Internal Medicine Commons^™

Understanding Patient Uncertainty As A Driver Of Emergency Department Utilization: A Concept Mapping Approach, Angela Gerolamo, Phd, Rn, Shannon Doyle, Mph, Rhea E. Powell, Md, Mph, Amanda M.B. Doty, Ms, Marianna Lanoue, Phd, Kristin L. Rising, Md, Mshp

Department of Emergency Medicine Posters

Background and Purpose

• Most previous research regarding factors associated with increased risk of emergency department (ED) use has been done via retrospective review of medical records rather than obtaining patients’ perspectives.
• Recent research identified patient uncertainty related to symptoms as a primary motivator for seeking ED care, and ongoing uncertainty at the time of ED discharge as an unmet need (Rising et al. 2015; Rising, Hudgins, Reigle, Hollander, & Carr 2016).
• While providers have limited ability to influence many factors identified by retrospective medical record review (e.g. financial concerns), patient uncertainty can be addressed by providers directly. To do so …

Insufficiency Of Dna Repair Enzyme Atm Promotes Naive Cd4 T-Cell Loss In Chronic Hepatitis C Virus Infection, Juan Zhao, Xindi Dang, Peixin Zhang, Lam Nhat Nguyen, Dechao Cao, Lin Wang, Xiaoyuan Wu, Zheng D. Morrison, Ying Zhang, Zhansheng Jia, Qian Xie, Ling Wang, Shunbin Ning, Mohamed El Gazzar, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

T cells have a crucial role in viral clearance and vaccine response; however, the mechanisms regulating their responses to viral infections or vaccinations remain elusive. In this study, we investigated T-cell homeostasis, apoptosis, DNA damage, and repair machineries in a large cohort of subjects with hepatitis C virus (HCV) infection. We found that naive CD4 T cells in chronically HCV-infected individuals (HCV T cells) were significantly reduced compared with age-matched healthy subjects. In addition, HCV T cells were prone to apoptosis and DNA damage, as evidenced by increased 8-oxoguanine expression and γH2AX/53BP1-formed DNA damage foci—hallmarks of DNA damage responses. Mechanistically, …

A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile And Connected Tools For Underserved Individuals With Type 2 Diabetes And Comorbid Overweight Or Obesity: Pilot Comparative Effectiveness Trial, Jing Wang, Chunyan Cai, Nikhil Padhye, Philip Orlander, Mohammad Zare

Faculty, Staff and Student Publications

BACKGROUND: Self-monitoring is a cornerstone of behavioral lifestyle interventions for obesity and type 2 diabetes mellitus. Mobile technology has the potential to improve adherence to self-monitoring and patient outcomes. However, no study has tested the use of a smartphone to facilitate self-monitoring in overweight or obese adults with type 2 diabetes mellitus living in the underserved community.

OBJECTIVE: The aim of this study was to examine the feasibility of and compare preliminary efficacy of a behavioral lifestyle intervention using smartphone- or paper-based self-monitoring of multiple behaviors on weight loss and glycemic control in a sample of overweight or obese adults …

Gastric Calcifying Fibrous Tumor Mimicking Gi Stromal Tumor, Nneoma Okoronkwo, Shima Ghavimi, Ravi Chokshi, Stephen Peters, Sushil Ahlawat

Internal Medicine

A 27-year-old female with no significant medical history was referred for an EUS to evaluate a large, firm, gastric mass, which was detected during esophagastroduodenoscopy done for persistent reflux symptoms and intermittent epigastric pain. EUS revealed a polypoid, broad-based, solid intramural mass, 2 cm x 4 cm in size, heterogeneous in echo-texture with calcifications and post-acoustic shadowing. The polypoid gastric mass appeared to arise from the muscularis propria.

The Role And Safety Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Diagnosis And Management Of Infected Bronchogenic Mediastinal Cysts In Adults, Hazim S. Bukamur, Emad Alkhankan, Haitem Mezughi, Nancy J. Munn, Yousef R. Shweihat

Internal Medicine

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such …

A Comprehensive Meta-Analysis Of Stem Cell Therapy For Chronic Angina, Rahman Shah, Samuel B. Latham, Sajjad A. Khan, Muhammad Shahreyar, Inyong Hwang, Ion S. Jovin

Section of Internal Medicine

Background: A substantial proportion of patients with coronary artery disease do not achieve complete revascularization and continue to experience refractory angina despite optimal medical therapy. Recently, stem cell therapy has emerged as a potential therapeutic option for these patients. However, findings of individual trials have been scrutinized because of their small sample sizes and lack of statistical power. Therefore, we conducted an updated comprehensive meta-analysis of available randomized controlled trials (RCTs) with the largest sample size ever reported on this subject.
Hypothesis: In patients with chronic angina stem cell therapy improves clinical outcomes.
Methods: Scientific databases and websites were searched …

A Rare Case Of Tafro Syndrome, Elizabeth Gold Do, Ross Biggs Do

Department of Medicine

No abstract provided.

Will Aiming For Quantity Affect Quality? Establishing Open Access At A Fellow-Run Gastroenterology Clinic., Matthew Sullivan Do, Patrick Hickey Do, Eric Nellis Md, Abdul Aleem Mbbs, Rajesh Essrani Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

A Rare Case Of Complicated Cutaneous Leishmaniasis., Sandhya Venkataraman Do, Lalita Shastry Md, Luther Rhodes Iii Md, Facp, Jarrod W. Kile Rphd

Department of Medicine

No abstract provided.

Triple Valve Infective Endocarditis - A Late Diagnosis, Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu, Ananu F. Vreju

Journal of Mind and Medical Sciences

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established.

We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation.

The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and …

The Importance Of Circulating Tumor Products As „Liquid Biopsies” In Colorectal Cancer, Alina Miscoci, Cristian D. Pirvu, Veronica Calborean, Costin T. Streba, Otilia C. Rogoveanu, Vlad Pădureanu, Cristin C. Vere

Journal of Mind and Medical Sciences

Liquid biopsies represent an array of plasma analysis tests that are studied to evaluate and identify circulating tumor products, especially circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Examining such biomarkers in the plasma of colorectal cancer patients has attracted attention due to its clinical significance in the treatment of malignant diseases. Given that tissue samples are sometimes challenging to procure or unsatisfactory for genomic profiling from patients with colorectal cancer, trustworthy biomarkers are mandatory for guiding treatment, monitoring therapeutic response, and detecting recurrence.

This review considers the relevance of flowing tumor products like circulating tumor cells (CTCs), circulating …

Association Between Thyroid Status And Glucose Intolerance Inhyperthyroid Patients, Wismandari Wisnu, Pradana Soewondo, Imam Subekti

Jurnal Penyakit Dalam Indonesia

Introduction. The most common endocrinopathy in adults are diabetes mellitus (DM) and thyroid disease. Hyperthyroidism decreases blood glucose control and increased the need of insulin. However, the mechanism of abnormal glucose metabolism in hyperthyroidism is not fully understood. This study aims to determine the relationship of thyroid status with incidence of glucose intolerance in hyperthyroid patients compared to hyperthyroid patients who have achieved clinical status of eutyroid and normal population. Methods. This study was cross sectional design in outpatients with hyperthyroidism in hyperthyroid and euthyroid/subclinical hyperthyroid status, and healthy volunteers who had matching age and sex. An oral glucose test …

Pemeriksaan Bilasan Lambung: Alternatif Diagnostik Tuberkulosis Pada Pasien Hiv Dewasa?, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Association Of Clinical Features And Hematological Laboratoriesbetween Ph (+)/Bcr-Abl (+) Chronic Myeloid Leukemia And Other Type Of Ph/Bcr-Abl Chronic Myeloid Leukemia, Wulyo Rajabto, A. Harryanto, Hilman Tadjoedin, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with chronic phase Chronic Myeloid Leukemia (CML) at Hematology-Medical Oncology Clinic Department of Internal Medicine dr. Cipto Mangunkusumo National Hospital who haveperformed cytogenetic and RTPCR BCR-ABL examination showed: Ph (+)/BCR-ABL (+) CML and other type of Ph/BCR-ABL CML. This study aims to identify the clinical features and hematological laboratories of chronic phase CML, the proportion of Ph (+)/BCR-ABL (+) CML, and association of clinical features and hematological laboratories between Ph (+)/BCR-ABL (+) CML and other type of Ph/ BCR-ABL CML. Methods. This is a cross-sectional study. The samples were taken by consecutive method. We used Chi-square test and …

Validation Of C-Reactive Protein And Curb-65 In The Firsthospital Admission Community Acquired Pneumonia Patient Asa Predictor 30 Days Mortality, Borries Foresto Buharman, Ceva Wicaksono Pitoyo, Gurmeet Singh, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Child Turcotte Pugh Score, diastolic dysfunction, liver cirrhosis, liver dysfunction

Left Ventricular Diastolic Dysfunction In Liver Cirrhotic Patients: Proportion, Correlation, And Relationship Of Diastolic Parameters With Stage Of Liver Dysfunction, Prionggo Mondrowinduro, Irsan Hasan, Idrus Alwi, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

Introduction. Cardiovascular complication of liver cirrhosis is relatively obscure. Pathophysiology of liver cirrhosis, involving portal hypertension made the possibility of cirrhosis complication manifested as left ventricular diastolic dysfunction. This study aims to determine proportion of left ventricular diastolic dysfunction among liver cirrhotic patients according to American Society of Echocardiography-European Association of Echocardiography (ASE-EAE) 2009 and conventional approach, to determine any correlation between left ventricular diastolic dysfunction severity stages with severity stages of liver dysfunction in cirrhotic patients represented by Child Turcotte Pugh (CTP ) score, also to asses relationship between severity stages of parameters of diastolic function according to ASE-EAE …

Management Of Antithrombotic In Endoscopic Procedures, Dwi Suseno, Ari Fahrial Syam

Jurnal Penyakit Dalam Indonesia

The use of antithrombotic medicine has increased along with the growing number of cardiovascular disease in the world. Endoscopy procedure often done to the patients who use antithrombotic medicine. Eventhough most of endoscopies are safe for those patients, there are some main things related to antithrombotic treatment management that have to be noted such as the kind of antithrombotic that being used, stratification of bleeding risk on the procedure, the risk of future thromboembolic, and the process of antithrombotic treatment re-initiation. So that, patient’s safety in undergoing endoscopy procedure is guaranteed.

Association Between Stigma, Arv Therapy And Complications Ofpsychiatric Disorders Iin Hiv / Aids Patients, Yamaji Adi Wicaksono, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro, Hari Peni

Jurnal Penyakit Dalam Indonesia

Introduction. Stigma and discrimination among HIV/AIDS patients cause varrious problems such as physical, psychological, and social. Therefore, its management requires comprehensive intervention. Antiretroviral therapy improves the patient’s clinical course, but may lead to neuropsychiatric complications especially anxiety disorders, depression, and psychotic disorders. This study aimed to know the associationbetween stigma,ARV therapy and complications of psychiatric disorders of HIV patients. Methods. A cross-sectional study was conducted among HIV/AIDS patients undergoing antiretroviral therapy in VCT-CST RSUP dr. Kariadi and RSUD RAA Soewondo Pati. Subjects were recruited using consecutive sampling method. Asessment of disorders and stigma was conducted using Structured Clinical Interview for …

Performance Of Xpert Mtb/Rif By Using Gastric Lavage Samplein The Diagnosis Of Pulmonary Tuberculosis In Hiv Patients Withsuspected Pulmonary Tuberculosis, Manuel Lamberto Willem Mboeik, Ceva Wicaksono Pitoyo, Teguh Harjono Karjadi, Anis Karuniawati, Esthika Dewiasty

Jurnal Penyakit Dalam Indonesia

Introduction. Xpert MTB/RIF test on gastric lavage sample may improve pulmonary tuberculosis (TB) case finding, but its performance as a diagnostic test for pulmonary TB in HIV-infected adults patients has not been studied widely, including in Indonesia. This study aims to determine the performance of the Xpert MTB/RIF test in diagnosing pulmonary tuberculosis 30 | Jurnal Penyakit Dalam Indonesia | Vol. 5, No. 1 | Maret 2018 Manuel Lamberto Willem Mboeik, Ceva Wicaksono Pitoyo, Teguh Harjono Karjadi, Anis Karuniawati, Esthika Dewiasty among HIV-infected adult patients with suspected pulmonary tuberculosis by using gastric lavage sample. Method. A cross-sectional study was conducted …

Rino-Orbital-Cerebral Mucormicosys In A Patient Type 1diabetic: A Case Report, Hamka Gunawan Marpaung, Gery Dala Prima Baso, Aulia Rizka, Erni Juwita Nelwan, Retno S. Wardani, Retno Wahyuningsih

Jurnal Penyakit Dalam Indonesia

Mucormycosis is an opportunistic andfrequently fulminating fungal infection causedby members of the family Mucoraceae, orderMucorales and class Zygomycetes which highly invasive and high mortality. Mucormycosis occurs in diabetic patients with poor blood glucose control. We reported a case of rhinocerebral mucormycosis in 20-year-old female patient with type 1 diabetes. The patient was treated for diabetic ketoacidosis and swollen symptoms in the left eye and out secretions from the left nose containing blackish spots. The probable diagnosis of rhinocerebral mucormycosis is made based on the results of direct examination and culture of nasal and palate tissue biopcywhich result suitable for Mucor …

Apolipoprotein-Defined Lipoprotein Subclasses, Serum Apolipoproteins, And Carotid Intima-Media Thickness In T1d, Arpita Basu, Alicia J. Jenkins, Julie A. Stoner, Ying Zhang, Richrd L. Klein

Kinesiology and Nutrition Sciences Faculty Research

Circulating apolipoprotein-defined lipoprotein subclasses (ADLS) and apolipoproteins predict vascular events in the general and type 2 diabetes populations, but data in T1D are limited. We examined associations of ADLS, serum apolipoproteins, and conventional lipids with carotid intima-media thickness (IMT) measured contemporaneously and 6 years later in 417 T1D participants [men: n = 269, age 42 +/- 6 y (mean +/- SD); women: n = 148, age 39 +/- 8 y] in the Epidemiology of Diabetes Interventions and Complications study, the follow-up of the Diabetes Control and Complications Trial (DCCT). Date were analyzed by multiple linear regression stratified by sex, and …

Large, Long Range Tensile Forces Drive Convergence During, David R. Shook, Eric Kasprowicz, Md, Lance A. Davidson, Raymond Keller

Division of Internal Medicine Faculty Papers & Presentations

Indirect evidence suggests that blastopore closure during gastrulation of anamniotes, including amphibians such as Xenopus laevis, depends on circumblastoporal convergence forces generated by the marginal zone (MZ), but direct evidence is lacking. We show that explanted MZs generate tensile convergence forces up to 1.5 mN during gastrulation and over 4 mN thereafter. These forces are generated by convergent thickening (CT) until the midgastrula and increasingly by convergent extension (CE) thereafter. Explants from ventralized embryos, which lack tissues expressing CE but close their blastopores, produce up to 2 mN of tensile force, showing that CT alone generates forces sufficient to close …

Spontaneous Regression Of A Primary Squamous Cell Lung Cancer Following Biopsy: A Case Report, Nathan Esplin, Khadija Fergiani, Timothy B. Legare, John W. Stelzer, Hammad Bhatti, Sayed Karar

Internal Medicine, East Africa

Background: Spontaneous regression has been defined as occurring when the malignant tumor mass partially or completely disappears without any treatment or as a result of a therapy considered inadequate to influence systemic neoplastic disease. Recently, studies have implicated immunological responses as likely being involved. We report a case of a patient with squamous cell carcinoma of the lung who experienced spontaneous regression following biopsy without other intervention.

Case Presentation: A 57-year-old white man was referred to our pulmonary clinic after an incidental finding of a nodule in the lower lobe of his left lung. Thoracic computed tomography revealed a 2.0 …

Small Cell Carcinoma Of Prostate: A Case Report Of A Patient With Concomitant Transitional Cell Cancer Of The Bladder, Waiel Abusnina, Eric Y. Auyoung, Mohammed Megri, Toni H. Pacioles

Internal Medicine

Small cell carcinomas (SCCs) are aggressive neoplasms commonly associated with a pulmonary origin. However, albeit rare, extrapulmonary SCC can occur in a variety of sites with an incidence in North America approximated to be 0.1% to 0.4%. Among these sites, approximately 10% of extrapulmonary SCC cases occur in the prostate and are associated with a poor mortality with a median survival of 10 months. Because of the rarity of the prostatic SCC, there is no formal treatment protocol. In this case report, we present a patient who was diagnosed with SCC in the prostate as primary origin. Adjuvant concurrent chemoradiotherapy …

Outcome Of Patients With Small Vessel Vasculitis After Renal Transplantation: National Database Analysis, Amr El-Husseini, Sherif Saleh, Omer Hamad, Xiaonan Mei, Ana L. Castellanos, Daniel L. Davenport, Roberto Gedaly, B. Peter Sawaya

Internal Medicine Faculty Publications

Background. Small vessel vasculitis commonly affects the kidney and can progress to end-stage renal disease. The goal of this study is to compare outcomes of patients who received a renal transplant as a result of small vessel vasculitis (group A) with those who received kidney transplants because of other causes (group B). Methods. This is a retrospective analysis of United Network for Organ Sharing registry data for adult primary kidney transplants from January 2000 to December 2014. Group A patients (N = 2196) were compared with a group B (N = 6588); groups were case matched for age, race, sex, …

Delayed Sternal Closure Does Not Reduce Complications Associated With Coagulopathy And Right Ventricular Failure After Left Ventricular Assist Device Implantation, Roh Yanagida, Navin Rajagopalan, Daniel L. Davenport, Thomas A. Tribble, Mark A. Bradley, Charles W. Hoopes

Internal Medicine Faculty Publications

Delayed sternal closure (DSC) is occasionally adopted after implantation of left ventricular assist device (LVAD). Recent studies suggest that DSC be used for high risk group of patients with coagulopathy, hemodynamic instability or right ventricular failure. However, whether DSC is efficacious for bleeding complication or right ventricular failure is not known. This study is single center analysis of 52 patients, who underwent LVAD implantation. Of those 52 patients, 40 consecutive patients underwent DSC routinely. The sternum was left open with vacuum assist device after implantation of LVAD. Perioperative outcome of the patients who underwent routine DSC were compared with 12 …

Cough, Hemoptysis And Hair Expectoration: An Intrapulmonary Teratoma, Shanila Ahmed, Habib Kibzai, Talha Shahzad, Saulat Fatimi, Madiha Bilal L Qureshi

Section of Haematology/Oncology

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs (gonads), they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum.We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis (hair expectoration).We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary …

Closed-Eye Visualizations In The Setting Of Hyponatremia., Travis Peck, Christopher Mercogliano, Eugene York

Reading Hospital Internal Medicine Residency

Purpose: To report a case of closed-eye visualizations and to clarify the different types of hallucinations and their etiologies.

Methods: Retrospective case report of a patient with closed-eye visualizations secondary to hyponatremia. Clinical findings, physical exam, laboratory assessment, treatment, and disease course from the patient's hospitalization were used in creating this report. Follow-up data after discharge were also obtained.

Results: Closed-eye visualizations were diagnosed as secondary to hyponatremia, as they did not occur with the eyes open, and potential alternate causes were excluded. Serum sodium nadir was 119 mEq/L. Symptoms resolved with correction of hyponatremia via fluid resuscitation and electrolyte …

Primary Thyroid Maltoma- A Rare Diagnosis Of An Unassuming Thyroid Nodule., Pragya Shrestha, Kimberly Aderhold, Sharon Swierczynski, Catherine Lin, Ronald Herb

Reading Hospital Internal Medicine Residency

Primary thyroid lymphoma, although a rare malignancy, can arise in common chronic inflammatory conditions such as Hashimoto's thyroiditis. Incidental finding of a thyroid nodule with chronic thyroid inflammation warrants further investigation. Early detection of malignancy can play a vital role in improved outcomes. We report a case of a 60-year-old male who presented to the clinic for a routine visit. An enlarged, firm, non-tender thyroid gland was appreciated on exam with high thyroid stimulating hormone (TSH) level. Fine needle aspiration of the mass revealed nonspecific atypical lymphocytes. The pathology and immunohistochemical stains were consistent with histologic impression of extra nodal …

Prevalence Of Irritable Bowel Syndrome, Psychological Ill-Health And Health-Seeking Behavior In A Population Of Nigerian Medical Students, Abiodun Christopher Jemilohun, Olukayode Abayomi, Philip Adebayo

Internal Medicine, East Africa

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with considerable morbidity and profound negative impact on quality of life. It has been observed that patients with psychological disturbances relate more frequently with the symptoms of IBS, and they have more debilitating illness than control populations. We examined the prevalence of IBS among a population of Nigerian medical students and its association with two common psychological conditions (anxiety and depression).

Methods: In a descriptive cross-sectional study, we enrolled 321 consenting medical students aged 20 to 50 years. A 34-item self-reporting questionnaire consisting of sociodemographic data, the Rome III …