Medicine and Health Sciences Commons^™

Metagenomic Characterization Of Gut Microbiota In Children With Autism Spectrum Disorder: Microbial Signatures And Modulation By Anti-Inflammatory Diet And Probiotics, Marysol Valencia-Buitrago, Rodrigo Dias Oliveira-Carvalho, Valbert Cardoso, Jessica Triviño-Valencia, Luisa Matilde Salamanca-Duque, Vanessa Martínez-Díaz, Jovanny Zabaleta, Narmer Fernando Galeano-Vanegas, Carlos Andrés Naranjo-Galvis

School of Medicine Faculty Publications

Background: Autism Spectrum Disorder (ASD) is increasingly associated with alterations in gut microbiota, intestinal permeability, and immune dysregulation. However, integrative studies exploring these mechanisms in Latin American populations are lacking. Objective: To characterize gut microbiota profiles in Colombian children with ASD and evaluate the effects of two microbiota-targeted interventions, an anti-inflammatory diet and a probiotic formulation, on microbial diversity and taxonomic composition. Methods: In a two-phase study, shotgun metagenomic sequencing was performed on fecal samples from 23 children with ASD and 7 typically developing (TD) controls. In the second phase, 17 children with ASD were randomized to receive a 12-week …

The Predilection Of Specific Diseases To Affect Different Sections Of The Esophagus, Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Certain esophageal diseases have a predilection for affecting different parts of the esophagus. This predilection is noted in our clinical practice as we investigate various esophageal diseases using multiple imaging and motility studies, as well as endoscopic procedures with biopsies. Clinical presentations vary with the stage and location of the disease. Clinicians can suspect certain diseases when a particular part of the esophagus is involved and then can perform appropriate investigations. Esophageal diseases with section involvement, with their symptomatology, diagnostic tests, and management, have been discussed in this narrative review. This review aims to revisit those diseases with a current …

09.15.2025 Ored Connect, Liz Williamson

ORED Newsletter

• NIH Common Forms
• ORED Field Fest

Staff Education About Cultural Awareness In A Healthcare Setting, Phylis Titty Tarawally

Walden Dissertations and Doctoral Studies

Summary This quality improvement project was carried out to address a practice gap in culturally responsive care among nursing staff working in a skilled nursing facility. African-American residents often face disparities in healthcare due to staff’s limited knowledge of cultural health beliefs and confidence in engaging with diverse populations. To improve this, an educational intervention was designed using the ADDIE instructional model and evaluated to see if it could enhance staff knowledge and confidence related to African-American cultural practices. The project was guided by the practice-focused question: Will a structured African-American cultural awareness program improve staff knowledge and confidence to …

Early Definitive Fusion Versus Magnetic Growing Rods In "Tweeners": What Do Parents Prefer?, Sylvia Culpepper, Ravi Rajendra, Brett Lullo, Anthony A. Catanzano, Tyler C. Mcdonald, R Carter Clement

School of Medicine Faculty Publications

INTRODUCTION: In treating early-onset scoliosis (EOS), pediatric orthopaedic surgeons and families must often choose between growth-friendly interventions such as magnetically controlled growing rods (MCGR) and early definitive posterior spinal fusion (PSF). While each strategy has associated pros and cons, little is understood about the specific preferences of patients' families. Addressing potential nuances in these preferences is crucial for meaningful shared decision-making (SDM). To better understand the factors influencing family decisions, we conducted a choice-based conjoint (CBC) analysis to explore parents' preferences for PSF and MCGR as treatment options. METHODS: A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) …

Radiosensitization Of Intrahepatic Cholangiocarcinoma And Metastatic Disease In The Liver Using Microbubble Cavitation: Results From A Phase 2 Clinical Trial, Corinne E. Wessner, Tania Siu Xiao, Allison Chang, Jenny Liu, Weelic Chong, Ji-Bin Liu, Kristen Bradigan, Flemming Forsberg, Andrej Lyshchik, Patrick O'Kane, Scott W. Keith, Stephen R. Topper, Kevin Anton, John R. Eisenbrey

Department of Radiology Faculty Papers

Ultrasound triggered microbubble destruction (UTMD) has been shown to sensitize tumors to radiation. This study evaluated the feasibility, safety, and efficacy of using UTMD for radiosensitization in participants with intrahepatic cholangiocarcinoma (ICC) and/or metastatic disease to the liver (MDL) receiving Yttrium-90 transarterial radioembolization (Y90-TARE). This was a prospective single-center IRB-approved clinical trial. Participants received four contrast ultrasound sessions: 1-2 weeks prior to Y90-TARE, 1-4 h post-treatment, and 1 week and 2 weeks post-Y90-TARE. The control group consisted of 1:1 nearest-neighbor propensity score matched historical controls participants that received Y90-TARE as part of standard-of-care. Safety was evaluated through general lab values, …

Setd2 Suppresses Tumorigenesis In A Krasg12c-Driven Lung Cancer Model, And Its Catalytic Activity Is Regulated By Histone Acetylation, Ricardo J Mack, Natasha M Flores, Geoffrey C Fox, Hanyang Dong, Metehan Cebeci, Simone Hausmann, Tourkian Chasan, Jill M Dowen, Brian D Strahl, Pawel K Mazur, Or Gozani

Faculty, Staff and Student Publications

Histone H3 trimethylation at lysine 36 (H3K36me3) is a key chromatin modification that regulates fundamental physiological and pathological processes. In humans, SETD2 is the only known enzyme that catalyzes H3K36me3 in somatic cells and is implicated in tumor suppression across multiple cancer types. While there is considerable crosstalk between the SETD2-H3K36me3 axis and other epigenetic modifications, much remains to be understood. Here, we show that Setd2 functions as a potent tumor suppressor in a KRASG12C-driven lung adenocarcinoma (LUAD) mouse model, and that acetylation enhances SETD2 in vitro methylation of H3K36 on nucleosome substrates. In vivo, Setd2 ablation accelerates lethality in …

Bayesian Clustering Prior With Overlapping Indices For Effective Use Of Multisource External Data, Xuetao Lu, J Jack Lee

Faculty, Staff and Student Publications

The use of external data in clinical trials offers numerous advantages, such as reducing enrollment, increasing study power, and shortening trial duration. In Bayesian inference, information in external data can be transferred into an informative prior for future borrowing (i.e. prior synthesis). However, multisource external data often exhibits heterogeneity, which can cause information distortion during the prior synthesizing. Clustering helps identifying the heterogeneity, enhancing the congruence between synthesized prior and external data. Obtaining optimal clustering is challenging due to the trade-off between congruence with external data and robustness to future data. We introduce two overlapping indices: the overlapping clustering index …

Educational Case: Diabetic Nephropathy, Emily W. Gripp, Joanna Chan

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Primary objective

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see https://www.academicpathologyjournal.org/pcme.

Objective UTK5.4: Diabetic Nephropathy. Describe the pathogenesis of diabetic nephropathy and the associated clinicopathologic features. Competency 2: Organ System Pathology; Topic: Kidney (UTK); Learning Goal 5: Glomerular Disorders.

Secondary objective

Objective CHEM1.5: Renal Disorders. Discuss the …

Case Series: Atrx Variants In Four Patients With Metastatic Pheochromocytoma, Briana Noel Cortez, Mickey J. M. Kuo, Abhishek Jha, Mayank Patel, Jorge A. Carrasquillo, Tamara Prodanov, Kailah M. Charles, Sara Talvacchio, Alberta Derkyi, Frank I. Lin

School of Medicine Publications

Few reports have highlighted the rare presence of somatic ATRX variants in clinically aggressive, metastatic pheochromocytoma/paraganglioma (PCC/PGL); however, none have addressed detailed clinical presentation (including biochemistry and imaging) and management of these patients. Here, we address these clinical features and management based on four PCC patients with somatic ATRX variants from our National Institutes of Health PCC/PGL cohort. A total of 192 patients underwent exome sequencing (germline, somatic, or both), and four males were found to have somatic ATRX variants (with additional somatic VHL and FH oncogenic variants in patients 2 and 4, respectively). Per-lesion and per-patient comparisons were performed …

Reaching International Consensus On The Definition Of Refractory Migraine Using The Delphi Method, Jennifer Robblee, Fawad A. Khan, Michael J. Marmura, Hope L. O'Brien, Lawrence D. Robbins, Marielle K. Samaha, Morris Levin, Simona Sacco, Raffaele Ornello, Stephanie J. Nahas, Heike Hesse, Annika Ehrlich, Adam S. Sprouse-Blum, Christina Sun-Edelstein, Bronwyn Jenkins, Elizabeth K, Seng, Shivang Joshi, Meredith J. Barad, Mi Ji Lee, Sheena K. Aurora, Mario Fernando Prieto Peres

Department of Neurology Faculty Papers

Aim: Despite its frequency in tertiary headache centers, the International Classification of Headache Disorders, 3rd edition (ICHD-3) does not include refractory migraine. Multiple definitions have been proposed with a recent 2020 proposal for both refractory migraine and resistant migraine by the European Headache Federation (EHF). The aim is to reach an international consensus on the definition of refractory migraine.

Methods: This study is a Delphi consensus carried out by a group of international experts in headache medicine. Following a focus group, a panel of 20 experts and one facilitator reviewed the EHF proposed criteria to build upon their definitions. The …

Developmental Transformations Of Purkinje Cells Tracked By Dna Electrokinetic Mobility, Cheryl Brandenburg, Garrett W Crutcher, Andrea J Romanowski, Sarah G Donofrio, Lita R Duraine, Richard N A Owusu-Mensah, Benjamin H Cooper, Izumi Sugihara, Gene J Blatt, Roy V Sillitoe, Alexandros Poulopoulos

Duncan NRI Faculty and Staff Publications

Brain development begins with neurogenesis in progenitor zones and ends with expansive, intricately-patterned cellular diversity in the adult brain. We took advantage of bioelectric interactions between DNA and embryonic tissue to perform "stereo-tracking," a developmental targeting strategy that differentially labels cells at different depths within progenitor zones. This 3D labeling was achieved by delivery of plasmids with distinct electrokinetic mobilities in utero. We applied stereo-tracking with light sheet imaging in the cerebellum and identified that Purkinje cells follow embryonically committed developmental trajectories, linking distinct progenitor zone subfields to the mature topography of the cerebellar cortex. We additionally identified an unexpected …

Regional Citrate Anticoagulation And Infectious Complications In Critically Ill Children And Young Adults Receiving Continuous Renal Replacement Therapy, Katja M Gist, Sai Prasad N Iyer, H David Humes, Stuart L Goldstein, Mihaela Damian, Andrea Cappoli, Catherine Joseph, Danielle E Soranno, Michelle Starr, Ashita Tolwani, Kevin K Chung, Theresa Mottes, Huaiyu Zang, Jangdong Seo, Nicholas J Ollberding, Shina Menon

Faculty, Staff and Students Publications

Introduction: Recent studies have identified an association between regional citrate anticoagulation (RCA) and subsequent infectious complications during continuous renal replacement therapy (CRRT). We aimed to determine if RCA was associated with infectious complications in children and young adults receiving CRRT.

Methods: A secondary analysis of the multinational Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry (34 centers, 9 countries), was performed, including patients from 2015 to 2018. Patients were excluded if they (1) died within 72 h of CRRT initiation, had minor trauma or were postsurgical (analysis 1), or (2) met an exclusion in analysis 1 …

Assessing Morbidity And Malignancy Risk In Patients Presenting With Pulmonary Embolism In An Ambulatory Care Setting, Muhammed Memon, Eram Anwar, Kamran Shakir, Chafik Bouhaddioui, Mueed Akram, Shakeel Awan, Muhammad Khalil, Muhammad Usama, Adnan Agha

Sultan Qaboos University Medical Journal

Objectives: Venous thromboembolism (VTE), especially pulmonary embolism (PE), can be treated in an outpatient setting after appropriate risk assessment. However, front-door physicians may be resistant to follow this practice. The possibility of cancer-associated VTE complicates the outpatient management of PE. This study aimed to assess the morbidity and mortality in patients with PE who were managed in an emergency/acute medicine-led outpatient clinic as per risk stratification as well as detecting diagnoses of new cancer sites (NCSs) in these patients. Methods: This retrospective study included all patients with confirmed PE managed in an acute medicine outpatient setting at Queens Hospital, …

Hematologic And Serum Biochemical Reference Intervals For Formosan Sika Deer (Cervus Nippon Taiouanus) From A Semi-Free-Ranging Population In Taiwan, Chen-Wei Wang, Ke-Lun Chen, Hung-Yi Wu, Chia-Ying Lin

The Thai Journal of Veterinary Medicine

The Formosan sika deer (Cervus nippon taiouanus), an endemic Taiwanese subspecies, holds a pivotal role in local conservation. This study addresses a significant knowledge gap by establishing population-specific reference intervals (RIs) for this species, as existing RIs are based on limited captive populations and may not accurately reflect the health of semi-free-ranging cohorts. We analyzed 632 sampling events from 232 healthy adult deer within Kenting National Park over 12 years (2013–2024). This study adhered to ASVCP guidelines, establishing instrument-specific RIs and employing linear mixed-effects models (LMMs) to evaluate the complex interactions among analytical instruments, sex, and body weight. …

Aphasia In South Asian Languages (Asal) Project: A Protocol Of Connected Speech Tasks For Investigating Cross-Linguistic Grammatical Profiles In Aphasia For South Asian Languages, Arpita Bose, Sakshi Bhatia, Lakshmi Venkatesh, Sayantani Banerjee, Gurujegan Murugesan, Sunila John, Sakshi Upadhyay, Manaswita Dutta, Mythili Menon, Danielle Fahey, Multiple Additional Authors

Speech and Hearing Sciences Faculty Publications and Presentations

Background

Languages vary in their syntactic (e.g. word order in sentences), lexical (e.g. presence of specific word classes), and morphological (e.g. inflectional or derivational forms of words) properties. This cross-linguistic variation in language typology influences the manifestation of agrammatic symptoms. However, most theoretical models of agrammatism are based on English and a few European languages, limiting their generalizability. This narrow focus neglects the rich syntactic, lexical and morphological variations available in languages globally. Clinically, the lack of language-specific characteristics of agrammatic impairments limits translational potential for precise and improved diagnosis. The Aphasia in South Asian Languages (ASAL) project addresses this …

Redefining The Albumin-Bilirubin Score: Predictive Modeling And Multidimensional Integration In Liver And Systemic Disease, Berkay Demirors, Ramin Shekouhi, Paola Berrios Jimenez, Anjali Yadav, Guido Chiriboga, Vishal A. Mahesh, Harsheen K. Manaise, Jade Bowers, Angel Aguayo Merly, Emmanuel Gabriel

School of Medicine Faculty Publications

This editorial comment is on the article by Xu et al. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI’s components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI’s role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily …

Trajectories Of Recovery After Intravenous Propofol Versus Inhaled Volatile Anaesthesia (Thrive) Randomised Controlled Trial In The Usa: A Protocol, Bethany R Tellor Pennington, Laura Swisher, Mara L Bollini, Michael S Avidan, Et Al.

2020-Current year OA Pubs

INTRODUCTION: Millions of patients receive general anaesthesia every year with either propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA). It is currently unknown which of these techniques is superior in relation to patient experience, safety and clinical outcomes. The primary aims of this trial are to determine (1) whether patients undergoing (a) major inpatient surgery, (b) minor inpatient surgery or (c) outpatient surgery have a superior quality of recovery after INVA or TIVA and (2) whether TIVA confers no more than a small (0.2%) increased risk of definite intraoperative awareness than INVA.

METHODS AND ANALYSIS: This protocol was …

Glucometer Cleanliness On A Neuro-Medical Intensive Care Unit, Abbey Camire

Operations Transformation

Glucometers on the Neuro-Medical ICU are being docked with visible reddish/brown residue, indicating they are not properly cleaned beforehand. This poses a risk of transmitting pathogens, endangering patient and staff safety, and violates hospital policy and regulatory standards. Proper disinfection of mobile medical equipment is essential for infection control and hospital accreditation.

Naming Practice Effects And Inconsistencies Relate To Treatment Outcome In People With Aphasia, Janina Wilmskoetter, Katherine Blackwood, Sigfus Kristinsson, Grant Walker, Julius Fridriksson, Deena Schwen Blackett, Dirk B. Den Ouden, Chris Rorden, Argye E. Hillis, Gregory Hickok, Sara Sayers, Leigh Ann Spell, Leonardo Bonilha

Communication Sciences and Disorders Faculty Articles and Research

Background and aims

Method

Isolated Transaminitis As A Sentinel Sign Of Duchenne Muscular Dystrophy In An Infant: A Case Report, Ayesha Khalid, Tuba Chaudhry, Ayesha Liaqat, Lauren Tufts

School of Medicine Faculty Publications

Duchenne muscular dystrophy (DMD) is an X-linked recessive muscular dystrophy (MD) that typically presents after ambulation due to progressive proximal muscle weakness. The average age of diagnosis is 4.83 years. However, there are some subtle signs that can help in early diagnosis and delay the progression of the disease. We present a non-classical DMD case in a six-month-old infant with failure to thrive, persistent emesis, transaminitis, and truncal weakness, leading to an early diagnosis of DMD. Initial workup for failure to thrive was unremarkable, other than persistently elevated liver enzymes aspartate aminotransferase (AST) and alanine transaminase (ALT) with normal alkaline …

Study Of Clinical And Bacteriological Profile Of Culture-Positive Neonatal Sepsis At A Tertiary Care Hospital, Qudsiya Ansari, Vaibhav Pawar, Kailas Randad, Poonam Wade

Digital Journal of Clinical Medicine

Background: Neonatal sepsis is a significant global health challenge, leading to substantial morbidity and mortality among neonates. Its clinical manifestations and causative agents show regional and temporal variations, necessitating localized studies to guide effective management. This study aimed to assess the clinical features, bacteriological profile, and antimicrobial resistance patterns in culture-positive neonatal sepsis at a tertiary NICU. Methods: This retrospective observational study analyzed records of 131 inborn neonates with culture-proven sepsis admitted between April 2019 and March 2020. Data on demographic characteristics, clinical presentations, causative organisms, and treatment outcomes were examined. Antibiotic susceptibility patterns were also evaluated. Results: Of the …

Somatostatin Receptor 2 Overexpression In Hepatocellular Carcinoma: Implications For Cancer Biology And Therapeutic Applications, Servando Hernandez Vargas, Solmaz Aghaamiri, Jack T Adams, Tyler M Bateman, Belkacem Acidi, Sukhen C Ghosh, Vahid Khalaj, Ahmed O Kaseb, Hop S Tran Cao, Majid Momeny, Ali Azhdarinia

The Brown Foundation: Institute of Molecular Medicine

Background: Somatostatin receptor 2 (SSTR2), a G protein-coupled receptor, is overexpressed in multiple malignancies, including hepatocellular carcinoma (HCC). While SSTR2 has traditionally been viewed as an inhibitory receptor involved in suppressing hormone secretion and cell proliferation, emerging evidence suggests a more complex role in cancer biology. However, the functional implications of SSTR2 expression in HCC remain poorly understood. This study aimed to systematically investigate the molecular landscape associated with SSTR2 expression in HCC and evaluate its potential as a therapeutic target.

Methods: SSTR2 expression patterns across 22 tumor types were assessed using TNMplot, and its expression in HCC was further …

Preclinical Perspectives On Disorders Of The Temporomandibular Joint: Tracing The Past, Navigating The Present, And Shaping The Future, John K Neubert, Kyle Allen, Tamara Alliston, Alejandro J Almarza, Kyriacos A Athanasiou, Basak Donertas-Ayaz, Bruna Balbino De Paula, Roxanne Bavarian, Nidhi Bhutani, Brian E Cairns, Robert M Caudle, Yang Chai, Jian-Fu Chen, Yong Chen, Glenn T Clark, Yenisel Cruz-Almeida, Alexandre F Dasilva, Paul L Durham, Airam Vivanco Estela, Millie Embree, Roger Fillingim, Fernando Guastaldi, Shruti Handa, Sunil D Kapila, David Keith, Keith L Kirkwood, Phillip Kramer, Katherine T Martucci, Niall P Murphy, Andrea G Nackley, Richard Ohrbach, Benedikt Sagl, Shad B Smith, Feng Tao, Beth Winkelstein, Hai Yao, Simon Young, Michael S Gold

Faculty, Staff and Student Publications

Temporomandibular disorders (TMDs) are complex conditions characterized by orofacial pain and dysfunction, affecting a significant portion of the population. TMDs may involve joint and/or muscle pain, dysfunction (e.g., noise, limited or altered jaw movements), or both, leading to a marked decrease in quality of life. Patients often experience functional limitations that hinder eating, speaking, and daily activities. Additionally, TMDs are frequently associated with psychological distress, including anxiety and depression, which further impacts overall well-being. Despite the profound individual and societal impact of TMDs, effective therapies remain elusive, partly due to deficiencies in translational research. A primary limitation in the TMD …

Potential For Therapeutic Alteration Of The Underlying Biology Of Epilepsy, Michael R. Sperling, Jurriaan M. Peters, Qian Wu, Michelle Guignet, H. Steve White, Evelyn K. Shih, Leock Y. Ngo, Enrique Carrazana, Adrian L. Rabinowicz

Department of Neurology Faculty Papers

Approximately 30-35% of people with epilepsy experience seizures despite taking antiseizure medications. Recurrent seizures that are independent of status epilepticus can be associated with neuronal injury and structural changes to the brain, as well as diminished cognitive function, mood, and quality of life. A treatment that alters the underlying biology of epilepsy, thereby reducing the seizure burden and its attendant consequences, would be of great value in preventing these detrimental effects. In this review, we summarize preclinical and clinical research on pharmacological treatments that may favorably alter the underlying biology of epilepsy (i.e., disease modification or antiepileptogenesis). A reduction in …

Pediatric Epilepsy Surgery: The Noninvasive Presurgical Evaluation, Deepankar Mohanty, Michael Quach

Faculty, Staff and Students Publications

Background: Drug-resistant epilepsy is a debilitating condition that afflicts individuals across all demographics, including children. The only recourse for many of these individuals is neurosurgery to reduce seizure burden, by either resecting or ablating the cerebral source or modulating it with a stimulator device. In either case, a thorough presurgical evaluation is required to identify brain regions of interest and construct an appropriate surgical plan. The scope of this evaluation has grown rapidly over the years as new and refined techniques have emerged. The aim of this article was to condense the most salient points regarding investigational tools used commonly …

Practice Patterns In The Management Of Pemphigus – An International Survey Study, Idy Tam, Gabriela Cobos, Zachary M. Schwager, Erin X. Wei

The Lahey Journal

Introduction: Anti-CD20 therapy (rituximab) has emerged as an effective and disease modifying treatment for pemphigus, especially in early disease. However, significant variability exists around the clinical application of this therapy.

Methods: In this survey-based study among bullous disease experts, we investigated practice patterns surrounding the use of rituximab in the management of pemphigus. Anonymized surveys were sent to physician members of the internation Pemphigus and Pemphigoid Foundation. Topics of inquiry included the use of rituximab first line in newly diagnosed pemphigus, rituximab dosing regimen, use of concomitant steroid sparing agents, criteria for retreatment, and the use of antimicrobial prophylaxis.

Results: …

Severe Hyponatremia Presenting With Mild Symptoms And Multifactorial Etiology, Nathaniel Lin, Muhammad Cheema, Usman Fahim, Abdullah Ali, Andrew Weber

Journal of Community Hospital Internal Medicine Perspectives

Hyponatremia is a common electrolyte disturbance; however, serum sodium level of 99 mEq/L without severe symptoms or known duration is rare and noteworthy. We report a case of an 87-year-old female who presented with fatigue, decreased appetite, and mild emesis for the past 2 days in which blood work revealed a serum sodium level 99 mEq/L. The etiology of hyponatremia in an elderly patient may be complex due to higher likelihood of co-morbid medical conditions. Additionally, syndrome of inappropriate antidiuretic hormone (SIADH) can pose a diagnostic challenge as fewer than 50% of patients have typical lab results that confirm the …

Bilateral Pulmonary Embolism With Bi-Atrial Cardiac Thrombi Entrapped In A Patent Foramen Ovale, Denise Mourad, Fahd Eissa Mohamed, Yashi Ballal, Elie Mrad, Natasa Petreska, Sachin Singh, Paritharsh Ghantasala

Journal of Community Hospital Internal Medicine Perspectives

Bi-atrial thrombi with bilateral pulmonary embolism (PE) through a patent foramen ovale (PFO) is rare and life-threatening, requiring urgent management due to embolization risk. We present a 53-year-old female with left lower extremity extensive deep vein thrombosis (DVT), bilateral PE, and bi-atrial thrombi straddling a PFO. She underwent thrombectomy, PFO closure, and pulmonary embolectomy but later experienced recurrent DVT and PE. Anticoagulation was limited due to bleeding risk given a recent neurosurgery. Literature lacks clear guidelines for managing such cases necessitating individualized treatment. This case highlights the complexity of bi-atrial thrombi with PFO and the need for further research to …

Investigation Of The Optimal Length Of Discharge Summaries In Care Transitions: A Cross-Sectional Study, Taku Harada, Shintaro Kosaka, Aki Morishima, Seitaro Iguchi

Journal of Community Hospital Internal Medicine Perspectives

Introduction

Discharge summaries are essential documents that support continuity of care during patient transitions between inpatient and outpatient settings. They help ensure that crucial clinical information is conveyed accurately and completely. However, while their clinical significance is well established, there is little consensus on the optimal format, particularly in terms of length and structural clarity. Excessively brief summaries may omit key details, while overly lengthy ones can hinder efficient information transfer. Despite varied suggestions in the literature—ranging from half a page to four pages—empirical data on physician preferences are limited.

Methods

We conducted a cross-sectional, web-based survey among physicians who …