United States

Chylothorax, a rare complication of hepatic cirrhosis, is often under-recognized in the absence of ascites or other classical signs of portal hypertension. The diagnosis can be challenging due to its infrequent presentation, which highlights the clinical significance of this case. A 57-year-old male with a history of decompensated liver cirrhosis presented with progressive dyspnea. Imaging showed a right-sided pleural effusion. Pleural fluid analysis confirmed chylothorax, with elevated triglycerides and normal cholesterol levels. The patient underwent chest tube placement, which resulted in drainage of 2L of chylous fluid and marked symptomatic improvement. Further management included admission to the intensive care unit, initiation of total parenteral nutrition, and transition to a low-fat diet. The patient was transferred to an academic center as his clinical status failed to improve. This case portrays the diagnostic challenges of the etiology of chylothorax in patients with hepatic cirrhosis and emphasizes the role of portal hypertension in disrupting lymphatic drainage. Increased awareness of this rare complication is essential for timely recognition and appropriate management.

AMA Research Challenge 2025 

Leaky Lymphatics: Uncovering an Uncommon Complication of Hepatic Cirrhosis

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

poster

Low back pain (LBP) is the leading cause of disability worldwide, affecting 600 million people. Chronic low back pain (cLBP) impacts 10–13% of the population. Forty percent is discogenic in origin. Due to aging, increased lifespan, and obesity, individuals are outliving or overburdening their intervertebral discs.
 
Traditional treatments focus on symptoms. Conservative management, including rehabilitation and medications, has limited efficacy and carries risks such as opioid dependence. Percutaneous non-biologic therapies, like epidural steroid injections, provide only short-term relief and may be chondrotoxic and tenotoxic. Surgical interventions pose additional risks, including prolonged recovery, permanent loss of spinal flexibility, accelerated degenerative disc disease, and inconsistent outcomes. None of these approaches halt or reverse disc degeneration.
 
The pathogenesis of intervertebral disc disease is multifactorial, involving complex cellular and biochemical changes. Orthobiologic therapies, are natural therapies such as platelet-rich plasma (PRP), aim to target these biological pathways. However, their adoption is hindered by skepticism, lack of standardization, limited high-quality research, and cost barriers. Despite these challenges, patient interest in orthobiologics continues to grow, largely driven by word-of-mouth, peer experiences, and a preference for natural or holistic treatments. 
 
Further, primary care physicians (PCPs) serve as the initial point of contact for many patients with dLBP. Research indicates that clinicians who provide comprehensive education—explaining the science, treatment options, risks, costs, and supporting evidence—can positively impact patient decision-making and adherence. This study aims to explore current data related to the treatment of chronic discogenic low back pain as it relates to patient outcomes and further how this impacts primary care referrals for pain management.


Orthobiologics and Discogenic Low Back Pain: A Systematic Review

Background
Behçet’s Disease (BD) is a multisystem vasculitis with variable manifestations, including gastrointestinal involvement in 10–15% of cases. Intestinal BD often mimics Crohn’s disease or ulcerative colitis, making diagnosis challenging due to overlapping endoscopic and histologic features. While ileocecal involvement is typical, atypical patterns can obscure recognition. This case highlights an unusual presentation of intestinal BD without ileocecal predominance, underscoring the need for clinical vigilance and systemic evaluation to differentiate it from primary IBD.
Case Presentation
We present a 40-year-old woman with a known 10-year history of BD, on colchicine and hydroxychloroquine, was admitted with hematochezia, recurrent vomiting, and severe anemia (Hb 5.1 g/dL). Clinical examination revealed oral aphthous ulcers, genital ulcers, and erythema nodosum. Colonoscopy showed skip lesions, mucosal erythema, and superficial ulcers throughout the colon, terminal ileum, and ileocecal valve. Biopsy revealed edematous lamina propria infiltrated by lymphocytes, neutrophils, and eosinophils without granulomas, transmural lymphoid aggregates and granulomatous lymphangitis consistent with intestinal BD. The diagnosis was confirmed using the International Criteria for Behçet’s Disease (ICBD score = 6). The patient responded well to colchicine, with resolution of GI symptoms within four weeks.
Discussion
This case illustrates an uncommon presentation of intestinal Behçet’s Disease with diffuse gastrointestinal involvement without the typical ileocecal predilection. The similarity in clinical presentation and colonoscopy findings to inflammatory bowel disease highlights the diagnostic challenge. In such circumstances, histopathological evaluation becomes crucial. In our patient, the diagnosis was guided by systemic features and confirmed with ICBD criteria and biopsy study. The novelty lies in the atypical distribution of lesions, reinforcing the need to consider intestinal BD in patients with unexplained GI bleeding and mucocutaneous symptoms. Early recognition and appropriate immunomodulatory therapy can prevent misdiagnosis, reduce morbidity, and avoid unnecessary surgical interventions.

Gastrointestinal Bleeding in Behçet’s Disease: A Dual Pathology or Mere IBD Mimicry?

Like the governmental control that led to the involuntary sterilization of Civil Rights Activist Fannie Lou Hamer and thousands of others, Project 2025, a political proposal written by the Heritage Foundation, plans to restrict the reproductive rights and bodily autonomy of women by eliminating abortion access. Individuals should have the right to choose how and when to reproduce without risking their health or feeling unprepared. 
As defined by Critical Race Theory, using colorblind perspectives when creating policies does not change the implicit biases of people or how social structures are maintained throughout history, and policies should be evaluated based on how they impact the most disadvantaged groups. Project 2025 aims to fully ban abortion to “heal the family crisis”, the idea that the lack of fathers and healthy families are what cause poverty, crime, etc. However, a complete abortion ban only furthers systemic racism and increases barriers to care for marginalized groups, a practice that has historically discriminated against women of color. In addition to harming citizens, the proposal for a nationwide abortion ban is in violation of international standards that the US has agreed to as a member of the United Nations.

Restriction of Reproductive Autonomy: From Eugenics to Abortion

Background 
Eating disorders (EDs) are complex psychiatric conditions with systemic implications, including a range of dermatologic manifestations. Cutaneous findings related to nutritional deficiencies and disordered behaviors may appear early in the disease course, sometimes preceding a formal diagnosis. Despite their diagnostic relevance, these manifestations are frequently overlooked in clinical practice. This review highlights the critical role of recognizing dermatologic signs in EDs to enable earlier detection, support comprehensive evaluation, and promote interdisciplinary management.

Methods
A systematic literature review and meta-analysis were conducted using PubMed and Google Scholar, encompassing studies published between 2020 and 2025. Nine peer-reviewed studies were selected based on their relevance and inclusion of data on the dermatologic manifestations of eating disorders, focusing on nutritional deficiencies, clinical presentation, and diagnostic value.

Results 
Xerosis was the most frequently reported cutaneous finding in both anorexia nervosa and bulimia nervosa, often accompanied by cheilitis, hypertrichosis, alopecia, acrocyanosis, periungual erythema, nail changes, and oral manifestations related to nutritional deficiencies and purging behaviors. Similar dermatologic patterns were noted in pediatric populations, with additional features such as lanugo and signs of self-injury. Several studies also reported a significant association between atopic dermatitis and eating disorders, potentially linked to negative body image and immune dysregulation.

Conclusion
Dermatologic manifestations of eating disorders are often overlooked, despite their potential to support earlier diagnosis and intervention. Greater clinical recognition of these signs can promote timely, multidisciplinary care and improve patient outcomes. Continued research is needed to clarify the underlying mechanisms and define the role of dermatologic findings in comprehensive eating disorder management.

Dermatologic Manifestations of Eating Disorders: An Underrecognized Diagnostic Intersection

Background

Ensuring alignment between lecture content and defined learning objectives is critical for LCME accreditation (Standards 6, 7, and 8) and improving student outcomes. Traditional curriculum mapping is time-intensive, manual, and variable. This project introduces a web-based tool that automates the analysis of medical lecture transcripts against defined course objectives. The tool enables medical school deans to rapidly perform gap analyses, provide faculty feedback, and improve outcomes. It integrates with Learning Management System (LMS) platforms to quantify objective alignment.

Methods

We developed a process using a Large Language Model (LLM) to parse pre-clinical lecture transcripts and compare them against predefined learning objectives. The project consists of three phases. In Phase 1, we developed a 100-point scoring system to quantify alignment. As a preliminary experiment, we analyzed eight publicly available medical school lectures and their corresponding objectives using ChatGPT’s o3 LLM model. We tested three unique prompt engineering workflows with objectives and transcripts as input. The outputs included alignment scores and narrative reports based on the Bloom Rating System for each objective then identifying opportunities for improvement. In Phase 2, we will refine the scoring system in collaboration with deans and faculty to ensure feedback is actionable. Phase 3 will incorporate this feedback and finalize the scoring process, along with building a simple web interface for non-technical users.

Results

After calculating alignment scores for each objective across all eight lectures, the scores were averaged to determine the overall alignment for each of the three distinct LLM workflows. The workflows produced average scores of 88.65, 84.6, and 65.89 across the lectures. Reports included specific feedback and timestamps highlighting improvement areas (e.g., topic depth, anecdotal stories, unaddressed objectives). Anticipated findings include average objective coverage per lecture, frequency of missed objectives, and early feedback on the tool’s utility.

Conclusion

This project offers a reproducible, scalable method to evaluate alignment between lecture content and curricular objectives in undergraduate medical education. By automating the review process, it supports data-driven faculty development and curriculum improvement while reducing administrative burden. Preliminary findings demonstrate that LLMs can quantify alignment using lecture transcripts. The project builds on institutional experience with AI-assisted curriculum mapping and targets broad use, especially in programs lacking curriculum analytics infrastructure. Next steps include integrating user feedback and piloting the tool with institutional content.

Automating Lecture-to-Objective Coverage:
A Tool for Curriculum Quality Improvement

Abstract Title: Single Authorship Trends in High-Impact Otolaryngology Journals: A Bibliometric Analysis
Educational Objectives: 
As the quality of evidence-based research continues to evolve, authorship trends would be expected to change in parallel. Single-authorship has never been used to characterize this phenomenon in academic otolaryngology.
Objectives:
To characterize trends in single-authorship in otolaryngology literature over the last three decades.
Study Design: Bibliometric Analysis
Methods:
The Web of Science was queried for studies published in first-quartile impact factor otolaryngology journals between 1994-2024. Single-author publications were identified via manual coding. The studies were analyzed by publication type, country of origin, open access status, and five-year total citation accrual. Results were compared between studies published in each decade, including 1994-2003 (D1), 2004-2013 (D2), and 2014-2023 (D3).
Results:
Out of 62,897 identified total publications in the study period, 4,322 (6.87%) were single-author studies. The rate of single authorship significantly decrease in each decade (D1: 12.5%, D2: 6.6%, D3: 4.7%, p < 0.00001). 
• In 1999, 8.03% of publications were single author
• In 2009, 6.4% of publications were single author.
• In 2019, 4.96% of publications were single author. 
• This matches the overall trend of the decades. 
The proportion of single author studies categorized as “articles” in the Web of Science also decreased from 1999 (3.7%) to 2009 (2.69%) and 2019 (1.1%, p < 0.00001), respectively. Five-year citation accrual of single-author articles increased throughout the study period (1999: 3.69 citations per article, 2009: 6.36 citations per article, 2019: 16.23 citations per article). For comparison, five-year citation accrual of multi-author articles is 7.01 citations per article for 1999, 9.89 citations per article for 2009, and 14.54 citations per article for 2019.
Open access distinction for single author articles increased over the study period (1999: 1/35, 2009: 6/41, 2019: 9/28)
The USA had a majority of single author articles in 1999 with 23 out of 35. The USA and Australia tied for most single author articles in 2009, each 7 out of 41. The USA had the most single author articles in 2019 with 10 out of 28.
Conclusion:
Single-author articles in high-impact otolaryngology journals steadily decreased over the last three decades. When looking at a representative year in each decade, citations per article increased across the study period even in proportion to the increase in multi author citations per article. These findings suggests the importance of single authorship in producing impactful papers in the field of otorhinolaryngology and raises concerns with shifting to multi author publications.

Single Authorship Trends in High-Impact Otolaryngology Journals: 
A Bibliometric Analysis

Background: African Americans (AA) with a history of psychosis and or schizophrenia are overrepresented in the prison population. This may be due to schizophrenia being more frequently diagnosed in racialized individuals, who also face higher incarceration rates. African Americans also under-report experience or history of mental illness during and after incarceration. They are also less likely than their white counterparts to seek mental healthcare upon release. Upon release, the shadows of incarceration in the form of barriers to re-entry contribute to the poor transition of mental healthcare and psychosis management amongst AAs. For AA males specifically, their multiple intersections of race, gender, and criminal record cause them to be viewed as even more socially unacceptable
Methods:This study examines continuity of care by analyzing treatment outcomes through antipsychotic prescriptions and other mental health service use among formerly incarcerated individuals on Medicaid or similar programs within 6–12 months post-release.
Results: Overall, connection with health services following release demonstrated better treatment continuity. States with policies on expedited referral or pre-release enrollment for Medicaid, also demonstrated greater use of mental health services within 6 to 12 months after release (Wennerstrom, Morissey). However, expedited Medicaid approval is more likely for whites than non-whites. Non-whites also had a higher likelihood of using community based mental health services (Gary, Hedden). 
Conclusion: Timely, appropriate mental healthcare for justice-involved individuals with schizophrenia reduces violent recidivism and government spending (Igoumenou, Lin), highlighting its role in crime reduction, rehabilitation, and societal reintegration. Expedited enrollment in Medicaid is an effective solution to bridge the gap in care. Ultimately, insight is lacking into the nuances of race as a factor impacting continuity of psychosis management, despite its prominence in the sphere of psychosis diagnoses and incarceration of African Americans
Keywords: Incarceration, Post-release Race, Psychosis, Schizophrenia, Mental Health, Anti-psychotics, Medicaid, African-American.


Racial Disparities in Post-Incarceration Psychosis Management

Background
Increased prevalence of chronic disease and the rising demand for healthcare services necessitates innovative approaches to address these challenges. Fresh and Savory Culinary and Lifestyle Medicine Program (FSCLMP) is a shared medical appointment (SMA) started in 2017 and transitioned to a virtual setting during the COVID-19 pandemic. SMAs, especially those centered on lifestyle medicine, have gained traction in recent years as an efficacious and cost effective therapeutic modality for treating chronic modifiable disease. This study sought to understand the efficacy of teaching kitchens through the virtual FSCLMP on self-reported lifestyle habits and confidence in maintaining lifestyle changes and patients’ biometric outcomes. 

Methods
Our study used pre and post intervention surveys to evaluate the impact of participation in FSCLMP on patient nutrition, biometrics, and overall confidence in maintaining lifestyle goals.. We further examined how these changes impacted patients’ biometric outcomes like blood pressure and BMI. This study was supported by our institution’s Institutional Review Board.

Results
There were 207 participants across seven cohorts of FSCLMP. Of these participants, 207 pre-surveys and 108 post-surveys were collected with a total of 81 matched pairs identified for evaluation. The average age of participants was 63.2 (SD = 9.23). Patient consumption of fast food, packaged foods, and sugary drinks significantly decreased (p = 0.0001) after participation in the program. Our analysis showed a significant decrease of participants’ BMI, from a mean BMI of 32.06 (SD = 6.79) to 31.17 (SD = 7.49) (p=0.02489). There was also significant improvement in self-perceived overall health (p=0.00002), with 92.6% of participants reporting a slight or significant improvement since graduating the program.


Conclusion
Our study found that participation in the virtual FSCLMP led to better eating habits and improved biometrics for patients. Participants had significant decreases in BMI and diastolic blood pressure, ate more meals made with fresh ingredients with decreased consumption of fast food and sugary drinks, and had increased self-efficacy when preparing plant-based meals. Overall, the virtual FSCLMP promoted key lifestyle changes, including consuming less processed products, increasing physical activity, and improving self-perceived health. These findings not only reflect the benefits of FSCLMP for participant health and wellness, but also suggest a crucial role for virtual teaching kitchens in helping patients with modifiable chronic diseases maintain nutrition and lifestyle goals.


Evaluation of virtual teaching kitchen on nutrition, biometrics, and lifestyle self-efficacy in patients with chronic modifiable disease

Background:
Children who undergo procedures requiring general anesthesia can experience stress, anxiety, and behavioral changes both before and after the procedure. Prior research has shown that pediatric patients can undergo changes in their behavior post anesthesia, however less information has been published about the duration, types, and predictors of changes seen. Furthermore, little is known about the effect of language spoken at home on these changes. This study aims to compare native English speakers' behavior post anesthesia to native Spanish speakers' experience in a pediatric population and describe the varying behaviors post-anesthesia.

Methods:
A telephone survey will be administered with both English and Spanish speaking guardians of the patients aged 7-12 post-discharge after a scheduled procedure with anesthesia. The survey will be given at 2 weeks and 4 weeks post-procedure and will ask the guardians of the patients a number of questions surrounding behavioral changes (diet, activity, sleep, anger,dependence, etc.) of the child since anesthesia. The data will then be analyzed to compare English to Spanish speaking behavioral differences after anesthesia. The survey tool is the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery 9. The Post Hospitalization
Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) is a 1-1 item Liken-style tool validated in parents (80% non-Hispanic White) of children 2 through 12 years of age 9. It was found reliable in the rating of child behavior change after outpatient surgery with general anesthesia (Cronbach alpha 0.80). Additional participant data will be obtained through medical record review and will include procedure type, type and duration of anesthesia, pre-anesthesia medications, and demographic data.

Results: 
We anticipate that (1) children who undergo a procedure requiring anesthesia will have significant behavior changes and that (2) children in Spanish-speaking families will have comparable behavior changes to English native speakers. We expect this to be supported objectively by similar responses on our telephone survey at both timeframes.

Conclusion:
This study entertains the idea that health professionals may be able to give parents and their children better anticipatory guidance about the peri-anesthesia period and provide ways to prevent these behaviors with prior knowledge.

Post-Anesthesia Behavioral Changes in Children: A Comparison Between English and Spanish-Speaking Families

Title: Impact of OBGYN Involvement on Reproductive and Metabolic Outcomes in Women of Childbearing Age Undergoing Bariatric Surgery
Authors: Nneka Ajah, MD, MBA; Antonia F. Oladipo, MD MSCI; Pooja Bhate; Sanjana Sharma, MS; Christina O’Leary, MS; Erica Amianda, PA; Themba Nyirenda, PHD; Burton Surick, MD 
Background:
Bariatric surgery is an increasingly common intervention for obesity in reproductive-aged women. However, the rapid improvement in fertility following surgery, combined with hormonal and metabolic shifts, presents significant reproductive health risks if not appropriately managed. Despite ACOG guidelines recommending contraception and pregnancy delay post-surgery, the role of routine OBGYN involvement in this population remains underexplored.
Objective:
To evaluate how OBGYN involvement impacts reproductive planning, contraception use, and metabolic outcomes among women aged 18–45 undergoing bariatric surgery.
Methods:
This IRB approved retrospective chart review included 454 women who underwent primary sleeve gastrectomy at Hackensack University Medical Center from January 2021 to December 2023. Data collected included BMI, comorbidities, PCOS symptoms, HbA1c, number of hypertension medications, contraceptive use, OBGYN follow-up, and pregnancy outcomes. Comparative statistics assessed associations between OBGYN involvement and clinical outcomes.
Results:
Patients experienced significant postoperative BMI reduction (mean decrease: 13.63 points, p<0.001). Among patients with PCOS (n=54), 18.5% reported improved menstrual regularity, and 20.4% improved glycemic control post op. Only 29.3% had documented contraception, but uptake was significantly higher among those with documented OBGYN follow-up (p=0.02). Pregnancy occurred in 17.4% of patients within three years.
Conclusion:
OBGYN involvement in postoperative care is associated with improved contraceptive use and better documentation of reproductive health outcomes in women undergoing bariatric surgery. These findings support a multidisciplinary approach to optimize care in this high-risk population and highlight an opportunity to strengthen reproductive counseling during metabolic health interventions.

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