Medicine and Health Sciences Commons^™

The Unusual Suspect: Citrobacter Infection As A Rare Cause Of Renal Abscess, Nismat Javed, Nishant Allena, Sai Allu, Paul Kelly

Journal of Community Hospital Internal Medicine Perspectives

Citrobacter infections have emerged as now a common nosocomial pathogen. Most of the infections manifest in patients with underlying medical conditions. The features of infection can range from infections in the lower urinary tract, respiratory tract, gastrointestinal disease, or bacteremia, however renal abscesses remain uncommon. Here we present the case of a 48-year-old female with medical history of diabetes that presented with a right renal abscess secondary to Citrobacter koseri infection managed with drainage and antimicrobial treatment.

Endocrine Shades Of Silicone Fillers: A Case Of Calcitriol-Mediated Hypercalcemia, Maria Martinez-Cruz, Thayse Lozovoy Madsen-Barbosa, Fidini Antoni, Christopher Haas

Journal of Community Hospital Internal Medicine Perspectives

Background: The inflammatory reaction of foreign body granulomas (FBG) may be so vast that it leads to severe systemic effects. Case Report: A 42-year-old woman was referred to the ED with severe recurrent symptomatic hypercalcemia associated with worsening kidney function. She had presented multiple times with similar complaints. Severe hypercalcemia (13.8 mg/dL) was noted, with appropriately low PTH, elevated PTHrP, low 25-hydroxyvitamin D, and normal 1,25-dihydroxyvitamin D levels. She admitted having significant subcutaneous silicone filler injections in the hips six years prior. Admission workup revealed a normal 25-hydroxyvitamin D, but a marked elevation of 1,25-dihydroxyvitamin D (138 pg/mL). Whole-body PET-CT …

A Rare Case Report Of Hypoketotic Hypoglycemia Induced Seizures Due To Secondary Carnitine Deficiency In A 44-Year-Old Female, Ayrton Bangolo, Nicole Tesoro, Sonia Onyeka, Mary Bangura, Rekha Shrestha, Vignesh K. Nagesh, Roua Alrestom, Joshua Rathod, Eugenio L. Gomez, Youssef Laabidi, Imane Laabidi, Conrad Erikson, Aayat Sheikh, Sharon Maria, Mansi Naria, Erwin J. Tabucanon, Juilee V. Dongre, Auda Auda, Mohammed Jurri, Reshma Radhakrishnan, Hisham Alrefai, Simcha Weissman

Journal of Community Hospital Internal Medicine Perspectives

Carnitine deficiency is a rare metabolic condition that can result in fasting hypoglycemia. Carnitine deficiency could be primary or secondary to other conditions. Among secondary causes, antiepileptics such as valproic acid have been incriminated. Valproic acid is known to deplete carnitine stores and inhibit the process of β-oxidation. Herein we report the case of a 44-year-old female with epilepsy that presented with breakthrough seizures associated with hypoglycemia despite being on appropriate antiepileptic therapy. The patient was later found to have carnitine deficiency. Discontinuation of valproic acid and supplementation with L-carnitine resolved the patient’s hypoglycemia and breakthrough seizures. With this case …

The Not-So-Benign Sickle Cell Trait: A Case Of Renal Medullary Carcinoma, Fatima Halilu, Siddartha Guru, Fuscaldo Joseph

Journal of Community Hospital Internal Medicine Perspectives

Sickle cell trait (SCT) has long been considered a benign carrier state with malarial protection, but carriers can be affected by increased venous thromboembolism, exercise-related injury, renal complications and very rarely a fatal renal malignancy. Renal medullary carcinoma is a very rare and aggressive renal tumor described almost exclusively in sickle cell trait. A review of the current literature provides clues to this link and describes trends expected in these cases. We report a case of renal medullary carcinoma in a 32-year-old female with known sickle trait who presented with cough, hemoptysis, left flank pain and gross hematuria. Initial presentation …

Role Of Artificial Intelligence In Endoscopic Intervention: A Clinical Review, Nismat Javed, Haider Ghazanfar, Bhavna Balar, Harish Patel

Journal of Community Hospital Internal Medicine Perspectives

Gastrointestinal diseases are increasing in global prevalence. As a result, the contribution to both mortality and healthcare costs is increasing. While interventions utilizing scoping techniques or ultrasound are crucial to both the timely diagnosis and management of illness, a few limitations are associated with these techniques. Artificial intelligence, using computerized diagnoses, deep learning systems, or neural networks, is increasingly being employed in multiple aspects of medicine to improve the characteristics and outcomes of these tools. Therefore, this review aims to discuss applications of artificial intelligence in endoscopy, colonoscopy, and endoscopic ultrasound.

Physicians' Perspective On Percutaneous Left Atrial Appendage Closure In Patients With Atrial Fibrillation And Chronic Kidney Disease In Pakistan, Rubaiqa Khan, Malik Faisal Iftikhar, Naveed Hussain, Waleed Abbasi, Jahanzeb Malik, Waheed Akhtar, Amin Mehmoodi, Muhammad Awais

Journal of Community Hospital Internal Medicine Perspectives

This study, conducted in Pakistan, examines the perspectives of 1200 physicians across diverse specialties regarding Left Atrial Appendage Occlusion (LAAO) procedures for atrial fibrillation (AF) patients with chronic kidney disease (CKD). Using a random sampling approach, physicians participated in a survey that assessed their familiarity with LAAO, views on its effectiveness and safety, experience levels, and encountered challenges. The results unveil a spectrum of knowledge levels among physicians, reinforcing the need for tailored medical education and training programs. The majority of patients were between 30 and 49 years old (59.8%). A notable proportion, 33.3%, had limited or no knowledge of …

Impact Of Covid-19 On Food Insecurity And Subsequent Consequences In Post-Secondary Students In The United States: A Systematic Review With Meta Analysis, Meshora Suthanthira, Valerie Cadet

Research Day

Introduction

Food insecurity is a prevalent problem in the United States that affects the livelihoods of many individuals and families. Food security is defined as “a situation that exists when all people, at all times, have physical and social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy lifestyle.” (Committee on World Food Security (CFS), 2012). The purpose of this systematic review is to compare food insecurity and its effects on mental health, physical health, and academics, prior to the start of the pandemic and after stay-at-home …

A Holistic Approach To Idiopathic Intracranial Hypertension Treatment And Management, Roshni R. Patel, Hannah Kruse, Julienne Ryland, L. Michael Waters Jr

Research Day

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri or benign intracranial hypertension, is a neurological condition characterized by elevated intracranial pressure, leading to headache, tinnitus, and transient visual loss. There is currently no clearly outlined pathophysiology; however, IIH predominantly impacts reproductive-aged women who are overweight or obese. The prevalence of IIH is estimated to be approximately 1 in 100,000 individuals. In young females with obesity, the rate increases to 20 out of every 100,000. Beyond its neurological implications, IIH can give rise to psychiatric manifestations over time. The initial presentation of IIH, especially for those experiencing it for the …

Unraveling The Collective Impact Of Health Disparities Associated With Hip Arthroplasty, Tina Alkhazali, Quinn Astrachan, Aribah Ali, Jovante Dockery, Robert Ablove

Research Day

Introduction

Hip arthroplasty, also known as hip joint replacement, is a surgical procedure that significantly improves the quality of life for individuals suffering from severe hip joint dysfunction. However, social determinants, such as ethnicity/race and socioeconomic status (SES), can play a pivotal role in the utilization rate, surgical outcomes, and the postsurgical events. Nearly all past studies have focused on a single social determinant. This narrative review aims to shed light on the existing health disparities in hip arthroplasty utilization and patient outcomes in a comprehensive and collective manner.

Methods

Review was conducted using the OneSearch database with a combination …

The Impact Of Low-Level Laser Therapy With Chronic Genital Lymphedema: A Case Study, Shelley Dicecco, Jennifer Wiley, Katherine Palmer

Research Day

Introduction: Lymphedema is a frequent outcome for people who have undergone cancer treatments due to the damage to the lymphatic system from radiation, chemotherapy, or surgery. Complete Decongestive Therapy (CDT) is the standard treatment for the increased edema and fibrosis resulting from lymphedema and can lower a person’s risk of developing an infection (4). Another possible intervention is using a low-level laser, such as the 904-nm one from RainCorp, to target the fibrotic tissue, leading to tissue breakdown to improve ROM and QOL. Most research on adjunct treatments, like the RianCorp low-level laser therapy (LLLT), that can break down fibrotic …

Microbial Dysbiosis And Nutritional Factors That Promote Remyelination In Multiple Sclerosis, Katherine C. Grant, Francis Jenney

Research Day

Multiple Sclerosis (MS) is an autoimmune disease characterized by the infiltration of peripheral lymphocytes into the central nervous system, resulting in inflammation and demyelination. Microbial dysbiosis has been observed in MS patients and may play a role in the loss of immune tolerance, leading to autoimmunity. Thus, it is believed that the gut microbiota can influence the inflammation seen in MS patients through the gut-brain axis. Diet and nutrition are highly implicated in inflammatory diseases because they can control the abundance of bacterial species and transcription factors and gene expression in host cells, ultimately creating pro-inflammatory or anti-inflammatory immune responses. …

A Case Comparison Of Two Instances Of Idiopathic Intracranial Hypertension, Hannah Kruse, Roshni Patel, Julienne Ryland, L. Michael Waters

Research Day

Idiopathic Intracranial Hypertension (IIH) is a condition in which intracranial pressures become elevated with no clear or obvious cause. While the pathophysiology remains elusive, a multitude of medications, comorbid states, and risk factors have been attributed to IIH. Clinical presentation includes intense headaches with papilledema, tinnitus, and transient vision loss. IIH is a diagnosis of exclusion and patients are often instructed to lose weight and provided medication in the event of flare ups.

Case 1

Patient GA was a 23 year old Caucasian female at the time of diagnosis with a BMI of 34.3 kg/m2. Personal history at the time …

Case Review: Rattlesnake Bite With Compartment Syndrome And Fasciotomy, Darya Hosein, Tracey Bastiaans

Research Day

Introduction: In the United States, approximately 9,000 people suffer from snake bites per year with an estimated five deaths reported annually.1 Majority of venomous snake bites are from one of two broad classes, Crotalinae (pit vipers) or Elapidae (coral snakes). More than 99% of snake bites that occur in the United States are from pit vipers and majority of those are due to rattlesnakes. The presentation of envenomation by one of these classes of snakes is distinctly different from one another and management options rely on discerning the etiology of a patient’s snake bite. 2 The severity of a snake …

A Modern Collared Cementless Femoral Stem For The Arthroplasty Treatment Of Femoral Neck Fractures, Justin T. Butler, Mary Jane Mcconnell, Ryan Decook, Brian Seng, Thomas Bradbury, Brandon H. Naylor

Research Day

Background: The use of cemented femoral fixation during hip arthroplasty for femoral neck fracture (FNF) is often recommended due to a widely reported decreased risk of early perioperative fracture and reoperation. However, newer generation cementless, collared, triple-tapered stems, may offer advantages over more traditional press fit femoral components. The purpose of this study was to investigate the 30-day survivorship of a modern, collared cementless stem when treating FNFs with hip arthroplasty through the direct anterior (DA) approach.

Methods: We conducted a retrospective study of all patients who underwent hemiarthroplasty (HA) and total hip arthroplasty (THA) for isolated displaced FNF between …

Comparing Gait Biomechanics And Function In Children With Bilateral Spastic Cerebral Palsy When Wearing Oskar Afo-Footwear Combination Versus Standard Afo-Footwear Combination: An Exploratory Study, Teresa Pierce

Research Day

INTRODUCTION: Ankle foot orthoses (AFOs) are often prescribed for children with spastic cerebral palsy (CP) to enhance ankle/foot alignment and improve gait. Typical AFOs are made to hold the ankle at a right angle, or plantigrade position, without consideration of structural limitations or musculoskeletal function, causing compensatory gait patterns and compromised foot postures in children with CP with limited gastrocnemius muscle length. Literature suggests that walking ability can be maximized when AFOs are optimized to accommodate for structural limitations and tuned to facilitate a walking pattern that more closely aligns with typical gait parameters. There is limited research examining gait …

A First Year Medical Student Using Omt As An Adjunct Treatment For Managing An 80-Year-Old With Cervical Radiculopathy, Tran M. Vo, Anne K. Belocura, Jessica P. Blakley, Joy Zarandy

Research Day

Introduction

Cervical radiculopathy is commonly attributed to degenerative spinal changes associated with aging. Conservative management with NSAIDS, muscle relaxers, opioids, and glucocorticoids can relieve symptoms, but have inherent risks particularly for patients >65 years-old or with comorbidities like diabetes mellitus. Alternatively, osteopathic manipulative treatment (OMT) is relatively low risk, even when performed by a supervised first-year DO student. One study highlights the overall effectiveness of OMT performed by first- and second-year DO students on family members outside a graded environment. Our case study demonstrates how adjunct OMT in an elderly patient with symptomatic cervical radiculopathy and diabetes mellitus provides symptomatic …

Acquired Reactive Perforating Collagenosis: A Case Report, Neena Edupuganti, Joseph M. Dyer, Onyebuchi Neita

Research Day

Background:

Reactive Perforating Collagenosis (RPC), a subtype of perforating dermatosis, is a rare skin condition in which altered collagen is eliminated through the epidermis. There are two forms of RPC: (1) the inherited form which is very rare and presents in childhood, and in this case (2) the acquired form which presents in adulthood and is associated with systemic diseases, most notably reported being diabetes mellitus and/or chronic renal failure. This case highlights the importance of having a high clinical index of suspicion in patients with systemic disease who present with diffuse pruritic keratotic papules.

Case Presentation:

A 65 year-old …

Masking During The Pandemic: Their Role In Possible Delaying Medical Diagnoses; A Case Report, Sanjana Das, Ryan Kanungo, Ranjita Sengupta

Research Day

Introduction:

The COVID-19 pandemic in 2020 brought a profound global shift particularly in medicine and daily life (2). Within healthcare, masks assumed heightened significance as frontline workers attended to potentially infected/infected patients. Initially, limited data existed on effectiveness, mask types, and ideal duration of use, resulting in a generalized protocol of patients and the healthcare team wearing masks during healthcare visits (3). While serving as a shield against COVID-19, masks also possess the potential to conceal subtle disease indicators present only beneath their covering. Notably, no studies to date have explored whether the widespread use of masks throughout the pandemic …

A “Clot”-Astrophe: Recurrent Dvts In A Pediatric Patient, Pooja Parikh, Erik Zarandy, David Flowers

Research Day

Background:

Thoracic outlet syndrome is largely overlooked in the pediatric population due to its widely varied presentation and not being commonly viewed as a pediatric disorder. This case study will demonstrate an adolescent with recurrent DVTs who was found to have venous thoracic outlet syndrome caused by anatomic compression and an underlying hypercoagulable disorder. The aim of this report is to highlight the presentation of venous TOS in a pediatric patient without a clear anatomic cause or Paget Schroetter syndrome.

Case Presentation:

A 17-year-old Caucasian male with no PMHx presented to the Pediatric ED with 1 day of sudden onset …

Efavirenz, A Cyp46a1 Activator Ameliorates Pathological Neovascularization In A Mouse Model Of Oxygen-Induced Retinopathy, Shubhra Rajpurohit, Josephine M. Rudd, Allston Oxenrider, Ravirajsin N. Jadeja, Menaka C. Thounaojam

Research Day

Introduction: In a prior study, we documented the predominant reliance of the developing retina on the alternate bile acid (BA) synthesis pathway. However, in the context of oxygen-induced retinopathy (OIR) in mouse models, retinal BA synthesis undergoes significant dysregulation, marked by a pronounced reduction in the activity of the key rate-limiting enzyme, Cytochrome P450 enzymes (CYP or P450) 46A1.

Objective: The objective of this current investigation is to assess the impact of efavirenz (EFV)-mediated activation of CYP46A1 on retinal neovascularization in OIR mice, a model representative of retinopathy of prematurity (ROP).

Methods: Seven-day-old (P7) C57BL/6J mice were subjected to the …

Resolution Of Chronic Coccydynia After Osteopathic Manipulative Treatment: A Case Report, Daniel A. Valdés, Meagan Sherrington, L. Michael Waters Jr

Research Day

Coccydynia is characterized by pain or discomfort in the coccyx region, most frequently caused by direct trauma. This condition, exacerbated by sitting on flat or hard surfaces, may cause immobility and adversely impact the daily lives of those afflicted. Standard treatment options include ergonomic adaptations, manual or physical therapy, nerve blocks, or surgery. Currently, there is very little evidence supporting the use of osteopathic manipulative treatment (OMT) as a therapeutic option for patients suffering from chronic coccydynia. The authors describe the case of a 26-year-old female, previously healthy, highly active competitive volleyball player who developed chronic coccydynia following direct trauma …

41-Year-Old Female With Self-Resolving Abdominal Aorta Injury: Case Report, Nicholas Beckmann, Mykenna Nichols

Research Day

Purpose: This case report will analyze current research on the treatment of traumatic aortic injuries and describe the case of a 41-year-old female whose injury healed without intervention with the purpose of furthering knowledge of conservative treatment options for aortic injury.

Materials and Methods: This case study’s methods include a review of published literature on traumatic aortic injuries and a description of a unique case that demonstrates the importance of injury classification and noninvasive treatment.

Results: A 41-year-old female patient with high energy trauma presented with a multifocal low grade (grade 1) abdominal aorta injury which healed without surgical intervention. …

Ebstein’S Anomaly In A Professional Soccer Player: A Case Report, Erik Zarandy, Eldad G. Saler, Saavan S. Boghara, Rithvik R. Sarasani, Vraj N. Patel

Research Day

INTRODUCTION:

Ebstein’s anomaly (EA) is a rare congenital defect involving malformation of the heart’s tricuspid valve. EA is associated with other congenital heart defects as well as increased risk of cardiac arrhythmia. This makes its identification especially important in athletes, as it could lead to sudden cardiac death. In this case, a young professional soccer player was found to have EA with WPW. Our goal is to highlight the appropriate work-up and subsequent treatment and follow-up of a competitive athlete with Ebstein’s Anomaly.

CASE REPORT:

A 20-year-old male professional soccer player received a preparticipation EKG and physical and was noted …

43-Year-Old Female Without Insurance With Progressive Back Pain For Two Years Due To Multiple Symptomatic Tarlov Cysts, Shereen M. Mohammed, Fatema Z. Momin, Joy I. Zarandy

Research Day

Introduction: Tarlov Cysts (TCs) are meningeal cysts that can affect spinal nerve roots, usually in the sacrum. Pathology is largely unclear. Women are twice as affected as men, with increased incidence around 40-50 years old. These cysts are generally asymptomatic and incidentally found on imaging. Estimated prevalence is 4.6%, with approximately 1% of TCs causing nonspecific symptoms like low back pain. Due to its vague symptomatology, TCs are commonly misdiagnosed. Because most TCs are asymptomatic, treatment guidelines for symptomatic cysts are ill-defined; however, surgical removal should be considered for TCs >1.5cm or causing symptoms to prevent possible progression to nerve …

Optimizing Pediatric Care: Bridging Gaps And Addressing Disparities For Children With Disabilities Or Medical Complexities Through Medication Therapy Management (Mtm), Phuongloan Hoang, Drew Mccanless, Seana-Pierre Williams, Rajat Sharma, Mariam-Sere Diaby, Lauren Callaway, Jihui Diaz

Research Day

INTRODUCTION

Children with disabilities and medical complexity require complex medication regimens that are challenging for caregivers when managing medication. We conducted a secondary meta-analysis using data from the National Health Interview Survey (NHIS) to explore medication adherence disparities based on caregivers’ socioeconomic status. Medication Therapy Management (MTM) and similar services have been shown to improve treatment adherence. We aim to investigate the utilization of MTM services among underprivileged communities by developing a structured survey for the target population and aim to examine whether caregivers’ socioeconomic status (SES) impacts medication adherence within our study cohort. Our ultimate goal is to improve …

Where Is The Baby?, Priya Merai, Shree Desai, Rohit Karnati, Sheba Mathew, Fatema Momin, Joy Zarandy, David Adelstein

Research Day

Introduction: People experiencing homelessness can struggle to have basic healthcare needs met due to a variety of factors, potentially resulting in the progression of untreated health issues and development of complications. Since the COVID19 pandemic, rates of homelessness have increased and women are the fastest growing subgroup. Women have a higher need for preventative care, especially when considering reproductive health and gynecologic issues. Health education and treatment, even for seemingly benign conditions, is imperative for improving health outcomes of women experiencing homelessness.

Case description: A 38-year-old woman experiencing homelessness becomes unresponsive, and an onlooker calls 9-1-1. No medical history is …

Quantitative Analysis Of Cadaveric Cervical Lymph Nodes And The Relationship With Cervical Carcinoma Treatments, Samuel Ighodaro, Mierra C. Robinson, Casey Thompson, Shelley Dicecco

Research Day

Introduction

Head and Neck Lymphedema develops most commonly as a secondary effect of cancer and its treatment (Banjdar). The head and neck, or cervical, region contains an intricate network of over 300 lymph nodes and serves as a critical component of the body’s immune system (Peach). Head and cervical lymph nodes are often combined in a total number, therefore this study focused primarily on quantifying the ranges of lymph nodes that are specifically in the cervical region. Knowledge of the anatomic relationships of the lymphatic nodal levels and the structures they drain is critical in the delivery of appropriate therapy …

Compression Garments For Genital Lymphedema: A Case Series, Shelley Dicecco

Research Day

Introduction: Individuals with genital lymphedema can experience gait deviations, urinary/bowel dysfunctions, pain, cellulitis, and reduced quality of life. An important aspect of treatment is the use of compression garments to help with the reduction and/or maintenance phases. It can be difficult to select a compression garment for the genital region due to the function, location, shape, and size of the genitals. The aim of this study was to investigate the ability of off-the-shelf compression shorts with a sex-specific pad insert to maintain the reduction of edema and the health of the tissues for two patients with controlled genital lymphedema. Methods: …

Enhancing Total Hip Arthroplasty Outcomes With Internet-Based Patient Engagement Platforms, Justin T. Butler, Ryan Decook, Joyce Harary, Thomas Bradbury, Charlie Decook, Brandon Naylor

Research Day

Introduction: As Internet-based patient engagement platforms (IPEPs) become increasingly utilized following THA (total hip arthroplasty), a clearer understanding of their role in influencing clinical outcomes is needed. This study aims to determine whether increased patient engagement with an IPEP has notable impacts on patient-reported outcome measures (PROMs) and post-acute care visits.

Methods: This retrospective study analyzed 5,557 patients who underwent Total Hip Arthroplasty (THA) and participated in an Internet-based Patient Engagement Platform (IPEP) from 2018 to 2022. Patients were categorized based on their engagement levels with the IPEP, measured as high or low based on the frequency of interactions. Key …

A Review Of Current Mrna-Based Cancer Vaccinations With Special Consideration For Future Breast Cancer Prevention Strategies, Alexandra She, Alexa Cornwell, Francis Jenney

Research Day

INTRODUCTION: According to the World Cancer Research Fund International (WCRFI), breast cancer (12.5%) has now topped lung cancer (12.2%) as the most prevalent form of cancer in the world (WCRFI, 2022). While therapeutic advances continue to be made, the current treatment of cancer is widely associated with severe side effects from classic therapies such as radiation and chemotherapy. Over the last two decades, studies have examined breast cancer vaccines in pre-clinical and clinical settings. Here, we present an in-depth review of current mRNA-based cancer vaccine literature to assess the prevalence of this technology in this field of medicine. This includes …