Digital Commons Network^™

Squamous Cell Carcinoma Of The Sigmoid Colon: A Rare Late Presentation Of Metastatic Urothelial Cancer With Squamous Differentiation Of The Bladder, Hamzah Shariff, Md, Ghazal Ghafari, Do, Mph, Zachary Hoffer, Md, Phd, Danyall Saeed, Anila Mahesh, Md, Kishore Kumar, Md

The Medicine Forum

Urothelial cell carcinoma (UCC) with squamous differentiation (SqD) is a subtype of bladder cancer with high metastatic potential. Metastasis of muscle-invasive UCC to the GI tract, with complete transition to squamous cell carcinoma (SCC), is rare, particularly in females. We present a female patient with high grade UCC with SqD treated with radical cystectomy and immunotherapy who presented with hematochezia 1 year after her cancer treatment. Imaging and colonoscopy revealed an annular, obstructing mass in the rectosigmoid region prompting sigmoid colectomy and partial proctectomy. Histopathology revealed invasive SCC. New gastrointestinal (GI) symptoms with prior invasive bladder cancer should prompt evaluation …

Radiation-Induced Biliary Strictures Leading To Recurrent Pyogenic Liver Abscesses: A Case Report, Rhea Ratan, Md, Beatriz Torre, Md, Rishi Pawa, Md

The Medicine Forum

Introduction

Radiation-induced biliary damage, including strictures, stenosis, cholangitis, and posthepatic cholestasis, is a rare complication of radiation therapy reported most frequently in the context of hepatobiliary cancers and other upper abdominal mal ignancies.^1-3 This complication often occurs with a delayed presentation, with a variable latency period ranging from months to as late as decades after treatment.^1-4 Histologic examination demonstrates segmental bile duct wall thickening, cholestasis, fibrosis, and features consistent with radiation injury.^1,5 Most reported cases involve the common bile duct and major hepatic ducts, where endoscopic and percutaneous interventions remain feasible. These are identified during surveillance imaging, …

Occupational Hydrocarbon Exposure Presenting As Acute Hepatocellular Injury With Atypical Mitotic Figures On Liver Histopathology In An Oil Rig Worker: A Case Report, Hamzah Shariff, Md, Maria Averbuch, Do, Leanna Rucker, Md, Madison Force, Md, Dina Halegoua-De Marzio, Md

The Medicine Forum

Occupational exposure to hydrocarbons and aromatic solvents in the petroleum industry has been somewhat associated with hepatotoxicity, though the clinical manifestations and histologic features remain incompletely characterized. We present the case of a 33-year-old oil rig worker with prolonged occupational exposure to benzene and hydrocarbon compounds who presented with acute hepatocellular liver injury and concurrent biliary pathology. The patient presented with right upper quadrant pain, jaundice, and pale stools. Laboratory evaluation demonstrated marked hepatocellular injury with alanine aminotransferase (ALT) elevation to 1183 U/L and total bilirubin of 6 mg/dL. Extensive infectious, metabolic, and autoimmune evaluation was unrevealing. ANA and ASMA …

Gastric Nodules As A Rare Presentation Of Diffuse Large B Cell Lymphoma, Hamzah Shariff, Md, Ghazal Ghafari, Do, Mph, Anila Mahesh, Md, Kishore Kumar, Md

The Medicine Forum

Diffuse large B-cell lymphoma (DLBCL) commonly involves the gastrointestinal tract, though typical endoscopic findings include ulcerations or masses. We report a 79-year-old woman with iron deficiency anemia found to have multiple small gastric nodules on endoscopy. Biopsy demonstrated DLBCL, with imaging confirming disseminated disease and secondary gastric involvement. This presentation is atypical, as nodular morphology is rarely described. Importantly, such findings may mimic other malignancies, particularly neuroendocrine tumors. This case highlights that gastric nodules may be an atypical manifestation of secondary DLBCL and underscores the necessity of adequate tissue biopsy to establish diagnosis and guide management.

Diet And Dysphagia: Balancing Aspiration Risk With Quality Of Life, Margot Noyelle, Md, Kenna Hawes, Md, J. Marco Cipriaso, Md, Megan Cecchine, Md

The Medicine Forum

Nil per os (NPO) diets are often prescribed for patients who have dysphagia to prevent aspiration pneumonia, but recent studies have questioned the efficacy of such strict recommendations. This case report describes the care provided to a 73-year-old woman with chronic dysphagia who described her inability to eat or drink as the “single greatest agony” of a months-long hospitalization. This report highlights the ethical challenges of determining diet orders for patients with dysphagia.

Lost In Stratification: The Underutilization Of Fib-4-Guided Masld Screening In The Primary Care Setting, Sanjna Shelukar, Md, Ananya Venkatesh, Md, Breanne Mcdermott, Bs, Julietta Gervase, Ba, Maria Winte, Md, Rebecca Loh, Md, Dina Halegoua-De Marzio, Md

The Medicine Forum

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading contributor to chronic liver disease worldwide. Early identification of MASLD and hepatic fibrosis in the primary care setting is essential for timely and effective management. The Fibrosis-4 (FIB-4) index is recommended as a first-line, non-invasive tool to screen at-risk patients for advanced fibrosis. This study aims to determine FIB-4 screening rates in at-risk patients in an urban resident-led primary care clinic.

A retrospective chart review was conducted in a single Internal Medicine resident-led primary care clinic. Patients aged 36 to 65 years were included, and FIB-4 scores were calculated. Patients were …

A Clinical Assessment: Counseling Families On Timing Of Colorectal Cancer Screening, Bertilia Tavarez, Md, Hamzah Shariff, Md, Breanne Mcdermott, Bs, Sanjna Shelukar, Md, Limi Jamma, Md, Sonali Shah, Md, Akash Patel, Do, Christopher Henry, Md, Aaron Martin, Md

The Medicine Forum

Colorectal cancer (CRC) remains the second most common cause of cancer mortality in the United States. Current recommendations advise initiating colonoscopy at age 40, or 10 years earlier than the youngest affected first-degree relative (FDR), in individuals with a family history of CRC or advanced polyps (AP). Despite these guidelines, their translation into routine clinical counseling is not well defined. This study examines how often patients with CRC or AP receive guidance about early screening for FDRs.

A retrospective review was performed using electronic health records from an urban academic center. Patients diagnosed with CRC or AP between January 2019 …

Commentary On The Withdrawal-Af Trial And Its Applicability In Select Patient Populations, David Zhang, Md

The Medicine Forum

Segan et al. report that 90% of patients with atrial fibrillation- mediated cardiomyopathy (AFCM) maintained left ventricular ejection fraction (LVEF) ≥50% af ter withdrawing heart failure therapy following successful rhythm control.¹ While these results challenge the current practice of indefinite guideline-directed medical therapy (GDMT) in patients with improved ejection fraction, two important questions remain before these findings can be applied more broadly: which patients are appropriate candidates for withdrawal, and how should they be monitored?

The trial excluded patients with coronary disease, structural heart disease, and AF duration exceeding one year. This approach reveals a fundamental challenge, distinguishing pure …

Sudden Syncope Due To Intra Hisian Block With Severely Prolonged His–Ventricular Interval Diagnosed On Electrophysiology Study, Sheraz Qamar, Md, Meiqi Luo, Md

The Medicine Forum

Syncope is a common cause of emergency department evaluation in older adults, when sudden loss of consciousness without prodromal symptoms raises concern for cardiac etiology. We present this case of an 80 year old woman with a prior history of vasovagal syncope who presented after a collapse. Initial evaluation, including electrocardiogram, telemetry, echocardiogram, and ambulatory monitoring, was unrevealing. Given the high risk clinical features such as lack of prodromal symptoms and sudden collapse, an inpatient electrophysiology (EP) study was pursued and demonstrated severe intra Hisian conduction disease with split His bundle electrograms and a markedly prolonged His–ventricular interval. A permanent …

A Strain On The Heart: The Hidden Threat Of Ventricular Tachycardia, Sheraz Qamar, Md, Meiqi Luo, Md, Naila Ijaz, Md, Behzad Pavri, Md, Facc, Praveen Mehrotra, Md, Facc

The Medicine Forum

Mitral valve prolapse (MVP) is increasingly recognized to have an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death independent of mitral regurgitation severity. Mitral annular disjunction (MAD) is a key structural abnormality implicated in abnormal myocardial mechanics and myocardial fibrosis. We describe a patient with MVP and MAD who developed recurrent non-sustained ventricular tachycardia in association with markedly abnormal basal lateral wall longitudinal strain and progressive myocardial fibrosis on cardiac magnetic resonance imaging. Surgical mitral valve repair performed for MAD resulted in resolution of annular disjunction, improvement in regional myocardial strain, and elimination of ventricular arrhythmias. This case …

Lvad Patient With Delayed Family Involvement Due To Incarceration, J. Marco Cipriaso, Md, Kathleen Mechler, Md

The Medicine Forum

Left ventricular assist device (LVAD) placement requires an extensive support system for success. Patients who are incarcerated face unique challenges in achieving this due to prison rules. We describe a case in which an LVAD patient suffered a massive intracranial hemorrhage, leaving him unable to make his own decisions. Medical teams did not involve his family in admissions for his slow chronic decline, but family were asked to make decisions for him at this acute change causing them significant distress. We advocate that families of incarcerated patients be more routinely involved in provider communications and education related to their chronic …

Isolated Left Ventricle Apical Non-Compaction- A Diagnostic Conundrum, Trisha Sindhu, Md, Ranjita Sengupta, Md

The Medicine Forum

Left ventricular non-compaction (LVNC) cardiomyopathy is a rare myocardial disorder characterized by abnormal morphogenesis of the left ventricle (LV). It is typically associated with additional cardiac abnormalities and is most often diagnosed in childhood.¹ We present a unique case of isolated LVNC in a 42-year-old, physically active African American police officer. This case highlights an uncommon presentation of LVNC and underscores the variable specificity of current diagnostic criteria across diverse patient populations.³

A Dose Of Trouble: A Case Of Furosemide Exacerbating Amiodarone-Induced Hypothyroidism, Muneeba Ali, Md, Enad Haddad, Md, Warda Naqvi, Md, Ayesha Afzal, Md, Eddy Mizrahi, Md

The Medicine Forum

Heart failure with reduced ejection fraction is a clinical condition that often requires the concurrent use of multiple medications. Unfortunately, cross reactivity between multiple drugs occurs frequently. Today, we present the case of a 79-year-old male with heart failure and atrial fibrillation on long term amiodarone therapy. His furosemide dose was increased from 40 milligrams (mg) to 80 mg after he developed bilateral lower extremity swelling. The patient eventually developed generalized joint pains, weakness, difficulty maintaining balance, and frequent falls. He reported to the Emergency Department (ED), where he was noted to be suffering from severe acute kidney injury (AKI), …

Ascending Aortic Thrombus With Systemic Embolization: Implications For Risk Stratification And Management, Warda Naqvi, Md, Moses Morgan, Md, Muneeba Ali, Md, Enad Haddad, Md, Zaineb Alhassani, Md

The Medicine Forum

Ascending aortic thrombus is an uncommon clinical finding, particularly in the absence of significant underlying aortic disease, yet it poses a substantial risk for systemic embolization. We describe a 53-year-old woman with a history of cocaine use who presented with acute neurologic deficits and was found to have a left middle cerebral artery occlusion requiring mechanical thrombectomy. Cross-sectional imaging incidentally identified a 1.8 cm thrombus within the ascending aorta. Anticoagulation with intravenous heparin was initiated, however, her clinical course was complicated by recurrent embolic phenomena, including renal infarction and bowel perforation consistent with mesenteric ischemia. Ongoing deterioration with multiorgan failure …

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

We are honored to present this latest edition of The Medicine Forum. This platform is in its twenty-seventh year serving as an outlet for our medical community’s scholarly and creative efforts. This year, it has been my pleasure to work with Nehar, Jasmine, Hamzah, and Allison on this project. It has been impressive to see them balance their efforts on this scholarly work with their efforts on the wards.

As a Department, we are a productive group of writers, thinkers, scientists, and artists, who send out our work for publication in the larger medical community. What makes The Medicine …

From The Chief Residents, Brian Schonewald, Md, Beatriz Torre, Md, Chukwuemezie Mamanu, Md, Julia Palecki, Md

The Medicine Forum

As the current Chief Residents, we beam with pride at the 27th edition of The Medicine Forum – a culmination of the passion, hard work, and talent of the residents of the Thomas Jefferson Internal Medicine Residency Program. We believe that The Medicine Forum stands as a testament to the fact that our residents are not only outstanding clinicians and medical educators, but also excel across all facets of medicine, including research, quality improvement, and the humanities.

We applaud our talented and driven Chief Editors, Nehar Damle, Hamzah Shariff, Allison Kayne, and Jasmine Lee, who worked diligently to ensure the …

From The Editors, Nehar Damle, Md, Pharmd, Hamzah Shariff, Md, Allison Kayne, Md, Jasmine Lee, Md

The Medicine Forum

As physicians in training, much of our work is shaped by immediacy – responding to evolving clinical situations, navigating diagnostic uncertainty, and making decisions with present information. In this environment, it can be easy to prioritize action over reflection. Yet it is through reflection, inquiry, and shared scholarship that we deepen our understanding of medicine and the patients we serve.

It is within this spirit that we present Volume 27 of The Medicine Forum. This publication represents not only scholarly achievement, but also the intellectual curiosity and dedication that define our community.

This year, we were particularly struck by …

From The Desk Of The Residency Program Director, Christopher Henry, Md. Facp

The Medicine Forum

I am excited to once again share this year’s The Medicine Forum. It continues to open a window into the tireless commitment our residents bring to the bedside and to the field of medicine at large. As is uniquely our brand at Jefferson, the residents accomplish this with as much rigorous intellect as with their abundant enthusiasm and personality.

In an era where artificial intelligence has become an ever-burgeoning tool in the clinical landscape, the ingenuity displayed by our residents both in their artistic talents and their scholarly pursuits serves as a vital reminder. It reminds me that the …

Table Of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum: Volume 27

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 27, 2025-2026

TABLE OF CONTENTS

• Case Reports
• Letter to the Editor
• Research Studies
• Humanities & Reflections

First Photographic Record Of A Pale-Colored Wild Boar (Sus Scrofa) Consistent With Leucism In The Zagros Mountains, Iraqi Kurdistan, Bahez F. Ali, Hana A. Raza, Nabaz Horeni

AUIQ Complementary Biological System

Pigmentation anomalies in wild mammals are rare and poorly documented in wild boar (Sus scrofa) populations. Leucism, characterized by partial loss of melanin while retaining normal eye pigmentation, represents one of the least frequently reported coloration anomalies in the species. During a camera-trap survey in Bamo Mountain, Zagros Mountains of Iraqi Kurdistan, an unusually pale-colored wild boar consistent with leucism was recorded. The individual exhibited cream to light-blond pelage with retained darker pigmentation on the snout and distal limbs, while the eyes remained normally pigmented. Its morphology and behavior were otherwise consistent with those of a typical wild …

Discordance Between Self-Report And Performance-Based Measures Among At-Risk Older Adults: A Secondary Data Analysis, Chiung-Ju Liu, Wen-Pin Chang, Inga Wang

Occupational Therapy Faculty Publications

Importance: Subtle, age-related declines in occupational performance among at-risk older adults may go undetected when assessed solely with self-report measures, potentially leading to missed intervention opportunities. Understanding discrepancies between self-reported and performance-based occupational performance outcomes can inform assessment selection and interpretation.

Objective: To examine the discrepancies between the two types of measure among community-dwelling older adults at risk for losing independence.

Design: Cross-sectional study using secondary data analysis.

Participants: Seventy-one community-dwelling older adults (M age = 74 yr, SD = 9) who showed muscle weakness and reported difficulty with activities of daily living.

Outcomes and measures: Canadian Occupational Performance Measure …

Neonatal And Maternal Outcomes In Pregnancies With Sonographically Diagnosed Nuchal Cord: A Prospective Cohort Study, Eman Muhammad Ramadan, Samar Sarsam

Iraqi Postgraduate Medical Journal

ABSTRACT:Background: Nuchal cords, where the umbilical cord encircles the fetal neck, are a common obstetric finding, potentially impacting neonatal and maternal outcomes. Their clinical significance remains debated.Aim of the Study: To evaluate the prevalence of nuchal cords in pregnancies at Al Elwiya maternity teaching hospital and to evaluate the association between nuchal cord presence and effects on neonatal and maternal outcomes.Patients and Methods: A prospective, single-center, cohort study was conducted at Al-Elwiya Maternity Teaching Hospital from first of January to first of December 2024. It included 600 pregnant women in the study 107 had an ultrasound diagnosed with nuchal cords. …

Use Of The Bethesda System For Reporting Thyroid Cytopathology In Thyroid Nodules Incoordination To The Appropriate Surgical Intervention, Rusul Abid Kareem, Basim Rassam Ghadhban

Iraqi Postgraduate Medical Journal

Background: The thyroid nodule refers to an abnormal growth of thyroid cells. Although the vast majority of thyroid nodules are benign, a small proportion of thyroid nodules are malignant. In order to diagnose and treat malignant thyroid nodules at the earliest stage, most of them need radiological and cytological evaluation. Fine-needle aspiration (FNA) using The Bethesda System for reporting thyroid cytopathology.Aim of study: To evaluate the significance of the Bethesda classification in detecting malignant thyroid nodule and relate the appropriate surgical intervention accordingly.Methods: prospective, case control study was conducted in Baghdad teaching hospital, 2nd floor. from 1st of December 2021 …

Esophageal Stricture Post Congenital Tracheoesophageal Fistula Repair, Zaid A. Zaid, Momtaz Al-Nima

Iraqi Postgraduate Medical Journal

Background: It’s a narrowing of > 50% of the esophagus lumen or as a narrowing detected on a contrast study , or at esophagostomy in combination with symptomsTracheoesophageal fistula (TEF) is a relatively rare congenital anomaly occurring in one in 2500-3000 live births (3)Moreover, the life expectancy of the patients without proper treatment may be measured in weeksAim of study: evaluation of the demographics, surgical details, and postoperative outcomes of pediatric patients undergoing surgery for Tracheoesophageal Fistula (TEF) repair.Methods: The study was conducted at Pediatric Teaching Hospital/Medical City from December, 2022, to November , 2023. A total of 35 cases post …

Understanding How Fire Impacts Soil Carbon And Nutrient Cycling: Toward Standardized Reporting Of Fire Metrics For The Integrated Plant-Soil System, Julia B. Gaudinski, Kate Wilkin, Jasquelin Peña, Mary E. Miller, Margaret S. Torn

Michigan Tech Publications

Fire events impact soil carbon (C) and nutrient stocks immediately due to combustion of biomass and organic matter and set up additional post-fire changes to ecosystem inputs and losses. The literature on this topic is expanding rapidly as large and intense wildfires are increasingly affecting communities globally. However, many of these studies do not describe initial post-fire soil conditions adequately or consistently, nor do they link the impacts of fire on C and nutrient cycling to key soil properties and soil inputs, stocks and fluxes. Here we conduct a systematic analysis of 56 review- papers published in 2010 or later …

Reviewing The Perioperative Process For Gastrostomy Tube Care: A Qualitative Study, Douglas J. Fox Iii, Owen N. Ferriola, Allen J. Huang, Nicholas A. Long, Joan C. Bruce, Erin M. Morris, Jeannette M. Joly, Carleen V. Cuevas, Terry Fisher, Kuojen Tsao

Summer Research Program Abstracts

No abstract provided.

Community-Based Tuberculosis Screening With Computer-Aided Detection Technology Alone And In Combination With Point-Of-Care C-Reactive Protein Testing: A Paired Screen-Positive Trial, Klaus Reither, Fiona Vanobberghen, Anna Verjans, Harsh Harkare, Bart Jacobs, Alastair Heerden, Shriya Misra, Fabrizio Tedios, Curdin Brugger, Alfred Keter

Population Health, East Africa

Background Active tuberculosis case-finding in communities is crucial for early disease detection and disruption of transmission; however, it is complex and costly. A thorough analysis of tuberculosis screening strategies is essential, particularly because the health systems affected often have limited resources. We aimed to compare two community screening approaches in terms of tuberculosis case yield and cost.

Methods This pragmatic community trial, with a paired screen-positive design (ie, within-person comparison), was conducted in the Butha-Buthe District in Lesotho and the uMgungundlovu District in South Africa. All household members aged at least 18 years were eligible to participate, except those who …

Sharksrx Newsletter Summer 2026, Nova Southeastern University

NSU Sharks Rx

No abstract provided.

Effects Of Targeted Interventions On Hiv Testing, Knowledge And Sexual Risk Behaviours Among Long-Distance Truck Drivers: A Systematic Review And Meta-Analysis, Cyrus Mutie, Berrick Otieno, Kawira Kithuci, John Gachohi, Grace Mbuthia

School of Nursing & Midwifery, East Africa

Objectives We aimed to systematically summarise and quantify the empirical evidence on targeted interventions and their effects on various HIV prevention outcomes for long-distance truck drivers (LDTDs) globally.

Design A systematic review and meta-analysis.

Data sources We searched PubMed, PubMed Central (PMC), Cumulated Index to Nursing and Allied Health Literature (CINAHL), ProQuest Central, EBSCOhost, ScienceDirect, World Health Organisation (Global Index Medicus), Cochrane Library, Scientific Electronic Library Online (SCiELO), Japan Science and Technology Information Aggregator, Electronic (J-STAGE) and China National Knowledge Infrastructure (CNKI) up to 15th May 2026.

Eligibility criteria We included original peer-reviewed interventional studies involving LDTDs of either gender …