Internal Medicine Commons^™

Peritoneal Immunosurgery: Immunotherapy Augmented Surgery For The Treatment Of Peritoneal Cancers, Ada I Ozcan, Arianexys Aquino López, Mary K Mckenna, Malcolm K Brenner, Alastair M Thompson

Faculty, Staff and Students Publications

Peritoneal malignancy often indicates disruptions in multiple physiological systems resulting from widespread cancer. The heterogenous origin and dynamic nature of peritoneal cancer make it difficult to treat with standard approaches that fit into guidelines. We describe how successful treatment should address the underlying pathology, the systemic response to surgical treatments and target the immune perturbations that facilitate the establishment and propagation of this multifaceted disease.

Hubungan Frailty Dengan Kesintasan Satu Tahun Pada Pasien Lanjut Usia Dengan Tumor Padat Ganas Stadium Lanjut, Trian Satrio, Aulia Rizka, Findy Prasetyawaty, Alvina Widhani, Noto Dwimartutie, Rm Suryo Anggoro, Mira Yulianti, Dono Antono

Jurnal Penyakit Dalam Indonesia

Introduction. Frailty is characterized by a multisystem physiological decline that increases the risk of morbidity and mortality, especially in patients with advanced-stage solid malignancies. The association between frailty and one-year survival in older adults with solid malignancies in Indonesia has not yet been established. This study aimed to assess the association between frailty status and one-year survival in elderly patients with advanced-stage solid tumors.

Methods. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta utilizing patient data from a previous study conducted between November 2020 and 2021. Subjects were cancer patients aged …

Hubungan Aktivitas Fisik Dengan Kualitas Hidup Pasien Hemodialisis Reguler, Shofi 'Ainun Azzahra Br Manurung, Bayu Rusfandi Nasution, Imelda Rey

Jurnal Penyakit Dalam Indonesia

Introduction. Hemodialysis (HD) is one of the renal replacement therapies commonly used in patients with end-stage renal disease. Patients undergoing hemodialysis typically exhibit lower levels of physical activity compared to inactive yet healthy individuals. A decline in physical function and muscular strength may impair the ability to perform daily activities, ultimately affecting patients’ quality of life (QoL). This study aimed to examine the relationship between physical activity and quality of life among hemodialysis patients at Rumah Sakit Khusus Ginjal Rasyida Medan.

Methods. This was an analytical observational study with a cross-sectional design involving 50 respondents undergoing hemodialysis therapy …

Faktor-Faktor Yang Berhubungan Dengan Gejala Depresi Pada Pasien Insomnia Usia Lanjut Di Rawat Jalan, Amalia Nur Pratiwi, Edy Rizal Wahyudi, Profitasari Kusumaningrum, Hamzah Shatri, Ikhwan Rinaldi, Rino Alvani Gani, Ika Prasetya Wijaya, Adityo Susilo, Kaka Renaldi

Jurnal Penyakit Dalam Indonesia

Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia.

Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score …

Penggunaan Continous Glucose Monitoring Pada Pasien Dm Tipe 2 Dengan Insulin Dosis Tinggi, Amanda Trixie Hardigaloeh, Dicky Tahapary, Em Yunir, Tri Juli Edi Tarigan

Jurnal Penyakit Dalam Indonesia

Type 2 diabetes mellitus (T2DM) is a chronic disease with a high risk of complications, requiring optimal glycemic control. This case report aims to describe the use of continuous glucose monitoring (CGM) in the evaluation of a patient with T2DM and obesity whose glycemic levels remained uncontrolled despite high-dose insulin therapy. A 58-year-old woman with an 18-year history of T2DM presented to the Endocrinology Clinic of Cipto Mangunkusumo Hospital with uncontrolled blood glucose accompanied by classic diabetic symptoms. CGM revealed that the majority of glucose levels were within the time above range (TAR) at 83% without hypoglycemia, while the time …

Kerentanan Dan Kanker Pada Usia Lanjut: Sebuah Tantangan, Rahmat Cahyanur

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Hubungan Faktor Psikologis Dengan Atrium Fibrilasi: Suatu Tinjauan Kepustakaan, Arina Widya Murni, Annesa Fadella

Jurnal Penyakit Dalam Indonesia

Psychological factors influence the onset of cardiac rhythm and dysrhythmia disorders, including atrial fibrillation (AF), which is defined as uncoordinated atrial activation resulting in ineffective contractions. Psychological factors have a bidirectional relationship with AF, as AF symptoms can lead to a decline in mental health, which in turn negatively affects the clinical course. One explanation for how psychological stress impacts the heart and contributes to AF involves the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Anxiety and depression are common comorbidities in AF. These conditions can be assessed using standardized instruments, such as the Hospital Anxiety and Depression Scale …

Hubungan Hiperurisemia Dengan Penurunan Lfg Pada Pasien Penyakit Ginjal Diabetes Di Rscm Jakarta, Rury Maharani Adna, Maruhum Bonar Hasiholan Marbun, Ikhwan Rinaldi, Em Yunir, Sukamto Koesnoe, Gurmeet Singh, Robert Sinto

Jurnal Penyakit Dalam Indonesia

Introduction. Elevated serum uric acid levels are associated with the progression of kidney disease in patients with type 2 diabetes mellitus (DM), through mechanisms involving endothelial dysfunction, oxidative stress, and chronic inflammation. Research in Indonesia on the relationship between uric acid levels and the decline of glomerular filtration rate (GFR) in diabetic patients remains limited. This study aimed to determine the association between serum uric acid (SUA) levels and decline in glomerular filtration rate among patients with diabetes mellitus diagnosed with diabetic kidney disease at Cipto Mangunkusumo Hospital, Jakarta, over a one-year period.

Methods. This retrospective cohort study …

Pengaruh Heart Rate Variability Terhadap Kesintasan Pasien Dengan Kanker: Laporan Kasus Berbasis Bukti, Kartika Anastasia Kosasih, Nida Raniah, Rudi Putranto, Wulyo Rajabto, Hamzah Shatri, Edward Faisal, Vinandya Irvianita Poespitasari

Jurnal Penyakit Dalam Indonesia

Depression, anxiety, and poor outcomes in cancer are possibly mediated by autonomic dysfunction. Autonomic disfunction found in cancer patients can cause increase in sympathetic tone and decrease in cardiac muscle vagal tone. Heart rate variability (HRV) is a non-invasive index for measuring vagal response and a potential stress response in autonomic dysfunction. In patients with cancer, high vagal tone measured by HRV is significantly correlated with increased overall survival. This evidence-based case report aims to investigate the role of HRV as a prognostic factor in cancer patients. Literature search was done by two authors on five databases: Pubmed, Cochrane Library, …

Hubungan Visceral Adiposity Index Dengan Neuropati Diabetik Perifer Pada Pasien Diabetes Melitus Tipe 2, Muhammad Arif Sanusi, Dian Anindita Lubis, Santi Syafril

Jurnal Penyakit Dalam Indonesia

Introduction. Type 2 diabetes mellitus (T2DM) is the leading metabolic disease in Indonesia. Diabetic peripheral neuropathy (DPN), a major complication of T2DM, was associated with insulin resistance and adipose dysfunction. Visceral adiposity index (VAI) is a tool to measure visceral fat as the indicator of adipose dysfunction and insulin sensitivity. The association between VAI and DPN has not been widely researched, especially in Indonesia. This study aims to assess the association between them.

Methods. This was a cross-sectional study conducted on adult patients (aged ≥18 years) with T2DM at H. Adam Malik General Hospital, Medan, from December 2024 …

Social Disparities, Delirium Occurrence, And Related Outcomes Among Hospitalized Older Adults, Alan P Pan, Kathryn Agarwal, Thomas Potter, Karim Borei, Sara Nowakowski, Courtenay R Bruce, George E Taffet, Farhaan S Vahidy

Faculty, Staff and Students Publications

Background: Underlying socio-economic and health burden may variably impact delirium presentation among older adults. We characterized differences in patient factors related to social marginalization and studied their effects on delirium occurrence and hospital outcomes.

Methods: We conducted a 7-year retrospective analysis of older adults (aged ≥ 70 years) who systematically underwent screening for delirium at an 8-hospital healthcare system. Our primary exposure included patient characteristics related to demographics and social marginalization. Multivariable logistic regression models were built to identify factors associated with increased odds of delirium occurrence, either (1) present-on-admission (D-POA) or (2) hospital-acquired (HAD). Secondary outcomes included hospital length …

A Case Of Kikuchi-Fujimoto Disease In Texas, United States, Divya Chandramohan, Moyosore Awabajo-Otesanya, Deepak Chandramohan, James C. Saca

Graduate Medical Education Research Journal

Kikuchi-Fujimoto disease (KFD) commonly presents with lymphadenopathy, with a third of cases presenting with fevers. It is seen in young female patients of Asian descent, with Taiwan accounting for most of the reported cases. It is imperative to consider KFD in an individual presenting with fever and lymphadenopathy. While it might not be common in the United States, there is an increasing number of cases being reported. Histologic features in KFD are unique, and a lymph node biopsy determines the diagnosis. We outline a case of KFD in the United States and describe histologic details that resulted in the diagnosis.

Buprenorphine/Naloxone Therapy For Opioid Withdrawal, Medication-Assisted Treatment, And Pain Management In An Adolescent Patient, Sindhu H. Manjunath, Michael Spickler, Annas Aljassem

Conference Presentation Abstracts

Introduction: Opioid addiction is a chronic disorder centered around craving and compulsive use of prescription or non-medical opioids. The last three decades have seen a dramatic increase in opioid use order (OUD) in the United States, with about 87,000 adolescents in the 12–17 age group estimated to have OUD in 2019. Less than 10% receive medication-assisted treatment (MAT). We present a case of a 17-year-old male who received treatment with buprenorphine-naloxone (Suboxone) for withdrawal management, MAT and acute pain.

Case Description: A 17-year-old-male with a history of anxiety, depression, and attention deficit/hyperactivity disorder (ADHD) presented to the emergency department (ED) …

When To Tap: Complex Febrile Seizure With Atypical Course As Early Presentation Of Hsv-1 Meningoencephalitis, Isabella Comsa, Sindhu H. Manjunath, Elise Gross, Rawad Obeid, Graham Krasan

Conference Presentation Abstracts

Introduction: Febrile seizures have a prevalence of 2-5% among children ages 6-60 months. Less than 1% of complex febrile seizures without meningeal signs are associated with bacterial or viral meningitis. Current literature supports limiting routine lumbar puncture in this population. We present a case of Herpes Simplex Virus (HSV) encephalitis presenting with complex febrile seizure, who progressed to cerebritis requiring decompressive craniectomy, and discuss indications for further diagnostic evaluation.

Case Description: 2-year-old male with a history of simple febrile seizure presenting with a 10 minute tonic-clonic seizure with right-sided gaze deviation. He had tactile fever and low energy at home …

The Sodium Chronicles: Unraveling The Enigma Of Hypothyroidism-Induced Hyponatremia, Raquel Z. Lara, Tejaswini Swamy, Jennifer Rojas Huen, Ricardo Serna

Research Colloquium

Background: Hyponatremia is an electrolyte disturbance with various etiologies, but hypothyroidism is rarely the primary cause. Literature suggests that hypothyroidism-related hyponatremia occurs primarily in severe cases, with some studies suggesting that hypothyroidism should not be considered a sole contributor if TSH levels are below 50 mIU/L. Patients with hyponatremia have a high risk of prolonged hospital stays and readmission, underscoring the clinical importance of identifying uncommon causes such as severe hypothyroidism. This case highlights this rare association, contributing to the existing limited literature.

Case Presentation: A 74-year-old woman with Type 2 Diabetes, complicated nephrotic syndrome and nephropathy, congestive heart failure, …

Deprescribing And Polypharmacy In Heart Failure Patients Aged 80 Years And Older: A Case Report, Learsi R. De Hoyos, Elizabeth Mills-Reyes, Chelsea Chang

Research Colloquium

Background: Since 2004, the number of adults aged 65 and older has increased by 5.6%. With a growing geriatric population, medical management should maximize benefits and minimize risks. Polypharmacy, defined as the concurrent use of 5 or more medications, is a common concern in older adults. In adults 80 years and older, the prevalence of polypharmacy is 67.1%. Among adults with heart disease, the prevalence of polypharmacy increased from 40.6% to 61.7% between 2000 and 2018. In the context of heart failure, guideline-directed medical therapy (GDMT) includes beta-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 …

Bilateral Small Vessel Strokes In A Young Male With Coccidioidal Meningitis And Suspected Cns Vasculitis, Hugo Zamarron, Ahsan Ali

Research Colloquium

Background: Cerebral small vessel strokes in young, otherwise healthy adults without traditional vascular risk factors are rare and warrant further investigation. Central nervous system (CNS) vasculitis is an uncommon etiology that may be triggered by infections, including fungal pathogens. This case is notable for a suspected primary CNS vasculitis manifesting as bilateral deep infarcts in the setting of Coccidioidal meningitis. It highlights the importance of considering fungal infections and vasculitis in the differential diagnosis of stroke in younger patients.

Case Presentation: A 32-year-old previously healthy male presented with fever, headache, and was diagnosed with aseptic meningitis. He was later readmitted …

Trends And Disparities In Acute Coronary Syndrome-Related Mortality In The United States: Implications For Healthcare, Muhammad Khuzzaim Khan, Ibrahim Ahmed Khan, Abdul Moiz Javed, Arslan Wazir, Hira Saleem, Muhammad Zohaib, Faisal Rasheed, Priyanka Mohan Lal, Syeda Laiba Sherazi, Amiaz Karim, Nikhil Duseja, Hussam Al Hennawi

Abington Jefferson Health Papers

Acute coronary syndrome (ACS) is a major cause of morbidity and mortality in the United States (US). However, the trends and disparities in ACS mortality are not well understood. This study aimed to analyze the ACS mortality in the US from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. The age-adjusted mortality rates (AAMR) due to ACS were calculated for each year from 1999 to 2020, stratified by sex, race, urbanization, and state. The trends and disparities in AAMR were examined using descriptive statistics and graphical methods. The AAMR due …

Delayed Diagnosis Of Systemic Lupus Erythematosus Presenting As Autoimmune Hemolytic Anemia: A Case For Heightened Clinical Suspicion, Diana Acosta Pozo, Luis Álvarez Pérez

Research Colloquium

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem involvement, including hematologic manifestations. Autoimmune Hemolytic Anemia (AIHA), though an established feature, is relatively uncommon and may occur early or in isolation. When AIHA presents without overt systemic symptoms, the underlying autoimmune etiology may be overlooked, resulting in delays in diagnosis and treatment. Prompt recognition is essential to prevent unnecessary interventions and prolonged morbidity.

Case Presentation: A 39-year-old woman residing in Texas presented to the Rheumatology office with persistent synovitis and severe transfusion-dependent anemia, requiring red blood cell transfusions every 48 hours for over three months. She …

A Puzzling Case Of Visual Disturbances Leads To A Fatal Neurodegenerative Diagnosis, Courtney J. Austin, Aaron Carrillo, Jennifer Rojas Huen, Victoria Parada

Research Colloquium

Background: Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease in which early diagnosis is complicated by the presence of early non-specific and atypical presentations. Sporadic CJD (sCJD), the most common type of CJD, is caused by the spread of a disease-forming prion known as PrPSc. PrPSc multiplies and binds to the normal form of prion, or PrP, converting it to an abnormal, structurally altered disease form that spreads throughout the brain. sCJD can initially present with six different phenotypes: cognitive, affective, classic, visual (Heidenhain variant), atactic (Oppenheimer-Brownell variant), and indeterminate. The classic presentation of CJD includes rapidly progressive dementia with …