Internal Medicine Commons^™

Diagnostic And Treatment Problems Of Primary Sclerosingcholangitis, Rezky Aulia Nurleili, Intan Airlina F, Anna Mira Lubis

Jurnal Penyakit Dalam Indonesia

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with high incidence reported in America (1/100.000 population), but there is still no data available in Indonesia. The best management of this disease is still not found. Thus, in this article author will discuss about the case of PSC in 49-years male patients hospitalized in Cipto Mangunkusumo hospital Jakarta and its treatment.

Change Of Interleukin-6, C-Reactive Protein And Soluble Vascularcell Adhesion Molecule-1 Concentrations In Hemodialysispatients With Reprocessed Dialyzer, Pringgodigdo Nugroho, Aida Lydia, Marulam Mp Panggabean

Jurnal Penyakit Dalam Indonesia

Introduction. Cardiovascular disease is a major cause of morbidity and mortality in hemodialysis patients. In addition to traditional cardiovascular risk factors, non-traditional cardiovascular risk factors such as inflammation were also involved. Reprocessed dialyzer has been showed to induce less inflammation than new dialyzer, but data in diacetate cellulose membrane have not been presented. Methods. Twenty hemodialysis (HD) patients were enrolled. Pre and post study design was conducted to know post dialysis concentration changes of interleukin 6 (IL-6), C-reactive protein (CRP) and soluble vascular cell adhesion molecule-1 (sVCAM-1) at reuse 0, 5 and 10. Patients were recruited if medically stable, on …

The Role Of Hydration And N-Acetyl Cysteine Combination In 48hours Contrast-Induced Nephropaty After Percutaneous Coronaryintervention In Stage Three Chronic Kidney Disease Patients, Lydia D. Simatupang, Endang Susalit, Ika Prasetya Wijaya

Jurnal Penyakit Dalam Indonesia

Introduction. Contrast Induced Nephropathy (CIN) after percutaneous coronary intervention (PCI) is common in stage 3 chronic kidney disease (CKD) patients. While there is no cure for CIN and some cases are fatal for the kidney or even life, it is preventable. Eventhough controversial, hydration and N-Acetyl Cysteine (NAC) are modalities to prevent CIN. Not having a certain guideline to prevent CIN in Integrated Cardiac Services (ICS) Cipto Mangunkusumo Hospital for PCI patients generates interest to study it. Methods. A prospective cohort is conducted to evaluate plasma creatinine before and 48 hours after PCI, meanwhile recording whom is given combined hydration …

Benarkah Dialiser Proses Ulang Memicu Inflamasi?, Suhardjono Suhardjono

Jurnal Penyakit Dalam Indonesia

No abstract provided.

The Difference Of C-Reactive Protein Levels In Acute Fever Causedby Dengue And Typhoid Infections, Adeputri Tanesha Idhayu, Lie Khie Chen, Suhendro Suhendro

Jurnal Penyakit Dalam Indonesia

Introduction. Dengue infection and typhoid fever are endemic disease in Indonesia. But in the early days of onset sometimes it is difficult to distinguish them. A simple modality test is needed to support the diagnosis. C-Reactive Protein (CRP) is an affordable, fast and relatively less expensive diagnostic tool to diagnose the causes of acute fever. This study was aimed to determine the differences of CRP level in the acute febrile caused by dengue infection or typhoid fever. Methods. A cross sectional study has been conducted among acute febrile patients with diagnosis of dengue fever/ dengue hemorrhagic fever or typhoid fever …

Factors Related To Delayed Antiretroviral Therapy Initiation Inhiv Patients, Dwi Rahayu Nlp, Teguh H. Karjadi, Erni J. Nelwan

Jurnal Penyakit Dalam Indonesia

Introduction. Increase access towards antiretroviral therapy (ART) contribute to global decrease of HIV-associated morbidity and mortality. Time to initiation of ART in eligible HIV-infected patients is associated with reduction in mortality and morbidity. Delayed initiation of antiretroviral therapy can lead to increased of mortality rate more than 10% compare to early initiation. Methods. This study was a cross sectional study among adult HIV patients in Out-patient Clinic of HIV Integrated Clinic Cipto Mangunkusumo General Hospital who started ARV therapy for the first time (ART-naïve patients) enrolled from January 2013 to December 2014. The data were extracted from medical records to …

Predictors Of Health-Related Quality Of Life In Adult Hemophiliapatients In Cipto Mangunkusumo Hospital, Findy Prasetyawaty, Lugyanti Sukrisman, Bambang Setyohadi

Jurnal Penyakit Dalam Indonesia

Introduction. Currently, one of the main focus of hemophilia treatment is to increase health-related quality of life. Due to financial constraints, factor VIII substitution is used only on demand in Indonesia, which might contribute to musculoskeletal complications and affect the quality of life of adult hemophilia patients. This study aimed to evaluate quality of life of adult hemophilic patients and its related factors. Methods. A cross-sectional study on hemophilia patients aged 18 years or older was conducted at the Hematology-Medical Oncology outpatient clinic, Cipto Mangunkusumo Hospital Jakarta from March to May 2012. The radiologic assessment for arthropathy used the Arnold-Hilgartner …

Diagnostic Approach And Treatment Of Instestinal Tuberculosis, Artati Murwaningrum, Murdani Abdullah, Dadang Makmun

Jurnal Penyakit Dalam Indonesia

Tuberculosis (TB) has become a resurgent global problem with increasing numbers of patients. TB infection is still common and remains an important cause of morbidity and mortality, particularly in underdeveloped and developing nations. Intestinal tuberculosis (intestinal TB) rates are rising, consistet with the overall trend. In 2014 Indonesia has the second highest TB prevalence in South East Asia after Timor Leste. Intestinal TB is the sixth highest manifestation of extrapulmonal TB. Manifestations can be non-specific and mimic many conditions, including malignancies causes’ intestinal TB diagnosis more difficult to be accurately determined. Findings from endoscopy and radiological imaging are countless, and …

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

Anticoagulation Following Gastrointestinal Bleeding: Assessing Harms And Benefits, Jacob Jeffers

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Sengupta N, Feuerstein JD, Patwardhan VR, et al. The risks of thromboembolism vs. recurrent gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized in patients with gastrointestinal bleeding: a prospective study. Am. J. Gastroenterol. 2014;110:328-335. doi: 10.1038/ajg.2014.398

Inactivation Of Type I Ifn Jak-Stat Pathway In Ebv Latency, Shunbin Ning, Ling Wang

ETSU Faculty Works

Epstein-Barr Virus (EBV) latent infection is associated with a variety of lymphomas and carcinomas. Interferon (IFN) Regulatory Factors (IRFs) are a family of transcription factors, among which IRF7 is the “master” regulator of type I IFNs (IFN-I) that defends against invading viruses. Robust IFN-I responses require a positive feedback loop between IRF7 and IFN-I. In recent years, we have discovered that IRF7 is significantly induced and activated by the principal EBV oncoprotein--Latent Membrane Protein 1 (LMP1); however, IRF7 fails to trigger robust IFN-I responses in EBV latency. We believe this intriguing finding is critical for EBV latency and oncogenesis, yet …

Left Ventricular Noncompaction Syndrome: A Rare Congenital Cardiomyopathy, Ashwini V. Mallad, Mbbs, Waseem Ahmed, Md, Madhulika Urella, Md, Dr. Mehiar El-Hamdani, Md, Facc, Fscai

Marshall Journal of Medicine

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance …

Vitamin K2 (Menaquinone) Supplementation And Its Benefits In Cardiovascular Disease, Osteoporosis, And Cancer, Grant S. Buchanan, Md, Thomas Melvin, Brandon Merritt, Charles Bishop, Md, Franklin D. Shuler, Md, Phd

Marshall Journal of Medicine

Vitamin K is known to play an essential role in the coagulation cascade; however, a growing body of research has found that a subtype of this vitamin, vitamin K₂ (menaquinone) may have a beneficial effect in osteoporosis, cardiovascular disease, and cancer. This purpose of this article is to provide a comprehensive review of recent literature regarding menaquinone and its role in human health. This review discusses the physiology of menaquinone, its clinical benefits in cardiovascular disease, osteoporosis, and cancer, and how it may interact with certain medications. The authors conclude that menaquinone supplementation has been shown to improve carboxylation …

Restriction Therapy In Acute Heart Failure Is Not Shown To Be Effective, Amrit K. Basi, Colleen W. Harkreader, Nicholus H. Yee M.D., Shadia A. Yeihey M.D., Suraiya K. Azom M.D.

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Travers B, O’Loughlin C, Murphy NF, et al. Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. J Card Fail. 2007;13(2):128-132. doi: 10.1016/j.cardfail.2006.10.012

From The Editors, Anusha Govind, Md, Loheetha Ragupathi, Md, Jad Al Danaf, Md, Mph, Shuwei Wang, Md

The Medicine Forum

Dear Students, Residents, Faculty, and Friends of the Forum,

We are excited to present you with the 17th annual edition of The Medicine Forum. This work reflects the talent, passion, creativity, and scientific inquisitiveness of Jefferson medical students, residents, fellows and faculty. It also celebrates the diverse patients who serve as the centerpiece for each story.

Unique to this issue is the initiation of Grand Rounds Discussions focusing on controversial medical topics with inputs from an array of experts. This year we discussed perioperative management of anticoagulation and antiplatelet agents, and we had exciting viewpoints from experienced cardiologists, a hematologist, …

A Difficult Conversation, Shuwei Wang, Md

The Medicine Forum

I put on my isolation gown, knocked on his hospital room door, and entered to initiate the family meeting. I had been dreading this meeting all morning. It is never easy telling the loved ones of a thirty-seven year old that his disease is terminal, and he is actively dying.

I greeted Mr. M, his girlfriend and sister with the help of a Spanish translator. He smiled and had a twinkle in his jaundiced eyes. He was debilitated, bed bound with anasarca, his right thigh tightly bound by multiple blood stained pressure dressings. "Hola", I greeted them with the little …

A Tribute To Our Nurses, Anusha Govind, Md

The Medicine Forum

I turned faint and weary as the page came through "Your patients heart rate is one hundred eighty" My legs shook as I ran up the stairs Thoughts racing a mile a minute, hoping someone more knowledgeable might be there first As I turned a corner, color draining from my face Then I spot my savior, the nurse, holding a syringe filled with the medication I knew now my patient and I were in good hands.

Grand Rounds Panel Discussion: Blood Thinners Peri-Operatively: What To Do?, Jad Al Danaf, Md, Anusha Govind, Md, Loheetha Ragupathi, Md, Shuwei Wang, Md

The Medicine Forum

PANELISTS

Mathew DeCaro, MD: Associate Professor of Cardiology, Director of the Coronary Cardiac Unit, Cardiology fellowship program director

John Doherty, MD: Professor of Cardiology

Gregary Markefka, MD: Associate Professor of Cardiology, Associate Director of the Coronary Cardiac Unit, Cardiology fellowship assistant program director

Geno Merli, MD: Professor of Vascular Medicine, Co-director of Jefferson Vascular Center

Srikanth Nagalla, MD, MS: Associate Professor of Medicine, Director, Clinical Hematology

Eric Schwenk, MD: Assistant Professor of Anesthesiology, Director of orthopedic anesthesia

Barry Ziring, MD: Clinical Associate Professor of Internal Medicine / Primary Care, Director of the division …

The Financial Dialogue In The Development Of Medical Treatment Plans, Christopher D. Busack, Ms3, Bethany Fox, Ms3

The Medicine Forum

As patients face increasingly high out-of-pocket costs and difficulties navigating the healthcare system, failing to discuss available treatment options in financial terms can lead to grave consequences for patients. Medical bills are responsible for the majority of bankruptcies in the United States. Given the severe financial implications of medical bills, it is imperative that patients become more involved in discussions of their treatment plans and become aware of the costs of their decisions up front. Counseling about costs ensures that physicians avoid placing a debilitating financial burden on patients and maintain adherence to the ethical principle of non-maleficence. Various studies …

Pemphigoid Gestationis: A Rare Dermatosis Of Pregnancy, Victoria Tran, Ms3, Meghan Belamorich, Md

The Medicine Forum

INTRODUCTION

Pemphigoid gestationis is a rare dermatosis of pregnancy that often goes unrecognized or misdiagnosed. It can lead to adverse fetal outcomes including preterm delivery, low fetal birth weight, and even neonatal pemphigoid gestationis1. As such, proper diagnosis and management is critical in reducing fetal risk.

Identification And Management Of Cobalt Toxicity: A Case Report Of Rapidly Progressing Toxicity After Hip Arthroplasty Revision, Neena Mohan, Md, Eric Kasprowicz, Md

The Medicine Forum

INTRODUCTION

Patients undergoing total hip arthroplasty represent a growing portion of the population. More than 330,000 hip replacements are performed annually1, and more than 2.5 million Americans are living with a hip prosthesis2. Many hardware configurations utilize metal alloys for the femoral head and/or acetabulum. Although their use is decreasing due to safety concerns, cobalt-chromium femoral heads were still used in 51% of total hip arthroplasties in 20143. There is rising concern about the adverse effects of metal ions released from these joint replacements. However, little published evidence is available supporting specific interventions for the management of cobalt toxicity.

Given …

Kikuchi Disease: Recognizing A Common Presentation Of An Uncommon Condition, Ramya Punati, Md

The Medicine Forum

INTRODUCTION

Kikuchi disease, also known as histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease, is a rare condition that typically presents with fever and cervical lymphadenopathy in previously healthy young women. First described by Dr. Kikuchi and independently by Dr. Fujimoto in Japan in 1972, the disease is benign and usually self-limited. However, because it can present dramatically and mimic more serious conditions such as lymphoma and tuberculous adenitis, recognizing Kikuchi disease is crucial to avoid misdiagnosis and inappropriate treatment. This case describes a patient who presented with severe manifestations of Kikuchi disease that generated an extensive workup and differential diagnosis prior …

A Case Report Of Multiple Aseptic Facial And Spinal Abscesses In A 45-Year-Old With Inflammatory Bowel Disease, Matthew Zheng, Md, Kristen Jackson, Md, Gloria Francis, Md, Bolin Niu, Md

The Medicine Forum

INTRODUCTION

Sterile abscess syndrome is a rarely described entity that is often associated with auto-inflammatory disorders. Although clinically similar to septic abscesses, sterile abscesses are known to be unaffected by antibiotic regimens and instead highly sensitive to steroids. The association of sterile abscesses with inflammatory bowel disease has been well-described. The majority of sterile abscess syndromes described in the literature are intraabdominal abscesses related to a primary gastrointestinal inflammatory disease. We describe a unique case of extra-abdominal sterile abscess syndrome associated with inflammatory bowel disease presenting as facial and paraspinal lesions.

Distal Renal Tubular Acidosis And Diabetes Insipidus Leading To The Diagnosis Of Sjögren's Syndrome, Loheetha Ragupathi, Md, Elijah Grillo, Md, Jonathan Yadlosky, Md, Ravi Sunderkrishnan, Md

The Medicine Forum

INTRODUCTION

Sjögren's syndrome is a chronic inflammatory disease characterized by the infiltration and progressive destruction of salivary and lacrimal glands. A common presentation involves the complaints of dry eyes and dry mouth, known as the “sicca complex.” Extra-glandular involvement is not uncommon, and is known to involve the lungs, vascular and peripheral nervous system, and kidney.1 The reported renal involvement ranges broadly from 2 – 67%,and is variably defined: the most commonly reported renal pathology is an a tubulo- interstitial nephritis resulting in tubular dysfunction and immune-mediated glomerular disease; however distal renal tubular acidosis (RTA) in particular can be present …

Bilateral Adrenal Hemorrhage In A Patient With Antiphospholipid Syndrome, Silpa Yalamanchili, Md

The Medicine Forum

INTRODUCTION

Bilateral adrenal hemorrhage is relatively uncommon, with a reported incidence in the United States of 0.3-1.8% in hospital post-mortems1.Clinical manifestations of adrenal hemorrhage are widely variable, making diagnosis a challenge. Left undiagnosed and untreated, bilateral adrenal hemorrhage may lead to cardiovascular collapse and/or death. Here we present a rare case of bilateral adrenal hemorrhage in a patient with antiphospholipid syndrome; the aim of this case, and the corresponding literature review, is to highlight risk factors for and management of this condition.

Amiodarone-Induced Thyrotoxicosis And Ventricular Arrhythmias: Case Report And Review Of The Literature, Ashish Shah, Md

The Medicine Forum

INTRODUCTION

Amiodarone is a common drug used to treat arrhythmias and its side effects are diverse. An important adverse effect is amiodarone-induced thyrotoxicosis (AIT), which can potentially lead to a pro-arrythmogenic state. There have been limited studies on the pathogenesis of how thyrotoxicosis increases the risk of ventricular arrhythmias, which causes providers to face a therapeutic challenge in patients who require this medication for the prevention of life threatening arrhythmias. This case report will present a patient with a left ventricular assist device (LVAD) who had recurrent ventricular arrhythmias on chronic amiodarone therapy in the setting of AIT.

Two Cases Of Vibrio Infection And Sepsis In The Delaware Estuary, René Daniel, Md, Joseph Yoo, Md, Roberto Fratamico, Md, Robert Measley, Md

The Medicine Forum

INTRODUCTION

Vibrio is a genus of Gram-negative motile rods. Several species are pathogenic, including Vibrio vulnificus and Vibrio parahaemolyticus. The interest in this genus is due to its extreme virulence and often fatal outcomes. In healthy patients, these infections are typically self-limited; however, in immunocompromised and cirrhotic patients, infections can result in bacteremia, which has a high fatality rate1. Both pathogens may cause acute gastroenteritis, necrotizing wound infections, and if severe, subsequent bacteremia. In this report, we present two cases of Vibrio infections recently identified in the Delaware River Estuary that resulted in severe sepsis and, in one case, death.

Unexplained Recurrent Fevers And The Importance Of Inquiring About Occupation: A Case Report, Zachary Reese, Ms4, Poonam Maru, Do

The Medicine Forum

INTRODUCTION

Many different tick-borne diseases are identified in various geographical areas throughout the United States. Ixodes scapularis tick-borne diseases can present unique diagnostic challenges because of their constellation of vague symptoms. The Ixodes scapularis tick, more commonly known as the blacklegged tick, is responsible for three specific tick-borne infections: Lyme disease (Borellia burgdorferii), Babesiosis (Babesia microti), and Anaplasmosis (Anaplasma phagocytophilum) also known as human granulocytic anaplasmosis. Although these three tick-borne diseases are characteristically found in the New England area, the geographical distribution of the Ixodes tick has expanded to encompass much of the northeastern United States and even states in …

Case Report: Pthrp Related Hypercalcemia In Diffuse Large B-Cell Lymphoma, Ankita Mehta, Md, Evan Caruso, Md

The Medicine Forum

INTRODUCTION

Hypercalcemia is commonly associated with solid tumor malignancies, but less often with hematologic malignancies. When present in hematologic malignancies, hypercalcemia is often secondary to overproduction of Vitamin D from the tumor cells. Very few cases with parathyroid hormone related peptide (PTHrP) induced hypercalcemia in B-cell lymphomas have been reported. Here we present a 44 year old male with a history of chronic lymphoctic leukemia who presented with hypercalcemia and an elevated PTHrP, found to have a transformation to Diffuse Large B-cell Lymphoma (DLBCL).

Anorectal Melanomas: Case Series, Jinyu Zhang, Md, Matthew Sochat, Md, Edward R. Feller, Md

The Medicine Forum

INTRODUCTION

Melanoma is the most common tumor to metastasize to the gastrointestinal (GI) tract. 60% of patients who die with malignant melanoma have GI involvement at autopsy1. Symptomatic disease presenting during life is unusual. Anorectal melanoma, a rare tumor that represents 1% of all melanomas and less than 4% of all anal malignancies, manifests with a range of non-specific symptoms and physical exam findings2. In fact, about one-third of lesions may be amelanotic3,4. Initial misdiagnosis as a benign lesion such as hemorrhoid is common.

We report 3 cases of anorectal melanoma presenting as primary GI complaints all without known cutaneous …