Internal Medicine Commons^™

Managing Diffuse Alveolar Hemorrhage In A Critical Care Setting, Yong-Chan Kim, Jessica Marcela Daza, Juan C. Naranjo, Timothy Heath

Research Symposium

Background: Diffuse alveolar hemorrhage (DAH) is defined as disruption of the alveolar-capillary basement membrane, causing bleeding into the alveolar spaces. It is one of the rarest complications in systemic lupus erythematosus (SLE) and life-threatening conditions. Symptoms include shortness of breath, cough, fluctuating fever, and rarely hemoptysis. Complications include acute respiratory distress syndrome. The test of choice for diagnosis is bronchoalveolar lavage (BAL). The hallmark is that BAL aliquots are progressively more hemorrhagic. CT-chest shows ground glass or consolidative opacities that are usually diffuse and bilateral nonspecific. There is no cornerstone therapy for DAH due to SLE. Considering this a fatal …

New Onset Bilateral Pleural Effusion: An Uncommon Presentation Of Subclinical Hypothyroidism Or A Premature Closure Diagnosis Error?, Molly Chapman, Andrea Soto Abarca, Duc Khiem Ngo, Carlos T. Ramos

Research Symposium

Background: Subclinical hypothyroidism is biochemically defined with normal serum-free T4 in the presence of an elevated serum TSH. Common symptoms of an underactive thyroid can include fatigue, weakness, cold intolerance, weight gain despite poor appetite, hair loss, constipation, and depression. Pleural effusions have also been recognized as a clinical sequelae in the literature, where up to 25% of patients can develop a pleural fluid collection in the setting of hypothyroidism. Although not well understood, a mechanism includes an increased capillary permeability that leads to the retention of fluid in pleural cavities and other tissues.

Case presenting: A 66-year-old woman …

From Carious To Salivarius: A Case Of Streptococcus Salivarius Infective Endocarditis, Maria E. Torres Perez, Ed Wong Alvarado, Cecilia Salinas Domene, Jennifer Rojas Huen, Sara G. Mojica, C. Garza, Usman Sheriff

Research Symposium

Background: Streptococcus salivarius forms part of the Viridans family which accounts for almost 40% of all endocarditis cases. However, S.salivarius is only attributed to 2% of those cases. In the most common setting, S.salivarius is a commensal bacterium of both the oral mucosa and the gut, but it has proven to have infective potential. S.salivarius accounts as an easily missed and commonly misdiagnosed Viridians strep species, but has been implicated as a rare cause of infective endocarditis.

Case presentation: We present the case of a 43-year-old male who presented with worsening fatigue, chest pain, shortness of breath, and subjective fever. …

Asymptomatic Spontaneous Pneumopericardium In A Young Post-Covid-19 Patient: A Case Report, Jose Gomez Casanovas, Andreina Baird Borja, Eric Sanchez, Alcibiades Fleires, Daniela Hernandez

Research Symposium

Background: Pneumopericardium is a rare clinical condition which is defined as the presence of air or gas in the pericardial cavity. Although uncommon to see, it can present after chest trauma, barotrauma, fistula between the pericardium and surrounding structures, gas producing microorganisms and iatrogenic causes. But spontaneous presentations are even more uncommon. Coronavirus Disease 2019 (COVID 19) infection became a large global epidemic and in addition to respiratory symptoms, involvement of other organs such as pericardium was also reported. We here present a young patient post COVID 19 infection with isolated spontaneous pneumopericardium.

Case Presentation: A 19 year old patient …

A Case Of Recently Diagnosed Uncontrolled Hyperthyroidism Associated With Bilateral Pulmonary Embolism, Jose Gomez Casanovas, Mery Bartl, Lina Pedraza Sanchez, Alcibiades Fleires, Andres Suarez Parraga

Research Symposium

Background: Pulmonary embolism (PE) is a relatively common acute cardiovascular disorder with considerable mortality, despite advances in diagnosis and treatment. In 25 to 50% of first-time cases, no readily identifiable risk factor can be found. Several studies have suggested hyperthyroidism to be a potential hypercoagulable and hypofibrinolytic state. In this case, we present a patient with uncontrolled hyperthyroidism with incidental bilateral PE.

Case Presentation: A 47-year-old Hispanic lady with past medical history of recently diagnosed hyperthyroidism who was not compliant with medical therapy, presented to the emergency department with 4-hour history of chest pain. She described it as sudden onset, …

Transient Sinus Node Dysfunction In A Postpartum Female With Sinus Bradycardia: A Case Report, Jose Gomez Casanovas, Andreina Baird Borja, Laura Rincon-Rueda, Mery Bartl, Daniela Hernandez

Research Symposium

Background: Conduction disorders are common cardiac complications during pregnancy in women with and without structural heart disease. Sinus bradycardia has been described in few case reports secondary to increased vagal tone. Prevalence of newly acquired sinus node dysfunction without structural heart disease is unknown. In this case, we present a post-partum female with symptomatic acquired sinus node dysfunction who presented with severe sinus bradycardia.

Case Presentation: A 32-year-old Hispanic lady with a past medical history of obesity and obstetric formula of G4P4, who recently delivered her 4th child via C-section 4 weeks prior, presented to the Women´s Hospital as a …

Enterococcus Avium Peritonitis, Jian Garcia Cruz, Johanne Chaglasian, Oliverio Abarca Guzman

Research Symposium

Introduction: Enterococcus spp. are part of normal human GI tract flora which has been known to cause community acquired UTI, bacteremia, and nosocomial infections. Enterococcus faecalis and faecium are the most commonly isolated pathogens within enterococcus family although there have been few to no cases reported of peritonitis secondary to enterococcus avium in the setting of recent paracentesis and end-stage-liver disease. The incidence of peritonitis from rare organisms is increasing because of improved microbiological identification techniques. This case is relevant because it shows us that enterococcus avium even if it is not common show be considered when choosing antibiotics coverage …

Syncope As A Presentation Of Waldenstrom Macroglobulinemia, Jian Garcia Cruz, Julio Perez Rodriguez, Roy Subash Kondapavuluru, Eunbee Cho

Research Symposium

Abstract: Syncope as defined by ACC/AHA is defined as a symptom that presents with an abrupt, transient, complete loss of consciousness, associated with inability to maintain postural tone, with rapid and spontaneous recovery without clinical features of other non-syncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness. Syncope is a common complaint treated in the emergency department and a major reason for hospital admissions. Identification of the etiology of syncope is important for diagnostic and therapeutic purposes. Syncope is a symptom as a presentation with multiple differential diagnosis listed and clearly explained …

Grey Turner's Sign Unveiling A Rare Case Of Neuroendocrine Tumor In The Tail Of The Pancreas: A Reminder To Expand The Differential In Young Patients With Chronic Back Pain, Jennifer Rojas Huen, Gilbert Flores Jr., Ismael Pavel Polo Pérez, Nabeel Sarhill

Research Symposium

Background: Pancreatic cancer is often difficult to diagnose due to its asymptomatic nature, silent progression or symptoms overlapping with more common benign conditions. We present a case of a 30-year-old male with chronic worsening back pain, weight loss, and Grey Turner's sign, ultimately leading to the diagnosis of a neuroendocrine tumor in the tail of the pancreas. The rarity of this diagnosis in a young patient with atypical symptoms emphasizes the importance of considering uncommon diagnoses and expanding differentials, even when presented with seemingly typical symptoms, to enable early detection and intervention.

Case Presentation: 30-year-old male past medical history of …

Wait, Wait, Could It Be Autoimmune Pancreatitis? A Case Of Localized Autoimmune Pancreatitis Mimicking Pancreatic Cancer, Grecia Dominguez Rivera, Hari Movva, Heriberto Cantu, Nabeel Sarhill

Research Symposium

Background: Autoimmune pancreatitis (AIP), an IgG4-related disorder, is a rare condition that typically presents as obstructive jaundice and pancreatic enlargement in older adults mimicking the manifestations of pancreatobiliary malignancies. Although the diagnosis of AIP has improved through growing awareness and proposed diagnostic criteria, differentiating between AIP and pancreatic cancer remains challenging.

Case Presentation: A 69-year-old Hispanic male presented with a 1-month history of nausea, epigastric pain, jaundice, and 20-pound weight loss. His medical history revealed type 2 diabetes. Physical exam showed scleral icterus, and laboratory results demonstrated an ALT of 412, AST 404, alkaline phosphate 501, total bilirubin 7.5, direct …

The Great Mimicker. A Case Of Gastrointestinal Tuberculosis., Grecia Dominguez Rivera, Jose Roberto Flores Gonzalez

Research Symposium

Background: Gastrointestinal (GI) tuberculosis (TB) is rare, accounting for 1-3 % of all TB cases worldwide. Mycobacteria enter the GI tract via hematogenous spread from active pulmonary TB, swallowing infected sputum, or ingesting contaminated food. The ileocecal area is most affected; however, tuberculous enteritis can involve any part of the GI tract. The vague clinical presentation makes the diagnosis challenging and often delayed requiring a high index of suspicion.

Case Presentation: A 28-year-old female who emigrated to the US from Mexico presented to the ED with a 4-month history of abdominal pain, vomiting, diarrhea, anorexia, 40-pound weight loss, intermittent fever, …

Spindle-Cell Mesothelioma Arising From The Right Pleura: A Case Report And Review Of The Literature, Duc Khiem Ngo, Karina Torres, Sobia Hassan Memon, Carlos T. Ramos Jr.

Research Symposium

Background: Spindle cell mesothelioma, or Sarcomatoid mesothelioma, is a rare and insidious type of malignant mesothelioma with a high mortality rate. It arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium, and it is usually associated with asbestos exposure. Spindle cell mesothelioma could be challenging to treat because most patients have advanced disease at presentation with an average prognosis of six months. In this case report we present a rare case of spindle-cell mesothelioma arising from the right pleura.

Case presentation: An 82-year-old male with a history of atrial fibrillation and coronary artery disease, status …

Delayed Management Of Pfo After Stroke Presentation In A Healthy Hispanic Female, Diana Othon Martinez, Barbara Malaga-Espinoza, Nestor Gerardo Astorga, Vamsikalayan Borra, Roque Mifuji

Research Symposium

Background: Strokes are a leading cause of long term disability. Around 800,000 people in the USA have a stroke every year. (CDC) 25% of the population have a Patent foramen ovale (PFO). Stroke in the presence of PFO has been described to be found in up to 40% of patients with “embolic stroke of undetermined source”, otherwise known as cryptogenic strokes. Despite the aforementioned prevalence, there is mixed data on PFO management options. Current management guidelines include dual anti-platelet therapy, anticoagulants, and percutaneous transcatheter closure. Some studies suggest that PFO might be an incidental finding in patients with cryptogenic stroke. …

Navigating The Viral Maze: A Twisted Tale Of Ebv-Induced Autoimmune Hemolytic Anemia With Hepatitis, Blesset Alexander, Mery Bartl, Alfarooq Alshaikhli, Michelle Lopez

Research Symposium

Background: Epstein Barr Virus (EBV) is a widely disseminated virus known to cause infectious mononucleosis and a range of associated conditions. Autoimmune hemolytic anemia (AIHA) is a rare complication of EBV infection, with only a small percentage of cases reported in the literature. We present a unique case of a young female patient with a complex autoimmune pattern, later found to be associated with EBV.

Case Presentation: A 22-year-old Hispanic female with no past medical history presented to the Emergency Department with generalized weakness, nausea, left upper quadrant pain, and jaundice progressing for one week. Physical examination revealed scleral icterus, …

Hemophagocytic Syndrome, Radhika Mehta, Bareera Akhtar

Research Symposium

Background: Hemophagocytic syndrome is a rare and potentially fatal disorder characterized by abnormal immune activation leading to multiorgan dysfunction. Although genetic mutation is the most common cause in the pediatric population, adults often present with HPS secondary to infection, autoimmune disease or malignancy. Hodgkin’s lymphoma is a type of lymphoma characterized by Reed Sternberg cells. HL can cause various complications including hemophagocytic syndrome. This is a case of a 22-year-old male with incidental pancytopenia and jaundice, found to have Hodgkin’s lymphoma and hemophagocytic syndrome.

Case Presentation: A 22-year-old male with no significant past medical history presented to the Emergency Department …

Anaphylaxis After Avocado Ingestion In A Patient Located In The Rio Grande Valley, Eric Sanchez, Andreina Baird Borja, David London, Daniela Hernandez, Jose Gomez Casanovas

Research Symposium

Background: The avocado is an integral part of the Tex-Mex cuisine, especially in the Rio Grande Valley. Cases of severe anaphylactic reaction related to avocado mostly occur with previous history of latex-sensitization, also known as "latex-fruit syndrome," rather than caused by avocado alone. One of the major identified avocado allergens is the protein Prs a 1, a chitinase that helps the plant for protection and has cross-reaction with natural rubber latex allergens. According to the most recent national survey done in 2014, the prevalence of anaphylaxis in the United States ranged from 1.6% to 5.1%. Food reactions accounted as the …

Hiding In Plain Sight: Renal Cell Carcinoma Due To Suspected Von Hippel-Lindau Syndrome, Eric Sanchez, Andreina Baird Borja, Jose Gomez Casanovas, Alcibiades Fleires, Daniela Hernandez

Research Symposium

Background: Von Hippel-Lindau (VHL) is a hereditary autosomal dominant disease that affects several organs, characterized by the presence of cysts and tumors, more commonly associated with the central nervous system, eyes, and visceral organs. Prevalence in the US is estimated to be 1 per 30,000.

In this case, we present a 31 year old male from an underserved population in the Rio Grande Valley, presenting with multiple cerebellar and visceral lesions. The rarity of genetic disorders proves to be a diagnostic and management challenge.

Case Presentation: The case is about a 31 year old male with no apparent past medical …

Ampullary Carcinoma In A Veteran With Exposure To Agent Orange, Eunbee Cho, Shreel Patel, Roy Subash Kondapavuluru

Research Symposium

Introduction: Agent Orange(2,3,7,8-Tetrachlorodibenzo-p-dioxin), also referred to as “dioxin”, is a herbicide, extensively used during the Vietnam War. It is proven to be associated with various types of cancers, including chronic B-cell leukemias, Monoclonal gammopathy of undetermined significance(MGUS), Non-Hodgkin’s and Hodgkin’s lymphoma, as well as diseases such as diabetes mellitus type II and Parkinson’s disease. Primary ampullary carcinoma is a rare cancer of the gastrointestinal tract, with an incidence of 4 to 10 cases per million population. They can occur sporadically or in the setting of a hereditary syndrome. The etiology of sporadic ampullary tumors remains uncertain. Here, we present a …

Hodgkin's Lymphoma-Associated Thoracic Central Venous Obstruction, Eunbee Cho

Research Symposium

Introduction: Hodgkin's lymphoma is a malignancy of the lymphatic system characterized by the presence of Reed-Sternberg cells. B symptoms, lymphadenopathy of the cervical and/or supraclavicular nodes, and mediastinal mass are some common initial clinical manifestations of Hodgkin’s lymphoma. This abstract presents a case study of a 33-year-old man diagnosed with type IV classic type nodular Hodgkin’s lymphoma who presented with brachiocephalic vein compression, resulting in left chest wall edema. This case highlights the importance of recognizing and investigating uncommon presentations of Hodkin's lymphoma to ensure timely diagnosis and management.

Case: A 33-year-old man without significant past medical history presented with …

Hape (High-Altitude Pulmonary Edema) - Hiking Trip From Texas To Colorado Turns Into Nightmare, Eunbee Cho, Jessica Marcela Daza, Shakirat Ganiyu

Research Symposium

Introduction: High-altitude pulmonary edema (HAPE) is a non-cardiogenic pulmonary edema that typically occurs in lowlanders who ascend rapidly to altitudes greater than 2,500 meters to 3,000 meters (8,200 feet to 10,000 feet) above sea level. Risk factors for developing HAPE include a history of high altitude illness, rapid ascent without acclimatization, and comorbidities that impair ventilation or respiration. The southern part of Texas is one of the regions with the lowest altitude in the United States. It has proximity to Colorado, well known for its Rocky Mountain National Park, with elevations from 7,890 feet to 14,259 feet. This case presents …

Development And Validation Of A Nomogram For Predicting Pulmonary Infection In Patients Receiving Immunosuppressive Drugs, Chuxuan Luo, Yue Zhang, Jiajie Zhang, Chen Jin, Xiaolan Ye, Yan Ren, Huajuan Shen, Maosheng Chen, Yiwen Li, Qiang He, Guangbiao Xu, Lina Shao

Faculty, Staff and Student Publications

Objective: Pulmonary infection (PI), a severe complication of immunosuppressive therapy, affects patients' prognosis. As part of this study, we aimed to construct a pulmonary infection prediction (PIP) model and validate it in patients receiving immunosuppressive drugs (ISDs). Methods: Totally, 7,977 patients being treated with ISDs were randomised 7:3 to the developing (n = 5,583) versus validation datasets (n = 2,394). Our predictive nomogram was established using the least absolute shrinkage and selection operator (LASSO) and multivariate COX regression analyses. With the use of the concordance index (C-index) and calibration curve, the prediction performance of the final model was …

Overnight 1-Mg Dst Serum Cortisol In Various Stages Of Chronic Kidney Disease-Normative Data And Underlying Mechanisms, Robin Garg, Saba Samad Memon, Anurag Lila, Vijaya Sarathi, Priyanka Patil, Tukaram Jamale, Sreyashi Bose, Manjiri Karlekar, Virendra Patil, Nalini Shah, Tushar Bandgar

Faculty, Staff and Student Publications

CONTEXT: Data on the overnight 1 mg-dexamethasone suppression test (ONDST) in renal dysfunction are limited.

OBJECTIVE: We aim to determine the normative range of ONDST cortisol across chronic kidney disease (CKD) stages and reasons for its alteration.

METHODS: Prospectively, 180 CKD (30 each in G2-G5/5D) patients and 30 healthy controls underwent ONDST 8 Am serum cortisol (chemiluminescent immunoassay [CLIA]). In an exploratory cohort, 45 (15 each: G3b/G4, G5/G5D, and healthy controls) individuals' blood biochemistry for basal (8 Am) cortisol and adrenocorticotropin (ACTH), post-ONDST 8 Am dexamethasone, ACTH, cortisol (CLIA and liquid chromatography-tandem mass spectrometry), and 4 Pm cortisol was collected. …

Metabolomic Rewiring Promotes Endocrine Therapy Resistance In Breast Cancer, Songyeon Ahn, Jun Hyoung Park, Sandra L Grimm, Danthasinghe Waduge Badrajee Piyarathna, Tagari Samanta, Vasanta Putluri, Dereck Mezquita, Suzanne A W Fuqua, Nagireddy Putluri, Cristian Coarfa, Benny Abraham Kaipparettu

Faculty, Staff and Students Publications

Approximately one-third of endocrine-treated women with estrogen receptor-alpha positive (ER+) breast cancers (BC) are at risk of recurrence due to intrinsic or acquired resistance. Thus, it is vital to understand the mechanisms underlying endocrine therapy resistance in ER+ BC to improve patient treatment. Mitochondrial fatty acid β-oxidation (FAO) has been shown to be a major metabolic pathway in triple-negative BC (TNBC) that can activate Src signaling. Here, we found metabolic reprogramming that increases FAO in ER+ BC as a mechanism of resistance to endocrine therapy. A metabolically relevant, integrated gene signature was derived from transcriptomic, metabolomic, and lipidomic analyses in …

Qiditangshen Granules Alleviates Diabetic Nephropathy Podocyte Injury: A Network Pharmacology Study And Experimental Validation In Vivo And Vitro, Fei Gao, Ying Zhou, Borui Yu, Huidi Xie, Yang Shi, Xianhui Zhang, Hongfang Liu

Faculty, Staff and Student Publications

BACKGROUND: QiDiTangShen granules (QDTS), a traditional Chinese medicine (TCM) compound prescription, have remarkable efficacy in diabetic nephropathy (DN) patients, and their pharmacological mechanism needs further exploration.

METHODS: According to the active ingredients and targets of the QDTS in the TCMSP database, the network pharmacology of QDTS was investigated. The potential active ingredients were chosen based on the oral bioavailability and the drug similarity index. At the same time, targets for DN-related disease were obtained from GeneCards, OMIM, PharmGKB, TTD, and DrugBank. The TCM-component-target network and the protein-protein interaction (PPI) network were constructed with the Cytoscape and STRING platforms, respectively, and …

Covid-19 Convalescent Plasma Therapy Decreases Inflammatory Cytokines: A Randomized Controlled Trial, Feben Habtehyimer, Xianming Zhu, Andrew D Redd, Kelly A Gebo, Alison G Abraham, Eshan U Patel, Oliver Laeyendecker, Thomas J Gniadek, Reinaldo E Fernandez, Owen R Baker, Malathi Ram, Edward R Cachay, Judith S Currier, Yuriko Fukuta, Jonathan M Gerber, Sonya L Heath, Barry Meisenberg, Moises A Huaman, Adam C Levine, Aarthi Shenoy, Shweta Anjan, Janis E Blair, Daniel Cruser, Donald N Forthal, Laura L Hammitt, Seble Kassaye, Giselle S Mosnaim, Bela Patel, James H Paxton, Jay S Raval, Catherine G Sutcliffe, Matthew Abinante, Kevin S Oei, Valerie Cluzet, Marie Elena Cordisco, Benjamin Greenblatt, William Rausch, David Shade, Amy L Gawad, Sabra L Klein, Andrew Pekosz, Shmuel Shoham, Arturo Casadevall, Evan M Bloch, Daniel Hanley, Aaron A R Tobian, David J Sullivan

Faculty, Staff and Student Publications

This study examined the role that cytokines may have played in the beneficial outcomes found when outpatient individuals infected with SARS-CoV-2 were transfused with COVID-19 convalescent plasma (CCP) early in their infection. We found that the pro-inflammatory cytokine IL-6 decreased significantly faster in patients treated early with CCP. Participants with COVID-19 treated with CCP later in the infection did not have the same effect. This decrease in IL-6 levels after early CCP treatment suggests a possible role of inflammation in COVID-19 progression. The evidence of IL-6 involvement brings insight into the possible mechanisms involved in CCP treatment mitigating SARS-CoV-2 severity.

Autoimmune Hepatitis: An Unusual Presentation., Ahmed Ali Aziz, Muhammad Ali Aziz, Deep Mehta, Muhammad Humayoun Rashid

Journal of Community Hospital Internal Medicine Perspectives

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that occurs in a bimodal age distribution in the second and fifth-sixth decade of life. The disease is more prevalent in females and presents with variable clinical manifestations ranging from being asymptomatic to acute liver failure. AIH is often overlooked and not worked up in elderly patients who present with liver failure. This can lead to increased morbidity and mortality in elderly patients. AIH should be considered as a differential diagnosis in patients who present with elevated transaminases regardless of age or gender as early recognition and treatment leads to improved …

Cases From A Community Hospital…Jchimp Series #2: 66-Year-Old Man With Recurrent Painful Rashes And Oral Ulcerations, Fatima Halilu, Jing Wu, Joseph Fuscaldo, Nathan Dunsmore, Zain Syed, Pauline Daley

Journal of Community Hospital Internal Medicine Perspectives

This is part of a series of case reports detailing scenarios from our community hospital. The cases are selected to feature clinical dilemmas, provide a review on what is currently known about the topic with expert perspective. A 66-year-old black man presented to the primary care clinic with his fourth episode of generalized painful rash and oral ulcerations without a diagnosis despite two emergency room (ED) visits alongside doxycycline treatment. Symptoms interfered with daily activities with skin exam notable for widespread erythematous patches and plaques. In office biopsies were obtained with final diagnosis of erythema multiforme. Etiologic workup revealed positive …

Rare Case Of Mycobacterium Avium Complex Peritonitis In A Patient With Multiple Myeloma Undergoing Peritoneal Dialysis, Sacide S. Ozgur, Nida Ansari, Dhruv Patel, Ryan Rahman, Raymond Shih

Journal of Community Hospital Internal Medicine Perspectives

Mycobacterium avium complex (MAC) infections can present as a variety of severe diseases. While it has a predilection for immunocompromised patients such as those with Human immunodeficiency virus (HIV), it can also affect immunocompetent patients as well. One of the rare yet severe diseases that MAC infections can present is MAC peritonitis. Often hard to distinguish from other causes of peritonitis, high clinical suspicion should be maintained for those who are susceptible. Here we present an 85-year-old female with a past medical history of end-stage renal disease on peritoneal dialysis who presented with nausea and vomiting. She was found to …

De-Implementation Of Fecal Occult Blood Testing In The Emergency Department And Hospital Units: A Quality Improvement Project, Adewale Ajumobi, Joline De Castro, Ammar Qureshi

Journal of Community Hospital Internal Medicine Perspectives

Background: Fecal occult blood tests (FOBT) are inappropriately used in patients with melena, hematochezia, coffee ground emesis, iron deficiency anemia, and diarrhea. The use of FOBT for reasons other than screening for colorectal cancer is considered low-value and unnecessary. Methods: Quality Improvement Project that utilized education, Best Practice Advisory (BPA) and modification of order sets in the electronic health record (EHR). The interventions were done in a sequential order based on the Plan-Do-Study-Act (PDSA) method. An annotated run chart was used to analyze the collected data. Results: Education and Best Practice Advisory within the EHR led to significant reduction in …

High Expression Of Trop2 Is Associated With Aggressive Localized Prostate Cancer And Is A Candidate Urinary Biomarker, Shiqin Liu, Sarah J Hawley, Christian A Kunder, En-Chi Hsu, Michelle Shen, Lennart Westphalen, Heidi Auman, Lisa F Newcomb, Daniel W Lin, Peter S Nelson, Ziding Feng, Maria S Tretiakova, Lawrence D True, Funda Vakar-Lopez, Peter R Carroll, Jeffry Simko, Martin E Gleave, Dean A Troyer, Jesse K Mckenney, James D Brooks, Michael A Liss, Tanya Stoyanova

Faculty, Staff and Student Publications

Distinguishing indolent from clinically significant localized prostate cancer is a major clinical challenge and influences clinical decision-making between treatment and active surveillance. The development of novel predictive biomarkers will help with risk stratification, and clinical decision-making, leading to a decrease in over or under-treatment of patients with prostate cancer. Here, we report that Trop2 is a prognostic tissue biomarker for clinically significant prostate cancer by utilizing the Canary Prostate Cancer Tissue Microarray (CPCTA) cohort composed of over 1100 patients from a multi-institutional study. We demonstrate that elevated Trop2 expression is correlated with worse clinical features including Gleason score, age, and …