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  Do critically ill patients with guardianships receive more aggressive treatment?

  Misha Haq, Jacob Keeley, and Enrique Calvo-Ayala

  Publication Date: 5-2025

  • Patients suffering from certain conditions can become unable, unwilling, or unavailable to make decisions regarding their end-of-life care1.
  • • In these cases, a court appointed guardian is responsible for carrying out medical decisions on behalf of the patient2.
  • Patients with guardians tend to receive more aggressive care, regardless of the benefit, because it is perceived as safer 3.
  • Guidelines and laws for medical decision-making for patients with guardians are inconsistent, leaving this population vulnerable4.

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  Low CPAP Adherence Amongst the African American and Arabic Population in Patients with Obstructive Sleep Apnea

  Nikki Nguyen and Bhavinkumar Dalal

  Publication Date: 5-2025

  • Obstructive sleep apnea (OSA) is a breathing disorder that occurs from a recurring decreased or completely blocked airflow during sleep leading to symptoms including excessive daytime sleepiness and impaired cognitive function1.

  • Primary treatment for moderate to obstructive sleep apnea is continuous positive airway pressure (CPAP) reducing daytime sleepiness, improves neurocognitive function, and improves quality of life2.

  • Current literature shows that compliance varies from 40-85% with poor adherence reducing the treatment’s effectiveness in preventing chronic health problems3.

  • Although more CPAP use is generally associated with subjective and adherence is typically defined as at least 4 hours of usage as this is typically the benchmark for improved energy during the day3.

  • Currently, little data exists on CPAP adherence of Middle Eastern Americans.

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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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  Multidisciplinary Approach to Pulmonary Arterial Hypertension Therapy Transition: A Patient Case Report

  Jacqueline Brewer, Tania Saeed, and Bhavinkumar Dalal

  Publication Date: 10-2024

  Pulmonary arterial hypertension (PAH) is a rare, incurable disease that causes vasoconstriction of the pulmonary vasculature

  Therapy goals include improving hemodynamics as well as alleviating symptoms

  Therapies range from injectable to inhaled to oral to parenteral

  PAH treatment teams often transition between the various forms of therapies to reach therapy goals but also to improve patient’s quality of life

  The use of a supportive, multidisciplinary team approach, including physicians, nurse practitioners (NP), pharmacists, and nurses during these therapy transition phases is beneficial to achieve success and improve patient care

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  Pulmonary Embolism in Pregnancy and Early Postpartum – Identifying Significant Variables to Improve Risk Stratification

  Nida Haider and Bhavinkumar Dalal

  Publication Date: 5-2024

  • Pulmonary embolism (PE) resulting from deep vein thrombosis (DVT) is one of the leading causes of maternal deaths in developed countries1
  • The causative Virchow triad (venous stasis, endothelial injury, and hypercoagulable state) is enhanced in pregnancy making pregnancy an independent risk factor1
  • Due to significant overlap between normal physiological changes in pregnancy and clinical symptoms of PE, the threshold for CTPA, confirmatory imaging for PE with potentially harmful effects due to ionizing radiation, is low with increasing incidence of false positives2

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  Clinical Differences in Isolated Post-Capillary Pulmonary Hypertension and Combined Pre- and PostCapillary Pulmonary Hypertension

  Emily Schneider and Bhavinkumar D. Dalal

  Publication Date: 5-2024

  PULMONARY HYPERTENSION (PH) = RESTING MEAN PULMONARY ARTERY PRESSURE (MPAP) > 20 MMHG.

  The World Health Organization recognizes five groups of pulmonary hypertensions:

  • • Estimated that > 50% of patients with left heart disease are also affected by pulmonary hypertension.1
  • 1 in 4 Americans will develop heart failure in their lifetime.
  • Gold standard for diagnosis of PH is a right heart catheterization (RHC).3
  • Global burden of PH remains unknown as this illness is poorly surveilled and cases remain underestimated.4,5

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  Understanding Infectious Disease Consultation Role for Septic Patients in the Medical Intensive Care Unit

  Marisa Stratelak, Cloe Nazeer, and Bhavinkumar Dalal

  Publication Date: 5-2024

  • Sepsis is a medical emergency requiring immediate recognition and prompt treatment.
  • 1 in every 3 hospitalized patients who die have sepsis1.
  • The mortality rate for patients with severe sepsis in the intensive care unit (ICU) is 32.2%2.
  • Early intervention with fluid resuscitation and intravenous antibiotics can reduce mortality rates by 7-9%3.
  • Infectious disease (ID) consultation on antimicrobial therapy in the ICU is associated with reduced ICU mortality and ICU length of stay (LOS)4.
  • Gaps in literature exist regarding frequency of ID consultation for septic patients in the ICU, including comparing outcomes of patients with and without ID consultation.
  • It is hypothesized ID consultation results in decreased LOS and mortality rate of septic patients in the medical intensive care unit (MICU).

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  Evaluating the Accuracy and Quality of the Information on Pulmonary Rehabilitation Videos Shared on YouTube amidst the COVID-19 pandemic

  Payaum Fotovat-Ahmadi, Bilal M. Ali, and Bhavinkumar Dalal

  Publication Date: 5-2023

  YouTube is a visual library that is growing at incredible pace, especially with the rise of COVID-19 pandemic. Pulmonary rehabilitation refers to the rehabilitation treatment of patients with chronic pulmonary diseases. YouTube has made it possible to practice remote rehabilitation, the effectiveness of which have been proven non-inferior to traditional approaches.

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  A Survey of Medical Student Experiences During the COVID-19 Pandemic

  Stephanie Gappy, Girish Nair, and Dwayne Baxa

  Publication Date: 5-2023

  During the COVID-19 pandemic, medical students switched from an in-person to virtual curriculum. This shift placed stress on medical schools to find alternatives to train students. Students relied on recorded lectures, emails, and video-conferencing to stay up-to-date with schoolwork. Understanding student experiences during the pandemic will help prepare students and administrators for repeat lockdown events. The goal of this study is to understand the experiences of medical students during the pandemic.

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  Impact of Structured Reporting Template on the Quality of HRCT Radiology Reports for Interstitial Lung Disease

  Han G. Ngo, Girish B. Nair, and Sayf Al-Katib

  Publication Date: 5-2023

  This QI study compared the completeness of HRCT radiology reports before and after the implementation of a disease-specific structured reporting template for suspected cases of interstitial lung disease (ILD).

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  Evaluation of Phenobarbital in the Treatment of Alcohol Withdrawal in the Intensive Care Unit

  Sienna J. Ringgenberg and Vishal K. Patel

  Publication Date: 5-2023

  Alcohol withdrawal syndrome (AWS) is typically managed using the Clinical Institute Withdrawal Assessment (CIWA) protocol which includes benzodiazepines, supportive care, and close clinical monitoring. Alternatives to benzodiazepines such as phenobarbital provide several advantages including less frequent dosing, longer tapering off of doses, and additional glutamate inhibition. The purpose of this study is to evaluate the effectiveness and potential benefit to using phenobarbital in addition to CIWA protocol in the treatment of AWS at Beaumont, Royal Oak.

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  Transition of continuous intravenous epoprostenol to oral treprostinil in a patient with pulmonary arterial hypertension: A patient case report

  Tania Saeed, Heidi Klotz, Klea Noskey, Jacqueline Brewer, Samuel Allen, and Rebecca Baker

  Publication Date: 9-28-2023

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  A Study to Compare Baseline Functional Residual Capacity and Forced Vital Capacity as Predictors of Mortality and Hospitalization in a Cohort of Mild to Moderate Interstitial Lung Disease

  Olga R. Gomez Rojas, Ehsun Naeem, Filip Ionescu, Edward Castillo, and Girish B. Nair

  Publication Date: 5-2022

  Forced Vital Capacity (FVC) is a common parameter used to assess disease progression in patients with Interstitial lung disease (ILD) and acts as a surrogate for mortality. Previous studies suggest Functional Residual Capacity (FRC) may be an earlier predictor of disease progression in ILD. In this study, we compared predictive ability of baseline FRC to FVC to predict one-year-mortality and respiratory related hospitalization in patients with mild to moderate ILD

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  Diabetic Ketoacidosis Precipitated by COVID-19 Induced Acute Pancreatitis

  Tamera Tennant and Bhavinkuma Dalal

  Publication Date: 5-13-2022

  Gastrointestinal manifestations of COVID-19 infection are increasingly being recognized, such as nausea, vomiting, and diarrhea. Research into the pathophysiology is ongoing. I present a case of a 52-year-old female without a history of diabetes who presented to the emergency room with progressive lethargy and altered mental status. Her tests results were consistent with diabetic ketoacidosis with glycemia 1440 mg/dL, venous pH 7.23, beta hydroxybutyrate of 7.53 mmol/L, bicarbonate 14 mmol/L, and anion gap 32. COVID-19 (SARSCoV- 2) testing by nucleic acid amplification was positive on admission. She was admitted to the intensive care unit and started on an insulin drip. Her severe abdominal pain led to the diagnosis of acute pancreatitis with lipase >1200 U/L and computed tomography of the abdomen showed inflammatory changes around the head of the pancreas and second portion of the duodenum. Workup for the cause of her pancreatitis was unrevealing. A right upper quadrant ultrasound negative for evidence of cholelithiasis, common bile duct dilation or liver abnormalities. She denied alcohol and drug use, which was confirmed with a negative blood alcohol level and urine drug screen on admission. Furthermore, she was not taking any medications prior to arrival, specifically those known to cause pancreatitis. She was diagnosed with diabetes mellitus during this admission and DKA was the presenting situation precipitated by COVID-19 pancreatitis. She was treated with intravenous fluids and supportive care. The remainder of her hospital stay was unremarkable. She was discharged home with an insulin regimen, and her HbA1C two months later was 8.3%. Follow-up CT of the abdomen one month after discharge showed no abnormalities. Literature review revealed a study in China reported an elevated incidence of pancreatic injury with few exhibiting hyperglycemia, and without a diagnosis of acute pancreatitis (1). There are few cases of acute pancreatitis that are classified as being caused by COVID-19 infection (2). However, none of these reported a complication of DKA. This case demonstrates pancreatitis and DKA as rare, yet possible, complications of COVID-19 and emphasizes the importance of thorough history-taking and diagnostic evaluation.