Internal Medicine Commons^™

Diagnostic Value And The Role Of Inferior Vena Cava Diametercollapsibility Index To Evaluate Dry Weight In Hemodialysispatients, Muhammad Artisto Adi Yussac, Dharmeizar Dharmeizar, Murdani Abdullah, Dono Antono, Muhadi Muhadi

Jurnal Penyakit Dalam Indonesia

Introduction. In daily clinical practice, fluid status in Hemodialysis (HD) patients is well correlated with dry weight calculation. Dry weight calculation is commonly practiced by clinical observation, which is not accurate. Because of these, few methods has been suggested to calculate the dry weight non-invasively. Bioelectrical Impedance Analysis (BIA) is widely available in overseas but not readily available in all dialysis center in Indonesia, while inferior vena cava diameter is a relatively inexpensive method, and readily available in all dialysis center because it can be performed with ultrasonography (USG) instrument. Methods. A cross-sectional study was performed in a group of …

Prevalence And Predictors Of Atopy In Hiv/Aids Patients, Jimmy Tesiman, Heru Sundaru, Teguh H. Karjadi, Siti Setiati

Jurnal Penyakit Dalam Indonesia

Introduction. HIV infection attacks the center of immune control system resulting opportunistic infection, malignancy and death. Immune system dysregulation plays the central role in the progression of the disease. Some studies reported that HIV-infected patient prone to have allergic disease such as sinusitis, asthma and atopic dermatitis. Elevated serum immunoglobulin E (IgE) and increased prevalence of atopy had also been reported in HIV-infected patient. Methods. A cross sectional study was performed in 92 HIV-infected persons and 90 non-HIV persons. Atopy diagnosis was based on immediate hypersensitivity to six common aeroallergen using skin prick test. CD4 cell count, total serum immunoglobulin …

Hiv In Geriatrics, Nur Ainun, Evy Yunihastuti, Arya Govinda Roosheroe

Jurnal Penyakit Dalam Indonesia

Through both prolonged survival and late acquisition of the disease, numbers of older adults with HIV are climbing. Along with ageing process is an accumulation of HIV-associated non-AIDS related comorbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and social issues.

Hyper-Ige Syndrome With Bullous Pemphigoid And Esophagealstricture, Laras Budiyani, Adeputri Tanesha Idayu, Ika Prasetya Wijaya, Alvina Widhani

Jurnal Penyakit Dalam Indonesia

Laras

Expansion Of Myeloid-Derived Suppressor Cells Promotes Differentiation Of Regulatory T Cells In Hiv-1+ Individuals, Ling Wang, Juan Zhao, Junping P. Ren, Xiao Y. Wu, Zheng D. Morrison, Mohamed A. El Gazzar, Shunbin Ning, Jonathan P. Moorman, Zhi Q. Yao

ETSU Faculty Works

Objective: Regulatory T cells (Tregs) contribute to HIV-1 disease progression by impairing antiviral immunity; however, the precise mechanisms responsible for the development of Tregs in the setting of HIV-1 infection are incompletely understood.

Design: In this study, we provide evidence that HIV-induced expansion of monocytic myeloid-derived suppressor cells (M-MDSCs) promote the differentiation of Foxp3+ Tregs.

Methods: We measured MDSC induction and cytokine expression by flow cytometry and analyzed their functions by coculturing experiments.

Results: We observed a dramatic increase in M-MDSC frequencies in the peripheral blood of HIV-1 seropositive (HIV-1+) individuals, even in those on antiretroviral therapy with undetectable viremia, …

Severity Of Lower Urinary Tract Symptoms Among Middle Aged And Elderly Nigerian Men: Impact On Quality Of Life, Patrick Temi Adegun, Philip Adebayo, Peter Olufemi Areo

Internal Medicine, East Africa

Objectives. To compare the severity of LUTS among middle aged and elderly Nigerian men and determine the influence of LUTS severity on QoL.

Methods. This cross-sectional study was conducted among new patients presenting with LUTS attending Urology clinic between 2011 and 2015. Assessment of symptoms was based on IPSS and bother score completed by the eligible subjects on the same day of their clinic visits.

Results. Four hundred patients were studied comprising 229 middle aged and 171 elderly men. Interquartile range (IQR) of IPSS scores for men < 65 years and those ≥65 years was 14.0 (16.0) and 19 (15.0), respectively (p < 0.001). Mild LUTS was significantly associated with best, good, and poor quality of life while moderate LUTS was associated with poor QoL. Severe LUTS was significantly associated with all the categories of QoL (Best-Worst). Among the cohort of subjects with poor QoL, elderly patients had a significantly higher median IPSS score (p < 0.05).

Conclusions. There is no level of severity of LUTS in which patients’ QoL …

Increasing Hiv-1 Pretreatment Drug Resistance Among Antiretroviral-Naïve Adults Initiating Treatment Between 2006 And 2014 In Nairobi, Kenya, Michael Chung, Silverman Rachel, Beck Ingrid, Yatich Nelly, Dross Sandra, Jennifer Mckernan-Mullin, Stephen Bii, Kenneth Tapia, Joshua Stern, Chohan Bhavna, Samah R. Sakr, James N. Kiarie

Internal Medicine, East Africa

Antiretroviral-naïve adults initiating antiretroviral therapy in Nairobi, Kenya were tested for HIV-1 drug resistance at codons K103N, Y181C, G190A, M184V, and K65R using an oligonucleotide ligation assay. Prevalence of pretreatment drug resistance increased from 3.89% in 2006 to 10.93% in 2014 (P < 0.001), and 95% of those with resistance had at least one nonnucleoside reverse transcriptase inhibitor mutation. Resistance to tenofovir (K65R) was found in 2014 but not in 2006.

Barriers To Anticoagulation In Atrial Fibrillation Among Cardiologists, Internists And Family Physicians, Jad Al Danaf, Md, Mph, Mitul Kanzaria, Md, John U. Doherty, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Current Performance:

The rates of AC in patients 18 years or older who visited general internists & family physicians not seen by cardiologists from 4/30/2013 to 4/30/2015, cardiologists from 11/29/2012 to 11/29/2014 and all 3 specialties from 1/30/2014 to 1/30/2016 were derived from the EHR.

A 12-question survey was shared using RedCap with these physicians to examine potential reasons for not prescribing AC.

Multiorgan Chronic Inflammatory Hepatobiliary Pancreatic Murine Model Deficient In Tumor Necrosis Factor Receptors 1 And 2, Helieh S. Oz

Physiology Faculty Publications

AIM: To provoke persistent/chronic multiorgan inflammatory response and to contribute to stones formation followed by fibrosis in hepatobiliary and pancreatic tissues.

METHODS: Tumor necrosis factor receptors 1 and 2 (TNFR1/R2) deficient mice reared in-house were given dibutyltin dichloride (DBTC) twice within 10 d by oral gavage delivery. Sham control animals received vehicle treatment and naïve animals remained untreated throughout the study. Animals were monitored daily for symptoms of pain and discomfort. The abdominal and hindpaw hypersensitivity were assessed with von Frey microfilaments. Exploratory behaviors were recorded at the baseline, after initiation of treatment, and before study termination. Histopathological …

Does Myocardial Necrosis Occur In Rhabdomyolysis?, Gabriel M Aisenberg, Herbert L Fred

Faculty, Staff and Student Publications

No abstract provided.

Carotid Ultrasound Is Not Helpful In Simple Syncope, Nicholus Yee M.D., Shilin Patel M.D., Raymond Gong

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Scott JW, Schwartz AL, Gates JD, Gerhard-Herman M, Havens JM. Choosing wisely for syncope: low-value carotid ultrasound use. J Am Heart Assoc. 2014 Aug 13;3(4). pii: e001063. doi: 10.1161/JAHA.114.001063

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At Akuhn, Stephen Omondi Otieno

Master of Medicine in Internal Medicine

Background: An advance directive is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves, and which is then used to guide decisions on life-sustaining treatment in the event that they become incapacitated. Advance directives can take one of four forms: a living will, a limitation of care document, a do-not-resuscitate order, and an appointment of a surrogate by durable power of attorney. The completion rate of advance directives varies from region to region, and it is influenced by different patient, caregiver, legal, institutional, cultural, and religious factors. …

Outcomes In Patients With Acute Coronary Syndromes At The Aga Khan University Hospital, Nairobi, Mohamed Hasham Varwani

Master of Medicine in Internal Medicine

Background: As the prevalence of cardiovascular diseases in Sub-Saharan Africa rises, coronary artery disease, with its acute presentations, is being increasingly recognized in Kenyans and treated at tertiary level hospitals. It is just over a decade since the introduction and wide availability of modern cardiology services, including interventional cardiology in Kenya. Following an acute coronary syndrome (ACS), patients remain at high risk of death and other adverse events such as heart failure, recurrent myocardial infarction, stroke, and bleeding. Local and regional data on long-term outcomes following ACS are lacking. These data are important to clinicians for prognostication and to health …

The Association Between Asymptomatic And Mild Neurocognitive Impairment And Adherence To Antiretroviral Therapy Amongst People Living With Hiv, Violet Maloba Awori

Master of Medicine in Internal Medicine

Background: HIV disease is associated with neurocognitive impairment which is one of the neurological complications of the viral infection. The spectrum of HIV Associated neurocognitive impairment has significantly changed since the advent of ART. The inclusion of the asymptomatic but cognitively impaired population of patients has changed the dynamics of this population, and requires further research to identify the impact it has on the progression of the disease as well as on any other aspects. Poor adherence to ART is one of the main causes of treatment failure and studies done previously point towards the milder forms of Neurocognitive Impairment …

Risk Factors, Clinico-Pathologic Characteristics And Outcomes In Young Kenyan Female Patients With Breast Cancer In Akuh-N, Gilford Mutwiri Mwikamba

Master of Medicine in Internal Medicine

Background: Breast cancer in the young refers to a diagnosis of breast cancer in a female under the age of forty years. This is considered a distinct disease with different risk factors, biology, and prognosis. Young age at breast cancer diagnosis is reportedly more common among African-Americans. The highest proportion of breast cancer in the young has been reported in Africa. Early detection of breast cancer in Africa is hampered by lack of access to health care services, appropriate screening tools, and high cost of magnetic resonance imaging for the high risk groups. Despite a worse prognosis, management of breast …

Vitamin D Supplementation: Preventing Fractures, Courtney L. Carn, Michael S. Doherty

Physician Assistant Capstones, 2016 to 2019

Objective: To assess the ability of vitamin D supplementation in preventing musculoskeletal fractures. Methods: Systematic literature review using Google Scholar search terms “vitamin D supplementation” and “preventing hip fractures” from 2006-2015. Only RCTs, meta-analysis, and clinical guidelines were included. Results: Our search resulted in one meta-analysis and two randomized controlled trials. Conclusion: The summation of our investigation into vitamin D deficiency and the presence of musculoskeletal fractures has proven to be relatively inconclusive. The resulting data from our three studies did not provide any definitive proof that improved vitamin D levels correlates with better bone health.

Chronic Kidney Disease And Acute Myocardial Infarction: The Story After 1 Year, Paulette S. Wehner, William A. Nitardy

Internal Medicine

When chronic kidney disease (CKD) is part of the clinical history for a patient with acute myocardial infarction, the interventional cardiologist experiences an increased anxiety level. An acute myocardial infarction with renal disease requires more attention to dye load and fluid status, and general opinion exists regarding the negative outcomes of these “sicker” patients.

Mark Navarro and colleagues completed a thorough study from a different angle. We know the interventionalists’ concerns are justified acutely as these CKD patients have a higher level of inpatient complications, but these authors chose to look at the patients 1 year from their event to …

Esophageal Diagnosis Of A Malignant Aspergilloma, Muneer Al Zoby, Nancy Munn,, Yousef Shweihat

Internal Medicine

A 59-year-old male patient developed a new 4 cm × 6 cm cavitary left upper lung lesion over a 2 months period. The patient had a prior history of a surgically resected Stage IA non-small cell lung cancer in the right upper lobe 3 years prior. He was treated for possible infection with radiographic improvement on subsequent imaging. Further imaging after 3 months revealed an oval soft tissue density within the cavity with air crescent sign. Bronchoscopy with transbronchial biopsies showed an acute and chronic granulomatous inflammation. Aspergillus fumigatus was noted on culture and voriconazole was initiated. Subsequent imaging showed …

Protein Phosphatase 1 Abrogates Irf7-Mediated Type I Ifn Response In Antiviral Immunity, Ling Wang, Juan Zhao, Junping Ren, Kenton H. Hall, Jonathan P. Moorman, Zhi Q. Yao, Shunbin Ning

ETSU Faculty Works

Interferon (IFN) regulatory factor 7 (IRF7) plays a key role in the production of IFN‐α in response to viral infection, and phosphorylation at IRF7 C‐terminal serine sites is prelude to its function. However, phosphatases that negatively regulate IRF7 phosphorylation and activity have not been reported. In this study, we have identified a conserved protein phosphatase 1 (PP1)‐binding motif in human and mouse IRF7 proteins, and shown that PP1 physically interacts with IRF7. Exogenous expression of PP1 subunits (PP1α, β, or γ) ablates IKKε‐stimulated IRF7 phosphorylation and dramatically attenuates IRF7 transcriptional activity. Inhibition of PP1 activity significantly increases IRF7 phosphorylation and …

Enhancing Nurse-Physician Communication And Collaboration, Pamela D. Missi

Graduate Theses, Dissertations, and Capstones

In healthcare organizations today, creating a culture of safety is critically important. Communication failures among healthcare providers have been linked to 70% of annual sentinel events. Seventy-six percent of individuals experiencing a sentinel event die (Joint Commission, 2009). Lack of good communication behavior between nurses and physicians has been recognized as a cause of preventable harm to patients (Institute of Medicine, 2004; Zwarenstein & Reeves, 2006). In hospital settings, communication failures are linked to increases in length of stay, patient harm, resource utilization, more rapid turnover, and caregiver dissatisfaction (Dingley et al., 2008). Numerous national organizations and commissions have officially …