Internal Medicine Commons^™

New Therapies, New Challenges: Cystic Lung Disease After Cancer Immunotherapy, Ananya Venkatesh, David Camacho, Ross Summer, Michael Dong

Division of Internal Medicine Faculty Papers & Presentations

Immunotherapies have reduced reliance on cytotoxic strategies with their associated high toxicity levels, revolutionizing cancer care. However, these targeted therapies have also increased prevalence of previously rare sequelae, impacting patients experiencing longer survival. We describe a case of endometrial adenocarcinoma with lung metastases, in which tumor resolution following immunotherapy created cystic airspaces, leading to a pneumothorax complication. A 49-year-old female with advanced stage endometrial adenocarcinoma and lung metastasis developed cystic lung lesions in areas of previous metastatic lesions after treatment with Pembrolizumab and Bevacizumab. She developed a pneumothorax secondary to the rupture of one of the large lung cysts, leading …

Hughes-Stovin Syndrome: A Case Report Of A 24-Year-Old Male With Pulmonary Aneurysms And Deep Vein Thrombosis, Clara Liu, Zhiyin Li, Supriya Bhupathy, Bradley Todd Andersen, Andrew Hwang

HCA Healthcare Journal of Medicine

Background

Hughes-Stovin Syndrome (HSS) is a rare vasculitis characterized by pulmonary artery aneurysms (PAAs) and peripheral venous thrombosis. Anticoagulation, the standard treatment for venous thrombosis, is often contraindicated in HSS due to the risk of fatal pulmonary hemorrhage, especially since mortality rates of patients with a history of hemoptysis are reported at 50%-100% from PAA ruptures, yet treatment guidelines are limited due to the condition’s rarity with fewer than 90 reported cases globally. This report highlights the complex management decisions required.

Case Presentation

A 24-year-old man with a 3-month history of PAAs, left lower extremity deep vein thrombosis (DVT), and …

Wilson’S Disease Psychosis In A Young Man With Autism Spectrum Disorder: A Case Report And Focus On Management, Landon C. Sowell, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Wilson's disease is a rare autosomal recessive disorder, affecting approximately 1 in 30 000 individuals and is characterized by abnormal copper accumulation in the body, primarily affecting the liver and brain. Psychiatric manifestations as a first presentation, particularly psychosis, are less commonly recognized resulting in failure to begin treatment early in the course of the disease. This case report highlights a patient that presented to the hospital with psychosis, who was later diagnosed with Wilson’s disease. This case underscores the importance of considering organic causes in first-episode psychosis.

Case Presentation

An 18-year-old man with a history of autism spectrum …

Faktor-Faktor Yang Berhubungan Dengan Kualitas Hidup Pasien Geriatri Yang Menjalani Hemodialisis, Nurhidayat Mohammad, Czeresna Heriawan Soejono, Aida Lydia, Ikhwan Rinaldi, Muhammad Syafiq, Elizabeth Yasmine Wardoyo

Jurnal Penyakit Dalam Indonesia

Introduction. The decline in quality of life among geriatric patients undergoing hemodialysis has a negative impact on treatment adherence, physical functioning, dietary patterns, and mortality. This study was conducted to assess the quality of life of geriatric hemodialysis patients and its association with comorbidities, functional status, frailty, sarcopenia, nutritional status, depression, hemoglobin levels, hemodialysis vintage, vascular access, and hemodialysis adequacy.

Methods. This study employed a cross-sectional design with primary data collection. Consecutive sampling was used to recruit participants. The study was conducted at the hemodialysis units of Cipto Mangunkusumo National General Hospital (RSCM), Persahabatan National General Hospital (RSP), …

Rekam Medis Elektronik Berbasis Artificial Intelligence: Sudahkan Saatnya Digunakan?, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Korelasi Kadar Serum Vegf-A Dengan Rasio Albumin-Kreatinin Urin Pada Pasien Penyakit Ginjal Diabetik, Hannie Q. Syaiful, Drajad Priyono, Harnavi Harun, Arina W. Murni, Akmal M. Hanif, Eifel Faheri, Arnelis Arnelis, Vesri Yoga

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetic kidney disease (DKD) is a major microvascular complication of diabetes mellitus, characterized by persistent albuminuria and a progressive decline in glomerular filtration rate (GFR), making it a leading cause of chronic kidney disease (CKD) and end-stage renal disease. Vascular endothelial growth factor-A (VEGF-A) is implicated in the pathogenesis of DKD, being overexpressed in the kidneys and contributing to increased vascular permeability, inflammation, and fibrosis. Albuminuria, an early indicator of renal damage in DKD, is a strong predictor of CKD progression and cardiovascular events. The urine albumin-to-creatinine ratio (UACR) is the recommended test for detecting and monitoring albuminuria. …

Kadar Transthyretin Plasma Pada Lanjut Usia Sarkopenia Dan Non-Sarkopenia, R. Ifan A. Fahrurozi, Rose D. Martini, Roza Mulyana, Arina W. Murni, Eva Decroli, Saptino Miro, Deka Viotra, Vesri Yoga

Jurnal Penyakit Dalam Indonesia

Introduction. Sarcopenia is a geriatric syndrome marked by an age-related decline in muscle mass, which is affected by protein intake. Transthyretin is a visceral protein used to evaluate nutritional status and acts as a positive regulator of muscle mass. This study aimed to assess the difference in plasma transthyretin levels between elderly groups with and without sarcopenia.

Methods. This was an analytical observational study with a cross-sectional approach. Subjects were elderly patients who visited the Internal Medicine Polyclinic of Dr. M. Djamil Hospital Padang and met the inclusion and exclusion criteria from August to September 2024. Subjects were …

Optimalisasi Rekam Medis Elektronik Berbasis Artificial Intelligence, Ikhwan Rinaldi, Wahyu Sulistiadi

Jurnal Penyakit Dalam Indonesia

Electronic medical records (EMRs) are essential to modern healthcare systems, yet their implementation continues to face challenges such as disruption of doctor–patient communication, administrative burden, and documentation structures misaligned with clinicians’ clinical reasoning processes. This narrative review aims to assess the limitations of conventional EMRs and examine the potential of artificial intelligence (AI) to improve documentation efficiency, accuracy, and overall clinical performance. The literature indicates that AI technologies, including machine learning, deep learning, and natural language processing, can automate documentation, streamline workflows, enhance decision support, and reduce physician burnout, thereby allowing clinicians to devote more attention to patient care. Nevertheless, …

Faktor Prediktif Post Dialysis Fatigue Sedang Pada Pasien Yang Menjalani Hemodialisis Reguler, Ivan Virnanda Amu, Maruhum Bonar H Marbun, Pringgodigdo Nugroho, Ikhwan Rinaldi, Hamzah Shatri, Nunuk Mardiana, Rudy Hidayat, Endang Susalit, Evy Yunihastuti, Dyah Purnamasari, Elizabeth Y. Wardoyo

Jurnal Penyakit Dalam Indonesia

Introduction. Fatigue is often found in patients with CKD-HD. Fatigue serves as an indicator of mortality and may be a viable target in a treatment strategy. Current research has not established the determinants of moderate PDF in individuals with CKD who are undergoing HD. Therefore, this study was conducted to prove the predictor factors of moderate PDF.

Methods. A retrospective cohort study in CKD-HD patients at Fatmawati Central General Hospital during the period of November-December 2024. The independent variables of this study are comorbidities, MIS, depression, intradialytic SBPV, dialysis vintage, UFG, IDWG, and anemia status. Primary data from …

Pengaruh Ivabradin Terhadap Variabilitas Detak Jantung Pada Gagal Jantung Dengan Fraksi Ejeksi Rendah Akibat Penyakit Jantung Koroner, Handy Kurnia, Charles Limantoro, Friska Anggraini Helena Silitonga, Andreas Arie Setiawan

Jurnal Penyakit Dalam Indonesia

Introduction. Heart failure is one of the major challenges in global health due to its significant contribution to morbidity and mortality. One of the pathophysiological aspects is autonomic nervous system dysfunction which can be monitored through heart rate variability (HRV) parameters. Ivabradine is a pharmacological agent that potentially improves the balance of sympathetic and parasympathetic tone. This study was designed to evaluate the impact of ivabradine administration on HRV parameters in heart failure with reduced ejection fraction (≤40%) due to coronary heart disease in Indonesian population.

Methods. This study used a quasi-experimental research type with a pretest and posttest …

Polisitemia Sekunder Pada Pasien Laki-Laki Muda Dengan Sindrom Nefrotik, Ariani Intan Wardhani, Pringgodigdo Nugroho, Ikhwan Rinaldi, Meilania Sarasawati, Monik Ediana Miranda, Agnes Stephanie Harahap

Jurnal Penyakit Dalam Indonesia

Polycythemia is a condition characterized by an abnormal increase in the total red blood cell mass and is classified into primary and secondary polycythemia. Secondary polycythemia occurs as a physiological response to tissue hypoxia or increased erythropoietin production, without intrinsic abnormalities in erythroid progenitor cells. This condition is rare, particularly when associated with nephrotic syndrome. This report aims to describe a case of secondary polycythemia associated with focal segmental glomerulosclerosis (FSGS). A 20-year-old man presented with generalized edema for five months prior to admission, accompanied by foamy urine. Physical examination revealed peripheral edema and minimal ascites. Laboratory investigations demonstrated massive …

Perbandingan Ablasi Radiofrekuensi Dengan Transplantasi Hati Sebagai Terapi Kuratif Pada Karsinoma Hepatoseluler Stadium Awal: Laporan Kasus Berbasis Bukti, Mikhael Fabian Gunawan, Ranindita Amaida Safira, Gurmeet Singh, Kemal Fariz Kalista

Jurnal Penyakit Dalam Indonesia

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the second leading cause of cancer-related mortality worldwide. Liver transplantation is considered the definitive treatment for HCC; however, in Indonesia, adult liver transplantation is still rarely performed due to donor limitations and high costs. Radiofrequency ablation (RFA) has therefore become a preferred therapeutic option in the management of HCC. This report discuss about the survival and recurrence rates of HCC in patients treated with RFA compared with those undergoing liver transplantation. A literature search was conducted using the PubMed, Cochrane, Embase, and Scopus databases. Selected articles were screened …

Cytomegalovirus As A Potential Trigger For Acute Coronary Syndrome: A Case Of Nstemi In A Previously Healthy Patient, Hussam Al Hennawi, Muhammad Sabri, David Teng, Maxwell Berman, Botros Shenoda

Abington Jefferson Health Papers

Cytomegalovirus (CMV) infection has been implicated in endothelial dysfunction and atherogenesis, yet its role as a potential trigger for acute coronary syndrome (ACS) remains underrecognized. We present a case of a 32-year-old male with no prior medical history who developed non-ST elevation myocardial infarction (NSTEMI) and was subsequently found to have active CMV infection. The patient had no known history cardiovascular disease, though subsequent testing did reveal additional underlying risk factors. This case highlights the need to consider infectious etiologies, including CMV, as contributors to ACS in young, otherwise apparently healthy individuals. Understanding the interplay between viral infections and atherosclerotic …

Development And Evaluation Of The Agitation In Alzheimer's Screener For Caregivers (Aasc): A Clinical Tool To Screen For Agitation., Carolyn Clevenger, W Clay Jackson, Jared Stroud, Malaak Brubaker, Mehul Patel, Iwona Bucior, Emily Bratlee-Whitaker, T Michelle Brown, Sheri Fehnel, Sue Peschin, Jeffrey Cummings, George Grossberg

Ambulatory and Primary Care Articles

OBJECTIVE: Although agitation is a common neuropsychiatric symptom in Alzheimer's dementia, it can be challenging to recognize and diagnose. Caregivers of individuals with Alzheimer's dementia are often the first to encounter agitation behaviors but may struggle to recognize and communicate symptoms to healthcare professionals (HCPs). Here, we describe the development and evaluation of the Agitation in Alzheimer's Screener for Caregivers (AASC), a practical screening tool to identify agitation symptoms and facilitate caregiver-HCP communication.

METHODS: The AASC was developed based on the International Psychogeriatric Association (IPA) criteria for agitation in cognitive disorders, input from multidisciplinary experts, and qualitative interviews with caregivers …

Flawed Design And Selection Bias In Critical Care Randomized Controlled Trials (Rcts): The Patient Safety Risk Of The "Rct Mimic"., Lawrence A Lynn

Ambulatory and Primary Care Articles

Over three decades, randomized controlled trials (RCTs) for critical care syndromes such as acute respiratory distress syndrome (ARDS), sepsis, and community acquired pneumonia (CAP) have repeatedly produced non-reproducible results, at times leading to high-impact reversals of global protocols when later studies revealed harm. These trials enroll patients using expert-derived threshold sets intended to define the syndrome. This analytic review presents the first historical and formal methodological review and mathematical analysis of such RCT using causal symbolic modeling (cSM), directed acyclic graphs (DAGs), and do-calculus. The review includes landmark publications, task-force threshold sets, and case examples, including the 2025 REMAP-CAP corticosteroid …

Epidemiology, Presentation, And Diagnosis Of Type 2 Diabetes Mellitus In Children And Adolescents, Bisher Alsabbagh, Whard Alsabbagh

School of Integrative Biological & Chemical Sciences (Formerly Dept. of Biology)

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents has increased substantially over recent decades, paralleling rising rates of pediatric obesity and metabolic risk. Youth-onset T2DM is characterized by significant insulin resistance accompanied by an inadequate compensatory insulin response, resulting in progressive hyperglycemia and early beta-cell dysfunction. Incidence varies widely among racial and ethnic groups, with the highest rates observed in non-Hispanic Black, Hispanic, Native American, Asian American, and Pacific Islander youth. Risk factors include obesity, family history, high-risk ethnicity, pubertal insulin resistance, prenatal metabolic exposures, and comorbid conditions such as polycystic ovary syndrome. Clinical presentation ranges …

A Review Of Recent And Developing Studies Regarding Percutaneous Coronary Intervention (Pci): A Narrative Review, Bisher Alsabbagh, Azeez Shala, Joshua Rupert, Abdallah Elsayed

School of Integrative Biological & Chemical Sciences (Formerly Dept. of Biology)

This comprehensive literature review synthesizes the most recent evidence and evolving clinical guidelines concerning percutaneous coronary intervention (PCI) from 2015 to 2025. The study integrates findings from 42 peer-reviewed trials, meta-analyses, registries, and international guideline statements issued by the American College of Cardiology/American Heart Association (ACC/AHA), European Society of Cardiology (ESC), and related societies. Results reveal a decade-long evolution in PCI practice marked by a shift from anatomy-driven to physiology and imaging-guided decision-making, supported by tools such as fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), intravascular ultrasound (IVUS), and optical coherence tomography (OCT). Modern guidelines emphasize individualized, team-based revascularization …

Laboratory Monitoring In Patients With Moderate To Severe Plaque Psoriasis, Jonathan M. Fenkel, John A. Osborne, April W. Armstrong, Bruce Strober, Linda Stein Gold, Michael Cameron, Mark Lebwohl

Department of Medicine Faculty Papers

OBJECTIVES: Plaque psoriasis is a common immune-mediated disease associated with various comorbidities, including cardiovascular disease, diabetes, psoriatic arthritis, liver disease, and mood disorders. Biologic and small-molecule therapies are efficacious and well tolerated in adults with moderate to severe plaque psoriasis. However, dermatologists may be uncertain about appropriate laboratory monitoring in patients treated with these therapies, especially those with comorbidities.

METHODS: This review summarizes prescribing information and provides expert recommendations based on real-world experience in the monitoring of concerning laboratory values in patients with psoriasis.

RESULTS: Individualized monitoring is essential for maximizing the benefits and minimizing the risks associated with biologic …

The Nature Of Nasal Discharge In Chronic Rhinosinusitis: A Systematic Review And Meta-Analysis Using Patient-Reported Outcomes, Ethan M. Kallenberger, Asher T. Ripp, Shaun A. Nguyen, Erin Briggs, Alexander N. Duffy, Isabella V. Schafer, Jess C. Mace, Timothy L. Smith, Zachary M. Soler, Rodney J. Schlosser

SKMC Student Presentations and Publications

OBJECTIVE: The objective of this study is to answer the question "What is the most common and severe type of nasal discharge in patients with chronic rhinosinusitis (CRS) at baseline as measured by patient-reported outcomes?".

METHODOLOGY: Two independent reviewers evaluated studies for inclusion, extracted data from included studies, and performed critical appraisal of studies. Data on the four Sino-Nasal Outcome Test 22 (SNOT22) discharge questions, demographic, and comorbidity data was collected. Meta-analysis of single means and proportions was performed for demographic, comorbidity, severity, and prevalence data.

RESULTS: A total of 53 studies (n = 6584) were included for analysis. Postnasal …

Asymptomatic Cryptococcal Antigenemia: A Multi-Clinic Cross-Sectional Study On The Prevalence, Associated Factors And Predictors Of Three-Month Outcomes Among Antiretroviralnaïve And Antiretroviral-Experienced Hiv Patients In Dar Es Salaam, Tanzania, Mandela Makakala, Mukasa Mohammed, Mabula Mabelele, Kamran Hameed, Philip Adebayo

Internal Medicine, East Africa

Background: Cryptococcal meningitis remains a leading cause of HIV/AIDS-related mortality, predominantly in Sub-Saharan Africa. Current screening and prevention efforts primarily target antiretroviral therapy (ART)-naïve patients, whereas strategies for ART-experienced individuals are less well defined.

Objectives: This study primarily aimed at determining the prevalence of asymptomatic cryptococcal antigenemia (ACA) among ART-naïve and ART-experienced patients, along with associated factors and predictors of three-month outcomes among HIV patients in three HIV clinics in Dar es Salaam, Tanzania. Secondarily, factors associated with serum cryptococcal antigen positivity in the overall study population were also assessed.

Methods: This cross-sectional clinic-based study recruited 273 HIV-positive participants (ART-naïve …

Impact Of Structured Internal Medicine Pharmacotherapy Education In Improving Pharmacist Readiness In Transitioning To An Academic Medical Center, Jude Pierre, Erika Dittmar, Heidi Clarke, Radhan B. Gopalani, Stephanie Palma

Nursing & Health Sciences Research Journal

Introduction: Baptist Hospital of Miami (BHM) is transitioning to an academic medical center by starting medical residency training in July 2025. As healthcare systems expand, pharmacists must ensure safe medication dispensing and provide real-time clinical decision support. To support this transition, a structured internal medicine pharmacotherapy curriculum was developed to refresh clinical knowledge and enhance confidence among experienced clinical pharmacists.

Methods: A single-site, Institutional Review Board-exempt, quality improvement project was conducted at BHM. Inclusion criteria included Clinical Pharmacists 2s (primarily decentralized pharmacists with ≥ 1 year of pharmacy experience at BHM) who completed a structured pharmacotherapy curriculum from January 2025 …

Responsible Adoption Of Multimodal Artificial Intelligence In Health Care: Promises And Challenges., Ghazal Azarfar, Sara Naimimohasses, Sirisha Rambhatla, Matthieu Komorowski, Diana Ferro, Peter R Lewis, Darren Gates, Nawar Shara, Gregg M Gascon, Anthony Chang, Muhammad Mamdani, Mamatha Bhat

Ambulatory and Primary Care Articles

Clinicians rely on various data modalities-such as patient history, clinical signs, imaging, and laboratory results-to improve decision making. Multimodal artificial intelligence (AI) systems are emerging as powerful tools to process these diverse data types; however, the clinical adoption of multimodal AI systems is challenging because of data heterogeneity and integration complexities. The 2024 Temerty Centre for AI Research and Education in Medicine symposium, held on June 17, 2024, in Toronto, Canada, explored the potential and challenges of implementing multimodal AI in health care. In this Review, we summarise insights from the symposium. We discuss current applications, such as those used …

Bridging The Gut And The Heart-Exploring Pathophysiology, Risk Factors, And Therapeutic Implications Of Cardiovascular Disease In Inflammatory Bowel Disease, Diana Othon-Martinez, Sylvia Valeria Peña-Muñoz, Margarita Riojas-Barrett, Genesis Vidales-López, Josué Moisés Sánchez Guzmán, Lukasz Kwapisz

School of Medicine Publications

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is a chronic systemic immune dysregulated disorder affecting the gastrointestinal tract that often has extraintestinal manifestations. Limited data exist on the cardiovascular (CV) implications of IBD, but a higher prevalence of CV disease (CVD) has been observed compared to the general population, resulting in increased mortality risk. This review examines the pathophysiology and risk factors linking IBD to CVD, highlighting several key mechanisms: The “lipid paradox” in active IBD, arterial stiffness and endothelial dysfunction, proinflammatory cytokine activity, gut microbiota dysbiosis, and drug-induced myocardiopathy. The main findings include information about IBD …

A Rare Case Of Chilaiditi Syndrome As A Driver Of Chronic Respiratory Failure, Paige C. Adams, Daniel Kramer

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

Chilaiditi sign is a rare radiographic finding demonstrating interposition of the colon between the liver and the diaphragm; Chilaiditi syndrome is the manifestation of gastrointestinal or respiratory symptoms secondary to this finding. This syndrome rarely can be associated with acute and chronic respiratory failure. We report a case of a 66-year-old woman with chronic hypercapnic and hypoxemic respiratory failure due to severe restrictive pulmonary mechanics in the setting of Chilaiditi syndrome. Imaging showed an elevated right hemidiaphragm initially concerning for hemidiaphragm paralysis; however a fluoroscopic Sniff test suggested normal diaphragm function. Despite hospitalisation for aggressive bowel decompression combined with noninvasive …

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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

Advances in Clinical Medical Research and Healthcare Delivery

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

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