Internal Medicine Commons^™

Two Cases Of Vibrio Infection And Sepsis In The Delaware Estuary, René Daniel, Md, Joseph Yoo, Md, Roberto Fratamico, Md, Robert Measley, Md

The Medicine Forum

INTRODUCTION

Vibrio is a genus of Gram-negative motile rods. Several species are pathogenic, including Vibrio vulnificus and Vibrio parahaemolyticus. The interest in this genus is due to its extreme virulence and often fatal outcomes. In healthy patients, these infections are typically self-limited; however, in immunocompromised and cirrhotic patients, infections can result in bacteremia, which has a high fatality rate1. Both pathogens may cause acute gastroenteritis, necrotizing wound infections, and if severe, subsequent bacteremia. In this report, we present two cases of Vibrio infections recently identified in the Delaware River Estuary that resulted in severe sepsis and, in one case, death.

Unexplained Recurrent Fevers And The Importance Of Inquiring About Occupation: A Case Report, Zachary Reese, Ms4, Poonam Maru, Do

The Medicine Forum

INTRODUCTION

Many different tick-borne diseases are identified in various geographical areas throughout the United States. Ixodes scapularis tick-borne diseases can present unique diagnostic challenges because of their constellation of vague symptoms. The Ixodes scapularis tick, more commonly known as the blacklegged tick, is responsible for three specific tick-borne infections: Lyme disease (Borellia burgdorferii), Babesiosis (Babesia microti), and Anaplasmosis (Anaplasma phagocytophilum) also known as human granulocytic anaplasmosis. Although these three tick-borne diseases are characteristically found in the New England area, the geographical distribution of the Ixodes tick has expanded to encompass much of the northeastern United States and even states in …

Case Report: Pthrp Related Hypercalcemia In Diffuse Large B-Cell Lymphoma, Ankita Mehta, Md, Evan Caruso, Md

The Medicine Forum

INTRODUCTION

Hypercalcemia is commonly associated with solid tumor malignancies, but less often with hematologic malignancies. When present in hematologic malignancies, hypercalcemia is often secondary to overproduction of Vitamin D from the tumor cells. Very few cases with parathyroid hormone related peptide (PTHrP) induced hypercalcemia in B-cell lymphomas have been reported. Here we present a 44 year old male with a history of chronic lymphoctic leukemia who presented with hypercalcemia and an elevated PTHrP, found to have a transformation to Diffuse Large B-cell Lymphoma (DLBCL).

Anorectal Melanomas: Case Series, Jinyu Zhang, Md, Matthew Sochat, Md, Edward R. Feller, Md

The Medicine Forum

INTRODUCTION

Melanoma is the most common tumor to metastasize to the gastrointestinal (GI) tract. 60% of patients who die with malignant melanoma have GI involvement at autopsy1. Symptomatic disease presenting during life is unusual. Anorectal melanoma, a rare tumor that represents 1% of all melanomas and less than 4% of all anal malignancies, manifests with a range of non-specific symptoms and physical exam findings2. In fact, about one-third of lesions may be amelanotic3,4. Initial misdiagnosis as a benign lesion such as hemorrhoid is common.

We report 3 cases of anorectal melanoma presenting as primary GI complaints all without known cutaneous …

Case Report: Uncontrolled Anasarca: Capillary Leak Syndrome, Ankita Mehta, Md, Mansi Shah, Md

The Medicine Forum

INTRODUCTION

Capillary leak syndrome (CLS) is a rare clinical disease that causes edema, hypoproteinemia, episodic hypotension, dyspnea, hyponatremia, and weight gain that can be life threatening1. Although the underlying pathology is currently unknown, CLS is thought to be secondary to a systemic process associated with hyperpermeability of the body's microcirculation, resulting from a diffuse and severe disruption of the endothelium and causing generalized edema and often acute respiratory distress2.

Limitations Of The Perioperative Cardiovascular Evaluation For Assessing Coronary Artery Disease: A Case Report, Rady Ho, Md, Mitul Kanzaria, Md, Paul Walinsky, Md

The Medicine Forum

INTRODUCTION

The American College of Cardiology (ACC) and the American Heart Association (AHA) publ ished pre-operative risk stratification guidelines in 2014. These guidelines have routinely been used by physicians to pre-operatively risk stratify patients. In this case report, a patient was found to have multi-vessel coronary artery disease post-operatively in the setting of unremarkable cardiac work-up preoperatively. This case highlights a limitation of the 2014 ACC/AHA guidelines.

Case Report: Diagnosis Of Dual-Biopsy Negative Severe Cardiac Amyloidosis, Kristin Lohr, Md, Eric Kasprowicz, Md

The Medicine Forum

INTRODUCTION

Amyloidosis is a rare disorder that involves the deposition of misfolded protein in extracellular tissue. Disease manifestations vary depending on the affected organs. Areas most often involved include the kidneys, gastrointestinal tract, heart, nervous system, and musculoskeletal system. The most common type is AL amyloidosis, in which plasma cells produce an abundance of a monoclonal proteins that affect numerous organ systems. A second variety, AA amyloidosis, is associated with inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease. Finally, a heritable version of amyloidosis mediated by mutations in the transthyretin protein (TTR) has a predilection for deposition in …

Coronary Subclavian Steal Syndrome, Rady Ho, Md, Jonathan A. Dunn, Md

The Medicine Forum

INTRODUCTION

Coronary subclavian steal (CSS) syndrome is a rare complication of coronary artery bypass graft surgery (CABG) involving the left internal mammary artery (LIMA) graft to the left anterior descending (LAD) artery. It results from stenosis of the left subclavian artery proximal to the LIMA, which compromises myocardial blood flow. The incidence of CSS syndrome is between 0.1-3.4% in the United States.1 Most cases occur as a result of long-standing subclavian stenosis due to progres-sion of the stenosis following CABG. We report a case of CSS syndrome, which presented as a non-ST elevation myocardial infarction (NSTEMI).

Allergic Inflammatory Mediated Coronary Artery Vasospasm: A Case Report Of Kounis Syndrome, Jonathan Hullman, Ms4, Jaehee Kim, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Kounis syndrome is an acute coronary syndrome occurring secondary to an anaphylactic reaction. A wide variety of triggers such as drugs and environmental exposures have been described for the so-called allergic myocardial infarction. The pathophysiology of Kounis syndrome is thought to be due to the release of inflammatory mediators such as histamine and cytokines by mast cells and eosinophils resulting in either coronary vasospasm, myocardial infarction or stent thrombosis.

Squamous Cell Carcinoma Metastatic To The Heart Mimicking St-Elevation Myocardial Infarction, Jason Chen, Md, Colin Craft, Md, Andrew W. Panakos, Md, Gregary D. Marhefka, Md, Facc, Facp

The Medicine Forum

INTRODUCTION

Heart disease remains the leading cause of mortality in the United States, accounting for about one quarter of all deaths in 20131. Acute ischemic heart disease is a major subpopulation of this group, and typically presents with characteristic electrocardiographic (EKG) changes. The most concerning of these findings are ST-elevations, as ST Elevation Myocardial Infarction (STEMI) typically indicates the need for emergent reperfusion therapy because 30-day mortality of untreated STEMI is approximately 10-15% versus 5% in treated cases2. As a result, clinicians are taught to recognize the symptoms and signs of myocardial ischemia and STEMI in order to achieve timely …

Table Of Contents

The Medicine Forum

Table of Contents The Medicine Forum

The Journal of Thomas Jefferson University Hospital

Department of Internal Medicine

Volume 17, 2015-2016

From The Desk Of The Residency Director, Emily Stewart, Md, Facp

The Medicine Forum

I am honored to be writing my first message for the Forum as the Residency Program Director. This journal, now in its 17th edition, continues to exemplify the dedication, inquisitiveness, passion and talent of our Internal Medicine residents.

It has been an exciting year of changes at Jefferson, which began with Dr. Gregory Kane being appointed Chair of the Department of Medicine. As a new Program Director I could not have asked for a leader who is more dedicated to the educational needs of the residents, and has such a keen understanding of the ever changing residency training environment. This …

The Carefirst Patient-Centered Medical Home Program: Cost And Utilization Effects In Its First Three Years, Alison Cuellar, Lorens A. Helmchen, Gilbert Gimm, Jay Want, Sriteja Burla, Bradley Kells, Iwona Kicinger, Len M. Nichols

Health Policy and Management Faculty Publications

Background

Enhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.

Objective

To test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.

Design

We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized …

Epidemiology And Outcomes Of Out-Of-Hospital Cardiac Arrest In A Developing Country-A Multicenter Cohort Study., Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam Syed, Amber Mehmood, Bryan Mcnally, Kent Stevens,, R. Nuruddin, Mohammad Ishaq, J. Razzak

Section of Cardiology

Background

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country.

Methods

We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a …

Precision Medicine Informatics, Lewis J Frey, Elmer V Bernstam, Joshua C Denny

Faculty, Staff and Student Publications

No abstract provided.

Hiperimunoglobulin E, Atopi Dan Hiv, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Five-Year Survival In Patients With 3-Vessels Coronary Arterydisease And Diabetes Mellitus Undergoing Coronary Arterybypass Graft, Coronary Percutaneus Intervention, Or Receivingpharmacological Therapy In Cipto Mangunkusumo Hospital, Andreas Arie Setiawan, Marulam Panggabean, M Yamin, Siti Setiati

Jurnal Penyakit Dalam Indonesia

Introduction. Revascularization results in patients with diabetes mellitus (DM) and coronary artery disease involving 3 vessels (CAD 3VD) undergo coronary artery bypass surgery (CABG) are better compared with those undergo percutaneous coronary intervention (PCI) or medical therapy. However, CABG is not always done despite being recommended in accordance with Syntax Score because some patients unwilling to undergo CABG or PCI . This trial determined whether the choice of revascularization affect 5-years survival. Methods. This was a retrospective cohort study with survival analysis to examine the 5-years survival rate of CAD 3VD DM patients undergoing CABG, PCI, or medical therapy. The …

Comparison Of Chemotherapy Regiments Between Cisplatinetoposide And Cisplatin-Docetaxel On 2-Year And Progressionfree Survival In Late-Stage Non-Small Cell Lung Cancer Patients, Salman Paris Harahap, Noorwati Sutandyo, Cleopas Martin Rumende, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Chemotherapy is one of therapy choices for the advanced Non-Small Cell Lung Cancer (NSCLC). The success in therapy is measured with the 1-year survival, 2-year survival and the Progression Free Survival (PFS). The success is influenced by many factors: resistant to the citostatic, dosage, administer intensity, chemotherapy regiment, type histology, stage, performance status, comorbidity and social economic. In Indonesia, funding and chemotherapy regiment become the challenge for the success of therapy. Methods. The study used the Retrospective Cohort study with survival analysis. The Patients included in this study were the advanced NSC Lung Cancer (At least Stadium IIIa) who …

The Correlation Of Depression Level With Tumor Necrosis Factoralpha (Tnf-Α) Concentration In Uncontrolled Bronchial Asthmapatients, Muhammad Ali Apriansyah, Rudi Putranto, Eddy Mart Salim, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Depression occurs at high rates in people with chronic diseases, including bronchial asthma, with the prevalence of depression approaches 50% in tertiary care asthma clinic. Tumor necrosis factor alpha (TNF-α) is known to play a critical role in the pathogenic mechanism of a number of chronic inflammatory disease, including bronchial asthma and depression. There has not been any research data on the subject in Indonesia. The objective of this study was to investigate the correlation between depressive level and TNF-α level in uncontrolled bronchial asthma. Methods. This was a cross sectional study conducted in 40 patients with uncontrolled bronchial …

The Role Of Duke Treadmill Score As A Predictor Of Coronaryartery Disease In Patients With Positive Treadmill Test Results, Muhammad Ikhsan, Sally Aman Nasution, Ika Prasetya Wijaya, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Coronary Artery Disease (CAD) is one of the disease entity that leading cause of morbidity and mortality in worldwide. Treadmill test is part of the diagnostic modality which readily available to assess possibility of narrowing coronary artery and guiding us whether we need for the further investigation. Despite of that, treadmill test has limitation in diagnostic accuracy. Duke Treadmill Score (DTS) was also tested as a diagnostic score, and shown to predict significant CAD better than the ST-segment response alone. Methods. This is a cross-sectional study performed in adult patients with stable CAD that underwent treadmill test and coronary …