Internal Medicine Commons^™

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 …

Does Ecg And Arrhythmia Simulation Training In Adjunct To Didactics Improve Medical Students’ Clinical Skills Compared To Didactics Alone?, Reed Krause, Amy C. Hayton Md

Loma Linda University Student Journal

Medical Schools continue to face the challenge of bridging the gap between classroom education and its application in the clinical environment. Several studies have shown utility of incorporating simulation training into a variety of healthcare related topics. We hypothesize that incorporating ECG and arrhythmia simulation training in adjunction to ECG and arrhythmia didactics; it would improve Year-3 medical students’ preparedness for managing arrhythmias in the clinical setting.

Pharmacomechanical Catheter-Directed Thrombolysis For Deep-Vein Thrombosis., Suresh Vedantham, Samuel Z Goldhaber, Jim A Julian, Susan R Kahn, Michael R Jaff, David J Cohen, Elizabeth Magnuson, Mahmood K Razavi, Anthony J Comerota, Heather L Gornik, Timothy P Murphy, Lawrence Lewis, James R Duncan, Patricia Nieters, Mary C Derfler, Marc Filion, Chu-Shu Gu, Stephen Kee, Joseph Schneider, Nael Saad, Morey Blinder, Stephan Moll, David Sacks, Judith Lin, John Rundback, Mark Garcia, Rahul Razdan, Eric Vanderwoude, Vasco Marques, Clive Kearon

Reading Hospital Interventional Radiology

BACKGROUND: The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome.

METHODS: We randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up.

RESULTS: Between 6 and 24 …

A Rare Case Of Hemophagocytic Lymphohistiocytosis Of Unknown Etiology, Ida Micaily, Marie Helene Gagnon, Richard Friedenheim, Jason A. Damsker

Division of Internal Medicine Faculty Papers & Presentations

Hemophagocytic lymphohistiocytosis (HLH) is an uncommon cytokine storm syndrome marked which can cause high mortality. In adults, acquired HLH usually has an underlying infectious, autoimmune or malignant process that triggers the syndrome. In this case report, we present a 64-year old Caucasian male presenting with productive cough, fevers, weight loss and altered mental status who was ultimately found to have HLH of unknown etiology.

Implementing Evidence-Based Opioid Prescription Practices In A Primary Care Setting, Cyril Gaiennie

Doctor of Nursing Practice

The use and misuse of opioid pain medication has reached epidemic proportions in the United States. More than 16,000 people die each year due to the misuse or abuse of prescription opioid medications, which is more than from heroin, cocaine, and benzodiazepines combined. The purpose of this evidence-based practice project is to establish processes enabling a primary care clinic to implement and adhere to the 2016 Centers for Disease Control’s guidelines for opioid prescription practices in the primary care setting. A retrospective chart review conducted prior to implementation of the guidelines demonstrated that four of six of the CDC’s recommendations …

Hypermucoviscous Klebsiella Syndrome It's In The Community!, Muneeba Ahsan Sayeed, Nida Latif, Syed Faisal Mahmood

Section of Internal Medicine

Hypermucoviscous Klebsiella syndrome is a unique syndrome caused by a new variant of Klebsiella pneumoniae (KP), characterized by abscess formation at distant body sites. This emerging KP strain is different from the usual classic strains in having the rmp gene which increases capsule formation making this strain resistant to phagocytosis and helping in its dissemination to distant organs. A 50 years old diabetic man presented with facial swelling after dental procedure which progressively increased despite being on antibiotics. On examination he was febrile, had neck swelling with signs of inflammation and tender hepatomegaly. Ultrasonography showed submental and liver abscesses which …

High-Volume Forced Diuresis With Matched Hydration Using The Renalguard System To Prevent Contrast-Induced Nephropathy: A Meta-Analysis Of Randomized Trials, Rahman Shah, Sarah J. Wood, Sajjad A. Khan, Amina Chaudhry, M. Rehan Khan, Mohamed S. Morsy

Section of Internal Medicine

Background: Contrast-induced nephropathy (CIN) is a well-recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide-induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints.
Hypothesis: Forced diuresis with matched hydration using the RenalGuard system improves clinical outcomes in patients undergoing coronary angiography.
Methods: Scientific databases and websites were searched for relevant RCTs. The pooled risk ratios were calculated using random-effects …

National Trends In Admission And In-Hospital Mortality Of Patients With Heart Failure In The United States (2001–2014), Emmanuel Akintoye, Alexandros Briasoulis, Alexander Egbe, Shannon M. Dunlay, Sudhir Kushwaha, Diane Levine, Luis Afonso, Dariush Mozaffarian, Jarrett Weinberger

Internal Medicine Faculty Publications

Background-—To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines.

Methods and Results-—Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%–3.5%) and 3.5% (2.9%–4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions …

One- Vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy For Pancreatic Carcinoma: Single Institution Retrospective Review, Philip Anthony Sutera, Mark E. Bernard, Beant S. Gill, Kamran K. Harper, Kimmen Quan, Nathan Bahary, Steven A. Burton, Herbert Zeh, Dwight E. Heron

Radiation Medicine Faculty Publications

Background/introduction: Early reports of stereotactic body radiation therapy (SBRT) for pancreatic ductal adenocarcinoma (PDAC) used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT to determine whether any outcome differences existed.

Methods and materials: Patients treated with SBRT in any setting for PDAC at our facility were included, from 2004 to 2014. Overall survival (OS), local control (LC), regional control (RC), distant metastasis (DM), and late grade 3 or greater radiation toxicities from the time of SBRT were calculated using Kaplan–Meier estimation to either the date …

Lmp1 Signaling Pathway Activates Irf4 In Latent Ebv Infection And A Positive Circuit Between Pi3k And Src Is Required, Ling Wang, Junping Ren, Guang Li, Jonathan P. Moorman, Zhi Q. Yao, Shunbin Ning

ETSU Faculty Works

Interferon (IFN) regulatory factors (IRFs) have crucial roles in immune regulation and oncogenesis. We have recently shown that IRF4 is activated through c-Src-mediated tyrosine phosphorylation in virus-transformed cells. However, the intracellular signaling pathway triggering Src activation of IRF4 remains unknown. In this study, we provide evidence that Epstein–Barr virus (EBV) latent membrane protein 1 (LMP1) promotes IRF4 phosphorylation and markedly stimulates IRF4 transcriptional activity, and that Src mediates LMP1 activation of IRF4. As to more precise mechanism, we show that LMP1 physically interacts with c-Src, and the phosphatidylinositol 3 kinase (PI3K) subunit P85 mediates their interaction. Depletion of P85 by …

"Toll-Free" Pathways For Production Of Type I Interferons, Ling Wang, Shunbin Ning

ETSU Faculty Works

Pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) are recognized by different cellular pathogen recognition receptors (PRRs), which are expressed on cell membrane or in the cytoplasm of cells of the innate immune system. Nucleic acids derived from pathogens or from certain cellular conditions represent a large category of PAMPs/DAMPs that trigger production of type I interferons (IFN-I) in addition to pro-inflammatory cytokines, by specifically binding to intracellular Toll-like receptors or cytosolic receptors. These cytosolic receptors, which are not related to TLRs and we call them "Toll-free" receptors, include the RNA-sensing RIG-I like receptors (RLRs), the DNA-sensing HIN200 family, …

Improved Service Efficiency Improves Racial Disparity In Diabetic Care, Abel Irena, Kushal Patel, David Thompson, Gregory Schleis, Abiy Gesese, Richard Battiola

Journal of Patient-Centered Research and Reviews

Background: Racial disparities in diabetes care have been documented. Disparities also have been shown to affect service quality and outcome of diabetic care. Analysis of our internal medicine residency clinic diabetic care management performance across REAL-G (race, ethnicity, age, preferred language and/or gender) showed race-based disparity on two outcome measures: 1) measurement of glycohemoglobin (A1C) at least twice a year; and 2) target blood pressure of < 140/90.

Purpose: Develop interventions to decrease racial disparities in diabetes care among patients managed by an internal medicine residency clinic, as part of the Alliance of Independent Academic Medical Center’s National Initiative V project.

Methods: …

Predictors Of In Hospital Mortality In Acute Pancreatitis, David E. Mossad, Brian V. Dinh, Ronald J. Markert, Mustafa N. Musleh, Sangeeta Agrawal

Internal Medicine Faculty Publications

Background and Aims Pancreatitis presents with significant risk for morbidity and mortality acutely. The purpose of this study was to evaluate demographics, comorbidity burden, and hospital characteristics and their effect on in-hospital mortality in patients with acute pancreatitis. Methods Data was collected from The National Hospital Discharge Survey for patients admitted for acute pancreatitis from 2001-2010. Patients were separated into those who suffered in-hospital mortality and those that were discharged. Data was analyzed regarding demographics, length of stay, comorbidity burden, mortality, principal payment, and hospital size. Statistical comparisons were made using SPSS with chi-square and student T tests with a …

Acquired Von Willebrand Disease Associated With Monoclonal Gammopathy Of Unknown Significance, Sijan Basnet, Catherine Lin, Rashmi Dhital, Izza Mir, Elan Mohanty, Biswaraj Tharu, Sushil Ghimire, Dilli Ram Poudel

Reading Hospital Internal Medicine Residency

We present a case of a 79-year-old male who presented with retroperitoneal hematoma a week after motor vehicle accident. Prior history and family history of bleeding were nonsignificant. His activated partial thromboplastin time was found to be prolonged in the emergency department. Further workup with coagulation studies showed decreased factor VIII, vWF antigen, and vWF:ristocetin cofactor assay, and negative Bethesda assay, indicating acquired von Willebrand disease. Immunofluorescence to find an underlying etiology was suggestive of MGUS. Management of AvWD depends on controlling active bleeding and treating the underlying cause. He was treated with factor VIII, haemate-p, rituximab, two cycles of …