University of Toledo Open Journal System

Maag, Serena

Bailey, Brianna

Holt, Mathieu

Butt, Danyal

Shrestha, Bibek

Iqbal, Ayman

Willis, Davontae

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1386   ©2025 UTJMS 
  
 
Septic Shock of Unknown Etiology 
Serena Maag1*, Brianna Bailey1, Mathieu Holt1, Danyal Butt2,  Bibek Shrestha2, Ayman Iqbal3,  Davontae Willis4 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2Internal Medicine Resident, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, 
Toledo OH 43615 
3Resident, Department of Neurology, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
4Resident, Department of Anesthesiology, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: serena.maag@rockets.utoledo.edu 
Received: 2024-08-15 
Accepted: 2024-09-16 
Published: 2025-06-30 
Introduction: Septic shock, marked by hypotension, tachycardia, multi-organ failure, and altered mental 
status (AMS), presents significant diagnostic challenges. Conditions such as untreated liver cirrhosis, 
acute kidney injury (AKI), and rabies can mimic sepsis.  
Case Presentation: This case report discusses the complexities of diagnosing the cause of septic shock in 
an Amish woman with limited healthcare access, emphasizing the need for a broad differential diagnosis 
in such populations. Case Presentation: An 81-year-old woman with a history of hypertension presented 
with fever, hypotension, new-onset atrial fibrillation. She was admitted to the ICU for pressor support as 
labs revealed leukocytosis and elevated inflammatory markers. Urinalysis, blood cultures, ammonia 
levels, and Hepatitis B and C tests were negative. Despite various antibiotic trials and consultations, no 
definitive diagnosis was made. She continued to deteriorate and family decided to withdraw support. 
Infectious Disease considered Histoplasma, Aspergillus, West Nile virus, and rabies. Due to lack of a 
lumbar puncture (LP) during a week-long admission at an outside hospital, Internal Medicine 
recommended an LP. Neurology deemed the patient too unstable for the procedure and suggested an 
MRI. The patient was discharged to home hospice before MRI was performed.  
Discussion: The cause of septic shock and potential encephalopathy of unknown origin can be 
particularly challenging to diagnose, especially in populations with limited access to healthcare. This case 
underscores the importance of early lumbar puncture in refining the differential diagnosis and 
emphasizes the need to consider both common and rare causes of sepsis and AMS to avoid diagnostic 
anchoring and improve patient outcomes.  
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1386   ©2025 UTJMS 
  
 
Conclusion: For patients with sepsis and AMS, especially those from backgrounds with limited 
healthcare access, considering rare causes alongside common ones is crucial to avoid diagnostic biases 
and ensure effective management. 
Keywords: Septic Shock, Altered Mental Status, Case Report 
 


English

Septic Shock of Unknown Etiology

Nawras, Yusuf

Merza, Nooraldin

Alfatlawi, Halah

Hosny, Jerome

Varughese, Tony

Hassan, Mona

Kobeissy, Abdallah

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
https://dx.doi.org/10.46570/utjms-2025-1395   ©2025 UTJMS 
  
 
Gender-Based Differences in Pancreatic Cancer 
Outcomes and Hospital Mortality Rates: A Ten-
Year Review Using the US Nationwide Inpatient 
Sample Database 
Yusuf Nawras1*, Nooraldin Merza2, Halah Alfatlawi2, Jerome Hosny4, Tony Varughese5, Mona Hassan6, Abdallah 
Kobeissy7 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615  
2Fellow, Division of Gastroenterology, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
3Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue The University of 
Toledo, Toledo OH 43615 
4Department of Internal medicine, Hackensack University Medical Center, Hackensack NJ 
5Department of Internal Medicine, The University of Balamand, Balamand, Lebanon 
6Assistant Professor and Associate Program Director Gastroenterology Fellowship, Division of 
Gastroenterology, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
7Associate Professor and Associate Program Director Gastroenterology Fellowship, Division of 
Gastroenterology, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
Email: ynawras@rockets.utoledo.edu 
Received: 2024-08-16 
Accepted: 2024-09-16 
Published: 2025-06-30 
Backgroundː Pancreatic cancer is a highly lethal gastrointestinal cancer with a low 5-year survival rate 
and difficulty in early detection (1, 2, 3). A comprehensive understanding of gender-based epidemiology, 
comorbidities, clinical presentations, and risk factors for pancreatic cancer are of great significance for 
possible effective prevention and helping target future therapies (4, 5).  
Methodsː We identified patients with a discharge diagnosis of pancreatic cancer in the National 
Inpatient Sample from 2004 to 2014 using the International Classification of Diseases Clinical 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
https://dx.doi.org/10.46570/utjms-2025-1395   ©2025 UTJMS 
  
 
Modification, 9th revision (ICD-9-CM) codes. We looked at gender-based primary epidemiology, the 
yearly trend in hospitalizations with pancreatic cancer, and outcomes, which included length of stay 
(LOS), hospital charges, and in-hospital mortality. We also performed multivariate analysis to look for the 
predictors of mortality.  
Resultsː We identified 177,763 patients with a discharge diagnosis of pancreatic cancer. There was a 
significant increase in hospitalizations with pancreatic cancer in 2014 compared to 2004. Most of the 
patients were White (74.4%), had Medicare as primary insurance (58.1%), were from the Southern 
region (36.5%), and had a higher Charlson Comorbidity Index (CCI) (42.7% with CCI > = 3). Trends of the 
mortality rate for hospitalized individuals with pancreatic cancer in the male gender decreased from 
12.2% (2004) to the lowest mortality rate of 8.09% in (2014). Interestingly, based on gender 
stratification, mortality rates were consistently higher in the male gender than 7.03% in females.  
Conclusionsː Our study showed overall downward trends for in-hospital mortality despite increasing 
hospitalizations with pancreatic cancer. Based on gender stratification, mortality rates were consistently 
higher in males. 
Keywords: Pancreatic Cancer, Gender Disparity, Inpatient Mortality Rate, Length of Stay, Hospitalization 
Cost 
 
References 
1. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer 
treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89. 
Doi:10.3322/caac.21349  
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30. 
doi:10.3322/caac.21332  
3. Michaud CM, McKenna MT, Begg S, Tomijima N, Majmudar M, Bulzacchelli MT, Ebrahim S, Ezzati M, 
Salomon JA, Kreiser JG, Hogan M, Murray CJ. The burden of disease and injury in the United States 1996. 
Popul Health Metr. 2006;4:11. doi:10.1186/1478-7954-4-11  
4. Wang Y, Schrag D, Brooks GA, Dominici F. National trends in pancreatic cancer outcomes and pattern of 
care among Medicare beneficiaries, 2000 through 2010. Cancer. 2014;120(7):1050–8. Epub 2014/01/03. 
10.1002/cncr.28537  
5. Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, Pitt HA, Tielsch JM, Cameron JL. 
Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 
1998;228(3):429–38.  


Gender-Based Differences in Pancreatic Cancer Outcomes and Hospital Mortality Rates: A Ten-Year Review Using the US Nationwide Inpatient Sample Database

Kwak, Eun Seo

Bansal, Nahush

Burns, Keith

Chinnam, Sahithi

Dong, Tony

Moore, Emily

Alastal, Yaseen

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1408   ©2025 UTJMS 
  
 
Impact of Clostridium Difficile Infection on 
Inpatient Outcomes of Acute Pancreatitis: A 
Nationwide study 
Eun Seo Kwak1, Nahush Bansal1, Keith Burns2, Nooraldin Merza1, Sahithi Chinnam1, Tony Dong3, Emily Moore3, 
Yaseen Alastal 4 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
2Resident, Division of Gastroenterology, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
3College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
4Assistant Professor, Program Director of the Gastroenterology Fellowship, Division of Gastroenterology, 
Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: ekwak2@rockets.utoledo.edu 
Received: 2024-08-09 
Accepted: 2024-09-09 
Published: 2025-06-30 
Background: Clostridium difficile infection (CDI) is linked to unfavorable outcomes in hospitalized adults. 
Patients with acute pancreatitis (AP) are frequently admitted to the hospital and may be at risk for CDI 
due to antibiotic exposure. We investigated the healthcare outcomes of CDI in individuals with AP.  
Methods: The National Inpatient Sample (NIS) 2020 Database was analyzed for adult patients with acute 
pancreatitis as the primary discharge diagnosis and clostridium difficile infection as a secondary 
discharge diagnosis, identified using ICD-10 codes. The primary outcome measured was inpatient 
mortality, with secondary outcomes including length of stay (LOS), hospitalization charges, acute kidney 
injury, acute respiratory failure, severe sepsis, and septic shock. Multivariate logistic and linear 
regression analyses were employed to adjust for confounders. Statistical analyses were conducted using 
STATA software.  
Results: Out of 258,965 patients admitted with acute pancreatitis, 1632 (0.64%) were identified as 
having clostridium difficile infection. The inpatient mortality in AP patients with CDI, compared to those 
without CDI, was adjusted odds ratio, 2.14; 95% CI (1.18-6.39, p=0.019). AP patient with CDI had longer 
length of stay 11.51 (10.19-12.83, p<0.001) and hospitalization charges $125846.9 (103885.1-147808.6, 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2  
 
 
 
 
https://dx.doi.org/10.46570/utjms-2025-1408   ©2025 UTJMS 
  
 
p<0.001), as well as increased odds of acute kidney injury 2.11 (1.60-2.78, p<0.001), acute respiratory 
failure 5.56 (4.11-7.53, p<0.001), severe sepsis 9.34 (5.85-14.91, p<0.001) and septic shock 9.33 (5.39-
16.12, p<0.001).  
Conclusions: These results suggest that acute pancreatitis patients with clostridium difficile infection 
have significantly higher odds of mortality, acute kidney injury, acute respiratory failure, severe sepsis, 
and septic shock compared to those without clostridium difficile infection. 
Keywords: Clostridium Difficile, Acute Pancreatitis, National Inpatient Sample, Inpatient Mortality 
 
 


Impact of Clostridium Difficile Infection on Inpatient Outcomes of Acute Pancreatitis: A Nationwide study

Albandak, Maram

Sawaf, Bisher

Hallak, Yusuf

Altorok, Nezam

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Symposium  UTJMS 2025 June 30, 13(S3):e1-e2 
                   
 
https://dx.doi.org/10.46570/utjms-2025-1413   ©2025 UTJMS 
  
 
Pancreatic Cancer in Young Adults Aged 18-39: 
Insights from National Inpatient Sample (NIS) 
2016-2020 
Maram E. Albandak1*, Bisher Sawaf1, Yusuf Hallak1, Nezam Altorok2 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
2Professor, Program Director Rheumatology Fellowship, Director Internal Medicine Residency Program, 
Division of Rheumatology, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo 
OH 43615  
Email: MaramElena.Albandak@utoledo.edu 
Received: 2024-07-10 
Accepted: 2024-09-08 
Published: 2025-06-30 
Background: This study aimed to investigate the number and demographic characteristics of pancreatic 
cancer patients aged 18-39.  
Methods: Data from the National Inpatient Sample (NIS) for 2016-2020 were analyzed using STATA 15 to 
identify pancreatic cancer cases among young adults aged 18-39 using the International Classification of 
Diseases, 10th Revision (ICD-10). Descriptive statistics summarized patient demographics and clinical 
characteristics, while regression analysis assessed associated risk factors. Multivariate analysis was 
adjusted for age, type of insurance, race, smoking status, alcohol overuse, income, year of diagnosis, 
gender, hospital location, and region.  
Results: A total of 1,124 pancreatic cancer patients aged 18-39 were identified, with a mean age of 33.8 
years, representing 1.08% of all pancreatic cancer cases in the dataset. Among these, 20.28% (228) had 
cancer in the head of the pancreas, 10.32% (116) in the tail, 5.78% (65) in the body, and 1.33% (15) in 
the duct. Of these patients, 51.51% (579) were female, 52.40% (589) were White, and 20.55% (231) were 
Hispanic. Age distribution showed 7.8% were 18-25 years old and 82.3% were 30-39 years old. Regarding 
insurance status, 49.11% (552) had private insurance, and 35.68% (401) were on Medicaid. A total of 
4.80% (54) died, with 90.7% (49) of deaths occurring in the 30-39 age group. Multivariate regression 
showed a significantly increased association with age, especially the 35-39 age group (OR: 9.67; 95% CI: 
7.56-12.38; P < 0.0001), Hispanic ethnicity (OR: 1.83; 95% CI: 1.37-2.44; P < 0.0001), hospital location 
(OR: 1.73; 95% CI: 1.50-1.99; P < 0.0001), and region (OR: 1.13; 95% CI: 1.06-1.21; P < 0.0001).  
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Symposium  UTJMS 2025 June 30, 13(S3):e1-e2 
                   
 
https://dx.doi.org/10.46570/utjms-2025-1413   ©2025 UTJMS 
  
 
Conclusion: Pancreatic cancer in young adults predominantly affects those in the older segment of this 
age group. The higher prevalence among females and those with private insurance suggests areas for 
targeted interventions and further research into risk factors and healthcare access. 
Keywords: Pancreatic Cancer, Clinical Characteristics, Risk Factors, Healthcare Disparities 
 


Pancreatic Cancer in Young Adults Aged 18-39: Insights from National Inpatient Sample (NIS) 2016-2020

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium   UTJMS 2025 June 30, 13(S3):e1-e2                     
 
 
https://dx.doi.org/10.46570/utjms-2025-1416   ©2025 UTJMS 
  
 
Patterns of Analgesic Usage Among 
Inflammatory Bowel Disease Patients: Insights 
from a National Inpatient Sample (2016-2020) 
Maram Albandak1*, Bisher Sawaf1, Yusuf Hallak1, Nezam Altorok2 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University 
of Toledo, Toledo OH 43615 
2Professor, Program Director Rheumatology Fellowship, Director Internal Medicine Residency, Division of 
Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
Email: maram.albandak@utoledo.edu 
Received: 2024-08-30 
Accepted: 2024-09-16 
Published: 2025-06-30 
Background: Understanding analgesic usage patterns among inflammatory bowel disease (IBD) patients 
is crucial for improving clinical practices and tailoring pain management across different age groups. 
Methods: We analyzed data from a National Inpatient Sample (2016-2020), for individuals aged 18 and 
above diagnosed with IBD, stratified into young adults (18-39 years), adults (40-59 years), and older 
adults (?60 years). The prevalence and trends of analgesic usage, specifically opiates and NSAIDs, was 
investigated across various age groups, races, insurance statuses, and income levels.  
Results: The analysis included 304,969 IBD patients (114,940 with ulcerative colitis and 190,029 with 
Crohn's disease), with a mean age of 54.18 years. The cohort was 56.38% female, 78.83% White, 11.23% 
Black, and 6.11% Hispanic. Of these patients, 3.59% (10,948 patients) reported analgesic use, exhibiting 
a statistically significant trend over the study period (OR: 1.07; p < 0.0001). Among them, 78.87% (8,635) 
used opiates, 24.97% (2,734) used NSAIDs, and 3.8% (421) used both, with significant trends observed 
for opiates (OR: 1.05; p < 0.0001) and NSAIDs (OR: 1.16; p < 0.0001). Older adults showed a higher 
prevalence of analgesic use compared to young adults (38.47% vs. 23.91%; p < 0.0001). Opiate usage 
was significantly higher among older adults and adults (OR: 1.08 and 1.06, respectively; p < 0.0001). 
NSAID usage was also more common in older adults (44.44%) compared to adults (34.64%) and young 
adults (20.92%), with significant trends observed across age groups. Disparities included higher opiate 
use among White patients (81.22%), Medicare recipients (46.49%), and those in the lowest income 
quartiles (27.06%).  
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium   UTJMS 2025 June 30, 13(S3):e1-e2                     
 
 
https://dx.doi.org/10.46570/utjms-2025-1416   ©2025 UTJMS 
  
 
Conclusion: This study highlights significant age-related and demographic disparities in analgesic use 
among IBD patients. Older adults use analgesics more, particularly NSAIDs, while opiate use is higher in 
certain racial and socioeconomic groups. Targeted pain management strategies and policy interventions 
are needed to address these disparities. 
Keywords: Inflammatory Bowel Disease, Ulcerative Colitis, Crohn's Disease, Opiates, NSAIDs, 
Demographic Disparities 
 
 


Patterns of Analgesic Usage Among Inflammatory Bowel Disease Patients: Insights from a National Inpatient Sample (2016-2020)

Abu-Rumaileh, Mohammed

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2
                        
 
 
https://dx.doi.org/10.46570/utjms-2025-1423   ©2025 UTJMS 
  
 
Occipital Strokes and Bilateral Oculomotor Palsy 
Due to Bilateral Giant Cell Arteritis 
Mohammed Abu-Rumaileh1*, Nezam Altorok2 
1Resident, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University 
of Toledo, Toledo OH 43615 
2Professor, Program Director Rheumatology Fellowship, Director Internal Medicine Residency, Division of 
Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
Email: mohammed.aburumaileh@utoledo.edu 
Received: 2024-07-04 
Accepted: 2024-09-02 
Published: 2025-06-30 
Introduction: Giant cell arteritis (GCA) is a vasculitis affecting large and medium arteries, it commonly 
involves temporal arteries and can lead to severe complications such as vision loss and stroke. 
Oculomotor palsy is a very rare but serious manifestation. This case report discusses a 79-year-old 
female with GCA, occipital strokes, and bilateral oculomotor palsy, emphasizing the need for early 
recognition and treatment.  
Case Presentation: A 79-year-old woman with a history of migraine presented with a two-day history of 
worsening frontal headache, sinus pain, blurry and double vision, fatigue, dizziness, chills, night sweats, 
nausea, vomiting, dry cough, and decreased oral intake. Her headache was different from her usual 
migraines and unresponsive to ibuprofen. Physical exam revealed double vision and diffuse facial 
tenderness. Labs showed elevated WBC, creatinine, procalcitonin, CRP, ESR (67 mm/h), and lactate. 
Initial imaging and tests showed left occipital strokes and enterocolitis. Initial ophthalmology exam 
showed vision loss due to occipital stroke and oculomotor palsy. Despite starting pulse-dose steroids 
after CSF ruled out meningitis, her vision deteriorated, resulting in total vision loss in the right eye. 
Repeat ophthalmology exam showed optic disc edema and hemorrhage suggestive of GCA. Bilateral 
temporal artery biopsy was positive for GCA. She was discharged on a 6-week prednisone taper and 
Tocilizumab. A follow-up ophthalmology exam showed similar right eye findings, however left eye 
oculomotor palsy resolved.  
Discussion: GCA requires prompt diagnosis and treatment to prevent severe complications. This case 
illustrates the diagnostic challenges, especially with overlapping symptoms like sepsis-like presentations, 
and blurry/double vision in the setting of occipital strokes and oculomotor palsy. The progression to 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2
                        
 
 
https://dx.doi.org/10.46570/utjms-2025-1423   ©2025 UTJMS 
  
 
complete vision loss despite treatment highlights the aggressive nature of GCA. Multidisciplinary 
management involving neurologists, ophthalmologists, and rheumatologists is crucial. This case aims to 
increase awareness of GCA’s atypical presentation, severe manifestations, and the need for timely 
intervention. 
Keywords: Giant Cell Arteritis, Stroke, Oculomotor Palsy 
 
 


Occipital Strokes and Bilateral Oculomotor Palsy Due to Bilateral Giant Cell Arteritis

Khorsand Askari, Mani

Aradhyula, vaish

Mutgi, Anand

Khuder, sadik

Akpunonu, basil

shabpiray, hoda

federman, douglas

Heyman, Lisa

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2        
 
https://dx.doi.org/10.46570/utjms-2025-1433   ©2025 UTJMS 
  
 
The Critical Role of Accurate ICD-10 Coding in 
Hospital Discharge Diagnoses and Impact on 
Healthcare Management 
Mani K. Askari1*, Vaishnavi Aradhyula2, Anand Mutgi3, Sadik Khuder4, Basil Akpunonu5, Hoda 
Shabpiray6, Douglas Federman7, Lisa Heyman8 
1Assistant Professor, Internal Medicine Clerkship Program Director, Division of Internal Medicine, Department 
of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
3Retired, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
4Professor, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
5Professor, Chair of the Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
6Assistant Professor, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The 
University of Toledo, Toledo OH 43615 
7Professor, Interim Division Chief of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The 
University of Toledo, Toledo OH 43615 
8Manager of Professional Coding and Documentation, The University of Toledo Physicians Group, 2801 W 
Bancroft St, Toledo OH 43614 
Email: mani.askari@utoledo.edu 
Received: 2024-08-23 
Accepted: 2024-09-09 
Published: 2025-06-30 
Introduction: Accurate coding using the ICD-10 is critical for reliable diagnoses, healthcare 
reimbursement, and thorough patient care; however, the transition to this new coding system is a 
challenge for many institutions, leading to significant healthcare burden. This study evaluates the 
frequency of usage of specific versus nonspecific ICD-10 coding in hospital discharge diagnoses, focusing 
on four common disorders, including diabetes mellitus, heart failure, chronic obstructive pulmonary 
disease (COPD), and pneumonia. The impact of race, gender, age, and length of stay (LOS) on the use of 
nonspecific ICD codes was also analyzed.  
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2        
 
https://dx.doi.org/10.46570/utjms-2025-1433   ©2025 UTJMS 
  
 
Methods: A retrospective cross-sectional analysis was conducted using the 2021-2022 National Hospital 
Discharge Data from the Healthcare Cost and Utilization Project. Patients with primary or secondary 
diagnoses of diabetes mellitus, heart failure, COPD, and pneumonia were included. Descriptive statistics 
and logistic regression models assessed the use of specific versus nonspecific ICD-10 codes and the 
influence of demographic factors.  
Results: Among 6,666,752 discharges in 2021, the rates of specified coding by disease were: Diabetes 
(97.86%), Heart Failure (94.01%), Pneumonia (91.42%), and COPD (77.13%). Age and race were 
significant predictors of unspecified diagnosis for all four diseases. Older patients and those with 
extended LOS were also associated with higher nonspecific coding rates (p<0.0001). Gender was 
significant predictors for COPD and Pneumonia. Females were more likely to receive nonspecific codes, 
particularly in COPD.  
Conclusion: Nonspecific ICD-10 coding is common and more frequent in COPD and is influenced by 
demographic factors and LOS. Nonspecific coding can lead to inaccurate diagnoses, and subsequent 
delayed and inaccurate reimbursement. This impacts healthcare statistics and budget planning by 
insurance companies. Targeted efforts to standardize coding practices and enhance the specificity of ICD-
10 codes are necessary to improve data quality, patient care, and financial outcomes. 
Keywords: ICD-10 Coding, Nonspecific Coding, Hospital Discharge Diagnosis, Chronic Diseases 
 
 


The Critical Role of Accurate ICD-10 Coding in Hospital Discharge Diagnoses and Impact on Healthcare Management

Fickert, Andrew

Kapur, Sahil

Markho, Mario

Houdi, Mark

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2                
  
 
https://dx.doi.org/10.46570/utjms-2025-1448   ©2025 UTJMS 
  
 
The Efficacy and Safety of Red Light Therapy 
Andrew Fickert1*, Sahil Kapur, Mario Markho, Mark Houdi 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: andrew.fickert@rockets.utoledo.edu 
Received: 2024-08-09 
Accepted: 2024-09-09 
Published: 2025-06-30 
Background: Red Light Therapy (RLT) is a popular non-invasive treatment for skin rejuvenation, targeting 
wrinkles and loss of elasticity by stimulating collagen production and enhancing skin texture. Studies 
have shown significant improvements in skin appearance, yet comprehensive research on RLT’s long-
term safety and efficacy is limited (1).  
Objective: Explore the research of RLT and its safety and efficacy of treating age related stress lines and 
wrinkles. Methods: This project conducted a review of articles in the fields of dermatology and anti-
aging studies using PubMed as the database. Search criteria included: “Red Light therapy” WITH “Skin 
Treatment” from material published in 2020 and onward. Using this search logic, 20 articles were 
amassed for this literature review.  
Results: Recent studies on Red Light Therapy (RLT) have demonstrated promising results in skin 
rejuvenation and anti-aging. Some studies show significant reductions in visible signs of aging, such as 
wrinkles and fine lines, following RLT treatment, with patients experiencing noticeable skin 
improvements (1).  Similarly, another such study found a 30% reduction in periocular wrinkle volume in 
their randomized controlled trial, indicating the effectiveness of RLT in targeted facial areas (2). 
Evaluation of the safety and efficacy of a home-use LED device, noting high user satisfaction and 
improvements in skin texture (3). However, despite these positive outcomes, the limited number of 
recent studies emphasizes the need for further research to solidify RLT’s long-term safety and efficacy, 
ensuring its continued viability as an anti-aging treatment.  
Conclusion: Despite promising short-term results, the rapid commercialization of RLT products, driven by 
consumer demand, may outpace scientific validation. Recent studies highlight user satisfaction but stress 
the need for more rigorous long-term trials (2,4). While RLT shows potential as an anti-aging therapy, 
providers should guide patients in making informed decisions, emphasizing the importance of evidence-
based practice to ensure both efficacy and safety. 
Keywords: Red Light Therapy, Anti-Aging 
 
 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium             UTJMS 2025 June 30, 13(S3):e1-e2                
  
 
https://dx.doi.org/10.46570/utjms-2025-1448   ©2025 UTJMS 
  
 
References 
1. Couturaud V, Le Fur M, Pelletier M, Granotier F. Reverse skin aging signs by red light 
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The  Efficacy and Safety of Red Light Therapy

Aldhaheri, Anwer

Altoroi, Nezam

Khuder, PhD, Sadik

The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2
                    
 
https://dx.doi.org/10.46570/utjms-2025-1459   ©2025 UTJMS 
  
 
Investigating the common genes involved in 
development of Sjogren's syndrome and 
Cardiomyopathy 
Anwer Aldhaheri1, Nezam Altorok2, Sadik A. Khuder3* 
1College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
2Professor, Program Director Rheumatology Fellowship, Director Internal Medicine Residency, Division of 
Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of Toledo, Toledo OH 
43615 
3Professor, Division of Internal Medicine, Department of Medicine, 3000 Arlington Avenue, The University of 
Toledo, Toledo OH 43615 
Email: sadik.khuder@utoledo.edu 
Received: 2024-10-04 
Accepted: 2024-10-09 
Published: 2025-06-30 
Background: Recent research has identified an association between SS and cardiomyopathy (CMP). 
However, the underlying mechanisms and shared genetic factors contributing to the coexistence of SS 
and CMP remain unclear.  
Objectives: To identify common genes involved in the development of both SS and CMP.  
Methods: Gene expression data for SS and CMP, including RNA sequencing (include the GSE number of 
each RNA-seq) and microarray (include the GSE number of each microarray dataset) datasets, were 
obtained from the Gene Expression Omnibus (GEO) database. GEO2R was used to identify the top 1,000 
differentially expressed genes for each disease. The WGCNA package was used to identify co-expression 
modules significantly associated with each disease state. The DAVID database was used for Gene 
Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Hub genes were 
identified, and their associated pathways were examined.  
Results:  WGCNA revealed ten significant modules related to SS and CMP. Thirteen genes were selected 
based on the DAVID analysis results, with criteria including their known roles in disease development, 
shared pathways, and evidence from the literature. These genes—IFNLR1, IRF5, MDK, IL1RN, SOD2, 
PIAS4, SSPN, ELAVL1, TRAF3, TRAF6, CTNNB1, HIF1A, and JAK1—were differentially expressed and linked 
to both SS and CMP. IL1RN, for example, is protective against inflammation, but its polymorphisms are 
associated with various inflammatory, cancerous, and autoimmune conditions. INF genes overexpression 
The University of Toledo Translation Journal of Medical Sciences 
Dr. Lance D. Dworkin Department of Medicine Research Symposium  UTJMS 2025 June 30, 13(S3):e1-e2
                    
 
https://dx.doi.org/10.46570/utjms-2025-1459   ©2025 UTJMS 
  
 
is known to recruit T cell for its inflammatory response. T cell activity in both SS and CMP drives tissue 
damage and inflammation, worsening disease progression.  
Conclusion: This study identified 13 genes implicated in the shared development pathways of both SS 
and CMP. These findings provide new insights into the concurrent development of these diseases and 
offer potential targets for therapeutic intervention. 
Keywords: Sjogren's Syndrome 
 
 


Investigating the common genes involved in development of Sjogren's syndrome and Cardiomyopathy

Koenig, MD, Adam

Mariani, Jack

Elmazi, MD, Mirlinda

Becher, MD, Asif

Kelly, MD, Victoria

The University of Toledo Translation Journal of Medical Sciences 
UTJMS 2025 October 15, 14(S1):e1-e1 doi:10.46570/utjms-2025-1496 
10.46570/utjms-2025-1496 ©2025 UTJMS 
I Got My Patient Arrested: A Novel Forensic 
Encounter in Consultation-Liaison Psychiatry
Adam Koenig1*, Jack Mariani2, Mirlinda Elmazi1, Asif Becher1, Victoria Kelly3 
1Resident, Department of Neurosciences and Psychiatry, 3000 Arlington Avenue, The University of Toledo, 
Toledo OH 43615 
2College of Medicine and Life Sciences, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
3Assistant Professor, Vice Chair for Education, General Psychiatry Residency Program Director, Department of 
Neurosciences and Psychiatry, 3000 Arlington Avenue, The University of Toledo, Toledo OH 43615 
Email: adam.koenig@utoledo.edu 
Received: 12/3/2024 
Accepted: 12/18/2024 
Published: 10/15/2025 
Psychiatric patients with criminal forensic issues pose a unique challenge to the general psychiatrist due to the 
complexity of the overlapping legal & medical systems of practice.  Medical ethics defines tenets to which 
healthcare professionals shall abide to preserve the rights of—and ensure the overall well-being of—their 
patients. Outside of specific legal obligations, coordinating with law enforcement to facilitate the arrest of a 
patient generally violates the ethical principles of autonomy, beneficence, and nonmaleficence. This report 
describes a 39-year-old Black male with a psychiatric history of schizoaffective disorder, bipolar type and 
alcohol use disorder who was admitted to the trauma service following a motor vehicle accident in which the 
patient was a pedestrian, allegedly run over by a sibling after an altercation. The patient has a history of 
forensic psychiatric treatment and was charged with additional crimes for events which occurred just prior to 
this admission. Throughout his admission, the patient consistently reported heightened anxiety related to the 
threat of his arrest, which manifested clinically as physical agitation and paranoia. This was compounded by 
the patient’s premature discharge to police custody only to be returned to the hospital shortly thereafter. On 
his last hospital day, the patient reported his desire to be arrested in order to treat his anxiety. He consented 
for the psychiatry consultation-liaison service to contact local law enforcement on his behalf which resulted in 
the patient’s arrest. This case highlights an important example in which being taken into police custody not 
only aligned with the patient’s psychiatric goals of care but also served as an intervention that upheld the 
ethical principles of autonomy, beneficence, and nonmaleficence. 
Keywords: Ethics,Forensic,Arrest,Beneficence,Consultation-Liaison


I Got My Patient Arrested: A Novel Forensic Encounter in Consultation-Liaison Psychiatry

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