Medical Specialties Commons^™

Dispersi Gelombang Qt, Simon Salim

Jurnal Penyakit Dalam Indonesia

Sejak elektrokardiografi (EKG) dibawa ke perhatian klinisi oleh Einthoven1 sampai dengan saat ini, EKG masih merupakan modalitas yang tidak dapat dipisahkan dalam penilaian sistem kardiovaskular. Namun, pemeriksaan yang sederhana dan tidak invasif ini, tidak selalu mudah untuk diintepretasikan. Hasil yang tergambar di kertas EKG tidak murni dipengaruhi jaringan otot jantung saja, namun dipengaruhi juga oleh jaringan tubuh lain yang terdapat di antara jantung dan lokasi dimana elektroda diletakkan. Dengan demikian, hal ini juga harus dipertimbangkan dalam menginterpretasikan hasil EKG.

Association Of Proprotein Convertase Kexin/Type 9 With Atherosclerosis In People With Type 2 Diabetes Mellitus: A Systematic Review, Farissa Luthfia, Wismandari Wisnu, Dicky Levenus Tahapary, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. Type 2 diabetes melitus is the leading cause of cardiovascular event with high level of low-density lipoprotein as the main predictor marker of atherosclerosis. PCSK9 plays a role in LDL-receptor regulation, its association with atherosclerosis had been investigated but the result is inconsistent. This study aimed to examine the association between PCSK9 level and atherosclerosis in people with type 2 diabetes.

Methods. A systematic review was done in July 18 – September 02, 2020 and registered in PROSPERO. Risk of bias of each study was analyzed with Newcastle Ottawa scale tools. Studies involved in this systematic …

The Effect Of Angiotensin-Converting Enzyme Genepolymorphism And Angiotensin Ii Levels In Coronary Slowflow Phenomenon At Mohammad Hoesin General Hospitalpalembang, Arlis Karlina, Taufik Indrajaya, Ali Ghanie, Erwin Sukandi, Ferry Usnizar, Syamsu Indra, Rukiah Chodilawati, Imran Saleh

Jurnal Penyakit Dalam Indonesia

Introduction. The presence of ACE gene polymorphism is expected to have a role in cardiovascular diseases, including coronary slow flow phenomenon (CSFP). Angiotensin converting enzyme (ACE) gene polymorphism also plays an essential role in increasing angiotensin II levels. Therefore, this study aimed to analyze the effect of angiotensin-converting enzyme gene polymorphism and angiotensin II levels in the coronary slow flow phenomenon in Mohammad Hoesin General Hospital Palembang. Methods. This case-control study was started from July 2019 to July 2020 at RSMH Palembang with 32 subjects for each case (CSFP patients) and the control group (non-CSF patients). This study used a …

Controlled Blood Pressure Factors In Hypertension Patients Atarifin Achmad Hospital, Riau Province: Cross Sectional Study, Dimas Pramita Nugraha, Eka Bebasari

Jurnal Penyakit Dalam Indonesia

Introduction. Hypertension is a chronic disease that causes 1 in every 7 deaths. Controlled blood pressure will reduce the complication of hypertension. The aim of this study was to determine the factors that influence controlled blood pressure. Methods.This research was conduct by using an observational method with a cross-sectional study design to analyze factors for controlled blood pressure. The population of this research was all of the hypertension patients at the internal medicine polyclinic in Arifin Achmad Hospital Riau Province. The sample was selected using accidental sampling method. Patient adherence level factor was measured using the Morisky medication adherence scale-8 …

Comparison Of Red Cell Distribution Width Values Towardsmortality In Adult And Elderly Hospital-Acquired Pneumoniapatients In Dr. Sardjito Hospital, Desty Gusti Sari, Rizka Humardewayanti Asdie, Heni Retnowulan

Jurnal Penyakit Dalam Indonesia

Introduction. Hospital-acquired pneumonia (HAP) is a major cause of morbidity and mortality. Red cell distribution width (RDW) is associated with mortality in patients with septic shock and community-acquired pneumonia (CAP). However, little is known about the effect of elevation of RDW value on mortality in HAP patients, especially in the elderly population who have a worse prognosis. This study aimed to determine the proportion of adult and elderly HAP patients who have an increase in RDW value and the relation between the increase in RDW value to the risk of mortality in HAP patients during hospitalization. Methods. A cross-sectional and …

Microfracture For Cartilage Defects In Today’S Orthopaedics: Pearls And Pitfalls, Himanshu Yn, Sufyan Ibrahim

Manipal Journal of Medical Sciences

Microfracture technique has vacillating clinical outcomes, limited demographic applicability, high failure rate, and variable patient satisfaction. Although it does not deserve to be a gold standard technique, there has not been a technique that could overcome all possible disadvantages associated with the technique and at the same time give a favourable result/be suitable for widespread use/not have its own disadvantages. Microfracture, integrated with biomaterial/stem cell transfer has shown promise over the past decade but studies evaluating the long-term efficacy of the tests and standardization are lacking. Besides, cost and operative difficulties limit widespread use. Twenty-five years into the field, microfracture …

Impact Of Scabies On Indonesian Public Boarding School Students’ Quality Of Life: A Mixed-Method Analysis, Sri Linuwih Sw Menaldi, Danny Surya, Valensia Vivian The, Melani Marissa

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Scabies is a neglected tropical disease in which people affected primarily presents with intense pruritus. The disease is often recurrent, especially in people living in close contacts, such as in a community; thus, it negatively impacts their quality of life (QoL).This study analyzes the impact of pruritus in scabies on the QoL of patients living in a public boarding school (PBS) in West Java, Indonesia.

Methods: This study is a mixed-method study conducted on 39 subjects. TheQoL was examined using the Indonesian version of the dermatology life quality index (DLQI) questionnaire and in-depth interviews.

Results: Most …

Prevalence Of Cutibacterium Acnes And Staph Spp. In The Lesions Of Acne Vulgaris In Jakarta, Melyawati Hermawan, Enty Tjoa, Inneke J. Hidajat, Maria Teressa, Eka B. Layadi, Alegra Wolter

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Acne vulgaris (AV) is a chronic skin disorder that is commonly seen in young adults. Recent studies have shown that bacteria other than Cuticubacterium acnes found in the skin microbiota also play vital roles in the pathogenesis of AV. Understanding the skin microbiota and its disruption in patients with AV is paramount in treating patients with AV.

Methods: Samples were obtained from 36 subjects to evaluate the proportion of Cutibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus in lesions of AV by means of bacterial culture.

Results: There were 69 specimens collected from the 36 subjects with …

A Comparison Of Single-Dose Versus Divided-Dose Of Metronidazole On Bacterial Vaginosis Among Female Sex Workers In Surakarta, Willa Damayanti, Rini Hastuti, Agung Triana, Danu Yuliarto, Ardelia Dyah Ayu, Endra Yustin Ellistasari

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Bacterial vaginosis (BV) is the most common vaginal infection in sexually active women. Metronidazole (MTZ) is still one of the recommended regimens for BV either as a single-dose or divided-dose. In addition to its affordability and availability, oral metronidazole also produces fewer adverse effects. This study aimedto determine the efficacy of single-dose versus divided-dose metronidazole for BV among female sex workers (FSWs) in Surakarta.

Methods: A single-blind randomized clinical trial was conducted in Surakarta. FSWswith BV (⩾3 Amsel criteria) were enrolled. The subjects were grouped into two, and treated with MTZ either as a single-dose of …

Multisystem Langerhans Cell Histiocytosis In High-Risk Group: A Case Series Of Two Infants, Anggun Putri Yuniaswan, Putri Rachma Safitri, Diah Prabawati Retnani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Langerhans Cell Histiocytosis (LCH) has diverse manifestations, from asymptomatic to aggressive, which involves many organs. Histopathological examination playsa crucialrole as a basic diagnostic standard for LCH. Writing Group of the Histiocyte Society proposes a guideline for diagnosing LCH, divided into presumptive, designated, and definitive diagnosis.

Case Illustration: Two cases of a 14 month-old girl and an 18 month-old girl presented similar clinical manifestation and multi-organ involvement. Dermatological examination revealed red papules and plaques covered by brownish scales and crusts on the scalp and body, erosion in some folds of the body. Histopathological examination of the first case …

Basal Cell Carcinoma In A 14-Year-Old: A Rare Case Of A Common Skin Cancer, Danang Tri Wahyudi, Firman Parrol, Aida Sofiati Hoemardani, Agassi Suseno Sutarjo

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Basal cell carcinoma (BCC) is the most common cutaneous malignancy. It usually arises in sun-exposed areas of the body, with the face and neck being the most common sites for BCC. BCC is typically found in older individuals, but it is becoming more prevalent in people younger than 50. However, such cases in children under 15 are rarely encountered. Pigmented BCC is a common presentation in people of color, while such presentation is relatively unusual in Caucasians. Pediatric cases could be idiopathic, but it is more commonly associated with a genetic defect, such as basal cell nevus syndrome, …

Noninvasive Diagnostic Modality For Skin Cancer, Remenda Siregar, Raja Nurhayati, Widyaningsih Oentari, Ari Karmila Sari

Journal of General - Procedural Dermatology and Venereology Indonesia

Histopathological examination is the gold standard for the diagnosis of nonmelanoma and melanoma skin cancer, but it is an invasive procedure that consumes time and requires large costs. The average cure rate for skin cancer is high with early detection and appropriate treatment. This is an article review that was made through findings from several scientific articles. There are several noninvasive imaging modality choices that can be used for screening at low cost, high quality, and faster result, which includes dermoscopy, optical coherence tomography, reflectance confocal microscopy, electrical impedance spectroscopy, multispectral imaging, and SIAscopy®. These imaging modalities can assist in …

Solitary Plasmacytoma Of Manubrium Sterni - A Case Report, Shyamasunder N. Bhat, Sp Mohanty

Manipal Journal of Medical Sciences

Solitary plasmacytoma is a tumour consisting of neoplastic monoclonal plasma cells without systemic involvement. It constitutes about 5% of all plasma cell dyscrasias and is mainly detected in the spine, pelvis and ribs and rarely in the sternum.

Here we report a case of a 45-year-old man presenting with pain and swelling in the midline of the chest over manubrium sterni. Plain radiograph and CT scan revealed an expansile, osteolytic lesion in the manubrium sterni. There was no M Band in protein electrophoresis, and the iliac bone marrow aspirate did not show plasmacytoma. However, histopathology of the lesion was suggestive …

Proportion Of Pre-Dialysis Prolonged Qt Dispersion In Twiceweekly Chronic Hemodialysis Patients And Its Associated Factors, Arief Pattiiha, Muhammad Yamin, Aida Lydia, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

Introduction. Cardiovascular disease (CVD) is the common cause of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Causes of CVD in ESRD patients are multifactorial. Ventricular arrhythmia is known as the leading cause of sudden death in dialysis patients. QT dispersion, which is measured from electrocardiography (ECG), is known as one of the parameters to assess the risk of arrhythmia in HD patients. This study aimed to determine the proportion of pre-dialysis prolonged QT dispersion in chronic twice-weekly HD patients and the associated factors. Methods. A cross-sectional study was conducted among HD patients age ≥18 years with dialysis …

Analysis Of Genetic Variants Associated With Levels Of Immune Modulating Proteins For Impact On Alzheimer’S Disease Risk Reveal A Potential Role For Siglec14, Benjamin C. Shaw, Yuriko Katsumata, James F. Simpson, David W. Fardo, Steven Estus

Biostatistics Faculty Publications

Genome-wide association studies (GWAS) have identified immune-related genes as risk factors for Alzheimer’s disease (AD), including TREM2 and CD33, frequently passing a stringent false-discovery rate. These genes either encode or signal through immunomodulatory tyrosine-phosphorylated inhibitory motifs (ITIMs) or activation motifs (ITAMs) and govern processes critical to AD pathology, such as inflammation and amyloid phagocytosis. To investigate whether additional ITIM and ITAM-containing family members may contribute to AD risk and be overlooked due to the stringent multiple testing in GWAS, we combined protein quantitative trait loci (pQTL) data from a recent plasma proteomics study with AD associations in a recent …

Comparison Of Turnaround Times (Tat) In Pathology Laboratories From Developed And Developing Countries, And Its Impact On Treatment, Rishikha Jeyapal, Shajeedth Suresh Naidu, Jeevan K K. Shetty, Venkatesh Ramaswamy Naik

Manipal Journal of Medical Sciences

The timeliness of histopathology reports is one of the most crucial aspects of patient care. Turnaround Time (TAT) is one such parameter that is often considered when performing tests in pathology labs. Simply put, it is the time interval between the day a specimen is accessed in the lab, to the day the final report is signed out. Aims: This study aimed to compare the turnaround times in histopathology labs of developed and developing countries and to explore the impact of turnaround times on medical treatment. Materials and Methods: Our current review on retrieved articles from databases such as PubMed, …

An Investigation Of A Novel Dural Repair Device For Intraoperative Incidental Durotomy Repair., Kartik Shenoy, Chester J. Donnally, Evan D. Sheha, Krishn Khanna, Srinivas K. Prasad

Rothman Institute Papers

Incidental durotomies, or dural tears, can be very difficult and time consuming to repair properly when they are encountered in confined spaces. A novel dural repair device was developed to address these situations. In this paper, the novel device was assessed against the use of traditional tools and techniques for dural repairs in two independent studies using an intricate clinical simulation model. The aim was to examine the results of the two assessments and link the outcomes to the clinical use of the novel device in the operating room. The novel device outperformed conventional techniques as measured by dural repair …

Closing Gaps In The Care Of Patients With Heart-Kidney Disease: The Time Is Now., Janani Rangaswami

Department of Medicine Faculty Papers

No abstract present.

The Shape Of The Oral Glucose Tolerance Test-Glucose Response Curve In Islet Cell Antibody-Positive Vs -Negative Obese Youth Clinically Diagnosed With Type 2 Diabetes, Joon Young Kim, Hala Tfayli, Fida Bacha, Silva Arslanian

Children’s Nutrition Research Center Staff Publications

BACKGROUND: The oral glucose tolerance test (OGTT)-glucose response curves (GRCs; incessant increase, monophasic, and biphasic) reflect insulin sensitivity and β-cell function, being worse in the former and superior in the latter. Here, we examined if the OGTT-GRC pattern is worse in obese antibody (glutamic acid decarboxylase 65-kDa [GAD65] and insulinoma-associated protein-2 [IA-2])-positive (Ab

METHODS: Forty-seven obese youth, 15 Ab

RESULTS: Incessant increase OGTT-GRC is the most frequent curve type and is three-fold higher in Ab

CONCLUSION: Severe insulin deficiency, a characteristic of type 1 diabetes, seems to be related to higher prevalence of incessant increase in Ab

Barbadin Potentiates Long-Term Effects Of Lorcaserin On Pomc Neurons And Weight Loss, Yang He, Hailan Liu, Na Yin, Yongjie Yang, Chunmei Wang, Meng Yu, Hesong Liu, Chen Liang, Julia Wang, Longlong Tu, Nan Zhang, Lina Wang, Yanlin He, Makoto Fukuda, Qi Wu, Zheng Sun, Qingchun Tong, Yong Xu

Children’s Nutrition Research Center Staff Publications

Obesity is a serious global health problem because of its increasing prevalence and comorbidities, but its treatments are limited. The serotonin 2C receptor (5-HT_2CR), a G-protein-coupled receptor, activates proopiomelanocortin (POMC) neurons in the arcuate nucleus of hypothalamus (ARH) to reduce appetite and weight gain. However, several 5-HT analogs targeting this receptor, e.g., lorcaserin (Lor), suffer from diminished efficacy to reduce weight after prolonged administration. Here, we show that barbadin (Bar), a novel β-arrestin/β2-adaptin inhibitor, can prevent 5-HT_2CR internalization in cells and potentiate long-term effects of Lor to reduce appetite and body weight in male mice. Mechanistically, …

Clinical Characteristics And Treatment Regimen Of Pemphigus Patients: A Retrospective Study, Windy Keumala Budianti, Eyleny Meisyah Fitri, Puti Rineska Meilinda, Endi Novianto, Shafira Anindya, Arlha Aporia Debinta

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Pemphigus is a potentially life-threatening autoimmune bullous disease. In pemphigus, the therapeutic options are based on the clinical characteristics of each patient. However, other than corticosteroids, most therapeutic options for pemphigus are currently limited. Steroid-sparing agents might be considered since the initiation of therapy to prevent the side effects of corticosteroid. The objective of this study is to identify the clinical characteristics and therapy of choice in patients with pemphigus at Dr. Cipto Mangunkusumo General Hospital.

Method: All cases of pemphigus from 2016 to 2018 at Dermato-Allergo-Immunology Clinic, Department of Dermatology and Venerology Dr. Cipto Mangunkusumo General …

Alternative Modality In The Treatment Of Acne Vulgaris: Low Level Laser Therapy, Rudi Chandra, Nelva K. Jusuf

Journal of General - Procedural Dermatology and Venereology Indonesia

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit with polymorphic manifestations. The four key elements leading to the formation of acne lesions are alteration of follicular keratinization that leads to comedones, increased and altered sebum production under androgen control, follicular colonization by Propionibacterium acnes, and complex inflammatory mechanisms that involve both innate and acquired immunity. Phototherapy (light, lasers, and photodynamic therapy) has been proposed as an alternative therapeutic modality to treat acne vulgaris and is proposed to have less side effects compared to other treatment options. Recently, low-level laser (light) therapy (LLLT) which refers to the use …

Dermoscopy-Guided Carbon Dioxide Laser Destruction For Nevus Sebaceous: Two Case Reports, Larisa Paramitha Wibawa, Kuniaki Ohara

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Nevus sebaceous (NS) is a common hamartoma of the cutaneous adnexal structure, clinically appear as a well demarcated yellow-orange plaque, sometimes with verrucous surface. Dermoscopy may aid the diagnosis of NS and also guide carbon dioxide (CO2) laser therapy.

Case Illustration: Two cases of brown and yellowish plaque on the face, with clinical appearance, dermoscopic, and histopathological findings consistent with NS. The patients consented to undergo serial CO­2laser destruction, aimed to reduce recurrences and shorten the duration of the downtime. Dermoscopy aided in locating the area and the depth of each treatment.

Discussion: The dermoscopy finding …

Childhood-Onset Borderline Tuberculoid Leprosy With Reversal Reaction, Ramona D. Lubis, Mila Darmi, Rudi Chandra

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Leprosy is a chronic granulomatous infection caused by Mycobacterium lepraethat predominantly affects the skin and peripheral nerves. Leprosy among children is still common in endemic countries.

Case Illustration: A 12-year-old girl complained about a hypopigmented anesthetic patch on her face for 11 years, which became larger and spread slowly to her arms and legs. She had a history of close contact with her aunt, who was diagnosed with multibacillary leprosy. On slit-skin-smear test, acid-fast-bacilli (bacteriologic index +1) were found. She was diagnosed with multibacillary leprosy and treated with children’s multidrug therapy-multibacillary (MDT-MB) regimen. After 2 months of …

Evolution Of Targeted Therapy Resistance In Eml4-Alk Positive Non-Small Cell Lung Cancer, Robert Vander Velde

USF Tampa Graduate Theses and Dissertations

Targeted therapies have emerged as potent treatments that lead to the remission of many tumors. However, they rarely cure cancers in advanced, metastatic settings. This is due to the evolution of resistance, which in turn can be ascribed to the survival of small subpopulations of tolerant and/or resistant cells. Here we investigated the evolution of resistance to EML4-ALK inhibitors in non-small cell lung cancer (NSCLC) and demonstrated that resistance evolves gradually, from unique pre-treatment sub-populations, as multiple resistance mechanisms accumulate in a Darwinian fashion. Despite accumulating multiple changes, cells evolved, in parallel, toward similar inhibitor specific phenotypes. Evolving cells have …

Comparison Of Clinical Characteristics And Outcomes Between Covid-19 Pneumonia And H1n1 Influenza, Nosheen Nasir, Iffat Khanum, Kiren Habib, Rimsha Ahmed, Mujahid Hussain, Zahra Hasan, Muhammad Irfan

Department of Medicine

Introduction: The COVID-19 pandemic has been likened to the 2009 H1N1 influenza pandemic. We aim to study the similarities and differences between patients hospitalized with COVID-19 and H1N1 influenza in order to provide better care to patients, particularly during the co-circulation of Influenza A Subtype H1N1 and SARS-CoV-2.
Material and methods: A retrospective cohort study was conducted in order to compare clinical characteristics, complications, and outcomes of hospitalized patients with PCR-confirmed H1N1 influenza pneumonia and COVID-19 at a tertiary care center in Karachi, Pakistan.
Results: A total of 115 patients hospitalized with COVID-19 were compared with 55 patients with H1N1 …

Gene Therapy Knockdown Of Hippo Signaling Induces Cardiomyocyte Renewal In Pigs After Myocardial Infarction, Shijie Liu, Ke Li, Leonardo Wagner Florencio, Li Tang, Todd R Heallen, John P Leach, Yidan Wang, Francisco Grisanti, James T Willerson, Emerson C Perin, Sui Zhang, James F Martin

Faculty, Staff and Students Publications

Human heart failure, a leading cause of death worldwide, is a prominent example of a chronic disease that may result from poor cell renewal. The Hippo signaling pathway is an inhibitory kinase cascade that represses adult heart muscle cell (cardiomyocyte) proliferation and renewal after myocardial infarction in genetically modified mice. Here, we investigated an adeno-associated virus 9 (AAV9)–based gene therapy to locally knock down the Hippo pathway gene Salvador (Sav) in border zone cardiomyocytes in a pig model of ischemia/reperfusion-induced myocardial infarction. Two weeks after myocardial infarction, when pigs had left ventricular systolic dysfunction, we administered AAV9-Sav …

A Rare Fatal Case Of Adenovirus Serotype 4 Associated Acute Disseminated Encephalomyelitis In An Adult: A Case Report, Zahra Qamar, Catherine Tucker, Lawrence C. Kenyon, Tricia. Royer

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease directed against the myelin sheath of the central nervous system that typically presents 1–4 weeks after an infection or vaccination, most commonly in children. We describe a case of a young female who presented with rapidly progressive mental deterioration and died secondary to ADEM following an adenovirus upper respiratory tract infection.

Nox4 Signaling Mediates Cancer Development And Therapeutic Resistance Through Her3 In Ovarian Cancer Cells., Wen-Jing Liu, Ying-Xue Huang, Wei Wang, Ye Zhang, Bing-Jie Liu, Jian-Ge Qiu, Bing-Hua Jiang, Ling-Zhi Liu

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Development of resistance to therapy in ovarian cancer is a major hinderance for therapeutic efficacy; however, new mechanisms of the resistance remain to be elucidated. NADPH oxidase 4 (NOX4) is responsible for higher NADPH activity to increase reactive oxygen species (ROS) production. In this study, we showed that higher levels of NOX4 were detected in a large portion of human ovarian cancer samples. To understand the molecular mechanism of the NOX4 upregulation, we showed that NOX4 expression was induced by HIF-1α and growth factor such as IGF-1. Furthermore, our results indicated that NOX4 played a pivotal role in chemotherapy and …

Starting Triple Oral Hypoglycemic Agent Therapy In Poorly Controlled Type 2 Diabetes Is A Suitable Therapeutic Strategy To Lower Hba1c When Insulin Therapy Is Not Desired, Mara A. Darian

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Søfteland E, Meier JJ, Vangen B, Toorawa R, Maldonado-Lutomirsky M, Broedl UC. Empagliflozin as Add-on Therapy in Patients With Type 2 Diabetes Inadequately Controlled With Linagliptin and Metformin: A 24-Week Randomized, Double-Blind, Parallel-Group Trial. Diabetes Care. 2016;40(2):201-209. https://doi.org/10.2337/dc16-1347

for a patient with uncontrolled type 2 diabetes on metformin and sitagliptin and hesitant to begin insulin therapy.