Medical Specialties Commons^™

Predictors Of Incidence Of Candida Endocarditis In Patients With Candidemia: Insights From The National Inpatient Sample (2016-2020, Didien Meyahnwi Md, Tawanda Zinyandu, Ashraf Ahmed, Isaac Opoku Md

Posters

This study identifies critical predictors of CE incidence in patients with candidemia, including IV drug use, male gender, and the presence of prosthetic devices. These findings highlight the importance of targeted surveillance and management strategies in vulnerable populations.

A Rising Threat: Epidemiologic Trends In Incidence, Mortality, And Cost Of Candida Endocarditis In The United States, Didien Meyahnwi Md, Ashraf Ahmed, Tawanda Zinyandu, Isaac Opoku Md

Posters

Candida Endocarditis (CE) is a rare yet critical form of infective endocarditis (IE), accounting for approximately 1% of all IE cases. In light of the evolving epidemiology of candidemia, this study aims to elucidate any associated shifts in the epidemiology of CE within the United States.

Patient Care Technician Led Reduction In Blood Culture Contamination Rates, Elena Estrella Pct, Elissa Reyes Msn, Rn, Ccrn, Bethany Zoufaly Msn, Rn, Jennifer O'Neil Bsn, Rn, Anne M. Aquila Dnp, Rn, Cenp

Posters

Purpose:

To decrease blood culture contamination by improving staff competency

Adipose Injectable Filler With Use Of Meshed Dermal Matrix And Porcine Urinary Bladder Matrix For The Management Of A Complex Achilles Wound, Francois M. Lokenye Dpm, Orlexia Thomas Dpm, Mariam Kamil Bs, Lady Paula Dejesus Dpm, Facfas, Facpm, Dwsp

Posters

Chronic Achilles wounds present a significant clinical challenge due to limited vascularity, high mechanical stress, and the complex anatomy of the posterior lower leg.

Regenerative medicine offers a promising alternative to traditional wound management through the use of advanced biologic materials.

This case highlights a novel approach utilizing a combination of adipose-derived injectable filler, acellular dermal matrix, and porcine urinary bladder matrix to enhance tissue regeneration, provide structural support, and promote wound healing.

Dual Circulatory Support With Ecmo And Mcs Devices Is Associated With Shorter Hospital Stay Without Compromising Heart Transplant Survival, Tawanda Zinyandu, Abhinav Aggarwal, Ashraf Ahmed, Isaac Opoku Md, Didien Meyahnwi Md, Yussuf Isaka Md, Stuart Zarich, Carlos Davila

Posters

• ECMO is commonly used as a bridge to heart transplantation in critically ill patients.
• Additional MCS devices (e.g., Impella, IABP) may be used alongside ECMO to enhance cardiac output.
• The effect of dual circulatory support vs. ECMO alone on post-transplant survival is unclear especially after 2018, when the heart allocation system was revised to reduce waitlist times for MCS patients.

Discussion Of “Biggest” Problems Facing Burn Units Today; A Survey Based Analysis And Discussion From Our Aba Burn Surgeon Forum Workgroups 2024, Roselle E. Crombie Md/Mph Facs Faba, Alexandra Lacey Md, Facs, Faba, Kathleen Romanowski Md, Facs, Faba

Posters

Burn Units are a unique environment and microcosm of patients. Additionally, there have been certain factors contributing to what burn care providers consider the most important challenges facing optimal delivery of care. Formally exploring these issues may elucidate solutions by gathering different perspectives.

Reducing Vancomycin In A Cicu, Karoline Krzywda, Lauren Johnson, Allison Taber

Posters

Introduction: In the cardiac intensive care unit (CICU) empiric vancomycin is frequently prescribed. This practice occurs without wide knowledge of the true rates of methicillin resistant staph aureus (MRSA) and methicillin resistant staph epidermidis (MRSE) infections. Given the potential for harmful side effects of vancomycin as well as concern for growing antibiotic resistance we sought to better characterize local unit prescribing practices and MRSA/MRSE infection rates to guide our quality improvement project with an aim of reducing vancomycin use in our CICU. Methods: This project is taking place at Children’s Mercy Kansas City CICU, a 24 bed unit with an …

In Search Of The Unknown Mimic Of Abusive Head Trauma (Aht), Ruairi Smith-Dewey, Angela Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Danielle Horton, Nicole Johnson, Jan Leonard, Megan Letson, Caitlin Mcnamara, Shalon Nienow, Ashley K. Sherman, Stuart Sommers, Joanne Wood, James Anderst

Posters

Background Child Abuse Pediatricians (CAPs) are accused of misdiagnosing a yet-to-be-identified mimic as abusive head trauma (AHT), particularly in ill children with an isolated subdural hemorrhage (SDH). Though not diagnostic criteria, specific social stressors are identified as AHT risk factors. The existence of a mimic can be assessed by comparing the prevalence of AHT risk factors across study groups (See Table 1). Objective We hypothesize that the distribution of AHT risk factors will be: fewer in the CAP-identified mimic group versus the CAP-diagnosed abuse group, no difference between ill SDH only and SDH+CSI groups as these are likely the same …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenberg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Posters

Background: Antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it helps to limit unnecessary antibiotic exposure while continuing to provide appropriate care for infections. In our emergency department (ED), clinicians are using first-line guideline-recommended antibiotics as an appropriate choice for most patients (per our ASP report tracking), however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). National guidelines recommend shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however currently only 22% of patients discharged from our ED receive the recommended duration. Objective: …

Acceptability Of A Brief Acceptance And Commitment Therapy Intervention For Caregivers Of Children With Pediatric Feeding Disorder, Emma Murray, Taylor P. Harris, Annie L. Ryder, Alexandra Zax, Taylor M. Datillo, Corey Schurman, Laura Slosky, Sarah T. Edwards, Delwyn Catley, Ann M. Davis, Dana Bakula

Posters

Introduction: Pediatric feeding disorder (PFD) affects 1 in 37 young children and is associated with heightened stress and anxiety among caregivers. Currently, there are no established interventions that target PFD caregiver stress, and traditional models of adult mental healthcare face feasibility issues in pediatric care settings. To address this gap, we developed a brief acceptance and commitment therapy (ACT) intervention (Clinical Trials #NCT06001398). We assessed caregiver-perceived acceptability to inform future efficacy testing. Method: Twenty caregivers participated in a NIMH-funded pilot study of a 2-session ACT intervention for parents of children with PFD. Caregivers with children aged 2 to 6 years …

Aht Diagnoses: The Influences Of Clinical Presentation And Evidence Of Impact, Ruairi Smith-Dewey, Angela Bachim, Colleen Bressler, Kristine Campbell, Lori Frasier, Christopher Greeley, Danielle Horton, Nicole Johnson, Jan Leonard, Megan Letson, Caitlin Mcnamara, Ashley K. Sherman, Shalon Nienow, Joanne Wood, James Anderst

Posters

In cases where Child Abuse Pediatricians (CAPs) diagnose abusive head trauma (AHT) in young children, some factors surrounding the diagnosis have been challenged including causative shaking, necessity of external signs of impact, or concomitant suspicious injuries. Evaluation of CAP diagnoses in children with subdural hemorrhage (SDH) can give insight into factors related to the frequency of abusive head trauma (AHT) diagnoses. Additionally, characterization of those with SDH+CSI without evidence of impact may inform controversies around AHT diagnoses. Objective We aim to compare CAP diagnoses in subjects with SDH across clinical presentations and in the context of evidence of head impact. …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative, Allison Adam, Lina Patel, Christopher Kaberline, Ibad Siddiqi, Leslie Hueschen

Posters

No abstract provided.

A Risk Score To Predict Recurrent High Intensity Inpatient Resource Utilization For Children With Medical Complexity., Charles Maloy, Matt Hall, Jessica L. Bettenhausen, Yr Chan, Leah Jones, Kathryn Kyler, Laura Plencner, Jessica Markham, Jacqueline Walker, Smit Shah, Sian Best, Jonathan Ermer, Shelby Chesbro, Maria Newmaster, Hank Puls

Posters

Background

Children with medical complexity (CMC) use a greater amount of inpatient resources and stand to benefit from unique care models and coordination. However, hospital resources can be limited, and a better understanding of which CMC are high resource users could improve hospital and staff planning.

Objective:

To develop a risk score predictive of recurrent high intensity inpatient utilization among CMC.

Methods:

We conducted a retrospective cohort study of children < 18 years old with ≥3 complex chronic conditions (CCC) discharged from one of 48 children’s hospitals in the Pediatric Health Information System during 2021 and 2022. To reflect CMC typically cared for by a general medical service, children with cardiac procedures, dialysis, oncology, or transplant CCCs, and index hospitalization mortality were excluded. We used multivariable logistic regression to determine factors present on the index hospitalization associated with ≥5 hospitalizations or ≥3 hospitalizations with one lasting ≥25 days within any 365-day period (high inpatient utilization) in 2021-2023. We developed risk scoring system using model coefficients and defined the optimal risk score cutoff to maximize sensitivity and specificity. We then applied the risk score cutoff to children discharged to determine (a) ratio of predicted:actual CMC with recurrent high resource use and (b) the total predicted daily volume on 50th, 75th, and 90th percentile days for each hospital.

Results:

Of 44,432 included children , 9,596 (21.6%) had high inpatient utilization (Table). Children under 1 year of age had the highest odds of high inpatient utilization (OR 2.26 [95% …

Opportunities For Solid Organ Donation In The Neonatal Intensive Care Unit, Sarah Pippin, Ashley Sherman, Julie Weiner, Jotishna Sharma

Posters

Background: Pediatric patients are at an increased risk of mortality when waiting for an organ transplant. Approximately 50% of pediatric patients wait for> a year for a solid organ transplant and infants < 1 year of age have the highest death rate while awaiting transplantation. There are two pathways for organ donation (OD), donation after death by neurologic criteria (DDNC) or donation after circulatory determination of death (DCDD). Neonates rarely meet brain death criteria, and since most deaths in the NICU occur aftera planned extubation, DCDD with organ procurement after a planned extubation from mechanical ventilation can be a consideration especially with kidney and liver donations. Organ procurement may be limited by warm ischernic time (WI1); usually :'.S 90 minutes. The question remains which neonates would meet criteria for DCDD.

Purpose: The aim of this study is to characterize theoretical eligibility of DCDD in infants undergoing withdrawal of care in the NICU based on WIT :'.S 90 minutes

Method: Retrospective study of a cohort of infants 2:36 weeks at the time of death who died at a level IV NICU from January 1, 2012, to December 31, 2022. Demographic information was obtained. Mode of death was categorized as …

Maternal Guilt Following Pediatric Burn Injury, Sabrina Ung, Abby Dugan, Casey Lawless, Mallory Netz, Alec Bernstein, Carisa Parrish

Posters

Background: Previous research has shown that parental guilt is a risk factor for poor parental adjustment (e.g., depression, posttraumatic stress) following a pediatric burn injury (Hawkins et al., 2019). However, few studies have examined risk factors for parental guilt. Objectives/Goal: The current study aimed to examine relationships among demographic variables, burn characteristics, maternal mental health, with maternal guilt following their child’s burn injury. Methods/Design: Mothers of 147 children who experienced a burn injury (mean child age = 6.28 years, 46% female, 44.7% White, 19.2% Black or African American, 9.6% Hispanic, 1.3% Asian, 11.9% multiracial, total body surface area range .10 …

Facilitators, Barriers, & Recommendations For Pediatric Research Sites Conducting Decentralized Clinical Trials (Dcts), Abby Kietzman

Posters

The COVID-19 pandemic drastically altered the way clinical research is conducted through a widespread adoption of telemedicine practices to continue clinical trial procedures during peak periods of global COVID-19 spread. Using telehealth/telemedicine services allows researchers to conduct “decentralized clinical trials”, or DCTs, for all or portions of study protocol procedures while maintaining safety measures implemented for pandemic control. However, research sites are hesitant to adopt DCT policies due to concerns around digital health technology, data safety and quality, and limited information in the literature specifically assessing telemedicine use for pediatric clinical research via DCTs or how equipped pediatric research sites …

Antibiotics Vs Surgical Resection In Foot And Ankle Osteomyelitis, Travis Rich, Marshall G. Solomon

Posters

Osteomyelitis, a serious bone infection, is particularly challenging in diabetic patients due to poor vascularization and impaired immune response.1 Timely and effective treatment is essential to prevent severe complications, including limb loss or even death.2 This study aims to evaluate the likelihood of surgical excision or amputation versus antibiotic treatment alone in diabetic patients with bone biopsyconfirmed acute osteomyelitis of the lower extremity.

Case Report Of Surgical Management For Charcot Foot Medial Column Beaming With Stj Arthrodesis, Prachi Patel, Randy Semma

Posters

Medial column beaming is a surgical procedure that involves inserting a metallic beam to the medial column of the foot to treat the Charcot deformity of the foot.

A surgeon will use a large diameter screw to insert a beam into medial column which includes the first metatarsal, medial cuneiform, navicular and talus (fig 3) The beam shares the load of weightbearing with the foot's ligaments and joints, reducing the abnormal loss of structural integrity that can occur in Charcot arthropathy of the foot.

Subtalar joint fusion is often performed concurrently with medial column beaming to enhance the overall stability …

Polymicrobial Prosthetic Joint Infection Including Mycobacterium Tuberculosis: A Case Report, Hernan Andres Yunis, Zachary J. Walker, Matthew E. Charlick, Daniel P. Mccall

Posters

• Usual culprits of PJI affecting total hip and knee arthroplasty are Staphylococcus aureus and streptococcus epidermidis in the acute phase.

• During the chronic presentation, microbes become much more diverse as they may seed due to hematogenous spread from other body sites.

• The purpose of this case study was to illustrate an instance when polymicrobial total hip arthroplasty PJI included Mycobacterium Tuberculosis.

Subclinical Presentation Of Cutibacterium Acnesinfection Following Revision Rotator Cuff Repair: A Case Report, Zachary Walker, David Shuster, David Sosnoski, Ali Hamade, Hussein Saad, Marc Milia

Posters

Cutibacterium acnesis a gram-positive anaerobic bacillus which is commonly found in the sebaceous glands of the skin generally in the axilla, chest and back regions1,2.

Shoulder infections have been reported to occur at 3.4% following arthroscopic or open shoulder surgeries, where they are most commonly due to C. acnes3,4.

This case report demonstrates a unique case and management of a subclinical presentation of confirmed C. acnes infection.

Case Report: Diagnosing & Treating Triple Negative Breast Cancer During Pregnancy, Sydney Mefford, Chloe Page

Posters

• Pregnancy associated breast cancer (PABC) is rare and can be seen in every 1 in 3000 pregnantpatients.It is associated with a high morbidity rate, especially in cases of Triple Negative Breast Cancer (TNBC).
• Prevalence has increasedas society grows to have pregnancies at later ages. Risk is elevated for 1 year after delivery of baby.

Sole Searching: The Mystery Of A Left Foot Mood Swing Unraveled Patient, Kaitlin Sebranek

Posters

About 0.2% of patients in the Diabetic population have Charcot Neuroarthropathy.

When the gold standard of offloading in a total contact cast fails for CN patients, surgical treatment can be considered to achieve a stable, plantigrade, and functional foot.

Due to the complexity of the condition, potential complications such as hardware breakage, nonunion, and infection can result over time.

The Diagnosis Of Polyarteritis Nodosa In The Setting Of Lower Extremity Lesions: A Case Report, Eric Li, Jihan Toma

Posters

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis affecting medium-sized arteries, involving multiple organs, with the most frequently affected tissues being skin and peripheral nerves (1). The distinct pearl neckless pattern led to the naming of this condition (2). Cutaneous polyarteritis nodosa (CPAN) is a variant of PAN confined to the skin, muscles and peripheral nerves in the absence of any systemic involvement (1). This rare form of systemic necrotizing vasculitis is limited to the medium-sized arteries of the skinand has a more favorable prognosis (1). PAN is also linked to Hepatitis B(2).The current diagnostic criteria for CPAN were proposed …

Stepping Into Relief: Conquering Rheumatoid Arthritic Foot Pain With Podiatric Management, Natalie Diaz, Marshall Solomon, Inocencio Cuesta

Posters

Rheumatoid arthritis (RA) is a chronic multifactorial autoimmune disease that causes progressive joint destruction along with causing cutaneous manifestations such as nodules. RA negatively impacts life by producing pain, impairing quality of life and biomechanical function of the lower extremities.

Antibiotics Vs Surgical Resection In Foot And Ankle Osteomyelitis, Travis Rich, Marshall G. Solomon

Posters

Osteomyelitis, a serious bone infection, is particularly challenging in diabetic patients due to poor vascularization and impaired immune response.1 Timely and effective treatment is essential to prevent severe complications, including limb loss or even death.2 This study aims to evaluate the likelihood of surgical excision or amputation versus antibiotic treatment alone in diabetic patients with bone biopsyconfirmed acute osteomyelitis of the lower extremity.

Kaposi Sarcoma: Case Study, Mohamed Elshebiny, Marshall G. Solomon

Posters

Kaposi Sarcoma (KS) is a vascular tumor usually caused by a herpestype virus HHV-8

Lesions often appear as flat or raised purple-colored, and depending on the stage may be nodular and break the skin when they ulcerate.

Stages of KS are Patch stage (early stage), Plaque stage, and Nodular stage (tumor/late stage).

Can be one of four types:

–AIDS related KS – infected with HIV (AKS)

– Transplant-associated – in immunosuppressed pts

Classic – often in pts Eastern-European, Mediterranean/Middle Eastern descent

– Endemic

The Curious Case Of Ainhum Dactolysis Spontanea, Jesse Miller, Michele Bertele-Semma, Randy Semma

Posters

HPI

• 46 yoAfrican male, no major PMH.
• Pt presents with severe pain in the right 5thtoe.
• Pt had used a corn remover at home treatment 2 years ago which they stated started the progression in the pain of the patient.
• Pt states that the toe has progressively become more constricted and painful.
• Pt states that they want their toe amputated to relieve the pain.

Repair Of Achilles Tendon Re-Rupture With Fhl Transfer: A Case Study, Taylor Allison, Joshua Kazdan

Posters

The Achilles tendon consists of the soleus muscle and two heads of the gastrocnemius muscle. Loss of its function can result in loss of plantarflexion strength, which can impact activities of daily living. In a study by Scheller et al, Achilles tendon ruptures were missed on initial evaluation on 25% of their patients. Other studies have reported a similar incidence of misdiagnoses. Patients may also delay treatment due to decreased pain after the initial injury. Ruptures diagnosed 4 weeks from injury are often considered chronic, and many of these patients benefit from surgical repair. A flexor hallucis longus (FHL) transfer …

Complications And Formation Of Sinus Tracts Due To Presence Of Lead From Foreign Bodies Insoft Tissue: A Case Report, Peter J. Godoy, Marshall G. Solomon

Posters

A cornerstone of lower extremity limb salvage is to avoid development of wound complicationsinvolved in soft tissue infections .

Predicting probability of sinus tract development due to presence of lead in soft tissues from foreign bodies. Inthis particular case a bulletfragment from a previous gunshot wound was noted to be the catalyst disrupting multiple biologic processes and impairing the function of soft tissues to heal. Predicting a level of contamination in this particular case leadbelieved to cause oxidative stress and inflammation and prompt excisional removal canavoid sinus tract formations and complications.

This study presents a unique case that demonstratesbeneficial patient …

Laryngeal Tuberculosis Mimicking Laryngeal Candidiasis, Claire Walters, Maranda Saigh, Eytan Keidar

Posters

Tuberculosis (TB) from the bacterium Mycobacterium tuberculosisand candidiasis from the fungus Candida albicansare both opportunistic pathogens with the ability to instigate infections within the larynx with similar clinical features, yet vastly different diagnostic parameters and treatment regimens.

Here, we highlight a case of an Indian woman on immune-modulating drugs who presented with severe laryngeal symptoms initially presumed to be laryngeal candidiasis but was later discovered to be laryngeal tuberculosis.