Medicine and Health Sciences Commons^™

Taking Chances: Plagiarism In Manuscripts, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

The Editor-in-Chief reflects on why authors plagiarize after the journal received several manuscripts containing plagiarized work.

Novel Case Of Staphylococcal Scalded Skin Syndrome In A 26-Year-Old With A History Of Ichthyosis, Gunja S. Shah, Sarah Snyder, Kayvan Mirhadi

Advances in Clinical Medical Research and Healthcare Delivery

Staphylococcal scalded skin syndrome (SSSS) is a bacterial toxin-mediated skin disorder that primarily affects neonates but rarely also presents in adults with underlying kidney disease. We present a case of a 26-year-old male with SSSS which was challenging to identify due to an underlying diagnosis of congenital epidermolytic ichthyosis. This case is novel as it is the first documented case of SSSS in an adult with ichthyosis. It highlights the unique challenge of recognizing cutaneous infections in patients with underlying skin disorders especially in the setting of a rural hospital without in-person dermatology coverage.

An Interesting Case Of Wunderlich Syndrome And Page Kidney, Megan Worthington, Nicholaus Monsma, Raj Pyne

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of Wunderlich Syndrome and Page Kidney, a rarely reported combination. Wunderlich Syndrome, characterized by spontaneous renal hemorrhage without a history of trauma, is typically associated with Lenk’s triad of flank pain, mass, and hypovolemia. Page Kidney induced hypertension, a rare condition resulting from external renal compression associated with renin-mediated mechanisms. Our case demonstrates the importance in quick recognition and treatment as blood pressure changes can be fast and dramatic. Our case also has the added dimension of renin measurements. After the patients hypertension developed, his initial renin levels were within normal range, but they later showed …

Missing The Overlap, Rutwik Pradeep Sharma, Mohamed Mohamed Ahmed, Ryan Tam, Alexander T. Kusnik, Ali Jaan, Ari Chodos, Krishna Tangirala

Advances in Clinical Medical Research and Healthcare Delivery

A 43-year-old female presented with painful obstructive jaundice, a mixed pattern of elevation of liver injury markers and neutrophilic leukocytosis. Evaluation with endoscopic retrograde cholangiopancreatography (ERCP) was unremarkable. The antimitochondrial antibody (AMA) titers were elevated. She was discharged on ursodeoxycholic acid (UDCA) for Primary Biliary Cirrhosis (PBC) but was readmitted for worsening symptoms. The patient's liver biopsy results suggested Overlap syndrome (Primary Biliary Cirrhosis-Autoimmune hepatitis). She was then given corticosteroid therapy concurrently with UDCA after which she improved and remained asymptomatic. In conclusion, we would like to report this atypical presentation of overlap syndrome and hope the medical community learns …

Pembrolizumab Induced Hyponatremia. A Case Report, Mouna Reghis, Taanvi Gowdar, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

Hyponatremia is the most common electrolyte abnormality inpatient. Medications are a common cause of this. Cancer treatment has evolved with immune check point inhibitors replacing conventional chemotherapy agents. Pembrolizumab, which is a program cell death receptor-1 ligand has been shown to cause endocrinopathies. We describe a case of hyponatremia due to pembrolizumab

Case Report Of Unilateral Dysphagia In The Context Of A Classical Type Of Eagle Syndrome, Ryan Tam, Stephen D. Howard, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

A patient presents with unilateral, right-sided dysphagia and generalized facial symptoms following past surgical history of tonsillectomy that is consistent with an underdiagnosis of Eagle Syndrome. The elongation of the styloid process likely impinged on the glossopharyngeal and vagus nerves resulting in symptoms. Given the lack of recognition of the disease, this case report describes the presentation of Eagle Syndrome to encourage physicians to consider this disease as part of a broader differential diagnosis.

Peer Support For Second Victims In The Healthcare Setting, Levi Gangi

Advances in Clinical Medical Research and Healthcare Delivery

Adverse and traumatic events happen regularly in healthcare settings, and often they create a clinician “second victim” who struggles with feelings of guilt, isolation, doubt, and incompetence. Research has shown that clinicians desire support in the wake of such adverse events, but that factors such as stigma, culture of perfection, and lack of an available structured peer program limit the support that might be offered. Healthcare institutions contract with EAP (employee assistance program) agencies to provide counseling for employees, but it is more likely that a second victim will seek out or welcome help first from a peer who shares …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

Cocaine As A Rare Cause Of Cholecystitis, Abdullah A. Orakzai, Osama Sherjeel Khan, Mustafa Shah, Syeda Sarah Raza, Mehr A. Orakzai, Muhammad H. Sharif

Advances in Clinical Medical Research and Healthcare Delivery

Cholecystitis, inflammation of the gallbladder, is diagnosed in approximately 200,000 people in the US each year. Cocaine is an illicit drug that is wildly abused in the US, GI complications such as acute pancreatitis, colitis, bowel perforation, mesenteric ischemia, and biliary tree obstruction have been reported in limited studies. To the best of our knowledge, there are no reported cases of cocaine-induced cholecystitis and no established treatment plans to date, however, we strongly believe that our patient’s cocaine use resulted in cholecystitis. Hence, we wanted to shed some light on the possible side effects of cocaine on the gall bladder.

The Role Of Osteopathic Manipulative Treatment In Neonatal Abstinence Syndrome, Kathryn Workman, Andrea M. Bodine, Md, Victoria Tuttle, Do

Advances in Clinical Medical Research and Healthcare Delivery

Context: The United States opioid epidemic has been an ongoing public health crisis. Nationally, maternal opioid use resulted in 82% increase in Neonatal Abstinence Syndrome (NAS), from 2010 to 2017. The opioid withdrawal process of NAS can lead to somatic dysfunctions. Osteopathic Manipulative Treatment (OMT) may decrease muscular and fascial strain in the body and provide relaxation to the NAS neonate.

Objectives: The objectives of this study were to compare the length of hospital stay (LOS) of NAS neonates who received OMT, and neonates given standard medical care without OMT and to evaluate the change in weight of the two …

Intrathecal Bupivacaine And Clonidine For Refractory Hyperhidrosis In Spinal Cord Injury, Soun Sheen, Hemant Kalia

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: Autonomic dysreflexia (AD) in spinal cord injury (SCI) can present as hyperhidrosis due to sudomotor dysfunction. There are no standard treatment guidelines for refractory hyperhidrosis due to persistent noxious stimulation.

Case: A 58-year-old female with C7 ASIA-A quadriplegia was admitted to the hospital in 2018 for T7-8 discitis. Discitis acted as a noxious stimulus manifesting clinically as autonomic dysreflexia. On average, she experienced 50-60 sweating episodes every day. She underwent serial stellate ganglion blocks with >75% improvement which provided 9 months of continued relief. Patient transitioned to intrathecal bupivacaine 2.5mg/ml + Clonidine 200mcg/ml with the catheter tip located at …

Unlikely Cohabitants: A Collision Tumor Of Metastatic Small Cell Lung Carcinoma And Adrenal Adenoma, Michael Demeritt, Savanna Atwal, Stefan Johnson, Kevin Lightner, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

This case report is the second known publication of a very specific collision tumor, where small cell lung cancer metastasized to an adrenal adenoma. The focus is primarily on multimodal radiologic findings of the developing neoplasm, including CT, MRI, and FDG PET/CT. These findings are compared with established diagnostic criteria for adrenal adenomas and metastases, as identified by the literature and content expert review. Epidemiological data regarding collision tumors is discussed, as well as proposed treatment strategies. Similar topics are elucidated for small cell lung carcinoma. Reporting of this collision tumor adds to the relatively thin body of knowledge of …

Musings On Ai Hallucinations And Reading Your References, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

The Editor-in-Chief discusses impressions on the journal's first known AI hallucination reference.

Letter To The Editor: Cheaters Never Prosper...Or Do They?, Samantha M. Lavertue, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

The following article is a perspectives piece regarding the newly discovered USMLE cheating rings taking place in Nepal, India, Pakistan, Jordan, and Japan. As this situation escalates, we call for action to find a solution to a widespread problem: eliminate the need for cheating by making licensure exams pass/fail. Score frenzy is out of control, and it has created a problem for graduate medical education as it applies to both applicants and programs. Here we address this problem and provide a solution that encourages readers to consider how we can create a system of resident selection that focuses not on …

Abdominal Aortic Aneurysm Screening And Surveillance – Can We Do Better? A Qi Project, Hassan Saeed, Hania Liaqat, Vidisha Master, Binita Neupane

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Background:

Abdominal aortic aneurysm (AAA) has a global prevalence of about 5% and its first presentation can be acute and fatal. USPSTF recommends one time screening for men aged 65 to 75 years who have ever smoked. We designed a study to evaluate the effect of resident education on AAA screening ordered in our outpatient primary care clinic.

Methods:

All men aged 65 to 75 years of age attending appointments in the resident run clinic were included in the study. Pre-intervention data was collected retrospectively for 5 weeks which included patient demographics and the rates of appropriate AAA screening …

A Rare Case Of Shock In A Patient With Non-Severe Range Babesiosis, Ayushi Lalwani, Robert Libera, Christopher Reggio

Advances in Clinical Medical Research and Healthcare Delivery

Babesiosis is a tickborne illness caused by microscopic parasites that infect red blood cells. Infections present on a spectrum from asymptomatic to severe, life-threatening presentations. However, life-threatening disease is more typically seen in patients who are asplenic, immunocompromised, or with hepatic/renal disease. We present an unusual case of babesiosis where an immunocompetent patient with age as the only risk factor, became extremely ill with relatively low parasite burden and no co-infection with other tickborne illnesses. A 73-year-old man with essential hypertension and remote prior Lyme disease infection presented to the hospital in late Spring due to acute mental status change …

Bifidobacterium Bacteremia Following Gastrointestinal (Gi) Procedures: A Case Report Of An Unusual Infection And Review Of The Literature, Sheza Malik, Hajra Khan, Ali S. Mohamed, Gaby Razzouk

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Bifidobacterium is a rare cause of bacteremia that mostly affects extremes of ages with the majority of cases seen in premature infants. This report details a case of bacteremia caused by Bifidobacterium in a 75-year-old male patient. Our patient was admitted after a mechanical fall resulting in subdural and subarachnoid hemorrhage. His hospital course was complicated by swallowing problems and ultimately needed the placement of a gastrojejunal (GJ) tube for nutrition. He subsequently developed Bifidobacterium bacteremia. It was presumed that the GJ tube was the cause of bacterial translocation into the bloodstream due to invasion of the mucosal barrier. …

Efficacy And Safety Of Bempedoic Acid As A Treatment Option For Hyperlipidemia: A Systematic Review, Muhammad Hammad Sharif, Abdullah A. Orakzai, Madeeha Khaleeque, Syeda Sarah Raza, Osama Sherjeel Khan, Muhammad Hassan Jan, Atif Ahmed, Muhammad Arsalan

Advances in Clinical Medical Research and Healthcare Delivery

Introduction:

Bempedoic acid (BA) is an inhibitor of ATP-citrate lyase (ACL) and is used in the treatment of hyperlipidemia by inhibiting cholesterol synthesis. Randomized clinical trials (RCTs) have shown the efficacy of BA in lowering LDL-C levels and it is currently approved as a treatment option for patients with hyperlipidemia to achieve target LDL-C levels. We conducted a systematic review to further elucidate the efficacy and safety profile of BA in patients with hyperlipidemia.

Methods:

We searched the electronic database Medline, Embase, and Cochrane Library for RCTs between 2013 and 2023. We used keywords (“Bempedoic Acid”) AND (“Hypercholesterolemia”) AND (“Lipid …

Amiodarone-Induced Lung Toxicity: An Underrecognized And Fatal Presentation, Andrew Takla, Fahad Eid, Hina Ukrani, Moghniuddin Mohamed, Elizabeth Lee

Advances in Clinical Medical Research and Healthcare Delivery

Amiodarone, a widely utilized antiarrhythmic drug, poses a significant risk of amiodarone-induced lung toxicity (ALT) in up to 10% of patients and can be fatal. This report presents the diagnostic challenges associated with ALT, given its non-specific clinical and radiological presentation. Clinicians should maintain a high index of suspicion for potential ALT, especially in patients with progressive respiratory failure despite optimization of other potential causes such as CHF. The mainstay of treatment is discontinuing amiodarone and initiating steroids. However, outcomes can remain unpredictable, emphasizing the need for heightened awareness and regular monitoring of patients on amiodarone therapy.

Why Do Osteopathic Medical Students Take The Usmle Step 1?, Constantino G. Lambroussis, John Weston, Richard R. Terry, Jennifer Spencer

Advances in Clinical Medical Research and Healthcare Delivery

In 2022, 4722 osteopathic medical students chose to take the United States Medical Licensing Examination Step 1 (USMLE Step 1) in addition to the Comprehensive Osteopathic Medical Licensing Examination Level 1 (COMLEX Level 1). Both of these examinations are currently pass/fail assessments to demonstrate clinical knowledge competency. Osteopathic medical students are only required to take the COMLEX series of examinations for graduation from an osteopathic medical school while allopathic medical students are only required to take the USMLE Step series of examinations instead. Correlation between these examinations exists, and information from multiple entities has been for the COMLEX and the …

Anomalous Presentation And Endoscopic Findings Of Acute Esophageal Necrosis: A Case Report, Ahmed Shehadah, Abdullah A. Orakzai, Sheza Malik, Alshaima Yousef, Ali Jaan, Patrick Okolo

Advances in Clinical Medical Research and Healthcare Delivery

Introduction:

Acute esophageal necrosis (AEN), is a rare disorder with an estimated incidence of 0.01-0.28%. It typically affects the distal third of the esophagus. Approximately 90% of patients with acute esophageal necrosis present with upper gastrointestinal (GI) bleeding, primarily due to ischemic insult or severe hemodynamic compromise. In this report, we describe a case in which the patient presented with odynophagia and dysphagia, but without upper GI bleeding. The patient exhibited pan mucosal involvement of the esophagus, which extended to the gastric antrum.

Case: A 55-year-old man with a history of type 2 diabetes mellitus and substance abuse presented with …

Ocular Syphilis: A Case Report And Public Health Discussion, Andrew L. Fine, Hope V. Daskalakis, Rutwik Pradeep Sharma M.D., Mirna Ogeilat M.D.

Advances in Clinical Medical Research and Healthcare Delivery

Ocular Syphilis describes a localized manifestation of a systemic treponema pallidum infection. It most commonly presents with decreased visual acuity due to uveitis and can occur at any time throughout the disease course. This report describes a case of undiagnosed syphilis that was serendipitously diagnosed with blood product screening. This case highlights the need for better public education and outreach pertaining to sexually transmitted infections. This report will detail this patient's clinical course and discuss how healthcare providers can aid in early disease detection to improve both patient outcomes and overall public health.

New Onset Positive Autoantibodies Following Covid-19 Infection, David Hernandez, Adnaan Sheikh, Shakira Laing, Mariana Adieb, Omar Siddiqui, Rohail Baig, Annabel Antonini, James Vienneau, Camden Burns

Advances in Clinical Medical Research and Healthcare Delivery

The World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic on March 11, 2020. Since the original outbreak in December 2019, over 100 million people have been confirmed to have been infected by COVID-19 and over two million people have died. The presentation seen in patients may vary widely based on multiple factors. Fever has been reported in up to 99% of patients, while other common symptoms seen are dyspnea, fatigue, anosmia, and myalgia. Around 80% of COVID-19 patients present with a mild respiratory illness that can be managed at home, while around 15% need basic …

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 …

A Case Of Streptococcus Constellatus Bacteremia Secondary To Respiratory Syncytial Virus Bronchiolitis In A Neonate, Ronald G. Lott Iii, Samantha M. Lavertue, Xavier Zonna, Samuel Wlasowicz, Roland Zhang, Ravi Kavuda

Advances in Clinical Medical Research and Healthcare Delivery

Common causes of bacteremia in the neonatal period include group B streptococcus, listeria, and E. coli. We report a rare case of neonatal bacteremia with culture-positive Streptococcus constellatus. Streptococcus constellatus is part of the normal flora of the orogenital regions of the body; when found elsewhere, it causes pyogenic abscesses in the brain and digestive tract. In this case, the Streptococcus constellatus bacteremia was secondary to prolonged hospitalization in a patient with respiratory syncytial virus (RSV) bronchiolitis. This report serves to make physicians aware of and to define treatment options for Streptococcus constellatus as a rarely isolated organism that …

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 …

A Rare Appendiceal Mucocele Of The Appendix Captured On The Ultrasound: Case Report, Vera Shulgina, Meghan Single, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Appendiceal mucocele is a rare disease which results from an accumulation of mucus in the lumen of the appendix, leading to distension and obstruction of the lumen. Clinical diagnosis is often delayed, as the presenting symptoms are usually non-specific. Even with the use of imaging, preoperative diagnosis is difficult. The treatment is surgical, with the extent determined by the surgical specimen. Definitive diagnosis is by histopathology. Our case report presents a rare case of appendiceal mucocele originally captured by ultrasound. The aim of this paper is to further understand the clinical presentation, discuss key ultrasound findings, and examine the proper …

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.

Covid-19-Associated Myocarditis: Screening For Early Diagnosis, Yousuf Khan, Salmman Ahmed, Samuel John Wlasowicz, Ronald G. Lott Iii, Xavier C. Zonna

Advances in Clinical Medical Research and Healthcare Delivery

The SARS-CoV-2 virus (causing COVID-19), has infected about 770 million people, and caused the death of about 6.9 million people worldwide in the span of three years (John Hopkins Resource Center). Common symptoms of a patient infected with the virus include shortness of breath, fever, chills, fatigue, loss of taste or smell, and muscle aches. However, recent studies have also shown a prevalence of patients presenting with cardiac inflammation (endocarditis, myocarditis or pericarditis) as a potential comorbidity, both during the infectious stage as well as after the infection has subsided. A pattern of specific clinical markers may be indicative of …

Intracystic Hemorrhage In A Simple Liver Cyst Due To Dual Anti-Platelet Therapy After Percutaneous Coronary Intervention, Nauman Naeem, Andrew Takla, Saarwaani Vallabhajosyula, Nagesh R. Jadhav

Advances in Clinical Medical Research and Healthcare Delivery

Hemorrhage into a simple hepatic cyst often results in development of a complex cystic lesion, which makes this identical to a cystic tumor. We present a striking example of this decision-making in a patient with suspected intracystic hemorrhage from recent anti-platelet medication use post-percutaneous coronary intervention (PCI). 83-year-old male presented to the hospital with acute right upper quadrant (RUQ) abdominal pain, severe and constant. This was associated with nausea and constipation. Medical history was significant for recent PCI and initiation of dual anti-platelet therapy (DAPT) ten days ago, and chronic thrombocytopenia. Ultrasound and CT confirmed complex 12.8 x 11.4 x …