Internal Medicine Commons^™

Cva In Patient With Systemic Sclerosis On Aspirin Therapy: A Case Report, Rahyan Mahmud, Bianna Koutsenko, Kenneth Goich, Usaid Hasan

Rowan-Virtua Research Day

Introduction

Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.

Case Presentation

A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke …

Splenic Artery Aneurysm Masquerading As Chest Pain: A Case Report Of A Rare Clinical Presentation, Emily Forester, Anjeanette Brown Md

Rowan-Virtua Research Day

Background: Splenic artery aneurysms most commonly present with vague epigastric or left upper quadrant abdominal pain that may radiate to the left shoulder. Chest pain associated with splenic artery aneurysm is an unusual phenomena. This case presents a rare occurrence of a splenic artery aneurysm originally presenting as atypical chest pain. Case Presentation: A 46 year old G3P2 AAF patient with family history of hypertension presented to the ER with pleuritic left chest pain, episodes of shortness of breath, and new onset hypertension. Chest x-ray and ECG were unremarkable. Pertinent labs included a hemoglobin of 10.6 and D-dimer of 4.10. …

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

The Ethical Concerns Of Improper Semaglutide Administration After Acquisition From A Compounded Pharmacy, Syed Basit Haider, Renu Thomas, E’Joven Reed, Aneesha Shaju, Bushra Bangash, Jakob Schnell, Edrianna Mae Ablola

Gulf Coast Division Research Symposium 2024

No abstract provided.

Intracrnial Hemorrhage And Ecg Changes, Negar Niknam, Eric N. Riha, Bushra Bangash, Parshvi Patel, Skantha K. Manjunath, Gnananandh Jayaraman, Ramesh Kesavan, Siva T. Sarva

Gulf Coast Division Research Symposium 2024

No abstract provided.

Unusual Delayed Invasive Infection With Staphylococcus Capitis Following Coronary Artery Bypass Grafting: A Case Report And Literature Review, Suhas Tatapudi, Daniel J. Avila Castillo, Ibrahim Yazji

Gulf Coast Division Research Symposium 2024

No abstract provided.

Mycobacterium Flavescens Infection: An Unusual Case Of Prosthetic Joint Infection, Peter Holleb, Suresh Antony

Central & West Texas Research Day 2024

No abstract provided.

Multidisciplinary Management For Large And Difficult Choledocholithiasis: The Role Of Choledochotomy, Jilpa Shah, Balu Chandra

North Texas Research Forum 2024

Extracranial carotid artery aneurysm is a rare sequela of atherosclerosis, trauma, and conditions of chronic inflammation. Standard treatments include antiplatelet medications, open resection, or endovascular stenting. Transcarotid artery revascularization (TCAR) has become a well-recognized alternative treatment in the past few decades. This case study documents the first reported case of Horner’s syndrome post-TCAR for an internal carotid artery (ICA) aneurysm. A 68 year-old male with intermittent double vision was referred to vascular surgery clinic with brain CT angiography showing a 9mm saccular aneurysm with dissection flap of the right cervical ICA. Prior attempts by neuro-interventional radiology were unsuccessful due to …

Partial Anomalous Pulmonary Venous Return: To Fix Or Not To Fix?, Akshaj Pole, Jennifer Austin, Amnah Andrabi

North Texas Research Forum 2024

Patient is a 56-year-old male with a past medical history of type 2 diabetes, hypertension, prior MVA with chest trauma, and coronary artery disease with 2 prior stents in the obtuse marginal and right coronary artery who was brought to the ED for severe chest pain. Patient was immediately taken to the cath lab for cardiac intervention. Patient was identified to have 90-95% stenosis of his left circumflex but was unable to be stented due to tortuosity of the vessel and tight lesion. Due to patient’s multivessel coronary artery disease and newly diagnosed diabetes, patient was referred to cardiothoracic surgery …

Comparing Large Language Models Accuracy In Following Interval Surveillance Colonoscopy Guidelines, Olufemi Osikoya, Gregory Brennan

North Texas Research Forum 2024

Introduction: Providing pathology results and appropriate recommendations after resection of colon polyps is mandatory. Large language models (LLMs) such as ChatGPT and Google Bard, have shown promise in clinical workflows such as pathology results letters. We tested whether LLMs could provide appropriate surveillance recommendations based on current guidelines from the US multi-society task force for post-colonoscopy follow-up. Methods: Our aim was to compare the accuracy of ChatGPT 3.5, ChatGPT 4, and Google Bard in providing appropriate interval surveillance recommendations. An example prompt being “Write a patient pathology result letter after a colonoscopy with one tubular adenoma polyp (< 10mm) resected. Include recommendations for when the next surveillance colonoscopy should be completed.” Seventeen different post polypectomy surveillance queries and responses were analyzed (correct, partially correct, incorrect) compared to USMSTF guidelines. Results: When …

Polypharmacy And Potentially Inappropriate Prescribing In Geriatric Population, Maryam Burney, Barry Brown, Victoria Nguyen, Garrett Furth, Ambreen I. Ahmed

North Texas Research Forum 2024

Polypharmacy is a ubiquitous concern among patients, especially geriatric patients, who are at a higher risk of clinical burden. It is associated with an increase in healthcare costs, decreased functional status, and adverse drug events, contributing to geriatric syndromes, such as falls, cognitive decline, and urinary retention. Geriatric care is multi-tiered, requiring assistance and care from a thorough physician who is attune to the potential risks of medications that are commonly prescribed. Smaller communities, often with less resources and clinical providers and with an aging population, especially at the hospital setting, are vulnerable to oversights when it comes to medication …

Association Of Glucagon-Like Peptide-1 Receptor Agonist Treatment With Perioperative And Postoperative Complications In Patients Undergoing Elective Bariatric Surgery, Justin Sanchez, Enith Espinosa, Sean Sojdie, Michael Green, Lauren Wonderly

North Texas Research Forum 2024

Glucagon-like peptide receptor agonists (GLP-1 RA) are FDA-approved medications for the treatment of type 2 diabetes mellitus, and obesity, and are also beneficial in cardiovascular risk reduction. However, due to known GLP-1 RA adverse effects, notably delayed gastric emptying, the ASA has implemented GLP-1RA guidelines aiming to minimize potential complications related to GLP-1 RA use in patients undergoing procedures requiring general anesthesia. With the ever-increasing number of patients being prescribed GLP-1 RAs, more research needs to be conducted to investigate their potential impact in other areas of healthcare. This retrospective study aims to compare surgical outcomes before and following the …

Efektivitas Sacubitril/Valsartan Dalam Mencegah Gagal Jantung Pada Stemi Pasca Percutaneous Coronary Intervention, Nobian Andre, Lana Adila, Aulia Rizka, Lusiani Rusdi

Jurnal Penyakit Dalam Indonesia

Heart failure is a possible complication following ST-elevation myocardial infarction (STEMI) even after revascularization. Neuroendocrine activation in the process of ventricular remodeling can be regulated by angiotensin receptor-neprilysin inhibitor (ARNI) as well as angiotensin-converting enzyme (ACE) inhibitor. The use of ARNI in heart failure with reduced ejection fraction has been found to be superior to ACE inhibitor. The role of ARNI on cardiac function in STEMI has not been established. A clinician treating a patient with STEMI considered giving sacubitril/valsartan to reduce the risk of developing heart failure. Literature search was performed in three electronic databases: PubMed, Embase, and Cochrane. …

Dietary Analysis For Hashimoto’S Thyroiditis: An Integrative Review, Evan Thompson, Alison Hultquist

Master of Science in Nursing Final Projects

Abstract

Hashimoto’s Thyroiditis (HT) is the leading cause of primary hypothyroidism in the United States. In HT, there is an infiltration by lymphocytes which leads to the production of autoantibodies against the thyroid gland. Throughout this integrative review, the aim was to evaluate the effectiveness of micronutrient supplementation and dietary management as adjunct treatments in HT. The purpose was to assist primary care providers in the development of a more holistic plan of care. Literature published within the past seven years was gathered and reviewed from PubMed, CINAHL, and Cochrane Library. Findings indicate that many patients with HT may benefit …

Perbedaan Kadar Insulin-Like Growth Factor-1 Dan Tumor Necrosis Factor-Α Serum Pada Berbagai Derajat Sarkopenia Pasien Lanjut Usia: Studi Potong Lintang, Auliangi Tamayo, Roza Mulyana, Rose Dinda Martini

Jurnal Penyakit Dalam Indonesia

Introduction. Sarcopenia is a phenomenon of progressive decline in muscle function that occurs due to the aging process. Insulin-like growth factor-1 (IGF-1) and tumor necrosis factor-α (TNF-α) have an important role in the occurrence of sarcopenia as a positive and negative regulator of muscle mass. Research shows differences in IGF-1 and TNF-α levels between sarcopenia and non-sarcopenia groups, but research on differences in severity of sarcopenia remains unclear. The purpose of this study was to determine the difference in levels of IGF-1 and TNF-α in various degrees of sarcopenia in elderly patients.

Methods. This was an analytical observational …

Unknown Rectal Lesions: A Case Of Severe Proctitis Secondary To Mpox In The Setting Of Concomitant Hiv, Syphilis, Hsv, And Chlamydia, Nicole Robertson Mph, James Crosby Do, Cynthia R. Young Md, Msc, Anne E. Sayers Md, Nicholas J. Van Sickles Md

ePublications of Emerging Medical Research Scholars

Introduction:

Mpox emerged as a public health crisis with limited research describing co-occurring HIV and sexually transmitted infections (STIs). We present a case of severe proctitis secondary to Mpox with concomitant HIV (Human Immunodeficiency Virus), syphilis, HSV (Herpes Simplex Virus), and chlamydia and review presentation, diagnosis, treatment, and prevention of Mpox with concurrent STIs.

Case Presentation:

34-year-old male living with HIV (LWH) presenting with worsening rectal pain, multiple anal papules, and fever. His laboratory workup revealed simultaneous positive results for orthopoxvirus, chlamydia, and HSV-1 PCR. We initiated tecovirimat due to rectal involvement and uncontrolled pain. He subsequently developed lesions on …

Mixed Beri’S: High Output Heart Failure From Severe Anemia And Thiamine Deficiency, Rohan Umrani, Hiral Amin, Ashley Pinckney, Charles Yang, Daniel Tran

Rowan-Virtua Research Day

Background: Severe anemia and thiamine deficiency can independently result in high output heart failure (HOHF) through different mechanisms. Data on the threshold and timeframe at which these etiologies may precipitate HOHF is unclear.

Case: A 63-year-old male with alcohol use disorder consuming 18 drinks/week presented with progressive shortness of breath and lower extremity edema for a few months. Physical exam revealed tachycardia, anasarca, jugular venous distension, Lancisi’s sign, and a midsystolic murmur. Echocardiogram demonstrated EF of 30-35%, dilated left ventricle, and cardiac index of 4.2L/min/m2.

Decision-Making: Heart failure can independently precipitate anemia while severe alcoholism can induce myelosuppression and promote …

Focused Pocus: Cardiopulmonary Curriculum For Internal Medicine Residents, Daniel Tran, Krunalkumar Patel, Shivani Dalal, Umang Patel, Troy Randle

Rowan-Virtua Research Day

Problem Statement: Point-of-care ultrasound (POCUS) is currently not a required core competency in internal medicine (IM) residency despite its inherent benefits, and many hospitalists are not equipped to confidently acquire nor interpret basic ultrasound images.

Background: POCUS is used at the bedside by physicians to answer directed clinical questions to help guide patient management. During the COVID-19 pandemic, the use of ultrasound for quick, accurate diagnosis of life-threatening pathology has been instrumental in early detection of acute cardiopulmonary failure, monitoring treatment response, and minimizing nosocomial spread. We aimed to determine interest in learning POCUS, confidence level, self-rated proficiency, and perceived …

Characterization Of Antibiotic Susceptibility Profiles Of Extensively- And Pan-Drug Resistant Acinetobacter Baumannii Clinical Isolates, Rachel Carr, Justin Halim, Rebecca Fliorent, Henry Fraimow, Dejan Nikolic, Valerie Carabetta

Rowan-Virtua Research Day

Acinetobacter baumannii is an opportunistic pathogen common in intensive care units (ICUs), particularly among immunocompromised individuals. Nosocomial A. baumannii infections have become increasingly problematic in recent years, as these bacteria rapidly acquire antibiotic resistance, leading to the emergence of multidrug, extensively drug and pan drug-resistant (MDR, XDR, and PDR, respectively) isolates. Recently, Cooper University Hospital (CUH) experienced a large increase in highly drug-resistant A. baumannii infections, which had a mortality rate of 60%. Oftentimes, physicians had to turn to combinations of drugs with no experimental verification or historically shelved antibiotics, such as the polymyxins, in a desperate attempt to save …

Case Report: The Challenge Of Balancing Stewardship And Advocacy, Samuel Thalathoti, Kishan Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 62-year-old female who presented with chief complaint of generalized weakness and was ultimately diagnosed with hypereosinophilia. This chief complaint is challenging for many EM physicians, and the differential diagnosis of generalized weakness is vast. Etiologies of generalized weakness in the adult population ranges from infection, dehydration, cardiovascular disease, to neurologic compromise. It is crucial for the Emergency Physician to put emphasis on proper history collection, detailed physical exam, and appropriate ancillary testing. In this case report we showcase the significance of the optimal evaluation of life-threatening disorders that presents as generalized weakness, as well …

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

Rowan-Virtua Research Day

BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.

Case Report: Anaphylactic Reaction To Magnesium Sulfate, Nicholas Coan, Kelly Schiers, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 65-year-old female who prior to being discharged from the hospital developed an anaphylactic reaction after receiving an intravenous magnesium sulfate infusion. After extensive literature review, there are few documented hypersensitivity reactions documented. This case report is to highlight a known human response, anaphylaxis, but in response to the repletion of an essential electrolyte to human life, magnesium.

Monitoring Concordance In The Management Of Transfusing Blood Components In Cirrhotic Patients For Paracentesis With Evidence-Based Guidelines, Joseph Kim, Gregory Moses

North Texas Research Forum 2023

Initiative to decrease unnecessary hemostatic agent transfusion in cirrhotic patients undergoing paracentesis: a resident-led approach quality improvement project to prevent transfusion overuse. Currently, there is no official guideline placed in the hospital for the administration of a hemostatic agent such as fresh frozen plasma in the setting of an elevated international normalized ratio, which paradoxically is an anticipated finding in cirrhotic patients. This process leads to unnecessarily prolonging the duration of the hospital course due to delays in performing the interventional procedures and interruptions in scheduling. The goal of this project is to educate and provide physicians with the most …

A Case Of An African American Female Presenting With Idiopathic Granulomatous Lobular Mastitis, Wendy Timirau, Esra Sari, Maham Shahid, Nilmarie Guzman, Augusto Villegas

South Atlantic Division Research Day 2023

No abstract provided.

Performance Of A Sars-Cov-2 Rt-Pcr Assay With Non-Traditional Specimen Types, Subathra Marimuthu, Holly Aliesky, Heather Ness, Daniya Sheikh, Sathya Rashmit, Dawn Balcom, Leslie A. Wolf

The University of Louisville Journal of Respiratory Infections

During the first two years of the coronavirus disease 2019 (COVID-19) pandemic, nasopharyngeal (NP) specimens were the gold standard for clinical diagnostic testing. As information about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic continued to be shared, it was clear that the virus could be detected in other specimen types during an active infection. The University of Louisville Infectious Diseases Laboratory accepted non-traditional specimen types, most without a paired, positive NP result, for research purposes only to support local epidemiology efforts. A real-time reverse transcription-polymerase chain reaction (RT-PCR) assay originally validated for NP specimens was used …

A Retrospective Study Comparing Mortality Rates Between Vaccinated And Unvaccinated Kidney Transplant Recipients, Anaam Fayyaz, Judy Pozzerle, Suresh Antony

Central & West Texas Research Day 2023

No abstract provided.

Crochetage Pattern: An Electrocardiographic Warning Sign For Scuba Divers, Sarah Crawford

West Florida Division Research Day 2023

No abstract provided.

Dermatologic Manifestations Of Rheumatic Disease: Cutaneous Manifestations Of Vasculitides, Julianna S. Kang, Julia Nunley, Tiffany Ho, Mavra Masood, Fnu Nutan, Beth Rubinstein

Open and Affordable Course Content at VCU

Cutaneous Manifestations of Vasculitides is a Powerpoint based learning module that begins with the definition of terms and findings often found in vasculitis, followed by a review of several systemic vasculitides, highlighting how characteristic cutaneous lesions may be predictive of the vessel of involvement as well as the associated histologic changes. Moreover, significant clinical and laboratory findings utilized to make the correct diagnosis will be emphasized. This module is not meant to be an exhaustive review of vasculitis, but to serve as an introduction to understanding disease processes and how systemic vasculitis and skin findings interrelate.

It is part of …

Dermatologic Manifestations Of Rheumatic Disease: Malignant Cutaneous Tumors, Divya Shan, Julianna S. Kang, Allison Cinats, Julia R. Nunley, Beth Rubinstein

Open and Affordable Course Content at VCU

Malignant Cutaneous Tumors is a Powerpoint-based learning module that focuses on skin cancers. It begins with the definition of terms and findings, followed by a review of several clinical cases. The goal of the module is to provide the students with the ability to differentiate the most common types of skin cancer and precancerous lesions and gain an awareness of cutaneous lymphomas. This module will include images and clinical findings from diverse skin tones to prepare students to identify cutaneous findings in a heterogeneous patient population. This module is not a comprehensive review of skin cancers but an introduction to …

Reducing Unnecessary Cbcs On The Inpatient Resident Service: Interviewing Stakeholders To Identify Underlying Causes, Feras Al-Moussally, Zara Bashir, Jorge Rodriguez, Ashlee Sidhu, Brain Murr, Liliana Franco, Jorge Restrepo, Ashwini Komarla

North Florida Division Research Day 2023

No abstract provided.