Medical Specialties Commons^™

Source Model Parameters For Beam Commissioning Of Scanning Proton Therapy Treatment Planning System: Multi-Institutional Survey And Analysis, Chih-Wei Chang, Liyong Lin, Lei Dong, Heng Li, Jan Po Schuemann, Jiajian Shen, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To create a beamline-specific repository of source model parameters and beam commissioning data for scanning proton therapy (PT) treatment planning system (TPS).

Methods: We surveyed 28 PT centers, collecting beam commissioning source model parameters of diverse beamlines from different vendors: Hitachi, IBA, Varian, Mevion. Parameters included (i) beam meterset calibration in protons per MU, (ii) in-air spot size at isocenter in terms of standard deviation in x- (crossline, σ_x) and y- (inline, σ_y) directions, (iii) in-air angular spread at isocenter in x-direction (θ_x) and y-direction (θ_y). We plotted each parameter as …

Urinary Tract Infection Caused By Gardnerella Vaginalis In A 6 Week Old Infant, Rhythm Sharma, Malika Goel, Ruba Barbar

Conference Presentation Abstracts

Introduction: Gardnerella vaginalis is a frequent cause of bacterial vaginosis (BV) in adults. However, G. vaginalis infection is infrequent in infants. Only a few cases of G. vaginalis UTI have been reported so far in infants and none in the United States.

Case Description: A 6-week-old female, ex full-term at 39 3/7 weeks via vaginal delivery with no significant postnatal medical history, presented with a 2-day history of fever, mild cough, and congestion.

In the emergency department, the patient was febrile to 38.1°C, pulse 139 beats/minute, respiratory rate 34 breaths/minute, and SpO2 98% on room air. She was active and …

Proteomic Characterization Of Antibody Drug Conjugate Target Expression Profiles In Small Cell Lung Cancer (Sclc), Edwin Lin, Atulya A. Khosla, Nina K. Smrecek, Abdul Rafeh Naqash, Kaushal Parikh, Yanis Boumber, Muhammad Khalil, Aakash Desai

Conference Presentation Abstracts

No abstract provided.

Proteomics-Based Target Identification For Optimizing Bispecific Antibody Use In Nsclc, Atulya A. Khosla, Edwin Lin, Madhan Srinivasan Kumar, Jessy Deshane, Kayla Goliwas, Selvarangan Ponnazhagan, Ishmael Jaiyesimi, Aakash Desai

Conference Presentation Abstracts

No abstract provided.

Impact Of Race And Ethnicity On Financial Toxicity And Outcomes In Lung Cancer, Atulya A. Khosla, Nitya Batra, Rohit Singh, I Deshmukh, Avi Harisingani, Muni Rubens, Anjali Saxena, Venkataraghavan Ramamoorthy, Ishmael Jaiyesimi, Aakash Desai

Conference Presentation Abstracts

No abstract provided.

Exploit The Potential Clinical Benefit Of Using Proton Arc Therapy For Esophageal Cancer, Peilin Liu, Xiaoda Cong, Raymond Dalfsen, Martin Soukup, James E. Dolan, Shupeng Chen, Craig Stevens, Rohan Deroniyagala, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

No abstract provided.

Quantitative Evaluation Of Gantry Rotation Perturbation Effects On Spot-Scanning Arc Therapy (Sparc), Peilin Liu, Lewei Zhao, Gang Liu, Xiaoda Cong, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To quantitatively assess the impact of random gantry rotation perturbations on spot-scanning arc (SPArc) therapy.

Methods:

To simulate random gantry rotation perturbations, the initial gantry angle of SPArc treatment plans was modified using an in-house script. Four cases from different disease sites include brain, lung, liver and prostate were selected to evaluate. Original SPArc plans (SPArc_org) were developed through iterative processes, including control point re-sampling, redistribution of control points & energy layers, energy layer filtration, and re-sampling. Considering potential limitations, rotation perturbations of 1mm and 2mm were applied to al SPArc_org plans to generate perturbed SPArc …

Against: Adoption Of New Technologies In Radiation Oncology Must Be Evidence-Based, Xuanfeng Ding

Conference Presentation Abstracts

No abstract provided.

Evaluation Of Current Redating Guidelines For Pregnancies ≤9 6/7 Weeks' Gestation, Grace Chen, Clara Choi, Allyson Nguyen, Mark Brunk-Grady, Tuan Nguyen

Conference Presentation Abstracts

Objectives: The aim was to evaluate the validity of the current redating guidelines for pregnancies ≤9 6/7 weeks’ gestation. We postulated that visually apparent discrepancies between crown-rump length (CRL) measured by ultrasound (US) and CRL by last menstrual period (LMP) were statistically significant. Methods: This is a retrospective, cross-sectional study conducted between January 2019 and June 2023 at a tertiary referral center. Individuals who had singleton gestations between ≥6 0/7 and ≤9 6/7 weeks by known LMP were reviewed. For estimated gestational age (EGA) by LMP ≥6 0/7 and ≤8 6/7 weeks, a 3–5 day discrepancy between EGA by LMP …

Examining The Influence Of The General Surgery Resident Colorectal Experience On The Pursuit Of Colorectal Surgery Fellowship, Adam D. Price, Bilal W. Nasim, Frances Hu, Desmond Layne, Robyn Richmond, Zachary E. Hier, Antonela Muca, Alexander R. Cortez, Jonathan Abelson, Jitesh A. Patel

Conference Presentation Abstracts

Purpose/Background: Colon and Rectal Surgery (CRS) is a highly sought after and competitive fellowship following General Surgery (GS) residency. However, it has not been studied as to how a resident’s CRS experience during residency impacts their career choice and pursuit of CRS. This study aims to identify individual and program factors associated with matriculation into CRS fellowship. Methods/Interventions: An analysis of case logs and demographic data from graduates of 19 ACGME-accredited GS residency programs between 2010-2020 was completed utilizing the US Resident OPerative Experience (ROPE) Consortium. The demographics and operative experience of residents who pursued CRS fellowship were compared to …

Erdheim-Chester Disease Presenting In The Foramen Magnum With Mass Effect Of A 39-Year-Old Male, Joseph Fullmer, Brandon Metcalf, Casey Schukow

Conference Presentation Abstracts

Background: Erdheim-Chester disease (ECD) is a rare clonal histiocytosis neoplastic condition. This condition is characterized by a non-specific infiltration of foamy macrophages in multiple organs, such as the bone or skeletal system (>95%), retroperitoneum, kidneys, and heart, resulting in inappropriate inflammation, fibrosis, and multi-end organ dysfunction. central nervous system (CNS) is present in a minority of cases. This condition is extremely rare with only a few hundred cases reported in medical literature. Methods: We present a case of ECD in a 39-year-old male with past medical history for type-2 diabetes mellitus, neuropathy, and low testosterone on replacement therapy who …

Insights From Targeted Fecal Metabolomic Analysis Reveal Altered Metabolic Pathways In Treatment-Naive Pediatric Subjects With Crohn's Disease, Nadia Ashrafi, Ali Yilmaz, Nicolette Monacelli, Rose E. Callahan, Ilyas Ustun, Nathan M. Novotny, J W. Rattray, Kypros Nicolaides, Stewart Graham

Conference Presentation Abstracts

Crohn’s disease (CD) is a heterogeneous and multifactorial inflammatory bowel disease with a significant global health impact. Genetic and lifestyle factors contribute to its etiology, emphasizing dysregulation of intestinal and dietary habits. Our study aimed to identify fecal metabolites from treatment-naïve, pediatric sufferers of CD, which allowed us to investigate the underlying biochemical perturbations associated with the disease, highlighting potential, translational targets. Using a Waters Acquity UPLC coupled with a Xevo-TQ-S mass spectrometer, we quantified >500 metabolites in fecal samples (n=72) of pediatric CD sufferers. We developed diagnostic tests capable of accurately discriminating between children with CD and healthy individuals …

A Wide Range Of Fusions And Alterations Are Detected In Myb- Or Mybl1- Altered Gliomas, S Rajan, Z Abdullaev, H Lidov, Y Wilson, D Thomas, Joseph Fullmer, K Jones, D Brown, P Kobalka, A Buckley

Conference Presentation Abstracts

Background: Diffuse astrocytoma, MYB- or MYBL1-altered are rare pediatric low-grade gliomas, reported in young adults that are often associated with refractory seizures and generally located in the supratentorial compartment. While GFAP is consistently expressed, interestingly OLIG2 expression (another glial marker) is not a common finding. Here we describe the various associated genetic alterations. Methods: Fourteen cases matching to methylation class (MC), Diffuse astrocytoma, MYB- or MYBL1-altered, were analyzed for structural variants/fusion partners. Results: The median age was 16 years (range 1-64), with male: female ratio of 1:1. All but one was supratentorial (one located in pons). On histology, some showed …

Not Your Typical Recurrent Pericarditis Patient!, Tarek Alsibai, Naomi Cret, Shaiva G. Meka

Conference Presentation Abstracts

No abstract provided.

From Immune Checkpoint Inhibition To Intubation, Sabena Toor, Samridhi Gulati, Shaiva G. Meka

Conference Presentation Abstracts

No abstract provided.

Provider Perceptions Of Pediatric Obesity Management In The Primary Care Setting, Rina Edelson

Conference Presentation Abstracts

Background: Childhood obesity is a critical public health issue. The primary care setting provides an accessible avenue for management. However, primary care physicians report significant barriers to success in treating this condition.

Objective: The purpose of this study was to compare clinician perception of pediatric overweight and obesity management before and after implementation of a standardized treatment protocol based on the clinical practice guidelines released by the American Academy of Pediatrics in January 2023.

Design/Methods: This study was deemed exempt by the Institutional Review Board. A survey was created by the study team to assess 5 domains: disease knowledge, current …

Examining The Rate Of Failed Hearing Tests In Children >15 Months Of Age Who Are Referred To Speech Therapy: A Retrospective Analysis, Malika Goel, Kerry Mychaliska

Conference Presentation Abstracts

No abstract provided.

Nsaids Role In Triggering Ibd Exacerbations; Reality Or Misunderstanding? A Systematic Review, Alec Swartz, Malitha Hettiarachchi

Conference Presentation Abstracts

Introduction: Initial studies seemed to show that NSAID use was associated with increased risk of IBD exacerbation. Supported by known role of COX-1/2 isoenzymes (specifically their prostaglandin [PG] products) in maintaining GI mucosal barrier and mediating inflammation Combination of early research findings and COX prostaglandin knowledge resulted in NSAID avoidance in IBD patients. Recent data seemingly contradicts prior research, and NSAID use is predicted to not play a role in IBD exacerbation Methods: We conducted a systematic review of the literature using PubMed and American Journal of Gastroenterology. Of the thousands of results, we narrowed our results to 4 recent …

Moonlighting: A Pilot Project To Assess Impact Of Extracurricular Activities On Career Satisfaction And Quality-Of-Life In Graduate Medical Education, Charlotte O'Sullivan, David Lee, Karen Childers, Justine Nasr

Conference Presentation Abstracts

Background: Moonlighting is the delivery of healthcare outside of training programs in exchange for compensation. The Accreditation Council on Graduate Medical Education allows individual training programs to permit or restrict moonlighting, which leads to variation in prevalence and practice. Guidelines and regulations for moonlighting vary greatly across graduate medical education programs. Yet, limited research has been done to determine resident and fellow physician attitudes towards moonlighting and its impact on quality-of-life. Objective: This pilot study investigates how participating in moonlighting and extracurricular activities may impact resident and fellow physicians’ self-perceptions of quality-of-life and career satisfaction. Methods: 442 residents and fellow …

Amniotic Bladder Therapy For Treating Interstitial Cystitis/Bladder Pain Syndrome: A 6 Month Follow Up, Jack Considine, Codrut Radoiu, Sophie Wittenberg, Nivedita Dhar, Raghav Madan, Jack Vercnocke, Aron Liaw, Alaa Hamada

Conference Presentation Abstracts

Introduction: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a debilitating condition marked by chronic pelvic pain and concurrent lower urinary tract symptoms. Our prior research established the efficacy of Amniotic Bladder Therapy (ABT) in offering symptomatic relief to refractory IC/BPS patients for a duration of up to 3 months. This study aims to delve into the durability of ABT, examining its effects over a more extended period, specifically up to 6 months. Materials and Methods: Consecutive IC/BPS patients participated in the study, receiving intra-detrusor injections of 100mg micronized amniotic membrane. Comprehensive clinical evaluations were complemented by patient reported outcome measures, encompassing …

Navigating Clinical Uncertainty: A Convergence Of Hiv, Positive Ana, And Genetic Cardiomyopathy, Ioannis Karageorgiou, Nicolaas Schimmel, Phillip Marchese, Tawhida Khatoon

Conference Presentation Abstracts

We present a case involving a 36-year-old male with a complex medical history, including hypertension, hyperlipidemia, cerebrovascular accident (CVA), and Hypertrophic Obstructive Cardiomyopathy (HOCM). The patient presented with a week-long history of chest, lower extremity, and back pain, tingling, and a history of recurrent falls. The initial presentation, combined with his history of ICD placement in 2019, led to investigations for Acute Coronary Syndrome (ACS) and ICD malfunction. The patient's initial laboratory workup, which included a comprehensive drug screen, was unremarkable except for mild normocytic anemia and elevated protein levels. CT scans of the head and spine and X-rays of …

Has Colon Cancer Screening Guidelines Reduced Mortality Associated With Colon Cancer?, Sumit Gami, Rakesh Shah, Malitha Hettiarachchi

Conference Presentation Abstracts

Introduction Colorectal cancer (CRC) is a major public health concern worldwide, with high incidence and mortality rates. Globally, CRC is the third most commonly diagnosed cancer in males and the second in females, according to the World Health Organization GLOBOCAN database. The primary goal of CRC screening is to prevent mortality and morbidity from the disease. USPSTF screening recommendations for colorectal cancer, May 18, 2021: Screen all adults 45 to 75 years of age. Recommended screening strategies include: High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year or Stool DNA-FIT every 1 to 3 years …

Not-So-Typical Neurologic Effects: Unraveling Lithium Toxicity, Alexsandra Biel, Vickie Xin, Mujtaba Moazzam, Ramona Berghea

Conference Presentation Abstracts

Introduction: Lithium is one of the mainstay treatments for bipolar disorder. Given its narrow therapeutic window, acute and chronic toxicity can develop. Acute toxicity includes gastrointestinal and cardiac manifestations whereas chronic toxicity manifests as neurologic, thyroid, and renal dysfunction. The therapeutic range of lithium is 0.6 to 1.2 mmol/L. With chronic use, lithium may be toxic at 1.2 mmol/L or greater (1). Neurological toxicity includes tremors, hyperreflexia, nystagmus, ataxia, confusion, and even seizures, however, rare reports have shown peripheral neuropathy as a manifestation. Case: A 40-year-old male with a history of bipolar disorder complicated by lithium induced chronic kidney disease …

Aids Associated Cryptosporidial And Cmv Cholangiopathy, Nada Alsharif, Luxhman Gunaseelan, Mamoun Souleiman, Cecilia Big

Conference Presentation Abstracts

Introduction AIDS-associated cholangiopathy is a biliary tract condition seen in AIDS patients who are severely immunosuppressed, contributing to significant mortality in this population even in developed countries with access to HAART therapy. Case Description We discuss a thirty-six-year-old HIV positive male, non-compliant with HAART therapy, who presented with a one year history of weight loss, persistent fatigue and chronic diarrhea, which had worsened significantly in the past few weeks. Routine laboratory studies on presentation indicated elevated liver enzymes and alkaline phosphatase, a CD4 count of two, and a high HIV RNA count of 8.8 million. Imaging via CT abdomen and …

Streptococcus Pneumoniae Neck Abscess In A Patient With Waldenstrom's Macroglobulnemia, Tanya Amal, Paul Johnson, Ayesha Sharif

Conference Presentation Abstracts

Patients with Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma are at increased risk of sinopulmonary infections, pyelonephritis, and septicemia. The underlying etiology is assumed to be immune dysregulation. Patient's with Waldenstrom's macroglobulinemia have been shown to have somatic mutations in the "V". "D" and "J/H' segments of immunoglobulin gene. These mutations can affect affinity maturation and formation of memory B cells. Subsequently patient's with Waldenstrom's macroglobulinemia also have a suboptimal response to vaccination against Staphylococcus aureus, Streptococcus pneumoniae and Varicella, similar to those with multiple myeloma. Severe infections with gram positive organisms causing multifocal osteomyelitis, pleural effusion and sepsis have also been reported with …

Double Trouble Unmasked: Femoral Pseudoaneurysm And Deep Venous Thromboses Following Coronary Angiography, Mariam Jamil, Antoine Egbe, Khurram Arshad, Yazan Alamro, Essa Kadiri

Conference Presentation Abstracts

Iatrogenic pseudoaneurysms, while infrequent, represent a formidable complication of interventional cardiac catheterization, particularly in cases involving femoral artery access. This report details a unique case involving a 73-year-old male, receiving warfarin for a mechanical aortic valve, who developed a substantial right groin hematoma attributed to an iatrogenic pseudoaneurysm post-cardiac catheterization, subsequently resulting in concomitant deep venous thromboses (DVTs) in the right leg. The pathophysiology of DVTs following left heart catheterization typically involves the formation of a sizable pseudoaneurysm, exerting pressure on adjacent veins, leading to blood pooling and subsequent clot formation. Alternatively, the development of large hematomas in the thigh …

Effect Of Iv Iron-Carbohydrate Supplement On Morbidity And Mortality In Patients With Heart Failure, Yousef Alsmairat, Malitha Hettiarachchi

Conference Presentation Abstracts

Objectives: To study the effect of intravenous iron on morbidity and mortality in hospitalized patients with heart failure with reduced ejection fraction. The current European Society of Cardiology's 2021 heart failure guidelines recommend the consideration of Ferric Carboxymaltose in symptomatic patients with a left ventricular ejection fraction < 45%. Methods and results: We conducted a systematic review using articles published in PubMed and EMBASE databases. The number of records first identified was 263. The study only reviewed Randomized Clinical Trails (RCTs) published in the years 2013-2023 and removed all the duplicates and irrelevant articles using Rayyan.ai tool. The final number of qualified articles that met the study's inclusion criteria was 3, with a total of 2,279 participants. The inclusion criteria for the study included: Age > 18, and heart failure (HF) with left ventricular ejection fraction (LVEF) < 50%. The study showed that intravenous iron supplementation in patients with heart failure and iron deficiency has been proven to reduce the symptoms of heart failure, improve quality of life, increase exercise capacity and skeletal muscle strength. IV iron-carbohydrate therapy significantly reduced hospitalization for worsening heart failure, but did not significantly impact all-cause mortality, compared to control. Conclusion: IV iron-carbohydrate therapy significantly reduced hospitalization for worsening heart failure, but did not significantly impact all-cause mortality, compared to control. Based on the study review, we recommend IV iron therapy for patients with systolic dysfunction heart failure associated with iron deficiency anemia.

How Dry Is Too Dry? Dehydration Management Of Pediatric Patients In The Ed, Shruthi Rethi

Conference Presentation Abstracts

Background: Gastroenteritis and dehydration are some of the leading causes of morbidity within pediatric EDs in the US, with over 1.7 million visits and more than 70,000 hospitalizations. There are many different guidelines/standards on the definition of dehydration. Clinical exam guidance using dehydration scales have been explored (eyes, mucous membranes, and tears). However, use of them in practice is varied.
Electrolyte lab values have not been included in dehydration scales, as a cut off is difficult to determine to guide IV vs oral rehydration, or admission. There can be little overlap between clinical exam and laboratory results. Studies have shown …

The Silent Michigan Epidemic: Unraveling Neurological Changes Posed By Recreational Nitrous Oxide Abuse, Tabssum Chauhan, Mariam Jamil, Nada Alsharif, Antoine Egbe Bessong Tabot, Ammara Aftab, Erin Frankowicz, Rajiv John

Conference Presentation Abstracts

Introduction Nitrous oxide (N2O), traditionally considered a benign, odorless gas with analgesic and anesthetic properties, has seen a rise in abuse among young individuals in the United States. This abuse can lead to clinically significant neurological symptoms, including peripheral neuropathy and subacute combined degeneration of the spinal cord due to functional B12 deficiency induced by N2O. This case series examines four patients with N20 toxicity, and the functional recovery observed during subsequent follow-up visits after appropriate management. We will explore their motivation for abusing N20, their sources of access, and why its use is on the rise. Cases Description: The …

Pituitary Cushing's Disease And Compression Fractures: A Case Presentation, Nora Mcheik, Ajaz Banka

Conference Presentation Abstracts

Introduction: Cushing's disease, arising from a pituitary macroadenoma, is marked by excessive cortisol production. Labs usually signify overproduction of adrenocorticotropic hormone (ACTH), leading to elevated cortisol levels. While cortisol is essential for various physiological functions, its excess can result in various symptoms and complications associated with Cushing's disease. Notably, individuals with this condition may experience an association with compression fractures, particularly in the vertebrae, due to weakened bones. Prolonged exposure to elevated cortisol levels contributes to the development of osteoporosis, characterized by weakened bone density, making fractures more likely. These compression fractures can manifest as localized or radiating back pain, …