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  Central Retinal Artery Occlusion in 17-Year-Old Female on Oral Contraceptives

  Zain Alajjouri, Deanna Deschler, Mariah Barnes, and Lisa Ambrose

  Publication Date: 5-9-2025

  Central retinal artery occlusion (CRAO) is a condition in which the main vessel supplying the retina becomes occluded, resulting in sudden, painless vision loss in that eye. It most commonly presents in elderly patients, secondary to thromboembolism. It is associated with cardiovascular risk factors, but incidence rates increase significantly with age. In this report, we describe a rare case where a 17-year-old female on oral contraceptive pills (OCPs) presented with acute vision loss.

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  Case Report: Kell Antigen Alloimmunization in a Gestational Carrier After Embryo Transfer Following in Vitro Fertilization

  Hawraa Alsaedi, Melissa Schott, Robin Strouse, Emma Giuliani, Marcos Cordoba Munoz, Mili Thakur, and Valerie Shavell

  Publication Date: 5-9-2025

  The Kell antigen group is a highly immunogenic set of red blood cell (RBC) antigens, similar to ABO and Rh, that can provoke the formation of alloantibodies when introduced into the immune system of individuals who lack these antigens. Kell alloimmunization can lead to severe complications such as transfusion reactions and hemolytic disease of the fetus and newborn (HDFN). This report presents a case of Kell antigen alloimmunization in a gestational carrier who achieved a successful pregnancy with a genetically unrelated euploid embryo after in vitro fertilization (IVF) and preimplantation genetic testing (PGT).

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  Assessing Recurrence Outcomes in Breast-Conserving Surgery with and without Cavity Shave Margin Resection

  Pavitra Attanayake, Hannah Liefeld, Jacob Sypniewski, Steven Lee, Anna Levine, Gerald P. Wright, and Jessica Thompson

  Publication Date: 5-9-2025

  For patients undergoing breast conserving surgery (BCS) for breast cancer, cavity shave margin (CSM) resection has correlated to positive margin rate reductions, ranging from 50% to over 70%, and occult multifocal disease identification, ranging from 8% to 19%. There is a paucity of data on the impact of CSM on locoregional recurrence (LRR), therefore our study sought to compare whether rates of recurrence differed between partial mastectomy with CSM versus without.

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  Initial Steroid Treatment in a MOGAD Patient with Super High MOG Antibody and Lesion without Contrast Enhancement

  Ayla Barakat, Ling Ling Rong, Nicholas Lannen, and Jessica Feistel

  Publication Date: 5-9-2025

  Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a central nervous system autoimmune demyelinating disease, distinct from multiple sclerosis and neuromyelitis optic spectrum disorder radiologically and histopathologically, also in treatment response and outcomes. The presence of MOG-IgG is the core criterion for diagnosing MOGAD. Whether extremely high MOG-antibody titers affect treatment response has not been elucidated. Here we report a case of a patient with extremely high MOG-IgG level and non-enhancing lesion in the spinal cord, who demonstrated rapid response to steroid therapy.

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  Perceptions of Cardiopulmonary Resuscitation Success in Children: A Survey of Family Attitudes and Media Influence

  Carissa Bartkowiak, Jon Giolotti, Mary Reiber, Madi Mangione, Paige Sims, Sydney Brief, Emily Hillard, Katrina Elzinga, Xhesika Topalli, and Amanda Croft-DeHagen

  Publication Date: 5-9-2025

  Emergency department (ED) families grapple with the dilemma of choosing whether to proceed with cardiopulmonary resuscitation (CPR) and other medical interventions that could potentially prolong a child's life. This research aimed to survey adults to determine their perceptions regarding CPR in children, specifically its probability of leading to survival.

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  On the Tip of the Tongue: Anesthetic Dilemmas for C-Section with Metastatic Cancer

  Zoe Baxter, Theresa Nguyen, and Laurie Chalifoux

  Publication Date: 5-9-2025

  Cancer is one of the most common causes of death of women in their reproductive years, yet malignancy during pregnancy is understudied due to its rare incidence of 1 in 1000 pregnancies.1 Oral squamous cell carcinoma (SCC) is extremely rare in pregnancy, comprising < 2% of all malignancies in pregnant women, with a reported 36% mortality rate2. Herein, we present a complex case of a 30 yo pregnant patient (G2P1) with metastatic stage IV SCC of the tongue. Our discussion focuses on the anesthesia approach during delivery, pertinent pathological and radiological findings important in this anesthesia case, and the importance of navigating anesthesia complications to maximize outcomes.

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  Anti-Kelch Like 11 Protein Encephalitis in a Patient with a Regressed Testicular Germ Cell Tumor

  Ryan Bean, Jordan Gates, and Nicholas Lannen

  Publication Date: 5-9-2025

  Kelch-like protein 11 (KLHL11) antibody encephalitis is an intracellular antibody-associated paraneoplastic syndrome, associated with testicular germ cell tumors and teratomas. Through T-cell mediated destruction of KLHL11-expressing neurons, KLHL11 antibody encephalitis has varied clinical manifestations, and is often characterized by rhombencephalitis, cochleovestibulopathy, and limbic encephalitis that is poorly responsive to immunotherapy.

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  Impact of Legalized Cannabis on Pediatric Emergency Visits: Characteristics and Outcomes of Hospitalized Patients

  Nawal Bennett, Emma Dixon, Victoria Moaddel, Abbigail Behmlander, Man Yee Keung, Matthew Singh, Nathaniel Ladaga, Angela Zamarripa, Lindsey Rauch, and Jeffrey Jones

  Publication Date: 5-9-2025

  Following the legalization of marijuana for adult use, there has been a significant rise in the availability and consumption of cannabis, increasing in pediatric emergency department (ED) visits. Our study aimed to examine the clinical features and outcomes of children who were hospitalized due to cannabis exposure.

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  Updated Congenital CMV Identification Protocol

  Meghan Berry, Anthony Bernicchi, Annalise Bowen, and Ashlyn Sovereen

  Publication Date: 5-9-2025

  The AAP recommends routine hearing screening in newborns to identify hearing loss that can occur from a variety of etiologies, including congenital CMV (cCMV) infection which can cause sensorineural hearing loss.1 The incidence of cCMV in newborn babies is 0.5%-0.7% of births in industrialized countries, with estimated 25% of babies with congenital CMV experiencing long-term health problems, which can include sensorineural hearing loss or other neuro-disability2,3. Current policy at Corewell Health facilities is to implement hearing screening at 24 hours of life, and to follow-up with audiology for further evaluation. There is currently no routine CMV testing performed in the newborn nursery. Our goal is to implement routine CMV testing in the newborn nursery using a newly designed standard protocol and further evaluate the results of CMV testing in the future.

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  Pigmented Villonodular Synovitis with Atypical Presentation in the Foot: A Case Report

  Humza Bhatti, Hussein Hazime, and Philip Nowicki

  Publication Date: 5-9-2025

  Pigmented villonodular synovitis (PVNS), also known as tenosynovial giant cell tumor (TGCT), is a rare proliferative disease of the synovial tissue that most commonly affects large joints such as the knee, hip, and shoulder in young individuals.1,2 PVNS can broadly be categorized into two types: localized PVNS (LPVNS) and diffuse PVNS (DPVNS), with the localized form being a mass within the synovium and the diffuse form involving the entire synovium.2,3 This rare condition has an incidence rate of 1.8 per million and is often misdiagnosed as arthritic disease. Early diagnosis is crucial as PVNS is often aggressive, and recurrence rates in the diffuse type have been reported to be as high as 46%.

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  Cannabis-Induced Anxiety Disorder in Pediatrics: A Community-based Study of Emergency Department Visits

  Simran Bhogal, Ryan Throrburgh, Megan Courtley, Mariah Barnes, Jason Seamon, Jennifer Bach, Christian Kolacki, Thomas Peterson, and Jeffrey Jones

  Publication Date: 5-9-2025

  Legalization of recreational cannabis is associated with an increase in visits to the ED associated with the drug's psychiatric effects. The purpose of this study was to describe the prevalence, clinical features, and disposition of cannabis-induced anxiety disorder in children and adolescents.

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  Hepatitis with Acute Liver Injury Secondary to Undifferentiated Viral Upper Respiratory Infection in an Immunocompetent Adult Patient

  Ryan Blackmer and Jeff Jones

  Publication Date: 5-9-2025

  Acute upper respiratory infections (URIs) are self-resolving airway infections with symptoms such as cough, runny nose, congestion, low-grade fever, headache, malaise, sneezing, and facial pressure. Caused by over 200 viruses, URIs affect millions annually and last 1-3 weeks, with common complications such as ear, sinus, throat infections, and pneumonia. Rarely, URIs can lead to liver complications. The liver produces bile, clotting factors, breaks down toxins, and fights infection. Elevations in liver enzymes (ALP, ALT, AST) indicate liver injury. Severe URIs can rarely cause mild transient liver enzyme elevation mostly seen in immunocompromised patients or children. This report describes a novel case of an immunocompetent adult with viral hepatitis and acute liver injury following an undifferentiated viral URI.

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  Nailed! Penetrating Head Injury in a 19-Year-Old Male

  Brode Breuker, Jason Seamon, and Tiffany Fleeger

  Publication Date: 5-9-2025

  Penetrating brain injuries are a rare but severe presentation to the emergency department accounting for approximately 0.4% of all head injuries. Preoperative management of these injuries is challenging as there are no standardized guidelines on the management of penetrating brain injuries. It is essential for emergency physicians to have general guidelines to follow for the management of these injuries.

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  Trends in Plastic Surgery Research Productivity - An Increase in Scientific Abstract Submissions, Presentations, and Conference Lengths

  Elizabeth Bushong, Hanna Pfershy, Samuel Girian, Matthew Fahrenkopf, and Ronald Ford

  Publication Date: 5-9-2025

  Matching into one of the current 213 Integrated Plastic Surgery residency positions is highly competitive. Only 58.84% of applicants matched in the most recent 2023-2024 application cycle, less than the previous year's rate of 62.35%. In addition to academic excellence, applicants have also historically possessed more research experiences and publications than applicants in most other specialties. We hypothesize that the increased emphasis of research productivity on the applicant has led to increases in the number of scientific abstracts submitted to and presented at plastic surgery conferences, particularly as Step 1 became P/F in 2022. These changing landscapes have likely altered the length and agenda of conferences.

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  A Pediatric Presentation of Guillain-Barré Syndrome Mimicking Refractory Migraines

  Bradley Buska, Nathaniel Ladaga, and Nawal Bennett

  Publication Date: 5-9-2025

  Guillain-Barré syndrome (GBS) is an acute autoimmune polyneuropathy that typically presents with progressive weakness, gait disturbances, and areflexia. Its presentation in pediatric patients can be variable, leading to delays or challenges with diagnosis. This case follows a 7-year-old boy initially diagnosed with migraines due to recurrent headaches and vomiting with unremarkable CT results. His condition progressed to ataxia and left-sided weakness, ultimately leading to admission and diagnosis of GBS.

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  Writhy, Weary, and Wobbly. What Could it Be? An Atypical Presentation of Chorea and Ataxia in a Pediatric Patient

  Dorothy Anne Cabantan and Anacleto Diaz

  Publication Date: 5-9-2025

  Ataxia and choreiform movements in the pediatric population hold an expansive differential, including infectious, autoimmune, genetic, toxicology, neurologic, and behavioral etiologies that can make accurate diagnosis challenging. Anti-N-methyl-D-aspartate (NMDA) receptor еnceрhalitiѕ usually affects young adults and children. It generally presents with prodromal headaches, fevers, or a viral-like process, followed by psychiatric and/or neurological symptoms. Diagnosis is confirmed by positive immսոοglobulin G antibodies against the GluN1 subunit of the NMDA receptor. Early initiation of immunomodulatory therapy is associated with improved outcomes, but progressive neurologic deterioration and death can occur if untreated. This case highlights a post-infectious syndrome in a pediatric patient with ataxia, hypersomnolence, and chorea, in the setting of known, non-verbal autism.

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  A Literature Review of Platelet Rich Plasma Injection in Lumbar Facet Arthropathy

  Aaron Chang, Juston Dzierzawski, Oluseun Olufade, and Di Cui

  Publication Date: 5-9-2025

  Low back pain is an increasing issue in the world. Current treatment of low back pain includes physical rehab, pharmaceutical pain control, steroid injections, and spine surgery. Regenerative medicine has recently become an option for treatment of low back pain. Platelet rich plasma (PRP) is one of the options that falls into this treatment. PRP is an autologous source that contains multiple growth factors and cytokines that can promote tissue healing and regeneration. There has been a great amount of research done on PRP and intradiscal low back pain therapy that has shown promising results. However there has been limited research on PRP and lumbar facet arthropathy. This literature review set out to determine the effects PRP injection on intra articular back pain.

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  Case Report: Recurrent Metastatic Breast Cancer in Pregnancy Complicated by Uncontrolled Pain

  Lauren Chapman, Samantha Damocles, and Laurie Chalifoux

  Publication Date: 5-9-2025

  Pain management during pregnancy is a complex clinical challenge, particularly in the context of advanced malignancy with extensive metastases. Balancing maternal comfort with fetal outcomes requires interdisciplinary collaboration and careful decision-making.

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  The Role of Clinical Simulation in Ultrasound Training for Advanced Practice Providers

  Dale Chilton, Joy Tompkins, and Dale McNinch

  Publication Date: 5-9-2025

  It is widely established that the use of point of care ultrasound (POCUS) and echocardiography (echo) are vital tools in assessing chronic and acute pathologies in inpatient and outpatient settings. Pathologies include but are not limited to trauma, cardiac disease, fluid collection, abscesses, organ system assessment, and much more. At many institutions, access to POCUS and echo education isn't readily available to providers, especially advanced practice providers (APPs). This is typically due to a lack of resources such as equipment, expertise in POCUS and echo education, infrastructure for billing, and image storage. With the growth in clinical simulation and innovative technology, POCUS and echo education has expanded to APPs within our institution.

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  The Many Images of Abernethy Syndrome; Unraveling the Radiologic, Laboratory, and Clinical Findings in an Adolescent Patient Presenting with Congenital Portosystemic Shunt

  Nicholas Comeau, Breana Bouchard, and Andrew Zbojniewicz

  Publication Date: 5-9-2025

  Abernethy syndrome, known as congenital portosystemic shunt syndrome (CEPS), is characterized by an aberrant connection between the mesenteric and systemic vessels. Normally, the splenic vein (SV) and superior mesenteric vein (SMV) form the portal vein which carries blood to the hepatic sinusoids. Then, blood is returned to the systemic system via the inferior vena cava (IVC). CEPS is divided into type 1 where portal blood bypasses the liver entirely, and type 2 where a hypoplastic portal vein delivers blood to the liver and IVC. Manifestations range from incidental imaging findings to hepatopulmonary syndrome. Early radiological evaluation enables timely medical-surgical intervention. Our report studies a 7 year old female with developmental and endocrine abnormalities found to have CEPS on imaging. We will review the radiological findings, notable manifestations and treatment options.

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  Recurrent Torsades de Pointes in an Elderly Woman with a Long QT Syndrome

  Travis Cook, Matthew Singh, and Andrea Reeder

  Publication Date: 5-9-2025

  The QT interval represents the duration of ventricular depolarization and repolarization. Prolongation of the QT interval may be congenital or acquired. This increases the risk of polymorphic ventricular tachycardia (i.e torsades de pointes) and cardiac arrest. To increase the awareness of this life-threatening phenomenon I outline an illustrative case in which acquired prolongation of the QT interval due to electrolyte derangement and administration of ciprofloxacin resulted in cardiac arrest due to torsade de pointes.

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  Metastatic Infection Caused by Hypermucoviscous Klebsiella Pneumoniae Presenting as Endogenous Endophthalmitis

  Megan Courtley and Brode Breuker

  Publication Date: 5-9-2025

  Endogenous endophthalmitis is a rare and challenging ophthalmic emergency, but one that requires prompt diagnosis and management to preserve sight. Hematogenous spread is traditionally associated with chronic disease like diabetes or immunosuppression. Klebsiella pneumoniae is a common bacterial source. An emerging hypermucoviscous strain has an increased ability to cause metastatic infection and endophthalmitis, with devastating vision outcomes. This strain was first described in Asian populations but is now becomingly increasingly recognized in other Western regions and in healthy, young individuals. It typically causes underlying community acquired liver abscess and metastatic involvement of other organ systems such as renal, neurologic and pulmonary. Increased awareness is needed for appropriate consideration of this strain and its diagnosis and treatment.

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  Da Vinci SP (single port) Surgery: A Novel Approach to Gynecologic Procedures

  Allison Cropsey and Leigh Seamon

  Publication Date: 5-9-2025

  The da Vinci SP™ is a single-port robotic surgical system that was FDA approved for urologic and ENT procedures in 2018 in the United States. It was approved for gynecologic use in 2023 in Japan, where the majority of cases have been described but remains non-FDA approved in the US. Due to the novelty of the da Vinci SPTM, there is limited data describing the surgical outcomes and even fewer studies describing gynecologic procedures using the SP robot. To our knowledge, there have been less than 200 gynecology SP cases reported in the literature worldwide with only two of them occurring in the United States at Mayo clinic. Here, we present a novel approach to gynecologic surgery and our initial experience with the da Vinci SP robotic system which will revolutionize the way gynecologic surgery is performed in the future.

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  Trach-Together: An Interdisciplinary Approach to Tracheostomy Support

  Sammy Dia, Scott Hawkins, Bradd Hemker, Rachel Macak, Kelley Brechting, Elizabeth Prentice, Carolyn Dress, and Jessica Sturgill

  Publication Date: 5-9-2025

  Children with complex respiratory needs often face the critical decision of pursuing a tracheostomy and mechanical ventilation. This project aims to support families through this decision-making process by developing an interdisciplinary trach-vent care team. Objectives: -Identify stakeholders. -Establish a systematic early referral process. -Enhance informed consent and confidence in families through comprehensive education and early consultations. -Implement hands-on care simulations to improve parental knowledge and comfort. -Provide a model for resource-limited hospitals to improve patient outcomes through multidisciplinary collaboration.

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  The Masquerade or What's in This Skin; A Case of Cutaneous Sarcoidosis

  Daniel Emrick and Anacleto Diaz

  Publication Date: 5-9-2025

  First described in 1877 by Jonathan Hutchinson, sarcoidosis affects approximately 150,000 to 200,000 patients in America and is characterized by the presence of non-caseating granulomas. The exact cause remains poorly understood. In the United States, risk is greater in African-American patients and in greater predominance in women compared to men. It can affect any organ system, though it most frequently begins in the lungs. Cutaneous sarcoidosis can be seen in approximately one third of cases. Cutaneous forms can be nonspecific as in erythema nodosum, or specific with granulomatous infiltration. Cutaneous sarcoidosis is a particularly challenging diagnosis, as a single patient can have a variety of lesions in terms of appearance, each of which may appear resemble countless other pathologies including; lichen planus, psoriasis, fungal infection, or cutaneous T-cell lymphoma