Internal Medicine Commons^™

The Association Of Hyponatremia With Race, Ethnicity, And Gender In Patients Admitted For Acute Decompensated Heart Failure Diagnoses, Vikas Sunder, Md, Rene Alvarez, Md, Evan Carabelli, Md

Division of Internal Medicine Faculty Papers & Presentations

Background: Hyponatremia, defined by a serum sodium concentration less than 135 mEq/L, is seen in approximately 25% of patients admitted with congestive heart failure (CHF). Hyponatremia on admission has been shown to increase in-hospital mortality and to be an independent predictor of 6month mortality. Prior work has shown that CHF patients with hyponatremia on admission are more likely to be Caucasian. Given its prognostic significance, hyponatremia and its association with patient characteristics warrants further study.

Methods: We queried for unique admissions to Temple University Hospital between 2011 and 2015 with a DRG code of "291-293" to represent a …

Evaluation Outcomes Of A Modified Early Warning System For Early Identification Of Sepsis In The Adult Population Requiring Acute Care, Gavin M. Turpin

DNP Projects

Objectives: To examine the use of a Modified Early Warning System (MEWS) for sepsis identification and evaluate its effects on treatment and outcomes for those patients diagnosed with sepsis after admission, during their stay at an acute care facility.

Design: A retrospective chart audit was conducted on the electronic medical records (EMRs) of patients who developed, and were diagnosed with, sepsis post admission. Specifically, a retrospective separate sample pretest posttest design was used to examine the accuracy of the MEWS, differences in outcomes (ICU days, length of hospital stay, qSOFA Score and mortality rates), and treatment initiation time (fluid resuscitation, …

Pulmonary Mucormycosis In Chronic Lymphocytic Leukemia And Neutropenia., Izza Mir, Sijan Basnet, David Ellsworth, Elan Mohanty

Reading Hospital Internal Medicine Residency

Pulmonary mucormycosis is a rare life-threatening fungal infection associated with high mortality. We present the case of a 61-year-old man with history of chronic lymphocytic leukemia who presented with fever and cough, eventually diagnosed with pulmonary mucormycosis after right lung video-assisted thoracoscopic surgery. The patient was successfully treated with amphotericin B and right lung pneumonectomy; however, he later died from left lung pneumonia.

The Association Between Asymptomatic And Mild Neurocognitive Impairment And Adherence To Antiretroviral Therapy Among People Living With Human Immunodeficiency Virus, Violet Awori, Peter Mativo, Gerald Yonga, Reena Shah

Internal Medicine, East Africa

Background: Asymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART).

Objective: To assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART.

Methods: This was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental …

Sex Differences In Prevalence Of Emergency Department Patient Substance Use, Robert D. Cannon Do, Gillian A. Beauchamp Md, Paige Roth Lsw, Jennifer Stephens Do, David B. Burmeister Do, Facep, Cpe, David M. Richardson Md, Alanna Balbi Bs, Tennessee Park Ba, Stephen W. Dusza Drph, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

Purpose

Substance use and misuse is prevalent in emergency department (ED) populations. While the prevalence of substance use and misuse is reported, sex-specific trends in ED populations have not been documented. We set out to determine the sex-specific prevalence of ED patient substance use during this current epidemic.

Methods

A retrospective electronic data abstraction tool, developed for quality-improvement purposes, was used to assess ED visits in 3 hospitals in northeastern Pennsylvania. All patients with ED diagnosis codes for substance use F10.000 through F 19.999 (excluding F17 codes for nicotine) were abstracted for network ED visits at all 3 hospitals. Data …

Vitamin E Status Is Inversely Associated With Risk Of Incident Tuberculosis Disease Among Household Contacts, Omowunmi Aibana, Molly F Franke, Chuan-Chin Huang, Jerome T Galea, Roger Calderon, Zibiao Zhang, Mercedes C Becerra, Emily R Smith, Carmen Contreras, Rosa Yataco, Leonid Lecca, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Few studies have previously assessed how pre-existing vitamin E status is associated with risk of tuberculosis (TB) disease progression.

OBJECTIVE: We evaluated the association between baseline plasma concentrations of 3 vitamin E isomers (α-tocopherol, γ-tocopherol, and δ-tocopherol) and TB disease risk.

METHODS: We conducted a case-control study nested within a longitudinal cohort of household contacts (HHCs) of pulmonary TB cases in Lima, Peru. We defined cases as HHCs who developed active TB disease ≥15 d after the diagnosis of the index patient, and we matched each case to 4 control cases who did not develop active TB based on …

Just Another Fever And Rash? A Broad Differential Leading To A Relatively Uncommon Condition In Adult Still's Disease., Nathan Brewster Do, Jaimin Patel Do, Rachel Kinney Do

Department of Medicine

No abstract provided.

Incremental Dialysis For Preserving Residual Kidney Function—Does One Size Fit All When Initiating Dialysis?, A. T. Mathew, Y. Obi, C. M. Rhee, J. A. Chou, K. Kalantar-Zadeh

Journal Articles

© 2018 Wiley Periodicals, Inc. While many patients have substantial residual kidney function (RKF) when initiating hemodialysis (HD), most patients with end stage renal disease in the United States are initiated on 3-times per week conventional HD regimen, with little regard to RKF or patient preference. RKF is associated with many benefits including survival, volume control, solute clearance, and reduced inflammation. Several strategies have been recommended to preserve RKF after HD initiation, including an incremental approach to HD initiation. Incremental HD prescriptions are personalized to achieve adequate volume control and solute clearance with consideration to a patient's endogenous renal function. …

Validity Of Simple Risk Index And Evaluation Of Methods Andmanagement Of Acute Coronary Events To Predict Mortality Inacute Coronary Syndrome Patients In Intensive Coronary Careunit Cipto Mangunkusumo Hospital, Rahmah Safitri Meutia, Sally Aman Nasution, Lukman H. Makmun

Jurnal Penyakit Dalam Indonesia

Introduction. Risk stratification is an important part in the management of patients with an Acute Coronary Syndrome (ACS) to avoid overtreatment or undertreatment. Although Simple Risk Index (SRI) and Evaluation of Methods and Management of Acute Coronary Events (EMMACE) have been validated in other countries, no study of its applicability has been performed in Indonesia with different patients’ characteristics. This study aims to obtain the calibration and discrimination performance of SRI and EMMACE to predict 30 days mortality in ACS patients in ICCU of Cipto Mangunkusumo Hospital. Methods. A retrospective cohort study with consecutive sampling was conducted in ACS patients …

Vaksinasi Pada Lansia, Iris Rengganis

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Antiphospholipid Antibody Profile In Hiv/Aids Patients, Inolyn Pandjaitan, Nanang Sukmana, Shufrie Effendy

Jurnal Penyakit Dalam Indonesia

Introduction. Through the process of molecular mimicry, human immunodeficiency virus (HIV) infection can increase the concentration of antiphospholipid antibody (APA) which has possible association with thrombosis. The molecular mimicry in this HIV/AIDS patients is influenced by several factors, such as immunocompromised condition, the use of antitretroviral (ARV) therapy, hepatitis B and C coinfection, use of other drugs, and history of intravenous drug user (IDU). We conducted this study to determine the profile and prevalence of antiphospholipid antibody in patients with HIV/ AIDS in Dr. Cipto Mangunkusumo General Hospital. Further, we explored the relationship between APA in HIV/AIDS patients with the …

The Relationship Between Age And Activity Of Daily Living Withthe Fall Risk Of Patients In Geriatric Outpatient Installation, Agustin Junior Nanda Deniro, Nuniek Nugraheni Sulistiawati, Novira Widajanti

Jurnal Penyakit Dalam Indonesia

Introduction. Fall is one of the physical problems that happened quite frequently and resulted in morbidity and mortality of old people. There are several factors related to fall risk, among others are age and independence in activity of daily living. Methods. This research is an observational analytical study with cross sectional approach, by collecting free variable data (age and activity of daily living) through interview and Barthel index score, dependent variable (fall risk) by direct observation using Timed Up and Go test that analyzed by Rank Spearman correlation test. The number of samples with incidental sampling technique was 55 patients …

Predictor Factors Affecting Seroconversion Post-Influenzavaccination In The Elderly, Saskia Aziza Nursyirwan, Sukamto Koesnoe, Edy Rizal Wahyudi

Jurnal Penyakit Dalam Indonesia

Introduction. The influenza vaccine as the most effective method for preventing influenza virus infection currently has lower efficacy in the elderly than younger adults due to change of immune response as well as other risk factors. This study aims to identify predictor factors affecting seroconversion post-influenza vaccination in elderly. Methods. retrospective cohort study in the elderly population in East Jakarta Posyandu who got the influenza vaccine. A total of 277 subjects with antibody titre pre and one month post-vaccination influenza were examined. Risk factors such as age, gender, exercise status, smoking status, type 2 diabetes, pulmonary, and cardiovascular disease, nutritional …

Diagnosis And Treatment Of Pneumocystis Carinii Pneumonia (Pcp)/Pneumocystis Jirovecii Pneumonia In Hiv Patient: A Case Report, Dewi Rizki Agustina, Christy Efiyanti, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

Pneumocystis carinii pneumonia (PCP) or pneumocystis jirovecii pneumonia is an opportunistic infection that can occur in immunocompromised patients. In patients with HIV, PCP is the most common opportunistic infection especially in patients with CD4 cell counts less than 200 cell /ul. To diagnose a PCP is very difficult because symptoms, blood tests, and thoracic radiography are not pathognomonic for PCP. However, untreated PCP is almost always fatal. Trimethroprimsulfamethoxazole (TMX-SMX) orally or intravenously for 21 days is the drug of choice for managing PCP with or without HIV. This article discusses a case with patients with symptoms of dyspneu, unproductive cough, …

Cardiotoxicity Complication Of Radiotherapy, Beta Agustia Wisman, Sally Aman Nasution, Marulam M. Panggabean

Jurnal Penyakit Dalam Indonesia

Radiation is an important modality in the management of malignancy. Some cases of malignancy requiring radiotherapy in the chest include breast cancer, Hodgkin's lymphoma, or lung cancer.Cardiotoxicity due to radiotherapy can occur within 3 to 29 years after radiotherapy, mostly in the second or third decade after therapy. Some cardiovascular complications resulting from radiotherapy may affect pericardial, myocardial, vascular, heart valves and conduction disturbances. Symptomatic cardiotoxicity may occurs 10% in patients undergoing radiotherapy in the chest area. It is important for clinicians to understand the cardiotoxicity of radiotherapy for educational purposes, therapeutic and dosing considerations, treatment monitoring and early detection. …

The Patterns Of Primary Cotrimoxazole Prophylaxis In Adult Hivpatients In Hiv Integrated Clinic Cipto Mangunkusumo Hospitaljakarta In 2004-2013, Ken Ayu Mastini, Zubair Djoerban, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

Introduction. Low rate use of cotrimoxazole which is a standard of primary prevention against toxoplasmosis infection and Pneumocystis jirovecii pneumonia (PCP) in patients with CD4 <200 cell>/mm3 was found. This study aims to describe prescription pattern of cotrimoxazole primary prophylaxis in adult HIV patients in RSCM. Methods. A cohort retrospective study was conducted in HIV Integrated Clinic Cipto Mangunkusumo Hospital patients from 2004 to 2013. Individuals were eligible for this study if they were ≥18 years old and had indication of primary cotrimoxazole prophylaxis. Variable analyzed in this study were initiation, discontinuation, dosage, duration, duration percentage, and adverse events of primary …

Association Between Disease Activity And Depression Inrheumatoid Arthritis Patients, E Mudjaddid, Myra Puspitasari, Bambang Setyohadi

Jurnal Penyakit Dalam Indonesia

Introduction. Rheumatoid Arthritis (RA) is a chronic, systemic disease that cause synovialinflammation and progressive destruction to cartilages and deformities. Prevalence of depressionin RA patients is 20 to 30%. Disease activity is considered to have association with depression. This study aims to identify the prevalence of depression in RA patients and the associationbetween disease activity index and depression in RA patients. Methods. A cross-sectional study of 145 RA patients that fulfilled the inclusion criteria was conducted in Rheumatology Outpatient Clinic at Cipto Mangunkusumo Hospital Jakarta from January to March 2017.Evaluation of Disease Activity Score - 28 (DAS 28) and Back Depression …

Limd1 Is Induced By And Required For Lmp1 Signaling, And Protects Ebv-Transformed Cells From Dna Damage-Induced Cell Death, Ling Wang, Mary E. A. Howell, Brooke Mcpeak, Katrina Riggs, Carissa Kohne, Jether Uel Yohanon, Daniel E. Foxler, Tyson V. Sharp, Jonathon P. Moorman, Zhi Q. Yao, Shunbin Ning

ETSU Faculty Works

LIMD1 (LIM domain-containing protein 1) is considered as a tumor suppressor, being deregulated in many cancers to include hematological malignancies; however, very little is known about the underlying mechanisms of its deregulation and its roles in carcinogenesis. Epstein-Barr Virus (EBV) is associated with a panel of malignancies of lymphocytic and epithelial origin. Using high throughput expression profiling, we have previously identified LIMD1 as a common marker associated with the oncogenic transcription factor IRF4 in EBV-related lymphomas and other hematological malignancies. In this study, we have identified potential conserved IRF4- and NFκB-binding motifs in the LIMD1 gene promoter, and both are …

A Case Of Probable Amiodarone-Induced Pancreatitis In The Treatment Of Atrial Fibrillation: A Literature Review And Case Report., Christopher J. Mercogliano, Muhammad Khan, Mussaber Ahmad

Reading Hospital Internal Medicine Residency

Amiodarone is an effective medication used in the treatment of several different arrhythmias. Its most well-known adverse effects include pulmonary fibrosis, thyroid dysfunction, and hepatotoxicity. A less common side effect is acute pancreatitis. A 67-year-old male being treated for atrial fibrillation in rapid ventricular response with Amiodarone developed acute epigastric abdominal pain 24 hours after initiation of therapy. He was diagnosed as having acute pancreatitis based on characteristic findings seen on an abdominal CT scan. Commonly encountered etiologies of pancreatitis were ruled out through a combination of the history, laboratory values, and imaging results. Based on the temporal association of …

Is Engagement Alone Sufficient To Ensure “Active Learning”?, Reed Krause, Amy C. Hayton Md, Jeff Wonoprabowo, Lawrence Loo

Loma Linda University Student Journal

“Active Learning” is commonly defined as any instructional method that engages students in the learning process. However, active learning encompasses a broad range of educational methods and its impact on learning outcomes has been variable. In 2015, our IM clerkship redesigned its half-day learning sessions from a largely passive didactic style of lecturing to more active learning approaches. We further revised the curriculum in 2016 to further convert the sessions to primarily case based learning led by a faculty or resident. The goal of our intervention was to increase the Self-Reported Engagement Measure (STOBE) of each didactic session and improve …