Medicine and Health Sciences Commons^™

Analysis Of Secondary Neurodegeneration In Spinal Cord Mri In Post-Stroke Patients, Sarvani Uppati, Sravani Mannuru, Kelsey Baker

Research Colloquium

Background: Stroke, also termed cerebral infarction, results in neurodegeneration and neuroinflammation in the brain at area of the infarct and peri-infarct regions. It has also been established that damage in the motor pathways including the corticospinal tract contribute to motor deficits in post-stroke patients. Recent research has recognized the involvement of alternate sensorimotor pathways in the spinal cord that underline disease progression and the degree of functional recovery post-stroke. Evaluating the role of alternate sensorimotor pathways in the brain can be challenging, since the pathways remained crossed until they reach the spinal cord. Although MRI has been used to examine …

A Case Of Cannabis Smoking Induced Leukocytosis, Ramiro A. Rodriguez Jr., Rukayat Akande, Nevin Varghese

Research Colloquium

Background: Leukocytosis relates to infections, malignancies, stress response, and multiple intoxicants. Like other intoxicants, cannabis smoking can result in a persistent leukocytosis. Here we report a case of cannabis-induced leukocytosis.

Case Presentation: A 20-year-old Hispanic female with a history of anxiety disorder presented with 3-days of nausea, vomiting, and colicky abdominal pain. She endorsed heavy marijuana smoking as self-medication and compulsive hot showers for symptom relief. She was admitted for oral intake intolerance, concerning for cannabis hyperemesis syndrome. Her history demonstrated multiple admission for cannabis hyperemesis syndrome during which she demonstrated a leukocytosis which improved with abstinence of marijuana. Her …

Mallory-Weiss Syndrome In The Setting Of Multiple Seizures, Pooja Maknoor, Himabindu Kolli, Nestor Gerardo Astorga, Timothy Heath

Research Colloquium

Background: Mallory-Weiss syndrome is a longitudinal mucosal laceration in the distal esophagus and proximal stomach, usually associated with forceful retching or vomiting. Here, we present a case of Mallory Weiss syndrome in the setting of multiple seizures without any retching or vomiting.

Case Presentation: A 64-year-old man with history of epilepsy on anticonvulsant medications presented to the emergency department with complaints of multiple seizures. During the initial evaluation, he was alert, in no acute distress and was answering questions appropriately. He denied any trauma, loss of consciousness, nausea, vomiting, retching, tongue biting or incontinence. On examination, blood pressure was 92/53 …

Hepatic Chylothorax, A Rare Finding In A Patient With Subacute Hepatic Hydrothorax, Oscar Rodrigo Zamudio Herrera, Shadi Jafari-Esfahani, Fatimah Bello

Research Colloquium

Background: The presence of chyle in the pleural space is termed chylothorax. Etiologies include traumatic (iatrogenic, blunt, or penetrating injury) and non-traumatic (non-malignant and malignant). Liver cirrhosis is a rare cause of non-traumatic, nonmalignant chylothorax. We describe a case of a transudative chylothorax in a patient with cirrhosis and hepatic hydrothorax.

Case presentation: A 72-year-old woman presents with complaints of shortness of breath for 7 days, altered mental status, and abdominal distention. Patient has past medical history of diabetes, hypertension, and liver cirrhosis. On arrival, vital signs demonstrated T 96.2 F°, HR 75, RR 16, BP 143/68, and SO2 97%. …

A Case Of Device Lead Induced Severe Tricuspid Regurgitation And Right-Sided Heart Failure, Nina Shyama Appareddy, Michaela Iglesia, Ayman Khaddam, Henry Kwang, Eduardo D. Flores

Research Colloquium

Background: Interference of device leads with closure of the tricuspid leaflets can cause severe tricuspid regurgitation (TR) and right-sided heart failure, as can heart failure with reduced LV function (HfrEF), and left sided valve disease.

Case Presentation: A 78-year-old male with history of coronary artery disease s/p remote coronary bypass, ischemic cardiomyopathy with left ventricular ejection fraction 35-40%, and inducible ventricular tachycardia status post defibrillator presented with worsening dyspnea on exertion, easy fatigue, lower extremity pitting edema, anasarca, abdominal bloating and new systolic murmurs at the right upper and left lower sternal borders. An Echocardiogram demonstrated severe aortic stenosis with …

A Case Of Pericardial Effusion: Aid Of Bedside Ultrasound In Clinical Decision Making, Nestor G. Astorga, Aramide M. Tijani, Nevin A. Varghese

Research Colloquium

Background: In life-threatening conditions, such as cardiac tamponade, we need to recognize signs of impending decompensation in a timely manner. Point of care ultrasound is non-invasive and is readily available, particularly in a resource limited setting. In this case, we present a patient with worsening pericardial effusion and the importance of bedside cardiac ultrasound.

Case presentation: A 76-year-old male with stage IV adenocarcinoma of the lung was admitted for worsening dysphagia for 3 days and decreased oral intake. He was normotensive but was tachycardic with muffled heart sounds. CT of the chest demonstrated a significant pericardial effusion. Bedside ultrasound to …

Pneumocystis Jirovecii Pneumonia In A Newly Diagnosed Aids Geriatric Patient, Ashley Sareen, Nathan Tanner, James Fahey

Research Colloquium

Background: Approximately 40% of new HIV infections originate from people who are unaware of their diagnosis. Median time from infection to diagnosis was 3 years in 2015. Cases of newly diagnosed HIV in the geriatric population are rare.

Case Presentation: 71 year old Hispanic man with history of diabetes and anemia presenting to the hospital with generalized weakness, presyncopal episodes, shortness of breath, loose stools, and falls for past two weeks. He is a poor historian so wife contacted to provide detailed history. Patient with 100 pound weight loss in 6 months. Intravenous drug use 30 years ago, and blood …

Creutzfeldt-Jakob Disease, A Stroke Masquerade Case: Case Report, Natalia C. Pinto, Yilen Karen Ng-Wong, Reham Majzoub

Research Colloquium

Background: The first Creutzfeldt-Jakob disease (CJD) outbreak was in 1996 in the UK, where 10 cases of a new rare neurological disease were reported. CJD continues to be an unclear neurodegenerative disease. The disease is usually higher in the retina and the brain, which in the majority of cases results in neurological symptoms, including rapidly progressing dementia, extrapyramidal signs, myoclonus, and visual symptoms with a mean age of 67. There are 3 groups of human prion disease, sporadic CJD accounts for about 85% of the cases.

Case presentation: A 66-year-old woman who presented with slurred speech and forgetfulness started in …

Variation In Functional Pelvic Tilt In Patients Undergoing Total Hip Arthroplasty With Acetabular Dysplasia, Myung-Jin Cha, Joel Wells, Yin Xi, Avneesh Chhabra

Research Colloquium

Purpose: It is important to clarify the link between acetabular dysplasia and pelvic tilt to optimize surgical planning and postoperative outcomes. We sought to investigate functional pelvic tilt in patients undergoing total hip arthroplasty with acetabular dysplasia.

Materials & Methods: From 2014 to 2020, pre-operative AP Pelvis X-rays, CT scans, and other patient-specific data such as pelvic tilt, lumbar lordotic angle, etc were collected as part of surgical planning for total hip arthroplasty. From this database, we investigated 678 female patients under the age of 50 that had undergone preoperative standing AP pelvis X-rays. Analysis was performed by investigating how …

Are You Numb Yet?, Monica Lozano Garcia, Chelsea Erazo Macias, Victoria Cuello, Kelsey Baker

Research Colloquium

Background: Recent research has suggested that after a spinal cord injury (SCI), detrimental reorganization of neural structures favors stronger muscles while inhibiting weaker muscles. Temporary deafferentation (TD) is a technique that uses short-term anesthesia, to inactivate sensation pathways from stronger muscles so that the brain releases inhibition that was placed on weaker muscles, thereby strengthening them. Here, we seek to evaluate when peak TD is achieved to define when strength-building exercises on a weaker muscle should begin.

Methods: 5% lidocaine cream was applied to the right biceps of 7 healthy volunteers. We measured sensation every 15 minutes after …

Proton-Pump Inhibitors Related Acute Interstitial Nephritis. A Case Report, Mery B. Bartl, Reham Majzoub

Research Colloquium

Background: Acute Interstitial nephritis is a common and reversible cause of Acute Kidney Injury, accounting for 15-27% of renal biopsies performed because of this condition. Its incidence has been increasing worldwide. By and large, drug-induced AIN is currently the most common etiology, with antimicrobials and nonsteroidal anti-inflammatory drugs being the most frequent offending agents. The hallmark pathologic features are interstitial edema, interstitial inflammation, and tubulitis with a predominance of CD4+ T lymphocytes and mononuclear cells, with variable numbers of eosinophils. Patients with AIN typically present with nonspecific symptoms of acute renal failure, including oliguria, malaise, anorexia, nausea, and vomiting and …

Well-Being And Resilience: A Survey Of Physician Needs During Covid-19, Delta, And Omicron, Melinda M. Wilding

Research Colloquium

Background: Physician moral distress during COVID-19, Delta, and Omicron has resulted in a decrease in self-care and a reduction in empathy for patients. Determining physician well-being and resilience assists clinicians in maintaining pliancy during times of uncertainty.

Methods: An IRB quantitative survey aims to illustrate levels of moral distress, self-care tactics, and physician fortitude during the three waves of the pandemic from 2020-2022. The questionnaire elicits responses regarding how physicians have pivoted to remain healthy during the pandemic, what measures physicians have engaged in maintaining empathy and ethics towards patients, and what physicians need in the future to retain self-care. …

A Rare Case Report Of A Testicular Germ-Cell Tumor (Gct) Metastasis Mimicking Pancreatic Malignancy, Lakshman Vigneswaran, Nolan Perez, Seema B. Jabbar, Carlos T. Ramos

Research Colloquium

Introduction: Testicular germ cell tumors (TGCT), evenly divided into two histologic types, seminomas and nonseminomas, are the most common malignancy among males between ages 15 to 44 years [1, 2]. The incidence of TGCT in the U.S. has increased over the past 20 years, being attributed to chronic exposure environmental risk factors (i.e. pesticides and plastic component polyvinyl chloride) in addition to genetic predisposition [1, 3-6].

Description: We report of an unusual case of retroperitoneal metastatic GCT clinically simulating a pancreatic lymphoma. A 31-year-old male presented with a 2-month history of abdominal pain in the right upper quadrant, 40-pound weight …

Supportive Care Team Challenges On The Border In The Pandemic, Meghana Rao, Andrew N. Dentino

Research Colloquium

Background: Hospice and Palliative Medicine (HPM) is a subspecialty of medicine, recognized in 2008 by the ABMS, with over 200 fellowship programs nationally. This Supportive Care Team (SCT) interprofessional paradigm of MD’s, NP’s, PA’s, MSW’s, Pharm.D.’s, chaplains, RN’s and therapists holistically cares for persons with advanced life-limiting illnesses.

UTRGV SOM and DHR Health, in extreme south Texas on the border with Mexico, inaugurated the HPM fellowship in 2019. Its current fellow began in 2021.

The intent of the fellowship was for care and services to flow uninterruptedly throughout the RGV. However, in early 2020 the world changed indelibly due to …

Euglycemic Diabetic Ketoacidosis In A Patient Using Sodium-Glucose Cotransporter-2 Inhibitor (Sglt 2 Inhibitor), Mays F. Abdulazeez, Alain Velazquez, Daniel Ibarias Paz, Aileen Aguilar, Baldemar Gonzalez, Heidi Pareja, Sunand Kallumadanda

Research Colloquium

Background: Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes Mellitus type-1 and occasionally type-2 diabetes, associated with high blood glucose levels>250 mg/dl. Normal glucose levels in all diabetic patients may delay diagnosis and management of DKA and result in increased morbidity and mortality.

Case Presentation: A 68-year-old male having a medical history of Diabetes Mellitus type-2, atrial fibrillation, aortic stenosis status post total valve replacement, coronary artery disease, gastric bypass surgery, and previous stroke presented with two episodes of hematemesis a few hours prior to admission. The patient denied using drugs or ingestion of methanol, ethylene glycol, and …

Rate Control Is The Key-Tachycardia Induced Cardiomyopathy, Maria Najam, Shadi Jafari-Esfahani, Nevin Varghese

Research Colloquium

Introduction: Tachycardia-induced cardiomyopathy is the systolic dysfunction that results from tachyarrhythmias. It presents symptoms of heart failure and can be reversed with rate control or normalization to sinus rhythm. The aim of presenting this case report is to the awareness of tachycardia-induced cardiomyopathy, which if recognized early can be reversed by the treatment.

Case Presentation: A 62-year-old male with a history of tobacco use presented with orthopnea, palpitations, and exertional dyspnea. A month ago, he was seen by his primary care physician for palpitations and was diagnosed with new-onset atrial fibrillation. There was a gradual progression of his exertional symptoms …

Development Of A Novel Fluorescent Nir Probe For Cancer Bioimaging, Neeraj Chauhan, Marco A. Cabrera, Silverio A. Lopez, Karen S. Martirosyan, Meena Jaggi, Subhash C. Chuahan, Murali M. Yallapu

Research Colloquium

Background: Optimal cancer bioimaging is imperative and come in various forms, ranging from screening to detection and surgical guidance. Current imaging tools being used are not cancer-specific and tend to expose patients to radiation. Therefore, there is a crucial need to develop newer and safer imaging modalities. Near InfraRed fluorescence (NIRF) agents have been gaining great attraction for cancer imaging in the past years, because of their high resolution/sensitivity, low cost, and real-time visualization/imaging capabilities without ionizing radiation. Hence, NIRF-based cancer imaging counterpoises some of the obstacles elicited by traditional imaging. Indocyanine green (ICG) is the only FDA approved NIR …

Inpatient Palliative Care Utilization In Sickle Cell Disease: Temporal Trends And Factors Associated With Usage, Lois C. Akpati

Research Colloquium

Background: Sickle cell disease (SCD) is a highly morbid condition notable for recurrent hospitalizations due to vaso-occlusive crises and complications of end-organ damage. Palliative care (PC) aims to provide holistic care to patients with serious chronic illnesses. Little is known about the use of inpatient palliative care services in adult patients with SCD.

Methods: We conducted a retrospective cross-sectional study utilizing data from the National Inpatient Sample (NIS) from 2008-2017. Patients >18 years old hospitalized with a primary or secondary ICD-9-CM and ICD-10-CM diagnosis of SCD were included. Outcome of interest was PC service utilization using ICD-9-CM and ICD-10-CM diagnosis …

Insulin In Combination With N-Acetylcysteine Protects Hypoxia-Induced Toxicity In 661w Cells, Lili M. Guerra, Laura Valdez, Benxu Cheng, Andrew Tsin

Research Colloquium

Background: Proliferative diabetic retinopathy (PDR) is the leading cause of blindness among working-age adults. Photoreceptors are the most numerous and metabolically demanding cells in the retina thus oxygen is essential for retinal function. It has been reported that photoreceptors found in rat retina are specifically vulnerable to hypoxia. Hypoxia-induced metabolic stress leads to photoreceptor atrophy and retinopathy. Furthermore, photoreceptor cell death is known to occur mainly through apoptosis. However, the protection of hypoxia-induced-cytotoxicity in cone photoreceptor cells has not been investigated extensively. The aim of this study was to determine whether co-treatment of insulin and the N-Acetyl-L-Cysteine (NAC) (a free …

Molecular Event In Hrp Apoptosis, Laura Valdez

Research Colloquium

Background: Human retinal pericytes (HRP) are contractile cells providing support for endothelial cells of capillaries, essential in the regulation of retinal vasculature. Early stages of DR are characterized by the loss of HRP, leading to angiogenesis. Our preliminary studies identified monocyte-derived macrophages secrete TGF-β1, inducing the expression and secretion of a TGFβ1-Induced, pro-apoptotic BIGH3 protein leading to apoptosis of HRP. Based on a preliminary study in renal cells (unpublished data), CTP with an RGD domain is released from BIGH3 by proteolysis leading to renal cell apoptosis. In the present study, we employed Western Blots to determine if a similar molecular …

Irbp In Diabetic Retinopathy – Cell Culture & Ophthalmic Pathology Studies, Laura Valdez

Research Colloquium

Background: Interphotoreceptor-Retinoid-Binding-Protein (IRBP) is restricted to the subretinal space by the external limiting membrane and RPE zonulae occludens. Its expression is reduced in diabetic retinopathy (DR) and increased expression is protective. Hypoxia decreases viable conelike photoreceptors (661W) but increased VEGF, suggesting a role of photoreceptors in proliferative DR (PDR) (Rodriguez et al, Arch Clin Exp. Ophthal 3:23,2021). Here, we investigated the effects of high glucose and VEGF on IRBP expression by 661W and rod-like Y79 cells and distribution of IRBP and albumin in human globes with PDR and NPDR.

Methods:  661W and Y79 cells were cultured in DMEM or RPMI …

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

Research Colloquium

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in …

Gene By Environment Interaction And Metabolic-Associated Fatty Liver Disease In Mexican American Patients With Depression, Khalid Sheikh, Vincent P. Diego, Sandra L. Laston, Eron G. Manusov, Sarah Williams-Blangero, John Blangero

Research Colloquium

Knowledge of genetic and environmental (G x E) interaction effects on metabolic-associated fatty liver disease (MAFLD) is limited. The purpose of this study was to examine the impact of G x E interaction effects on MAFLD in Mexican Americans in the Rio Grande Valley (RGV). The environment examined was depression as measured by the Beck Depression Inventory-II (BDI-II). We examined potential G x E interaction in the phenotypic expression of MAFLD, including hepatic steatosis and hepatic fibrosis, using variance component models and likelihood-based statistical inference. Significant G x E interactions were identified for hepatic fibrosis x BDI-II. These findings provide …

Rotator Cuff Injury In The Pediatric Population: A Systematic Review Of Patient Characteristics, Treatment, And Outcomes, Kevin J. Orellana, Kathleen L. Harwood, John G. Horneff 3rd, Joseph J. King, Brendan A. Williams

Research Colloquium

Background: Rotator cuff injuries (RCIs), traditionally thought to be an adult-type pathology, have been reported in the pediatric population, but there remains limited evidence regarding this injury pattern in pediatric patients. The purpose of this study was to systematically review the literature to characterize the epidemiology, injury patterns, treatment modalities, and outcomes for pediatric patients with RCIs.

Methods: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines reviewing Pubmed, Embase, Cochrane, and CINAHL databases. Studies reporting imaging confirmed RCIs and treatment outcomes in patientsdemographics, mechanism, injury type and injury location were …

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …

E-Cigarette Or Vaping Use-Associated Lung Injury (Evali) In A Hispanic Male During The Covid-19 Pandemic, Juan C. Naranjo, Muhammad Jamal, Aramide Tijani, Fatimah Bello

Research Colloquium

Background: Electronic cigarette or vaping product use–associated lung injury established the relationship between vaping products and lung injury. Overlapping clinical manifestations may mimic those of other respiratory conditions including COVID-19. Multiple radiographic findings including diffuse, bilateral, ground-glass infiltrates with lower-lobe predominance, eosinophilic pneumonia, and diffuse alveolar damage have been described. It is important to consider this as an alternative diagnosis, particularly in patients with respiratory symptoms and a history of vaping in the last 90 days due to increased risk of COVID-19 infection and worse outcomes.

Case presentation: A 25-year-old male with a history of polysubstance abuse and frequent E-cigarette …

A Simple Case Of Viral Myopericarditis Or A Complication Of Monoclonal Antibody Infusion?, Jose A. Rivera, Michael Menowsky

Research Colloquium

Background: Myocarditis has been a rare, but well-documented side effect of the mRNA-based vaccines against SARS-CoV-2 as well as a complication of viral infections including SARS-CoV-2. However, myopericarditis as a complication of monoclonal antibody infusion or as complication of allergic reaction to antibody infusions might be and underreported.

Case presentation: In this case, we report a 30-year-old man with a previous diagnosis of COVID infection 1 week prior to presentation, unvaccinated for SARS-CoV-2 who was referred from a monoclonal infusion center where he received casirivimab and imdevimab and 15 minutes after infusion began to complain of chills, chest pain, shortness …

Subacute Combined Degeneration Due To Nitrous Oxide-Induced Vitamin B-12 Deficiency, Jorge Nadal, Daniela Hernandez, Brandon Cantazaro

Research Colloquium

Background: Nitrous oxide also known as “laughing gas” is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, recreational use is on the rise.1 Here, I will present a case of subacute combined degeneration in the setting of nitrous oxide induced vitamin B-12 deficiency.

Case presentation: 23-year-old right-handed gentleman with no past medical history presented to the ED complaining of 1 week of bilateral lower extremity …

Trauma Center Designation Effects On Clinical Outcomes In Pediatric Dog Bites: A Retrospective Study, Jessy Feng, Sabrina Orta, Alejandro Aquino, Lori Berry, Demba Fofana, Paul Berry

Research Colloquium

Introduction: Clinical outcomes associated with the American College of Surgeons (ACS) trauma center designation have been examined for many conditions. However, we sought to analyze the association between ACS pediatric trauma center designation and outcomes following pediatric dog bite trauma cases, which has rarely been studied.

Methods: The National Trauma Data Bank was queried to identify pediatric (0-19y) dog bite trauma patients admitted to ACS pediatric level I or II trauma centers from 2007-2016. Chi-Squared and Odds Ratio statistical analyses were used to compare the outcomes.

Results:We identified 6,196 pediatric dog bite trauma patients treated at ACS level …

Covid-19 As A Second Hit For Anti-Phospholipid Syndrome, Himabindu Kolli, Pooja Maknoor, Celin Rajan, Nevin Varghese

Research Colloquium

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis, usually in setting of underlying autoimmune disorders. Here, we present a case of anti-phospholipid syndrome post covid infection.

Case Presentation: 41-year-old lady presented to the ER with complaints of left sided facial droop for 3-day duration. On further evaluation, she was found to have subacute ischemic stroke and was managed with anticoagulation and supportive treatment. Past medical history is significant for a recent diagnosis of Covid infection and for subsequent development of lower extremity deep vein thrombosis (DVT). She was started on anticoagulation with rivaroxaban for …