Papers by Thomas C Varkey
Exploration of Medicine
The patient is a 58-year-old male who presented with chief complaints of right-sided numbness, ti... more The patient is a 58-year-old male who presented with chief complaints of right-sided numbness, tingling, and loss of temperature sensation in the upper and lower extremities. The patient’s symptoms began around the face and right corner of the mouth [maxillary/mandibular (V2/V3) distribution] before descending to the arm, trunk, and followed by the lower leg and foot. His home medication regimen included lisinopril, atorvastatin, long and short-acting insulin, and amlodipine. During the interview, the patient admitted to abstinence from his medications. Upon examination, the patient was found to have a loss of hot and cold touch on the right side and expressed 2+ reflexes (brisk response; normal) on both upper and lower extremities. In the initial work-up of the patient, he received a computed tomography (CT) scan which demonstrated an area of potential ischemic infarct of one of the left sided pontine perforator arteries. Immediately at that time he was given a loading dose of 325 ...
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Exploration of Medicine
Bell’s palsy is a rapid unilateral peripheral paralysis of cranial nerve VII whose etiology is va... more Bell’s palsy is a rapid unilateral peripheral paralysis of cranial nerve VII whose etiology is varied, most commonly associated with an acute infectious or inflammatory demyelinating process. Nerve injury can result in edema because of increased permeability of vascular structures, which can sometimes be seen as a locus of enhancement of magnetic resonance imaging (MRI). Bell’s palsy is typically considered a clinical diagnosis and the specificity and sensitivity of imaging have been poorly studied. Herein is describe a case of a 73-year-old male who presented to the emergency department with left-sided facial droop and no other focal neurological abnormalities. With a history of a Janus kinase 2 (JAK2) mutation and the new initial facial drooping, acute cerebrovascular insult was high on the differential. Initial labs and computerized tomography (CT) head were inconclusive, but MRI showed pronounced enhancement of the left distal internal carotid artery (ICA) with contiguous enhanc...
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MedEdPublish, Jul 17, 2023
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MedEdPublish
Background: Dyad learning is a two-person learning dynamic in which one student observes the othe... more Background: Dyad learning is a two-person learning dynamic in which one student observes the other performing tasks, with their roles then being reversed such that both students experience the observer and the performer role. The efficacy of dyad learning has been tested in medical education contexts, such as in medical simulation. To our knowledge, this is the first systematic review that has evaluated the efficacy of dyad learning in a medical simulation context. Methods: PubMed, Google Scholar, Cochrane Library databases were searched in September 2021 and January 2022. Prospective studies of randomized design that compared dyad learning to a single medical student or physician learning in a medical simulation were included. Non-English language studies, secondary literature papers, non-human based studies, and papers that were published prior to 2000 were excluded. The methodological quality of these studies was assessed using the Medical Education Research Study Quality Instrum...
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Neurology - Neuroimmunology Neuroinflammation
We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing fa... more We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing failed to confirm a specific diagnosis; hence, she was diagnosed with seronegative neuromyelitis optica spectrum disorder and treated with the immunotherapy rituximab, later in conjunction with mycophenolate mofetil. She achieved a durable remission for 9 years until she presented with paresthesia affecting her left fifth digit, right proximal thigh, and left foot, while also reporting a 25-pound weight loss over the prior 3 months. New imaging demonstrated a longitudinally extensive and enhancing optic nerve, in conjunction with multifocal enhancing lesions within the spinal cord, in a skip-like distribution. The differential diagnosis is discussed.
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Journal of Evidence-Based Integrative Medicine, 2019
The leaf of Osyris quadripartita is traditionally used for the management of diarrhea in differen... more The leaf of Osyris quadripartita is traditionally used for the management of diarrhea in different parts of Ethiopia. However, its use has not been scientifically validated for its efficacy. The aim of this study was to investigate antidiarrheal activity of hydroalcoholic leaf extract of O. quadripartita in mice models. Different doses of the methanolic leaf extract of O. quadripartita (100, 200, and 400 mg/kg) were tested for antidiarrheal activity using castor oil–induced diarrhea, enteropooling, and gastrointestinal motility models in Swiss Albino mice. The activities of the extract at different doses were compared with standard drugs and negative control groups of mice. The extract at all tested doses resulted in significant reduction ( P < .01) in number of wet feces, whereas significant reduction ( P < .01) in frequency of defecation in castor oil–induced diarrhea was seen at a dose of 400 mg/kg. It also showed a dose-dependent and significant reduction of volume of inte...
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Academia Medicine
This case study focuses on the evaluation of a patient with both upper and lower gastrointestinal... more This case study focuses on the evaluation of a patient with both upper and lower gastrointestinal (GI) complaints in the outpatient setting, that is, how the evaluation skipped over several crucial diagnostic steps, and how this impacted the patient. Special care is given to the patient’s perspective, differential diagnosis, recommended laboratory testing, and their corresponding costs, taking on a patient-centered approach to the evaluation, diagnosis, and treatment of illness. In this case, sufficient medication history was not obtained, causing the patient to undergo an expensive and unnecessary procedure. Acquiring this information is the cornerstone of an effective patient-physician relationship. Based on the history, a standardized diagnostic approach can be employed, given the likelihood of certain diagnoses. Often, the workup should start with less invasive and expensive tests. However, it is important to consider each isolated case, as a more aggressive approach may be indicated in certain instances. Special attention to communication between the patient and provider is key in ensuring that the patient understands what is happening in their medical care, which improves their communication with relevant information to the care provider, and through such understanding, our patients are better able to provide informed consent.
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Academia Medicine, Sep 19, 2023
This case study focuses on the evaluation of a patient with both upper and lower gastrointestinal... more This case study focuses on the evaluation of a patient with both upper and lower gastrointestinal (GI) complaints in the outpatient setting, that is, how the evaluation skipped over several crucial diagnostic steps, and how this impacted the patient. Special care is given to the patient’s perspective, differential diagnosis, recommended laboratory testing, and their corresponding costs, taking on a patient-centered approach to the evaluation, diagnosis, and treatment of illness. In this case, sufficient medication history was not obtained, causing the patient to undergo an expensive and unnecessary procedure. Acquiring this information is the cornerstone of an effective patient-physician relationship. Based on the history, a standardized diagnostic approach can be employed, given the likelihood of certain diagnoses. Often, the workup should start with less invasive and expensive tests. However, it is important to consider each isolated case, as a more aggressive approach may be indicated in certain instances. Special attention to communication between the patient and provider is key in ensuring that the patient understands what is happening in their medical care, which improves their communication with relevant information to the care provider, and through such understanding, our patients are better able to provide informed consent.
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Emergency Care Journal
Neck pain has become a commonly encountered complaint in the emergency department and primary car... more Neck pain has become a commonly encountered complaint in the emergency department and primary care office. A large proportion of the population, ranging from a fifth (⅕) to a third (⅓) of the total, will experience non-specific neck pain in their lifetime. Because of the difficulty to quickly parse out the differential and the severity of several of these diagnoses, it is imperative for physicians in the emergency department to establish a systematic and effective approach for evaluating nonspecific neck pain. This article will present a standardized case of a patient presenting with nonspecific neck pain, critically analyze current evidence and guidelines from major ruling bodies in internal medicine, neurology, neurosurgery, and radiology, examine major statements released by the Choosing Wisely Campaign, and propose a new diagnostic decision tree for the management of nonspecific neck pain.
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Journal of Family & Reproductive Health
Objective: The transgender male body is often considered a “black box” by even the most senior of... more Objective: The transgender male body is often considered a “black box” by even the most senior of attending physicians. Because of the stigma and fear associated with the utilization of Hormone Replacement Therapy (HRT) and the lack of clinical knowledge surrounding the subject, many transgender men will experience unnecessary testing for endometrial cancers. Materials and methods: This narrative review looked through publicly available PubMed and GoogleScholar articles on the topic of the use of pelvic ultrasounds in gynecological screening in transgendered males. 18,000 articles were filtered by relevance, date, clarity of the topic, and clinical recommendations. Of these articles 37 were included for discussion. Results: Of these 18,000 articles, only 37 were included for discussion. The resulting table, diagnostic tree, and discussion section are included within. Conclusion: Herein, the authors discuss the current understanding of the role of imaging in the diagnosis and treatme...
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Galician Medical Journal
The purpose of this study was to demonstrate the desire and need for peer-to-peer tutoring progra... more The purpose of this study was to demonstrate the desire and need for peer-to-peer tutoring programs at Division 1 Dell Medical School at the University of Texas. Materials and Methods. Two sets of surveys were created and sent to students at the Dell Medical School, University of Texas, USA. One survey asking about the need or desire to engage with a peer tutor was sent to first-year students, and another one asking about the desire to provide these services to underclassmen as a potential leadership course option was sent to third-year students. Results. For the first-year student survey, 52.9% of respondents disagreed or strongly disagreed of being aware of near-peer tutoring and 70.5% of respondents either agreed or strongly agreed that it would be an option utilized by students. For the third-year student survey, 75% of students either disagreed or felt neutral in being aware of near-peer tutoring as an option to serve underclassmen, whereas 65% of upperclassmen either agreed or...
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International Journal of Medical Science and Clinical Invention
The intentional and unintentional use of scents have long been implemented in the arts. As an ele... more The intentional and unintentional use of scents have long been implemented in the arts. As an element of design, the use of fragrances may increase audience immersion by engaging the sense of smell through the olfactory receptors, in addition to becoming a tool for the performers. Since the COVID-19 pandemic began, most performing companies have been forced to shift the showcasing of work primarily online. Many of the subtle effects produced by both the cast and the design team that one may appreciate in-person are inevitably lost in virtual theatre, falling secondary to the screen. One potential solution for ensuring that digital productions can continue traditions of theatre while considering the safety of guests would be through the utilization of strategically crafted scents that support the performance’s story and the overall direction of the production. In virtual performances, the use of scent can be useful to ground both the audience and performers within the same world by l...
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Current Medicine
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The coronavirus disease 2019 (COVID-19) pandemic has produced a world-wide collapse of social and... more The coronavirus disease 2019 (COVID-19) pandemic has produced a world-wide collapse of social and economic infrastructure, as well as constrained our freedom of movement. This respiratory tract infection is nefarious in how it targets the most distal and highly vulnerable aspect of the human bronchopulmonary tree, specifically, the delicate yet irreplaceable alveoli that are responsible for the loading of oxygen upon red cell hemoglobin for use by all of the body\u27s tissues. In most symptomatic individuals, the disease is a mild immune-mediated syndrome, with limited damage to the lung tissues. About 20% of those affected experience a disease course characterized by a cataclysmic set of immune activation responses that can culminate in the diffuse and irreversible obliteration of the distal alveoli, leading to a virtual collapse of the gas-exchange apparatus. Here, in Part I of a duology on the characterization and potential treatment for COVID-19, we define severe COVID-19 as a c...
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Emergency Care Journal
Patients often present to the emergency department with nonspecific complaints of lumbar back pai... more Patients often present to the emergency department with nonspecific complaints of lumbar back pain. Because of the nature of the emergency department, the lack of knowledge or time on the part of providers, and the high levels of quick decision making, unnecessary imaging studies are often ordered to provide care for the patient’s emotional and perceived physical needs. This narrative review will present a hypothetical typical standardized case of a patient presenting with lower back pain, examine the current evidence and recommendations from the major ruling bodies in internal medicine, neurology, neurosurgery, and radiology, evaluate the major statements released by the Choosing Wisely campaign, and finally, present a new diagnostic decision tree for the management of lumbar back pain.
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BMC Medical Education
Background Inappropriate prescription of intravenous fluid therapy is highly prevalent in hospita... more Background Inappropriate prescription of intravenous fluid therapy is highly prevalent in hospitals, with up to 1 in 5 patients suffering from preventable, additional morbidity. Since trainee physicians are frequently responsible for prescribing intravenous fluids, it is possible that common medical student resources do not sufficiently cover the topic. There is a paucity of recent literature on this issue, which this study was designed to address. Methods Two original evaluation tools were created by the authors to evaluate reference books, official guidelines, and online reference sources commonly used by medical students in the United States of America, Australia, and the United Kingdom on their coverage of foundational and clinically relevant principles of intravenous fluid prescription. The choice of student resources was guided by a literature search and personal experience. A total of 10 resources was assessed. Results Resources were generally deficit in their coverage of bas...
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International Journal of Medical Students
Attaining admission into medical school has been described as a very competitive process by succe... more Attaining admission into medical school has been described as a very competitive process by successful matriculants. The processes that medical schools use to stratify applicants can greatly differ between institutions. These systemic differences flow over onto the applicant level, such that individuals from different geographic regions can have varied and diverse application experiences depending on local medical school admissions protocols. This piece compares the medical school admission processes of Australia and the United States of America, in the form of a narrative recount of a successful medical school matriculant in each country, with the individual experiences of matriculants from alternative pathways blended into the piece. The authors discovered significant differences in admissions protocols between the two countries, with the greatest differences revolving around admissions exams, applicant profile (high school students versus college students), degree types and alter...
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Cureus, 2021
This paper discusses an interesting case of pan plexopathy and the difficulties associated with t... more This paper discusses an interesting case of pan plexopathy and the difficulties associated with the diagnostic processes based on patient-specific circumstances. It walks through the major differential of the etiology of the patient’s particular presenting symptoms and the associated diagnostic and therapeutic process by which this particular patient was treated. In the discussion, the relevant anatomy of the brachial plexus and the surrounding structures in both the cervical and the axillary regions is discussed and key clinical pearls that became apparent throughout the diagnostic workup that was significant for a hematoma and therapeutic process aimed at providing symptomatic relief until recovery to baseline. This case study discusses the benefits, drawbacks, and financial costs of utilizing the major different imaging modalities such as CT, MRI, or Point of Care Ultrasound (POCUS). Finally, this study provides a new diagnostic algorithm for the selection of the imaging modality...
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International Journal of Medical Reviews and Case Reports, 2021
This paper looks at a classical case study and evaluates the patient based on the current literat... more This paper looks at a classical case study and evaluates the patient based on the current literature and recommended best practices at the time of writing. The main focus is on the different treatment approaches and how these can be leveraged to ensure both patient safety and prevent non-adherence to their medications due to cost. Finally, the authors highlight some key clinical pearls for the betterment of medical students and resident trainees.
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Papers by Thomas C Varkey