Internal Medicine Commons^™

The Current State Of Fellowship Leadership In Dermatology: Trends In Workforce Demographics And Scholarly Productivity, Steven Idell, David D Mcpherson, Jessica Martin, Andrew Dentino, Luis Ostrosky-Zeichner, Julia V Philley, Paul Mcgaha, Megan Devine, Jacqueline Bronicki, Daniel D Karp

Faculty, Staff and Student Publications

In 2018, The University of Texas Health Science Center-Tyler and University of Texas Rio Grande Valley were invited to develop clinical research units for an existing Clinical and Translational Science Award (CTSA) consortium with the objective to equip medically underserved, economically disadvantaged communities and subsequently to deploy COVID-19 clinical trials in response to a public health emergency.

Engineered Cord Blood Megakaryocytes Evade Killing By Allogeneic T-Cells For Refractory Thrombocytopenia, Bijender Kumar, Vahid Afshar-Kharghan, Mayela Mendt, Robert Sackstein, Mark R Tanner, Uday Popat, Jeremy Ramdial, May Daher, Juan Jimenez, Rafet Basar, Luciana Melo Garcia, Mayra Shanley, Mecit Kaplan, Xinhai Wan, Vandana Nandivada, Francia Reyes Silva, Vernikka Woods, April Gilbert, Ricardo Gonzalez-Delgado, Sunil Acharya, Paul Lin, Hind Rafei, Pinaki Prosad Banerjee, Elizabeth J Shpall

Faculty, Staff and Student Publications

The current global platelet supply is often insufficient to meet all the transfusion needs of patients, in particular for those with alloimmune thrombocytopenia. To address this issue, we have developed a strategy employing a combination of approaches to achieve more efficient production of functional megakaryocytes (MKs) and platelets collected from cord blood (CB)-derived CD34+ hematopoietic cells. This strategy is based on ex-vivo expansion and differentiation of MKs in the presence of bone marrow niche-mimicking mesenchymal stem cells (MSCs), together with two other key components: (1) To enhance MK polyploidization, we used the potent pharmacological Rho-associated coiled-coil kinase (ROCK) inhibitor, KD045, …

Why Test Results Are Still Getting "Lost" To Follow-Up: A Qualitative Study Of Implementation Gaps, Andrew J Zimolzak, Umber Shahid, Traber D Giardina, Sahar A Memon, Umair Mushtaq, Lisa Zubkoff, Daniel R Murphy, Andrea Bradford, Hardeep Singh

Faculty, Staff and Students Publications

BACKGROUND: Lack of timely follow-up of abnormal test results is common and has been implicated in missed or delayed diagnosis, resulting in potential for patient harm.

OBJECTIVE: As part of a larger project to implement change strategies to improve follow-up of diagnostic test results, this study sought to identify specifically where implementation gaps exist, as well as possible solutions identified by front-line staff.

DESIGN: We used a semi-structured interview guide to collect qualitative data from Veterans Affairs (VA) facility staff who had experience with test results management and patient safety.

SETTING: Twelve VA facilities across the USA.

PARTICIPANTS: Facility staff …

Inpatient Coding System And Opportunities For Documentation Optimization: An Interactive Session For Internal Medicine Residents, Lindsey Jordan Gay, Doris Lin, Ziba Colah, Glynda Raynaldo

Faculty, Staff and Students Publications

INTRODUCTION: The Inpatient Prospective Payment System, the framework for categorization of admissions, is based upon physician documentation leading to International Classification of Diseases, Tenth Revision code generation and Medical Severity Diagnosis-Related Group (MS-DRG) assignment. In this curriculum, we introduced internal medicine residents to this inpatient coding framework and its effects on hospital quality metrics and reimbursement. We focused on educating learners about the importance of physicians being proficient in providing thorough and specific clinical documentation to produce appropriate DRG assignment.

METHODS: Internal medicine residents participated in a 90-minute session that introduced the basic framework of inpatient coding, discussed effects of …

An Automated Risk Index For Diabetic Ketoacidosis In Pediatric Patients With Type 1 Diabetes: The Ri-Dka, David D Schwartz, Rosa Banuelos, Serife Uysal, Mili Vakharia, Kristen R Hendrix, Kelly Fegan-Bohm, Sarah K Lyons, Rona Sonabend, Sheila K Gunn, Selorm Dei-Tutu

Faculty, Staff and Students Publications

Identifying patients at high risk for diabetic ketoacidosis (DKA) is crucial for informing efforts at preventive intervention. This study sought to develop and validate an electronic medical record (EMR)-based tool for predicting DKA risk in pediatric patients with type 1 diabetes. Based on analysis of data from 1,864 patients with type 1 diabetes, three factors emerged as significant predictors of DKA: most recent A1C, type of health insurance (public vs. private), and prior DKA. A prediction model was developed based on these factors and tested to identify and categorize patients at low, moderate, and high risk for experiencing DKA within …

Paraventricular Vitamin D Receptors Are Required For Glucose Tolerance In Males But Not Females, Jessie Beck, Silvania Da Silva Teixeira, Keisha Harrison, Gabrielle Phillips, Yanlin He, Stephanie Sisley

Faculty, Staff and Students Publications

When delivered directly into the brain, vitamin D, can improve glucose levels in male mice. Additionally, the loss of the vitamin D receptor (VDR) in male mice's paraventricular hypothalamus (PVH) results in impaired glucose tolerance. Data in humans shows that low vitamin D levels are detrimental to glucose homeostasis, an effect that may be more prominent in men. However, it is unknown if vitamin D action in the brain is required for normal glucose regulation in female mice. This study shows that in both viral and genetic models, male mice with obesity and PVH VDR loss have impaired glucose tolerance …

Analysis Of Recurrent Urinary Tract Infection Management In Women Seen In Outpatient Settings Reveals Opportunities For Antibiotic Stewardship Interventions, Marissa A Valentine-King, Barbara W Trautner, Roger J Zoorob, George Germanos, Michael Hansen, Jason L Salemi, Kalpana Gupta, Larissa Grigoryan

Faculty, Staff and Students Publications

OBJECTIVES: We characterized antibiotic prescribing patterns and management practices among recurrent urinary tract infection (rUTI) patients, and we identified factors associated with lack of guideline adherence to antibiotic choice, duration of treatment, and urine cultures obtained. We hypothesized that prior resistance to nitrofurantoin or trimethoprim-sulfamethoxazole (TMP-SMX), shorter intervals between rUTIs, and more frequent rUTIs would be associated with fluoroquinolone or β-lactam prescribing, or longer duration of therapy.

METHODS: This study was a retrospective database study of adult women with

RESULTS: Among 214 patients with 566 visits, 61.5% of prescriptions comprised first-line agents of nitrofurantoin (39.7%) and TMP-SMX (21.5%), followed by …

Sr9009 Improves Heart Function After Pressure Overload Independent Of Cardiac Rev-Erb, Hui Li, Shiyang Song, Chih-Liang Tien, Lei Qi, Andrea Graves, Eleni Nasiotis, Thomas P Burris, Yuanbiao Zhao, Zheng Sun, Lilei Zhang

Faculty, Staff and Students Publications

The core clock component REV-ERB is essential for heart function. Previous studies show that REV-ERB agonist SR9009 ameliorates heart remodeling in the pressure overload model with transverse aortic constriction (TAC). However, it is unknown whether SR9009 indeed works through cardiac REV-ERB, given that SR9009 might target other proteins and that REV-ERB in non-cardiac tissues might regulate cardiac functions indirectly. To address this question, we generated the REV-ERBα/β cardiac-specific double knockout mice (cDKO). We found that REV-ERB cardiac deficiency leads to profound dilated cardiac myopathy after TAC compared to wild-type (WT) control mice, confirming the critical role of REV-ERB in protecting …

Diagnosis And Interpretation Of Testing For Cat Scratch Disease, Nasim Khalfe, Doris Lin

Faculty, Staff and Students Publications

Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae that presents as regional lymphadenopathy which can appear within weeks after a cat scratch. There is no gold standard for diagnosis. Rather, clinicians rely on an amalgam of criteria to make a definitive diagnosis. We describe a case of a 44-year-old woman with six cats who presented with a painful left inguinal mass, had splenic lesions on imaging, and had positive serology but a negative polymerase chain reaction test for B. henselae.

An Evidence-Based, Structured, Expert Approach To Selecting Essential Indicators Of Primary Care Quality, Sylvia J Hysong, Kelley Arredondo, Ashley M Hughes, Houston F Lester, Frederick L Oswald, Laura A Petersen, Lechauncy Woodard, Edward Post, Shelly Deperalta, Daniel R Murphy, Jason Mcknight, Karin Nelson, Paul Haidet

Faculty, Staff and Students Publications

BACKGROUND: The purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a …

Clinical Factors Implicated In Antibiotic Resistance In Helicobacter Pylori Patients, Brian White, Maria Winte, Joshua Desipio, Sangita Phadtare

Division of Internal Medicine Faculty Papers & Presentations

Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. py-lori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strat-egies. Consensus guidelines recommend use of proven …

The Difference In Nutrition Intake Adequacy Amonginstitutionalized Elderly Residents With And Without Sarcopeniaat Nursing Homes In Bandung, West Java, Delia Anastasia Tirtadjaja, Muhamad Apandi, Lazuardhi Dwipa

Jurnal Penyakit Dalam Indonesia

Introduction. The changes in the elderly’s daily routine including dietary intake and nutritional pattern may cause them to be more susceptible to malnutrition. The changes also increase the risk of sarcopenia that may lead to poor health outcomes such as fall injury, fracture, hospitalization, disability, or even death. Sarcopenia is more likely to occur in a nursing home compared to community settings. This study aimed to determine the difference in nutrition intake adequacy between institutionalized elderly subjects with and without sarcopenia in Bandung, West Java. Methods. A cross-sectional study was held in Ciparay and Budi Istri Nursing Home, Bandung, West …

Factors Associated With Length Of Stay Of Covid-19 Patients At Serui Regional General Hospital Papua Province: Cross-Sectional Study, Fahri Ahmad Baihaqi, Henny Rumaropen

Jurnal Penyakit Dalam Indonesia

Introduction. Coronavirus Disease 2019 (COVID-19) is a respiratory infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 has become a global health problem. The length of stay of the patient is related to the use of hospital resources. COVID-19 patients are at risk of increasing length of stay due to various factors and the increased length of stay can increase the burden of health services. The purpose of this study was to determine the factors that influence the length of stay of COVID-19 patients.Methods. An observational analytic study with a cross-sectional design was conducted at Serui Regional General …

The Relationship Of Subjective Global Assessment (Sga) With Energy Intake, Protein, Hand Grip Strength And Body Mass Index In Chronic Kidney Disease (Ckd) Patients With Continuous Ambulatory Peritoneal Dialysis (Capd), Yudhi Adrianto, Ni Made Hustrini, Triyani Kresnawan, Annisa Eka Amelia, Fitri Hudayani

Jurnal Penyakit Dalam Indonesia

Introduction. Energy and protein intake in chronic kidney disease (CKD) with continuous ambulatory peritoneal dialysis (CAPD) therapy plays an important role in balancing hypercatabolic conditions. Unbalanced intake will result in energy and protein deficits which are increasing the risk of muscle catabolism, decreasing body mass index (BMI), and malnutrition. Subjective global assessment (SGA) as the gold standard in nutritional assessment is needed in assessing nutritional status and determining malnutrition, therefore nutritional intervention can be delivered and improve CAPD patients’ quality of life. This study was conducted to determine the relationship between SGA with energy and protein intake, hand grip strength, …

Correlation Between Polypharmacy And Length Of Stay Geriatric Patient In Mohammad Hoesin Palembang Hospital, Iswadi Tanzil, Nur Riviati, Irsan Saleh

Jurnal Penyakit Dalam Indonesia

Introduction. Geriatric patients have multipathological characteristics, low physiologic reserves, atypical clinical signs and symptoms, decreased functional status, and nutritional disturbances. This situation is a risk factor for polypharmacy. Polypharmacy is closely related to drug side effects, drug interactions, and patient compliance. Polypharmacy is thought to have a relationship with the length of stay in geriatric patients. The purpose of this study was to determine the correlation between polypharmacy and length of stay in geriatric patients at Moehammad Hoesin Hospital Palembang. Methods. This was a cross-sectional study with a correlation test design conducted at Dr. Mohammad Hoesin Hospital (RSMH) Palembang from …

Depresi Pada Populasi Lanjut Usia Yang Menjalani Hemodialisis, Edward Faisal

Jurnal Penyakit Dalam Indonesia

Menurut laporan tahunan European Renal Association–European Dialysis and Transplant Association (ERA-EDTA), pasien yang menjalani transplantasi ginjal dari tahun 2014 sampai 2018 memiliki kesempatan hidup hanya setengah dari usia dengan sisa fungsi ginjal yang ditransplantasikan, sedangkan untuk pasien yang dilakukan hemodialisis (HD) adalah 70% lebih pendek.

Management Of Chronic Kidney Disease-Mineral And Bone Disorder (Ckd-Mbd), Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Chronic kidney disease (CKD) is still a burden on worldwide health issues affecting about 11-13% of the general population. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication in CKD, which occurs early in the disease, and progresses as kidney function deteriorates. With declining kidney function, mineral homeostasis becomes progressively dysregulated, including alterations in several parameters such as calcium, phosphate, intact parathyroid hormone (iPTH). Changes in these parameters are associated with bone disorders and vascular abnormalities, which are strongly correlated with increased cardiovascular (CV) morbidity and mortality, and overall mortality. Currently, CKD-MBD and its complication management have been …

Comparison Of Lipid Profiles In Patients With Type 2 Diabetes Mellitus With Good Glycemic Control And Poor Glycemic Control In Rsud Dr. Saiful Anwar Malang, Nyoman Satvika Dharma Yudha, Putu Moda Arsana, Rulli Rosandi

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia due to insulin resistance, deficiency of insulin action, or both with a prevalence of 8.5% in Indonesia. Evidence regarding the relationship between HbA1c and lipid profile in type 2 DM is currently contradictory, therefore a study was conducted to examine the relationship between glycemic control and lipid profile for DM patients.Methods. This survey research was conducted at the outpatient endocrine clinic Dr. Saiful Anwar Malang Hospital in 2014-2019 with a total of 1,308 patients. Patients were then classified into type 2 DM patients with good (HbA1c < 7%, n = 291) and poor glycemic control (HbA1c > 7%, …

Depressive Symptoms As A Predictor Factor Of All-Cause Mortality Within Six Months In Elderly Hemodialysis Patients, Langgeng Perdhana, Shofa Chasan, Yudo Murti Mupangati, Siti Nuraini

Jurnal Penyakit Dalam Indonesia

Introduction. Depression is a mental disorder that is often found in the elderly and hemodialysis patients, resulting in bad effects on patients. There is no study on the relationship between depression and all-cause mortality risk in elderly hemodialysis patients in Indonesia. This study aimed to determine the role of depression as a predictor factor of all-cause mortality within 6 months in elderly hemodialysis patients. Methods. A prospective cohort study was conducted from February to August 2020 at the hemodialysis unit of Roemani Muhammadiyah Hospital, Semarang. The inclusion criteria were elderly patients (aged ≥60 years), undergoing hemodialysis ≥3 months, hemodialysis frequency …

The Challenges Of Diagnosis And Management Of Suspectedautoimmune Hepatitis In A 34-Year-Old Woman With Periodicparalysis And Graves’ Disease, Yeni Larasati, C. Singgih Wahono

Jurnal Penyakit Dalam Indonesia

Periodic paralysis hypokalemia is a muscle weakness that can be caused by hyperthyroidism due to Graves’ disease. The prevalence reaches 10% of patients with periodic paralysis hypokalemia with symptoms of thyrotoxicosis. Graves’ disease is an immune system disorder that can cause other organ dysfunction, such as autoimmune hepatitis. Currently, the diagnosis of autoimmune hepatitis is still a challenge for clinicians due to limited supporting examination facilities, such as SMA, AMA, anti-LKM-1. This article discusses a case of a 34-year-old woman with limb weakness for 3 months, losing 4 kg of weight in 1 month, often feeling hungry, restless, having trouble …