Medicine and Health Sciences Commons^™

Women's Preferences For Home-Based Self-Sampling Or Clinic-Based Testing For Cervical Cancer Screening, Joël Fokom Domgue, Monalisa Chandra, Olajumoke Oladoyin, Manali Desai, Robert Yu, Sanjay Shete

Faculty, Staff and Student Publications

Importance: While home-based self-sampling for cervical cancer screening is an evidence-based strategy proven to increase screening access and uptake, it is not currently recommended in the US despite recent Food and Drug Administration approval of the first at-home self-sampling device. Little nationally representative research has examined preference for and drivers of home-based self-sampling over clinic-based testing (the standard of care).

Objective: To assess women's perspectives about, reasons for considering, and factors associated with preferring at-home self-sampling for cervical cancer screening.

Design, setting, and participants: This population-based cross-sectional study used data from the 2024 Health Interview National Trends Survey (HINTS 7), …

Osimertinib Activates A Tgf-Β2-Dependent Secretory Program That Drives Lung Adenocarcinoma Progression, Madhurima Ghosh, Chao Wu, Abhishek Kumar, Monique Nilsson, John V Heymach, Weina Zhao, Jiang Yu, Xin Liu, Na Ding, Shike Wang, Guan-Yu Xiao, Angelo Chen, Kate Grimley, William K Russell, Chad J Creighton, Xiaochao Tan, Jonathan M Kurie

Faculty, Staff and Student Publications

EGFR-mutant lung adenocarcinomas (LUADs) that are vulnerable to the EGFR antagonist osimertinib (Osi) eventually relapse, owing in part to the emergence of drug-tolerant persister (DTP) cells that arise through epigenetic mechanisms. Intratumoral DTP cells can herald a worse clinical outcome, but the way in which DTP cells influence LUAD progression remains unclear. Osi-resistant (OR) cells exhibit typical DTP cell features, including a propensity to undergo senescence and epithelial-mesenchymal transition (EMT), which can activate heightened secretory states. Therefore, we postulated that OR cells influence LUAD progression through paracrine mechanisms. To test this hypothesis, we utilized congenic pairs of EGFR-mutant LUAD cell …

Dispersion-Enhanced Nitrogen-Centered Photocatalysis Of The Direct Hydrogen Atom Transfer, Jiasong Zhang, Kaitong Zhuang, Ramon Trevino, Babu Raj Dhungana, Huiying Sun, Shuyu Yin, Yuting Li, Jacob A Sanchez, Xiaoyu Xia, Ramy Elerian, Yao Sun, Seth O Fremin, Chao Huang, Min He, Maosheng Cheng, Oleg V Larionov, Shengfei Jin

Faculty, Staff and Student Publications

The development of structurally distinct and modular photocatalysts for direct hydrogen atom transfer (HAT) has emerged as a key frontier in radical-mediated C-H functionalization of strong carbon-hydrogen bonds. Despite the largely untapped potential across the fields of organic synthesis, medicinal chemistry, and materials science, few classes of direct HAT photocatalysts are currently known, and the approaches to enhancing their photocatalytic activity remain underdeveloped. We report herein the development of nitrogen-centered direct HAT photocatalysts based on the acridine framework, which leverage a C9-ortho-biaryl substituent for enhancing the photocatalytic activity through stabilizing dispersion interactions with the substrate as the key steering effect. …

The Impact Of Vascular Management On Postoperative Complications In Patients Undergoing Surgery For Retroperitoneal Leiomyosarcoma, Neha Malik, Seokhun Kim, Christopher P Scally, Emily Z Keung, Heather Lillemoe, Keila E Torres, Kelly K Hunt, Sophia Khan, Christina L Roland, Heather G Lyu

Faculty, Staff and Student Publications

Background: Retroperitoneal leiomyosarcomas are aggressive malignancies. Complete surgical resection with negative margins is crucial to decrease the risk of recurrence but can be risky due to vascular involvement. The aim of our study was to evaluate the different approaches to IVC and renal vein management and their impact on postoperative complications.

Methods: We performed a retrospective review of patients who underwent surgery for retroperitoneal leiomyosarcoma with IVC and/or renal vein involvement at our institution from 2016 to 2024. Patients were stratified by intraoperative vascular management, including ligation only versus varying forms of vascular reconstruction. Postoperative complications, including bleeding, transfusions, the …

Clinician Perceptions Of Barriers And Strategies To Improve Pediatric Hypertension Detection, Abbas H. Zaidi, Erica D. Sood, Sarah De Ferranti, Fabliha Khurshan, Samuel Gidding, Varsha Zadokar, Jonathan M Miller, Anne E Kazak

Department of Pediatrics Faculty Papers

IMPORTANCE: Pediatric hypertension remains underrecognized despite its high prevalence (approximately 5%) and long-term cardiovascular implications. Although guidelines for screening and diagnosis exist, less than 25% of affected children are diagnosed, and more than half do not receive timely follow-up care. Clinician-specific implementation barriers and directly informed strategies, which may alleviate this gap, are insufficiently described.

OBJECTIVE: To identify clinician-reported barriers and actionable recommendations to improve pediatric hypertension detection and follow-up in primary care using the Consolidated Framework for Implementation Research.

DESIGN, SETTING, AND PARTICIPANTS: Semistructured qualitative interviews were conducted between November 1, 2022, and March 31, 2023, with health care …

Mapping The Causal Chain From Genetic Risk Variants To Lipid Dysmetabolism In Parkinson’S Disease, Ruth B De-Paula, Jonggeol Kim, Herve Rhinn, Hiba Saade, Fatima Chavez, Téah Segura, Maria Valeria Lozano, Michelle Etoundi, Karla Silos, Naomi Kass, Viktoriya Korchina, Harshavardhan Doddapaneni, Eric Venner, Joseph C Masdeu, Valory Pavlik, Melissa M Yu, Chi-Ying R Lin, Joseph Jankovic, Aron S Buchman, Donna Muzny, Richard A Gibbs, Sarah H Elsea, Asa Abeliovich, Peter Lansbury, Nora Vanegas-Arroyave, Chad A Shaw, Joshua M Shulman

Faculty, Staff and Students Publications

The molecular pathways linking genetic variants to Parkinson's disease (PD) onset and progression remain incompletely defined; however, risk alleles in multiple genes, including GBA1, strongly implicate lipid metabolism. To systematically identify causal biomarker signatures, we analyzed comprehensive metabolome profiles from blood plasma in 149 PD patients and 150 controls, along with complementary genetic, RNA-sequencing, and metabolic data from other available clinical and pathologic cohorts. Using colocalization and summary-data-based Mendelian randomization, we tested whether expression and metabolic quantitative trait loci mediate the association between implicated genetic variants and PD risk. We further integrated differential metabolomics and proteomics from blood and brain …

Clinical Features Of Infantile Epileptic Spasms Syndrome: A Systematic Review, Xiao Meng, Danielle S Takacs, Yashaswini Kelagere, Zihan Zhang, Sanjanaa Seshadri, Jiyeon Cha, Ming Li, Lei-Shih Chen

Faculty, Staff and Students Publications

Introduction

Infantile Epileptic Spasms Syndrome (IESS) is a severe epilepsy in children between one month and two years of age. Urgent referral of possible IESS cases from pediatricians and family physicians who care for children to neurologists for diagnosis and treatment has been shown to significantly improve patient health outcomes. Yet, a comprehensive list of IESS clinical features is lacking. We conducted a systematic review of studies to report IESS clinical features.

Methods

Articles from the MEDLINE Complete and Embase databases were searched from the earliest years of databases availability (1979) to July 31, 2024. We followed the Preferred Reporting …

Midlife Wellness: Building Healthy Lifestyle Habits To Ensure Quality Of Life, Naomi Brower, Elizabeth Davis

All Current Publications

Life expectancy has increased significantly, but women often spend their later years in poor health unless they take proactive steps to build healthy habits early. This fact sheet provides information on healthy habits women can develop to help manage hormonal changes during perimenopause and menopause and reduce long-term health risks.

National Landscape Of Pediatric And Adult Inpatient Sickle Cell Disease Care, Ashley M. Jenkins, Spoorthy Vangala, Matthew Mcintosh, Robert Legros, Sophie Lanzkron, Kevin Fiscella

Department of Medicine Faculty Papers

No abstract provided.

The Use Of Acupuncture To Address Health Disparities In The Treatment Of Low Back Pain, Vivian Li, Alexander Reals, Deepa Manda, Elizabeth Loomis

Advances in Clinical Medical Research and Healthcare Delivery

Low back pain (LBP) is a leading cause of disability, and treatment often involves a combination of pharmacological and non-pharmacological therapies. Acupuncture is a medical treatment and ideology rooted in traditional Chinese medicine that utilizes applying small needles or pressure to specific points in the body. Utilized as an adjunct to supplement standard medical care, acupuncture is a procedure that can be done in a primary care setting. Multiple studies have shown efficacy in treating acute or chronic back pain, with up to 1.5% of the US population having used acupuncture at one point.

In the pursuit of holistic health, …

Evidence Based Management Of High Ldl-C For Prevention Of Atherosclerotic Cardiovascular Disease In Adult Patients In Resident Run Clinic: A Qi Project, Astha Prasai, Sahej Manesh Singh Arora, Hafsa Jawaid, Aakriti Jain, Omofolarin Babayale, Nauman Naeem, Hina Ukrani, Nawid Latifi, Binita Neupane, Soon-Il Song, Gaurav Sharma

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide and in the United States, with significant healthcare and economic burden. Despite clear guideline recommendations, the implementation of ASCVD risk assessment and statin use for primary prevention remains suboptimal.

Methods:

A quality improvement project was conducted at a resident run clinic with an objective to improve ASCVD risk documentation and guideline-based lipid management. A total of 600 patients aged 40-75 years without a history of cardiovascular disease were randomly selected- 300 in the pre-intervention group and 300 in the post-intervention group. The intervention included didactic sessions and quick …

Rare Event: Neonatal Anaphylaxis Following Hepatitis B Vaccination – A Case Series From A Tertiary Care Center In India, Aarthi Ma, Revanth R

Advances in Clinical Medical Research and Healthcare Delivery

We report two cases of anaphylaxis following Hepatitis B vaccination in one-day-old neonates at a tertiary care hospital in India. Both cases presented with similar patterns of cutaneous reactions and respiratory symptoms shortly after intramuscular administration of the Hepatitis B vaccine. To our knowledge, this is among the few documented case series of neonatal anaphylaxis post–Hepatitis B vaccination, underscoring its rarity yet clinical importance. The cases highlight the critical importance of vigilant post-vaccination monitoring and prompt recognition of vaccine-associated adverse events in neonates. This report reviews current literature on anaphylaxis following vaccination and discusses optimal management strategies.

An Exploratory Study Of Social Determinants And Pediatric Lead Exposure In Chemung County, Ny, Jenna Mccracken, Anika Stundtner, Megan Kerbag, Madison Desantis, Jennifer Coseo, Richard Terry

Advances in Clinical Medical Research and Healthcare Delivery

Background: Lead exposure in children is a persistent public health concern due to its irreversible neurological and developmental effects. Children under 6 years old are particularly vulnerable due to frequent hand-to-mouth activity and increased environmental exposure. Existing literature suggests a relationship between adverse social determinants of health (SDOH), such as low parental education and residence in high-poverty areas, and elevated pediatric blood lead levels (BLLs). This study, subsidized through a community service grant from Excellus Blue Cross Blue Shield, aimed to examine the association between BLLs and SDOH among children screened at the ACCEL Community Health Clinic in Chemung County, …

Hallucinations And Diabetes – Could It Be The Hip? An Interesting Case Of Cobalt Poisoning, Mahrukh Tariq, Zauraiz Anjum

Advances in Clinical Medical Research and Healthcare Delivery

Cobalt (Co) poisoning has been described historically in beer-drinkers when cobalt was used as an additive. In present times, this type of poisoning is usually caused by occupational exposure or metal prosthesis breakdown. We present a case of Co poisoning from metal prosthesis breakdown with exceptionally high levels, and thus, some unique symptoms. Interestingly our patient not only had symptoms commonly associated with Co poisoning, e.g., paresthesia, sensory-neural hearing loss, acute kidney failure, but also developed new onset diabetes, which is not commonly associated with this type of pathology. Moreover, when we had this patient under our care, we had …

Late Bioprosthetic Valve Migration- A Rare Entity After Tavi, Sahej Arora, Ghazi Khan, Jeremiah Depta

Advances in Clinical Medical Research and Healthcare Delivery

We present a case of hemolytic anemia due to a rare complication of late bioprosthetic valve migration, who underwent successful treatment with valve in valve transcatheter aortic valve implantation. Our patient with symptomatic moderate aortic stenosis underwent the index procedure a year ago and treated for bacteremia 3 months ago, presented with hemolytic anemia and echocardiography revealing aortic paravalvular leak. The hemolysis was attributed to Bioprosthetic valve dysfunction after a negative hematological workup. The patient's aortography revealed ventricular migration of the valve, not seen on a cardiac CT scan performed before. This was followed by a successful valve in valve …

Neuroinflammation And Its Role In Depression– A Review Of Emerging Biomarkers And Therapeutic Targets, Sophia M. Valerino

Advances in Clinical Medical Research and Healthcare Delivery

Major depressive disorder (MDD) is a prevalent and debilitating mental illness that affects millions globally. Traditionally, the pathophysiology of MDD was thought to be due primarily neurotransmitter imbalances. However, emerging research highlights the role of neuroinflammation in MDD pathogenesis. Elevated levels of pro-inflammatory cytokines, microglial activation, and blood-brain barrier dysfunction have been implicated in the etiology of MDD. Additionally, biomarkers such as C-reactive protein and neuroimaging findings further support the neuroinflammatory hypothesis. This growing body of evidence has led to increased interest in novel treatment approaches, including anti-inflammatory medications and lifestyle interventions, as potential therapeutic strategies. While selective serotonin reuptake …

Prompt Thyroid Hormone Replacement Reversing Severe Bradycardia & Syncope, Cassie R. Girardin, George Vega, Rohail Baig

Advances in Clinical Medical Research and Healthcare Delivery

Thyroid disease, particularly hypothyroidism, can significantly affect the cardiovascular system, leading to structural, functional, and conduction abnormalities. Hypothyroidism decreases inotropy and chronotropy and may cause bradycardia or conduction defects. Although these changes are typically reversible with thyroid hormone replacement, severe cases may necessitate pacemaker placement. This case describes an 82-year-old female with hypothyroidism, atrial fibrillation, and left bundle branch block (LBBB) who presented with recurrent syncope due to hypothyroidism-induced bradycardia with sinus pauses. Her symptoms resolved with thyroid hormone optimization, highlighting the importance of prompt recognition and treatment of hypothyroidism-related cardiac manifestations to prevent unnecessary pacemaker implantation.

Diagnostically Complex Case Of Trivalvular Infectious Endocarditis Complicated By Hiv, Hcv, Pulmonary Septic Emboli, And Epidural Abscess, Madison Baker, Natasha Singh, Rohail A. Baig, Justin Nistico

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Infective endocarditis (IE) can be visualized on echocardiograms. However, there is a significant discrepancy between transthoracic and transesophageal echocardiograms. This imaging modality is also impacted by operator dependent factors. The risk of right sided endocarditis is elevated in people who inject drugs (PWID). In individuals with human immunodeficiency virus (HIV), there is an increased risk of IE, and there is also a relationship that has yet to be fully established between hepatitis C virus (HCV) and IE.

This report describes a woman with a history of IVDU who was diagnosed with HIV/AIDS, HCV, and sepsis secondary to methicillin-resistant Staphylococcus …

A Rare Case Of Gastrointestinal Stromal Tumor Outside The Gastrointestinal Tract, Ashton I. D'Souza, Jasdeep S. Bajwa, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Extra-gastrointestinal stromal tumors are rare mesenchymal tumors occurring outside the gastrointestinal tract, comprising ~5% of all gastrointestinal stromal tumors. A 65-year-old man undergoing evaluation for nephrolithiasis was incidentally found to have a 7.2 cm mesenteric mass proven to be gastrointestinal stromal tumors on biopsy. After limited response to imatinib, the patient underwent successful surgical resection. Mesenteric gastrointestinal stromal tumors often present larger and more aggressive, but in this instance, early incidental detection permitted effective intervention. This case highlights the diagnostic challenges posed by extra-gastrointestinal stromal tumors due to their atypical location and nonspecific symptoms. Extra-gastrointestinal stromal tumors should be considered …

Successful Rituximab Therapy In Igg4-Related Sclerosing Mesenteritis, Sanjana L. Thimmannagari, Shiamak Cooper, Annie H. Yang, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly common autoimmune, multiorgan fibro-inflammatory disorder. Its involvement of organs like the pancreas, lacrimal glands, salivary glands and kidneys is well known but IgG4RD presenting as sclerosing mesenteritis is a rare entity. On imaging, it presents as a mesenteric mass and biopsy is the gold standard for confirmation as elevated serum IgG4 levels are unreliable to establish the diagnosis. Here we report a previously healthy 33-year-old African American female who presented with one week history of generalized abdominal pain. Imaging studies revealed a mass within the mesentery and post-operative biopsy of the mass confirmed …

A Rare Case Of Lithium Toxicity Inducing Complete Heart Block And Nephrogenic Diabetes Insipidus, Rohail A. Baig, Gurtej Dhaliwal, Nimra Shafi, Omar Siddiqui, Michelle L. Malnoske

Advances in Clinical Medical Research and Healthcare Delivery

Lithium is a commonly utilized mood stabilizer for the treatment of bipolar disorder. Although it is efficacious, elevated levels may lead to neurologic, cardiac, nephrogenic, and gastrointestinal side effects. Management of severe lithium toxicity has been an evolving topic of debate in terms of its clinical management. We report a case of a 23-year-old female who presented to the emergency department with severe lithium toxicity, who needed intensive intervention and a critical level of care. This case provides an example of how utilizing standardized care algorithms may provide great benefit to clinicians managing lithium toxicity in emergencies and critical care …

A Minimally Invasive Palliative Approach Using Radiofrequency Ablation And Cementoplasty In A Painful Metastatic Acetabular Lesion, Liliya S. Agarkov, Korinne Diss, Garrett C. Schneider

Advances in Clinical Medical Research and Healthcare Delivery

Up to 75% of patients with advanced metastatic disease experience excruciating pain that affects their daily life. We elaborate on a case of a 63-year-old male with Stage IV squamous cell lung carcinoma with advanced osseous metastatic lesions who presented with symptoms of ambulatory dysfunction due to a lesion in the right acetabulum. This case report demonstrates how radiofrequency ablation can offer pain relief through meticulous ablation of a metastatic lesion without the necessity and negative side effects of external beam radiation.

Gabapentin Induced Seizures: A Rare Presentation Of Toxicity, Muhammad Umer Mukhtar, Akaansha Varma, Abdullah M. Firoze Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Gabapentin is a medication used for the management of neuropathic pain, focal seizures, and several other medical conditions. We report a case of a young male who experienced generalized tonic clonic seizures following the intentional ingestion of 31 grams of gabapentin. This case describes an unusual manifestation of gabapentin toxicity, namely seizures, and highlights the overdose of gabapentin for recreational purposes. Furthermore, this report emphasizes the rising misuse of gabapentin and underscores the importance of providers remaining vigilant in recognizing potential substance use disorders.

Idiosyncratic Drug Induced Liver Injury Secondary To Ciprofloxacin: A Reminder To Always Check Medication History, Xavier Zonna, Conor Banta, Erika Anson Md

Advances in Clinical Medical Research and Healthcare Delivery

A 38-year-old Caucasian male with no significant past medical history presented to the emergency department with complaints of nausea, vomiting, abdominal pain, and jaundice of 2 days duration. He noticed this in addition to pruritus, fever, and malaise. He had severe transaminitis and hyperbilirubinemia on laboratory evaluation. He was admitted for acute liver injury of an unknown etiology. He had taken a course of ciprofloxacin days prior to presentation for UTI at an outlying facility. Serologies were also concerning possible autoimmune liver disease with elevated Anti-Nuclear Antibody and equivocal Anti Smooth Muscle Antibody. Liver biopsy was negative for any autoimmune …

Rare Presentation Of Omental Tuberculosis With Drug-Induced Jaundice In A Teenage Female: A Case Report, Archana Venkatesan, Krishna Ravi

Advances in Clinical Medical Research and Healthcare Delivery

Omental tuberculosis (TB) is a rare form of abdominal TB, often presenting with nonspecific symptoms that mimic malignancies. We report a case of a 16-year-old female from India who presented with abdominal distension, vomiting, weight loss, and amenorrhea. Imaging revealed an abdominal mass, and a diagnosis of omental TB was confirmed via histopathology. This case highlights the diagnostic challenge posed by such atypical presentations, especially in TB-endemic regions. The patient also developed rifampicin-induced jaundice, which resolved upon drug cessation and supportive care. Anti-TB therapy was cautiously reintroduced at a modified dose. This report underscores the need for high clinical suspicion, …

Literally Heartburn: A Case Report Exploring Potential Preventive Measures Of Esophageal Injury After Radiofrequency Ablation For Atrial Fibrillation, Venkat Arutla, Chengu Niu, Prajjwol Bhatta, Basil George Verghese

Advances in Clinical Medical Research and Healthcare Delivery

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal …

Bilateral Nephrectomy For Refractory Hypertension In A Patient With Esrd On Intermittent Hemodialysis, Kavya Balusu, Vijay Sheldon, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

In nearly 20 percent of patients with end-stage renal disease (ESRD), hypertension remains poorly controlled despite pharmacological therapy and volume reduction through dialysis. Further, morbidity from hospitalization for hypertensive crisis is significantly higher in patients with ESRD than in patients without ESRD. For those who fail conventional therapies for hypertension, therapeutic bilateral nephrectomy can be considered as a last resort option. With appropriate candidate selection, patients are expected to have improved quality of life. We describe the case of a 37-year-old African American male with ESRD on intermitted hemodialysis who underwent bilateral nephrectomy for the management of hypertension refractory to …

Bilateral Congenital Radioulnar Synostosis - Case Report, Derek A. Diangelis, Matthew J. Hudson

Advances in Clinical Medical Research and Healthcare Delivery

A 2-year-old male presented to an orthopedic outpatient office due to a supination defect in both of his upper limbs. X-rays of the affected limbs revealed fusion of the proximal radioulnar joints indicating congenital radioulnar synostosis (CRUS). CRUS is abnormal development of the upper limbs occurring during weeks 3—7 of embryological development. Causes of CRUS include genetic syndromes and spontaneous mutations. Treatment options include nonoperative and surgical treatments, however, treatment is controversial due to a lack of clinical evidence. Proposed screening methods could help improve detection rates and improve clinical management. This report aims to increase awareness of CRUS and …

Pembrolizumab-Induced Primary Adrenal Insufficiency: A Rare But Life-Threatening Endocrine Irae, Syeda Sarah Raza, Mehr A. Orakzai, Abdullah A. Orakzai

Advances in Clinical Medical Research and Healthcare Delivery

Pembrolizumab, a PD-1 checkpoint inhibitor, is widely used in the treatment of various malignancies. While it improves overall survival, it can lead to immune-related adverse events (irAEs), including rare endocrine disorders such as primary adrenal insufficiency (PAI). We present a case of PAI induced by Pembrolizumab in a 75-year-old man, emphasizing the importance of early recognition and timely management.

‘Is The Patient Clear For Surgery?’ Takotsubo Cardiomyopathy Presenting As T-Wave Inversions In A Pre-Operative Ekg: A Case Report, Muhammad Hammad Sharif, Madeeha Khaleeque, Syed Faiz Abbas, Gaurav Sharma, Aditya Sanjeevi, Muhammad Hassan Jan, Atif Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Takotsubo cardiomyopathy (TC) can cause dynamic changes in the electrocardiogram (EKG) and troponin elevation which can be misinterpreted as an acute coronary event that can cause an unnecessary delay in the surgery and affect the outcomes of a non-cardiac surgery. We present a case of a patient with pre-operative T-wave inversions diagnosed with TC. A 90-year-old female presented with a femur fracture. Pre-operative EKG showed symmetric T-wave inversions in the inferior and pre-cordial leads. Delta troponin was unremarkable and she remained chest pain-free. Transthoracic echocardiogram (TTE) showed an ejection fraction of 60% with apical ballooning and basal hyperkinesis concerning for …