Internal Medicine Commons^™

Can Capture Be Used To Identify Undiagnosed Patients With Mild-To-Moderate Copd Likely To Benefit From Treatment?, Nancy K. Leidy, Fernando J. Martinez, Karen G. Malley, David M. Mannino, Meilan K. Han, Elizabeth D. Bacci, Randall W. Brown, Julia F. Houfek, Wassim W. Labaki, Barry J. Make, Catherine A. Meldrum, Wilson Quezada, Stephen Rennard, Byron Thomashow, Barbara P. Yawn

Preventive Medicine and Environmental Health Faculty Publications

Background: COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE™) uses five questions and peak expiratory flow (PEF) thresholds (males ≤350 L/min; females ≤250 L/min) to identify patients with a forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC)11 60%–80% predicted) who may also benefit from diagnosis and treatment.

Methods: Data from the CAPTURE development study were used to test its sensitivity (SN) and specificity (SP) differentiating mild-to-moderate COPD (n=73) from no COPD (n=87). SN and SP for differentiating all COPD cases (mild to severe; n=259) from those without COPD (n=87) were …

Daptomycin Associated Eosinophilic Pneumonia: Case Report And Differential Diagnoses., Sijan Basnet, Niranjan Tachamo, Rashmi Dhital, Biswaraj Tharu

Reading Hospital Internal Medicine Residency

Daptomycin is a bactericidal antibiotic approved for treatment of gram-positive skin and soft tissue infections. We present a case of an 89-year-old man who presented with fever, shortness of breath and nonproductive cough on week 4 of starting daptomycin for infective endocarditis. Computerized tomography scan showed bilateral interstitial infiltrates predominantly affecting the lower lobes. He also had peripheral eosinophilia of 6%. He was diagnosed with eosinophilic pneumonia secondary to daptomycin use. His symptoms improved with discontinuation of daptomycin and initiation of corticosteroids. Clinical correlation of pneumonia-like presentation with recent use of daptomycin should make physicians rule out this rare adverse …

Posterior Reversible Encephalopathy Syndrome (Pres) After Bevacizumab Therapy For Metastatic Colorectal Cancer., Mohsin Hamid, Ali Ghani, Ida Micaily, Usman Sarwar, Md, Bilal Lashari, Md, Faizan Malik

Abington Jefferson Health Papers

Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognizable neuro-clinical syndrome. Clinical and neurological manifestations of PRES include hypertension, headache, encephalopathy, seizures, and symmetrical white matter changes on brain MRI. Most common precipitants of PRES are acute medical illness, hypertensive crisis, eclampsia, immunosuppressive therapy, and chemotherapy. Bevacizumab is a monoclonal antibody that halts angiogenesis by inhibiting vascular endothelial growth factor. It has gained widespread popularity in oncology world especially for metastatic and recurrent cancers due to its inherent ability to stop angiogenesis; a vital step for tumor growth. Bevacizumab has also been implicated as the cause of PRES due to …

A Deadly Prescription: Combination Of Methotrexate And Trimethoprim-Sulfamethoxazole., Mohsin Hamid, Bilal Lashari, Irfan Ahsan, Ida Micaily, Usman Sarwar, Joseph Crocetti

Abington Jefferson Health Papers

Methotrexate (MTX) is a chemotherapeutic synthetic(s) phase cell cycle inhibitor, and its role has evolved as an immunological agent in autoimmune diseases like rheumatoid arthritis, psoriasis, and systemic lupus erythematosus, etc. Trimethoprim-sulfamethoxazole (TS) is one of the most widely prescribed antibiotics commonly used for urinary tract infections, exacerbations of chronic bronchitis, traveler's diarrhea, and pneumocystis pneumonia. Both MTX and TS can have significantly overlapping side effects involving dermatologic, renal, and hematological systems, and the combination of these can be deadly. Our case is about the combination of MTX and TS that leads to mucocutaneous ulceration, leukopenia, and renal insufficiency. The …

Multifactorial Aetiology For Non-Uremic Calciphylaxis: A Case Report., Sijan Basnet, Niranjan Tachamo, Rashmi Dhital, Biswaraj Tharu

Reading Hospital Internal Medicine Residency

Calciphylaxis is commonly associated with end-stage renal disease patients on haemodialysis. We present a rare case of calciphylaxis in a non-uremic patient. The diagnosis was made clinically and confirmed with skin biopsy showing calcification of the dermal and subcutaneous tissues in the von Kossa stain. We believe that the combination of uncontrolled diabetes mellitus, a non-functioning paraganglioma and vitamin D deficiency in a susceptible female patient was responsible for causing calciphylaxis in our patient. An index of suspicion should be maintained by clinicians for calciphylaxis even in patients without uremia.

Cross-Departmental Educational Program On Complex Airway And Epistaxis Management, Adam Vasconcellos, Md, Meghan Crawley, Md, Michael Topf, Md, Ryan Gerritsen, Md, Dominick Gadaleta, Md, Joseph Spiegel, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Internists, emergency medicine physicians, and intensivists routinely provide essential care for patients with complex airways (i.e. tracheostomy and laryngectomy) and patients with epistaxis. Any of these physicians may serve as first responder in a complex airway or epistaxis emergency situation. Therefore, a basic understanding of complex airway and epistaxis management is essential. The otolaryngology department aims to provide our colleagues with fundamental take-home points to improve crossdepartmental care of these patients.

Get With The Rhythm – Telemetry Education In Internal Medicine Residency, Rashesh Shah, Md, Hanna Sofie Ellingsen, Md, Molly Halloran, Md, Reetu Mukherji, Md, Juergen Kloo, Md, Yair Lev, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aim

• Our aim was to design and implement cardiac monitoring education for medical residents in order to help residents feel more comfortable navigating and assessing telemetry.
• Our objective was to create and pilot a telemetry education video among Internal Medicine residents (from March to May 2018) resulting in a 75% increase in ability to demonstrate essential telemetry skills as determined by a pre and post video assessment.

The ‘Med History Note’: A Standardized Method Of Reducing Medication History Errors Among Internal Medicine Residents In A Teaching Hospital, Odunayo Banjoko, Md, Babatunde Ogunnaike, Md, Genene Amoia-Pigliacelli, Pharmd, Doron Schneider, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Problem Statement

According to the institute of medicine’s preventing medication errors report, the average hospitalized patient is subject to at least one medication error per day. Errors have been known to occur during admission, transfer and discharge of patients. An accurate medication history on admission is crucial and can go a long way in preventing medication reconciliation errors. Of note, more than 40% of medication errors occur from inadequate reconciliation, during admission, transfer and discharge of patients. Of these, 20% result in harm.

The H Syndrome: A Genodermatosis, Sohaib Bhatti, Asma Jamil, Samrah Hasan Siddiqui, Uzair Yaqoob, Luqman Naseer Virk, Areesh Bhatti

Medical College Documents

H syndrome (histiocytosis lymph adenopathy plus syndrome) is an autosomal recessive disorder caused by mutations in the SLC29A3 gene, encoding the human equilibrative nucleoside transporter (hENT3), characterized by cutaneous hyperpigmentation and hypertrichosis, hepatosplenomegaly, hearing loss, heart anomalies, hypogonadism, low height, hyperglycemia/insulin-dependent diabetes mellitus, and hallux valgus/flexion contractures. Exophthalmos, malabsorption, renal anomalies, flexion contractions of interphalangeal joints and hallux valgus, and lytic bone lesions, as well as osteosclerosis, are also seen. If these are lacking, the constellation of additional findings should raise suspicion for H syndrome. As most of the patients reported to date with H syndrome are from traditional, low-income …

A Bibliometric Analysis Of The Top 100 Cited Articles On Hepatic Magnetic Resonance Imaging., Waqas Ullah, Hafez Mohammad A. Abdullah, Ejaz Ahmad, Mamoon Ur Rashid, Muhammad Bashir, Asad Ur Rahman, Asrar Ahmad, Abu Hurairah

Abington Jefferson Health Papers

The purpose of this study is to guide the readers to the impact of the articles published on hepatic magnetic resonance imaging (MRI). We searched Scopus using 10 different search terms for hepatic MRI. The selected studies were thoroughly reviewed by two independent authors and any disagreement was sorted out by mutual consensus. The list of articles and journals was downloaded into an excel spreadsheet. Only the top 100 cited articles were selected by mutual consensus among all the authors. These articles were further read in the full-text form and were further categorized into subgroups. Three authors independently reviewed the …

Letter To The Editor: Digital Dementia-Is Smart Technology Making Us Dumb?, Sanaa Moledina, Adeel Khoja

Section of Internal Medicine

No abstract provided.

Acinetobacter Infections: A Retrospective Study To Determine In – Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel

Master of Medicine in Internal Medicine

Background: Acinetobacter infections are increasingly being recognized as a cause for significant in – hospital morbidity and mortality worldwide. Increasingly multi – drug resistant strains of Acinetobacter are being isolated, increasing the burden on healthcare resources. Our objectives were to determine the outcomes and clinical factors related to outcomes of Acinetobacter infections at the Aga Khan University Hospital. Methods: A retrospective study of Acinetobacter infections (from any site) was conducted. Patient records were used to gather relevant clinical information. The collected data was tabulated and analysed for any significant differences in demographic or clinical variables. The Pearson Chi squared test …

The Disappearing Murmur: Systolic Anterior Motion Of The Mitral Valve Leaflet In A Non-Hypertrophic Cardiomyopathy Patient, Syed Rafay Ali Sabzwari, James R. Kimber, Hiwot Ayele, Nimra Khan, Tarick Sheikh, Ghulam Akbar Md, Bruce Feldman Do

Department of Medicine

Systolic anterior motion (SAM) of the mitral valve is a well-known phenomenon associated with left ventricular outflow tract obstruction and hemodynamic compromise. This finding may occur in patients with or without hypertrophic cardiomyopathy. In this report, a patient with no prior medical history presented to the hospital with left-sided chest pain and high-risk echocardiogram (ECG) findings. Left heart catheterization with coronary angiography was negative for coronary artery disease. His initial examination was significant for a systolic murmur due to the underlying SAM, as demonstrated by transthoracic echocardiogram. During his hospitalization, he developed acute heart failure syndrome as a result of …

Long-Term Outcomes And Factors Associated With Mortality Among Patients With Moderate To Severe Pulmonary Hypertension In Kenya, Abdulaziz Mansur Abeid

Master of Medicine in Internal Medicine

Background: Pulmonary hypertension (PH) is a condition that carries significant morbidity and mortality. Studies done in sub-Saharan Africa have reported poor short-term outcomes. However, data on long-term outcomes and prognostic factors are lacking. Objectives: This study sought to determine the one and two-year survival rates and prognostic factors associated with mortality in patients with moderate to severe PH. Methods: A retrospective review of moderate to severe PH patients [pulmonary artery systolic pressure (PASP), ≥45 mmHg] diagnosed at Aga Khan University Hospital, Nairobi from 2014 to 2017 was carried out. Demographic, clinical and in hospital outcome data were extracted from medical …

A Randomized Control Trial Of English-Speaking Advanced Cancer Patients At Akus Medical And Surgical Clinics And The Impact On Qol Of One Session Of Dignity Therapy, Miriam Gatehi-Muriithi

Master of Medicine in Internal Medicine

Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005. Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as Legacy documents to group 1 participants. Post intervention ESAS scores were obtained in both groups after 6 weeks. …

Exacerbation Recovery Patterns In Newly Diagnosed Or Maintenance Treatment-Naïve Patients With Copd: Secondary Analyses Of Ticari 1 Trial Data, David M. Mannino, Emmanuelle M. Clerisme-Beaty, Joanne Franceschina, Naitee Ting, Nancy K. Leidy

Preventive Medicine and Environmental Health Faculty Publications

Background: Little is known about the recovery patterns from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in newly diagnosed or maintenance treatment-naïve patients with COPD. This study describes the course of AECOPD in these patients at the time of treatment for the symptoms of acute respiratory tract infection (RTI).

Methods: This study was a secondary analysis of data from a 12-week, randomized clinical trial (TICARI 1) testing the efficacy and safety of once-daily tiotropium 18 µg maintenance therapy versus placebo in newly diagnosed or maintenance treatment-naïve COPD patients with acute RTI symptoms for ≤7 days. Patients received standard care …

Capecitabine And Temozolomide In Neuroendocrine Tumor Of Unknown Primary, Aman Chauhan, Zainab Farooqui, Leaundra Murray, Heidi L. Weiss, Zin W. Myint, Arun Kumar A. Raajasekar, B. Mark Evers, Susanne M. Arnold, Lowell B. Anthony

Internal Medicine Faculty Publications

Incidence of low grade well-differentiated neuroendocrine tumors (NET) is on the rise. The North American Neuroendocrine Tumor Society estimates that the United States has more than 150,000 gastroenteropancreatic NET patients. About 10% of metastatic NETs can be unknown primary, and due to their rarity, dedicated treatment algorithms and regimens are not defined. Combination of capecitabine and temozolomide (CAPTEM) is one of the systemic treatments used in gastroenteropancreatic NETs. We explored clinical activity of CAPTEM in NET of unknown primary. Methods. Retrospective review of NET of unknown primary managed at the University of Kentucky over the past five years (2012–2016). …

Nontypeable Haemophilus Influenzae Meningitis In The Context Of Endoscopic Endonasal Surgery – A Case Report., Ricky Buckshaw Do, Casey Judge Do, Jennifer Strow Do

Department of Medicine

No abstract provided.

The Non-Healing Lleocecal Ulcer., Kyle Kreitman Do, Patrick Hickey Do, Paola Blanco Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

A Neuroendocrine Presentation Of Sarcoidosis Not To Be Forgotten., Sandhya Venkataraman Do, Thomas Quinn Do

Department of Medicine

No abstract provided.

Ganglioglioma Masked As Migraines., Kyle Kreitman Do

Department of Medicine

No abstract provided.

Pituitary Apoplexy Mimicking A Meningoencephalitis., Chun Chu Md, Gretchen A. Perilli Md, Rachel Kinney Do, Stacey Smith Md, Facp

Department of Medicine

No abstract provided.

Scurvy In An Alcohol Dependent Patient With Cirrhosis And Encephalopathy – A Case Report., Ricky Buckshaw Do, Ryan Murphy Do

Department of Medicine

No abstract provided.

Going Beyond The Final Impression With Radiologic Data In The Era Of Clerical Medicine: A Case Report Of Coronary Artery Disease Found Incidentally On Computed Tomography, Andrea M. Lauffer

Marshall Journal of Medicine

Introduction:

Given the challenges in modern healthcare, physicians find themselves devoting a great deal of mental and emotional energy into executing the appropriate care for patients as well as performing their daily clerical duties. Many clinicians have resorted to innovative ways to minimize their tasks which often leads to narrowing the focus of a patient’s overall care and the birth of medical errors described in the Swiss cheese effect model.

Case Description:

A 66 year old male established care with a new primary care physician. Previous radiologic data revealed a pulmonary nodule that did not have appropriate follow up imaging. …

Herpes Zoster Patient Education: A Coloring Book Approach, Sophia Charuhas

Senior Honors Theses

Shingles, the disease caused by the herpes zoster virus, is a widespread and widely misunderstood illness in the United States. It is preventable, but many at-risk patients do not know what measures they may take to prevent it. Clear communication from physician to patient is crucial for patient understanding of diseases. Many patient education materials on herpes zoster currently available are often unused. It is therefore beneficial to public health to disseminate new mediums of medical communication, and one way of accomplishing this is through adult coloring books. The pathophysiology of herpes zoster virus is here explored and the idea …

Understanding Patient Uncertainty As A Driver Of Emergency Department Utilization: A Concept Mapping Approach, Angela Gerolamo, Phd, Rn, Shannon Doyle, Mph, Rhea E. Powell, Md, Mph, Amanda M.B. Doty, Ms, Marianna Lanoue, Phd, Kristin L. Rising, Md, Mshp

Department of Emergency Medicine Posters

Background and Purpose

• Most previous research regarding factors associated with increased risk of emergency department (ED) use has been done via retrospective review of medical records rather than obtaining patients’ perspectives.
• Recent research identified patient uncertainty related to symptoms as a primary motivator for seeking ED care, and ongoing uncertainty at the time of ED discharge as an unmet need (Rising et al. 2015; Rising, Hudgins, Reigle, Hollander, & Carr 2016).
• While providers have limited ability to influence many factors identified by retrospective medical record review (e.g. financial concerns), patient uncertainty can be addressed by providers directly. To do so …

Insufficiency Of Dna Repair Enzyme Atm Promotes Naive Cd4 T-Cell Loss In Chronic Hepatitis C Virus Infection, Juan Zhao, Xindi Dang, Peixin Zhang, Lam Nhat Nguyen, Dechao Cao, Lin Wang, Xiaoyuan Wu, Zheng D. Morrison, Ying Zhang, Zhansheng Jia, Qian Xie, Ling Wang, Shunbin Ning, Mohamed El Gazzar, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

T cells have a crucial role in viral clearance and vaccine response; however, the mechanisms regulating their responses to viral infections or vaccinations remain elusive. In this study, we investigated T-cell homeostasis, apoptosis, DNA damage, and repair machineries in a large cohort of subjects with hepatitis C virus (HCV) infection. We found that naive CD4 T cells in chronically HCV-infected individuals (HCV T cells) were significantly reduced compared with age-matched healthy subjects. In addition, HCV T cells were prone to apoptosis and DNA damage, as evidenced by increased 8-oxoguanine expression and γH2AX/53BP1-formed DNA damage foci—hallmarks of DNA damage responses. Mechanistically, …

A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile And Connected Tools For Underserved Individuals With Type 2 Diabetes And Comorbid Overweight Or Obesity: Pilot Comparative Effectiveness Trial, Jing Wang, Chunyan Cai, Nikhil Padhye, Philip Orlander, Mohammad Zare

Faculty, Staff and Student Publications

BACKGROUND: Self-monitoring is a cornerstone of behavioral lifestyle interventions for obesity and type 2 diabetes mellitus. Mobile technology has the potential to improve adherence to self-monitoring and patient outcomes. However, no study has tested the use of a smartphone to facilitate self-monitoring in overweight or obese adults with type 2 diabetes mellitus living in the underserved community.

OBJECTIVE: The aim of this study was to examine the feasibility of and compare preliminary efficacy of a behavioral lifestyle intervention using smartphone- or paper-based self-monitoring of multiple behaviors on weight loss and glycemic control in a sample of overweight or obese adults …

Gastric Calcifying Fibrous Tumor Mimicking Gi Stromal Tumor, Nneoma Okoronkwo, Shima Ghavimi, Ravi Chokshi, Stephen Peters, Sushil Ahlawat

Internal Medicine

A 27-year-old female with no significant medical history was referred for an EUS to evaluate a large, firm, gastric mass, which was detected during esophagastroduodenoscopy done for persistent reflux symptoms and intermittent epigastric pain. EUS revealed a polypoid, broad-based, solid intramural mass, 2 cm x 4 cm in size, heterogeneous in echo-texture with calcifications and post-acoustic shadowing. The polypoid gastric mass appeared to arise from the muscularis propria.

The Role And Safety Of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration In The Diagnosis And Management Of Infected Bronchogenic Mediastinal Cysts In Adults, Hazim S. Bukamur, Emad Alkhankan, Haitem Mezughi, Nancy J. Munn, Yousef R. Shweihat

Internal Medicine

Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such …