Internal Medicine Commons^™

Metastatic Large Cell Neuroendocrine Carcinoma: A Rare Cause Of Hypopituitarism, Smriti Nair, Taskeen Ahmed, Jessica Watari

Division of Internal Medicine Faculty Papers & Presentations

Pituitary metastases from pulmonary large cell neuroendocrine carcinoma (LCNEC) are exceedingly rare but should be considered in patients presenting with arginine vasopressin deficiency and panhypopituitarism in the context of known or suspected metastatic lung cancer. Early recognition and prompt initiation of hormonal replacement therapy are essential to prevent life-threatening endocrine crises and to improve symptom burden. We describe a case of a 43-year-old male who presented with dyspnea, weight loss, and weakness who was found to have metastatic LCNEC involving the liver. Endocrine evaluation revealed central hypothyroidism, central adrenal insufficiency, and later arginine vasopressin deficiency manifested by polyuria and hypernatremia. …

Bilateral Intracranial Subdural Hematoma Following Epidural Anesthesia, Eric B. Cox, Adaeza Onuoha

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

False Halos: A Case Of Digoxin Poisoning, Usman Nazeer, Sarita Thanedar, Jacob Sanderson, Gongkai Liu, Hitesh Gidwani

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Defining A Multi-Omic, Ai-Enabled Stool Screening Paradigm For Colorectal Cancer: A Consensus Framework For Clinical Translation, Arturo Loaiza-Bonilla, Yan Leyfman, Viviana Cortiana, Rhys Crawford, Shivani Modi

Einstein Health Papers

Colorectal cancer (CRC) develops through both conventional adenoma-carcinoma and serrated neoplasia pathways, yet noninvasive screening still under-detects the advanced precursor lesions that enable true cancer prevention. Stool-based screening reduces CRC mortality, but its preventive impact remains constrained by limited detection of advanced precancerous lesions (APLs), including advanced adenomas and sessile serrated lesions. Next-generation multitarget stool DNA assays (mt-sDNA; e.g., Cologuard Plus) have established high sensitivity for CRC and specificity approaching 94%, leaving improved APL detection as the principal opportunity for innovation. This review presents a consensus framework for a multi-omic stool screening paradigm that integrates host epigenetic markers (DNA methylation) …

Unwrapping The Candy Cane: An Underrecognized Cause Of Postoperative Abdominal Pain, Priscilla Itua, Uzma Ali, Mohammad Mahdi, Osamah Salim, Sarib Sultan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Survival Following Extreme Metformin-Associated Lactic Acidosis In A Patient With Acute-On-Chronic Kidney Disease Managed With Crrt, Phil Khong, Danielle Sudilovsky, Logan Blackney, Ryan Spilman, Alex Enurah

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Biliary Obstruction From An Unexpected Source, Max Dinicola, Trevor Link, Derek Welch

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Predictors Of Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation: Systematic Review And Random-Effects Meta-Analysis, Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Predictors Of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Contemporary Systematic Review And Meta-Analysis Of Adjusted Risk Factors, Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Tackling Tele Box Shortage Via Educational Initiative, Guntash Khasria, Bushra Ambreen

Gulf Coast Division GME Research Day 2026

No abstract provided.

Redo-Tavr Vs Tavr Explant Vs Redo-Savr: Comparative Outcomes In Failed Transcatheter Bioprostheses, Yves Najm Mrad, Ahmad Al-Taweel, Bahaeddin Shabaneh

Gulf Coast Division GME Research Day 2026

No abstract provided.

Finding Foxg1 Syndrome In An Adult Patient, Claudia Ludden, Timothy P. Connelly

South Atlantic Division GME Research Days 2026

No abstract provided.

The Great Mimicker: Intrathecal Opioid-Induced Esophageal Dysfunction, Abhishek Desai, Lisa Persaud, Desiree Aird

South Atlantic Division GME Research Days 2026

No abstract provided.

Improving Inpatient Colonoscopy Bowel Preparation Quality In A Community Hospital Via Split-Dose Polyethylene Glycol Regimen, Brenden Pearce, Yashaswi Koguru, Schuyler Nebeker, Minh Nguyen, Lauren Roper, Kathleen Raynor

South Atlantic Division GME Research Days 2026

No abstract provided.

Minimizing Unnecessary Ttes For Pfo Evaluation In Stroke Patients, Jeffrey Lesser, Salman Islam, Aneesha Shaju, Aarohi Parikh, Jonathan Nguyen, Marelle Montanez

Gulf Coast Division GME Research Day 2026

No abstract provided.

Neurologic Complications In Adult Va-Ecmo: Incidence, Phenotypes, And Mortality From Contemporary Elso Registry Analyses And Meta-Analytic Evidence, Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Case Report: Primary Recurrent Gallstones Following Cholecystectomy, Gabriel Noguera, Nimal Patel

West Florida Division GME Research Day 2026

No abstract provided.

A Single-Center, Retrospective Analysis Of The Safety And Efficacy Of Disc Tissue Allograft Supplementation For Discogenic Axial Low Back Pain, Nomen Azeem, Ali Amirzadeh

West Florida Division GME Research Day 2026

No abstract provided.

Stewards In The Making: Approaching "Penicillin-Allergies" With Confidence, Trent Percy, Craig Spergel

West Florida Division GME Research Day 2026

No abstract provided.

From Peg To Perfusion: A Case Of Malnutrition Reversed By Mesenteric Revascularization, Sacha Saba, Mahi Basra, Alvin Newman Caro, Vikas Sethi, Marc Kudelko

West Florida Division GME Research Day 2026

No abstract provided.

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 …

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, …

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 …

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.

A Rare Case Of Successful Resolution Of Bifurcation Stenosis Using Double Kissing Crush Stenting Technique, Greeshma Molugu, Tony Alacron, Karthik Anand, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Bifurcation lesions are associated with greater procedural complexity and consequently are at higher risk for stent restenosis. Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in the main vesseI and side branch Iimits the Iong-term prognosis. We present a rare case of successful resolution of bifurcation stenosis in a patient by using the double kissing (DK) crush stenting technique.

Case Description: A 52-year-old male patient with a past medical history of hypertension presented to the hospital for elective left heart catheterization as a part of an evaluation for a …

Empiric Antibiotic And Corticosteroid Prescribing For Hospitalized Acute Exacerbations Of Copd: Associations With Length Of Stay And Readmissions In A Large Multicenter U.S. Cohort, Kumar Abhishek, Pratyush Kumar, Archana Machavarapu, Munaf Siyamwala, Michael Waxman, Jeffrey Durbin, Kari Nilsen

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Conduction System Pacing Vs Biventricular Pacing: A Meta Analysis Of Randomized Controlled Trials In Cardiac Resynchronization Therapy, Mustafa Tahir, Muhammad Abdullah, Jaafar Hamdan, Michael D. Moore, Nagaraja D. Sharma, Olu Oyesanmi, Salman M. Muddassir

West Florida Division GME Research Day 2026

No abstract provided.

Prophylactic Distal Perfusion Catheters In Femoral Va-Ecmo: Association With Lower Limb Ischemia And Major Limb Outcomes (Systematic Review & Meta-Analysis), Yves Najm Mrad, Snehalkumar Patel

Gulf Coast Division GME Research Day 2026

No abstract provided.

Devising A Protocol For Mri Clearance In Patients With Cardiac Implantable Electronic Devices (Cied), Sienna Luk, Alvin Mathew, Darshan Bhatty, Kamran Rizvi

North Texas GME Research Forum 2026

Background: Magnetic Resonance Imaging (MRI) in patients with Cardiac Implantable Electronic Devices (CIEDs) remains a logistical challenge in many clinical settings. At Medical City Denton, the absence of a standardized institutional policy has led to significant inefficiencies, including prolonged hospital stays and increased healthcare costs. The primary objective of this project was to address these barriers by developing a streamlined, evidence-based protocol to improve care coordination and resource utilization for patients with CIEDs requiring diagnostic imaging.

Methods: Launched in 2026, this pilot initiative utilized a multi-stakeholder approach involving hospitalists, EPs, radiology staff, and device representatives. A core component of the …

Relationship Between Exception Request For Higher Listing Urgency And Aggressiveness In Accepting Heart Offers, Jorim Parmar, Yingxian Liu, Devika Adusumilli, Luke Taylor, Shakir Al-Ezzi, Usman Khan, Claudio Bravo, Claudius Mahr, Song Li

North Texas GME Research Forum 2026

BACKGROUND: Transplant programs may submit exception requests to upgrade a listed patient’s priority, often anticipating a higher likelihood of accepting marginal or high-risk donor organs. This study explores whether exception request status is associated with increased risk tolerance in organ acceptance.

METHODS: We conducted a retrospective analysis using data from the Scientific Registry of Transplant Recipients (SRTR), focusing on adult patients (≥18 years) listed for heart transplantation. Statistical analyses were performed using SAS/STAT 14.1. Descriptive statistics summarized demographic and clinical variables. Baseline characteristics were compared between recipients with and without exception requests. Primary analysis: Mixed-effects linear regression was used to …