Medicine and Health Sciences Commons^™

Stump Appendicitis., Chad A Keller, Rebecca Dudley Do, Elizabeth M Huycke, Richard Chow Do, Arjumand Ali Md

Department of Emergency Medicine

Stump appendicitis is a rare and late complication following appendectomy and can often be overlooked. Our case details a 42-year-old male who presented to the Emergency Department with right-sided lower abdominal pain, nausea, and vomiting. A computed tomography scan of his abdomen and pelvis demonstrated a tubular, fluid-filled structure with surrounding inflammatory changes at the level of the patient's appendectomy clips with a 2.3-cm calcified intraluminal stone. Findings were concerning for stump appendicitis with appendicolith. He was admitted and taken to the operating room for a laparoscopic stump appendectomy. Stump appendicitis should always be considered in the differential ...

Multidisciplinary Treatment Of Non-Spine Bone Metastases: Results Of A Modified Delphi Consensus Process., Erin F Gillespie, Noah J Mathis, Max Vaynrub, Ernesto Santos Martin, Rupesh Kotecha, Joseph Panoff, Andrew L Salner, Alyson Mcintosh Md, Ranju Gupta, Amitabh Gulati, Divya Yerramilli, Amy J Xu, Meredith Bartelstein, David M Guttmann, Yoshiya J Yamada, Diana Lin, Kaitlyn Lapen, Deborah Korenstein, David G Pfister, Allison Lipitz-Snyderman, Jonathan T Yang

Department of Radiation Oncology

Purpose: Local treatment for bone metastases is becoming increasingly complex. National guidelines traditionally focus only on radiation therapy (RT), leaving a gap in clinical decision support resources available to clinicians. The objective of this study was to reach expert consensus regarding multidisciplinary management of non-spine bone metastases, which would facilitate standardizing treatment within an academic-community partnership.

Methods and Materials: A multidisciplinary panel of physicians treating metastatic disease across the Memorial Sloan Kettering (MSK) Cancer Alliance, including community-based partner sites, was convened. Clinical questions rated of high importance in the management of non-spine bone metastases were identified via survey. A literature ...

Does Augmenting Antidepressant Medication In Euthyroid Patients With Thyroid Hormone Supplement Improve Depression Treatment?, Yoonjie Chung, Drew Keister Md

Department of Family Medicine

No abstract provided.

Young Professionals, Lehigh Valley Health Network

Young Professionals

No abstract provided.

A National Study Of Pregnancy-Related Maternal And Fetal Outcomes In Women With Inflammatory Bowel Disease., Zahid Ijaz Tarar, Umer Farooq, Muhammad Usman Zafar, Saad Saleem, Ahmad Nawaz, Faisal Kamal, Ghulam Ghous, Faisal Inayat, Yezaz A Ghouri

Department of Medicine

BACKGROUND AND AIMS: The incidence of inflammatory bowel disease (IBD) among women is highest during their reproductive years and current estimates suggest that the rate of conception is low in female IBD patients. The aim of our study was to assess the burden of adverse maternal and perinatal outcomes among female IBD patients.

METHODS: Using the national inpatient sample database from 2016 to 2018, we recruited all female patients above the age of 15 years admitted with a primary diagnosis of pregnancy and a secondary diagnosis of IBD. We adjusted our results for hospital and patient level variables including age ...

Single-Stage Cranioplasty With Customized Polyetheretherketone Implant After Tumor Resection Using Virtual Reality And Augmented Reality For Precise Implant Customization And Placement: Illustrative Case., Christian I Rios-Vicil, Daniela Barbery, Phuong Dang, Walter C. Jean

Department of Surgery

BACKGROUND: Cranioplasties are routinely performed to restore cosmesis and to protect intracranial contents after trauma, resection of tumors, or other pathologies. Traditionally done as a second-stage procedure, new single-stage cranioplasty protocols have been developed to minimize recovery periods, decrease complications, and improve patient satisfaction. These protocols, however, still require the use of larger than planned implants or use larger than ideal incisions to accommodate three-dimensional (3D) templates, which may not be optimal in regions with complex bony anatomy.

OBSERVATIONS: A 50-year-old woman with a painful and progressively enlarging hemangioma of the left frontal bone underwent a single-stage resection followed by ...

Ugrc 2021 Recommendations On Gme Transition: Pros And Cons, Opportunities And Limitations., John R Gimpel, Jennifer L Swails, Jessica L Bienstock, Grant L Lin, Michelle A Roett, Juhee Patel Do, Daniel W Giang

Department of Pediatrics

The Coalition for Physician Accountability's Undergraduate Medical Education-Graduate Medical Education (UME-GME) Review Committee (UGRC): Recommendations for Comprehensive Improvement of the UME-GME Transition final report includes a total of 34 recommendations and outlines opportunities to transform the current processes of learner transition from a US-based MD- or DO-granting medical school or international medical education pathway into residency training in the United States. This review provides a reflection on the recommendations from the authors, all members of the UGRC, describing the pros and cons and the opportunities and limitations, in the hopes that they might inspire readers to dig deeper into ...

Point-Of-Care Ultrasound Utilized For Foreign Body In A Toe: A Case Report Of Botfly Larvae., Megumi T Mori, Claire L. Paulson Do, Marna R. Greenberg Do, Mph, Facep, Kevin R. Roth Do, Facoep

Department of Emergency Medicine

BACKGROUND: Myiasis, as defined by the Centers for Disease Control and Prevention, is infection with fly larvae commonly occurring in tropical and subtropical areas. Whereas the presentation of skin infection with organisms such as Dermatobia hominis (human botfly) is more easily recognized in these regions, identification of myiasis in the United States is difficult due to its rarity. Due to unspecific signs and symptoms, myiasis may initially be mistaken for other conditions, like cellulitis.

CASE REPORT: This case details a patient with pain, swelling, drainage, and erythema of the right second toe. The patient recently returned from Belize and reported ...

The Transformation Of Residency Recruitment In The Era Of Covid-19: Optimizing Residency Recruitment For Lehigh Valley Health Network, David Bosch, Margaret A. Hadinger Edd, Ms, Drew Keister Md

USF-LVHN SELECT

No abstract provided.

A Ruptured Mycotic Aortic Aneurysm In A Patient With Urinary Retention: A Case Report., Samantha L. Gaetani Md, Jerome C. Deutsch Do, Mila H. Ju Md

Department of Emergency Medicine

Symptomatic abdominal aortic aneurysm (AAA) is a diagnosis that is a true emergency. Since AAAs are typically asymptomatic prior to rupturing, they can easily be missed. When an abdominal aortic aneurysm becomes symptomatic and ruptures, the ramifications can be catastrophic for the patient. We present a case of a 55-year-old male who presented with urinary retention and suprapubic pain. Computerized tomography demonstrated a rapidly expanding AAA and signs of impending rupture. Emergent vascular surgical repair was performed successfully. There was concern for mycotic nature of the AAA with recent COVID-19 infection and possible bacteremia. This case demonstrates the need for ...

Pulmonary Artery Root Replacement For Leiomyosarcoma: A Viable Thoracic Oncovascular Operation., Papus Keita, Matthew Janko, Nicholas J Peterman, Sandor Toledo, Marc Pelletier

Department of Surgery Residents

Leiomyosarcoma of the pulmonary artery is a rare but potentially fatal disease. Due to its rarity, the treatment algorithm is not well-established. While there may be a role for both chemotherapy and radiotherapy, surgical management is the most definitive method. Unfortunately, when the disease process is advanced, surgery may not be curative. However, it may still be a palliative treatment option. In this case report, we present a patient who suffered from respiratory symptoms that were initially attributed to pulmonary embolism (PE). However, upon the diagnosis of pulmonary artery leiomyosarcoma (PAL), surgery intervention was undertaken and resulted in an improved ...

Transcatheter Occlusion Of A Patent Ductus Arteriosus For A Symptomatic Left-To-Right Shunt., Papus Keita, Frank Han, Nicholas J Peterman, Sandor Toledo, Anthony Munaco

Department of Surgery Residents

Congenital diaphragmatic hernias (CDH) can induce life-threatening pulmonary hypertension and right heart failure. The patent ductus arteriosus (PDA) is often maintained in CDH to allow for decompression into the systemic circulation. However, if the PDA becomes hemodynamically significant, PDA closure may be indicated. Traditional methods rely on pharmacological closure. In this report, we document a rare transcatheter closure of a hemodynamically significant PDA.

Authors' Response To Ashton Gatewood And Michael Harding: Tribal Partnerships As An Avenue Forward., Larry A Green, William L. Miller Md, Ma, John J Frey, Hilliard Jason, Jane Westberg, Deborah J Cohen, Robin S Gotler, Frank V Degruy

Department of Family Medicine

No abstract provided.

Malignant Acute Disseminated Encephalomyelitis (Adem) Presenting As A Stroke Alert: A Case Report., Madeline J Hooper, Joshua A. Kalter Ms3, Nicholas S. Imperato, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

Acute disseminated encephalomyelitis (ADEM) is a rare illness. Generally characterized by encephalopathy and non-specific, heterogeneous neurological deficits depending on the location of the demyelinated lesions, ADEM is considered a clinical diagnosis with radiological findings that may or may not have supportive features based on the temporal relationship of an inciting factor and symptom onset. Even rarer, hyperacute or malignant ADEM can be defined by rapid symptom onset followed by catastrophic brain edema and its sequelae. We present a case of a patient who presented with an acute stroke with activation of a rapid sequence care pathway (stroke alert protocol) to ...

An Unusual Case Of A Gastric Xanthoma: A Case Report., Megan R. Greenberg Bs, Shashin Shah Md

USF-LVHN SELECT

Gastric xanthomas are rare tumor-like lesions, most commonly occurring in the antral region. We set out to describe a patient with a history of Barrett's esophagus status post two radiofrequency ablations (RFAs) and an endoscopic mucosal resection (EMR) who developed a gastric xanthoma just below the Z-line with recurrent esophageal metaplasia. Histopathological confirmation of xanthomas are needed to rule out malignancy. While gastric xanthomas themselves are benign conditions, regular follow-up is recommended if there is a high index of suspicion of malignancy or alarming symptoms develop.

Improving Blood Pressure Screening In Neonatal Follow-Up Clinic: A Quality Improvement Initiative., Rachel S Flynn, Jacqueline Zedalis, Michelle R Denburg, Judy C Bernbaum, Sara B Demauro

Department of Pediatrics

Introduction: The American Academy of Pediatrics recommends blood pressure screening at every health care encounter in children younger than 3 years if they have a history of prematurity or other neonatal complications requiring intensive care because these children have an increased risk for hypertension.

Methods: A multidisciplinary team conducted a quality improvement initiative to improve blood pressure screening at a single-center outpatient neonatal follow-up clinic. We developed a focused intervention program including a standardized blood pressure measurement protocol, staff training and education, and streamlined documentation. We conducted two Plan-Do-Study-Act cycles from November 2019 to January 2021. The outcome measure was ...

Social Media As A Medium For Dermatologic Education., Benjamin R Cooper, Anthony Concilla, J Mark Albrecht, Aashni Bhukhan, Melissa R Laughter, Jaclyn B Anderson, Chandler W Rundle, Emily Mceldrew Do, Colby L. Presley Do

Department of Medicine

Purpose of Review: We explore the utility of social media platforms as educational tools in dermatology, providing a summary of how these sites are used by the public and dermatologists alike, and demonstrating ways these findings may be applied for educational purposes.

Recent Findings: Over half of the world's population utilizes social media platforms. More recently, these platforms have increasingly been used for educational purposes. In the field of dermatology, a large portion of the educational content is coming from users with no formal medical or dermatologic training.

Summary: Each of the top five social media platforms in the ...

Proton Beam Therapy Causing Pericarditis - A Rare Case Of Radiation Induced Cardiotoxicity., Rahul Gupta Md, Muling Lin, Gary M Freedman, Deborah W Sundlof Do, Cheri Silverstein Fadlon

Cardiology Division

Acute pericarditis is caused by the inflammation of the pericardium which can result in an effusion around the heart. Proton beam therapy causing radiation-induced pericarditis is not a well-known cause of pericarditis. We present a case of a patient with Li-Fraumeni Syndrome who developed acute onset pericarditis, presumed to be secondary to proton beam therapy.

Emergency Extra-Intracranial Bypass Surgery In A Patient With Neurologic Deficit After An Accident In Carotid Occlusive Test: A Case Report., Hung M Ngo, Hien T Trinh, Rocky Felbaum, Walter C. Jean Md

Department of Surgery

OBJECTIVE: BTO is the procedure performed to assess the collateral circulation within the Willis circle in a giant ICA aneurysm. An ICA occlusion after BTO is very rare. We present a case of an internal carotid artery occlusion as a complication of BTO that required urgent revascularization surgery.

CASE PRESENTATION: A 56-year-old female with a history of transient ischemic attacks for one year was diagnosed with multiple aneurysms: a giant aneurysm of the left supra-clinoid ICA, two small ones on left MCA and right ophthalmic. A BTO was performed to assess collateral supply and determine whether bypass surgery should be ...

Icoplast-From Infancy To The First World Congress., Gregory R D Evans, Robert X. Murphy Jr, Md, Ms, Hinne A Rakhorst, Lucie Lessard, Ahmed Khashaba, Julio D Kirschbaum, Horacio F Mayer

Department of Surgery

No abstract provided.

Bee First: A Standardized Point-Of-Care Ultrasound Approach To A Patient With Dyspnea., Meghana Ganapathiraju, Claire L. Paulson Do, Marna R. Greenberg Do, Mph, Facep, Kevin R. Roth Do, Facoep

Department of Emergency Medicine

Dyspnea is a common complaint in patients who present to the emergency department and can be due to numerous etiologies. This case report details a 90-year-old female with a history significant for hypertension, hyperlipidemia, and new diagnosis of ovarian malignancy whose symptoms increased over the past three days. Point-of-care Ultrasonography showed multiple B-lines, a plethoric IVC without respiratory variation, a markedly low EF and a lack of RV dilation. There was also no evidence of effusion which led the emergency medicine team to the diagnosis of acute decompensated heart failure. This quick diagnosis was possible due to using the standardized ...

Utilization Of The Lempert Maneuver For Benign Paroxysmal Positional Vertigo In The Emergency Department., Vanessa Hwu, Arielle Burris, Jessica R Pavolko, Daniel Sawyer Pt, Dpt, Marna R. Greenberg Do, Mph, Facep, David B. Burmeister Do, Facep, Cpe

Department of Emergency Medicine

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. Symptoms from BPPV lead to Emergency Department (ED) visits, and persistence of symptoms, particularly in the elderly, may impact patient disposition. We describe the techniques used in the case of a 72-year-old male with dizziness, who had symptom resolution, and was able to be safely discharged after a Lempert maneuver (barbeque (BBQ) roll) was performed in the ED setting. The patient presented to the ED with left gaze nystagmus, and otherwise normal evaluation results. Physical therapy was consulted, and their initial evaluation indicated right horizontal canalithiasis noted by fatiguing ...

A Novel Mixed Methods Approach Combining Geospatial Mapping And Qualitative Inquiry To Identify Multilevel Policy Targets: The Focused Rapid Assessment Process (Frap) Applied To Cancer Survivorship., Autumn Kieber-Emmons Md, Mph, William L. Miller Md, Ma, Ellen B Rubinstein, Jenna Howard, Jennifer Tsui, Jennifer L Rankin, Benjamin F Crabtree

Department of Family Medicine

Multi-level perspectives across communities, medical systems and policy environments are needed, but few methods are available for health services researchers with limited resources. We developed a mixed method health policy approach, the

Impact Of Covid-19 In Hematopoietic Stem Cell Transplant Recipients: A Systematic Review And Meta-Analysis., Moazzam Shahzad, Sibgha Gull Chaudhary, Muhammad Usman Zafar, Maha A Hassan, Ali Hussain, Fatima Ali, Iqra Anwar, Mamoon Ahmed, Nausheen Ahmed, Sharad Khurana, Muhammad A Rauf, Faiz Anwar, Peiman Hematti, Natalie S Callander, Sunil H Abhyankar, Joseph P Mcguirk, Muhammad Umair Mushtaq

Department of Emergency Medicine

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of mortality and morbidity with coronavirus disease 2019 (COVID-19) due to severe immune dysfunction.

METHODS: A literature search was performed on PubMed, Cochrane, and Clinical trials.gov from the date of inception to 12/08/2021. We identified 19 original studies reporting data on COVID-19 in HSCT recipients after screening 292 articles. Data were extracted following preferred reporting items for systematic reviews and meta-analysis guidelines. Quality evaluation was done using the National Institutes of Health (NIH) quality assessment tool. Inter-study variance was calculated using Der Simonian-Laird Estimator. Pooled analysis ...

Development Of An Evidence-Based Compendium Of Institutional Graduate Medical Education Leadership Competencies (Gmelcs), Margaret Hadinger, Edd Ms, Brigham C. Willis, Jacqueline E. Levesque, Kathryn M. Andolsek, Sharon Hall, Karen Broquet

Department of Education

No abstract provided.

Covid-19 Cardiovascular Connection: A Review Of Cardiac Manifestations In Covid-19 Infection And Treatment Modalities., Theresa Maitz Do, Dominic Parfianowicz Do, Ashley Vojtek Do, Yasotha Rajeswaran Md, Apurva Vyas Md, Rahul Gupta Md

Department of Medicine

The coronavirus pandemic has crippled healthcare system since its outbreak in 2020, and has led to over 2.6 million deaths worldwide. Clinical manifestations of COVID-19 range from asymptomatic carrier to severe pneumonia, to life-threatening acute respiratory distress syndrome (ARDS). The early efforts of the pandemic surrounded treating the pulmonary component of COVID-19, however, there has been robust data surrounding the cardiac complications associated with the virus. This is suspected to be from a marked inflammatory response as well as direct viral injury. Arrhythmias, acute myocardial injury, myocarditis, cardiomyopathy, thrombosis, and myocardial fibrosis are some of the observed cardiac complications ...

Predictors Of Severe Outcome Following Opioid Intoxication In Children., Neta Cohen, Mathew Mathew, Adrienne Davis, Jeffrey Brent, Paul Wax, Suzanne Schuh, Stephen B Freedman, Blake Froberg, Evan Schwarz, Joshua Canning, Laura Tortora, Christopher Hoyte, Andrew L. Koons Do, Michele M Burns, Joshua Mcfalls, Timothy J Wiegand, Robert G Hendrickson, Bryan Judge, Lawrence S Quang, Michael Hodgman, James A Chenoweth, Douglas A Algren, Jennifer Carey, E Martin Caravati, Peter Akpunonu, Ann-Jeannette Geib, Steven A Seifert, Ziad Kazzi, Rittirak Othong, Spencer C Greene, Christopher Holstege, Marit S Tweet, David Vearrier, Anthony F Pizon, Sharan L Campleman, Shao Li, Kim Aldy, Yaron Finkelstein

Department of Emergency Medicine

INTRODUCTION: While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication. We explore predictors of severe outcome (i.e., intensive care unit [ICU] admission or in-hospital death) in children who presented to the Emergency Department with an opioid intoxication.

METHODS: In this prospective cohort study we collected data on all children (0-18 years) who presented with an opioid intoxication to the 50 medical centers in ...

A 74-Year-Old Woman Presenting With Multiple Skin Masses, Chun Siu Do, Shabnam Assar Md

Department of Medicine

No abstract provided.

Predictors Of Primary Care Practice Among Medical Students At The Michigan State University College Of Human Medicine., Jennifer Edwards-Johnson, Youngjun Lee, Andrea Wendling, Baijiu Patel Md, Julie Phillips

Department of Medicine

INTRODUCTION: This study examines the evolution of student and physician interest in primary care from medical school matriculation to practice, focusing on student factors that potentiate primary care (PC) practice.

METHODS: We compiled a dataset of 2,047 Michigan State University College of Human Medicine graduates from 1991 to 2010. PC interest was assessed using the Association of American Medical Colleges (AAMC) matriculating student (MSQ) and graduation (GQ) questionnaires. PC practice was determined using AMA physician Masterfile data. C

RESULTS: PC interest at matriculation and at graduation were the factors most likely to predict PC practice. After controlling for URM ...

A Severe Case Of Siliconoma-Induced Hypercalcemia Due To Illicit Gluteal Silicone Injections., Mallorie L Huff, Nitisha Mehta, Aaron Jacobs Md, Marshall G. Miles Do

Department of Surgery

Siliconoma-induced hypercalcemia is a rare complication of siliconoma, occurring secondary to a foreign body granulomatous process induced by the introduction of silicone into soft tissue. This is a case report of a woman presenting with sequelae of illicit silicone injections performed in an unknown woman's basement in Florida 20 years before presentation. A 39-year-old woman presented with a 2-month history of 20-pound weight loss, malaise, and intractable vomiting with a remote history of unregulated cosmetic injections to the bilateral gluteal and thigh regions. Her laboratory studies were consistent with severe hypercalcemia secondary to a foreign body granulomatous process. Initially ...