Medical Specialties Commons^™

Todd's Paralysis: Sharpnel-Induce Seizure, Kenny Tran, Alain Folefack

North Texas Research Forum 2025

When evaluating seizure in war veterans, distinguishing new-onset hemiparesis with aphasia from stroke can be challenging due to prior brain injury and anticonvulsant therapy. This case involves a patient with a shrapnel injury displaying stroke-symptoms after a seizure highlights the differences between stroke and seizure-related deficits in this population. Careful consideration of imaging, history and clinical presentation are essential for accurate diagnosis and management.

Streamlining Bubble Study Requests In Echo Orders: A Qi Initiative, Vineeth Lekkala, Sharvani Raguthu, Taher Yusufali, Mahmood Ahmad, Mohan Sengodan

North Texas Research Forum 2025

Introduction: This quality improvement project centers around the implementation of a dedicated mechanism for ordering bubble studies in echocardiograms at Medical City North Hills Hospital. Drawing inspiration from successful implementations observed at Medical City Denton Hospital, the project aims to address existing challenges, standardize practices, and improve overall efficiency in the echocardiogram ordering workflow. Background: The echocardiogram ordering process at Medical City North Hills Hospital currently faces challenges, specifically the absence of a dedicated mechanism for ordering bubble studies. This deficiency introduces the risk of oversights, particularly in cases of syncope and stroke, thereby compromising diagnostic precision. Acknowledging these challenges, …

Improving Annual Wellness Visit Documentation In Clinic, Chak Lam Yeung, Gurunath Subramanyam, Krishna Ramesh, Mohammad Nadim, Jasmyne Bowser, John Sturgeon

North Texas Research Forum 2025

Introduction: Medicare beneficiaries who received an annual wellness visit (AWV) were noted to have reduced Medicare spending. Review of Medical City North Hills Internal Medicine Clinic data showed that 44% of eligible patients received an AWV. Improper documentation and coding were the primary reasons eligible AWVs were not accounted for even though they were performed. Majority of incomplete documentation was missing information regarding patient’s functional ability, level of safety, home safety, and activities of daily living. The information is normally obtained from a questionnaire completed by the patient prior to the visit. Questionnaire was noted by residents to be unorganized …

Dilemma In Managing Patients Presenting With Nstemi & Concurrent Gi Bleed, Mehak Sachdeva, Kathleen Mattingly, Franklin Hernandez, Jonathan Grube

North Florida Division GME Research Day 2025

No abstract provided.

Denovo Malignancy After Liver Transplantation In Patients With And Without Hepatocellular Carcinoma, Mohammad Abuassi, Carson Creamer, Harsimran Kalsi, Kobina Essilfie-Quaye, Tony S. Brar, Yaseen Perbtani

North Florida Division GME Research Day 2025

No abstract provided.

Reconciliaction Ensuring Accurate Home Medication List, Juan Pablo Meruvia Garron, Saud Khan, Akash Patel, Anna Maria Abi Nehme, Jomaris Centeno Girona, Olga Karasik

North Florida Division GME Research Day 2025

No abstract provided.

Sodium-Glocuse Cotransporter-2 Inhibitor Decreases The Risk Of Heart Failure Hospitalization & Regardless Of Left Ventricular Ejection Fraction, Hussein A. Noureldine, Thais Schwartz, Qusai Alqudah, Maryam Alhousseini, Ann T. Tong

North Florida Division GME Research Day 2025

No abstract provided.

Improving Skin Cancer Screening In A Fm Residency: Dermatoscope Utilization, Aleksandra Radzio, Navina Delight, Aniruddha Logan

North Florida Division GME Research Day 2025

No abstract provided.

Improving Colon & Rectal Cancer Screening At Medical City North Hills Clinic, Basil Nduma, Sharvani Raguthu, Gurunath Subrahmanyam, John Sturgeon

North Texas Research Forum 2025

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths globally. Despite its severity, fewer than half of eligible Americans undergo annual screening. The U.S. Preventive Services Task Force (USPSTF) recommends CRC screening from age 45 to 75, with personalized assessments for those aged 76 to 85. The current CRC screening rate at the Medical City North Hills Internal Medicine Residents’ Clinic is 9.3%, significantly below the target rate of over 66%. Objective: This project aimed to increase the CRC screening rate from 9.3% to over 66% at the Medical City North Hills Internal Medicine Residents Clinic, in …

Navigating The Complexity Of Ards And Cardiogenic Shock With Veno-Arterial Ecmo: A Case Report, Sanjana Kesireddy, Mohan Sengodan

North Texas Research Forum 2025

INTRODUCTION: When deciding between VA ECMO (veno-arterial ECMO) and VV ECMO (veno-venous ECMO), the primary consideration is the underlying pathology affecting the patient’s heart and lungs. VA ECMO provides support for both the cardiovascular and respiratory systems, making it suitable for patients experiencing cardiogenic shock or combined cardiac and respiratory failure. In contrast, VV ECMO is used exclusively for respiratory failure, offering support to patients with severe lung dysfunction but intact cardiac function. CASE PRESENTATION: 41 year old male with no known past medical history presented s/p cardiac arrest secondary to aspiration pneumonia due to alcohol and opioid intoxication. Chest …

Malignant Phyllodes Tumor With Osteosarcomatous Differentiation, Chris Robert, Kayla Mccarthy, Danielle Pigneri

North Texas Research Forum 2025

Introduction: Phyllodes tumors are fibroepithelial tumors accounting for 1% of primary breast neoplasm with malignant transformations occurring in 10-20% of the tumors. Heterologous osteosarcomatous differentiation is a rare and aggressive variant associated with poor prognosis. Case report: A 38-year-old female presented with a mass that she noticed a month ago with increase in size of mass to 10cm at time of presentation. A biopsy of the mass showed a fibroepithelial lesion with focal areas of stromal overgrowth, accompanied by stromal hypercellularity without evidence of nuclear pleomorphism, mitotic activity, necrosis and heterogenous elements most likely a benign phyllodes tumor. Due to …

Never Admit Or Release Without Considering A Naloxone Script (Narcan), Farid Mughni, Mustafa Ibrahim, Dante Janolo, Samuel Ramos, Emma Rivas, Olga Karasik

North Florida Division GME Research Day 2025

No abstract provided.

Use Of Va Ecmo In Patients With Acute Pulmonary Embolism Presenting With Obstructive Cardiogenic Shock Undergoing Mechanical Thrombectomy, Luke Taylor, Otoniel Espinoza, Omar O. Hernandez, Shannon Biggers, Shirin Miller, Srinivas Yallapragada, Amer Alaiti, Andrew Fredericks, Song Li, Claudius Mahr

North Texas Research Forum 2025

BACKGROUND: Management of VA ECMO has substantially evolved over the years. Much literature has been published regarding indications, management, and outcomes; however, limited evidence exists detailing strategies to manage, progress, and wean patients from VA ECMO. We present our experience using a VA ECMO expected progression patient management guideline. METHODS: The VA ECMO Expected Progression Patient Management Guideline, approved on June 1, 2021, consists of six goal-oriented stages with suggestive interventions for managing cardiogenic shock patients undergoing VA ECMO therapy. Patient characteristics and outcomes were collected retrospectively and compared between March 2019 to May 2021 (VA Non-Expected Progression group) and …

There’S A Qr Code For That: Trauma Performance Improvement, Patient Safety, And Peer Review, April Miller, Luis Taveras, Elizabeth Kim, Kathy Galt

North Texas Research Forum 2025

In preparation for our facility’s initial ACS verification visit, a Trauma Consultative Site visit in 2021 identified the need for a streamlined process to communicate issues to the Trauma Program that were recognized during patient care. This was especially true on weekends and nights when issues were most likely to occur. A recent literature review revealed implementation of electronic communication tools increased reporting of performance improvement and patient safety (PIPS) events and improved tracking and resolution of events. The authors of that study used a virtual chatroom accessible from cell phone to post PIPS events. One perceived drawback to this …

Anti-Pd-1 Monoclonal Antibody Induced Diabetic Ketoacidosis In Melanoma, Boney Lapsiwala, Jacqueline Bekhit, Indira Tata, Vibhuti Veeranna

North Texas Research Forum 2025

Background: Immune checkpoint inhibitors (ICIs), including pembrolizumab, are increasingly used in cancer therapy, particularly for melanoma. While effective, these agents are associated with various immune-related adverse events (IRAEs), including endocrine disorders like diabetic ketoacidosis (DKA). This report aims to contribute to the understanding of pembrolizumab-induced DKA, especially in patients with pre-existing prediabetes. Case Presentation: A 78-year-old male with a history of melanoma, prediabetes, and other comorbidities developed DKA after 1.5 years of pembrolizumab treatment. He presented with symptoms of weakness, thirst, dry mouth, and diarrhea, alongside severe hyperglycemia and metabolic acidosis. Diagnostic workup confirmed DKA, and his clinical improvement followed …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Keloids, Marshall Hall, Alyssa Forsyth, Paige Loux, Henry Lim, Christian Scheufele, Garrett Furth, Michael Carletti, Stephen Weis

North Texas Research Forum 2025

Introduction: Keloids are benign, firm nodules resulting from excessive scar formation, typically following trauma, but they can also arise spontaneously. They commonly affect areas like the chest, shoulders, back, cheeks, and earlobes. Their growth exceeds the boundaries of the original injury. Keloids can cause discomfort, pruritus, or cosmetic concerns. While they are more prevalent in individuals with darker skin tones, they occur across all age groups and skin types. Differentiating keloids from conditions such as hypertrophic scars, dermatofibromas, acrochordons, inflamed nevi, cysts, and lipomas i s crucial for proper diagnosis and management. This review highlights the diverse clinical presentations of …

Gastrografin Enema To The Rescue Of The Glorious Cecal Bascule, Dominique Pean, Bushra Bangash, Guntash Khasria, Ismail Hader

Gulf Coast Division GME Research Day 2025

No abstract provided.

A Rare Case Of Brucellosis Relapse, Rabia Mahfooz, Grant Patterson, Annmary Behanan, Babivigasan Gunasegaran

Gulf Coast Division GME Research Day 2025

No abstract provided.

Recurrent Syncope In A Young Adult With Postural Orthostatictachycardia Syndrome (Pots): A Diagnostic And Therapeutic Challenge, Syed Raza, Shuchita Jhaveri, Neethu George, Julian Nguyen

Gulf Coast Division GME Research Day 2025

No abstract provided.

Planned Out Of Hospital Birth Maternal And Neonatal Outcomes In A Single Institution, Priyanka Vuppala, Juhi Singhal, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Fetal Presentation Confirmation On L&D With Ultrasound, Noelle Coen, Aaron Poole

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Incarcerated Gravid Uterus, Adelene Morrow, Aaron Poole

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Management Of Placenta Accreta Spectrum Disorder Diagnosed Prior To Viability, Anjali Patel, Virginia Lowe, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Management Of A Venomous Snake Bite Resistant To Crofab And Anavip: A Case Report, Michelle D. Hernandez, Ernest Gonzalez

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Immune Related Cardiac Cardiac Tamponade Triggered By Pd-L1 Blockade In Breast Cancer: A Case Report, Luis Salcedo, Ivan Mogollon, Francisco Arias, Jose Donis, Michelle Lopez

Gulf Coast Division GME Research Day 2025

No abstract provided.

Atn Masquerading Rapidly Progressive Glomerulonephritis: Atypical Presentation Of P-Anca Associated Vasculitis With Rpgn, Nimmy Joy, Anabel Al Abdallah, Andrea Francis, Saurabh Pande

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Excitation And Polarization Of Isolated Neurons By High-Frequency Sine Waves For Temporal Interference Stimulation, Iurii Semenov, Vitalii Kim, Giedre Silkuniene, Andrei G. Pakhomov

Bioelectrics Publications

The capacity of temporal interference (TI) stimulation to target deep brain regions without affecting nearby surface electrodes remains uncertain. Using artifact-free optical recording, we compare excitation patterns and thresholds in hippocampal neurons stimulated by “pure” and amplitude-modulated sine waves, representing TI waveforms near electrodes and at the target, respectively. We show that pure 2- and 20-kHz sine waves induce repetitive firing at rates that increase up to 60–90 Hz with stronger electric fields. Beyond this limit, action potentials merge into sustained depolarization, resulting in an excitation block. Modulating the sine waves at 20 Hz aligns firing with amplitude “beats” and …

Time Of Urine Sampling May Influence The Association Between Urine Specific Gravity And Body Composition, Patrick B. Wilson, Brian K. Ferguson, Ian P. Winter

Exercise Science Faculty Publications

Urine specific gravity (USG) is frequently utilized in sports practice and research to assess hydration status. Prior research suggests that individuals with large amounts of fat-free mass (FFM) and muscle have elevated USG, but little is known about whether the time of collection (first-morning vs. spot sampling) and various nutritional factors influence these relationships. This cross-sectional, observational study assessed fasted first-morning (n = 55) and non-fasted spot USG (n = 51) samples in adults and evaluated relationships of USG with body composition and nutrition intake. The InBody 770 was used to estimate FFM, skeletal muscle mass (SMM), and total body …

Plasma S100Β Is A Predictor For Pathology And Cognitive Decline In Alzheimer’S Disease, Geetika Nehra, Bryan J. Maloney, Rebecca Smith, Wijitra Chumboatong, Erin L. Abner, Peter T. Nelson, Björn Bauer, Anika M. S. Hartz

UK CARES Faculty Publications

Background Blood–brain barrier dysfunction is one characteristic of Alzheimer’s disease (AD) and is recognized as both a cause and consequence of the pathological cascade leading to cognitive decline. The goal of this study was to assess markers for barrier dysfunction in postmortem tissue samples from research participants who were either cognitively normal individuals (CNI) or diagnosed with AD at the time of autopsy and determine to what extent these markers are associated with AD neuropathologic changes (ADNC) and cognitive impairment.

Methods We used postmortem brain tissue and plasma samples from 19 participants: 9 CNI and 10 AD dementia patients who …

Artesunate Enhances The Efficacy Of Enzalutamide In Advanced Prostate Cancer, Xinyi Wang, Jinghui Liu, Fengyi Mao, Yifan Kong, Qiongsi Zhang, Chaohao Li, Daheng He, Chi Wang, Yanquan Zhang, Ruixin Wang, Sally R. Ellingson, Qiou Wei, Zhiguo Li, Xiaoqi Liu

Toxicology and Cancer Biology Faculty Publications

Prostate cancer (PCa) is one of the leading causes of death among men worldwide. Treatments targeting the androgen receptor pathway remain the standard therapy for PCa patients. Enzalutamide (ENZ), a second-generation androgen receptor inhibitor, was developed to treat castration-resistant prostate cancer. However, while patients initially respond to ENZ, drug resistance typically develops within a few months. Artesunate (ART), a semisynthetic derivative of the Artemisinin plant, is approved for antimalaria treatment. In this study, we conducted an FDA-approved drug screening and identified ART as a potential candidate for overcoming ENZ resistance in PCa. Mechanistically, ART induces the degradation of c-Myc, enhancing …