Medical Specialties Commons^™

The Impact Of Asymmetry In Lower Limb Muscle Strength And Power On Straight-Line Running Speed In Female Soccer Players, Dariusz Skalski, Magdalena Prończuk, Kinga Łosińska, Michał Spieszny, Maciej Kostrzewa, Piotr Aschenbrenner, Adam Maszczyk

Baltic Journal of Health and Physical Activity

The aim of this study was to investigate and determine the impact of asymmetries in muscle strength and power between the right and left lower limbs on straight-line running speed in female soccer players.30 right-footed female soccer players playing in the Ekstraliga participated in the study. The Modulus. Number formula was used to avoid negative results and to assess only the difference in relative strength and power between the lower limbs, not the dominance of one of them. A result equal to or below the threshold defined group G1 "with lower asymmetry," and a result above the threshold defined group …

Lyrical Stillness, Madhav Patel

HCA Healthcare Journal of Medicine

“Lyrical Stillness” is a poem I wrote during my radiation oncology rotation, during which I was provided the opportunity to learn more about multidisciplinary cancer care while delving deeper into radiotherapy. Cancer can be an overwhelming disease process physically, psychologically, and emotionally. Patients undergoing treatment often experience stress and anxiety with the uncertainty of their prognoses. In this poem, I describe a patient receiving radiation therapy whom I enjoyed speaking to about his favorite hobby: bird watching. During his subsequent radiation treatment sessions, I decided to play a CD of mockingbirds singing in a tropical forest, in the hopes it …

Apocrine Breast Cancer With Psammoma Bodies In A Male Patient, Alena Bashinskaya, Eric W. Baum, Michael B. Morgan

HCA Healthcare Journal of Medicine

Introduction

While male breast carcinoma is a relatively uncommon occurrence, its incidence is on the rise, potentially attributed to sporadic pathophysiological mechanisms, primarily involving hormonal imbalances. Invasive apocrine carcinoma represents a small fraction of global breast malignancies, with limited instances reported among male patients in the literature. The clinical presentation of an apocrine breast carcinoma closely resembles that of other breast cancer subtypes, as it is most often described as a solitary ulcerative nodular lesion occupying a retro-areolar region of the breast. Herein, we describe a novel case of an apocrine male breast carcinoma metastasizing to the skin, given that …

Hemophagocytic Lymphohistiocytosis In A Critically Ill Patient: A Case Report Of A Potentially Fatal Entity, Ali Khreisat, Inna Mikaella Sta Maria, Giovi Grasso-Knight, Meghan Mansour

HCA Healthcare Journal of Medicine

Background

Hemophagocytic lymphohistiocytosis (HLH) is a non-neoplastic proliferation and macrophage activation that induces cytokine-mediated bone marrow suppression and features of intense phagocytosis in the bone marrow and liver, leading to multi-organ dysfunction and ultimate failure. The diagnosis of HLH in an intensive care setting is challenging, and it is associated with high morbidity and mortality. HLH-94 is the standard protocol for treatment, consisting of dexamethasone and chemotherapy like etoposide.

Case Presentation

We present the case of a 73-year-old woman who had a prolonged hospitalization for vomiting, diarrhea, and dehydration. Her conditions were complicated by acute refractory pancytopenia on the 12th …

Evaluation Of A Patient With A Severe Systemic Inflammatory Response To Nitrofurantoin, Brigitte Vanle, Timothy Beatty

HCA Healthcare Journal of Medicine

Background

Nitrofurantoin is a prevalent antibiotic used to treat urinary tract infections. Despite nitrofurantoin’s general safety, it can cause serious side effects, including acute pulmonary toxicity, fulminant hepatitis, and severe systemic inflammatory responses, which may mimic conditions such as ischemia and infection. However, reports of acute systemic inflammatory response syndrome after nitrofurantoin ingestion are uncommon in medical literature.

Case Presentation

This case describes a severe systemic inflammatory response syndrome in an 85-year-old woman presenting with hypoxia, altered mental status, and profound leukocytosis after exposure to a single dose of nitrofurantoin.

Conclusion

Herein we report on a patient with suspected bacteremia …

Veillonella Discitis: A Rare Presentation And Review Of Literature, Akankcha Alok, Vidya Sagar Kollu, Gautam Kalyatanda

HCA Healthcare Journal of Medicine

Background

Veillonella is an anaerobic gram-negative coccus found as a commensal organism in the oral, respiratory, gastrointestinal, and genitourinary tract of humans. Rarely, it can cause serious infections by the production of lipopolysaccharide, an endotoxin. Although most Veillonella infections occur in immunocompromised individuals, we herein describe cases of Veillonella discitis, a rare presentation of Veillonella, in immunocompetent patients.

Case Presentation

The first presented case was encountered in a patient admitted at our facility. All patient data were obtained from the hospital's electronic medical record system. Thereafter, a literature search and subsequent review was done on PubMed with the MEDLINE …

Clinical Variant Of Serpentine Supravenous Hyperpigmentation Following Subcutaneous Bortezomib Injection, Madelyn Richards, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

Bortezomib is a reversible proteasome inhibitor that is a first-line chemotherapeutic agent for multiple myeloma. Bortezomib can be administered intravenously or subcutaneously with similar efficacy. Subcutaneous administration has fewer side effects. Many cutaneous reactions have been associated with bortezomib treatment. These include morbilliform exanthems, erythematous nodules and papules, leukocytoclastic vasculitis, Sweet syndrome, and rarely Stevens-Johnson Syndrome.

Case Presentation

This paper reports the occurrence of serpentine supravenous hyperpigmentation (SSH) after subcutaneous administration of bortezomib. SSH is a rare, characteristic cutaneous reaction that has been reported following intravenous administration of chemotherapeutic agents. Intravenous administration of bortezomib rarely results in documented cases …

Successful Treatment Of An Atypical Presentation Of Disseminated Retroperitoneal Seminoma: A Case Report, Mahmoud Abd-El-Hafez, Kylie Johnson, Joe Cates, Alosh Madala

HCA Healthcare Journal of Medicine

Background

Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites. Due to the curable nature of the malignancy (5-year survival rate > 95%), detection at early stages of the disease is key. This case presentation explores the delayed diagnosis and treatments of an atypical presentation of disseminated seminoma.

Case Presentation

We present the unusual case of a 56-year-old male who had …

Hemophagocytic Lymphohistiocytosis Due To Ehrlichiosis: A Case Series, Ajay Iyer, Mattias D'Anna, Shruti Verma, Thomas Pritchard, Vladimir Begilman, Himal Bajracharya, Kaveh Naemi

HCA Healthcare Journal of Medicine

Background

Hemophagocytic lymphohistiocytosis (HLH) is an immunologic syndrome characterized by excessive inflammation and tissue injury due to uncontrolled activation of the phagocytic system. The underlying mechanism is a lack of downregulation of activated macrophages and lymphocytes by natural killer and T cells. Unfortunately, the diagnosis is often delayed or missed due to the rarity of the disease, decreased awareness, and clinical picture variability. Ehrlichiosis is becoming a more prevalent tick-borne illness in endemic regions and a relatively uncommon but increasingly considered cause of HLH.

Case Presentation

We describe the cases of 2 patients diagnosed with secondary HLH as per the …

Endovascular Repair Of A Superior Mesenteric Arteriovenous Fistula And Pseudoaneurysm After A Single Gunshot Wound To The Abdomen, Robert Ringersen Iii, Michael Shockley, Sanjiv Gray, Tracy Bilski, Julio Calderin, Philip Kondylis

HCA Healthcare Journal of Medicine

Background

Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case Presentation

A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was …

Investigating The Effects Of Nosocomial Clostridioides Difficile Infection Among Acute Leukemia Patients: Insights From The 2020 National Inpatient Sample, Zubair Hassan Bodla, Mariam Hashmi, Fatima Niaz, Umer Farooq, Muhammad Jahanzeb Khalil, Farhan Khalid, Kipson Charles, Christopher L. Bray

HCA Healthcare Journal of Medicine

Background

Rising nosocomial Clostridioides difficile infections pose high risks, especially for immunocompromised leukemia patients, necessitating targeted research to enhance patient care and outcomes.

The objective of this study was to investigate the impact of nosocomial Clostridioides difficile infections (CDI) on patients hospitalized with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).

Methods

Our study was a retrospective analysis of adult patients hospitalized with a primary diagnosis of ALL or AML, using the Nationwide Inpatient Sample (NIS) database for 2020. Primary outcomes included the incidence of nosocomial CDI and all-cause inpatient mortality. Secondary outcomes included hospital length of stay, resource …

Assessment Of The European Hernia Society Classification Of Ventral Hernias And Clinical Outcomes, Oluwatunmininu A. Anwoju, Ashtyn Barrientes, Connor Hogan, Erik Askenasy, Jacob Greenberg, Keith Jerrod, Scott J. Roth, Zuhair Ali, Mike K. Liang

HCA Healthcare Journal of Medicine

Background

Ventral hernias are a common but heterogeneous disease. Communication among key stakeholders (eg, patients, clinicians, administrators, payers, and researchers) can be augmented by a widely utilized classification system. The European Hernia Society (EHS) developed an expert-opinion-based hernia classification system organized by hernia type (primary versus incisional) and size. We sought to assess what components of the EHS ventral hernia classification system were correlated to real-world clinical outcomes.

Methods

This was a multicenter cohort study. All hospitals contributing to the database were affiliated with 1 of 6 academic institutions. All adult patients who underwent ventral hernia repair over a 4-year …

Second Generation Antipsychotics And Cardiovascular Adverse Effects: Developing Evidence-Based Recommendations For Primary Care Medicine, Sana Borda, Ahn-Dao Lee, Paul F. Bell

HCA Healthcare Journal of Medicine

Background

Second-generation antipsychotic medications (SGAs) are often used by primary care physicians (PCPs) to treat multiple psychiatric diagnoses. SGAs have been connected to a number of adverse effects, including cardiovascular disease. Currently, there are no published evidence-based recommendations addressing SGAs and cardiotoxicity that are directed toward PCPs. This project aims to fill this gap.

Methods

Relevant search terms related to SGAs and cardiovascular disease were identified and then used to search databases (PubMed, PubMed Central, and AccessMedicine). Research studies obtained from the searches were narrowed to include systematic reviews and meta-analyses. The Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool was …

Hubungan Abnormalitas Ekokardiografi Terhadap Mortalitas Pasien Terkonfirmasi Covid-19 Derajat Berat Dan Kritis Di Rsupn Dr. Cipto Mangunkusumo, Fidiaji Hiltono Santoso, Idrus Alwi, Sally A. Nasution, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. The mortality rate of COVID-19 patients in Indonesia is high with manifestations of cardiac complications. Echocardiographic evaluation can help identify cardiac functional and structural disorders associated with patient mortality. Therefore, this study aims to determine the relationship between echocardiographic abnormalities and mortality in severe and critical COVID-19 patients.

Methods. A retrospective cohort study was conducted using medical record data of severe and critical COVID-19 patients at Dr. Cipto Mangunkusumo Hospital Jakarta during March 2020 to April 2021. Subjects were selected using total sampling. Descriptive analysis was performed, presenting descriptive tables, and bivariate analysis was conducted using the …

The Use Of Primal Reflex Release Technique To Address Pain And Stress: An Exploratory Case Series, Nathan R. Reep, Sydney N. Leverett, Rebecca M. Heywood, Zachary Johnson, Alan Nasypany, James May, Scott W. Cheatham

Clinical Practice in Athletic Training

The majority of the world population is experiencing more stress after the COVID-19 pandemic. Working in an outpatient healthcare setting it can be expected that patients will present with stress in combination with other perceptions of pain related to injury. Stress alone may be the cause of pain perception especially in patients who present with no specific mechanism of injury. There is a need for a quick full-body approach to assessment and treatment while considering the stress response to injury. Therefore, the purpose of this study was to determine the immediate effects of Primal Reflex Release Technique (PRRT) Primals on …

College Student-Athlete Perceptions Of Characterizations And Interpersonal Trust In Their Athletic Trainer: A Point-Of-Care Research Study, Ryan N. Moran, Deidre Leaver-Dunn, Jeff Allen, Jessica Wallace

Clinical Practice in Athletic Training

Patient-centered care is essential in athletic training with limited research examining the relationship between patient and clinician. Previous theory has identified constructs of quality athletic trainers (ATs); however, it remains unknown how current athletes perceive these theorized constructs in the ATs providing them medical care. The purpose of this study was to determine the perceptions of characterizations of a quality athletic trainer and interpersonal trust between the student-athlete and AT in the collegiate setting and establish reliability of these surveys. A second aim was to explore differences between sex, previous exposure to an AT, and having had access to an …

The Impact Of Video-Assisted Education On Knowledge And Retention Compared To Paper Education Material, Keiona M. Nance, Matthew J. Drescher, Lindsey E. Eberman, Matthew J. Rivera

Clinical Practice in Athletic Training

When educating patients, clinicians must be effective to assure patients understand their treatment plan and abide by such to achieve optimal outcomes. Teaching methods that stimulate numerous senses more positively impact learning outcomes. The purpose of this study is to compare paper and video-assisted education at the point-of-care with the aim of changing patient education and local practice in a system for individuals undergoing total hip arthroplasties (THAs). We used a randomized cohort design to explore patient knowledge and retention and educational method at the point-of-care. We compared the current education method (paper) to video-assisted materials using pre and post-education …

Exploratory Clinical Assessment And Treatment Of Autonomic Nervous System Dysregulation Post Concussion: A Case Study, Megan Coker, James May

Clinical Practice in Athletic Training

The physiological alterations in autonomic nervous system (ANS) function due to concussion are suggested to play a role in persistent post-concussion symptoms (PPCS). Currently, there are few objective and clinically feasible measurements to assess ANS vitality in patients experiencing PPCS. The following case study details an assessment and treatment protocol targeted towards regulating the ANS in an adolescent female suffering from PPCS one month after injury. Pre-intervention, patient-reported outcome measures (PROMs) used to assess perceived pain, anxiety, stress, and breathing function were administered as well as a physical assessment performed for breath function and vagus nerve integrity. The patient was …

Comparing Mental Health Between Ncaa Division Iii Student-Athletes Competing In Team- And Individual-Sports, Autumn Presley, Tiffany Franklin, Jeffrey Williams

Clinical Practice in Athletic Training

Mental health is a topic that has gained attention in recent years, but few studies have examined NCAA Division III student-athletes. Division III student-athletes are known to experience high levels of distress, and previous literature indicates there may be a significant psychological difference between student-athletes who compete in individual-sports compared to those who participate in team-sports. The purpose of this study was to explore mental health challenges (levels of depression, stress, and anxiety symptoms) among Division III student-athletes, particularly between those participating in team- and individual-sports. A cross-sectional survey design was used. The independent variable was group (team-sport athletes and …

Medical Disqualification As A Barrier To Healthcare In Military Service Members, Kaitlyn A. Jones, Joshua R. Jaime, Zachary K. Winkelmann

Clinical Practice in Athletic Training

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Automated Segmentation Of The Ulnar Nerve In Mri Using Deep Learning Techniques, Akhil Nagulapalli

Theses

Cubital Tunnel Syndrome (CuTS), a condition caused by compression of the ulnar nerve, results in numbness, tingling, pain, and even muscle atrophy, affecting fine motor skills and diminishing patient quality of life. Accurate diagnosis of CuTS is challenging, as current diagnostic methods—including clinical exams, nerve conduction studies, and unaided MRI—often lack the precision to reliably identify the nerve and detect compression in its early stages. Deep learning-based segmentation offers a promising solution, enabling precise and automated identification of nerve structures in MRI images, which could significantly improve diagnostic accuracy and support timely intervention.

A novel deep learning model for segmenting …

Molecular Mechanism Governing The Plasticity Of Use-Dependent Spike Broadening In Dorsal Root Ganglion Neurons, Tyler D. Alexander, Stephen Tymanskyj, Kyle J. Kennedy, Leonard K. Kaczmarek, Manuel Covarrubias

SKMC Student Presentations and Publications

Use-dependent spike broadening (UDSB) results from inactivation of the voltage-gated K+ (Kv) channels that regulate the repolarization of the action potential. However, the specific signaling and molecular processes that modulate UDSB have remained elusive. Here, we applied an adeno-associated viral vector approach and dynamic clamping to conclusively demonstrate how multisite phosphorylation of the N-terminal inactivation domain (NTID) of the Kv3.4 channel modulates UDSB in rat dorsal root ganglion (DRG) neurons. The Kv3.4 phosphonull variant promotes slow recovery from inactivation, cumulative inactivation, and UDSB. In contrast, the Kv3.4 phosphomimic variant promotes fast recovery from inactivation and robust resistance to cumulative inactivation …

Iatrogenic Ventricular Septal Defect After Transcatheter Aortic Valve Implantation: A Rare Complication, Muhammad Sabri, Hussam Al Hennawi, Shayan Qadir, Lucy Checchio, Chaitra Janga, Hamza Muhammadzai, Donald C. Haas

Abington Jefferson Health Papers

Iatrogenic ventricular septal defect (VSD) is a rare complication following transcatheter aortic valve implantation (TAVI). An 83-year-old male underwent TAVI for severe aortic stenosis (AS) and was diagnosed with a peri-membranous VSD on echocardiography, which was not evident on pre-procedural imaging. This case highlights the risk factors, symptoms, diagnosis, and management of iatrogenic VSD following TAVI.

Concussions In Women’S Rugby: A Timely Review Of Available Data, Shannon M. Wright

Clinical Practice in Athletic Training

Rugby is a growing full-contact sport across the world for both men and women; as a full-contact sport with no protective equipment, it has a reputation for high injury rates, including concussions. Organized men’s rugby has been established for over a century, whereas organized women’s rugby has struggled to achieve the same success over the years. With a much shorter amount of time to track injuries, women’s rugby lacks data to assess when, where, and what kinds of injuries are most common. The guiding study attempts to examine epidemiological trends for concussion in women’s rugby union and league. After pooling …

Effective Anterior Cruciate Ligament Injury Prevention Programming In Young Female Athletes: An Evidence-To-Practice Review, Janay Ward, Kina M. Ingram, Jackson Biffle, Emily E. Hildebrand, Peter Lisman

Clinical Practice in Athletic Training

Anterior cruciate ligament (ACL) injuries are common in adolescents, in particular females participating in sports requiring frequent jumping, pivoting, and rapid acceleration. Consequently, the prevention of ACL injury is a principal concern of athletic trainers and other sports medicine professionals. Neuromuscular training (NMT) programs have been effective in reducing ACL injury risk in athletic populations, though additional clarity on programmatic factors, such as exercise selection, timing, and training dosage is warranted. Therefore, the primary purpose of this evidence-to-practice review was to present which components of NMT programs have been found to be most effective in reducing ACL injury incidence in …

The Use Of Abdominal Fascial Plane Blocks For Post-Operative Analgesia In Intestinal Rehabilitation Patients – A Retrospective Comparative Study, Brittany A. Brown, Lauren E. Costello, Elizabeth C. Ternent-Recht, Trevor J. Wilke, Cale A. Kassel

Graduate Medical Education Research Journal

Background: Short gut syndrome affects both pediatric and adult patients often requiring multiple surgical procedures to improve intestinal function. Identifying methods to improve pain control and reduce opioid consumption is an important consideration for this patient population.

Methods: A retrospective chart review of 115 patients less than 12 years of age undergoing abdominal procedures between August 1, 2012, and December 31, 2019, was performed. From this group, 64 patients had a perioperative abdominal wall fascial plane block performed and were compared to 51 patients who did not have a block performed.

Results: Mean opioid use defined as morphine equivalent daily …

Occupational Therapy Using Cbt To Improve Work Productivity In Schizophrenia: A Case Study, Artha Nisa Thohiroh Triyantari, Reza Nur Arsyi, Muhammad Luthfi, Ayleen Alicia K, Hermito Gideon, Zulfa Khoirunisah, Putri Dirgantara, Purnama Betty R. Sitorus

Jurnal Fisioterapi Terapan Indonesia

Schizophrenia is a chronic mental disorder that often impairs an individual's social and occupational functioning, including productivity-related activities. Patients with schizophrenia frequently face challenges in maintaining employment or running an independent business due to cognitive and emotional disturbances affecting their adaptive skills. This single-case study integrates Cognitive Behavioral Therapy (CBT) into occupational therapy to enhance productivity in a schizophrenia patient through an entrepreneurial activity—independently opening a coffee shop. The study subject is a 50-year-old male diagnosed with schizophrenia undergoing psychosocial rehabilitation at RSJ Dr. Soeharto Heerdjan. The CBT-based intervention was designed to develop adaptive thinking patterns and occupational skills through …

Enhancement Of Functional Ability In Supraspinatus Tendinitis Using Ultrasound And Isotonic Exercise: Case Study, Tu Lidya Ike Putri, Christabelle Aurelia

Jurnal Fisioterapi Terapan Indonesia

Supraspinatus tendinitis is an inflammation of the supraspinatus tendon caused by the supraspinatus muscle tendon overlapping with the caput longus bicep tendon so that friction and repetitive pressure occur over a long period of time and result in damage to the supraspinatus muscle tendon and supraspinatus tendinitis occurs. Characterized by complaints of pain around the shoulder followed by limitation of motion in the shoulder joint. The clinical question arises "can the application of ultrasound and isotonic exercise reduce pain and functional ability improvement?". To be able to answer this question, an evidence search was conducted on 3 data bases, namely …

Perbandingan Konservatif Fisioterapi Dengan Core Stability Exercise Pada Kasus Nyeri Punggung Bawah, Angria Pradita, Nurul Halimah

Jurnal Fisioterapi Terapan Indonesia

ABSTRACT: Low back pain is a major complaint caused by multifactorial conditions. The most common factors of low back pain complaints are due to age, occupation and gender. This study aims to compare the differences in therapeutic effects of conservative physiotherapy with the provision of electrotherapy, namely; microwave diathermy combined with transcutaneous electrical nerve stimulation (TENS), core stability exercise techniques and a combination of electrotherapy with core stability exercise (CSE). This type of research is quasi experimental with a pre-post test design in a population of 90 low back pain patients who seek treatment at the Physiotherapy clinic. By using …

Treating Type Ii Medial Tibial Stress Syndrome With Primal Reflex Release Technique: A Novel Approach, Shelli Green, Jenna Morogiello, Kurrel Fabian, James May, Alan Nasypany

Clinical Practice in Athletic Training

Five NCAA Division I cheerleaders (age 20 ± 1.4; 3 males, 2 females) presented with Medial Tibial Stress Syndrome (MTSS). Following an evaluation, all patients diagnosed with MTSS were treated using Primal Reflex Release Technique (PRRT). Immediate improvements in reported pain were demonstrated after one treatment. Improvements in perceived dysfunction were demonstrated after 4.2 (± 0.84) treatments over 15.4 (± 5.86) days with no time lost. All improvements were maintained at two-week follow-up. Type II MTSS patients treated with PRRT may experience an immediate, lasting reduction in pain, improvement in function, and shorter time to overall resolution.