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Beyond the Final Breath: Postmortem Diagnosis of Hantavirus Pulmonary Syndrome
No full textIntroduction: Hantavirus, a zoonotic virus transmitted to humans by inhalation of aerosolized excrement from infected rodents. Hantavirus Pulmonary Syndrome (HPS) is one of the major manifestations in humans. We present a challenging case of HPS that was diagnosed postmortem. Case presentation: A 36-year-old nonsmoker female presented with shortness of breath, mucoid cough, myalgia, and fever of one-day duration. She denied chest pain, sick contacts, recent travel. She was a cashier at a family-owned meat shop. Vitals T 102.4F, tachypneic, saturating 70% on RA. Exam was remarkable for coarse breath sounds with bilateral crackles. Computed Tomography of Chest showed diffuse interstitial edema and multifocal infiltrates(Figure A/B). Pertinent blood work showed leukocytosis with left shift. Normal platelets. ABG: pH 7.22, pCO2 35 pO2 95 on presentation, on non-invasive ventilation (NIV). She was started on broad spectrum antibiotics. Approximately four hours later, she developed significant respiratory distress requiring intubation. Shortly thereafter, she developed severe shock requiring vasopressors. Despite maximal support with mechanical ventilation, she remained hypoxic to 60-65% which prompted emergent Extracorporeal Membrane Oxygenation (ECMO). Unfortunately, in the interim, she sustained a cardiac arrest and deceased. Upon enquiring with family, she had exposure to rodents. This was key to her diagnosis, which unfortunately came into light rather delayed. Based on rodent exposure, the acuity of her illness with rapid deterioration, Hantavirus Pulmonary Syndrome was suspected. Autopsy revealed Acute Pneumonitis with Diffuse Alveolar Damage (Figure C/D). Immunohistochemical (IHC) stains confirmed Hantavirus antigens in the lungs and kidneys (Figure E/F). Discussion: Hantavirus Pulmonary syndrome can range from mild to severe forms, the latter has high case fatality rates of up to 50%1. Often has prodromal phase mimicking viral infections which poses a diagnostic challenge. Pathogenesis involves endothelial dysfunction resulting in capillary leak, and dysregulated immune response2. In severe forms with cardiopulmonary involvement, the onset of hypotension and noncardiogenic pulmonary edema is rapid and fatal. Although there are no definitive criteria for diagnosis, in endemic areas, a triad of thrombocytopenia, presence of immunoblasts, and a left-shifted granulocytes are used in suspecting HPS3. Testing includes hantavirus specific IgM or IgG; RNA in clinical specimens, or IHC in lung biopsy or autopsy tissues. Management is mainly supportive therapy with lung protective ventilation, early consideration of ECMO. There is no antiviral therapy yet. Conclusion: Hantavirus Pulmonary Syndrome has high fatality rates. This case report highlights the importance of thorough social history, and the challenges posed in diagnosing such cases
3.43 MED13 Syndrome: A Literature Review of a Rare Genetic Mutation and Exploration of Associated Psychiatric Features
No full textObjectives: The objectives of this study were to: 1) examine the prevalence of neurodevelopmental and psychiatric manifestations in MED13 syndrome, emphasizing their clinical significance; and 2) address the importance of comprehensive neurodevelopmental and genetic testing in patients with suspected intellectual and developmental disabilities (IDDs). Methods: A PubMed search for reports including keywords such as “MED13 syndrome” and “MED13 chromosome 17q23.2” produced a total of 116 articles. Results: were narrowed to include 7 reports detailing the neurodevelopmental characteristics of 21 individuals with MED13 syndrome. One additional individual was examined based on a clinical case report finding in an article that is pending publication submission. Data frequencies were calculated using SPSS statistical software. Results: Of the 22 MED13 syndrome cases reviewed, the prevalence of neuropsychiatric diagnoses was stratified as follows: IDD (72.7% present, 4.5% absent, 22.7% not reported/assessed), ASD (45% present, 55% not reported/assessed), and ADHD (18.2% present, 81.8% not reported/assessed). Only 4 of the 22 cases reported other unspecified psychiatric symptoms, including sleep disturbance or MDD. It is well known that in the general population, there is a relatively high co-occurrence of IDD and ASD, with these diagnoses often linked to genetic mutations. Many adolescents with IDD also have comorbid psychiatric disorders. One study highlights the benefits of receiving a genetic diagnosis, including improved monitoring of comorbid conditions, a stronger sense of identity, and a greater understanding of their condition. Conclusions: Early screening and intervention for neuropsychiatric comorbidities in MED13 syndrome and other underlying genetic disorders may improve patient outcomes, and clinicians should maintain a high index of suspicion. This review suggests that these conditions may be undertested. Similarly, with many IDDs linked to genetic causes, genetic testing can aid in identifying comorbid conditions and empowering patients and caretakers. Neuropsychiatric manifestations in MED13 syndrome remain poorly characterized. A key limitation of this study is the small number of reported cases due to how rare this disorder is. Future research should focus on their prevalence, clinical significance, and treatment strategies. ND, GS, S
Tackling the Cardio-Kidney-Metabolic Burden in Cancer.
No full textPURPOSE OF THE REVIEW: This review aims to examine the clinical relevance of cardio-kidney-metabolic syndrome (CKMS) in oncology, highlighting its role as both a preexisting comorbidity and a consequence of cancer treatment. It aims to integrating CKMS staging into personalized cancer care.
RECENT FINDINGS: CKMS is a progressive syndrome marked by dysfunction across cardiovascular, renal, and metabolic systems. Cancer therapies-particularly hormonal agents, immune checkpoint inhibitors, and chemotherapeutics-can accelerate or reveal underlying CKMS through inflammatory and metabolic pathways. Early risk stratification based on CKMS stage enables more effective monitoring, referral, and therapeutic strategies. A stage-based, multidisciplinary approach tailored to cancer type and comorbidity burden is essential for optimizing outcomes. With rising multimorbidity among cancer patients, recognizing and addressing CKMS is increasingly critical. Routine CKMS assessment in oncology offers a pathway for earlier intervention and potentially altering its course. A comprehensive, individualized care model based on CKS stage is necessary to mitigate CKMS-related complications and deliver high-quality, integrated cancer care
Primary Hyperparathyroidism in Pregnancy: Parathyroidectomy in the Third Trimester
No full textPrimary hyperparathyroidism (PHPT) is characterized by hypercalcemia and elevated or non-suppressible parathyroid hormone (PTH) levels. The clinical presentation ranges from asymptomatic to symptoms or signs of hypercalcemia, as well as renal and/or skeletal manifestations. In pregnancy, hypercalcemia presents heightened risks for both maternal and fetal health, necessitating early recognition and prompt intervention to mitigate morbidity and mortality.Case PresentationA 28-year-old female at 27 weeks and 5 days of gestation presented to the ED with bilateral flank pain. Imaging via CT of the abdomen revealed ureteropelvic calculi and bilateral hydronephrosis. Laboratory findings were notable for corrected calcium of 13 mg/dL, ionized calcium of 1.55 mmol/L, 25-hydroxyvitamin D of 4.3 ng/ mL, magnesium of 1.1 mg/dL, and PTH of 130 pg/mL. A 24-hour urine calcium collection confirmed hypercalciuria. The patient was diagnosed with PHPT four years prior; however, she was lost to follow-up. She reported no history of nephrolithiasis, fractures, or medications associated with hypercalcemia (e.g., lithium or hydrochlorothiazide).Initial management with intravenous fluids failed to significantly reduce calcium levels. Given the relative contraindications of most pharmacologic treatments for hypercalcemia during pregnancy, parathyroidectomy (PTX) was recommended. She underwent partial PTX and lithotripsy with stent placement simultaneously. Intraoperative findings revealed a right upper parathyroid adenoma. Postoperative PTH levels confirmed successful excision.Discussion: Young age, marked hypercalcemia, and nephrolithiasis are indications for PTX in PHPT. Managing this condition during pregnancy requires balancing maternal and fetal safety with the timing of surgical intervention. PTX is ideally performed in the second trimester, a period associated with reduced risks of preterm labor and miscarriage. Surgery during the third trimester is generally avoided due to risks of preterm delivery. Untreated hypercalcemia in pregnancy carries maternal risks, including worsening nephrolithiasis and renal insufficiency, while fetal risks include intrauterine growth restriction, neonatal hypocalcemia, and stillbirth due to transplacental calcium transfer. In this case, surgery was necessary, as the risks of untreated hypercalcemia outweighed surgical complications. This underscores the need for individualized management based on a careful riskbenefit assessment.ConclusionThis case highlights the importance of timely diagnosis and management of PHPT in reproductive-aged women, particularly before pregnancy. In pregnant women, a multidisciplinary approach involving endocrinology, obstetrics, and surgery is essential to determine the safest course of action
Impact of Early Term Induction of Labor on Cesarean Delivery and Maternal-Fetal Outcomes in Patients with Obesity: A Retrospective Cohort Study
No full textIntroduction: Obesity (body mass index [BMI] ≥ 30 kg/m²) is increasingly prevalent in pregnancy and is associated with numerous complications, including gestational diabetes, hypertension, and higher cesarean delivery (CD) rate. There are many risks for patients with obesity during pregnancy; however, there is little evidence supporting early-term (37 0/7 to 38 6/7 weeks of gestation) induction of labor (IOL) to reduce complications. This study aimed to evaluate whether IOL in patients with obesity is associated with a decreased CD rate.
Methods: This retrospective cohort study included pregnancies that underwent IOL between 37 0/7 and 41 6/7 weeks of gestation from 2018-2023 at a single institution. Exclusion criteria included pre-labor rupture of membranes, spontaneous labor, prior CD, multiple gestations, fetal anomalies, or non-vertex presentation. The primary exposures were pre-gravid BMI (≥ 30 vs. \u3c 30 kg/m²) and gestational age (GA) at IOL (≥ 39 vs. \u3c 39 weeks of gestation). The primary outcome was CD rate; secondary outcomes included shoulder dystocia (SD), obstetric anal sphincter injuries (OASIS), postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission.
Results: Of the 6,477 patients included, 69.7% had obesity, and 70.7% delivered at ≥ 39 weeks. Obesity was associated with higher rates of CD (20.6% vs. 12.1%, p
Discussion: In patients with obesity, early term IOL does not reduce cesarean delivery rates. It may, however, decrease the risk of SD, although this benefit may be accompanied by an increased risk of NICU admission. Further prospective studies are required to establish the optimal timing of delivery in this population
The Implementation of Indoor Urban Gardening: A Microgreens Pilot Study in a University Setting
No full textIntroduction: “Food deserts” are geographical areas that lack affordable full-service grocery stores and have higher densities of unhealthy or “fast food” options. These deserts not only exist in communities such as Philadelphia, but also on college campuses. One solution to creating access to fresh vegetables is urban farming, which refers to green areas (i.e. community gardens) that provide places for food to be grown by local residents. Microgreens Health Outreach Project (HOP), aimed to build and implement a small, indoor community garden cart within the Health Sciences Building (HSB) at Drexel University; the organization hoped that this cart would be regularly utilized by the Drexel University College of Medicine (DUCOM) students. Methods: Microgreens HOP contacted the Office of Student Affairs at DUCOM and the owners of the HSB. Funding, responsibility, space necessary, and permanence of the garden were issues discussed during the planning process. Results: A small, free-standing, indoor community garden cart was built and implemented on the ninth floor of HSB at Drexel University in September 2024. Discussion: There was little existing literature addressing indoor urban gardening, and Microgreens HOP was unable to effectively compare the costs for building this garden. Through internet research and price comparisons, Microgreens HOP designed a custom-built urban farming cart. Communication, funding, and a supportive community at DUCOM were crucial to the success of this project. Conclusion: Future research should explore taste preferences of microgreens and the effectiveness of shared harvesting and community garden rules
Provider Perceptions of Over-the-Counter Progestin-Only Birth Control Pills in Urban, Suburban, and Rural Populations of Pennsylvania
No full textBackground The Opill is an over-the-counter, progestin-only oral contraceptive and the first of its kind to free women from the need to obtain a prescription for birth control. Opill is approved in Pennsylvania, a remarkably diverse state containing urban, rural, and suburban regions spanning the state. As women gain easier access to birth control that does not require a medical provider\u27s prescription, the Opill may help overcome healthcare gaps when seeking birth control methods. It is crucial to understand provider opinion on progestin-only pills (POPs), which influence patient education and use of the progestin-only pills to prevent unintended pregnancies. In this study, we aim to survey providers who prescribe birth control in Pennsylvania\u27s rural, urban, and suburban regions to gain insight into their opinions of the Opill. Methodology The surveys were emailed to healthcare providers in OBGYN, family medicine, internal medicine, and pediatrics using Drexel University College of Medicine\u27s affiliated clinical sites throughout Pennsylvania. The provider\u27s demographics, knowledge, and attitudes toward Opill were collected. Results The survey was sent to 764 providers, and 60 (8%) completed it. Fifty-one (85%) participants did not receive any information from their institution regarding over-the-counter birth control pills, and 36 (61%) received no formal training on patient counseling for over-the-counter birth control. Unawareness of the availability of Opill among rural, suburban, and urban providers was 3 (75.0%), 11 (34.5%), and 6 (27.3%), respectively. Conclusions There is a notable lack of awareness and clinical training of the Opill within Pennsylvania\u27s urban, suburban, and rural providers. Because of the lack of training, providers may be less likely to support and recommend Opill to patients as opposed to other oral contraceptives. As Opill continues to gain traction in the market, further studies are needed to determine whether provider training, perceptions, and recommendations regarding Opill will change over time
The Roles of Fasciotomy and Peripheral Nerve Decompression in Electric Burn Patients: A Systematic Review and Meta-Analysis.
No full textINTRODUCTION: Peripheral nerves preferentially conduct electricity due to their low resistance as compared with other tissues, predisposing them to injury from electrical burns. The purpose of this study was to investigate the efficacy of fasciotomy and peripheral nerve decompression on peripheral nerves after electric injury.
METHODS: A systematic review of patients who had sustained electric burn injuries was performed according to PRISMA Guidelines. Incidence, demographic and injury characteristics, and patterns of symptoms were analyzed. Meta-analysis was performed to examine changes from baseline from nerve conduction studies. Outcomes for fasciotomy and various nerve decompressions were also analyzed.
RESULTS: Of the 119 articles included in for systematic review, 16,773 patients were included. Most available studies the case reports or case series that yielded moderate- to poor-quality evidence. The median follow-up of the included patients was 44 weeks (IQR 15-97 weeks). Patients who underwent fasciotomy had significantly lower rates of peripheral neuropathy than those who did not by the last recorded follow-up (45% vs. 92%, p \u3c 0.0001). Patients who underwent peripheral nerve decompression after 30 days of injury had lower rates of peripheral neuropathy at the last follow-up compared with those who underwent decompression within 30 days (21% vs. 53%, p \u3c 0.0001).
CONCLUSIONS: A paucity of high-quality evidence exists to standardize management recommendations for peripheral nerve injury; however, of what literature does exist, it seems that fasciotomy and nerve decompressions are associated with improved peripheral nerve function in the long-term, but nerve decompression likely provides more benefit when performed if symptoms persist one-year post-injury
Treatment of obesity in spinal cord injury with tirzepatide: a case report.
No full textINTRODUCTION: Individuals with spinal cord injury (SCI) experience alterations in metabolism that result in increased central obesity, insulin resistance, and dyslipidemia placing them at elevated risk for developing cardiometabolic disease (CMD). Increased exercise and dietary modifications are the primary interventions for preventing CMD. However, people with SCI face unique challenges that prevent them from increasing their physical activity and easily modifying their nutritional intake. Tirzepatide is a medication that has been approved by the Food and Drug Administration to be used in conjunction with lifestyle changes to treat obesity in adults with type 2 diabetes mellitus.
CASE PRESENTATION: A male in his 40\u27s with C6 American Spinal Injury Association Impairment Scale B SCI 15 years prior with a body mass index of 32 presented to his primary care provider for treatment of obesity. He previously worked with multiple dietitians and increased his physical activity to lose weight. Despite these interventions, he was unable to reduce his weight. He was started on tirzepatide. After 3 months of treatment, he lost 31 pounds and saw improvements in his lipid profile. The only adverse effect reported was heartburn.
DISCUSSION: The metabolic dysfunction associated with SCI and barriers to adequate exercise for weight loss place individuals with SCI at increased risk for obesity and developing CMD. Tirzepatide may be an effective adjunct therapy to lifestyle interventions to help prevent CMD in those with SCI. Further research is indicated to examine the long-term efficacy, benefits, and adverse effects that may be associated with tirzepatide