Medical Specialties Commons^™

Percutaneous Pneumothorax Placement, Miranda Bingham, Christopher Houston

North Texas GME Research Forum 2026

Background: Timely and accurate chest tube placement in the Emergency Department (ED) is critical for the management of life-threatening conditions such as a pneumothorax. At Medical City North Hills Emergency Department, chest tube placement can be delayed or complicated due to variability in available equipment types, sizes, storage locations, and setup processes. Providers may be unfamiliar with less commonly used kits, experience skill decay due to infrequent procedural exposure, or lack access to bedside educational resources during high-stress, time-sensitive situations. These challenges contribute to procedural delays, increased complication rates, prolonged hospital stays, and higher healthcare costs. This quality improvement project …

Gastroduodenal Artery Coil Erosion Causing Pyloric Obstruction And Upper Gi Bleeding, Corey Newman, Mahad Rehman, Cody Beltran, Michael Carrick

North Texas GME Research Forum 2026

Background Trans-arterial embolization (TAE) of the gastroduodenal artery (GDA) is a well-established and effective treatment for peptic ulcer bleeding and visceral pseudoaneurysms. Although generally safe, delayed migration or erosion of embolization coils into the gastrointestinal lumen is a rare but recognized complication that may occur months to years after the procedure. Proposed mechanisms include ischemic mucosal injury, mechanical pressure from the coil mass, and chronic inflammation. Clinical manifestations vary widely, ranging from occult bleeding and ulceration to perforation or gastric-outlet obstruction. Only a limited number of cases describing GDA coil erosion presenting with both bleeding and obstruction have been reported. …

Nitrous Oxide Vs. Ketamine: Impacts On Pediatric Emergency Department Length Of Stay, Tabitha Brock, Anna Suessman

North Texas GME Research Forum 2026

Background Nitrous oxide (N₂O) is a well-established analgesic and anxiolytic agent, widely used for procedural sedation in pediatric dentistry. Despite its demonstrated safety and efficacy, its use in Pediatric Emergency Departments (PEDs) remains limited and underexplored. To address this gap, we implemented a comprehensive training program for PED providers and introduced N₂O as an alternative sedation agent.

Objective We hypothesized that using N₂O for procedural sedation would significantly reduce patient length of stay (LOS) without compromising safety or outcomes.

Methods We conducted a retrospective chart review of pediatric patients who underwent painful procedures in a tertiary children’s hospital emergency department. …

Association Of Glp-1 Receptor Agonist Use With Postoperative Outcomes After Rotator Cuff Repair In Patients With Diabetes: A Propensity Score–Matched Analysis, Mckenna W. Box, Troy B. Puga, Hans Drawbert, Aysu Erdemir, John T. Riehl

North Texas GME Research Forum 2026

Background Diabetes impairs tendon healing after rotator cuff repair (RCR), with early postoperative poor glycemic control linked to a higher failure risk in studies. GLP-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control. Preclinical studies indicate that GLP-1RA may benefit rotator cuff healing through anti-inflammatory mechanisms as well. However, real-world data on the effects of GLP-1RAs on RCR outcomes remain incompletely understood.

Methods We conducted a retrospective cohort study using an institutional dataset (01/01/2016 to 09/30/2024) of adults aged 18-74 years with type 2 diabetes who underwent RCR. GLP-1RA exposure was established by home medication lists. Patients with autoimmune …

Retrospective Analysis Of Predictive Accuracy In Applying The Nih Stroke Scale, Rachel Hoang, Ray Rahimi, Kelly Mofor, Charley Meadows, Ty Shields, Hibba Thayyil, Hannah A. Affleck, Parker Owen, Sanjay Sharma

North Texas GME Research Forum 2026

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is widely used to quantify neurologic deficits in acute stroke, yet it is based on observable symptoms rather than ischemic stroke pathophysiology. Because ischemic stroke typically results from focal vascular occlusion, deficits classically localize to a single hemisphere and do not cross the midline. The frequency with which patients presenting with bilateral or contralateral symptoms have MRI-confirmed ischemic infarction, compared with those with unilateral deficits, remains unclear.

METHODS: We performed a retrospective analysis of patients for whom a code stroke was activated at a single institution. Patients presenting with bilateral/contralateral or …

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

Esophageal Squamous Cell Carcinoma Incidentally Detected On Barium Swallow: A Case Report, Muhammad Rubeel Akram, Aditya Rao, Muhammad T. Siddique

North Texas GME Research Forum 2026

Background: Esophageal cancer is an aggressive malignancy with a poor prognosis, and has high rates of recurrence despite curative-intent therapy. While endoscopy with biopsy remains the gold standard for diagnosis, non-diagnostic imaging studies are performed when evaluating for dysphagia, and may bring to light underlying pathology, warranting further workup. Surgical resection following neoadjuvant chemoradiation is often performed, but postoperative complications and disease recurrence are important concerns. This case highlights the crucial role of early detection via imaging and the clinical burden associated with esophageal squamous cell carcinoma.

Case Presentation: A 76-year-old female presented with dysphagia and underwent a barium esophagogram, …

Stronger Together: A Resident-Led Initiative Advancing School Nurse Readiness In Pediatric Seizures And Pediatric Cardiology, Shana-Kay Lambert-Johnson, Amy Nguyen-Pham, Tony Do, Devika Adusumilli, Jorim Parmar, Dimitar Semerdzhiev, Elizabeth White, Joanna John, Myrna Garcia, Nicholas Gerden, Tasaduq Mir, Michele Mccarroll

North Texas GME Research Forum 2026

BACKGROUND: School nurses play a vital role in safeguarding the health and safety of children by serving as frontline providers within the school setting. Timely recognition and appropriate management of acute medical conditions can reduce morbidity, prevent unnecessary emergency department utilization, and improve long-term outcomes. Needs assessment surveys identified knowledge and confidence gaps among school nurses related to pediatric seizure management and pediatric cardiology.

METHODS: This prospective educational quality improvement initiative was conducted across the Dallas–Fort Worth (DFW) region during the 2025-2026 academic year. Over 25 residents served as curriculum developers and educators, creating and delivering evidence- and case-based education …

Analysis Of Stemi Activations, Ashleigh Wilson, Christopher Houston

North Texas GME Research Forum 2026

Background Prior studies of ST-segment elevation myocardial infarctions (STEMI) presentations have shown that longer door-to-balloon (D2B) times are associated with increased mortality. Percutaneous Coronary Intervention (PCI) within 90-minutes is standard. It appears that STEMI patients without prehospital notifications have longer ischemic times. Prehospital activation of cathlab involves EKG transmission that the Emergency Physician interprets before activating cathlab, which has the potential to cause delays. We propose that prehospital notification and prehospital having the ability to activate cathlab could decrease D2B times.

Study aims:

• Evaluate current prehospital notification system.
• Assess EMS accuracy in STEMI identification and cathlab activation. 
• Does prehospital notification …

An Unusual Case Of Genetic Dilated Cardiomyopathy Unmasked By Covid-19 Infection, Greeshma Molugu, Daniel Mcmahan, Seline Haci, Giridhar Mundluru, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Titin (TTN) mutations are a well-known cause of dilated cardiomyopathy (DCM), occurring in approximately 25% of familial cases of idiopathic DCM and 18% of sporadic cases. Recognition and referral for genetic testing remains underutilized but has important prognostication and helps the patient better understand the disease transmission. This case report stresses the importance of a complete evaluation for genetic causes of DCM.

Case Presentation: A 21-year-old male who was adopted as an infant was hospitalized with COVID-19 infection and diagnosed with non-ischemic cardiomyopathy with an initial left ventricular ejection fraction (EF) of 10%. He was assumed to have DCM …

Improving The Utilization Of Palliative Care Services At Medical City Fort Worth, Gennipher Smith, Shervin Sarji, Maanasa Palani, Samuel Chen, Mary Halm, Kristina Bowman, Morvarid Rezaie

North Texas GME Research Forum 2026

Palliative Care (PC) is a specialized medical care that aims to optimize the quality of life and alleviate the suffering of patients with serious medical illness. Benefits of palliative care include improved symptom management, enhanced quality of life, reduced healthcare utilization, better care alignment, improved communication and support, and financial savings. Hospital Corporation of America (HCA) Medical City Fort Worth (MCFW) has a PC consult service. However, it is underutilized. According to data collected from January 2025 to December 2025, the percentage of PC consults for high risk units, such as oncology and ICU, by day 3 of admission varies …

Cor Triatriatum Sinistrum: An Underrecognized Indication For Anticoagulation, Boney Lapsiwala, Karthik Kasireddy, Tenna Mathew, Babu Makkena

North Texas GME Research Forum 2026

Background: Cor triatriatum (CTS) is a rare congenital heart defect in which a fibromuscular membrane divides the atrium into two chambers, disrupting normal blood flow and potentially leading to circulatory impairment. Accounting for 0.1% to 0.4% of congenital heart diseases, CTS presents variably depending on the degree of left atrial obstruction. Patients may report exertional dyspnea, orthopnea, or palpitations; severe cases can progress to heart failure, pulmonary hypertension, or thromboembolic events. We present the case of a young adult male who developed symptomatic heart failure and atrial fibrillation and was incidentally found to have CTS on imaging.

Case presentation: A …

Prognostic Value Of Systemic Inflammatory Indices For Predicting Mace In Nstemi Patients Undergoing Pci, Boney Lapsiwala, Aditya Sharma, Usman Khan, Jorim Parmar, Justin Soloman, Veeranna Vibhuti, Mehdi Khalafi

North Texas GME Research Forum 2026

Background: Cardiovascular diseases (CVD) account for nearly one-third of global mortality, with ischemic heart disease caused by a mismatch between myocardial oxygen supply and demand. Despite advances in percutaneous coronary intervention (PCI) and contemporary pharmacotherapy, patients with non–ST-segment elevation myocardial infarction (NSTEMI) continue to experience substantial residual risk for major adverse cardiovascular events (MACE). As traditional risk stratification tools have limited ability to identify high-risk individuals, interest has shifted toward biomarkers reflecting inflammatory pathways central to atherosclerosis and plaque instability. Hematologic inflammatory markers including pan inflammatory value (PIV), systemic immune inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) initially …

A Not So Typical Case Of Alcoholic Pancreatitis, Wendy Phillips, Kaleem Munazzah, Asad Rehman, Robert Keller

North Texas GME Research Forum 2026

BACKGROUND Acute pancreatitis (AP) has become one of the leading gastrointestinal diagnoses resulting in inpatient hospitalization¹. AP is diagnosed by meeting two of three criteria: characteristic clinical presentation, biochemical evidence (elevated lipase or amylase levels), and imaging findings with pancreatic inflammation. Gallstones and heavy alcohol use account for most cases (40%–70% and 25%–35%, respectively). Hypertriglyceride induced AP (HTG-AP) accounts for only about 7-10% of AP cases³ and often tends to present in younger, male, obese, patients with a higher rate of diabetes¹. Below we present a unique case of a coinciding alcoholic and HTG - AP in an otherwise healthy …

Biologic Versus Non-Biologic Immunosuppressant Use And Outcomes After Orif Of Closed Ankle Fractures: A Propensity-Matched Analysis, Mckenna W. Box, Troy B. Puga, Lachlan Anderson, Alyssa Kozlowski, John T. Riehl

North Texas GME Research Forum 2026

Background: The effect of biologic immunosuppressant therapy on postoperative outcomes following ankle fracture open reduction and internal fixation (ORIF) remains unclear, and concerns regarding infection and impaired healing often influence perioperative decision-making. We hypothesized that biologic immunosuppressant use would be associated with higher rates of postoperative complications following ORIF of closed ankle fractures compared with non-biologic immunosuppressant therapy.

Methods: We conducted a retrospective cohort study using a multi-hospital administrative dataset (2017-2025) to identify adult patients undergoing ORIF for closed bimalleolar or trimalleolar ankle fractures who were prescribed immunosuppressive therapy. Patients were categorized based on biologic versus non-biologic immunosuppressant use. A …

Handheld Magnet Screening Of External Fixator Components: A Laboratory Assessment Of Gross Ferromagnetism Relevant To Mri Safety, Troy B. Puga, Mckenna W. Box, Lyn D. Ward, John T. Riehl

North Texas GME Research Forum 2026

Introduction Much controversy remains regarding the ability of patients with an external fixator in place to undergo Magnetic Resonance Imaging (MRI). The main concern for radiology departments is that the external fixator system components can lead to adverse events due to interactions of the external fixator and the magnet of the MRI. However, there is no clear evidence to support these claims or theories in the current literature. Yet, MRI’s are denied daily across the country for patients having an external fixator in place. Numerous patients with an external fixator would likely benefit from an MRI to prevent delayed care, …

Efficacy And Outcomes Of Oxidized Regenerated Cellulose (Orc) In Total Joint Arthroplasty (Tja): A Systematic Review And Meta-Analysis, Jenna Chrabolowski, Troy B. Puga, Abanoub Attalah, Kyle P. O'Connor, Mckenna W. Box, Ashley Stovall, Michael Muncy, John T. Riehl

North Texas GME Research Forum 2026

Introduction Intraoperative and postoperative blood loss is a major concern and challenge for surgeons in total joint arthroplasty (TJA). Patients with large blood loss can develop postoperative anemia and associated complications. Novel hemostatic agents, such as oxidized regenerated cellulose (ORC) have grown in popularity as intraoperative hemostatic adjuncts. The aim of this systematic review and meta-analysis is to evaluate the efficacy of ORC for intraoperative and postoperative blood loss.

Methods A search was conducted across MEDLINE/Pubmed, Cochrane, Google Scholar, Web of Science, and Embase databases. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and …

Double Trouble: A Rare Co-Existence Of Hypertrophic Obstructive Cardiomyopathy And Anomalous Origin Of The Right Coronary Artery, Greeshma Molugu, Srinivasan Rajaganapathy, Seline Haci, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) and anomalous origin of the right coronary artery (RCA) are well-known but rare congenital heart diseases that are recognized as independent leading causes of sudden cardiac death(SCD). The independent prevalence of both these conditions is less than 1%. The co-occurrence of these two conditions is seldom ever reported in the literature. We present an extremely rare case of HOCM and the anomalous origin of the RCA in the same individual.

Background: A 67-year-old male with no significant past medical history presented for chest pain and palpitations. EKG showed atrial fibrillation with rapid ventricular response. Troponin …

Long-Term Incidence Trends And Stage Distribution Of Cutaneous Melanoma In The United States (1975–2022): A Seer Population-Based Analysis, Thea Danielle Amadasun, Shahzaib Maqbool

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Smarca4-Deficient Carcinoma Of The Gastroesophageal Junction, Hanna Riga, Austin Lehr

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

A Rare Case Of New Onset Lisinopril-Induced Angioedema Improved With Tranexamic Acid: A Case Report, Hafiz Numan Ijaz, Shahzaib Maqbool, Yugandhar Kandimalla

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Atypical Del(5q) Mutation In Myelodysplastic Syndrome Presenting With Thrombocytopenia: A Case Report Of Tp53-Mutated High-Risk Biology, Shahzaib Maqbool, Munaf Siyamwala, Amelia Goslin, Shivani R. Scharf, Katsiaryna Laziuk

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Intestinal Tuberculosis Masquerading As Crohn’S Disease: A High-Risk Diagnostic Mimic, Maikel Tawadrous, Tejaswi Vadde, Subuhee Ahmed, Lawrence San Jose, Chelsea Curry, Aradhana Pandey

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

High-Flow Ectatic Anomalous Right Coronary Artery From The Pulmonary Artery With Stimulant-Induced Cardiomyopathy: A Case Report, Prithvi Basu Roy, Danish Bawa, Louis Orlando

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

From Focal Peroneal Neuropathy To Complex Regional Pain Syndrome: A Case Of Progressive Unilateral Lower Extremity Pain, Ali Haider, Yu-Shiuan Hsu

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Alpha 1 Antitrypsin Deficiency In Primary Care: A Case Presentation, John Sweetman, Gazala Parvin

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Intermittent Hypoxia In A Middle-Aged Woman With A Probable Bethlem Myopathy Carrier State And Suspected Complex Sleep-Related Hypoventilation, Jonathan Paul Ladera, Louis Orlando

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

"Qt Okay, Bowel Not Okay"- Dofetilide Masking An Evolving Small-Bowel Obstruction, Tejaswini Yeshala, Pankti Shah, Syed Ali Abidi, Archana Machavarapu

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Efficacy Of A Vertically Integrated, Module-Based Small Group Discussion And Virtual Patient Simulation Model To Enhance Cardiology Knowledge And Clinical Reasoning In Medical Students, Kumar Abhishek, Pratyush Kumar, O Puri, M Pathania

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Time To Safe Chest Tube Removal After Water-Seal Trial, Rahul Pawa, Joshua Gazzetta, Leo A. Benedict, Sean Nix, Phillip Jones, Yoon Cho, Alyssa Fesmire

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.