Poster Day 2025: Abstracts: Clinical Research

Amanda Kettman, OMSIII, Tiffany Dang, OMSIII, Julia Kaufmann, OMSIII, Holly Michelle Brown, DO

To describe a rare case of acute ischemic stroke (AIS) during the third trimester of pregnancy successfully treated with tenecteplase (TNK) followed by mechanical thrombectomy.

Background:

AIS during pregnancy is uncommon, occurring in roughly 30 per 100,000 pregnancies. While thrombolytic therapy and mechanical thrombectomy are established standards of care in nonpregnant patients presenting within the therapeutic window, their use in pregnancy remains controversial. This uncertainty stems from limited available data and the lack of formalized treatment guidelines for this unique population.

Design/Methods:

A 40-year-old woman at 35 weeks gestation, with no medical or obstetric complications, presented with a sudden-onset headache, word-finding difficulty, and expressive aphasia beginning at 11:15 AM. On arrival, her blood pressure measured 188/85 mmHg. Neurologic examination showed preserved strength and cranial nerve function, with isolated expressive aphasia. Non-contrast CT ruled out hemorrhage. CT angiography demonstrated a proximal left middle cerebral artery (M2) occlusion, and CT perfusion confirmed a left frontoparietotemporal penumbra. After multidisciplinary discussion among neurology, neurointerventional, and obstetric teams—and shared decision-making with the patient and her spouse—intravenous TNK was administered. Blood pressure was managed with labetalol and nicardipine. She then underwent successful mechanical thrombectomy without complications.

Results:

The patient showed rapid improvement in language function following intervention and experienced no maternal, obstetric, or fetal complications. She remained stable throughout hospitalization and was later discharged in good condition.

Conclusion:

This case underscores the feasibility and safety of combining tenecteplase with mechanical thrombectomy for acute ischemic stroke in late pregnancy. A coordinated multidisciplinary approach facilitated timely decision-making and favorable outcomes for both mother and fetus. As the use of tenecteplase expands, further case data are essential to inform evidence-based guidelines for stroke management during pregnancy

Milan Regmi, MD; Syed S. Fatmi, MD; Roger Lin, MD; Arthur Kendig, MD; Mina M. Saba, MD, Om Prakash Bhatta, MD

Background:

Left atrial appendage occlusion (LAAO) is an alternative stroke prevention strategy for patients with atrial fibrillation and contraindications to oral anticoagulation. Pericardial effusion is a recognized complication that is potentially related to device compression. The relationship between the compression index and pericardial effusion remains incompletely understood with limited research.

Milan Regmi, MD; Sanjeev Bhandari, MD; Mina Saba, MD; Roger Lin, MD; Paarmit Chhabra, MD

Background:

The study aimed to investigate the relationship between triglyceride (TG)/high-density lipoprotein (HDL) cholesterol levels and the severity of coronary artery stenosis in patients with acute coronary syndrome.

Methods:

A total of 151 cases of acute coronary syndromes (ACS) that underwent coronary angiography were taken in the study. Clinical information, lipid profile with TG/HDL cholesterol ratio and vessel score, and lesion score from coronary angiography were obtained. Statistical analysis was undertaken using Statistical Package for the Social Sciences (SPSS) version 25.

Results:

The mean age of patients with ACS was 58.15±12.12 years, with maximum patients belonging to the age group 60-69 years; 66.9%were males and 33.1% were females, 25.2% of the patients with ACS were current smokers, 23.8% were ex-smoker and 51% were nonsmoker, 44.4% were hypertensive. Out of 151 patients with ACS, 11.92% with a mean TG/HDL ratio of 3.47 had no vessel involvement on CAG, 39.73% with a mean TG/HDL ratio of 3.71 had (Single Vessel Disease) SVD, 25.82% with a mean TG/HDL ratio of 5.90 had (Double Vessel Disease) DVD and 22.51% with mean TG/HDL ratio of 6.51 had Triple Vessel Disease (TVD). Out of 151 patients, 41.06% had a lesion score of 0-5 with a mean TG/HDL of 3.89, 48.34% had a lesion score of 6-10 with a mean TG/HDL ratio of 5.38, and 10.60% had a lesion score of 11-15 with mean TG/HDL ratio of 6.39. Among them, 9 patients had normal coronaries with a lesion score of 0. There was a statistically significant correlation between TG/HDL level and vessel score in ACS patients, r = 0.351, n = 151, p = <0.001. Similarly, the correlation between TG/HDL level and lesion score was also statistically significant, r = 0.253, n = 151, p = 0.002. The mean TG/HDL ratio was lower in patients with single vessel disease (SVD) compared to patients with double vessel disease (DVD) and triple vessel disease. However, there was no significant difference between mean TG/HDL ratio levels in patients with double and triple vessel disease (5.90 vs 6.51) and between no vessel involvement and single vessel involvement (3.47 vs 3.71), suggesting the TG/HDL ratio level can only predict the severity between single vessel disease and multivessel disease.

Conclusion:

Our study showed that an increased TG/HDL (3.71 vs 5.9/6.51) ratio is directly correlated with the severity of the coronary artery disease, especially differentiating between single-vessel disease and multivessel disease.

Milan Regmi, MD; Muhammad Qureshi, MD; Mina Saba, MD; Paarmit Chhabra, MD ; Roger Lin, MD; Syed S. Fatmi, MD

Background:

AFib with RVR is a frequent emergency presentation associated with increased morbidity, especially in patients with heart failure. Metoprolol and diltiazem are widely used for acute rate control, but their adverse effect profiles, particularly bradycardia and hypotension, may limit their use.

Methods:

This retrospective cohort study analyzed data from 739,418 patient encounters at a US community hospital between August 2024 and February 2025. Among 10,601 patients who had a diagnosis of atrial fibrillation, 3,412 were having RVR; among them, 1,613 received metoprolol and 1,799 received diltiazem intravenously. We evaluated incidences of bradycardia (heart rate <60 bpm), hypotension (systolic BP <90 mm Hg), and hospital length of stay (LOS) using chi-squared tests and two-sample t-tests.

Results:

Bradycardia occurred in 13.2% of metoprolol-treated patients versus 4.3% of those receiving diltiazem (p<0.001). Hypotension was observed in 12.5% and 10.2% of patients in the metoprolol and diltiazem groups, respectively (p=0.034). Overall, metoprolol-treated patients had a longer LOS (8 days) compared to diltiazem-treated patients (7 days) (p<0.001).

Conclusion:

Metoprolol and diltiazem are both effective in achieving rate control in atrial fibrillation with RVR. However, we found metoprolol was associated with a significantly higher incidence of bradycardia and hypotension and longer hospitalization. Diltiazem appears safer with fewer hemodynamic adverse effects and shorter hospital stays. Further prospective studies are warranted to verify these findings.

Hira Javaid MD, Mishal Basit MBBS, Mahnoor Farooq Raja MBBS, Asma Mahmood MD, Syeda Hooria Imtiaz MD, Osama Kunwer Naveed MD

Background:

Diabetic ketoacidosis (DKA), historically linked to type 1 diabetes, is increasingly affecting individuals with type 2 diabetes, with rising mortality highlighting urgent public health concerns. This study examines temporal, demographic, and regional trends in DKA-related deaths among non-insulin-dependent diabetes mellitus (NIDDM) patients in the U.S. from 1999–2023.

Methods:

Death certificate data for individuals aged >15 were extracted from the CDC Wonder database. Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) per 1,000,000 population were calculated. Joinpoint regression assessed trend changes and annual percentage changes (APC).

Results:

From 1999–2023, 14,608 DKA and NIDDM-related deaths were recorded. AAMR remained stable from 1999–2010, increased from 1.38 (2011) to 2.91 (2018; APC 11.5%), followed by a marked rise to 5.51 in 2021 (APC 24.5%), and then decline to 4.07 by 2023 (APC -14.4%). COVID-19 corresponded with elevated mortality across all demographic groups. Males experienced higher APC (13.7%) than females (11.2%) between 2021–2023. Regionally, the Midwest exhibited the highest AAMR (2.35), the Northeast the lowest (1.05), and state-level rates ranged from 0.73 (Connecticut) to 3.54 (Kentucky). Mortality was highest among individuals aged 65–84 years and lowest in those 15–34 years.

Conclusion:

DKA-related mortality in NIDDM has escalated over two decades, peaking during the COVID-19 pandemic, with marked sex, age, and regional disparities. These findings highlight the urgent need for targeted prevention and management strategies in high-risk populations to mitigate preventable deaths.

Kayla Leiber OMS-III, Priya Pohani OMS-IV, Dr. Wayne Parker PharmD

Background:

Excoriation disorder, also called skin picking disorder, is a body focused repetitive behavior characterized by recurrent, compulsive picking that leads to tissue damage, infection risk, and psychosocial impairment. Although it is classified within the obsessive compulsive and related disorders in the DSM 5, growing evidence suggests that it shares behavioral and neurobiological mechanisms with neurodevelopmental conditions, particularly autism spectrum disorder (ASD). Individuals with autism may engage in repetitive or self injurious behaviors, including skin picking, as a result of atypical sensory processing, difficulties with emotional regulation, or self stimulation. Research has identified both central and peripheral contributors, including altered reward processing, dysfunction of cortico striato thalamo cortical circuitry, and abnormalities in the epidermal barrier that increase sensory discomfort. This overlap creates diagnostic uncertainty and unique treatment challenges across psychiatry, neurology, and behavioral medicine.

Methods:

A scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews (PRISMA ScR) checklist. PubMed and Google Scholar were searched for English language studies published between 2015 and 2025 using the terms “autism,” “excoriation,” “skin picking,” “dermatillomania,” and “self injury.” After duplicate removal and screening, 19 articles met inclusion criteria. Foundational literature published before 2015 was included selectively for historical and conceptual context. Data were extracted across behavioral, neurological, sensory, and psychosocial domains to identify shared mechanisms and clinical implications for comorbidity.

Results:

Findings support a bidirectional relationship between excoriation disorder and ASD. Shared characteristics include sensory hypersensitivity, emotional regulation difficulties, and impaired inhibitory control within cortico striatal networks. Peripheral sensory abnormalities such as reduced skin hydration, elevated surface pH, and increased inflammatory signaling through interleukin 17A may heighten pruritus and tactile dysregulation, reinforcing repetitive picking behaviors. Diagnostic overshadowing is common, as skin picking in autistic individuals is often misattributed to autism itself, delaying intervention. Conversely, persistent or treatment resistant excoriation may raise suspicion for undiagnosed autism. Evidence for treatment efficacy remains limited. Cognitive behavioral therapy and habit reversal training remain first line but often require adaptations for autistic individuals, such as visual supports, structured routines, caregiver participation, and sensory regulation strategies. Pharmacologic treatments including selective serotonin reuptake inhibitors, risperidone, and N acetylcysteine have shown mixed outcomes. Adjunctive measures such as barrier repair emollients, hydrocolloid dressings, and internet based behavioral programs show additional benefit, supporting a multimodal and sensory informed approach to care.

Conclusion:

Excoriation disorder and autism spectrum disorder share overlapping behavioral and neurobiological mechanisms linked through sensory dysregulation, impaired inhibition, and abnormal reward processing. Recognizing this overlap can reduce diagnostic overshadowing, improve early identification, and promote individualized interventions. Integrating sensory focused dermatologic management, behavioral modification, and neuropsychiatric care offers a comprehensive framework for treatment. Future research should explore shared neurobiological and genetic pathways, evaluate combined behavioral and pharmacologic interventions, and assess the role of epidermal barrier optimization in reducing repetitive self injurious behaviors. Enhanced clinician education and interdisciplinary collaboration are essential to improve recognition, reduce morbidity, and guide precision based management for this under recognized comorbidity.

Kayla Leiber OMS-III, Priya Pohani OMS-IV, Dr. Wayne Parker PharmD

Background:

The increasing prevalence of synthetic drugs and chemical adulterants has introduced new clinical challenges, as novel dermatologic manifestations are increasingly linked to substance use. Xylazine, a veterinary sedative commonly found as a fentanyl adulterant, has been associated with progressive, nonhealing necrotic ulcers that may appear at sites distant from injection areas. Levamisole, a cocaine adulterant, produces a characteristic vasculopathic pattern that includes retiform purpura, necrosis, and vasculitis. Methamphetamine and other synthetic stimulants are frequently associated with excoriations, chemical burns, and chronic secondary infections. These dermatologic findings are clinically significant because they often serve as visible indicators of systemic toxicity and ongoing substance exposure.

Methods:

A narrative review of recent literature was conducted using PubMed and Google Scholar. Search terms included “synthetic drugs,” “adulterants,” “xylazine,” “levamisole,” “methamphetamine,” and “cutaneous manifestations.” Studies and case reports published between 2015 and 2025 that described dermatologic findings associated with synthetic or adulterated drug use were included. The data were synthesized to identify patterns of cutaneous presentation, pathophysiologic mechanisms, and implications for clinical management and harm reduction.

Results:

Distinct dermatologic patterns were identified across substances. Xylazine exposure produced necrotic ulcerations with violaceous borders and poor healing, often independent of injection sites. Levamisole induced retiform purpura and leukocytoclastic vasculitis, reflecting immune mediated vascular injury. Methamphetamine use was linked to excoriations and contact chemical burns due to repetitive scratching, skin picking, and chemical irritation. In many cases, skin findings provided critical diagnostic clues for systemic complications including infection, vasculopathy, or multi organ toxicity. Recognition remains limited, as patients may delay presentation due to stigma or fear of disclosure. Early dermatologic evaluation allows for accurate diagnosis, wound care, and linkage to addiction and harm reduction services.

Conclusion:

Synthetic drugs and adulterants are producing an expanding spectrum of dermatologic disease with significant clinical and public health implications. Recognition of these cutaneous signs can facilitate timely diagnosis, guide appropriate management, and reduce morbidity. Dermatologic assessment serves not only a diagnostic role but also a point of engagement for harm reduction, infection prevention, and treatment referral. As the synthetic drug supply continues to evolve, multidisciplinary research and clinician education are essential to identify new patterns of injury and integrate public health strategies into clinical dermatology.

Siddharth Sharma, MD; Abinaya Sivakumar, MD; Mina Saba, MD; Gaurab K.C., MD; Srusti Ghetiya, MD, Kevin Meek, DO, Sagar Madan, MD; Yoseph Herpo, MD

Introduction:

Sellar and suprasellar masses are rare but clinically significant due to their proximity to critical neurovascular and endocrine structures. They can present variably, making prompt diagnosis and multidisciplinary management essential.

Case Presentation:

A middle-aged woman presented with progressive nausea, vomiting, headache, visual changes, anorexia, and unintentional 30-pound weight loss in one month. She reported marijuana use and had a distant history of similar self-resolving symptoms. CT and MRI revealed a large heterogeneous sellar/suprasellar mass (1.8 x 2.3 x 2.8 cm) abutting the optic chiasm, with nonenhancing edema in bilateral thalami and basal ganglia. Neurosurgical resection was performed; postoperative diabetes insipidus developed, managed with DDAVP and fluids, but complicated by severe hypernatremia. Neurological decline and imaging showed infarct, cerebral edema, and abscess formation, requiring emergent craniectomy and evacuation. Cultures revealed polymicrobial infection. Intensive care included ventilatory, endocrine, nutritional, and electrolyte management. Despite two neurosurgeries and broad-spectrum antibiotics, refractory shock and malignant cerebral edema led to withdrawal of care after family consensus. The patient died on hospital day 12.

Discussion:

This case exemplifies the complex interplay of neurological, endocrine, infectious, and critical care challenges in managing large sellar/suprasellar masses with catastrophic postoperative complications. It highlights the need for rapid multidisciplinary assessment, vigilant management of endocrine crises and sepsis, and continuous communication with patient families in cases with poor prognosis. Team-based, coordinated care is critical throughout the diagnosis, intervention, and postoperative course.

Ahmed H. Al Sharie, MD; Rania Al-Bataineh, MD; Mahmoud Ahmad, MD; Anastasiia Merkulova, MD; Milan Regmi, MD

Background:

Recent advances in cancer biology have elucidated the importance of tumor microenvironment assessment which contributes to optimizing immunotherapy strategies, identifying potential biomarkers and predicting patients’ outcomes. Herein, we investigate the molecular drivers of immune suppression in high-grade ccRCC through a multi-omics approach.

Methods:

To identify possible immune pathway aberrations in such cohort, the Cancer Genome Atlas Program (TCGA) was utilized to obtain distinct sets of patients characterized by an extreme tumor differentiation (grade 1, n = 14) and poorly differentiated ones (grade 4, n = 78) according to the Fuhrman’s grading system. Gene set enrichment analysis (GSEA) was carried to detect enriched transcripts belonging to immune modulatory pathways within the gene ontology (GO) sets. The prognostic utility of selected genes was tested using survival curves augmented with multivariate Cox regression analysis. Precalculated immune cells infiltration scores were obtained using Tumor Immune Estimation Resource (TIMER 2.0 using CIBERSORT or xCell algorithms).

Results:

GSEA revealed a significant enrichment of the tumor escape from immune attack (normalized enrichment score = 1.53, P = .023) and IL-10 positive production (normalized enrichment score = 2.10, P <.001). gene sets withing the GO biological processes. Although IL10 expression did not exhibit any prognostic potential in ccRCC, a total of four IL-10 regulatory genes out of 22 enriched ones possessed an independent prognostic value after eliminating confounding clinicopathological variables. The prognostic genes include IL20RB (HR: 2.090, 95% CI: 1.295-3.373, P = .003), IL6 (HR: 2.572, 95% CI: 1.628-4.062, P = < .001), TLR9 (HR: 1.666, 95% CI: 1.072-2.588, P = .023), and BCL3 (HR: 1.841, 95% CI:1.159-2.924, P = .010). High-grade ccRCC tumors exhibited a significantly higher immune score (P = .0024) and microenvironment score (P = .0052) in comparison to low-grade tumors. On the other hand, the latter possessing a higher stromal score (P = .0313). Poorly differentiated ccRCC is associated with significant regulatory T-cells (P = .0172) and cancer-associated fibroblasts (P = .0155) infiltrations.

Conclusion:

High-grade ccRCC utilizes several mechanisms to escape immune attack including the up regulation of IL-10 controlling genes. The therapeutic and prognostic potential of such findings as well as the exact molecular mechanisms involved required further evaluation.

Kevin Lillis, MPH, BSN, RN, CNRN, OMS-III; Sanyukta Wagle, MS, BS, OMS - III; Walter Johnson, BS, OMS-II; Abigail Hunter, BS, OMS-II; James Martin, MS, BS, OMS-II; Alexandra Smith, BS, OMS-II; Emmalee Stephens, BS, OMS-II

Background:

In the United States, Stroke is the fifth leading cause of death and continues to be a leading cause of serious, long-term disability. Subarachnoid hemorrhage (SAH) is a particularly devastating subset of stroke that has a high burden of mortality and morbidity. Among those who survive, up to 30% experience permanent impairment. Many studies have looked at the association between socioeconomic status and morbidity in stroke patients, but much less is understood regarding SAH specifically. 

Methods:

We performed a literature review on PubMed using the terms Subarachnoid Hemorrhage, SAH, aneurysmal subarachnoid hemorrhage, and/or aSAH, and socioeconomic factors, socioeconomic status, SES, and/or income, education, health disparity, health inequality, or social determinants of health. Our search retrieved 1,618 results and after applying inclusion and exclusion criteria, 21 articles remained. Of the 21 remaining articles, 7 addressed hospital discharge and clinical outcomes. 

Results:

Among the 7 remaining articles, low SES, gender, race/ethnicity, smoking, insurance status, and receiving care at a teaching hospital were associated with disparities in recovery, quality of life, outcomes, number of comorbidities, and/or non-routine discharge.

Conclusion:

SAH outcomes are greatly impacted by social determinants of health such as low SES, gender, race/ethnicity, smoking, insurance status, and hospital teaching status. More studies need to be conducted to fully understand these associations and how we can further mitigate their negative effects on SAH outcomes.

Khedari, Mohamad. MD Bhatti, Samid. MD Patel, Saawan. MD

Abstract:

Valacyclovir is a widely used antiviral agent, generally considered safe, but it can cause neurotoxicity in patients with impaired renal function. Early recognition is essential to prevent severe neurological complications.