Internal Medicine Commons^™

Bleeding Lungs: A Case Of Hydralazine Induced Systemic Lupus Erythematosus With Diffuse Alveolar Hemorrhage, Damara Miller, Munanchu Poudel, Neil Maithel, Deekshita Valiveti, Arjun Kamath, Rahul Dadhwal, Ali Mohammed, Rene Franco Jr., Abhay Vakil, Zuhair Ali

Gulf Coast Division GME Research Day 2025

No abstract provided.

Assessing And Improving Resident Understanding Of Inpatient Sepsis, Hamza Naveed, E'Joven Reed, Mike Wong

Gulf Coast Division GME Research Day 2025

No abstract provided.

To Bridge Or Not To Bridge, Diane Habib, Negar Niknam, Mohammed Rajab, Lea El Achkar, Mahyar Mahmoudi

Gulf Coast Division GME Research Day 2025

No abstract provided.

A Match Made In Heaven: The Heart And The Kidney, A Case Report On Uremic Pericardial Effusion With Complete Resolution Post Transplant, Sania Moonnumackel, Victor Delprincipe, Vivek Bhupathi, Srinivasan Rajaganapathy, Anand Karthik, Machaiah Madhrira

North Texas Research Forum 2025

Introduction: Pericardial effusion resulting from uremic pericarditis is a complication associated with chronic kidney disease (CKD). In patients with advanced CKD or End Stage renal disease (ESRD) renal transplant is the definitive treatment to improve long term outcomes. However, the presence of a large pericardial effusion poses a risk of hemodynamic compromise during transplant surgery. Options of stabilizing the patient with aggressive dialysis, pericardiocentesis or pericardial window can be considered. Here we present a case of a patient with advanced CKD who underwent pre-emptive kidney transplant and in three months had complete resolution of a large pericardial effusion noted pre-operatively. …

Todd's Paralysis: Sharpnel-Induce Seizure, Kenny Tran, Alain Folefack

North Texas Research Forum 2025

When evaluating seizure in war veterans, distinguishing new-onset hemiparesis with aphasia from stroke can be challenging due to prior brain injury and anticonvulsant therapy. This case involves a patient with a shrapnel injury displaying stroke-symptoms after a seizure highlights the differences between stroke and seizure-related deficits in this population. Careful consideration of imaging, history and clinical presentation are essential for accurate diagnosis and management.

Streamlining Bubble Study Requests In Echo Orders: A Qi Initiative, Vineeth Lekkala, Sharvani Raguthu, Taher Yusufali, Mahmood Ahmad, Mohan Sengodan

North Texas Research Forum 2025

Introduction: This quality improvement project centers around the implementation of a dedicated mechanism for ordering bubble studies in echocardiograms at Medical City North Hills Hospital. Drawing inspiration from successful implementations observed at Medical City Denton Hospital, the project aims to address existing challenges, standardize practices, and improve overall efficiency in the echocardiogram ordering workflow. Background: The echocardiogram ordering process at Medical City North Hills Hospital currently faces challenges, specifically the absence of a dedicated mechanism for ordering bubble studies. This deficiency introduces the risk of oversights, particularly in cases of syncope and stroke, thereby compromising diagnostic precision. Acknowledging these challenges, …

Improving Annual Wellness Visit Documentation In Clinic, Chak Lam Yeung, Gurunath Subramanyam, Krishna Ramesh, Mohammad Nadim, Jasmyne Bowser, John Sturgeon

North Texas Research Forum 2025

Introduction: Medicare beneficiaries who received an annual wellness visit (AWV) were noted to have reduced Medicare spending. Review of Medical City North Hills Internal Medicine Clinic data showed that 44% of eligible patients received an AWV. Improper documentation and coding were the primary reasons eligible AWVs were not accounted for even though they were performed. Majority of incomplete documentation was missing information regarding patient’s functional ability, level of safety, home safety, and activities of daily living. The information is normally obtained from a questionnaire completed by the patient prior to the visit. Questionnaire was noted by residents to be unorganized …

Dilemma In Managing Patients Presenting With Nstemi & Concurrent Gi Bleed, Mehak Sachdeva, Kathleen Mattingly, Franklin Hernandez, Jonathan Grube

North Florida Division GME Research Day 2025

No abstract provided.

Denovo Malignancy After Liver Transplantation In Patients With And Without Hepatocellular Carcinoma, Mohammad Abuassi, Carson Creamer, Harsimran Kalsi, Kobina Essilfie-Quaye, Tony S. Brar, Yaseen Perbtani

North Florida Division GME Research Day 2025

No abstract provided.

Reconciliaction Ensuring Accurate Home Medication List, Juan Pablo Meruvia Garron, Saud Khan, Akash Patel, Anna Maria Abi Nehme, Jomaris Centeno Girona, Olga Karasik

North Florida Division GME Research Day 2025

No abstract provided.

Sodium-Glocuse Cotransporter-2 Inhibitor Decreases The Risk Of Heart Failure Hospitalization & Regardless Of Left Ventricular Ejection Fraction, Hussein A. Noureldine, Thais Schwartz, Qusai Alqudah, Maryam Alhousseini, Ann T. Tong

North Florida Division GME Research Day 2025

No abstract provided.

Improving Colon & Rectal Cancer Screening At Medical City North Hills Clinic, Basil Nduma, Sharvani Raguthu, Gurunath Subrahmanyam, John Sturgeon

North Texas Research Forum 2025

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths globally. Despite its severity, fewer than half of eligible Americans undergo annual screening. The U.S. Preventive Services Task Force (USPSTF) recommends CRC screening from age 45 to 75, with personalized assessments for those aged 76 to 85. The current CRC screening rate at the Medical City North Hills Internal Medicine Residents’ Clinic is 9.3%, significantly below the target rate of over 66%. Objective: This project aimed to increase the CRC screening rate from 9.3% to over 66% at the Medical City North Hills Internal Medicine Residents Clinic, in …

Navigating The Complexity Of Ards And Cardiogenic Shock With Veno-Arterial Ecmo: A Case Report, Sanjana Kesireddy, Mohan Sengodan

North Texas Research Forum 2025

INTRODUCTION: When deciding between VA ECMO (veno-arterial ECMO) and VV ECMO (veno-venous ECMO), the primary consideration is the underlying pathology affecting the patient’s heart and lungs. VA ECMO provides support for both the cardiovascular and respiratory systems, making it suitable for patients experiencing cardiogenic shock or combined cardiac and respiratory failure. In contrast, VV ECMO is used exclusively for respiratory failure, offering support to patients with severe lung dysfunction but intact cardiac function. CASE PRESENTATION: 41 year old male with no known past medical history presented s/p cardiac arrest secondary to aspiration pneumonia due to alcohol and opioid intoxication. Chest …

Never Admit Or Release Without Considering A Naloxone Script (Narcan), Farid Mughni, Mustafa Ibrahim, Dante Janolo, Samuel Ramos, Emma Rivas, Olga Karasik

North Florida Division GME Research Day 2025

No abstract provided.

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: Management of VA ECMO has substantially evolved over the years. Much literature has been published regarding indications, management, and outcomes; however, limited evidence exists detailing strategies to manage, progress, and wean patients from VA ECMO. We present our experience using a VA ECMO expected progression patient management guideline. METHODS: The VA ECMO Expected Progression Patient Management Guideline, approved on June 1, 2021, consists of six goal-oriented stages with suggestive interventions for managing cardiogenic shock patients undergoing VA ECMO therapy. Patient characteristics and outcomes were collected retrospectively and compared between March 2019 to May 2021 (VA Non-Expected Progression group) and …

Anti-Pd-1 Monoclonal Antibody Induced Diabetic Ketoacidosis In Melanoma, Boney Lapsiwala, Jacqueline Bekhit, Indira Tata, Vibhuti Veeranna

North Texas Research Forum 2025

Background: Immune checkpoint inhibitors (ICIs), including pembrolizumab, are increasingly used in cancer therapy, particularly for melanoma. While effective, these agents are associated with various immune-related adverse events (IRAEs), including endocrine disorders like diabetic ketoacidosis (DKA). This report aims to contribute to the understanding of pembrolizumab-induced DKA, especially in patients with pre-existing prediabetes. Case Presentation: A 78-year-old male with a history of melanoma, prediabetes, and other comorbidities developed DKA after 1.5 years of pembrolizumab treatment. He presented with symptoms of weakness, thirst, dry mouth, and diarrhea, alongside severe hyperglycemia and metabolic acidosis. Diagnostic workup confirmed DKA, and his clinical improvement followed …

Gastrografin Enema To The Rescue Of The Glorious Cecal Bascule, Dominique Pean, Bushra Bangash, Guntash Khasria, Ismail Hader

Gulf Coast Division GME Research Day 2025

No abstract provided.

A Rare Case Of Brucellosis Relapse, Rabia Mahfooz, Grant Patterson, Annmary Behanan, Babivigasan Gunasegaran

Gulf Coast Division GME Research Day 2025

No abstract provided.

Recurrent Syncope In A Young Adult With Postural Orthostatictachycardia Syndrome (Pots): A Diagnostic And Therapeutic Challenge, Syed Raza, Shuchita Jhaveri, Neethu George, Julian Nguyen

Gulf Coast Division GME Research Day 2025

No abstract provided.

Immune Related Cardiac Cardiac Tamponade Triggered By Pd-L1 Blockade In Breast Cancer: A Case Report, Luis Salcedo, Ivan Mogollon, Francisco Arias, Jose Donis, Michelle Lopez

Gulf Coast Division GME Research Day 2025

No abstract provided.

Atn Masquerading Rapidly Progressive Glomerulonephritis: Atypical Presentation Of P-Anca Associated Vasculitis With Rpgn, Nimmy Joy, Anabel Al Abdallah, Andrea Francis, Saurabh Pande

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Exploring The Link Between Low-Income Communities And Increased Cancer Risk From Nitrate Contamination In Drinking Water: A Review, Anna Wiggins, Rena Phillips, Michael L. Phillips, Wei-Hsiung Yang

South Atlantic Division GME Research Day 2025

No abstract provided.

Occlusive Thrombosis Of Superior Mesenteric And Portal Veins, Radhika Mohan, Genevieve Mccloskey, Curtis Wong, Hedaya Othman, Valerie Sinkler

South Atlantic Division GME Research Day 2025

No abstract provided.

A Case Of Dress Syndrome Following Recurrent Hardware-Related Knee Infection: Diagnosis, Management, And Recovery, Cooper Alden Josephs, Himani Patel, James Everhart

South Atlantic Division GME Research Day 2025

No abstract provided.

Impact Of Fluid Balance On Clinical Outcomes In Icu Patients W. Pulmonary Arterial Hypertension, Geran Maule, John Rickards, Abdallah Rayyan, Moh'd Alamin Daise, Kobina Essilfie-Quaye, Peters Okonoboh

North Florida Division GME Research Day 2025

No abstract provided.

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Life Over Limb: A Case Of Rapidly Rrogressive Necrotizing Fasciitis, Olesya A. Balashova, Adam Lerchenfeld, Rahul Ramakrishnan, Ashley Diaz, Anna Felizcek, Daniel Heller

East Florida Division GME Research Day 2025

No abstract provided.

Platypnea-Orthodeoxia Syndrome In A Case Of Septal Occlusion Device Migration, Bike Ozkan, Richard Shalmiyev, Adam Devine, Michael Pelekhach, Siddarth Kathuria, Daniel Heller, Mauricio Danckers

East Florida Division GME Research Day 2025

Introduction

Platypnea-orthodeoxia syndrome (POS) is defined by dyspnea and hypoxemia in the upright position, which improves upon recumbency. While often linked with hepatopulmonary syndrome, intracardiac etiologies, particularly a patent foramen ovale (PFO), may also be responsible. PFOs are typically managed with device closure, and while rare, device migration can occur unbeknownst to the patient with resultant critical sequelae.

Methods

Here, we present the case of an 89-year-old female with a medical history of hypertension, diabetes, and coronary artery disease status post PCI, who arrived with severe dyspnea and was subsequently intubated for profound hypoxia. A chest CT angiogram ruled out …

Oil And Air Don’T Mix: Vitamin E Acetate In Evali, Angelo Lopez-Lacayo, Jordan Taylor-Bentley, Josef Masseli, Michelle Silva, Christy Diaz, Daniel Zapata

East Florida Division GME Research Day 2025

Introduction: Electronic cigarette or vaping-associated lung injury (EVALI) is an acute or subacute condition characterized by acute respiratory symptoms and bilateral pulmonary infiltrates seen in patients who are exposed to electronic cigarettes or vapes. The condition has been strongly linked to inhalation of aerosolized vitamin E acetate, particularly in THC-containing e-cigarette products. Despite regulation of vitamin E acetate in the production of electronic vapes, it continues to be a byproduct of EVALI due to counterfeit electronic vapes. Clinically, patients with EVALI present in various ways but are not limited to fever, shortness of breath, cough, chills, body aches, pleuritic chest …

Lactate/Albumin And Rdw/Albumin Ratios For Mortality And Readmission In Post-Mi Heart Failure, Amogh Killedar, Hamza Khan, Henry Cusnir

East Florida Division GME Research Day 2025

BACKGROUND Robust biomarkers that capture the combined effects of inflammation and tissue hypoperfusion, are needed to refine post–acute myocardial infarction (AMI) risk stratification—especially in the large subset that develops congestive heart failure (CHF). Two emerging candidates are the lactate/albumin ratio (LAR) and the red-cell-distribution-width/albumin ratio (RAR). Separate studies have linked each ratio to short- and long-term mortality in critical illness, AMI, and heart failure, yet no work has directly compared their performance together. We addressed this evidence gap in a large, multi-hospital dataset.

METHODS We performed a retrospective analysis of 8 115 encounters drawn from the HCA Healthcare database (2016-2024). …