Internal Medicine Commons^™

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.

Improving Healthcare Team Recognition By Patients, Abhijit Marathe, Tin Pham, Semeon Tadesse, Franca Samoilovich, Manuel Egued, Joshua Shultz, Ashwini Komarla, Olga Karasik

North Florida Division GME Research Day 2022

No abstract available.

A Rare Case Of Metoclopramide-Induced Serotonin Syndrome, Muhammad Monk, Matthew Bear, Krina Viroliya, Jaijo Vennatt, Grace Kim, Donte Mcclary

Gulf Coast Division GME Research Day 2022

No abstract provided.

Lady In Red: A Fatal Case Of Dress, Hytham Rashid, Ndifreke Ekpa, Tusharkumar Pansuriya, Mir Ali Sadat

Gulf Coast Division GME Research Day 2022

No abstract provided.

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.

Increasing The Rate Of Pneumococcal Vaccination In Patients Over 65 At Hca Florida Osceola Primary Care, Ubaldo Gonzalez Morales, Muna Alhusban, Chelsea Guan, Natalia Cavin, Humeyra Dogan, Allison Ferrara

North Florida Division GME Research Day 2022

No abstract available.

Improving Use Of A Standardized Medical Icu Order Set, Ernesto Munoz, Sesha Sai Kanakamedala, Ramzy Daoud, Suhail Saad Omer, Aarushi Varshney, Tristan Tanner

North Florida Division GME Research Day 2022

No abstract available.

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.

Increasing Utilization Of The Fib-4 Score To Improve Appropriate Nafld Consultation To The Orlando Va Gi/Hepatology Service, Omar Masarweh, Teayoung Kim, Mohammed Rahhal, Fanny Stampfil Silva, Stephanie Lopez Orizondo, Feras Al-Moussally

North Florida Division GME Research Day 2022

No abstract available.

Increasing The Rate Of Discharges Before 11 Am, Victoria Odeleye, Heather Mcgovern, Melissa Khalil, Rey Marrero, Musab Shouman, Zeeshan Zafar, Joshua Shultz

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.

A Retrospective Cohort Study Assessing Acute Kidney Injury And Renal Recovery Among Septic Patients Empirically Treated With Vancomycin Piperacillin–Tazobactam Versus Vancomycin Cefepime, Brian Pacca Elliott, Michael M. Tang, Joshua Alexander Madden, Ronald J. Markert, Steven Dale Burdette, Craig Matthew Pleiman, Emily Claire Speelmon

Internal Medicine Faculty Publications

Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used antimicrobial regimen for septic patients. VPT is more nephrotoxic than other regimens such as vancomycin plus cefepime (VC) when given over several days. This risk of nephrotoxicity is less clear when VPT is given for initial empiric therapy in sepsis and de-escalated quickly based on evolving clinical information. The objective of this study was to assess nephrotoxicity among septic patients empirically treated with either VPT or VC at initial clinical presentation. We conducted a retrospective study of septic patients who received VPT or VC within 12 h of presentation to the emergency …

Whistling Scrotum: An Unusual Presentation Of Pneumomediastinum In The Setting Of An Open Scrotal Wound, Brant Bickford, Andrew J. Berglund, Ronald J. Markert, Hari Polenakovik

Internal Medicine Faculty Publications

BACKGROUND Pneumoscrotum is a rare clinical occurrence in which air accumulates in the scrotum. The origin of air is primarily from trauma, but spontaneous pneumoscrotum can develop from gastrointestinal or pulmonary sources. Physical examination of pneumoscrotum typically includes crepitus of the perineal region and scrotal swelling and associated findings depending on the origin of the free air. However, pneumoscrotum in the setting of a scrotal wound, which allows air to pass freely outside the body, has not been previously documented in the literature. CASE REPORT A 72-year-old man who recently underwent a scrotal incision and drainage for recurrent epididymitis presented …

Detection Of Progression Or Regression Of Gynecologic Cancers By Circulating Tumor Dna (Ctdna), Bipin Ghimire, Ujjwal Karki, Emma Herrman, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Objectives The use of post-operative circulating tumor DNA (ctDNA) to detect cancer recurrence has been reported in various studies but the literature describing variable changes in ctDNA is limited. The objective of this study is to describe the utility of single and serial ctDNA values in detecting the progression or regression of gynecological cancers.

Methods This is a retrospective observational study including nineteen patients, aged >=18 years who had the ctDNA test completed at hematology/oncology clinic of William Beaumont – Royal Oak and Troy Hospitals, Michigan, USA.

Results Among the nineteen patients, fifteen had breast, three had ovarian, and one …

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.

Improving Code Status Discussion And Documentation For Patients 65 Years Or Older At Hca Fl Osceola Hospital, Taylor Murphy, Mark Duros, Faris Matanes, Keishla Garcia Fernandez, Raj Shah, Olga Karasik

North Florida Division GME Research Day 2022

No abstract available.

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.

Self- Vs Provider-Referral Differences For Coronary Artery Calcium Testing, Rebekah Lantz, Steve Young, Janet Lubov, Anas Ahmed, Ronald J. Markert, Srikanth Sadhu

Internal Medicine Faculty Publications

Study objectives: The objectives of this study were to identify independent predictors for moderate/accentuated coronary artery calcium (CAC) score and compare patients who self-referred for CAC Computed Tomography (CT) testing to those who were provider-referred. Design: Patients underwent CAC between January to July 2019. The analysis was divided into self-referred patients influenced by a CAC community campaign who identified themselves as having cardiovascular risk factors compared to provider-referred intermediate-risk patients who were asymptomatic. SAS version 9.4 (SAS Institute, Inc., Cary, NC) was used for all analyses. Setting: Seven southwest Ohio hospitals from a single network. Participants: 2124 adult patients who …

Clinical Factors Implicated In Antibiotic Resistance In Helicobacter Pylori Patients, Brian White, Maria Winte, Joshua Desipio, Sangita Phadtare

Division of Internal Medicine Faculty Papers & Presentations

Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. py-lori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strat-egies. Consensus guidelines recommend use of proven …

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: …

Initial Antihyperglycemic Options For Populations With Type 2 Diabetes Who Cannot Take Metformin, Rena Ogino

Capstone Showcase

Type 2 diabetes is a common disease in the United States that can result in life-threatening cardiac, vascular, and/or renal complications. The treatment of type 2 diabetes includes but is not limited to exercise, diet, multi-disciplinary approaches, and pharmaceuticals. Metformin is the first line pharmaceutical for newly diagnosed type 2 diabetes, however patients may be unable to tolerate metformin. With more than seven different antihyperglycemic drug classes and over twenty antihyperglycemic drugs, clinicians may have difficulty choosing the best agent for patients when metformin is not tolerated. This article compares common anti-hyperglycemic pharmaceutical agents and their drug classes, focusing on …

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 …

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

Capstone Showcase

Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

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 …