Internal Medicine Commons^™

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Optimizing Antibiotic Strategies With A Clinical Pathway Approach: Enhanced Initiation And De-Escalation In Community-Acquired Pneumonia, Ahmad Behzadpour

HCA Healthcare Journal of Medicine

Background

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization, mortality, and health care expenditure worldwide. Inappropriate use of broad-spectrum antibiotics contributes to antimicrobial resistance, adverse drug events, and increased costs. Antibiotic stewardship and standardized clinical pathways are key strategies to improve prescribing practices.

Methods

This quality improvement (QI) initiative was conducted at a 240-bed tertiary care teaching hospital from January 2023 through January 2025. A CAP-specific digital clinical pathway was developed using Curbside Health® and integrated into the electronic health record (EHR), accessible through a structured order set to support real-time clinical decision-making. The intervention included provider education and …

A Rare And Challenging Polymicrobial Pleural Infection Involving Cupriavidus Pauculus In A Patient With Rheumatoid Arthritis And Multiple Complications, Moiz Ahmed Khan, Syeda Samiya Kamal, Muhammad Muneeb, Summaya Zafar

The University of Louisville Journal of Respiratory Infections

A 58-year-old female with a 15-year history of rheumatoid arthritis (RA) and a history of treatment consisting of methotrexate, hydroxychloroquine, leflunomide, and chronic prednisolone therapy, presented with fever, productive cough, dyspnea, and left leg cellulitis. She developed septic shock complicated by tension pneumothorax requiring emergency thoracostomy and non-ST-elevation myocardial infarction (NSTEMI). Pleural fluid culture grew Cupriavidus pauculus, a rare environmental gram-negative bacillus, alongside Burkholderia cepacia and Candida parapsilosis, indicating polymicrobial infection which was most likely predisposed by patient's immunosuppressed state from RA and prolonged steroid use. Treatment consisted of trimethoprim/sulfamethoxazole, meropenem, fluconazole, and cardiopulmonary support, and culminated in …

Miliary Mimicry: Rapidly Progressive Pulmonary Adenocarcinoma Presenting As Suspected Miliary Tuberculosis, Bailey Weidner, Max Wei, Amaar Ahmad, Bailey Trinkino, Chakradhar Kotaru

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Sweet Drop To Lung Pop: Sertraline-Induced Pneumothorax In Aep, Jeanette Adereti, Laaraeb Nadeem, Azad Patel, Ariana Azimi-Shooshtari, Ramesh Babu Kesavan

Gulf Coast Division GME Research Day 2026

No abstract provided.

Invasive Aspergillosis In An Immunocompetent Patient, Grant Haden, Alexis Lopez Cruz, Julianna Vecchio, Munanchui Poudel, Sahista Kapadia, Zuhair Ali

Gulf Coast Division GME Research Day 2026

No abstract provided.

A Study On Metastatic Primary Lung Adenocarcinoma In A Marijuana Smoker, Sarah Hendee, Cristina Lee, Maria Aguirre, Dmitriy Scherbak

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Spontaneous Hemidiaphragm Elevation, A Subtle, Early Sign Of Malignancy, Michael Lee Phillips, Caitlyn Brown, Rena Phillips, John Ashby, Chad Martins

South Atlantic Division GME Research Days 2026

No abstract provided.

Impact Of Sputum Collection Within 24 Hours Of Admission For Patients Hospitalized With Pneumonia, Sally Baker, Madelaine Duarte, Lauren Kirk, Mohamed Faris

South Atlantic Division GME Research Days 2026

No abstract provided.

Pulmonary Tumor Thrombotic Microangiopathy Presenting As Rapidly Progressive Pulmonary Hypertension: A Case Report, Ali Basaran, Jacob Slowinski, Tesnim Hamdan, Kumaraswamy Nutalapati, Jason Stanberry, Ahmed Tarbay, Dunn Ryan

West Florida Division GME Research Day 2026

No abstract provided.

Shrinking Lung Syndrome In An Undifferentiated Connective Tissue Disease, Saul Alvarado Maldonado, Justin Gisel, Osama Srour

South Atlantic Division GME Research Days 2026

No abstract provided.

Necrotizing Pneumonia And Alveolar-Pleural Fistula After Foreign Body Aspiration, Vineet Madishetty, Adam Hurwitz, Ritvik Peesapati, Jessica Neugebauer, James Flanagan

West Florida Division GME Research Day 2026

No abstract provided.

Efficacy Of Ensifentrine In Chronic Obstructive Pulmonary Disease (Copd): A Meta-Analysis Of Randomized Controlled Trials, Muhammad Abdullah, Mustafa Bin Tahir, Natalya Ahsan, Michael Moore, Nagaraja Sharma, Salman Muddassir

West Florida Division GME Research Day 2026

No abstract provided.

Primary Lung Adenocarcinoma Mimicking Miliary Tuberculosis Pattern: A Rare Presentation, Reza Alavi, Casper Chen, Idelisse Suarez Maldonado, William Arvan, Mukesh Patel, Elie Feghali

West Florida Division GME Research Day 2026

No abstract provided.

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 …

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 …

Don’T Blame The Heart When On Steroids: A Rare Case Of Glucocorticoid Dependant Childhood Asthma Causing Non-Ischemic Dilated Cardiomyopathy, Greeshma Molugu, Srinivasan Rajaganapathy, Machaiah Madhrira, Karthik Anand

North Texas GME Research Forum 2026

Background: Steroids are known to have various cardiac side effects, such as hypertension, left ventricular hypertrophy, myocardial infarction, and sudden cardiac death. They are also known to cause rare but potentially life-threatening cardiomyopathy. The mechanisms behind steroid-induced cardiomyopathy are multifactorial, potentially involving direct or indirect myocardial toxicity, such as tissue fibrosis, apoptosis, and alterations in cardiac remodeling pathways via the renin-angiotensin-aldosterone system. Cardiomyopathy is known to occur with anabolic steroid use, but the literature on glucocorticoid-induced cardiomyopathy is scant. We present a rare case of glucocorticoid-induced dilated cardiomyopathy(DCM) in a patient with a history of refractory asthma who was treated …

The Uncommon Suspect: Cavitary Pulmonary Tuberculosis In A Previously Healthy Adult In Colorado, Nikita Zanko, Cristina Lee, Dmitriy Scherbak

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

A Double-Edged Sword: Accelerated Metastasis After Video-Assisted Thoracoscopic Surgery In Advanced Lung Adenocarcinoma, Grace Anne Martin, Kanwar Bir Dhaliwal, Mala Goyal

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

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.

Invasive Pulmonary Aspergillosis: A Two-Year Journey, Jason Woods, Padmaditya Sureddi, Nga Van, Danielle Ford

North Texas GME Research Forum 2026

BACKGROUND: Highly active anti-retroviral therapy (HAART) has decreased the incidence of opportunistic infections among persons with HIV. Invasive aspergillosis specifically is uncommon among individuals with clusters of differentiation 4 (CD4) count >100 cells/mm3. Furthermore, treatment of aspergillosis in the HIV-infected population has not been examined systematically. We report a patient with CD4 count >200 cells/mm3, compliant with HAART therapy who developed invasive pulmonary aspergillosis (IPA) over the course of two years that was successfully treated through a combination of bronchial artery embolization and liposomal amphotericin.

CASE PRESENTATION: A 56-year-old man from southern Africa with four-year history of HIV-1 on HAART …

Type 2 Myocardial Infarction In Adults Admitted For Severe Persistent Asthma With Status Asthmaticus: Evaluating Predictors And Mortality Burden, Kanwar Bir Dhaliwal, Rahul Pawa, Naresh Kodwani

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Baseline Right Ventricular-Pulmonary Arterial Coupling As A Predictor Of Clinical Outcomes In Endobronchial Valve Therapy For Advanced Emphysema, Syed Ali Raza Abidi, Prithvi Basu Roy, Munaf Siyamwala, Amelia Goslin

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Beyond Drainage: Can Pleural Effusion Serve As A Natural Tamponade Against Tumor Hemorrhage? A Case Report And Mechanistic Hypothesis, Pratyush Kumar, Kumar Abhishek, Pankti Shah, Amelia Goslin, Archana Machavarapu, Catherine Joyce, Michael Waxman

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

A Retrospective Study Of Pulmonary Function Tests In Bronchiectasis: An Infectious Disease Of The Respiratory System, Vinod Mutkule, Mahesh Shinde, Vidya Bapmare, Sangramsingh Dixit, Atharva Sharma, Kshitij Sarwey, Yogeshwari Patil, Sanket Jethlia, Aayushi Dwivedi, Disha Pardeshi, Anmol Rai, Kunal Shah, Vidhi Kalwar

The University of Louisville Journal of Respiratory Infections

Introduction: Bronchiectasis, currently being recognized worldwide, is an abnormal dilatation of the bronchi and bronchioles brought on by recurrent cycles of inflammation and airway infection. Impaired pulmonary function has a predictive significance in bronchiectasis. When treating patients with suspected or confirmed respiratory diseases, pulmonary function tests (PFT) are useful examinations. Very few studies have been done on PFTs in bronchiectasis. The main aim of this study is to study PFTs in bronchiectasis.

Method: This is a retrospective observational study done on 50 patients over two years at the tertiary care center. The previous records of patients were collected from the …

Case Report: A Case Of Tracheal Perforation, Cyrus Davati, Eric Maddock

Rowan-Virtua Research Day

Here we present the case of a 93-year-old female with a past medical history of arthritis and dementia who came to the hospital for a change in mental status and decreased responsiveness at home. The patient was intubated at home by EMS secondary to continued respiratory distress. The patient had a history of a productive cough over the past three days. The patient arrived at the emergency department with continued respiratory failure. During the ED evaluation, the patient was noted to have tracheal rupture. The patient was admitted to the ICU for severe sepsis and continued on broad spectrum IV …

Clinical Outcomes For Patients With Ventilator-Associated Pneumonia In Octogenarians, Nonagenarians, And Centenarians: A Population-Based Study, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Syed, Olga Sarah, Abdallah Hussein

Rowan-Virtua Research Day

We sought to examine the national inpatient sample data-base to describe in-hospital outcomes among patients over seventy who acquire ventilator-associated pneumonia after being on the ventilator for over 48 hours.

Characteristics And Outcomes Of Adults Hospitalized With Respiratory Syncytial Virus, Brian S. Shaw, Cara Slaton, Ian P. Murphy, Michael Mcalister, Daniel Egan, Kwabena Ayesu

The University of Louisville Journal of Respiratory Infections

Background: Respiratory syncytial virus (RSV) is a negative sense single-stranded RNA virus (ssRNA) that primarily causes respiratory infections in both children and older adults. We examined clinical characteristics and outcomes of hospitalized adult patients who tested positive for RSV.

Methods: This was a multicenter, retrospective, descriptive study that examined adult patients admitted with a positive RSV test over two years across eight hospitals in Orlando, Florida.

Results: A total of 120 patients were included, of which 88 (73%) were 60 years old and older. Overall, patients with RSV infection were caucasian (62%) with a median age of 70 years and …

Use Of Va Ecmo In Patients With Acute Pulmonary Embolism Presenting With Obstructive Cardiogenic Shock Undergoing Mechanical Thrombectomy, Luke Taylor, Otoniel Espinoza, Omar O. Hernandez, Shannon Biggers, Shirin Miller, Srinivas Yallapragada, Amer Alaiti, Andrew Fredericks, Song Li, Claudius Mahr

North Texas Research Forum 2025

Background Patients with massive/sub-massive pulmonary embolism (PE) and right ventricular strain have a significant risk of hemodynamic collapse. VA ECMO support provides an excellent salvage option for patients with acute/unstable pulmonary embolism with obstructive cardiogenic shock undergoing mechanical thrombectomy. Using VA-ECMO for a “protective PE” procedure allows control of hemodynamics and enables interventionalists to perform the thrombectomy in a more controlled environment. Here, we present our experience. Methods A retrospective data analysis on consecutive VA ECMO patients with cardiogenic shock secondary to pulmonary embolism was abstracted from August 2022 to June 2024. Results Patient characteristics and outcomes are described in …

Necrotizing Alternaria Pneumonia In An Immunocompetent Male, Joel Mathews, Jose Aguilar-Martinez, Sean Sojdie, Zain Tariq, Tamer Hudali

North Texas Research Forum 2025

Abstract: Alternaria species is a rare cause of invasive fungal pneumonia, typically described as an opportunistic pathogen, usually seen in immunocompromised patients producing virulent forms of sinus, cutaneous, and ocular infections. Alternaria species sparingly affect immunocompetent individuals and are often managed without any medical interventions. We present a case of invasive fungal necrotizing pneumonia caused by Alternaria alternata species in an immunocompetent 28-year-old male with only a past medical history of well-controlled asthma managed with an as-needed albuterol inhaler. His complaints included worsening foul-smelling productive cough with yellow-dark brown sputum along with subjective fevers, chills, chest pain, and dyspnea for …