Medical Specialties Commons^™

Hydralazine Associated Neutrophilic Dermatosis: A Unique Case Observing Dile, Anca Vasculitis, And Sweet Syndrome, Nicholas Olen, Jacob Horsley, Berk Celik, Joseph Skender, Shailesh Niroula

Conference Presentation Abstracts

Introduction: This case report highlights a 73-year-old male with biopsy-proven neutrophilic dermatosis with concern for Sweet Syndrome in the context of suspected hydralazine-induced systemic lupus erythematosus and autoimmune markers that initially pointed towards hydralazine-induced ANCA vasculitis. Case Presentation: The patient is a 73-year-old male with a past medical history significant for chronic kidney disease, urothelial cancer in 2021, renal cancer in 2013, and stage 1A left lung cancer. The patient additionally underwent workup for low white count and splenomegaly in months leading up to hospitalization, with bone marrow biopsy and workup negative for myelodysplastic syndrome or malignancy. Patient initially presented …

The Impact Of External Beam Radiation Therapy (Xrt) On Shoulder Surgical Outcomes, Rami Beydoun

Conference Presentation Abstracts

Purpose: To assess whether prior history of breast cancer treated with XRT has an impact on outcomes following shoulder surgery Significance: Long-term effects of XRT on complications and outcomes following shoulder surgery are largely unknown. Methods: 20-year single institution retrospective chart review. Inclusion criteria: patients with history of breast cancer treated with XRT and a subsequent ipsilateral shoulder surgical procedure. Demographics, comorbidities, and postoperative outcomes including ROM and VAS pain scores were collected. Results: 18 female patients (average age 66.3 years) were identified. 10 underwent rotator cuff repair, 7 shoulder arthroplasty (3 reverse), and 1 arthroscopic labral repair. Four patients …

Euglycemic Dka: Commonly Missed Diagnosis, Atulya A. Khosla, Pawan Gyawali, Twahida Khatoon

Conference Presentation Abstracts

No abstract provided.

Rare Case Of Hemorrhagic Pericardial Effusion Due To Coxsackie B Pericarditis, Nolan Shoukri, Hazem Alakhras, Kateryna Strubchevska, Steven Timmis

Conference Presentation Abstracts

Introduction Acute pericarditis is caused by inflammation of the pericardial sac. Amongst the vast number of potential causes, viruses tend to trigger pericarditis most frequently. Some of the more common viral causes are coxsackie A/B, echovirus, adenovirus, CMV, HSV, and HIV.1-3 Pericarditis often presents with signs and symptoms such as a friction rub, pain relieved with sitting up and leaning forward. ST segment elevations and PR segment depressions are seen on EKG. Laboratory tests showed increased inflammatory markers and WBC count. Pericardial effusion is a common complication and can be visualized on echocardiogram. In some cases, the pericardial effusion can …

Non-Immune Hemolytic Anemia In The Setting Of Alcohol-Associated Hepatitis: Zieve's Syndrome, Morgan Kiryakoza, Nazli Begum Ozturk, Justin Skrzynski

Conference Presentation Abstracts

Introduction: Zieve’s syndrome describes a triad of non-immune hemolytic anemia, jaundice, and transient hyperlipidemia found in patients with alcohol-use disorder/alcohol-associated liver disease. This case involves a 39-year-old female with suspected Zieve’s syndrome in the setting of severe alcohol-associated hepatitis. Case Description: A 39-year-old female with alcohol-use disorder presented to the emergency department with complaints of jaundice, lethargy, and confusion. On initial presentation, patient was anemic with a hemoglobin of 7.8 g/dL (12.1- 15.0 g/dL), ALP of 235 U/L (33-120 U/L), AST of 116 U/L (< 35 U/L), ALT of 41 (< 37 U/L) total bilirubin of 24.2 mg/dL (< 1.2mg/dL), direct bilirubin of >15 mg/dL (< 0.4mg/dL). Her blood alcohol level was negative. She was admitted due to concerns for alcohol-associated hepatitis. Her hospital course was complicated by frequent declines in hemoglobin requiring a total of six transfusions of packed red blood cells. No overt bleeding such as hematemesis or hematochezia was ever evident during these declines. Further hematologic workup revealed a normal glucose 6 phosphate dehydrogenase (G6PD), normal pyruvate kinase, elevated plasma hemoglobin of 150 mg/dL (< 30 mg/dL), decreased haptoglobin of < 8 mg/dL (40-250 mg/dL), and elevated lactate dehydrogenase (LDH) of 595 (100-240 U/L), elevated reticulocyte count of 213 bil/L (21-100 bil/L). Direct Coombs Test was negative. The combination of these labs illustrated a picture of non-immune hemolytic anemia. Patient’s course was further complicated by a persistent rise in her total bilirubin, eventually peaking at 30.6 mg/dL, and ascites which required paracentesis and fluid studies was consistent with spontaneous bacterial peritonitis (SBP). Given the presence of SBP, corticosteroid therapy was not initiated for alcohol-associated hepatitis. Lipid panel remained within normal limits on two separate occasions. Vitamin E level was < 2.5 mg/L (5.5 – 17.0 mg/L). During hospitalization, she tested positive for Influenza A H1N1, developed acute hypoxic respiratory failure, was intubated, and was transferred to the intensive care unit and later extubated. Her mental status during her hospital stay was frequently waxing and waning and never fully recovered. The patient was eventually discharged home with hospice and her hemoglobin levels remained stable after supportive blood transfusions during her stay. Discussion: Zieve’s syndrome is an underdiagnosed cause of anemia in patients with alcohol-associated liver disease. There are multiple proposed mechanisms to explain the pathophysiology behind the red cell lysis seen in this disorder. One leading hypothesis suggests the red cell membrane becomes unstable due to vitamin E deficiency leading to disordered pyruvate kinase. Importance of early recognition of this syndrome is essential as treatment revolves around strict abstinence from alcohol.

Splenic Infarct Following Roux-En-Y Gastric Bypass Surgery, Khurram Arshad, Yazan Alamro, Rabia Latif, Zaid Mahameed, Omar Nasser Rahal, Rajiv John

Conference Presentation Abstracts

Introduction: Roux-en-Y gastric bypass (RYGB) is a standard surgical procedure used to treat morbid obesity. Although RYGB is generally considered safe, it's essential to remain vigilant in identifying and addressing rare complications such as splenic infarction. Splenic infarction is a primarily silent condition, and because many cases go undiagnosed, the exact incidence of the condition is obscure and likely underestimated. Similarly, the incidence and severity of these rare conditions in the postoperative period for bariatric surgeries are still unknown. Case presentation: A 31-year-old female with morbid obesity underwent RYGB six weeks before presentation with acute abdominal pain, nausea, and a …

Instent Thrombosis 20 Years After Stent Placement, Hussein Gaith, Najeebullah Bangash

Conference Presentation Abstracts

Stent thrombosis is not very common but it is a serious complication of percutaneous coronary intervention (PCI). Here in, we present a case of 55 years old who presented with acute chest pain, was found to have non ST elevation myocardial infarction due to a thrombotic occlusion of prior drug eluting stent placed 20 years ago. A 55 years old male presented to the emergency department with one day history of mid-chest retrosternal pain that started while playing hockey, associated with nausea and diaphoresis. On initial evaluation, vital signs were stable, and patient was afebrile. Cardiac examination was normal with …

Molecular Characterization Of Kif11 Variants In Familial Exudative Vitreoretinopathy, Konstantinos Koustas, Kenneth P. Mitton, Wendy Dailey, Kimberly A. Drenser

Posters

Pediatric retinal diseases including Familial exudative vitreoretinopathy (FEVR) and Norrie Disease are linked to mutations in Wnt signaling network genes like FZD4, LRP5, TSPAN12, and NDP (see Figure-1). Active Norrin signaling is crucial for the normal growth and proliferation of developing retinal vasculature. Similarly, the absence of KIF11's kinesin activity can hinder the growth and proliferation of retinal vasculature, leading to peripheral avascular neural retina. According to the UniProt database there are about 41 disease causing variants for KIF11, and 17 specifically associated with FEVR. Nextgeneration sequencing was employed to sequence 76 subjects, aiming to identify novel variants to broaden …

The Use Of A Short And User-Friendly Questionnaire As A Screening Tool To Identify Potential Gaps In Nutrition Knowledge Of Adolescent Athletes, Roben Ohev Shalom, David Lick, Virginia E. Uhley

Posters

Nutrition knowledge in adolescent athletes is rarely formally assessed by physicians. Current popular nutrition questionnaires include the CDC’s Youth Risk Behavior Survey (YRBSS) and the Nutrition for Sport Knowledge Questionnaire (NSKQ). These questionnaires are long and are not optimal to assess nutrition knowledge in adolescent athletes at their preparticipation examinations. A systematic review conducted by Tam et al, showed that questionnaires would benefit from interactive and attractive features including images. A novel nutrition questionnaire was adapted from the NSKQ that was user friendly, short in length, electronic and included images. We hypothesized that through collecting physicians feedback on the questionnaire …

Cancer Screening Guidelines In Midwest Adult Correctional Facilities, Stephen Greenwell, Jason Adam Wasserman

Posters

National cancer screening guidelines (CSGs) exist to promote early cancer detection, reducing mortality, morbidity, and cost. The incarcerated population is at increased risk for certain cancers, decreased cancer screening, and barriers to treatment. In this study we investigate how state and federal prison CSGs differ from the National Comprehensive Cancer Network’s (NCCN) CSGs.

A Comparison Of Post-Operative Pain Management Following Lumbar Laminectomy Fusions Utilizing Tlip Or Intra-Operative Local Anesthesia Block, Lauren Eberhardt, Philip Zakko, Karen Childers, Daniel Park

Conference Presentation Abstracts

Background/Introduction: Spinal fusion patients suffer significant acute post-operative pain, potentially leading to chronic pain. Opioids are commonly used for peri-operative pain management despite significant side effects. The thoracolumbar interfascial plane (TLIP) and erector spinae plane (ESP) block, alternative analgesic options with rare side effects, have proven to reduce pain and opioid consumption compared to standard non-block care. This study aimed to determine if a significant difference exists between block groups with multi- and single level laminectomy fusions in post-operative and discharge opioid consumption and length of stay. Materials/Methods: A retrospective review was performed via data query for lumbar laminectomy fusion …

Assessing Impact Of Image-Based Immunization Education On Pediatric Vaccine Uptake Within Families Of Low English Literacy, Ahmed Ali, Mariam Bassalious, Sharfaa Chowdhury, Coral Hufnagel, Salwa Bajjey, Amaal Haimout, Nelia Afonso, Raouf Seifeldin

Posters

• Vaccinations have been hailed as the most effective public health strategy in mitigating infectious diseases. Since the advent of vaccines at the end of the 18th century, the incidence, prevalence, and mortality of vaccine-preventable diseases have markedly decreased.
• Vaccine hesitancy has been increasing within the last decade due to various reasons including misinformation and a lack of understanding. 2 This is especially true amongst patients with limited literacy skills as traditional vaccine education material is not optimal for their understanding.
• Several studies across various healthcare disciplines have shown that the use of picture-based health education for patients with limited literacy …

Predictors Of Icu Admission Following Endoscopic Endonasal Skull Base Surgery, Brandon Prentice, Max Dehaan, Adam Folbe

Posters

• Endoscopic Endonasal Skull Base Surgery (EESBS) encompasses a wide range of surgeries; pituitary adenoma resection is the most common of these.
• Patients routinely are admitted to the ICU post-operatively for monitoring of serious complications such as intracerebral hemorrhage and meningitis.
• Some complications such as diabetes insipidus, however, do not require a stay within the ICU and can be managed as an out-patient.
• Besides adding stress and discomfort to the patient, stays in the ICU are costly with one study reporting a cost of $2,902 per day.
• Previous studies identified preoperative hypertension and large tumor volume (>4500 mm3) as risk …

Comparing The Outcomes Of Titanium And Stainless Steel Flexible Nails In Repairing Pediatric Long Bone Fractures, Novelpreet Boparai, Suzan Kamel-Elsayed, Ehab Saleh

Posters

• Traditionally, pediatric femoral fracture treatment favored conservative methods.
• Surgical intervention was deferred until age 6, as non-operative approaches often resulted in complications.
• Titanium elastic nailing (TENS) emerged as an effective treatment for diaphyseal femoral fractures in ages 6 to 16. However, the choice between TENS and stainless steel elastic nailing (SSENS) remains debated due to inconsistent findings.

Public Perception Of Robotic Assisted Total Hip Replacement Surgery, Marvee Espiritu, James E. Feng, Phillip Vartanyan, Drew Moore, Robert Moore, Mark Karadsheh

Posters

• Robotic or technology assisted THA has received significant attention recently due to its precision in acetabular cup placement within the Lewinnek safe zone.1
• Few studies have assessed the public’s perception of robotic-assisted THA.3,4 Insight into patients’ perception of robotic-assisted THA may yield valuable information that may impact further integration of the technology within hospitals and surgeon training.

Morbidity Of Tendon Harvest Site For Acl Autograft; A Systematic Review, Jessi Fore, Betina Hinckel, Elijah Auch

Posters

Primary anterior cruciate ligament (ACL) ruptures are highly common and lead to a significant number of primary ACL reconstruction surgeries in the U.S.1. When choosing a graft, surgeons can pick between auto- and allografts2. An autograft can include a bone-patellar tendon-bone (BPTB) graft, a hamstrings tendon (HT) graft, or a quadriceps tendon (QT) graft2. Currently, there is a wide range of research on graft types, but no paper compares all threes graft types directly. This review will compare literature to determine the morbidity associated with each graft type and determine which autograft is best for primary reconstruction.

Metastatic Osteosarcoma Involving The Skin: A Systematic Review Of Patient Demographics, Clinical Characteristics, And Treatment Outcomes, Sarah Fried, Ameen Suhrawardy, Rafey Rehman, Malik Al-Jamal, Drew Moore, Darius Mehregan

Posters

Skeletal osteosarcomas - most common primary malignant bone tumor1 and commonly metastasize to:

• Lungs (95%)2 •

Other bones (50%)2 •

Kidneys (12%)2 •

Rarely to the skin3

Extraskeletal osteosarcomas (ESOS) – soft tissue tumors that may also metastasize to the skin4,5,6

Value in gathering data on this rare phenomenon:

• Informs biology and dermatologic care of patients suffering from this cancer.

This systematic review characterizes metastatic osteosarcomas involving the skin.

Assessing Patient Preferences For Technology-Assisted Versus Traditional Total Knee Arthroplasty Using A Validated Online Survey Marketplace: Before And After Patient Education, Tanner J. Hafen, James E. Feng, Phillip Vartanyan, Drew Moore, Robert Runner

Posters

• Computer (CA) and robotic (RA) assisted TKA has becoming increasingly prevalent in orthopaedic surgery1,2.
• There is limited insight into the public perception of CA and RA3.

Outcomes Of Primary Acl Repair For Proximal Tears: A Systematic Review And Meta Analysis, Collin Braithwaite, Tanner Hafen, Robert Dean, Joseph Guettler, James Bicos

Posters

The purpose of this study was to determine which primary ACL repair technique resulted in the lowest failure rates postoperatively.

Pediatric Upper Cervical Spine Trauma: A 10-Year Single Center Retrospective Study, Sazid Hasan, Muhammad Waheed, Shahrukh Naseer, Jad G. Khalil, Ehab S. Saleh

Posters

This study seeks to answer whether or not there is a significant association between mechanism of injury and patient age, and to elucidate any notable differences in overall outcomes based on various treatment modalities.

Accuracy Of Ora And Newer Generation Formulas For Iol Power Calculation After Prior Refractive Surgery, Raheel Khan, Mark Rolain

Posters

• Patients with cataracts have cloudiness of the lens that impairs vision.
• It must be replaced with a prosthetic lens however the lens’ refractive power has to be calculated using formulas to predict the kind of lens that will be implanted for best visual outcomes.
• Patients that have had prior refractive surgery of the cornea do not have as good refractive outcomes after cataract surgery.1
• The concern is that there is not a goldstandard formula that can be used for this population to predict the refractive power of the lens that should be implanted.
• Optiwave refractive analysis (ORA) is a new …

Coats And Coats-Like Retinopathy In Female Patients, Zara Saleem, Drew Scoles, Antonio Capone Jr

Posters

To report the presentation, stage, clinical characteristics, and course of female patients with Coats and Coats-like retinopathy.

Fractionated Radiosurgery Associated With High Rates Of Local Control For Large Volume Intact Brain Metastases, Ryan Ko, Hong Ye, Peter Chen, Zachary Seymour, Kuei Lee, Inga Grills

Posters

Radiosurgery is a well-established treatment modality for patients with intact brain metastases, and there is a known impact of tumor size and volume on tumor control. Utilizing our single-institution database, we investigated outcomes for patients with intact brain metastases treated with FSR using LINAC or GK modalities.

Comparison Of Associated Autoimmune Disease Diagnoses In Myasthenia Gravis And Multiple Sclerosis Patients, Alecca Como, Jacob Keeley, Daniel Menkes

Posters

Autoimmune diseases often co-exist given the non-specific nature of the immune response. For example, myasthenia gravis [MG], a well-established autoimmune disease, has a 2.36-fold increased risk of developing thyroid diseases as compared to normal controls. 1,2 In contrast, multiple sclerosis [MS] is a disorder in which the immune system subserves an important pathogenic role, although there is insufficient evidence to definitively classify it as an autoimmune disease. 3,4 Since the etiology of MS has yet to be identified, and the specific autoimmune mechanism requires further elucidation, the comparison of its coassociated autoimmune diseases with that of a well-studied neuroautoimmune disease, …

Targeted-Sequencing Evaluation For Fzd4 Variants In Familial Exudative Vitreo-Retinopathy, Mary Drekh, Wendy Dailey, Vincent Le, Savyo Krikor, Kimberly A. Drenser, Kenneth P. Mitton

Posters

• The Familial hereditary vision loss disease may present with symptoms including retinal detachment, folding, neovascularization, or vitreous hemorrhage due to peripheral retina avascularity.
• The manifestation of FEVR genetically has been associated with a loss of function mutation of the Wnt/bcantenin-signaling pathway involving 7 genes (FZD4, NDP, CTNNB1, KIF11, LRP5, TSPAN12, and ZNF408). In our patient population of 72 individuals the distribution of FZD4 gene variants leading to FEVR has been recorded.
• The Frizzled4 gene (FZD4) codes for the G-coupled protein receptor and effects Wnt/b-cantenin-signaling pathway In endothelial cells.
• What frequency of FEVR from our patient pool will have FZD4 variants …

Physician-Patient Face Masking’S Influence On Post-Intravitreal Injection Endophthalmitis Rates, Conner Liddle, Antonio Capone Jr, Matthew Trese

Posters

Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) medications and intravitreal steroids are standard treatment options for variety of retinal diseases. Serial IVIs are often required to achieve disease control, but IVIs are not without risk. Recognized serious complications of IVIs include but are not limited to retinal detachment, vitreous hemorrhage, and acute endophthalmitis.1 Although post-IVI endophthalmitis is uncommon, it is a feared complication because of the potential for irreversible vision loss. Given that IVIs are one of the most commonly performed medical procedures in the United States, it is essential to ensure that steps are taken to mitigate …

Methenamine Prophylaxis Reduces Recurrent Urinary Tract Infections, Salwan Al Hani, Matthew Sims

Posters

• Recurrent urinary tract infections (UTIs) are the most common outpatient infection in the US and are often managed with antibiotics in clinical practice.
• A recurrent UTI is defined as 2 or UTIs each 6 months or 3 or more UTIs each year.
• Methenamine is an antiseptic compound approved by the FDA to prevent rUTIs but is seldom used in clinical practice.
• Under acidic conditions, methenamine is converted to 6 molecules of formaldehyde, a compound which prevents bacterial growth.
• This study seeks to determine the effectiveness of methenamine for prevention of recurrent UTIs.

The Hiv Care Continuum - A Quality Improvement Project To Reconnect With Hiv-Positive Patients Lost To Follow-Up Care, Kate Romero, Janet Lombardi, Carmen Demarco, Paul C. Johnson

Posters

• Human Immunodeficiency Virus (HIV): incurable illness transmitted through sex, blood, and trans placentally • Consistent management of HIV prevents progression to AIDS.
• 2013 study à HIV-positive patients who failed to attend their follow-up visit within 4-6 months of the prior visit were more likely to have virologic failure.
• Not much published on barriers to care, but one prior study found barriers shown in Figure 2 below – What are barriers to care faced by HIV-positive patients in Southeast Michigan?

Hiv Diagnosis And Linkage To Care In The Emergency Department, Gabrielle Rowlison, Christopher F. Carpenter

Posters

• It is estimated that 1.2 million people are living with human immunodeficiency virus (HIV) in the United States, and that 14% of this population are unaware of their status.
• Approximately 40% of community transmissions happen between people who do not know they have HIV.
• Current CDC recommendations are that anyone seeking treatment for a sexually transmitted infection (STI) be routinely screened for HIV.
• The Emergency Department (ED) is an ideal place to test for HIV, especially in areas with underinsured populations and high rates of ED visits.
• The HIV testing rate in Corewell Health (CH) East’s ED was previously found …

Near-Surface Dose Correlates With Moist Desquamation And Unplanned Reconstructive Surgery In Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy, Patrick Thrasher, Ronald Levitin, Bryan S. Squires, Allison J. Hazy, Michael J. Maywood, Anthony P. Delise, Muayad F. Almahariq, Nayana Dekhne, Lauren Oliver, Peter Y. Chen, Kailee J. Walters, Diane Dudley, Joshua T. Dilworth

Posters

Postmastectomy radiation therapy (PMRT) utilized as part of a breast cancer treatment regimen reduces the risk of disease recurrence in appropriately selected patients.1,2,3,4,5 However, PMRT increases risk of radiationrelated toxicities that can interfere with breast reconstruction post-mastectomy.6 Following mastectomy, implant-based reconstruction can increase patient satisfaction and quality of life7,8; complications induced by PMRT such as infection and tissue contracture, though, increase risk for implant loss and may ultimately require further surgeries for the patient.

PMRT is delivered based on treatment plans that are optimized to provide appropriate radiation dosages to tissues along the chest wall while simultaneously limiting exposure of …