Internal Medicine Commons^™

Medical, Socioeconomic, And Geographic Disparities In Primary Health Care Access And Utilization: A Population-Based Study Of 8038 Individuals Aged One Year And Older In Rural Uganda, Saadiyah Mayet, Christin Puthur, Betty Nabatte, Benjamin Tinkitina, Christopher Opio, Yin-Cong Zhi, Narcis Kabatereine, Goylette Chami

Internal Medicine, East Africa

Background There is limited data on trends in primary health care (PHC) access and utilisation in rural sub-Saharan Africa, with a particular lack of knowledge on disparities beyond geographic barriers.

Methods A cross-sectional study was conducted within the community-based cohort, SchistoTrack. 2191 households were randomly sampled from 52 rural villages in Pakwach, Buliisa, and Mayuge Districts in Uganda. All household members aged one year and older were surveyed between 2022–2024, resulting in 8038 individuals with baseline health access information. Key outcomes included any care sought within the month preceding the study, type of care sought, and usual source of care. …

A Rare Manifestation Of Mycobacterium Kansasii As A Cutaneous Infection: A Case Report, Wandera Carey, Antony Kimani, Zamanali Khakhar, Dheer Kalaiya, Alok Iyer, Sayed Karar

Internal Medicine, East Africa

Nontuberculous mycobacteria (NTM) are environmental organisms increasingly recognized as opportunistic pathogens, particularly in immunocompromised individuals. Mycobacterium kansasii, a slow-growing photochromogen (Runyon group I), is primarily associated with pulmonary disease; however, extrapulmonary and cutaneous manifestations are uncommon and often underdiagnosed. Given the rising incidence of NTM infections, cutaneous disease should be considered in the differential diagnosis of skin lesions, especially in immunocompromised patients. Early microbiological confirmation is crucial for appropriate therapy, as M. kansasii is intrinsically resistant to pyrazinamide. Herein, we present a case of pathologically confirmed cutaneous M. kansasii infection occurring in isolation, illustrating the diagnostic challenges and therapeutic outcomes.

A Blended Genome And Exome Sequencing Method Captures Genetic Variation In An Unbiased And Cost-Effective Manner, Toni Boltz, Benjamin Chu, Matthew Defelice, Calwing Liao, Julia Sealock, Robert Ye, Jacqueline Goldstein, Lerato Majara, Jack Fu, Lukoye Atwoli

Internal Medicine, East Africa

Here we developed and deployed the blended genome exome (BGE) method, a DNA library approach that generates low-pass whole-genome (1–4× mean depth) and deep whole-exome (30–40× mean depth) data in a single sequencing run. BGE is cost-effective, empowers most genomic discoveries possible with deep whole-genome sequencing and captures global common single-nucleotide polymorphism diversity. We applied BGE to sequence >53,000 samples from the PUMAS Project (Populations Underrepresented in Mental Illness Associations Studies), including African, African American and Latin American populations. Imputed genotypes showed high concordance with Illumina Global Screening Array calls (R2 ≥ 95% for minor allele frequency ≥1%; …

Predicting In-Hospital Mortality In Patients With Hypertensive Emergency: A Retrospective Cohort Study, Jay Satasiya, Bs, Devin Vasoya, Md, Darius Farzad, Md

The Medicine Forum

Approximately 1.3 billion adults worldwide have hypertension.¹ Between 2006 and 2013, there was a two-fold increase in Emergency Department visits for hypertensive emergency.² The prevalence of hypertensive emergency ranges from 0.08% to 0.76% in patients presenting to the Emergency Department.^1,3-6 The estimated incidence of hospitalization with a hypertensive emergency is 111 per 100,000 patients.^1,7 Hypertensive emergency is also associated with significant morbidity and mortality, often leading to ischemic stroke, pulmonary edema, acute heart failure.^3-6 In-hospital mortality among patients with hypertensive emergency varies between 0.48% and 12.5%.^5,7 This retrospective cohort study aims to further clarify …

Assessment And Intervention For Health Behavior Change In Primary Care Across The Lifespan: A Guide For Residents In Primary Care Specialties, Stacy A. Ogbeide, Alexis Ramos, Bridget Murphy, Angel Ogbeide

HCA Healthcare Journal of Medicine

More than 45% of Americans have at least 1 chronic disease, with chronic disease also being a leading cause of death in the United States. In primary care settings, about 75% of visits are for management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Clinicians (PCCs) to manage these conditions alone and point to the need for innovative solutions to chronic disease care. One evidence-based innovation is team-based care to improve the treatment of these conditions. Clinicians such as clinical pharmacists, registered …

Navigating Complex Esophageal Perforations: A Case-Specific Approach To Successful Outcomes, Harsimran Kalsi, Anushree Rai, Kobina Essilfie-Quaye, Neeka Akhavan, Yaseen Perbtani, Tony S. Brar

HCA Healthcare Journal of Medicine

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the …

Hubungan Kadar Malondialdehida (Mda) Serum Dan Fraksi Ejeksi Ventrikel Kiri Pada Pasien Hemodialisis Reguler, Teguh Setiadi Amir, Taufik Indrajaya, Zulkhair Ali

Jurnal Penyakit Dalam Indonesia

Introduction. Malondialdehyde (MDA) is a marker of oxidative stress that is elevated in chronic kidney disease (CKD) patients undergoing regular hemodialysis. Oxidative stress can affect cardiac function especially left ventricular function. This study aimed to evaluate the relationship between serum MDA levels with left ventricular function in regular hemodialysis patients at Dr. Mohammad Hoesin Genaral Hospital, Palembang.

Methods. This study was an analytic observational study with a cross-sectional design conducted on regular hemodialysis patients in the Hemodialysis Installation of Dr. Mohammad Hoesin Genaral Hospital, Palembang. The MDA levels were examined from the serum of post-hemodialysis patients using ELISA …

Takikardia Ventrikel Berulang Pasca Coronary Artery Bypass Grafting (Cabg): Laporan Kasus Berbasis Bukti, Ika Prasetya Wijaya, Simon Salim, Audina Dhiya Nabila

Jurnal Penyakit Dalam Indonesia

Coronary artery bypass grafting (CABG) remains the treatment of choice for patients with complex multivessel coronary artery disease but carries a risk of serious perioperative complications, including ventricular arrhythmias such as ventricular tachycardia (VT). Although VT following CABG is rare, it is potentially life-threatening and often results from multiple interrelated factors. This report presents a case of recurrent ventricular tachycardia after CABG and to highlight the underlying mechanisms, risk factors, and evidence-based management strategies aimed at preventing adverse outcomes.We report a 54-year-old woman with diabetes, hypertension, prior myocardial infarction, and severe left ventricular dysfunction who underwent urgent CABG for three-vessel …

Variabel Dan Model Prediktor Perdarahan Varises Esofagus Berulang Pada Pasien Sirosis Hati Di Rsupn Dr. Cipto Mangunkusumo, Ifani Media Sari, Juferdy Kurniawan, Kemal Fariz Kalista, Aulia Rizka, Eka Ginanjar, Sally Aman Nasution, Leonard Nainggolan Md. Internal Medicine, Tropic-Infection Spesialist, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Introduction. Liver cirrhosis is a chronic condition associated with severe complications, including esophageal variceal bleeding, which carries high morbidity and mortality rates. Approximately 60% of patients with cirrhosis experience recurrent bleeding within one year, with a mortality rate of 20–60% within six weeks after the initial bleeding episode. Therefore, identifying predictors of recurrent bleeding is essential for improving preventive strategies. This study aimed to identify predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis and to develop a predictive model.

Methods. This retrospective study included 220 patients with liver cirrhosis and a history of esophageal variceal …

Kontinuitas Terapi Lupus: Kesenjangan Antara Evidence-Based Medicine Dan Real-World Practice, Abirianty P. Araminta

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Hubungan Penggantian Imunosupresan Tidak Terencana Dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif Di Rsupn Dr. Cipto Mangunkusumo, Jakarta, Rosvitha Amanda, Sukamto Koesnoe, Alvina Widhani, Ikhwan Rinaldi, Adityo Susilo, Juferdy Kurniawan, Rudi Putranto, Birry Karim

Jurnal Penyakit Dalam Indonesia

Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients.

Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability …

Efektivitas Penambahan Suplementasi Vitamin C Terhadap Penurunan Malondialdehid Dan Perbaikan Derajat Aktivitas Penyakit Lupus Eritematosus Sistemik: Uji Klinis Acak Tersamar Ganda, Yuniza Yuniza, Nova Kurniati, Theodorus Theodorus, Eddy M. Salim, Kristian S. Hartanto

Jurnal Penyakit Dalam Indonesia

Introduction. Vitamin C is an antioxidant that exerts its effects at multiple cellular levels. However, evidence regarding its effects in systemic lupus erythematosus (SLE) remain inconclusive. This study aimed to evaluate the potential of vitamin as an adjunctive antioxidant therapy in patients with SLE by assessing its effects on serum malondialdehyde (MDA) levels and disease activity using the Mexical Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) score.

Methods. This pilot double-blind, randomized controlled trial was conducted at Dr. Mohammad Hoesin General Hospital, Palembang. Participants were patients with mild-to-moderate SLE diagnosed according to the 2019 European Alliance of Association …

Profil Biomarker Apolipoprotein B Dan Lipid Terhadap Skor Syntax Pada Pasien Sindrom Koroner Kronik, Muhammad Novran Chalik, Erwin Sukandi, Taufik Indrajaya, Ferry Usnizar, Syamsu Indra, Imran Saleh, Rukiah Chodilawati, Irfannuddin Irfannuddin

Jurnal Penyakit Dalam Indonesia

Introduction. Apolipoproteins are structural components of plasma lipoproteins that are involved in lipoprotein metabolism and lipid transport, reflecting the number of circulating atherogenic particles. The degree of coronary artery stenosis can be assessed by calculating the Synergy between PCI with TAXUS/paclitaxel-eluting stent and Cardiac Surgery (SYNTAX) score, which is an angiographic scoring system used to evaluate the complexity of coronary artery lesions. This study aimed to investigate the profile of apolipoprotein B and lipids, as well as their correlation with the SYNTAX score in patients with chronic coronary syndrome.

Methods. An observational analytic study with a cross-sectional design …

Gagal Jantung Kanan Pada Hipertiroid Tidak Terkontrol: Laporan Kasus, Kevin Lazuardy, Leonard Nainggolan, Nadim Marchian Tedyanto

Jurnal Penyakit Dalam Indonesia

Right heart failure is a clinical syndrome that is influenced by various factors. The incidence of heart failure reaches 5/1,000 population, while the prevalence of heart failure reaches 1-2% of the adult population. Management of the main etiology of heart failure is the main therapy. In some cases, hyperthyroidism is an indirect cause of heart failure, especially in right heart failure. Hyperthyroidism can cause reversible pulmonary hypertension which causes right heart failure, although the underlying mechanism is uncertain at the moment. This study reports a 46-year-old woman who was diagnosed with right heart failure and also had hyperthyroidism. In this …

Miopati Atrium, Fibrilasi Atrium, Dan Stroke: Mengungkap Hubungan Tersembunyi, Muhammad Yamin, Mohamad Syahrir Azizi, Anneira Amanda Putri

Jurnal Penyakit Dalam Indonesia

Atrial fibrillation (AF) is the most common arrhythmia and has been long recognized as a cause for atrial thrombus formation leading to cardioembolic stroke. However, recent studies reveal that the relationship between atrial fibrillation and stroke is an association rather than a temporal relationship. Left atrial thrombus formation is associated with vascular risk factor, atrial remodeling, and thrombogenesis. Various atrial electrical and structural markers of atrial myopathy have been linked to ischaemic stroke, even in the absence of AF. In addition to the CHA2DS2-VASc score as a consideration for anticoagulant administration, accurate atrial myopathy markers are needed to allow early …

Sex-Based Differences In Clinical Outcomes Among Cardiogenic Shock Patients Treated With Mechanical Circulatory Support, Emmanuel Olumuyide, Ju Young Bae, Rongras Damrongwatanasuk, Ezaz Rahman, Barbara Malaga-Espinoza, Jiun-Ruey Hu, S. Elissa Altin

School of Medicine Publications

Despite advances in therapies, cardiogenic shock (CS) remains associated with high mortality rates, often necessitating mechanical circulatory support (MCS) to preserve end-organ perfusion. Despite increasing rates of MCS utilization, less is known about sex-related differences in clinical outcomes to guide practice. Additionally, standardized management protocols for CS patients requiring MCS that account for sex differences are lacking. In this study, we evaluate sex-specific outcomes in CS patients requiring MCS, examine patterns of MCS utilization by sex, and further stratify clinical outcomes by sex across the overall CS cohort, including the acute myocardial infarction-related CS (AMI-CS), acute heart failure-related CS (AHF-CS), …

Using United States Medicare Program Claims To Identify Reliable Measures Of Low Value Services Influenced By Primary Care Physician Decisions, Chris Fleming, Dmitriy Poznyak, Rhea E. Powell, Claire Erba, Eunhae Shin, Rui Wang, Claire Burkhart, Arkadipta Ghosh, Eugene C. Rich

Division of Internal Medicine Faculty Papers & Presentations

BACKGROUND: Low-value services (LVS) are those that “… provide little to no benefit to patients….”¹ Among an existing set of 31 LVS are invasive procedures not typically performed by primary care physicians (PCPs), and other LVS that may be commonly provided by specialists. To facilitate research on the role of primary care physicians in low-value care, we sought to identify the reliability of two subsets of LVS measures that are more directly subject to PCPs’ decisions. We refer to these as primary care adjacent (“PCA”) LVS measures.

METHODS: Retrospective observational cohort study to identify which of a 31-item LVS …

Ep 64 - Operation No Noro: A Multidisciplinary Approach To Containing A Norovirus Outbreak In An Inpatient Rehabilitation Unit, Donika Marko, Roula Hilli, Priscila Bercea, Pamela S. Bozigar, Levi Launder, Stephanie Robertson, Trini A. Mathew

Conference Presentation Abstracts

Norovirus is a highly contagious viral gastroenteritis and can rapidly spread in healthcare settings, particularly in congregate environments such as inpatient rehabilitation units. In March 2025, a cluster of acute gastrointestinal illness was identified on a 34-bed inpatient rehabilitation unit within a 150-bed acute care hospital. Eight patients developed: • Nausea • Vomiting • Diarrhea • Abdominal pain Due to shared spaces, communal therapy activities, and high patient interaction, rapid intervention was initiated to prevent further spread.

Comparing The Effect Of Oral And Transdermal Estrogen Therapy On Lipid Profile In Postmenopausal Women: A Systematic Review And Meta-Analysis Of Randomized Clinical Trials, Mohamed Doma, Jose J. Loayza Pintado, Aria Atwal, Angelica Lopez Jesus, Farhaan Zahrawi, Ibrahim Saleh, Ahmed El Gammal, Zeyad Maharm, Adham Galal Ramadan, Benito Vlassis, Mustafa Shafeeq Ali, Mohammad Khodr Aljamali, Ralph Pandey, Mounira Mefti, Merhan Badran, Muaaz Aslam, Anuj Subedi, Jaffer Shah, Hani Aiash

Research Colloquium

Introduction: Menopause is associated with significant physiological changes, including alterations in lipid profiles. Estrogen therapy plays a crucial role in managing symptoms and preventing long-term complications. This study aims to compare oral and transdermal routes of estrogen therapy among postmenopausal women and assess changes in lipid parameters from baseline.

Methods: Randomized clinical trials comparing oral and transdermal estrogen therapy in postmenopausal women were identified through searches in PubMed, Scopus, Web of Science, and ClinicalTrials.gov. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical analysis was conducted using R version 4.3.2.

Results: Eight randomized …

Cardiovascular Response Patterns To Oral Versus Transdermal Estrogen Therapy In Postmenopausal Women, Mohamed Doma, Jose J. Loayza Pintado, Aria Atwal, Angelica Lopez Jesus, Farhaan Zahrawi, Ibrahim Saleh, Ahmed El Gammal, Zeyad Maharm, Adham Galal Ramadan, Benito Vlassis, Mustafa Shafeeq Ali, Mohammad Khodr Aljamali, Ralph Pandey, Mounira Mefti, Merhan Badran, Muaaz Aslam, Anuj Subedi, Jaffer Shah, Hani Aiash

Research Colloquium

Introduction: The comparative effects of oral versus transdermal estrogen therapy on cardiovascular parameters in postmenopausal women remain incompletely understood. This analysis aimed to evaluate blood pressure and heart rate responses between administration routes.

Methods: A systematic review of randomized trials comparing oral and transdermal estrogen therapy in postmenopausal women was conducted. Primary outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate. Random-effects meta-analysis was performed to calculate pooled mean differences (MD) with 95% confidence intervals (CI).

Results: Analysis of 8 randomized trials (N=885) showed no significant differences between oral and transdermal routes in mean …