Medical Specialties Commons^™

The Significance Of So-Called Equivocal Immunohistochemical Staining For Cytomegalovirus In Colorectal Biopsies, David A Johnson, Philip O Katz, David Armstrong, Henry Cohen, Brendan C Delaney, Colin W Howden, Peter Katelaris, Radu I Tutuian, Donald O Castell

Faculty, Staff and Student Publications

The availability of over-the-counter (OTC) proton pump inhibitors (PPIs) for the short-term (2 weeks) management of frequent heartburn (≥2 days/week) has increased markedly, yet evidence-based recommendations have not been developed. A panel of nine international experts in gastroesophageal reflux disease developed consensus statements regarding the risks and benefits of OTC PPIs using a modified Delphi process. Consensus (based on ≥80% approval) was reached through multiple rounds of remote voting and a final round of live voting. To identify relevant data, the available literature was searched and summarized. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system terminology was used to …

Keberhasilan Pengobatan Antiretroviral (Arv), Teguh H. Karyadi

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Approach To Diagnosis And Treatment Of Drug Allergy, Roy Akur Pandapotan, Iris Rengganis

Jurnal Penyakit Dalam Indonesia

Drug allergy is a serious medical problem. Drug allergy can be defined as an adverse drug reaction involving immunological mechanism. However, it is not easy to decide whether an adverse drug reaction is an allergic reaction, and it requires a systematically diagnostic approach. Beside a thorough history taking and physical examination, there are general and specific laboratory examination to investigate drug allergy which can be done in vivo, in vitro, or biopsy. The management of drug allergy include the avoidance of the precipitating event, and specific methods to reduce the drug reaction which include threating through, dosing test, desensitization, and …

Challenges In Providing Treatment Of Severe Malaria Case In Adistrict Hospital Of Remote Area In Indonesia, Dimas Priantono, Asep Purnama, Erni Juwita Nelwan

Jurnal Penyakit Dalam Indonesia

Severe Malaria is commonly found due to Plasmodium falciparum infection, which is causing high mortality in patient. A Severe case might be difficult to treat optimally in the remote settings area that could be due to lack in awareness of disease manifestation and inadequate diagnostic facilities. We report a case of Severe Malaria Falciparum infection, confirmed by blood smear examination of Plasmodium falciparum (Pf) parasites. Patient had received Artemicinin Based Combination Therapy (ACT), which consisted of dihydroartemisinin (DHA)-piperaquine and primaquine (PQ) with no clear clinical and microscopy improvement. The second line anti malaria consisted of quinine, doxycycline, and PQ was …

Cost Of Care Saving Of Terminal Cancer Adult Patient Usingpalliative Care Consultation In Cipto Mangunkusumo Hospital, Rudi Putranto, Laksono Trisnantoro, Yos Hendra

Jurnal Penyakit Dalam Indonesia

Introduction. Terminal cancer patients was increasing in Indonesia, and need attention to approach palliative and end of life care. Terminal cancer management was burden the hospital, because it causes high costly and the length of stay This study aimed to get a general picture of service palliative at Cipto Mangunkusumo, then to evaluate the relationship hospitalization and rates of inpatient services people with terminal cancer adults who received the intervention palliative care and to evaluate the relationship variable rates for accommodation (room), doctor visit, procedure/surgery, medicines and consumables, laboratory and radiology to palliative interventions in patients with terminal cancer in …

The Association Between Vitamin D 25(Oh)D Level Andalbuminuria In Type 2 Diabetes Mellitus, Tities Anggraeni Indra, Aida Lydia, Dyah Purnamasari, Siti Setiati

Jurnal Penyakit Dalam Indonesia

Introduction. Vitamin D 25(OH)D deficiency was reported as a possible risk factor for the development of diabetic nephropathy in several epidemiologic studies. Whether vitamin D 25(OH)D deficiency plays a role in the development of diabetic nephropathy in Indonesia is unknown. This study aims to determinate the association between vitamin D 25(OH)D level with albuminuria in patients with type 2 diabetes mellitus in Indonesia. Methods. A cross-sectional study was conducted in 96 patients with type 2 diabetes mellitus at outpatient clinic of MetabolicEndocrine Cipto Mangunkusumo Hospital. Serum vitamin D level was assessed using Diasorin kit with CLIA method, while albuminuria was …

Risk Factors Of Antituberculosis Induced-Hepatotoxicity Amonghiv/Aids Patients, Lies Luthariana, Teguh H. Karjadi, Irsan Hasan, C. Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Antituberculosis (ATT) induced hepatotoxicity is commonly found among HIV/AIDS patients. Several risk factor related to drug-induced hepatotoxicity such as alcoholism, hepatitis B or hepatitis C infection, abnormal baseline aminotransferase/bilirubin, poor nutritional status and concomitant hepatotoxic drugs consumption, are usually found in these patients. This study was conducted to evaluate risk factor of ATT-induced hepatotoxicity in HIV/AIDS patients. Methods. This is a case control retrospective study with matching of age, sex, antituberculosis regimen, and alcohol consumption. Risk factors evaluated are hepatitis C and hepatitis B coinfection, concomitant hepatotoxic drugs consumption, abnormal baseline aminotransferase and or bilirubin. Results. We collected data …

Predictors Of Virological Failure In Hiv Patients Receiving Firstline Antiretroviral Therapy With Good Adherence, Farid Kurniawan, Samsuridjal Djauzi, Evy Yunihastuti, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate success or failure of ART. However, in country with limited resources, viral load measurement is not easily accessible by HIV patients receiving ART. Therefore, it is necessary to know which factors that can predict virological failure. In previous studies, adherence was an important factor for suppression of HIV viral load. This study is aimed to know predictors of virological failure in HIV patients receiving recent first line ART regimen with good adherence in Indonesia. Methods. A retrospective cohort …

Effect Of Structured Education And Antihypertensive Medicationsadherence To Decrease Blood Pressure For Hypertension Inelderly: A Randomized Controlled Trial, Ayatullah Khomaini, Siti Setiati, Aida Lydia, Esthika Dewiasty

Jurnal Penyakit Dalam Indonesia

Introduction. Hypertension is one of the important problems in elderly due to high impact of cardiovascular complications. Education and antihypertensive medication adherence are considered as influence factors in a holistic and comprehensive hypertension treatment. This study was conducted to determine the effect of structured education and antihypertensive medication adherence in decreasing blood pressure as part of the hypertension treatment in elderly patients. Methods. A randomized clinical trial was conducted in October 2012 to February 2013 on hypertensive elderly patients at Cipto Mangunkusumo hospital, Jakarta. Subjects were divided into 3 groups: group I was received structured education and checklist, group II …

Factors Related To 30 Day Mortality In Critically Ill Patients Withinvasive Candidiasis In Cipto Mangunkusumo Hospital, Ardi Ardian, Ceva W. Pitoyo, Dita Adhitianingsih, Widayat Djoko Santoso, Siti Setiati

Jurnal Penyakit Dalam Indonesia

Introduction. Mortality rate of invasive candidiasis is still high, approximately 30-70%. Every study has a variety mortality rate depend on study design and sample. There is no data in Indonesia about profile and mortality factors analysis in critically ill patients with invasive candidiasis. Methods. The Study design was cross sectional. We studied 102 hospitalized critically ill patients with invasive candidiasis. The demographic, clinical and laboratory data, the risk factors for invasive candidiasis and the outcome of each patient in 30 days were recorded. An analysis bivariate with chi square or Fisher’s test was carried out to analyse some factors such …

Sarcoidosis Mimicking Multiple Myeloma., Gabriela Firak Do, Sehris Khawaja Do

Department of Medicine

No abstract provided.

Identification Of Kansarl As The First Cancer Predisposition Fusion Gene Specific To The Population Of European Ancestry Origin, Jeff Xiwu Zhou, Xiaoyan Yang, Shunbin Ning, Ling Wang, Kesheng Wang, Yanbin Zhang, Fenghua Yuan, Fengli Li, David D. Zhuo, Liren Tang, Degen Zhuo

ETSU Faculty Works

Gene fusion is one of the hallmarks of cancer. Recent advances in RNA-seq of cancer transcriptomes have facilitated the discovery of fusion transcripts. In this study, we report identification of a surprisingly large number of fusion transcripts, including six KANSARL (KANSL1-ARL17A) transcripts that resulted from the fusion between the KANSL1 and ARL17A genes using a RNA splicingcode model. Five of these six KANSARL fusion transcripts are novel. By systematic analysis of RNA-seq data of glioblastoma, prostate cancer, lung cancer, breast cancer, and lymphoma from different regions of the World, we have found that KANSARL fusion transcripts were rarely detected in …

Spotlight On Blisibimod And Its Potential In The Treatment Of Systemic Lupus Erythematosus: Evidence To Date, Aleksander Lenert, Timothy B. Niewold, Petar Lenert

Internal Medicine Faculty Publications

B cells in general and BAFF (B cell activating factor of the tumor necrosis factor [TNF] family) in particular have been primary targets of recent clinical trials in systemic lupus erythematosus (SLE). In 2011, belimumab, a monoclonal antibody against BAFF, became the first biologic agent approved for the treatment of SLE. Follow-up studies have shown excellent long-term safety and tolerability of belimumab. In this review, we critically analyze blisibimod, a novel BAFF-neutralizing agent. In contrast to belimumab that only blocks soluble BAFF trimer but not soluble 60-mer or membrane BAFF, blisibimod blocks with high affinity all three forms of BAFF. …

Bioactive Lipids And Circulating Progenitor Cells In Patients With Cardiovascular Disease, Salim S. Hayek, Yuri Klyachkin, Ahmed Asfour, Nima Ghasemzadeh, Mosaab Awad, Iraj Hesaroieh, Hina Ahmed, Brandon Gray, Jinhee Kim, Edmund K. Waller, Arshed A. Quyyumi, Ahmed K. Abdel-Latif

Internal Medicine Faculty Publications

Bone marrow-derived progenitor cells are mobilized into the peripheral blood after acute myocardial injury and in chronic ischemic heart disease. However, the mechanisms responsible for this mobilization are poorly understood. We examined the relationship between plasma levels of bioactive lipids and number of circulating progenitor cells (CPCs) in patients (N = 437) undergoing elective or emergent cardiac catheterization. Plasma levels of sphingosine-1 phosphate (S1P) and ceramide-1 phosphate (C1P) were quantified using mass spectrometry. CPCs were assessed using flow cytometry. S1P levels correlated with the numbers of CD34+, CD34+/CD133+, and CD34+/CXCR4+ CPCs even after adjustment for potential confounding factors. However, …

Performance Of Medication Reconciliation For Internal Medicine Hospital Admissions – Before And After Educational Intervention, Gabriela Andries, Merita Shehu, Dennis Roarke, Syed Zaid, Christopher Nabors, Sachin Sule

NYMC Faculty Posters

No abstract provided.

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety At A Tertiary Hospital In Kenya: A Cohort Study, Anthony Kamau, Vitalis Mung’Ayi, Gerald Yonga

Anaesthesiology, East Africa

Background: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction.

Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.

Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and …

Acute Intermittent Porphyria: A Test Of Clinical Acumen., Rashmi Dhital, Sijan Basnet, Dilli Ram Poudel, Khema Raj Bhusal

Reading Hospital Internal Medicine Residency

Acute intermittent porphyria (AIP) is a rare autosomal dominant hepatic porphyria due to deficiency of hydroxymethylbilane synthase (HMBS), also known as porphobilinogen deaminase leading to accumulation of porphyrin precursors. However, gene defect alone is usually not sufficient to cause an acute attack, and many extrinsic factors play a role. Diagnostic tests are defined, but clinical suspicion is often delayed as symptoms mimic other common conditions. We report a case of a 18-year-old male with severe, persistent, and generalized abdominal pain along with marked hyponatremia, with subsequent development of altered mentation needing intensive care. He improved after infusion of intravenous dextrose. …

Frequency Of Worsening Liver Function In Severe Dengue Hepatitis Patients Receiving Paracetamol: A Retrospective Analysis Of Hospital Data., Ahsan Ali Syed, Faisal Aslam, Haris Hakeem, Faraz Siddiqui, Noreen Nasir

Department of Medicine

Objective: To determine the frequency of worsening liver function among hospital in-patients with severe dengue hepatitis receiving paracetamol.

Methods: This retrospective study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, and comprised records of dengue patients with severe hepatitis who received paracetamol for control of fever between June 2007 and December 2014. Alanine aminotransferase at baseline and following paracetamol administration was noted, as well as dosage and duration of paracetamol, along with participants' demographic details. Frequency of patients who developed worsening or improvement of alanine aminotransferase was also noted. SPSS 19 was used for data analysis. …

An Over-The-Counter Treatment For Diarrhea Leading To Euphoria And Fatal Arrhythmia., Angela Magdaleno, Michael Sumner Do, Travis Magdaleno Md, Justin L. Guthier Do, Apurva Vyas Md

Department of Medicine

No abstract provided.

Shigella Sonnei Bacteremia Presenting With Profound Hepatic Dysfunction, Oluwaseun Shogbesan, Andrew Rettew, Bilal Shaikh, Abdullateef Abdulkareem, Anthony Donato

Reading Hospital Internal Medicine Residency

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases of Shigella infection are reported annually in the United States. Shigella bacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of a Shigella sonnei bacteremia with marked hepatic derangement in a 27-yearold previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two …

Risk Factors For Poor Multidrug-Resistant Tuberculosis Treatment Outcomes In Kyiv Oblast, Ukraine, Omowunmi Aibana, Mariya Bachmaha, Viatcheslav Krasiuk, Natasha Rybak, Timothy P Flanigan, Vasyl Petrenko, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Ukraine is among ten countries with the highest burden of multidrug- resistant TB (MDR-TB) worldwide. Treatment success rates for MDR-TB in Ukraine remain below global success rates as reported by the World Health Organization. Few studies have evaluated predictors of poor MDR-TB outcomes in Ukraine.

METHODS: We conducted a retrospective analysis of patients initiated on MDR-TB treatment in the Kyiv Oblast of Ukraine between January 01, 2012 and March 31st, 2015. We defined good treatment outcomes as cure or completion and categorized poor outcomes among those who died, failed treatment or defaulted. We used logistic regression analyses to identify …

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Barriers And Perceptions Regarding Code Status Discussion With Families Of Critically Ill Patients In A Tertiary Care Hospital Of A Developing Country: A Cross-Sectional Study, Ahsan A. Syed, Aysha Almas, Quratulain Naeem, Umer F. Malik, M. Tariq

Department of Medicine

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.
Aim: To determine the barriers and perceptions in discussion of code status by physicians.
Design: Questionnaire-based cross-sectional study.
Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included. …

What Can A Primary Care Physician Discuss With Older Patients To Improve Advance Directive Completion Rates? A Clin-Iq, Judith M. Myers, Edmund Duthie Jr., Kathryn Denson, Steven Denson, Deborah Simpson

Journal of Patient-Centered Research and Reviews

Advance directives (ADs) provide patients with the opportunity to indicate their preferences for medical care while they still maintain the capacity to express their wishes, thus retaining autonomy. ADs increase the likelihood that patients will receive the care they desire, as their family members and physicians will better understand the level of care desired. Despite this, the AD completion rate by elderly patients continues to be low, especially for patients not facing serious illnesses. Primary care physicians (PCPs) are uniquely positioned to engage patients in discussions about ADs before a health crisis arises yet often do not due to time …

Did You Hear What I Meant To Say?, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

The author introduces Volume 4, Issue 1 of Journal of Patient-Centered Research and Reviews by acknowledging the importance of communication between patient and caregiver in the clinical setting. Failure to communicate effectively can have a negative impact on a patient's well-being, therefore efforts to improve communication skills among clinicians, researchers and health practice administrators should be undertaken with regularity.

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At A Tertiary Hospital In Kenya, Stephen Omondi, John Weru, Asim Jamal, Gerald Yonga

Internal Medicine, East Africa

Background: An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on lifesustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of …

End-Of-Life Training In Us Internal Medicine Residency Programs: A National Study, Derek Cegelka, Timothy R. Jordan, Jiunn-Jye Sheu, Joseph A. Dake, Ragheb Assaly

Faculty Publications

Background: End-of-life care is a required and important component of medical training for internal medicine residents; many of whom will go on to provide care for adults at the end-of-life stage. Although a body of past research suggests that physician training in end-of-life care needs significant improvement, a comprehensive national study of end-of-life education within US internal medicine residency programs has never been published.

Objective: To determine the status of end-of-life education in internal medicine residency programs in the United States.

Method: The study was a cross-sectional, observational study of all internal medicine Residency Program Directors in the US as …

Surviving As A Cancer Survivor: A Case Report Of Radiation-Induced Autonomic Dysfunction, Daphne Sy, Mark Schauer

Research Day

While radiation and chemotherapy have achieved high rates of cure for Hodgkin lymphoma, the medical community is only now starting to characterize the long-term effects of treatment on these young cancer survivors, many decades later. Mantle radiation has been implicated in significantly increased cardiovascular risks, pulmonary fibrosis, other cancers, and thyroid disease over the patient’s lifetime. However, new syndromes are still being discovered within this population as they age. The purpose of this case study was to consider the unique health issues of cancer survivors, and how their treatment history should prompt us to broaden our differentials. Our patient presented …

Mrsa Induced Pulmonary-Renal Syndrome, Mohammed Megri, Majdi Al-Dliw, Yousef Shweihat, Zeid Khitan

Internal Medicine

We present a rare case of pulmonary-renal syndrome secondary to recurrent MRSA spondylodiscitis. The mechanism of involvement of each organ system is unique. The organs, lung and kidneys, have been affected by different pathologic processes that were induced, we think, by the chronic MRSA infection.

Low Serum Sodium Levels At Hospital Admission: Outcomes Among 2.3 Million Hospitalized Patients, Saleem M. Al Mawed, Vernon Shane Pankratz, Shiraz Mishra, Mark Unruh

Hospital Medicine

Background: Hyponatremia is the most common electrolyte disorder among hospitalized patients. Controversies still exist over the relationship between hyponatremia and outcomes of hospitalized patients. Methods: To analyze the association of low serum sodium levels at hospital admission with in-hospital mortality and patient disposition and to compare the distribution of the risk of death associated with hyponatremia across the lifespan of hospitalized patients, we conducted an observational study of 2.3 million patients using data extracted from the Cerner Health Facts database between 2000 and 2014. Logistic regression models were used in the analyses. Results: 14.4% of hospitalized patients had serum sodium …