Medical Specialties Commons^™

Growth Hormone Pathway As A Prognostic And Therapeutic Biomarker In Patients With Unresectable Hepatocellular Carcinoma Treated With Radiation Therapy, Joe R Eid, Safa Kaseb, Lianchun Xiao, Ryan Sun, Mahesh Kumar Kannan, Manal Hassan, Asif Rashid, Hop S Tran Cao, Hesham M Amin, Eugene J Koay

Faculty, Staff and Student Publications

Purpose: Radiation therapy (RT) has emerged as an effective local therapy option for patients with unresectable hepatocellular carcinoma (HCC) and is associated with improved overall survival (OS). However, some patients still have poor outcomes after RT, and biomarkers are needed to stratify prognostic groups. High circulating growth hormone (GH) levels promote HCC proliferation and survival and are associated with aggressive disease. In this study, we evaluated whether pretreatment GH levels are associated with OS and progression-free survival (PFS) in patients who underwent RT for unresectable HCC.

Methods and materials: Patients undergoing RT for HCC during 2017-2023 were identified from a …

Corrigendum To 'Risk Factors For Bronchiolitis Obliterans Syndrome After Initial Detection Of Pulmonary Impairment After Hematopoietic Cell Transplantation' [Transplantation And Cellular Therapy 29/3 (2023) 204-204], Mansour Alkhunaizi, Badar Patel, Luis Bueno, Neel Bhan, Tahreem Ahmed, Muhammad H Arain, Rima Saliba, Gabriela Rondon, Burton F Dickey, Lara Bashoura, David E Ost, Liang Li, Shikun Wang, Elizabeth Shpall, Richard E Champlin, Rohtesh Mehta, Uday R Popat, Chitra Hosing, Amin M Alousi, Ajay Sheshadri

Faculty, Staff and Student Publications

No abstract provided.

Transitioning To Adolescent And Young Adult Or Adult Cancer Survivorship Care: A Systematic Review Of Contemporary Guidelines And Trials, Darren Haywood, Hammersley, Ursula Sansom-Daly, Jordana Mcloone, Evan Dauer, Helen Wilding, Nicolas H. Hart, Thomas Walwyn

Research outputs 2022 to 2026

Background: Health service transitions of child, adolescent, and young adult cancer survivors between paediatric and adult cancer care services are pervasively fragmented, resulting in poor coordination, reduced satisfaction, and adverse outcomes for cancer survivors and significant others (e.g., caregivers and family members). Numerous trials and clinical guidelines have been developed to support care transitions, but their convergence, divergence, and methodological quality remain unclear. To advance clinical practice and quality research about care transitions, a synthesis of trials and guidelines on child, adolescent, and young adult care transition across age-appropriate cancer services is required to inform future research, practice, guideline, and …

Severe Transvalvular And Paravalvular Aortic Regurgitation As Late Tavr Failure Successfully Treated With Percutaneous Therapy, Ashley Armstrong, Luca Halalau, Ivan Hanson

Conference Presentation Abstracts

BACKGROUND - Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis. With improving long-term survival, late prosthetic valve–related complications are increasingly recognized. CASE SUMMARY - We report a 74-year-old man who presented eight years after TAVR with progressive dyspnea, orthopnea, and bilateral lower extremity edema, identified to be acute decompensated heart failure with a new diastolic murmur. Transthoracic echocardiography demonstrated severe aortic regurgitation. Subsequent transesophageal echocardiography identified concomitant severe paravalvular and severe transvalvular regurgitation of the bioprosthetic valve. Invasive hemodynamic assessment revealed acute volume overload with markedly elevated filling pressures, secondary pulmonary hypertension, and right ventricular …

Opioid-Free Hernia Repair Protocol Reduces Pediatric Opioid Exposure Without Compromising Pain Control, Abigail Teitelbaum, Kristin E. Lemarbe, Diane Studzinski, Corey Shafer, Antonela Muca, Emanuela Peshel, Randall Hilleary, Anthony Stallion, Nathan M. Novotny, Pavan Brahmamdam, Begum Akay

Conference Presentation Abstracts

Abstract: Purpose: Protocolizing perioperative pain management may reduce opioid exposure in children. We designed a multimodal pain management protocol for pediatric ambulatory hernia surgery with the goal of reducing opioid use. This study evaluates the impact of this protocol on opioid use, pain control, and patient/proxy satisfaction. Methods: Our protocol utilized child life services, regional anesthesia, and non-opioid analgesic adjuncts in the perioperative period. We reviewed all pediatric ambulatory hernia cases two years before and after protocol implementation. Protocol adherence was stratified by level of opioid use: high (no opioid use), medium (opioids used intraoperatively or postoperatively), and low adherence …

Novel Applications Of Coronary Cta In Patients With Intermediate Risk Of Cad, Ashley Armstrong, Luai Madanat, Robert D. Safian

Conference Presentation Abstracts

Background: ACC/AHA guidelines provide class 1 and 2A recommendations respectively for coronary CTA and FFRCT in patients with chest pain and intermediate risk of CAD. We present a case in which novel applications of CTA excluded obstructive CAD, identified the correct diagnosis, and allowed optimization of medical therapy. Case: In a 72-year-old male with stable angina and HEART score 6, stress ECG was positive for angina and frequent PVCs (Fig 1A). Coronary CTA (Fig 1B) and FFRCCT (Fig 1C) showed non-obstructive CAD and intramyocardial bridging/severe systolic compression in the mid-LAD (Fig 1D). AI plaque analysis demonstrated a mixed plaque burden …

Right Atrial Thrombosis In Behcet's Disease Presenting With Tricuspid Inflow Obstruction, Famta Basher Bisher, Thekrayat M. Asad, Sireen Shehadah

Conference Presentation Abstracts

Introduction Behçet’s disease (BD) is a chronic multisystem vasculitis characterized by recurrent mucocutaneous, ocular, vascular, and neurologic manifestations. Cardiac involvement is rare but can be severe, with intracardiac thrombosis representing an uncommon and potentially life-threatening complication. Management is challenging, as first-line medical therapy may be limited by bleeding risk or hemodynamic compromise. Case Presentation A 26-year-old woman with a 9-year history of Behçet’s disease presented with two weeks of progressive dyspnea, palpitations, fever, fatigue, and cough. She denied chest pain, or syncope, or lower extremity swelling. One year prior, she had been hospitalized for pulmonary embolism and was found to …

Leveraging State Of The Art Simulation-Based Education To Enhance Medical Student Interest In Internal Medicine And Cardiology, Mohamed Abdalaziz, Nicholas Mitchell, Ryan Madder

Conference Presentation Abstracts

Abstract Background: Early clinical exposure plays a critical role in shaping medical student interest, and therefore choice in medical specialty. Traditional curricula offer limited opportunities for hands-on engagement with cardiovascular decision-making and procedures. Simulation-based education may address this gap by providing immersive, low-risk learning experiences. Methods: An internal medicine resident and Cardiology fellow led, faculty-supported simulation curriculum was developed for third- and fourth-year medical students using a state-of-the-art simulation laboratory. Two 75-minute sessions were conducted over a two-month period, with a total of 27 students participating. The first session included a focused electrocardiography didactic emphasizing ST-elevation myocardial infarction (STEMI) recognition, …

Igg4-Related Aortitis Presenting As Intramural Hematoma Of The Descending Thoracic Aorta, Sarah Ibrahim, Tejasvini Khanna, Lark Steafo, Ioannis Karageorgiou, Judith Bateman

Conference Presentation Abstracts

IgG4-related aortitis is a rare manifestation of IgG4-related disease and can closely mimic acute aortic syndromes, including intramural hematoma (IMH), on imaging. Isolated involvement of the descending thoracic aorta is particularly uncommon, and misdiagnosis may lead to unnecessary surgical or endovascular intervention. A 68-year-old man with extensive cardiovascular disease, including prior coronary artery bypass grafting, recent percutaneous coronary intervention with drug-eluting stent placement, permanent pacemaker implantation for complete heart block, and recent pulmonary embolism, presented with three days of chest pain, shortness of breath, and left lower quadrant abdominal pain. At presentation, he was receiving apixaban, aspirin, and clopidogrel. Computed …

The Role Of Simulation In General Surgery Residency: Advancing Technical Proficiency And Clinical Confidence, Matthew A. Daniel, Alyssa Mcmandon, Rachel Daley, Andrew Gustetic, Alexis Howarth, Meghana Jacob, Holden Lewis, Kushali Patel, Taylor Locklear, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Surgical training has changed significantly over the past several decades, largely due to advances in technology. After the introduction of laparoscopic and robotic surgery into residency programs, simulation-based training (SBT) has become an important addition to surgical education. Simulation-based training offers a safe and structured environment to practice skills, receive feedback, and develop technical and non-technical abilities. While its benefits are well recognized, wider use of SBT continues to face challenges, including high costs, limited faculty availability, and time constraints within residency schedules. New technologies such as artificial intelligence, virtual and augmented reality, and standardized simulation frameworks may help address …

Building A Better Clinical Competency Committee: A Multi-Institutional Approach To Improving The Quality Of Resident Feedback Through Appreciative Inquiry, Nikita Khetan, Emma Omoruyi, Elizabeth Hanson

HCA Healthcare Journal of Medicine

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires pediatric faculty to convene twice yearly as a Clinical Competency Committee (CCC) to review resident performance and provide feedback. Variability in review processes and limited feedback quality remain common challenges. Incorporating Appreciative Inquiry within a Deliberate Practice framework may enhance the quality of summative feedback provided to residents.

Methods

This project was conducted with pediatric residents and faculty during the 2019–20 academic year at The University of Texas Health Science Center at Health San Antonio (UTHSA) and during the 2021-22 academic year at The University of Texas Health Science Center …

Optimizing Antibiotic Strategies With A Clinical Pathway Approach: Enhanced Initiation And De-Escalation In Community-Acquired Pneumonia, Ahmad Behzadpour

HCA Healthcare Journal of Medicine

Background

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization, mortality, and health care expenditure worldwide. Inappropriate use of broad-spectrum antibiotics contributes to antimicrobial resistance, adverse drug events, and increased costs. Antibiotic stewardship and standardized clinical pathways are key strategies to improve prescribing practices.

Methods

This quality improvement (QI) initiative was conducted at a 240-bed tertiary care teaching hospital from January 2023 through January 2025. A CAP-specific digital clinical pathway was developed using Curbside Health® and integrated into the electronic health record (EHR), accessible through a structured order set to support real-time clinical decision-making. The intervention included provider education and …

Impact Of Innovative Interprofessional Practice And Education Intervention Led By Graduate Medical Education Resident Physicians With School-Based Nursing In 32 School Districts, Christoffer A. Amdahl, Hans Drawbert, Sadra Forati, Tyler Fields, James Mantil, Afsha Rais Kaisani, Marci Ayers, Michele L. Mccarroll Phd

HCA Healthcare Journal of Medicine

Background

School nurses play a critical role in student well-being, underscoring their growing importance in both education and health care systems. Research consistently demonstrates their contributions to individual student care and broader population health.

Methods

This resident-led project explored community-based partnerships to facilitate mutual learning between school nurses and graduate medical education (GME) physicians. Conducted during the 2023–2024 academic year, this quality initiative (QI) involved the Medical City Healthcare (HCA Healthcare) GME programs and North Texas school districts. Educational resources were delivered through in-person teaching sessions led by resident physicians and hands-on medical simulations. School nurses who attended the Continuing …

Enhancing Resident Preparedness For The American Board Of Surgery Certifying Exam Through Low-Stakes Mock Oral Sessions, Camila R. Guetter, Taylor Locklear, Omar Haque, P Nina Scalise, Saptarshi Biswas, R. Wesley Vosburg

HCA Healthcare Journal of Medicine

Background

The American Board of Surgery (ABS) requires trainees to pass both a written qualifying examination (ABSQE) and oral certifying examination (ABSCE) to achieve board certification. The high-stakes nature of the ABSCE, which assesses knowledge, clinical judgment, and decision-making, necessitates extensive preparation. To address the challenges of the ABSCE format and associated trainee stress, structured mock oral programs have been developed. Here we evaluate the impact of structured mock oral sessions on residents' comfort levels and familiarity with the ABSCE at a single institution.

Methods

A mixed-methods survey was given to 50 general surgery residents in different training years who …

Severe Chemotherapy-Induced Peripheral Neuropathy Presenting With Paraplegic Symptoms: A Rehabilitation Case Report, Cecilia Hammond, Elizabeth Campione

Oncology Rehabilitation in Practice

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is characterized by sensory and/or motor symptoms in distal extremities starting within 24 hours of receiving chemotherapy and can potentially last for years. Management of CIPN may include medication (i.e. Duloxetine) and physical therapy (PT). The purpose of this case report is to describe the rehabilitation process and adjustments to the plan of care for a patient with severe CIPN. This case underscores the importance of a proper diagnosis and the need for research to develop evidence-based guidelines for PT interventions for non-ambulatory patients with severe CIPN.

Case description: The patient was a 53-year-old female …

Igg4-Related Disease As An Uncommon Cause Of Myocarditis: A Case Report., Emily Ellis, Sarah Grebennikov, Rodolfo Jose Denadai Benatti

Heart and Vascular Articles

BACKGROUND: IgG-4-related disease (IgG4-RD) is a systemic fibroinflammatory disease that can affect any organ system. Myocarditis is a rare manifestation.

CASE SUMMARY: A 65-year-old woman with clinically diagnosed IgG4-RD, who had recently completed corticosteroid taper, presented with multiple admissions for recurrent chest pain and myocardial injury. Coronary angiography repeatedly showed preserved coronary anatomy, and initial transthoracic echocardiography showed preserved left ventricular systolic function. Subsequent transthoracic echocardiography showed rapid decline in ejection fraction, and cardiac magnetic resonance imaging (MRI) showed myocardial oedema, infarct scar, and patchy non-ischaemic fibrosis. A probable diagnosis of IgG4-RD myocarditis was made clinically based on medical history, …

Knowledge Gaps In High-Energy Sacral Fracture Treatment And Management, Ashraf N. El Naga, Marko H. Neva, Ahmed Abdelazim Hassan, Gregory D. Schroeder, Mohammad El-Sharkawi, Sebastian F. Bigdon, Andrei F. Joaquim, Klaus Schnake, Richard Bransford, Emre Yilmaz

Rothman Institute Papers

High-energy sacral fractures (HESF) are often challenging injuries due to the location of the sacrum at the junction of the spine and pelvis, the complex biomechanics of the pelvic ring and the wide spectrum of injury patterns, which make treatment standardization challenging. Despite advances in classification systems - particularly the AOSpine Sacral Injury Classification - significant gaps remain in understanding optimal management. To review and discuss the management and identify knowledge gaps related to HESF. A narrative review of the literature was conducted, focusing on five domains: 1. Relative instability and biomechanics affected in different injury patterns; 2. The significance …

Cyanosis-Associated Coagulopathy In Neonates Undergoing Cardiopulmonary Bypass: A Scoping Review, Lily Crickmar

Student Works

2. Structured summary:

A. Background: Patients with cyanotic congenital heart disease exhibit coagulation abnormalities related to chronic hypoxemia, which may increase the risk of bleeding and thrombosis, particularly during cardiopulmonary bypass.

B. Objective: This scoping review mapped the existing literature on coagulation disturbances and perioperative hemostatic outcomes in pediatric patients with cyanotic congenital heart disease.

C. Methods: 14 studies meeting the inclusion criteria were identified through structured database searching. The data were collected and synthesized descriptively due to heterogeneity in study design, patient populations, and coagulation assessment methods.

D. Results: Across studies, cyanotic patient physiology was associated with platelet dysfunction, …

Occupational Stressors And Health Impacts Among First Responders, Mason N. Roach

Honors College Theses

The United States 911 emergency response system is an interconnected web of public services that seeks to provide its community with care, resources, and safety in times of need. However, the impact of this support on the employees providing the service often goes unnoticed. This review identifies and analyzes the unique strains on first responders' physical and mental health using the Job Demand-Control Model and the Allostatic Load Model. A review of available research literature supports the conclusion that occupational-related stress, including trauma exposure, shift work, poor leadership, and inadequate communication, can have long-lasting negative impacts on provider health.

Extrapulmonary Small Cell Carcinoma Presenting As Bilateral Papilledema, Hyponatremia, Encephalitis, Seizures, Crmp5-Igg Reactivity, And Prominent Anterior Tubular Perivascular Spaces, Ramsis Benjamin, Drew Thomas, Nina Mourao, J. Judd Fite, Brianna Woodliff, Shubhank Goyal

School of Medicine Publications

Background: Paraneoplastic syndromes that affect both the optic disc and the brain parenchyma typically harbor antibodies directed toward CV2/collapsin response-mediator protein 5 (anti-CRMP5), amphiphysin, Ma antigen 2 (Ma2/Ta), and Yo. The most common cancers linked to anti-CRMP5 antibodies include small-cell lung carcinoma (SCLC), followed by thymoma, renal cell carcinoma, and thyroid papillary carcinoma. A long-held belief explains papilledema as related to increased pressure within the subarachnoid space or the microvascular capillaries, but intracranial pressures within the normal standard range may exist in a person with a paraneoplastic syndrome and papilledema. The glymphatic system, a central waste-clearance conduit, may play a …

Mislabeling And Inappropriate Analysis Render Interpretations From “The Effect Of The Participatory Heat Education And Awareness Tools (Heat) Intervention On Agricultural Worker Physiological Heat Strain: Results From A Parallel, Comparison, Group Randomized Study” Unreliable, Chelsi M Webster, Yasaman Jamshidi-Naeini, Lilian Golzarri-Arroyo, Colby J Vorland, Zachary J Schlader, Blair D Johnson, David B Allison

Faculty, Staff and Students Publications

No abstract provided.

From Pages To Practice: Course Design For Integrative And Connected Learning, Prutha Deshpande

UNLV Best Teaching Practices Expo

The poster provides resources for the design of courses to incorporate considerable reading, paired with purposeful activities and reflection questions that deepen understanding of key points of learning, support knowledge transfer, and encourage dialogue and connection.

“Finding From The Field”—An Approach To Encourageexperiential And Epistemological Reflection, Julian Kilker

UNLV Best Teaching Practices Expo

The “Findings from the Field” teaching practice asks students to document and analyze experiences, locations, or artifacts encountered outside the classroom. While traditional field trips emphasize experiential learning by, ideally, linking course concepts to real-world experiences, this “Findings from the Field” approach extends this model through epistemological reflection guided by annotating observations. Students are prompted to consider not only what they observe, but how they know what they know, encouraging metacognition about observation, experience, and empirical research.

Reinforcement Learning Improves Llm Accuracy And Reasoning In Disease Classification From Radiology Reports, Yishu Wei, Yi Lin, Adam Flanders, George Shih, Yifan Peng

Department of Radiology Faculty Papers

Accurate disease classification from radiology reports is essential for many applications. While supervised fine-tuning (SFT) of lightweight LLMs improves accuracy, it can degrade reasoning. We propose a two-stage approach: SFT on disease labels followed by Group Relative Policy Optimization (GRPO) to refine predictions by optimizing accuracy and format without reasoning supervision. Across three radiologist-annotated datasets, SFT outperformed baselines and GRPO further improved classification and enhanced reasoning recall and comprehensiveness.

A Systematic Review And Meta-Analysis Finds That Psychological Well-Being Predicts All-Cause Mortality Independently Of Psychological Ill-Being., Max Genecov, David Yeager

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND: Does psychological well-being (e.g. life satisfaction, happiness, meaning in life) predict the length of a person’s life, or are measures of well-being simply assessing the absence of ill-being (depression, loneliness, sadness) and are therefore redundant with ill-being measures? Individual studies have examined this question by measuring and controlling for both well-being and ill-being, but inconsistent findings have been reported. METHODS: A systematic review and random-effects meta-analysis was conducted on the literature of prospective longitudinal studies linking all-cause mortality to well-being. Studies that controlled for ill-being were compared to studies that did not control for ill-being to identify the unique …

An Exploration Of Drivers Of Sepsis Outcomes In Racial And Ethnic Minority Populations, Matthew Moritz, Omar Pandhair, Shelley Schoepflin Sanders

Books, Presentations, Posters, Etc.

RATIONALE: Race and ethnicity affect sepsis outcomes in unclear ways. Existing data is conflicting, with some studies suggesting minority patients do worse, while others did not show a difference in outcomes between these groups. We sought to investigate whether inequalities exist in sepsis outcomes for different racial and ethnic groups in our large hospital system and to characterize how they may manifest. METHODS: We performed a retrospective cohort study of adults diagnosed with sepsis and discharged from any of Providence’s 52 hospitals between January 1 and December 31, 2023. We grouped patients into ten different race/ethnicity groups including White, Black, …

Behavior Change In A Young Woman: The Secret Lies In The Ovarian Tumor, Matthew Moritz, Md, Linh Tang Taylor, Md, Olivia L Snir, Stephanie Griffith, Md

Books, Presentations, Posters, Etc.

Introduction: Autoimmune encephalitis is a rare immune-mediated disorder characterized by neuropsychiatric symptoms. Anti-NMDA receptor (NMDA-R) encephalitis, the most common subtype, affects approximately 1 in 1.5 million people annually. We present a case of a young female with new-onset hallucinations, behavioral changes, and personality disturbance. Case Presentation: A 32-year-old female with remote methamphetamine use and recent trauma presented with acute mental status changes, aggression, emotional lability, and hallucinations. Vitals were normal; on exam she appeared confused, agitated, and displayed unusual behavior, including hallucinations. Initial evaluation revealed mild leukocytosis, but otherwise normal urine drug screen, chest radiograph, TSH, ANA, VDRL, heavy metal …

Ecmo As A Bridge To Lung Transplant For Refractory Rapidly Progressive Interstitial Lung Disease, Matthew Moritz, Omar Pandhair

Books, Presentations, Posters, Etc.

Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody is most frequently associated with dermatomyositis with various degrees of clinical manifestations including rapidly progressive interstitial lung disease (RP-ILD), inflammatory arthritis, vasculopathy, and other cutaneous findings. Clinically amyopathic dermatomyositis (CADM) is frequently associated with RP-ILD and has high mortality rates. Here we present a case of anti-MDA5 associated RPILD but without other features of dermatomyositis that did not respond to standard immunosuppressive therapy. A 41-year-old woman with recently diagnosed interstitial lung disease and polyarthritis previously on methotrexate presented with progressive dyspnea and worsening hypoxemic respiratory failure. She was previously admitted for respiratory failure two …

Hydroxocobalamin In Septic Shock Management – Should It Be Introduced Sooner?, Linh Tang Taylor, Md, Cameron Miles Long, Md, Omar Pandhair

Books, Presentations, Posters, Etc.

Introduction: Treating sepsis involves timely antibiotics, adequate fluid resuscitation, and vasopressor support if shock develops. Plasma concentrations of nitric oxide and hydrogen sulfides are elevated in early sepsis, contributing to vasoplegia,1 a pathology that isn’t addressed by vasopressors. High-dose hydroxocobalamin (vitamin B12) does, and therefore, has long been explored as a potential adjunct to vasopressors, though no consensus or official guidelines for its use have been published. Case Report: A 26-year-old man who was diagnosed with acute myeloid leukemia a few months prior presented to the emergency room for fever, weakness, and emesis. He was found to be profoundly hypotensive …

Hypercalcemic Crisis After Open Mitral Valve Replacement, Andrew Sunwood, Do, Jason Heino

Books, Presentations, Posters, Etc.

59. Hypercalcemic Crisis After Open Mitral Valve Replacement Andrew Sunwood, DO Background: Hypercalcemic crisis is a rare manifestation of primary hyperparathyroidism characterized by a sudden increase in serum calcium levels to >14 mg/dL with symptoms of hypercalcemia including adverse gastrointestinal symptoms, abdominal pain, and even predisposition to cardiac arrhythmias. There is only one other documented case of hypercalcemic crisis occurring after open heart surgery. Case information: 69-year-old female with a history of primary osteoporosis on alendronate and valvular heart failure presented for mitral valve replacement. Preoperative lab work did not show evidence of electrolyte abnormalities. She under- went open bioprosthetic …