Medical Specialties Commons^™

Pancytopenia, Enterovirus Infection, And Pcr Testing, Stephen Mock, Salome Herzstein, Andrea Horbey

East Florida Division GME Research Day 2023

Introduction: This is a case of a patient presenting with fever, rash, and vomiting. Upon further studies, patient was found to have pancytopenia which started an extensive hospital work up.

Case Description: A previously healthy 9- year-old female presented to the emergency department with 3 days of tactile fever, 2 days of rash, and 1 day of nonbilious nonbloody emesis. The rash initially appeared on the trunk and by the day of admission, had begun to spread peripherally to the extremities. The rash on the abdomen was described as mild, generalized, blanchable and maculopapular. The rash on the extremities was …

Does Remdesivir Increase The Risk Of Pneumothorax In Covid-19 Patients?, Rebecca Smidy, Michael Gindi, Dhruv Reddy, Jacob Poliakoff

West Florida Division GME Research Day 2023

COVID-19, sars-cov-2, Remdesivir, Pneumothorax

Where’S Adam? Successful Treatment Of Covid-19 Vaccine-Related Refractory Thrombotic Thrombocytopenic Purpura, Christopher Fontela, Alfredo Toll, Jose Fernandez, Gabriel Barciela-Perez, Jorge Diaz, Greisy Curbelo-Sesin, Ilde Manuel Lee, Jose Gascon

East Florida Division GME Research Day 2023

A 54-year-old man with a medical history notable for hypertension and type 2 diabetes mellitus presented with altered mental status. Initial assessment revealed altered consciousness, aphasia, and diffuse generalized petechiae. Having recently migrated from Colombia, he had received four doses of the Pfizer COVID-19 vaccine, with the last dose administered one month prior to presentation. Laboratory results indicated severe thrombocytopenia (platelet count: 3), microangiopathic hemolytic anemia, acute myocardial, liver, and kidney injury, prompting a presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP). Confirmation was achieved through an ADAMTS13 level of less than 2 percent. Despite initiating high-dose solumedrol and emergent plasmapheresis, …

From Pest Control To Poison Control: A Novel Case Report Of Delayed Carbamate Poisoning., Kashan Mahmood, Erin Marra, Taylor Craig, Gaurav Patel

East Florida Division GME Research Day 2023

Introduction: Carbamates are a class of insecticides structurally and mechanistically similar to organophosphate (OP) insecticides. Carbamates are N-methyl carbamates derived from a carbamic acid and cause carbamylation of acetylcholinesterase at neuronal synapses and neuromuscular junctions. While they possess a similar mechanism of action to the irreversible phosphorylation of acetylcholinesterase by organophosphates, carbamates bind to acetylcholinesterase reversibly. Subsequently, carbamates typically have a similar toxicological presentation to OP poisonings with a duration of toxicity that is typically less than 24 hours.

Case Presentation: We present a case of a 51-year-old male who was complaining of diarrhea, lacrimation, salivation, headache, photophobia, diaphoresis, and …

A Case Of Coxsackievirus Type B-Induced Myocarditis Presenting With Gi Symptoms, Daniel Karpel, Jason Nguyen, Cristina Benites, Mohammed Akram, Francini Alcocer-Guzman, Evelyn Garcia, Shany Quevedo, Ambar Sekulits, Livasky Concepcion Perez

East Florida Division GME Research Day 2023

Please see supplemental content for full abstract with references.

Myocarditis affects 1.5 million people worldwide and in chronic forms can lead to heart failure. This inflammatory disorder is a primary cause of dilated cardiomyopathy globally and is frequently a complication of viral infections. Although Coxsackievirus B3 continues to be a prominent causative agent, further exploration has discovered a number of Coxsackie serotypes responsible for myocarditis. Despite being a well-known contributor to congestive heart failure, there is a lack of conventional techniques available to aid in diagnosis, making diagnosing acute viral myocarditis a complex and tedious process. We discuss the case …

When Hypothyroidism Goes Unchecked, Jeong Hwan J. Kim, Yasimin Taheri, Matt Rostami, Ian Joel, Jasprit Takher

Far West Division GME Research Day 2023

No abstract provided.

Risk Factors For Depression Progression In Parkinson's Disease: A Retrospective Cohort Study, David Kosoy, James Cassuto, Gregory Kurgansky

East Florida Division GME Research Day 2023

Introduction: Depression is a common non-motor symptom in Parkinson's disease (PD) with a significant impact on quality of life and overall prognosis. Despite the availability of effective treatments, many PD patients with depression do not receive timely diagnosis and appropriate intervention. This study aimed to identify risk factors for depression progression in PD to inform clinical practice and future research.

Methods: We conducted a retrospective cohort study of PD patients using registry data from the Parkinson's Progression Markers Initiative (PPMI) dataset. The primary outcome was depression progression, defined as a 2-point or greater increase in the MDS-UPRDS depression score within …

A Case Of Hyperkalemia Secondary To Table Salt Alternative In A Patient With Normal Renal Function, Souhil M. Jaafil, Laura Tortora, Erin Marra, Steven Shapiro

East Florida Division GME Research Day 2023

Introduction: Hyperkalemia is a commonly presenting electrolyte derangement, usually secondary to chronic kidney disease or medication use. In one retrospective study by Singer et al of 100,260 Emergency Department (ED) patient visits it was found that 1 in 11 ED patients presented with a potassium derangement (1). Patients can present in various ways, from asymptomatic to life threatening arrhythmias. A less commonly recognized cause of hyperkalemia is dietary substitutions for everyday table salt. Ayach et al reported a patient with potassium of 9.8 mmol/L secondar to dietary substitutions but with acute kidney injury and ACE inhibitor use (2). Through a …

A Young Case Of Giant Cell Arteritis, Tricia O'Brien, Philip Mesquita, Zahid Chaudhry

East Florida Division GME Research Day 2023

Introduction: Giant Cell Arteritis is condition that commonly affects patients between the ages of 70 and 80 years old. It rarely affects those younger than 50 years of age.

Description: A 40-year-old African American woman, who had previously been diagnosed with Giant Cell Arthritis via temporal artery biopsy at age 33, presented to the emergency department due to facial and arm numbness and throbbing headache. Her ESR was markedly elevated and she was placed on prednisone.

Discussion: The incidence of Giant Cell Arthritis is between 5.8 to 31.3 per 100,000 in the population. This disease affects women 2-3 times more …

Current Treatment Options For Avn (Freiberg's Infraction) Of The Second Metatarsophalangeal Joint, Nehal Modha, Fahad Rahman, Warren Windram

East Florida Division GME Research Day 2023

Avascular necrosis (AVN) of the second metatarsal is a debilitating condition characterized by the loss of blood supply to the bone, leading to cellular death and potential collapse of the affected metatarsal head. This study presents a comprehensive review of contemporary literature to elucidate the spectrum of treatment options available for managing AVN of the second metatarsal.

A systematic search of reputable medical databases yielded a total of 38 pertinent studies detailing various treatment modalities for AVN of the second metatarsal. The review encompassed surgical and non-surgical approaches, evaluating their efficacy, long-term outcomes, and complications.

Non-surgical interventions, such as protected …

A Stiff Lower Lip, Tricia O'Brien, Philip Mesquita, Zahid Chaudry

East Florida Division GME Research Day 2023

No abstract available.

Comparing The Expression Of Er, Pr, Her-2 Between Initial Biopsy And Excision Specimens In Invasive Breast Carcinoma Cases. Is There A Need For Universal Repeat Testing?, Gul Wymer, Astrid Sacasa, Susana Ferra

East Florida Division GME Research Day 2023

BACKGROUND: The current College of American Pathologist (CAP) recommendation is that breast biomarkers Estrogen (ER), Progesterone (PR) and HER2 neu (Her2) testing be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors with the aim to identify patients that will benefit from hormonal treatment or anti-Her2 therapy. Repeat testing on a subsequent specimen is not usually indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need of adopting universal reflex re-testing of breast biomarkers in subsequent excision specimens. The rationale behind this study was based upon …

Subacute Stroke Like Presentation Likely Due To Disseminated Histoplasmosis In An Immunocompromised Patient, Ashley R. Diaz, Priya Mohan, Utmitha Konda, Alfonso Manotas, Issac Ichoa

East Florida Division GME Research Day 2023

Histoplasmosis capsulatum is an opportunistic fungal infection that is largely asymptomatic and found to have nonspecific signs and symptoms. It predominates in Central and North America, and is one of the leading causes of hospitalization among the fungal family. However, in the right host, such as in this case, a patient with significant immunosuppression can develop serious manifestations as it disseminates outside of the pulmonary system. The challenging element of disseminated histoplasmosis is that despite proper treatment immunocompromised patients will frequently relapse with worsening presentation. There is limited literature on subacute stroke-like presentation in a patient with chronic infection of …

Save A Limb: Potential Utility Of Empiric Plasmapheresis For Recurrent Brachial Artery Thrombosis And Acute Limb Ischemia Following Left Heart Catheterization, Peter Harrill, Mariel Duchow, Levy Amar

East Florida Division GME Research Day 2023

Please see supplemental content for abstract with figures.

Background: Although radial artery thrombosis following left-sided cardiac catheterization is a recognized complication, with an incidence reported anywhere from 1-10%, there are very few reports of recurrent brachial artery thrombosis and acute limb ischemia following such a procedure.

Case: 64-year-old female with past medical history of a previous CVA of unknown etiology with no residual deficits and hyperlipidemia who was initially admitted for management of a suspected NSTEMI. She was started on an IV Heparin infusion prior to undergoing a Left Heart Catheterization, which was normal, using right radial artery access. Within …

An Intersting Presentation Of Angina Due To Left Posterolateral To Right Posterolateral Coronary Artery Fistula, Vivek Nadipalli, Ahmed Mahmood, Muhammad Uzair Lodhi, Bilal Hussain, Sohail Khan, Christel Cuevas, Thomas Alexander

Gulf Coast Division GME Research Day 2023

No abstract provided.

Anti-Nmda Encephalitis In A Patient With Active Covid-19 Infection, Ali Abu-Alya, Janita Sidhu, Hamza Hansoti, Tyler Voss-Hamrick, Venkatachalam Veerappan, Ruhin Sidhu

Far West Division GME Research Day 2023

No abstract provided.

A Case Of Phlegmasia Cerulea Dolens, Stefanie Navarrete

East Florida Division GME Research Day 2023

Introduction: This is the case of a patient presenting with phlegmasia cerulea dolens after recent travel with concurrent extensive pulmonary emboli. Patient’s symptoms progressed quickly, atypically, and he did not have known common risk factor for the extent of his disease.

Case Description: The patient is a 78-year-old Caucasian male who presented to the emergency department complaining of left leg swelling and mild pain that began 1 day prior. Patient flew in 3 weeks prior from Scotland. On exam, patient was found to have extensive erythema and ecchymosis of left leg. On admission, venous ultrasound showed complete extensive thrombosis of …

Microvascular Compression Causing Strokes From Subdural Hematoma Treated By Middle Meningeal Artery Embolization, Roy S. Escobar, Ali Abu-Alya, Vishnu Halthore, Julia Collins, Tanvir Khosla, Hamza Hansoti, Janite Sidhu, Venkatachalam Veerappan, Cyndi Tran

Far West Division GME Research Day 2023

No abstract provided.

Case Based Review On Headaches And Cerebral Venous Thromboembolism Post Covid-19 Infection, Aishwarya Raich, Tanvir Khosla, Vishnu Halthore, Ali Abu-Alya, Venkatachalam Veerappan

Far West Division GME Research Day 2023

No abstract provided.

Utility Of Daily Cbc In Hospitalized Patients, Lauren Howard, Kayla Engstrom, Aisha Khan, Andrew Vest, Carlos Vargas

Gulf Coast Division GME Research Day 2023

No abstract provided.

Sudden Onset Ams, Focal Weakness, Fever And Aphasia Due To Intracranial Subdural Empyema In Left Temporo-Parietal Lobe, Lily Hyunjung Lim, Menachem M. Nagar, Pallavi Aneja

East Florida Division GME Research Day 2023

Intracranial subdural empyema (ISE) is a rare infection of brain, which occurs when pus is collectively located in the space between dura and arachnoid matter. In the past, its mortality was nearly 100%, if it was not treated appropriately within 24-48 hours. Thanks to improvement of diagnostic modalities and treatment, its mortality has dramatically decreased. Though, it can still cause a devastating consequence if it is not managed in a timely manner. The common etiology of ISE is different depending on the age group. In younger patients, it occurs frequently as a complication of infection in neighboring structures like sinusitis …

Expert Consensus For Key Components Of A High Quality Ventral Hernia Repair Operative Note, Shreena Patidar, Peter Yu, Jonathan S. Lall, Said Maldonado, Nicole B. Lyons, Zuhair Ali, Mike Liang

Gulf Coast Division GME Research Day 2023

No abstract provided.

Pregnancy Induced Pancreatitis In The Setting Of Medical Abortion And Severe Hyponatremia, Nd Ekpa, Sheila Chandrahas, Randy Chung

Gulf Coast Division GME Research Day 2023

No abstract provided.

A Rare Case Of Right Atrial Appendage Mass In Patient With Recurrent Methicillin-Resistant Staphylococcus Aureus Bacteremia, Vivek Nadipalli, Ahmed Mahmood, Thomas Alexander

Gulf Coast Division GME Research Day 2023

No abstract provided.

Intracerebral Hemorrhage And Reversible Cerebral Vasoconstriction Syndrome Ina Patient With Covid-19, Matthew Bear, Branden Wilson, Aswin Srinivasan, Amar Hasan, Salman Alim, Mohamad Ezzeldin

Gulf Coast Division GME Research Day 2023

No abstract provided.

A Resident Led Newsletter Is A Powerful Communication Tool, Jonathan Brown, Rachel Hogan, An Dao, Zuhair Ali, Rajeev Raghavan

Gulf Coast Division GME Research Day 2023

No abstract provided.

Fatal Atrio-Esophageal Fistula Presenting As New Onset Seizures, Hytham Rashid, Jonathan Brown, Eryn Percenti, Justin Saunders, Sivatej Sarva

Gulf Coast Division GME Research Day 2023

No abstract provided.

Rare Case Of Chylopericardium Status Post Coronary Artery Bypass Graft, Hytham Rashid, Harris R. Khawaja, Ashley Charales, Essam Girgawy, Ramesh Kesavan, Michael Daniel

Gulf Coast Division GME Research Day 2023

No abstract provided.

Appeal: Advocating Polst Education And Adherence At End Of Life, Carlo Reyes, Susan Hickman, Neil Gerts, Mandeep Sablok, Jasprit Takher

Far West Division GME Research Day 2023

No abstract provided.

A Late Onset Leg Rash, Unique Janeway Lesions Or Jarisch Herxheimer Reaction?, Andrew Kim, Cristian Valdez, Tony Alarcon

Far West Division GME Research Day 2023

No abstract provided.