Internal Medicine Commons^™

Potts Puffy Tumor: A Rare Complication Of Rhinosinusitis, Bipin Ghimire, Omar Jameel, Sumesh Khanal, Ryan Owen, Ashbina Pokharel, Samiksha Pandey

Conference Presentation Abstracts

Pott's puffy tumor is a sub-periosteal abscess of the frontal bone with associated osteomyelitis. It arises as a complication of untreated or partially treated frontal sinusitis. Overall prevalence has decreased due to timely treatment with antibiotics. It is largely limited to the pediatric population and is rare in adults. A 46-year-old Caucasian male with a history of chronic rhinosinusitis presented with one-week history of progressive painful swelling over the left forehead without any other systemic signs of infection. He was started on intravenous ampicillin-sulbactam and given one dose of dexamethasone due to concern for intracranial involvement. Facial CT showed 3 …

A Broken Heart: A Case Of Stress Induced Cardiomyopathy Precipitated By Community Acquired Pneumonia, Adam Foglesong, Abdulla Kara Balla, A Neil Bilolikar

Conference Presentation Abstracts

Takotsubo cardiomyopathy or stress-induced cardiomyopathy is a syndrome characterized by a transient reduction of systolic cardiac function generally in response to emotional or physical stressors. Stress-induced catecholamine excess is believed to be the main factor driving myocyte dysfunction. Most patients are female and postmenopausal. We present a case of a 62-year-old Caucasian male with a past medical history of hypertension who presented to the ED with the chief complaint of squeezing chest pain followed by multiple episodes of productive cough and epigastric discomfort. ECG showed sinus tachycardia with premature supraventricular complexes. Chest X-ray showed severe pulmonary vascular congestion. Labs showed …

Acute Renal Failure And An Acid-Base Dilemma, Kamil Sardarli, Russell Leong, Matthew Weatherhead, Bhavinkumar Dalal

Conference Presentation Abstracts

Introduction: Acute renal failure (ARF) is well-recognized to result in metabolic acidosis. The acidosis of ARF is associated with decreased ammoniagenesis and anion excretion. Alkalosis in the presence of ARF presents diagnostic uncertainty and therapeutic challenges. This vignette describes a case of ARF resulting in several electrolyte imbalances and metabolic alkalosis. Case Description: A 54-year-old female with past medical history of small bowel resection with colostomy presented for nausea and vomiting for two weeks. On presentation, she was noted to be tachycardic and lethargic. Her workup revealed a serum creatinine of 6.8 mg/dL, blood urea nitrogen of 147 mg/dL, bicarbonate …

Triggers And Outcomes Of Takotsubo Cardiomyopathy In Cancer Patients, Antoine Addoumieh, Dinu Balanescu, Teodora Donisan, Juan Lopez-Mattei, Peter Kim

Conference Presentation Abstracts

Background: Takotsubo cardiomyopathy (TC) is a well described entity characterized by transient and reversible left ventricular (LV) systolic dysfunction. Primary TC is triggered by psychological or emotional stress, whereas secondary TC could be due to trauma, surgery or medications. We aimed to compare outcomes in primary TC and secondary TC in cancer patients. Methods: We retrospectively identified 80 patients who presented with TC to MD Anderson between December 2008 and January 2019. Baseline characteristics were obtained. We identified the triggers leading to TC. Univariate analysis was done using Cox regression. Kaplan Meier method (KM) was used to compare survival based …

Covid-19 Vaccine Hesitancy Among Medical And Dental Students, Arati Kelekar, Neila Afonso, Victoria Lucia, Ana Karina Mascarenhas

Conference Presentation Abstracts

No abstract provided.

Hyperlipasemia Does Not Confer Worse Clinical Outcomes In A Retrospective Cohort Of Novel Coronavirus (Covid-19) Patients, Zaid Imam, Inayat Gill, Bana Antonios, Andrew Aneese, Gaurav Kakked, Faisal Kamal, Bara Al Kurdi, Alexandra Halalau

Conference Presentation Abstracts

Abstract Background Gastrointestinal manifestations and hyperlipasemia commonly occur as part of novel coronavirus infection (COVID-19), while data on acute pancreatitis is limited to case reports. We aimed to study the prevalence of hyperlipasemia and acute pancreatitis in a large inpatient cohort of COVID-19 patients and their impact on clinical outcomes. Methods Retrospective chart review of all hospitalized patients with confirmed COVID-19 at an 8-hospital health system in Michigan, USA was performed between February 1,2020 through April 1,2020 with inclusion of patients with obtained lipase levels. Univariate analyses were performed to evaluate associations between hyperlipasemia and degree of hyperlipasemia and clinical …

A Look Into Medical Students' Knowledge On Adverse Childhood Experiences, Lara Fawaz, Neila Afonso

Conference Presentation Abstracts

No abstract provided.

Immune Thrombocytopenia In Covid Pneumonia: A Case Report Of The Oldest Patient, Samiksha Pandey, Kamil Sardarli, Candace Franklin, Ashbina Pokharel, Sumesh Khanal, Bipin Ghimire, Feroze A. Momin

Conference Presentation Abstracts

Introduction: COVID infection has shown to cause thrombocytopenia with multiple different mechanisms including the destruction of platelets with immune system stimulation similar to ITP with little evidence for optimal management. Here, we present a COVID infected patient presented with idiopathic thrombocytopenia with a partial delayed response to the treatment. Case Presentation: A 92-year-old man with a past medical history of coronary artery disease status post remote coronary artery bypass graft, hypertension, diabetes mellitus presented with petechiae, epistaxis, and was found to be profoundly thrombocytopenic with a platelet count of 1x109/L. He also had an asymptomatic COVID 19 infection, a normal …

Self-Expanding Metal Stent (Sems) Placement To Treat Bleeding From Late Radiation Esophagitis, Inayat Gill, Bana Antonios, Zaid Imam, Gahad Ghaith

Articles

Radiation esophagitis is a serious complication occurring in patients receiving radiotherapy for head and neck cancers. Current treatment with proton pump inhibitors and mucosal protectants provides symptomatic relief with few studies showing improvement in erosive esophagitis or ulceration. Use of self-expandable metal stents (SEMS) in cases of erosive radiation esophagitis refractory to medical therapy has not been studied. We report a case of a patient presenting with recurrent hematemesis from late (chronic) radiation esophagitis with bleeding esophageal ulceration successfully treated with SEMS placement after failure of conservative medical management, proposing a possible utility for SEMS in this setting.

Diagnosis Of Early Delayed Graft Function (Dgf) Using Timp-2*Igfpb-7 Product In Transplant Recipients: Preliminary Results, Russell Leong, Cassandra Rodd, Kellyann M. Gomes, Solomiia Savedchuk, Paul S. Kellerman

Conference Presentation Abstracts

Background: DGF is acute kidney injury (AKI) defined as need for dialysis within one week of renal transplant. AKI is defined by a change in serum creatinine (SCr), however early recognition is limited by delay in creatinine rise. Accurate early biomarkers may lead to prevention or treatment of established AKI. The product of two novel biomarkers of cell cycle arrest, tissue Inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IGFBP-7) have shown promise in predicting AKI. In prior studies, TIMP-2*IGFPB-7 ≤0.3 had high negative predictive value, and ≥2 high positive predictive value for AKI. Aims - 1) Investigate …

A Patient With Combined Metformin-Induced Lactic Acidosis And Euglycemic Diabetic Ketoacidosis, Kamil Sardarli, Russell Leong, Inayat Gill, Sami S. Zarouk

Conference Presentation Abstracts

Introduction: Metformin is a small, non-protein-bound molecule that can cause lactic acidosis in 6 out of 100,000 patients with a mortality rate of 30-50%. Concurrent euglycemic diabetic ketoacidosis (DKA) from sodium-glucose co-transporter-2 (SGLT2) inhibitor has been reported in one case. We report a unique case of a patient with acute kidney injury (AKI) in the setting of metformin-induced lactic acidosis and osmotic diuresis due to euglycemic DKA complicated by celecoxib use. Case Description: A 66-year-old female with a past medical history of type 2 diabetes mellitus for 21 years on metformin 1000 mg twice daily and empagliflozin 25 mg daily …

Aortic Valve Calcium Score Indexed To Transaortic Valve Gradient: A Novel Hemodynamic And Anatomic Index For Patients With Low Gradient Aortic Stenosis., Ramy Mando, George S Hanzel, Francis Shannon, Ashish Chaddha, Craig Tucker, Michael Gallagher, Robert D Safian, Amr E Abbas

Conference Presentation Abstracts

Background Aortic valve calcium score (AVCS) is a marker for aortic stenosis (AS) severity. We sought to evaluate the effect of aortic valve (AV) variables of flow defined by stroke volume index (SVI), area (AVA), and gradient (MG) on AVCS and study the role of AVCS/MG ratio in patients with low gradient AS.

Methods We retrospectively studied patients undergoing transcatheter aortic valve replacement (TAVR) for severe AS (defined by Echo, Cath, and multimodality team consensus) at our institution from January 1, 2014 through September 1, 2018. AVCS was compared among patient groups defined by their MG (low < or high ≥40 mmHg), echocardiographic SVI (low < or normal ≥35 mL/m2), and AVA (< 0.8 or ≥0.8 cm2) using a three-way factorial ANOVA. The AVCS/MG ratio was developed and compared to AVCS and AVCS/cm2 (annular area) to identify severe AS in patients with low gradient. AVCS/MG was developed based on AVSC (AU) 2000 in males, and 1600 in females/ 40 mmHg (50 and 30, retrospectively)

Results Our analysis …

A265 Lymphocytic Esophagitis: A Single Tertiary Center’S Experience With This Emerging Clinical Entity., C Shams, M Co, M Cappell

Conference Presentation Abstracts

Background: Various disorders can produce esophagitis. Lymphocytic esophagitis (LE) has emerged as another clinical entity responsible for esophagitis symptoms. Although increasingly reported pathologically, the clinical characteristics of LE have not been well characterized. Aims: The present study extends the clinicopathologic characterization of LE by comprehensive analysis of 30 affected patients and identifies specific clinical presentations significantly associated with LE. Methods: Thirty patients were identified from January 2000-December 2016 that satisfied diagnostic criteria for LE by lower esophageal biopsy; (1) high concentration of intraepithelial lymphocytes and (2) few granulocytes (ratio of lymphocytes:granulocytes >50:1). Controls, selected from patients undergoing esophagogastroduodenoscopy (EGD) during …