Internal Medicine Commons^™

Power Outage: Acute Subtotal Occlusion Of The Left Circumflex Artery With Minimal Ecg Changes, Daniel Moylan, Md, Brady Houtz, Md

The Medicine Forum

Acute coronary syndrome (ACS) represents one of the most recognizable causes of death in the United States. Despite significant advances in cardiovascular preventative health, an American will have a myocardial infarction approximately every 40 seconds.¹ Fortunately, rapid diagnosis and treatment of ACS have allowed for significant reductions in both morbidity and mortality of myocardial infarctions.² Thus, prompt identification of ACS is crucial, and nonetheless, it can still present a noteworthy challenge to physicians. In this case, we present a near-electrically silent acute thrombotic coronary subtotal occlusion. It constitutes a stark reminder that diagnosis of an acute myocardial infarction …

Mitral Annular Disjunction As A Cause Of Cardiac Arrest In Young Patient: A Case Report, Sheraz Qamar, Md

The Medicine Forum

Mitral annular disjunction is a structural abnormality where there is a separation of the mitral valve annulus and left atrial wall. We present a case of cardiac arrest in a young patient with known mitral valve prolapse that was now found to have mitral annular disjunction due to myxomatous mitral valve disease. This case highlights the importance of finding the etiology of cardiac arrest, which in this case, is myxomatous mitral valve disease causing mitral annular disjunction. It also highlights the importance of secondary prevention of sudden cardiac death with defibrillator placement in these patients.

Hot Coffee-Induced Takotsubo Cardiomyopathy: A Case Report, Zachary Pang, Md, M. D. Kilpatrick, Md, Jasmine Lee, Md, Gregary D. Marhefka, Md

The Medicine Forum

Takotsubo cardiomyopathy is a well-known phenomenon due to physical or emotional stress, causing a catecholamine surge leading to myocardial wall motion abnormalities, most commonly apical ballooning of the left ventricle.1-3 The diagnosis of Takotsubo cardiomyopathy can be challenging as its presentation often mimics acute coronary syndrome. This case highlights the classic presentation of the apical ballooning variant of Takotsubo cardiomyopathy and appropriate workup and diagnosis.

Be Afraid Of Severe Pulmonary Hypertension And Right Ventricular Failure In The Peri-Op Patient, Avish Patel, Md, Lily Ackermann, Md

The Medicine Forum

Heart failure (HF), particularly right ventricular (RV) failure, and pulmonary hypertension (PH) present significant risks during the perioperative period. Despite the fact that these comorbidities are not always considered in preoperative risk evaluation, they are very important when considering perioperative risk. Current risk assessment tools mainly include the Revised Cardiac Risk Index (RCRI); however, it does not effectively assess severity of HF or PH. This review aims to highlight the major points on peri-operative management in non-cardiac surgeries using a case of a patient with severe PH who experienced unexpected mortality from acute RV failure post-operatively.

A Case Of Type 4 Spontaneous Coronary Artery Dissection (Scad), Virginia Gonzalez, Md, Ms, Kashka Mallari, Md, Marina Gonzalez, Md, Svenja Schneider, Md, Sung-Hae Cho, Md, Paulina Gorodin-Kiliddar, Md

The Medicine Forum

A 52-year-old female presented to the emergency department ten minutes after the development of sudden-onset crushing chest pain radiating to both of her arms, associated with dyspnea on exertion. Notably, she reported a several-month history of significant stress caring for her elderly mother with Alzheimer’s disease. On admission, her vital signs revealed sinus bradycardia with a heart rate of 56 beats/min.

The patient reported a past medical history of hypothyroidism, breast cancer status post lumpectomy, nicotine dependence, and anxiety. She did not have a prior history of cardiovascular disease or stroke, nor a family history of premature coronary disease. She …

Evaluating Mortality And Bleeding Risk After Percutaneous Left Atrial Appendage Closure In Atrial Fibrillation: A Propensity-Matched Analysis Using A Multi-Institutional Database, Youssef Elfatatry, Md, Ryan Gardner, Md

The Medicine Forum

Percutaneous left atrial appendage closure (pLAAC) has emerged as an effective treatment strategy for stroke prevention in patients with atrial fibrillation (AF) who otherwise cannot tolerate anticoagulation (AC) therapy. The American College of Cardiology, American Heart Association, American College of Chest Physicians, and Heart Rhythm Society combined guidelines offer a class 2a recommendation to pursue pLAAC in patients with an elevated risk of stroke from AF and a contraindication to oral AC, and a class 2b recommendation for pLAAC in patients with elevated risk of stroke from AF and elevated risk of life-threatening bleeding from AC.¹ The predominant pLAAC …

3d-Printed Coronary Arteries: An Effective Tool In Medical Education, Zachary Pang, Md, Shreyas Chandragiri, Md, Shumpei Mori, Md, Phd, Alexander Hajduczok, Md, Cannon G. Hiranaka, Md, Jesse Ottaway, Md, Zachary Mace, Md, Michael Wong, Md, Tammy Yoshioka, Md, Noah Haroian, Md, Pharmd, Guiyan Zhang, Md, Phd

The Medicine Forum

Anatomy and physiology can be a challenging topic due to their inherent complexity. Anatomy is most effectively learned through a combination of memorization, comprehension, and visualization.¹ Lectures and textbooks provide efficient means for memorization and comprehension but can often be challenging for thee-dimensional (3D) visualization. Conceptualizing 3D structures from two-dimensional (2D) textbook figures poses difficulty for many students. Anatomical education can be accompanied by dissection of cadavers, which can aid in visualization, but can be time-consuming and expensive.² 3D printing technology, however, holds the potential to solve this problem and enhance the anatomical education experience.

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-sixth year serving as an outlet for our medical community’s scholarly and creative efforts. This year, it has been my pleasure to work with Marc, Marina, Virginia, and Devin on this project. I have not only worked with them on the Forum, but also on the wards. It is impressive to see the same excellence they bring to patient care applied to this academic publication.

This journal serves as a showcase for the efforts of our Department. It is always exciting …

From The Chief Residents, Akash Patel, Do, Ashley Traczuk, Md, Mark Liotta, Md, Claire Zurlo, Md

The Medicine Forum

It is with great pride that we present this year’s edition of The Medicine Forum, a reflection of the passion, intellectual curiosity, and multidimensional talents that define our Internal Medicine residency program.

This journal continues to be more than a collection of case reports and research findings — it is a celebration of who we are as a community. It reflects our shared commitment to inquiry, creativity, and the art of medicine. From the rigor of original research to the introspection of narrative writing and the vibrancy of visual art, this edition captures the full spectrum of our residents’ …

From The Editors, Marina Gonzalez, Md, Virginia Gonzalez, Md, Devin Vasoya, Md, Marc Yorker, Md

The Medicine Forum

It is with great enthusiasm that we present to you the 26th edition of our internal medicine residency journal. As chief editors, we have the privilege of curating the latest insights, research, and reflections from the ever-evolving world of medicine, all to enrich our shared knowledge and foster meaningful discussions within our community.

Over the years, this journal has served as a platform for scholarly exploration, clinical advancements, and the voices of residents shaping the future of internal medicine. With each edition, we strive to uphold the highest standards of academic excellence while embracing the diversity of thought and expertise …

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

The Medicine Forum

The Jefferson Forum is a reflection of our residents' dedication to patient care, education, resilience, and research. Within these pages, you’ll find a unique combination of hard work, intellectual curiosity, and personality. As Program Director, I have the privilege of watching their transformation from learners to skilled clinicians and scholars, a journey marked by perseverance and a sense of purpose.

In a time of rapid political and societal change, this publication stands as a testament to our renewed commitment to science, well-being, and the pursuit of knowledge. As physicians and researchers, we remain steadfast in our mission to improve health …

Table Of Contents: The Medicine Forum, Volume 26, 2024-2025

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 26, 2024-2025

The Medicine Forum: Volume 26

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 26, 2024-2025

TABLE OF CONTENTS

• Research Studies
• Case Reports
• Humanities & Reflections

Cardiovascular Health In Cardiac Rehabilitation: Applying The American Heart Association Life's Simple 7 Framework In A Center-Based Cohort, Audry Chacin-Suarez, Tomoaki Hama, Matthew P. Johnson, Helayna Abraham, Thomas P. Olson, Laprincess C. Brewer

Einstein Health Papers

BACKGROUND: Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease program with structured lifestyle interventions to reduce morbidity and mortality. The American Heart Association cardiovascular health (CVH) framework measures health-promoting behaviors and clinical factors, but it has not been rigorously evaluated in the CR setting.

METHODS: This retrospective cohort study analyzed patients attending CR from January 2018 to September 2020. Patients were evaluated at baseline (pre-CR) and completion (post-CR) using 3 clinical factors (blood pressure, cholesterol, and hemoglobin A1c) and 4 health behaviors (smoking, body mass index, physical activity, and diet). CVH score was computed as a composite of each …

Slow-Growing Lung Mass In A Patient With Multiple Endocrine Neoplasia Type I: Consider Carcinoid Tumor, Ramin Talebi, Charalambos C. Solomides, Nathaniel R. Evans Iii, Gregory C. Kane

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

A 23-year-old man with multiple endocrine neoplasia type 1 (MEN 1) with pancreatic tail masses and Cushing syndrome (status after transsphenoidal adenomectomy) presented with a slow-growing, asymptomatic right lower lung lobe mass confirmed to be an atypical carcinoid tumor by pathologic staging following successful basilar segmentectomy with mediastinal lymphadenectomy. Pulmonary carcinoid tumor (PCT) is a rare neoplasm in patients with MEN 1, but there is limited data on trends in atypical versus typical carcinoid tumors in these patients. This case emphasizes the need to characterize these trends given the implications for metastatic potential and 5-year survival, which can help guide …

A Tubo-Ovarian Abscess In Aplastic Anemia Presenting As Fever Of Unknown Origin, Rashi Mittal, Saurabh Kumar Gautam, Prasan Kumar Panda, Latika Chawla

Chulalongkorn Medical Journal

This report describes a complex case of a tubo-ovarian abscess (TOA) presenting atypically as fever of unknown origin (FUO) in a young woman initially diagnosed with severe aplastic anemia. The case involved protracted febrile illness, heavy menstrual bleeding, and pancytopenia. Identification of an Escherichia coli tubo-ovarian abscess, rather than tuberculosis, emphasized the need for a thorough evaluation in atypical presentations of TOA. Negative tuberculosis tests highlighted the variety of possible microbial etiologies. The resolution of fever following drainage and tailored antibiotic therapy, along with timely surgical intervention, demonstrated the importance of specific management strategies in such cases. Awareness of the …

Management And Optimization Of Chronic Renal Insufficiency In The Setting Of Kidney Cancer A Systematic Review, Jessica K. Cobb, Hiroko Miyagi, Jad Chahoud, Claude Bassil, Philippe E. Spiess

Division of Internal Medicine Faculty Papers & Presentations

PURPOSE: There is a bidirectional relationship between chronic kidney disease and the incidence of renal cell carcinoma. Despite the frequency of patients with both chronic kidney disease and renal cell carcinoma, there are limited systematic reviews detailing the nuanced treatment. This review provides comprehensive insights for clinicians for managing chronic kidney disease, and renal cell carcinoma. Methods and Methods: We reviewed published literature that examined either chronic kidney disease and renal cell carcinoma or an indirect contributor of both.

RESULTS: We compare and contrast renal cell carcinoma treatment with partial and radical nephrectomies, ablative techniques, and radiation and their impact …

Building Models, Building Capacity: A Review Of Participatory Machine Learning For Hiv Prevention, Mark Sendak, Meg Young, Jee Young Kim, Alifia Hasan, Clare Kelsey, Catherine O’Neal, Tonya Jagneaux, Wayne Wilbright, John Couk, Stephen Lim, Tamachia Davenport, Shirley Lolis, Jennifer Thomas, Shannon Widman, Suresh Balu, Meredith Clement, Lance Okeke

School of Medicine Faculty Publications

A growing number of researchers and practitioners are embracing a “participatory turn” in machine learning (ML) to improve model development, prevent harm, and provide communities more influence over systems that impact them. In this paper, we explore the intersection of participatory practices in healthcare and the emerging focus on responsible AI with a focus on human immunodeficiency virus (HIV) care. We review the historical context of participation in HIV treatment and prevention, emphasizing how patient activism has shaped practices in this field. We then review participatory ML in HIV prevention and present a brief case study of a project designed …

Disparities In Mortality Associated With Disseminated Intravascular Coagulation: A Nationwide Study, Manas Pustake, Atulya Khosla, Saif Syed, Avi Harisingani

Conference Presentation Abstracts

Background : Disseminated intravascular coagulation (DIC) is a serious and often life-threatening condition that can result in widespread morbidity and mortality. Despite its clinical significance, there remains a lack of comprehensive, national-level data analyzing trends in DIC-related mortality. Understanding these trends is crucial for identifying at-risk populations, informing public health strategies, and optimizing clinical interventions. Aims : This study aims to analyze DIC mortality trends from 2018 to 2023, focusing on key demographic and regional factors, to provide insights that can guide future healthcare policy and practice. Methods : An analysis of DIC mortality trends from 2018 to 2023 was …

Impact Of Metabolically Healthy Obesity On Post Percutaneous Coronary Intervention Outcomes In Patients With Acute Myocardial Infarction: A Nationwide Propensity Matched Analysis, Rupak Desai, Adhvithi Pingili, Arankesh Mahadevan, Vishal Reddy Bejugam, Hafeezuddin Ahmed, Vamsikalayan Borra, Adil Sarvar Mohammed, Gayatri Bondi, Shobana Krishnamurthy, Nithya Borra

School of Medicine Publications

Background

Obesity paradox in post-percutaneous coronary intervention (PCI) outcomes among acute myocardial infarction (AMI) patients is a known controversy. However, these studies included patients who had diabetes, hypertension, or hyperlipidemia. We studied relationship between metabolically healthy obesity (MHO—without diabetes, hypertension, or hyperlipidemia) and in-hospital post-PCI outcomes among AMI patients.

Methods

We extracted data from National Inpatient Sample 2020 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for admissions of AMI patients who underwent PCI. We then identified patients with diabetes, hypertension, and hyperlipidemia using Elixhauser comorbidity index and Clinical Classifications Software and excluded them. Then, using Elixhauser …