United States

Introduction:
Crohn&#39;s Disease (CD) is a chronic inflammatory bowel disease affecting any part of the gastrointestinal tract and leading to debilitating symptoms. It impacts a substantial number of people in the US, including an estimated 80,000 children (half with CD) and over 0.7% of adults. Current treatments focus on symptom management through immune suppression, inflammation reduction, and inducing remission using immunomodulators, biologics, nutritional therapy, or surgery. However, CD can still lead to severe long-term complications significantly impacting quality of life and daily activities. Further research is essential to understand the role of gut microbiota dysbiosis in CD pathogenesis and the potential benefits of microbiota transplant.

Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic review was conducted on the impact of gut microbiota on CD studies published between January 2024 to April 2025. Our inclusion criteria include systematic review, randomized control trials (RCTs) done on the pediatric and adult populations. Exclusion criteria were studies done on animals. DAta was collected from Pubmed. The following keywords were used: Crohn’s Disease, Microbiota, and Microbiota transplantation. All data were assessed independently for eligibility. 4 authors collected data using the above-mentioned keywords. All eligible publications were added to a spreadsheet. To minimize bias, 4 authors reviewed, analyzed, and approved the data that was collected according to our pre-set criteria. Any publication that was duplicated or didn’t meet our inclusion criteria, was marked as so and was not included in our literature review. Moreover, any disagreements concerning the eligibility of the publication were discussed among the researchers, and a consensus was met.

Results: 
Our study included 257 studies, of which 5 met the inclusion criteria. These studies with limited pediatric studies reported potential benefits with 56.3% clinical remission rates in small cohorts. Microbiota interventions consistently led to beneficial gut microbiome changes, including increases in beneficial bacteria (e.g., Faecalibacterium prausnitzii) and decreases in harmful bacteria (e.g., Escherichia coli). Responders to Fecal Microbiota Transplantation (FMT) showed microbiome shifts towards donor profiles, increased alpha diversity, and enrichment of short-chain fatty acid-producing bacteria. Safety profiles were generally favorable, with most adverse events being minor and no mortality reported.

Conclusion:
In summary, the studies highlighted positive potential in implementing microbiota transplantation in the management of CD. That being said, more studies are needed to better understand the Microbiota transplantation in treating CD and its consequences. Bringing awareness to the dire need to modulate effective treating strategies to prevent long term complications associated with CD.


AMA Research Challenge 2025 

Exploring The Effects of Gut Microbiota Transplantation on Crohn’s Disease: 
A Systematic Review  

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Introduction:
Crohn's Disease (CD) is a chronic inflammatory bowel disease affecting any part of the gastrointestinal tract and leading to debilitating symptoms. It impacts a substantial number of people in the US, including an estimated 80,000 children (half with CD) and over 0.7% of adults. Current treatments focus on symptom management through immune suppression, inflammation reduction, and inducing remission using immunomodulators, biologics, nutritional therapy, or surgery. However, CD can still lead to severe long-term complications significantly impacting quality of life and daily activities. Further research is essential to understand the role of gut microbiota dysbiosis in CD pathogenesis and the potential benefits of microbiota transplant.

Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic review was conducted on the impact of gut microbiota on CD studies published between January 2024 to April 2025. Our inclusion criteria include systematic review, randomized control trials (RCTs) done on the pediatric and adult populations. Exclusion criteria were studies done on animals. DAta was collected from Pubmed. The following keywords were used: Crohn’s Disease, Microbiota, and Microbiota transplantation. All data were assessed independently for eligibility. 4 authors collected data using the above-mentioned keywords. All eligible publications were added to a spreadsheet. To minimize bias, 4 authors reviewed, analyzed, and approved the data that was collected according to our pre-set criteria. Any publication that was duplicated or didn’t meet our inclusion criteria, was marked as so and was not included in our literature review. Moreover, any disagreements concerning the eligibility of the publication were discussed among the researchers, and a consensus was met.

Results: 
Our study included 257 studies, of which 5 met the inclusion criteria. These studies with limited pediatric studies reported potential benefits with 56.3% clinical remission rates in small cohorts. Microbiota interventions consistently led to beneficial gut microbiome changes, including increases in beneficial bacteria (e.g., Faecalibacterium prausnitzii) and decreases in harmful bacteria (e.g., Escherichia coli). Responders to Fecal Microbiota Transplantation (FMT) showed microbiome shifts towards donor profiles, increased alpha diversity, and enrichment of short-chain fatty acid-producing bacteria. Safety profiles were generally favorable, with most adverse events being minor and no mortality reported.

Conclusion:
In summary, the studies highlighted positive potential in implementing microbiota transplantation in the management of CD. That being said, more studies are needed to better understand the Microbiota transplantation in treating CD and its consequences. Bringing awareness to the dire need to modulate effective treating strategies to prevent long term complications associated with CD.


poster

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Repurposing Atypical Antipsychotics for Aggressive Prostate Cancer Treatment: Investigating Their Role in Cell Proliferation, Migration, and ER Stress
Grace Lee, OMS-III, Berony Geneste, OMS-III, Dalal Dawud, B Pharm, Zakaria Y Abd Elmageed, PhD
Department of Biomedical Science, Discipline of Pharmacology, Edward Via College of Osteopathic Medicine, Monroe, LA 71203, USA
Background & Aim: Repurposing atypical antipsychotics for untreated metastatic castration-resistant prostate cancer (mCRPC) therapy is an intriguing area of research. Several studies have shown that some antipsychotic drugs, originally developed to treat psychiatric disorders, exhibit anticancer properties. This study aimed to evaluate atypical antipsychotics anticancer properties for treatment of mCRPC by reducing cellular proliferation and migration while inducing endoplasmic reticulum (ER) stress, with fewer side effects compared to first-generation antipsychotics.
Methods: This study explored the anticancer potential of four atypical antipsychotics: cariprazine, xanomeline, pimavanserin, and iloperidone. Cytotoxic assay was performed to determine the half-maximal inhibitory concentration IC50 values of these drugs in mCRPC cells. Colony formation assay was also used to assess the ability of cells to inhibit clonogenic survival. Transwell migration assay was conducted to evaluate the impact of these agents on cell migration. To elucidate the underlying molecular mechanisms, immunoblotting analysis was conducted to evaluate pimavanserin’s role in inducing ER stress by quantifying protein markers such as CHOP, BiP, calnexin, PDI, and PERK.
Results
We found that MTT assay identified a wide range of IC50 values for the tested antipsychotics, with pimavanserin demonstrating the highest potency in reducing cell viability. Therefore, pimavanserin was selected for further investigation due to its superior efficacy and tolerability profile. Colony formation assay further confirmed pimavanserin’s superior ability to impair clonogenic survival. The transwell migration assay revealed significant inhibition of mCRPC cell migration by all four drugs, with pimavanserin exhibiting the strongest effect. These results highlight pimavanserin as a promising candidate for mCRPC therapy. Western blot analysis will validate whether pimavanserin induces ER stress by upregulating markers such as CHOP, BiP, calnexin, PDI, and PERK, which are critical components of the unfolded protein response.
Conclusion: Repurposing atypical antipsychotics offers a promising approach to cancer treatment. Among the tested agents, pimavanserin displayed the most potent effects in reducing mCRPC cell proliferation, clonogenic survival, migration, and positioning it as a leading candidate for further research. Ongoing studies will focus on elucidating the molecular mechanisms underlying its anticancer activity, particularly its capacity to induce ER stress. These results support the potential development of pimavanserin for preclinical and clinical trials.
Keywords: mCRPC, atypical antipsychotic agents, cel proliferation, colony formation, migration


Repurposing Atypical Antipsychotics for Aggressive Prostate Cancer Treatment: Investigating Their Role in Cell Proliferation, Migration, and ER Stress

Background
Acanthamoeba keratitis (AK) is an opportunistic infection caused by Acanthamoeba castellanii. In immunocompromised individuals, the organism can also lead to disseminated infections and granulomatous encephalopathy. Although there are limited resources for novel drug discovery, there remains a pressing need for new antiamoebal agents. One practical approach in such settings involves drug repurposing, which means testing compounds originally developed for other diseases. Since some proteases in Acanthamoeba are known to contribute to its pathogenicity, protease inhibitors were selected as candidates for evaluation.

Methods
Phenotypic assays compatible with high-throughput screening were developed for A. castellanii. A Resazurin-based fluorescence assay was optimized in a 96-well plate format using YPG medium supplemented for amoebae. Compounds were screened at 0.5% DMSO and incubated for 72 h. The growth or inhibition of A. castellanii was monitored fluorescence on a microplate reader. Microscopy was performed on oil immersion at 100x magnification. 

Results
The diverse protease inhibitor panel included aspartyl and cysteine protease inhibitors with previously reported activity in conditions like ischemia, AIDS, and COVID-19. Several compounds were identified as growth inhibitors of A. castellanii, representing a range of pharmacophores. One of the most active, TUN-00065 (a calpain inhibitor) demonstrated low micromolar potency. Morphological analysis suggested that TUN-00065-treated cells exhibited compromised cell walls. In contrast, cells treated with TUN-00064, a SARS-CoV-2 Mpro inhibitor, showed increased vacuolization. Additional screening revealed synergistic effects between certain protease inhibitors and existing antiparasitic agents. Sequence alignment of four putative Acanthamoeba protease homologs revealed 5 to 25 percent identity with human calpains and 15 to 25 percent identity among the amoebic sequences themselves. 

Conclusion
These findings support the potential of repurposing protease inhibitors as therapeutic or preventative agents against A. castellanii. The identification of active compounds, including TUN-00065, along with evidence of synergistic effects and conserved protease homologs, supports further investigation into targeted therapeutic strategies. Future work will focus on enzyme-based validation of these protease inhibitors in amoebal homologs.


Inhibiting Pathogenic Amoeba Growth Like a Pro(tease Inhibitor)

Abstract Title
Heart transplantation for amyloid cardiomyopathy has comparable outcomes with other etiologies: The UNOS perspective

Background
Previous evidence suggests that heart transplantation in patients with amyloid cardiomyopathy (ACM) may be suboptimal given the risk of amyloid recurrence. This study aimed to provide updated nationwide data on outcomes in heart transplantation in ACM compared with other cardiomyopathy etiologies.

Methods
United Network for Organ Sharing data for patients over eighteen who underwent heart transplant for ACM and other cardiomyopathies including idiopathic dilated cardiomyopathy (DCM), ischemic cardiomyopathy (ICM), idiopathic restrictive cardiomyopathy (RCM) and cardiomyopathy associated with congenital heart disease (CHD) were reviewed from January, 2001 through December, 2022. The data were analyzed with a propensity score-matched analysis comparing ACM patients with transplant for the cardiomyopathies to measure primary outcomes including five-year, ten-year, and all-cause mortality accounting for differences at baseline.

Results
Of 21,457 heart transplant recipients that met eligibility criteria, there was a 100% increase of heart transplants for ACM from 2010 to 2020 (p<0.001). The unadjusted mortality did not differ significantly among ACM, DCM, ICM, RCM, and CHD groups, and five-year mortality was comparable between ACM and DCM patients. ACM patients had significantly lower incidence of postoperative stroke (p=0.044), and risk factors for ACM transplant mortality were identified as mechanical ventilation at the time of transplant (HR: 3.8, p = 0.023) and older donor age (HR: 1.1, p = 0.015). Our analysis further revealed a trend towards an increasing rate of transplants for patients with ACM compared to the DCM, RCM, ICM, and CHD from 2001 to 2022.

Conclusion
The number of heart transplants for ACM has increased in recent years, and medical data on these ACM transplants has shown similar survival outcomes to transplant for other cardiomyopathies. Despite historical concerns regarding poor prognosis and amyloid recurrence, our findings suggest that carefully screened ACM patients can benefit from heart transplantation as the outcomes of heart transplantation for ACM patients are not inferior to those for patients with other cardiomyopathies. However, our results have limitations including the inherent limitations of a retrospective study design, our data set was limited to the US organ system, and we did not assess waitlist mortality. Therefore, further research is warranted along with investigating optimization of ACM patient eligibility criteria and patient selection alongside investigation of concurrent adjunct therapies such as chemotherapy and stem cell transplantation and management strategies, to offer a promising treatment of ACM with heart transplantation.


Nationwide Outcomes of Heart Transplantation for Amyloid Cardiomyopathy are Comparable with other Etiologies: The UNOS Perspective


Background:
Patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction are at elevated risk for venous thromboembolism (VTE) due to prolonged operative times, cancer-associated hypercoagulability, and postoperative immobility. Despite the prevalence of VTE risk, there is limited consensus on standardized prophylaxis regimens in this high-risk population.
Methods:
A retrospective chart review was conducted of all patients who underwent DIEP flap breast reconstruction performed by the senior author between October 2021 and July 2024. A standardized VTE prophylaxis protocol was applied to all patients, including preoperative education, subcutaneous heparin, intraoperative efficiency techniques, and a postoperative regimen consisting of early ambulation (physical therapy initiated at 8:00 AM on postoperative day one), sequential compression devices, compressive garments, and two weeks of enoxaparin. Patient demographics, operative details, and VTE outcomes were recorded.
Results:
A total of 187 DIEP flaps were performed on 110 patients. The average age was 49.3 years, and the mean BMI was 29.7 kg/m². All flaps were performed by a single surgeon. There was one reported VTE event—an upper extremity deep vein thrombosis (DVT) 119 days after surgery, associated with intravenous access during a revision procedure. No lower extremity DVTs or pulmonary embolisms were reported. Therefore, the VTE rate attributable directly to DIEP flap reconstruction was 0.0%.
Conclusions:
A standardized, multimodal VTE prophylaxis protocol integrating pre-, intra-, and postoperative measures—including structured early ambulation—can result in a remarkably low VTE rate in DIEP flap patients. Our findings support that such a regimen is safe, effective, and may obviate the need for risk-based pharmacologic stratification using tools such as the Caprini Risk Assessment Model in this population.

Optimizing Venous Thromboembolism (VTE) Prophylaxis Following Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction

Evaluating SiamMask and XMem for Real-Time Tumor Tracking in MR-Guided Radiotherapy

Swati Rampalli, Wookjin Choi, Karen Mooney, Nicole Simone, and Hamidreza Nourzadeh

Background
Magnetic Resonance Linear Accelerator (MRLinac) marks a major advancement in radiation therapy by enabling real-time tumor tracking. To improve tracking accuracy, there is growing interest in high-performance algorithms. General-purpose object-tracking algorithms have shown promising speed and adaptability in visual environments (e.g., driving, surveillance), but have not been extensively validated in medical imaging applications. Prior efforts developed AI models specifically trained on medical datasets, but these often require extensive expert-labeled annotations and lack generalizability across broader medical data. In this study, we evaluate the performance of SiamMask and XMem, two general purpose object tracking algorithms, initially developed from natural video data, now applied to cine MRI data. We explore the application of two off-the-shelf computer vision models in anatomical tracking without domain-specific training.

Methods
Both SiamMask and XMem models were tested on the publicly available TrackRad2025 Challenge Dataset. Our study consisted of a subset of 50 patients in two MRLinac systems 0.35 T (Institution A: 25 patients) and 1.5 T (Institution B: 15 patients, Institution C: 10 patients). Each patient had 2D+t MRI sequences with expert-drawn contours of a target structure. Both models were shown the labeled target in the first frame, tracked it across subsequent frames, and generated a bounding box around it. Tracking performance was assessed by comparing predicted bounding boxes with expert contours using the Dice Similarity Coefficient, Intersection over Union (IoU), and Hausdorff Distance, all standard image segmentation metrics.

Results
While threshold values for strong tracking performance vary depending on anatomy and imaging modality, higher scores reflect better overlap. DICE scores greater than 0.95 are often used as a threshold in clinical applications. Across all subgroups, XMem consistently achieved higher tracking accuracy than SiamMask, with an average DICE score of 0.861 ± 0.168, IoU of 0.783 ± 0.183, and Hausdorff Distance 95 (HD95) of 5.51 ± 7.02 mm. In comparison, SiamMask averaged a DICE score of 0.773 ± 0.232, IoU of 0.710 ± 0.244, and HD95 of 9.62 ± 8.30 mm.

Conclusion
Our findings show that XMem outperformed SiamMask across all patients, indicating greater overlap with initially drawn contoursstronger alignment with expert contours. However, overlap metrics like DICE and IoU alone do not guarantee clinical readiness viability as performance must also account for target complexity and proximity to critical structures. Clinically acceptable tracking performance varies with target size, proximity to critical structures, and steep dose gradients. HD95, a boundary-based metric capturing worst-case segmentation error, is especially critical in high-precision tracking. When broken down by subgroup, XMem exhibited variable Hausdorff distances in Institution B, driven by a small number of outlier frames with poor segmentation quality. Further investigation is needed to assess clinical applicability in high-risk anatomical regions. Both models also showed reduced performance on the 0.35 T system (Institution A), highlighting the impact of field strength and image quality, and underscoring the need for further statistical evaluation (e.g., ANOVA) across MR-Linac systems. Nonetheless, improved automated tracking can enable shorter treatments, more precise radiation delivery, and safer dose escalation. Off-the-shelf computer vision models such as SiamMask and XMem offer a strong foundation for enhancing MR-guided radiotherapy workflows. Future efforts will focus on integrating statistical comparisons across systems and refining these models for broader clinical implementation, with the potential to enable safer dose escalation and more efficient, personalized treatment delivery.


Evaluating SiamMask for Real-Time Tumor Tracking in MR-Guided Radiotherapy Without Domain Training

Background: Ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor, is a cornerstone therapy for Chronic Lymphocytic Leukemia (CLL). However, its use is linked to significant cardiotoxicity, including atrial fibrillation, hypertension, and a rare but critical risk of ventricular arrhythmias and sudden cardiac death.

Objective: To highlight the importance of recognizing Ibrutinib-associated sudden cardiac death through a case of a CLL patient with a complex pre-existing cardiac history.

CASE PRESENTATION
Patient Profile
A 67-year-old African American male was diagnosed with Stage 4 Chronic Lymphocytic Leukemia (CLL) in August 2022.
Cytogenetic analysis revealed a 13q14.2 deletion, indicating a favorable prognosis for his CLL.
His significant past medical history included chronic atrial fibrillation, hypertension, and a prior surgical repair of an atrial septal defect (ASD).

Treatment and Clinical Course
The patient was started on the standard-dose Ibrutinib (a Bruton's tyrosine kinase inhibitor) at 420 mg once daily.
Throughout his treatment, he reported experiencing chronic palpitations, which were clinically attributed to his known history of atrial fibrillation.
In April 2023, approximately eight months after treatment initiation, he developed worsening thrombocytopenia. As a result, his Ibrutinib dose was reduced to 280 mg daily. The patient tolerated this lower dose well with stabilization of his CLL.

Outcome
In 2025, despite his CLL remaining stable, the patient suffered a sudden and unwitnessed cardiac arrest at home and was pronounced deceased. The presentation was consistent with sudden cardiac death.

CONCLUSION
Ibrutinib is a potential contributor to sudden cardiac death, even in patients with stabilized CLL.
A high-risk cardiac history is a critical factor; fatal cardiotoxicity can occur despite a favorable hematologic prognosis.
This case underscores that vigilant cardiovascular surveillance is non-negotiable for all patients on Ibrutinib.

Clinical Recommendations
Baseline Evaluation: Perform a thorough cardiac risk assessment, including an EKG, before initiating Ibrutinib.
Active Monitoring: Implement routine monitoring during treatment to detect early signs of cardiotoxicity.
Collaborative Care: Utilize a Cardio-Oncology team approach for proactive management of high-risk patients.
Future Directions: Further research is needed to identify biomarkers that can risk-stratify patients and guide the selection of safer, newer BTK inhibitors.


The Unseen Risk: A Case of Sudden Cardiac Death in Ibrutinib-Treated CLL

Background
Aspergillus species are molds which cause infection via conidia inhalation. Invasive aspergillosis (IA) typically affects immunocompromised individuals and presents with fever unresponsive to antibiotics, thrombosis, and pulmonary infarction. However, IA can occur in immunocompetent patients due to contamination during vascular and cardiac surgeries. Early recognition of aspergillus aortitis and endocarditis is important given the high mortality rate (92.7%). We describe an immunocompetent patient with a remote history of coronary artery bypass graft (CABG) who presented with progressive strokes and was found to have an infected aortic thrombus caused by Aspergillus flavus.

Case Presentation
A 69-year-old man presented five hours after onset of dysarthria and confusion. Medical history was significant for well-controlled diabetes mellitus and history of CABG ten months prior to presentation. The patient was seen by Neurology due to concern for stroke. Computed tomography (CT) of the head and CT angiography of the brain and neck were unremarkable. However, a filling defect of the ascending aorta showed a thrombus and possible dissection. Given the concern for aortic dissection, thrombolytics were not given. Magnetic resonance imaging (MRI) of the brain showed multiple acute infarcts concerning for a stroke of cardioembolic origin.
On hospital day two, the patient developed fever and bilateral lower extremity weakness. Repeat MRI showed further stroke burden. Chest radiograph and urinalysis were unremarkable. Blood cultures were obtained. Due to concern for endocarditis, vancomycin and meropenem were started. By day five, he was responsive only to pain. On day seven, blood cultures grew aerobic fungal elements and caspofungin and isavuconazonium were initiated. On day eight, Aspergillus flavus was identified from the blood culture. Due to poor neurologic status, surgical repair of the aorta was not advised. Comfort measures were initiated, and the patient died with family at the bedside on day ten.

Discussion
While IA primarily occurs in immunocompromised patients, immunocompetent patients can develop IA after cardiac or vascular surgeries due to intraoperative contamination. Symptoms can develop up to two years after surgery. Aspergillus aortitis proximal to the brachiocephalic arch mimics endocarditis given the proximity to the carotid arteries. Aspergillus flavus shows reduced susceptibility to amphotericin B; therefore, concomitant antifungals such as caspofungin or voriconazole should be used. Emergent surgical intervention and resection is
the preferred treatment for IA involving the aorta given the potential for emboli and rupture.

Invasive Aspergillosis following CABG in an Immunocompetent Patient

Background: Autoimmune encephalitis (AE) comprises a group of inflammatory central nervous system disorders characterized by neuronal autoantibodies targeting intracellular or cell-surface proteins, often associated with distinct clinical phenotypes and underlying malignancy. Anti-ZIC4 antibodies, which target a cerebellar zinc-finger transcription factor involved in neuronal development, are rare and classically associated with paraneoplastic cerebellar degeneration, particularly in small-cell lung cancer. Their significance may be underrecognized, especially when co-occurring with more common antibodies such as anti-Hu.
Case Presentation: We report a case of a 70-year-old woman who presented with rapidly progressive encephalopathy and was found to have isolated anti-ZIC4 antibody positivity. Brain magnetic resonance imaging (MRI) revealed bilateral temporal lobe involvement, and continuous electroencephalogram (EEG) monitoring demonstrated refractory focal status epilepticus originating from the left posterior quadrant, evolving into an ictal–interictal continuum with brief recurrent seizures. No evidence of malignancy or cerebellar dysfunction was found, and infectious etiologies were thoroughly excluded. The patient received immunomodulatory treatment with high-dose methylprednisolone and intravenous immunoglobulin (IVIG) for suspected AE. Despite aggressive therapy, she passed away four weeks after admission.
Discussion: To our knowledge, this is the first reported case of isolated anti-ZIC4–associated encephalitis with temporal lobe predominance and no detectable malignancy, expanding the clinical and radiological spectrum of ZIC4 autoimmunity beyond its classical cerebellar phenotype. While ZIC4 antibodies often coexist with anti-Hu or CRMP5 antibodies, this case supports the notion that ZIC4 alone may have pathogenic relevance. It underscores the importance of paraneoplastic antibody testing even in atypical presentations and highlights the need for early recognition given the potential for rapid clinical deterioration despite treatment.

Isolated Anti-Zic4 Autoimmune Encephalitis with Temporal Lobe Involvement in the Absence of Malignancy

Background
Temporal crescent syndrome is a rare monocular visual field defect characterized by the loss of peripheral vision in the temporal field of one eye, typically caused by a contralateral retrochiasmal lesion on the visual pathway. Visual defects from retrochiasmal lesions are usually homonymous field defects, except for temporal crescent syndrome. Temporal crescent syndrome is an overall rare occurrence with few documented cases, especially when attributed to brain tumors, as more common etiologies include ischemic and hemorrhagic infarcts. Patients with temporal crescent syndrome often report visual disturbances such as blurred vision in the peripheral temporal field, and the condition is generally determined via visual field test.  
Case Presentation
A 40-year-old female presented with a history of grade II astrocytoma presented with a new onset of visual disturbances, specifically reporting of recent flashes of light in the right eye and blurriness. Her initial complaints were of headaches, fever, and seizures, though a meningitis workup proved negative. The patient’s medical history is significant for a left parietal astrocytoma that grew to affect the anteromedial occipital lobe, which was diagnosed in 2014. Over the past ten years, the tumor grew slowly, eventually leading to a loss of peripheral vision in the contralateral eye. 
  During initial evaluation, a formal visual field test revealed a loss of temporal vision in the right eye, initially corresponding with the tumor’s location on the left hemisphere. A neuro-ophthalmology consultation was conducted and concluded that the astrocytoma likely contributed to her visual symptoms. Despite ongoing symptoms, neurosurgery determined that surgical intervention was not warranted, as outpatient monitoring was deemed appropriate. The patient was started on steroid therapy to manage symptoms, which improved her condition but also induced hypoglycemia for which she has received counseling. During follow-up visits over the next decade, the patient reported persistent visual disturbances but no significant pain or further loss of vision.
Discussion
This case report highlights a rare manifestation of temporal crescent syndrome secondary to a grade II parietal astrocytoma. This case underscores the importance of considering CNS tumors in patients with peripheral visual field defects, particularly temporal crescent syndrome. Differential Diagnoses regarding this case include Creutzfeldt-Jacob disease, hemorrhagic infarction, and anterior striate cortex ischemia. Other ocular manifestations of parietal astrocytomas include sensory dysfunction, difficulty with spatial awareness, and issues with motor coordination. The unusual presentation of temporal crescent syndrome in this context underscores the need for interdisciplinary management and careful monitoring to address complex neurological conditions. 


Temporal Crescent Syndrome Secondary to Parietal Astrocytoma

Background 

Health access in Puerto Rico varies across regions and populations, with ongoing gaps in available services. Extensive literature highlights long-standing differences in health status among people with limited access to health or social services.¹,² Differences on the island continue to affect populations including people experiencing homelessness, people born outside the United States, older adults in geographically isolated regions, and communities affected by trauma.² These populations face barriers to care such as shortages of culturally and linguistically appropriate providers, stigma within service environments, fragmented systems, and restrictive eligibility requirements. Without the implementation of targeted and sustainable interventions, these health differences will persist. To address these gaps, we aimed to develop an evidence-based policy framework to strengthen access to care to care across four priority populations by proposing universal solutions and group-specific strategies. 

Methods 

Community forums were conducted with key stakeholders from each of the four priority populations (n=223). Participants shared experiences and challenges related to service access, trust in systems, and basic infrastructure needs. Responses were analyzed using thematic coding to identify common and distinct access barriers. Recommendations were then developed using a needs-centered lens grounded in public health best practices, emphasizing system-level accountability and community-defined priorities. 

Results 
Common themes across all groups included: a lack of trauma-informed and culturally competent providers, transportation barriers, restricted eligibility due to ID or insurance requirements, and underfunded community-based care.   

Universal recommendations include:   
- Expand mobile and telehealth units, particularly in remote and rural regions.   

- Train and deploy community-based case managers across all municipalities.  

- Remove documentation barriers for service access.   

- Improve health data systems to track equity metrics in vulnerable populations.   

Group-specific recommendations include:   

- People experiencing homelessness: Fund street medicine teams and prohibit care denial based on housing status.  

- Communities experiencing trauma: Mandate trauma-informed care training for all frontline health workers.  

- Elderly in isolated areas: Subsidize transport and repair post-disaster infrastructure (road, ferry systems, etc).   

- Foreign-born persons: Eliminate the five-year residency requirements for health benefits and expand protections for undocumented individuals.   

Conclusion 

Addressing health service gaps in Puerto Rico requires both system-wide reforms and population-tailored solutions. Each recommendation addresses barriers identified by affected populations and aligns with equity-focused best practices. Implementation can inform legislative reform, drive health system redesign, and guide public health leaders toward a more just and accessible model of care in Puerto Rico. This work directly contributes to filling long-standing policy gaps by centering the voices of those most impacted.

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