California Miramar University

Finding the clinical significance of facial swelling was of utmost importance in this case. Ludwig angina is a life-threatening cellulitis of the floor of the mouth that is mainly due to infectious causes. This particular patient had an atypical presentation except for the facial swelling in which the patient’s non-specific symptoms made it difficult to obtain a diagnosis. Severe edema can make it difficult to intubate the patient; however, our case did not present with any common symptoms such as this. This is why it is of utmost importance to maintain dental/mouth hygiene and maintenance because of complications such as Ludwig angina. Ludwig angina is becoming more common amongst hospitals, but being able to obtain a diagnosis quickly even with atypical symptoms is of top priority for resolution.

Disclosure: P.I. Godspower: None. S. Verma: None. F. Shifaly: None. L. Yousif: None. C. Dos Santos: None. C. Dominguez-Bali: None. A. Dominguez-Bali: None.Over the past four years, more than 12 million immigrants—legal and undocumented—have arrived in the U.S., with many settling in South Florida. Latin Americans account for over 60% of these new arrivals. More than 90% come from countries with limited or non-existent healthcare systems, and over 75% are from low socio-economic and educational backgrounds. These factors pose serious challenges to women’s healthcare, particularly in underserved areas like Miami. This study analyzed clinical data over four years from two hospitals and two outpatient centers in South Florida, focusing on immigrant women presenting with newly diagnosed or advanced-stage diseases. Findings revealed a resurgence of diseases rarely seen in the U.S., including tuberculosis, scabies, amoebiasis, and giardiasis, polyparasitism, helminthiasis, uncinariasis, increase in lice infections. Advanced cases of breast, cervical, endometrial, and ovarian cancers—as well as large uterine fibroids—were also observed, often linked to over a decade of missed preventive care. Sexual health outcomes are also worsening. Rates of sexually transmitted infections (including HIV, higher in the Latin-American population and lower in American population) intended pregnancies, ectopic pregnancies, and abortions are rising among the Latino population, contrary to national trends. Many patients reported histories of trauma, unstable relationships, sexual dysfunction, and in some cases, genital mutilation or trafficking. Most had not received routine screenings like Pap smears or mammograms in 10 to 15 years. These trends reflect a broader phenomenon referred to as “immigration syndrome,” characterized by compounded physical, emotional, psychological, economical, sexual, social and cultural stressors, and legal persecution This study highlights the urgent need for trauma-informed, culturally sensitive healthcare services and improved access to screenings for immigrant women—both to support their wellbeing and protect public health in host communities.Presentation: Monday, July 14, 2025

Abstract Disclosure: S. Verma: None. S. Hermida: None. P. Godspower: None. C. Dos Santos: None. D. Alame: None. L. Yousif: None. F. Shifaly: None. A. Perera: None. A. Dominguez-Bali: None. Inguinal ovarian hernia are most commonly seen in pediatric population or reproductive age females, the cases of inguinal ovarian hernia in postmenopausal women are exceedingly rare. This abstract explores the pathophysiological link between estrogen deficiency and the development of inguinal ovarian hernia in post-menopausal women. The structural integrity of pelvic connective tissue and musculature depends heavily on estrogen. As the level of estrogen declines with age, the pelvic floor weakens, muscle atrophies, and there is decreased uterosacral ligament resilience, as supported by studies in Bone, British Journal of Surgery, and Menopause. Such changes in tissues predisposes postmenopausal women, or women who have low estrogen to herniation by weakening the supportive structures around the inguinal canal. A case of a 69-year-old woman presenting with a left-sided tender groin mass was reviewed alongside 17 prior cases of adult ovarian hernias. CT scans and MRI imaging confirmed an ovary within the hernial sac, and surgery successfully repositioned the structure. There was no evidence of mullerian anomalies further supporting an acquired rather than congenital etiology. This case underlines the importance of recognizing estrogen deficiency induced musculoskeletal weakening as a modifiable factor for herniation in postmenopausal women or women with low estrogen. Imaging and diagnosis are crucial to avoid complications such as strangulation. Education and awareness of this mechanism can improve detection and management in post menopausal patients. This disorder could be an unknown described part of what has been recently published as the musculoskeletal syndrome of menopause. Presentation: Monday, July 14, 2025

Idiopathic intracranial hypertension (IIH) is a clinical diagnosis made from the exclusion of other possible causes of increased intracranial pressure (ICP): cerebrospinal fluid (CSF) overflow obstruction, mass lesion, infection, or malignancies. IIH is a phenomenon with a rapid onset that most notably presents in obese women of childbearing age. We present the case of a 30-year-old African American woman with a past medical history of bipolar disorder who arrived at the emergency department (ED) with acute bilateral vision loss, two weeks of bilateral retro-orbital headache, painful eye movements, and progressive vision loss with a decrease in appetite. Management involved plasma exchange, high-dose steroids, consistent neurological and ophthalmic tests, and close observation and follow-up. One week after the most recent ED visit, the patient confirmed a significant improvement in vision. When diagnosing our patient with IIH, it was imperative to rule out myelinating oligodendrocyte glycoprotein antibody-associated disease (MOGAD), multiple sclerosis (MS), and other demyelinating diseases such as optic neuritis.Initial brain imaging using computed tomography (CT) without contrast showed no evidence of intracranial hemorrhagebut demonstrated the presence of prominent sheath complexes, suggestive of optic neuritis, and a slightly small pituitary gland height for a patient who is 30 years of age. Further testing with a CT venogram (CTV) and a magneticresonance imaging (MRI) of the head and neck confirmed demyelination. The patient's lumbar puncture continuously revealed a normal opening pressure during her hospital stay. This case presentation will highlight and compare the current literature regarding the clinical presentation and management of idiopathic intracranial hypertension.

Fluoropyrimidine-based chemotherapy drugs such as 5-fluorouracil (5-FU) have documented cardiotoxic effects from mild chest discomfort to severe ischemia.Early detection of complications is important to ensure patient safety and outcomes. We report the case of a 68-year-old woman with invasive non-keratinizing squamous cell carcinoma who developed recurrent chest pain during chemotherapy with 5-FU and mitomycin. While she had no history of coronary artery disease, she experienced mid-sternal chest pressure radiating to the neck and left arm during both cycles of chemotherapy. Initial presentation showed elevated troponin levels and B-type natriuretic peptide, first-degree atrioventricular node block on electrocardiography (EKG), and preserved left ventricular ejection fraction. She was initially managed with verapamil and Imdur; however, persistent pain during the second cycle required adding ranolazine and a switch from Imdur to Isordil. Following these medication adjustments, she remained symptom-free and was discharged with outpatient follow-up. This case highlights the potential for 5-FU-induced cardiotoxicity and the need for individualized cardiovascular management in patients with an oncologic history. Calcium channel blockers and nitrates can be effective in symptom control, underscoring the importance of early recognition and intervention.

Intermittent explosive disorder (IED) is an understudied psychiatric condition marked by impulsive aggression and poorly regulated emotional control, often resulting in interpersonal and societal consequences. Better understanding of comorbidities can improve screening, diagnosis, and treatment. To investigate the prevalence of IED and its associations with psychiatric, neurological, and somatic disorders. In this cohort study, matched groups of patients with and without IED were identified from the TriNetX Research Network (dated January 31, 2024). Electronic medical record data were analyzed. The mean (SD) time from the first to last known visits was 4.8 (5.4) years. Lifetime diagnosis of IED. Main outcomes were International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnostic categories and root codes. Cox proportional hazard models were used to estimate and compare probabilities of acquiring other diagnoses. Key measures include the numbers and proportions of patients with these diagnoses and adjusted hazard ratios (HRs) for IED. Overall, 30 357 individuals with IED and 30 357 demographically matched controls were included. In each group, 21 313 (70%) were male, with a mean (SD) age at the first visit 26 (17) years. Despite only 0.03% of the total patient population having an IED diagnosis, extensive comorbidities with psychiatric, neurological, and somatic conditions were found. A notable 95.7% of individuals with IED (29 054 individuals) had another psychiatric diagnosis. All psychiatric subcategories and 92% of the psychiatric diagnoses were significantly associated with IED, with HRs ranging from 2.1 (95% CI, 2.0-2.2) for substance use disorder to 76.6 (95% CI, 65.4-89.6) for disorders of adult personality and behavior (excluding IED). Among neurological conditions, neurodegenerative diseases (HR, 5.0; 95% CI, 4.1-6.1) and epilepsy (HR, 4.9; 95% CI, 4.3-5.6) had the highest HRs, followed by movement disorders (HR, 3.1; 95% CI, 2.8-3.5), cerebral palsy (HR, 2.6; 95% CI, 2.2-3.0), and sleep disorders (HR, 2.2; 95% CI, 2.1-2.3). Significant associations with IED were also observed for many somatic diseases, including obesity (HR, 1.6; 95% CI, 1.5-1.7), hyperlipidemia (HR, 1.5; 95% CI, 1.4-1.5), hypertension (HR, 1.6; 95% CI, 1.5-1.7), and gastroesophageal reflux disease (HR, 1.7; 95% CI, 1.7-1.9). These findings highlight the extensive comorbidities between IED and psychiatric, neurological, and somatic disorders, emphasizing the need for integrated diagnostic and treatment approaches addressing both psychological and physical health aspects of IED. Limitations related to reliance on medical records and low diagnostic rates of IED caution the generalizability of these findings, underscoring the need for further validation in prospective studies and more accurate, inclusive diagnosis of IED in patients with mental disorders.

Aims: To examine how data-driven strategies can be integrated into community health programs as innovative approaches for effective operation. Problem Statement: Numerous government engagements in different crucial sectors have limited her concerns about health provision and distribution to many citizens living in remote communities. Health provision characterized with easy accessibility and low cost should not be marginalized and should be the right of every citizen. However, many lives have been lost due to lack of this in some communities. Significance of Study: To curb this, non-profit sectors are now engaging in community health programs to ameliorate the difficulties faced by distanced citizens living in remote localities. With the advent of this program, it is imperative to incorporate data-driven strategies as innovative approaches to improve and enhance the current state of operations in community health programs. Discussion: A medical practice that addresses the well-being of people within a particular geographical location is referred to as community health. This technical review paper discusses the concepts, roles and mode of operations of community health workers and the programs that are embedded. The attributes of a robust well-functioning health system as stated by World Health Organisation (WHO) were discussed alongside program components that are often executed by village workers. Value-based care, patient-centered care and P4 medicine were identified as the major ideologies behind data-driven strategies and the characteristic features of each were adequately discussed. Conclusion: A data-driven healthcare innovative approach must put into consideration the real definition of data management policies, organize training for health care workers who are handling health data and also support the implementation in order to secure the designed information systems.

The study examined the effect of capital adequacy on financial performance of microfinance banks in Kenya. Capital buffer theory and stakeholder theory was utilized. Causal research design was adopted and fourteen microfinance banks were targeted. Thirteen microfinance banks were selected based on purposive sampling technique which was informed by the time scope of the study which is 2013 to 2019. Secondary panel data was used and consequently, panel regression analysis was applied. The study concluded that core capital to total assets ratio is a significant predictor of financial performance of microfinance banks in Kenya. It was also concluded that core capital to total deposits ratio is important in determining the financial performance of microfinance banks in Kenya. The study recommends that microfinance banks should strive towards holding capital buffer with regards to core capital in relation to total assets upon reaching the minimum requirements. This should however be done in a prudent manner where financial intermediation role is not distorted. A joint core capital and total deposits objective should be put in place by the management of microfinance banks. The study recommends that the capital adequacy guidelines by the Central Bank of Kenya should be in view of underlying banking conditions. Capital regulatory and supervisory initiative by the apex bank should balance between protecting depositors and ensuring stable financial performance. Keywords: Capital Adequacy, Core Capital to Total Assets Ratio, Core Capital to Total Deposits Ratio, Financial Performance and Microfinance Banks DOI: 10.7176/RJFA/15-4-05 Publication date: April 30 th 2024

This case report describes a 28-year-old man with autoimmune polyglandular syndrome (APS) type 1 who presented with pericardial tamponade complicated by pulseless electric activity cardiac arrest. After 59 minutes of cardiopulmonary resuscitation and pericardiocentesis, spontaneous circulation returned. Although pericardial tamponade has been rarely associated with APS type 2, to the best of our knowledge, it has never been reported in APS-1. This unique case highlights the importance of recognizing autoimmune pathology as a potential cause of pericardial effusion in patients with APS.