Internal Medicine Commons^™

A Case Of Severe Synodic Stenosis In A Patient With Granalomatosis With Polyangitis Requiring Tracheostomy, Yousuf Sherwani, Mohan Sengodan

North Texas Research Forum 2025

Granulomatosis with polyangiitis (GPA) is characterized by vasculitis of small and medium sized blood vessels and granulomatous lesions of the upper respiratory tract. A rare condition associated with GPA, subglottic stenosis, presents in about 20% of cases on inpatient GPA. Symptoms such as stridor, hoarseness, dyspnea and dysphagia are hall marks of subglottic stenosis. Here we present the case of a male patient with life threatening subglottic stenosis that required tracheostomy.

Assessing And Improving Resident Understanding Of Inpatient Sepsis, Hamza Naveed, E'Joven Reed, Mike Wong

Gulf Coast Division GME Research Day 2025

No abstract provided.

Navigating The Complexity Of Ards And Cardiogenic Shock With Veno-Arterial Ecmo: A Case Report, Sanjana Kesireddy, Mohan Sengodan

North Texas Research Forum 2025

INTRODUCTION: When deciding between VA ECMO (veno-arterial ECMO) and VV ECMO (veno-venous ECMO), the primary consideration is the underlying pathology affecting the patient’s heart and lungs. VA ECMO provides support for both the cardiovascular and respiratory systems, making it suitable for patients experiencing cardiogenic shock or combined cardiac and respiratory failure. In contrast, VV ECMO is used exclusively for respiratory failure, offering support to patients with severe lung dysfunction but intact cardiac function. CASE PRESENTATION: 41 year old male with no known past medical history presented s/p cardiac arrest secondary to aspiration pneumonia due to alcohol and opioid intoxication. Chest …

Platypnea-Orthodeoxia Syndrome In A Case Of Septal Occlusion Device Migration, Bike Ozkan, Richard Shalmiyev, Adam Devine, Michael Pelekhach, Siddarth Kathuria, Daniel Heller, Mauricio Danckers

East Florida Division GME Research Day 2025

Introduction

Platypnea-orthodeoxia syndrome (POS) is defined by dyspnea and hypoxemia in the upright position, which improves upon recumbency. While often linked with hepatopulmonary syndrome, intracardiac etiologies, particularly a patent foramen ovale (PFO), may also be responsible. PFOs are typically managed with device closure, and while rare, device migration can occur unbeknownst to the patient with resultant critical sequelae.

Methods

Here, we present the case of an 89-year-old female with a medical history of hypertension, diabetes, and coronary artery disease status post PCI, who arrived with severe dyspnea and was subsequently intubated for profound hypoxia. A chest CT angiogram ruled out …

The Role Of Bandemia In Clinical Outcomes Of Critically Ill Septic Patients., Yerandi Gil, Grettel Gonzalez Garcia, Ambar Sekulis, Rafael Miret, Siddarth Kathuria, Mauricio Danckers, Daniel Heller

East Florida Division GME Research Day 2025

Rationale: Bandemia, defined as the presence of immature neutrophils in circulation, is commonly used as an early marker of systemic inflammation and infection. 1 However, its prognostic significance in sepsis, severe sepsis, and septic shock remains uncertain. 1-2 This study aimed to determine whether bandemia is associated with adverse clinical outcomes and increased intensive care unit (ICU) resource utilization among critically ill septic patients admitted from the emergency department (ED).

Methods: A retrospective analysis was conducted using de-identified data from the HCA Healthcare database. Adult patients (aged 18–90 years) admitted to the ICU at HCA Florida Aventura Hospital from the …

The Fluid Resuscitation Paradox: Refractory Shock In A Patient With Recurrent Ascites And Encapsulating Peritoneal Sclerosis, Chiraag Ashokkumar, Justin Gisel

South Atlantic Division GME Research Day 2025

No abstract provided.

Management Of Covid-19 In A Patient With Kartagener Syndrome: A Case Report, Yatin Ramesh Babu, Shivani Patel, Andy Aleman Espino, Mallory Kazaleh, Hamlet Monteagudo, Odalys Frontela

HCA-NSU MD Research Day

The unprecedented global health challenge posed by COVID-19, caused by SARS-CoV-2, has driven research into its diverse clinical manifestations and underlying pathophysiological mechanisms. This report explores the interplay between pre-existing conditions, particularly Kartagener Syndrome, and COVID-19 outcomes. Kartagener Syndrome, characterized by primary ciliary dyskinesia, presents a unique perspective due to its anatomical and physiological features. The case details a 63-year-old female with Kartagener Syndrome admitted with COVID-19 symptoms. The gold-standard approach for Kartagener Syndrome involves comprehensive management strategies, including airway clearance techniques, pharmacotherapy, and surgical interventions. The patient's treatment encompassed bronchodilators, antibiotics, and subsequent improvements, leading to discharge with a …

Malignancy-Related Ascites: Thinking Outside The Liver, Nisha Chachad, Erica Pieper Do, Nisha Chachad, Ana Angeli, Pedro Bayonas Md, Jose Gonzalez-Pantaleon Md

HCA-NSU MD Research Day

Introduction. Our objective in discussing this case is to explore an approach to the various etiologies of ascites, thereby encouraging clinicians to consider extrahepatic differentials during disease management. To do so, we examined the following case of ascites in the setting of underlying malignancy. Case Presentation. An 85-year-old female presented with rapid-onset abdominal distension as well as dark stools and shortness of breath. She had also experienced progressive weakness, malaise, and weight loss over the last year. Past medical history was notable for endometriosis, hyperlipidemia, and xanthogranulomatous pyelonephritis. She was mildly tachycardic on admission. Labs were notable for leukocytosis with …

Nosebleed No More: Recognizing And Diagnosing Factor Viii Inhibitor, Salam Harb, Leidy Huie Martinez Md, Jose Alvarado Md, Ajit Koli Do, Hazem Nasef Ms4

HCA-NSU MD Research Day

Acquired hemophilia is a condition characterized by the unexpected onset of severe bleeding due to an issue with coagulation factors. Typically, this disorder results from the production of autoantibodies against the Factor VIII coagulation factor. Although acquired hemophilia is an extremely rare condition, with an annual incidence of just 1.5 cases per million, it is crucial to recognize and understand it. This is because diagnosing this disorder is intricate, and if left undiagnosed and untreated, it can lead to high levels of morbidity and mortality. This case stands out as the condition typically targets older adults, with around 80% of …

Aging- And Alcohol-Associated Spatial Transcriptomic Signature In Mouse Acute Pancreatitis Reveals Heterogeneity Of Inflammation And Potential Pathogenic Factors, Rachel R Tindall, Yuntao Yang, Isabella Hernandez, Amy Qin, Jiajing Li, Yinjie Zhang, Thomas H Gomez, Mamoun Younes, Qiang Shen, Jennifer M Bailey-Lundberg, Zhongming Zhao, Daniel Kraushaar, Patricia Castro, Yanna Cao, W Jim Zheng, Tien C Ko

Faculty, Staff and Student Publications

The rapidly aging population is consuming more alcohol, leading to increased alcohol-associated acute pancreatitis (AAP) with high mortality. However, the mechanisms remain undefined, and currently there are no effective therapies available. This study aims to elucidate aging- and alcohol-associated spatial transcriptomic signature by establishing an aging AAP mouse model and applying Visium spatial transcriptomics for understanding of the mechanisms in the context of the pancreatic tissue. Upon alcohol diet feeding and caerulein treatment, aging mice (18 months) developed significantly more severe AAP with 5.0-fold increase of injury score and 2.4-fold increase of amylase compared to young mice (3 months). Via …

Abdominal Aortic Aneurysm Screening And Surveillance – Can We Do Better? A Qi Project, Hassan Saeed, Hania Liaqat, Vidisha Master, Binita Neupane

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Background:

Abdominal aortic aneurysm (AAA) has a global prevalence of about 5% and its first presentation can be acute and fatal. USPSTF recommends one time screening for men aged 65 to 75 years who have ever smoked. We designed a study to evaluate the effect of resident education on AAA screening ordered in our outpatient primary care clinic.

Methods:

All men aged 65 to 75 years of age attending appointments in the resident run clinic were included in the study. Pre-intervention data was collected retrospectively for 5 weeks which included patient demographics and the rates of appropriate AAA screening …

Chronic Schizophrenia Presenting With Psychogenic Polydipsia Masking Stage Iv Uterine Adenocarcinoma, Dakota B. Pastore, Kamayel Jaludi, Angelo Sica

Rowan-Virtua Research Day

Background: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.

Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien …

Splenic Artery Aneurysm Masquerading As Chest Pain: A Case Report Of A Rare Clinical Presentation, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Splenic artery aneurysms most commonly present with vague epigastric or left upper quadrant abdominal pain that may radiate to the left shoulder. Chest pain associated with splenic artery aneurysm is an unusual phenomena. This case presents a rare occurrence of a splenic artery aneurysm originally presenting as atypical chest pain. Case Presentation: A 46 year old G3P2 AAF patient with family history of hypertension presented to the ER with pleuritic left chest pain, episodes of shortness of breath, and new onset hypertension. Chest x-ray and ECG were unremarkable. Pertinent labs included a hemoglobin of 10.6 and D-dimer of 4.10. …

Cva In Patient With Systemic Sclerosis On Aspirin Therapy: A Case Report, Rahyan Mahmud, Bianna Koutsenko, Kenneth Goich, Usaid Hasan

Rowan-Virtua Research Day

Introduction

Systemic sclerosis is an autoimmune disorder characterized by microvascular damage and multiorgan fibrosis. These patients have a higher risk of cerebrovascular events, but it is difficult to develop strategies for prevention due to limited understanding of underlying pathophysiology.

Case Presentation

A 76-year-old female with a history of systemic sclerosis presented to the emergency department with acute onset slurred speech, facial droop, and left arm pain with a National Institutes of Health (NIH) Stroke Scale of 1. She was outside the thrombolytic window. Other history includes hypertension and hyperlipidemia; both were well controlled. MRI confirmed right frontal lobe ischemic stroke …

Typhlitis In A Neutropenic Patient, Alice He Bs, Wern Lynn Ng Md, Lay She Ng Md, Si Yuan Khor Md, Chandi Garg Md

Tower Health Research Day

No abstract provided.

Risk Factors For In-Hospital Seizure And New-Onset Epilepsy In Coiling And Clipping Treatment Of Aneurysmal Subarachnoid Hemorrhage, Viet-Thang Le, Anh Minh Nguyen, Phuc Long Nguyen

Faculty, Staff and Student Publications

OBJECTIVE: To identify risk factors associated with in-hospital seizures and new-onset epilepsy in patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent coiling embolization or clipping surgery.

METHODS: This retrospective descriptive study included 195 patients diagnosed with aneurysmal SAH and treated with coiling embolization or clipping surgery between January 2018 and June 2022.

RESULTS: Among the 195 patients meeting inclusion criteria, 9 experienced an onset seizure at the time of SAH. In-hospital seizures were observed in 33 patients, of which 24 were electrographic seizures detected in 24 patients with suspected subclinical seizures. After 12 months of follow-up, 11 patients met criteria …

Definition Of Polypharmacy In Heart Failure: A Scoping Review Of The Literature, Keshav Patel, Jorge A Irizarry-Caro, Adil Khan, Travis Holder, Darrell Salako, Parag Goyal, Min Ji Kwak

Faculty, Staff and Student Publications

Patients with heart failure (HF) have a high prevalence of polypharmacy, which can lead to drug interactions, cognitive impairment, and medication non-compliance. However, the definition of polypharmacy in these patients is still inconsistent. The aim of this scoping review was to find the most common definition of polypharmacy in HF patients. We conducted a scoping review searching Medline, Embase, CINAHL, and Cochrane using terms including polypharmacy, HF and deprescribing, which resulted in 7,949 articles. Articles without a definition of polypharmacy in HF patients and articles which included patients < 18 years of age were excluded; only 59 articles were included. Of the 59 articles, 49% (n = 29) were retrospective, 20% (n = 12) were prospective, 10% (n = 6) were cross-sectional, and 27% (n = 16) were review articles. Twenty percent (n = 12) of the articles focused on HF with reduced ejection fraction, 10% (n = 6) focused on HF with preserved ejection fraction and 69% (n = 41) articles either focused on both diagnoses or did not clarify the specific type of HF. The most common cutoff for polypharmacy in HF was five medications (59%, n = 35). There was no consensus regarding the inclusion or exclusion of over-the-counter medications, supplements, or vitamins. Some newer studies used a cutoff of 10 medications (14%, n = 8), and this may be a more practical and meaningful definition for HF patients.

Case Of Rosai Dorfman Disease In A Patient With Newly Diagnosed Hodgkin Lymphoma, Liza Salloum, Jennifer Rojas Huen, Ricardo Serna, Alisha Valdez

Research Symposium

Background: Rosai Dorfman Disease (RDD, also known as sinus histiocytosis with massive lymphadenopathy) is a rare non-Langerhans cell histiocytosis, classified into nodal (classic) and extranodal disease. Most patients present with non-tender cervical lymphadenopathy, although other sites including the inguinal and axillary regions have been reported. Extranodal disease (~43% of cases) can involve any organ system. RDD is more common in children, but cases have been reported in patients in their 70s. The prognosis of nodal RDD can correlate with the number of nodal groups involved. Many cases can be managed only with observation, although surgery, chemotherapy, corticosteroids, and immunomodulators have …

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

The Efficacy-Associated Biomarkers For Immune Checkpoint Inhibitors In Gastrointestinal Cancer: A Literature Review, Jessie Lee, Yifei Shan, Angelique Wong, Elizabeth A Brown, Mitchell Callahan, Robert A Hernandez, Michael J Mienaltowski

Faculty, Staff and Student Publications

White striping (WS) is a common myopathy seen in fast-growing broilers. Studies have demonstrated that chitosan is effective as an antioxidant and has antiobesity and fat-absorption reduction properties. We hypothesized that the dietary supplementation of chitosan would have similar effects when fed to fast-growing broilers and would thus lower WS incidence and improve meat quality. One hundred twenty-six broilers were fed corn-soy diets. The grower and finisher diets contained either 0, 0.2, or 0.4% chitosan. After a 6 wk growth period, birds were euthanized, and then WS and gross pathology scores were assessed. Pectoralis major tissues were collected to evaluate …

Transmembrane Stem Factor Nanodiscs Enhanced Revascularization In A Hind Limb Ischemia Model In Diabetic, Hyperlipidemic Rabbits, Eri Takematsu, Miles Massidda, Gretchen Howe, Julia Goldman, Patricia Felli, Lei Mei, Gregory Callahan, Andrew D Sligar, Richard Smalling, Aaron B Baker

Faculty, Staff and Student Publications

Therapies to revascularize ischemic tissue have long been a goal for the treatment of vascular disease and other disorders. Therapies using stem cell factor (SCF), also known as a c-Kit ligand, had great promise for treating ischemia for myocardial infarct and stroke, however clinical development for SCF was stopped due to toxic side effects including mast cell activation in patients. We recently developed a novel therapy using a transmembrane form of SCF (tmSCF) delivered in lipid nanodiscs. In previous studies, we demonstrated tmSCF nanodiscs were able to induce revascularization of ischemia limbs in mice and did not activate mast cells. …

Hidden In Plain Sight: A Case Of Hiatal Hernia Causing Recurrent Pancreatitis, Jason Nguyen, Kevin Gopala Rao, Carmen Tormo Carrillo, Priya Mohan, Mohammed Akram, Werner Andrade-Ortiz, Bernardo Reyes

East Florida Division GME Research Day 2024

No abstract provided.

Bronchobiliary Fistula And Bilioptysis: A Rare Complication Of Hepatic Lobe Abscess, Pranav Mahadevan, Pratik Patel, Domenick Roma, Nikola Tankosic

South Atlantic Division GME Research Day 2024

No abstract provided.

A Rare Case Of Anoxic Brain Injury Secondary To Masld-Induced Hyperammonemia, Renu Thomas, Nhu Chau T. Nguyen, Daniel Bao, Jonathan Tang, Uzma Ali, Damon Cao

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Suspected Retropharyngeal Abscess Resulting In Quadruple Amputation: A Case Report, Olivia Little, Noah Pierzchajlo, Jimmy Nguyen, Zachery D. Neil, Maulik Patel

South Atlantic Division GME Research Day 2024

No abstract provided.

Retropharyngeal Abscess Or Malignancy? A Difficult Differential Diagnosis In New Neck Masses, Mary Therese Thomas, Brooke Reese, Mary Carter

South Atlantic Division GME Research Day 2024

No abstract provided.

Acute Mesenteric Ischemia In Patients With Covid-19, Tristan Fun, Natalie Hurlock, Danielle Ford

North Texas GME Research Forum 2024

Introduction: Patient with COVID-19 are more likely to have thrombotic events, including deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC). There have been many case reports of patient with acute mesenteric ischemia (AMI) in the setting of COVID-19. Incidences of AMI occur in about 0.1% of acute hospital admissions. Short term mortality from AMI range from 26-86%. Therefore, early diagnosis and treatment are essential, yet diagnosis is difficult and AMI can often go unrecognized as a cause of death. This study attempted to establish the risk of patients with COVID-19 having acute mesenteric ischemia and compare …

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Anchoring Sepsis Management: A Retrospective Cohort Study On Fluid Resuscitation In Advanced And End-Stage Renal Disease With Sepsis, Hunter Reed, Abraheim Al-Nasseri, Adam Robarge, Uzman Kazi

West Florida Division GME Research Day 2024

No abstract provided.

Differences In Clinical Interventions And Outcomes In Septic Patients With Heart Failure A Prospective Single Center Experience From The Sepsisquad Investigators, Jose Rodriguez Castro, Manjot Malhi, Rafael Miret, Kristen Santana, Anna Feliszek, Kevin Gopala Rao, Lyanne Rolon, Garrett Wagner, Siddarth Kathuria, Raiko Diaz, Daniel Heller, Mauricio Danckers

East Florida Division GME Research Day 2024

No abstract provided.