Internal Medicine Commons^™

When Dequervain’S Depigments: A Case Of Iatrogenic Hypopigmentation, Tatiana Bekker, Md

The Medicine Forum

INTRODUCTION

Localized joint and soft tissue corticosteroid injections are being increasingly utilized to decrease inflammation, improve pain, and recover mobility. Adverse effects from injections are rare, with a 1% incidence of skin depigmentation.

Maggots—Friend Or Foe? Treating Myiasis In A Patient With Chronic Wounds, James Harrigan, Pharmd, Anita Modi, Md, Gretchen Diemer, Md

The Medicine Forum

INTRODUCTION

Myiasis, or the infestation of living vertebrates with dipterous (two-winged fly) larvae, can take many forms. Depending on their species, maggots will feed on living or dead tissue, liquid body substances, or even ingested food.1 The anatomical classification system of such larvae is based on the host location of infestation: sanguinivorous, cavitary, or cutaneous, including furuncular, migratory, or wound.1 While pathologic myiasis can result in significant morbidity in both humans and livestock, therapeutic myiasis has played an important role in wound debridement for centuries. This article will explore the varying forms of pathologic cutaneous myiasis and the evolving role …

Liver Abscess Turned Metastatic Infection In An Otherwise Healthy Patient: A Case Report, Samik Shah, Md, Ritu Nahar, Md, Neha Bansal Etherington, Md

The Medicine Forum

INTRODUCTION

The most common type of visceral abscesses are liver abscesses, which have a mortality rate of at least 2.5 percent.1,2 Most liver abscesses are polymicrobial, containing both facultative and anaerobic enteric pathogens, and develop secondary to another infection such as peritonitis and cholangitis, or from hematogenous spread.2-4 Liver abscesses are sometimes associated with systemic diseases such as colorectal cancer and diabetes mellitus.5,6 Rarely, as in our case presentation, primary liver abscesses occur spontaneously in patients with no identifiable precipitating or predisposing conditions.

Octreotide-Induced Hypoglycemia In A Cirrhotic Patient, Debbie Chen, Md

The Medicine Forum

INTRODUCTION

Hepatorenal syndrome (HRS) is characterized by functional renal impairment in patients with end-stage liver cirrhosis and no parenchymal kidney disease. It is due to splanchnic vasodilation, which results in renal vasoconstriction with consequent reduction in renal plasma flow and glomerular filtration rate.1 In the United States, treatment is with a combination of octreotide, midodrine, and human albumin to increase the effective blood volume and subsequently improve renal function.2 While octreotide, a long-acting somatostatin analog, is used to induce splanchnic vasoconstriction in this setting, it also affects the secretion of insulin and glucagon.

Case Report: Coexistence Of Papillary Thyroid Cancer And Thyroid Lymphoma, Christine Mathai, Md, Edward Ruby, Md

The Medicine Forum

We describe a case of a 75-year-old female found to have concurrent papillary thyroid cancer and diffuse large B cell lymphoma of the thyroid.

Cat Scratching Your Valve: An Elusive Case Of Bartonella Endocarditis, Ritu Nahar, Md, Evan Caruso, Md

The Medicine Forum

INTRODUCTION

Bartonella Henselae is an uncommon, but significant cause of “culture-negative” endocarditis. While six Bartonella species have reportedly caused infective endocarditis (IE) in humans, the vast majority of cases are secondary to either B. quintana or B. henselae. The epidemiologic features of patients predisposed to Bartonella endocarditis are varied. Alcoholism, body lice infestation, and homelessness have been associated with B. quintana endocarditis, while B. henselae endocarditis has been linked to prior valvular disease and cat exposure.1-4 Patients with Bartonella endocarditis have clinical manifestations similar to those seen with traditional forms of subacute bacterial endocarditis. However, the rarity of the disease …

Acute Aortic And Mitral Valve Insufficiency Precipitated By Infective Endocarditis, Raj Patel, Md, Tatiana Bekker, Md, Daniel Kramer, Md

The Medicine Forum

INTRODUCTION

Acute severe valvular regurgitation is a medical emergency requiring prompt recognition and diagnosis. Both mitral and aortic valve rupture, if left untreated, inevitably lead to advanced heart failure, cardiovascular collapse, and death. As such, rapid diagnosis is critical and surgical valve repair or replacement is a life-saving intervention. We present a case of a patient with both mitral valve and aortic valve bacterial endocarditis who developed acute valvular rupture, regurgitation, and cardiovascular collapse.

Roth Spots In Bacterial Endocarditis, Michael Weintraub, Md

The Medicine Forum

CASE PRESENTATION

A 30-year-old female with a history of intravenous drug use presented to the hospital with left wrist pain. Physical exam revealed a left volar ulnar wrist abscess with purulent drainage, a holosystolic murmur heard best at the apex radiating to the axilla and Janeway lesions on the right hand and bilateral feet. A transthoracic echocardiogram revealed a 20 mm mobile vegetation on the mitral valve along with valve perforation and severe regurgitation consistent with bacterial endocarditis. On eye exam, Roth spots (Figure 1) were noted bilaterally. Roth spots are present in less than 2% of all infective endocarditis …

Massive Pneumoperitoneum, Harry Wang, Md

The Medicine Forum

CASE PRESENTATION

A 72-year-old man with a past medical history of pancreatic adenocarcinoma status post biliary and duodenal stent placement presented to the emergency department for one week of cramping abdominal pain in the setting of a surveillance abdominal/pelvis computed tomography (CT) scan done two days prior to admission that showed massive pneumoperitoneum (Figure 1). The patient felt bloated but otherwise had no complaints on presentation. His physical exam was significant for marked abdominal distension with mild diffuse tenderness on palpation, normal bowel sounds, and no peritoneal findings of guarding or rebound. Given concern for perforated viscus causing pneumoperitoneum, he …

Clinical Image: Halo Sign, Brandon Menachem, Md, Alan Gandler, Md

The Medicine Forum

CASE PRESENTATION

A 68-year-old man with no significant past medical history was transferred to our hospital for evaluation of newly diagnosed acute leukemia. His bone marrow biopsy showed acute undifferentiated leukemia. He was initiated on standard induction chemotherapy with cytarabine and idarubicin. His hospital course was complicated by neutropenic fever secondary to Fusobacterium bacteremia. He was started on antibiotic therapy with intravenous cefepime and oral metronidazole. Intravenous vancomycin was added in the setting of recurrent intermittent fevers. On hospital day 20, he developed minimal hemoptysis, pleuritic chest pain, and recurrent fevers. A CT scan of the chest showed a right …

Table Of Contents: The Medicine Forum Volume 19, 2017-2018

The Medicine Forum

Table of Contents: The Medicine Forum Volume 19, 2017-2018

From The Editors, Neha Bansal Etherington, Md, Anita Modi, Md, Debbie Chen, Md, Brianna Shinn, Md, Colin Thomas, Md

The Medicine Forum

We are delighted to present you with the 19th annual edition of The Medicine Forum. Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

From The Desk Of The Residency Program Director, Emily Stewart, Md, Facp

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. This publication is just one example of the passion, dedication and creativity our residents continue to provide to the Jefferson Community. The residents are not just outstanding clinicians but excel in all aspects of medicine including: research, humanities and medical education.

The Medicine Forum: Volume 19

The Medicine Forum

The Medicine Forum: Volume 19

Ammonia Vs. Lactic Acid In Predicting Positivity Of Microbial Culture In Sepsis: The Alps Pilot Study, Yazan Numan, Yasir Jawaid, Hisham Hirzallah, Damir Kusmic, Mohammed Megri, Obadah Aqtash, Ahmed Amro, Haitem Mezughi, Emmon Maher, Yonas Raru, Jamil Numan, Sutoidem Akpanudo, Zeid Khitan, Yousef Shweihat

Internal Medicine

Objective: The use of serum ammonia as a novel marker for sepsis compared to lactic acid levels in intensive care unit (ICU) patients.

Design and Interventions: Single arm, prospective clinical trial to collect arterial blood samples from patients with sepsis. Serial ammonia and lactic acid levels were sent every six hours for a total of three days.

Measurements and results: Compare mean levels of ammonia and lactic acid in terms of diagnosing sepsis and patient outcome, including length of stay and mortality. A total of 30 patients were enrolled in the pilot study. On admission, mean ammonia level was 35.7 …

Aspirin In Primary Prevention Of Myocardial Infarction/Angina And Stroke In Hypertensive Patients, Aysha Almas, Muhammad Salman Ghazni, Shahrukh Hashman, Zain Mushtaq

Section of Internal Medicine

No abstract provided.

Association Of Catechol-Omethyltransferase (Comt Val158met) With Future Risk Of Cardiovascular Disease In Depressed Individuals - A Swedish Population-Based Cohort Study, Aysha Almas, Yvonne Forsell, Vincent Millischer, Jette Möller, Catharina Lavebrat

Section of Internal Medicine

Background: Catechol-O-methyltransferase (COMT Val¹⁵⁸Met) has been implicated in both depression and cardiovascular disease. The purpose of this study was to assess if COMT Val¹⁵⁸Met, which influences the COMT enzyme activity, has an effect on the risk of cardiovascular disease (CVD) in individuals with a history of depression and also to determine if the risk differs depending on gender.

Methods: Data from a longitudinal cohort study of mental health among Swedish adults was used. Depression was assessed twice 3 years apart for each participant, in 1998-2001 and 2001-2003. Saliva DNA was contributed by 4349 (41.7%) of the …

Pemeriksaan Prokalsitonin Pada Penyakit Infeksi, Erni Juwita Nelwan

Jurnal Penyakit Dalam Indonesia

Penegakkan diagnosis infeksi pada seorang pasien tidak selamanya mudah untuk dilakukan. Upaya ini harus selalu dimulai dari melakukan anamnesis yang terarah, pemeriksaan fisik yang menyeluruh ditambah dengan pemeriksaan laboratorium yang sesuai dengan kecurigaan tempat terjadinya infeksi.

Central Venous Access System, John Gurley

Internal Medicine Faculty Patents

A catheter system and method of use for re-establishing venous access near an occluded vessel.

Correlation Between Rheumatoid Factor And Vascular Cell Adhesion Molecule-1 Levels In Rheumatoid Arthritis Patients Without Metabolic Syndrome, Reza Yogaswara, Rudy Hidayat, Muhadi Muhadi, Ikhwan Rinaldi

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Bone Marrow Tuberculosis In Severe Systemic Lupus Erythematosus: A Case Study, Vinandia Irvianita Poespitasari, Anastasia Asylia Dinakrisma, Raden Mas Suryo Anggoro

Jurnal Penyakit Dalam Indonesia

No abstract provided.

The Role Of Clinical Sign And The Added Value Of Procalcitonin In Determining The Existance Of Infection In The Treated Diabetic Foot Ulcer, Andra Aswar, Em Yunir, Anis Karuniawati, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Performance Of Combination Of Symptoms, Chest X-Rays And Mgit 960 Culture For Diagnosis Of Pulmonary Tuberculosis In Hiv Patients, Desi Salwani, Ujainah Zaini Nasir, Evy Yunihastuti, Kuntjro Harimurti, Andriansjah Andriansjah

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Determinant Factors And Added Value Of Osteoprotegerin (Opg) To Detect Carotid Intima-Media Thickness (Cimt) In Type 2 Diabetes Mellitus Patient, Shirly Elisa Tedjasaputra, Em Yunir, Ika Prasetya Wijaya, Siti Setiati

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Relationship Between Serum Interferon Gamma Level With Sputum Positivity Of Acid-Fast Bacillus In New Case Pulmonary Tuberculosis, Andi Khomeini Takdir, Erwin Arief, Nur Ahmad Tabri, Arifin Seweng

Jurnal Penyakit Dalam Indonesia

No abstract provided.

The Distinction In Level Of Stress, Anxiety, And Depression Between Efavirenz With Nevirapine Therapies (Study On Hiv/Aids-Infected Patients At Vct-Cst Clinic Dr.Kariadi Hospital Semarang), Muflihatunnaimah Muflihatunnaimah, Alifiati Fitrikasari, Muchlis Achsan Udji Sofro

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Endoscopic Management Of Esophageal Strictures, Ahmad Hazim, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Exploring The Excluded Stomach: A Case Series Of Novel Endoscopic Techniques To Diagnose Gastric Cancer In The Excluded Stomach After Roux-En-Y Gastric Bypass Surgery, Saeed Ali, Abdelkader Chaar, Wesam Frandah, Rola Altoos, Zeeshan Sattar, Muhammad Hasan

Internal Medicine

Gastric cancer is the fifth most common malignancy worldwide and the fourth leading cause of cancer-related deaths. The diagnosis is usually made by direct visualization with supporting histopathology. However, patients with gastric bypass surgery pose a challenge in diagnosis due to the difficulty in the evaluation of the excluded stomach. We present two cases of gastric cancer in the excluded stomach after Roux-en-Y gastric bypass (RYGB) surgery was diagnosed using two different endoscopic approaches.

Precision Oncology Decision Support: Current Approaches And Strategies For The Future, Katherine C Kurnit, Ecaterina E Ileana Dumbrava, Beate Litzenburger, Yekaterina B Khotskaya, Amber M Johnson, Timothy A Yap, Jordi Rodon, Jia Zeng, Md Abu Shufean, Ann M Bailey, Nora S Sánchez, Vijaykumar Holla, John Mendelsohn, Kenna Mills Shaw, Elmer V Bernstam, Gordon B Mills, Funda Meric-Bernstam

Faculty, Staff and Student Publications

With the increasing availability of genomics, routine analysis of advanced cancers is now feasible. Treatment selection is frequently guided by the molecular characteristics of a patient's tumor, and an increasing number of trials are genomically selected. Furthermore, multiple studies have demonstrated the benefit of therapies that are chosen based upon the molecular profile of a tumor. However, the rapid evolution of genomic testing platforms and emergence of new technologies make interpreting molecular testing reports more challenging. More sophisticated precision oncology decision support services are essential. This review outlines existing tools available for health care providers and precision oncology teams and …

Urinothorax Caused By Xanthogranulomatous Pyelonephritis, Waiel Abusnina, Hazim Bukamur, Zeynep C. Koc

Internal Medicine

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.