Medicine and Health Sciences Commons^™

Unexpected Biliary Duct Dilation, A Wise Decision-Making Case., Mario A. Trujillo, Mathew R. Peynado, Muhammad Ali Siddiqui, Laura P. Ackerman

Research Colloquium

Background: Common bile duct dilation is expected in certain healthy populations with specific factors like age or post procedure status. When a size larger than expected is found in an acute setting further investigation is required. In the setting of acute abdominal pain in a patient with past medical history of cholelithiasis, the study protocol for patients with more than expected enlarged common bile duct and no apparently underlying disease in the biliary tree is not well elucidated.

Case: A 68-year-old female with past medical history but not limited to cholelithiasis, hypertension, type 2 diabetes mellitus, end stage renal …

Viral Party Gone Wrong: Polyviral Pericarditis Masquerading As Gastritis, Maria Eugenia Torres Perez, Joan Beatrice Capellan, Deanna Yamamura

Research Colloquium

Background: Acute pericarditis is a rapid inflammatory condition of the pericardium with both infectious and non-infectious etiologies. Diagnosis is usually based on clinical criteria with typical symptoms including chest pain that worsens with deep inspiration and decreases by leaning forward, and distinctive electrocardiographic changes. Pericarditis is typically self-limiting however, complications like pericardial effusion and cardiac tamponade may arise.

Case presentation: A 31-year-old male presented to the emergency department due to severe epigastric pain radiating to the right upper abdomen; the pain was associated with subjective fever and inability to eat due to its severity. His physical exam revealed tachycardia …

Stealthy Intrusion: Multivalve Culture-Negative Infective Endocarditis, Jennifer Rojas Huen, Carlos Luis Alejos Aguero, Duc Khiem Ngo, Maria E. Torres Perez

Research Colloquium

Introduction: Infective endocarditis (IE) typically targets a single valve, with involvement of more valves being rare. Timely targeted therapy hinges on identifying the responsible microorganism through blood culture. However, blood culture-negative endocarditis (BCNE), representing 5% of all endocarditis cases, poses diagnostic challenges and is associated with higher long-term mortality rates compared to blood culture-positive endocarditis (BCPE).

Case Presentation: A 53-year-old male with a history of congestive heart failure (CHF), end stage renal disease on peritoneal dialysis, and 30- years of cocaine use presented with an abnormal echocardiogram. The patient reported a two-week history of chills, sweat, generalized weakness, and exertional …

Navigating Economic Constraints In The Management Of Hfref - A Case Study Of An Uninsured Patient, Vamsikalayan Borra, Diana Othon Martinez, Barbara Malaga-Espinoza, Martha Solis, Nestor Gerardo Astorga, Prakhar Jain, Cesar Gutierrez

Research Colloquium

Background: Heart failure (HF) is a significant health concern, resulting in more than 500,000 new cases, 1.9 million hospitalizations, and a cost of $31 billion in the US. HF treatment aims to decrease hospitalizations, improve quality of life, and extend survival through GDMT. Social determinants of health (SoDH) have been associated with poor outcomes and higher readmission rates in HF patients. Addressing SoDH is crucial for achieving health equity and improving overall population health outcomes, per the CMS Framework for Health Equity 2022-2023. In the Rio Grande Valley, immigration is a common SoDH. It is estimated that 100,000 people are …

Heart Failure In The Setting Of Cocaine Abuse… Cause Or Progression? A Case Report., Diana Othon Martinez, Kashif Ali, Elimar Gonzalez Morales, Barbara Malaga-Espinoza, Jian Garcia, Cesar Gutierrez

Research Colloquium

Background: 1 out of 3 substance abuse emergency department visits are related to cocaine. In the US (United States), >5.5 million people consume cocaine. Hospitalizations for heart failure have a similar amount, with 5.7 million. Cocaine's cardiovascular adverse effects arise secondary to sympathetic nervous system stimulation, including decreased myocardial oxygen supply, coronary vasoconstriction, acceleration of atherosclerosis and thrombus formation. Studies have demonstrated contradictory information regarding cardiac anatomical changes (dilation/hypertrophy) secondary to chronic cocaine use. Cocaine cessation and guideline- directed medical therapy (GDMT) for HF are mainstay management. We present a case of a patient with HF and cocaine abuse.

Case …

Late Tamponade After Coronary Artery Bypass Grafting, Jian Garcia Cruz, Roy Kondapavuluru, Diana Othon Martinez, Julio Perez Rodriguez

Research Colloquium

Introduction: Pericardial effusion (PE) incidence can go up to 85% after cardiac procedures, however, not every pericardial effusion causes hemodynamic instability. Progression to Pericardial Tamponade (PT) occurs in 0.1 to 8.8% and may be either early (within 24 h post-cardiac surgery) or late (presenting within a week post-procedure). Both presentations may be attributed to anticoagulant use, inadequate mediastinal drainage, coagulopathy, post-pericardiotomy syndrome (recurrent pericardial effusion).

Patient presentation time might be misleading, as pericardial effusion’s clinical symptoms are varied, ranging from asymptomatic, to shortness of breath, chest pain or discomfort, hypotension, tachycardia, or other non-specific symptoms like cough, fever, and malaise. …

Multiple Intracardiac Thrombi In A Patient With Ischemic Cardiomyopathy, Jian Garcia Cruz, Julio Perez Rodriguez

Research Colloquium

Introduction: Ischemic cardiomyopathy is defined by the American Heart Association (AHA) as cardiomyopathy caused by ischemic heart disease. The most common complication of ischemic cardiomyopathy is systolic congestive heart failure. Heart failure patients are in a hypercoagulable state that predisposes them to develop intracardiac thrombus. The incidence of LV thrombus in patients with dilated cardiomyopathy and sinus rhythm is 13% with the clot in the left atrial appendage in 68% of these cases. The thrombus formation results from impaired blood flow within the 4 chambers of the heart and can present as a life-threatening complication of end stage heart failure. …

Cardiac Tamponade Secondary To Purulent Pericarditis With Mrsa, Jian Garcia Cruz, Julio Perez Rodriguez

Research Colloquium

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that causes severe morbidity and mortality worldwide. MRSA pericarditis is a rare life-threatening condition that can cause purulent pericarditis with only 7 cases having been reported so far. Several reasons why a patient may develop MRSA pericarditis are healthcare-associated infection, weakened immune system, invasive procedures and spread from other infections. Although not typically associated with tamponade, if MRSA were to cause an infection in the pericardial space, it could potentially lead to inflammation and fluid accumulation, resulting in tamponade. We present a case of a woman that developed tamponade secondary …

Unveiling The Neurological Aftermath: Pres After Cardiac Arrest, Oyinlola O. Fasehun, Jessica Daza, Sriharsha Koneru, Victor Tran, Eunbee Cho, Fatimah Bello

Research Colloquium

Background: Posterior Reversible Encephalopathy Syndrome (PRES), also known as ‘Reversible Posterior Leukoencephalopathy Syndrome (RPLS)’, is a clinical radiographic syndrome originally described by Hinchey et al in 1996. PRES has been significantly underdiagnosed due to difficulty in confirmation. As such, there is currently no epidemiological data regarding its incidence, but it has been diagnosed in all age groups with a preponderance in females. A variety of medical conditions have been implicated as causes of PRES, including severe hypertension, immunosuppressive therapy, sepsis, renal diseases and autoimmune disorders. The mechanism of PRES is thought to be related to disordered cerebral autoregulation and endothelial …

Pernicious Anemia Presenting With Pancytopenia And Hemolysis: A Case Report From South Texas, Yareli Durazo, Victor Tran, Sriharsha Koneru, Andres Suarez Parraga

Research Colloquium

Introduction: Pancytopenia is a commonly encountered hematologic entity with varying clinical presentations. It results from various disease processes ranging from simple to life-threatening. The most common cause of pancytopenia is megaloblastic anemia, and the most common causes of megaloblastic anemia are deficiencies of vitamin B9 or B12. Thus, folate and B12 deficiency should be high in the differential diagnosis when patients present with pancytopenia. Hemolytic anemia, anemia due to the shortened survival of circulating erythrocytes, often represents a more difficult diagnostic challenge for the clinician. While recognition of ongoing hemolysis is usually rapid and relatively simple, establishing the cause can …

Gastrointestinal Bleed In The Context Of Hemophilia A In An Incarcerated Patient In The Rio Grande Valley, Cameron B. Caldwell, Hector Trejo, Andres Suaez-Parraga

Research Colloquium

Background: Hemophilia A, the most common X-linked hereditary hemostasis disorder, has an incidence of approximately 1 in 5600 male live births worldwide. It results from a deficiency of clotting factor VIII, crucial for fibrin generation in the coagulation cascade, leading to inadequate fibrin generation and defective secondary hemostasis. Hemophilia can cause life-threatening bleeding, characterized as severe (<1% factor VIII activity), moderate (2-5%), or mild (6-40%). Social determinants of health pose significant challenges in managing hemophilia in underserved populations. This case presents gastrointestinal bleeding in a mild hemophilia A patient in the Rio Grande Valley.

Case Presentation: A 24-year-old Hispanic male with mild hemophilia A presented with a three-day history of melena, headaches, dizziness, and mild abdominal discomfort. Despite recent normal colonoscopy and EGD results, he had a history of intermittent black stool episodes. On admission, …

Polyp Puzzle, Get To Know Your Family. An Unfortunate Late Diagnosis Of Familial Adenomatous Polyposis: A Case Report., Jorge A. Aboytes, Aura Calderon

Research Colloquium

Introduction: Familial Adenomatous Polyposis (FAP) is a rare genetic condition affecting the APC gene characterized by the development of hundreds to thousands of colorectal polyps increasing the risk of cancer. Diagnosis usually occurs between ages 20 and 40. We present the unfortunate case of a patient with FAP that developed colon cancer and many years of complications. Had her family history been properly obtained at a younger age with early screening and testing, outcome and prognosis could have been different.

Case Report: A 34-year-old woman diagnosed with colon cancer in 2016 had total proctocolectomy with chemoradiation. From 2018 to 2024 …

Atypical Clinical Presentation Of Murine Typhus Infection In Relative Immunosuppressed Patient In South Texas, Johanna Mora, Kirhyn Stein, Hernan Guanajuato, Sobia Memon, Laura Garcia, Jose Campo Maldonado

Research Colloquium

Background: Murine typhus, caused by Rickettsia typhi, is a zoonotic infection transmitted to humans via fleas. It typically begins with nonspecific symptoms such as fever, headache, and nausea. Most cases resolve without complications after a 7–14-day incubation period. The primary reservoirs are rats, opossums, cats, and dogs. This case highlights an atypical presentation of murine typhus in an immunosuppressed patient in South Texas.

Case Presentation: 34-year-old female with ankylosing spondylitis treated recently with secukinumab presented to her Primary Care Physician (PCP) due to fevers. PCP ordered laboratory workup which was unrevealing. Four days later, the patient went to the …

Pleural Effusions In Patients Diagnosed With Pneumonia In Urgent Care Clinics, Nathan C. Dean, Jacqueline R. Eve, Allison M. Butler, James H. Hart, Theadora Sakata, Karen E. Connor, Edward A. Stenehjem, Y.C.G. Lee

The University of Louisville Journal of Respiratory Infections

Introduction: Pleural effusions in patients with community-acquired pneumonia have been associated with worse outcomes in emergency department and hospital inpatient populations, but the incidence of effusions and their outcomes in outpatient urgent care clinics is unknown. This observational cohort study describes patients diagnosed with pneumonia and pleural effusions on upright 2-view chest X-rays performed in urgent care clinics.

Methods: We extracted electronic health record data from January 2019 through December 2020 on all patients over 12 years old with an International Statistical Classification of Diseases 10^th revision diagnosis of pneumonia entered by the treating clinician, plus “possible” or “likely” …

Antibodies Gone Rogue: Autoimmunity Pairs With Antibiotic Allergy, Shubhank Goyal, Jose Jonathan Loayza Pintado, Cesar Uribe

Research Colloquium

Background: Autoimmune autonomic ganglionopathy (AAG) is a rare and complex disorder marked by severe dysautonomia, profoundly affecting a patient's quality of life. Treatment typically involves immunoglobulin (IVIG) infusions, which play a critical role in managing symptoms and improving patient outcomes. Managing AAG alongside acute infections such as cystitis, especially in patients with complicated drug allergies and sensitivities, presents unique clinical challenges. This case is noteworthy due to the patient’s rare combination of autoimmune autonomic ganglionopathy, chronic orthostatic hypotension, and a history of severe allergic reactions to antibiotics, complicating both infection management and treatment planning. The use of immunoglobulins in the …

Viscous Vengeance: A Case Report Of Hyperviscosity Syndrome In Iga Lambda Multiple Myeloma, Afoma Onyechi, Jessica Ohemeng-Dapaah, Ayesha Kang, Alexandre Lacasse, Ranju Kunwor

Journal of Community Hospital Internal Medicine Perspectives

Multiple myeloma (MM) is a relatively uncommon neoplastic proliferation of monoclonal plasma cells. Common manifestations are related to infiltration of plasma cells into bones and other organs, causing an increased total serum protein concentration, hypercalcemia, kidney injury, and anemia. The most common type of MM is IgG Kappa, and the second most common type is the IgA subtype. Hyperviscosity (HVS) is a rare presentation of MM and management includes prompt plasmapheresis, resulting in significant reduction of serum viscosity and symptomatic relief. We present a case of IgA Lambda MM presenting with HVS.

The Internist's Post V.1 N.7, The University Of Texas Rio Grande Valley. School Of Medicine, Diana Othon Martinez, Edgar Dorsey Trevino, Barbara Malaga-Espinoza, Ramon Elizondo Romo, Carlos Alejos Aguero, Roque Mifuji Lira, Martha Solis, Cesar Gutierrez

School of Medicine Publications and Presentations

Newsletter of the University of Texas Rio Grande Valley School of Medicine - Internal Medicine Residency Program.

Idiopathic Granulomatous Lobular Mastitis: A Case Report, Wendy M. Timirau, Esra Sari, Maham Shahid, Nilmarie Guzman, Augusto Villegas

HCA Healthcare Journal of Medicine

Introduction

Idiopathic granulomatous mastitis (IGM), also known as nonpuerperal mastitis or granulomatous lobular mastitis, is a rare, benign, chronic inflammatory breast disease first characterized in 1972. IGM is characterized by sterile noncaseating lobulocentric granulomatous inflammation, usually affecting parous premenopausal women with a history of lactation.

Case Presentation

We present a 38-year-old African American woman presenting to our continuity clinic complaining of a painful right breast mass discovered during a self-breast examination. An initial right breast ultrasound demonstrated an area of concern with asymmetry, architectural distortion, and a questionable mass correlating to a 5.1 cm hypoechoic mass at the 12:30 position. …

Clinical And Radiological Identification And Management Of Sapho Syndrome, Obyda Al-Housni, Jessica M. Alonso, Matthew Thornburg, Enny Cancio

HCA Healthcare Journal of Medicine

Introduction

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an autoinflammatory disease whose acronymic name stands for the symptoms commonly seen in the disease. These symptoms typically occur simultaneously, in different combinations, in patients during exacerbations of the disease. SAPHO syndrome is a rare disease, most frequently seen in patients aged 30 to 50. It is estimated to be found in 1 in 10 000 persons in White populations, with an even lower incidence seen in non-White populations.

Case Presentation

A post-menopausal woman with a medical history of SAPHO presented to the emergency department with left foot pain and …

Steroid-Dependent Recurrent Iga Vasculitis In A 19-Year-Old Woman, Hannah Berrett, Shivangi Gohil, Rebecca Kurian, Patricia Neyman

HCA Healthcare Journal of Medicine

Background

Immunoglobulin A (IgA) vasculitis is common in children and typically resolves spontaneously. However, when presenting in adults, it is more likely to be severe and recurrent.

Case Presentation

We present the case of a 19-year-old female patient with recurrent steroid-dependent IgA vasculitis. She had a history of a prolonged episode of IgA vasculitis in childhood. She presented to our hospital with proteinuria and a painful, palpable purpuric rash on her bilateral lower extremities. She was treated with high-dose intravenous steroids. When steroids were tapered, the patient had a recurrence of her painful rash. Over several months, she developed steroid-induced …

A Pilot Physician Mentoring Program In A Large Hospital System, Crista C. Keller Md

HCA Healthcare Journal of Medicine

This article summarizes the development and implementation of a mentoring program designed to support and educate physicians new to practice in a large, outpatient hospital system. The program addresses organizational, operational, and financial elements of medical practice. Topics include efficiency and time management, coding education, leadership, and burnout. These topics are often not directly addressed in medical education, yet are crucial to physician well-being. The article describes the program structure, initial feedback, and recommendations for program replication and expansion.

A Community-Engaged Interprofessional Project Led By Medical Students, School Of Social Work Students, And Resident Physicians: Lessons Learned And Recommendations For Success, Sabrina Orta, Daniela Santos Cantu, Giuiseppe Allan Fonseca, Luis R. Torres-Hostos, Chelsea Chang

School of Medicine Publications and Presentations

Addressing health disparities through community engagement and interprofessional partnerships is increasingly critical. However, learner-led approaches that integrate medical students, resident physicians, and social work students are not well-studied. We designed a learner-led, interprofessional, public health campaign for a majority Hispanic community, with the goals of building interprofessional leadership skills, engaging learners to address COVID-19 inequities, and disseminating lessons learned. Faculty and students from the University of Texas Rio Grande Valley Schools of Medicine and Social Work partnered with community leaders to pilot an interprofessional project supported by the American Association of Medical Colleges’ Nurturing Experiences for Tomorrow’s Community Leaders (AAMC …

Pembrolizumab Induced Hyponatremia. A Case Report, Mouna Reghis, Taanvi Gowdar, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

Hyponatremia is the most common electrolyte abnormality inpatient. Medications are a common cause of this. Cancer treatment has evolved with immune check point inhibitors replacing conventional chemotherapy agents. Pembrolizumab, which is a program cell death receptor-1 ligand has been shown to cause endocrinopathies. We describe a case of hyponatremia due to pembrolizumab

Cocaine As A Rare Cause Of Cholecystitis, Abdullah A. Orakzai, Osama Sherjeel Khan, Mustafa Shah, Syeda Sarah Raza, Mehr A. Orakzai, Muhammad H. Sharif

Advances in Clinical Medical Research and Healthcare Delivery

Cholecystitis, inflammation of the gallbladder, is diagnosed in approximately 200,000 people in the US each year. Cocaine is an illicit drug that is wildly abused in the US, GI complications such as acute pancreatitis, colitis, bowel perforation, mesenteric ischemia, and biliary tree obstruction have been reported in limited studies. To the best of our knowledge, there are no reported cases of cocaine-induced cholecystitis and no established treatment plans to date, however, we strongly believe that our patient’s cocaine use resulted in cholecystitis. Hence, we wanted to shed some light on the possible side effects of cocaine on the gall bladder.

Population-Level Trends In Self-Reported Healthcare Utilization Among Older Adults In Mexico With And Without Cognitive Impairment, José Eduardo Cabrero Castro, Rebeca Wong, Rafael Samper Ternent, Brian Downer

Student and Faculty Publications

BACKGROUND: Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico.

METHODS: Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and …

The Efficacy Of Colchicine In Preventing Atrial Fibrillation Recurrence And Pericarditis Post-Catheter Ablation For Atrial Fibrillation – A Systematic Review And Meta-Analysis Of Prospective Studies, Vamsikalayan Borra, Arankesh Mahadevan, Sidhartha Gautam Senapati, Roopeessh Vempati, Vikash Jaiswal, Nithya Borra, Javaria Ahmad, Oscar Rodrigo Zamudio Herrera, Carlos Vergara Sanchez, Tanisha Prasad

School of Medicine Publications and Presentations

Highlights

• Recurrent AF after CA occurred in 29.0% of the colchicine group and 39.5% of the placebo group.

• Post-ablation pericarditis occurred in 5.3 % of the colchicine group and 16.5% of the placebo group.

• Pooled analysis of prospective studies showed that colchicine decreased the odds of recurrent AF [OR: 0.63 (95 % CI: 0.50–0.78), p < 0.01, I2 = 8 %] and post-ablation pericarditis [OR: 0.34 (95 % CI: 0.16–0.75), p < 0.01, I2 = 57 %].

Introduction

Catheter ablation (CA) initiates a proinflammatory process responsible for atrial fibrillation (AF) recurrence (25–40%) and pericarditis (0.8%). Due to its anti-inflammatory properties, colchicine, a microtubule inhibitor, …

The Internist's Post V.1 N.6, The University Of Texas Rio Grande Valley. School Of Medicine, Eunbee Cho, Jian Garcia Cruz, Ramon Elizondo Romo, Roque Mifuji Lira, Martha Solis, Cesar Gutierrez, Diana Othon Martinez

School of Medicine Publications and Presentations

Newsletter of the University of Texas Rio Grande Valley School of Medicine - Internal Medicine Residency Program.

A Case For Increasing Taxes On Cigarettes, Vapes And Oral Nicotine Pouches, Ken, Cyprian Mostert, Olalekan Ayo-Yusuf, Manasi Kumar, Andrew Aballa, Willie Njoroge, Edna Bosire, Linda Khakali, John Thomi, Lukoye Atwoli, Zul Merali

Population Health, East Africa

No abstract provided.

Effect Of Semaglutide On Regression And Progression Of Glycemia In People With Overweight Or Obesity But Without Diabetes In The Select Trial, Steven E Kahn, John E Deanfield, Ole Kleist Jeppesen, Scott S Emerson, Trine Welløv Boesgaard, Helen M Colhoun, Robert F Kushner, Ildiko Lingvay, Bartolome Burguera, Grzegorz Gajos, Deborah Bade Horn, Irene M Hramiak, Ania M Jastreboff, Alexander Kokkinos, Michael Maeng, Ana Laura S A Matos, Francisco J Tinahones, A Michael Lincoff, Donna H Ryan, Select Trial Investigators

Student and Faculty Publications

OBJECTIVE: To determine whether semaglutide slows progression of glycemia in people with cardiovascular disease and overweight or obesity but without diabetes.

RESEARCH DESIGN AND METHODS: In a multicenter, double-blind trial, participants aged ≥45 years, with BMI ≥27 kg/m2, and with preexisting cardiovascular disease but without diabetes (HbA1c

RESULTS: Of 17,604 participants, 8,803 were assigned to semaglutide and 8,801 to placebo. Mean ± SD intervention exposure was 152 ± 56 weeks and follow-up 176 ± 40 weeks. In both treatment arms mean nadir HbA1c for participants was at 20 weeks. Thereafter, HbA1c increased similarly in both arms, with a mean difference …

Assessing The State Of Obesity Care: Quality, Access, Guidelines, And Standards, Lee M Kaplan, Caroline M Apovian, Jamy D Ard, David B Allison, Louis J Aronne, Rachel L Batterham, Luca Busetto, Dror Dicker, Deborah B Horn, Aaron S Kelly, Jeffrey I Mechanick, Jonathan Q Purnell, Ximena Ramos-Salas, Assessing The State Of Obesity Care Writing Group

Student and Faculty Publications

BACKGROUND: An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence.

AIMS: The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity.

METHODS: The panel was held in Leesburg, Virginia in September 2019.

RESULTS: The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice …