Residents & Medical Students Poster Presentations - 72nd Fall ASA
We want to sincerely thank all of our residents, students, and faculty for participating in the 72nd Annual Meeting & Scientific Assembly Resident & Medical Student Poster Presentations.
We realize how much dedicated work and time you have spent to make these the best they can be. Thank you!
The posters are listed below in alphabetical order by title. If you need to enlarge a section when viewing the poster, utilize the zoom button on the PDF viewer.
- Haley Mathews (UNMC, M3)
Patients who are obese are more likely to develop colorectal cancer than normal-weight individuals. Body mass index (BMI) is significantly associated with increased mortality due to colon cancer. However, the trend in BMI for patients presenting for screening colonoscopy is unknown at this time. This study assesses weight trajectories of patients electing to undergo routine colonoscopies.
A review of patients presenting for routine colonoscopy to family medicine faculty was conducted. Demographic data and BMI were recorded. Patients were categorized into the following five BMI categories: normal, 18.5–24.9 kg/m2; overweight, 25–29.9 kg/m2; class I obesity, 30–34.9 kg/m2; class II obesity, 35–39.9 kg/m2; and class III obesity, ≥ 40 kg/ m2.
The average BMI of patients (n=3,045) presenting for colonoscopy for was 30.24 kg/m2. The distribution of patients into five classes indicated 214 (7%) are categorized as class III obese, 404 (13%) class II obese, 753 (25%) class I obese, 1098 (36%) overweight, 568 (19%) normal weight, and 8 (3%) underweight. This trend appears to be stable over the past seven years.
The incidence of obesity in our study group was higher than the average population of the state of Nebraska, where 34.1% of the population was estimated to be obese. Our findings would indicate that the trends in body weight in our patient population have not changed since 2012. Our findings suggest an unmet need for obesity intervention and education of patients, who potentially are increased risk of colon cancer mortality.
- Joshua Samec (CUMC, M4)
Leflunomide is a common disease modifying anti-rheumatic drug (DMARD) for treatment of inflammatory arthritis. This is a category X drug per the FDA and once a patient decides to attempt conception, a washout of the drug must be completed. This washout process is commonly done with the bile acid sequestrant, cholestyramine. This clinical case demonstrates that colestipol, another bile acid sequestrant, was successfully used as an alternative to cholestyramine. Many patients have reported that the powder of cholestyramine mixed with water in order to ingest the medication has an unsavory taste that is difficult to consume. By using colestipol instead, a patient would be ingesting pills while achieving the increased elimination of leflunomide. There are currently no case reports of colestipol being used for leflunomide washout. This clinical case report shows that it can be effective for this use and may be a better tolerated alternative.
- Connor O'Neill Dee (CUMC, M4)
26-year-old male was brought to the emergency department after being found unresponsive and hypothermic (32.1C), in a creek. Vitals on admission included BP of 171/74, HR of 59, and 99% oxygen saturation on mechanical ventilation. Physical exam was remarkable for weak peripheral pulses and several abrasions on his body. Laboratory testing was significant for leukocytosis, elevated anion gap metabolic acidosis, lactic acidosis, hypokalemia, acute kidney injury, elevated creatinine kinase, acute liver injury and hyperglycemia. The patient was transferred to the ICU and given IV fluids, antibiotics and continued warming. The patient’s condition improved within the next 24 hours and he was subsequently extubated. Further investigation into his laboratory abnormalities revealed that his AKI and elevated CK were secondary to rhabdomyolysis, and lactic acidosis and acute liver failure were secondary to hypoperfusion. The patient’s leukocytosis improved throughout the course of his hospital stay and antibiotics were discontinued. His hyperglycemia (Blood glucose 314) resolved as his temperature normalized without the use of insulin or other oral hyperglycemic agents. Diabetic workup was negative (HgB A1C 5.4) and the patient had no known diabetes or other medical history, allowing us to conclude that his hyperglycemia was caused by hypothermia. Once conscious, the patient was able to provide more history and disclosed that he had attempted suicide via drowning. He denied any ingestion prior to his attempt which was confirmed with laboratory workup. Psychiatry was consulted and the patient was evaluated and treated at an inpatient psychiatry facility once medically stable.
Identifying the Roles of Medical Providers in Addressing Barriers to HPV Vaccination Rates in Rural Nebraskan Clinics: A Community Initiative
- Abby Laudi (CUMC, 2022)
- Amelia Simmons (CUMC, 2022)
Although the vaccination rates in Nebraska among adolescent girls and boys are both above the national average (Office of Disease Prevention and Health Promotion, 2017), there is still room for improvement, particularly among the early adolescent population of 9-11-year-olds. Additionally, there is a disparity in childhood vaccination rates in Nebraska when comparing pediatric patients with Medicaid versus private insurance (Varman et. al, 2018); Medicaid patients to date have shown higher vaccination rates than privately insured patients. The current disparity in vaccination rates in Nebraska may also be due to the abundance of rural communities with limited access to health information by a qualified medical professional. Our cohort prospective study will first examine medical providers’ baseline attitudes and approaches of HPV vaccination in privately insured clinics in rural areas of Nebraska. Subsequently, the study will implement educational interventions in rural NE clinics who have had no prior partnerships or other projects such as this to increase rates for pediatric patients 9-15-years-old. Our educational outreach program at the selected 10-13 CHI clinics will serve as these rural clinics’ first efforts to selectively work toward improving HPV vaccination rates.
Impact of Delirium on Mortality in Patients Hospitalized for Heart Failure: A National Inpatient Sample Study
- Charlotte Ritchie (CUMC, M2)
Heart Failure (HF) is one of the leading causes of hospitalization in the United States accounting for ≈ 800,000 hospital discharges and $11 billion annually. Delirium occurs in 30-80% of elderly hospitalized patients. Given the advancing age of the HF population, we hypothesized that rates of delirium in HF hospitalizations are increasing and that delirium is associated with adverse outcomes in HF hospitalizations. We queried the 2001-2014 Nationwide Inpatient Sample to identify hospitalizations that included a primary discharge diagnosis of HF (ICD-9-CM: 428.xx) stratified by presence or absence of delirium (ICD-9-CM: 239.0, 290.41, 293.0, 293.1, 348.31). The delirium trend was evaluated using orthogonal polynomial contrasts, whereas differences between delirium and non-delirium for in-hospital mortality, length of stay (LOS), and hospital costs were evaluated using propensity-score matched cohorts. Major predictors of delirium included advanced age, Caucasian race, underlying dementia or psychiatric diagnoses, higher Elixhauser Comorbidity Index, renal failure, cardiogenic shock, and coronary artery bypass surgery. In the propensity-score matched analysis of 76,411 hospitalization with delirium compared to 76,612 without delirium, in-hospital mortality (odds ratio: 1.67, 95% CI: 1.51-1.77), LOS (rate ratio [RR]: 1.47, 95% CI: 1.45-1.51), and hospital costs (RR: 1.44, 95% CI: 1.41-1.48) were all statistically higher in the presence of delirium (all p < 0.001). In patients hospitalized with HF, delirium is an independent predictor of increased in-hospital mortality, longer LOS, and excess hospital costs despite adjustment for baseline characteristics. Whether interventions targeting prevention and treatment of delirium will mitigate this excess risk requires evaluation in future studies.
- Anna Gerst (CUMC, M2)
- Tej Murthy (CUMC)
PTSD is a major public health problem associated with significant disability, suboptimal treatment response and relapses. We report a case series of veterans with PTSD successfully treated with adjunctive minocycline. Studies have shown that chronic stress associated with PTSD may be related to chronic inflammation, observed through increased levels of pro-inflammatory markers. Minocycline is a broad-spectrum tetracycline antibiotic with anti-inflammatory and neuroprotective properties. In an animal model of PTSD, decreased cytokine levels were found in those treated with minocycline compared to controls. We reviewed medical records of patients who participated in a 12-week study evaluating the efficacy of minocycline in treating PTSD. All patients decreased their Clinician-Administered PTSD Scale for DSM-5 scores (CAPS-5) by the end of the study. C-reactive protein levels decreased or remained the same, and the results of other inflammatory markers such as IL-6 and TNF-a warrant further exploration. Adjunctive minocycline was not associated with any serious adverse events or laboratory abnormalities. With no data yet published on the efficacy of minocycline treatment in veterans with PTSD, these findings could be expanded on in a larger clinical trial.
- Peter Mitchell Martin, DO (UNMC, 2021)
This case details the initial presentation, exam, and treatment of a 42-year-old male with lower extremity pain and swelling that occurred with running and fast walking. Although he had a broad differential, he was diagnosed with chronic exertional compartment syndrome (CECS), with swelling from bilateral fascial hernias. CECS is reversible, exercise induced ischemia, at predictable levels of exercise, secondary to noncompliant osseofascial compartments. Lower extremity fascial hernias may present with or without CECS symptoms and cause significant distress for patients due to the pain and associated swelling with activity. There are numerous cases supporting use of botulinum toxin injections for CECS, but little evidence to date for its use in fascial hernias alone. This case was important as the use of Botox injections effectively treated his fascial hernias to reduce the size and severity of such. This then sparks the question if compartment testing and botulinum toxin treatment should be considered for all fascial hernias, including those without CECS symptoms, which could be a game-changer for this condition. In addition to PT and gait retraining, this offers an alternate approach to fasciotomy for these patients.
- Elliott Baker (CUMC, M4)
Post-partum psychosis (PPP) is a rare but devastating complication following pregnancy. It is usually observed in women that already have been diagnosed with a mood disorder, most often bipolar disorder. Screening for current mental health issues, history of psychiatric treatment, and family history of mental issues is paramount during pregnancy in order to accurately gage problems during the post-partum period. Positive screening necessitates education and monitoring in the weeks following childbirth. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not define PPP as a unique disorder, but rather classifies patients with PPP based on a primary mood disorder with an additional specifier of “peripartum” if the onset of illness occurs within the first four weeks of delivery. A 29 y.o. female with history of depression, anxiety, substance abuse, and two prior psychiatric admissions was admitted with paranoia, auditory/visual hallucinations, psychomotor retardation, and low mood. Contributing factors leading to admission included discontinuation of psychiatric medications prior to the death of her 6-month-old child. The patient required inpatient treatment for 20 days that included the use of second-generation antipsychotics, SSRIs, and benzodiazepines. This case provides an example of why the DSM-5 definition of PPP may not be inclusive enough and lead to missed cases of PPP due to lack of screening and monitoring in the post-partum period. Additional monitoring may have been able to prevent this episode of PPP or limit the severity of her psychotic symptoms.
- John Price, MD (LMEP, 2023)
A 40-year-old woman presents to the trauma bay after being mauled by a tiger. She was emergently transported to the local tertiary community hospital for stabilization and treatment. She suffered from 33 different lacerations of multiple puncture wounds across her chest, full thickness lacerations to her left and posterior neck, left posterior scalp, and left arm. Vitals were stable and GCS 15. She was able to move all extremities with some weakness to her LUE and right sided facial droop with ptosis. She was subsequently intubated for distress, potential airway decompensation, and possible carotid artery injury. CT imaging illustrated a stable spinous process fractures at C5 and C6, non-displaced fractures of the left transverse process at C7 and T1, extensive subcutaneous emphysema within the inferior neck, superior right chest, and left clavicular region, as well as, air within the cervical canal and extrinsic to the thecal sac. MRI suggested ligamentous strain in the posterior longitudinal ligament at the C2-3 level, small amount of paraspinal hemorrhage on the left C2-3, within the interspinous ligaments C3-7 and marked edema/hemorrhage within the trunks and divisions of the left brachial plexus highly suspicious for brachial plexus injury. ENT and neurosurgeon diagnosed right facial palsy and began dexamethasone treatment. ID physician tailored antibiotics to vancomycin for human skin flora and ampicillin/sulbactam for Pasteurella multocida from the tiger. She was to switch to doxycycline, amoxicillin/clavulanate, and wound care after discharge. She was transferred for reconstructive surgery for the brachial plexus injury, electromyography, and electroneuronography testing.