Medicine and Health Sciences Commons^™

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 …

Median Arcuate Ligament Syndrome: A Rare Cause Of Abdominal Pain That Is Difficult To Identify, Mark E. Eskander, Matthew Thrall, Joel P. Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Median arcuate ligament syndrome (MALS) is a rare disease that occurs when the celiac artery is compressed by the median arcuate ligament. Patients with MALS typically present with non-specific symptoms that overlap with more common diseases. As a result, patients may undergo extensive workup and unnecessary treatments before being properly diagnosed with MALS. In this case we present a 23-year-old female with chronic postprandial abdominal pain that persisted despite undergoing a cholecystectomy. This case highlights the symptoms and imaging findings needed to diagnose MALS and thus prevent unnecessary surgical interventions.

Radiologic And Histologic Findings Of Locally Advanced Mucoepidermoid Carcinoma Managed With Total Surgical Excision, Christopher R. Huber, Don Truong, Joseph Hatem, Joel Thompson, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

The present case report provides images from computed tomography and histology of a patient with a salivary gland neoplasm consistent with mucoepidermoid carcinoma.

Comparing Pleural Fluid Removal Volume And Oxygenation Change In Therapeutic Thoracentesis: Is There A Relationship?, Hannah Zazulak, Ryanne Burke, Andrea Bodine

Advances in Clinical Medical Research and Healthcare Delivery

Background: During therapeutic thoracentesis (TT), pleural fluid is typically drained to completion. Fluid removal improves oxygenation, and the amount of fluid removed is directly associated with the risk of serious complications. A relationship between the amount of fluid removed during TT and the change in oxygenation has not been found in the literature. A direct relationship was hypothesized in this study. Differences in the change in oxygenation between sexes, age, and pre-procedure oxygen support were secondarily hypothesized. This information would assist in the guidance of future TT protocols.

Methods: Subjects of this retrospective cohort study were males and females aged …

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 …

Late-Onset Isolated Myositis Following Transobturator Mid-Urethral Sling: A Case Report, Bruce Lee, Mohamad Mahmoud

Advances in Clinical Medical Research and Healthcare Delivery

Late onset of isolated myositis following a Transobturator (TOT) mid-urethral sling (MUS) is a rare post-operative complication.

A 38-year-old gravida 3 para 3003 with a long standing history of mixed urinary incontinence, Stage 2 anterior prolapse, dysmenorrhea, and abnormal uterine bleeding underwent a hysteroscopy with dilation and curettage, levonorgestrel intrauterine device insertion, anterior colporrhaphy, MUS insertion using the TOT approach and cystoscopy. Eight weeks post-op, she presented to the emergency room with right inguinal and low back pain, difficulty ambulating, and fevers. Magnetic Resonance Imaging (MRI) of the right hip revealed inflammatory fluid collection within the adductor brevis with posterior …

Pedagogy Of Problems, Ryan Babineau

Advances in Clinical Medical Research and Healthcare Delivery

No abstract provided.

Covid-19 Vaccination Hesitancy In Pregnancy: A Retrospective Cohort Study Of Patients’ Perceptions, Molly Schassberger, Charlotte Kirk, Samantha Fields, Carol Brenner, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

COVID-19 Vaccination Hesitancy in Pregnancy: A Retrospective Cohort Study of Patients’ Perceptions

Schassberger¹, M, MS III, Kirk¹, C, MS III, Fields¹, S, MS III, Brenner¹, C, Ph.D., Bodine², A, M.D.

¹University of New England College of Osteopathic Medicine, Biddeford, Maine

²Berkshire Medical Center, Pittsfield, Massachusetts

Introduction: The COVID-19 vaccination rate of US pregnant individuals of childbearing age was 42.3%, compared to 63.7% of the total population as of 1/15/2022 despite ACOG and CDC recommendations. Our objectives were to determine patients’ perceptions on COVID-19 vaccine safety and efficacy …

Quality Improvement Project To Increase Pneumococcal Vaccination Rates In Adults With Inflammatory Bowel Diseases (Ibd) Being Treated With Immunosuppressants., Le Yu Naing, Sheza Malik, Jay Bapaye, Nagesh Jadhav

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Patients with inflammatory bowel diseases (IBD) are at an increased risk of pneumonia, and using immunosuppressive medications further increases this risk. Hospitalized patients with IBD have a significantly higher mortality rate from infections with pneumonia being one of them. The American College of Gastroenterology recommends pneumococcal vaccination for all IBD patients as a part of preventative care for IBD patients. However, compliance rates of pneumococcal vaccination in IBD patients have been very low. Quality improvement projects in this regard have been successful at demonstrating increased immunization rates. Our quality improvement project was aimed at increasing pneumococcal vaccination rates in …

Rare Case Of Late-Onset Myasthenia Gravis In A 65-Year-Old Female With Prolonged Doxycycline Use, Angel Wong, Kayvan Mirhadi

Advances in Clinical Medical Research and Healthcare Delivery

Myasthenia gravis (MG) is a rare autoimmune condition caused by antibody-mediated disruption of acetylcholine receptors (AChR) or their associated proteins. The age of onset of MG has a bimodal distribution, with a predominance of female cases in the second and third decades and a predominance of male cases in the sixth to eighth decades. MG is often unmasked by stressors such as systemic illness, medication, surgery, and pregnancy. We present a case of late-onset MG in a 65-year-old female with a recent history of prolonged doxycycline use. However, there are aspects of her past medical history, including comorbidities involving the …

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.

Innovative Research Framework For Strengthening Health Care And Public Health Engagement In Neighborhood Change As A Social Determinant Of Health, Christopher Williams, Nathaniel Woodard, Charlene Chao-Li Kuo

Advances in Clinical Medical Research and Healthcare Delivery

Background

Neighborhood change is a social determinant of health (SDOH) that has been associated with adverse health and increased health care utilization. The number of cities and neighborhoods undergoing intense gentrification, defined as an influx of wealthy populations into a working-class neighborhood, is not highly numerous. Public health and health systems are increasingly engaged with SDOH in community-level interventions. Pathways to study and affect NC-related health impacts are limited. This unfunded study provides a research framework to address concerns about financial investment, identifying population health needs, and community stakeholder engagement.

Methods

The authors conducted a cross-sectional pilot study in a …

Review Of Orthoplastic Techniques For Lower Extremity Reconstruction: Part One, Benjamin Heddy, Brady Webb

Advances in Clinical Medical Research and Healthcare Delivery

Orthoplastic techniques are effective tools for limb salvage in the lower extremity. In order to apply proper techniques successfully, a surgeon must be aware of all the different types of flaps available. Proper pre-operative evaluation and patient selection are also important factors. The following review covers six papers that give surgeons a strong foundation in the anatomical basis and surgical technique of intrinsic muscle flaps and other fasciocutaneous or adipofascial flaps of the foot. These flaps, along with split thickness skin grafts, external fixation, and dermal regenerative templates, quickly close soft tissue deficits in the foot and ankle that often …

A New Wave Of The Overdose Epidemic Arises During The Covid-19 Pandemic, Tolga Suvar Md, Asokumar Buvanendran Md, Stephen Music Do, Wilson M. Compton Md, Mpe

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Objective:

The goal of this manuscript is to highlight the notoriety of the overdose epidemic which has been masked by the Coronavirus pandemic.

Methods:

A thorough literature review of PubMed and the latest statistics from the Centers for Disease Control and Prevention (CDC) was performed for the most relevant and updated data regarding overdose deaths.

Conclusion:

The global health crisis known as the Coronavirus Disease 2019 (COVID-19) pandemic collided with the opioid epidemic in March of 2020, with devastating consequences for the United States. By overwhelming the healthcare system, the pandemic impacted patients who require continued mental health services, …

A Case Of Maintenance Prednisone In Anca Glomerulonephritis, Arjun Sekar, Pulkit Gandhi, Vijay Sheldon, Aswanth Reddy, Ruth Campbell

Advances in Clinical Medical Research and Healthcare Delivery

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a rare condition that can cause rapid renal failure. Treatment involves steroids and other immunosuppressive agents. Agents for induction include rituximab, cyclophosphamide, pulse dose steroids and avacopan.

Maintenance regimens include tapered doses of steroids, azathioprine and rituximab

We present a case of severe AAV that maintained remission with a protracted course of low dose prednisone without maintenance rituximab or azathioprine.

A 70-year-old woman was admitted for acute kidney injury (AKI), with a serum creatinine (sCr) of 6.93 mg/dL (baseline sCr of 0.9 mg/dL, nil proteinuria.) Serologic work-up was positive for P-ANCA. She …

Telemedicine, Not The Panacea We Thought It Would Be. A Tale Of Caution, Ahmed Elkhapery, Syed Faiz Abbas, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

In the last few decades, the growing use of telemedicine has allowed access to healthcare at reduced costs and increased monitoring of chronic conditions, especially in underserved and rural areas. It is a tool of great value in low-income countries where there is a paucity of specialists. In the height of the COVID-19 pandemic, telemedicine was used to screen patients with COVID-19 like symptoms and send them to test sites directly. This helped minimize unnecessary healthcare staff and patient exposure to the infection and helped decompress ERs. Due to a lack of testing resources, many mildly symptomatic patients were presumed …

Racial Disparities In Access To Pain Management Services During Covid Pandemic At An Urban Safety-Net Hospital, Mohammad Ghorbanhoseini, Akhil Venkat Uppalapati, Allen Yang, Rafael Ortega, Eduard Vaynberg

Advances in Clinical Medical Research and Healthcare Delivery

Background: Race has been identified as one of the great divisions of mankind, associated with differences in healthcare access in the US. The COVID pandemic has shed light on a variety of disparities, including access to pain management services.

Method: All the adult patients who were referred to the pain clinic at Boston Medical Center (BMC) from December 2019- December 2020 were included in this study. A total of 2023 cases (1243 White Race and 790 People of Color) were recruited.

Result: Patients of WR received care at a younger age. COVID-19 increased the average age of WR by 2.5 …

Graves' Disease And Major Histocompatibility Complex Class Ii: A Meta-Analysis Of Hla-Dq And Hla-Drb1, Dylan Thibaut, Connor Sweeney, Shannon South, Mohamed Hussein

Advances in Clinical Medical Research and Healthcare Delivery

Background: Human leukocyte antigen (HLA) class II has shown potential in determining prognosis, understanding medication reactions, and predicting onset of Graves’ disease. The aim of this study is to further investigate the association between Graves’ disease and HLA class II, specifically HLA-DQ and HLA-DR, via meta-analysis to find HLAs that can be further examined for prognostic reasons.

Methods: Statistical analysis was performed to determine if variants of HLA-DQA1, HLA-DQB1, or HLA-DRB1 were associated with significantly altered odds of Graves’ disease. A minimum of three studies pertaining to a particular HLA was required for inclusion. Studies were excluded if …

In Honor Of Our Peer Reviewers, Richard Alweis, Elizabeth Mamo, Christina Goodermote

Advances in Clinical Medical Research and Healthcare Delivery

This editorial is our annual recognition of our peer reviewers.

Interosseous Access Osteomyelitis, Omar Siddiqui, Adnaan Sheikh, Rohail Baig, Harsha Surath, Siri Chadalavada, Firas Siddiqui, Ganesh Arun, Jaskarn Virk, Nikita Shah

Advances in Clinical Medical Research and Healthcare Delivery

Intraosseous (IO) access is a recommended technique in cases of an emergency situation where IV access cannot be obtained. Despite advancements in IO devices and FDA approval of many types of IO devices, it has various complications that although are rare, can be potentially life-threatening. We report a case of acute tibial osteomyelitis in an adult female with a history of polysubstance drug abuse a few weeks after an IO access from a previous hospital stay.

Elevated Troponin In Patients With Intracerebral Hemorrhage, Kaycee Umeoji, Uma Yoganathan, Ann A. Palathingal

Advances in Clinical Medical Research and Healthcare Delivery

Troponin, a known marker for cardiac damage, also plays a role in predicting mortality and morbidity in patients with intracerebral hemorrhage (ICH). Elevated troponin levels have been noted in patients with ICH and studies have shown that such patients are more likely to experience adverse outcomes. The mechanism behind this is suggested to be the release of sympathetic hormones causing myocardial injury. The first differential that often comes to mind when a physician sees an elevated troponin level is a myocardial infarction (MI). In this paper, we present a case of a 54-year-old female who presented to the ED with …

An Invading Stent: Conservative Management Of A Penetrating Splenic Injury By A Migrated Pancreatic Duct Stent, Jay Bapaye, Ahmed Shehadah, Chengu Niu, Anas Hashem, Rutwik Pradeep Sharma, Patrick Okolo

Advances in Clinical Medical Research and Healthcare Delivery

Pancreatic duct (PD) stenting is a common treatment modality for PD calculi or strictures, which are common complications of chronic pancreatitis. PD stent migration is a described complication of the procedure. Penetrating splenic injury may result in life-threatening hemorrhage, often requiring splenic artery embolization or splenectomy. Herein, we describe a unique case of a 49- year-old female with chronic pancreatitis and PD stent who presented with abdominal pain. A computed tomography of her abdomen revealed the distal end of her PD stent to have migrated internally through her spleen with an associated perisplenic fluid collection. After initial clinical stabilization she …

Case Study: Abnormal Presentation Of Infective Endocarditis With Streptococcus Canis And Chiari Network, Shahbaz Afzal, Ryan Russell, Alexander Chekhov

Advances in Clinical Medical Research and Healthcare Delivery

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis …

Metastatic Testicular Cancer Patient With Synchronous Oral Squamous Cell Carcinoma Presented With Gastrointestinal Bleeding: A Case Report, Manar F. Ashour, Sundus Nasim, Hallas M. Kadhim, Maan Faraj, Sylvia E. Eshak

Advances in Clinical Medical Research and Healthcare Delivery

Testicular cancer is a curable oncologic disease of males mostly aged 15-44 years. Most of the patients are successfully treated with radical orchiectomy. However, a delayed presentation may lead to a dismal prognosis. There are several risk factors including cryptorchidism, a first-degree relative with testicular cancer, hypospadias, childhood inguinal hernia, and military pollutant exposure, among others. The distant metastasis of testicular carcinoma to the lung, liver, and brain are widely described. We present a unique case of a 28-year-old male who presented with gastrointestinal (GI) bleeding. Later, it was discovered that he had a metastatic testicular carcinoma synchronous with an …

Mystery Rash: Atypical Presentation Of Suspected Cat-Scratch Disease In Primary Care, Nicole Hunter, Rutwik Pradeep Sharma, Omobolanle Adetimehin, Yasir Loai

Advances in Clinical Medical Research and Healthcare Delivery

No abstract provided.

Comparison Of Pregnancy Complication Rates: Does Opioid Agonist Pharmacotherapy Make A Difference?, Alexa Pfeiffer Oms-Iii, Michael Falcone Oms-Iii, Pritha Aggarwal Oms-Iii, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: Over the past decade, the prevalence of opioid use disorder (OUD) in pregnant patients has increased by 131% with an associated increase in pregnancy complications. Opioid agonist pharmacotherapy (OAP) with methadone or buprenorphine is recommended by ACOG for the management of OUD. The objectives of our study are to compare the incidence of pregnancy complications among patients who at the time of their delivery used OAP, OAP plus any additional substance (OAP+), illicit or prescribed opioids, and no opioids.

Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA, between January 1, 2018, through December …

Evaluation Of Antibody Response To Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) Vaccination In Patients With Lymphoid And Solid Organ Malignancies, Mukul Singal, Sanjana Kalvehalli Kashinath, S. Shahzad Mustafa, Edward Walsh, Karthik Vadamalai, Saad Jamshed

Advances in Clinical Medical Research and Healthcare Delivery

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current COVID-19 pandemic. There is emerging evidence regarding suboptimal response to vaccination against COVID-19 in patients with hematologic and solid organ malignancies.

We conducted a single-center prospective study assessing seroconversion in response to vaccination against COVID-19 in 53 patients with chronic lymphocytic leukemia (CLL), non-Hodgkin’s lymphoma (NHL), multiple myeloma (MM), and solid organ malignancies.

A quantitative immunoassay of IgG antibodies to SARS-CoV-2 Spike (S) protein was measured prior to vaccination and at 2 weeks after completion of two-dose vaccination series. A fourfold increase in antibody titers was considered positive …

Reliability, Validity, And Exploratory Factor Analyses Of Gentrification Health Research Measures, Christopher Williams, Nathaniel Woodard, Charlene Chao-Li Kuo

Advances in Clinical Medical Research and Healthcare Delivery

Background

Gentrification is a type of neighborhood change (NC) that causes demographic shifts and improvement in the built environment. Adverse health outcomes associated with NC have not been consistently established in the literature. Yet, major methodological barriers define this field of study including lack of tailored and culturally relevant measures. This aim of this study was to assess the psychometric properties of novel and adapted NC measures that sought to improve appropriateness for all literacy levels, to enhance survey efficiency, and to assess features of the built environment.

Methods

We conducted a cross-sectional study in a highly gentrifying neighborhood in …

Emergency Medicine Journal Club, Dave 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.