Internal Medicine Commons^™

Delayed Sternal Closure Does Not Reduce Complications Associated With Coagulopathy And Right Ventricular Failure After Left Ventricular Assist Device Implantation, Roh Yanagida, Navin Rajagopalan, Daniel L. Davenport, Thomas A. Tribble, Mark A. Bradley, Charles W. Hoopes

Internal Medicine Faculty Publications

Delayed sternal closure (DSC) is occasionally adopted after implantation of left ventricular assist device (LVAD). Recent studies suggest that DSC be used for high risk group of patients with coagulopathy, hemodynamic instability or right ventricular failure. However, whether DSC is efficacious for bleeding complication or right ventricular failure is not known. This study is single center analysis of 52 patients, who underwent LVAD implantation. Of those 52 patients, 40 consecutive patients underwent DSC routinely. The sternum was left open with vacuum assist device after implantation of LVAD. Perioperative outcome of the patients who underwent routine DSC were compared with 12 …

Cough, Hemoptysis And Hair Expectoration: An Intrapulmonary Teratoma, Shanila Ahmed, Habib Kibzai, Talha Shahzad, Saulat Fatimi, Madiha Bilal L Qureshi

Section of Haematology/Oncology

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs (gonads), they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum.We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis (hair expectoration).We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary …

Closed-Eye Visualizations In The Setting Of Hyponatremia., Travis Peck, Christopher Mercogliano, Eugene York

Reading Hospital Internal Medicine Residency

Purpose: To report a case of closed-eye visualizations and to clarify the different types of hallucinations and their etiologies.

Methods: Retrospective case report of a patient with closed-eye visualizations secondary to hyponatremia. Clinical findings, physical exam, laboratory assessment, treatment, and disease course from the patient's hospitalization were used in creating this report. Follow-up data after discharge were also obtained.

Results: Closed-eye visualizations were diagnosed as secondary to hyponatremia, as they did not occur with the eyes open, and potential alternate causes were excluded. Serum sodium nadir was 119 mEq/L. Symptoms resolved with correction of hyponatremia via fluid resuscitation and electrolyte …

Primary Thyroid Maltoma- A Rare Diagnosis Of An Unassuming Thyroid Nodule., Pragya Shrestha, Kimberly Aderhold, Sharon Swierczynski, Catherine Lin, Ronald Herb

Reading Hospital Internal Medicine Residency

Primary thyroid lymphoma, although a rare malignancy, can arise in common chronic inflammatory conditions such as Hashimoto's thyroiditis. Incidental finding of a thyroid nodule with chronic thyroid inflammation warrants further investigation. Early detection of malignancy can play a vital role in improved outcomes. We report a case of a 60-year-old male who presented to the clinic for a routine visit. An enlarged, firm, non-tender thyroid gland was appreciated on exam with high thyroid stimulating hormone (TSH) level. Fine needle aspiration of the mass revealed nonspecific atypical lymphocytes. The pathology and immunohistochemical stains were consistent with histologic impression of extra nodal …

Prevalence Of Irritable Bowel Syndrome, Psychological Ill-Health And Health-Seeking Behavior In A Population Of Nigerian Medical Students, Abiodun Christopher Jemilohun, Olukayode Abayomi, Philip Adebayo

Internal Medicine, East Africa

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with considerable morbidity and profound negative impact on quality of life. It has been observed that patients with psychological disturbances relate more frequently with the symptoms of IBS, and they have more debilitating illness than control populations. We examined the prevalence of IBS among a population of Nigerian medical students and its association with two common psychological conditions (anxiety and depression).

Methods: In a descriptive cross-sectional study, we enrolled 321 consenting medical students aged 20 to 50 years. A 34-item self-reporting questionnaire consisting of sociodemographic data, the Rome III …

Hepatitis B Virus Infection In Tanzania: Current Status And Challenges, Semvua B. Kilonzo, Daniel W. Gunda, Bonaventura C.T. Mpondo, Fatma Bakshi, Hyasinta Jaka

Internal Medicine, East Africa

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.

Chasing The Dragon, Daniel Young Cho, Hani Nazha, Kalin Fisher

Marshall Journal of Medicine

Abstract: Although rare, toxic leukoencephalopathy (TLE) associated with heroin inhalation have been reported. ‘Chasing the dragon’ may lead to progressive spongiform degeneration of the brain and presents with a large range of neuropsychological sequelae. A thorough social history and clinical suspicion are paramount in recognizing the diagnosis. This case is an example of TLE in a middle-aged white male with a history of polysubstance abuse. He presented with a three week history of progressive neuropsychological symptoms, including abulia, bradyphrenia, hyperreflexia, and visual hallucinations. He was initially suspected to have progressive multifocal leukoencephalopathy, however, JCV PCR was negative. MRI showed diffuse …

Infection Of A Ventricular Septal Defect Patch With Acremonium Species, Nosheen Nasir, Kauser Jabeen, Joveria Farooqi, Binish Arif Sultan, Afia Zafar, Aamir Hameed Khan, Muneer Amanullah, Farheen Ali

Section of Internal Medicine

A ventricular septal defect (VSD) patch infection with Acremonium species isolated from vegetation and blood culture is described. Antifungal treatment was discontinued after 3 months and patient developed relapse. Surgery with prolonged oral voriconazole was instituted with recovery. We emphasize importance of surgery and prolonged therapy to treat such infections.

Mammographic Breast Density And Breast Cancer Molecular Subtypes: The Kenyan-African Aspect, Asim Jamal, Maeve Mullooly, Shahin Sayed, Rose Ndumia, Innocent Abayo, James Orwa, Ronald Wasike, Zahir Moloo, Gretchen L. Gierach

Internal Medicine, East Africa

Introduction: Data examiningmammographic breast density (MBD) among patients in Sub-Saharan Africa are sparse.We evaluated how MBD relates to breast cancer characteristics in Kenyan women undergoing diagnostic mammography.

Methods: This crosssectional study included women with pathologically confirmed breast cancers (𝑛 = 123). Pretreatment mammograms of the unaffectedbreast were assessed to estimate absolute dense area (cm2), nondense area (cm2), and percent density (PD). Relationships between density measurements and clinical characteristics were evaluated using analysis of covariance.

Results: Median PD and dense area were 24.9% and 85.3 cm2. Higher PD and dense area were observed in younger women (𝑃 < 0.01). Higher dense and nondense areas were observed in obese women (𝑃-trend < 0.01). Estrogen receptor (ER) positive patients (73%) had higher PD and dense area than ER-negative patients (𝑃 ≤ 0.02). Triple negative breast cancer (TNBC) patients (17%) had lower PD and dense area (𝑃 ≤ 0.01) compared with non-TNBCs. No associations were observed between MBD and tumor size and grade.

Conclusions: Our findings show …

Beta-Catenin Cleavage Enhances Transcriptional Activation, Tatiana Goretsky, Emily M. Bradford, Qing Ye, Olivia F. Lamping, Tomas Vanagunas, Mary Pat Moyer, Patrick C. Keller, Preetika Sinh, Josep M. Llovet, Tianyan Gao, Qing-Bai She, Linheng Li, Terrence A. Barrett

Internal Medicine Faculty Publications

Nuclear activation of Wnt/β-catenin signaling is required for cell proliferation in inflammation and cancer. Studies from our group indicate that β-catenin activation in colitis and colorectal cancer (CRC) correlates with increased nuclear levels of β-catenin phosphorylated at serine 552 (pβ-Cat⁵⁵²). Biochemical analysis of nuclear extracts from cancer biopsies revealed the existence of low molecular weight (LMW) pβ-Cat⁵⁵², increased to the exclusion of full size (FS) forms of β-catenin. LMW β-catenin lacks both termini, leaving residues in the armadillo repeat intact. Further experiments showed that TCF4 predominantly binds LMW pβ-Cat⁵⁵² in the nucleus of inflamed and …

Refractory Abdominal Pain In A Patient With Chronic Lymphocytic Leukemia: Be Wary Of Acquired Angioedema Due To C1 Esterase Inhibitor Deficiency., Abdullateef Abdulkareem, Ryan S D'Souza, Joshua Mundorff, Pragya Shrestha, Oluwaseun Shogbesan, Anthony Donato

Reading Hospital Internal Medicine Residency

Acquired angioedema due to C1 inhibitor deficiency (C1INH-AAE) is a rare and potentially fatal syndrome of bradykinin-mediated angioedema characterized by episodes of angioedema without urticaria. It typically manifests with nonpitting edema of the skin and edema in the gastrointestinal (GI) tract mucosa or upper airway. Edema of the upper airway and tongue may lead to life-threatening asphyxiation. C1INH-AAE is typically under-diagnosed because of its rarity and its propensity to mimic more common abdominal conditions and allergic reactions. In this article, we present the case of a 62-year-old male with a history of recently diagnosed chronic lymphocytic leukemia (CLL) who presented …

Agranulocytosis Associated With Topiramate: A Case Report And Review Of Published Cases., Saroj Lohani, Niranjan Tachamo, Salik Nazir, Anthony Donato

Reading Hospital Internal Medicine Residency

A 41-year-old female presented to the hospital with sore throat and shortness of breath. She was hypoxic with an oxygen saturation of 87% in room air. Physical examination revealed swollen uvula with exudates. She had been started on topiramate for treatment of migraine few months ago. The dose of topiramate was increased to 100 mg twice daily 2 weeks ago. Complete blood count revealed an absolute neutrophil count (ANC) of 8 c/mm

Deciphering A Case Of Pulmonary Hypertension In A Young Female: Partial Anomalous Pulmonary Venous Drainage The Culprit, Hiten R. Patel, Suchit Bhutani, Fayez Shamoon, Hartaj Virk

Abington Jefferson Health Papers

Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital cardiac defect and is associated with sinus venosus atrial septal defect. While most cases are asymptomatic, a patient can present with pulmonary hypertension (PHTN) and it can be difficult to diagnose. Here, we discuss the case of a young female with PHTN who was found to have two right-sided PAPVD. Through this case, authors try to emphasize the importance of meticulous and thorough investigation when evaluating PHTN, which allows for correct diagnosis and a timely intervention before PHTN becomes irreversible.

Racial/Ethnic Disparities Among Asian Americans In Inpatient Acute Myocardial Infarction Mortality In The United States, E. J. Kim, N. R. Kressin, M. K. Paasche-Orlow, L. Lopez, J. E. Rosens, M. Lin, A. D. Hanchate

Journal Articles

No abstract provided.

Understanding The Digital Gap Among Us Adults With Disability: Cross-Sectional Analysis Of The Health Information National Trends Survey 2013, E. J. Kim, Y. Yuan, J. Liebschutz, H. Cabral, L. Kazis

Journal Articles

©Eun Ji Kim, Yiyang Yuan, Jane Liebschutz, Howard Cabral, Lewis Kazis. Background: Disabilities affect more than 1 in 5 US adults, and those with disabilities face multiple barriers in accessing health care. A digital gap, defined as the disparity caused by differences in the ability to use advanced technologies, is assumed to be prevalent among individuals with disabilities. Objective: This study examined the associations between disability and use of information technology (IT) in obtaining health information and between trust factors and IT use. We hypothesized that compared to US adults without disabilities, those with disabilities are less likely to refer …

Fertility Information Needs And Concerns Post-Treatment Contribute To Lowered Quality Of Life Among Young Adult Female Cancer Survivors, C. Benedict, B. Thom, D. N. Friedman, E. Pottenger, N. Raghunathan, J. F. Kelvin

Journal Articles

No abstract provided.

The Intersection Of Financial Toxicity And Family Building In Young Adult Cancer Survivors, B. Thom, C. Benedict, D. N. Friedman, J. F. Kelvin

Journal Articles

No abstract provided.

Disparities In Potentially Preventable Hospitalizations: Near-National Estimates For Hispanics, C. Feng, M. K. Paasche-Orlow, N. R. Kressin, J. E. Rosen, L. López, E. J. Kim, M. Y. Lin, A. D. Hanchate

Journal Articles

© Health Research and Educational Trust Objective: To obtain near-national rates of potentially preventable hospitalization (PPH)—a marker of barriers to outpatient care access—for Hispanics; to examine their differences from other race-ethnic groups and by Hispanic national origin; and to identify key mediating factors. Data Sources/Study Setting: Data from all-payer inpatient discharge databases for 15 states accounting for 85 percent of Hispanics nationally. Study Design: Combining counts of inpatient discharges with census population for adults aged 18 and older, we estimated age-sex-adjusted PPH rates. We examined county-level variation in race-ethnic disparities in these rates to identify the mediating role of area-level …

A Computerized Method For Measuring Computed Tomography Pulmonary Angiography Yield In The Emergency Department: Validation Study., S. Richardson, P. Solomon, A. O'Connell, S. Khan, J. Gong, A. Makhnevich, G. Qiu, M. Zhang, T. Mcginn

Journal Articles

BACKGROUND:Use of computed tomography pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) has markedly increased over the past two decades. While this technology has improved the accuracy of radiological testing for PE, CTPA also carries the risk of substantial iatrogenic harm. Each CTPA carries a 14% risk of contrast-induced nephropathy and a lifetime malignancy risk that can be as high as 2.76%. The appropriate use of CTPA can be estimated by monitoring the CTPA yield, the percentage of tests positive for PE. This is the first study to propose and validate a computerized method for measuring the CTPA …

Improvement In Parameters Of Hematologic And Immunologic Function And Patient Well-Being In The Phase Iii Resonate Study Of Ibrutinib Versus Ofatumumab In Patients With Previously Treated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma., J. C. Barrientos, S. O'Brien, J. R. Brown, N. E. Kay, N. M. Reddy, S. Coutre, C. Tam, S. Mulligan, U. Jaeger, P. Hillmen, +18 Additional Authors

Journal Articles

BACKGROUND: Ibrutinib compared with ofatumumab significantly improves progression-free and overall survival in patients with previously treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).

PATIENTS AND METHODS: Measures of well-being were assessed in RESONATE, where previously treated patients with CLL/SLL were randomized to receive ibrutinib 420 mg/day (n = 195) or ofatumumab (n = 196) for up to 24 weeks. Endpoints included hematologic function, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), disease-related symptoms, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 (EORTC QLQ-C30), and medical resource utilization.

RESULTS: With up to 24 months' follow-up (median, 16.4 …