Medical Specialties Commons^™

Can Endothelin-1 Help Address The Diagnostic And Prognostic Challenges In Multimorbid Acute Heart Failure Patients?, Bianca-Ana Dmour, Minerva Codruta Badescu, Cristina Tuchiluș, Corina Maria Cianga, Daniela Constantinescu, Nicoleta Dima, Ștefania Teodora Duca, Awad Dmour, Alexandru Dan Costache, Maria-Ruxandra Cepoi, Adrian Crișan, Sabina Andreea Leancă, Cătălin Loghin, Ionela-Lăcrămioara Șerban, Irina Iuliana Costache-Enache

Faculty, Staff and Student Publications

The management of acute heart failure (AHF) is becoming increasingly complex, especially in patients with multiple comorbidities. Endothelin-1 (ET-1), a vasoconstrictive peptide, is an important mediator of neurohormonal activation, endothelial dysfunction, and cardiac remodeling-key processes involved in the pathogenesis of AHF. The aim of our study was to evaluate the diagnostic and prognostic performance of ET-1 in multimorbid AHF patients, compared to established markers such as amino terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). We conducted a single-center prospective study including 76 patients; 54 with AHF and 22 serving as controls. Upon admission, all patients …

Acute Rheumatic Fever Presenting With Isolated Myocarditis And Right Coronary Artery Occlusion, Sumedh Iyengar, Md Mashiul Alam, Shaun Abid Md, Evgeny Shkolnik, Stuart Zarich

Posters

Acute Rheumatic Fever (ARF) and rheumatic heart disease continues to be a major health hazard in most developing countries.

Coronary artery obstruction has long been regarded as an uncommon complication of rheumatic heart disease and has rarely been reported in ARF.

Metaplastic Breast Cancer: A Retrospective Chart Review Of Clinical Features, Nidhi Navaratna, Mariam Aoun, Nitya Batra, Mohammad M. Chisti

Conference Presentation Abstracts

No abstract provided.

Profil Kadar Vitamin D Dan Hubungannya Dengan Derajat Keparahan Klinis Serta Parameter Inflamasi Pada Pasien Terkonfirmasi Covid-19, Wicensius Parulian Hasudungan, Andhika Rachman, Alvina Widhani, Arif Mansjoer

Jurnal Penyakit Dalam Indonesia

Introduction. The available data currently is not adequate to show the differences in vitamin D levels across various clinical stages of COVID-19 in Indonesia. Therefore, this study was conducted to determine the profile of vitamin D levels and its relationship with the clinical severity and inflammatory parameters in confirmed COVID-19 patients.

Methods. The study was conducted at Cipto Mangunkusumo Hospital and Wisma Atlet COVID-19 Emergency Hospital from January to December 2021. Subjects who were 18 years old and above and had confirmed COVID-19 status through COVID-19 Polymerase Chain Reaction (PCR) from oropharyngeal swab were included. Those who refused …

Profil Anafilaksis Di Rsu Hasanah Graha Afiah, Depok Pada Januari 2023 – April 2024, Sukamto Koesnoe, Risky Wulandari, Bramantya Wicaksana

Jurnal Penyakit Dalam Indonesia

Introduction. Anaphylaxis is a severe hypersensitivity reaction that occurs rapidly and can be life-threatening. This reaction disrupts the respiratory, cardiovascular, digestive, and/or integumentary systems. The global prevalence of anaphylaxis is 1-2%, with a mortality rate of 0.3%. However, data on anaphylaxis in Indonesia is very limited. The aim of this study was to obtain anaphylaxis profile at Hasanah Graha Afiah Hospital, Depok.

Methods. This study used a cross-sectional descriptive study from January 2023 to April 2024 at Hasanah Graha Afiah Hospital, Depok, Jawa Barat. Inclusion criteria include patients aged ≥17 years, diagnosed with anaphylaxis in medical records in …

Hubungan Heart Rate Variability Dengan Global Longitudinal Strain Pada Pasien Diabetes Melitus Tipe 2 Di Puskesmas Jakarta, Dwi Rendra Hadi, Lusiani Rusdi, Tri Juli Edi Tarigan, Arif Mansjoer

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetes mellitus (DM) remains a major global health issue due to its direct consequences and complications, particularly cardiovascular complications. These complications are influenced by autonomic neuropathy, which can be assessed by Heart Rate Variability (HRV). Autonomic dysfunction is thought to impair heart function, which can potentially be predicted early by observing Global Longitudinal Strain (GLS). The relationship between HRV and GLS has not been extensively studied. Therefore, this study aimed to identify the relationship between HRV and GLS.

Methods. A cross-sectional study with a population of adult type 2 DM patients residing in Jakarta in December 2020. …

Infeksi Oportunistik Pada Pasien Hiv Yang Dirawat Inap Di Rsup Dr. Hasan Sadikin Bandung Tahun 2019-2022, Katarina Salma, Yovita Hartantri, Nisa Fauziah

Jurnal Penyakit Dalam Indonesia

Introduction. Human Immunodeficiency Virus (HIV) is a virus that infects and attacks the human immune system. The high morbidity and mortality rates in HIV patients can be attributed to various factors, one of which is the presence of opportunistic infections due to the weakened immune response, making HIV patients highly susceptible to other infections. This study aims to provide an overview of opportunistic infections in HIV patients hospitalized at Dr. Hasan Sadikin General Hospital in Bandung within the period of 2019-2022.

Methods. This descriptive observational study was conducted on 255 HIV patients with opportunistic infections who were hospitalized at dr. …

Penghambat Kanal Kalsium Sebagai Kontrol Glukosa Darah Pada Insulinoma: Sebuah Laporan Kasus, Nadhira Nizam, Ryan Tresna Putra, Anshari Saifuddin Hasibuan

Jurnal Penyakit Dalam Indonesia

Insulinoma is a rare neuroendocrine tumor of the pancreas arising from β-cells, leading to excessive insulin secretion and resultant hypoglycaemia. Surgical resection is the first-line treatment for insulinoma, but when surgery is not feasible, medical therapy is an important option. Calcium channel blockers (CCBs) such as verapamil can inhibit insulin release from β-cells and have been proposed as an adjunct therapy to help control blood glucose levels in insulinoma. We report a 43-year-old man who presented to the emergency department with decreased consciousness due to hypoglycaemia. His capillary blood glucose at home was 35 mg/dL, about 8 hours after his …

Advanced Hiv Disease: Wajah Hiv Yang Hampir Terlupakan, Evy Yunihastuti, Bramantya Wicaksana

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Efek Hipnoterapi Untuk Meningkatkan Kualitas Hidup Pada Pasien Penyakit Ginjal Kronik: Suatu Laporan Kasus Berbasis Bukti, Aisha Putri Chairani, Rudi Putranto, Hamzah Shatri, Maruhum Bonar Hasiholan Marbun, Edward Faisal, Vinandia Irvianita, Diah Martina

Jurnal Penyakit Dalam Indonesia

Chronic Kidney Disease (CKD) is a condition of kidney damage with a decrease in glomerulus filtration rate of 60 ml/min/1.73 m3 for a duration of more than three months. CKD is closely related to the patient’s quality of life because the patient must carry out various lifestyle restrictions to slow the progression of kidney damage. Lifestyle restrictions often cause problems in the psychosocial field that increase the severity of symptoms and decrease kidney function faster. This evidence-based case review was compiled to determine the effectiveness of hypnotherapy in improving the quality of life of CKD patients. Literature searches were conducted …

Pencegahan Sindrom Delirium Akut Pada Pasien Lansia Di Rawat Inap, Vera Vera

Jurnal Penyakit Dalam Indonesia

Acute delirium syndrome is often found in hospitalized older patients, requiring longer hospital stay and higher hospital cost. Studies showed that 40% of these delirium cases in older patients may be prevented with multicomponent intervention based on National Institute for Health and Clinical Excellence (NICE) and Hospital Elder Life Program (HELP) guidelines. This article explained multicomponent intervention, which includes protocols for disorientation, dehydration, hypoxia, constipation, malnutrition, pain control, infection control, infection prevention, drugs evaluation, early mobilization, and education for patients’ family / caregiver. Prevention of acute delirium syndrome in hospitalized older patients will reduce the medical cost and distress among …

Status Gizi Sebagai Faktor Risiko Mortalitas Di Rumah Sakit Pada Pasien Lanjut Usia Pasca Reseksi Tumor Kolorektal, Ayu Fitri Sekar Wulandari, Parish Budiono, Yudo Murti Mupangati

Jurnal Penyakit Dalam Indonesia

Introduction. Malnutrition in elderly patients, particularly those with colorectal cancer, increases morbidity, mortality, and length of hospital stay due to metabolic dysregulation and hypermetabolic perioperative response, affecting wound healing, infection risk, postoperative complications, and nutritional deficits. This study aimed to analyze whether nutritional status is a risk factor for in-hospital mortality in elderly patients after colorectal tumor resection.

Methods. A case-control matching study was conducted on elderly patients who underwent colorectal tumor resection, using secondary data from elderly inpatients at Dr. Kariadi General Hospital from January 2020 to April 2024. The collected data were analyzed using bivariate analysis …

Stercoral Colitis: A Case Of Severe Constipation, Ji Won Lee Bs, Anish Parameswaran Do

Tower Health Research Day

No abstract provided.

When Elevated Creatinine Is Not What It Seems: Intraperitoneal Urinary Leak Mimicking Acute Kidney Injury, Hatem Ahmed, Mohamed K. Mansour, Hamza Obeid

Tower Health Research Day

No abstract provided.

Stop The Bleed! Acute Epistaxis Management, Christopher R. Cannell

Lynchburg Journal of Medical Science

Epistaxis, the most common Otolaryngology-related emergency, is responsible for one in 200 emergency department (ED) visits in the United States (US) and one-third of otolaryngology visits.^1,11 Up to 60% of the population will experience epistaxis during their lifetime, and 6% -10 % will require medical intervention.^2,3 Epistaxis occurs in children and adults and has a seasonal variation. Although 85% of nosebleeds are idiopathic, they are more frequent in those on supplemental oxygen, anticoagulation, antiplatelet therapy, and in those with other conditions that may predispose them to bleeding. Most clinicians will encounter patients with acute epistaxis; therefore, it is …

Testosterone Replacement Therapy In The Middle-Aged Male, Gina N. Demilt

Lynchburg Journal of Medical Science

The purpose of this review was to investigate the use of testosterone supplementation in the middle-aged male with a focus on the pathophysiology of testosterone throughout the lifespan, current supplementation options and their adverse effects, and the overall benefit of supplementing to enhance quality of life. A comprehensive search of electronic databases was conducted identifying studies that assessed clinical outcomes, pathophysiology, supplementation options, adverse effects and benefits of treatments. The findings suggested that testosterone levels naturally decline with age with most men developing symptoms of hypogonadism around age 60. Testosterone supplementation outside of current guidelines is not recommended, however men …

Non-Canonical Splice Variants In Thoracic Aortic Dissection Cases And Marfan Syndrome With Negative Genetic Testing, David R Murdock, Dong-Chuan Guo, John S Depaolo, Ulrike Schwarze, Xue-Yan Duan, Alana C Cecchi, Isabella C Marin, Yingying Tang, Jessica X Chong, Michael J Bamshad, Kathleen A Leppig, Peter H Byers, Scott M Damrauer, Dianna M Milewicz

Faculty, Staff and Student Publications

Individuals with heritable thoracic aortic disease (HTAD) face a high risk of deadly aortic dissections, but genetic testing identifies causative variants in only a minority of cases. We explored the contribution of non-canonical splice variants (NCVAS) to thoracic aortic disease (TAD) using SpliceAI and sequencing data from diverse cohorts, including 551 early-onset sporadic dissection cases and 437 HTAD probands with exome sequencing, 57 HTAD pedigrees with whole genome sequencing, and select sporadic cases with clinical panel testing. NCVAS were identified in syndromic HTAD genes such as FBN1, SMAD3, and COL3A1, including intronic variants in FBN1 in two Marfan syndrome (MFS) …

Trajectories Of Forced Vital Capacity In Patients With Systemic Sclerosis-Associated Interstitial Lung Disease, Oliver Distler, Madelon C Vonk, Arata Azuma, Maureen D Mayes, Dinesh Khanna, Kristin B Highland, Gerrit Toenges, Margarida Alves, Yannick Allanore

Faculty, Staff and Student Publications

We used data from the SENSCIS and SENSCIS-ON trials to assess decline in forced vital capacity (FVC) in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) who received long-term treatment with nintedanib and the effect of switching patients from placebo to nintedanib. In the SENSCIS trial, patients were randomised to receive nintedanib or placebo until the last patient reached week 52 but for ≤ 100 weeks. In SENSCIS-ON, the extension to SENSCIS, all patients received open-label nintedanib. Per protocol, the off-treatment period between these trials was ≤ 12 weeks. We assessed the trajectory of FVC in patients who received nintedanib …

Intraoperative Code Status: Moving From Misinformation To Respect For Patient Autonomy, Jacob Applegarth, Jacob M. Morton, Nathan M. Novotny, Ngan Nguyen, Abram Brummett

Conference Presentation Abstracts

Introduction: Intraoperative code status represents a complicated topic for patients and providers. Prior studies demonstrated a lack of understanding of intraoperative code status, specifically do not resuscitate (DNR) orders. This misunderstanding appears common despite clear professional recommendations. A recent survey of surgery residents at our institution showed variability in understanding of intraoperative code status policy despite clear institutional guidelines. Few studies utilized simulated education for surgeons and surgical residents to navigate intraoperative DNR status. This project aims to create a simulation-based program for residents to navigate intraoperative DNR status ethically and to assess its impact on learning, practice patterns and …

Precision Phenotyping For Curating Research Cohorts Of Patients With Unexplained Post-Acute Sequelae Of Covid-19, Alaleh Azhir, Jonas Hügel, Jiazi Tian, Jingya Cheng, Ingrid V Bassett, Douglas S Bell, Elmer V Bernstam, Maha R Farhat, Darren W Henderson, Emily S Lau, Michele Morris, Yevgeniy R Semenov, Virginia A Triant, Shyam Visweswaran, Zachary H Strasser, Jeffrey G Klann, Shawn N Murphy, Hossein Estiri

Faculty, Staff and Student Publications

BACKGROUND: Scalable identification of patients with post-acute sequelae of COVID-19 (PASC) is challenging due to a lack of reproducible precision phenotyping algorithms, which has led to suboptimal accuracy, demographic biases, and underestimation of the PASC.

METHODS: In a retrospective case-control study, we developed a precision phenotyping algorithm for identifying cohorts of patients with PASC. We used longitudinal electronic health records data from over 295,000 patients from 14 hospitals and 20 community health centers in Massachusetts. The algorithm employs an attention mechanism to simultaneously exclude sequelae that prior conditions can explain and include infection-associated chronic conditions. We performed independent chart reviews …

Meta-Analysis On Sex Differences In Mortality And Neurodevelopment In Congenital Heart Defects, Alyssa K Crain, Zhia N Lim, Chloe J Sarfatis, Magela Arias, Travis Holder, Alvaro G Moreira, Antonio F Corno, Tina O Findley

Faculty, Staff and Student Publications

Given the increasing survival rates among congenital heart disease (CHD) patients and the growing emphasis on their quality of life, there is a need to comprehensively assess the impact of surgical interventions on neurodevelopmental outcomes. With increasing awareness in sex-related disparities in CHD, there is a need to explore potential differences in surgical mortality and neurodevelopmental outcomes between male and female patients. In this systematic review, we adhered to PRISMA guidelines and PROSPERO registration (#CRD42021225610). Articles published from 2015 to 2021 were searched using MeSH descriptors in three major databases (MEDLINE Ovid, Elsevier Embase, and Cochrane Library). Study selection criteria …

Case Report: Oral Contraceptives-Induced Cholestasis, Aura Calderon, Taiwo Ajani, Nayiri Derian, Catherine Matos, Ivan Mogollon, Andres Suarez

Research Symposium

Background: Oral contraceptives represent one of the most prevalently utilized pharmacological interventions for contraception, renowned for their safety and efficacy. However, their advantageous safety profile, these pharmaceuticals are intermittently correlated with infrequent yet significant hepatobiliary complications, including drug-induced cholestasis and hyperbilirubinemia1. The estrogenic constituents of oral contraceptives are recognized for their capacity to disrupt bile acid transport within the hepatic system, culminating in intrahepatic cholestasis2. This phenomenon is particularly alarming in individuals possessing inherent genetic susceptibilities, such as Dubin-Johnson Syndrome, wherein bilirubin metabolism and excretion are already adversely affected3. The identification and comprehension of these adverse effects are imperative for …

An Endocrine Enigma: The Implications Of Pembrolizumab Therapy, Miguel A. Lopez, Mario Trujillo Acosta, Jose Romero Villarreal Calderon, Laura Garcia

Research Symposium

Disorders of the endocrine system are a potential complication of cancer treatment despite newer immunotherapy agents holding promise to improve patient outcomes. Breast cancer in particular requires pharmacologic intervention based on the receptor positivity. For example, a triple negative workup often requires neoadjuvant therapy with the newer immunotherapy agent pembrolizumab. Clinicians should be aware of the potential adverse effects of this drug, most notably adrenal insufficiency. This case follows a 52 year old hispanic female patient with a history of triple negative left sided breast cancer on immunotherapy with pembrolizumab, who presented to the emergency department after a syncopal episode …

New Onset Atrial Fibrillation In Hospitalized Patients, Arafat Ali Farooqui, Syed Mohammad Mazhar Uddin, Sanjay Kumar Maheshwari, Kevin Clements, Rabiah Ashraf, Jay Keith, Neha Sharma, Haris Bilal, Naira Saleem, Vijay S. Shetty

Journal of Community Hospital Internal Medicine Perspectives

Objectives: To evaluate different factors precipitating new onset atrial fibrillation (AF) in hospitalized patients and their effect on in-patient mortality.

Design: Retrospective cross-sectional study

Setting: Urban tertiary care center in New York City

Measurements:

Primary outcomes:

• Determine different factors precipitating new onset atrial fibrillation in hospitalized patients and their effect on in-patient mortality

Secondary outcomes:

• Determine the duration of hospital stay after admission precipitating new onset atrial fibrillation and its effect on mortality
• Evaluate different factors in COVID-19 patients with new onset atrial fibrillation

Results: Out of 464 patients; 62.3% were males and 37.72% were females. Evaluation of patients before …

Impact Of Primary Care Team Configuration On Access And Quality Of Care, Sylvia J Hysong, Kelley Arredondo, Houston F Lester, Richard Sorelle, Trang Pham, Frederick L Oswald, Lechauncy Woodard, Laura A Petersen, Joshua Hamer, Ashley M Hughes

Faculty, Staff and Students Publications

Background: Team-based primary care has become the norm within many large healthcare systems; however, limited guidance exists on how to optimally staff primary care teams in relationship to healthcare.

Objective: This paper examines the associations between variations in team staffing configurations on primary care access and clinical quality.

Design: Observational study linking national Veterans Health Administration (VHA) data from February 2020 on primary care team staffing configurations to data on access to and quality of care the teams delivered.

Participants: We examined data from 22,390 primary care personnel assigned to 7050 teams from 1050 VA Medical Centers and Community-Based Outpatient …

Health Inequities In An Undocumented Immigrant Woman With Scleroderma: A Case Report Of Uninsured Care Challenges, Jorge A. Aboytes, Jose J. Loayza, Ismael Cantu

Research Symposium

Introduction: Systemic sclerosis (SSc), commonly known as scleroderma, is a rare connective tissue disorder involving widespread fibrosis, immune system dysregulation, and vascular abnormalities¹. The disease disproportionately affects women, with a female-to-male ratio of 4:1 to 9:1, and is marked by significant ethnic and healthcare disparities². Underserved populations often experience worse outcomes, driven by higher medical costs and increased utilization of emergency and inpatient services³. Among Hispanic patients, language and cultural barriers further exacerbate disparities in access to and quality of care⁴. These challenges underscore the need for equitable healthcare strategies. We present …

Intracavitary Left Ventricular Thrombus In A Patient With Severe Ischemic Cardiomyopathy And Nstemi: A Case Report And Management Approach, Ivan Mogollon, Luis Salcedo, Francisco Arias, Aura Calderon, Catherine Matos, Ismael Cantu

Research Symposium

Background: Intracavitary thrombi are a known complication of ischemic cardiomyopathy, often arising in the setting of severely reduced left ventricular ejection fraction. These thrombi can predispose patients to thromboembolic events and exacerbate cardiovascular compromise. Diagnostic challenges arise when intracavitary masses are identified in conjunction with other critical pathologies, such as acute coronary syndromes or peripheral artery disease. This report highlights the case of a 74-year-old male with multiple cardiovascular comorbidities who presented with near syncope, non-ST elevation myocardial infarction, and an incidental finding of an intracavitary left ventricular thrombus.

Case Presentation: A 74-year-old male with a history of coronary artery …

Cancer Of Unknown Primary With Squamous Cell Carcinoma Phenotype Presenting As Isolated Axillary Mass, Nicole Liang, Mohamed Ashal, Lynne J. Goebel

Internal Medicine

Cancer of unknown primary (CUP) is a rare metastatic malignancy where no primary tumor can be found. We report the case of a 71-year-old female with a strong family history of breast cancer presenting with isolated axillary lymphadenopathy after a tick bite. A biopsy of the axillary mass revealed poorly differentiated squamous cell carcinoma and after extensive evaluation, she was diagnosed with metastatic squamous cell carcinoma with unknown primary tumor. We present this case because of the role of confounding history complicating her initial diagnosis and bringing awareness to a rare disease.

Atypical Dengue Fever With Severe Hematological Manifestations: A Case From The Rio Grande Valley, Elias Arellano Villanueva, Alhasan Asaad, Jose Campo Maldonado

Research Symposium

Background: Dengue fever, a mosquito-borne viral illness, is endemic in tropical regions, including border regions like the Rio Grande Valley while often self-limited, severe presentations such as dengue hemorrhagic fever and dengue shock syndrome highlight its challenges and complexities. This report describes an atypical dengue case with severe hematological manifestations, underscoring the diagnostic challenges and the importance of early recognition, multidisciplinary evaluation, and evidence-based management.

Case Presentation: A 22-year-old Hispanic female with no significant past medical history presented to the ED with hematemesis and fever following her travel to Monterrey, Mexico. Initial symptoms included high fever (107.6°F), chills, diarrhea, vomiting, …

A Peculiar Pancreatitis: Investigating The Adverse Effects Of Mesalamine, Elias Arellano Villanueva, Miguel Lopez, Alhasan Asaad, Jose Campo Maldonado

Research Symposium

Background: Acute pancreatitis (AP) is a leading cause of gastrointestinal-related hospitalizations in the United States, accounting for approximately 300,000 emergency department visits annually. It is characterized by parenchymal and peripancreatic fat necrosis accompanied by inflammation. The clinical diagnosis of AP is based on elevated serum amylase and lipase levels, characteristic imaging findings, and epigastric pain often radiating to the back. While gallstones and alcohol use are the most common causes of AP, drug-induced pancreatitis (DIP) is a rare but increasingly recognized etiology, contributing to 0.1–5% of cases. DIP is typically diagnosed by excluding other causes and is often associated with …