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Myxedema Coma With Cardiogenic Shock: Diagnostic Challenges And Risks Of Amiodarone In Acute Thyroid Failure, Jean Carlos Ramos Cardona, Gunjan Mundhra, Munachiso Egbo, Veniamin Melnychuk, Suzanne Quinn Martinez

HCA Healthcare Journal of Medicine

Background

Myxedema coma is a rare but life-threatening manifestation of severe hypothyroidism characterized by altered mental status, hypothermia, bradycardia, and multiorgan dysfunction. Delayed diagnosis is common, particularly in elderly patients with multiple comorbidities. Cardiac complications, including malignant arrhythmias, are underrecognized contributors to morbidity and mortality. Profound hypothyroidism compromises cardiac myocyte function through reduced activity of enzymes involved in calcium uptake, leading to impaired myocardial contraction and relaxation. This results in decreased heart rate, reduced cardiac output, and altered left ventricular function, which may be further exacerbated in patients with heart failure with reduced ejection fraction. Prolongation of the ventricular action …

Neuromotor Compromise As A Presenting Symptom In Advanced Lower Extremity Soft Tissue Sarcoma: A Case Series, Adam Maestas, Parsa Charkhchi, Farbod Malek

HCA Healthcare Journal of Medicine

Background

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, representing less than 1% of adult cancers. Approximately half arise in the extremities, most often presenting as a painless, enlarging mass. Symptoms are often misattributed to benign neuropathic or musculoskeletal causes, leading to delayed diagnosis and treatment. Neurological deficits such as foot drop or distal weakness are exceptionally uncommon presenting signs and generally indicate advanced local invasion or compression of major peripheral nerves. Recognizing acute neuromotor compromise as a potential manifestation of soft tissue malignancy is crucial for timely oncologic evaluation and limb-sparing management.

Case Presentation

This series …

Avoiding Unnecessary Surgery In Acute Longus Colli Calcific Tendinitis: A Clinical Image Of A Retropharyngeal Abscess Mimicker, Brandon M. Nielsen, Oluyemi O. Omotoso

HCA Healthcare Journal of Medicine

Acute calcific tendinitis of the longus colli (LCT) is a rare, benign condition that frequently mimics retropharyngeal abscesses (RPA), a true surgical emergency. We present a 34-year-old woman presenting with 4 days of severe posterior neck pain, stiffness, and odynophagia. Initial evaluation revealed significantly elevated inflammatory markers (erythrocyte sedimentation rate [ESR] 113 mm/hr, C-reactive protein [CRP] 128 mg/L) and leukocytosis, raising immediate concern for deep neck infection. Contrast-enhanced computed tomography (CT) demonstrated a retropharyngeal fluid collection; however, the absence of peripheral ring enhancement and the presence of a pathognomonic calcification anterior to the C1 arch pointed toward LCT. This distinction …

Gallbladder Ascariasis Presenting As Acalculous Biliary Colic, Carmen A. Urbina, Luigi G. Cubeddu, Luigi X. Cubeddu

HCA Healthcare Journal of Medicine

We detail a case of gallbladder ascariasis, presenting as an acute episode of acalculous biliary colic, nausea, bloating, an unremarkable abdominal ultrasound, and negative helminth and protozoa stool smears. A follow-up ultrasound provided unexpected images consistent with gallbladder infection by Ascaris lumbricoides. Repeat ultrasonography performed 10 days after anthelmintic therapy showed no live worms and 2 newly appearing echogenic areas suggestive of gallbladder calculi that were confirmed following elective cholecystectomy. The case course highlights key clinical, diagnostic, and management considerations in gallbladder ascariasis and underscores the value of repeated ultrasonographic evaluation in affected patients.

Blaschko-Linear Lupus Erythematosus In A Pediatric Patient, Marshall Hall, Olivia Mayer, Henry Lim, Dustin V. Wilkes, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

The lines of Blaschko represent epithelial cell migration during embryonic development. Rare forms of cutaneous lupus erythematosus may manifest along these lines, and lesions are termed Blaschko-linear lupus erythematosus (BLE). The purpose of this case study is to present a rare manifestation of linear cutaneous lupus erythematosus following the lines of Blaschko in a pediatric patient. To date, there are very few reports of BLE. We present a 17-year-old female with a 2-month history of a mildly tender growing lesion along the right nasofacial sulcus. The patient denied lesions elsewhere and any systemic, joint, or mucosal symptoms. A biopsy of …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Hidradenitis Suppurativa, Jamie Y. Choe, Henry Lim, Marshall Hall, Christian Scheufele, Dustin V. Wilkes, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent deep-seated nodules and painful abscesses with scars, fistulae, and sinus tracts that predominately affect the intertriginous sites. Onset typically occurs soon after puberty. Depending on disease severity, HS can lead to varying levels of pain, disability, and disfiguration with significant impacts on quality of life. Hidradenitis suppurativa is diagnosed clinically, and no diagnostic tests are specific to the disease. Therefore, clinicians must have the knowledge and competence to identify the clinical features of HS accurately. The purpose of this report is to provide descriptions of characteristic clinical presentations …

Sebaceous Gland Heterotopia Of The Esophagus: A Rare Incidental Finding During Upper Endoscopy, Samuel Ramos, Margaret-Anne Huntley, Eric Vargas, Jignesh Parikh, Vania Zayat

HCA Healthcare Journal of Medicine

Esophageal heterotopic sebaceous glands (EHSG) are an extremely rare finding within the esophageal epithelium. These glands are typically benign, presenting as small, yellow-white plaques or lesions observed on endoscopy, often in the middle third of the esophagus. Esophageal heterotopic sebaceous glands are generally asymptomatic, and surveillance is not required. While their origin is unclear, proposed mechanisms include metaplastic transformation and congenital development. Recognition and histologic confirmation are essential to distinguish EHSG from other esophageal lesions and to avoid unnecessary interventions. We report the case of a 55-year-old man in whom multiple diminutive plaques were identified in the mid-esophagus during esophagogastroduodenoscopy …

Comparing The Expression Of Estrogen Receptors, Progesterone Receptors, And Human Epidermal Growth Factor Receptor 2 Between Initial Biopsy And Excision Specimens In Invasive Breast Carcinoma Cases. Is There A Need For Universal Repeat Testing? Experience From A Community Hospital, Astrid M. Sacasa, Gul Emek Wymer, Susana Ferra

HCA Healthcare Journal of Medicine

Background

The current national recommendation is that breast biomarkers estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) testing should be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors. Repeat testing on a subsequent excision specimen is not indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need for adopting universal reflex re-testing of breast biomarkers in excision specimens in our institution.

Methods

The study population included 70 sequential invasive breast cancer patients where the results of ER, PR, and …

Opioid Free Anesthesia In Arthroscopic Knee Surgery: A Feasible Approach To Patient Care, Carson Gifford, Denise Vidal, Dail Kim, Austin Goff, Paul Reynolds

HCA Healthcare Journal of Medicine

Background

The opioid epidemic has prompted exploration of opioid-free anesthesia (OFA) techniques, but the optimal approach is still debated. While some OFA protocols substitute opioids with other agents, these alternatives can introduce their own risks. The objective of this study was to investigate whether eliminating intraoperative opioids without analgesic substitution in arthroscopic knee procedures affects postoperative pain control and opioid requirements.

Methods

We conducted a retrospective analysis of 205 patients who underwent arthroscopic knee procedures between August and November 2023. Patients were divided into 2 groups: those who received intraoperative fentanyl (25-200 mcg, n = 144) and those who received …

Psychological Adaptation In Colorectal Cancer Survivors: Pilot Study Findings, Anuja L. Sarode, Emily M. Su, Amber Kerstetter-Fogle, Steve Paciorek, Erica L. Laipply

HCA Healthcare Journal of Medicine

Background

In this pilot study, we examined psychological impacts of colorectal cancer (CRC), focusing on cancer-related posttraumatic stress disorder (CR-PTSD) symptoms, posttraumatic growth (PTG), and their relationship with coping strategies in surgically treated CRC patients.

Methods

This prospective pre- and postoperative pilot study assessed CRC patients at 2 time points, pre- and postoperative. Psychological symptoms were evaluated using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the PTG Inventory Short Form (PTGI-SF). Coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (COPE) instrument. Changes in CR-PTSD, PTG, and coping …

Coping Beyond Cancer: Exploring Fear Of Recurrence In Colorectal Cancer Survivors—A Pilot Investigation, Emily M. Su, Steve Paciorek, Erica L. Laipply, Anuja L. Sarode

HCA Healthcare Journal of Medicine

Background

Evidence is limited on the fear of cancer recurrence (FCR) among colorectal cancer (CRC) survivors in the US, especially regarding patterns and trends of post-recovery coping mechanisms. This pilot mixed-methods study quantified FCR, examined its associations with Brief COPE domains, and contextualized coping through qualitative analysis.

Methods

Twenty-three patients who successfully underwent CRC surgery were included in this pilot study. Fear of cancer recurrence was measured using the FCR Inventory (FCRI) Short Form, and coping strategies were assessed with the Brief Coping Orientation to Problems Experienced (COPE) survey. Descriptive statistics summarized participant characteristics, FCR, and COPE scores. Spearman correlation …

An Acknowledgement To The Hca Healthcare Journal Of Medicine's Reviewers And Editors For The First Half Of 2026, Graig Donini

HCA Healthcare Journal of Medicine

The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members.

Erratum: Presentation Of Cutaneous Large B-Cell Lymphoma, Leg Type

HCA Healthcare Journal of Medicine

This corrects the article “Presentation of Cutaneous Large B-Cell Lymphoma, Leg Type” in volume 6, issue 6 on page 527.

Introduction To Volume 9: Climate And Responsibility, Heather L. Scheuerman, Sylvia J. Whitney Beitzel

International Journal on Responsibility

No abstract provided.

Translating Higher Education Into Vietnamese: An Applied Linguistics Approach To Language Equity And Higher Education Access, Z.W. Taylor, Alan Do, Jase Kugiya, Tuan Le

Journal of Southeast Asian American Education and Advancement

One growing population of non-native English speakers in the U.S. education system are native Vietnamese speakers, yet no studies have examined how higher education communication could be made more accessible for Vietnamese speakers. As a result, this case study reports on human and machine translational linguistics work conducted in partnership with the University of Iowa focused on simplifying and translating English enrollment management information into Vietnamese. Findings suggest that the institution increased the clarity and accessibility of enrollment management information by using second-person pronouns, shorter sentence structures, clearer diction, and explanations of institution-specific jargon. Moreover, analyses of machine and human …

2018 Editor’S Introduction, Lauren M. Bowen

Undercurrents: A Journal of Undergraduate Student Composition

No abstract provided.

Enhancing Ecg Classification Using Systematic Cubic Spline Control Points With Deep Neural Networks, Hussein Qahtan Khalaf, Abeer Tariq Maolood, Nor Shahida Mohd Shah

Engineering and Technology Journal

The healthcare industry has undergone substantial growth over the past few years. Despite the development of medical technology, the diagnosis of cardiac arrhythmia is still a significant challenge for modern diagnostic methods for correct and efficient classification of electrocardiogram (ECG) signals, especially in cases of class imbalance and the complexity of the arrhythmia. This study proposes a novel deep learning model where the class imbalance problem is addressed using the Synthetic Minority Oversampling Technique (SMOTE) and the effect of signal resolution on the classification is investigated using Cubic Spline (CS) interpolation and Lightweight Deep Neural Network (CSLWDNN). Both the MIT-BIH …

Solar-Driven Photocatalytic Ceramic Membrane Reactors For Paracetamol Degradation: Process Optimization, Transport Dynamics, And Preliminary Cyclic Reusability, Adel Zrelli, Asma Abdennebi, Manoj Chandra Garg, Fanghua Li

Engineering and Technology Journal

The use of membrane separation and heterogeneous photocatalysis together appears to be an innovative way to remove long-lasting pollutants such as paracetamol (PCT) from water. To overcome the limited process by understanding hindering the practical deployment of solar-driven photocatalytic membrane reactors (PMRs), this study proposes a process-engineering-centered framework for a low-cost, integrated ceramic PMR. A laboratory-scale system was developed using inexpensive red clay ceramic membranes modified by immobilizing TiO₂ (P25) for paracetamol degradation under natural sunlight and ultraviolet irradiation. Unlike previous studies mainly focused on material development, this work evaluates the coupled effects of TiO₂ loading, membrane inclination, …

Neural Network Modelling Of Magnetic Effects In Solid-State Transformer Performance Under Variable Magnetic Operating Conditions, Godfrey Murairidzi Gotora, Blessed Ziyambe, Emanuel Rashayi

Engineering and Technology Journal

Solid State transformers (SSTs) are pivotal for renewable energy integration and smart grids, yet their performance is critically limited by non-linear magnetic effects such as core losses, flux- density saturation, and magnetising-inductance drift, that conventional analytical methods and prior artificial neural network (ANN) studies have struggled to model simultaneously across the electrical, thermal and magnetic domains. This study develops and evaluates a unified multi-output ANN framework that predicts six SST performance indicators which are efficiency, power density, total harmonic distortion, temperature rise, core loss and magnetising inductance from six operating variables (switching frequency, duty cycle, load current, ambient temperature, input …

Experimental Investigation Of Mechanical Performance Of Glass/Epoxy Hybrid Composites Reinforced With Natural Fibers, Bestwn Omer, Gailan Ismail Hasan

Engineering and Technology Journal

The use of epoxy-based composites has increased significantly due to their wide range of applications across various industries. However, these composites often require enhanced mechanical properties tailored to specific applications through the incorporation of different types of reinforcements. In this study, the effect of natural fibers on the mechanical properties (flexural strength, tensile strength, and impact energy) of composites based on two types of epoxy resins (LR202 and Sikadur®-52 LP) was investigated using the hand lay-up method. Different reinforcement fibers (fiberglass, cotton, and jute) were incorporated at various percentages. The results indicate that, among composites reinforced with a single type …

Ameliorative Effect Of Ethanolic Extract Of Nardostachys Jatamansi Against High Fat Diet Induced Dyslipidemia In Rats, Umanath Preethi, Govindaraj Sumathy, Nathiya Shanmugam

Chulalongkorn Medical Journal

ABSTRACT:

Background and objective: The present study aimed to evaluate the antioxidant and hypolipidemic effects of ethanol extract of Nardostachys Jatamansi (N.J) in a high-fat diet-induced obesity model in male Wistar albino rats.Materials and methods:36 male Wistar albino rats were randomly divided into six groups, each comprising six animals: Group I received a normal diet for 9 weeks, while Group II was fed a high-fat diet (HFD) for the same period. Groups III–VI were also given HFD throughout. From week 5, Group III received rosuvastatin (10 mg/kg), and Groups IV–VI were treated with Nardostachys Jatamansi. extract at 100, 200, and …

Assessing The Reliability Of Machine Learning Models In Classifying Depression Severity Using Facebook Text, Keito Yoneyama

Chulalongkorn Medical Journal

Depression is a growing global issue that requires urgent attention, particularly in Thailand. Without timely intervention, it can lead to serious consequences such as health complications, reduced social participation, and even suicide. Consequently, there has been increased research focused on developing algorithms to identify and classify social media data according to depression severity. This study aimed to evaluate the extent to which such algorithms are a suitable tool for the preliminary classification of Thai Facebook text into different levels of depression severity. The methodology involved data collection through surveys and Facebook scraping, followed by data preprocessing, feature engineering, and model …

The Normative Status Of States' Obligations To Mitigate The Climate Crisis: Implications For The Right To Adequate Housing, Erna Dyah Kusumawati, Sasmini Sasmini

Padjadjaran Jurnal Ilmu Hukum (Journal of Law)

The convergence of the global climate crisis, pursuant to the UNFCCC Paris Agreement and its implementing protocols as well as the fundamental right to housing has fundamentally disrupted established legal paradigms, necessitating a rigorous re-examination of the normative status of state obligations. This paper examines the scope of governmental responsibility to mitigate climate-induced threats to housing security. Drawing upon international human rights frameworks and contemporary legal discourse, the study interrogates the complex friction emerging at the intersection of environmental mandates and housing protections. Through a systematic analysis of the existing literature and recent developments in the international climate change framework, …

Territorial Representation In Fiscal Governance: A Comparative Constitutional Analysis Of Indonesia's Regional Representative Council And South Africa's National Council Of Provinces, Endah Yuniningsih, Deden Rafi Syafiq Rabbani

Padjadjaran Jurnal Ilmu Hukum (Journal of Law)

This article examines the institutional role of territorial chambers in fiscal governance through a comparative constitutional analysis of Indonesia's Regional Representative Council (DPD) and South Africa's National Council of Provinces (NCOP). While the DPD was established to strengthen regional representation following Indonesia's decentralization reforms, its legislative role in fiscal policymaking remains institutionally constrained. Existing scholarship has primarily focused on the DPD's constitutional status in debates on bicameralism, with comparatively little attention to how constitutional design shapes the role of territorial chambers in fiscal governance and intergovernmental fiscal relations. Using a normative legal research method that combines statutory, conceptual, and comparative …

Geoengineering And Criminal Liability Comparative Lessons For Penal Reform, Zico Junius Fernando, Deviana Yuanitasari, Chairul Huda, Muhammad Yamani, Arimbi Fajari Furqon

Padjadjaran Jurnal Ilmu Hukum (Journal of Law)

Geoengineering has emerged as a controversial climate technology involving large-scale interventions such as cloud seeding, weather modification, and unregulated carbon capture. While these practices are promoted as solutions to climate change, they also generate significant ecological risks that remain largely unaddressed within criminal law frameworks. This article examines the absence of explicit criminal liability for geoengineering-related harms and explores how comparative legal experiences can inform future penal reform. This research uses normative research methods with several approaches, including comparative, conceptual, and futuristic approaches. The collected legal materials are analysed qualitatively, and content analysis is employed to classify and interpret relevant …

The Expansive Power Of The House Of Representatives As A Precondition For Constitutional Rot, Isnawati Isnawati, Adam Setiawan

Padjadjaran Jurnal Ilmu Hukum (Journal of Law)

This study examines how the expansive powers of the Indonesian House of Representatives have contributed to constitutional rot because those powers no longer operate effectively or proportionately. It identifies dysfunction in the House of Representatives through weak legislative performance, inadequate oversight of the executive branch, and transactional political practices in appointment processes. Using a doctrinal legal method and contemporary constitutional theory as its analytical framework, this study argues that the expansive powers of the House of Representatives constitute a precondition for constitutional rot, evidenced by the poor exercise of legislative authority and institutional intervention through amendments to the Rules of …

Reconstructing Legal Certainty In Legacy Oil Well Management: A Systemic Model For Resource Governance, Azhar Azhar, Bagaskara Sagita Wijaya, Siti Darwinda Mohamed Pero, Cynthia Azhara Putri

Padjadjaran Jurnal Ilmu Hukum (Journal of Law)

Legacy oil wells present persistent legal and institutional challenges in resource-dependent regions, where ageing infrastructure, informal extraction, environmental risk, and fragmented public authority intersect. This article examines how legal certainty is weakened in the management of legacy oil wells and how it may be reconstructed through a systemic model for resource governance. Using interdisciplinary socio-legal research, the study combines doctrinal legal analysis of Indonesia's oil and gas regulatory framework with qualitative field insights from Musi Banyuasin, a subnational setting in which formally recognised legacy wells coexist with community-operated wells. The analysis shows that legal uncertainty does not arise merely from …

Bank Indonesia's Floating Rate Notes (Bi-Frn) And Federal Reserve Instruments: A Comparative Analysis From An Institutional-Legal Perspective, Abdul Madjid Podungge

Padjadjaran Jurnal Ilmu Hukum (Journal of Law)

This paper analyses the legal validity of Bank Indonesia's Floating Rate Notes (BI-FRN) following the Law Number 4 of 2023 on the Development and Strengthening of the Financial Sector (P2SK Law) from a public law viewpoint. Doctrinal legal research utilises statutory, conceptual, and comparative methodologies, augmented by literature network visualisation, to pinpoint structural deficiencies. The network analysis reveals a significant divide between technical financial transactions and administrative legal oversight. The findings indicate that Article 11 of the P2SK Law enforces a stringent priority clause that centres monetary policy solely on Rupiah stability. This legal barrier prohibits abuse of power by …

How U.S. Legal Stagnation Can Be Aided By Decolonization, Marquel Gardner

McNair Summer Research Program

Decolonization is a term often used to present a simple shift from colonial thinking, heavily maintaining the establishment of colonial systems today. However, this usage oversimplifies and overshadows the word’s key purpose. Common proclamations of the term forgo the fundamental indigenous essence behind the word. Doing so, we not only strip the word of its inherent power, but obstruct further possibilities for actual decolonization to appear in our world. Many argue that the U.S. legal system, a product of colonial factors, has reached an alarming state. Our current legal, political atmosphere gears not towards justice or morality, but fascism and …

Tracking Toward Zero: Implementing A Picc Team Tracker To Prevent Clabsis, Christian Justin Carreon

Master's Projects and Capstones

Problem: Central line-associated bloodstream infections (CLABSIs) remain a significant and preventable patient safety concern in acute care settings, contributing to increased morbidity, mortality, prolonged hospitalization, and substantial healthcare costs.

Context: At Hospital A, a tertiary referral center in Northern California, six adult CLABSIs were identified between June and December 2025 following an eight-month CLABSI-free period. Four events occurred in adult medical surgical telemetry. All peripherally inserted central catheter (PICC) line CLABSIs were attributed to gaps in maintenance bundle adherence and the lack of a standardized, real-time tracking mechanism for the PICC Team.

Interventions: A PICC Team Tracker was implemented as …