Medicine and Health Sciences Commons^™

Impact Of Dermatology Access On Dermatofibrosarcoma Protuberans Outcomes, Joseph H. Kelly, Marcus L. Frohm

Scholarship Pathways Program

Impact of Dermatology Access on Dermatofibrosarcoma Protuberans Outcomes

Joseph H. Kelly MD

Mentor: Marcus L. Frohm, MD

Introduction: Dermatofibrosarcoma protuberans is a locally aggressive rare dermal sarcoma with a relatively high rate of local recurrence. Incidence in the United States has been reported around 4 occurrences per million people per year, and recurrence rates have been reported between 2 to 19%. Recurrence poses a higher risk for sarcomatous transformation, increasing the risk for metastasis. Early and accurate diagnosis, coupled with appropriate management, is essential to minimize these risks. This study extended previous research by evaluating whether access to dermatology care …

The Cadaver As The First Patient: Early Integration Of Pathology In The Preclinical Anatomy Laboratory, Sruthi Shriram, Lauren Desantis, Tulika Singhal, Kevin Ta, Courtney Shields, Muhammad Jawwad Arshad, Varna Taranikanti, Madison Konja

Posters

No abstract provided.

Head Impacts In Collegiate Rodeo Athletes: An Observational Study, Colton D. Carlson, Jacob Miller, Jason C. Dorman, Verle D. Valentine, Thayne A. Munce

Scholarship Pathways Program

Head Acceleration Events in Collegiate Rodeo Athletes

Colton Carlson, MS4

Mentor: Thayne Munce, PhD

Introduction: Brain health has been a growing concern across a wide range of contact sports in the last three decades. While most of the early brain health research was focused on identifying and preventing concussions, newer research has found that an accumulation of repetitive head impacts (RHI) is more predictive of long-term brain health than the number of concussions sustained. Consequently, being able to assess RHI in sports despite the lack of outward symptoms has become paramount in promoting the long-term health of athletes. While the …

Addressing Vaccine Hesitancy With Patient Education, Belle Grady, Victor Huber

Scholarship Pathways Program

Addressing Vaccine Hesitancy with Patient Education

Belle Grady, MD | Mentor: Victor Huber, PhD

Background: Vaccine hesitancy is a complex global issue, exacerbated by pandemics and social media. In addition to hesitancy, state policies loosening childhood vaccine requirements and alternative vaccination schedules may contribute to recent vaccine-preventable illness outbreaks in the United States. In South Dakota alone, kindergarten vaccination rates have gradually declined over the past decade. Such vaccine hesitancy and decreasing vaccination rates is a public health concern and must be addressed. Accessible patient education resources on the topic are necessary to increase vaccination rates.

Project Description: This project …

Licensed Massage Therapists On The Frontline Of Skin Cancer: Enhancing Early Detection And Prevention In Rural South Dakota, Kianna Thelen, Leah Naasz, Meagan Kray, Marc Dvorack

Scholarship Pathways Program

Title: Licensed Massage Therapists on the frontlines of skin cancer detection: A pilot educational intervention in rural South Dakota

Authors:

Kianna Thelen, MD | Mentor: Marc Dvoracek, MD

Introduction: Skin cancer is the most common malignancy in the United States. Early detection improves outcomes, yet rural communities face barriers to dermatologic care. Licensed massage therapists (LMTs) are uniquely positioned to observe skin changes during client encounters. This intervention aims to assess the impact of a tailored educational intervention on rural LMTs’ knowledge, confidence, and practices for identifying suspicious skin lesions.

Methods: Between July 2023 and January 2024, 46 LMTs and …

Calcineurin-Mediated Immunosuppressants In Binge Ethanol Drinking And Stress Responsivity, E. Kirschenmann, J. Agar, T. P. Beresford, P. J. Ronan

Scholarship Pathways Program

Calcineurin-Mediated Immunosuppressants in Binge Ethanol Drinking and Stress Responsivity

Emily Kirschenmann MD | Patrick J. Ronan PhD

Introduction: Previous research has found that the calcineurin-mediated immunosuppressants cyclosporine A (CsA) and tacrolimus inhibit binge alcohol drinking in mice. Further research has shown that this effect is mediated directly in brain, as intracerebroventricular administration also significantly decreases drinking. As these immunosuppressants have severe systemic toxic effects along with dangerous inhibition of immune function, our goal is to determine proximal mechanisms by which these immunosuppressants are working in order to develop effective treatments for alcohol use disorder (AUD) with fewer side effects. One …

Using Geospatial Analysis To Compare Metropolitan Greenspace And Adolescent Obesity, Rachel Schild, Denyelle Kenyon, Zachary Schild

Scholarship Pathways Program

Using Geospatial Analysis and Machine Learning to Compare Metropolitan Greenspace and Rates of Adolescents with Obesity

 Rachel Schild MD | DenYelle Kenyon PhD

 Introduction: Insufficient outdoor activity, influenced by limited access to exercise-friendly greenspaces, may contribute to increasing childhood obesity rates. However, rigorous evaluation of greenspace quality on a citywide scale is lacking. This study aims to characterize greenspace vegetation types and correlate them with adolescent obesity outcomes, identifying optimal characteristics for promoting health. This data could aid city planners in optimizing greenspace allocation and improving vegetation choices.

Methods: Satellite imagery and municipal data were used to map ten cities, …

Determining The Relatedness Of Simian Varicella Virus Strains Using Polymerase Chain Reactions And Delta Herpesvirus-Dervied Primers, Ellyn M. Waits

Honors Theses

This study examines genetic variation among strains of Simian Varicella Virus (SVV) using genomic analysis. The primary goal of this experiment was to observe potential genomic differences among the Liverpool vervet virus (LVV), the Tsukuba herpesvirus, and the Delta herpesvirus (DHV) strains using primer sets developed from the fully sequenced DHV strain. SVV strains were initially cultivated in Vero cell cultures to begin viral propagation. Viral proliferation in these cell cultures enables DNA isolation via standard purification methods. The extracted viral DNA is subjected to polymerase chain reaction (PCR) amplification targeting specific regions of open reading frames (ORFs) in the …

Targeted Skin Cancer Education Improves Agricultural Workers' Safe Sun Practices And Knowledge In South Dakota: A Farm Show Survey, Leah Naasz, Kianna Thelen, Candace Zeigler

Scholarship Pathways Program

Targeted Skin Cancer Education Improves Agricultural Workers' Safe Sun Practices and Knowledge in South Dakota: A Farm Show Survey

Leah Naasz, MD | Candace Zeigler, MD

Background: Agricultural workers are at increased risk for skin cancer due to prolonged ultraviolet (UV) exposure, yet many underutilize sun protection. Brief, community-based educational interventions may improve knowledge and preventive behaviors.

Objective: To provide a targeted skin cancer educational session to increase awareness and promote sun protection behaviors among agricultural workers in South Dakota.

Methods: Twenty agricultural workers attending the Vermillion and Sioux Falls Farm Shows participated in a pre- and post-educational survey. Inclusion …

Comparative Analysis Of Antegrade And Retrograde Nailing For Proximal, Shaft, And Distal Femur Fractures, Saahil Noupada

Rowan-Virtua Research Day

Background:

Antegrade and retrograde intramedullary nailing are widely used for femoral fractures, yet their relative advantages across fracture locations remain debated. This study compares union rates, time to union, malunion, and functional outcomes between approaches, stratified by AO/OTA classification.

Methods:

A systematic review of PubMed, Embase, Cochrane Library, Web of Science, and Scopus (2015 to 2025) was performed. Studies reporting outcomes of antegrade and/or retrograde nailing for proximal (31), diaphyseal (32), and distal (33) femoral fractures were included. Data on demographics, fracture classification, fixation method, and outcomes were extracted. Risk of bias was assessed using ROBINS-I. Pooled estimates were calculated …

Medical Providers’ Perspective On Barriers Faced By Intellectual And Developmental Disabled (Idd) Patients From Medically Underserved Backgrounds, Mayra A. Flores

Rowan-Virtua Research Day

•Complexities of obtaining healthcare access can be difficult for all patients across the board, so much so that it’s viewed as a maze. Studies have shown that these challenges are added on for medically underserved communities.2-3 Some of these challenges include insurance, language barriers, appointment availability, stigma, financial limitations and lack of transportation.2 •Identify the barriers that patients with intellectual and developmental disabilities (IDD) from medically underserved backgrounds face in healthcare access. •Intellectually and developmentally disabled patients from medically underserved communities face exacerbated barriers in healthcare access. •Participating medical providers from the Regional Integrated Special Needs Center (RISN) – Sewell …

Management Of Libman-Sacks Endocarditis: The Role Of Anticoagulation And Immunosuppressive Therapy, Klaudia Matanaj, Demi Poulathas, David Altimore

Rowan-Virtua Research Day

Background: Libman-Sacks endocarditis (LSE) is a nonbacterial thrombotic endocarditis detected in 10-40% of patients with systemic lupus erythematosus (SLE), depending on imaging modality. LSE is strongly associated with antiphospholipid syndrome (APS). The condition significantly increases the risk of cerebrovascular accidents and inpatient mortality compared to SLE without cardiac involvement. Despite these serious complications, optimal management remains uncertain. Objective: To review the current evidence on the pathophysiology and management of LSE. Methods: A literature review was conducted using 12 peer-reviewed articles addressing LSE pathophysiology, clinical outcomes, and treatment strategies. Results: Combination anti-inflammatory and antithrombotic therapy achieved 76% …

Age And Genotype-Dependent Baseline Characterization Of Spatial Learning And Memory In App/Ps1 Rats Using The Morris Water Maze, Thomas George, Mohammadreza Arbab, Nathanael Ricardo Alicea, Mahdie Kerdari, Christopher Janson

Rowan-Virtua Research Day

Background: Alzheimer’s disease (AD) is characterized by progressive cognitive decline. Transgenic APP/PS1 rat models offer improved translational relevance compared to mouse models due to closer similarity to human neurobiology.

Objective: To establish a baseline profile of spatial learning and memory across age and genotype in rate model.

Methods: The Morris Water Maze (MWM) was used to assess four groups of rats: young Wild Type (WT), young APP/PS1 (AD), middle-aged WT, and middle-aged AD. Spatial learning was evaluated during acquisition (Day 1–4) using cumulative proximity and escape latency. Memory was assessed using probe trials (Day 2–4). Swim velocity …

Tat-Beclin 1 And Exercise: Investigating Their Potential Synergy In Improving Sarcopenia-Related Muscle Changes In A Mouse Model, Shreya Krishnan, Thuan Thien Tchen, Kleiton Silva, Gabryel Sales Nascimento

Rowan-Virtua Research Day

No abstract provided.

Improving Adherence To Comprehensive Gynecological Assessments In Female Rectal Cancer Patients Prior To Rectal Cancer Treatment, Rachael Smith, Eleanor Williams, Emily Young

Rowan-Virtua Research Day

Background: A retrospective chart review of 139 female patients with Stage I-III rectal cancer treated at our institution (2017-2022) revealed only 32.6% (n=45) had documented age-appropriate gynecologic screenings prior to surgical intervention. These findings were disseminated to colorectal surgeons, medical oncologists, and radiation oncologists through departmental meetings and tumor boards. This follow-up study evaluates the impact of that educational initiative on gynecologic referral patterns. 

Hypothesis: Targeted education of colorectal surgeons, medical oncologists, and radiation oncologists would significantly increase gynecologic referral rates for female rectal cancer patients. 

Methods: This pre-post quality improvement study compared gynecologic referral rates among female patients with …

Understanding The Immune Responses Of Macrophages And Neutrophils In Synovial Fluid And Post-Operative Joint Environments, Allison Noelle Snyder

Rowan-Virtua Research Day

Periprosthetic joint infections (PJI) are devastating complications of total joint replacement (TJA). Even with aggressive antibiotic treatments, PJI recurrence rates are >17%, and 5-year survival is only 87.3%. Understanding the levels of inflammatory markers and cell types present at different timepoints is crucial in maximizing antimicrobial therapy and preventing adverse outcomes following TJA. This study tests the hypothesis that the synovial fluid environment of PJI induces immunosuppression in human macrophages, thereby hindering their ability to kill bacteria.

How Do Adverse Social Determinants Of Health Influence 30-Day Hospital Readmission Rates Among Patients With Heart Failure?, Noor Baig

Rowan-Virtua Research Day

Heart failure is one of the leading causes of hospitalization in the United States, with nearly 1 in 4 patients readmitted within 30 days of discharge. Clinical severity largely accounts for this risk, but social determinants of health (SDOH), including income, housing stability, transportation access, and health literacy, also play a role in post-discharge outcomes. This review synthesized seven cohort, observational, and qualitative studies from PubMed (2018–2025) examining the relationship between SDOH and 30-day readmission in heart failure patients.

Several patterns emerged across the literature. Neighborhood socioeconomic disadvantage, measured through ADI and SDI, was independently associated with higher readmission and …

Premenstrual Disorders In Females With Neurodevelopmental Conditions: A Systematic Review, Akhila Archakam, Nikhila Archakam, Harshal Parmar, Wesley Kim

Rowan-Virtua Research Day

Background: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are prevalent conditions associated with substantial functional impairment and psychiatric morbidity. Symptoms are driven by heightened sensitivity to cyclical fluctuations in estrogen and progesterone rather than absolute hormone levels. Individuals with neurodevelopmental conditions, particularly attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), may exhibit altered neurobiological and emotional regulation pathways that increase vulnerability to these hormonal changes; however, this relationship has not been systematically synthesized.

Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane CENTRAL were searched from 2000–2026 for studies evaluating associations between ADHD, …

Ai-Augmented Digital Auscultation For Point-Of-Care Screening Of Valvular Heart Disease: A Systematic Review And Meta-Analysis, Harshal Parmar, Akhila Archakam, Nikhila Archakam, Wesley Kim, Eduard Koman Md

Rowan-Virtua Research Day

Background: Valvular heart disease (VHD) affects >10% of adults aged 75+ yet remains underdiagnosed when asymptomatic due to declining auscultatory proficiency. AI-augmented digital auscultation offers a point-of-care screening solution, though no meta-analysis has pooled diagnostic accuracy across VHD subtypes in adults using echocardiography as the reference.

Methods: A systematic review and meta-analysis were conducted per PRISMA guidelines. PubMed, Embase, Cochrane, IEEE Xplore, and Scopus were searched without date restriction. Studies applying AI or machine learning to digital auscultation or phonocardiography for VHD classification in adults with echocardiographic reference and patient-level diagnostic metrics were included. Studies using only public datasets, pediatric …

In Patients With Acne Vulgaris, How Do Standard Acne Treatments Combined With Adjunct Microbiome-Targeted Therapies Compare To Standard Acne Treatments Alone In Affecting Clinical Outcomes?, Sree Gowri Sudharshan

Rowan-Virtua Research Day

Background: Acne vulgaris is a very common chronic skin condition that occurs when hair follicles become clogged with oil, dead skin cells, and bacteria. Nearly 50 million Americans are affected annually, and it usually occurs around puberty. Due to rising antibiotic resistance and unwanted side effects to current mediations, emerging research on the role of skin and gut microbiome in acne development is of interest.

Hypothesis: Adjuvant microbiome-targeted therapies may offer better clinical outcomes than standard acne treatments alone.

Methods: Literature search performed in PubMed and Embase using keywords related to acne vulgaris, microbiome-targeted therapies, and targeted acne treatments. Of …

What Is The Role Of The Gut Microbiome In Modulating Immune Tolerance And The Development Of Allergic Disease In Infants?, Priyal Gajera

Rowan-Virtua Research Day

Introduction: The infant gut microbiome plays a critical role in immune system development during the early-life “window of immune education.”¹ Microbial colonization influences immune tolerance through mechanisms such as regulatory T-cell (Treg) induction, short-chain fatty acid (SCFA) production, and mucosal immune regulation. Disruptions in this process (dysbiosis) are associated with increased risk of allergic diseases, including food allergy, atopic dermatitis, and asthma. Environmental and maternal factors such as delivery mode, antibiotic exposure, and feeding practices significantly impact microbial composition and immune outcomes.²

Methods: A literature review was conducted using PubMed with search terms related to the gut microbiome, …

Resensitization Of Clinical Isolates Of Mdr-Acinetobacter Baumannii To Antibiotics Using Bacteriophage Therapy, Priyal Gajera, Valerie J. Carabetta

Rowan-Virtua Research Day

Introduction:

Antibiotic resistance poses a major global health threat, particularly with multidrug-resistant (MDR) pathogens such as Acinetobacter baumannii, which exhibits resistance to multiple antibiotic classes, including carbapenems.¹ As conventional treatments become less effective, alternative therapies such as bacteriophage therapy are gaining attention. Bacteriophages offer targeted antibacterial activity and may enhance antibiotic efficacy or resensitize resistant strains. This study investigates the synergistic effects of bacteriophage ΦCO03 combined with antibiotics against MDR A. baumannii.

Methods:

Clinical isolates (M20, M5) of A. baumannii were cultured in LB broth at 37°C. Bacteriophage ΦCO03 was isolated and purified using plaque assays. Synergy between phage …

Incidence Of Stroke Post Pulmonary Thrombectomy: Implications For Periprocedural Management, Rohan Umrani, Rameez Shahid, Luai Tabaza

Rowan-Virtua Research Day

Background: The incidence of stroke after pulmonary thrombectomy (PT) remains unknown. Given the incidence of patent foramen ovale (PFO) of 25% in autopsy studies, the concern for paradoxical embolus in this patient population warrants evaluation of periprocedural management.

Methods: We queried the EPIC EHR at Virtua Health in New Jersey for all patients who underwent PT from 2021-2025, categorized by utilization of the Inari Flowtriever system or the Penumbra thrombectomy device. We assessed post-PT cerebrovascular accident (CVA), PFO presence by transthoracic echocardiogram (TTE), and gender via descriptive statistics. Age, average anesthesia time and procedure supply cost were assessed via two-sided …

Effect Of Parkinson’S Disease On The Lateralization Of The Digastric Muscle In A Rodent Model, Estelle Richardson, Francois Gould

Rowan-Virtua Research Day

In Parkinson’s disease, the loss of dopaminergic neurons in the substantia nigra can cause dysphagia, which affects all phases of swallowing. In swallowing, bilateral pairs of muscles under the control of independent unilateral neural mechanisms must simultaneously activate to coordinate their movements and produce a swallow. However it is unknown how Parkinson’s disease impairs the activation of the right and left sides of those muscles. In this study we tested how Parkinson’s disease impacts the lateralization of the digastric muscle in rats. We hypothesized that Parkinson’s disease will cause a difference in activation of the right and left digastric muscles …

Atypical Presentation Of Alpha-Gal Syndrome Identified During Evaluation Of Transient Neurologic Symptoms, Austin J. Wong, Todd Schachter

Rowan-Virtua Research Day

Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity reaction to galactose-α-1,3-galactose, typically associated with tick exposure and delayed allergic reactions to mammalian meat products. While most commonly presenting with urticaria, gastrointestinal symptoms, or anaphylaxis, atypical and systemic manifestations remain poorly characterized.

We present the case of a 39-year-old male with minimal vascular risk factors who developed acute onset shortness of breath, chest pressure, and transient neurologic symptoms concerning for a transient ischemic attack. Extensive cardiac, vascular, and autoimmune evaluation was largely unremarkable aside from abnormalities in lupus anticoagulation screening and elevated homocysteine and protein C levels.

Further evaluation revealed elevated alpha-gal–specific …

Lactate-Induced Mitochondrial Magnesium Uptake And Its Metabolic Implications In The Mcardle’S Disease Model, Thiruvelselvan Ponnusamy, Jeremy Mehta, Haris Waseem, Marianne Assogba, Dianne Langford, Natarajaseenivasan Kalimuthusamy, Shanmughapriya Santhanam

Rowan-Virtua Research Day

McArdle disease, caused by mutations in the PYGM gene, impairs glycogenolysis in skeletal muscle, reducing lactate production and leading to energy deficits, fatigue, and risk of rhabdomyolysis. Using a CRISPR/Cas9-generated PYGM knockout (KO) rat model, we investigated whether reduced lactate production disrupts mitochondrial magnesium (Mg²⁺) homeostasis. KO rats failed to elevate lactate during static muscle contraction and showed diminished mitochondrial Mg²⁺ uptake, disrupted ATP synthesis, and impaired mitochondrial respiration. In vitro, caffeine-stimulated KO myotubes lacked lactate production and mitochondrial Mg²⁺ uptake despite preserved Ca²⁺ oscillations. Raising glucose concentration restored lactate levels, rescued mitochondrial Mg²⁺ transport, and improved metabolic output in …

Comparative Efficacy Of Intravenous Ketamine And Lidocaine Infusions For Pain Management In Sickle Cell Vaso-Occlusive Crisis (Voc), Akhil Tumpudi Md

Rowan-Virtua Research Day

Sickle cell disease (SCD) is a hereditary hemoglobin disorder characterized by vaso-occlusion and recurrent acute painful crises, which are the leading cause of hospitalization in affected individuals (1,2). Opioids remain the primary treatment for vaso-occlusive crisis (VOC) pain but are associated with adverse effects, tolerance, and risk of dependence, prompting investigation into opioid-sparing adjuncts (1,2). Intravenous ketamine, an NMDA receptor antagonist, has shown modest opioid reduction in randomized and observational studies, though pain score improvements are inconsistent (3–6). Intravenous lidocaine, a sodium channel blocker, has also demonstrated potential opioid-sparing effects in retrospective cohorts with limited evidence of analgesic superiority (7–9). …

Cold Agglutinin Disease A Case On Diagnostic Pitfalls And Decision-Making Strategy, Portia Shaheed, Shefali Waghray Do, Te Du Md, Phd

Rowan-Virtua Research Day

Cold agglutinin disease is a rare subtype of autoimmune hemolytic anemia (AIHA) characterized by complement-mediated hemolysis triggered by cold temperatures. Because of its rarity and variable presentation, cold agglutinin disease is frequently underrecognized, often leading to extensive and sometimes unnecessary diagnostic evaluations. By recognizing cold agglutinin disease as a differential diagnosis in patients with recurrent admissions for hemolysis, clinicians can avoid unnecessary workups, consults, and distress for their patients.

Focal Status Epilepticus In A Patient With Responsive Neurostimulation: A Rare Complication And Management Insights, Ana Leticia Fornari Caprara Md, Jamir Pitton Rissardo, Pranaya Gade, Estefania Joselinne Alba-Rodriguez Md, Eric P. Nagele Md, Salman Assad Md, Islam Fayed Md, Evren Burakgazi-Dalkilic Md

Rowan-Virtua Research Day

Introduction: Responsive neurostimulation (RNS) is an established therapy for drug-resistant focal epilepsy, yet device-related complications during acute seizures remain underreported. We describe a case of focal status epilepticus in a patient with RNS, illustrating the interplay of possible device malfunction, systemic illness, and medication nonadherence. Case Report: A 39-year-old man with drug-resistant focal epilepsy and schizoaffective disorder, status post right frontal craniotomy and RNS implantation, presented with focal status epilepticus after several days of antiseizure medication (ASM) nonadherence, febrile illness, vomiting, and urinary tract infection (UTI). On admission, he was lethargic with frequent focal seizures (< 30 s) characterized by left head turn, left arm followed by bilateral arm tonic stiffening, and impaired awareness. Continuous EEG confirmed focal status epilepticus. Family declined intubation. A ketamine bolus (20 mg) followed by infusion (0.25–0.5 mg/kg/hr) for 24 hours achieved seizure cessation. Despite broad ASM therapy (phenytoin, zonisamide, perampanel, levetiracetam, clorazepate, cenobamate, carbamazepine, clonazepam, lacosamide), seizures persisted until RNS interrogation revealed high lead impedance; the device was deactivated. ASM doses were optimized, PEG tube placed for consistent delivery, and UTI treated. He stabilized and was discharged to rehabilitation. Conclusion: This case highlights the need for comprehensive evaluation in RNS patients presenting with focal status epilepticus. Device malfunction, systemic illness, and inconsistent ASM adherence can synergistically worsen seizure control. Multidisciplinary management including neurocritical care, device troubleshooting, and nutritional support was pivotal for recovery.

Methadone-Associated Qt Prolongation: The Importance Of Early Recognition And Monitoring In The Emergency Department, Uma Murrugappan, Kelsey Murray, James Espinosa Md, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 43-year-old female with cervical cancer and bilateral percutaneous nephrostomy tubes receiving high-dose methadone maintenance therapy who presented to the emergency department with bilateral flank and abdominal pain. She denied cardiac symptoms. Electrocardiogram obtained during evaluation revealed marked QT prolongation (QTc 596 ms) following recent methadone dose escalation. The patient was placed on continuous cardiac monitoring and intravenous magnesium was ordered. While intravenous access was being obtained, she developed polymorphic ventricular tachycardia consistent with torsades de pointes and became pulseless. Advanced cardiac life support was initiated including defibrillation and magnesium administration, with return of spontaneous …