Medicine and Health Sciences Commons^™

Cms Sepsis Bundle Compliance Analysis At The Time Of Patient Admission During The Covid-19 Pandemic In A Community Hospital In South Texas, Jose Ramos, Daniel Habenicht, Carlos Ramos

Research Symposium

Background: Sepsis remains an important cause of mortality in hospitals across the globe. The Centers for Medicare and Medicaid Services (CMS) have increased efforts to lower the mortality rate in sepsis patients via the CMS quality measure. The COVID-19 pandemic changed how we conduct healthcare and key elements of sepsis management might have been compromised, affecting the CMS sepsis bundle compliance rate. Our goals were to determine whether compliance rates were affected and to further analyze the mortality rates associated with sepsis management during the COVID-19 pandemic.

Methods: A retrospective chart review was conducted to analyze the adherence to the …

Qi In Resident Leadership Workshop, Heidi Y. Pareja, Chelsea H. Chang, Daniel Aragon, Deepu George

Research Symposium

Background: Many residency programs provide some type of leadership training for chief residents. As these emerging leaders transition into their role, it is imperative to provide them with skills and knowledge to help them develop their leadership style. UTRGV’s department of Graduate Medical Education (GME) organized their first “Resident Leader Workshop” for all rising Chiefs and GME Resident Leadership Council (RLC) members. Using a pre and post survey, participants provided feedback on the effectiveness of knowledge and skills presented during the workshop.

Methods: All residency and fellowship rising Chiefs and GME RLC members were invited. The workshop took place …

Bitten To The Bone: A Case Of Anxiety-Induced Osteomyelitis, Jose A. Rivera, Daniel Aragon, Daniela Hernandez

Research Symposium

Background: Onychophagia is a habitual nail-biting disorder, usually associated with mental or emotional diseases. It affects 20–30% of the population in all age groups. Human bites have the potential to become serious injuries due to high virulence in the human oral flora and may often require hospital admission, antibiotics and even debridement in the operating room. Thus, repetitive nail biting has the potential to be limb-threatening if not treated early and appropriately.

Case Presentation: Patient is a 49-year-old gentleman with a past medical history of severe refractory anxiety treated with hydroxyzine and scheduled alprazolam, after failing multiple other treatments, …

Residential Treatment Of Substance Use Disorder And Related Comorbidities In Older Adults, Dale J. Dyben

Research Symposium

Purpose: Substance Use Disorders (SUD) are a leading contributor to health problems and premature mortality in the United States. Stigma and misconceptions about persons with SUD contribute to negative outcomes. The misconception that older adults do not suffer from severe SUD has contributed to a paucity of treatment options that meet the unique needs this population.

Description: The Center for Older Adult Recovery (COAR) at Hanley Center in West Palm Beach, Florida provides a model for residential treatment of older 65 and older with severe SUD and related medical and mental health comorbidities. Older adults who meet DSM-V diagnostic …

Quality Improvement In Healthcare: A Practical Guide For Providers, Jeremy Ellis

Transformative Medicine

No abstract provided.

The Adverse Effects Of Proton Pump Inhibitors And How To De-Escalate Therapy, Christina Swiger, Mary Hoang, Emily Wagner, Maley Zents

Transformative Medicine

This article discusses how many patients, both inpatient and outpatient, are initiated on proton pump inhibitors (PPIs) for stomach acid related symptoms, as well as for prophylaxis. These medications may inadvertently be continued long-term. Chronic use of PPIs can result in adverse events, such as vitamin deficiencies, community-acquired pneumonia, and an increased risk for Clostridium difficile infection. Clinicians should periodically evaluate the need for PPIs in patients and discontinue as appropriate.

“What Pattern Does This Ecg Show?”, Ravi Choxi, Arun Kundra

Transformative Medicine

No abstract provided.

A Medical Spanish Curriculum Model For Resident Physicians, Jessica Castro, Meghna Lama, Victor A. Cabello, Luis A. Murillo

Transformative Medicine

No abstract

Utilizing A Web-Based Program For Educational Material Distribution In An Obgyn Residency Program, Sarah Dreibelbis, Peter F. Schnatz

Transformative Medicine

Background: Online modules and assignments are commonly used for continuing education among residents. Ensuring ease of distribution and access to learning modules, assignments and simulations allows for the efficient completion of these tasks.

Objective: The purpose of this quality improvement project is to propose a new method for distribution of educational material and assignments to improve resident satisfaction and ease of completion as well as tracking completion by the program manager.

Methods: A survey was sent to the 2020-21 academic year OBGYN residents regarding the current in-hospital folder-based distribution of resources. Based on the survey feedback, a checklist was designed …

Pericardial Hematoma Following Coronary Angiography, Davin Evanson, Allegra Delman, Michael Romeo

Transformative Medicine

Introduction: Pericardial hematoma is defined as an accumulation of blood in the pericardial space, located in close proximity to the myocardium and deep to the fibrous pericardial sac, which encloses the heart.

Case Description: We present a rare case of pericardial hematoma following percutaneous coronary intervention in an individual presenting with stenotic vein graft following symptoms of a myocardial infarction. Initial computed tomography (CT) scan demonstrated hematoma in the pericardial space. This finding was managed conservatively and hematoma was deemed stable on serial CT scans.

Discussion: In this urgent situation, CT imaging proves valuable due to its speed, convenience, and …

Diagnostic Criteria Of Takotsubo Cardiomyopathy In The Clinical Setting: A Case Report, Annu R. Suresh Md, Yi-Ju Chen Md, Richa Neupane Md, Jessica Cunningham Md

Transformative Medicine

Introduction

Takotsubo cardiomyopathy (TTS) is a rare condition related to stress featuring apical hypokinesis. Current guidelines suggest that the exclusion of other causal factors like myocarditis is required to diagnose TTS. However, we propose that the existing diagnostic criteria for TTS, particularly, required exclusion of myocarditis, adds to the challenge of making this diagnosis in the clinical setting. Hereby, we present a case with basal hypokinesis that could have been attributed to a conjunction of reverse Takotsubo syndrome (rTTS) with viral or toxic myocarditis.

Case Presentation:

A 29-year-old female complained of acute persistent chest pain, palpitations, and vomiting after smoking …

A Survey Evaluating Extent Of Undergraduate Medical Education Regarding Sex-Based Differences In Pathophysiology, Ashni Nadgauda, Tej Ganti, Amanda Horowitz, Matthew Coates, Aditya Brahmbhatt, Ana Nunez, Peter Schnatz

Transformative Medicine

Introduction

A historical gap in research on sex differences in health outcomes has led to a lack of education on sex-based differences in pathophysiology. The primary objective of this research study was to survey pathophysiology professors of medical schools in the United States (US) to understand the current extent to which the impact of sex on disease is included in the pre-clinical curricula of undergraduate medical institutions in the US.

Methods

A survey tool was created via literature review to assess the extent of education on sex-based differences in pathophysiology. This survey was distributed using the Qualtrics electronic platform to …

Welcome To The Fall Issue Of Transformative Medicine, Adam Sigal

Transformative Medicine

No abstract provided.

Architectural Features Of Streetscapes And Aging In Cameron County, Texas: Preliminary Results, Cristian Maestre, Michael Minor, Rosa V. Pirela, Noe Garza, Alvaro Diaz-Badillo, Karla D. Lopez-Lorenzo, Ney Alliey-Rodriguez, Gladys E. Maestre

Research Symposium

The impact of architectural features in urban settings reveals priorities for its residents and the integration of social and natural environments. It has been estimated that 23% of global deaths to the environments in which people live. We aim to characterize the most prevalent architectural features of Cameron County, Texas streetscapes and analyze their role in health promotion and healthy aging.

The Impact Of Social Isolation On The Neural Pathways Of Dopamine Neurons In The Ventral Tegmental Area (Vta) And The Nucelus Accumbens (Nac): Implications For The Treatment Of Depression, Anxiety, And Drug Addiction., Cristian M. Botello, Sasawan Heingraj, John L. Vandeberg, Mario Gil

Research Symposium

As the literature on the Monodelphis domestica continues to grow, it is important to contribute to the knowledge base regarding neural pathways and their role in social behavior in this species. Previous studies have provided evidence that increased activity in ventral tegmental area (VTA) dopamine neurons were associated with more social activity in mice. It is also known that in traditional rodent models, the Nucleus Accumbens (NAcc) is implicated in interaction reward processes like motivation; however, more research is needed to elucidate the role of the NAcc in social behavior of the M. domestica. The present study was designed …

A Two State-Wide Population Based Analysis Of Hepatosplenic T-Cell Lymphoma In Hispanic Vs Non-Hispanic Patients In Texas And Florida, Christine E. Loftis, Rosa White, Joel Michalek, Liu Qianqian, Adolfo Diaz

Research Symposium

Introduction: Peripheral T-cell lymphomas (PTCLs) are a diverse, aggressive form of neoplasms that are rare and constitute % of all non-Hodgkin lymphoma cases (Am J Pathol, PMID:1698028). A sub-set of PTCLs is hepatosplenic T-cell Lymphoma (HSTCL) which is described as an extra-nodal T-cell lymphoma of mature gamma or delta T-cells (Am J Pathol, PMID:1698028). HSTCL is extremely rare accounting for less than 1% of all cases of NHL and because of this, epidemiological research is lacking (Blood PMID: 21300984). Hispanics (H) are one of the fastest growing races in the US but tend to have poorer …

Can Alternative Medical Methods Evoke Neuro-Functional Somatosensory Responses? A Case Study Suggesting Functional Improvement, Alhasn Otaif, Mashan E. Alshammari, Christine G. Gerin

Research Symposium

Somatosensory pathways act as the avenue in transferring information concerning the body and its interaction with the external environment to the brain. We aim to demonstrate that through studying somatosensory, motor cortical and subcortical networks, we can explain functional recovery after stimulations applied as an alternative medical treatment. Those stimulations might have evidenced neural pathways and networks important in recovery of function. Materials and methods: The de-identified medical reports of nine patients with initial presentations of cerebral trauma or stroke inducing paralysis were studied.These included the alternative treatments they received and other available materials such as videos and photographs. Patients …

Differential Cortical Monoamines Release During Exercise In Rats Chronically Implanted With Microdialysis Probes, Christine G. Gerin

Research Symposium

Physical exercise is known to positively influence mood, to reduce anxiety and to improve reaction to stress. Cerebral monoaminergic systems are thought to underly the neurochemical influence of exercise on mood and behavior. We hypothesized that beneficial effects of exercise can be shown by variations of neurotransmitters release in the cerebral cortex. We aimed at demonstrating that there is a temporal relationship between release of plasma and cerebral monoamines (A, NA, 5-HT, DA) and spontaneous running exercise in rats. Ten Spague Dawley rats (250 g) were chronically implanted (for up to 39 days) with a left common carotid cannula and …

The Effectiveness Of Temporary Deafferentation For Upper Limb Rehabilitation, Chelsea Erazo Macias, Daniel Salinas, Monica Lozano Garcia, Victoria Cuello, Kelsey Baker

Research Symposium

Background: Temporary deafferentation (TD) is an approach that has been investigated in rehabilitation practices to improve motor function in people with spinal cord injuries. The overall goal of temporary deafferentation is to voluntarily reduce sensory input into the nervous system to improve efferent output. Temporary deafferentation is typically achieved using either topical or injectable anesthetics. Recently, our group sought to optimize a protocol for temporary deafferentation using topical anesthetic cream, and results suggested that temporary deafferentation was achieved 50 minutes after anesthetic cream application. Here, we aimed to determine if our optimized protocol impacted limb electromyography (EMG) after the intervention. …

Medical Treatment Options For Cannabis Use Disorder: An Updated Narrative Review, Chase M. Watson, Ihsan Salloum

Research Symposium

Background: Cannabis use disorder (CUD) is a common and growing condition in the United States and across the world. With the alteration of the legal landscape of the substance, normalization of the substance use in society, and a continual increase in frequency in recent years, more treatment options are desperately needed. CUD has been shown to be associated with various symptoms of mental illness. Most therapies to date have been psychotherapeutic in nature, involving theories such as cognitive-behavioral motivational-based methods. However, these are not always the most effective or accessible options for patients.

Methods: Articles for this review were obtained …

Postoperative Delirium After Hip Arthroplasty In The Elderly, Sung Kwan Hwang, Changho Yi

Research Symposium

Purpose: Our study was done to evaluate the influence of postoperative delirium on the prognosis of hip arthroplasty, and risk factors for postoperative delirium in individuals older than 65.

Materials and Methods: Among patients who received hip arthroplasty in our hospital (WCH) between March 2004and March 2008, we chose 193 patients for our study after excluding patients who had preoperative delirium and who had a history of dementia and cognitive dysfunction. We divided our cohort of 193 patients into two groups, 131patients with postoperative delirium and 62 patients without delirium. We checked for clinical results for hip arthroplasty. We checked …

Disseminated Infection With Bartonella Henselae In A Drug-Induced Immunosuppressed Adult Causing Fever, Thrombocytopenia, And Encephalitis: Case Report, Celin Rajan, Ileana Mendez, Jacinto Kadour, Mohammed Jamal, Maria Najam

Research Symposium

Cat scratch disease (CSD) is caused by the bacterium Bartonella henselae, typically characterized by self-limiting regional lymphadenopathy. CSD is more prevalent in immunocompromised individuals. However, serious illness is infrequent. This case report demonstrates uncommon symptoms of disseminated Bartonella henselae infection manifesting as encephalopathy, thrombocytopenia, and septic shock.

A 62-year-old malnourished, Hispanic man presented with fever and malaise for 1 week which was associated with headache. Past medical history was significant for rheumatoid arthritis treated with prolonged, unmonitored prednisone, chronic obstructive pulmonary disease, and a history of 18 cats at home. On examination, the patient was alert and oriented, febrile, and …

Prevalence Comparison Of Accompanying Lesions Between Primary And Recurrent Anteriordislocation In The Shoulder, Doo-Sup Kim, Changho Yi, Yeo-Seung Yoon

Research Symposium

Background: Many authors have reported the presence of intra-articular lesions after primary dislocation of the shoulder joint. However, few studies have focused on their prevalence or the differences in accompanying lesions between primary and recurrent dislocations of the shoulder joint.

Purpose: This study was undertaken to investigate and analyze accompanying lesions, including types of anteroinferior labrum injuries, using diagnostic arthroscopy and magnetic resonance arthrography (MRA) in 144 patients with traumatic anterior dislocation of the shoulder joint.Study Design: Cohort study; Level of evidence, 3.

Methods: There were 33 patients with 33 dislocations in the primary dislocation group and 111 patients with …

Comparison Of The Clinical Outcomes Of Open Surgery Versus Arthroscopic Surgery For Chronic Refractory Lateral Epicondylitis Of The Elbow, Doo Sup Kim, Hoe Jeong Chung, Chang-Ho Yi, Seong-Hyeon Kim

Research Symposium

Numerous surgical options have been introduced for the treatment of chronic refractory lateral epicondylitis of the elbow, but it remains unclear which option is superior. The clinical outcomes of an open surgery group and an arthroscopic surgery group were evaluated, and the results of the 2 procedures were compared. From among patients with lateral epicondylitis refractory to 6 months of conservative treatment, 68 patients satisfying study criteria were recruited. Open surgery was performed in 34 cases (group 1), and arthroscopic surgery was performed in 34 cases (group 2). Compared with preoperatively, the 2 groups had significantly improved values for grip …

Familial Chylomicronemia Syndrome: A Family Case Report In U.S./Mexico Border By Cediamet, Carlos E. Maldonado, Carlo Hector, Mariana Mendez, Claudia Munguia-Cisneros, Leonel Vela, Juan Carlos Lopez Alvarenga

Research Symposium

Primary familiar hyperchylomicronemia syndrome (FHS) is an extremely rare autosomal recessive condition. In 80% of cases is a result of a mutation in lipoprotein lipase, meanwhile, the 20% is a malfunctioning enzyme due to APOC2, APOA5, LMF1, or GP1HBP1. It is estimated FHS affects 3000 to 5000 individuals globally, with no correlation by sex or race. We are presenting a family with FHS in Reynosa, Mexico.

The index patient was a male 36 years old who attended the CEDIAMET clinic after his 6th episode of acute pancreatitis. He has triglycerides 1300 mg/dl and CT scan with Balthazar C score. He …

Hepatic Encephalopathy Complicated By Decompensated Alcoholic Liver Cirrhosis In A Hispanic Male, Baron S. Ekeledo, Semenawit Burka, Shreel Patel, Joseph Pean

Research Symposium

Introduction: Alcohol can directly affect the brain via neuroinflammation or alter the gut microbiome which concomitantly results in hepatic encephalopathy. Hepatic encephalopathy can cause altered mental status from liver dysfunction with or without portal-systemic blood shunting. Chronic alcohol use has been associated with dementia, cirrhosis, and hepatic encephalopathy. This case report highlights the prognosis of hepatic encephalopathy in the setting of decompensated liver cirrhosis complicated by acute alcohol intoxication.

Case report: A 35-year-old Hispanic man with history of alcohol use disorder, decompensated alcoholic liver cirrhosis with ascites, severe anemia secondary to upper GI bleeding with underlying esophageal varices who was …

Quality Assessment Of The Utrgv-Dhr Fmrp Wellness Committee, Cameron Paul Lancarte, Deepu George

Research Symposium

Purpose: The purpose of the University of Texas Rio Grande Valley (UTRGV)-Doctors Hospital at Renaissance (DHR) Family Medicine Residency Program’s (FMRP) Wellness Committee (WC) was aimed at improving resident wellbeing as measured by the annual ACGME well-being survey. In 2021, residents reported higher rates of illbeing in the annual wellness survey, potentially influenced by the COVID-19 pandemic. Specifically, Resident responses to the following items fell below the national average: fostering a supportive environment by the program, feeling emotionally drained, and needing more recovery time. The WC hypothesized that the following elements are critical in improving resident wellbeing: a definitive wellness …

Duolingo To Improve Linguistics Of The Medical Resident, Cameron Paul Lancarte, James Fahey

Research Symposium

Purpose: Create an attainable Spanish language education program within a medical residency program to increase the quality, efficiency, and equality of healthcare received by patients.

Description: Free DuoLingo language education application was chosen for the program due to being easily accessible, offering the ability to break down lessons into small timeframes, being user-friendly, and game format design. User’s learning goals can be tracked on this application.

The duration of the QI Project was 4 months, and the population size was 3 residents. Each were requested to complete 10 minutes per day or 70 min per week (on average) for Spanish …

Tale Of Traveling In A Stealth Mode, Blesset Alexander, Priyasha Suri, Don Rajan, Praveen Vijhani

Research Symposium

Background: Melanoma is an aggressive malignancy that tends to form metastases in the brain. The nature of metastatic melanoma with unknown primary is poorly understood and has only theoretical assumptions. Less than 10% of melanoma cases present with an unknown primary tumor location.

Case presentation: A 68-year-old Caucasian male patient, Canadian citizen, presented to the hospital with left-sided weakness and deviation of right side of angle of mouth for three days. Pertinent positive physical signs were motor weakness of left upper and lower extremities. Labs were unremarkable. CT-scan of the brain showed right temporal lobe lobulated masses associated with vasogenic …

Takotsubo Cardiomyopathy, Presentation As A Cardiac Arrest In A 67 Year Old Female With Depression And Anxiety History, Blesset Alexander, Joseph Caporusso, Priyasha Suri, Brandon Cantazaro

Research Symposium

Background: Takotsubo cardiomyopathy also known as broken heart syndrome or stress induced cardiomyopathy is a sudden transient reversible dramatic left ventricular apical akinesis mimicking acute coronary syndrome, making it a diagnostic challenge. Most common mechanism for Taktosubo is stress induced catecholamine release causing sympathetic activation leading to microvascular dysfunction or direct toxicity. Mayo Clinic Criteria for making diagnosis at the time of presentation requires 1) transient hypokinesis, dyskinesis, or akinesis of the LV midsegments with or without apical involvement, and a stressful trigger is often but not always present. 2) absence of obstructive coronary disease or angiographic evidence of acute …