The definition for the abbreviation TEE in these video legends should read "transesophageal echocardiogram." For the convenience of our readers, AnnalsATS is replacing the online version of the article with a corrected version; we apologize for the error.

Optimizing Telehealth Experience Design Through Usability Testing In Hispanic American And African American Patient Populations: Observational Study., D. King, S. Khan, J. Polo, J. Solomon, R. Pekmezaris, N. Hajizadeh

Journal Articles

BACKGROUND:Telehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices. …

Progressive Dyspnea After Use Of Electronic Vaping, Taylor Studsrud, Morgan Zegers, Gary Cook, Narrani Kanapathippillai, Hilton Alemar-Hernandez

West Florida Division GME Research Day 2020

No abstract provided.

Profile Of Cardiac Arrhythmia In Acute Stroke Patients, Julius Stephen Nkhondeya Msukuya

Master of Medicine in Internal Medicine

Introduction: Cardiac arrhythmias are common and can be fatal in acute strokes, but they are often under-recognized. The presence of cardiac arrhythmia in acute stroke doubles the mortality. Objectives: This study aimed to determine the types of cardiac arrhythmia in acute stroke patients admitted in two urban hospitals in Dar es Salaam, The Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital. The secondary objectives were to determine the associations between the characteristic of stroke and cardiac arrhythmias as well as to determine the impact of cardiac arrhythmia on 30- days stroke outcomes. Methods: This was a prospective longitudinal …

The Clinicodemographic Profile Of Multiple Sclerosis At Aga Khan University Hospital (Nairobi), Imran Jamal

Master of Medicine in Internal Medicine

Background: Multiple sclerosis (MS) is the leading cause of nontraumatic disability in young adults and is the most common immune-mediated inflammatory demyelinating disease of the CNS. MS was initially considered to be rare in sub-Saharan Africa (SSA). However, there have been reports of rising trends of MS in regions with previously low prevalence. Objective: The primary objective of this study was to describe the demographic and clinical characteristics of MS patients at AKUHN. Methods: Medical records of patients with MS at the AKUHN were obtained using the ICD 10 code search at the medical records section of the hospital between …

Outcomes Of Inpatients Hospitalized With Community Acquired Pneumonia, Jamila Nambafu

Master of Medicine in Internal Medicine

Background: The morbidity from lower respiratory tract infections has varied between age groups and from region to region. In sub-Saharan Africa, pneumonia remains the most frequent reason for adult hospitalization, with approximately 4 million episodes and about 200,000 deaths every year. Some of the attributable factors have been HIV pandemic, pulmonary tuberculosis, and poor socio-economic status. Objective: The main objective was to determine the morbidity of community-acquired pneumonia in patients admitted to a tertiary hospital in Nairobi, Kenya, between May 2019, and March 2020. The results are anticipated to help in informing protocols for the evaluation and treatment of community-acquired …

Internal Medicine Consultation For Dentists, Nina Mingioni, Md

Clinical Education Teaching Tools

Learning Objectives:

• Recognize ubiquitous nature of common medical condition in general population
• Discuss implications of common medical conditions on dental care of patients
• Identify concerns affecting patients that would necessitate medical consultation prior to dental intervention

Unusual Infectious Metastases Secondary To Acupuncture Induced Mssa Septicemia, Kayla Chory, Neil Bobenhouse, Maria Pena, Adwait Mehta

Faculty, Staff and Student Publications

We describe a rare case of methicillin-sensitive

A Policy Analysis Of The 2017 Fasting Guidelines Among Gi Surgical Patients, Toney Banks

Doctor of Nursing Practice Projects

The objective of the fasting guidelines is to improve the quality and efficacy of anesthesia care. It is based on two main researched principles: The ingested material must be clear without particulates, and it must not be within two hours of the procedure. The purpose of this project is to equip the medical community with the latest guidelines on NPO (fasting), ensuring that patients are seen on time without delays or cancellations of surgery and with improved patient comfort. A retrospective chart review of 500 randomly chosen charts from patients seen at an Endoscopy Center. Pearson’s Chi-square value and the …

Case Report: Concomitant Diagnosis Of Plasma Cell Leukemia In Patient With Jak2 Positive Myeloproliferative Neoplasm., Christine J Kurian, Colin Thomas, Sarah Houtmann, Thomas Klumpp, Adam Finn Binder

Division of Internal Medicine Faculty Papers & Presentations

Plasma cell dyscrasias and myeloproliferative neoplasms (MPN) are hematologic malignancies arising from two distinct hematopoietic cell lineages. They rarely occur concomitantly. Here, we report a case of a patient with a recent diagnosis of a JAK2 V617F positive MPN who presented with a new diagnosis of plasma cell leukemia. The patient had presented to the hospital with a leukocytosis predominantly comprised of plasma cells, followed by work-up involving peripheral blood flow cytometry, FISH analysis, and bone-marrow biopsy. FISH analysis was suggestive of a common progenitor cell for these distinct hematologic malignancies. To our knowledge, this case represents the second reported …

Safety, Feasibility, And Efficacy Of Early Rehabilitation In Patients Requiring Continuous Renal Replacement: A Quality Improvement Study, Kirby P. Mayer, Amanda R. Hornsby, Victor Ortiz Soriano, Timothy C. Lin, Jennifer T. Cunningham, Hanwen Yuan, Caroline E. Hauschild, Peter E. Morris, Javier A. Neyra

Physical Therapy Faculty Publications

Introduction: Early rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT.

Methods: Study design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse …

Effect Of Unmaskes On Delivering Difficult News Among Residents, Karishma Sharma

Master of Medicine in Internal Medicine

Background: Effective delivery of difficult news to patients and family has been shown to improve the physician-patient relationship, quality of care, and overall patient satisfaction. However, delivery of difficult news (DDN) remains a challenging task for even the most experienced providers. Little has been studied about delivery of difficult news by resident physicians in the sub-Saharan setting. We developed a 4-minute, easily accessible, graphic video using the mnemonic UNMASKES to help improve delivery of difficult news by resident physicians at our institution and their patients. Objective: To determine the impact of a short training video called UNMASKES in helping resident …

Occult Hepatitis B Virus Infection In A Cohort Of Hiv Infected Antiretroviral Therapy Naïve Adults, Adil Suleiman Salyani

Master of Medicine in Internal Medicine

Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic to sub-Saharan Africa (SSA) with co-infection being common. Infection with HIV is a risk factor for occult hepatitis B virus infection (OBI), defined as presence of HBV deoxyribonucleic acid (DNA) in the absence of hepatitis B surface antigen (HBsAg). Occult hepatitis B virus infection is further classified based on HBV DNA level as true (/mL) or false (≥200 IU/mL). Presence of OBI is associated with development of liver cirrhosis and hepatocellular carcinoma (HCC). Objectives: The primary outcome was to determine the prevalence of OBI in anti-retroviral therapy (ART) …

Utility Of Glasgow-Blatchford Scoring System In Identification Of Low Risk Patients With Upper Gastrointestinal Bleeding In Emergency Departments In Dar Es Salaam Hospitals, Tanzania, Selestin D. Mpiri

Master of Medicine in Internal Medicine

Background: Acute upper gastrointestinal bleeding (UGIB) remains a common cause of visits to the Emergency Department (ED). To stratify the risk of complications, rebleeding, need for clinical intervention, or death, several clinical scores are in use. Glasgow-Blatchford Score (GBS) is an excellent risk assessment tool and has shown to accurately identify patients with a low risk of death or requiring intervention. In urban Tanzania, there is a lack of standardized protocol and a well-validated risk assessment tool for analyzing patients presenting with UGIB symptoms. Good performance of GBS score and its use will help to reduce unnecessary emergency endoscopies and …

Gynecologic Large Cell Neuroendocrine Carcinoma: A Review, Grant Burkeen, Aman Chauhan, Rohitashva Agrawal, Riva Raiker, Jill M. Kolesar, Lowell B. Anthony, B. Mark Evers, Susanne Arnold

Internal Medicine Faculty Publications

Large cell neuroendocrine carcinomas (LCNEC) are rare, aggressive high-grade neuroendocrine neoplasms within the neuroendocrine cell lineage spectrum. This manuscript provides a detailed review of published literature on LCNEC of gynecological origin. We performed a PubMed search for material available on gynecologic LCNEC. We analyzed 104 unique cases of gynecologic LCNECs, of which 45 were cervical primary, 45 were ovarian, 13 were uterine, and 1 was vaginal. A total of 45 cases of cervical LCNEC were identified with a median age of 36 years. Median overall survival was 16 months. We identified 45 ovarian LCNEC cases in the published literature with …

Medical Student Attitudes Toward Cell Phone Use On Rounds, Jacob Garcia, Sarah E. Rosenberg, Md

Phase 1

Purpose: Mobile devices are ubiquitous and serve as an important resource for on-the-spot research about patient questions and conditions. However, even when a device is used to address patient needs, patients and members of the medical team may assume the student is using their phone for non-clinical activities and perceive the student as uninterested and disengaged. Medical students are aware of this potential for misperception, and as such, we designed a study to investigate the attitudes of third and fourth year medical students towards cell phone use on internal medicine rounds.

Methods: Our target learner population was third and fourth …

Point-Of-Care Ultrasound (Pocus) Workshop For Internal Medicine Residents: A Pre/Post-Training Assessment Of Confidence And Knowledge, Abraham Lee, Cesar Gutierrez, Michelle Lopez

MEDI 9331 Scholarly Activities Clinical Years

Across the country, internal medicine residency training programs are having difficulty figuring out how to optimally implement an effective point-of-care ultrasound training into their respective curricula. This study aimed to assess whether a week-long training course of didactics, followed by hands-on practice, improved both the confidence and knowledge skills of internal medicine residents using point-of-care ultrasound (POCUS). The trainees were asked to complete pre/post-training surveys, which tested their ability to interpret POCUS images and also asked them to score their confidence in using POCUS. Results showed a statistically significant improvement in not only their confidence in using POCUS, but also …

Time-To-Completed-Imaging, Survival And Function In Patients With Spinal Epidural Abscess: Description Of A Series Of 34 Patients, 2015–2018, Caroline King, Cameron Fisher, Patrick C.M. Brown, Kelsey C. Priest, Mary Tanski, Peter Sullivan

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Spinal epidural abscess (SEA) is a rare and life-threatening infection with increasing incidence over the past two decades. Delays in diagnosis can cause significant morbidity and mortality among patients.

Objective: The objective of this study was to describe trends in time-to-imaging and intervention, risk factors, and outcomes among patients presenting to the emergency department with SEA at a single academic medical center in Portland, Oregon.

Methods: This retrospective cohort study analyzed data from patients with new SEA diagnosis at a single hospital from October 1, 2015 to April 1, 2018. We describe averages to time-to-imaging and …

Broken And Forgotten: A Case Of Unintentionally Retained Foreign Object, Hong Loan Nguyen, Lauren Nicholas Herrera, Ali Cheema, Pralay Kumar Sarkar

Faculty, Staff and Students Publications

Central venous catheter have become ubiquitous with greater than 15 million catheter days/year in the intensive care setting alone. However, the procedure carries with it several immediate and other delayed complications that can result in significant morbidity, mortality, and increased healthcare cost. We report a rare case of significantly delayed complications associated with intravascular loss of guide wire during central venous catheter placement and its impact on patient's long term management. The case highlights not only the importance of proper technique and safety precaution in performing an increasingly common procedure, but also the need for timely identification and rectification of …

Aromatase Inhibitors Plus Weight Loss Improves The Hormonal Profile Of Obese Hypogonadal Men Without Causing Major Side Effects, Georgia Colleluori, Rui Chen, Christie G Turin, Francesca Vigevano, Clifford Qualls, Biju Johnson, Sanjay Mediwala, Dennis T Villareal, Reina Armamento-Villareal

Faculty, Staff and Students Publications

Objective: In obese men, the increased expression of the aromatase enzyme in adipose tissue leads to high conversion of androgens to estrogens contributing to hypogonadotropic hypogonadism (HHG). Our objective is to evaluate efficacy and safety of weight loss (WL) plus aromatase inhibitor (AI) therapy in severely obese men with HHG. We hypothesize that AI+WL will be more effective as compared to WL alone in improving the hormonal profile, thus muscle strength and symptoms of HHG (primary outcomes), with no significant adverse effects on lean mass, metabolic profile, and bone mineral density (secondary outcomes).

Design: Randomized double-blind placebo-controlled pilot trial.

Methods: …

Pre-Treatment Hiv-Drug Resistance Associated With Virologic Outcome Of First-Line Nnrti-Antiretroviral Therapy: A Cohort Study In Kenya, Ingrid A. Beck, Molly Levine, Christine J. Mcgrath, Steve Bii, Ross S. Milne, James M. Kingoo, Isaac So, Nina Andersen, Sandra Dross, Michael Chung

Internal Medicine, East Africa

Background: Pre-treatment HIV-drug-resistance (PDR) to WHO-recommended 1st-line non-nucleoside reverse transcriptase inhibitors (NNRTI)-based antiretroviral treatment (ART) is increasing in low-resource communities. We evaluated the risk of PDR on treatment failure if detected at single or multiple codons, at minority (2–9%) or higher (≥10%) frequencies during efavirenz- vs. nevirapine-ART.

Methods: We conducted a pooled analysis across three cohorts of Kenyans initiating 1st-line NNRTI-ART between 2006 and 2014. Mutations K103N, Y181C, G190A, M184V and K65R were detected by an oligonucleotide ligation assay (OLA) and confirmed by Sanger and next-generation sequencing (NGS). PDR was defined as detection of any mutation by OLA when confirmed …

Revisiting Caroli Syndrome In A Tanzanian Patient, Casmir Wambura, Munish Sharma, Salim Surani

Internal Medicine, East Africa

Caroli disease and Caroli syndrome are two rare congenital diseases of the intrahepatic bile ducts. Caroli syndrome is characterized by the saccular dilatation of intrahepatic bile ducts associated with congenital hepatic fibrosis. It is rarely diagnosed in childhood. We hereby describe a case of Caroli syndrome in a young Tanzanian female who had abdominal pain and distension since childhood. Her history suggested the presence of portal hypertension possibly from congenital hepatic fibrosis. The diagnosis was reached based on ultrasound, computed tomography (CT) scan of the abdomen, and magnetic resonance cholangiopancreatography (MRCP)

Individual And Community Social Determinants Of Health Associated With Diabetes Management In A Mexican American Population, Kehe Zhang, Belinda Reininger, Miryoung Lee, Qian Xiao, Cici Bauer

Faculty, Staff and Student Publications

Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies.

Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) …

The Impact Of Scaling Up Cervical Cancer Screening And Treatment Services Among Women Living With Hiv In Kenya: A Modelling Study, Pablo Noel Perez-Guzman, Michael Chung, Hugo De Vuyst, Shona Dalal, Kennedy K. Mutai, Karanja Muthoni, Bartilol Kigen, Timothy B. Hallett, Mikaela Smit

Internal Medicine, East Africa

Introduction: We aimed to quantify health outcomes and programmatic implications of scaling up cervical cancer (CC) screening and treatment options for women living with HIV in care aged 18–65 in Kenya.

Methods: Mathematical model comparing from 2020 to 2040: (1) visual inspection with acetic acid (VIA) and cryotherapy (Cryo); (2) VIA and Cryo or loop excision electrical procedure (LEEP), as indicated; (3) human papillomavirus (HPV)-DNA testing and Cryo or LEEP; and (4) enhanced screening technologies (either same-day HPV-DNA testing or digitally enhanced VIA) and Cryo or LEEP. Outcomes measured were annual number of CC cases, deaths, screening and treatment interventions, …

Case Report Of Kikuchi-Fujimoto Disease From Sub-Saharan Africa: An Important Mimic Of Tuberculous Lymphadenitis, Karishma Sharma, Fredrick Otieno, Reena Shah

Internal Medicine, East Africa

Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced …