Medical Specialties Commons^™

Malignancy Masquerading As Steroid Resistant Hypereosinophilic Syndrome, Sonya Parashar, Aarti Pandya

Posters

Introduction: Hypereosinophilia syndrome (HES) is defined as 1500 eosinophils/mL or above with evidence of end-organ damage due to the eosinophils at least 4 weeks apart. Case description: A 3-year-old male was admitted for newly found anterior mediastinal mass and left pleural effusion. About 6 weeks prior to admission, he was seen in his primary care office for difficulty breathing. Despite the appropriate treatment for his symptoms, the patient continued to have significant respiratory symptoms and a chest x-ray showed a large left pleural effusion. He was immediately transferred to a tertiary care center and a CT chest showed large left …

A Rare Cause Of Urticaria In An Nsaid Tolerant Patient, Thao Le, Mary K. Mcleod, Laurianne Wild

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Introduction: Acetaminophen is one of the most used anti-pyretics to mitigate fever. Few cases have been reported of hypersensitivity reactions to acetaminophen without non-steroidal anti-inflammatory drug (NSAID) intolerance. It is recommended that if there is suspected drug hypersensitivity then the patient should undergo an oral drug challenge. Case Description: A 49-year-old male presented for evaluation of urticaria that occurred with acetaminophen ingestion. He reported several episodes where he developed diffuse urticaria within 15 minutes of ingestion, but no other symptoms concerning for anaphylaxis. He was unsure of the dose. He also noted urticaria with Excedrin migraine, which contains acetaminophen, aspirin, …

Improving Fluid Management Of Extreme Premature Infants By Providing A Restrictive Fluid Management Algorithm In The Icn, Jacob S. Ward, Dena Hubbard, Nicholas Clark

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Intro: Excessive fluid intake in extremely premature infants during the first week of life is known to increase risk of adverse events such as necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), and overall mortality. There also is some correlation with the need for mechanical ventilation and development bronchopulmonary dysplasia (BPD). While fluid restriction is recommended to decrease the likelihood of adverse outcomes, at our institution we found there was a wide variability in and lack of evidence-based standards on fluid management in this vulnerable population. We aimed to improve the fluid management of the extremely premature infants by standardizing a …

Cardiac Biomarkers In Differentiating Kawasaki Disease And Multisystem Inflammatory Syndrome In Children Associated With Covid-19, Mollie Walton, Geetha Raghuveer, K Kamakoti, N Dahdah, L Garrido, S Tierney, T Harris, M Khoury, M Hicar, E Braunlin, D Thacker, M Khare, F Dallaire, R Lowndes, I Glassmeyer, J Ballweg, G Goldenberg, S Merves, C Manlhiot, P Farid, Bw Mccrindle

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Introduction – Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap making differentiation challenging, particularly in the absence of evidence of evidence of prior COVID-19. Hypothesis – Cardiac biomarkers can differentiate KD from MIS-C. Methods – The International KD Registry enrolled n=2903 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 42 sites in 8 countries from January 2020 through July 2022. The study population was confined to 1489 MIS-C patients meeting CDC criteria with confirmed evidence of prior COVID-19 infection and 387 KD patients meeting AHA guideline criteria with confirmed evidence …

Case Report: Autoimmune Anemia And Thrombocytopenia Following Hematopoietic Stem Cell Transplant, Thomas Cochran, Gabor Oroszi, Nancy Terwilliger, Gabe Metzler, Lejla Music Aplenc

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Background: Autoimmune cytopenias (AIC) post hematopoietic stem cell transplant (HSCT) are rare but exceptionally challenging complications. Here, we report anti E, warm autoimmune hemolytic anemia (WAIHA), cold autoantibody, polyagglutination and immune thrombocytopenia in a 5-year-old boy with a history of chronic granulomatous disease, who underwent an ABO incompatible, mismatched (9/10) unrelated HSCT. Study design: Case report. Four months after HSCT, the patient was admitted for fever, fatigue, and decreased appetite. His original blood type was O+ and donor’s blood type B+. Prior to the admission he was transfused with 2 doses of red cells and 2 doses of platelets. On …

Mobile Health Software Platform Implementation To Improve Pediatric Remote Patient Monitoring Outcomes, Lori A. Erickson, Amy Ricketts, Jenny Marshall, Krista Nelson, Peter Churchill, Dawn Wolff, Robert W. Steele

Posters

Background: Children’s High Acuity Monitoring Program (CHAMP®) is a software platform for pediatric remote patient monitoring. It is used with a proactive, personalized, pediatric care model providing a link for communication with a specialized healthcare team to patients and families in their homes. Successful implementation since 2014 includes: adoption at 12 pediatric hospitals and over 870 infants with a survival of 96.5% (down from 20% in 2012). This work led our team to engage leadership to discuss a remote patient monitoring department with new monitoring devices and expanded access to pediatric conditions.

Methods: Strategic Planning and Innovation facilitated navigation of …

Stewardship Opportunities For Cervical Lymphadenitis And Deep Neck Space Infections, Aaron Shaw, Brian R. Lee, Lauren Kazmaier, Emily Baker, Tina Dao, Sandra Arnold, Angela Myers

Posters

Background: Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities. Methods: Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, …

Inverted Appendix Presenting As Abdominal Pain And Lower Gastrointestinal Bleeding, Moises Alatorre-Jimenez, Thomas M. Attard

Posters

Background: Cecal polyps are challenging insofar as the region represents the highest risk of bleeding and perforation during polypectomy . In addition, polypoid lesions in the cecum may represent a morphologically abnormal ileocecal valve or an inverted appendix. Inadvertent polypectomy in those scenarios would lead to serious sequelae including perforation. Case report: Our patient is a 6-year-old male with a background history of prematurity, lactose intolerance, chronic esophagitis, gastritis, constipation, and painless rectal bleeding. He presented with a acute onset diffuse, severe abdominal pain associated with diarrhea that evolved to include hematochezia. At the time of presentation, he required aggressive …

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

Alterations In The Metabolic Comorbidities Of Youth With Overweight And Obesity During The Covid-19 Pandemic, Safa Farrukh, Erica Wee, Ashley Sherman, Yun Yan

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Background: Childhood obesity rates have continued to increase with the COVID-19 pandemic. However, data are limited on the impact of increasing obesity on associated comorbidities. Methods: We evaluated the progression of overweight- or obesity-associated comorbidities by investigating change in laboratory results pre–COVID-19 pandemic and post–COVID-19 pandemic onset in youth with overweight or obesity. Results: There was no significant BMI progression. There was progression of metabolic comorbidities. HbA1c progression and LDL progression were significantly correlated. HbA1c and LDL progression were significantly associated with older age and Hispanics respectively. Conclusion: The results indicate that despite no significant increase in BMI, youths with …

Two Siblings With Microvillous Inclusion Disease, Moises Alatorre-Jimenez, Brandi Weller, Meike Orlick, William San Pablo

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Introduction: Microvillous Inclusion Disease (MVID) (OMIM#251850) is a rare autosomal recessive condition caused by mutations or deletions mostly in the MYH6 gene but also STX3 and STXBP2 genes. It is characterized by protracted diarrhea with severe congenital alteration of the intestinal epithelium resulting in watery diarrhea, metabolic acidosis, failure to thrive, and permanent malabsorption that normally leads to a lifelong dependency on total parenteral nutrition (TPN) and the eventual possibility of bowel transplantation . Histological hallmarks of MVID in small intestinal biopsies are hypoplastic, atrophic, or disorganized villi without crypt hypertrophy, or immune cell infiltrate and, at the intestinal cellular …

Endoscopic Removal Of Safety Pin From Appendiceal Orifice, Alex Biller, Moises Alatorre-Jimenez, Jeremy Stewart, Ruba A. Abdelhadi

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Introduction: Foreign body ingestion in children is considered a common concern in every Emergency Department worldwide. In the United States, it is estimated that foreign body ingestions cause approximately 1,500 deaths yearly (1). Safety pins ingestions are estimated to be 1% of the foreign body ingestions in children (2). In literature, ingested safety pins have been reported to be lodged mostly in the upper gastrointestinal tract, but a few cases have been reported to be lodged in the appendix (2,3,4). Objective: Recommendations for safety pin ingestions when past the second portion of the duodenum. Case: We report the case of …

Nasopharyngeal Swabs Gone Wrong: An Unexpected Complication Of A Common Procedure, Moyosoreoluwa Laditan, Riya Kalra, Laurene Reed, Paras Khandhar

Posters

No abstract provided.

Acute Pericarditis And Acute Pleuritis/Empyema Following Submandibular Infection In A Covid-19 Positive Patient - An Autopsy Revealing The Danger Space Of The Neck, Jessica D. Anderson, Seyedalireza Fatemi, Joseph Fullmer, Ping I. Zhang

Posters

Acute pericarditis and empyema are life-threatening complications of severe odontogenic infections; reports of these findings from an autopsy perspective are rare. We report an autopsy case demonstrating infection from the mandibular molars to the pericardium and pleura in a patient following Covid-19 infection

Association Of Isolated Colitis With Non-Steroidal Anti-Inflammatory Drugs Usage, Ashbita Pokharel, Wei Li

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Non-steroidal anti-inflammatory drugs (NSAIDs) have been known to produce various clinical gastrointestinal side-effects and histopathological changes. It has been reported that NSAIDs usage is associated with isolated colitis in periappendiceal orifice region. This study aims to further evaluate the clinicopathologic features of 16 patients with isolated colitis limited to the cecum or peri-appendiceal orifice region.

Cd30 Expression In Cutaneous B-Cell Lymphomas, Olabisi Afolayan-Oloye, Lili Zhao, Trilokraj Tejasvi, May P. Chan, Paul W. Harms, Douglas R. Fullen, Ryan A. Wilcox, Alexandra C. Hristov

Posters

CD30 expression has been infrequently described in cutaneous B-cell lymphomas (CBCL). We examined CD30 expression in reactive lymphoid hyperplasia (RLH) and CBCL and correlated expression with clinicopathologic features.

Endoscopic Retrograde Cholangiography Using A Colonoscope In A Pediatric Liver Transplant Patient With Roux-En-Y Biliary Anastomosis, Nadia Ibrahimi, Thomas M. Attard, Ryan T. Fischer, Voytek Slowik, Richard J. Hendrickson, Bhargava Mullapudi, Moises Alatorre-Jimenez, Syed Jafri

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Introduction: Biliary ducal sequelae including occlusions, strictures, leaks, or necrosis frequently complicate pediatric liver transplantation. The underlying etiology includes prolonged intraoperative ischemia or postoperative arterial inflow obstruction. In adult patients the role of endoscopic retrograde cholangiography (ERC) is well established in the management of biliary complications post-liver transplantation. In contrast, in the pediatric population, due to the combination of small patient size and the complexity of Roux-en-Y anastomotic techniques, ERC has been described as difficult or virtually impossible. This limits the options available for managing biliary duct complications to percutaneous techniques Endoscopic management of biliary complications in pediatric patients with …

Repeat Tracheal Aspirates In Pediatric Intensive Care Patients: Frequency, Resistance And Antimicrobial Use, Edward Lyon, Jennifer Goldman, Brian Lee, Margaret Campbell, Rangaraj Selvarangan, Elizabeth Monsees

Posters

Background: Tracheal aspirates (TA) are frequently obtained in the pediatric intensive care unit (PICU); however, no data exists on the frequency or clinical management of multiple TA cultures on the same PICU patient. In this study, we describe the frequency of repeat TAs in PICU patients, the emergence of multidrug resistant organisms (MDRO), frequently cultured pathogens of TAs, and associated antibiotic prescribing patterns. Methods: We identified 70 PICU patients between 2018-2019 who met our criteria for retrospective chart review with ≥2 TAs obtained during their hospitalization. The following information was collected: patient demographics, number of TAs per patient, microbiology with …

Intraductal Papillary Mucinous Neoplasm In An 18-Year-Old With Recurrent Pancreatitis, Nadia Ibrahimi, Thomas M. Attard, Moises Alatorre-Jimenez, Karie Robinson, Syed Jafri

Posters

Introduction: Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are premalignant, intraductal, mucin secreting cystic lesions. IPMNs are a rare entity in the pediatric population and commonly seen in men in their 6 to 7 decade. Pediatric IPMN has been previously reported in a 14-year-old and a neonate, who also had hyperinsulinism and a de novo germline SKIL gene mutation. . Kim et al. did a ten-year single centered pediatric pancreatic malignancy study discovering IPMN in one patient of 35 with pancreatic mass removals . Case: Our patient is an 18-year-old male who initially presented at the age of 15 …

Impact Of Remote Monitoring During The Interstage Period On Outcomes In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal, Lori Erickson, Janelle R. Noel-Macdonnell, Girish S. Shirali, Hayley S. Hancock, Doaa Aly, Natalie Jayaram

Posters

Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation. We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period. Methods: Using the CHAMP database, we identified 607infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with a Windows-based …

Safety, Timing, And Outcomes Of Early Postoperative Cardiac Catheterization Following Congenital Heart Surgery, Karoline Krzywda, Jeremy Affolter, Darcie Al-Hassan, William Gibson, Ryan Romans, Kelly S. Tieves

Posters

Intro: Historically, early postoperative (<6weeks) cardiac catheterization (EPOCC) was considered high risk and often delayed. Recently, the safety of early postoperative cardiac catheterization has been demonstrated. The timing of catheterization in the struggling postoperative patient remains variable and optimal timing remains uncertain. There is limited data on the impact of EPOCC on outcomes such as length of stay, duration of mechanical ventilatory or extracorporeal support, and surgical or catheter- based interventions. The aim of this study was to describe our experience with EPOCC and its impact on management, length of stay, and duration of mechanical ventilatory support. Methods: This is a descriptive retrospective cohort study of patients who underwent cardiac surgery between 01/01/2010 and 12/31/2019 and cardiac catheterization within 30 days after surgery. Patients with catheterization for LA decompression on ECMO, endomyocardial biopsy, or BAS post hybrid procedure were excluded. We collected information surrounding timing, indication, and complications of catheterization, duration of mechanical ventilation/ECMO, and ICU/hospital LOS and compared these differences in patients who underwent EPOCC < 72hours (earlier) versus >72hours (later). Data was analyzed using IBM SPSS, version 28. Chi-square and Student’s t-test, or appropriate nonparametric tests were used to compare categorical and continuous variables, respectively. Results: There were 2542 surgeries performed during the study period with 167 patients undergoing cardiac catheterization within the defined 30 days. Twenty-six patients met exclusion criteria, leaving 141 patients for analyses. Median time from surgery to EPOCC was 10 days (1-30), with 26 patients(18.4%) having an earlier EPOCC. Interventions were performed in 70 patients (49.6%), not statistically different in those with earlier vs later EPOCC [n=9 (12.9%) vs …

Use Of Cgm In Monitoring Neonatal Diabetes, Emily Metzinger, Kelsee Halpin

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Introduction Although continuous glucose monitoring (CGM) has increased in patients with Type 1 diabetes, its use in the neonatal population has remained limited. Neonates, particularly preterm infants, are at risk of impaired glucose control. Several studies have looked at the use of these devices in improving care for premature infants without diabetes. We describe a case of a very low birth infant with neonatal diabetes secondary to a GATA-6 mutation. Clinical Case This is a late preterm infant with IUGR, truncus arteriosus, and neonatal diabetes. Exome genetic panel showed a mutation in GATA-6. Her neonatal diabetes was challenging to control …

Detection Of Enterotoxin Gene Cluster In Staphylococcus Epidermidis Recovered From Neonatal Liver Abscess, Bishara J. Freij, Barbara E. Robinson-Dunn, Patrick M. Schlievert

Posters

• Neonatal pyogenic liver abscesses are rare • Potential routes of hepatic infection include: portal vein, biliary ducts, hepatic artery during sepsis, or direct spread from infected contiguous structures • Risk factors may include bloodstream infection, abdominal surgery, umbilical vein catheterization, total parenteral nutrition, necrotizing enterocolitis, and/or immune deficiencies • More common in premature infants at present • Variety of etiologic agents for neonatal liver abscess: Staphylococcus aureus (methicillin-susceptible and resistant), coagulase-negative staphylococci (CONS), streptococci, Escherichia coli, Klebsiella, Pseudomonas, Enterobacter, Serratia, and Candida • Umbilical stump and catheter exit site hub often colonized with CONS • CONS colonize nearly all …

Vampirism For The Microbiologist, Joudeh B. Freij, Bishara J. Freij

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Vampirism has been a means to explain the cause of communicable diseases throughout the centuries.

Hyperinsulinemic Hypoglycemia And Growth Hormone Deficiency Secondary To 20p11 Deletion, Erica Wee, Kavitha Dileepan, Sarah Tsai, Emily Paprocki

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No abstract provided.

Hemoglobin A1c Increase In Youth At Risk For Developing Type 2 Diabetes Mellitus During The Covid-19 Pandemic, Erica Wee, Ashley Sherman, Mark A. Clements, Kelsee Halpin, Yun Yan

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No abstract provided.

Myocardial Work By Strain Echocardiography: A Predictor Of Exercise Capacity In The Fontan Population, Amulya Buddhavarapu, Suma Goudar, David A. White, Daniel Forsha, Doaa Aly

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INTRODUCTION: Global myocardial work index (GWI) obtained by non-invasive pressure-strain loops is a fast-emerging tool to assess myocardial contractility, independent of loading conditions. Data about the feasibility and utility of this modality in single ventricles are still lacking. AIM: We aimed to explore the relationship between the non-invasive myocardial work indices and exercise parameters in the Fontan population. METHOD: Fontan patients were prospectively evaluated by exercise testing and echocardiography. The systemic ventricle was tracked in 3 orthogonal apical planes for global longitudinal strain (GLS). Pressure-strain loops were generated against brachial blood pressure (surrogate for ventricular systolic pressure in the absence …

Pre-Medical Student Concerns Regarding Applying To Medical School During Covid-19 Pandemic, Rachel Connell

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INTRODUCTION
Over the last two years, the COVID-19 pandemic has altered the system processes of medical education. The primary goal of this study is to identify themes regarding the concerns of pre-medical students in the 2020-2021 application cycle through qualitative analysis of www.studentdoctor.net medical school admission forum posts in order to contribute to the limited literature available on this relatively novel topic.

Death Exposure Influence On Medical Students’ Attitudes Toward End-Of-Life Care, Sara J. Barlow, Nelia Alfonso, Jason A. Wasserman

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INTRODUCTION
Advance directives help guide individuals and their families in making end-of-life decisions that physicians must respect and carry out on behalf of patients to provide optimal care that aligns with their wishes. The facilitation of end-of-life care and the application of advance directives are impacted by physicians’ attitudes and knowledge regarding this topic. Current studies focus on the perspective that practicing physicians have toward advance directives. Our goal is to examine the end-of-life preferences of medical students at Oakland University William Beaumont (OUWB) School of Medicine before and after clinical exposure to better appreciate how and when opinions regarding …

Custom Ampliseq Targeted Sequencing Panel For Orphan Pediatric Retinal Diseases: Norrie Disease, Fevr, And Retinoschisis, Michael Sun, Wendy Dailey, Amanda Petrilli Cicerone, Jennifer Felisky, Kaylee Moyer, Naomi Haque, Alvaro Guzman, Kendra Mellert, Kimberly Drenser, Kenneth P. Mitton

Posters

INTRODUCTION
DNA-sequencing is not readily available in countries with little research resources or where health insurance does not cover the costs. This is especially true for very rare (orphan) inheritable retinal diseases. We wanted to develop a rapid targeted-sequencing protocol for eight genes involved in Familial Exudative Vitreo-Retinopathy (FEVR), Norrie Disease, and Retinoschisis, at greatly reduced cost.