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Full-Text Articles in Medicine and Health Sciences
A Letter To M, Shifa Gandhi, Md
An Encounter With “The Difficult Patient”, Rabia Iqbal, Md
An Encounter With “The Difficult Patient”, Rabia Iqbal, Md
The Medicine Forum
On morning pre-rounds during my Methodist rotation, I was rushing to see all the patients in anticipation of the bolus of admissions that would be coming in soon. I spotted the gray and yellow cart near my patient’s door and opened the cart door while simultaneously trying to fit my handoff into a scrub pocket. I was about to knock on the door with my gown and gloves on, but my flimsy gown was falling so I ended up opening the door with my leg as I was retying it around my neck. The nurse down the hall briefly looked …
Evaluation Of Asthma Control In Patients With And Without Sinonasal Polyps Following Treatment With Biologic Agents, Prachi Patel, Chandala Chitguppi, Md, Alan Gandler, Md, Kira Murphy, Md, Tawfiq Khoury, Md, Stephanie Bork, Crnp, Pamela Monostra, Pa, Elina Toskala, Md, Phd, Mindy Rabinowitz, Md, Marc Rosen, Md, Gurston Nyquist, Md, Jessica Most, Md
Evaluation Of Asthma Control In Patients With And Without Sinonasal Polyps Following Treatment With Biologic Agents, Prachi Patel, Chandala Chitguppi, Md, Alan Gandler, Md, Kira Murphy, Md, Tawfiq Khoury, Md, Stephanie Bork, Crnp, Pamela Monostra, Pa, Elina Toskala, Md, Phd, Mindy Rabinowitz, Md, Marc Rosen, Md, Gurston Nyquist, Md, Jessica Most, Md
The Medicine Forum
Background: The effects of biologics on severe asthmatics with chronic rhinosinusitis with sinonasal polyposis (CRSwNP) have not been well established. This study evaluates overall control of asthma in patients with and without sinonasal polyps following initiation of biologics therapy.
Methods: Retrospective review of patients with asthma treated with a biologic agent (benralizumab, omalizumab, dupilumab, mepolizumab) and CRSwNP. Charts were assessed for ACT scores at time of biologic enrollment and at 4-7 months.
Results:82 patients met inclusion criteria; 42 (52.5%) patients with asthma and 40 (47.5%) with concurrent sinonasal polyps. The average ACT score for the non-polyp cohort was 13.16 …
Increasing Patient Confidence In Managing Asthma Using Asthma Action Plans, Pankhuri Jha, Jessica F. Most, Md
Increasing Patient Confidence In Managing Asthma Using Asthma Action Plans, Pankhuri Jha, Jessica F. Most, Md
The Medicine Forum
Asthma is a common illness affecting 8% of the US population and costing $81.9 billion per year.1,2 Due to its chronic and variable nature, asthmatics need frequent medication adjustments, making management challenging for both physicians and patients. Studies show that patients can control their asthma using an asthma action plan (AAP), which includes directions for daily self-assessment, baseline medications and steps to facilitate detection and treatment of an exacerbation. Self-management education using AAPs is associated with a reduction in hospital admissions and ED visits by 40% and 20%, respectively.3 Despite evidence that AAPs are efficacious, the underlying reason …
Stemi In A Young Patient With Covid-19; Too Great A Burden?, Naman Upadhyay, Md, Gillian Naro, Md, Med, Gregary Marhefka, Md
Stemi In A Young Patient With Covid-19; Too Great A Burden?, Naman Upadhyay, Md, Gillian Naro, Md, Med, Gregary Marhefka, Md
The Medicine Forum
Myocardial infarcts (MIs) can be especially devastating when their pathogenesis stems from a coronary artery occlusion by an intracoronary thrombus (ICT). ICTs are most frequently a result of an underlying atherosclerotic plaque rupture, however, can also be a result of emboli, vasospasm, hypercoagulable states, among other etiologies. Patients suffering from the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be in both a hypercoagulable and proinflammatory state resulting in an increased risk of clot formation, endothelial damage, and plaque destabilization, thus increasing the ICT burden in infected patients.1 The literature does reflect an increase in ICT ST-segment elevation …
Pancreatic Plasmacytoma: A Rare Extramedullary Manifestation Of Multiple Myeloma, Justin Robbins, Md, Gregory Habig, Md
Pancreatic Plasmacytoma: A Rare Extramedullary Manifestation Of Multiple Myeloma, Justin Robbins, Md, Gregory Habig, Md
The Medicine Forum
Multiple myeloma is a plasma cell dyscrasia in which neoplastic plasma cells pathologically produce monoclonal immunoglobulin and infiltrate bone marrow throughout the skeletal system. The disease is classically characterized by bone pain caused by lytic bone lesions, marked increases in monoclonal antibodies in blood or urine, hypercalcemia, and other systemic signs and symptoms of malignancy including weight loss and night sweats. A rare variant of multiple myeloma presents with extramedullary plasmacytomas, or plasma cell tumors, which arise in organs outside of the bone marrow1. The case presented here exhibits this disease variant, with a woman with severe multiple …
Idiopathic Retroperitoneal Fibrosis, Candace Derenge, Md
Idiopathic Retroperitoneal Fibrosis, Candace Derenge, Md
The Medicine Forum
Idiopathic retroperitoneal fibrosis (IRF) is a rare and unusual etiology of abdominal pain that is becoming more frequently diagnosed with the use of CT imaging for abdominal pain. Retroperitoneal fibrosis is characterized by the development of extensive fibrosis throughout the retroperitoneum that can encircle the aorta, iliac arteries, and ureters. About two thirds of retroperitoneal fibrosis cases are idiopathic, thought to be due to an autoimmune process of antibodies stimulating desmoplastic reaction. One third of cases are secondary to drugs (methysergide, beta-blockers, hydralazine, ergotamine, LSD) or diseases the stimulate desmoplastic reaction (tumors, infections, radiation, and Erdheim-Chester disease). Histology of IRF …
A Case Of Refractory Gestational Trophoblastic Neoplasia Requiring Hysterectomy After Methotrexate, Ida Micaily, Md, Saveri Bhattacharya, Do, Russell J. Schilder, Md
A Case Of Refractory Gestational Trophoblastic Neoplasia Requiring Hysterectomy After Methotrexate, Ida Micaily, Md, Saveri Bhattacharya, Do, Russell J. Schilder, Md
The Medicine Forum
Gestational trophoblastic neoplasia (GTN) refers to a group of malignant conditions that develop due to abnormal fertilization causing abnormal proliferation of tissue. GTN is primarily treated with surgical evacuation of the underlying proliferative tissue. Approximately half of cases of GTN arise from molar pregnancy1. GTN include invasive moles, choriocarcinomas, placentalsite trophoblastic tumors and epithelioid trophoblastic tumors. The most common risk factors associated with GTN are prior molar pregnancy, advanced maternal age (>40 years of age), and Asian and Native American ancestry2-4. Following evaluation of a molar pregnancy, a post-molar GTN is diagnosed based on the …
A Rare Presentation Of A Clear Cell Variant Of Peritoneal Mesothelioma, Nivethietha Maniam, Md, Michael Lee, Md, Mihir M. Shah, Md, H. Richard Alexander, Md
A Rare Presentation Of A Clear Cell Variant Of Peritoneal Mesothelioma, Nivethietha Maniam, Md, Michael Lee, Md, Mihir M. Shah, Md, H. Richard Alexander, Md
The Medicine Forum
Primary malignant peritoneal mesothelioma with clear cell subtype is a rare malignancy with few previously reported cases. We present a 63-year-old female who presented with abdominal distention and was diagnosed with clear cell mesothelioma of the peritoneum with an isolated metastasis to the liver. The patient underwent surgical resection of a greater than 50 cm mass with en-bloc partial liver and gastric resection with an uneventful post-operative course. There are established prognostic and treatment recommendations for peritoneal mesothelioma based on histological subtype and patient-specific factors, although they do not explicitly incorporate clear cell subtype. This case report describes the presentation, …
A Slow Burning Diagnosis: A Case Report Of Hemophagocytic Lymphohistiocytosis Preceding The Diagnosis Of Subcutaneous Panniculitis-Like T-Cell Lymphoma, Steven Manobianco, Md, William Bradford, Md, Ida Micaily, Md, Adam Binder, Md
A Slow Burning Diagnosis: A Case Report Of Hemophagocytic Lymphohistiocytosis Preceding The Diagnosis Of Subcutaneous Panniculitis-Like T-Cell Lymphoma, Steven Manobianco, Md, William Bradford, Md, Ida Micaily, Md, Adam Binder, Md
The Medicine Forum
HLH is a severe inflammatory syndrome characterized by primary or secondary immune dysregulation causing excess activation of macrophages and cytotoxic lymphocytes, leading to multi-system dysfunction. Diagnosing and managing HLH can be challenging for clinicians, with HLH-2004 criteria for diagnosis requiring a molecular diagnosis or the presence of at least five of the following: fever, splenomegaly, cytopenia involving two or more cell lineages, hypertriglyceridemia and/or hypofibrinogenemia, hemophagocytosis in the bone marrow, spleen or lymph nodes with no evidence of malignancy, low or no NK cell activity, elevated ferritin, or elevated soluble IL-2 receptor1. These criteria have been utilized to …
Opioid-Induced Secondary Adrenal Insufficiency In A Young Patient With Chronic Pancreatitis, Amry Majeed, Nicholas Noverati, Md, Christine Kurian, Md, Shirin Jaggi, Do
Opioid-Induced Secondary Adrenal Insufficiency In A Young Patient With Chronic Pancreatitis, Amry Majeed, Nicholas Noverati, Md, Christine Kurian, Md, Shirin Jaggi, Do
The Medicine Forum
Opioid misuse is a national public health crisis that has contributed to a decrease in life expectancy in men and women in the US. From 1999-2017, the rate of drug overdose deaths tripled, largely due to the rise in opioid use1. Despite widespread misuse, chronic opioid therapy still has a role in the clinical setting. Adverse effects include dizziness, nausea, vomiting, respiratory depression, and dependence2. While these side effects are well- documented, other effects of opioids are less explored, including opioidinduced adrenal insufficiency3,7. The typical presentation of adrenal insufficiency from any cause can include …
A Severe Case Of Hypertriglyceridemia In Alcoholic Hepatitis, Jillian Cooper
A Severe Case Of Hypertriglyceridemia In Alcoholic Hepatitis, Jillian Cooper
The Medicine Forum
A 53-year-old man with a past medical history of hypertension and alcohol abuse with prior episodes of alcoholic hepatitis presented to the hospital with generalized weakness. He was in his usual state of health until 4 days prior to admission when he began to develop generalized weakness, nausea, and vomiting. Notably, he had had multiple prior admissions with similar symptoms attributed to hyponatremia. He endorsed drinking a few beers daily but denied any other drug use. Review of systems was otherwise negative.
New-Onset Rheumatologic Disease In An Elderly Patient Initially Presenting As Worsening Sequelae Of Longstanding Peripheral Vascular Disease, Peri Levey, Lauren Lally, Md, Xuejun Alice Wang, Md, Vivek Batra, Md
New-Onset Rheumatologic Disease In An Elderly Patient Initially Presenting As Worsening Sequelae Of Longstanding Peripheral Vascular Disease, Peri Levey, Lauren Lally, Md, Xuejun Alice Wang, Md, Vivek Batra, Md
The Medicine Forum
Systemic lupus erythematosus (SLE) is an autoimmune disease that is believed to activate and attack nuclear antigens in genetically susceptible individuals after exposure to environmental factors causing cell damage.1,2 Although it is most common in females of child-bearing age, initial presentation is not strictly limited to this population, as onset over the age of 50 years is reported in 3-18% of cases.2 The common manifestations of SLE affect nearly every system of the body and may include arthralgia, myalgia, fever, rash, hepatosplenomegaly, lymphadenopathy, pleuritis, glomerulonephritis, pericarditis and neuropsychiatric manifestations.1-3 Common laboratory findings in SLE with varying degrees …
Carbamazepine Induced Bullous Pemphigoid In A 49 Year Old Male, Brendan Gleason, Lisa Matonti, Pharmd, Bcps, Xuejun Alice Wang, Md, Bahar Dasgeb, Md
Carbamazepine Induced Bullous Pemphigoid In A 49 Year Old Male, Brendan Gleason, Lisa Matonti, Pharmd, Bcps, Xuejun Alice Wang, Md, Bahar Dasgeb, Md
The Medicine Forum
Bullous pemphigoid is an autoimmune blistering condition mediated by autoantibodies1. It is categorized as an uncommon disorder2-4, with an estimated incidence of 2.4-21.7 cases per million2-6 but carries significant morbidity and mortality, warranting clinical awareness and investigation7,8. A number of medications have been implicated in the development of bullous pemphigoid including loop diuretics, ace inhibitors, and anti-epileptic drugs.
This is a case report of carbamazepine-induced bullous pemphigoid in a 49-year-old male after taking the medication for almost 30 years. Diagnosis of bullous pemphigoid was based on biopsy histology and immunofluorescence, as well as the presence of BP 180 antibody. Clinical …
A Case Of Native Hip Pseudomonas Aeruginosa Septic Arthritis Caused By Vesico-Acetabular Fistula, Tudor Sturzoiu, Md
A Case Of Native Hip Pseudomonas Aeruginosa Septic Arthritis Caused By Vesico-Acetabular Fistula, Tudor Sturzoiu, Md
The Medicine Forum
A 61-year-old man with a past medical history significant for metastatic rectal cancer treated with local resection, chemotherapy, and radiation complicated by vesicocutaneous fistula presented with subacute ambulatory dysfunction secondary to right hip pain. Imaging studies were consistent with a right hip effusion, and fluoroscopyguided hip aspiration revealed septic arthritis caused by Pseudomonas aeruginosa. Resistance patterns identified this strain of Pseudomonas to be the same one that caused pyelonephritis that was treated during the same hospitalization. Although further diagnostic imaging was not pursued, the presentation was most consistent with vesico-acetabular fistula causing native hip septic arthritis. This is a very …
Severely Impaired Gastric Emptying In The Setting Of An Extensive Malignancy History: A Case Of Paraneoplastic Gastroparesis, Gregory Habig, Md, Justin Robbins, Md
Severely Impaired Gastric Emptying In The Setting Of An Extensive Malignancy History: A Case Of Paraneoplastic Gastroparesis, Gregory Habig, Md, Justin Robbins, Md
The Medicine Forum
Gastroparesis is a disorder of the stomach involving a delay in the emptying of gastric contents that typically presents with nausea, vomiting, early satiety, and weight loss. Though commonly associated with diabetes or as a complication of surgical procedures, etiologies stemming from paraneoplastic processes are important to consider despite often being overlooked. The case presented here describes a patient with a significant malignancy history and evidence of severely impaired gastric emptying concerning for paraneoplastic gastroparesis and highlights the evaluation, diagnosis, and management of the condition.
Acute Mitral Regurgitation Presenting With Right Upper Lobe Opacification, John Wallis, Md, Mark Decaro, Md
Acute Mitral Regurgitation Presenting With Right Upper Lobe Opacification, John Wallis, Md, Mark Decaro, Md
The Medicine Forum
We describe a rare entity in which acute mitral regurgitation causes asymmetric findings on chest radiograph. The patient presented with rapid-onset respiratory failure from flash pulmonary edema. She had unilateral infiltrates on chest radiograph, which evoked infectious etiology. However, we identified a flail mitral valve leaflet, for which the patient received an emergent mitral valve replacement. Fortunately, she made a full recovery. We discuss the mechanism of the asymmetric chest radiograph findings, which we were able to confirm using a transesophageal echocardiogram.
Effusive-Constrictive Pericarditis Due To Poorly Differentiated Carcinoma Of The Mediastinum, John Wallis, Md, Naman Upadhyay, Md, Fred Karaisz, Md, Mark Decaro, Md, René Alvarez, Md
Effusive-Constrictive Pericarditis Due To Poorly Differentiated Carcinoma Of The Mediastinum, John Wallis, Md, Naman Upadhyay, Md, Fred Karaisz, Md, Mark Decaro, Md, René Alvarez, Md
The Medicine Forum
A 33-year-old male developed subacute effusiveconstrictive pericarditis with recurrent pleural effusions and mediastinal lymphadenopathy. He was found to have poorly differentiated carcinoma of the mediastinum that led to constrictive physiology not amenable to medical or surgical management, ultimately requiring hospice. This case was remarkable for its rare etiology and presentation.
“Covid Nails”, Gillian Naro, Md, Med, Gregory Kane, Md, Macp
“Covid Nails”, Gillian Naro, Md, Med, Gregory Kane, Md, Macp
The Medicine Forum
A 73-year-old female presented to an outpatient clinic for management of her COPD. Two months prior, she had experienced a febrile illness with a cough and subsequently tested positive for the SARS-CoV-2 virus, requiring hospitalization and intubation in an intensive care unit. Physical examination revealed transverse white lines extending across the nail plate about 5mm from the base of the nail on multiple nails. These findings were consistent with Beau Lines, a sign of acute systemic inflammation resulting in the sudden interruption of nail keratin synthesis. The location of the line relative to the growth of the nail can reflect …
From The Editors, Xuejun Alice Wang, Md, Nivethietha Maniam, Md, Hillary Landon, Md, Jillian Cooper, Md, Joseph Grogg, Md, Akanksha Arya, Md
From The Editors, Xuejun Alice Wang, Md, Nivethietha Maniam, Md, Hillary Landon, Md, Jillian Cooper, Md, Joseph Grogg, Md, Akanksha Arya, Md
The Medicine Forum
It is our honor to present the product of 22 years of resident-run tradition – the 2020-2021 annual edition of The Medicine Forum. In the world of Jefferson traditions, ours is a small one. There is no regalia, pomp and circumstance, or any such fanfare in this marking of the year’s close. Rather than the celebratory release of those other springtime occasions, this publication is a representation of the yearlong dedication and hard work of our residents and fellows in their academic pursuits.
We at The Medicine Forum know that producing scholarly work even during what would constitute a …
From The Desk Of The Residency Program Director, Emily Stewart, Md
From The Desk Of The Residency Program Director, Emily Stewart, Md
The Medicine Forum
The past year has been the most trying many of us have faced as physicians. Despite the challenges, I leave this academic year with hope and gratitude for the future of medicine. The exceptional altruism and dedication portrayed by our colleagues both within and outside the Department of Medicine made this year possible. I've been overwhelmed by the collegiality and dedication of all our colleagues, but specifically our residents. Despite the challenges, they have risen to every encounter with grace and poise working alongside faculty to support the Jefferson mission: We Improve Lives. In the midst of the chaos, our …
Table Of Contents: The Medicine Forum Volume 22, 2020-2021
Table Of Contents: The Medicine Forum Volume 22, 2020-2021
The Medicine Forum
Table of Contents: The Medicine Forum Volume 22, 2020-2021
The Medicine Forum: Volume 22
The Medicine Forum
The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 22, 2020-2021
TABLE OF CONTENTS
Clinical Images
Case Reports
- Cardiology
- Gastroenterology and Hepatology
- General Medicine
- Hematology and Oncology
- Pulmonary Medicine
Resident Reflection
Narrative Medicine In Ophthalmology, Martina Rama
Narrative Medicine In Ophthalmology, Martina Rama
inSIGHT
While technological and medical advancements have made it possible to diagnose and treat previously deadly conditions, modern day medicine comes with a new set of challenges around the doctor-patient relationship. Scientifically competent medicine cannot always help patients cope emotionally with their health issues. For physicians, understanding patients’ experience with illness in order to comfort and accompany them through their challenges is just as important as meeting their physical health needs. Dr. Rita Charon, the founder of narrative medicine, highlights how physicians today sometimes lack the ability to connect with, empathize with, and support their patients through difficult diagnoses.1 When …
An Inside Look: Oculoplastics And “Droopy Eyelids”, Payton Boere
An Inside Look: Oculoplastics And “Droopy Eyelids”, Payton Boere
inSIGHT
In writing this article, I had the pleasure of speaking with Dr. Alison Watson, an oculoplastic attending surgeon at Wills Eye Hospital, all about this exciting and innovative specialty. During our discussion, she said that one of the things she loves most about this field is its diversity, including the range of procedures she gets to perform and patients she is able to treat. While there are procedures common to all oculoplastic surgeons, such as cosmetic and functional eyelid surgery to address both upper and lower eyelid malposition, reconstruction following periocular cancer resection, along with nasolacrimal surgery, Dr. Watson explained …
The Present And Future Of Artificial Intelligence In Ophthalmology, Robert Abishek, Elliot Cherkas
The Present And Future Of Artificial Intelligence In Ophthalmology, Robert Abishek, Elliot Cherkas
inSIGHT
Dr. Ravi Goel is a comprehensive ophthalmologist and cataract surgeon at Wills Eye Hospital, with a specific interest in finding ways that AI can help ophthalmologists improve their clinical care and treat more patients. Dr. Goel also publishes a daily blog, Protecting Sight, where he discusses a variety of topics ranging from advances in cataract surgery to medical education. One common thread throughout his blog is the burgeoning impact of AI on the field of ophthalmology, such as the utility of deep learning algorithms for diagnosing various diseases and the impact that improved intra-ocular lens (IOL) power calculations will have …
Off Label Innovation: Discovering New Uses For Glaucoma Drops, Glenn Oh
Off Label Innovation: Discovering New Uses For Glaucoma Drops, Glenn Oh
inSIGHT
Dr. Jason Hsu and his team (Ophthalmic Consultants of Boston, Boston, Massachusetts; Retinal Consultants of Houston, Houston, Texas; Retina Service of Wills Eye Hospital and Mid Atlantic Retina, Philadelphia, Pennsylvania; Associated Retinal Consultants, Royal Oak, Michigan) performed a multicenter randomized placebo-controlled clinical trial in which patients with nAMD who were suboptimal responders despite frequent anti-VEGF injections were randomized to use either dorzolamide-timolol drops or artificial tears.16 Eligible patients were 45 years or older with nAMD who were receiving ranibizumab or aflibercept injections at 4 - 6 week intervals (i.e., at least four injections within six months prior to enrollment) and …
A Career Of Honor And Humility: Interview With A Pioneer In Ophthalmology, Eli Cehelyk
A Career Of Honor And Humility: Interview With A Pioneer In Ophthalmology, Eli Cehelyk
inSIGHT
Imagine being a first-time parent in your early 30s, and you have just learned that your three-month old infant has retinoblastoma. Thanksgiving is right around the corner and you have no idea what the future holds. How would you feel? What thoughts would be racing through your head? With both hope and anxiety, you make an appointment at Wills Eye to see Dr. Carol Shields, a world-renowned expert on ocular oncology. With confidence and compassion, she walks into the room with her entire team and says, “Don’t worry, we will get everything under control for you. We will take your …
An Experience In The Wills Academic Global Ophthalmology Fellowship And Beyond, Crystal Lee, Mph
An Experience In The Wills Academic Global Ophthalmology Fellowship And Beyond, Crystal Lee, Mph
inSIGHT
Even before medical school, Dr. John Anhalt knew he wanted to serve communities all over the globe—after college, he joined the Peace Corps for two years, teaching math and science in the Kingdom of Lesotho. After seeing the vast differences between the health care in Lesotho and in the United States, Dr. Anhalt was inspired to apply to medical school with the intention of pursing a specialty in infectious disease before launching a career in global medicine. It was not until his ophthalmology rotation in University of Texas San Antonio, that he realized that ophthalmology, with its mix of medical …
Insight, Volume 1, Issue 1, 2021
Insight, Volume 1, Issue 1, 2021
inSIGHT
Contents
10 - An Experience in the Wills Academic Global Ophthalmology Fellowship and Beyond
By Crystal Lee
14 - A Career of Honor and Humility: Interview with a Pioneer in Ophthalmology
By Eli Cehelyk
19 - Off Label Innovation: Discovering New Uses for Glaucoma Drops
By Glenn Oh
22 - The Present and Future of Artificial Intelligence in Ophthalmology
By Robert Abishek & Elliot Cherkas
26 - An Inside Look: Oculoplastics and “Droopy Eyelids”
By Payton Boere
31 - Narrative Medicine in Ophthalmology
By Martina Rama