Diseases Commons^™

Prevalence And Clinical Correlates Of Restless Legs Syndrome In Neuromyelitis Optica Spectrum Disorder: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

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Background: Restless legs syndrome (RLS) is increasingly recognized in neuromyelitis optica spectrum disorder (NMOSD), yet published prevalence estimates remain highly variable, largely because of small sample sizes and methodological heterogeneity. We sought to estimate the pooled prevalence of RLS in NMOSD using published observational studies. Methods: A systematic literature search of PubMed was performed using the terms “restless legs syndrome” AND “neuromyelitis optica spectrum disorder”, identifying all original studies reporting RLS prevalence in NMOSD. Seven studies (2016–2026) met inclusion criteria. Study‑level data on RLS events and NMOSD sample size were extracted. A proportion‑weighted fixed‑effect meta‑analysis was performed. Pooled prevalence estimates …

Informed Consent For Porcine Islet Xenotransplantation To Treat Type 1 Diabetes: A Scoping Review, Jennifer Kovalcik, Sheetal Mohanty, Mairead Clare Higgins, Daniel J. Hurst

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Purpose: The objective of this review is to systematically map and synthesize the existing literature regarding informed consent for porcine islet xenotransplantation for the treatment of Type 1 Diabetes.

Methods: The search was conducted in May 2025 through the following databases: PubMed, SCOPUS, EMBASE, and CINAHL. Broad search strings were used to combine the text words “islet” AND “xenotransplantation” AND “consent” or similar permutations and combinations. Peer-reviewed articles were included if they were published between January 1990 and May 2025 and written in English. The final search results were manually exported to a reference manager system (Zotero), and the PRISMA-ScR …

Impact Of Early Term Induction Of Labor On Cesarean Delivery And Impact Of Early Term Induction Of Labor On Cesarean Delivery And Maternal-Fetal Outcomes In Patients With Obesity: A Maternal-Fetal Outcomes In Patients With Obesity, Priya Patel, Nathanael Hoskins

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Introduction: Obesity (body mass index [BMI] ≥30 kg/m²) in pregnancy is associated with increased risks, including gestational diabetes, hypertensive disorders, and higher cesarean delivery (CD) rates. Evidence supporting early-term (37 0/7–38 6/7 weeks) induction of labor (IOL) to improve outcomes remains limited. This study evaluated whether IOL in patients with obesity is associated with decreased CD rates.

Methods: This retrospective cohort study included pregnancies undergoing IOL between 37 0/7 and 41 6/7 weeks from 2018–2023 at a single institution. Exclusion criteria included spontaneous labor, prior CD, multiple gestations, fetal anomalies, non-vertex presentation, and pre-labor rupture of membranes. Primary exposures were …

Case Report: Pott’S Puffy Tumor, A Rare Complication Of Sinusitis, Je Seong Lee, Esai A. Hernandez, James Espinosa, Alan Lucerna

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We report the case of an 11-year-old female who presented with lethargy and new left upper extremity weakness after a recent Emergency Department visit for fever, rhinorrhea, and head fullness, and was subsequently diagnosed with Pott’s Puffy Tumor(PPT). Pott’s Puffy Tumor is a frontal bone osteomyelitis with an frontal  subperiosteal abscess and represents a rare but potentially life-threatening complication of sinusitis. Prompt imaging and timely clinical intervention are critical, though variable presentations can make diagnosis challenging. This case highlights the importance of early recognition, appropriate imaging, and prompt surgical and antibiotic management given the PPT’s  strong association with intracranial complications. …

Case Report: Adult Distal Lleal Perforation Mimicking Meckel's Diverticulum, Dip Patel, Wayne Tamaska, James Espinosa, Alan Lucerna

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Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, but clinically significant disease in adulthood is uncommon and often difficult to diagnose before surgery. In adults, symptomatic Meckel’s most often presents with obstruction, bleeding, or inflammation, and cross-sectional imaging may not clearly distinguish it from other distal ileal processes.

We report the case of a 35-year-old man who presented with several days of fever, abdominal pain, vomiting, and diarrhea. CT imaging suggested a complicated distal ileal diverticular process, most concerning for perforated Meckel’s diverticulum with an adjacent abscess. He underwent emergent small bowel resection and abscess drainage. …

Title: Impact Of Hypertriglyceridemia ≥500 Mg/Dl On Acute Pancreatitis Outcomes: A Propensity Score–Matched Cohort Study, Jashanveer S. Johal, Bianca Patel, Mahmoud Al-Bataineh, Archana Salek, Om Patel, Jason Hyman, Yecheskel Schneider, Abdallah Hussein

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Background: Hypertriglyceridemia is a recognized cause of acute pancreatitis, but the prognostic impact of markedly elevated triglycerides (TG) on clinical outcomes remains unclear. We evaluated whether TG ≥500 mg/dL at presentation predicts worse pancreatitis outcomes.

Methods: Using the TriNetX multicenter electronic health record network, adults hospitalized with acute pancreatitis and a TG measurement within 48 hours of admission between 2018–2024 were identified. Patients with TG ≥500 mg/dL were compared with those with TG < 500 mg/dL after 1:1 propensity score matching on demographics and comorbidities (n=7,014 per group). Primary outcomes included ICU stay, pancreatic complications, need for procedure, and all-cause mortality. Secondary outcomes included acute renal failure, cardiovascular events, repeat pancreatitis, infection, and liver failure. Odds ratios (OR) with 95% confidence intervals were estimated.

Results: Compared with TG < 500 mg/dL, patients with TG ≥500 mg/dL had higher risks of ICU admission (25.3% vs. 17.2%; OR 1.63), pancreatic complications (5.3% vs. 4.5%; OR 1.19), and mortality (4.6% vs. 3.3%; OR 1.39). Need for procedural intervention was lower in the high-TG group (1.2% vs. 3.6%; OR 0.34). Secondary outcomes including acute renal failure (15.5% vs. 10.7%; OR 1.54), repeat pancreatitis (58.6% vs. 51.9%; OR 1.31), and infection (13.7% vs. 12.0%; OR 1.17) were all significantly elevated. Cardiovascular events and liver failure did not differ significantly.

Conclusions: TG ≥500 mg/dL in acute pancreatitis was associated with greater ICU utilization, complications, and mortality, but lower procedural intervention rates. Admission triglyceride …

Glp-1 Receptor Agonists And Neurocognitive Outcomes In Type 2 Diabetes: A Propensity-Matched Real-World Analysis Of Cognitive Impairment, Neurodegeneration, And Mortality, Om Patel, Shefali Waghray Do, Jashanveer S. Johal, Jason Hyman, Tatiana Gandrabura

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Background: GLP-1 receptor agonists improve glycemic and cardiovascular outcomes in type 2 diabetes mellitus (T2DM), but their impact on neurocognitive and neurological outcomes remains incompletely characterized. We evaluated the association between GLP-1 agonist use and incident cognitive impairment, neurodegeneration, and healthcare utilization in T2DM patients without baseline cognitive deficits.

Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Adults (≥40 years) with T2DM and no prior cognitive impairment, Alzheimer's disease, Parkinson's disease, multiple sclerosis, or cerebral infarction were identified. Cohort 1 received a GLP-1 agonist (semaglutide, tirzepatide, liraglutide, or dulaglutide) after T2DM diagnosis; Cohort 2 received …

Training Vs. Reality: The Challenges Of Preventing Heat-Related Illness In Migrant Farmworkers, Sonya Homami

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Background: Heat‑Related Illness (HRI) is a major occupational hazard for migrant farmworkers, who are 35 times more likely to die from HRI than workers in other industries. Although HRI training aims to improve prevention knowledge, its effect on actual HRI outcomes is unclear.

Methods: Following PRISMA guidelines, a systematic review of PubMed, Embase, and Web of Science identified studies evaluating HRI training and reporting HRI prevalence or related symptoms. Fifteen studies met inclusion criteria.

Results: HRI training did not reduce HRI prevalence or provide protective effects. Training increased reporting of workplace injuries and concern about HRI. Despite high training uptake—over …

Beyond Glycemic Control: A Comparative Analysis Of Dapagliflozin Vs Empagliflozin, Wesley Augustus Kim, Heaven Chu, Kayla Ancheta, Nicole Shellenbarger, Sophia Ginet, Akash Patel

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SGLT2 inhibitors have emerged as a drug class with cardiorenal benefits beyond glycemic control in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). This review compares two widely used SGLT2 inhibitors dapagliflozin and empagliflozin across efficacy, safety, and cost-effectiveness outcomes in patients with comorbid CKD and T2DM. A systematic literature search of PubMed, Scopus, and Embase yielded 10 final articles after screening. Both agents demonstrated comparable cardiorenal benefits, with dapagliflozin showing advantages in weight, blood pressure, and glycemic markers, while empagliflozin proved more cost-effective for CKD-specific disease management. Neither drug demonstrated significant safety concerns over placebo …

Wearable And Technology‑Assisted Gait And Balance Interventions In Parkinson’S Disease: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo Md, Nishant Patel, Jarvish Shah, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

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Background: Wearable sensors and cue‑based technologies are increasingly used to augment rehabilitation in Parkinson’s disease (PD). However, the magnitude of benefit across clinical domains remains uncertain. Objective: This meta‑analysis aimed to quantify the effects of technology‑assisted interventions in PD. Methods: Randomized controlled trials evaluating wearable‑assisted interventions were systematically identified from PubMed. Outcomes included motor severity (Movement Disorders Society Unified Parkinson Disease Rating Scale Part III), balance (Berg Balance Scale, Mini‑BESTest, POMA balance), gait speed, walking endurance, freezing of gait (FOG‑Q/NFOG‑Q), fear of falling, and quality-of-life (PDQ‑39/PDQ‑8). Meta‑analyses were performed using random‑effects models to account for between‑study heterogeneity. Statistical heterogeneity was …

Trends And Disparities In Mortality Involving Epilepsy And Aspiration Pneumonia Among Older Adults In The United States, 1999–2020, Pranaya Gade, Jarvish Shah, Daarsh Goradia, Nishant Patel, Jamir Pitton Rissardo Md, Ana Leticia Fornari Caprara Md

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Introduction: Epilepsy in older adults is frequently complicated by swallowing dysfunction, increasing the risk of aspiration pneumonia. Despite its clinical relevance, national trends and demographic disparities in deaths involving these conditions remain poorly characterized. Methods: We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999–2020) for individuals aged ≥65 years with epilepsy (ICD-10 G40, G41) and aspiration pneumonia (J69) listed as causes. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percentage changes (APCs) with 95% confidence intervals were calculated using Joinpoint Regression. Analyses were stratified by sex, race/ethnicity, census region, and state. Results: From 1999 …

Cerebrospinal Fluid And Serum Manganese Levels In Parkinson’S Disease: A Method‑Stratified Meta‑Analysis, Jamir Pitton Rissardo Md, Daarsh Goradia, Jarvish Shah, Nishant Patel, Pranaya Gade, Ana Leticia Fornari Caprara Md

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Background: Manganese (Mn) exposure can cause parkinsonism, but circulating and cerebrospinal fluid (CSF) Mn levels in idiopathic Parkinson’s disease (PD) have been reported inconsistently. This study aims to determine whether Mn concentrations differ between patients with PD. Methods: A systematic review of PubMed/Medline studies reporting CSF/serum Mn concentrations in PD was done. Random‑effects models with inverse‑variance weighting were used to pool mean differences (MDs). Studies were stratified a priori by analytical method. Results: For CSF Mn, the overall pooled effect showed no significant difference between PD and controls (MD 0.08 μg/L, 95% CI −0.31 to 0.47; I2=85.7%). Subgroup analysis revealed …

Efficacy And Safety Of Levetiracetam For Essential Tremor: A Systematic Review And Meta‑Analysis, Jamir Pitton Rissardo, Daarsh Goradia, Nishant Patel, Jarvish Shah, Pranaya Gade, Ana Leticia Fornari Caprara Md

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Background: Essential tremor (ET) is a common movement disorder with limited therapeutic options. Levetiracetam has been proposed as a potential treatment, but published studies report inconsistent efficacy and safety findings. We performed a meta‑analysis to quantify the efficacy and safety of levetiracetam in patients with essential tremor using pooled effect estimates. Methods: A systematic review of PubMed was performed to identify clinical studies evaluating levetiracetam for ET. Continuous efficacy outcomes were pooled using standardized mean differences (SMD) with inverse‑variance random‑effects models. Binary adverse events were pooled using risk ratios (RR) with Mantel–Haenszel random‑effects models. Heterogeneity was assessed using I2 statistics. …

Effects Of Subthalamic Nucleus Deep Brain Stimulation On Depressive Symptoms In Patients With Parkinson’S Disease: A Meta‑Analysis, Jamir Pitton Rissardo Md, Jarvish Shah, Nishant Patel, Daarsh Goradia, Pranaya Gade, Ana Leticia Fornari Caprara Md

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Background: Depression is a prevalent non‑motor symptom of Parkinson’s disease (PD) and may adversely affect quality-of-life and overall treatment outcomes. Subthalamic nucleus deep brain stimulation (STN‑DBS) is an established therapy for motor symptoms, yet its impact on depressive symptoms remains controversial. This meta‑analysis aimed to evaluate the effect of STN‑DBS on depressive symptoms in PD. Methods: PubMed‑indexed studies meeting predefined eligibility criteria were identified and included. Random‑effects meta‑analyses were performed using REML. Mean differences (MDs) between STN‑DBS and control conditions were pooled separately for Beck Depression Inventory (BDI) and its revision (BDI-II), and the Hamilton Depression Rating Scale (HAMD). Heterogeneity …

Case Report: Dandy-Walker Malformation In An Adolescent Presenting With Aggressive Behavior, Kristen Arulsamy, Wayne Tamaska, James Espinosa, Alan Lucerna

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We report a case of a 15-year-old male who presented to the Emergency Department(ED) for agitation and was subsequently diagnosed with Dandy-Walker malformation (DWM). DWM is a rare congenital abnormality of the posterior fossa characterized by hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and enlargement of the posterior fossa. It is typically diagnosed during infancy due to hydrocephalus, developmental delay, or neurologic abnormalities. Late presentations in adolescence are uncommon and may occur incidentally during evaluation for unrelated conditions.

Collet–Sicard Syndrome Secondary To Internal Carotid Artery Dissection Following Cervical Self-Manipulation, Ryan K. Alali, James Espinosa Md, Alan Lucerna

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We report a case of a 40-year-old male presenting with progressive dysphagia who was ultimately diagnosed with Collet–Sicard syndrome secondary to internal carotid artery (ICA) dissection. While most reported cases are associated with trauma, this case highlights an atypical etiology following cervical self-manipulation. The patient presented with dysphagia to solids, liquids, and saliva, along with several days of ipsilateral headache and neck pain. Neurologic examination revealed tongue deviation, prompting advanced imaging. CTA demonstrated left ICA dissection, which was further characterized on MRI. The patient was managed with dual antiplatelet therapy and multidisciplinary care, including neurology, neurosurgery, and speech-language pathology, and …

A Stemi That Wasn’T: Staphylococcus Aureus Bacteremia Presenting With Troponin Elevation And Pericardial Involvement, Taqi A. Khan, Kelsey A. Murray, James Espinosa, Alan Lucerna

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A 75-year-old female presented to the emergency department (ED) with vomiting, weakness, and altered mental status. Initial evaluation revealed a markedly elevated troponin level and an electrocardiogram (ECG) demonstrating diffuse ST-segment depressions with relative ST elevation in lead aVR, prompting activation of a STEMI alert. After cardiology consultation, emergent catheterization was deferred. Computed tomography (CT) imaging demonstrated an anterior mediastinal fluid collection extending toward the pericardial space with a loculated pericardial effusion. Splenic infarctions were also identified. Blood cultures later grew Staphylococcus aureus. The patient was treated with broad-spectrum antibiotics and transferred to a tertiary care center for further management. …

Gram-Negative Infective Endocarditis : A Rare Case Of Escherichia Coli Pulmonic Valve Endocarditis, Caroline Nguyen, Philip Willsie, James Espinosa, Alan Lucerna

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Infective endocarditis (IE) is most commonly caused by gram-positive organisms, while Escherichia coli accounts for less than 1% of reported cases. Pulmonic valve involvement is particularly rare, representing fewer than 2% of IE cases. We report a case of E. coli infective endocarditis involving the pulmonic valve complicated by spinal epidural abscess and ascending cholangitis in a patient with intravenous drug use. Blood cultures demonstrated persistent E. coli bacteremia, and further evaluation with echocardiography and MRI revealed pulmonic valve vegetations and epidural abscess. This case highlights the importance of evaluating persistent gram-negative bacteremia for infective endocarditis and metastatic infection.

Case Report: Postpartum Ovarian Vein Thrombosis Without Abdominal Pain, Moshammat Nishu, Russell Mordecai, James Espinosa, Alan Lucerna

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We report a case of a 27-year-old woman (2 prior pregnancies: 1 term birth, 1 preterm birth, 2 living children)  who presented with right ovarian vein thrombosis (OVT) in the absence of abdominal pain on postpartum day 5 after spontaneous vaginal delivery. Although OVT is classically associated with abdominal pain, this case illustrates that OVT may present without abdominal pain and should be considered as a differential to prevent a delay of diagnosis in the emergency department. This case also highlights the diagnostic challenge in postpartum fever when an alternative infectious source may lead to premature closure and prevent the …

Case Report: Reverse Takotsubo Cardiomyopathy, Aveen Saed, Dhara Patel, James Espinosa, Alan Lucerna

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Reverse Takotsubo cardiomyopathy (rTTC) is a rare variant of stress-induced cardiomyopathy characterized by basal and mid–left ventricular (LV) akinesis with apical sparing. It may mimic acute coronary syndrome and can present with cardiogenic shock. We present a 32-year-old female with substance use disorder who presented with severe abdominal pain and hypertensive emergency (SBP >240 mmHg), found to have reverse Takotsubo cardiomyopathy with an ejection fraction (EF) decline to 25% complicated by cardiogenic shock requiring inotropic support. Her course was notable for dynamic LV mid-cavity obstruction during recovery and complete normalization of LV systolic function (EF 65%) within two weeks. This …

Septic Pulmonary Emboli Revealing Tricuspid Valve Endocarditis In A Patient Presenting With Opioid Withdrawal Symptoms, Dong Shin, Dhara Patel, James Espinosa, Alan Lucerna

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Septic embolism is a serious complication of systemic infection, most commonly arising from infective endocarditis. In patients with intravenous drug use (IVDU), right-sided endocarditis may lead to septic pulmonary emboli, often presenting with nonspecific or misleading symptoms. A 36-year-old female with recent intravenous fentanyl use presented with presumed opioid withdrawal, along with chest pain, dyspnea, and systemic symptoms. Initial evaluation revealed leukocytosis and bilateral pulmonary nodules on imaging. Computed tomography angiography demonstrated multiple cavitary and non-cavitary nodules consistent with septic pulmonary emboli. Blood cultures grew Staphylococcus aureus, and echocardiography revealed tricuspid valve vegetations with severe regurgitation. The patient required escalation …

Case Report: Primary Appendiceal Cancer Presenting As Acute Appendicitis, Armeet Singh, Wayne Tamaska, James Espinosa, Alan Lucerna

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We report a case of a 46‐year‐old male who presented to the emergency department with right lower quadrant abdominal pain and was initially suspected to have acute appendicitis. Further evaluation and surgical pathology revealed primary appendiceal adenocarcinoma. Appendiceal cancer is rare and often presents with nonspecific symptoms that mimic common abdominal conditions such as appendicitis or diverticulitis. Early diagnosis can be challenging, and many cases are discovered incidentally during surgery or imaging for suspected appendicitis. This case highlights the importance of maintaining a broad differential diagnosis for right lower quadrant pain.

Case Report: Acute Encephalopathy Revealing Severe Babesiosis With Lyme Co-Infection, Czarina Gebrelle K. Soriano, James Espinosa, Alan Lucer

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Acute confusion in older adults is a common emergency department presentation with a broad differential diagnosis. Tick-borne illnesses can cause significant systemic disease and may present with nonspecific neurologic or constitutional symptoms, making early recognition challenging. Babesiosis is a tick-borne parasitic infection transmitted by Ixodes ticks and may occur concurrently with other infections such as Lyme disease, further complicating diagnosis. We present a case of a 67-year-old male who presented with acute confusion and was found to have concurrent babesiosis and Lyme disease. This case highlights the importance of maintaining a high index of suspicion for tick-borne co-infections in patients …

When Venom Isn’T The Only Threat: Roseomonas Mucosa Bacteremia Following A Snake Bite, Cyrus Davati, Kishan Patel, James A. Espinosa Md, Alan Lucerna

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Snake bites in the ED  overall are rare in the United States. While mortality is low due to modern interventions, the sequelae - including tissue necrosis, digit amputation, and subsequent infection  remain a significant concern.  Here we present the case of a  presumptively non-venomous snakebite, which  was associated with R. mucosa bacteremia.

A Pain In The Neck: Lemierre Syndrome Presenting With Retropharyngeal Abscess, Clara Keum, Leo Midure

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Lemierre syndrome is a rare but potentially life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein following an oropharyngeal infection. It is most commonly associated with Fusobacterium necrophorum,  and typically begins with pharyngitis or deep neck space infections, which can extend into adjacent vascular structures. Retropharyngeal abscesses are among the deep neck infections that may predispose patients to this complication due to their proximity to the internal jugular vein and surrounding fascial planes.

Although Lemierre syndrome classically occurs in otherwise healthy adolescents and young adults, it can also develop in immunocompromised individuals or patients with complex medical conditions. …

Case Report: Vancomycin-Resistant Enterococcus Faecium Urinary Tract Infection With Stercoral Colitis Presenting In An Elderly Patient, Muhammad Zain Raza, James Espinosa, Alan Lucerna

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We report a case of a 76-year-old female who presented with altered mental status characterized by confusion, decreased verbal interaction, and reduced responsiveness noted by her spouse. The patient had a history of chronic constipation and was brought from home for further evaluation. Initial evaluation raised concern for infection or intracranial hemorrhage as a possible cause of altered mental status. Imaging of the CT brain without contrast was unremarkable, however; abdomen and pelvis revealed a large rectal stool impaction with rectal wall thickening and surrounding perirectal fat stranding consistent with Stercoral Colitis. Urine culture subsequently identified vancomycin-resistant enterococcus faecium. The …

Arrhythmic Syncope And Brugada Syndrome: Critical Identification Of High-Risk Patterns At The Ed Frontline, Kristine Rubi, Brittany Fera, Kelsey Murray, James Espinosa, Alan Lucerna

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Brugada Syndrome (BrS) is a premier cause of sudden cardiac death (SCD) in structurally normal hearts, particularly in Southeast Asia (SEA) where it is historically recognized as Sudden Unexplained Nocturnal Death Syndrome (SUNDS). We report the case of a 55-year-old male of Vietnamese descent who presented to the emergency department (ED) after a sudden, non-prodromal syncopal episode at rest. The event was significant for urinary incontinence and diaphoresis, classic red flags for arrhythmic syncope. Bedside electrocardiogram (EKG) demonstrated the pathognomonic Type 1 coved ST-segment elevation in leads V1 and V2. This symptomatic presentation following a six-year "follow-up gap" since a …

The Klatskin Tumor: A Tumor At The Liver’S Crossroads, Asma Zahid, Sergey Medlenov, James Espinosa, Alan Lucerna

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We present a 68-year-old female with no significant oncologic history who presented to

the emergency department with a  two –week history of progressive jaundice and diarrhea.

Systematic ED evaluation revealed marked hyperbilirubinemia (total bilirubin 22.3 mg/dL), a

cholestatic laboratory pattern, and multimodal imaging demonstrating multifocal hepatic

masses, a porta hepatis soft tissue mass,  and biliary ductal dilatation consistent with hilar cholangiocarcinoma (Klatskin tumor) with metastatic disease.

A CA 19-9 marker was markedly elevated at 379 U/mL. The patient was admitted and she underwent successful biliary decompression via ERCP with stent placement.  Outpatient oncologic therapy was initiated. This case highlights the …

Heterotopic Pregnancy: A Case Report, Oluwatomi Alade, Robin Lahr, James Espinosa, Alan Lucerna

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Heterotopic pregnancy occurs when there is simultaneous intrauterine pregnancy as well as extra uterine ectopic pregnancy.  Historically, this was considered very rare with an estimated incidence of 1 in 30,000 pregnancies however, the incidence has been increased with the use of assisted reproductive  technology.  The most common location is the fallopian tube and less common include the cervix or the ovary. It can be difficult to diagnose because the presence of an intrauterine pregnancy on ultrasound may falsely reassure clinicians and delay evaluation for a concurrent ectopic pregnancy.  These patients usually present with nonspecific symptoms including abdominal pain, vaginal bleeding, …

Case Report: Acute Cerebrovascular Accident With An Initial Absence Of Infarct Findings On Mri, Alyssa Baldini Md, Brittany Fera

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We report a case of a 42-year-old female whose diffusion-weighted magnetic resonance imaging (MRI) performed 28 hours after symptom onset was negative for acute infarction. Repeat MRI 3 days later demonstrated left-sided corona radiata infarction.

Diffusion-weighted MRI imaging may not be sensitive or specific enough in early stages of acute stroke. Caution should be used in relying on imaging alone to make the diagnosis of ischemic stroke. Clinical assessment likely should be given priority in determining appropriate initial treatment and the need for secondary stroke prevention treatment when imaging is negative. Consideration should be given to the timing of initial …