Internal Medicine Commons^™

Betel Nut Use And Hyperglycemia, Edward Nabrinsky, Badar Hasan, Talal Asif, Rebecca R. Pauly

Marshall Journal of Medicine

Betel nut chewing previously has not been common in North America, yet it is the fourth major source of addiction and abuse worldwide. Approximately 700 million individuals, or 10 % of the global population, chew beetle nut on regular basis. It is important for patient safety and improved quality to recognize its use in uncontrolled diabetes. Our case is of a 49 year-old Burmese female with PMH of DM2, HTN, and benign paroxysmal positional vertigo (BPPV) who presented with a complaint of dizziness. Patient denied alcohol or tobacco use, but reported a 20-year history of betel nut chewing (4-5 times/day). …

Retrospective Analysis To Describe Associations Between Tumor Necrosis Factor Alpha Inhibitors And Copd-Related Hospitalizations, Neil A. Accortt, James B. Chung, Machaon Bonafede, Brendan L. Limone, David M. Mannino

Preventive Medicine and Environmental Health Faculty Publications

Background: Limited information exists on the impact of tumor necrosis factor inhibition on COPD exacerbations. This retrospective study characterized this impact among COPD patients with underlying autoimmune conditions, exposed to tumor necrosis factor inhibitors (TNFi) and/or non-biologic disease-modifying antirheumatic drugs (DMARDs).
Patients and methods: Adult COPD patients with ≥1 diagnosis for rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) before or within 6 months following the index COPD diagnosis were identified from the Truven Health MarketScan^® databases. Patients were required to have a second claim for RA, PsO, PsA, AS, or DMARD use (biologic or …

Changes In The Gut Microbial Communities Following Addition Of Walnuts To The Diet, Lauri O. Byerley, Derrick Samuelson, Eugene Blanchard, Meng Luo, Brittany N. Lorenzen, Shelia Banks, Monica A. Ponder, David A. Welsh, Christopher M. Taylor

School of Graduate Studies Faculty Publications

Walnuts are rich in omega-3 fatty acids, phytochemicals and antioxidants making them unique compared to other foods. Consuming walnuts has been associated with health benefits including a reduced risk of heart disease and cancer. Dysbiosis of the gut microbiome has been linked to several chronic diseases. One potential mechanism by which walnuts may exert their health benefit is through modifying the gut microbiome. This study identified the changes in the gut microbial communities that occur following the inclusion of walnuts in the diet. Male Fischer 344 rats (n=20) were randomly assigned to one of two diets for as long as …

Bronchopleural Fistula Resolution With Endobronchial Valve Placement And Liberation From Mechanical Ventilation In Acute Respiratory Distress Syndrome: A Case Series, Haris Kalatoudis, Nikhil Meena, Fuad Zeid, Yousef Shweihat

Internal Medicine

Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs. In each case, EBV placement led to immediate resolution of PAL. We believe endobronchial valve …

Pembrolizumab Reactivates Pulmonary Granulomatosis, Majdi Al-Dliw, Mohammed Megri, Ibrahim M. Shahoub, Gaurav Sahay, Teresa I. Limjoco, Yousef Shweihat

Internal Medicine

Sarcoid like reaction is a well-known entity that occurs as a consequence to several malignancies or their therapies. Immunotherapy has gained a lot of interest in the past few years and has recently gained approval as first line therapy in multiple advanced stage malignancies. Pneumonitis has been described as complication of such therapy. Granulomatous inflammation has been only rarely reported subsequent to immunotherapy. We describe a case of granulomatous inflammation reactivation affecting the lungs in a patient previously exposed to Pembrolizumab and have evidence of a distant granulomatous infection. We discuss potential mechanisms of the inflammation and assert the importance …

Diabetic Ketoacidosis Characteristics And Differences In Type 1 Versus Type 2 Diabetes Patients, Muhammad Owais Rashid, Aisha Sheikh, Abdus Salam, Saad Farooq, Zareen Kiran, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Diabetes is undoubtedly one of the most challenging health problems of the 21st century. It is well known that diabetes once develop can lead to several complications. Diabetic ketoacidosis (DKA) is one of the life-threatening complications of diabetes. This study was designed to determine the frequency of DKA in diabetes patients and find out the clinical and biochemical determinants of DKA.

Methods: This descriptive study was conducted at Aga Khan University Hospital (AKUH) Karachi, Pakistan from January 2010 to February 2016. All known or newly diagnosed diabetic patients of >16 years of age irrespective of gender and type of …

Initial Construct Validity Evidence Of A Virtual Human Application For Competency Assessment In Breaking Bad News To A Cancer Patient, Timothy C. Guettermann, Frederick W. Kron, Toby C. Campbell, Mark W. Scerbo, Amy B. Zelenski, James F. Cleary, Michael D. Fetters

Psychology Faculty Publications

Background: Despite interest in using virtual humans (VHs) for assessing health care communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN) to a VH patient.

Methods: We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN. Group A (n=15) completed the VH simulation before and after the seminar, and Group B (n=12) completed the VH simulation only after the BBN seminar to avoid the possibility that testing alone affected performance. Pre-and postseminar differences for Group A were analyzed with a …

The Association Between Elevated Levels Of Erythropoietin Andendothelial Progenitor Cell With Improvement Of Endothelialfunction In Renal Failure Patients 3 Months After Kidneytransplantation, Linda Armelia, Endang Susalit, Maruhum Bonar Hm, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Endothelial progenitor cell (EPC) is considered possible to reduce asymmetric dimethylarginine (ADMA) levels, which is a marker of improved endothelial function. However, clinically, there is still a debate about the role of EPC. This study was conducted to determine the correlation of elevated levels of erythropoietin (Epo) and the number of EPC CD34 + and CD133 + with improvement of endothelial function in renal failure patients 3 months after kidney transplantation. Methods. A cross-sectional study was conducted in prior and 3 months after kidney transplantation of renal failure patients who underwent a kidney transplant in Cipto Mangunkusumo hospital. The …

The Changes Of Amino Terminal Pro B-Type Natriuretic Peptide(Nt-Probnp) Concentration And Left Ventricular Ejectionfraction On Doxorubicin Chemotherapy Patients, Telly Kamelia, Sarwono Waspadji, Lukman Hakim Makmun, Shufrie Effendi, Muchlis Ramli, Ina Susanti Timan

Jurnal Penyakit Dalam Indonesia

Introduction. Cancer patients who received chemotherapy regimen containing doxorubicin has been known to have serious side effect in heart, called as cardiotoxicity. The measurement of NT-proBNP proposed to be used as a new parameter to identify and evaluate cardiotoxicity in cancer patients earlier before it has been manifested, superior than measurement of left ventricle ejection fraction (LVEF). The aims of this study to examine the changes of NT-proBNP concentration and LVEF on patients with cancer who receive chemotherapy regimen containing doxorubicin. Methods. The study used pre and post test design to observe the changes of NT-proBNP concentration and LVEF on …

Validation Of Rapid Emergency Medicine Score (Rems) In Predicting30 Days Mortality In Elderly Visiting Emergency Department, Aulia Rizka, Kuntjoro Harimurti, Ceva W. Pitoyo, Soekamto Koesno

Jurnal Penyakit Dalam Indonesia

Introduction. Rapid Emergency Medicine Score (REMS) has been known as a useful instrument to stratify patients in emergency department (ED) based on its ability to predict short term mortality. As the clinical characteristics of elderly patients visiting ED are frequently aypical, validation of REMS in this specific population is very important. To measure predictive validity of REMS in elderly patients visiting ED Methods. Prospective cohort study in elderly visiting ED of Cipto Mangunkusumo between September to October 2016. Subjects were followed for 30 days after visiting ED. Calibration (Hosmer Lemeshow test), discrimination (Area Under ROC Curve) and REMS predictive value …

Factors Associated With Retention In Care One Year After Deliveryin Patients Undergoing Prevention Of Mother To Child Transmission(Pmtct) At Rscm, Yulidar Yulidar, Evy Yunihastuti, Samsuridjal Djauzi, Astrid Citra Padmita, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Introduction. Retention in care is important to the successful of HIV treatment. This study is aimed to analyze factors associated with retention in care one year after delivery in patients undergoing PMTCT at HIV integrated clinic of RSCM. Methods. A retrospective cohort study was conducted among post-partum HIV patients who were given ARV therapy for PMTCT at HIV intergrated clinic of Cipto Mangunkusumo Hospital from January 2004 to May 2014. Evaluation of one year retention in care after PMTCT was performed by observing medical records of the patient. The collected data were factors associated with one year after delivery retention …

Clinical Characteristic And Prevalence Of Invasive Candidiasis Patient In Cipto Mangunkusumo Hospital, Kemal Fariz Kalista, Lie Khie Chen, Retno Wahyuningsih, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Incidence of invasive fungal infections (IFI) are reportedly increasing in many countries. Candida is the most common cause of IFI. This study was conducted to determine the prevalence, clinical characteristics, and etiologic pathogen in adult patients with invasive candidiasis (IC) at Cipto Mangunkusumo Hhospital. Methods. This was a cross sectional study with restropective data collection fromof septic patients that’ medical records hospitalized in January 2012 until June 2014. Subjects were selected based on EORTC/MSG 2008 diagnostic criteria for IC. Demographic data, clinical and supporting data, diagnosis, etiologic pathogens, antibiotics, antifungal, outcome, and length of stay were recorded. Results. The …

Correlation Between Disease Duration, Disease Activity Scoreand Disability Score With Diastolic Dysfunction In Rheumatoidarthritis Women In Dr. Cipto Mangunkusumo Hospital, Dono Antono, Bernard Agus Sakti Dhaki, Harry Isbagio, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. There are only few studies about correlation between non traditional risk factor and diastolic dysfunction in RA patients. This study aims to determinate the correlation between non traditional risk factors, including disease duration, disease activity and disability score with the diastolic dysfunction of women with RA. Methods. A cross-sectional, consecutive sampling study was conducted to 52 RA women without any previous cardiovascular disease history. All participants underwent an echocardiography to assess diastolic dysfunction and other findings associated. Duration of disease was assesed by direct interview, while the disease activity by calculating DAS28 and disability score by HAQ-DI. Results. Diastolic …

Risiko Kardiovaskuler Pada Pasien Artritis Reumatoid, Rudy Hidayat

Jurnal Penyakit Dalam Indonesia

No abstract provided.

A 30 Years Old Woman With Sepsis, Skin And Soft Tissueinfection, And Obesity, Franzeska Adm Widinartasari, Muhammad Ali Sodiq, Muchlis Au Sofro

Jurnal Penyakit Dalam Indonesia

Obesity increases morbidity and mortality through its multiple efects on nearly every human system. Obesity has efect on the immune response which leads to susceptibility to infections. ß lactamases are bacterial enzymes that inactivate ß-lactam antibiotics by hydrolysis. One group of ß lactamases, extended-spectrum ß lactamases (ESBLs), have the ability to hydrolyse and cause resistance to various types of the newer ß-lactam antibiotics. The management of skin and soft tissue infection with polymicrobial infection and multi drug resistance can be challenging problem. We present a case of an obese patient with polymicrobial SSTI. bPatient showed clinical sign of sepsis with …

Diagnostic Approach And Treatment Of Dieulafoy's Lesion, Anshari Saifuddin, Kaka Renaldi, Indah Situmorang

Jurnal Penyakit Dalam Indonesia

Dieulafoy’s lesion is a rare cause of upper gastrointestinal bleeding but become an important etiology. Pathogenesis of the disease evolved from earlier of its invention till now. It has been stated in recent study that the etiology of this disease is vary, from age to genetic. Size and arteriol configuration abnormality has been known as the main pathogenesis of the disease. Endoscopic procedure become the primary diagnostic tool, which effectiveness reached more than 90%. However, in some situation, it’s difficult to find the abnormality by endoscopic procedure. Hemostatic procedure via endoscopy is the main therapy of Dieulafoy’s lesion, which has …

Resident Reflection: Mrs. C, Rachel Nash, Md

The Medicine Forum

“Make friends with those critical care nurses in the ICU,” my friend from high school and general floor nurse whispered in my ear before the start of my MICU rotation. “They can really save your butt.” This was one of my many goals I set out to achieve during my first month in the intensive care unit as an intern. I wanted to become more comfortable managing very sick patients, get some procedures under my belt, and mostly “survive” the emotionally and physically taxing weeks that were sure to come.

The sign out I received on my 3-patient load suddenly …

Grand Rounds Panel Discussion: Provider Payment Reform: Past, Present, And Future, Neha Bansal Etherington, Md, Shuwei Wang, Md, Debbie Chen, Md, Anita Modi, Md, Jad Al Danaf, Md

The Medicine Forum

Panelists:

Gregory C. Kane, MD, FACP The Jane and Leonard Korman, Professor and Chairman, Department of Medicine

David B. Nash, MD, MBA The Dr Raymond C and Doris N Grandon Professor, and Dean of the Jefferson College of Population Health

Rhea E. Powell, MD, MPH Assistant Professor of Medicine

Rachel B. Sorokin, MD, FACP Associate Professor of Medicine and Medical Director of Safety and Quality

Lawrence D. Ward, MD, MPH Associate Professor of Medicine and Vice Chairman for Clinical Practice and Quality

Introduction:

The impetus for provider payment reform in healthcare grew out of the recognition that growth in healthcare …

Fatal Rituximab-Induced Nonspecific Interstitial Pneumonia: Case Report And Review Of The Literature, Rino Sato, Md, Jeremy Molligan, Md, Sameh Gaballa, Md

The Medicine Forum

Introduction:

Rituximab is a chimeric anti-CD20 monoclonal antibody that is used to treat some hematological malignancies such as B-cell lymphomas, and various autoimmune diseases including immune thrombocytopenic purpura, systemic lupus erythematous, rheumatoid arthritis, and autoimmune hemolytic anemia. The most common side effects include fever, chills, and rigors. Respiratory complications such as cough, bronchospasm, sinusitis, and rhinitis have also been reported in 30% of patients in clinical trials.1 Rituximab-induced lung injury is a very rare but potentially fatal complication. We report a case of fatal single agent rituximab-induced nonspecific interstitial pneumonia to increase awareness about this serious side effect and review …

Brugada Syndrome: Diagnosis And Management, Amit Vira, Md, Ehsanur Rahman, Md

The Medicine Forum

Introduction:

The vast majority of cases of sudden cardiac arrest (SCA) are caused by ventricular tachyarrhythmias (VT), with most cases associated with structural heart disease. SCA in a structurally normal heart is an uncommon occurrence, most often occurring in the third decade of life and accounting for 5-15% of total SCA cases1-2. Common causes include Brugada syndrome, congenital long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy, and idiopathic ventricular tachycardia1-3. The majority of these patients with a structurally normal heart are undiagnosed until presenting with sudden cardiac death. It is believed that cardiac arrest is the initial …