Medicine and Health Sciences Commons^™

A Rare Case Of Metachronous Gastric Lymphoma And Gastric Adenocarcinoma, Rofinna Johnkennedy Md, Mph, Cheng-Hung Tai, Alexa Plato Md, Department Of Medicine,, Caroline Loeser

Posters

Reports of metachronous primary gastric lymphoma and gastric adenocarcinoma exist in the literature, but it remains a rare entity. We present a rare case of metachronous gastric adenocarcinoma in a patient diagnosed initially with primary gastric lymphoma.

Amyloidosis: A Rare Cause Of Pan-Dysmotility, Rofinna Johnkennedy Md, Mph, Cheng-Hung Tai, Alexa Plato Md, Department Of Medicine,

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Amyloidosis is a rare systemic infiltrative disease, with a prevalence estimated to be 6-10 cases per million person-years. It involves the extracellular deposition of beta-sheet fibrillar protein and can manifest in any organ system in the body. Diagnosis of gastrointestinal involvement of amyloidosis can be difficult, given its nonspecific symptoms including abdominal pain, nausea, dysphagia, and diarrhea.

Risk Of Stroke In Patients With Left Ventricular Thrombosis Who Undergo Coronary Angiography: A System-Wide Retrospective Analysis, Ashraf Ahmed, Shaun Abid Md, Abhinav Aggarwal, Samdish Sethi, Ilia Ryzhkov, Nur Rahman Md, Assad Ur Rehman Md, Mohamed A. Badheeb, Isaac Opoku Md, Rasha Kaddoura, Rajvir Singh Md, Sandeep S. Nayak, Gilead Lancaster

Posters

Left ventricular thrombus (LVT) has been associated with an increased risk of cardioembolic stroke. However, it has not been established if coronary angiography (CAG) or percutaneous intervention (PCI) would enhance that risk. This study aims to determine the risk of cardioembolic stroke among patients with LVT who underwent CAG or PCI.

To Screen Or Not To Screen, That Is The Question, Saddam Zaidi Md, Cheng-Hung Tai, Caroline Loeser

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AASLD and EASL recommend biennial HCC screening for Child-Pugh A and B, but not C. We report a 43-year-old female with alcohol related hepatitis and cirrhosis. Her Fibro test score improved from F4 in 2021 to F2 in 2023 with strict alcohol abstinence. AASLD guidelines for HCC screening in such cases remain unclear.

Cardiac Arrest Associated With Thyrotoxicosis: A Systematic Review, Ashraf Ahmed, Mohamed A. Badheeb, Shaun Abid Md, Douglas Webber, Samdish Sethi, Mayowa Adefuye, Deepak R. Vangipuram, Anda Gonciulea Md, Stuart Zarich, Gregory K. Buller

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Thyrotoxicosis is a systemic condition caused by the effects of elevated levels of thyroid hormones. The cardiovascular manifestations of thyrotoxicosis range from sinus tachycardia and atrial fibrillation to heart failure. The incidence of malignant arrhythmias and cardiac arrest associated with thyrotoxicosis is not well known, and much of the current literature regarding this is limited to case reports. This study conducts a systematic review of the literature to identify patient demographics and outcomes where thyrotoxicosis manifests as cardiac arrest.

An Interesting Case Of Candida Tropicalis Endocarditis, Abbas Mallick Md, Farrah R. Khan Md, Sohrab Singh Md, Salman Ayaz Md, Prandeep Kumar Devarakonda Md, Iyad Al-Bustami Md

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Infective Endocarditis (IE) is a disease characterized by microbe and fibrin rich complex adhesion to the cardiac valvular apparatus. Common culprit microorganisms include gram positive bacteria however valvular infections with fungal organisms are rare. We present an uncommon case of Candida Tropicalis endocarditis.

Outcomes After Major Adverse Cardiovascular Events In Obese Versus Non-Obese Masld Patients: A Nationwide Inpatient Sample Study, Prince A. Ameyaw, Sarpong Boateng, Tawanda Zinyandu, Basile Njei, Ashraf Ahmed

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MASLD is the most common etiology of chronic liver disease globally. MASLD is strongly associated with obesity and adverse cardiovascular outcomes. This study aims to investigate the outcomes after MACE in patients with obese versus non-obese MASLD.

A Rare Case Of Neuroleptic Malignant Syndrome, Farrah R. Khan Md, Salman Ayaz Md, Rasha Saleth Md, Aysha Rana Md, Bryan Schaf Md, Zahra Khan Md

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This case highlights the importance of identifying the signs of NMS in patients who are on antipsychotics. Although it is an uncommon phenomenon, heightened awareness is important to prevent delays or worsening conditions.

Outcomes Of Alcohol-Associated Hepatitis In Hospitalized Patients With Prior Bariatric Surgery: A Nationwide Analysis, 2016-2020, Sarpong Boateng, Prince A. Ameyaw, Karthik Mathialagan, Basile Njei

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Alcohol-associated hepatitis (AAH) is a severe liver condition often necessitating hospitalization and has a one-year mortality of 40%. The increasing prevalence of obesity has led to a rise in bariatric surgery (BS), which can alter the outcomes of various comorbid conditions. There are some concerns about possible increased risk and severity of alcohol related disorders in patients with a history of BS due to alteration in alcohol metabolism after surgery.

Thrombotic Events In Masld Cirrhosis Versus Cirrhosis Of Other, Prince A. Ameyaw, Sarpong Boateng, Rofinna Johnkennedy Md, Mph, Karthik Mathialagan, Basile Njei

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The complex physiologic changes of cirrhosis increase the risks of thrombotic and hemorrhagic complications. Thrombosis in cirrhosis increases in-patient and 90-day mortality. MASLD increases thrombotic risks independent of cirrhosis. We investigate the impact of cirrhosis etiology on risk

Are Patients With Mash- Or Alcohol-Associated Cirrhosis More Likely To Develop Hepatic Hydrothorax? A National Transplant Database Analysis, Sarpong Boateng

Posters

Hepatic hydrothorax (HH) is a complication of end-stage liver disease involving the accumulation of pleural fluid in patients with cirrhosis, in the absence of other cardiopulmonary disease. HH occurs in 10% of patients with decompensated cirrhosis, conferring a 5-fold increased risk of mortality.¹ Alcohol-associated liver disease (ALD) and metabolic dysfunction associated steatohepatitis (MASH), which accounts for 80% of liver cirrhosis in the US are known risk factors for HH. ²

REFERENCES

1. Asrani, Sumeet K., et al. "Burden of liver diseases in the world." Journal of hepatology 70.1 (2019): 151-171.

2. Banini, Bubu A., et al. "Multidisciplinary management of …

Prevention Of Amputation By Minimally Invasive Surgery In A Diabetic Patient With Osteomyelitis And Peripheral Vascular Disease With A History Of Previous Amputations, Orlexia Thomas Dpm, Francois M. Lokenye Dpm, Lady Poaula Dejesus Dpm, Facfas, Facpm, Dwsp

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This study aims to demonstrate the efficacy of minimally invasive surgical interventions in preventing foot amputation and promoting wound healing in a diabetic patient with osteomyelitis and peripheral vascular disease, compounded by a history of ray resection.

The Severity Of Obstructing Tubulopathy Is Often Associated With Foci Of Renal Tubular Obstruction, Ping L. Zhang, Hassan D. Kanaan, Wei Li

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Etiologies of renal failure due to renal tubular injury may result from either ischemic/toxic injury of proximal tubules (ATN), variants of interstitial nephritis or obstructing tubulopathy by the luminal blocking of either monoclonal casts, uric acid or calcified deposits. Our previous studies indicate that the polarizable semi-transparent calcium oxalate deposits block proximal tubules, whereas monoclonal casts, uric acid deposits and bluish calcium phosphates block the distal tubules. We hypothesized that the serum creatinine (SCr) levels and the number of tubular obstructing deposits were correlated so that pathologic identification of obstructing foci can be predictable for the extent of renal dysfunction.

An Early Successful Hematopoietic Stem Cell Transplant (Hsct) For A Boy With Ipex Syndrome, Ali H. Alnajim, Salman Aljubran

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Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare inborn error of immunity. It affects about one in every 1.6 million people. It is caused by mutations in the forkhead box P3 (FOXP3) gene on chromosome Xp11.23. FOXP3 is a vital regulator of T cell development and function. Dysfunctional FOXP3 allows the hyperactivation of T cells, resulting in skin rash, enteropathy, diabetes, thyroiditis, hemolytic anemia, and thrombocytopenia. The classic clinical presentation is intractable diarrhea, growth problems, dermatitis, and autoimmune endocrinopathy. Case Description: A 4-week-old male was transferred to our hospital’s NICU due to respiratory distress and feeding difficulties. Neurology …

Intraoperative Status Asthmaticus In A Morbidly Obese Preteen Undergoing Concomitant Vertical Sleeve Gastrectomy And Orthotopic Liver Transplant, Abigail Pint, Neal Campbell, Preethi Tumati

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10-year-old morbidly obese male with cirrhotic ESLD secondary to vertically transmitted Hepatitis C presented for liver transplantation and concomitant vertical sleeve gastrectomy. Other history included moderate persistent asthma, OSA, and presumed HPS with baseline SpO2 of 94%. Induction was smooth; intubation with an armored ETT was easy. During invasive monitor placement, bronchospasm worsened SpO2. Continuous albuterol nebulization provided reasonable reversal, and all stakeholders agreed to proceed. Postoperative course was complicated by status asthmaticus and dramatic extubation on POD3 when patient bit and kinked armored ETT. To date, patient has good graft function and a 16% reduction from his peak BMI.

Elevated Tryptase Level Identifies A Case Of Hereditary Alpha Tryptasemia, Ali H. Alnajim, Salman Aljubran

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Introduction Hereditary alpha tryptasemia (HaT) is a rare genetic disorder characterized by elevated serum tryptase levels due to duplication or triplication of the TPSAB1 gene. Affecting 6 to 8 percent of the population, HaT presents with diverse symptoms, including idiopathic anaphylaxis, skin rashes, and gastrointestinal issues. This report highlights a case that underscores the complexities and diagnostic challenges of HaT. Case Description A 4-year-old male presented with recurrent skin rashes and gastrointestinal symptoms following ingestion of certain foods, despite negative allergy tests. Persistent symptoms led to further investigations, revealing elevated tryptase levels of 10.3 ng/ml, 12.1 ng/ml, and 8.3 ng/ml …

Variables Affecting Neurodevelopmental Outcome In Infants With Critical Congenital Heart Disease, Elizabeth Loughman, Marcie G. Files, Julie Weiner

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Background: The mortality of cardiac conditions in infancy is improving with advances in surgical planning and medical management. Neurologic morbidity remains significant. Clinically correlating an infant with their neurologic exam, MRI/EEG, and subsequent developmental testing remains a challenge. Counseling regarding neurologic outcomes after cardiac intervention is difficult due to the wide range of findings that can sometimes be clinically irrelevant. Purpose: The goal of this study is to identify factors associated with poor neurodevelopmental outcomes in infants with critical congenital heart defects (CCHD) as assessed by the Bayley Scales of Infant and Toddler Development Edition IV (Bayley). Methods: This is …

Increased Red Cell Distribution Width (Rdw) Is Associated With Culture Positive Sepsis And With Increased Need Of Escalation In Respiratory Support In Very Low Birth Weight Infants More Than Seven Days Of Life Undergoing Sepsis Workup Secondary To Vitals Instability In The Form Of Multiple Episodes Of True Apneas Or Bradycardia And Desaturations Associated With Apnea, Kedar Tilak, Aashka Patel, Anna Zylak

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Background Apnea of prematurity is nearly universal among very low birth weight infants (VLBW). In VLBW infants, changes in clinical status usually occur due to sepsis or non-infectious causes and it is challenging to differentiate between the two. We as clinicians use irregularities in vital signs as an early warning sign of sepsis to facilitate early treatment and improve patient outcomes. Adults have used RDW as a marker of worsening respiratory status and mortality from acute respiratory distress syndrome (ARDS). In this study, we seek to investigate elevations in Red Cell Distribution Width (RDW) as markers for culture positive sepsis …

Grading And Follow-Up Of T Lymphocyte-Mediated Acute Interstitial Nephritis Following Checkpoint Inhibitor Therapy, Ping L. Zhang, Wei Li, Hassan D. Kanaan

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Immuno-check point inhibitors (CPI) such as PD-1/PD-L1 inhibitors have been used to treat a variety of metastatic carcinoma with positive effects. However, there are complications such as gastrointestinal, hepatic and endocrine symptoms and kidney dysfunction. We describe our experience with CPI-associated acute interstitial nephritis (AIN).

System-Based Integrated Comprehensive Simulation Program In Pediatric Residency Education: Our Institutional Experience, Mahmoud Jaara, Jenn M. Zimmerman, Jean Ann Hutton, Nancy Joseph, Maritza Plaza-Verduin

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Background: Simulation provides the opportunity for learners to bridge the gap between evidence-based theoretical knowledge and clinical practice experience. Residency programs often utilize simulation to expose the learners to various patients who are presenting in extremis in a safe environment. This empowers the trainee by providing them with tools and experiences to enhance their pediatric education. Simulation is also utilized to practice non-technical skills like team dynamics and communication in a psychologically safe setting. Despite the widespread use of simulation in pediatric residency programs, there remains a gap in standardization. In response to this gap, we sought to create a …

A Genomics Driven Human Induced Pluripotent Stem Cell Model Of Infant All – Updates On Hematopoietic Differentiation, Meagan Vacek, Jacqelyn Nemechek, Irina Pushel, Priyanka Kumar, Bradley Thornton, Molly Leyda, Midhat Farooqi, Erin Guest, Jay L. Vivian, John M. Perry

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Acute lymphoblastic leukemia in infants (iALL) is a high-risk subtype of childhood leukemia, with poor survival outcomes despite intensive therapies. Rearrangement of KMT2A (KMT2A-r) occurs in 70% of cases and is associated with chemotherapy resistance, early relapse, and rapid leukemic progression, all of which contribute to poor survival outcomes. The most common KMT2A-r in iALL is KMT2A::AFF1 (MLL::AF4), derived from t(4;11)(q21;23). This KMT2A-r generates a driver fusion oncogene which leads to epigenetic dysregulation of target gene transcription. Infant ALL’s cell of origin is thought to be a very early hematopoietic precursor, with transcriptomic studies of iALL blasts showing similarities to …

"Ghosts In This Country": Pediatric Caregiver Perspectives On Immigration Status In The Healthcare Setting, Anik Patel, Ali Fowler, Juan Farias Torres, Ana Contreras, Claudia Zepeda, Estefania Bazan, John Cowden, Frances Turcotte Benedict, Jennifer Watts, Kimberly A Randell

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Background: There are approximately 11.4 million undocumented immigrants (UI) in the United States. Immigration status (IS) is a unique social determinant of health that directly and indirectly impacts health and healthcare access. There are gaps in our understanding about how IS impacts health, particularly because it is not frequently discussed in the healthcare setting. This study expands our understanding of immigrant caregiver perceptions about discussing IS in the healthcare setting and provides insight into specific needs that we may not be currently addressing. Methods: Setting: ED or Spanish-speaking majority pediatric clinic at Children's Mercy Inclusion criteria: Caregivers who are 18+, …

Association Between Neighborhood Opportunity And Youth Mental Health Emergency Department Visits, Shelby Chesbro, Matt Hall, Adrienne Deporre, Molly Krager, Laura Plencner, Shayla Sullivant, Henry T. Puls

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No abstract provided.

Variables Affecting Neurodevelopmental Outcomes In Infants With Critical Congenital Heart Disease, Elizabeth Loughman, Marcie G. Files, Julie Weiner

Posters

Background: The mortality of cardiac conditions in infancy is improving with advances in surgical planning and medical management. Neurologic morbidity remains significant, and clinically correlating an infant with their neurologic exam, MRI/EEG, and subsequent developmental testing remains a challenge. Counseling parents regarding neurologic outcomes after cardiac intervention is difficult due to the wide range of findings that can sometimes prove to be clinically irrelevant. Purpose: The goal of this study is to identify factors associated with poor neurodevelopmental outcomes in infants with critical congenital heart defects (CCHD) as assessed by the Bayley Scales of Infant and Toddler Development Edition IV …

Using An Artificial Intelligence (Ai) Tool (Chatgpt) To Identify The Main Indications And Side Effects Of Drugs, Mai Elzieny, Christian Santiago, Zhenhong Qu

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This study evaluated the efficacy of ChatGPT, an AI powered language model (1), in retrieving drug information for pathology practice compared to UpToDate. The research focused on 160 commonly prescribed drugs, assessing the speed and accuracy of information retrieval. Results showed that ChatGPT efficiently provided indications and side effects of multiple drugs in batches within seconds, comparable to UpToDate's information but remarkably faster (2). The study suggests that ChatGPT is a promising valuable tool to help pathologists in accessing drug information, potentially improving diagnostic accuracy and work efficiency

Optimize Artificial Intelligence Language Model Use In Medical Board Exams: Insights From Instruction Quality And Domain Context Analysis, Zhenhong Qu, Mai Elzieny, Kanika Arora

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Artificial intelligence language models (AI-LMs) show promise in medical education and clinical problem solving, but their performance in medical board exams has been inconsistent (1,2,3).

This study investigated how prompt engineering and providing essential reference material influence AI-LM performance on board exam questions.

We tested ChatGPT and Claude-2 on 360 questions in various formats under three conditions: simple prompt, elaborate CRAFTS prompt, and CRAFTS prompt with references (CRAFTS stands for context, role, action, format, tone, and style).

Results showed significant improvement in accuracy from simple prompts (67-83.5%) to CRAFTS prompts (76.2-92.5%) to CRAFTS prompts with references (97.3- 99.4%)

These findings …

Post-Operative Diagnosis Of Anomalous Left Coronary Artery From The Right Pulmonary Artery Via Transthoracic Echocardiogram, Lavina Desai, Sanket Shah, Edo Bedzra, Christopher Mathis

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A term infant female was diagnosed with a ventricular septal defect (VSD) and aortic coarctation. Preoperative echocardiography and computed tomography angiography (CTA) showed a normal right coronary artery origin, but inconclusive left coronary artery (LCA) origin. There was a normal flow profile in the LCA by echocardiography. She underwent repair with extended end-to-end anastomosis and VSD closure during which surgical inspection revealed a usual appearing, retro pulmonary path of the LCA towards the left sinus of Valsalva. Postoperative echocardiogram revealed mild global dysfunction but no regional wall motion abnormalities.   Repeat echocardiogram revealed severe dysfunction most prominent in the anterolateral and …

Rhabdomyolysis As A Cause Of Pth Independent Hypocalcemia In A Child With Acute Influenza Infection, Samhita Bhattarai, Kelsee Halpin

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INTRODUCTION Hypocalcemia is characterized by abnormally low level of calcium in the blood. Normal reference range for calcium for children between 12- 19-year-old is 8.5-10.6 mg/dl . Severe hypocalcemia is considered as serum calcium level of <7 mg/dl and can present with tetany, seizures, and life-threatening cardiac arrhythmias. Etiology of hypocalcemia varies but hypoparathyroidism, pseudohypoparathyroidism and Vitamin D deficiency are some of the most common causes encountered by pediatrician endocrinologists. Association of rhabdomyolysis with hypocalcemia and elevated PTH is a rare presentation that should be considered, particularly for those children presenting with acute viral illness. We present a rare case of rhabdomyolysis associated with hypocalcemia not related to hypoparathyroidism. CASE A 12-year-old female presented to the emergency department with body ache, decreased oral intake and vomiting. She was found to be influenza positive. Electrolytes showed hypocalcemia (4.8 mg/dl). She subsequently had an undetectable 25-OH vitamin D level (<5 ng/ml) and elevated iPTH level (609 pg/ml). We discussed the possibility of her etiology of hypocalcemia to be Vitamin D deficiency although her presentation was atypical at an older age with a negative imaging for rickets, hyperphosphatemia (6.0 mg/dl), and normal alkaline phosphatase (334 unit/L). She also did not have any phenotypic features of Albright’s hereditary osteodystrophy and renal function was within normal limits. She was identified to have elevated creatinine kinase (4829 U/L) supporting rhabdomyolysis secondary to acute influenza as a cause of her hypocalcemia. Rhabdomyolysis, a known complication of influenza infection, causes cell membrane destruction which impairs the normal function of Na-K-ATPase channel. This leads to increase in intracellular sodium activating Na/Ca exchanger which in turn causes influx of calcium intracellularly causing hypocalcemia. Additionally, any injury or infection leads to high phosphorus release from cells due to cell lysis. High phosphorus is also caused by reduced oxidative metabolism in muscles impairing phosphate use. This excess of phosphate then combines with calcium and causes calcium-phosphate complex in soft tissues. Hyperphosphatemia also additionally inhibits 1 alpha hydroxylase limiting formation of calcitriol leading to hypocalcemia. CONCLUSION Our patient had severe hypocalcemia due to influenza-related rhabdomyolysis. Rhabdomyolysis is an important consideration as a cause of hypocalcemia in children, especially with acute viral illness. Accordingly, it is also important to obtain serum electrolytes in patients presenting with rhabdomyolysis as hypocalcemia may lead to complications like seizures and cardiac arrhythmia if not appropriately recognized and treated.

3d Bioprinting The Tumor Microenvironment For Immunotherapy Development, Molly Leyda, Tykeem Manor, John Szarejko, Douglas Myers, John M. Perry

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The tumor microenvironment (TME) is a complex system that plays a crucial role in tumor progression, immune evasion, and therapy resistance. The TME is composed of various cell types, including tumor cells, stromal cells, and immune cells such as macrophages. Macrophages are versatile myeloid cells which can exhibit both pro-tumoral and anti-tumoral functions, depending on their phenotype and the TME context. M1 macrophages have demonstrated promising pro-inflammatory and anti-tumor effects, while tumor associated M2 macrophages (TAMs) play an anti-inflammatory role and promote tumor immune escape. Understanding the complex interactions between TAMs and the TME is, therefore, essential for developing effective …

Case Report Of Surgical Management For Charcot Foot Medial Column Beaming With Stj Arthrodesis, Prachi Patel, Randy Semma

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Medial column beaming is a surgical procedure that involves inserting a metallic beam to the medial column of the foot to treat the Charcot deformity of the foot.

A surgeon will use a large diameter screw to insert a beam into medial column which includes the first metatarsal, medial cuneiform, navicular and talus (fig 3) The beam shares the load of weightbearing with the foot's ligaments and joints, reducing the abnormal loss of structural integrity that can occur in Charcot arthropathy of the foot.

Subtalar joint fusion is often performed concurrently with medial column beaming to enhance the overall stability …