Internal Medicine Commons^™

The Importance Of A Broad Differential Diagnosis: Hepatitis C Virus Associated Cryoglobulinemic Vasculitis, Shadi Jafari-Esfahani, Christine E. Loftis, Juan Naranjo, Emilia Dulgheru

Research Symposium

Introduction: Mixed cryoglobulinemia syndrome (MCS) is a systemic inflammatory syndrome affecting small-medium sized vessels due to the presence of type II or III cryoglobulins in the serum. MSC can manifest as systemic vasculitis with symptoms varying from weakness, arthralgia, palpable purpura, peripheral neuropathy, and renal involvement. The most common cause of MCS includes lymphoproliferative disorders, autoimmune diseases and viral infections, with hepatitis C virus (HCV) being the most common etiology.

Case Presentation: A 60-year-old lady was referred to our office for evaluation of rheumatoid arthritis. She reported history of bilateral thumb pain, bilateral knee pain associated with episodes of swelling, …

Evaluation Of The Effectiveness Of Foot-And-Mouth Disease Vaccination Of Animals In The Buffer Zone Of The Republic Of Armenia In 2016–2020, Satenik Kharatyan, Khachik Sargsyan, Hasmik Elbakyan, Tigran Markosyan, Pertsh Tumanyan, Varduhi Hakobyan, Vazgen Sargsyan, Manvel Badalyan, Gayane Chobanyan, Jenna E Achenbach

Faculty, Staff and Student Publications

BACKGROUND: Foot-and-mouth disease (FMD) is a high impact viral disease of livestock for which vaccines are extensively used for limiting the spread of infection. Armenia shares a border with both Turkey and Iran where FMD is endemic, making vaccination an important component of Armenia's control strategy. Additionally, Armenian veterinary services utilize both passive and active monitoring for prevention control.

METHODS: We sought to determine the immune status of animals vaccinated against FMD and to evaluate the effectiveness of our vaccination policy in Armenia. This was conducted in three regions including Shirak, Armavir, and Ararat Region which are located in the …

Patchy Alopecia In A Young Adult With A Generalized Rash, Oscar Rodrigo Zamudio Herrera, Nevin Varghese

Research Symposium

Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.

Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was …

A Swinging Heart: Relevance Of Point Of Care Ultrasound In The Diagnosis Of An Atypical Complication Of Acute Pericarditis, Oscar Rodrigo Zamudio Herrera, Nevin Varghese

Research Symposium

Background: Cardiac tamponade is a life-threatening condition, that results from progressive or acute accumulation of fluid in the pericardial space impairing cardiac hemodynamics. It is a rare complication of acute pericarditis. About two-thirds of acute pericarditis present with pericardial effusion. Of which, hemodynamic instability is seen in 3-5% of the cases. Point of Care Ultrasound is a cost-effective tool that aids in the prompt identification of life-threatening conditions such as tamponade.

Case presentation: 36-year-old male presented with complaints of fever and dyspnea on exertion for 4 days. He reported being tachycardic at home on his personal pulse oximeter. Past medical …

Mediastinal Mass Presenting As An St-Elevation Mi, Oscar J. Lopez, Gabriel J. Lora Ferreira, Carlos B. Ceron

Research Symposium

Background: MINOCA is defined as a clinical syndrome in which there is myocardial ischemia in the setting of normal coronary arteries. Different causes include coronary spasms, SCAD, or external compression, e.g., by a mediastinal mass. CT or MRI would show presence of the mass, deferring any need for coronary angiography.

Case: The patient is a 57-year-old lady with a past medical history of hypertension who presented to the ED complaining of shortness of breath associated with chest pain. Upon evaluation her vitals were BP 126/76, HR 94, RR 18, O2 98% on room air. Physical exam was unremarkable. Troponin peaked …

A Whole Clotta Pain: A Case Of Ivc Thrombosis Presenting As Severe Abdominal Pain In A Patient With Anti-Phospholipid Syndrome, Mery Bartl, Christine E. Loftis, Josenny Rodriguez-Paez, Emilia C. Dulgheru

Research Symposium

Background: Anti-phospholipid syndrome (APS) is an immune-mediated condition characterized by the presence of antiphospholipid antibodies in the setting of venous and arterial thrombosis and or pregnancy loss [1]. APS can be a primary syndrome or can be associated with connective tissue diseases such as systemic lupus erythematosus. The goal of treatment in patients with APS is to decrease the risk of thromboembolic events and the standard of care is warfarin therapy. We describe a case of a 42-year-old gentleman with a history of APS on anticoagulation with apixaban who presented to the hospital with severe abdominal pain secondary to infrarenal …

A Case Of Osteogenesis Imperfecta In A Patient Diagnosed In Adulthood, Khalid Sheikh, M. Lastovica, N. S. Appareddy, R. Wagner, E. Luna

Research Symposium

Background: Osteogenesis imperfecta (OI) is an extremely rare inherited connective tissue disorder, with an incidence of 1 in 20,000 births in the United States. Our aim is to assist other providers in diagnosing and managing patients with OI and concurrent medical morbidities.

Case Presentation: A 21 year old male with a BMI of 34 and a lifetime history of over 10 fractures presented to the Emergency department after a complex seizure at home. The seizure was witnessed by his mother and lasted less than one minute. He had another seizure two weeks prior to presentation. In the ED, the patient …

Comparing Stroke Symptom Recognition And Intervention Times In The Rio Grande Valley, Joshua M. Ninan, Kelsey Baker

Research Symposium

This is a retrospective study that aims to evaluate the duration from onset of stroke-like symptoms to presentation to medical facilities for aid in the Rio Grande Valley. The main goal of the study is to understand the extent of pre-hospital delays with regards to the treatment of stroke in the RGV.

Hepatopulmonary Syndrome In A 22 Year Old Gentleman With Liver Cirrhosis, Blesset Alexander, Joseph Caporusso, Priyasha Suri

Research Symposium

Background: Hepatopulmonary syndrome is a severe complication of end-stage liver disease characterized by triad of liver disease, intrapulmonary vascular dilatation, and arterial hypoxemia. Although the pathogenesis is not completely understood, pulmonary vascular dilatation occurs due to imbalance between vasodilators and vasoconstrictors. Liver injury is thought to increase endothelin production and cause bacterial translocation, causing increased nitric oxide production, causing vasodilation of pulmonary vasculature. History and physical examination are important in leading the physician to the correct diagnosis as the majority of these patients present with non-specific clinical manifestations and imaging. Identification of specific physical exam findings is important in not …

Antigen Staining For Detection Of Muc13 And Mcu16 In Carcinoma Tissue, Jose A. Benitez

Research Symposium

MUC13 and MUC16 are mucosal epithelial expressed proteins associated with various carcinomas. Overexpression of these biomarkers appear to play a role in tumor growth; this discovery has paved a road for multiple studies discussing the potential of targeting mucin proteins and optimize immunotherapy approaches against carcinomas. Our study serves to investigate the level of expression of MUC13 and MUC16 in cancerous and normal tissue and to discuss the implications our findings may have for the utilization of these biomarkers for cancer therapy.

Insulin Resistance And Insulin Handling In Chronic Kidney Disease, Vishnu P Parvathareddy, Jiao Wu, Sandhya S Thomas

Faculty, Staff and Students Publications

Insulin regulates energy metabolism involving multiple organ systems. Insulin resistance (IR) occurs when organs exhibit reduced insulin sensitivity, leading to difficulties in maintaining glucose homeostasis. IR ensures decades prior to development of overt diabetes and can cause silent metabolic derangements. IR is typically seen very early in the course of chronic kidney disease (CKD) and is evident even when the estimated glomerular filtration rate (eGFR) is within the normal range and IR persists at various stages of kidney disease. In this article, we will discuss insulin handling by the kidneys, mechanisms responsible for IR in CKD, measurements and management of …

Tale Of Traveling In A Stealth Mode, Blesset Alexander, Priyasha Suri, Don Rajan, Praveen Vijhani

Research Symposium

Background: Melanoma is an aggressive malignancy that tends to form metastases in the brain. The nature of metastatic melanoma with unknown primary is poorly understood and has only theoretical assumptions. Less than 10% of melanoma cases present with an unknown primary tumor location.

Case presentation: A 68-year-old Caucasian male patient, Canadian citizen, presented to the hospital with left-sided weakness and deviation of right side of angle of mouth for three days. Pertinent positive physical signs were motor weakness of left upper and lower extremities. Labs were unremarkable. CT-scan of the brain showed right temporal lobe lobulated masses associated with vasogenic …

Takotsubo Cardiomyopathy, Presentation As A Cardiac Arrest In A 67 Year Old Female With Depression And Anxiety History, Blesset Alexander, Joseph Caporusso, Priyasha Suri, Brandon Cantazaro

Research Symposium

Background: Takotsubo cardiomyopathy also known as broken heart syndrome or stress induced cardiomyopathy is a sudden transient reversible dramatic left ventricular apical akinesis mimicking acute coronary syndrome, making it a diagnostic challenge. Most common mechanism for Taktosubo is stress induced catecholamine release causing sympathetic activation leading to microvascular dysfunction or direct toxicity. Mayo Clinic Criteria for making diagnosis at the time of presentation requires 1) transient hypokinesis, dyskinesis, or akinesis of the LV midsegments with or without apical involvement, and a stressful trigger is often but not always present. 2) absence of obstructive coronary disease or angiographic evidence of acute …

A Patient With Advanced Head And Neck Squamous Cell Carcinoma Presenting With Unexplained Syncope, Andreina Baird, Eric Sanchez Maria, Dawn Jensen, Daniela Hernandez

Research Symposium

Background: Head and neck squamous cell carcinoma (HNSCC) arise from the mucosal epithelium in the oral cavity. These malignancies account for 90% of the US annual incidence of head and neck cancers. Rarely, these masses can cause syncope. In this case, we present a 61-year-old male from an underserved population in the Rio Grande Valley, with advanced HNSCC, causing carotid sinus syndrome (CSS), due to compression of the carotid sinus by the tumor. Probability of syncope in this setting is <1%.

Case Presentation: A 61-year-old male with HNSCC presented to the emergency department with facial pain, increased oral secretions, fever, dysphagia, …

Prevalence Of Fibromyalgia And Chronic Fatigue Syndrome Among Individuals With Irritable Bowel Syndrome: An Analysis Of United States National Inpatient Sample Database, Zahid Ijaz Tarar, Umer Farooq, Ahmad Nawaz, Mustafa Gandhi, Yezaz A Ghouri, Asmeen Bhatt, Brooks D Cash

Faculty, Staff and Student Publications

Background and Aim: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with other somatic disorders. We studied the prevalence and predictors of fibromyalgia and chronic fatigue syndrome (CFS) in IBS patients. Methods: We used the National Inpatient Sample and included hospitalization of individuals with IBS, using ICD-10 codes, from 2016–2019. The prevalence and predictors of fibromyalgia and CFS in IBS patients were studied. Univariate and multivariate patient- and hospital-level regression models were used to calculate the adjusted odds of fibromyalgia and CFS in the IBS patient population. Results: Of 1,256,325 patients with an ICD-10 code of IBS included …

Prevalence Of Fibromyalgia And Chronic Fatigue Syndrome Among Individuals With Irritable Bowel Syndrome: An Analysis Of United States National Inpatient Sample Database, Zahid Ijaz Tarar, Umer Farooq, Ahmad Nawaz, Mustafa Gandhi, Yezaz A Ghouri, Asmeen Bhatt, Brooks D Cash

Faculty, Staff and Student Publications

Background and Aim: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with other somatic disorders. We studied the prevalence and predictors of fibromyalgia and chronic fatigue syndrome (CFS) in IBS patients. Methods: We used the National Inpatient Sample and included hospitalization of individuals with IBS, using ICD-10 codes, from 2016–2019. The prevalence and predictors of fibromyalgia and CFS in IBS patients were studied. Univariate and multivariate patient- and hospital-level regression models were used to calculate the adjusted odds of fibromyalgia and CFS in the IBS patient population. Results: Of 1,256,325 patients with an ICD-10 code of IBS included …

Applications Of Degradable Hydrogels In Novel Approaches To Disease Treatment And New Modes Of Drug Delivery, Bo Hu, Jinyuan Gao, Yu Lu, Yuji Wang

Faculty, Staff and Student Publications

Hydrogels are particularly suitable materials for loading drug delivery agents; their high water content provides a biocompatible environment for most biomolecules, and their cross-linked nature protects the loaded agents from damage. During delivery, the delivered substance usually needs to be released gradually over time, which can be achieved by degradable cross-linked chains. In recent years, biodegradable hydrogels have become a promising technology in new methods of disease treatment and drug delivery methods due to their many advantageous properties. This review briefly discusses the degradation mechanisms of different types of biodegradable hydrogel systems and introduces the specific applications of degradable hydrogels …

See One, Do One, Teach One: Resident As Teacher Workshop For Communicating Challenging News, Rebecca Shafer, Gabrielle R. Goldberg, Stephanie Izard, Sindee Weiss-Domis, Lauren Block

Internet Journal of Allied Health Sciences and Practice

Purpose: Communicating challenging news to patients is a core skill for all physicians, yet internal medicine residents have variable preparation and comfort level in this area. Lack of well-trained faculty and faculty time pressures limit resident education in communication skills. The use of near peer teachers can be used to expand the capacity of instructors for this vital skill-set. Method: Internal medicine residents participated in a communication skills workshop (Workshop A) based on the SPIKES framework facilitated by palliative-care faculty. In a follow-up session (Workshop B), eight months later, 3^rd year residents acted as near peer teachers for 1 …

Evaluating Atezolizumab In Patients With Urinary Tract Squamous Cell Carcinoma (Aurora): Study Protocol For A Single Arm, Open-Label, Multicentre, Phase Ii Clinical Trial, Simon Crabb, Robin Wickens, Sarah Jane-Bibby, Denise Dunkley, Megan Lawrence, Allen Knight, Robert Jones, Alison Birtle, Robert Huddart, Mark Linch, Jonathan Martin, Adam Coleman, Konstantinos Boukas, Hannah Markham, Gareth Griffiths

Faculty, Staff and Student Publications

BACKGROUND: Bladder and urinary tract cancers account for approximately 21,000 new diagnoses and 5,000 deaths annually in the UK. Approximately 90% are transitional cell carcinomas where advanced disease is treated with platinum based chemotherapy and PD-1/PD-L1 directed immunotherapy. Urinary tract squamous cell carcinoma (UTSCC) accounts for about 5% of urinary tract cancers overall making this a rare disease. We have yet to establish definitive systemic treatment options for advanced UTSCC. Preliminary translational data, from UTSCC patient tumour samples, indicate high PD-L1 expression and tumour infiltrating lymphocytes in a proportion of cases. Both of these features are associated with differential gene …

Associations Between Telomere Attrition, Genetic Variants In Telomere Maintenance Genes, And Non-Small Cell Lung Cancer Risk In The Jammu And Kashmir Population Of North India, Gh Rasool Bhat, Rajeshwer Singh Jamwal, Itty Sethi, Amrita Bhat, Ruchi Shah, Sonali Verma, Minerva Sharma, Hana Q Sadida, Sara K Al-Marzooqi, Tariq Masoodi, Sameer Mirza, Mohammad Haris, Muzafar A Macha, Ammira S Alshabeeb Akil, Ajaz A Bhat, Rakesh Kumar

Faculty, Staff and Student Publications

BACKGROUND: Telomeres are repetitive DNA sequences located at the ends of chromosomes, playing a vital role in maintaining chromosomal integrity and stability. Dysregulation of telomeres has been implicated in the development of various cancers, including non-small cell lung cancer (NSCLC), which is the most common type of lung cancer. Genetic variations within telomere maintenance genes may influence the risk of developing NSCLC. The present study aimed to evaluate the genetic associations of select variants within telomere maintenance genes in a population from Jammu and Kashmir, North India, and to investigate the relationship between telomere length and NSCLC risk.

METHODS: We …