Internal Medicine Commons^™

Development And Evaluation Of A Peer Education-Based Ultrasound Curriculum With Emphasis On Clinical Reasoning, Nisha Patel, Arati Kelekar

Posters

Point-of-care ultrasonography (POCUS) is being increasingly incorporated in pre-clerkship physical diagnosis courses. However, the development of such a curriculum at many medical schools is limited by financial constraints, the availability of trained faculty, and the recent COVID-19 pandemic. Here, we describe an optional POCUS curriculum that circumvents these barriers while still providing basic image acquisition skills and pathophysiological correlations.

One Thing Leads To Another: Embracing Complexity In Geriatric Cardiology, Ashok Krishnaswami, Min Ji Kwak

Faculty, Staff and Student Publications

No abstract provided.

Review Of Salvage Therapy For Mrsa Bacteremia At Beaumont Health System, Hazem Alakhras, Matthew D. Sims, Tracey A.H. Taylor

Posters

Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.

Identification Of Molecular Markers Associated With Copd In Non-Smokers And Smokers: A Bioinformatics Analysis, Agede O. Ayodele, Isa M. Wasagu, Ademola E. Fawibe, Alakija K. Salami

The University of Louisville Journal of Respiratory Infections

Background

Even though the proportional burden of COPD among never-smokers is significant in both developing and developed nations, accounting for around 30% of all COPD in the community, there is little awareness of the prevalence of COPD in this population. Understanding the molecular processes that underlie COPD in nonsmokers is essential.

Methods

Dataset (GSE146560) was acquired from the Gene Expression Omnibus (GEO). The limma and clusterProfiler software tools were used to identify differentially expressed genes (DEGs) and conduct a functional enrichment analysis respectively.

Results

In all, 10,583 DEGs were found, of which 1,065 were up-regulated and 9,518 were down-regulated. The …

Highlights From The Second Choosing Wisely Africa Conference: A Roadmap To Value-Based Cancer Care In East Africa (9–10 February 2023, Dar Es Salaam, Tanzania), Rugengamanzi Eulade, Godwin Abdiel Nnko, Jerry Ndumbalo, Nazima Dharsee, Larry O. Akoko, Christian Ntizimira, Beda Likonda, Harrison Chuwa, Salum Lidenge, Verna Vanderpuye, Nazik Hammad, Sikudhani Muya, Rubagumya Rubagumya

Internal Medicine, East Africa

The ecancer Choosing Wisely conference was held for the second time in Africa in Dar es Salaam, Tanzania, from the 9th to 10th of February 2023. ecancer in collaboration with the Tanzania Oncology Society organised this conference which was attended by more than 150 local and international delegates. During the 2 days of the conference, more than ten speakers from different specialties in the field of oncology gave insights into Choosing Wisely in oncology. Topics from all fields linked to cancer care such as radiation oncology, medical oncology, prevention, oncological surgery, palliative care, patient advocacy, pathology, radiology, clinical trials, research …

Effect Of Comorbidities And Choice Of Treatment On Overall Survival In Elderly Patients With Acute Myeloid Leukemia: A Beaumont Experience, Bilal M. Ali, Emma Herrman, James Huang Huang, Mohammad Muhsin Chisti

Posters

First line therapy for Acute Myeloid Leukemia (AML) is 7+3 regimen. It often cannot be used in elderly patients due to intensity. Venetoclax + hypomethylating agent (HMA) is approved for AML treatment in these patients. We investigate the efficacy of this treatment in a community setting where patients do not have the same resources available to them as a large academic center. Primary outcome was survival of patients greater than 60 years of age with a diagnosis of AML who received 7+3 therapy versus those who received venetoclax + HMA. Secondary outcomes included characteristics of those who received the two …

Changes In Electrocardiographic And Cardiac Implantable Electronic Device Parameters Following Transcatheter Aortic Valve Replacement, Elizabeth Seeley, Luai Madanat, Nishaki Mehta

Posters

Transcatheter aortic valve replacement (TAVR) is known to cause conduction abnormalities leading to the need for permanent pacemaker implantation. However, the impact of TAVR-related conduction abnormalities on cardiac implantable electronic device (CIED) parameters in patients with preexisting devices is not known. We sought to investigate and describe changes in EKG and CIED parameters following TAVR in patients with preexisting CIEDs.

Patient With Genital Lymphedema, Pain, And Rash, Resa G Magill, Dylan Supak, Rachel Pham, Dustin Luse, Cooper R Benson

Faculty, Staff and Student Publications

No abstract provided.

Neuroendocrine Tumor Of The Ampulla Of Vater: A Case Report, Mohammad S Aman, Bidhan C Das, Aminul Islam, Murshidul Arefin, Satya N Gupta

Faculty, Staff and Student Publications

Neuroendocrine tumors (NETs) of the ampulla of Vater are extremely rare. Here, we discuss the clinical presentation, diagnostic challenges, and treatment options of a recently experienced case of NET of the ampulla of Vater in light of the literature. A 56-year-old woman presented with recurrent upper abdominal pain. Ultrasonography (USG) of the whole abdomen showed multiple gallstones along with a dilated common bile duct (CBD). For evaluating the dilated CBD, a magnetic resonance cholangiopancreatography was performed, which revealed the double-duct sign. Subsequently, an upper gastrointestinal endoscopy showed a bulged-out ampulla of the Vater. Biopsy and histopathological examination of the growth …

Interleukin-33 Facilitates Liver Regeneration Through Serotonin-Involved Gut-Liver Axis, Yankai Wen, Christoph Emontzpohl, Long Xu, Constance L Atkins, Jong-Min Jeong, Yang Yang, Kangho Kim, Chuan Wu, Shizuo Akira, Cynthia Ju

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: Insufficient liver regeneration causes post-hepatectomy liver failure and small-for-size syndrome. Identifying therapeutic targets to enhance hepatic regenerative capacity remains urgent. Recently, increased IL-33 was observed in patients undergoing liver resection and in mice after partial hepatectomy (PHx). The present study aims to investigate the role of IL-33 in liver regeneration after PHx and to elucidate its underlying mechanisms.

APPROACH AND RESULTS: We performed PHx in IL-33 -/- , suppression of tumorigenicity 2 (ST2) -/- , and wild-type control mice, and found deficiency of IL-33 or its receptor ST2 delayed liver regeneration. The insufficient liver regeneration could be …

Therapeutic Potential Of Tumor Treating Fields For Malignant Brain Tumors, Youyou Zhou, Xiaoqing Xing, Jinyun Zhou, Han Jiang, Peili Cen, Chentao Jin, Yan Zhong, Rui Zhou, Jing Wang, Mei Tian, Hong Zhang

Faculty, Staff and Student Publications

BACKGROUND: Malignant brain tumors are among the most threatening diseases of the central nervous system, and despite increasingly updated treatments, the prognosis has not been improved. Tumor treating fields (TTFields) are an emerging approach in cancer treatment using intermediate-frequency and low-intensity electric field and can lead to the development of novel therapeutic options.

RECENT FINDINGS: A series of biological processes induced by TTFields to exert anti-cancer effects have been identified. Recent studies have shown that TTFields can alter the bioelectrical state of macromolecules and organelles involved in cancer biology. Massive alterations in cancer cell proteomics and transcriptomics caused by TTFields …

Candidate Biomarkers As Predictors Of Future Kidney Disease And Cardiovascular Dysfunction In Adolescents With Type 2 Diabetes, Fida Bacha, Laure El Ghormli, Barbara H Braffett, Amy S Shah, Santica M Marcovina, Lorraine E Levitt Katz, Steven M Willi, Sonia Caprio, Ruban Dhaliwal, Samuel S Gidding

Faculty, Staff and Students Publications

AIMS: Evaluate changes in circulating biomarkers as predictors of kidney disease, and cardiac/vascular dysfunction in participants from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.

METHODS: Candidate biomarkers were assessed annually in 507 participants over a mean follow-up of 6.9 ± 2.4 years. Moderate albuminuria was defined as urine albumin-to-creatinine ratio ≥ 30 mg/g and hyperfiltration as eGFR ≥ 135 mL/min/1.73 m

RESULTS: At baseline, 35.7% were male, with a mean age 13.9 years, diabetes duration 7.8 months, and HbA1c 6.0%. Higher concentrations of E-selectin and proinsulin were associated with incident moderate albuminuria and hyperfiltration. …

Genetic Associations Between Modifiable Risk Factors And Alzheimer Disease, Jiao Luo, Jesper Qvist Thomassen, Céline Bellenguez, Benjamin Grenier-Boley, Itziar De Rojas, Atahualpa Castillo, Kayenat Parveen, Fahri Küçükali, Aude Nicolas, Oliver Peters, Anja Schneider, Martin Dichgans, Dan Rujescu, Norbert Scherbaum, Deckert Jürgen, Steffi Riedel-Heller, Lucrezia Hausner, Laura Molina Porcel, Emrah Düzel, Timo Grimmer, Jens Wiltfang, Stefanie Heilmann-Heimbach, Susanne Moebus, Thomas Tegos, Nikolaos Scarmeas, Jordi Clarimon, Fermin Moreno, Jordi Pérez-Tur, María J Bullido, Pau Pastor, Raquel Sánchez-Valle, Victoria Álvarez, Mercè Boada, Pablo García-González, Raquel Puerta, Pablo Mir, Luis M Real, Gerard Piñol-Ripoll, Jose María García-Alberca, Jose Luís Royo, Eloy Rodriguez-Rodriguez, Hilkka Soininen, Teemu Kuulasmaa, Alexandre De Mendonça, Shima Mehrabian, Jakub Hort, Martin Vyhnalek, Sven Van Der Lee, Caroline Graff, Goran Papenberg, Vilmantas Giedraitis, Anne Boland, Delphine Bacq-Daian, Jean-François Deleuze, Gael Nicolas, Carole Dufouil, Florence Pasquier, Olivier Hanon, Stéphanie Debette, Edna Grünblatt, Julius Popp, Luisa Benussi, Daniela Galimberti, Beatrice Arosio, Patrizia Mecocci, Vincenzo Solfrizzi, Lucilla Parnetti, Alessio Squassina, Lucio Tremolizzo, Barbara Borroni, Benedetta Nacmias, Sandro Sorbi, Paolo Caffarra, Davide Seripa, Innocenzo Rainero, Antonio Daniele, Carlo Masullo, Gianfranco Spalletta, Julie Williams, Philippe Amouyel, Frank Jessen, Patrick Kehoe, Magda Tsolaki, Giacomina Rossi, Pascual Sánchez-Juan, Kristel Sleegers, Martin Ingelsson, Ole A Andreassen, Mikko Hiltunen, Cornelia Van Duijn, Rebecca Sims, Wiesje Van Der Flier, Agustín Ruiz, Alfredo Ramirez, Jean-Charles Lambert, Ruth Frikke-Schmidt

Faculty, Staff and Students Publications

IMPORTANCE: An estimated 40% of dementia is potentially preventable by modifying 12 risk factors throughout the life course. However, robust evidence for most of these risk factors is lacking. Effective interventions should target risk factors in the causal pathway to dementia.

OBJECTIVE: To comprehensively disentangle potentially causal aspects of modifiable risk factors for Alzheimer disease (AD) to inspire new drug targeting and improved prevention.

DESIGN, SETTING, AND PARTICIPANTS: This genetic association study was conducted using 2-sample univariable and multivariable mendelian randomization. Independent genetic variants associated with modifiable risk factors were selected as instrumental variables from genomic consortia. Outcome data for …

Obstructive Sleep Apnea Modulates Clinical Outcomes Post-Acute Myocardial Infarction: A Large Longitudinal Veterans’ Dataset Report, Ritwick Agrawal, Amir Sharafkhaneh, Vijay Nambi, Ahmed Bahammam, Javad Razjouyan

Faculty, Staff and Students Publications

BACKGROUND: While the longer-term Obstructive Sleep apnea (OSA)-related intermittent hypoxia (IH) leads to various comorbidities, it has become increasingly evident that OSA confers protective advantages during and after acute myocardial infarction (AMI). We hypothesized in patients who were admitted with acute MI, the presence of OSA is associated with lower in-hospital mortality compared to those without a prior diagnosis of OSA.

METHODS: In this nationwide retrospective study utilizing Veterans Health Administration records, we included patients hospitalized for MI with a history of sleep disorders from 1999 to 2020. We divided patients into two cohorts: those with OSA and those without …

Upright Positioning To Maintain Quantitative Measurement Of Higher Right Atrial Pressures, Zaven Sargsyan, Stephanie Sherman

Faculty, Staff and Students Publications

No abstract provided.

Accidental Extravasation Of Mitomycin C Into The Subcutaneous Tissue, Johnathon Chung, Brooke Walterscheid, Jose Lopez-Vera, Hytham Rashid, Mike K. Liang

HCA Healthcare Journal of Medicine

Introduction

Mitomycin C (MMC) is a common chemotherapeutic agent used to treat a variety of solid tumors. Cutaneous adverse events are rare, but MMC is a known vesicant reported to cause tissue necrosis and sloughing, erythema, and ulceration if incorrectly infused into the subcutaneous tissue. Definitive treatment of extravasation injuries due to MMC depends on the severity of the cutaneous manifestation, which includes stopping the infusion, removing the catheter, or possible debridement.

Case Presentation

We present the case of a 70-year-old female with extensive soft-tissue injury secondary to extravasation of MMC that required hospital admission and surgical intervention to remove …

Death Due To Drug Reaction With Eosinophilia And Systemic Symptoms (Dress) Syndrome: A Case Report, Samantha P. Sternad, Jane Pangburn, Chad Johnston, David Rowe

HCA Healthcare Journal of Medicine

Background

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening, multi-organ adverse drug reaction with an incidence of 1 in 1000 to 1 in 10 000 highrisk drug exposures.

Case Presentation

An elderly female presented to the hospital with progressive weakness and a diffuse erythematous macular rash covering most of her body that started 3 days prior. Over the next 3 days, the patient quickly deteriorated, developing disorientation with acute onset left-sided weakness, leukocytosis, thrombocytopenia, eosinophilia, liver and kidney failure, and hypoxia. Clinical and histological changes supported the diagnosis of DRESS syndrome caused by intravenous (IV) ampicillin …

It Wasn’T A Duck: A Case Of The Misdiagnosis Of Ketoacidosis, Shiva Mohan, Brandon Vu, Danielle Ford

North Texas GME Research Forum 2023

Introduction Most clinicians have heard the old adage: if it looks like a duck, walks like a duck, and quacks like a duck, it’s a duck. However, this is not always true. Ketoacidosis is a complicated physiological state resulting from fatty acid and amino acid degradation often associated with type 1 diabetics. It can also arise with excess alcoholism, pregnancy, starvation, and exercise. Diabetic, alcoholic, and starvation ketoacidosis may present similarly. Clinicians can often mistake alcoholic and starvation ketoacidosis for diabetic ketoacidosis due to its common presentation. We present a case of a young non-pregnant woman with a history of …

A Rare Case Of Rapidly Progressive Cll/Sll Presenting As Bilateral Tonsillar Enlargement And Upper Airway Obstruction, William Mangin, Kashif Aslam

North Texas GME Research Forum 2023

Although chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) differ in clinical presentation, they are both arise from the same pathologic process, namely the clonal expansion of mature B-cells. This malignancy is usually quite indolent and carries a favorable prognosis. Thanks to a number of highly-effective oral targeted therapies, such as the Bruton tyrosine kinase (BTK) inhibitor, Ibrutinib, patient outcomes have improved significantly. Unfortunately, these therapies are not always well tolerated and many patients are forced to discontinue the medication due to side effects. Many patients experience a disease flair and some even transformation to a high-grade malignancy after …

An Exceedingly Rare Case Of Bilateral Synchronous Germ Cell Testicular Tumors Of Different Histological Types, Joseph Kim, Ray Page, Gregory Moses, Rod Carlo Columbres

North Texas GME Research Forum 2023

It is exceedingly rare to find a case of bilateral synchronous germ cell testicular tumors of different histological types, and there have been only a handful of cases because of a lack of connections through lymphatic or vascular pathways between the testes. Here we present a unique case of a 43-year-old man who initially presented to the primary care physician for increasing right testicular swelling. He had a testicular sonogram that showed a large right testicular mass as well as a 1.7 cm left testicular mass suspicious of malignancy. Pre-surgical laboratories showed PSA 0.97, alpha-fetoprotein 1875, quantitative hCG 2508, and …

Euglycemic Diabetic Ketoacidosis Secondary To Sglt2 Inhibitors In Combination With A Low-Carbohydrate Diet, George Yeung, Nhi Duong, Akshaj Pole, Benjamin Larsen, Syed Ahmed

North Texas GME Research Forum 2023

Euglycemic diabetic ketoacidosis (EuDKA) is a rare complication of type 2 diabetes mellitus (T2DM) characterized by normoglycemia in the presence of anion gap metabolic acidosis and blood ketone. EuDKA has been associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) but the reported adverse events are scarce. We present a case of a 68-year-old gentleman with T2DM and coronary artery disease, who developed EuDKA after starting empagliflozin (Jardiance) with a low-carbohydrate diet for a few days. SGLT2i block proximal tubule glucose reabsorption, resulting in a state of carbohydrate starvation and subsequent ketosis. The combination of SGLT2i with a low-carbohydrate diet …

Covid-19 Masking An Atypical Presentation Of Hairy Cell Leukemia, Kahmalia-Kalee Sada

North Texas GME Research Forum 2023

Hairy cell leukemia is a rare lymphoid neoplasm of small mature B cell lymphoid cells. Hairy cell leukemia only accounts for about 1 to 2 percent of adult leukemia cases. Early diagnosis of Hairy cell Leukemia is important, it is proven that without treatment the median survival of this cancer is four years. After numerous studies the age-adjusted risk of death with proper diagnosis and treatment has decreased by 85%. The greatest outcomes are seen in individuals who are younger with earlier diagnosis. Hairy Cell Leukemia is a rare leukemia seen with the classic triad of splenomegaly, pancytopenia, and “hairy” …

51-Year-Old Female With Epistaxis And Generalized Weakness For 2 Months Diagnosed With Rpgn, Meihuan Lin

North Texas GME Research Forum 2023

Rapidly progressive glomerulonephritis (RPGN)’s clinical presentation including acute onset of macroscopic hematuria, decreased urine output, acute onset of hypertension, and edema. Other clinical findings include nephritis presentation on urine analysis with proteinuria, micro and macroscopic hematuria, red blood cells, dysmorphic RBC and RBC casts. Pathological findings characterized extensive crescent formation. Untreated patients can rapidly progress to end-stage kidney disease over a very short periods (days to months). Renal biopsy can further differentiate the types of crescentic glomerulonephritis. There are three major types of RPGN: 1. Anti-glomerular basement membrane (GBM) disease cause by anti-GBM antibodies. It is also associated with pulmonary …

A Case Of Erythema Nodosum, Mahmood Ahmad, Sunitha Valayil

North Texas GME Research Forum 2023

Background: Erythema nodosum (EN) is characterized as a delayed hypersensitivity reaction to subcutaneous adipose tissue. This panniculitis process presents as erythematous, tender nodules and plaques most commonly located on the pretibial areas. EN may be idiopathic or may be caused by a number of factors such as infection, chronic systemic inflammatory processes, drugs or malignancy.

Case presentation: A 29-year-old male with no significant past medical history presented with a 2-week history of worsening bilateral lower extremity erythema, nodules and pain. This patient was initially seen in the emergency department after a 4-day history of his symptoms. At this time, he …

Extraintestinal Salmonellosis Unmasked In A Parotid Mass, Kahmalia-Kalee Sada

North Texas GME Research Forum 2023

Salmonella infection can cause a wide range of presentations, predominantly gastrointestinal but occasionally with cardiovascular or other extraintestinal manifestations. The diagnosis of extraintestinal salmonellosis requires a high degree of clinical suspicion and should be considered in patients with deep-seated abscesses. [1]. Typically, these types of infections, are extremely rare, and when revealed are typically seen in the immunocompromised patient with chronic illness, HIV, or Hepatitis. While the incidence of nontyphoid salmonellosis is estimated at over 2 million cases annually, extraintestinal manifestations account for less than 1% of cases. Studies have revealed that individuals with diabetes have risk for salmonellosis due …

A Case Of Viral Pneumonia And Acute Respiratory Distress Syndrome During The Covid-19 Pandemic, Mark Cheneler, Khizir Qureshi, Carlos Bahrami

North Texas GME Research Forum 2023

Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the ICU setting and a continued source for investigation to improve outcomes. It is characterized by acute respiratory failure with an identifiable insult, bilateral infiltrates on imaging, and a PaO2/FiO2 ratio (PF ratio) of less than 300 mmHg. It can be further classified into mild, moderate, and severe ARDS with a PF ratio of less than 300, 200, and 100 mmHg respectfully. Treatment requires elucidation of the underlying insult to the pulmonary system and prompt treatment. Presented here is a case of ARDS secondary to herpes …

Monitoring Concordance In The Management Of Transfusing Blood Components In Cirrhotic Patients For Paracentesis With Evidence-Based Guidelines, Joseph Kim, Gregory Moses

North Texas GME Research Forum 2023

Initiative to decrease unnecessary hemostatic agent transfusion in cirrhotic patients undergoing paracentesis: a resident-led approach quality improvement project to prevent transfusion overuse. Currently, there is no official guideline placed in the hospital for the administration of a hemostatic agent such as fresh frozen plasma in the setting of an elevated international normalized ratio, which paradoxically is an anticipated finding in cirrhotic patients. This process leads to unnecessarily prolonging the duration of the hospital course due to delays in performing the interventional procedures and interruptions in scheduling. The goal of this project is to educate and provide physicians with the most …

An Interesting Case Of Suppurative Thrombophlebitis And Perivascular Abscesses As A Cause Of Complicated Mrsa Bacteremia, Ramya Ramachandran, Punjan Patel, Nasima Mehraban, Win Leth Shwe Yee

North Texas GME Research Forum 2023

Methicillin resistant staph aureus (MRSA) Bacteremia has become a serious re-emerging infection. As per the Centers of Disease Control (CDC), the worsening opioid epidemic has created a snowballing effect, in that there is not only an increase in invasive MRSA infections but also in complications from MRSA. Early source control through the form of early foci identification, obtaining serial blood cultures, decolonization and hygiene measures, appropriate antibiotic stewardship are used to eradicate this bacteria and prevent its spread. There are multiple challenges in treating injection drug users with MRSA bacteremia is not only in medical management but also in trying …

Rare Presentation Of Primary Malignant Peripheral Nerve Sheath Tumor Of The Femur In Neurofibromatosis-1, Akshaj Pole, Danielle Ford, Elizabeth Pollard

North Texas GME Research Forum 2023

Malignant peripheral nerve sheath tumors (MPNSTs) are rare sarcomas, most commonly seen in patients with Neurofibromatosis type 1 (NF1), that are characterized as aggressive with high rate of local recurrence. Among NF1 patients, the risk of developing MNPSTs is approximately 8-13% over a lifetime. Primary MPNST is exceedingly rare, of which the vast majority are concentrated in the head and neck region. Here, we present a case of a 40-year-old male with NF1 who presented with a giant MPNST that originated in the right proximal femur. The mass was treated with complete surgical resection with right hip disarticulation. In a …

The Domino Effect: Spontaneous Abortions As A Sequela Of Eisenmenger Syndrome, Riddhiben Patel, Anas Hamadeh, Laura Montoya, Senthil Thambidorai

North Texas GME Research Forum 2023

Background: Eisenmenger's syndrome (ES) is a congenital cardiac abnormality in which a significant chronic left-to-right shunt results in pulmonary arterial hypertension and a reversal of the shunting direction. A woman with ES should ideally avoid conception given the increased risk of unexpected fetal demise and maternal mortality. Case: We present a case of a 35-year-old female patient G3, P0, at 9 weeks gestation with reported PMHx of erythrocytosis and spontaneous abortions who presented to the hospital with complaints of vaginal bleeding and worsening SOB. She was noted to have a Hct of 70 and a Hb of 23.8, with SaO2 …