Medical Specialties Commons^™

External Fixation Assisted Intramedullary Total Femur Arthroplasty: A Case Report, Matthew Hnatow, Blake Martin, Emma Herrera

School of Medicine Publications

Introduction:Total femur replacement (TFR) is a salvage procedure for patients with multiple failed hip and knee arthroplasties and is associated with high complication rates. Intramedullary TFR has emerged as a technique to preserve critical soft tissue attachments; however, maintaining limb length, alignment, and rotation remains challenging.

Case Presentation: We describe a novel case of intramedullary TFR utilizing external fixation to address these technical challenges. A 64-year-old male with subsidence of a hinged knee tumor prosthesis to the level of the greater trochanter underwent intramedullary TFR. External fixation was applied to the residual femoral and tibial bones to maintain …

Plant-Based Dietary Patterns Are Associated With Slower Epigenetic Aging, Alexis C Wood, Audrey Ting, Morgan E Grams, Bing Yu, Kelly Ruggles, James S Floyd, Dan E Arking, Casey M Rebholz

Faculty, Staff and Students Publications

Greater adherence to plant-based diets is associated with health benefits. Dietary intake can modify DNA methylation patterns, but it is unknown whether plant-based diets in a largely non-vegetarian population are associated with DNA methylation-based epigenetic aging measures. We examined the associations between 4 different types of plant-based diets indices (PDI) [overall PDI, provegetarian diet, healthy PDI, and unhealthy PDI] and epigenetic aging. We used data from the Atherosclerosis Risk in Communities (ARIC) Study (N=2,810) and National Health and Nutrition Examination Survey (NHANES, N=2,056). PDIs negatively scored higher intake of animal products and positively scored higher intake of all or selected …

Integration Of Cross-Species Multi-Omics With In Vivo Experimental Validation Identifies Parkinson’S Disease Therapeutic Targets And Novel Risk Factors Within Endolysosomal Pathway Subnetworks, Justin Moore, Leo Rao, Sara Garcia-Bellido, Fangfei Guo, Jorge Botas, Juan Botas

Duncan NRI Faculty and Staff Publications

Parkinson's disease (PD), the most common neurodegenerative movement disorder, imposes a growing healthcare and socioeconomic burden worldwide. A defining hallmark of PD is the accumulation of α-synuclein (αSyn) within intracellular inclusions such as Lewy bodies and Lewy neurites. Genomic studies have identified numerous PD risk factors within the endolysosomal pathway (ELP), an essential cellular system for protein and membrane recycling. Concordantly, recurrent transcriptomic and proteomic alterations in ELP components implicate broad ELP dysfunction as a causal contributor to PD and suggest that additional, uncharacterized ELP genes may cooperate in polygenic disease mechanisms. A promising but underexplored therapeutic concept is that …

Educational Intervention To Improve Awareness Of The Female Athlete Triad Among Division I Athletes, Carly J. Haring, Jonathan Olson Md

Aesculapius Journal (Health Sciences & Medicine)

Introduction: The Female Athlete Triad poses short- and long-term health risks for female athletes through the interrelated components of low energy availability, menstrual dysfunction, and impaired bone health. Despite its prevalence, awareness and education surrounding the Triad remain limited, contributing to delayed recognition and care. The objective of this project was to assess baseline knowledge and comfort discussing Female Athlete Triad–related topics among Division I female athletes and to evaluate the impact of a brief educational intervention on knowledge, attitudes, and help-seeking intentions.

Methods: A community-based educational initiative was conducted in November 2025 among Division I female athletes …

Neurobiological Pathways Underlying Brain Tumor Progression: Basis For Oncogenicity And Opportunities For Immunotherapeutic Intervention, Carrie E. Andrews, Jenny Zilberberg, Raul Perez-Olle, David Andrews, Mark A. Exley

Department of Neurosurgery Faculty Papers

Both primary and metastatic brain tumors rely on signals from the surrounding environment for their survival and progression. In particular, the most common and lethal brain cancer, glioblastoma (GBM), derived from glial cells (astrocytes or microglia), has been shown to integrate into synaptic networks and to receive paracrine signals from neighbouring tumor microenvironment (TME) cells. There is increasing evidence that metastatic disease in the brain exhibits similar behavior. The TME both maintains malignant cells and is maintained by them, a process that relies on cancer stem cells (CSCs). These stem cells and their signaling mechanisms, including in the case of …

From Screen To Newborn: Making Sense Of Prenatal Genetics In Primary Care, Bob Underwood, Lylach Haizler-Cohen

Pediatrics in Practice: A CME Podcast

This episode dives into the essentials of prenatal genetic testing and its significance for pediatricians. Learn about different types of tests like NIPT and microarrays, and how to interpret results to better care for newborns. Join Dr. Lylach Heisler Cohen, a prenatal genetic testing expert, as she breaks down the complexities of pediatric genetics.

Click here to stream the podcast episode.

Sepsis-Triggered Proteolysis Of Profibrinolytic Annexin A2 Associated With Microvasculopathy-Related Organ Dysfunction, Hana I. Lim, Michael Bender, Huigen Chen, Frances M. West, Julio Lanfranco, Dena Almeida, Katherine A. Hajjar

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Sepsis is a systemic inflammatory disorder marked by dysregulated inflammation and coagulopathy. Annexin A2 (A2), a profibrinolytic protein, assembles plasminogen and tissue plasminogen activator on cell surfaces, thereby maintaining vascular patency. However, its role in human sepsis has remained poorly defined. We investigated whether A2 undergoes qualitative or quantitative modification during human sepsis with associated end-organ dysfunction. Peripheral blood mononuclear cells and plasma were collected from 65 patients with sepsis and 27 healthy controls. A2 expression and integrity were evaluated with cell surface plasmin generation using immunoblot and fluorometric assays. Both A2 integrity and plasmin generation were significantly reduced in …

Come Together: The Be-Tils-Efficient Multiplex Base Editing Of Tumor-Infiltrating Lymphocytes, Viktor Glaser, Dimitrios L Wagner, Tobias Bexte

Faculty, Staff and Students Publications

No abstract provided.

Fibrinogen-Bmal1 Signaling As A Therapeutic Target To Limit Aortic Dissection By Preserving Vsmc Contractility, Xiaohan Zhong, Dongjie Li, Yuanfei Zhao, Lu Dai, Jinzhang Li, Zhiqi Ji, Bojing Zuo, Hongshan Liu, Haixia Huang, Wei Wang, Haiyang Li, Yuyong Liu, Ming Gong, Xin-Liang Ma, Wenjian Jiang, Meili Wang, Hongjia Zhang

Department of Emergency Medicine Faculty Papers

Aortic dissection (AD) is a life-threatening vascular disease with a high mortality rate. Surgery is essential in the acute phase but carries significant risks, whereas elective surgery during the chronic phase yields better outcomes. However, no pharmacological therapy has been proven effective in slowing AD progression. In our recent pilot clinical study, an association between higher plasma fibrinogen levels and improved clinical outcomes was observed in AD patients, suggesting a potential protective role of fibrinogen. However, direct evidence supporting this hypothesis is lacking. In this study, a population-based analysis of nonsurgically managed patients with acute AD revealed a distinct association: …

Targeting Cardiomyocyte-Derived Extracellular Vesicle Mir-574-5p Protects Against Cognitive Impairment Induced By Ischemia-Reperfusion, Erya Chen, Xiaoyu Zhu, Haiqing Chang, Qi Li, Zhenkun Zhao, Changteng Zhang, Yu Cao, Yajing Wang, Xinliang Ma, Tao Zhu, Shu Zhang, Lu Gan, Jin Liu, Chan Chen

Department of Emergency Medicine Faculty Papers

BACKGROUND:  Acute myocardial ischemia/reperfusion (MI/R) increases risk for cognitive decline, yet the underlying mechanisms mediating heart-brain communication remain poorly understood. Small extracellular vesicles (sEVs) have emerged as novel long-range signaling mediators and may play a critical role.

METHODS: MI/R was induced by transient ligation of the left anterior descending artery. Cognitive performance was assessed using multiple behavioral tests. sEVs derived from cardiomyocytes were labeled to track their distribution and cellular uptake in the brain. Heart and brain tissues were analyzed for microRNAs (miRNAs) expression using bioinformatics, qPCR, and RNAScope. The role of specific miRNAs was investigated through genetic inhibition of …

Evaluating Eight Smoking Metrics For Modelling Survival In Non-Small Cell Lung Cancer, Andrew Cl Lam, Yao Li, M Catherine Brown, Yangqing Deng, Katrina Hueniken, Frances A Shepherd, Zhichao Wang, Jui Kothari, Angela S Wenzlaff, Haoran Liu, Takashi Kohno, Angela Cecilia Pesatori, Curtis Harris, Hongxia Ma, Juncheng Dai, Matthew J Barnett, Ryan Diver, Leticia Ferro Leal, Guillermo Fernandez-Tardon, Mónica Pérez-Ríos, Michael Pa Davies, Bernd Holleczek, Paul Brennan, David Zaridze, Ivana Holcatova, Jolanta Lissowska, Beata Świątkowska, Dana Mates, Milan Savic, Hermann Brenner, Angeline S Andrew, Fiona Taylor, John K Field, Alberto Ruano-Ravina, Sanjay S Shete, Adonina Tardon, Ying Wang, Loic Le Marchand, Rui Manuel Reis, Matthew B Schabath, Marian L Neuhouser, Hongbing Shen, Maria Teresa Landi, Kouya Shiraishi, Jie Zhang, Ann G Schwartz, Ming S Tsao, David C Christiani, Ping Yang, Rayjean J Hung, Wei Xu, Geoffrey Liu

Faculty, Staff and Student Publications

Introduction: Smoking is a strong modifiable prognostic factor for lung cancer survival. We compared eight smoking metrics to determine which metric best models the relationship between smoking exposure with overall survival (OS) and lung cancer-specific survival (LCSS). These metrics included cigarettes-per-day, smoking duration, pack-years, square-root pack-years, logcig-years, the comprehensive smoking index, age-of-initiation, and years-since-quit.

Materials/methods: This retrospective, pooled analysis included 25 International Lung Cancer Consortium studies between June 1, 1983-December 31, 2019. The performance of smoking metrics for modelling OS was compared based on 1) strength and significance in adjusted Cox-proportional hazard models and 2) linearity based on the goodness-of-fit …

Self-Clustering Of Three Cbx2 Molecules Drives Prc2 To Promote Facultative Heterochromatinization Of Polycomb Target Genes, Xinlong Luo, Axel Espinoza, Joey Wen, Chengjie Zhu, Joseph Tucker, Kalkidan Astatike, Christopher J Phiel, Hatim Sabaawy, Tatiana G Kutateladze, Tao P Wu, Tingting Yao, Chao Lu, Srinivas Ramachandran, Xiaojun Ren

Faculty, Staff and Students Publications

Phase separation is increasingly recognized in facultative heterochromatinization of Polycomb target genes; however, the mechanisms underlying this process remain obscure. Using single-molecule imaging and tracking, we show that individual condensates in mouse embryonic stem cells (mESCs) contain approximately 3 CBX2 molecules and numerous Polycomb repressive complex (PRC)1 and PRC2 subunits and indicate that the composition and dynamics of condensates are developmentally regulated. We reveal that CBX2 clusters PRC2 and controls the spatial distribution of both PRC2 and H3K27me3. Using genomic approaches, we demonstrate that CBX2 binds to condensate initiation sites, which are enriched for PRC2 nucleation sites. CBX2 deletion causes …

Immunotherapy Of Tsa-1.C4 Or In Combination With Bnz Confers Protection Against Trypanosoma Cruzi Infection With A Distinct Cytokine Response, Fabian Gusovsky, Kathryn Jones, Peter Hotez, Liliana Estefanía Villanueva-Lizama, Maria Elena Bottazzi, Jaime Ortega-Lopez, Julio Vladimir Cruz-Chan

Faculty, Staff and Students Publications

Chagas disease is a poverty-related neglected tropical disease caused by the protozoan Trypanosoma cruzi affecting approximately 6.3 million people, predominantly in the Americas. Approximately 30% of T. cruzi infections progress to chronic cardiomyopathy and 10% of these cases end in death from cardiac failure. The first-line drug Benznidazole (BNZ) require a prolonged treatment regimen and can be highly toxic. Here, we evaluate a therapeutic vaccine in T. cruzi-infected mice, based on the recombinant Trypomastigote Surface Antigen 1 (TSA-1.C4) protein and the emulsified adjuvant E6020, and in combination with a suboptimal dose of BNZ. We observed a reduced burden parasite in …

Immunotherapy Of Tsa-1.C4 Or In Combination With Bnz Confers Protection Against Trypanosoma Cruzi Infection With A Distinct Cytokine Response, Fabian Gusovsky, Kathryn Jones, Peter Hotez, Liliana Estefanía Villanueva-Lizama, Maria Elena Bottazzi, Jaime Ortega-Lopez, Julio Vladimir Cruz-Chan

Faculty, Staff and Students Publications

Chagas disease is a poverty-related neglected tropical disease caused by the protozoan Trypanosoma cruzi affecting approximately 6.3 million people, predominantly in the Americas. Approximately 30% of T. cruzi infections progress to chronic cardiomyopathy and 10% of these cases end in death from cardiac failure. The first-line drug Benznidazole (BNZ) require a prolonged treatment regimen and can be highly toxic. Here, we evaluate a therapeutic vaccine in T. cruzi-infected mice, based on the recombinant Trypomastigote Surface Antigen 1 (TSA-1.C4) protein and the emulsified adjuvant E6020, and in combination with a suboptimal dose of BNZ. We observed a reduced burden parasite in …

The Neutralizing Antibody Titer Correlate Of Covid-19 Risk In The Covid-19 Variant Immunologic Landscape (Covail) Trial Was Not Modified By Sars-Cov-2 Amino Acid Sequence Distances, Fei Heng, Craig A Magaret, Nadine G Rouphael, Angela R Branche, Youyi Fong, Lindsay N Carpp, Chenchen Yu, Shiyu Chen, Bo Zhang, David J Diemert, Ann R Falsey, Daniel S Graciaa, Lindsey R Baden, Sharon E Frey, Jennifer A Whitaker, Susan J Little, Satoshi Kamidani, Emmanuel B Walter, Richard M Novak, Richard Rupp, Lisa A Jackson, Tara M Babu, Angelica C Kottkamp, Anne F Luetkemeyer, Lilly C Immergluck, Rachel M Presti, Martín Bäcker, Patricia L Winokur, Siham M Mahgoub, Paul A Goepfert, Dahlene N Fusco, Robert L Atmar, Christine M Posavad, Jinjian Mu, Mat Makowski, Mamodikoe K Makhene, Seema U Nayak, Viviana Simon, Harm Van Bakel, Paul C Roberts, Peter B Gilbert, Coronavirus Variant Immunologic Landscape Trial (Covail) Study Team

Faculty, Staff and Students Publications

In the Coronavirus Variant Immunologic Landscape Trial (COVAIL) conducted in the United States in 2022–2023, 985 participants received a second COVID-19 booster with one of twelve monovalent or bivalent mRNA inserts. Pseudovirus serum inhibitory dilution 50% neutralizing antibody titer (nAb titer) measured two-weeks post booster significantly associated with lower COVID-19 incidence over six months follow-up in this trial. COVAIL investigators sequenced SARS-CoV-2 Spike amino acid sequences for all COVID-19 cases, with a sequence successfully obtained from 129 of 195 cases. For COVID-19 endpoint cases we calculated five distances of the case-causing sequence to a reference sequence, the first two physico-chemical …

Onc-Safe: Oncology-Specific Fall Prevention Initiative, Aubry C. Townzen, Stella Chigbrow, Katie Mcbride, Payton Bolin

SPARK Symposium Presentations

ONC-SAFE: Oncology-Specific Fall Prevention Initiative

Aubry Townzen, Stella Chigbrow, Katie McBride, Peyton Bolin

ONC-SAFE aims to decrease fall rates and fall-related injuries on an inpatient oncology unit by improving staff adherence to bed alarm activation for high-risk patients through the use of doorframe reminder posters and targeted staff education. Falls are a significant patient safety concern in oncology populations due to cancer- and treatment-related risk factors such as chemotherapy-induced peripheral neuropathy, anemia, orthostatic hypotension, fatigue, muscle weakness, cognitive changes, and medication effects, including opioids, sedatives, and antiemetics. Hospitalized oncology populations identify impaired mobility, treatment-related symptoms, and medication effects as primary …

Depression And Psychotic Disorders Worsen Perioperative Outcomes And Increase Resource Utilization After Multilevel Lumbar Fusion: Implications For Screening And Perioperative Care, Leonidas E. Mastrokostas, Paul G. Mastrokostas, Luke B. Schwartz, Abigail Razi, Sean Inzerillo, John K. Houten, Arya Varthi, Alex R. Vaccaro, Jad Bou Monsef, Afshin E. Razi, Mitchell K. Ng

Rothman Institute Papers

CONTEXT: Multilevel lumbar fusion use has increased with an aging U.S. population. Depression and psychotic disorders are linked to poorer surgical outcomes, but their effects in this setting are unclear.

AIMS: The aims of this study were to quantify the prevalence of these disorders and evaluate associations with perioperative outcomes and resource use.

SETTINGS AND DESIGN: This was a retrospective cohort study using the National Inpatient Sample from 2016 to 2022.

SUBJECTS AND METHODS: Depression and psychotic disorders were defined using Elixhauser-derived indicators. Outcomes included medical and mechanical complications, discharge disposition, length of stay (LOS), and costs.

STATISTICAL ANALYSIS USED: …

Outcomes Of Lumbar Fusion Surgery In Isthmic Versus Degenerative Spondylolisthesis: A Systematic Review And Meta-Analysis, Pavlos Texakalidis, Stavros Matsoukas, Constantine L. Karras, Christopher S. Ahuja, Najib El Tecle, Tyler R. Koski, Nader S. Dahdaleh

Department of Neurosurgery Faculty Papers

Lumbar spondylolisthesis can cause a significant disability due to back and lower extremity pain. Degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) are the two most common types. DS results from arthritic changes and degenerative disc disease, whereas IS occurs secondary to a pars interarticularis defect. This study compared surgical outcomes between IS and DS. A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty studies comprising 3136 patients were included (DS: 1944; IS: 1192). No differences were identified in terms of estimated blood loss (mean difference [MD]: 5.79, 95% …

Advancing Hope: Clinical Trials In Pediatric Cancer, Michael Smith, Kevin Ginn

Pediatrics in Practice: A CME Podcast

Clinical trials are the backbone of progress in pediatric oncology, offering new pathways to treatment and survival for children facing cancer. In this episode, we sit down with Kevin Ginn, MD, a leading expert in pediatric cancer research, to explore why clinical trials matter, how pediatricians can support families through the process, and what innovations are shaping the future of care. From ethical considerations to practical challenges, Dr. Ginn shares insights that empower pediatricians to guide families with confidence and compassion.

Click here to stream the podcast episode.

Ear Infections In Pediatrics: Prevention, Treatment And When To Refer, Michael Smith, Laura Neff

Pediatrics in Practice: A CME Podcast

Ear infections are one of the most common conditions seen in pediatrics. In this episode, Laura Neff, MD, pediatric otolaryngologist, shares practical guidance on preventing and treating ear infections in children.

We discuss antibiotic decision‑making, watchful waiting, prevention strategies, and when recurrent infections or hearing concerns should prompt an ENT referral. Pediatricians will leave with clear, evidence‑based takeaways for everyday practice.

Click here to stream the podcast episode.

Patient Perceptions And Knowledge Of Corticosteroid Injections: A Cross-Sectional Survey Study, Juliet Chung, Sina Ramtin, Philip Koehler, Stephen Stache, Charles Langman, Bryan Hozack, Asif M. Ilyas

Rothman Institute Papers

INTRODUCTION: Although cortisone injections are commonly used, patient understanding of cortisone is variable and often affected by misconceptions. This study explores patient perspectives, identifies misconceptions, and emphasizes the importance of improved patient education to enhance patient-centered care.

METHODS: A cross-sectional survey study was conducted from April to August 2024 among patients aged 18 and older presenting to an orthopedic physicians' office. Patients completed a novel anonymous questionnaire designed to assess their knowledge and perceptions of cortisone injections. A total of 246 patients participated, with responses collected electronically via SurveyMonkey.

RESULTS: Among 246 respondents, individuals with history of prior cortisone infections …

The Agreement Between Pulse Oximetry And Measured Arterial Oxygen Saturations In Postoperative Functionally Univentricular Patients, Pranathi Pilla, Vikram Shah, Saul Flores, Rohit S Loomba

Faculty, Staff and Students Publications

Background: Pulse oximetry is widely used to estimate arterial oxygen saturation, yet accuracy may vary for a number of reasons. Data on children with functionally univentricular circulation are limited. The primary aim of this study was to evaluate the agreement between arterial oxygen saturation measured by blood gas and pulse oximetry in children with functionally univentricular circulations. Methods: A retrospective analysis was performed of paired arterial blood gas and pulse oximetry oxygen saturation measurements following Norwood, Glenn, or Fontan procedures. Signed difference was defined as arterial oxygen saturation by blood gas-arterial oxygen saturation by pulse oximetry. Bland-Altman analyses, …

Impact Of Long-Term Nitrogen Scavenger Therapy On Clinical Outcome In Individuals With Urea Cycle Disorders, Florian Gleich, Andrea L Gropman, Sandesh C S Nagamani, Georg F Hoffmann, Stefan Kölker, Matthias Zielonka

Faculty, Staff and Students Publications

Principles of long-term medical management in individuals with urea cycle disorders (UCDs) encompass (1) a low protein diet, (2) supplementation of arginine and/or citrulline along with essential amino acids, nutrients, vitamins and trace elements, and (3) use of nitrogen scavenging agents to reduce recurrent hyperammonemic events (HAEs). These principles aim at providing metabolic stability, elimimation of chronic complications, and achievement of normal development as well as growth. A retrospective comparative analysis was performed by studying 138 individuals with male ornithine transcarbamylase deficiency (mOTC-D), citrullinemia type 1 (CTLN1) and argininosuccinic aciduria (ASA) based on in vitro residual enzymatic activity for severity-adjustment. …

“Real-World Prognostic Performance Of Different Severe And Advanced Heart Failure Definitions: Data From The Swedish Heart Failure Registry”, Camilla Hage, Felix Lindberg, Christian Basile, Alessandro Villaschi, Francesca Musella, Davide Stolfo, Raffaele Scorza, Guillame Baudry, Charlotta Ljungman, Oscar Braun, Valeria Valente, Biykem Bozkurt, Marco Metra, Gianluigi Savarese

Faculty, Staff and Students Publications

Background: A valid definition of severe heart failure (HF) is essential for earlier identification, timely referral for advanced therapies, and to optimize clinical trial design.

Objectives: To assess the prevalence, prognostic performance, and 1-year outcomes associated with different definitions of severe and advanced HF (AdvHF) in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: We included 15,153 patients with EF < 40%, HF duration >6 months, and no prior left ventricular assist device or heart transplant, from the Swedish Heart Failure Registry. Several definitions of severe/AdvHF were evaluated: a simplified Heart Failure Association (HFA) definition (NYHA III-IV, EF < 30%, ≥2 HF hospitalizations in 12 months), the GALACTIC-Severe-definition (NYHA III-IV, EF < 30%, ≥1 hospitalization in 6 months), and variations adding/removing criteria such as NT-proBNP levels and diuretic dose to the HFA-AdvHF definition. Predictive performance and 1-year outcomes were analyzed.

Results: The HFA-definition identified …

The Level Of Physical Activity And The Feeling Of Stress In Difficult Life Situations Among Refugees From Ukraine, Bartosz Gondek, Iwona Bonisławska, Milena Lachowicz

Baltic Journal of Health and Physical Activity

Background: Russia's attack on Ukraine in February 2022 started the largest armed conflict in Europe since World War II. In the face of danger, crowds of civilians decided to leave their homes and escape, among others, to Poland in search of shelter. Materials and methods: The research was conducted on groups of refugees from Ukraine who registered in the first days of the war in Sopot and Pruszcz Gdanski. The refugees came from Kharkov, Mariupol, Kherson, Zaporizhzhia, and western Ukraine (not involved in hostilities). People from the war zone areas mostly came with only hand luggage. The respondents were divided …

Recurrent Pubic Osteomyelitis And Urosymphyseal Fistula In A Prostate Cancer Survivor: A Multidisciplinary Management Challenge, Peng Jhen Wu, Navin Sampathkumar, Tanmay Singh, Sonal Gandhi

Journal of Community Hospital Internal Medicine Perspectives

A 67-year-old male with a history of prostate cancer, treated with prostatectomy and subsequent radiation for recurrence, presented with a complex clinical course of recurrent osteomyelitis and a persistent urosymphyseal fistula with associated phlegmon. Following stereotactic body radiation therapy (SBRT) for a T4 vertebral lesion, he developed pelvic osteomyelitis, from which Kocuria species was cultured. The progression of his disease led to a urosymphyseal fistula, necessitating a cystectomy with ileal conduit and pubic bone debridement. Despite this extensive surgical intervention, he presented one year later with recurrent ileal conduit phlegmon and osteomyelitis. This case highlights the significant diagnostic and management …

An Unexpected Cause Of Thrombocytopenia In Pregnancy: A Case Of Malaria In A Non-Endemic Setting With Unclear Transmission Source, Jessica Ohemeng-Dapaah, Riham Mohammed, Ikechuwku Eke-Okoro

Journal of Community Hospital Internal Medicine Perspectives

Malaria remains a significant global health threat, with increasing concern for imported and locally acquired cases in non-endemic regions. We present the case of a 35-year-old pregnant woman from Sierra Leone, living in Missouri, who despite no recent international travel, was found to have symptomatic Plasmodium falciparum malaria. Her clinical course was notable for fever, severe thrombocytopenia, mild anemia and intraerythrocytic ring forms on her peripheral smear. She had a history of chronic hepatitis B and prior chemotherapy for Hodgkin lymphoma and recent travel to Florida, where local malaria transmission has been documented. The patient responded rapidly to artemisinin-based therapy, …

Diagnosis And Characterization Of Thyroid Dysfunction In Patients Evaluated In Primary Care In A Rural Zone Of Honduras, Javier Shafick Asfura, Travis Wesley Harris, Amanda Reeck, María Fernanda Chévez

Journal of Community Hospital Internal Medicine Perspectives

Background: Thyroid disorders are prevalent and frequently underdiagnosed in primary care, particularly in resource-limited rural areas. Their nonspecific symptoms complicate early recognition and treatment. This study aimed to determine the prevalence of thyroid dysfunction and describe the clinical reasoning, diagnostic strategies, and laboratory findings among adults evaluated with TSH testing in rural Honduras. Methods: A retrospective, descriptive, cross-sectional study was conducted at Hospital Loma de Luz in Balfate, Honduras. Adult patients aged ≥18 years who underwent diagnostic TSH testing between January 1, 2022, and January 31, 2023, were included. Patients with prior thyroid diagnoses or current pregnancy were …

Infectious Aortitis Secondary To Gastrointestinal Pathogens: A Case Series And Syndromic Review, Natasa Kostic, Ilana Goldberg, Devin Weber

Division of Internal Medicine Faculty Papers & Presentations

Aortitis is a rare but serious complication of infection that results in high morbidity and mortality. The most common location is in preexisting aneurysmal disease in a patient with multiple chronic comorbidities. The pathogens often reflect gastrointestinal bacteria, the classic example being Salmonella spp., but also include other enteric flora, Staphylococcus aureus, Streptococcus spp., and more. Herein, we describe 2 cases of aortitis caused by gastrointestinal bacteria and review management of this complex syndrome.

Genomic Medicine In Pediatrics: What Pediatricians Need To Know Now, Michael Smith, Scott T. Younger

Pediatrics in Practice: A CME Podcast

Genomic medicine is playing an increasingly important role in pediatric care, but it can feel complex for general pediatricians. In this episode of Pediatrics in Practice, Scott Younger, PhD, discusses how genomics is already influencing pediatric diagnosis and care today, common scenarios where genetic insights may be helpful, and why genomic testing can be valuable even when it doesn’t lead to a targeted therapy. This conversation offers practical guidance on when to consider genomics, when to refer, and how pediatricians can partner with genetics and subspecialty teams to support patients and families.

Click here to stream the podcast episode.