Medicine and Health Sciences Commons^™

Severe Digital Necrosis In The Context Of Raynaud's Phenomenon, Antiphospholipid Antibody Syndrome, And Vasculitis: A Diagnostic Dilemma, Silvana Iskandar, Karan Chhabra, Omar Jameel, Tucker Billups

Conference Presentation Abstracts

Abstract: A 73-year-old male with polyarticular gout, hypertension, and rheumatoid arthritis presented with non-healing necrotic wounds on the distal aspect of his upper extremity digits, most severely affecting the left index finger with eschar. His symptoms had been present for the past six weeks. He also had a history of Raynaud’s phenomenon, which preceded these symptoms. Examination revealed necrotic wounds on the nail beds of seven fingers bilaterally, with significant left index finger necrosis. Despite the severity of his condition, he remained hemodynamically stable throughout hospitalization. Laboratory studies showed positive cardiolipin IgM and beta-2 glycoprotein antibodies on two separate occasions, …

Streptococcus Pneumoniae Cervical Abscess In A Pcv-Immunized Female With Waldenstrom's Macroglobulinema: Exploring The Role Of Opsosonization Failure And Functional Hyposplenesim Beyond The Spectrum Of Malignant B-Cell Disorders, Tanya Amal, Paul Johnson, Ayesha Sharif, Usman Bin Hameed

Conference Presentation Abstracts

A 64-year-old female with recently diagnosed Waldenström's macroglobulinemia presented with pain and swelling in the neck. Three weeks prior, she had accidentally punctured her neck with her fingernail, leading to initial swelling. She visited the ER, but workup showed no acute infection. A contrast-enhanced CT scan revealed enlarged bilateral cervical lymph nodes. Over the next two weeks, the swelling became increasingly painful. On presentation, she had sharp, localized pain (10/10 intensity), tachycardia, and a 3x3 cm swelling on the right side of her neck, with redness, warmth, and tenderness. Laboratory results showed lymphocytic leukocytosis (WBC 31.5, lymphocyte 24.8%, neutrophil 6.1%). …

A Rare Case Of Horner Syndrome Secondary To Perineural Catheter Placement After Orif Of The Right Humeral Shaft, Joseph Dakki, Natalie Dakki, Sant Yadav, Justine Nasr

Conference Presentation Abstracts

Introduction: Horner Syndrome (HS) is a clinical syndrome characterized by the triad of unilateral ptosis, miosis, and anhidrosis. HS is caused by an interruption of the oculosympathetic nerve pathway, a three-neuron pathway. Common causes of Horner Syndrome include carotid dissection, stroke, trauma, tumors, cluster headaches, inflammation, and medical and surgical procedures. However, many cases of HS are also idiopathic. The standard workup of Horner Syndrome includes MRI of the brain, cervical spine, and upper thoracic spine and CT angiography of the circle of willis, aortic arch, and intracranial arteries. This case report will analyze an instance of Horner Syndrome that …

The Diagnostic Dilemma Of Multisystemic Vasculitides - A Case Report Of Granulomatosis With Polyangiitis, Muhammed Hussain, Tabssum Chauhan, Hafsa Hassan, Marian Jamil, Cecilia Big, Rajiv John

Conference Presentation Abstracts

Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis disorder that classically involves the upper and lower respiratory tract as well as the kidneys. However, its presentation is not limited to these organ systems as it can present with ocular, dermatological or cardiac involvement, thus creating a broad differential when evaluating patients. This case illustrates the diagnostic challenges with infectious and inflammatory etiologies in a patient with systemic symptoms, concerning imaging and travel to a TB-endemic region. A 57-year-old female with a pertinent history of recurrent sinusitis, left otitis media, and prior sinus surgeries was evaluated for suspicion of possible …

Septic Arthritis Caused By A Rare Yeast, Lodderomyces Elongisporus, Osman Muslehuddin, Daphne Pete, Husam Muslehuddin, Hafeezuddin Ahmed

Conference Presentation Abstracts

Introduction: We present a rare case of septic arthritis caused by Lodderomyces elongisporus, a yeast rarely implicated in human infections. This case highlights the diagnostic challenges and management strategies for fungal septic arthritis in an immunocompromised patient. Case Presentation: A 63-year-old African American woman with a complex medical history, including chronic heart failure (CHF), hypertension, end-stage renal disease (ESRD) on hemodialysis, severe protein-energy malnutrition on total parenteral nutrition, duodenal switch with malabsorption, deep vein thrombosis (DVT) on warfarin, and previous sepsis episodes, presented with worsening dyspnea. She was admitted in August 2024 for acute-on-chronic CHF exacerbation. During her admission, she …

Characterization Of Contributors To Pleural Fluid Viscosity, Yujai Lin, Megan Rushmeyer, Christopher G. Roy, Shannon Donovan, Rachel Cutting, Matthew Buttarazzi, Charlotte Crist, Ted Sears, J B. Zuckerman

Costas T. Lambrew Research Retreat 2025

Background: Pleural effusion is a common consequence of pulmonary disease and may result from a spectrum of conditions. This pilot study seeks to describe relationships between pleural fluid viscosity and fluid analytes commonly measured in clinical laboratories.

Physical Activity Programming To Improve Qol In Pediatric Ibd Patients, George Russell, Anya K. Cutler, Anna Furr, Julia Fritz, Kevin Sztam, Birgitta Polson, Rebecca Edwards, Noah Hoffman

Costas T. Lambrew Research Retreat 2025

Discussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.

Mental Health Conditions Among Patients With A Disorder Of The Gut-Brain Interaction, Ambia Ahmed, Nicole Smith, Anya Cutler, Mariaelena Terzis, Laura J. Faherty, Julia Fritz

Costas T. Lambrew Research Retreat 2025

Two thirds of pediatric patients with disorders of the gut-brain interaction have mental health comorbidity.

Laying The Groundwork: Implementing The 2021 Aap Well Appearing Febrile Infant Clinical Practice Guideline Across A Rural Health System, E Freeman, L Mallory, Lm Seften, T Palnitkar, A Cutler, J Gregory, M Jackson

Costas T. Lambrew Research Retreat 2025

The American Academy of Pediatrics (AAP) published their first-ever Clinical Practice Guideline (CPG) on the management of well-appearing febrile infants aged 8-60 days in 2021. A system specific CPG and order set for the management of well-appearing febrile infants has been published across MaineHealth (MH) to align with the AAP.

Factors Influencing No Show Rates In Adult Urology Patients, Bruce T. Ndebanje, Ethan Griffin, Evelyn James, Lily C. Wang

Costas T. Lambrew Research Retreat 2025

Our study highlights a strong association between insurance status and no-show rates. Patients with Medicaid or no insurance were significantly more likely to miss appointments (OR 3.25 and 5.99).

Test-Retest Agreement And Reliability Of Psychosis And Mental Health Screens For Maine Adolescents And Young Adults In Primary Care, Erika Mayer, Eb Bernier, Merelise Ametti, Julia Plumb, Adriana Lovric, Yaerin Wallenberger, Kristen Woodberry

Costas T. Lambrew Research Retreat 2025

Psychotic spectrum disorders are among the most severe mental health conditions. Although early intervention can lead to significantly improved outcomes, minimizing delays in the identification of psychotic spectrum symptoms (PSS) remains challenging.

Implementation And Evaluation Of A Resident Pediatric Complex Care Education Series, Calivin Schaffer, Danielle Doctor, Amy Buczkowski, Bonnie Lynne Boomsma, Logan Murray

Costas T. Lambrew Research Retreat 2025

Children with medical complexity have significant chronic health problems that affect multiple organ systems and result in functional limitations, high health care need or utilization, and often dependence on medical technology. Addressing their needs requires optimizing care within the medical home and medical neighborhood.

Evaluation Of Engagement And Collaboration Among Hospitals In The Maine Rural Maternity & Obstetrics Management Strategies (Rmoms) Network, Molly Volt, Lori Travis, Caroline Zimmerman, Erica Swan, Katherine Crothers, Anna Gilbert, Kate Allerding

Costas T. Lambrew Research Retreat 2025

Introduction

• Maine RMOMS Network: Grant awarded to Maine in 2022, 16 rural birthing hospitals & 5 state partners

• Network Goal: Improve access to maternity and obstetrics care for rural communities

• A qualitative Network Health Evaluation was conducted to diagnose strengths and areas of growth regarding engagement and collaboration

Rigid Sternal Fixation Alone Does Not Result In A Reduction In Postoperative Opiod Administration Following Cardiac Surgery, Jane Branch, Chinedu Okoli, Kyla Wigant, Jaime Rabb, Robert S. Kramer, Anne Hicks, Ansar Hassan

Costas T. Lambrew Research Retreat 2025

Background: Persistent postoperative pain, infection, and sternal dehiscence are devastating complications after cardiac surgery that affect patient quality of life and increase healthcare system burden. Chronic sternal pain lasting more than 1 year affects 25 to 33% of cardiac surgery patients, and wound complications such as infection and sternal nonunion represent significant peri-operative risk factors1,2. Wire cerclage (WC) is the most widely accepted sternal closure technique among cardiac surgeons because of its perceived lower rates of sternal dehiscence, wound infection, and cost.

A Quality Improvement Project To Reduce Variation In Pediatric Asthma Care Using The Hospital Asthma Severity Scoring (Hass) Tool, Sean Patterson, Leah-Marie Seften, Rachel Williams, Noah Diminick, Anne Coates, Laura Amar-Dolan

Costas T. Lambrew Research Retreat 2025

The aim of this project was to increase HASS score use to greater than 50%within one year and determine the impact of our interventions on the quality of asthma care and patient outcomes.

An Opt Out Tobacco Cessation Referral Process For A Cancer Care Network, Amy Litterini, David Spaulding, Tia Robbins, Brett Cropp, Lauren Couture

Costas T. Lambrew Research Retreat 2025

Opt out tobacco cessation referrals should be standard of care.

Pediatric Asthma Subspecialty Referral Practices In Rural Maine, Paras Patnaik, John Dipalazzo, James Bohnhoff

Costas T. Lambrew Research Retreat 2025

Over 7.2 million children in the United States have asthma.

• >300,000 asthma-related ED visits & hospitalizations yearly
• Both PCP’s and pediatric asthma subspecialists (allergist/immunologists and pediatric pulmonologists) provide long-term asthma care

Overcoming Specialty Care Connection Barriers: The Econsult Effect, Genevieve Whiting, Noah Hoffman, Anya K. Cutler, Leah M. Seften, Laura J. Faherty

Costas T. Lambrew Research Retreat 2025

Pediatric patients are 2.6x more likely to attend a new specialist visit after Specialist affirms referral need via eConsult.

Pilot Study Of Serial Telemedicine Assessments To Safely Exclude Neonates From Therapeutic Hypothermia Treatment, Alexa Craig, Anya K. Cutler

Costas T. Lambrew Research Retreat 2025

Two neonatal encephalopathy exams performed by telemedicine, with scores of less than 4, correctly excluded neonates from treatment with therapeutic hypothermia.

Physical Activity Programming To Improve Qol In Pediatric Ibd Patients, Anna Briley, George Russell, Anya K. Cutler, Anna Furr, Julia Fritz, Kevin Sztam, Birgitta Polson, Rebecca Edwards, Noah Hoffman

Costas T. Lambrew Research Retreat 2025

Discussion: This work contributes to limited literature supporting the positive impact of PA in a target population and provides novel guidelines to implement an accessible PA program proven to be effective and well-liked by patients & families. Findings support incorporation of PA into the holistic care of pediatric patients with IBD.

A Rare Presentation Of Necrotizing Fasciits: A Diagnostic Challenge Triggered By Isolated Persistent Atrial Fibrillation With Rapid Ventricular Response (Afib With Rvr), Rosalyn Bloch, Amira Al-Nabolsi, Jessica Kopicha, David Lang

Conference Presentation Abstracts

According to the most recent review on necrotizing fasciitis (NF), NF often presents with nonspecific findings such as pain, erythema, and swelling. Clinical features include pain out of proportion to physical examination, failure to respond to broadspectrum antibiotics, and the presence of cutaneous bullae on the skin. We report a rare case in which the diagnosis of NF was unexpected due to its atypical presentation and was ultimately prompted by further underlying exploration in the setting of diabetic ketoacidosis (DKA) and persistent Afib with RVR. Case Summary: A 61-year-old male with a history of type 2 diabetes mellitus presented with …

Lower Extremity Edema In A 27-Year-Old Female With Systemic Lupus Erythematosus Glomerulonephritis: Is It Renal-Related Or Does It Warrant Further Workup?, Christine Buchanan, Rosalyn Bloch

Conference Presentation Abstracts

Lupus myocarditis (LM) is a potentially fatal manifestation of systemic lupus erythematosus (SLE) occurring in 5-10% of SLE patientspatients with SLE (1). Lupus nephritis (LN) is a form of glomerulonephritis that constitutes one of the most severe organ manifestations of SLE (2). We present a unique case of a 27-year-old female with acute lower extremity edema secondary to LM with concomitant LN . This case report highlights LM as a rare manifestation of SLE and the importance of a thorough workup of acute bilateral lower extremity swelling in SLE patientspatients with SLE and glomerulonephritis. A 27-year-old female with a past …

A Multimodal Intervention To Improve Treatment And Clinical Outcomes In Children With Recurrent Otitis Media, Daniel Courtaney

Evidence-Based Practice Project Reports

Acute otitis media is the number one cause for primary health care visits and antibiotic prescriptions in the pediatric population (El Feghaly & Jackson, 2023). Upwards of 27% of children experience multiple episodes of otitis media (OM) that meet recurrent otitis media (ROM) diagnosis criteria (Pelton & Marchisio, 2023). Guided by the Iowa Model (Iowa Model Collaborative, 2017), the project’s purpose was to implement a multimodal intervention to decrease recurrent OM and repeat clinic visits. A comprehensive literature search of 5 databases yielded 16 sources ranging from levels I-IV (Melnyk & Fineout-Overholt, 2023). Using the AGREE II and JBI Critical …

A Rare Case Of Esophageal Perforation: Esophageal Perforation Following Cervical Spine Hardware Removal, Amira Al-Nabolsi, Jessica Kopchia, Cameron Hubbard, Hussein Hamade, Mouhamed Shatila

Conference Presentation Abstracts

An esophageal perforation is an uncommonly encountered life-threatening emergency that can lead to leakage of gastric contents into surrounding esophageal tissue. It is most commonly due to iatrogenic injury, typically involving endoscopy, intubation, or esophageal surgery. We describe an unusual case of esophageal perforation secondary to the removal of infected cervical spine hardware. A 73-year-old male with cervical spine central stenosis with history of an anterior cervical spinal fusion of C5-C7 over 40 years ago presented to the emergency department at the request of his pulmonologist. A CT scan of the neck was obtained in the outpatient setting, as the …

Crispr/Ncas9-Edited Cd34+ Cells Rescue Mucopolysaccharidosis Iva Fibroblasts Phenotype, Angélica María Herreno-Pachón, Andrés Felipe Leal, Shaukat Khan, Carlos Javier Alméciga-Díaz, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Mucopolysaccharidosis (MPS) IVA is a bone-affecting lysosomal storage disease (LSD) caused by impaired degradation of the glycosaminoglycans (GAGs) keratan sulfate (KS) and chondroitin 6-sulfate (C6S) due to deficient N-acetylgalactosamine-6-sulfatase (GALNS) enzyme activity. Previously, we successfully developed and validated a CRISPR/nCas9-based gene therapy (GT) to insert an expression cassette at the AAVS1 and ROSA26 loci in human MPS IVA fibroblasts and MPS IVA mice, respectively. In this study, we have extended our approach to evaluate the effectiveness of our CRISPR/nCas9-based GT in editing human CD34+ cells to mediate cross-correction of MPS IVA fibroblasts. CD34+ cells were electroporated with the CRISPR/nCas9 system, …

A Complex Case Of Tracheoesophageal Fistula Following Chemoradiation And Esophagectomy, Mujtaba Moazzam, Usman Bin Hameed, Fady Banno, Rocco Sbrocca, Ramona M. Berghea

Conference Presentation Abstracts

Tracheoesophageal fistula (TEF) is a pathological connection between the trachea and esophagus. It is a rare but serious complication following esophagectomy, particularly in patients who have undergone concurrent radiation therapy, with rates of 5-15%. TEFs often manifest with severe complications such as malnutrition, infections, and life-threatening bleeding, making them exceptionally difficult to manage. This case report highlights a rare presentation of TEF in a patient with esophageal adenocarcinoma treated with multimodal therapy. A 45-year-old male with stage III esophageal adenocarcinoma underwent concurrent chemoradiation, esophagectomy, and immunotherapy. Subsequent oligometastatic disease required further treatment, including radiofrequency ablation and Keytruda maintenance. The patient …

A Case Of Orbital Apex Syndrome And Mucormycosis In Undiagnosed Diabetes, Basant Sanad, Deena Sukhon, Merzia Subhan, Mamon Tahhan

Conference Presentation Abstracts

Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressive and indolent condition often characterized by nonspecific symptoms at onset, which can result in delayed diagnosis and the development of severe complications. We report a case presenting with HHS/DKA, left orbital apex syndrome due to invasive fungal sinusitis, and multiple neuropathies. Despite aggressive surgical debridement, antifungal therapy, and ongoing ophthalmologic monitoring, he remains at risk for further complications, including potential orbital exenteration. A 45-year old male who has not sought medical care in the past 20 years and has no significant past medical history presented with progressive bilateral leg pain …

Real-World Clinical Burden Of Patients Presenting With Vaginitis Symptoms In The United States, Justin Chen, Jenny Tse, Liucheng Shi, Mindy M. Cheng, Rebecca Lillis, Aimee M. Near

School of Medicine Faculty Publications

Background: While vaginitis is a leading cause of primary care visits among women with a gynecologic-related diagnosis, there are limited contemporary data on the healthcare burden. This study describes the real-world healthcare resource utilization (HCRU) of patients presenting with vaginitis symptoms in the United States (US) at symptom presentation and over long-term follow-up. Methods: This retrospective study utilized IQVIA's Longitudinal Prescription (LRx) and Medical Claims (Dx) databases to capture patients presenting with vaginitis symptoms from January 1, 2018 to September 30, 2022. The date of the first diagnosis code for vaginitis or related symptoms was considered the first clinical presentation …

Examining Demographic, Geographic, And Temporal Patterns Of Melanoma Incidence In Texas From 2000 To 2018: Retrospective Study, Kehe Zhang, Madison M Taylor, Jocelyn Hunyadi, Hung Q Doan, Adewole S Adamson, Paige Miller, Kelly C Nelson, Cici Bauer

Faculty, Staff and Student Publications

Background: Melanoma currently ranks as the fifth leading cancer diagnosis and is projected to become the second most common cancer in the United States by 2040. Melanoma detected at earlier stages may be treated with less-risky and less-costly therapeutic options.

Objective: This study aims to analyze temporal and spatial trends in melanoma incidence by stage at diagnosis (overall, early, and late) in Texas from 2000 to 2018, focusing on demographic and geographic variations to identify high-risk populations and regions for targeted prevention efforts.

Methods: We used melanoma incidence data from all 254 Texas counties from the Texas Cancer Registry (TCR) …

Pericardial Effusion Of Uncommon Origin: A Diagnostic Journey, Tannoz Norouzi, Carol Lima, Sayf Al-Katib

Conference Presentation Abstracts

Tuberculous (TB) pericarditis is a rare yet serious form of extrapulmonary tuberculosis, characterized by a diverse clinical presentation and the potential to occur as an isolated extrapulmonary manifestation. In developed countries, tuberculosis is a rare cause of pericarditis, contributing to less than 5% of pericardial effusion cases and an even smaller percentage of constrictive pericarditis cases. This case describes a 27-year-old male from Mali with no significant medical history presenting with progressive fatigue, shortness of breath, and palpitations over one year. Family history revealed sudden cardiac death in his father in his 30s. Physical examination and initial investigations, including echocardiography, …