Internal Medicine Commons^™

Worldwide Procedural Variations Of Primary Percutaneous Coronary Intervention For St-Elevation Myocardial Infarction: Insights From The "Stent - Save A Life!" Initiative, Hélder Pereira, Ana Pereira, Rita Calé, Dejan Orlić, Rhena Delport, Sayfollah Abdi, Bagrat Alekyan, Khalid Alhabib, Carolina Artucio, Mzee Ngunga

Internal Medicine, East Africa

Background

Methods

Results

Performance Of The Grace Acs Risk Score In Predicting In-Hospital And Six-Month Mortality In Patients With Acs: A Single Center Retrospective Cohort Study, Albert Nyanga, Jeilan Mohamed, Miriam Msunza, James Orwa, Mzee Ngunga

Internal Medicine, East Africa

Introduction: The incidence of coronary heart disease (CHD) is rising globally. Despite the high burden of CHD in Africa, little is known about appropriate risk stratification systems that can be used to predict outcomes in patients with acute coronary syndromes (ACS) in this region.

Methodology: This was a single-center retrospective cohort study conducted at the Aga Khan University hospital. Data was explored descriptively by summarizing categorical variables using frequencies/percentages and continuous variables using medians and interquartile ranges. Risk groups and mortality were compared using Fisher’s exact test or the chi-square test. The area under the receiver operating characteristic curve (AUROC), …

Utilization Of Evidence-Based Secondary Preventive Therapies Post-Acute Coronary Syndrome: A Heart Registry Cohort Study In Kenya, Anthony Ochola, Jasmit Shah, Jeilan Mohamed, Harun Otieno, Anders Barasa, Felix Barasa, Constantine Akwanalo, Benard Gitura, Mzee Ngunga

Internal Medicine, East Africa

Introduction: cardiovascular disease is a growing concern in Africa, with coronary artery disease emerging as a leading cause of mortality. Despite strong evidence and international guidelines recommending secondary prevention therapy post-acute coronary syndrome (ACS)-including antiplatelet agents, statins, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors-suboptimal use remains a concern, especially in low- and middle-income countries. This study aimed to quantify the use of guideline-recommended secondary prevention medications after ACS in Kenya using the data from the Kenya Heart Registry study.

Methods: a cohort study was conducted using data from the Kenya Heart Registry across three hospitals in Kenya from …

From A Papule To Friable Papillary Projections: A Case Of Old World Cutaneous Leishmaniasis, Zamanali Khakhar, Adil Salyani, Soraiya Manji, Rajiv Patel, Sayed Karar

Internal Medicine, East Africa

This case aims to characterize an unusual cutaneous manifestation in a patient with confirmed cutaneous leishmaniasis, highlighting clinical features that are often underrecognized and may contribute to diagnostic uncertainty. By exploring this atypical presentation, it underscores the potential for misdiagnosis and its implications for patient management. Additionally, it emphasizes the broad spectrum of cutaneous lesions that can mimic Old World cutaneous leishmaniasis, further increasing the risk of diagnostic error.

Mapping Social Determinants Of Health Data In Sub-Saharan Africa: A Scoping Review Protocol, Felix Anyiam, Jessica Gjonaj, Ngeresa Osango, Richard Mugo, Peace Aber, Jasmit Shah, Judith Mangeni, Rajesh Vedanthan, Joseph Hogan, Ann Mwangi

Internal Medicine, East Africa

Introduction Research has increasingly underscored the impact of factors such as socioeconomic status, education, healthcare access, housing and environmental conditions in shaping population health outcomes. These factors, collectively called social determinants of health (SDOH), provide crucial context for understanding drivers of health outcomes. In sub-Saharan Africa (SSA), the study of SDOH is critical due to the region’s unique sociocultural and economic conditions. Understanding how SDOH interacts with health systems and capturing SDOH in data is crucial for informing modelling efforts and policies improving population health more effectively. This scoping review aims to map the types of data used to capture …

Investigating The Risk Factors Affecting The Control Of Diabetes And Hypertension In The Refugees Living In Egypt, Noura Seada

Theses and Dissertations

Introduction: Non-Communicable Diseases (NCDs) account for 74% of global deaths, with high prevalence of Diabetes and Hypertension worldwide. Egypt hosts over 1 million registered refugees and asylum seekers, often lacking inclusion in social protection or insurance schemes. This study aimed to assess the factors affecting the control of Type 2 Diabetes (T2D) and Hypertension (HTN) among Syrian and Sudanese refugees in Egypt, focusing on healthcare access, sociodemographic characteristics, lifestyle, and health behaviours.

Methods: This study employed a cross-sectional design using a self-administered questionnaire and BMI measurement. Data were collected from 246 refugees diagnosed with type T2D and/or HTN in the …

Beyond The Rash: Cutaneous Peripheral T-Cell Lymphoma As A Diagnostic Pitfall In Primary Care, Jared Hensley, Aura Calderon, Blake Martin, Cristina Kochi, Andres Suarez Parraga

School of Medicine Publications

Cutaneous manifestations of T-cell lymphomas may resemble common dermatologic or infectious conditions, increasing the risk of delayed recognition. We report a 78-year-old woman with known peripheral T-cell lymphoma (PTCL) who presented with a rapidly progressive, diffuse erythematous rash accompanied by cervical lymphadenopathy. Initial evaluation prioritized more common etiologies; however, inpatient medicine broadened the differential diagnosis, prompting early hematology and oncology consultation. Contrast-enhanced CT of the neck demonstrated multiple enlarged, partially necrotic left cervical lymph nodes consistent with disease progression. After multidisciplinary discussions and consideration of prognosis, the patient elected palliative-focused management with oncology follow-up. This case underscores the importance of …

A Strategy For Surge Management: Senior Residents On The Admitting Frontlines, Hamza Saifuddin, Oliver Yockey, Rachelle Pichot, Gwendolyn Brainard, Samantha Labay, Michael S. Wang

Journal of Community Hospital Internal Medicine Perspectives

Hospitals adapt to surges in a variety of ways, including expediting admitting and discharge procedures, hiring temporary staff and locums to meet increased demand, and temporarily expanding or creating facilities. To mitigate negative effects associated with surges, a small community-based hospital’s Internal Medicine (IM) residency program and hospitalist program collaborated by shifting senior residents into admitting physician roles with indirect supervision to meet increased surge needs. This shift allowed an admitting attending physician to shift to a newly created rounding service and, on average, the number of rounding services was increased from seven to nine. Over a fifteen-month period (five …

Empowering Residents In Community-Based Internal Medicine Programs: A Structured Framework Integrating Simulation Labs, Ai, And Gamification, Nirmay Sonar, Zaynah Sadiq, Bernie Sergent

Journal of Community Hospital Internal Medicine Perspectives

Community-based internal medicine residencies train nearly half of all U.S. IM residents and are essential for staffing underserved areas. These programs often face educational gaps due to limited resources, faculty development, and procedural training opportunities. We designed a 12-month quality initiative for 27 residents at a small community hospital blending new high-fidelity simulation drills (e.g. in-situ rapid-response and procedural labs), restructured didactics (gamified quizzes, NEJM Resident 360™, HumanDx cases), enhanced orientation (“intern survival guide”), research education, wellness retreats, community outreach and AI-driven, individualized case feedback. New interventions were implemented alongside existing activities, with targeted outcomes including clinical competency, board readiness, …

A Case Of Listeria Monocytogenes Bacteremia In A Middle-Aged Woman With A History Of Primary Biliary Cholangitis, Caleb Smack, Jared T. Lausen, Aaron Mills

Eastern Virginia Medical Journal

In this report, we discuss the case of a patient with Listeria monocytogenes bacteremia likely resulting from primary biliary cholangitis (PBC) induced cirrhosis. We aim to bolster the body of literature on Listeria bacteremia and establish PBC as a risk factor for this rare complication. Our patient, who presented with sepsis, was subsequently found to have Listeria bacteremia and received intravenous antibiotic treatment of ampicillin for 3 total weeks with complete resolution of her disease. This is the first case suggesting that cirrhosis as a result of PBC may be an independent risk factor for Listeria bacteremia. In patients at …

Weight-Loss Efficacy Of Glp-1 Receptor Agonists Relative To Lifestyle-Based Interventions, Amy Betterton

Lynchburg Journal of Medical Science

ABSTRACT

This clinical review compares the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with traditional lifestyle modifications in managing obesity. This article also examines barriers to accessing the medications in both civilian and veteran populations. This clinical review was conducted through a wide-ranging review of the published literature, including clinical trials, observational studies, and review articles on lifestyle modifications, GLP-1 receptor agonists, and barriers to obesity treatment. While lifestyle modifications are generally considered a first-line approach and are cost-effective, they tend to yield only modest weight loss. In contrast, GLP-1 RAs offer significantly greater reductions in body weight as …

Rapid Inpatient Methadone Induction In The Fentanyl Era: A Systematic Review Of Safety, Efficacy, And Protocols For Hospitalized Patients With Opioid Use Disorder, Lorik Berisha, Sapan Patel, Charlotte Pirquet, Navina Magesh Kumar, Yousef Soliman, Ahsan Ullah, Daniel M. Matassa

Division of Internal Medicine Faculty Papers & Presentations

Purpose of Review: The potency of illicit fentanyl has rendered standard methadone inductions inadequate for many hospitalized adults with opioid use disorder. Standard protocols often fail to achieve therapeutic doses quickly enough to manage withdrawal and cravings in fentanyl-tolerant individuals, contributing to poor retention and higher self-discharge rates. This review examines emerging evidence on dosing strategies, outcomes, and safety of rapid methadone inductions in acute-care hospitals. Recent Findings: Nine studies (five retrospective cohorts, four case series/reports) encompassing 380 patients met inclusion criteria. Median starting doses were 30–40 mg (range 20–90 mg), with daily or symptom-triggered increases achieving 60–100 mg within …

After Hours, Faster Reperfusion: A Multidisciplinary Quality Improvement Initiative To Reduce Stemi Door-To-Balloon Time, Suhas Tatapudi, Aarohi Parikh, Jeffrey Lesser, Alexander Rhodes, M Daniel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Improving Sepsis Order Set Utilization Through Targeted Resident Education: A Lean Six Sigma Green Belt Quality Improvement Project, Sarah Sheikh, Puneeth Shridhar, Bushra Bangash, Valerie Chukelu, Tonya Meirhofer, Arunima Jose, Zainab Shakir, Shane Jenks, Augusto Sepulveda, Trung Nguyen, Rajeev Raghavan

Gulf Coast Division GME Research Day 2026

No abstract provided.

A Shocking Case Of Wolf Parkinson White (Wpw) Syndrome, Sarah Hendee, Bailey Reale, Tate Higgens, David Taylor, Dmitriy Scherbak

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Unwrapping The Candy Cane: An Underrecognized Cause Of Postoperative Abdominal Pain, Priscilla Itua, Uzma Ali, Mohammad Mahdi, Osamah Salim, Sarib Sultan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Watery Diarrhea And Hypotension: A Missed Clue To Adrenal Crisis In A Patient With Addison's Disease, Wafa Mehboob, Umema Irfan, Keyaben Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Disseminated Mycobacterium Avium Complex (Mac) Infection Presenting With Mycotic Aneurysm And Multisystem Involvement In A Patient With Newly Diagnosed Acquired Immunodeficiency Syndrome (Aids), Hannah Rector, Michael Haddad, Dmitriy Scherbak

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Necrotizing Sweet Syndrome In A Young Male: A Rare Clinical Mimic Of Necrotizing Fasciitis, Evan King, Rawad Radaa, Ryne Peters

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Case Report: Successful Treatment Of Clot In Transit In The Ra And Rv, Venkata Kalyan Byrapogu, Garret D. Olsen, Rati Shirodkar, Brett Hiendylmayr, Pratik Saha

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Survival Following Extreme Metformin-Associated Lactic Acidosis In A Patient With Acute-On-Chronic Kidney Disease Managed With Crrt, Phil Khong, Danielle Sudilovsky, Logan Blackney, Ryan Spilman, Alex Enurah

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Case Reports: A 66-Year-Old Male With Severe Hypocalcemia In The Setting Of Metastatic Prostate Cancer And Denosumab Use, Danielle Sudilovsky, Marissa Patterson, Sophia Eschelbeck, Madeline Whitney, George Issa

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Biliary Obstruction From An Unexpected Source, Max Dinicola, Trevor Link, Derek Welch

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Stroke To Spread: Pachymeningeal Carcinomatosis In A 40-Year-Old With Metastatic Breast Cancer Confirmed Via Dural Biopsy, Aneesha Shaju, Thomas K. Hoang, Grace Desrochers, Woondong Jeong

Gulf Coast Division GME Research Day 2026

No abstract provided.

Ai-Powered Chatbot For Structural Valve Education And Shared Decision-Making: A Pilot Simulation Study, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Hidden In The Hilum: A Rare Case Of Mediastinal Mucormycosis In A Patient With Uncontrolled Diabetes Mellitus, Neethu George, Anusha Putta, Harikaran Ragireddy

Gulf Coast Division GME Research Day 2026

No abstract provided.

Contemporary Transcatheter Therapies For Severe Tricuspid Regurgitation, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Environmental Footprint Of Aortic Valve Replacement: A Comparative Life-Cycle Analysis Of Surgical And Transcatheter Procedures, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Aleukemic Philadelphia-Positive Acute Lymphoblastic Leukemia Presenting As Fdg-Avid Skeletal Disease Mimicking Multiple Myeloma: A Diagnostic Pitfall, Roy Muriu, Asif Lakhani

Gulf Coast Division GME Research Day 2026

No abstract provided.

Euglycemic Diabetic Ketoacidosis (Eudka) Is A Rare But Serious, Potentially Fatal Complication Of Sglt2 Inhibitors, Praise Ohabor, Alexis Lopez Cruz, Zuhair Ali

Gulf Coast Division GME Research Day 2026

No abstract provided.