Internal Medicine Commons^™

Barriers To Adherence To Standard Of Care In Appalachia: A Qualitative Assessment In Gastrointestinal Cancers, Brittany Levy, Jennifer T. Castle, Roshmita Bardhan, Mark Dignan, Avinash S. Bhakta

Internal Medicine Faculty Publications

Purpose: Appalachian Kentucky, a 32-county region in the eastern part of the state, has elevated colon cancer mortality rates. While recommended as the standard of care, access to adjuvant chemotherapy treatment is limited in this region due to scarce health services and significant social and geographical barriers. The purpose of this investigation was to improve understanding of barriers that cancer patients residing in rural areas not served directly by tertiary medical systems must overcome in completing adjuvant therapy.

Methods: Participants were recruited from two medical centers: A tertiary care NCI designated Cancer Center and a regional hospital. Participants underwent a …

Circulating Molecular Drivers Of Bone Remodeling In Pancreatitis, Rachel L. Hill, Dhiraj Yadav, Phil A. Hart, David C. Whitcomb, Kristen J. Mcquerry, Kelsey N. Karnik, Kimberly M. Stello, Darwin L. Conwell, Madhumathi Rao

Internal Medicine Faculty Publications

INTRODUCTION: 

Pancreatitis-associated osteopathy is a clinically significant but mechanistically underexplored complication of pancreatic disease. We aimed to characterize stage-specific alterations in bone remodeling biomarkers across the spectrum of disease: recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP).

METHODS: 

In a cross-sectional analysis of North American Pancreatitis Study 2 participants, we measured serum mechanistic (sclerostin, dickkopf-1, receptor activator of nuclear factor κβ ligand, and osteoprotegerin), hormonal (fibroblast growth factor 23, insulin, and leptin), and modulatory (osteopontin, oncostatin, and osteoactivin) markers in controls (n = 30), RAP (n = 40), and CP (n = 40) using a multiplex assay. Group differences were …

Digital Health Interventions For Colorectal Cancer Screening Uptake: A Scoping Review, Sujin Kim, Andrew J. Whipkey, Jihye Bae, Avinash S. Bhakta

Internal Medicine Faculty Publications

Digital health interventions (DHIs) are increasingly employed to improve colorectal cancer (CRC) screening uptake, yet comprehensive syntheses of their effectiveness across diverse contexts remain scarce. This scoping review examines how individual, contextual, technological, and timing-related factors shape CRC screening outcomes in DHI-based trials. Following PRISMA-ScR guidelines, we conducted a systematic search of PubMed, Google Scholar, and ClinicalTrials.gov from March 1 to April 20, 2024, identifying 4,523 records through databases and an additional 2,039 through backward citation tracking. After deduplication and screening, 51 studies were included and charted using the PICOT (Population, Intervention, Comparison, Outcome, and Timing) framework. Included studies spanned …

Early-Onset Bevacizumab-Associated Knee Osteonecrosis In A Young Adult With Astrocytoma, Chandra L. Kakarala, Nicole A. Lisek, Clyde Coleman, John L. Villano, Katherine L. Copely, Patricia A. Santos

Internal Medicine Faculty Publications

We describe a rare case of knee osteonecrosis in a 22-year-old man with astrocytoma and neurofibromatosis type 1 after short-term treatment with bevacizumab and corticosteroids. Magnetic resonance imaging (MRI) identified infarctions and osteonecrosis of the distal femur and proximal tibia. Osteonecrosis associated with bevacizumab is typically limited to the jaw; this case highlights the potential for earlier, extra-jaw involvement. Clinicians should maintain a high index of suspicion for osteonecrosis in patients on vascular endothelial growth factor inhibitors, especially with concurrent steroid use, and consider prompt MRI in the evaluation of unexplained joint pain.

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.

Pill Impaction Unmasking Eosinophilic Esophagitis And Acute Ulcerative Herpes Simplex Esophagitis In An Immunocompetent Patient, Fernando Lugo-Hernandez, Omar Jureyda, Bhavtosh Dedania

West Florida Division GME Research Day 2025

No abstract provided.