Internal Medicine Commons^™

A Fatal Case Of Covid-19 Pneumonia In A Fully Vaccinated Heart Transplant Recipient, Agastya D. Belur, Diana Otero, Christina Dunbar Matos

The University of Louisville Journal of Respiratory Infections

The development and administration of mRNA vaccines against SARS-CoV-2 are seeing lower numbers of COVID-19 cases and fatalities among fully vaccinated, immunocompetent adults. We present a case of fatal COVID-19 pneumonia in a heart transplant recipient who had received two doses of mRNA COVID-19 vaccine before the Centers for Disease Control and Prevention had recommended additional doses.

Left Ventricular Outflow Tract Thrombus In A Patient With Covid-19-A Ticking Time Bomb: A Case Report., Hamza Zahid Ullah Muhammadzai, Nathaniel Rosal, Muhammad Arslan Cheema, Donald Haas

COVID-19 Papers, Posters, and Presentations

Background: Coronavirus disease 2019 (COVID-19) is a manifestation of severe acute respiratory syndrome coronavirus 2, which results in many different complications including left ventricular (LV) thrombi.

Case summary: We present a 30-year-old female presenting with chest pain and shortness of breath. Patient had an extensive history including heart failure with an ejection fraction 15-20% and COVID-19 2 months ago. Echocardiogram revealed a 3.3 cm ×  1.7 cm LV thrombus which was not present 4 months ago before her diagnosis of COVID-19. The LV thrombus embolized resulting in an embolus extending from the distal infrarenal abdominal aorta to the common iliac …

Covid-19, Vaccination, And Heart Transplantation, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Death Exposure Influence On Medical Students’ Attitudes Toward End-Of-Life Care, Sara J. Barlow, Nelia Alfonso, Jason A. Wasserman

Posters

INTRODUCTION
Advance directives help guide individuals and their families in making end-of-life decisions that physicians must respect and carry out on behalf of patients to provide optimal care that aligns with their wishes. The facilitation of end-of-life care and the application of advance directives are impacted by physicians’ attitudes and knowledge regarding this topic. Current studies focus on the perspective that practicing physicians have toward advance directives. Our goal is to examine the end-of-life preferences of medical students at Oakland University William Beaumont (OUWB) School of Medicine before and after clinical exposure to better appreciate how and when opinions regarding …

Case Report: Covid Arm (Covid Vaccine Arm), Joseph Pagano, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

We report the case of a 38-year-old male physician who was vaccinated with the Pfizer vaccine. He experienced arm pain and swelling on the vaccinated arm as well as systemic symptoms, including fever, chills, headache and weakness. The systemic symptoms improved after the use of oral prednisone. A review of the literature on the COVID vaccine is presented.

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …

Back To The Basics With Smart Goals: A Multimodal Intervention For Adults Who Have Type 2 Diabetes, Alyssa L. Snyder

Evidence-Based Practice Project Reports

Diabetes, the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2020a) and the ninth leading cause of death worldwide (World Health Organization [WHO], 2020), has increased by 70% over the last two decades (WHO, 2020). Type 2 diabetes (T2D), the most prevalent type accounting for 90% to 95% of diagnosed cases (CDC, 2020a), affects individuals of all ages and often results in major health problems including stroke, heart attack, and kidney disease. The purpose of this patient-centered, evidence-based practice (EBP) project was to evaluate the effectiveness of a multimodal intervention on hemoglobin …

Walking Is Worthy: Walking For Hypertension, Ashleigh Y. Peterson

Evidence-Based Practice Project Reports

Elevated blood pressure (BP), or hypertension (HTN), can cause a cascade of detrimental effects to the body. It is associated with increased risk of stroke, angina, myocardial infarction, heart failure, peripheral artery disease, end-stage renal disease, and abdominal aortic aneurysms (Whelton et al., 2018). HTN is also a major risk factor for the development of cardiovascular disease (CVD), which is the United States’ (U.S.) leading cause of death in men and women (U.S. Preventive Services Task Force [USPSTF], 2020). The PICOT question for this project was: does an eight-week (T) structured walking program utilizing a smartwatch for step counts and …

Angiotensin Receptor Blockers Associated Enteropathy- Brief Report, Falgun Gosai, Neha Gosai

Journal of Community Hospital Internal Medicine Perspectives

The current literature has shown equivocal results regarding the association of Olmesartan and other angiotensin receptor blockers (ARBs) use and the presence of Celiac sprue-like enteropathy (CSLE). Various factors affecting the association are- patient population under study, geographic area, and duration of use of medication. Various case reports/ case series and observational studies have shown the mixed results regarding an association. We have tried to answer a question what exists in the literature regarding the angiotensin receptor blockers related sprue like enteropathy.

The Racial Divide: A Follow Up Study On Racial Disparity Amongst Covid-19 Survivors In An Urban Community, Christopher Millet, Emily Racoosin, Spandana Narvaneni, George Horani, Sherif Roman, Alisa Farokhian, Arslan Chaudhry, Sohail Chaudhry, Yezin Shamoon, Humberto Jimenez, Patrick Michael, Jin Suh

Journal of Community Hospital Internal Medicine Perspectives

Background Studies have shown that COVID-19 has had a disproportionate effect on minority groups in both the clinical and social settings in America. We conducted a follow up study on patients previously diagnosed with COVID-19 one year ago in an urban community in New Jersey. The purpose of the study was to evaluate the socioeconomic impact of COVID-19 as well as assess for receptiveness towards COVID-19 vaccination amongst various ethnic groups.

Methods This was a prospective cohort study consisting of patients who had recovered from COVID-19 one year prior. The patients included in the study had a confirmed COVID-19 diagnosis …

Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md

Journal of Community Hospital Internal Medicine Perspectives

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous system at any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called “The Great Pretender” or “The monkey among diseases” (12). This is a case report of an 83-year-old female with a history of multiple …

Development Of A Community Hospital Medicine Affiliated Inpatient Rotation For Family Medicine Residents - A Collaborative Success, David M. Gallagher, Anthony J. Viera, William E. Bynum, Poonam Sharma, John W. Ragsdale, Jeffrey Eschbach, Lalit Verma

Journal of Community Hospital Internal Medicine Perspectives

Background: Hospitalists perform key roles as inpatient educators for family medicine residents. For the past decade, Duke University Family Medicine Residency Program had its inpatient family medicine resident rotation at non-Duke facilities.

Objective: The authors describe the steps taken in 2020 to develop an inpatient Duke family medicine rotation at a North Carolina community hospital, Duke Regional Hospital, and provide outcomes data.

Methods: Duke Family Medicine Residency and Duke Regional Hospital Medicine collaborated in addressing key issues to develop an inpatient rotation for family medicine residents. Performance metrics of patients cared for by both the family medicine inpatient resident team …

Investigating The Effectiveness Of A Mindfulness Based Stress Reduction Course Within Healthcare: A Qualitative Methods Study, Patrick Herndon, Michael Moussa, Alyssa Heintschel, Scott Sabbagh, Ruth Lerman

Posters

INTRODUCTION
Mindfulness practice has emerged as a promising means to address stress in healthcare workers (HCW). Virtually all HCW studies of the standardized, validated Mindfulness Based Stress Reduction (MBSR) curriculum have been conducted using homogeneous (HCW only) populations. This work examines the novel approach of comparing the effects of heterogeneous MBSR classes: HCW, oncology patients and family members (HCW-HE) as compared to homogeneous classes HCW and their family members only (HCW-HO)

Exploring The Effects Of Mindfulness Based Stress Reduction On Pre-Clinical Medical Students: A Qualitative Methods, Longitudinal Pilot Study, Alyssa Heintschel, Scott Sabbagh, Patrick Herndon, Michael Moussa, Ruth Lerman

Posters

INTRODUCTION
Mindfulness Based Stress Reduction has become an increasingly popular practice in healthcare-affiliated populations. MBSR is a course designed to promote mindfulness and awareness within oneself through a combination of formal and informal practices. Studies suggest healthcare workers are at higher risk of experiencing stress and burnout; this is prevalent among pre-clinical medical students due to the rigorous nature of medical school coursework. The primary objective of this study is to evaluate the effectiveness and feasibility of implementing an MBSR program to facilitate improvements in key areas of mental health among medical students throughout their training.

Investigating The Effects Of A Mindfulness Based Stress Reduction Course On A Grouping Of Oncology Patients, Health Care Workers And Their Families On Measures Of Stress And Burnout In Health Care Workers: A Randomized Control Trial, Michael Moussa, Patrick Herndon, Alyssa Heintschel, Scott Sabbagh, Ruth Lerman

Posters

INTRODUCTION
Mindfulness Based Stress Reduction (MBSR) can improve the mental health of health care workers (HCW). How will the inclusion of oncology patients (OP) in MBSR classes for HCW affect the mental health of HCW?

Patient Perceptions Of Their Health Care Teams And Preferences For Making Decisions Regarding Medical Care, Veronica F. Williams, Nelia Afonso

Posters

INTRODUCTION
Beaumont Hospital values patient and family-centered care, but a clear understanding of how patients perceive their health care teams and prefer to make decisions regarding their medical treatment have not been well-described. It is necessary to understand patients’ preferences regarding various factors that impact their medical care in order to foster an effective health care environment. The primary goal of this study is to determine how patients’ care teams impact the ways in which they make decisions regarding their medical treatment. A secondary goal is to determine the individuals, both inside and outside of the health care setting, that …

Comparison Of Collaborative Goal Setting With Enhanced Education For Managing Diabetes-Associated Distress And Hemoglobin A1c Levels: A Randomized Clinical Trial, Lechauncy Woodard, Amber B Amspoker, Natalie E Hundt, Howard S Gordon, Brian Hertz, Edward Odom, Anne Utech, Javad Razjouyan, Suja S Rajan, Nipa Kamdar, Jasmin Lindo, Lea Kiefer, Praveen Mehta, Aanand D Naik

Faculty, Staff and Student Publications

IMPORTANCE: Type 2 diabetes is a prevalent and morbid condition. Poor engagement with self-management can contribute to diabetes-associated distress and hinder diabetes control.

OBJECTIVE: To evaluate the implementation and effectiveness of Empowering Patients in Chronic Care (EPICC), an evidence-based intervention to improve diabetes-associated distress and hemoglobin A1c (HbA1c) levels after the intervention and after 6-month maintenance.

DESIGN, SETTING, AND PARTICIPANTS: This hybrid (implementation-effectiveness) randomized clinical trial was performed in Veterans Affairs clinics across Illinois, Indiana, and Texas from July 1, 2015, to June 30, 2017. Participants included adults with uncontrolled type 2 diabetes (HbA1c level >8.0%) who received primary care …

Effective Therapies And Nursing Approaches: Improving Cognition In Older Adult Stroke Patients, Selyna Baltazar

Nursing | Senior Theses

Background

Ischemic stroke occurs in thousands of older adults throughout the year. Due to the lack of oxygen entering the brain, many patients experience a decline in cognitive function due to ischemic stroke. Cognition is the ability to understand, learn, and remember information which is needed for completing daily tasks. Modern technology has allowed for patients to survive ischemic strokes but has yet to provide proper screening tools and methods for stroke-related cognitive impairment.

Objective

To investigate the best practices for identifying, treating, and caring for patients with a cognitive injury related to a stroke. A review of the research …

Validation Of The Kiswahili Version Of The Migraine Disability Assessment Scale In Dar Es Salaam, Tanzania, Aliasger Nagri

Master of Internal Medicine

Background: Migraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and many neurological symptoms. The MIDAS is a five (5) question-based questionnaire used in clinical practices to identify the disability caused by migraine at work, school, household or social life; with a score indicating little or no disability (0-5), mild disability (6-10), moderate disability (11-20), and severe disability (21+). Translated versions of the MIDAS scale in a number of languages has been validated. Translating and validating the Kiswahili version of the MIDAS questionnaire is essential and needed to ensure its comparability to the original English …

Feasibiity And Acceptability Of Tele-Neurology Services At A Regional Tertiary Referral Centre: A Prospective Study., Fazal Yakub

Master of Medicine in Internal Medicine

Background: Neurological diseases are a leading cause of morbidity and mortality worldwide with a great burden lying in Sub-Saharan Africa. The paucity of neurologists in the region makes neurological care disproportionately inaccessible. Utility of tele-medicine is low cost, time efficient, convenient, reducing the carbon footprint and ultimately increasing health care access. Objective: We identified whether the concept of tele-neurology was feasible within our setup for patients with stable neurological diseases while establishing the cost effectiveness, efficiency, convenience and the carbon footprint burden. Methods: We conducted a prospective cross-sectional study. New patients were triaged by the neurologist based on guidelines from …

Hiv Among Cancer Patients: Prevalence And Cancer Description By Hiv Status, Diana Wambui Muturi

Master of Medicine in Internal Medicine

Background: Antiretroviral therapy (ART) has resulted in a higher life expectancy of persons living with Human Immunodeficiency Virus (PLHIV) leading to an aging population at risk for non-AIDS defining cancers (NADCs) rather than AIDS-defining cancers (ADCs). Identification of HIV-cancer comorbidity through diagnostic HIV testing of patients presenting for cancer care is not offered routinely. The HIV prevalence among cancer patients in Kenya is undefined. In addition, the spectrum of malignancies in PLHIV has not been well characterized outside of ADCs. Objective: Our primary objective was to determine the prevalence of HIV among patients with cancer. Secondary objectives were to determine …

Adolescent Connectedness: A Scoping Review Of Available Measures And Their Psychometric Properties, Ezra Too, Esther Chongwo, Adam Mabrouk, Amina Abubakar

Institute for Human Development, East Africa

Introduction: Adolescent connectedness, a key component of positive youth development, is associated with various positive health outcomes. Several measures have been developed to assess this construct. However, no study has summarized data on the existing measures of adolescent connectedness. We conducted this scoping review to fill this gap. We specifically aimed to: (i) identify the existing measures of adolescent connectedness, (ii) determine the most frequently used measures among the identified measures, and (iii) summarize the psychometric properties of these measures with a keen interest in highlighting their cross-cultural utility and validity.

Methods: We searched CINAHL, Embase, PsycInfo, PubMed, …

It Is Not A Boerhaave! A Case Of Spontaneous Pneumothorax, Imran Khan, Rukma R Govindu, Hussam Ammar

Faculty, Staff and Student Publications

Spontaneous pneumothorax is a pneumothorax that is not caused by trauma or an apparent precipitating factor. This report presents a case of a 91-year-old man with no history of lung disease who developed pneumothorax after two days of persistent nausea and vomiting. He was misdiagnosed as a case of Boerhaave's syndrome. A chest computed tomography with iohexol oral contrast showed no evidence of esophageal rupture, and an upper endoscopy revealed a small gastric ulcer and no gastric outlet obstruction. The patient was managed conservatively; his spontaneous pneumothorax, nausea, and vomiting resolved.

Necrotizing Enterocolitis Rates In Preterm Infants, Alexis Howard

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Breast milk and donor human milk is used in the prevention of necrotizing enterocolitis (NEC) in preterm infants born prior to 37 weeks gestation and those with very low birth weight. This process occurs through direct breast feeding and tube feeding. The aim of this study was to compare the use of breast milk and donor milk to the use of formula feed in preterm infants. A systematic review was conducted using articles collected from CINAHL and PubMed and was guided by PRISMA guidelines. A total of 15 studies that met criteria were analyzed by purpose, variables, study design, population …

Small Vessel, Large Problems: An Unusual Cause Of Heart Failure In An Elderly Female., Nicholas Pettit, Jason Bensch

Providence Portland Medical Center Internal Medicine 2022

No abstract provided.

Adipocyte-Derived Serum Amyloid A Promotes Angiotensin Ii–Induced Abdominal Aortic Aneurysms In Obese C57bl/6j Mice, Preetha Shridas, Ailing Ji, Andrea C. Trumbauer, Victoria P. Noffsinger, Steve W. Leung, Adam J. Dugan, Sean E. Thatcher, Lisa A. Cassis, Frederick C. De Beer, Nancy R. Webb, Lisa R. Tannock

Internal Medicine Faculty Publications

Background: Obesity increases the risk for human abdominal aortic aneurysms (AAAs) and enhances Ang II (angiotensin II)-induced AAA formation in C57BL/6J mice. Obesity is also associated with increases in perivascular fat that expresses proinflammatory markers including SAA (serum amyloid A). We previously reported that deficiency of SAA significantly reduces Ang II-induced inflammation and AAA in hyperlipidemic apoE-deficient mice. In this study. we investigated whether adipose tissue-derived SAA plays a role in Ang II-induced AAA in obese C57BL/6J mice.

Methods: The development of AAA was compared between male C57BL/6J mice (wild type), C57BL/6J mice lacking SAA1.1, SAA2.1, and SAA3 …

Clinical Pathways Leading To Antibiotic Initiation In Patients With Suspected Infection And Their Association With Delays And Mortality, X Han, C Lopez-Espina, P A. Verhoef, A Spicer, A Bhargava, L Schmalz, Matthew Sims, Alexandra Halalau, Nicholas Maddens, Aimee Espinosa

Conference Presentation Abstracts

Rationale: Delayed antibiotic therapy is associated with increased mortality in patients hospitalized with infection. The decision toinitiate therapy in patients with suspected infection is influenced by a variety of information, such as vital signs, and laboratoryresults. Identifying different patterns of events that lead to initiation is necessary to discover factors that could serve as targets forinterventions to expedite this process. We aimed to identify the most common sequences of events that precede antibioticordering and to quantify the time intervals between each event that contribute to antibiotic delays. Methods: This was aretrospective study of adult patients hospitalized at 4 community hospitals …

Discrimination And Abuse Amongst Health Care Workers In A Tertiary Hospital In Kenya, Farah Alnoor Ebrahim

Master of Medicine in Internal Medicine

Background: Discrimination is defined as the unequal or disadvantageous treatment of an individual or a group of individuals. Discrimination in the health care setting can take many forms, including gender, race, verbal or emotional abuse, physical abuse, and sexual abuse. The prevalence of discrimination varies, with common forms being gender and racial discrimination as well as verbal and emotional abuse. Workplace discrimination often leads to a hostile environment for healthcare workers, resulting in significant mental strain. Patients, their relatives, and consultants are the foremost perpetrators of discrimination and abuse across the globe. Little is known about discrimination and abuse within …

Diagnostic Utility Of Red Cell Indices In Relation To Serum Iron Indices For Evaluation Of Iron Deficiency In Heart Failure, Larry Wangai Mburu

Master of Medicine in Internal Medicine

Background: Iron deficiency (ID) in heart failure (HF) causes poorer outcomes, and evaluation using ferritin and transferrin saturation (TSAT) in our setting is hampered by cost and availability. Though the red cell indices (RCIs), routinely used for assessment of ID anaemia, have shown utility in predicting outcomes in HF, they have not been evaluated in this population for prediction of ID relative to the iron indices. A combination of the RCIs, the combined cell index (CCI), may be more accurate. Validating the diagnostic accuracy of the RCIs would improve evaluation of ID in low-resource settings and improve uptake of iron …

Dysglycemia In Patients Presenting With Stroke And Acute Coronary Syndrome At Aga Khan University Hospital, Nairobi, Beverly Yongo Owino

Master of Medicine in Internal Medicine

Background: Dysglycemia is often diagnosed late in sub-Saharan Africa with a significant number of patients presenting with complications. Data is needed to expand knowledge on the impact diabetes has on major adverse cardiovascular outcomes. Objective: We aimed to determine the prevalence of dysglycemia in patients with stroke and Acute Coronary Syndrome (ACS) and define characteristics of the patients with dysglycemia. Methods: A prospective cross-sectional study was conducted at Aga Khan University Hospital, Nairobi which is a tertiary facility. Consenting adults above 18 years (n=211) with stroke and acute coronary syndrome were recruited in the study in the period of April …