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  The Impact of Physician Vaccine Recommendation on the Pregnant Chaldean Population

  Sylvia Kashat and Nelia Afonso

  Publication Date: 5-2025

  • A variety of factors contribute to modern vaccine hesitancy, including balancing the risks and benefits of vaccination and delayed negative outcomes. • An important population to consider are pregnant women and their fetus, as the immune compromised state may increase the burden of disease. • It is the duty of healthcare providers to properly educate mothers on the effectiveness of vaccination on vaccinetreatable and vaccine-preventable diseases. • A subgroup that has been impacted by this greatly in the metro-Detroit area is the Chaldean community. • With the Michigan Chaldean population being greater than 160,000, and most of the community members residing in the Detroit area, this research is pertinent in serving a large portion of the Michigan population.1 • The Chaldean population is seen as a minority in overall research data collection, making this study pertinent to minority health.2 • The lack of health care and social services prevents Chaldean women from obtaining the educational guidance they need from a physician during pregnancy.3

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  An Analysis on Gender and Race for Burnout Among Michigan Internists

  Elan Pszenica, Jookta Basu, Esha Ahmed, and Hugo Davila

  Publication Date: 5-2025

  Burnout among physicians, particularly in the field of internal medicine, has become a significant concern in recent years. This condition is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, which can have detrimental effects on both healthcare providers and patient care. 1 While burnout is a recognized issue globally, its impact on internal medicine physicians in Michigan has not been comprehensively studied. Understanding the unique stressors faced by these physicians is critical for developing targeted interventions to reduce burnout rates and improve the overall healthcare environment. Internal medicine physicians often face intense workloads, long hours, administrative burdens, and increasing patient demands, which contribute to high levels of stress.

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  Associations Between Health Literacy and Comprehension of Health Visits in a Community Setting

  Amanda Romaya, Adel Andemeskel, Salim Abdul-Razak, Linda Dillon, and Victoria Lucia

  Publication Date: 5-2025

  Low health literacy is a significant social determinant of health that is associated with poor health outcomes1-3. Bringing attention to health literacy will aid in promoting the health of the population. However little has been done to implement national policies and interventions that address patient health literacy, especially in a community setting4.

  We hypothesized that our assessment of the identified patient population’s health literacy will not meet adequate standards and will indeed demonstrate a need for community-focused interventions

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  The Mysterious Case of Laryngeal TB

  James Aldridge, Katharine Glover, and Amal Khalife

  Publication Date: 5-9-2024

  ▪ Laryngeal Tuberculosis (TB) is a rare manifestation of tuberculosis. ▪ While historically common, it now only represents about 1% of TB cases.

  ▪ Mean patient age is 47 and about 72% were male.

  ▪ It most commonly occurs outside of the USA, and cases within are typically born outside of the USA.

  ▪ Mortality is about 3%.

  ▪ About 86% of the time, it is associated with pulmonary TB.

  ▪ Most common symptoms include dysphonia, dysphagia, odynophagia and weight loss.

  ▪ Unfortunately, due to these symptoms and its rarity in the USA, laryngeal TB is often overlooked in the differential for other infections or malignancies [1], [4].

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  Assessing impact of image-based immunization education on pediatric vaccine uptake within families of low English literacy

  Ahmed Ali, Mariam Bassalious, Sharfaa Chowdhury, Coral Hufnagel, Salwa Bajjey, Amaal Haimout, Nelia Afonso, and Raouf Seifeldin

  Publication Date: 5-2024

  • Vaccinations have been hailed as the most effective public health strategy in mitigating infectious diseases. Since the advent of vaccines at the end of the 18th century, the incidence, prevalence, and mortality of vaccine-preventable diseases have markedly decreased.
  • Vaccine hesitancy has been increasing within the last decade due to various reasons including misinformation and a lack of understanding. 2 This is especially true amongst patients with limited literacy skills as traditional vaccine education material is not optimal for their understanding.
  • Several studies across various healthcare disciplines have shown that the use of picture-based health education for patients with limited literacy backgrounds had an overall positive effect on patient learning, compliance, and health outcomes.
  • There is limited research on applying the concept of imaged-based education to vaccinations, however. Our developed education materials included simple images that highlight the concept of vaccine-generated immunity in an attempt to enhance vaccinate uptake in pediatric patients with parents of low-English literacy backgrounds.

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  Esophagitis in a Post-Liver Transplant Patient: A Case of Cytomegalovirus and Herpes Simplex Virus-1 Coinfection

  Amira Al-Nabolsi, Ammad Javaid Chaudhary, Taher Jamali, Allyce Caines, and Mazen Elatrache

  Publication Date: 10-28-2024

  Infectious esophagitis is the third most common cause of esophagitis, after gastroesophageal reflux disease and eosinophilic esophagitis.

  Common infectious organisms include candida, herpes simplex virus (HSV), and cytomegalovirus (CMV).

  The occurrence of CMV esophagitis is rare in CMV infected patents and there are minimally reported cases of CMV/HSV esophagitis co-infection.

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  Drug Induced Liver Injury: A Case of Amoxicillin-Clavulanate-Induced Liver Injury

  Amira Al-Nabolsi, Barbara Senger, Hassan Eidy, Rami Dali, Mohmaed Musheinesh, and Ashbita Pokharel

  Publication Date: 10-27-2024

  Drug induced liver injury (DILI) is the most common cause of acute liver failure.

  Common causes include antibiotics, supplements, anti-inflammatory agents.

  Diagnosis is typically one of exclusion and usually does not require liver biopsy.

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  Risperidone-Induced ITP

  Amira Al-Nabolsi, Vraj Tripathi, George Darany, and Omar Khan

  Publication Date: 5-9-2024

  Immune Thrombocytopenia Purpura is a hematologic condition characterized by a selective decrease in platelet count.

  White blood cell and hemoglobin levels remain within normal limits.

  Clinical manifestation includes widespread purpuric rash and mucocutaneous bleeding.

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  More Than You Can Swallow: Mycotic Aneurysm, An Uncommon Etiology of Dyspepsia

  Hussein Bazzy, Katharine Glover, Steven Jones, James Aldridge, Michael Potes, and Katie Sumnicht

  Publication Date: 5-9-2024

  Dyspepsia is defined as predominant epigastric pain lasting greater than one month.

  Common etiologies of dyspepsia include peptic ulcer disease, medications, and gastroesophageal reflux.

  We present a rare case of dyspepsia caused by a mycotic aneurysm due to accidental foreign body ingestion leading to emergent inpatient intervention.

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  Feeling Something Deeper: A Case of Hyalinizing Clear Cell Carcinoma of Lung Primary With Suspected Lynch Syndrome

  Hussein Bazzy, Cameron Hubbard, Ahmad Tahawi, Narayana Gandham, Richard Zekman, Phillip V. Kaplan, Erich J. Schwartz, and Kevin Jamil

  Publication Date: 5-22-2024

  Hyalinizing Clear Cell Carcinoma (HCCC) is a type of Salivary Gland-type Tumor (SGT) that can present as a rare subset of lung neoplasms1

  The association of HCCC with loss of mismatch repair expression (MMR) has not yet been described.

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  Trends in Mortality Due to Pancreatitis Among Patients Aged 55 and Older in the United States: Insights From the CDC Wonder Database

  Ammad Javaid Chaudhary, Amira Al-Nabolsi, Muhammad Naveed, Ahila Ali, Rabia Iqbal, Bazil Azeem, Muhammad Omer Rehan, Rabia Asim, Nouman Shafique, and Syed-Mohammed Jafri

  Publication Date: 10-28-2024

  Pancreatitis is one of the leading causes of death in the elderly.

  This study analyzed trends and demographic differences in mortality due to pancreatitis among patients and 55 and older from 1999-2020.

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  Atypical Presentation of Legionnaires' Disease

  Hassan Eidy, Barbara Senger, Joshua Steele, and Jolian Kathawa

  Publication Date: 5-9-2024

  Legionnaires’ disease or Legionellosis is a subtype of pneumonia caused by the gram negative bacilli, Legionella pneumophila.

  L. pneumophila serogroup 1 accounts for 50-80% of Legionnaires’ disease. ▪ Patients commonly present with fevers, chills, myalgia, cough and less commonly with confusion, nausea, vomiting, diarrhea, and/or anorexia.

  Treatment primarily consists of antibiotics with supportive measures. ▪ Renal and hepatic extrapulmonary manifestations from Legionella are rare, and often present with multisystem involvement when they do occur.

  This case highlights a unique, and rare, presentation of Legionnaires’ disease mimicking alcoholic hepatitis with 2:1 AST/ALT transaminitis and physical exam findings.

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  A Bizarre Halloween: A Rare Etiology of Phytobezoar

  Catharine R. Glover, James Aldridge, and Tedd March

  Publication Date: 5-9-2024

  A phytobezoar is defined as the composition of indigestible food particles found in the GI tract, primarily composed of plant material, such as fibers and cellulose.

  Any individual may develop a phytobezoar, but those with altered gastrointestinal anatomy or decreased motility are at highest risk.

  They often present with nausea, vomiting, and/or symptoms of gastric outlet syndrome.

  Complications include ulcerations, bleeding, bowel obstruction, and/or perforation.

  Thus, complete removal is the ultimate treatment.

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  Pediatric Upper Cervical Spine Trauma: A 10-year Single Center Retrospective Study

  Sazid Hasan, Muhammad Waheed, Shahrukh Naseer, Jad G. Khalil, and Ehab S. Saleh

  Publication Date: 5-2024

  This study seeks to answer whether or not there is a significant association between mechanism of injury and patient age, and to elucidate any notable differences in overall outcomes based on various treatment modalities.

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  Purr-Ils of the Liver: A Case of Mash Cirrhosis Complicated by Disseminated Pasteurella

  Joanna Henry, Alaa Abujame, Cameron Hubbard, Angela Shermetaro, James Hebden, Hussein Bazzy, Jared Grodman, Katie Sumnicht, and Christopher Cooley Cooley

  Publication Date: 5-9-2024

  Pasteurella Multicoda is a gram-negative coccobacillus that is commensal to mammals such as domesticated pets and transmitted to humans by scratches or bites. The extent of infection is often limited to soft tissue, bone, and joint.

  Disseminated infection by P. multicoda infrequently is typically associated with peritoneal dialysis.

  We present a case of disseminated P. multocida infection with bacteremia and peritonitis in a patient with NASH Cirrhosis.

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  Anti-Yo Positive Paraneoplastic Cerebellar Degeneration: A Case of Discovering Fallopian Tube Cancer From Neurological Symptoms

  Sydney Jacobs, Alaina Skotak, and Inna Sta Maria

  Publication Date: 5-9-2024

  Paraneoplastic syndromes are rare neurological disorders associated with cancer at distant tumor sites. Prevalence is ~1-3% of all cancers, with an estimated 17,099 cases in the US in 2021.

  Paraneoplastic cerebellar degeneration (PCD) is one subtype, primarily associated with gynecological and breast cancer, especially in women older than 60.2

  Can cause significant functional impairment (e.g. abrupt onset truncal ataxia, room-spinning dizziness, dysarthria, and diplopia).

  Neurological symptoms often precede cancer diagnosis.

  Pathophysiology of PCD: Tumor-induced autoimmunity against cerebellar antigens.4 About 30 types of antibodies, one being anti-Yo antibody (or Purkinje cell cytoplasmic antibody type 1, (PCA-1)) acting on human cerebellar degeneration-related protein.

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  Uncommon Presentation of Gastrointestinal Histoplasmosis in an Immunocompromised Patient

  Usha Kellampalli, Nathanial Bartosek, Alsadiq Al-Hillan, and Dariusz Lazarczyk

  Publication Date: 10-29-2024

  Histoplasmosis rarely involves the GI tract, with only < 1 % of all histoplasmosis cases.

  Most common sites of involvement are Colon or rectum.

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  Exploring Familial Links to Cholangiocarcinoma: Insights into Genetic Predisposition and Risk Factors

  Usha Kellampalli, Nathanial Bartosek, Mohammed Alkhero, and Laith H. Jamil

  Publication Date: 10-29-2024

  Cholangiocarcinoma is a rare aggressive malignancy that varies widely by geographic region and often reoccurs.

  While a family history of bile duct cancer can increase the risk of developing the disease, it is still considered low due to its rarity and lack of clear hereditary patterns.

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  Readmission Rates In Complex Cases Does Review of AVS with Patients/Families Lead to Lower Readmissions?

  Nick Leventis

  Publication Date: 5-9-2024

  Does review of discharge plans with patients in complex cases truly have a benefit? The primary objective of this quality improvement project was to investigate if reviewing after visit summaries (AVS) with patients/families in complex cases leads to lower readmission rates compared to discharges where this was not performed.

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  Takotsubo Cardiomyopathy Resulting in Hypoxic Hepatitis

  Jamil Qarqash, Devon Pyykkonen, and Olga Brushaber

  Publication Date: 5-9-2024

  Elevated liver enzymes are frequently observed in hospital settings, requiring a high level of suspicion for shock liver. In this report, we present a rare case of shock liver induced by Takotsubo cardiomyopathy (TCM). After other common causes of aminotransferase levels exceeding 1000 U/L were excluded, the focus shifted to managing the patient’s hemodynamics. This approach resulted in significant improvement of transaminase levels back to normal.

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  A Rare Case of Radial Arteriovenous Formation After Transradial Cardiac Catheterization

  Barbara Senger, Hassan Eidy, Andrew Gray, and Robert Grodman

  Publication Date: 5-2024

  In the United States, more than one million cardiac catheterization procedures are performed each year for diagnostic and therapeutic purposes.

  Right heart catheterizations allow for direct measurement of right-sided cardiac and pulmonary hemodynamics while left heart catheterizations provide a diagnostic and therapeutic role in those with coronary artery disease.

  In 1989, Lucien Campeau proposed the use of a smaller caliber catheter to access the small radial artery as a way to reduce the rates of bleeding complications.

  Advantages of utilizing the transradial artery (TRA) approach over the transfemoral artery (TFA) approach include:

  – Improved patient quality-of life metrics.

  – Reduced major bleeding and access site complications.

  – Lower total hospital costs.

  Access-site complications including radial artery occlusion and arteriovenous fistula (AVF) formation from TRA are rare and usually of minimal clinical impact.

  AVF may present with pain and edema at the puncture site, a pulsatile thrill, and/or visible dilated superficial veins.

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  Mounjaro Mediated Drug-Induced Immune Thrombocytopenia

  Barbara Senger, Zachary Howarth, Ali Baydoun, and Benjamin Rossi

  Publication Date: 5-9-2024

  Thrombocytopenia is a condition in which a person has low platelets or thrombocytes in the blood.

  Symptoms of thrombocytopenia vary based on severity.

  Mild: asymptomatic.

  Moderate: prolonged bleeding following trauma, easy ecchymosis, petechiae and purpura.

  Severe: spontaneous ecchymosis/petechiae/purpura, spontaneous mucosal bleeding, life threatening internal bleeding.

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  Liver Injury, Renal Failure, and Pancytopenia after Radioactive Iodine Treatment for Papillary Thyroid Carcinoma: A Case Report

  Angela Shermetaro, Grant Hupp, and Jordan Bushman

  Publication Date: 5-9-2024

  Radioactive Iodine (RAI) has been used for diagnosis and treatment of thyroid carcinomas since the 1940’s. Some known side effects include gastritis, radiation thyroiditis, and bone marrow suppression. However, there are minimal reports on radioactive iodine causing drug induced liver injury (DILI) and renal failure.

  To our knowledge, this is the first reported case of both hepatic injury and renal failure following RAI treatment.

  We describe an 83-year-old female who developed DILI and renal failure after radioactive iodine ablation.

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  Subacute Combined Degeneration of the Spinal Cord Induced by Nitrous Oxide Abuse: A Rare Patient Presentation to a Spine Surgery Clinic

  Jacob Shermetaro, Michael Bridges, Jonathan Avon, Nilesh Patel, and Brian Vosko

  Publication Date: 5-9-2024

  Subacute combined degeneration (SCD) of the spinal cord is a disease involving the lateral and posterior columns of the spinal cord that can manifest in patients with vitamin B12 deficiency.

  Nitrous oxide (N2O) induced SCD of the spinal cord is a result of N2O interfering with the metabolism of vitamin B12 and results in nervous system demyelination.

  This is an infrequent complication of N2O anesthesia however cases are rising with recreational N2O use.

  Given wide availability of N2O, clinicians must maintain a high index of suspicion when confronting patients with concerning clinical pictures.

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  Review of Salvage Therapy for MRSA Bacteremia at Beaumont Health System

  Hazem Alakhras, Matthew D. Sims, and Tracey A.H. Taylor

  Publication Date: 5-2023

  Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.