Medical Specialties Commons^™

Cost-Effectiveness Of Recombinant Zoster Vaccine For Vaccinating Immunocompromised Adults Against Herpes Zoster In The United States, Desmond Curran, Ahmed Salem, Stephane Lorenc, Brandon Patterson, Justin Carrico, Katherine A. Hicks, Elizabeth M. La, Sara Poston, Christopher F. Carpenter

Conference Presentation Abstracts

Background. Individuals who are immunocompromised (IC) due to disease or therapy are at increased risk of herpes zoster (HZ), with HZ cases in IC populations also resulting in increased health care resource use and costs as compared with the immunocompetent population. This study assesses the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in IC adults aged ≥ 18 years in the United States (US). Methods. A Markov model with a one-year cycle length was developed to follow a hypothetical cohort of one million IC individuals for a 30-year time horizon. The model estimates …

Direct Oral Anticoagulants For Stroke Prevention In Patients With Atrial Fibrillation And Bioprosthetic Heart Valves, Vardhmaan Jain, Kirtipa Bhatia, Devika Aggarwal, Agam Bansal, Bharat Narasimhan, Michael J. Hendrickson, Sameer Arora, Michael J. Ricciardi, Arman Qamar

Articles

No abstract provided.

A Novel Combination Chemotherapy Targeting Extramedullary Disease In Multiple Myeloma Following First-Line Treatment Failure, Ruaa M. Elteriefi, Nourelhuda Abbas Hamed, Omar Nasser Rahal, Faisal Musa

Conference Presentation Abstracts

Introduction:

Multiple Myeloma (MM), a plasma cell neoplasm that resides in the bone marrow’s intramedullary space.

Extramedullary disease (EMD) occurs when plasma cells extend through the bone cortex or via hematogenous spread to different organs.

This case of EMD of MM didn’t respond to the first line RVD regimen per NCCN guidelines which includes Lenalidomide (Revlimid), Bortezomib (Velcade), and Dexamethasone (Decadron). Therefore, new combination chemotherapy including Daratumumab, and Carfilzomib was initiated with excellent response.

Case description:

62-year-old female presenting to the oncologist for progressive right hip pain for 4 weeks. Initial hip x-ray and bone scan suspected malignancy. MRI showed …

Cost-Effectiveness Analysis Of Recombinant Zoster Vaccine For The Prevention Of Herpes Zoster In Immunocompromised Adults Diagnosed With Select Cancers In The United States, Desmond Curran, Brandon Patterson, Justin Carrico, Ahmed Salem, Elizabeth La, Stephane Lorenc, Katherine Hicks, Sara Poston, Christopher Carpenter

Conference Presentation Abstracts

Introduction / Background / Significance: Immunocompromised (IC) populations diagnosed with cancer are at increased risk for herpes zoster (HZ) due to their underlying disease and/or therapy. This risk is highest among individuals receiving hematopoietic stem cell transplant (HSCT) to treat multiple myeloma, lymphomas, or other diseases. HZ is characterized by a painful vesicular rash. IC populations with HZ are also at increased risk of developing HZ-related complications such as postherpetic neuralgia, a persistent pain that can last for months or years. This study evaluates the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in …

Diabetic Preventative Care In A Resident Clinic: A Quality Improvement Study, Karishma Chopra, Charity Owusu-Asare, Aimee Espinosa, Alexandra Halalau

Conference Presentation Abstracts

Introduction: Studies have shown significant gaps in diabetic preventative care in resident clinics compared to private clinics of practicing physicians. In our medicine-pediatrics resident clinic at Beaumont Hospital, diabetic point of care resources are largely underutilized. We aim to improve the care of patients with diabetes by increasing resident awareness of point of care A1c and retina scan resources. Methods: A team of residents, attendings, and nurses was created. Baseline data looking at use of point of care resources, specifically the number of orders placed in electronic medical record for A1c and retina scan tests, was obtained. A root cause …

Late Onset Burkitt Post Transplant Lymphoproliferative Disorder (Ptld) Following Solid Organ Transplant, Melinda Sager, Devika Aggarwal

Conference Presentation Abstracts

Post Transplant Lymphoproliferative Disorder (PTLD) is an uncommon complication after solid organ transplant, with several different monomorphic subtypes; Burkitt Lymphoma PTLD (B-PTLD) is particularly rare and aggressive.

A 30 year old female with a history of IgA nephropathy and two renal transplants presented to the emergency room with nausea, vomiting, and diffuse abdominal distention and pain that started one week prior to presentation. CT imaging showed significant mesenteric and pelvic lymphadenopathy with moderate ascites, paracentesis was performed. Her immunosuppressive therapy was adjusted: azathioprine was held, tacrolimus was decreased for lower target level, and steroid was continued. A lymph node biopsy …

Type 1 Cryoglobulinemia Secondary To Primary Plasma Cell Leukemia, Antonio Faieta, Khatoon Tawhida

Conference Presentation Abstracts

Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia that comprises 1% of the plasma cell dyscrasias. Even more rare is its association with type 1 cryoglobulinemia which management can be challenging. A 63-year-old African American male with no past medical history presented with severe burning pain in his legs, necrotizing rash, constitutional symptoms and severe acute kidney injury (AKI). HIV, hepatitis B and C were negative. Serum electrophoresis revealed an M-spike of 5.67, IgG of 7000, free lambda of 152.10 with a K/L of 0 and cryoglobulin of 81%. CT revealed extensive lytic …

Refractory Non-Tumor Lambert Eaton Syndrome Treated With Rituximab, Bipin Ghimire, Samiksha Pandey, Ashbina Pokharel, Emma Herrmann, Mohammad Muhsin Chisti

Conference Presentation Abstracts

With a worldwide prevalence of 3-4 per million, Lambert-Eaton syndrome is a rare entity. It often occurs as a paraneoplastic syndrome, most commonly associated with small cell lung cancer. Less frequently, it occurs as an autoimmune disease in the absence of cancer. Both entities demonstrate circulating immunoglobulins against presynaptic voltage-gated calcium channels and Electromyogram (EMG) with an increase in compound muscle action potential on repetitive stimulation. A 35-year-old female with past medical history of hypothyroidism presented with bilateral lower extremity weakness, generalized fatigue, blurry vision, and slurred speech in 2010. Upon further workup, Lambert-Eaton syndrome was diagnosed after she tested …

Social Determinants Of Health Correlating With Mechanical Ventilation Of Covid-19 Patients; A Multi-Center Observational Study, Alexa Giovanatti, Heba Elassar, Patrick Karabon, Tracy Wunderlich-Barillas, Alexandra Halalau

Conference Presentation Abstracts

Importance: Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities, however few have specifically examined the association between social determinants of health and mechanical ventilation (MV). Objective: To determine which demographics impact MV rates among COVID-19 patients. Design: This observational study included COVID-19 patient data from eight hospitals’ EMR between February 25, 2020 to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses. Setting: Multicenter (8 hospitals), largest health system in Southeast Michigan Participants: Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic …

Intracardiac Leiomyomatosis Presenting As Syncope, Ujjwal Karki, Bijaya Thapa, Shailesh Niroula, Bipin Ghimire, Tucker Billups, Shrinjaya Thapa

Conference Presentation Abstracts

Primary cardiac tumors are rare, with incidence less than 0.1 percent. Secondary tumors are 20 times more common. Tumor thrombus extending to the right heart is commonly seen with renal cell carcinoma. Less common etiologies include intravenous leiomyoma, gynecological malignancies, Wilms tumor, hepatoma, and adrenocortical carcinoma. 46-year-old female with history of uterine fibroid presented with two episodes of syncope, lasting 30 seconds each. Echocardiogram revealed a mobile echogenic mass in right atrium extending from the inferior vena cava (IVC) and moving across the tricuspid valve, causing dynamic obstruction. Cardiac MRI showed the mass originated from the renal vein with similar …

Improving Telemetry Utilization In An Inpatient Hospital Setting, Kamil Sardarli, Lauren Reinhold, Ankit Arora, Sumesh Khanal, Pradeep Kaminoulu, Alexandra Halalau

Conference Presentation Abstracts

Background: Telemetry is a cardiac monitor that continuously records heart activity and monitors abnormal rhythms. Most current clinical indications are limited to 48 hours maximum, but telemetry monitoring service (TMS) is commonly used for a greater duration. This leads to resource exploitation that may create limitations of the resource and also comes with economic burden. Limiting usage to appropriate indications and durations can reduce overall costs and improve profit margin for the hospital and also cut down on unnecessary burden for patients. Through our study, we aim to decrease TMS overuse. Methods: The study was done at Beaumont Hospital Royal …

Granular Cell Tumor Of The Breast: A Breast Malignancy Mimicker, Emma Herrmann, Markie Zimmer, Bana Antonios, Bipin Ghimire, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Granular cell tumors are soft tissue neoplasms that can arise from virtually any body site. They are thought to arise from Schwann cells of the peripheral nervous system. The overwhelming majority are benign, with only 1-2% of cases being malignant. Granular cell tumors of the breast can often mimic breast malignancy. A 62-year-old female with past medical history of hypertension and prior tobacco use had abnormal screening mammography. Family history was positive for breast malignancy in 2 sisters and a maternal first cousin. Prior mammography was unremarkable, aside from one year prior which revealed a concerning 6 mm nodule in …

Gallstone Ileus Complicating Rectal Cancer: A Red Herring Cause Of Abdominal Pain, Nicholas Lazar, Ovidiu Niculescu, Carol Lima, Neiberg Lima

Conference Presentation Abstracts

A 68-year-old male with a history of alcohol abuse presented with a one-week history of fatigue and weakness, and a one-year history of fecal incontinence. On admission, vital signs were stable. Physical exam revealed cachexia, skin pallor, and mild abdominal distention. Fecal occult blood testing was positive. Laboratory analysis was significant for hemoglobin of 6.8g/dL. Of note, computed tomography (CT) scans of his chest, abdomen, and pelvis done months prior for evaluation of anemia and incontinence had shown rectal wall thickening, lung nodules concerning for metastasis, and gallstones. He declined further diagnostic evaluation and was lost to follow up. During …

Massive Pulmonary Embolism After Pfizer Vaccine, Samiksha Pandey, Bipin Ghimire, Emma Herrmann, Dilip Khanal

Conference Presentation Abstracts

Introduction Vaccines against COVID -19 have been reported to cause venous thromboembolism (VTE). To our knowledge, this is the first case to report the massive, near-fatal Pulmonary Embolism (PE) associated with BNT162b2 Covid-19 (Pfizer/BioNTech) vaccine and discuss the associated risk factors for PE. Case 41-year-old, non-smoker, female on OCP, presented for syncope and seizure-like activity. Upon presentation, she was obtunded and tachypneic. Initial labs showed leukocytosis, mild anemia, and thrombocytopenia, respiratory and metabolic acidosis. She deteriorated quickly to cardiac arrest requiring Cardiopulmonary Resuscitation and intubation. Tissue Plasminogen Activator administered for possible PE. Computed Tomography Angiography (CTA) pulmonary confirmed sagittal pulmonary …

Synergistic Bleomycin Toxicity And Evali: A Lethal Combination, Daniel O'Connor, Nader Mina, Hira Iftikhar

Conference Presentation Abstracts

Introduction: Both vaping and bleomycin-based chemotherapy regimens are known risk factors for acute lung injury. Few, if any, cases are documented in the literature of these insults co-occurring. Case description: A 20-year-old male was diagnosed with Stage III testicular cancer in Autumn of 2020. He began BEP (bleomycin-etoposide-platinum), of which he completed three cycles before developing pulmonary sequelae. Social history was notable for marijuana use and vaping, including during his active chemotherapy, to help with cancer-related nausea, anxiety, and anorexia. Winter 2021, he visited the ED for dizziness, fatigue, and diarrhea, felt to be consistent with chemotherapy side effects, but …

Metronidazole Neurotoxicity--Not Your Usual Suspect, Markie Zimmer, Bana Antonios, Emma Herrmann, Ramona Berghea

Conference Presentation Abstracts

An 85-year-old female with past medical history notable for chronic lymphocytic leukemia and Stage III Merckel cell carcinoma presented to our hospital for evaluation of generalized weakness of a few weeks duration. Notably, she had a recent hospital admission for E. coli bacteremia in the setting of hepatic abscesses that underwent ultrasound guided drainage. She was discharged to inpatient rehabilitation, and ultimately home, with a planned six-week course of ceftriaxone and metronidazole, in addition to oral vancomycin for C. difficile infection. Upon readmission, she was fatigued and had progressive lower extremity weakness. She denied any bowel or bladder incontinence or …

Modified Clinical Risk Score To Predict Hospital Admission And In-Hospital Mortality In Covid-19 Patients, Olga R. Gomez Rojas, Inayat Gill, Zaid Imam, Patrick Karabon, Alexandra Halalau

Conference Presentation Abstracts

BACKGROUND: The COVID-19 pandemic has resulted in over 1 million deaths globally. Prognostic tools to identify high risk patients are crucial to guide resource allocation efforts. We aimed at developing a risk assessment tool for patients with COVID-19 based on the risk factors with most significant effect on hospital admission and in-hospital mortality METHODS: We performed a retrospective analysis of patients with positive COVID-19 presenting in between 3/31/2020 – 5/15/2020 at Beaumont Health’s 8 emergency departments (ED). Data was abstracted using automated reports. The electronic health record (HER) embedded risk score previously externally validated was modified based on risk factors, …

Efficacy Of A Pharmacist-Managed Diabetes Clinic In High-Risk Diabetes Patients, A Randomized Controlled Trial-"Pharm-Md", Alexandra Halalau, Melda Sonmez, Ahsan Uddin, Patrick Karabon, Zachary Scherzer, Scott Keeney

Conference Presentation Abstracts

BACKGROUND: Diabetes mellitus affects 13% of American adults. To address the complex care requirements necessary to avoid diabetes-related morbidity, the American Diabetes Association recommends utilization of multidisciplinary teams. Research shows pharmacists have a positive impact on multiple clinical diabetic outcomes. We aimed to determine impact of an education-focused pharmacist managed diabetes clinic model (PMDC) on hemoglobin A1c (HbA1c) and other diabetes core measures at 6 and 12 months follow-up. METHODS: Open-label randomized controlled trial with 1:1 allocation. Patients 18-75 years old with type 2 diabetes mellitus and most recent HbA1c ≥9% were enrolled from a single institution resident- run outpatient …

“Nut” An Anatomical Malignancy! A Solid Tumor Characterized By A Genetic Translocation, Bana Antonios, Ruby Gupta, Nwabundo Anusim, Markie Zimmer, Emma Herrman, Ishmael Jaiyesimi

Conference Presentation Abstracts

NUT midline carcinomas are rare poorly differentiated tumors driven by t(15,19) rearrangements and clinically characterized by rapid progression and high mortality. A 49 year-old-male with no comorbidities, presented with acute worsening of chronic cough, new onset hemoptysis and left sided chest pain for 2 weeks. Workup revealed NUT midline carcinoma of the lung as confirmed by next-generation sequencing that revealed the presence of a NUTM1-BRD4 fusion. He was diagnosed with NUT midline lung cancer clinical stage IIIB. The tumor was not amenable to surgical resection, therefore, he was started on concurrent chemoradiation with weekly carboplatin and paclitaxel for 5 weeks. …

Potts Puffy Tumor: A Rare Complication Of Rhinosinusitis, Bipin Ghimire, Omar Jameel, Sumesh Khanal, Ryan Owen, Ashbina Pokharel, Samiksha Pandey

Conference Presentation Abstracts

Pott's puffy tumor is a sub-periosteal abscess of the frontal bone with associated osteomyelitis. It arises as a complication of untreated or partially treated frontal sinusitis. Overall prevalence has decreased due to timely treatment with antibiotics. It is largely limited to the pediatric population and is rare in adults. A 46-year-old Caucasian male with a history of chronic rhinosinusitis presented with one-week history of progressive painful swelling over the left forehead without any other systemic signs of infection. He was started on intravenous ampicillin-sulbactam and given one dose of dexamethasone due to concern for intracranial involvement. Facial CT showed 3 …

Rare Case Of Recurrent Hyperhemolysis Syndrome (Hhs) And Methemoglobinemia In A Patient With Sickle Cell Anemia, Ashbina Pokharel, Pradeep Khanal, Dilip Khanal, Samikshya Pandey, Bipin Ghimire

Conference Presentation Abstracts

Hyperhemolysis syndrome (HHS) is a rare but serious and potentially life-threatening complication of red blood cell (RBC) transfusion and has been described in both sickle cell disease and non-sickle cell disease patients. It is characterized by destruction of both donor and host RBC. Methemoglobinemia is another rare condition leading to cyanosis, tissue hypoxia and potentially death. We present a middle-aged female with sickle cell anemia who developed methemoglobinemia and hyperhemolysis after a surgical procedure. 41 yo female with sickle cell anemia (SC type) was hospitalized for elective right total hip resection arthroplasty. Patient received 3 units blood transfusion during the …

Very Late Relapse Of Hodgkin Lymphoma 18 Years After Remission, Bana Antonios, Markie Zimmer, Emma Herrman, Shiva Shrotriya, Ishmael Jaiyesimi

Conference Presentation Abstracts

A 72-year-old male with a history of protein C and protein S deficiency, factor V Leiden mutation, DVT/PE, and stage IIIB nodular sclerosis Hodgkin lymphoma (diagnosed 18 years back) presented with shortness of breath. EKG showed complete heart block and a transvenous pacemaker was placed. Laboratory studies showed severe normocytic anemia with hemoglobin of 6.2 g/dL, WBC of 2.6 bil/L, platelets of 113 bil/L, and INR of 2.8. The direct antiglobulin test was positive for Anti-IgG and negative for Anti-C3D. LDH was normal and haptoglobin was elevated, contrary to hemolysis. Computed tomographic scan of the abdomen and pelvis showed extensive …

Type 1 Cryoglobulinemia Secondary To Primary Plasma Cell Leukemia, Antonio Faieta, Khatoon Tawhida

Conference Presentation Abstracts

Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia that comprises 1% of the plasma cell dyscrasias. Even more rare is its association with type 1 cryoglobulinemia which management can be challenging. A 63-year-old African American male with no past medical history presented with severe burning pain in his legs, necrotizing rash, constitutional symptoms and severe acute kidney injury (AKI). HIV, hepatitis B and C were negative. Serum electrophoresis revealed an M-spike of 5.67, IgG of 7000, free lambda of 152.10 with a K/L of 0 and cryoglobulin of 81%. CT revealed extensive lytic …

A Broken Heart: A Case Of Stress Induced Cardiomyopathy Precipitated By Community Acquired Pneumonia, Adam Foglesong, Abdulla Kara Balla, A Neil Bilolikar

Conference Presentation Abstracts

Takotsubo cardiomyopathy or stress-induced cardiomyopathy is a syndrome characterized by a transient reduction of systolic cardiac function generally in response to emotional or physical stressors. Stress-induced catecholamine excess is believed to be the main factor driving myocyte dysfunction. Most patients are female and postmenopausal. We present a case of a 62-year-old Caucasian male with a past medical history of hypertension who presented to the ED with the chief complaint of squeezing chest pain followed by multiple episodes of productive cough and epigastric discomfort. ECG showed sinus tachycardia with premature supraventricular complexes. Chest X-ray showed severe pulmonary vascular congestion. Labs showed …

Acute Renal Failure And An Acid-Base Dilemma, Kamil Sardarli, Russell Leong, Matthew Weatherhead, Bhavinkumar Dalal

Conference Presentation Abstracts

Introduction: Acute renal failure (ARF) is well-recognized to result in metabolic acidosis. The acidosis of ARF is associated with decreased ammoniagenesis and anion excretion. Alkalosis in the presence of ARF presents diagnostic uncertainty and therapeutic challenges. This vignette describes a case of ARF resulting in several electrolyte imbalances and metabolic alkalosis. Case Description: A 54-year-old female with past medical history of small bowel resection with colostomy presented for nausea and vomiting for two weeks. On presentation, she was noted to be tachycardic and lethargic. Her workup revealed a serum creatinine of 6.8 mg/dL, blood urea nitrogen of 147 mg/dL, bicarbonate …

Triggers And Outcomes Of Takotsubo Cardiomyopathy In Cancer Patients, Antoine Addoumieh, Dinu Balanescu, Teodora Donisan, Juan Lopez-Mattei, Peter Kim

Conference Presentation Abstracts

Background: Takotsubo cardiomyopathy (TC) is a well described entity characterized by transient and reversible left ventricular (LV) systolic dysfunction. Primary TC is triggered by psychological or emotional stress, whereas secondary TC could be due to trauma, surgery or medications. We aimed to compare outcomes in primary TC and secondary TC in cancer patients. Methods: We retrospectively identified 80 patients who presented with TC to MD Anderson between December 2008 and January 2019. Baseline characteristics were obtained. We identified the triggers leading to TC. Univariate analysis was done using Cox regression. Kaplan Meier method (KM) was used to compare survival based …

Hyperlipasemia Does Not Confer Worse Clinical Outcomes In A Retrospective Cohort Of Novel Coronavirus (Covid-19) Patients, Zaid Imam, Inayat Gill, Bana Antonios, Andrew Aneese, Gaurav Kakked, Faisal Kamal, Bara Al Kurdi, Alexandra Halalau

Conference Presentation Abstracts

Abstract Background Gastrointestinal manifestations and hyperlipasemia commonly occur as part of novel coronavirus infection (COVID-19), while data on acute pancreatitis is limited to case reports. We aimed to study the prevalence of hyperlipasemia and acute pancreatitis in a large inpatient cohort of COVID-19 patients and their impact on clinical outcomes. Methods Retrospective chart review of all hospitalized patients with confirmed COVID-19 at an 8-hospital health system in Michigan, USA was performed between February 1,2020 through April 1,2020 with inclusion of patients with obtained lipase levels. Univariate analyses were performed to evaluate associations between hyperlipasemia and degree of hyperlipasemia and clinical …

Covid-19 Vaccine Hesitancy Among Medical And Dental Students, Arati Kelekar, Neila Afonso, Victoria Lucia, Ana Karina Mascarenhas

Conference Presentation Abstracts

No abstract provided.

A Look Into Medical Students' Knowledge On Adverse Childhood Experiences, Lara Fawaz, Neila Afonso

Conference Presentation Abstracts

No abstract provided.

Immune Thrombocytopenia In Covid Pneumonia: A Case Report Of The Oldest Patient, Samiksha Pandey, Kamil Sardarli, Candace Franklin, Ashbina Pokharel, Sumesh Khanal, Bipin Ghimire, Feroze A. Momin

Conference Presentation Abstracts

Introduction: COVID infection has shown to cause thrombocytopenia with multiple different mechanisms including the destruction of platelets with immune system stimulation similar to ITP with little evidence for optimal management. Here, we present a COVID infected patient presented with idiopathic thrombocytopenia with a partial delayed response to the treatment. Case Presentation: A 92-year-old man with a past medical history of coronary artery disease status post remote coronary artery bypass graft, hypertension, diabetes mellitus presented with petechiae, epistaxis, and was found to be profoundly thrombocytopenic with a platelet count of 1x109/L. He also had an asymptomatic COVID 19 infection, a normal …