Internal Medicine Commons^™

Increasing Hpv Vaccination Rates In Residents' Primary Care Clinics, Normonique Dyer, Do, Amman Bhasin, Md, Abdul Ekiyoyo, Md, Umma Fatema, Md, Ilana Goldberg, Md, Chukwuemezie Mamanu, Md, Tamar Wolinsky, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• The human papillomavirus (HPV) vaccine was approved in 2014 for the prevention of anogenital, cervical, and oropharyngeal cancers in female and male adolescents up to 26 years of age^1,2
• Data compiled from multiple clinical trials performed between 2006 and 2018 sought to evaluate benefit from extending the vaccination age given the implications on improving quality of life, morbidity/mortality, and reducing overall healthcare costs for preventable diseases³
• Results showed that increasing the vaccination age up to 45 in both males and females could offer additional protections against high-risk oncogenic strains of the HPV virus3
• Current recommendations from the …

Procedural Realignment To Ensure Superb Hypertension Regulation: The Presher Study, Eleni Florakis, Md, Emily Khantses, Md, Bret Mccarty, Md, Jeffrey White, Md, Jason Ojeda, Md

Health Equity and Quality Improvement (HEQI) Summit

Problem Definition

Hypertension (HTN), defined by the American Heart Association as systolic blood pressure (SBP) over 130 mm Hg or diastolic blood pressure (DBP) over 80 mm Hg, remains a major health concern worldwideas it leads tocongestive heart failure, chronic kidney disease, and stroke. Blood pressure control is an important task for the primary care physician (PCP). However, adequate management remains suboptimal as nearly half of US adults have uncontrolled high blood pressure.

After reviewing selected patients in our primary care office and discussing with our stakeholders, we found that more than two-thirds (69%) of uncontrolled hypertensive patients from a …

Nsaids Role In Triggering Ibd Exacerbations; Reality Or Misunderstanding? A Systematic Review, Alec Swartz, Malitha Hettiarachchi

Conference Presentation Abstracts

Introduction: Initial studies seemed to show that NSAID use was associated with increased risk of IBD exacerbation. Supported by known role of COX-1/2 isoenzymes (specifically their prostaglandin [PG] products) in maintaining GI mucosal barrier and mediating inflammation Combination of early research findings and COX prostaglandin knowledge resulted in NSAID avoidance in IBD patients. Recent data seemingly contradicts prior research, and NSAID use is predicted to not play a role in IBD exacerbation Methods: We conducted a systematic review of the literature using PubMed and American Journal of Gastroenterology. Of the thousands of results, we narrowed our results to 4 recent …

Instent Thrombosis 20 Years After Stent Placement, Hussein Gaith, Najeebullah Bangash

Conference Presentation Abstracts

Stent thrombosis is not very common but it is a serious complication of percutaneous coronary intervention (PCI). Here in, we present a case of 55 years old who presented with acute chest pain, was found to have non ST elevation myocardial infarction due to a thrombotic occlusion of prior drug eluting stent placed 20 years ago. A 55 years old male presented to the emergency department with one day history of mid-chest retrosternal pain that started while playing hockey, associated with nausea and diaphoresis. On initial evaluation, vital signs were stable, and patient was afebrile. Cardiac examination was normal with …

A Rare Case Of Primary Sclerosing Pneumocytoma In A Healthy Female, Nitya Batra, Atulya Aman Khosla, Mohammad Muhsin Chisti, Vikash Jaiswal, Ashbita Pokharel

Conference Presentation Abstracts

Introduction: Pulmonary sclerosing pneumocytoma is a rare group of benign pulmonary neoplasms that usually affects older adults over 50 years of age . This neoplasm is more commonly seen in women, with female to male ratio of 5:1 and is predominantly seen in Asian ethnicities. These tumors originate from type II alveolar pneumocytes and are hence classified as adenoma under the 2021 World Health Organization (WHO) classification of tumors . They account for 3-5 percent of total benign lung tumors. One of the striking aspects of PSP is its clinical presentation, or rather the lack thereof in many cases. It …

Not-So-Typical Neurologic Effects: Unraveling Lithium Toxicity, Alexsandra Biel, Vickie Xin, Mujtaba Moazzam, Ramona Berghea

Conference Presentation Abstracts

Introduction: Lithium is one of the mainstay treatments for bipolar disorder. Given its narrow therapeutic window, acute and chronic toxicity can develop. Acute toxicity includes gastrointestinal and cardiac manifestations whereas chronic toxicity manifests as neurologic, thyroid, and renal dysfunction. The therapeutic range of lithium is 0.6 to 1.2 mmol/L. With chronic use, lithium may be toxic at 1.2 mmol/L or greater (1). Neurological toxicity includes tremors, hyperreflexia, nystagmus, ataxia, confusion, and even seizures, however, rare reports have shown peripheral neuropathy as a manifestation. Case: A 40-year-old male with a history of bipolar disorder complicated by lithium induced chronic kidney disease …

Aids Associated Cryptosporidial And Cmv Cholangiopathy, Nada Alsharif, Luxhman Gunaseelan, Mamoun Souleiman, Cecilia Big

Conference Presentation Abstracts

Introduction AIDS-associated cholangiopathy is a biliary tract condition seen in AIDS patients who are severely immunosuppressed, contributing to significant mortality in this population even in developed countries with access to HAART therapy. Case Description We discuss a thirty-six-year-old HIV positive male, non-compliant with HAART therapy, who presented with a one year history of weight loss, persistent fatigue and chronic diarrhea, which had worsened significantly in the past few weeks. Routine laboratory studies on presentation indicated elevated liver enzymes and alkaline phosphatase, a CD4 count of two, and a high HIV RNA count of 8.8 million. Imaging via CT abdomen and …

Streptococcus Pneumoniae Neck Abscess In A Patient With Waldenstrom's Macroglobulnemia, Tanya Amal, Paul Johnson, Ayesha Sharif

Conference Presentation Abstracts

Patients with Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma are at increased risk of sinopulmonary infections, pyelonephritis, and septicemia. The underlying etiology is assumed to be immune dysregulation. Patient's with Waldenstrom's macroglobulinemia have been shown to have somatic mutations in the "V". "D" and "J/H' segments of immunoglobulin gene. These mutations can affect affinity maturation and formation of memory B cells. Subsequently patient's with Waldenstrom's macroglobulinemia also have a suboptimal response to vaccination against Staphylococcus aureus, Streptococcus pneumoniae and Varicella, similar to those with multiple myeloma. Severe infections with gram positive organisms causing multifocal osteomyelitis, pleural effusion and sepsis have also been reported with …

Double Trouble Unmasked: Femoral Pseudoaneurysm And Deep Venous Thromboses Following Coronary Angiography, Mariam Jamil, Antoine Egbe, Khurram Arshad, Yazan Alamro, Essa Kadiri

Conference Presentation Abstracts

Iatrogenic pseudoaneurysms, while infrequent, represent a formidable complication of interventional cardiac catheterization, particularly in cases involving femoral artery access. This report details a unique case involving a 73-year-old male, receiving warfarin for a mechanical aortic valve, who developed a substantial right groin hematoma attributed to an iatrogenic pseudoaneurysm post-cardiac catheterization, subsequently resulting in concomitant deep venous thromboses (DVTs) in the right leg. The pathophysiology of DVTs following left heart catheterization typically involves the formation of a sizable pseudoaneurysm, exerting pressure on adjacent veins, leading to blood pooling and subsequent clot formation. Alternatively, the development of large hematomas in the thigh …

Effect Of Iv Iron-Carbohydrate Supplement On Morbidity And Mortality In Patients With Heart Failure, Yousef Alsmairat, Malitha Hettiarachchi

Conference Presentation Abstracts

Objectives: To study the effect of intravenous iron on morbidity and mortality in hospitalized patients with heart failure with reduced ejection fraction. The current European Society of Cardiology's 2021 heart failure guidelines recommend the consideration of Ferric Carboxymaltose in symptomatic patients with a left ventricular ejection fraction < 45%. Methods and results: We conducted a systematic review using articles published in PubMed and EMBASE databases. The number of records first identified was 263. The study only reviewed Randomized Clinical Trails (RCTs) published in the years 2013-2023 and removed all the duplicates and irrelevant articles using Rayyan.ai tool. The final number of qualified articles that met the study's inclusion criteria was 3, with a total of 2,279 participants. The inclusion criteria for the study included: Age > 18, and heart failure (HF) with left ventricular ejection fraction (LVEF) < 50%. The study showed that intravenous iron supplementation in patients with heart failure and iron deficiency has been proven to reduce the symptoms of heart failure, improve quality of life, increase exercise capacity and skeletal muscle strength. IV iron-carbohydrate therapy significantly reduced hospitalization for worsening heart failure, but did not significantly impact all-cause mortality, compared to control. Conclusion: IV iron-carbohydrate therapy significantly reduced hospitalization for worsening heart failure, but did not significantly impact all-cause mortality, compared to control. Based on the study review, we recommend IV iron therapy for patients with systolic dysfunction heart failure associated with iron deficiency anemia.

Hydralazine Associated Neutrophilic Dermatosis: A Unique Case Observing Dile, Anca Vasculitis, And Sweet Syndrome, Nicholas Olen, Jacob Horsley, Berk Celik, Joseph Skender, Shailesh Niroula

Conference Presentation Abstracts

Introduction: This case report highlights a 73-year-old male with biopsy-proven neutrophilic dermatosis with concern for Sweet Syndrome in the context of suspected hydralazine-induced systemic lupus erythematosus and autoimmune markers that initially pointed towards hydralazine-induced ANCA vasculitis. Case Presentation: The patient is a 73-year-old male with a past medical history significant for chronic kidney disease, urothelial cancer in 2021, renal cancer in 2013, and stage 1A left lung cancer. The patient additionally underwent workup for low white count and splenomegaly in months leading up to hospitalization, with bone marrow biopsy and workup negative for myelodysplastic syndrome or malignancy. Patient initially presented …

Uterine Leiomyoma: Rare Cause Of Pulmonary Embolism, Pawan Gyawali, Prekchha Jha, Sant K. Yadav, Justin Skrzynski

Conference Presentation Abstracts

Pulmonary embolism is a life-threatening condition that most commonly occurs due to the embolization of deep venous thrombus in the lower limbs, arising from a constellation of risk factors that affect the flow, stasis, or coagulability of blood. Stasis is an important mechanism and is the primary factor in venous obstruction and long-haul flights. We present a case of a young woman who experienced pulmonary embolism due to venous compression in the pelvis from a massive leiomyoma. A 30-year-old female presented to the emergency department with dyspnea and palpitations lasting for a duration of 2 days. She had a past …

Navigating Recurrent Acute In-Stent-Thrombosis: Insights From A Single Admission Case Study, Antoine Egbe Bessong Tabot, Mariam Jamil, Hussein Gaith, Wafa Ahmed, Mohammad Ali Mozaffari, John Rajiv, Essa Kadiri

Conference Presentation Abstracts

In-stent thrombosis (ISR) is one of the dreaded complications of percutaneous coronary angioplasty. Despite marked reductions in ISR since the transition from bare metal stents to drug-eluting stents, ISR still occurs at a rate of 1% -2 % per year. We present the case of a 64-year-old Caucasian male who was admitted for staged angioplasty after a left heart catheterization had shown he had significant stenosis to the LAD and mid ramus intermedius. He had DES placed to the mid-LAD and to the mid-ramus intermedius. Despite being placed on dual antiplatelet therapy after the stent placement, 6 hours later he …

From Collapse To Recovery: Thiamine Intervention In Cardiac Beriberi, Khurram Arshad, Zaid Mahameed, Rabia Latif, Ruaa Elteriefi, Yazan Alamro

Conference Presentation Abstracts

Introduction: Thiamine deficiency, historically known as Beriberi, poses diagnostic dilemmas due to its potential occurrence without overt malnutrition or alcohol dependence. This case report explores the intricate dynamics of cardiocirculatory collapse coupled with pericardial effusion, unveiling an underlying thiamine deficiency. Case Description: A 68-year-old male with a medical history of hypothyroidism, heart failure, and chronic mild pericardial effusion presented with worsening dyspnea, leg edema, and hypotension. The patient's physical evaluation disclosed notable findings, including marked obesity, distant heart sounds, an audible S4 sound, and swelling in the lower extremities. Laboratory results revealed chronic anemia. Brain natriuretic peptide (BNP) was mildly …

Aggressive Renal Cell Carcinoma In A Patient With A Rare Genetic Syndrome, Nidhi Navaratna, Nitya Batra, Mohammad Chisti

Conference Presentation Abstracts

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an exceedingly rare genetic disorder characterized by skin and uterine leiomyomas and an increased risk of renal cell cancer. HLRCC follows an autosomal dominant pattern and is due to inactivating germline and somatic mutations in the gene encoding the fumarate hydratase enzyme (FH) involved in the citric acid cycle. The rarity and wide phenotypic variation in the presentation of HLRCC complicates suspicion and testing for this syndrome. We describe the case of a young woman who presented with pathological fracture secondary to bone metastasis from renal cell carcinoma. The patient presented to …

Euglycemic Dka: Commonly Missed Diagnosis, Atulya A. Khosla, Pawan Gyawali, Twahida Khatoon

Conference Presentation Abstracts

No abstract provided.

Non-Immune Hemolytic Anemia In The Setting Of Alcohol-Associated Hepatitis: Zieve's Syndrome, Morgan Kiryakoza, Nazli Begum Ozturk, Justin Skrzynski

Conference Presentation Abstracts

Introduction: Zieve’s syndrome describes a triad of non-immune hemolytic anemia, jaundice, and transient hyperlipidemia found in patients with alcohol-use disorder/alcohol-associated liver disease. This case involves a 39-year-old female with suspected Zieve’s syndrome in the setting of severe alcohol-associated hepatitis. Case Description: A 39-year-old female with alcohol-use disorder presented to the emergency department with complaints of jaundice, lethargy, and confusion. On initial presentation, patient was anemic with a hemoglobin of 7.8 g/dL (12.1- 15.0 g/dL), ALP of 235 U/L (33-120 U/L), AST of 116 U/L (< 35 U/L), ALT of 41 (< 37 U/L) total bilirubin of 24.2 mg/dL (< 1.2mg/dL), direct bilirubin of >15 mg/dL (< 0.4mg/dL). Her blood alcohol level was negative. She was admitted due to concerns for alcohol-associated hepatitis. Her hospital course was complicated by frequent declines in hemoglobin requiring a total of six transfusions of packed red blood cells. No overt bleeding such as hematemesis or hematochezia was ever evident during these declines. Further hematologic workup revealed a normal glucose 6 phosphate dehydrogenase (G6PD), normal pyruvate kinase, elevated plasma hemoglobin of 150 mg/dL (< 30 mg/dL), decreased haptoglobin of < 8 mg/dL (40-250 mg/dL), and elevated lactate dehydrogenase (LDH) of 595 (100-240 U/L), elevated reticulocyte count of 213 bil/L (21-100 bil/L). Direct Coombs Test was negative. The combination of these labs illustrated a picture of non-immune hemolytic anemia. Patient’s course was further complicated by a persistent rise in her total bilirubin, eventually peaking at 30.6 mg/dL, and ascites which required paracentesis and fluid studies was consistent with spontaneous bacterial peritonitis (SBP). Given the presence of SBP, corticosteroid therapy was not initiated for alcohol-associated hepatitis. Lipid panel remained within normal limits on two separate occasions. Vitamin E level was < 2.5 mg/L (5.5 – 17.0 mg/L). During hospitalization, she tested positive for Influenza A H1N1, developed acute hypoxic respiratory failure, was intubated, and was transferred to the intensive care unit and later extubated. Her mental status during her hospital stay was frequently waxing and waning and never fully recovered. The patient was eventually discharged home with hospice and her hemoglobin levels remained stable after supportive blood transfusions during her stay. Discussion: Zieve’s syndrome is an underdiagnosed cause of anemia in patients with alcohol-associated liver disease. There are multiple proposed mechanisms to explain the pathophysiology behind the red cell lysis seen in this disorder. One leading hypothesis suggests the red cell membrane becomes unstable due to vitamin E deficiency leading to disordered pyruvate kinase. Importance of early recognition of this syndrome is essential as treatment revolves around strict abstinence from alcohol.

Moonlighting: A Pilot Project To Assess Impact Of Extracurricular Activities On Career Satisfaction And Quality-Of-Life In Graduate Medical Education, Charlotte O'Sullivan, David Lee, Karen Childers, Justine Nasr

Conference Presentation Abstracts

Background: Moonlighting is the delivery of healthcare outside of training programs in exchange for compensation. The Accreditation Council on Graduate Medical Education allows individual training programs to permit or restrict moonlighting, which leads to variation in prevalence and practice. Guidelines and regulations for moonlighting vary greatly across graduate medical education programs. Yet, limited research has been done to determine resident and fellow physician attitudes towards moonlighting and its impact on quality-of-life. Objective: This pilot study investigates how participating in moonlighting and extracurricular activities may impact resident and fellow physicians’ self-perceptions of quality-of-life and career satisfaction. Methods: 442 residents and fellow …

The Silent Michigan Epidemic: Unraveling Neurological Changes Posed By Recreational Nitrous Oxide Abuse, Tabssum Chauhan, Mariam Jamil, Nada Alsharif, Antoine Egbe Bessong Tabot, Ammara Aftab, Erin Frankowicz, Rajiv John

Conference Presentation Abstracts

Introduction Nitrous oxide (N2O), traditionally considered a benign, odorless gas with analgesic and anesthetic properties, has seen a rise in abuse among young individuals in the United States. This abuse can lead to clinically significant neurological symptoms, including peripheral neuropathy and subacute combined degeneration of the spinal cord due to functional B12 deficiency induced by N2O. This case series examines four patients with N20 toxicity, and the functional recovery observed during subsequent follow-up visits after appropriate management. We will explore their motivation for abusing N20, their sources of access, and why its use is on the rise. Cases Description: The …

Rare Case Of Hemorrhagic Pericardial Effusion Due To Coxsackie B Pericarditis, Nolan Shoukri, Hazem Alakhras, Kateryna Strubchevska, Steven Timmis

Conference Presentation Abstracts

Introduction Acute pericarditis is caused by inflammation of the pericardial sac. Amongst the vast number of potential causes, viruses tend to trigger pericarditis most frequently. Some of the more common viral causes are coxsackie A/B, echovirus, adenovirus, CMV, HSV, and HIV.1-3 Pericarditis often presents with signs and symptoms such as a friction rub, pain relieved with sitting up and leaning forward. ST segment elevations and PR segment depressions are seen on EKG. Laboratory tests showed increased inflammatory markers and WBC count. Pericardial effusion is a common complication and can be visualized on echocardiogram. In some cases, the pericardial effusion can …