Internal Medicine Commons^™

4r-Cembranoid Suppresses Glial Cells Inflammatory Phenotypes And Prevents Hippocampal Neuronal Loss In Lps-Treated Mice, Luis A Rojas-Colón, John B Redell, Pramod K Dash, Pedro E Vegas, Wanda Vélez-Torres

Faculty, Staff and Student Publications

Chronic neuroinflammation has been implicated in neurodegenerative disease pathogenesis. A key feature of neuroinflammation is neuronal loss and glial activation, including microglia and astrocytes. 4R-cembranoid (4R) is a natural compound that inhibits hippocampal pro-inflammatory cytokines and increases memory function in mice. We used the lipopolysaccharide (LPS) injection model to study the effect of 4R on neuronal density and microglia and astrocyte activation. C57BL/6J wild-type mice were injected with LPS (5 mg/kg) and 2 h later received either 4R (6 mg/kg) or vehicle. Mice were sacrificed after 72 h for analysis of brain pathology. Confocal images of brain sections immunostained for …

Middle Meningeal Artery Embolization In Acute Leukemia Patients Presenting With Subdural Hematoma, Binoy Yohannan, Juan Carlos Martinez Gutierrez, Peng Roc Chen, Adan Rios

Faculty, Staff and Student Publications

Intracerebral hemorrhage is a potentially fatal complication in patients with acute leukemia and contributing factors include thrombocytopenia and coagulopathy. Patients with acute leukemia may develop subdural hematoma (SDH) spontaneously or secondary to trauma. In patients with acute leukemia and SDH, the surgical evacuation of the hematoma causes significant morbidity and mortality. New approaches and strategies to reduce the need for surgical evacuation are needed to improve outcomes in patients with acute leukemia and intracerebral hemorrhage. We report two cases of acute SDH in patients with acute leukemia successfully treated with middle meningeal artery embolization, a minimally invasive interventional radiology technique, …

Evaluating The Readability Of Online Blood Cancer Education Materials Across Different Readability Measures, Ashley Shin, Surbhi Banubakode, Sara Taveras Alam, Anneliese O Gonzalez

Faculty, Staff and Student Publications

Introduction The National Institutes of Health and the American Medical Association recommend patient education materials (EMs) be at or below the sixth-grade reading level. The American Cancer Society, Leukemia & Lymphoma Society, and National Comprehensive Cancer Network have accurate blood cancer EMs. Methods One hundred one (101) blood cancer EMs from the above organizations were assessed using the following: Flesch Reading Ease Formula (FREF), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook Index (SMOG), and the Coleman-Liau Index (CLI). Results Only 3.96% of patient EMs scored at or below the seventh-grade reading level in all modalities. …

Tavr In Older Adults, Abdulla A Damluji, Gwen Bernacki, Jonathan Afilalo, Radmila Lyubarova, Ariela R Orkaby, Min Ji Kwak, Scott Hummel, James N Kirkpatrick, Mathew S Maurer, Nanette Wenger, Michael W Rich, Dae Hyun Kim, Roberta Y Wang, Daniel E Forman, Ashok Krishnaswami

Faculty, Staff and Student Publications

Calcific aortic stenosis can be considered a model for geriatric cardiovascular conditions due to a confluence of factors. The remarkable technological development of transcatheter aortic valve replacement was studied initially on older adult populations with prohibitive or high-risk for surgical valve replacement. Through these trials, the cardiovascular community has recognized that stratification of these chronologically older adults can be improved incrementally by invoking the concept of frailty and other geriatric risks. Given the complexity of the aging process, stratification by chronological age should only be the initial step but is no longer sufficient to optimally quantify cardiovascular and noncardiovascular risk. …

Definition Of Polypharmacy In Heart Failure: A Scoping Review Of The Literature, Keshav Patel, Jorge A Irizarry-Caro, Adil Khan, Travis Holder, Darrell Salako, Parag Goyal, Min Ji Kwak

Faculty, Staff and Student Publications

Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients < 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients.

Risk Of Developing Hypertension In Atopic Dermatitis Patients Receiving Long-Term And Low-Dose Cyclosporine: A Nationwide Population-Based Cohort Study, Yu Ri Woo, Arum Choi, Seo Won Song, Suyeun Kim, Sang Wook Son, Sang Hyun Cho, Sukil Kim, Jung Eun Kim

Faculty, Staff and Student Publications

BACKGROUND: Cyclosporine (CS) is a first-line immunosuppressive agent used to manage moderate to severe atopic dermatitis (AD). To date, the risk of developing hypertension associated with the long-term use of low-dose CS in AD patients is understudied.

OBJECTIVE: To determine the cumulative dose-dependent effect of CS on the risk of developing hypertension in patients with AD.

METHODS: A nationwide population-based retrospective cohort with 1,844,009 AD patients was built from the Korean National Health Insurance System database from 2005 to 2009. A Cox proportional-hazard regression analysis was performed according to patients' CS treatment history adjusted for potential confounders.

RESULTS: Current use …

Risk Factors For In-Hospital Seizure And New-Onset Epilepsy In Coiling And Clipping Treatment Of Aneurysmal Subarachnoid Hemorrhage, Viet-Thang Le, Anh Minh Nguyen, Phuc Long Nguyen

Faculty, Staff and Student Publications

OBJECTIVE: To identify risk factors associated with in-hospital seizures and new-onset epilepsy in patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent coiling embolization or clipping surgery.

METHODS: This retrospective descriptive study included 195 patients diagnosed with aneurysmal SAH and treated with coiling embolization or clipping surgery between January 2018 and June 2022.

RESULTS: Among the 195 patients meeting inclusion criteria, 9 experienced an onset seizure at the time of SAH. In-hospital seizures were observed in 33 patients, of which 24 were electrographic seizures detected in 24 patients with suspected subclinical seizures. After 12 months of follow-up, 11 patients met criteria …

Abatacept Pharmacokinetics And Exposure Response In Patients Hospitalized With Covid-19, Stephen J Balevic, Daniel K Benjamin, William G Powderly, P Brian Smith, Daniel Gonzalez, Matthew W Mccarthy, Linda K Shaw, Christopher J Lindsell, Sam Bozzette, Daphne Williams, Benjamin P Linas, John Blamoun, Heta Javeri, Christoph P Hornik

Faculty, Staff and Student Publications

IMPORTANCE: The pharmacokinetics of abatacept and the association between abatacept exposure and outcomes in patients with severe COVID-19 are unknown.

OBJECTIVE: To characterize abatacept pharmacokinetics, relate drug exposure with clinical outcomes, and evaluate the need for dosage adjustments.

DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary analysis of data from the ACTIV-1 (Accelerating COVID-19 Therapeutic Interventions and Vaccines) Immune Modulator (IM) randomized clinical trial conducted between October 16, 2020, and December 31, 2021. The trial included hospitalized adults who received abatacept in addition to standard of care for treatment of COVID-19 pneumonia. Data analysis was performed between September 2022 …

Machine Learning-Enabled Maternal Risk Assessment For Women With Pre-Eclampsia (The Piers-Ml Model): A Modelling Study, Tünde Montgomery-Csobán, Kimberley Kavanagh, Paul Murray, Chris Robertson, Sarah J E Barry, U Vivian Ukah, Beth A Payne, Kypros H Nicolaides, Argyro Syngelaki, Olivia Ionescu, Ranjit Akolekar, Jennifer A Hutcheon, Laura A Magee, Peter Von Dadelszen, Piers Consortium

Faculty, Staff and Student Publications

BACKGROUND: Affecting 2-4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia.

METHODS: We used health system, demographic, and clinical data from the day of first assessment with pre-eclampsia to predict a Delphi-derived composite outcome of maternal mortality or severe morbidity within 2 days. Machine learning methods, multiple imputation, and ten-fold cross-validation were used to fit models on a development dataset (75% of …

Modified Technique Improves Efficacy For In-Office Posterior Nasal Nerve Ablation, Daniel Gorelik, Aatin K Dhanda, Alexander Choi, Masayoshi Takashima, Najm S Khan, Nicholas R Rowan, Aria Jafari, Tariq Syed, Omar G Ahmed

Faculty, Staff and Students Publications

Objectives: Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves.

Methods: Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to …

Hubungan Rasio Neutrofil Limfosit Terhadap Komplikasi Kardiovaskular Pada Pasien Penyakit Ginjal Kronik Hemodialisis, Thariq Hikmatul Akmal, Agung Susanto, Ratih Tri Kusuma Dewi, Agus Jati Sunggoro

Jurnal Penyakit Dalam Indonesia

Introduction. The neutrophil-to-lymphocyte ratio (NLR) is a simple parameter to assess the inflammatory status, especially in chronic kidney disease (CKD) patients experiencing capillary damage due to increased glomerular capillary pressure. In a state of vascular endothelial inflammation, there is a higher tendency to form atherosclerotic plaques and calcification that can induce cardiovascular events such as heart failure, coronary heart disease, and stroke. This study aimed to determine the relationship between the NLR and cardiovascular complications in CKD patients undergoing hemodialysis.

Methods. An analytical observational study with cross-sectional approach was conducted among 119 CKD patients undergoing hemodialysis at Dr …

Faktor-Faktor Yang Memengaruhi Kualitas Hidup Pasien Gagal Jantung Kronik Fraksi Ejeksi Terjaga (Hfpef) Rawat Jalan Di Rsupn Dr. Cipto Mangunkusumo, Derin Anugrah Pratama, Sally Aman Nasution, Muhadi Muhadi, Arif Mansjoer, Idrus Alwi, Dyah Purnamasari, Aida Lydia, Dicky Levenus Tahapary

Jurnal Penyakit Dalam Indonesia

Introduction. The prevalence of heart failure in Indonesian adults is 1.5%, at least half of which categorized as heart failure with preserved ejection fraction (HFpEF). Quality of life assessment plays an important role in the management of heart failure, one of the tools widely used is the Minnesota Living with Heart Failure (MLHF) questionnaire. In Indonesia, there is still no data regarding risk factors that affect the quality of life of HFpEF patients. This study aimed to determine the quality of life profile of HFpEF patients and the relationship between the risk factors (age, hypertension, DM, smoking, and obesity) …

Evaluasi Pengukuran Kekakuan Limpa Dalam Memprediksi Perdarahan Varises Esofagus Berulang Pada Pasien Sirosis Hati, Andi Cahaya Tahir, Juferdy Kurniawan, Marcellus Simadibrata, Aulia Rizka, Hamzah Shatri, Cosmas Rinaldi A. Lesmana, Nadia Ayu Mulansari

Jurnal Penyakit Dalam Indonesia

Introduction. Esophageal variceal bleeding is one of the complications caused by an increase in pressure within the portal vein blood vessels. The gold standard examination for portal pressure is the hepatic venous pressure gradient (HVPG), but HVPG examination is invasive, involving transjugular catheterization of the hepatic vein. Currently, non-invasive methods for measuring portal hypertension are being developed to predict esophageal varices and esophageal variceal bleeding using spleen stiffness measurements. This study aimed to evaluate the accuracy of spleen stiffness measurement in predicting recurrent esophageal variceal bleeding in patients with liver cirrhosis.

Methods. This study used a retrospective cohort …

Efektivitas Terapi Antituberkulosis Empirik Pada Pasien Dengan Penyakit Hiv Stadium Lanjut: Sebuah Laporan Kasus Berbasis Bukti, Natasha Chandra, Dina Elita, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

Patients with advanced human immunodeficiency virus (HIV) disease have a high risk of mortality, with tuberculosis (TB) being one of the leading causes. Empiric antituberculosis therapy could be considered as a strategy to reduced mortality although there is no strong evidence. This study aims to review the efficacy of empiric antituberculosis therapy in patient with advanced HIV disease compared to isoniazid prophylaxis therapy and assessed with mortality as outcome. A 46- year old male patient with advanced HIV disease on antiretroviral therapy (ARV) and liver cirrhosis was admitted to hospital due to difficulties in sleeping and walking. During hospitalization he …

Program Multidisiplin Pasien Gagal Jantung Kronik Untuk Menurunkan Angka Perawatan Ulang Rumah Sakit, Lusiani Lusiani, Nurhayati Adnan

Jurnal Penyakit Dalam Indonesia

Heart failure is a complex disease caused by abnormalities in the structure or function of the heart resulting in decreased cardiac output. The complexity of heart failure causes an increasing burden of mortality and morbidity. This has further exacerbated the burden of treatment costs as well as the high rate of hospital readmissions. Readmission rate in patients with heart failure within 30 days post-hospitalization can reach 17.5%. In order to reduce re-hospitalization rates, multidisciplinary programs were introduced. The program involves collaboration of cardiologists, specialty nurses, pharmacists, nutritionists, and social workers using home or clinic-based models. Studies show that special management …

Gambaran Klinis Pasien Terduga Tuberkulosis Paru Resisten Obat (Tb-Ro) Dengan Kolonisasi Candida Sp. Di Rumah Sakit Hasan Sadikin Bandung, Hasna Rafifah Zahira Zalfa, Iceu Dimas Kulsum, Hendarsyah Suryadinata, Chrysanti Chrysanti, Intan Mauli Warma Dewi

Jurnal Penyakit Dalam Indonesia

Introduction. Candida sp. is a fungus that lives as a commensal in human body, but may cause infection upon immune suppression. The decrease in immunity due to TB infection and long-term use of antibiotics in TB patients may increase the risk of the Candida sp. colonization in patient. Data regarding the prevalence of Candida sp. colonization in TB patients and its impact has not been widely reported. This study was conducted to determine the prevalence and clinical characteristics of presumptive drug-resistance TB patients with Candida sp. colonization.

Methods. A cross-sectional study was conducted using secondary data from a …

Hubungan Tingkat Stres, Kecemasan, Dan Depresi Dengan Konstipasi Fungsional Pada Mahasiswa Kedokteran, Khafifah Z, Wilson Wilson, Agustina Arundina Triharja Tejoyuwono

Jurnal Penyakit Dalam Indonesia

Introduction. Stress, anxiety, and depression are factors associated with functional constipation that affect students’ quality of life. Stress, anxiety, and depression are often experienced by first-year medical students, but studies assessing these three variables with functional constipation are still limited.

Methods. This study used a cross-sectional analytical design. Study was carried out in July 2023 involving 88 first-year medical students from the Tanjungpura University Medical Study Program. Analysis of relationship tests was carried out using Kendall’s Tau-B tests.

Results. Most students were in the normal category of stress, anxiety and depression levels, however 21 students were in …

Etika Publikasi Di Bidang Kedokteran, Chyntia Olivia Murine Jasirwan, Edward Faisal, Evy Yunihastuti

Jurnal Penyakit Dalam Indonesia

Publikasi ilmiah merupakan penjelasan sistematis mengenai hipotesis, bukti, dan kesimpulan dari sebuah penelitian yang dimaksudkan untuk mengedukasi masyarakat. Publikasi merupakan tujuan utama dari penelitian, dan peer-review dilakukan untuk memverifikasi temuan dan meningkatkan kepercayaan penulis untuk evaluasi penelitian yang dipublikasi. Publikasi merupakan salah satu persyaratan khusus dalam suatu institusi akademik dan dapat mendukung promosi ke jabatan akademis. Publikasi (nasional dan internasional) telah menjadi norma yang dapat dikatakan wajib dalam dunia pendidikan. Berbagai pelanggaran etika banyak terjadi dan kita temukan, seperti plagiarisme, tata bahasa yang tidak pantas, dan praktik pengelolaan data yang meragukan. Kurangnya pemahaman tentang etika penelitian seringkali menjadi akar dari …

Infark Ventrikel Kanan Dengan Blok Atrioventrikular: Laporan Kasus Dengan Tinjauan Pustaka, Naomi Niari Dalimunthe, Refli Hasan, Herwindo Ahmad, Rahmad Isnanta, T Realsyah, Zainal Safri

Jurnal Penyakit Dalam Indonesia

Inferior myocardial infarction is frequently accompanied by right ventricular infarction. This report presents two cases of right ventricular infarction accompanied by hemodynamic disorder and atrioventricular block complications. These patients were diagnosed with right ventricular infarction based on history, clinical presentations, and electrocardiography findings. The management approach for these patients involved optimizing volume and fluid status, using temporary pacemakers, and urgent percutaneous coronary intervention. This report highlights the need to promptly identify right ventricular involvement in inferior myocardial infarction, as the treatment strategies for right ventricular infarction are different from left ventricular infarction.

Transcriptional Responses Of Different Brain Cell Types To Oxygen Decline, Camille Ravel-Godreuil, Ethan R Roy, Srinivas N Puttapaka, Sanming Li, Yanyu Wang, Xiaoyi Yuan, Holger K Eltzschig, Wei Cao

Faculty, Staff and Student Publications

Brain hypoxia is associated with a wide range of physiological and clinical conditions. Although oxygen is an essential constituent of maintaining brain functions, our understanding of how specific brain cell types globally respond and adapt to decreasing oxygen conditions is incomplete. In this study, we exposed mouse primary neurons, astrocytes, and microglia to normoxia and two hypoxic conditions and obtained genome-wide transcriptional profiles of the treated cells. Analysis of differentially expressed genes under conditions of reduced oxygen revealed a canonical hypoxic response shared among different brain cell types. In addition, we observed a higher sensitivity of neurons to oxygen decline, …