Internal Medicine Commons^™

Rx On The Rocks: Prescribing Solutions For Alcohol Use Disorder, Arisa Gonzalez, Laura Botero, Adlin Lawrence, Kenneth Jimenez, Eric Chen, Richard Henriquez, Shamol Williams

North Florida Division GME Research Day 2025

No abstract provided.

Streamlining Stroke Care: Optimizing In-House Stroke Alert Order Set Utilization, Drashti Desai, Joshua Shultz, Yu Ya Nway, Hasib Ibne-Rasa

North Florida Division GME Research Day 2025

No abstract provided.

Phentermine Induced Thrombocytopenia, Claudia Thornton, Jack Demirjian, Jason Pereira, Juan Nunez Rodriguez

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

A Vaping Nightmare: Sudden Death Provoked By Vaping In The Setting Of Pectus Excavatum, Anoop Gala, Nga Van, Grace Rustom, Danielle Ford, Phuc Nguyen

North Texas Research Forum 2025

Pectus excavatum (PE), characterized by an inward depression of the sternum, is the most common congenital chest wall abnormality. It has been rarely linked to cardiac abnormalities, such as arrhythmias and sudden cardiac arrest (SCA). In addition, emerging research suggests that vaping is a cardiovascular risk factor that has the potential to destabilize cardiac rhythm and promote arrhythmias. There is a lack of FDA oversight and long-term research on the effects of vaping. The rising popularity of vaping among youth, coupled with misconceptions about its safety, underscores the urgent need to understand the potential interactions vaping has in precipitating fatal …

Bradycardia In A Renal Transplant Patient Receiving Rabbit Antithymocyte Globulin, John Mathew, Victor Delprincipe, Seline Haci, Karthik Anand, Rangina Farhad

North Texas Research Forum 2025

Rabbit antithymocyte globulin (rATG) is widely used for induction and treatment of acute T-cell mediated rejection in renal transplant patients. Bradycardia is reported as a rare side effect of this medication (citation). With the increasing number of transplanted kidneys in today's world, there is greater need to understand the adverse effects of these drugs in transplant recipients.. Here we report a case of symptomatic bradycardia in a renal transplant patient receiving rATG for acute T-cell mediated rejection.

Streptococcus Intermedius In The Setting Of Adalimumab Use, Gerardo Martinez Arroyo, Amelia Mellor, Joseph Prokop, Oscar Garcia

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Exploring The Link Between Covid-19 And Transverse Myelitis: A Case Report, Sara Sanghera, Trivianne Franklin, Veeranna Vibhuti, Danielle Ford

North Texas Research Forum 2025

Transverse myelitis (TM) is a rare inflammatory syndrome of the spinal cord that is often attributed to immune-mediated responses which lead to demyelination and the resultant varying degrees of motor, sensory, and autonomic dysfunction. While COVID-19 virus itself is known to present with anosmia, ageusia and Guillian Barre syndrome, a few rare cases of COVID-virus related TM have been reported. This case presents a 61-year-old female experiencing bilateral lower extremity weakness with brisk to absent reflexes. Onset of the symptoms was of 3 days origin, and she was tested positive for COVID-19. Patient did not have upper extremity symptoms but …

Hypothyroidism Associated Hyponatremia, A Complicated Presentation, Gary Lee, Spencer Steinberg, Samiuallh Shahid, Evangelista Ezenduka, Edgardo Flores

North Texas Research Forum 2025

Introduction: Hypothyroidism is a well known text-book cause of euvolumic hyponatremia that is a rare occurrence in clinical practice in the absence of other potential etiologies of hyponatremia. We review a case of a 48 year old female presenting with profound generalized weakness found to have severe hyponatremia, later found to have severe hypothyroidism during admission. We review the potential mechanisms whereby hypothyroidism results in hyponatremia and whether or not hypothyroidism-induced hyponatremia truly exists and the current evidence supporting these views Case Presentation: 48 year old female with history of hypothyroidism, breast cancer post right lumpectomy and radiation presented for …

Has The Elimination Of Mandatory Buprenorphine X-Waiver Increased Presciptions Of This Medication Upon Discharge From The Hospital?, Kendall Moore, Robyn Meadows, Robyn Hoelle, Matthew Calestino

North Florida Division GME Research Day 2025

No abstract provided.

Adverse Bleeding Events In Patients Taking Verapamil With Apixaban Or Rivaroxaban, Heena Patel, Franklin Hernandez, Kathleen Mattingly, Seth Sukriti, Chandan Mitra

North Florida Division GME Research Day 2025

No abstract provided.

Association Of Glp-1 Receptor Agonist With Risk Of Hepatocellular Carcinoma, Joane Titus, Vinay Katukuri, Moheb Boktor, Ishak Mansi

North Florida Division GME Research Day 2025

No abstract provided.

Development Of A Continous Renal Replacement Therapy Protocol For A Midsize Community Hospital, Srinidhi Shyamkumar, Eric Riha, Crystal Ike, Rachel Wright, D Villareal, Justin Shanks, Damon Cao

Gulf Coast Division GME Research Day 2025

No abstract provided.

A Case Of Gastric Outlet Obstruction Secondary To A Gallstone, Mahesh Tummala, Adam Devine, Akash Tummala, Livasky Concepcion-Perez

East Florida Division GME Research Day 2025

Introduction: Bouveret syndrome is characterized by a gallstone passing through a bilioenteric fistula causing gastric outlet obstruction and represents 1-3% of gallstone obstructions. Fistualization occurs when chronic inflammation from the gallstone on the gallbladder wall leads to ischemia and perforates into the bowel. Over 60% of patients with cholelithiasis are asymptomatic. Biliary colic is the most common presentation in symptomatic patients. A biliary fistula occurs in 3-5% of cases and just 7-10% of these cases lead to gallstone ileus. The highest prevalence is among women of advanced age. Typical presentation is with general symptoms of nausea/vomiting and vague abdominal pain. …

Cocaine Induced Agranulocytosis And Neutropenia, Maria Gomez Alvarez, Ashish Govan, Raymond Larocque

East Florida Division GME Research Day 2025

Introduction: Cocaine use in the United states is seen in many cases within the hospital system. Typically, they present with tachycardia, hypertension, sweating, even heart attack. Due to the uncontrolled sale and distribution of drugs, patients can be exposed to other additives in drugs which can lead to unexpected complications. Cocaine laced with levamisole (an antiparasitic drug used in veterinary medicine) can lead to agranulocytosis and neutropenia. Cocaine being the second most used illegal drug following marijuana it may be much more common than we think. Millions of individuals use cocaine yearly and develop a heavy addiction with use of …

National Outcomes Of Pre-Emptive Tips In Patients With Acute-On-Chronic Liver Failure And Variceal Bleeding, Aya Akhras, Waseem Wahood, Azizullah Beran, Bisher Sawaf, Asad Ur Rahman, David Goldberg, Muhammed U. Shahid

East Florida Division GME Research Day 2025

Background

Pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS), defined as placement within 72 hours of initial endoscopic therapy for an active variceal bleed, has been proposed as a strategy to reduce rebleeding and improve survival in high-risk patients with cirrhosis. We evaluated outcomes of patients with acute-on-chronic liver failure (ACLF) who presented with variceal bleeding and underwent therapeutic endoscopy (EGD) with or without the addition of pre-emptive TIPS.

Methods

The Nationwide Readmissions Database (2010–2022) was queried for patients with ACLF using previously validated algorithms admitted with variceal upper GI bleeding who received endoscopic intervention. Patients were stratified into two groups: therapeutic …

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 …