Internal Medicine Commons^™

Pomalidomide Reverses Gamma-Globin Silencing Through The Transcriptional Reprogramming Of Adult Hematopoietic Progenitors, B. M. Dulmovits, A. O. Appiah-Kubi, J. Papoin, M. He, Y. Al-Abed, S. Didier, M. Gould, S. Husain-Krautter, S. A. Singh, A. Vlachos, S. L. Allen, J. M. Lipton, J. M. Liu, L. Blanc, +7 Additional Authors

Journal Articles

Current therapeutic strategies for sickle cell anemia are aimed at reactivating fetal hemoglobin. Pomalidomide, a third-generation immunomodulatory drug, was proposed to induce fetal hemoglobin production by an unknown mechanism. Here, we report that pomalidomide induced a fetal-like erythroid differentiation program, leading to a reversion of gamma-globin silencing in adult human erythroblasts. Pomalidomide acted early by transiently delaying erythropoiesis at the BFU-E/CFU-E transition, but without affecting terminal differentiation. Further, the transcription networks involved in gamma-globin repression were selectively and differentially affected by pomalidomide including BCL11A, SOX6, IKZF1, KLF1, and LSD1. IKAROS (IKZF1), a known target of pomalidomide, was degraded by the …

Elevate Wellness: Unlocking The Potential Of Creative Problem Solving To Improve Wellness In Residency Programs., B. Pathak, E. Parry, L. Block, S. V. Desai

Journal Articles

No abstract provided.

Burnout’S Prevalence Estimations: A House Of Cards?, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

Elmariah et al. (2016) found that 65% of the internal medicine residents who were assessed suffered from burnout. We have 3 concerns about the conclusion. First, the authors used a cutoff score on a burnout measure that is problematic because (a) it is devoid of theoretical or clinical grounding and (b) burnout items were formatted in an unorthodox manner, and (c) including residents who responded "neutral" to a symptom item among those identified as burned out. Second, the authors identified as burned out residents who worked on the night float rotation although the data suggest otherwise. Third information on symptom …

The Diagnostic Accuracy Of Determine™ Tb Lam Antigen In Detection Of Extra Pulmonary Tuberculosis (Eptb), Fatimah Osman Juma

Master of Medicine in Internal Medicine

Background: TB remains a key global health challenge; particularly Extra pulmonary Tuberculosis (EPTB) and is also a major cause of morbidity and mortality in sub-Saharan Africa. The increasing incidence of EPTB compounded by difficulties in making a timely diagnosis portends to poor prognosis and increased mortality. Delays in diagnosis and misdiagnosis of EPTB in suspected patients account for mortality as well. Challenges in diagnosis of EPTB are mainly due to disease related factors, the paucibacillary nature of disease and challenges with sample collection and processing. Reference standard test such as TB culture, geneXpert and histology which are used in the …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

A Comparison Of Various Monoclonal Antibodies To The Previous Standard Of Care Chemotherapy In The Treatment Of Advanced-Stage Melanoma, Kevin Verde, Lauren Johnson, Alex Clancy, Ashley Goldberg, Aleia Monden, Priya Philip

Internet Journal of Allied Health Sciences and Practice

In the year 2015, it is estimated that the number of new cases of invasive melanoma will be 42,670 in males and 31,200 in females.¹ Melanoma is treatable with early diagnosis; however, more advanced disease has devastating outcomes. For the past decade, two chemotherapy agents, dacarbazine and temozolomide, have been the treatment of choice for advanced stage III or IV melanoma requiring systemic treatment. Interleukin-2 (IL-2) therapy has been used but with serious side effects. More recently, the focus has shifted to monoclonal antibodies and enzyme inhibitors as the main systemic treatment for advanced cutaneous melanoma. This literature review …

Selective Induced Altered Coccidians To Immunize And Prevent Enteritis, Helieh S. Oz

Physiology Faculty Publications

Microbiomic flora in digestive tract is pivotal to the state of our health and disease. Antibiotics affect GI, control composition of microbiome, and shift equilibrium from health into disease status. Coccidiosis causes gastrointestinal inflammation. Antibiotic additives contaminate animal products and enter food chain, consumed by humans with possible allergic, antibiotic resistance and enigmatic side effects. Purposed study induced nonpathogenic, immunogenic organisms to protect against disease and abolish antibiotics’ use in food animals and side effects in man. Diverse species of Coccidia were used as model. Immature organisms were treated with serial purification procedure prior to developmental stages to obtain altered …

Cme/Cne Article: A Framework Of Care In Multiple Sclerosis, Part 1, Scott D Newsome, Philip J Aliotta, Jacquelyn Bainbridge, Susan E Bennett, Gary Cutter, Kaylan Fenton, Fred Lublin, Dorothy Northrop, David Rintell, Bryan D Walker, Megan Weigel, Kathleen Zackowski, David E Jones

Faculty, Staff and Student Publications

Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org.

TARGET AUDIENCE: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS).

LEARNING OBJECTIVES: Apply new information about MS to a comprehensive individualized treatment plan for patients with MSIntegrate the team approach into long-term planning in order to optimize rehabilitation care of patients with MSAccreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) …

Nutritional Status And Tuberculosis Risk In Adult And Pediatric Household Contacts, Omowunmi Aibana, Xeno Acharya, Chuan-Chin Huang, Mercedes C Becerra, Jerome T Galea, Silvia S Chiang, Carmen Contreras, Roger Calderon, Rosa Yataco, Gustavo E Velásquez, Karen Tintaya, Judith Jimenez, Leonid Lecca, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Studies show obesity decreases risk of tuberculosis (TB) disease. There is limited evidence on whether high body mass index also protects against TB infection; how very high body mass indices influence TB risk; or whether nutritional status predicts this risk in children. We assessed the impact of body mass index on incident TB infection and disease among adults and children.

METHODS AND FINDINGS: We conducted a prospective cohort study among household contacts of pulmonary TB cases in Lima, Peru. We determined body mass index at baseline and followed participants for one year for TB infection and disease. We used …

Telephone Versus Face To Face Palliative Care Consults During Referral, John Weru

Internal Medicine, East Africa

Introduction: Palliative care aims at ameliorating patients and families suffering when they are faced with life-limiting illnesses. It involves symptoms management as well as psychosocial, spiritual support. As such, proper communication between clinicians taking care of the patient is an important aspect of this care. Studies have shown that errors in communication are common and relevant in palliative care as they negatively impact on the quality of care provided. The service at Aga Khan University Hospital, Nairobi (AKUHN) provides both in and out patient consult services. Primary physicians to patients consult the palliative care team via telephone models as well …

Implementation Of Hiv Drug Resistance Testing In Kenya, Horacio Duarte, Ingrid Beck, James Munyao, Molly Levine, Catherine Kiptinness, Bhavna Chohan, Samah Sakr, Michael Chung, Lisa Frenkel

Internal Medicine, East Africa

Background: Testing for HIV drug resistance prior to antiretroviral therapy (ART) is standard of care in the United States but is rarely performed in Africa due to its high cost. The prevalence of HIV drug resistance is increasing in resource-limited settings (RLS). An affordable and feasible strategy is needed in RLS to identify individuals with drug resistance and prescribe effective ART. Our group developed a low-cost oligonucleotide ligation assay (OLA) that detects mutations conferring resistance. Little data exists on implementing HIV drug resistance testing in RLS. Here, we describe the implementation of OLA in one laboratory in Kenya and discuss …

A Case Of Refractory Thrombotic Thrombocytopenic Purpura Treated With Plasmapheresis And Rituximab, Nicholas Kirui, Ahmed Sokwala

Internal Medicine, East Africa

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder with no prevalence or incidence studies in sub-Saharan Africa. Acquired TTP has several causes, all of which lead to decreased activity of von Willebrand factor cleaving protease (ADAMTS13) due to autoantibodies that are directed towards ADAMTS13. We report a case of a 46-year-old man who presented with most of the classic clinical manifestations of TTP.

Short Communication: Analysis Of Minor Populations Of Human Immunodeficiency Virus By Primer Identification And Insertion-Deletion And Carry Forward Correction Pipelines, Paul Hughes, Wenjie Deng, Scott C. Olson, Robert W. Coombs, Michael Chung, Lisa M. Frenkel

Internal Medicine, East Africa

Accurate analysis of minor populations of drug-resistant HIV requires analysis of a sufficient number of viral templates. We assessed the effect of experimental conditions on the analysis of HIV pol 454 pyrosequences generated from plasma using (1) the ‘‘Insertion-deletion (indel) and Carry Forward Correction’’ (ICC) pipeline, which clusters sequence reads using a nonsubstitution approach and can correct for indels and carry forward errors, and (2) the ‘‘Primer Identification (ID)’’ method, which facilitates construction of a consensus sequence to correct for sequencing errors and allelic skewing. The Primer ID and ICC methods produced similar estimates of viral diversity, but differed in …

Trombositopenia Refrakter, Andhika Rachman

Jurnal Penyakit Dalam Indonesia

Tranfusi trombosit berperan penting dalam manajemen kasus trombositopenia akibat kelainan hematologi dan onkologi. Namun, hampir sebagian besar pasien yang mendapatkan tranfusi trombosit berulang, sering mengalami kejadian tranfusi trombosit refrakter baik akibat faktor imunologi maupun non imunologi.

Perbedaan Pola Sirkadian Tekanan Darah Pada Pasien Penyakit Ginjal Kronik Pra Dan Pascatransplantasi Ginjal Di Rscm, Marihot Tambunan, Endang Susalit, Dharmeizar Dharmeizar, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Pendahuluan: Meningkatnya tekanan darah (TD) 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Transplantasi ginjal akan memperbaiki TD dan nondipper. Namun demikian, satu bulan pasca transplantasi ginjal, kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD. Perlu dilakukan studi untuk mengetahui seberapa dini perubahan pola sikardian, sehingga dapat dijadikan pertimbangan penatalaksanaan hipertensi yang lebih tepat pada pasien PGK 5D pra dan pasca transplantasi ginjal.

Metode: Studi Pre experimental dengan before and after design …

Faktor-Faktor Yang Berhubungan Dengan Kenaikan Cd4 Pada Pasien Hiv Yang Mendapat Highly Active Antiretroviral Therapy Dalam 6 Bulan Pertama, Indria Yogani, Teguh Harjono Karyadi, Anna Uyainah, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Pendahuluan: HIV adalah infeksi yang menyerang sistem kekebalan tubuh dengan CD4 sebagai sel targetnya. Ditemukannya Highly Active Antiretroviral Therapy (HAART) diharapkan mampu menurunkan angka morbiditas dan mortalitas HIV. Namun, kenaikan CD4 tidak sama untuk setiap pasien serta terdapat faktor lain yang berhubungan dengan kenaikan CD4 pada pasien HIV.

Metode: Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan di Unit Pelayanan Terpadu HIV Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta selama Mei- Juni 2014.. Data penelitian didapatkan dari rekam medis selama Januari 2004-Desember 2013. Analisis data menggunakan program SPSS dengan uji Mann Whitney, uji Chi Square atau Fisher …

Faktor-Faktor Yang Berperan Terhadap Terjadinya Lipodistrofi Pada Pasien Hiv Yang Mendapatkan Terapi Antiretroviral Lini Pertama, Ratu Ratih Kusumayanti, Evy Yunihastuti, Dyah Purnamasari, F Witjaksono, Esthika Dewiasty

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Seiring dengan perkembangan antiretroviral, harapan hidup pasien HIV terus meningkat namun menjadi rentan terhadap efek samping pengobatan. Salah satu efek samping pengobatan adalah sindrom lipodistrofi, meliputi lipoatrofi, lipohipertrofi, atau gabungan keduanya. Faktor risiko yang dikaitkan dengan lipodistrofi pada HIV adalah usia, jenis kelamin, lama terapi antiretroviral, CD4 awal, Stadium HIV, dan pemakaian Stavudin. Belum ada publikasi di Indonesia yang meneliti kejadian lipodistrofi pada populasi pasien HIV yang mendapat terapi ARV lini pertama serta faktor-faktor yang memengaruhinya. Berdasarkan hal tersebut, penelitian ini dilakukan untuk mengetahui kejadian lipodistrofi pada pasien HIV dalam terapi ARV lini pertama berbasis Stavudin dan Zidovudin …

Pengaruh Pemberian N-Acetylcysteine Oral Terhadap High Sensitivity C Reactive Protein (Hs-Crp) Pada Pasien Hemodialisis Kronis, Ratih Tri Kusuma Dewi, Parlindungan Siregar, Idrus Alwi, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Inflamasi dan stres oksidatif merupakan faktor risiko penyakit kardiovaskuler pada pasien penyakit ginjal kronis yang menjalani hemodialisis. Pasien hemodialisis kronis akan mengalami peningkatan kadar Hs-CRP. Hs-CRP merupakan marker inflamasi yang telah terbukti pada beberapa penelitian bermanfaat dalam memprediksi cardiovascular event. Pemberian N-Acetylcysteine (NAC) oral dapat digunakan sebagai strategi untuk menurunkan proses inflamasi yaitu disfungsi endotel dan stress oksidatif yang berperan pada atherosclerosis pada pasien hemodialsis. Pemberian NAC ini diharapkan dapat menurunkan angka morbiditas dan mortalitas karena penyakit kardiovaskuler.

Metode. Penelitian eksperimen dengan Randomized Double Blind Controlled Trial pada 65 pasien hemodialisis kronis yang memenuhi kriteria inklusi di …

Pendekatan Diagnosis Dan Tatalaksana Endokarditis Infektif Dengan Komplikasi Emboli Septik Pulmoner Pada Pasien Hemodialisis Kronik, Jeremia Immanuel Siregar, Imelda Maria Loho, Idrus Alwi

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Endokarditis infektif (EI) pada pasien hemodialisis (HD) merupakan salah satu contoh EI yang terkait dengan perawatan kesehatan dan menjadi penyebab kematian kedua pada pasien HD setelah penyakit kardiovaskuler. Penggunaan kateter intravaskuler sebagai akses HD meningkatkan risiko kejadian bakteremia sebesar sepuluh kali lipat serta infeksi “metastatik” seperti EI dan emboli septik pulmoner sebesar 10-40%. Ilustrasi Kasus. Seorang laki-laki berusia 35 tahun datang dengan keluhan dyspnea d’effort, orthopnea, dan post-nocturnal dyspnea, disertai batuk dengan bercak darah dan demam tinggi sejak lima hari sebelum masuk rumah sakit. Pasien menjalani HD kronik selama 15 bulan dengan menggunakan catheter double-lumen (CDL). Dari pemeriksaan fisik …

Hubungan Antibodi Anti Trombosit Terhadap Respon Transfusi Trombosit Pada Pasien Hemato-Onkologi Yang Mendapatkan Multitransfusi Trombosit Di Rs Dr. Cipto Mangunkusomo, Anna Mira Lubis, Aru W. Sudoyo, Shufrie Effendy, Tb Djumhana, Kuntjoro Harimurti

Jurnal Penyakit Dalam Indonesia

Pendahuluan: Multitransfusi donor random dan paparan terhadap konsentrat trombosit yang termasuk non-leukocyte depleted diketahui sebagai faktor risiko terjadinya alloimunisasi (HLA dan HPA) yang dapat menjadi salah satu penyebab kegagalan transfusi. Oleh karena itu, perlu dilakukan penelitian mengenai hubungan antibodi anti trombosit tersebut dengan kegagalan respon transfusi trombosit pada pasien hemato-onkologi sehingga dapat dilakukan metode seleksi donor dan crossmatching trombosit donor dan resipien.

Metode: Studi observasional dilakukan pada pasien hemato-onkologi dewasa yang mendapatkan multitransfusi trombosit di Rumah Sakit dr Cipto Mangunkusumo (RSCM) Jakarta. Pengamatan dilakukan pada respon transfusi dengan mengukur corrected count increment (CCI) 1 jam post transfusi dengan …