Digital Commons Network^™

An Exploratory Study Of Social Determinants And Pediatric Lead Exposure In Chemung County, Ny, Jenna Mccracken, Anika Stundtner, Megan Kerbag, Madison Desantis, Jennifer Coseo, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

Background: Lead exposure in children is a persistent public health concern due to its irreversible neurological and developmental effects. Children under 6 years old are particularly vulnerable due to frequent hand-to-mouth activity and increased environmental exposure. Existing literature suggests a relationship between adverse social determinants of health (SDOH), such as low parental education and residence in high-poverty areas, and elevated pediatric blood lead levels (BLLs). This study, subsidized through a community service grant from Excellus Blue Cross Blue Shield, aimed to examine the association between BLLs and SDOH among children screened at the ACCEL Community Health Clinic in Chemung County, …

Hallucinations And Diabetes – Could It Be The Hip? An Interesting Case Of Cobalt Poisoning, Mahrukh Tariq, Zauraiz Anjum

Advances in Clinical Medical Research and Healthcare Delivery

Cobalt (Co) poisoning has been described historically in beer-drinkers when cobalt was used as an additive. In present times, this type of poisoning is usually caused by occupational exposure or metal prosthesis breakdown. We present a case of Co poisoning from metal prosthesis breakdown with exceptionally high levels, and thus, some unique symptoms. Interestingly our patient not only had symptoms commonly associated with Co poisoning, e.g., paresthesia, sensory-neural hearing loss, acute kidney failure, but also developed new onset diabetes, which is not commonly associated with this type of pathology. Moreover, when we had this patient under our care, we had …

Transient T-Wave Inversions In A Pregnant Patient: Normal Variant Or Cause For Concern?, Muhammad Hammad Sharif, Madeeha Khaleeque, Muhammad Hassan Jan, Atif Ahmed, Aniket-Vijay Rao, Aditya Sanjeevi, Bipul Baibhav

Advances in Clinical Medical Research and Healthcare Delivery

Pregnancy can cause physiological changes in various body systems, including the cardiovascular system. This manifests as physiological changes in the electrocardiogram (EKG) in the form of sinus tachycardia, a change in the QRS axis, a short PR interval, the development of Q waves, a prolonged QT interval, T-wave inversions, and ST-segment depression. These changes are typically benign and reflect the body's adaptation to pregnancy. Physiological T-wave inversions can occur during pregnancy because of an increased workload on the heart due to expanding blood volume. It is important to identify these physiological EKG changes to avoid unnecessary invasive cardiac work-up and …

Late Bioprosthetic Valve Migration- A Rare Entity After Tavi, Sahej Arora, Ghazi Khan, Jeremiah Depta

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of hemolytic anemia due to a rare complication of late bioprosthetic valve migration, who underwent successful treatment with valve in valve transcatheter aortic valve implantation. Our patient with symptomatic moderate aortic stenosis underwent the index procedure a year ago and treated for bacteremia 3 months ago, presented with hemolytic anemia and echocardiography revealing aortic paravalvular leak. The hemolysis was attributed to Bioprosthetic valve dysfunction after a negative hematological workup. The patient's aortography revealed ventricular migration of the valve, not seen on a cardiac CT scan performed before. This was followed by a successful valve in valve …

Neuroinflammation And Its Role In Depression– A Review Of Emerging Biomarkers And Therapeutic Targets, Sophia M. Valerino

Advances in Clinical Medical Research and Healthcare Delivery

Major depressive disorder (MDD) is a prevalent and debilitating mental illness that affects millions globally. Traditionally, the pathophysiology of MDD was thought to be due primarily neurotransmitter imbalances. However, emerging research highlights the role of neuroinflammation in MDD pathogenesis. Elevated levels of pro-inflammatory cytokines, microglial activation, and blood-brain barrier dysfunction have been implicated in the etiology of MDD. Additionally, biomarkers such as C-reactive protein and neuroimaging findings further support the neuroinflammatory hypothesis. This growing body of evidence has led to increased interest in novel treatment approaches, including anti-inflammatory medications and lifestyle interventions, as potential therapeutic strategies. While selective serotonin reuptake …

Prompt Thyroid Hormone Replacement Reversing Severe Bradycardia & Syncope, Cassie R. Girardin, George Vega, Rohail Baig

Advances in Clinical Medical Research and Healthcare Delivery

Thyroid disease, particularly hypothyroidism, can significantly affect the cardiovascular system, leading to structural, functional, and conduction abnormalities. Hypothyroidism decreases inotropy and chronotropy and may cause bradycardia or conduction defects. Although these changes are typically reversible with thyroid hormone replacement, severe cases may necessitate pacemaker placement. This case describes an 82-year-old female with hypothyroidism, atrial fibrillation, and left bundle branch block (LBBB) who presented with recurrent syncope due to hypothyroidism-induced bradycardia with sinus pauses. Her symptoms resolved with thyroid hormone optimization, highlighting the importance of prompt recognition and treatment of hypothyroidism-related cardiac manifestations to prevent unnecessary pacemaker implantation.

Diagnostically Complex Case Of Trivalvular Infectious Endocarditis Complicated By Hiv, Hcv, Pulmonary Septic Emboli, And Epidural Abscess, Madison Baker, Natasha Singh, Rohail A. Baig, Justin Nistico

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Infective endocarditis (IE) can be visualized on echocardiograms. However, there is a significant discrepancy between transthoracic and transesophageal echocardiograms. This imaging modality is also impacted by operator dependent factors. The risk of right sided endocarditis is elevated in people who inject drugs (PWID). In individuals with human immunodeficiency virus (HIV), there is an increased risk of IE, and there is also a relationship that has yet to be fully established between hepatitis C virus (HCV) and IE.

This report describes a woman with a history of IVDU who was diagnosed with HIV/AIDS, HCV, and sepsis secondary to methicillin-resistant Staphylococcus …

A Rare Case Of Gastrointestinal Stromal Tumor Outside The Gastrointestinal Tract, Ashton I. D'Souza, Jasdeep S. Bajwa, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Extra-gastrointestinal stromal tumors are rare mesenchymal tumors occurring outside the gastrointestinal tract, comprising ~5% of all gastrointestinal stromal tumors. A 65-year-old man undergoing evaluation for nephrolithiasis was incidentally found to have a 7.2 cm mesenteric mass proven to be gastrointestinal stromal tumors on biopsy. After limited response to imatinib, the patient underwent successful surgical resection. Mesenteric gastrointestinal stromal tumors often present larger and more aggressive, but in this instance, early incidental detection permitted effective intervention. This case highlights the diagnostic challenges posed by extra-gastrointestinal stromal tumors due to their atypical location and nonspecific symptoms. Extra-gastrointestinal stromal tumors should be considered …

Successful Rituximab Therapy In Igg4-Related Sclerosing Mesenteritis, Sanjana L. Thimmannagari, Shiamak Cooper, Annie H. Yang, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly common autoimmune, multiorgan fibro-inflammatory disorder. Its involvement of organs like the pancreas, lacrimal glands, salivary glands and kidneys is well known but IgG4RD presenting as sclerosing mesenteritis is a rare entity. On imaging, it presents as a mesenteric mass and biopsy is the gold standard for confirmation as elevated serum IgG4 levels are unreliable to establish the diagnosis. Here we report a previously healthy 33-year-old African American female who presented with one week history of generalized abdominal pain. Imaging studies revealed a mass within the mesentery and post-operative biopsy of the mass confirmed …

A Rare Case Of Lithium Toxicity Inducing Complete Heart Block And Nephrogenic Diabetes Insipidus, Rohail A. Baig, Gurtej Dhaliwal, Nimra Shafi, Omar Siddiqui, Michelle L. Malnoske

Advances in Clinical Medical Research and Healthcare Delivery

Lithium is a commonly utilized mood stabilizer for the treatment of bipolar disorder. Although it is efficacious, elevated levels may lead to neurologic, cardiac, nephrogenic, and gastrointestinal side effects. Management of severe lithium toxicity has been an evolving topic of debate in terms of its clinical management. We report a case of a 23-year-old female who presented to the emergency department with severe lithium toxicity, who needed intensive intervention and a critical level of care. This case provides an example of how utilizing standardized care algorithms may provide great benefit to clinicians managing lithium toxicity in emergencies and critical care …

A Minimally Invasive Palliative Approach Using Radiofrequency Ablation And Cementoplasty In A Painful Metastatic Acetabular Lesion, Liliya S. Agarkov, Korinne Diss, Garrett C. Schneider

Advances in Clinical Medical Research and Healthcare Delivery

Up to 75% of patients with advanced metastatic disease experience excruciating pain that affects their daily life. We elaborate on a case of a 63-year-old male with Stage IV squamous cell lung carcinoma with advanced osseous metastatic lesions who presented with symptoms of ambulatory dysfunction due to a lesion in the right acetabulum. This case report demonstrates how radiofrequency ablation can offer pain relief through meticulous ablation of a metastatic lesion without the necessity and negative side effects of external beam radiation.

Gabapentin Induced Seizures: A Rare Presentation Of Toxicity, Muhammad Umer Mukhtar, Akaansha Varma, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Gabapentin is a medication used for the management of neuropathic pain, focal seizures, and several other medical conditions. We report a case of a young male who experienced generalized tonic clonic seizures following the intentional ingestion of 31 grams of gabapentin. This case describes an unusual manifestation of gabapentin toxicity, namely seizures, and highlights the overdose of gabapentin for recreational purposes. Furthermore, this report emphasizes the rising misuse of gabapentin and underscores the importance of providers remaining vigilant in recognizing potential substance use disorders.

Idiosyncratic Drug Induced Liver Injury Secondary To Ciprofloxacin: A Reminder To Always Check Medication History, Xavier Zonna, Conor Banta, Erika Anson Md

Advances in Clinical Medical Research and Healthcare Delivery

A 38-year-old Caucasian male with no significant past medical history presented to the emergency department with complaints of nausea, vomiting, abdominal pain, and jaundice of 2 days duration. He noticed this in addition to pruritus, fever, and malaise. He had severe transaminitis and hyperbilirubinemia on laboratory evaluation. He was admitted for acute liver injury of an unknown etiology. He had taken a course of ciprofloxacin days prior to presentation for UTI at an outlying facility. Serologies were also concerning possible autoimmune liver disease with elevated Anti-Nuclear Antibody and equivocal Anti Smooth Muscle Antibody. Liver biopsy was negative for any autoimmune …

Rare Presentation Of Omental Tuberculosis With Drug-Induced Jaundice In A Teenage Female: A Case Report, Archana Venkatesan, Krishna Ravi

Advances in Clinical Medical Research and Healthcare Delivery

Omental tuberculosis (TB) is a rare form of abdominal TB, often presenting with nonspecific symptoms that mimic malignancies. We report a case of a 16-year-old female from India who presented with abdominal distension, vomiting, weight loss, and amenorrhea. Imaging revealed an abdominal mass, and a diagnosis of omental TB was confirmed via histopathology. This case highlights the diagnostic challenge posed by such atypical presentations, especially in TB-endemic regions. The patient also developed rifampicin-induced jaundice, which resolved upon drug cessation and supportive care. Anti-TB therapy was cautiously reintroduced at a modified dose. This report underscores the need for high clinical suspicion, …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

Bilateral Nephrectomy For Refractory Hypertension In A Patient With Esrd On Intermittent Hemodialysis, Kavya Balusu, Vijay Sheldon, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

In nearly 20 percent of patients with end-stage renal disease (ESRD), hypertension remains poorly controlled despite pharmacological therapy and volume reduction through dialysis. Further, morbidity from hospitalization for hypertensive crisis is significantly higher in patients with ESRD than in patients without ESRD. For those who fail conventional therapies for hypertension, therapeutic bilateral nephrectomy can be considered as a last resort option. With appropriate candidate selection, patients are expected to have improved quality of life. We describe the case of a 37-year-old African American male with ESRD on intermitted hemodialysis who underwent bilateral nephrectomy for the management of hypertension refractory to …

Bilateral Congenital Radioulnar Synostosis - Case Report, Derek A. Diangelis, Matthew J. Hudson

Advances in Clinical Medical Research and Healthcare Delivery

A 2-year-old male presented to an orthopedic outpatient office due to a supination defect in both of his upper limbs. X-rays of the affected limbs revealed fusion of the proximal radioulnar joints indicating congenital radioulnar synostosis (CRUS). CRUS is abnormal development of the upper limbs occurring during weeks 3—7 of embryological development. Causes of CRUS include genetic syndromes and spontaneous mutations. Treatment options include nonoperative and surgical treatments, however, treatment is controversial due to a lack of clinical evidence. Proposed screening methods could help improve detection rates and improve clinical management. This report aims to increase awareness of CRUS and …

Pembrolizumab-Induced Primary Adrenal Insufficiency: A Rare But Life-Threatening Endocrine Irae, Syeda Sarah Raza, Mehr A. Orakzai, Abdullah A. Orakzai

Advances in Clinical Medical Research and Healthcare Delivery

Pembrolizumab, a PD-1 checkpoint inhibitor, is widely used in the treatment of various malignancies. While it improves overall survival, it can lead to immune-related adverse events (irAEs), including rare endocrine disorders such as primary adrenal insufficiency (PAI). We present a case of PAI induced by Pembrolizumab in a 75-year-old man, emphasizing the importance of early recognition and timely management.

‘Is The Patient Clear For Surgery?’ Takotsubo Cardiomyopathy Presenting As T-Wave Inversions In A Pre-Operative Ekg: A Case Report, Muhammad Hammad Sharif, Madeeha Khaleeque, Syed Faiz Abbas, Gaurav Sharma, Aditya Sanjeevi, Muhammad Hassan Jan, Atif Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Takotsubo cardiomyopathy (TC) can cause dynamic changes in the electrocardiogram (EKG) and troponin elevation which can be misinterpreted as an acute coronary event that can cause an unnecessary delay in the surgery and affect the outcomes of a non-cardiac surgery. We present a case of a patient with pre-operative T-wave inversions diagnosed with TC. A 90-year-old female presented with a femur fracture. Pre-operative EKG showed symmetric T-wave inversions in the inferior and pre-cordial leads. Delta troponin was unremarkable and she remained chest pain-free. Transthoracic echocardiogram (TTE) showed an ejection fraction of 60% with apical ballooning and basal hyperkinesis concerning for …

Incidence And Predictors Of Encephalopathy In Patients Admitted With Lower Urinary Tract Infections: A Nationwide Analysis, Purva Shah, Shiamak Cooper, Ali Jaan, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Background. There are no large-scale study assessing the incidence and predictors of encephalopathy in patients with UTI. Also, there is a lack of data on encephalopathy outcomes in patients hospitalized with UTI. We aim to evaluate the incidence, predictors, and impact of encephalopathy on the outcomes of LUTI hospitalizations

Methods. Retrospective cohort study using data from the National Inpatient Sample (NIS) database (2017–2020). We included adult patients (aged ≥18 years) admitted with a principal diagnosis of lower urinary tract infection (LUTI), utilizing the International Classification of Diseases, Tenth Revision, and Clinical Modifications (ICD-10- CM) codes. Multivariate logistic and linear regression …

Nstemi Or Pericarditis: Which Came First?, Trisha K. Mehta, Steven Clark, Garrett Barb, Magdelynn Mege, Umber Waseem

Advances in Clinical Medical Research and Healthcare Delivery

Myocardial infarction (MI) is a common cardiac event often occurring in patients with a history of cardiovascular disease. MI is classified by the presence of ST segment elevation (STEMI) or non-ST segment elevation (NSTEMI). Pericarditis is inflammation of the pericardium usually caused by a bacterial or viral infection. The patient under discussion is an 86-year-old male with a previous history of coronary artery disease (CAD), hypertension (HTN), hyperlipidemia, and percutaneous coronary intervention (PCI). He presented with a three-week history of exertional chest pain that abated with rest and worsened while supine. EKG and laboratory findings supported a diagnosis of NSTEMI, …

A Case Of Fatal Herpes Zoster Ophthalmicus And Encephalitis In An Immunocompetent Host With A Review Of Literature, Kellyn E. Wilkes, Rutwik Pradeep Sharma, Laurie Proia

Advances in Clinical Medical Research and Healthcare Delivery

Herpes zoster is a common disease that can have several complications. Here, we present a case of herpes zoster ophthalmicus with coexisting encephalitis that unfortunately resulted in patient mortality. A 70-year-old male with a past medical history of Parkinson’s disease and schizophrenia presented to the emergency department after being found altered at home. Physical exam was notable for left-sided crusted facial rash, left conjunctival injection, and purulent drainage coming from the right eye. Given the location and appearance of his rash, he was diagnosed with herpes zoster ophthalmicus. There was suspicion for encephalitis given his altered mental status but unfortunately, …

Ensuring Successful H. Pylori Test Of Cure: A Quality Improvement Initiative Focused On Post-Treatment Testing, Prajjwol D. Bhatta, Smriti Bhetuwal, Asim Pandey, Ahmed Shehadah, John Shrestha, Venkat Arutla, Chengu Niu, Himal Kharel, Abdullah Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Background

Eradication of Helicobacter. Pylori (HP) infection is crucial for preventing serious sequelae, such as peptic ulcer disease and gastric malignancies. The ACG guideline recommends mandatory re-testing to ensure HP eradication. However, studies have shown that only less than 25% of patients undergo eradication testing.

Objectives:

The main objective of this study is to evaluate the effectiveness of a simple educational intervention on test of cure compliance rate. Our target population includes patients with confirmed HP infection who were treated with HP eradication therapy.

Design: Quality improvement pre-post intervention

Participants: Internal Medicine residents

Intervention: Educational training on the importance …

Mycobacterium Shimoidei: A Case Report Of A Rare Nontuberculous Mycobacterial Infection In An American Patient With A Favorable Outcome, Madison Baker, Farah Majdoub, Asad Nasir

Advances in Clinical Medical Research and Healthcare Delivery

Non-tuberculous mycobacteria (NTM) are common environmental pathogens, but they are an uncommon cause of illness. One such mycobacteria, Mycobacterium shimoidei, was discovered in 1968 and found to cause a respiratory illness in 1975. Since then, fewer than 100 cases have been reported worldwide. Symptoms can include cough, fever, weight loss, and hemoptysis This report describes an American patient with no travel history who was found to have significant pulmonary disease caused by this rare non-tuberculous mycobacteria.

Analysis Of Superior Economic Potential In South Tangerang City With Banten Province Comparator Using Location Quotient, Dynamic Location Quotient, And Shift Share Analysis Methods, Muhammad Qabus Abid Khairullah, Rastika Widiastuti, Cindy Adria Ananda Putri, Hayuning Anggrahita

Jurnal Geografi Lingkungan Tropik (Journal of Geography of Tropical Environments)

Gross Regional Domestic Product (GRDP) is a key indicator for understanding regional economic structure and dynamics. Differences in sectoral contributions reflect levels of specialization, competitiveness, and growth potential, making comparative and dynamic sectoral analyses essential for regional development planning. This study aims to identify leading, supporting, potential, and lagging economic sectors using Location Quotient (LQ), Dynamic Location Quotient (DLQ), and Shift Share Analysis by comparing the economic performance of South Tangerang City with Banten Province. The analysis is based on GRDP at constant prices by industrial sector for the period 2019-2023. LQ is applied to identify sectoral comparative advantages, DLQ …

Proceeding Book Of The 17th Indonesian Occupational Medicine Updates (Iomu), Perdoki .

Occupational and Environmental Medicine Journal of Indonesia

Bali, Indonesia, 16th - 18th May 2025

Who Pays For Preparedness? Valuing Disaster App Features Through A Factorial Survey Experiment In Flood-Prone Communities, Katsuya Tanaka, Tadashi Kito, Kohji Tanaka

Center for Public Service Publications and Reports

This study evaluates public preferences for next-generation disaster preparedness apps using a factorial survey experiment in flood-prone Japanese communities. The analysis first reveals a fundamental heterogeneity in public receptiveness, identifying two distinct segments: a small "receptive" minority (approx. 20 %) willing to consider adoption, and a large "unreceptive" majority (approx. 80 %) that rejects the app regardless of its features or price. Consequently, focusing on the receptive segment, the study estimates the economic value of specific app features. Results show that functions for immediate personal safety and family security—such as Rescue Request and Family Status Confirmation—are most highly prized. These …

Older Adults And Suicide: Protective Pathways To Apply Shores In Counseling, Anna A. Ellenson, Jenny L. Cureton

Adultspan Journal

Older adult suicide (OAS) is a growing concern as the U.S. population continues to age and access to counseling expands. Despite legal and ethical requirements, counselors are often underprepared to address suicide in later life, especially through the lens of suicide protective factors (SPFs). This conceptual article introduces SHORES, a research-informed mnemonic (Skills and strategies for coping, Hope, Objections to suicide, Reasons for living/Restriction of means, Engaged care, and Support), to help counselors assess, intervene, and plan treatment with older adults. We review literature on OAS, highlight gaps in counselor training, and provide an application guide for using SHORES with …

Building School, Family, And Community Partnerships That Support Rural Diverse And Exceptional Learners, Jerrie L. Brooks, Brooke A. Moore, Megan S. Finnerty

The Rural Educator

Research demonstrates that school, family, and community partnerships are mutually beneficial, holding the potential to foster positive educational, emotional, and behavioral benefits for all students, especially diverse and exceptional students. Our qualitative study examined survey responses from 109 administrators, general and special educators, and parents in rural schools across western Kansas. We identified common barriers and successes to building parent partnerships related to communication, access, and attitudes about working with diverse and exceptional families. One major finding was the importance of “place”—rural communities are often close-knit and connected across generations. We propose a model that can be used by rural …

Rural Schools Of Choice: Virtual Charter Schools, Karen Eppley

The Rural Educator

No abstract provided.