Internal Medicine Commons^™

Perioperative Genitourinary Infection Associated With Sodium-Glucose Co-Transporter 2 Inhibitor Use., Stephen Melnick, Priya Rajagopalan, Theresa Lynn, Anthony Donato

Reading Hospital Internal Medicine Residency

Context: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are a novel treatment approved for type 2 diabetes mellitus to lower hyperglycemia, systolic blood pressure, and promote weight loss. Commonly reported serious adverse events include increased mycotic urogenital infections, orthostatic hypotension, and normoglycemic ketoacidosis. Case report: We present a case of a 47-year old man with a history of type 2 diabetes mellitus initiated on the SGLT-2 inhibitor canagliflozin preoperatively before a penile implant, who presented with late postoperative MRSA bacteremia and scrotal abscess requiring implant extraction. Conclusion: As the SGLT-2 inhibitors are gaining in popularity, prescribers must be aware …

Oral Contraception Woes: Idiosyncratic Drug Induced Liver Injury, Abdul Aleem Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

Role Of Hybrid Argon-Plasma Coagulation (Hybrid Apc) In The Management Of Barrett’S Esophagus: A Case Series Report, Abdul Aleem Md, Kyle Kreitman Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Microbiological Testing Of Adults Hospitalised With Community-Acquired Pneumonia: An International Study, Manuela Carugati, Stefano Aliberti, Luis Felipe Reyes, Ricardo Franco Sadud, Muhammad Irfan

Section of Pulmonary & Critical Care

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines.

This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureusPneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015.

In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), …

Strategies To Improve Post-Procedural Safe Patient Handoffs, Marguerite Peggy Anderson, Tara Herman, Janice Nichols, Robyn Dixon, Elizabeth Van Der Linden, Bonnie Boivin, Stephen Tyzik

Operations Transformation

STRATEGIES TO IMPROVE SAFE PATIENT HANDOFFS AND POST PROCEDURAL FLOW

During patient transfers from one care unit to another, it is imperative for patient safety and satisfaction that timely and complete communication between staff occurs. In an academic tertiary care medical center, a team consisting of representatives from 6 patient care units used improvement methods of operational excellence to improve patient centered movement.

The goal of this project was to improve the percentages of two questions related to information sharing on the FY2018 AHRQ Culture of Patient Safety Survey. Using baseline metrics to reflect the current state of patient wait …

Strategies To Improve Timeliness For Cleaning Inpatient Rooms Following Patient Discharge, Lora Dixon, Mark Parker, Ruth Hanselman, Suneela Nayak, Amy Sparks

Operations Transformation

STRATEGIES TO IMPROVE THE TIME FRAME FOR CLEANING INPATIENT ROOMS BY ENVIRONMENTAL SERVICES

In an inpatient rehab hospital, it was noted that Environmental Services (EVS) was delayed in cleaning rooms between patient discharges and admissions. This resulted in the frequent use of a “stat clean” order that allows only 50% of the normal cleaning time , forcing patients to wait and impacting patient flow.

A root cause analysis demonstrated lack of communication between the rehab hospital and the contracted cleaning services. A number of counter measures were initiated with the goal that cleaning would be started within 20 minutes of …

Improving Safe Handoffs & Transitions From The Ed To Adult Inpatient: A Response To The Ahrq Hospital Patient Safety Culture Survey, Natalie Talbot, Joanne Chapman, Rhonda Diphilippo, Gail Savage, Michele Higgins, Nancijean Goudey, Lori Sweatt, Erin Graydon Baker, Joseph East, Stephen Tyzik, Suneela Nayak, Mark Parker, Ruth Hanselman, Amy Sparks

Operations Transformation

SAFE TRANSITIONS AND PATIENT HANDOFFS IN A LARGE ACUTE CARE HOSPITAL

It is well documented in the literature that ineffective patient handoffs and transitions continues to be an area that can lead to adverse patient safety events so it is an urgent opportunity for a performance improvement plan. At an academic tertiary care medical center, the lowest scoring domain from the FY2017 AHRQ Patient Safety Culture Survey was patient handoffs and transitions.

A team was established consisting of staff from the Emergency Department and a medical/surgical unit to develop a plan for implementing improvement interventions. Their goal was to attain …

Reducing Substance Use By An Emergency Department Intervention, Matthew D. Marschall Do, Smeet Bhimani Do, Rachel Fieman Md, Derek J. Fikse Do, Paige Roth Lsw, Jennifer Stephens Do, Manuel F. Colón Bs, Kevin Weaver D.O.,Facoep, David M. Richardson Md, Marna R. Greenberg Do, Mph, Facep, Robert D. Cannon Do

Department of Emergency Medicine

No abstract provided.

The Association Between D-Dimer Concentration And Laboratory Parameters For Plasma Leakage In Dengue Infection, Suhendro Suwarto, Riyanti Astrid Diahtantri, Elian Hudiya

Jurnal Penyakit Dalam Indonesia

Introduction. Plasma leakage and activation of the coagulation system are the pathological hallmark of dengue hemorrhagic fever (DHF) that causes an increase in D-dimer concentration due to the degradation of fibrin clots. This study was conducted to determine the association between of D-dimer and laboratory parameters of plasma leakage, namely: thrombocytopenia, hypoalbuminemia, hemoconcentration and concentration serum glutamic oxaloacetic transaminase (SGOT) in dengue infected patients. Methods. A retrospective study was conducted at private hospitals in Jakarta, from December 2016 to March 2018. Patients >14 years with dengue infection and positive NS-1 were included in this study, and were classified into dengue …

Comparison Of Renal Safety Of Tenofovir And Telbivudine In Chronic Hepatitis B Patients: A Real World Study In Indonesia, Rino Alvani Gani

Jurnal Penyakit Dalam Indonesia

Introduction. Tenofovir disoproxil fumarate (tenofovir) and telbivudine are two available nucleos(t)ide analogue (NA) for the treatment of chronic hepatitis B (CHB) patients. Tenofovir has been known as a nephrotoxic agent in HIV patients, but still controversy in CHB patients. On the other hand, telbivudine had a renal protective effect and increased estimated glomerular filtration rate (eGFR). This studi aimed to address the renal safety of tenofovir and telbivudine in Indonesian patients. Method. A retrospective cohort study design was conducted in CHB patients who prescribed with tenofovir or telbivudine from January 2013 to December 2016. Patients who hade baseline eGFR

Cedera Hati Hipoksik Pada Infark Miokard Akut, Chyntia Olivia Maurine Jasirwan

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Composite Lymphoma: Hodgkin And Non-Hodgkin Lymphoma A Case Report, Noorwati Soetandyo, Ruth Vonky Rebecca, Maria Yunti, Arry Harryanto Reksodiputro

Jurnal Penyakit Dalam Indonesia

Composite lymphoma (CL) is a rare disease. Composite lymphoma is two or more different type of lymphoma that sequentially or simultaneously occur in one anatomical site. Making a diagnosis of CL is a challenge and there is still no guidelines about the treatment. This case report is about a 36 y.o female with CL, sequentially consisted of Hodgkin and non-Hodgkin lymphoma.

Hypoxic Liver Injury As Predictor Of Major Adverse Cardiac Events In Acute Myocardial Infarction Patients Admitted To Intensive Coroner Care Unit Of Cipto Mangunkusumo National General Hospital, Muhadi Muhadi, Nurhayati Adnan Prihartono

Jurnal Penyakit Dalam Indonesia

Introduction. Major adverse cardiac events (MACE) is a complicating myocard infarct which consist of acute heart failure, cardiogenic shock, and fatal arrhytmia. An accurate, easy and cost-effective biomarker is needed to predict MACE and mortality in patients with myocard infarct. Hypoxic liver injury (HLI) is a potential biomarker using serum glutamic-oxaloacetic transaminase (SGOT) level as the parameter. This study is aimed to discover HLI’s role in predicting MACE in non ST elevation myocard infarct (NSTEMI). Methods. This study was designed as cross sectional to predict MACE and prospective cohort for survival analysis. Study population was all NSTEMI patients admitted to …

Validation Of A2ds2 Score As Predictor Of Pneumonia Among Patients Hospitalized For Acute Ischemic Stroke, Toman Nababan, Ceva Wicaksono Pitoyo, Salim Harris, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. This study aimed to assess the performance of calibration and discrimination of A2 DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke. Methods. A retrospective cohort study was conducted among adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Age, atrial fibrillation, dysphagia, sex (male), and stroke severity …

The Differences Of Marital Satisfaction Of Odha Couples With And Without Depression Symptoms, Muhammad Ismail Salahudin, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro, Hari Peni Julianti

Jurnal Penyakit Dalam Indonesia

Introduction. HIV/AIDS disease has caused physical, social, and emotional problems to infected individuals and their spouses. ODHA couples have a prevalence of depression symptoms with physical complaints, which amounted to 12.7%. There is a relationship between love, communication, and physical intimacy to satisfaction in marriage. Depression in ODHA couples is correlated with marital satisfaction. This study aimed to analyze the differences of marital satisfaction of ODHA HIV negative couples who experience depression symptoms with ODHA who do not experience depression symptoms Methods. The research design was cross-sectional. The samples were 52 official couples of ODHA aged 18-60 years who had …

Antibiotic Treatment Based On Guidelines For Reducing Length Of Stay (Los) In Patients With Community Acquired Pneumonia (Cap), Fetri Charya Munarsih, Ronald Irwanto Natadidjadja, Syamsudin Syamsudin

Jurnal Penyakit Dalam Indonesia

Introduction. Community acquired pneumonia (CAP) now is known as the most common infection presented. Empiric antibiotic administered followed by observing parameters. This study aimed to know how far the American Thoracic Society/ Infectious Disease Society of America (ATS/IDSA) antibiotic guidelines 2007 based treatment influenced the length of stay (LOS) of CAP subject in a private hospital ward between January 2014-August 2015 Methods. A retrospective cohort was conducted with bivariate analysis and multivariate analysis for reducing the confounding factor. Sample taken with proportional sampling formula at ward in a hospital in Jakarta. Results. The result showed that subjects with unproper empiric …

Efficacy And Safety Of Oral Antidiabetic Drugs In Type 2 Diabetes Mellitus With Chronic Kidney Disease, Retta C. Sihotang, Rizka Ramadhani, Dicky L. Tahapary

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Takotsubo Cardiomyopathy Associated With Polycythemia Vera., Sijan Basnet, Priya Rajagopalan, Rashmi Dhital, Biswaraj Tharu

Reading Hospital Internal Medicine Residency

Takotsubo cardiomyopathy is characterized by transient apical ballooning with preserved basal ventricular function triggered by physical or emotional stressors. We present a case of a 75-year-old man referred to our facility for the management of acute myocardial infarction later diagnosed as takotsubo cardiomyopathy. We believe platelet-mediated adrenaline release from massive thrombocytosis might have been the precipitating factor for the pathogenesis of takotsubo cardiomyopathy.

Equal Efficacy Of Clopidogrel Versus Ticagrelor As Monotherapy In Peripheral Artery Disease, Aimee L. Vos

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Hiatt H, Fowkes G, Heizer G, et al. Ticagrelor versus clopidogrel in symptomatic peripheral artery disease. N Engl J Med. 2017;376:32-40. doi: 10.1056/NEJMoa1611688.

Hcv-Associated Exosomes Promote Myeloid-Derived Suppressor Cell Expansion Via Inhibiting Mir-124 To Regulate T Follicular Cell Differentiation And Function, Ling Wang, Dechao Cao, Ling Wang, Juan Zhao, Lam Nhat Nguyen, Xindi Dang, Yingjie Ji, Xiao Y. Wu, Zheng D. Morrison, Qian Xie, Mohamed El Gazzar, Shunbin Ning, Jonathon P. Moorman, Zhi Q. Yao

ETSU Faculty Works

Virus-infected cells can regulate non-permissive bystander cells, but the precise mechanisms remain incompletely understood. Here we report that this process can be mediated by transfer of viral RNA-loaded exosomes shed from infected cells to myeloid-derived suppressor cells (MDSCs), which in turn regulate the differentiation and function of T cells during viral infection. Specifically, we demonstrated that patients with chronic hepatitis C virus (HCV) infection exhibited significant increases in T follicular regulatory (TFR) cells and decreases in T follicular helper (TFH) cells. These MDSC-mediated T-cell dysregulations resulted in an increased ratio of TFR/TFH and IL-10 production in peripheral blood. Specifically, co-culture …

Autologous Blood Patch After Ct-Guided Lung Biopsy Might Reduce Pneumothorax Requiring Chest Tube Placement, Tiffani Strickland

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Malone LJ, Stanfill RM, Wang H, Fahey KM, Bertino RE. Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. American Journal of Roentgenology. 2013;200(6):1238-1243. doi: 10.2214/ajr.12.8980.

Inhibition Of Trf2 Accelerates Telomere Attrition And Dna Damage In Naïve Cd4 T Cells During Hcv Infection, Lam Nhat Nguyen, Juan Zhao, Dechao Cao, Xindi Dang, Ling Wang, Jianqi Lian, Ying Zhang, Zhansheng Jia, Xiao Y. Wu, Zheng Morrison, Qian Xie, Yingjie Ji, Zheng Zhang, Mohammed El Gazzar, Shunbin Ning, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

T cells play a crucial role in viral clearance and vaccine responses; however, the mechanisms that regulate their homeostasis during viral infections remain unclear. In this study, we investigated the machineries of T-cell homeostasis and telomeric DNA damage using a human model of hepatitis C virus (HCV) infection. We found that naïve CD4 T cells in chronically HCV-infected patients (HCV T cells) were significantly reduced due to apoptosis compared with age-matched healthy subjects (HSs). These HCV T cells were not only senescent, as demonstrated by overexpression of aging markers and particularly shortened telomeres; but also DNA damaged, as evidenced by …

A Systematic Review Of The Efficacy And Safety Of Fecal Microbiota Transplant For Clostridium Difficile Infection In Immunocompromised Patients, Oluwaseun Shogbesan, Dilli Ram Poudel, Samjeris Victor, Asad Jehangir, Opeyemi Fadahunsi, Gbenga Shogbesan, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Background: Fecal microbiota transplantation (FMT) has been shown to be effective in recurrent

Methods: We searched MEDLINE and EMBASE for English language articles published on FMT for treatment of CD infection in immunocompromised patients (including patients on immunosuppressant medications, patients with human immunodeficiency virus (HIV), inherited or primary immunodeficiency syndromes, cancer undergoing chemotherapy, or organ transplant, including-bone marrow transplant) of all ages. We excluded inflammatory bowel disease patients that were not on immunosuppressant medications. Resolution and adverse event rates (including secondary infection, rehospitalization, and death) were calculated.

Results: Forty-four studies were included, none of which were randomized designs. A total …

Evaluation Of Quality Of Warfarin Therapy By Assessing Patient's Time In Therapeutic Range At A Tertiary Care Hospital In Pakistan, Haris Hakeem, Ammar Zaman Khan, Kashif Aziz, Ayesha Abbasi, Anam Haider, Bushra Moiz, Mohammad Wasay

Section of Neurology

Objective: To assess the time in therapeutic range in patients on warfarin anti-coagulation therapy.

Methods: The retrospective chart review was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients having undergone anti-coagulation with warfarin from January 2013 to April 2015. To determine the mean time in therapeutic range, Rosendaal method was used. Association of time in therapeutic range with the composite outcome, bleeding and thromboembolic events was also assessed. Percentage of patients with time in therapeutic range <60% was calculated.

Results: There were 92 patients whose median time in therapeutic range was 34.9% (interquartile range: 20.0- 55.7). Overall, 71(77.2%) …

Utilization Of Imaging To Identify A Benign Condition Mimicking Acute Appendicitis In A Child, Neelam Phalke Md, Zubin Mehta Md, Samrat Das Md

School of Medicine Faculty Research

One of the most concerning causes of abdominal pain affecting children is acute appendicitis. However, there are benign conditions that can closely mimic appendicitis in children. In this article, we present a case of a child admitted for possible acute appendicitis and determined to have a condition known as omental infarction. The patient was managed medically and made a full recovery without surgical intervention. The aim of this case report is to review omental infarction and present a way of differentiating this disease from appendicitis, utilizing imaging, with the goal of avoiding surgical intervention. We also discuss the presentation and …

Anidulafungin: A Noninferior Alternative To Fluconazole For Treatment Of Esophageal Candidiasis, Blake S. Sanford

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Krause DS, Simjee AE, van Rensburg C, et al. A randomized, double-blind trial of anidulafungin versus fluconazole for the treatment of esophageal candidiasis. Clin Infect Dis. 2004;39(6):770-775. doi: 10.1086/423378.

Intravenous Glucocorticoids Provide No Additional Benefit Over Oral Glucocorticoids In Chronic Obstructive Pulmonary Disease Exacerbation, Alexander C. Waselewski

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of de Jong YP, Uil SM, Grotjohan HP, Postma DS, Kerstjens HA, van den Berg JW. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest. 2007;132(6):1741-1747. doi: 10.1378/chest.07-0208

The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa

The University of Louisville Journal of Respiratory Infections

Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.

Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for …

Continuous Infusion Of Epoprostenol As Salvage Therapy For Severe Pulmonary Arterial Hypertension, Jenna Rousseau, Jie Chi

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Barst RJ, Rubin LJ, Long WA, McGoon MD, Rich S. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. New Eng J Med. 1996;334(5):296-301. doi: 10.1056/nejm199602013340504

Bevacizumab: A Rare Cause Of Nonischemic Cardiomyopathy., Oreoluwa Oladiran, Salik Nazir

Reading Hospital Internal Medicine Residency

Left ventricular dysfunction is a rare side effect of bevacizumab occurring in 2-4% of cases. We report the case of a 68-year-old woman who presented to the emergency department (ED) with sudden onset of shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She was tachypneic and in respiratory distress. Physical examination revealed jugular venous distention, diffuse expiratory wheeze, and bipedal edema. She had been started on bevacizumab for the treatment of hereditary hemorrhagic telangiectasia 1 month prior to presentation. Laboratory tests revealed BNP of 1697 pg/ml with slightly elevated troponin 0.05 ng/ml. Chest X-ray showed interstitial edema with cardiomegaly, and …