Digital Commons Network^™

It Is Not Pcp; It Is Cyclophosphamide Induced Toxicity, Mery Bartl, Yilen Karen Ng-Wong, Blesset Alexander, Josenny L. Rodriguez-Paez, Jose G. Gomez Casanovas, Christine Loftis, Andres Suarez Parraga

Research Colloquium

Background: Cyclophosphamide (CYC) is an immunosuppressive medication used to treat life threatening complications of various rheumatic diseases like vasculitis and systemic lupus erythematosus. 1% of patients on this medication develop pneumonitis. When considering CYC induced lung toxicity, other etiologies such as opportunistic infections and diffuse alveolar hemorrhage should be ruled out.

Case presentation: The patient is an 83-year-old woman with a past medical history of microscopic polyangiitis, and hypothyroidism who presented with progressive dyspnea at rest, exacerbated on exertion, associated with orthopnea. The patient was admitted due to acute on chronic hypoxemic respiratory failure with multifactorial etiology and heart failure …

Surgical Technique For Glenoid Bone Defect In Revision Shoulder Arthroplasty: Distal Clavicle Excision And Grafting For 1-Stage Reverse Total Shoulder Prosthesis, Ryan Bialaszewski, Ross Chapel, Frank Gerold

Research Colloquium

Introduction: Reverse shoulder arthroplasty (RSA) has expanded its indications and use in North America since the early 1990s. Because of this, the prevalence of revision reverse total shoulder arthroplasty cases has continued to rise. On occasion, the need for revision of RSA can be due to and is complicated by glenoid bone loss defects, making this one of the most challenging cases for arthroplasty surgeons to perform. Historically, iliac crest or tibial grafts are most commonly used for these defects, although this comes with the disadvantage of requiring two surgical sites to be prepped and draped. The purpose of this …

A Case Of A Thick Heart: Hypertrophic Obstructive Cardiomyopathy, Johanne Chaglasian, Pooja Patel

Research Colloquium

Background: Hypertrophic cardiomyopathy is a genetic disorder characterized by left ventricular hypertrophy unexplained by secondary causes and a nondilated left ventricle with preserved or increased ejection fraction. Prevalence has been estimated at 0.16% to 0.29% in the general adult population. In the United States alone, there are fewer than 100 deaths per year due to HOCM at a rate of 1:220,000 athletes. We report newly diagnosed Hypertrophic Obstructive Cardiomyopathy.

Case Presentation: 40-year-old gentleman with past medical history of CVA with residual left sided weakness, polysubstance abuse presented to the emergency department with the chief complaint of shortness of breath and …

A Boneless Chicken At Eg Junction., Mery Bartl, Blesset Alexander, Jose G. Gomez Casanovas, Alcibiades Fleires, Roque Mifuji

Research Colloquium

Introduction: Esophageal food impaction (EFI) is the third most common non-biliary emergency in gastroenterology with an annual incidence rate of 13 episodes per 100,000 person-years and 1,500 deaths per year. An underlying esophageal cause is commonly found, with structural abnormalities being the most common, and dysmotility disorders and malignancy less frequently. When a patient presents with EFI, removal of the food bolus within 24 hours is indicated, however more urgent removal if acute symptoms are present. The following is a patient that presented for acute food impaction at EG Junction.

Case presentation: A 64-year-old gentleman with past medical history of …

Pelvic Inflammatory Disease Associated With Genital Herpes Simplex Virus Type-1 Infection - A Case Report, Mays Abdulazeez, Andreina Prado, Juan Rodriguez, Changho Yi, Rani Rabah, Yuri Cuellar De La Cruz, Jose Cano, Heidi Pareja

Research Colloquium

Background: Pelvic inflammatory disease (PID) refers to acute and subclinical infection of the upper genital tract in females encompassing uterus, fallopian tubes, and ovaries. The involvement of the neighboring pelvic organs often accompanies this disease, resulting in endometritis, salpingitis, oophoritis, peritonitis, perihepatitis, and tubo-ovarian abscess. Most PID cases, 85% are caused by sexually transmitted or bacterial vaginosis-associated pathogens. The remaining 15% are associated with enteric or respiratory pathogens that have colonized the lower genital tract. The etiologic differences among these processes have significant implications for treatment and prevention.

Case presentation: A 21-year-old female G6-P5-A1 presented to the ED with lower …

Patent Foramen Ovale, Deep Venous Thrombosis And Stroke; A Paradoxical Embolism In An 80-Year-Old Male, Jose Rivera, Elio Garcia Sosa, Josenny Rodriguez Paez, Francisco Gonzalez, Daniela Hernandez

Research Colloquium

Background: A patent foramen ovale (PFO) is a congenital cardiac malformation describing a shunt in between the atrial walls. The overall incidence of a PFO is around 27.3% with a progressive decrease to 25.4% in the 4^th and 8^th decades. Once it has been established that a patient with an ischemic stroke/transient ischemic attack (TIA) has a PFO and other sources of the stroke have been ruled out, it is imperative to consider deep vein thrombosis (DVT) as the source of a paradoxical embolus.

Case Presentation: 80-year-old gentleman with a history of right internal carotid occlusion of 80-90% …

Necrotizing Pneumonia From Mdr S.Pneumoniae In A Young Patient: A Case Report, Sonya R. Montes, Jose Gerardo Gomez Casanovas, Laura Rincon-Rueda, Mery Bartl, Alcibiades Fleires

Research Colloquium

Background Community-acquired pneumonia (CAP) is a leading cause of hospitalizations, and due to its diverse disease presentation, determining appropriate level of treatment is essential. CAP can lead to different complications, including necrotizing pneumonia. Due to its high morbidity and mortality rates, necrotizing pneumonia is critical to rapidly identify and treat accordingly. Therefore, we present a case of a young patient who presented with necrotizing pneumonia after failing CAP outpatient therapy.

Case Presentation A 42-year-old Hispanic lady with past medical history of hypertension and hyperlipidemia presented to the emergency department with 6-day history of right upper quadrant pain, associated with fever, …

A Unique Case Of Diffuse Large B Cell Lymphoma Presenting With Cranial Nerve Palsy, Hari Movva, Hari Das, Giri Movva, Cesar A. Peralta, Jose Campo Maldonado

Research Colloquium

• Diffuse large B cell lymphoma is the most common lymphoma responsible for 25 to 30% of non-Hodgkin lymphomas.1-4

• It commonly manifests as splenomegaly, hepatomegaly, enlarged lymph nodes and B symptoms such as fever, night sweats and weight loss. Approximately 50% of patients have extra nodal involvement; most commonly of the stomach, GI tract, and skin. 1-4

• Overall incidence in the United States is approximately 7 cases per 100,000 per year and accounts for roughly 25% of all NHL cases worldwide. 1-4

• We present a case of a 59-year-old female with

Ischemic Steal Syndrome In A Hemodialysis Patient, Hari Movva, Giri Movva, Hari Das, Cesar A. Peralta, Jose Campo Maldonado

Research Colloquium

•Steal Syndrome is a phenomenon seen in patients with retrograde flow in an ipsilateral vertebral artery due to stenosis or occlusion of the subclavian artery. 1-3 •It commonly manifests asymptomatically in most patients but can be found incidentally when there is a blood pressure difference or through upper extremity symptoms such as pain and ischemia or through neurological symptoms. 1-3 •Overall Incidence is currently unknown but most literature reports prevalence of 0.6% to 6.4%. 1-3 •We present a 45-year-old male with newly diagnosed Steal Syndrome who presented with a small blister on left ring finger, pain and bluish-black skin discoloration.

Gradual Onset Of Paralysis In A Soccer Athlete: Challenges In Diagnosis In The Patient With A Socioeconomic Condition, Changho Yi, Evan Perez, Jose Cano

Research Colloquium

Background Cauda equina syndrome is a rare but serious condition from compressing the roots of the cauda equina in the lower lumbar spinal canal that accompany one of the following: Bladder and/or bowel dysfunction, reduced sensation in the saddle area, sexual dysfunction with possible neurological deficit in the lower limb. MRI findings are needed for confirmation. If it is not diagnosed early and treated properly, there can be disastrous outcomes such as permanent dysfunction in bowel, bladder, and sexual functions. Commonly it presented acute symptoms, but it is possible in gradual onset like in this case.

Case presentation The patient …

Opioid Dependence Induced By Hydromorphone Use In The Acute Care Hospital Setting., Changho Yi, Justin Faye, Jose Cano

Research Colloquium

Background and objectives: Opioids have been used broadly for pain control in patients with intense pain in the hospital setting. Hydromorphone is one of the semisynthetic opioids with high potency that is occasionally chosen for better pain control when non-opioids and natural opioids fail to control pain¹. And sometimes it is preferred in patients with hemodialysis because of the pharmacokinetics of hydromorphone which elimination is achieved easily by dialysis². It is unknown whether its potential for abuse is higher than other opioids^3,4. However, the authors experienced three cases of opioid dependence induced by using …

Ascending Colon Cancer Presenting As A Recurrent Abdominal Abscess In A Hispanic Woman, Baron S. Ekeledo, Ernesto Garza, Sandeep Samuel, Nicole Grigg-Gutierrez, Fatimah Bello

Research Colloquium

Introduction/Background There are multiple case reports on abdominal wall infiltration by colonic cancerous cells in conjunction with secondary infection appearing as abdominal abscesses. However, there are only few cases reported in literature for which a recurrent abdominal abscess is the initial presentation of an ascending colon cancer.

Case Report We present an 87-year-old Hispanic woman with history of recurrent RUQ abdominal abscess, constipation, melena and hematochezia who presented to the ED with continued discharge status post I&D of RUQ abscess. The patient was a poor historian, and no other complaints were elicited. CT abdomen/pelvis with contrast showed persistent colonic gastric …

Severe Covid-19 Infection Complicated With Bilateral Pneumothorax And Cardiac Arrest, Alfarooq Alshaikhli, Francisco J. Cabral-Amador, Joseph Caporusso, Eric Sanchez

Research Colloquium

Background: Severe cases of COVID-19 are often associated with acute respiratory distress syndrome resulting in hypoxic respiratory failure; however, it is crucial to consider other differential diagnoses in patient’s presenting with worsening hypoxia, including severe pneumothorax given the barotrauma associated in some patients.

Case presentation: Our team presents a case of a 62-year-old man with a history of kidney transplant on immunosuppressive therapy, hypertension, stroke with residual contracted right upper extremity who presented with severe COVID-19 pneumonia. The patient was admitted to the Intensive Care Unit (ICU) where he was intubated and sedated, ventilator settings were tuned according to acute …

Methicillin-Resistant Staphylococcus Aureus (Mrsa) Nasal Screening As A Tool For Antibiotic Stewardship Program, Alexandria N. Gonzalez, Myung-Jin Cha, Oryana Otero, Jose Campo Maldonado

Research Colloquium

Background Methicillin-Resistant Staphylococcus aureus (MRSA) nasal screening is a tool which may aid in avoiding unnecessary empiric MRSA therapy for community acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP) and other infections in the inpatient setting. Appropriate antibiotic therapy is vital in minimizing hospital stay, avoidance of multi-drug resistance, and patient mortality. The objective of this project was to evaluate the use of MRSA nasal screening and understand its use which will ultimately help inform the implementation of quality improvement interventions to improve antibiotic usage at an acute care hospital in our region.

Methods From 409 inpatient visits for patients who had …

Terbinafine Induced Liver Injury Is Rare. We Report A Case Of Terbinafine Induced Hepatitis-Cholestatic Injury., Denis X. Gutierrez, Jian Garcia Cruz

Research Colloquium

Abstract Drug induced liver injury (DILI) is a cause of significant morbidity; timely diagnosis is important and requires a high index of suspicion. Terbinafine induced liver injury is rare. We report a case of Terbinafine induced hepatitis-cholestatic injury. The patient had a prolonged recovery phase lasting three months after discontinuation of drug.

Background A 44-year-old Gentleman presented to the hospital with history of pruritus and progressive jaundice. He had been taking Terbinafine 250 mg once a day for onychomycosis for a total duration of 7 weeks after which he developed jaundice, pruritus, and dark urine. He had no history of …

Disparities In Available Surgeons And Specialty Physicians Providing Endocrine-Related Health Care Coverage To Populations In South Texas And The Rio Grande Valley., Valentine S. Alia, Ed Wong Alvarado, Henry Reinhart

Research Colloquium

Background: The Rio Grande Valley and South Texas is home to some of the most medically underserved populations in the nation, with gaps in health care ranging from low rates of adequately insured individuals, to the amount of primary and specialty healthcare services available [1]. Populations living in these areas near the Texas-Mexico border have some of the highest incidence of metabolic and endocrine-related disease in the U.S., while paradoxically having a large deficit in endocrine-specialists available to meet the medical and surgical needs of the community [1,2,3].

Methods: We analyzed data from the National Center for Health Workforce Analysis …

Bone Health Matters: A Closer Look At Osteoporosis Within The Rio Grande Valley, Ryan Bialaszewski, Philippe J. Dentino, John Ronnau

Research Colloquium

Background: Osteoporosis is a condition characterized by decreased bone mass and decreased bone quality, leading to increased bone fragility and risk of fractures. The number of fractures due to osteoporosis is projected to increase to over 3 million by the year 2025 and cost $25.3 billion annually. It ranks highly among diseases that cause patients to become bedridden with serious complications and reduced quality of life. Additionally, osteoporosis disproportionately affects Hispanics, which comprise most of the Rio Grande Valley (RGV) population. We hypothesize individuals residing in the Rio Grande Valley have higher rates of Osteoporosis and lower rates of Osteoporosis …

The Covid-19 Impact On Physician Wellness In The Rio Grande Valley, Lauren A. Herrera, Ruth Escalera, Ericka Vazquez, Victoria Jacobsen

Research Colloquium

Background: Current research on physician burnout is not only scarce when looking at rural communities, but it is further limited when evaluating its prevalence in physicians caring for the medically underserved. This study aims to determine the rate of physician burnout during the COVID-19 pandemic and identify effective coping interventions in an underserved mixed rural–urban region along the Texas–Mexico border.

Methods: We conducted a regional study in a small sample of US physicians from various specialties using a structured questionnaire. Participants were contacted using listed work emails within the UTHealth Rio Grande Valley system over a five week period …

Let’S Eat Healthy: Piloting A Brief Interactive Nutrition Session For High School Students – Role Of A Physician, Michaela Q. Ramirez Iglesia, Chelsea Chang

Research Colloquium

Background: 26.2% of Hispanic American children are obese, while 19.7% of children in the United States are obese. We developed and delivered a 30-minute interactive nutrition session for high school students including a nutrition knowledge assessment in the predominantly Hispanic region of South Texas, the Rio Grande Valley.

Methods: We designed the curriculum to teach high school students about the health impacts of sugar-sweetened beverages, the importance of eating whole foods, and tools for making healthy choices. We presented “Let’s Eat Healthy” to 70 high school students as part of a day-long interprofessional conference by University of Texas Rio Grande …

Utilization Of Palliative Care Service In Patients With Liver Cirrhosis In An Underserved Area, 2015-2019, Ismael Polo Perez, Dailis S. Corria Cedeno, Hari Movva, Hari Das, Giri Movva

Research Colloquium

Palliative care is a service with a very wide vision and potent tool. Palliative care applies early in the course of terminal illness in conjunction with therapies intended to prolong life; it is not limited to end-of-life care. Patients with liver cirrhosis only have one healing treatment, a liver transplant, but the limitation in the number of organ donors and eligibility criteria reduces the number of transplants. The MELD-Na score provides validated mortality prognostic for the next 90 days in patients with liver cirrhosis. This study aimed to determine if palliative care services are underutilized and could be more evident …

Takatsubo Cardiomyopathy In A Hispanic Female With Covid-19 Infection., Percy M. Thomas, Jose Rivera, Josenny Rodriguez-Paez, Arup Ganguly

Research Colloquium

Background: Takatsubo (tako- octopus, tsubo- a pot) Cardiomyopathy (TTS) colloquially known as broken heart syndrome is a left or right (in 1/3^rd patients) ventricular motion abnormality that extends even beyond the coronary artery supply areas, with non-obstructive coronaries. Most commonly due to emotional or physical stressors and in some cases in hospitalized patients (2). The Coronavirus-19 (COVID-19) pandemic has resulted in a total death toll of 1.1 million in the United States of America so far, with cardiovascular complications such as heart failure (7.7%) and ischemic heart disease (10.9%) being significant contributors(1). TTS prevalence in the general population is …

The Influence Of Age And The Social Determinants Of Health On Frailty Among Older Adults, Lubna A. Nasr, Vincent P. Diego, Carolina Gomez De Ziegler, Gerardo Munoz-Monaco, Eron Manusov

Research Colloquium

Background: Frailty is an age-related phenotype characterized by physiological decline and increased vulnerability to stressors, leading to the risk of adverse events including falls, hospitalizations, re-admissions, and mortality. The prevalence of frailty depends on the setting (nursing home > hospital > ambulatory) and is higher in those with socioeconomic instability, lower education levels, unsafe environments, and poor healthcare access. Our two goals included identifying the prevalence of frailty in patients cared for at the UT Health Knapp Family Health Center (ambulatory) and assessing the relationship between frailty and the social determinants of health (SDoH).

Methods: We performed a cross-sectional study from September …

Congenital Nephrogenic Diabetes Insipidus: A Case Report In A Hispanic Male, Percy M. Thomas, Gloria P. Rodriguez-Gomez, John Manllo Dieck

Research Colloquium

Background: Diabetes Insipidus (DI) is a rare condition that manifests with large volumes of diluted urine and plasma hyperosmolarity secondary to decreased production or response to antidiuretic hormone (vasopressin). Congenital forms represent

Case presentation: A 32 year-old-male with a history of long-standing polydipsia (10 L/day) and polyuria, with similar symptoms in his son and nephew, was admitted to the intensive care unit following a motor vehicle accident. The patient was initially sedated and intubated and his sodium level at admission was 140 mmol/L. He developed severe hypernatremia 6 hours after arrival (Na+ 163 mmol/L), with a serum hyperosmolarity …

A New Technique: Transposition Of Transverse Breast Mound Mastectomy Scars To The Inframammary Fold, Allison Podsednik Gardner, Annalisa Lopez, Aidee Nunez, Mauricio De La Garza

Research Colloquium

Background: Mastectomy scar appearance impacts patients’ perception of themselves following breast reconstruction. If a peri-elliptical approach for skin-sparing mastectomy is used the resultant mastectomy scar lies transversely across the center of the breast mound, causing patient dissatisfaction and emotional stress. The authors describe a surgical technique to avoid the presence of mastectomy scars across the breast mound by progressively lowering the mastectomy scar until it lies in a discrete position under the breast in patients undergoing implant-based reconstruction.

Methods: The authors first describe the operative technique in detail. A retrospective chart review of 26 patients from 2017-2022 who underwent the …

A Case Of Red Breast Syndrome, Allison Podsednik Gardner, Aidee Nunez, Mauricio De La Garza

Research Colloquium

Background: Increasingly popular for use in breast reconstruction, acellular dermal matrix (ADM) can provide support and protection to implants. However, use of ADM may be associated with infections and complications, including Red Breast Syndrome (RBS). RBS was first documented in 2009 and is reported to have a low mean incidence. The phenomenon is an inflammatory event which typically presents with cutaneous erythema over the domain of the surgically placed ADM.

Case Presentation: The authors present and describe a case of RBS resultant from ADM. As ADM is used with more frequency, presumably more cases of RBS will occur. …

Head And Neck Metastasis Of Colorectal Adenocarcinoma: A Case Report And Literature Review, Taha Al Hassan, Rachel A. Giese

Research Colloquium

Background: Colorectal Adenocarcinoma (CRC) metastasis is found in approximately 1 in 5 patients diagnosed with CRC and frequently spreads to the liver, lungs, peritoneum, bone, and nervous system. There are several subtypes of adenocarcinoma but the single most associated with distant metastasis, multiple sites of metastasis, and poorer survival is the signet-ring cell carcinoma variant. We present an unusual case of a head and neck mass demonstrating immunohistochemical staining specific for colorectal origin in a patient with a history of mucinous adenocarcinoma of the colon.

Case Presentation: A 53-year-old female was referred for a left cervical neck mass associated with …

Acute Generalized Exanthematous Pustulosis Secondary To Levofloxacin Use, Rukayat Akande, Johanne Chaglasian

Research Colloquium

Background We present a patient who developed pustular rash following levofloxacin use. Acute generalized exanthematous pustulosis is a rare drug reaction. This abstract will review the patient’s symptoms, diagnosis and management.

Case presentation 25-year-old man presented with fever, facial swelling, and pruritic rash on face and body of a day duration. Two days prior, he had been prescribed levofloxacin for a sore throat. His symptoms developed within 24 hours of his first use of levofloxacin. He denied previous use of levofloxacin. His vital signs were T 101.7, RR 18, HR 114, BP 112/59, SPO2 100% on RA. On examination, he …

Acute Submassive Bilateral Pulmonary Embolism In Patient With Recent Covid-19 Pneumonia, Rukayat Akande, Nevin A. Varghese

Research Colloquium

Background A 37-year-old man with multiple comorbidities who developed pulmonary embolism after a recent COVID-19 pneumonia. Clinicians must have a high index of suspicion for pulmonary embolism in patients who are at risk. Supportive findings of pulmonary embolism on echocardiogram and ECG are reviewed.

Case Presentation A 37-year-old Hispanic man with class III obesity, diabetes, and COVID-19 pneumonia three weeks prior presented with progressive shortness of breath, subjective fevers, and cough of two days duration. Vitals were T 97.7F HR 118/’ BP 124/85 mmHg, RR 24/’, SPO2 95% on 4 L oxygen. He was lethargic, in respiratory distress, and had …

A Rare Case Of Paraneoplastic Autoimmune Encephalitis In A Hispanic Male With Gastric Adenocarcinoma., Percy M. Thomas, Gloria P. Rodriguez-Gomez, Jose Rivera, Brandon Cantazaro

Research Colloquium

Background: Paraneoplastic syndromes (PNS) with Gastric cancer is a rare occurrence with very few reported cases, literature review showed that only four prior cases have been reported of patients with gastric adenocarcinoma that developed PNS, the high-risk phenotypes described in these cases were paraneoplastic limbic encephalitis; opsoclonus-myoclonus; and Lambert- Eaton myasthenic syndrome. Our patient with gastric adenocarcinoma on chemotherapy presented with a sudden onset of altered mental status, a series of diagnostic tests concluded autoimmune encephalitis as the culprit. This article will increase awareness of autoimmune encephalitis as a paraneoplastic complication of Gastric adenocarcinoma.

Case Presentation: 40-year-old male patient with …

Subtotal Iliac Vein Occlusion Secondary To May-Thurner Syndrome, Myung-Jin Cha, Shyama Appareddy, Jennifer Rojas Huen, Usman Sheriff, Jose Ramos

Research Colloquium

Introduction May Thurner Syndrome (MTS), an anatomical variant present in over 20% of the population, can present with iliofemoral deep venous thrombosis (DVT) caused by compression of the common iliac vein by the adjacent iliac artery.

History of presentation An 86-year-old male with hypertension, dyslipidemia, coronary artery disease status post remote drug-eluting stent placement, and a history of DVT presented with a three-week history of unilateral left lower extremity swelling. He had been increasingly sedentary over the past several months.

Investigations Whole-leg duplex ultrasonography was performed which showed extensive DVT from the knee to the ankle (Fig. 1a). Dense echoes …