Medical Specialties Commons^™

Improving Patients’ Postpartum Contraception Plans And Access To Postpartum Contraception, Rebecca Johnson, Timothy Kremer, Nicole Tenzel

North Texas Research Forum 2025

Introduction: ACOG recommends prenatal discussions with patients regarding their lifetime reproductive plans and postpartum contraception. Up to 40% of patients are not seen for postpartum visits and this rate is highest amongst populations with limited resources (ACOG Practice Bulletin: Optimizing Postpartum Care). By having consistent documentation amongst our clinic providers we aim to maximize patient education and choice in their postpartum contraception. Methods: The providers at our clinic were educated on where to document postpartum contraception discussions on the obstetric flow sheet under the “problems” tab. Providers were to document the discussion even if the patient declined postpartum contraception. Every …

Streptococcus Intermedius In The Setting Of Adalimumab Use, Gerardo Martinez Arroyo, Amelia Mellor, Joseph Prokop, Oscar Garcia

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Exploring The Link Between Covid-19 And Transverse Myelitis: A Case Report, Sara Sanghera, Trivianne Franklin, Veeranna Vibhuti, Danielle Ford

North Texas Research Forum 2025

Transverse myelitis (TM) is a rare inflammatory syndrome of the spinal cord that is often attributed to immune-mediated responses which lead to demyelination and the resultant varying degrees of motor, sensory, and autonomic dysfunction. While COVID-19 virus itself is known to present with anosmia, ageusia and Guillian Barre syndrome, a few rare cases of COVID-virus related TM have been reported. This case presents a 61-year-old female experiencing bilateral lower extremity weakness with brisk to absent reflexes. Onset of the symptoms was of 3 days origin, and she was tested positive for COVID-19. Patient did not have upper extremity symptoms but …

Comparison Of Fibula Plating Versus Fibula Nailing: A Systematic Review With Meta-Analysis Of All Current Comparative Literature, Troy Puga, Mckenna Box, Charles Marchese, Alan Lam, Sam Stegelmann, John Riehl

North Texas Research Forum 2025

Introduction Ankle fracture surgeries are common orthopaedic procedures. Fibular fixation is often an important component in restoring ankle stability. Fibular intramedullary nailing (fIMN) has gained recent interest as an alternative technique to fibular plating. This systematic review and meta-analysis was performed to compare the outcomes of fibular nailing versus fibular plating for all current available literature. Methods A PRISMA-compliant systematic review was conducted across MEDLINE/Pubmed, Cochrane, and Embase databases for cohort and clinical trial studies comparing outcomes of fibular nailing and fibular plating of ankle fractures. Demographics and results of the studies were extracted from the articles. Outcomes of interest …

Hematometra In A Pre-Menopausal Patient: A Case Report Of Idiopathic Cervical Occlusion, Sandra Zhi, Claire Middleton, Chrystal Stallworth, Mindy Beth Luck, Nicole Tenzel

North Texas Research Forum 2025

Introduction: Hematometra is a blood collection caused by a structural blockage of the vagina or cervix. Most cases of hematometra and/or hematocolpos occur in a relatively rare condition of imperforate hymen or Mullerian anomalies in children or adolescent patients. Case: We present a case of a 46 year old G2P2002 with a past surgical history of two C-sections with increasingly severe pelvic pain and abnormal uterine bleeding for the prior five years since her last Cesarean delivery. A large hematometra was found on CT imaging. Pelvic exam showed no vaginal abnormalities and a discolored, pale cervix. Digital pressure led to …

Telestration With Augmented Reality In Surgery: A Comprehensive Systematic Review And Meta-Analysis, Hannan A. Maqsood, Minaam Farooq, Laiba Sarfraz, Michael Truitt

North Texas Research Forum 2025

Objective: Augmented reality (AR) telestration has the potential to completely transform surgical teaching and training. In contrast to traditional telestration and telestration without AR, this systematic review and meta-analysis attempted to thoroughly assess the effect of telestration with AR on a variety of performance metrics, including task completion time, error rates, GOALS task-specific scores, OSATS task-specific scores, and GOALS Global scores. Methods: Six relevant publications were included after a thorough literature search was carried out to March 2024 across relevant databases. To evaluate the impact of telestration with AR on performance indicators, meta-analyses were carried out, and statistical analysis produced …

Hypothyroidism Associated Hyponatremia, A Complicated Presentation, Gary Lee, Spencer Steinberg, Samiuallh Shahid, Evangelista Ezenduka, Edgardo Flores

North Texas Research Forum 2025

Introduction: Hypothyroidism is a well known text-book cause of euvolumic hyponatremia that is a rare occurrence in clinical practice in the absence of other potential etiologies of hyponatremia. We review a case of a 48 year old female presenting with profound generalized weakness found to have severe hyponatremia, later found to have severe hypothyroidism during admission. We review the potential mechanisms whereby hypothyroidism results in hyponatremia and whether or not hypothyroidism-induced hyponatremia truly exists and the current evidence supporting these views Case Presentation: 48 year old female with history of hypothyroidism, breast cancer post right lumpectomy and radiation presented for …

Treatment Of Starvation Ketoacidosis In The Third Trimester Of Pregnancy: A Case Report, Christine Le, Charmaine Oladell, Nicole Tenzel

North Texas Research Forum 2025

INTRODUCTION: Starvation ketoacidosis represents a rare but complicated maternal morbidity that primarily occurs in the third trimester of pregnancy. With increased insulin resistance and metabolism manifesting in pregnancy, prompt care is required to diagnose and treat starvation ketoacidosis as it appears at an accelerated rate. However, despite the severity of maternal and fetal complications arising from this condition, standardized treatment protocols have not been elucidated. CASE PRESENTATION: In this case report, a 33-year-old gravida 3 para 0-2-0-2 at 31 weeks and 5 days gestational age was admitted to antepartum services for intractable nausea, vomiting, and anuria and transferred to the …

Video Games In The Management Of Adhd: A Novel Approach To Adjunct Traditional Treatment, Lekhya Kintada, France Leandre

North Florida Division GME Research Day 2025

No abstract provided.

Has The Elimination Of Mandatory Buprenorphine X-Waiver Increased Presciptions Of This Medication Upon Discharge From The Hospital?, Kendall Moore, Robyn Meadows, Robyn Hoelle, Matthew Calestino

North Florida Division GME Research Day 2025

No abstract provided.

Adverse Bleeding Events In Patients Taking Verapamil With Apixaban Or Rivaroxaban, Heena Patel, Franklin Hernandez, Kathleen Mattingly, Seth Sukriti, Chandan Mitra

North Florida Division GME Research Day 2025

No abstract provided.

Association Of Glp-1 Receptor Agonist With Risk Of Hepatocellular Carcinoma, Joane Titus, Vinay Katukuri, Moheb Boktor, Ishak Mansi

North Florida Division GME Research Day 2025

No abstract provided.

Development Of A Continous Renal Replacement Therapy Protocol For A Midsize Community Hospital, Srinidhi Shyamkumar, Eric Riha, Crystal Ike, Rachel Wright, D Villareal, Justin Shanks, Damon Cao

Gulf Coast Division GME Research Day 2025

No abstract provided.

Femoral Neck Allograft For Glenoid Reconstruction During Revision Reverse Total Shoulder Arthroplasty: A Case Report, Devin Q. John, Leon Z. Liu, Diego J L Lima, Howard D. Routman

East Florida Division GME Research Day 2025

No abstract provided.

Fatal Overlapping Cns Infections: Radiologic Correlates Of Ventriculitis, Encephalitis, And Meningitis​, Jesse F. Simon, Sara Darwish, Stephanie Nagy, Richard Shalmiyev, David Kosoy, Bryan Rubio, Gustavo Pantol, Mauricio Danckers

East Florida Division GME Research Day 2025

Introduction: This case study explores an uncommon triad of encephalitis, ventriculitis, and meningitis complicated by ischemic strokes and seizures in a COVID-19-positive patient. Prior studies suggest that bacterial meningitis and encephalitis can lead to cerebral infarctions due to inflammation and vascular injury.1,2,5 Ventriculitis, in particular, is rarely observed and typically is seen as a severe complication of meningitis, and can be managed with neurosurgical interventions such as CSF shunt placement, ventricular drains, or other intracranial devices.3,4 The simultaneous presentation of all three conditions in a single patient is rare and poses significant challenges from a diagnostic and management standpoint.

Case …

Can Residents Cheat The Unknown Slide Sessions By Using The Large Language Models? Which Model Should They Use: Chat-Gpt, Claude, Or Gemini?​, Gul Emek Wymer, Susana Ferra

East Florida Division GME Research Day 2025

Introduction: In recent years, artificial intelligence tools, such as large language models (LLMs) have expanded the potential for diagnostic medicine, including histopathology. This study aims to evaluate the diagnostic ability and utility of the publicly available large language models in predicting the accurate diagnosis of the unknown cases by using the images of the hematoxylin-eosin stained slides taken by a mobile phone and compare their performance with the residents’ performance.

Method: The twenty cases, including a variety of entities, were collected from teaching sets of non-HCA patients and public available domains, which are used for unknown slide sessions for residents. …

Comparing Chatgpt And Deepseek For Deprescription Support In Geriatric And Palliative Care: An Exploratory Study Using Clinical Vignettes, Gokhan Demir, Angel Sanchez, Sanaz Kashan

East Florida Division GME Research Day 2025

Background: Polypharmacy is common in older adults and increases risks of adverse drug events, falls, and hospitalizations. Deprescription can mitigate these harms but is often hindered by time constraints, fragmented guidelines, and complex comorbidities. Artificial intelligence (AI) large language models (LLMs) may provide decision-support for deprescription in geriatric and palliative care.

Objective: To compare ChatGPT and DeepSeek in their deprescription recommendations across standardized polypharmacy vignettes.

Methods: Three validated clinical vignettes, varied by activities of daily living (ADL) status and cardiovascular disease (CVD) history, were presented to ChatGPT (GPT-4/5) and DeepSeek (2024 version). Each vignette was tested in three replicates per …

Variability In Emergency Medicine Provider Practices For Recommending Days Off From Work Or School By Chief Complaint​, Jaime Said, Dennis Cardriche

East Florida Division GME Research Day 2025

No abstract provided.

A Case Of Gastric Outlet Obstruction Secondary To A Gallstone, Mahesh Tummala, Adam Devine, Akash Tummala, Livasky Concepcion-Perez

East Florida Division GME Research Day 2025

Introduction: Bouveret syndrome is characterized by a gallstone passing through a bilioenteric fistula causing gastric outlet obstruction and represents 1-3% of gallstone obstructions. Fistualization occurs when chronic inflammation from the gallstone on the gallbladder wall leads to ischemia and perforates into the bowel. Over 60% of patients with cholelithiasis are asymptomatic. Biliary colic is the most common presentation in symptomatic patients. A biliary fistula occurs in 3-5% of cases and just 7-10% of these cases lead to gallstone ileus. The highest prevalence is among women of advanced age. Typical presentation is with general symptoms of nausea/vomiting and vague abdominal pain. …

Cocaine Induced Agranulocytosis And Neutropenia, Maria Gomez Alvarez, Ashish Govan, Raymond Larocque

East Florida Division GME Research Day 2025

Introduction: Cocaine use in the United states is seen in many cases within the hospital system. Typically, they present with tachycardia, hypertension, sweating, even heart attack. Due to the uncontrolled sale and distribution of drugs, patients can be exposed to other additives in drugs which can lead to unexpected complications. Cocaine laced with levamisole (an antiparasitic drug used in veterinary medicine) can lead to agranulocytosis and neutropenia. Cocaine being the second most used illegal drug following marijuana it may be much more common than we think. Millions of individuals use cocaine yearly and develop a heavy addiction with use of …

Real Time Non-Targeted Renal Biopsy Adequacy Evaluation: A Successful Quality Improvement Activity, Astrid Sacasa, Susana Ferra

East Florida Division GME Research Day 2025

Introduction. Adequate renal biopsies are essential for the diagnosis and treatment of medical renal disease. This process requires a sufficient number of glomeruli for light microscopy, immunofluorescence, and electron microscopy evaluation. On-site microscopic evaluation of kidney biopsy specimens significantly improves sample adequacy and the ability to render a diagnosis, with studies showing a much higher rate of inadequate samples when on-site evaluation is absent. Inadequate biopsies can have a significant negative impact on patient care including delay of adequate diagnoses, worsening of the patients’ condition and complications, and increasing costs due to the need for repeat biopsies. A real time …

Quality Improvement Project To Increase Compliance With Standard 5.8: A Community Hospital Institutional Experience., Robert Bender, Nicole Sant 'Elia, Susana Ferra

East Florida Division GME Research Day 2025

Background: The Commission on Cancer (CoC) was established by the American College of Surgeons in 1922. In 2020, they launched the Cancer Surgery Standards Program that introduced six operative standards. Standard 5.8 requires curative intent lung resections to include sampling from at least 1 hilar, and at least 3 mediastinal lymph node stations.

Goal: To increase our institution’s compliance with CoC standard 5.8 to greater than 80% overall adherence.

Method: Included in the study were patients undergoing curative intent lung resection for lung cancer. A protocol, including a documentation paper worksheet with metric requirements, was implemented in February 2024. Monthly …

Emerging Role Of Liafensine In The Treatment Of Treatment Resistant Depression: Insights From The Enlighten Trial, Karla Narvaez, Saad Masud, Richard Callahan

East Florida Division GME Research Day 2025

Background: Treatment-resistant depression (TRD) remains a significant unmet need, affecting about one third of patients with major depressive disorder who fail to respond to two or more antidepressant trials. There is a need for new pharmacological approaches. Liafensine (also known as DB104) is a first-in-class triple reuptake inhibitor targeting serotonin, norepinephrine, and dopamine transporters, whose development has recently incorporated a precision medicine approach. Mechanism of Action: Liafensine inhibits reuptake of all three major monoamines (serotonin, norepinephrine, and dopamine) distinguishing it from existing SSRIs, SNRIs, or other agents which typically target one or two systems. A genetic biomarker, ANK3 (also called …

National Outcomes Of Pre-Emptive Tips In Patients With Acute-On-Chronic Liver Failure And Variceal Bleeding, Aya Akhras, Waseem Wahood, Azizullah Beran, Bisher Sawaf, Asad Ur Rahman, David Goldberg, Muhammed U. Shahid

East Florida Division GME Research Day 2025

Background

Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS), defined as placement within 72 hours of initial endoscopic therapy for an active variceal bleed, has been proposed as a strategy to reduce rebleeding and improve survival in high-risk patients with cirrhosis. We evaluated outcomes of patients with acute-on-chronic liver failure (ACLF) who presented with variceal bleeding and underwent therapeutic endoscopy (EGD) with or without the addition of pre-emptive TIPS.

Methods

The Nationwide Readmissions Database (2010–2022) was queried for patients with ACLF using previously validated algorithms admitted with variceal upper GI bleeding who received endoscopic intervention. Patients were stratified into two groups: therapeutic …

The Role Of Bandemia In Clinical Outcomes Of Critically Ill Septic Patients., Yerandi Gil, Grettel Gonzalez Garcia, Ambar Sekulis, Rafael Miret, Siddarth Kathuria, Mauricio Danckers, Daniel Heller

East Florida Division GME Research Day 2025

Rationale: Bandemia, defined as the presence of immature neutrophils in circulation, is commonly used as an early marker of systemic inflammation and infection. 1 However, its prognostic significance in sepsis, severe sepsis, and septic shock remains uncertain. 1-2 This study aimed to determine whether bandemia is associated with adverse clinical outcomes and increased intensive care unit (ICU) resource utilization among critically ill septic patients admitted from the emergency department (ED).

Methods: A retrospective analysis was conducted using de-identified data from the HCA Healthcare database. Adult patients (aged 18–90 years) admitted to the ICU at HCA Florida Aventura Hospital from the …

Laproscopic Robotic-Assisted Common Bile Duct Exploration For Primary Choledochlithiasis 20 Years After Cholecystetomy In A Hostile Abdomen, Enoch Wong, Kristen Payne, James Burdick, Hassan Ahmed

North Texas Research Forum 2025

Introduction: The incidence of concomitant cholelithiasis and choledocholithiasis is 5-20%. Primary choledochlithiasis more than 3 years after cholecystectomy is an even rarer event with only a handful of case reports in the literature. Robot-assisted laparoscopic common bile duct exploration with intraoperative choledochoscopy is a relatively recent development in biliary surgery. In this report, we describe the use of this technique in a patient with rare presentation and surgically challenging anatomy. Objective: To describe a minimally invasive approach for CBD exploration with extraction of choledocholithiasis in a surgically hostile abdomen and Roux-En-Y anatomy. Methods: This report describes the case of a …

An Unexpected Source Of Gi Bleeding: Enteric Muco-Submucosal Elongated Polyp In The Proximal Jejunum With Literature Review, Galvin Dhaliwal, Dev Patel, Ashvin Singh Dhaliwal, Aakriti Soni, Bilal Ashraf, Shane Sweeney, Sushovan Guha, Ahmed Ouni

Gulf Coast Division GME Research Day 2025

No abstract provided.

Turmeric, Red Yeast Paste, And Statins: A Recipe For Dili, John V. Nahas, Sinay Ceballos, Franklin Kasmin

East Florida Division GME Research Day 2025

Introduction Drug induced liver injury (DILI) contributes to a significant portion of acute liver injuries and acute liver failure in the west. DILI accounts for approximately 11% of acute liver failure cases in the US according to ACG. Insulting agents are numerous and well documented in the NIH LiverTox database, however the rarity and complexity of individual agents is a matter of ongoing study. Case Description/Methods A 52 year old man with PMH of HTN and HLD presents for a 2 week history of abdominal swelling, bilateral lower extremity swelling, decreased appetite, and positional shortness of breath. He endorses occasionally …

Unintentional Lead Dislodgement In Twiddler’S Syndrome, Howard Tan, Ashok Chaudhary, Nishant Nerella, Suman Pasupuleti

West Florida Division GME Research Day 2025

No abstract provided.

Development Of Intra-Hospital Ceftriaxone Resistance Of Serratia Marcescens Endocarditis, Mahyar Doraji, Michael Denney, Adeel Malik, Praveen Chekka, Nishant K. Nerella

West Florida Division GME Research Day 2025

No abstract provided.