Internal Medicine Commons^™

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.

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 …

Pituitary Cushing's Disease And Compression Fractures: A Case Presentation, Nora Mcheik, Ajaz Banka

Conference Presentation Abstracts

Introduction: Cushing's disease, arising from a pituitary macroadenoma, is marked by excessive cortisol production. Labs usually signify overproduction of adrenocorticotropic hormone (ACTH), leading to elevated cortisol levels. While cortisol is essential for various physiological functions, its excess can result in various symptoms and complications associated with Cushing's disease. Notably, individuals with this condition may experience an association with compression fractures, particularly in the vertebrae, due to weakened bones. Prolonged exposure to elevated cortisol levels contributes to the development of osteoporosis, characterized by weakened bone density, making fractures more likely. These compression fractures can manifest as localized or radiating back pain, …

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 …

Myxedema Coma-Induced Heart Failure With Reduced Ejection Fraction: Unraveling The Complex Interplay, Mohammad Ali Mozaffari, Batool Shukr, Hafsa Hassan, Khurram Arshad, Antoine Egbe Bessong Tabot, Mariam Jamil, Rajiv John, Adam Hafeez

Conference Presentation Abstracts

Introduction Myxedema coma is a rare condition with a high mortality rate. It poses the risk of cardiovascular complications, typically affects elderly females, and is often triggered by an underlying infection or systemic illness in the setting of preexisting severe hypothyroidism. Patients may exhibit multiorgan dysfunction with altered mentation ranging from disorientation and lethargy to obtundation and coma. Other physical exam findings may include dry scaly skin, non-pitting edema, delayed reflexes, bradycardia, and hypothermia. Prompt diagnosis and early treatment are crucial to reducing mortality rates associated with this severe condition. Case description A 74-year-old female with no known past medical …

Pleural Epithelioid Hemangioendothelioma: An Ultra Rare Etiology For Recurrent Pleural Effusion, Ali Khreisat, Paul Bozyk

Conference Presentation Abstracts

Introduction Epithelioid hemangioendothelioma (EHE) is an extremely rare sarcoma of vascular origin. EHE has an incidence of less than 0.1 per 100,000 patients per year. It can involve multiple organs; pleural involvement is relatively rare and under-reported in the medical literature. We present a unique case of pleural EHE presenting with recurrent pleural effusion, severe pleuritis, scarring, and trapped lung syndrome. Case presentation A 54-year-old Caucasian female was referred to the pulmonary clinic for two months of progressive dyspnea, fatigue, and right pleuritic chest pain. Initial chest x-ray showed a large right pleural effusion. Thoracentesis identified exudative lymphocyte predominant pleural …

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 …

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 …

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

Conference Presentation Abstracts

No abstract provided.

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 …

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.

Splenic Infarct Following Roux-En-Y Gastric Bypass Surgery, Khurram Arshad, Yazan Alamro, Rabia Latif, Zaid Mahameed, Omar Nasser Rahal, Rajiv John

Conference Presentation Abstracts

Introduction: Roux-en-Y gastric bypass (RYGB) is a standard surgical procedure used to treat morbid obesity. Although RYGB is generally considered safe, it's essential to remain vigilant in identifying and addressing rare complications such as splenic infarction. Splenic infarction is a primarily silent condition, and because many cases go undiagnosed, the exact incidence of the condition is obscure and likely underestimated. Similarly, the incidence and severity of these rare conditions in the postoperative period for bariatric surgeries are still unknown. Case presentation: A 31-year-old female with morbid obesity underwent RYGB six weeks before presentation with acute abdominal pain, nausea, and a …

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 …

Chronic Schizophrenia Presenting With Psychogenic Polydipsia Masking Stage Iv Uterine Adenocarcinoma, Dakota B. Pastore, Kamayel Jaludi, Angelo Sica

Rowan-Virtua Research Day

Background: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.

Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien …

Splenic Artery Aneurysm Masquerading As Chest Pain: A Case Report Of A Rare Clinical Presentation, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Splenic artery aneurysms most commonly present with vague epigastric or left upper quadrant abdominal pain that may radiate to the left shoulder. Chest pain associated with splenic artery aneurysm is an unusual phenomena. This case presents a rare occurrence of a splenic artery aneurysm originally presenting as atypical chest pain. Case Presentation: A 46 year old G3P2 AAF patient with family history of hypertension presented to the ER with pleuritic left chest pain, episodes of shortness of breath, and new onset hypertension. Chest x-ray and ECG were unremarkable. Pertinent labs included a hemoglobin of 10.6 and D-dimer of 4.10. …

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

Rowan-Virtua Research Day

According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

Relationship Between Gut Microbiota And Dementia, Saad Ahmed, Zack Harris, Russell David Levi

Rowan-Virtua Research Day

This paper explores the complex relationship between gut microbiota, dietary habits, and dementia, focusing particularly on Alzheimer's disease (AD). Growing evidence suggests a significant link between the composition of gut bacteria, dietary choices, and susceptibility to dementia. Notably, individuals with dementia demonstrate a noticeable reduction in gut bacteria diversity, highlighting the crucial role of a balanced microbiome in maintaining cognitive health. Conversely, dietary preferences characterized by excessive consumption of processed foods and sugars are associated with an increased risk of dementia, emphasizing the critical influence of diet on shaping gut microbiota and subsequent neurocognitive outcomes. Importantly, dietary interventions featuring a …