Medical Specialties Commons^™

Case Report: Pulmonary Infarction Following Recent Pulmonary Embolism, David Marconi, James Espinosa, Alan Lucerna

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A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and a recent pulmonary embolism (PE) on anticoagulation presented with acute pleuritic chest pain and worsening dyspnea. Computed tomographic angiography (CTA) of the chest revealed a small distal segmental PE in the left lower lobe and an adjacent irregular consolidation, raising concern for pulmonary infarction versus pneumonia. The patient was empirically started on antibiotics for possible pneumonia and admitted for anticoagulation and supportive care. He left the hospital against medical advice (AMA) before completing treatment, but returned days later with exacerbated symptoms. This case highlights the diagnostic challenge …

Case Report: Non-Ketotic Hyperglycemia Hemichorea-Hemiballismus In The Emergency Department, Veroneka Mikhail, James Espinosa, Alan Lucerna

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Non-ketotic hyperglycemia hemichorea-hemiballismus (NH-HC), also known as diabetic striatopathy, is a rare condition characterized by glucose levels greater than 200 mg/dL and continuous, involuntary, and irregular large amplitude jerky movements localized predominantly to one side of the body called hemichorea-hemiballismus. While the differential diagnosis of irregular movements is vast, including seizures disorder, stroke, tumors, Tourette’s syndrome and rheumatic fever, clinicians should also consider diabetic striatopathy as a differential as it has very good prognosis and is easily treatable if diagnosed early. Here we discuss the case of a 72 year-old male with history of non-insulin dependent type 2 diabetes (T2DM), …

A Twist Of Fate: A Case Of Spiral Humerus Fracture After Arm Wrestling, Alec Mirchandani, James Espinosa, Alan Lucerna

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Fractures of the humerus are relatively uncommon, with spiral fractures typically resulting from rotational forces. This case report describes a 25-year-old male who sustained a right-sided spiral humerus fracture during an arm-wrestling match. The diagnosis was confirmed through radiographic imaging, and the fracture was successfully managed with closed reduction and posterior long arm splinting. This case highlights the importance of recognizing less common mechanisms of injury, like arm wrestling, in the context of humeral fractures. It also emphasizes the effective non-operative treatment of such fractures in young, healthy individuals.

A Rare Case Of Diffuse Alveolar Hemorrhage In The Setting Of Iga Nephropathy, Vasculitis And Atypical Hemolytic Uremic Syndrome In A Previously Healthy Young Adult, Karl Schlicht, Nancy Kaura

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IgA Nephropathy, also known as Berger disease, can precipitate acute renal failure in patients. IgA Nephropathy (IgAN) is deposition of protein from IgA into the renal tissue with subsequent renal dysfunction. IgA vasculitis (IgAV) is another condition where similarly the protein of IgA is deposited into the vessels. There are some cases of co-existing atypical hemolytic uremic syndrome (aHUS) with IgAN. However, rare combinations seen with all three IgAN, IgAV, and aHUS without any pre-existing conditions nor medical history. Patients that develop any one of these conditions are looking at life long changes with hemodialysis (HD) and organ transplants being …

Aortic Dissection Triggered By Self Stimulation, Anna M. Delancy, Robin Lahr

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Aortic dissection is a life-threatening condition requiring immediate diagnosis and intervention. Untreated aortic dissection has a mortality rate of 1-2% per hour. Misdiagnosis occurs in approximately 33.8% of cases, with common symptoms including chest pain, back pain, and syncope. It is important to have a high index of suspicion and utilize appropriate diagnostic tools, such as CT angiography, for prompt diagnosis. Here we describe a rare scenario of a patient with Marfan syndrome ultimately found to have a Stanford A/DeBakey I aortic dissection after a masturbation event. Prompt recognition and treatment of this lethal disease are essential to reduce the …

Tricyclic Antidepressant (Tca) Overdose Causing Diffuse Alveolar Hemorrhage: A Case Report, Md Fateha, Jose Aragon, Joan Wiley

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Tricyclic antidepressant (TCA) overdose is an uncommon complication that results from excessive administration of TCAs. Signs and symptoms include bradycardia, fever, dry mouth, and altered mental status. Patients can develop cardiac arrhythmia and diffuse alveolar hemorrhage, which can be fatal. This case report details a 65-year-old female who experienced a suspected TCA overdose as a suicide attempt. She had a history of depression and a previous suicide attempt. The patient was unresponsive with declining oxygen saturation, necessitating emergent intubation. Important lab findings included a decreased partial pressure of oxygen to fraction of inspired oxygen ratio (P/F ratio) and prolonged QRS …

Traumatic Cavernous Carotid Fistula Following A Motor Vehicle Accident, Alec Mirchandani

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Traumatic cavernous carotid fistulas are a rare but serious complication following blunt trauma, such as motor vehicle accidents, where the internal carotid artery is damaged, creating an abnormal connection with the cavernous sinus. This case report describes a 32-year-old female who presented with pulsatile proptosis, conjunctival chemosis, and visual disturbances following a motor vehicle accident. Imaging confirmed the presence of a traumatic cavernous carotid fistula. The patient underwent successful endovascular embolization, resulting in resolution of her symptoms. This report highlights the importance of early diagnosis and timely intervention, particularly through endovascular techniques, as the treatment of choice is to prevent …

Case Report: Haemophilus Influenzae Meningitis In A 65 Year Old Female, Kaywan Saed, Russell Mordecai

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We report a case of a 65-year-old female who presented with fever, altered mental status, and neck stiffness. Cerebrospinal fluid (CSF) analysis confirmed Haemophilus influenzae meningitis. The differential diagnosis of bacterial meningitis in older adults is broad and includes Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, and Haemophilus influenzae. However, in the post-Hib vaccine era, non-typeable H. influenzae has emerged as a significant cause of invasive disease in older adults, particularly in those with underlying comorbidities.

Older patients often present with atypical symptoms, which may delay diagnosis and treatment. In this case, early recognition and prompt administration of empiric antibiotic therapy …

Mitral Kombat: A Case Of Paravalvular Leak And Hemolysis After Tmvr, Isaac Su, Kishan B. Patel

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A 71-year-old woman with prior TMVR presented with dyspnea, jaundice, and hypoxia. She was found to have severe anemia with lab evidence of mechanical intravascular hemolysis due to a paravalvular leak (PVL), a known TMVR complication. This case highlights the importance of recognizing post-operative complications in valve replacement patients, including PVL-related hemolysis.

Establishing The Dose-Response Effect Of Myofascial Release On Muscle Physiology, Sanjana Davuluri, Seth Spicer, Tyler Pigott

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Context: Osteopathic manipulative treatment (OMT) is often indicated for back pain due to its high tolerability and post-treatment improvement in patients’ self-reported pain and functionality. Specifically, myofascial release (MFR) has been found to yield a significant improvement in both symptoms and quality of life. Until recently, there has not been much data published about the quantifiable effect of MFR and other OMT modalities on muscle physiology, especially taking treatment dose and force into consideration. Therefore, quantifying the changes in muscle characteristics through myotonometry would greatly benefit the field of osteopathic medicine in order to create more personalized treatment plans …

Mapping Fat Embolism As A Complication Of Liposuction And Fat Grafting: A Systematic Review Of Anatomical And Technical Risk Factors, Jared Garfinkle, Jack Hennen, Wen Luo

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Fat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). …

Impact Of St-Elevation Myocardial Infarction (Stemi) On Patients With Celiac Disease, Rahul Patel, Darshan Patel, Tirth Patel, Trinava Roy, Shashank Gupta, Rafail Beshai, Joshua Soliman, C. Jonathan Foster, Brian Blair

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Background

Celiac Disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), sarcoidosis. The latter 3 have cardiovascular manifestations There are limited studies on the hospital outcomes of Celiacs with cardiac manifestations. The aim of this study was to evaluate the economic burden and hospital outcomes of Celiacs with concomitant ST elevation myocardial infarction (STEMI).

Methods

Patients aged 18 years and older with Celiac disease and STEMI versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized, multivariate regression analysis was used to estimate the odds ratios …

How Does Exposure To Early-Life Stressors Shape Eating Behaviors In Adulthood?, Surabhi Panda

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The objective of this literature review is to explore the relationship between early-life stress and the development of disordered or dysregulated eating in adulthood. A search was conducted across PubMed, CINAHL, Embase, and PsycINFO databases. Results from each study were compared and synthesized. Twelve studies were analyzed including case reports, systematic reviews, cohort studies, and cross-sectional studies. Research indicates that childhood emotional abuse, often more prevalent than other forms of maltreatment, is a significant risk factor for eating pathology, with studies investigating psychological mediators such as anger, anxiety, and dissociation in this relationship. Adverse Childhood Experiences (ACEs) and early life …

The Presence Of Cardiac Arrhythmias Impacts Hospitalized Patients With Celiac Disease, Rahul Patel, Tirth Patel, Darshan Patel, Trinava Roy, Sachin Prasad, Paul Gill, Rafail Beshai, Joshua Soliman, Brian Blair, C. Jonathan Foster

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Background

Celiac disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and sarcoidosis. The latter 3 also have cardiovascular manifestations associated with them. However, there are limited studies on the in-hospital outcomes of Celiac disease with cardiac manifestations. Therefore, the aim of this study was to evaluate the hospital outcomes of Celiac disease with concomitant arrhythmias.

Methods

Patients aged 18 years with Celiac disease and arrhythmias (atrial fibrillation, atrial flutter, ventricular tachycardia, and supraventricular tachycardia) versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized. Multivariate …

Effects Of Social Isolation On Cecum Opioid Receptor Expression And Affective Behavior, Jordan Riser, John Tkaczynski, Nicole Shellenbarger, Maya Patel, Daniel Chandler, Daniel Manvich

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BACKGROUND

Psychological stress can induce gastrointestinal symptoms and exacerbate existing gastrointestinal disorders, indicating an interaction between the central and enteric nervous systems. Central nervous system activation of opioid receptors stimulates sympathetic outflow to the enteric nervous system, delaying motility and reducing gastrointestinal secretions, producing a similar clinical presentation to IBS.

HYPOTHESIS

We hypothesize that social isolation induces anxiety states, disrupting homeostatic noradrenergic activity in the brain and gut, leading to neurophysiological changes in the cecum characterized by altered expression of opioid receptors.

METHODS

Sprague-Dawley rats were housed in either group (control) or socially isolated conditions. Affective behavior was assessed using …

Impact Of Fluid Composition On Mortality And Kidney Injury In Sepsis: A Literature Review, Kush C. Patel, Simran Gandhi, Harmann Singh, Abdullah Noory, Akash M. Patel

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Background

Fluid resuscitation is a cornerstone of early sepsis management. While normal saline (NS) has been widely used, emerging evidence suggests that balanced crystalloids such as lactated Ringer’s and Plasma-Lyte may offer improved renal outcomes and reduced mortality by avoiding hyperchloremic metabolic acidosis.

Hypothesis

In adult patients with sepsis, initial resuscitation with balanced crystalloids reduces mortality and the incidence of acute kidney injury (AKI) compared to normal saline.

Methods

A literature review was conducted using PubMed and MEDLINE databases focusing on randomized controlled trials and meta-analyses published from 2010–2024. Key studies included the SMART, SALT-ED, BaSICS, and PLUS trials. The …

Maternal Responsiveness To Infant Hunger Cues: Is It Possible To Mitigate Risk Of Obesity Starting In Infancy?, Arrianna A. Powers

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Background: Childhood obesity is becoming a predominant health concern with over 37 million children under the age of 5 being overweight. Instances of rapid weight gain in infancy correlate to greater risk for obesity later on in life.

Methods: This study aimed to look at feeding modality and style for their impact on maternal responsiveness to infant hunger cues and RWG. A database search identified 21 studies eligible to be included in the review out of 150.

Discussion: Key findings showed breast-feeding mothers were most responsive to hunger cues, breastfed infants expressed greater cues than their formula-fed peers, and responsive …

Clinical Outcomes For Patients With Obstructive Shock With Pe In Octogenarians, Nonagenarians, And Centenarians: An Analysis Of The National Inpatient Sample, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Wasim Syed, Olga Sarah, Abdallah Hussein

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One of the most common causes of obstructive shock is massive pulmonary embolism. I these patients with compounded morbidities and limited filling of the heart we sought to sample databases to analyze the inpatient outcomes of the population.

Patient Education And Health Literacy Effects On Statin Use And Adherence, Ian M. Smith, Richard G. Olarsch, Alison M. Mancuso

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Background: While the use of statins (HMG-CoA reductase inhibitors) plays a significant role in the prevention of cardiovascular disease, it is estimated approximately 60% of patients who would benefit from a statin are receiving these medications. Current research suggests that a preference for life-style intervention over medical management, concern over medical adverse reactions, and a lower perceived risk of cardiovascular events is associated with statin non-adherence.

Methods: An IRB-approved paper survey was administered to patients aged 18 to 89 at an ambulatory primary care clinic for non-acute visits. Qualtrics was utilized to collect, store, and process data. Information elicited from …

Identifying Early Presentation Of Serotonin Syndrome In A 20-Year-Old Male Prescribed Clomipramine And Quetiapine: A Case Report, Veronica Alday, Justin Scarano, Jonathan Yuh, Christie Richardson

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Serotonin syndrome, a potentially life-threatening condition, can be challenging to diagnose due to its diverse etiology and varied symptomatology. Despite its severity, serotonin syndrome may present from mild to fatal, with symptoms such as autonomic instability, altered mental status, and neuromuscular excitation (e.g. muscle rigidity, hyperreflexia). Here, we present a 20-year-old male with an extensive psychiatric history who was prescribed clomipramine and developed serotonin syndrome. Few cases of serotonin syndrome have been reported to date, exacerbating the difficulty in recognizing and quickly treating such cases. Cases of serotonin syndrome should continue to be reported, in order to familiarize clinicians with …

Takotsubo Syndrome: A Case Of Acute Altered Mental Status, Aphasia, And Weakness, Yue Chen, Ramza Rukia, Daniel Goldsmith

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Background: Stress-induced cardiomyopathy (SICM), also known as Takotsubo syndrome, can mimic acute coronary syndrome despite the absence of obstructive coronary artery disease. This case report explores the diagnostic workup and management of a patient with potential SICM presenting with sudden onset altered mental status, aphasia, and weakness.

Case: A 46-year-old woman with no past medical history presented with acute altered mental status, aphasia, and weakness requiring intubation. Blood glucose level was 123 mg/dL. Initial workup for stroke was negative. Extensive neurological workup, including cranial imaging and electroencephalography, revealed no abnormalities.

Initial ECG was unremarkable, but elevated troponin levels and a …

Barriers To Care For Neonatal Abstinence Syndrome In Southern New Jersey, Gabriela Taslitsky, Hijab Zaidi, Nafisa Zalil

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Neonatal Abstinence Syndrome (NAS) is a spectrum of clinical manifestations seen in newborns due to withdrawal secondary to intrauterine illicit and/or prescription drug exposure. Newborns with NAS present with common signs of withdrawal such as poor feeding, irritability, seizures, hypertonicity, low birth weight, loose stool, and premature birth. Maternal opioid use is the most common cause of NAS and with the increase in opioid use in the past decade the cases of NAS have also increased. This study examines the prevalence and challenges associated with NAS in Southern New Jersey. Our analysis reveals that Atlantic and Gloucester counties reported the …

Dabigatran Reduced Acute Microgliosis In A Mouse Model With Tbi, Nicholas R. Eltman, Rashmeena Abbasi, Mary C. Kosciuk, Syed Ahmed, Jose L. Pascual, Randel L. Swanson, Nimish K. Acharya

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Objective:

The study objective was to investigate the acute anti-inflammatory effects of dabigatran in a preclinical mouse controlled cortical impact (CCI) model of severe traumatic brain injury (TBI).

Design

Mice were separated into three groups: controlled cortical impact (CCI) with dabigatran (drug treatment, n=5), CCI with saline (positive control, n=5), and sham CCI without saline or dabigatran (negative control, n=3). Dabigatran (80mg/kg) or saline was administered orally at 2, 10, 18, 26, 34, and 42 hours following experimental CCI in the drug treatment or positive control groups, respectively. Animals in the negative control group received sham CCI only. 48h following …

The Anxiolytic Effects Of Ashwagandha Supplementation In Adults With Autism Spectrum Disorder And Anxiety, Jessica Mitchell, Andrea Iannuzzelli, Wendy Aita

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BACKGROUND: The neuroendocrine system activates the hypothalamus-pituitary-adrenal (HPA) axis during stress,1 and individuals with autism spectrum disorder (ASD) may have atypical stress responses linked to HPA axis dysregulation.2 Prolonged activation of this system increases cortisol secretion, the body’s primary stress hormone.3 Withania somnifera (Ashwagandha) is a traditional herbal remedy believed to reduce stress by modulating the HPA axis and lowering cortisol levels.5

HYPOTHESIS: Following four weeks of Ashwagandha supplementation, the treatment group is expected to exhibit reduced cortisol levels, improved Aberrant Behavior Checklist (ABC) scores, and decreased stress-related behaviors, reflecting its anxiolytic effects.

METHODS: Forty-two adult participants with ASD and …

Case Report: Alpha Gal Syndrome, Eric Haljasmaa, David Parkes, Wayne Tamaska

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We report a case of a 40-year-old male who presented with sensation of throat closing and shortness of breath while at work at a meat processing facility. The differential diagnosis of shortness of breath is throat closing includes, but is not limited to, allergic reactions to antibiotics in meat, allergy to food additives, Symptom triggers are useful in identifying causes and a good supporting history and exposures can help with diagnosis. In this case, the patient had a known diagnosis of Alpha-gal syndrome (AGS) which is a tick-bite associated, possibly life-threatening immunoglobin E-mediated (IgE) hypersensitivity to galactose-alpha-1,3-galactose (alpha-gal). The patient …

A Case Report Of Primary Central Nervous System Lymphoma Presenting With Diabetes Insipidus, Lan Ngo, Adam Kandil

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Diabetes insipidus (DI) is characterized by decreased secretion or action of antidiuretic hormone (ADH), resulting in polyuria, polydipsia, and potential electrolyte disturbances. Severe hypernatremia secondary to uncontrolled DI can manifest with neurologic symptoms including seizure-like activity. This case report discusses a case of central DI arising from damage to the pituitary gland as the first presentation of a brain tumor, in the context of a 56-year-old patient who presented with seizure-like activity and sensory changes.

Case Report: Ruptured Infrarenal Abdominal Aortic Aneurysm, Jenna Rapone

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A ruptured abdominal aortic aneurysm (AAA) is a life-threatening vascular emergency with high mortality rates. We report a case of a 79-year-old male with no reported past medical history but a significant lifelong smoking history who presented to the emergency department with generalized weakness, lower abdominal pain, hypotension, tachycardia, and a reported syncopal episode. Emergency medical services (EMS) found the patient at home during a welfare check, appearing pale and weak. Upon movement from his bed to a stretcher, he experienced a syncopal episode, became tachycardic, and was transiently hypoxic. Initial laboratory studies revealed a hemoglobin of 13 g/dL, hematocrit …

Case Report: Idiopathic Intracranial Hypertension With Venous Sinus Stenosis In A Young Female, Zain Raza

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We report a case of a 19-year-old female who presented with transient, painless left eye vision loss and left-sided headache for 2 weeks. The patient, a known carrier of TTN mutation, which is a gene code for titin (mutations are inherited in an autosomal dominant pattern). The patient was diagnosed with idiopathic intracranial hypertension secondary to bilateral transverse sigmoid venous sinus stenosis. The differential diagnosis included ocular migraine, transient ischemic attack) and optic neuritis, but subsequent imaging and lumbar puncture revealed elevated intracranial pressure and significant venous stenosis. This case highlights the importance of an early identification and intervention to …

Case Report: When Confusion Signals A Crisis: Rethinking The Diagnosis Of Meningitis In Geriatric Sepsis, Asma Zahid

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We report the case of an 88-year-old female who presented with altered mental status, initially suspected to have urosepsis but ultimately diagnosed with streptococcal meningitis. The patient had a history of lethargy and anorexia over the past few days and was found to have sepsis. Despite initial focus on urosepsis, blood cultures revealed Streptococcus, and cerebrospinal fluid analysis confirmed bacterial meningitis. This case highlights the potential for meningitis to be overlooked in elderly patients with suspected sepsis, underscoring the importance of broad diagnostic considerations and early intervention. This case highlights the importance of considering meningitis in elderly patients presenting with …

Case Report: Todd’S Paralysis In A Patient With An Extensive Stroke History, Thuc Vu, Kishan B. Patel

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Here we present the case of a 70-year-old patient who presented to the emergency department with altered mental status, left-sided gaze preference, left-sided hemineglect, and inability to follow commands. He had a past medical history of seizure activity and cerebrovascular accident (CVA) with residual dysarthria and was on apixaban. His symptoms began after seizure activity and improved gradually. He was ultimately diagnosed by stroke neurology as having had an episode of Todd’s Paralysis. The differential diagnosis for patients for altered mental status with neurological deficits can be vast, but, in general, Todd’s Paralysis can be an ischemic stroke mimic upon …