Medical Specialties Commons^™

Medical, Socioeconomic, And Geographic Disparities In Primary Health Care Access And Utilization: A Population-Based Study Of 8038 Individuals Aged One Year And Older In Rural Uganda, Saadiyah Mayet, Christin Puthur, Betty Nabatte, Benjamin Tinkitina, Christopher Opio, Yin-Cong Zhi, Narcis Kabatereine, Goylette Chami

Internal Medicine, East Africa

Background There is limited data on trends in primary health care (PHC) access and utilisation in rural sub-Saharan Africa, with a particular lack of knowledge on disparities beyond geographic barriers.

Methods A cross-sectional study was conducted within the community-based cohort, SchistoTrack. 2191 households were randomly sampled from 52 rural villages in Pakwach, Buliisa, and Mayuge Districts in Uganda. All household members aged one year and older were surveyed between 2022–2024, resulting in 8038 individuals with baseline health access information. Key outcomes included any care sought within the month preceding the study, type of care sought, and usual source of care. …

A Rare Manifestation Of Mycobacterium Kansasii As A Cutaneous Infection: A Case Report, Wandera Carey, Antony Kimani, Zamanali Khakhar, Dheer Kalaiya, Alok Iyer, Sayed Karar

Internal Medicine, East Africa

Nontuberculous mycobacteria (NTM) are environmental organisms increasingly recognized as opportunistic pathogens, particularly in immunocompromised individuals. Mycobacterium kansasii, a slow-growing photochromogen (Runyon group I), is primarily associated with pulmonary disease; however, extrapulmonary and cutaneous manifestations are uncommon and often underdiagnosed. Given the rising incidence of NTM infections, cutaneous disease should be considered in the differential diagnosis of skin lesions, especially in immunocompromised patients. Early microbiological confirmation is crucial for appropriate therapy, as M. kansasii is intrinsically resistant to pyrazinamide. Herein, we present a case of pathologically confirmed cutaneous M. kansasii infection occurring in isolation, illustrating the diagnostic challenges and therapeutic outcomes.

A Blended Genome And Exome Sequencing Method Captures Genetic Variation In An Unbiased And Cost-Effective Manner, Toni Boltz, Benjamin Chu, Matthew Defelice, Calwing Liao, Julia Sealock, Robert Ye, Jacqueline Goldstein, Lerato Majara, Jack Fu, Lukoye Atwoli

Internal Medicine, East Africa

Here we developed and deployed the blended genome exome (BGE) method, a DNA library approach that generates low-pass whole-genome (1–4× mean depth) and deep whole-exome (30–40× mean depth) data in a single sequencing run. BGE is cost-effective, empowers most genomic discoveries possible with deep whole-genome sequencing and captures global common single-nucleotide polymorphism diversity. We applied BGE to sequence >53,000 samples from the PUMAS Project (Populations Underrepresented in Mental Illness Associations Studies), including African, African American and Latin American populations. Imputed genotypes showed high concordance with Illumina Global Screening Array calls (R2 ≥ 95% for minor allele frequency ≥1%; …

Predicting In-Hospital Mortality In Patients With Hypertensive Emergency: A Retrospective Cohort Study, Jay Satasiya, Bs, Devin Vasoya, Md, Darius Farzad, Md

The Medicine Forum

Approximately 1.3 billion adults worldwide have hypertension.¹ Between 2006 and 2013, there was a two-fold increase in Emergency Department visits for hypertensive emergency.² The prevalence of hypertensive emergency ranges from 0.08% to 0.76% in patients presenting to the Emergency Department.^1,3-6 The estimated incidence of hospitalization with a hypertensive emergency is 111 per 100,000 patients.^1,7 Hypertensive emergency is also associated with significant morbidity and mortality, often leading to ischemic stroke, pulmonary edema, acute heart failure.^3-6 In-hospital mortality among patients with hypertensive emergency varies between 0.48% and 12.5%.^5,7 This retrospective cohort study aims to further clarify …

Assessment And Intervention For Health Behavior Change In Primary Care Across The Lifespan: A Guide For Residents In Primary Care Specialties, Stacy A. Ogbeide, Alexis Ramos, Bridget Murphy, Angel Ogbeide

HCA Healthcare Journal of Medicine

More than 45% of Americans have at least 1 chronic disease, with chronic disease also being a leading cause of death in the United States. In primary care settings, about 75% of visits are for management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Clinicians (PCCs) to manage these conditions alone and point to the need for innovative solutions to chronic disease care. One evidence-based innovation is team-based care to improve the treatment of these conditions. Clinicians such as clinical pharmacists, registered …

Navigating Complex Esophageal Perforations: A Case-Specific Approach To Successful Outcomes, Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S. Brar

HCA Healthcare Journal of Medicine

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the …

Hubungan Kadar Malondialdehida (Mda) Serum Dan Fraksi Ejeksi Ventrikel Kiri Pada Pasien Hemodialisis Reguler, Teguh Setiadi Amir, Taufik Indrajaya, Zulkhair Ali

Jurnal Penyakit Dalam Indonesia

Introduction. Malondialdehyde (MDA) is a marker of oxidative stress that is elevated in chronic kidney disease (CKD) patients undergoing regular hemodialysis. Oxidative stress can affect cardiac function especially left ventricular function. This study aimed to evaluate the relationship between serum MDA levels with left ventricular function in regular hemodialysis patients at Dr. Mohammad Hoesin Genaral Hospital, Palembang.

Methods. This study was an analytic observational study with a cross-sectional design conducted on regular hemodialysis patients in the Hemodialysis Installation of Dr. Mohammad Hoesin Genaral Hospital, Palembang. The MDA levels were examined from the serum of post-hemodialysis patients using ELISA …

Takikardia Ventrikel Berulang Pasca Coronary Artery Bypass Grafting (Cabg): Laporan Kasus Berbasis Bukti, Ika Prasetya Wijaya, Simon Salim, Audina Dhiya Nabila

Jurnal Penyakit Dalam Indonesia

Coronary artery bypass grafting (CABG) remains the treatment of choice for patients with complex multivessel coronary artery disease but carries a risk of serious perioperative complications, including ventricular arrhythmias such as ventricular tachycardia (VT). Although VT following CABG is rare, it is potentially life-threatening and often results from multiple interrelated factors. This report presents a case of recurrent ventricular tachycardia after CABG and to highlight the underlying mechanisms, risk factors, and evidence-based management strategies aimed at preventing adverse outcomes.We report a 54-year-old woman with diabetes, hypertension, prior myocardial infarction, and severe left ventricular dysfunction who underwent urgent CABG for three-vessel …

Variabel Dan Model Prediktor Perdarahan Varises Esofagus Berulang Pada Pasien Sirosis Hati Di Rsupn Dr. Cipto Mangunkusumo, Ifani Media Sari, Juferdy Kurniawan, Kemal Fariz Kalista, Aulia Rizka, Eka Ginanjar, Sally Aman Nasution, Leonard Nainggolan Md. Internal Medicine, Tropic-Infection Spesialist, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Introduction. Liver cirrhosis is a chronic condition associated with severe complications, including esophageal variceal bleeding, which carries high morbidity and mortality rates. Approximately 60% of patients with cirrhosis experience recurrent bleeding within one year, with a mortality rate of 20–60% within six weeks after the initial bleeding episode. Therefore, identifying predictors of recurrent bleeding is essential for improving preventive strategies. This study aimed to identify predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis and to develop a predictive model.

Methods. This retrospective study included 220 patients with liver cirrhosis and a history of esophageal variceal …

Kontinuitas Terapi Lupus: Kesenjangan Antara Evidence-Based Medicine Dan Real-World Practice, Abirianty P. Araminta

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Hubungan Penggantian Imunosupresan Tidak Terencana Dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif Di Rsupn Dr. Cipto Mangunkusumo, Jakarta, Rosvitha Amanda, Sukamto Koesnoe, Alvina Widhani, Ikhwan Rinaldi, Adityo Susilo, Juferdy Kurniawan, Rudi Putranto, Birry Karim

Jurnal Penyakit Dalam Indonesia

Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients.

Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability …

Efektivitas Penambahan Suplementasi Vitamin C Terhadap Penurunan Malondialdehid Dan Perbaikan Derajat Aktivitas Penyakit Lupus Eritematosus Sistemik: Uji Klinis Acak Tersamar Ganda, Yuniza Yuniza, Nova Kurniati, Theodorus Theodorus, Eddy M. Salim, Kristian S. Hartanto

Jurnal Penyakit Dalam Indonesia

Introduction. Vitamin C is an antioxidant that exerts its effects at multiple cellular levels. However, evidence regarding its effects in systemic lupus erythematosus (SLE) remain inconclusive. This study aimed to evaluate the potential of vitamin as an adjunctive antioxidant therapy in patients with SLE by assessing its effects on serum malondialdehyde (MDA) levels and disease activity using the Mexical Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) score.

Methods. This pilot double-blind, randomized controlled trial was conducted at Dr. Mohammad Hoesin General Hospital, Palembang. Participants were patients with mild-to-moderate SLE diagnosed according to the 2019 European Alliance of Association …

Profil Biomarker Apolipoprotein B Dan Lipid Terhadap Skor Syntax Pada Pasien Sindrom Koroner Kronik, Muhammad Novran Chalik, Erwin Sukandi, Taufik Indrajaya, Ferry Usnizar, Syamsu Indra, Imran Saleh, Rukiah Chodilawati, Irfannuddin Irfannuddin

Jurnal Penyakit Dalam Indonesia

Introduction. Apolipoproteins are structural components of plasma lipoproteins that are involved in lipoprotein metabolism and lipid transport, reflecting the number of circulating atherogenic particles. The degree of coronary artery stenosis can be assessed by calculating the Synergy between PCI with TAXUS/paclitaxel-eluting stent and Cardiac Surgery (SYNTAX) score, which is an angiographic scoring system used to evaluate the complexity of coronary artery lesions. This study aimed to investigate the profile of apolipoprotein B and lipids, as well as their correlation with the SYNTAX score in patients with chronic coronary syndrome.

Methods. An observational analytic study with a cross-sectional design …

Gagal Jantung Kanan Pada Hipertiroid Tidak Terkontrol: Laporan Kasus, Kevin Lazuardy, Leonard Nainggolan, Nadim Marchian Tedyanto

Jurnal Penyakit Dalam Indonesia

Right heart failure is a clinical syndrome that is influenced by various factors. The incidence of heart failure reaches 5/1,000 population, while the prevalence of heart failure reaches 1-2% of the adult population. Management of the main etiology of heart failure is the main therapy. In some cases, hyperthyroidism is an indirect cause of heart failure, especially in right heart failure. Hyperthyroidism can cause reversible pulmonary hypertension which causes right heart failure, although the underlying mechanism is uncertain at the moment. This study reports a 46-year-old woman who was diagnosed with right heart failure and also had hyperthyroidism. In this …

Miopati Atrium, Fibrilasi Atrium, Dan Stroke: Mengungkap Hubungan Tersembunyi, Muhammad Yamin, Mohamad Syahrir Azizi, Anneira Amanda Putri

Jurnal Penyakit Dalam Indonesia

Atrial fibrillation (AF) is the most common arrhythmia and has been long recognized as a cause for atrial thrombus formation leading to cardioembolic stroke. However, recent studies reveal that the relationship between atrial fibrillation and stroke is an association rather than a temporal relationship. Left atrial thrombus formation is associated with vascular risk factor, atrial remodeling, and thrombogenesis. Various atrial electrical and structural markers of atrial myopathy have been linked to ischaemic stroke, even in the absence of AF. In addition to the CHA2DS2-VASc score as a consideration for anticoagulant administration, accurate atrial myopathy markers are needed to allow early …

Sex-Based Differences In Clinical Outcomes Among Cardiogenic Shock Patients Treated With Mechanical Circulatory Support, Emmanuel Olumuyide, Ju Young Bae, Rongras Damrongwatanasuk, Ezaz Rahman, Barbara Malaga-Espinoza, Jiun-Ruey Hu, S. Elissa Altin

School of Medicine Publications

Despite advances in therapies, cardiogenic shock (CS) remains associated with high mortality rates, often necessitating mechanical circulatory support (MCS) to preserve end-organ perfusion. Despite increasing rates of MCS utilization, less is known about sex-related differences in clinical outcomes to guide practice. Additionally, standardized management protocols for CS patients requiring MCS that account for sex differences are lacking. In this study, we evaluate sex-specific outcomes in CS patients requiring MCS, examine patterns of MCS utilization by sex, and further stratify clinical outcomes by sex across the overall CS cohort, including the acute myocardial infarction-related CS (AMI-CS), acute heart failure-related CS (AHF-CS), …

Using United States Medicare Program Claims To Identify Reliable Measures Of Low Value Services Influenced By Primary Care Physician Decisions, Chris Fleming, Dmitriy Poznyak, Rhea E. Powell, Claire Erba, Eunhae Shin, Rui Wang, Claire Burkhart, Arkadipta Ghosh, Eugene C. Rich

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Low-value services (LVS) are those that “… provide little to no benefit to patients….”¹ Among an existing set of 31 LVS are invasive procedures not typically performed by primary care physicians (PCPs), and other LVS that may be commonly provided by specialists. To facilitate research on the role of primary care physicians in low-value care, we sought to identify the reliability of two subsets of LVS measures that are more directly subject to PCPs’ decisions. We refer to these as primary care adjacent (“PCA”) LVS measures.

METHODS: Retrospective observational cohort study to identify which of a 31-item LVS …

Operation No Noro: A Multidisciplinary Approach To Containing A Norovirus Outbreak In An Inpatient Rehabilitation Unit, Donika Marko, Roula Hilli, Priscila Bercea, Pamela S. Bozigar, Levi Launder, Stephanie Robertson, Trini A. Mathew

Conference Presentation Abstracts

Norovirus is a highly contagious viral gastroenteritis and can rapidly spread in healthcare settings, particularly in congregate environments such as inpatient rehabilitation units. In March 2025, a cluster of acute gastrointestinal illness was identified on a 34-bed inpatient rehabilitation unit within a 150-bed acute care hospital. Eight patients developed: • Nausea • Vomiting • Diarrhea • Abdominal pain Due to shared spaces, communal therapy activities, and high patient interaction, rapid intervention was initiated to prevent further spread.

Comparing The Effect Of Oral And Transdermal Estrogen Therapy On Lipid Profile In Postmenopausal Women: A Systematic Review And Meta-Analysis Of Randomized Clinical Trials, Mohamed Doma, Jose J. Loayza Pintado, Aria Atwal, Angelica Lopez Jesus, Farhaan Zahrawi, Ibrahim Saleh, Ahmed El Gammal, Zeyad Maharm, Adham Galal Ramadan, Benito Vlassis, Mustafa Shafeeq Ali, Mohammad Khodr Aljamali, Ralph Pandey, Mounira Mefti, Merhan Badran, Muaaz Aslam, Anuj Subedi, Jaffer Shah, Hani Aiash

Research Colloquium

Introduction: Menopause is associated with significant physiological changes, including alterations in lipid profiles. Estrogen therapy plays a crucial role in managing symptoms and preventing long-term complications. This study aims to compare oral and transdermal routes of estrogen therapy among postmenopausal women and assess changes in lipid parameters from baseline.

Methods: Randomized clinical trials comparing oral and transdermal estrogen therapy in postmenopausal women were identified through searches in PubMed, Scopus, Web of Science, and ClinicalTrials.gov. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical analysis was conducted using R version 4.3.2.

Results: Eight randomized …

Cardiovascular Response Patterns To Oral Versus Transdermal Estrogen Therapy In Postmenopausal Women, Mohamed Doma, Jose J. Loayza Pintado, Aria Atwal, Angelica Lopez Jesus, Farhaan Zahrawi, Ibrahim Saleh, Ahmed El Gammal, Zeyad Maharm, Adham Galal Ramadan, Benito Vlassis, Mustafa Shafeeq Ali, Mohammad Khodr Aljamali, Ralph Pandey, Mounira Mefti, Merhan Badran, Muaaz Aslam, Anuj Subedi, Jaffer Shah, Hani Aiash

Research Colloquium

Introduction: The comparative effects of oral versus transdermal estrogen therapy on cardiovascular parameters in postmenopausal women remain incompletely understood. This analysis aimed to evaluate blood pressure and heart rate responses between administration routes.

Methods: A systematic review of randomized trials comparing oral and transdermal estrogen therapy in postmenopausal women was conducted. Primary outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate. Random-effects meta-analysis was performed to calculate pooled mean differences (MD) with 95% confidence intervals (CI).

Results: Analysis of 8 randomized trials (N=885) showed no significant differences between oral and transdermal routes in mean …

Severe Cold Agglutinin Hemolytic Anemia Secondary To Mycoplasma Pneumoniae And Epstein-Barr Virus Co-Infection In An Elderly Patient, Aura Mc Calderon, Jose Loayza, Luis Salcedo, Ivan Mogollon, Asmik Asatrian

Research Symposium

Introduction: Cold autoimmune hemolytic anemia (AIHA) is an uncommon, complement-mediated hemolysis typically driven by IgM autoantibodies; secondary forms are often infection-related. Severe, transfusion-refractory presentations are rare in older adults. We present an elderly patient with Mycoplasma pneumoniae and Epstein–Barr virus co-infection complicated by life-threatening cold agglutinin hemolysis.

Case report: Upon admission, a 79-year-old male patient presented with a one-week history of fatigue, pyrexia, nasal congestion, and dyspnea; examination findings revealed pallor, bibasilar crackles, and mild splenomegaly. Laboratory investigations indicated the presence of severe hemolytic anemia accompanied by compensatory reticulocytosis and thrombocytosis (hemoglobin 5.5 g/dL, hematocrit 17.2%, MCV 100 fL, reticulocytes …

Iptacopan-Responsive Pnh With Pancytopenia: Hematologic Normalization And Dose Adjustment For Transaminitis, Aura Mc Calderon, Jose Loayza, Francisco Arias, Catherine Matos, Bharat Peddinani, Diane Nguyen

Research Symposium

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal hematopoietic stem-cell disorder driven by loss of GPI-anchored complement regulators (CD55, CD59), leading to complement-mediated intravascular hemolysis, cytopenias, and thrombosis. We report a new PNH diagnosis in a young woman with severe pancytopenia who achieved hematologic improvement on oral iptacopan, requiring dose adjustments for mild liver enzyme elevation.

Case Report: On February 27, 2025, a 38-year-old female patient exhibited symptoms of progressive fatigue, dyspnea, and jaundice. Initial laboratory assessments indicated the presence of severe hemolytic anemia accompanied by pancytopenia, hemoglobin level recorded at 4.7 g/dL, white blood cell count at 1.6×10³/µL (absolute …

Gper As A Therapeutic Target In Breast Cancer: Pharmacologic Inhibition And Microbiome Associations, Sierra E. Vidaurri, Shweta Singh, Valerie E. Ledezma, Rajesekhar Baru, Emma Garza, Francisco Flores, Muhammad Noorani, Shubhank Goyal, Aura Calderon, Alexander Lim, Anupam Dhasmana, Swati Dhasmana, Murali Yallapu, Subhash Chauhan, Diane Nguyen, Sheema Khan

Research Symposium

Background: The G protein–coupled estrogen receptor (GPER) mediates rapid estrogen signaling that promotes proliferation, migration, and therapeutic resistance in breast cancer, including in hormone receptor–negative subtypes. Notably, standard endocrine therapies may inadvertently activate GPER, highlighting the need for direct targeting of this pathway. The objectives of this study were to evaluate GPER as a therapeutic target using pharmacologic modulators and to determine how GPER-driven tumor behavior relates to tumor microbiome composition across breast cancer subtypes.

Methods: Breast cancer cell lines representing Luminal A (MCF7), Luminal B (BT474), HER2-enriched (SKBR3), and triple-negative (HCC38, MDA-MB-453, MDA-MB-231) subtypes were treated with Ormeloxifene (ORM). …

Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle In Adult Cardiac Care Units, Marwa Abdo

Nursing

Ventilator-associated pneumonia (VAP) is among the most common ICU infections for ventilated patients, associated with increased mortality (20-50%), morbidity, and health care costs. Nurses' knowledge of VAP prevention bundles is vital to reducing its incidence in critical care areas. Aim: To assess Nurses’ knowledge regarding the ventilator-associated pneumonia prevention bundle in Adult Cardiac Care Units. Study design: A cross-sectional study design was used. Setting: This study was conducted in both the adult cardiac intensive care unit and the cardiac care unit at Aswan Heart Centre–Magdy Yacoub Foundation, Egypt. Subject: A convenience sample of 67 nurses was selected. Data collection tool: …

Targeting Inequities: Addressing Lung Cancer Care Challenges In Africa Through Drug Access, Radiotherapy, And Surgical Innovations, Elvis Obomanu, Chidiebube Ugwu, Muluken Megiso, Tarfa Verinumbe, Colton Jones, Verna Vanderpuye, Nazik Hammad

Division of Internal Medicine Faculty Papers & Presentations

Lung cancer remains one of the leading causes of cancer-related mortality in Africa, with survival rates starkly lagging behind global benchmarks because of systemic inequities in prevention, diagnosis, and treatment access. Despite representing only 6% of global smokers, the continent faces a disproportionate burden driven by environmental and occupational carcinogens, aggressive tobacco marketing, and fragmented health care infrastructure. Key challenges include prohibitive delays in accessing targeted therapies like epidermal growth factor receptor inhibitors and immunotherapies, a dire shortage of radiotherapy infrastructure-0.12 megavoltage units per million people versus the International Atomic Energy Agency's recommended five megavoltage units per million, and a …

Secondary Cutaneous Involvement In Peripheral T-Cell Lymphoma: Diagnostic Frameworks, Staging Integration, And Therapeutic Implications, Aura Calderon, Jose Loayza Pintado, Cristina Kochi, Jared Hensley, Andres Suarez Parraga, Everardo Cobos

School of Medicine Publications

The occurrence of secondary cutaneous manifestations in peripheral T-cell lymphoma (PTCL) is relatively infrequent and can resemble benign dermatoses, leading to diagnosis delays. We present the case of a 78-year-old female patient with a diagnosis of PTCL affecting the left parotid gland, who experienced a 2-day sudden and intensely pruritic skin eruption, which progressed from both forearms to the trunk, involving more than 50% of the total body surface area. Initially, the eruption was managed as a hypersensitivity reaction with antihistamines and corticosteroids, with temporary symptomatic relief; however, the rapid clinical progression in the context of an established diagnosis of …

Social Relationships, Mental Health, And Stigma: A Qualitative Study Of Social Networks And Hiv Disclosure In Western Kenya, Sarah Obatsa, Adel Mburia-Mwalili, Salvador Jauregui, Karla Wagner, Lukoye Atwoli, Francesca Odhiambo, Jayne Lewis-Kulzer, Suzanne Goodrich, Kara Wools-Kaloustian, Jennifer Syvertsen

Internal Medicine, East Africa

The disclosure of one’s HIV-positive status is a personal decision that can play an important role in engagement in HIV treatment and care. Social network approaches situate individuals within broader webs of social connections that influence health and wellbeing and thus hold the potential to elucidate key social factors shaping the process of disclosure. As part of a larger clinical study examining how substance use and mental health shape HIV outcomes, we recruited 61 individuals newly diagnosed with HIV at two clinics in Western Kenya to participate in an egocentric social networks study. We conducted a survey that generated a …

Ambulatory Blood Pressure Monitoring Phenotypes And Circadian Blood Pressure Patterns Among Adults Referred For Diagnostic Evaluation At Aga Khan University Hospital, Nairobi, Kenya: A Retrospective Cross-Sectional Study, Nadeem Kassam, Mzee Ngunga, James Orwa, Alisa Bhojani, Mohamed Varwani, Swaffiya Salim, Yvonne Oketch, Salim Surani, Anthony Ochola, Barbara Karau, Jeilan Mohamed, Etienne Amendezo

Internal Medicine, East Africa

Introduction: hypertension represents the primary modifiable risk factor for cardiovascular disease and poses a public health challenge in sub-Saharan regions, with Kenya experiencing particularly low detection and control rates. Traditional office-based blood pressure measurements often fail to detect key phenotypes, such as white-coat and masked hypertension. Ambulatory Blood Pressure Monitoring (ABPM) offers a comprehensive 24-hour profile that excludes white-coat hypertension and allows for the evaluation of circadian patterns, including nocturnal hypertension and non-dipping status, both of which are recognized as high-risk phenotypes strongly linked to adverse cardiovascular events. This study evaluated ABPM data from Aga Khan University Hospital, Nairobi …

Development And Validation Of The Lifetime Sense Of Safety Scale In Kenyan Adults, Karen Blackmon, Anne Nyambura, Anne Gitere, Levi Muyela, Catherine Onyancha, Kendi Muchungi, Catherine Ajalo, Litha Musili, Rachel Maina, Edna Bosire, Lukoye Atwoli, Zul Merali, Chinedu Momoh

Brain and Mind Institute

Background. Safety supports psychological wellbeing and potentially shapes brain aging yet existing scales overlook cumulative lifespan safety experiences.

Methods. To address this gap, we developed and validated the Lifetime Sense of Safety (LSS) scale in Kenyan adults. The LSS uses visual analog scaling with a red-to-green color gradient to retrospectively rate felt safety across life stages and settings. We evaluated scale psychometrics and associations with social determinants of health and indicators of brain health.

Results. The LSS shows adequate internal consistency and test-retest reliability, with two distinct but correlated factors representing childhood and adulthood safety. Women and …

An Aggressive Presentation Of Anti-Melanoma Differentiation-Associated Gene 5 (Mda-5)-Positive Dermatomyositis With Rapidly Progressive Interstitial Lung Disease: A Case Report, Zamanali Khakhar, Shreedhi Patel, Rajiv Patel, Soraiya Manji, Fredrick Otieno, Sayed Karar

Internal Medicine, East Africa

Anti-melanoma differentiation-associated gene 5 (MDA-5) dermatomyositis is an uncommon condition that is frequently complicated by rapidly progressive interstitial lung disease (RP-ILD), resulting in a poor prognosis. Due to its aggressive course, management is often challenging and requires timely interventions to improve outcomes. This case of a female patient with anti-MDA-5-positive DM and RP-ILD aims to document this unique and uncommon condition, its aggressive clinical course, associated complications, diagnostic challenges, and management considerations.