Digital Commons Network^™

True Love: Heart Says To The Kidneys ‘Don’T Fail Me’, Greeshma Molugu, Srinivasan Rajaganapathy, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Valvular calcification is an increasingly important cardiac valvular pathology in end-stage renal disease (ESRD) patients, most frequently involving the aortic and mitral valves. The incidence/prevalence of mitral annular calcification in ESRD patients is about 30%, with mitral stenosis occurring in less than 5%. Various predisposing factors for valvular calcification in ESRD patients include age (median age >/= 60 years), hypertension, diabetes, use of calcitriol and calcium-containing phosphate binders, secondary hyperparathyroidism and duration of dialysis (median duration of >/= 5 years). We present a rare case of a young male with ESRD on peritoneal dialysis (PD) for less than two …

Invasive Pulmonary Aspergillosis: A Two-Year Journey, Jason Woods, Padmaditya Sureddi, Nga Van, Danielle Ford

North Texas GME Research Forum 2026

BACKGROUND: Highly active anti-retroviral therapy (HAART) has decreased the incidence of opportunistic infections among persons with HIV. Invasive aspergillosis specifically is uncommon among individuals with clusters of differentiation 4 (CD4) count >100 cells/mm3. Furthermore, treatment of aspergillosis in the HIV-infected population has not been examined systematically. We report a patient with CD4 count >200 cells/mm3, compliant with HAART therapy who developed invasive pulmonary aspergillosis (IPA) over the course of two years that was successfully treated through a combination of bronchial artery embolization and liposomal amphotericin.

CASE PRESENTATION: A 56-year-old man from southern Africa with four-year history of HIV-1 on HAART …

White Plaques With High Stakes: A Case Of Esophageal Leukoplakia, Boney Lapsiwala, Ritika Sharma, Karthik Kasireddy, Devika Pavuluri, Rupali Prabhukhot, Amjad Awan

North Texas GME Research Forum 2026

Introduction: Esophageal leukoplakia, also termed esophageal epidermoid metaplasia (EEM), is a rare esophageal epithelial disorder characterized by keratinized squamous plaques on esophagogastroduodenoscopy (EGD). With a prevalence of < 0.5%, it is often incidentally identified during evaluation for nonspecific upper gastrointestinal symptoms. EEM is considered a premalignant condition due to its association with esophageal squamous cell carcinoma (SCC), yet management and surveillance strategies remain undefined.

Case Presentation: A 65-year-old woman with hypothyroidism, hypertension, hyperlipidemia, and remote aplastic anemia treated with bone marrow transplantation 35 years prior presented with chronic cough and progressive dysphagia to solids and liquids. She denied tobacco, alcohol, or illicit drug use. No weight loss, abdominal pain, or blood in stool was noted. CT of the neck with contrast revealed curvilinear mucosal hyperenhancement involving the mid to distal thoracic esophagus without lymphadenopathy. Physical examination and …

The Unlikely Case Of Sporadic Immune Thrombotic Thrombocytopenic Purpura With Refractory And Seizure-Like Activity Features: Case Report, Brandon Gremmer, Alain Folefack

North Texas GME Research Forum 2026

Introduction/Background: Thrombotic Thrombocytopenic Purpura (TTP) is a multisystem disease that can lead to multiorgan failure by disseminated mechanical destruction, microangiopathic hemolytic anemia, and thrombocytopenia. Most TTP cases are classified as acquired or hereditary; however, sporadic immune TTP with a refractory episode during the same hospital admission is not well documented in the literature. Furthermore, seizure-like activity during plasma exchange is not a common adverse effect.

Case Presentation: A 35-year-old African American female with no documented medical, surgical, or social history, changes to medications, or lifestyle changes presented with full body fatigue, fever, loss of balance, and confusion. On arrival, labs …

Case Of Toxic Epidermal Necrolysis With High Body Surface Area Involvement And Review Of Predictors Of Severity Of Illness, Hannah R. Riva, Clay J. Cockerell, Muhammad T. Siddique, James M. Cross

North Texas GME Research Forum 2026

BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare and potentially fatal cutaneous adverse drug reactions. The most common mortality predictor used for TEN is the SCORTEN (Severity-of-Illness Score for Toxic Epidermal Necrolysis). Various scoring systems have been used and are being developed for predicting mortality and guiding treatment in SJS/TEN. We describe a case of TEN with a high body surface area involvement and discuss the scoring predictors for severity of illness.

CASE PRESENTATION: A 63-year-old male was transferred to our burn center for a suspected diagnosis of SJS/TEN. He was intubated prior to arrival. He …

Devising A Protocol For Mri Clearance In Patients With Cardiac Implantable Electronic Devices (Cied), Sienna Luk, Alvin Mathew, Darshan Bhatty, Kamran Rizvi

North Texas GME Research Forum 2026

Background: Magnetic Resonance Imaging (MRI) in patients with Cardiac Implantable Electronic Devices (CIEDs) remains a logistical challenge in many clinical settings. At Medical City Denton, the absence of a standardized institutional policy has led to significant inefficiencies, including prolonged hospital stays and increased healthcare costs. The primary objective of this project was to address these barriers by developing a streamlined, evidence-based protocol to improve care coordination and resource utilization for patients with CIEDs requiring diagnostic imaging.

Methods: Launched in 2026, this pilot initiative utilized a multi-stakeholder approach involving hospitalists, EPs, radiology staff, and device representatives. A core component of the …

Relationship Between Exception Request For Higher Listing Urgency And Aggressiveness In Accepting Heart Offers, Jorim Parmar, Yingxian Liu, Devika Adusumilli, Luke Taylor, Shakir Al-Ezzi, Usman Khan, Claudio Bravo, Claudius Mahr, Song Li

North Texas GME Research Forum 2026

BACKGROUND: Transplant programs may submit exception requests to upgrade a listed patient’s priority, often anticipating a higher likelihood of accepting marginal or high-risk donor organs. This study explores whether exception request status is associated with increased risk tolerance in organ acceptance.

METHODS: We conducted a retrospective analysis using data from the Scientific Registry of Transplant Recipients (SRTR), focusing on adult patients (≥18 years) listed for heart transplantation. Statistical analyses were performed using SAS/STAT 14.1. Descriptive statistics summarized demographic and clinical variables. Baseline characteristics were compared between recipients with and without exception requests. Primary analysis: Mixed-effects linear regression was used to …

Cardiac Step-Down Unit (Csu), Two Failures Drive Suboptimal Vte Prevention: Quality Improvement, Jorim Parmar, Shakir Al-Ezzi, Anvi Manduva, Muhammad Suleman, Fahed Alsayed, Debra Medsker

North Texas GME Research Forum 2026

BACKGROUND: In the Cardiac Step-down Unit (CSU), two failures drive suboptimal VTE prevention: (1). over-ordering of SCDs in patients unlikely to benefit and (2). < 10% documented application when SCDs are truly indicated. Baseline data indicates that curbing over-ordering alone would reduce recorded non-compliance by >50%, revealing a clear opportunity for system redesign.

METHODS: To integrate the updated “3 Bucket” Risk Model assessment into the computerized physician order entry (CPOE) in order to delineate the prophylaxis for a given patient population. Once the manual risk assessment proves to be viable in increasing compliance, we can propose having the tool adopted into the CPOE system. Root Cause Analysis revealed that lack of standardized VTE risk stratification leads to inconsistent ordering practices – …

Reconsidering Routine Postpartum Complete Blood Count In Uncomplicated Vaginal Deliveries: A Quality Improvement Project, Mira Ibrahim, Katie Johnson, Isabella Sciacca, Ali Ohm, Nicole Tenzel

North Texas GME Research Forum 2026

BACKGROUND

While a postpartum CBC may be helpful to detect anemia, it may not be necessary in a routine, uncomplicated patient and may be more of a burden and cause inconvenience without providing significant benefit. The goal of our project is to have a positive impact on patient care, hospital efficiency, and healthcare cost for both hospital and patient.

METHODS

Using data from July 2025 onwards for a six-month period is the intended duration of our study. We are looking at which patients got a postpartum CBC (which is usually collected one day after delivery) and whether that lab draw …

Reducing Respiratory Viral Testing In A Pediatric Emergency Department: A Quality Improvement Initiative, Anna Suessman

North Texas GME Research Forum 2026

Background: Respiratory viral testing in pediatric emergency departments (EDs) is frequently performed despite limited impact on clinical management for many low-risk presentations. Unnecessary testing increases cost and operational burden may delay patient throughput and can provide false reassurance to caregivers. Additionally, pediatric emergency department nurses agreed with overburden and impact to throughput based on overuse of viral testing (qualitative nursing survey conducted on September 4, 2024 showed >98% felt testing was unnecessary). We hypothesized that reducing testing through standardized team education and discharge processes would not negatively affect patient experience. This initiative aimed to decrease unnecessary respiratory viral testing during …

Outcomes After Orif Of Closed Bimalleolar And Trimalleolar Ankle Fractures In Patients With Autoimmune Disease, Mckenna Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: Autoimmune disease is associated with chronic systemic inflammation, immunosuppressive therapy, and increased medical comorbidity, which may influence postoperative outcomes following fracture fixation. Data evaluating outcomes after ankle fracture surgery in this population remain limited. We hypothesized that autoimmune disease would be associated with higher postoperative complication rates following open reduction and internal fixation (ORIF) of closed ankle fractures.

Methods: We performed a retrospective cohort study using a multi-hospital dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures. Patients with autoimmune disease were propensity score matched 1:2 to patients without autoimmune disease based on …

Impact Of Mips Measure 66 On The Incidence Of Pta's, Sydney Finch, Christopher Houston

North Texas GME Research Forum 2026

INTRO

A number of randomized controlled trials indicate that using point-of-care group A strep (POC GAS) testing decreases antibiotic utilization without compromising health outcomes. In 2018, the Merit-based Incentive Payment System (MIPS) measure 66 went into effect requiring the testing for GAS when treating pharyngitis. The intent was to decrease the unnecessary use of antibiotics in the treatment of pharyngitis, given that most cases are viral. Anecdotally, some physicians have noticed the increased incidence of peritonsillar abscesses (PTA). Our research group aims to investigate if there has been a significant increase in incidence of PTAs after the implementation of MIPS …

Cost Effectiveness Of Lifestyle Program For Diabetes Remission In The Era Of Glp-1, Prasanthi Tondapu, Haasini Sunkavalli, Micaela C. Karlsen, Kara L. Staffier, Kathryn J. Pollard, Surabhi Naik

North Texas GME Research Forum 2026

BACKGROUND: GLP-1 receptor agonists are popular for managing type 2 diabetes (T2D) and obesity but are costly and can result in side effects including weight rebound. Intensive therapeutic lifestyle change (ITLC) programs present an effective alternative, facilitating an HbA1C (A1C) less than 6.5% for 3 months without medication and long-term weight control.

CASE PRESENTATION: We present a 69-year-old Black man with T2D, hypertension, chronic kidney disease, obesity, and sleep apnea. In 2023, he was hospitalized with a blood glucose of 800 mg/dL and A1C 10.8% and discharged on insulin. And, with a BMI of 32 kg/m2 and weight of 238.6 …

A Storm At Both Ends: Hypertensive Emergency Unmaksing C3-Dominant Glomerulonephritis, Karthik Kasireddy, Boney Lapsiwala, Marisha Sharma, Rupali Prabhukhot, Victor Canela

North Texas GME Research Forum 2026

Background: C3 glomerulopathy (C3G) encompasses a group of diseases that result from abnormalities in the alternative pathway of complement regulation, and has been defined by C3 only or C3-dominant immunofluorescence staining seen on renal biopsy. C3G includes C3 glomerulonephritis (C3GN) and dense deposit disease (DDD); the latter of which is characterized ultra-structurally by the presence of highly osmiophilic intramembranous deposits. Both C3GN and DDD often present with a membranoproliferative pattern of glomerular injury, a finding that can also be seen in thrombotic microangiopathy (TMA). Most common causes include infection, autoimmune and monoclonal gammopathy.

Case presentation: A 70-year-old man with hypertension, …

Pulse Check: Im Resident Wellness Initiative -- A Continuous Qi Project, Jacqueline Bekhit, Ngoc Vu, Yasasvi Sabbineni, Nihar Raju, Parth Patel, Teena Mathew

North Texas GME Research Forum 2026

Background Burnout is a psychological syndrome that arises from chronic workplace stress that has not been effectively managed. It is characterized by emotional exhaustion, increased mental distance or cynicism toward one’s work, and a sense of reduced professional efficacy (WHO, 2019). Due to the long work hours, high workload, and extensive training demands, medical residents are particularly vulnerable to experiencing burnout, contributing to higher rates of anxiety and depression. Burnout typically emerges mid-intern year and progresses through the remainder of residency. Burnout can contribute to higher medical errors, decreased work efficiency, and poor patient-physician interactions.

Methods This QI is a …

2026 North Texas Gme Research Forum - Program Summary, Michele L. Mccarroll

North Texas GME Research Forum 2026

No abstract provided.

Rare Presentation Of Diffuse B-Cell Lymphoma (Dlbcl), Jasmine M. Silva, Vinay Antin

North Texas GME Research Forum 2026

No abstract provided.

Gastroparesis As Initial Feature Of Neuromyelitis Optica Spectrum Disorder, Jasmine M. Silva, Jorim J. Parmar, Shivani Gandhi, Sreevani Gudiseva

North Texas GME Research Forum 2026

No abstract provided.

Internal Jugular Injuries: Outcomes From The American Association For The Surgery Of Trauma Prospective Observational Vascular Injury Treatment (Proovit) Multicenter Registry, April Miller, Pranay Arora, Devika Pavuluri, John Bini

North Texas GME Research Forum 2026

Introduction: Since March 2013, the PROOVIT database has been a prospective, multi-center observational trial established for the study of vascular trauma. Here we present the data for the management of internal jugular vein injuries due to blunt and penetrating trauma.

Methods: Inclusion criteria for the PROOVIT study included patients age >2 years with radiologic or clinical/operative diagnosis of injury to named vessels in trauma patients at participating facilities. The database was reviewed to examine injury presentation, surgical management, postprocedural medical management with antiplatelet or anticoagulant therapy, and mortality. SPSS software was used to perform the descriptive and exploratory analysis for …

Surgical Management Of A Giant Colonic Diverticulum, Courtney Koplyay, Mason Workman, Michael Truitt, Muhammad T. Siddique

North Texas GME Research Forum 2026

INTRODUCTION: Giant colonic diverticulum (GCD), defined as a diverticulum >4 cm, is a rare manifestation of diverticular disease with less than 200 reported case reports. CT imaging is the preferred imaging modality to identify and confirm the presence of a GCD, which provides an accurate depiction of the size, location, and contents of the diverticulum GCD can present with nonspecific abdominal symptoms, abdominal pain, bloody stools, or an enlarging mass. Given the risk of serious complications, including diverticulitis, bowel obstruction, and perforation, early recognition and management are essential to prevent further complications. Surgical management with diverticulectomy or partial colectomy is …

Too Young For A Broken Heart: Stemi At Twenty, Shana-Kay Lambert-Johnson, Jason Thompson

North Texas GME Research Forum 2026

Background: ST-elevation myocardial infarction (STEMI) is exceptionally rare in young adults, accounting for less than 1% of acute coronary syndromes in individuals younger than 35 years. When it occurs in early adulthood, particularly among women, it introduces diagnostic uncertainty and exposes gaps in post-discharge continuity of care. This case of a 20-year-old female with STEMI highlights the role of primary care in preserving evidence-based therapy while addressing psychosocial determinants of recovery.

Case Presentation: A 20-year-old female presented to her primary care clinic for post-discharge follow-up after hospitalization for an anterior STEMI that began with sudden-onset substernal chest pain radiating to …

Meconium Pseudocyst Of The Perineum: Diagnostic Uncertainty And Surgical Management, Matthew Li, Muhammad T. Siddique, Charles Black, James Davis

North Texas GME Research Forum 2026

No abstract provided.

Percutaneous Pneumothorax Placement, Miranda Bingham, Christopher Houston

North Texas GME Research Forum 2026

Background: Timely and accurate chest tube placement in the Emergency Department (ED) is critical for the management of life-threatening conditions such as a pneumothorax. At Medical City North Hills Emergency Department, chest tube placement can be delayed or complicated due to variability in available equipment types, sizes, storage locations, and setup processes. Providers may be unfamiliar with less commonly used kits, experience skill decay due to infrequent procedural exposure, or lack access to bedside educational resources during high-stress, time-sensitive situations. These challenges contribute to procedural delays, increased complication rates, prolonged hospital stays, and higher healthcare costs. This quality improvement project …

Gastroduodenal Artery Coil Erosion Causing Pyloric Obstruction And Upper Gi Bleeding, Corey Newman, Mahad Rehman, Cody Beltran, Michael Carrick

North Texas GME Research Forum 2026

Background Trans-arterial embolization (TAE) of the gastroduodenal artery (GDA) is a well-established and effective treatment for peptic ulcer bleeding and visceral pseudoaneurysms. Although generally safe, delayed migration or erosion of embolization coils into the gastrointestinal lumen is a rare but recognized complication that may occur months to years after the procedure. Proposed mechanisms include ischemic mucosal injury, mechanical pressure from the coil mass, and chronic inflammation. Clinical manifestations vary widely, ranging from occult bleeding and ulceration to perforation or gastric-outlet obstruction. Only a limited number of cases describing GDA coil erosion presenting with both bleeding and obstruction have been reported. …

Nitrous Oxide Vs. Ketamine: Impacts On Pediatric Emergency Department Length Of Stay, Tabitha Brock, Anna Suessman

North Texas GME Research Forum 2026

Background Nitrous oxide (N₂O) is a well-established analgesic and anxiolytic agent, widely used for procedural sedation in pediatric dentistry. Despite its demonstrated safety and efficacy, its use in Pediatric Emergency Departments (PEDs) remains limited and underexplored. To address this gap, we implemented a comprehensive training program for PED providers and introduced N₂O as an alternative sedation agent.

Objective We hypothesized that using N₂O for procedural sedation would significantly reduce patient length of stay (LOS) without compromising safety or outcomes.

Methods We conducted a retrospective chart review of pediatric patients who underwent painful procedures in a tertiary children’s hospital emergency department. …

Association Of Glp-1 Receptor Agonist Use With Postoperative Outcomes After Rotator Cuff Repair In Patients With Diabetes: A Propensity Score–Matched Analysis, Mckenna W. Box, Troy B. Puga, Hans Drawbert, Aysu Erdemir, John T. Riehl

North Texas GME Research Forum 2026

Background Diabetes impairs tendon healing after rotator cuff repair (RCR), with early postoperative poor glycemic control linked to a higher failure risk in studies. GLP-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control. Preclinical studies indicate that GLP-1RA may benefit rotator cuff healing through anti-inflammatory mechanisms as well. However, real-world data on the effects of GLP-1RAs on RCR outcomes remain incompletely understood.

Methods We conducted a retrospective cohort study using an institutional dataset (01/01/2016 to 09/30/2024) of adults aged 18-74 years with type 2 diabetes who underwent RCR. GLP-1RA exposure was established by home medication lists. Patients with autoimmune …

Retrospective Analysis Of Predictive Accuracy In Applying The Nih Stroke Scale, Rachel Hoang, Ray Rahimi, Kelly Mofor, Charley Meadows, Ty Shields, Hibba Thayyil, Hannah A. Affleck, Parker Owen, Sanjay Sharma

North Texas GME Research Forum 2026

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is widely used to quantify neurologic deficits in acute stroke, yet it is based on observable symptoms rather than ischemic stroke pathophysiology. Because ischemic stroke typically results from focal vascular occlusion, deficits classically localize to a single hemisphere and do not cross the midline. The frequency with which patients presenting with bilateral or contralateral symptoms have MRI-confirmed ischemic infarction, compared with those with unilateral deficits, remains unclear.

METHODS: We performed a retrospective analysis of patients for whom a code stroke was activated at a single institution. Patients presenting with bilateral/contralateral or …

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

Esophageal Squamous Cell Carcinoma Incidentally Detected On Barium Swallow: A Case Report, Muhammad Rubeel Akram, Aditya Rao, Muhammad T. Siddique

North Texas GME Research Forum 2026

Background: Esophageal cancer is an aggressive malignancy with a poor prognosis, and has high rates of recurrence despite curative-intent therapy. While endoscopy with biopsy remains the gold standard for diagnosis, non-diagnostic imaging studies are performed when evaluating for dysphagia, and may bring to light underlying pathology, warranting further workup. Surgical resection following neoadjuvant chemoradiation is often performed, but postoperative complications and disease recurrence are important concerns. This case highlights the crucial role of early detection via imaging and the clinical burden associated with esophageal squamous cell carcinoma.

Case Presentation: A 76-year-old female presented with dysphagia and underwent a barium esophagogram, …

Stronger Together: A Resident-Led Initiative Advancing School Nurse Readiness In Pediatric Seizures And Pediatric Cardiology, Shana-Kay Lambert-Johnson, Amy Nguyen-Pham, Tony Do, Devika Adusumilli, Jorim Parmar, Dimitar Semerdzhiev, Elizabeth White, Joanna John, Myrna Garcia, Nicholas Gerden, Tasaduq Mir, Michele Mccarroll

North Texas GME Research Forum 2026

BACKGROUND: School nurses play a vital role in safeguarding the health and safety of children by serving as frontline providers within the school setting. Timely recognition and appropriate management of acute medical conditions can reduce morbidity, prevent unnecessary emergency department utilization, and improve long-term outcomes. Needs assessment surveys identified knowledge and confidence gaps among school nurses related to pediatric seizure management and pediatric cardiology.

METHODS: This prospective educational quality improvement initiative was conducted across the Dallas–Fort Worth (DFW) region during the 2025-2026 academic year. Over 25 residents served as curriculum developers and educators, creating and delivering evidence- and case-based education …