Internal Medicine Commons^™

Severe Transvalvular And Paravalvular Aortic Regurgitation As Late Tavr Failure Successfully Treated With Percutaneous Therapy, Ashley Armstrong, Luca Halalau, Ivan Hanson

Conference Presentation Abstracts

BACKGROUND - Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis. With improving long-term survival, late prosthetic valve–related complications are increasingly recognized. CASE SUMMARY - We report a 74-year-old man who presented eight years after TAVR with progressive dyspnea, orthopnea, and bilateral lower extremity edema, identified to be acute decompensated heart failure with a new diastolic murmur. Transthoracic echocardiography demonstrated severe aortic regurgitation. Subsequent transesophageal echocardiography identified concomitant severe paravalvular and severe transvalvular regurgitation of the bioprosthetic valve. Invasive hemodynamic assessment revealed acute volume overload with markedly elevated filling pressures, secondary pulmonary hypertension, and right ventricular …

Social Correlates Of Trauma And Posttraumatic Stress Disorder: The Importance Of Context, Lukoye Atwoli, Linnet Ongeri

Internal Medicine, East Africa

Understanding trauma and posttraumatic stress disorder (PTSD) requires a contextual perspective that considers historical legacies, social environments, and cultural realities. This paper draws on empirical evidence from Kenya and Uganda to demonstrate the limitations of applying trauma frameworks developed in high-income countries to African contexts. Findings from the Orphaned and Separated Children’s Assessment Related to Their Health and Well-Being (OSCAR) study challenge assumptions about care environments. The study reveals higher PTSD rates among orphans in family-based settings compared to institutional care, and highlights the protective roles of religion and social support. The Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAP-Psychosis) study provides …

Optimizing Antibiotic Strategies With A Clinical Pathway Approach: Enhanced Initiation And De-Escalation In Community-Acquired Pneumonia, Ahmad Behzadpour

HCA Healthcare Journal of Medicine

Background

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization, mortality, and health care expenditure worldwide. Inappropriate use of broad-spectrum antibiotics contributes to antimicrobial resistance, adverse drug events, and increased costs. Antibiotic stewardship and standardized clinical pathways are key strategies to improve prescribing practices.

Methods

This quality improvement (QI) initiative was conducted at a 240-bed tertiary care teaching hospital from January 2023 through January 2025. A CAP-specific digital clinical pathway was developed using Curbside Health® and integrated into the electronic health record (EHR), accessible through a structured order set to support real-time clinical decision-making. The intervention included provider education and …

Eosinophilic Fasciitis Masquerading As Myositis: A Diagnostic Challenge, Jennifer L. Wong, Do, Elizabeth S. Ballner, Do, Mary Elizabeth Swift-Taylor

Books, Presentations, Posters, Etc.

Introduction: Eosinophilic fasciitis (EF), or Shulman’s disease, is a rare disorder of unknown etiology and poorly understood pathogenesis. It is characterized by fibroblast activation and interleukin-driven eosinophilia. Early clinical features include limb or trunk erythema, non-pitting edema, and progressive fascial thickening, often producing an “orange peel” appearance. Eosinophilia is a prominent laboratory finding in the early phase, but diagnosis often requires a full-thickness skin-to-muscle biopsy. Systemic corticosteroids are first-line therapy, with methotrexate as the steroid -sparing agent for refractory disease. We present a unique and diagnostically challenging case of EF confirmed by histopathology. Case Presentation: A 56-year-old man presented with …

Targeting Oxidative Stress In Cadasil: Case Insights And Therapeutic Approaches, Maria Meshreky, Richard Weinberger, Giana Johnson, Andrew Abraham, Jacob Rosendale

The Journal of Integrated Primary Care

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare hereditary small-vessel disease caused by NOTCH3 mutations, leading to recurrent ischemic strokes, cognitive decline, and early-onset dementia. Oxidative stress has been implicated in the pathophysiology of small-vessel cerebrovascular disease, but therapeutic strategies targeting oxidative injury remain limited. We present a 40-year-old female with recurrent ischemic strokes involving the right and left middle cerebral arteries, persistent hypercoagulability of unknown etiology, and no identifiable inherited or acquired thrombophilia. Despite well-controlled blood pressure and standard medical management, the patient remains at high risk for cerebrovascular injury. An extensive review of …

Bilateral Intracranial Subdural Hematoma Following Epidural Anesthesia, Eric B. Cox, Adaeza Onuoha

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

From Hard Hat To Headache: Cryptococcal Empyema And Meningitis In A Newly Diagnosed Hiv-Positive Construction Worker, Sebastian Echegaray, Collin Vargas, Vy Ngo

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Fatal Ochrobactrum Anthropi Bacteremia Following Intravenous Stem Cell Therapy In Immunocompetent Patient, Daler Kudratov, Wendy Martinez, Jonathan Barnett

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Coexisting Systemic Lupus Erythematosus And Acquired Thrombotic Thrombocytopenic Purpura In A Clinically Stable Patient With Class V Lupus Nephritis, Anabel Al Abdallah, Nimmy Joy, Rodrigo Alfaro

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Mme (Mini Medical Education): A Preliminary Study Of A Targeted Curriculum To Improve Resident Knowledge And Clinical Confidence, Andrea Francis, Andres Vivar, Paul Mathew

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

A Case Of Secondary Hemophagocytic Lymphohistiocytosis, Nafis Deen, Sarita Thanedar, Aaron De La Cruz

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Trends And Demographic Disparities In Septicemia-Associated Cardiac Arrest Mortality In The United States, 1999–2023, Muhammad Owais, Maham Mehfooz, Hamza Nazir, Preeti Advani, Roha Riaz, Khanij Arya, Javeria Nawaz, Syed Hadi Raza Rizvi, Murtaza Aslam, Usman Nazeer, Jairo Melo, Bravein Amalakuhan

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Recurrent Ventricular Tachycardia In Young Hcm Patient With Icd, Michael Rollins, Garza, Laura Preece

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Type 2 Diabetes Mellitus And Early Peg Tube Complications, Eric E. Romero Rodriguez, Adrian Reta, Angelo Manuel Piazza, Kuljot Bansi

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Structural Degeneration Of The Neoaortic Valve Leading To Pseudoaneurysm And Neurologic Complications Post-Ross Procedure, Cassandra Millan, Sarita Thanedar, Chandra Kunavarapu

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

The Future Of Right-Sided Endocarditis?: A Case Report Of Tricuspid Valve Endocarditis Treated With Angiovac And Review Of Current Literature, Saad Masud, Gongkai Liu, Hayyan Yousuf, Bravein Amalakuhan

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Severe Gastritis Mimics Acute Coronary Syndrome With Elevated Cardiac Enzymes, Michael Rollins, Laura Preece, Micheline Tantchou

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Welch Allyn Panoptic Fundoscopic Training For Internal Medicine Residents, Vinh Ngo, Huy Vuong, Oscar Garcia

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Rare Clinical Presentation Of Primary Cutaneous Diffuse Large B-Cell Lymphoma (Pcdlbcl), Germinal Center B-Cell Subtype (Gcb), Confined To The Scalp, Anabel Al Abdallah, Angelo Piazza Ortiz, Joshua Rodriguez, Juan Herrada

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

A Rare Complication Of Leukemic Retinopathy Secondary To Chronic Myeloid Leukemia In Blast Phase, Waleed S. Malik, Vinh Ngo, Kuljot Bansi

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.