Internal Medicine Commons^™

The Role Of Heart Rate Variability In The Management Of Inflammatory Bowel Disease: A Scoping Review, Zarif A. Ladak, Krisha Patel, Dylan Bagley, Jeffery Powers

Rowan-Virtua Research Day

Complications associated with Inflammatory Bowel Disease (IBD) have an unclear pathophysiology. Heart Rate Variability (HRV) is a potent modality for monitoring autonomic nervous system function and may give insight into the timing of flares and complication development. Existing literature suggests a link between IBD complications and inflammation as well as inflammation and HRV. However, research directly exploring the relationship between HRV and IBD complications is limited. This review aims to examine the state of the science as it pertains to the relationship between HRV and IBD complications highlighting current knowledge gaps to guide future research. A search was conducted using …

Clinical Outcomes For Patients With Ventilator-Associated Pneumonia In Octogenarians, Nonagenarians, And Centenarians: A Population-Based Study, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Syed, Olga Sarah, Abdallah Hussein

Rowan-Virtua Research Day

We sought to examine the national inpatient sample data-base to describe in-hospital outcomes among patients over seventy who acquire ventilator-associated pneumonia after being on the ventilator for over 48 hours.

The Presence Of Cardiac Arrhythmias Impacts Hospitalized Patients With Celiac Disease, Rahul Patel, Tirth Patel, Darshan Patel, Trinava Roy, Sachin Prasad, Paul Gill, Rafail Beshai, Joshua Soliman, Brian Blair, C. Jonathan Foster

Rowan-Virtua Research Day

Background

Celiac disease has links to inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and sarcoidosis. The latter 3 also have cardiovascular manifestations associated with them. However, there are limited studies on the in-hospital outcomes of Celiac disease with cardiac manifestations. Therefore, the aim of this study was to evaluate the hospital outcomes of Celiac disease with concomitant arrhythmias.

Methods

Patients aged 18 years with Celiac disease and arrhythmias (atrial fibrillation, atrial flutter, ventricular tachycardia, and supraventricular tachycardia) versus Celiac Disease alone were identified from the US Nationwide Inpatient Sample (NIS), from the years 2019-2020. ICD 10 codes were utilized. Multivariate …

Case Report: When Confusion Signals A Crisis: Rethinking The Diagnosis Of Meningitis In Geriatric Sepsis, Asma Zahid

Rowan-Virtua Research Day

We report the case of an 88-year-old female who presented with altered mental status, initially suspected to have urosepsis but ultimately diagnosed with streptococcal meningitis. The patient had a history of lethargy and anorexia over the past few days and was found to have sepsis. Despite initial focus on urosepsis, blood cultures revealed Streptococcus, and cerebrospinal fluid analysis confirmed bacterial meningitis. This case highlights the potential for meningitis to be overlooked in elderly patients with suspected sepsis, underscoring the importance of broad diagnostic considerations and early intervention. This case highlights the importance of considering meningitis in elderly patients presenting with …

Rectosigmoid Intussusception Due To A Nonmalignant Etiology: An Extremely Rare Cause Of Acute Lower Gastrointestinal Bleeding In An Elderly Patient, Kashif Ali, Samra Sohail, Grecia Dominguez Rivera, Valeska Balderas

School of Medicine Publications

An intussusception at the rectosigmoid junction with acute gastrointestinal bleeding is exceedingly rare. We present a case of an 88-year-old man who presented in the emergency department with bilateral lower quadrant abdominal pain and frank rectal bleeding for 2 days. A computed tomography abdomen pelvis angiogram with contrast showed a target sign, and a flexible sigmoidoscopy showed congested bowel, ischemia, frank blood, and intussusception at the rectosigmoid junction. He underwent an exploratory laparotomy with the removal of the affected part. The pathology and the peritoneal fluid cytology results came out negative for dysplasia and malignancy.

Global Multi-Specialty Clinician Perspectives On The Implementation Of Alzheimer's Disease Blood Biomarkers, Joanne Rodda, Lindsey A. Kuchenbecker, Wyllians V. Borelli, Mari L. Demarco, Raphael M. Castilhos, Erin E. Cawston, Tinatin Chabrashvili, Melissa M. Budelier, Claudia Duran Aniotz, Chinedu Momoh

Brain and Mind Institute

Introduction: Clinicians' views on the clinical readiness of Alzheimer's disease (AD) blood biomarkers (BBMs) are not well understood.

Methods: The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment Biofluid-Based Biomarkers Professional Interest Area conducted a survey to elicit clinician opinions on AD BBM implementation, including contexts of use, assay selection, reporting, and result interpretation.

Results: Clinician respondents (n = 212) practiced in Europe (56%), North America (24%), the Caribbean and Central/South America (11%), and other continents (9%). Most respondents were medical doctors (80%) practicing in secondary or tertiary care (88%). For 56%, cerebrospinal fluid AD …

Clerkship Students' Use Of Clinical Reasoning Concepts After A Pre-Clinical Reasoning Course, Shradha A Kulkarni, Gurpreet Dhaliwal, Arianne Teherani, Denise M Connor

Faculty, Staff and Students Publications

Background: Many medical schools have incorporated clinical reasoning (CR) courses into their pre-clinical curricula to address the quality and safety issue of diagnostic error. It is unknown how students use concepts and practices from pre-clinical CR courses once in clerkships.

Objective: We sought to understand how students utilize CR concepts from a pre-clinical course during clerkships and to identify facilitators and barriers to the use of reasoning concepts.

Design: We used structured interviews to gain insight into medical students' experiences with CR concepts in clerkships.

Participants: We interviewed 16 students who had completed a pre-clinical CR course and subsequently completed …

Maternal Dysbiosis Produces Long-Lasting Behavioral Changes In Offspring, Jacob Hudobenko, Claudia M Di Gesù, Patrick R Mooz, Joseph Petrosino, Nagireddy Putluri, Bhanu P Ganesh, Kristen Rebeles, Frank W Blixt, Venugopal R Venna, Louise D Mccullough

Faculty, Staff and Student Publications

Advanced maternal age (AMA) is defined as a pregnancy in a woman older than 35 years of age. AMA increases the risk for both maternal and neonatal complications, including miscarriage and stillbirth. AMA has also been linked to neurodevelopmental and neuropsychiatric disorders in the offspring. Recent studies have found that age-associated compositional shifts in the gut microbiota contribute to altered microbial metabolism and enhanced inflammation in the host. We investigated the specific contribution of the maternal microbiome on pregnancy outcomes and offspring behavior by recolonizing young female mice with aged female microbiome prior to pregnancy. We discovered that pre-pregnancy colonization …

Hemophagocytic Lymphohistiocytosis Secondary To Disseminated Histoplasmosis., Mackenzie Caruthers, Shaili Kothari, Conor Kelly, Kim M Jordan, Branden Luna

Ambulatory and Primary Care Articles

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory condition resulting in erroneous activation of the immune system. Treatment is directed at the underlying pathology that prompts activation of the immune system and usually includes immunosuppressant therapy, including steroids, etoposide, or rituximab. However, the best treatment for patients with significant infection remains unclear. Few cases of HLH are associated with disseminated histoplasmosis, and there are no clear treatment guidelines in these cases. Due to the significant morbidity and mortality associated with HLH, further investigation is needed to identify the best treatment regimens.

Intracolonic Migration Of A Dislocated Acetabular Cup Prosthesis, Jack R. Lubka, Cyrus Tamboli, Philip Brunetti, Sarosh Tamboli, Alex Davis, Hamish Patel, Olugbenga Oyesanmi, Michael Strobbe, Shaival Thakore, Subhasis Misra, Jeffrey Mino

HCA Healthcare Journal of Medicine

Background

Acetabular cup migration is a rare complication of hip replacement surgery. If the acetabular socket of the ilium is weak, the prosthesis can erode or pass through it. There have been multiple reports of acetabular cup prosthesis migration to the colon, creating a coloarticular fistula between the hip joint and the cecum, sigmoid colon, or rectum. We report a rare presentation of a complete intracolonic migration of a prosthetic acetabular cup without creating a fistula.

Case Presentation

A 53-year-old female patient with a remote history of a total right hip replacement presented with abdominal pain and rectal bleeding. Computed …

Combating Physician Burnout And Fostering Wellness In Graduate Medical Education For Resident Physicians, Abdulaziz Mheir, Zohare Khan, Franklin Hernandez, Alaa Mohamed, Chandan Mitra

HCA Healthcare Journal of Medicine

Background

Over the last 2 decades, there has been a cultural shift in the graduate medical education (GME) space, focusing on an important facet: physician burnout. Burnout is defined as a combination of emotional exhaustion, depersonalization, and a lack of personal accomplishment. With increasing awareness of physician burnout, various wellness initiatives have begun to be implemented throughout training programs, and their results have been measured for effectiveness in reducing burnout rates. Due to the increasing rates of burnout emerging throughout GME programs, an initiative to evaluate our internal medicine (IM) residency on this matter was discussed with all residents at …

The Pernicious Right Should Pain, Julie Hwang, Md, Weiya Wysham, Md, Qian Leng, Md

Providence Portland Medical Center Internal Medicine 2025

Case Presentation: •Background: Non-traumatic diaphragmatic rupture is a rare condition, only 28 cases previously reported •73 year old female presented to PCP via virtual visit with 6 weeks of gradually worsening shoulder pain despite recent steroid injection. During the virtual visit, patient was found with dyspnea on exertion •PMHx: Recurrent ovarian cancer (granulosa cell type) •Surgical Hx: Hysterectomy with BSO, Lap partial hepatectomy with cauterization of right diaphragm metastasis 7 years prior to presentation •Vitals: normal, on RA •Exam: No R shoulder focal tenderness or limited movement •Labs: CBC - WBC 13.7 with absolute neutrophil count 11.2. CMP - normal. …

A Deadly Case Of Encephalopathy, Brenna Ostertag, Md, Gita D Gelfer, Andrea Roast

Providence Portland Medical Center Internal Medicine 2025

Introduction: Human prion disease are heterogenous groups of neurodegenerative disorders characterized by spongiform degeneration, astrogliosis, and neuronal loss in the central nervous system from misfolding and subsequent spread of the prion protein. This disease manifests rapidly and is often accompanied by visual and speech abnormalities, gait changes, and progressive encephalopathy. It is always fatal. Around 400 people are diagnosed with prion disease in the United States annually. Recent innovations in diagnostics using Real-Time Quaking Induced Conversion (RT-QuIC) has allowed for antemortem diagnosis of prion disease. Case Presentation: A 66-year-old male with a history of alcohol use disorder in remission and …

Clinicians’ Perspectives Concerning Treatment Initiation And Escalation Strategies For Digital Ulcers In Patients With Systemic Sclerosis, Giulia Campanaro, Giulia Bandini, Alessia Alunno, Stefano Di Donato, Begonya Alcacer-Pitarch, Ilaria Galetti, Barbara Ruaro, Silvia Bellando Randone, Alberto Moggi Pignone, Marco Matucci-Cerinic, Zsuzsanna H Mcmahan, Michael Hughes

Faculty, Staff and Student Publications

Objectives: Digital ulcers (DUs) are a major cause of pain and disability in systemic sclerosis (SSc) patients and remain a major treatment challenge. Our aim was to explore clinicians' perspectives towards treatment initiation and escalation, akin to a 'Treat to Target' (T2T) strategy.

Methods: SSc clinicians were invited to participate in an online survey.

Results: A total of 173 responses (75% rheumatologists) were obtained from 33 countries. When initiating a change in oral drug therapy for SSc-DUs, most (80%) respondents would consider adding new medication to existing treatment, and 50% would increase existing treatment dose. Time to assess the impact …

Myth Of The Pentad: Approaching Thrombotic Thrombocytopenic Purpura, Nidhi Patel, Md, Meera Jain, Natasha Edwin, Md

Providence Pharmacy PGY2 Program at Providence Medical Group 2025

Introduction: •Thrombotic Thrombocytopenic Purpura (TTP) is a thrombotic microangiopathy that leads to microthrombi formation. •Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count due to both increased platelet destruction and impaired platelet production. •Though both involving thrombocytopenia, prompt recognition of TTP is critical, as it has a high mortality rate if left untreated Case Presentation: •42-year-old female with rheumatoid arthritis (RA) who was started on tocilizumab three months prior to presentation •Platelet counts dropped to 30,000 (Figure 1). Her rheumatologist presumed that it was ITP and treated her with steroids •Presented to outside emergency …

Endocarditis Prophylaxis In Vulnerable Valve; Antibiotic Stewardship Or Suboptimal Care?, Zachary Taylor, Andrea Roast, Michael Layoun

Providence Portland Medical Center Internal Medicine 2025

Introduction Infective endocarditis (IE) is a relatively uncommon disease with an annual incidence of 5 per 100,000 people in the U.S.. Dental procedures are an exceptionally rare cause of IE. Amidst a global emphasis on antibiotic stewardship, U.S. and European guidelines only recommend antibiotic prophylaxis for dental procedures in high-risk groups. Having a bicuspid aortic valve (BAV) confers an 11-fold risk of endocarditis compared to the general public, and yet, is not classified as high-risk per AHA/IDSA guidelines. We present a patient with BAV who developed IE following a noninvasive dental procedure and review whether patients with BAV are under-classified …

One Pulse At A Time: Exploring Spinal Cord Stimulator Anatomy To Enhance M1 Medical Education, Matthew Tufts, Sruthi Shriram, Arush Rao, Ariel Banks, Ragad Almsaddi, Gabrielle Abdelmessih, Varna Taranikanti

Posters

No abstract provided.

Survey Of Medical Student Attitudes Regarding Uterine Transplant For Cisgender And Transgender Women, Oakland University William Beaumont School Of Medicine Medical School Medical Student, Deidre Hurse, Abram Brummett

Posters

No abstract provided.

How Long Must We Wait? A Review Of Adherence To Established Npo Guidelines, Ellen C. Bouaziai, Anthony S. Hernandez, Shashi Sahai, Kerry Peters Mychaliska

Conference Presentation Abstracts

Background: Patients undergoing a procedure with anesthesia are required to be nil per os (NPO) for a defined period to reduce the risk of aspiration of gastric contents. In 2017, the American Society of Anesthesiologists (ASA) published guidelines for preoperative fasting, which allow for consumption of a full meal 8 hours before a procedure; non-human milk, light meal, and infant formulas 6 hours prior; breastmilk 4 hours prior; and clear liquids 2 hours prior to procedure. It is well known that these NPO guidelines are inconsistently applied to pediatric patients. The purpose of this study is to determine the percentage …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.