Internal Medicine Commons^™

Case Of Toxic Epidermal Necrolysis With High Body Surface Area Involvement And Review Of Predictors Of Severity Of Illness, Hannah R. Riva, Clay J. Cockerell, Muhammad T. Siddique, James M. Cross

North Texas GME Research Forum 2026

BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare and potentially fatal cutaneous adverse drug reactions. The most common mortality predictor used for TEN is the SCORTEN (Severity-of-Illness Score for Toxic Epidermal Necrolysis). Various scoring systems have been used and are being developed for predicting mortality and guiding treatment in SJS/TEN. We describe a case of TEN with a high body surface area involvement and discuss the scoring predictors for severity of illness.

CASE PRESENTATION: A 63-year-old male was transferred to our burn center for a suspected diagnosis of SJS/TEN. He was intubated prior to arrival. He …

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 …

Cardiac Step-Down Unit (Csu), Two Failures Drive Suboptimal Vte Prevention: Quality Improvement, Jorim Parmar, Shakir Al-Ezzi, Anvi Manduva, Muhammad Suleman, Fahed Alsayed, Debra Medsker

North Texas GME Research Forum 2026

BACKGROUND: In the Cardiac Step-down Unit (CSU), two failures drive suboptimal VTE prevention: (1). over-ordering of SCDs in patients unlikely to benefit and (2). < 10% documented application when SCDs are truly indicated. Baseline data indicates that curbing over-ordering alone would reduce recorded non-compliance by >50%, revealing a clear opportunity for system redesign.

METHODS: To integrate the updated “3 Bucket” Risk Model assessment into the computerized physician order entry (CPOE) in order to delineate the prophylaxis for a given patient population. Once the manual risk assessment proves to be viable in increasing compliance, we can propose having the tool adopted into the CPOE system. Root Cause Analysis revealed that lack of standardized VTE risk stratification leads to inconsistent ordering practices – …

Cost Effectiveness Of Lifestyle Program For Diabetes Remission In The Era Of Glp-1, Prasanthi Tondapu, Haasini Sunkavalli, Micaela C. Karlsen, Kara L. Staffier, Kathryn J. Pollard, Surabhi Naik

North Texas GME Research Forum 2026

BACKGROUND: GLP-1 receptor agonists are popular for managing type 2 diabetes (T2D) and obesity but are costly and can result in side effects including weight rebound. Intensive therapeutic lifestyle change (ITLC) programs present an effective alternative, facilitating an HbA1C (A1C) less than 6.5% for 3 months without medication and long-term weight control.

CASE PRESENTATION: We present a 69-year-old Black man with T2D, hypertension, chronic kidney disease, obesity, and sleep apnea. In 2023, he was hospitalized with a blood glucose of 800 mg/dL and A1C 10.8% and discharged on insulin. And, with a BMI of 32 kg/m2 and weight of 238.6 …

A Storm At Both Ends: Hypertensive Emergency Unmaksing C3-Dominant Glomerulonephritis, Karthik Kasireddy, Boney Lapsiwala, Marisha Sharma, Rupali Prabhukhot, Victor Canela

North Texas GME Research Forum 2026

Background: C3 glomerulopathy (C3G) encompasses a group of diseases that result from abnormalities in the alternative pathway of complement regulation, and has been defined by C3 only or C3-dominant immunofluorescence staining seen on renal biopsy. C3G includes C3 glomerulonephritis (C3GN) and dense deposit disease (DDD); the latter of which is characterized ultra-structurally by the presence of highly osmiophilic intramembranous deposits. Both C3GN and DDD often present with a membranoproliferative pattern of glomerular injury, a finding that can also be seen in thrombotic microangiopathy (TMA). Most common causes include infection, autoimmune and monoclonal gammopathy.

Case presentation: A 70-year-old man with hypertension, …

Pulse Check: Im Resident Wellness Initiative -- A Continuous Qi Project, Jacqueline Bekhit, Ngoc Vu, Yasasvi Sabbineni, Nihar Raju, Parth Patel, Teena Mathew

North Texas GME Research Forum 2026

Background Burnout is a psychological syndrome that arises from chronic workplace stress that has not been effectively managed. It is characterized by emotional exhaustion, increased mental distance or cynicism toward one’s work, and a sense of reduced professional efficacy (WHO, 2019). Due to the long work hours, high workload, and extensive training demands, medical residents are particularly vulnerable to experiencing burnout, contributing to higher rates of anxiety and depression. Burnout typically emerges mid-intern year and progresses through the remainder of residency. Burnout can contribute to higher medical errors, decreased work efficiency, and poor patient-physician interactions.

Methods This QI is a …

Rare Presentation Of Diffuse B-Cell Lymphoma (Dlbcl), Jasmine M. Silva, Vinay Antin

North Texas GME Research Forum 2026

No abstract provided.

Gastroparesis As Initial Feature Of Neuromyelitis Optica Spectrum Disorder, Jasmine M. Silva, Jorim J. Parmar, Shivani Gandhi, Sreevani Gudiseva

North Texas GME Research Forum 2026

No abstract provided.

Meconium Pseudocyst Of The Perineum: Diagnostic Uncertainty And Surgical Management, Matthew Li, Muhammad T. Siddique, Charles Black, James Davis

North Texas GME Research Forum 2026

No abstract provided.

A Lethal Connection Uncovered: Direct Endoscopic Evidence Of A Primary Aortoenteric Fistula, Joel Mathews, Trina Lewis, Munazzah Kaleem, Long Hoang

North Texas GME Research Forum 2026

BACKGROUND: Primary Aortoenteric Fistulas (PAEFs) are a rare condition that occurs when the native aorta develops an abnormal connection with the gastrointestinal lumen. PAEFs tend to develop within the duodenum, specifically the distal region of the third part of the duodenum, which is retroperitoneal and is anterior to the aorta. Duodenal PAEFs can be difficult to diagnose and are often lethal, given their non-specific presenting symptoms and rapid progression to hemorrhagic shock.

CASE PRESENTATION: This case focuses on a 70-year-old male with a history of T4N2 colon adenocarcinoma with hemicolectomy, active smoking, and abdominal aortic aneurysm (AAA) who was transferred …

Esophageal Squamous Cell Carcinoma Incidentally Detected On Barium Swallow: A Case Report, Muhammad Rubeel Akram, Aditya Rao, Muhammad T. Siddique

North Texas GME Research Forum 2026

Background: Esophageal cancer is an aggressive malignancy with a poor prognosis, and has high rates of recurrence despite curative-intent therapy. While endoscopy with biopsy remains the gold standard for diagnosis, non-diagnostic imaging studies are performed when evaluating for dysphagia, and may bring to light underlying pathology, warranting further workup. Surgical resection following neoadjuvant chemoradiation is often performed, but postoperative complications and disease recurrence are important concerns. This case highlights the crucial role of early detection via imaging and the clinical burden associated with esophageal squamous cell carcinoma.

Case Presentation: A 76-year-old female presented with dysphagia and underwent a barium esophagogram, …

Stronger Together: A Resident-Led Initiative Advancing School Nurse Readiness In Pediatric Seizures And Pediatric Cardiology, Shana-Kay Lambert-Johnson, Amy Nguyen-Pham, Tony Do, Devika Adusumilli, Jorim Parmar, Dimitar Semerdzhiev, Elizabeth White, Joanna John, Myrna Garcia, Nicholas Gerden, Tasaduq Mir, Michele Mccarroll

North Texas GME Research Forum 2026

BACKGROUND: School nurses play a vital role in safeguarding the health and safety of children by serving as frontline providers within the school setting. Timely recognition and appropriate management of acute medical conditions can reduce morbidity, prevent unnecessary emergency department utilization, and improve long-term outcomes. Needs assessment surveys identified knowledge and confidence gaps among school nurses related to pediatric seizure management and pediatric cardiology.

METHODS: This prospective educational quality improvement initiative was conducted across the Dallas–Fort Worth (DFW) region during the 2025-2026 academic year. Over 25 residents served as curriculum developers and educators, creating and delivering evidence- and case-based education …

An Unusual Case Of Genetic Dilated Cardiomyopathy Unmasked By Covid-19 Infection, Greeshma Molugu, Daniel Mcmahan, Seline Haci, Giridhar Mundluru, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Titin (TTN) mutations are a well-known cause of dilated cardiomyopathy (DCM), occurring in approximately 25% of familial cases of idiopathic DCM and 18% of sporadic cases. Recognition and referral for genetic testing remains underutilized but has important prognostication and helps the patient better understand the disease transmission. This case report stresses the importance of a complete evaluation for genetic causes of DCM.

Case Presentation: A 21-year-old male who was adopted as an infant was hospitalized with COVID-19 infection and diagnosed with non-ischemic cardiomyopathy with an initial left ventricular ejection fraction (EF) of 10%. He was assumed to have DCM …

Improving The Utilization Of Palliative Care Services At Medical City Fort Worth, Gennipher Smith, Shervin Sarji, Maanasa Palani, Samuel Chen, Mary Halm, Kristina Bowman, Morvarid Rezaie

North Texas GME Research Forum 2026

Palliative Care (PC) is a specialized medical care that aims to optimize the quality of life and alleviate the suffering of patients with serious medical illness. Benefits of palliative care include improved symptom management, enhanced quality of life, reduced healthcare utilization, better care alignment, improved communication and support, and financial savings. Hospital Corporation of America (HCA) Medical City Fort Worth (MCFW) has a PC consult service. However, it is underutilized. According to data collected from January 2025 to December 2025, the percentage of PC consults for high risk units, such as oncology and ICU, by day 3 of admission varies …

Cor Triatriatum Sinistrum: An Underrecognized Indication For Anticoagulation, Boney Lapsiwala, Karthik Kasireddy, Tenna Mathew, Babu Makkena

North Texas GME Research Forum 2026

Background: Cor triatriatum (CTS) is a rare congenital heart defect in which a fibromuscular membrane divides the atrium into two chambers, disrupting normal blood flow and potentially leading to circulatory impairment. Accounting for 0.1% to 0.4% of congenital heart diseases, CTS presents variably depending on the degree of left atrial obstruction. Patients may report exertional dyspnea, orthopnea, or palpitations; severe cases can progress to heart failure, pulmonary hypertension, or thromboembolic events. We present the case of a young adult male who developed symptomatic heart failure and atrial fibrillation and was incidentally found to have CTS on imaging.

Case presentation: A …

Prognostic Value Of Systemic Inflammatory Indices For Predicting Mace In Nstemi Patients Undergoing Pci, Boney Lapsiwala, Aditya Sharma, Usman Khan, Jorim Parmar, Justin Soloman, Veeranna Vibhuti, Mehdi Khalafi

North Texas GME Research Forum 2026

Background: Cardiovascular diseases (CVD) account for nearly one-third of global mortality, with ischemic heart disease caused by a mismatch between myocardial oxygen supply and demand. Despite advances in percutaneous coronary intervention (PCI) and contemporary pharmacotherapy, patients with non–ST-segment elevation myocardial infarction (NSTEMI) continue to experience substantial residual risk for major adverse cardiovascular events (MACE). As traditional risk stratification tools have limited ability to identify high-risk individuals, interest has shifted toward biomarkers reflecting inflammatory pathways central to atherosclerosis and plaque instability. Hematologic inflammatory markers including pan inflammatory value (PIV), systemic immune inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) initially …

A Not So Typical Case Of Alcoholic Pancreatitis, Wendy Phillips, Kaleem Munazzah, Asad Rehman, Robert Keller

North Texas GME Research Forum 2026

BACKGROUND Acute pancreatitis (AP) has become one of the leading gastrointestinal diagnoses resulting in inpatient hospitalization¹. AP is diagnosed by meeting two of three criteria: characteristic clinical presentation, biochemical evidence (elevated lipase or amylase levels), and imaging findings with pancreatic inflammation. Gallstones and heavy alcohol use account for most cases (40%–70% and 25%–35%, respectively). Hypertriglyceride induced AP (HTG-AP) accounts for only about 7-10% of AP cases³ and often tends to present in younger, male, obese, patients with a higher rate of diabetes¹. Below we present a unique case of a coinciding alcoholic and HTG - AP in an otherwise healthy …

Double Trouble: A Rare Co-Existence Of Hypertrophic Obstructive Cardiomyopathy And Anomalous Origin Of The Right Coronary Artery, Greeshma Molugu, Srinivasan Rajaganapathy, Seline Haci, Machaiah Madhrira

North Texas GME Research Forum 2026

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) and anomalous origin of the right coronary artery (RCA) are well-known but rare congenital heart diseases that are recognized as independent leading causes of sudden cardiac death(SCD). The independent prevalence of both these conditions is less than 1%. The co-occurrence of these two conditions is seldom ever reported in the literature. We present an extremely rare case of HOCM and the anomalous origin of the RCA in the same individual.

Background: A 67-year-old male with no significant past medical history presented for chest pain and palpitations. EKG showed atrial fibrillation with rapid ventricular response. Troponin …