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IgG4-Related Autoimmune Pancreatitis in Patients with Prior Occupational Exposure: A Case Report and Review of Risks Concerning Blue-Collared Workers
Get PDFAutoimmune pancreatitis (AIP), a manifestation of IgG4-related disease (IgG4-RD), is a rare, often misdiagnosed condition that can closely mimic pancreatic cancer, particularly in its clinical and radiographic presentation. We report the case of a 76-year-old retired plumber who presented with painless jaundice and was initially suspected to have pancreatic cancer based on imaging findings. Subsequent endoscopic evaluation, biopsy, and markedly elevated serum IgG4 levels led to a diagnosis of type 1 AIP. Treatment with corticosteroids resulted in rapid clinical improvement and reduction in IgG4 levels, confirming the diagnosis.
This case highlights the diagnostic challenges of AIP, especially among blue-collar workers with limited access to subspecialty care and potential exposure to immune-disrupting substances such as asbestos, chemical fumes, and mineral dusts. A targeted literature review supports an emerging association between occupational exposure and IgG4-RD. Recognition of these risk factors is critical to avoid unnecessary oncologic interventions and ensure timely, appropriate treatment.
Clinicians should maintain a high index of suspicion for AIP in patients with pancreatic masses and relevant occupational histories. Early diagnosis using criteria such as HISORt and prompt initiation of steroid therapy can significantly reduce morbidity. Further research is needed to refine diagnostic tools and better understand occupational risk factors contributing to IgG4-RD in diverse patient populations
Mechanisms Mediating the Protective Effects of Caffeine on Alzheimer’s Disease Progression
Get PDFBackground: This review aims to examine the molecular mechanisms through which caffeine may exert neuroprotective effects against Alzheimer’s Disease (AD).
Methods: A literature review was done across PubMed and Embase to identify studies between 2000 and 2024, exploring the mechanism behind caffeine’s effects on AD. The criteria focused on peer-reviewed articles involving human or animal models. Information was gathered on study design, participant characteristics, caffeine consumption, proposed mechanisms, and effects on cognition.
Results: The studies support caffeine\u27s potential as a therapeutic, neuromodulator against AD through six mechanisms: inhibition of adenosine A2A receptors, decreased amyloid-beta production and aggregation, promotion of amyloid beta clearance, prevention of aberrant tau phosphorylation, induction of hippocampal neurogenesis, downregulation of AD-associated genes, and upregulation of an anti-inflammatory microglial phenotype.
Discussion: We define six key neuroprotective mechanisms of caffeine against AD, which will allow us to understand the pathology of AD, and help us develop novel treatments. Future research on this topic should prioritize exploring these high-evidence mechanisms in human subjects studies
CONTINGENCY MANAGEMENT FOR OPIOID USE DISORDER BUPRENORPHINE TREATMENT ENGAGEMENT: 3-MONTH OUTCOMES
Get PDFIndividuals with opioid use disorder exhibit difficulty sustaining prolonged buprenorphine treatment engagement. Contingency management (CM; incentives) may serve to increase the reinforcing value of treatment itself, but most buprenorphine CM studies delivered incentives more frequently than in typical outpatient practice. This study sought to compare CM with treatment as usual (TAU; regular clinic procedures) in visit attendance and adherence (defined as urine samples positive for buprenorphine and negative for other opioids) in new outpatients at a hospital opioid treatment clinic. Participants (46 per group) were randomized to either CM or TAU and monitored by medical record for 12 weeks; for CM participants, incentives were delivered on a reloadable debit card. The CM group, compared to TAU, had higher rates of attendance and adherence at first follow-up after intake (attendance: CM = 67.4% vs. TAU = 45.7%; adherence: CM = 30.4% vs. TAU = 26.1%), and perfect attendance and adherence over all 12 weeks (attendance: CM = 22.2% vs. TAU = 8.7%; adherence: CM = 17.8% vs. TAU = 4.3%). The CM group, compared to TAU, had 1.56 times higher average attendance (95% CI [1.28, 1.91]), 1.63 times longer continuous attendance streak (95% CI [1.31, 2.02]), 1.98 times higher average adherence (95% CI [1.35, 2.14]), and a 1.94 times longer continuous adherence streak (95% CI [1.46, 2.59]). This study supports CM to increase early buprenorphine engagement delivered as standard clinic practice
Symptomatic Treatment of Cannabis Withdrawal Syndrome: A Review of the Existing Literature
Get PDFDespite its public reputation as a recreational substance that does not cause physical withdrawal symptoms, cannabis withdrawal syndrome (CWS) was added to the DSM-5 in 2013. Existing research would suggest that almost half of regular cannabis users will experience symptoms such as mood symptoms, insomnia, and gastrointestinal distress. For more than 20 years, the rates of cannabis use have continued to trend upward due to expanding legislation on the recreational use of marijuana. Currently, there are no FDA approved treatments for CWS. Considering this trend, the lack of a well-formed treatment protocol for CWS will have a growing impact on public health. This literature review sets out to survey the existing knowledge on treatment of CWS
The Effective Utilization of Artificial Intelligence (AI) in Early Melanoma Detection
Get PDFBackground:
Melanoma, while comprising only 1% of skin cancer cases, accounts for a high mortality rate due to its ability to metastasize if not detected early. Traditional face-to-face dermatologic evaluations provide limited access to care, resulting in delayed diagnoses.
Significance:
Artificial Intelligence (AI) offers a novel approach to improve diagnostic accuracy and accessibility by alleviating strain on healthcare resources in medically underserved areas.
Methods:
A literature review was conducted using studies published in the last ten years. Eligible resources included case reports, clinical studies, clinical trials, meta-analyses, reviews, and systematic reviews in English. Studies that were repetitive or inapplicable were excluded.
Results:
AI-assisted diagnostic tools, particularly deep learning algorithms, exhibited high sensitivity and specificity in melanoma detection. These technologies have shown melanoma detection to be comparable to, and in some aspects better than traditional methods.
Discussion:
AI-assisted diagnosis shows the capability to improve melanoma outcomes through standardization. Despite promising findings, limitations persist, including variability in AI training datasets and reduced generalizability due to controlled study environments.
Future Directions:
Future research involves expanding AI training across diverse populations, integrating AI into routine clinical practice, and assessing its impact in primary care and medically underserved settings
Case Report: Herba Epimedium (Horny Goat Weed) Toxicity with Severe Muscle Spasms and Elevated Creatine Kinase and Creatinine
Get PDFHere we present the case of a 33-year-old male who presented to the emergency department (ED) with a complaint of severe muscle spasms of a ten-hour duration. He noted that he took a supplement which he purchased over the internet called Epimedium, also known as Horny Goat Weed, for the purpose of improving his mood and sense of energy and reducing his sense of anxiety. He noted that he started this supplement one month prior to ED presentation, coincident with the first episodes of muscle cramps. In the ED, he had elevations of his CK and creatinine and required hospital admission. He was given instructions to stop taking horny goat weed supplements. Epimedium contains a wide variety of chemicals that vary somewhat by individual species. Over 200 chemical constituents have been identified in various species of Epimedium, including flavonoids, lignans, ionones, phenol glycosides and sesquiterpines. Epimedium is sold in health stores and on the internet, in a variety of forms, using various species and sometimes in combination with known vitamins and other botanicals . However, a number of online, non-peer reviewed sources note muscle spasms and muscle cramps to be a side effect of Epimedium. To our knowledge, this is the first specific case report of severe muscle spasms with associated elevation of CK and creatinine. This case reinforces the importance of asking a patient about all medications, including over-the-internet, over the counter and herbal medication
Clinical Outcomes for Patients with Obstructive Shock with PE in Octogenarians, Nonagenarians, and Centenarians: An Analysis of the National Inpatient Sample
No full textOne of the most common causes of obstructive shock is massive pulmonary embolism. I these patients with compounded morbidities and limited filling of the heart we sought to sample databases to analyze the inpatient outcomes of the population
The Impact of Food Deserts and Food Insecurity on Cardiovascular Outcomes in New Jersey
Get PDFFood deserts - areas with limited access to affordable, healthful food - are increasingly being recognized as risk factors for adverse cardiovascular outcomes. This review discusses the link between food desert density and cardiovascular disease risk with a special emphasis on New Jersey. A systematic PubMed, Cochrane, and Embase literature review of studies from 2014 through 2024 was conducted, with some relevant older research dating back to 2001. Some of the keywords used in the search included food desert, food insecurity, cardiovascular disease, and New Jersey. The search was restricted to English-language research conducted within the United States. The literature examined demonstrates that limited access to healthy foods is associated with higher rates of obesity, smoking, poor sleep, and stress—conditions known to increase cardiovascular risk. A total of 11 studies were included and populations varied based on the databases or surveys utilized. Studies targeting New Jersey populations reveal the same trends, with food environment scores inversely relating to healthy behaviors. The findings point to the significant impact of food deserts on cardiovascular health, particularly in vulnerable populations. These inequalities can be addressed through targeted New Jersey public health interventions in high-risk areas, a path toward improved outcomes and reduced disease burden
Optimizing Preventive Care: The Impact of a Student-Led Initiative to Improve Cancer Screenings in Primary Care
Get PDFContext:
Preventative health measures, including routine cancer screenings, are essential for early detection, timely treatment, and reduction of cancer mortality rates.
Colorectal, breast, and cervical cancer are among the most routinely screened cancers due to advancements in screening technologies1. However, despite the well-established importance of early detection, patient adherence and compliance with national guidelines remain suboptimal, limiting the effectiveness of these screening efforts and delaying possible treatment.2
Objective:
To address this issue, we initiated a medical student-led project focused on improving adherence to national cancer screening guidelines across Rowan-Virtua Family Medicine (FM) practices. This poster outlines the overall efficacy of this project, including penetration rate into the patient population, closure of care gaps, and outcomes of screening and detection.
Methods:
The study is a prospective interventional cohort study. Rowan-Virtua Family Medicine patients between the ages of 21-80 (n=911) were identified between January 1, 2023 to February 1, 2025 as overdue on cancer screenings based on chart review. Participants were excluded (n=3) if they were deceased or were no longer patients of Rowan-Virtua FM. Student volunteers contacted patients to discuss options for overdue screenings and inform patients of current national cancer screening guidelines. Patients were given the option to make their screening appointment, obtain a referral from the clinic, or decline screening. Patient demographics including sex, age, race/ethnicity, and insurance type were collected. Outcomes included patient eligibility, number and rates of patients reached, up-to-date patients, referrals placed, completion rates for referrals, and abnormal screening findings occurrence.
Results:
Among the 908 patients included in this analysis, the average age was 60.96 (SD: 9.52), 74.01% were female, 63.33% were white, 15.75% were Black, 3.19% were Hispanic, 2.97% were Asian and 14.76% did not specify their race/ethnicity. Per chart review, 822 (90.53%) patients were identified as being due for at least one cancer screening. Of those patients, 386 (46.96%) patients reached via telephone, 28.5% received at least one referral for cancer screening, 13.73% reported being up-to-date on screenings, 19.17% reported they already had a referral and would make an appointment, and 38.6% declined screening. A total of 47 colonoscopy, 39 Cologuard® test, 48 mammogram, and 22 pap smear referrals were placed among 110 patients. 41.81% (46 out of 110) received referrals for more than one screening. Of the patients who received referrals, 54.55% of patients went on to receive at least one of their recommended screenings. The completion rates for referrals were as follows: 40.43% for colonoscopies, 41.03% for Cologuard, 56.25% for mammograms, and 45.45% for pap smears. Of the patients who completed their screenings, the rate of positive findings was as follows: 63.16% for colonoscopies, 18.75% for Cologuard, 33.33% for mammograms, and 0% for pap smears.
Conclusion: This project emphasizes the crucial role of primary care in promoting adherence to preventive health screening guidelines and highlights the importance of patient outreach in improving compliance. Notably, among the patients who completed their screenings, abnormal results were detected, necessitating further management or increased future surveillance. These findings underscore the critical role of routine screenings in early detection and intervention. Moving forward, continued efforts to educate patients on the importance of cancer screenings, increasing awareness of guidelines, and addressing barriers to screening access will be essential to further improve patient adherence and promote holistic care. This study also demonstrates the crucial impact that trained and engaged medical students can have in the closure of care gaps and improvement of preventive screening outcomes in the primary care setting
Heart to Heart: Exploring Why Cardiovascular Risk Is Higher in South Asians
Get PDFCardiovascular disease (CVD) is a leading global cause of mortality, but South Asians experience a disproportionately high burden of disease, often developing CVD at younger ages and with lower body mass indices compared to other populations. This project explores the underlying genetic and lifestyle factors contributing to elevated cardiovascular risk in South Asians, aiming to highlight the need for targeted prevention strategies and policy reforms.
A literature review was conducted using peer-reviewed studies, meta-analyses, and reviews published between 2007 and 2024. After screening 47 initial articles, 18 were selected for analysis based on their relevance to genetic and lifestyle risk factors in South Asian adults.
The review identified several genetic markers associated with increased CVD risk, including variations in APOC3, LPA, APOA5, and others, which contribute to elevated triglyceride levels, central obesity, and insulin resistance. Lifestyle contributors such as high dietary saturated fat intake, low fruit consumption, and sedentary behavior were also strongly associated with increased CVD prevalence. The interplay between these genetic and environmental factors underscores the need for multifaceted interventions.
Current cardiovascular guidelines often lack specificity for South Asians, which may lead to underdiagnosis and undertreatment. Evidence supports the implementation of culturally tailored public health initiatives, aggressive lipid and metabolic monitoring, and community-based programs to reduce risk in this population.
This study emphasizes the importance of inclusive research and targeted healthcare strategies to address the unique cardiovascular risk profile of South Asians and improve health outcomes across diverse populations