Digital Commons Network^™

Stones, Bones, And Hormones: A Multisystem Presentation Of Primary Hyperparathyroidism Due To Parathyroid Adenoma, Gadgesh B, Varsha Tandure, Nandini K, Chandana Srinath

Digital Journal of Clinical Medicine

Primary hyperparathyroidism is an endocrine disorder characterized by excessive secretion of parathyroid hormone, most commonly due to a solitary parathyroid adenoma, resulting in hypercalcemia and multisystem involvement [1]. Although many patients are diagnosed incidentally, delayed recognition may lead to severe renal, skeletal, gastrointestinal, and cardiovascular complications.

We report the case of a 44-year-old male who presented with sepsis and acute kidney injury, later found to have hypercalcemia with nephrocalcinosis, chronic calcific pancreatitis, skeletal deformities, and markedly elevated parathyroid hormone levels. Imaging localized a parathyroid adenoma, and the patient underwent successful parathyroidectomy with significant biochemical and clinical improvement.

This case emphasizes …

Clinical Correlates And Predictors Of Suicide Attempt Severity In Elderly Patients: A Cross-Sectional Study From South India, Rajamani Siddamallappa, Kiran Kumar Kadarappa Dr, Megha C N

Digital Journal of Clinical Medicine

Background: Suicide in late life is a major yet under-recognized public health problem in low- and middle-income countries. Elderly suicidal behaviour reflects interactions between psychiatric morbidity, substance use, psychological distress, intent, and method selection. Indian data examining these factors comprehensively remain limited.

Objectives: To assess psychiatric morbidity, hopelessness, suicide intent, planning patterns, methods, and independent predictors of suicide attempt severity among elderly suicide attempters.

Methods: This cross-sectional study included 75 elderly individuals (≥60 years) admitted following a suicide attempt to a tertiary care hospital in South India. Depression severity, hopelessness, and suicide intent were assessed using Beck’s Depression Inventory-21 (BDI-21), …

Family Mental Health – A Case Report, Vikrant Arora, Medha Kosireddy, Mathumitha Ananth, Kishor M. Manohar Rao

Digital Journal of Clinical Medicine

Psychiatric illness in India is estimated to be 15% as per National Mental Health Survey 2015-16.  Mental health challenges within families, especially depression, anxiety disorders that are not common and when unaddressed exert cascading effects on all members, disrupting emotional cohesion, relational functioning, and socioeconomic stability. There are few case reports on entire family presenting to psychiatry department.

With informed consent a city-based middle-class family of non-consanguineous origin, where the 40-year-old female, presented with intractable limb pains and health anxiety, she had multiple consultation in last few months and her 48-year-old husband also had with episodic pains, irritability and her …

From Controversy To Comeback: The Renewed Role Of Pralidoxime In Op Poisoning, Dr Sanaa Jain, Dr Savitha V, Dr . Shashidhara K C

Digital Journal of Clinical Medicine

Organophosphorus compounds are commonly used as pesticides in agriculture, but they are responsible for approximately one-third of suicide deaths in Asian countries.The symptoms of organophosphate (OP) poisoning vary over time and are categorized into three phases: Acute Cholinergic Crisis (minutes to 24 hours), Delayed Phase (24 hours to 2 weeks), which may include intermediate syndrome, coma, and extrapyramidal symptoms, and Late Phase (OPIDP). Treatment typically involves Atropine, Pralidoxime, and symptomatic management, including airway support and mechanical ventilation.

Ropinirole-Induced Sleep-Related Behavioral Disturbances And Psychotic Symptoms In Parkinson's Disease: A Case Report, Kareena Arora, Akshatha C. J, Rajesh Raman, Vikrant Arora, Bindu Annigeri, Megha Sadashiv

Digital Journal of Clinical Medicine

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms such as bradykinesia, rigidity, and tremor. Though commonly associated with motor symptoms but can also present with significant non-motor symptoms such as sleep disturbances, psychosis, and cognitive decline. These symptoms may arise spontaneously or be medication-induced. We present the case of a 53-year-old male with Parkinson’s disease who developed nocturnal behavioural disturbances and psychotic features, likely secondary to dopaminergic agonist medication. Symptom resolution followed adjustment of antiparkinsonian medications and the introduction of antipsychotic medication

Unusual Case Of Pelvic Fracture Urethral Distraction Defect, Varuni Pragya, Madhukesh Rudramurthy, Siddalinga Murthy G

Digital Journal of Clinical Medicine

INTRODUCTION

Urinary bladder ruptures are an uncommon injury, occurring in less than 1% of all blunt abdominal trauma. Extraperitoneal bladder ruptures are generally associated with pelvic fractures and usually managed nonoperatively but open surgery is required when these injuries are associated with additional trauma to structures like prostate and urethra.

CASE PRESENTATION

We report our experience with a 32-year-old male who suffered a head on collision with a four-wheeler while driving a two-wheeler in a road traffic accident. He presented to the hospital with abdominal and pelvic pain, difficulty in passing urine and swelling of the scrotum. His X Ray …

Biomedical Waste Management Practices In A Rural Health Training Centre In Southern India: A Cross-Sectional Facility Audit Using Kayakalp Guidelines, Mathivathani Palaniyappan, Kathiravan Rajendran

Digital Journal of Clinical Medicine

Background

Effective biomedical waste management (BMWM) is essential to prevent environmental contamination and health hazards in healthcare settings. In India, regulatory frameworks like the Biomedical Waste Management Rules, 2016, mandate proper handling, but compliance varies, particularly in rural facilities. This study evaluated BMWM practices at a rural health training centre using the Kayakalp assessment tool.

Methods

A cross-sectional audit was conducted from April to June 2024 at a rural health training centre affiliated with a medical college in Coimbatore, Tamil Nadu, India. The Kayakalp checklist for primary health centres was employed, encompassing 10 measurable elements with 20 checkpoints scored as …

Pulmonary Hemosiderosis In A Young Child Presenting With Recurrent Respiratory Illness And Refractory Anemia: A Case Report, Praveen Das, Ratnapriya Chowdhry, Neha Bhongale, Poonam Wade

Digital Journal of Clinical Medicine

Pulmonary hemosiderosis (PH) is a rare cause of diffuse alveolar hemorrhage in children and often presents with nonspecific respiratory symptoms and refractory iron‑deficiency anemia. We report a 2.5‑year‑old girl with recurrent lower respiratory tract infections, severe transfusion‑dependent anemia, failure to thrive, and persistent bilateral pulmonary infiltrates since infancy. Bronchoalveolar lavage demonstrated hemosiderin‑laden macrophages, confirming pulmonary hemosiderosis. Further evaluation revealed C‑ANCA positivity and PR3‑ANCA negativity, raising suspicion for an ANCA‑associated vasculitis; however, there was no renal, ear‑nose‑throat, or other systemic involvement, and a lung biopsy could not be performed. The child was managed with systemic corticosteroids with clinical improvement. This case …

State Social Benefit Schemes For Women In Continuity Of Psychiatric Care: A Case Report, Mathumitha A, Kishor M. Manohar Rao Professor

Digital Journal of Clinical Medicine

Mental health disorders are a major global public health challenge. The disorders affect over a billion people worldwide, while depressive and bipolar spectrum disorders also contribute substantially to disability and reduced quality of life. According to the World Health Organization, major depression alone affects more than 300 million people globally and is considered a leading cause of years lived with disability. Beyond clinical morbidity, mental illnesses exert a profound economic impact, with depression and anxiety accounting for an estimated USD 1 trillion annually in lost productivity worldwide, while the overall global economic burden of mental disorders is projected to reach …

Dietary Micronutrients And The Risk Of Gestational Diabetes: Evidence From A Tertiary Care Setting In India, Sujatha Mahadevarao Premnath, Moneesh Sivasoupramaniane, Maghida S

Digital Journal of Clinical Medicine

Background: Gestational Diabetes Mellitus (GDM) is a significant health concern in India, affecting nearly 22.4% of pregnant women. While macronutrient roles are well explored, the impact of micronutrients on GDM risk, particularly with the Indian ethnic phenotype, requires exploration

Objectives: To compare the micronutrient intake between GDM and non-GDM pregnancies and evaluate the association between specific dietary micronutrients and GDM risk

Methods: An observational cross-sectional study was conducted among 115 South Indian pregnant women. Dietary history was taken using 24-hour recalls on two occasions and analysed via the Indian Food Composition Table (IFCT). GDM was diagnosed using International Association of …

Spectrum Of Neurodevelopmental Disorders In Children Attending A Developmental Clinic In Dar Es Salaam, Tanzania, Aleya Zulfikar Remtulla, Sumayyah Nasiruddin Saudin, Orujul Hassan, Mariam Noorani

Paediatrics and Child Health, East Africa

Background: Neurodevelopmental disorders (NDDs) in children present significant challenges for healthcare systems globally. In Tanzania, children with NDDs and their families face significant challenges due to late diagnosis, lack of standardized screening tools, widespread stigma and cultural beliefs that deter health-seeking behaviours. Awareness about NDDs is low, and financial constraints further complicate access to necessary medical interventions. The country suffers from a severe shortage of specialized healthcare providers, and general healthcare providers often lack adequate training. Additionally, limited specialized facilities, high treatment costs and insufficient healthcare policies dedicated to NDDs make it difficult to manage these conditions effectively. Understanding the …

Sex Differences In Clinical Characteristics, Treatment, And Outcomes Of Cardiovascular Disease: Kenya Heart Registry Analysis, Lilian Mbau, Martha Gulati, Mzee Ngunga, Jasmit Shah, Felix Barasa, Jeilan Mohamed, Anders Barasa, Bernard Gitura, Harun Otieno, Etienne Amendezo

Internal Medicine, East Africa

Background Cardiovascular disease is the leading cause of death globally, with approximately 80% of these deaths occurring in low- and middle-income countries. Sex differences in cardiovascular disease are well described in high-income countries but limited in low- and middle-income countries.

Objectives This study sought to evaluate the sex differences in clinical presentation, cardiovascular risk profile, diagnosis, treatment, and outcomes among patients in the Kenya Heart Registry.

Methods Data were prospectively collected from 3 tertiary hospitals, including patients with heart failure, acute coronary syndrome, venous thromboembolism, and atrial fibrillation. Primary outcomes were in-hospital and 6-month mortality, as well as sex-specific differences …

In Memoriam: Professor Dan J. Stein (1962-2025) — A Global Pioneer With An African Heart, Gregers Wegener, Bernard Lerer, Alan Frazer, Anthony Grace, Kazutaka Ikeda, Gabriella Gobbi, Allan Young, Joseph Zohar, Pierre Blier, Lukoye Atwoli

Internal Medicine, East Africa

With profound sadness we mark the passing of Professor Dan J. Stein—clinician, scientist, philosopher, and friend. A pioneer of International and African psychiatry, and a central figure in global neuropsychopharmacology, he devoted his life to understanding and relieving the burden of mental disorders in South Africa, across the African continent, and worldwide. In his death, we have lost a true giant.

Experience Of Using Anti-Cd 20 Therapies In Multiple Sclerosis Patients In Kenya, Eunice Nyambane, Tejal Patel, Jacqueline Mavuti, Juzar Hooker, Dilraj Sokhi

Internal Medicine, East Africa

Objective: The objective of the study was to evaluate the safety and efficacy of ocrelizumab (OCR) and rituximab (RTX) in multiple sclerosis.

Methods: This was a retrospective single-centre study. Ocrelizumab- and rituximab-treated patients were identified through the multiple sclerosis (MS) registry maintained at Aga Khan University Hospital Nairobi (AKUHN), Kenya. Adult patients aged 18–65 years old who fulfilled the McDonald 2017 diagnosis criteria and received treatment with either rituximab or ocrelizumab between January 2016 and June 2025 were retrospectively evaluated. Data collected at baseline included age, gender, first symptoms, disease duration since onset, MS phenotype, treatment duration, previous …

Prognostic Factors For Patients Under 45 Undergoing Surgery For Colorectal Liver Metastases: A Seer Population-Based Study, Gabrielle Grob, Fang Fang, Matvey Karpov, Eric Feliberti, Marybeth Hughes, Rachel Burke, Winifred Lo

Department Surgery Faculty Publications

Background and Objectives: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The aim of this study was to describe patient and tumor characteristics associated with disease-specific survival in young patients (<  45 years) versus older patients (≥ 45 years) with isolated CRLM.

Methods: The SEER database was queried for patients with CRLM who underwent colon and liver resection from 2010 to 2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. Cox regression was used to analyze demographic factors, tumor …

Impact Of Social Determinants Of Health On Perioperative And Interstage Outcomes In Congenital Heart Surgery A Systematic Review, Sara Sakowitz, Jennifer S. Nelson, Justin Robinson, Camilla S. Rossi, David M. Shahian, David T. Cooke, Jeffrey P. Jacobs, Shelby Aughtman, Megan Schultz, Meena Nathan, Claude Beaty, Michal Shafer, Deborah Kozik, Glenn J. Pelletier

Department Surgery Faculty Publications

Importance: Social determinants of health (SDoH)- conditions in which patients live, grow, and age, - are increasingly recognized to influence the health of patients with congenital heart disease (CHD).

Objective: To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery.

Evidence Review: A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria …

Enhancing Graduate Surgical Education: Recommendations For Development Of Common Surgery Education And Training Accreditation Standards, Edwin Christopher Ellison, David B. Hoyt, L. D. Britt, Gerald B. Healy, John R. Potts Iii, Michael M. Awad, Eric A. Gantwerker, Apostolos Gaitanidis, Carol R. Bradford, Robert Phillip Burns, Mary T. Hawn, John G. Hunter, Cheryl T. Lee, Keith D. Lillemoe, Najjia N. Mahmoud, Jeffrey B. Matthews, Michael W. Neumeister, Kathleen C. Y. Sie, The Independent Committee For Graduate Surgical Education

Department Surgery Faculty Publications

Background:

Concerns persist within the surgical community that completion of an accredited surgical residency no longer consistently ensures that trainees are ready for independent practice. In response, the Independent Committee for Graduate Surgical Education (ICGSE) was established in January 2025 to address the unique requirements of surgical training. The committee’s mandate was to recommend program standards that would potentially optimize education and training for surgical residents, with the goal of improving patient care.

Methods:

The ICGSE, consisting of 71 surgeons across 16 specialties, reviewed the history of surgical accreditation and relevant literature. Workgroup-led discussions identified strategies for improving trainee readiness …

Osteopathic Manipulative Treatment For Pain With Medication And Opioid-Sparing Effects: A Narrative Review, Austin Buroker, Matthew A. Savallo, Ryan Relyea, Matthew Eximond, Dennis Besong

South Atlantic Division GME Research Days 2026

No abstract provided.

Cologuard, Call To Action! A Structured Outreach Intervention For Patients With Unreturned Cologuard Kits, Crystal Bharat, Sophia Zia, Harsh Bhatt, Abd Almasih Barbar Askar, Kulwinder Bhatnura, Dhruv Patel, Dennis Besong

South Atlantic Division GME Research Days 2026

No abstract provided.

A Stroke That Wasn’T: Thrombotic Thrombocytopenic Purpura Presenting With Isolated Neurologic Deficits, Renuka Mahatara, Sahil N. Parikh, Amelia Piccone, Merid Moqattash, Nicole Ryan, Dmitri Zbarsky

South Atlantic Division GME Research Days 2026

No abstract provided.

A Case Of Rocky Mountain Spotted Fever, Deepa Nuthalapati, Natalie Kuo-Hsuan Yang, Rajiv Shah, Valerie Sinkler

South Atlantic Division GME Research Days 2026

No abstract provided.

Utilization Of Psa Testing For Prostate Cancer Screening Among Patients At A Resident-Run Outreach Clinic In Charleston, South Carolina, Usa From 2020-2025: A Retrospective Analysis, Matthew Eximond, Nick Mullins, Arpit Arora, Sirin Khajaviyan, Chris Fecek

South Atlantic Division GME Research Days 2026

No abstract provided.

A Quality Improvement Project To Enhance Early And Consistent Prenatal Care In The Spanish Speaking Female Population At The Fqhc West Ashley Fetter Clinic, Ana Martinez Conde, Sophia Zia, Joye Fordham, Dennis Besong

South Atlantic Division GME Research Days 2026

No abstract provided.

Increasing Patient Enrollment In The Healow App At Fetter Health Care Network, Genevieve Mccloskey, Goodness Ezeanyaso, Collin Cheatle, Dennis Besong

South Atlantic Division GME Research Days 2026

No abstract provided.

The Effects Of A Stepped-Care Mental Health Program On Trauma Recidivism At A Level I Trauma Center, Gabriella Rivas, Juliette Gammel, Kola George, Kenneth Ruggiero, Tatiana Davidson, Hannah Espeleta, Langdon Hartsock, Kristoff Reid

South Atlantic Division GME Research Days 2026

No abstract provided.

Red Flags: Intraoperative Transfusion As A Predictor Of Anastomotic Failure, Alejandro De Leon Castro, Aj Schwartz, A Todd-Tharaday, A Collier, Ch Meyer, C Dente, Rn Smith, Jd Sciaretta, J Nguyen

South Atlantic Division GME Research Days 2026

No abstract provided.

Does The Serum Salicylate Need To Be Checked On Every Patient With An Overdose? Could A Toxic Salicylate Concentration Be Ruled Out With The Absence Of An Elevated Anion Gap?, Ibrahim Al-Saadi, William Lopez Jr, Hedaya Othman, Nicholas Connors

South Atlantic Division GME Research Days 2026

No abstract provided.

When The Caregiver Becomes The Victim: Root Cause Analysis Of A Provider Safety Event And Development Of A Quality Improvement Framework, Sadia Akram, Barbara Gracious, Anjali Pathak, Muniza Shah

South Atlantic Division GME Research Days 2026

No abstract provided.

Comparative Assessment Of Arterial Line And Pulse Contour Derived Hemodynamics Monitoring In A Post-Cardiac Surgery Icu Patient: Pilot Observation, Chiraag Ashokkumar, Justin Gisel

South Atlantic Division GME Research Days 2026

No abstract provided.

Duodenal Switch Vs Roux-En-Y Gastric Bypass: Comparison Of Outcomes And Cost With Medical Management, Rachel E. Burke, Christian M. Simon, Husain Abbas

South Atlantic Division GME Research Days 2026

No abstract provided.