Internal Medicine Commons^™

The Role Of Bandemia In Clinical Outcomes Of Critically Ill Septic Patients., Yerandi Gil, Grettel Gonzalez Garcia, Ambar Sekulis, Rafael Miret, Siddarth Kathuria, Mauricio Danckers, Daniel Heller

East Florida Division GME Research Day 2025

Rationale: Bandemia, defined as the presence of immature neutrophils in circulation, is commonly used as an early marker of systemic inflammation and infection. 1 However, its prognostic significance in sepsis, severe sepsis, and septic shock remains uncertain. 1-2 This study aimed to determine whether bandemia is associated with adverse clinical outcomes and increased intensive care unit (ICU) resource utilization among critically ill septic patients admitted from the emergency department (ED).

Methods: A retrospective analysis was conducted using de-identified data from the HCA Healthcare database. Adult patients (aged 18–90 years) admitted to the ICU at HCA Florida Aventura Hospital from the …

Turmeric, Red Yeast Paste, And Statins: A Recipe For Dili, John V. Nahas, Sinay Ceballos, Franklin Kasmin

East Florida Division GME Research Day 2025

Introduction Drug induced liver injury (DILI) contributes to a significant portion of acute liver injuries and acute liver failure in the west. DILI accounts for approximately 11% of acute liver failure cases in the US according to ACG. Insulting agents are numerous and well documented in the NIH LiverTox database, however the rarity and complexity of individual agents is a matter of ongoing study. Case Description/Methods A 52 year old man with PMH of HTN and HLD presents for a 2 week history of abdominal swelling, bilateral lower extremity swelling, decreased appetite, and positional shortness of breath. He endorses occasionally …

Pseudoachondroplasia, A Case Report (Preprint), Alec J. Pupo, Connor J. Stinson, Autumn Dye

Internal Medicine Resident Research

No abstract available.

Wearable-Derived Heart Rate Variability Reveals Autonomic Dysfunction In Schizophrenia (Preprint), Alec J. Pupo, Stephanie H. Felgoise

Internal Medicine Resident Research

Autonomic dysfunction has long been implicated in schizophrenia, yet objective physiological markers remain underutilized in psychiatric research. Heart rate variability (HRV), a noninvasive measure of autonomic regulation, is conventionally derived from short electrocardiographic recordings. In this study, we tested whether continuous, wearable-derived HRV can identify physiologic alterations in schizophrenia-spectrum disorders. Using the NIH All of Us database, we analyzed second-level Fitbit heart rate data from 26 individuals with schizophrenia-spectrum diagnoses and 26 matched controls. Frequency-domain analyses focused on ultra-low frequency (ULF), very low frequency (VLF), and truncated low frequency (tLF) bands, given sampling constraints. Schizophrenia participants showed significantly reduced power …

Elevated Neutrophil-To-Lymphocyte Ratios In Schizophrenia: Insights From A Precision Medicine Cohort (Preprint), Alec J. Pupo, Connor J. Stinson, Chinwendu Madukwe, Stephanie H. Felgoise

Internal Medicine Resident Research

Systemic inflammation has been increasingly implicated in the pathophysiology of schizophrenia. The neutrophil-to-lymphocyte ratio (NLR), a readily available marker of systemic inflammation, has not been thoroughly investigated in large, demographically-matched schizophrenia cohorts. Using data from the All of Us Research Program, we analyzed participants with schizophrenia (n = 396) matched to controls (n = 396) by sex, race, and age. NLR was calculated as the ratio of each participant’s median neutrophil count to median lymphocyte count across all available measurements, excluding extreme values (NLR > 7). Distribution normality was assessed using the Shapiro–Wilk test, and group differences were evaluated with the …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

Recombinant Factor Viia: New Insights Into The Mechanism Of Action Through Product Innovation, Miguel A Escobar, Maureane Hoffman, Giancarlo Castaman, Cedric Hermans, Johnny Mahlangu, Johannes Oldenburg, Charles L Percy, Mark T Reding, Amy D Shapiro, Steven W Pipe

Faculty, Staff and Student Publications

Management of bleeding in persons with hemophilia and inhibitors involves treatment with bypassing agents, including recombinant activated factor VII (rFVIIa). Two rFVIIa products are commercially approved for use in the United States and the European Union. Eptacog alfa and eptacog beta share the same amino acid sequence but differ in posttranslational modifications. Although rFVIIa has been used to manage bleeding in persons with hemophilia and inhibitors for over 30 years, its mechanisms of action is still being studied. In vitro and in vivo studies have suggested that rFVIIa could promote hemostasis by (1) increasing tissue factor-dependent activation of factor (F)X …

All-Cause And Exacerbation-Related Readmissions In Thrombotic Microangiopathy Requiring Plasmapheresis: A Population-Based Cohort Study, Alexander R. Thebert, Toru Yoshino, Sae X. Morita, Misa Ito, Ayman Qasrawi, Hirotaka Kato

Internal Medicine Faculty Publications

Objective: Thrombotic microangiopathy (TMA) is a serious condition characterized by microangiopathic hemolytic anemia and thrombocytopenia, with high exacerbation rates. This study examined all-cause and exacerbation-related readmission risks among patients hospitalized with TMA requiring plasmapheresis.

Materials and Methods: Secondary analysis of the 2020 Nationwide Readmission Database was conducted, including discharge data from non-federal hospitals in 31 U.S. states. Patients aged 18 years or older admitted non-electively with a primary or secondary diagnosis of TMA requiring plasmapheresis were included. Exacerbation-related readmission was defined as subsequent admission requiring plasmapheresis within 7 or 30 days after the original discharge. Multivariable logistic regression and Cox …

Clonal Hematopoiesis Of Indeterminate Potential And The Risk Of Cognitive Impairment In The Women’S Health Initiative Memory Study, Yasminka A. Jakubek, Aaron P. Smith, Xiaoyan I. Leng, Megan E. Hall, Daniel Ezzat, Yash Pershad, Jason M. Collins, Md Mesbah Uddin, David W. Fardo, Pradeep Natarajan, Alexander G. Bick, Jacob O. Kitzman, Michael C. Honigberg, Kathleen M. Hayden, Joann E. Manson, Siddhartha Jaiswal, Eric A. Whitsel, Alexander P. Reiner

Internal Medicine Faculty Publications

INTRODUCTION

Clonal hematopoiesis of indeterminate potential (CHIP) confers an increased risk of several chronic aging-related diseases. Paradoxically, CHIP was associated with lower risk of dementia in recent studies.

METHODS

We examined associations between baseline CHIP and incident mild cognitive impairment (MCI) and/or probable dementia in the Women's Health Initiative Memory Study. CHIP was detected using blood-based targeted sequencing. Cox proportional hazards models examined time to onset of cognitive impairment, adjusting for traditional risk factors.

RESULTS

Using a conventional variant allele fraction (VAF) threshold of 2%, CHIP was not associated with incident cognitive impairment. The presence of larger CHIP clone (VAF …

Dual Biologic Therapy Induces Remission In Refractory Crohn’S Disease With Vedolizumab And Ustekinumab, Syed Adeel Hassan, Courtney Perry, Patrick Carey, Durham Colohan, Mohamed Gebril Eltaher, Nabila Dawoud, Mahmoud Elkammar, Waqas Rasheed, Casie Mayne, Amy Stuffelbeam, Deborah R. Auer Flomenhoft, Terrence A. Barrett

Internal Medicine Faculty Publications

Background

Despite advancements in the therapeutic armamentarium for Crohn’s disease (CD), biologic and small molecule monotherapies are associated with sub-optimal response and remission rates. Utilizing dual biologic therapy (DBT) holds the potential to increase efficacy in the treatment of refractory or partially responsive CD. Evidence pertaining to this strategy remains limited. Methods

We retrospectively examined refractory CD patients treated with a combination of ustekinumab and vedolizumab. Outcomes to DBT at week (wk) 52 were compared to monotherapy. The primary outcome constituted corticosteroid-free remission. Secondary outcomes included adverse events, infections, hospitalizations, surgeries, treatment persistence, and disease clearance. Results

Sixteen of 21 …

Unintentional Lead Dislodgement In Twiddler’S Syndrome, Howard Tan, Ashok Chaudhary, Nishant Nerella, Suman Pasupuleti

West Florida Division GME Research Day 2025

No abstract provided.

Development Of Intra-Hospital Ceftriaxone Resistance Of Serratia Marcescens Endocarditis, Mahyar Doraji, Michael Denney, Adeel Malik, Praveen Chekka, Nishant K. Nerella

West Florida Division GME Research Day 2025

No abstract provided.

Metastatic Cardiac Tumor: New Onset Cardiac Tamponade And Atrial Fibrillation, Maheen N. Mirza, Aixa M. Rivera Rodriguez, Antonio J. Santiago Rodriguez, Adeel Malik, Matthew Vincent Tavares

West Florida Division GME Research Day 2025

No abstract provided.

Pancytopenia, A Rare Case Associated With Influenza A, Aida Sarita Gonzalez, Ajith Vivek, Gabriela Salazar, Joseph Maslak

West Florida Division GME Research Day 2025

No abstract provided.

A Case Report: Cardiac Tamponade Secondary To Myelofibrosis Induced Extramedullary Hematopoiesis In Pericardium, Jaafar A. Hamdan, Mustafa Tahir, Ahmed Taha, Chrissy Sharma, Amrita Randhawa

West Florida Division GME Research Day 2025

No abstract provided.

Enhancing Patient Safety Through Simulated Safety Event Analysis (Ssea) In Graduate Medical Education, Mustafa Tahir, Anthony Furiato, Salman Muddassir, Olu Oyesanmi

West Florida Division GME Research Day 2025

No abstract provided.

Hemoptysis In A Previously Healthy Hispanic Male: A Case Of Anca Vasculitis Diagnosis, Muhammad Anzar Ullah, Angel Pacheco-Rueda, Marwa Hegagi

West Florida Division GME Research Day 2025

No abstract provided.

Early Management Of Kodamaea Ohmeri Infection In A Diabetic Patient With Recurrent Otitis Externa: A Case Report, Madison Groom, Linette Diaz, Ryan Fernandez, Jose Vasquez

West Florida Division GME Research Day 2025

No abstract provided.

Interaction Between Dapsone And Warfarin Causes Supratherapeutic Inr, Farhan Hiya, Omar Jureyda, Zachary Harwood, Fernando Lugo, Andrew Niclosi

West Florida Division GME Research Day 2025

No abstract provided.

Bilateral Spontaneous Pneumothorax In Suspected Pulmonary Lymphangioleiomyomatosis (Lam), Fernando Lugo-Hernandez, Madison Groom, Muhammad Anzar Ullah, Muhammad Zain Abideen, Ahmad Hayat, Nadia Eid

West Florida Division GME Research Day 2025

No abstract provided.