Internal Medicine Commons^™

A Fatal Case Of Ards: Concomitant Blastomycosis & Aspergillosis In An Immunocompetent Male, Hytham Rashid, Alexander Llop, Tusharkumar Pansuriya, Jayaram Turuvekere

Gulf Coast Division GME Research Day 2022

No abstract provided.

High Risk Newly Diagnosed Multiple Myeloma, Phebe Abraham, Cassie Robertson, Aswin Srinivasan, Murtaza N. Bhuriwala, Shan Guo

Gulf Coast Division GME Research Day 2022

No abstract provided.

Triple Sars-Cov2, Influenza A & Influenza B Co-Infection, Feras Al-Moussally, Mohammed Rahhal, Rey Marrero, Roger Crouse

North Florida Division GME Research Day 2022

No abstract available.

Chiari-Eustachian Valve Infective Endocarditis: A Rare Consequence Of Implanted Venous Access Ports, Larissa Check, Lidice Galindo, Robert Sherertz, Shashikanth Nagabandi

South Atlantic Division GME Research Day 2022

No abstract provided.

A Rare Case Of Splenic Artery Thrombosis Provoked By Medroxyprogesterone Acetate (Dmpa) Requiring Splenectomy, Raghav Bassi, Asad Haider, Pranav Prakash, Abdullahi Hussein, Hamza Alzghoul, Muhammad Bilal, Anuoluwa Oyetoran, Uma Iyer

North Florida Division GME Research Day 2022

No abstract available.

Contrast-Induced Encephalopathy Following Diagnostic Coronary Angiography, Hytham Rashid, Andrew Good, Jonathan Brown, Tusharkumar Pansuriya, Alan Fisher Covin, Mir Ali Sadat

Gulf Coast Division GME Research Day 2022

No abstract provided.

Left Atrial Enlargement In Cryptogenic Strokes Without Atrial Fibrillation: A Multicenter Retrospective Analysis, Hytham Rashid, Tushar Pansuriya, Jonathan Brown, Jarey Wang, Sivatej Sarva, Syed Raza

Gulf Coast Division GME Research Day 2022

No abstract provided.

Double-Edged Sword: Status Asthmaticus Complications In An Opiate Tolerant Patient, Hytham Rashid, Kenneth Salu, Jordan Babcock, Tushar Pansuriya, Adrienne Madison, Sivatej Sarva

Gulf Coast Division GME Research Day 2022

No abstract provided.

Kikuchi-Fujimoto Disease Complicated By Rheumatoid Arthritis, Type 1 Diabetes Mellitus, And Hypothyroidism, Soroush Shahrokh, Ammar Hasan, Salman Raza Alim, Michelle Hebert, Khulood Rizvi

Gulf Coast Division GME Research Day 2022

No abstract provided.

Not Just An Accident: A Case Of Insulinoma, Asanka Ekanayake, Harrison Stubbs, Dominique Broutin, Olga Karasik, Mustafa Kinaan

North Florida Division GME Research Day 2022

No abstract available.

A Right Atrial Mass With Fever And Cutaneous Nodules, Feng Gao, Stephanie Koh, Sara Taveras-Alam, Umair Khalid

Faculty, Staff and Student Publications

Primary cardiac tumors, although exceedingly rare, should be considered in the differential diagnosis during workup of any cardiac mass. Extranodal cardiac lymphomas have a natural aggressive course due to delayed diagnosis. We present a 71-year-old male with a dual-chamber pacemaker who presented with fevers and new cutaneous nodules. He was found to have a right atrial primary anaplastic large-cell lymphoma and had a complete metabolic response after chemotherapy. Our case highlights the importance of a multimodality approach in the diagnosis of cardiac tumors and during follow-up after treatment.

The Slow Rhythm Of Midodrine: A Peculiar Case Of Profound Bradycardia, Larissa Check, Louis Tsichlis, Mohamed Faris

South Atlantic Division GME Research Day 2022

No abstract provided.

A Case Of Severe Bilateral Posterior Epistaxis Secondary To Essential Thrombocytosis, An Dao, Branden Wilson, Shan Guo, Christian Cajavilca

Gulf Coast Division GME Research Day 2022

No abstract provided.

A Sudden Fall: Hypokalemic Familial Thyrotoxic Periodic Paralysis, Haroutiun Hamzoian, Aswin Srinivasan, Reuben Plasencia, Branden Wilson, Rajeev Raghavan

Gulf Coast Division GME Research Day 2022

No abstract provided.

Unusual Case Of Isolated Pancreatitis Secondary To Blunt Abdominal Trauma, Haroutiun Hamzoian, Reuben Plasencia, Ndifreke Ekpa, Elias Georg

Gulf Coast Division GME Research Day 2022

No abstract provided.

Patient And Provider Perspectives On Medication Non-Adherence Among Patients With Depression And/Or Diabetes In Diverse Community Settings – A Qualitative Analysis, Jane E Hamilton, Eduardo Blanco, Salih Selek, Kelly L Wirfel, Elmer V Bernstam, Dawn Velligan, Meghana Gudala, Kirk Roberts

Faculty, Staff and Student Publications

BACKGROUND: Diabetes and depression affect a significant percentage of the world's total population, and the management of these conditions is critical for reducing the global burden of disease. Medication adherence is crucial for improving diabetes and depression outcomes, and research is needed to elucidate barriers to medication adherence, including the intentionality of non-adherence, to intervene effectively. The purpose of this study was to explore the perspectives of patients and health care providers on intentional and unintentional medication adherence among patients with depression and diabetes through a series of focus groups conducted across clinical settings in a large urban area.

METHODS: …

Management Of Adult Growth Hormone Deficiency Related To Hypopituitarism, Kellie Jamin

Capstone Showcase

The treatment of growth hormone deficiency (GHD) is well-established in childhood but less understood in adults, given the more complex role that growth hormone (GH) assumes in this population. Decreased functionality of the pituitary gland, otherwise known as hypopituitarism, can present with an isolated GHD in adulthood, which may result from a number of factors including neoplasm, ischemia, infection, traumatic injury, or systemic disease. Adult GHD may be definitively diagnosed with a stimulation test, the insulin tolerance test (ITT) being the study of choice. With a positive ITT, the disorder can be treated with growth hormone replacement therapy (GHRT), which …

Complexities And Complications Of Extreme Obesity, Haval Ali, Udit Naik, Michelle Mcdonald, Mohammad Almosa, Karen Horn, Alexis Staines, Louis Maximilian Buja

Faculty, Staff and Student Publications

Obesity is a common chronic disorder and has detrimental long-term consequences if left untreated. Herein, we report a case of a young lady who suffered from morbid obesity and many of its consequences, and we present a literature review of these complications. While the cause of obesity is multifactorial, the genetic component is particularly important in the pathophysiology of marked obesity. Resistance to Leptin is considered one of the main causes of obesity. There is a unique relationship between polycystic ovary syndrome and obesity, as observed in our case. Obesity is associated with cardiovascular and lung diseases such as heart …

Kidney Disease After Heart And Lung Transplantation, Carlos M Zapata, Hassan N Ibrahim

Faculty, Staff and Student Publications

Chronic kidney disease (CKD) is not only common after lung and heart transplantation but also is associated with increased morbidity and mortality due to multiple pre-, peri- and post-transplant factors. While the exact incidence of CKD in this population is not well-defined, it seems to have gradually increased over the years as older recipients are more frequently considered. The increasing success of the procedure and expanding transplant candidate pool has allowed many with comorbid conditions to receive a transplant, which was considered prohibitive in the past. This review presents risk factors that have been linked to CKD as well as …

Risk Of Developing Alzheimer's Disease And Related Dementias In Association With Cardiovascular Disease, Stroke, Hypertension, And Diabetes In A Large Cohort Of Women With Breast Cancer And With Up To 26 Years Of Follow-Up, Xianglin L Du, Lulu Song, Paul E Schulz, Hua Xu, Wenyaw Chan

Faculty, Staff and Student Publications

BACKGROUND: No study on the long-term incidence of Alzheimer's disease (AD) and related dementias (ADRD) has been reported in women with breast cancer by vascular diseases.

OBJECTIVE: to determine the risk of ADRD in association with cardiovascular diseases (CVD), stroke, hypertension, and diabetes in women with breast cancer.

METHODS: Study identified 246,686 women diagnosed with breast cancer at age≥65 years in 1991-2015 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Women were free of ADRD at the time of cancer diagnosis and followed from 1991 to 2016.

RESULTS: Cumulative incidence of AD over 26 years of follow-up varied …

Palliative Endoscopic Salvage Of A Functionally Obstructed Gastrojejunostomy - Report Of Technique, Elias A Chamely, Bryan Hoang, Nadim S Jafri, Melissa M Felinski, Kulvinder S Bajwa, Peter A Walker, Jaideep Barge, Erik B Wilson, Putao Cen, Shinil K Shah

Faculty, Staff and Student Publications

BACKGROUND: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

CASE DESCRIPTION: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical …

Renal Disease And The Heart, Hassan N Ibrahim

Faculty, Staff and Student Publications

No abstract provided.

Safety Of Exercise For Adults With Thoracic Aortic Aneurysms And Dissections, Jesse Li, Alexandra Boyd, Michael Huang, Joshua Berookhim, Siddharth K Prakash

Faculty, Staff and Student Publications

BACKGROUND: Current guidelines for patients with thoracic aortic aneurysms or dissections (TAD) restrict vigorous exertion with the intention to prevent acute aortic dissections. However, a safe threshold for exercise intensity has not been established for TAD patients. In this study, we measured exertional changes in systolic and diastolic blood pressure during isometric and dynamic exercises in a cohort of TAD patients to determine safety of moderate intensity exercise.

METHODS: Thirty-one adults with TAD and 14 controls were recruited from UTHealth outpatient clinics. All participants completed an exercise protocol consisting of two circuits of five moderate intensity exercises: hand grips, leg …

Engineered Cord Blood Megakaryocytes Evade Killing By Allogeneic T-Cells For Refractory Thrombocytopenia, Bijender Kumar, Vahid Afshar-Kharghan, Mayela Mendt, Robert Sackstein, Mark R Tanner, Uday Popat, Jeremy Ramdial, May Daher, Juan Jimenez, Rafet Basar, Luciana Melo Garcia, Mayra Shanley, Mecit Kaplan, Xinhai Wan, Vandana Nandivada, Francia Reyes Silva, Vernikka Woods, April Gilbert, Ricardo Gonzalez-Delgado, Sunil Acharya, Paul Lin, Hind Rafei, Pinaki Prosad Banerjee, Elizabeth J Shpall

Faculty, Staff and Student Publications

The current global platelet supply is often insufficient to meet all the transfusion needs of patients, in particular for those with alloimmune thrombocytopenia. To address this issue, we have developed a strategy employing a combination of approaches to achieve more efficient production of functional megakaryocytes (MKs) and platelets collected from cord blood (CB)-derived CD34+ hematopoietic cells. This strategy is based on ex-vivo expansion and differentiation of MKs in the presence of bone marrow niche-mimicking mesenchymal stem cells (MSCs), together with two other key components: (1) To enhance MK polyploidization, we used the potent pharmacological Rho-associated coiled-coil kinase (ROCK) inhibitor, KD045, …

Why Test Results Are Still Getting "Lost" To Follow-Up: A Qualitative Study Of Implementation Gaps, Andrew J Zimolzak, Umber Shahid, Traber D Giardina, Sahar A Memon, Umair Mushtaq, Lisa Zubkoff, Daniel R Murphy, Andrea Bradford, Hardeep Singh

Faculty, Staff and Students Publications

BACKGROUND: Lack of timely follow-up of abnormal test results is common and has been implicated in missed or delayed diagnosis, resulting in potential for patient harm.

OBJECTIVE: As part of a larger project to implement change strategies to improve follow-up of diagnostic test results, this study sought to identify specifically where implementation gaps exist, as well as possible solutions identified by front-line staff.

DESIGN: We used a semi-structured interview guide to collect qualitative data from Veterans Affairs (VA) facility staff who had experience with test results management and patient safety.

SETTING: Twelve VA facilities across the USA.

PARTICIPANTS: Facility staff …

Diagnosis And Interpretation Of Testing For Cat Scratch Disease, Nasim Khalfe, Doris Lin

Faculty, Staff and Students Publications

Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae that presents as regional lymphadenopathy which can appear within weeks after a cat scratch. There is no gold standard for diagnosis. Rather, clinicians rely on an amalgam of criteria to make a definitive diagnosis. We describe a case of a 44-year-old woman with six cats who presented with a painful left inguinal mass, had splenic lesions on imaging, and had positive serology but a negative polymerase chain reaction test for B. henselae.

Sr9009 Improves Heart Function After Pressure Overload Independent Of Cardiac Rev-Erb, Hui Li, Shiyang Song, Chih-Liang Tien, Lei Qi, Andrea Graves, Eleni Nasiotis, Thomas P Burris, Yuanbiao Zhao, Zheng Sun, Lilei Zhang

Faculty, Staff and Students Publications

The core clock component REV-ERB is essential for heart function. Previous studies show that REV-ERB agonist SR9009 ameliorates heart remodeling in the pressure overload model with transverse aortic constriction (TAC). However, it is unknown whether SR9009 indeed works through cardiac REV-ERB, given that SR9009 might target other proteins and that REV-ERB in non-cardiac tissues might regulate cardiac functions indirectly. To address this question, we generated the REV-ERBα/β cardiac-specific double knockout mice (cDKO). We found that REV-ERB cardiac deficiency leads to profound dilated cardiac myopathy after TAC compared to wild-type (WT) control mice, confirming the critical role of REV-ERB in protecting …

An Automated Risk Index For Diabetic Ketoacidosis In Pediatric Patients With Type 1 Diabetes: The Ri-Dka, David D Schwartz, Rosa Banuelos, Serife Uysal, Mili Vakharia, Kristen R Hendrix, Kelly Fegan-Bohm, Sarah K Lyons, Rona Sonabend, Sheila K Gunn, Selorm Dei-Tutu

Faculty, Staff and Students Publications

Identifying patients at high risk for diabetic ketoacidosis (DKA) is crucial for informing efforts at preventive intervention. This study sought to develop and validate an electronic medical record (EMR)-based tool for predicting DKA risk in pediatric patients with type 1 diabetes. Based on analysis of data from 1,864 patients with type 1 diabetes, three factors emerged as significant predictors of DKA: most recent A1C, type of health insurance (public vs. private), and prior DKA. A prediction model was developed based on these factors and tested to identify and categorize patients at low, moderate, and high risk for experiencing DKA within …

Paraventricular Vitamin D Receptors Are Required For Glucose Tolerance In Males But Not Females, Jessie Beck, Silvania Da Silva Teixeira, Keisha Harrison, Gabrielle Phillips, Yanlin He, Stephanie Sisley

Faculty, Staff and Students Publications

When delivered directly into the brain, vitamin D, can improve glucose levels in male mice. Additionally, the loss of the vitamin D receptor (VDR) in male mice's paraventricular hypothalamus (PVH) results in impaired glucose tolerance. Data in humans shows that low vitamin D levels are detrimental to glucose homeostasis, an effect that may be more prominent in men. However, it is unknown if vitamin D action in the brain is required for normal glucose regulation in female mice. This study shows that in both viral and genetic models, male mice with obesity and PVH VDR loss have impaired glucose tolerance …

Sporadic Creutzfeldt-Jakob Disease After Receiving The Second Dose Of Pfizer-Biontech Covid-19 Vaccine, Andrea J. Folds, Melanie-Belle Ullrich, Sann Htoo, Anjeza Chukus

Internal Medicine

No abstract provided.