Internal Medicine Commons^™

Percutaneous Coil Embolization To Manage Pulmonary Artery Hemorrhage After Distal Endarterectomy, Chirantan Mangukia, Paul Forfia, Anjali Vaidya, Veronica Williams, Dmitry Niman, Parth Rali, Yoshiya Toyoda

Internal Medicine Resident Research

Selective pulmonary artery coil embolization can be a viable treatment option for acute pulmonary hemorrhage after pulmonary thromboendarterectomy.

Prevalence Of Risk Factors Of Acute Kidney Injury In A Tertiary Care Hospital In Pakistan, Ainan Arshad, Ahmed Ayaz

Section of Internal Medicine

The objective of this study was to determine the prevalence of preventable risk factors of acute kidney injury in a tertiary care hospital in Pakistan. All patients admitted at Aga Khan University Hospital, Karachi with diagnosis of acute kidney injury were included out of which 134 were selected via random sampling. Patients with existing CKD were excluded. Data was then collected retrospectively from medical records of these patients. Mean age was 60±11.7 years while mean serum creatinine on admission was 2.4±1.3 (mg/dl). Sepsis played a role in almost half of the patients [60 (45%)]. Other factors included diarrhoea [23 (17%)], …

Development, Expansion And Role Of Myeloid-Derived Suppressor Cells In Post-Sepsis Immune Suppression, Tuqa Alkhateeb

Electronic Theses and Dissertations

Myeloid-derived suppressor cells (MDSCs) numbers increase significantly in sepsis and are associated with high mortality rates. These myeloid cell precursors promote immunosuppression, especially in the late (post sepsis) stage. However, the mechanisms that underlie MDSC expansion and programming are not completely understood. To investigate these mechanisms, we used a cecal-ligation and puncture (CLP) mouse model of polymicrobial sepsis that progresses from an early/acute proinflammatory phase to a late/chronic immunosuppressive phase. Previous studies in our laboratory showed that microRNA (miR)-21 and miR-181b elevate levels of the transcription factor nuclear factor 1 (NFI-A) that promotes MDSC expansion. We report here that miR-21 …

Out-Patient Neurological Disorders In Tanzania: Experience From A Private Institution In Dar Es Salaam, Philip Adebayo, Omar Aziz, Rose E. Mwakabatika, Mandela Makakala, Mugisha Clement, Shabbir Adamjee, Noureen Mushi, Ahmed Jusabani, Eric Aris

Internal Medicine, East Africa

Background and introduction: Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa.

Objective: To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD).

Materials and methods: The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively …

Enrichment Strategy For Systemic Sclerosis Clinical Trials Targeting Skin Fibrosis: A Prospective, Multiethnic Cohort Study, Carina Mihai, Rucsandra Dobrota, Shervin Assassi, Maureen D Mayes, Oliver Distler

Faculty, Staff and Student Publications

OBJECTIVE: The modified Rodnan skin score (mRSS) is often used as a primary outcome measure in systemic sclerosis (SSc) randomized clinical trials (RCTs). Previous cohort studies with predominantly European Caucasian patients showed that setting an upper limit of mRSS as a selection criterion for RCTs leads effectively to enrichment with progressive patients. This study aimed to demonstrate this effect in an ethnically diverse cohort, rich in patients positive for anti-RNA polymerase III antibodies (Pol3).

METHODS: We selected from the Genetics versus Environment in Scleroderma Outcomes Study (GENISOS) cohort patients with diffuse cutaneous SSc (dcSSc), who had mRSS of 7 or …

The Efficacy Of Different Type Of Phototherapy Light Devices For Neonatal Jaundice Treatment, Ismail Mohammad Hanafi

Student Works (2020-2029)

It has been reported that 60% of term neonates and 80% of the pre-terms develop jaundice in the first week of life and the proportion of jaundice in Malaysia is on the rise. As phototherapy light is the primary source of treatment for jaundice, it is crucial for hospital to have the best phototherapy light devices which can help to treat jaundice effectively. This would help to shorten neonate patient hospital stay, reduce staff workload as well as increasing treatment capacity of the hospital. Hospitals in Malaysia are using several type of phototherapy devices in their wards. The most commonly …

Reflections Of The Angiotensin Receptor Blocker Recall By The Fda And Repercussions On Healthcare, Michael Gillette, Addison Taylor, Djenita Butulija, Himabindu Kadiyala, Hani Jneid

Faculty, Staff and Students Publications

PURPOSE: Beginning in July of 2018, the FDA issued a voluntary recall regarding the presence of a contaminant found in the manufacturing of valsartan. What would ensue has become a largely unprecedented sequence of alarming events since the FDA began reporting public recalls, withdrawals and safety alerts on their website in 2016. Since then, the United States has been significantly impacted by drug recalls affecting angiotensin receptor blockers. This report arms clinicians with additional guidance and provides a framework for responding appropriately to future similar incidents and includes an overview of the angiotensin receptor blockers, and their effects and safety …

Qualitative Approach To Understanding Barriers To Delivering Difficult News In Sub Saharan Africa, Karishma Sharma, Jasmit Shah, Sayed Karar

Internal Medicine, East Africa

Communication, especially delivery of difficult news (DDN), remains a key part of clinical practice. Despite its importance, many medical providers lack the skill and ability to effectively DDN to their patients. Due to lack of data specific to sub-Saharan Africa and to help us develop an appropriate training tool for this geographical area, we sought to explore what challenges and barriers residents at our institution faced when they deliver difficult news to their patients.

Invasive Pulmonary Infection By Syncephalastrum Species: Two Case Reports And Review Of Literature, Memoona Irshad, Nosheen Nasir, Urooj Haider Hashmi, Joveria Farooqi, Syed Faisal Mahmood

Section of Internal Medicine

Background: Syncephalastrum species belong to the class Zygomycetes and order Mucorale. These are found in the environment and tropical soil, usually presenting as colonizers and rarely cause human infection. Syncephalastrum racemosum is a species of the genus Syncephalastrum and is the most commonly identified pathogen. Most cases are reported in immunocompromised individuals, such as patients on long term steroids, poorly controlled diabetes, or patients with malignancy.
Case presentation: We are describing two cases of rare fungal infection by Syncephalastrum species causing invasive pulmonary manifestation. Both patients had compromised immune status and presented with worsening dyspnea to the emergency room. Both …

A Fatal Case Of Primary Amoebic Meningoencephalitis (Pam) Complicated With Diabetes Insipidus (Di): A Case Report And Review Of The Literature, Zain Mushtaq, Saad Bin Zafar Mahmood, Adil Aziz

Section of Internal Medicine

Naegleria fowleri is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries. We are presenting a case of a 44-year-old male with fever, worsening headache, and generalized weakness. Lumbar puncture showed a …

The Medicine Forum: Volume 21

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 21, 2019-2020

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine

Literature Review

Editorial

Recurring Pleural Effusion Secondary To Walled-Off Pancreatic Necrosis, Adwait Mehta, Gabriel Aisenberg, Roy Tomas Davee, Eden Henry, Nicole Thomason

Faculty, Staff and Student Publications

Recurring, exudative, lymphocytic-predominant pleural effusions have not been previously reported in association with walled-off pancreatic necrosis. We present a case of chronic pancreatitis complicated by a large pancreatic fluid collection and recurrent pleural effusion. Endoscopic drainage of the walled-off pancreatic necrosis was the definitive treatment for both fluid collections.

A Mysterious Paratracheal Mass: Parathyroid Carcinoma., Qian Zhang, Khine S. Shan, Neethu Gopisetti, Md, Thomas Yoon, Iqra Iqbal

Abington Jefferson Health Papers

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. We detail a 60-years-old gentleman who was otherwise healthy presented to the hospital due to acute encephalopathy. He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. The parathyroid carcinoma was later surgically resected with the diagnosis confirmed via pathology specimen. The patient was safely discharged from the hospital with recommendations of close routine outpatient followup.

Covid-19 And Stroke In Sub-Saharan Africa: Case Series From Dar Es Salaam, Philip Adebayo, Nadeem Kassam, Omar Aziz, Ahmed Jusabani, Samina Somji, Mugisha Clement

Internal Medicine, East Africa

Low and middle-income countries including those in sub-Saharan (SSA) Africa are experiencing a steady increase in the number of COVID-19 cases. To the best of our knowledge, reports of COVID-19 related strokes are scarce in SSA. The peculiar situation of stroke care in SSA makes COVID-19 associated stroke a bothersome entity as it adds other dynamics that tilt the prognostic balance. We present a case series of COVID -19 related stroke in 3 patients from Tanzania. We emphasized protected code stroke protocol.

Wellness Project Implementation Within Houston's Faith And Diabetes Initiative: A Mixed Methods Study, Rebecca Wells, Ellen D Breckenridge, Stephen H Linder

Faculty, Staff and Student Publications

BACKGROUND: Faith-based health promotion has shown promise for supporting healthy lifestyles, but has limited evidence of reaching scale or sustainability. In one recent such effort, volunteers from a diverse range of faith organizations were trained as peer educators to implement diabetes self-management education (DSME) classes within their communities. The purpose of this study was to identify factors associated with provision of these classes within six months of peer-educator training.

METHODS: This study used the Consolidated Framework for Implementation Research (CFIR) to identify patterns from interviews, observations, attendance records, and organizational background information. Two research team members thematically coded interview transcripts …

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

Is Rocky Mountain Spotted Fever Transmitted In Maine?, Eric J. Ray

Journal of Maine Medical Center

Introduction:

Tickborne disease occurs worldwide with recent recognition of changes in tick vector distributions. Rocky Mountain Spotted Fever (RMSF) is already widespread across the United States; however, it is being monitored for introduction to non-endemic areas.

Clinical Findings:

A 65-year-old male with a history of psoriatic arthritis on adalimumab and local tick exposures but no known recent bites presented to the emergency department with fevers, myalgias, arthralgias, and a maculopapular rash of unclear etiology. Initial testing showed transaminitis, worsened chronic thrombocytopenia, and slight neutropenia with absolute neutrophil count 2,330 (reference value: 2,400-7,600 cells per µL); however, he was stable …

Thinking Outside The Box In Liver Tox, Kimberly Brizell, Geoffrey L. Goldsberry

West Florida Division GME Research Day 2020

DILI is the most common cause of acute liver failure in the United States. However, it is important to consider that the agent at play may not be common to the United States. We aim to highlight the importance of using a "global mindset" when treating international and frequent traveling patients, but also demonstrate the severe hepatotoxic risks associated with Nimesulide.

H2s Donor Gyy4137 Ameliorates Paclitaxel-Induced Neuropathic Pain In Mice, Bedoor Qabazard, Willias Masocha, Maitham Khajah, Philip Adebayo

Faculty of Health Sciences, East Africa

Paclitaxel-induced neuropathic pain (PINP) is a dose-limiting side effect that largely affects the patient’s quality of life and may limit the use of the drug as a chemotherapeutic agent for treating metastatic breast cancer and other solid tumors. Recently, a putative role for the gaseous mediator hydrogen sulfide (H2S) in nociception modulation has been suggested. The aim of the present study was to investigate the potential efficacy of the slow release H2S donor GYY4137 to alleviate and prevent PINP. Female BALB/c mice that were intraperitoneally (i.p.) injected with paclitaxel (2 mg/kg) for 5 consecutive days developed thermal hyperalgesia, cold and …

A Rare Case Of Leprosy In West Florida, Adrian Lugo, Taylor Studsrud, Nemer Dabage, James Demaio

West Florida Division GME Research Day 2020

• Leprosy is caused by acid-fast bacilli of the M. leprae complex, which includes M. leprae and M. lepromatosis.
• Transmission in the U.S. is rare, but has been documented in hunters who handle wild ninebanded armadillo.
• The origins of M. leprae infection among armadillos, the geographic range of the infected animals, and the potential risks infected armadillos present to people have been topics of concern.
• The infection originated amongst armadillos decades before they were ever used in leprosy research, and numerous surveys have confirmed that armadillos in the southern United States are a large natural reservoir for M. leprae; its prevalence …

Postoperative Myocardial Injury In A Patient With Left Ureteric Stone And Asymptomatic Covid-19 Disease, Nadeem Kassam, Omar Aziz, Ally Zain Ismail, Rodgers Swai, Samina Somji, Robert Mvungi, Mustaafa Bapumia, Ali Akbar Zehri, Salim Surani

Internal Medicine, East Africa

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes …

Invasive Liver Abscess Syndrome Caused By Klebsiella Pneumoniae: First Tanzanian Experience, Nadeem Kassam, Omar Aziz, Samina Somji, Zainab Yusuf Fidaali, Salim Ramzan Surani

Internal Medicine, East Africa

Over the past 20 years there has been growing awareness of community-acquired primary liver abscess caused by strains of Klebsiella pneumoniae (K. pneumoniae) especially in patients of Asian descent, a minority of which are characterized by metastatic spread. A common and frequent destructive complication is endophthalmitis as well as the involvement of the central nervous system (CNS), causing suppurative meningitis or brain abscess. Here we report a case of invasive liver abscess caused by K. pneumoniae in an Asian patient who presented to our hospital in Tanzania with bilateral lower limb swelling for 6 weeks with acute onset of difficulty …

Clinical Manifestations And Epidemiology Of Adolescent Tuberculosis In Ukraine, Silvia S Chiang, Maria Dolynska, Natasha R Rybak, Andrea T Cruz, Omowunmi Aibana, Yana Sheremeta, Vasyl Petrenko, Andrii Mamotenko, Iana Terleieva, C Robert Horsburgh, Helen E Jenkins

Faculty, Staff and Student Publications

BACKGROUND: During adolescence, childhood and adult forms of tuberculosis (TB) overlap, resulting in diverse disease manifestations. Knowing which patient characteristics are associated with which manifestations may facilitate diagnosis and enhance understanding of TB pathophysiology.

METHODS: In this cross-sectional study, we included 10-19-year-olds in Ukraine's national TB registry who started TB treatment between 2015 and 2018. Using multivariable regression, we estimated associations between patient characteristics and four presentations of TB: pleural, extrathoracic, cavitary and rifampicin-resistant (RR). We also described the epidemiology of adolescent TB in Ukraine.

RESULTS: Among 2491 adolescent TB cases, 88.4% were microbiologically confirmed. RR-TB was confirmed in 16.9% …

Efficacy Of Argon Plasma Coagulation Treatment In Radiation Colitis Patients And Its Confounding Factors, Aru Ariadno, Dadang Makmun, Andri S. Sulaiman, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Introduction. Argon plasma coagulation (APC) is widely used in the treatment of radiation colitis among patients with gynecology, colorectal and urology malignancy. This study aimed to measure the result of APC conducted on radiation colitis patients and its counfounding factors. Methods. An analytic descriptive study with retrospective cohort design was conducted among radiation colitis patients received APC treatment in Cipto Mangunkusumo Hospital, Jakarta. Data were collected from medical record database between April 2012 until October 2019. Results. As much as 180 radiation colitis patients received APC treatment fulfilled inclusion criteria with characteristics female patients (89.4%) and age >50 years old …

Pengelolaan Predialisis Pasien Penyakit Ginjal Kronik, Ni Made Hustrini

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Factors Associated With Late Referral In End Stage Renal Disease Patients At Dr. Cipto Mangunkusumo Hospital, Aida Lydia, Grecia Rachmaningrum, Hamzah Shatri, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Relationship Between Total Session Of Hyperbaric Oxygen Therapy As Adjuvant Therapy With Diabetic Foot Ulcers Improvement In Dr. Mintohardjo Naval Hospital In The Year 2016−2018, Naufal Hilmi Andrisha, Pritha Maya Savitri, Nurfitri Bustamam

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetic foot ulcers (DFU) are a common complication of diabetes mellitus (DM). High rates of amputation risk and mortality in DM patients with DFU as well as the use of conventional therapies that often fail to improve the DFU condition cause an adjuvant therapy such as hyperbaric oxygen therapy (HBOT) to be used. HBOT is known can facilitate wound bed closure and reduce the amputation rates in diabetic gangrene foot. This study aimed to determine the relationship between total sessions of HBOT as adjuvant therapy with an improvement of DFU patients. Method. A cross-sectional study was conducted among DFU …

The Correlation Between Transforming Growth Factor-Beta (Tgf- Β) Serum Level And Beck Depression Inventory (Bdi) Score In Colorectal Cancer Patients At Rsmh Palembang, Muhammad Ali Apriansyah, Mediarty Syahrir, Muhammad Rosyidi Kgs, Ahmad Faisyar

Jurnal Penyakit Dalam Indonesia

Introduction. Depression not only increase the mortality rate, but also can interfere the quality of life of colorectal cancer patients during treatment. Low levels of systemic inflammation may contribute to the development of depression. The inflammatory process can be seen by measuring serum transforming growth factor-β (TGF-β) levels and depressive symptoms using the beck depression inventory (BDI) score. This study aimed to determine the correlation between TGF-β serum levels with depression in colorectal cancer patients. Methods. Analytical observational research with cross sectional design was conducted among colorectal cancer patients who underwent chemotherapy with a BDI score ≥10 (depression) in the …

Prediction Model Of 30-Day Mortality In Elderly Patients Admitted To Geriatric Acute Ward Using Comprehensive Geriatric Assessment Domain, Noto Dwimartutie, Slti Setiati, Edy Rizal Wahyudi, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Advanced Directives In Palliative Care, Hamzah Shatri, Edward Faisal, Rudi Putranto, Budi Sampurna

Jurnal Penyakit Dalam Indonesia

Initially palliative care is emphasized at the end of life, but the right thing is to begin identifying palliative care needs when the disease is diagnosed. Palliative care is the treatment needed to improve the quality of life of patients and their families that suffering from life threatening and progressive disease such as cancer, non-cancer diseases, and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). Palliative care decision must be in place from the beginning of treatment, so the patient’s preferences are met. The goals of this care are to reduce physical, social, psychological, and spiritual suffers. Further treatment plan is based …