Medical Specialties Commons^™

Does Maternal Sars-Cov-2 Infection Or Sars-Cov-2 Vaccination Trigger An Inflammatory Response In The Fetus?, Ali Alhousseini, Sonia Sajja, Onur Turkoglu, Kurt Wharton, Kirsten Gage, Jaber Saad, Jay Idler, Ray Bahado-Singh

Conference Presentation Abstracts

Objective SARS-CoV-2 infection triggers a significant maternal inflammatory response. There is a dearth of data regarding whether maternal SARS-CoV-2 infection or SARS-CoV-2 vaccination triggers an inflammatory response in the fetus. Fetal Inflammatory Response Syndrome (FIRS) has been described in other clinical conditions such as intraamniotic infection and has been defined as a cord blood Interleukin-6 (IL-6) level > 11 pg/ml. The objective of the study is to evaluate Il-6 levels in the cord blood of three delivering women: SARS-CoV-2 infection group, SARS-CoV-2 vaccinated group, and a control group.

Study Design A prospective case control study of a total of 61 pregnant …

Prediction Of Small For Gestational Age Neonates By Combining Maternal Risk Factors With Biophysical Markers, Anthony O. Odibo, Umit Kayisli, Richard Bronsteen, Charles Lockwood

Conference Presentation Abstracts

OBJECTIVE: Studies have suggested a role for biophysical markers (BPM) including uterine artery Doppler (UAD) and maternal mean arterial pressure (MAP) in prediction of neonatal SGA. We sought to determine if the addition of flow velocities in spiral artery (SA), UAD, MAP and maternal risk factors could improve prediction of neonatal SGA, compared with using maternal risk factors alone. STUDY DESIGN: This is a prospective longitudinal study over a 5-year period. We measured SA UAD and MAP at: 11 to 13 + 6, 18 to 22 + 6/7 and 28 to 34+ 6/7 weeks of gestation. Prediction models for SGA …

Differential Impact Of Static Lung Compliance On Need For Reintubation In Mechanically Ventilated Covid-19 Positive And Negative Patients, L A. Abplanalp, F Ionescu, O Gomez Rojas, E Castillo, G B. Nair

Conference Presentation Abstracts

Rationale: The decision to liberate from mechanical ventilation (MV) remains the result of multi-disciplinary discussion based on imperfect clinical tools such as the rapid shallow breathing index and spontaneous breathing trials. We have previously shown that static lung compliance (Cp) can help identify patients at high risk of reintubation despite meeting traditional criteria. In this study, we hypothesized that low Cp may not explain the reintubation risk in the distinct pathophysiologic scenario of COVID-19. Methods: This was a retrospective, multi-center analysis of COVID-19-negative (Dec. 2017-Dec. 2019) and -positive patients (Mar.-Oct. 2020) who required MV and were liberated during the same …

Hex Of The Dex: Dexmedetomidine Induced Malignant Hyperthermia In Myotonic Dystrophy, K Almerico, T Salimnia, S Dogra

Conference Presentation Abstracts

Dexmedetomidine is an alpha2 agonist that has been shown to have anxiolytic, analgesic, and sedative properties making it a popular medication in the intensive care unit. Over the years, its use has become more widespread. Thus, there have been more adverse events, most notably hypotension and bradycardia. Over the past few years the side effect of hyperthermia has grown to recognition with various case reports being documented. We report a case of dexmedetomidine induced malignant hyperthermia (MH) up to 42.2 degrees Celsius in a patient with underlying myotonic dystrophy that resolved within 24 hours of discontinuing the medication. The patient …

Pulmonary Cement Emboli: An Underreported Phenomenon Or Rare Kyphoplasty Complication, A Cimino, A Alchakaki

Conference Presentation Abstracts

Kyphoplasty is an intervention to treat and stabilize painful vertebral compression fractures by injecting Polymethymethacrylate (PMMA) cement in the vertebral cavity. It has become increasingly important procedure in pathologic compression fracture treatment. Pulmonary cement embolism (PCE) happens by leakage of cement through the venous plexus or retrograde migration in the arterial vessels to aorta. It was reported as a rare complication of this procedure (3.5%) but others have suggested that because of paucity in symptoms, PCE is often overlooked and can happen in up to 28.6% of kyphoplasty patients. PCE cause a wide spectrum of symptoms ranging from asymptomatic to …

Evaluation Of Vancomycin Based On Risk Factors In Emergent And Critically Ill Patients, Morgan Ragsdale, Lisa Hal Zimmerman, Elizabeth Messana, Derek Volgyi

Conference Presentation Abstracts

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with prolonged hospital length of stay and mortality rates up to 20%. Risk factors for MRSA and presumed type of infection often guide vancomycin prescribing. This study evaluated the presence of MRSA risk factors in emergent and critically ill patients who received vancomycin therapy. METHODS: This retrospective study evaluated emergent and critically ill patients who received vancomycin for at least 24 hours for a presumed infection from 1/2020—3/2020. Patients were excluded if vancomycin was administered for surgical prophylaxis. Patients were divided into groups: MRSA Risk (MRSA-R) vs MRSA No Risk (MRSA-NR). MRSA …

Tpn-Induced Excipient Lung Disease, Tanza Salimnia, Raashi Chawla, Rameen Ghandchi, Dhiviyan Valentine, Ping Zhang, Christopher Dado, Paul Bozyk

Conference Presentation Abstracts

INTRODUCTION: Patient is a 73 year old female with past medical history of colon cancer status post colectomy/ ileostomy with ileal conduit on chronic total parenteral nutrition (TPN) who presented to the hospital for fatigue and hypotension. She reported that the night prior, she had an 8 hour lapse in her memory and a sensation of dyspnea. In the ED, she was hypotensive and hypoxic. CTA of the chest was notable for a small and nonocclusive right lower lobe embolism, massive right heart strain with RV/LV 1.5 as well as innumerable bilateral centrilobular micronodules. The above findings were not present …

Identifying Novel Subphenotypes In Covid-19 Using Protein Biomarkers, A Spicer, P A. Verhoef, C Lopez-Espina, A Bhargava, L Schmalz, M Sims, A V. Palagiri, K V. Iyer, M J. Crisp, A Halalau, N Maddens, A Espinosa

Conference Presentation Abstracts

RATIONALE: COVID-19 is widely heterogeneous in presentation, even across patients with similar demographics and medical history. Identification of subphenotypes based on host immune responses that are biologically discrete and predict outcomes may enable personalized COVID-19 therapies. Accordingly, using a composite of electronic health record (EHR) data and 36 research biomarkers, we sought to compare COVID-19 immune responses across patients of varying disease severity, identify subphenotypes within hospitalized COVID-19 patients, and test for heterogeneity of treatment effect (HTE) to intravenous corticosteroids across these subphenotypes. METHODS: In this multicenter retrospective analysis of prospectively collected data, patients presenting to three medical centers from …

Pneumothorax Ex Vacuo As Initial Presentation Of Endobronchial Tuberculosis By Mycobacterium Bovis, Olga Romina Gomez Rojas, Matthew Weatherhead, Matthew Hicks, Christopher Dado, Abdulgadir Adam

Conference Presentation Abstracts

INTRODUCTION: Mycobacterium bovis infection in humans is an extremely rare entity. M. tuberculosis and M. bovis are clinically and radiographically indistinguishable, hence, genotype-based identification is required. Management and outcomes of M. bovis infection are not well described. We present the first case of endobronchial tuberculosis secondary to M. bovis in an immunocompetent host. DESCRIPTION: A 19 year old woman without past medical history presented to the emergency department for sudden onset left-side chest pain and dry cough. A preoccupational evaluation noted a positive tuberculin skin test with normal chest-xray. Physical exam significant for absent breathing sounds in the left upper …

National Trends And Survival Outcomes Of Performing Immediate Breast Reconstruction For Male Breast Cancer Patients, Neha Sarvepalli, Nayana Dekhne, Mohamad Sebai, Patrick Karabon

Conference Presentation Abstracts

INTRODUCTION: Immediate breast reconstruction after a mastectomy was reported in 43.3% of female patients in 2014; and has been associated with improved quality of life and adherence to adjuvant therapies. While there are many studies regarding immediate breast reconstruction in women, little has been reported about reconstruction rates and outcomes in male breast cancer. The purpose of this study is to examine the trends and outcomes of performing Immediate Breast Reconstruction (IBR) in male breast cancer (MBC) patients following a mastectomy. METHODS: The National Cancer Database (NCDB) registry from 2004 to 2014 was used to identify non-metastatic MBC patients who …

Deep Brain Stimulation: A Treatment Option For Parkinson's, Michael D. Staudt

Conference Presentation Abstracts

No abstract provided.

Laparoscopic Assisted Robotic Radical Prostatectomy With Pelvic Lymph Node Dissection Using Viable Cryopreserved Umbilical Tissue To Improve Cavernosal Nerve Function., Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason Hafron

Conference Presentation Abstracts

Radical prostatectomy is the preferred treatment for patients with clinically localized prostate cancer and is typically performed using a robotic approach. Surgical techniques that preserve the neurovascular bundle minimize the risk of incontinence and erectile dysfunction post-operatively. Umbilical cord tissue is a relatively new technique, which has been shown to reduce inflammation and promote regenerative healing. In this video we show a robotic radical prostatectomy with bilateral nerve sparing technique utilizing a cryopreserved umbilical cord allograft nerve wrap.

Robotic Spleen Preserving Distal Pancreatectomy (Warshaw Techniqe) In A 12-Year-Old Female., Rachel Harvey, Begum Akay, Pavan Brahmamdam

Conference Presentation Abstracts

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare entity seen in young females. Complete surgical resection is often curative. This video shows a robotic spleen preserving distal pancreatectomy for a SPN in a 12-year-old female using the Warshaw technique. This technique preserves the short gastric and left gastroepiploic vessels allowing for splenic survival after ligation of the splenic vessels. This video demonstrates the feasibility of using the robot to perform this procedure in a pediatric patient. MRI at 18 months follow up showed that the spleen was completely perfused, with no evidence of recurrence or metastasis.

Non-Contraceptive Uses And Benefits Of Intrauterine Contraceptive Devices, Frederick Eruo

Conference Presentation Abstracts

No abstract provided.

Microbial Profile Of Lacrimal System Dacryolith In Midwest Patient Population, Peter Kally, Olivia Cheng, Thai Do, Dianne Schachter, Francesca Nesi-Eloff

Conference Presentation Abstracts

Introduction: Dacryoliths of the lacrimal excretory system are found in patients undergoing surgical treatment of primary canaliculitis and nasolacrimal duct obstruction.1,2 Dacryoliths of the canalicular pathway are classically attributed to Actinomyces species, yet a growing body of literature throughout Asia and the Middle East supports a shift towards Streptococcus and Staphylococcus species being the most common cultured organism.1–4 The Midwest microbial profile in 2009 was reported to maintain Actinomyces as the most common organism.1 The objective of this paper is to update the American Midwest demographic and microbial profile of lacrimal system dacryoliths to direct tailored regional approaches to treatment. …

Cost-Effectiveness Of Recombinant Zoster Vaccine For Vaccinating Immunocompromised Adults Against Herpes Zoster In The United States, Desmond Curran, Ahmed Salem, Stephane Lorenc, Brandon Patterson, Justin Carrico, Katherine A. Hicks, Elizabeth M. La, Sara Poston, Christopher F. Carpenter

Conference Presentation Abstracts

Background. Individuals who are immunocompromised (IC) due to disease or therapy are at increased risk of herpes zoster (HZ), with HZ cases in IC populations also resulting in increased health care resource use and costs as compared with the immunocompetent population. This study assesses the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in IC adults aged ≥ 18 years in the United States (US). Methods. A Markov model with a one-year cycle length was developed to follow a hypothetical cohort of one million IC individuals for a 30-year time horizon. The model estimates …

Weakened Igg4 Staining And Positive Pla2r Staining Indicate Resolving Primary Membranous Glomerulopathy (Mgn), Y Al-Othman, W Li, H Kanaan, P Zhang

Conference Presentation Abstracts

Introduction/Objective: IgG4 related disease, a systemic autoimmune inflammatory disorders, can be identified by high% of IgG4 positive plasma cells, thus IgG4 staining in paraffin embedded tissue is widely available in the most of pathology labs. IgG4 staining has been found useful to identify primary MGN (PLA2R and/or THSD7A positive) by others and us. This study was to scrutinize the findings of primary vs secondary MGN needed for IgG4 staining as a screening tool in our renal pathology practice over pasts 5 years Methods/Case Report: IgG4 staining in paraffin embedded tissue was performed in 45 primary MGN and 43 secondary MGN …

Recurrent Focal Segmental Glomeruloscleosis Progressing To Collapsing Glomerulopathy In Renal Graft Of An Autopsy Study, C Thorburn, K J Jabbar, W Li, H Kanaan, P Zhang

Conference Presentation Abstracts

Introduction/Objective: Collapsing glomerulopathy (CGN) mainly occurs in patients of African descent because a majority of these patients have APOL-1 gene mutations that results in damage of terminally differentiated podocytes, diffuse fusion of foot processes, and podocyte hyperplasia. Idiopathic FSGS is associated with high rates of recurrent FSGS in renal transplants and can be seen in patients with APOL-1 gene mutations as well, but recurrent FSGS progressing to CGN is not reported. Here we report an autopsy case with renal transplant showing recurrent FSGS progressing to CGN. Methods/Case Report: Our patient was a 32 year old African American man who had …

Gata3 Is A Useful Immunohistochemical Marker To Differentiate Variants Of Renal Tubular Lesions From Different Segments Of Renal Tubules, M Deebajah, Z Qu, P Zhang

Conference Presentation Abstracts

Introduction/Objective GATA3 is found in glomerular mesangial cells, and the distal tubules & collecting ducts in metanephros and eventual kidneys, but not associated with the proximal tubules and loops of Henle. We hypothesize that GATA3 can be used as a marker to identify the origin of tubular differentiation in most renal tumors.

Methods/Case Report Ten negative controls and 43 renal mass lesions (RCC, papillary, clear cell papillary, and chromophobe carcinomas, oncocytoma, and polycystic kidney disease). GATA3 nuclear stain was graded as negative (absent stain), equivocal and positive (< 5 and > 5% cells, respectively). Details of their GATA3 nuclear expression was analyzed for …

Increased Activated Plasma Cells In Inflammatory Bowel Disease When Compared To Ischemic Acute Colitis, C Thornburn, Z Qu, P Zhang

Conference Presentation Abstracts

Introduction/Objective Inflammatory bowel disease (IBD) and acute ischemic colitis can both be involved by active colitis. IBD is characterized by crypt architectural distortion, basal lymphoplasmacytosis, and occasional granulomatous changes. However, diagnosis of IBDs is still largely by exclusion of other types of active colitis with similar changes. We previously demonstrated that glucose regulated protein 94 (grp94) is mainly expressed by activated plasma cells. We postulate that increased numbers of grp94-positive plasma cells may support diagnosis of IBDs. Here, we compared IBD and active ischemic colitis for grp94 expression in mucosal plasma cells of colectomy specimens

Methods/Case Report Tissue sections from …

Case Report. Cryoglobulin Hyaline-Thrombi Associated Acute Jejunitis In A Patient With Type 2 Cryoglobulinemic Glomerulonephritis, Y Al-Othman, Z Qu, P Zhang

Conference Presentation Abstracts

Introduction/Objective Only one prior case report indicates that mixed positive cryoglobulin in serum can be associated with intestinal vasculitis (Annals of Internal Medicine, 1974).

Methods/Case Report We report a 63-year old man with history of positive serum cryoglobulin and hepatitis-C 4 years ago and membranoproliferative pattern of glomerulonephritis with possible cryoglobulin type of deposits by electron microscopy on renal biopsy. After treatment, his hepatitis C became negative. But he was recently found to have monoclonal IgM-kappa and positive cryoglobulin in his serum, and the concurrent renal biopsy showed membranoproliferative pattern of glomerulopathy with many hyaline-thrombi (eosinophilic vascular occlusions with no …

A Case Report Of Autopsy: Large Mass Of Pulmonary Metastatic Calcification In A Patient With End-Stage Renal Disease, V D. Mahalingam, P Zhang

Conference Presentation Abstracts

Introduction/Objective: Metastatic calcifications are reported in patients with end-stage renal disease (ESRD) in radiology literature but there are no pathologic reports regarding this clinical scenario in autopsy. Methods/Case Report: We report the case of a 27-yearold African American man with nephrotoxic injury secondary to gentamicin treatment at a young age leading to ESRD requiring dialysis who then later developed congestive heart disease and arrhythmia. Prior to the patient’s last hospitalization, he had normal breath sounds with no signs of respiratory distress, rales, or wheezing. Imaging of the chest showed a patchy density in the right lung and a large parenchymal …

Review Of A Common Nomenclature, Michael D. Staudt

Conference Presentation Abstracts

No abstract provided.

A Novel Combination Chemotherapy Targeting Extramedullary Disease In Multiple Myeloma Following First-Line Treatment Failure, Ruaa M. Elteriefi, Nourelhuda Abbas Hamed, Omar Nasser Rahal, Faisal Musa

Conference Presentation Abstracts

Introduction:

Multiple Myeloma (MM), a plasma cell neoplasm that resides in the bone marrow’s intramedullary space.

Extramedullary disease (EMD) occurs when plasma cells extend through the bone cortex or via hematogenous spread to different organs.

This case of EMD of MM didn’t respond to the first line RVD regimen per NCCN guidelines which includes Lenalidomide (Revlimid), Bortezomib (Velcade), and Dexamethasone (Decadron). Therefore, new combination chemotherapy including Daratumumab, and Carfilzomib was initiated with excellent response.

Case description:

62-year-old female presenting to the oncologist for progressive right hip pain for 4 weeks. Initial hip x-ray and bone scan suspected malignancy. MRI showed …

Current State Of Pediatric Obesity: Management Trends In An Outpatient Pediatric Clinic, Susan Edlibi, Ryan Rogers, Dina Abdo, Charity Owusu-Asare, Reem Wassef, Mary Coffey, Lihua Qu, Aimee Pollak, Stacey Shubeck, Kerry Mychaliska

Conference Presentation Abstracts

Background: The prevalence of pediatric obesity has increased over the last 30 years resulting inan earlier onset of obesity-related comorbidities. The greatest acceleration of Body Mass Index(BMI) in children has been reported to occur between the ages of 2 and 6 and is associated with anincreased risk of sustained obesity in adulthood. Objectives: The purpose of this study is to assess the characteristics of overweight (BMI at orabove 85th percentile) pediatric patients and current management trends in a single academicoutpatient clinic setting. Design/Methods: This IRB approved retrospective study conducted a chart review of pediatricpatients that presented to an outpatient clinic …

Effect Of Sars-Cov2 On Adolescent Phq-9 Screening Result, Aimee Pollak, Kerry Mychaliska, Stacey Shubeck, Olufunke Adeyemo, Anisah Hashmi, Mara Rubenstein, Leah Ludwig

Conference Presentation Abstracts

Background: The SARS-COV2 pandemic created numerous stressors for adolescents. Prior studies have shown an increased risk for self-reported depression symptoms in pediatric patients after trauma. . Objectives: This study compares the rates of newly diagnosed adolescent depression, and self-reported depression symptoms, in an outpatient clinic during the pandemic as compared to pre-pandemic. Design/Methods: This IRB approved study involved a retrospective chart review of adolescents aged 12-17 who attended an academic clinic between January 1, 2018 and March 22, 2020.Included were adolescents aged 12 to 17 who completed a PHQ-9 questionnaire at their annual wellness visit, without a prior diagnosis or …

Cystoscopy Scenarios You Should Recognize, Jason P. Gilleran

Conference Presentation Abstracts

No abstract provided.

A Case Of Penile Fracture With Bilateral Corporal Injury And Complete Urethral Disruption, Brett Watson, Samantha Kraemer, Bradley Rosenberg

Conference Presentation Abstracts

Introduction: Penile fracture with bilateral corporal rupture and complete urethral disruption is an uncommon injury, with approximately 60 cases reported in the literature. Case: A 54-year-old man presented with penile pain, ecchymosis, and detumescence, as well as urethral bleeding after blunt trauma sustained during vaginal intercourse. Clinical diagnosis of penile fracture was made and he was taken to the operating room for penile exploration. Complete transection of the urethra and bilateral disruptions of the corpora cavernosa were identified in the proximal penile shaft. The corpora were repaired with 3-0 vicryl. Primary urethroplasty was then performed using 4-0 PDS. Foley catheter …

Robotic Radical Prostatectomy Using Umbilical Tissue To Improve Cavernosal Nerve Function, Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason M. Hafron

Conference Presentation Abstracts

No abstract provided.

Reimbursement Incentive Associated With Decreased Inpatient Opioid Prescribing Following Robotic Radical Prostatectomy, Brett Watson, Ross Touriel, Joshua Volin, Frank Burks

Conference Presentation Abstracts

Introduction: Various strategies have been explored to decrease the quantity of opioids prescribed for post-operative pain. The Michigan Opioid Prescribing Engagement Network, in partnership with BCBS-Michigan, has developed a pain optimization pathway for several surgical procedures, including prostatectomy. Urologists who follow the pain optimization pathway, which includes pre-operative patient education and limiting discharge opioids to 6 tablets of oxycodone 5 mg, can report a modifier for additional reimbursement. We explored the impact of this incentive on inpatient opioid prescribing practices following robotic assisted radical prostatectomy (RARP). Methods: Patients undergoing RARP between January 2017 and August 2019 at a single institution …