All posts by The Chiefs

A Fun Time Hosting North Texas ACP

Our Program hosted the 2018 North Texas ACP meeting on Thursday, May 17. Four programs graciously came over and made a special evening possible.

All pictures of the event can be viewed here.

The programs were:

  • Texas Health Presbyterian
  • Methodist Dallas
  • UT Health East Texas- Longview
  • Baylor, Scott and White

The event was attended by Dr. Roger Khetan, President of Texas ACP. Sixty posters were presented by the 5 programs (including UTSW), followed by oral presentations and dinner in the Faculty club. Dr. Kazi welcomed the guests followed by a short talk by Dr. Khetan on ACP and its member benefits and role for shaping the career of young physicians.

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The 5 oral presenters were:

  • Vishal Kaila
  • Elizabeth Brewer
  • Zehra Hussain
  • Brooke Mills
  • Mridula Nadamuni

 

The poster presenters from UTSW were:

  • Andrew Sumarsono
  • An Lu
  • Jessy Barnes
  • Stephanie Chiao
  • Nivedita Arora
  • Ross Schumacher
  • Stephane Buteau
  • Natalie Hoeting
  • Ashlin Christensen-Szalanski
  • Jeff Chidester
  • Ananya Kondapalli
  • Giuliana Cerro-Chiang
  • Roy Elias
  • Joseph Obi

Greta job, guys!!

 

utsw

Thanks to the judges from all the institutes for their help in evaluating the posters and talks. The judges from UTSW were Dr. Swathi Reddy, Dr. Ambarish Pandey, and Dr. Purav Mody.

The ‘winners’ of the evening were then declared:

  • Best Clinical Vignette (Poster): Danielle Ivey ( (Baylor, Scott and White)
  • Best Research (Poster): Joesph Obi (UTSW)
  • Best Clinical Vignette (Oral): Brooke Mills (Baylor, Scott and White)

 

They will get a chance to present at the Texas meeting in the fall, and then an opportunity at ACP nationals. Thanks to the very special Education Office team of Camille, Brittani, Lynne, Marc, Henry, and Barbara for making this evening possible. See you next year!

wert

— Chiefs

Cox’s Conference: Hypokalemia

In today’s Cox’s Conference, Dr. Ezim Ajufo presented a case of profound hypokalemia to expert discussant, Dr. Biff Palmer. We had an excellent discussion about the differential diagnosis and mental framework for hypokalemia. A previous blog post that summarizes this framework is linked here: Cox’s Conference: Recurrent hypokalemia.

In addition to the linked blog post, additional pearls from our discussion are paraphrased here.

Manifestations and Consequences of Hypokalemia:

Clinical Symptoms and Signs
  • Muscle weakness (or paralysis in extreme cases)
    • Decreased extracellular potassium leads to hyperpolarization of cell membranes. This results in decreased sensitivity of muscle cells to generate an action potential to excitatory stimuli.
  •  Confusion or affective disorders
    • Alterations in central nervous system conduction due to membrane polarization disturbances
  • Ileus
    • Due to smooth muscle depolarization abnormalities due to membrane polarization disturbances
  • Rhabdomyolysis
    • Extracellular potassium normally mediates vasodilation. When muscle cells depolarize, intracellular potassium is released, leading to vasodilation and increased blood flow to the muscle fibers. In states of hypokalemia, this vasodilation is attenuated, leading to relative ischemia and rhabdomyolysis
  • Cardiac
    • EKG
      • U-wave amplitude increased (may be misread as QT prolongation)
      • ST depression
      • T-wave flattening
    • ventricular or supraventricular tachyarrhythmias
  • Renal
    • Impaired urinary concentration
      • leads to polyuria and polydipsia
      • due to decrease in the medullary gradient AND due to decreased responsiveness to antidiuretic hormone (mechanism poorly understood)
    • chronic tubulointerstitial nephropathy
  • Endocrine
    • Glucose intolerance/hyperglycemia
      • hypokalemia decreases pancreatic beta-cell insulin release

References:

Am J Kidney Dis. 2010 Dec;56(6):1184-90.

 

The 2018 Seldin Symposium

On May 3rd, 2018 we held our 3nd Annual Donald W. Seldin, MD Research Symposium showcasing the scholarly work of our housestaff. A total of 132 posters were presented, of which 96 were by first and second year residents! The breadth and depth of the work was outstanding!

Here are some of the pics. (You can view and download all the the pics of the symposium from this link).

Some of our residents were serious!

poster 3.JPG

Some found their doppleganger!

Poster 1.JPG

Others are just well happy and well dressed!

Poster 2.JPG

We thank all our judges for probing into each poster and researcher’s work, and helping select the six finalists: our six Foster Fellows. After Dr. Michael Brown’s incredible grand rounds lecture on ‘Controlling Cholesterol’ on May 4th, including his friendship with Dr Goldstein and a touching personal tribute to Dr. Seldin, the six Foster Fellows were announced.

On May 11th, the Six Foster Fellow’s presented their work in a 5 minute short-oral form to the UTSW community, including Parkland, Clements and Texas Health. After 2 minutes of fast and furious questioning, it was time for all the audience to VOTE. The audience voted using their phones and paper ballots on the winning presentation and the chosen Seldin Scholar.

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On May 11th, the Six Foster Fellow’s presented their work in a 5 minute short-oral form to the UTSW community, including Parkland, Clements and Texas Health. The sessions were moderated by Dr. Susan Hedayati. After 2 minutes of fast and furious questioning, it was time for all the audience to vote. The audience voted using their phones and paper ballots on the winning presentation and the chosen Seldin Scholar.

While votes were actively tallied, Dr. Johnson took a few minutes to present a special award that specifically recognizes research in quality of care and education at Parkland Hospital. This award was enabled by the Ron Anderson MD Professorship held by Dr. Carlos Girod, supported by a donation from the Hoblitzelle Foundation​ to UT Southwestern.  This award went to Neil Keshvani for his project, “Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-based Chemotherapy at a Safety-Net Hospital.” His mentors were Dr. Jenny Li and Dr. Navid Sadeghi.

Neil.jpg

Dr. Johnson also presented awards to four of the most outstanding case presentations we saw this year at the Symposium.

  • Ari Bennett, for his presentation, Erythromelalgia Gets Misdiagnosed Again and Again
  • Ashlin Christensen-Szalanski, for his presentation, Psychotic, Paranoid, and Parkinsonian
  • John Marshall, for his presentation, Calcitriol-Mediated Hypercalcemia in Borderline Lepromatous Leprosy
  • Mridula Nadamuni, for her presentation, Diarrhea for Days: GI Disturbance as the Presenting Symptom of Anti-DPPX Encephalitis.

Case winners.jpg

 

And then, came the Finale! Votes were in! And in a close race with votes tallied from across all UTSW sites – the 2018 Seldin Scholar was:
Dr. Ezim Ajufo and her mentor Dr. Amit Khera.

Ezim.jpg

Congratulations to all our winners – and to all the housestaff and their fabulous mentors for their submissions.

Final pic.jpg

We also would like thank all those that made this event possible, including Dr. Johnson, Dr. Kazi, Dr. Towler, Dr. Hedayati, the Education Office, Chair’s Office and Research Office, and specifically Chris Huang and Beni Stewart for carrying this event along.

See you in 2019!

— Chiefs

Image Challenge of the Week!

Shown below is the chest film a patient with allergic rhinitis and hyperlipidemia on atorvastatin presenting with cough and shortness of breath.

reverse pulmonary edema
Postgrad Med J. 2015 Jul;91(1077):411-2.

What is the classic descriptor of the above chest film and the associated differential diagnosis? Scroll down for answer.

Continue reading Image Challenge of the Week!

Image Challenge of the Week!

What is the appropriate treatment for the following finding? What are the complications of delaying or lack of adequate treatment?

staghorn-calculus
Case courtesy of Dr Natalie Yang, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a&gt;. From the case <a href=”https://radiopaedia.org/cases/9733″>rID: 9733</a>

Scroll down for answer.

Continue reading Image Challenge of the Week!

Varun Sondhi Publishes in Cell Metabolism

PGY3 Varun Sondhi, one of our PSTPs, published a paper in Cell Metabolism last week. Titled, ”The Hormone FGF21 Stimulates Water Drinking in Response to Ketogenic Diet and Alcohol”, the paper comes from the Mangelsdorf/Kliewer laboratory.

From the UT Southwestern press release:

Why does drinking alcohol or consuming sugar make us thirsty? An international study of mice in Texas and humans in Europe reveals an unexpected anti-dehydration mechanism. In a study published today in Cell Metabolism, UT Southwestern researchers identify a hormone that acts on the brain to increase the desire to drink water in response to specific nutrient stresses that can cause dehydration. The findings are reported by Dr. David Mangelsdorf and Dr. Steven Kliewer – who have run a joint laboratory at UT Southwestern since 2002.

Continue reading Varun Sondhi Publishes in Cell Metabolism