Medicine and Health Sciences Commons^™

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Michael King, Heather Schramm

West Florida Division GME Research Day 2020

No abstract provided.

Carcinoid Syndrome Arising From The Descending Colon Causing Carcinoid Heart Disease, Julien A. Exposito, Adam Salomon, Oliver Fowler, Christopher Cooke, Joelle Ellis, Patricia Chun, Christiano Caldeira

West Florida Division GME Research Day 2020

No abstract provided.

Pneumonia: An Unexpected Graveyard Visitor?, Daniel A. Casas, Jigar Chauhan, Melanie Williams, Jan Sambataro, David Sukhai, Pablo G. Dubon, Jorge Perez

West Florida Division GME Research Day 2020

Community acquired pneumonia caused by Influenza can present with superinfection. On rare occasions, an unexpected organism is discovered.

Idiopathic Chylopericardium: A Rare Entity, Seema Jaga, Joseph Namey, Christiano Caldeira, Salah Al-Andary

West Florida Division GME Research Day 2020

• Idiopathic chylopericardiumis a rare entity in which the acculumation of chylousfluid surrounds the pericardial space.
• Herein, we present a case of a 50 year old healthy female patient with no known past medical history that was diagnosed with idiopathic chylopericardiumand was successfully treated using a pleurXcatheter drainage for two and a half weeks and a low fat diet.

Novel Infection Status Post Electrocution Requiring A 4th Ray Amputation, William R. Judson, John D. Murphy, Phillip H. Sussman, John N. Harker

West Florida Division GME Research Day 2020

• Prevotella bivia is an anaerobic, non-pigmented, Gram-negative bacillus species that is known to inhabit the human female vaginal tract and oral flora. It is most commonly associated with endometritis and pelvic inflammatory disease.^{1, 2}
• Rarely, P. bivia has been found in the nail bed, chest wall, intervertebral discs, and hip and knee joints.¹ The bacteria has been linked to necrotizing fasciitis, osteomyelitis, or septic arthritis.^{3, 4}
• Only 3 other reports have described P. bivia infections in the upper extremity with one patient requiring amputation2, and one with deep soft tissue infection requiring multiple debridements and extensive tenosynovectomy. …

Giant Splenic Artery Pseudoaneurysm Rupture Presenting As Hemorrhagic Shock, Jaya Sanapati, Parth R. Desai, Locke W. Barber, Johnathan Frunzi, Timothy Lee

West Florida Division GME Research Day 2020

A 56-year-old Asian male was brought to the emergency department by first responders after he developed severe, sudden-onset headache and chest pain at his home. Past medical history was insignificant. On arrival to the emergency department, the patient was in respiratory distress. Vital signs revealed temperature of 36.0°C, blood pressure of 71/44, heart rate of 90 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 95% with delivery of oxygen at 2 liters per minute via nasal cannula. Examination of the abdomen revealed diffuse tenderness. Laboratory findings and arterial blood gas analysis revealed normocytic anemia …

Cervical Cancer Recurrence In The Colon, Samantha A. Erb, Shreyash Pandya, Johnny Johnson

West Florida Division GME Research Day 2020

Cervical cancer is the fourth leading cancer worldwide in women, ranking only after breast cancer, colorectal cancer, and lung cancer. Because it is typically diagnosed at a younger age compared to other major cancer types, it leads to a proportionally greater loss in life-years. Most cancers occur in squamo-columnar junction, the transition point between squamous and columnar cells; squamous cell carcinoma accounts for approximately 70% of cervical cancer cases. Treatment options vary depending on the stage at diagnosis and include surgery (conization or hysterectomy), radiation, chemotherapy, targeted therapy, and immunotherapy. Prognosis is affected by stage, tumor volume, age and performance …

Iatrogenic Pneumothorax With Subsequent Subcutaneous Emphysema, George Michael, Eric Yuschak, My Myers

West Florida Division GME Research Day 2020

Lung cancer is the leading cause of cancer-related death in the United States, accounting for 13% of all new cancer diagnoses and 24% of all cancer deaths.1 Transthoracic CT-guided biopsy (CTGB) is commonly used as a diagnostic tool for lung cancer, with high diagnostic accuracy, sensitivity, and specificity. 2 This procedure, however, is not without its risks which include pulmonary hemorrhage and iatrogenic pneumothorax (IPNX). Emergent chest tube placement is standard care of treatment for massive or symptomatic IPNX, commonly with the use of smaller caliber chest tubes. 2 There is, however, a growing discussion over use of larger caliber …

New Onset Psychosis Secondary To Neurosyphilis, Samantha Linda Jane Vu, Lauren Angela Demarco, Francis Butler, Nihal Shah

West Florida Division GME Research Day 2020

Syphilis is a highly contagious sexually transmitted infection (STI) caused by the spirochetal bacterium Treponema pallidum. Transmission occurs through direct contact of painless ulcerative lesions, chancres, located on the genitalia (penis, labia) and oral mucosa. Neurosyphilis is any involvement of the central nervous systems (brain, meninges, or spinal cord) by the bacterium.

Bilateral Sporotrichoid Cutaneous Atypical Mycobacterial Infection Due To Primary Inoculation, Erin Lowe, Alexa Broderick, Richard Miller

West Florida Division GME Research Day 2020

The group of mycobacterial species that excludes Mycobacteria tuberculosis and Mycobacteria leprae is known as nontuberculosis or atypical mycobacteria. Nearly all atypical mycobacteria species can cause cutaneous infection. The diagnosis is challenging as disease may take months to become clinically apparent, morphology is non-specific, routine culture has a low sensitivity, and organisms can be sparse on histopathologic examination. Antibiotic resistance and further complicates management. The Gulf Coast is the highest incidence region of cutaneous atypical mycobacterial infections. Here we present a challenging case of bilateral sporotrichoid atypical mycobacterial infection due to primary inoculation.

Acral Lentiginous Melanoma: A Rare Variant With Unique Diagnostic Challenges, Taylor Gray, Brett Brazen, Maheera Farsi, Richard Miller

West Florida Division GME Research Day 2020

Acral lentiginous melanoma (ALM), named for its location and histological growth pattern, is a rare variant of melanoma. ALM presents on palms, soles, or in association with the nail unit.1 While ALM accounts for approximately 5% of melanomas diagnosed each year, it is the most commonly diagnosed subtype of melanoma in non-Caucasian patients.

Evaluating Awareness Of Low-Dose Computerized Tomography For Lung Cancer Screening, Roshni Leboutillier, Bansi Savla, Vincent Wu, Zia Khan, Erick Mejia, Leah Tehranchi, My Myers, Khine Min, Jennifer Broyles, Stacy Chase

West Florida Division GME Research Day 2020

In the U.S., excluding melanoma, lung cancer is the leading cause of cancer-related deaths.¹
Cigarette smoking is the number one risk factor and is linked to 80-90% of lung cancer deaths.²
Low-dose Computerized Tomography has been shown to reduce lung cancer deaths by 20% in randomized control trials and observational studies.⁴
The U.S. Preventative Task Force recommends annual screening for lung cancer with low-dose computerized tomography (LDCT) in adults ages 55-80 years of age who:

• Have a 30 pack-year smoking history and
• Currently smoke or
• Have quit within the past 15 years.

Vitamin D Deficiency And Perceived Pain, Theodore Korty, Adam Grunbaum, Ken Baxa, Olu Oyesanmi

West Florida Division GME Research Day 2020

Vitamin D deficiency has been shown to contribute to the onset of musculoskeletal pain, headaches, and fatigue (1, 2). Deficient levels of calcium phosphate have been linked to musculoskeletal pain associated with vitamin D deficiency (3). Low levels of calcium phosphate may result in an inadequately mineralized bone matrix, and normalization of vitamin D levels should help to diminish symptoms of pain by correcting suboptimal mineralization of bone matrix (3). One prior study of patients who underwent orthopedic procedures (including treatment of vertebral compression fractures, Colle’s fractures, hip & knee arthroplasty, ligament repair, and meniscal repair), showed that 44% (n …

Evolving De Winter Presentation Of Acute Myocardial Infarction, Caroline Shepherd, Anthony Furiato

West Florida Division GME Research Day 2020

de Winter ECG pattern first detailed in 2008 in a case series Diagnostic criteria

• Tall, prominent, symmetric T waves in the precordial leads
• Upsloping ST segment depression >1mm at the J-point in the precordial leads
• Absence of ST elevation in the precordial leads
• ST segment elevation (0.5mm-1mm) in aVR

Strongly correlated with acute LAD occlusion

Acute Hypoxic Respiratory Failure Due To Organizing Pneumonia With Lipoid/Cholesterol Component Caused By Thc Vaping With E-Cigarette, Jinal K. Patel, Kiran Tirumalasetty, Jessica Khabra, Imran Khan, Johnathan Frunzi

West Florida Division GME Research Day 2020

Vaping has been the new and deemed “safer” way to inhale addictive chemicals such as nicotine and tetrahydrocannabinol (THC), but it does not encompass the detrimental effects of other ingredients in these vaping cartridges that can cause lung injury[1,2]. Similar studies with dabbing (heating THC wax concentrate at high temperatures with butane) showcase rapidly progressing lung injury with massive consolidation and lasting effects on lung parenchyma over a period of time [3]. This case report aims to educate people, especially the younger generation, of the dangers of newer ways of combustible alternatives that have been marketed as a “safer” way …

The Difficult Airway: Developing A Consistent Approach, Catherine Divingian, Tammy Ferro, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

The primary objectives were to determine the best practices in managing difficult airways (DAs) and to generate a simplified algorithm for a consistent approach. Additional objectives included organizing a DA cart, and integrating the information into the electronic medical record (EMR).

Fracture Blisters, Jessica Khabra, Jinal K. Patel, Gauthier L. Stepman, Kulveer Dabb, Kenny Hernandez, Debra Angelo, Johnathan Frunzi

West Florida Division GME Research Day 2020

Fracture blisters are tense vesicles or bullae that develop on edematous skin following some acute long bone fractures. Fracture blisters are infrequently seen, as the reported incidence is 2.9% to 6.6%.¹ This rare complication, may not regularly be encountered by Physicians in the hospital. Fracture blisters typically occur within 24-48 hours following high energy trauma injuries & may last up to several weeks. Ultimately, this condition can lead to prolonged hospital stay due to an increased risk of infection and delay in surgical intervention.² Early recognition of this dermatologic complication may be helpful in reducing hospital stays.

Hailey-Hailey Disease Successfully Treated With Low-Dose Naltrexone, John Moesch, Richard Miller

West Florida Division GME Research Day 2020

Hailey-Hailey disease (HHD) is an uncommon autosomal dominant disorder resulting from a mutation in the ATP2C1 gene resulting in dysfunction of the Golgi apparatus calcium-associated ATPase, thus interfering with intercellular calcium signaling.

HHD presents clinically as flaccid blisters and erosions in intertriginous areas, especially the axillae and groin.

The major histologic finding is acantholysis throughout the spinous layer of the epidermis, commonly referred to as a “dilapidated brick wall” appearance.

The initial lesions and associated symptoms usually develop during the second or third decade of life.

Complications of HHD include infections (bacterial, fungal, and viral), and malignant transformation (cutaneous squamous …

Progressive Collateral Stenosis Leading To Symptomatic Chronic Total Occlusion, Farhan Shah, Andrew Maiolo

Capital Division GME Virtual Research Day 2020

Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.

Segmental Neurofibromatosis: Isolated Eruption Of Neurofibromas On The Scapula In A Middle-Aged Man, Christopher White, Brett Brazen, Richard Miller

West Florida Division GME Research Day 2020

No abstract provided.

A Rare Case Of Primary Cutaneous Mucoepidermoid Carcinoma, Hassie Cooper, Maheera Farsi, Richard Miller, Pay Kamrani, Dudith Pierre Victor

West Florida Division GME Research Day 2020

Mucoepidermoid carcinoma (MEC) is a well-documented malignant tumor commonly found in the salivary glands. Cutaneous involvement is very rare, especially when presenting as a primary cutaneous neoplasm. Gallagher first described primary cutaneous MEC in 1959 and since then, to the best of our knowledge, there have been approximately 20 reports published in the literature. Here we present a very rare case of primary cutaneous mucoepidermoid carcinoma.

Teriparatide And Its Bone Healing Power, Aneeta J. Joseph, Jesus L. Penabad, Antonio Pinero-Pilona

West Florida Division GME Research Day 2020

Teriparatide, a parathyroid hormone analog, is an important anabolic agent approved by the U.S. Food and Drug Administration to increase bone mineral density in osteoporotic patients. Parathyroid hormone (PTH) regulates calcium, phosphate, and active vitamin-D metabolites. The amino terminal peptide fragments of PTH has been known to increase bone mass and are being used in clinical practice for osteoporosis management.3 Teriparatide increases bone density of lumbar spine and femoral neck, and decreases the risk of vertebral and non-vertebral fractures both in postmenopausal women and men. It is also known to prevent fractures in patients with osteoporosis and promote healing of …

Bilateral Posterior Fracture-Dislocation Of The Proximal Humerus After First-Time Seizure, John D. Murphy, Phillip Braunlich, Mohit Bansal

West Florida Division GME Research Day 2020

Fractures of the proximal humerus are commonly associated with osteoporosis and comprise 5.7% of all adult fractures [1]. Posterior dislocations of the shoulder comprise 2-5% of all shoulder dislocations, and when bilateral are even more infrequent, occurring less than 5%. [2,3]. Posterior dislocations are often associated with motor vehicle accidents, seizures, or electrical shock [4]. Fracture-dislocations of the proximal humerus occur in only 1% of all shoulder dislocations, thus making posterior fracture-dislocations off the proximal humerus exceedingly rare [5]. In this case report, we present a previously undescribed case presentation and treatment for bilateral posterior fracture-dislocations of the proximal humerus …

A Case Of Babesiosis Seen Outside Of Its Endemic Area And Outside Of Its Incubation Period, Kiran Tirumalasetty, Jinal K. Patel, Gauthier L. Stepman, Bassem Zeidan, K V. Sundaresh, Parth R. Desai, Johnathan Frunzi

West Florida Division GME Research Day 2020

Babesiosis Microti is a parasitic alveolate that is usually transmitted by Ixodes scapularis ticks. In the United States, the endemic areas of Babesiosis include the Northeast and Upper Midwestern regions [1]. Symptoms include fever, malaise, fatigue, vomiting, and jaundice [1]. Current therapy primarily consists of a combination of azithromycin and atovaquone. Clindamycin and quinine may be administered in severe cases. For its emerging health risk worldwide, clinicians must be aware of the several presenting manifestations of babesiosis. Since 2017, the Centers Disease Control and Prevention (CDC) has deemed Babesiosis is a reportable disease. This case focuses on the importance of …

Impact Of Order Set Use On Stroke Care, Bilal Nadeem, Edward Waseleski, Meryem Maras-Casey, Sabih Alam, Adnan Faruqui, Michael Gutierrez, Maruthsakhi Molugu, Christina Oricompil, Ashar Mahmood, Katherine Torralba, Fatima Agha, Nour Tlimat, Olu Oyesanmi, Salman Muddassir, Nikolay Mitzov

West Florida Division GME Research Day 2020

A case control study of 118 patients from Oak Hill Hospital between the months of August 2019 and January 2020 was recently completed for a hospital research quality improvement study. The objective was to determine if the use of either Hemorrhagic or Ischemic Stroke Order Set had an effect on the length of stay (LOS) or adherence to current stroke guideline recommendations when compared to its disuse. Results indicate use of either the Hemorrhagic or Ischemic Stroke Order Set led to a decreased length of stay and an increased adherence to current stroke guideline recommendations. Limitations of the study included …

A Case Of Medication-Induced Diffuse Alveolar Hemorrhage In Neurofibromatosis Type 1, Ashar Mahmood, Liz Palmer, Rebecca Schuyler, Svitlana Sharpovalova, Bilal Nadeem, Mukesh Mehta, Salman Muddassir, Nikolay Mitzov, Monicka S. Felix

West Florida Division GME Research Day 2020

• Amiodarone, an antiarrhythmic and apixaban, an anticoagulant have been associated with diffuse alveolar hemorrhage (DAH).
• Cases have been documented demonstrating DAH in the setting of amiodarone and apixabantreatment, however there are few cases examining DAH in combination therapy.
• We present a case of diffuse alveolar hemorrhage in the setting of amiodarone and apixaban treatment for paroxysmal atrial fibrillation.
• NF1 is know to have higher risk for major bleeds due to their friable vasculature.

Diaphragmatic Paralysis: A Presentation Of Spontaneous Chest Pain And Shortness Of Breath, Donna Dorriz, Hilary Lois, Candace Wise, Brady Dehart

Capital Division GME Virtual Research Day 2020

Chest pain accounts for approximately 7.6 million annual visits to emergency departments (ED) in the United States and can include a broad differential1. The workup warranted includes extensive testing with the goal of demonstrating a reassuring cardiopulmonary status. When preliminary chest pain workup is negative, the subtle features of common primary symptoms can provide insight into other less common etiologies. This case looks to highlight the rare presentation of a relatively healthy middle age male with complaint of chest pain and shortness of breath, worsened with exertion and supine position. When standard cardiopulmonary workup was negative, further specialty testing was …

A Rare Cause Of Pneumoperitoneum, Robert Zusman, George Michael, Anna E. Augustin, My Myers, Dudith Pierre-Victor

West Florida Division GME Research Day 2020

Pneumoperitoneum is most commonly associated with a perforated viscus. When free air is seen on imaging, the most common course of action is an emergent exploratory laparotomy. However, pneumoperitoneum may not always be indicative of a perforated bowel. In the case described below, we will discuss a patient who developed acute peritonitis and pneumoperitoneum after undergoing chest compressions during cardiopulmonary resuscitation (CPR) and positive pressure mechanical ventilation.

Creative Writing In Residency Training, Julia Fashner

HCA Healthcare Journal of Medicine

Residents compose notes for medical purposes on a daily basis. As part of wellness, I have done creative writing during didactic time with family medicine residents. I present some of the poems that have been created.

Nicaraguan Homeowner Showing Gratitude For Concrete Flooring As Part Of A Public Health Mission Trip, Breonna Kinnison

HCA Healthcare Journal of Medicine

I’m Bree Kinnison, a fourth-year medical student and aspiring psychiatrist. When I’m not studying, I enjoy painting using acrylics. This painting depicts a very fond memory of mine. After completing the medical portion of our mission trip in Nicaragua, we began our public health portion. Along with fellow students, I laid concrete flooring in this woman’s house. For all 76 years of her life, she had never experienced anything other than a dirt floor in her home. Traditional dirt flooring in Nicaraguan homes is responsible for many preventable illnesses. When shown the final product, she reached out and hugged the …