Medical Specialties Commons^™

Protocol For A Randomized Controlled Trial To Determine If Biomarkers Predict Response To A Pediatric Chronic Pain Symptom Management Program, Rona L Levy, Tasha B Murphy, Margaret M Heitkemper, Miranda A L Van Tilburg, Ann R Mcmeans, Jocelyn Chang, Cynthia Boutte, Katherine Lamparyk, Bruno P Chumpitazi, Robert J Shulman

Children’s Nutrition Research Center Staff Publications

Background/Objectives: Disorders of gut-brain interaction (DGBI), characterized by chronic abdominal pain and significant disability, affect 15-20% of children and adults and continue into adulthood in ~60% of cases. Costs for adults reach USD 30 billion per year, yet effective management strategies are elusive. Studies support using cognitive behavioral therapy (CBT), but abdominal pain only improves in ~40% of patients. Dietary management (low FODMAP diet; LFD) has also shown promise but it is effective in only a similar percentage of patients. Studies suggest that biologic factors (biomarkers) contribute to CBT response. Similarly, gut microbiome composition appears to influence abdominal pain …

Language Mapping During Awake Brain Surgery In A Deaf Patient With A Brain Tumor: Illustrative Case, Ene Chibawanye I, Elizabeth Silva, Kyle Noll, Mariana Bradshaw, Katherine Connelly, Ho-Ling Liu, Ravi Tummala, David Ferson, Frederick F Lang, Vinodh A Kumar

Faculty, Staff and Student Publications

Background: Signed language integrates complex sensorimotor processes involving visual and motor networks. The contribution of language regions such as Broca's and Wernicke's areas during signing is not well established. Here, the authors report the case of a 45-year-old right-handed male with congenital deafness, who communicates using American Sign Language (ASL) and Signed English, presenting with focal seizures. Imaging showed a diffuse infiltrative glioma in the right cerebral hemisphere.

Observations: Remarkably, preoperative functional MRI language activations were bihemispheric and overlapped for both traditional language paradigms and sign paradigms, suggesting that the same cortical regions of the brain are used for language …

Gut Dysbiosis Patterns In Cvid Patients With Noninfectious Complications Observed In A Germ-Free Mouse Model Through Fecal Microbiota Transplantation, Joud Hajjar, Anita Y Voigt, Margaret E Conner, Alton G Swennes, Stephanie Fowler, Chadi Calarge, Danielle D Mendonca, Dominique Armstrong, Chen-Yen Chang, Jolan E Walter, Manish J Butte, Tor Savidge, Julia Oh, Farrah Kheradmand, Joseph F Petrosino

Faculty, Staff and Students Publications

Patients with common variable immunodeficiency (CVID) who develop noninfectious complications (NIC) have worse clinical outcomes than those with infections only (INF). While gut microbiome aberrations have been linked to NIC, reductionist animal models that accurately recapitulate CVID are lacking. Our aim in this study was to uncover potential microbiome roles in the development of NIC in CVID. We performed whole-genome shotgun sequencing on fecal samples from CVID patients with NIC, INF, and their household controls. We also performed fecal microbiota transplants from CVID patients to germ-free mice. We found potentially pathogenic microbes

Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes

Doctor of Nursing Practice Scholarly Projects

Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Pulmonary Embolism Response Team In Acute Care Settings: A Scoping Review Of The Evidence, Tia Glover Bsn, Rn, Leslie Asplund Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Pulmonary embolism (PE) is a critical cardiovascular emergency associated with high morbidity and mortality. Despite its prevalence, traditional PE management often lacks cohesion, leading to suboptimal outcomes. Pulmonary Embolism Response Teams (PERTs) offer a multidisciplinary approach aimed at improving patient outcomes by streamlining diagnosis, facilitating timely interventions, and promoting evidence-based treatment. This scoping review evaluates the evidence supporting PERT efficacy across various clinical and resource-related outcomes with the aim to decrease mortality rates, shorten inpatient length of stay, improve cost efficacy, and minimize adverse events from treatment modalities.

Methods

A comprehensive literature search was conducted using PRISMA guidelines across …

Preserving What Matters: A Multimodal Approach To Maintaining Fat-Free Mass During Anti-Obesity Medication Based Weight Loss, Sarah Gore

Evidence-Based Practice Project Reports

Weight loss is often associated with reductions in fat-free mass (FFM), which can negatively impact metabolic rate, thermoregulation, bone density, functional capacity, and overall quality of life (Roth et al., 2022; Sedlmeier et al., 2021). This Evidence-Based Practice project aimed to reduce FFM loss in adults prescribed anti-obesity medications (AOMs) for weight management through a targeted, multimodal intervention. Twenty-two patients beginning AOM treatment at a family practice in northwest Indiana were invited to participate, with 19 consenting to enroll. Each participant received personalized guidance, including tailored calorie and protein intake goals to support a hypocaloric, high-protein diet, alongside evidence-based aerobic …

Impact Of Implementing An Updated Cervical Cancer Screening Protocol In The Primary Care Setting, Teri A. Koch

Evidence-Based Practice Project Reports

Cervical cancer is one of the most common types of cancer among women globally. Current screening methods by clinicians include cytology sampling, high-risk human papillomavirus sampling, or co-testing with both methods. These tests may detect cell changes before they become cancerous, yet the uptake of these methods has decreased in recent years (Aginga, 2022; Office of Disease Prevention and Health Promotion, 2023; Popalis et al., 2022; Sung et al., 2021). The primary purpose of this evidence-based practice project was to determine if the implementation of an updated cervical screening protocol improved the linkage of abnormal results to appropriate clinical follow-up …

A Multi-Modal Intervention To Improve Identification, Management, And Prevention Of Early Childhood Caries In The Primary Care Setting, Rieley M. Hull

Evidence-Based Practice Project Reports

Early childhood caries (ECC) is the most prevalent chronic childhood disease and, if untreated, can lead to significant long-term health and social consequences, posing a substantial healthcare burden (AAPD, 2023; ADA, 2023; USPSTF, 2021; WHO, 2022). This evidence-based practice (EBP) project aimed to implement a multi-modal intervention to reduce ECC risk factors, prevent new dental caries, and halt the progression of existing dental caries. Conducted in a pediatric primary care setting in West Michigan, the project included patients five and under who received an oral examination and dental caries risk assessment following the AAP’s guidelines. Based on their oral health …

Alzheimer’S Disease Protective Allele Of Clusterin Modulates Neuronal Excitability Through Lipid-Droplet-Mediated Neuron-Glia Communication, Xiaojie Zhao, Yan Li, Siwei Zhang, Ari Sudwarts, Hanwen Zhang, Alena Kozlova, Matthew J Moulton, Lindsey D Goodman, Zhiping P Pang, Alan R Sanders, Hugo J Bellen, Gopal Thinakaran, Jubao Duan

Duncan NRI Faculty and Staff Publications

Background: Genome-wide association studies (GWAS) of Alzheimer's disease (AD) have identified a plethora of risk loci. However, the disease variants/genes and the underlying mechanisms have not been extensively studied.

Methods: Bulk ATAC-seq was performed in induced pluripotent stem cells (iPSCs) differentiated various brain cell types to identify allele-specific open chromatin (ASoC) SNPs. CRISPR-Cas9 editing generated isogenic pairs, which were then differentiated into glutamatergic neurons (iGlut). Transcriptomic analysis and functional studies of iGlut co-cultured with mouse astrocytes assessed neuronal excitability and lipid droplet formation.

Results: We identified a putative causal SNP of CLU that impacted neuronal chromatin accessibility to transcription-factor(s), with …

Prognostic Value Of Serum And Bronchoalveolar Lavage Fluid Galactomannan Levels In Invasive Aspergillosis: An 8-Year Experience At A Tertiary Cancer Center, Saliba Wehbe, Anne-Marie Chaftari, Ray Hachem, Hiba Dagher, Andrea Haddad, Ann Philip, Ying Jiang, Ramia Zakhour, Peter Bakht, Jishna Shrestha, Peter Lamie, Robin Sherchan, Jennifer Makhoul, Patrick Chaftari, Issam I Raad

Faculty, Staff and Student Publications

Background: Invasive aspergillosis (IA) is a life-threatening fungal infection that primarily affects immunocompromised individuals and has high morbidity and mortality rates, necessitating timely diagnosis and treatment. This study aimed to evaluate the prognostic utility of serum and bronchoalveolar lavage (BAL) fluid galactomannan levels, as well as galactomannan kinetics, in patients with IA.

Methods: We retrospectively reviewed the medical records of patients who were diagnosed with proven or probable IA from March 2016 to April 2024 at a tertiary cancer center. The collected data included patient characteristics, baseline and peak galactomannan levels in serum and BAL fluid, galactomannan trends, and …

Post-Discharge Telephone Intervention With A Clinical Pharmacy Specialist For Gastrointestinal Medical Oncology Patients, Jane E. Rogers, Michael Leung, Amanda Sirisaengtaksin, Jennifer Zadlo, Van Nguyen, Morgan Mace, Wendy Covert, Makenna Smack, Stacy Diao, Zhou Fang, Andrea Landgraf, Mariela Blum Murphy

Advances in Cancer Education and Quality Improvement

Background: Oncology patients are a vulnerable population with medication-related problems spanning across care settings. Gastrointestinal medical oncology (GIMO) patients often have unique medication challenges due to extensive treatment history. High-quality medication reconciliation aids in preventing medication discrepancies and potential adverse events during transitions of care. We conducted a pilot post-hospital discharge intervention with clinical pharmacy specialists for GIMO patients.

Objective: The primary objective was to identify the frequency of medication discrepancies.

Methods: GIMO patients discharged from our hospital were identified and called within 7 days of discharge. Clinical pharmacy specialist telephone encounters occurred between December 2021 and February 2022.

Results: …

Factors Associated With Emergency Difficult Tracheal Intubation And Difficult Airway Management In A Non–Operating Room Setting At A Cancer Treatment Center, Jackson Su, Neil Bailard, Jens Tan, Jeffrey Lim, Catherine Vu, Wenli Dong, Gang Zheng

Advances in Cancer Education and Quality Improvement

Difficult tracheal intubations are reported more often in the emergency non−operating room setting than in the operating setting. To identify the factors associated with emergency difficult intubation (DI) and difficult airway (DA) management in hospitalized patients with cancer, we conducted a single-center retrospective study in hospitalized patients who underwent emergency intubations in a non−operating setting from 2016 to 2019 at a cancer treatment center. Cases of DI (inability to visualize the vocal cords and/or >2 intubation attempts) and DA (DI, advanced airway device use, and/or need for a surgical airway) were included. We reviewed 763 cases; the DI and DA …

Evaluating The Impact Of A Renal Dosing Refreshable Sidebar Report On Appropriateness Of Antimicrobial Dosing At A Large Acute Care Cancer Hospital, Emily Fox, Jovan Borjan, Nancy Vuong, Hannah Aune, Claire Marten, Joshua Hendrickson

Advances in Cancer Education and Quality Improvement

Background: Appropriate antimicrobial dosing is vital in the treatment of patients with infectious diseases, though adherence to guideline recommended doses is often suboptimal.

Outcomes: This study was conducted to evaluate the impact of a renal dosing refreshable sidebar report, which displayed recommendations from a previously developed institutional antimicrobial dosing guide at the time of antimicrobial order entry. The primary outcome was adherence to daptomycin dosing guideline recommendations before and after implementation.

Methods: This was a pre- and post-quasi-experimental study at a 600-bed acute care cancer hospital. Adult patients (≥18 years old) that received daptomycin from February-April 2021 (pre-intervention phase) and …

Smoking Cessation Education In Caregivers Of Pediatric Patients Hospitalized With Asthma Exacerbation, Maya Emptage, Kaitlynn Lineberry, Suzanne Kayali, Bobby Bellflower Dnsc, Nnp-Bc, Faanp, Michelle Rickard Dnp, Pnpac-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Pediatric asthma is rising globally, currently affecting over 300 million individuals and projected to reach 400 million by 2025. This scoping review aims to summarize existing evidence on the impact of providing smoking education to caregivers during hospitalization on reducing pediatric asthma exacerbations, with the goal of encouraging further research.

Methods

The search spanned from August 2022 to November 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria focused on studies involving human participants and caregivers of children receiving smoking cessation education in relation to asthma exacerbation and hospital admission. Databases searched included …

When Pressure Rises: Identifying Abdominal Compartment Syndrome Amid Critical Illness, Mariam Jamil, Muhammed Hussain, Amna Jafri, Asim Mohamed, Rajiv John

Conference Presentation Abstracts

Introduction Abdominal Compartment Syndrome (ACS) occurs in approximately 15% of patients with severe acute necrotizing pancreatitis and is associated with a poor prognosis. Treatment typically involves urgent decompressive laparotomy. However, diagnosing ACS in an intensive care unit (ICU) setting can be challenging, as patients often present with primary illnesses that independently drive end-organ dysfunction. This case highlights a diagnostic framework for ACS while emphasizing common pitfalls and challenges. Case Description A 54-year-old male with a history of alcohol abuse presented with a two-week history of abdominal discomfort and shortness of breath. Initial evaluation, including clinical examination, imaging, and laboratory findings, …

Water-Associated Bacterial Infection Without Aquatic Exposure, Meghan Glaser, Ashley Armstrong, Justin Skrzynski

Conference Presentation Abstracts

Introduction: Shewanella algae is a gram-negative, facultatively anaerobic bacterium most commonly found in marine environments. It is an emerging human pathogen, most often associated with hepatobiliary and skin and soft tissue infections (SSTI) following water exposure. Known risk factors for infection include those participating in recreational water activities, flood victims, and those with underlying liver disease, immunosuppression, or IV drug use. This case involves a 70-year-old male who was involved in a motor vehicle accident in 2008 leading to multiple orthopedic surgeries complicated by recurrent prosthesis infections who presented with concern for sepsis. Case Description: Patient is a 70-year-old male …

A Single Center Qualitative Study To Improve Coordination Of Follow-Up Care For Patients Diagnosed With Abusive Head Trauma, Ruairi Smith-Dewey, Elise Wright, Daniella Donofrio, Hannah Goebel, Sara Kilbride

Posters

Introduction: Children diagnosed with abusive head trauma (AHT) have subsequent long-term developmental, behavioral, and medical consequences resulting in increased medical system utilization. There were 16 overall potential needs identified, with a single patient having 12. In 2023 at Children’s Mercy Hospital (CMH), 47% (8/17) of patients with AHT had < 50% of follow-up needs addressed at time of discharge. None had 100% of follow-up needs addressed. Needs not being addressed included need not identified or written documentation for need of follow-up without subsequent referral placed/appointment scheduled. Project goal was all follow-up needs to be addressed for at least 50% of children with AHT by January 2025. Methods (include PDSA cycles): Children admitted to CMH from January 2024-December 2024 and diagnosed with AHT by the Safety, Care & Nurturing (SCAN) team were included. Interventions were designed and implemented by a multidisciplinary team to address barriers including variation in scheduling process per specialty, lack of knowledge, and changing caregivers. • PDSA 1 (1/1/24): SCAN added standardized list of potential follow-up needs to documentation. • PDSA 2 (2/1/24): Trauma NP placed ophthalmology outpatient referrals. • PDSA 3 (3/1/24) Social work placed and documented early intervention referrals. Transitioned to SCAN RN responsibility. • PDSA 4 (4/10/24): AHT caregiver handouts with description of all potential follow-up needs added to discharge instructions. • PDSA 5 (12/11/24): AHT Evidence Based Practice guideline created including follow-up needs. Appointments and referrals were tracked by the author. QI tools used included fault tree, fishbone, and PICK Chart. Results: In 2024, 27 children were diagnosed with AHT by SCAN team at CMH. Five children were excluded from the study as 3 died and 2 were transferred to another hospital. The number of patients with < 50% of follow-up needs addressed was reduced from 47% to 43%. All follow-up needs were addressed in 13% (3/23) of patients. Conclusions: While project aims weren’t met, there was progress. Next steps include educating all discharging teams at CMH as there is no single team discharging these patients. Overall, there are few of these patients so standardization of discharge practices is challenging. SCAN created a working group and point person for appointment tracking to ensure follow-up needs established at discharge.

A Storm Within: Anti-Nmda Receptor Encephalitis Mimicking Anxiety In A Young Woman, Izma Khaliq, Omar Sami Abdelhai, Angela Ishaq, Emmanuel Meram, Anointing Onuoha, Ahmed Jabri, William Dillon

Conference Presentation Abstracts

Case Description: A 21-year-old female with a history of asthma presented to the emergency department (ED) with restlessness, anxiety, and loss of appetite shortly after returning from a trip to France, where she and her boyfriend ended their relationship. Her initial evaluation, including unremarkable laboratory results, led to the attribution of her symptoms to anxiety from life stressors. She was treated with supportive measures in the ED and prescribed Xanax by her primary care physician at follow-up. Six days later, the patient returned to the ED with hallucinations and panic attacks. Again, laboratory results were unremarkable, and she was diagnosed …

Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Acne On The Valve: A Case Of Cutibacterium Acnes Prosthetic Valve Endocarditis And Aortic Root Abscess, Aiden Van Loo, Mitchell Schwocho, Francisco Davila

Conference Presentation Abstracts

Introduction Infective endocarditis (IE) is a serious infection of the endocardium and the cardiac valves. Its incidence is on the rise, and this has been attributed to the aging population, healthcare-associated infections, and the growing use of intracardiac devices and prosthetic valves. IE is typically caused by gram positive cocci; although other more fastidious organisms can present in a subacute fashion. One such organism that is now becoming identified is Cutibacterium Acnes. It is a gram-positive anaerobe, most commonly known for causing acne. Given its ubiquity as skin flora, it can enter the blood stream and cause systemic infections. Here …

A Case Of Futile Mechanical Thrombectomy In Chronic Thromboembolic Pulmonary Hypertension, Daivd Connolly, Michael Barnes

Conference Presentation Abstracts

Introduction Percutaneous mechanical thrombectomy is a mainstay therapy in the management of high-risk acute pulmonary embolism (PE), as it reduces pulmonary artery pressure and improves right ventricular function. However, the role of percutaneous mechanical thrombectomy in the management of chronic PE or acute on chronic PE is unclear. Case Description We present the case of a 46-year-old male who presented to the emergency department with 4 days of worsening dyspnea and pleuritic chest pain. Past medical history is significant for class II obesity, prior transient ischemic attack, pulmonary hypertension with right-sided heart failure, and four admissions over the previous 10 …

Unmasking Lupus Through Myopericarditis, Athanasios Rempakos, Lark Steafo, Tawhida Khatoon

Conference Presentation Abstracts

Systemic lupus erythematosus (SLE) is a complex, multisystem autoimmune that often presents with nonspecific symptoms, complicating diagnosis. Myopericarditis is a rare initial manifestation, mimicking infections or malignancies. We present a case underscoring the importance of considering SLE in refractory multisystem illness. A 26-year-old previously healthy male presented to an outside hospital with a one-week history of left-sided pleuritic chest pain, fever, chills, palpitations, fatigue, cough, sinus congestion, and headache. Initial evaluation revealed marked tachycardia (heart rate 180s/min on exertion). CT pulmonary angiography excluded pulmonary embolism but identified a large right-sided consolidation consistent with pneumonia. His initial troponin was 223 with …

Stroke With Pfo, Uncovering Underlying Mutations And Malignancy: A Case Report, Haiqi Guo, Karan Chhabra, Atulya Khosla, Florian Bukovec, Dilip Khanal

Conference Presentation Abstracts

Introduction: Stroke is the leading cause of long-term disability, with most cases being ischemic. In patients aged 18–60 years, patent foramen ovale (PFO) is implicated in 10% of strokes. Pathophysiologies include paradoxical thromboembolism and thrombus formation in the PFO, leading to cerebral or systemic embolism. Cancer is a comorbidity in 5–10% of patients with acute stroke, with mechanisms such as direct tumor effects, coagulopathy, and cancer therapy. Two common inherited thrombophilia predisposing to deep vein thrombosis (DVT) are Factor V Leiden (FVL) and G20210A Prothrombin gene mutation (PTM). FVL results in poor anticoagulant response to activated Protein C, while PTM …

Not A Cyst, But Gist: A Case Report, Jessica Kopchia, Amira Al-Nabolsi, Barbara Senger, Gurveer Gill, Yevhen Drobot

Conference Presentation Abstracts

Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal neoplasms found in the gastrointestinal (GI) tract, although they only account for 1-2% of gastrointestinal tumors. It is suspected that GISTs originate from the Cajal cells, necessary for regulating peristalsis. Diagnosis relies heavily on histopathologic examination, majority of GISTs being caused by an oncogenic mutation in the KIT gene, responsible for the regulation of tyrosine kinase. KIT upregulates the interstitial cells of Cajal, resulting in tumor formation. Therefore, these tumors are predominantly found in the stomach and small intestine, less frequently in colon, esophagus, and rectum. Often these neoplasms are benign, …

An Incidental Finding Of Inferior Vena Cava Thrombosis In A Patient Presenting With Gastroenteritis, Berk Celik, Ovidiu Niculescu

Conference Presentation Abstracts

Introduction Inferior vena cava (IVC) thrombosis is an under-recognized entity that is associated with significant morbidity and mortality. IVC thrombosis is prevalent (60% to 80%) among patients with congenital IVC anomalies. These anomalies occur in 0.5%–1% of the general population. Thrombosis of the IVC in the absence of congenital abnormalities is rare and is usually a result of a predisposing hypercoagulable state or IVC filter. Here, we present a case of an incidental finding of IVC thrombosis in a patient presenting with gastroenteritis. Case description A 57-year-old female with a past medical history of obstructive sleep apnea, and non-alcoholic steatohepatitis …

Recurrent Malignant Retroperitoneal Solitary Fibrous Tumour Leading To Obstructive Uropathy And Sepsis, A Case Report, Wesam Almasri, Imran Bitar, Aagamjit Singh, Yusra Zakria, Dilip Khanal

Conference Presentation Abstracts

Introduction Solitary Fibrous Tumours (SFT) are rare mesenchymal tumours. Although initially described pleural in origin, they can arise from virtually any site. SFTs of retroperitoneal origin are especially rare, with limited literature on their management. Here we present a unique case of an aggressive recurrent retroperitoneal SFT causing mass effect leading to obstructive uropathy. Brief case description A 47-year-old Hispanic man without past medical history presented to a neighboring hospital with months-long abdominal pain and urinary retention. CT showed a 14x12x12 cm pelvic mass that could not be separated from the prostate, together with right hydroureteronephrosis. He was discharged with …

Severe Digital Necrosis In The Context Of Raynaud's Phenomenon, Antiphospholipid Antibody Syndrome, And Vasculitis: A Diagnostic Dilemma, Silvana Iskandar, Karan Chhabra, Omar Jameel, Tucker Billups

Conference Presentation Abstracts

Abstract: A 73-year-old male with polyarticular gout, hypertension, and rheumatoid arthritis presented with non-healing necrotic wounds on the distal aspect of his upper extremity digits, most severely affecting the left index finger with eschar. His symptoms had been present for the past six weeks. He also had a history of Raynaud’s phenomenon, which preceded these symptoms. Examination revealed necrotic wounds on the nail beds of seven fingers bilaterally, with significant left index finger necrosis. Despite the severity of his condition, he remained hemodynamically stable throughout hospitalization. Laboratory studies showed positive cardiolipin IgM and beta-2 glycoprotein antibodies on two separate occasions, …

The Silent Progression Of Otomastoiditis: A Case Report On Skull Base Osteomyelitis And Cerebral Venous Thrombosis, Tabssum Chauhan, Ammara Aftab, Ahamed Abdulbagi, Wafa Ahmed, Rajiv John

Conference Presentation Abstracts

Introduction Otomastoiditis, a common ear infection, can progress to severe complications such as skull base osteomyelitis (SBO) and cerebral venous thrombosis (CVT), though these are rare. The incidence of CVT in the context of otomastoiditis is approximately 3 to 4 cases per million adults, but it remains life-threatening. Pre antibiotics, CVT secondary to otomastoiditis showed a near100% mortality rate. Today, early recognition and multidisciplinary management make these complications preventable. This case raises the importance of in-time diagnosis and management in averting severe outcomes such as neurological deficits and death. Case Report A 78-year-old female with uncontrolled insulin-dependent diabetes (HbA1c 10.3%) …

Streptococcus Pneumoniae Cervical Abscess In A Pcv-Immunized Female With Waldenstrom's Macroglobulinema: Exploring The Role Of Opsosonization Failure And Functional Hyposplenesim Beyond The Spectrum Of Malignant B-Cell Disorders, Tanya Amal, Paul Johnson, Ayesha Sharif, Usman Bin Hameed

Conference Presentation Abstracts

A 64-year-old female with recently diagnosed Waldenström's macroglobulinemia presented with pain and swelling in the neck. Three weeks prior, she had accidentally punctured her neck with her fingernail, leading to initial swelling. She visited the ER, but workup showed no acute infection. A contrast-enhanced CT scan revealed enlarged bilateral cervical lymph nodes. Over the next two weeks, the swelling became increasingly painful. On presentation, she had sharp, localized pain (10/10 intensity), tachycardia, and a 3x3 cm swelling on the right side of her neck, with redness, warmth, and tenderness. Laboratory results showed lymphocytic leukocytosis (WBC 31.5, lymphocyte 24.8%, neutrophil 6.1%). …