Medicine and Health Sciences Commons^™

Adult-Onset Alexander Disease Uncovered In A Previously Healthy Patient Presenting With Acute Stroke-Like Symptoms, Usaamah M. Khan, Matthew Barrett, Alex Dworetz Do

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Alexander Disease is a rare, often fatal, leukoencephalopathy of early childhood associated with a heterozygous mutation of the glial fibrillary acid protein (GFAP) gene. Adult-Onset Alexander Disease (AOAD) is an exceptionally rare leukoencephalopathy that often presents with slowly progressive brainstem and cervical cord dysfunction features. Acute onset of AOAD has only ever been reported three times in the literature. We report a case of acute onset AOAD in a patient that presented with bulbar symptoms and left hemiplegia initially concerning for acute stroke.

Patient And Provider-Level Factors That Underlie Alcohol Use Disorder Treatment Offer And Acceptance In Veterans With Cirrhosis, Nikki Duong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration.

Methods: Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1-year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ-2) from the electronic health record.

Results: The cohort …

Characterizing Abdominal Pain In Patients With Gastroparesis, Dylan Vainer, Henry Parkman, Dariush Shahsavari

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

TITLE: CHARACTERIZING ABDOMINAL PAIN IN PATIENTS WITH GASTROPARESIS

AUTHORS (LAST NAME, FIRST NAME): Vainer, Dylan¹; Shahsavari, Dariush²; Parkman, Henry P.²

INSTITUTIONS (ALL): 1. Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States. 2. Temple University Health System Inc, Philadelphia, PA, United States.

ABSTRACT BODY: Introduction: Patients with gastroparesis (Gp) typically present with nausea, vomiting, and early satiety. Abdominal pain can be present in Gp. The cause of abdominal pain in patients with Gp is often unknown. In patients whose predominant symptom is abdominal pain, other causes of abdominal pain …

Lessons Learned From Inspire Super-Performers, Thomas H. Fitzpatrick Iv, Ryan S. Nord

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Objective: The purpose of this study is to examine what demographic factors correlate with greater rates of upper airway stimulation adherence and efficacy.

Study Design: Case control study

Introduction:

Upper airway stimulation (UAS) is emerging as an effective procedure for select patients with obstructive sleep apnea. As initially studied, this procedure is reserved for those exhibiting body mass index (BMI)

Methods:

We queried a single surgeon’s database of UAS cases, totaling 97 at the time of study. The electronic medical record (EMR) was queried for each patient and pertinent demographics were recorded. We began by defining cohorts: super-adherers were …

Firearm Curriculum For Pediatric Residents Improves Safe Storage Counseling, Hannah Hollon Md, Darina Dinov Do, Benjamin Sandifer Md, Scott Risney Md, Heemali Kamdar Do, Christopher Ferrante Do, Leroy Thacker Phd, Michael S. Ryan Md, Mehp, Elizabeth Wolf Md, Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Objectives

Firearms are the leading cause of death among children and adolescents. Despite evidence to support physician training in firearm safety counseling, formal curricula are limited in pediatric residency programs. We sought to develop and implement a resident-led, feasible, sustainable, and impactful firearm safety curriculum for pediatric residents.

Methods

A firearm safety curriculum was developed by pediatric residents using Kern’s curriculum development framework and delivered to their peers at a single academic center from 2019 - 2020. The three-part series included workshops on basic firearm safety counseling principles, case-based practice, and advocacy training and a gun lock program in collaboration …

Assessing Opportunities To Improve Sedation/Analgesia Use In Neonatal Patients On Ecmo, Rita Hazboun, Prattyak Mukhopadhyay,, Vaneeza Khan, Miheret Yitayew, Nayef Chahin, Nada Darwish, Lisa Shaver, Jie Xu, Thacker Leroy, Karen Hendricks-Munoz

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: Sedation is used during ECMO to prevent agitation. Analgesia is used to dampen pain perception as neonatal procedural pain related stress is associated with later altered neurodevelopment with poorer perceptual reasoning and visual perception. Common sedatives/analgesics used during ECMO are opiates and benzodiazepines. Studies have shown that lipophilic drugs such as Fentanyl and Midazolam are significantly sequestered in the circuit suggesting opportunities to improve delivery for pain.

Hypothesis and Methods: We hypothesized opportunities to improve sedation/analgesia drug treatment in ECMO patients. Using a retrospective analysis of all neonatal patients receiving ECMO between 2015-2020, we aimed to assess the relationship …

Cryptogenic New Onset Refractory Status Epilepticus (Norse) Responsive To Rituximab, Matthew David Anderson, Teryn Nogles, Soundarya Gowda

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Objective: Discuss a case of new onset refractory status epilepticus (NORSE) in an otherwise healthy adult that had a positive outcome and suggests considering immunomodulators as first line treatment.

Background: NORSE is diagnosed when refractory status patients have no known history of seizures and an unremarkable workup. Other than antiepileptics and anesthetic coma, there are currently no established guidelines for management. Typically, IV steroids, plasma exchange, and IVIG are first line treatments. When these fail, second line immunomodulators are considered. Deciding between these agents is often arbitrary, and no particular agent has demonstrated consistently positive results. Prognosis is poor with …

Ectopic Pregnancy In A Woman With T9 Ais A Paraplegia Secondary To High-Grade Spinal Cord Pilocytic Astrocytoma, Elisabeth K. Acker

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma

Background

In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy.

Methods

This is a case report on a female Veteran who initially presented to the …

Erector Spinae Plane Block And Improved Perioperative Outcomes In Breast Brachytherapy, Jialiu D. Li, Yvonne Nguyen Md, Michael Buxhoeveden, Sabrina Dhillon

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Hip Labral Injury Worsens After Platelet Rich Plasma Injections: A Case Report, Brennan M. Wright, Carmen Wong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Case Description

A 47-year-old active male presented with 2.5 years of right hip pain suggestive of labral pathology. Ice, heat, celecoxib, ibuprofen, diclofenac gel, and physical therapy provided minimal relief. A diagnostic intra-articular bupivacaine injection resolved the pain. A subsequent MR arthrogram revealed a non-displaced tear of the right anterior superior acetabular labrum.

In pursuit of conservative treatment, the patient agreed to a series of 3 right hip intra-articular PRP (platelet rich plasma) injections. When he presented for the second injection, he reported his pain had decreased by 20% and he was tolerating light running. Due to improvement in symptoms, …

Utility Of Non-Invasive Testing For Fibrosis Assessment In Patients With End Stage Renal Disease, Nikita Chadha Do, Taseen Syed Mbbs, Richard K. Sterling Md, Msc

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: Non-alcoholic fatty liver disease (NAFLD) risk factors including metabolic syndrome (MS) and its components obesity (BMI ≥ 30), diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DL), has an increased prevalence in end stage renal disease (ESRD). The goal of study was to assess utility of non-invasive testing (NIT) including transient elastography (TE) for liver stiffness (LS), controlled attenuated parameter (CAP) for steatosis, Fibrosis-4 (FIB-4), AST to platelet ratio (APRI) and NAFLD Fibrosis score (NFS), for assessment of NAFLD in patients with ESRD undergoing renal transplant (RT) evaluation.

Methods: Demographic, clinical and laboratory data were collected within 12 weeks of …

A Closer Look At The Psychiatric Effects Of Deep Brain Stimulation To Further Guide Treatment Of Refractory Epilepsy: A Focused Review, Latangela Smith

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction: Effective treatment of medically-refractory epilepsy remains a formidable challenge in many patients. The SANTE trial (2010) led to the FDA approval of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) for the treatment of medically-refractory epilepsy. However, ANT DBS also raised significant mental health concerns. This review will take another look at the psychiatric effects of DBS to more definitively outline the mental health risks and identify additional targets to guide future treatment.

Methods: A search of the clinical literature published between January 1, 1990 and December 31, 2019 was completed. The most relevant papers …

Reduced Length Of Stay In Major Hepatectomy Surgery After Implementation Of An Enhanced Recovery Pathway In The United States Veteran Population, Yvonne Nguyen Md, Marilyn Mcnulty Np, Leopoldo Fernandez Md, Michael R. Kazior Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS).

Methods

After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all …

The Effect Of Stress Inoculation Training On Endotracheal Intubation, Alexandra P. Lambert

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Stressful situations pervade emergency medicine. Many studies demonstrate the deleterious impacts of stress on a physician’s immediate actions and lasting mental health. It is well-documented in the literature that preparedness can help mediate stress. Stress inoculation training (SIT) is utilized to prevent adverse stress response. This training teaches coping skills and defensive thinking to actively mitigate the negative physiological effects that occur during stressful events. SIT theory involves a conceptualization phase, skills training phase and application phase. The goal of this study is to evaluate the effect of SIT on endotracheal intubation performance of novice intubators.

Methods

The study …

Seminal Vesicle Adherent To Rectal Wall Following Neoadjuvant Chemoradiotherapy: A Potential False-Positive Diagnostic Pitfall, Samia Liaquat, Michael O. Idowu, Bryce Hatfield

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

The standard of care for stage T3 and stage T4 rectal adenocarcinomas involves neoadjuvant chemoradiotherapy followed by either low anterior resection or abdominopelvic resection. The presence of residual adenocarcinoma or positive surgical margins provides useful prognostic information and can influence ongoing adjuvant therapy. Although uncommon, mimics of treated adenocarcinoma may be present in the surgical specimen. A high index of suspicion is critical in avoiding potential false-positive pitfall, and the exclusion of mimics of treated adenocarcinoma is paramount to accurate diagnosis and treatment. Seminal vesicle epithelium has long been a challenge in differentiating prostatic adenocarcinoma from benign epithelium. However, the …

Increasing Accurate And Timely Completion Of Medication Reconciliation In Pediatrics, George Thieroff, Megan Coe, Maria Belen Pappa, Imen Becetti, Kemper Wesley Steffe, Kelley Byrum, Kristi Higgins, Ashlie Tseng

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Quiet Please: The Effects Of Sleep Quality And Quantity As A Result Of A Qi Project To Minimize Nighttime Sleep Interruptions, Chari Stump, Ashlie Tseng, Jennifer Brigle, Clifton Lee

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions

INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown.

OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive …

The Influence Of Health Disparities On Risk Factors In Patients With Colorectal Cancer, Neha Hippalgaonkar Md, Khalid Matin Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Comparison Of The Performance Of Two Different Alk Antibody Clones (D5f3 And Alk1) In Anaplastic Large Cell Lymphoma (Alcl), Dana Martin, Steven Smith, Alden Chesney, Terra Lewis, Raghavendra Pillappa

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background:Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma characterized by CD30 expression and subdivided into anaplastic lymphoma kinase (ALK) positive and negative subtypes that show clinically significant differences in outcomes. The current standard for evaluating ALK status is immunohistochemistry using the mouse monoclonal anti-human CD246 (ALK1) or fluorescence in situ hybridization. The novel rabbit monoclonal anti-human CD246 (D5F3) is proposed as an alternative to ALK1 and FDA approved for diagnosis of ALK-rearranged lung adenocarcinoma. However, its performance has not been systematically tested and compared to ALK1 in ALCL.

Design: Twenty-seven cases of ALCL were identified from institutional database searches …

What’S That Beeping Sound? Case Report, Ellie Balakhanlou Md, Olivier Rolin Md, Eugenio Monasterio

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Abstract Title: What’s that Beeping Sound? A Case Report

Ellie Balakhanlou, Medical Doctor - Medical Resident, Virginia Commonwealth University School of Medicine (Role: Presenting Author)

Olivier Rolin, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)

Eugenio Monasterio, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)

Disclosure: None. Setting: Outpatient pediatric clinic Patient: A 21 year old female with spastic quadriplegic cerebral palsy (CP) with an intrathecal baclofen (ITB) pump

Case Description:

The patient presented with concerns of intermittent beeping sounds from her pump. She does not endorse any …

Polysomnographic Features Of Sleep Paralysis (Sp) Captured In A Patient With Narcolepsy, Alex Dworetz Do, Ee-Rah Sung Do, Maha Alattar Md

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction:

SP is a transient episode of muscle atonia that occurs during the transition between sleep and wakefulness, manifesting as immobility despite preserved consciousness. Isolated SP may occur in healthy individuals, however recurrent SP is a well-documented feature of narcolepsy. There is limited literature describing the polysomnographic features of SP, partly owning to its rarity and unlikelihood of being captured during a single study. We aim to illustrate the key neurophysiological features in a patient experiencing SP.

Methods:

We report a 24-year-old female who presented to our sleep clinic for excessive daytime somnolence and recurrent SP episodes upon …

Depression Is Associated With Weight Gain In Patients Transplanted For Nash Cirrhosis But Not Other Etiologies Of Cirrhosis, Jose Hernandez-Roman, Steven Shen, Samarth Patel, Mohammad Bilal Siddiqui, Anchalia Chandrakumaran, Masoud Faridnia, Emily Zhang, Emily Lee, Mohammad Shadab Siddiqui

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

The present study was to bridge this gap in knowledge by evaluating the relationship between depression, liver disease and weight change after LT. Weight gain after liver transplantation (LT) is common, particularly in patients transplanted for NASH cirrhosis, and is associated with reduced survival. In non-LT patients, presence and sub-optimal management of depression is closely associated with weight gain and obesity. The impact of depression as predictor of post-LT weight gain is currently not known. Method:All adult patients receiving LT between 7/2007 to 7/2017 were included in the analysis. Patients with graft failure or death within 6 months after …

Gastrointestinal Stromal Tumor (Gist) In Long Standing Crohn’S Disease On Anti-Tnf Therapy, David Mendel, Taseen Syed, H R. Lippman, Brian Davis

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction

Patients suffering from inflammatory bowel disease (IBD) are at increased risk for developing cancer. Adenocarcinomas are the most commonly observed tumors of the gastrointestinal tract whereas data on gastrointestinal stromal tumor (GIST) in IBD patients is limited. GIST is a neoplasm that originates from the interstitial cells of Cajal in the smooth muscle layers of the gastrointestinal tract. [1] The association between GIST and Crohn’s disease (CD) is debated, as the tumor inconsistently present in areas of inflammatory activity. We report an interesting case of CD maintained on Infliximab, who presented with a flare that revealed GIST in the …

Chronic Post-Surgical Abdominal Pain Treated With Percutaneous Peripheral Nerve Stimulation Of Iliohypogastric And Ilioinguinal Nerves, Harnek Bajaj, Denise Lester

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Chronic pelvic and lower abdominal pain can be a severely debilitating condition that affects between 7% to 24% of the general population (4). The anterior rami of L1 and T12 give contributions to the ilioinguinal and iliohypogastric nerves which provide sensory innervation to the lower abdomen and pubic regions (3). Entrapment or damage of these nerves can occur due to a variety of mechanisms, and common treatment options have included medications (2), nerve blocks (1), and in rare cases, surgical resection of the involved nerve. In this case, a 47 year old morbidly obese female with history of chronic left …

Improving Early Antibiotic Administration For Treatment Of Sepsis At Children’S Hospital Of Richmond At Vcu: 2012-2019, Hannah Miller Md, Ashlie Tseng Md, Perry Taylor Pharmd, Matthew Schefft Do Msha, Sheila Pedigo Pharmd Bcpps, Tracy Lowerre Bsn Ms, Jose Munoz Md, Mark Astoria Md, Jonathan Silverman Md Mph

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The Surviving Sepsis Campaign recommends initiating IV antibiotic administration within one hour of recognition of severe sepsis. Several studies have shown that prompt blood culture collection, administration of broad-spectrum antibiotics, and fluid resuscitation following recognition improves child survival.

Objective: Our goal was to evaluate effectiveness of sepsis initiatives and institutional changes in the timing of early antibiotic administration at Children’s Hospital of Richmond at VCU.

Methods: We formed a Pediatric Sepsis Committee with representatives from each unit in 2013. In 2016, the committee began tracking time from the order of a first stat dose IV antibiotic to administration as …

Selecting The Optimal Unrelated Hematopoietic Stem Cell Transplant Donor For Relapse Prevention In Acute Myeloid Leukemia, Elizabeth Krieger, Rehan Qayyum, Amir Toor

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Introduction/Background

Hematopoietic cell transplantation (HCT) provides

a cure for patients with acute myeloid leukemia.

Natural killer cells (NK) play an important role

in graft versus leukemia (GVL) effect after HCT,

through killer immunoglobulin-like receptor (KIR)

interaction with HLA ligands. This study is

undertaken to validate our previously published

mathematical model accounting for the KIR-KIRL

interactions in a post HCT setting.

Methods

Retrospective data were obtained from the Center

for International Blood and Marrow Transplant

Registry for 2317 donor recipient pairs (DRP) who

underwent 7/8 or 8/8 HLA allelic matched

unrelated donor (URD) HCT for AML. KIR-HLA

interaction scores were calculated …

Quiet A Puzzle: A Case Report Of 15 Year Old Female With Severe Anemia Due To Scurvy, Shaikha Alqahtani, Wang Zhihong

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency.

She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam …

Acute Septic Shock From Routine Ureteroscopy With Laser Lithotripsy, Sameer Goel

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

No abstract provided.

Time To Conversion Of Hemi/Total Shoulder Arthroplasty To Reverse Total Shoulder Arthroplasty; A Systematic Review Of Longevity And Factors Influencing Conversion, David Constantinescu, James Satalich, Kevin Lacy, Alexander Vap

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Background: The primary purpose of this study was to determine the average time from hemiarthoplasty (HA) or total shoulder arthroplasty (TSA) to conversion to reverse total shoulder arthroplasty (RTSA). The secondary purpose of this study was to determine the factors leading to conversion to RTSA.

Methods: A review of the literature regarding the existing evidence for conversion of HA/TSA to RTSA was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). nclusion criteria were as follows: reporting of conversion of a HA or TSA to RTSA with a follow …