Medicine and Health Sciences Commons^™

A Case Of Systemic Sclerosis Sine Scleroderma, Adrian Lugo, Andrew Cappiello, Nemer Dabage, Guruswamy Ramamurthy

West Florida Division Virtual Research Day 2020

• Scleroderma and systemic sclerosis are autoimmune phenomena that can cause progressive and permanent damage to the organs of the human body.
• They can cause fibrosis of various internal organs, including the kidneys, lungs, GI tract, and heart
• Rarely, the only manifestation of systemic sclerosis is severe hypertension with renal failure, a subset known as systemic sclerosis sine scleroderma.

Thinking Outside The Box In Liver Tox, Kimberly Brizell, Geoffrey L. Goldsberry

West Florida Division Virtual Research Day 2020

DILI is the most common cause of acute liver failure in the United States. However, it is important to consider that the agent at play may not be common to the United States. We aim to highlight the importance of using a "global mindset" when treating international and frequent traveling patients, but also demonstrate the severe hepatotoxic risks associated with Nimesulide.

A Rare Case Of Leprosy In West Florida, Adrian Lugo, Taylor Studsrud, Nemer Dabage, James Demaio

West Florida Division Virtual Research Day 2020

• Leprosy is caused by acid-fast bacilli of the M. leprae complex, which includes M. leprae and M. lepromatosis.
• Transmission in the U.S. is rare, but has been documented in hunters who handle wild ninebanded armadillo.
• The origins of M. leprae infection among armadillos, the geographic range of the infected animals, and the potential risks infected armadillos present to people have been topics of concern.
• The infection originated amongst armadillos decades before they were ever used in leprosy research, and numerous surveys have confirmed that armadillos in the southern United States are a large natural reservoir for M. leprae; its prevalence …

A Novel Indication For Oocyte Cryopreservation Prior To Autologous Hematopoietic Cell Transplantation For Refractory Multiple Sclerosis, Neal R. Trulock, Luke Ying, Edward Zbella, Mark Sanchez

West Florida Division Virtual Research Day 2020

Multiple sclerosis (MS) is an immune mediated inflammatory diseases of the central nervous system characterized by focal ovoid like lesions of demyelination seen on MRI(1,2). The etiology of MS is unknown, however inflammation followed by CNS demyelination and axonal degeneration are known to be part of the pathologic processes that lead to the disease (1). The mean age of onset of MS is 28-31 years old and tends to affect women more often then men with a ratio of 2.3:1 (3,4) . Other risk factors associated with MS include vitamin D deficiency, smoking, and certain viruses (5). The pattern of …

Kounis Syndrome, Charles Doerner, Mark Sawh, Tamer A. Amer, Konstantinos Marmagkiolis

West Florida Division Virtual Research Day 2020

Kounis syndrome, also known as allergic vasospastic angina, is a type of acute coronary syndrome caused by an allergic reaction or immune response to a substance.[1] It is essentially an “allergic angina” which is believed to be caused by mast cell activation and release of cytokines and histamine causing spasm of the artery leading to acute coronary syndrome and acute myocardial infarction. Stress cardiomyopathy (Takotsubo syndrome), which predominantly affects post-menopausal women, may also occur in anaphylaxis where transient ventricular dysfunction associated with regional ventricular wall abnormalities extending beyond the regions of coronary blood supply ensues.[2] The suspected prevalence of Kounis …

A Case Of Pott's Disease: Typical Presentation Of An Uncommon Disease In The United States, Neha Patel, Ravi Patel, Marek Krysztofiak, K V. Sundaresh

West Florida Division Virtual Research Day 2020

Pott’s disease (PD), also known as tuberculosis spondylitis, is a rare disease of the spine which is typically caused by extraspinal infection. The basic lesion in Pott's disease is a combination of osteomyelitis and arthritis, usually affecting more than one vertebra. The anterior aspect of the vertebral body adjacent to the subchondral plate is commonly involved. Spinal TB can include any of the following: progressive bone destruction leading to vertebral collapse and kyphosis, cold abscess formation (due to extension of infection into adjacent ligaments and soft tissues), spinal canal narrowing by abscesses, granulation tissue or direct dural invasionresulting in spinal …

Bedside Point Of Care Ultrasound Diagnosing Bilateral Valve Involvement In Infective Endocarditis, Corey Cole, Alfredo Tirado, Jonathan Schwadron

West Florida Division Virtual Research Day 2020

Endocarditis is a well known complication of intravenous drug abuse which classically affects the tricuspid valve. It is usually diagnosed by formal echocardiogram and positive blood cultures. Vegetations involving both the mitral and tricuspid valves are rare, occurring in less than 5% of all cases of infective endocarditis. 1 Here we report a case of a patient with vegetations on both valves which was discovered by point of care ultrasound.

Internal Hernia As A Late Complication Of Roux-En-Y Gastric Bypass Procedure, Samantha Purton, Gabriel Meshekow, My Myers, Edgar Mercado, Allan Katz

West Florida Division Virtual Research Day 2020

As the prevalence of obesity continues to rise, so does the popularity of bariatric surgery. Previously the Roux-en-Y gastric bypass was the most common bariatric procedure, but now falls second to the gastric sleeve. It remains a relevant procedure, however, accounting for 17% of bariatric procedures in 2018. Due to its prevalence, it is important that the radiologist be familiar with the procedure and its complications such as leak, obstruction, stricture, or, as in this case, internal herniation through a mesenteric defect. Internal hernias are more commonly associated with the laparoscopic approach versus open. This is likely due to fewer …

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, Irina Davis, Salman Muddassir, Nikolay Mitzov

West Florida Division Virtual Research Day 2020

• A case control study on stroke patients was recently completed for a quality improvement (QI) investigation.
• 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

Pasteurella Multocida Bacteremia Secondary To Multiple Cat Scratches, Charles Boadu, Andrea Hernandez, Bassem Zeidan, John T. Young, Johnathan Frunzi

West Florida Division Virtual Research Day 2020

Pasteurella multocida(P. multocida)is part of the normal gastrointestinal and upper respiratory flora of domestic and wild animals such as dogs, cats, rabbits, opossums, boars, tigers, lions and horses ^{(1, 2)}. Transmission of P. multocidais usually through scratches and bites leading to infections of the soft tissue and skin ^(3,4). P. multocida bacteremia is rare, but occurs in individuals with major risk factors including chronic pulmonary disease, diabetes mellitus, end state renal disease (ESRD), and an immunocompromised state ^(3,4). Non traumatic infections of P. multocida in immunocompromised individuals,are more likely to require care in the intensive care unit …

End The Glow!, Roli Kushwaha, Anthony Furiato, Justin Mcnamee

West Florida Division Virtual Research Day 2020

Aortic dissection (AD) is part of a group of acute aortic syndromes consisting of intramural aortic hematoma, penetrating aortic ulcer, and aortic rupture. On its own, the incidence is ~3 to 8 cases per 100,000 per year, and up to 25% of cases are missed. The in-hospital mortality when treated is 27%, and with a 2% increase in mortality/hour. Imaging modalities like CT angiography, TEE, and MRA have made improved diagnosis of the disease, but are costly, potentially harmful, time consuming, and require patient stability when in use (1). The key question we have as emergency department providers is if …

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 Virtual 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.

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

West Florida Division Virtual Research Day 2020

No abstract provided.

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

West Florida Division Virtual 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 …

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

West Florida Division Virtual 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

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

West Florida Division Virtual 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.

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

West Florida Division Virtual 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 …

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

West Florida Division Virtual 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.

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

West Florida Division Virtual 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 …

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

West Florida Division Virtual 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.

The Evil Twin: The Case Of Heterotopic Pregnancy, Rashmi Jadhav, Vegas Brown, Gabriel Cabrera

West Florida Division Virtual Research Day 2020

• Heterotopic pregnancy occurs in about 1 in 30,000 naturally conceived pregnancies (5). The risk rises 1-3% for pregnancies occurring through assisted reproductive technologies (ART) (1).
• Isolated ectopic pregnancy affects an average of 1 in every 150 live births (1).
• A known pre-existing intrauterine pregnancy (IUP) can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.
• Presentation is vague and 45% of patients have no symptoms (5).
• Differential Diagnoses: endometritis, incomplete miscarriage, ruptured ovarian cyst, non-GYN cause (ie: appendicitis or UTI).
• Risk Factors: Infertility treatment, in vitro fertilization (IVF), prior ectopic, prior tubal surgery, use of …

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

West Florida Division Virtual 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 …

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 Virtual 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.

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

West Florida Division Virtual 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.

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

West Florida Division Virtual 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 …

An Atypical Presentation Of Neuroleptic Malignant Syndrome, Rudy Forte, Shiwani Kamath, Debra Angelo, Johnathan Frunzi

West Florida Division Virtual Research Day 2020

Neuroleptic Malignant Syndrome (NMS) is a rare, but potentially life threatening condition associated with dopamine blockade, particularly first-generation antipsychotics. The complex pathophysiology of NMS remains somewhat unclear and debatable as the symptoms are not fully explained by dopamine blockade alone.¹ D2 dopamine receptor antagonism remains responsible for most cases of NMS, however a few cases have been reported in which little to no D2 blockade activity was present.¹

This poster is about an atypical presentation of NMS.

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

West Florida Division Virtual Research Day 2020

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

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

West Florida Division Virtual 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).

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

West Florida Division Virtual 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 Virtual 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. …