Medical Specialties Commons^™

Peripheral Blood Count Characteristics, Neutrophil-Lymphocyte Ratio, And Platelet-Lymphocyte Ratio Pulmonary Tuberculosis Patients With Depression, Hamzah Shatri, Reinaldo Alexander, Rudi Putranto, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with pulmonary tuberculosis (TB) had an increased risk for depression up to 1.53 times from a large cohort study. Studies have found an increase in the neutrophil - lymphocyte ratio (NLR) in various mood disorders including depression, also the value of the platelet-lymphocyte ratio (PLR) associated with major depression accompanied by psychotic symptoms. This study aimed to describe the peripheral blood characteristics, NLR, and PLR in pulmonary TB patients with depression. Methods. A cross-sectional study of 106 non-multidrug-resistant pulmonary TB patients was done at outpatient department of Cipto Mangunkusumo General Hospital, Jakarta from August to October 2018. The …

Penanda Respons Imun Perifer Pada Penyakit Kronik: Sudahkah Dapat Menjadi Pedoman Adanya Inflamasi Sistemik?, Andhika Rachman

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Association Between Silica Dust Exposure And Serum Transforming Growth Factor-Β1 In Stone Quarry Workers, I Putu Eka Krisnha Wijaya, Ida Bagus Ngurah Rai, I Putu Andrika

Jurnal Penyakit Dalam Indonesia

Introduction. Silicosis is a disease that most often occurred as a result of silica dust exposure. Silica dust particles will stimulate alveolar macrophages to secrete proinflammatory mediators for fibroblast proliferation and collagen deposition. TGF-ß1 is one of the most extensively involved mediators in the development of fibrosis. To date, several studies have not shown consistent results regarding the association between silica dust exposure and TGF-β1. This study examined silica dust exposure and serum TGF-β1, which aims to determine the risk of silicosis in stone quarry workers. Methods. An analytic cross-sectional study was conducted at Company X, Karangasem in March 2016. …

Correlation Between Proper Antibiotics Administration To Community Acquired Pneumonia Patients Based On Alur Gyssens With Clinical Response, Cleopas Martin Rumende, Lie Khie Chen, Anis Karuniawati, Joyce Bratanata, Rezyta Falasiva, Truly Panca Sitorus, Erwin Christian Susanto

Jurnal Penyakit Dalam Indonesia

Introduction. The proper of antibiotics treatment will increase the improvement of the patient with community-acquired pneumonia (CAP) and also counteract antimicrobial resistance. Community-Acquired Pneumonia is commonly found in Indonesia with an incidence of 2.4%. This study aimed to determine the proper of antibiotic selection for CAP based on IDSA-ATS 2007 guidelines with Gyssens method and evaluate the relationship between the proper of antibiotic treatment with the clinical response of patients. Methods. A retrospective cohort study was conducted with secondary data from the previous study. Study was conducted in three hospitals in Jakarta, namely Cipto Mangunkusumo General Hospital, Budhi Asih Hospital, …

Correlation Between Glycemic Control In Type 2 Diabetes Mellitus Patients With Natural Killer Cell Activity, Dian Ristanti, Gatot Soegiarto, Hermina Novida

Jurnal Penyakit Dalam Indonesia

Introduction. Most of the previous studies showed decreased polymorphonuclear cells and monocytes/macrophages in type 2 diabetes mellitus (T2DM). Natural killer (NK) cell functions were rarely studied in T2DM. This study aimed to evaluate NK cell activity and determine its correlation with glycemic control in T2DM patients. Methods. Type 2 diabetes mellitus (T2DM) patients who regularly visit the diabetes outpatient clinic of Dr. Soetomo General Hospital during July – August 2018 and fulfill the inclusion-exclusion criteria were recruited to the study. The HbA1c level was measured according to the standard procedure. The NK cell activity was measured using flow cytometry and …

Survival Kidney Transplantation From Related And Emotionally Related Living Donors In Cipto Mangunkusumo Hospital 2010-2015, Utami Susilowati, Bambang Sutrisna, Maruhum Bonar H Marbun, Endang Susalit

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Conn’S Syndrome Due To Adrenal Adenoma, Haerani Rasyid, Syakib Bakri, Hasyim Kasim, Andi Rahmat Hidayat, Syarif Syarif, Abd Azis

Jurnal Penyakit Dalam Indonesia

Conn’s syndrome is characterized by an increase in aldosterone level causes sodium retention and an increase in urine excretion of potassium. This syndrome is characterized by trias hypokalemia, hypertension, and metabolic alkalosis. This article discussed a case report of a patient with uncontrolled hypertension with neuromuscular symptoms caused by recurrent hypokalemia. After an evaluation of the imaging test, we found a left adrenal tumor then we performed unilateral adrenalectomy surgery. Histopathology examination from the excised tumor revealed the adrenal adenoma. After unilateral adrenalectomy, the patient showed clinical and laboratory improvement.

Peripheral Arterial Disease And Cardiovascular Mortality In Type-2 Diabetes Mellitus, Dekta Filantropi Esa, Adelia Nova Prahasary, Dicky L. Tahapary, Em Yunir

Jurnal Penyakit Dalam Indonesia

Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM), which increases the risk of cardiovascular mortality. Ankle-brachial index (ABI) is one of the simple and widely available tool to diagnose PAD. The authors aim to find out the cardiovascular mortality in T2DM patient with PAD. Bundo et al. study found HR 2.45 (95% CI: 0.84 to 7.17). Mostaza et al. study reported HR 1.64 (95% CI: 0.64 to 4.49). Aboyans et al. study declared HR 2.21 (95% CI: 1.16 to 4.22). Mohammedi K et al. claimed HR 1.35 (95% CI: 1.15 to 1.60). …

Gastroesophageal Reflux Risk Factor Analysis At Saiful Anwar Hospital In Malang, Ricky C. Tarigan, Bogi Pratomo

Jurnal Penyakit Dalam Indonesia

Introduction. Gastroesophageal reflux disease (GERD) is a pathological condition as a result of reflux of stomach contents into the esophagus with various symptoms that arise due to the involvement of the esophagus, larynx, and airways. The prevalence of GERD has increased lately. In Indonesia, 22.8% cases of esophagitis were reported. Analysis of the risk factors for GERD is very important in reducing the prevalence of GERD. This study aimed to identify the most influential risk factors for GERD patients so that it could become a reference to reduce the prevalence of GERD in the following year. Methods. This study was …

Topological Dna Damage, Telomere Attrition And T Cell Senescence During Chronic Viral Infections, Yingjie Ji, Xindi Dang, Lam Ngoc Thao Nguyen, Lam Nhat Nguyen, Jaun Zhao, Dechao Cao, Sushant Khanal, Madison Schank, Xiao Y. Wu, Zheng D. Morrison, Yue Zou, Mohamed El Gazzar, Shunbin Ning, Ling Wang, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

Background: T cells play a key role in controlling viral infections; however, the underlying mechanisms regulating their functions during human viral infections remain incompletely understood. Here, we used CD4 T cells derived from individuals with chronic viral infections or healthy T cells treated with camptothecin (CPT) - a topoisomerase I (Top 1) inhibitor - as a model to investigate the role of DNA topology in reprogramming telomeric DNA damage responses (DDR) and remodeling T cell functions.

Results: We demonstrated that Top 1 protein expression and enzyme activity were significantly inhibited, while the Top 1 cleavage complex (TOP1cc) was …

Thalidomide For The Treatment Of Metastatic Hepatic Epithelioid Hemangioendothelioma: A Case Report With A Long Term Follow-Up, Felipe Salech, Sebastián Valderrama, Bruno Nervi, Juan Carlos Rodriguez, Danny Oksenberg, Alvaro Koch, Gladys Smok, Ignacio Duarte, Rosa María Pérez-Ayuso, Nicolás Jarufe, Jorge Martínez, Alejandro Soza, Marco Arrese, Arnoldo Riquelme

Internal Medicine Faculty Publications

Hepatic epithelioid hemangioendothelioma (HEH) is an unusual, low-grade malignant vascular tumor of the liver. Here we describe a case of a 40-year-old woman who presented with abdominal pain in the upper right quadrant and giant hepatomegaly, in which imaging studies and a fine-needle liver biopsy confirmed the presence of a large EHE with an isolated lung metastasis. After balancing all possible therapeutic modalities the patient was treated conservatively with thalidomide (300 mg/day). The drug was well tolerated with minimal toxicity and thepatient continues on therapy 109 months after treatment was started with no disease progression. Current therapeutic options for HEH …

Acute Generalized Exanthematous Pustulosis: A Rare Side Effect Of Clindamycin., Sijan Basnet, Rashmi Dhital, Biswaraj Tharu

Reading Hospital Internal Medicine Residency

Acute generalized exanthematous pustulosis (AGEP) is a rare adverse effect of clindamycin characterized by widespread papules and pustulosis 1 - 3 weeks of its use. Case description: We present a case of a 71-year-old woman diagnosed with AGEP after clindamycin use for a tooth infection. She had been started on empiric prednisone without benefit. She did not have any systemic involvement and had an unremarkable blood work . Her rash resolved completely in a month.

No Hard Feelings, Colin Thomas, Md

The Medicine Forum

No abstract provided.

To Those Who Don The White Coat, Cuckoo Choudhary, Md

The Medicine Forum

No abstract provided.

Heart Failure With Preserved Ejection Fraction: A Review Of The Acc/Aha Guidelines And Evidence-Based Management Strategy, Vikas Sunder, Md

The Medicine Forum

Introduction

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome in which a patient has signs and symptoms of heart failure including dyspnea, fatigue, pulmonary rales, peripheral edema and an ejection fraction greater than 50%.1-4 Approximately half of patients with heart failure have a preserved ejection fraction.2-5 HFpEF is considered a distinct clinical entity from other causes of heart failure with a preserved ejection fraction such as valvular heart disease, pericardial disease, and infiltrative cardiomyopathy. HFpEF carries a poor prognosis, with an annual mortality of 29% in patients discharged after an acute decompensated heart failure admission.5 5-year survival …

A Gram-Negative False-Negative: Normal Procalcitonin Level In A Patient With Multiple Klebsiella Pneumoniae Intra-Abdominal Abscesses: A Case Report And Literature Review, Mario Caldararo, Md

The Medicine Forum

Introduction

Despite over 3,000 peer-reviewed articles on procalcitonin (PCT) since 2004, guidance on its usage is sparse.1 An analysis of more than 500 United States hospitals in the Premier Healthcare Database found large differences in utilization exist across regions (115 PCT encounters per 10,000 patients in the Northeast vs. 408 to 576 in other regions) and teaching vs. non-teaching hospitals (345 vs. 530 PCT encounters per 10,000 patients, respectively).2 The purpose of this work is to describe a case that exemplifies the caveats in PCT interpretation and to summarize the current knowledge of the clinical utilization of PCT.

Can Our Hearts Take The New Guidelines?, Eitan Frankel, Md

The Medicine Forum

No abstract provided.

Resident Experiences With Journaling, Tara Sunder, Md, Gretchen Diemer, Md, Vikas Sunder, Md

The Medicine Forum

Background

Each year, medical school graduates don their long white coat for the first time and begin their residency. While residency promises the excitement of learning and increased autonomy, it also brings long duty hours and stressful situations worsened by inexperience. Due to these stressors, burnout affects many residents each year. Studies have been done to see if wellness curricula help decrease resident burnout, and since journaling is a known way to relieve stress and enhance reflection, journaling has become a common intervention in these curricula.1,2 While there are studies evaluating the impact of journaling on mental health and stress …

Pneumatosis Intestinalis In A Patient With Systemic Lupus Erythematosus, Sean Dikdan, Md, Michael Lake, Md

The Medicine Forum

Introduction

Pneumatosis intestinalis (PI) refers to the radiographic finding of gas within the small or large bowel wall. It can be seen in association with gas in the portal venous system. The clinical significance of these findings is variable and depends on the patient's etiology and initial presentation. PI can be seen anywhere in the gastrointestinal tract distal to the stomach and is caused by a myriad of conditions.1 We present a case of a patient admitted to the intensive care unit with PI and portal vein gas.

Hemothorax And Hemorrhagic Ascites: A Rare Presentation Of Endometriosis, Harry Wang, Md

The Medicine Forum

Introduction

Endometriosis is a common diagnosis in reproductive age women characterized by the presence of endometrial tissue outside the uterine cavity.1 Although it is typically confined to the pelvis, rare manifestations involving the thorax, abdomen or pericardium have been documented.2-5 Even more rare is the concurrent presence of endometriosis- associated hemorrhagic pleural effusion and ascites, which can prove a diagnostic challenge. We describe a case of hemothorax and hemorrhagic ascites in a woman with shortness of breath and abdominal pain.

Subacute Onset Hand Clumsiness In A Renal Transplant Patient With A Recent Icu Stay, William Bradford, Md

The Medicine Forum

Introduction

Solid organ transplant recipients carry a high burden of disease and are susceptible to opportunistic infections not seen in other patient subgroups. Signs and symptoms that would not necessarily warrant timely attention in other patient groups may call for an aggressive workup in this subset of patients. Here, we present one case in which a seemingly trivial complaint denoted serious underlying pathology, and timely attention to this minor but unusual concern led to early intervention with appropriate treatment of an uncommon disorder.

Hyperviscosity In Non-Igm Lymphoplasmacytic Lymphoma, Mario Fonseca-Paricio, Md, Sushil Chmire, Md, Adam Binder, Md

The Medicine Forum

The following is a case of how a non-IgM paraproteinemia can present with symptoms of hyperviscosity and coagulopathy, an uncommon occurrence.1-3 As this case demonstrates, this diagnosis must be considered even in patients with relatively normal coagulation laboratory results. Such pathology requires urgent treatment with plasmapheresis.

Worsening Autoimmune Neutropenia After Stopping Ibrutinib In A Patient With Chronic Lymphocytic Leukemia: Case Report And Review Of Literature, Natalie Rosen, Ba, Thomas Klumpp, Md, Sameh Gaballa, Md, Msc

The Medicine Forum

Introduction

Autoimmune cytopenia (AIC) is relatively common in patients with chronic lymphocytic leukemia occurring in 5-10% of patients during the course of their disease.1 Autoimmune hemolytic anemia (AIHA) constitutes the highest prevalence (5-10%) of CLL-associated AIC followed by idiopathic thrombocytopenic purpura (ITP) (2-5%), pure red cell aplasia (PRCA) (<1%), and autoimmune neutropenia (AIN) (<1%).2,3 The prevalence of AIN, however, may in fact be higher than reported due to a lack of awareness of the condition and difficulty in its diagnosis.4 Despite its rarity, autoimmune neutropenia can be a significant clinical challenge in patients with CLL and can increase the risk of infectious complications. Thus, the prompt diagnosis and resolution of CLL-associated AIN is essential to the management of these patients.

Ibrutinib is a selective inhibitor of Bruton tyrosine kinase and induces a durable response in patients with CLL.5 The activity of ibrutinib in CLL-associated AIC is largely unknown as pivotal clinical trials excluded patients with AIC. We report a case of a patient with CLL who experienced worsening of AIN after …

Bilateral Choroidal Metastases As Initial Presentation Of Widespread Follicular Thyroid Cancer, Jennifer Hong, Md

The Medicine Forum

Introduction

Follicular thyroid cancer (FTC) is the second most common malignancy of the thyroid gland and comprise 10-15% of all thyroid tumors; the usual mode of spread is via hematogenous dissemination with the most common sites of metastases being the lungs and bones.4 A case is presented to demonstrate the unusual presentation of follicular thyroid cancer as bilateral choroidal metastases. Although exceptional, a diagnosis of choroidal metastases should be considered in any decline in visual acuity in patients with thyroid cancer.

Complicated Persistent Peritonitis, Lindsey Roth, Ba, Kumar Sarkar, Md

The Medicine Forum

Introduction

Spontaneous bacterial peritonitis (SBP) is a common complication of end-stage liver disease. SBP can present with many symptoms such as abdominal pain, fever and altered mental status.1 The diagnosis of SBP is made when ascitic fluid from a paracentesis has an absolute neutrophil count (ANC) more than 250/uL, there is a positive ascitic fluid culture, and no secondary source of infection can be idenitifed.2 However, nearly 60% of patients with SBP have negative fluid cultures.3 These patients can still potentially have SBP and should be treated as such since in-hospital mortality ranges from 20-40%.1,4 Conventional treatment for SBP includes …

Sealing The Diagnosis Of Celiac Disease In Pregnancy, Ritu Nahar, Md, Avani Aman, Md

The Medicine Forum

Introduction

Celiac disease (CD) is an immune mediated condition that results from a reaction to dietary gluten and primarily affects the small intestine. Genetically predisposed individuals develop a chronic inflammatory state of the small intestine which leads to malabsorption. The disease is mediated by HLA DQ2 or DQ8 haplotypes, which bind the gliadin peptides of gluten, present the peptides to CD4+ T lymphocytes and trigger cytokine and B lymphocyte responses.1

The prevalence of CD in the United States is approximately 1% and can reach up to 4-5% in at-risk groups.2 Serologic study of asymptomatic elderly patients in the United Kingdom …

Thyrotoxic Periodic Paralysis – A Case Report Of A Rare Cause Of Paralysis In A 39-Year-Old Asian Man, R. Benson Jones, Md, James Uricheck, Md

The Medicine Forum

Introduction

Uncontrolled hyper thyroidism has a myriad of presentations. Classically, symptoms include weight loss, tremor, palpitations, shortness of breath, diarrhea, anxiety, and heat intolerance. A rare manifestation of hyperthyroidism is thyrotoxic periodic paralysis (TPP). Periodic paralysis is a musculoskeletal channelopathy manifested by episodes of painless muscle weakness often precipitated by heavy exercise, fasting, or high carbohydrate meals. Although classically associated with painless weakness; cramping, myalgias, and stiffness can also occur prior to the episodes as prodromal symptoms. Neurologic examination during an attack typically demonstrates proximal more than distal muscle weakness, and the upper extremities are more commonly affected than the …

A Case Report Of Pseudohypoglycemia In A Patient With Leukocytosis, Michael Weintraub, Md, Deepika Nandiraju, Md, Monika Shirodkar, Md

The Medicine Forum

Introduction

Hypoglycemia is most convincingly documented by Whipple’s triad: low plasma glucose, symptoms of hypoglycemia and relief of symptoms after treatment.1 Pseudohypoglycemia is a condition where there is an artifactually low glucose concentration and an absence of hypoglycemic symptoms. We present a case of pseudohypoglycemia where leukocytosis played a role in lowering venous glucose.

A Case Of Left Ventricular Myocardial Calcification In A Patient With Severe Sepsis, Carly Sedlock, Md, Randi Zukas, Md, Hillary Landon, Md

The Medicine Forum

Introduction

Sepsis is an important source of morbidity and mortality among patients admitted to the Intensive Care Unit (ICU) and can cause critical damage to all organ systems. Regarding cardiac complications, sepsis can acutely result in cardiomyopathy characterized by ventricular dilatation and a depressed ejection fraction.1 Myocardial calcification is a more rare, delayed cardiac complication of severe sepsis that has been reported in literature.1-6 Herein we report a case of a patient with Acute Myeloid Leukemia (AML) admitted to the TJUH ICU requiring prolonged vasopressor support for severe sepsis whose clinical course was complicated by left ventricular myocardial calcification.

Fibrous Web In The Right Atrium: A Complication Of Fungal Endocarditis And Previous Lead Infections, Harry Wang, Md

The Medicine Forum

A 57-year-old woman with a past medical history of severe non-ischemic cardiomyopathy undergoing orthotopic heart transplant evaluation on milrinone, prior extraction of multiple pacemaker and implantable cardioverter defibrillator (ICD) leads due to Staphylococcus epidermidis endocarditis, and multiple central venous catheter infections presented with several days of worsening dyspnea on exertion, orthopnea and lower extremity edema, prompting admission for congestive heart failure exacerbation.