Medical Specialties Commons^™

A Case Series Of Unusual Iga Vasculitis, Jared Bradley, Ian Whitaker, Brittany Lyons, Amy Mangla

HCA Healthcare Journal of Medicine

Introduction

Immunoglobulin A vasculitis (IgA)is a rare condition characterized by palpable purpura, often involving the skin, gastrointestinal tract, joints, and kidneys. Presentation is usually acute and is more common in children and adolescents of Southeast Asian and European descent. In the adult population, it is less common and therapies are not as well-established.

Case Presentation

Disease prevalence of IgA vasculitis outside Southeast Asian and European populations is not well-documented. In this case series, we present 2 cases of IgA vasculitis in 2 older adult males, one of Native American descent and one of African American descent.

Conclusion

IgA vasculitis must …

Acute Bilateral Pyelonephritis In The Setting Of Newly Diagnosed Diabetes Mellitus: A Case Report, Jessenia Ariana Contreras, Satwinder Singh, Ramesh Alwarappan

HCA Healthcare Journal of Medicine

Introduction

Acute pyelonephritis is a bacterial infection that starts in the bladder and ascends to the kidneys, causing inflammation of the renal parenchyma. Women are more likely to get infected compared to men, with diabetics being at higher risk. The pathophysiology of how diabetics are more prone to getting urinary tract infections/pyelonephritis has been studied, particularly the difference between bilateral pyelonephritis and unilateral pyelonephritis.

Case Presentation

This case presentation follows a 51-year-old Spanish-speaking woman with a past medical history of prediabetes, bilateral tubal ligation, and perimenopause. She presented to the hospital for abdominal and back pain, fevers, and weakness that …

Mpox-Induced Proctitis, Saif Ghias, Niyati Joshi, Dzenana Cabaravdic, Ramesh Nathan, Jasprit Takher

HCA Healthcare Journal of Medicine

Introduction

Mpox, formerly known as monkeypox, is a zoonotic virus in the genus Orthopoxvirus, which has a variable incubation period and an extensive array of symptoms. While those infected with Mpox have displayed generalized viral prodromal symptoms, atypical symptoms such as proctitis have also been seen. Proctitis associated with Mpox is a relatively infrequent initial presenting symptom with a reported incidence of 14-32.9% that has seen an uptick in prevalence since the 2022 global endemic.

Case Presentation

We present a confirmed case of Mpox in a 27-year-old male who presented with 3 days of intermittent anorectal bleeding and various forms …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Chronic Atopic Dermatitis, Cecilia Nguyen, Jordan Thompson, Daniel A. Nguyen, Christopher M. Wong, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Atopic dermatitis is a chronic inflammatory skin disorder classically affecting flexural areas of the body. It is present in children and adults, including those with darker skin pigmentation. Chronic lesions are hyperpigmented plaques that are dry, cracked, and/or scaly often with lichenification. Differential diagnoses include psoriasis, seborrheic dermatitis, ichthyosis, and pityriasis rosea. This article will showcase clinical images with varying presentations of chronic atopic dermatitis in a range of age groups and skin colors according to the Fitzpatrick scale.

Percutaneous Endoscopic Gastrostomy: A Possible Trigger For Dieulafoy's Lesion, Ali Tariq Alvi, Elsa Tchouambou, Murali Shankar

HCA Healthcare Journal of Medicine

Introduction

Upper gastrointestinal (GI) bleeding is a medical condition commonly seen in clinical practice due to variable etiologies and a multitude of presentations. The patients can present with hematemesis, melena, or hematochezia in case of severe bleeding. The initial evaluation should involve assessing the hemodynamic status with adequate resuscitation followed by diagnostic tests to identify the source and potentially treat it. Dieulafoy's lesion, sometimes referred to as Dieulafoy's disease, is a rare cause of upper GI bleeding with no clear risk factors, which makes it a diagnostic conundrum. Here we describe an unusual case of Dieulafoy's lesion developing following percutaneous …

Characteristics And Hospital Outcomes Of 1403 Patients Hospitalized At Community Hospitals With Ankylosing Spondylitis, Se Won Lee, Carol Elsakr, Jonathan Holt, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

In this study, we aimed to assess the hospital course, outcomes after hospitalization, and predictors of outcomes in patients with ankylosing spondylitis (AS).

Methods

We included 1403 patients with AS between 2016 and 2021 who were identified using International Classification of Disease (ICD) codes from a large for-profit healthcare system database. Demographics and clinical characteristics were compared between those who had a favorable outcome, defined as being discharged to home without readmission within 3 months of discharge, versus those who had an unfavorable outcome. A stepwise logistic regression was used to identify demographic and clinical characteristics associated with home …

Subacute Defibrillator Lead Associated Right Ventricular Perforation In A Young Individual With Non-Ischemic Cardiomyopathy: A Unique Clinical Case, Jackson V. Littlejohn, Aditya Sharma, Marisha R. Sharma, Kamran Rizvi

North Texas GME Research Forum 2024

Pacemaker-lead associated complications are often documented in elderly populations with ischemic heart disease. Acute perforations within 24 hours of implantation are the most common, and immediate life-threatening complications are most likely to occur during an acute perforation. Subacute perforations between 1 day and 30 days after implantation are less common and carry a lower risk of life-threatening complications. Here, we present a unique case of subacute right ventricular perforation in a young individual with non-ischemic cardiomyopathy, challenging the conventional understanding of such an occurrence. Further adding to the intrigue of our case, the patient had recurrent hospital visits both before …

Discharge Implementation Project: Ascertaining If Discharge Implementation Orders Overall Improves Discharge Metrics At A Texas Hospital, Zachary Paras, Omar Nawab, Komthorn Cunvong, Jackson V. Littlejohn

North Texas GME Research Forum 2024

There are several factors preventing discharges out of the hospital within 24 hours that ultimately affects metrics for both hospital systems and physicians. These factors include pending labs, imaging, or procedures; pending placement approval at a facility outside of the hospital upon discharge; notification of family and caretakers; secured funding for devices and medicines; and others. In an attempt to mitigate preventable extra days spent in the hospital once a patient is medically ready for discharge, a Texas hospital implemented a discharge order set for providers to utilize that informs all involved parties including case management, PT/OT, social work, nurses, …

A Challenging Diagnosis Of Intestinal Tuberculosis Mimicking Crohn's Disease, Justin Sanchez, Gabriel Gonzales, Monte Troutman

North Texas GME Research Forum 2024

Intestinal tuberculosis (ITB) is an underrecognized disease that shares many clinical, radiologic, endoscopic, and pathologic features with Crohn's disease, making differentiation difficult. This poses a significant problem as initiation of immunosuppressives for an assumed diagnosis of CD in a patient with ITB can lead to exacerbation of infection and life-threatening consequences. A 30-year-old Nepali man with a medical history only significant for Raynaud disease presented with a febrile illness, right lower quadrant abdominal pain, and productive cough over the course of a month. He immigrated from Nepal 3 years prior to presentation, denying other risk factors or specific symptoms of …

Myelodysplastic Syndrome With An Unusual De-Novo Gata1 Mutation In An Elderly Caucasian Male: A Case Report, Minh-Triet Nguyen, Maryam Fallahi, Talha Riaz

North Texas GME Research Forum 2024

Myelodysplastic syndrome (MDS) is a disorder of blood cell proliferation that has been shown to have multiple risk factors for pathogenesis. One risk factor well documented in existing literature is a mutation in GATA-binding factor 1 (GATA1) which is classically seen in younger individuals with Down syndrome. However, in our case report, we present an unusual presentation of MDS with a de novo GATA1 mutation in a 75-year-old male with no history of Down syndrome, who initially presented with isolaterombocytopenia. A 75-year-old male presented for evaluation of unexplained asymptomatic thrombocytopenia found incidentally on outpatient laboratory evaluation. Further evaluation of the …

Comparing Large Language Models Accuracy In Following Interval Surveillance Colonoscopy Guidelines, Olufemi Osikoya, Gregory Brennan

North Texas GME Research Forum 2024

Introduction: Providing pathology results and appropriate recommendations after resection of colon polyps is mandatory. Large language models (LLMs) such as ChatGPT and Google Bard, have shown promise in clinical workflows such as pathology results letters. We tested whether LLMs could provide appropriate surveillance recommendations based on current guidelines from the US multi-society task force for post-colonoscopy follow-up. Methods: Our aim was to compare the accuracy of ChatGPT 3.5, ChatGPT 4, and Google Bard in providing appropriate interval surveillance recommendations. An example prompt being “Write a patient pathology result letter after a colonoscopy with one tubular adenoma polyp (< 10mm) resected. Include recommendations for when the next surveillance colonoscopy should be completed.” Seventeen different post polypectomy surveillance queries and responses were analyzed (correct, partially correct, incorrect) compared to USMSTF guidelines. Results: When …

Mast Cell Colitis Associated With Yersinia Enterocolitica, Olufemi Osikoya, Gregory Brennan

North Texas GME Research Forum 2024

Introduction: Mast cells (MCs) have many functions including regulation of GI epithelial homeostasis, cross talk of the brain gut axis, host immune defenses, and inflammatory pathways. MCs are found in all layers of the GI tract and have been implicated in various gastrointestinal diseases. Although previously described in the literature, mast cell colitis is not considered a distinct clinical entity. This poses a challenge to the gastroenterologist who encounters such pathologic findings. Case Presentation: This is a case of a 76-year-old woman who was referred to the gastroenterology clinic for evaluation of a new diagnosis of colitis. The patient …

The Role Of Ercp In Post Covid-19 Cholangiopathy: A Systemic Review Of Published Case Reports, Olufemi Osikoya, Gregory Brennan

North Texas GME Research Forum 2024

Introduction: Post COVID-19 cholangiopathy (CC) is a rare complication of COVID-19 infection. It is characterized by abnormal elevation of serum alkaline phosphatase, with evidence of bile duct injury (via imaging or biopsy) in the absence of other causes. Not much is known regarding the role of ERCP in post COVID-19 cholangiopathy. We sought to better understand the findings, interventions and outcomes in patients with CC undergoing ERCP. Methods: We searched Pubmed, Scopus and Embase from December 2019 to present. Search words included "post-Covid-19 cholangiopathy," and “ERCP.” Data on patient characteristics, COVID-19 infection, imaging, ERCP fluoroscopic findings, ERCP interventions, …

Mcs Assisted High Risk Multi-Vessel Percutaneous Intervention In Cardiogenic Shock Patient With Lv Thrombus, Amanpreet Kaur, Akhil Gade, Srinivasan Rajaganapathy, Ruben Abreu, Victor Delprincipe

North Texas GME Research Forum 2024

Background: Acute coronary syndrome patients presenting with Cardiogenic shock carry a very high mortality risk >70% without appropriate intervention in a timely fashion. Here we present a patient requiring an axial pump mechanical circulatory support despite having an apical thrombus. Case report: 55-year-old male with past medical history of type 2 diabetes mellitus and medication noncompliance was transferred from outside facility for high risk ACS with EKG showing ST segment elevation in inferior and anterolateral leads. Lab showed hsTroponin more than 125K, BG 556, HCO3 17, and Beta hydroxybutyrate of 41.87 indicating DKA. Emergent coronary angiography showed mid LAD artery …

Gut Fermentation Syndrome: Unraveling The Enigma Of Auto-Brewery Syndrome., Jatin Sadarangani, Vaishnavi Singh, Sathish Karmegam

North Texas GME Research Forum 2024

A disorder known as "auto-brewery syndrome" or "gut fermentation syndrome" occurs when bacteria or fungus in the urinary, oral, or gastrointestinal tract ferment endogenously, producing ethanol. Patients with auto-brewery syndrome frequently report eating a diet heavy in sugar and carbohydrates and exhibit many of the symptoms and indicators of alcohol intoxication while disputing alcohol consumption. Research on Nonalcoholic Fatty Liver Disease indicates that endogenous alcohol synthesis may have bacterial roots; these bacteria may also be the causative agents in GFS. Probiotics, low-carb diets, anti-fungal medications, and antibiotics are currently used as therapies for GFS. Fecal microbiota transplantation may also have …

A Bullous Eruption In An 81-Year-Old Male, Garrett S. Furth, Christian J. Scheufele, Carlos S. Bahrami, Stephen E. Weis

North Texas GME Research Forum 2024

INTRODUCTION: When a patient presents with a blistering rash arriving at the diagnosis can seem overwhelming. Bullous Pemphigoid (BP) is the most common autoimmune blistering disease and tends to affect older individuals, with a mean age of presentation of eighty. It is caused by antibodies targeting the basement membrane zone, the structure between epidermis and dermis, specifically affecting the BP180 (Type-XVII collagen) and BP230 (a plakin) proteins. Antibody-antigen complexes lead to complement activation and destruction of these transmembrane proteins, causing separation of the epidermis and dermis, and formation of tense, subepidermal blisters and bullae. Identification of key clinical features and …

Ulcerating Plaques Of The Lower Extremities Of A 23-Year-Old Female, Robyn O. Okereke, Christian J. Scheufele, Michael Carletti, Stephen E. Weis

North Texas GME Research Forum 2024

INTRODUCTION: What should come to mind when any physician sees dark red spots on the legs? If you answered vasculitis, then you are on the right track. Leukocytoclastic vasculitis (LCV) is defined as small vessel inflammation of the dermal capillaries and venules. The clinical hallmark finding of LCV is palpable purpura (raised, round, purple plaques) on the lower extremities. LCV is confirmed by histopathology showing neutrophilic infiltration in the walls of dermal vasculature. Though LCV is the most common cause of clinical vasculitis, the annual incidence of biopsy-proven LCV is approximately 30-45 per million individuals. LCV typically occurs in adults …

The Impact Of Tamsulosin And Duration In Catheter-Associated Uti (Cauti) At Weatherford, Feeza Hasan, Diana Steedley, Maria Guerrero, Muhammad Siddique

North Texas GME Research Forum 2024

Among Catheter-Associated Urinary Tract Infections (CAUTI) acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. UTIs are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). The most important risk factor for developing a CAUTI is prolonged use of the urinary catheter. Therefore, catheters …

Navigating Social Media In Healthcare: Implications, Challenges, And Guidelines For Physicians, Charles F. Clinton, Logan Brown, Bhuvaneshwari Muchandi, José Ignacio González Martínez

South Atlantic Division GME Research Day 2024

No abstract provided.

Cured By Time? Exploring The Complexity Of Diagnosing Acute Encephalopathy, Charles F. Clinton, Avery Stokes, Chandler Boyett, Bhuvaneshwari Muchandi

South Atlantic Division GME Research Day 2024

No abstract provided.

Stop That Bloody Cough: A Case Of Hemoptysis After Intrapleural Tpa Administration, Khizir Qureshi, Mark Cheneler, Carlos Bahrami

North Texas GME Research Forum 2024

Introduction: Congestive heart failure is a morbid condition with a myriad of pathologic sequelae. Recurrent accumulations of fluid in the pleural space serve as a nidus for infection. The combination of CHF-induced pleural effusions and concomitant pneumonia are a recipe for disaster as bacteria can translocate to form parapneumonic effusions with empyemas as potential complications. Empyemas are one of many etiologies of exudative pleural effusions and are treated with complete drainage of the infected pleural fluid; however, loculations create a barrier for thoracostomy drainage. Since the MIST2 trial in 2011, intrapleural alteplase and dornase alfa have been utilized as …

Stop Horsing Around: A Case Of Cenbuterol Toxicity, Justin Sanchez, Mark Cheneler, Alexandra Villacres

North Texas GME Research Forum 2024

Introduction: Clenbuterol is a medication that is relatively unknown outside of the equestrian and bodybuilding worlds. It acts as a sympathomimetic compound with beta-2 agonism and can cause tachycardia and bronchodilation. It is utilized for this bronchodilation as a means of improving equestrian performance. Its sympathomimetic effects were utilized in the bodybuilding community as a weight loss medication by increasing catabolic metabolism. Here we present a case of intentional clenbuterol toxicity for weight loss. Case presentation: A 34-year-old woman with past medical history of migraines presented to the emergency department for evaluation of palpitations and an EKG showed sinus …

Improving The Screening For Abdominal Aortic Aneurysm At Grand Prairie Internal Medicine Clinic ​, Riddhi H. Patel, Danielle Ford

North Texas GME Research Forum 2024

Introduction: An abdominal aortic aneurysm (AAA) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger. The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries. The current prevalence of AAA in the United States is unclear because of the low uptake of screening. This QI project will involve MCA residents and Grand Prairie clinic attending to incorporate screening for abdominal aortic aneurysm guidelines used by USPSTF and attempt to encourage all our established and new patients who fit into the criteria for …

Esophageal Foreign Body: A Case Of The Hidden Wire Brush, Rebecca Ashton Taylor, Sandra Scott, William Jones, Jonnalagadda Veeraen

South Atlantic Division GME Research Day 2024

No abstract provided.

A Common Complaint With An Unexpected Diagnosis: A Case Of Mycobacterium Avium Complex Pulmonary Abscesses, Maryam Fallahi, Mark Cheneler, Qazi Haider, Madhukanth Reddy

North Texas GME Research Forum 2024

Introduction: Mycobacterial infections are an atypical organism for pulmonary infections. These infections are classically separated in tuberculous (MTB) and nontuberculous (NTM) groups due to their differing pathogenicity and microbiologic therapy regimens. MTB is typically treated with a 4-drug therapy known as RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) however NTM is typically treated with 3- or 4-drug therapy with a backbone of rifampin, macrolide, and ethambutol. Due to the long courses of therapy required for NTM, stringent diagnostic criteria of clinical, radiologic, and microbiologic findings are required. Despite meeting all 3 criteria for diagnosis, not every patient is a candidate for …

A Rare Case Of Invasive Adenocarcinoma Of The Duodenum And A Bovel Biliary Stent: A Case Report, Sabastiana Sanz, Nasima Mehraban, Bradley Gustafson, Amjad Awan

North Texas GME Research Forum 2024

Adenocarcinoma of the duodenum is a rare but aggressive malignancy making up less than 0.5% of gastrointestinal cancer cases (Tuan et al., 2023), (Cloyd, 2016). We present a rare case of invasive adenocarcinoma of the first part of the duodenum and major papilla that required complex biliary stenting. A 72-year-old male was admitted to our hospital for further workup of gastrointestinal bleeding and 30-pound weight loss. Through imaging it was noted he had lymphadenopathy and biliary dilation. Patient underwent multiple gastrointestinal procedures and was endoscopically found to have a circumferential mass within the ampulla. After unsuccessful cannulation during endoscopic retrograde …

Cyanide Toxicity Induced By Apricot Kernel Consumption: A Case Report, Jatin Sadarangani, Vaishnavi Singh, Benjamin K. Kingsly

North Texas GME Research Forum 2024

Functional foods are food items that should be consumed as part of a regular diet in order to provide advantages beyond what are typically referred to as traditional nutritional benefits. Furthermore, in order to support the better function claim or the decreased illness risk claim, these positive outcomes must be scientifically proven. Foods with particular health benefits have been referred to as "superfoods" more recently. Superfoods are conceptually defined as foods with high biological value because of their high concentration of bioactive components and high concentration of nutrients, as well as their high bioavailability and bioactivity in the body. As …

Thymoma With Paraneoplastic Myasthenia Gravis, Dallin Beus, Sherwin Thomas, Amnah Andrabi

North Texas GME Research Forum 2024

Background: Myasthenia gravis is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue. Paraneoplastic myasthenia gravis, a rare manifestation of this condition, is often associated with underlying malignancies, such as thymic tumors. We present the case of a 51-year-old female patient with a mediastinal mass who developed paraneoplastic myasthenia gravis, highlighting the diagnostic challenges and therapeutic considerations in such cases. Case Description: A 51-year-old female presented with a one-month history of progressive muscle weakness, diplopia, and dysphagia. Clinical examination and serological tests led to the diagnosis of myasthenia gravis. Computed tomography (CT) imaging revealed a 6 cm mediastinal mass, …

Streptococcocal Induced Toxic Shock Syndrome: Importance Of Diagnosis And Initiating Life Saving Treatment, Lincy Sakwa, Danielle Ford

North Texas GME Research Forum 2024

Toxic Shock Syndrome (TSS) is a toxin induced illness characterized by fever, rash, and hypotension. TSS low incidence report and rapid onset of clinical symptoms makes getting to the diagnosis critical so that treatment can be started as soon as possible. A 65-year-old woman was brought into the emergency department (ED) after being found on the floor unresponsive during a well fair check. It was noted that she has not been seen or heard from by her family members in the last five days. She has no known past medical history and she was unresponsive and hemodynamically unstable in the …

Early Implementation Of Chf Orders And Physician Education​, Qazi Haider, Tapannita Padhi, Hunter Thornberg, Barry Brown, Alexandra Villacres

North Texas GME Research Forum 2024

Each year, 700,000 patients are hospitalized with acute decompensated congestive heart failure. In order to effectively treat these patients, they require delicate management of volume status. Measuring volume status incorporates the following components: recording strict inputs and outputs of urine/fluids, recording daily standing weights and fluid restriction. This project focused on recording daily weights as a measure of accurate volume status and how that affected length of hospital stay. Data will be gathered by patient chart review including patient's admitted from Jan 2023 -Jan 2024 at Medical City Weatherford admitted with a primary/admitting diagnosis of congestive heart failure. Using PDSA …