United States

Abstract Title
Population Genomic Analysis Identifies MDN1 Variant Linked to Endocrine Resistance in Breast Cancer
Background 
Endocrine resistance remains a critical challenge in the treatment of hormone receptor-positive breast cancer. The overexpression of MDN1 (midasin AAA ATPase 1), a nuclear chaperone involved in 60s ribosomal biogenesis, was previously linked to aggressive tumor behavior. Ongoing studies implicate alterations in MDN1 and estrogen receptor (ESR1) mutations that co-occur and are associated with endocrine resistance. 
This study investigates whether germline single nucleotide polymorphisms (SNPs) in MDN1 are associated with endocrine therapy resistance and explores plausible molecular links using multi-platform bioinformatics and biological studies. 
Methods
Using data from the All of Us Research Program, women aged ≥51 with a diagnosis of breast cancer were stratified as endocrine-sensitive or endocrine-resistant based on medication history. Genotypes for the MDN1 region were extracted using the Hail framework. Fisher’s exact test assessed the significance of the genotype-phenotype associations between SNPs and treatment status. The variant effect predictor (VEP) defined the functional protein impact of these variations. cBioportal, a multi-omics cancer platform, provided MDN1-ESR1 mutation co-occurrence data, while immunoblot analysis provided protein expression data. 
Results
Of the 236 variants identified, 133 were analyzed to assess genotype-phenotype associations. Two MDN1 SNPs were found to be significantly associated with endocrine therapy response: genotype IDs gt_GT_89702058 (p = 0.04879) and gt_GT_89707365 (p = 0.003311). The heterozygous genotype (0/1) of gt_GT_89707365 was observed in 20 endocrine-resistant cases and four endocrine-sensitive cases. The odds ratio 4.35 (95% CI: 1.47–16.67) suggests that individuals carrying the variant allele had a significantly higher likelihood of being resistant to endocrine therapy. VEP analysis revealed gt_GT_89707365 to be a missense variant with moderate impact, confirming an amino acid substitution suggesting a possible functional protein consequence. 
Data from cBioportal demonstrated that MDN1 alterations are associated with known estrogen receptor alterations (log2 odds ratio 1.5928, p-value= 0.027). In vitro studies revealed a 3-fold and 1.5-fold increase (p-value&lt;0.05) in the expression of MDN1 in endocrine-resistant breast cancer cells with estrogen receptor point mutations Y537S and D538G, respectively. 

Conclusion
This study is the first to identify germline MDN1 variants potentially associated with endocrine therapy resistance. The significant enrichment of a missense SNP and evidence linking MDN1 to estrogen receptor mutations in treatment highlight a novel association with clinical relevance. These findings suggest MDN1 variation may influence endocrine therapy response. While there was a low variant frequency, ongoing studies in independent cohorts may support clinical implementation of MDN1 genotyping as a biomarker for therapy stratification.


AMA Research Challenge 2025 

Population Genomic Analysis Identifies MDN1 Variant Linked to Endocrine Resistance in Breast Cancer

Abstract Title
Population Genomic Analysis Identifies MDN1 Variant Linked to Endocrine Resistance in Breast Cancer
Background 
Endocrine resistance remains a critical challenge in the treatment of hormone receptor-positive breast cancer. The overexpression of MDN1 (midasin AAA ATPase 1), a nuclear chaperone involved in 60s ribosomal biogenesis, was previously linked to aggressive tumor behavior. Ongoing studies implicate alterations in MDN1 and estrogen receptor (ESR1) mutations that co-occur and are associated with endocrine resistance. 
This study investigates whether germline single nucleotide polymorphisms (SNPs) in MDN1 are associated with endocrine therapy resistance and explores plausible molecular links using multi-platform bioinformatics and biological studies. 
Methods
Using data from the All of Us Research Program, women aged ≥51 with a diagnosis of breast cancer were stratified as endocrine-sensitive or endocrine-resistant based on medication history. Genotypes for the MDN1 region were extracted using the Hail framework. Fisher’s exact test assessed the significance of the genotype-phenotype associations between SNPs and treatment status. The variant effect predictor (VEP) defined the functional protein impact of these variations. cBioportal, a multi-omics cancer platform, provided MDN1-ESR1 mutation co-occurrence data, while immunoblot analysis provided protein expression data. 
Results
Of the 236 variants identified, 133 were analyzed to assess genotype-phenotype associations. Two MDN1 SNPs were found to be significantly associated with endocrine therapy response: genotype IDs gt_GT_89702058 (p = 0.04879) and gt_GT_89707365 (p = 0.003311). The heterozygous genotype (0/1) of gt_GT_89707365 was observed in 20 endocrine-resistant cases and four endocrine-sensitive cases. The odds ratio 4.35 (95% CI: 1.47–16.67) suggests that individuals carrying the variant allele had a significantly higher likelihood of being resistant to endocrine therapy. VEP analysis revealed gt_GT_89707365 to be a missense variant with moderate impact, confirming an amino acid substitution suggesting a possible functional protein consequence. 
Data from cBioportal demonstrated that MDN1 alterations are associated with known estrogen receptor alterations (log2 odds ratio 1.5928, p-value= 0.027). In vitro studies revealed a 3-fold and 1.5-fold increase (p-value<0.05) in the expression of MDN1 in endocrine-resistant breast cancer cells with estrogen receptor point mutations Y537S and D538G, respectively. 

Conclusion
This study is the first to identify germline MDN1 variants potentially associated with endocrine therapy resistance. The significant enrichment of a missense SNP and evidence linking MDN1 to estrogen receptor mutations in treatment highlight a novel association with clinical relevance. These findings suggest MDN1 variation may influence endocrine therapy response. While there was a low variant frequency, ongoing studies in independent cohorts may support clinical implementation of MDN1 genotyping as a biomarker for therapy stratification.


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Background
Treatment of orthopedic cases requiring limb-lengthening or complex reconstruction often necessitates the use of external fixators. Since these devices employ pins that remain exposed to the environment, infections at insertion points (pin-site infections) occur frequently. Because development of antibiotic resistance remains a threat, new methods of controlling pin-site infections using experimental pin coating materials are constantly being sought. A 2023 study showed that a simvastatin/hydroxyapatite coating prevented S. aureus biofilm formation in vivo—with hydroxyapatite acting simply to facilitate osseointegration. However, since some species common to pin-tract infections are Gram-negative, and since the literature indicates that atorvastatin may be more effective than simvastatin at inhibiting Gram-negative species, it was of interest to explore the effectiveness of atorvastatin as well as of simvastatin/atorvastatin combinations against such species.

Methods
Quadruplicate Kirby-Bauer disc diffusion assays were performed for Pseudomonas aeruginosa and Serratia marcescens. Blank discs were placed on the surfaces of bacteria-coated nutrient agar plates, and DMSO solutions of simvastatin, atorvastatin calcium, or simvastatin/atorvastatin calcium were micropipetted onto each disc. Simvastatin concentrations ranged from 50 to 400 mg/mL, while atorvastatin calcium concentrations ranged from 25 to 200 mg/mL. Simvastatin/atorvastatin calcium combinations included 100 mg/mL simvastatin / 300 mg/mL atorvastatin, 200 mg/mL simvastatin / 200 mg/mL atorvastatin, and 300 mg/mL simvastatin / 100 mg/mL atorvastatin. After incubating at 37oC for 24 hours, the diameters of zones of inhibition were measured.

Results
The greatest average diameter of inhibition for S. marcescens using atorvastatin was 0.83 cm. The greatest average diameter for S. marcescens using simvastatin was 0.84 cm. The average diameter of inhibition for P. aeruginosa using atorvastatin was 0.64 cm (the diameter of the disc itself). The greatest average diameter for P. aeruginosa using simvastatin was 0.95 cm. The average diameter of inhibition for S. marcescens using simvastatin/atorvastatin combinations was 0.64 cm (disc diameter). The average diameters for P. aeruginosa using simvastatin/atorvastatin combinations ranged from 1.35 to 1.90 cm; the 1.90 cm average diameter was achieved using 300 mg/mL simvastatin / 100 mg/mL atorvastatin.

Conclusion
The most significant result was obtained for P. aeruginosa using simvastatin/atorvastatin combinations. Since no inhibition of P. aeruginosa occurred using atorvastatin alone and only moderate inhibition occurred using simvastatin alone, it is clear that simvastatin/atorvastatin combinations produce synergistic inhibitive effects—with the greatest effect being seen at high simvastatin/low atorvastatin concentration. This result speaks strongly to the need for further investigation of the antibacterial potential of statin combinations.

An In vitro Study of the Ability of Simvastatin and Atorvastatin to Inhibit Select BSL-2 Bacteria Associated with Pin-Tract Infections

Background: Advanced heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation experience variable outcomes, and patient-specific anatomical features may influence risk. The HeartMate 3, a fully magnetically levitated LVAD, has shown superior hemocompatibility and survival benefits. However, a smaller preoperative left ventricular end-diastolic diameter (LVEDD) may portend worse outcomes due to altered ventricular mechanics, restrictive physiology, and increased right ventricular afterload. These anatomic factors are more frequently observed in females and patients with ischemic cardiomyopathy. We aimed to determine whether a smaller LVEDD (<55 mm) independently predicts mortality and adverse events following HeartMate 3 implantation, using real-world data from the MOMENTUM 3 trial portfolio.
Methods: We performed a retrospective cohort analysis of 1,921 patients who underwent HeartMate 3 implantation across the MOMENTUM 3 IDE and CAP registries (NCT02224755, NCT02892955). Patients were stratified into LVEDD <55 mm (n=108) and ≥55 mm (n=1,813). Primary endpoints included 2-year survival, early (≤30 days) and late (>30 days) right heart failure, and hemocompatibility-related events (stroke, bleeding, pump thrombosis). Statistical analysis included Kaplan-Meier survival estimates and Cox regression modeling.
Results: The LVEDD <55 mm group was older (63 ± 11 vs 60 ± 12 years; p = 0.005), more often female (31% vs 20%), and had more ischemic cardiomyopathy (60.2% vs 42.6%; p < 0.001). In-hospital mortality was significantly higher (14.8% vs 5.7%; p = 0.0007). Two-year survival was lower (63.3% vs 81.8%; HR 1.97, 95% CI 1.39–2.79; p = 0.0002). Hemocompatibility-related death (2.8% vs 0.6%; HR 4.61; p = 0.018), early right heart failure (7.4% vs 2.0%; HR 3.70; p = 0.001), and late right heart failure (12.0% vs 4.8%; HR 2.58; p = 0.003) were significantly higher. Rehospitalizations due to low-flow alarms were nearly double (17.4% vs 8.3%; HR 2.39; p < 0.001).
Conclusions: Smaller LVEDD (<55 mm) is independently associated with higher in-hospital mortality, right heart failure, and hemocompatibility-related complications following HeartMate 3 implantation. These findings support the incorporation of LV geometry into preoperative risk stratification models and highlight a need for tailored surgical and post-operative strategies, especially for smaller-bodied and female patients.



Impact of Left Ventricular End-Diastolic Diameter on Outcomes Following HeartMate 3 LVAD Implantation

Abstract Title
High Hepatitis C Cure Rates Among Patients with Alcohol Use at a Safety-Net Clinic

Background
Alcohol use has historically been associated with lower adherence to HCV treatment and reduced cure rates. However, with the introduction of direct-acting antivirals (DAAs), recent studies suggest that patients with alcohol use may achieve similar outcomes to those without alcohol use. Understanding this relationship is critical for ensuring equitable access to treatment. This study aimed to evaluate the impact of alcohol use on hepatitis C virus (HCV) treatment outcomes by assessing: (1) the prevalence of alcohol use among patients, (2) whether alcohol use influenced the likelihood of starting treatment, and (3) whether alcohol use affected cure rates following treatment.

Case Presentation
This retrospective study analyzed data from 954 patients evaluated at the Grady Liver Clinic in Atlanta, GA, a specialty HCV clinic within a safety-net hospital. Alcohol use was identified through two sources: clinician documentation at the initial visit and International Classification of Diseases, Tenth Revision (ICD-10) coding. Patients were included if they had chronic HCV and were eligible for DAA therapy. Researchers examined treatment initiation rates and cure rates, defined as sustained virologic response (SVR) at 12 weeks post-treatment. Logistic regression models were used to assess whether alcohol use influenced treatment outcomes.

Discussion
Alcohol use was common in the study population, but it did not affect the likelihood of starting HCV treatment. Patients who drank alcohol were just as likely to begin treatment as those who did not. Among those who completed treatment and had follow-up testing, nearly all were cured of HCV, regardless of alcohol use. In conclusion, alcohol use did not lower HCV cure rates or prevent patients from starting treatment. These findings support the inclusion of individuals with alcohol use in HCV treatment programs and highlight the importance of providing equitable access to care.


High Hepatitis C Cure Rates Among Patients With Alcohol Use at a Safety-Net Hepatitis C Clinic

Background: Breast cancer is the most commonly diagnosed cancer among women, and mastectomy remains a cornerstone of surgical treatment. Many patients who undergo mastectomy also receive immediate implant-based breast reconstruction (IBBR). Anthracycline- based chemotherapy is a standard adjuvant therapy, commonly used for aggressive subtypes such as triple-negative or HER2-positive breast cancers. Non-anthracycline regimens are often selected for lower-risk disease or patients with comorbidities such as cardiac dysfunction. However, limited data exist on the impact of these chemotherapy regimens on postoperative outcomes following IBBR. Our study aims to compare outcomes between patients who received anthracycline and non-anthracycline-containing adjuvant chemotherapy regimens to inform clinical risk assessment and support multidisciplinary decision-making in breast cancer care.

Methods: A retrospective review of patients who underwent IBBR reconstruction between 2017 and 2023 was performed. From an initial cohort of 730 patients, 71 received anthracycline- containing and 68 received non-anthracycline-containing adjuvant chemotherapy. Propensity score matching was used to control for confounders including age, BMI, ASA class, diabetes status, smoking history, and radiation therapy, yielding 49 matched pairs (n=98). Paired t-tests were used for continuous variables and McNemar’s test for categorical variables. Primary outcomes included implant loss, wound complications, seroma, and infection.

Results: Following matching, baseline demographics and comorbidities were well balanced. The proportion of bilateral cases was similar between anthracycline and non-anthracycline groups (57.1% vs 69.4%, p = 0.016). Implant loss occurred in 10.2% (5/49) of patients in the anthracycline group compared to 0% in the non-anthracycline group (p = 0.03). Seroma formation was significantly more common in the non-anthracycline group (18.4% vs. 0%, p < 0.01). No significant differences were observed in infection rates (10.2% vs. 4.1%, p = 0.26), wound complications (12.2% vs. 18.4%, p = 0.37), or 30-day readmission (8.2% vs. 4.1%, p = 0.41). Mastectomy skin flap necrosis rates were similar between cohorts. The average length of hospital stay, number of revision surgeries, and drain duration were similar between groups.

Conclusion: Anthracycline-containing chemotherapy is associated with a higher rate of implant loss, whereas non-anthracycline-containing regimens have a higher rate of seroma formation. The observed differences may reflect underlying biological mechanisms, such as chemotherapy-induced immunosuppression or tissue edema, which can potentially impair wound healing and alter fluid dynamics. Future studies should explore potential interventions to reduce postoperative complications following IBBR in patients receiving chemotherapy. These efforts can improve management while enhancing patient counseling.

Postoperative Outcomes Following Implant-based Breast Reconstruction in Patients Receiving Anthracycline vs Non-Anthracycline Adjuvant Chemotherapy

Background
Lung cancer remains a leading cause of cancer-related mortality, with early detection and classification significantly improving patient outcomes. The LUNA25 challenge provides a standardized dataset to develop computational methods for lung nodule classification. Transfer learning by leveraging advanced neural networks like GoogleNet has shown promise in improving diagnostic performance, yet optimizing model training and architecture remains crucial.

Methods
We utilized the LUNA25 dataset, extracting 3D lung nodule patches and transforming them into 2D images via a 2.75D spiral scan technique. Using GoogleNet, we applied transfer learning strategies, selectively unfreezing specific layers, fully connected (fc), inception5b, and inception5a, in separate experiments. Each model configuration was trained for 10 epochs, employing randomized rotations and translations for data augmentation. Model performance was assessed using Area Under the Curve (AUC).

Results
Selective unfreezing demonstrated increasing performance with more layers unfrozen, though there were diminishing returns. Training only the fc layer achieved a peak AUC of 0.8549, unfreezing fc plus inception5b layers improved AUC to 0.9007, and unfreezing fc, inception5b, and inception5a layers yielded the best performance with an AUC of 0.9050. The model with unfrozen fc, 5b, and 5a was submitted to the open development phase of the LUNA 25 challenge and scored AUC of 0.8608 on a private dataset.

Conclusion
Overall, we used a transfer learning approach to fine-tune and re-train GoogleNet for pulmonary nodule classification with reasonable accuracy. Our findings indicate that progressively unfreezing the layers of a network, starting from the final fully connected layer and moving backwards, enhances model performance up to a point. Leveraging transfer learning with selective layer training provides a practical approach to optimize predictive accuracy, contributing to improved automatic classification of lung nodules.

Transfer Learning with GoogleNet for Lung Nodule Classification from CT Imaging

Background:
Lomentospora prolificans (formerly Scedosporium prolificans and Scedosporium inflatum) is an environmental mold and recognized human pathogen which can infect both immunocompetent and immunocompromised hosts. Immunocompetent hosts most commonly suffer soft tissue or osteoarticular infections following direct, often-traumatic inoculation. Treatment is complicated by its intrinsic resistance to most anti-fungals. Novel agents are being investigated including the first-in-class dihydroorotate dehydrogenase inhibitor, olorofim. Here we present a case of osteoarticular infection following traumatic inoculation in an immunocompetent host treated with olorofim, with significant results showing clinical improvement.

Case Presentation:
A 39-year-old male with no past medical history presented to the hospital after sustaining an accidental, self-inflicted axe injury to his left suprapatellar region. It was 2 cm in length and superficial, not extending past subcutaneous adipose tissue. Over the ensuing 30 days after wound closure, he had progressive swelling of the left knee with significant tenderness that limited ambulation and required arthrocentesis and imaging. Unfortunately, given the lack of systemic signs of infection, his joint effusion and synovitis were attributed to non-infectious etiologies. A later arthrocentesis was performed and began to grow mold (speciated to Lomentospora prolificans), prompting surgical debridement of the joint capsule and synovium with initiation of anti-infective therapy. In total, he underwent nine surgical procedures - debridement and irrigation procedures with anti-septic irrigants, placement of anti-fungal impregnated beads, and placement of an antifungal impregnated articular spacer. The patient was briefly managed with voriconazole monotherapy but was eventually transitioned to a combination of voriconazole, terbinafine, and caspofungin. Despite this, intraoperative findings and cultures continued to suggest ongoing fungal infection. Given the pan-resistance of the patient’s isolate, an emergency IND application for olorofim as a salvage regimen was pursued and approved. Debridement performed after a week of olorofim therapy resulted in a greatly reduced number of positive tissue cultures with successful post-operative healing and improved function. Within four months of drug administration, fungal cultures from debridement were negative and fungitell labs were undetectable.

Discussion:
This case illustrates a prototypic presentation of Lomentospora prolificans in the immunocompetent host, including the diagnostic delay that is commonly encountered. After our patient failed to respond to both voriconazole alone and a salvage regimen of voriconazole, terbinafine, and caspofungin, he was placed on an investigational therapy with positive clinical results. Within four months after the initiation of olorofim, the patient’s last surgical washout yielded no additional positive fungal cultures and demonstrated negative fungitell labs.


Bury My Axe in Wounded Knee: Lomentospora Prolificans Joint Infection in an 
Immunocompetent Host

Cytophagic histiocytic panniculitis (CHP) is a rare form of lobular panniculitis, characterized by macrophages (histiocytes) exhibiting hemophagocytosis within subcutaneous fat. This reflects a deeper immune dysregulation that may progress to hemophagocytic lymphohistiocytosis (HLH), a life-threatening hyperinflammatory syndrome.
We present the case of a 6-year-old boy with a history of inverse psoriasis who developed subcutaneous plaques and joint swelling. A prompt skin biopsy confirmed CHP. Shortly afterward, he developed high fever and progressive respiratory distress, meeting diagnostic criteria for secondary HLH. His treatment included high-dose corticosteroids, biologic agents, cytotoxic immunosuppressants, and extracorporeal membrane oxygenation (ECMO).
This case emphasizes the importance of early recognition and biopsy of atypical panniculitis, given the potential for rapid progression to HLH with high mortality despite aggressive therapy.

Cytophagic Histiocytic Panniculitis with Secondary Hemophagocytic Lymphohistiocytosis in a Child: A Case Report


Case Report: Treatment of Diffuse-Type Tenosynovial Giant Cell Tumor with Vimseltinib

Background
Tenosynovial Giant Cell Tumor (TSGCT) is a rare, benign proliferative disorder involving the synovial lining of joints, bursae, and tendon sheaths. The diffuse subtype (D-TSGCT) is particularly uncommon, with an estimated incidence of approximately 5 cases per million person-years. It is locally aggressive and can be challenging to manage, particularly when surgical resection is incomplete.

Case Presentation
A middle-aged male with no prior history of trauma presented to his primary care physician with progressive right knee pain, stiffness, and swelling over the course of one year. He was initially diagnosed with a meniscal injury and treated conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs) before being referred to an orthopedic specialist. Magnetic resonance imaging (MRI) revealed hemosiderin deposition along the synovium, raising suspicion for diffuse-type TSGCT. Despite surgical intervention, the patient reported only minimal symptomatic improvement. He was subsequently referred to a hematologist-oncologist and initiated on Vimseltinib, a selective CSF1R inhibitor. Within two weeks of therapy, the patient experienced marked improvement in knee pain, stiffness, and swelling.

Discussion
TSGCTs are driven by overexpression of colony-stimulating factor 1 (CSF1) due to chromosomal translocations, leading to recruitment of CSF1 receptor (CSF1R)-expressing cells and subsequent tumor growth. Complete surgical excision is often difficult, especially in diffuse cases, and recurrence is common following incomplete resection. This case illustrates the efficacy of Vimseltinib, an oral, selective CSF1R inhibitor recently approved by the FDA for the treatment of TSGCT. The patient demonstrated significant clinical improvement shortly after initiation of therapy, highlighting the potential of targeted pharmacologic treatment as a viable alternative or adjunct to surgery in managing diffuse-type TSGCT.


Case Report: Treatment of Diffuse-Type Tenosynovial Giant Cell Tumor with Vimseltinib

Background.
Any traveler with a fever within two months of visiting a malaria-endemic area should be
presumed to have malaria until definitively diagnosed, given the high prevalence in these
regions. We are presenting a clinical case where the travel history was a clue in the diagnosis of
the patient with unexplained severe abdominal pain and no fever on admission.
Case presentation.
A 48-year-old woman with no significant past medical history presented with severe right upper
quadrant abdominal pain radiating to the lower back, accompanied by nausea and bilious
vomiting that began one day prior to admission. She reported normal bowel movements and no
fever or chills. The patient had traveled to Sierra Leone for one month and returned two weeks
before admission, with no prior preventive medical treatment or vaccination before her trip.
Her vital signs: t 98.9 F, heart rate 118 bpm, blood pressure 100/68 mm Hg; non icteric sclera;
significant tenderness and guarding along the right lower rib cage on palpation, with no signs of
fluid shift.
Laboratory test on admission were normal except mild elevation of liver function tests (LFT):
Total bilirubin 2.3 mg/dL ( reference range 0.0 - 1.3), AST 76 U/L (14-36), ALT 67 U/L (<35),
Alkaline Phosphatase 113 U/L (38-126), Lipase 102 U/L (23-300)
CT abdomen with IV contrast: liver without focal lesions, no intrahepatic ductal distention, non
distended gallbladder, normal pancreas.
Third day from admission: fever of 102.2°F, with a significant drop in platelet and hemoglobin
levels, Hb 8.6 (G/DL), Platelet 69 (10^3uL), and worsening LFT: total bilirubin 4.4, direct bilirubin
2.3, AST 40, ALT 35, Alkaline phosphatase 90.
Blood smear revealed ring form inclusions in the red blood cells (RBC), positive for parasites.
Antigen test was positive for Plasmodium falciparum (PF).
Discussion.
Malarial hepatopathy, characterized by bilirubin levels >2.5x upper limit of normal and elevated
transaminases, indicates malaria-associated liver injury.
Elevated liver function tests (LFTs) in early-stage PF infection are significantly associated with
parasite load and inflammatory markers. Later, the progression of severe PF malaria often
results from parasitized RBC cytoadherence to the vascular endothelium, as well as from
infected RBC (platelet-mediated agglutination) and uninfected erythrocyte interactions
(rosetting). This sequestration in the microvasculature reduces local oxygen delivery, leading to
vital organ failure.
Malarial hepatopathy should be considered in travelers presenting before the fever onset to
facilitate early diagnosis of malaria.

Early Malaria Presentation in Afebrile Patient with Unexplained Severe Abdominal Pain

Abstract Title: A Decade Of Headaches Unraveled: Jugular 
Decompression Via C1 Osteotomy In Venous Eagle Syndrome
Background:
Eagle syndrome is a rare disorder most commonly associated with an elongated styloid process causing cervicofacial pain, dysphagia, or carotid compression. A lesser-known variant, venous Eagle syndrome, involves internal jugular vein (IJV) compression, typically between the styloid process and the C1 transverse process, which can impair venous outflow from the brain. This variant is increasingly recognized in the pathophysiology of headache disorders, yet the role of C1 transverse process osteotomy as a definitive treatment remains poorly documented and underreported in literature.
Case Presentation:
A 57 y/o female with no significant past medical history presented with intractable right sided headaches and facial pain persisting for over a decade that were near daily and disabling. She denied associated nausea, vomiting, or visual disturbances. The impact on her quality of life was substantial, limiting her daily function and productivity. Extensive evaluation including CT brain, CTA neck and CTA brain revealed no acute findings or vascular malformations. Prior treatments including medication and conservative measures by her neurologists had failed. Given her refractory symptoms, diagnostic cerebral venography with manometry was performed, which identified bilateral IJV stenosis due to compression between the styloid process and the C1 transverse process, worse on the left. Dynamic occlusion of the left IJV occured with certain neck positions. Critically, monometry demonstrated a > 4 cm H2O pressure gradient across the stenosis, confirming hemodynamic significance of the compression. The patient underwent microsurgical resection of the left C1 transverse process with stereotactic navigation. Notably, no styloidectomy was performed. The procedure was uncomplicated. Postoperatively, she experienced complete and sustained resolution of her headaches and facial pain, with full relief maintained at her three month follow up with no use of medications, marking her first period of complete remission in over ten years.
Discussion:
This case underscores the importance of recognizing venous Eagle syndrome as a potential cause of refractory chronic headache, particularly when standard imaging is unrevealing. While styloidectomy is the traditional surgical approach, C1 transverse process osteotomy alone can be curative when bony impingement at C1 contributes to IJV compression. The use of manometry was pivotal in documenting the physiologic impact and guiding surgical decision making. For patients with chronic, unexplained headaches and documented venous outflow obstruction, C1 transverse process osteotomy may offer complete symptom relief. This case contributes to the limited literature on this targeted intervention and highlights the need for greater clinical awareness of venous Eagle syndrome in headache evaluation.

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An In vitro Study of the Ability of Simvastatin and Atorvastatin to Inhibit Select BSL-2 Bacteria Associated with Pin-Tract Infections

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