Internal Medicine Commons^™

A Deadly Case Of Encephalopathy, Brenna Ostertag, Md, Gita D Gelfer, Andrea Roast

Providence Portland Medical Center Internal Medicine 2025

Introduction: Human prion disease are heterogenous groups of neurodegenerative disorders characterized by spongiform degeneration, astrogliosis, and neuronal loss in the central nervous system from misfolding and subsequent spread of the prion protein. This disease manifests rapidly and is often accompanied by visual and speech abnormalities, gait changes, and progressive encephalopathy. It is always fatal. Around 400 people are diagnosed with prion disease in the United States annually. Recent innovations in diagnostics using Real-Time Quaking Induced Conversion (RT-QuIC) has allowed for antemortem diagnosis of prion disease. Case Presentation: A 66-year-old male with a history of alcohol use disorder in remission and …

Myth Of The Pentad: Approaching Thrombotic Thrombocytopenic Purpura, Nidhi Patel, Md, Meera Jain, Natasha Edwin, Md

Providence Pharmacy PGY2 Program at Providence Medical Group 2025

Introduction: •Thrombotic Thrombocytopenic Purpura (TTP) is a thrombotic microangiopathy that leads to microthrombi formation. •Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count due to both increased platelet destruction and impaired platelet production. •Though both involving thrombocytopenia, prompt recognition of TTP is critical, as it has a high mortality rate if left untreated Case Presentation: •42-year-old female with rheumatoid arthritis (RA) who was started on tocilizumab three months prior to presentation •Platelet counts dropped to 30,000 (Figure 1). Her rheumatologist presumed that it was ITP and treated her with steroids •Presented to outside emergency …

Endocarditis Prophylaxis In Vulnerable Valve; Antibiotic Stewardship Or Suboptimal Care?, Zachary Taylor, Andrea Roast, Michael Layoun

Providence Portland Medical Center Internal Medicine 2025

Introduction Infective endocarditis (IE) is a relatively uncommon disease with an annual incidence of 5 per 100,000 people in the U.S.. Dental procedures are an exceptionally rare cause of IE. Amidst a global emphasis on antibiotic stewardship, U.S. and European guidelines only recommend antibiotic prophylaxis for dental procedures in high-risk groups. Having a bicuspid aortic valve (BAV) confers an 11-fold risk of endocarditis compared to the general public, and yet, is not classified as high-risk per AHA/IDSA guidelines. We present a patient with BAV who developed IE following a noninvasive dental procedure and review whether patients with BAV are under-classified …

Clinicians’ Perspectives Concerning Treatment Initiation And Escalation Strategies For Digital Ulcers In Patients With Systemic Sclerosis, Giulia Campanaro, Giulia Bandini, Alessia Alunno, Stefano Di Donato, Begonya Alcacer-Pitarch, Ilaria Galetti, Barbara Ruaro, Silvia Bellando Randone, Alberto Moggi Pignone, Marco Matucci-Cerinic, Zsuzsanna H Mcmahan, Michael Hughes

Faculty, Staff and Student Publications

Objectives: Digital ulcers (DUs) are a major cause of pain and disability in systemic sclerosis (SSc) patients and remain a major treatment challenge. Our aim was to explore clinicians' perspectives towards treatment initiation and escalation, akin to a 'Treat to Target' (T2T) strategy.

Methods: SSc clinicians were invited to participate in an online survey.

Results: A total of 173 responses (75% rheumatologists) were obtained from 33 countries. When initiating a change in oral drug therapy for SSc-DUs, most (80%) respondents would consider adding new medication to existing treatment, and 50% would increase existing treatment dose. Time to assess the impact …

Survey Of Medical Student Attitudes Regarding Uterine Transplant For Cisgender And Transgender Women, Oakland University William Beaumont School Of Medicine Medical School Medical Student, Deidre Hurse, Abram Brummett

Posters

No abstract provided.

One Pulse At A Time: Exploring Spinal Cord Stimulator Anatomy To Enhance M1 Medical Education, Matthew Tufts, Sruthi Shriram, Arush Rao, Ariel Banks, Ragad Almsaddi, Gabrielle Abdelmessih, Varna Taranikanti

Posters

No abstract provided.

How Long Must We Wait? A Review Of Adherence To Established Npo Guidelines, Ellen C. Bouaziai, Anthony S. Hernandez, Shashi Sahai, Kerry Peters Mychaliska

Conference Presentation Abstracts

Background: Patients undergoing a procedure with anesthesia are required to be nil per os (NPO) for a defined period to reduce the risk of aspiration of gastric contents. In 2017, the American Society of Anesthesiologists (ASA) published guidelines for preoperative fasting, which allow for consumption of a full meal 8 hours before a procedure; non-human milk, light meal, and infant formulas 6 hours prior; breastmilk 4 hours prior; and clear liquids 2 hours prior to procedure. It is well known that these NPO guidelines are inconsistently applied to pediatric patients. The purpose of this study is to determine the percentage …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Can Endothelin-1 Help Address The Diagnostic And Prognostic Challenges In Multimorbid Acute Heart Failure Patients?, Bianca-Ana Dmour, Minerva Codruta Badescu, Cristina Tuchiluș, Corina Maria Cianga, Daniela Constantinescu, Nicoleta Dima, Ștefania Teodora Duca, Awad Dmour, Alexandru Dan Costache, Maria-Ruxandra Cepoi, Adrian Crișan, Sabina Andreea Leancă, Cătălin Loghin, Ionela-Lăcrămioara Șerban, Irina Iuliana Costache-Enache

Faculty, Staff and Student Publications

The management of acute heart failure (AHF) is becoming increasingly complex, especially in patients with multiple comorbidities. Endothelin-1 (ET-1), a vasoconstrictive peptide, is an important mediator of neurohormonal activation, endothelial dysfunction, and cardiac remodeling-key processes involved in the pathogenesis of AHF. The aim of our study was to evaluate the diagnostic and prognostic performance of ET-1 in multimorbid AHF patients, compared to established markers such as amino terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). We conducted a single-center prospective study including 76 patients; 54 with AHF and 22 serving as controls. Upon admission, all patients …

Acute Rheumatic Fever Presenting With Isolated Myocarditis And Right Coronary Artery Occlusion, Sumedh Iyengar, Md Mashiul Alam, Shaun Abid Md, Evgeny Shkolnik, Stuart Zarich

Posters

Acute Rheumatic Fever (ARF) and rheumatic heart disease continues to be a major health hazard in most developing countries.

Coronary artery obstruction has long been regarded as an uncommon complication of rheumatic heart disease and has rarely been reported in ARF.

Metaplastic Breast Cancer: A Retrospective Chart Review Of Clinical Features, Nidhi Navaratna, Mariam Aoun, Nitya Batra, Mohammad M. Chisti

Conference Presentation Abstracts

No abstract provided.

Profil Kadar Vitamin D Dan Hubungannya Dengan Derajat Keparahan Klinis Serta Parameter Inflamasi Pada Pasien Terkonfirmasi Covid-19, Wicensius Parulian Hasudungan, Andhika Rachman, Alvina Widhani, Arif Mansjoer

Jurnal Penyakit Dalam Indonesia

Introduction. The available data currently is not adequate to show the differences in vitamin D levels across various clinical stages of COVID-19 in Indonesia. Therefore, this study was conducted to determine the profile of vitamin D levels and its relationship with the clinical severity and inflammatory parameters in confirmed COVID-19 patients.

Methods. The study was conducted at Cipto Mangunkusumo Hospital and Wisma Atlet COVID-19 Emergency Hospital from January to December 2021. Subjects who were 18 years old and above and had confirmed COVID-19 status through COVID-19 Polymerase Chain Reaction (PCR) from oropharyngeal swab were included. Those who refused …

Profil Anafilaksis Di Rsu Hasanah Graha Afiah, Depok Pada Januari 2023 – April 2024, Sukamto Koesnoe, Risky Wulandari, Bramantya Wicaksana

Jurnal Penyakit Dalam Indonesia

Introduction. Anaphylaxis is a severe hypersensitivity reaction that occurs rapidly and can be life-threatening. This reaction disrupts the respiratory, cardiovascular, digestive, and/or integumentary systems. The global prevalence of anaphylaxis is 1-2%, with a mortality rate of 0.3%. However, data on anaphylaxis in Indonesia is very limited. The aim of this study was to obtain anaphylaxis profile at Hasanah Graha Afiah Hospital, Depok.

Methods. This study used a cross-sectional descriptive study from January 2023 to April 2024 at Hasanah Graha Afiah Hospital, Depok, Jawa Barat. Inclusion criteria include patients aged ≥17 years, diagnosed with anaphylaxis in medical records in …

Hubungan Heart Rate Variability Dengan Global Longitudinal Strain Pada Pasien Diabetes Melitus Tipe 2 Di Puskesmas Jakarta, Dwi Rendra Hadi, Lusiani Rusdi, Tri Juli Edi Tarigan, Arif Mansjoer

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetes mellitus (DM) remains a major global health issue due to its direct consequences and complications, particularly cardiovascular complications. These complications are influenced by autonomic neuropathy, which can be assessed by Heart Rate Variability (HRV). Autonomic dysfunction is thought to impair heart function, which can potentially be predicted early by observing Global Longitudinal Strain (GLS). The relationship between HRV and GLS has not been extensively studied. Therefore, this study aimed to identify the relationship between HRV and GLS.

Methods. A cross-sectional study with a population of adult type 2 DM patients residing in Jakarta in December 2020. …

Infeksi Oportunistik Pada Pasien Hiv Yang Dirawat Inap Di Rsup Dr. Hasan Sadikin Bandung Tahun 2019-2022, Katarina Salma, Yovita Hartantri, Nisa Fauziah

Jurnal Penyakit Dalam Indonesia

Introduction. Human Immunodeficiency Virus (HIV) is a virus that infects and attacks the human immune system. The high morbidity and mortality rates in HIV patients can be attributed to various factors, one of which is the presence of opportunistic infections due to the weakened immune response, making HIV patients highly susceptible to other infections. This study aims to provide an overview of opportunistic infections in HIV patients hospitalized at Dr. Hasan Sadikin General Hospital in Bandung within the period of 2019-2022.

Methods. This descriptive observational study was conducted on 255 HIV patients with opportunistic infections who were hospitalized at dr. …

Penghambat Kanal Kalsium Sebagai Kontrol Glukosa Darah Pada Insulinoma: Sebuah Laporan Kasus, Nadhira Nizam, Ryan Tresna Putra, Anshari Saifuddin Hasibuan

Jurnal Penyakit Dalam Indonesia

Insulinoma is a rare neuroendocrine tumor of the pancreas arising from β-cells, leading to excessive insulin secretion and resultant hypoglycaemia. Surgical resection is the first-line treatment for insulinoma, but when surgery is not feasible, medical therapy is an important option. Calcium channel blockers (CCBs) such as verapamil can inhibit insulin release from β-cells and have been proposed as an adjunct therapy to help control blood glucose levels in insulinoma. We report a 43-year-old man who presented to the emergency department with decreased consciousness due to hypoglycaemia. His capillary blood glucose at home was 35 mg/dL, about 8 hours after his …

Advanced Hiv Disease: Wajah Hiv Yang Hampir Terlupakan, Evy Yunihastuti, Bramantya Wicaksana

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Efek Hipnoterapi Untuk Meningkatkan Kualitas Hidup Pada Pasien Penyakit Ginjal Kronik: Suatu Laporan Kasus Berbasis Bukti, Aisha Putri Chairani, Rudi Putranto, Hamzah Shatri, Maruhum Bonar Hasiholan Marbun, Edward Faisal, Vinandia Irvianita, Diah Martina

Jurnal Penyakit Dalam Indonesia

Chronic Kidney Disease (CKD) is a condition of kidney damage with a decrease in glomerulus filtration rate of 60 ml/min/1.73 m3 for a duration of more than three months. CKD is closely related to the patient’s quality of life because the patient must carry out various lifestyle restrictions to slow the progression of kidney damage. Lifestyle restrictions often cause problems in the psychosocial field that increase the severity of symptoms and decrease kidney function faster. This evidence-based case review was compiled to determine the effectiveness of hypnotherapy in improving the quality of life of CKD patients. Literature searches were conducted …

Pencegahan Sindrom Delirium Akut Pada Pasien Lansia Di Rawat Inap, Vera Vera

Jurnal Penyakit Dalam Indonesia

Acute delirium syndrome is often found in hospitalized older patients, requiring longer hospital stay and higher hospital cost. Studies showed that 40% of these delirium cases in older patients may be prevented with multicomponent intervention based on National Institute for Health and Clinical Excellence (NICE) and Hospital Elder Life Program (HELP) guidelines. This article explained multicomponent intervention, which includes protocols for disorientation, dehydration, hypoxia, constipation, malnutrition, pain control, infection control, infection prevention, drugs evaluation, early mobilization, and education for patients’ family / caregiver. Prevention of acute delirium syndrome in hospitalized older patients will reduce the medical cost and distress among …

Status Gizi Sebagai Faktor Risiko Mortalitas Di Rumah Sakit Pada Pasien Lanjut Usia Pasca Reseksi Tumor Kolorektal, Ayu Fitri Sekar Wulandari, Parish Budiono, Yudo Murti Mupangati

Jurnal Penyakit Dalam Indonesia

Introduction. Malnutrition in elderly patients, particularly those with colorectal cancer, increases morbidity, mortality, and length of hospital stay due to metabolic dysregulation and hypermetabolic perioperative response, affecting wound healing, infection risk, postoperative complications, and nutritional deficits. This study aimed to analyze whether nutritional status is a risk factor for in-hospital mortality in elderly patients after colorectal tumor resection.

Methods. A case-control matching study was conducted on elderly patients who underwent colorectal tumor resection, using secondary data from elderly inpatients at Dr. Kariadi General Hospital from January 2020 to April 2024. The collected data were analyzed using bivariate analysis …