Medicine and Health Sciences Commons^™

A Case Of Type 4 Spontaneous Coronary Artery Dissection (Scad), Virginia Gonzalez, Md, Ms, Kashka Mallari, Md, Marina Gonzalez, Md, Svenja Schneider, Md, Sung-Hae Cho, Md, Paulina Gorodin-Kiliddar, Md

The Medicine Forum

A 52-year-old female presented to the emergency department ten minutes after the development of sudden-onset crushing chest pain radiating to both of her arms, associated with dyspnea on exertion. Notably, she reported a several-month history of significant stress caring for her elderly mother with Alzheimer’s disease. On admission, her vital signs revealed sinus bradycardia with a heart rate of 56 beats/min.

The patient reported a past medical history of hypothyroidism, breast cancer status post lumpectomy, nicotine dependence, and anxiety. She did not have a prior history of cardiovascular disease or stroke, nor a family history of premature coronary disease. She …

Evaluating Mortality And Bleeding Risk After Percutaneous Left Atrial Appendage Closure In Atrial Fibrillation: A Propensity-Matched Analysis Using A Multi-Institutional Database, Youssef Elfatatry, Md, Ryan Gardner, Md

The Medicine Forum

Percutaneous left atrial appendage closure (pLAAC) has emerged as an effective treatment strategy for stroke prevention in patients with atrial fibrillation (AF) who otherwise cannot tolerate anticoagulation (AC) therapy. The American College of Cardiology, American Heart Association, American College of Chest Physicians, and Heart Rhythm Society combined guidelines offer a class 2a recommendation to pursue pLAAC in patients with an elevated risk of stroke from AF and a contraindication to oral AC, and a class 2b recommendation for pLAAC in patients with elevated risk of stroke from AF and elevated risk of life-threatening bleeding from AC.¹ The predominant pLAAC …

3d-Printed Coronary Arteries: An Effective Tool In Medical Education, Zachary Pang, Md, Shreyas Chandragiri, Md, Shumpei Mori, Md, Phd, Alexander Hajduczok, Md, Cannon G. Hiranaka, Md, Jesse Ottaway, Md, Zachary Mace, Md, Michael Wong, Md, Tammy Yoshioka, Md, Noah Haroian, Md, Pharmd, Guiyan Zhang, Md, Phd

The Medicine Forum

Anatomy and physiology can be a challenging topic due to their inherent complexity. Anatomy is most effectively learned through a combination of memorization, comprehension, and visualization.¹ Lectures and textbooks provide efficient means for memorization and comprehension but can often be challenging for thee-dimensional (3D) visualization. Conceptualizing 3D structures from two-dimensional (2D) textbook figures poses difficulty for many students. Anatomical education can be accompanied by dissection of cadavers, which can aid in visualization, but can be time-consuming and expensive.² 3D printing technology, however, holds the potential to solve this problem and enhance the anatomical education experience.

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

We are honored to present this latest edition of The Medicine Forum. This platform is in its twenty-sixth year serving as an outlet for our medical community’s scholarly and creative efforts. This year, it has been my pleasure to work with Marc, Marina, Virginia, and Devin on this project. I have not only worked with them on the Forum, but also on the wards. It is impressive to see the same excellence they bring to patient care applied to this academic publication.

This journal serves as a showcase for the efforts of our Department. It is always exciting …

From The Chief Residents, Akash Patel, Do, Ashley Traczuk, Md, Mark Liotta, Md, Claire Zurlo, Md

The Medicine Forum

It is with great pride that we present this year’s edition of The Medicine Forum, a reflection of the passion, intellectual curiosity, and multidimensional talents that define our Internal Medicine residency program.

This journal continues to be more than a collection of case reports and research findings — it is a celebration of who we are as a community. It reflects our shared commitment to inquiry, creativity, and the art of medicine. From the rigor of original research to the introspection of narrative writing and the vibrancy of visual art, this edition captures the full spectrum of our residents’ …

From The Editors, Marina Gonzalez, Md, Virginia Gonzalez, Md, Devin Vasoya, Md, Marc Yorker, Md

The Medicine Forum

It is with great enthusiasm that we present to you the 26th edition of our internal medicine residency journal. As chief editors, we have the privilege of curating the latest insights, research, and reflections from the ever-evolving world of medicine, all to enrich our shared knowledge and foster meaningful discussions within our community.

Over the years, this journal has served as a platform for scholarly exploration, clinical advancements, and the voices of residents shaping the future of internal medicine. With each edition, we strive to uphold the highest standards of academic excellence while embracing the diversity of thought and expertise …

From The Desk Of The Residency Program Director, Christopher Henry, Md. Facp

The Medicine Forum

The Jefferson Forum is a reflection of our residents' dedication to patient care, education, resilience, and research. Within these pages, you’ll find a unique combination of hard work, intellectual curiosity, and personality. As Program Director, I have the privilege of watching their transformation from learners to skilled clinicians and scholars, a journey marked by perseverance and a sense of purpose.

In a time of rapid political and societal change, this publication stands as a testament to our renewed commitment to science, well-being, and the pursuit of knowledge. As physicians and researchers, we remain steadfast in our mission to improve health …

Table Of Contents: The Medicine Forum, Volume 26, 2024-2025

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 26, 2024-2025

The Medicine Forum: Volume 26

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 26, 2024-2025

TABLE OF CONTENTS

• Research Studies
• Case Reports
• Humanities & Reflections

The Status Of Fluoridation

West Michigan District Dental Society Bulletin

The future of community water fluoridation is uncertain amid legal action and federal leadership changes. Fluoridation is still recommended by the federal government, with new research following those recommendations affirming previous findings of safety and efficacy, however dentists remain central to public education and advocacy. A link to updated resources from the MDA is included.

Clinical Corner: Pearls From Local Dentists

West Michigan District Dental Society Bulletin

"Clinical Corner" is a section of the WMDDS Bulletin where local dentists share clinical pearls for fellow practitioners.

Topics for this inaugural edition include correcting deep bites, troubleshooting implant complications, and an option for improving extractions.

Wmdds Bulletin Spring 2025

West Michigan District Dental Society Bulletin

In the Spring 2025 issue, the reader will find the following feature articles:

• Advocacy Avenue: "The Status of Fluoridation"
• "WMDDS at the MDA Annual Session"
• "The Shrinking Stack: A Shift Toward Digital in Dental Publications"
• A NEW and highly requested section, Clinical Corner! Each Bulletin will feature 2-4 pearls of clinical wisdom from local dentists and specialists.

Also included are your monthly tripartite update, news from West Michigan counties, the President's Message and Editor's Letter.

Potential Strategies For Reducing Mortality And Morbidity In Acute Ischemic Cardiogenic Shock, Richard Smalling, James Mccarthy, Tim Henry, Ali Denktas

Journal of Shock and Hemodynamics

Cardiogenic shock is predominantly caused by acute ischemic myocardial injury. Despite advancements in reperfusion strategies, outcomes remain poor, with the duration of ischemia before reperfusion playing a crucial role in the development of irreversible damage. This review synthesizes insights from animal models and human studies, highlighting the limited myocardial salvage beyond 90 minutes of ischemia. In light of the high mortality rates associated with cardiogenic shock, this review proposes re-evaluating pre-hospital fibrinolysis, exploring left ventricular unloading strategies before reperfusion, and assessing the potential role of endothelin antagonists. These approaches aim to improve outcomes in this high-risk population.

Unmasking Myocardial Bridging: Multimodal Imaging And Tailored Medical Approach In Exercise-Induced Angina – A Case Report, M.A. Amico, M. Casini, E.N. Costanzo, M. Moroni, N. Carrabba

Journal of the Saudi Heart Association

Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of a coronary artery runs intramyocardially. We present the case of a 38-year-old male with myocardial bridging in the mid-left anterior descending artery who developed exerciseinduced angina. This case underscores the importance of recognizing MB as a cause of ischemia that should not be overlooked in the diagnostic workup of patients with angina, especially in younger individuals. A comprehensive diagnostic approach, including multimodality imaging, is essential to uncover the pathology. A tailored pharmacological strategy is recommended. Long-term clinical follow-up is crucial for optimizing symptom management and reducing complications.

Assessment Of The Relationship Between Serum Vitamin D Levels And Its Cardiovascular Outcomes: A Systematic Review And Meta-Analysis Study, Reza Madadi, Sina Bakhshaei, Arian Tavasol, Mahmood Gorjizad, Rouhollah Hemmati, Masood Zangi

Journal of the Saudi Heart Association

Introduction: Cardiovascular events are the most common cause of mortality worldwide. Various studies have shown the relationship between serum 25- hydroxyvitamin D [25(OH) D] levels and cardiovascular events. The purpose of this study is to investigate the meta-analysis of the relationship between serum 25(OH) D levels and the risk of cardiovascular diseases (CVD), including stroke, coronary heart disease, peripheral arterial disease, and aortic disease in the population. Method: Using valid keywords and searching the Medline, Science Direct, Scopus, and web of sciences databases, 22 papers were compiled. Data analysis was performed in the group of people with low serum 25(OH)D …

The N-Pact Factor, Replication And Power Associated With Quantitative Research In Physical Activity And Health, Angelina Haidar, Jeffrey J. Martin, Adam J. Martin, Sarah Rogers, Fatemeh Dehghan, Eva Prokesova

International Journal of Physical Activity and Health

Physical Activity (PA) and health science researchers often face challenges related to sample size, which can impact the reliability and generalizability of study findings. The purpose of the current paper is to address these issues by discussing key statistical concepts: effect size and Type I and Type II errors, with a specific focus on examining statistical power and sample size using studies from the Disability and Health Journal (DHJ). We examined research articles published in DHJ over a 15-year period (2008–2022), covering 62 issues and analyzing a total of 1,177 articles. Our analysis revealed that the median sample sizes …

Examining The Anxiolytic Effects Of Flavonoids In Passionflower: A Gut-Brain Axis Perspective, Khelen R. Walsh

PSU McNair Scholars Online Journal

This literature review investigates the influence of Passiflora incarnata on the Gut-Brain Axis, focusing on the role of flavonoids and the specific biological mechanisms involved in this process. The study aims to identify Passiflora incarnata as a practical, non-harmful, and cost-effective alternative to current modern anxiety medications. This study also emphasizes the need for further clinical trials to integrate Passiflora incarnata further into healthcare settings. Using a narrative review approach, this analysis will examine pre-existing empirical articles, all of which have been found on credible sites, are peer-reviewed, and have been published within the past twenty-five years. The data discussed …

Revealing The Role Of Saccharibacteria (Tm7) In The Oral Cavity And Its Potential Applications In Fighting Gum Disease, Tyrese Ostin-Bordeaux

PSU McNair Scholars Online Journal

This study explores the physiology of TM7, a mysterious microbe, in preventing gum disease. A literature review of 42 articles examines TM7's interactions with other microbes, deeming the microbe's behavior could help modulate pathogenic bacteria in the oral cavity as a probiotic.

Sports And Physical Activity Of Poles In The Context Of Good Health And Well-Being As A Sustainable Development Goal, Elżbieta Biernat, Monika Piątkowska, Robert Podstawski

Baltic Journal of Health and Physical Activity

Investing in physical activity (PA) is vital for achieving sustainable development goals. We examine PA trends in Poland using data from Eurobarometer surveys conducted in 2013, 2017, and 2022. In 2022, 64.6% of Poles did not participate in sports, and 41.8% did not engage in non-sport PA. There is a concerning trend of increasing inactivity in sports (Chi²_2022/2017 = 34.64; p < 0.001; Chi²_2017/2013 = 56.98; p < 0.001) and non-sports PA (Chi²_2022/2017 = 18.3, p < 0.01 and Chi²_2017/2013 = 16.95, p < 0.01). Participation in sport and PA is influenced by individual, inter-personal, environmental, political, and global factors. Notably, there is an upward trend in interpersonal (e.g., club membership, volunteering), environmental (e.g., PA in parks/nature, at home), and political (e.g., dissatisfaction with local government actions) factors. Government intervention is crucial and requires: (1) establishment of an institution for leadership and advocacy of PA, (2) adoption of a cross-sectoral approach for a coordinated change, and (3) increased in-vestment in monitoring systems to track the impact of interventions. These actions are essential for fostering a more active and healthier population in Poland.

Psycho-Analysis Will Not Save Us: Reflections On The Gen Z Mental Health Crisis, Victor Dubitans

Middle Voices

Generation Z (born between 1997 – 2012) is characterized as having both unprecedented mental health awareness and unprecedented mental distress. An apparent contradiction with troubling implications for the mental health field: Either the response to the mounting crisis has been insufficient or the field forms part of the problem. Taking seriously Wilks’ (2023) criticism of “therapeutic overreach” of the contemporary mental health field in the lives and development of youth, this paper attempts a selfanalysis and moral inventory about the field’s potential complicity in the crisis and in the history of hysteria. Lacan’s writings on the “analyst’s discourse” are considered …

The Effect Of Finasteride On Parity Rates In Drosophila Melanogaster, Trey Bruno, Carly Turner, Michael Guildin, Carol Mitchell, Dominic Sandell, Alesha Fleming

Beyond: Undergraduate Research Journal

Finasteride has been used to treat male pattern baldness and benign prostate hyperplasia and could potentially treat female pattern baldness and polycystic ovary syndrome. The impact on reproduction in female patients who are taking or have taken finasteride is unknown. Using drosophila melanogaster as a model, this study was designed to investigate the impact of finasteride on female fly reproduction and their offspring. The female flies in this study will be fed dosage equivalents of 0.5 mg, 1 mg, and 5 mg of finasteride, along with a control group of females who consume no finasteride. The flies will be allowed …

Updates In Cryopreservation And Assisted Reproductive Techniques, Maha Abd Aljabbar Al-Sammak

BioMed Visions Journal

Cryopreservation is a crucial part of assisted reproductive technologies (ART) that has developed to maintain gametes and embryos viable for long periods of time. Recent technological developments, such as vitrification and innovative cryoprotectant that have significantly raised pregnancy success rates and enhanced embryo viability are highlighted in this review. The integration of state-of-the-art technology like single-cell sequencing is explored, and persistent issues with genetic stability and cryoinjury are addressed. The necessity for strong international regulations is emphasized in the discussion of ethical issues, especially those pertaining to the long-term storage and use of embryos. These developments are influencing the direction …

Comparative Study Between Multiple Insulin Doses Regimen Versus Twice Daily Regimen In Children And Teenagers With Type One Diabetes In Mosul City, Raghad T. Aziz, Nourhan T. Younis, Sarmad O. Rashid, Zakaria A Kassim

BioMed Visions Journal

Objectives: To evaluate the glycemic control and to identify the possible side effects of multiple insulin regimen versus twice daily regimen among diabetic patients whom visited the endocrine unit at Al Khansa’a Teaching Hospital in Mosul from the 1^st of January 2023 to the end of December 2023.

Methods: This is a cohort descriptive study. Patients case sheets were reviewed to acquire the mandatory information. The questionnaire was composed of two sections, first section included demographic information while the second covered specific diabetes Mellitus information.

Results: Sixty-nine children with type 1 diabetes were included in the study, with …

In Silico Screening For Computational Exploration Of Interactions, Synthesis, And Comparative Evaluation Of Novel Furan-2-Quinolone Derivatives As Potent Anticoagulants, Karm A. Khalaf, Noor A. Majeed, Adnan O. Omar

BioMed Visions Journal

There is an urgent need for the design and development of new and safer drugs for the treatment of (Blood coagulation). New derivatives of furan-2-qoinoline as anti-coagulation drug bearing furan, quinolone, were synthesized with the aim of developing new drug inhibitors (Factor Xa enzyme) respectively. In our study, synthesis of the new organic compounds derived from Furo-2-quinolone substituted by treated with ammonia derivatives like hydrazine, give K6, and (1-Amino-4,6-dimethyl furo[3,2-g] quinoline-2-one) K6 then react with Formaldehyde to form K6a. And evaluated their effects on coagulation in the docking (MCULE). then compared this compound, with the Rivaroxaban. compound give the result …

Public Acceptance, Attitude And Perception Toward Covid-19 Vaccination In Mosul City; Iraq, Nadia Hazem Saied

BioMed Visions Journal

Background: No doubt the recent coronavirus disease (COVID-19) pandemic represents the most serious health and life threats globally. Vaccination against the disease is considered the cornerstone for controlling the disease.

Aim of the study is to explore public attitudes, perception toward vaccination against COVID-19 infection.

Material and methods: A cross-sectional study was conducted by using a modified questionnaire form which was translated into Arabic language and transformed into a Google form. The form was disseminated to the population online using different platforms in Mosul City over a period of one month during November 2021 and the participants were volunteered for …

Top Ten Types Of Childhood Cancer In Nineveh Governorate 2018–2022: A Time Series Analysis, Marab Younis Abdullah Al-Fathy, Ahmed Asaad Hussein, Hiba Farooq Mohamed Ameen, Maan Younis Al-Fathi

BioMed Visions Journal

Background: Childhood cancer incidence and deaths reflects the low health status, which can be prevented by setting upstrategies with help of different sectors in community.

Aim: To describe the childhood cancer in Nineveh governorate during 2018–2022.

Methods: A Biometry study used to review 646 a cancer registration form for five years 2018–2022, using Can-Rej 5 inquiryforms adopted by Ministry of Health measuring [sex ratio, sex and cause specific death rate, the incidence rate, the case fatalityrate, the proportion mortality rate and trend of (occurrences and death)].

Results: The total number of participants was 646, the commonest childhood cancer was among …

The Relation Between Carpal Tunnel Syndrome And Ulnar Nerve Entrapment: An Electrophysiological Study, Mohammed Issa Suleiman

BioMed Visions Journal

Entrapment of the median nerve; carpal tunnel syndrome (CTS), is a common neuropathy that result from compression, ischemia or repetitive movement of the wrist. Ulnar nerve entrapment (UNE) frequency come after the median nerve syndrome, it occurs at the wrist and at the elbow. The neurological finding of median and ulnar nerves compression are presented as a sensory or motor or both.

Aim of the study: To investigate the frequency of carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE).

Material and method: Fifty patients were included in this study suffering from CTS. The patients with the CTS diagnosis through; …

Tomoxifen Mono-Therapy For Breast Cancer In Elderly Women, Shahbaa A Al-Bayati, Taha H Al-Siagh, Faris A Ahmed

BioMed Visions Journal

Background: Tamoxifen is an estrogen antagonist used as neo-adjuvant drug for breast cancer treatment in women.

Objective: To evaluate tamoxifen monotherapy on breast cancer for elderly women with estrogen positive, progesterone positive, and Her2/neu negative.

Materials and methods: Seventeen breast cancer women were examined. The age range of the patients was between 73 and 87 years (mean ± SD: 79.2 ± 3.8 years). The patients were examined and diagnosed by a surgeon, and histopathologic examination. The patients included in the study were estrogen positive, progesterone positive, and Her2/neu negative. The patients were treated with tamoxifen monotherapy 20 mg/day orally during …

Comparative Impact Of Thiazides Vs. Dihydropyridines On Heart Failure Risk In Hypertensive Patients: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials, Safaa M. Alsanosi, Yosra Z. Alhindi

Saudi Toxicology Journal

Background: Uncontrolled hypertension (HTN) is a progressive condition that significantly elevates the risk of heart failure (HF). The selection of antihypertensive agents plays a critical role in modulating HF risk. Thiazide diuretics and dihydropyridine calcium channel blockers (DHPs) are frequently utilized in clinical practice, yet their comparative long-term cardiovascular outcomes, particularly regarding HF incidence, remain underexplored. Methods: A systematic literature review was undertaken, drawing four key databases—MEDLINE, EMBASE, Web of Science, and Cochrane—covering the period from 1994 to October 2024. The scope was limited to randomized controlled trials (RCTs) evaluating thiazides or DHPs, with a minimum of 100 participants diagnosed …

Short-Term Outcomes Of A Comprehensive Rehabiliation Program With Peripheral Magnetic Stimulation In Polyneuropathy: A Case Report, Tuangtip Surarangsit

Chulalongkorn Medical Journal

Polyneuropathy, a condition affecting the peripheral nervous system, often results in sensory and motor dysfunction in older adults. Treatment options include medications and various physical therapy modalities including Peripheral Magnetic Stimulation (PMS). However, evidence supported treating nerve dysfunction with PMS is limited. In this case, an 84-year-old male with a history of diabetes mellitus and osteoarthritis presented with bilateral lower extremity sensory and motor polyneuropathy, experiencing weakness, sensory deficits, and gait instability. After limited success with conventional treatments, a comprehensive rehabilitation program was implemented over four weeks, integrating PMS, occupational therapy, and advanced gait training. Following the intervention, light touch …