Medical Specialties Commons^™

Cardiospecific Overexpression Of Atpgd1 (Carnosine Synthase) Increases Histidine Dipeptide Levels And Prevents Myocardial Ischemia Reperfusion Injury, Jingjing Zhao, Daniel J. Conklin, Yiru Guo, Xiang Zhang, Detlef Obal, Luping Guo, Ganapathy Jagatheesan, Kartik Katragadda, Liqing He, Jasmit Shah

Internal Medicine, East Africa

Background: Myocardial ischemia reperfusion (I/R) injury is associated with complex pathophysiological changes characterized by pH imbalance, the accumulation of lipid peroxidation products acrolein and 4-hydroxy trans-2-nonenal, and the depletion of ATP levels. Cardioprotective interventions, designed to address individual mediators of I/R injury, have shown limited efficacy. The recently identified enzyme ATPGD1 (Carnosine Synthase), which synthesizes histidyl dipeptides such as carnosine, has the potential to counteract multiple effectors of I/R injury by buffering intracellular pH and quenching lipid peroxidation products and may protect against I/R injury.

Methods and Results: We report here that β-alanine and carnosine feeding enhanced myocardial …

Diagnostic Accuracy Of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review And Meta-Analysis., Waqas Ullah, Sohaib Roomi, Hafez M. Abdullah, Maryam Mukhtar, Zain Ali, Ping Ye, Donald C. Haas, Vincent M. Figueredo

Abington Jefferson Health Papers

Background: Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR.

Methods: Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (RevMan) 5.3 and Stata software.

Results: A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR …

Outcomes Of Patients Hospitalized With Community-Acquired Pneumonia With Liver Disease Or Cirrhosis., Bibodh Jung Karki, Sravan K. Ponnekanti, Vidyulata Salunkhe, Nishita Tripathi, Mahder A. Tella, Stephen P. Furmanek, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Introduction: Liver disease and cirrhosis are common causes of mortality worldwide. Community-acquired pneumonia is recognized as a significant cause of morbidity and mortality in this population of adults. There is a lack of data regarding outcomes or prognosis in patients with liver dysfunction who develop CAP. The objective of this study was to evaluate the clinical characteristics, incidence, and outcomes of hospitalized patients with CAP and liver disease.

Methods: This was a secondary analysis of the University of Louisville Pneumonia Study, which was a prospective population-based cohort study of adults hospitalized with community-acquired pneumonia. All patients were divided into three …

Improving Outpatient Pneumococcal Vaccination Rates In Patients Age <65, Evan Nardone, Md, Mark Mallozzi, Md, Alvin George, Md, Christine Kurian, Md, Omar Safdar, Md, Timothy Kuchera, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• To increase pneumococcal vaccination rates for patients 19-64 at JHAP to reach 70% over 3 months.
• To increase resident knowledge of indications for pneumococcal vaccination in patients 19-64 by 25% over 3 months

Jefferson Internal Medicine Associates (Jima) Patient Triage Initiative, Mary White, Alexandra Leto, Barry Ziring, Md

Health Equity and Quality Improvement (HEQI) Summit

HOW MIGHT WE:

1. Contact patients to triage them for in-person versus virtual visits and teach them to use telehealth quickly?
2. How might we screen patients who are coming to the office for COVID-19 symptoms and exposures?

#Team-Based Approach To Sedation Management In Patients With Sars Cov-2 Aka Covid-19 In The Medical Icu, Hadiatou Barry, Md, Mph, Franklin Thelmo, Do, Atsoufi Amewuame-Kpehor, Md

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19 pandemic has led to a proliferation of patients developing ARDS and requiring prolonged supportive care on mechanical ventilation. As a result, patients need elevated levels of sedation, often on multiple agents for a period greater than typically seen in an ICU population. As a result of this high sedation phenomenon, patients are developing higher rates of expected complications including severe constipation, neurocognitive delay, ICU myopathy, poor sedation weaning, and high pain control requirements. These complications lead to an increased rate of mortality in a population that is already very high and decreases the rate of successful extubation and …

Changing Internal Medicine Residents’ Perspective On Social Determinants Of Health, Daniel Tran, Do, Hiba Ansari, Do, Layla Barrera, Do, Magdala Chery, Do

Health Equity and Quality Improvement (HEQI) Summit

Background: Social determinants of health (SDOH) shape the conditions of a person’s daily life and include factors such as housing, occupation, education, safety and income. While physicians are aware of the inequalities that exists in healthcare, not all physicians feel adequately able to address such concerns. Understanding of factors that contribute to the development and perpetuation of inequities in health care must be developed at the medical education training level.

Objectives: Evaluate internal medicine residents’ understanding of SDOH and implement a curriculum on health disparities in order to improve their comfort in addressing social needs.

Methods: A survey regarding several …

Assessing Internal Medicine Resident Comfort With Obtaining Consent For Autopsies, Zach French, Kelly Hughes, Edward Wang, Elizabeth Braden

Health Equity and Quality Improvement (HEQI) Summit

Objective

We aim to increase resident comfort and knowledge of the autopsy process by 20% based on average survey response scores

A Rare Clinical Presentation Of Metastatic Crohn's Disease, Kaitlyn L Streight, Tara L Braun, Nicholas Lowe, Soo Jung Kim

Faculty, Staff and Students Publications

A 31-year-old female with a history of systemic lupus erythematous, IgA nephropathy, and psoriasis presented with a one-month history of a painful, pruritic rash under the bilateral breasts and in the genital region. Cutaneous examination revealed a large, tender ulcer under the left breast with a shiny erythematous base and peripheral hypertrophic changes. Small ulcers were present on the bilateral inguinal folds, and the labia majora were edematous with multiple erythematous papules. Histological examination of the left breast revealed ulceration with granulomatous dermatitis, consistent with a diagnosis of metastatic Crohn's disease. Metastatic Crohn's disease is a rare cutaneous manifestation of …

Dieulafoy Lesion In The Jejunum: A Rare Cause Of Massive Gastrointestinal Bleeding, Olubunmi Oladunjoye, Adeolu Oladunjoye, Lydia Slater, Asad Jehangir

Reading Hospital Internal Medicine Residency

No abstract provided.

A Rare Association Of Takotsubo Cardiomyopathy With Neuroleptic Malignant Syndrome, Waqas Ullah, Muhammad Arslan Cheema, Ammar Ashfaq, Maryam Mukhtar, Zain Ali, Mamoon Ur Rashid, Vincent Figueredo

Abington Jefferson Health Papers

Neuroleptic malignant syndrome is a potentially fatal neurological condition secondary toantipsychotic medication. It is characterized by distinctive clinical findings and autonomicdisturbances. NMS has not been associated with Takotsubo cardiomyopathy (TCM).

TCM is an abnormal response to physiological stressors resulting from the autonomicabnormalities which at times can mimic myocardial infarction (MI). We present a unique caseof a 54-year-old female with bipolar disease presenting with lithium and haloperidol-inducedNMS complicated by TCM. The purpose of this case is to make clinicians aware of this rareassociation.

Pancreatic Stromal Gremlin 1 Expression During Pancreatic Tumorigenesis, Joy M. Davis, Binglu Cheng, Madeline M. Drake, Qiang Yu, Baibing Yang, Jing Li, Chunhui Liu, Mamoun Younes, Xiurong Zhao, Jennifer M. Bailey, Qiang Shen, Tien C. Ko, Yanna Cao

School of Medicine Faculty Publications

Chronic pancreatitis (CP) is a major risk factor of pancreatic ductal adenocarcinoma (PDAC). How CP promotes pancreatic oncogenesis remains unclear. A characteristic feature of PDAC is its prominent desmoplasia in the tumor microenvironment, composed of activated fibroblasts and macrophages. Macrophages can be characterized as M1 or M2, with tumor-inhibiting or -promoting functions, respectively. We reported that Gremlin 1 (GREM1), a key pro-fibrogenic factor, is upregulated in the stroma of CP. The current study aimed to investigate the expression of GREM1 and correlation between GREM1 and macrophages within the pancreas during chronic inflammation and the development of PDAC. By mRNA in …

Wound And Stoma Care Education For Primary Care Providers, Deanna Garza

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem. Patients with percutaneous endoscopic gastrostomy (PEG) tubes and their families report physical and psychosocial changes associated with complications after gastrointestinal surgeries. They are at particular risk for tube dislodgement, leakage, infection, poor fit, and skin irritation. The lack of specialization and fundamental stoma care knowledge among community health care providers potentially results in unintended consequences, leaving the system inefficient with fundamental inequities of stoma care delivery. While there is an increasing amount of accessibility to specialty centers for other types of wound care, stoma care support resources are scarce and not readily available to patients.

Context: This Doctor …

A Rare Case Of Coronary Artery Thrombosis In A Patient With Recently Diagnosed Giant Cell Arteritis: Is Anticardiolipin Antibody Involved?, Khine S. Shan, Qian Zhang, Sharmila Bisaria, Anubha Tewary

Abington Jefferson Health Papers

Giant cell arteritis (GCA) is an immune-mediated systemic inflammation of large-sized arteries that predominantly affects elderly women. It may be considered as one of the risk factors for acute coronary syndrome (ACS). Moreover, patients with GCA may have increased anticardiolipin antibodies (aCL). However, its relationship with antiphospholipid syndrome (APS) is not clear. We present a case of a unique presentation of GCA with a connection to both ACS and APS. A 76-year-old woman who initially presented to the hospital with a chief complaint of intermittent unilateral headache, blurry vision along with transient aphasia was found to have a biopsy confirmed …

A Rare Presentation Of Coronavirus Disease 2019 (Covid-19) Induced Viral Myositis With Subsequent Rhabdomyolysis., Qian Zhang, Khine S. Shan, Artem Minalyan, Conor O'Sullivan, Travis Nace

Abington Jefferson Health Papers

A 38-year-old gentleman with no significant past medical history but had recent COVID-19 exposure presented to the hospital with the chief complaints of fever, shortness of breath, and generalized myalgia. He was unfortunately found to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive. Laboratory findings showed creatine kinase (CK) >42,670 U/L along with elevated inflammatory markers and unremarkable creatinine, cardiac troponin level. The cause of his rhabdomyolysis was discovered to be due to COVID-19 as he had no evidence of other viral infections, strenuous exercise, seizure, or other nontraumatic exertional etiologies. He received aggressive fluid resuscitation while we trended …

Endobronchial Tuberculosis: A Rare Presentation, Nadeem Kassam, Omar M. Aziz, Samina Somji, Grace Shayo

Internal Medicine, East Africa

Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree by Mycobacterium tuberculosis. It is common among young females. Patient can present with fever, cough, wheeze, with or without any constitutional symptoms. It presents as a diagnostic dilemma, as patient sputum smear can be false negative. CT scan may or may not show any abnormality, or any endobronchial lesion. Bronchoscopy with bronchoalveolar lavage and biopsy offers the diagnostic choice. We hereby report a case of a young immunocompetent Asian female who was found to have endobronchial pathology, leading to diagnosis and timely therapy.

Efficacy Of A Mobile Application In A Chronic Kidney Disease Population, Jennifer R. Zamora

Evidence-Based Practice Project Reports

Chronic kidney disease (CKD) is associated with high healthcare costs, poor health outcomes and low quality of life (Donald et al., 2018). The US CKD prevalence is 15%, costing Medicare $79 billion in 2016 (United States Renal Data System, 2018). Self-management could reduce CKD burden (Jeddi, Nabovati, and Amirazodi, 2017). Mobile technology offers a low-cost, ease-of-access platform for chronic disease self-management (Whitehead & Seaton, 2016), potentially slowing disease progression and improving health outcomes (Jeddi, 2017). The purpose of this project was to utilize a CKD-specific mobile application, CARELogiQ, to facilitate symptom management; increasing patient satisfaction and decreasing hospitalizations and ER …

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

West Florida Division GME 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.

Carcinoid Syndrome Arising From The Descending Colon Causing Carcinoid Heart Disease, Julien A. Exposito, Adam Salomon, Oliver Fowler, Christopher Cooke, Joelle Ellis, Patricia Chun, Christiano Caldeira

West Florida Division GME Research Day 2020

No abstract provided.

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

West Florida Division GME Research Day 2020

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

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

West Florida Division GME 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.

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

West Florida Division GME 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 Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold

Evidence-Based Practice Project Reports

Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …

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

West Florida Division GME 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 …

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

West Florida Division GME 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 …

Acute Hypoxic Respiratory Failure Due To Organizing Pneumonia With Lipoid/Cholesterol Component Caused By Thc Vaping With E-Cigarette, Jinal K. Patel, Kiran Tirumalasetty, Jessica Khabra, Imran Khan, Johnathan Frunzi

West Florida Division GME Research Day 2020

Vaping has been the new and deemed “safer” way to inhale addictive chemicals such as nicotine and tetrahydrocannabinol (THC), but it does not encompass the detrimental effects of other ingredients in these vaping cartridges that can cause lung injury[1,2]. Similar studies with dabbing (heating THC wax concentrate at high temperatures with butane) showcase rapidly progressing lung injury with massive consolidation and lasting effects on lung parenchyma over a period of time [3]. This case report aims to educate people, especially the younger generation, of the dangers of newer ways of combustible alternatives that have been marketed as a “safer” way …

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

West Florida Division GME 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).

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

West Florida Division GME 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.

Progressive Collateral Stenosis Leading To Symptomatic Chronic Total Occlusion, Farhan Shah, Andrew Maiolo

Capital Division GME Virtual Research Day 2020

Chronic total occlusion is defined as the complete obstruction of a coronary artery, with TIMI 0 or TIMI 1 flow, and an occlusion duration of greater than 3 months. We present a case of symptomatic chronic total occlusion in a functional 79 year old female with no past history of coronary artery disease, previously asymptomatic due to robust collateral circulation.

A Case Of Babesiosis Seen Outside Of Its Endemic Area And Outside Of Its Incubation Period, Kiran Tirumalasetty, Jinal K. Patel, Gauthier L. Stepman, Bassem Zeidan, K V. Sundaresh, Parth R. Desai, Johnathan Frunzi

West Florida Division GME Research Day 2020

Babesiosis Microti is a parasitic alveolate that is usually transmitted by Ixodes scapularis ticks. In the United States, the endemic areas of Babesiosis include the Northeast and Upper Midwestern regions [1]. Symptoms include fever, malaise, fatigue, vomiting, and jaundice [1]. Current therapy primarily consists of a combination of azithromycin and atovaquone. Clindamycin and quinine may be administered in severe cases. For its emerging health risk worldwide, clinicians must be aware of the several presenting manifestations of babesiosis. Since 2017, the Centers Disease Control and Prevention (CDC) has deemed Babesiosis is a reportable disease. This case focuses on the importance of …