Internal Medicine Commons^™

Cardiovascular Manifestations Of Pseudoxanthoma Elasticum., Aimee Willett, Vivek V Jasti, Sean M Muir, Jay Anderson

Ambulatory and Primary Care Articles

Pseudoxanthoma elasticum (PXE) is a rare systemic disorder of elastic fibers. The most common manifestations include characteristic papules and ocular angioid streaks. Cardiovascular complications include peripheral arterial disease, hypertension, premature coronary artery disease, and cerebrovascular disease. These associations are secondary to dystrophic elastic fibers, resulting in the calcification of small- to medium-sized arteries. We present the case of a 22-year-old otherwise healthy female patient diagnosed with PXE following a biopsy of a neck lesion. Ophthalmologic evaluation revealed characteristic angioid streaks. The patient also reported early satiety and leg cramping, which prompted referral to gastroenterology and cardiology. Further investigation raised concern …

Complications And Management Of Idiopathic Multicentric Castleman Disease, Kavanya Feustel, Jacob W. Keeling, Olivia Makos, Dmitriy Scherbak

HCA Healthcare Journal of Medicine

Background

The pathophysiology of idiopathic multicentric Castleman disease (iMCD) is poorly understood compared to the other subtypes of MCD, which has contributed to limited treatment options and poor prognosis for iMCD patients. The pathogenesis of iMCD is thought to be mediated in part by dysregulation of interleukin (IL)-6.

Case Presentation

We present a case report of a 39-year-old Caucasian man with siltuximab-refractory iMCD. He presented with severe lower extremity lymphedema and wounds. His disease progressed through standard-of-care siltuximab. Due to his severe disease-related morbidity, he contracted recurrent infections, often complicated by sepsis. Ultimately, he required a left lower extremity amputation. …

Covid-19 Vaccine-Induced Rhabdomyolysis In A 53-Year-Old Woman, Akash Hazari, Jack Chien, Daniel Nunez

HCA Healthcare Journal of Medicine

Introduction

COVID-19-induced rhabdomyolysis is a common complication in COVID-19 infection. However, only a handful of cases have been reported showing links between COVID-19 vaccine and rhabdomyolysis.

Case Presentation

We present the case of a 53-year-old woman, who recently received COVID-19 vaccine and presented to the hospital with progressive extremity weakness. Common reasons for rhabdomyolysis were ruled out as possibility and the patient was found to have rhabdomyolysis induced from COVID-19 vaccine.

Conclusion

Even though COVID-19 vaccine-induced rhabdomyolysis is rare, it should be considered in the differential diagnosis with patients presenting with neuromuscular complaints and a recent COVID-19 vaccine.

Clinical Outcomes After Hospitalization For Acute Coronary Syndrome In Patients Treated With Semaglutide Versus Bariatric Surgery: A Retrospective Multicenter Analysis, Nameer Ascandar, Charles Boadu, Gauthier Stepman, George Skaf, Olugbenga Oyesanmi, Sabry Omar, Rias Ali, Michael Schandorf-Lartey

HCA Healthcare Journal of Medicine

Background

Obesity is a chronic medical condition with a rising prevalence in the United States. A wide range of morbidity and mortality is associated with obesity, with coronary artery disease being among the most common. Ischemic heart disease continues to be the primary cause of death in the United States. Taken together, interventions to minimize the detrimental effects of obesity on patients at risk of heart disease will not only benefit the patient, but the health care system as well.

Methods

In this retrospective study, we used the HCA Healthcare enterprise data warehouse to identify all adult patients who were …

Efficacy And Safety Of Lotilaner Ophthalmic Solution 0.25% In Demodex Blepharitis: A Systematic Review, Stephanie P. Fabara, Thalia Fabara, Akankcha Alok, Nausheen Khuddus

HCA Healthcare Journal of Medicine

Demodex blepharitis is a chronic eyelid inflammation caused by Demodex mites, which are ubiquitous skin parasites. Lotilaner, a newly United States Food and Drug Administration (FDA)-approved drug, is an antiparasitic agent that selectively inhibits parasite-specific γ-aminobutyric acid chloride channels, inducing spastic paralysis and death of Demodex mites. It is applied as an ophthalmic solution, 0.25%, twice a day for 6 weeks, and it has a long half-life and high lipophilicity, facilitating the penetration of the drug into the eyelash follicles and meibomian glands where the mites reside. This study systematically reviewed 6 clinical trials that compared lotilaner with placebo for …

Mortalitas Pada Pasien Hemodialisis: Masih Menjadi Tantangan Globa, Anandhara Indriani Indriani Khumaedi, Dina Elita

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Faktor-Faktor Yang Berhubungan Dengan Massa Otot, Kekuatan Otot, Dan Performa Fisik Pada Lansia, Nur Riviati, Taufik Indrajaya, Rukiah Chodilawati, Ridzqie Dibyantari, Bima Indra

Jurnal Penyakit Dalam Indonesia

Introduction. Despite its high prevalence and significant impact on health, comprehensive studies are still needed to explore the factors affecting sarcopenia parameters, such as muscle mass, muscle strength, and physical performance. This study aimed to identify the factors influencing sarcopenia parameters in the elderly, including muscle mass, muscle strength, and physical performance.

Methods. A cross-sectional study was conducted from July to December 2022 on elderly individuals (>60 years old) at the Geriatric Polyclinic, Moh. Hoesin General Hospital, Palembang, selected through consecutive sampling. Muscle mass was measured using bioimpedance analysis, expressed in ASMI values; muscle strength was measured …

Faktor Risiko Yang Berhubungan Dengan Kematian Pasien Penyakit Ginjal Kronis Pada Usia Dewasa Yang Menjalani Hemodialisis Reguler Di Provinsi Lampung, Joue Abraham Trixie Latupeirissa, Mondastri Korib Sudaryo, Muhamad Zulfikar Hadiaturahman, Steven Sapta Putra Sinaga

Jurnal Penyakit Dalam Indonesia

Introduction. Although mortality among adult chronic kidney disease (CKD) patients on regular hemodialysis remains infrequent within the first three months, it is still a potential outcome. Given that hemodialysis is required for life, identifying risk factors for mortality is critical. This study aims to examine risk factors associated with mortality in adult CKD patients undergoing regular hemodialysis.

Methods. A case-control study, without matching, was conducted using medical record data from adult CKD patients (≥18 years) receiving regular hemodialysis between 2022 and 2024 at three hospitals (types A, B, and C) in Lampung Province. The case group consisted of …

Gejala Neuropsikiatri Pasien Hiv Setelah Menjalani Transisi Antiretrovirus Nevirapin Ke Dolutegravir Di Rumah Sakit Cipto Mangunkusumo, Jakarta, Metra Adi Pratama, Rudi Putranto, Herqutanto Herqutanto, Aisyah Syahrani, Aljira Fitya Hapsari, Veritea Natali, Meivina Ramadhani Pane, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

Introduction. Dolutegravir (DTG) is one of the effective antiretroviral therapies (ART) for suppressing HIV replication and has a favorable safety profile. However, reports regarding neuropsychiatric side effects, especially in patients transitioning from a nevirapine (NVP) regimen to dolutegravir, have started to emerge. This study aimed to describe the changes in neuropsychiatric symptoms before and after the transition from a NVP-based ARV regimen to DTG in HIV patients at Cipto Mangunkusumo Hospital (RSCM), Jakarta.

Methods. This study employed a prospective cohort design involving 292 HIV patients at Cipto Mangunkusumo Hospital who were transitioning from NVP to DTG regimen. Participants …

Peran Prediktif Il-6, Il-10, Dan Tnf-Α Plasma Terhadap Gagal Ginjal Akut Pada Pasien Dengan Covid-19 Derajat Sedang Dan Berat, Dewi Gathmyr, Maruhum Bonar H Bonar, Adityo Susilo, Kuntjoro Harimurti, Ginova Nainggolan, Alvin Tagor, Hamzah Shatri, Cosmas Rinaldi Adithya Lesmana, Zulkifli Amin

Jurnal Penyakit Dalam Indonesia

Introduction. Acute kidney injury (AKI) is associated with higher mortality rate in COVID-19 patients due to inflammation and immune dysregulation. This study aimed to correlate serum levels of IL-6, IL-10, and TNF-α with serum creatinine changes and their roles to predict incidence of acute kidney injury (AKI) in patients with moderate and severe COVID-19.

Methods. This prospective cohort study was conducted among patients with moderate to severe COVID-19 in Pertamina Central Hospital Jakarta, Indonesia during November 2020 to January 2021. All serum levels of cytokines (IL-6, IL-10, and TNF-α) and creatinine were collected on the first day and …

Korelasi Stenosis Penyakit Arteri Perifer Di Bawah Lutut Dengan Kecepatan Hantar Saraf Pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2, Akbarbudhi Antono, Dono Antono, Birry Karim, Manfaluthy Hakim, Kuntjoro Harimurti, Dyah Purnamasari Sulistianingsih, Eka Ginanjar, Erni Juwita Nelwan, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN.

Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 …

Laporan Kasus Hipokalemi Periodik Paralisis Pada Pasien Dengan Graves’ Disease, Anggi Cahaya Millenia S Sirait, Borries Foresto Buharman, Adinda Zhafira Dyanti Putri, Derby Ayudhia Utami Iskandar Putri

Jurnal Penyakit Dalam Indonesia

Hypokalemia periodic paralysis (HPP) characterized by episodes of flaccid weakness or paralysis that may be associated with abnormalities of the serum potassium level. HPP often associated with hyperthyroidism and Graves’ disease. HPP prevalence is 1 in 100.000. Each individual has different clinical manifestations, so it’s necessary to adjust therapy based on the etiology. This case report was developed to provide more information regarding Graves’ disease, considering lack of information about management and description of HPP with Graves’ disease. A 27-year-old male with sudden weakness in both legs radiating to upper extremity, shortness of breath, palpitations, and sweating. Over the last …

Pemberian Asupan Kalori Terestriksi Vs. Asupan Kalori Standar Yang Berlanjut Pada Pasien Penyakit Kritis Dengan Refeeding Syndrome: Laporan Kasus Berbasis Bukti, Sukma Hapsari, Rabbinu Rangga Pribadi

Jurnal Penyakit Dalam Indonesia

Refeeding syndrome is a different clinical symptom and metabolic disorder that occur during the reintroduction of nutrition in chronically malnourished patients. Calorie restriction can increase survival and reduce mortality rates. This evidence-based case report was developed to examine the influence of caloric restriction on mortality, morbidity, and duration of critical illness. A literature search was performed using PubMed, EBSCOHost, ScienceDirect, and Cochrane with the keywords: “critically ill,” “restricted caloric intake,” “standard caloric intake,” “mortality,” “morbidity,” and “duration”. Articles were appraised using the University of Oxford Centre for Evidence-Based Medicine (CEBM) tools. Two studies met the inclusion criteria. The first was …

Tata Laksana Fraktur Panggul Pada Geriatri: Sudut Pandang Internis, Laila M. Jannah, Noto Dwimartutie

Jurnal Penyakit Dalam Indonesia

Hip fracture are a common issue in geriatric patients, associated with increased risk of morbidity and mortality. The complex and multimorbid characteristics of geriatric patients presents significant challenge in their management. Optimal outcomes require a comprehensive interdisciplinary approach to care, aiming to restore functional status and reduce postoperative complications. A holistic strategy, grounded in thorough Comprehensive Geriatric Assessment (CGA), is essential to guide individualized treatment and ensure effective, patient-centered management.

Immune Thrombocytopenic Purpura Association With Epstein-Barr Virus, Amer Aldamouk, Bachr Masri, Ali Khan, Pulkita Uppal

Graduate Medical Education Research Journal

Immune thrombocytopenia (ITP), also referred to as idiopathic thrombocytopenic purpura, is an acquired form of thrombocytopenia caused by antibodies directed against platelet glycoproteins, particularly anti-GpIIb/IIIa antibodies. Epstein-Barr virus (EBV), a herpes virus infecting a large majority of the population before adulthood, has been implicated in various immune-mediated disorders, including ITP. In this report, we present a case of a young adult female with a history of thrombocytopenia who was found to have severe thrombocytopenia attributed to chronic EBV infection. Despite initial treatment with corticosteroids and intravenous immunoglobulin (IVIG), the patient's condition necessitated second-line therapies, including rituximab and thrombopoietin receptor agonists. …

Intermittent Fasting For Metabolic Syndrome Management, Tony Laborde

Lynchburg Journal of Medical Science

This paper reviews the potential of intermittent fasting as a non-pharmacological therapeutic approach to the treatment of metabolic syndrome (MetS). MetS is a global health problem with risk factors that include obesity, hypertension, hyperglycemia, low high-density lipoprotein (HDL) cholesterol, and high triglycerides that predispose to cardiovascular disease and type 2 diabetes. Traditional treatment approaches, including pharmacological agents and lifestyle modification, are typically of short-term benefit. Intermittent fasting, with its scheduled cycles of eating and fasting, presents another strategy for improving weight control, insulin sensitivity, lipid profiles, and blood pressure. Various intermittent fasting regimens, including time-restricted feeding and alternate-day fasting, have …

The Acute Care Mobility Assessment Is A Promising Tool For Evaluating Day-To-Day Mobility In Clinical Settings: Linguistic And Convergent-Validity In Danish Geriatric Patients, Britt Stævnsbo Pedersen, Lea Kromann Johansen, Thomas Kallemose, Thomas Bandholm, Cynthia J. Brown, Mette Merete Pedersen

School of Medicine Faculty Publications

Objective: Low in-hospital mobility is highly prevalent and can cause hospital-associated-disability. In both research and clinical care, valid and reliable outcome measures of in-hospital mobility are necessary. The Acute Care Mobility Assessment (ACMA) provides a single measure of hospital out-of-bed mobility and may be a promising tool. The purpose of this study was to perform a cross-cultural validation to facilitate international uptake. Methods: We performed a linguistic validation (translation, cognitive interviewing, cultural adaptation) of the ACMA in Denmark and investigated the convergent-validity of the Danish version (ACMA-DK) in older hospitalized (+65) Danish adults by evaluating the correlation between the ACMA-DK …

Small Gifts, Big Questions: The Ethical Dilemma In Accepting Gifts In Medicine, Meiqi Luo, Md

The Medicine Forum

I remember discussing the topic of gift-giving by patients in a small group session in medical school. When asked whether it’s ethical for medical professionals to accept gifts from patients, I responded, “It depends on the value of the gifts.” If the gifts were of appropriate value and given purely out of appreciation, they serve to strengthen the physician-patient relationship. However, what I failed to realize was the difficulty in determining the value and intention of a gift. My personal experience of receiving gifts from a patient made me aware of such ethical ambiguities.

At the community clinic where I …

Navigating Care And Loss Through Aging, Disease, And Decision-Making In The Covid Era, Michael Predi, Do

The Medicine Forum

There is only one of the loved one you know.
Often it can be hard to let go.
Five years old the world became cold.
Lost my mother to breast cancer.
A cold wound that can’t be answered
Father raised you in a foreign land.
Drove you to school, combed your hair, gave you a life you could have never planned.
Taught me that I would catch a cold from the wind.
No arguing about modern medicine, my dad was thick skinned,
Here comes college, first generation, what an exciting time.
Get to medical school so exciting; here comes the …

Existential Pain, Kian Waddell

The Medicine Forum

A new type of pain
Never covered in a lecture
Not neuropathic, visceral, post-procedural, cancer, phantom pains,
But existential.

She didn’t want pain meds
And she had her reasons -
We didn’t push.

What she wanted was to talk
To be heard
For us to be silent and stop
Asking her every second
If she’d moved bowels, vomited, slept…

What she wanted was to talk.
What other medication is there for pain of the soul?