Internal Medicine Commons^™

Identification Of Pp1 As The First Phosphatase For Irf7, Shunbin Ning, Ling Wang

ETSU Faculty Works

Excerpt: Interferon (IFN) regulatory factor 7 (IRF7) is phosphorylated and activated in response to pathogenic infections for production of type I IFNs

16 Year Old Baseball Pitcher Presenting With Gradual Worsening Of Posterolateral Right Elbow Pain And Negative Mri Findings, Nithin Natwa, Reema Sheth, Nisha Sheth

Research Day

Background: Elbow pain is a common presenting symptom in repetitive motion performing athletes. Due to the popular use of prolonged conservative therapy in elbow pain, and the importance of early surgical intervention in Elbow Synovial Fold Syndrome, proper and prompt diagnosis is essential. In our case report, a 16 year old male right hand-dominant baseball pitcher presents with gradual onset of posterolateral right elbow pain over 4 months. Purpose: This study helps reflect the correct timeline in imaging along with the appropriate duration of conservative management. After reviewing this study the reader will be better able to differentiate between Lateral …

A Case Of Native Valve Staphylococcus Epidermidis Endocarditis With Cardiac Abscess Formation, Emily Cordes, Chris Jacob, Mark Loehrke

Research Day

Introduction: Staphylococcus epidermidis is the most common commensal bacteria of the skin; however it can be pathogenic and is the most frequent cause of medical device associated endocarditis. It is also a well-known cause of endocarditis in IV drug abuse (IVDA). However, in individuals without obvious disruption of the skin barrier, it is a relatively rare, but emerging entity of native valve endocarditis. Coagulase negative staphylococci account for only 1-5% of community acquired native valve infective endocarditis and most resolve with treatment. We report a case of a 56 year old male with an aggressive strain of community acquired Staphylococcus …

Challenges In The Diagnosis And Management Of Pediatric Pulmonary Tuberculosis In Madagascar, Emily Cordes, Richard Roach

Research Day

Introduction: Tuberculosis (TB) remains an important cause of morbidity and mortality in Madagascar. According to the World Health Organization (WHO), in 2015, the estimated incidence of TB was 57,000 and 11,000 of those cases were of patients less than 14 years old. Of the reported cases, 89% were bacteriologically confirmed. However, it is well established that bacteriologic confirmation of TB in children is especially difficult. Therefore, the incidence of TB in the pediatric population in Madagascar, and likely worldwide, is under estimated. We report a case of a 4 year old male that illustrates the challenges in diagnosis and management …

Widening The Differential: A Case Of Hemophagocytic Lymphohistiocytosis Disguised As A Fever Of Unknown Origin, Emily Cordes

Research Day

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is an under recognized, aggressive inflammatory disease characterized by excessive activity of histiocytes and lymphocytes. According to the HLH-2004 guidelines, five of the following eight criteria must be met to diagnose HLH: fever >38.5¡ã C, splenomegaly; cytopenias affecting ¡Ý two cell lines; hypertriglyceridemia/hypofibrinogenemia; evidence of hemophagocytosis in the bone marrow, spleen or lymph nodes; hyperferritinemia; low NK cell activity; or high levels of soluble CD25. Once a diagnosis of HLH is established, investigations for infectious, malignant or autoimmune etiologies must be pursued. We report a case of fever of unknown origin (FUO) that presented multiple times …

Importance Of Physical Activity In Women, Minaz Mawani

Department of Medicine

No abstract provided.

Babesiosis-Associated Immune Thrombocytopenia, Roshni Narurkar, Aleksandra Mamorska-Dyga, A Agarwal, John Nelson, Delong Liu

NYMC Faculty Publications

Thrombocytopenia is a common feature of babesiosis. The mechanism for thrombocytopenia in babesiosis remains elusive. We report a case of babesiosis with severe new onset immune thrombocytopenia (ITP). In addition to antibiotics treatment for babesiosis, ITP therapy was administered. ITP in the present case was most likely triggered by the babesia infection. The severity of ITP in this case was not proportional to the severity of parasitemia. The neoantigen triggering the autoimmune response in babesiosis requires further characterization.

Alcohol Use And Immune Reconstitution Among Hiv-Infected Patients On Antiretroviral Therapy In Nairobi, Kenya, Anthony Cagle, Christine Mcgrath, Barbra A. Richardson, Dennis Donovan, Sameh Sakr, Nelly Yatich, Richard Ngomoa, Agnes Chepngeno Langat, Grace John-Stewart, Michael Chung

Internal Medicine, East Africa

Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire …

Mhealth In Palliative Care For Cancer Patients & Care Givers, Newton Andebe, Peter Waiganjo, John Weru

Internal Medicine, East Africa

Patients and caregivers in palliative care experience multidimensional pain. In current practice, information about a cancer patient progress is known when they visit a clinic or make a distress call when their conditions worsen. This strategy is not efficient for systematic monitoring of symptoms, which is key in improving palliative care. Mobile phones have helped to transform healthcare through diagnosis, health education and symptoms management of chronic illnesses. In this study, a mobile phone assessment tool was implemented at an outpatient palliative care clinic for cancer patients in Aga Khan University Hospital, Nairobi. The usefulness of the mobile phone application …

Retention In Continuous Care And Sustained Viral Suppression: Examining The Association Among Individuals Living With Hiv, Timothy N. Crawford, Alice C. Thornton

Internal Medicine Faculty Publications

Objectives: To examine the relationship between retention in continuous care and sustained viral suppression.

Methods: The authors retrospectively followed 653 persons who were virally suppressed and seeking care at an infectious disease clinic in Kentucky for an average of 6 years to determine the rates of retention in medical care (≥2 visits separated by ≥3 months within a 12-month period) and sustained viral suppression (<400 copies/mL). A generalized linear mixed model was used to determine an association between retention and suppression over time.

Results: Approximately 61% of the study population were retained in continuous care and 75% had sustained viral suppression for all patient-years. Persons retained in care were 3 times the odds of sustaining viral suppression over …

Viral And Cellular Micrornas In Regulation Of Ebv Latency And Oncogenesis, Ling Wang, Shunbin Ning

ETSU Faculty Works

Epstein-Barr virus (EBV), an oncogenic virus that ubiquitously establishes life-long persistence in humans, encodes viral miRNAs in two clusters, BHRF1 and BART. EBV also regulates expression of a large pool of cellular miRNAs, including miR-155, miR-146a, miR-21, miR-29, and miR-34a. These miRNAs targets both viral and cellular genes involved in the entire viral lifetime from lytic infection to oncogenesis, including viral replication, immune responses, cell cycle regulation, apoptosis, and cell proliferation, and are indispensable for persistent infection, latency establishment and maintenance, and cancer development. Among them, circulating miRNAs and unique miRNA profiles are promising diagnosis and prognosis biomarkers alone or …

Can Contrast Harmonic Endoscopic Ultrasonography Replace Endoscopic Ultrasonography-Guided Fine-Needle Aspiration In Patients With Solid Pancreatic Lesions? An American Perspective., Joseph Yoo, Linda H. Yan, Ali A. Siddiqui

Division of Internal Medicine Faculty Papers & Presentations

No abstract provided.

Global Health Elective: Swaziland, Africa, Jane Duong

Posters

Describes her learning experience providing care with the Baylor International Pediatric AIDS Initiative (BIPAI) in September 2017.

Risk Factors For Hypoxia And Tachypnea Among Adolescents With Vertically-Acquired Hiv In Nairobi, Engi F. Attia, Noel S. Weiss, Elizabeth Maleche Obimbo, Christine J. Mcgrath, Anthony Cagle, Eoin T. West, El Antouny G. Neveen, Attwa Mena, Crothers Kristina, Michael Chung

Internal Medicine, East Africa

Background: Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya.

Methods: We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for …

Development Of A Health Care Systems Curriculum., Zachary Pruitt, Rahul Mhaskar, Bryan G. Kane Md, Robert D. Barraco Md, Mph, Deborah J Dewaay, Alexander M. Rosenau Do, Kristin A. Bresnan Md, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.

Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created …

Practical Neurology Linked To The Curriculum: An Online Resource, Dilraj Sokhi, Alice Brockington, Christine Lo

Internal Medicine, East Africa

Navigating the online galaxy for up-to-date evidence-based knowledge in clinical neurology can be a challenge. Practical Neurology is a noted and popular online clinical resource,1 which according to its website is "…practical in the sense of being useful for everyone who sees neurological patients and who want to keep up to date, and safe, in managing them." As UK-based neurology trainees, we have been fortunate to have automatic access to Practical Neurology during our training. We found that the articles adequately covered most elements in our syllabus and were ideal reference material for our department. This accords with the …

Patient Predictors Of Poor Drug Sensitive Tuberculosis Treatment Outcomes In Kyiv Oblast, Ukraine, Omowunmi Aibana, Andrej Slavuckij, Mariya Bachmaha, Viatcheslav Krasiuk, Natasha Rybak, Timothy P Flanigan, Vasyl Petrenko, Megan B Murray

Faculty, Staff and Student Publications

Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high.

We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes.

Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default (lost to follow up) or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. …

Fungsi Ginjal Dan Kematian Akibat Sindrom Koroner Akut, Eka Ginanjar

Jurnal Penyakit Dalam Indonesia

Penyakit kardiovaskuler merupakan salah satu penyebab kematian utama di dunia. World Health Organization (WHO) melaporkan 17,5 juta orang meninggal akibat penyakit kardiovaskuler pada tahun 2012, atau diperkirakan 3 dari 10 kematian terjadi akibat penyakit jantung.

Factors Related To Diagnosis Of Community-Acquired Pneumonia In The Elderly, Elza Febria Sari, C. Martin Rumende, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Introduction. Diagnosing community-acquired pneumonia (CAP) in the elderly remains a clinical challenge for various reasons. The clinical manifestation in the elderly is not frank and atypical manifestations, e.g. falls, decrease of functional status and food intake or urinary incontinence, may be present. These reasons may be associated with under or over diagnosis, which consequently contribute to the higher observed mortality rate in the elderly population with CAP. Study about factors related to diagnosis of CAP in the elderly was ra rely performed.

Methods. From January to October 2010, 158 elderly patients suspected of having pneumonia at RSCM were registered. Relationship …

Estimated Glomerular Filtration Rate (Egfr) As An In-Hospital Mortality Predictor In Acute Coronary Syndrome Patients In Iccu, Esthika Dewiasty, Idrus Alwi, Dharmeizar Dharmeizar, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

No abstract provided.