Diagnosis Commons^™

Etiologies, Management, And Outcomes Of Pediatric Stroke In A Tertiary Care Center, Supinya Naruphanthawart, Tanitnun Paprad, Tanai Trongmonthum, Tunchanok Paprad, Krisanachai Chomtho

Chulalongkorn Medical Journal

Background

Recent developments in neuroimaging and treatments, such as thrombolysis and endovascular thrombectomy, have improved across pediatric stroke diagnosis and management. However, no contemporary data exist on stroke characteristics related to clinical outcomes among Thai children.

Objectives

To study clinical characteristics, investigations, and treatments associated with outcomes in Thai pediatric stroke patients.

Methods

Methods: We enrolled children aged 28 days to 18 years with "cerebrovascular disease" recorded as ICD 10 and inpatient records from January 2011 to September 2022. Outcomes included disability at discharge (mRS grade 4-5), in-hospital mortality, and two-year recurrent stroke rate.

Results

Of 206 patients, 53.4% had …

Diagnostic Accuracy Of Cerebral Amyloid Angiopathy Criteria In The First Pathologically Confirmed Thai Cohort: A Pilot Study, Thanapoom Taweephol, Thachamai Smitasiri, Thanakit Pongpitakmetha, Sekh Thanprasertsuk, Anand Viswanathan

Chulalongkorn Medical Journal

Background: The gold standard for diagnosing cerebral amyloid angiopathy (CAA), full brain post-mortem examination, is rarely performed. Current diagnostic criteria, primarily based on clinico-radiological features, were developed from Western populations and may have limited applicability to Asian populations.

Objective: We aimed to evaluate the accuracy of current diagnostic criteria and examine the clinico-radiological characteristics of Thai CAA patients.

Methods: Brain histopathological specimens from patients with clinical symptoms of CAA who underwent neurosurgical procedures, including intracerebral hemorrhage (ICH) evacuation, between 2011 and 2021 at King Chulalongkorn Memorial Hospital, Thailand, were reviewed. Patient characteristics and clinical events for each individual were retrospectively …

How Does Pattern Of Bone Healing Affect The Strain Of Plate Implant Via Frequency Detection? A Biomechanical Cadaveric Study, Chavarin Amarase, Chanyaphan Virulsri, Pairat Tangpornprasert, Pisitpong Chancharoen, Saran Tantavisut

Chulalongkorn Medical Journal

Background: Detecting bone union is a crucial process in treating bone fractures to prevent complications, including implant failure and bone nonunion. Nowadays, there are many methods and new innovative devices for detecting bone union through strain measurements, such as strain gauges, fluid level displacement, contrast media, and frequency changes. There is also a trend toward increasing these methods in the future. However, the patterns of bone healing studied with these methods still do not provide a standard for determining the true bone healing process. The aim of this study is to identify the most appropriate bone healing pattern for …

Pediatric Pqct-Derived Tibial Bone Mineral Density Estimates: A Systematic Review And Meta-Regression, Anna Maria Markarian, Dennis R. Taaffe, Daniel A. Galvão, Jodie Cochrane Wilkie, Carolyn J. Peddle-Mcintyre, Mark Markarian, Daniel J. Schiferl, Robert U. Newton

Research outputs 2022 to 2026

Background: Assessing bone mineral density (BMD) in children and adolescents is essential for detecting skeletal deficits and fracture risk. Peripheral quantitative computed tomography (pQCT) has gained increasing attention as a valuable imaging tool due to its ability to assess bone quality. Unlike dual-energy x-ray absorptiometry, pQCT provides volumetric BMD measurements and distinguishes between cortical and trabecular compartments. Despite these advantages, its clinical adoption remains limited due to the lack of reference data and standardized protocols. Methods: A systematic search was conducted in CINAHL, Embase, PubMed, SPORTDiscus, and Web of Science from inception to November 2024. Studies reporting pQCT-derived tibial BMD …

Factors Associated With Upstaging In Patients With Resectable Non-Small Cell Lung Cancer: A Modern Institutional Sample, Sneha Alaparthi, Hamza Rshaidat, Luke Meredith, Scott H. Koeneman, Christina Grindley, Jacob Heilizer, Purab Kothari, Prarthna Chandar, Tyler Grenda, Nathaniel R. Evans Iii, Olugbenga T. Okusanya

Department of Surgery Faculty Papers

BACKGROUND: There is significant value in predicting and better assessing patients who are at risk of post-surgery upstaging in lung cancer. The objective of this study is to review patients who were upstaged following resection and evaluate their clinical and demographic data to elucidate which factors portend an increased risk of pathologic upstaging at our institution (the Thomas Jefferson University Hospital).

METHODS: A retrospective review of institutional data was performed between 2011 and 2023. Patients with stage I-II non-small cell lung cancer (NSCLC) were included. Patients were excluded if they received neoadjuvant systemic therapy, including chemotherapy and/or immunotherapy, and were …

Spatially Distinct Cellular And Molecular Landscapes Define Prognosis In Triple-Negative Breast Cancer, Kavitha Mukund, Darya Veraksa, David Frankhouser, Lixin Yang, Jerneja Tomsic, Raju Pillai, Srijan Atti, Zahra Mesrizadeh, Daniel Schmolze, Jovanny Zabaleta, Xiao-Cheng Wu, Mary-Anne Leblanc, Lucio Miele, Augusto Ochoa, Victoria Seewaldt, Shankar Subramaniam

School of Medicine Faculty Publications

Triple-negative breast cancer (TNBC) is a prevalent breast cancer subtype with the lowest 5-year survival. Several factors influence outcomes, but their inherent molecular and cellular heterogeneity are increasingly acknowledged as crucial determinants. Here, we report on the spatio-molecular heterogeneity underlying TNBC tumors in a retrospective, treatment-naive cohort with differential prognoses (17 good prognoses [GPx] >15-year survival and 15 poor prognoses [PPx] < 3-year survival]) profiled using GeoMx Digital Spatial Profiler. Analyses reveal that epithelial and microenvironment (TME) states are transcriptionally distinct between groups. Invasive GPx epithelia show an increase in immune transcripts, with a more immune-rich TME (via IF). PPx epithelia, in contrast, are more metabolically and translationally active, with a mesenchymal/fibrotic TME. Pre-cancerous epithelia in PPx exhibit a presence of aggressiveness, marked by increased EMT signaling and complement activity. We identify distinct epithelial gene signatures for PPx and GPx that can accurately classify diagnostic samples and likely inform therapy.

Intralabyrinthine Mri Flair As A Predictive Marker For Hearing Loss In Vestibular Schwannomas In Neurofibromatosis Type 2, Robert L. Walker, Maxwell T. Laws, H. Jeffrey Kim, Christopher Zalewski, Ashok Asthagiri, Sruthi Ranganathan, Christina Hayes, John D. Heiss, John A. Butman, Prashant Chittiboina

Department of Radiation Oncology Faculty Papers

BACKGROUND AND OBJECTIVES: The onset of hearing loss due to vestibular schwannomas (VS) is inevitable but does not correlate with the size of the tumor. In patients with Neurofibromatosis Type 2 (NF2) and VS, we previously found an association between pre-contrast fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR MRI) signal in the labyrinth and hearing loss. Here, we asked whether FLAIR hyper-intensity could serve as a predictive biomarker for hearing loss in NF2 patients with VS.

METHODS: A prospective longitudinal study (NCT00598351) of NF2 enrolled 168 subjects between 2008 and 2013. This study included 34 patients with small VS (total …

Accuracy Of Frozen Section For Hpv-Associated Squamous Cell Carcinoma Of Unknown Primary, Sindhura Sridhar, Annie Moroco, Shravan Gowrishankar, Mitra Mehrad, Kim Ely, James Lewis, Madalina Tuluc, Stacey Gargano, Melanie Hicks, Kyle Mannion, Arielle Thal, Adam Luginbuhl, Joseph Curry, David Cognetti, Michael Topf

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

INTRODUCTION: Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP.

METHODS: A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed.

RESULTS: 77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 …

Development Of The Self-Administered Health Complexity Screening Instrument, Sheila Specker, Rachel Andrew, Emily Drexler, Emily Koithan, Steven Thurber, Steven Frankel

School of Medicine Faculty Publications

PURPOSE: The purpose of the study was to develop a self-administered screening tool to assist case managers, primary care physicians, and other clinicians in quickly and accurately identifying patients with complex health needs who require a definitive and detailed case management evaluation. In addition to medical and psychiatric items, this tool incorporates multiple social determinants of health (SDOH), known to add to clinical complexity. PRIMARY PRACTICE SETTING: This instrument is most appropriate for identifying patients with high complexity in the primary care sector. Due to the abundance of such patients with high biopsychosocial complexity and costs of treating these patients, …

686. Antibiotic Prescribing For Urinary Tract Infections In Outpatient Settings: A Multicenter Assessment Based On The Five Ds Of Stewardship, Amy Y. Kang, Oliver Tan, Sunwoo Oh, Nikki Derleth, Megan Shieh, Helen Vu, Inna Tagarino, Audrey Harrington, Deborah Kupferwasser, Loren G. Miller

Pharmacy Faculty Articles and Research

Background   Urinary tract infections (UTIs) are a leading cause of outpatient antibiotic use. Prior studies have documented inappropriate prescribing during outpatient UTI visits, but few have assessed intervention opportunities using a structured stewardship framework. We evaluated UTI prescribing practices in a healthcare system using the Five Ds framework: Diagnosis, Drug, Dose, Duration, and De-escalation.   Methods

We conducted a retrospective study across 4 medical centers and > 20 outpatient clinics within the Los Angeles County Department of Health Services, the second largest U.S. safety net healthcare system. To ensure adequate representation across sites while maintaining feasibility for manual chart review, we reviewed …

Broad Laboratory Testing Does Not Show Utility For Telogen Effluvium: A Retrospective Analysis Of 22-Million Laboratory Results Using Trinetx, Zachary J.K. Neubauer, Shari R. Lipner

Student Papers, Posters & Projects

No abstract provided.

Prognostic Value Of Baseline Qfr In Single-Vessel Intermediate Coronary Stenosis, Yanfeng Lu, Abdulrahman Alqazzaz, Jasmine Bao, Gary S. Mintz, Jiahao Feng, Yong Zhang, Shanshan Gao, Qiang Song, Feifei Ning, Xin Huang, Ning Guo

Student Papers, Posters & Projects

BACKGROUND AND OBJECTIVES: The prognostic value of baseline Quantitative Flow Ratio (QFR) in real-world patients remains unclear. This study aimed to evaluate the prognostic value of baseline QFR and its three-tier model-low, grey-zone, and high QFR-in patients with single-vessel intermediate stenosis.

METHODS: This retrospective study included 478 patients with QFR between 0.70 and 0.90 who underwent coronary angiography between May and June 2023. Patients were stratified into Low (0.70-0.74), Grey-Zone (0.75-0.85), and High (0.86-0.90) QFR groups. The primary endpoint was major adverse cardiac events (MACE); the key secondary endpoint was target vessel failure (TVF). Kaplan-Meier and Cox proportional hazards models …

The Role Of Extracellular Vesicles As Diagnostic Tools In Gut-Brain Axis Disorders, Patricia Marçal Da Costa, Paulo Iury Gomes Nunes, Gabriella Cunha Vieira Ciurleo, José Wagner Leonel Tavares Junior, Pedro Braga Neto, Ludmila Belayev, Reinaldo Barreto Oriá

School of Graduate Studies Faculty Publications

The gut–brain axis represents a dynamic two-way signaling network whose dysregulation has been implicated in a wide range of neurogastrointestinal disorders. In this context, extracellular vesicles (EVs) have emerged as critical mediators of intercellular signaling and as promising non-invasive biomarkers. Derived from host and microbial cells, EVs carry bioactive cargo—including proteins, lipids, nucleic acids, and metabolites—that reflect the physiological or pathological state of their cells of origin. Their ability to cross biological barriers, such as the blood–brain barrier, underscores their potential for diagnosing and monitoring gut–brain axis dysfunctions. In this mini-review, we integrate microbial and brain-derived EVs within the framework …

Seconds Matter: Rapid Pocus Diagnosis Of Ruptured Type B Aortic Dissection With Left Hemothorax, Jeby Kalathoor, Derrick Huang

Gulf Coast Division GME Research Day 2026

No abstract provided.

Beware Of Bears: Severe Hydronephrosis & Urinary Retention Hidden Behind A Uti, Bjorn Sorensen, Victoria Jackson, Carissa Ford

Gulf Coast Division GME Research Day 2026

No abstract provided.

Tackling Tele Box Shortage Via Educational Initiative, Guntash Khasria, Bushra Ambreen

Gulf Coast Division GME Research Day 2026

No abstract provided.

Partial Molar Pregnancy With Extreme Elevation Of Quantitative Β-Hcg, Zachary Franklin, Amanda Royek, Kaitlyn Vu, Anthony Royek

South Atlantic Division GME Research Days 2026

No abstract provided.

Acute Aortic Dissection Masquerading As Testicular Torsion: A Case Report, Bruce M. Lo, Megyn K. Christensen, Coral E. Byrns, Benjamin Chidester

Department of Emergency Medicine Faculty Publications

Introduction: Aortic dissection is a rare but life-threatening condition with a high mortality rate if diagnosis is delayed. Aortic dissection classically presents with sudden-onset, sharp pain in the chest or back. However, atypical presentations can also occur, which could lead to a delay in diagnosis.

Case Report: A patient initially presented to the emergency department (ED) with left testicular pain ongoing for several hours. On examination, he had tenderness in the left lower quadrant abdomen and left testicle. A testicular ultrasound revealed decreased blood flow to the left testicle, raising concern for testicular torsion. The patient was taken to the …

Metabolic Syndrome Beyond Diagnostic Criteria: Population-Scale Integrative Metabolomics Characterization, Marwa Talal

Theses and Dissertations

Background: Metabolic syndrome (MetS) is a complex cluster of interrelated metabolic abnormalities associated with elevated cardiometabolic risk. While diagnosis is based on well-established five clinical criteria, these may overlook early or atypical metabolic alterations. Large-scale metabolomic profiling offers an opportunity to identify biochemical signatures of MetS beyond diagnostic bias and to evaluate their relative importance across different presentations of the syndrome.

Methods: Data from 117,147 UK Biobank participants were analyzed in a cross-sectional design. High-throughput NMR quantified 75 circulating metabolites, for. Univariate analyses, MetS subtype stratification, and elastic net models with SHAP interpretation were applied to assess feature …

Implementation And Clinical Utility Of Ultra-Low-Field Portable Magnetic Resonance Imaging For Postprocedural Neurological Evaluation In Ambulatory Neurosurgery: Illustrative Cases, Devan Patel, Vinay Jaikumar, Taysia P. T. Morioka, Laz Rifkin, Kenneth S. Jacoby, Jaims Lim, Anais Andrade, Aimee C. Degaetano, Pui Man Rosalind Lai, Elad I. Levy

EVMS School of Health Professions Faculty Publications

BACKGROUND

Elective endovascular neurosurgical procedures are increasingly performed in ambulatory neurosurgery centers, enabled by advances in catheter technology, safety of conscious sedation, and refined patient selection. Although complication rates are low, rapid evaluation of postprocedural neurological deficits remains critical. Conventional MRI is often impractical in outpatient or procedural settings, whereas ultra-low-field portable MRI (ULF-pMRI) systems (such as Swoop) allow bedside imaging with favorable diagnostic performance.

OBSERVATIONS

Two women in their 60s developed acute neurological deficits at an ambulatory neurosurgery center (ANSC) after diagnostic cerebral angiography in one case and elective internal carotid artery flow diversion in the other. In both …