Internal Medicine Commons^™

Recurrent Cyanotic Spells In An Octogenarian, Chin Tong Kwok, Chun Kit Wong

Journal of the Hong Kong College of Cardiology

We report rare case of an octogenarian who, after years of diagnostic delay, was found to have a patent foramen ovale, and due to an ascending aortic aneurysm that anatomically facilitated right-to-left shunt, presenting with life-threatening cyanotic attacks. The characteristic orthodeoxia-platypnea syndrome and high alveolar arterial gradient hint to the diagnosis. She was eventually treated successfully with urgent percutaneous PFO closure. Routine ordering of a transthoracic echocardiogram, without agitated saline injection under provocation maneuvers, may not be sufficient to rule out shunts.

The “Evolving” Role Of Intravascular Imaging In Myocardial Infarction With Nonobstructive Coronary Arteries, D L Fischman, Vaikom S. Mahadevan, Eric R. Bates

Division of Internal Medicine Faculty Papers & Presentations

No abstract provided.

Reply To The Letter To The Editor Titled “Before Blaming Legionella For Severe Rhabdomyolysis, Consider Alternative Triggers”, Harish Gopalakrishna, Ahmad Al-Abdouh, Gayatri Nair, Vinod Solipuram, Ammer Bekele

Journal of Community Hospital Internal Medicine Perspectives

No abstract provided.

Association Between Early Antibiotic Administration And In-Hospital Mortality In Moderate And Severe Covid-19 Patients, Lie Khie Chen, Jason Nathanael, Sharifah Shakinah, Adeline Pasaribu, Robert Sinto, Leonard Nainggolan, Adityo Susilo

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with moderate and severe COVID-19 generally receive antibiotic therapy with consideration of the possibility of co-infection or secondary bacterial infection which clinically is difficult to distinguish from COVID-19 symptoms. Overuse of antibiotics can lead to an increased risk of bacterial resistance to antibiotics which is associated with poor outcomes in COVID-19 patients. This study aimed to assess the effect of early antibiotic administration on mortality in moderate and severe COVID-19 patients. Methods. An observational study with a retrospective cohort design was conducted at Dr. Cipto Mangunkusumo Hospital. Data were obtained from medical records of patients admitted from March …

Cutaneous Adverse Drug Reaction Among Hiv-Infected Patients Starting Antituberculosis Treatment, Alvina Widhani, Teguh Harjono Karjadi, Evy Yunihastuti, Desi Salwani, Angga Pramudita, Saut Horas Nababan, Mirna Nurasri Praptini, Prionggo Mondrowinduro

Jurnal Penyakit Dalam Indonesia

Introduction. Treatment of tuberculosis (TB) in HIV patients is complicated due to numerous comorbidities and possible adverse effects. One of which is cutaneous adverse drug reaction (CADR). This adverse event is often difficult to manage because of multiple medications the patients get. The objective of this study was to know the prevalence and risk factors of CADR among HIV-infected patients starting anti-TB treatment. Methods. This retrospective study reviewed data from medical records of new patients at Working Group on AIDS outpatient clinic at Cipto Mangunkusumo Hospital, Indonesia in January 2008-December 2010 that had started anti-TB treatment. Risk factors of CADR …

Determinant Factors Of Cognitive Frailty In Elderly Patients, Valencia Santoso, Rensa Rensa

Jurnal Penyakit Dalam Indonesia

Introduction. Physical frailty and cognitive impairment have a strong relationship and there are differences in factors associated with cognitive frailty. This research aimed to determine the prevalence of cognitive frailty and identify factors associated with cognitive frailty in the elderly population in hospital polyclinic. Methods. A cross-sectional study with secondary data on patients aged ≥60 years in the Internal Medicine Polyclinic of Atma Jaya Hospital, Jakarta, from May 2020 to May 2021. The independent variables of this study were age, cardiovascular disease, type 2 diabetes mellitus, dyslipidemia, risk of malnutrition, risk of depression, and functional status. The alternative criteria by …

Effectiveness Of Garlic Extract (Allium Sativum) To Reduce Level Of Malondialdehyde Serum And Improve Quality Of Life In Patients With Chronic Hemodialysis: A Randomized Double-Blind Placebo-Controlled Trial, Amelia Istiqomah, Zulkhair Ali, Irsan Saleh

Jurnal Penyakit Dalam Indonesia

Introduction. Study reported that malondialdehyde (MDA) levels as an in vivo marker of oxidative stress were increased in patients undergoing hemodialysis. Antioxidants allicin compounds contained in garlic (Allium sativum) are known to have antioxidant activity by inducing antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and inhibiting prooxidant enzymes (nitric oxide synthase, xanthine, NADPH oxidase, and cyclooxygenase). This study aimed to investigate the effectiveness of Allium sativum to reduce level of MDA serum and improve quality of life in patients with chronic hemodialysis. Methods. This study was a crossover randomized double-blind placebo-controlled trial. The subjects were 40 chronic kidney …

Value Of Heart Rate Variability, Neutrophil-Lymphocyte Ratio And Quality Of Life Of Patients With Depressive Symptoms In Acute Myocardial Infarction, Hamzah Shatri, Mizanul Adli, Muhadi Muhadi, Murdani Abdullah, Cosphiadi Irawan, Rudi Putranto, Sukamto Koesnoe, Ika Prasetya Wijaya

Jurnal Penyakit Dalam Indonesia

Introduction. Major depression criteria can be found in more than 20% of coronary heart patients and more than 30% acute coronary syndrome patients have significant depressive symptoms. Several studies have shown that reduction of hearth rate variability (HRV) and enhancement of neutrophil lymphocyte ratio (NLR) can cause enhancement of morbidity and mortality in myocardial infarction patients. On the other hand, depression can cause reduction of HRV, enhancement of NLR and reduction of quality of life. This study aimed to determine differences in HRV, NLR and quality of life between acute myocardial infarction (AMI) patients with depressive symptoms and AMI patients …

Kecubung Intoxication: A Case Report On A 16-Year-Old Male At Kuningan District, Monica Djaja Saputera, Jessica Djaja Saputera

Jurnal Penyakit Dalam Indonesia

Kecubung (angel’s trumpet) is a plant with hallucinogen effect which contain a tropane alkaloid, which are widely grown in Indonesia and is widely abused by several groups of adolescents aged 18 years in East Nusa Tenggara. Kecubung intoxication is a common case in Indonesia, but rarely reported and hard to make a definitive diagnosis due to lack of the toxicology screening assessment. Besides, an antidote of this case also not available in this country. We present a case of 16-years old male who visited the emergency room with fluctuating level of consciousness accompanied by anxiety, anger, and a visual hallucination. …

Second-Line Therapy Tyrosine Kinase Inhibitor For Chronic Phase Chronic Myeloid Leukemia Resistant To Imatinib, Chici Pratiwi, Wulyo Rajabto

Jurnal Penyakit Dalam Indonesia

Since the era of tyrosine kinase inhibitor (TKI) therapy, there has been an increase in the median survival of chronic myeloid leukemia. Nevertheless, nowadays there were several cases of chronic myeloid leukemia that are resistant to the first-line TKIs, so that several second-line TKIs were introduced. Assessment of the therapeutic response was performed using a complete peripheral blood examination, bone marrow aspiration cytogenetic examination, and quantitative BCR-ABL examination. The treatment failure criteria were applied based on the ELN criteria. In selecting the second line TKI should be based on the results of mutation analysis and consider the safety profile of …

Pemberian Antibiotik Dini Berpengaruh Terhadap Mortalitas Covid-19?, Muchlis Achsan Udji Sofro

Jurnal Penyakit Dalam Indonesia

Coronavirus disease 2019 (COVID-19) merupakan infeksi saluran napas yang diakibatkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data di seluruh dunia sampai akhir Juni 2022 menunjukkan bahwa COVID-19 telah menyebabkan 6,2 juta kematian dengan jumlah 530 juta kasus.

Effect Of Advance Care Planning On Heart Failure Patients: An Evidence Based Case Report, Hamzah Shatri, Nandika Nurfitria, Dika Sinulingga, Vinandia Irvianita, Edward Faisal, Rudi Putranto, Diah Martina

Jurnal Penyakit Dalam Indonesia

Despite the advances in medical therapy, heart failure remains a disease that requires attention due to the course of the illness; it can lead to unpredictable, progressive, and fatal conditions. Existing therapy aims to improve the condition and prevent disease progression, with a balanced secondary therapy for various conditions that can trigger acute decompensated heart failure. Advances in technology and therapy may increase the prevalence of patients with heart failure, including prolonging the refractory phase of the disease. There are recommendations for advance care planning to support patient therapy and improve the quality of life of patients with heart failure. …

Suspected Anaphylactic Reaction Following Second Dose Of The Pfizer-Biontech (Bnt162b2) Coronavirus Vaccine In A Geriatric Female, Angelina Hong, Giezy Sardinas

HCA Healthcare Journal of Medicine

Anaphylaxis is a rare but serious adverse reaction that can occur following mRNA-based vaccination against coronavirus (COVID-19). This is a case of a geriatric patient presenting with hypotension and an urticarial rash with bullous lesions following a syncopal episode with incontinence. She received the second dose of the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine three days prior, and first developed the skin abnormalities the morning after receiving the vaccine. She had no past history of anaphylaxis or allergies to vaccinations.

Her presentation met the diagnostic criteria for anaphylaxis, according to the World Allergy Organization: she had acute onset illness involving the skin …

Case Study: Abnormal Presentation Of Infective Endocarditis With Streptococcus Canis And Chiari Network, Shahbaz Afzal, Ryan Russell, Alexander Chekhov

Advances in Clinical Medical Research and Healthcare Delivery

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis …

Exploring The Experiences Of Clients Receiving Opioid Use Disorder Treatment At A Methadone Clinic In Kenya: A Qualitative Study, Sarah Kiburi, Jackline Mwangi, Geoffrey Maina

Internal Medicine, East Africa

Background: Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program’s efectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya.

Method: This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefts and challenges. Interviews were transcribed, and NVIVO 12 software was used to …

An Unexpected Case Of Non-Uremic Calciphylaxis In A Patient With Multiple Risk Factors, Shannon Nugent, Fred Karaisz, Maisa Elbadawi, Andrew Touati, Neda Nikbakht, Jason B. Lee, Hasan Arif

Division of Internal Medicine Faculty Papers & Presentations

A 58-year-old woman with a history of morbid obesity, asthma, and prior warfarin use presented to the hospital with shortness of breath and a three-month history of painful, ulcerated ulcers with retiform purpura of her bilateral distal extremities. A punch biopsy specimen demonstrated focal necrosis and hyalinization of the adipose tissue with subtle arteriolar calcium deposition, findings consistent with calciphylaxis. We discuss the presentation of non-uremic calciphylaxis and review the risk factors, pathophysiology, and interdisciplinary management approach of this rare disease.

Comprehensive Review Of Cardiovascular Disease Risk In Nonalcoholic Fatty Liver Disease, Kevan Josloff, Jacob Beiriger, Adnan Khan, Richard J. Gawel, Richard S. Kirby, Aaron Kendrick, Abhinav K. Rao, Roy Wang, Michelle Schafer, Margaret Pearce, Kashyap Chauhan, Yash B. Shah, Gregary D. Marhefka, Dina Halegoua-De Marzio

Department of Medicine Faculty Papers

Nonalcoholic Fatty Liver Disease (NAFLD) is a growing global phenomenon, and its damaging effects in terms of cardiovascular disease (CVD) risk are becoming more apparent. NAFLD is estimated to affect around one quarter of the world population and is often comorbid with other metabolic disorders including diabetes mellitus, hypertension, coronary artery disease, and metabolic syndrome. In this review, we examine the current evidence describing the many ways that NAFLD itself increases CVD risk. We also discuss the emerging and complex biochemical relationship between NAFLD and its common comorbid conditions, and how they coalesce to increase CVD risk. With NAFLD's rising …

Cardiogenic Shock Due To Atrial Arrhythmia As The Initial Presentation Of Transthyretin Cardiac Amyloidosis, Svenja M. Schneider, Kirpal Kochar, Max Ruge, Stefanie Marek-Iannucci, Tanuka Datta, Alexander Hajduczok, Waqas Ullah, Indranee Rajapreyar, Yevgeniy Brailovsky

Jefferson Hospital Staff Papers and Presentations

Atrial arrhythmias are common in transthyretin cardiac amyloidosis (ATTR-CA), with a prevalence of ≤80%. They are often not well tolerated. We describe 3 patients with decompensated heart failure and cardiogenic shock precipitated by atrial arrhythmias who ultimately received diagnoses of ATTR-CA. (Level of Difficulty: Intermediate.)

Oral N-Acetyl Cysteine Versus Rectal Indomethacin For Prevention Of Post Ercp Pancreatitis: A Multicenter Multinational Randomized Controlled Trial, Pezhman Alavinejad, Nguyen-Phuong Nhu Tran, Omid Eslami, Omar El Shaarawy, Omar El Shaarawy, Ahmad Hormati, Seied Saeed Seiedian, Abazar Parsi, Mohammed Hussien Ahmed, Amna Subhan Butt

Section of Gastroenterology

Background: This multicenter multinational RCT designed to compare the efficacy of suppository indomethacin and NAC for prevention of PEP.
Methods: During a 6-month period, all of the ERCP cases in seven referral centers were randomly assigned to receive either 1200 mg oral NAC, indomethacin suppository 100 mg, 1200 mg oral NAC plus indomethacin suppository 100 mg or placebo 2 hours before ERCP. The primary outcomes were the rate and severity of any PEP.
Results: A total of 432 patients included (41.4% male). They were originally citizens of 6 countries (60.87% Caucasian). They were randomly allocated to receive either NAC (group …

Getting Ahead: A Resident Led Quality Improvement Project To Increase Diabetic Nephropathy Screening In An Underserved Hispanic-Predominant Population, Stephanie Luu, Jose Rivera, Daniel Aragon, Victor Zamora, Irma Huayanay, Reham Majzoub, Andreina Baird, Cristina Escobar, Eric Sanchez, Juan Carlos Lopez-Alvarenga, Daniela Hernandez, Chelsea Chang

Journal of Community Hospital Internal Medicine Perspectives

Introduction: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.

Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year.

Methods: We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and …