Internal Medicine Commons^™

When Birth Control Turns Biliary: A Rare Case Of Profound Hyperbilirubinemia From Oral Contraceptives, Taiwo Ajani, Aura Calderon, Jose J. Loayza Pintado, Nayiri Derian, Catherine Matos, Ivan Mogollon, Andres Suarez Parraga

School of Medicine Publications

Oral contraceptives (OCs) are extensively utilized and generally considered safe (reference); nonetheless, infrequent hepatobiliary complications such as cholestasis and hyperbilirubinemia have been documented, particularly among individuals with a genetic predisposition. We present a case involving a 19-year-old female who exhibited significant conjugated hyperbilirubinemia shortly after the commencement of OC therapy. Comprehensive investigations ruled out alternative causes, and the findings from liver biopsy, in conjunction with the clinical context, indicated an estrogen-induced cholestatic injury, likely revealing an underlying Dubin–Johnson syndrome. This case underscores the critical necessity of acknowledging hepatic adverse effects associated with estrogen as well as the influence of genetic …

Disseminated Tuberculosis Presenting With A Nodo-Colonic Fistula In A Newly Diagnosed Hiv-Positive Patient: A Case Report From Tanzania, Samina Somji, Salim Surani, Joshua Ngimbwa, Tevin Kahwa, Frank Swai, Fatema Tayabali, Bishoy Rofaeil

Population Health, East Africa

We present the case of a 35-year-old male with no known comorbidities who presented with chronic gastrointestinal (GI) and constitutional symptoms and was empirically treated with several antibiotics during multiple clinic visits at different health facilities. The laboratory test sent included a stool GeneXpert, which was positive for Mycobacterium tuberculosis (MTB). CT imaging revealed multiple necrotic abdominal and retroperitoneal lymph nodes, hypoenhancing splenic lesions, a nodo-colonic fistula between the necrotic retroperitoneal lymph nodes and the adjacent colon, and a mild left-sided pleural effusion. Colonoscopy demonstrated caseating discharge from the fistulous tract 40 cm from the anal verge, and histology showed …

Building Qualitative Research Capacity In The Global Health Workforce And Developing A Community Of Practice In Parts Of Sub-Saharan Africa: A Case Study, Jack Lumsdon, Catherine Dotchin, Albert Akpalu, Benedict Calys-Tagoe, Dilraj Sokhi, Momodou Cham, Njideka Okubadejo, Richard Morton, Violet Naanyu, Richard Walker

Internal Medicine, East Africa

Background Qualitative research offers unique insights into the lived experience of individuals with chronic conditions which can tie directly into public health priorities and identifying the need for additional support. More participatory approaches and qualitative data surrounding chronic diseases are needed in sub-Saharan Africa (SSA). Valuable “insider” insights are often missing as the conceptualisation of research often overlooks the value of such interactions. For successful and meaningful global health research, it is imperative to involve in-country experts and strengthen the capacity of research teams with qualitative skills.

Methods To address this, two hybrid qualitative research skills workshops were conducted in …

Renal Adverse Effects Of Antiangiogenic Agents In A Tertiary Hospital In Kenya, Joan Wambugu, Joyce Bwombengi, Jasmit Shah, Manel Haj Mansour

Internal Medicine, East Africa

Introduction Anti-angiogenic therapies, including vascular endothelial growth factor (VEGF) inhibitors and tyrosine kinase inhibitors (TKIs), have transformed cancer management by targeting tumor vasculature and suppressing metastasis. However, these agents can induce renal toxicities such as hypertension, proteinuria, and acute kidney injury (AKI), which may affect treatment continuity and outcomes. Data from sub-Saharan Africa on these adverse effects remains scarce.

Methods This was a retrospective cross-sectional study conducted at the Aga Khan University Hospital, Nairobi, oncology clinic. Medical records of adult patients receiving anti-angiogenic therapy between January 2020 and December 2024 were reviewed. Demographic data, comorbidities, treatment regimens, renal parameters, and …

Assessing The Association Between Musculoskeletal Injury And Mental Health In Rugby Players-A Cross-Sectional Study, Mordicai Atinga, Jasmit Shah, Sarah Karanja, Mark Lumbasi, Miriam Ndungu, Sarah Kiburi, James Ondiege, Njalalle Baraza

Internal Medicine, East Africa

Background: Musculoskeletal injuries are common among athletes and can negatively affect both physical and psychological wellbeing. Beyond physical disability, injuries have been linked to poor mental health, loss of athletic identity, and increased substance use. In low- and middle-income countries (LMICs), where awareness and management of mental health remain limited, the psychological burden of sports injuries may be underrecognized. Rugby, a physically demanding contact sport, has one of the highest rates of injury, but little is known about how such injuries influence mental health and related outcomes in African contexts. This study explored the relationship between musculoskeletal injuries and health …

A Review Of Yellow Fever: Epidemiology, Pathogenesis, Clinical Manifestations, Treatment, Prevention, And Prognosis, Farah Ebrahim, Samina Somji, Reena Shah, Salim Surani

Internal Medicine, East Africa

Yellow fever is a mosquito-borne viral illness caused by the yellow fever virus (YFV), a member of the Flaviviridae family. Despite the availability of an effective live-attenuated vaccine, the disease remains endemic in regions of Africa and South America. Transmission occurs primarily via an infected mosquito called Aedes aegypti, with distinct urban, sylvatic, and intermediate transmission cycles. Clinically, infection ranges from mild febrile illness to severe disease, which is characterized by jaundice, hemorrhage, and multiorgan failure. Pathogenesis involves viral replication in hepatocytes, immune-mediated injury, and dysregulated inflammatory responses, leading to characteristic hepatic mid-zone necrosis. Diagnosis relies on molecular detection …

Faktor Risiko Perdarahan Gastrointestinal Pada Pasien Dengan Sindrom Koroner Akut: Sebuah Tinjauan Sistematis, Assyadilla Kirana Setyobudi, Amie Vidyani, Jonathan Christianto Sutadji, Lady Aqnes Kurniawati, Kevin Fernando Suhardi

Jurnal Penyakit Dalam Indonesia

Introduction. Gastrointestinal bleeding (GIB) is a serious but potentially preventable condition. Its symptoms include hematemesis, hematochezia, and melena. Risk factors for GIB include medications such as antiplatelets and anticoagulants, which are standard treatments for acute coronary syndrome (ACS). GIB is strongly associated with ACS and represents the most common bleeding complication in these patients. This study aimed to systematically review the factors contributing to GIB in patients with ACS.

Methods. Relevant articles were retrieved from PubMed, ScienceDirect, Springer, and EBSCO databases, covering studies on GIB risk factors in ACS patients published between March 31, 2003, and March 31, …

Campak: Refleksi Keberhasilan Program Vaksinasi, Erni Juwita Nelwan

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Waktu Pemulihan Saturasi Oksigen Pada Pasien Covid-19 Di Rsnd Semarang: Pengaruh Usia, Derajat Keparahan, Dan Komorbiditas, Hererapratita Aysha Hapsari, Yosef Purwoko, Edwin Basyar, Dwi Ngestiningsih

Jurnal Penyakit Dalam Indonesia

Introduction. COVID-19 may cause impaired oxygenation that affects the recovery process, making oxygen saturation an important parameter in clinical monitoring. Age, disease severity, and comorbidities are suspected to influence the duration of oxygen saturation recovery. This study aimed to analyze differences in oxygen saturation recovery time based on age, disease severity, and comorbidity status in hospitalized COVID-19 patients.

Methods. This was an observational analytic study with a retrospective cohort design using a survival analysis approach. The study was conducted at Diponegoro National Hospital (RSND) Semarang from October to November 2021 using medical records of hospitalized COVID-19 patients from …

Skoring Risiko Mortalitas Pada Pneumonia Komunitas Sedang-Berat, Ni Nyoman Indirawati Kusuma, Gurmeet Singh, Vally Wulani, Cleopas Martin Martin Rumende, Fauzar Fauzar, Telly Kamelia, Sukamto Koesnoe, Adityo Susilo, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Community Acquired Pneumonia (CAP) is a lung parenchyma infection acquired outside of the hospital and is significantly associated with morbidity and mortality rates. Identifying patients with moderate-severe CAP at high risk of mortality through a combination of these variables is expected to serve as a basis for prompt and appropriate intervention, ultimately improving clinical outcomes for CAP patients. This study aimed to develop a scoring system using clinical characteristics, radiological findings, and serum biomarkers to assess the mortality risk in patients with moderate-severe CAP.

Methods. This study employs a retrospective cohort design with moderate-severe CAP patients treated …

Manfaat Latihan Kekuatan Otot Terhadap Kadar Hba1c Pada Orang Dewasa Dengan Prediabetes: Laporan Kasus Berbasis Bukti, Owen Paruhum Simanjuntak, Anna Mira Lubis

Jurnal Penyakit Dalam Indonesia

Prediabetes is a metabolic condition of impaired glucose homeostasis which results in elevated blood glucose levels. Besides the higher risk of developing diabetes, prediabetes is associated with increased risk of cancer, dementia, heart failures, and coronary artery disease. The common first line treatment regimen given to this group are healthy diet and aerobic exercise. However, some conditions might prevent patients from doing aerobic exercises therefore there is a need for alternatives. This evidence-based case report aims to evaluate the benefit of resistance training on HbA1c levels compared to control group (no exercise) in prediabetic adults. Literature search was conducted across …

Koeksistensi Spondiloartritis Perifer Dan Fokal Segmental Glomerulosklerosis: Sebuah Laporan Kasus Jarang, Zakiya Zulaifah, Florentina Carolin Puspita Hapsari, Virly Nanda Muzellina

Jurnal Penyakit Dalam Indonesia

Spondyloarthritis is a group of inflammatory rheumatic diseases characterized by shared clinical features, genetic predispositions, and pathogenic mechanisms. Without appropriate management, it carries a risk of various complications. We report the case of a young male patient with a one-year history of nephrotic syndrome prior to admission, presenting with chronic polyarthritis. Initially, systemic lupus erythematosus (SLE) with renal and musculoskeletal involvement was suspected, although SLE is relatively uncommon in young males. However, based on the clinical presentation of arthritis, imaging findings of sacroiliitis, and the absence of diagnostic criteria supporting SLE, the patient was subsequently diagnosed with peripheral spondyloarthritis and …

Campak Dan Vaksinasi Campak Pada Orang Dewasa, Robert Sinto, Sukamto Koesnoe, Erni Juwita Nelwan, Alvina Widhani, Sharifah Shakinah, Adeline Pasaribu, Bernadine Gracia Duindrahajeng, Suhendro Suwarto, Leonard Nainggolan, Lie Khie Chen, Adityo Susilo, Suzy Maria, Anshari Saifuddin Hasibuan, Bramantya Wicaksana

Jurnal Penyakit Dalam Indonesia

Measles is a highly contagious viral infection that remains a significant global health problem despite the availability of an effective vaccine. Measles re-emergence is driven by gaps in immunization coverage, waning post-vaccination immunity, and increased population mobility. In adults, measles infection is associated with greater disease severity compared to children. This literature review was conducted by reviewing recent scientific publications addressing the epidemiology, pathogenesis, clinical manifestations, diagnosis, management, complications, and prevention of measles, with a focus on the adult population.  Measles is caused by an RNA virus of the Paramyxoviridae family and is transmitted through respiratory droplets and aerosols. Typical …

Prevalensi Covid-19 Derajat Berat Dan Kritis Saat Admisi Pada Pasien Penyakit Reumatik Autoimun Dan Faktor-Faktor Yang Berhubungan, Mulia Destini, Anna Ariane, Mira Yulianti, Aulia Rizka, Ikhwan Rinaldi, Arif Mansjoer, Hasan Maulahela, Syahidatul Wafa

Jurnal Penyakit Dalam Indonesia

Introduction. Patients with autoimmune rheumatic diseases are known to be more vulnerable to severe and critical infections, including COVID-19. Although it is no longer classified as a pandemic, SARS- CoV-2 infection still persists, and several surges of cases have been reported, including in Indonesia. To date, no data are available regarding the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases in Indonesia and the associated factors. This study aimed to determine the prevalence of severe and critical COVID-19 at admission in patients with autoimmune rheumatic diseases at Dr. Cipto Mangunkusumo National General Hospital, …

Kesintasan Hidup Satu Tahun Pasien Sirosis Hati Yang Dirawat Di Rumah Sakit Cipto Mangunkusumo Pada Periode Covid-19, Gita Aprilicia, Ichwan Baihaki, Riri Oktavani Banjarnahor, Kemal Fariz Kalista, Rino Alvani Gani

Jurnal Penyakit Dalam Indonesia

Introduction. Liver cirrhosis represents the terminal stage of chronic liver disease and is characterized by a markedly reduced survival rate. Understanding the characteristics and laboratory parameters of patients with liver cirrhosis can provide valuable insights into their prognosis and potential interventions. This study was conducted during the COVID-19 pandemic period, which may have influenced patient outcomes due to potential impact of COVID-19 infection on patients with chronic liver disease. This study aimed to evaluate the one-year survival rate of hospitalized liver cirrhosis patients at Cipto Mangunkusumo Hospital during the COVID-19 and to identify clinical and laboratory factors associated with …

Breast Cancer-Derived Extracellular Vesicle Mir-425-5p (Mir-425) Promotes Brain Metastasis Via Activating Astrocytes Through The Novel Mir-425-Znf24-Ccl8 Signaling Axis, Grace L Wong, Munazza S Khan, Sara Manore, Shivani Bindal, Ravi Singh, Hui-Wen Lo

Faculty, Staff and Student Publications

Mechanisms underlying breast cancer brain metastasis (BCBM) are still not well understood. Here, we identified that BCBM patient serum contained extracellular vesicles (EVs) with high levels of microRNAs (miRNAs)-107 and -425. Levels of miR-107 and miR-425 were elevated in brain metastases, and the elevation was associated with poor patient prognoses. Ectopic expression of miR-107 and miR-425 promoted mammospheres; however, the inhibition of miR-425, but not miR-107, suppressed breast cancer mammosphere formation. We further observed that EVs from miR-425-overexpressing breast cancer cells strongly activated astrocytes whereas their inhibitors abrogated the effect. Conditioned media from miR-425-activated astrocytes promoted mammospheres. To elucidate how …

Atrial Fibrillation In Athletes: Mechanisms, Management, And Future Directions, Ibrahim Alameh, Ghina Al Fout, Michael D. Ezekowitz, Mohammed Kamareddine

Department of Medicine Faculty Papers

BACKGROUND: High-volume endurance training may shift exercise from cardioprotective to arrhythmogenic, increasing the risk of atrial fibrillation (AF) in healthy athletes.

CASE SUMMARY: A 38-year-old marathon runner with a 15-year history of high-intensity endurance training presented with episodic palpitations and reduced athletic performance. Electrocardiogram showed paroxysmal AF; echocardiography revealed mild left atrial enlargement without structural heart disease. Symptoms worsened during the recovery phase after runs, suggesting vagally mediated AF. After unsuccessful flecainide therapy, he underwent pulmonary vein isolation. Twelve months later, he remained free of recurrent AF on Holter monitoring and successfully resumed endurance training following an 8-week recovery period. …

Recurrent Pubic Osteomyelitis And Urosymphyseal Fistula In A Prostate Cancer Survivor: A Multidisciplinary Management Challenge, Peng Jhen Wu, Navin Sampathkumar, Tanmay Singh, Sonal Gandhi

Journal of Community Hospital Internal Medicine Perspectives

A 67-year-old male with a history of prostate cancer, treated with prostatectomy and subsequent radiation for recurrence, presented with a complex clinical course of recurrent osteomyelitis and a persistent urosymphyseal fistula with associated phlegmon. Following stereotactic body radiation therapy (SBRT) for a T4 vertebral lesion, he developed pelvic osteomyelitis, from which Kocuria species was cultured. The progression of his disease led to a urosymphyseal fistula, necessitating a cystectomy with ileal conduit and pubic bone debridement. Despite this extensive surgical intervention, he presented one year later with recurrent ileal conduit phlegmon and osteomyelitis. This case highlights the significant diagnostic and management …

An Unexpected Cause Of Thrombocytopenia In Pregnancy: A Case Of Malaria In A Non-Endemic Setting With Unclear Transmission Source, Jessica Ohemeng-Dapaah, Riham Mohammed, Ikechuwku Eke-Okoro

Journal of Community Hospital Internal Medicine Perspectives

Malaria remains a significant global health threat, with increasing concern for imported and locally acquired cases in non-endemic regions. We present the case of a 35-year-old pregnant woman from Sierra Leone, living in Missouri, who despite no recent international travel, was found to have symptomatic Plasmodium falciparum malaria. Her clinical course was notable for fever, severe thrombocytopenia, mild anemia and intraerythrocytic ring forms on her peripheral smear. She had a history of chronic hepatitis B and prior chemotherapy for Hodgkin lymphoma and recent travel to Florida, where local malaria transmission has been documented. The patient responded rapidly to artemisinin-based therapy, …

Infectious Aortitis Secondary To Gastrointestinal Pathogens: A Case Series And Syndromic Review, Natasa Kostic, Ilana Goldberg, Devin Weber

Division of Internal Medicine Faculty Papers & Presentations

Aortitis is a rare but serious complication of infection that results in high morbidity and mortality. The most common location is in preexisting aneurysmal disease in a patient with multiple chronic comorbidities. The pathogens often reflect gastrointestinal bacteria, the classic example being Salmonella spp., but also include other enteric flora, Staphylococcus aureus, Streptococcus spp., and more. Herein, we describe 2 cases of aortitis caused by gastrointestinal bacteria and review management of this complex syndrome.