Internal Medicine Commons^™

A Rare Case Of Gigantic Ascending Aortic Arch Thrombus, Srujana Dasari, Akhil R. Gade, Nethuja Salagundla, Chandralekha Ashangari, Rashonda Carlisle

North Texas GME Research Forum 2023

An ascending aortic arch thrombus (ACT) is a rare finding in an anatomically normal aorta. It can be seen with aortic dissection or aneurysm. Complications of large thrombus like stroke or systemic emboli are less likely when found in normal aorta. Even with the low risk embolic events, it is even less likely if patients are on therapeutic anticoagulation. Here we discuss this rare case in detail. 49 y/o with PMHx of HTN, HLD, COVID19, DVT s/p thrombectomy, noncompliant with warfarin, ICH from fall presents with left-sided weakness and blurry vision. MRI head showed scattered acute infarction along right PCA …

Early Diagnosis Of Purulent Pericarditis Secondary To Methicillin-Sensitive Staphylococcus Aureus In An End-Stage Renal Disease Patient, Stephen Shey, Alejandro Espinosa-Tello, Amnah Andrabi

North Texas GME Research Forum 2023

Introduction Purulent pericarditis is a rare illness in the modern age of medicine due to the increased usage of antibiotics. Unfortunately, diagnosis of this disease is often delayed due to its nonspecific symptoms. Without treatment, the mortality is nearly one hundred percent due to major complications such as cardiac tamponade and constrictive pericarditis. As a result, most cases of purulent pericarditis are discovered post-mortem. This case report details an early diagnosis of purulent pericarditis secondary to methicillin-sensitive Staphylococcus aureus (MSSA) in an end-stage renal disease (ESRD) patient. Case Presentation A 66-year-old female with past medical history of ESRD initially presented …

Heartworm Adulticide Treatment: A Tropical Perspective, Filipe Dantas-Torres, Jennifer Ketzis, Gabriela Pérez Tort, Andrei Daniel Mihalca, Gad Baneth, Domenico Otranto, Malaika Watanabe, Bui Khanh Linh, Tawin Inpankaew, Pablo Borrás, Sangaran Arumugam, Barend Louis Penzhorn, Adrian Patalinghug Ybañez, Peter Irwin, Rebecca J Traub

Faculty, Staff and Student Publications

Dirofilaria immitis (the canine heartworm) is widespread in the tropics, with prevalence surpassing 30% in high-risk areas. In addition to the suitable climatic conditions that favour mosquito abundance and filarial larva development, there is low compliance with the recommended year-round use of preventives in these transmission hotspots. This represents a major concern, considering that melarsomine (first-line heartworm adulticide) is unavailable in several tropical countries, resulting in the so-called slow-kill protocol being the only available adulticide treatment option. In this article, the members of TroCCAP (Tropical Council for Companion Animal Parasites) review the current distribution of heartworm in the tropics and …

Cerebal Venous Sinus Thrombosis In A Patient With Smith-Magenis Syndrome, Hovra Zahoor, Ameer Hamza, Daniel Vather-Wu, Nilmarie Guzman

South Atlantic Division GME Research Day 2023

No abstract provided.

Artificial Intelligence In Colonoscopy In A Community Setting, Kunaal Patel, Brett Vanleer-Greenberg

South Atlantic Division GME Research Day 2023

No abstract provided.

A Case Of An African American Female Presenting With Idiopathic Granulomatous Lobular Mastitis, Wendy Timirau, Esra Sari, Maham Shahid, Nilmarie Guzman, Augusto Villegas

South Atlantic Division GME Research Day 2023

No abstract provided.

Under Pressure: A Case Of Acute Compartment Syndrome/Vitt After The Covid-19 Vaccine, Thashali Anthony, Brittany Lyons

South Atlantic Division GME Research Day 2023

No abstract provided.

Disseminated Miliary Tuberculosis And Intestinal Tuberculosis Mimicking Ibd, Danny Tran, Kunaal Patel, Areeba Asfaq, Brittany Lyons

South Atlantic Division GME Research Day 2023

No abstract provided.

A Case Of Type 1 Cryoglobulinemia With Waldenstrom’S Macroglobulinemia/Lymphoplasmocytic Lymphoma And Dry Gangrene, Abhinav Rao, Diego Garrido, Fahim Syed, Kody Dhaliwal, Charles Holladay, Julia Saylors, Matthew Madden, Jason Clark

South Atlantic Division GME Research Day 2023

No abstract provided.

Effect Of High Sensitivity Troponin Assay On Hospital Resources And Emergency Department Discharges In Patients Presenting With Symptoms Concerning For Myocardial Infarction, Hans Koop, Keysha N. Gonzalez, Madalyn Nygren, Andrea Deneen, Jennifer Chapman

South Atlantic Division GME Research Day 2023

No abstract provided.

Case Report: Right Ventricular Free Wall Rupture Due To Displaced Aicd Lead, Abhinav Rao, Angeli Patel, Kunaal Patel, Craig Herrforth, Fahim Syed, Brittany Lyons, E Maci

South Atlantic Division GME Research Day 2023

No abstract provided.

Metformin Discontinuation In Acute Heart Failure, Curtis Wong, Erica Junqueira, Nayda Parisio-Poldiak, Nancy Crossley, Shantae Jenkins

South Atlantic Division GME Research Day 2023

No abstract provided.

Haemorrhoidal Artery Ligation Compared To Alternative Surgical Techniques For The Treatment Of Grade Ii-Iv Haemorrhoids: A Systematic Review, Dayna Van De Hoef, Aisling Hogan

Journal of Mind and Medical Sciences

Background. Haemorrhoidal disease is a common disorder in the Western World that commonly requires surgical treatment, but original open techniques were associated with significant complications and pain. Haemorrhoidal Arterial Ligation (HAL) has gained popularity for relatively low complication and postoperative pain rates. This review assesses clinical outcomes of this technique in comparison to alternative modern techniques. Methods. The literature was searched on MEDLINE, EMBASE, Google Scholar, and Cochrane Library databases. Search terms: dearterialization, artery ligation, mucopexy, recto-anal repair. Inclusion criteria: RCTs, original publications, grade II, III and/or grade IV haemorrhoids, elective procedures. Exclusion criteria: non-English, non-adults, published pre-2016. Results. 14 …

Impact Of Risk Factors On The Evolution Of Severe Acute Pancreatitis, Andra Maria Trotea, Raluca Grigorescu, Dragos Serban, Radu Palade, Simona Balasescu, Cristian Mihai Branescu, Daniel Radu, Corneliu Tudor, Tiberiu Alexandru Trotea

Journal of Mind and Medical Sciences

Introduction. Severe acute pancreatitis (SAP) is an acute inflammatory condition of the pancreas with increasing incidence and mortality rates in recent years. The aim of this study was to evaluate the impact of age, comorbidities, and different scoring systems on the complications and outcomes of SAP. Materials and Methods. A retrospective study was conducted on 161 patients diagnosed and treated for SAP at the Bucharest University Hospital in the intensive care unit (ICU), in the period 2014-2021. The impact of risk factors for the development of SAP, occurrence of complications (respiratory, cardiac, etc.), length of hospital stays and mortality was …

Rapid Escape Of New Sars-Cov-2 Omicron Variants From Ba2-Directed Antibody Responses, Aiste Dijokaite-Guraliuc, Raksha Das, Daming Zhou, Helen M Ginn, Chang Liu, Helen M E Duyvesteyn, Jiandong Huo, Rungtiwa Nutalai, Piyada Supasa, Muneeswaran Selvaraj, Thushan I De Silva, Megan Plowright, Thomas A H Newman, Hailey Hornsby, Alexander J Mentzer, Donal Skelly, Thomas G Ritter, Nigel Temperton, Paul Klenerman, Eleanor Barnes, Susanna J Dunachie, Optic Consortium, Cornelius Roemer, Thomas P Peacock, Neil G Paterson, Mark A Williams, David R Hall, Elizabeth E Fry, Juthathip Mongkolsapaya, Jingshan Ren, David I Stuart, Gavin R Screaton

Faculty, Staff and Student Publications

In November 2021, Omicron BA.1, containing a raft of new spike mutations, emerged and quickly spread globally. Intense selection pressure to escape the antibody response produced by vaccines or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection then led to a rapid succession of Omicron sub-lineages with waves of BA.2 and then BA.4/5 infection. Recently, many variants have emerged such as BQ.1 and XBB, which carry up to 8 additional receptor-binding domain (RBD) amino acid substitutions compared with BA.2. We describe a panel of 25 potent monoclonal antibodies (mAbs) generated from vaccinees suffering BA.2 breakthrough infections. Epitope mapping shows potent …

A Rare Case Of Autopsy Proven Achromobacter Xylosoxidans Endocarditis Involving Tricuspid Valve: A Case Report, Chaitra Janga, Mackenzie Kramer, Ifrah Naeem, Lucy Checchio, Md, Zahra Qamar

Abington Jefferson Health Papers

Infective endocarditis refers to infection of one or more valves of the heart, with Achromobacter xylosoxidans (A. xylosoxidans) being a rare cause. So far, 24 cases of A. xylosoxidans endocarditis were reported, with only one case describing tricuspid valvular involvement. Despite the rarity of A. xylosoxidans endocarditis, it is important for clinicians to be aware of atypical presentation and the high mortality associated with it. We present an autopsy-proven case of tricuspid valve endocarditis in the setting of A. xylosoxidans bacteremia in a 43-year-old female.

Advance Care Planning: An Evidence-Based Practice Project, Gabrielle Alanna Harvey

Evidence-Based Practice Project Reports

Advance care planning (ACP) is a topic that can be difficult for patients and providers to discuss due to lack of time, knowledge, communication skills, and discomfort surrounding the subject (Barkley et al., 2019; Hafid et al., 2021; Halpert et al., 2022; Marin, 2022). Delayed or absent ACP discussions may lead to nonbeneficial care, increased healthcare costs, end of life suffering and increased post-death family distress (Halpert et al., 2022; O’Hanlon et al., 2018). The purpose of this evidence-based practice (EBP) project was to increase the discussions and documentation regarding ACP in a family practice setting. The PICOT question guiding …

Increasing Colorectal Cancer Screening Uptake Among Hispanic/Latino Patients: A Quality Improvement Initiative, Erick Hernandez Campos, Elizabeth Morse, David Phillippi

DNP Projects

Background: In 2021, cancer (CRC) screening rates for Latino men (42%) and women (47.5%) remain well below the Health People 2020 target (70.5%). Extensive documentation of barriers for screening include language, insurance status, and other sociocultural barriers which contribute to delays in diagnosis and/or diagnosis at advanced stages of the disease, and worse health outcomes. Latinos need culturally and linguistically appropriate health promotion interventions aimed to increase CRC screening rates with any modality (FIT, Cologuard, or Colonoscopy).

Methods: The Donabedian Structure-Process-Outcome (S-P-O) Model for quality improvement was used to develop and target a provider-driven, language-concordant communication interventions for …

Redox And Nucleophilic Reactions Of Naphthoquinones With Small Thiols And Their Effects On Oxidization Of H2s To Inorganic And Organic Hydropolysulfides And Thiosulfate, Kenneth R Olson, Kasey J Clear, Yan Gao, Zhilin Ma, Nathaniel M Cieplik, Alyssa R Fiume, Dominic J Gaziano, Stephen M Kasko, Jennifer Luu, Ella Pfaff, Anthony Travlos, Cecilia Velander, Katherine J Wilson, Elizabeth D Edwards, Karl D Straub, Gang Wu

Faculty, Staff and Student Publications

Naphthoquinone (1,4-NQ) and its derivatives (NQs, juglone, plumbagin, 2-methoxy-1,4-NQ, and menadione) have a variety of therapeutic applications, many of which are attributed to redox cycling and the production of reactive oxygen species (ROS). We previously demonstrated that NQs also oxidize hydrogen sulfide (H2S) to reactive sulfur species (RSS), potentially conveying identical benefits. Here we use RSS-specific fluorophores, mass spectroscopy, EPR and UV-Vis spectrometry, and oxygen-sensitive optodes to examine the effects of thiols and thiol-NQ adducts on H2S-NQ reactions. In the presence of glutathione (GSH) and cysteine (Cys), 1,4-NQ oxidizes H2S to both inorganic and organic hydroper-/hydropolysulfides (R2Sn, R=H, Cys, GSH; …

Loss-Of-Function Variants In Mycbp2 Cause Neurobehavioural Phenotypes And Corpus Callosum Defects, Lama Alabdi, Muriel Desbois, Domniţa-Valeria Rusnac, Raashda A Sulaiman, Jill A Rosenfeld, Seema Lalani, David R Murdock, Lindsay C Burrage, Ping Yee Billie Au, Shelley Towner, William G Wilson, Lawrence Wong, Theresa Brunet, Gertrud Strobl-Wildemann, Jennifer E Burton, George Hoganson, Kirsty Mcwalter, Amber Begtrup, Yuri A Zarate, Elyse L Christensen, Karla J Opperman, Andrew C Giles, Rana Helaby, Artur Kania, Ning Zheng, Brock Grill, Fowzan S Alkuraya

Faculty, Staff and Student Publications

The corpus callosum is a bundle of axon fibres that connects the two hemispheres of the brain. Neurodevelopmental disorders that feature dysgenesis of the corpus callosum as a core phenotype offer a valuable window into pathology derived from abnormal axon development. Here, we describe a cohort of eight patients with a neurodevelopmental disorder characterized by a range of deficits including corpus callosum abnormalities, developmental delay, intellectual disability, epilepsy and autistic features. Each patient harboured a distinct de novo variant in MYCBP2, a gene encoding an atypical really interesting new gene (RING) ubiquitin ligase and signalling hub with evolutionarily conserved functions …