Medical Specialties Commons^™

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

Background:

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

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

A Case Of Fatal Herpes Zoster Ophthalmicus And Encephalitis In An Immunocompetent Host With A Review Of Literature, Kellyn E. Wilkes, Rutwik Pradeep Sharma, Laurie Proia

Advances in Clinical Medical Research and Healthcare Delivery

Herpes zoster is a common disease that can have several complications. Here, we present a case of herpes zoster ophthalmicus with coexisting encephalitis that unfortunately resulted in patient mortality. A 70-year-old male with a past medical history of Parkinson’s disease and schizophrenia presented to the emergency department after being found altered at home. Physical exam was notable for left-sided crusted facial rash, left conjunctival injection, and purulent drainage coming from the right eye. Given the location and appearance of his rash, he was diagnosed with herpes zoster ophthalmicus. There was suspicion for encephalitis given his altered mental status but unfortunately, …

Ensuring Successful H. Pylori Test Of Cure: A Quality Improvement Initiative Focused On Post-Treatment Testing, Prajjwol D. Bhatta, Smriti Bhetuwal, Asim Pandey, Ahmed Shehadah, John Shrestha, Venkat Arutla, Chengu Niu, Himal Kharel, Abdullah Ahmed

Advances in Clinical Medical Research and Healthcare Delivery

Background

Eradication of Helicobacter. Pylori (HP) infection is crucial for preventing serious sequelae, such as peptic ulcer disease and gastric malignancies. The ACG guideline recommends mandatory re-testing to ensure HP eradication. However, studies have shown that only less than 25% of patients undergo eradication testing.

Objectives:

The main objective of this study is to evaluate the effectiveness of a simple educational intervention on test of cure compliance rate. Our target population includes patients with confirmed HP infection who were treated with HP eradication therapy.

Design: Quality improvement pre-post intervention

Participants: Internal Medicine residents

Intervention: Educational training on the importance …

Mycobacterium Shimoidei: A Case Report Of A Rare Nontuberculous Mycobacterial Infection In An American Patient With A Favorable Outcome, Madison Baker, Farah Majdoub, Asad Nasir

Advances in Clinical Medical Research and Healthcare Delivery

Non-tuberculous mycobacteria (NTM) are common environmental pathogens, but they are an uncommon cause of illness. One such mycobacteria, Mycobacterium shimoidei, was discovered in 1968 and found to cause a respiratory illness in 1975. Since then, fewer than 100 cases have been reported worldwide. Symptoms can include cough, fever, weight loss, and hemoptysis This report describes an American patient with no travel history who was found to have significant pulmonary disease caused by this rare non-tuberculous mycobacteria.

Patient And Population Impacts Of Multigene Panel And Pembrolizumab Coverage In Metastatic Melanoma, Deirdre Weymann, Emanuel Krebs, Samantha Pollard, Melanie Mcphail, Ian Bosdet, Stephen Yip, Alison M. Weppler, Aly Karsan, Helen Anderson, Tania M. Bubela

Office of the Provost

Background: Targeted treatment or immunotherapy may yield increased, durable responses for melanoma patients. Whether patient-level benefits translate to population health is unknown. This study sought to estimate patient and population impacts of a cancer control policy that reimbursed multigene panel testing and pembrolizumab for metastatic melanoma in British Columbia, Canada.
Methods: This retrospective study examined a population-based cohort of 721 adults diagnosed with metastatic melanoma in British Columbia who received single or multigene testing between 2013 and 2018. We determined patient-level policy impacts using 1:1 genetic algorithm matching of policy-affected patients with historical control patients and Kaplan-Meier analysis and inverse …

Cleavage And Polyadenylation Specificity Factor Subunit 5 Regulates Pulmonary Artery Smooth Muscle Expansion And Hypoxic Response, Scott D Collum, Lisha Zhu, Tingting W Mills, Rene Girard, Jamie Tran, Tinne C J Mertens, Cory Wilson, Nancy Wareing, Erik E Suarez, Howard J Huang, Rahat Hussain, Bindu Akkanti, Wenjin J Zheng, Hari K Yalamanchili, Bela Patel, Eric J Wagner, Sandeep Agarwal, Harry Karmouty-Quintana

Faculty, Staff and Student Publications

Pulmonary hypertension (PH) is a fatal condition that affects individuals with systemic sclerosis (SSc), a multiorgan fibrotic disease with limited treatment options. A central feature of PH is vascular remodeling, defined by the narrowing of the arteriole lumen due to cell proliferation and extracellular matrix deposition. Herein, we identify a central mechanism that can regulate multiple transcripts important for vascular remodeling. The highlight of our study is the demonstration that reduced pulmonary artery smooth muscle (PASMC) Nudt21, which codes for the RNA binding protein Cleavage and Polyadenylation Specificity Factor Subunit 5 (CPSF5) The, known to regulate alternative polyadenylation, results …

The Role Of C-Terminal Crosslinking Telopeptide Of Type Ii Collagen (Ctx-Ii) After Anterior Cruciate Ligament Reconstruction: A Systematic Review., Ali Naderi, S Ali Ghasemi, Andrea Fabregas, Gene Shaffer, James Raphael

Orthopedic Surgery Resident Research

Anterior cruciate ligament (ACL) injuries are known to accelerate cartilage degradation and predispose patients to early-onset osteoarthritis. C-terminal cross-linked telopeptide of type II collagen (CTX-II), a biomarker of cartilage breakdown, can be detected in various body fluids, including urine, offering a non-invasive method for evaluating cartilage degeneration. This systematic review aimed to assess existing evidence on urinary CTX-II (uCTX-II) levels following ACL reconstruction (ACLR). A systematic search of two medical databases was conducted in accordance with PRISMA guidelines. Studies were screened for inclusion based on their assessment of CTX-II in human subjects undergoing ACLR, and methodological quality was evaluated using …

Rectal Adenocarcinoma Presenting As Full-Thickness Prolapse With External Haemorrhoids: Case Report., Samantha Temucin, Sean Singh, Valerie Bauer, Roy Sandau

General Surgery Resident Research

We present a case of a 51-year-old male with a colonic adenocarcinoma that presented as a full-thickness rectal prolapse with external haemorrhoids. This patient had no significant medical or surgical history and presented to the emergency department with a rectal prolapse which had become incarcerated and increasingly painful over the previous 2 weeks. A computed tomography (CT) abdomen and pelvis appeared benign, demonstrating a full-thickness rectal prolapse with no definite rectal mass. A colonoscopy was performed, revealing anterior rectal mucosal edema, fibrosis, and a possible mass. This prompted the patient to be taken to the operating room for a low …

Improvements In Eeg Tracing Following Initiation Of Cannabidiol: A Case Report, Katherine Horman, Ara Hall, Kailash Pawar

Posters

No abstract provided.

Perceptions Of Family Medicine Among First-Year Medical Students At Aga Khan University, Nairobi, Kenya, Catherine Gathu, Lucy Mwangi, Peter Kioko, Tatiana Elwes

Family Medicine, East Africa

Background: Family Medicine (FM) is vital in delivering comprehensive and continuous care essential for robust primary healthcare systems. However, it remains underappreciated in many settings, particularly in sub-Saharan Africa.

Aim: This study aimed to assess the perceptions of FM among first-year medical students at Aga Khan University (AKU), Kenya.

Setting: A cross-sectional survey was conducted between August 2024 and September 2024 among the first-year medical students at AKU. All were invited to participate via email.

Methods: An 18-item questionnaire focused on three areas: perception and choice of medicine as a career, perception of FM and choice of FM as a …

Pericardial Effusion, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Kawasaki Disease, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

The Scope And Impact Of Walking The Talk For Dementia 2024, Sherril B. Gelmon, Kate Irving, Walter Dawson, Jonathan Adrián Zegarra-Valdivia, Lingani Mbakile-Mahlanza, Fernando Aguzzoli-Peres

Institute on Aging Publications

Walking the Talk for Dementia (WTD) is a global educational initiative integrating a walk along the Camino de Santiago with a symposium to combat dementia stigma, raise awareness, and foster inclusion.

Patient, Family And Clinician Priorities For Critical Care Research In Asia And Africa: A James Lind Alliance Priority Setting Partnership Using Modified Delphi And Nominal Group Techniques, Ccaa Priority Setting Partnership Steering Group, Teddy Abonyo, Sumaiya Arfin, Diptesh Aryal, Abi Beane, Martina Borellini, Arjen Dondorp, Emma Donley, Punam Gautam, Tiffany Gooden

Anaesthesiology, East Africa

Background This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions important to adult patients, their families and health professionals with lived experience of critical care across Asia and Africa.

Methods Modified Delphi techniques were used to generate suggestions using an online survey. Following verification, literature review and content analysis, these suggestions were iteratively codified into emergent topics. Topics were presented in a second online survey for ranking, prior to an online workshop where nominal group technique was used to identify top priority questions across stakeholder groups. Surveys were disseminated using snowballing techniques.

Findings The …

Pregnancy Outcomes Among Women With And Without Hiv Infections Who Underwent Excisional Treatment For High-Grade Cervical Intraepithelial Neoplasia: A Retrospective Cohort Study In Low-Resource Settings, Poli Amubuomombe, Peter Itsura, Philiph Tonui, Elkanah Orang'o, Benjamin Odongo, Patrick Loehrer, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objective The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high-grade cervical intraepithelial lesions.

Design This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did …

Use Of Hybrid Versus Video-Only Teledermatology Varies By Condition: A Cross-Sectional Study Of 2064 Encounters, Jacqueline Penn, Kathryn Achuck, Christine Deng, Richard W. Hass, Elizabeth Jones

Department of Medicine Faculty Papers

No abstract provided.

Management Of Displaced Supracondylar Fractures Of The Humerus Using Lateral Versus Crossed Kirschner Wires: A Prospective Randomized Controlled Clinical Trial, Ashlee Dobbe, Emily K. Schaeffer, Njalalle Baraza, Firoz Miyanji, Christine Alvarez, Anthony P. Cooper, Chris W. Reilly, Kishore Mulpuri

General Surgery, East Africa

Aims: We sought to evaluate whether loss of reduction in lateral Kirschner (K)-wiring is noninferior to crossed K-wiring in closed reduction and percutaneous pinning of Type III supracondylar humerus fractures.

Methods: A prospective, randomized, non-inferiority trial was conducted. Emergency department patients aged three to seven years with Type III supracondylar humerus fractures were invited to participate with informed consent. Block randomization allocated patients into one of two pin configuration groups (lateral or crossed). Surgical technique and postoperative management were standardized between groups. All patients were treated with above-elbow casts, but no strict standardized protocol was applied. The primary outcome was …

Adult Out Of Hospital Cardiac Arrest Criteria For Extracorporeal Cardiopulmonary Resuscitation Activation May Not Be The Same For Pediatric Out Of Hospital Cardiac Arrest, Lindsay Fick, Sherouk A. Abdelmoity, Jennifer Flint, Ashley Sherman, Jenna Miller

Presentations

Pediatric out-of-hospital cardiac arrest (OHCA) remains a high-mortality event, with survival to discharge consistently below 10%. Although extracorporeal cardiopulmonary resuscitation (E-CPR) improves outcomes for in-hospital cardiac arrest, its application in the pre-hospital environment is not well defined for pediatrics. Identifying which pediatric patients might benefit from OHCA ECPR activation is essential for developing feasible pre hospital pediatric E-CPR systems. Preliminary analysis of applying  criteria for adult OHCA ECPR activation can provide a crucial next step in establishing feasibility and applicability for the pediatric patient population.

Methods

A single center retrospective review was conducted of pediatric OHCA cases presenting from 2018–2025. …