Internal Medicine Commons^™

Targeting Inequities: Addressing Lung Cancer Care Challenges In Africa Through Drug Access, Radiotherapy, And Surgical Innovations, Elvis Obomanu, Chidiebube Ugwu, Muluken Megiso, Tarfa Verinumbe, Colton Jones, Verna Vanderpuye, Nazik Hammad

Division of Internal Medicine Faculty Papers & Presentations

Lung cancer remains one of the leading causes of cancer-related mortality in Africa, with survival rates starkly lagging behind global benchmarks because of systemic inequities in prevention, diagnosis, and treatment access. Despite representing only 6% of global smokers, the continent faces a disproportionate burden driven by environmental and occupational carcinogens, aggressive tobacco marketing, and fragmented health care infrastructure. Key challenges include prohibitive delays in accessing targeted therapies like epidermal growth factor receptor inhibitors and immunotherapies, a dire shortage of radiotherapy infrastructure-0.12 megavoltage units per million people versus the International Atomic Energy Agency's recommended five megavoltage units per million, and a …

Secondary Cutaneous Involvement In Peripheral T-Cell Lymphoma: Diagnostic Frameworks, Staging Integration, And Therapeutic Implications, Aura Calderon, Jose Loayza Pintado, Cristina Kochi, Jared Hensley, Andres Suarez Parraga, Everardo Cobos

School of Medicine Publications

The occurrence of secondary cutaneous manifestations in peripheral T-cell lymphoma (PTCL) is relatively infrequent and can resemble benign dermatoses, leading to diagnosis delays. We present the case of a 78-year-old female patient with a diagnosis of PTCL affecting the left parotid gland, who experienced a 2-day sudden and intensely pruritic skin eruption, which progressed from both forearms to the trunk, involving more than 50% of the total body surface area. Initially, the eruption was managed as a hypersensitivity reaction with antihistamines and corticosteroids, with temporary symptomatic relief; however, the rapid clinical progression in the context of an established diagnosis of …

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 …

Development And Validation Of The Lifetime Sense Of Safety Scale In Kenyan Adults, Karen Blackmon, Anne Nyambura, Anne Gitere, Levi Muyela, Catherine Onyancha, Kendi Muchungi, Catherine Ajalo, Litha Musili, Rachel Maina, Edna Bosire, Lukoye Atwoli, Zul Merali, Chinedu Momoh

Brain and Mind Institute

Background. Safety supports psychological wellbeing and potentially shapes brain aging yet existing scales overlook cumulative lifespan safety experiences.

Methods. To address this gap, we developed and validated the Lifetime Sense of Safety (LSS) scale in Kenyan adults. The LSS uses visual analog scaling with a red-to-green color gradient to retrospectively rate felt safety across life stages and settings. We evaluated scale psychometrics and associations with social determinants of health and indicators of brain health.

Results. The LSS shows adequate internal consistency and test-retest reliability, with two distinct but correlated factors representing childhood and adulthood safety. Women and …

An Aggressive Presentation Of Anti-Melanoma Differentiation-Associated Gene 5 (Mda-5)-Positive Dermatomyositis With Rapidly Progressive Interstitial Lung Disease: A Case Report, Zamanali Khakhar, Shreedhi Patel, Rajiv Patel, Soraiya Manji, Fredrick Otieno, Sayed Karar

Internal Medicine, East Africa

Anti-melanoma differentiation-associated gene 5 (MDA-5) dermatomyositis is an uncommon condition that is frequently complicated by rapidly progressive interstitial lung disease (RP-ILD), resulting in a poor prognosis. Due to its aggressive course, management is often challenging and requires timely interventions to improve outcomes. This case of a female patient with anti-MDA-5-positive DM and RP-ILD aims to document this unique and uncommon condition, its aggressive clinical course, associated complications, diagnostic challenges, and management considerations.

Left Bundle Branch Area Pacing Outcomes From An African Registry: Short-Term Findings From The Macop Study, Willy Mucyo, Marcus Ngantcha, Mzee Ngunga, Miriam Msunza, Justin Ragadu, Klindheer Rampersad, Jeilan Mohamed, Brian Vezi

Internal Medicine, East Africa

Background

Objective

Methods

Results

Government Health Care Worker Training Needs For Intestinal Schistosomiasis Morbidity Management, Phyllis Isaiah, Betty Nabatte, Lauren Wilburn, John Oryema, Noah Ukumu, Morris Okumu, Juma Nabhonge, Hilda Kyarisiima, Prudence Beinamaryo, Christopher Opio

Internal Medicine, East Africa

Background Schistosomiasis causes substantial chronic morbidity in sub-Saharan Africa, yet case definitions, clinical management guidance, and health worker training for schistosomiasis-related morbidity remain limited.

Methods We conducted a qualitative needs assessment for schistosomiasis morbidity management. Workshops were held over one day in each of Pakwach, Buliisa, and Mayuge Districts in Uganda in October 2024. 105 government health workers participated including clinicians, nurses, laboratory technicians, sonographers, and district health managers from health facilities at different levels of care. The workshops comprised six structured sessions: presentations on schistosomiasis burden in Uganda and the SchistoTrack cohort, a clinical case report by an expert …

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 …

Feasibility And Acceptability Of A Mobile App And Wearable Device For Collecting Mental Health Survey And Passively Sensed Data Among Health Care Workers In Kenya: Mixed Methods Pilot Study, Linda Khakali, Andrew Aballa, Dorcas G. Mwigereri, Willie Njoroge, Rachel Maina, Amos Bunde, Peris Musitia, Moses Nyongesa, James Orwa, Jasmit Shah, Anthony Ngugi, Lukoye Atwoli, Amina Abubakar, Zul Merali

Brain and Mind Institute

Background: Mobile apps and wearable devices may help to facilitate early detection of mental health conditions by providing objective, real-time data to supplement other forms of feedback and diagnoses. Few studies have investigated the acceptability and feasibility of using a mobile app to track survey- and wearable-based data in mental health research in Sub-Saharan Africa.

Objective: This pilot study evaluated the feasibility and acceptability of using a mobile app and wearables to capture mental health–based survey data and passively sensed data among Kenyan health care workers.

Methods: A mixed methods study was conducted among health care workers …

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.

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 …

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 …

Targeted Therapy With Braf/Mek Inhibitors And Immune Check Point Inhibitors In Anaplastic Thyroid Cancer - A Case Report, Yagnapriya Ammakola, Muhammad Ibrahim Majeed, Ishmael Jaiyesimi

Conference Presentation Abstracts

Introduction- Anaplastic thyroid carcinoma (ATC) is a highly aggressive malignancy constituting about 1% of all the thyroid neoplasms. It has poor prognosis with median survival of around 3 to 6 months. Recent advancements with targeted therapies have improved the survival outcome in these patients. We report a case of anaplastic transformation of papillary thyroid cancer with BRAF V600E mutation who responded to targeted therapy. Case presentation- A 54 year old male presented with a palpable left sided mass. Labs were unremarkable but imaging with contrast enhanced CT scan showed a 3 cm left thyroid nodule with bilateral cervical lymphadenopathy. Biopsy …