Translation: The University of Toledo Journal of Medical Sciences

Primary hyperparathyroidism resolution via auto-infarction discovered intraoperatively

2024-09-12T19:43:23+00:00

Primary hyperparathyroidism is a condition frequently attributed to the excessive secretion of parathyroid hormone (PTH), often stemming from adenoma, hyperplasia, or carcinoma. While the conventional approach to addressing this condition involves surgical intervention, there exist rare instances where spontaneous resolution occurs, typically because of auto-infarction or necrosis of the parathyroid adenoma. In this report, we present the case of a 64-year-old male with hypercalcemia, referred for surgical intervention. Preoperative imaging unveiled a nodular lesion, and intraoperatively, an acutely infarcted adenoma was discovered. Microscopic examination confirmed parathyroid necrosis. Similar cases documented in the medical literature shed light on the potential for non-surgical management options. Factors such as cinacalcet treatment and hypocalcemia-inducing medications have been explored, suggesting alternative approaches to address this condition. Furthermore, cases of spontaneous remission highlight the paramount importance of long-term follow-up in managing primary hyperparathyroidism, ensuring comprehensive and individualized patient care. The awareness of these infrequent occurrences significantly contributes to well-informed decision-making within the medical community.

Cutaneous Leishmaniasis After a Trip to Costa Rica

2024-10-30T14:15:11+00:00

We present a case of cutaneous leishmaniasis in a patient with chronic ulcerating skin lesions who recently traveled to Costa Rica. A 21-year-old male presented with a non-healing ulcer of six weeks duration on the right lower extremity. The patient was treated with multiple courses of antibiotics as empiric treatment for cellulitis with no response, and a decision was made to biopsy the lesion. The initial skin biopsy was negative for cultures and pathology. Due to high suspicion of Leishmania, a repeat biopsy was done, and the sample was sent to the US Centers for Disease Control and Prevention for further evaluation; it was positive for Leishmania spp. Though treatment of Leishmania varies depending on the species, the patient was treated with miltefosine due to the prevalence of Leishmania guyanensis in Costa Rica. The patient had an appropriate response with good wound healing after eight weeks of therapy and wound care.

Case Report of Vocal Cord Palsy and Neutropenia due to B-12 Deficiency

2023-05-30T11:58:09+00:00

This case presents an interesting combination of vitamin B12 deficiency and cefepime use, both isolated causes of neutropenia, occurring together. A 67-year-old male presented to the Emergency Department with severe leukopenia after six weeks of cefepime for osteomyelitis. On arrival, he endorsed pharyngitis, dyspnea, cough productive of clear sputum, and headaches for five days. The next day, he developed new onset dysphagia with thick, white oral secretions requiring suctioning with a strong productive cough. He then reported breathy, gravelly voice changes, present days prior to admission. Laryngoscopy demonstrated acute left true vocal cord immobility with right hypomobility, dysphonia, and dysphagia. Hematology cited both vitamin B12 deficiency and cefepime course were likely causing his neutropenia. Vitamin B12 deficiency commonly causes megaloblastic anemia and rarely pancytopenia. Manifestations may include gastrointestinal and neurological symptoms, such as dysphagia and vocal cord paralysis, as in this case. These complications can persist if not treated immediately. Antibiotics, such as cephalosporins, are also a known cause of neutropenia. This case highlights the broad spectrum of manifestations of vitamin B12 deficiency and emphasizes the importance of keeping this disorder on the differential diagnosis with a variety of clinical presentations.

Rhabdomyolysis Secondary to Lamotrigine Toxicity: A Case Report and Literature Review

2024-09-25T16:11:35+00:00

Lamotrigine, an anticonvulsant and mood-stabilizing medication, is used for managing seizure disorders and bipolar disorder. However, it can cause side effects ranging from mild hypersensitivity reactions to severe conditions like Stevens-Johnson syndrome. In overdose cases, lamotrigine primarily impacts the central nervous system and cardiovascular system, potentially leading to seizures and cardiac conduction abnormalities. This report describes a rare case of rhabdomyolysis in a 36-year-old female who overdosed on lamotrigine. The patient, with a history of seizures, anxiety, and depression, presented with nausea, abdominal pain, and elevated myoglobin and creatine kinase levels. She was treated with normal saline for rhabdomyolysis and improved over four days. This case highlights the need for awareness of unusual complications like rhabdomyolysis in lamotrigine toxicity and the importance of prompt management. Further research is needed to understand the mechanisms behind these rare effects and refine treatment approaches.

Brachioradial Pruritus Case Misdiagnosed for a Decade: Cervical Nerve Compression and New Hypotheses for Seasonality, Capsaicin Response, and Icing

2025-12-10T16:14:45+00:00

Idiopathic itching of the upper extremities or scapula is a seemingly dermatological condition confounded by an unexplained connection to ultraviolet (UV) exposure that together conspire to mask a frequent etiology in cervical nerve compression. This underlying cause is not commonly recognized outside of certain specialties, nor is it included in skin-related screening algorithms for general practitioners, resulting, together with frustratingly nonspecific diagnostic tools, in protracted suffering of patients. A case study reported here suggests synergistic diagnostic and treatment approaches that reflect the role of cervical nerve compression, including radiography, capsaicin response, and physical therapy. The patient experience supports an alternative hypothesis, occupational seasonality, to account for the apparent UV connection that should be evaluated in new epidemiological research that better isolates brachioradial pruritus from conditions with superficially similar presentations.

From TAVR to SAVR

2026-07-27T02:22:21+00:00

Background:
Transcatheter aortic valve replacement (TAVR) is an established minimally invasive therapy for severe aortic stenosis, with a steadily declining incidence of procedural complications. Nevertheless, emergent conversion to surgical aortic valve replacement (SAVR), although rare, remains associated with substantial morbidity and mortality.

Case Summary:
A 71-year-old male with severe aortic stenosis and multiple comorbidities underwent elective transfemoral TAVR using a 26-mm SAPIEN 3 Ultra Resilia valve. Initial post-deployment imaging demonstrated satisfactory valve position and hemodynamic performance. On postoperative day 0, the patient developed severe hypertension followed by embolization of the bioprosthetic valve into the left ventricular outflow tract (LVOT), resulting in obstruction and interference with the mitral valve apparatus. Given the risk of hemodynamic collapse, the patient was taken emergently for explant of the TAVR . Intraoperative findings revealed a migrated and rotated transcatheter valve causing partial LVOT obstruction and laceration of the ventricular side of the anterior mitral valve leaflet. The valve was successfully explanted, and surgical aortic valve replacement was performed. The postoperative course was complicated by transient acute kidney injury, which resolved prior to discharge on postoperative day 9.

Conclusion:
This case illustrates a rare but life-threatening complication of TAVR requiring emergent surgical intervention and highlights the importance of vigilant monitoring, strict hemodynamic control, and immediate surgical readiness.

Nonoperative Management of a Perforated Peptic Ulcer in the Setting of Decompensated Alcoholic Cirrhosis

2026-08-14T18:31:05+00:00

Perforation of peptic ulcers is typically considered a surgical emergency, but management must account for patient comorbidities. Surgical management of perforated ulcers in the setting of decompensated cirrhosis can be complicated by coagulopathy and delayed wound healing, leading to increased morbidity and mortality. This case outlines the nonoperative management of a perforated peptic ulcer in a 47-year-old male with decompensated alcoholic cirrhosis. Computed tomography scan revealed pneumoperitoneum, and further imaging showed a large perforated ulcer of the superior fornix of the duodenal bulb. Due to the patient’s high preoperative risk, a nonoperative approach was chosen by his multidisciplinary care team. Initial management included nil per os with nasogastric tube decompression, antibiotics, and therapeutic paracentesis. Due to the patient’s declining hemoglobin, an urgent esophagogastroduodenoscopy was performed, and the hemorrhage was treated with epinephrine injection and clipping, followed by placement of a percutaneous pigtail catheter adjacent to the site of perforation. An upper gastrointestinal series completed 11 days later showed no leak from the site of perforation. The patient tolerated dietary advancement and continued to improve until discharge on hospital day 36. In this case, a nonoperative approach yielded resolution of the patient’s bleeding perforated ulcer and resulted in a favorable outcome for our patient.

Translation: Vol. 16, No. 2 (2026)

2026-10-21T16:28:43+00:00

Auditory Hallucination Simulation in The Medical School Curriculum

2024-11-17T21:22:54+00:00

Objective: Having an empathetic understanding of auditory hallucinations (AH) is a crucial skill for mental health professionals, significantly impacting patient outcomes. Simulation-based learning offers an opportunity to enhance medical education and foster greater confidence when interacting with individuals experiencing AH. This study aimed to investigate the impact of Auditory Hallucination Simulations (AHSs) on medical students' knowledge, attitudes, and empathy toward individuals experiencing auditory hallucinations.

Methods: 154 third-year medical students participated in a pre-simulation survey measuring empathy and attitudes. Students then completed an AHS experience followed by a post-simulation survey. Data was subsequently divided by participant demographics, specialty interest, and clinical rotation block.

Results: Overall, empathy scores significantly increased after the AHS experience. This increase was observed in both genders and was more pronounced among students interested in person-oriented specialties. No significant correlation was found between empathy scores and clinical rotation block.

Conclusion: This study suggests that AHS holds promise as a tool to enhance empathy in medical students, potentially impacting future patient care. However, limitations exist, including the study's single-institution nature and lack of long-term follow-up. Further research with larger, diverse samples and long-term assessments is recommended. Future studies could also explore the impact of AHSs within specific specialties.

Dalbavancin dosage regimens in the treatment of gram-positive infections: a case series and review of the literature

2024-10-21T13:58:54+00:00

Background: Dalbavancin is approved by the United States Food and Drug Administration (FDA) for one-dose or two-dose regimens in the treatment of acute bacterial skin and skin structure infections (ABSSSIs). This agent may also be utilized off-label for invasive gram-positive infections, but there are no standard dosage recommendations for off-label use (1). We evaluated different dosage regimens used in real-life experiences.

Methods: Medication administration data at ProMedica Health System and The University of Toledo Medical Center was reviewed to identify patients treated with dalbavancin to evaluate the efficacy and safety of common dosing regimens for both invasive and noninvasive gram-positive infections. The primary outcome was treatment failure defined as recurrence or hospitalization due to the same infection within one year. Baseline characteristics between successfully treated and failed groups were compared.

Results: Throughout the 5 years (2016-2021), 131 patients who received dalbavancin were enrolled. 82 (63%) of patients had ABSSSIs. Forty-nine (37%) fell under the category of invasive gram-positive infections. Forty-one patients (31%) of them had failure of treatment.

Of the patients who failed treatment, twenty-three patients received one dose of intravenous dalbavancin, and eighteen patients received at least two doses of dalbavancin. Adverse events were noticeable for one patient with transient rash on the hand and one patient had non Clostridioides difficile diarrhea.

Conclusion: Dalbavancin has been a safe and convenient option for the treatment of gram-positive infections. A regimen of two doses or more of dalbavancin may offer a better outcome than one dose only for both invasive and non-invasive gram-positive infections.

Quality Assessment of Blepharoplasty Information on TikTok: An Observational Qualitative Study

2026-07-15T13:55:19+00:00

Introduction: Following a decline in overall surgical volume in 2020 due to the pandemic, there was a +81.7% increase in traditional blepharoplasties in the year 2021. 68% of a study's respondents reported increased awareness of facial plastic surgery (FPS) procedures through social media, which was significantly correlated with the decision to pursue FPS (P = 0.02). TikTok (ByteDance) is a social media platform commonly used by healthcare professionals and patients to share individual experiences and medical advice, and this study evaluates the quality and reliability of TikTok videos discussing blepharoplasties.

Methods: This observational qualitative study analyzed the quality and reliability of TikTok videos discussing blepharoplasties. Videos were selected using six hashtags related to blepharoplasty: #blepharoplasty, #upperblepharoplasty, #lowerblepharoplasty, #eyelidsurgey, and videos tagged with the combination of #blepharoplasty and #surgeryrecovery. The top 20 videos with a minimum of 1,000 views were collected for each hashtag and reviewed by four independent reviewers using the DISCERN tool to assess video quality and reliability. Statistical analyses were performed in Excel using the Data Analysis ToolPak.

Results: Of the 100 TikTok videos that were screened, 99 met inclusion criteria. Healthcare professionals (HCP) created the majority of videos reviewed (n = 51, 51.5%). Plastic surgeons created the most content of all HCPs (n = 31, 60.8%), followed by unspecified physicians (n = 10, 19.6%) and ophthalmologists (n = 6, 11.8%). Videos created by HCPs had significantly higher reliability (T = 5.37, P < 0.001), quality (T = 5.11, P < 0.001), and overall DISCERN scores (T = 8.40, P < 0.001) compared to non-healthcare professionals.

Conclusions: TikTok videos about blepharoplasties have significantly greater reliability, quality, and overall DISCERN scores when they are created by HCPs as compared to non-healthcare professionals. This study underscores the need for active engagement by healthcare professionals on social media to combat misinformation.

Anesthesia complications in COVID-19 positive pediatric patients: Results from a rapid literature review and meta-analysis

2024-11-17T21:12:48+00:00

Children are less likely to experience severe COVID-19-related complications compared to adults, they are still an understudied, vulnerable population. Given the unique challenges posed by COVID-19 in pediatric patients, effective perioperative management is essential to mitigate potential complications and ensure safe anesthesia practices. In this manuscript, the objective was to produce a systematic literature review with meta-analysis to increase the understanding of current research to help guide anesthesiologists in perioperative management. Our analysis of the literature identifies respiratory complications as a primary concern for patients undergoing anesthesia while infected with COVID-19. Three databases were searched and screened for reviews and there were 939 combined articles found. These databases are large collections of published scientific articles which were sorted through using keywords which allowed us to find and analyze these articles. After the databases were screened there were a number of articles which worked within our criteria which were looking for pediatric anesthesia patients during the beginning of the pandemic and their complications. The odds ratio was calculated for each paper to generate an overall combined effect size, heterogeneity, and publication bias. After screening and removing duplicates, 10 articles were included for further review, and 6 were eligible for meta-analysis. Their combined effect size was 3.71 (CI 2.45, 7.24, p = 0.05), heterogeneity I²=0.76, and funnel plot for publication bias demonstrated right skew. Our results show there is a statistically significant increase in modest COVID-19 complications in pediatric patients from anesthesia. These modest complications include respiratory events, use of vasopressors, cardiac, SIRS, and unplanned escalations of care. Clinically insignificant results may have been missed due to publication bias in our study. While we found statistically significant results showing an increase in pediatric complications, it is possible that clinically insignificant results could add even more to this topic so we concluded that larger, more robust, studies need to be conducted.

EDAX quantitation of phosphorus is an objective biomarker for psoriatic disease activity and treatment response

2026-06-09T15:55:32+00:00

Assessing the effectiveness of newer treatments of psoriasis continue to be analyzed by various clinical parameters. Such evaluations include psoriasis area and severity index (PAPS), body surface area (BSA), dermatology life quality index (DLQI), physician's global assessment (PGA), self-administered PASI (SAPASI), and psoriasis epidemiology screening tool (PEST). Of note, there are few objective tests for use in determining treatment response with psoriasis. Of all the objective tests discussed, energy dispersive x-ray microanalysis quantitates and localizes the element to the tissue studied and moreover could act as an objective test to act as a biomarker for psoriatic activity and treatment response.