Medical Specialties Commons^™

The “Cushion Effect” Revisited:, George A. Flores, Annelyn Torres-Reveron, Raul Barreda

Research Symposium

Background: It is known the pattern and severity of injuries sustained during a motor vehicle accident depend on many variables. An interesting avenue for research is obesity as a positive or negative modifier for injury distribution patterns in MVA. We hypothesize that body mass index (BMI) will influence MVC related injury patterns.

Methods: We queried STRAC data for DHR - Edinburg for the years 2014 to 2018 using CPT codes for MVC/MVA, IS > 8, age 15 - 64. Interactions between injury location, BMI, seatbelt and gender were analyzed.

Results: We had 191 detailed crashes, we found increasing age to be …

Stem Cell Technology For Age Related Macular Degeneration Intervention, Laura Valdez

Research Symposium

Retinal pigmented epithelium (RPE) cells are located between the choroid and photoreceptors within the eye and are essential to provide nutrients from blood to rods and cones, as well retinoids of the visual cycle. Vision loss and various ocular diseases are attributable to the degeneration or dysfunction of the RPE cells, leading to blindness.One of the major ocular problem from RPE dysfunction is macular degeneration. Age-related macular degeneration (AMD) can be frequently diagnosed in patients over the age of 60. In the early stages of AMD, some symptoms may not be noticeable but will lead to vision loss in both …

Pharmacoeconomics Of Metastatic Colorectal Cancer Treatment With Targeted Therapies Guided By Companion Molecular Diagnostics, Luis E. Fernández-Garza, Hector Sánchez-Ibarra, Daniela Treviño-Sáenz, Hugo A. Barrera-Saldaña

Research Symposium

Background: To guide the treatment with monoclonal antibodies (MAbs) against the epidermal growth factor receptor (EGFR) of metastatic colorectal cancer (mCRC), the FDA recommends prior companion molecular diagnosis (CMDx). It initially recommended screening for mutations in exon 2 of the KRAS gene, and most recently to extend to screening to exons 2, 3, and 4 of KRAS and 2, 3, and 4 of NRAS genes; furthermore, to evaluate the BRAF exon 15 mutation status (including V600E). To date, no studies have been done to compare the cost-benefit of these different CMDXs.

Methods: We have compared the cost of treatment without …

Outcomes Of Hypofractionated Radiation Therapy In Locally Advanced Non-Small Cell Carcinoma Lung : A Single Institutional Experience, Meenu Gupta, Shivani Mehra, Vipul Nautiyal, Sunil Saini, Mushtaq Ahmed

Research Symposium

Introduction: Radical treatment in locally advanced non small cell carcinoma lung presents a management dilemma in patients with compromised performance status. Hypofractionated EBRT resolves this by confering high efficacy while avoiding excessive early toxicity.

Objectives: To evaluate the efficacy and tolerance of hypofractionated radiotherapy in locally advanced lung cancer patients with compromised performance status.

Methods: From January 2019 to January 2020,62 patients were enrolled to receive hypofractionated radiotherapy with 40Gy in 16 fractions with 5 fractions per week (2.5Gy per fraction) because of compromised performance status. Follow-up was conducted at 6 weeks and 3 months for symptomatic and radiological response …

Pediatric Covid-19 Encephalitis, Nelson D. Gonzalez, Dustin Paul, Ana Almeda, Samuel Serna, Linette Linsangan

Research Symposium

Background: Neurologic complications of COVID-19 in the pediatric population have been reported in a limited number of reports. There have been reports of COVID-19-associated encephalitis in pediatric cases along with neuroimaging findings revealing involvement of some parts of the nervous system. We present the first case of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - associated encephalitis targeting the parietal lobes.

Case: A 14-year-old morbidly obese Hispanic male with no past medical history presented to the hospital for new onset seizures. Family reported exposure to his COVID-19 positive mother, a one-week history of fever, and a three-month history of …

Moans, Palpable Groin, And Entrapment Of Bone: A Case Of Malignant Peripheral Nerve Sheath Tumor In An Otherwise Healthy Hispanic Male, Nelson D. Gonzalez, Christine E. Loftis, Rosa Guedez-White

Research Symposium

Background: Malignant peripheral nerve sheath tumors (MPNTs) are rare malignant soft tissue sarcomas that have an incidence of about 0.001 %. MPNTs typically occur in individuals who have neurofibromatosis or secondary to radiation therapy and rarely occur sporadically. We present a case of a previously healthy 56-year-old gentleman who was diagnosed with MPNTs.

Case: A healthy 56-year-old gentleman presented with worsening LLQ abdominal pain for 6 months. Associated symptoms included bloating, LLE swelling, early satiety for the past 2 months, and a 5-10lb unintentional weight loss. Patient denied recent cough, night sweats, dyspnea, fever, chills, melena or hematochezia. Vitals were …

Long Non-Coding Rna (Lncrna) As A New Biomarker For Hepatocellular Carcinoma (Hcc) Drug Resistance, Areeb Masood, Kyle Doxtater, Anupam Dhasmana, Subhash C. Chuahan, Sanjaya Satapathy, Manish Tripathi

Research Symposium

Background: Hepatocellular carcinoma (HCC) is the 4^th leading cause of cancer-related deaths worldwide and the 6^th most common cancer worldwide. When HCC progresses to advanced stages, drug resistance becomes a major hurdle and leaves clinicians with limited therapeutic options. Long non-coding RNAs (lncRNAs) have shown to promote drug resistance in various cancers. The goal of our research is to explain the molecular role of lncRNAs in HCC drug resistance and compile a comprehensive list of studied lncRNAs involved in HCC drug resistance.

Methods: To compile a list of lncRNA involved in HCC drug resistance we performed an advanced …

Improving Internal Medicine Residents’ Self Perceived Confidence, Knowledge And Procedural Skill Performing Pap Smears, Azucena Del Real, Adriana C. Betancourth, Leonardo Pozo, Gabriel J. Lora Ferreira, Andres Suarez, Stephanie Luu, Jose Rivera, Christine E. Loftis, Cesar Gutierrez

Research Symposium

Background: Cervical cancer is the second most common cancer in women worldwide; early detection plays a key role in reducing morbidity and mortality. In Texas’ counties lining the border, cervical cancer death rate is 30% higher than the rest of the state.

Methods: A total of 20 Internal medicine residents from the UTRGV - DHR were randomized to an intervention and control groups. Before the intervention, residents had not received any formal training skills on Pap smear technique during their residency. The educational intervention consisted of an eleven-minute video on Thin prep specimen collection and a single-day hands-on training skills …

Fat Distribution And Differential Effects On Metabolic Liver Fat Infiltration In Young Mexicans In Reynosa, Mexico: A Collaborative Study Across The U.S.-Mexico Border, Esperanza Milagros Garcia-Oropesa, Adriana Leticia Perales-Torres, Estrella Martinez-Lopez, Claudia Munguia-Cisneros, Edna Nava-Gonzalez, Monserrat Perez-Navarro, Marisol Rosas-Diaz, Neyla Baltazar, Alvaro Diaz-Badillo, Octelina Castillo-Ruiz, Joselin Hernandez-Ruiz, Srinivas Mummidi, Laura Yanneth Ramirez-Quintanilla, Carlos Ramirez-Pfeiffer, Juan Carlos Lopez-Alvarenga

Research Symposium

Introduction: Metabolic-associated fatty liver disease (MAFLD) is a descriptive term for NAFLD (Non-alcoholic) physiopathology associated with obesity. The age of onset linked to body fat distribution is poorly studied. Therefore, we aimed to assess the body fat effect on liver fat infiltration and stiffness (LSt) mediated by insulin resistance (IR).

Methods: After obtaining informed consent, five hundred freshmen from two universities in Reynosa, Mexico (UMAN & UAT) were enrolled in the study. They completed a questionnaire focused on familial cardiometabolic risk and provided anthropometric measurements. In a subset of N=200, we obtained blood samples for biochemical measurements, body fat percentage …

Variant Of Fii Gene Plays A Critical Role In Coagulation Potential In Mexican-Americans, Hoang Anh T. Nguyen, Shuchita Vijay Jhaveri, Marcio A. Almeida, Vincent P. Diego, Satish Kumar, Juan M. Peralta, Joanne E. Curran, Bernadette W. Luu, Donna M. Lehman, Ralph A. Defronzo, Laura Almasy, Sarah Williams-Blangero, Ravi Duggirala, John Blangero, Tom Howard

Research Symposium

Background: Disruption in the balance between coagulation and bleeding can result in varying phenotypes such as hypercoagulability and can lead to the development of cardiovascular disease. In our study utilizing extended families of Mexican-Americans from South Texas, we performed a search for protein-altering variants influencing coagulation potential.

Methods: Mexican-Americans in the study were genotyped using Illumina-(human)-exome-24 chip to screen for protein-altering variants. Variants were analyzed for their association with FII activity, aPTT, and PT. Linear-mixed-model analysis was performed to estimate trait heritabilities and to interrogate single nucleotide variations (SNV) for evidence of genetic association. To control for multiple testing, associations …

Vitamin D Deficiency Among Children And Adolescents Living In Sunny South Texas, Yoscelina E. Martinez-Lopez, Margarita Faz, Beatriz Tapia, Juan C. Lopez-Alvarenga, Francisco J. Cervantes

Research Symposium

Background: Exposure to sunlight is essential to produce Vitamin D (ViD). Recent studies suggest obesity is associated with low ViD concentration. Living in South Texas with 220 sunny days a year should be enough to maintain adequate ViD levels. We aimed to analyze ViD levels and obesity in children and adolescents.

Methods: We included 1239 pediatric (1.5 to 18.8 years old) participants (primary care clinic from Laredo) with registered CDC percentiles of BMI (pBMI) and serum concentrations of ViD (Atellica™). Data are described as median (p25, p75), Loess correlation between pBMI and ViD, ANCOVA to adjust by age, sex, and …

Characterization Of Oral Cavity And Oropharyngeal Cancer In The Texas Rio Grande Valley, Jared A. Sperling, Rachel Giese

Research Symposium

Background: Cancers of the oral cavity (OC) and oropharynx (OP) account for 3% of cancers diagnosed in the United States each year. A primary cause of death among the Hispanic population in the United States is cancer, accounting for 20% of annual mortality. The Rio Grande Valley (RGV) is a medically-underserved area of South Texas with a large Hispanic population facing health disparities. In this study, we examine the incidence and mortality of OC and OP cancer in the RGV.

Methods: CDC population-level incidence and mortality rate per 100,000 of OC/OP cancer among patients in the RGV counties of Hidalgo …

Association Of Nutritional Status With Failure To Complete Planned Treatment In Patients With Hnscc- A Prospective Cohort Study In A Tertiary Cancer Centre In Northern India., Anshika Arora, Sunil Kumar Saini

Research Symposium

Background: To determine the association between Nutritional status of patient and the ability to complete all planned treatment in Head & Neck Squamous Cell Carcinoma(HNSCC).

Materials & Methods: This prospective cohort study was conducted at CRI India between 2018 and 2020. Patients diagnosed with HNSCC and planned for treatment were enrolled after written informed consent. Nutritional status was determined using- anthropometric measures and Subjective Global Assessment(SGA) scale before starting treatment. Patients were followed up for treatment details, complications and failure to complete planned treatment. Statistical analysis was performed using SPSS version 22. Data was analyzed using parametric and non-parametric …

Arrhythmogenic Right Ventricular Cardiomyopathy: Is Coxsackie The Criminal?, Areeb Masood, Lily Chen, Paulina Vega, Henry Kwang

Research Symposium

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by right ventricular dysfunction, which can precipitate sudden cardiac death in young adults.

Case Presentation: A 22-year-old Hispanic male with PMH of hypertriglyceridemia and exertional syncopal episodes was brought to the ED after experiencing a sudden cardiac arrest while on the treadmill. On arrival, the patient was intubated and placed on a defibrillator which detected Vfib with torsade de pointes. On arrival to ED, initial ECG revealed 1-2 mm ST depressions in leads II, III, and aVF and incomplete RBBB. Chest XR showed water-bottle-shaped cardiac silhouette. Coronary angiography demonstrated …

A Survival Analysis Of High-Grade Gliomas In Sub-Himalayan Population Including The Times Of Lockdown During Covid 19 Pandemic: A Single Institutional Experience, Pooja Kalra, Meenu Gupta, Vipul Nautiyal, Ranjeet Kumar, Sanjeev Pandey, Nazia Shirazi, Brijesh Tiwari, Mushtaq Ahmad

Research Symposium

Background and Objectives: High Grade Gliomas are categorised as Grade III and IV and have high mortality rate with poor prognosis. How we should adopt clinical practice in neuro-oncology during Covid 19 Pandemic is another area of scientific exploration . Hypofractionated radiotherapy protocols can be easily utilised in high grade gliomas during Covid 19 pandemic .

Materials and Methods: Retrospective analysis of 147 patients with diagnosis of high-grade gliomas between January 2009 till December 2020 including Covid-19 pandemic lockdown time was done. Age , gender , KPS , symptoms , extent of surgery and use of concurrent temozolamide , were …

Acute Exacerbation Of Heart Failure In A 35-Year-Old Hispanic Female With Premature Coronary Artery Disease Status Post Cabg X 4 And Multiple Comorbidities: A Case Report, Nelson D. Gonzalez, Bhargavi Akkineni

Research Symposium

Background: Coronary artery disease (CAD) is the leading cause of death in adults worldwide.¹ Although CHD prevalence is highest in adults of middle age and above, it is important to be aware of risk factors in young adults that predispose them to premature CAD and its complications. We present a case of a young Hispanic female with acute exacerbation of heart failure (HF), CAD, and multiple comorbidities.

Case: A 35-year-old Hispanic female with past medical history of CAD status post coronary artery bypass graft (CABG) X 4, HF with reduced ejection fraction (EF) of 40-45%, chronic kidney disease stage …

A Case Of Minoca In A Patient With Recent History Of Covid-19 Infection, Don C. Rajan, Nghia Nguyen, Nevin A. Varghese

Research Symposium

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a syndrome of myocardial ischemia resulting from microvascular dysfunction and with < 50% stenosis of major epicardial vessels. The incidence of MINOCA is 6% among patients with acute myocardial infarction. We present a case of MINOCA in a patient with a recent history of COVID-19 infection.

Case presentation: A 22-year-old man with recent history of Covid 19 infection presented with 3 days history of typical cardiac chest pain. He was not taking any medications or illicit drugs. EKG revealed sinus rhythm with ST elevations in leads II, V5, V6. Troponin I was elevated to 5.3ng/ml. He underwent coronary angiography which was reported as normal with no signs of obstructive coronary artery disease. Further workup including viral panel, ESR, CRP, HIV, hepatitis panel were negative. He was …

Cardiac Tamponade: Innovative Sternotomy Simulation Model For Training Pediatric Cardiac Intensive Care Team, Tolu Akinpelu, Mohammed Alhendy, Malarvizhi Thangavelu, Karen Weaver, Nicole Muller, James Mcelroy, Daniel Nento, Utpal Bhalala

Research Symposium

Introduction: Cardiac tamponade occurring after cardiac surgery is rare but life threatening and requires simultaneous resuscitation and emergent sternotomy by the intensive care team. A simulated scenario using innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the face validity of this innovative mannequin, the confidence level and crisis resource management skills of the team during sternotomy to manage postoperative cardiac tamponade.

Methods: The simulation case scenario was developed using innovative sternotomy mannequin for children’s hospital cardiac intensive care unit (CICU) teams. The case involved a 3-year old male, intubated, mechanically …

Social Determinants Of Health And Stage Of Presentation Of Oral Cavity Squamous Cell Carcinoma, Taha Al Hassan, Saba Suleman, Adam Bender-Heine, Rachel A. Giese

Research Symposium

Objectives: The purpose of this study is to investigate the risk factors that contribute to the development of oral cavity squamous cell carcinoma (SCC) in the Rio Grande Valley and understand factors that may be associated with advance stage at presentation.

Methods: Initially 1,609 charts from the University of Texas Rio Grande Valley outpatient clinics were evaluated for a diagnosis of SCC and 69 patients were identified for potential inclusion. 44 patients were included for final analysis. Data were analyzed using SPSS 28.0.0. Descriptive and inferential statistics were conducted.

Results: Patients without insurance coverage were more likely to present with …

The Morbidity Of Greater Trochanteric Pain Syndrome Is Similar To That Of Hip Osteoarthritis Awaiting Total Hip Arthroplasty, Sonia Wadekar, Joel Wells, Avneesh Chhabra, Yin Xi, Emily Middleton

Research Symposium

Background: Greater trochanteric pain syndrome (GTPS) is characterized by chronic lateral hip pain and dysfunction. While psychosocial measures of other tendinopathies have been gaining traction, GTPS is less well studied. We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA).

Methods: This study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life (QOL), pain, and level of disability, in all patients with GTPS and end-stage, pre-THA hip OA. All patients presented at a single academic medical center between October 2016 to November …

Changes In Severity Of Pelvic Floor Dysfunction After Hip Surgery, Amisha Mehta, Joel E. Wells, Sonia Wadekar, Taylor Price, Donald Kasitinon

Research Symposium

Introduction: Despite growing evidence that suggests an association between hip pathology and pelvic floor disorder (PFD), the comprehensive effects of hip surgery on PFD symptoms are not well understood. The primary purpose of this study was to report the role of surgical hip procedures on the severity of PFD symptoms.

Methods: A prospective database of demographic and outcome data for all female patients that were operated on between 2019-2020 at a single institution was queried. The PDFI-20 was used to assess symptom severity, and cases with both pre and postoperative surveys were included (n=62). MCID was used to determine significance …

Characterization Of Prostate Cancer In Transgender Women, Simita Gaglani, Rajveer Purohit, Ashutosh Tewari, Dara Lundon, Natasha Kyprianou

Research Symposium

Background: The risk of developing prostate cancer (PC) in transgender women is unknown. Many patients are unaware that the prostate is not removed during male-to-female surgical transition. It is unclear what the exposure of estrogens and androgen blockers in these transgender patients has on the prostate. Our aim was to examine and characterize the different presentations of PC in published cases and augment this with an additional case series from one institute.

Methods: A retrospective review of prospectively maintained medical records was performed identifying features of PC diagnoses in transgender women. These included age, duration of feminizing hormone therapy, PSA …

The Importance Of A Broad Differential Diagnosis: Hepatitis C Virus Associated Cryoglobulinemic Vasculitis, Shadi Jafari-Esfahani, Christine E. Loftis, Juan Naranjo, Emilia Dulgheru

Research Symposium

Introduction: Mixed cryoglobulinemia syndrome (MCS) is a systemic inflammatory syndrome affecting small-medium sized vessels due to the presence of type II or III cryoglobulins in the serum. MSC can manifest as systemic vasculitis with symptoms varying from weakness, arthralgia, palpable purpura, peripheral neuropathy, and renal involvement. The most common cause of MCS includes lymphoproliferative disorders, autoimmune diseases and viral infections, with hepatitis C virus (HCV) being the most common etiology.

Case Presentation: A 60-year-old lady was referred to our office for evaluation of rheumatoid arthritis. She reported history of bilateral thumb pain, bilateral knee pain associated with episodes of swelling, …

Pelvic Fracture Urethral Trauma– Going With The Flow, Frank Burks

Website/Multimedia Contributions

No abstract provided.

Massive Transfusion In Trauma– The Basics And Beyond, Kristina Davis

Website/Multimedia Contributions

No abstract provided.

Elastic Stable Intramedullary Nail Fixation Versus Submuscular Plate Fixation Of Pediatric Femur Shaft Fractures In School Age Patients: A Prisma-Compliant Systematic Review And Meta-Analysis, Donglai Hu, Zihang Xu, Tao Shi, Hui Zhong, Yuting Xie, Junjie Chen

Faculty, Staff and Student Publications

BACKGROUND: Studies of clinical outcomes that compare the elastic stable intramedullary nail (ESIN) with the submuscular plate (SMP) were controversial. The meta-analysis was performed to summarize existing evidence, aiming to determine whether ESIN was superior to SMP in pediatric femur shaft fractures.

METHODS: Search strategies followed the recommendations of the Cochrane collaboration. Electronic searches such as PubMed, Embase, Web of Science, Cochrane were systematically searched for publications concerning ESIN and SMP from the inception date to March 2023. Two investigators independently searched, screened, and reviewed the full text of the article. Disagreements generated throughout the process were resolved by consensus, …

A Case Report: A Patient Rescued By Va-Ecmo After Cardiac Arrest Triggered By Trigeminocardiac Reflex After Nasal Surgery, Xu Zhang, Bin Sun, Chen Pac-Soo, Daqing Ma, Liwei Wang

Faculty, Staff and Student Publications

Rationale:

Cardiac arrest (CA) caused by trigeminocardiac reflex (TCR) after endoscopic nasal surgery is rare. Hence, when a patient suffers from TCR induced CA in the recovery room, most doctors may not be able to find the cause in a short time, and standard cardiopulmonary resuscitation and resuscitation measures may not be effective. Providing circulatory assistance through venous-arterial extracorporeal membrane oxygenation (VA-ECMO) can help healthcare providers gain time to identify the etiology and initiate symptom-specific treatment.

Patient concerns:

We report a rare case of CA after endoscopic nasal surgery treated with VA-ECMO.

Diagnoses:

We excluded myocardial infarction, pulmonary embolism, allergies, …

Structurally Competent Healthcare And Health Inequities, James Meza

Conference Presentation Abstracts

No abstract provided.

Neurologic Outcomes For Adult Spinal Cord Ependymomas Stratified By Tumor Location: A Retrospective Cohort Study And 2-Year Outlook, Keanu Chee, Grégoire P Chatain, Michael W Kortz, Stephanie Serva, Keshari Shrestha, Timothy H Ung, Jens-Peter Witt, Michael Finn

Department of Neurosurgery Faculty Papers

Determine whether craniocaudal spinal cord tumor location affects long-term neurologic outcomes in adults diagnosed with spinal ependymomas (SE). A retrospective cohort analysis of patients aged ≥ 18 years who underwent surgical resection for SE over a ten-year period was conducted. Tumor location was classified as cervical, thoracic, or lumbar/conus. Primary endpoints were post-operative McCormick Neurologic Scale (MNS) scores at < 3 days, 6 weeks, 1 year, and 2 years. One-way ANOVA was performed to detect significant differences in MNS scores between tumor locations. Twenty-eight patients were identified. The average age was 44.2 ± 15.4 years. Sixteen were male, and 13 were female. There were 10 cervical-predominant SEs, 13 thoracic-predominant SEs, and 5 lumbar/conus-predominant SEs. No significant differences were observed in pre-operative MNS scores between tumor locations (p = 0.73). One-way ANOVA testing demonstrated statistically significant differences in post-operative MNS scores between tumor locations at < 3 days (p = 0.03), 6 weeks (p = 0.009), and 1 year (p = 0.003); however, no significant difference was observed between post-operative MNS scores at 2 years (p = 0.13). The mean MNS score for patients with thoracic SEs were higher at all follow-up time points. Tumors arising in the thoracic SE are associated with worse post-operative neurologic outcomes in comparison to SEs arising in other spinal regions. This is likely multifactorial in etiology, owing to both anatomical differences including spinal cord volume as well as variations in tumor characteristics. No significant differences in 2-year MNS scores were observed, suggesting that patients ultimately recover from neurological insult sustained at the time of surgery.

Cocaine Use Disorder Effects On Blood Oxytocin Levels And Oxtr Dna Methylation, Manassés Soares Souza, Breno Sanvicente-Vieira, Aline Zaparte, Talita Baptista, Maria Aparecida Nagai, Flávia Rotea Mangone, Ana Carolina Pavanelli, Thiago Wendt Viola, Rodrigo Grassi-Oliveira

School of Medicine Faculty Publications

Substance use disorders have been associated with alterations in the oxytocinergic system, but few studies have investigated both the peptide and epigenetic mechanisms potentially implicated in the regulation of oxytocin receptor. In this study, we compared plasma oxytocin and blood DNA methylation in the OXTR gene between people with and without cocaine use disorder (CUD). We measured the oxytocin levels of 51 people with CUD during acute abstinence and of 30 healthy controls using an enzyme immunoassay. The levels of DNA methylation in four CpG sites at exon III of the OXTR gene were evaluated in a subsample using pyrosequencing. …