Medical Specialties Commons^™

Reconsidering The Clinical Implications Of Albumin In Severe Acute Pancreatitis, Alexis Notarianni, Md, Jacqueline Krieger, Md

The Medicine Forum

In this single-center pilot trial of 60 ICU patients, early administration of 5% albumin in addition to crystalloid did not significantly improve Systemic Inflammatory Response Syndrome (SIRS) remission at Day 3 nor reduce 60-day mortality.¹ However, a statistically significant reduction in sepsis was observed in the albumin group compared with crystalloid alone (10% vs. 36.7%, P = 0.01). Although the study concludes that albumin did not improve prognosis, we believe the observed difference in sepsis merits further consideration.

Infection and persistent organ failure are well-established determinants of mortality in acute pancreatitis, particularly in the later phases of disease progression. …

Accounting For Sex-Specific Physiology In Wearable Devices Identifying Inflammatory Bowel Disease Flares, Sonali Shah, Md

The Medicine Forum

The study “Physiological Data Collected from Wearable Devices Identify and Predict Inflammatory Bowel Disease Flares” evaluates how the use of wearable devices to collect physiological data can help identify inflammatory bowel disease (IBD) flares.1 The study found significant differences in longitudinal heart rate (HR), heart rate variability (HRV), as well as resting heart rate (RHR) during periods of both inflammatory (measured by elevation in CRP, ESR, or fecal calprotectin) and symptomatic flares. Additionally, the authors found that these variables were often different up to 7 weeks prior to a flare, suggesting that the use of wearable devices could aid clinicians …

When It’S Not Gastroparesis: Isolated Idiopathic Acth Deficiency Presenting With Recurrent Gastrointestinal Symptoms, Navya Pendyala, Md, Ramya Pendyala, Md, Anna Mathew, Md, Beatriz Torre, Md, Christopher Henry, Md

The Medicine Forum

Adrenal insufficiency is an uncommon but important cause of nonspecific gastrointestinal symptoms. We present a 33-year-old male with recurrent nausea, vomiting, and presumed gastroparesis who was ultimately found to have isolated idiopathic ACTH deficiency after discordant diagnostic findings prompted further evaluation. His symptoms resolved rapidly with glucocorticoid replacement. This case highlights the importance of considering adrenal insufficiency in patients with unexplained gastrointestinal symptoms and systemic features despite negative structural work up and underscores the role of diagnostic anchoring in delayed diagnosis.

Squamous Cell Carcinoma Of The Sigmoid Colon: A Rare Late Presentation Of Metastatic Urothelial Cancer With Squamous Differentiation Of The Bladder, Hamzah Shariff, Md, Ghazal Ghafari, Do, Mph, Zachary Hoffer, Md, Phd, Danyall Saeed, Anila Mahesh, Md, Kishore Kumar, Md

The Medicine Forum

Urothelial cell carcinoma (UCC) with squamous differentiation (SqD) is a subtype of bladder cancer with high metastatic potential. Metastasis of muscle-invasive UCC to the GI tract, with complete transition to squamous cell carcinoma (SCC), is rare, particularly in females. We present a female patient with high grade UCC with SqD treated with radical cystectomy and immunotherapy who presented with hematochezia 1 year after her cancer treatment. Imaging and colonoscopy revealed an annular, obstructing mass in the rectosigmoid region prompting sigmoid colectomy and partial proctectomy. Histopathology revealed invasive SCC. New gastrointestinal (GI) symptoms with prior invasive bladder cancer should prompt evaluation …

Radiation-Induced Biliary Strictures Leading To Recurrent Pyogenic Liver Abscesses: A Case Report, Rhea Ratan, Md, Beatriz Torre, Md, Rishi Pawa, Md

The Medicine Forum

Introduction

Radiation-induced biliary damage, including strictures, stenosis, cholangitis, and posthepatic cholestasis, is a rare complication of radiation therapy reported most frequently in the context of hepatobiliary cancers and other upper abdominal mal ignancies.^1-3 This complication often occurs with a delayed presentation, with a variable latency period ranging from months to as late as decades after treatment.^1-4 Histologic examination demonstrates segmental bile duct wall thickening, cholestasis, fibrosis, and features consistent with radiation injury.^1,5 Most reported cases involve the common bile duct and major hepatic ducts, where endoscopic and percutaneous interventions remain feasible. These are identified during surveillance imaging, …

Occupational Hydrocarbon Exposure Presenting As Acute Hepatocellular Injury With Atypical Mitotic Figures On Liver Histopathology In An Oil Rig Worker: A Case Report, Hamzah Shariff, Md, Maria Averbuch, Do, Leanna Rucker, Md, Madison Force, Md, Dina Halegoua-De Marzio, Md

The Medicine Forum

Occupational exposure to hydrocarbons and aromatic solvents in the petroleum industry has been somewhat associated with hepatotoxicity, though the clinical manifestations and histologic features remain incompletely characterized. We present the case of a 33-year-old oil rig worker with prolonged occupational exposure to benzene and hydrocarbon compounds who presented with acute hepatocellular liver injury and concurrent biliary pathology. The patient presented with right upper quadrant pain, jaundice, and pale stools. Laboratory evaluation demonstrated marked hepatocellular injury with alanine aminotransferase (ALT) elevation to 1183 U/L and total bilirubin of 6 mg/dL. Extensive infectious, metabolic, and autoimmune evaluation was unrevealing. ANA and ASMA …

Gastric Nodules As A Rare Presentation Of Diffuse Large B Cell Lymphoma, Hamzah Shariff, Md, Ghazal Ghafari, Do, Mph, Anila Mahesh, Md, Kishore Kumar, Md

The Medicine Forum

Diffuse large B-cell lymphoma (DLBCL) commonly involves the gastrointestinal tract, though typical endoscopic findings include ulcerations or masses. We report a 79-year-old woman with iron deficiency anemia found to have multiple small gastric nodules on endoscopy. Biopsy demonstrated DLBCL, with imaging confirming disseminated disease and secondary gastric involvement. This presentation is atypical, as nodular morphology is rarely described. Importantly, such findings may mimic other malignancies, particularly neuroendocrine tumors. This case highlights that gastric nodules may be an atypical manifestation of secondary DLBCL and underscores the necessity of adequate tissue biopsy to establish diagnosis and guide management.

Diet And Dysphagia: Balancing Aspiration Risk With Quality Of Life, Margot Noyelle, Md, Kenna Hawes, Md, J. Marco Cipriaso, Md, Megan Cecchine, Md

The Medicine Forum

Nil per os (NPO) diets are often prescribed for patients who have dysphagia to prevent aspiration pneumonia, but recent studies have questioned the efficacy of such strict recommendations. This case report describes the care provided to a 73-year-old woman with chronic dysphagia who described her inability to eat or drink as the “single greatest agony” of a months-long hospitalization. This report highlights the ethical challenges of determining diet orders for patients with dysphagia.

Lost In Stratification: The Underutilization Of Fib-4-Guided Masld Screening In The Primary Care Setting, Sanjna Shelukar, Md, Ananya Venkatesh, Md, Breanne Mcdermott, Bs, Julietta Gervase, Ba, Maria Winte, Md, Rebecca Loh, Md, Dina Halegoua-De Marzio, Md

The Medicine Forum

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading contributor to chronic liver disease worldwide. Early identification of MASLD and hepatic fibrosis in the primary care setting is essential for timely and effective management. The Fibrosis-4 (FIB-4) index is recommended as a first-line, non-invasive tool to screen at-risk patients for advanced fibrosis. This study aims to determine FIB-4 screening rates in at-risk patients in an urban resident-led primary care clinic.

A retrospective chart review was conducted in a single Internal Medicine resident-led primary care clinic. Patients aged 36 to 65 years were included, and FIB-4 scores were calculated. Patients were …

A Clinical Assessment: Counseling Families On Timing Of Colorectal Cancer Screening, Bertilia Tavarez, Md, Hamzah Shariff, Md, Breanne Mcdermott, Bs, Sanjna Shelukar, Md, Limi Jamma, Md, Sonali Shah, Md, Akash Patel, Do, Christopher Henry, Md, Aaron Martin, Md

The Medicine Forum

Colorectal cancer (CRC) remains the second most common cause of cancer mortality in the United States. Current recommendations advise initiating colonoscopy at age 40, or 10 years earlier than the youngest affected first-degree relative (FDR), in individuals with a family history of CRC or advanced polyps (AP). Despite these guidelines, their translation into routine clinical counseling is not well defined. This study examines how often patients with CRC or AP receive guidance about early screening for FDRs.

A retrospective review was performed using electronic health records from an urban academic center. Patients diagnosed with CRC or AP between January 2019 …

Commentary On The Withdrawal-Af Trial And Its Applicability In Select Patient Populations, David Zhang, Md

The Medicine Forum

Segan et al. report that 90% of patients with atrial fibrillation- mediated cardiomyopathy (AFCM) maintained left ventricular ejection fraction (LVEF) ≥50% af ter withdrawing heart failure therapy following successful rhythm control.¹ While these results challenge the current practice of indefinite guideline-directed medical therapy (GDMT) in patients with improved ejection fraction, two important questions remain before these findings can be applied more broadly: which patients are appropriate candidates for withdrawal, and how should they be monitored?

The trial excluded patients with coronary disease, structural heart disease, and AF duration exceeding one year. This approach reveals a fundamental challenge, distinguishing pure …

Sudden Syncope Due To Intra Hisian Block With Severely Prolonged His–Ventricular Interval Diagnosed On Electrophysiology Study, Sheraz Qamar, Md, Meiqi Luo, Md

The Medicine Forum

Syncope is a common cause of emergency department evaluation in older adults, when sudden loss of consciousness without prodromal symptoms raises concern for cardiac etiology. We present this case of an 80 year old woman with a prior history of vasovagal syncope who presented after a collapse. Initial evaluation, including electrocardiogram, telemetry, echocardiogram, and ambulatory monitoring, was unrevealing. Given the high risk clinical features such as lack of prodromal symptoms and sudden collapse, an inpatient electrophysiology (EP) study was pursued and demonstrated severe intra Hisian conduction disease with split His bundle electrograms and a markedly prolonged His–ventricular interval. A permanent …

A Strain On The Heart: The Hidden Threat Of Ventricular Tachycardia, Sheraz Qamar, Md, Meiqi Luo, Md, Naila Ijaz, Md, Behzad Pavri, Md, Facc, Praveen Mehrotra, Md, Facc

The Medicine Forum

Mitral valve prolapse (MVP) is increasingly recognized to have an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death independent of mitral regurgitation severity. Mitral annular disjunction (MAD) is a key structural abnormality implicated in abnormal myocardial mechanics and myocardial fibrosis. We describe a patient with MVP and MAD who developed recurrent non-sustained ventricular tachycardia in association with markedly abnormal basal lateral wall longitudinal strain and progressive myocardial fibrosis on cardiac magnetic resonance imaging. Surgical mitral valve repair performed for MAD resulted in resolution of annular disjunction, improvement in regional myocardial strain, and elimination of ventricular arrhythmias. This case …

Lvad Patient With Delayed Family Involvement Due To Incarceration, J. Marco Cipriaso, Md, Kathleen Mechler, Md

The Medicine Forum

Left ventricular assist device (LVAD) placement requires an extensive support system for success. Patients who are incarcerated face unique challenges in achieving this due to prison rules. We describe a case in which an LVAD patient suffered a massive intracranial hemorrhage, leaving him unable to make his own decisions. Medical teams did not involve his family in admissions for his slow chronic decline, but family were asked to make decisions for him at this acute change causing them significant distress. We advocate that families of incarcerated patients be more routinely involved in provider communications and education related to their chronic …

Isolated Left Ventricle Apical Non-Compaction- A Diagnostic Conundrum, Trisha Sindhu, Md, Ranjita Sengupta, Md

The Medicine Forum

Left ventricular non-compaction (LVNC) cardiomyopathy is a rare myocardial disorder characterized by abnormal morphogenesis of the left ventricle (LV). It is typically associated with additional cardiac abnormalities and is most often diagnosed in childhood.¹ We present a unique case of isolated LVNC in a 42-year-old, physically active African American police officer. This case highlights an uncommon presentation of LVNC and underscores the variable specificity of current diagnostic criteria across diverse patient populations.³

A Dose Of Trouble: A Case Of Furosemide Exacerbating Amiodarone-Induced Hypothyroidism, Muneeba Ali, Md, Enad Haddad, Md, Warda Naqvi, Md, Ayesha Afzal, Md, Eddy Mizrahi, Md

The Medicine Forum

Heart failure with reduced ejection fraction is a clinical condition that often requires the concurrent use of multiple medications. Unfortunately, cross reactivity between multiple drugs occurs frequently. Today, we present the case of a 79-year-old male with heart failure and atrial fibrillation on long term amiodarone therapy. His furosemide dose was increased from 40 milligrams (mg) to 80 mg after he developed bilateral lower extremity swelling. The patient eventually developed generalized joint pains, weakness, difficulty maintaining balance, and frequent falls. He reported to the Emergency Department (ED), where he was noted to be suffering from severe acute kidney injury (AKI), …

Ascending Aortic Thrombus With Systemic Embolization: Implications For Risk Stratification And Management, Warda Naqvi, Md, Moses Morgan, Md, Muneeba Ali, Md, Enad Haddad, Md, Zaineb Alhassani, Md

The Medicine Forum

Ascending aortic thrombus is an uncommon clinical finding, particularly in the absence of significant underlying aortic disease, yet it poses a substantial risk for systemic embolization. We describe a 53-year-old woman with a history of cocaine use who presented with acute neurologic deficits and was found to have a left middle cerebral artery occlusion requiring mechanical thrombectomy. Cross-sectional imaging incidentally identified a 1.8 cm thrombus within the ascending aorta. Anticoagulation with intravenous heparin was initiated, however, her clinical course was complicated by recurrent embolic phenomena, including renal infarction and bowel perforation consistent with mesenteric ischemia. Ongoing deterioration with multiorgan failure …

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

We are honored to present this latest edition of The Medicine Forum. This platform is in its twenty-seventh year serving as an outlet for our medical community’s scholarly and creative efforts. This year, it has been my pleasure to work with Nehar, Jasmine, Hamzah, and Allison on this project. It has been impressive to see them balance their efforts on this scholarly work with their efforts on the wards.

As a Department, we are a productive group of writers, thinkers, scientists, and artists, who send out our work for publication in the larger medical community. What makes The Medicine …

From The Chief Residents, Brian Schonewald, Md, Beatriz Torre, Md, Chukwuemezie Mamanu, Md, Julia Palecki, Md

The Medicine Forum

As the current Chief Residents, we beam with pride at the 27th edition of The Medicine Forum – a culmination of the passion, hard work, and talent of the residents of the Thomas Jefferson Internal Medicine Residency Program. We believe that The Medicine Forum stands as a testament to the fact that our residents are not only outstanding clinicians and medical educators, but also excel across all facets of medicine, including research, quality improvement, and the humanities.

We applaud our talented and driven Chief Editors, Nehar Damle, Hamzah Shariff, Allison Kayne, and Jasmine Lee, who worked diligently to ensure the …

From The Editors, Nehar Damle, Md, Pharmd, Hamzah Shariff, Md, Allison Kayne, Md, Jasmine Lee, Md

The Medicine Forum

As physicians in training, much of our work is shaped by immediacy – responding to evolving clinical situations, navigating diagnostic uncertainty, and making decisions with present information. In this environment, it can be easy to prioritize action over reflection. Yet it is through reflection, inquiry, and shared scholarship that we deepen our understanding of medicine and the patients we serve.

It is within this spirit that we present Volume 27 of The Medicine Forum. This publication represents not only scholarly achievement, but also the intellectual curiosity and dedication that define our community.

This year, we were particularly struck by …

From The Desk Of The Residency Program Director, Christopher Henry, Md. Facp

The Medicine Forum

I am excited to once again share this year’s The Medicine Forum. It continues to open a window into the tireless commitment our residents bring to the bedside and to the field of medicine at large. As is uniquely our brand at Jefferson, the residents accomplish this with as much rigorous intellect as with their abundant enthusiasm and personality.

In an era where artificial intelligence has become an ever-burgeoning tool in the clinical landscape, the ingenuity displayed by our residents both in their artistic talents and their scholarly pursuits serves as a vital reminder. It reminds me that the …

Table Of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 27, 2025-2026

The Medicine Forum: Volume 27

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 27, 2025-2026

TABLE OF CONTENTS

• Case Reports
• Letter to the Editor
• Research Studies
• Humanities & Reflections

Just Opt For Caesarean Section And Pick The Birthdate': A Qualitative Study Exploring Women's Delivery Preferences After Caesarean Section In Urban Tanzania, Daudi Gidion, Columba Mbekenga, Miriam Mgonja, Marleen Temmerman, Muzdalfat Abeid

Obstetrics and Gynaecology, East Africa

Objectives To explore perspectives, preferences and decision-making regarding mode of delivery after a previous caesarean section among women in urban Tanzania.

Design A descriptive qualitative study using semi-structured in-depth interviews. Data were analysed using thematic analysis.

Setting A private tertiary hospital in Dar es Salaam, Tanzania.

Participants 11 women with one previous caesarean section who delivered at the study site were interviewed on the third day after delivery. Participants were purposively sampled to include both modes of delivery: five women underwent repeat caesarean section and six attempted a trial of labour after caesarean (TOLAC).

Results Thematic analysis identified four key …

May Measurement Month 2023: Results Of An Opportunistic Blood Pressure Screening Campaign In Kenya, Mzee Ngunga, Thomas Beaney, Gabriele Kerr, Bernard Samia, Lilian Mbau, Neil Poulter, Hellen Nguchu, Jeilan Mohamed, Elijah Ogola

Internal Medicine, East Africa

The May Measurement Month (MMM) is a global screening campaign launched in 2017 to raise awareness of raised blood pressure (BP). Kenya has participated in all previous MMM campaigns. Adults aged ≥18 years were recruited through convenience sampling in nine counties of Kenya. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140mmHg or diastolic BP ≥90mmHg or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP < 140/90mmHg. Multiple imputation was used to estimate missing BP readings. In total, 4,601 were screened, with a mean age of 41.7 years and 42.7% were female. Of all participants, 1,176 (25.6%) had hypertension, of whom 198 (16.8%) were aware, and 190 (16.2%) were on antihypertensive medication. Of those on antihypertensive medication, 65 (34.2%) had controlled BP, and of all participants with hypertension, 5.5% had controlled BP. The mean systolic and diastolic BPs of those on treatment was significantly higher than those without hypertension. Hypertensive disease in a previous pregnancy was associated with higher BP amongst female participants.

The MMM campaign in Kenya identified a substantial …

Myelomalacia Severity On Preoperative Magnetic Resonance Imaging Does Not Predict Patient-Reported Outcomes After Anterior Cervical Discectomy And Fusion, Mitchell K. Ng, Joshua Mathew, Robert J. Oris, Yulia Lee, Jonathan Dalton, Gregorio Baek, Ashley Thommana, William A. Green, Yasmine Eichbaum, Morgan Hitchner, Brandon Martinazzi, Ali Farooqi, Alec Giakas, Paul Gunter, Vinay Bijoor, Andrew Vanchikorn, John J. Mangan, David I. Kaye, Mark F. Kurd, Thomas Cha, Jose A Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Christopher K. Kepler, Gregory D. Schroeder

Department of Orthopaedic Surgery Faculty Papers

STUDY DESIGN/SETTING: Retrospective cohort study.

BACKGROUND: Signal changes within the spinal cord on magnetic resonance imaging (MRI) or myelomalacia, are frequently seen in patients with cervical myelopathy. While often assumed to predict the outcomes, their prognostic value remains uncertain. Therefore, this study aimed to: (1) describe the clinical characteristics of patients with myelomalacia undergoing Anterior cervical discectomy and fusion (ACDF); (2) evaluate whether MRI findings correlate with patient-reported outcomes (PROMs); and (3) determine whether morphology predict recovery.

METHODS: A retrospective review at a single tertiary care center was performed (2014-2021). Patients were included if they underwent a primary elective ACDF …

Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope And Limitations, Kai-Uwe Lewandrowski, Álvaro Dowling, Jun Ho Lee, Benedikt W Burkhardt, Óscar L. Alves, Avelino Parajón, Jorge Felippe Ramirez, Nicola Montemurro, Alex R. Vaccaro, Morgan P. Lorio

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity.

OBJECTIVE: To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence.

METHODS: An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied …

Insurance Type And Menopausal Hormone Therapy Use Among Us Women, Arina Chesnokova, Sunni Mumford, Allison Schachter, Rebecca Hamm, Scott Lorch, Matthew Klebanoff, Sarah Lindley, Erika Harness, Makeba Williams, Marilyn Schapira

Student Papers, Posters & Projects

IMPORTANCE: Access to menopausal hormone therapy (MHT) in the US remains low. Understanding whether insurance type is associated with MHT underuse and racial disparities in menopausal care is critical for designing interventions that increase evidence-based and equitable menopause care.

OBJECTIVE: To examine whether Medicaid compared with private insurance is associated with lower MHT use among US women. A secondary objective explored the degree that payer type is associated with observed racial differences in MHT use.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2013-2014, 2015-2016, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify …

How To Tell A True Food Allergy From An Intolerance, Sarah Gubara, Aarti Pandya

Pediatrics in Practice: A CME Podcast

This episode explains the key history elements and symptom timeline that differentiate an IgE-mediated food allergy from an intolerance or sensitivity, so clinicians and parents can make safer, evidence-based decisions. Aarti Pandya, MD, Medical Director of the Food Allergy Center at Children’s Mercy, reviews symptom patterns, timing and red flags for anaphylaxis. Learn about food allergy testing, IgE-mediated food allergy, anaphylaxis action plan, epinephrine auto-injector, food intolerance and when testing is truly warranted.

Click here to stream the podcast episode.

Immediate Postoperative Pacing Dependency Is Not Associated With Worse Mid-Term Survival In Redo Mitral Valve Surgery, Devon Kelley, Joyce Ho, Andrew Belec, Takahiro Tashima, Victoria Li, James Lao, Varun Kathawate, Kazuhiro Ueno, Amit Iyengar, Jessica Dominic, Pavan Atluri

Division of Cardiology Faculty Papers

Risk factors (RF) for permanent pacemaker (PPM) placement in cardiac surgery include valvular operations and redo operations. We aim to identify RF for PPM placement prior to discharge (DC) specifically among redo mitral valvular operations, and to analyze outcomes in this population. Our retrospective review considered 943 patients undergoing redo MV operations between 01/2002 and 12/2021, excluding patients experiencing in-hospital death within 48 hours of their operation and patients with existing PPM or implanted cardiac defibrillator (ICD). Patients (n = 742) were categorized based on whether they received a PPM before DC or not. Of the 742 patients analyzed, 47 …