Medicine and Health Sciences Commons^™

Uncommon Presentation Of Kaposi Sarcoma In An Hiv-Negative Patient: A Case Report And Review Of The Literature, Hope Daskalakis, Nina M. Ventura, Joy Anne Lowry, Mara Weinstein Velez

Advances in Clinical Medical Research and Healthcare Delivery

Kaposi Sarcoma (KS) is a multifocal systemic disease first identified in 1872. It most commonly involves the skin, mucous membranes, lymph nodes, and gastrointestinal tract. There are four clinically distinct subtypes of KS that have been identified: Chronic or classic KS, African endemic KS, KS due to iatrogenic immunosuppression, and AIDS-related epidemic KS. The human herpesvirus 8 (HHV-8) has been implicated in all subtypes of KS. We present a unique case of KS in a 79-year-old male with a widespread distribution of skin lesions on his palms, soles, chest, and back. This case report highlights a novel presentation of classical …

Primary Adrenal Insufficiency In Autoimmune Polyglandular Syndrome Type 1 - A Case Report And Literature Review, Hafiza A. Qadeer Md, Reshma Samkutty, Caitlyn Moss

Advances in Clinical Medical Research and Healthcare Delivery

Autoimmune Polyglandular Syndrome (APS) type 1 is a rare autosomal recessive disorder secondary to AIRE gene mutation, that is classically characterized by autoimmune hypoparathyroidism, chronic mucocutaneous candidiasis and Addison’s disease. A review of the literature shows that these disease manifestations may present in any order in different age groups. Patients with APS type 1 are also at risk for other endocrinopathies. We present the case of a female patient with a history of APS type 1 and type 1 diabetes who presented with new onset hypoglycemia and decreased insulin requirement and was diagnosed with new onset adrenal insufficiency due to …

Radio-Histopathological Presentation And Multidisciplinary Treatment Of Adolescent Paratesticular Rhabdomyosarcoma: A Case Report, Troy Nguyen, Joseph Hatem, Abhijit Datir, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Paratesticular rhabdomyosarcoma (PRMS) is a rare condition predominantly affecting the pediatric and adolescent population. In this case report, we discuss a 17-year-old male with a slow-growing, painless scrotal mass, ultimately diagnosed as embryonal PRMS — the most common and favorable rhabdomyosarcoma subtype. The report underscores the typical clinico-radiological presentation of PRMS and the pivotal part of histopathological evaluation in establishing a definitive diagnosis. Multidisciplinary intervention including surgery and chemoradiotherapy resulted in total remission. Therefore, this report underlines the significance of prompt diagnosis and comprehensive management in ensuring a favorable prognosis of PRMS.

Colocolic Fistula: A Rare Consequential Presentation Of Cecal Mucinous Adenocarcinoma, Jessica Rutyna, Paige Stratton, Rutwik Pradeep Sharma, Anthony V. Baratta Jr

Advances in Clinical Medical Research and Healthcare Delivery

Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Relative to a 5-year survival rate, CRC patients diagnosed with localized disease accrue a 90% survival rate while those diagnosed with distant-stage disease maintain 14% survival. Mucinous adenocarcinoma (MAC) is a unique subtype of CRC characterized by the presence of extracellular mucin occupying 50% of tumor expansion. Fistula complications of colonic malignancy have rarely been reported and more commonly occur as complications of diverticulitis. Colocolic fistulae are atypical consequences of colon cancer, which have been rarely reported. We wish to report a unique case …

Metastatic Breast Cancer Found During Colon Cancer Screening, Rutwik Pradeep Sharma, Tausif Syed, Meenal Sharma, Jay Bapaye, Ahmed Shehadah, Alexander T. Kusnik, Ali Jaan, Richard Alweis, Andrej Strapko

Advances in Clinical Medical Research and Healthcare Delivery

No abstract provided.

A Case Of A Retroperitoneal Leiomyoma During Total Laparoscopic Hysterectomy, Bruce Lee, Mohamad Mahmoud

Advances in Clinical Medical Research and Healthcare Delivery

Retroperitoneal leiomyomas are rare clinical entities and poses clinical and therapeutic challenges to the benign gynecologist. We present the case of a 51 year-old gravida 2 para 2 with symptomatic leiomyomas undergoing definitive surgical management with total laparoscopic hysterectomy. Intraoperatively, a retroperitoneal mass in the pelvic side was identified, excised, and removed from the abdominal cavity without complications. Final pathology confirmed a leiomyoma.

Race/Socioeconomic Status And Covid-19: A Narrative Review, Olubunmi Oladunjoye, Akinwale Akingbule, Adebola Omogunwa, Logan Lawson, Anthony Donato

Advances in Clinical Medical Research and Healthcare Delivery

Background: COVID-19 infection has resulted in more than 620 million infections and 6.6 million deaths. Since the pandemic, many articles have been published on socioeconomic and racial disparities in COVID-19 infection and its outcomes. This article aims to review the impact of race and socioeconomic status on COVID-19 infection and vice versa.

Findings: Most studies showed an increase in COVID infections and hospitalizations in communities of color, with some showing higher mortality rates while others did not. Social determinants, including insurance and care access, food security, housing security appear to have worsened over the same period for these …

Stiff Person Syndrome: A Rare Presentation Of A Rare Disorder, Muhammad Hammad Sharif, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Stiff Person Syndrome (SPS) is a rare autoimmune disease that is caused by the lack of inhibition to excitatory neurotransmitters in the central nervous system (CNS) which then leads to inappropriate and excessive motor unit firing causing stiffness, a characteristic feature of the disease. SPS has an incidence of one case in a million and occurs in the middle-aged population with a female predominance. SPS mostly occurs in the background of autoimmune disorders like type 1 diabetes, thyroid disorders, pernicious anemia, and less often, vitiligo. The pathophysiology is not completely understood; however, there is a strong correlation between high …

Non-Histaminergic Angioedema Following Infection With Covid-19, Sheza Malik, Basil George Verghese, S Shahzad Mustafa

Advances in Clinical Medical Research and Healthcare Delivery

Non-respiratory manifestations of COVID-19, including dermatological manifestations, have been reported, and although urticaria associated with COVID-19 has been reported, there have been no reports of non-histaminergic angioedema following infection with mild COVID-19. Non-histaminergic angioedema has a gradual onset and is characterized by submucosal swelling without accompanying urticaria or pruritus, and poor response to antihistamines and corticosteroids. We report a case of non-histaminergic angioedema in a 29-year-old woman with a history of mild COVID-19 infection. Our case highlights the fact that early diagnosis of non-histaminergic angioedema in mild COVID-19 patients is crucial for effective treatment and requires a high level of …

Death After Marijuana Use In A 27-Year-Old Male: A Case Report, Samantha M. Lavertue*, Sadie Signorella*, Rohail Baig, Amarah Emerson, John Joyce, Roland Zhang

Advances in Clinical Medical Research and Healthcare Delivery

The dangers of marijuana use are well documented across most body systems. We report a 27-year-old male who ingested marijuana and then experienced an ST-elevation myocardial infarction, subsequent cerebrovascular accident, and death within the span of a week. Toxicology reports were positive for THC only, echocardiography revealed diffuse hypokinesis with an ejection fraction estimated at 15-20%, and troponins peaked at greater than 270,000 pg/mL. Due to decreased Glasgow Coma Score and hemodynamic instability, the patient was not taken for cardiac catheterization, but was subsequently sedated, intubated, and placed on pressor support in the ICU. Initial brain imaging was negative for …

Extrinsic Allergic Alveolitis: A Systematic Review Of Hla-Dr In Pigeon Breeder’S Disease, Dylan Thibaut, Ryan A. Witcher, Anitha Kunnath, James Toldi

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Introduction: Pigeon Breeder’s Pneumonitis (PBP) results due to a complex pathophysiology that includes exposure to avian antigens. Susceptibility has been linked to human leukocyte antigen (HLA) class II, though consensus has not been reached. The goal of this systematic review is to further elucidate the association between PBP and HLA-DR subtypes.

Methods: Databases utilized included PubMed, Google Scholar, ScienceDirect, and Cochrane Library. Inclusion required a minimum of three studies in English presenting HLA-DR alleles of PBP and control subgroups. Exclusion was due to insufficient data or non-feasible control groups. Forest plots were created for HLA-DR subtypes’ association …

Journal Club: Glymphatic System In Neurodegenerative Diseases, Ronald G. Lott Iii, Xavier Zonna, Samuel Wlasowicz

Advances in Clinical Medical Research and Healthcare Delivery

Neurodegenerative diseases such as Alzheimer's Disease impact a multitude of individuals worldwide. The neural Glymphatic system is a relatively newly discovered cellular transport pathway within the brain that has been implicated in neurodegenerative diseases. This article serves to provide a journal club review of current literature on the Glymphatic system to raise awareness of this system and its potential for future treatment and prevention of neurodegenerative conditions.

An Unexpected Case Of Herpes Simplex Virus Esophagitis Presenting Amidst Corticosteroid Therapy For An Acute Copd Exacerbation: A Case Report, Aqeel Khanani, Kayvan Mirhadi

Advances in Clinical Medical Research and Healthcare Delivery

Herpes simplex virus (HSV) is prevalent worldwide, with a recent report by the World Health Organization estimating that 3.7 billion individuals under the age of 50 have been infected by the virus. After the initial infection, HSV-1 enters a latent phase with the potential for intermittent reactivation, often secondary to episodes of infection, stress, or immunosuppression. Per current literature review, esophageal involvement in the form of herpes simplex virus esophagitis (HSVE) is more commonly associated with immunocompromised patients, such as transplant recipients and HIV-positive individuals. The patient discussed in this report is a 79-year-old female with a past medical history …

Stones, Bones, And Groans With Cancerous Overtones - A Rare Case Of Diffuse Large B Cell Lymphoma Presenting As Hypercalcemia, Evan Becker, Caitlyn Moss, Steve Chung

Advances in Clinical Medical Research and Healthcare Delivery

Diffuse large B cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma that can present in a variety of ways including fever, weight loss, weakness, and drenching night sweats. Uncommonly, hypercalcemia of malignancy can be associated with DLBCL through multiple mechanisms that include synthesis of parathyroid hormone related peptide (PTHrP) or elevated calcitriol levels. It is estimated that hypercalcemia in the setting of DLBCL is present in 18% of newly diagnosed cases. This report details a case of an 80-year-old man with history of chronic anemia and CKD stage 3b that presented with weakness, decreased oral intake, and self-reported weight …

A Rare Presentation Of Pericardial Tumor Presenting As Chronic Cough, Swarup Sharma Rijal, William H. Risher, Aakankshya Kharel, Upendra Kaphle

Advances in Clinical Medical Research and Healthcare Delivery

Chronic cough can pose various diagnostic and therapeutic dilemmas to physicians. Airway narrowing secondary to endoluminal disease or extrinsic compression are known etiologies of chronic cough. We report an extremely rare case of chronic cough due to extrinsic airway compression by a large pericardial lipoma with subsequent resolution of symptoms after the resection of the mass. This case provides insight into the rare etiology of chronic cough that is addressable with surgical intervention.

Hemoglobin As A Predictor For Covid-19 Disease Severity, Nicholas Sarcia, Dan Thai, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: The dilemma of who is at highest risk for COVID-19 severe disease and death persists. Hemoglobin levels may be an indicator of COVID-19 disease severity. There is inconsistent data on Emergency Department (ED) hemoglobin levels and severity of disease. Our objective was to examine if COVID-19 patients presenting with abnormal hemoglobin levels have an increased risk of severe disease and in-hospital mortality.

Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA to investigate the relationship of COVID-19 disease severity with hemoglobin level. Inclusion criteria consisted of ED patients over 18 years with …

Disease Severity In Covid-19 Breakthrough Cases, Dan Thai, Nicholas Sarcia, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background

Vaccine breakthrough is a phenomenon wherein vaccinated individuals become infected with disease despite adequate protection. During this study period, the Centers for Disease Control (CDC) reported 66.6% of US people have been fully vaccinated. Any measures to improve trust would increase vaccination rates. This study aims to understand vaccine breakthrough cases in COVID-19 by comparing their severity to unvaccinated cases. Our objective is to compare disease severity based on the worst initial vital signs (temperature, respiratory rate, oxygen saturation), length of stay (LOS), and age between vaccinated and unvaccinated COVID-19 cases.

Methods

We conducted a retrospective cohort study at …

“Hiccups” With Covid-19 Management, Yong W. Lee, Jacob Psomiadis, Sarah Akbani, Marvin Lopez-Medal, Aisha Miller

Advances in Clinical Medical Research and Healthcare Delivery

Hiccups, medically referred as singultus, is a condition that results from involuntary contraction of the diaphragm and intercostal muscles. Singultus is usually a self-limiting condition which typically lasts less than 48 hours but in rare cases, can persist greater than 48 hours. This is a case of a 48 year-old male who was prescribed dexamethasone for COVID-19 but developed intractable singultus for two weeks. Patient was unable to tolerate diet due to intractable singultus leading to vomiting. He underwent various non-pharmacological maneuvers and pharmacotherapy without resolution. Dexamethasone- induced hiccups have been reported as an under recognized side effect of dexamethasone. …

Emergency Medicine Journal Club, David Gibbs, Dylan Norton, Kyle Barbour

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations and bottom line interpretation.

A Rare Combination Of Persistent Left Superior Vena Cava And Partial Anomalous Pulmonary Venous Return, Sang Lee, Bishoy Elbebawy, Neena Joy, George Demosthenes, William Deluccia

Advances in Clinical Medical Research and Healthcare Delivery

A persistent left superior vena cava (LSCV) is a form of anomalous venous drainage of the superior vena cava into the left atrium. We present a case of LSCV and partial anomalous pulmonary venous return (PAPVR) in a patient with progressively worsening dyspnea on exertion. A 57-year-old female with a history of aortic valve stenosis, and tobacco abuse presented with dyspnea on exertion for 4 days. On presentations her vitals were unremarkable except elevated blood pressure and oxygen saturation of 94% on 5L oxygen. Physical exam was pertinent for 3/6 crescendo-decrescendo murmur with a radiation to the right carotid, mild …

A Rare Case Of Severe Amlodipine-Induced Gingival Overgrowth: A Case Report, Marika Shahid, Yong W. Lee, Gande Li, Chisom Mogbo, Roger Vega

Advances in Clinical Medical Research and Healthcare Delivery

Gingival overgrowth, or gingival hyperplasia is the hypertrophy of periodontium caused by local systemic diseases or medications. These medications can be broadly categorized into three main groups including immunosuppressants, anticonvulsants, and calcium channel blockers (CCBs). Amlodipine-induced gingival overgrowth (AIGO) is a less documented phenomenon. This is a unique case of 68-year-old African American woman who developed severe AIGH after taking amlodipine for three years for essential hypertension. The gingival overgrowth happened over a period of two weeks and was so extreme that the patient was unable to approximate her lips or tolerate any oral intake. Labs, images, and biopsies were …

Community And Provider Acceptability Of The Covid-19 Vaccine: A Systematic Review And Meta-Analysis, Christian Akem Dimala, Benjamin Momo Kadia, Hai Nguyen, Anthony Donato

Advances in Clinical Medical Research and Healthcare Delivery

Background:

The novel coronavirus disease (COVID-19) vaccines may help control the current pandemic but would require immunization levels that would achieve herd immunity. This study aimed to quantify current COVID-19 vaccine acceptance rates, as well as characterize the determinants, enablers and barriers to vaccine acceptability across the globe by synthesizing published evidence.

Methods:

A systematic review and meta-analysis of studies was performed on studies assessing the acceptability of a COVID-19 vaccine published between November 1^st, 2019, and November 30^th, 2020. PubMed, Embase and Cochrane central were searched for eligible studies. Data extracted from retained studies was …

Evaluating A1c Reduction In Patients With Diabetes Receiving Pharmacy Intervention, Christopher R. Evans, Kirsten Held, Stephanie Thomas, Jeanne Spencer

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Diabetes affects 34 million Americans and is the 7th leading cause of death in the United States. According to the American Diabetes Association (ADA) the A1c goal for most patients is less than 7%; however, in patients at risk for hypoglycemia or with complications that goal can be increased up to less than 8%. Management of diabetes with diet and exercise is essential, but insufficient for most patients and pharmacologic intervention is necessary to achieve therapeutic goals. Reducing A1c is associated with lower cardiovascular risk and a reduction in diabetes-associated complications. Previous studies have shown that pharmacist management of …

A Pilot Study Of Knee And Hip Osteoarthritis Patient Experience With Telemedicine During The Covid-19 Pandemic, Rondy M. Lazaro, Kyle J. Smith, Mohammad H. Bawany, Nathan Barford, Jennifer H. Paul

Advances in Clinical Medical Research and Healthcare Delivery

Objective: The purpose of this pilot study is to examine patients' experience and satisfaction using telemedicine for knee and hip osteoarthritis care during the COVID-19 pandemic.

Methods: Adult patients seen via telemedicine for knee and/or hip osteoarthritis pain completed surveys through the REDCap online platform or pen/paper evaluating their experiences and satisfaction with telemedicine, assessed using yes/no and Likert scale questions. Demographic information was collected from the electronic medical record (EMR).

Results: 32 subjects (9 males, 23 females, mean age 63.2 years [SD = 12.2 years]) completed surveys. 90.6% of subjects stated that they were satisfied with the audio/video quality …