Internal Medicine Commons^™

Ventilasi Noninvasif Pada Obstructive Sleep Apnea Dan Obesity Hypoventilation Syndrome, Herikurniawan Herikurniawan, Joanna Audrey, Firina Adelya

Jurnal Penyakit Dalam Indonesia

Chronic respiratory disease such as obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS) remain are respiratory sleeping disorder that gradually affect quality of life. Comprehensive treatment such as the use of non-invasive ventilation (NIV) is a method adopted to improve the patient’s quality of life. The correct choice of NIV mode, mask and titration methods will provide optimal therapeutic effects to the patient. This article review lays out an update on the use of non-invasive ventilation as the treatment of OSA and OHS.

Penggunaan Antibiotik Empiris Yang Rasional Pada Era Infeksi Oleh Organisme Multi Drug Resistant, Robert Sinto

Jurnal Penyakit Dalam Indonesia

Resistensi antimikroba (antimicrobial resistance, AMR), secara khusus antibiotik, telah menjadi masalah dunia saat ini. Masalah resistensi antibiotik terjadi pada seluruh jenis antibiotik yang ada, dan terjadi di seluruh negara, termasuk Indonesia. Dalam skala global, Perserikatan Bangsa-Bangsa mengeluarkan World Health Assembly Resolution WHA 68.7 dengan judul Global Action Plan on Antimicrobial Resistance sebagai wujud perhatian yang mendalam terhadap masalah global ini.

Abses Iliopsoas Akibat Tuberkulosis: Sebuah Laporan Kasus, Desty Gusti Sari, Rosatya Imanuela, Resultanti Resultanti

Jurnal Penyakit Dalam Indonesia

Psoas abscess is a rare condition with an unclear clinical presentation where there is a collection of pus in the iliopsoas compartment. The most common cause of an iliopsoas abscess is infection with Staphylococcus aureus. Mycobacterium tuberculosis rarely causes psoas abscesses, with an incidence of about 10–30% of extrapulmonary tuberculosis and only 3% of tuberculosis in general. Psoas abscesses due to tuberculosis is quite rare and has non-specific symptoms, so it sometimes causes a late diagnosis. This case study reports on male aged 43-year-old patient who had previously been diagnosed with spondylitis tuberculosis (TBC) and complained of pain accompanied by …

Nilai Diagnostik Italian Score Untuk Memprediksi Infeksi Bakteri Extended Spectrum Beta-Lactamase (Esbl) Pada Pasien Sepsis Di Rsup Dr. M. Djamil Padang, Fadrian Fadrian, Armen Ahmad, Khairat Khairat

Jurnal Penyakit Dalam Indonesia

Introduction. Infections caused by Extended-Spectrum Beta-Lactamase (ESBL) bacteria, especially in septic patients, require adequate management. Giving definitive antibiotics according to culture results takes a long time. Therefore, a clinical scoring system is needed to predict ESBL bacterial infection, one of which is the Italian score.

Methods. This research used a cross-sectional design and was conducted in the inpatient room of RSUP Dr. M. Djamil Padang for 6 months. The samples in this study were septic patients who underwent culture examination at RSUP Dr. M. Djamil Padang who met the research inclusion and exclusion criteria. Sampling was carried out …

Blood Pressure During Hospital Stay For Delivery And Risk For Postpartum Readmission For Hypertension, Kaitlyn Taylor, Sai S. Pochana, Andrew Chapple, Maureen Dempsey, Elizabeth F. Sutton

School of Medicine Faculty Publications

OBJECTIVE: To evaluate the association of changes in peripartum blood pressure (BP) with risk for postpartum readmission for hypertension. METHODS: We conducted a retrospective cohort study of birthing individuals delivering from January 1, 2017, to March 1, 2020, in Louisiana. We identified patients with postpartum readmission for hypertension (readmission within 30 days of delivery) and compared BP and clinical and sociodemographic characteristics with those of patients who were not readmitted for hypertension. Patients were also grouped by their BP at both admission for delivery and 36 hours postpartum: systolic below 130 mm Hg and diastolic below 80 mm Hg, systolic …

An Unusual Presentation Of Erythrodermic Psoriasis, Eden L. Parks, Kojo-Frimpong B. Awuah Md, Caitlin D. Couper Md

Transformative Medicine

Introduction

Erythrodermic psoriasis is a rare form of psoriasis, occurring in less than 3% of patients with psoriasis. Limited information is known regarding diagnosis and treatment for this form of psoriasis, with most studies involving small groups or single patients. This unusual case of erythrodermic psoriasis outlines the presentation, diagnosis, and treatment that occurred in a 53-year-old patient who initially presented with dyspnea and a fever.

Case Presentation

The 53-year-old patient was originally admitted for dyspnea and a fever. A maculopapular rash developed diffusely on the upper extremities, lower extremities, trunk, and face. The rash then desquamated over several days, …

Thrombectomy For Stroke With Large Infarct On Noncontrast Ct: The Tesla Randomized Clinical Trial, Writing Committee For The Tesla Investigators, Albert J Yoo, Osama O Zaidat, Sunil A Sheth, Ansaar T Rai, Santiago Ortega-Gutierrez, Curtis A Given, Syed F Zaidi, Ramesh Grandhi, Hugo Cuellar, Maxim Mokin, Jeffrey M Katz, Amer Alshekhlee, Muhammad A Taqi, Sameer A Ansari, Adnan H Siddiqui, Nobl Barazangi, Joey D English, Alberto Maud, Jawad Kirmani, Rishi Gupta, Dileep R Yavagal, Jason Tarpley, Dhruvil J Pandya, Marshall C Cress, Sushrut Dharmadhikari, Kaiz S Asif, Tareq Kass-Hout, Ajit S Puri, Nazli Janjua, Aniel Q Majjhoo, Aamir Badruddin, Randall C Edgell, Rakesh Khatri, Larry Morgan, Anmar Razak, Alicia Zha, Priyank Khandelwal, Nils Mueller-Kronast, Dennis J Rivet, Thomas Wolfe, Brian Snelling, Ali Sultan-Qurraie, Shao-Pow Lin, Rajkamal Khangura, Alejandro M Spiotta, Parita Bhuva, Sergio Salazar-Marioni, Eugene Lin, Abdul R Tarabishy, Edgar A Samaniego, Murali K Kolikonda, Mouhammad A Jumaa, Vivek K Reddy, Pankaj Sharma, Olvert A Berkhemer, Pieter-Jan Van Doormaal, Adriaan C G M Van Es, Wim H Van Zwam, Bart J Emmer, Ludo F Beenen, Charles B L M Majoie, Nancy Buderer, Michelle A Detry, Anna Bosse, Todd L Graves, Christina Saunders, Lucas Elijovich, Ashutosh Jadhav, Mary Patterson, Hannah Slight, Kristine Below, Sami Al Kasab, Tesla Investigators

Faculty, Staff and Student Publications

Importance: Recent large infarct thrombectomy trials used heterogeneous imaging modalities and time windows for patient selection. Noncontrast computed tomographic (CT) scan is the most common stroke imaging approach. It remains uncertain whether thrombectomy is effective for patients with large infarcts identified using noncontrast CT alone within 24 hours of stroke onset.

Objective: To evaluate the effect of thrombectomy in patients with a large infarct on a noncontrast CT scan within 24 hours of onset.

Design, setting, and participants: Open-label, blinded-end point, bayesian-adaptive randomized trial with interim analyses for early stopping (futility or success) or population enrichment, which was conducted at …

Unexpected Biliary Duct Dilation, A Wise Decision-Making Case., Mario A. Trujillo, Mathew R. Peynado, Muhammad Ali Siddiqui, Laura P. Ackerman

Research Colloquium

Background: Common bile duct dilation is expected in certain healthy populations with specific factors like age or post procedure status. When a size larger than expected is found in an acute setting further investigation is required. In the setting of acute abdominal pain in a patient with past medical history of cholelithiasis, the study protocol for patients with more than expected enlarged common bile duct and no apparently underlying disease in the biliary tree is not well elucidated.

Case: A 68-year-old female with past medical history but not limited to cholelithiasis, hypertension, type 2 diabetes mellitus, end stage renal …

Viral Party Gone Wrong: Polyviral Pericarditis Masquerading As Gastritis, Maria Eugenia Torres Perez, Joan Beatrice Capellan, Deanna Yamamura

Research Colloquium

Background: Acute pericarditis is a rapid inflammatory condition of the pericardium with both infectious and non-infectious etiologies. Diagnosis is usually based on clinical criteria with typical symptoms including chest pain that worsens with deep inspiration and decreases by leaning forward, and distinctive electrocardiographic changes. Pericarditis is typically self-limiting however, complications like pericardial effusion and cardiac tamponade may arise.

Case presentation: A 31-year-old male presented to the emergency department due to severe epigastric pain radiating to the right upper abdomen; the pain was associated with subjective fever and inability to eat due to its severity. His physical exam revealed tachycardia …

Stealthy Intrusion: Multivalve Culture-Negative Infective Endocarditis, Jennifer Rojas Huen, Carlos Luis Alejos Aguero, Duc Khiem Ngo, Maria E. Torres Perez

Research Colloquium

Introduction: Infective endocarditis (IE) typically targets a single valve, with involvement of more valves being rare. Timely targeted therapy hinges on identifying the responsible microorganism through blood culture. However, blood culture-negative endocarditis (BCNE), representing 5% of all endocarditis cases, poses diagnostic challenges and is associated with higher long-term mortality rates compared to blood culture-positive endocarditis (BCPE).

Case Presentation: A 53-year-old male with a history of congestive heart failure (CHF), end stage renal disease on peritoneal dialysis, and 30- years of cocaine use presented with an abnormal echocardiogram. The patient reported a two-week history of chills, sweat, generalized weakness, and exertional …

Navigating Economic Constraints In The Management Of Hfref - A Case Study Of An Uninsured Patient, Vamsikalayan Borra, Diana Othon Martinez, Barbara Malaga-Espinoza, Martha Solis, Nestor Gerardo Astorga, Prakhar Jain, Cesar Gutierrez

Research Colloquium

Background: Heart failure (HF) is a significant health concern, resulting in more than 500,000 new cases, 1.9 million hospitalizations, and a cost of $31 billion in the US. HF treatment aims to decrease hospitalizations, improve quality of life, and extend survival through GDMT. Social determinants of health (SoDH) have been associated with poor outcomes and higher readmission rates in HF patients. Addressing SoDH is crucial for achieving health equity and improving overall population health outcomes, per the CMS Framework for Health Equity 2022-2023. In the Rio Grande Valley, immigration is a common SoDH. It is estimated that 100,000 people are …

Heart Failure In The Setting Of Cocaine Abuse… Cause Or Progression? A Case Report., Diana Othon Martinez, Kashif Ali, Elimar Gonzalez Morales, Barbara Malaga-Espinoza, Jian Garcia, Cesar Gutierrez

Research Colloquium

Background: 1 out of 3 substance abuse emergency department visits are related to cocaine. In the US (United States), >5.5 million people consume cocaine. Hospitalizations for heart failure have a similar amount, with 5.7 million. Cocaine's cardiovascular adverse effects arise secondary to sympathetic nervous system stimulation, including decreased myocardial oxygen supply, coronary vasoconstriction, acceleration of atherosclerosis and thrombus formation. Studies have demonstrated contradictory information regarding cardiac anatomical changes (dilation/hypertrophy) secondary to chronic cocaine use. Cocaine cessation and guideline- directed medical therapy (GDMT) for HF are mainstay management. We present a case of a patient with HF and cocaine abuse.

Case …

Late Tamponade After Coronary Artery Bypass Grafting, Jian Garcia Cruz, Roy Kondapavuluru, Diana Othon Martinez, Julio Perez Rodriguez

Research Colloquium

Introduction: Pericardial effusion (PE) incidence can go up to 85% after cardiac procedures, however, not every pericardial effusion causes hemodynamic instability. Progression to Pericardial Tamponade (PT) occurs in 0.1 to 8.8% and may be either early (within 24 h post-cardiac surgery) or late (presenting within a week post-procedure). Both presentations may be attributed to anticoagulant use, inadequate mediastinal drainage, coagulopathy, post-pericardiotomy syndrome (recurrent pericardial effusion).

Patient presentation time might be misleading, as pericardial effusion’s clinical symptoms are varied, ranging from asymptomatic, to shortness of breath, chest pain or discomfort, hypotension, tachycardia, or other non-specific symptoms like cough, fever, and malaise. …

Multiple Intracardiac Thrombi In A Patient With Ischemic Cardiomyopathy, Jian Garcia Cruz, Julio Perez Rodriguez

Research Colloquium

Introduction: Ischemic cardiomyopathy is defined by the American Heart Association (AHA) as cardiomyopathy caused by ischemic heart disease. The most common complication of ischemic cardiomyopathy is systolic congestive heart failure. Heart failure patients are in a hypercoagulable state that predisposes them to develop intracardiac thrombus. The incidence of LV thrombus in patients with dilated cardiomyopathy and sinus rhythm is 13% with the clot in the left atrial appendage in 68% of these cases. The thrombus formation results from impaired blood flow within the 4 chambers of the heart and can present as a life-threatening complication of end stage heart failure. …

Cardiac Tamponade Secondary To Purulent Pericarditis With Mrsa, Jian Garcia Cruz, Julio Perez Rodriguez

Research Colloquium

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that causes severe morbidity and mortality worldwide. MRSA pericarditis is a rare life-threatening condition that can cause purulent pericarditis with only 7 cases having been reported so far. Several reasons why a patient may develop MRSA pericarditis are healthcare-associated infection, weakened immune system, invasive procedures and spread from other infections. Although not typically associated with tamponade, if MRSA were to cause an infection in the pericardial space, it could potentially lead to inflammation and fluid accumulation, resulting in tamponade. We present a case of a woman that developed tamponade secondary …

Unveiling The Neurological Aftermath: Pres After Cardiac Arrest, Oyinlola O. Fasehun, Jessica Daza, Sriharsha Koneru, Victor Tran, Eunbee Cho, Fatimah Bello

Research Colloquium

Background: Posterior Reversible Encephalopathy Syndrome (PRES), also known as ‘Reversible Posterior Leukoencephalopathy Syndrome (RPLS)’, is a clinical radiographic syndrome originally described by Hinchey et al in 1996. PRES has been significantly underdiagnosed due to difficulty in confirmation. As such, there is currently no epidemiological data regarding its incidence, but it has been diagnosed in all age groups with a preponderance in females. A variety of medical conditions have been implicated as causes of PRES, including severe hypertension, immunosuppressive therapy, sepsis, renal diseases and autoimmune disorders. The mechanism of PRES is thought to be related to disordered cerebral autoregulation and endothelial …

Pernicious Anemia Presenting With Pancytopenia And Hemolysis: A Case Report From South Texas, Yareli Durazo, Victor Tran, Sriharsha Koneru, Andres Suarez Parraga

Research Colloquium

Introduction: Pancytopenia is a commonly encountered hematologic entity with varying clinical presentations. It results from various disease processes ranging from simple to life-threatening. The most common cause of pancytopenia is megaloblastic anemia, and the most common causes of megaloblastic anemia are deficiencies of vitamin B9 or B12. Thus, folate and B12 deficiency should be high in the differential diagnosis when patients present with pancytopenia. Hemolytic anemia, anemia due to the shortened survival of circulating erythrocytes, often represents a more difficult diagnostic challenge for the clinician. While recognition of ongoing hemolysis is usually rapid and relatively simple, establishing the cause can …

Gastrointestinal Bleed In The Context Of Hemophilia A In An Incarcerated Patient In The Rio Grande Valley, Cameron B. Caldwell, Hector Trejo, Andres Suarez-Parraga

Research Colloquium

Background: Hemophilia A, the most common X-linked hereditary hemostasis disorder, has an incidence of approximately 1 in 5600 male live births worldwide. It results from a deficiency of clotting factor VIII, crucial for fibrin generation in the coagulation cascade, leading to inadequate fibrin generation and defective secondary hemostasis. Hemophilia can cause life-threatening bleeding, characterized as severe (< 1% factor VIII activity), moderate (2-5%), or mild (6-40%). Social determinants of health pose significant challenges in managing hemophilia in underserved populations. This case presents gastrointestinal bleeding in a mild hemophilia A patient in the Rio Grande Valley.

Case Presentation: A 24-year-old Hispanic male with mild hemophilia A presented with a three-day history of melena, headaches, dizziness, and mild abdominal discomfort. Despite recent normal colonoscopy and EGD results, he had a history of intermittent black stool episodes. On admission, …

Polyp Puzzle, Get To Know Your Family. An Unfortunate Late Diagnosis Of Familial Adenomatous Polyposis: A Case Report., Jorge A. Aboytes, Aura Calderon

Research Colloquium

Introduction: Familial Adenomatous Polyposis (FAP) is a rare genetic condition affecting the APC gene characterized by the development of hundreds to thousands of colorectal polyps increasing the risk of cancer. Diagnosis usually occurs between ages 20 and 40. We present the unfortunate case of a patient with FAP that developed colon cancer and many years of complications. Had her family history been properly obtained at a younger age with early screening and testing, outcome and prognosis could have been different.

Case Report: A 34-year-old woman diagnosed with colon cancer in 2016 had total proctocolectomy with chemoradiation. From 2018 to 2024 …

Mesenchymal Stromal Cells Protect Combined Oncolytic And Helper-Dependent Adenoviruses From Humoral Immunity, Ada Irmak Özcan, Arianexys Aquino Lόpez, Alexandra N Wolff, Audrey Ma, Amanda Rosewell Shaw, Masataka Suzuki, Malcolm K Brenner, Mary K Mckenna

Faculty, Staff and Students Publications

Systemic delivery of oncolytic and immunomodulatory adenoviruses may be required for optimal effects on human malignancies. Mesenchymal stromal cells (MSCs) can serve as delivery systems for cancer therapeutics due to their ability to transport and shield these agents while homing to tumors. We now use MSCs to deliver a clinically validated binary oncolytic and helper-dependent adenovirus combination (CAdVEC) to tumor cells. We show successful oncolysis and helper-dependent virus function in tumor cells even in the presence of plasma from adenovirus-seropositive donors. In both two- and three-dimensional cultures, CAdVEC function is eliminated even at high dilutions of seropositive plasma but is …