Internal Medicine Commons^™

Social Relationships, Mental Health, And Stigma: A Qualitative Study Of Social Networks And Hiv Disclosure In Western Kenya, Sarah Obatsa, Adel Mburia-Mwalili, Salvador Jauregui, Karla Wagner, Lukoye Atwoli, Francesca Odhiambo, Jayne Lewis-Kulzer, Suzanne Goodrich, Kara Wools-Kaloustian, Jennifer Syvertsen

Internal Medicine, East Africa

The disclosure of one’s HIV-positive status is a personal decision that can play an important role in engagement in HIV treatment and care. Social network approaches situate individuals within broader webs of social connections that influence health and wellbeing and thus hold the potential to elucidate key social factors shaping the process of disclosure. As part of a larger clinical study examining how substance use and mental health shape HIV outcomes, we recruited 61 individuals newly diagnosed with HIV at two clinics in Western Kenya to participate in an egocentric social networks study. We conducted a survey that generated a …

Ambulatory Blood Pressure Monitoring Phenotypes And Circadian Blood Pressure Patterns Among Adults Referred For Diagnostic Evaluation At Aga Khan University Hospital, Nairobi, Kenya: A Retrospective Cross-Sectional Study, Nadeem Kassam, Mzee Ngunga, James Orwa, Alisa Bhojani, Mohamed Varwani, Swaffiya Salim, Yvonne Oketch, Salim Surani, Anthony Ochola, Barbara Karau, Jeilan Mohamed, Etienne Amendezo

Internal Medicine, East Africa

Introduction: hypertension represents the primary modifiable risk factor for cardiovascular disease and poses a public health challenge in sub-Saharan regions, with Kenya experiencing particularly low detection and control rates. Traditional office-based blood pressure measurements often fail to detect key phenotypes, such as white-coat and masked hypertension. Ambulatory Blood Pressure Monitoring (ABPM) offers a comprehensive 24-hour profile that excludes white-coat hypertension and allows for the evaluation of circadian patterns, including nocturnal hypertension and non-dipping status, both of which are recognized as high-risk phenotypes strongly linked to adverse cardiovascular events. This study evaluated ABPM data from Aga Khan University Hospital, Nairobi …

Recurrent Upper Gastrointestinal Bleeding Due To Gastric Arteriovenous Malformation, Lavender Otom, Priyanka Panwar, Gerald Odong, Christopher Opio, Saleem Abdulkarim

Internal Medicine, East Africa

We present the case of a 45-year-old male with repeated episodes of upper gastrointestinal bleeding due to a gastric arteriovenous malformation (AVM). The case underscores the diagnostic challenges, multidisciplinary decision-making, and management considerations associated with gastrointestinal vascular malformations. Given the rarity of gastric AVMs and their potential for serious complications, this report highlights the importance of an integrated approach to diagnosis and treatment, including advanced imaging and endovascular interventions.

Assessing Aflatoxin Knowledge, Perceptions, And Related Practices, In A Rural Coastal Community: A Population-Based Cross-Sectional Survey, Rosebella Iseme, Joseph Abuodha, Anthony Ngugi, Innocent Abayo, Mansoor Saleh

Population Health, East Africa

Background

Aflatoxin contamination is a significant yet under-addressed food safety challenge in low-resource settings, driven by a complex interplay of environmental, agricultural, and socio-economic factors. Limited access to agricultural inputs, inadequate post-harvest handling and storage, and weak regulatory enforcement alongside food scarcity and climate change heighten the risk of contamination and exposure. Human exposure is associated with serious health consequences, including hepatocellular carcinoma, immune suppression, and childhood stunting. Although aflatoxin is increasingly recognized as a global food safety concern, little is known about community-level knowledge, risk perceptions, and preventive practices. This study examined household heads’ awareness, perceptions, and behaviours related …

Pernicious Anemia Presenting As Pseudothrombotic Microangiopathy: A Case Report, Sai Sushrutha M Vemula, Shreeya Adhikari, Shreya Motkur, Alfarooq Alshaikhli, Borys Hrinczenko

School of Medicine Publications

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ dysfunction, with high untreated mortality that can be effectively reduced with timely plasma exchange (PLEX) and immunosuppressive therapy. However, several conditions can produce a clinically similar pseudo-TMA picture, among which severe vitamin B12 deficiency is an underrecognized and potentially treatable mimic that occurs due to ineffective intramedullary erythropoiesis, megaloblastic fragmentation of structurally abnormal erythrocytes, and pancytopenia in the absence of true endothelial injury or ADAMTS13 deficiency. We present a 74-year-old female patient who presented with altered mental status, bradycardia, and severe …

Health Practices And Use Of Traditional Medicine Among Asian Indian Immigrants In The United States: A Pilot Study, Parita Patel, Anil N.F. Aranha

Medical Student Research Symposium

Title: Health Practices and Use of Traditional Medicine Among Asian Indian Immigrants in the United States: A Pilot Study

Authors

Parita Patel, MPH¹; Anil N.F. Aranha, PhD^1,2

Medical Education¹, Internal Medicine², Wayne State University School of Medicine, Detroit, Michigan

Abstract

Background and Purpose: Traditional and alternative medicine (TAM), including Ayurveda, Homeopathy, Naturopathy, and home remedies, remains widely used among Asian Indian (AI) immigrants in the United States alongside Western medicine. Cultural familiarity, family influence, and perceived safety shape these practices. This pilot study examined TAM prevalence, patterns, and perceptions among AI immigrants and …

Polymorphic Ventricular Tachycardia, Sarcoidosis, And The Ultimate Unmasking Of A Pheochromocytoma, Anusha U. Saga, Elizabeth Clark, Isaac R. Whitman

Department of Medicine Faculty Papers

The pitfall of anchoring bias may contribute to diagnostic conundra. In this case, a patient with a history of systemic sarcoidosis presented to the electrophysiology clinic with palpitations. Rhythm monitoring revealed polymorphic ventricular tachycardia (PMVT). A diagnosis of cardiac sarcoidosis was presumed and pursued even though repeat cardiac imaging was negative. In the interim, the patient developed new hypertension, and the patient’s primary care provider screened the patient for pheochromocytoma. Despite the initial pursuit of a misdiagnosis in a patient with a high pretest probability for the wrong diagnosis, the pheochromocytoma was resected and the PMVT and hypertension was cured.

Pneumomlpred: Innovating Pneumonia Management With Guideline Adherence Review And Explainable Machine Learning-Based Mortality Prediction - A Single-Centre Retrospective Study, Kamel A. Samara, Hiba Jawdat Barqawi, Saryia Adra, Batool Aldaher, Drishti D. Kampani, Enad Haddad, Hebah Soudan, Islam Ibrahim Anwar, Mohamad Besher Adi, Omar Hamadi, Yumna Almour, Mohamed Nassef, Zaher Al Aghbari, Eman Abu-Gharbieh

Abington Jefferson Health Papers

Introduction: Community-acquired pneumonia (CAP) is one of the leading causes of death globally. Changing antibiotic resistance profiles, paucity of reliable CAP mortality prediction models, and ageing populations will increase its burden. This study aims to evaluate adherence to CAP management guidelines as well as develop an ML-based mortality prediction model.

Methods: This retrospective, chart review included all CAP cases between 2016 and 2021. Variables collected included patients' demographics, comorbidities, vitals, laboratory, imaging, and culture findings, as well as initial and targeted antibiotic regimens. Data was pre-processed and analysed in python-3. Adherence to the American thoracic society/infectious diseases society of America …

Getting To The Heart Of The Problem: Blood Pressure Management Through Medication Adherence, Mallory G. Livengood

Evidence-Based Practice Project Reports

Clinical hypertension affects one in four adults globally, making it the most common chronic condition. Despite its widespread impact, hypertension can be prevented, as it represents the most modifiable risk factor in preventing cardiovascular disease. The primary purpose of this evidence-based project was to determine whether a one-month follow-up with a healthcare provider improved medication adherence through enhanced hypertension management. Twelve eligible participants were selected from a primary clinic located in Northwest Indiana, based on their newly initiated anti-hypertensive medications or who required a medication adjustment due to poor hypertension management. Each participant’s preferred method of communication was noted, and …

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Blinded By Relapse: A Rare Case Of Bilateral Vision Loss From Leukemic Meningeal Infiltration, Aun A. Bangash, Tejaswini Swamy, Chloe C. Harris, Victoria Parada

Research Symposium

Background: Acute lymphoblastic leukemia (ALL) accounts for 20% of adult leukemias, with outcomes improving through modern systemic and CNS-directed therapies. Leukemic meningeal relapse, defined as infiltration of the meninges and detected by cerebrospinal fluid cytology, is reported in 4–7% of adult ALL patients and remains a devastating complication despite CNS prophylaxis. CNS involvement typically presents with nonspecific symptoms such as headache, nausea, or cranial neuropathies; isolated, abrupt vision loss is rare. With a median survival of less than six months if untreated, timely recognition is critical. We present a case of intracranial hypertension with bilateral vision loss due to leukemic …

A Hidden Giant: Tee Superiority In Mrsa Endocarditis With A Massive Supravalvular Aortic Mass, Mohammad Abed Alhaleem, Nebras Abu Abed, Salman Muslem, Fatma Bisher, Nadeen Sukhon, Wehbi Hanayni

Conference Presentation Abstracts

Background: A 66-year-old male with MRSA bacteremia developed septic pulmonary emboli, sternoclavicular joint infection, and prosthetic knee infection. While initial TTE was negative, subsequent TEE identified a large supravalvular aortic vegetation necessitating surgical excision and valve repair, underscoring the diagnostic superiority of TEE and the need for early surgical consideration in complicated MRSA endocarditis. Case Presentation: A 66-year-old male with diabetes, hypertension, and prior knee arthroplasty presented with MRSA bacteremia complicated by septic pulmonary emboli, sternoclavicular joint infection, and prosthetic knee infection. He underwent debridement of the chest wall and knee prosthesis with cultures confirming MRSA. Initial transthoracic echocardiography (TTE) …

Avoiding Anchoring Bias In Lymphadenopathy: Metastatic Thyroid Cancer Mimicking Tuberculous Lymphadenitis, Giuliano Romano, Mitchell Schwocho, Jacob Morton

Conference Presentation Abstracts

Introduction The differential diagnosis for a new neck mass is broad and includes malignant, infectious, and autoimmune etiologies. A systematic approach incorporating history, physical examination, and diagnostic testing is essential when developing and narrowing down a differential. Case Presentation A 52-year-old man with a history of diabetes, asthma, ankylosing spondylitis on weekly etanercept, and GERD presented with a 2-day history of painless right-sided neck swelling. He denied fever, chills, weight loss, night sweats, dysphagia, dyspnea, cough, recent illness, or constitutional symptoms aside from mild fatigue. He had recently returned from a 1.5- month trip to Bangladesh and had self-discontinued etanercept …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …

Global Perspectives On Cns Drug Innovation: Achievements, Barriers, And Priorities For The Next Decade, Hiroyuk Uchida, Gabriella Gobbi, Joseph Zohar, Allan Young, Dan Rujescu, Ming-Chyi Huang, Suresh Sundram, Lukoye Atwoli, Jana Vukovic, Kazutaka Ikeda

Internal Medicine, East Africa

Background Over the past decade, neuropsychopharmacology has shifted from stagnation to momentum, with first-in-class mechanisms and biomarker-enabled trials spanning psychiatry and neurology.

Methods We narratively synthesized advances from 2013 to 2026 across central nervous system (CNS) discovery and development, including pivotal trials, regulatory actions, digital/real-world evidence, genetics, artificial intelligence (AI), and implementation/global-access themes that are endorsed by international societies.

Results Therapeutic gains include rapid-acting drugs for treatment-resistant depression (intranasal esketamine); psychedelic-assisted therapy for posttraumatic stress disorder and depression; neuroactive steroid γ-aminobutyric acid-A receptor positive allosteric modulators (brexanolone, zuranolone) for postpartum depression; non-dopaminergic muscarinic agonists (xanomeline–trospium) for schizophrenia; orexin receptor antagonists …

A Rare Convergence: Malignant Thymoma With Pericardial Invasion In A Brca2 Mutation Carrier With A Synchronous Breast Mass, Mahmoud Yacout, Mohammad Chisti

Conference Presentation Abstracts

Introduction Thymomas are rare epithelial tumors of the anterior mediastinum, accounting for < 1% of adult malignancies, with an estimated annual incidence of approximately 0.15 cases per 100,000 persons. Although often indolent, thymomas are malignant by definition and may invade locally, recur, and, less commonly, disseminate. They are classically associated with autoimmune conditions, most notably myasthenia gravis, yet their relationship with hereditary cancer syndromes remains poorly defined. Germline BRCA2 mutations are well established in the pathogenesis of breast, ovarian, pancreatic, prostate, and other malignancies through impaired homologous recombination DNA repair. However, an association between BRCA2 mutations and thymic epithelial tumors has rarely been reported. We describe an unusual case of invasive malignant thymoma with pericardial invasion in a BRCA2 mutation carrier, discovered concurrently with a synchronous FDG-avid breast mass suspicious for malignancy. Case Presentation An 85-year-old man with a history of CAD, hypertension, GERD, and prior radical prostatectomy presented with several months of unintentional weight loss and chronic diarrhea. During evaluation for recurrent appendicitis, imaging incidentally revealed a large anterior mediastinal mass measuring up to 7.9 cm with irregular margins. FDG-PET demonstrated moderate metabolic activity within the mass (SUVmax 3.8). CT-guided biopsy revealed a thymic epithelial neoplasm consistent with thymoma. There was no clinical evidence of myasthenia gravis. He subsequently underwent partial sternotomy with thymectomy. Pathology demonstrated a 6-cm type B2 thymoma with direct pericardial invasion, positive surgical margins (R1), and no regional lymph node involvement (pN0), consistent with pT2 stage III disease by the Masaoka–Koga system. Given high-risk features, adjuvant radiation therapy was initiated, with planned surveillance using PET imaging and circulating tumor DNA monitoring. Concurrent PET imaging identified a palpable FDG-avid right breast mass. Genetic testing revealed a pathogenic germline BRCA2 mutation. The breast lesion is currently undergoing diagnostic biopsy and surgical evaluation. Discussion Thymomas are malignant neoplasms with a predilection for local invasion. Type B2 thymomas carry a higher risk of recurrence, particularly in the presence of pericardial invasion or incomplete resection. Complete surgical excision remains the cornerstone of management, while postoperative radiotherapy is recommended in invasive or R1 disease to reduce locoregional recurrence. The coexistence of invasive thymoma and a germline BRCA2 mutation is exceedingly rare and raises questions regarding shared oncogenic mechanisms. While thymic epithelial tumors are not classically associated with BRCA mutations, DNA repair defects may contribute to tumorigenesis in rare malignancies. The presence of a synchronous FDG-avid breast mass in a male BRCA2 carrier further underscores the importance of comprehensive oncologic and genetic evaluation and highlights the need for multidisciplinary management in complex hereditary cancer presentations. Conclusion We report a rare case of malignant type B2 thymoma with pericardial invasion in a BRCA2 mutation carrier, identified alongside a synchronous breast mass suspicious for malignancy. This case highlights the potential intersection between thymic epithelial tumors and hereditary cancer syndromes, reinforces the importance of genetic evaluation in patients with multiple malignancies, and underscores the need for long‑term multidisciplinary surveillance. Further investigation is warranted to elucidate any causal relationship between BRCA‑mediated DNA repair dysfunction and thymoma development.

Severe Transvalvular And Paravalvular Aortic Regurgitation As Late Tavr Failure Successfully Treated With Percutaneous Therapy, Ashley Armstrong, Luca Halalau, Ivan Hanson

Conference Presentation Abstracts

BACKGROUND - Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis. With improving long-term survival, late prosthetic valve–related complications are increasingly recognized. CASE SUMMARY - We report a 74-year-old man who presented eight years after TAVR with progressive dyspnea, orthopnea, and bilateral lower extremity edema, identified to be acute decompensated heart failure with a new diastolic murmur. Transthoracic echocardiography demonstrated severe aortic regurgitation. Subsequent transesophageal echocardiography identified concomitant severe paravalvular and severe transvalvular regurgitation of the bioprosthetic valve. Invasive hemodynamic assessment revealed acute volume overload with markedly elevated filling pressures, secondary pulmonary hypertension, and right ventricular …

Igg4-Related Aortitis Presenting As Intramural Hematoma Of The Descending Thoracic Aorta, Sarah Ibrahim, Tejasvini Khanna, Lark Steafo, Ioannis Karageorgiou, Judith Bateman

Conference Presentation Abstracts

IgG4-related aortitis is a rare manifestation of IgG4-related disease and can closely mimic acute aortic syndromes, including intramural hematoma (IMH), on imaging. Isolated involvement of the descending thoracic aorta is particularly uncommon, and misdiagnosis may lead to unnecessary surgical or endovascular intervention. A 68-year-old man with extensive cardiovascular disease, including prior coronary artery bypass grafting, recent percutaneous coronary intervention with drug-eluting stent placement, permanent pacemaker implantation for complete heart block, and recent pulmonary embolism, presented with three days of chest pain, shortness of breath, and left lower quadrant abdominal pain. At presentation, he was receiving apixaban, aspirin, and clopidogrel. Computed …

A Pain That Wouldn't Sleep: Osteoid Osteoma Masquerading As Lateral Epicondylitis, Madelyn Bagley, Luca Halalau, Aimee Espinosa, Terrence Metz

Conference Presentation Abstracts

Osteoid osteoma is a benign osteogenic tumor that accounts for approximately 10% of all benign bone tumors and predominantly affects adolescents and young adults. It classically presents with nocturnal pain that responds dramatically to nonsteroidal anti-inflammatory drugs, a feature attributed to increased prostaglandin production within the nidus. The femur and tibia are most commonly involved, whereas upper extremity lesions are relatively uncommon. A 19-year-old male presented with nearly two years of chronic, progressive left lateral elbow pain and left wrist weakness. The pain was nocturnal, radiated along the left arm, and was markedly relieved by nonsteroidal antiinflammatory drugs. He was …

Novel Applications Of Coronary Cta In Patients With Intermediate Risk Of Cad, Ashley Armstrong, Luai Madanat, Robert D. Safian

Conference Presentation Abstracts

Background: ACC/AHA guidelines provide class 1 and 2A recommendations respectively for coronary CTA and FFRCT in patients with chest pain and intermediate risk of CAD. We present a case in which novel applications of CTA excluded obstructive CAD, identified the correct diagnosis, and allowed optimization of medical therapy. Case: In a 72-year-old male with stable angina and HEART score 6, stress ECG was positive for angina and frequent PVCs (Fig 1A). Coronary CTA (Fig 1B) and FFRCCT (Fig 1C) showed non-obstructive CAD and intramyocardial bridging/severe systolic compression in the mid-LAD (Fig 1D). AI plaque analysis demonstrated a mixed plaque burden …