Pathological Conditions, Signs and Symptoms Commons^™

Opposing Synovial Cannabinoid Receptor Type 2 And Transient Receptor Potential Vanilloid 1 Expression In Painful Osteoarthritis, Collin A. Toups, Lauren G. Guillot, Kaitlyn Redondo, Sydney Jensen, Jennifer Klein, Luis Marrero

School of Medicine Faculty Publications

Knee osteoarthritis (kOA) poses a major health challenge worldwide, but current non-surgical treatments have limited long-term success and do not address the underlying disease process. This study explores the complex relationship between the endocannabinoid system (ECS) and the endovanilloid system (EVS) in the synovial membrane of patients with kOA undergoing total knee replacement, focusing on how these systems relate to patient-reported pain and histological synovitis. Synovial tissues and fluid from patients grouped into high and low pain categories based on the Knee Injury and Osteoarthritis Outcome Score (KOOS) were examined for cannabinoid receptor type 2 (CB2R), transient receptor potential vanilloid …

Spatial-Temporal Variation Of Diarrhea Among Children Under 5 Years Old Between 2010-2020 In Rwanda, Amans Ntakarutimana Dr., Patrick A. Tschida Dr., Elias Nyandwi Dr.

Journal of Social, Behavioral, and Health Sciences

We used secondary data from the Rwanda Demographic and Health Surveys of 2010, 2015, and 2020 to assess the spatial-temporal variation of diarrhea among children under 5 years old between the years 2010 and 2020 in Rwanda. Stratified descriptive statistics, pairwise comparisons, and logistic regression designs were used for data analysis in SPSS. A statistically significant variation of diarrhea among children under 5 years old was observed across districts, regions, and urban–rural areas but not at the national level between 2010–2020. Some districts of the Western region, including Nyabihu (OR = 2.5), Ngororero (OR = 2.3), and Karongi …

Increased Risk Of Postoperative Complications In Patients With Hypertension Undergoing Mohs Micrographic Surgery, Alexandra Elder, Henry Yang, Megan O'Donnell-Capelli, Jenna Mandel, Molly Wallace, Lauren Banner, Ramsay Hafer, Thomas Rohan, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

Hypertension has been previously associated with higher intraoperative bleeding risk in patients undergoing Mohs micrographic surgery. However, the risks of common postoperative Mohs micrographic surgery complications have not been substantiated by large studies. Our study aimed to assess the risks of common Mohs micrographic surgery complications for patients with hypertension utilizing the TriNetX database, a global health records database encompassing over 105 million patients' data, from January 2009 to January 2024. After 1:1 propensity score matching for age, sex, race, diabetes, nicotine dependence, obesity, and anticoagulant use, the final analysis included 80,739 patients in each cohort of patients with hypertension …

Real-World Treatment Patterns And Management Gaps Of Lumbar Disc Herniation In The United States, Amit Bhandutia, Min Yang, Qing Liu, Yipeng Gao, Jiaxuan Liu, Steven Liu, Amy Guo, Kinsuk Chauhan

School of Medicine Faculty Publications

BACKGROUND: Lumbar disc herniation (LDH) affects approximately 1% to 3% of the population annually and leads to substantial physical burden, quality-of-life burden, and productivity loss. Commonly used interventions, including pharmacological and epidural steroid injections (ESIs), have limited high-quality evidence to support their effectiveness in the long-term for treating LDH beyond symptom relief. In general, there is a lack of consensus for timing of treatment after LDH onset and limited data on real-world treatment of LDH. The objective of this study was to describe current real-world treatment patterns and inform gaps in clinical management of patients with LDH. METHODS: A retrospective …

Antibiotic Stewardship In Pediatric Head And Neck Surgery, Mary Grace Robichaux, Zhide Fang, Jill N. D'Souza

School of Medicine Faculty Publications

OBJECTIVE: This study seeks to determine the rate of postoperative surgical site infections (SSI) among clean head and neck surgeries and review perioperative antibiotic administration practices. STUDY DESIGN: Retrospective review. SETTING: Pediatric tertiary care institution in New Orleans over a ten-year period. METHODS: A retrospective review was undertaken to identify clean head and neck surgical procedures performed at Manning Family Children's between 2013 and 2023. EPIC SlicerDicer™ was used to identify patients between ages 0-18 who underwent clean head and neck surgeries. Each chart was reviewed for perioperative antibiotic administration and occurrence of postoperative SSI. Rates of SSI were compared …

Biofluid Biomarkers Aid In Diagnosing And Developing Improved Treatments For People With Alzheimer's Disease, Jonatan A. Lopez

University Honors Theses

Dementia is a disease in which daily life is disrupted by a loss of cognitive function. Late-onset Alzheimer's disease (AD) is the most common dementia that largely begins to affect individuals in their mid 60s or older. AD was selected as the focus of this paper because it is the most common form of dementia, accounting for 50-70% of dementia cases. A typical diagnostic approach used by physicians starts with a simple clinical test, the Mini-Mental State Examination (MMSE), when cognitive decline is suspected in a patient. Then if there is enough evidence to suggest AD, a physician would order …

Educational Point-Of-Care Ultrasound Discovers Adrenal Cortical Carcinoma, A Case Report: Clinical Implications And Review Of The Literature, Minh Q. Nguyen, Moshe Bengio, Vu H. Tran

HCA Healthcare Journal of Medicine

Introduction

Point-of-care ultrasound (POCUS) has become an indispensable tool for emergency physicians in assessing intra-abdominal pathology due to its real-time visualization, portability, and cost-effectiveness. While POCUS is not traditionally focused on adrenal gland assessment, incidental findings of adrenal masses during examinations have been reported. Our patient presented with a chronic obstructive pulmonary disease (COPD) exacerbation and was found to have a large adrenal mass, discovered incidentally, during thoracic ultrasound.

Case Presentation

This case report presents the discovery of an adrenal mass in a patient with respiratory distress due to a COPD exacerbation, emphasizing the importance of sonographers’ ability to identify …

A Hard Problem: Managing Constipation In The Geriatric Population, William G. Jones, Veeraen Jonnalagadda, Alexandra E. Thomson, Victoria Grumbles, Chase Cottle, Christian Robertson, Maulikkumar Patel

HCA Healthcare Journal of Medicine

Constipation is a common condition among geriatric patients with different presenting symptoms and potential serious complications. Additionally, the condition causes a significant burden on our healthcare system. Here, we summarized recommendations from several societies, including the American College of Gastroenterology, American Geriatrics Society, and American Academy of Family Physicians to provide guidance on managing constipation with geriatric patients. Our aim was to emphasize the importance of prevention of constipation in this population and methods to do so. We also give recommendations on how to manage constipation when it does develop and how to manage it across different healthcare settings. These …

Should We Subtype Gastric Intestinal Metaplasia In Gastric Biopsies, A Single Institution's Experience, Haibo Wang, Yu Liu, Asra Feroze, Zengying Wu, Jonathan D. Somma, Zhiyan Fu

School of Medicine Faculty Publications

Gastric intestinal metaplasia (GIM) is considered a risk factor for gastric dysplasia and adenocarcinoma. While surveillance endoscopies are often performed, particularly for incomplete GIM, the clinical value of histologic subtyping (complete, incomplete, or mixed) remains unclear. This study evaluated the progression risk of different GIM subtypes diagnosed through random gastric biopsies and their association with various clinical factors. Archived pathology data from 206 gastric biopsy cases were analyzed, including 52 negative controls, 56 complete GIM, 54 incomplete GIM, and 44 mixed GIM. Histologic slides were reviewed for subtype confirmation and other pathological changes; clinical data were extracted from medical records. …

Segmental Atrophy Of The Liver: Review Of A Rare Pseudotumor, Ayesha Younus, Yu Liu, Ellen E. Connor, Zeng-Ying Wu, Hwajeong Lee, Zhi-Yan Fu

School of Medicine Faculty Publications

Segmental atrophy (SA) of the liver is a rare, often underrecognized, benign condition that presents as a mass lesion, mimicking a neoplasm, which poses a significant diagnostic challenge. Given its rarity, only a limited number of case reports and series have been published, resulting in sparse literature on the entity. This review aims to summarize the clinicopathologic and diagnostic features of SA and thus improve its recognition.

Are Orthopaedic Trauma Surgeons At Risk Of Occupational Noise-Induced Hearing Loss?, Vincent W. Lau, Stephanie A. Kwan, Jack Graham, Gregory K. Deirmengian

Rothman Institute Papers

OBJECTIVES: Orthopaedic surgeons are at risk of occupational, noise-induced hearing loss due to exposure to instruments in the operating room. The primary objective of this study was to determine whether orthopaedic trauma procedures exceed recommended decibel (dB) limits. The secondary objective was to demonstrate which actions during a case create the highest sound levels.

METHODS: Intraoperative recordings were taken during orthopaedic trauma surgeries and classified into open reduction internal fixation (ORIF), intramedullary nailing, closed reduction percutaneous pinning, external fixation, soft tissue procedures, or a combination thereof. Recordings were taken of drilling, screw insertion, suctioning, saw use, and mallet striking. Decibel …

A Case Of Adrenal Insufficiency Presenting With Seizures, Complicated By Developmental Cerebral Venous Anomaly And Takotsubo Cardiomyopathy: A Case Report, Katrina Villegas, Brittany Eason, Karolina Janiec, Alaa Musallam, Ahmed Hammouda, Samia Ammar Aldwaik, Radhika Tailor

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Adrenal insufficiency is a potentially life-threatening condition that often presents with nonspecific symptoms. While fatigue, hypotension, and electrolyte disturbances are common features, seizures and stress-induced cardiomyopathy are rare initial manifestations. This case is reported for its atypical presentation and to highlight the diagnostic challenge it posed in the absence of classic biochemical findings.

CASE PRESENTATION: We report a case of a 68-year-old Hispanic woman with diabetes, hypertension, dyslipidemia, and hypopituitarism secondary to Sheehan syndrome, who presented with new-onset seizures after abruptly discontinuing chronic steroid therapy. Her symptoms included progressive weakness and behavioral changes over several weeks. Initial evaluation revealed …

Retrieval Of An Embolized Left Atrial Appendage Occluder From The Aortic Arch Using A Transcatheter Retrieval Device, Juan Siordia, Hussam Al Hennawi, Muhammad Sabri, Daniel Ice, Ronald Ross, Sheena Rastogi, Chunguang Chen, Richard Kovach, Muhammad Raza

Abington Jefferson Health Papers

BACKGROUND: Device embolization is a recognized complication of left atrial appendage occlusion (LAAO) procedures, with outcomes depending on the location of the embolized device and patient management.

CASE SUMMARY: A 70-year-old male with atrial fibrillation underwent LAAO due to high bleeding risk. Postoperative surveillance revealed an Amplatzer Amulet device embolized in the transverse arch of the aorta. The patient remained asymptomatic, and transcatheter retrieval was planned. A percutaneous approach was used with the ONOCOR system and snare devices with successful retrieval. The patient recovered without complications and remained stable at follow-up.

DISCUSSION: Device embolization often presents challenges, with clinical outcomes …

Dissatisfaction And Residual Symptoms In Younger And Older Adult Patients After Total Knee Arthroplasty, Nicholas Pohl, Parker Brush, Adrian Santana, Sebastian Fras, Eleanor Jenkins, Arjun Saxena

Department of Orthopaedic Surgery Faculty Papers

INTRODUCTION: Total knee arthroplasty (TKA) is an increasingly used treatment option for younger patients with osteoarthritis. Previous research has found only 66% patients < 60 years who underwent TKA postoperatively reported that their knees felt normal. However, the prior studies did not compare underlying causes for dissatisfaction based on age. This study compared the satisfaction and residual symptom rates between patients ages < 60 and ≥60 years and identified specific reasons for their dissatisfaction between the age groups.

METHODS: Patients who underwent unilateral TKA for osteoarthritis from 2014 to 2016 were electronically sent a 15-question survey pertaining to surgery satisfaction. Following patient identification and survey completion, patient demographics, medical history, surgical time, and length of stay were collected through manual review of medical records. Patients who completed surveys were grouped by age (< 60 years or ≥60 years) for analysis.

RESULTS: In total, 1189 ≥ 60-year-old patients and 388 < 60-year-old patients were included. Most patients in both cohorts reported satisfaction with overall knee function (< 60: 68.6%; ≥60: 71.8%; P = 0.175). Fewer < 60-year patients reported normal knee function (66.5% vs. 75.2%; P < 0.001). The most common residual symptom in both cohorts was continued pain.

CONCLUSION: Patients younger than 60 years reported less satisfaction with performing normal activities …

Gastrointestinal Fistulas-What Gastroenterologists Need To Know In 2025, Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Gastrointestinal fistulas are increasingly being encountered in our clinical practice because of the increased burden of Crohn's disease, bariatric surgeries, interventional endoscopic procedures, nonsurgical trauma, and war and disaster zones worldwide. Presentation depends on the location and specific type of the fistula. Symptomatic ones can have a tremendous impact on social life and can cause dehydration, electrolyte imbalance, malnutrition, increased morbidity, and mortality. Different imaging studies and endoscopic procedures are done to establish the diagnosis. Treatment modalities to close the fistula depend on the underlying disease and the type of fistula. They include conservative treatment, medical therapy, endoscopic interventions, and …

Association Between Weather Variables And Fascial Space Infections Of The Head And Neck: A Retrospective Chart Review, Teresa E. Fowler, Ryan F. Bloomquist, Jeffrey N. James

School of Dentistry Faculty Publications

BACKGROUND: The incidence of fascial space infections of the head and neck has long been suggested to correlate with weather patterns, though objective evidence is inconsistent, and a causative effect is difficult to prove. One issue in the existing literature is that correlations between space infections and weather patterns have been assessed in only a few climates, so data from additional regions is needed. The purpose of this study is to understand whether head and neck infection rates correlate with weather patterns in a humid subtropical climate, adding to the current literature derived largely from temperate environments. METHODS: In this …

Molecular Inflammatory Expression Profiles Associated With The Frequency Of Pain In Individuals With Sickle Cell Disease, Lana Mucalo Katunaric, Shuang Jia, Ashima Singh, Mark F. Roethle, Julie A. Panepinto, David C. Brousseau, Martin J. Hessner, Amanda M. Brandow

Department of Pediatrics Faculty Papers

Pain is the most common complication of sickle cell disease (SCD). The underlying biology of SCD pain is not well understood, which is a barrier to novel, effective analgesic and preventive therapies. A wide variability in the phenotypic expression of pain exists among individuals with SCD, despite the inheritance of a similar defective hemoglobin gene. This interindividual pain variability further complicates the ability to understand the biology and effectively treat pain. We sought to discover a biological signature comprising differentially expressed genes unique to SCD that could differentiate between individuals with varied pain frequency. We conducted plasma-induced transcription analysis from …

Cns And Retinal Radiologic Findings Of A Young Patient With Heterozygous Prothrombin G20210a Gene Mutation, Justina Kasteri, Timothy Ehmann, Bryan Scott

Advances in Clinical Medical Research and Healthcare Delivery

Stroke is one of the leading causes of death and acquired long-term disability in the world.¹ In United States stroke is the 5^th leading cause of death with a mortality rate of 49.1 deaths per 100,000 people.² Strokes can be ischemic or hemorrhagic in origin, of which 85% are ischemic strokes. Approximately 10--15% of ischemic strokes occur in patients 18-50 years of age, and inherited thrombophilia may be a contributing factor through induction of a hypercoagulable state. Prothrombin G20210A mutation has an overall prevalence of approximately 2% of the general population, with an association between young patients …

Discontinuation Rates And Predictors Of Medical Cannabis Cessation For Chronic Musculoskeletal Pain, Mohammad Khak, Sina Ramtin, Juliet Chung, Asif M. Ilyas, Ari Greis

Rothman Institute Papers

Medical cannabis (MC) is increasingly used as a treatment for chronic musculoskeletal pain, but there is limited data on factors influencing its discontinuation. This study aims to investigate the rates of MC discontinuation and explore factors influencing it in patients with chronic musculoskeletal pain. A retrospective analysis was conducted on 78 patients certified for medical cannabis over a 2 year period. Patient demographics, pain origin, and Global Physical Health (GPH) and Global Mental Health (GMH) scores were collected before intervention. Discontinuation rates were measured at three-month and one-year follow-up. Statistical analyses, including Fisher's Exact Test and two-sample t-tests, were performed …

Feasibility And Preliminary Efficacy Of A Lymphedema And Fibrosis Self-Management Program For Head And Neck Cancer Survivors: A Pilot Randomized Controlled Trial, Jie Deng, Barbara Murphy, Lucy Andersen, Erin Mcmenamin, John Lukens, Joy Cohn, Karthik Rajasekaran, Ryan Quinn, Bryan Spinelli, Alexander Lin

Department of Physical Therapy Faculty Papers

OBJECTIVES: Survivors of head and neck cancer (HNC) are at high risk for developing lymphedema and fibrosis (LEF). Once diagnosed with LEF, survivors must engage in a lifelong program of self-care to minimize long-term adverse effects. However, evidence-based LEF self-management (SM) programs are lacking. To fill this void, we developed and pilot-tested a LEF-SM program for HNC survivors.

MATERIALS AND METHODS: The LEF-SM Program was developed using the Information-Motivation-Behavioral Skills model of health behavior change as a framework. The program was pilot tested in a three-group randomized controlled trial evaluating feasibility and preliminary efficacy. Fifty-nine participants were randomized to: Usual …