Internal Medicine Commons^™

Phq 9 Utilization In Maine Health, Steven Gerrish, Kerri Barton, Neil Korsen

Costas T. Lambrew Research Retreat 2021

The PHQ is a brief patient survey for diagnosing depression and monitoring response to treatment.

A Retrospective Review Of Outcomes In Intensive Care Unit Patients Infected With Sars-Cov2 In Correlation To Admission Acute Physiologic Assessment And Chronic Health Evaluation Ii Scores, Pratishtha Singh, Kayle M. Warren, Hannah Adler, Andrew Mangano, Jilian Sansbury, Richard Duff

South Atlantic Division GME Research Day 2021

No abstract provided.

Assessment Of Palliative Care Needs In A Kenyan Intensive Care Unit Based On A Trigger-Based Model., Linda Atero Barasa

Master of Medicine in Internal Medicine

Background: Palliative care triggers have been used in the Intensive Care Unit (ICU) setting, usually in high-income countries, to identify patients who may benefit from palliative care consults. The utility and benefits of palliative care triggers in the ICU have not been previously studied in sub-Saharan Africa. Objectives: The primary objective of this study was to estimate the prevalence of ICU admissions who meet the criteria for one or more palliative care triggers. The secondary objectives were to determine an association between palliative care consults and length of ICU stay, mortality, and time to formal change of goals of care …

Compliance Of Checking Hba1c In A Tertiary Care Hospital Of Pakistan, Abdul Aziz, Syed Ahsan Ali

Section of Diabetes, Endocrinology and Metabolism

Background and objectives: The prevalence of diabetes mellitus worldwide was 171 million one and half decade ago, while the prediction is 366 million patients by 2030 and more than 640 million people by 2040. HbA1c value represents average blood glucose over the past 2-3 months and accounts for both pre-prandial and post-prandial blood glucose levels. A link between HbA1c and diabetic complications has been confirmed. In general, patients with controlled diabetes mellitus should have at least biannual testing, while patients with uncontrolled diabetes mellitus or unmet glycemic targets should be tested every three months. The objective was to see compliance …

F-Wave Parameters And Body Mass Index In Carpal Tunnel Syndrome, Philip Adebayo, Rose E. Mwakabatika

Internal Medicine, East Africa

Background: Severe carpal tunnel syndrome (CTS) readily lends itself to both clinical and electrophysiological recognition. The uncertainty sometimes is in identifying and quantifying motor involvement in mild and, perhaps, in moderate CTS. Our study aimed to evaluate F responses in mild and moderate CTS and determine the contribution of BMI to the F-wave parameters.

Methods: A retrospective review of the clinical and electrophysiological data of patients with CTS seen at the clinical neurophysiology laboratory of Aga Khan Hospital, Dar es Salaam, between 1 August 2017 and 31 July 2019 was retrieved. Carpal tunnel syndrome was graded according to the …

Occult Hepatitis B Virus Infection In A Kenyan Cohort Of Hiv Infected Anti-Retroviral Therapy Naïve Adults, Adil Salyani, Jasmit Shah, Rodney Adam, George Otieno, Evelyn Mbugua, Reena Shah

Internal Medicine, East Africa

Background: Occult hepatitis B virus (HBV) infection (OBI) is a phase of HBV infection characterised by the presence of HBV DNA in the absence of detectable hepatitis B surface antigen (HBsAg). OBI is of concern in the HIV-infected due to high prevalence and risk of HBV reactivation. The prevalence and clinico-demographic characteristics of OBI in anti-retroviral therapy (ART) naïve HIV infected adults in Kenya is unknown.

Methods: A cross sectional study carried was out at three sites in Kenya. HIV infected ART naïve adults were enrolled and demographic data collected. Blood samples were assayed for HBsAg, HBV DNA, alanine aminotransferase, …

Effective Monitoring Of Diabetic Patients On Progressive Chronic Kidney Disease Among Patients Attending Diabetic Clinic At Muhimbili National Hospital, Tanzania, Gudila Valentine Shirima, Paschal Ruggajo, Obadia Venance Nyongole, Francis Furia, Kimu Marko Njiku

Internal Medicine, East Africa

Background:

Diabetic Kidney Disease is a complication of Diabetes Mellitus (DM) following the natural history of diabetes. Worldwide up to 40 % of patients with diabetes mellitus will develop Diabetic Kidney Disease. Kidney Disease Outcome Quality Initiative (KDOQI) guidelines recommends monitoring for proteinuria, blood sugar, renal functions and blood pressure in the patients with DM so that progression to complications including renal failure is prevented. Our study aimed to audit on effective monitoring of progressive chronic kidney disease among patients attending diabetic clinic at Muhimbili National Hospital.

Material and methods:

This was a retrospective clinical audit which included patients who …

Seroprevalence Of Hepatitis B Virus Infection, Anti-Hcv Antibodies And Hiv And Knowledge Among People Who Use Drugs Attending Methadone Therapy Clinic In Tanzania: A Cross-Sectional Study, Semvua B. Kilonzo, Daniel I. W Gunda, David C. Majinge, Hyasinta Jaka, Paulina M. Manyiri, Fredrick Kalokola, Grahame Mtui, Elichilia R. Shao, Fatma Bakshi, Alex Stephano

Internal Medicine, East Africa

Background: Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania.

Methods: We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV.

Results: An overall …

Prevalence Of Incidental Prostate Carcinoma Among Patients Undergoing Turp For Benign Prostatic Enlargement, Isaac H. Mawalla, Masawa Nyamuryekung’E, Authar Ali, Aidan Njau, Philip Adebayo, Ali A. Zehri

Internal Medicine, East Africa

Background: Incidental prostate cancer is detected by histological examination of resected biopsy tissue that has been previously diagnosed as benign. It has the potential for progressing to become a disease necessitating active treatment. There is paucity of data on detection of incidental prostate cancer in Tanzania. A study done in northern Tanzania among the urban public sector revealed an alarming detection rate of 21.71%. We aimed to establish the prevalence of incidental prostate cancer among men surgically treated for benign prostate enlargement with considered normal range of prostate specific antigen.

Methods: This was a retrospective hospital-based cross-sectional study conducted to …

Prevalence And Severity Of Malnutrition In People Living With Hiv On Chronic Haemodialysis In Dar Es Salaam., Hanifa Mbithe

Master of Medicine in Internal Medicine

BACKGROUND: Human immunodeficiency virus is still a global burden more so in sub-Saharan Africa. Chronic kidney disease and end-stage renal disease are important comorbid conditions that are prevalent in HIV-infected individuals. Patients who are HIV positive and on hemodialysis have triple risk factors for development of malnutrition (i.e. Human immunodeficiency virus, chronic kidney disease, and haemodialysis). Malnutrition greatly impacts these patient’s morbidity and mortality and thus the great need to address this gap which will improve their prognosis. OBJECTIVE: The objective of the study was to assess the prevalence and severity of malnutrition in people living with HIV on chronic …

Dual-Functional Phosphorene Nanocomposite Membranes For The Treatment Of Perfluorinated Water: An Investigation Of Perfluorooctanoic Acid Removal Via Filtration Combined With Ultraviolet Irradiation Or Oxygenation, Joyner Eke, Lillian Banks, M. Abdul Mottaleb, Andrew J. Morris, Olga V. Tsyusko, Isabel C. Escobar

Internal Medicine Faculty Publications

Nanomaterials with tunable properties show promise because of their size-dependent electronic structure and controllable physical properties. The purpose of this research was to develop and validate environmentally safe nanomaterial-based approach for treatment of drinking water including removal and degradation of per- and polyfluorinated chemicals (PFAS). PFAS are surfactant chemicals with broad uses that are now recognized as contaminants with a significant risk to human health. They are commonly used in household and industrial products. They are extremely persistent in the environment because they possess both hydrophobic fluorine-saturated carbon chains and hydrophilic functional groups, along with being oleophobic. Traditional drinking water …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

Antibiotic Stewardship In Skin And Soft Tissue Infections, Shah Z. Ali, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

Antibiotic use during inpatient hospitalizations have a significant impact on both patient care and healthcare costs. Using data collected over a one month period in 2019 from inpatient hospitalizations, we aim to determine the most common indicated uses for vancomycin and piperacillin-tazobactam, along with the average days of therapy for their use in treating skin and soft tissue infections.

Management Of Refractory Ventricular Fibrillation With Double Sequential Defibrillation, Kaitlyn A. Brown

Capstone Showcase

Patients experiencing cardiac arrest are treated according to ACLS protocols, however current protocols lack recommendations for the treatment of refractory Ventricular Fibrillation which persists after more than 3 cycles of CPR and defibrillation. One potential intervention for these cases that is being researched is the use of simultaneous or sequential activation of two defibrillators. This literature review analyzed the results of several studies to determine if double sequential defibrillation (DSD) is a viable treatment to achieve return of spontaneous circulation (ROSC) and improved patient survival. The results of the studies were mixed with some showing positive outcomes, and others showing …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

A Rare Case Of Solid Pseudopapillary Neoplasm Of The Pancreas, Steven Michael, Nadeem Kassam, Aidan Njau, Omar A. Sherman, Harrison Chuwa, Salim Surani

General Surgery, East Africa

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity. It is almost exclusively seen in females within the second and third decades of life with only small minority affecting children. Due to the paucity of the number of cases seen, the natural history of the disease is not fully understood. SPN tumors of the pancreas are usually found incidentally and usually have an excellent prognosis. We herein present a case of a 33-year-old lady diagnosed with SPN, who presented with abdominal fullness, two weeks post cesarean sectio

Anorectal Malformation, Associated With Colon Atresia And Intestinal Malrotation, A Case Report, Allyzain Ismail, Lazaro Mboma, Victor Ngotta, Masawa Nyamuryekung'e

Internal Medicine, East Africa

Introduction and importance: In this case report from Muhimbili National Hospital, Dar es salaam, Tanzania, we present the unexpected findings of anorectal malformation, colonic atresia, and intestinal malrotation in a 2-day old neonate. This combination is exceedingly rare, with only case reports published in the literature. We describe the challenges in diagnosis and offer our insights based on this experience and review of the literature.

Case presentation: Our patient was a male born at term, weighing 2600 g, diagnosed clinically with a high anorectal malformation. He was planned for colostomy, and we unexpectedly found a collapsed descending colon. Exploration revealed …

Covid-19 And Teleneurology In Sub-Saharan Africa: Leveraging The Current Exigency, Philip Adebayo, Olusegun John Oluwole, Funmilola Tolulope

Internal Medicine, East Africa

Africa has over 1.3 billion inhabitants, with over 60% of this population residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural …

Determining Risk Factors That Affect Progression In Patients With Nonproliferative Diabetic Retinopathy, Dalbert J Chen, Jacky C Kuo, Alex J Wright, Alice Z Chuang, Wenyaw Chan, Robert M Feldman, Eric L Crowell

Faculty, Staff and Student Publications

PURPOSE: to determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR.

RESULTS: Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1-9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99,

CONCLUSION: HbA1c level is a significant modifiable risk factor in controlling …

Diagnosis Of Early Delayed Graft Function (Dgf) Using Timp-2*Igfpb-7 Product In Transplant Recipients: Preliminary Results, Russell Leong, Cassandra Rodd, Kellyann M. Gomes, Solomiia Savedchuk, Paul S. Kellerman

Conference Presentation Abstracts

Background: DGF is acute kidney injury (AKI) defined as need for dialysis within one week of renal transplant. AKI is defined by a change in serum creatinine (SCr), however early recognition is limited by delay in creatinine rise. Accurate early biomarkers may lead to prevention or treatment of established AKI. The product of two novel biomarkers of cell cycle arrest, tissue Inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IGFBP-7) have shown promise in predicting AKI. In prior studies, TIMP-2*IGFPB-7 ≤0.3 had high negative predictive value, and ≥2 high positive predictive value for AKI. Aims - 1) Investigate …