Internal Medicine Commons^™

Faktor-Faktor Yang Berhubungan Dengan Gejala Depresi Pada Pasien Insomnia Usia Lanjut Di Rawat Jalan, Amalia Nur Pratiwi, Edy Rizal Wahyudi, Profitasari Kusumaningrum, Hamzah Shatri, Ikhwan Rinaldi, Rino Alvani Gani, Ika Prasetya Wijaya, Adityo Susilo, Kaka Renaldi

Jurnal Penyakit Dalam Indonesia

Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia.

Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score …

Penggunaan Continous Glucose Monitoring Pada Pasien Dm Tipe 2 Dengan Insulin Dosis Tinggi, Amanda Trixie Hardigaloeh, Dicky Tahapary, Em Yunir, Tri Juli Edi Tarigan

Jurnal Penyakit Dalam Indonesia

Type 2 diabetes mellitus (T2DM) is a chronic disease with a high risk of complications, requiring optimal glycemic control. This case report aims to describe the use of continuous glucose monitoring (CGM) in the evaluation of a patient with T2DM and obesity whose glycemic levels remained uncontrolled despite high-dose insulin therapy. A 58-year-old woman with an 18-year history of T2DM presented to the Endocrinology Clinic of Cipto Mangunkusumo Hospital with uncontrolled blood glucose accompanied by classic diabetic symptoms. CGM revealed that the majority of glucose levels were within the time above range (TAR) at 83% without hypoglycemia, while the time …

Kerentanan Dan Kanker Pada Usia Lanjut: Sebuah Tantangan, Rahmat Cahyanur

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Hubungan Faktor Psikologis Dengan Atrium Fibrilasi: Suatu Tinjauan Kepustakaan, Arina Widya Murni, Annesa Fadella

Jurnal Penyakit Dalam Indonesia

Psychological factors influence the onset of cardiac rhythm and dysrhythmia disorders, including atrial fibrillation (AF), which is defined as uncoordinated atrial activation resulting in ineffective contractions. Psychological factors have a bidirectional relationship with AF, as AF symptoms can lead to a decline in mental health, which in turn negatively affects the clinical course. One explanation for how psychological stress impacts the heart and contributes to AF involves the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Anxiety and depression are common comorbidities in AF. These conditions can be assessed using standardized instruments, such as the Hospital Anxiety and Depression Scale …

Hubungan Hiperurisemia Dengan Penurunan Lfg Pada Pasien Penyakit Ginjal Diabetes Di Rscm Jakarta, Rury Maharani Adna, Maruhum Bonar Hasiholan Marbun, Ikhwan Rinaldi, Em Yunir, Sukamto Koesnoe, Gurmeet Singh, Robert Sinto

Jurnal Penyakit Dalam Indonesia

Introduction. Elevated serum uric acid levels are associated with the progression of kidney disease in patients with type 2 diabetes mellitus (DM), through mechanisms involving endothelial dysfunction, oxidative stress, and chronic inflammation. Research in Indonesia on the relationship between uric acid levels and the decline of glomerular filtration rate (GFR) in diabetic patients remains limited. This study aimed to determine the association between serum uric acid (SUA) levels and decline in glomerular filtration rate among patients with diabetes mellitus diagnosed with diabetic kidney disease at Cipto Mangunkusumo Hospital, Jakarta, over a one-year period.

Methods. This retrospective cohort study …

Pengaruh Heart Rate Variability Terhadap Kesintasan Pasien Dengan Kanker: Laporan Kasus Berbasis Bukti, Kartika Anastasia Kosasih, Nida Raniah, Rudi Putranto, Wulyo Rajabto, Hamzah Shatri, Edward Faisal, Vinandya Irvianita Poespitasari

Jurnal Penyakit Dalam Indonesia

Depression, anxiety, and poor outcomes in cancer are possibly mediated by autonomic dysfunction. Autonomic disfunction found in cancer patients can cause increase in sympathetic tone and decrease in cardiac muscle vagal tone. Heart rate variability (HRV) is a non-invasive index for measuring vagal response and a potential stress response in autonomic dysfunction. In patients with cancer, high vagal tone measured by HRV is significantly correlated with increased overall survival. This evidence-based case report aims to investigate the role of HRV as a prognostic factor in cancer patients. Literature search was done by two authors on five databases: Pubmed, Cochrane Library, …

Hubungan Visceral Adiposity Index Dengan Neuropati Diabetik Perifer Pada Pasien Diabetes Melitus Tipe 2, Muhammad Arif Sanusi, Dian Anindita Lubis, Santi Syafril

Jurnal Penyakit Dalam Indonesia

Introduction. Type 2 diabetes mellitus (T2DM) is the leading metabolic disease in Indonesia. Diabetic peripheral neuropathy (DPN), a major complication of T2DM, was associated with insulin resistance and adipose dysfunction. Visceral adiposity index (VAI) is a tool to measure visceral fat as the indicator of adipose dysfunction and insulin sensitivity. The association between VAI and DPN has not been widely researched, especially in Indonesia. This study aims to assess the association between them.

Methods. This was a cross-sectional study conducted on adult patients (aged ≥18 years) with T2DM at H. Adam Malik General Hospital, Medan, from December 2024 …

Social Disparities, Delirium Occurrence, And Related Outcomes Among Hospitalized Older Adults, Alan P Pan, Kathryn Agarwal, Thomas Potter, Karim Borei, Sara Nowakowski, Courtenay R Bruce, George E Taffet, Farhaan S Vahidy

Faculty, Staff and Students Publications

Background: Underlying socio-economic and health burden may variably impact delirium presentation among older adults. We characterized differences in patient factors related to social marginalization and studied their effects on delirium occurrence and hospital outcomes.

Methods: We conducted a 7-year retrospective analysis of older adults (aged ≥ 70 years) who systematically underwent screening for delirium at an 8-hospital healthcare system. Our primary exposure included patient characteristics related to demographics and social marginalization. Multivariable logistic regression models were built to identify factors associated with increased odds of delirium occurrence, either (1) present-on-admission (D-POA) or (2) hospital-acquired (HAD). Secondary outcomes included hospital length …

A Case Of Kikuchi-Fujimoto Disease In Texas, United States, Divya Chandramohan, Moyosore Awabajo-Otesanya, Deepak Chandramohan, James C. Saca

Graduate Medical Education Research Journal

Kikuchi-Fujimoto disease (KFD) commonly presents with lymphadenopathy, with a third of cases presenting with fevers. It is seen in young female patients of Asian descent, with Taiwan accounting for most of the reported cases. It is imperative to consider KFD in an individual presenting with fever and lymphadenopathy. While it might not be common in the United States, there is an increasing number of cases being reported. Histologic features in KFD are unique, and a lymph node biopsy determines the diagnosis. We outline a case of KFD in the United States and describe histologic details that resulted in the diagnosis.

Buprenorphine/Naloxone Therapy For Opioid Withdrawal, Medication-Assisted Treatment, And Pain Management In An Adolescent Patient, Sindhu H. Manjunath, Michael Spickler, Annas Aljassem

Conference Presentation Abstracts

Introduction: Opioid addiction is a chronic disorder centered around craving and compulsive use of prescription or non-medical opioids. The last three decades have seen a dramatic increase in opioid use order (OUD) in the United States, with about 87,000 adolescents in the 12–17 age group estimated to have OUD in 2019. Less than 10% receive medication-assisted treatment (MAT). We present a case of a 17-year-old male who received treatment with buprenorphine-naloxone (Suboxone) for withdrawal management, MAT and acute pain.

Case Description: A 17-year-old-male with a history of anxiety, depression, and attention deficit/hyperactivity disorder (ADHD) presented to the emergency department (ED) …

When To Tap: Complex Febrile Seizure With Atypical Course As Early Presentation Of Hsv-1 Meningoencephalitis, Isabella Comsa, Sindhu H. Manjunath, Elise Gross, Rawad Obeid, Graham Krasan

Conference Presentation Abstracts

Introduction: Febrile seizures have a prevalence of 2-5% among children ages 6-60 months. Less than 1% of complex febrile seizures without meningeal signs are associated with bacterial or viral meningitis. Current literature supports limiting routine lumbar puncture in this population. We present a case of Herpes Simplex Virus (HSV) encephalitis presenting with complex febrile seizure, who progressed to cerebritis requiring decompressive craniectomy, and discuss indications for further diagnostic evaluation.

Case Description: 2-year-old male with a history of simple febrile seizure presenting with a 10 minute tonic-clonic seizure with right-sided gaze deviation. He had tactile fever and low energy at home …

The Sodium Chronicles: Unraveling The Enigma Of Hypothyroidism-Induced Hyponatremia, Raquel Z. Lara, Tejaswini Swamy, Jennifer Rojas Huen, Ricardo Serna

Research Colloquium

Background: Hyponatremia is an electrolyte disturbance with various etiologies, but hypothyroidism is rarely the primary cause. Literature suggests that hypothyroidism-related hyponatremia occurs primarily in severe cases, with some studies suggesting that hypothyroidism should not be considered a sole contributor if TSH levels are below 50 mIU/L. Patients with hyponatremia have a high risk of prolonged hospital stays and readmission, underscoring the clinical importance of identifying uncommon causes such as severe hypothyroidism. This case highlights this rare association, contributing to the existing limited literature.

Case Presentation: A 74-year-old woman with Type 2 Diabetes, complicated nephrotic syndrome and nephropathy, congestive heart failure, …

Deprescribing And Polypharmacy In Heart Failure Patients Aged 80 Years And Older: A Case Report, Learsi R. De Hoyos, Elizabeth Mills-Reyes, Chelsea Chang

Research Colloquium

Background: Since 2004, the number of adults aged 65 and older has increased by 5.6%. With a growing geriatric population, medical management should maximize benefits and minimize risks. Polypharmacy, defined as the concurrent use of 5 or more medications, is a common concern in older adults. In adults 80 years and older, the prevalence of polypharmacy is 67.1%. Among adults with heart disease, the prevalence of polypharmacy increased from 40.6% to 61.7% between 2000 and 2018. In the context of heart failure, guideline-directed medical therapy (GDMT) includes beta-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 …

Bilateral Small Vessel Strokes In A Young Male With Coccidioidal Meningitis And Suspected Cns Vasculitis, Hugo Zamarron, Ahsan Ali

Research Colloquium

Background: Cerebral small vessel strokes in young, otherwise healthy adults without traditional vascular risk factors are rare and warrant further investigation. Central nervous system (CNS) vasculitis is an uncommon etiology that may be triggered by infections, including fungal pathogens. This case is notable for a suspected primary CNS vasculitis manifesting as bilateral deep infarcts in the setting of Coccidioidal meningitis. It highlights the importance of considering fungal infections and vasculitis in the differential diagnosis of stroke in younger patients.

Case Presentation: A 32-year-old previously healthy male presented with fever, headache, and was diagnosed with aseptic meningitis. He was later readmitted …

Trends And Disparities In Acute Coronary Syndrome-Related Mortality In The United States: Implications For Healthcare, Muhammad Khuzzaim Khan, Ibrahim Ahmed Khan, Abdul Moiz Javed, Arslan Wazir, Hira Saleem, Muhammad Zohaib, Faisal Rasheed, Priyanka Mohan Lal, Syeda Laiba Sherazi, Amiaz Karim, Nikhil Duseja, Hussam Al Hennawi

Abington Jefferson Health Papers

Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the United States (US). However, the trends and disparities in ACS mortality are not well understood. This study aimed to analyze the ACS mortality in the US from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. The age-adjusted mortality rates (AAMR) due to ACS were calculated for each year from 1999 to 2020, stratified by sex, race, urbanization, and state. The trends and disparities in AAMR were examined using descriptive statistics and graphical methods. The AAMR due …

Delayed Diagnosis Of Systemic Lupus Erythematosus Presenting As Autoimmune Hemolytic Anemia: A Case For Heightened Clinical Suspicion, Diana Acosta Pozo, Luis Álvarez Pérez

Research Colloquium

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement, including hematologic manifestations. Autoimmune Hemolytic Anemia (AIHA), though an established feature, is relatively uncommon and may occur early or in isolation. When AIHA presents without overt systemic symptoms, the underlying autoimmune etiology may be overlooked, resulting in delays in diagnosis and treatment. Prompt recognition is essential to prevent unnecessary interventions and prolonged morbidity.

Case Presentation: A 39-year-old woman residing in Texas presented to the Rheumatology office with persistent synovitis and severe transfusion-dependent anemia, requiring red blood cell transfusions every 48 hours for over three months. She …

A Puzzling Case Of Visual Disturbances Leads To A Fatal Neurodegenerative Diagnosis, Courtney J. Austin, Aaron Carrillo, Jennifer Rojas Huen, Victoria Parada

Research Colloquium

Background: Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease in which early diagnosis is complicated by the presence of early non-specific and atypical presentations. Sporadic CJD (sCJD), the most common type of CJD, is caused by the spread of a disease-forming prion known as PrPSc. PrPSc multiplies and binds to the normal form of prion, or PrP, converting it to an abnormal, structurally altered disease form that spreads throughout the brain. sCJD can initially present with six different phenotypes: cognitive, affective, classic, visual (Heidenhain variant), atactic (Oppenheimer-Brownell variant), and indeterminate. The classic presentation of CJD includes rapidly progressive dementia with …

Optimizing Antibiotic Stewardship In Pneumonia: Evidence-Based Protocols For Enhanced Treatment And Resistance Reduction In A University-Affiliated Community Hospital, Carlos Luis Alejos, Jennifer Rojas Huen, Joan Beatrice Capellan, Ricardo Serna, Tejaswini Swamy, Jose Campo Maldonado

Research Colloquium

Introduction: National guidelines recommend early, targeted diagnostics such as respiratory viral panels, procalcitonin testing, Methicillin resistant staphylococcus aureus (MRSA) nasal swabs, and sputum cultures, for the effective management of pneumonia. However, our retrospective review at a university-affiliated community hospital revealed inconsistent application of these tools. These may contribute to excessive use of broad-spectrum antibiotics, higher costs, and increased antimicrobial resistance. The reason is that we aim to implement a standardized pneumonia order set in the electronic medical record (EMR) to improve diagnostic accuracy and antibiotic stewardship.

Methods: We conducted a retrospective chart review of adult inpatients admitted with community-acquired, hospital-acquired, …

The Intersection Of Obesity And Breast Cancer In South Texas: Clinical Implications And Regional Disparities, Aura M. C. Calderon, Ivan Mogollon, Luis Salcedo, Jose Loayza, Diane Nguyen

Research Colloquium

Introduction: Breast cancer continues to be the most frequently identified malignancy among females in both Texas and the broader United States. Although South Texas presents a marginally diminished incidence rate overall, the area persists in confronting significant disparities in terms of disease burden and health outcomes. These discrepancies are particularly pronounced among Hispanic women residing in the Rio Grande Valley (RGV), who encounter heightened probabilities of receiving diagnoses at advanced stages despite a lower general incidence rate. Structural inequities, such as restricted access to healthcare services, socioeconomic deprivation, and inadequate health literacy, interact with obesity-associated biological risk factors, thereby engendering …

Progressive Pulmonary Sarcoidosis In A Young Adult Mimicking Miliary Tuberculosis: A Case Report And Literature Review, Aura M. C. Calderon, Luis Salcedo, Ivan Mogollon, Francisco Arias, Juan Pablo Gomez

Research Colloquium

Introduction: Pulmonary sarcoidosis can pose considerable diagnostic challenges, particularly in young adults hailing from regions endemic to tuberculosis (TB), wherein radiographic manifestations may closely mimic those of miliary TB. This case underscores the necessity of sustaining an extensive differential diagnosis and accentuates the critical role of histological verification in the assessment of diffuse pulmonary micronodular infiltrates, especially in instances where the infectious workup yields negative results.

Case Report: A 26-year-old male from the Democratic Republic of Congo, with no significant medical history, presented with a 10–12 month history of chronic dry cough and exertional dyspnea. He denied fever, weight loss, …

Posterior Reversible Encephalopathy Syndrome (Pres) Secondary To B-Cell Acute Lymphoblastic Leukemia: A Case Report, Aura M. C. Calderon, Luis Salcedo, Ivan Mogollon, Jeyilis Carmona, Juan Pablo Gomez

Research Colloquium

Background: Posterior Reversible Encephalopathy Syndrome (PRES) represents a rare and potentially reversible neurotoxic disorder, distinguished by the presence of acute neurological manifestations and vasogenic edema, frequently detected through neuroimaging techniques. Although traditionally linked to hypertensive crises, renal insufficiency, and cytotoxic therapies, a growing body of evidence suggests that hematological malignancies, specifically acute lymphoblastic leukemia (ALL), should be regarded as an independent risk factor.

Case Presentation: A 73-year-old Hispanic female with a medical history significant for hypertension, type 2 diabetes mellitus, end-stage renal disease requiring hemodialysis, and Parkinson’s disease presented with a progressive decline in strength and altered cognitive status. Upon …

Cervical Cancer Disparities In Hispanic Women: A Multilevel Analysis Using Seer And Texas State Data, Aura M. C. Calderon, Ivan Mogollon, Shubhank Goyal, Jose Loayza, Everardo Cobos, Diane Nguyen

Research Colloquium

Background: Cervical carcinoma continues to exert a disproportionate burden on Hispanic women within the United States, notably in jurisdictions such as Texas, where individuals of Hispanic descent constitute more than 40% of the demographic populace. Notwithstanding progress in screening methodologies and preventive measures, considerable disparities persist in incidence rates, mortality figures, and survival outcomes when assessed through the lens of racial and ethnic stratifications.

Objective: To examine and visually communicate disparities in cervical cancer burden among Hispanic women through a combination of national survival data and Texas state-level incidence and mortality statistics.

Methods: Publicly accessible datasets were employed from the …

Case Report: Familial Hypomagnesemia In A Patient With History Of Hodgkin Lymphoma, Aura M. C. Calderon, Ivan Mogollon, Catherine Matos, Jose Loayza, Everardo Cobos

Research Colloquium

Introduction: Magnesium constitutes an essential electrolyte integral to the functioning of neuromuscular systems, the regulation of cardiovascular parameters, and the facilitation of metabolic processes. Chronic hypomagnesemia may precipitate significant complications, including the onset of arrhythmias and seizures. In cases where hypomagnesemia is refractory to supplementation and manifests in multiple family members, a hereditary tubulopathy, such as Gitelman syndrome (GS), warrants consideration. Gitelman syndrome is classified as an autosomal recessive disorder, resulting from mutations in the SLC12A3 gene, which impairs the thiazide-sensitive sodium-chloride cotransporter located in the distal convoluted tubule.

Case Presentation: A 39-year-old female with a history of classical Hodgkin …

Case Report: Clonidine Withdrawal-Induced Posterior Reversible Encephalopathy Syndrome (Pres), Aura M. C. Calderon, Francisco Arias, Ivan Mogollon, Luis Salcedo, Hector Arredondo

Research Colloquium

Introduction: Clonidine, an agonist of central α2-adrenergic and imidazoline receptors, possesses the capacity to elicit transient episodes of hypertension succeeded by hypotension and bradycardia. This particular case underscores a rare yet significant complication, Posterior Reversible Encephalopathy Syndrome (PRES), that can occur subsequent to the abrupt cessation of clonidine administration.

Case Presentation: An 18-year-old male with severe asthma and prior ICU admissions presented to the emergency department after two seizures. He had recently been treated for an asthma exacerbation complicated by hypertension, for which clonidine was initiated. He was discharged on clonidine and prednisone but discontinued clonidine the day before admission …

Etomidate Vs Ketamine In Rapid Sequence Intubation: A Comparative Review Of Clinical Efficacy And Safety, Abelardo Rodriguez, Cesar Ortega, Jessica Daza

Research Colloquium

Background: Rapid Sequence Intubation (RSI) is a critical procedure in emergency and critical care settings, and the choice of induction agent can significantly affect patient outcomes. Etomidate and Ketamine are two widely used agents with distinct pharmacologic profiles. Understanding their comparative efficacy and safety across clinical contexts is essential for optimizing care in high-acuity environments.

Objective: To compare Etomidate and Ketamine as induction agents for RSI, focusing on their mechanisms of action, hemodynamic effects, and clinical outcomes in various patient populations.

Methods: A literature-based review was conducted using key databases including PubMed, Cochrane, and clinical guidelines. Studies examining the use …

Refractory Neutropenic Fevers In Aml: Unmasking Voriconazole-Resistant Invasive Aspergillosis, Abdel Martinez Borrego, Sahir Bhatti, Cesar Gutierrez

Research Colloquium

Background: Persistent fever in neutropenic patients with acute myeloid leukemia (AML) often raises concern for invasive fungal infections (IFIs), especially when unresponsive to broad-spectrum antibiotics and first-line antifungal agents like voriconazole. Invasive aspergillosis (IA), primarily caused by Aspergillus fumigatus, is a major cause of morbidity and mortality in this population, with mortality rates exceeding 50% in refractory cases. The emergence of azole-resistant Aspergillus, now reported in up to 10–15% of isolates in some regions, has complicated management. Patients may present with nonspecific symptoms such as persistent fevers, as well as concerning findings like cutaneous lesions—a clue to hematogenous spread—and …

Predictors Of All-Cause In-Hospital Mortality In Patients With Malignant Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors, Elvis Obomanu, Tarfa Verinumbe, Tinsae Anebo, Colton Jones, Claudia Dourado

Einstein Health Papers

BACKGROUND: Factors influencing in-hospital mortality in patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) remain understudied, highlighting gaps in optimizing acute clinical outcomes. This study aimed to identify sociodemographic and clinical predictors of all-cause in-hospital mortality in this population.

METHODS: Using 2016 - 2020 data from the National Inpatient Sample (NIS), patients with malignant well-differentiated GEP-NETs were identified via the International Classification of Diseases, 10th Revision (ICD-10) codes. The primary outcome was in-hospital mortality. Sociodemographic and clinical variables (heart failure (HF), malnutrition, Charlson Comorbidity Index (CCI), and tumor site) were analyzed using multivariable logistic regression.

RESULTS: Among 5,642 patients (mean age …

Fluid Resuscitation Choice And Its Effect On Plasma Chloride And Acute Kidney Injury In Severe Acute Pancreatitis: A Randomized Study Of Normal Saline Vs. Balanced Crystalloids (Physiomax), Mandip Singh Bhatia, Ritu Attri, Ashok Kumar Pannu, Atul Saroch, Saurabh C Sharda, Neeraj Singla, Sakshi Mehta

Journal of Community Hospital Internal Medicine Perspectives

Background: Acute pancreatitis (AP) is a potentially fatal gastrointestinal condition, often associated with organ failure and acute kidney injury (AKI). Early fluid resuscitation with Normal saline (NS) may lead to hyperchloremia and AKI, which prompted interest in using balanced crystalloids. However, the optimal choice of crystalloid fluid remains uncertain. This study aimed to compare the effects of NS versus Physiomax on plasma chloride levels and AKI incidence during early resuscitation in patients with predicted severe AP (pSAP).

Methods: A single-center, prospective, randomized study was conducted between November 2022 and December 2023 at PGIMER, Chandigarh, India. 112 patients with pSAP were …

Role Of Addiction Medicine Consultation Service In A Community Hospital: Evaluation Of The Novel Service, Srikrishna Varun Malayala, Wesley Cervantes Perez, Rukshar Thapa, Archie Madan, Kushagar Singla, Pragyat Singh, Pelash Kumar, Akshay Thaper

Journal of Community Hospital Internal Medicine Perspectives

Objectives: Fewer than 2,500 physicians nationwide are certified in addiction medicine. Inpatient addiction hospitalist services have been shown to improve patient outcomes, but their capabilities and impact are underexplored in community hospitals. This study evaluates the role of an addiction medicine hospitalist service in enhancing patient outcomes in two community-based hospitals.

Methods: A retrospective chart review was conducted on patients who received care from addiction medicine service in two hospitals. The data were collected within the first 120 days of the establishment of service. The reason for consultation, substances used, types of management, impact on transition of care, readmissions and …

Left Atrial Thrombus In Rheumatic Mitral Stenosis: A Case Of Therapeutic International Normalized Ratio Failure, Muhammad Salman Sabri, Carly Weber, Yanis Belkadi, Donald C. Haas, Yasotha Rajeswaran

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Atrial fibrillation or flutter in rheumatic mitral stenosis (MS) increases left atrial appendage (LAA) thrombus risk despite therapeutic anticoagulation.

CASE SUMMARY: A 72-year-old woman on warfarin with moderate MS and atrial flutter presented with dyspnea. Transesophageal echocardiogram (TEE) showed a large LAA thrombus despite an international normalized ratio >2.5. Cardioversion was deferred, and the international normalized ratio target was raised to a range of 2.5 to 3.5.

TAKE-HOME MESSAGES: While cardioversion can be considered in patients with uninterrupted anticoagulation without TEE, those with rheumatic MS are at high risk of LAA and LA thrombus and should undergo TEE before …