Internal Medicine Commons^™

Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi

Master of Medicine in Internal Medicine

Background: Stroke is a sudden neurological deficit due to a vascular cause, which can be ischaemic, haemorrhagic stroke or another cause. It is a leading cause of disability and long term functional impairment in the world. The definitive management of an acute ischaemic stroke is thrombolysis and/or mechanical thrombectomy, both of which has been shown to improve functional outcome but the utilization remains quite low in most hospitals, especially in Africa. This is due to certain pre-hospital and in-hospital barriers, and these factors have been shown to differ from country to country. Objective: To determine the pre-hospital barriers that prevent …

Is Music Therapy Effective At Reducing Pain In Fibromyalgia Patients?, Amanda M. Vicznesky

PCOM Physician Assistant Studies Student Scholarship

The objective of this selective evidence based medicine (EBM) review is to determine whether or not music therapy is effective at treating pain in fibromyalgia patients.

STUDY DESIGN: This is a systematic review of three primary studies that were peer-reviewed published between the years of 2013-2016.

DATA SOURCES: Two randomized control trials and one cross-control study evaluating if music therapy is affective at treating pain in fibromyalgia patients. Data sources obtained for this review were found using PubMed Database.

OUTCOMES MEASURED: The outcome measured was the effectiveness of music therapy at reducing pain in fibromyalgia patients. Outcomes were measured via …

Interventions To Increase Research Publications In Graduate Medical Education Trainees: A Systematic Review., Ryan Zimmerman, Richard Alweis, Alexandra Short, Tom Wasser, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Introduction: Competency-based educational models recommend trainee exposure to research, but the best methods for Graduate Medical Education (GME) programs to accomplish this have not been clarified. The objective of this study was to quantify published interventions to generate resident research and compare effectiveness among those interventions.

Material and methods: A systematic review of English-language articles of studies of GME programs was performed, describing resident research interventions and quantifying the number of publications as an outcome.

Results: The search produced 13,688 potentially relevant articles, and included 47 articles in the final synthesis. Publication effectiveness was calculated as publications per year. The …

A Case Of Multisystem Langerhans Cell Histiocytosis Presenting As Central Diabetes Insipidus, P. Daniel Nicholas Iii, Ian Garrahy

Reading Hospital Internal Medicine Residency

Langerhans cell histiocytosis (LCH) is a rare malignancy most commonly characterized by histiocytic infiltration of bone. LCH lesions in the skull place the adjacent central nervous system (CNS) at risk for involvement, which can manifest as central diabetes insipidus (CDI) when there is infiltration of the hypothalamic-pituitary axis. We present a case of a 39-yearold female who presented with polyuria and polydipsia for 1 year and left-sided hearing loss, gait instability, and nystagmus for 5 days. She was found on laboratory evaluation to have CDI and underwent left cortical mastoidectomy for a destructive peripherally enhancing mastoid lesion seen on MRI …

Using Cirupa To Help Foster Communication With Families About Brain Death In Sub‑Saharan Africa, Sayed Karar, Anthony Ochola, Fatima Juma, Feroza Daroowalla

Internal Medicine, East Africa

Brain death, with a functioning cardiovascular system, remains a difficult issue to grasp for most families. Furthermore, conversations about brain death remain challenging even for the most experienced physicians. We developed an acronym, CIRUPA, to further improve the goals of care conversations in patients diagnosed with brain death. To our knowledge, this is the first acronym within Sub‑Saharan Africa, which helps provide a structured method on how to foster conversations centered around brain death.

Randomized Controlled Trial Of Influenza Vaccine In Patients With Heart Failure To Reduce Adverse Vascular Events (Ivve): Rationale And Design, Mark Loeb, Hisham Dokainish, Antonio Dans, Lia M. Palileo-Villanueva, Ambuj Roy, Ambuj Roy, Kamilu Karaye, Jun Zhu, Yan Liang, Gerald Yonga

Internal Medicine, East Africa

Background: Influenza is associated with an increase in the risk of cardiac and other vascular events. Observational data and small randomized trials suggest that influenza vaccination may reduce such adverse vascular events.

Research Design and Methods: In a randomized controlled trial patients with heart failure are randomized to receive either inactivated influenza vaccine or placebo annually for 3 years. Patients aged ≥18 years with a clinical diagnosis of heart failure and NYHA functional class II, III and IV are eligible. Five thousand patients from 10 countries where influenza vaccination is not common (Asia, the Middle East, and Africa) have been …

Patients’ Experiences On Accessing Health Care Services For Management Of Hypertension In Rural Bangladesh, Pakistan And Sri Lanka: A Qualitative Study, Helena Legido Quigley, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Z Samad

Department of Medicine

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertensiondisproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. …

Mesenchymal Stromal Cell Therapeutic Delivery: Translational Challenges To Clinical Application, Henry Caplan, Scott D Olson, Akshita Kumar, Mitchell George, Karthik S Prabhakara, Pamela Wenzel, Supinder Bedi, Naama E Toledano-Furman, Fabio Triolo, Julian Kamhieh-Milz, Guido Moll, Charles S Cox

Faculty, Staff and Student Publications

For several decades, multipotent mesenchymal stromal cells (MSCs) have been extensively studied for their therapeutic potential across a wide range of diseases. In the preclinical setting, MSCs demonstrate consistent ability to promote tissue healing, down-regulate excessive inflammation and improve outcomes in animal models. Several proposed mechanisms of action have been posited and demonstrated across an array of in vitro models. However, translation into clinical practice has proven considerably more difficult. A number of prominent well-funded late-phase clinical trials have failed, thus calling out for new efforts to optimize product delivery in the clinical setting. In this review, we discuss novel …

Disseminated Tuberculosis And Gastric Mucormycosis Coinfection, Alexandre Malek, Alejandro De La Hoz, Roberto Arduino, Gabriel M Aisenberg

Faculty, Staff and Student Publications

Tuberculosis and mucormycosis coinfection has rarely been reported in the medical literature. We present a case of gastrointestinal (GI) mucormycosis in a diabetic patient with disseminated tuberculosis. Early diagnosis, addressing the risk factors for mucormycosis, surgical debridement, and timely antifungal treatment are the mainstay of care.