Background: The “July effect” is a perceived increased risk of medical errors that occurs when US medical graduates begin residencies. There is substantial variability in results across studies of the “July effect” on patients who are admitted for heart attacks. Furthermore, studies that do show statistically significant increase in mortality at the start of residency [...]

Case Presentation: A 28 year old Nepali female presented with convulsive activity and one week of progressive changes in behavior and mental acuity. She had polyarthralgia, painful cervical lymph nodes, malar rash, subjective fever, headaches, and fatigue for 2 months. Previous workup revealed positive antinuclear antibody (ANA), anti-ribonuclearprotein (RNP), and anti-Ro antibodies with no formal [...]

Case Presentation: A 57 year old male with HIV/AIDS was transferred to our hospital for acute onset of lethargy and incoherent speech. He intially presented with a few weeks of headaches, slurred speech, and intermittent confusion, and was diagnosed with toxoplasmosis. He was started on atovaquone and sulfadiazine for taxoplasmosis and levetiracetam for seizure prophylaxis, [...]

Case Presentation: A 29-year-old male presented with a new onset focal seizure and dull persistent right sided headaches for 2 weeks. Physical exam was negative for any focal neurological deficit except for a diffuse erythematous rash involving trunk and his extremities, bilateral conjunctival injection and mild confusion. An urgent CT head revealed a small acute [...]

Case Presentation: Introduction:Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that most commonly affects younger women. Late onset SLE is relatively rare and represents a specific subgroup. Laryngeal involvement in SLE is uncommon and has a wide range of disease severity. Case: A 68 year old female patient with history of diabetes mellitus type [...]

Case Presentation: 59 year old woman with a history of recently diagnosed rheumatoid arthritis (RA) not on therapy presents with substernal non radiating chest pain and right upper quadrant pain worsening with inspiration and dyspnea on exertion (DOE) for one week. Patient also reported dysphagia, dry mouth and Raynaud’s phenomenon. Exam showed normal vital signs [...]

Case Presentation: A 66-year-old female presented to the hospital with two days of acute chest pressure which occurred at rest. It was intermittent in nature but had persisted over the past two days which prompted her to present to the hospital. She had a past medical history of diabetes mellitus, hypertension, and heart failure with [...]