Medicine and Health Sciences Commons^™

Methotrexate Toxicity Induced Pancytopenia And Oral Ulcerations, Brooke Mcvaney, Salim Lutfalla

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Authors: Brooke McVaney, DO; Salim Lutfallah, MS3; Ashley Misky, DO; Najy Masri, MD Louisiana State University Internal Medicine, New Orleans, LA

Case: A 65-year-old male presented to the emergency department with painful oral ulcerations for 10 days and a generalized rash for 6 days. His medical history was significant for coronary artery disease, seropositive rheumatoid arthritis on MTX, and paroxysmal atrial fibrillation. Vital signs were within normal limits upon presentation. On exam he was noted to have scattered petechiae with central erosions and excoriations to the bilateral upper and lower extremities, palms, back and trunk. He had oral mucosal lesions …

Cryptogenic Pyogenic Liver Abscess Due To Parvimonas Micra And Fusobacterium Nucleatum, Hope Otto Moise, Allen Byl

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Cryptogenic Pyogenic Liver Abscess due to Parvimonas micra and Fusobacterium nucleatum

Authors and Affiliates: Allen Byl, DO, Hope Oddo Moise, MD, Danielle Gilbert, DO, Nataliya Khimitch, MD, Paul Videau, MD, Victoria Burke, MD

Case: A 30-year-old male presented with fevers, chills, body aches, and abdominal pain for 7 days. He had a medical history of obesity and alcohol use. He reported abdominal pain as colicky in nature and associated with nausea, persistent non-bloody and non-bilious vomiting. At the time of hospital admission, he was afebrile but tachycardic with a heart rate of 122 BPM. His physical exam was significant for …

Leptospirosis: An Uncommon Cause Of Fever And Transaminitis In The Continental United States, Hope Otto Moise, Allen Byl

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Leptospirosis: An Uncommon Cause of Fever and Transaminitis in the Continental United States

Authors and Affiliates: Allen Byl, DO; Hope Oddo Moise, MD; Danielle Gilbert, DO, MPH; Michael Olejniczak, MD; Ashley Misky, DO; Tom Fox, MD; Alexa Lapointe, MD; Michael Modica, MD; Michelle Blyth, MD.

Case: A 24-year-old man presented with fevers, rigors, body aches, and headache for 6 days. He had recently returned from a 2-week trip to Colombia, during which time he went white water rafting, drank filtered stream water, had prolonged insect exposure with bites, and ate locally prepared food, including various meats. No one else from …

Sinister Sinusitis: Unraveling The Myserty Of Subgaleal Abscess, Salim Lutfallah

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No abstract provided.

Marantic Endocarditis In Antiphospholipid Syndrome: An Incidental Discovery Leading To Aortic Valve Replacement, Sepehr Sadgeghi

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Marantic endocarditis in antiphospholipid syndrome: An incidental discovery leading to aortic valve replacement.

Sepehr Sadeghi, DO. Department of Medicine, LSU Health Sciences Center, New Orleans, LA.

Case Presentation: A 60-year-old female with a past medical history of left popliteal DVT, APS, pulmonary embolism with open embolectomy, and ischemic stroke presented to the hospital after being referred by her cardiologist after a large mobile aortic valvular vegetation was noted on a routine TTE. On presentation, patient was asymptomatic with unremarkable vital signs. Physical exam showed cyanosis and mottling in the left lower extremity, of which a venous doppler US was negative. …

West Nile Virus Encephalitis: An Atypical Case Presentation, Sepehr Sadgeghi

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West Nile Virus encephalitis: An atypical case presentation

Sepehr Sadeghi, DO; Gurtaj Mahil, OMS-4. Department of Medicine, LSU Health Sciences Center, New Orleans, LA.

Case Presentation: A 60-year-old male with a history of hypertension, type 2 diabetes, stroke with left-sided hemiparesis, and epilepsy presented after being found unconscious in his backyard. He could not provide history due to altered mental status, but his brother reported that the patient lived independently. Initially, he was only oriented to person, had a fixed rightward gaze, left hemineglect, increased muscle tone, and generalized tremors. He was hypertensive to 241/102 and febrile at 102.6 F. …

Parkinsonism-Hyperpyrexia Syndrome: A Case Report Emphasizing Early Recognition And Management In Parkinson's Disease, Hannah Rader

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Parkinsonism-Hyperpyrexia Syndrome: A Case Report Emphasizing Early Recognition and Management in Parkinson's Disease

Nguyen, DD1,2, Rader, H1,2, Coe, B1,2, Bell, M1,2, Qureshi, H1,2, Olejniczak, M1,2, McCarron, RE1,2 1Department of Internal Medicine, LSU Health, New Orleans, LA 2Ochsner Medical Center, Kenner, LA

Abstract Parkinsonism-hyperpyrexia syndrome is an uncommon but severe clinical entity with diverse symptoms, including muscular stiffness, hyperthermia, autonomic dysfunction, respiratory distress, and altered consciousness. PHS can be triggered by the abrupt cessation of dopaminergic agents in Parkinson's disease patients. We present a case of a 67-year-old man with Parkinson's disease who developed PHS due to nonadherence to dopaminergic medications. …

A Rare Presentation Of Scurvy In A Well-Nourished Patient, Connor Robin

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A Rare Presentation of Scurvy in a Well-Nourished Patient

Connor Robin (LSUHSC School of Medicine)

Vitamin C deficiency, otherwise known as scurvy, is a rare diagnosis among populations with adequate nutritional resources. We present a 37-year-old female patient with bilateral lower extremity edema, episodic anasarca, petechiae, and easy bruising who was diagnosed with scurvy. Given the clinical presentation, a broad differential was investigated with no findings suggestive of hematologic or cardiovascular pathology. Initial laboratory studies were unremarkable. Progression of cutaneous symptoms and subsequent laboratory findings demonstrating low vitamin C levels supported a diagnosis of scurvy. Classical symptoms of scurvy include …

A Rare Case Of Tuberculous Pyomyositis Masquerading As Dermatomyositis, Yasi Magharehabed, Tayana Rodriguez

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A Rare Case of Tuberculous Pyomyositis Masquerading as Dermatomyositis

Tayana Rodriguez M.D., Yasmeen Magharehabed MS, Amy Wolfe M.D., Crystal Zheng M.D., Laura Hutchins M.D. LSU Department of Pulmonary and Critical Care

Medicine Intro: Tuberculosis (TB) can manifest as two diseases: latent tuberculosis (LTI) or active tuberculosis. TB frequently involves the lung but can be extrapulmonary. Primary tuberculous myositis accounts for <1% of skeletal TBI.1 Here we discuss a rare case of primary tuberculous pyomyositis. The patient was treated for what was thought to be dermatomyositis (DM) given his presentation with bilateral upper extremity swelling and positive markers on the myositis panel. Immunosuppressive therapy was administered for approximately 9 months. After many hospitalizations, including ICU admissions, he was eventually diagnosed and treated for tuberculous pyomyositis.

Case: A healthy 44 year-old-male with no past medical history was admitted to the hospital for bilateral hand swelling, R periorbital edema, dyspnea and fever. On admission he was found to be hypoxic to 91%. Chest CT that showed ground …

Reversal Of Vision Metamorphopsia: A Rare Presentation Of Status Migrainosus, Sepehr Sadgeghi

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Reversal of Vision Metamorphopsia: A Rare Presentation of Status Migrainosus

Sepehr Sadeghi, DO1; Sumrita Bindra, DO2; Tejal Naik, MD1; Mohammed Ziada, MD1. Department of Medicine1; Department of Neurology2 LSU Health Sciences Center, New Orleans, LA

Case Presentation: Our patient is a 42-year-old female with a past medical history of migraines secondary to traumatic bifrontal small subarachnoid hemorrhages in 2017. She presented to the emergency department with left upper extremity weakness and a headache that began an hour before arrival. In the emergency department, she was stroke-activated. CT of the Head without contrast and CTA of the head and neck were …

Recurrent Choledocolithiasis After Cholecystectomy And Endoscopic Treatment: A Case Report And Review Of Risk Factors, Wayne Wheeler

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Recurrent Choledocolithiasis After Cholecystectomy and Endoscopic Treatment: A Case Report and Review of Risk Factors

Authors: Wayne Wheeler, MD1 Connor Pate, MD1 Kent Broussard, MD2 Stephen Landreneau, MD, FACG2 1LSU Health Sciences Center Department of Internal Medicine 2LSU Health Sciences Center Department of Gastroenterology

Introduction: The presence of gallstones in the common bile duct (CBD) defines choledocolithiasis. Stones can form in the CBD or they can migrate to the CBD from the gallbladder, or less commonly, the intrahepatic biliary tree (hepatolithiasis). Symptoms include episodic right upper quadrant (RUQ) abdominal pain, nausea, fever, jaundice, and weight loss. Symptoms of biliary colic …

What Swims Within: A Case Of Enterobius Vermicularis Discovery, Wayne Wheeler

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Title: “What Swims Within: A Case of Enterobius Vermicularis Discovery”

Authors: Wayne Wheeler, MD, William Chastant, MD, John Hutchings, MD, FACG

Introduction: With increasing tourism and immigration into the United States, the incidence of intestinal helminth infections will rise. These parasitic worms can remain asymptomatic for years, causing increased morbidity and mortality if left undetected (1). When intestinal parasites are suspected, the laboratory testing of stool samples is typically diagnostic. In addition to microscopic evaluation, recent studies have highlighted the utility of endoscopy in making a diagnosis of intestinal parasite infection (2,3). This case is an example of asymptomatic enterobiasis …

Percutaneous Interventions In Recurrent Peripheral Artery Disease: A Case Of Total Popliteal Artery Occlusion Addressed With A Multi-Modality Approach, Sepehr Sadgeghi

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Percutaneous interventions in recurrent peripheral artery disease: A case of total popliteal artery occlusion addressed with a multi-modality approach

Sepehr Sadeghi, DO; Asad Mussarat, MD. Department of Medicine LSU Health Sciences Center, New Orleans, LA Case Presentation: A 67-year-old male with a medical history of hypertension, hyperlipidemia, and coronary artery disease with multiple prior interventions presented with acute-onset pain in his right lower extremity following bicycle exercise. Concurrent symptoms included dyspnea, chest pain, diaphoresis, and non-bloody emesis. Physical examination revealed notable pallor in the right lower limb, absent left pedal pulses, and an EKG indicating normal sinus rhythm with PVCs …

Almost Gone But Never Forgotten: Scurvy With An Initial Presentation Of Hemarthrosis, Donnel White, Aleena Kazmi

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Almost gone but never forgotten: Scurvy with an initial presentation of hemarthrosis

Aleena Kazmi, MD1, Donnell White, III, PhD2, Austin Clark, BS2, Bradford Calvit, MD1, Guido DeJesus, MD1, and Vince Cataldo, MD3 1Department of Internal Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA 2School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 3Department of Hematology and Oncology, Louisiana State University Health Sciences Center, Baton Rouge, LA

Case Presentation A 48-year-old female presents with a chief complaint of progressively worsening bilateral knee pain. She has a past medical history of squamous cell carcinoma of the oropharynx …

Current Practices In Ed Social Determinants Screening And Care Connection: A Literature Review, Samhita Basavanhalli

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Current Practices in ED Social Determinants Screening and Care Connection: A Literature Review

Samhita N. Basavanhalli, Student, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana Trevor Anderson, Student, Tulane University School of Medicine, New Orleans, Louisiana Jordan Vaughn, M.D., Clinical Assistant Professor, LSU School of Medicine Associate Director of Social Emergency Medicine and Diversity Equity and Inclusion, LSU Emergency Medicine Spirit of Charity

Background: Social determinants of health (SDOH) screening in emergency departments (ED) is a promising method to capture and address the individualized social needs of a broad patient population, ideally lowering emergency department readmissions …

Evaluation Of The Hand Trauma Transfers At A Level-1 Trauma Center After Joining The Assh Hand Trauma Center Network, William Delahoussaye

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Evaluation of the Hand Trauma Transfers at a Level-1 Trauma Center after Joining the ASSH Hand Trauma Center Network William Delahoussaye, BS; Madeline Gautreaux, BS; Patrick Palines, MD; Kelly Babineaux, MD LSUHSC; LSUHSC Department of Surgery

Introduction: Hand trauma remains among the most prevalent and expensive injury types within the United States. However, there remains limited access to specialized hand surgical care throughout much of the country, particularly in rural areas. In 2007, the American Society for Surgery of the Hand (ASSH) and the American College of Surgeons (ACS) established the National Hand Trauma Center Network (NHTCN) to improve coordination …

Single-Institutional Analysis Of Post-Splenectomy Vaccine Administration And Infectious Complications In Trauma Patients, Rebekah Fayard

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TITLE: Single-Institutional Analysis of Post-Splenectomy Vaccine Administration and Infectious Complications in Trauma Patients AUTHORS: Rebekah Fayard, Logan Gold, Lillian Bellfi, PharmD; John Hunt, MD, MPH; Alan Marr, MD; Lance Stuke, MD; Patrick Greiffenstein, MD; Jonathan Schoen, MD; Monique St. Romain, RN; Ana Payne, RN; Elizabeth Molina, RN; Samantha Graham, RN; Alison A. Smith, MD, PhD

AFFILIATIONS: Louisiana State University Health Sciences Center, New Orleans, Louisiana, University Medical Center New Orleans, LA

BACKGROUND: Abdominal trauma can result in splenectomy. Patients who undergo splenectomy are at increased risk for infections by encapsulated bacteria. As a result, postsplenectomy vaccinations for organisms posing a …

Incidence Of Withdrawal Of Life Sustaining Measures In Patients Readmitted To The Intensive Care Unit, Jack Leoni

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Incidence of Withdrawal of Life Sustaining Measures in Patients Readmitted to the Intensive Care Unit Cameron Fontenot, BS, Genevieve Messa, BS, Jack Leoni, BS, Jenna Dennis, BS, Alison Smith, MD, PhD, Berje Shammassian, MD, MPH

Introduction Traumatic brain injury (TBI) constitutes a major cause of death and disability in the United States. Failure to rescue these patients can cause unwanted complications, such as unplanned intensive care unit (ICU) readmission or death. This study aimed to analyze the characteristics of TBI patients with unplanned readmission to the ICU and to determine the incidence of withdrawal of life sustaining measures (WLSM).

Methods …

Umcno Ed Nurse Retention, Michael Okoronkwo

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UMCNO ED Nurse Retention Michael Okoronkwo (LSU New Orleans Section of Emergency Medicine), David Rayburn (LSU)

Several sources have attributed inadequate workforce support, poor workplace conditions, and Emergency Department (ED) boarding challenges as significant factors challenging retention in nursing staff working in critical care environments [1][2][3]. Over 22,000 nurses were sampled (most of which in California, New York, and Texas) to explore feelings they experienced which challenged their work experience in a two-week period. Feelings of exhaustion, overwhelm, and irritability predominated [4]. Findings from a sample of University Medical Center New Orleans (UMCNO) ED nurses suggest overwhelm as the major …

Evaluation Of Trauma Informed Care Training On Physician Attitudes And Perceptions, Selby White

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Evaluation of Trauma Informed Care Training on Physician Attitudes and Perceptions Selby White MS, Erika Rajo PsyD, Sandy Hyatt PsyD, Annelies DeWulf MD, Rebecca Moreci MD MS, Rose Luder, Kelsey Byrd DO, Alison A. Smith MD PhD

Background: In recent years, trauma-informed care (TIC) has gained increasing recognition as a crucial framework for understanding and addressing the complex needs of individuals affected by trauma. Within healthcare settings, the adoption of trauma-informed principles has become essential in providing holistic and effective care. Being trauma-informed means understanding the prevalence and impact of trauma on individuals, organizations, and communities. Despite its significance, there …

Perceived Importance Of Adult Immunizations Among Medical Providers From Hiv Outpatient Program, Tat Yau

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Authors: Tat Yau, Blane Edwards, Lauren Richey Abstract Poster Presentation

Title: Perceived Importance Of Adult Immunizations Among Medical Providers From HIV Outpatient Program Introduction Immunizations are key to primary care for people with HIV (PWH). Literature suggests that physician recommendations play an important role in improving immunization rates. Methods As part of the clinical quality improvement project at HIV Outpatient Program (HOP) at University Medical Center New Orleans, a survey (Pre-test) was conducted to evaluate clinicians’ perceived importance of a variety of immunizations for adult patients with HIV. The pre-test was followed by a 45-minute presentation to review updates of …

Ofatumumab: A Novel Anti‑Cd20 Monoclonal Antibody For Multiple Sclerosis: A Review Of Clinical Considerations, William Barham, Katie Dillman

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Multiple sclerosis (MS) is an antigen-specific, cell-mediated chronic autoimmune disease of the central nervous system (CNS). The disease is characterized by immune infiltration, progressive demyelination, and subsequent axonal loss, leading to a coterie of degenerative neurological symptoms, including, but not limited to, optic neuritis, partial myelitis, sensory disturbances, and internuclear ophthalmoplegia. While the exact inciting cause of the body’s autoreactivity in MS is not fully understood, it is has been linked to genetic, environmental, and infectious factors. Among the FDA-approved medications for the treatment of relapsingremitting multiple sclerosis (RRMS), such as interferon-β, glatiramer acetate, natalizumab, mitoxantrone, fingolimod, teriflunomide, and alemtuzumab, …

Caring For The Incarcerated Patient: Provider Perceptions Of Quality Of Care, Haley Beavers Khoury

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Louisiana has the highest rate of incarceration in the United States, with a rate of 1,094 people per 100,000. In 2023, roughly 50,000 people were housed in over 100 prisons, jails, detention centers, juvenile facilities throughout the state. There are notable racial disparities in incarceration. Roughly 32% of the state’s overall population and roughly two thirds of its prison population is Black. These disparities can be traced to policy issues. A recent lawsuit against Louisiana Department of Public Safety and Corrections (DPSC), Lewis v. Cain, found the healthcare offered at its flagship facility, Louisiana State Penitentiary (widely known as Angola) …

Predictors Of Chronic Osteomyelitis Between Comorbid Conditions Versus Social Determinants Of Health, Angella Chang

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Background: Osteomyelitis often requires surgery and a long course of antibiotics to treat. However, recurrent infection can still occur. Moore et al. found that health comorbidities, such as coronary artery disease (CAD) and chronic kidney disease (CKD), are risk factors for recurrent infection1. Social determinants of health (SDOH) are other risk factors important to consider for poor health outcomes, including recurrence of osteomyelitis. One study found that living in poverty-driven neighborhoods increases mortality from trauma-related injury2. Moreover, recurrent osteomyelitis is a challenging diagnosis as it can lead to adverse events related to prolonged antibiotics3. It is, therefore, imperative to understand …

Factors Associated With Post-Operative Opioid Use In Opioid Naïve Patients Undergoing Total Knee Arthroplasty, Clifton Daigle

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Background: Opioids persist as a concern for post-surgical complications such as ileus, urinary retention, delayed rehabilitation, and opioid dependence. Yet, they are still routinely prescribed following total knee arthroplasty (TKA). Evidence suggests that preoperative and in-hospital opioid use are risk factors for postoperative opioid use after TKA or total hip arthroplasty. However, there is still a paucity of information regarding the extent to which intraoperative opioid exposure contributes to postoperative opioid use in opioid naïve TKA patients. Our study aimed to assess the effect of in-hospital opioids, such as intraoperative IV, post-anesthesia care unit (PACU) IV, or PACU oral opioids, …

Case Series: Safety And Effectiveness Of 3-Level Lumbar Percutaneous Decompression With An Interspinous Spacer, Eric Finke

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Background: Lumbar interspinous process decompression (IPD) to treat lumbar spinal stenosis (LSS) was first made available in the 1980s. In 2015, the FDA approved a second-generation IPD spacer. The main difference is that this surgery may be performed by an interventional pain medicine physician under moderate sedation. 5-year data from an industry-sponsored study on IPD have been published showing improvements in quality of life (QOL) and pain scores.1 Indications for Vertiflex IPD include skeletally mature patients who have neurogenic intermittent claudication secondary to moderate stenosis at one or two levels. Function should improve when the patients are in lumbar flexion. …

Impact Of Late Prenatal Care On Anemia Prevalence And Sga Outcomes, Breyanah Graham

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Background: Inadequate prenatal care is associated with an increased risk of adverse maternal and neonatal outcomes. This correlation is due to the potential delays in identifying and addressing pregnancy complications during routine prenatal visits. Anemia, for instance, is a common laboratory finding that is detected during prenatal screenings. However, without adequate prenatal care, anemia may be undiagnosed and untreated, leading to complications such as small for gestational age (SGA) infants. Therefore, when patients establish prenatal care late in pregnancy, the early detection and management of conditions such as anemia is essential to reduce the risks associated with SGA and ensure …

Sga Neonatal Outcomes In Anemic Gravid Patients: Does Treatment In Pregnancy Improve Neonatal Birthweight?, Mallory Brignac

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Objective: Small for gestational age (SGA) neonatal outcomes are associated with increased risks of stillbirth, preterm delivery, neonatal morbidity/mortality, and cognitive delay in childhood. Preventable etiologies of SGA, such as anemia, can be addressed with adequate prenatal care and identifying disparities in social determinants of health. In the first part of our study, we aim (1) to define the prevalence of anemia in all patients delivering at our community hospital (2) to understand the likelihood of SGA outcomes in anemic patients and (3) to determine if treatment of anemia during pregnancy improves the rate of appropriate neonatal birthweight. Methods: A …

A Novel Approach To Vegetation Aspiration In Native Valve Infective Endocarditis With The Alphavac System, Luke Sharrock, Sepehr Sadeghi

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A novel approach to vegetation aspiration in native valve infective endocarditis with the AlphaVac System

Luke Sharrock, DO; Sepehr Sadeghi, DO; Fernanda Correa, MD; Walter B. Rentrop, MD; Scott Laura, MD; Frank Smart, MD LSU Health Science Center, New Orleans, LA/ Department of Cardiology

Vegetative valvular endocarditis from non-sterile injections in opioid-dependent patients presents a challenging dilemma in healthcare. Even when meeting guideline criteria, these patients are often not deemed an appropriate candidate for valvular replacement/repair. Therefore, these patients are often treated conservatively with long-term intravenous antibiotics alone. Alternatively, with the advancement of endovascular aspiration thrombectomy, providers have been able …

Adverse Events Associated With The Presence And Treatment Of Chronic Osteomyelitis, Renee Breauz

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Background: The presence and treatment of chronic osteomyelitis (COM) are known to cause complications and adverse reactions in some patients. In a previous study, researchers examined acute kidney infections (AKI) as a complication of diabetic foot osteomyelitis (DFO).1 They found that patients diagnosed with AKI as a result of DFO were more likely to experience an increased number of hospitalizations and recurrences of infection relative to patients without this complication. In addition, antibiotic treatment of COM has also been known to cause complications. According to the CDC, 26.2% of adverse drug reactions are caused by antibiotics.2 Given the high frequency …