Medical Specialties Commons^™

Prospective Phase Ii Clinical Trial Of Molecular Glioblastoma (Historical Grade 2 And 3 Idh Wildtype Gliomas) Preliminary Novel Exploratory Analyses: Treatment Intensification, Margin Reduction And Epigenetic Stratified Outcomes With Radiation Therapy And Chemotherapy, Debra Nana Yeboa, Benjamin T Whitfield, Ruitao Lin, Chinenye Lynette Ejezie, Todd A Swanson, Thomas H Beckham, Chenyang Wang, Brian De, Subha Perni, Martin C Tom, Jing Li, Susan L Mcgovern, Rebecca Harrison, Nazanin K Majd, Vinay K Puduvalli, Ashley E Aaroe, Monica Loghin, Barbara J O'Brien, Anuj D Patel, Chirag B Patel, Jeffrey S Wefel, Ceylan Altintas Taslicay, Maria Gule-Monroe, Arnold C Paulino, Mary Frances Mcaleer, David R Grosshans, Amol J Ghia, Wen Jiang, Caroline Chung, Moshe Maor, Cheng-Han Yang, Maria A Gubbiotti, Carlos Kamiya-Matsuoka, Leomar Y Ballester, Shiao-Pei Weathers, Jason T Huse

Faculty, Staff and Student Publications

Purpose: Molecular glioblastoma (molGBM) is a variant lacking the full histopathological profile of glioblastoma. We report a trial aimed at addressing the optimal management of this newly recognized rarer form of glioma.

Methods: In this phase II study, molGBM patients were treated with radiation to a dose of 60Gy to the gross tumor volume (GTV) only, and a single smaller margin potentially as low as 1cm to the clinical tumor volume (CTV). As the trial is ongoing, we report on important exploratory biomarker findings correlating with median overall survival (mOS). Analysis included Kaplan-Meier and univariable/multivariable cox proportional hazard models. Available …

Cofilin Inhibition Ameliorates Piezo2 And Ampa Dysfunction In A Mouse Model Of Angelman Syndrome, Luis O Romero, Manisha Bade, Elisa Carrillo, Sonia Paz-López, Syed A M Hasan, William James Antonisamy, Vasanthi Jayaraman, Zahoor A Shah, Valeria Vásquez, Julio F Cordero-Morales

Faculty, Staff and Student Publications

Angelman syndrome (AS) is a neurogenetic disorder characterized by motor coordination and cognitive deficits. In AS, hippocampal neurons show reduced filamentous (F-)actin, a decrease we also reported in dorsal root ganglia (DRG) neurons, along with impaired mechanosensitive ion channel activity. Currently, there are no pharmacological targets to prevent the decrease of F-actin in AS. Here, we utilize a first-in-class selective cofilin inhibitor (SZ-3) to restore PIEZO2 function in DRG neurons and glutamate-evoked currents in hippocampal neurons from AS mice. Using atomic force microscopy, we demonstrate that inhibiting cofilin, an actin-severing protein, with SZ-3 increases cellular stiffness by stabilizing the actin …

Targeting Gd2 With Naxitamab Overcomes Gd3 Synthase-Driven Immune Suppression In Triple-Negative Breast Cancer, Vivek Anand, Bolutyfe Oderinde, Maryam Siddiqui, Anudishi Tyagi, Jenny Borgman, Chong Wu, Michael Andreeff, V Lokesh Battula

Faculty, Staff and Student Publications

Gangliosides are acidic glycosphingolipids involved in cell-adhesion, signal-transduction and tumor progression. GD3 synthase (GD3S/ST8SIA1), a key enzyme in ganglioside biosynthesis, is upregulated in many cancers, including GD2+ breast cancer stem-like cells (BCSCs) in triple-negative breast cancer (TNBC). Here, we demonstrated the immunomodulatory role of GD3S and identified a fully humanized anti-GD2 antibody, naxitamab, as a therapeutic tool to target GD3S/GD2+ breast tumors. GD3S expression correlates with immune-checkpoint activation and reduced immune infiltration. Ectopic overexpression of GD3S suppressed macrophage-mediated phagocytosis and NK or T cell-induced cell death in BC cells. Lipidomic analysis identified GD2 as the major effector ganglioside …

Integrating Pathogenic Variants, Polygenic Risk Score, And Family History For Prostate Cancer Risk Estimation In Men Of African Ancestry, Fei Chen, Xin Sheng, Anqi Wang, Yili Xu, Raymond Hughley, Wei Xiong, Loreall Pooler, Peggy Wan, Susan M Gundell, Godfrey Kigozi, Gertrude Nakigozi, Fred Nalugoda, Joseph Kagaayi, Grace Nalwoga Kigozi, Stephen Mugamba, Emmanuel Kyasanku, James Nkale, Vitalis Ofumbi Olwa, Alexander Lubwama, Alex Daama, Resty Nakajugo, Ben Adusei, Mohamed Jalloh, Serigne Magueye Gueye, Andrew A Adjei, James Mensah, Pedro W Fernandez, Akindele Olupelumi Adebiyi, J Olufemi Ogunbiyi, Oseremen Inokhoife Aisuodionoe-Shadrach, Lindsay Petersen, Wenlong Carl Chen, Jo Mcbride, Jeannette T Bensen, James L Mohler, Jack A Taylor, Caroline Andrews, Mbaaga Kigongo, Amanya Colline, Vicky Kiddu, Juliet Namugambe, Shallot Owamaani, Kuteesa Job, Benon Joseph Masaba, Frank Asiimwe, Proscovia Muwanga, Joy Namulondo, Florence Nagawa, Charity Kayiraba, Martin Ogwang, Ronald Okidi, David Oweka, Elio Kitara, James Obonyo, Daniel Lajul, Paul Matovu, Precious Arinda Muheki, Johnson Natumanya, Emmanuel Agaba, Emmanuel Aculokin, Amos Twongyeirwe, George Mutema, Denis Bitamazire, Eboneé N Butler, Sue Ann Ingles, Benjamin A Rybicki, Janet L Stanford, Wei Zheng, Sonja I Berndt, Stephen J Chanock, Chad D Huff, Joseph Lachance, Luc Multigner, Burcu F Darst, Timothy R Rebbeck, Laurent Brureau, Stephen Watya, David V Conti, Christopher A Haiman

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVE: The impact of germline pathogenic variants (PVs) in cancer predisposition genes on risk of prostate cancer (PCa) remains understudied in large populations of African ancestry. This study aims to characterize the range of genetic risk of PCa and aggressive disease phenotypes in men of African ancestry.

METHODS: We analyzed 7176 PCa cases and 4873 controls from seven countries across North America and Africa to assess the association between PVs in 37 cancer predisposition genes and the risk of overall, aggressive, and metastatic PCa. Genes significantly associated with PCa risk were used to estimate lifetime absolute risk based …

Incidence And Risk Factors For Pneumonitis Due To Trastuzumab Deruxtecan In Metastatic Breast Cancer: A Retrospective Cohort Study, Maria Azhar, Felipe Soto, Amber Su, Norma Alicia Vazquez Gonzalez, Kevin Bernal Medina, Alejandro Lizarraga Madrigal, Cesar Chavez Duran, Carlos Ignacio Rodriguez Reyna, Colin Chan, Girish S Shroff, Roland L Bassett, Sarah Pasyar, David Zhang, Vickie R Shannon, Mehmet Altan, Melissa P Mitchell, Funda Meric-Bernstam, Jason Mouabbi, Rashmi K Murthy, Saadia A Faiz, Lara Bashoura, Bora Lim, Ajay Sheshadri

Faculty, Staff and Student Publications

Background: Fam-trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate (ADC) that targets human epidermal growth factor receptor 2 (HER2) and delivers a topoisomerase inhibitor payload. T-DXd has been effectively used to treat metastatic breast cancer but causes pneumonitis in 10–15% of cases. Risk factors associated with T-DXd pneumonitis are not well described.

Research question: What are the major clinical risk factors for T-DXd pneumonitis?

Study design and methods: We conducted a retrospective study of women with metastatic breast cancer at our institution treated with T-DXd as standard of care between 2020 and 2024. We collected clinical data, including demographics, relevant review …

Psych Assessment In The Er, Bailey J. Thompson, Addie Cowger, Hailie Hollis

Scholars Week

An immense amount of patients who enter the emergency department, whether for a psychiatric illness or not, struggle with mental health challenges. By creating a standardized routine and checklists for the care of high-risk psychiatric patients, the new quality and consistency can enhance patient experiences. This process will start at the triage stage and continue throughout their stay. Presenting the supportive research to the emergency department staff and introducing these changes gradually will help with staff buy-in and become a more sustainable process. Finally, with a structured approach, psychiatric patient outcomes will benefit significantly.

Roux-En-Y Gastric Bypass Is Associated With Increased Intestinal Glucose Uptake In Humans, Florina Corpodean, Maryam Naseri, Michael Kachmar, Julia St Amant, Denis P. Blondin, Owen T. Carmichael, Vance L. Albaugh

School of Medicine Faculty Publications

CONTEXT: In animal models, Roux-en-Y gastric bypass (RYGB) is associated with increased Roux limb intestinal glucose uptake that may contribute to early metabolic benefits, though prospective clinical studies are lacking. OBJECTIVE: The present study aimed to test the hypothesis that Roux limb glucose uptake would increase relative to baseline in a cohort of patients undergoing RYGB. METHODS: RYGB patients underwent preoperative baseline, and 3- and 6-month positron emission tomography/computed tomography postoperative imaging. Maximum and mean standardized uptake values (SUV) were measured from the following predefined regions of interest: cecum, hepatic flexure, splenic flexure, sigmoid colon, duodenal bulb, Roux limb, and …

Optimising Drowning Prevention Counselling Through A Physician Maintenance Of Certification (Moc) Quality Improvement (Qi) Initiative, Tracy E Mccallin, Anthony R Arredondo, Elizabeth A Camp, Shabana Yusuf

Faculty, Staff and Students Publications

Drowning is the leading cause of death in children 1–4 years old in the USA. Paediatricians play an important role in giving anticipatory guidance on drowning prevention. This quality improvement initiative aimed to increase the rate of drowning prevention counselling with provision of educational materials to caregivers of children aged 0–10 years during clinical encounters in an outpatient setting.

We refined a previously published Texas state educational programme that included evidence-based counselling strategies across three Plan Do Study Act (PDSA) cycles, with the addition of preintervention baseline counselling phase during expansion of the programme nationally to 17 and 21 states …

Timing And Mode Of Death Following Treatment Of Neonatal Symptomatic Tetralogy Of Fallot, Sara M Trucco, Yun Zhang, Andrew C Glatz, Michael L O'Byrne, Christopher J Petit, Athar M Qureshi, Jeffrey D Zampi, Shabana Shahanavaz, George T Nicholson, Allen Ligon, Jennifer C Romano, Shiraz A Maskatia, Jeffery J Meadows, Christopher Mascio, Jay Patel, Kathryn Stack, Asaad G Beshish, Mark Law, Sarosh P Batlivala, Jeannette Wong-Siegel, Kristal Hock, Sarah Speed, Hala Khan, Disha Goel, Courtney Mccracken, Bryan H Goldstein

Faculty, Staff and Students Publications

Background: Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention, using a staged or primary repair strategy. Postprocedural mortality risk within this group is considerable. The mode of death and associated factors have been inadequately defined in early childhood mortality following treatment of sTOF. This study aims to describe the timing, cause, and associated risk factors of postprocedural death in infants with sTOF.

Methods: Neonates with sTOF who had an initial intervention from 2005 to 2017 at 9 centers of the Congenital Cardiac Research Collaborative were reviewed. Among nonsurvivors, details regarding timing, cause of death, and last …

Use And Outcomes Of The Medical Hybrid Procedure For Stage 1 Palliation In Infants With Hypoplastic Left Heart Syndrome And Variants., Daniel N. Beauchamp, Christopher J. Statile, Huaiyu Zang, David A. Parra, Justin Godown, Natalie Jayaram, Matthew L. Moehlmann, Garick D. Hill

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Staged palliation of hypoplastic left heart syndrome and variants begins with the Norwood or hybrid procedure. Hybrid palliation is used in a minority of cases and often reserved for high-risk patients. Stented hybrid (SH) comprises bilateral pulmonary artery bands and ductal stenting, and medical hybrid (MH) comprises bilateral pulmonary artery bands and prostaglandins. MH use and outcomes have not been well described. We sought to compare MH, SH, and surgical stage 1 (SS1) using a national database.

METHODS: Patients from the National Pediatric Cardiology Quality Improvement Collaborative database born between 2016 and 2021 were categorized by initial intervention: MH, …

The Real-World Evaluation Of Remote Electrical Neuromodulation In Pediatric Migraines: A Preliminary Study., Amit Blumovich, Trevor Gerson, Mark Connelly, Tammie Wingert, Gina Jones

Manuscripts, Articles, Book Chapters and Other Papers

Background/Objectives: Pediatric migraine disrupts school performance and daily functioning. Concerns about medication overuse and limited efficacy highlight the need for non-pharmacologic treatments. The Nerivio remote electrical neuromodulation (REN) device, which is FDA-cleared for ages 8 and above, was evaluated in this study to assess real-world perceptions among patients in a pediatric neurology clinic. Methods: Patients aged 10-18 years who had used both acute medications and Nerivio completed two structured questionnaires, one reflecting on experiences with acute medication and one reflecting on experiences with acute REN treatment, assessing school and daily functioning, headache control, medication use, satisfaction, and preference. Descriptive statistics …

Pregnancy Outcomes In Women With Heritable Thoracic Aortic Disease: Data From The Eorp Esc Registry Of Pregnancy And Cardiac Disease (Ropac) Iii, Puck N J Peters, Johanna A Van Der Zande, Julie De Backer, Guillaume Jondeau, Osama Ahmad, Marjorie Richardson, Francesca M Comoglio, Heleen Van Der Zwaan, Siddharth K Prakash, Christina Christersson, Karishma P Ramlakhan, Roger Hall, Mark R Johnson, Jolien W Roos-Hesselink, Ropac Investigators

Faculty, Staff and Student Publications

Aims: The risk of pregnancy in women with heritable thoracic aortic disease (HTAD) is estimated to be high, but supporting data are scarce. The aim of this study is to prospectively investigate pregnancy outcomes to improve patient management and care.

Methods and results: The Registry of Pregnancy and Cardiac disease (ROPAC) III is a prospective global registry including pregnant women with known aortic pathology between 2018 and 2023. Cardiac, obstetric and fetal outcomes, beta-blocker use, and the impact of breastfeeding were investigated. Additionally, changes in aortic diameters were assessed. In total, 176 pregnancies in 170 women (mean age 32 years, …

Disparate Leukemia Mutations Converge On Nuclear Phase-Separated Condensates, Gandhar K Datar, Elmira Khabusheva, Archish Anand, Joshua Beale, Marwa Sadek, Chun-Wei Chen, Evdokiia Potolitsyna, Nayara Alcantara-Contessoto, Guangyuan Liu, Josephine De La Fuente, Christina Dollinger, Anna Guzman, Alejandra Martell, Katharina Wohlan, Abhishek Maiti, Nicholas J Short, S Stephen Yi, Vibeke Andresen, Bjørn Tore Gjertsen, Brunangelo Falini, Rachel E Rau, Lorenzo Brunetti, Nidhi Sahni, Margaret A Goodell, Joshua A Riback

Faculty, Staff and Students Publications

During cancer development, mutations promote changes in gene expression that cause transformation. Leukemia associated with aberrant HOXA expression is driven by translocations of nucleoporin genes or KMT2A as well as mutations in NPM1. The mechanistic convergence of these disparate mutations remains elusive. Here, we demonstrate that mutant nucleophosmin 1 (NPM1c) forms nuclear condensates in human cell lines, mouse models, and primary patient samples. We show NPM1c phase separation is necessary and sufficient to recruit NUP98 and KMT2A to condensates. Through extensive mutagenesis and pharmacological destabilization of phase separation, we find that NPM1c condensates are necessary for regulating gene expression, promoting …

Serum Response Factor Is Essential For Endometrial Function And Prevention Of Inflammatory Fibrosis, Ryan M Marquardt, Sara A Grimm, San-Pin Wu, Peter F Lais, Shu-Yun Li, Xin Xu, Erin Smithberger, David Cunefare, Charan Ganta, David Olson, Eunhee M Jeong, Jae-Wook Jeong, Bruce A Lessey, John P Lydon, Francesco J Demayo

Faculty, Staff and Students Publications

Pregnancy requires a supportive uterine environment facilitated by steroid hormone–regulated differentiation of endometrial stromal fibroblasts into decidual cells and tight control of inflammation. Serum response factor (SRF) is a widely expressed transcription factor essential for mesenchymal cell growth and differentiation with noted roles in hormonal regulation of muscle tissues but little characterization in reproductive organs. Here, we reveal that endometrial SRF is dysregulated in human endometriosis and is critical for female reproductive success in mice through regulation of endometrial stromal and epithelial cells. Immunohistochemical analysis identified decreased endometrial SRF expression in infertile endometriosis patient tissues. RNAi-based SRF knockdown in human …

Global Trends And Forecast Of Cardiovascular Diseases, Cancer, And Shared Risk Factors: Insights From The Gbd 2021, Chieh Y Koo, Bryan Chong, Jayanth Jayabaskaran, Srinithy Nagarajan, Silingga M Jauhari, Yiming Chen, Li L Tan, Anurag Mehta, Muhammad S Khan, Mark Muthiah, Derek Hausenloy, A M Richards, Dennis T Ko, Christian D Mallen, Eric A Secemsky, Mark Y Chan, Paaladinesh Thavendiranathan, Nicholas W S Chew, Mamas A Mamas

Faculty, Staff and Students Publications

Background: Cardiovascular disease (CVD) and cancer share multiple risk factors and are the leading causes of morbidity and death worldwide. This study aims to examine historical and projected trends of the combined CVD-cancer global estimates and their shared risk factors.

Methods: Death and disability-adjusted life years (DALYs) associated with CVDs, cancers, and their risk factors were obtained from the GBD (Global Burden of Disease) 2021 study. Historical estimates from 1990 to 2021 and forecast data from 2025 to 2050 were examined across age groups, regions, sociodemographic index, and sex.

Results: In 2021, CVD-cancer resulted in age-standardized DALY rates of 8009 …

A Recurrent Acaa2 Variant Causes A Dominant Syndrome Of Lipodystrophy, Lipomatosis, Infantile Steatohepatitis And Hypoglycemia, Vinaya Simha, Mary Kate Lopiccolo, Anna Platt, Rebecca J Brown, Xandria Johnson, Deanna Alexis Carere, Colleen Donnelly, Matthew T Snyder, Chao Xing, Thomas P Mathews, Purva Gopal, Stephen C Ward, Diana R Tomchick, Anil K Agarwal, Ralph J Deberardinis, Abhimanyu Garg

Faculty, Staff and Student Publications

No abstract provided.

Effects Of Combining Traditional East Asian And Conventional Western Medicine On Acute Stroke Outcomes, Dong-Seok Gwak, Jong-Sik Lee, Dawid Schellingerhout, Jinyong Chung, Hyerin Oh, Sang-Wuk Jeong, Ji Sung Lee, Hee-Joon Bae, Mikyung Kim, Dong-Jun Choi, Dong-Eog Kim

Faculty, Staff and Student Publications

Background: Traditional East Asian medicine (TM) is widely used in Korea and other East Asian countries. However, the effects of TM treatment on acute ischemic stroke (AIS) outcomes remain unclear, as previous studies lacked a sufficient sample size, a consecutive series design, or a prospective outcome capture approach. We aimed to investigate whether combining TM with conventional Western medicine (CM) treatments (C+TM) leads to better outcomes after AIS, relative to CM treatment alone.

Methods: We retrospectively analyzed 2157 consecutive patients with AIS from a prospectively collected registry (2011-2021) at our center and compared the CM and C+TM groups in terms …

Therapeutic Potential Of Prmt1 As A Critical Survival Dependency Target In Multiple Myeloma, Tabish Hussain, Sharad Awasthi, Farid Shahid, S Stephen Yi, Nidhi Sahni, C Marcelo Aldaz

Faculty, Staff and Student Publications

Multiple myeloma (MM) is a neoplasm of antibody-producing plasma cells and is the second most prevalent hematological malignancy worldwide. Development of drug resistance and disease relapse significantly impede the success of MM treatment, highlighting the critical need to discover novel therapeutic targets. In a custom CRISPR/Cas9 screen targeting 197 DNA damage response-related genes, Protein Arginine N-Methyltransferase 1 (PRMT1) emerged as a top hit, revealing it as a potential therapeutic vulnerability and survival dependency in MM cells. PRMT1, a major Type I PRMT enzyme, catalyzes the asymmetric transfer of methyl groups to arginine residues, influencing gene transcription and protein function through …

Association Of Acute Kidney Injury Risk And Same-Day Discharge Practices After Percutaneous Coronary Intervention., Anezi Uzendu, Rayan El Zein, Jennifer A Rymer, Dan D Nguyen, R Angel Garcia, Nobuhiro Ikemura, Neel Butala, Howard M Julien, Saket Girotra, Dharam J Kumbhani, Oladipupo Olafiranye, Rebecca Young, Leo Brothers, John A Spertus

Heart and Vascular Articles

BACKGROUND: Same-day discharge (SDD) after percutaneous coronary intervention (PCI) may be altered when complications occur. We sought to determine whether risk of the most common complication, acute kidney injury (AKI), is associated with SDD in practice.

METHODS: Using the NCDR (National Cardiovascular Data Registry) CathPCI registry, we calculated the AKI risk for elective PCIs from 2018 to 2022 using the NCDR prediction model. Hierarchical logistic regression models were constructed to predict SDD with AKI risk and procedural variables as fixed effects, and site as a random effect. Trends in SDD rate across AKI risk categories were described and variability across …

Antimicrobial Resistance In Ukraine—What Healthcare Providers Need To Know When Treating Ukrainian Refugees, Olga Vasylyeva

Advances in Clinical Medical Research and Healthcare Delivery

The scoping review assesses the trends in clinical infectious diseases reporting antimicrobial resistance (AMR) in Ukraine following a year of full-scale Russo-Ukrainian war (2022) to offer recommendations for healthcare providers caring for patients traveling from Ukraine.

Background: Until 2019, antibiotics were available to Ukrainians over the counter, and there was no systematic program to monitor bacterial resistance. Only in 2023 did a document standardizing the rational use of antibacterial and antifungal drugs become available for Ukrainian healthcare providers. By 2020, high levels of carbapenem-resistant bacteria were reported in military hospitals, 29.5%–64.2%, with Acinetobacter baumannii particularly problematic. Nosocomial infections were significantly …

Accidental Daily Dosing: Severe Methotrexate Toxicity In A Patient With Rheumatoid Arthritis, Sidra Memon, Kavitha Vemuri, Syed Uzair Mahmood, Darshit Patel

Advances in Clinical Medical Research and Healthcare Delivery

This case highlights a crucial complication of oral methotrexate therapy: toxicity due to dosing errors. A patient’s daily dosing regimen, instead of the intended weekly schedule, led to a significantly excessive cumulative dose of methotrexate over a short period, resulting in severe hematologic and mucosal toxicity. This underscores the importance of clear patient education and vigilant prescription practices to prevent such errors.

Plasmacytoma As The Initial Presentation Of Multiple Myeloma: A Case Report, Chantelle Martin, Sidra Memon, Austin Kim, Saleha Asghar

Advances in Clinical Medical Research and Healthcare Delivery

We report an unusual case of a woman who presented with nonspecific symptoms of unilateral facial mass and bleeding from her lower lip over several weeks. The mass was found to be relatively fixed and irregular with destruction of facial bone as evidenced by imaging. Initial investigations indicated the possibility of multiple myeloma, which was later confirmed with serum protein electrophoresis and bone marrow biopsy. Cervical lymph node biopsy confirmed presence of plasmacytoid cells positive for CD 20.

Inadvertent Transhepatic Placement Of Percutaneous Endoscopic Gastrostomy (Peg) Tube, Stephanie Yu, Brian Wight, Elizabeth Mamo, Alexander Kurchin

Advances in Clinical Medical Research and Healthcare Delivery

Of 294 patients who had a PEG tube placed and subsequently underwent CT scan of the abdomen, in 20 patients the tube traverses the left lobe of the liver. Only one of these 20 patients had a major complication, indicating the transhepatic PEG is usually well tolerated, and, if detected can be left in place.

Cardioembolic Versus Cryptogenic Stroke: A Case Report And Discussion, Lily Sitisa, Shabir Ferdows, Jonathan Brach

Advances in Clinical Medical Research and Healthcare Delivery

Ischemic strokes account for about 85% of cerebrovascular accidents. About 30–40% of ischemic strokes are classified as cryptogenic, which is defined as an ischemic stroke of the brain without a clear etiology. This case report presents a 56-year-old male with a history of uncontrolled hypertension who was admitted to a community hospital for cardioembolic versus cryptogenic stroke. It is essential for clinicians to be familiar with cryptogenic stroke and its implications for patient care.

Rare Case Of Visual Hallucinations In A 60-Year-Old Female With A Recurring Pituitary Macroadenoma, Angelica Alday, Farah Qureshi, Kayvan Mirhadi

Advances in Clinical Medical Research and Healthcare Delivery

Pituitary adenomas are the third most frequently occurring primary intracranial tumor and are benign neoplasms that can have profound clinical implications. While most of these masses cause hormone hypersecretion, they may also be clinically silent until they elicit symptoms of mass effect, including severe headaches and visual field defects such as bitemporal hemianopia. This report highlights an atypical presentation of a pituitary adenoma that could be valuable for internists to consider when forming a differential diagnosis for patients with hallucinations. We discuss a case of a 60-year-old woman with a recent history of multiple emergency department visits for ongoing urinary …

Aortic Valvular Papillary Fibroelastoma Presenting As Transient Ischemic Attacks, Mahrukh Tariq, Zauraiz Anjum, Joel Shapiro

Advances in Clinical Medical Research and Healthcare Delivery

We present an aortic valve Papillary Fibroelastoma diagnosed on a transesophageal echo (TEE) in 2020 in a patient who had been presenting with recurrent CNS symptoms since 2013 without any known cause. She had clean imaging including transthoracic echo (TTE) and the Fibroelastoma was discovered only on a TEE in 2020. We hope to highlight the elusive nature of the lesion as an obscure cause of CNS symptomatology.

Impact Of Frailty On Inpatient Outcomes Of Covid-19 Patients: Evidence From A Us National Inpatient Sample, Ali Jaan, Priyanshi Shah, Ashish Dhawan, Saria Qaiser, Azka Ali, Hla Myo Thwe, Oluwatosin Abimbolu, Clara Chimuanya Okpara, Michael Rajnik

Advances in Clinical Medical Research and Healthcare Delivery

Introduction: The global impact of Coronavirus Disease 2019 (COVID-19), caused by severe-acute-respiratory-syndrome coronavirus 2 (SARS-CoV-2), has been profound, claiming the lives of more than 3 million individuals within a year and a half. Among the affected population, heightened vulnerability is observed among older and frailer individuals, leading to more severe symptoms and adverse outcomes compared to their younger, non-frail counterparts. This study to analyze the impact of frailty on the outcomes of adult patients admitted with COVID-19.

Methods: Using the National Inpatient Sample (NIS) database 2020, we identified adult patients admitted with a principal diagnosis of COVID-19. The …

A Rare Case Of Systolic Heart Failure In A 32-Year-Old Man, Neha Narayanan, Paulina N. Goodermote, Mohammad Jawish

Advances in Clinical Medical Research and Healthcare Delivery

There is limited data about heart failure in individuals below 65 years of age, despite the increasing incidence and rapidly progressive nature of heart failure in this patient population. This case of a 32-year-old African American male highlights the importance of early diagnosis and rapid transfer to higher level care given the quick progression of his systolic heart failure. This case also aims to discuss the common etiologies behind heart failure in young adults, highlighting how crucial it is to consider this diagnosis in an individual with polysubstance use. We hope this case report sheds light on the rising incidence …

Giant Cell Arteritis After Mrna Covid Vaccines: Concerning Or A False Alarm?-A Retrospective Cohort Study, Syed M. F. Zabiullah, Rutwik Pradeep Sharma, Roshan Subedi, Viqarunnisa Faaiza Zahid, Yasir Loai, Sarathlal Mannumbethlal, Aatifa Aatifa

Advances in Clinical Medical Research and Healthcare Delivery

Background: The coronavirus disease (COVID-19) pandemic led to the first large-scale rapid deployment of novel messenger RNA (mRNA) vaccines. Although the effectiveness and safety of these vaccines were rigorously studied, post-vaccination adverse events such as giant cell arteritis (GCA) continue to be reported. More than two hundred and sixty three cases of new-onset GCA occurring after mRNA vaccine administration are listed in the Vaccine Adverse Events Reporting System as of October 2024. We aimed to explore the incidence of GCA after mRNA vaccines among patients in our health system and study their characteristics and outcomes.

Methods: We conducted a …

Postoperative Pain Management In Older Patients, Stephanie Guercio, Andrea M. Bodine

Advances in Clinical Medical Research and Healthcare Delivery

Background: Postoperative pain management in the older population has been described as a complex topic with providers trying to balance pain control while minimizing adverse effects of decreased physiologic reserve such as delirium and decreased cognitive function. The goal of this study was to compare pain scores and pain medications prescribed at discharge between an older age group and a middle age group after an elective cholecystectomy.

Methods: We conducted a retrospective study at a community hospital in western Massachusetts collecting data from March 1, 2022, to February 28, 2023 using laparoscopic cholecystectomy CPT code. Included were patients between 50 …