Internal Medicine Commons^™

Barriers To Definitive Hyper-Acute Management Of Stroke At A Tertiary Facility In Nairobi, Kenya, Caroline Wangui Mithi

Master of Medicine in Internal Medicine

Background: Stroke is a sudden neurological deficit due to a vascular cause, which can be ischaemic, haemorrhagic stroke or another cause. It is a leading cause of disability and long term functional impairment in the world. The definitive management of an acute ischaemic stroke is thrombolysis and/or mechanical thrombectomy, both of which has been shown to improve functional outcome but the utilization remains quite low in most hospitals, especially in Africa. This is due to certain pre-hospital and in-hospital barriers, and these factors have been shown to differ from country to country. Objective: To determine the pre-hospital barriers that prevent …

Is Music Therapy Effective At Reducing Pain In Fibromyalgia Patients?, Amanda M. Vicznesky

PCOM Physician Assistant Studies Student Scholarship

The objective of this selective evidence based medicine (EBM) review is to determine whether or not music therapy is effective at treating pain in fibromyalgia patients.

STUDY DESIGN: This is a systematic review of three primary studies that were peer-reviewed published between the years of 2013-2016.

DATA SOURCES: Two randomized control trials and one cross-control study evaluating if music therapy is affective at treating pain in fibromyalgia patients. Data sources obtained for this review were found using PubMed Database.

OUTCOMES MEASURED: The outcome measured was the effectiveness of music therapy at reducing pain in fibromyalgia patients. Outcomes were measured via …

Interventions To Increase Research Publications In Graduate Medical Education Trainees: A Systematic Review., Ryan Zimmerman, Richard Alweis, Alexandra Short, Tom Wasser, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Introduction: Competency-based educational models recommend trainee exposure to research, but the best methods for Graduate Medical Education (GME) programs to accomplish this have not been clarified. The objective of this study was to quantify published interventions to generate resident research and compare effectiveness among those interventions.

Material and methods: A systematic review of English-language articles of studies of GME programs was performed, describing resident research interventions and quantifying the number of publications as an outcome.

Results: The search produced 13,688 potentially relevant articles, and included 47 articles in the final synthesis. Publication effectiveness was calculated as publications per year. The …

A Case Of Multisystem Langerhans Cell Histiocytosis Presenting As Central Diabetes Insipidus, P. Daniel Nicholas Iii, Ian Garrahy

Reading Hospital Internal Medicine Residency

Langerhans cell histiocytosis (LCH) is a rare malignancy most commonly characterized by histiocytic infiltration of bone. LCH lesions in the skull place the adjacent central nervous system (CNS) at risk for involvement, which can manifest as central diabetes insipidus (CDI) when there is infiltration of the hypothalamic-pituitary axis. We present a case of a 39-yearold female who presented with polyuria and polydipsia for 1 year and left-sided hearing loss, gait instability, and nystagmus for 5 days. She was found on laboratory evaluation to have CDI and underwent left cortical mastoidectomy for a destructive peripherally enhancing mastoid lesion seen on MRI …

Using Cirupa To Help Foster Communication With Families About Brain Death In Sub‑Saharan Africa, Sayed Karar, Anthony Ochola, Fatima Juma, Feroza Daroowalla

Internal Medicine, East Africa

Brain death, with a functioning cardiovascular system, remains a difficult issue to grasp for most families. Furthermore, conversations about brain death remain challenging even for the most experienced physicians. We developed an acronym, CIRUPA, to further improve the goals of care conversations in patients diagnosed with brain death. To our knowledge, this is the first acronym within Sub‑Saharan Africa, which helps provide a structured method on how to foster conversations centered around brain death.

Randomized Controlled Trial Of Influenza Vaccine In Patients With Heart Failure To Reduce Adverse Vascular Events (Ivve): Rationale And Design, Mark Loeb, Hisham Dokainish, Antonio Dans, Lia M. Palileo-Villanueva, Ambuj Roy, Ambuj Roy, Kamilu Karaye, Jun Zhu, Yan Liang, Gerald Yonga

Internal Medicine, East Africa

Background: Influenza is associated with an increase in the risk of cardiac and other vascular events. Observational data and small randomized trials suggest that influenza vaccination may reduce such adverse vascular events.

Research Design and Methods: In a randomized controlled trial patients with heart failure are randomized to receive either inactivated influenza vaccine or placebo annually for 3 years. Patients aged ≥18 years with a clinical diagnosis of heart failure and NYHA functional class II, III and IV are eligible. Five thousand patients from 10 countries where influenza vaccination is not common (Asia, the Middle East, and Africa) have been …

Mesenchymal Stromal Cell Therapeutic Delivery: Translational Challenges To Clinical Application, Henry Caplan, Scott D Olson, Akshita Kumar, Mitchell George, Karthik S Prabhakara, Pamela Wenzel, Supinder Bedi, Naama E Toledano-Furman, Fabio Triolo, Julian Kamhieh-Milz, Guido Moll, Charles S Cox

Faculty, Staff and Student Publications

For several decades, multipotent mesenchymal stromal cells (MSCs) have been extensively studied for their therapeutic potential across a wide range of diseases. In the preclinical setting, MSCs demonstrate consistent ability to promote tissue healing, down-regulate excessive inflammation and improve outcomes in animal models. Several proposed mechanisms of action have been posited and demonstrated across an array of in vitro models. However, translation into clinical practice has proven considerably more difficult. A number of prominent well-funded late-phase clinical trials have failed, thus calling out for new efforts to optimize product delivery in the clinical setting. In this review, we discuss novel …

Disseminated Tuberculosis And Gastric Mucormycosis Coinfection, Alexandre Malek, Alejandro De La Hoz, Roberto Arduino, Gabriel M Aisenberg

Faculty, Staff and Student Publications

Tuberculosis and mucormycosis coinfection has rarely been reported in the medical literature. We present a case of gastrointestinal (GI) mucormycosis in a diabetic patient with disseminated tuberculosis. Early diagnosis, addressing the risk factors for mucormycosis, surgical debridement, and timely antifungal treatment are the mainstay of care.

Depresi, Ansietas, Dan Komplikasi Pasca Sindrom Koroner Akut, Taufik Indrajaya

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Relationship Between Symptoms Of Depression And Anxiety With Major Adverse Cardiac Event In 7 Days In Patients With Acute Coronary Syndrome In Cipto Mangunkusumo Hospital, Diah Pravita Sari, E Mudjaddid, Eka Ginanjar, Muhadi Muhadi

Jurnal Penyakit Dalam Indonesia

Introduction. One of the causes of death in acute coronary syndrome is the occurrence of complication known as major adverse cardiac events (MACE). There are several predictors of the occurance of MACE in patients with ACS, including depression and anxiety. Thi study aimed to determine the association between depression and anxiety with major adverse cardiac events within 7 days in patients with acute coronary syndrome. Methods. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in …

The Effects Of Curcumin On Nf-Κb Level And Degree Of Liver Fibrosis In Rat Liver Fibrosis, Supriono Supriono, Bogi Pratomo, Dedy Indra Praja

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Infection Of Plasmodium Knowlesi Malaria In Human, I Gede Yasa Asmara

Jurnal Penyakit Dalam Indonesia

Plasmodium knowlesi (P. knowlesi) has been recognised as the fifth of malaria infections in human after P. vivax, P. falciparum, P. malariae and P. ovale. Epidemiology and clinical features of the disease have much been discussed only in several literatures since the incidence increased in Kapit Division, Sarawak, Malaysia in 2004. A large-scale research investigating real incidence of the infection in South East Asia is important. Because of rapid life cycle, the number of parasite in the blood can increase significantly, result in potential severe malaria. Pathophysiology aspect of the disease has not been clear yet, particularly on how severe …

Correlation Between History Of Fall And Timed Up And Go Test In Geriatric, Mifta Nurmalasari, Novira Widajanti, Rwahita Satyawati Dharmanta

Jurnal Penyakit Dalam Indonesia

Introduction. Fall is the global major problem in geriatrics as it causes physical and physicological impairment, even leads to mortality. Timed up and go test (TUG) is the screening method which commonly used in medical practice as standard examination to assess mobility, balance, and fall risk.This study aimed to determine the correlation between TUG and history of falls in geriatric patients at General Hospital Dr. Soetomo Surabaya, Indonesia. Methods. A cross-sectional study was conducted among geriatric patients in Dr. Soetomo hospital with criteria ≥ 60 years old, mini mental state examination (MMSE) score ≥ 17, did not suffer from hemiplegic …

Comparison Of Absolute Neutrophil Count Between Hospital And Community Acquired Methicillin-Resistant Staphylococcus Aureus Infection, Kurniyanto Kurniyanto, Widayat Djoko Santoso, Leonard Nainggolan, Juferdy Kurniawan

Jurnal Penyakit Dalam Indonesia

Introduction. The virulence factors from community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) mainly due to toxins like Panton Valentin Leukocidin (PVL) and Phenol Soluble Modulin (PSM). Both of toxins cause decrease of value through neutrophil lysis. This study aimed to identify different value of absolute neutrophil count between hospital and community acquired MRSA. Methods. A cross sectional was conducted which included subjects who were infected by MRSA and hospitalized during 2012-2017. Classification of MRSA were divided due to its sensitivity and resistance to non-beta lactam antibiotics. Isolate that resistance to ≤ 2 antibiotics were classified as CA-MRSA. The others with resistance …

Relationship Between Neutrophil Lymphocyte Ratio And Lower Extremity Peripheral Artery Disease In Patients With Type 2 Diabetes Mellitus, Krishna Adi Wibisana, Imam Subekti, Dono Antono, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. Lower extremity peripheral artery disease (PAD) is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio (NLR) has been used as a marker of chronic inflammation. This study aimed to determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient in Cipto Mangunkusumo hospital. Methods. A cross sectional study was conducted on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index (ABI) examination …

Cause Of The Low Positivity Of Blood Culture In Septic Patients, Krishna Yana, Bachti Alisjahbana, Yovita Hartantri

Jurnal Penyakit Dalam Indonesia

Introduction. Sepsis due to bacterial infection is one of the main causes of high disease morbidity and mortality. Management of sepsis, the detection of bacteriemia by examination of blood cultures has an important role, but until now the positivity of blood culture results at Hasan Sadikin Hospital (RSHS) is still low (13.45%). The purpose of this study was to determine profile the causes of low positivity of blood culture results in sepsis patients in RSHS. Methods. A cross sectional study was conducted on sepsis patient treated in Emergency Un it (ER) and inpatient of Hasan Sadikin hospital Internal Medicine from …

Herpes Zooster Induced Diabetic Ketoacidosis, Christopher Surya Suwita, Michael Johan, Dicky L. Tahapary, Budiman Darmowidjojo

Jurnal Penyakit Dalam Indonesia

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes which is common in daily practice. DKA is the result of severe insulin deficiency and often presents as the first symptom of an undiagnosed diabetes even though it may also appear in individuals with diabetes. Some conditions that can trigger DKA include infections, myocardial infarction, stroke, pancreatitis, trauma, or poor treatment compliance. Skin tissue infections such as herpes zoster are rare inciting factor in DKA. This article will discuss a case of DKA that is triggered by herpes zoster.

Sarcoidosis Presenting As Acute Respiratory Distress Syndrome., Bilal Lashari, Ahmad Raza, Vincent Chan, William Ward

Abington Jefferson Health Papers

Sarcoidosis is a multisystem granulomatous disease of unknown origin. It typically involves the lungs and mediastinal lymph nodes in a chronic fashion. However, acute syndrome has been reported possibly in response to systemic release of proinflammatory cytokines. Acute pulmonary manifestations, especially acute respiratory failure or acute respiratory distress syndrome, remain extremely uncommon in individuals without a prior diagnosis. We present the case of a 41-year-old African American female, who presented with ARDS. An extensive workup into the cause of her illness remained negative, and she subsequently succumbed to her illness. A diagnosis of sarcoidosis was made upon autopsy, after exclusion …

It's Getting Hot In Here: A Rare Case Of Heat Stroke In A Young Male., Oriana Ramirez, Yury Malyshev, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Heat stroke is a severe acute illness characterized by a core temperature greater than 40°C (104°F) and central nervous system manifestations, such as delirium, convulsions, or coma, resulting from exposure to environmental heat or strenuous physical activity. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications, such as cardiac arrest, rhabdomyolysis and acute renal failure, are essential to reduce morbidity and mortality. Herein we describe a case of heat stroke in a 23-year-old male who suffered cardiac arrest in which prompt initiation of cooling measures prevented permanent neurological sequelae, provided swift neurological recovery and resolution of …

Agep Overlap Induced By Hydroxychloroquine: A Case Report And Literature Review., Christopher Mercogliano, Muhammad Khan, Catherine Lin, Elan Mohanty, Ryan Zimmerman

Reading Hospital Internal Medicine Residency

Acute Generalized Exanthematous Pustulosis (AGEP) is a rare drug reaction manifesting as pustular lesions with surrounding erythema following exposure. The disease is often self-limited and treatment is supportive. It may present in an atypical variant with vesicles that desquamate into erosions, which classifies the disease as an AGEP/SJS Overlap. This overlap syndrome can carry a substantial mortality rate and necessitate elevation in the level of care. Hydroxychloroquine has been implicated in cases of AGEP, and we present a case of AGEP/SJS overlap attributed to this common medication. Given the prevalence of drug eruptions, it is critical for the physicians to …