Archives of clinical and medical case reports最新文献

{"title":"Moyamoya Vasculopathy with Atypical Cogan's Syndrome: A Case Report.","authors":"Amy Phu, Erica Chao, Ranjana Sood, David R Chen, Devendra K Agrawal","doi":"10.26502/acmcr.96550761","DOIUrl":"10.26502/acmcr.96550761","url":null,"abstract":"<p><p>Cogan's syndrome (CS) is a rare autoimmune disorder involving audio-vestibular and ocular inflammation. While systemic vasculitis is a known complication, its association with Moyamoya-type cerebrovascular remodeling has not been previously documented. A 19-year-old Asian woman was diagnosed with atypical CS following a presentation of hyperpyrexia, unintentional weight loss, and severe bilateral sensorineural hearing loss. After five years of appropriate immunosuppressive treatment, she developed subacute headaches, hypertension, and left hemiparesis and paresthesia. Despite normal inflammatory markers, neuroimaging revealed right-sided internal carotid artery occlusion and extensive collateralization characteristic of Moyamoya syndrome. Genetic testing showed a variant of uncertain significance in SLC37A4. The patient underwent a right extracranial-intracranial (STA-MCA) bypass, resulting in complete resolution of neurological symptoms. The late emergence of Moyamoya suggests that chronic autoimmune-mediated vascular injury may trigger progressive steno-occlusive disease. Clinicians should consider Moyamoya syndrome as a differential for new neurological symptoms in CS patients, even when systemic inflammation appears controlled. To our knowledge, this is the first reported case of concurrent Cogan's syndrome and Moyamoya vasculopathy at time of writing this article.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 4","pages":"323-328"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Presentation of Degenerative Cervical Myelopathy: A Case Report.","authors":"Sumanjali Reddy Kanmantha Reddy, Amirpasha Ehsan, Kiin Kim, Marcel P Fraix, Devendra K Agrawal","doi":"10.26502/acmcr.96550760","DOIUrl":"10.26502/acmcr.96550760","url":null,"abstract":"<p><p>Degenerative cervical myelopathy (DCM) is a progressive condition most caused by degenerative changes that lead to spinal canal stenosis and characteristic neurologic deficits involving both upper and lower extremities. We report an atypical presentation of DCM manifesting exclusively as new-onset lower extremity weakness following lumbar decompression surgery, without neck pain or upper extremity symptoms. This case highlights the importance of maintaining a high index of suspicion for cervical myelopathy and performing whole-spine imaging in patients with unexplained postoperative neurologic deficits.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 3","pages":"320-322"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Pandemic Evaluation of Emergency Medicine Workforce Stability.","authors":"Fihr Chaudhary, Devendra K Agrawal","doi":"10.26502/acmcr.96550751","DOIUrl":"10.26502/acmcr.96550751","url":null,"abstract":"<p><p>Physician workforce projections in emergency medicine were developed in the year 2020 based on the assumptions and baseline data during the unprecedented disruption in healthcare delivery due to COVID-19 pandemic. However, the fundamental assumptions in this project might not be realistic in the post COVID-19 era. In this article, the accuracy of 2020 emergency medicine workforce oversupply projection was critically evaluated and comprehensively reassessed considering post COVID-19 data. The findings support the underestimation of the demand and exaggeration of projected physician surplus. The post-pandemic trends suggest a more fragile emergency medicine workforce marked by sustained attrition and vulnerability to stressors. A stable or modest increase in the demand for emergency physicians between the years 2030 and 2040 is projected. The findings suggest that clinical workload per physician is likely to increase due to the emergency care of aging population, delayed presentations of acute and chronic diseases, and increased boarding and throughput challenges. Accordingly future workforce projections must incorporate updated attrition estimates and account for structural shifts in emergency care delivery. This would require maintaining or expanding demand for emergency physicians in next decade and beyond.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 2","pages":"60-66"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Analysis of Dermatological Manifestations in Lower Limb Para-Athletes.","authors":"Andre Aabedi, Vera Wang, Devendra K Agrawal","doi":"10.26502/acmcr.96550745","DOIUrl":"10.26502/acmcr.96550745","url":null,"abstract":"<p><p>In this article, a critical evaluation of current evidence is presented on the prevalence, mechanisms, prevention, and management of sport-related skin complications in amputee athletes using lower limb prostheses, highlighting emerging technologies aimed at improving skin health and athletic performance. Skin complications were highly prevalent, affecting 34%-77% of lower limb prosthesis users, with even greater frequency among athletes. The most common conditions included maceration, friction blisters, pressure ulcers, contact dermatitis, verrucous and epidermal hyperplasia, and bacterial or fungal infections. Key risk factors encompassed poor prosthetic fit, elevated activity levels, increased perspiration, prolonged wear, inadequate hygiene, and hot or humid environments. Mechanical loading and shear stress at the socket-skin interface, compounded by moisture and heat retention, were central pathophysiologic drivers. Prevention and management strategies emphasize meticulous prosthetic fitting, consistent hygiene practices, routine skin inspection, and prompt intervention for early lesions. Multidisciplinary collaboration among dermatologists, prosthetists, and rehabilitation specialists improves detection and management outcomes. Recent innovations including vented liners, temperature-regulating materials, antimicrobial coatings, and sensor-based \"smart prosthetics\" show promise in reducing friction, heat, and infection risk, though evidence in athletic populations remains limited. Cutaneous complications in amputee athletes are common, multifactorial, and preventable. Optimal prosthetic fit, athlete education, and coordinated interdisciplinary care are essential for minimizing morbidity and maintaining athletic participation. Technological advancements such as real-time pressure and temperature monitoring, antimicrobial materials, and adaptive socket systems may transform prevention strategies, but further sport-specific, longitudinal research is required to validate their clinical impact and guide evidence-based practice.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 1","pages":"18-25"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: A Comprehensive Analysis of Dermatological Manifestations in Lower Limb Para-Athletes.","authors":"Andre Aabedi, Vera Wang, Devendra K Agrawal","doi":"10.26502/acmcr.96550755","DOIUrl":"10.26502/acmcr.96550755","url":null,"abstract":"<p><p>[This corrects the article PMC13038035.].</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 2","pages":"90-92"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Interventions for Functional Restoration and Pain Management following Traumatic Brain Injury.","authors":"Sugeeth Kandikattu, Manas Aavula, David Parvizi, Devendra K Agrawal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Traumatic brain injury is a major cause of death and long-term disability worldwide and can lead to persistent functional impairment and chronic pain that significantly impact quality of life. Patients with traumatic brain injury commonly experience motor deficits, impaired balance and coordination, cognitive dysfunction, and behavioral changes. Chronic pain, particularly post-traumatic headaches and musculoskeletal pain, is also frequently reported and can limit participation in rehabilitation and daily activities. This narrative literature review summarizes current evidence on the epidemiology, pathophysiology, and clinical course of traumatic brain injury, with a focus on functional restoration and pain management. Existing research supports the use of multidisciplinary rehabilitation approaches that incorporate physical therapy, occupational therapy, cognitive rehabilitation, and structured exercise to improve recovery and independence. In addition, both pharmacologic and non-pharmacologic pain management strategies play an important role in addressing chronic symptoms and supporting rehabilitation efforts. Overall, early recognition of functional deficits and integrated rehabilitation strategies are essential for improving long-term outcomes and quality of life in patients with traumatic brain injury.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 2","pages":"78-89"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting Career Landscapes: Analyzing the Fall in Physician-Owned Practices.","authors":"Andre Aabedi, Vera Wang, Ramtin Sahafi, Devendra K Agrawal","doi":"10.26502/acmcr.96550750","DOIUrl":"10.26502/acmcr.96550750","url":null,"abstract":"<p><p>Over the past several decades, the structure of physician employment in the United States has shifted markedly, with a growing proportion of physicians choosing employed positions over private practice. This transition reflects broader economic, regulatory, and organizational changes within the healthcare system. This literature review examines the decline in physicians entering private practice and analyzes the economic, administrative, professional, and market-driven factors contributing to this trend, as well as its implications for physician autonomy, patient care, and healthcare costs. A comprehensive review of national workforce data, longitudinal studies, and peer-reviewed literature published between 1983 and 2024 was conducted. Trends in physician employment were evaluated across specialties, geographic regions, and demographic groups, with particular attention to policy changes, healthcare consolidation, and evolving practice models. The proportion of self-employed physicians declined from 35.2% in the early 2000s to under 25% by the mid-2010s, with continued declines in subsequent years. Contributing factors include rising overhead costs, declining reimbursement, increasing regulatory and administrative burdens, and narrowing income differentials between employed and self-employed physicians. Younger physicians and women demonstrate a stronger preference for employment, often citing work-life balance, financial stability, and organizational support. Healthcare consolidation, hospital employment, and private equity acquisition further limit opportunities for independent practice. The ongoing decline of private practice has significant implications for physician autonomy, continuity of care, healthcare spending, and patient-physician relationships. While employed models offer stability and infrastructure, they may compromise professional independence and increase system-level costs without improving care quality. Alternative models such as direct primary care and concierge medicine may offer partial solutions but raise concerns regarding equity and access. Structural reforms in reimbursement, regulation, and practice support are necessary to preserve a diverse and sustainable physician workforce.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"10 2","pages":"52-59"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care of HIV Patients in Long-Term Care Facilities: A Growing Concern and a Call to Action.","authors":"Minghsun Liu, William D King, Derrick Butler, Mitchell H Liu","doi":"10.26502/acmcr.96550727","DOIUrl":"10.26502/acmcr.96550727","url":null,"abstract":"<p><p>As the population of people living with HIV (PWH) ages, they face increased risks of chronic diseases and may require care in nursing homes (NHs). This study identifies systemic barriers to optimal HIV care in NHs through three case examples, illustrating issues such as knowledge gaps in HIV management across the care spectrum, miscommunication during transition of care, and stigma. Proposed solutions include targeted education, improved drug interaction software, and enhanced protocols for HIV care in NHs. Addressing these gaps is crucial for improving outcomes for this aging and vulnerable population.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"9 4","pages":"164-170"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12410836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case of Nisin Oral Ingestion and its LC-MS/MS Detection in Human Urine Over Time: A Case Report.","authors":"Pachiyappan Kamarajan, Ahmad Kassem, Allan Radaic, James Wohlschlegel, Yvonne L Kapila","doi":"10.26502/acmcr.96550707","DOIUrl":"10.26502/acmcr.96550707","url":null,"abstract":"<p><strong>Objective: </strong>Nisin is a bioactive peptide with antibacterial properties that has been examined for its therapeutic potential. This case report documents the development of a targeted mass spectrometry assay that accurately measures nisin levels in human urine following oral ingestion.</p><p><strong>Case presentation: </strong>Nisin ZP was orally ingested by a 59-year-old healthy white female then LC-MS/MS methodology was used to detect its excretion in human urine over time over 2 days. Briefly, 20 grams of nisin were ingested in two doses of 10 grams/150 ml of water. Sterile urine was then collected over 2 days. Urine was centrifuged to precipitate insoluble material followed by filtration through a 10 kilodalton molecular weight cutoff membrane. The filtrate was then concentrated by lyophilization, desalted, and then analyzed by LC-MS/MS. After online fractionation using C18 reversed-phase chromatography, the sample was electrosprayed into a Thermo Fusion Lumos mass spectrometer. Data was acquired using a parallel reaction monitoring (PRM) strategy focused on the +5 charge states of nisin. Extracted ion chromatograms for MS/MS fragments corresponding to those charge states were generated using the skyline algorithm and used for quantitation of nisin. Western blotting was also used to evaluate the presence of nisin in the urine samples.</p><p><strong>Results: </strong>Orally ingested nisin can be detected early in human urine after oral ingestion. Mass spectrometry data revealed that nisin was detected in urine samples 4-20 hours after the first ingestion and up to 14 hours after the second ingestion, indicating a potentially fast turnover and excretion of nisin in the human body. In line with the mass spectrometry data, immunoblotting data validated the findings, further supporting the notion of a fast turnover and excretion of nisin.</p><p><strong>Conclusion: </strong>We successfully applied the LC-MS/MS method to analyze nisin in urine obtained after oral administration of therapeutic doses of nisin. To the best of our knowledge, this constitutes the first report of nisin's detection following human oral ingestion and its presence in urine after excretion.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"9 2","pages":"38-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Critical Analysis of the Clinical Use of Incretin-Based Therapies: Efficacy and Adverse Events.","authors":"Ilana Radparvar, Devendra K Agrawal","doi":"10.26502/acmcr.96550740","DOIUrl":"10.26502/acmcr.96550740","url":null,"abstract":"<p><p>Obesity is a major public health challenge in the United States, despite widespread implementation of regulated diet plans, exercise programs, behavioral interventions, and surgical procedures. The emergence of incretin-based therapies, particularly GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) receptor agonists, has transformed the therapeutic landscape for initially type 2 diabetes and now obesity. Beyond their metabolic effects, incretin therapies exert meaningful cardiovascular, gastrointestinal, and neuroprotective actions. Semaglutide, a GLP-1 receptor agonist, and tripeptide, a dual GLP-1/GIP agonist, demonstrate substantial weight reduction, improved glycemic control, and reductions in cardiometabolic risk factors. Tirzepatide consistently produces greater weight loss effects than semaglutide, likely due to synergistic dual-receptor effects. However, these therapies are accompanied by adverse effects, most commonly gastrointestinal disturbances, and, less frequently, gallbladder disease, pancreatitis, or rare ophthalmologic concerns. Long-term safety data remain limited, particularly in older adults, pediatric patients, pregnant women, and individuals with comorbid disease. Emerging evidence also suggests potential roles in cancer prevention, hypertension, and neurodegenerative disease. As the indications for incretin-based therapies continue to expand, longer-duration trials and more diverse study populations will be essential to fully examine their long-term clinical effects. Though these agents hold considerable promise, careful and informed use remain vital.</p>","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"9 6","pages":"242-253"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}