Medical Specialties Commons^™

Negative Imaging, Ongoing Hemorrhage: An Ulcerated Jejunal Avm Requiring Advanced Endoscopic Intervention, Joel Mathews, Trina Lewis, John Mathew, Long Hoang

North Texas GME Research Forum 2026

Small bowel bleeding is relatively uncommon, accounting for less than 10% of all gastrointestinal (GI) bleeds. Small bowel angiodysplasias are the most common cause of small bowel bleeding. These lesions can often be difficult to identify on radiographic imaging or endoscopy and tend to rebleed after intervention. Our case centers on an 86-year-old patient who presented with an acute GI bleed from an obscure ulcerated jejunal arteriovenous malformation (AVM); his past medical history includes an undisclosed prior upper GI bleed treated with endoscopic clipping, paroxysmal atrial fibrillation, type 2 diabetes, prostate cancer with prostatectomy, and other chronic conditions. He presented …

A New Conceptual Framework For The Approach To The Emergency Department Patient, Christopher Houston

North Texas GME Research Forum 2026

Background

The Emergency Department (ED) is an often chaotic environment where you have little information, little time, and must evaluate for multiple serious conditions. This can be overwhelming for trainees and young physicians. Having a thought process specifically tailored to the ED could be helpful organizing priorities and diagnostic pathways. There are several disease specific core measures that are time sensitive in the ED. Specifically; STEMI, stroke, sepsis, and trauma. Each of these conditions must be rapidly identified, and appropriate pathways initiated.

Trainees are traditionally taught to approach a patient with a wide differential diagnosis for each chief complaint and …

The Rapid Case Of Anoxic Brain Injury Secondary To Hyperammonemia, Jacqueline Bekhit, Ngoc Vu, Jiaming Xue, Gabriella David, Qasim Sajawal

North Texas GME Research Forum 2026

Background: Acute hyperammonemia presents as a toxic state with the clinical presentation as altered consciousness, seizures, and coma. Hyperammonemia disrupts astrocytes osmotic balance via glutamine accumulation, triggering brain edema, inflammation, and apoptosis whom mechanism is closely parallel to hypoxic ischemic injury. This overlap necessitates differentiating metabolic causes from hypoxic etiologies, as timely ammonia clearance therapies can prevent catastrophic outcomes. This case underscores the need for close clinical vigilance and early recognition of severe hyperammonemia

Case Presentation: A 65-year-old woman with metabolic dysfunction-associated steatotic liver disease related cirrhosis complicated by recurrent ascites requiring bimonthly paracentesis presented with abdominal distension and pain. …

An Unusual Source Of A Lethal Pathogen: Paeniclostridium Sordellii Bacteremia In Acute Cholecystitis, Myrna Garcia, Leena Algarin, Olutoyin Abitoye, Rachel Gnanaprakasam

North Texas GME Research Forum 2026

Paeniclostridium sordellii is a spore-forming, gram-positive, anaerobic bacilli known for its highly virulent toxin production, often leading to fulminant sepsis and shock. It is most commonly associated with gynecologic infections and necrotizing soft tissue infections associated with intravenous drug use. However, reports of P. sordellii bacteremia in the setting of gall bladder infections are quite rare. This case report highlights an unusual presentation of P. sordellii infection with bloodstream infection originating from acute cholecystitis, demonstrating a non-fulminant clinical course and successful treatment with ceftriaxone.

Ashwagandha-Associated Liver Injury: A Systematic Literature Review, David Teplitsky, Jacob Sebaugh, Danielle Ford, Rashid Syed

North Texas GME Research Forum 2026

Background: Ashwagandha (Withania somnifera), an herb with origins in Ayurvedic medicine, has recently grown in global popularity due to its reported stress- and anxiety-relieving properties. While generally regarded as safe, emerging cases in medical literature have raised concern for its ability to cause drug- or herb-induced liver injury (DILI/HILI). As use of this supplement rises, it is particularly important to characterize ashwagandha’s potential hepatotoxicity.

Methods: Cases of ashwagandha-induced liver injury were collected by accessing PubMed, Europe PMC, Google Scholar, and the HCA Healthcare Library and searching combinations of the terms “liver” or “hepatic” and one of the following names for …

Massive Subcutaneous Emphysema Following Robot-Assisted Total Laparoscopic Hysterectomy: A Case Report, Alia Valdez, Isabella Sciacca, Charmaine Oladell

North Texas GME Research Forum 2026

Background Subcutaneous emphysema is the presence of air within subcutaneous tissues, often presenting as swelling and palpable crepitus. Air may spread along fascial planes and arise from traumatic, iatrogenic, infectious, or spontaneous sources. In laparoscopic surgery, it is most commonly related to carbon dioxide insufflation. Reported incidence following laparoscopic procedures ranges from 2% to 24%, depending on procedure type, surgical duration, insufflation pressure, and patient factors. In gynecologic laparoscopy, incidence has been reported as low as 2.3% in some studies, with rates up to 10–15% in others, particularly with higher intraabdominal pressures. Although often benign, extensive subcutaneous emphysema may lead …

Salvage Percutaneous Spyglass-Assisted Lithotripsy Via A Cholecystostomy Tract After Failed Ercp: A Case Report, Nicholas Gerden, Tiffany Hong, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

IR-driven percutaneous cholangioscopy with SpyGlass-assisted lithotripsy is an emerging salvage technique for biliary stone disease in patients with failed or contraindicated endoscopic retrograde cholangiopancreatography (ERCP) due to complex anatomy. We report an 85-year-old patient with an indwelling cholecystostomy tube and biliary stent who presented with recurrent obstructive jaundice, with cholangiography demonstrating occlusion of the common bile duct stent due to choledocholithiasis. Conventional ERCP was unsuccessful because of complex biliary and gastrointestinal anatomy. A multidisciplinary interventional radiology–gastroenterology approach was therefore pursued, utilizing antegrade percutaneous choledochoscopy through an existing cholecystostomy tract with SpyGlass-assisted lithotripsy, followed by cholecystostomy tube exchange. The procedure resulted …

Cocaine Kicks Mitral Valve In The Pap- A Rare Case Of Papillary Muscle Rupture Secondary To Cocaine-Induced Ischemia Mimicking A Tumor Vs Vegetation, Greeshma Molugu, Seline Haci, Mehdi Khalafi, Amir Z. Malik, Machaiah Madhrira

North Texas GME Research Forum 2026

Background: Cocaine is known to have many cardiotoxic effects, specifically secondary to increased sympathetic output from the increased catecholamines, calcium modulation, and increased platelet aggregation. This can cumulatively cause suppression of myocardial contractility and decreased coronary blood flow, resulting in arrhythmias, myocardial ischemia, or even infarction. Papillary muscle rupture, already a rare complication of myocardial infarction (MI), is exceedingly rarely associated with cocaine toxicity in the absence of MI. Also, acute mitral regurgitation(MR) due to papillary muscle rupture from cocaine-induced ischemia remains exceedingly rare. We present a second-ever reported case of papillary muscle rupture secondary to cocaine-induced ischemia in the …

Hemoptysis And Shock From A Proximal Bronchial Artery Aneurysm Successfully Treated With Endovascular Embolization, Gautham Raghuthaman, Charmi Mehta, Tamer Hudali

North Texas GME Research Forum 2026

Background: Bronchial artery aneurysm (BAA) is a rare vascular abnormality and an uncommon cause of hemoptysis. Although many BAAs are asymptomatic, rupture can result in life-threatening hemorrhage and shock. Proximal BAAs arising near the bronchial artery origin are particularly rare and may be underrecognized due to nonspecific clinical and radiographic findings.

Case Presentation: Patient is a 49-year-old male with a history of pituitary tumor resection complicated by secondary adrenal insufficiency and hypothyroidism presented with three days of cough, fatigue, and hemoptysis. He was hypotensive and hypoxic on arrival and required vasopressor support with stress-dose corticosteroids. Computed tomography angiography (CTA) of …

Use Of Preoperative Chlorhexidine Scrub In Prevention Of Groin Surgical Site Infections, Enoch Wong, Pranay Arora, Hunter Knight, Carissa Lucero, Edic Stephanian

North Texas GME Research Forum 2026

Background: Surgical site infections (SSIs) following groin exposure in vascular surgery are associated with significant morbidity, prolonged hospital length of stay, and increased healthcare costs. The groin is particularly susceptible to infection due to local skin flora and moisture, with studies demonstrating higher infection rates compared to other vascular operative sites (1). Despite standard perioperative infection prevention measures in the operating room, SSI rates following groin exposure remain unacceptably high. This quality improvement (QI) project aimed to reduce groin SSI rates through the implementation of a standardized preoperative chlorhexidine-based scrub protocol.

Methods: A single-center QI initiative was evaluated using a …

Antibody-Mediated Allograft Rejection 23 Years After Heart Transplant, Jorim Parmar, Boney Lapsiwala, Devika Adusumilli, Sienna Luk, Nguyen Dung, Song Li, Kamala Tamirisa

North Texas GME Research Forum 2026

INTRODUCTION: Orthotopic heart transplantation (OHT) remains the gold standard treatment for patients with advanced heart failure refractory to optimal medical and device-based therapies. Despite advances in perioperative management, immunosuppressive regimens, and long-term surveillance protocols, graft rejection remains a major determinant of post-transplant morbidity and mortality [1]. We report a case, representing one of the longest documented intervals in literature, of suspected antibody-mediated rejection (AMR) occurring 23 years after heart transplantation in which conventional endomyocardial biopsy (EMB) could not be successfully performed. This case highlights the diagnostic uncertainty associated with very late AMR and underscores the potential role of clinical presentation, …

An Unusual Culprit Behind A Massive Pulmonary Embolism: Atypical May-Thurner Syndrome From Iliac Artery Aneurysm, Boney Lapsiwala, Jiaming Xue, Mayank Singh, Sai Krishan Reddy Dronadula, Sadia Zahid, Mian Yousef

North Texas GME Research Forum 2026

Background: Venous thromboembolism (VTE) is a major cause of global morbidity and mortality. May-Thurner syndrome (MTS) is an iliofemoral venous compression syndrome caused by extrinsic compression of the left common iliac vein (LCIV), classically by the right common iliac artery at the level of the fifth lumbar vertebra. Although the estimated anatomic prevalence ranges from 18-49%, only 2-5% of cases are diagnosed during evaluation for lower-extremity deep vein thrombosis (DVT). Clinical manifestations range from asymptomatic venous compression to unilateral leg swelling, venous insufficiency, and acute iliofemoral DVT, with pulmonary embolism (PE) reported infrequently.

Case presentation: A 75-year-old man with hypertension, …

A Hidden Culprit: Disseminated Tuberculosis Masquerading As Abdominal Abscesses, Sudiksha Veerareddy, Alex Hall, Urvi Sakhuja, Sarah Abuelayyan, Evangelista Ezenduka, Rinu Varghese

North Texas GME Research Forum 2026

Introduction: Tuberculosis (TB) is an insidious pulmonary infection that is most prevalent in developing countries. Primary TB may also become latent after initial infection and remain dormant in the body until the patient becomes immunocompromised. The infection will then resume and can become disseminated, moving hematogenously and through the lymphatics to other areas of the body. Disseminated TB is known to manifest in a variety of ways, making it difficult to diagnose.

Case Presentation: A 28-year-old- male patient presented to Medical City Arlington with complaints of left lower quadrant abdominal pain. He immigrated from Cameroon 4 years prior. Initial CT …

A Rare Case Of Disseminated Strongyloidiasis Causing Polymicrobial Sepsis In A Patient With Lupus: A Diagnostic Conundrum, Greeshma Molugu, Anupama Chennupati, Ayo Dereje, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Disseminated strongyloidiasis is a very rare condition with case-fatality rates approaching 90%. However, the diagnosis is often delayed because of nonspecific presenting symptoms. Early diagnosis relies on a high index of clinical suspicion, especially in immunocompromised hosts. Long-term corticosteroid therapy, leading to some suppression of inflammatory and immunologic responses, is a well-known risk factor for severe strongyloidiasis.

Case presentation: A 52-year-old male with a past medical history of lupus on chronic corticosteroid therapy presented with chief complaints of dyspnea and diarrhea. He has a recent history of travel to Mexico. Hemoglobin was 5.3. CTAP with contrast showed diffuse colitis …

Prognostic Impact Of Sentinel Lymph Node Dissection In High-Risk Uterine Serous Carcinoma, Katie Johnson, Chrystal Stallworth, Prakriti Srivastava, Abel Moron, Brandon Roane, Hannah Affleck, Michele Mccarroll

North Texas GME Research Forum 2026

Objective: To assess overall survival (OS) for patients undergoing surgical staging with sentinel lymph node dissection (SLND) in patients with high risk uterine serous carcinoma (USC).

Methods: Patients diagnosed with USC that underwent surgical staging with SLND from the years 2018-2022 were included for analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) national database. Patients were stratified by pathologic lymph node (LN) assessment into true SLND group (1-2 pelvic LN retrieved) and false SLND group (> 2 pelvic LN retrived). Patients with 0 LN retrieved were excluded from the data. OS was recorded in months from time of primary …

Transcatheter Aortic Valve Replacement For Moderate Aortic Stenosis In Heart Failure With Reduced Ejection Fraction: A Randomized Comparison With Guideline-Directed Medical Therapy, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Tricenarian Seizure Cascade: Uremic Encephalopathy And Suspected Dialysis Disequilibrium, Purva Dahat, Jessica Nguyen, Sara Abuelayyan, Amnah Andrabi

North Texas GME Research Forum 2026

Introduction Uremic encephalopathy and dialysis disequilibrium syndrome (DDS) are distinct neurologic complications of renal failure that can precipitate seizures. While uremic encephalopathy reflects toxin-mediated metabolic dysfunction, DDS may occur during hemodialysis initiation from rapid osmotic shifts. They are usually described as separate entities, particularly in established CKD. Sequential neurologic events spanning the pre-dialysis period and dialysis initiation in previously undiagnosed renal failure are poorly characterized.

Case presentation A previously healthy African American man in his 30s with no known history of kidney disease presented with new-onset generalized tonic-clonic seizure accompanied by respiratory distress. Initial laboratory testing revealed profound azotemia with …

Acute-On-Chronic Right Pulmonary Artery Thrombus With Systemic–Pulmonary Collateral Fistulas And Post-Thrombectomy Distal Rca Occlusion Due To Pfo, Joseph Davis, Jesse Bolton, Sridhar Sampath Kumar, Sundeep Viswanathan

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Survival Outcomes Following Thyroidectomy In Secondary Thyroidal Metastases, Hannan Maqsood, Tanya Odisho, Yaqeen Qudah, Umar Butt, Awni Shahait

North Texas GME Research Forum 2026

Background: The management plan for metastasis to the thyroid from distant primary malignancies remains unclear. Methods: This systematic review is being conducted to evaluate the outcomes for performing thyroidectomy in non thyroidal metastatic cancer. Data: Data was collected via literature search using pubmed, cochrane, web of science, and google scholar.

PICO:

• Population: Patients undergoing thyroidectomy in nonthyroidal metastatic from distal primary cancer
• Intervention: Thyroidectomy (lobar/total)
• Comparison: No comparison group
• Outcomes: Overall survival Locoregional Recurrence Mortality

Results: As per literature review, renal cell carcinoma was most common, (around 30-35%) patients, followed by lung and gastrointestinal malignancies. Surgical management was associated with …

Beyond The Temporal Lobe: Atypical Presentation In Adult Hsv-2 Encephalitis, Analekha Chesnick, Michaela Littlefield, Brock Cardon

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Mixed Cause Of Heart Failure, Brandon West, Austin Meyer, Kenya Lindstrom, Jason Hall, Jennifer Griffith

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Robotic Cholecystectomy With Choledochoscopy After Failed Ercp: A Case Report, James Zhang, Ethan Pavlovsky, Jennifer Austin, Furrukh Jabbar, Hassan Ahmed

North Texas GME Research Forum 2026

Background: In the United States, there are an estimated 20 million cases of cholelithiasis, though a majority remain asymptomatic. Development of choledocholithiasis is seen in 10%-20% of those with cholelithiasis. Typically, choledocholithiasis is managed via a two-stage approach starting with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy on the same admission. More recent trends have seen a shift towards surgeon-directed management of the common bile duct through one-stage procedures that combine cholecystectomy with intraoperative common bile duct (CBD) exploration using choledochoscopy. We present a case of chronic choledocholithiasis with large, impacted gallstones that was managed with robotic cholecystectomy, choledochotomy, …

Induced Vaginal Delivery In Pregnant Patient With Enlarging Choroidal Hemangioma, Sandra Zhi, Allison Burkes, Monica Saripella, Bhagyashri Pandey, Keith Storts, Kishan Patel, J William Harbour

North Texas GME Research Forum 2026

INTRODUCTION: Sturge Weber Syndrome (SWS) is a rare congenital neurocutaneous disorder affecting capillary formation, classically presenting with a facial port-wine birthmark and seizures. Associated symptoms vary by individual but may include additional brain and eye manifestations such as cognitive impairment, headache, stroke-like episodes, and glaucoma or visual field defects. Because SWS results from a sporadic mutation, it does not carry specific contraindications to pregnancy regarding fetal risk. However, pregnancies in patients with SWS should be managed by an multidisciplinary team and closely monitored for acute neurological and ophthalmologic complications. In childbirth, previous case reports have favored Cesarean section over vaginal …

Navigating Recurrent Hematuria In Vesicular Varices: A Case Of Successful Multidisciplinary Intervention, Morgan Grosdidier, Muiz Khan Tareen, Danielle Ford

North Texas GME Research Forum 2026

Background Hematuria secondary to vesicular varices is a rare but serious complication of portal hypertension, often associated with liver cirrhosis. Effective management requires a multidisciplinary approach, often involving urology, gastroenterology, and interventional radiology to address acute bleeding and prevent recurrence.

Case Presentation We present a case of a patient with alcoholic liver cirrhosis who experienced severe hematuria, highlighting the diagnostic and therapeutic challenges encountered. The patient presented with a two-day history of acute hematuria and blood clots, ultimately attributed to vesicular varices secondary to portal hypertension from alcoholic liver cirrhosis. Urology was consulted, who recommended continuous bladder irrigation (CBI), initially …

Improving Cord Gas Collection Rates On Labor & Delivery, Sandra Zhi, Diane Gilbertson, Ifeoluwa Adesina-Aina, Sarah Moore, Jack Graham

North Texas GME Research Forum 2026

Background: Cord blood gas measurements are helpful to determine the acid-base status of a neonate after delivery and can determine risk for neonatal encephalopathy. Collection usually occurs right after delivery of the infant and after the umbilical cord has been cut and clamped. The OBGYN residents are currently trained to draw cord blood for gas analysis if clinical status of the neonate is subpar, but there exist other indications for drawing cord blood to send for cord gases as recommended by the American College of Obstetricians and Gynecologists as well as the American Academy of Pediatrics. This project will focus …

Extra-Intestinal Clostridioides Difficile Abscess In A Small Bowel Gist: A Rare Tumor-Associated Complication, Nicholas Gerden, Pradip Gautam, Asad Rehman, Long Hoang

North Texas GME Research Forum 2026

Extra-intestinal infections caused by Clostridioides difficile are exceedingly rare and typically occur in settings that disrupt the gastrointestinal barrier, including recent gastrointestinal surgery, bowel perforation or microperforation, and severe colonic disease.

We present the case of a 75-year-old man with abdominal pain and hemoperitoneum in the setting of a suspected small bowel leak secondary to an intestinal mass. Computed tomography angiography revealed an 11.0 × 9.6 cm pelvic fluid collection, prompting exploratory laparotomy with drainage of a pelvic abscess and evacuation of hemoperitoneum. Intraoperatively, a small bowel perforation caused by a 4.4 cm gastrointestinal stromal tumor (GIST) was identified. Operative …

Effects Of Glucagon-Like-Peptide-1 Receptor Agonists (Glp-1a) Medications In Patients Undergoing Total Hip Arthroplasty (Tha): A Systematic Review And Meta-Analysis, Tanner Haechten, Troy B. Puga, Vincent Dieu, Mckenna W. Box, Kyle O'Connor, John T. Riehl

North Texas GME Research Forum 2026

Background Glucagon-Like-Peptide-1 Receptor Agonists (GLP-1a) medications have rapidly grown in popularity, however, their effects on the outcomes of Total Hip Arthroplasty (THA) remain largely unclear. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing THA and using a GLP-1a medication. Methods A search was conducted across six databases. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted from included articles. …

Operative Localization Of Occult Gastrointestinal Bleeding Using Intraoperative Small Bowel Endoscopy, Shuda Xia, Furrukh Jabbar, Muhammad T. Siddique

North Texas GME Research Forum 2026

No abstract provided.

Implementation Of Standardized Screening And Patient Education Regarding Hpv Vaccination Within An Ob-Gyn Clinic, Kristina Krupa, Nicole Tenzel

North Texas GME Research Forum 2026

Background: Each year, millions of women become infected with Human Papillomavirus Virus (HPV). The HPV virus can cause multiple types of cancer including cervical, vaginal, vulvar, penile, anal, vaginal, and oropharyngeal. HPV vaccination has the potential to prevent majority of these cancers. Despite this, a large portion of the United States population remains unvaccinated. Standardizing screening protocols and patient education materials within our OBGYN clinic can help educate patients about the HPV vaccine benefits and facilitate shared decision-making regarding vaccination.

Methods: This ongoing quality improvement project was initially created as a single-phase initiative that involved implementation of a screening questionnaire …

Roles Of Thyroid Stimulating Hormone (Tsh) And Vitamin D Levels In Asthma Severity And Length Of Stay, Kumail Rizvi, Kenny Tran, Michele Mccarrol, Mohan Sengodan

North Texas GME Research Forum 2026

Background: Asthma exacerbations leading to hospitalization are very common and result from multifactorial causes. This research aims to investigate factors such as thyroid-stimulating hormone (TSH) and Vitamin D, which may play a role in the modulation of asthma-related hospitalizations and patient outcomes. TSH influences numerous cellular processes in the body, particularly during times of stress and illness, yet its role in asthma exacerbations and hospital length of stay remains unclear. Vitamin D has been studied for its role in enhancing medication absorption and regulating immune function, and multiple studies have shown that low serum Vitamin D levels are associated with …