Medicine and Health Sciences Commons^™

Philippines Global Health, Thomas Rieth, Kourtney Bettinger, Ryan Northup

Posters

Provides reflections on resident's experience working with cardiologists and neonatologists in Manila.

Evaluation Of Antimicrobial Prophylaxis In Spine Surgery Within An Enhanced Recovery Program At A Large Community Teaching Hospital, Sabrina Dipietro, Klea Noskey, Richard Zoltowski, Tania Saeed, Sapna Shah

Posters

The risk of surgical site infections post spine surgery is 0% to 18%.1

• American Society of Health System Pharmacists (ASHP) and Enhanced Recovery After Surgery (ERAS) Society guidelines recommend using an agent with activity against the most common surgical site pathogens including Staphylococcus aureus. 2,3

• The preferred agent is cefazolin 2 grams intravenous (IV) (3 grams if patient weighs ≥120 kilograms [kg]) administered 30 minutes prior to skin incision and re-dosed every four hours intraoperatively.2,3

• In the case of a cephalosporin allergy, clindamycin 900 milligrams (mg) IV or vancomycin 15 mg/kg IV are recommended alternatives.2,3

• Due …

Pharmacist-Provided Educational Intervention And Its Impact On Medical Resident Knowledge And Comfort Level With Continuous Glucose Monitors (Cgms), Chelsea Dezfuli, Sarah Muench, Colleen Lauster

Posters

Continuous glucose monitors (CGMs) have become an integral component of diabetes care

American Diabetes Association now recommends that CGMs be offered to all patients on insulin who can use the device safely

Integrating CGMs into clinical practice can be challenging for several reasons: – Data overload – Cost – Need for education on data interpretation

Safety Evaluation Of Intravenous Heparin Protocol Following Alteplase Treatment In Patients With Suspected Or Confirmed Pulmonary Embolism, Erika Waldsmith, Lisa Hall Zimmerman, Claudia Hanni

Posters

No abstract provided.

Evaluation Of Safety Outcomes Of Two Hydrocortisone Dosing Regimens In Patients In Septic Shock, Alexandra Rola, Joshua Wirtz, Daniel Kalaj, Vasil Rrushi, Megan Cadiz

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• Steroids are used in shock to minimize the impact of shock-induced dysregulation of inflammatory response – Hydrocortisone is preferred for its activity as a glucocorticoid and a mineralocorticoid • Available data on the use of hydrocortisone shows mixed benefit – Data to guide dosing is limited, use of 100 mg IV every 8 hours may have benefit over 50 mg IV every 6 hours • Use of steroids has been associated with potential risks, including gastrointestinal bleeding, hyperglycemia, hypernatremia, superinfection, etc.

Impact Of Continuous Infusion Ketamine As Sedation On Concomitant Opioid And Sedative Requirements In Mechanically Ventilated Covid-19 Patients, Gabrielle R. Bradley, Megan Cadiz, Allycia Natavio

Posters

Characterize the impact of continuous infusion ketamine (CIK) on concomitant opioid and sedative requirements in mechanically ventilated COVID-19 patients

Levetiracetam For Seizure Prophylaxis In Spontaneous Intracerebral Hemorrhage, Alanah Bratley, Krystal Commons, Allycia Natavio

Posters

Characterize the use of levetiracetam for early seizure prophylaxis in patients with sICH

Evaluation Of Antibiotic Selection And Duration In Patients With Non-Severe Community Acquired Pneumonia, Emily Reich, Sandra Hartnagle, Jennifer Pilotto, Heidi Klotz, Ryan Herc

Posters

No abstract provided.

Eosinophilic Myocarditis Secondary To Hypereosinophilic Syndrome Vs. Eosinophilic Granulomatosis With Polyangiitis: A Diagnostic Dilemma, Nathan Lavoy, Brian Birnbaum, Julia G. Harris, Aarti Pandya, Allison Taber

Posters

Introduction: Hypereosinophilic syndrome (HES) is a rare but detrimental diagnosis in the pediatric population. Cardiac involvement within HES can present as a diagnosis of Eosinophilic Myocarditis which can progress to irreversible damage and potentially death. This case report discusses a 16-year-old male treated for HES, although HES can have overlap with Eosinophilic Granulomatosis with Polyangiitis (EGPA) and requires a multi-disciplinary approach to patient management. Case Description: The patient was a 16-year-old male, with a history of asthma, presenting with acute onset of chest pain. He was found to have peripheral eosinophilia with an absolute eosinophil count of 11.71. He had …

Malignancy Masquerading As Steroid Resistant Hypereosinophilic Syndrome, Sonya Parashar, Aarti Pandya

Posters

Introduction: Hypereosinophilia syndrome (HES) is defined as 1500 eosinophils/mL or above with evidence of end-organ damage due to the eosinophils at least 4 weeks apart. Case description: A 3-year-old male was admitted for newly found anterior mediastinal mass and left pleural effusion. About 6 weeks prior to admission, he was seen in his primary care office for difficulty breathing. Despite the appropriate treatment for his symptoms, the patient continued to have significant respiratory symptoms and a chest x-ray showed a large left pleural effusion. He was immediately transferred to a tertiary care center and a CT chest showed large left …

A Rare Cause Of Urticaria In An Nsaid Tolerant Patient, Thao Le, Mary K. Mcleod, Laurianne Wild

Posters

Introduction: Acetaminophen is one of the most used anti-pyretics to mitigate fever. Few cases have been reported of hypersensitivity reactions to acetaminophen without non-steroidal anti-inflammatory drug (NSAID) intolerance. It is recommended that if there is suspected drug hypersensitivity then the patient should undergo an oral drug challenge. Case Description: A 49-year-old male presented for evaluation of urticaria that occurred with acetaminophen ingestion. He reported several episodes where he developed diffuse urticaria within 15 minutes of ingestion, but no other symptoms concerning for anaphylaxis. He was unsure of the dose. He also noted urticaria with Excedrin migraine, which contains acetaminophen, aspirin, …

Improving Fluid Management Of Extreme Premature Infants By Providing A Restrictive Fluid Management Algorithm In The Icn, Jacob S. Ward, Dena Hubbard, Nicholas Clark

Posters

Intro: Excessive fluid intake in extremely premature infants during the first week of life is known to increase risk of adverse events such as necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and overall mortality. There also is some correlation with the need for mechanical ventilation and development bronchopulmonary dysplasia (BPD). While fluid restriction is recommended to decrease the likelihood of adverse outcomes, at our institution we found there was a wide variability in and lack of evidence-based standards on fluid management in this vulnerable population. We aimed to improve the fluid management of the extremely premature infants by standardizing a …

Cardiac Biomarkers In Differentiating Kawasaki Disease And Multisystem Inflammatory Syndrome In Children Associated With Covid-19, Mollie Walton, Geetha Raghuveer, K Kamakoti, N Dahdah, L Garrido, S Tierney, T Harris, M Khoury, M Hicar, E Braunlin, D Thacker, M Khare, F Dallaire, R Lowndes, I Glassmeyer, J Ballweg, G Goldenberg, S Merves, C Manlhiot, P Farid, Bw Mccrindle

Posters

Introduction – Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap making differentiation challenging, particularly in the absence of evidence of evidence of prior COVID-19. Hypothesis – Cardiac biomarkers can differentiate KD from MIS-C. Methods – The International KD Registry enrolled n=2903 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 42 sites in 8 countries from January 2020 through July 2022. The study population was confined to 1489 MIS-C patients meeting CDC criteria with confirmed evidence of prior COVID-19 infection and 387 KD patients meeting AHA guideline criteria with confirmed evidence …

Case Report: Autoimmune Anemia And Thrombocytopenia Following Hematopoietic Stem Cell Transplant, Thomas Cochran, Gabor Oroszi, Nancy Terwilliger, Gabe Metzler, Lejla Music Aplenc

Posters

Background: Autoimmune cytopenias (AIC) post hematopoietic stem cell transplant (HSCT) are rare but exceptionally challenging complications. Here, we report anti E, warm autoimmune hemolytic anemia (WAIHA), cold autoantibody, polyagglutination and immune thrombocytopenia in a 5-year-old boy with a history of chronic granulomatous disease, who underwent an ABO incompatible, mismatched (9/10) unrelated HSCT. Study design: Case report. Four months after HSCT, the patient was admitted for fever, fatigue, and decreased appetite. His original blood type was O+ and donor’s blood type B+. Prior to the admission he was transfused with 2 doses of red cells and 2 doses of platelets. On …

Histopathologic Comparison Of Discoid Lupus Erythematosus And Folliculotropic Mycosis Fungoides In A Series Of 12 Cases, Camilla Cascardo, Sandra Oska, Uma Sundram

Posters

Background: Folliculotropic mycosis fungoides (FMF) is a rare cutaneous malignancy that can be confused with other inflammatory diseases, such as discoid lupus erythematosus (DLE), due to the variety of histopathological findings. Methods: This study aims to describe histopathologic patterns common to DLE using 12 biopsies from patients with a confirmed diagnosis and compares these features to known FMF histopathologic patterns. Results: The most frequent histopathologic pattern was folliculocentric/folliculotropic pattern, with no follicular mucinosis. Plasma cells and mild cellular atypia were present in all biopsies. Other common findings included follicular plugging, syringotropism, interstitial mucin, and a lichenoid interface. Less common findings …

Mobile Health Software Platform Implementation To Improve Pediatric Remote Patient Monitoring Outcomes, Lori A. Erickson, Amy Ricketts, Jenny Marshall, Krista Nelson, Peter Churchill, Dawn Wolff, Robert W. Steele

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Background: Children’s High Acuity Monitoring Program (CHAMP®) is a software platform for pediatric remote patient monitoring. It is used with a proactive, personalized, pediatric care model providing a link for communication with a specialized healthcare team to patients and families in their homes. Successful implementation since 2014 includes: adoption at 12 pediatric hospitals and over 870 infants with a survival of 96.5% (down from 20% in 2012). This work led our team to engage leadership to discuss a remote patient monitoring department with new monitoring devices and expanded access to pediatric conditions.

Methods: Strategic Planning and Innovation facilitated navigation of …

Stewardship Opportunities For Cervical Lymphadenitis And Deep Neck Space Infections, Aaron Shaw, Brian R. Lee, Lauren Kazmaier, Emily Baker, Tina Dao, Sandra Arnold, Angela Myers

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Background: Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities. Methods: Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, …

Inverted Appendix Presenting As Abdominal Pain And Lower Gastrointestinal Bleeding, Moises Alatorre-Jimenez, Thomas M. Attard

Posters

Background: Cecal polyps are challenging insofar as the region represents the highest risk of bleeding and perforation during polypectomy . In addition, polypoid lesions in the cecum may represent a morphologically abnormal ileocecal valve or an inverted appendix. Inadvertent polypectomy in those scenarios would lead to serious sequelae including perforation. Case report: Our patient is a 6-year-old male with a background history of prematurity, lactose intolerance, chronic esophagitis, gastritis, constipation, and painless rectal bleeding. He presented with a acute onset diffuse, severe abdominal pain associated with diarrhea that evolved to include hematochezia. At the time of presentation, he required aggressive …

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

Alterations In The Metabolic Comorbidities Of Youth With Overweight And Obesity During The Covid-19 Pandemic, Safa Farrukh, Erica Wee, Ashley Sherman, Yun Yan

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Background: Childhood obesity rates have continued to increase with the COVID-19 pandemic. However, data are limited on the impact of increasing obesity on associated comorbidities. Methods: We evaluated the progression of overweight- or obesity-associated comorbidities by investigating change in laboratory results pre–COVID-19 pandemic and post–COVID-19 pandemic onset in youth with overweight or obesity. Results: There was no significant BMI progression. There was progression of metabolic comorbidities. HbA1c progression and LDL progression were significantly correlated. HbA1c and LDL progression were significantly associated with older age and Hispanics respectively. Conclusion: The results indicate that despite no significant increase in BMI, youths with …

Two Siblings With Microvillous Inclusion Disease, Moises Alatorre-Jimenez, Brandi Weller, Meike Orlick, William San Pablo

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Introduction: Microvillous Inclusion Disease (MVID) (OMIM#251850) is a rare autosomal recessive condition caused by mutations or deletions mostly in the MYH6 gene but also STX3 and STXBP2 genes. It is characterized by protracted diarrhea with severe congenital alteration of the intestinal epithelium resulting in watery diarrhea, metabolic acidosis, failure to thrive, and permanent malabsorption that normally leads to a lifelong dependency on total parenteral nutrition (TPN) and the eventual possibility of bowel transplantation . Histological hallmarks of MVID in small intestinal biopsies are hypoplastic, atrophic, or disorganized villi without crypt hypertrophy, or immune cell infiltrate and, at the intestinal cellular …

Endoscopic Removal Of Safety Pin From Appendiceal Orifice, Alex Biller, Moises Alatorre-Jimenez, Jeremy Stewart, Ruba A. Abdelhadi

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Introduction: Foreign body ingestion in children is considered a common concern in every Emergency Department worldwide. In the United States, it is estimated that foreign body ingestions cause approximately 1,500 deaths yearly (1). Safety pins ingestions are estimated to be 1% of the foreign body ingestions in children (2). In literature, ingested safety pins have been reported to be lodged mostly in the upper gastrointestinal tract, but a few cases have been reported to be lodged in the appendix (2,3,4). Objective: Recommendations for safety pin ingestions when past the second portion of the duodenum. Case: We report the case of …

Disseminated Cutaneous Nodules Presenting In A Patient Secondary To Anti-Pd-L1 Therapy For Metastatic Malignant Melanoma, Vasudevan D. Mahalingam, John M. Moesch

Posters

Checkpoint inhibitor immunotherapy, including pembrolizumab, a programmed cell death-ligand 1 (PD-L1) inhibitor, has been increasingly utilized with favorable outcomes in patients diagnosed with metastatic malignant melanoma. Along with the successful expanded use of this class of medication has been the rise of newly discovered adverse side effects. A 63-year-old woman with a history of choroidal melanoma, treated with radiation therapy two years prior, developed a metastatic lung mass in her right upper lobe. She underwent tumor resection followed by adjuvant pembrolizumab therapy. Shortly after receiving treatment, she noticed two painful subcutaneous nodules on her left hip. A PET scan performed …

A Remarkable Manifestation Of Reactive Ecrrine Syringofibroadenoma, Vasudevan D. Mahalingam, Grace Y. Wang

Posters

Eccrine syringofibroadenoma is a rare benign cutaneous neoplasm with a variety of clinical associations. Reactive eccrine syringofibroadenoma (RES), a subtype characterized by ductal hyperplasia, is thought to be caused by repeated damage to eccrine structures from chronic injury. A 62-year-old woman with a history of a motor vehicle collision over twenty years ago requiring multiple surgeries to her left lower extremity presented with a non-healing, erythematous, and warm lesion on her left plantar heel. The wound was excised with concurrent bone biopsy showing no osteomyelitis. Histopathology showed classic features of thin anastomosing strands of small and uniform basaloid cells arising …

Endoscopic Retrograde Cholangiography Using A Colonoscope In A Pediatric Liver Transplant Patient With Roux-En-Y Biliary Anastomosis, Nadia Ibrahimi, Thomas M. Attard, Ryan T. Fischer, Voytek Slowik, Richard J. Hendrickson, Bhargava Mullapudi, Moises Alatorre-Jimenez, Syed Jafri

Posters

Introduction: Biliary ducal sequelae including occlusions, strictures, leaks, or necrosis frequently complicate pediatric liver transplantation. The underlying etiology includes prolonged intraoperative ischemia or postoperative arterial inflow obstruction. In adult patients the role of endoscopic retrograde cholangiography (ERC) is well established in the management of biliary complications post-liver transplantation. In contrast, in the pediatric population, due to the combination of small patient size and the complexity of Roux-en-Y anastomotic techniques, ERC has been described as difficult or virtually impossible. This limits the options available for managing biliary duct complications to percutaneous techniques Endoscopic management of biliary complications in pediatric patients with …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Frequency, Resistance And Antimicrobial Use, Edward Lyon, Jennifer Goldman, Brian Lee, Margaret Campbell, Rangaraj Selvarangan, Elizabeth Monsees

Posters

Background: Tracheal aspirates (TA) are frequently obtained in the pediatric intensive care unit (PICU); however, no data exists on the frequency or clinical management of multiple TA cultures on the same PICU patient. In this study, we describe the frequency of repeat TAs in PICU patients, the emergence of multidrug resistant organisms (MDRO), frequently cultured pathogens of TAs, and associated antibiotic prescribing patterns. Methods: We identified 70 PICU patients between 2018-2019 who met our criteria for retrospective chart review with ≥2 TAs obtained during their hospitalization. The following information was collected: patient demographics, number of TAs per patient, microbiology with …

Nasopharyngeal Swabs Gone Wrong: An Unexpected Complication Of A Common Procedure, Moyosoreoluwa Laditan, Riya Kalra, Laurene Reed, Paras Khandhar

Posters

No abstract provided.

Intraductal Papillary Mucinous Neoplasm In An 18-Year-Old With Recurrent Pancreatitis, Nadia Ibrahimi, Thomas M. Attard, Moises Alatorre-Jimenez, Karie Robinson, Syed Jafri

Posters

Introduction: Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are premalignant, intraductal, mucin secreting cystic lesions. IPMNs are a rare entity in the pediatric population and commonly seen in men in their 6 to 7 decade. Pediatric IPMN has been previously reported in a 14-year-old and a neonate, who also had hyperinsulinism and a de novo germline SKIL gene mutation. . Kim et al. did a ten-year single centered pediatric pancreatic malignancy study discovering IPMN in one patient of 35 with pancreatic mass removals . Case: Our patient is an 18-year-old male who initially presented at the age of 15 …

Acute Pericarditis And Acute Pleuritis/Empyema Following Submandibular Infection In A Covid-19 Positive Patient - An Autopsy Revealing The Danger Space Of The Neck, Jessica D. Anderson, Seyedalireza Fatemi, Joseph Fullmer, Ping I. Zhang

Posters

Acute pericarditis and empyema are life-threatening complications of severe odontogenic infections; reports of these findings from an autopsy perspective are rare. We report an autopsy case demonstrating infection from the mandibular molars to the pericardium and pleura in a patient following Covid-19 infection

Association Of Isolated Colitis With Non-Steroidal Anti-Inflammatory Drugs Usage, Ashbita Pokharel, Wei Li

Posters

Non-steroidal anti-inflammatory drugs (NSAIDs) have been known to produce various clinical gastrointestinal side-effects and histopathological changes. It has been reported that NSAIDs usage is associated with isolated colitis in periappendiceal orifice region. This study aims to further evaluate the clinicopathologic features of 16 patients with isolated colitis limited to the cecum or peri-appendiceal orifice region.