Internal Medicine Commons^™

Hepatitis B Virus Infection In Tanzania: Current Status And Challenges, Semvua B. Kilonzo, Daniel W. Gunda, Bonaventura C.T. Mpondo, Fatma Bakshi, Hyasinta Jaka

Internal Medicine, East Africa

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.

Chasing The Dragon, Daniel Young Cho, Hani Nazha, Kalin Fisher

Marshall Journal of Medicine

Abstract: Although rare, toxic leukoencephalopathy (TLE) associated with heroin inhalation have been reported. ‘Chasing the dragon’ may lead to progressive spongiform degeneration of the brain and presents with a large range of neuropsychological sequelae. A thorough social history and clinical suspicion are paramount in recognizing the diagnosis. This case is an example of TLE in a middle-aged white male with a history of polysubstance abuse. He presented with a three week history of progressive neuropsychological symptoms, including abulia, bradyphrenia, hyperreflexia, and visual hallucinations. He was initially suspected to have progressive multifocal leukoencephalopathy, however, JCV PCR was negative. MRI showed diffuse …

Infection Of A Ventricular Septal Defect Patch With Acremonium Species, Nosheen Nasir, Kauser Jabeen, Joveria Farooqi, Binish Arif Sultan, Afia Zafar, Aamir Hameed Khan, Muneer Amanullah, Farheen Ali

Section of Internal Medicine

A ventricular septal defect (VSD) patch infection with Acremonium species isolated from vegetation and blood culture is described. Antifungal treatment was discontinued after 3 months and patient developed relapse. Surgery with prolonged oral voriconazole was instituted with recovery. We emphasize importance of surgery and prolonged therapy to treat such infections.

Mammographic Breast Density And Breast Cancer Molecular Subtypes: The Kenyan-African Aspect, Asim Jamal, Maeve Mullooly, Shahin Sayed, Rose Ndumia, Innocent Abayo, James Orwa, Ronald Wasike, Zahir Moloo, Gretchen L. Gierach

Internal Medicine, East Africa

Introduction: Data examiningmammographic breast density (MBD) among patients in Sub-Saharan Africa are sparse.We evaluated how MBD relates to breast cancer characteristics in Kenyan women undergoing diagnostic mammography.

Methods: This crosssectional study included women with pathologically confirmed breast cancers (𝑛 = 123). Pretreatment mammograms of the unaffectedbreast were assessed to estimate absolute dense area (cm2), nondense area (cm2), and percent density (PD). Relationships between density measurements and clinical characteristics were evaluated using analysis of covariance.

Results: Median PD and dense area were 24.9% and 85.3 cm2. Higher PD and dense area were observed in younger women (𝑃 < 0.01). Higher dense and nondense areas were observed in obese women (𝑃-trend < 0.01). Estrogen receptor (ER) positive patients (73%) had higher PD and dense area than ER-negative patients (𝑃 ≤ 0.02). Triple negative breast cancer (TNBC) patients (17%) had lower PD and dense area (𝑃 ≤ 0.01) compared with non-TNBCs. No associations were observed between MBD and tumor size and grade.

Conclusions: Our findings show …

Beta-Catenin Cleavage Enhances Transcriptional Activation, Tatiana Goretsky, Emily M. Bradford, Qing Ye, Olivia F. Lamping, Tomas Vanagunas, Mary Pat Moyer, Patrick C. Keller, Preetika Sinh, Josep M. Llovet, Tianyan Gao, Qing-Bai She, Linheng Li, Terrence A. Barrett

Internal Medicine Faculty Publications

Nuclear activation of Wnt/β-catenin signaling is required for cell proliferation in inflammation and cancer. Studies from our group indicate that β-catenin activation in colitis and colorectal cancer (CRC) correlates with increased nuclear levels of β-catenin phosphorylated at serine 552 (pβ-Cat⁵⁵²). Biochemical analysis of nuclear extracts from cancer biopsies revealed the existence of low molecular weight (LMW) pβ-Cat⁵⁵², increased to the exclusion of full size (FS) forms of β-catenin. LMW β-catenin lacks both termini, leaving residues in the armadillo repeat intact. Further experiments showed that TCF4 predominantly binds LMW pβ-Cat⁵⁵² in the nucleus of inflamed and …

Refractory Abdominal Pain In A Patient With Chronic Lymphocytic Leukemia: Be Wary Of Acquired Angioedema Due To C1 Esterase Inhibitor Deficiency., Abdullateef Abdulkareem, Ryan S D'Souza, Joshua Mundorff, Pragya Shrestha, Oluwaseun Shogbesan, Anthony Donato

Reading Hospital Internal Medicine Residency

Acquired angioedema due to C1 inhibitor deficiency (C1INH-AAE) is a rare and potentially fatal syndrome of bradykinin-mediated angioedema characterized by episodes of angioedema without urticaria. It typically manifests with nonpitting edema of the skin and edema in the gastrointestinal (GI) tract mucosa or upper airway. Edema of the upper airway and tongue may lead to life-threatening asphyxiation. C1INH-AAE is typically under-diagnosed because of its rarity and its propensity to mimic more common abdominal conditions and allergic reactions. In this article, we present the case of a 62-year-old male with a history of recently diagnosed chronic lymphocytic leukemia (CLL) who presented …

Agranulocytosis Associated With Topiramate: A Case Report And Review Of Published Cases., Saroj Lohani, Niranjan Tachamo, Salik Nazir, Anthony Donato

Reading Hospital Internal Medicine Residency

A 41-year-old female presented to the hospital with sore throat and shortness of breath. She was hypoxic with an oxygen saturation of 87% in room air. Physical examination revealed swollen uvula with exudates. She had been started on topiramate for treatment of migraine few months ago. The dose of topiramate was increased to 100 mg twice daily 2 weeks ago. Complete blood count revealed an absolute neutrophil count (ANC) of 8 c/mm

Deciphering A Case Of Pulmonary Hypertension In A Young Female: Partial Anomalous Pulmonary Venous Drainage The Culprit, Hiten R. Patel, Suchit Bhutani, Fayez Shamoon, Hartaj Virk

Abington Jefferson Health Papers

Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital cardiac defect and is associated with sinus venosus atrial septal defect. While most cases are asymptomatic, a patient can present with pulmonary hypertension (PHTN) and it can be difficult to diagnose. Here, we discuss the case of a young female with PHTN who was found to have two right-sided PAPVD. Through this case, authors try to emphasize the importance of meticulous and thorough investigation when evaluating PHTN, which allows for correct diagnosis and a timely intervention before PHTN becomes irreversible.

Racial/Ethnic Disparities Among Asian Americans In Inpatient Acute Myocardial Infarction Mortality In The United States, E. J. Kim, N. R. Kressin, M. K. Paasche-Orlow, L. Lopez, J. E. Rosens, M. Lin, A. D. Hanchate

Journal Articles

No abstract provided.

Understanding The Digital Gap Among Us Adults With Disability: Cross-Sectional Analysis Of The Health Information National Trends Survey 2013, E. J. Kim, Y. Yuan, J. Liebschutz, H. Cabral, L. Kazis

Journal Articles

©Eun Ji Kim, Yiyang Yuan, Jane Liebschutz, Howard Cabral, Lewis Kazis. Background: Disabilities affect more than 1 in 5 US adults, and those with disabilities face multiple barriers in accessing health care. A digital gap, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. Objective: This study examined the associations between disability and use of information technology (IT) in obtaining health information and between trust factors and IT use. We hypothesized that compared to US adults without disabilities, those with disabilities are less likely to refer …

Fertility Information Needs And Concerns Post-Treatment Contribute To Lowered Quality Of Life Among Young Adult Female Cancer Survivors, C. Benedict, B. Thom, D. N. Friedman, E. Pottenger, N. Raghunathan, J. F. Kelvin

Journal Articles

No abstract provided.

The Intersection Of Financial Toxicity And Family Building In Young Adult Cancer Survivors, B. Thom, C. Benedict, D. N. Friedman, J. F. Kelvin

Journal Articles

No abstract provided.

Disparities In Potentially Preventable Hospitalizations: Near-National Estimates For Hispanics, C. Feng, M. K. Paasche-Orlow, N. R. Kressin, J. E. Rosen, L. López, E. J. Kim, M. Y. Lin, A. D. Hanchate

Journal Articles

© Health Research and Educational Trust Objective: To obtain near-national rates of potentially preventable hospitalization (PPH)—a marker of barriers to outpatient care access—for Hispanics; to examine their differences from other race-ethnic groups and by Hispanic national origin; and to identify key mediating factors. Data Sources/Study Setting: Data from all-payer inpatient discharge databases for 15 states accounting for 85 percent of Hispanics nationally. Study Design: Combining counts of inpatient discharges with census population for adults aged 18 and older, we estimated age-sex-adjusted PPH rates. We examined county-level variation in race-ethnic disparities in these rates to identify the mediating role of area-level …

A Computerized Method For Measuring Computed Tomography Pulmonary Angiography Yield In The Emergency Department: Validation Study., S. Richardson, P. Solomon, A. O'Connell, S. Khan, J. Gong, A. Makhnevich, G. Qiu, M. Zhang, T. Mcginn

Journal Articles

BACKGROUND:Use of computed tomography pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) has markedly increased over the past two decades. While this technology has improved the accuracy of radiological testing for PE, CTPA also carries the risk of substantial iatrogenic harm. Each CTPA carries a 14% risk of contrast-induced nephropathy and a lifetime malignancy risk that can be as high as 2.76%. The appropriate use of CTPA can be estimated by monitoring the CTPA yield, the percentage of tests positive for PE. This is the first study to propose and validate a computerized method for measuring the CTPA …

Improvement In Parameters Of Hematologic And Immunologic Function And Patient Well-Being In The Phase Iii Resonate Study Of Ibrutinib Versus Ofatumumab In Patients With Previously Treated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma., J. C. Barrientos, S. O'Brien, J. R. Brown, N. E. Kay, N. M. Reddy, S. Coutre, C. Tam, S. Mulligan, U. Jaeger, P. Hillmen, +18 Additional Authors

Journal Articles

BACKGROUND: Ibrutinib compared with ofatumumab significantly improves progression-free and overall survival in patients with previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).

PATIENTS AND METHODS: Measures of well-being were assessed in RESONATE, where previously treated patients with CLL/SLL were randomized to receive ibrutinib 420 mg/day (n = 195) or ofatumumab (n = 196) for up to 24 weeks. Endpoints included hematologic function, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), disease-related symptoms, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 (EORTC QLQ-C30), and medical resource utilization.

RESULTS: With up to 24 months' follow-up (median, 16.4 …

Postthrombotic Syndrome In Patients Treated With Rivaroxaban Or Warfarin For Venous Thromboembolism., C. I. Coleman, J. Beyer-Westendorf, T. J. Bunz, C. E. Mahan, A. C. Spyropoulos

Journal Articles

Postthrombotic syndrome (PTS) is a frequent complication of venous thromboembolism (VTE). Using MarketScan claims data from January 2012 to June 2015, we identified adults with a primary diagnosis code for VTE during a hospitalization/emergency department visit, ≥6 months of insurance coverage prior to the index event and newly started on rivaroxaban or warfarin within 30 days of the index VTE. Patients with

Young Adult Female Cancer Survivors' Concerns About Future Children's Health And Genetic Risk, N. J. Raghunathan, C. Benedict, B. Thom, D. N. Friedman, J. F. Kelvin

Journal Articles

No abstract provided.

The Relationship Of Physical Performance And Osteoporosis Prevention With Vitamin D In Older African Americans (Poda), R. Dhaliwal, M. Mikhail, G. Usera, A. Stolberg, S. Islam, L. Ragolia, J. F. Aloia

Journal Articles

© 2017 Elsevier Inc. Rationale Vitamin D deficiency is associated with bone loss, poor muscle strength, falls and fracture. This information in older African Americans (AAs) is sparse. Objective The study of the relationship of Physical performance, Osteoporosis prevention with vitamin D in older African Americans (PODA) is a randomized, double-blind, placebo-controlled 3-year trial examining the effect of vitamin D on bone loss and physical performance in older AA women. Methods 260 healthy AA women aged > 60 years were assigned to receive placebo or vitamin D3. Initial vitamin D3dose was determined by the baseline serum 25OHD level, and adjusted further …

Mycobacterium Tuberculosis Infection In The Setting Of Interstitial Lung Disease: Coincidence Or Bad Luck?, Christian Wong, Sonu Sahni, Muhammad Azaz I. Cheema, Asma Iftikhar

Touro College of Osteopathic Medicine (New York) Publications and Research

Mycobacterium tuberculosis (MTB) infection is the ninth leading cause of death worldwide, with many individuals with undiagnosed active or latent disease. The presence of parenchymal lung disease, such as interstitial lung disease (ILD), has been suggested to increase the risk of pulmonary tuberculosis (TB). In the clinical setting of ILD, the diagnosis of an underlying MTB infection may be challenging due to the interstitial process and underlying fibrosis, which may mask the infection. An atypical presentation and misleading radiological patterns may delay the diagnosis of the underlying MTB infection. Herein, we describe a unique case of ILD complicated by active …

Successful Pulmonary Thromboendarterectomy In A Patient With Sickle Cell Disease And Associated Resolution Of A Leg Ulcer, A. Agrawal, R. Shah, M. D. Bacchetta, A. Talwar

Journal Articles

© 2017 Indian Chest Society | Published by Wolters Kluwer -Medknow. Pulmonary hypertension (PH) is a relatively frequent and severe complication of sickle cell disease (SCD). PH associated with SCD is classified as Group 5 PH. The exact pathogenesis of PH in SCD in not known. There are also very limited treatment options available at this time for such patients with Group 5 PH. Patients with SCD are predisposed to a hypercoagulable state and thus can also suffer from chronic thromboembolism. These patients can have associated chronic thromboembolic pulmonary hypertension (CTEPH), thus being classified as Group 4 PH. We present …

Prostate Cancer Patients’ Understanding Of The Gleason Scoring System: Implications For Shared Decision-Making, E. K. Tagai, S. M. Miller, A. Kutikov, M. A. Diefenbach, R. A. Gor, T. Al-Saleem, D. Y. Chen, S. Fleszar, G. Roy

Journal Articles

© 2018 American Association for Cancer Education The Gleason scoring system is a key component of a prostate cancer diagnosis, since it indicates disease aggressiveness. It also serves as a risk communication tool that facilitates shared treatment decision-making. However, the system is highly complex and therefore difficult to communicate: factors which have been shown to undermine well-informed and high-quality shared treatment decision-making. To systematically explore prostate cancer patients’ understanding of the Gleason scoring system (GSS), we assessed knowledge and perceived importance among men who had completed treatment (N = 50). Patients were administered a survey that assessed patient knowledge and …

Reduction In Social Activities Mediates The Relationship Between Diarrhea And Distress In Rectal/Anal Cancer Survivors, C. Benedict, K. Duhamel, C. J. Nelson

Journal Articles

No abstract provided.

Streptococcus Intermedius Brain And Diverticular Abscesses After Dental Manipulation: A Case Report., H. Al Moussawi, M. Krzyzak, Z. Awada, J. M. Chalhoub

Journal Articles

A brain abscess is defined as a focal intracerebral infection consisting of an encapsulated collection of pus, which can be a life-threatening complication of infections, trauma, or surgery. While immunocompromised patients can have a wide array of causative organisms, bacterial species represent the most common etiology in immunocompetent individuals. The incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000, with a high predisposition among immunocompromised patients and in those with disruption of the blood-brain barrier. The most common causative organisms found were Streptococcus species, particularly S. viridians and S. pneumonia, Enterococcus, and Staphylococcus species, mainly S. aurieus and …

Alk-Negative Anaplastic Large Cell Lymphoma Presenting As Disseminated Intravascular Coagulation And Hemophagocytic Lymphohistiocytosis: A Potentially Fatal Presentation., U. Ibrahim, A. Saqib, M. Rehan, J. P. Atallah

Journal Articles

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder that can be familial in etiology or a result of infections, malignancy, and autoimmune or inflammatory disorders. Disseminated intravascular coagulation (DIC) is common in patients admitted to intensive care units and can confound and delay the diagnosis of HLH. We present a case of a 69-year-old female who presented with dyspnea and malaise. Her condition declined rapidly with laboratory parameters consistent with DIC. In addition, she had a ferritin of 32,522 ng/mL, low haptoglobin, and elevated LDH, and bone marrow biopsy showed hemophagocytic lymphohistiocytes. She was started on HLH-directed therapy, and later, a …

Indwelling Pleural Catheters: Complications And Management Strategies, M. Chalhoub, A. Saqib, M. Castellano

Journal Articles

©Journal of Thoracic Disease. Indwelling pleural catheters (IPCs) are increasingly being used for patients with recurrent malignant pleural effusions. They are simple to place and can be done on an outpatient basis under local anesthesia. IPCs uniformly relieve dyspnea and improve quality of life of patients with malignant pleural effusions. In some patients with recurrent non-malignant pleural effusions, IPCs proved to be effective as well. With increasing use of IPCs, physicians and patients are faced with complications related to the presence of an indwelling catheter for extended periods of time. The purpose of this review is to describe the various …

Computerized Cognitive Training In Prostate Cancer Patients On Androgen Deprivation Therapy: A Pilot Study, L. M. Wu, A. Amidi, M. L. Tanenbaum, G. Winkel, W. A. Gordon, S. J. Hall, K. Bovbjerg, M. A. Diefenbach

Journal Articles

© 2017, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Prostate cancer patients who have undergone androgen deprivation therapy (ADT) may experience cognitive impairment, yet there is an unmet need for nonpharmacological interventions to address cognitive impairment in this population. This study examines the feasibility, acceptability, and preliminary efficacy of a home-based computerized cognitive training (CCT) program to treat cancer-related cognitive impairment. Methods: Sixty men who had received ≥ 3 months of ADT were screened for at least mild cognitive or neurobehavioral impairment and randomized to 8 weeks of CCT or usual care. Follow-up assessments occurred immediately post-intervention or equivalent …

Examining The Impact Of A Multimedia Intervention On Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients: Results From A Nationwide Rct., M. A. Diefenbach, C. Benedict, S. M. Miller, A. L. Stanton, M. E. Ropka, K. Wen, N. E. Mohamed, S. J. Hall

Journal Articles

Men diagnosed with early stage prostate cancer face multiple treatment options, each with distinctive side effects that have significant implications for post-treatment quality of life. Healing Choices for Men with Prostate Cancer is a multimedia educational and decision aid program. This nation-wide randomized controlled trial evaluated the impact of Healing Choices on reducing decisional conflict and distress. Eligible prostate cancer patients who called the National Cancer Institute's Cancer Information Service (CIS) were invited to participate. After a baseline interview, participants were randomized to usual personalized consultation with a CIS specialist (comparison condition) or CIS personalized consultation plus the Healing Choices …

Racial And Ethnic Disparities In Diagnosis Of Chronic Medical Conditions In The Usa, E. J. Kim, T. Kim, J. Conigliaro, J. M. Liebschutz, M. K. Paasche-Orlow, A. D. Hanchate

Journal Articles

No abstract provided.

Is 30-Day Posthospitalization Mortality Lower Among Racial/Ethnic Minorities?: A Reexamination, M. Lin, N. R. Kressin, M. K. Paasche-Orlow, E. J. Kim, L. Lopez, J. E. Rosen, A. D. Hanchate

Journal Articles

No abstract provided.

Nephrocutaneous Fistula Due To Xanthogranulomatous Pyelonephritis, Simcha Weissman, Madeeha Ghaffar, Dana Safavian, Sharma Rubal, Anthony Khabut, Mohammad G. Maruf, Michael Krzyzak

Touro College of Osteopathic Medicine (New York) Publications and Research

While the development of a fistulous tract from the kidney to the proximal adjacent organs is relatively common, a tract leading to the skin is a rare occurrence. The primary cause of a fistula is prior surgical intervention or malignancy leading to abscess formation. Our case involves Xanthogranulomatous pyelonephritis (XGP) causing a longstanding lobulated abscess, ultimately leading to the formation of a fistulous tract.