Annual Mount Sinai Morningside_West Internal Medicine Research Week 2024-2025 Abstract Book_FINAL

Annual Icahn School of Medicine Mount Sinai Morningside/West Internal Medicine Residency Research Week

PROGRAM AND ABSTRACTS May 7-8, 2025

Table of Contents Introduction Selection Committee and Oral Presentations List of Abstracts with Posters Abstracts with Posters List of Abstracts 2024-2025 Abstracts 2024-2025 List of Publications 2024-2025 Index of Posters Index of Resident Authors

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Mount Sinai Morningside/West Internal Medicine Residency Annual Research Week May 7-8, 2025

Georgina Osorio, MD, MPH

John A. Andrilli, MD, FACP Program Director Internal Medicine Residency Mount Sinai Morningside/West

Sreekala Raghavan, MD Interim Program Director Internal Medicine Residency Mount Sinai Morningside/West

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Mount Sinai Morningside/West Internal Medicine Residency Research Week Selection Committee 2024-2025 Selection committee members did not participate in the discussion or voting for abstracts in which they were involved or with which they had any additional conflict of interest.

Presenters were selected using a double-blind review process.

COMMITTEE MEMBERS Georgina Osorio, MD, MPH, Chair

John Andrilli, MD, FACP Valida Bajrovic, MD Ruchika Batwara, MD Stephanie Behringer-Massera, MD

Alfred Burger, MD Salvador Caceros Diaz, MD Abel Casso Dominguez, MD Natalie Cedeno, MD Ashish Correa, MD Christina Cruz, MD Deborah Edelman, MD Jason Filopei, MD Lindsey Fox, MD Jennifer Fung, MD Rahul Gaikwad, MD Tamara Goldberg, MD Satwant Grewal, MD Katherine Hawkins, MD, JD Krystle Hernandez, MD

Waleed Javaid, MD Mariam Khandaker, MD Zoe Lawrence, DO David Perlman, MD

Martine Pollack-Zollman, MD Alejandro Prigollini, MD Corinna Psomadakis, MD Sreekala Raghavan, MD Adam Rothman, MD Caileen Sennett, MD Vasundhara Singh, MD Christine Stavropoulos, MD Daniel Steinberg, MD Melissa Wiener, MD, MS

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Abstracts selected to be oral presentations on Wednesday, May 07, 2025 at 8AM.

BASIC SCIENCE Rodrigo Paredes de la Fuente, PGY2 ABSTRACT #96: CIRCULATING TUMOR DNA MUTATIONS AS MARKERS FOR BRAIN METASTASES AT DIAGNOSIS AND DURING TREATMENT

CASE REPORT/CLINICAL REVIEW/CLINICAL VIGNETTE Julia Torrellas, PGY3 ABSTRACT #123: A CASE OF GASTROINTESTINAL ADVERSE EFFECTS OF GLP-1 AGONISTS WHEN USED FOR WEIGHT LOSS

CLINICAL RESEARCH Do Han Kim, PGY2 ABSTRACT #63: SGLT-2 INHIBITOR USE IS ASSOCIATED WITH LOWER MORTALITY AND HEPATIC DECOMPENSATION IN PATIENTS WITH MASH CIRRHOSIS AND TYPE 2 DIABETES MELLITUS: A MULTINATIONAL ANALYSIS

MEDICAL EDUCATION Alexandria Markley, PGY3 ABSTRACT #76: REGIONAL DISPARITIES EXIST IN GENDER REPRESENTATION AMONG GI TRAINEES AND FACULTY IN THE UNITED STATES

QUALITY IMPROVEMENT Piya Kositangool, PGY3 ABSTRACT #66: A LOOK BEHIND THE SCREEN: IMPROVING HEPATITIS B VIRUS SCREENING RATES AT AN URBAN COMMUNITY PRACTICE

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Annual Icahn School of Medicine at Mount Sinai Morningside/West Internal Medicine Residency Research Week

Research Day Judges May 8, 2025

Yousaf, Ali

Fernando Carnavali

Natalie Cedeno

Abel Casso Dominguez

Maya Fakhoury

Lena Fan

Debbie Fermin

Martin Emmanuel Garcia

Justin Gasper

Peter Goulden

Sara Huda

Raymonde Jean 6

Julie Kanevsky

Mariam Khandaker

Se-Min Kim

Brian Markoff

Corinna Psomadakis

Argelis Rivera

Ashwin Sawant

Matthew Seplowe

Samuel Seward

Janet Shapiro

Lauren Shapiro

Avinash Singh

Christine Stavropoulos

Javier J. Zulueta 7

List of Abstracts with Posters

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LIST OF ABSTRACTS WITH POSTERS A POCKET OF UNTAPPED POTENTIAL: SHIFTING PARADIGMS IN PROCEDURAL COMPETENCY Joseph Abraham1, Vasundhara Singh1, Brian Markoff1, Lance Maresky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025, the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025, and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

FRAILTY AND OUTCOMES AFTER BISPECIFIC T-CELL ENGAGER THERAPY FOR PATIENTS WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA Benjamin O. Adegbite1, Carlyn Rose Tan2, Tala Shekarkhand2, Ross S. Firestone2, Eric M. Jurgens2, Kevin Miller2, Alexander M. Lesokhin2, Gunjan L. Shah2, Neha Korde2, Sridevi Rajeeve2, David J. Chung2, Heather J. Landau2, Michael Scordo2, Hani Hassoun2, Kylee H. Maclachlan2, Urvi A. Shah2, Malin Hultcrantz2, Issam S. Hamadeh2, Sergio Giralt2, Sham Mailankody2, Saad Z. Usmani2, Hamza Sloan Hashmi2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 6-9, 2024.

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COORDINATED CARDIAC CARE: OUTCOMES OF A NOVEL WORKSHOP COLLABORATION BETWEEN CARDIOLOGY, EMERGENCY MEDICINE, AND PHYSICAL MEDICINE & REHABILITATION TO IMPROVE COMMUNITY HEALTH *Adedeji Adeniyi1,2, Raysha Farah3, Jaciara N. De Souza2, Juana Merino-Lopez2, Christian Auguste2, Victoria Ngai2, Amulya Marellapudi1, Victor De La Cruz3, Nathan Hankerson2, Jimmy Truong2, Gloria Flex2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Columbia University Irving Medical Center, New York, NY, United States; 3Harvard Medical School, Boston, MA, United States

Presented at the both Student National Medical Association (SNMA) Annual Medical Education Conference that was held in St. Louis, Missouri, United States from April 16-20, 2025 and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

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OPTIMIZING PRE-OPERATIVE GLYCEMIC CONTROL IN THE OUTPATIENT SETTING Arushi Agarwal1, Ilana Bass1, Francisco Diaz1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

AMOXICILLIN-INDUCED CORONARY VASOSPASM: UNCOVERING A RARE CASE OF KOUNIS SYNDROME Uchenna Ajulu1, Kaitlyn Clausell1, Tamara Goldberg1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States *These authors contributed equally to this work.

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LIST OF ABSTRACTS WITH POSTERS

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UNVEILING THE UNCOMMON: ACUTE VALVULITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS WITHOUT LIBMAN-SACKS ENDOCARDITIS Melissa Akselrad1, Tharaka Wijesinghe1, Raagni Kumar1, Michael Kaplan1, Amir Amhadi1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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ADVERSE PREGNANCY OUTCOMES AND EFFECT OF TREATMENT IN WILSON DISEASE DURING PREGNANCY: SYSTEMATIC REVIEW AND META-ANALYSIS Ashley N. Brown1*, M. Marcia Lange1,2*, Lital Aliasi-Sinai3, Xiaotao Zhang1, Sasha Kogan4, Lily Martin1, Tatyana Kushner 1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Brigham and Women's Hospital, Boston, MA, United States; 3Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Jacobs School of Medicine at the University of Buffalo, Buffalo, NY, United States

Published in Liver International, 2024. PMID: 39206599. *These authors contributed equally to this work.

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A DISORGANIZED CASE OF EOSINOPHILIC PNEUMONIA Mohammed Alsaud1, Connor Smith1, Bertin D. Salguero1, Christian M. Lo Cascio1, Mary M. O’Sullivan1, Avinash Singh1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

A UNIQUE CASE OF ADULT-ONSET ATOPIC DERMATITIS MIMICKING VASCULITIS Shubhankar Anand1, Niurka Liranzo Tejera1, John A. Andrilli1

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Allergy, Asthma, and Immunology’s Annual Scientific Meeting that was held in Boston, Massachusetts, United States from October 2428, 2024.

HANDING OVER WITH PRECISION: STANDARDIZING THE HANDOFF FOR INPATIENT MEDICINE Kimberly Fasciglione1, Jood Ani1, Norah Sadek1, Melissa Akselrad1, Randy Leibowitz1, Salvador Caceros Diaz1, Krystle Hernandez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

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ACUTE PANCREATITIS WITH ACUTE KIDNEY INJURY IS ASSOCIATED WITH WORSE 30-DAYS AND 90-DAYS OUTCOMES Do Han Kim1 *, Donghyun Ko2*, Jose A. Porres3, Jordan Arabian1, Wilhelm S. Basegoda4, Frank J. Lukens5, Pedro Palacios Argueta6, Paul T. Kröner7 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT, United States; 3Universidad Francisco Marroquin Facultad de Medicina, Guatemala City, Guatemala; 4University of South Alabama Health System, Mobile, AL, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Thomas Jefferson University Hospital, Philadelphia, PA, United States *These authors contributed equally to this work.

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LIST OF ABSTRACTS WITH POSTERS ENDOVASCULAR AND SURGICAL REVASCULARIZATION FEMOROPOPLITEAL LESIONS Matthew Baer1, Florian Enzmann2, Serdar Farhan3

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TECHNIQUES

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Innsbruck Medical University, Innsbruck, Tyrol, Austria; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Morningside Department of Cardiology’s 2nd Cardiology Multidisciplinary Annual Meeting that was held in New York, New York, United States on June 12, 2024.

NEPHROTIC SYNDROME AS A MANIFESTATION OF OVERLAPPING SYSTEMIC LUPUS ERYTHEMATOSUS AND ANCA-ASSOCIATED VASCULITIS Pragati Basera1, Rodrigo Paredes de la Fuente1, Shota Obata1, Andrea Duque Lopez1, Ruchika Batwara1, Miriam Chung2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Physicians (ACP) Internal Medicine Annual Meeting that was held in New Orleans, Louisiana, United States from April 3-5, 2025.

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A CASE OF WEST NILE NEUROINVASIVE DISEASE Hannah Bava1,2*, Yuhong Yang1,2*, Karen Go1,2, Ko Harada1, Boram Kim1,2, Svetlana Chernyavsky2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Presented at the American College of Physicians (ACP) Internal Medicine Annual Meeting that was held in Boston, Massachusetts, United States from April 18-20, 2024. *These authors contributed equally to this work.

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DECISIONAL AMBIVALENCE OR INCAPACITY? LESSONS FROM A COMPLEX CASE OF ADVANCED KIDNEY DISEASE Raul Benavides1, Tamara Goldberg1, Noelle Javier1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

IT’S ALL ABOUT THE GRADIENT: WARING BLENDER SYNDROME IMPROVES WITH DIURESIS Brandon Berman1, Harrison Bonilla1, Abel Casso Dominguez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society for Cardiovascular Angiography & Interventions (SCAI) Annual Meeting that was held in Washington, DC, United States from May 1-3, 2025.

THE RISE OF E-CIGARETTE SMOKE: A UNIQUE CASE OF VAPING-ASSOCIATED LUNG INJURY Nooshin Beygui1, Sonya Prasad1, Alfred Burger1, Vasundhara Singh1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

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LIST OF ABSTRACTS WITH POSTERS

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OUTCOMES ASSOCIATED WITH GLUCAGON-LIKE PROTEIN RECEPTOR AGONIST USE IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION: A SYSTEMATIC REVIEW AND META ANALYSIS OF RANDOMIZED CONTROL TRIALS Brandon Berman1, Harrison Bonilla¹, Joshua Guardia¹, Esther Tsyngauz¹, Kiran Mahmood1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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PENICILLIN ALLERGY DE-LABELING MADE EASY: EVALUATING A MINIMALINTERVENTION PATIENT OUTREACH STRATEGY Sneha Bupathi1, Desiree Chow2, Songhui Ma2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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REVIEW AND META-ANALYSIS OF GLOBAL LONGITUDINAL STRAIN CHANGES AFTER ANGIOTENSIN RECEPTOR NEPHRILYSIN INHIBITOR INITIATION IN PATIENTS WITH HEART FAILURE Kristen Carter1, Soumya Gupta1, Ashish Correa1, Kiran Mahmood1, Arieh Fox1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 15-17, 2024.

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RARE BUT FATAL SIDE EFFECT OF NOVEL CANCER THERAPIES: IMMUNE CHECKPOINT INHIBITOR-RELATED MYOCARDITIS Changwoong Cho1, Arshdeep Dhaliwal1, Sara Diaz Saravia1, Tamera Goldberg1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

ATYPICAL N3 SLEEP PATTERN IN CRITICALLY ILL PATIENTS AND ITS ROLE AS A MARKER OF OUTCOME Christiana Choi1, Benjamin Samuel1, Suraj Shah2, Arshdeep Dhaliwal1, Connor Smith1, Adrian Chernyk1, Keshav Dixit1, David Tai1, Dan Levendowski2, Priscilla Loanzon1, Lloyd Muzangwa1, Raymonde Ernest Jean1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Advanced Brain Monitoring, Inc., Carlsbad, CA, United States

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To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

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ARTIFICIAL INTELLIGENCE-ENHANCED RECOGNITION OF OCCLUSION IN ACUTE CORONARY SYNDROME: A RETROSPECTIVE REVIEW James Choi1, Vincent Torrelli1, Sara Saravia Diaz1, Esha Vaish1, Luka Katic1, Alexander Nagourney1, Zara Khan1, Alexander Silverman1, Serdar Farhan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 15-17, 2024.

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LIST OF ABSTRACTS WITH POSTERS

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A CHALLENGING DIAGNOSIS OF STREPTOCOCCUS INTERMEDIUS HEPATIC ABSCESS IN A PATIENT WITH COVID-19 INFECTION Emily Cosentino1, Shasawat Kumar1, Kaitlyn Clausell1, Natia Pantsulaia1, Rahul Gaikwad1, Irina Zaretsky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

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INTRACTABLE NAUSEA AND VOMITING DUE TO HYPERTHYROIDISM Sofia Dawson1 and Hoa Chi1,2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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THROMBOTIC THROMBOCYTOPENIC PURPURA INDUCED BY PLASMODIUM FALCIPARUM: A CASE REPORT HIGHLIGHTING DIAGNOSTIC DILEMMAS Mrittika Deb1, Lloyd Muzangwa1, Christiana Choi1, Bridget Dolan1, Nikita Desai1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

THE IMPACT OF DIET ON QUALITY OF LIFE IN PATIENTS WITH PERIANAL FISTULIZING CROHN’S DISEASE Jake DeBroff1, Bharati Dev1, Shabari Shenoy1, Elisabeth Giselbrecht2, Hunter Moran2, Nicole Gbenebitse2, Stephanie Gold2, Serre-Yu Wong2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

A CASE OF LUPINE INDUCED FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME Sara Dehbozorgi1, Sohini Kamdar2, Eugene Choo2 1

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Presented at both the American Academy of Allergy, Asthma, & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress Annual Meeting that was held in San Diego, California, United States from February 28, 2025 to March 3, 2025 and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

CARDIOGENIC SHOCK IN PATIENTS WITH CANCER Sara Diaz Saravia1, Vincent Torelli1, Maninderjit Ghotra1, Samuel Tan1, Marko Novakovic1, Paulus Adinugraha1, Katharine Idrissi1, Basera Sabharwal1, Gagan Sahni2, Matthew I. Tomey1,2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Presented at the Society for Cardiovascular Angiography & Interventions (SCAI) Annual Meeting that was held in Washington, DC, United States from May 1-3, 2025.

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LIST OF ABSTRACTS WITH POSTERS

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A CRYPTIC ESOPHAGEAL LESION: BENIGN OR MALIGNANT? Carlos G. Diola1, Mantej Sehmbhi1, Alexandra Rozalen2, Adelsalam Sharabi2, Edward Lung1, Ian Cohen1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

A PROPER HOME MEDICATION RECONCILIATION UNMASKING WITHDRAWAL IN A CRITICALLY ILL PATIENT Keshav Dixit1, Deborah Edelman1, Amir Ahmadi1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

A CASE OF THYROID STORM REFRACTORY TO MEDICAL MANAGEMENT Paige Dixon1, Suma Gondi2, Jennifer Abrams2, Peter Goulden1 1

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025 and to be presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting that will be held in Orlando, Florida, United States from May 15-17, 2025.

COMPARISON OF GENOMIC LANDSCAPES IN PRIMARY ADENOID CYSTIC CARCINOMA AND SALIVARY PRIMARY AND METASTATIC ADENOID CYSTIC CARCINOMA TUMORS USING SINGLE CELL RNA SEQUENCING Eduard I. Drizik1 and Nicholas Rohs2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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AMPULLA OF VATER ADENOMA: A RARE AND OFTEN MISSED CAUSE OF PANCREATITIS Jose Duran1,2, Jake Debroff1,2, Bharati Dev1,2, Luis Rendon-Rodriguez1,2 1

Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Morningside/West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

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EDEMA AND SEROSITIS AS AN ADVERSE EVENT AMONG PATIENTS WITH CANCER RECEIVING IMMUNE CHECKPOINT BLOCKADE Evelyn Elias1, Mako Koseki1, Fnu Chesta2, Kensuke Takaoka2, Yoshito Nishimura2, Nicholas C.ari Rohs3, Yu Fujiwara4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States 2

Presented at the American Society of Clinical Oncology (ASCO) Annual Meeting that was held in Chicago, Illinois, United States from June 2-6, 2023.

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LIST OF ABSTRACTS WITH POSTERS

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PREDICTIVE VALUE OF PSYCHOSOCIAL FACTORS ON WEIGHT LOSS OF OVERWEIGHT AND OBESE PATIENTS ENROLLED IN WEIGHT MANAGEMENT CLINIC Ryan Eng1 and Rebecca Shafer1

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DOUBLE TROUBLE OR BETTER TOGETHER? DOUBLE ANTIBODY POSITIVE PULMONARY-RENAL SYNDROME Tansu Eris1, Niurka Liranzo Tejera1, Martin Sedlacek1

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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RELATIONSHIP FIRST: ENHANCING PATIENT CONTINUITY IN SEVERAL URBAN FEDERALLY QUALIFIED HEALTHCARE CENTERS Ines Varela Knorr1, Kimberly Fasciglione1, Niurka Liranzo Tejera1, Aphrodite Megaris1, Aesha Patel1, Lauren Shapiro1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

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DEXA BONE-ANZA: OSTEOPOROSIS SCREENING RATES GET A BONA FIDE BOOST FROM EMR TEMPLATES AT A RESIDENT CLINIC Samuel Nemiroff1, Julia Ferreira de Carvalho1, Laura Bock1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Physicians (ACP) Annual Meeting that will be held in Chicago, Illinois, United States from May 13-17, 2025.

BLEEDING IN LUNG CANCER PATIENTS RECEIVING THERAPEUTIC ANTICOAGULATION WHILE BEING TREATED WITH VEGF AND EGFR INHIBITORS Thomas F. Fusillo1, Avi Leader2, Simon Mantha2, Helen Ajufo2, Andriy Derkach2, Adam Schoenfeld2, Rohan Singh2, Peter Kaplinsky2, Jeffrey I. Zwicker2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Memorial Sloan Kettering Cancer Center, New York, NY, United States

2

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 7-10, 2024.

BRIEF ALCOHOL ADVICE IN THE INPATIENT AND OUTPATIENT SETTING Kristine Lou Gargaritano1 and Peter Barelli1

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1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

ENHANCING DELIRIUM DETECTION AND MANAGEMENT: A QUALITY IMPROVEMENT INITIATIVE USING POCKET CARDS FOR FRONTLINE PROVIDERS Stefano Gattazzo1, Ariel Gordon1, Kaitlyn Clausell1, Omar Amir1, Yuji Yamada1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

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LIST OF ABSTRACTS WITH POSTERS

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A TALE OF TWO RESCUE CLIPS: MITRAL-TEER IN LATE PRESENTING STEMI WITH ACUTE MITRAL REGURGITATION AND CARDIOGENIC SHOCK Maninderjit Ghotra1, Samuel Tan1, Marko Novakovic1, Paulus Adinugraha1, Sara Diaz Saravia1, Vincent Torelli1, Lexi Robbins1, Katharine Idrissi1, Basera Sabharwal1, Matthew I. Tomey1,2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Society for Cardiovascular Angiography & Interventions SHOCK Annual Meeting that was held at Washington, D.C., United States from October 17-19, 2024.

ENHANCING PENICILLIN DELABELING Christian Gomez Hernandez1, Erika Tsutsui1, Songhui Ma2

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Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the New York Allergy & Asthma Society Teaching Day that was held in New York, New York, United States in September 2024.

THE ROLE OF COMBINED RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS PLUS BETA BLOCKER THERAPY FOR CARDIOTOXICITY PREVENTION IN PATIENTS UNDER CHEMOTHERAPY FOR BREAST CANCER: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Mohammad I. Khan1, Hannah Hart1, James Choi1, Amir Akbari2, Justin Goodfarb1, Raisa S. Zahir3, Francisco J Romeo4, Kiran Mahmood1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, United Kingdom; 3Wayne State University School of Medicine, Detroit, MI, United States; 4University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, United States 2

Presented at the European Society of Cardiology (ESC) Congress that was held in London, United Kingdom from August 30, 2024 to September 2, 2024.

46

USE OF KETAMINE AND AN INTERDISCIPLINARY TEAM APPROACH TO RAPIDLY TAPER A PATIENT’S ULTRA-HIGH OPIOID REGIMEN Ariel Gordon1, Evan L. Zazula2, Joseph D. Elder2, Estelle Jungah Hong3, Jordan NickelDubin3, Yu Shindo2, Ayla Pelleg2, Laura Belland2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York University, New York, NY, United States 2

Presented at the Annual Assembly of Hospice and Palliative Meeting that was held in Phoenix, Arizona, United States from March 20-23, 2024.

47

COMPARATIVE ANALYSIS OF DRIVER MUTATIONS, CANCER STAGE, AND METASTATIC BURDEN IN PATIENTS WITH LUNG ADENOCARCINOMA WITH PRISM COMPARED TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND NORMAL LUNG FUNCTION Toshiro Goto1, Rodrigo Paredes1, Jorge Gomez2, Christian Rolfo3, David Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University, Columbus, OH, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

16

LIST OF ABSTRACTS WITH POSTERS

48

PROTEIN-LOSING ENTEROPATHY IN AIDS: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE Joel Grimaldo Ochoa1, Harsimran Bhatia1, Argelis Rivera1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

49

PLATYPNEA ORTHODEOXIA SYNDROME SECONDARY TO AN IATROGENIC ATRIAL SEPTAL DEFECT Joshua Guardia1, Joyce Gu2, Aesha Patel1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Lake Erie College of Osteopathic Medicine, Seton Hill, PA, United States

2

50

51

CLINICAL OUTCOMES OF SGLT2 INHIBITORS IN PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE: A META-ANALYSIS OF RANDOMIZED CONTROL TRIALS Soumya Gupta1, Won Joon Koh1, Hanna Hart1, Kiran Mahmood1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

THE USE OF MAVACAMTEN FOR MANAGEMENT OF POST TRANSCATHETER AORTIC VALVE REPLACEMENT OBSTRUCTION: A NOVEL APPROACH TO TREATMENT Hannah Hart1, Prabhjot Grewal1, Karan Sud1, Abel Casso Dominguez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

52

A RETROSPECTIVE ANALYSIS OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA, ASTHMA, AND COPD BY HOME SLEEP TESTING OUTCOMES William He1, Toshiro Goto1, Zachary Roberts2, Vincent Grbach2, Boris Gilyadov2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

53 54

LACTATE AS A PREDICTOR IN SEPSIS OUTCOMES Chad Henry1, William Wallach1, Alvin Yang1, Jorge Sinclair1, Benjamin Samuel1, Lloyd Muzangwa1, Raymonde Jean1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

RECURRENT HYPOGLYCEMIA IN TYPE 1 DIABETES: A CASE HIGHLIGHTING HYPOGLYCEMIA UNAWARENESS AND MORTALITY RISK Rayling Herrera1 and Lauren Shapiro1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

17

LIST OF ABSTRACTS WITH POSTERS

55

PREDICTIVE VALUE OF THE CANCER AND AGING RESEARCH GROUP GERIATRIC SCORE FOR CHEMOTHERAPY TOXICITIES IN OLDER ADULTS WITH CANCER Kohei Horiuchi1, Toshiki Kuno2, Hisato Takagi3, Debora Afezolli4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Montefiore Medical Center, Bronx, NY, United States; 3Shizuoka Medical Center, Shizuoka, Japan; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the International Society of Geriatric Oncology (SIOG) Annual Meeting that was held in Montreal, Québec, Canada from October 17-19, 2024.

56 57

NATURAL HISTORY SUPPORTS ACTIONABLE GASTROESOPHAGEAL REFLUX DISEASE IN LOS ANGELES GRADE B ESOPHAGITIS Rama Hussein1, Soha Noorani1, Yuying Luo1, Daniela Jodorkovsky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

BEYOND THE USUAL SUSPECT: HEPARIN-INDUCED THROMBOCYTOPENIA DUE TO ENOXAPARIN Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Jason Piersaint1, Kata Boros1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

58 59

COMPLETE FOR TREATS: IMPROVING MEDICATION RECONCILIATION WITHIN 24 HOURS OF HOSPITAL ADMISSION AT MOUNT SINAI WEST HOSPITAL Loren Barhold1, Samuel Johnson1, Kristy Huang1, Krystle Hernandez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

NEW PRESENTATION OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY FOLLOWING CHEMOTHERAPY Luka Katic1, Vincent Sinatra1, Krysthel Engstrom1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

60

OUTPATIENT ENIGMA: FEVER OF UNKNOWN ORIGIN IN A SENIOR PATIENT WITH A COMPLICATED PAST Madison Kennedy1, Salvador Caceros Diaz1, Tamara Goldberg1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

61

THE EFFICACY OF CATHETER ABLATION COMPARED TO MEDICAL THERAPY IN HEART FAILURE PATIENTS WITH CONCOMITANT ATRIAL FIBRILLATION Mohammad Ishrak Khan1, James Choi1, Amir Reza Akbari2, Hannah Hart1, Justin Goodfarb1, Francisco Jose Romeo3, Kiran Mahmood1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, United Kingdom; 4University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, United States 2

Presented at the European Society of Cardiology (ESC) Congress that was held in London, United Kingdom from August 30, 2024 to September 2, 2024.

18

LIST OF ABSTRACTS WITH POSTERS

62

BITTEN BY THE LOVE BUG! ATRIAL FIBRILLATION SECONDARY TO CHRONIC CHAGAS CARDIOMYOPATHY Zara Khan1, Sneha Bupathi1, Jared Levanthal1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

63

SGLT-2 INHIBITOR USE IS ASSOCIATED WITH LOWER MORTALITY AND HEPATIC DECOMPENSATION IN PATIENTS WITH MASH CIRRHOSIS AND TYPE 2 DIABETES MELLITUS: A MULTINATIONAL ANALYSIS Do Han Kim1, Donghyun Ko2, Jose A. Porres3, Wilhelm S. Basegoda4, Luis M. Nieto5, Pedro Palacios Argueta6, Paul T. Kröner7, Frank Lukens8 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad Francisco Marroquin Facultad de Medicina, Guatemala City, Guatemala; 4University of South Alabama Health System, Mobile, AL, United States; 5Emory University, Atlanta, GA, United States; 6Thomas Jefferson University Hospital, Philadelphia, PA, United States; 7Riverside Health System, Newport News, VA, United States; 8Mayo Clinic in Florida, Jacksonville, FL, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

64

META-ANALYSIS OF CLINICAL OUTCOMES AMONG BALLOON ANGIOPLASTY, DRUG-COATED BALLOONS, AND SECOND- OR NEWER-GENERATION DRUGELUTING STENTS Yuko Kiyohara1, Tadao Aikawa2,3, Toshiki Kuno4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Jichi Medical University Saitama Medical Center, Saitama, Japan; 3Hokkaido Cardiovascular Hospital, Sapporo, Japan; 4 Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

Presented at the Transcatheter Cardiovascular Therapeutics (TCT) Annual Meeting that was held in Washington, D.C., United States from October 27-30, 2024.

65

ASSOCIATION BETWEEN INFLAMMATORY BOWEL DISEASE AND HIDRADENITIS SUPPURATIVA Mako Koseki1, Ahuva Cices2, Ross O’Hagan2, Lauren Lenz2, Scott Stratman2, Diana Ruiz2, Aaron Rips3, Adam Faye3, Sydney Roth5, Dana Lukin5, Vivek Mohan6, Ruby Greywoode6, Manasi Agrawal5, Jean-Frederic Colombel2, Benjamin Ungar2, Serre-Yu Wong2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York University Langone Health, New York, NY, United States; 5Weill Cornell Medicine, New York, NY, United States; 6Montefiore Medical Center, Bronx, NY, United States

Presented at both the Crohn’s & Colitis Congress Annual Meeting that was held in San Francisco, California, United States from February 6-8, 2025 and the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

66

A LOOK BEHIND THE SCREEN: IMPROVING HEPATITIS B VIRUS SCREENING RATES AT AN URBAN COMMUNITY PRACTICE Piya Kositangool1, Jake Debroff1, Bharati Dev1, Anna Mageras2, Desiree Chow3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

19

LIST OF ABSTRACTS WITH POSTERS ASSESSING INTERNAL MEDICINE RESIDENTS' CONFIDENCE AND KNOWLEDGE GAPS IN INPATIENT VERSUS OUTPATIENT EXPENSES Sarah Kosse1, Ann Mercurio1, Sara Luby1, Lindsey Fox1, Vasundhara Singh1

67

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025. *All authors contributed equally to the project.

68

OUTCOMES AND DISPARITIES OF ASIAN PATIENTS WITH SEVERE CHRONIC KIDNEY DISEASE ADMITTED FOR HEART FAILURE Samuel Tan1, Wenchy Siu1, Shasawat Kumar1, Paulus Adinugraha1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Philadelphia, Pennsylvania, United States on November 11, 2023.

THYROID ACROPACHY: A CLINICAL RESPONSE TO TEPROTUMUMAB Javier Lira1, Mone Zaidi2, Se Min Kim2,3

69

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the Endocrine Society’s (ENDO) Annual Meeting that was held in Boston, Massachusetts, United States from June 1-4, 2024.

SARCOIDOSIS BEYOND THE LUNG Niurka Liranzo Tejera1 and Shu Min Lao1,2

70 71

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

SEPSIS Scott Low1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

LEPROSY MIMICKING ATYPICAL ANTIPHOSPHOLIPID SYNDROME Sophia Lutgen1, Murilo Roberto Bastos Silva, Michael Kaplan1

72

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, NY, United States

2

Presented at the Congress of Clinical Rheumatology Annual Meeting held in Destin, Florida, United States from May 8-12, 2024.

20

LIST OF ABSTRACTS WITH POSTERS

73

EFFECT OF CARDIAC AMYLOIDOSIS ON TRANSCATHETER AORTIC VALVE REPLACEMENT IN LOW-FLOW LOW-GRADIENT AORTIC STENOSIS Joseph Maenza1, Lakshay Chopra1, Francesca Prandi2, Ranbir Singh2, Parasuram Krishnamoorthy2, Gilbert H. L. Tang2, Samin K. Sharma2, Annapoorna S. Kini2, Stamatios Lerakis2 1

Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the London Valves Conference that was held in London, England, United Kingdom from November 24-26, 2024 and published in the Cardiovascular Revascularization Medicine, 2024. PMID: 39550305.

74

IMPACT OF ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE AND SEVERE MITRAL REGURGITATION UNDERGOING TRANSCATHETER EDGE-TOEDGE REPAIR Carlo Mannina1,2, Akarsh Sharma3, Yash Prakash3, Andreina Carbone4, Eduardo Bossone5, Antonino Tuttolomondo2, Edgar Argulian1, Sahil Khera3, Parasuram MelarcodeKrishnamoorthy3, George Dangas3, Jonathan Halperin3, Gilbert H L Tang 3, Samin Sharma3, Annapoorna Kini3, Gregg W. Stone3, Stamatios Lerakis3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Palermo, Palermo, Italy; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4University Hospital "Luigi Vanvitelli", Naples, Italy; 5Federico II University, Naples, Italy 2

75

GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST PRESCRIBING PATTERNS IN AN URBAN OUTPATIENT HEART FAILURE POPULATION Joseph Marinelli1, Christopher N. Matthews1, Anna Mueller1, Vincent Torelli1, Alexander Silverman1, Zara Khan1, Ashish Correa1, Arieh Fox1, Kiran Mahmood1 1

Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

76

REGIONAL DISPARITIES EXIST IN GENDER REPRESENTATION AMONG GASTROENTEROLOGY TRAINEES AND FACULTY IN THE UNITED STATES Alexandria Markley1*, Marni Wilkoff1*, Nivita Sharma2, Rama Hussein1, Mako Koseki1, Rashmi Advani3, Yuying Luo1, Haley M Zylberberg4, Loren G Rabinowitz5 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Duke University School of Medicine, Durham, NC, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Weill Cornell Medicine, New York, NY, United States; 5Beth Israel Deaconess Medical Center, Boston, MA, United States 2

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025. *These authors contributed equally to this work.

77

PRIMARY CUTANEOUS CRYPTOCOCCOSIS CAUSED NEOFORMANS IN AN IMMUNOCOMPETENT PATIENT Olga Marushchak1, Shane A. Meehan2, Sue Ann Wee3

BY

CRYPTOCOCCUS

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; New York University Grossman School of Medicine, New York, NY, United States; 3The Art & Science of Dermatology, PC, New York, NY, United States 2

Published in the SKIN The Journal of Cutaneous Medicine, 2023.

21

LIST OF ABSTRACTS WITH POSTERS

78

PROGNOSTIC IMPACT OF BASELINE PULMONARY HYPERTENSION, TRICUSPID REGURGITATION, AND RIGHT VENTRICULAR FUNCTION ON OUTCOMES AFTER TRANSCATHETER MITRAL VALVE PROCEDURES Christopher N. Matthews1, Brandon Berman1, Sara Diaz Saravia1, Abel Casso Dominguez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Meeting that was held in Washington, D.C, United States from May 1-3, 2025.

79 80

DISCUSSING CLINICAL STATUS AND DELIVERING SERIOUS ILLNESS NEWS: A NEEDS ASSESSMENT OF INTERNAL MEDICINE RESIDENTS Anahi McIntyre1 and Georgina Osorio1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

IMPROVING HEALTH CARE PROXY DOCUMENTATION ON MEDICINE FLOORS Aphrodite Megaris1, Hannah Bava1, Elisabeth Rosen1, Joy McIlvaine1, Lina Miyakawa1 1

Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

THE GENDER SCOPE: ELEVATING PATIENT COMFORT FOR DIRECT ACCESS PROCEDURES Sonia Mehra1, Lauren Alpert2, Jeanette Rios2, Lina Jandorf3, Zoe Gottlieb3, Tatyana Kushner4, Yuying Luo1

81

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Weill Cornell Medicine, New York, NY, United States

Presented at both the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024 and the New York Society for Gastroenterology & Endoscopy (NYSGE) Annual Meeting that was held in New York, New York, United States from December 12-13, 2024.

82

HEALTHCARE PROXY DOCUMENTATION QUALITY IMPROVEMENT INITIATIVE Shruti D. Ramachandra1, Alyson Meyer1, Madeline Reznik1, Aphrodite Megaris1, Lindsey Fox1

83

NAVIGATING DIAGNOSTIC CHALLENGES: MISIDENTIFIED AS MULTIPLE MYELOMA Lance Maresky1*, Jiaxi Miao1*, Olivia Skiro1

84

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States *These authors contributed equally to this work.

A CASE

OF

BREAST

CANCER

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States *These primary authors contributed equally to this work.

A CASE STUDY OF ACQUIRED HEMOPHILIA A IN A 93-YEAR-OLD FEMALE PRESENTING WITH THIGH HEMATOMA Serene Mirza1, Tharaka Wijesinghe1, Brett Sherman1, Vongai Tizora2, David Fruchter1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

22

LIST OF ABSTRACTS WITH POSTERS

85

VERY HIGH DONOR-DERIVED CELL-FREE DNA LEVELS ARE ASSOCIATED WITH INCREASED MORTALITY RATES IN HEART TRANSPLANT RECIPIENTS Catherine M. Moeller1,2, Andrea Fernandez Valledor2,3, Daniel Oren2, Adi Hertz2, Anamarija Priscan1, Christopher Musial1, Salwa Rahman2, Boaz Elad2, Julia Baranowska2, Carolyn Ann Hennecken2, Jayant K. Raikhelkar2, Justin A. Fried2, Kevin J. Clerkin2, Kyung T. Oh2, David Bae2, David Majure3, Dor Lotan2, Adil Yunis2, Ersilia M. DeFilippis2, Farhana Latif2, Nir Uriel2, Gabriel T. Sayer2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Columbia University Irving Medical Center, New York, NY, United States; 3Weill Cornell Medical College, New York, NY, United States

Presented at the International Society for Heart and Lung Transplantation Conference that was held in Boston, Massachusetts, United States on April 29, 2025.

86

REFRACTORY ERYTHEMA NODOSUM LEPROSUM WITH BIOLOGIC FAILURE: EXPLORING NOVEL THERAPIES Nicole Morel1, Yuhong Yang1, Corinna E. Psomadakis1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

87

CHEMOIMMUNOTHERAPY AS TREATMENT FOR PANCREATIC NEUROENDOCRINE CARCINOMA: SURVIVAL OUTCOMES AND IMMUNOGENOMIC ANALYSIS Drew Moss1, Catherine O’Connor2, Zeynep Tarcan2,3, Taehyung Kim2,3, Maria Perry2, Rohit Thumalapalli2,3,4, Olca Basturk2,3, Marsha Reyngold2,3,4, Kevin Soares2,3,4, Geoffrey Ku2,3, Zoe Goldberg2,3, David Kelsen2,3,4, James Harding2,3, Vinod Balachandran2,3,4, Chris Crane2,3,4, Christine Iacobuzio2,3,4, William Jarnagin2,3,4, Nitya Raj2,3,4, Diane ReidyLagunes2,3,4, Eileen M. O’Reilly2,3,4,5, Wungki Park2,3,4,5 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3Weill Cornell Medical College, New York, NY, United States; 4 David M. Rubenstein Center for Pancreas Cancer Research, New York, NY, United States; 5Parker Institute for Cancer Immunotherapy, New York, NY, United States

Presented at the Society for Immunotherapy of Cancer (SITC) Annual Meeting that was held in Houston, Texas, United States from November 6-10, 2024.

88

SUBCLINICAL ATHEROSCLEROSIS DETECTION: THE IMPORTANCE OF IMAGING IN LOW AND BORDERLINE RISK POPULATIONS Anna Mueller1, Nima Nasibi1, Taraneh Zamani1, Leila Nia1, Edgar Argulian1, Jagat Narula2, Jonathon Leipsic3, Amir Ahmadi1 ¹Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; ²University of the Texas Health, Houston, TX, United States; ³ University of British Columbia, Vancouver, BC, Canada

Presented at the American College of Cardiology (ACC) Annual Meeting that was held in Chicago, Illinois, United States from March 29–31, 2025.

89

A RARE CASE OF SPINAL CORD COMPRESSION SECONDARY TO SPINAL BROWN TUMOR IN A MIDDLE-AGED FEMALE WITH END-STAGE RENAL DISEASE ON HEMODIALYSIS Fahema Nadira 1, Tamara Goldberg 1, Lindsey Fox 1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025 and to be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

23

LIST OF ABSTRACTS WITH POSTERS

90

ERTAPENEM-INDUCED HALLUCINATIONS IN A HEMODIALYSIS PATIENT Natalie Nedley1, Melissa Akselrad1, Changwoong Cho1, Forough Hakimzada1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

ECTOPIC CERVICAL THYMOMA IN A PATIENT DIAGNOSED WITH GRAVES DISEASE Samuel Nemiroff1, Raymond Chai2, Jun Fan2, Ilana Ramer-Bass1

91

92

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Published in the Journal of Clinical Endocrinology and Metabolism, 2023.

PMID: 38169312 A RARE CASE OF PROLONGED BENZODIAZEPINE ELIMINATION Archana Pattupara1, Destiny Nguyen2, Mrunalini Gaikwad2, Marlis Gnirke3, Silpa Yarra2, Mark K. Su3, Young Lee2, Aniket Sharma4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York University Langone/Bellevue Hospital Center, New York, NY, United States; 4Mount Sinai Hospital, Long Island City, NY, United States 2

Presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Diego, California, United States from May 17-22, 2024.

93

94

CONFIRMING THE CONCORDANCE OF LA GRADE B ESOPHAGITIS WITH GASTROESOPHAGEAL REFLUX DISEASE ON REFLUX QUANTIFICATION TESTING Soha Noorani1, Rama Hussein1, Yuying Luo1, Daniela Jodorkovsky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

A NOVEL CASE OF IGA NEPHROPATHY AND TUBULOINTERSTITIAL NEPHRITIS IN PATIENTS WITH CROHN’S DISEASE TREATED WITH ADALIMUMAB – WHAT IS THE CULPRIT? Shota Obata1 and Martine Pollack-Zollman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Nephrology Annual Meeting that was held in San Diego, California, United States from October 23-27, 2024.

95

FATAL AEROCOCCUS URINAE ENDOCARDITIS IN A YOUNG PATIENT WITHOUT RISK FACTORS Benita Panigrahi1, Sean Liu2, Lance Maresky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

24

LIST OF ABSTRACTS WITH POSTERS

96

CIRCULATING TUMOR DNA MUTATIONS AS MARKERS FOR BRAIN METASTASES AT DIAGNOSIS AND DURING TREATMENT Rodrigo Paredes de la Fuente1, Toshiro Goto1, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University Comprehensive Center, Columbus, OH, United States 2

Presented at the International Association for the Study of Lung Cancer (IASLC) Annual Meeting was held in San Diego, California, United States from September 7-10, 2024.

97

ASSESSING THE IMPACT OF RADIOLOGIC EMPHYSEMA REPORTING ON FOLLOWUP COMPLIANCE FOR INCIDENTAL LUNG NODULES: IMPLICATIONS FOR MALIGNANCY DETECTION Aesha Patel1, Oluwatumilara Akeke1, Junyu Qi1, Alvin Yang1, Nicolette Lam1, Sasha Adler1, Victor Wang1, Steven Lim1, Javier Zulueta1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 17-22, 2025.

98

UNDERSTANDING LONG-TERM CANCER RISKS: OUTCOMES OF POSITIVE STOOL DNA TESTS WITH NEGATIVE COLONOSCOPIES Swati Patel1, Jin Woo Yoo2, Mark A. Schattner2, Arnold J. Markowitz2, Robin B. Mendelsohn2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

99

100

POSTPARTUM THROMBOTIC MICROANGIOPATHY: HELLP, TTP OR AHUS? Anamarija Priscan1 and Martin Sedlacek1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

REAL-WORLD EFFECTIVENESS OF UPADACITINIB FOR PERIANAL CROHN’S DISEASE: A MULTI-CENTER RETROSPECTIVE STUDY Jalpa Devi1, Baseer Quraishi2, Bharati Dev2, Meredith Kline3, Fnu Jaiprada1, Katherine Huang1, Abdul Khan4, Sami Alanazi5, Alyssa Anita Seeraj5, Laura Maas6, Arpita Jajoo6, Navreet Chowla7, Molly stone8, Tingyi Tan1, Anish Patel9, Anthony Xu10, Richa Shukla10, Shrinivas Bishu8, Amanda M. Johnson7, Alyssa Parian6, Andres J Yarur4, Jeffery McCurdy5, Benjamin D McDonald3, Serre-Yu Wong2, Parakkal Deepak1 1

Washington University School of Medicine in St. Louis, Saint Louis, MO, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, United States; 4Cedars-Sinai Medical Center, Los Angeles, CA, United States; 5University of Ottawa, Ottawa, Ontario, Canada; 6Johns Hopkins University, Baltimore, MD, United States; 7Mayo Clinic, Rochester, MN, United States; 8University of Michigan, Ann Arbor, MI, United States; 9Brooke Army Medical Center, San Antonio, TX, United States; 10Baylor College of Medicine, Houston, TX, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

25

LIST OF ABSTRACTS WITH POSTERS

101 102

103

ISOLATED ENDOBRONCHIAL TELANGIECTASIAS HEMOPTYSIS Shruti Ramachandra1, Steven Lim1, Avinash Singh1

AS

A RARE

CAUSE

OF

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians Annual Meeting held in Boston, Massachusetts, United States from October 6-9, 2024.

A SHOCKING CASE SERIES OF INVASIVE GROUP A STREPTOCOCCUS Catherine Zaw1, Andrea Ramirez Cazares1, Nikita Desai1, Meagan Murphy1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 17-22, 2025.

CELIAC DISEASE AND INFLAMMATORY BOWEL DISEASE: CHARACTERISTICS OF A DUAL DIAGNOSIS Alexandria Markley1, Luis Rendon Rodriguez1, Carlos Diola1, Yonatan Israel2, Haley Waite2, Peter HR Green3, Christopher Cao2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, New York, NY, United States; 3Columbia University Irving Medical Center, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

104

A POSSIBLE UNIFYING DIAGNOSIS IN A CASE OF NEW HEART FAILURE AND ENDOCARDITIS IN A PATIENT WITH MULTIPLE AUTOIMMUNE DISEASES Masih A. Babagoli1, Norah Sadek2, Kiran Mahmood2, Arieh Fox2, Basera Kaur Sabharwal2, Ashish Correa2 1

Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

105

UNMASKING AN INTRACARDIAC SHUNT IN A CASE OF PERSISTENT UNEXPLAINED HYPOXIA Sanjay Sivalokanathan1,2, Usman Saeedullah2, Komail Jafri2, Harrison Bonilla2, Auston Locke1, Maria Giovanna Trivieri3 1

Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in Reports, 2025.

106

NOT WITHOUT RISK, A CASE OF SEVERE LIFE-THREATENING NALOXONE INDUCED NONCARDIOGENIC PULMONARY EDEMA Benjamin Samuel1, Patrick Tobin-Schnittger1, Nikita Desai1, Sanam Ahmed1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting to be held in San Francisco, California, United States from May 16-21, 2025.

26

LIST OF ABSTRACTS WITH POSTERS

107

GLUCAGON-LIKE PEPTIDE RECEPTOR AGONIST (GLP-1 RA) USE IS NOT AN INDEPENDENT PREDICTOR OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) ON QUANTITATIVE REFLUX TESTING Robinderpal Sandhu1, Alexandria Markley1, Emily S. Seltzer1, Joseph Abraham1, Rama Hussein1, Binoy Desai1, James Choi1, Kimberly Cavaliere1, Yuying Luo1, Michael S. Smith1,2, Daniela Jodorkovsky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Digestive Diseases Week (DDW) Annual Meeting that was held in Washington DC, United States from May 18-21, 2024.

108

RAPID DETERIORATION IN HHV-8-ASSOCIATED MULTICENTRIC CASTLEMAN DISEASE IN AN UNCONTROLLED HUMAN IMMUNODEFICIENCY VIRUS PATIENT Yoshihiro Sawaguchi1 and Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

109

IMPACT OF DARATUMUMAB REFRACTORINESS ON CLINICAL OUTCOMES FOLLOWING CAR T-CELL THERAPY FOR RELAPSED/REFRACTORY MULTIPLE MYELOMA Tara Sebastian1, Sridevi Rajeeve2, Bruno Almeida Costa3, Eric Jurgens2, Noriko Nishimura2, Tasmin Farzana4, Ross Firestone2, Kevin Miller2, Alexander M. Lesokhin2,4, Gunjan L. Shah2, Neha Korde2,4, Carlyn Rose Tan4, David J. Chung2, Heather J. Landau2, Michael Scordo2, Hani Hassoun2,4, Kylee H. Maclachlan4, Urvi A. Shah2, Malin Hultcrantz2, Issam S. Hamadeh2, Sergio A. Giralt2,4, Sham Mailankody2, Saad Z. Usmani2,4, Hamza Hashmi2,4 1

Mount Sinai Morningside-West Hospitals, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3Mount Sinai Hospital, New York, NY, United States; 4Weill Cornell Medical College, New York, NY, United States

Presented at the Tandem Meetings Annual Meeting that was held in Honolulu, Hawaii, United States from February 12-15, 2025.

110

A RARE CASE OF INTERSTITIAL LUNG DISEASE FROM ANTISYNTHETASE SYNDROME WITH CONCOMITANT BREAST CANCER Aesha Patel1, Priya Shah1, Nicole Ng2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 14-19, 2025.

111

ADVANCED THERAPIES FOR ACUTE PULMONARY EMBOLISM AND RV FUNCTION ON OUTPATIENT FOLLOW-UP: A CROSS-SECTIONAL STUDY Hammad Sheikh1, Connor Smith1, Howard Freeman1, Jeeyune Bahk2, Avinash Singh1, Abdul Rehman3, Keshav Dixit1, Alvin Yang1, Maria Riasat1, Sakul Sakul1, Edgar Argulian1, David J. Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Tidal Health Peninsula Regional, Salisbury, MD, United States 2

27

LIST OF ABSTRACTS WITH POSTERS

112

DIAGNOSIS OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION USING DEEP LEARNING ON ELECTROCARDIOGRAMS Samantha V. Shetty1, Joshua Lampert2, Joy Jiang3, Girish NadkarnI2, Akhil Vaid2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

113

IMPACT OF COVID-19 ON GERIATRIC eLEARNING: NEW USER DEMOGRAPHIC SHIFTS IN THE VA GERIATRIC SCHOLARS PROGRAM Yuka Shichijo1, Eugenia Dorisca2, Helen Fernandez3, Judith Howe2,3, Fred Ko2,3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2James J. Peters VA Medical Center, Bronx, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the James J. Peters Veterans Affairs Medical Center Annual Research Day that was held in Bronx, New York, United States that was held on May 23, 2024.

114

THE ROLE OF THE COMPOSITE PULMONARY EMBOLISM SHOCK SCORE IN OUTCOME PREDICTION OF INTERMEDIATE-RISK PULMONARY EMBOLISM Jorge Sinclair De Frias1, Agostina Velo1, Aesha Patel1, Hammad Sheikh1, Hong Yu Wang1, Destiny Nguyen1, Priyanka Sridhar1, Madeline Ehrlich2, Abdul Rehman3, Avinash Singh1, Robert Lookstein4, David Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Rutgers-New Jersey Medical School, Newark, NJ, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

To be presented at the American Thoracic Society (ATS) Annual Meeting to be held in San Francisco, California, United States from May 16-21, 2025.

ORAL DECITABINE/CEDAZURIDINE IS A TOLERABLE AND EFFECTIVE AMBULATORY REGIMEN FOR PATIENTS WITH ADVANCED MYELOPROLIFERATIVE NEOPLASMS

115

Ganesh Sivakumar1, Shivani Handa 2, Andrew Srisuwananukorn3, Douglas Tremblay 2, John Mascarenhas 2, Marina Kremyanskaya2, Yelena Ginzburg 2, Xiaoli Wang2, Ronald Hoffman2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States

Presented at the American Society of Hematology (ASH) Annual Meeting held at San Diego, California, United States from December 9-12, 2023.

HYPERSOMNIA IN THE INTENSIVE CARE UNIT: A MARKER FOR POOR OUTCOMES?

116

Suraj Shah1, Adrian Chernyk1, Christiana Choi1, Keshav Dixit1, Priscilla V. Loanzon1, Hua-hsin Tai1, Alvin Yang1, Connor Smith1, Benjamin Samuel1, Hammad Sheikh1, Arshdeep Dhaliwal1, Idayat Brimah1, Deepanjali Radhakrishnan Nair1, Daniel Levendowski2, Raymonde Jean1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Advanced Brain Monitoring, Carlsbad, CA, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting held at Boston, Massachusetts, United States from October 6-9, 2024.

28

LIST OF ABSTRACTS WITH POSTERS

117

EARLY IDENTIFICATION OF VITAMIN B12 DEFICIENCY: A CRITICAL STEP IN PREVENTING REVERSIBLE COMPLICATIONS AND SCREENING FOR UNDERLYING MALIGNANCY Astitva Soni1, Maninderjit Ghotra1, Forough Hakimzada1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

END-OF-LIFE CHEAT SHEET: AN END-OF-LIFE SYMPTOM MANAGEMENT POCKET REFERENCE CARD FOR RESIDENTS AND GENERAL INTERNISTS Dylan Suyama1, Raul Benavides1, Yu Shindo2, Noelle Marie Javier2

118

119

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at both the McGill International Palliative Care Annual Congress that was held in Montreal, Québec, Canada from October 15-18, 2024 and Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

AN INTROSPECTIVE LOOK INTO ULTRASOUND CURRICULUM – INTRODUCING BASIC ULTRASOUND TECHNIQUES THROUGH ULTRASOUND-GUIDED INTRAVENOUS LINE INSERTION Hua-Hsin Tai1 and Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

120 121 122

ETHNIC DIFFERENCE IN SPONTANEOUS CORONARY ARTERY DISSECTION Samuel Tan1, Lucy S. Zheng1, Wenchy Tan1, Shasawat Kumar1, Esha Vaish1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held in Atlanta, Georgia, United States from April 6-8, 2024.

ASSOCIATION OF Z-CODES WITH MORTALITY AND DIALYSIS IN PATIENTS WITH ACUTE KIDNEY INJURY AND HEART FAILURE Wenchy Tan1, Samuel Tan1, Lili Chan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Nephrology Society Annual Meeting held in San Diego, California, United states from October 23-27, 2024.

BIOPSY IN CARDIAC SARCOIDOSIS: IS IT CRUCIAL FOR PREDICTING ARRHYTHMIAS AND GUIDING DEVICE THERAPY? Vincent Torrelli1, Alexander Silverman1, Usman Saeedullah1, Syed Zaidi1, Komail Jafri1, Luka Katic1, Sanjay Sivalokanathan1, Ashish Correa1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

123

A CASE OF GASTROINTESTINAL ADVERSE EFFECTS OF GLP-1 AGONISTS WHEN USED FOR WEIGHT LOSS Julia Torrellas1 and Alfred Burger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

29

LIST OF ABSTRACTS WITH POSTERS

124

OUTCOMES ASSOCIATED WITH GLP1 RECEPTOR AGONIST USE ON PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION Brandon Berman1, Esther Tsyngauz1, Harrison Bonilla1, Joshua Guardia1, Kiran Mahmood1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

125

PERSONALIZED TARGETED THERAPY OF CAR+ T-CELL LYMPHOMA AFTER ANTIBCMA CAR-T Oliver Van Oekelen1*, Adolfo Alema2*, David T. Melnekoff2, Leah Grossman2, Tarek Mouhieddine2, Agata Kurowski2, Shannon Meledathu2, Malini P. Naidu2, Ivan Odak2, Sidorela Reci2, Shriya Desai2, Katerina Kappes2, Ksenyia Serebryakova2, Hayley Jackson2, Jordan Lu2, Anastasia Chatikhine3, Christian Rayamajhi2, Shambavi Richard2, Adrianna Rossi2, Joshua D. Brody2, Christian Salib2, Jane Houldsworth2, Patrick M. Brunner2, Alessandro Laganà2, Sundar Jagannath2, Samir Parekh2,4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Bedminster Township Highschool, Bedminister NJ, United States; 4Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025. *These authors contributed equally to this work.

126

127

CHALLENGING ASSUMPTIONS: IS THERE EVIDENCE THAT GASTROPARESIS INCREASES THE RISK OF GASTROESOPHAGEAL REFLUX DISEASE? Ines Varela Knorr1, Yuying Luo1, Daniela Jodorkovsky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

OUTCOMES OF PATIENTS WITH INTERMEDIATE-LOW RISK ACUTE PULMONARY EMBOLISM MANAGED IN THE INTENSIVE CARE UNIT VERSUS MEDICINE FLOORS: A PROPENSITY SCORE-MATCHED ANALYSIS Agostina Velo1, Jorge Sinclair De Frias1, Aesha Patel1, Hong Yu Wang1, Hammad Sheikh1, Destiny Nguyen1, Priyanka Sridhar1, Abdul Rehman2, Avinash Singh1, Robert Lookstein3, David J. Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Rutgers-New Jersey Medical School, Newark, NJ, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

To be presented at the American Thoracic Society (ATS) Annual Meeting to be held in San Francisco, California, United States from May 16-23, 2025.

CLINICAL OUTCOMES FOR BLACK PATIENTS WITH URTICARIA Megha Verma1, Danielle C. Thor2, Tony Elias3, Mahija Cheekati4, Marie Mccleary5 1

128

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Jefferson Health New Jersey, New Jersey, NJ, United States; 3Rowan-Virtua School of Osteopathic Medicine, New Jersey, NJ, United States; 4Morristown Medical Center, New Jersey, NJ, United States; 5Virtua Our Lady of Lourdes Hospital, New Jersey, NJ, United States

Presented at the American Academy of Asthma, Allergy, and Immunology (AAAAI) Annual Meeting that was held in San Diego, California, United States from February 28, 2025 to March 3, 2025.

30

LIST OF ABSTRACTS WITH POSTERS

129

FACTORS ASSOCIATED WITH STAGE AT DIAGNOSIS OF RECTAL CANCER: A POPULATION-BASED ANALYSIS Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Sirish Dharmapuri2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States

2

130

IMPROVING ACCESS TO TREATMENT FOR ADULT ADHD PATIENTS BY ALIGNING MEDICATION DISTRIBUTION POLICY WITH NEW YORK STATE REGULATIONS Anushri K. Wagner1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

131

EVALUATING THE IMPACT OF A LONGITUDINAL SIMULATION-BASED TRAINING CURRICULUM ON RESIDENT CONFIDENCE AND PREPAREDNESS IN MANAGING CLINICAL EMERGENCIES William J. Wallach1, Priscilla V. Loanzon1, Susannah Kurtz1 1

Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, United States

132

ASSOCIATION BETWEEN RACE AND INSURANCE WITH FOLLOW-UP RATES OF INCIDENTAL LUNG NODULES: A RETROSPECTIVE STUDY Hong Yu Wang1, Nour Ayoub1, Shasha Chen1, Steven Lim1, Sara Luby1, Agostina Velo1, Junyu Qi1, Sascha Adler1, Javier J. Zulueta1 1

Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians Annual Meeting held in Boston, Massachusetts, United States from October 6-9, 2024.

133

134

MULTIFOCAL STROKES IN ESSENTIAL THROMBOCYTOSIS: A CLINICAL VIGNETTE Tharaka R. Wijesinghe1 and Krystle Hernandez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

GASTROINTESTINAL BLEEDING SIMULATION IMPROVES RESIDENT KNOWLEDGE AND CONFIDENCE Marni H. Wilkoff1, Emily S. Seltzer1, Nicholas R. Piniella2, Harrindra Seepersaud1, Priscilla Loanzon1, Susannah Kurtz1, James Salonia1, Daniela Jodorkovsky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2RWJ Barnabas, Jersey City Medical Center; Jersey City, NJ, United States

Presented at American College of Gastroenterology (ACG) Annual Scientific Meeting that was held in Washington, D.C. United States from October 25–30, 2024.

135

SUCCESSFUL TREATMENT OF REFRACTORY IMMUNE CHECKPOINT INHIBITORRELATED ENTEROCOLITIS USING RISANKIZUMAB Yuhong Yang1, Patrick Magahis2, David Faleck3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Cornell School of Medicine, New York, NY, United States; 3Memorial Sloan Kettering Cancer Center, New York, NY, United States 2

31

LIST OF ABSTRACTS WITH POSTERS

136

ROUTINE BIOPSIES FOR EOSINOPHILIC ESOPHAGITIS ARE UNHELPFUL IN PATIENTS WITH DYSPHAGIA WITH A NORMAL-APPEARING ESOPHAGUS ON ENDOSCOPY Ahmun Zafar1, Mako Koseki1, Daniela Jodorkovsky1, Michael S. Smith1,2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

137

A RARE CASE OF DELIRIUM TREMENS WITH LOW CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL SCORE Susu Zhou1 and Erica Grabscheid1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

VACATION COSTS AND VISION LOSS Vincent Courant1, Evan Zyskowski2, Mark Horowitz1

138

1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York State Rheumatological Society Annual Meeting that was held in New York, New York, United States from October 27-29, 2024.

32

Abstracts with Posters

33

ABSTRACT #1 QUALITY IMPROVEMENT GENERAL INTERNAL MEDCINE A POCKET OF UNTAPPED POTENTIAL: SHIFTING PARADIGMS IN PROCEDURAL COMPETENCY Joseph Abraham1, Vasundhara Singh1, Brian Markoff1, Lance Maresky1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025, the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025, and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: With increasing sub-specialization in the field of Internal Medicine, the role of the hospitalist has metamorphosed, and the expectation for certification in specialized procedures, such as paracentesis, has diminished. Many hospitalist groups have traditionally relied on procedure services to manage specialized procedures. As a result, the majority of hospitalist faculty, and to a greater degree house staff, are uncertified to perform these procedures which were previously squarely in their scope of practice. This gap in certification poses challenges for procedural safety and operational efficiency.

METHODS: We are leveraging secure chat technology to connect paracentesis-certified faculty and residents with new learners eager to gain certification. The initiative aims to enhance procedural safety, streamline operations, and ensure compliance with guidelines while proliferating procedural competency within the Hospital Medicine service. The project involved several key components: 1. Secure Chat Integration: A secure chat platform was implemented to facilitate real-time communication between certified faculty, residents, and new learners. This platform enabled quick access to expertise and support during procedures. 2. Certification Program Embedded in New Innovations Logging: A structured certification program was established, focusing on training and certifying residents in paracentesis. This program aimed to increase the number of certified practitioners and ensure consistent procedural standards. 3. Operational Streamlining: The secure chat system helped streamline procedural operations by ensuring that certified personnel were available to supervise and assist with procedures, reducing delays and enhancing patient safety. 4. Rigorous Training: A partnership between the Mount Sinai Morningside/West Internal Medicine Residency Program and the Department of Critical Care Medicine has yielded proprietary online modules which provide comprehensive insight into the procedure, and a high bar is set for the minimum requirement of procedures successfully completed before becoming independently certified. 5. Compliance and Guidelines: Clear guidelines and protocols were developed to ensure compliance with medical standards and billing procedures, emphasizing the importance of consent and proper documentation.

RESULTS: Data is still in the collection phase, but we will be focusing on the number of procedures logged by trainees before and after the intervention, total percentage of certified residents, as well as compared to other institutions within the Mount Sinai Health System who do not have active interventions like our own. We hope to also analyze our data to determine average time to performance of paracentesis from the time of admission as compared to prior to our intervention.

CONCLUSION: The structured approach of this initiative, facilitating access to both training and supervision, has enhanced faculty and resident competency and confidence with advanced procedures, in addition to increasing the number of certified proceduralists. The integration of secure chat technology and the establishment of a certification program have significantly improved procedural safety and efficiency, as well as optimized patient care by decreasing previously experienced delays. Preliminary data shows an average of 3 procedure requests per week, with an average response time by a supervisor within five minutes, and the

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procedure being attempted later that same day. By utilizing our program’s own vetted and expert-designed online self-paced learning module, as well as connecting certified proceduralists with new learners at various levels of training, the initiative has fostered a collaborative, energetic learning environment. Finally, clear guidelines, protocols, and compliance measures have supported the initiative's long-term success and sustainability.

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ABSTRACT #2 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY FRAILTY AND OUTCOMES AFTER BISPECIFIC T-CELL ENGAGER THERAPY FOR PATIENTS WITH RELAPSED/REFRACTORY MULTIPLE MYELOMA Benjamin O. Adegbite1, Carlyn Rose Tan2, Tala Shekarkhand2, Ross S. Firestone2, Eric M. Jurgens2, Kevin Miller2, Alexander M. Lesokhin2, Gunjan L. Shah2, Neha Korde2, Sridevi Rajeeve2, David J. Chung2, Heather J. Landau2, Michael Scordo2, Hani Hassoun2, Kylee H. Maclachlan2, Urvi A. Shah2, Malin Hultcrantz2, Issam S. Hamadeh2, Sergio Giralt2, Sham Mailankody2, Saad Z. Usmani2, Hamza Sloan Hashmi2 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 6-9, 2025.

BACKGROUND/INTRODUCTION: Multiple myeloma is a disease of the elderly with a median age of 69 years at diagnosis. In addition to advanced age, many of these patients are frail with pre-existing comorbidities and have been historically excluded from clinical trials evaluating cellular immunotherapy including bispecific antibodies for relapsed refractory settings. It has been shown that chronologic age alone should not be a barrier towards effective treatment modalities, including autologous stem cell transplant and CAR-T. Rather, frailty scores should be incorporated into screening and eligibility assessments. With limited literature on safety and efficacy of bispecific antibodies in frail patients, we conducted a single center retrospective study to evaluate clinical characteristics and outcomes of frail patients with relapsed refractory multiple myeloma who received bispecific antibodies.

METHODS: Analysis included patients with relapsed refractory multiple myeloma who had received teclistamab, talquetamab, and/or elranatamab between December 2017 and March 2024. Frailty was defined using the simplified frailty index as established and utilized Facon et al. [score based on age + ECOG performance status (PS) + Charlson Comorbidity Index (CCI); non-frail = score 0-1, frail = score ≥ 2] (Leukemia. 2020; 34(1): 224233). Descriptive statistics were used to analyze clinical characteristics such as age, performance status, and comorbidities. Response outcomes were evaluated using the International Myeloma Working Group (IMWG) criteria. Adverse events were graded based on the American Society for Transplantation and Cellular Therapy (ASTCT) and Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria. Key datapoints included incidence and severity of cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), treatment-related mortality, response rates, progression-free survival (PFS), and overall survival (OS). Kaplan-Meier analysis was used for PFS and OS assessments. Cox hazard model was used to determine predictors of PFS and OS in the frail and non-frail patient populations.

RESULTS: Of 112 patients analyzed (age range, 40–88 years), 83 (74%) were considered frail at the time of bispecific antibodies treatment. As expected, the frail group had a higher proportion of patients with age>70 years (45% versus 7%, p<0.001), renal insufficiency (38% versus 7%, p=0.005), PS≥2 (35% versus 0%, p<0.001), and worse median CCI (4 versus 1, CCI 3+ 75% versus 17%, p<0.001). However, the frail group had lower rates of extramedullary disease (25% versus 56%, p=0.009). Median number of prior of lines of therapy (6 versus 7, p=0.48), high-risk cytogenetics (35% versus 31%, p=0.88), and triple class refractory disease rates (84% versus 68%, p=0.17) were similar between the frail and non-frail groups, respectively. Patients in the frail group experienced similar rates of all grade cytokine release syndrome (62% versus 62%, p= 1) and immune effector cell associated neurotoxicity syndrome (14% versus 3%, p= 0.21) when compared to the non-frail group.

Incidence of grade 3+ CRS (frail 2% versus non-frail 3%, p= 1.0) and grade 3+ ICANS (frail 2% versus non-frail 0%, p= 0.98) were also similar between the two groups. Treatment-related mortality was observed in 12 (14%) patients in the frail group compared to 2 (7%) patients in the non-frail group (p=0.46). Best overall response rate (ORR) was 72% (13% sCR/CR, 43% VGPR, 16% PR) in the frail group versus 62% (24% sCR/CR, 17% VGPR,

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21% PR) in the non-frail group with p=0.43 (sCR=stringent complete response, CR= complete response, VGPR=very good partial response, PR=partial response). With a median follow up of 7.3 months (range, 3.712.2 months), median PFS and OS for the entire patient population was 5.6 (2.7-10.4) and 7.4 (3.9-12.6) months, respectively. Median PFS was 6.5 (2.8-11.4) months in the frail group versus 4.6 (2.5-8.0) months in non-frail group (HR, 0.82; 95%CI, 0.5-1.40; p=0.45). Similarly, median OS was 7.5 (3.6-12.1) months in the frail group versus 7.3 (4.6-13.6) months in the non-frail group (HR, 1.50; 95%CI 0.9-2.51; p=0.16).

CONCLUSION: A majority of patients treated with bispecific antibodies for relapsed refractory multiple myeloma in this study were frail based on the simplified frailty index and would have most likely been excluded from clinical trials. While these patients had worse performance status and higher comorbidity burden at time of bispecific antibodies treatment, they did not experience any excessive high-grade toxicities including treatment-related mortality. When compared to the non-frail group, frail patients had similar efficacy outcomes. This study highlights the tolerable safety and reasonable efficacy of bispecific antibodies for frail multiple myeloma patients in a real-world practice, highlighting that frailty should not be a barrier towards the use of bispecific antibodies in this patient population.

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ABSTRACT #3 MEDICAL EDUCATION CARDIOLOGY/GENERAL INTERNAL MEDICINE COORDINATED CARDIAC CARE: LONGITUDINAL OUTCOMES OF A NOVEL WORKSHOP CURRICULUM BETWEEN CARDIOLOGY, EMERGENCY MEDICINE AND PHYSICAL MEDICINE & REHABILITATION (PM&R) TO IMPROVE COMMUNITY HEALTH *Adedeji Adeniyi1,2, Raysha Farah3, Jaciara N. De Souza2, Juana Merino-Lopez2, Christian Auguste2, Victoria Ngai2, Amulya Marellapudi1, Victor De La Cruz3, Nathan Hankerson2, Masaki Rhodes2, Sean Nguyen2, Hami Kang2, Gloria Flex2, Jimmy Truong2 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Columbia University Irving Medical Center, New York, NY, United States; 3Harvard Medical School, Boston, MA, United

States

Presented at the both Student National Medical Association (SNMA) Annual Medical Education Conference that was held in St. Louis, Missouri, United States from April 16-20, 2025 and the Mount Sinai

Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025. *Adedeji AdeniyI, MD is the founder of the Columbia PM&R Series and the Principal Investigator (PI). More information about the organization can be found at the following link (https://www.instagram.com/columbiapmrseries/).

BACKGROUND/INTRODUCTION: Myocardial infarction remains the leading cause of death worldwide, where it demands coordinated care between multiple specialties such as Cardiology, Emergency Medicine, and Physical Medicine & Rehabilitation (PM&R). These specialties cover the spectrum from acute intervention to long-term rehabilitation and prevention. Despite their importance, the coordination between these fields is often underemphasized in medical education. We developed a novel multi-institutional full-day workshop curriculum to introduce a diverse group of pre-medical students to cardiac health, while uniquely showcasing the intersection of Cardiology, Physical Medicine & Rehabilitation, and Emergency Medicine. Emergency Medicine experts covered acute myocardial infarction symptoms and management, while Cardiology and Physical Medicine & Rehabilitation experts focused on cardiac rehabilitation and risk factors.

METHODS: This workshop, conducted in October 2024, was a collaborative effort among faculty, residents and medical students including the Icahn School of Medicine Mount Sinai, Columbia University Irving Medical Center, and Harvard University. Pre- and post-workshop surveys were administered to assess participants' demographics, previous exposure to medical fields, baseline knowledge of critical care interventions such as cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) usage, and their understanding of the roles of Emergency Medicine, Cardiology and Physical Medicine & Rehabilitation across the continuum of cardiac care. Unpaired t-tests were performed to assess participants' performance before and after the workshop, as well as at five months follow-up.

RESULTS: 220 participants completed the pre-workshop survey and were either enrolled or were waitlisted for the event, with 78% identifying as female and 50% belonging to an underrepresented racial minority group (URIM). The majority were undergraduate students, where 78.1% identified as females, 71% were prospective first-generation medical students, and 49.8% belonging to groups underrepresented in Medicine. (Figure 1A-B) The post-workshop had an 83% response rate, with 49/59 workshop attendees completing an evaluation.

Statistical analysis indicated significant improvements (p<0.0003) in students' knowledge of the disease process and timeline of care for myocardial infarction, the necessity and knowledge of prompt emergency interventions such as CPR and AED, and appropriate case referrals to PM&R for sustained care. (Figure 1C). A five-month follow-up (response rate 53%, n=26/49) revealed no statistical difference and retention of students' knowledgebase (p>0.05).

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DISCUSSION/CONCLUSION: The results of this workshop highlighted the importance of collaboration between Cardiology, Emergency Medicine, and Physical Medicine & Rehabilitation, offering a comprehensive educational experience for undergraduates, especially underrepresented students. By strengthening their understanding of heart attack management, timely intervention, and care coordination through understanding myocardial infarction risk factors and taught practical skills such as CPR and AED usage, the initiative aims to improve community cardiac health and diversity within the medical fields of Cardiology, Emergency Medicine, and Physical Medicine & Rehabilitation as they enter medical school. This model is a foundation for integrating multidisciplinary approaches in future medical school and undergraduate curricula.

Figure 1. Demographics (A and B) and Workshop Outcomes and Learning Objectives (C).

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ABSTRACT #4 QUALITY IMPROVEMENT ENDOCRINOLOGY OPTIMIZING PRE-OPERATIVE GLYCEMIC CONTROL IN THE OUTPATIENT SETTING Arushi Agarwal1, Ilana Bass1, Francisco Diaz1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Poorly controlled diabetes increases risk for post-operative complications including poor wound healing, infections, cardiovascular events, and renal dysfunction. Early identification of uncontrolled diabetes and referral to specialist care has been shown to help mitigate these risks. While limited data exists recommending specific goals, an HbA1c<8% is recommended. This quality improvement (QI) initiative aims to optimize preoperative glycemic control in the outpatient setting to improve patient outcomes and minimize the risk of surgical complications associated with uncontrolled diabetes.

METHODS: This QI intervention is being conducted at a large, urban academic center in outpatient clinics. We first identified primary care providers (PCPs) and surgeons involved in pre-operative planning and sent an email informing them of this project, encouraging early referrals to our certified diabetes educator (CDE). Upon referral, a rapid CDE appointment was scheduled to ensure timely intervention. At the initial visit, baseline data were obtained, and the antidiabetic regimen was optimized using a standardized electronic medical record template.

Follow-up visits at 3-week intervals included antidiabetic regimen adjustments until optimized, as measured by a fructosamine level equivalent to an HbA1c<8%. The original procedure date was tracked, and if postponed, the reason for delay was recorded, and specifically whether glycemic control was a contributing factor.

RESULTS: Project data from one year, December 2023 to December 2024 is presented. A total of 14 patients were identified in this timeframe, as summarized in Figure 1. Of the 14 patients, nine are status-post optimization and underwent surgical procedures. Optimization was achieved for 2 patients status-post baseline visit, 5 statuspost follow-up visit 1, and 2 status-post follow- up visit 2. Two patients are pending follow-up visit 2, and 3 patients became ineligible at different points in the project due to their surgical procedure becoming indefinitely cancelled for confounding factors. A summary of baseline visit data (n=14) is as follows. Demographics for the patients depicted in Figure 2. Not all data points available for each patient. The average time from referral to CDE appointment (n=13) was 19.6 days (minimum 0, maximum 98). The average HbA1C at the time of presentation (n=14) was 10.5 percent (minimum 8.0, maximum 15.1). The average fructosamine at baseline (n=9) was 347 (minimum 237, maximum 473).

CONCLUSION: This QI initiative successfully established a structured process for optimizing preoperative glycemic control in an outpatient setting. By increasing specialist referrals and implementing standardized diabetes management with a certified diabetes educator, the intervention facilitated timely optimization for the majority of patients, with 9 out of 14 achieving glycemic control and proceeding with surgery over a one-year period. While the average time from referral to certified diabetes educator appointment varied, the intervention demonstrated a measurable impact on improving preoperative glycemic parameters. These findings highlight the feasibility of a systematic approach to preoperative diabetes management and suggest that implementing a program such as this can improve patient outcomes.

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Figure 1. Pre-operative glycemic control project summary 12/2023-12/2024.

Table 1. Demographics of patients (n=14).

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ABSTRACT #5 CASE REPORT/CLINICAL REVIEW ALLERGY/IMMUNOLOGY/CARDIOLOGY AMOXICILLIN-INDUCED CORONARY VASOSPASM: UNCOVERING A RARE CASE OF KOUNIS SYNDROME Uchenna Ajulu1, Kaitlyn Clausell1, Tamara Goldberg1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

*These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Kounis Syndrome is an acute coronary syndrome characterized by coronary artery vasospasm, acute myocardial infarction, and coronary stent thrombosis in the setting of a hypersensitivity event after an allergic trigger. The pathophysiology involves mast cell and platelet activation with the release of inflammatory mediators such as histamine, tryptases, proteases, thromboxane, prostacyclin, and cytokines which all have significant cardiac effects and can cause coronary vascular spasm with or without atherosclerotic plaque erosion and rupture. Antibiotics, anticholinergic agents, and radioactive dyes have all been described as usual precipitants, but it is possible that the syndrome could be triggered by a wide variety of substances. Kounis syndrome is typically seen in patients with a history of atopy, but frequently goes undiagnosed or misdiagnosed thus it is important that the physician should have a high index of suspicion when evaluating patients who present with allergic reactions or anaphylaxis.

CASE PRESENTATION: A 30-year-old female with history significant for atopy (eczema, asthma, and seasonal allergies) presented to the clinic for a follow-up visit after initially being evaluated at an urgent care center for chest pain. Her symptoms initially began a week before with malaise, myalgias, and a sore throat, and she went to the urgent care center to get evaluated. A streptococcal throat swab was negative, but she was given a prescription for amoxicillin capsules for empiric treatment for Streptococcal pharyngitis. Her constitutional symptoms improved when she started taking the medication as prescribed but shortly after commencement of amoxicillin therapy, she developed chest discomfort that progressed to chest pain that was crushing, substernal, non-radiating, and associated with shortness of breath prompting her to return to the urgent care center for reevaluation 3 days after she started taking the medication. At that visit, her blood pressure was elevated 130/101. The physician at the urgent care center advised the patient to discontinue amoxicillin. An EKG revealed T wave inversions in the inferior leads II, III, and aVF (Figure 1). With EKG changes, the patient was advised to go to the emergency department, but she ultimately opted to go home. The patient reported chest pain resolution after stopping the amoxicillin, and at follow-up 1-2 weeks at the outpatient clinic, she mentioned no repeat episodes of chest pain, and was found to be back at baseline normotensive blood pressure. The patient did not have any rashes, hives, urticaria, tongue swelling, abdominal pain, or throat-closing sensation associated with the chest pain and had never experienced symptoms prior to this event. A repeat EKG in the clinic 11 days after the initial urgent care visit revealed diffuse T wave inversions that were concerning for a cardiac event 2 weeks ago (Figure 2). The patient was given an urgent referral to Cardiology for further workup of a possible coronary event. One week later, the patient returned to the clinic before her scheduled Cardiology appointment for a woman’s health visit and a repeat EKG revealed “improved diffuse T wave inversions 2 weeks after initial onset of chest pain.”

DISCUSSION: Kounis Syndrome is a complex and underdiagnosed condition characterized by the simultaneous occurrence of acute coronary syndrome and hypersensitivity reaction. The syndrome was first described in 1991

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as vasospastic allergic angina and there are 3 main types. Type 1 occurs in patients with normal coronary arteries where an allergic reaction induces coronary artery spasm. Type 2 occurs in patients with pre-existing atherosclerotic disease where an allergic reaction leads to plaque rupture or erosion. Type 3 occurs in patients with coronary artery stents where an allergic reaction causes stent thrombosis. Common triggers include medications (especially antibiotics), insect stings, foods, dyes and environmental exposures . Amoxicillin is a frequent culprit in drug induced Kounis syndrome. Common comorbidities include hypertension, diabetes, and dyslipidemia, but the strongest association exists with patients who already have a history of atopy. Some cases exist where the allergic reaction and concomitant vasospasm occur Idiosyncratically in a patient with no prior history of allergic reactions. Patients typically present with chest discomfort, chest pain, and shortness of breath due to coronary vasospasm. Allergic symptoms such as urticaria, rash, angioedema or anaphylaxis may or may not accompany the cardiac symptoms. Diagnosis of Kounis syndrome is often missed when patients are evaluated, and this results in an underreporting of the actual incidence of the disease. Diagnosis requires obtaining a thorough clinical history of atopy, past allergic reactions, laboratory testing showing increased Troponins, CK-MB from cardiac injury, elevated tryptase, and ST segment changes on Electrocardiogram.

Imaging studies such as coronary angiography may reveal coronary spasm, plaque rupture of stent thrombosis.

Treatment involves addressing both the allergic reaction and the coronary event. Type 1 Kounis syndrome should be treated with Intravenous hydrocortisone for the allergic reaction and Calcium channel blockers or nitrates to reverse the coronary vasospasm. Care should be taken to avoid Epinephrine in patients with Kounis syndrome because while it is first line for anaphylaxis, its effects on the heart could worsen the coronary vasospasm and cardiac ischemia and make the patient hemodynamically unstable.

CONCLUSION: Kounis Syndrome is not a rare disease, it is often undiagnosed and thus not reported . It is important for Physicians to always consider this phenomenon in patients presenting with angina and concomitant anaphylactic reactions. Early diagnosis and prompt treatment are essential to mitigate morbidity and mortality associated with this often-missed diagnosis.

Figure 1. EKG at Urgent Care center with T wave inversions in the inferior leads II,III and aVF.

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Figure 2. EKG at outpatient clinic obtained 11 days after initial onset of chest pain with diffuse T wave inversions.

Figure 3. Repeat EKG in outpatient clinic with improved diffuse T wave inversions 2 weeks after initial onset of chest pain.

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ABSTRACT #6 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/RHEUMATOLOGY UNVEILING THE UNCOMMON: ACUTE VALVULITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS WITHOUT LIBMAN-SACKS ENDOCARDITIS Melissa Akselrad1, Tharaka Wijesinghe1, Raagni Kumar1, Michael Kaplan1, Amir Amhadi1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Lupus valvulitis refers to inflammation of the heart valves in patients with systemic lupus erythematosus (SLE). It is often associated with Libman-Sacks endocarditis (LSE), which is characterized by the presence of sterile vegetations on the heart valves. These vegetations are composed of immune complexes, hematoxylin bodies, and platelet thrombi and are typically found on the mitral and aortic valves, although they can affect any valve. The clinical presentation of valvulitis can vary. Many patients are asymptomatic, but some may develop significant valvular dysfunction such as regurgitation or stenosis, which can result in heart failure necessitating surgical intervention. The presence of antiphospholipid antibodies in SLE patients can increase the risk of valvular disease and thromboembolic complications. The diagnosis is primarily made using echocardiography, which can reveal valve thickening, vegetations, and regurgitation.

Transesophageal echocardiography (TEE) is more sensitive than transthoracic echocardiography (TTE) for detecting these abnormalities. Lupus valvulitis in the absence of LSE in patients with systemic lupus erythematosus (SLE) is a specific subset of valvular heart disease that is infrequently observed. The prevalence of valvular abnormalities in SLE patients varies, but specific data on lupus valvulitis without Libman-Sacks endocarditis is limited due to its rarity. We present a case of a patient with acute lupus valvulitis without LSE. CASE PRESENTATION: We present a case of a 25-year-old African American woman with a history of SLE who presented to the hospital with progressive dyspnea on exertion, substernal chest pain, and bilateral swelling of wrists and ankles for 2 weeks. She was diagnosed with SLE 9 months previously during a hospitalization in which she presented with acute renal failure, joint pain and swelling, and serositis. A kidney biopsy performed at that time showed findings consistent with lupus podocytopathy (Figure 1). A transthoracic echocardiogram at this time showed left ventricular ejection fraction of 60%, normal diastolic function, normal right ventricular function, mild mitral regurgitation, trace tricuspid regurgitation, mild pulmonic regurgitation, without pericardial effusion. She was briefly initiated on hemodialysis this admission, and with high doses of systemic glucocorticoids her renal function improved. She was discharged on hydroxychloroquine and oral glucocorticoids, but self-discontinued at home due to concern about side effects. She also had not followed up with her Rheumatologist since the diagnosis.

The patient then presented to the emergency room 6 months later with progressive dyspnea on exertion, substernal chest pain, and bilateral swelling of wrists and ankles for 2 weeks. Her initial vital signs included a blood pressure of 109/57 and body temperature of 36.4 °C (97.6 °F). Her heart rate was 128 bpm, respiratory rate was 30, and her oxygen saturation on room air was 85%. Physical exam was significant for decreased breath sounds at the bilateral bases and marked tachypnea and increased work of breathing. On cardiac auscultation, she was tachycardic with a regular rhythm, but heart sounds were diminished and distant. There were no appreciable murmurs or rubs. Abdominal palpation was negative for tenderness, distention, or hepatosplenomegaly. The extremities were warm and well-perfused with mild non-pitting edema in the ankles bilaterally. She had synovitis of the small joints in her hands and wrists bilaterally.

She was subsequently placed on high-flow nasal cannula and then escalated to bilevel positive airway pressure (BIPAP) when her acute hypoxic respiratory failure did not improve. She was then transferred to the cardiac intensive care unit for further management of suspected acute decompensated heart failure and concern for cardiac tamponade. The Rheumatology service was consulted for systemic lupus erythematosus flare with possible cardiac involvement. There was extensive multispecialty involvement during her stay including

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consultations from Heart Failure, Rheumatology, Pulmonology, cardiac intensive care, and Nephrology. A transthoracic echocardiogram was performed which revealed new severe mitral regurgitation, moderate tricuspid regurgitation, a large posterolateral loculated pericardial effusion without echocardiographic signs of cardiac tamponade, a large left pleural effusion, not seen on prior admission, and an ejection fraction of 50%. A computed tomography with angiogram (CTA) chest was negative for a pulmonary embolism but confirmed findings of bilateral pleural effusions and a large pericardial effusion.

Laboratory tests included autoimmune testing were notable for negative for anti-smith antibody, antiribonucleoprotein antibody, anti-La antibody, anti-histidyl-tRNA synthetase antibody, anti-centromere antibody, anti-topoisomerase 1 antibody, lupus anticoagulant antibody, beta-2-glycoprotein antibody, and anticardiolipin antibody. However, results were significant for a positive antinuclear antibody indirect immunofluorescence assay with a titer of 1:1280 in a homogeneous pattern, anti-double stranded DNA greater than 300 IU/mL (reference range <9 IU/mL), anti-Ro antibody 4.2 AI (reference range <0.2 AI), anti-chromatin antibody >8.0 AI (reference range <0-0.9 AI), anti-histone antibody 15.7 units (reference range <2.5 units). Inflammation markers were elevated on admission: C-reactive protein was 202.9 mg/L (reference range 0-5 mg/L) and sedimentation rate was 98 mm/hr (reference range 0-24 mm/hr). Cardiac enzymes were significant for an elevated proBNP to 5315 pg/mL (reference range 300-449 pg/mL) but a normal high sensitivity troponin of 3 ng/L (reference range 0-14 ng/L). Her creatine was normal at 0.88 mg/dL (reference range 0.5-1.1mg/dL) and her urine total protein/creatinine ratio was 5315 mg/g (reference range <201 mg total protein /g Creatinine).

The patient was given high dose intravenous diuretics to treat acute decompensated heart failure secondary to acute severe mitral and tricuspid regurgitation. She was also started on pulse dose glucocorticoids and hydroxychloroquine for lupus serositis involving her lungs and pericardium. Given her new valvular dysfunction, it was possible that she was presenting with LSE and a transesophageal echocardiogram (TEE) was pursued.

The TEE showed no vegetations, severe mitral regurgitation, moderate-severe tricuspid regurgitation, and large pericardial effusion with no compression (Figure 3). This TEE was most notable for findings for valvulitis, mostly affecting leaflet tips but there was no evidence of LSE. She steadily improved with her intravenous diuresis and glucocorticoids. She was able to be weaned off from supplemental oxygen and there was radiographic resolution of her pleural effusions and pericardial effusion. The cause of her heart failure was attributed to valvulitis in the setting of systemic lupus erythematosus. Patient was presented with treatment options for immunosuppression. She ultimately chose to be discharged home on an oral glucocorticoid taper, hydroxychloroquine, and azathioprine, with plans to follow up with Rheumatology in the clinic for further discussion on immunosuppression.

CONCLUSION: Valvular disease is a frequent manifestation in systemic lupus erythematosus, with valvular abnormalities being detected in a significant proportion of patients with SLE. However, the specific occurrence of lupus valvulitis without the presence of Libman-Sacks endocarditis is rare and not well documented. In a study

by Ong et al. valvular disease was observed in 37.5% of SLE patients, but LSE was rare, occurring in only 2.5% of cases. Similarly, Cervera et al. found valvular abnormalities in 44% of SLE patients, with only 4% showing echocardiographic patterns suggestive of non-infective verrucous vegetations indicative of LSE. Lupus valvulitis without LSE is characterized by inflammation and scarring of heart valves leading to valvular thickening and dysfunction. This condition is primarily driven by the autoimmune nature of SLE where immune complexes and autoantibodies play a significant role as they deposit on the valve surfaces leading to valvulitis.

These inflammatory processes can lead to leaflet thickening, fibrosis, and subsequent valvular dysfunction, such as regurgitation or stenosis, even in the absence of verrucous vegetations seen in LSE. The most common clinical presentations include mitral regurgitation and aortic regurgitation, which is often detected through echocardiography. Patients may be asymptomatic or present with symptoms related to valvular

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dysfunction, such as dyspnea, fatigue, and signs of heart failure in more severe cases. Echocardiography is the primary modality used to detect valvular thickening, valvular regurgitation, and heart failure.

Initial treatment of Lupus valvulitis without LSE primarily focuses on managing the underlying systemic lupus erythematosus and addressing the valvular dysfunction. A multidisciplinary approach including rheumatologists, cardiologists, and cardiothoracic surgeons are important to optimize treatment. Treatment options include immunosuppressive therapy with glucocorticoids and hydroxychloroquine and surgical intervention in severe cases of valvular dysfunction leading to hemodynamic compromise that require valvular repair or replacement.

There are currently no specific clinical trials investigating the effects of stronger immunosuppressants and cytotoxic agents on lupus valvulitis, and more research is needed in this field.

Lupus valvulitis without Libman-Sacks endocarditis is relatively uncommon. It is a significant cardiac manifestation of SLE not well reported in literature and can occur in severe, untreated SLE as seen in our patient.

Lupus valvulitis requires careful diagnostic evaluation and a multidisciplinary approach to management involving Rheumatologists, Cardiologists, and Cardiothoracic surgeons.

A

B

C

D

Figure 1. Mesangial areas containing electron dense immune-type deposits seen on immunofluorescence (Figure 1A). On electron microscopy, rare subendothelial electron dense deposits were also seen with preserved endothelial cell fenestrations. Glomerular basement membranes with normal thickness, texture, and contour. Podocytes displaying diffuse (100%) foot process effacement with microvillous transformation of podocyte cytoplasm and swelling of podocyte cell bodies (Figure 1B). Numerous endothelial tubuloreticular inclusions seen (Figure 1C). Proximal tubular cells showing attenuation and focal loss of brush borders (Figure 1D).

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Figure 2. CT of the chest with bilateral effusions and large pericardial effusion.

A

B

Figure 3. TEE with no vegetations, severe mitral regurgitation (Figure 3A), moderate-severe tricuspid regurgitation, and large pericardial effusion with no compression (Figure 3B). This TEE was most notable for findings for valvulitis, mostly affecting leaflet tips but there was no evidence of LSE.

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Figure 4. Cardiac MRI images revealed concentric thickening of the pericardium associated with inflammation and acute fibrosis associated with late gadolinium enhancement.

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ABSTRACT #7 CLINICAL RESEARCH GASTROENTEROLOGY ADVERSE PREGNANCY OUTCOMES AND EFFECT OF TREATMENT IN WILSON DISEASE DURING PREGNANCY: SYSTEMATIC REVIEW AND META-ANALYSIS Ashley N. Brown1*, M. Marcia Lange1,2*, Lital Aliasi-Sinai3, Xiaotao Zhang1, Sasha Kogan4, Lily Martin1, Tatyana Kushner 1 1Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Brigham and Women's

Hospital, Boston, MA, United States; 3Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Jacobs School of Medicine at the University of Buffalo, Buffalo, NY, United States

Published in Liver International, 2024. PMID: 39206599. *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Wilson disease is a rare disorder of copper metabolism, leading to liver and neurological disease. Existing literature on Wilson disease in pregnancy is scarce, limiting preconception and obstetrical counselling. In this systematic review with meta-analysis, we determine the prevalence of various adverse pregnancy and neonatal outcomes in Wilson disease, as well as evaluate the impact of Wilson disease treatment on these outcomes.

METHODS: Scopus, MEDLINE, and EMBASE were searched until May 12, 2023, for studies of pregnant individuals with Wilson disease and at least one pregnancy or neonatal outcome of interest. Meta-analysis of single proportions was conducted to pool prevalence data for each outcome. Outcome rates were compared between treated and untreated groups in a meta-analysis of dichotomous events.

RESULTS: Sixteen studies, published from 1975 to 2022, were included in the systematic review. Thirty-seven percent of pregnancies reported at least one adverse pregnancy outcome. Spontaneous abortions (20%), liver diseases of pregnancy (4.5%) and preterm births (2%) were the most frequent adverse pregnancy outcomes in patients with Wilson disease. The prevalence of spontaneous abortions was significantly lower in pregnant individuals with Wilson disease who received treatment during pregnancy (OR, 0.47, 95%CI, 35%–63%). The prevalence of any adverse pregnancy outcome was also significantly lower with treatment (OR, 0.53, 95%CI, 0.37–0.76), which appears to be mostly driven by the reduction of spontaneous abortions.

CONCLUSION: There is low to moderate quality evidence to suggest that preconception and obstetrical counselling for patients with Wilson disease should include a discussion on the potentially high frequency of adverse pregnancy outcomes in this population, as well as the importance of continuing Wilson disease treatment during pregnancy to ensure satisfactory pregnancy course and potentially minimize the risk of spontaneous abortions.

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ABSTRACT #8 CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE A DISORGANIZED CASE OF EOSINOPHILIC PNEUMONIA Mohammed Alsaud1, Connor Smith1, Bertin D. Salguero1, Christian M. Lo Cascio1, Mary M. O’Sullivan1, Avinash Singh1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Chronic eosinophilic pneumonia (CEP) is a significant cause of lung disease characterized by peripheral eosinophilia, lung infiltrates, eosinophilia in bronchoalveolar lavage fluid (BAL), and eosinophilic infiltration in histology. These key features define CEP, but the condition can also present with varied manifestations, complicating diagnosis in atypical cases. We describe a case of chronic eosinophilic pneumonia with atypical imaging and histological findings.

CASE PRESENTATION: An 86-year-old man presented to the emergency department with weeks of worsening hypoxemic respiratory failure, dry cough, dyspnea, and fatigue following recent hospitalization for communityacquired pneumonia that had been unresponsive to antibiotics. Laboratory tests revealed peripheral eosinophilia at 1.9 K/uL, higher than previous admissions, with no signs of sepsis or active infection. Chest computed tomography (CT) showed progression of bilateral, upper-lobe-predominant alveolar opacities that were airwayoriented with pleural sparing and effusions (Figure 1A). Bronchoscopy revealed a normal tracheobronchial tree, and BAL cell count showed a total of 223/uL with 33% eosinophils. Cultures for bacteria, fungi, and parasites were negative, as were tests for serum Strongyloides IgG, Fungitell®, and galactomannan. A transbronchial biopsy indicated an organizing pneumonia pattern without tissue eosinophils. Due to the combination of peripheral and BAL eosinophilia, progressive pulmonary infiltrates unresponsive to antibiotics, and a negative infectious workup, systemic steroids were initiated for presumed chronic eosinophilic pneumonia. Prednisone was started at 1 mg/kg and tapered over two months. Follow-up imaging after six weeks demonstrated nearcomplete resolution of the pulmonary opacities and effusions (Figure 1B), along with improvement in symptoms and respiratory function.

CONCLUSION: Chronic eosinophilic pneumonia and organizing pneumonia can present similarly with subacute respiratory failure and pneumonia unresponsive to antibiotics. One distinguishing feature of CEP is the presence of serum and BAL eosinophilia. Histopathology often helps to differentiate these diseases; organizing pneumonia classically shows granulation tissue in alveoli and terminal bronchioles, whereas CEP is marked by eosinophilic infiltration of the alveolar spaces. However, eosinophils are not present in the tissue in up to 36% of CEP cases with BAL eosinophilia. In this case, the combination of peripheral and BAL eosinophilia with radiographic findings suggests CEP, despite organizing pneumonia-like histology. Pleural effusions are common in acute eosinophilic pneumonia but may be rare in CEP, which underscores the importance of considering CEP in pneumonia cases with peripheral eosinophilia. Chronic eosinophilic pneumonia can present with diverse clinical features, including organizing pneumonia-like findings. A high index of suspicion is necessary for accurate diagnosis in cases with peripheral eosinophilia and non-resolving pneumonia.

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Figure 1. Chest computed tomography (CT) showed progression of bilateral, upper-lobe-predominant alveolar opacities that were airway-oriented with pleural sparing and effusions (Figure 1A). Follow-up imaging after six weeks demonstrated near-complete resolution of the pulmonary opacities and effusions (Figure 1B).

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ABSTRACT #9 CASE REPORT/CLINICAL REVIEW ALLERGY/IMMUNOLOGY/DERMATOLOGY/GENERAL INTERNAL MEDICINE/RHEUMATOLOGY A UNIQUE CASE OF ADULT-ONSET ATOPIC DERMATITIS MIMICKING VASCULITIS Shubhankar Anand1, Niurka Liranzo Tejera1, John A. Andrilli1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Allergy, Asthma, and Immunology’s Annual Scientific Meeting that was held in Boston, Massachusetts, United States from October 24-28, 2024.

BACKGROUND/INTRODUCTION: Atopic dermatitis (AD) is an inflammatory skin condition that causes itchiness and redness. Although AD develops early on in childhood, nearly 1 in 4 adults may experience adultonset AD that can also present in atypical fashion. Furthermore, misdiagnosis can lead to mismanagement and additional complications such as drug rashes, as in this case.

CASE PRESENTATION: We present a 45-year-old male with a history of type 2 diabetes and hypertension who presented with generalized pruritic rash concerning for leukocytoclastic vasculitis. The rash first started on his lower extremities and appeared as palpable purpura after which he presented to the urgent care where he was prescribed cephalexin for suspected bullous impetigo. Shortly after, he developed a morbilliform rash on his trunk, back, and upper extremities. He then reported bathing in cornstarch and used laundry soap to help soothe the rash, but symptoms worsened. During admission, Dermatology and Rheumatology were consulted. Skin biopsy showed spongiosis without vasculitic features and rheumatological workup was normal. He started a prednisone taper and topical emollients with subsequent rash improvement.

CONCLUSION: This case demonstrates the importance of considering AD in the differential diagnosis of atypical skin rashes such as suspected vasculitis. AD should still be considered in adults who report no family history of AD or severe allergies. Additionally, the use of cephalexin further complicated the clinical presentation, emphasizing the importance of obtaining a thorough clinical history and use of histopathology to confirm presentation of unusual dermatologic conditions and help guide appropriate treatment and management.

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ABSTRACT #10 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE HANDING OVER WITH PRECISION: STANDARDIZING THE HANDOFF FOR INPATIENT MEDICINE Kimberly Fasciglione1, Jood Ani1, Norah Sadek1, Melissa Akselrad1, Randy Leibowitz1, Salvador Caceros Diaz1, Krystle Hernandez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

BACKGROUND/INTRODUCTION: The Joint Commission (TJC) defines a sentinel event as one related to patient safety resulting in death, permanent, or severe harm. In TJC Sentinel Event Data Annual Review for 2022, communication breakdowns were identified as the root cause for these events. With stricter duty hour restrictions in hospitals nationally, the number of patient caregivers and thus handoffs between providers have increased, leading to an increased chance for sentinel events to occur. Standardizing the patient handoff process can improve patient outcomes and reduce medical errors. The objective of this project is to improve the quality of written handoffs in the Mount Sinai Morningside/West Internal Medicine residency program by increasing the inclusion of daily updates from 80% to 90%, patient-specific anticipatory guidance from 70% to 90%, and disposition status from 25% to 35% within two months of implementing a standardized handoff curriculum.

METHODS: Based on resident feedback, a committee was assembled to review handoffs. Preliminary chart review was performed assessing our primary metrics: 1) Updated within 24 hours, 2) Included patient-specific anticipatory guidance, and 3) Included disposition status (i.e., high risk of decompensation denoted as “Watcher,” ICU Downgrade, Medically Active, or Pending Discharge). Secondary metrics included a subjective review of the quality of the one-liner, and the inclusion of a task list for the team. An electronic medical record (EMR) smart phrase was created to standardize handoffs. A two-part intervention included interactive workshops during resident didactics and the introduction of the EMR smart phrase (Figure 1).

RESULTS: Prior to the intervention, a total of 325 charts were reviewed. The primary outcomes of handoffs updated within 24 hours, having patient specific anticipatory guidance, and having patient disposition status were performed 82.8%, 72.0%, and 26.1% of the time, respectively (Figure 2). Secondary outcomes of reviewing the quality of the one-liner and presence of task lists were performed 72.0% and 88.0% of the time, respectively.

Post-intervention chart review was performed weekly for eight weeks to evaluate improvement in handoff quality, with a total of 935 charts reviewed. The primary outcomes of handoffs updated within 24 hours, patient specific anticipatory guidance, and patient disposition status were performed 83.3% (increase of 0.5%), 83.3% (increase of 11.3%), and 69.8% (increase of 43.7%) of the time, respectively (Figure 2). Secondary outcomes for quality of one-liner and presence of task lists were increased by 12.7% and 10.3%, respectively.

Overall, there was an increase for all metrics analyzed post-intervention, the largest being in the presence of specific anticipatory guidance and patient disposition status. Project limitations included resident participation in utilizing the EMR smart phrase, as well as the subjective aspect of the secondary outcomes, based on reviewer.

CONCLUSION: Following the implementation of a standardized handoff tool and focused education in the largest Internal Medicine Residency Program in the country, written handoffs provided a more accurate picture of patients’ clinical status. By fostering better communication among providers, comprehensive handoffs increase the confidence of the oncoming team in patient care, enabling them to make informed decisions quickly, and preventing errors. The next phase of this project will include incorporating resident feedback to further develop the smart phrase and increase use of the standardized format.

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Figure 1. Standardized EMR smart phrase to be used for written handoff by residents.

Figure 2. Pre-and post-intervention evaluation of primary outcomes (handoffs updated within 24 hours, having patient specific anticipatory guidance, and having patient disposition status) and secondary outcomes (quality of the one-liner and presence of task lists).

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ABSTRACT #11 CLINICAL RESEARCH GASTROENTEROLOGY/NEPHROLOGY ACUTE PANCREATITIS WITH ACUTE KIDNEY INJURY IS ASSOCIATED WITH WORSE 30-DAYS AND 90-DAYS OUTCOMES: A MULTINATIONAL MULTICENTER ANALYSIS Do Han Kim1*, Donghyun Ko2*, Jose A. Porres3, Jordan Arabian1, Wilhelm S. Basegoda4, Frank J. Lukens5, Pedro Palacios Argueta 6, Paul T. Kröner7 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT, United States; 3Universidad Francisco Marroquin Facultad de Medicina, Guatemala City, Guatemala; 4University of South Alabama Health System, Mobile, AL, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7 Thomas Jefferson University Hospital, Philadelphia, PA, United States 2

INTRODUCTION: Acute kidney injury (AKI) in patients with acute pancreatitis has been consistently shown to impact clinical outcomes and is a marker of organ dysfunction, being a primary indicator and driver of disease severity. The cornerstone of management of acute pancreatitis is aggressive intravenous fluid administration, and AKI has traditionally been a surrogate measure of the adequacy of volume repletion, and is even recommended by the current American College of Gastroenterology guidelines to be monitored in 6-hour intervals for 24-48 hours from presentation. While having been proven to be a factor of paramount importance on prior studies, the aim of our study is to explore the magnitude of the association of AKI on select outcome s in patients with acute pancreatitis using a large multinational clinical database.

METHODS: A retrospective cohort study was performed using large population-based data from the TriNetX platform. Patients diagnosed with acute pancreatitis with AKI since January 1, 2014, were identified. This group was matched with patients diagnosed only with acute pancreatitis according to age, gender, demographics, comorbidities, and medication by using 1:1 propensity matching. Outcomes were mortality, shock, distributive shock, initiation of mechanical ventilation, ICU admission, venous thromboembolism (VTE), pancreatic pseudocyst, and acute pancreatitis with necrosis. These outcomes were analyzed at 30 days and 90 days posterior to the inciting event.

RESULTS: A total of 498,495 adult patients with acute pancreatitis were identified, 35,343 of these individuals had AKI; 34,591 out of 35,343 [mean (SD) age, 54.9 (17.7) years; 13,017 (37.6) female] were matched with 34,591 individuals [mean (SD) age, 55.0 (17.6) years; 12,919 (37.3%) female] who had no AKI. The AKI group had significantly higher risk of 30 days all-cause mortality [Hazard Ratio (HR), 9.85; 95%CI, 8.93-10.87), shock (HR, 3.37; 95%CI, 11.32-15.79), ICU admission (HR, 10.05; 95%CI, 9.39-10.76), VTE (HR, 3.69; 95%CI, 3.304.12), necrotizing acute pancreatitis (HR, 3.84; 95%CI, 3.51-4.21), and pseudocyst formation (HR, 2.24; 95%CI, 2.04-2.45). Similar results were observed at 90 days (Table 1).

DISCUSSION: While the association between acute kidney injury and poor outcomes in patients with acute pancreatitis is well-known, this study quantifies and reveals the sobering magnitudes of the associations of acute kidney injury with poor clinical outcomes in patients with acute pancreatitis at 30 and 90 days. This study echoes and underscores the importance of aggressively monitoring for and using acute kidney injury as a parameter to guide volume repletion in the setting of acute pancreatitis in an effort to minimize the possibility of long-term effects from the event. Future research continues to be needed in the realm of determining tailored optimal volume repletion strategies to minimize end-organ damage from acute pancreatitis.

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Acute Pancreatitis with AKI Outcomes

Included

Events

Acute Pancreatitis without AKI Included

HR (95% CI)

Events

30 days Mortality 33 306 4 019 34 355 442 9.85 (8.93, 10.87) Shock 34 591 1 910 34 591 150 13.37 (11.32, 15.79) Distributive shock 34 591 387 34 591 50 8.01 (5.97, 10.76) Mechanical ventilation 34 591 3 079 34 591 223 14.69 (12.82, 16.82) Intensive care unit 34 591 8 245 34 591 921 10.05 (9.39, 10.76) Venous thromboembolism 34 591 1 393 34 591 402 3.69 (3.30, 4.12) Pancreatic pseudocyst 34 591 1 388 34 591 665 2.24 (2.04, 2.45) Acute pancreatitis with 34 591 2 094 34 591 581 3.84 (3.51, 4.21) necrosis 90 days Mortality 33 306 5 173 34 355 867 6.69 (6.23, 7.19) Shock 34 591 2 160 34 591 214 10.86 (9.44, 12.50) Distributive shock 34 591 460 34 591 72 6.81 (5.31, 8.73) Mechanical ventilation 34 591 3 341 34 591 294 12.31 (10.93, 13.87) Intensive care unit 34 591 8 710 34 591 1 176 8.51 (8.01, 9.05) Venous thromboembolism 34 591 1 918 34 591 598 3.58 (3.26, 3.92) Pancreatic pseudocyst 34 591 2 264 34 591 1 053 2.44 (2.27, 2.63) Acute pancreatitis with 34 591 2 705 34 591 772 3.90 (3.60, 4.22) necrosis Abbreviations: AKI acute kidney injury; HR, hazard ratio; CI, confidence interval; AE, adverse events.

Table 1. Clinical Outcomes of Patients with Acute Pancreatitis with AKI compared to patients with Acute Pancreatitis without AKI.

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ABSTRACT #12 CLINICAL RESEARCH CARDIOLOGY ENDOVASCULAR AND SURGICAL REVASCULARIZATION TECHNIQUES IN FEMOROPOPLITEAL LESIONS – TWO YEAR RESULTS OF A PATIENT-LEVEL META ANALYSIS Matthew Baer1, Florian Enzmann2, Serdar Farhan3 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Innsbruck Medical University, Innsbruck, Tyrol, Austria; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai,

New York, NY, United States

Presented at the Mount Sinai Morningside Department of Cardiology’s 2nd Cardiology Multidisciplinary Annual Meeting that was held in New York, New York, United States on June 12, 2024.

BACKGROUND/INTRODUCTION: Revascularization strategies for femoropopliteal artery lesions range from endovascular techniques using drug-eluting stents (DES) and non-DES to surgical bypass utilizing polytetrafluorethylene (PTFE) as well as autologous vein grafts (AVG). None of the existing studies were adequately powered to compare these techniques.

METHODS: For this study a pooled analysis of individual patient data from five randomized controlled trials (RCTs) comparing endovascular and open surgical treatment of femoropopliteal lesions was performed. Major adverse limb events (MALE – composite of all-cause death, major amputation, or target limb revascularization) was the primary endpoint. Secondary endpoints included primary patency, limb-salvage, survival, and freedom from target-limb revascularization (FTLR).

RESULTS: A total of 639 patients were categorized into four groups: Non-DES (n=189), DES (n=136), PTFE (n=166) and AVG (n=148). The groups were similar regarding age, sex, body-mass index, and diabetics. The overall mean lesion length was 236mm with 89% occlusive lesions. At 2 years, there were no significant differences between the groups regarding MALE, limb-salvage, survival and FTLR. Primary patency was superior in the PTFE group (adjusted HR, 0.65; 95%CI, 0.45 - 0.94; p=0.023) and inferior in the non-DES group (aHR, 1.40; 95%CI, 1.02 - 1.92; p=0.037) compared to AVG. CONCLUSION: The clinical outcomes of endovascular interventions in femoropopliteal lesions are similar to surgical bypass techniques irrespective of the used stents or bypass graft material. The outcomes support endovascular interventions as safe and durable alternatives to surgical bypass options.

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ABSTRACT #13 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/NEPHROLOGY/RHEUMATOLOGY NEPHROTIC SYNDROME AS A MANIFESTATION OF OVERLAPPING SYSTEMIC LUPUS ERYTHEMATOSUS AND ANCA-ASSOCIATED VASCULITIS Pragati Basera1, Rodrigo Paredes de la Fuente1, Shota Obata1, Andrea Duque Lopez1, Ruchika Batwara1, Miriam Chung2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Physicians (ACP) Internal Medicine Annual Meeting that was held in New Orleans, Louisiana, United States from April 3-5, 2025.

BACKGROUND/INTRODUCTION: Systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are two distinct autoimmune diseases that can present concurrently as an overlap syndrome, though such cases are exceedingly rare. These syndromes are clinically significant, especially in patients with biopsy-proven glomerulonephritis (GN), where the prevalence of overlap syndrome is estimated to be approximately 2%. Patients with SLE/AAV overlap often exhibit severe renal involvement. Here, we describe a 71-year-old woman presenting with nephrotic-range proteinuria, rapidly progressive renal failure, and inflammatory myopathy.

CASE PRESENTATION: A 71-year-old woman with a history of polyarthritis and hypothyroidism presented with an 8-month history of progressive generalized weakness and bilateral lower extremity swelling. She denied any recent joint pain, rash, or any systemic symptoms such as fever or weight loss. Over time, her weakness became so profound that she required a wheelchair and assistance with daily activities. Initial laboratory studies revealed significant nephrotic-range proteinuria with a urinary protein-to-creatinine ratio (UPCR) of 4.3 g/gCr, microscopic hematuria with red blood cell casts, and preserved renal function (serum creatinine: 0.69 mg/dL). Further evaluation showed low complement levels (C3: 46 mg/dL, C4: <4) and a positive autoimmune panel, including ANA (1:160), dsDNA (1:80), MPO-ANCA (>8), and PR3-ANCA (3.4).

Imaging revealed nonspecific interstitial lung disease on a CT scan. MRI brain did not show any changes explaining the generalized weakness. Hence, a muscle biopsy was performed, which revealed severe inflammatory myopathy without evidence of vasculitis. To further investigate her nephrotic-range proteinuria, a renal biopsy was performed. It showed crescentic GN with IgG, IgM, C3, and kappa and lambda light chains, but negative C1q and IgA, suggesting class III lupus nephritis (LN) with possible ANCA-mediated crescentic injury.

The patient was treated with high-dose corticosteroids and mycophenolate mofetil (MMF) for presumed LN. However, her proteinuria persisted despite this regimen, prompting the initiation of rituximab to address the possibility of an AAV-related glomerulonephritis suggested by the biopsy findings and serology. Following two doses, the patient’s proteinuria improved significantly, with a marked reduction in her UPCR. The robust therapeutic response to rituximab, a treatment commonly used in antineutrophil cytoplasmic antibody-associated vasculitis, further supported the diagnosis of an SLE/AAV overlap syndrome.

CONCLUSION: SLE and ANCA-AAV overlap syndrome is a rare but clinically significant entity characterized by shared and distinct features of immune complex-mediated and pauci-immune glomerulonephritis. In our case, crescentic GN with immune complex deposits was consistent with lupus nephritis, but the absence of C1q deposits—a hallmark of LN—along with MPO-ANCA and PR3-ANCA positivity raised suspicion for a pauciimmune process, underscoring the diagnostic complexity of this overlap syndrome.

Despite these differences, crescentic GN is a shared feature, occurring in approximately 20% of biopsy-proven lupus nephritis cases. The coexistence of ANA and ANCA positivity in overlap syndrome contributes to the complexity of diagnosis, as these antibodies are found individually in many cases of lupus nephritis and

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antineutrophil cytoplasmic antibody-associated vasculitis without necessarily indicating overlap syndrome.

Patients typically present with severe clinical features, including rapidly progressive GN, significant proteinuria, and sometimes pulmonary involvement. The management of severe overlap syndrome involving SLE and antineutrophil cytoplasmic antibody-associated vasculitis requires a combination of immunosuppressive therapies tailored to address both conditions.

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ABSTRACT #14 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES IMMUNOCOMPROMISED AND CONFUSED: A CASE OF WEST NILE NEUROINVASIVE DISEASE Hannah Bava1,2*, Yuhong Yang1,2*, Karen Go1,2, Ko Harada1, Boram Kim1,2, Svetlana Chernyavsky2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Physicians (ACP) Internal Medicine Annual Meeting that was held in Boston, Massachusetts, United States from April 18-20, 2024. *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: West Nile Virus (WNV) has become a leading cause of epidemic encephalitis since it was first detected in New York around 1999. The median annual WNV neuroinvasive disease case was 1328 between 2009 - 2018, and the incidence has been increasing nationally. Neuroinvasive diseases occur in 1/150 cases in general population and are more common in populations with risk factors including immunocompromise (especially solid-organ transplant), cardiovascular disease, diabetes, etc. The treatment for WNV neuroinvasive disease is usually supportive care.

CASE PRESENTATION: A 62-year-old female with a history of kidney transplant and hypertension presented with five days of fever and fatigue. She was in her usual state of health until one week prior to arrival when she noted flu-like symptoms with associated dizziness, unsteady gait, nausea, and neck pain. She worked as a school teacher in New York City and does not have any recent travel, hiking, camping, or bug bites. Initial exam was significant for a fever (38.3 C) and neck stiffness but was otherwise neurotically and cognitively intact with normal CT head. Her initial lab was significant for hyponatremia of 121 mEq/L, and thrombocytopenia of 62 x103/µL. Her Cerebrospinal fluid (CSF) had elevated WBC with neutrophil dominant, concerning for viral meningitis. Considering that patient was taking tacrolimus and mycofenolate mofetil and was allergic to penicillin, vancomycin, meropenem, and acyclovir were empirically started. CSF from lumbar puncture and serum on Day 1 of admission resulted positive for WNV IgM. She was initially managed with supportive care, however, she had multiple admissions to the Intensive Care Unit due to altered mental status (only responsive to sternal rub) and seizure-like activities. CSF on Day 22 of admission was positive for WNV IgM and IgG. She received a 5-day course of intravenous immunoglobulin (IVIG) on Day 34 of hospitalization, followed by a 7-day course of IV methylprednisolone 1g and prolonged oral steroid taper on Day 41. Her mental status improved drastically after the pulse dose steroid, and she was discharged to an acute rehab for physical therapy.

DISCUSSION: Our patient who had a history of solid-organ transplant presented with WN neuroinvasive disease with symptoms including confusion/altered mental status (happens in 46–74% of cases), and seizure (happens in 1-4% of cases). Although the effectiveness of systemic steroids and IVIG therapy is not clear, cases are reported showing favorable outcomes. Systemic steroid and IVIG therapy do not seem to worsen the outcome, the decision was thus made to trial these therapies for our patient. Our patient improved after high-dose systemic steroid therapy. The steroid has potent anti-inflammatory effects. For IVIG therapy, studies suggest that passive transfer of virus-specific antibodies, especially early in clinical course, may play a role in controlling active infection. The evaluation of the efficacy of IVIG and steroids is complicated especially in solid-organ transplant patients, as they may have comorbid conditions that could complicate recovery. Patients with WNV encephalitis usually suffer from long-term neurological impairment with improvement seen six to eight weeks after the infection, and improvement usually reaches a limit after 12 weeks.

CONCLUSION: West Nile neuroinvasive diseases are more commonly seen in immunocompromised patients, who often suffer from 6-8 weeks of neurological impairment. Although the efficacy of IVIG and steroids is unclear, they might play a role in controlling active infection and inflammation.

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ABSTRACT #15 CASE REPORT/CLINICAL REVIEW NEPHROLOGY/PALLIATIVE CARE DECISIONAL AMBIVALENCE OR INCAPACITY? LESSONS FROM A COMPLEX CASE OF ADVANCED KIDNEY DISEASE Raul Benavides1, Tamara Goldberg1, Noelle Javier1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

BACKGROUND/INTRODUCTION: As chronic kidney disease progresses, patients often develop delirium, which can severely impair their capacity for making informed decisions about their future care. This cognitive decline, particularly in the context of uremic encephalopathy, complicates ethical decision-making as patients may refuse life-sustaining interventions. Balancing respect for patient autonomy with the medical team's obligation to provide appropriate care presents significant ethical challenges, requiring careful navigation of the interests of patients, families, and healthcare providers.

CASE PRESENTATION: A 64-year-old Hispanic male with Spanish language preference and history of gunshot wound to the bladder complicated by chronic kidney disease, stage 5 not on hemodialysis, was admitted to the hospital with urosepsis, acute-on-chronic renal failure, severe metabolic acidosis, and uremic encephalopathy.

The patient was somnolent but oriented x 3, able to follow commands appropriately. The initial plan was to start hemodialysis, but the patient declined, which per his family was consistent with his values and wishes. Though the patient was at high risk for rapid deterioration and had expressed a desire to pursue full life-prolonging measures, he continued to decline hemodialysis as well as transfer to the critical care unit. Palliative Care was consulted to address conflicting goals of care and decision-making capacity. After review, the Palliative Care team found him capable of decision-making.

The primary medical team felt ethically challenged between respecting the patient’s wishes and yet acting in his best interest medically. Legal counsel, social workers, and Spanish- speaking residents facilitated discussions, enhancing trust and communication with his family. After several conversations, the patient was eventually agreeable to starting hemodialysis to spend more time with his family.

IMPACT/DISCUSSION: Informed consent remains critical to respecting patient autonomy and clinicians must ensure that patients meet the necessary criteria, including understanding their situation and its potential consequences, demonstrating sound reasoning, and effectively communicating their decisions. Our case illustrates how decisional ambivalence (expressing conflicting preferences) overlapped with uremic encephalopathy and psychological stressors can confound the assessment of decision-making capacity. Such scenarios pose ethical and practical challenges for physicians, particularly in time-sensitive situations. The patient’s medical team and family additionally experienced moral distress due to the time-sensitive nature of the decision. Determining if the patient’s beliefs/preferences have changed or they have come to terms with something, can be distressing and requires regular contact and multidisciplinary collaboration with culturally competent care, involving language-concordant providers, in order to tease out the cause of ambivalence and minimizing decisional regret. Furthermore, screening tools to assess decision making capacity such as the Aid to Capacity Evaluation tool can help inform the subtleties of this process.

CONCLUSION: Decision-making capacity is dynamic and requires frequent reassessment. Contradictory patient statements often reflect their process of understanding and should be approached with regular, nuanced evaluation.

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ABSTRACT #16 CASE REPORT/CLINICAL REVIEW CARDIOLOGY IT’S ALL ABOUT THE GRADIENT: WARING BLENDER SYNDROME IMPROVES WITH DIURESIS Brandon Berman1, Harrison Bonilla1, Abel Casso Dominguez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society for Cardiovascular Angiography & Interventions (SCAI) Annual Meeting that was held in Washington, DC, United States from May 1-3, 2025.

BACKGROUND/INTRODUCTION: Waring Blender Syndrome is a rare complication of prosthetic valvular replacement, occurring due to shearing forces on the red blood cells (RBCs) as they pass through the valvular orifice. Aptly named, this condition is typically secondary to the RBCs being physically ground against the prosthetic valve leaflets, like passing through a blender. Waring Blender Syndrome has become progressively rarer as advances in bioprosthetic valvular technology have made them less prone to causing sufficient shearing stresses to result in significant hemolysis.

CASE PRESENTATION: A 68-year-old man with a remote history of multivalvular endocarditis status post aortic and mitral valve replacements, and tricuspid valve ring repair in 1998, with subsequent repeat bioprosthetic valve-in-valve replacement of both the mitral and aortic valves in 2015, who presented due to dyspnea on exertion. On admission, he was found to be significantly anemic to a hemoglobin of 3.9g/dL requiring transfusion of three units of blood. Given an unclear history of melena prior to presentation, acute gastrointestinal hemorrhage was excluded with a negative CTA of the abdomen and pelvis. With a rapidly rising direct bilirubin and LDH (3.4mg/dL and 682U/L, respectively) as well as an undetectable haptoglobin level, acute intravascular hemolysis was considered likely. An initial transthoracic echocardiogram demonstrated severe degeneration of the bioprosthetic mitral valve and a mean diastolic gradient of 16mmHg and peak E velocity of 2.7m/sec, as well as moderate to severe aortic stenosis with a mean gradient of 36mmHg and peak velocity of 3.9m/sec. Treatment with intravenous furosemide 40mg daily improved the gradient at the mitral valve with a mean gradient of 12mmHg status post diuresis. This also resulted in resolution of the hemolytic anemia as demonstrated by stabilized hemoglobin levels and down trending bilirubin and LDH levels. The structural heart team was consulted but deemed the patient not to be a candidate for transcatheter valvular interventions, recommending cardiothoracic surgical intervention as the definitive treatment. Surgical aortic and mitral valve replacements were planned for the outpatient setting.

CONCLUSION: In this case, the severity of the mitral valvular degeneration and the high gradients across the valve created a “perfect storm” in which the shearing stresses on the patient’s RBCs was sufficient to cause significant enough intravascular lysis to require life-saving transfusions. Reducing the gradient across the valve with diuresis, therefore, played a critical role in preventing continued hemolysis. Complicating this picture was the multivalvular nature of the patient’s structural heart disease. Diuresis in multi-valvular stenosis is a delicate art that requires balancing the need to offload volume to improve pressure gradients across the mitral valve, while also ensuring there is enough preload to overcome the stenosis at the subsequent aortic valve. With adequate diuresis, the gradient across the mitral valve decreased without causing significant worsening of the aortic stenosis gradient, thereby removing a key component of that shearing stress and preventing further mechanical hemolysis across the degenerated valve.

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ABSTRACT #17 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/PULMONARY/CRITICAL CARE THE RISE OF E-CIGARETTE SMOKE: A UNIQUE CASE OF VAPING-ASSOCIATED LUNG INJURY Nooshin Beygui1, Sonya Prasad1, Alfred Burger1, Vasundhara Singh1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

CASE PRESENTATION: A 26-year-old male with an extensive history of daily vape use presented with 3 days of myalgias, chills, fever, shortness of breath, and cough. On admission, he was hypertensive and febrile to 39.4°C, with a white blood cell count of 8.8K/uL and elevated lactate (2.0mmol/L). Computed tomography angiography (CTA) revealed multifocal ground-glass and consolidative opacities bilaterally without focal lobar consolidations. His worsening hypoxia required us of a non-rebreather mask. These findings raised concerns for severe community acquired pneumonia (CAP) versus e-cigarette or vaping product use-associated lung injury (EVALI) given how severe his symptoms and imaging were in an otherwise healthy, immunocompetent patient.

Empiric antibiotics were initiated along with high-dose steroids, beneficial for both CAP and EVALI. Lab testing for HIV infection, sexually transmitted infections, respiratory viruses, blood cultures, and legionella urine antigen were negative. The patient completed antibiotics and steroids, was weaned off oxygen, and discharged with a 1-week prednisone taper. At outpatient follow-up appointment 4 weeks later, the patient had complete resolution of symptoms and was at his baseline level of activity.

DISCUSSION: Here, we present a case of acute hypoxia in a young person with daily e-cigarette use with a differential diagnosis notable for CAP versus EVALI. It is difficult to decern between these conditions in this case given EVALI is a disease process without a singular diagnostic test that was first officially identified and investigated by the Center for Disease Control in 2019. He presented nausea, vomiting, cough, and fever, which are the most common symptoms seen in EVALI (present in more than 90% of documented EVALI cases). The typical radiologic finding in 56% of EVALI cases is bilateral lower lobe-predominate or diffuse ground glass opacities, consistent with CTA findings in our patient’s case. His case also raises the question as to whether ecigarette use could increase susceptibility to severe, acute disease and a more severe CAP. A report from the 2021 American Thoracic Society meeting on public health initiatives to address EVALI emphasized the importance of continued patient and public education on the risks of vaping products. This case provides evidence against e-cigarette products to support this effort, particularly in younger patients. The patient presented showed significant improvement with initial loading of high-dose steroids and subsequent taper. The ongoing use of electronic cigarette use warrants further consideration of EVALI in patients with severe, acute disease and known e-cigarette use. There has yet to be a consensus on an optimal treatment regimen for ecigarette or vaping product use-associated lung injury. More investigation into e-cigarette or vaping product useassociated lung injury treatment regimens and response is warranted.

CONCLUSION: This case outlines the importance of considering e-cigarette or vaping product use-associated lung injury as a diagnosis in situations where the patient’s clinical picture is incongruent with what would be expected in a patient based on medical history and initial work-up. The patient’s radiologic findings were more severe than expected in a healthy, young adult. His history of extensive vaping and significant improvement with systemic steroids corresponds with the clinical picture of e-cigarette or vaping product use-associated lung injury, a diagnosis of exclusion that warrants further investigation to optimize guidelines for treating this type of lung injury for future patients.

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ABSTRACT #18 CLINICAL RESEARCH CARDIOLOGY/ENDOCRINOLOGY OUTCOMES ASSOCIATED WITH GLUCAGON-LIKE PROTEIN RECEPTOR AGONIST USE IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION: A SYSTEMATIC REVIEW AND METAANALYSIS OF RANDOMIZED CONTROL TRIALS Brandon Berman1, Harrison Bonilla¹, Joshua Guardia¹, Esther Tsyngauz¹, Kiran Mahmood1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Glucagon-like protein receptor agonists (GLP1-RAs) have demonstrated benefit in cardiovascular outcomes trials among patients with type II diabetes. However, their effects in patients with heart failure with preserved ejection fraction (HFpEF) have shown inconsistent results across studies. This metanalysis evaluates the impact of GLP1-RAs on mortality, heart failure hospitalizations, left ventricular function, and functional status in patients with HFpEF. METHODS: After performing a systematic Pubmed and Google Scholar search followed by a full-text screen, all randomized controlled trials and secondary/post-hoc analyses that included patients with pre-existing HFpEF and the effects of GLP1-RAs on mortality, heart failure hospitalizations, LV function, and patients’ functional status were included. Combined data from the studies was analyzed in a metanalysis using Cochrane’s RevMan software.

RESULTS: Among 21 studies of HFpEF patients, the use of GLP1-RAs in HFpEF demonstrated an 11% reduction in the rate of mortality over the study period compared to placebo (HR, 0.89; 95%CI, 0.82-0.97; p=0.01) and a 17% reduction in the rate of heart failure hospitalizations (HR, 0.83; 95%CI, 0.74-0.93; p=0.002). There was a significant improvement in patients’ functional status when compared to placebo, as demonstrated by a greater than 17m increase in 6-Minute Walk Distance (MD, 17.70m; 95%CI, 14.20-21.19; p<0.00001), greater than 7-point increase in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (MD, +7.42; 95%CI, 6.42-8.42; p<0.00001), and 7% decline in N-terminal pro-B-type natriuretic peptide levels (treatment ratio, 0.93; 95%CI, 0.88-0.98; p=0.004) (Figure 1). Echocardiographic findings demonstrated significant improvements in diastolic function parameters, including decreases in E/e' (MD, -1.17; 95%CI, -1.36 to -0.98;0 p<0.00001), E velocity (MD, -4.94cm/s; 95%CI, -8.31 to -1.58; p=0.004), and E/A ratio (MD, -0.15; 95%CI, -0.23 to -0.08; p<0.001) (Figure 2).

CONCLUSION: The use of GLP1-RAs in patients with HFpEF showed significant reductions in both mortality and heart failure hospitalizations. Additionally, there were significant improvements in functional status and diastolic function parameters. These findings suggest that GLP1-RAs may be beneficial as an adjunct therapy for patients with HFpEF, particularly in those with obesity.

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Figure 1. Forest plots demonstrating the combined summary effects of GLP1-RAs in the meta-analysis of RCTs, including on mortality (top-left panel), heart failure (top-right panel), 6-Min Walk Distance (center panel), KCCQ-CS scores (bottom-left panel), and NT-ProBNP levels (bottom-right panel).

Figure 2. Forest plots demonstrating the combined summary effects of GLP1-RAs in the meta-analysis of RCTs on echocardiographic parameters, including on ejection fraction (top-left panel), E/A ratio (top-right panel), cardiac output (center panel), E/e’ ratio (bottom-left panel), and E-wave velocity (bottom-right panel).

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ABSTRACT #19 QUALITY IMPROVEMENT ALLERGY/IMMUNOLOGY/GENERAL INTERNAL MEDICINE PENICILLIN ALLERGY DE-LABELING MADE EASY: EVALUATING A MINIMAL-INTERVENTION PATIENT OUTREACH STRATEGY Sneha Bupathi1, Desiree Chow2, Songhui Ma2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Penicillin allergy remains the most commonly reported drug allergy, with a prevalence of up to 25% in the general population. Allergic reactions range from acute IgE-mediated responses to severe delayed reactions. However, studies indicate that over 95% of patients labeled as penicillin-allergic can tolerate penicillin as adults. Over labeling occurs due to various factors, including misinterpretation of viral exanthems, outgrown allergies, unclear childhood reactions, or dose-dependent side effects. Over labeling has significant clinical and public health implications, including increased reliance on more expensive and potentially more toxic alternative antibiotics, higher rates of Clostridium difficile infections, increased antibiotic resistance, and prolonged hospital stays. Given these risks, professional organizations and public health institutes continue to advocate for widespread penicillin allergy de-labeling. However, the scale of de-labeling efforts makes it impractical for any single discipline to manage alone. This study explores the efficacy of a low-effort, patientcentered approach to facilitate penicillin allergy de-labeling. Currently, 698 patients at General Medical Associates, a resident-run primary care clinic, have a documented penicillin allergy. Chart review reveals that most cases have not been further investigated. In the past six months, no referrals were placed to Allergy/Immunology for penicillin allergy evaluation. This project aims to support ongoing de-labeling efforts and reduce the negative consequences of inappropriate penicillin allergy labels through a low-effort communication strategy via patient portal messaging.

METHODS: Phase 1 of the project aimed to achieve a 10% referral rate for patients receiving a bulk Epic MyChart message, leading to an Allergy/Immunology evaluation within three months. The target population included patients at the Mount Sinai Beth Israel resident-run primary care clinic. The QI methodology followed the IHI Model for Improvement using the Plan-Do-Study-Act (PDSA) cycle. A bulk MyChart message was sent to all patients seen at the clinic in the last 12 months who had a documented penicillin allergy and an active MyChart account. The message stated: "You’ve been identified as having a penicillin allergy. Nine out of ten patients who report a penicillin allergy are not truly allergic or have outgrown their allergies. Non-penicillin antibiotics can be less effective, more costly, and have more side effects. Please contact your primary care doctor if you would like to be referred to anAallergist to discuss your allergy further. If you do NOT have an allergy to penicillin, please do not worry. Let us know at your next visit, and your chart will be updated."

The message was intentionally succinct to minimize patient confusion and burden.

RESULTS: Within two months of sending the message, 32 patients responded: • 3 patients expressed interest in discussing their allergy with their primary care provider.

• 2 patients had previously undergone drug challenges and required delabeling in Epic.

• 10 patients declined referral due to concern about a true allergy.

• 9 patients requested and successfully received Allergy referrals.

• 5 patients reported being incorrectly labeled as allergic.

• 2 patients had questions requiring further clarification.

Ultimately, 2% of patients were referred for Allergy/Immunology evaluation, falling short of the initial 10% goal.

CONCLUSION: MyChart messaging offers a simple, scalable method to reach a large patient population and encourage discussions about penicillin allergy de-labeling. However, limitations exist, including low MyChart engagement, a lack of patient understanding about de-labeling, and inaccuracies in electronic medical record

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documentation. Future strategies could improve effectiveness by timing messages closer to primary care appointments to prompt in-person discussions. Additionally, many patients may have MyChart accounts but do not actively use them or receive notifications. Engaging providers in the de-labeling initiative could enhance patient-provider discussions. While a short message may encourage response, providing additional education on drug challenges and the benefits of de-labeling could further motivate patients. A combined approach, involving both patient outreach and provider engagement, may be more effective in addressing widespread penicillin allergy mislabeling.

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ABSTRACT #20 CLINICAL RESEARCH CARDIOLOGY REVIEW AND META-ANALYSIS OF GLOBAL LONGITUDINAL STRAIN CHANGES AFTER ANGIOTENSIN RECEPTOR NEPHRILYSIN INHIBITOR INITIATION IN PATIENTS WITH HEART FAILURE Kristen Carter1, Soumya Gupta1, Ashish Correa1, Kiran Mahmood1, Arieh Fox1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 15-17, 2024.

BACKGROUND/INTRODUCTION: Angiotensin Receptor Nephrilysin Inhibitors (ARNi) have been established as a beneficial medication in patients with heart failure. This class of medications has been shown to decrease heart failure hospitalizations and has been included as one of the pillars in guideline directed medical therapy.

Recently, left ventricular (LV) global longitudinal strain (GLS) measurements on echocardiograms have become more common and provide a more precise measurement of LV function than ejection fraction. GLS is now being used as a more intricate way of monitoring improvement in the function of the myocardium, especially in patients with heart failure. This meta-analysis was conducted to determine if treatment with ARNi in heart failure patients significantly improves myocardial functioning measured by LV GLS. METHODS: A meta-analysis of 9 studies including observational studies and randomized controlled trials found in a Pubmed search was performed and included patients with heart failure who were initiated on an ARNi for guideline directed medical therapy and had LV GLS measurements taken on an echocardiogram before and after ARNi initiation. The study included patients with heart failure with reduced ejection fraction. Studies were excluded if the patient population did not have a diagnosis of heart failure and if LV GLS measurements were not available before and after treatment with ARNi. This analysis was performed to determine if initiation of ARNi in patients with heart failure led to a significant improvement in LV GLS on echocardiography and therefore a significant improvement in myocardial function.

RESULTS: There were 9 studies included in the analysis and 879 patients with heart failure who were treated with ARNi or a control. The change in LV GLS at the conclusion of the study period was measured in both treatment and control groups and the mean difference between the two groups was -1.61 with a 95% confidence interval of (-2.23, -0.98) (p<0.00001). This indicates that the ARNi treatment groups had a significant improvement in GLS compared to the control groups.

CONCLUSION: ARNi initiation was found to significantly improve LV GLS and therefore myocardial function in patients with heart failure with reduced ejection fraction. LV GLS is a precise measurement of myocardial function. Using this form of measurement in echocardiograms can aid in determining the effect different treatments have directly on myocardial function.

Figure 1. GLS change in each included study with accompanying Forest plot

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ABSTRACT #21 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/GENERAL INTERNAL MEDICINE/HEMATOLOGY/ONCOLOGY RARE BUT FATAL SIDE EFFECT OF NOVEL CANCER THERAPIES: IMMUNE CHECKPOINT INHIBITORRELATED MYOCARDITIS Changwoong Cho1, Arshdeep Dhaliwal1, Sara Diaz Saravia1, Tamera Goldberg1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

CASE PRESENTATION: A 72-year-old female patient with metastatic invasive ductal breast carcinoma status post bilateral mastectomy, chemotherapy, and radiation (RT to C3-L5) recently started on adjuvant therapy (Pembrolizumab/Taxol) two weeks prior, presented to the emergency department with 2-3 days of shortness of breath, cough, fever, and lethargy. She was hypoxic to 80% on room air, tachycardic, and was noted to be confused and drooling. Initial CT-chest showed multifocal pneumonia and left diaphragm elevation. She was eventually intubated due to acute hypoxic respiratory failure and started on pressor support with broad spectrum antibiotics. Her course was further complicated by elevated Troponin I to 6628 with accompanying CKMB of 168, ESR of 72 and CRP of 114.1 and EKG showed sinus tachycardia with anterior and inferior Q waves. She was then transferred to CCU due to concern for possible ACS versus type II MI vs myocarditis. Given, elevated biomarkers, signs of myocardial injury and severe LV dysfunction demonstrated on transthoracic echocardiogram, right/left heart catheterization was performed without endomyocardial biopsy (family declined), which showed absence of significant coronary atherosclerosis. Cardiac MRI was unable to be performed, and the decision was made to initiate empiric treatment for suspected myocarditis with intravenous pulse steroid.

Subsequently, biomarkers down trended and she was transitioned to oral steroid taper. She was extubated after 24 hours of admission to the CCU and was discharged with BIPAP. DISCUSSION: Immune checkpoint inhibitors are novel cancer therapies which are monoclonal antibodies that target the host immune negative regulation receptors such as CTLA-4, PD-1, and PD-L1. Important side effects of immune checkpoint inhibitors are Immune-related adverse effects (IRAEs). Among IRAEs, Immune checkpoint inhibitors-related myocarditis is rare, and case reports suggest high mortality. The presentation of this rare clinical syndrome can manifest from asymptomatic elevations in cardiac biomarkers to severe decompensation with end-organ damage. Due to its rarely reported incidence, it is essential to consider the combination of predisposing medical history, clinical features, and lab findings to prevent diagnostic delays and initiate treatment. In this case, our patient had a recent exposure to immune checkpoint inhibitors with no prior cardiac history, elevated biomarkers, and EKG findings. A comprehensive diagnostic approach is vital including endomyocardial biopsy and cardiac MRI, however if unable to be performed, empiric treatment with immunosuppression should be promptly initiated with monitoring of troponin and other biomarkers.

CONCLUSION: In summary, immune checkpoint inhibitors-related myocarditis is a complex disease, and rare disease that is similar in presentation to other acute cardiac syndromes with a high mortality rate. Therefore, it is imperative for clinicians to have a high suspicion for this immune checkpoint inhibitors -related myocarditis to ensure prompt treatment.

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ABSTRACT #22 CLINICAL RESEARCH PULMONARY/CRITICAL CARE ATYPICAL N3 SLEEP PATTERN IN CRITICALLY ILL PATIENTS AND ITS ROLE AS A MARKER OF OUTCOME Christiana Choi1, Benjamin Samuel1, Suraj Shah2, Arshdeep Dhaliwal1, Connor Smith1, Adrian Chernyk1, Keshav Dixit1, David Tai1, Dan Levendowski2, Priscilla Loanzon1, Lloyd Muzangwa1, Raymonde Ernest Jean1 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Advanced Brain Monitoring, Inc., Carlsbad, CA, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Intensive care unit (ICU) patients are known to have sleep disturbances with abnormal sleep patterns. Of those, atypical N3 (AN3), a delta wave pattern with limited theta and sigma activity, is associated with sepsis-associated encephalopathy and neurodegenerative diseases. This observational study analyzes AN3’s role as a potential biomarker for assessing patients’ outcomes in intensive care unit.

METHODS: Sleep Profiler, an FDA-approved device, was used to record physiological signals for 24 hours.

Patient data was auto scored by the Sleep Profiler software and was analyzed for AN3 pattern. Total of 96 eligible patients admitted to ICU were enrolled, and the data from 56 patients with recording time more than 15 hours were included in this study. Mann Whitney U and Chi-Square were used to find AN3’s association with variables including age, length of ICU stay, GCS, sleep time, and APACHE II. Multiple logistic regression was used to identify significant correlation of AN3 > 1.5 hours with variables such as death, ICU stay >10 days, and disposition.

RESULTS: Out of 56 patients, 25 patients had AN3 >1.5 hours. A p-value<0.05 was considered statistically significant. AN3 was associated with older age (78.2+10.7 versus 60.8+19.5 years, p=0.00038), longer ICU stays (15.6+14.9 versus 7.5+9.2 days, p=0.00056), and lower GCS scores (8.9+3.7 versus 12.0+4.3, p=0.006). AN3 had a close to significant association with a higher APACHE II score (20.0+5.8 versus 16.6+7.9, p=0.0524).

AN3 sleep pattern had the strongest association with ICU stay >10 days (OR, 1.33; 95%CI, 1.04-1.71; p=0.023).

APACHE II had the second strongest correlation with ICU stay >10 days (OR, 1.12; 95%CI, 1.03-1.30; p= 0.048).

AN3 had no statistically significant association with intubation status (p=0.25), hypersomnia (sleep >11 hours, p=0.067), death (p=0.322), disposition (p=0.460), or sepsis (p=0.18).

CONCLUSION: This study demonstrates that AN3 is associated with older age, worse GCS, and longer ICU stays. Mortality was not associated with AN3, further validating our previous study. Contrary to our previous study, AN3 did not predict disposition in this cohort. However, it showed a significant association with ICU stay > 10 days, which is comparable to that shown by APACHE II. Studies have shown that higher ICU length of stay is associated with greater 1-year mortality. Though this current study is limited to a single center, our study shows that AN3 may have a clinical role in the early recognition of outcomes in ICU patients, which warrants further investigation.

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ABSTRACT #23 CLINICAL RESEARCH CARDIOLOGY ARTIFICIAL INTELLIGENCE-ENHANCED RECOGNITION OF OCCLUSION IN ACUTE CORONARY SYNDROME: A RETROSPECTIVE REVIEW James Choi1, Vincent Torrelli1, Sara Saravia Diaz1, Esha Vaish1, Luka Katic1, Alexander Nagourney1, Zara Khan1, Alexander Silverman1, Serdar Farhan1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 15-17, 2024.

BACKGROUND/INTRODUCTION: Traditional ST-elevation criteria do not exhibit high sensitivity for acute occlusion detection, with many total occlusions presenting as non-ST-segment elevation myocardial infarction (NSTEMI). Artificial intelligence-based EKG (AI-EKG) interpretation may improve the identification of occlusion myocardial infarction. This study evaluates a novel AI-EKG device's accuracy and clinical outcomes for detecting occlusion myocardial infarction in suspected acute coronary syndrome (ACS) patients.

METHODS: Adult patients who underwent coronary angiogram (CAG) at Mount Sinai Morningside Hospital for unstable angina, NSTEMI, or STEMI between January 1 and December 31, 2022, were included. The AI model (PMCardio) analyzed all pre-CAG ECGs. Inclusion criteria: suspected ACS at the emergency department, no outside hospital transfers, and available peak troponin levels. Occlusion myocardial infarction was defined as a culprit vessel with TIMI 0-2 flow or TIMI 3 flow and peak cTnI > 10.0 ng/mL. Primary outcome: AI EKG model's sensitivity and specificity for predicting occlusion myocardial infarction on CAG. Secondary outcomes: F1 score, predictive values, AI occlusion myocardial infarction prediction of inpatient mortality, reduced ejection fraction at 1-year, unplanned readmissions, and STEMI criteria performance.

RESULTS: Of 257 patients, 222 met the inclusion criteria: 72 STEMI (32%), 145 NSTEMI (65%), and 5 unstable angina (3%). Confirmed angiographic occlusion myocardial infarction: 60 (83%) STEMI and 51 (35%) NSTEMI patients. AI model sensitivity was 81.08%, specificity 87.39%, AUROC 0.8423, F1 score 0.8372, PPV 86.54%, NPV 82.20%. Odds ratio of 12.44 (1.56 - 98.98) for AI-detected occlusion myocardial infarction patients, unplanned readmissions [OR, 1.15 (0.53 - 2.51)], and reduced ejection fraction at 1 year [OR, 0.24 (0.26 -2 .16)].

Traditional STEMI criteria sensitivity for occlusion myocardial infarction was 54.05%, and specificity 89.29%. The AI model was 100% sensitive for STEMI- occlusion myocardial infarction and correctly reclassified 8 out of 12 false positive STEMI patients as non-occlusion myocardial infarction.

CONCLUSION: The AI model nearly doubles the sensitivity of traditional STEMI criteria for occlusion myocardial infarction, enabling earlier detection. Further studies are needed to determine if earlier occlusion myocardial infarction detection with AI improves clinical outcomes. The AI's high specificity in detecting STEMI-occlusion myocardial infarction may reduce false positive catheterization lab activations while ensuring no true positive STEMI-occlusion myocardial infarction cases are missed.

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ABSTRACT #24 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/GENERAL INTERNAL MEDICINE/INFECTIOUS DISEASES A CHALLENGING DIAGNOSIS OF STREPTOCOCCUS INTERMEDIUS HEPATIC ABSCESS IN A PATIENT WITH COVID-19 INFECTION Emily Cosentino1, Shasawat Kumar1, Kaitlyn Clausell1, Natia Pantsulaia1, Rahul Gaikwad1, Irina Zaretsky1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 72-year-old woman with breast cancer treated with lumpectomy and radiation in 2021, diverticulosis diagnosed by colonoscopy in 2018, and recent dental work, presented to the emergency department with cough, congestion, diarrhea, dizziness, and an episode of near-syncope. Two days prior to presentation she tested positive for COVID-19 and was prescribed nirmatrelvir ritonavir. On arrival, vital signs were notable for a temperature of 37.9C, tachycardia (122 beats per minute), hypotension (88/53 mm Hg), and mild hypoxia (91% oxygenation on room air). Physical examination revealed bibasilar crackles. Initial laboratory workup showed an elevated white blood cell count (22.1 x 109/L), hyponatremia (128 mEq/L), transaminitis (AST 109 U/L, ALT 55 U/L, alkaline phosphatase 254 U/L), and a positive COVID-19 PCR. A chest X-ray demonstrated a hazy opacity in the left lung base. The patient was admitted with a presumptive diagnosis of COVID-19 infection with superimposed bacterial pneumonia and was started on intravenous hydration, broad spectrum antibiotics, and dexamethasone. On day 3, blood cultures resulted positive for Streptococcus intermedius and antibiotics were narrowed to ceftriaxone. Dexamethasone was discontinued as the patient had been weaned off supplemental oxygen. By day 6, the patient continued to report fatigue despite stable vital signs and a downward trend in white blood cell count. The elevation in her liver enzymes, attributed to COVID19 since admission, had decreased but persisted (AST 54 U/L, ALT 66 U/L, alkaline phosphatase 150 U/L).

Further evaluation with a right upper quadrant ultrasound was pursued and revealed a necrotic mass in the right lobe of the liver. A subsequent CT of the abdomen showed a 5 x 8 x 5 cm multiloculated liver collection. Given the patient’s history of breast cancer and concern for metastatic disease, an MRI of the abdomen was obtained and confirmed a multiseptated hepatic abscess. The location of the abscess precluded safe percutaneous drainage. In consultation with Infection Disease, the patient was transitioned to amoxicillin/clavulanate, with a plan for repeat imaging in three weeks to reassess the abscess.

DISCUSSION: Streptococcus intermedius is a gram-positive bacterium that belongs to the Streptococcus anginosus group (SAG), a subgroup of the viridans group streptococci. While it normally colonizes the oropharynx, gastrointestinal tract, and genitourinary system, S. intermedius has the potential to act as an opportunistic pathogen. A distinctive feature of this organism is its propensity to cause abscess formation, which can occur in various body sites including the liver, brain, and lungs. We suspect that our patient developed bacteremia from her dental procedure which led to hematogenous seeding of the liver. Her remote history of diverticulosis may have been another potential risk factor. This case posed a diagnostic challenge as the patient did not have any fevers since admission or abdominal pain, which are typically associated with a pyogenic liver abscess. Her concurrent COVID-19 diagnosis further complicated the clinical picture as symptoms such as malaise and transaminitis are commonly associated with a viral syndrome.

CONCLUSION: A high degree of vigilance is necessary in patients with S. intermedius bacteremia as this organism is abscess forming. Symptoms of a pyogenic liver abscess could be nonspecific, and the absence of fever or right upper quadrant pain should not delay further investigation.

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ABSTRACT #25 CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY/GENERAL INTERNAL MEDICINE INTRACTABLE NAUSEA AND VOMITING DUE TO HYPERTHYROIDISM Sofia Dawson1 and Hoa Chi1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Hyperthyroidism is a condition characterized by excessive thyroid hormone production, which can present with a wide range of clinical manifestations. While classic symptoms include weight loss, tremors, palpitations, and heat intolerance, gastrointestinal symptoms such as nausea and vomiting are less commonly recognized as primary manifestations. This case highlights the diagnostic challenges posed by hyperthyroidism presenting predominantly with gastrointestinal symptoms.

CASE PRESENTATION: A 57-year-old female with a medical history of hypertension and type 2 diabetes presented to the emergency department (ED) with nausea and vomiting persisting for two days. The vomitus was non-bloody and non-bilious. She reported experiencing similar symptoms intermittently over the past three months and noted a 20-pound unintentional weight loss during this period. An upper endoscopy performed one day prior to her ED visit had revealed esophagitis and gastritis of unspecified grade. She had been prescribed metoclopramide, which no longer provided symptom relief.

Upon presentation, her vital signs were stable, with blood pressure of 155/73 mmHg, heart rate of 85bpm, and body temperature of 36.2°C. Physical examination revealed mild epigastric tenderness but was otherwise unremarkable. A CT scan of the abdomen and pelvis suggested gastritis and colitis. Her symptoms improved with ondansetron, and she was discharged home. She returned to the ED two days later with persistent symptoms and was admitted for further evaluation and management. Gastroenterology was consulted, and an esophagram demonstrated moderate to high-volume gastroesophageal reflux. Her symptoms were attributed to severe gastroesophageal reflux, and she was started on sucralfate in addition to proton pump inhibitors and antiemetics. She was discharged after six days of hospitalization with symptom improvement.

Four days after discharge, she returned to the ED with intractable nausea and vomiting and was readmitted. A review of prior laboratory results revealed an undetected thyroid abnormality from the previous admission.

Further testing showed a suppressed thyroid-stimulating hormone (TSH) level of <0.01mIU/L, elevated total triiodothyronine (T3) at 231.12 ng/dL, and free thyroxine (FT4) >6.0 ng/dL. Additionally, thyroid-stimulating immunoglobulin was markedly elevated at 4.64 IU/L. A thyroid ultrasound demonstrated findings consistent with thyroiditis. She was diagnosed with hyperthyroidism due to Graves’ disease and started on methimazole 10 mg three times daily. Her symptoms improved significantly, and at a one-month endocrinology follow-up, she remained asymptomatic.

CONCLUSION: This case highlights the need to consider hyperthyroidism in patients presenting with persistent nausea and vomiting, even in the absence of classic symptoms. While commonly associated with weight loss, tachycardia, and heat intolerance, hyperthyroidism can also affect gastrointestinal function through altered gastric motility, sympathetic overactivity, and direct hormonal effects. The delayed diagnosis in this case emphasizes the difficulty of recognizing atypical presentations. Early recognition of hyperthyroidism can prevent mismanagement, as seen in this patient initially treated for gastroesophageal reflux. Thyroid function testing should be considered when standard evaluations fail to identify an underlying cause. A high index of suspicion is necessary for timely diagnosis, especially in patients with unexplained gastrointestinal symptoms and weight loss. The incidental discovery of suppressed TSH underscores the importance of thorough laboratory review and interdisciplinary collaboration in the evaluation of complex cases. With appropriate management, including antithyroid medications, patients can achieve symptom resolution and improved quality of life.

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ABSTRACT #26 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE THROMBOTIC THROMBOCYTOPENIC PURPURA INDUCED BY PLASMODIUM FALCIPARUM: A CASE REPORT HIGHLIGHTING DIAGNOSTIC DILEMMAS Mrittika Deb1, Lloyd Muzangwa1, Christiana Choi1, Bridget Dolan1, Nikita Desai1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Malaria and thrombocytopenic purpura (TTP) both can present with fever, microangiopathic hemolytic anemia (MAHA), thrombocytopenia, acute kidney injury, and changes in mental status. This case report highlights the challenges of diagnosing TTP in the context of malaria, illustrating the importance of early diagnosis and intervention in such complex clinical scenarios.

CASE PRESENTATION: A 69-year-old female with recent travel to Togo presented with fever and lethargy to the emergency department. CBC showed low hemoglobin and thrombocytopenia. Due to a high level of concern for malaria, further hematologic labs were obtained, including a peripheral blood smear, which showed Plasmodium falciparum with <3% parasitemia. The patient was treated with artemether-lumefantrine, resulting in improved parasitemia. The hospital course was further complicated by worsening thrombocytopenia, neurologic, and renal function. The patient was admitted to intensive care unit, where she was noted to have MAHA, disseminated intravascular coagulation, and worsening thrombocytopenia regardless of improved parasitemia. TTP was considered as part of differentials at this time, and the labs were sent to assess ADAMTS13 activities. Despite initial management, the patient rapidly deteriorated in a few days and passed away despite resuscitation efforts and before the work-up was completed. Posthumous evaluation confirmed significantly reduced ADAMTS13 activity and elevated ADAMTS13 antibodies, establishing the diagnosis of acquired TTP. CONCLUSION: This case illustrates the overlap between two serious conditions and emphasizes the healthcare provider’s need to consider the complete clinical picture, leading to timely and appropriate interventions. For this particular case, TTP was not immediately considered due to the low parasitemia, contributing to the failure to initiate plasma exchange therapy in a timely manner, which is a lifesaving intervention in TTP. As evidenced by this case, malaria can coexist with TTP or may even be a trigger. Clinicians, especially in regions where malaria is endemic, should be vigilant in monitoring for atypical presentations and act swiftly when symptoms align with TTP criteria. This case underscores the importance of maintaining a high index of suspicion for TTP in patients with malaria, advocating for early intervention, including plasma exchange, even in the absence of definitive diagnostic confirmation.

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ABSTRACT #27 CLINICAL RESEARCH GASTROENTEROLOGY THE IMPACT OF DIET ON QUALITY OF LIFE IN PATIENTS WITH PERIANAL FISTULIZING CROHN’S DISEASE Jake DeBroff1, Bharati Dev1, Shabari Shenoy1, Elisabeth Giselbrecht2, Hunter Moran2, Nicole Gbenebitse2, Stephanie Gold2, Serre-Yu Wong2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

BACKGROUND/INTRODUCTION: One in five patients with Crohn’s disease (CD) suffer from perianal fistulizing Crohn’s disease (PFCD), which can have a significant impact on quality of life. However, the impact of diet on quality of life has not been studied. Therefore, we aimed to assess food related quality of life in patients with active and inactive perianal fistulizing Crohn’s disease.

METHODS: We conducted a survey study of 109 patients with PFCD seen in an outpatient visit at a large, tertiary care center. A previously validated food-related quality of life (FRQoL) was utilized and modified to focus on PFCD. Demographic and clinical data were obtained through chart review. Clinically active versus inactive disease were defined as the presence or absence, respectively, of perianal pain and/or drainage as recorded in the perianal disease activity index (PDAI) at the time of survey completion. Bivariate comparisons were made using Chi-squared and student t-tests.

RESULTS: Among the 109 patients, 56% (n=61/109) were male, 67% (n=73/109) were Caucasian, and 18.3% (n=20/109) had a diversion ostomy with a mean age of 38.8 years (SD=13.9). Additional patient demographics and disease characteristics are listed in Table 1. 89 (82%) patients had active fistulizing disease. In this cohort, 61% of patients (66/108) felt strongly that what they eat impacts their inflammation and perianal disease symptoms. Comparing those with active and inactive PFCD, those without perianal pain and/or drainage were significantly less likely to associate diet and perianal disease symptoms or activity (13.6% versus 40%, p=0.04).

Similarly, those with active disease were significantly more interested in discussing the impact of diet and nutrition on PFCD with their provider as compared to those with inactive disease (30.7% versus 5.2%, p=0.02).Moreover, those patients with inactive disease were significantly less likely to avoid certain foods or have smaller portions in order to reduce symptoms of fistula drainage or perianal pain (5.2% versus 25%, p=0.02) and to lessen inflammation (3.4% versus 42.1%, p<0.01). Finally, those patients with inactive disease were also significantly less likely to have questions about how diet impacts their fistula (5.2% versus 30.7%, p=0.02).

CONCLUSION: Patients with perianal fistulizing Crohn’s disease, particularly those with active fistulas, report altering food intake and reducing portions to improve perianal symptoms and inflammation. These patients expressed a strong interest in discussing the impact of diet and nutrition on perianal fistulizing Crohn’s disease with their providers. This study highlights the need to address nutritional concerns for patients with perianal fistulizing Crohn’s disease and to provide dietary counseling to prevent restrictive eating behaviors and malnutrition in this high-risk cohort.

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Characteristics Age, years, mean Gender, female, n(%)

Race

Ethnicity Smoking Status

White, n (%) African American, n (%) Asian, n (%) Middle Eastern, n (%) Other, n (%) Hispanic or Latino, n(%) Former, n (%) Current, n (%) Never, n (%)

A1 (16 years or less), n (%) A2 (17-40 years), n (%) A3 (>40 years), n (%) L1 (Ileal), n (%) Montreal Disease Location L2 (Colonic), n (%) Classification L3 (Ileocolonic), n (%) B1 (non stricturing), n (%) Disease Behavior B2 (stricturing), n (%) B3 (penetrating), n (%) Advanced IBD Therapy at the time of enrollment, n (%) Ileostomy, n (%) Luminal anatomy at Colostomy, n (%) the time of enrollment IPAA, n (%) Active perianal disease* Active proctitis (within 1 year of enrollment) None, n (%) Prior EUAs 1, n (%) 2+ n (%) Table 1: Patient Demographics and Disease Characteristics Age at Diagnosis

Patient Cohort (n=109) 38.8 48 (44) 73 (67) 17 (16) 5 (5) 2 (2) 11 (10) 23 (21) 10 (9) 9 (8) 88 (81) 31 (31) 65 (64) 3 (3) 13 (13) 24 (24) 63 (62) 22 (22) 10 (10) 54 (54) 92 (84) 16 (15) 4 (4) 4 (4) 89 (82) 30 (28) 16 (15) 28 (26) 65 (60)

*As assessed using the Perianal Disease Activity Index (PDAI) IPAA: ileo-anal pouch anastomosis EUS: Exam under anesthesia IBD: Inflammatory bowel disease

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Survey Responses

Entire Cohort (n=109)

Active Disease (n=89)

Inactive Disease (n=20)

Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree Strongly Disagree Disagree Neutral Agree Strongly Agree

I believe that what I eat impacts the inflammation in my body and how quickly the fistula will heal n (%)

I am able to eat and drink similarly to those around me (including those that do not have IBD) n (%)

I feel comfortable eating and drinking around people I do not know despite my fistula n (%)

Survey Questions I avoid I avoid certain certain foods or have foods or smaller have portions smaller because I am portions afraid that because I some foods will am afraid cause more that some Inflammation foods will n (%) worsen my symptoms n (%)

I avoid eating to reduce the number of bowel movements each day so that I don't have so much pain or drainage from my fistula n (%)

I have questions about how diet will impact my perianal disease n (%)

I wish my doctors would tell me how diet impacts my fistula n (%)

3 (2.8)

15 (14.2)

2 (1.8)

10 (9.2)

11 (10.2)

25 (23.3)

8 (7.5)

6 (5.6)

19 (17.6) 20 (18.5) 40 (37)

20 (18.9) 11 (10.4) 43 (40.6)

7 (6.4) 8 (7.3) 61 (56)

21 (19.3) 12 (11) 42 (38.5)

19 (17.6) 14 (13) 41 (38)

32 (29.9) 14 (13.1) 24 (22.4)

16 (15) 27 (25.2) 33 (30.8)

14 (13.1) 34 (31.8) 28 (26.2)

26 (24.1)

17 (16)

31 (28.4)

24 (22)

23 (21.3)

12 (11.2)

23 (21.5)

25 (23.3)

2 (2.3)

12 (14.0)

2 (2.2)

5 (5.6)

3 (3.4)

16 (18.2)

3 (3.4)

3 (3.4)

18 (20.5) 12 (13.6) 34 (38.6)

20 (23.3) 9 (10.5) 34 (39.5)

5 (5.6) 8 (9) 52 (58.4)

18 (20.2) 9 (10.1) 37 (41.6)

18 (20.2) 12 (13.5) 35 (39.3)

28 (31.8) 11 (12.5) 22 (25)

12 (13.5) 24 (27) 28 (31.5)

10 (11.4) 28 (31.8) 27 (30.7)

22 (25)

11 (12.8)

22 (24.7)

20 (22.5)

21 (23.6)

11 (12.5)

22 (24.7)

20 (22.7)

1 (5.0)

3 (15.0)

0 (0.0)

5 (25.0)

8 (42.1)

9 (47.4)

5 (27.8)

3 (15.8)

1 (5.0) 8 (40.0) 6 (30.0)

0 (0.0) 2 (10.0) 9 (45.0)

2 (10.0) 0 (0.0) 9 (45.0)

3 (15.0) 3 (15.0) 5 (25.0)

1 (5.3) 2 (10.5) 6 (31.6)

4 (21.1) 3 (15.8) 2 (10.5)

4 (22.2) 3 (16.7) 5 (27.8)

4 (21.1) 6 (31.6) 1 (5.2)

4 (20.0)

6 (30.0)

9 (45.0)

4 (20.0)

2 (10.5)

1 (5.3)

1 (5.6)

5 (26.3)

Table 2: Food Related Quality of Life Survey

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ABSTRACT #28 CASE REPORT/CLINICAL REVIEW ALLERGY/IMMUNOLOGY/GENERAL INTERNAL MEDICINE A CASE OF LUPINE INDUCED FOOD PROTEIN INDUCED ENTEROCOLITIS SYNDROME (FPIES) Sara Dehbozorgi1, Sohini Kamdar2, Eugene Choo2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at both the American Academy of Allergy, Asthma, & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress Annual Meeting that was held in San Diego, California, United States from February 28, 2025 to March 3, 2025 and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Lupine (protein Lupinus albus) is growing in allergic importance due to peanut cross-reactivity and increasing usage in seeds, as a snack, or additives to wheat and gluten-free flours.

Lupine allergy may be due to cross-reactivity after sensitization to peanut or other legumes, or de novo sensitization. Cross-reactivity between peanut and lupine has been reported to be as high as 44%. Clinically, the reactivity rates are lower and vary widely between studies. Here we present the first known case of food protein induced enterocolitis syndrome (FPIES) to lupine.

CASE PRESENTATION: We present a 32-year-old woman with past medical history of lactose intolerance and irritable bowel syndrome who presented with three episodes of profuse diarrhea and projectile emesis three hours after ingestion of lupine; one episode included syncope. She has avoided peanut consumption since childhood as she had an unclear history of peanut allergy but was never tested for it. Percutaneous skin testing and specific IgE were negative for lupine and peanut.

CONCLUSION: FPIES typically starts in the first year of life; adult onset is exceedingly rare (0.22% of adults).

Similarly, lupine is a rare cause of adverse food reactions. This is the first instance to our knowledge of lupineinduced adult FPIES. In adult FPIES, seafood is the most common trigger (peanut is uncommon at <2%), and 40% have multiple food triggers. Allergy testing is typically negative in FPIES; diagnosis is generally made if prototypical clinical history is present and other etiologies are excluded. Oral food challenge is the gold standard for FPIES diagnosis but considered unnecessary if history is clear and a specific food trigger has been identified.

Our patient’s history and lack of other etiologies, including negative food allergy testing, strongly indicate adult food protein induced enterocolitis syndrome to lupine. Despite lupine's obscurity as an etiology of adverse food reactions in the United States, its growing popularity necessitates increased awareness, particularly with a history of adverse peanut reactions.

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ABSTRACT #29 CLINICAL RESEARCH CARDIOLOGY CARDIOGENIC SHOCK IN PATIENTS WITH CANCER: DISPARITIES IN USE OF MECHANICAL SUPPORT AND OUTCOMES IN A CONTEMPORARY NATIONWIDE SAMPLE Sara Diaz Saravia1, Vincent Torelli1, Maninderjit Ghotra1, Samuel Tan1, Marko Novakovic1, Paulus Adinugraha1, Katharine Idrissi2, Basera Sabharwal1, Gagan Sahni2, Matthew I. Tomey1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society for Cardiovascular Angiography & Interventions (SCAI) Annual Meeting that was held in Washington, DC, United States from May 1-3, 2025.

BACKGROUND/INTRODUCTION: Cardiogenic shock, the leading cause of cardiovascular death in hospitalized patients, encompasses a diverse spectrum of disease processes and severity with variable outcomes and heterogeneous use of resources, including temporary mechanical circulatory support (tMCS). Absent randomized evidence for routine benefit of tMCS in cardiogenic shock outside a single recent trial, allocation has reflected clinical judgment, including consideration of patient comorbidities. In recent years, growing incidence of cancer and advances in cancer therapies have increased the relevance of cancer as both a comorbidity and pathogenetic factor in heart disease including cardiogenic shock. Yet evidence is limited from extant trials and observational literature on the implications of a cancer diagnosis for tMCS use and outcomes of cardiogenic shock.

METHODS: We stratified a retrospective cohort of young adults (age 18-50 years) hospitalized with cardiogenic shock from 2016 to 2020 in the National Inpatient Sample according to history of cancer (active or past cancer).

We compared baseline characteristics of patients with or without cancer. We conducted logistic regression to evaluate associations of cancer with tMCS use and survival, adjusting for age, sex, hypertension, diabetes, coronary artery disease, heart failure, metastasis, and STEMI. In this analysis, tMCS included IABP, Impella and ECMO. RESULTS: Out of 19,867 young adults with cardiogenic shock, 543 (2.73%) had cancer. Patients with cancer had a lower burden of cardiovascular risk factors and cardiovascular disease at baseline (Figure 1). STEMI accounted for 13% of cardiogenic shock in patients without cancer and 4% in those with cancer. Patients with cancer were less likely to receive tMCS (OR, 0.54; 95%CI, 0.40-0.72; p<0.001) and more likely to die in the hospital (OR, 1.49; 95%CI, 1.23-1.80; p<0.001).

CONCLUSION: Among young adults hospitalized with cardiogenic shock in the United States in recent years, patients with cancer were less likely to receive tMCS and more likely to die in the hospital despite lower burden of pre-existing cardiovascular disease and comorbidities. Young patients with cancer and cardiogenic shock were less likely to experience cardiogenic shock as a consequence of STEMI, limiting applicability of recent randomized evidence.

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Figure 1. Baseline characteristics, temporary mechanical circulatory support use and outcomes of young patients with cardiogenic shock with or without cancer.

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ABSTRACT #30 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY A CRYPTIC ESOPHAGEAL LESION: BENIGN OR MALIGNANT? Carlos G. Diola1, Mantej Sehmbhi1, Alexandra Rozalen2, Adelsalam Sharabi2, Edward Lung1, Ian Cohen1 1 Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States BACKGROUND/INTRODUCTION: Granular cell tumors, previously known as Abrikossoff’s tumor or granular cell myoblasts, are rare tumors that can involve the gastrointestinal tract. Initially described in 1926 by Russian pathologist, Aleksei I. Abrikossoff, the tumor can affect anatomical regions around the head, neck, and oral cavity but rarely arises in the esophagus. These tumors are generally benign, neurogenic in origin, and esophageal involvement only has an incidence of approximately 33 per 100,000. The mean age of diagnosis is 45 years with lesions more commonly found in men but should be considered in women presenting with an intramural mass at the proximal or distal third of the esophagus. Dysphagia is a common symptom seen in 33% of patients with these tumors, while the rest are asymptomatic. Although rare, esophageal granular cell tumors do have malignant potential and must be monitored closely.

CASE PRESENTATION: In this case, a 57-year-old Caucasian female with a past medical history of gastroesophageal reflux disease presented to the Gastroenterology clinic for evaluation of intermittent dysphagia with acid reflux. The patient was having refractory symptoms despite omeprazole usage, thus warranting further workup. Subsequently, an upper endoscopy showed a nodule in the lower third of the esophagus, and diffuse mild inflammation with erythema in the gastric body and antrum. The esophageal biopsies were positive for S100 on immunohistochemistry, a protein marker of neural crest origin and gastric biopsies were positive for Helicobacter pylori (H. pylori). The diagnosis was thought to be a submucosal granular cell tumor. An upper endoscopic ultrasound demonstrated an eight mm in thickness hypoechoic and submucosal lesion with welldefined borders in the lower third of the esophagus. Endoscopic mucosal resection was then performed with complete removal. Pathology from the resected lesion demonstrated an underlying population of neoplastic cells, with strong S100 and CD68 positivity confirming the diagnosis of a granular cell tumor. The patient was also treated with bismuth-based quadruple therapy for coincidental H. pylori infection and omeprazole. The plan will be to repeat the upper endoscopic ultrasound in six months for surveillance.

CONCLUSION: As previously discussed, there is a potential for granular cell tumors to become malignant.

Approximately two percent of these lesions can undergo malignant transformation. Close monitoring with upper endoscopic ultrasound is critical in determining the choice of treatment. Small (<1cm) lesions are managed conservatively, and larger lesions (>1cm) are resected endoscopically. In this case, the patient still underwent endoscopic mucosal resection since the lesion was causing dysphagia. Diagnosis, work-up, and long-term management have not been well described due to the tumor’s rarity.

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Image 1. Endoscopic views of a single eight mm (subepithelial) nodule in the lower third of the esophagus.

Image 2. Histopathologic digital images of an esophageal nodule: (A) H&E stain at 2x magnification reveals esophageal mucosa with an underlying population of neoplastic cells. (B) H&E stain at 20x magnification displays characteristic sheets or packets of uniform epithelioid cells.

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ABSTRACT #31 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE A PROPER HOME MEDICATION RECONCILIATION UNMASKING WITHDRAWAL IN A CRITICALLY ILL PATIENT Keshav Dixit1, Deborah Edelman1, Amir Ahmadi1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

LEARNING OBJECTIVES: 1. Recognize features of serotonin-norepinephrine reuptake inhibitor (SNRI) withdrawal 2. Complete thorough medication reconciliations for all patients, including those with critically ill presentations CASE PRESENTATION: We present a 56-year-old female patient with a past medical history of severe aortic stenosis (status/post transcatheter aortic valve replacement), coronary artery disease with multiple stents, hypertension, hyperlipidemia, diabetes, asthma, stroke, Hodgkin’s Lymphoma (status/post chemotherapy and radiation), pituitary adenoma (status/post transsphenoidal resection), metastatic breast cancer (status/postmastectomy, chemotherapy), and chronic kidney disease who initially presented to the hospital with chest pain and shortness of breath. She was admitted to the cardiac care unit (CCU) for pulmonary edema and acute respiratory failure, for which she was intubated for airway protection. She underwent a cardiac catheterization, during which she had a stent and an intra-aortic balloon pump placed. Her vital signs were stable until after extubation, when she developed persistent tachycardia with intermittent fevers, tachypnea, lethargy, and headaches. She was treated empirically with antibiotics. Repeat infectious workup, and pan-imaging of the head, chest, abdomen, and pelvis were all unremarkable. An ultrasound of the lower extremities revealed a thrombus in the right common femoral vein. However, she tested negative for a pulmonary embolism. A heparin drip was started for treatment, but her symptoms persisted. Following a thorough, negative workup, a medication reconciliation was performed. It was discovered that before admission, she was taking Duloxetine, a serotoninnorepinephrine reuptake inhibitor (SNRI). Following its resumption, her symptoms and vital signs improved. She was transferred out of the CCU for further management.

DISCUSSION: SNRIs are now being increasingly prescribed for the treatment of mood and anxiety disorders, as well as chronic pain and menopausal symptoms. Antidepressant discontinuation syndrome from SNRIs can cause flu-like symptoms such as lethargy and headaches, as our patient experienced, with myalgias and diaphoresis; other symptoms include insomnia, hyperarousal (i.e. anxiety, agitation, irritability), balance difficulties (i.e. vertigo, dizziness) and more. These symptoms, which may often have a late onset, can last for several days to weeks. Withdrawal symptoms can occur during transitions of care, a vulnerable time for patients during which medication discrepancies arise due to inaccurate or delayed reconciliations.

CONCLUSION: Vital sign abnormalities commonly occur, often with unclear etiologies. In patients with nonspecific symptoms, including those critically ill, consider medication withdrawal as a possible cause, including from SNRIs. Completing early medication reconciliations with accurate medication histories will increase patient safety during and post hospitalization.

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ABSTRACT #32 CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY A CASE OF THYROID STORM REFRACTORY TO MEDICAL MANAGEMENT Paige Dixon1, Suma Gondi2, Jennifer Abrams2, Peter Goulden1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025 and to be presented at the American Association of Clinical Endocrinology (AACE) Annual Meeting that will be held in Orlando, Florida, United States from May 15-17, 2025.

BACKGROUND/INTRODUCTION: Thyroid storm represents a life-threatening manifestation of thyrotoxicosis, requiring urgent and aggressive treatment. Due to its rarity, evidence regarding the management of refractory cases remains limited and primarily confined to case reports. We present a case of thyroid storm resistant to standard medical therapy, which was successfully managed with total thyroidectomy.

CASE PRESENTATION: A 69-year-old female presented with a left middle cerebral artery (MCA) stroke.

Despite thrombolytic therapy, her neurological status deteriorated, and she developed atrial fibrillation.

Laboratory investigations revealed severe hyperthyroidism (TSH <0.01 μIU/mL, free T4 3.03 ng/dL, total T3 126 ng/dL). The Burch-Wartofsky Point Scale (BWPS) confirmed a diagnosis of thyroid storm. Initial treatment included high-dose propylthiouracil (PTU), propranolol, hydrocortisone, and potassium iodide. Thyroid autoantibodies were negative, and ultrasonography revealed a multinodular goiter.

Despite five days of aggressive medical therapy, her condition failed to improve. PTU was replaced with methimazole, and cholestyramine was added to the regimen. After 25 days of optimized medical management, her thyroid hormone levels normalized, but her clinical course remained complicated by persistent atrial fibrillation. Given the refractory nature of her thyroid storm and underlying multinodular goiter, a total thyroidectomy was performed. The surgery was successful, and the patient was initiated on levothyroxine therapy, achieving a stable euthyroid state.

CONCLUSION: Thyroid storm often arises from unrecognized or untreated hyperthyroidism and may be triggered by acute stressors such as cerebrovascular events. Diagnosis hinges on biochemical evidence of hyperthyroidism combined with clinical assessment, often guided by scoring systems like the BWPS. Management typically involves beta-blockers, glucocorticoids, and thionamides to inhibit thyroid hormone synthesis and peripheral conversion of T4 to T3. Adjunctive therapies, including potassium iodide, bile acid sequestrants, and plasma exchange, may be employed to further lower circulating thyroid hormone levels.

For refractory cases or those requiring rapid resolution due to cardiopulmonary compromise, total thyroidectomy represents a definitive treatment option. Surgical intervention may also be particularly appropriate in the setting of a multinodular goiter or when long-term medical management is untenable.

This case highlights the importance of recognizing thyroidectomy as a viable and effective intervention for refractory thyroid storm. In this patient, total thyroidectomy successfully resolved the thyroid storm after an extensive medical course failed to achieve clinical stability. This experience underscores the need for heightened clinical vigilance and timely consideration of surgical treatment in similar cases.

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ABSTRACT #33 BASIC SCIENCE HEMATOLOGY/ONCOLOGY COMPARISON OF GENOMIC LANDSCAPES IN PRIMARY ADENOID CYSTIC CARCINOMA AND SALIVARY PRIMARY AND METASTATIC ADENOID CYSTIC CARCINOMA TUMORS USING SINGLE CELL RNA SEQUENCING Eduard I. Drizik1 and Nicholas Rohs2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: There is an increasing number of cases of primary pulmonary adenoid cystic carcinomas (PACCs) that have been recently described, however it remains unclear how closely these tumors resemble their salivary gland counterparts. It is also unclear how distinct these tumors are from non-small cell lung cancers more traditionally associated with tracheobronchial involvement. Currently PACCs are treated similarly to non-small cell lung cancers (NSCLCs) with surgical resection, possible radiation, and adjuvant platinum-based chemotherapy, but the best approach to treatment is not absolutely certain. Recent RNA sequencing studies have attempted to elucidate biomarkers and actionable mutations of PACCs with some success. However, no study has yet compared cellular composition of these tumors. Here, we present a case report of a newly diagnosed PACC and compare publicly available single cell RNA sequencing data across tracheobronchial primary tumors as well as their salivary gland analogues.

CASE PRESENTATION: We present a 40-year-old female with past medical history of cigarette smoking who was found to have a right carinal mass on a PET/CT. No metastases were identified on initial imaging and the mass was noted to be minimally avid. Patient had subsequently undergone a complete right pneumonectomy with reconstruction of the trachea. Tumor histopathology showed a right sided 1.5cm adenoid cystic carcinoma involving the full thickness of the tracheobronchial wall with a notable cribriform growth pattern. Perineural but not angiolymphatic involvement was noted. As the initial encounters occurred at an outside hospital, it is unclear but likely that the patient then received some adjuvant radiation. Patient had subsequently undergone multiple follow-ups with various imaging modalities and has been noted to be in remission. However, patient has since developed a persistent cough, reversible airway reactivity, and increased susceptibility to airway infections.

METHODS/RESULTS: We propose a study comparing cellular composition and gene expression from paraffin embedded tissue of primary tracheobronchial ACC, primary salivary ACC, and metastatic SACC. Our literature review has identified publicly available single cell RNA sequencing data that was run on the same Illumina NovaSeq 6000 platform, which decreases technical variability. The data will be matched based on the normal lung tissue samples within each data set. T-SNE plots and gene expression fold changes will be analyzed to determine distinguishing and analogous features of each tumor type on a cellular and gene expression levels.

CONCLUSION: It is more common to find primary salivary gland tumors with metastatic spread to the lung rather than a primary pulmonary adenoid cystic carcinoma, but it is yet unclear if these rare subtypes should be distinguished as a distinct cancer type. As such, a definite treatment is not absolutely certain. In this case report, we present a patient who was found to have a low grade PACC with significant post-treatment morbidity. It is our hypothesis that PACCs and SACCs have highly similar compositions. If our analysis of single cell sequencing data comparing PACCs to their counterparts

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confirms our hypothesis, they should then be treated similarly, initially with resection and then subsequent RT and possible platinum-based chemotherapy to reduce the morbidity burden. However, it is likely that low grade operable tumors may only require minimal resection. It is also our hope that distinct gene expression changes identified through this process will also yield a targetable mutation, similarly to NSCLC, that would reduce the morbidity of such tumors further or can even be applied to treatment of high-grade tumors leading to increased survival.

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ABSTRACT #34 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY AMPULLA OF VATER ADENOMA: A RARE AND OFTEN MISSED CAUSE OF PANCREATITIS Jose Duran1,2, Jake Debroff1,2, Bharati Dev1,2, Luis Rendon-Rodriguez1,2 1Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside/West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Villous adenomas of the ampulla of Vatar are uncommon lesions that make up between 0.1 and 0.2% of gastrointestinal tumors, and they are often overlooked as a cause of extrahepatic cholestasis which may ultimately cause pancreatitis. Pancreatholithiasis, or pancreatic stone, is a sequela of chronic pancreatitis and may occur in the main ducts, side branches, or parenchyma, and can cause pancreatic duct obstruction which is an important cause of pain in chronic pancreatitis. We present a case of Ampullar of Vatar adenoma as a potential cause of recurrent pancreatitis and associated pancreatic duct stone.

CASE PRESENTATION: A 41-year-old female with a history of recurrent pancreatitis presented with acute epigastric pain radiating to the back. Her previous pancreatitis episode was approximately a year ago and was found to have elevated lipase level. She was treated with analgesia and fluids, and she underwent cholecystectomy for presumed biliary sludge and cholecystitis which were seen in magnetic resonance cholangiopancreatography (MRCP). During this presentation, patient again had an elevated lipase level, but otherwise normal laboratory results including normal autoimmune panel, liver function tests, and triglyceride values. Repeat MRCP was significant for interstitial pancreatitis and negative for biliary findings including lithiasis or dilation.

At follow-up, endoscopic ultrasound was performed which was significant for a simple hyperechoic focus measuring up to 3mm in diameter, suggestive of stone in the pancreatic head and no ampulla abnormalities.

Patient further underwent endoscopic retrograde cholangiopancreatography (ERCP), which showed a single pancreatic duct stone. Stone removal and sphincterotomy was performed, and a stent was placed. Incidentally, the ampulla of Vater was found prominent as well, and the biopsy revealed tubulovillous adenoma.

After further discussion with surgical oncology, decision was made to undergo ampullectomy given size and histology of lesion. The patient did not have another episode of pancreatitis at least 6 months after the procedure.

DISCUSSION/CONCLUSION: Adenoma of the ampulla of Vater is a difficult-to-diagnose cause of obstruction of the biliary duct. Rarely, it could cause cholestasis and subsequently pancreatitis. It is among the rarest of gastrointestinal neoplasms which is usually identified after gastroscopy or ERCP followed by biopsies. Treatment options include endoscopic resection, surgical ampullectomy or pancreatoduodenectomy, depending on the size, histology, and presence of ductal invasion. This case demonstrates how cholestasis from an ampullary adenoma may be the cause of recurrent pancreatitis and associated pancreatic duct stone, and there are only a handful of reports documenting ampulla of Vater adenoma associated with pancreatitis, and is relevant given its rarity, frequency of misdiagnosis, and risk for malignancy.

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ABSTRACT #35 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY EDEMA AND SEROSITIS AS AN ADVERSE EVENT AMONG PATIENTS WITH CANCER RECEIVING IMMUNE CHECKPOINT BLOCKADE: SYSTEMATIC REVIEW TO EVALUATE THIS IMMUNE-RELATED ADVERSE EVENT AND ASSOCIATED TREATMENT STRATEGIES Evelyn Elias1, Mako Koseki1, Fnu Chesta2, Kensuke Takaoka2, Yoshito Nishimura2, Nicholas C. Rohs3, Yu Fujiwara4 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI, United States; 3Mount Sinai Hospital, Icahn School

of Medicine at Mount Sinai, New York, NY, United States; 4Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States

Presented at the American Society of Clinical Oncology (ASCO) Annual Meeting that was held in Chicago, Illinois, United States from June 2-6, 2023.

BACKGROUND/INTRODUCTION: Immune checkpoint blockade (ICB) is a standard therapeutic option for certain patients with solid tumors, often leading to durable responses. Immune-related adverse events (irAEs) can impact treatment duration and patients' quality of life. The mechanism of irAEs is proposed to be an inflammatory response triggered by blocking immune checkpoints, and nonspecific symptoms such as edema and fluid accumulation can occur. We performed a systematic review to summarize the reported studies evaluating edema and serositis to explore edema and serositis as an irAE and management strategies.

METHODS: We performed a database search in Medline, EMBASE, and Web of Science for studies reporting the incidence and outcome of immune-related generalized edema (irGE) including peripheral edema, capillary leak syndrome, serositis, pleural/peritoneal/pericardial effusion, and anasarca as an irAE among patients with solid tumors treated with ICB. Two independent reviewers analyzed the eligibility of each article. Those that did not report outcomes related to irGE were excluded. The number of patients, cancer type, name, and type of ICB, type of irGE, treatment of irGE, and treatment outcome for irGE were extracted from each article to summarize the characteristics of irGE. RESULTS: 662 articles were identified, and 80 studies were included (65 case reports/series, 8 cohort studies, 3 phase 1/2 clinical trials) that described clinical characteristics and treatment outcomes for AEs from 196 patients, and 259 irGE incidences were reported. The median age was 62 years (Interquartile range: 55-68 years). 35.9% of cases were female (n=28/78). Commonly reported irGEs were pericardial effusion (n=115, 44.4%), pleural effusion (n=58, 22.4%), peripheral edema (n=40, 15.4%), and ascites (n=19, 7.3%). PD-1 blockade was utilized in 75.8% of cases, followed by PD-L1 blockade (14.9%) and dual ICB (CTLA4 and PD-1 blockade, 4.6%). Common cancers where irGE occurred were lung cancer (63.9%), malignant melanoma (17.0%), and urothelial carcinoma (3.1%). We classified irGEs into primary irGE (n=84, 42.9%), secondary to other irAEs (n=41, 20.9%), secondary to pseudoprogression (n=14, 7.1%), and cancer progression (n=13, 6.6%).

Glucocorticoid was used to manage irGEs in 91 patients (46.4%); 48 cases (24.5%) required the prednisoneequivalent dose of > 1 mg/kg/day. ICB discontinuation was confirmed in 96 cases (49.0%) among which 53 (27.0%) permanently stopped ICB use due to irGEs. CONCLUSION: irGE is a common and clinically important irAE among patients with solid tumors receiving ICB. Most cases required glucocorticoid therapy along with discontinuation of ICB, which could result in poorer quality of life and potentially impact outcomes. The pathophysiology, incidence, and clinical outcomes of irGE need to be accurately described in further studies.

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ABSTRACT #36 CLINICAL RESEARCH GENERAL INTERNAL MEDICINE PREDICTIVE VALUE OF PSYCHOSOCIAL FACTORS ON WEIGHT LOSS OF OVERWEIGHT AND OBESE PATIENTS ENROLLED IN WEIGHT MANAGEMENT CLINIC Ryan Eng1 and Rebecca Shafer1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Multiple studies have explored psychosocial factors associated with patients who lost and maintained weight loss vs patients who lost but then regained weight, however, studies are sparse and lack cohesion. This study aims to add to the current known data by quantifying two psychosocial factors, locus of control (LOC) and eating self-efficacy (ESE), amongst patients enrolled in a weight loss clinic, assess for changes in these psychosocial factors, and analyze for differences between patients who are weight responders versus weight non-responders.

METHODS: To do this, patients are recruited over a 6-month period and LOC and ESE are quantified using research-backed questionnaires. Patients’ weights will be measured with each visit and patients will be categorized into weight responders and weight non-responders, based on their weight change over the 6-month period.

RESULTS: Recruitment and data collection is ongoing at this moment. Currently, there are 31 patients (30 female and 1 male) enrolled with a range of locus of control and eating self-efficacy. The majority are obese, with several morbidly obese subjects and a few overweight. Majority of subjects have been started or continued pharmacological interventions. Frequent limitations to starting newer and more efficacious medications have been insurance approval. One subject has been referred to bariatric surgery for evaluation.

CONCLUSION: Conclusions are currently preliminary as data is still ongoing. Notably, the vast majority of patients are female and of low socioeconomic class, so this study may not have a high external validity. With further enrollment and data collection, this study will have greater power.

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ABSTRACT #37 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/NEPHROLOGY/PULMONARY/CRITICAL CARE DOUBLE TROUBLE OR BETTER TOGETHER? DOUBLE ANTIBODY POSITIVE PULMONARY-RENAL SYNDROME Tansu Eris1, Niurka Liranzo Tejera1, Martin Sedlacek1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Pulmonary renal syndrome (PRS) is a clinical syndrome characterized by diffuse alveolar hemorrhage and glomerulonephritis, often caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis or anti-glomerular basement membrane (anti-GBM) disease. Double-positive PRS exhibits features of both anti-GBM disease and ANCA vasculitis. Prompt treatment is crucial due to the high mortality and morbidity of pulmonary-renal syndrome. Treatment in double-antibody positive PRS follows a similar approach to anti-GBM disease, consisting of an induction phase with glucocorticoids, immunosuppression, and plasmapheresis (PLEX) to remove anti-GBM antibodies, followed by a maintenance phase with glucocorticoids and immunosuppression. Supportive measures, including transfusion, mechanical ventilation, and renal replacement therapy, may be required. Renal prognosis is variable across reported cases.

CASE PRESENTATION: A 86-year-old woman was referred to the emergency department for a marked rise in serum creatinine (8.0 mg/dL from 0.77 mg/dL two months prior) and a drop in hemoglobin (11 g/dL to 8.4 g/dL).

She reported weeks of “muddy” urine, fatigue, and weight loss. Her history included atrial fibrillation on apixaban, hypertension recently started on triamterene-hydrochlorothiazide, hyperlipidemia, prior CVA with residual rightsided weakness, MGUS with a faint IgG lambda M spike, and osteoporosis on alendronate. On presentation, her vitals were unremarkable except for a BP of 140/86 mmHg. Examination revealed trace bilateral lower extremity edema and right-sided 3/5 muscle strength, consistent with prior CVA, but was otherwise unremarkable, with no costovertebral angle or suprapubic tenderness. Laboratory results confirmed severe kidney dysfunction, metabolic acidosis, hypocalcemia, and normocytic anemia. Urinalysis showed significant proteinuria and hematuria, while urine microscopy revealed sheets of RBCs, no dysmorphic RBCs, and a muddy brown cast. A FeNa of 10.7% suggested intrinsic renal pathology. Renal ultrasound demonstrated increased cortical echogenicity without obstruction. Serologic testing revealed significantly elevated anti-MPO (4.9 U/mL) and anti-GBM antibodies (>8 U/mL). The patient maintained a daily urine output of 500 mL and showed no signs of uremia, hyperkalemia, or severe acidosis requiring urgent dialysis until this point.

FURTHER COURSE AND MANAGEMENT: The patient developed flank pain and hematuria, prompting a noncontrast CT on hospital day three, which showed non-obstructing left renal calculi and incidental signs of volume overload, with bilateral pleural effusions, pulmonary edema, and ascites. A follow-up chest X-ray revealed patchy opacities. Given positive anti-GBM antibodies and no infection, diffuse alveolar hemorrhage was suspected.

Chest CT confirmed bilateral perihilar ground-glass opacities and consolidations with interlobular septal thickening, suggesting pulmonary hemorrhage. Despite these findings, the patient remained asymptomatic with SpO₂ >95% on room air. Bronchoscopy with BAL confirmed diffuse alveolar hemorrhage. A renal biopsy revealed extensive crescentic glomerulonephritis with linear IgG capillary staining, active crescents in 64% of glomeruli, and acute tubular injury without vasculitis or immune complexes on electron microscopy. The final diagnosis was pulmonary-renal syndrome due to dual antibody positivity (anti-GBM and anti-MPO ANCA) with crescentic glomerulonephritis. On hospital day six, the patient developed nausea, fatigue, and 'brain fog,' raising concern for uremic encephalopathy, prompting initiation of hemodialysis. High-dose methylprednisolone of 1 g/day for three days was started and transitioned to a prednisone taper, cyclophosphamide 50 mg daily for a total of 1250 mg was administered along with PLEX, totaling nine sessions. Hemodialysis was required for four months before kidney function significantly improved, with creatinine returning to 1.5 mg/dL within six months.

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CONCLUSION: We present a case of double-positive PRS with concurrent anti-GBM and ANCA antibodies demonstrating a remarkable recovery. While the exact pathogenesis of double-antibody positive PRS remains unclear, it is postulated that ANCA-induced glomerular inflammation may expose cryptic epitopes, subsequently triggering an anti-GBM response. Double-positive PRS exhibits features of both anti-GBM disease and ANCA vasculitis, with variable renal prognosis across reported cases. DAH is subclinical in one-third of cases, similar to glomerulonephritis, where bleeding is often microscopic rather than macroscopic. The antibody profile significantly impacts treatment decisions, highlighting the importance of simultaneous antibody testing and renal biopsy in all patients when rapidly progressive glomerulonephritis is suspected.

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ABSTRACT #38 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE RELATIONSHIP FIRST: ENHANCING PATIENT CONTINUITY IN SEVERAL URBAN FEDERALLY QUALIFIED HEALTHCARE CENTERS Ines Varela Knorr1, Kimberly Fasciglione1, Niurka Liranzo Tejera1, Aphrodite Megaris1, Aesha Patel1, Lauren Shapiro1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

BACKGROUND/INTRODUCTION: Continuity in patient care fosters trust, enhances preventive services, improves chronic disease management, reduces healthcare costs, and increases satisfaction for both patients and providers, yet continuity at our Urban Federally Qualified Healthcare Centers (FQHC) averages just 15.3%, far below the national benchmark of 75% and the national median of 56% in resident continuity clinics. Our project aimed to strengthen patient-provider relationships and improve continuity at our resident-led clinics.

METHODS: We implemented targeted interventions through PDSA cycles. The first cycle enhanced patient access by offering provider schedules six months in advance and increasing the number of sessions per resident provider. The second introduced a group care model, assigning patients to a rotating team of four residents rather than a single provider. To support this model, patients received handouts with the names and availability of their primary care provider and the other members of their practice group. Additionally, support staff were encouraged to prioritize these practice groups when scheduling appointments to ensure consistency. The third cycle provided educational sessions for new residents, emphasizing the importance of continuity in patient care and offering practical strategies to improve it. Weekly reminders further ensured that continuity remained a central focus in both clinical practice and medical education. We assessed the impact of our interventions through various process measures. Our process measures for the first PDSA cycle included the total number of clinic sessions available per resident at each site and the percentage of patients able to schedule follow-up appointments within 2 or 4 months before leaving the clinic. The process measures for the second PDSA cycle focused on the degree of continuity within clinic panels, and the frequency of handout use. The third PDSA cycle built on the previous two, maintaining an emphasis on these measures. The outcome measure is the continuity rate by clinic site.

RESULTS: By increasing the number of clinic sessions per provider, we achieved an average 18.3% rise in visit volume across all clinic sites. Additionally, by implementing this intervention and providing schedules six months in advance, continuity across clinics improved by an average of 5.3% during the first five months (Table 1). As the PDSA cycles progress, we will continue to evaluate both process and outcome measures to drive sustained improvements.

CONCLUSION: Patient and provider continuity is essential to creating a trusting relationship with greater satisfaction, improving patient outcomes, and reducing healthcare utilization. By increasing the number of clinic sessions per provider, educating residents on the value of continuity, and creating continuity handouts, the continuity rate increased across our clinics.

Table 1. Continuity rate by site pre- and post-intervention.

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ABSTRACT #39 QUALITY IMPROVEMENT ENDOCRINOLOGY/GENERAL INTERNAL MEDICINE DEXA BONE-ANZA: OSTEOPOROSIS SCREENING RATES GET A BONA FIDE BOOST FROM EMR TEMPLATES AT A RESIDENT CLINIC Samuel Nemiroff1, Julia Ferreira de Carvalho1, Laura Bock1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American College of Physicians (ACP) Annual Meeting that will be held in Chicago, Illinois, United States from May 13-17, 2025.

BACKGROUND/INTRODUCTION: There are 8.9 million osteoporosis-associated fractures worldwide annually, for which the 1-year mortality rate for hip fractures is estimated to be as high as 58%. Both women and men are suboptimally screened in the US, with some studies estimating eligible populations receive DEXA scans for osteoporosis screening at a rate of 9.5% for women and 1.7% for men. Therefore, finding ways to increase screening rates and adherence to appropriate therapies would make healthcare expenditures more costeffective. In an initial assessment, most residents in our program noted difficulty with time constraints and knowledge of how and when to order DEXA scans. Our aim was to utilize a streamlined template intervention to increase the percentage of residents at our resident clinic ordering at least 1 DEXA screening exam for women aged >65 and men aged >70 years by 25% over a 5-month study period (July 2024- November 2024) and to increase the percentage of DEXA orders for eligible male and female patients to match the national average.

METHODS: We created templates within the electronic medical record (eClinicalWorks) with the goal of reducing keystrokes and clarifying qualifying criteria for common components of preventative healthcare. This included pre-populated descriptive assessments with attached ICD codes and orders. Residents were trained on how to use the templates and who to refer for osteoporosis screening during orientation and during weekly morning huddles. Data was extracted using Azara Healthcare (Burlington, MA 01803) and verified with manual chart review. Statistical comparisons of proportions were conducted using either Chi-squared exact test or Fisher’s exact test as appropriate.

RESULTS: The rate of residents ordering at least 1 DEXA from July to November 2023 was 49% (26/53), increasing to 65% (35/54) from July to November 2024 (p=0.10). Moreover, 17% (9/53) of residents ordered more than 1 DEXA scan in this period prior to intervention, compared to 33% (18/54) post-intervention (p=0.05).

Additionally, the percentage of orders for eligible males increased from 0.8% (2/240) to 6.6% (16/243) postintervention (p=0.001). Similarly, the percentage of orders for eligible females improved from 6.3% (37/583) to 13.3% (72/543), (p=0.0004).

CONCLUSION: Residents utilized a novel template system introduced in the 2024-2025 academic year, leading to a 32% rise in residents placing one or more DEXA orders during the first 5 months of the academic year compared to same period the year prior, along with a 126% surge in total DEXAs ordered. Furthermore, the proportion of orders placed for eligible patients improved significantly, increasing twofold and eightfold for females and males, respectively. Although the change in percentage of residents ordering more than one DEXA was not statistically significant, these findings indicate that the intervention successfully enhanced DEXA ordering practices at our clinic.

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ABSTRACT #40 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY BLEEDING IN LUNG CANCER PATIENTS RECEIVING THERAPEUTIC ANTICOAGULATION WHILE BEING TREATED WITH VEGF AND EGFR INHIBITORS Thomas F. Fusillo1, Avi Leader2, Simon Mantha2, Helen Ajufo2, Andriy Derkach2, Adam Schoenfeld2, Rohan Singh2, Peter Kaplinsky2, Jeffrey I. Zwicker2 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 7-10, 2024.

BACKGROUND/INTRODUCTION: The safety of concurrent anticoagulation and treatment with vascular endothelial growth factor inhibitors (VEGFi) and epidermal growth factor receptor inhibitors (EGFRi) is largely uncertain. Many VEGF and EGFR inhibitors have black box warnings and/or risk profiles including bleeding events, thus complicating decisions regarding administration of concomitant anticoagulation (AC). Our aim was to assess the rates of major and non-major bleeding events among patients receiving AC with VEGFi or EGFRi and compare those rates with patients receiving AC with chemotherapy alone (without VEGFi or EGFRi).

METHODS: In a retrospective cohort study, patients with lung cancer receiving AC (excluding prophylactic-dose low-molecular-weight-heparin [LMWH]) from 2012 to 2022 at Memorial Sloan Kettering Cancer Center (MSKCC) were assessed for major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) events as defined by the International Society on Thrombosis and Haemostasis (ISTH). Patients were identified using diagnostic codes and prescription data and were indexed on the first day of concurrent AC and anti-neoplastic therapy. The first 295 patients were reviewed via manual chart review. The subsequent 202 patients were reviewed using the CEDARS platform (Mantha et al, 2024), which uses natural language processing (NLP) to identify potential bleeding events that are then adjudicated by a physician, to identify CRNMB and MB outcomes over a 15-month period. Patients were censored for MB, discontinuation of AC or antineoplastic therapy (60 days after last prescription), end of 12-month follow-up, or death. The study exposure was type of anti-neoplastic therapy in the first 30 days post-index including chemotherapy alone, EGFRi with or without chemotherapy (EGFRi ± chemo), and VEGFi with or without chemotherapy (VEGFi ± chemo).

RESULTS: The study included 497 patients with a median age of 66.1 years (IQR 58.8-73.3 years) and consisting of 293 (59%) females and 204 (41%) males. A total of 248 (50%) patients received AC with a direct oral anticoagulant, 240 (48%) with LMWH, and 9 (2%) with a vitamin K antagonist. The majority had stage 4 cancer and the median follow-up was 5.79 months.

Cancer treatment groups included 206 (41%) chemotherapy alone, 193 (39%) EGFRi ± chemotherapy (168 EGFRi alone), and 98 (20%) VEGFi ± chemotherapy (28 VEGFi alone). The cumulative incidences for MB in the full cohort was 5.1% (95%CI, 3.3-7.5%) at 6-months and 8.2% (95%CI, 5.4-12%) at 12-months. The 12-month cumulative incidences of MB were 8.8% for the chemo-alone group, 8.1% for the EGFRi ± chemotherapy group, and 7.4% for the VEGFi ± chemotherapy group (p=0.91 for differences between the groups). The 12-month cumulative incidences of CRNMB were 17% for the chemo-alone group, 20% for the EGFRi ± chemotherapy group, and 16% for the VEGFi ± chemotherapy group (p=0.35).

Across all treatment groups at 12-months there were 28 MB. This included 4 (1.9%) GI hemorrhages in the chemo-alone group, 3 (1.5%) in the EGFRi ± chemotherapy group, and 0 in the VEGFi ± chemotherapy group.

Similarly, there were 4 (1.9%) cases of intracranial hemorrhage in the chemotherapy-alone group, compared with 4 (2.0%) in the EGFRi ± chemotherapy group, and 1 (1.0%) in the VEGFi ± chemotherapy group.

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CONCLUSION: Utilizing an NLP platform to help identify cases of hemorrhage, we observed that the risks of both CRNMB and MB with therapy regimens including VEGF and EGFR inhibitors appear similar to chemotherapy alone. This data should reassure clinicians that therapeutic anticoagulation can be administered to lung cancer patients being treated with VEGF or EGFR inhibitors without substantial increased risk of bleeding when compared to anticoagulating patients on chemotherapy alone.

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ABSTRACT #41 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE BRIEF ALCOHOL ADVICE IN THE INPATIENT AND OUTPATIENT SETTING Kristine Lou Gargaritano1 and Peter Barelli1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

BACKGROUND/INTRODUCTION: Screening, brief intervention and referral to treatment (SBIRTs) are a standardized comprehensive approach geared towards promoting healthy lifestyle behaviors in patients. This approach has been described in the literature on brief alcohol advice, notably in the outpatient clinical environment. Physicians often face barriers when conducting SBIRTs for alcohol cessation including lack of confidence, lack of training and personal discomfort. A 2024 needs assessment suggests that these barriers also exist within the Mount Sinai Morningside/West Internal Medicine Residency program. Through this educational initiative, we aimed to increase both knowledge and confidence in conducting brief alcohol advice with the goal of helping residents perform effective SBIRTs within the inpatient and outpatient setting.

METHODS: After the initial needs assessment was performed in March 2024, a combined didactic and casebased presentation was held during Resident Academic Half Day (AHD) in April 2024. Evaluation of PGY1/PGY2/PGY3 resident knowledge and confidence was performed via anonymous surveys. A total of 17 responses were collected pre-intervention and 16 responses were collected post-intervention. Following the initial intervention, Resident Arts and Practice sessions were subsequently developed to focus on practical application of motivational interviewing (these sessions will be conducted in February and March 2025). They will include an interactive skills practice exercise with opportunity for immediate constructive feedback (and outpatient-focused clinical scenarios). A 1-page brochure highlighting outpatient resources and pharmacological treatment options will be distributed among the residency class. Detailed surveys for the Resident Arts and Practice sessions will be provided with a feedback portion to assess participants’ overall familiarity with SBIRTs, comfortability in prescribing medications for alcohol use disorder (AUD) and connecting patients with outpatient resources.

RESULTS: The results of the 1st AHD educational intervention were as follows: 52% (pre-intervention) versus 75% (post-intervention) of learners correctly identified the number of criteria needed to make a formal diagnosis of AUD. 76% of learners (pre-intervention) were able to correctly characterize severity of AUD and this improved to 100% after the presentation. Prior to the session, only 8% of learners were familiar with the SBIRT process, which later improved to 68%. 23% of participants generally felt more comfortable prescribing medications for AUD, compared to 43% following the presentation. The overall belief that SBIRTs can be effective in the longterm as well comfortability in referral for outpatient resources also showed a similar upward trend.

CONCLUSION: This project demonstrates that conducting targeted educational sessions can have a positive impact on improving internal medicine residents’ knowledge and confidence in providing brief alcohol advice in a variety of clinical settings. This educational initiative was expanded as part of curriculum development to further enhance residents’ counselling skills.

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ABSTRACT #42 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE/GERIATRICS ENHANCING DELIRIUM DETECTION AND MANAGEMENT: A QUALITY IMPROVEMENT INITIATIVE USING POCKET CARDS FOR FRONTLINE PROVIDERS Stefano Gattazzo1, Ariel Gordon1, Kaitlyn Clausell1, Omar Amir1, Yuji Yamada1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Delirium is a common and serious condition among hospitalized older adults, often signaling an underlying life-threatening illness. It affects 5% to 44% of hospitalized patients and is associated with significant short- and long-term consequences, including increased fall risk, prolonged hospital stays, higher costs, cognitive and functional decline, need for long-term care, and mortality. Despite these risks, delirium remains underrecognized, with up to 83% of missed cases. Although the Confusion Assessment Method (CAM) is a validated tool with high sensitivity and specificity, its inconsistent use contributes to gaps in detection and management. Additional barriers include inadequate provider education, and challenges identifying subtle or hypoactive presentations. Non-pharmacologic preventive strategies, such as early mobilization, sleep-wake cycle optimization, and geriatric consultation, can reduce delirium incidence but do not shorten its duration once it develops. While pharmacologic interventions should be reserved for severe cases with safety concerns, a standardized evidence-based approach to delirium prevention, detection, and management is critical to improving outcomes.

METHODS: This 2-month quality improvement (QI) project aims to enhance provider education on delirium assessment and management through the deployment of pocket cards. Delirium pocket cards will be distributed to Front Line Providers (FLPs) including residents and interns on the Geriatric teaching service. FLPs’ cards will include the CAM on the front and pharmacologic intervention guidelines on the back. Providers will be encouraged to attach these cards to their ID badges for quick reference. To assess the impact of this intervention pre- and post-intervention surveys will be distributed to FLPs to evaluate changes in their confidence levels regarding delirium detection and management. These findings will guide further efforts to improve clinical practice.

RESULTS: Implementation and analysis are pending.

CONCLUSION: Delirium remains a prevalent yet underrecognized condition among hospitalized older adults, necessitating improved detection and management strategies. By equipping FLPs with practical, evidencebased pocket cards, this ongoing QI project seeks to standardize screening practices and reinforce best practices, enhancing provider confidence and improving delirium detection rates. Future analysis of survey data will help determine the effectiveness of this intervention in optimizing patient outcomes.

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Figure 1. Front side of the delirium pocket card

Figure 2. Back side of the delirium pocket card

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ABSTRACT#43 CASE REPORT/CLINICAL REVIEW CARDIOLOGY A TALE OF TWO RESCUE CLIPS: MITRAL-TEER IN LATE PRESENTING STEMI WITH ACUTE MITRAL REGURGITATION AND CARDIOGENIC SHOCK Maninderjit Ghotra1, Samuel Tan1, Marko Novakovic1, Paulus Adinugraha1, Sara Diaz Saravia1, Vincent Torelli1, Lexi Robbins1, Katharine Idrissi1, Basera Sabharwal1, Matthew I. Tomey1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society for Cardiovascular Angiography & Interventions SHOCK Annual Meeting that was held at Washington, D.C., United States from October 17-19, 2024.

BACKGROUND/INTRODUCTION: Patients with ST-segment elevation myocardial infarction (STEMI) who present late without primary reperfusion therapy are at elevated risk for mechanical complications, shock, and mortality. Acute mitral regurgitation (MR) can contribute to critical illness in some patients. For patients deemed prohibitively ill for surgery, transcatheter edge-to-edge repair (TEER) may offer means to mitigate MR, but outcomes are incompletely understood. We report here two cases with discordant outcomes.

CASE PRESENTATION: A 91-year-old female presented to a percutaneous coronary intervention (PCI)capable spoke hospital with dyspnea, inferior Q waves with associated ST-segment elevations, and initial highsensitivity troponin I above assay limits. Coronary angiography disclosed thrombotic occlusion of the proximal left circumflex artery. PCI was deferred. Echocardiography showed new severe MR. The patient transferred to a shock hub hospital, where pulmonary artery catheterization disclosed central venous pressure 10 mmHg, pulmonary artery pressure 48/22mmHg, cardiac output 1.9 L/min with index 1.2 L/min/m2, and pulmonary capillary wedge pressure 22mmHg with large V waves. Intra-aortic balloon pump (IABP) was placed with improvement in hemodynamics, followed by successful mitral TEER using one MitraClip™ XTW. Intervention occurred 1 day after initial hospital presentation. The patient improved clinically and hemodynamically permitting weaning off all vasoactive drugs and IABP support. Four days post-procedure, however, she abruptly arrested with findings of pulseless electrical activity, hemopericardium and left ventricular free wall rupture.

An 80-year-old male presented to a PCI-capable spoke hospital with atrial fibrillation, dyspnea, inferior Q waves, initial high-sensitivity troponin I exceeding assay limits, inferior akinesis on echocardiogram and severe MR due to restriction of the posterior leaflet. Coronary angiography showed single-vessel disease with occlusion of the distal right coronary artery. IABP was placed with transfer to a shock hub hospital, where pulmonary artery catheterization disclosed central venous pressure 6 mmHg, pulmonary artery pressure 46/13mmHg, cardiac output 2.7L/min with index 1.6 L/min/m2, and pulmonary capillary wedge pressure 16mmHg with large V waves.

Following heart team discussion and a period of supportive care, the patient underwent successful mitral TEER using one MitraClip™ NTW device with improved hemodynamics. Intervention occurred 23 days after initial hospital presentation. The patient recovered permitting discharge on guideline-directed medical therapies.

CONCLUSION: Acute ischemic MR can contribute to pathogenesis of shock in patients with late-presenting STEMI. Vasoactive drugs may be insufficient—and even counterproductive—in such cases to stabilize hemodynamics and promote recovery. Temporary mechanical circulatory support may help temporize hemodynamics while evaluating candidacy for valve intervention. Where surgery is deemed prohibitive, TEER can be technically feasible to ameliorate MR in select patients. These cases remind us, however, that mitigating MR does not eliminate all risk associated with late-presenting STEMI. Paralleling lessons from surgical literature, those patients who survive initial phases of recovery may be more likely to do well after later TEER. Implications of early mitral TEER for left ventricular geometry, hemodynamics, and propensity to rupture after STEMI are unknown and warrant further study.

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ABSTRACT #44 QUALITY IMPROVEMENT ALLERGY AND IMMUNOLOGY/GENERAL INTERNAL MEDICINE/INFECTIOUS DISEASES ENHANCING PENICILLIN DELABELING Christian Gomez Hernandez1, Erika Tsutsui1, Songhui Ma2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York Allergy & Asthma Society Teaching Day that was held in New York, New York, United States in September 2024.

BACKGROUND/INTRODUCTION: Penicillin allergy labels are the most reported allergy with prevalence of 625%. The labels are often based on self-reported or historical information, and it is said that over 95% of patients with labeled penicillin allergy can tolerate penicillin. Over-labeling penicillin allergy can have significant implications for both personal health and public health, including suboptimal antibiotic use, increased antibiotic resistance, and higher healthcare costs. Therefore, developing an effective intervention for addressing and delabeling penicillin allergy is critical.

METHODS: Part 1 involved a retrospective review of new patient visits to our allergy clinic from January to December 2023. Patients with documented penicillin allergies were identified, and the percentage in whom penicillin allergy was addressed during initial visits was analyzed. Part 2 assessed the percentage of patients referred for penicillin allergy testing or challenge who completed the procedure at a follow-up visit. Data was collected and assessed quarterly (Q1-Q4). Data on gender, ethnicity, and race were collected and analyzed to explore potential disparities in penicillin allergy management. The inclusion of demographic factors aimed to uncover potential factors influencing the management of penicillin allergies among our patient population.

RESULTS: Part 1: 159 new patients reported penicillin allergies. Of these, penicillin allergy was addressed at the time of the initial visit in 118 patients. Patients were risk stratified. Further evaluation with penicillin skin testing and challenge was offered to 99 patients. 65 patients were scheduled. 7 were de-labeled by history.

Testing was not offered to the remainders due to a history of severe reactions, comorbidities, or inability to stop antihistamines. Demographic breakdowns revealed variations in addressing penicillin allergy based on gender, ethnicity, and race. Part 2: Out of 65 patients who were scheduled for penicillin testing, 44 (68%) completed testing. Of the total 118 patients whom penicillin allergy was addressed, 44 (37%) were de-labeled. Demographic breakdown revealed higher numbers of men versus woman and Caucasians versus black to be tested.

DISCUSSION/CONCLUSIONS: This study highlights variations in addressing penicillin allergy based on demographic factors, emphasizing the need for tailored interventions. Quality improvement initiatives are crucial to ensure equitable care and optimize antibiotic use. Further research is warranted to refine de-labeling strategies and improve patient outcomes.

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ABSTRACT #45 CLINICAL RESEARCH CARDIOLOGY/HEMATOLOGY/ONCOLOGY THE ROLE OF COMBINED RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS PLUS BETA BLOCKER THERAPY FOR CARDIOTOXICITY PREVENTION IN PATIENTS UNDER CHEMOTHERAPY FOR BREAST CANCER: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Mohammad I. Khan1, Hannah Hart1, James Choi1, Amir Akbari2, Justin Goodfarb1, Raisa S. Zahir3, Francisco J Romeo4, Kiran Mahmood1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, United Kingdom; 3Wayne State

University School of Medicine, Detroit, MI, United States; 4University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, United States

Presented at the European Society of Cardiology (ESC) Congress that was held in London, United Kingdom from August 30, 2024 to September 2, 2024.

BACKGROUND/INTRODUCTION: Anti-neoplastic agents, including anthracyclines and trastuzumab, frequently employed in breast cancer treatment carry on considerable cardiotoxic effects impairing both cardiac chamber and cardiac fiber parameters leading to incident heart failure. In response to this challenging side effect, numerous randomized controlled trials (RCTs) have investigated the cardioprotective efficacy of RAASi and beta-blockers (BBs) in patients undergoing anthracycline and trastuzumab chemotherapy. We aim to perform an updated meta-analysis to elucidate the potential cardioprotective properties of these medications in patients undergoing chemotherapy for breast cancer.

METHODS: A comprehensive search of the literature was performed through February 2024 on PubMed, EMBASE and Clinicaltrials.gov. In total, data from 4 randomized studies were extracted and analyzed. The primary analysis was the effect of RAASi and BBs on LVEF as well as global longitudinal strain (GLS). Data were analyzed using a random-effects model to derive weighted mean differences (WMDs) and 95% confidence intervals for both LVEF and GLS. Data was analyzed using Review Manager 5.3 (RevMan 5.3) software.

RESULTS: In total, data from 248 patients (n=124 on cardioprotection; n=124 without cardioprotection) undergoing treatment with anti-neoplastic agents for breast cancer were included. At the end of treatment, patients undergoing cardioprotective therapy demonstrated improved LVEF preservation compared to the control group, [mean difference, 2.14 (0.03, 4.25); p=0.05; I2=79%). In addition, patients undergoing dual RAASi + BB therapy showed better GLS preservation compared to control group [mean difference –1.37 (-2.01, -0.72); p<0.0001; I2=0%].

CONCLUSION: In breast cancer patients undergoing anti-neoplastic regimens comprising anthracycline and trastuzumab, the concomitant administration of RAASi and BBs demonstrated better LVEF as well as GLS preservation upon completion of treatment over those without cardioprotective therapy. These findings shed light on the potential benefit derived from the synergistic effects of RAASi and BBs therapy in safeguarding both cardiac chamber and fiber functions amidst aggressive anti-cancer regimens, although further investigations still need to be conducted.

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Figure 1. Forest plot showing WMD of LVEF (%) at the end of treatment.

Figure 2. Forest plot showing WMD of GLS (%) at the end of treatment.

Figure 3: Outcome of cardiac chamber and cardiac fiber parameters of normal heart undergoing breast cancer chemotherapy treated with RAASi plus BB

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ABSTRACT #46 CASE REPORT/CLINICAL REVIEW PALLIATIVE CARE USE OF KETAMINE AND AN INTERDISCIPLINARY TEAM APPROACH TO RAPIDLY TAPER A PATIENT’S ULTRA-HIGH OPIOID REGIMEN Ariel Gordon1, Evan L. Zazula2, Joseph D. Elder2, Estelle Jungah Hong3, Jordan Nickel-Dubin3, Yu Shindo2, Ayla Pelleg2, Laura Belland2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York University,

New York, NY, United States

Presented at the Annual Assembly of Hospice and Palliative Meeting that was held in Phoenix, Arizona, United States from March 20-23, 2024.

BACKGROUND/INTRODUCTION: A case illustrating how to use intravenous ketamine to control intractable pain and methodically down-titrate ultra-high opioids over 24-48 hours. Potential mild side effects of ketamine can be treated non-pharmacologically by a comprehensive interdisciplinary team. Subanesthetic intravenous ketamine in palliative care patients can control pain that is poorly responsive to escalating doses of opioids, especially when ultra-high opioid [>1000 oral morphine equivalents (OME) daily] regimens are required.

Analgesic titration of intravenous ketamine is established, but it is less clear how to concurrently down-titrate ultra-high opioid doses. Here, intravenous ketamine was effective in controlling a patient’s intractable pain while we rapidly de-escalated her ultra-high opioid requirements. Additionally, we highlight the special role the palliative care interdisciplinary team plays in supporting patients on intravenous ketamine who experience mild side effects.

CASE PRESENTATION: A 39-year-old woman with hereditary thrombophilia complicated by recurrent venous thrombosis with chronic left lower leg pain on methadone presented with acute right leg pain due to a new deep vein thrombosis. Ineligible for thrombectomy or stenting, she was started on a hydromorphone patient-controlled analgesia. Her pain was intractable requiring upwards of 8,000 OME including methadone up-titration. Opioidinduced hyperalgesia was suspected, so the continuous dose of hydromorphone was rotated to morphine, however her pain remained uncontrolled on 5,000 OME. While administering a continuous infusion of intravenous ketamine over 36 hours, we tapered her opioid regimen by 25-30% every 4 to 8 hours with an 80% reduction in total OME. She reported good pain control and showed no signs of withdrawal. Ketamine-induced anxiety and mild dissociation were mitigated by interdisciplinary team members at bedside including chaplaincy, expressive arts therapy, and massage therapy who utilized non-pharmacological techniques to create a supportive environment and strengthen her therapeutic alliance with the entire team.

CONCLUSION: This case illustrates that intravenous ketamine is especially useful for intractable pain and high opioid requirements allowing for quick de-escalation of total opioid needs. Side effects from ketamine can be ameliorated by the support and expertise of a comprehensive interdisciplinary team.

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ABSTRACT #47 CLINICAL RESEARCH PULMONARY/CRITICAL CARE COMPARATIVE ANALYSIS OF DRIVER MUTATIONS, CANCER STAGE, AND METASTATIC BURDEN IN PATIENTS WITH LUNG ADENOCARCINOMA WITH PRISM COMPARED TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND NORMAL LUNG FUNCTION Toshiro Goto1, Rodrigo Paredes1, Jorge Gomez2, Christian Rolfo3, David Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University,

Columbus, OH, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Preserved Ratio Impaired Spirometry (PRISm) is a condition defined by an FEV1<80% predicted and FEV1/FVC ratio ≥0.7. While specific driver mutations, such as EGFR and ALK1,2, are well-documented in lung adenocarcinoma patients with chronic obstructive pulmonary disease (COPD), the mutation profile in PRISm patients remains underexplored in current medical literature. This study aimed to investigate the distribution and clinical implications of driver mutations in lung adenocarcinoma patients across different lung function groups, including PRISm, COPD, and normal lung function.

METHODS: A retrospective analysis was conducted of 147 adenocarcinoma patients treated in the Mount Sinai Health System from January 2018 to May 2024. Patients were categorized by lung function (normal, COPD, PRISm). We compared the prevalence of driver mutations (ALK, BRAF, EGFR, HER2, MET, KRAS, NRAS, PIK3C, RET, ROS1, TP53), emphysema, PD-L1 levels, ECOG performance, cancer stage, and metastases in patients with normal lung function, PRISm and COPD. Statistical analyses used Kruskal-Wallis and Chi-Square tests, with significance at p<0.05.

RESULTS: COPD patients had a significantly higher prevalence of emphysema (p=0.0005) and lower ECOG scores, indicating poorer functional status compared to PRISm and normal groups (p=0.015). Cancer stages III and IV were more common in PRISm and COPD groups than in the normal group (p=0.023). PRISm patients had a significantly higher metastatic burden (p=0.036). PD-L1 expression was not statistically significant across groups, and no significant differences were found for driver mutations between patients with normal lung function, PRISm and COPD. CONCLUSION: The findings reveal distinct profiles for lung adenocarcinoma patients based on lung function.

PRISm and COPD patients had higher metastatic burden and more advanced cancer stages than patients with normal lung function, suggesting a more aggressive disease course. Higher emphysema prevalence and lower ECOG scores in COPD demonstrate how COPD phenotype can affect functional status. Although driver mutations did not vary significantly between patients with normal lung function, PRISm and COPD, lung function stratification may be valuable in guiding treatment.

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ABSTRACT #48 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/INFECTIOUS DISEASES PROTEIN-LOSING ENTEROPATHY IN AIDS: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE Joel Grimaldo Ochoa1, Harsimran Bhatia1, Argelis Rivera1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Protein-losing enteropathy (PLE) is a rare but significant complication in patients with advanced Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS).

Protein-losing enteropathy is characterized by excessive loss of plasma proteins into the gastrointestinal lumen, leading to hypoproteinemia and hypoalbuminemia. Clinically, patients may present with chronic diarrhea, severe wasting, peripheral edema, effusions, nutritional deficiencies, and recurrent infections. In the context of HIV/AIDS, protein-losing enteropathy can arise due to various etiologies, including opportunistic infections, neoplasms, and idiopathic enteropathy. We discuss a case of protein-losing enteropathy in a patient with AIDS and prior disseminated MAC infection, emphasizing the diagnostic challenges and treatment strategies.

CASE PRESENTATION: A 54-year-old male with acquired immunodeficiency syndrome (AIDS) presented with severe bilateral lower extremity edema, abdominal pain, distention, and shortness of breath. His history includes multiple opportunistic infections [Pneumocystis pneumonia, disseminated Mycobacterium avium Complex (MAC), esophageal candidiasis], human papillomavirus (HPV) infection with anal dysplasia, and chronic obstructive pulmonary disease (COPD) with bronchiectasis. Examination revealed diffuse anasarca. Laboratory investigations showed a CD4 count of 7% (total 52), HIV viral load of 102, hypoalbuminemia, low serum immunoglobulins, elevated fecal alpha-1 antitrypsin, and mildly elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Electrolytes and renal function were normal. Stool tests for ova and parasites, Clostridioides difficile, Cryptosporidium, and Giardia were negative. CT abdomen showed large volume ascites with diffuse anasarca, a normal liver, and no lymphadenopathy. Echocardiogram revealed a normal left ventricular ejection fraction (LVEF) of 70%. Paracentesis yielded a low Serum Ascites Albumin Gradient (SAAG <1.1), suggesting chronic protein loss. The diagnosis of protein-losing enteropathy was established after excluding other etiologies. The management included a high-protein, low-fat diet with mediumchain triglycerides (MCTs), continuation of antiretroviral therapy, and chronic prophylaxis with ethambutol and clarithromycin for MAC. Diuretic therapy with bumetanide and spironolactone was prescribed to manage edema.

The patient was referred to Gastroenterology for endoscopic evaluation to confirm the diagnosis.

CONCLUSION: Protein-losing enteropathy presents significant diagnostic and therapeutic challenges, particularly in patients with complex medical histories such as those with AIDS. Diagnostically, protein-losing enteropathy requires a high index of suspicion and the exclusion of other causes of hypoproteinemia, such as malnutrition, proteinuria, and impaired protein synthesis due to liver disease. The diagnosis is often confirmed through elevated fecal alpha-1 antitrypsin clearance and imaging studies, which can identify underlying gastrointestinal or lymphatic abnormalities. Therapeutically, managing protein-losing enteropathy involves addressing both the underlying condition and the manifestations of protein loss. Nutritional support with a highprotein, low-fat diet enriched with medium-chain triglycerides is essential to reduce gastrointestinal protein loss.

Despite these interventions, the overall approach to protein-losing enteropathy remains empirical, and evidencebased recommendations for symptomatic therapy are limited. This case underscores the importance of considering protein-losing enteropathy in AIDS patients presenting with severe anasarca and highlights the need for a comprehensive diagnostic approach and multidisciplinary management.

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ABSTRACT #49 CASE REPORT/CLINICAL REVIEW CARDIOLOGY PLATYPNEA ORTHODEOXIA SYNDROME SECONDARY TO AN IATROGENIC ATRIAL SEPTAL DEFECT Joshua Guardia1, Joyce Gu2, Aesha Patel1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Lake Erie College of Osteopathic Medicine, Seton Hill, PA, United States

BACKGROUND/INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia worldwide, affecting an estimated 5 million Americans (Hsu et al., 2023). Percutaneous catheter ablation (PCA) has been demonstrated in clinical trials to be more effective than medical therapy in restoring sinus rhythm and is strongly endorsed by the Heart Failure Rhythm Society (HFRS) (Packer et al., 2019). According to the National Cardiovascular Data Registry (NCDR) AF ablation registry, the overall complication rate after PCA is 2.5%, while the incidence of pericardial effusion requiring intervention is 0.44%. During AF ablation via pulmonary vein isolation (PVI), an atrial transseptal puncture may rarely result in an iatrogenic atrial septal defect (iASD) (Hsu et al., 2023). This case describes a patient who developed pericardial effusion and platypnea orthodeoxia syndrome (POS) due to a right-to-left shunt secondary to an iASD following PVI. CASE PRESENTATION: A 60-year-old female with a past medical history of supraventricular tachycardia (SVT), paroxysmal atrial fibrillation (pAF), s/p dual chamber permanent pacemaker (PPM), and HFpEF (LVEF 50%) presented with dyspnea on exertion and palpitations who then underwent AF ablation with transseptal puncture, mapping, and successful PVI. On post-op day 2 (POD-2), the patient endorsed substernal chest pain and had hypotension (70/54 mmHg) which was unresponsive to 1L intravenous fluid. Bedside ultrasound revealed a moderate pericardial effusion with signs of cardiac tamponade, prompting pericardiocentesis. Following appropriate drainage of the pericardial effusion, she endorsed continued substernal chest pain and was noted to be hypoxic with improvement after placement in the supine position. This led to clinical suspicion for POS from a right-to-left shunt secondary to an iASD. Transesophageal echocardiogram (TEE) later revealed evidence of an atrial septal defect (ASD) consistent with transeptal rupture with a right-to-left shunt which exacerbated when the patient was seated upright versus laying supine. The patient then underwent successful ASD closure and was discharged.

CONCLUSION: This case highlights a rare but significant complication of transseptal catheter ablation for AFPOS due to an iASD. It underscores the need to recognize positional hypoxemia as a key diagnostic clue, particularly after resolving initial complications like pericardial effusion. The patient’s underlying conditions, including HFpEF and mild pulmonary hypertension, likely contributed to right-to-left shunting through the iASD. This aligns with evidence that altered intracardiac pressures can exacerbate shunting, especially in upright positions (Kamada et al., 2024). With increasing prevalence of AF ablation procedures, vigilance for iASD is crucial, since unrecognized symptomatic iASD requiring intervention can lead to significant morbidity. Postablation risk stratification is essential, as factors like prior cardiac interventions may increase complications.

Careful transseptal puncture, optimal catheter selection, and routine echocardiographic screening in high-risk patients can help prevent iASD (Kamada et al., 2024). This case underscores the importance of maintaining a high index of suspicion for POS in post-ablation patients and demonstrates how prompt diagnosis and definitive treatment can prevent further complications.

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ABSTRACT #50 CLINICAL RESEARCH CARDIOLOGY CLINICAL OUTCOMES OF SGLT2 INHIBITORS IN PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE: A META-ANALYSIS OF RANDOMIZED CONTROL TRIALS Soumya Gupta1, Won Joon Koh1, Hannah Hart1, Kiran Mahmood1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Acute heart failure presents challenges due to its poor prognosis and limited therapeutic options compared to chronic heart failure. The potential benefits of SGLT2 inhibitors in acute heart failure patients are being explored, yet systematic evaluation is lacking. Our meta-analysis aims to bridge this gap by comparing the efficacy and safety of SGLT2 inhibitors versus placebo in acute heart failure patients.

METHODS: We searched Medline, Embase, and Cochrane databases for randomized controlled trials involving adult patients hospitalized with acute heart failure who received SGLT2 inhibitors. Our primary outcomes were all-cause mortality, heart failure events, and readmissions. The secondary outcomes were change in weight, KCQ-TSS score and length of stay. Safety outcomes included hypotension, hypoglycemia, urinary tract infection, diabetic ketoacidosis, and acute renal failure. We used Review Manager 5.4 for statistical analysis, employing standardized mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CI).

RESULTS: 7 RCTs were included, involving a total of 2321 patients, with 49.5% receiving SGLT2 inhibitors.

With respect to the primary outcomes, the intervention group showed a significant reduction in the risk of allcause mortality by 24% (RR, 0.76; 95%CI, 0.59–0.99; p=0.04; I2=0%), heart failure events by 44% (RR, 0.66; 95%CI, 0.58–0.75; p≤0.00001; I2=0%), and readmissions by 23% (RR, 0.77; 95%CI, 0.63–0.93; p=0.006; I2=0%).

Patients receiving SGLT2 inhibitors also showed a non-significant but reduced risk of all-cause mortality by 24% (RR=0.76; p=0.04) and heart failure events by 27% (RR, 0.63; p=0.09). However, they showed a significantly higher improvement in the KCQ-TSS score (RR, 4.21; 95%CI, 1.90–6.53; p=0.0004; I2=0%). With respect to the secondary outcomes, there was a non-significant reduction in weight (Cohen’s d= -0.31; 95%CI, -0.80-0.17; p=0.21; I2=53%) and length of stay (Cohen’s d= -0.91; 95%CI= -0.20-0.18; p=0.91; I2=0%) in the intervention group as compared to the placebo group indicating improvement in the group receiving SGLT2 inhibitors. On analysis of the safety outcomes, the intervention group had a non-significant decrease in the risk of acute renal failure, urinary tract infection, and diabetic ketoacidosis compared to the placebo group. While an increase was seen in the risk of hypoglycemia and hypotension, it was not statistically significant.

CONCLUSION: In patients with acute heart failure, initiation of SGLT2 inhibitors showed a statistically significant reduction in all-cause mortality, heart failure events, and heart failure rehospitalizations. These findings suggest that starting SGLT2 inhibitors in patients hospitalized for acute hear failure is well tolerated and leads to substantial clinical benefits.

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ABSTRACT #51 CASE REPORT/CLINICAL REVIEW CARDIOLOGY THE USE OF MAVACAMTEN FOR MANAGEMENT OF POST TRANSCATHETER AORTIC VALVE REPLACEMENT OBSTRUCTION: A NOVEL APPROACH TO TREATMENT Hannah Hart1, Prabhjot Grewal1, Karan Sud1, Abel Casso Dominguez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Treatment of left ventricular outflow tract (LVOT) obstruction involves a combination of negative inotropic agents. However, these therapies have limitations which may result in insufficient control of symptoms, leading to more invasive options such as surgical septal myectomy or septal alcohol ablation. Mavacamten, a cardiac myosin inhibitor, is currently approved for the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM). We present a case of a patient treated with mavacamten in addition to β-blockers for management of post-transcatheter aortic valve replacement (TAVR) LVOT obstruction.

CASE PRESENTATION: A 76-year-old female with a past medical history of hypertension, severe aortic stenosis, and coronary artery disease underwent a Medtronic Evolut TAVR in March 2022. Her transthoracic echocardiogram (TTE) post TAVR showed LVOT peak gradient greater than 100 mm Hg, LVEF 75% and severe eccentric mitral regurgitation secondary to systolic anterior motion (SAM) of the mitral valve (MV). After multidisciplinary discussion, the patient was discharged on β-blocker therapy. Follow up TTE showed persistent obstruction and gradients, so diltiazem was added to her regimen. Her subsequent TTE in April 2023 showed an LVEF 65%, SAM, peak LVOT > 100 mmHg at rest, and severe mitral regurgitation. Given persistent findings, she was started on mavacamten, continued metoprolol, and tapered off of diltiazem. Her TTE 2 months after initiation of mavacamten revealed resolution of LVOT gradients, reduction of MR to mild-moderate and normal TAVR function. She tolerated the therapy well and endorsed ongoing symptomatic improvement on subsequent follow up.

CONCLUSION: With the increasing use of TAVR therapy, there has been a corresponding rise in cases of postTAVR obstruction that must be managed. As demonstrated by this case, management with β-blocker therapy alone may be suboptimal. Although mavacamten is currently approved in patients with HCM, the obstruction in post-TAVR patients is functionally similar. Thus, this medication was trialed as a supplemental treatment in this patient and yielded positive results. This case highlights the potential benefit of extending use of mavacamten alongside β-blocker therapy for this patient population and suggests the need for future studies.

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Figures 1-4. TTE after β-blocker therapy and TTE after mavacamten therapy; Comparing transaortic flow and mitral regurgitation, as well as LVOT flow on continuous wave doppler.

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ABSTRACT #52 CLINICAL RESEARCH PULMONARY/CRITICAL CARE A RETROSPECTIVE ANALYSIS OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA, ASTHMA, AND COPD BY HOME SLEEP TESTING OUTCOMES William He1, Toshiro Goto1, Zachary Roberts2, Vincent Grbach2, Boris Gilyadov2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Obstructive Sleep Apnea (OSA) has been associated with worse outcomes in patients who have underlying asthma and chronic obstructive pulmonary disease (COPD). OSA remains challenging to diagnose despite convenient testing options available including home sleep apnea testing (HSAT).

This retrospective cohort study aimed to demonstrate that patients with asthma and COPD are not being adequately diagnosed with OSA through HSAT due to the low completion rates.

METHODS: Patients aged 18 or older, male and female, with either OSA, asthma or COPD comorbidities, and a referral for HSAT were included in this retrospective cohort study. Patients were from a single ambulatory site of Mount Sinai Union Square from January 2024 to June 2024. This study was approved by the Mount Sinai Department of Medicine Quality Improvement Committee. Three cohorts were formed from patients already diagnosed with OSA, asthma or COPD. The primary outcomes were the HSAT completion rates, and the AHI3% and AHI4% results in patients who had HSAT performed. Logistic regression was conducted for odds ratios of HSAT completion including directly adjusting for confounders of age and sex, and two-sample t-testing was done for mean AHI3% and AHI4% with the OSA cohort used as the baseline group.

RESULTS: A total sample of 1114 patients meeting eligibility criteria were included for analysis. The OSA cohort included 865 patients, the asthma cohort included 199 patients, and the COPD cohort had 50 patients. Mean age of the COPD cohort was 65.7 years compared to 52.9 years and 51.6 years respectively in the asthma and OSA cohorts. 63.3% of the asthma cohort were female, while 52.0% and 43.1% of patients respectively were female in the COPD and OSA cohorts. The lowest completion was in the COPD cohort with 48.0% of HSAT completed, followed by 52.3% HSAT completed in the asthma cohort (Table 1). When compared to the OSA cohort, patients with COPD had 0.33 times lower adjusted odds of HSAT completion (aOR, 0.33; 95%CI, 0.190.59) and patients with asthma had 0.40 times lower adjusted odds of HSAT completion (aOR, 0.40; 95%CI, 0.29-0.54) (Table 1). Mean AHI3% and AHI4% results ranged from 23.7-32.5 and 15.7-19.9, however the mean differences between the cohorts were not statistically significant (Table 1).

CONCLUSION: HSAT completion rates are lower in patients with asthma or COPD compared to patients with OSA, however the presence of moderately severe obstructive sleep apnea being present in these populations demonstrates value in improving completion of HSAT in ambulatory settings.

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Table 1. A comparison of patients with obstructive sleep apnea versus asthma versus COPD by HST completion rates and AHI outcomes.

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ABSTRACT #53 CLINICAL RESEARCH PULMONARY/CRITICAL CARE LACTATE AS A PREDICTOR IN SEPSIS OUTCOMES Chad Henry1, William Wallach1, Alvin Yang1, Jorge Sinclair1, Benjamin Samuel1, Lloyd Muzangwa1, Raymonde Jean1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: The latest definition of septic shock, outlined by the sepsis-3 task force, is described as a severe form of sepsis with persistent hypotension requiring vasopressors to maintain a mean arterial pressure greater than or equal to 65mmHg and serum lactate levels >2 mmol/L despite adequate fluid resuscitation. However, there is currently some debate about the practical application of these criteria in clinical settings. This study delves into the clinical outcomes of patients based on varying levels of lactate to see if lactate alone a tool could be used to separate sepsis/severe sepsis from septic shock.

METHODS: A list of 231 admitted patients at Mount Sinai West (MSW) between the months of December 2023 and August 2024 who met SIRS criteria and were placed on the inpatient sepsis pathway was generated by redcap software on a monthly basis. Amongst these patients who were placed on the sepsis pathway, those with a suspected source of infection were recorded by medical record number and were sorted based on the highest lactate value within 24hours of SIRS alert. Lactate values were categorized into 3 groups: Lactate>4, Lactate between 2-4, and Lactate <2. For each category, disease severity was measured by the following: systolic blood pressure at time of SIRS alert, whether or not they required the use of pressors during admission and mortality rates for each admission.

RESULTS: Amongst those with Lactate >4: 30% had SBP < 90mmHg, 27% required pressors during admission, and 30% died during admission. Amongst those with lactate between 2-4: 35% had SBP < 90mmHg, 5% required pressors during admission and 15% died during admission. Amongst those with lactate<2: 14.63% had SBP <90, 4.88% required pressors during admission, 2.44% died during admission.

CONCLUSION: In general, patients whose highest lactate was >4 within 24 hours of SIRS alert were shown to have greater disease severity when compared to other patients whose highest lactates were between 2-4 or <2 within 24 hours of their respective SIRS alerts. An exception being those patients whose lactates where between 2-4 had a higher percentage of systolic blood pressures that were <90mmhg at time of SIRS alert compared to the other groups. Additionally, it appears that patients with lactates between 2-4 were shown to have greater disease severity compared to those with lactates <2.

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ABSTRACT #54 CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY/GENERAL INTERNAL MEDICINE RECURRENT HYPOGLYCEMIA IN TYPE 1 DIABETES: A CASE HIGHLIGHTING HYPOGLYCEMIA UNAWARENESS AND MORTALITY RISK Rayling Herrera1 and Lauren Shapiro1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Hypoglycemia unawareness, affecting approximately 25% of patients with type 1 diabetes, is marked by a lack of adrenergic warning symptoms during hypoglycemia, increasing vulnerability to severe episodes. Recurrent hypoglycemia desensitizes counterregulatory mechanisms, compounding the condition. Patients with hypoglycemia unawareness have a 2-3 times higher mortality risk, with severe hypoglycemia contributing to 10-15% of cardiovascular events in these individuals. Loss of consciousness during hypoglycemia is associated with increased mortality. Traumatic injuries from such episodes account for 6-10% of diabetes-related deaths. Repeated episodes also accelerate cognitive decline and are linked to pro-inflammatory and pro-thrombotic states, heightening long-term cardiovascular risks.

Continuous glucose monitors reduce hypoglycemia incidence by up to 50%, offering real-time glucose monitoring and predictive alerts. However, barriers such as cost, access, and adherence persist. A multidisciplinary approach involving Endocrinology, diabetes educators, and mental health support is critical to address these challenges and improve patient outcomes.

CASE PRESENTATION: A 37-year-old female with type 1 diabetes mellitus complicated by hypoglycemic seizures, diabetic ketoacidosis, and depression presented for diabetes follow-up. Her hemoglobin A1c was 12%, reflecting poor glycemic control despite reported adherence to her insulin regimen of 30 units Basaglar® at bedtime and 10 units Admelog® three times daily with meals. She reported a recent episode of loss of consciousness at a train station, attributed to hypoglycemia due to taking her prandial insulin without eating. She had not checked her blood glucose at the time. Education on hypoglycemia prevention and glucose monitoring was provided, along with a continuous glucose monitor prescription and referrals to Endocrinology and a diabetes educator. At follow-up 4 weeks later, she had a paucity of speech, appeared disengaged and was not responsive to questions. Her blood glucose was 34 mg/dL, requiring treatment with glucagon and oral glucose, which improved her levels to 93 mg/dL. She had not obtained a continuous glucose monitor nor attended referrals. Education on timely meals and continuous glucose monitor use was reiterated. A care coordinator was engaged to assist with continuous glucose monitor access and rescheduling missed visits.

CONCLUSION: Hypoglycemia unawareness affects 25% of type 1 diabetes patients and is linked to a 2-3 times higher mortality rate. Severe hypoglycemia leading to loss of consciousness poses risks of trauma and longterm complications, including cardiovascular events and cognitive decline. Continuous glucose monitors and multidisciplinary care are tools that could reduce the risk of severe hypoglycemia and potentially improve mortality.

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ABSTRACT #55 CLINICAL RESEARCH GERIATRICS/HEMATOLOGY/ONCOLOGY PREDICTIVE VALUE OF THE CANCER AND AGING RESEARCH GROUP GERIATRIC SCORE FOR CHEMOTHERAPY TOXICITIES IN OLDER ADULTS WITH CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS Kohei Horiuchi1, Toshiki Kuno2, Hisato Takagi3, Debora Afezolli4 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Montefiore Medical Center, Bronx, NY, United States United States; 3Shizuoka Medical Center, Shizuoka, Japan; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the International Society of Geriatric Oncology (SIOG) Annual Meeting that was held in Montreal, Québec, Canada from October 17-19, 2024.

BACKGROUND/INTRODUCTION: The Cancer and Aging Research Group Geriatric (CARG) score was designed as a prediction tool for chemotherapy toxicities in older patients with cancer. However, no systematic review is available to collate this data. We collected and analyzed evidence that evaluated the predictive value of the CARG score for ≥ grade 3 chemotherapy toxicities in older patients with cancer.

METHODS: Electronic databases (PubMed and EMBASE) were used in April 2024 to identify studies that evaluated older patients with cancer undergoing chemotherapy and the rate of toxicities stratified by CARG scores (low=0-5, medium=6-9, and high=10-23). A meta-analysis was conducted to calculate the relative risk (RR) of ≥ grade 3 chemotherapy toxicities (as described by CTCAE) for each CARG category. The topic was systematically reviewed.

RESULTS: Based on our criteria, 15 studies published between 2019 and 2023 were included in our analysis with a total of 2,483 patients: 782 with low CARG scores, 1,162 with medium CARG scores, and 539 with high CARG scores. Patients with a higher CARG score had significantly higher prevalence of ≥grade 3 chemotherapy toxicities leading to the following statistically significant relative risk calculations: medium CARG versus low CARG (RR, 1.31; 95%CI, 1.07-1.61; p=0.010), high CARG versus medium CARG (RR, 1.37; 95%CI, 1.21-1.56; p<0.001), high CARG versus low CARG (RR, 1.80; 95%CI, 1.34-2.41; p<0.001).

CONCLUSION: This systematic review confirms the value of the CARG score for accurately identifying older adults at higher risk of ≥ grade 3 chemotherapy toxicities and its routine use should be considered as part of informed treatment selection.

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ABSTRACT #56 CLINICAL RESEARCH GASTROENTEROLOGY NATURAL HISTORY SUPPORTS ACTIONABLE GASTROESOPHAGEAL REFLUX DISEASE IN LOS ANGELES GRADE B ESOPHAGITIS Rama Hussein1, Soha Noorani1, Yuying Luo1, Daniela Jodorkovsky1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

BACKGROUND/INTRODUCTION: The prioritization of personalized management when assessing patients with actionable gastroesophageal reflux disease (GERD) is at the foundation of the updated Lyon Consensus 2.0, with Los Angeles (LA) grade B esophagitis newly included as part of the umbrella of actionable GERD. The natural history of LA grade B esophagitis and outcomes of various management strategies is not clear compared to more severe grades of esophagitis.

METHODS: A retrospective analysis was performed of consecutive patients between the dates of October 2022 and September 2023 with evidence of LA grade B esophagitis on esophagogastroduodenoscopy (EGD).

Outcomes included proportion of patients referred for reflux quantification via pH impedance testing or wireless esophageal pH testing, escalations in their medical management, referral for fundoplication or referral for repeat EGD. Escalation in medical management was defined as increase in dose, frequency, or potency of acid suppression therapy.

RESULTS: Of 169 patients with LA grade B esophagitis on EGD (n= 80 female, average age 55 years ± 15.9 years), 16 were referred for reflux quantification testing off proton pump inhibitors. 53.8% of patients received medical escalation following EGD. 26 patients (15.4%) were referred for repeat EGD, while only 45% of these patients were referred for repeat EGD after escalation in medical management. 89% of patients who underwent repeat EGD following medication escalation were found to have either complete resolution of esophagitis or a decrease in severity to LA grade A. 50% of the patients who underwent repeat EGD without medical management escalation did not have any improvement on repeat EGD (p=0.13). 10 patients (5.9%) were referred for fundoplication with 50% of those who had fundoplication performed reporting symptomatic improvement.

CONCLUSION: Despite now being considered a conclusive GERD equivalent, only half of the patients with LA grade B esophagitis in our cohort received medical escalation, and even fewer were referred for additional reflux quantification, repeat endoscopy, or fundoplication. The high proportion of persistent esophagitis in those without medical escalation promotes a call to action for providers to start recognizing LA grade B esophagitis as actionable. Recognizing LA grade B esophagitis as conclusive evidence of GERD may increase the efficiency of treatment and achievement of swifter reflux control.

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Image 1. Evaluation of escalation of medical care following initial findings of LA Grade B esophagitis on EGD. *Medication escalation is defined as an increase in dose, frequency or potency of acid suppression therapy. **Improvement on repeat EGD is defined as complete resolution of esophagitis or findings of LA grade A esophagitis.

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ABSTRACT #57 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/HEMATOLOGY/ONCOLOGY BEYOND THE USUAL SUSPECT: HEPARIN-INDUCED THROMBOCYTOPENIA DUE TO ENOXAPARIN Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Jason Piersaint1, Kata Boros1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a rare but serious immunemediated complication of heparin therapy, driven by antibodies against platelet factor 4 (PF4)-heparin complexes. These immune complexes create a hypercoagulable state, leading to life-threatening thrombosis and thrombocytopenia. HIT occurs in approximately 5% of patients exposed to heparin products, with a higher incidence in those receiving unfractionated heparin (UFH) compared to low molecular weight heparin (LMWH).

The lower molecular weight and shorter saccharide chain of LMWH (15 units versus 45 units for UFH) reduce its binding to plasma proteins and cells, thereby decreasing the risk of HIT. While the incidence of HIT is approximately 3% with UFH and 0.2% with LMWH, clinicians must remain vigilant, as HIT can still occur with LMWH, including enoxaparin, a commonly used anticoagulant for deep venous thrombosis prophylaxis.

CASE PRESENTATION: An 85-year-old female with a medical history of coronary artery disease, hypertension, chronic lymphoid leukemia, deep venous thrombosis, and chronic inflammatory demyelinating polyneuropathy (CIDP) presented with a stage IV sacral decubitus ulcer infected with Proteus and Pseudomonas. After wound debridement, she completed a 14-day course of meropenem. Her hospital course was complicated by a pulmonary embolism, for which she was started on enoxaparin 1 mg/kg every 12 hours. On day 5 of enoxaparin therapy, her platelet count dropped from 237,000 to 115,000 and then to 57,000. The 4Ts score for heparininduced thrombocytopenia (HIT) was 5, indicating an intermediate probability. Heparin antibodies were sent, and anticoagulation was switched to fondaparinux 7.5 mg subcutaneously daily. Physical examination revealed no signs of thrombosis or skin necrosis, though it did show hemorrhagic skin lesions. After initiating fondaparinux, her platelet count began to recover, increasing to 90,000. The HIT antibody returned positive (2.15), and serotonin release assay as well confirming the diagnosis of enoxaparin-induced HIT. CONCLUSION: HIT is a well-recognized complication of heparin therapy; however, it is significantly less common with low molecular weight heparins (LMWH) such as enoxaparin. This case emphasizes that while the risk is lower, HIT remains a possibility even with LMWH, necessitating vigilance, particularly in high-risk populations. Accurate diagnosis of HIT is crucial due to its potentially life-threatening complications. In this case, the 4Ts score was instrumental in systematically assessing the probability of HIT, placing the patient at intermediate risk (score: 5). The combination of thrombocytopenia, timing consistent with HIT onset, and the absence of alternative causes heightened clinical suspicion. However, a definitive diagnosis of HIT requires laboratory confirmation, either through detection of anti-PF4/heparin antibodies or a functional assay such as the serotonin release assay. For most patients with high or intermediate 4Ts scores, combining clinical scoring with immunoassays is sufficient, often negating the need for functional assays. Management of HIT begins at the time of suspicion. Immediate cessation of all heparin products is critical, and anticoagulation should be transitioned to a non-heparin agent, such as fondaparinux or a direct thrombin inhibitor. This prompt intervention mitigates the risk of thrombotic complications and improves outcomes.

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ABSTRACT #58 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE COMPLETE FOR TREATS: IMPROVING MEDICATION RECONCILIATION WITHIN 24 HOURS OF HOSPITAL ADMISSION AT MOUNT SINAI WEST HOSPITAL Loren Barhold1, Samuel Johnson1, Kristy Huang1, Krystle Hernandez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

BACKGROUND/INTRODUCTION: Medication reconciliation is the process of identifying a patient’s home medication and utilizing the list to provide correct medications across the healthcare continuum. Accurate and prompt medication reconciliation is known to improve patient safety and reduce medication errors. In 2006 the Institute of Medicine reports drug-related errors are the most common type of medical error and can result from discrepancies in patient medications during periods of transition of care.

METHODS: Percentages of completed medication reconciliation were measured for General Medicine teams monthly and compared to the previous month to evaluate for improvement with the overall goal of improving the percent of completed medication reconciliation. The aim was to improve medication reconciliation by 10% among General Medicine teams over 7 months. Interventions to increase overall compliance with reconciliations included education sessions during resident didactics, visual how-to displays in documentation rooms, and edible rewards to teams with the highest percentage of completed medication reconciliations each month.

RESULTS: Following the first education intervention, medication reconciliation completion within 24 hours was 23% within the first month. The next three months demonstrated improvements: 38%, 41%, and 33% respectively after introducing our medication reconciliation competition between the four General Medicine teams. The project culminated in our highest percentage in February 2024 of 62% of medication reconciliations completed within 24 hours- a 39% precent improvement from August 2023.

CONCLUSION: Implementing improvements in medication reconciliation in inpatient medicine can have several positive outcomes for both healthcare providers and patients. Our project helps identify and prevent discrepancies in a patient's medication list, reducing the risk of errors such as omissions, duplications, or incorrect dosages. Moreover, we highlight that interventions to raise compliance on medication reconciliations completed in 24 hours of admission are effective. With time we hope to change the culture at our institution and maintain medication reconciliation as a priority in patient care.

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ABSTRACT #59 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/HEMATOLOGY/ONCOLOGY NEW PRESENTATION OF HYPERTROPHIC CHEMOTHERAPY Luka Katic1, Vincent Sinatra1, Krysthel Engstrom1

OBSTRUCTIVE

CARDIOMYOPATHY

FOLLOWING

1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder characterized by left ventricular hypertrophy with potential obstruction of the left ventricular outflow tract. It is often undiagnosed unless clinical events like syncope occur. This case details a new presentation of HOCM in a patient following chemotherapy, complicated by dehydration and urosepsis.

CASE PRESENTATION: We present a 68-year-old female with a history of breast cancer undergoing chemotherapy, atrioventricular nodal reentrant tachycardia post-ablation, and peripheral artery disease postpercutaneous coronary intervention. After experiencing hypotension, vomiting, and diarrhea symptomatic of severe dehydration, she was sent to the hospital from a chemotherapy session and subsequently diagnosed with urosepsis. During her evaluation, transthoracic echocardiography (TTE) revealed new findings indicative of hypertrophic obstructive cardiomyopathy (HOCM), a condition not previously evident in her complex medical history.

The TTE highlighted significant cardiac changes, most notably a progression of HOCM characterized by severe asymmetric septal hypertrophy (ASH), with a maximal wall thickness of 1.8 cm that has worsened compared to previous assessments. This hypertrophy contributes to a resting left ventricular outflow tract (LVOT) gradient of 100 mmHg, which escalates to 144 mmHg during the Valsalva maneuver, indicating an intensification of dynamic obstruction. Additionally, the TTE showed systolic anterior motion (SAM) of the mitral valve, accompanied by moderate mitral regurgitation and a dilated left atrium, suggesting worsening hemodynamic consequences due to the septal hypertrophy and outflow tract obstruction.

CONCLUSION: These TTE findings underscore the progressive nature of HOCM and highlight the potential impact of systemic conditions such as dehydration and increased metabolic demands due to chemotherapy on cardiac function. The patient's chemotherapy regimen, which included carboplatin, paclitaxel, and pembrolizumab, raises concerns about chemo-induced cardiotoxicity manifesting as exacerbated HOCM hemodynamics. Management focused on fluid resuscitation and beta-blockade, with a discussion around the appropriateness of an implantable cardioverter-defibrillator given the lack of typical HOCM symptoms such as syncope. The necessity of further diagnostic procedures like MRI for late gadolinium enhancement and genetic testing for familial HOCM was also highlighted, reflecting the complex diagnostic and management challenges.

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ABSTRACT #60 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE OUTPATIENT ENIGMA: FEVER OF UNKNOWN ORIGIN IN A SENIOR PATIENT WITH A COMPLICATED PAST Madison Kennedy1, Salvador Caceros Diaz1, Tamara Goldberg1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Fever of unknown origin (FUO) is a challenging and relatively rare clinical presentation in Internal Medicine, historically managed in the inpatient setting but now increasingly investigated in the outpatient setting. The following case describes a complex outpatient case: an elderly patient with multiple chronic conditions and a history of multiple malignancies who was diagnosed with FUO. This case highlights the importance of care coordination between primary care physicians and specialists and establishing patient trust.

CASE PRESENTATION: A 68-year-old female with a complex medical history, including cervical cancer status post total hysterectomy, intraductal breast cancer requiring bilateral mastectomy (currently in remission), distant provoked deep vein thrombosis, Graves’ disease status post radioactive iodine treatment, chronic obstructive pulmonary disease (COPD), heart failure with preserved ejection fraction, obstructive sleep apnea, coronary artery disease, hypertension, and previous sleeve gastrectomy presented to our Internal Medicine primary care clinic with a chief complaint of daily fever for 3 weeks.

Her symptoms included an objective daily fever as high as 101°F on multiple occasions (measured with a home oral thermometer), accompanied by sore throat and body aches. Of note, no fevers were documented at office visits. She denied shortness of breath, chest pain, abdominal pain, urinary symptoms, or rashes but noted baseline fatigue, decreased appetite and chronic arthralgias involving elbows and small joints of the hands.

There was no recent travel or exposure to sick contacts. Her chronic medications included aspirin, omeprazole, budesonide/formoterol inhaler, losartan, torsemide, carvedilol, atorvastatin, and levothyroxine with no new drugs added except for acetaminophen taken as needed for fever and pain. The patient's history revealed an overall poor understanding of her chronic medical conditions, minimal support at home, and general mistrust in the health system, as evidenced by multiple missed appointments.

Notable physical examination findings included mildly tender, symmetrically enlarged submandibular glands and bilateral symmetrical lower extremity edema to mid-leg without erythema. She was noted to have tenderness of the right wrist and bilateral knee joints with joint palpation. Cardiac, pulmonary, abdominal, and dermatologic examinations were unremarkable. Her initial work-up was negative for rapid Strep test, SARS-CoV-2 PCR, influenza A/B, acute EBV, HIV, syphilis, and tuberculosis; her urinalysis was unremarkable, ruling out common acute infections. Complete blood count showed no anemia or leukocytosis, and the TSH level was within the normal range. A chest x-ray was unremarkable, and a Doppler study of the lower extremities was normal. In the setting of arthralgias and fever, rheumatologic labs were sent; antinuclear antibodies and rheumatoid factor were negative, but cyclic citrullinated peptide was positive.

The patient’s fever persisted over the next six weeks. She was counseled to follow-up with her oncologist, referred to rheumatology, and arranged for frequent check-ins with her PCP to ensure care coordination.

Although initially hesitant to engage with unfamiliar physicians, she eventually accepted specialist referrals once she understood that her primary doctor would actively oversee and review all results. Following the establishment of a consistent primary care team, her appointment adherence improved dramatically. She re-established care with her breast oncologist and a whole-body nuclear bone scan along with CT chest/abdomen/pelvis were negative for signs of malignancy or metastatic disease. An echocardiogram showed preserved left ventricular ejection fraction and no evidence of endocarditis. Ultrasound of the thyroid and neck were also obtained given

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swollen and tender submandibular glands and was unremarkable. The patient was evaluated by rheumatology due to concern for new onset seropositive rheumatoid arthritis.

CONCLUSION: Despite a decline in its overall incidence and improvements in diagnostic technologies, FUO continues to pose a challenge in the inpatient and outpatient clinical practice, demanding comprehensive and individualized diagnostic approaches. In recent years, there has been a shift away from strict time-based criteria toward a more flexible approach that emphasizes the absence of a definitive diagnosis after a reasonable and thorough work-up, persisting for an arbitrary minimal duration of 2-3 weeks to rule out causes of self-limited febrile conditions. In elderly patients, special considerations are required due to factors such as age-related decrease in baseline body temperature, the presence of chronic medical conditions, atypical presentations of common illnesses, and a higher incidence of serious conditions, including cancer associated FUO. Recent data indicate that up to 10-25% of FUO cases in adults, and approximately 25-50% in elderly patients never achieve a diagnosis.

This case underscores several key points regarding the role of primary care physicians in managing complex diagnoses like FUO. First, the evaluation of FUO presents challenges in the outpatient setting. Studies indicate that while outpatient investigation for FUO is safe and effective for stable patients, they generally require more time to yield results and establish a diagnosis compared to inpatient evaluations, leading to diagnostic and treatment delays. Although the outpatient approach may extend the diagnostic timeline, studies have shown that it can result in significant cost savings. Second, a multidisciplinary approach for FUO is essential when addressing patients with intricate medical histories. In this instance, the patient’s history of multiple malignancies, Graves’ disease, underlying pulmonary and cardiac conditions, a prior venous thromboembolism, sleep apnea, and limited health literacy resulted in a broad differential diagnosis that required coordinated specialty imaging and persistent evaluation by her primary care team. Finally, because FUO workup in the outpatient setting often requires adherence with multiple diagnostic studies and specialty visits, building patient trust in the healthcare system is essential. In this case, the patient’s initial concerns regarding the medical system were addressed over time through regular primary care visits and inter-visit contact, which clarified the importance of such appointments.

In conclusion, though challenging, primary care physicians are uniquely positioned to address fever of unknown workup for complex stable patients by emphasizing care coordination and fostering patient trust.

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ABSTRACT #61 CLINICAL RESEARCH CARDIOLOGY THE EFFICACY OF CATHETER ABLATION COMPARED TO MEDICAL THERAPY IN HEART FAILURE PATIENTS WITH CONCOMITANT ATRIAL FIBRILLATION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Mohammad Ishrak Khan1, James Choi1, Amir Reza Akbari2, Hannah Hart1, Justin Goodfarb1, Francisco Jose Romeo3, Kiran Mahmood1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, United Kingdom; 4University of

Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, United States

Presented at the European Society of Cardiology (ESC) Congress that was held in London, United Kingdom from August 30, 2024 to September 2, 2024.

BACKGROUND/INTRODUCTION: The management of atrial fibrillation in patients with heart failure continues to be a topic of ongoing debate. We conducted a meticulous comparison between two primary treatment modalities: catheter ablation versus medical therapy. Our aim is to assess the efficacy of these interventions in patients presenting with both atrial fibrillation and heart failure, drawing from the randomized controlled trials.

METHODS: A comprehensive literature search was conducted up to February 2024, utilizing databases including PubMed, EMBASE, and Clinicaltrials.gov. A total of 10 randomized studies were identified and their data were extracted and analyzed. The primary outcomes assessed included the impact of catheter ablation on all-cause mortality, cardiovascular death, left ventricular ejection fraction (LVEF %), and 6-minute walk test (6MWT) in meters. Data were analyzed utilizing a random-effects model to calculate weighted mean differences for LVEF and 6MWT, and risk ratios for all-cause mortality and cardiovascular death on Review Manager 5.3 (RevMan 5.3) software.

RESULTS: In totality, data from 1944 heart failure patients (n=966 on catheter ablation; n=978 on medical therapy) with concomitant atrial fibrillation were included. Patients in the catheter ablation group exhibited a significant reduction in all-cause mortality (RR, 0.63; 95%CI, 0.48-0.83; p=0.001; I2=17%). Moreover, there was a notable decrease in cardiovascular death among patients undergoing catheter ablation (RR, 0.53; 95%CI, 0.34-0.81; p=0.004; I2=20%). Patients who underwent catheter ablation demonstrated a marked improvement in LVEF (MD, 5.79; 95%CI, 3.13-8.44; p<0.0001; I2=82%). The 6MWT revealed superior outcomes in the catheter ablation group (MD, 22.7; 95%CI, 9.87-35.5; p=0.0005; I2=38%).

CONCLUSION: Heart failure patients with concomitant atrial fibrillation undergoing catheter ablation therapy exhibited notable improvements in LVEF and 6MWT, alongside a significantly reduced risk of all-cause mortality and cardiovascular death compared to those receiving solely medical therapy. These findings shed light on the potential advantages and superior outcomes associated with catheter ablation therapy in preserving cardiac chamber function and mitigating mortality in such a patient cohort. However, further investigations are warranted to understand the long-term benefits and optimal management strategies for such individuals.

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ABSTRACT #62 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/INFECTIOUS DISEASES BITTEN BY THE LOVE BUG! ATRIAL FIBRILLATION SECONDARY TO CHRONIC CHAGAS CARDIOMYOPATHY Zara Khan1, Sneha Bupathi1, Jared Levanthal1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

INTRODUCTION/BACKGROUND: Chagas cardiomyopathy is the most common cause of nonischemic cardiomyopathy in Latin America. It is caused by Trypanosoma cruzi, a protozoan parasite that can cause acute myopericarditis as well as chronic fibrosing myocarditis. Patients may be asymptomatic or present with anginal chest pain, dyspnea, palpitations, or fatigue. Primary manifestations include heart failure, arrhythmias, thromboembolism, and sudden cardiac death. We present a case of a patient who demonstrated a unique case of atrial fibrillation in the setting of tachycardia mediated cardiomyopathy secondary to Chagas cardiomyopathy.

CASE PRESENTATION: A 48-year-old male with no known past medical history presented to the emergency room from an outpatient hand surgery clinic after he was found to be in new onset atrial fibrillation with rapid ventricular response (AF with RVR) during an elective surgery for an old wrist injury. He was given a beta blocker by the anesthesiologist and was then brought to the hospital for a full comprehensive evaluation. The transthoracic echocardiogram demonstrated a left ventricular ejection fraction of 30%, dilated right ventricle with reduced systolic function, and biatrial dilation. The patient underwent transesophageal echocardiogram with cardioversion and was briefly converted to normal sinus rhythm before converting back to atrial fibrillation. The patient was loaded with amiodarone and underwent second cardioversion with successful conversion to normal sinus rhythm. Coronary imaging revealed non-ischemic etiology of heart failure. With serologies positive for Chagas antibodies, the patient was determined to have chronic Chagas cardiomyopathy.

DISCUSSION: AF with RVR can be caused by a wide variety of factors including but not limited to electrophysiological abnormalities, structural heart disease, illness, thyrotoxicosis, alcohol intoxication, electrolyte imbalances, and in more rare instances Chagas cardiomyopathy. Chagas cardiomyopathy has two phases: acute and chronic. The acute phase begins one to two weeks after triatomine bug exposure. Patients typically present with non-specific symptoms such as malaise, fever, hepatosplenomegaly, Romaña sign (persistent unilateral edema, conjunctivitis, and lymphadenopathy), or chagoma (skin lesion at site of bite). The chronic phase, which can last indefinitely in the absence of treatment, can either be asymptomatic/indeterminate or symptomatic with up to 30-40% of individuals developing cardiomyopathy, arrhythmia, or mega viscera.

Diagnostic evaluation typically involves imaging demonstrating biventricular enlargement, thinning of ventricular walls, apical aneurysms, and mitral thrombi. Conduction system abnormalities are common, including right bundle branch block, left anterior fascicular block, and complete atrioventricular block. Though Chagas cardiomyopathy affects millions of people worldwide, diagnosis is often delayed as symptoms typically present decades after initial infection. The prognosis is generally poor, with a high mortality rate within a few years of diagnosis, especially in patients with advanced heart failure or significant ventricular damage. Typically, acute chagas disease is treated with either a 60-day course of benznidazole or nifurtimox for a ninety-day course.

However, in patients with Chagas cardiomyopathy management currently focuses on optimization of heart failure and cardiac dysrhythmias. The use of amiodarone in Chagas cardiomyopathy patients have been shown to be beneficial not only for rhythm control in patients with concomitant atrial fibrillation but also for its potential antiparasitic and antitrypanosomal properties. Despite its rare presentation, the severity of Chagas cardiomyopathy in patients from Latin America necessitates clinical awareness and consideration when these patients present with AF with RVR.

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ABSTRACT #63 CLINICAL RESEARCH ENDOCRINOLOGY/GASTROENTEROLOGY SGLT-2 INHIBITOR USE IS ASSOCIATED WITH LOWER MORTALITY AND HEPATIC DECOMPENSATION IN PATIENTS WITH MASH CIRRHOSIS AND TYPE 2 DIABETES MELLITUS: A MULTINATIONAL ANALYSIS Do Han Kim1, Donghyun Ko2, Jose A. Porres3, Wilhelm S. Basegoda4, Luis M. Nieto5, Pedro Palacios Argueta6, Paul T. Kröner7, Frank Lukens8 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad Francisco Marroquin Facultad de Medicina, Guatemala

City, Guatemala; 4University of South Alabama Health System, Mobile, AL, United States; 5Emory University, Atlanta, GA, United States; 6Thomas Jefferson University Hospital, Philadelphia, PA, United States; 7Riverside Health System, Newport News, VA, United States; 8Mayo Clinic in Florida, Jacksonville, FL, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

INTRODUCTION/BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis.

Currently, there are no treatments capable of significantly reversing cirrhosis, though several are under development. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors, used for type 2 diabetes mellitus (T2DM), have shown benefits in reducing hepatic steatosis and liver-related complications in MASLD. These findings suggest that SGLT-2 inhibitors may also provide beneficial effects for patients with MASH cirrhosis. The aim of this study is to assess whether SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality, liverrelated events, and cardiovascular outcomes in patients with MASH cirrhosis and T2DM. METHODS: A retrospective cohort study was performed using large population-based data from the TriNetX platform. We identified patients with T2DM and MASH cirrhosis who were prescribed SGLT-2 inhibitors between January 1, 2014, and November 24, 2024. This cohort was matched 1:1 with patients who did not receive SGLT2 inhibitors, using propensity matching based on age, gender, demographics, and comorbidities. Outcomes included all-cause mortality, hepatic decompensation, hepatocellular carcinoma (HCC), acute kidney injury (AKI), chronic kidney disease (CKD), and major adverse cardiovascular events (MACE). Cox-proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI).

RESULTS: A total of 66,093 adult patients with MASH cirrhosis and T2DM were identified, of whom 9,610 were on SGLT-2 inhibitors. Among these, 9,609 patients on SGLT-2 inhibitors [mean (SD) age, 63.4 (10.7) years; 4,867 (50.7%) female] were matched with 9,609 individuals [mean (SD) age, 63.4 (10.8) years; 4,828 (50.2%) female] not on SGLT-2 inhibitors. The SGLT-2 inhibitors group had a significantly lower risk of hepatic decompensation (HR, 0.91; 95%CI, 0.83-0.99), all-cause mortality (HR, 0.66; 95%CI, 0.61-0.71), and CKD (HR, 0.89; 95%CI, 0.82-0.98). There were no significant differences in the risk of developing HCC, MACE, or AKI. DISCUSSION: This study demonstrated that SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to the observed lower risk of hepatic decompensation. Prior studies have highlighted the benefits of SGLT-2 inhibitors in reducing liverrelated complications in MASLD, suggesting a similar potential in MASH cirrhosis patients. In conclusion, SGLT2 inhibitors offer promising benefits and could serve as an adjunctive therapy for patients with MASH cirrhosis.

Further studies are warranted to explore the underlying mechanisms and confirm these findings in larger and more diverse populations.

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Table 1. Outcomes Associated with SGLT-2 Inhibitor Use in Patients with MASH Cirrhosis and Type 2 Diabetes Mellitus SGLT2 Inhibitor non-SGLT2 Inhibitor HR (95%CI) Included Events Included Events Outcomes Mortality 9,547 1,195 9,526 2,020 0.66 (0.61, 0.71) HCC 9,053 251 9,169 277 1.07 (0.90, 1.3) Hepatic decompensation 6,765 896 6,690 1,097 0.91 (0.83, 0.99) MACE 6,047 675 6,067 823 0.95 (0.85, 1.05) Acute kidney injury 7,018 939 6,899 1,134 0.93 (0.85, 1.01) Chronic kidney disease 6,026 872 5,960 1,055 0.89 (0.82, 0.98) Abbreviations: HCC, Hepatocellular carcinoma; MACE, Major Adverse Cardiovascular Events; HR, Hazard ratio; CI, confidence interval

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ABSTRACT #64 CLINICAL RESEARCH CARDIOLOGY META-ANALYSIS OF CLINICAL OUTCOMES AMONG BALLOON ANGIOPLASTY, DRUG-COATED BALLOONS, AND SECOND- OR NEWER-GENERATION DRUG-ELUTING STENTS Yuko Kiyohara1, Tadao Aikawa2,3, Toshiki Kuno4 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Jichi Medical University Saitama Medical Center, Saitama, Japan; 3Hokkaido Cardiovascular Hospital, Sapporo, Japan; 4Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

Presented at the Transcatheter Cardiovascular Therapeutics (TCT) Annual Meeting that was held in Washington, D.C., United States from October 27-30, 2024.

BACKGROUND/INTRODUCTION: Drug-coated balloon emerged as a novel treatment strategy without stenting in various settings of percutaneous coronary intervention (PCI). The objective of this study was to evaluate the efficacy of the three strategies of balloon angioplasty, drug-coated balloon, and the second or newer drug-eluting stent (DES) in patients undergoing PCI for various coronary artery diseases.

METHODS: We searched PUBMED and EMBASE for randomized controlled trials (RCTs) comparing balloon angioplasty, drug-coated balloon or DES for clinical outcomes. We included all RCTs that enrolled patients with small coronary artery disease, in-stent restenosis, and others. The primary outcome of this network metaanalysis was a trial-defined major adverse cardiovascular event (MACE) – mostly a composite of cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR). The three strategies were ranked (best to worst) using p-scores. We conducted subgroup analyses of the primary outcome for small coronary artery disease, in-stent restenosis, and others.

RESULTS: Our search identified 30 eligible RCTs in a total of 6,050 patients, including 7 trials for patients with small coronary artery disease, 14 for in-stent restenosis, and 9 for others. Compared with balloon angioplasty, both drug-coated balloon and the second or newer DES were associated with reduced risk of MACE (relative risk, RR, 0.51; 95%CI, 0.38-0.69, and RR, 0.56; 95%CI, 0.38-0.84, respectively). There was no significant difference in D drug-coated balloon and the second or newer DES (RR=0.91,95%CI, 0.69-1.20). The rankogram analysis showed that drug-coated balloon had the lowest MACE risk. There were no significant differences in cardiovascular or all-cause death among the three strategies. Drug-coated balloon was associated with reduced risk of MI (RR, 0.64; 95%CI, 0.44-0.93) compared with balloon angioplasty, but there is no significant difference between the second or newer DES and balloon angioplasty (RR, 0.82; 95%CI, 0.49-1.37). There was no significant difference in drug-coated balloon and the second or newer DES (RR=0.78; 95%CI, 0.55-1.12). The subgroup analyses were consistent with the main analysis.

CONCLUSION: Drug-coated balloon yielded similar clinical outcomes as the second or newer DES. Drug-coated balloon and the second or newer DES were better in reducing MACE than balloon angioplasty.

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ABSTRACT #65 CLINICAL RESEARCH DERMATOLOGY/GASTROENTEROLOGY ASSOCIATION BETWEEN INFLAMMATORY BOWEL DISEASE AND HIDRADENITIS SUPPURATIVA Mako Koseki1, Ahuva Cices2, Ross O’Hagan2, Lauren Lenz2, Scott Stratman2, Diana Ruiz2, Aaron Rips3, Adam Faye3, Sydney Roth5, Dana Lukin5, Vivek Mohan6, Ruby Greywoode6, Manasi Agrawal5, Jean-Frederic Colombel2, Benjamin Ungar2, Serre-Yu Wong2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount

Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York University Langone Health, New York, NY, United States; 5Weill Cornell Medicine, New York, NY, United States; 6Montefiore Medical Center, Bronx, NY, United States

Presented at both the Crohn’s & Colitis Congress Annual Meeting that was held in San Francisco, California, United States from February 6-8, 2025 and the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

BACKGROUND/INTRODUCTION: Studies have shown an association between inflammatory bowel disease (IBD) and hidradenitis suppurativa (HS). However, the natural course of patients with IBD or HS who develop the other and the disease-specific characteristics and outcomes of patients with comorbid IBD and HS are not well-characterized. The natural course and outcomes of patients with comorbid IBD and HS are unknown. The purpose of this study was to compare the clinical characteristics and disease course of patients with both IBD and HS compared with those of patients with isolated IBD or isolated HS. METHODS: A retrospective chart review was conducted for patients who were seen at a single tertiary health system between July 1, 2016 and May 31, 2023. Of 970 patients diagnosed with HS by dermatologists within the same period, chart review revealed 35 patients with IBD. These IBD-HS comorbid patients were matched 1:1:1 with control cases having isolated IBD and isolated HS, based on age, sex, race, duration of the disease, and IBD type. Clinical variables related to HS and IBD were collected, including demographics, comorbid conditions, markers of disease severity, and treatment. We also initiated a multi-center study across four major centers in the New York metropolitan area. To date, we have accrued data for 94 HS-IBD comorbid patients.

RESULTS: Of 35 patients with both HS and IBD, 24 were female and 11 were male, with a median age of 34 years (range 14-81). Of patients with documented race, 16 were White (46%), 8 were Black (23%), and 5 were Southeast Asian (14%). The majority of patients had Crohn’s disease (n=29, 83%). The median age at diagnosis of IBD was 19 years (range, 12-24 years) and of HS was 24 years (range, 20-36 years). For those available, IBD diagnosis preceded HS diagnosis in 26 patients (90%), whereas HS preceded IBD in only 3 patients (10%).

When compared with the isolated IBD group, patients with comorbid Crohn’s disease-HS more often had perianal fistulizing Crohn’s disease [n=16 (55%) versus 6 (21%); p<0.01].

When compared for IBD-related outcomes, there were more frequent IBD-related hospitalizations in the comorbid IBD-HS group compared to the isolated IBD group (0.29 versus 1.38, p=0.02). The combination therapy of biologics and immunomodulators was required more in the comorbid group [n=13 (39%) versus 6 (17%); p=0.04]. The median number of advanced therapies was not significantly different between the two groups. Peripheral arthritis was increased in our comorbid population [n=12 (34%) versus 5 (14%); p=0.05].

When compared for HS-related outcomes, the severity of HS assessed by the Hurley stage and the number of past surgical treatments did not significantly differ between the comorbid IBD-HS group and the isolated HS group.

Multi-center preliminary analysis revealed that 55% of comorbid HS and IBD patients had perianal Crohn’s disease.

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CONCLUSION: In a single-center study of patients with comorbid IBD and HS within a diverse population, patients more often had Crohn’s disease than ulcerative colitis, and the proportion of patients with perianal Crohn’s disease was higher than in the IBD alone group. IBD exhibited more severe disease progression with more frequent combination therapy and hospitalizations, while HS severity was similar when compared with patients with IBD or HS alone, respectively. Preliminary data from a multi-center study reveals similarly high rates of perianal Crohn’s disease. Future directions include completion of the multi-center data collection and analysis to better characterize patients with comorbid hidradenitis suppurativa and inflammatory bowel disease.

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ABSTRACT #66 QUALITY IMPROVEMENT GASTROENTEROLOGY/GENERAL INTERNAL MEDICINE/INFECTIOUS DISEASES A LOOK BEHIND THE SCREEN: IMPROVING HEPATITIS B VIRUS SCREENING RATES AT AN URBAN COMMUNITY PRACTICE Piya Kositangool1, Jake Debroff1, Bharati Dev1, Anna Mageras2, Desiree Chow3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States 2

BACKGROUND/INTRODUCTION: The World Health Organization (WHO) estimates that approximately 254 million individuals worldwide are living with chronic hepatitis B virus (HBV), with an incidence of 1.2 million new infections annually. In 2023, the New York State Department of Health reported nearly 7,000 new cases of chronic HBV and approximately 255,000 individuals living with the condition. This quality improvement study aims to enhance HBV screening rates among New York City providers, with the goal of mitigating the spread of new infections.

METHODS: The study employed a Plan-Do-Study-Act (PDSA) methodology, wherein resident physicians at a primary care clinic in New York City participated in a 30-minute educational session from April 2024 to June 2024. This presentation covered current HBV screening guidelines, the disease's epidemiologic burden, and strategies for interpreting and effectively communicating screening results to patients, and the Best Practice Alert (BPA) which was the key focus of this presentation. The BPA, implemented in 2022, with providers receiving guidance on identifying and utilizing the BPA within the electronic medical record to streamline screening efforts.

Monthly screening rates across all outpatient clinics within a large, multicenter hospital system were tracked centrally to evaluate the intervention’s impact. Four months in 2024 were removed due to errors in the data collection process incorrectly citing a zero percent screening rate during that month. This was confirmed by random chart review which revealed screening was performed but at an unknown rate.

RESULTS: The BPA alert was implemented in September 2022, at which point the HBV screening rate was just 2%. Following this intervention, screening rates increased, reaching an average of 15% throughout 2023.

However, just prior to the educational intervention in 2024, screening rates began to show a decline to eight percent. At the height of the educational efforts in May 2024, the screening rate transiently rose to 29%, but then settled to an average of 15% post-intervention with the most recent quarter showing an average screening rate of 18%. Starting in July 2024, a slight decrease in rates was anticipated as new resident physicians entered the system without having yet received training on the updated screening guidelines.

DISCUSSION/CONCLUSION: The integration of best practice alerts, combined with an educational initiative emphasizing screening guidelines was seen to bolster HBV screening rates at a New York City primary care clinic. Due to the transient improvement post-education, establishing frequent re-education sessions every 6 months to reinforce the information will likely lead to further improvements in screening rates.

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ABSTRACT #67 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE COST-CONSCIOUS CARE: ASSESSING INTERNAL MEDICINE RESIDENTS' CONFIDENCE AND KNOWLEDGE GAPS IN INPATIENT VERSUS OUTPATIENT EXPENSES Sarah Kosse1, Ann Mercurio1, Sara Luby1, Lindsey Fox1, Vasundhara Singh1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025. *All authors contributed equally to the project.

INTRODUCTION: The rising cost of healthcare in the U.S. is a critical issue, with expenses outpacing inflation and creating challenges for patients and healthcare systems. Medical education must now address cost awareness and high-value care, but traditional residency programs often overlook the financial implications of medical decisions. Junior residents frequently order extensive tests, leading to unnecessary costs and incidental findings instead of targeted, cost-effective diagnostics.

Internal Medicine residents can significantly influence healthcare spending, yet their understanding of costconscious decision-making in inpatient and outpatient settings is underexplored. This needs assessment aims to assess their confidence and knowledge of inpatient and outpatient care costs. By identifying gaps in cost awareness, the research seeks to develop educational strategies that integrate cost-effective principles into residency training, fostering clinically competent and cost-conscious physicians.

METHODS: An electronic needs assessment was sent to 285 internal medicine residents at Mount Sinai Morningside and West to evaluate their confidence and knowledge of inpatient and outpatient care costs. The assessment included three questions on decision-making factors, confidence in cost-effective care, and selfperceived knowledge gaps in high-value care education. Participation was voluntary and anonymous.

Evaluation and Plan Responses were analyzed to identify knowledge gaps and areas for improvement in cost-awareness. The findings will guide the development of educational strategies to promote cost-conscious decision-making in clinical practice.

Summary of Results Of 285 residents, 48 responded: 31.3% were PGY-1, 45.8% PGY-2, and 22.9% PGY-3. Key findings include: • Decision Factors: 72.9% cited outpatient resources, 64.6% logistical factors, and only 33.3% considered cost.

• Confidence in Cost-Effective Care: 54.2% were "not very confident" and 12.5% were "not at all confident."

• Educational Interests: 85% wanted to learn about discharge costs, 77% about barriers to high-value care, and 51% about high-value care concepts.

These results highlight a need for education on cost-effective strategies, especially in discharge planning and overcoming barriers to high-value care.

DISCUSSION: This needs assessment shows a significant gap in residents' knowledge and confidence in costeffective care, with costs often overlooked in decision-making. However, there is a strong interest in learning about cost-conscious practices, particularly in discharge planning and overcoming barriers to high-value care.

These findings highlight the need to integrate cost-awareness training into residency programs to help future physicians make informed, cost-effective decisions while maintaining high-quality care.

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ABSTRACT #68 CLINICAL RESEARCH CARDIOLOGY/NEPHROLOGY OUTCOMES AND DISPARITIES OF ASIAN PATIENTS WITH SEVERE CHRONIC KIDNEY DISEASE ADMITTED FOR HEART FAILURE Samuel Tan1, Wenchy Siu1, Shasawat Kumar1, Paulus Adinugraha1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Philadelphia, Pennsylvania, United States on November 11, 2023.

BACKGROUND/INTRODUCTION: Socioeconomic disparities in cardiovascular and renal disease pose global public health challenges. Despite its large population, Asia lacks proportional representation in heart failure (HF) data, limiting our understanding of risk factors and outcomes for Asians with heart failure and severe chronic kidney disease (CKD). This study aims to explore the sex, racial, and ethnic differences in in-hospital all-cause mortality, baseline risk factors, and in-hospital complications among Asian patients admitted for HF with CKD. METHODS: This retrospective study included patients 18 or older with heart failure and CKD 3-5 on discharge from 2016 to 2019. Multivariate logistic regression calculated the odds ratio (OR) adjusting for Elixhauser comorbidities, age, and sex. The primary outcome was disparities in racial/ethnic, sex, and age of in-hospital mortality of patients admitted for HF complicated by CKD. RESULTS: This study involved 510,525 patients, revealing Hispanics (OR, 0.79; 95%CI, 0.71-0.87; p<0.001) and African Americans (OR, 0.66; 95%CI, 0.61-0.73; p<0.001) were associated with significantly lower mortality compared to Asians. Controlling for age and gender, Asians with heart failure and chronic kidney disease had significantly higher odds of diabetes, hyperlipidemia, and hypertension compared to non-Asians. Asian males with heart failure and chronic kidney disease were associated with significantly higher odds of mortality (OR, 1.07; 95%CI, 1.04-1.11; p<0.001) and cardiovascular co-morbidities including atrial fibrillation, coronary bypass graft, implantable pacemaker, and chronic ischemic heart disease compared to non-Asian males. Asians, compared to non-Asians, were associated with significantly higher odds of acute myocardial infarction, acute kidney injury, sepsis, and packed Red Blood Cell transfusion when controlling for Elixhauser co-morbidities.

CONCLUSION: This study reveals significant health disparities among Asian patients with heart failure and chronic kidney disease. The significant difference in odds of mortality and cardiovascular co-morbidities indicates the need for further research regarding the possible causality of such disparities.

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ABSTRACT #69 CASE REPORT ENDOCRINOLOGY THYROID ACROPACHY: A CLINICAL RESPONSE TO TEPROTUMUMAB Javier Lira1, Mone Zaidi2, Se Min Kim2,3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel,

Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Endocrine Society’s (ENDO) Annual Meeting that was held in Boston, Massachusetts, United States from June 1-4, 2024.

BACKGROUND: Thyroid acropachy is a rare extrathyroidal manifestation of Graves disease. Due to its rarity, generally benign clinical course and the limited understanding of its pathophysiology, there is currently no specific treatment for thyroid acropathy.

CASE PRESENTATION: A 25-year-old Asian male with a history of Graves disease, for which he had undergone total thyroidectomy 2 years prior, presented with worsening double vision. The patient also complained of swelling in the legs, and pain and stiffness in his hands and feet. On exam, he displayed bilateral asymmetric proptosis, conjunctival injection, and lid lags. Nodular and plaque-like lesions with non-pitting edema were observed on both pretibial skin. The fusiform swelling of fingers and prominent clubbing of finger and toenails was noted. Upon further questioning, he admitted to smoking at least a pack of cigarettes a day. His laboratory findings were as follows: TSH 0.40 uIU/ml (Normal 0.4-4.2) with levothyroxine supplement, thyrotropin receptor Ab (TRAB) 81.1 IU/L (Normal 0.0-1.75), which was significantly elevated compared with 34.6 IU/L right after thyroidectomy. A skin biopsy was performed, revealing well-differentiated myxomatous lesion involving dermis and subcutaneous fat, with a splaying of the collagen by abundant mucin representing hyaluronic acid, confirming thyroid dermopathy. Bilateral hand X-rays showed soft tissue swelling and extensive bilateral periostitis and subperiosteal bone formation in metacarpals and phalanges, consistent with thyroid acropachy.

After showing non-response to a trial of Prednisone, Teprotumumab was initiated for Graves ophthalmopathy.

The patient was advised to quit smoking. Following five infusions, significant improvement was observed in proptosis and orbital inflammation. The pretibial myxedematous lesion also improved. Furthermore, there was a marked decrease in swelling in bilateral metacarpals and phalanges with regaining full range of motion. All extrathyroidal manifestations further improved after the completion of a total of eight infusions of Teprotumumab, with TRAB levels down to 14.3 IU/L. CONCLUSION: Our case is the first example demonstrating clinical improvement in patients with thyroid acropathy following Teprotumumab treatment. This observation implies that the pathophysiology of thyroid acropathy encompasses the interplay between TSH receptor and IGF-1 receptor signaling, akin to Grave ophthalmopathy, and suggests that the direct skeletal effect of TSH may be caused by the interaction with IGF1 pathway, as shown in pre-clinical study (Boutin, et al, 2020).

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ABSTRACT #70 CASE REPORT/CLINICAL VIGNETTE RHEUMATOLOGY SARCOIDOSIS BEYOND THE LUNG: RARE MULTIORGAN INVOLVEMENT INCLUDING BRAIN, BONE, EXOCRINE GLANDS, JOINTS, MUSCLE, AND SKIN Niurka Liranzo Tejera1 and Shu Min Lao1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

BACKGROUND/INTRODUCTION: Sarcoidosis is a rare and chronic multi-organ disease of unknown etiology, mainly characterized by the formation of sarcoid granulomas that affect multiple tissues. Extrapulmonary organ involvement occurs in up to 50% of patients as lung involvement is the most common, in up to 90% of cases.

Sarcoidosis with organ involvement is variable; it displays an unpredictable clinical course and disease pattern.

Sarcoidosis affecting more than three organ systems is extremely rare. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease.

CASE PRESENTATION: A 34-year-old African-American female admitted in July 2023 with severe parotid/lacrimal gland swelling, bilateral eye dryness, jaw pain, myalgias, skin nodules, loss of smell and taste and amenorrhea. Physical examination significant for painful/enlarged parotid glands, dry mucous membranes, diffuse arthralgias, bilateral periorbital swelling, and multiple skin hypopigmented nodules in arms and back.

Laboratory findings significant for ACE 156 U/L, CRP 6.1mg/L, ESR 116mm/hr, Estradiol <24pg/mL, FSH 0.4MIU/mL, LH 0.5MIU/mL, TSH 0.31uIU/mL, and negative SSA/SSB and anti-dsDNA. Imaging with evidence of multiorgan sarcoid involvement and a positive skin biopsy suggestive of sarcoidosis granulomata. The patient was treated with high dose steroids and mycophenolate mofetil (which was later discontinued due to oral sores), also required hormone replacement therapy and levothyroxine due to disease involvement of pituitary gland.

More recently desmopressin was added, as patient developed signs of central diabetes insipidus. Given worsening clinical condition, Infliximab infusion was started with improvement of symptoms.

DISCUSSION/CONCLUSION: The pituitary gland is among the least commonly affected sites in neurosarcoidosis, comprising only 13.6% of cases involving the nervous system. Sarcoidosis affecting the parotid gland remains a rare manifestation. Our patient displayed bilateral involvement, which is considered the least predominant presentation, as unilateral involvement accounts for most cases. Skin involvement has been described as an early finding and requires biopsy. Our patient exhibited lupus pernio with hypopigmented nodules/granulomas. Musculoskeletal involvement in sarcoidosis in uncommon and highly unpredictable, often challenging to diagnose due to its resemblance to other conditions. The multilevel localization of disease in the brain, bone, exocrine glands, muscle, and skin represents rare extrapulmonary manifestations. Isolated involvement of these tissues is exceptionally uncommon, with this specific pattern rarely coexisting with other systemic symptoms. Notably, multiple organ involvement occurs in approximately 20% of cases (three or more organs), 7% (four or more), and 2% (five or more). Various treatment modalities are available, tailored to the affected organs and disease severity. In this case, the patient’s symptoms have improved following Infliximab infusion therapy.

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ABSTRACT #71 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE SEPSIS Scott Low1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: According to the World Health Organization, Sepsis accounts for about 20% of deaths worldwide, with half of those deaths occurring in a pediatric population. Sepsis is a complex disease process that is driven by an exaggeration of the body’s natural inflammatory response to a microbial infection.

The severity of this process can vary widely from immediate normalization of vital signs because of initial treatment to multiorgan dysfunction syndrome and death.

DIAGNOSIS: The diagnosis of sepsis can be thought of in a stepwise fashion with the addition of more findings and/or lack of response to initial treatment increasing the severity.

Step 1: is systemic inflammatory response syndrome (SIRS) (2 or more of the following): Temperature outside the range of 36-38C, heart rate over 90 bpm, respiratory rate over 20 (or PaCO2 <32mmHg), or white blood cell count outside the range of 4,000-12,000 (or >10% bands).

Step 2: If there is an identified or suspected source of infection then SIRS becomes sepsis.

Step 3: If there is organ dysfunction, hypotension (or relative hypotension), or abnormalities from hypoperfusion such as lactic acidosis, altered mental status, etc then the syndrome becomes “severe sepsis.” If hypotension persists after appropriate fluid resuscitation or vasopressors are needed during resuscitation, then it becomes “septic shock.” The number of organ systems failing because of this process (cardiovascular, hematologic, hepatic, neurologic, renal, and respiratory) is directly correlated to mortality.

Identification of the source of infection is key to diagnosing sepsis versus other acute illness. How might this be done if up to 49% of severe sepsis cases end up being “culture negative”? Sepsis is a diagnosis based on a combination of clinical presentation, imaging findings, microbiological findings (including viral and fungal testing when appropriate), common laboratory signs of sepsis, or response to antimicrobial therapy. There is a wide range of other acute illnesses with coincidental clinical pictures to sepsis such as: anaphylaxis, pulmonary embolism, diabetic ketoacidosis, alcohol withdrawal, and more.

MANAGEMENT: Due to the incidence and mortality of sepsis, the Society of Critical Care Medicine has developed the “Surviving Sepsis Campaign.” Management of sepsis is time-sensitive; if sepsis is probable or shock is present, blood cultures should be drawn followed by antimicrobials administered within the first hour.

Choice of antibiotic should be targeted towards likely organisms of a suspected infectious source as well as consideration if an individual is at high risk of methicillin resistant Staphylococcus aureus (MRSA), multidrug resistant pathogens, or fungal pathogens. Other considerations in antimicrobial choice include prior available microbiologic data for a patient and allergies. When shock is not present, investigation of non-infectious causes of acute illness should occur with antibiotic administration delayed up to 3 hours.

Further management is targeted at perfusion, oxygenation, and if necessary, management of resultant organ dysfunction. There is a strong recommendation from the “Surviving Sepsis Campaign” for the use of crystalloids for initial resuscitation. However, from 2016 to 2021 there was a downgrade from strong to weak recommendation of at least 30mL/kg of crystalloid to be given within the first 3 hours. If crystalloid fluid is not enough to maintain a MAP over 65 mmHg, then norepinephrine should be initiated with the consideration adding of vasopressin or inotropy in select cases where signs of hypoperfusion persist.

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CONCLUSION: Sepsis has a high incidence and significant mortality rate, especially in vulnerable populations such as geriatrics, immunocompromised people, and those with multiple chronic comorbidities, recent surgery, or critical illness. Interestingly, causative organisms or presence of bacteremia may not have any association with mortality while source, higher average heart rate, and lower mean arterial pressure are risk factors for mortality. The diagnosis of sepsis can be complex with many acute illnesses having overlapping clinical pictures and triggering of SIRS criteria. Therefore, early investigation, fluid resuscitation, and antimicrobial administration are key factors in improving outcomes; the cessation of antibiotics can always occur later as more information clarifies the clinical picture.

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ABSTRACT #72 CASE REPORT INFECTIOUS DISEASE/RHEUMATOLOGY LEPROSY MIMICKING ATYPICAL ANTIPHOSPHOLIPID SYNDROME Sophia Lutgen1, Murilo Roberto Bastos Silva, Michael Kaplan 1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, NY, United States

2

Presented at the Congress of Clinical Rheumatology Annual Meeting held in Destin, Florida, United States from May 8-12, 2024.

BACKGROUND/INTRODUCTION: Leprosy, a chronic granulomatous infection largely caused by Mycobacterium leprae, primarily affects the skin and peripheral nerves. Vasculitis is a recognized skin manifestation in both, leprosy, and antiphospholipid syndrome (APS). APS is characterized by thrombotic events, inflammatory infiltrate in vessel walls and positive autoantibodies, which can also be falsely elevated in leprosy.

Given the clinical and serologic overlap, we present a case of a patient initially diagnosed with atypical APS, who exhibited clinical deterioration on immunosuppression.

CASE PRESENTATION: A 37-year-old female residing in Queens, previously in Texas, presented with rapid onset severe bilateral lower extremity pain. A history was notable for Raynaud’s phenomenon and no thrombotic events. Physical exam revealed Jaccoud's arthropathy, bilateral ankle warmth, and edema; otherwise, no synovitis or enthesitis. Livedo reticularis was appreciated on both arms (Figure 1), and strength and sensitivity preserved. Initial laboratory workup revealed borderline inflammatory markers: CRP 22 mg/dl [normal (N) <22.1), ESR 45 mm/hr (N <24). Serology was positive for Beta-2-glycoprotein I AB IgM 63 mg/dl (N <9), and Anticardiolipin AB IgM 47 mg/dl (N < 9). Anticoagulant antibody was positive, later found to be persistent. Severe allodynia prompted electromyography and nerve conduction studies, which were abnormal, leading to a left sural nerve biopsy. Results demonstrated moderate neuropathy and inflammatory cells (CD4 and CD8) infiltration in the endoneurium, perineurium, and perivascular space with invasion of the small blood vessels wall. Given the suspicion of APS-associated vasculitis, the decision was made to start immunosuppression with Rituximab and prednisone. However, the patient's symptoms deteriorated following the first dose of rituximab; she developed a fever and a new maculopapular rash (Figure 2). She presented to the Emergency Room where a lesion was swabbed and found to be monkeypox on PCR. Immunosuppression was held and, when she recovered, she received her second dose of Rituximab. Following the infusion, she developed a new skin lesion: indurated papules (Figure 3). At this point, a skin biopsy was performed to distinguish between vasculitis and monkeypox.

It demonstrated positive staining for acid-fast bacilli, with PCR revealing Mycobacterium leprae organisms.

CONCLUSION: While treatment for leprosy has advanced, a lack of knowledge and awareness in the healthcare community, coupled with stigma, contributes to delayed diagnosis and prolonged suffering. Leprosy has become endemic in certain areas of Texas. Positive antiphospholipid serology markers in leprosy cases have been reported in the literature. Our patient had misleading physical characteristics like Jaccoud's arthropathy and Raynaud’s, often seen on many connective tissue diseases; and livedo reticularis, microvascular presentation of APS, which is also observed in leprosy. This case emphasizes the importance of considering infectious etiologies as co-existing and perhaps driving advanced rheumatologic disease. Collaboration with infectious disease becomes paramount as treatment may obviate the need for immunosuppression.

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Figure 1. Livedo reticularis was appreciated on both arms.

Figure 2. New maculopapular rash.

Figure 3. She developed a new skin lesion: indurated papules.

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ABSTRACT #73 CLINICAL RESEARCH CARDIOLOGY EFFECT OF CARDIAC AMYLOIDOSIS ON TRANSCATHETER AORTIC VALVE REPLACEMENT IN LOW-FLOW LOW-GRADIENT AORTIC STENOSIS Joseph Maenza1, Lakshay Chopra1, Francesca Prandi2, Ranbir Singh2, Parasuram Krishnamoorthy2, Gilbert H. L. Tang2, Samin K. Sharma2, Annapoorna S. Kini2, Stamatios Lerakis2 1

Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the London Valves Conference that was held in London, England, United Kingdom from November 24-26, 2024 and published in the Cardiovascular Revascularization Medicine, 2024.

PMID: 39550305.

BACKGROUND/INTRODUCTION: Low-flow low-gradient aortic stenosis (LF-LG AS) presents diagnostic and therapeutic challenges, particularly in determining the timing and indication for aortic valve replacement. This study investigates the impact of cardiac amyloidosis on the outcomes of Transcatheter Valve Replacement (TAVR) in LF-LG AS patients.

METHODS: A retrospective analysis was performed at a single center, including patients who underwent TAVR for LF-LG AS between January 2019 and December 2022 (median follow up 17.8 months). Patients were categorized based on amyloidosis status—confirmed (group A), suspected (group B), and none (group C)— using echo data, hematological diagnosis, and imaging (PYP). The primary endpoint was all-cause mortality; secondary endpoints included post-procedural complications.

RESULTS: Of the 471 patients analyzed, 14 were confirmed to have amyloidosis, 30 were suspected, and 427 had no amyloidosis. A significant disparity in mortality was observed between the confirmed amyloidosis group (group A) (8 deaths, 57%) compared to the non-amyloidosis group (group C) (79 deaths, 19%), resulting in a HR of 4.21 (95%CI, 2.02-8.76; p<.0001). Combining confirmed and suspected amyloidosis (groups A and B) showed a HR of 2.43 (95%CI, 1.45-4.06; p<0.0001). The presence or suspicion of amyloidosis did not significantly impact post-procedural complication rates.

CONCLUSION: Cardiac amyloidosis significantly worsens the prognosis for LF-LG AS patients undergoing TAVR. These findings underscore the importance of comprehensive amyloid evaluation in preoperative risk assessment and support enhanced diagnostic strategies to improve patient outcomes in this high-risk cohort.

The final updated analysis will be presented for the first time at New York Valves.

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ABSTRACT #74 CLINICAL RESEARCH CARDIOLOGY IMPACT OF ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE AND SEVERE MITRAL REGURGITATION UNDERGOING TRANSCATHETER EDGE-TO-EDGE REPAIR Carlo Mannina1,2, Akarsh Sharma3, Yash Prakash3, Andreina Carbone4, Eduardo Bossone5, Antonino Tuttolomondo2, Edgar Argulian1, Sahil Khera3, Parasuram Melarcode-Krishnamoorthy3, George Dangas3, Jonathan Halperin3, Gilbert H L Tang 3, Samin Sharma3, Annapoorna Kini3, Gregg W. Stone3, Stamatios Lerakis3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Palermo, Palermo, Italy; 3Mount Sinai Hospital, Icahn5 School of Medicine at Mount 4 Sinai, New York, NY, United States; University Hospital "Luigi Vanvitelli", Naples, Italy; Federico II University, Naples, Italy

BACKGROUND: Atrial fibrillation (AF) and mitral regurgitation (MR) are closely linked, and one may worsen the other. We aim to investigate the impact of AF in patients with MR undergoing transcatheter edge-to-edge repair (M-TEER).

METHODS: One-hundred-fifty-six consecutive patients with symptomatic heart failure (HF) undergoing MTEER for severe MR were studied. The primary endpoint was the composite outcome of death or HF hospitalization (HFH). Transthoracic echocardiograms were performed at baseline and follow-up.

RESULTS: Mean age was 80.88.8 years and 82 (52.6%) patients were female. MR etiology was primary in 69 (44.2%) and secondary in 87 (55.8%) patients. Atrial fibrillation or atrial flutter (AF) was present in 59 (37.8%) patients at baseline. M-TEER was successful (≤2+ MR) in 58 (98.3%) and 94 (96.9%) patients with and without AF respectively (p=0.59). During median 12.5 months follow-up, the primary endpoint occurred in 64 patients (2-year Kaplan-Meier estimated rate 41.0%), including death in 16 patients (10.3%) and HFH in 57 patients (36.5%). Baseline AF was the only independent predictor of death or HFH (HR, 2.26; 95%CI, 1.13-4.52; p=0.02). Left ventricular end-diastolic volume, left atrial volume and right ventricular systolic pressure decreased during follow-up among patients in sinus rhythm but not among those in AF. AF was associated with an increased risk of severe MR recurrence (18.6% versus 8.2%, p=0.05).

DISCUSSION/CONCLUSION: In patients with HF and severe MR treated with M-TEER, baseline AF was associated with impaired right and left heart remodeling, more frequent MR recurrence, and more than doubling of the risk of death or HFH.

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ABSTRACT #75 CLINICAL RESEARCH CARDIOLOGY GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST PRESCRIBING PATTERNS IN AN URBAN OUTPATIENT HEART FAILURE POPULATION Joseph Marinelli1, Christopher N. Matthews1, Anna Mueller1, Vincent Torelli1, Alexander Silverman1, Zara Khan1, Ashish Correa1, Arieh Fox1, Kiran Mahmood1 1Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: In the past few years, several cardiovascular outcome trials have shown reduction in major adverse cardiovascular event (MACE) with the use of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or obesity. Evaluating the baseline GLP-1 RA prescribing patterns in an outpatient heart failure population would help establish if these new recommendations have translated to clinical practice.

METHODS: Retrospective manual chart review of outpatient visits from multiple heart failure cardiologists at an urban academic institution from October 2023-December 2023 was performed. Demographic information recorded were age, sex, race, ethnicity, and insurance type. Objective patient data included the following: ejection fraction, hemoglobin A1c, presence of ASCVD, and glomerular filtration rate. Medications were reviewed for GLP-1 RAs prescribed and if not, why it was not prescribed. The main outcome was to determine the prescribing rate of GLP-1 RAs when indicated.

RESULTS: Among the 390 patients seen during the 3-month period, 196 had a diagnosis of T2DM with only 65 (33.2%) prescribed a GLP-1 RA by their heart failure provider, endocrinologist, or primary care provider. This population was predominantly African American and Hispanic, including those with T2DM. A large proportion of the patients with T2DM that were not prescribed a GLP-1 RA were also in the geriatric population. Within the subset of patients with T2DM and no GLP-1 RA prescribed, 107 (81.7%) had established ASCVD, 64 (48.9 %) with a body mass index ≥ 27, 71 (54.2%) with CKD Stage 3-5, and 53 (40.5%) with a hemoglobin A1c ≥ 7.

For most of those patients that were not prescribed a GLP-1 RA when indicated, there was no documentation of a discussion with the patient and their heart failure provider.

CONCLUSION: There is an underutilization of GLP-1 RAs in the heart failure population where they would otherwise be indicated, such as reducing MACE in established ASCVD, slowing progression of CKD, reaching goal hemoglobin A1c, or improving weight management. An interdisciplinary approach is essential to ensure GLP-1 RAs are appropriately prescribed and barriers to prescribing should be addressed.

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ABSTRACT #76 MEDICAL EDUCATION GASTROENTEROLOGY REGIONAL DISPARITIES EXIST IN GENDER REPRESENTATION AMONG GASTROENTEROLOGY TRAINEES AND FACULTY IN THE UNITED STATES Alexandria Markley1*, Marni Wilkoff1*, Nivita Sharma2, Rama Hussein1, Mako Koseki1, Rashmi Advani3, Yuying Luo1, Haley M. Zylberberg4, Loren G. Rabinowitz5 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Duke University School of Medicine, Durham, NC, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Weill Cornell Medicine, New York, NY, United States; 5Beth Israel Deaconess Medical Center, Boston, MA, United States 2

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025. *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Women continue to be underrepresented in Gastroenterology, making up only 21% of the workforce and 33% of all Gastroenterology fellow trainees. The aim of this study was to evaluate the representation of women Gastroenterology physicians and trainees across the United States and to identify factors associated with women in leadership.

METHODS: We conducted a cross-sectional study of all American College of Graduate Medical Education accredited Gastroenterology fellowship programs in the United States in 2023. All Gastroenterology program websites were reviewed, and programs were contacted to obtain program’s gender characteristics (n=224); programs without faculty and fellows listed on the fellowship program website were excluded (n=7). The distribution of women trainees and faculty members across United States regions was evaluated. Additionally, program characteristics were examined in univariate analyses and logistic regression models, adjusting for program type and United States region.

RESULTS: Two hundred and seventeen institutions were included in the analysis with the distribution of women fellows and faculty across United States regions shown in Figure 1a and b. Median percentage of women fellows per institution was highest in the West (50%), compared to the Northeast (38%), the South (33%), and the Midwest (33%, p=0.014). Overall, there were no differences in representation of women faculty by United States region, though median percentage of senior faculty, which included professor and associate rankings, was significantly highest in the Northeast (27%), followed by the West (25%), South (15%), and Midwest (8%, p=0.009). Analysis of program characteristics by gender of the Gastroenterology Division Chief (Table 1) showed that programs with women Gastroenterology Division Chiefs (compared with men) had more women Gastroenterology Fellowship Program Directors (60% versus 40%, p=0.001) and higher median percentage of women faculty members (33%, IQR 26-40 versus 26%, IQR 17-37, p=0.016). In regression models, the presence of a woman Gastroenterology Division Chief was independently associated with having a woman Gastroenterology Fellowship Program Director (p=0.008) and increased percentage of women faculty per institution (p<0.001).

CONCLUSION: Regional differences exist across the United States in the distribution of women Gastroenterology trainees and faculty members, which may have implications for faculty retention, trainee recruitment, and patient care. Additionally, the presence of a woman Gastroenterology Division Chief was associated with an increase in women fellowship program directors and women faculty members suggesting that women in leadership may help increase the representation of women in academic roles. This finding highlights the potential impact that gender diversity in leadership positions may have on shaping more representative faculty environments.

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Figure 1. Representation of Women Gastroenterology Fellows (A) and Women Gastroenterology Faculty (B) by Institution Zip Code.

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Table 1. Program characteristics by gender of Gastroenterology (GI) Division Chief Program Characteristics Overall, n(%) Women, n(%) Men, n(%) N=184 N= 35 N = 149 Type of Institution (n=184) Other 16 (8.7%) 3 (8.6%) 13 (8.7%) University based 168 (91%) 32 (91%) 136 (91%) Region (n=183) Midwest Northeast South West Gender of Dean (n=137) Women Men Gender of Medicine Chair (n=172) Women Men Gender of Endoscopy Director (n=97) Women Men Gender of GI Program Director (n=183) Women Men Percent Women Faculty (n=174) Median (IQR) Range Percent Women Fellows (n=163) Median (IQR) Range Presence of Women APD (n=120) Percent Women Junior Faculty (n=87) Median (IQR) Range Percent Women Senior Faculty (n=88) Median (IQR) Range

p-value1 >0.9

0.4 41 (22%) 59 (32%) 57 (31%) 26 (14%)

10 (29%) 10 (29%) 8 (23%) 7 (20%)

31 (21%) 49 (33%) 49 (33%) 19 (13%) 0.3

39 (28%) 98 (72%)

5 (20%) 20 (80%)

34 (30%) 78 (70%) 0.2

46 (27%) 126 (73%)

12 (36%) 21 (64%)

34 (24%) 105 (76%) 0.7

12 (12%) 85 (88%)

1 (5.9%) 16 (94%)

11 (14%) 69 (86%) 0.001

66 (36%) 117 (64%)

21 (60%) 14 (40%)

45 (30%) 103 (70%) 0.016

27 (18, 38) 0, 60

33 (26, 40) 11, 60

26 (17, 37) 0, 55 >0.9

38 (25, 50) 0, 100 64 (53%)

33 (25, 50) 0, 75 9 (36%)

38 (25, 50) 0, 100 55 (58%)

42 (29, 50) 0, 100

40 (33, 48) 13, 69

43 (26, 50) 0, 100

0.05 0.8

0.032 24 (0, 32) 0, 100

30 (19, 40) 0, 50

20 (0, 29) 0, 100

1Fisher’s exact test; Pearson’s Chi-squared test; Wilcoxon rank sum test APD: Assistant/Associate Program Director; IQR: Interquartile range

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ABSTRACT #77 CASE REPORT/CLINICAL REVIEW DERMATOLOGY/GENERAL INTERNAL MEDICINE/INFECTIOUS DISEASES PRIMARY CUTANEOUS CRYPTOCOCCOSIS CAUSED BY CRYPTOCOCCUS NEOFORMANS IN AN IMMUNOCOMPETENT PATIENT Olga Marushchak1, Shane A. Meehan2, Sue Ann Wee3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2New York University Grossman School of Medicine, New York, NY, United States; 3The Art & Science of Dermatology, PC,

New York, NY, United States

Published in the SKIN The Journal of Cutaneous Medicine, 2023.

BACKGROUND/INTRODUCTION: Cryptococcosis is a fungal infection caused by Cryptococcus species, most commonly affecting immunocompromised individuals, while very few cases of the infection in immunocompetent hosts are available in the literature. Cryptococcosis most commonly affects pulmonary and central nervous systems, manifesting as pneumonia and meningoencephalitis. Cutaneous lesions are typically a sign of the disseminated disease and can occur in about 5-20% of affected patients. Primary cutaneous infection may be caused by direct inoculation of the fungus into the skin by a contaminated object and is characterized by skin lesions with positive culture in the absence of systemic disease. The most common presentation of disseminated cutaneous cryptococcosis is umbilicated papules on the head or neck. In contrast, primary cutaneous cryptococcosis typically presents with solitary skin lesions (often ulcerated) in exposed body areas.

CASE PRESENTATION: A 67-year-old woman presented with a 6-month history of localized papules and plaques on her back. The review of systems was otherwise negative. Her past medical history was unremarkable and negative for malignancy, immunodeficiency, or immunosuppression. A more detailed history revealed exposure to pigeon droppings about one year prior to the onset of her skin lesions. In addition, a previous roommate had kept pet birds inside the patient's home several years prior. The physical examination revealed four ulcerated papules and plaques, some of which drained a purulent discharge on her left lower back. No similar lesions were found on other parts of the body. No relevant underlying disease was noted during the physical examination. A shave biopsy of the ulcer margin was obtained and the histopathologic examination revealed variably-sized yeast-like organisms surrounded by clear capsules and granulomatous infiltrate. The organisms were stained with PAS-D, GMS, Fontana-Masson, and a mucicarmine. Histological findings were consistent with cryptococcosis. The culture of the discharge showed heavy growth of Cryptococcus neoformans.

Given the absence of systemic signs and symptoms and a negative chest X-ray, the diagnosis of primary cutaneous cryptococcosis was made. The patient was treated with oral fluconazole which led to complete resolution of her skin lesions. There was no recurrence of lesions or evidence of dissemination during the four months of follow-up.

CONCLUSION: In this case, the cutaneous manifestation of localized lesions, histopathological findings, positive culture results, absence of fever, negative systemic workup, and excellent response to antifungal therapy support the diagnosis of primary cutaneous cryptococcosis, which is a rare condition recognized as a distinct clinical entity. Furthermore, reports on cryptococcosis cases suggest that C. neoformans commonly causes infection mainly in immunocompromised patients, while C. gattii variant usually affects immunocompetent hosts.

However, the culture from this immunocompetent patient was positive for C. neoformans, further confirming the rarity of this clinical presentation.

This case highlights an atypical clinical presentation of primary cutaneous cryptococcosis with ulcerated papules and plaques in an immunocompetent patient. Therefore, physicians should consider cutaneous cryptococcosis in their differential diagnosis of ulcerated skin lesions in patients with exposure to bird droppings, regardless of their immune status.

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ABSTRACT #78 CLINICAL RESEARCH CARDIOLOGY PROGNOSTIC IMPACT OF BASELINE PULMONARY HYPERTENSION, TRICUSPID REGURGITATION, AND RIGHT VENTRICULAR FUNCTION ON OUTCOMES AFTER TRANSCATHETER MITRAL VALVE PROCEDURES Christopher N. Matthews1, Brandon Berman1, Sara Diaz Saravia1, Abel Casso Dominguez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Meeting that was held in Washington, D.C, United States from May 1-3, 2025.

BACKGROUND/INTRODUCTION: In recent years the body of evidence on transcatheter mitral valve repair (TMVR) has rapidly grown. This meta-analysis evaluates the impact of baseline pulmonary hypertension (pHTN), tricuspid regurgitation (TR), and right ventricular (RV) dysfunction on mortality, and a composite outcome of mortality or heart failure hospitalization after TMVR. METHODS: Studies reporting hazard ratios (HR) for all-cause mortality, composite mortality, or heart failure hospitalization at least one-year post-TMVR were included.

RESULTS: A total of 19,343 patients from 39 studies were analyzed (17 pHTN studies, 6,399 patients; 30 TR studies, 16,222 patients; 11 RV function studies, 4,874 patients). TR ≥ severe showed the strongest association with mortality (HR 1.73; 95%CI, 1.46-2.04) and composite outcomes (HR, 1.52; 95%CI, 1.22-1.9) (Figure 1).

Pulmonary hypertension also correlated significantly with worse outcomes (Figure 2).

CONCLUSION: Tricuspid regurgitation and pHTN predict worse prognosis after TMVR, but RV function is not a consistent predictor.

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ABSTRACT #79 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE/PALLIATIVE CARE DISCUSSING CLINICAL STATUS AND DELIVERING SERIOUS ILLNESS NEWS: A NEEDS ASSESSMENT OF INTERNAL MEDICINE RESIDENTS Anahi McIntyre1 and Georgina Osorio1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND: Internal Medicine residents often deliver news of serious illness. However, there is more emphasis at times on diagnoses, management of illness, and treatment than communication skills during resident education. This needs assessment aimed to identify the barriers residents face and areas they find most difficult when discussing clinical status and delivering serious illness news to patients. The findings will be used to inform the development of an educational workshop to improve residents' communication skills in these challenging conversations.

METHODS: An anonymous needs assessment was sent to all Internal Medicine residents at Mount Sinai Morningside/West. The assessment included: 1. Rating personal comfort in delivering serious illness news on a 5-point Likert scale (1=very uncomfortable; 3=neutral; 5=very comfortable); 2. Rating nine common barriers encountered while discussing clinical status and serious illness news on a 5-point Likert scale (1=not a barrier; 3=sometimes a barrier; 5=always a barrier); and 3. Identifying the most challenging skill in delivering serious illness news from a list of options (sharing concerns about likely medical outcomes, responding with empathetic statements, communicating a concise headline, initiating a clinical update, avoiding medical jargon, and others).

Mean values were calculated for each Likert scale question.

RESULTS: 100 of 218 residents responded (46% response rate). 97% of polled residents reported having delivered serious illness news, of which 55% used a structured method. Residents felt mostly somewhat comfortable (45%, mean=3.33) delivering serious illness news, followed by somewhat uncomfortable (23%), neutral (20%), very comfortable (8%), and very uncomfortable (4%). Common barriers in discussing clinical status and delivering serious illness news included physician time (mean=3.21), suboptimal timing for discussion (mean=3.15), patient capacity to make decisions (mean=3.10), and lack of expertise to communicate prognosis (mean=3.07). Conversely, lack of preexisting therapeutic alliance (mean=2.90), language barrier (mean=2.81), lack of personal comfort (mean=2.72), desire to avoid strong emotions (mean=2.39), and lack of communication skills (mean=2.29) were less frequently identified as barriers. Residents reported the most difficulty with sharing concerns about likely medical outcomes (35%), followed by responding with empathetic statements (22%), communicating a concise headline (19%), initiating a clinical update (12%), avoiding medical jargon (8%), and other (3%).

DISCUSSION/CONCLUSION: The results of the needs assessment suggest that Internal Medicine residents face external (e.g., time constraints, suboptimal timing, patient capacity) and internal barriers (e.g., lack of expertise to communicate prognosis) when discussing clinical status and delivering serious illness news. The strong correlation between lack of expertise in communicating prognosis and the reported difficulty in sharing concerns about likely medical outcomes highlights the need for targeted training. The planned curriculum will focus on framing prognostic information, especially in situations with high individual variability. This will include a multi-modal approach with a role-playing workshop and written resources.

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ABSTRACT #80 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE IMPROVING HEALTH CARE PROXY DOCUMENTATION ON MEDICINE FLOORS Aphrodite Megaris1, Hannah Bava1, Elisabeth Rosen1, Joy McIlvaine1, Lina Miyakawa1 1Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

BACKGROUND/INTRODUCTION: Advanced care planning is a crucial part of health care, as it helps guide medical management and decision-making while honoring the patient’s wishes. Among its components, assigning a health care proxy empowers patients in selecting someone to make medical decisions on their behalf when they can’t. Each health care proxy is expected to make medical decisions based on the patient’s anticipated preferences or past discussions disclosing the patient’s wishes. To ensure the recognition of patients’ chosen health care proxy, formal documentation with a patient's signature is essential. Enhancing and standardizing health care proxy documentation practices is of utmost importance for patient-centered care and upholding patient autonomy in moments a patient cannot advocate for themselves. This quality improvement initiative aimed to identify and overcome barriers to health care proxy documentation, targeting a 15% increase in completion rates post-intervention.

METHODS: Multifaceted interventions were implemented to encourage health care proxy documentation. These included nurse education on initiating health care proxy discussions and completion of health care proxy form, integrating the form into admission packets, ensuring availability of blank health care proxy forms across hospital units including the Emergency Department, personalized weekly reminders via Epic chat for medical residents, and education for medical residents and hospitalists with tipsheets standardizing health care proxy documentation. Emphasis was placed on documentation for patients admitted to the general medicine service aged 65 years and above and was the focus of our analysis.

RESULTS: The pre-intervention mean rate of health care proxy completion was 31.93%, increasing significantly to 48.03% post-intervention (p<0.05), comparing corresponding months in 2022 and 2023 (October and November), given interventions in September 2023.

CONCLUSION: The statistically significant increase in health care proxy form completion is evident, with an immediate surge to 53.87%, followed by a slight decline, expected due to the nature of one-time interventions versus continuous efforts. The sustained increase from baseline suggests successful integration into practice, reinforced by high completion rates in subsequent months. This indicates knowledge internalization among staff, promising for future healthcare settings.

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ABSTRACT #81 CLINICAL RESEARCH GASTROENTEROLOGY THE GENDER SCOPE: ELEVATING PATIENT COMFORT FOR DIRECT ACCESS PROCEDURES Sonia Mehra1, Lauren Alpert2, Jeanette Rios2, Lina Jandorf3, Zoe Gottlieb3, Tatyana Kushner4, Yuying Luo1

1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn School of

Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Weill Cornell Medicine, New York, NY, United States

Presented at both the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024 and the New York Society for Gastroenterology & Endoscopy (NYSGE) Annual Meeting that was held in New York, New York, United States from December 12-13, 2024.

BACKGROUND: Data on patient preferences for endoscopist gender are conflicting, with few studies investigating the factors contributing to preferences. We aimed to evaluate demographic predictors of endoscopist gender preferences among patients presenting for direct access colonoscopy.

METHODS: In-person, pre-procedure prospective surveys were administered to patients referred for direct access colonoscopies. Participants were notified that their survey responses would not impact their current procedure. Demographic data, including age, race, sex, insurance provider, primary language spoken, and MyChart patient portal access, were collected through chart review. A Chi-square analysis was performed to evaluate the association between variables of interest and patients’ endoscopist gender preference.

RESULTS: Our cohort included 66 patients with a mean age of 53.6 years (SD=9.4). Half (50%) of the participants were female, and the majority (69.7%) were non-white. Of the study participants, 92.4% preferred English as their primary spoken language, 72.7% used commercial health insurance, 75.8% accessed MyChart within the past thirty days, and 63.6% reported that this was their first colonoscopy. Only 3 participants (4.6%) reported being offered a choice of provider gender before their procedure, and 19 (28.8%) participants expressed a gender preference for future procedures. There was a significant difference in preference by patient gender (45.5% women versus 12.1% men, p<0.01), patient age (33.3% <65 years old versus 0% >65 years old, p=0.04), and Asian race (75.0% Asian versus 0% >65 years old, p=0.04), and Asian race (75.0% Asian versus. 25.8% non-Asian, p=0.04). Among those with a preference, there was a significant difference by patient gender, where all females (100%) preferred a female endoscopist versus males (75.0%) preferred a male endoscopist, p<0.01).

There was no significant difference in preference when accounting for insurance type, primary language spoken, first colonoscopy, or MyChart access.

CONCLUSION: In a patient population presenting for direct access colonoscopies, over a quarter of participants expressed gender preference for their endoscopist; however, only three were asked about preference before their procedure. Female gender, younger age (<65 years), and Asian race were associated with expressing a preference, with all female participants preferencing female endoscopists. This is a call to increase femaleidentifying Gastroenterologists' recruitment and proactively ask about patient preferences to improve the overall experience.

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ABSTRACT #82 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE HEALTHCARE PROXY DOCUMENTATION QUALITY IMPROVEMENT INITIATIVE Shruti D. Ramachandra1, Alyson Meyer1, Madeline Reznik1, Aphrodite Megaris1, Lindsey Fox1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

*These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: Healthcare proxy (HCP) documentation is a vital component of advance care planning (ACP) in the inpatient setting, ensuring that medical decisions align with patients' preferences when incapacitated. The American Geriatrics Society emphasizes the importance of identifying a surrogate decisionmaker to prevent patients from becoming unrepresented, particularly in critical care settings where decisions are often value-laden and complex. Studies have shown that proper documentation of an HCP can significantly improve the alignment of hospital care with patient preferences, reducing unwanted interventions and enhancing patient satisfaction. For instance, a study on cancer patients revealed that early ACP discussions and documentation led to better adherence to patient wishes and reduced unnecessary hospitalizations. Similarly, research on homeless individuals demonstrated that those with completed advance directives, including HCPs, were more likely to have their care preferences documented and respected during hospitalizations. The American Thoracic Society and the American College of Critical Care Medicine also underscore the necessity of surrogate decision-makers in ICU settings to ensure that care decisions reflect the patient's values and goals. Overall, healthcare proxy documentation is essential for promoting patient-centered care, reducing medical errors, and ensuring that healthcare providers can make informed decisions that honor the patient's wishes. Our goal is to improve HCP documentation using the advanced care planning tab in EPIC within 72 hours of admission by the Internal Medicine Teaching teams at Mount Sinai Morningside (MSM) and Mount Sinai West (MSW) by 50% over the next 12 months.

METHODS: Our project was deemed a quality project by the Quality Improvement Committee in the Department of Medicine at Mount Sinai Hospital, and thus, an IRB submission was not required. Using the Plan-Do-StudyAct cycle (PDSA) methodology, the authors conducted a chart review of patients admitted to internal medicine teaching teams to identify the percentage of patients with legal HCP documentation uploaded into the system.

Both Mount Sinai Morningside and Mount Sinai West electronic medical record (EMR) data were reviewed.

Among the patients listed, the authors calculated the number of patients who had HCP listed as well as the formal documentation provided in the chart. Interventions implemented in the “Do” portion of the cycle included an educational lecture to PGY-1 internal medicine residents to introduce the concept of healthcare proxies and surrogates, identifying resources to find the HCP forms, and training on how to complete the form and upload them into EPIC EMR. In addition, another HCP documentation and upload training lecture was provided to PGY2 and PGY-3 internal medicine residents. We also provided printed forms for day and night admitting residents in all documentation rooms to improve accessibility. We sent email and short message service (SMS) reminders of the implementation of the HCP initiative every 6-8 weeks. A review of EMR charts will occur bimonthly with email, SMS, and Epic secure chat reminders of team performance reports.

RESULTS: Preliminary data during the plan portion of the PDSA cycle showed an initial documentation rate of 33% at MSM and 18% at MSW within internal medicine teaching teams. Following this collection, the interventions described above were implemented. An audit completed on February 8, 2025, showed the following (Table 1). Our preliminary data show an initial 64% increase in HCP documentation uploaded into the chart by solely our initial measures of text and email blasts to the residency program, as well as lectures given to internal medicine residents of all years.

CONCLUSION: Healthcare proxy documentation is essential for ensuring that medical decisions align with the patient’s preferences and values, particularly when they are unable to make decisions themselves.

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Having residents and interdisciplinary team members such as social workers and case managers participate in health care proxy documentation can significantly increase the number of patients with completed documentation and improve health outcomes. When patients have documented HCPs, future care teams can make medical decisions aligned with their preferences, reducing confusion and unnecessary interventions. By integrating HCP documentation into the workflow of an interdisciplinary team, hospitals, and clinics can ensure that more patients receive the opportunity to make their healthcare wishes known, leading to improved decision-making and overall health outcomes.

Since implementing this initiative, we have already observed an increase in health care proxy documentation rates. With continued engagement from residents and the interdisciplinary team, we aim to achieve at least 50% completion within the next 12 months. This improvement reflects the positive impact of a team-based approach in facilitating advance care planning and ensuring patients’ healthcare preferences are documented and honored.

Site

10/2024- Initial rate of HCP 2/8/25 Audit #1 form upload

MSW

18% -

MSM

33%

Total (avg of medicine teams): 28.6% Team based: Gold: 60% Silver: 50% Purple: 20% Bronze: 0% Orange: 0% Burgundy: 20% Pending Audit

Table 1. Health care proxy documentation rate pre- and post-intervention (audit on February 8, 2025) at each site.

Figure 1. Health care proxy documentation rate pre- and post-intervention.

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ABSTRACT #83 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/HEMATOLOGY/ONCOLOGY NAVIGATING DIAGNOSTIC CHALLENGES: A CASE OF BREAST CANCER MISIDENTIFIED AS MULTIPLE MYELOMA Lance Maresky1*, Jiaxi Miao1*, Olivia Skiro1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

*These primary authors contributed equally to this work.

CASE PRESENTATION: A 55-year-old female without a significant past medical history, who had not seen a primary care physician for over 20 years, presented with a 3-month history of generalized weakness, unintentional weight loss, and diffuse bone pain. In the emergency department, she was noted to be tachycardic around 120-130 beats per minute, confirmed to have sinus tachycardia on EKG. Physical examination was notable for dry mucous membranes, non-focal bilateral lower extremity weakness with 3/5 strength, and mild diffuse abdominal tenderness to palpation. Laboratory workup revealed severe hypercalcemia at 16.7 mg/dL, acute kidney injury evidenced by a creatinine level of 2.7 mg/dL with an unknown baseline, elevated alkaline phosphatase at 671 IU/L, elevated troponin peaking at 288 ng/L, and severe anemia with a hemoglobin level of 7.5 g/dL without a known baseline. Imaging studies revealed significant findings. A chest X-ray showed subacute/chronic right rib deformities and diffuse osteopenia. A CT abdomen and pelvis scan showed vertebral body compression deformities with diffuse lytic lesions throughout the visualized osseous structures at T11, T12, L2, and L5, representing pathological fractures of indeterminate age. Several cysts and small low attenuation lesions were also noted in the liver and kidney, which were too small to characterize. An MRI of the lumbar spine without contrast revealed diffuse osseous metastatic/myelomatous disease without evidence of conus medullaris compression. Hypercalcemia workup showed parathyroid hormone (PTH), vitamin D, and thyroid-stimulating hormone (TSH) all within normal limits, and parathyroid hormone-related protein (PTHrP) <2, suggestive of PTHindependent hypercalcemia. The patient was started on normal saline infusion, calcitonin, and pamidronate.

Over the following days, her acute kidney injury and hypercalcemia both resolved, with serum calcium stabilizing at 12 mg/dL and serum creatinine at approximately 1 mg/dL. The combination of severe hypercalcemia, kidney dysfunction, anemia, lytic bone lesions, and spinal compression fractures raised the suspicion of multiple myeloma. However, serum protein electrophoresis (SPEP), showed no M-spike, and the free kappa/lambda ratio was 1.45. Although the absence of an M-spike can occur in free light chain-only disease, it is unusual to see a near-normal serum free light chain ratio.

Moreover, no monoclonal protein was detected on urine protein electrophoresis (UPEP), and urine immunofixation electrophoresis (IFE) was negative for monoclonal free light chains (Bence Jones Protein). While a definitive diagnosis of multiple myeloma requires a bone marrow biopsy, these studies raised doubts about the initial diagnosis. The presence of liver lesions and small renal lesions also raised concern, as other malignancies could potentially cause lytic bone lesions, hypercalcemia, anemia, and acute kidney injury. Tumor markers CA 19-9, CA-125, and CEA were elevated at 613.1 U/mL, 320 U/mL, and 207.5 ng/mL, respectively. These findings prompted further investigation. An MRI of the abdomen and pelvis was ordered, and interventional radiology was consulted.

During her stay on the medicine floor, despite the gradual resolution of hypercalcemia and acute kidney injury, her sinus tachycardia remained unresolved despite adequate fluid repletion. Transthoracic echocardiography (TTE) showed no signs of cardiac strain; however, she had an elevated high-sensitivity troponin of 236 ng/L, which peaked at 288 ng/L, indicating demand ischemia, and given her high risk for pulmonary embolism, we initiated therapeutic anticoagulation with a heparin drip followed by subcutaneous enoxaparin while awaiting a ventilation/perfusion (V/Q) scan.

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On the second day of therapeutic anticoagulation, the patient noted a slight bloody discharge from her left nipple.

Physical examination revealed an ulcerated lesion involving the areola with bloody drainage on her left nipple.

Nodularity was palpated in both breasts. Upon further inquiry, the patient reported that the ulcerated left breast lesion had been present with ulceration and drainage for about 3 years. These findings raised concern for potential breast malignancy. Further, the MRI of the abdomen revealed a 2.8 cm left breast mass with apparent involvement of the overlying skin surface, suspicious for primary neoplasm, and partially imaged left axillary lymphadenopathy. There were bilobar liver lesions suspicious for metastatic disease, diffuse osseous metastases, bilateral simple renal cysts with no suspicious renal lesions, and small to moderate-sized bilateral pleural effusions with adjacent bibasilar atelectasis. These imaging findings, along with the physical examination, pointed to metastatic breast cancer as the final diagnosis.

Liver biopsy and breast punch biopsy were performed, which revealed metastatic ER+/PR+/HER2+ breast cancer to the liver, bone, and pleural effusions. She was started on Trastuzumab/Pertuzumab followed by anastrozole. She was later re-admitted for weakness and cognitive slowing, with findings suggestive of possible leptomeningeal disease, evidenced by diffuse dural pachymeningeal enhancement on brain MRI. The patient’s family opted to transition to another state for her care, and she was scheduled for follow-up there upon discharge.

Figure 1. Breast appearance on the second day of initiating therapeutic anticoagulation: nodules, plaques, and erythematous patches with center necrosis and hemorrhage, consistent with invasive breast cancer cutaneous changes.

DISCUSSION: Breast cancer is the most frequently diagnosed malignancy among elderly females, characterized by a diverse range of clinical presentations that may contribute to misdiagnosis. This report presents a case of breast cancer that was initially misidentified as multiple myeloma. Clinical features common to both multiple myeloma and breast cancer include anemia, bone pain, and hypercalcemia, particularly in instances where breast cancer has metastasized to bone. Physicians often utilize the acronym "CRAB" to recall the diagnostic criteria for multiple myeloma: hypercalcemia, renal insufficiency, anemia, and bone disease. In this case, the patient exhibited the complete spectrum of "CRAB" symptoms over five months, accompanied by spinal compression fractures evident on imaging. Although multiple myeloma represents only 1-2% of diagnosed malignancies, the pre-test probability associated with "CRAB" symptoms directed clinical attention towards this diagnosis, including input from specialists. However, negative results from additional tests, such as SPEP and UPEP, prompted clinicians to reconsider the diagnosis. Notably, the development of visible skin changes on the breast, which intensified following the initiation of therapeutic anticoagulation, shifted focus to a physical examination area often overlooked in internal medicine settings—breast examinations. This case underscores the critical importance of conducting thorough physical examinations in inpatient environments.

CONCLUSION: This case illustrates how confirmation bias related to classic clinical symptoms can hinder the accurate diagnosis of breast cancer, especially when its features overlap with those of multiple myeloma. It emphasizes the necessity of comprehensive physical examinations in inpatient settings, as the timely recognition of atypical presentations can significantly improve patient outcomes.

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ABSTRACT #84 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE A CASE STUDY OF ACQUIRED HEMOPHILIA A IN A 93-YEAR-OLD FEMALE PRESENTING WITH THIGH HEMATOMA Serene Mirza1, Tharaka Wijesinghe1, Brett Sherman1, Vongai Tizora2, David Fruchter1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 93-year-old female with a history of chronic microvascular ischemia and hypertension presented with four days of worsening right lower extremity pain. She was recently seen in vascular clinic for difficulty walking and associated pain, which was attributed to chronic venous insufficiency despite a negative Doppler ultrasound for peripheral vascular disease. In the emergency department, examination revealed a large hematoma over the right lateral thigh without any reported trauma.

Laboratory studies revealed a hemoglobin of 8.7g/dL (baseline 11-12 g/dL), aPTT>200 seconds, with an INR of 1.3. CT demonstrated edema in the right thigh along the course of the vastus lateralis muscle, with a rimenhancing suprapatellar joint effusion. Hematology was consulted, and the patient received desmopressin and prothrombin complex concentrate. The following day, she developed a second hematoma on her right arm due to compression from a blood pressure cuff. Additional labs revealed normal von Willebrand factor activity and antigen levels, mixing studies that failed to correct the PTT, and low factor VIII activity, leading to a diagnosis of acquired hemophilia A (AHA). The patient was started on immunosuppression with prednisone and prothrombin complex concentrate and repeat factor VIII activity level improved from 2 > 21 on discharge.

DISCUSSION: The AHA effect is a very rare but serious bleeding disorder (affects about 15/1,000,000 in people over 85 years) caused by the development of autoantibodies against factor VIII. A typical presentation involves an elderly patient with spontaneous hematomas, with the hallmark laboratory finding of prolonged PTT that does not correct with mixing studies. In this case, the patient initially presented with nonspecific pain and swelling of the right lower extremity, symptoms that were initially attributed to chronic venous insufficiency despite negative Doppler US until laboratory and CT studies pointed to atraumatic hematoma due to an acquired coagulopathy.

Acquired AHA management typically includes hemostatic therapy for acute bleeding and immunosuppressive therapy to address the underlying autoimmunity.

CONCLUSION: Despite being rare, AHA needs to be on the differential diagnosis due to the high incidence of mortality if it is not rapidly recognized and treated. Without appropriate treatment, life-threatening bleeding can occur in 8-22% of those diagnosed with acquired AHA. Early diagnosis and treatment are critical, and management involves immunosuppressive therapy and monitoring of factor VIII levels and PTT to assess response. Although rare, this diagnosis should be suspected in patients without a history of trauma or an inherited bleeding disorder.

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ABSTRACT #85 CLINICAL RESEARCH CARDIOLOGY VERY HIGH DONOR-DERIVED CELL-FREE DNA LEVELS ARE ASSOCIATED WITH INCREASED MORTALITY RATES IN HEART TRANSPLANT RECIPIENTS Cathrine M. Moeller1,2, Andrea Fernandez Valledor2,3, Daniel Oren2, Adi Hertz2, Anamarija Priscan1, Christopher Musial1, Salwa Rahman2, Boaz Elad2, Julia Baranowska2, Carolyn Ann Hennecken2, Jayant K. Raikhelkar2, Justin A. Fried2, Kevin J. Clerkin2, Kyung T. Oh2, David Bae2, David Majure3, Dor Lotan2, Adil Yunis2, Ersilia M. DeFilippis2, Farhana Latif2, Nir Uriel2, Gabriel T. Sayer2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Columbia University Irving Medical Center, New York, NY, United States; 3Weill Cornell Medical College, New York, NY, United States 2

Presented at the International Society for Heart and Lung Transplantation Conference that was held in Boston, Massachusetts, United States on April 29, 2025.

BACKGROUND/INTRODUCTION: Donor-derived cell-free DNA (dd-cfDNA) is released during allograft injury in transplant recipients. It is a non-invasive blood biomarker widely used by heart transplant (HT) centers in the United States to monitor for allograft rejection. High levels have been linked to adverse outcomes in lung transplant recipients. This study hypothesizes that very high dd-cfDNA levels (>1%) are similarly associated with adverse outcomes in heart transplant recipients.

METHODS: Adult, single-organ heart transplant recipients with dd-cfDNA (AlloSure, CareDx) data from September 2019 to July 2023 were included. Samples were paired with biopsies obtained within one month.

Histological rejection was defined as ISHLT grade >1R/1A and/or pAMR >0. The cohort was stratified into low (<0.20%), high (0.20%-1%), and very high (>1%) dd-cfDNA groups. Gene-expression profiling (GEP) was considered positive if >30 in the first five months post-HT and >34 thereafter. Outcomes included graft dysfunction (LVEF <50%), coronary allograft vasculopathy (CAV), and mortality rates.

RESULTS: A total of 2,385 dd-cfDNA samples from 254 HT patients were included. The very high dd-cfDNA group showed similar rates of prior acute cellular rejection or antibody-mediated rejection (p=0.14 for both), donor-specific antibodies (p=0.25), and graft dysfunction (p=0.40) compared to the high dd-cfDNA group. No significant differences were found in GEP levels (p=0.74) or positivity rates (p=0.87) between the very high and high dd-cfDNA groups. Similarly, there were no significant differences in rejection rates between these groups (8.5% versus 8.3%; p=0.97). Higher dd-cfDNA levels were associated with increased mortality (7.0% versus 3.9% versus 1.2%; log-rank; p<0.001). High dd-cfDNA levels were associated with a threefold increase in mortality risk (HR, 3.53; 95%CI, 1.91-6.51; p<0.001), while very high levels showed a sixfold increase (HR, 6.04; 95%CI, 2.70-13.54; p<0.001) compared to low levels. The median follow-up was 21 months (IQR, 13-31). The rates of graft dysfunction and CAV were similar between groups (p=0.81).

CONCLUSION: Elevated dd-cfDNA levels in heart transplant recipients are associated with a higher mortality risk, with very high dd-cfDNA levels (>1%) linked to a sixfold increase in mortality.

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ABSTRACT #86 CASE REPORT/CLINICAL REVIEW DERMATOLOGY/INFECTIOUS DISEASES/RHEUMATOLOGY REFRACTORY ERYTHEMA NODOSUM LEPROSUM WITH BIOLOGIC FAILURE: EXPLORING NOVEL THERAPIES Nicole Morel1, Yuhong Yang1, Corinna E. Psomadakis1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Erythema nodosum leprosum (ENL) is a severe immunologic complication of lepromatous leprosy that is challenging to manage due to resistance to conventional therapies and significant side effects. ENL is a type 2 reaction associated with both acute and chronic leprosy, irrespective of treatment status.

CASE PRESENTATION: A 40-year-old female with refractory lepromatous leprosy, complicated by severe erythema nodosum leprosum, small vessel vasculitis, avascular necrosis of the hip, and disabling neuropathy, presented with a five-day history of fever (103°F), nausea, and a tender, erythematous nodular skin lesion. She was co-managed as an outpatient by Dermatology, Rheumatology, and Infectious Disease, receiving multi-drug therapy (dapsone, clofazimine, thalidomide), infliximab (IFX) infusions, and low-dose steroids. Laboratory findings included an elevated C-reactive protein (375 mg/L), ferritin (1,603 ng/mL), and white blood cell count (16.7 × 10⁹/L). She received high-dose intravenous steroids (methylprednisolone 40 mg daily for one week), resulting in symptom improvement. The patient declined a biopsy of the lesion and was discharged after two days on a steroid taper regimen with antibiotic prophylaxis for Pneumocystis pneumonia.

Despite initial control of flares on IFX as an outpatient, she experienced recurrent symptoms, prompting Rheumatology consultation. One week after discharge, the patient’s symptoms and inflammatory markers had resolved. IFX therapy was discontinued while on a steroid taper, pending serologic levels and anti-IFX antibody results, and methotrexate and apremilast were considered for future management to reduce steroid dependence.

CONCLUSION: This case illustrates the challenges of managing refractory erythema nodosum leprosum. The patient failed traditional treatments, including thalidomide and corticosteroids, due to adverse effects like axonal neuropathy, avascular necrosis of the hip and immunocompromised state. Anti-TNF-α therapy, such as IFX, has shown success in prior case series, but its failure in this patient highlighted the need for alternative strategies.

Apremilast, a phosphodiesterase-4 inhibitor, has demonstrated promise in two cases of chronic recalcitrant erythema nodosum leprosum, showing significant improvement without adverse effects. Another potential approach, not yet attempted in this case, is cyclophosphamide pulse therapy, which has been reported to reduce flares and aid steroid tapering in recalcitrant cases.

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ABSTRACT #87 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY CHEMOIMMUNOTHERAPY AS TREATMENT FOR PANCREATIC NEUROENDOCRINE CARCINOMA: SURVIVAL OUTCOMES AND IMMUNOGENOMIC ANALYSIS Drew Moss1, Catherine O’Connor2, Zeynep Tarcan2,3, Taehyung Kim2,3, Maria Perry2, Rohit Thumalapalli2,3,4, Olca Basturk2,3, Marsha Reyngold2,3,4, Kevin Soares2,3,4, Geoffrey Ku2,3, Zoe Goldberg2,3, David Kelsen2,3,4, James Harding2,3, Vinod Balachandran2,3,4, Chris Crane2,3,4, Christine Iacobuzio2,3,4, William Jarnagin2,3,4, Nitya Raj2,3,4, Diane Reidy-Lagunes2,3,4, Eileen M. O’Reilly2,3,4,5, Wungki Park2,3,4,5 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Memorial Sloan Kettering Cancer Center, New York, NY, United States; 3Weill Cornell Medical College, New York, NY,

United States; 4David M. Rubenstein Center for Pancreas Cancer Research, New York, NY, United States; 5Parker Institute for Cancer Immunotherapy, New York, NY, United States

Presented at the Society for Immunotherapy of Cancer (SITC) Annual Meeting that was held in Houston, Texas, United States from November 6-10, 2024.

BACKGROUND: Pancreatic neuroendocrine carcinomas (PanNECs) are rare with poor prognosis. Over 70% of cases present as advanced disease and are traditionally treated with platinum plus etoposide, a regimen extrapolated from small cell lung cancer (SCLC). Pivotal SCLC trials (CASPIAN, IMPOWER133) established improved outcomes in patients who received combination chemotherapy/immunotherapy (ChemoIO) over chemotherapy (Chemo); however, there is a limited translation of these findings to PanNEC. We present a retrospective study of patients with PanNEC treated at Memorial Sloan Kettering Cancer Center, including survival and immunogenomic analyses.

METHODS: Institutional databases were queried to identify patients with PanNEC who were treated between 2014 and 2024 at Memorial Sloan Kettering Cancer Center. Mixed histology, predominantly with PanNEC cases included neuroendocrine tumors (NET) or non-pancreas NEC excluded. Tumor-infiltrating lymphocytes (TIL) and Ki67 index were measured. Median progression-free survival (mPFS) and median overall survival (mOS) estimated from commencement of metastatic treatment. Best objective response rate (ORR) was assessed using RECIST V1.1. MSK-IMPACT genomic data, including hotspot mutations, fraction genome altered (FGA), tumor mutation burden (TMB), and whole-genome doubling (WGD+) were analyzed. MSISensor and MiMSI assessed microsatellite status.

RESULTS: 13 patients met the inclusion criteria. Median age at diagnosis was 60 years. 7 were male and 6 were white patients. 10 hadPanNEC only, two had mixed PanNEC/acinar cells, and one hadPanNEC/adenocarcinoma. 8 patients had small-cell type, and five had large-cell type. Median Ki67 was 60% (range, 15-90%). All patients received treatment for metastatic disease; 5 received first-line (1L) ChemoIO with platinum/etoposide plus durvalumab (N=3) or atezolizumab (N=2), and 8 received 1L Chemo with platinum/etoposide. N=5 received ChemoIO/IO in later lines. Median follow-up was 25.2 months (M) (95%CI, 22.7-NR). The mPFS for 1L ChemoIO versus Chemo was 17.3 M (95%CI,11.6-NR) versus 5.8 M (95%CI, 2.0NR, p=0.0099), respectively. The mOS for 1L ChemoIO versus Chemo was 33.6 M (95%CI, 27.1-NR) versus 16.1 M (95%CI, 8.5-NR; p=0.0089), respectively. The ORR was 100% to 1L ChemoIO: 1 CR, 4 PR versus 37.5% in 1L Chemo. 2L+ ChemoIO/IO had 1 SD and 4 PD. Median TMB was 3.7 mutations/megabase. Commonly mutated genes consisted ofTP53 (N=9), RB1 (N=8), and KRAS (N=5). WGD+ was seen in 4 patients. Median FGA was 0.504 (range, 0.015-0.992). All 13 cases were microsatellite stable by MiMSI. CONCLUSIONS: Superior survival outcomes and significant radiographic regressions were observed in patients who received first-line chemoimmunotherapy versus chemotherapy alone in a small single-center cohort of heterogeneous PanNEC. Our study offers evidence to evaluate first-line chemoimmunotherapy in PanNEC. A prospective trial of first-line chemoimmunotherapy in advanced extrapulmonary NECs is ongoing NCT05058651.

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Variable Best Objective Response Rate Complete Response N (%) Partial Response N (%)

1L Chemoimmunotherapy (ChemoIO) Group (N=5) 100% 1 (20%) 4 (80%)

1L Chemotherapy (Chemo) Group (N=8) 37.5% 0 (0%) 3 (37.5%)

Stable Disease N (%)

0 (0%)

3 (37.5%)

Progression of Disease N (%) 0 (0%) Ongoing Therapy N (%) 2 (40%) Median Progression Free Survival on 17.3 M (95%CI, 11.6-NR) First-Line Therapy (95%CI) Median Overall Survival on First-Line 33.6 M (95%CI, 27.1-NR) Therapy (95%CI) Table 1. Patient characteristics and survival analysis.

p-value

2 (25%) 0 (0%) 5.8 M (95%CI, 2.0-NR)

p=0.0099

16.1 M (95%CI, 8.5-NR)

p=0.0089

Figure 1. Kaplan-Meier curves denoting Progression Free Survival (PFS) for patients treated with first-line chemoimmunotherapy versus first-line chemotherapy. The median PFS for the chemoimmunotherapy group was 17.3 months (95%CI, 11.6-NR) versus 5.8 months (95%CI, 2.0-NR) for the chemotherapy group (p=0.0099).

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ABSTRACT #88 CLINICAL RESEARCH CARDIOLOGY SUBCLINICAL ATHEROSCLEROSIS DETECTION: THE IMPORTANCE OF IMAGING IN LOW AND BORDERLINE RISK POPULATIONS Anna Mueller1, Nima Nasibi1, Taraneh Zamani1, Leila Nia1, Edgar Argulian1, Jagat Narula2, Jonathon Leipsic3, Amir Ahmadi1 ¹Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; ²University of the Texas Health, Houston, TX, United States; ³ University of British Columbia, Vancouver, BC, Canada

Presented at the American College of Cardiology (ACC) Annual Meeting that was held in Chicago, Illinois, United States from March 29–31, 2025.

BACKGROUND/INTRODUCTION: ASCVD risk scores are widely used to guide preventive therapies but may underestimate risk in populations with a family history of cardiovascular disease (CVD). This study examines the relationship between ASCVD risk scores and the presence of subclinical atherosclerosis (AS) in patients with a family history of CVD. METHODS: We conducted a retrospective analysis of 1,926 patients with a family history of CVD and no prior coronary artery disease (CAD) who underwent imaging-based screening for AS, including CCTA, CAC score, and carotid ultrasound. Each patient’s ASCVD risk score was calculated to assess atherosclerosis presence.

RESULTS: Among 1,224 low-risk patients, 513 (41.8%) had evidence of AS. In the borderline-risk group, 119 of 172 (69.2%) were similarly affected. In intermediate- and high-risk groups, 16.5% and 7.4%, respectively, showed no AS. Notably, 29% of those recommended for statins based on diabetes and 47% with LDL >190 mg/dL had no detectable AS. CONCLUSION: This study highlights a significant mismatch between ASCVD risk scores and actual atherosclerosis, particularly in low- and borderline-risk individuals—groups often overlooked in routine screening.

Incorporating imaging could substantially impact treatment decisions and improve cardiovascular outcomes. This message differs from current guidelines, which suggest imaging only for intermediate-risk groups, as the impact of early AS findings is higher in low and borderline-risk groups.

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ABSTRACT #89 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/ENDOCRINOLOGY/NEPHROLOGY A RARE CASE OF SPINAL CORD COMPRESSION SECONDARY TO SPINAL BROWN TUMOR IN A MIDDLE-AGED FEMALE WITH END-STAGE RENAL DISEASE ON HEMODIALYSIS Fahema Nadira 1, Tamara Goldberg 1, Lindsey Fox 1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025 and to be presented at the Society of General Internal Medicine (SGIM) Annual Meeting to be held in Hollywood, Florida, United States from May 14-17, 2025.

BACKGROUND/INTRODUCTION: In end-stage renal disease (ESRD), low serum calcium and high serum phosphate levels stimulate PTH secretion (secondary hyperparathyroidism), which can result in a wide array of skeletal abnormalities, including brown tumors. A brown tumor is a benign, locally destructive bone lesion that typically involves the mandible, ribs, pelvis, long bones, and very rarely the spinal cord. A literature review by Tayfun et al. found only 27 cases of spinal brown tumor, with only 5 cases of lumbar spine brown tumor due to secondary hyperparathyroidism. Among the 27 cases, 20 underwent tumor resection, and among said cases, only 8 underwent parathyroidectomy.

Therefore, this case report provides a rare learning opportunity for the clinical course of spinal brown tumor. The symptoms of spinal brown tumor depend on its location. In our patient, her symptoms of weak hip flexion, weak knee extension, sciatica, and sensory changes in the lateral thigh were consistent with radiculopathy at the level of L1. Management of brown tumor mainly involves controlling phosphate levels and in rare cases, parathyroidectomy. In our patient, phosphate levels remained elevated despite restricted dietary phosphorus, high phosphate dialyzer, phosphate binders, vitamin D, oral calcium supplements, and calcimimetics, and she developed a life-threatening spinal squamous cell carcinoma (SCC) warranting an emergent parathyroidectomy.

CASE PRESENTATION: A 47-year-old female with a history of advanced heart failure secondary to peripartum cardiomyopathy, anuric ESRD on hemodialysis with secondary hyperparathyroidism, nodular regenerative hyperplasia of the liver, currently undergoing evaluation for heart/liver/kidney transplant, presented to the emergency room with a two-week history of unremitting lower back pain with progressive bilateral leg weakness.

Her neurological exam was pertinent for 4/5 strength in her right hip flexors and 3/5 strength in her right knee extensors, decreased sensation in the right lateral thigh, and a positive straight leg raise in her right leg. Labs were pertinent for grossly elevated parathyroid hormone (PTH) of 2071pg/mL, hypocalcemia, and hyperphosphatemia. MRI showed severe cord compression (SCC) due to the expansile lytic lesion at the level of L1 and she subsequently underwent emergent tumor resection via decompressive laminectomy.

Histopathology was consistent with brown tumor. Thereafter, she underwent a total parathyroidectomy, and postoperatively, she was managed in the intensive care unit for hungry bone syndrome. She was stabilized and discharged to inpatient rehabilitation.

CONCLUSION: This report presents a case of a middle-aged female with SCC secondary to brown tumor. This case underscores the importance of brown tumor in the differential diagnosis of acute back pain in patients with longstanding secondary hyperparathyroidism in the setting of end-stage renal disease.

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ABSTRACT #90 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/INFECTIOUS DISEASES ERTAPENEM-INDUCED HALLUCINATIONS IN A HEMODIALYSIS PATIENT Natalie Nedley1, Melissa Akselrad1, Changwoong Cho1, Forough Hakimzada1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Ertapenem is a broad-spectrum carbapenem antibiotic, effective against many gram-negative, gram-positive, and anaerobic pathogens including extended spectrum beta-lactamases (ESBL)-producing organisms. It is renally-excreted and is thus dose adjusted in patients with chronic kidney disease. Neurotoxicity is an uncommon but well-known side effect of ertapenem and has been reported with varying presentations. We present a patient with end-stage renal disease who developed hallucinations after ertapenem treatment for a urinary tract infection.

CASE PRESENTATION: A 72-year-old male patient with a past medical history of diabetes mellitus, heart failure with preserved ejection fraction, alcohol-induced liver cirrhosis, end-stage renal disease on hemodialysis, and prostate cancer, treated with radiation complicated by radiation cystitis presented with acute urinary retention secondary to hemorrhagic cystitis. He remained transfusion-dependent throughout hospitalization and eventually underwent bladder embolization with urology. The procedure went without complication; however, it was ineffective, and the patient continued to require intermittent transfusions. His course was complicated by an ESBL-producing Klebsiella pneumoniae and Candida albicans urinary tract infection for which treatment with ertapenem and fluconazole was started. The patient was noted to become increasingly somnolent approximately five days into his antibiotic course and shortly thereafter began to develop visual hallucinations and dysarthria. Neurology was consulted and an altered mental status workup was initiated. CT head showed mild diffuse atrophy but no acute findings. EEG revealed mild diffuse cerebral dysfunction with no epileptiform discharges. Ammonia level was minimally elevated at 30.09 but improved from admission on lactulose and rifaximin. Vitamin B12 was within normal limits. TSH was 9.2 with free T4 of 0.92 and T3<3. Endocrinology was consulted and agreed with the likely diagnosis of euthyroid sick syndrome.

The remainder of the altered mental status workup was unremarkable. Given the patient’s persistent hallucinations and worsening dysphagia, ertapenem was discontinued given its side effect profile including neurotoxicity. Upon discontinuation, the patient was noted to have significant improvement in his mental status with resolution of hallucinations and return to baseline, documented by day 5 off ertapenem. His dysphagia resolved and he was able to tolerate a regular diet without complication.

CONCLUSION: Based on the Naranjo adverse drug reaction (ADS) probability scale, this reaction scored a 5 indicating a probable drug reaction. Given its renal excretion mechanism, toxic effects of ertapenem are frequently seen in patients with renal disease. The FDA suggests a dose adjustment for patients with creatinine clearance less than 30, while the European Medicines Agency (EMA) recommends against use in these patients.

This case, along with other similar documented occurrences demonstrates a need for further investigation into safe dosing of ertapenem in patients with renal dysfunction.

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ABSTRACT #91 CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY ECTOPIC CERVICAL THYMOMA IN A PATIENT DIAGNOSED WITH GRAVES DISEASE: A SYSTEMATIC LITERATURE REVIEW Samuel Nemiroff1, Raymond Chai2, Jun Fan2, Ilana Ramer-Bass1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in the Journal of Clinical Endocrinology and Metabolism, 2023. PMID: 38169312 BACKGROUND/INTRODUCTION: The thymus arises from the third and fourth brachial cleft embryologically, and it ultimately descends to the anterior mediastinum. From this migration process, thymic tissue may deposit anywhere between the neck and the diaphragm. Thymomas are typically benign thymic epithelial neoplasms that can have a similar anatomic distribution, though ectopic thymomas found outside the anterior mediastinum are considerably rarer. Graves’ disease is associated with thymic hyperplasia; however, it is not widely associated with thymic neoplasms. Here, we review 109 cases of ectopic cervical thymoma reported in the literature, highlighting one that is the first to describe a young female patient previously diagnosed with Graves’ disease who was found to have an ectopic cervical thymoma.

CASE PRESENTATION: A 22-year-old woman with a history of Graves’ disease presented with a palpable, right anterior neck mass, which she had first noticed 5 months earlier. The mass was nonpainful, stable in size, and did not affect her breathing, swallowing, or voice. Her Graves’ disease was first diagnosed 11 years prior to presentation, was treated with methimazole for 4 years, then subsequently developed autoimmune hypothyroidism, treated stably with levothyroxine 50 mcg daily. Her family history was notable for hypothyroidism in her mother and unspecified thyroid problems in her paternal grandmother and paternal uncle. Her only symptoms at presentation were fatigue, insomnia, and constipation. She denied any ocular complaints, weakness, or other symptoms that might be consistent with myasthenia gravis.

An ultrasonography examination showed a 2.4 × 1.2 × 2.2-cm mass with heterogeneous echogenicity, just lateral to the right lobe of the thyroid gland and right carotid sheath. Subsequent computed tomography of the neck showed a soft tissue mass suspicious for a pathological lymph node at the level of the lower aspect of the right lobe of the thyroid gland just posterior to the common carotid and internal jugular vessels, which caused mild displacement of the right common carotid artery anteriorly. A biopsy was recommended, and the patient underwent an ultrasound-guided fine-needle aspiration. Cytology showed findings consistent with thymic tissue, with features concerning for thymoma, type B1, and immunophenotyping by flow cytometry found an immature T-cell population with co-expression of CD4 and CD8, partial expression of CD10, and loss of surface CD3 expression. Based on these results, ectopic cervical thymoma was considered, though a thymic carcinoma, Tlymphoblastic leukemia, or lymphoma could not be excluded. A right, deep jugular node dissection was then performed. The mass was measured to be 2.5 × 2.3 × 1.5 cm and was resected en bloc for analysis. Pathology showed the mass to be completely encapsulated with a negative resection margin, consistent with Masaoka stage I. Histologically, the thymic lymphocytes expressed terminal deoxynucleotidyl transferase while thymic epithelial cells expressed AE1/3 and Cam 5.2, both consistent with a World Health Organization histologically staged type B2 thymoma. The patient's postoperative hospital course was without complications. Adjuvant radiotherapy was deferred. The patient has been followed for 1 year following resection without recurrence or adverse events.

CONCLUSION: Despite the association of Graves’ disease with thymic hyperplasia, thymic neoplasm is rare within this population. For Graves’ disease patients in stable euthyroid remission with the persistent or recurrent presence of an anterior neck mass, the extrathyroidal origin of the mass should always be considered, including the exceptional presence of a cervical ectopic thymoma.

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ABSTRACT #92 CASE REPORT/CLINICAL REVIEW PULMONARY DISEASE/CRITICAL CARE BREAKING THE SPELL: A RARE CASE OF PROLONGED BENZODIAZEPINE ELIMINATION Archana Pattupara 1, Destiny Nguyen2, Mrunalini Gaikwad2, Marlis Gnirke3, Silpa Yarra2, Mark K. Su3, Young Lee2, Aniket Sharma4 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York University Langone/Bellevue Hospital Center, New York, NY, United States; 4Mount Sinai Hospital, New York,

NY, United States

Presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Diego, California, United States from May 17-22, 2024.

BACKGROUND/INTRODUCTION: Benzodiazepines remain as the first-line treatment for alcohol withdrawal syndrome. Diazepam is preferred due to its long half-life (around 48 hours) and active metabolites. It islipophilic, and primarily metabolized by liver via the CYP2C19 and CYP3A4 pathways. Here, we describe the case of an elderly patient with persistent obtundation following administration of high dose diazepam for treatment of alcohol withdrawal syndrome which was reversed with flumazenil.

CASE PRESENTATION: A 67-year-old male with past medical history of alcohol use disorder presented to the hospital for one day of severe agitation, confusion, and emesis. He was hypertensive and tachycardic with exam notable for disorientation and tremor. Basic labs, CT scan of the brain, and lumbar puncture were unremarkable.

He was treated for presumed severe alcohol withdrawal syndrome with escalating doses of intravenous benzodiazepines and barbiturates, receiving a cumulative dose of 660 mg of intravenous diazepam and 130 mg of phenobarbital in the next 27 hours. His alcohol withdrawal syndrome symptoms improved but he remained obtunded. Extensive work-up including laboratory studies, MRI brain, and video EEG demonstrated no significant abnormalities to explain his encephalopathy leading to a decision of DNR/DNI and plan for comfort focused care.

Twenty-two days after last diazepam administration, a trial of intravenous flumazenil was given. He immediately woke up and followed commands. In consultation with the regional poison center, a daytime flumazenil infusion was initiated to allow physical therapy and family interaction until he regained spontaneous alertness 15 days later. He later developed transaminitis and new radiographic evidence of cirrhosis, not present on admission.

Serial concentrations of diazepam and nordiazepam were obtained and apparent elimination half-lives were calculated to be 124 and 156 hours, respectively. Genetic testing revealed normal CYP 3A4 and 2C19 activity.

The patient was eventually discharged home after a three-month hospital course.

DISCUSSION/CONCLUSION: This patient’s persistent encephalopathy was likely due to the prolonged elimination of diazepam. Cirrhosis and age are known to prolong diazepam elimination. Despite normal enzyme activity of CYP2C19 and CYP3A4, it may have been impaired due to cirrhosis even though it was not present on admission. In our review of the literature, there have been no reported cases of using flumazenil for persistent encephalopathy weeks after the last dose of diazepam. This case emphasizes the need to be judicious with high dose benzodiazepine administration in elderly patients and/or at risk for cirrhosis and encourages providers to consider flumazenil as a reversal agent once alternate diagnoses are excluded.

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ABSTRACT #93 CLINICAL RESEARCH GASTROENTEROLOGY CONFIRMING THE CONCORDANCE OF LA GRADE B ESOPHAGITIS WITH GASTROESOPHAGEAL REFLUX DISEASE ON REFLUX QUANTIFICATION TESTING Soha Noorani1, Rama Hussein1, Yuying Luo1, Daniela Jodorkovsky1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

INTRODUCTION: The Lyon Consensus 2.0 included the diagnosis of LA Grade B as actionable, suggesting that an endoscopic diagnosis alone was sufficient for management without the need for quantitative reflux testing.

However, given that symptoms of gastroesophageal reflux disease (GERD) may overlap with other esophageal disorders of the gut-brain interaction, reflux quantification can help elucidate distinctions.

METHODS: A retrospective analysis was performed of consecutive patients between October 2022 and September 2023 who had both evidence of LA Grade B esophagitis on esophagogastroduodenoscopy (EGD) and subsequent quantitative reflux testing (24-hour impedance monitoring and 48-hour wireless pH testing).

Outcomes included the identification of test factors aligning with positive pH study, including measurements of acid exposure time (AET), total number of reflux events, symptom index (SI), and symptoms association probability. Results: Of the 169 patients with LA Grade B esophagitis on EGD (n=80 female, average age 55 years +/- 15.9 years), 14 patients (8.2%) underwent subsequent reflux quantification testing off acid-suppressive medications (Table 1). There were no significant differences in mean age, sex, or smoking history between the patients who underwent reflux monitoring versus those who did not (n=155). Twelve patients (85%) had wireless pH monitoring, while 2 (14%) had 24-hour impedance monitoring. 85.7% had a total AET score >6%, and 100% had an AET>5%. Most patients (71%) had more than 80 total reflux events. 85% had positive symptom correlation defined as SI≥50%, and 64% had a symptoms association probability ≥95%. 71% of patients were recommended a change in therapy following testing, including medication escalation (50%) and referral for antireflux surgery (21%).

CONCLUSION: In our cohort, there was a positive concordance between quantitative reflux testing and the presence of LA grade B on endoscopy. This study supports the concept of LA grade B as “actionable” reflux.

Future studies with larger sample sizes could provide deeper insight as to the utility of EGD alone without quantitative reflux monitoring when referring to more invasive treatment options, such as surgery in patients with LA Grade B esophagitis.

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Table 1. Treatment recommendations for patients diagnosed with LA Grade B esophagitis and GERD *Symptom index (SI) measures included heartburn, chest, cough, regurgitation, and belch. Considered positive if at least one SI value was 50% or greater. +Symptom Association Probability (SAP) measures included heartburn, chest, cough, regurgitation, and belch.

Considered positive if at least one SAP value was 95% or greater.

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ABSTRACT #94 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/NEPHROLOGY A NOVEL CASE OF IGA NEPHROPATHY AND TUBULOINTERSTITIAL NEPHRITIS IN PATIENTS WITH CROHN’S DISEASE TREATED WITH ADALIMUMAB – WHAT IS THE CULPRIT? Shota Obata1 and Martine Pollack-Zollman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Nephrology Annual Meeting that was held in San Diego, California, United States from October 23-27, 2024.

BACKGROUND/INTRODUCTION: IgA nephropathy (IgAN) is associated with Crohn's disease and the use of tumor necrosis factor-alpha inhibitor (TNF-αi). Tubulointerstitial nephritis (TIN) is noted as an extra-intestinal manifestation of Crohn’s disease but also reported to be caused by the use of TNF-αi. Thus, it is challenging to underpin the culprit of IgAN and TIN among patients with Crohn’s disease treated with TNF-αi. We present a case of IgAN concomitant with TIN in a patient with Crohn’s disease on adalimumab, a TNF- αi.

CASE PRESENTATION: A 21-year-old man with a history of Crohn’s disease treated with adalimumab for six years presented with a sore throat, fever, gross hematuria, and acute kidney injury (Cr 3.0 mg/dL from 0.8 mg/dL). Urinalysis revealed numerous WBCs and RBCs, rare eosinophils, negative leukocyte esterase and nitrite, and a urine protein-creatinine ratio of 3.74 g/gCr. Kidney ultrasound showed normal size and echogenicity without hydronephrosis. Immunologic and infectious workups were negative. After hydration, creatinine improved to 1.8 mg/dL on discharge. He was referred for kidney biopsy, which revealed IgAN and acute tubular necrosis with acute and chronic interstitial nephritis. Adalimumab was switched to Skyrizi, an interleukin-23 (IL-23) antagonist, and losartan and prednisone 40 mg were initiated. At the last follow-up, his creatinine improved to 1.32 mg/dL with mild proteinuria of 0.251 g/gCr while on a slow prednisone taper.

CONCLUSION: It is challenging to determine whether Crohn’s disease or TNF-αi induces IgAN and TIN. In our case, extra-intestinal manifestation is unlikely to develop given the remission of Crohn’s disease. Thus, TNF-αi was switched to IL-23 antagonists in addition to administration of steroids, resulting in improved renal function and resolution of proteinuria. The mechanism of action how TNF-αi causes IgAN and TIN is unknown but may be due to an underlying predisposition to defective IgA1 structure along with altered immune regulation, autodrug and antibody formation, and/or molecular mimicry, which together leads to immune-complex deposits in the glomeruli. Whether this is a TNF-αi class effect or specific to adalimumab needs to be determined along with the possibility of future research to determine who is at risk. It is important for Gastroenterologists treating patients with Crohn’s disease to be aware of this risk, check baseline creatinine and urinalysis, and perform regular monitoring.

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ABSTRACT #95 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES FATAL AEROCOCCUS URINAE ENDOCARDITIS IN A YOUNG PATIENT WITHOUT RISK FACTORS Benita Panigrahi1, Sean Liu2, Lance Maresky1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

INTRODUCTION: Aerococcus urinae is a catalase-negative, gram-positive cocci typically associated with urinary tract infections. While confused for Viridens group streptococcus in the past, improvements in diagnostic technology have more precisely identified the Aerococcus as one of the top three emerging auropathogens, occurring in 15-20% of urinary tract infections. Virulence is associated with the pathogen's ability to develop biofilms and activate platelet aggregation. In many cases, infections can result in bacteremia and endocarditis.

Risk factors for invasive A. urinae infection include male gender, age over sixty-five years, and pre-existing urinary tract pathology.

CASE PRESENTATION: A 35-year-old male with a history of non-verbal autism presented to the emergency department with a five-day history of fever, dyspnea, and left shoulder pain. At the onset of symptoms, the patient initially presented to his primary care physician at the onset of symptoms for which he was given oral antibiotics.

However, the patient continued to have fevers and was not at his baseline mental status.

On presentation, the patient was febrile to 102.2F, tachycardic to 140bpm in SVT, tachypneic to 28/min, and hypoxic with a new oxygen requirement. On physical exam, the patient had increased work of breathing, without redness or tenderness around the left shoulder joint, or suprapubic tenderness. Initial laboratory analysis demonstrated WBC 27.5x103/µL with left shift, erythrocyte sedimentation rate >120sec, C-reactive protein 163mg/L, lactate 3.6mmol/L, creatinine 0.7mg/dL, INR 2.8, elevated transaminases (AST 157U/L, ALT 86U/L, GGT 90). High-sensitivity troponin 85 and pro-BNP 12412 were elevated, and the CTA chest demonstrated new segmental and subsegmental emboli in the right lower lobe without right heart strain. The patient was started on therapeutic enoxaparin for intermediate low-risk pulmonary embolism. Infectious workup included a turbid urinalysis positive for leukocyte esterase with many white and red blood cells and was treated for urosepsis.

Blood cultures initially obtained in the emergency department grew gram-positive cocci in approximately eighteen hours. The bacterium was identified as pan-sensitive Aerococcus urinae that grew from 4 blood culture bottles.

Notably, urine cultures showed no growth despite positive urine analysis. Despite broad-spectrum coverage with Vancomycin and Cefepime, the patient continued to have leukocytosis of 16 x103/µL. Overnight on the third day of admission, the patient became tachycardic to 110bpm with a new left bundle branch block on EKG, but a normal troponin level of 18. Tachycardia continued into mid-morning when the patient developed increased work of breathing and heart rate suddenly dropped to 50s-60s w/EKG showing complete AV dissociation. The patient was transferred to the cardiac intensive care unit, where a transvenous pacer was placed for heart block, and the patient was intubated for persistent tachypnea.

Once stabilized, the patient was sent for a stat transthoracic echocardiogram that demonstrated aortic valve vegetation and severe aortic insufficiency. Over the next few hours, hemodynamic stability deteriorated, necessitating maximum vasopressor support and the patient developed worsening shock (lactate 12). The patient developed anuric kidney injury (creatinine 2.7mg/dL) with electrolyte derangements (K 6.2mEq/L, pH 7.12, Anion Gap 21) for which CVVH was initiated. At the start of CVVH, the patient was unable to maintain blood pressure and then went into PEA arrest. After ROSC was achieved, pupils were noted to be discordant, consistent with embolic stroke. Shortly after, the patient had another cardiac arrest, at which time the family opted to withdraw care.

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DISCUSSION/CONCLUSION: Aeroccocus urinae is a gram-positive bacteria that can cause invasive infection including bacteremia and infective endocarditis in patients who are elderly or have pre-existing urinary pathology such as BPH, ureteral strictures, stents, or malignancy. However, the presented case involves a patient who was unusually young and without any pre-existing disease. Interestingly, despite growing Aerococcus in the blood culture, the organism did not grow in the urine culture, consistent with previous case reports. This patient presented with the typical constellation of fever, malaise, dyspnea, and septic shock, for endocarditis in any pathogens. Complete heart block is a known but rare complication of infective endocarditis; thus, once this is noted on EKG urgent transthoracic echocardiogram is warranted to confirm the diagnosis. Although Aerococcus is not one of the most common organisms that cause infective endocarditis, when a patient develops bacteremia, it is highly likely to result in infective endocarditis. Thus, there should be a low index of suspicion to get an echocardiogram to rule out vegetation, which most commonly occurs on the aortic or mitral valves. While Vancomycin or Meropenem are acceptable options for the treatment of gram-positive bacteremia, case reports describe the use of a prolonged course of beta-lactams with aminoglycosides for synergistic effect as the optimal treatment of Aerococcus urinae infective endocarditis, or without surgical therapy as appropriate.

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ABSTRACT #96 BASIC SCIENCE HEMATOLOGY/ONCOLOGY CIRCULATING TUMOR DNA MUTATIONS AS MARKERS FOR BRAIN METASTASES AT DIAGNOSIS AND DURING TREATMENT Rodrigo Paredes de la Fuente1, Toshiro Goto2, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine

at Mount Sinai, New York, NY, United States; 3Ohio State University Comprehensive Center, Columbus, OH, United States

Presented at the International Association for the Study of Lung Cancer (IASLC) Annual Meeting was held in San Diego, California, United States from September 7-10, 2024.

BACKGROUND: Brain metastasis is a common complication in non-small cell lung cancer (NSCLC), often associated with distinct genetic patterns. Although next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has been used as an early diagnostic tool for brain metastasis, it is still invasive. Circulating tumor DNA (ctDNA) has been utilized to predict brain metastasis in various diseases. Our aim was to evaluate ctDNA at diagnosis and throughout the disease course to identify potential predictive markers for brain metastasis in NSCLC. METHODS: We conducted a retrospective study from January 2018 to March 2024, including 607 NSCLC patients confirmed by tissue biopsy and imaging. Guardant360 reports were used to assess genomic profiles.

Associations were analyzed using the chi-squared test, and logistic regression evaluated odds ratios (OR).

RESULTS: Patients were stratified based on those with an initial liquid biopsy before treatment (n=438). Of these, 88 (20%) had brain metastases at diagnosis. ctDNA revealed that EGFR (n=34/117, p=0.00864), MET (including exon 14 skipping mutation) (n=24/82, p=0.037), and KRAS (n=17/47, p=0.007) mutations were significantly associated with brain metastases. These mutations increased the odds of brain metastases: EGFR (OR, 2.02; p=0.005), MET (OR, 1.86; p=0.023), and KRAS (OR, 2.4; p=0.009). Additionally we calculated the Sensitivity (SN), specificity (SP), positive predictive value, and negative predictive value of each mutation, which were as follows: EGFR (SN=38.2%, SP=76.3%, PPV=29.1%, NPV=82.9%), MET (SN=25.0%, SP=84.6%, PPV=29.3%, NPV=81.6%), and KRAS (SN=20.7%, SP=90.7%, PPV=36.2%, NPV=81.8%).

Patients with at least double mutations (n=13/37) had a significant association (p=0.0007) with brain metastases at diagnosis, with higher odds (OR, 4.07; p=0.0005) compared to patients without these mutations. SN and SP for predicting brain metastases with double mutations were 31.7% and 89.4%, respectively, with PPV and NPV of 35.1% and 87.9%.

In patients without brain metastases at diagnosis (n=144), 26 developed brain metastases after treatment. EGFR mutation was associated with later brain metastases (n=16/41, p=0.033; OR, 2.79, p=0.021).

CONCLUSION: ctDNA can serve as a predictive tool for brain metastases in NSCLC, as evidenced by its association with specific mutations. Additionally, it can dynamically assess the risk of brain metastases during treatment, highlighting its potential utility in clinical practice.

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ABSTRACT #97 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE ASSESSING THE IMPACT OF RADIOLOGIC EMPHYSEMA REPORTING ON FOLLOW-UP COMPLIANCE FOR INCIDENTAL LUNG NODULES: IMPLICATIONS FOR MALIGNANCY DETECTION Aesha Patel1, Oluwatumilara Akeke1, Junyu Qi1, Alvin Yang1, Nicolette Lam1, Sasha Adler1, Victor Wang1, Steven Lim1, Javier Zulueta1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 17-22, 2025.

BACKGROUND/INTRODUCTION: Lung cancer, the leading cause of cancer-related mortality globally, poses significant challenges in prevention and treatment due to its often-delayed detection. CT-detected emphysema is an independent predictor of lung cancer risk, regardless of disease severity, with about 50% of patients with emphysema also having lung nodules. This study aims to assess whether the presence of emphysema in radiology reports is associated with higher successful follow-up rates for incidental lung nodules.

METHODS: Using natural language processing we conducted a multi-center retrospective analysis of patients with incidental lung nodules reported by radiologists within the Mount Sinai Health System from January 1, 2022 to June 30, 2022. Patients with active cancer, missing follow-up recommendations, or old/stable/calcified nodules were excluded. Patients were categorized based on emphysema documentation, and data on demographics, smoking status, and nodule sizes were collected.

RESULTS: Of 1,340 patients, 773 (57.64%) were female. Emphysema status was documented for 415 patients (30.95%), with emphysema present in 260 patients (19.40%), absent in 155 (11.57%), and unreported in 925 patients (69.05%). Patients with emphysema were compared to those without a report of emphysema (no emphysema or not reported). Controlling for insurance and translator needs, reported emphysema status increased follow-up odds by 74.70% (95%CI, 1.32-2.31) compared to those without a report. Translator need does not independently affect the likelihood of follow-up. There was a higher proportion of lung cancer diagnoses [13 (5.00%) versus 33 (3.06%); p=0.18] and mortalities [11 (4.23%) versus 33 (3.05%); p=0.45] in patients with emphysema compared to those without, although the differences were not statistically significant.

CONCLUSION: Effective incidental lung nodules management is critical to enhance early lung cancer detection.

Our results show that radiologically documented emphysema leads to a higher rate of follow-up for incidental lung nodules, possibly due to previously established outpatient care. This not only facilitates earlier cancer detection but also aids in early identification of at-risk individuals. A limitation of this study is the assumption that patients without a reported emphysema diagnosis on a radiology report do not have the condition. Further studies are needed to determine if reporting the presence of emphysema has an impact on the diagnosis of cancer, and if established follow-up contributes to identifying malignancies earlier.

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ABSTRACT #98 CLINICAL RESEARCH GASTROENTEROLOGY/GENERAL INTERNAL MEDICINE/HEMATOLOGY/ONCOLOGY UNDERSTANDING LONG-TERM CANCER RISKS: OUTCOMES OF POSITIVE STOOL DNA TESTS WITH NEGATIVE COLONOSCOPIES Swati Patel1, Jin Woo Yoo2, Mark A. Schattner2, Arnold J. Markowitz2, Robin B. Mendelsohn2 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Memorial Sloan Kettering Cancer Center, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: A concern of multitarget stool DNA (mt-sDNA) test for colorectal cancer screening has been the unknown significance of a positive test with subsequent negative diagnostic colonoscopy for advanced colorectal neoplasia. Such discordant results can be particularly unsettling for patients with cancer history given the theoretical possibility of excretion of abnormal DNA markers into the aerodigestive tract by extra-colonic neoplasms. We aimed to describe long-term oncologic outcomes associated with positive mt-sDNA test and negative diagnostic colonoscopy in patients with non-colorectal cancer history.

METHODS: We performed a retrospective cohort study of patients with a history of non-colorectal cancer and positive mt-sDNA test (Cologuard®, Exact Sciences) who had a negative diagnostic colonoscopy for advanced colorectal neoplasia at Memorial Sloan Kettering Cancer Center from August 2014 to May 2024, with a minimum length of follow-up of 180 days. Outcomes included interval development of cancer (new disease) with or without aerodigestive tract involvement.

RESULTS: We identified 65 patients who met the study criteria, of whom 14 patients (23%) developed new disease in the form of either de novo cancer or recurrence of prior cancer. Of the 14 patients with a new disease, 13 patients (98%) had primary or metastatic involvement of the aerodigestive tract, including 6 patients with de novo cancer, 4 patients with recurrence of prior cancer, and 3 patients had progression of prior disease. Of the patients who developed de novo cancer involving the aerodigestive tract, 3 patients were diagnosed with aerodigestive tract cancer on combined upper endoscopy at the time of diagnostic colonoscopy. Median length of follow-up was 31 months (range, 4-98 months). The median time gap from negative diagnostic colonoscopy to new disease was 16 months (range, 0-57 months).

CONCLUSION: Data from this long-term oncologic follow-up of patients with history a of non-colorectal cancer and positive mt-sDNA test with negative diagnostic colonoscopy demonstrate a considerably high rate of observed de novo or recurrent cancer, mostly involving the aerodigestive tract. While limited by retrospective study design and single institution experience, these results suggest a potential need for additional clinical evaluation in such patients with non-colorectal cancer history.

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Table 1. Baseline Patient Characteristics

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ABSTRACT #99 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/NEPHROLOGY POSTPARTUM THROMBOTIC MICROANGIOPATHY: HELLP, TTP, OR AHUS? Anamarija Priscan1 and Martin Sedlacek1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a medical emergency caused by hereditary or immune-mediated severe ADAMTS13 deficiency, leading to thrombotic microangiopathy (TMA). Immune TTP is commonly seen in pregnancy and may be misdiagnosed as preeclampsia with severe features or hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome. Hemolytic uremic syndrome (HUS) presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI), typically due to Shiga toxin-producing E. coli. Complement-mediated TMA (CM-TMA) known as atypical HUS (aHUS), results from complement dysregulation and is treated with anti-complement therapy such as eculizumab.

CASE PRESENTATION: A 26-year-old G2P2 female with mosaic Turner syndrome and chronic hypertension in pregnancy presented after a normal vaginal delivery complicated by postpartum hemorrhage due to uterine atony and retained placenta. Hemodynamically stable with unremarkable physical exam, she was treated for disseminated intravascular coagulation. Her blood pressure later increased to 180/95, with findings of hemolysis, transaminitis, thrombocytopenia, and non-oliguric AKI, raising concerns for HELLP syndrome or preeclampsia with severe features, prompting magnesium sulfate administration. However, her renal function continued to worsen, with severe thrombocytopenia and hemolytic anemia with schistocytes, inconsistent with HELLP/preeclampsia.

A PLASMIC score of 6, negative ANA, anti-dsDNA, normal C3 and C4, and a history of non-bloody watery diarrhea two days before delivery broadened the differential diagnosis to TTP, HUS and aHUS, including CMTMA. While awaiting ADAMTS13 activity and aHUS testing, she was started on prednisone, plasmapheresis (PLEX) and eculizumab. Ten days postpartum, her condition began improving. ADAMTS13 activity was 68%, ruling out thrombotoic thrombocytopenic purpura.

Steroids and PLEX were discontinued, while eculizumab was continued pending aHUS testing results.

CONCLUSION: During the postpartum period, distinguishing HELLP, preeclampsia with severe features, SLE flare, HUS, and CM-TMA from TTP may be difficult due to similar clinical presentations and laboratory findings.

Contrary to HELLP and preeclampsia with severe features, delivery does not resolve HUS, CM-TMA (aHUS), SLE flare or TTP. This necessitates timely diagnosis and urgent initiation of treatment in cases of high suspicion (e.g. high PLASMIC score for TTP or renal failure) without waiting for either ADAMTS13 or aHUS test results.

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ABSTRACT #100 CLINICAL RESEARCH GASTROENTEROLOGY REAL-WORLD EFFECTIVENESS OF UPADACITINIB FOR PERIANAL CROHN’S DISEASE: A MULTI-CENTER RETROSPECTIVE STUDY Jalpa Devi1, Baseer Quraishi2, Bharati Dev2, Meredith Kline3, Fnu Jaiprada1, Katherine Huang1, Abdul Khan4, Sami Alanazi5, Alyssa Anita Seeraj5, Laura Maas6, Arpita Jajoo6, Navreet Chowla7, Molly stone8, Tingyi Tan1, Anish Patel9, Anthony Xu10, Richa Shukla10, Shrinivas Bishu8, Amanda M. Johnson7, Alyssa Parian6, Andres J Yarur4, Jeffery McCurdy5, Benjamin D McDonald3, Serre-Yu Wong2, Parakkal Deepak1 1Washington University School of Medicine in St. Louis, Saint Louis, MO, United States; 2Mount Sinai Morningside-West

Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, United States; 4Cedars-Sinai Medical Center, Los Angeles, CA, United States; 5University of Ottawa, Ottawa, Ontario, Canada; 6Johns Hopkins University, Baltimore, MD, United States; 7Mayo Clinic, Rochester, MN, United States; 8University of Michigan, Ann Arbor, MI, United States; 9Brooke Army Medical Center, San Antonio, TX, United States; 10Baylor College of Medicine, Houston, TX, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

BACKGROUND/INTRODUCTION: There is limited data on the clinical effectiveness of upadacitinib, an oral selective inhibitor of Janus kinase 1 (JAKi), in patients with perianal Crohn's disease. The objective of this study was to evaluate the real-world effectiveness of upadacitinib in perianal Crohn’s disease.

METHODS: This retrospective analysis utilized data on adults (>17 years) who initiated upadacitinib at 45 mg/day for active perianal Crohn’s disease across 10 centers in the United States and Canada. The primary outcome was clinical response, defined as a ≥3-point reduction in Perianal Disease Activity Index (PDAI) between baseline and follow-up. Secondary outcomes included normalization of CRP (<5 mg/L) or hsCRP (<1 mg/L), clinical remission (PDAI ≤4), and rates of hospitalization, antibiotic use, corticosteroid initiation, new perianal Crohn’s disease-related surgeries and fistula healing on MRI pelvis fistula protocol (defined as an absence of T2-weighted hyperintensity or where contrast is used, post-contrast enhancement on T1-weighted images). Predictive analyses used Cox proportional hazards models to evaluate baseline factors influencing time to PDAI response, including BMI, CRP, albumin, perianal Crohn’s disease duration, Montreal location, and prior biologic exposure (<2 versus 2+).

RESULTS: A total of 90 patients were treated with upadacitinib for perianal Crohn’s disease (median age 33 years and 54.4% male). Most (62.3%) presented with complex fistulas. Of these, 88.9% had prior anti-TNF exposure, and 73.4% had prior exposure to ≥2 biologics (Table 1). During a median follow-up of 2 months, clinical response (PDAI) was achieved in 25.6%. Improvement was observed in pain and restriction of activities (31.1%), restriction of sexual activity (17.8%), reduction in number of fistulas (11.1%), degree of induration (20%), and discharge (33.3%). A total of 17.8% of patients achieved a ≥50% reduction in CRP. MRI healing was limited to 23.6% (9/38). Proctitis on MRI decreased from 33.3% at baseline to 7.8% at follow-up. During follow-up, 8.9% of patients experienced hospitalizations, while 16.7% required antibiotics. Additionally, 7.8% underwent examination under anesthesia, 5.6% underwent seton placement, and 6.7% underwent abscess drainage.

Longer disease duration (>2 years) was associated with a trend of lower clinical response (22% versus 28.1%, p=0.602) and MRI healing (7.8% versus 13.1%, p=0.7). Clinical response rates across Montreal disease locations were numerically highest in those in terminal ileum (L1, 44.4% p=0.543). For biologic exposure, response rates were numerically lower in those exposed to 3 or more biologics compared to 0–2 biologics (23.5%

177

versus 33.3%, p=0.42). Survival analysis (Figure 1) showed no significant impact of biologic exposure (HR, 0.82; p=0.666) or Montreal disease location (p=0.90) on clinical response.

DISCUSSION/CONCLUSION: Upadacitinib in a real-world cohort is effective in patients with treatmentrefractory perianal Crohn’s disease. Randomized trials are needed to confirm these observations.

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Variable Age, at induction in years (mean ± SD) Follow up in months (n), median (IQR) Male Sex, n (%) Race/Ethnicity, n (%) White Black or African American Asian Hispanic or Latino Unclear Disease duration in years prior to starting UPA (n=), median (IQR) Montreal Classification (Location), n (%) Terminal Ileum (L1) Colon Only (L2) Ileocolonic (L3) Not specified Montreal Classification (Behavior), n (%) Nonstricturing, nonpenetrating (B1) Stricturing without penetrating disease (B2) Penetrating disease (B3) Not specified Perianal Class (AGA classification) Simple Complex Not specified History of prior bowel surgery, n (%) Perianal Disease Type, n (%) * - Prominent Skin Tag - Anal Fissure - Anal Stricture - Perianal Fistula - Rectovaginal Fistula - Anoscrotal Fistula - Perianal abscess History of Perianal Surgery, n (%) Prior biologic/small molecule exposure, n (%) - Anti-TNF (Infliximab, Adalimumab, Golimumab) - Vedolizumab - Ustekinumab - Tofacitinib - Risankizumab Number of advanced therapies 0, n (%) 1, n (%) 2+, n (%) Concurrent immunomodulator usage, n (%) Concurrent corticosteroid usage, n (%) Baseline CRP, mg/L (mean ± SD)

Upadacitinib (n=90) 33.00 [27.00, 45.00] 2.00 [1.00, 4.00] 49 (54.4) 50 (55.6) 13 (14.4) 2 (2.2) 3 (3.3) 22 (24.4) 12.64 [5.02, 19.52] 10 (11.1) 21 (23.3) 58 (64.4) 1 (1.1) 39 (43.3) 16 (17.8) 33 (36.7) 2 (2.2) 23, (37.7%) 38, (62.3%) 29 (32.2%) 49 (54.4) 17 (18.9) 23 (25.6) 12 (13.3) 76 (84.4) 6 (6.7) 1 (1.1) 46 (51.1) 67 (74.4) 80 (88.9) 25 (27.8) 47 (52.2) 1 (1.1) 7 (7.8) 7 (7.8) 17 (18.9) 66 (73.4) 1 (1.1) 19 (21.1) 3.75 [1.50, 15.75]

Table 1. Baseline characteristics of patients initiated on upadacitinib for perianal Crohn's disease.

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Figure 1. Survival Analysis curves for time to PDAl remission by Prior Biologic exposure status and Montreal disease location.

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ABSTRACT #101 CASE REPORT PULMONARY/CRITICAL CARE UNLATCH FROM MYCOBACTERIUM AVIUM COMPLEX: ISOLATED ENDOBRONCHIAL TELANGIECTASIAS AS A RARE CAUSE OF HEMOPTYSIS Shruti Ramachandra1, Steven Lim1, Avinash Singh1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians Annual Meeting held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Pulmonary arteriovenous malformations (pAVMs), are anomalous vascular structures formed between pulmonary arteries and veins that can occur anywhere in the lungs but primarily in the lower lobes. They bypass the pulmonary capillary bed and due to a right-to-left shunt can cause hypoxemia, strokes, and brain abscesses. Approximately 90% of pAVMs are attributed to hereditary hemorrhagic telangiectasia (HHT) but can also be caused by trauma, infection, or hepatopulmonary syndrome. pAVMs vary in severity from large or multiple pAVMs to microvascular pAVMs, such as endobronchial telangiectasias. Most commonly, large pAVMs cause asymptomatic hypoxemia, including orthodeoxia, hemoptysis, or hemothorax.

Endobronchial telangiectasias usually present as hemoptysis and are often associated with other autoimmune disorders, such as scleroderma. The following case describes a patient presenting with hemoptysis initially attributed to Mycobacterium avium complex (MAC) infection but found to likely be secondary to isolated endobronchial telangiectasias.

CASE PRESENTATION: A 74-year-old woman on warfarin for atrial fibrillation, and right appendage thrombus, was admitted for non-massive hemoptysis. Admission prothrombin time was 24.1s, with an international normalized ratio (INR) of 2.2. Platelet count was 131 x 10^3/Ul. Medication review noted no antiplatelet agents.

On chart review she was admitted to another hospital two years prior for hemoptysis, and elevated INR from coumadin. CT pulmonary angiogram (CTPA) at that time noted no pulmonary AVMs, bronchiectasis, or cavity.

Sputum culture was positive for MAC, which was not treated. CTPA this admission noted no pulmonary embolism. There were multiple sub-centimeter lung nodules in the right middle and upper lobes, without airspace opacities or bronchiectasis. Bronchoscopy demonstrated numerous flat, red, nonbleeding areas of superficial vessels consistent with endobronchial telangiectasia throughout the tracheobronchial tree. Bronchioloalveolar lavage (BAL) noted no active hemorrhage. BAL culture was smear-negative and grew MAC at 5 weeks of incubation. Given recurrent hemoptysis, decision was made to discontinue warfarin, and a left atrial appendage occlusion device was placed, with resolution of hemoptysis. Pulmonary MAC treatment and evaluation of HHT were planned as outpatient, but she was lost to follow-up.

CONCLUSION: This case illustrates the importance of keeping a broad differential in cases of hemoptysis. CT imaging can help identify etiology, and bronchoscopy may be indicated in cases where CT findings are indeterminate. Nontuberculous mycobacteria (NTM) associated endobronchial lesions such as polyps or ulcerations can lead to hemoptysis but are rare, and to date, no reports of telangiectasia from NTM have been described. Additionally, CT imaging did not identify any alternate etiology of hemoptysis. Vascular malformations contribute to approximately 0.2% of cases with hemoptysis. Incidence of isolated endobronchial telangiectasia is rare, and only described in case reports. Endobronchial telangiectasias specifically can be associated with HHT and scleroderma. A high index of suspicion is required to determine the etiology of recurrent hemoptysis without suggestive findings in thoracic imaging. Bronchoscopy is indicated in such cases. While MAC and other pulmonary infections may cause hemoptysis, this case highlights the importance of additional testing, when initial investigations are indeterminate. Isolated endobronchial telangiectasias without evidence of systemic AVMs are a rare cause of recurrent hemoptysis.

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ABSTRACT #102 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE A SHOCKING CASE SERIES OF INVASIVE GROUP A STREPTOCOCCUS Catherine Zaw1, Andrea Ramirez Cazares1, Nikita Desai1, Meagan Murphy1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 17-22, 2025.

BACKGROUND/INTRODUCTION: Invasive group A streptococcus (GAS) infections are often fulminant and pose a great challenge in their treatment and management, especially in the setting of septic shock. Severe outcomes of GAS infections include respiratory failure, toxic shock syndrome, necrotizing fasciitis, bacteremia, and death. Mortality in resource-ready countries is reported as high as 23%. In the United States, case fatality related to septic shock is estimated at 45%. We present two cases of GAS-related septic shock in middle-aged and otherwise healthy non-immunocompromised individuals and the diversity of complications and outcomes to their treatment.

CASE PRESENTATION: A 60-year-old man with a history of bicuspid aortic valve status post bioprosthetic aortic valve developed shortness of breath and cough before being found down by a neighbor the following day. He was admitted for septic shock and rhabdomyolysis, found with extensive purpuric lesions over his extremities and decreased ejection fraction on bedside ultrasound. Within 1 hour of presentation, he developed widecomplex ventricular tachycardia, was shocked, and was given antiarrhythmics but shortly after suffered PEA arrest. ROSC was achieved. However, his condition continued to deteriorate with further multiorgan failure. He later went into PEA arrest again and died despite maximal resuscitative efforts.

A 52-year-old woman with endometrial hypoplasia who presented after two days of shortness of breath. She was found in septic shock secondary to multifocal pneumonia and was positive for influenza B. Blood cultures returned with GAS, presumed from superimposed pneumonia. Within 21 hours of presentation, she developed molting of the upper and lower extremities, developing diffuse skin purpura, and peripheral necrosis of her hands, feet, and breasts. Ultimately, she steadily recovered and was discharged after a 28-day stay. She was, however, recommended for elective amputation of her hands.

CONCLUSION: Both cases presented in florid septic shock and multiorgan failure within 24-48 hours of symptom onset. The GAS speciated in cultures for both patients were pan-sensitive. Therefore, appropriate antibiotic treatment was initiated promptly. Despite this, both patients deteriorated rapidly. Our cases emphasize the indiscriminate nature of invasive GAS and the rapid onset of septic shock and complications related to such.

That said, data surrounding toxin suppression and antibiotic regimens for broad GAS treatment is accumulating, and management may soon evolve. While the literature has begun to identify risk factors for fatal invasive GAS, further investigation is important to understand characteristics signaling clinical decline and complications.

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ABSTRACT #103 CLINCIAL RESEARCH GASTROENTEROLOGY CELIAC DISEASE AND INFLAMMATORY BOWEL DISEASE: CHARACTERISTICS OF A DUAL DIAGNOSIS Alexandria Markley1, Luis Rendon Rodriguez1, Carlos Diola1, Yonatan Israel2, Haley Waite2, Peter HR Green3, Christopher Cao2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, New York, NY, United States; 3Columbia University Irving Medical Center, New York, NY, United

States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: A bidirectional association of celiac disease (CeD) and inflammatory bowel disease (IBD) has been well established. The existence of this dual diagnosis (CeD-IBD) poses questions regarding diagnosis, treatment, and potential synergistic effects on disease course. There remains a need for further understanding of the clinical implications of this dual diagnosis.

METHODS: A retrospective chart review of patients with celiac disease from Mount Sinai Hospital was performed.

In total, 354 patients carried a dual diagnosis of celiac disease-IBD. Any individual with serology and biopsy consistent with celiac disease and a concomitant diagnosis of IBD - either ulcerative colitis or Crohn’s disease – confirmed by histology was included. Patients were excluded if data from initial diagnosis of either disease was missing.

RESULTS: Of the 1038 patients with celiac disease, a total of 38 (3.7%) carried a confirmed dual diagnosis – 53% were female and mean age of the cohort was 31.29 years. The most common presenting symptoms were abdominal pain and diarrhea. At initial visit, mean TTG IGA was 108U/mL and the majority (68%) had Marsh 3 on biopsy. Mean age of diagnosis was oldest in the celiac disease-UC cohort. A higher proportion of celiac disease-IBD patients had Crohn’s disease (73.7%) compared to ulcerative colitis (26.3%). Interval time to second diagnosis of IBD and celiac disease was 4.1 years and 3.2 years respectively. Two patients had a gastrointestinal infection preceding IBD diagnosis (mean interval of 16.5 days), both in the Crohn’s disease cohort. 71% of celiac disease-IBD patients required the use of biologics for treatment of IBD. 14.2% of Crohn’s disease patients had stricturing or penetrating disease and 40% of ulcerative colitis patients had extensive colonic involvement.

DISCUSSION/CONCLUSION: Celiac disease-IBD dual diagnosis creates complex pathophysiology yet to be fully understood. Further investigation with direct comparisons to celiac disease and inflammatory bowel disease cohorts may be beneficial in order to better understand the interrelation of these diseases, outline potential disease course, and guide clinical management.

183

CeD+IBD Number of Patients

38

UC

10

CD

28

CeD

38

Number of Males

18 (47.3)

Number of Females

20 (52.6)

Mean Age

31.29

Race (%) White

29 (76.3)

Black

0

Asian/ Pacific Islander

1 (2.6)

Hispanic

0

Other

9 (23.6)

Mean BMI at Dx

21.88*

Mean (Median) Age of CeD Dx

23.04 (18.4)

Mean (Median) Age of CD Dx

20.32 (16.4)

Mean (Median) Age of UC Dx

33.89 (28.9)

Mean Time Between Dx, Years UC 1st, CeD 2nd

2

CD 1st, CeD 2nd

3.7

CeD 1st, UC 2nd

5.4

CeD 1st, CD 2nd

3

Family History Autoimmune

3 (7.9)

Celiac

7 (18.4)

IBD

5 (13.1)

184

Symptoms at Presentation, n Diarrhea

20

Nausea

8

Vomiting

5

Abdominal Pain

24

Bloody Stools

11

Constipation

6

Weight Loss

12

Bloating

5

Extra-intestinal Symptoms

10

Unknown

1

No Symptoms

1

Montreal Classification, n E1

2

E2

3

E3

4

S0

0

S1

5

S2

2

S3

2

A1

16

A2

7

A3

2

L1

8

L2

6

L3

11

L4

2

B1

21

185

B2

2

B3

1

B4

1

p

2

Penetrating Disease (%)

14.2

Paninvolvement (%)

40

Mean TTG at time of Dx

108

Marsh Classification, n I

11

II

0

IIIa

12

IIIb

8

IIIc

6

Unknown

1

Marsh III Classification (%)

26 (68.4)

Celiac Remission (%)

13 (34.2)

Mean (Median) Time to Remission in Years History of Prior GI Infection, n Mean (Median) Time between Infection and Dx in days

5 (5) 2 16.5 (16.5)

UC

0

CD

33

History of T- Cell Lymphoma, n

0

Table 1. Characteristics of Patients with a dual diagnosis of Celiac Disease and Inflammatory Bowel Disease.

CeD: Celiac Disease; UC: Ulcerative Colitis; CD: Crohn's Disease; IBD: Inflammatory Bowel Disease; GI: Gastrointestinal; BMI: Body Mass Index; Dx: Diagnosis; TTG: Tissue Transglutaminase; n: number.

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ABSTRACT #104 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/GENERAL INTERNAL MEDICINE A POSSIBLE UNIFYING DIAGNOSIS IN A CASE OF NEW HEART FAILURE AND ENDOCARDITIS IN A PATIENT WITH MULTIPLE AUTOIMMUNE DISEASES Masih A. Babagoli1, Norah Sadek2, Kiran Mahmood2, Arieh Fox2, Basera Kaur Sabharwal2, Ashish Correa2 1Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn

School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND: Early onset dilated cardiomyopathy in the young adult population is most often nonischemic in nature with etiologies including congenital or viral. However, in the presence of multiple comorbidities, a single unifying diagnosis must be explored. We present a case of a young male with newly diagnosed heart failure with reduced ejecting fraction (HFrEF) likely related to antiphospholipid syndrome.

CASE PRESENTATION: A 28-year-old male with recently diagnosed HFrEF of unclear etiology, recently diagnosed autoimmune hepatitis (AIH), and long-standing history of severe hidradenitis suppurativa presented with worsening abdominal pain and vomiting for three days. CTA chest showed splenic infarct and multiple subsegmental pulmonary emboli.

DISCUSSION: Transesophageal echocardiogram revealed biventricular dysfunction, left ventricular ejection fraction of 20%, four-chamber dilation, severe mitral and tricuspid regurgitation, and soft echodensities with leaflet thickening of the mitral and tricuspid valves. Infectious workup was negative. Given the recent diagnosis of AIH further rheumatological workup was explored and notable for positive antinuclear antibody (1:160, speckled), anti-smooth muscle antibody (1:80), and anti-cardiolipin IgG (moderate), thus supporting a diagnosis of nonbacterial thrombotic endocarditis (NBTE) secondary to antiphospholipid syndrome. To evaluate etiology of concomitant HFrEF, coronary CTA was pursued which was negative for coronary calcifications. Cardiac MRI found no evidence of prior infarct, inflammation, or infiltrative disease consistent with nonischemic dilated cardiomyopathy (NICM). Workup for hereditary cardiomyopathy was planned but never completed.

CONCLUSION: The presence of multi-valve NBTE secondary to antiphospholipid syndrome concomitant with new HFrEF secondary to NICM in a young patient with other autoimmune conditions raises the possibility of a unifying diagnosis: a multi-system autoimmune disease. This seems more likely than either viral myocarditis given the MRI findings or hereditary cardiomyopathy given the absence of any family history of genetic disease. However, as treatment for hiradenitis suppurativa, cardiomyopathy related to long-term exposure to potentially cardiotoxic biologics such as adalimumab cannot be ruled out.

Figure 1. TEE four chamber view showing tricuspid valve and mitral valve echo-dense lesions.

Figure 2. Cardiac MRI showing four chamber dilation.

187

ABSTRACT #105 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/PULMONARY/CRITICAL CARE UNMASKING AN INTRACARDIAC SHUNT IN A CASE OF PERSISTENT UNEXPLAINED HYPOXIA Sanjay Sivalokanathan1,2, Usman Saeedullah2, Komail Jafri2, Harrison Bonilla2, Auston Locke1, Maria Giovanna Trivieri3 1Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn

School of Medicine at Mount Sinai, New York, NY, United States;; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Published in Reports, 2025.

BACKGROUND/INTRODUCTION: Pulmonary hypertension is characterized by an increase in mean pulmonary arterial pressure and pulmonary vascular resistance. While it is frequently encountered in patients with significant intracardiac shunts, often necessitating closure device implementation or surgical correction, the occurrence of a concomitant atrial septal defect (ASD) with a right-to-left shunt inducing left ventricular dysfunction is a rare phenomenon.

CASE PRESENTATION: A 69-year-old female patient with a history of heart failure (with preserved ejection fraction) and end-stage renal disease on hemodialysis presented with syncope and hypoxia (oxygen saturation 62%). She was recently diagnosed with severe pulmonary hypertension, measuring 86 mmHg. Right heart catheterization revealed precapillary pulmonary hypertension (88/37, mean PAP 54 mmHg), prompting initiation of intravenous epoprostenol. Despite treatment, the patient remained persistently hypoxic. Review of prior echocardiogram with bubble study identified an intracardiac shunt. The combination of right ventricular failure and right-to-left shunt from the ASD was determined to contribute to persistent hypoxemia. Treatment with prostacyclin therapy was continued alongside adjunctive vasopressors, resulting in clinical stabilization. The patient was discharged on subcutaneous Treprostinil with significant clinical improvement.

CONCLUSION: This case highlights the importance of recognizing that the consequences of pulmonary hypertension are extensive, and that a rare yet significant etiology for persistent hypoxemia may be attributed to right-to-left shunting. A comprehensive diagnostic approach and multidisciplinary management are essential for optimal patient outcomes.

188

ABSTRACT #106 CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE NOT WITHOUT RISK, A CASE OF SEVERE LIFE-THREATENING NONCARDIOGENIC PULMONARY EDEMA Benjamin Samuel1, Patrick Tobin-Schnittger1, Nikita Desai1, Sanam Ahmed1

NALOXONE

INDUCED

1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting to be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Rapid onset respiratory depression is the leading cause of mortality associated with fentanyl. A competitive opioid receptor antagonist, naloxone is a lifesaving antidote; rarely, however, it can also be fatal. We report a case of severe naloxone-induced noncardiogenic pulmonary edema requiring extracorporeal membrane oxygenation (ECMO) support.

CASE PRESENTATION: A 23-year-old female with polysubstance use disorder and a previous unintentional drug overdose (requiring one week of ventilatory support) was found unresponsive at home. En route to the hospital, she received diazepam for a witnessed seizure in addition to intranasal naloxone. Copious frothy bloody secretions were noted during her emergent intubation at the hospital. Despite maximal ventilatory support, recruitment maneuvers, and paralysis, she remained profoundly hypoxemic (SpO2 <60%, PaO2 63mmHg). Chest imaging (X-ray and computed tomography) demonstrated bilateral diffuse reticular opacities suggestive of naloxone-induced noncardiogenic pulmonary edema. Inhaled nitric oxide was attempted but aborted due to further desaturation; she was thus transferred to the cardiothoracic intensive care unit for emergent venous-venous ECMO. Transthoracic echo showed normal cardiac anatomy and function. After 3 days of ECMO, intravenous furosemide (total of 420 mg), empiric antibiotics, and hydrocortisone she was successfully decannulated from ECMO and extubated. Interval thoracic imaging at 2.5 days showed complete resolution of the prior findings. She recovered from an acute kidney injury without dialysis (peak creatinine 1.46mg/dl on admission, 0.52mg/dl by day 7), mild delirium, and was discharged with Addiction Medicine follow-up.

CONCLUSION: Noncardiogenic pulmonary edema has been associated with fentanyl and naloxone. The incidence of naloxone-induced noncardiogenic pulmonary edema with fentanyl is 1-2% of all patients. Several mechanisms of injury have been proposed: hypoxia and acidosis from respiratory depression, increased permeability of pulmonary vasculature from direct toxicity to lung tissue, and edema from histamine release.

Naloxone-induced noncardiogenic pulmonary edema occurs in 0.2-3.6% of all patients and is associated with escalating dosages (above 4.4 mg per one large study) but can occur at doses as low as 0.8 mg. Naloxone is believed to cause an adrenergic crisis, increasing pulmonary vasoconstriction, hydrostatic pressures, and capillary permeability resulting in a sudden parenchymal volume shift. Distinguishing between the two causes is not always possible, but crucial for management and accurate prognostication. Compared to fentanyl, cases related to naloxone are typically very acute in onset, involve fewer organ systems, resolve faster, and are therefore considered less severe. This case adds to the limited literature on this rare but life-threatening complication of naloxone, highlighting its acuity, potential severity, and the importance of early consultation with cardiothoracic surgery for extracorporeal membrane oxygenation support.

189

ABSTRACT #107 CLINICAL RESEARCH GASTROENTEROLOGY GLUCAGON-LIKE PEPTIDE RECEPTOR AGONIST (GLP-1 RA) USE IS NOT AN INDEPENDENT PREDICTOR OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) ON QUANTITATIVE REFLUX TESTING Robinderpal Sandhu1, Alexandria Markley1, Emily S. Seltzer1, Joseph Abraham1, Rama Hussein1, Binoy Desai1, James Choi1, Kimberly Cavaliere1, Yuying Luo1, Michael S. Smith1,2, Daniela Jodorkovsky1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount

Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Diseases Week (DDW) Annual Meeting that was held in Washington DC, United States from May 18-21, 2024.

BACKGROUND/INTRODUCTION: There is recent increased Glucagon-Like Peptide-1 Receptor Agonist (GLP1 RAs) utilization for diabetic and weight management. These medications are thought to increase satiation through delayed gastric emptying, which is considered a risk factor for Gastroesophageal Reflux Disease (GERD). This study aims to determine whether GLP-1 RA use can predict GERD as defined by quantitative testing and/or findings on upper endoscopy (EGD).

METHODS: Patients presenting to a single high-volume motility center for ambulatory reflux testing and EGD between 1/2020 and 2/2024 were identified. Patients taking a GLP-1 RA were included in the analysis, while patients with prior foregut endoscopic or surgical interventions were excluded. Demographics, comorbidities, medications, and testing metrics were obtained. GERD was defined by the presence of Los Angeles Grade B, C, or D esophagitis or Barrett’s metaplasia and/or abnormal pH testing with cutoff values derived from the Lyon Consensus 2.0. Differences between patients on and off GLP-1 RAs were evaluated using logistic regression, ttests, or Fisher’s exact tests as appropriate.

RESULTS: A total of 457 patients met inclusion criteria, of which 59 were on a GLP-1 RA. Patients on GLP-1 RAs were older, had an increased body mass index (BMI), hemoglobin A1c, and were more likely to have diabetes (Table 1). Mean overall acid exposure time and post-prandial exposure time were significantly higher in GLP-1 RA users (8.5 versus 5.4, 10.9 versus 4.0, respectively). When adjusting for age, BMI, race, gender, and the presence of a hiatal hernia > 3 cm, GLP-1 RA patients did not have either more GERD (OR, 1.73; 95%CI, 0.84-3.55; p=0.137), an abnormal pH Study (OR ,1.86; 95%CI, 0.88-3.93; p=0.105), or more esophagitis (OR, 1.84; 95%CI, 0.68 4.95; p=0.23) (Table 2).

CONCLUSION: GLP-1 RA use was not an independent predictor for an abnormal quantitative reflux study after adjusting for variables associated with GERD, such as high BMI and hiatal hernia. However, given that GLP-1 RA users had higher post-prandial reflux exposure times, lifestyle and dietary modification may play a role in managing GLP-1 RA users’ reflux symptoms. Further studies investigating outcomes of results when GLP-1 RAs are held prior to testing, or whether duration of use alters GERD detection rates should be performed, as reflux testing often informs clinical decision making.

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ABSTRACT #108 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE RAPID DETERIORATION IN HHV-8-ASSOCIATED MULTICENTRIC CASTLEMAN DISEASE IN AN UNCONTROLLED HUMAN IMMUNODEFICIENCY VIRUS PATIENT Yoshihiro Sawaguchi1 and Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: HHV-8-associated multicentric Castleman disease (MCD) is a rare but aggressive lymphoproliferative disorder that can be seen in patients with human immunodeficiency virus (HIV) infection. The disease is driven by HHV-8-infected plasmablasts, which secrete viral interleukin-6 (vIL-6) and trigger excessive cytokine release. This leads to systemic inflammation, cytokine storm, and multi-organ failure if untreated. Early recognition is essential to prevent life-threatening complications.

CASE PRESENTATION: A 42-year-old male with uncontrolled HIV presented with one week of progressive fatigue. Physical examination revealed generalized lymphadenopathy, and laboratory studies showed severe anemia (Hb 3g/dL) due to autoimmune hemolytic anemia (AIHA) and an incidental iliac vein thrombosis. Lymph node biopsy confirmed HHV-8-associated MCD. During his hospital stay, the patient developed acute hypoxemic respiratory failure and acute renal failure in the setting of tumor lysis syndrome (TLS) and cytokine storm. Chest imaging showed bilateral pulmonary opacities.

His ICU course was complicated by recurrent bacteremia. Despite several weeks of aggressive critical care, including mechanical ventilation and continuous renal replacement therapy, the patient continued to deteriorate and ultimately succumbed prior to chemotherapy initiation.

DISCUSSION: Early diagnosis of MCD is critical. Patients with MCD often present with persistent fever, lymphadenopathy, hepatosplenomegaly, cytopenias, and constitutional symptoms, which overlap with other HIVassociated illnesses, delaying diagnosis. Severe anemia due to AIHA highlights the autoimmune dysregulation common in MCD, with up to 22.5% of patients developing autoimmune manifestations. MCD has also been linked to thrombotic complications like thrombotic thrombocytopenic purpura (TTP). Early tissue biopsy and HHV-8 testing are crucial for diagnosis, as delays can significantly impact outcomes.

Rapid clinical decline in HHV-8-associated MCD is driven by unchecked cytokine release, particularly vIL-6 and human IL-6, which can rapidly escalate into multi-organ failure with sepsis-like features. The patient’s acute respiratory failure can be explained by cytokine-induced capillary leak syndrome, a complication of MCD. Spontaneous tumor lysis syndrome (TLS) has been reported prior to chemotherapy, likely due to high cellular turnover of plasmablasts. This syndrome can cause acute kidney injury, hyperkalemia, and metabolic acidosis, contributing to the rapid deterioration observed in this patient.

The need for early therapeutic intervention is paramount. Historically, HIV-infected MCD patients without HIV treatment had high one-year mortality. However, rituximab-based therapy combined with antiretroviral therapy significantly improved survival, with five-year survival rates reaching approximately 90% when treatment is initiated early. Given the aggressive nature of MCD in HIV, patients require close monitoring in intensive care settings and aggressive supportive care to prevent catastrophic complications.

CONCLUSION: HHV-8-associated MCD is a rare but aggressive disease in uncontrolled HIV. Clinicians should maintain a high index of suspicion for MCD in patients with lymphadenopathy, AIHA, and systemic inflammation.

Early biopsy and prompt treatment initiation are crucial to improving outcomes. This case underscores the potential for rapid deterioration due to cytokine storm, TLS, and infections, emphasizing the need for proactive monitoring and early intervention.

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ABSTRACT #109 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY/PALLIATIVE CARE IMPACT OF DARATUMUMAB REFRACTORINESS ON CLINICAL OUTCOMES FOLLOWING CAR T-CELL THERAPY FOR RELAPSED/REFRACTORY MULTIPLE MYELOMA Tara Sebastian1, Sridevi Rajeeve2, Bruno Almeida Costa3, Eric Jurgens2, Noriko Nishimura2, Tasmin Farzana4, Ross Firestone2, Kevin Miller2, Alexander M. Lesokhin2,4, Gunjan L. Shah2, Neha Korde2,4, Carlyn Rose Tan4, David J. Chung2, Heather J. Landau 2, Michael Scordo2, Hani Hassoun2,4, Kylee H. Maclachlan4, Urvi A. Shah2, Malin Hultcrantz2, Issam S. Hamadeh2, Sergio A. Giralt2,4, Sham Mailankody2, Saad Z. Usmani2,4, Hamza Hashmi2,4 1Mount Sinai Morningside-West Hospitals, New York, NY, United States; 2Memorial Sloan Kettering Cancer Center, New

York, NY, United States; 3Mount Sinai Hospital, New York, NY, United States; 4Weill Cornell Medical College, New York, NY, United States

Presented at the Tandem Meetings Annual Meeting that was held in Honolulu, Hawaii, United States from February 12-15, 2025.

BACKGROUND/INTRODUCTION: Ciltacabtagene autoleucel (cilta-cel) and idecabtagene vicleucel (ide-cel) are CAR T-cell therapies targeting B-cell maturation antigen (BCMA) recently approved for relapsed/refractory multiple myeloma (RRMM) after 1-2 prior therapies, based on the CARTITUDE-4 and KarMMa-3 trials. While daratumumab refractoriness predicts inferior outcomes in subsequent therapies, not all patients in these trials were daratumumab refractory. We conducted a single-center retrospective analysis to compare outcomes of RRMM patients who had received BCMA-directed CAR T-cell therapy based on daratumumab refractoriness status.

METHODS: Our analysis included RRMM patients treated with ide-cel, cilta-cel, or orvacabtagene autoleucel (orva-cel) from April 2018 to November 2023. Patients were categorized into daratumumab refractory (DR) and daratumumab nonrefractory (DN) groups. DR was defined as disease progression on treatment or within 60 days post-daratumumab. Outcomes assessed included progression-free survival (PFS), overall survival (OS), overall response rate (ORR), and incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Response categories were defined per IMWG consensus. CRS/ICANS were graded according to ASTCT criteria.

RESULTS: The study included 127 patients, with 28 patients (22%) classified as DN. In the DR group (n=99), 41.4% received cilta-cel, 31.3% ide-cel, and 27.3% orva-cel. In the DN group (n=28), 50% received cilta-cel, 32.1% ide-cel, and 17.9% orva-cel. Except for one DR patient, all were triple-class exposed. The DR and DN groups had similar proportion of patients with ECOG performance status >0 (68.7% versus 60.7%) and high-risk cytogenetic abnormalities (70.7% versus 71.4%). However, the DR group had higher rates of extramedullary disease (EMD) (46.5% versus 28.6%), prior BCMA therapy (24.2% versus 7.1%), prior T-cell therapy (13.1% versus 3.6%), high tumor burden (28.3% versus 14.3%), and a higher median number of prior therapies (6 versus 4). With a median follow-up of 12 months (range, 1-72 months), best ORR was 77.7% (40% sCR/CR, 22% VGPR, 15% PR) in the DR group versus 85.7% (50% sCR/CR, 14% VGPR, 21% PR) in the DN group. 12-month PFS was 38% [95%CI, 28-not reached (NR)] in the DR group versus 57% (95%CI, 37-NR) in the DN group (HR, 0.6; p=0.08). 12-month OS was 74% (95%CI, 64-NR) in the DR group versus 86% (95%CI, 68-NR) in the DN group (HR, 0.56; p=0.18). CRS and ICANS rates were similar: 74.7% (4% grade ≥3) and 13.1% (2% grade ≥3), respectively, in the DR group, compared to 78.6% (4% grade ≥3) and 21.4% (0% grade ≥3) in the DN group.

CONCLUSION: Most patients treated with BCMA-directed CAR T for RRMM in this study were daratumumab refractory. Despite more lines of prior therapy and aggressive disease biology, the DR group showed comparable efficacy to the DN group. Expanded data with further efficacy and safety analyses will be presented at the meeting.

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ABSTRACT #110 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE/ RHEUMATOLOGY A RARE CASE OF INTERSTITIAL LUNG DISEASE FROM ANTISYNTHETASE SYNDROME WITH CONCOMITANT BREAST CANCER Aesha Patel1, Priya Shah1, Nicole Ng2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 14-19, 2025.

BACKGROUND/INTRODUCTION: Antisynthetase syndrome (ASyS) is a rare autoimmune disorder defined by inflammatory myopathy, arthritis, and interstitial lung disease (ILD). Prognosis is impacted by the degree of organ involvement and the presence of malignancies. No standardized treatment exists for ASyS, and management is extrapolated from data based on other forms of connective tissue diseases. ILD in ASyS is a key prognostic indicator, with lung involvement linked to increased mortality risk, highlighting the need for timely immunosuppressive therapy. However, the presence of concomitant malignancies complicates the use of immunosuppressants. Associated malignancies may include lung, breast, ovary, and liver cancer. Notably, patients with ASyS exhibit a lower risk of malignancy compared to other myositis types. We report a case of concurrent stage IV left breast cancer and ILD secondary to ASyS, illustrating the intricate relationship between autoimmune disease and malignancy.

CASE PRESENTATION: A 53-year-old female with no significant medical history presented with left axillary lymphadenopathy for three years and progressive dyspnea on exertion (DOE) over three months. Further evaluation of lymphadenopathy included mammogram, fine needle aspiration, and core biopsy, revealing poorly differentiated estrogen receptor-positive, HER2-positive invasive ductal carcinoma (cT2N1M1). A workup of DOE included pulmonary function testing which showed moderate restriction and moderate gas transfer defect. CT chest revealed peribronchovascular reticular ground-glass opacities with lower lung predominance suggestive of a nonspecific interstitial pneumonia (NSIP) pattern. Serological tests were positive for SSA, Ro52, PL12, and U1RNP. She was diagnosed with both stage IV breast cancer and ASyS-associated NSIP. Breast cancer treatment involved neoadjuvant chemotherapy, lumpectomy, and proton beam therapy, followed by adjuvant chemotherapy - all of which increased her risk of drug-induced pneumonitis. Her ILD treatment was delayed risking progression and/or exacerbation of ILD, she was temporized with prednisone and hydroxychloroquine.

One year post-diagnosis, she began treatment with mycophenolate mofetil and tapered prednisone, resulting in symptom improvement.

CONCLUSION: ASyS, characterized by anti-tRNA synthetase antibodies, inflammatory myopathy, and ILD, typically presents a lower malignancy risk compared to other idiopathic inflammatory myopathies. However, the presence of specific antibodies, particularly anti-TIF-1γ, is associated with an elevated risk of breast cancer and other solid tumors. The pathophysiology may involve chronic inflammation and immune dysregulation, which can promote oncogenesis, underscoring the importance of vigilant cancer screening in ASyS patients. This case emphasizes the complexities involved in treating patients who present with both diagnoses, highlighting the importance of multidisciplinary management between Oncology, Rheumatology, and Pulmonary.

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ABSTRACT #111 CLINICAL RESEARCH PULMONARY/CRITICAL CARE ADVANCED THERAPIES FOR ACUTE PULMONARY EMBOLISM AND RV FUNCTION ON OUTPATIENT FOLLOW-UP: A CROSS-SECTIONAL STUDY Hammad Sheikh1, Connor Smith1, Howard Freeman1, Jeeyune Bahk2, Avinash Singh1, Abdul Rehman3, Keshav Dixit1, Alvin Yang1, Maria Riasat1, Sakul Sakul1, Edgar Argulian1, David J. Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Tidal Health Peninsula

Regional, Salisbury, MD, United States

BACKGROUND/INTRODUCTION: The impact of catheter-directed thrombolysis (CDT), catheter-directed embolectomy (CDE) and surgical pulmonary embolectomy (SPE) on RV function among patients with acute PE remains unclear. We investigated the association of receipt of advanced therapies with echocardiographic parameters of RV function at outpatient follow-up among patients with acute PE. METHODS: A propensity score-matched analysis of all consecutive patients with acute PE, managed in the Mount Sinai Health System (New York, NY) by PERT between January 2021 and December 2023, was performed if baseline and follow-up echocardiography scans were available.

RESULTS: A total of 123 patients (70 male) were included with median age 64.4 years, median PESI score 87 points and ESC risk group low [1 (0.8%)], intermediate-low [25 (20.3%)], intermediate-high [76 (61.8%)] and high [21 (17.1%)] risk respectively. CDE, CDT and SPE were performed in 21 (17.1%), 11 (8.9%) and 11 (8.9%) cases. In matched analyses, receipt of any advanced therapy (compared to anticoagulation alone) was associated with increased RVOT VTI (4.6 cm; p=0.009) and RV S´ (2.0 cm/s; p=0.006) as well as higher odds of TR grade improvement (marginal OR, 3.0; p=0.002) and lower odds of 30-day mortality (marginal OR, 0.061; p<0.001) and 30-day major bleeding (marginal OR, 0.299; p<0.001).

CONCLUSION: Receipt of advanced therapies for acute PE was associated with statistically significant improvement in echocardiographic parameters of RV function at outpatient follow-up (median 26 weeks) compared to systemic anticoagulation alone. In matched analyses, advanced therapies were also associated with reduced 30-day mortality without an increase in adverse outcomes.

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ABSTRACT#112 CLINICAL RESEARCH CARDIOLOGY DIAGNOSIS OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION USING DEEP LEARNING ON ELECTROCARDIOGRAMS Samantha V. Shetty1, Joshua Lampert2, Joy Jiang3, Girish NadkarnI2, Akhil Vaid2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine

at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Left Ventricular Diastolic Dysfunction (LVDD) is implicated in conditions with abnormal LV filling and reduced LV distension and relaxation. Classified into grades I to IV, LVDD can be progressive particularly when its underlying cause is not appropriately treated. The prevalence of LVDD varies greatly (10-35%) in the elderly population, likely in the setting of varying inclusion criteria, LVDD grading and definitions. Specifically, LVDD Grade II/III is associated with a higher mortality risk and has been shown to predict major adverse cardiac events including myocardial infarction, heart failure, and all-cause mortality.

Echocardiography (echo) is used to quantify LVDD and its severity. Given its dynamic nature, identifying LVDD and its progression across other diagnostic modalities is vital. One such modality is the electrocardiogram (ECG).

Although ECGs are widely accepted for the identification of abnormalities in cardiac conduction, pathology, and structure, some ECG findings may go undetected by human interpreters. Applying machine learning techniques to ECG for detection of LVDD may help address this need.

METHODS: In this study, we used rule-based Natural Language Processing (NLP) on echo reports to extract Cardiologist-confirmed annotations for the presence and grading of LVDD. The NLP pipeline labeled reports as having no LVDD, indeterminate LVDD, or LVDD of grades I, II, or III. These labels were paired with ECG data collected within 7 days of the echo. ECGs paired with an echo of LVDD Grade II were considered cases and were paired with controls matched based on age, sex, and race. Patients were excluded if their ECG diagnostic codes indicated conduction abnormalities, concurrent ischemia, and prior intervention. We trained a ConvNeXt Large model capable of processing images of up to 512 x 512 pixels over 25 epochs against a patient-aware 80% training and 20% testing split.

RESULTS: We collected 121,161 ECGs from 27,760 patients with an outcome prevalence of 31.4%. Our model detected patients with LVDD Grade II/III with AUROC of 0.87 (95%CI, 0.86-0.87) and AUPRC of 0.82 (95%CI, 0.81-0.83) (Figure 1). Saliency heatmaps showed regions around the QRS complex as more important for diagnosis of LVDD (Figure 2).

CONCLUSION: Our study demonstrates how machine learning can augment clinical practice. Specifically, it may be a useful screening tool for patients at risk of worsening cardiac disease, resource limited areas, and primary care settings in which ECG is readily available.

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Figure 1. Performance Curves: LVDD Grade II/III. Receiver operator characteristics (ROC) curve (blue) and precision-recall curve (orange) used to identify LVDD Grade II/III

Figure 2. Saliency Mapping. Saliency mapping ECG examples of grade II+ LVDD. Leads are arranged from bottom to top: I, II, V1-V6.

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ABSTRACT #113 MEDICAL EDUCATION GERIARTICS IMPACT OF COVID-19 ON GERIATRIC eLEARNING: NEW USER DEMOGRAPHIC SHIFTS IN THE VA GERIATRIC SCHOLARS PROGRAM Yuka Shichijo1, Eugenia Dorisca2, Helen Fernandez3, Judith Howe2,3, Fred Ko2,3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2James

J. Peters VA Medical Center, Bronx, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the James J. Peters Veterans Affairs Medical Center Annual Research Day that was held in Bronx, New York, United States that was held on May 23, 2024.

BACKGROUND/INTRODUCTION: The COVID-19 pandemic has heightened the need for efficient geriatric care education and accelerated the transition to online learning. The VA Geriatric Scholars Program's Virtual Learning Community (VLC) has responded by expanding its eLearning offerings in Geriatrics. This study examines changes in demographic characteristics and educational course utilization among new VLC users after the emergence of COVID-19.

METHODS: We assessed the number of new VLC users, categorized by geography (state), demographics (age, sex, race, profession), and enrollments in 10 educational courses (e.g., Medication Management, Falls), from March 2017 to February 2023. Variables from 3 years before (“pre-COVID”) and after (”post-COVID”) the outset of COVID-19 pandemic, defined as March 2020, were compared. Differences in the proportion of these variables were evaluated by the Chi-square test.

RESULTS: The number of new VLC users increased post-COVID (n=1,642 versus n=1,587 pre-COVID), with a most notable difference in the 1 year after the outset of COVID (n=650, March 2020-February 2021 versus n=354, March 2019-February 2020). Post-COVID, new user registrations increased in the Southeast (NC, SC, GA, FL) by 407% (from n=30 (6%) to 122 (22%), p<0.001) and Northeast (MA, RI, NH, ME, VT, CT, NJ, PA) by 285% [from n=48 (9%) to 137 (25%), p<0.001], except NY state which decreased by 366% [from n=212 (40%) to 58 (11%), p<0.001]. Demographically, there was an increase in new users under 40 years of age (n=565 (36%) versus 896 (55%), p<0.001], Hispanics [72 (4%) vs 99 (6%), p=0.04], physicians [199 (13%) versus 254 (15%), p=0.02], and non-clinicians [276 (17%) versus 447 (27%), p<0.001]. Conversely, there was a decrease in White users [610 (38%) versus 513 (31%), p<0.001], nurse practitioners/physician assistants [197 (12%) versus 136 (8%), p<0.001], and registered/licensed nurses [466 (29%) versus 391 (24%), p<0.001]. Gender distribution stayed the same. Educational course enrollment increased in “Medication Management” (from n=94 to 399), “Interdisciplinary Teamwork” (n=58 to 186), “End-of-Life Care” (n=152 to 229), and “Falls” (n=117 to 227). Self-reported user satisfaction and recommendation rates were higher in some multimedia modules (e.g., “Depression” and “Dementia Caregiving”) post-COVID. CONCLUSION: The Virtual Learning Community enhanced the scope and accessibility of geriatric education after the emergence of COVID-19 as reflected by increases in new user and educational course enrollment.

Shifts in new user demographics suggest that this eLearning modality may be well-suited towards the need of younger and non-clinician learners, whereas increases in educational course and module enrollment indicate learning needs in several core content areas of geriatric care. Future research is needed to better understand how disparate geographic impacts of the pandemic, variable access to geriatric resources, and the extent of Virtual Learning Community's outreach influenced usage patterns of this eLearning platform.

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ABSTRACT #114 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE THE ROLE OF THE COMPOSITE PULMONARY EMBOLISM SHOCK SCORE IN OUTCOME PREDICTION OF INTERMEDIATE-RISK PULMONARY EMBOLISM Jorge Sinclair De Frias1, Agostina Velo1, Aesha Patel1, Hammad Sheikh1, Hong Yu Wang1, Destiny Nguyen1, Priyanka Sridhar1, Madeline Ehrlich2, Abdul Rehman3, Avinash Singh1, Robert Lookstein4, David Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Rutgers-New

Jersey Medical School, Newark, NJ, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting to be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: The Composite Pulmonary Embolism Shock (CPES) score is validated as a predictor of normotensive shock in patients with pulmonary embolism (PE). However, studies evaluating its association with clinical outcomes are limited. This study aimed to evaluate the CPES score’s predictive value for outcomes in patients with intermediate-risk PE. METHODS: This retrospective cohort study included adult patients (n=235) with intermediate-risk PE. The CPES score analyzed continuously and with a cutoff of ≥3, incorporated factors such as right ventricular dysfunction on imaging, elevated BNP and troponin, saddle or proximal PE, concomitant deep vein thrombosis, and tachycardia. Primary outcomes were in-hospital and 30-day mortality, length of stay (LOS), 30-day readmission, and major bleeding events.

RESULTS: The median age was 65 years (IQR: 53-76), with 55.7% female. Racial distribution was 55.7% White, 37.9 Black, and 5.1% Asian. Comorbidities included congestive heart failure in 7.2%, chronic obstructive pulmonary disease in 4.2%, active malignancy in 12.8%, and active smoking in 9.4%. Regarding treatment, 5.5% received systemic thrombolytics, 15.7% underwent mechanical thrombectomy, and 9.8% received catheterdirected thrombolysis. The median CPES score was 3, with 66 patients scoring <3 and 169 scoring ≥3. Significant differences between low and high CPES groups included a higher proportion of Asian patients in the low CPES group (10.6% versus 3.0%, p=0.041), increased respiratory rate in the high CPES group (median 19 versus 18 breaths/min, p=0.042), and a greater use of mechanical thrombectomy in the high CPES group (21.3% versus 1.5%, p<0.001). Outcomes showed that CPES ≥3 was associated with a longer LOS (median 6 versus 5 days, adjusted OR, 1.426, p=0.012) but was not a significant predictor of in-hospital or 30-day mortality after adjustment. As a continuous variable, CPES correlated significantly with 30-day readmission (adjusted OR, 1.133, p=0.021) and LOS (adjusted OR, 1.462, p=0.038) but was not associated with in-hospital or 30-day mortality. Major bleeding rates were lower in higher CPES groups (in-hospital adjusted OR, 0.270, p=0.025; 30day adjusted OR, 0.242, p=0.023), with AUROCs of 0.883 and 0.884, respectively.

CONCLUSION: The CPES score effectively predicts prolonged hospital stay, 30-day readmission, and a lower risk of major bleeding in stable, intermediate-risk PE patients, supporting its use in risk stratification. However, its limited association with mortality suggests further refinement is needed to improve predictive accuracy for severe outcomes.

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ABSTRACT #115 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY ORAL DECITABINE/CEDAZURIDINE IS A TOLERABLE AND EFFECTIVE AMBULATORY REGIMEN FOR PATIENTS WITH ADVANCED MYELOPROLIFERATIVE NEOPLASMS Ganesh Sivakumar1, Shivani Handa 2, Andrew Srisuwananukorn 3, Douglas Tremblay 2, John Mascarenhas 2, Marina Kremyanskaya2, Yelena Ginzburg 2, Xiaoli Wang2, Ronald Hoffman2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States

Presented at the American Society of Hematology (ASH) Annual Meeting held at San Diego, California, United States from December 9-12, 2023.

BACKGROUND/INTRODUCTION: Treatment options are limited for patients with advanced myeloproliferative neoplasms (MPNs). Most patients become refractory to JAK2 inhibitor (JAKi) therapy by 3 years with subsequent survival of only 11-16 months. Sequential treatment with chromatin-modifying agents including decitabine (D) can upregulate CXCR4 expression, correct abnormal trafficking of myelofibrosis (MF) stem cells, and eliminate JAK2V617F+ MF stem and progenitor cells in preclinical models (Wang et al, Cancer Res 2019, Blood 2010).

Combination therapy with intravenous D and ruxolitinib (Rux) had a favor-able effect on overall survival (OS) in a phase 2 study of MPN-accelerated/blast phase patients (Mascarenhas et al, Blood Adv 2020) and prolonged survival in a cohort of DIPSS-plus high-risk MF pts (Bader et al, Leuk Res 2015). Oral decitabine/cedazuridine (DC), therefore, represents an attractive ambulatory treatment option for patients with advanced MPNs. METHODS: We retrospectively reviewed the electronic health records of patients with advanced high-risk MF (AHR-MF) or MPN- accelerated phase (MPN-AP) seen at our institution that were treated with DC with or without a JAKi from 1/2021-7/2023. MPN- AP was defined by the presence of 10-19% blasts in peripheral blood/ bone marrow. AHR-MF was defined by the presence of 4-9% circulating blasts or 5-9% blasts in the bone marrow, and/or refractoriness to a JAKi. RESULTS: A total of 14 patients, 7 each with MPN-AP and AHR-MF, respectively received DC therapy (Table 1). Most pts (8/14 or 57%) were older than 75 years. All patients were classified as high risk/very high-risk (MIPPS70 plus v.2). Ten (71%) patients had one or more high molecular risk mutations ( ASXL1, EZH2, SRSF2, IDH1/2, U2AF1), with the most prevalent being ASXL1 mutations in 8/14 (57%) patients. Other somatic mutations included NF1, KRAS, NRAS, BRAF, GATA2, STAG2, DNMT3A and TET2 genes. Eight of the 14 patients (57%) had either an unfavorable or very high-risk karyotype (MIPSS70 plus v.2). Thirteen patients had previously failed JAKi therapy. The median number of cycles of DC therapy was 2 (range,1-6) and 4 (range,1-26) for MPN-AP and AHR-MF patients, respectively and 4/7 patients received a concurrent JAKi in each group. Two patients in AHR-MF cohort were successfully bridged to transplant. Two patients in the MPN-AP group discontinued treatment after cycle 1 due to neutropenic sepsis and progression to blast phase, respectively. Among MPN-AP patients who received ≥ 2 cycles of DC, circulating blasts were reduced to ≤ 5% in 4/5 patients, normalization of thrombocytopenia and improvement in hemoglobin by ≥1.5 g/dl each occurred in 3/5 patients (Figure 1). In the AHR-MF cohort, 6/7 patients received ≥2 cycles of DC with elimination of circulating blasts in one patient. WBC and platelet count were effectively reduced in 4/4 and 2/2 patients with baseline WBC of >50x 10 3/uL and platelet count >1000 x 10 3/uL, respectively. Spleen size reduction was achieved in two patients with combination of DC + Rux who were previously refractory to a JAKi. One patient achieved complete resolution of palpable splenomegaly after 2 cycles of combination therapy. The predominant treatment-related adverse event was neutropenic fever in three patients requiring hospitalization. DC cycle length was reduced from 5 to 3/28 days in 7/14 patients, which reduced the degree of therapy related neutropenia and anemia. Patients remained ambulatory during treatment except for hospitalizations related to neutropenic fever. With a median follow-up of 109 days (range, 28 days - 29 months), median OS has not been reached. Three patients in the MPN-AP cohort

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progressed to MPN-blast phase (BP), including two patients who only received one cycle of DC. Two patients with MPN-BP died after 28 and 68 days of DC therapy, respectively. None of the AHR-MF patients progressed to MPN-AP/BP. The most durable response was observed in a patient who has received a total of 26 cycles of DC + Rux with stable disease for >2 years and loss of BRAF and KRAS mutations after 9 months of treatment.

CONCLUSION: DC therapy appears to be a well-tolerated and effective oral ambulatory regimen with clinically meaningful responses in elderly, transplant ineligible patients as well as a bridge to transplant in high-risk patients with advanced MPNs. The ease of outpatient administration significantly reduces patient treatment burdens and positively impacts their quality of life. These data provide a rationale for studying oral decitabine/cedazuridine +/JAKi in a prospective manner, especially in patients with AHR-MF refractory to JAKi prior to evolution MPNAP/BP.

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ABSTRACT #116 CLINICAL RESEARCH PULMONARY/CRITICAL CARE HYPERSOMNIA IN THE INTENSIVE CARE UNIT: A MARKER FOR POOR OUTCOMES? Suraj Shah1, Adrian Chernyk1, Christiana Choi1, Keshav Dixit1, Priscilla V. Loanzon1, Hua-hsin Tai1, Alvin Yang1, Connor Smith1, Benjamin Samuel1, Hammad Sheikh1, Arshdeep Dhaliwal1, Idayat Brimah1, Deepanjali Radhakrishnan Nair1, Daniel Levendowski2, Raymonde Jean1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Advanced Brain Monitoring, Carlsbad, CA, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting held at Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Studies have shown that patients admitted to the intensive care unit (ICU) experience poor sleep. The role sleep may play in recovery for ICU patients is just beginning to be explored. We conducted an observational study aimed at evaluating sleep quality and quantity in patients admitted to the ICU.

METHODS: Sleep Profiler™, an FDA-approved device, was used to record physiological signals during wake and sleep for a period of 24 hours. Patient data was auto scored by the Sleep Profiler™ software prior to data analysis. The study included 35 eligible ICU patients, of which 15 were intubated and 20 non-intubated. Several variables were studied for associations, including intubation status, reasons for ICU admission, sleep time, presence of sepsis, disposition, and level of sedation as defined by the Richmond Agitation-Sedation Scale (RASS). Main diagnoses for ICU admission were stratified to acute respiratory failure, sepsis/shock, and others.

Dispositions were defined as home, death, and other. The patients were classified into short sleepers (<6 hours) and long sleepers (>10 hours). Multiple logistic regression models were used to identify significant associations of potential variables. The trends observed in patients with sleep time >=14 hours warranted a sub-group analysis.

RESULTS: The total sleep time (TST) was recorded in 35 patients. Subgroup analyses were performed between the 12 patients with 14 or more hours TST (classified as “hypersomnia”) versus the 23 patients without hypersomnia. Mean age and BMI were similar between the two groups (66.83 versus 67.65 and 28.96 versus 27.75, respectively). Hypersomnia was found to have the strongest associations with disposition and intubation.

A p-value of <0.05 was considered significant. 10 (83.3%) patients were intubated in the hypersomnia group, compared to 5 (21.7%) patients who were intubated in the non-hypersomnia group (p-value 0.0009). Mean sleep time was found to be 16.81 (SD 4.00) amongst intubated patients, compared to 8.43 (SD 5.44) amongst non intubated. The hypersomnia group had significantly worse dispositions (p-value 0.0369). Among the 12 patients with hypersomnia, 6 (50%) were discharged to home, and 6 (50%) died. Among the 23 patients without hypersomnia: 12 (52%) were discharged home, 5 (22%) died, and 6 (26%) were discharged to non -acute care settings. There were no statistically significant differences in the two groups when compared for diagnosis on ICU admission, presence of sepsis, ICU or hospital length of stay, or degree of sedation as determined by RASS score.

CONCLUSION: This study suggests that hypersomnia in the ICU (>=14 sleep hours) could be a novel marker for poor outcomes, including intubation and mortality. Interestingly, sedation as measured by RASS score, was not significantly associated with sleep length.

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ABSTRACT #117 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY EARLY IDENTIFICATION OF VITAMIN B12 DEFICIENCY: A CRITICAL STEP IN PREVENTING REVERSIBLE COMPLICATIONS AND SCREENING FOR UNDERLYING MALIGNANCY Astitva Soni1, Maninderjit Ghotra1, Forough Hakimzada1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Vitamin B12 is an essential co-enzyme required for DNA synthesis, erythropoiesis and neurologic function. Its deficiency can manifest with a range of symptoms including neuropsychiatric disturbances, gastrointestinal symptoms, macrocytosis and less commonly, pancytopenia and hemolytic anemia. Pernicious anemia is a relatively rare autoimmune disorder that decreases B12 absorption due to autoantibodies against intrinsic factor or gastric parietal cells. Here, we present a case with initial presentation of pancytopenia and hemolysis secondary to pernicious anemia, calling attention to the vital role of understanding B12 metabolism for accurate diagnosis and prompt intervention.

CASE PRESENTATION: A 59-year-old male with past medical history of major depressive disorder, hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, and prior cerebrovascular accident presented with one-month of intermittent nausea and non-bloody, non-bilious vomiting. The patient also reported 30lbs unintentional weight loss over a period of six months. Additionally, the patient was recently assessed by a Neurologist for memory loss and cognitive impairment. He denied any fever, chills, diarrhea, mouth ulcers, difficulty walking, weakness, recent falls, or numbness/tingling in his hands or legs. Social history was notable for daily marijuana use for 15 years. He has never been vegetarian/vegan and is not on a PPI or metformin. Family history is remarkable dementia and vitamin B12 deficiency in mother.

Initial laboratory evaluation was significant for leukopenia, (WBC 4.4 ×10³/µL), macrocytic anemia (Hgb 8.8 g/dL, MCV 115fL), thrombocytopenia (platelets 124 ×10³/µL) with biochemical markers of hemolysis (elevated lactate dehydrogenase, increased indirect bilirubin, and decreased haptoglobin). Coombs testing was negative. Peripheral smear revealed few tear-drop cells, multiple hyper segmented neutrophils, and schistocytes (Image 1a and 1b).

Further laboratory work-up demonstrated profound B12 deficiency (<148pg/mL), highly elevated methylmalonic acid and homocysteine levels. Serologic tests were positive for intrinsic factor and parietal cell antibodies, consistent with diagnosis of pernicious anemia. Given weight loss history and above findings, he underwent endoscopic evaluation which revealed diffusely atrophic mucosa throughout the stomach consistent with atrophic autoimmune gastritis. Several additional biopsies were obtained which were negative for H. pylori. A single 20 mm flat polyp was also identified and removed, which histopathology later revealed to be poorly differentiated gastric adenocarcinoma. Nausea and vomiting resolved with as needed antiemetics thought to be multifactorial in the setting of autoimmune gastritis and cannabis use. Patient was subsequently started on weekly B12 injections with daily oral supplementation and was discharged from the hospital with follow up with gastroenterology and oncology for further staging work-up for treatment planning.

CONCLUSION: Vitamin B12 deficiency can present with a spectrum of clinical manifestations, including asymptomatic macrocytosis, progressive neuropathy, and neuropsychiatric impairment. More rare hematologic findings include pancytopenia and hemolytic anemia from ineffective erythropoiesis, characterized by intramedullary destruction of cells including RBCs. Other proposed mechanisms for hemolysis include oxidative stress from hyperhomocysteinemia which can cause RBC membrane damage.

In this case, the patient presented with many classic findings of B12 deficiency including memory problems/cognitive impairment, macrocytosis, pancytopenia, hemolysis, and GI symptoms. Often though, cases may not appear as clear-cut and as such there should be heightened clinical suspicion, especially in patients with personal or family history of autoimmune disease.

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Vitamin B12 deficiency can be caused by several etiologies. In this case, family history reveals B12 deficiency in patient’s mother with associated cognitive decline. This patient also presents with other autoimmune diseases (i.e. hypothyroidism) which is often comorbid with pernicious anemia. As evident in this case, patients with atrophic autoimmune gastritis should undergo regular endoscopic surveillance due to increased risk of gastric cancers and should be tested for H. pylori. Patients should also be screened for other vitamin deficiencies due to atrophic gastritis-induced hypochlorhydria and subsequent malabsorption.

Ultimately, this case highlights the importance of early recognition of B12 deficiency in patients presenting with pancytopenia and hemolysis. Given the potential for reversible neurologic and hematologic complications, as well as the risk of concurrent gastric malignancy in autoimmune gastritis, identifying B12 deficiency and its underlying cause can aid in early diagnosis and treatment.

Figure 1. Peripheral smear revealed few tear-drop cells, multiple hyper segmented neutrophils, and schistocytes (image 1a and 1b).

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ABSTRACT #118 MEDICAL EDUCATION PALLIATIVE CARE END-OF-LIFE CHEAT SHEET: AN END-OF-LIFE SYMPTOM MANAGEMENT POCKET REFERENCE CARD FOR RESIDENTS AND GENERAL INTERNISTS Dylan Suyama1, Raul Benavides1, Yu Shindo2, Noelle Marie Javier2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the McGill International Palliative Care Annual Congress that was held in Montreal, Québec, Canada from October 15-18, 2024.

BACKGROUND/INTRODUCTION: End-of-life (EOL) symptom management is a key component of patientcentered care. Internal medicine residents are front line providers to many EOL patients and should be empowered to initiate timely and effective comfort-focused care. This medical education project aims to increase medical residents’ confidence and competence in EOL symptom control in the inpatient setting.

METHODS: A mixed-methods educational approach was designed after baseline needs assessment. The intervention consists of badge-sized reference cards (“Cheat Sheets”) complemented by small-group teaching sessions. An EMR-based ‘Comfort Care’ order set was developed to streamline end-of-life prescriptions. The Cheat Sheets contained key end-of-life symptoms, suggested medication dosages, directions to access the EMR order set, and indications for a palliative care consult. Data was gathered through pre- and post- surveys of residents at designated timepoints.

RESULTS: A needs assessment of 30 residents showed that 50% (n=15) had low confidence in EOL prescribing and 80% (n=24) described a lack of knowledge on medication dosages. Following our intervention, surveys of 26 participants revealed statistically significant improvements in resident confidence.

Mean comfort level for EOL prescription increased from 3.34 to 4.16 (p=0.0003; 95%CI, 0.39-1.23) with corresponding positive results in the domains of pain/dyspnea, nausea/vomiting, anxiety/agitation, and respiratory secretion management. An audit of the usage of the EMR Comfort Care order set is underway to determine the impact of the project on resident prescribing practices.

CONCLUSION: This medical education project uses innovative techniques to promote simplified resident led EOL care. Utilizing a handy pocket reference card along with didactic sessions and EMR-activated resources are effective tools in delivering high quality comfort-focused care.

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ABSTRACT #119 MEDICAL EDUCATION GENERAL INTERNAL MEDCINE/PULMONARY/CRITICAL CARE AN INTROSPECTIVE LOOK INTO ULTRASOUND CURRICULUM – INTRODUCING BASIC ULTRASOUND TECHNIQUES THROUGH ULTRASOUND-GUIDED INTRAVENOUS LINE INSERTION Hua-Hsin Tai1 and Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Point of care ultrasound (POCUS) is an advanced diagnostic bedside technique that assists physicians in aiding diagnosis and management of diseases. Commonly used in other specialties, there is an expanding need to incorporate POCUS curriculum in specialties like Internal Medicine.

Timely laboratory data is vital in accurately treating and diagnosing patients appropriately. Intravenous line insertion using ultrasound guidance can be a fundamental way to utilize and teach basic ultrasound techniques.

METHODS: Multiple small group sessions were hosted throughout the first two months of the academic year, to teach basic ultrasound (US) guided intravenous (IV) line insertion to the new Internal Medicine interns at Morningside/West Hospitals. Learners (n=54) attended a 30-minute session split into two parts – 1) an overview of the ultrasound machine, and 2) hands-on practice using line simulators with immediate feedback from certified instructors. Learners were then evaluated for competency at the end of the session. A pre-test and post-test analysis using paired sample T-test was performed following the sessions to gauge changes in confidence and competence of learners after the intervention.

RESULTS: Thirty-five percent of learners (n=19) had some prior experience with US before the sessions, and 92% (n=50) of learners thought it was “very useful” to have formal training on US-guided IV lines. There was a significant difference (p<0.001) in pre-to-post confidence and competence of learners after the intervention.

CONCLUSION: There was a significant difference in both the confidence and competence of learners after the intervention, suggesting the intervention was effective at teaching learners US-guided IV-line insertion techniques. One major complaint was that learners wanted more time to practice during the session as they felt it was too short.

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ABSTRACT #120 CLINICAL RESEARCH CARDIOLOGY ETHNIC DIFFERENCE IN SPONTANEOUS CORONARY ARTERY DISSECTION: A POPULATIONBASED ANALYSIS OF INCIDENCE AND CLINICAL OUTCOMES Samuel Tan1, Lucy S. Zheng1, Wenchy Tan1, Shasawat Kumar1, Esha Vaish1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Cardiology (ACC) Annual Meeting that was held in Atlanta, Georgia, United States from April 6-8, 2024.

BACKGROUND/INTRODUCTION: Spontaneous coronary artery dissection, a rare cause of acute coronary syndrome, is increasingly recognized. Additionally, the utility of intravascular ultrasound guided angiography in spontaneous coronary artery dissection is not fully elucidated. We investigated the demographic, socioeconomic and clinical characteristics using a large national database to identify potential disparities in incidence, comorbidities, and treatment outcomes.

METHODS: This was a retrospective study using data from the National Inpatient Sample database between January 2016 and December 2019. Spontaneous coronary artery dissection patients were identified and divided by use of intravascular ultrasound. Primary outcome was all-cause in-hospital mortality. Secondary outcomes included complications, cost, and length of stay. COVID-19 patients were excluded. Weighted multivariable logistic regression and chi-square tests were used to analyze outcomes. We controlled for comorbidities, age, gender and, when appropriate, race/ethnicity for the multivariable analysis.

RESULTS: A total of 5,262 spontaneous coronary artery dissection patients were identified. Annual incidence increased by 12.7% with the highest rise in patients aged 18-44 years (27%) and 65-85 years (16%). Black patients had the lowest mean age compared to White patients. Spontaneous coronary artery dissection incidence was highest among Black females. Significant income disparities were observed with 50% of Black and Hispanic patients in lower income quartiles. Patients undergoing angiography with intravascular ultrasound had better outcomes with lower odds of mortality and complications.

CONCLUSION: Significant demographic, socioeconomic, and clinical disparities in spontaneous coronary artery dissection incidence and outcome exist. Further studies are needed to refine patient selection and management strategies for intravascular ultrasound in spontaneous coronary artery dissection.

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ABSTRACT #121 CLINICAL RESEARCH CARDIOLOGY/NEPHROLOGY ASSOCIATION OF Z-CODES WITH MORTALITY AND DIALYSIS IN PATIENTS WITH ACUTE KIDNEY INJURY AND HEART FAILURE Wenchy Tan1, Samuel Tan1, Lili Chan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Nephrology Society Annual Meeting held in San Diego, California, United states from October 23-27, 2024.

BACKGROUND/INTRODUCTION: Acute kidney injury (AKI) is a serious complication in patients admitted for acute decompensated heart failure. Z-codes are part of the ICD-10-CM coding system codes for social determinants health (SDOH). There is a lack of data regarding the association of coding for SDOH on outcomes in patients admitted for acute decompensated heart failure.

METHODS: This was a retrospective study using the National Inpatient Sample to identify patients admitted for acute decompensated heart failure and diagnosed with AKI during their admission from 2016 to 2020.

Patients diagnosed with acute decompensated heart failure were identified with ICD 10 codes I50.21, I50.23, I50.31, I50.33, I50.41, I50.43, I50.9 and those with AKI were identified using ICD-10 codes N17.0, N17.1, N17.2, N17.8 and N17.9. Patients who had end-stage kidney disease were identified using ICD-10 codes N18.6 and Z99.2 were excluded. The primary outcome was in-hospital all-cause mortality. The secondary outcome was in-hospital dialysis. Weighted multivariable logistic regression and chi-square were used to analyze outcomes while controlling for Elixhauser Comorbidity Index, age, gender, and race/ethnicity.

RESULTS: There were 481,298 patients admitted for acute decompensated heart failure and diagnosed with AKI during their hospital stay. 4,650 patients with Z-codes were propensity matched with 4,650 patients without Z- codes. Compared to the control group, those who had Z-codes are associated with significantly lower odds of mortality (OR, 0.96; 95%CI, 0.96-0.97). Females (OR, 0.54; 95%CI, 0.50-0.578) and older (OR, 0.96; 95%CI 0.96-0.96) individuals were significantly less likely to have any Z-codes. Compared to Whites, Black (OR, 1.53; 95%CI, 1.41-1.66), Hispanic (OR, 1.14; 95%CI, 1.01-1.23) and Asian (OR, 1.35; 95%CI, 1.06-1.73) patients were significantly more likely to have Z-codes. Z-Code is associated with a significantly decrease odds of dialysis (OR, 0.52; 95%CI, 0.36–0.76). Compared to Whites those who are Hispanic (OR, 1.21; 95%CI, 1.11-1.31) and Asians (OR, 1.32; 95%CI, 1.15-1.51) are significantly more likely to end up on dialysis during their hospital stay. However, there is no significant association for odds of requiring dialysis when comparing Whites with Z-codes and Blacks (p=0.72) and Hispanics (p=0.61) with Z-codes.

CONCLUSION: We found that in matched cohorts, the presence of a Z-code lead to lower odds of mortality.

Black, Hispanic, and Asian individuals were significantly more likely to have Z-codes than White individuals.

These results may be due to provider recognition and documentation of unmet social determinants health, noting the importance of unmet social determinants health.

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ABSTRACT #122 CLINICAL RESEARCH CARDIOLOGY BIOPSY IN CARDIAC SARCOIDOSIS: IS IT CRUCIAL FOR PREDICTING ARRHYTHMIAS AND GUIDING DEVICE THERAPY? Vincent Torrelli1, Alexander Silverman1, Usman Saeedullah1, Syed Zaidi1, Komail Jafri1, Luka Katic1, Sanjay Sivalokanathan1, Ashish Correa1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Definitive diagnosis of cardiac sarcoidosis remains difficult by current Heart Rhythm Society guidelines, requiring either histopathological evidence of noncaseating granuloma on myocardial biopsy or granulomas on extracardiac biopsy with specific imaging findings. Endomyocardial biopsy demonstrates limited sensitivity (20-30%), and since cardiac sarcoidosis increases the risk of ventricular arrhythmias and sudden death, prompt initiation of management is crucial. As a result, guidelines for implantable cardioverter-defibrillator (ICD) implantation in cardiac sarcoidosis were modified to accommodate this risk. This analysis investigates whether biopsy proven cardiac sarcoidosis correlates with specific arrhythmias and device management decisions.

METHODS: We conducted a retrospective analysis using data from an ethics-approved, single-center registry of 90 patients diagnosed with cardiac sarcoidosis. Patients were stratified based on biopsy status, including both cardiac and extracardiac biopsy results. We assessed associations between biopsy status and arrhythmias, as well as rates of pacemaker (PPM) and CRT-D placements. Statistical analyses included ttests and adjusted logistic regression models.

RESULTS: Among the 90 patients with cardiac sarcoidosis, 52 had a positive biopsy (cardiac or extracardiac), and 38 were without positive biopsy results. Significant associations were observed between biopsy positivity and occurrence of ventricular tachycardia, ventricular fibrillation, and first-degree AV block.

Biopsy status did not significantly impact PPM or ICD placement.

CONCLUSION: While patients with biopsy-confirmed cardiac sarcoidosis are more likely to experience ventricular arrhythmias and first-degree AV block, biopsy results do not appear to influence device implantation decisions. Although myocardial biopsy is the gold standard for diagnosis, its low sensitivity limits its practical value, suggesting that device-based management of arrhythmias in cardiac sarcoidosis remains adequate regardless of biopsy confirmation. Future studies should be conducted to evaluate management practices based on biopsy status.

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ABSTRACT #123 CASE REPO RT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE A CASE OF GASTROINTESTINAL ADVERSE EFFECTS OF GLP-1 AGONISTS WHEN USED FOR WEIGHT LOSS Julia Torrellas1 and Alfred Burger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

CASE PRESENTATION: A 65-year-old male with past medical history of prediabetes, hyperlipidemia, and depression presented with chest discomfort and one day of intractable vomiting after taking 7 mg oral semaglutide daily for the past month. He reported one day of exertional chest pressure and shortness of breath all of which improved with rest. Initial vitals were temperature: 36.7 ºC, blood pressure: 123/69, heart rate: 107 bpm, respiratory rate: 20/min, SpO2: 96% on room air. He had triple acid-base disturbance with a urinalysis positive for ketones, and anion gap of 17.1 mEq/L concerning for starvation ketosis, with respiratory alkalosis, and contraction alkalosis. Lactate was normal at 1.5 mmol/L, WBC was elevated to 15.6 x 109/L, lipase was 10 (normal, 0-160 U/L) and initial high-sensitivity troponin was 26 (<14 ng/L). CT abdomen and pelvis did not show pancreatitis. Semaglutide, escitalopram, and rosuvastatin were held as possible medication-induced causes of vomiting. He was admitted with telemetry monitoring.

After fluid resuscitation and clear liquid diet, the vomiting improved, but nausea persisted. Troponins continued to increase 26, 46, 53, and 69. He was hypertensive with systolic blood pressure of 160s180s. Transthoracic echocardiogram showed normal left ventricular size and function, but hypokinesis of the basal inferior wall. Cardiology was consulted who reviewed his CT abdomen pelvis and noted extensive coronary calcification in the right coronary artery, left anterior descending artery, and left circumflex, concerning for moderate-to-severe coronary artery disease. He had ongoing burning chest discomfort which improved with sublingual nitroglycerin. Given concern for type 1 non-ST-elevation myocardial infarction, he underwent left heart catheterization which showed 60-70% stenosis of the distal right coronary artery and distal left circumflex artery. Coronary artery disease and hypertension were medically managed. Persistent nausea was attributed to semaglutide side effect, resulting in profound volume contraction which likely caused demand ischemia and unmasked his non-critical coronary artery disease.

CONCLUSION: Semaglutide was approved by the FDA for diabetes management in 2017, and later for weight loss in 2021. Recent studies have shown benefits in cardiac disease. However, GLP-1 agonists have been known to cause nausea and vomiting, especially at higher doses. Use of semaglutide increased risk of pancreatitis, gastroparesis, and bowel obstruction. Semaglutide associated gastroparesis can take 4-8 weeks to resolve. Our patient was started on 7 mg semaglutide rather than the recommended starting dose of 3 mg. Clinicians must be aware of the dose-dependent relationship between severe adverse gastrointestinal effects and semaglutide use, leading to hypovolemia and physiologic stress. Our case highlights the severity of potential gastrointestinal side effects of semaglutide and suggests a dose-dependent relationship. These adverse effects may result in hospitalization of patients at high risk for cardiovascular disease taking semaglutide. Thus, although generally started in the clinic, hospitalists must be aware of the potential adverse effects of this medication.

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ABSTRACT #124 CLINICAL RESEARCH CARDIOLOGY/ENDOCRINOLOGY OUTCOMES ASSOCIATED WITH GLP1 RECEPTOR AGONIST USE ON PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROL TRIALS Brandon Berman1, Esther Tsyngauz1, Harrison Bonilla1, Joshua Guardia1, Kiran Mahmood1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: There has been increasing interest in and use of glucagon-like receptor agonists (GLP1-RAs) in the past decade, especially in preventing and treating cardiovascular disease.

Randomized control trials have shown the efficacy of GLP1-RAs in cardiovascular outcomes but have shown inconsistent data on the efficacy and safety of these drugs in patients with heart failure with reduced ejection fraction (HFrEF). This meta-analysis evaluates the effects of GLP1-RAs on mortality, heart failure hospitalizations, left ventricular (LV) function, and patients’ functional status in patients with HFrEF. METHODS: After performing a systematic Pubmed and Google Scholar search followed by a full-text screen, all randomized controlled trials (RCT) and secondary/posthoc analyses that included patients with pre-existing HFrEF and the effects of GLP1-RAs on mortality, heart failure hospitalizations, LV function, and patient’s functional status were included. Combined data from the studies was analyzed in a meta-analysis using Cochrane’s RevMan software.

RESULTS: A total of 20 studies were analyzed. The use of GLP1-RAs in HFrEF demonstrated a modest 9% reduction in the rate of mortality over the study period compared to placebo (HR, 0.91; 95%CI, 0.84-0.98; p=0.01) and there was a significant improvement in patient’s functional status when compared to placebo, as demonstrated by a greater than 12m increase in 6-Minute Walk Distance (6MWD) (+12.84 m; 95%CI, 0.7924.88; p=0.04) and 7% decline in N-terminal pro-B-type natriuretic peptide (NT-ProBNP) levels (treatment ratio, 0.93; 95%CI, 0.88-0.98; p=0.004) (Figure 1). Significant effects were also seen in echocardiographic findings.

There was a mild but significant decline in LV ejection fraction (–1.02%; 95%CI, –1.96% to –0.08%; p=0.03), however cardiac output (0.42 L/min; 95%CI, 0.33-0.52; p< 0.00001) and cardiac index (0.32 ml/min/m2; 95%CI, 0.25-0.38; p<0.00001) demonstrated significant mild increases. Studies also demonstrated a significant decrease in E/e’ (-1.21; 95%CI, -1.40 to –1.01; p<0.00001) (Figure 2).

CONCLUSION: The use of GLP1-RAs in patients with reduced ejection fraction showed reductions in mortality.

However, this was less significant than in patients with heart failure with preserved ejection fraction. Additionally, there was a minimal and non-significant effect on heart failure hospitalizations in patients with reduced ejection fraction. Some trials even demonstrated trends toward slight harm in patients with more severe reduced ejection fraction. Therefore, prescribing GLP1-RAs to this patient population should be a clinical decision done on an individual basis.

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Figure 1. Forest plots demonstrating the combined summary effects of GLP1-RAs in the meta-analysis of RCTs, including on mortality (top-left panel), heart failure (top-right panel), 6-Min Walk Distance (center panel), KCCQCS scores (bottom-left panel), and NT-ProBNP levels (bottom-right panel).

Figure 2. Forest plots demonstrating the combined summary effects of GLP1-RAs in the meta-analysis of RCTs on echocardiographic parameters, including on ejection fraction (top-left panel), E/A ratio (top-right panel), cardiac output (center panel), E/e’ ratio (bottom-left panel), and E-wave velocity (bottom-right panel).

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ABSTRACT #125 BASIC SCIENCE HEMATOLOGY/ONCOLOGY PERSONALIZED TARGETED THERAPY OF CAR+ T-CELL LYMPHOMA AFTER ANTI-BCMA CAR-T Oliver Van Oekelen1*, Adolfo Alema2*, David T. Melnekoff2, Leah Grossman2, Tarek Mouhieddine2, Agata Kurowski2, Shannon Meledathu2, Malini P. Naidu2, Ivan Odak2, Sidorela Reci2, Shriya Desai2, Katerina Kappes2, Ksenyia Serebryakova2, Hayley Jackson2, Jordan Lu2, Anastasia Chatikhine3, Christian Rayamajhi2, Shambavi Richard2, Adrianna Rossi2, Joshua D. Brody2, Christian Salib2, Jane Houldsworth2, Patrick M. Brunner2, Alessandro Laganà2, Sundar Jagannath2, Samir Parekh2,4 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Bedminster Township Highschool,

Bedminister NJ, United States; 4Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025. *These authors contributed equally to this work.

BACKGROUND/INTRODUCTION: BCMA-directed chimeric antigen receptor (CAR) T cell therapy is an effective treatment option for patients with relapsed/refractory multiple myeloma. The development of secondary malignancies has been reported as a concern. Sporadic cases of T-cell malignancies have been reported, with substantial heterogeneity in clinical presentation. The optimal treatment is currently unknown.

CASE PRESENTATION: We report a case of clonal chimeric antigen receptor (CAR)+ peripheral T-cell lymphoma (PTCL) following BCMA-directed CAR-T therapy for multiple myeloma. A 51-year-old male presented six months after CAR-T cell infusion, and after recent COVID-19 and rhinovirus infections, with lymphocytosis and a facial lesion. The most recent multiple myeloma response assessment had shown no evidence of disease in the bone marrow and blood, including undetectable measurable residual disease. PET-CT demonstrated new FDG-avid cutaneous lesions on the nose and cheeks. A skin biopsy confirmed an atypical CD4-/CD8- T cell infiltrate. Aberrant CD4-/CD8- CAR-T cells were also found in the bone marrow and the peripheral blood. T-cell receptor sequencing (TCR-seq) and flow cytometry confirmed CAR expression and clonality, consistent with PTCL. Whole-genome sequencing (WGS) revealed the expansion of a TET2-mutant clone with additional TET2 and EZH2 mutations. A clonal CAR insertion in the 6th intron of TIA1 resulted in truncation and reduced TIA-1 expression. Since TET2 mutations have been associated with altered CAR-T function and TET2 knockout is under investigation to improve CAR-T function, we generated patient-derived CAR-T post-PTCL diagnosis and observed complete loss of cytotoxicity against BCMA-expressing multiple myeloma cells. Bulk RNA sequencing demonstrated differential expression of gene signatures associated with oncogenic proliferation and single-cell RNA-sequencing demonstrated a distinct expression profile compared to banked samples from patients with cutaneous T-cell lymphomas (CTCL) including CD4+ mycosis fungoides, primary cutaneous aggressive epidermotropic CD8+ CTCL or TCR-gamma/delta CTCL. Flow cytometry revealed overexpression of CCR4, and an in vitro small-molecule screen identified CAR T-specific vulnerabilities, including sensitivity to doxorubicin.

The patient achieved complete remission of PTCL with anti-CCR4 (mogamulizumab), liposomal doxorubicin, and gemcitabine. He started maintenance therapy with peginterferon alpha-2a and extracorporeal photochemotherapy.

CONCLUSION: In this patient, multiple factors may have contributed to the oncogenic transformation of CAR+ T cells, including the insertion of the CAR vector into the TIA1 gene. Available data suggests that immune dysregulation, pre-existing clonal hematopoiesis, and/or T-cell clonal expansion likely outweigh the role of CARrelated mutagenesis in most cases. This case underscores the need to monitor mutations associated with clonal hematopoiesis and the functional impact of TET2 loss. Additionally, it highlights the role of anti-CCR4 therapy and small-molecule screening as novel strategies to selectively target CAR-T, paving the way for personalized treatment approaches.

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ABSTRACT #126 CLINICAL RESEARCH GASTROENTEROLOGY CHALLENGING ASSUMPTIONS: IS THERE EVIDENCE THAT GASTROPARESIS INCREASES THE RISK OF GASTROESOPHAGEAL REFLUX DISEASE? Ines Varela Knorr1, Yuying Luo1, Daniela Jodorkovsky1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Digestive Disease Week (DDW) Annual Meeting that was held in San Diego, California, United States from May 3-6, 2025.

BACKGROUND/INTRODUCTION: Gastroparesis is considered a risk factor for gastroesophageal reflux disease (GERD) since many patients with gastroparesis have GERD-like symptoms. However, physiologic studies elucidating this association are contradictory. This study aims to clarify the relationship between gastroparesis and GERD-like symptoms by utilizing quantitative acid exposure testing.

METHODS: We conducted a retrospective case–control study of patients who underwent quantitative reflux monitoring at a single high-volume center between October 2021 and 2023. Patients were stratified based on gastric scintigraphy results, with the gastroparesis group defined as those exhibiting delayed gastric emptying with ≥10% retention at 4 hours. Conclusive GERD was identified based on a distal esophageal acid exposure time (AET) ≥6% in patients off proton pump inhibitors (PPIs) or an AET ≥4% in those on PPIs. Demographic data (age, gender, ethnicity) and reflux characteristics (number of post-prandial reflux events and weakly acidic reflux events) were collected. The primary outcome was the percentage of patients with conclusive evidence of GERD. Statistical analyses were performed using Fisher’s exact test and unpaired t-tests.

RESULTS: Of the 630 individuals identified with quantitative reflux testing, 181 underwent gastric emptying studies (GES); 146 (81%) patients in the non-gastroparesis group (normal/rapid GES) and 35 (19%) in the gastroparesis group (delayed GES). Etiology of gastroparesis included idiopathic (48%), diabetes (31%), and 20% from other factors like GLP-1 use or post-surgical. The groups did not differ significantly in age (51.15 versus 55.81 years; p=0.11), female proportion (60.9% versus 68.6%; p=0.44), or ethnicity (46.5% versus 54.3% White; p=0.45). Patients with gastroparesis were more likely to have conclusive GERD (54.3% versus 36.9%), but this difference was once again not statistically significant (p=0.084). No significant differences were found in postprandial events (29.98 versus 30.12; p=0.97) or weakly acidic reflux events (22.3 versus 25.9; p=0.41) between the two groups (Table 1).

CONCLUSION: Patients with delayed gastric emptying were not more likely to have conclusive GERD. No significant correlation was observed between gastroparesis and the number of weakly acidic reflux events or postprandial reflux events. The conclusive link between gastroparesis and GERD remains uncertain. Future research should explore the role of contributing factors such as hiatal hernia, esophageal dysmotility, and polypharmacy in this patient population.

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Age: Mean (SD)

Non-gastroparesis group (N= Gastroparesis 146) (N=35) 51.15 (15.48) 55.81 (16.89)

group pvalue 0.11

Female: N (%)

89 (60.9%)

24 (68.6%)

0.44

White: N (%)

68 (46.5%)

19 (54.3%)

0.45

Post pandrial reflux: Mean (SD)

29.98 (22.66)

30.12 (22.15)

0.97

Weakly acidic reflux: Mean (SD) 22.3 (20.31)

25.96 (25.19)

0.41

Conclusive GERD: N (%) 54 (36.9%) Without Conclusive GERD: N 92 (63%) (%)

19 (54.3%)

0.08

16 (45.7%)

-

Table 1. No significant differences were found in postprandial events (29.98 versus 30.12; p=0.97) or weakly acidic reflux events (22.3 versus 25.9; p=0.41) between the two groups

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ABSTRACT #127 RESEARCH CATEGORY PULMONARY/CRITICAL CARE OUTCOMES OF PATIENTS WITH INTERMEDIATE-LOW RISK ACUTE PULMONARY EMBOLISM MANAGED IN THE INTENSIVE CARE UNIT VERSUS MEDICINE FLOORS: A PROPENSITY SCOREMATCHED ANALYSIS Agostina Velo1, Jorge Sinclair De Frias1, Aesha Patel1, Hong Yu Wang1, Hammad Sheikh1, Destiny Nguyen1, Priyanka Sridhar1, Abdul Rehman2, Avinash Singh1, Robert Lookstein3, David J. Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Rutgers-New Jersey Medical School, Newark, NJ, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount

Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting to be held in San Francisco, California, United States from May 16-23, 2025.

BACKGROUND/INTRODUCTION: Acute pulmonary embolism (PE) can be risk-stratified according to guidelines from the European Society of Cardiology (ESC), which considers a patient’s hemodynamics, right ventricular function, and serum biomarkers. Hemodynamically stable patients with either evidence of right ventricular strain by imaging or positive biomarkers—but not both—are classified as intermediate-low risk (ILR).

This group of patients is sometimes managed in the intensive care unit (ICU) or on the floors, depending on institutional policies and PE Response Team (PERT) experience, although it is unclear if this influences overall patient outcomes. In this study, we explored the association of management in the ICU vs. floors with receipt of advanced therapies and overall outcomes for patients with ILR acute PE. METHODS: A retrospective chart review was performed of acute PE patients managed by PERT at one of three urban teaching hospitals in the Mount Sinai Health System from January 2019 to June 2024. A propensity scorematched analysis was performed using the MatchIt package for R with the optimal full matching specification.

Matching was performed for the Pulmonary Embolism Severity Index (PESI), National Early Warning Score (NEWS), presence of proximal deep vein thrombosis, and active malignancy. Regression models were constructed in the propensity score-matched sample to assess associations between the site of care (ICU vs. non-ICU) and receipt of advanced therapies or overall outcomes.

RESULTS: Seventy patients were included, with a median age of 63.5 [interquartile range (IQR): 53.0‒71.7 years) years and a median PESI score of 76 (IQR: 58-102) points. Females constituted 48.6% (n=34) of the sample. Advanced therapies were administered to 6 (7.1%) patients. Most patients were admitted to the ICU (n=62, 88.6%). Table 1 summarizes the baseline severity characteristics and outcomes for each group. In the propensity score-matched sample, no associations were noted between ICU level of care and 30-day mortality, re-admission, or major bleeding. Moreover, no significant associations were observed between ICU level of care and receipt of advanced therapies. However, length of stay (LOS) was significantly longer for patients managed in the ICU (incidence rate ratio: 2.1; p<0.001) compared to those managed on the floors.

CONCLUSION: When matched for severity of PE and acute illness, patients with ILR PE had longer LOS when managed in the ICU, without differences in mortality, therapies, or complications. Efforts should be undertaken to identify ILR patients who can be safely managed on the floors with potential decreases in LOS and hospital costs.

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ABSTRACT #128 CLINICAL RESEARCH ALLERGY AND IMMUNOLOGY CLINICAL OUTCOMES FOR BLACK PATIENTS WITH URTICARIA Megha Verma1, Danielle C. Thor2, Tony Elias3, Mahija Cheekati4, Marie Mccleary5 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Jefferson Health New Jersey, New Jersey, NJ, United States; 3Rowan-Virtua School of Osteopathic Medicine, New Jersey,

NJ, United States; 4Morristown Medical Center, New Jersey, NJ, United States; 5Virtua Our Lady of Lourdes Hospital, New Jersey, NJ, United States

Presented at the American Academy of Asthma, Allergy, and Immunology (AAAAI) Annual Meeting that was held in San Diego, California, United States from February 28, 2025 to March 3, 2025.

BACKGROUND/INTRODUCTION: A growing number of inquiries have emerged examining the link between urticaria and clinical outcomes, including but not limited to cancer risk or risk of autoimmunities. We sought to examine the National Inpatient Sample (NIS) database to describe in-hospital outcomes among the black population with urticaria.

METHODS: Data were extracted from the NIS Database from 2019 and 2020. The NIS was searched for hospitalizations of all patients greater than 18 years old with a recorded diagnosis of urticaria. We then analyzed the outcomes of patients who were identified as black. Multivariate logistic regression analysis was used to adjust for confounders; SPSS software was used for statistical analysis. The primary outcome was inpatient mortality and secondary outcomes are listed below.

RESULTS: This study included 10,285 patients with urticaria, of which 1182 (11.5%) were identified as Black.

Black patients with urticaria had a higher prevalence of hypertension (20.4% versus 15.7%, p<0.001) and chronic kidney disease (14.3% versus 10.3%, p<0.001), as well as a lower incidence of smoking (16.2% versus 17.5%, p<0001). Multivariate regression demonstrated that black patients with urticaria had higher inpatient mortality (OR, 1.048; 95%CI, 1.001-1.096; p<0.001). On secondary analysis, Black urticaria patients were found to be more likely to have a variety of disease processes, such as metastatic cancer (OR, 1.075; 95%CI, 1.049-1.102; p<0.001), leukemia (OR, 1.063; 95%CI, 1.033-1.093; p<0.001), and lymphoma (OR, 1.078; 95%CI, 1.033-1.125; p<0.001).

CONCLUSION: In this nationally representative, population‐based retrospective cohort study, hospitalized black patients with urticaria were associated with higher mortality and worse outcomes.

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ABSTRACT #129 CLINICAL RESEARCH GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY FACTORS ASSOCIATED WITH STAGE AT DIAGNOSIS OF RECTAL CANCER: A POPULATION-BASED ANALYSIS Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Sirish Dharmapuri2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States

BACKGROUND/INTRODUCTION: Rectal cancer is a significant public health concern due to rising incidence among younger adults over the past decades. Early-onset rectal cancer (EO-RC) is defined as rectal cancer diagnosed in individuals under 50 years of age. However, screening guidelines, remain primarily focused on older populations potentially contributing to diagnostic delays in younger individuals. The aim of this study is to investigate factors associated with the stage at diagnosis of rectal cancer.

METHODS: We analyzed patients aged ≥18 years with rectal cancer from the Surveillance, Epidemiology, and End Results (SEER) database, focusing on cases diagnosed between 2018 and 2021. This study period was selected due to the availability of microsatellite instability (MSI) data starting in 2018. Inclusion criteria encompassed adults with histologically confirmed rectal cancer as a first primary malignancy, complete MSI data, staging information, and known cause of death. A retrospective cohort study was conducted. Categorical variables were summarized using frequencies and percentages and compared via chi-squared tests. Ordinal logistic regression was employed to evaluate factors associated with the stage at diagnosis.

RESULTS: A total of 13,768 patients were included, with 2,661 (19.3%) diagnosed with EO-RC and 11,107 (80.7%) with average-onset rectal cancer (AO-RC). Most patients were male (60.8%), white (66.9%), diagnosed at stage III (34.8%), and had MSI-stable tumors (94.6%). Ordinal logistic regression revealed that EO-RC patients were more likely to be diagnosed at advanced stages compared to AO-RC patients (OR, 1.69; 95%CI, 1.56–1.82; p<0.001). Female patients had higher odds of earlier-stage diagnoses compared to males (OR, 0.88; 95% CI, 0.83–0.94; p<0.001), and MSI-high tumors were associated with earlier-stage diagnoses compared to MSI-stable tumors (OR, 0.75; 95% CI, 0.64–0.88; p<0.001).

CONCLUSION: EO-RC is significantly associated with advanced stage at diagnosis compared to AO-RC, raising concerns about delayed recognition in a population experiencing a rising incidence in recent years. The association between MSI-high tumors and earlier stage at diagnosis is consistent with literature suggesting an immunogenic nature of MSI-H tumors. Additionally, the observed gender disparity, with females more likely to present at earlier stages, highlights the need to explore potential differences in symptom recognition, healthcare access, or tumor biology. These findings emphasize the importance of tailored public health interventions to enhance awareness, promote timely detection, and reconsider screening strategies, particularly for younger populations at risk.

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Table 1. Ordinal logistic regression analysis of factors associated with stage at diagnosis of rectal cancer Unadjusted OR p Adjusted OR Variable (95% CI) value (95% CI) p value Race Non-Hispanic Ref. White 1.07 (0.981.15 (1.05-1.26) 0.001 0.091 Hispanic 1.18) Non-Hispanic 1.10 (0.981.11 (0.99-1.25) 0.066 0.088 Black 1.24) Non-Hispanic 1.05 (0.951.07 (0.97-1.18) 0.144 0.283 Asian/PI 1.16) 1.20 (0.851.14 (0.81-1.60) 0.448 0.283 Non-Hispanic AI 1.70) Onset Average-Onset Ref. 1.69 (1.561.68 (1.56-1.82) <0.001 <0.001☨ Young-Onset 1.82) Sex Male Ref. 0.88 (0.830.89 (0.84-0.95) <0.001 <0.001☨ Female 0.94) Socioeconomic Status <$40,000 Ref. $40,0000.97 (0.73-1.28) 0.842 $79,999 $80,000*Not included due to 0.93 (0.70-1.23) 0.629 $100,000 collinearity >$100,000 0.89 (0.67-1.19) 0.463 Area of Living NonRef. Metropolitan 1.04 (0.951.08 (0.98-1.18) 0.09 0.354 Metropolitan 1.14) MSI status MSI stable Ref. 1.15 (0.921.17 (0.94-1.45) 0.159 0.224 MSI low 1.43) 0.75 (0.640.78 (0.66-0.92) 0.003 0.001☨ MSI high 0.88) Multivariate logistic regression, adjusted logistic regression is adjusted to race, sex, area of living, MSI status and stage. Income was not included due to a VIF >10, suggesting collinearity. ☨: p value <0.05, statistically significant.

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ABSTRACT #130 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE IMPROVING ACCESS TO TREATMENT FOR ADULT ADHD PATIENTS BY ALIGNING MEDICATION DISTRIBUTION POLICY WITH NEW YORK STATE REGULATIONS Anushri K. Wagner1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

PURPOSE: We advocate for major mail-order pharmacy companies to update their policies to be in line with current state regulations to allow for sufficient supply, fewer refills required per year, and to provide timely personalized reminders to patients who suffer from executive function disabilities.

BACKGROUND: Adult Attention Deficit/Hyperactivity Disorder, or adult ADHD, is a chronic medical issue that greatly affects the economic and social productivity in the U.S. Though it is popularly known as a childhood behavioral disorder, ADHD was recognized in the early 2000s as a condition that persists into adulthood and continues to impact the executive functions of over 4% of the U.S. adult population. Studies show that untreated ADHD results in a 4-5% decrease in productivity at work as well as over $4000 in costs per affected employee.

There are a variety of barriers to timely and reliable treatment for adult ADHD patients, even for those who already passed the gauntlet of having an established diagnosis by a physician and having been optimized on a treatment regimen. To have an official diagnosis of ADHD, an adult patient must not only exhibit symptoms of any subtype of ADHD, but also have corroboration of the existence of these symptoms from prior to the age of twelve. Additionally, in order to qualify for medication therapy, these symptoms must have a significant impact on the executive cognitive processes of organization, task management, social and professional communication, finance management, and academic achievement. Therefore, adults who are already on a medication regimen have demonstrated a true medical need for reliable treatment in order to function and manage their personal and professional lives.

The most notable issues that have affected access to treatment for adult ADHD patients in New York State in recent years are distribution restrictions on medication and lack of accommodations in obtaining regular refills.

The first-line treatment for ADHD, according to evidence-based medical treatment guidelines, is psychostimulant therapy with amphetamine salts and methylphenidate compounds, which includes the well-known brands Adderall and Ritalin. These medications are classified as Schedule II by the Drug Enforcement Administration and, therefore, are regulated at the state and federal level by strict prescription and distribution laws.

METHODS: A legal and regulatory review specific to regulations on controlled substances was performed focusing on federal sources (FDA, DEA) as well as New York State regulations and policies released by private pharmaceutical companies.

Additionally, six of the top ten online/delivery pharmacy services in New York State were interviewed via telephone for details on their prescription filling policies for Schedule II controlled substances and specifically for amphetamine and methylphenidate compounds.

Results of Industry Policy and Regulation Review Recent shortages in local pharmacy supply since 2020 have exacerbated this issue of access as patients were unable to fill legitimate prescriptions or even obtain an emergency supply. The Federal Drug Administration (FDA) has officially recognized shortages of Adderall, Ritalin, and generic counterparts since October of 2022 and such shortages continue to date. However, the shortage has been attributed to distribution, rather than overall supply. For example, since February 2021 during the most recent opioid crisis in the U.S., a settlement

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involving federal and state governments versus three major pharmaceutical distributors - AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp - resulted in a policy proposed by Cardinal Health that now limits the number of any and all controlled substance prescriptions that can be filled by any pharmacy that sources from these major distributors. This went into effect in July 2022 and has greatly throttled the supply of not only opioids, but all scheduled drugs to New York State pharmacies - and pharmacies nationwide. Increased awareness about adult ADHD, and improved physician training, have led to an increase in the number of diagnoses and prescriptions written for ADHD treatment over the last few years, which have not been matched by changes in these distribution limits throughout and since 2023. In such situations it is difficult for patients and prescribing physicians to plan for sudden lack of inventory at their regular pharmacy.

Since 2013, prescriptions for most controlled substances in New York State are limited to 30-day supplies, with any refills only to be filled when a patient has “exhausted all but a seven days' supply of that controlled substance provided by any previously issued prescription” per New York State regulations Title 10, Subchapter K, Section 80.67. This required ADHD patients to introduce a disruptive and stressful task every few weeks to their previously optimized routines in order to coordinate the timing of refill requests while maintaining work performance and other responsibilities. To the benefit of patients with the true executive functional disability that is ADHD, an exception (Code B) for ADHD medication, which can be technically filled for a 90-day supply, with allowances for a 5-day emergency supply between prescriptions that were filled late for any reason. However, during 2023 multiple major pharmacy locations in New York had insufficient inventory to supply these prescriptions. Many patients found themselves unable to maintain their ADHD treatment regimens due to the impacts of this shortage, and even emergency supplies were not available.

Results of Interview of Major Online Pharmacy Services Due to the lack of local supply, many New Yorkers turned to major online mail-order delivery for their medications.

CVS Pharmacy, HealthMart, and RiteAid do not fill controlled substance prescriptions via their online services.

Therefore, patients who filled with these pharmacies were required to have their prescriptions transferred to other services once their physical pharmacy distribution quotas had been met. A CVS representative stated that they were unable to discuss the issue via phone interview. Per a pharmacist representative of a HealthMart location in Manhattan, they are not told by the FDA what their distribution quotas are for amphetamine and methylphenidate compounds and simply receive denial notices when they attempt to restock their supply, which has persisted for nine months as of February 2024.

Walgreens does deliver controlled prescriptions to patients through delivery but was unable to guarantee sufficient stock. A pharmacy representative from AllianceRx Walgreens Pharmacy, which is a mail-order service, stated via phone interview that while they were unable to discuss details about their policies on controlled substance filling, they do follow the same policies as physical locations as mandated by state laws. However, depending on the patient’s insurance, 90-day prescriptions may not be covered for mail-order prescriptions.

Costco pharmacists confirmed also via phone interview that they do fill Schedule II prescriptions, including ADHD stimulant medications via mail service. However, the pharmacy limits this service to patients with Costco contracted insurance plans. Additionally, the mail service at Costco pharmacy sources from a single manufacturer, which can limit their mail-order stock, unlike physical pharmacies that may source from multiple manufacturers in order to maintain a supply if the medication is available for distribution.

Express Scripts, which did have ADHD medication in stock, had a major discrepancy in state regulation versus company protocol that led to significant access issues for patients once again. Per phone interview with Express Scripts Patient Care Advocate (PCA), there is a state-controlled substance information search portal that advises all Express Scripts employees regarding the New York State 30-day supply maximum regulations. However, it does not include information regarding specific exceptions allowed for certain conditions including medications for the treatment of “attention deficit disorder” as indicated by the exception code.

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CONCLUSION: Based on this review of major online pharmacies as a supplier for much needed medication in times of shortage, it can be argued that the current barriers to medication supply, for adult patients on established ADHD regimens, should be addressed under the ADA. The policy discrepancies between pharmacies, insurance coverage, and lack of incentive to update policies to reflect state regulations, along with long processing periods, lead to difficulties in regular, reliable treatment for patients with ADHD who are unable to otherwise coordinate refills with their physicians and have no access to emergency supply during distribution shortages.

State law should require compliance under these regulations in that if a patient makes a request, a mail-order pharmacy service must fill a 90-day prescription for Schedule II medications that fall under the exceptions to the 30-day supply limit, specifically, but not limited to ADHD treatments.

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ABSTRACT #131 MEDICAL EDUCATION PULMONARY DISEASE/CRITICAL CARE EVALUATING THE IMPACT OF A LONGITUDINAL SIMULATION-BASED TRAINING CURRICULUM ON RESIDENT CONFIDENCE AND PREPAREDNESS IN MANAGING CLINICAL EMERGENCIES William J. Wallach1, Priscilla V. Loanzon1, Susannah Kurtz1 1Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Resident physicians encounter situations where rapid decision-making and clinical competence are critical. Despite structured medical training, confidence in managing these scenarios varies. Simulation-based training (SBT) provides a controlled environment for practicing high-risk, low-frequency events and has been recognized as an effective tool in medical education. This study evaluates whether participation in a longitudinal, scenario based SBT curriculum improves resident perception of confidence and preparedness.

METHODS: This study evaluated the impact of a three-year longitudinal SBT curriculum, focusing on selfreported confidence in managing unstable patients and perceived preparedness for handling clinical emergencies at their current level of training. Two groups were surveyed: 1) Group A: Residents who were participating in a three-year longitudinal SBT curriculum; 2) Group B: Residents who had no prior exposure to longitudinal SBT but underwent a single simulation session immediately before being surveyed. The three-year longitudinal SBT curriculum for Group A was comprised of six scenario based high-fidelity simulations throughout each year, complemented by procedural task training sessions. The scenario-based simulations included concepts such as cardiac arrest, undifferentiated shock, respiratory failure, sepsis, and use of point of care ultrasound. Group B participated in a single high-fidelity simulation of hemodynamic instability leading to cardiac arrest with ACLS management. Both groups completed a standardized survey assessing perceived confidence and preparedness. as well as satisfaction and expectations regarding the simulation experience. A Likert scale was used to quantify responses based on the degree of agreement with statements.

RESULTS: For PGY-2 residents, Group A had a trend of higher perceived confidence in managing unstable patients compared to Group B (2.60 versus 2.36, p=0.23). Group A reported a higher level of perceived confidence in managing unstable patients at 2.6, compared to Group B’s score of 2.36. The difference was not statistically significant). In terms of perceived preparedness in PGY-2 residents, Group A scored 2.74, while Group B scored 2.11, which was statistically significant (p=0.02). For perceived confidence in PGY-3 residents, Group A scored 3.07 and Group B scored 3.00. The difference was not statistically significant (p=0.69).

Regarding preparedness among PGY-3, Group A scored 3.11 and Group B scored 3.18, with no statistical significance (p=0.73). Satisfaction scores favored Group A without statistical significance in both PGY-2's (Group A: 3.20, Group B: 3.05, p=0.37), and PGY-3's (Group A: 3.28, Group B: 3.18, p=0.48). Whether expectations were met were also favored Group A without statistically significance for PGY-2's (Group A: 3.35, Group B: 3.15, p=0.82), and PGY-3's (Group A: 3.54, Group B: 3.36, p=0.31). Survey response rates were also higher in Group A (100%) compared to Group B (49%).

DISCUSSION/CONCLUSION: There were no significant differences in confidence levels or perceived preparedness between those who underwent the SBT curriculum and those who did not. As clinical experience accumulates over time, it is possible that differences attributable to additional simulation training become less pronounced. The difference in response rates between the two groups may indicate that their previous exposure to SBT made Group A more open to sharing their perceptions and feedback after finishing the session. Future research should use homogenous resident cohorts to control for confounding variables, assess generalizability of findings across different institutions and investigate other factors influencing survey response rates and engagement with simulation-based training.

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ABSTRACT #132 CLINICAL RESEARCH GENERAL INTERNAL MEDICINE/HEMATOLOGY/ONCOLOGY/PULMONARY DISEASE/CRITICAL CARE ASSOCIATION BETWEEN RACE AND INSURANCE WITH FOLLOW-UP RATES OF INCIDENTAL LUNG NODULES: A RETROSPECTIVE STUDY Hong Yu Wang1, Nour Ayoub1, Shasha Chen1, Steven Lim1, Sara Luby1, Agostina Velo1, Junyu Qi1, Sascha Adler1, Javier J. Zulueta1 1Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians Annual Meeting held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Lung cancer remains the leading cause of cancer-associated mortality within the United States. The evaluation and subsequent follow-up of lung nodules are critical components in the early detection of lung cancer, thereby potentially improving patient outcomes. Research has revealed significant disparities in health outcomes among diverse racial and ethnic groups. However, investigation into the relationship between race, insurance, and the management of incidental lung nodules have been notably limited.

This study aimed to investigate the impact of race and insurance status, particularly Medicaid, on the follow-up rates for incidental lung nodules, a factor that could significantly influence early detection and treatment outcomes.

METHODS: We conducted a multi-center retrospective review of all patients identified in January and February 2022 using Natural Language Processing (NLP), which identified all chest-related imaging studies mentioning lung nodules. Scans conducted for the investigation of active malignancy, those identifying false-positive nodules, stable lung nodules, scans not requiring follow-up according to the radiologist's evaluation, and cases without a follow-up recommendation were excluded from our analysis. Electronic health records were reviewed for demographics and types of health insurance. Patients were classified into three racial categories: White, Black, and Others. Similarly, insurance status was classified into three categories: Medicaid, uninsured, and other forms of insurance. The statistical analysis of the collected data was conducted utilizing the Statistical Analysis System (SAS) software.

RESULTS: NLP identified 756 patients with lung nodules, of which 364 (48.1%) patients were included for analysis. Mean age was 68.5+13.57 years and 143 (39.3%) were male. By race, 162 (44.5%) were White, 75 (20.6%) Black, and 127 (34.9%) other. Seventy (19.2%) patients were covered solely by Medicaid and 10 were uninsured. In comparison to White and other racial background patients, Black patients had a significantly lower rate of appropriate follow-up of incidental nodules (OR, 0.441; 95%CI, 0.242-0.804; p=0.008). Similarly, patients insured through Medicaid or lacking insurance were significantly less likely to undergo follow-up evaluation for their nodules (OR, 0.525; 95%CI, 0.287-0.960; p=0.04). There was no correlation between the rate of nodule follow-up and sex.

DISCUSSION/CONCLUSION: In this study, among patients with incidental lung nodules, those who were Black or were either uninsured or insured through Medicaid, had a significantly reduced rate of appropriate follow-up evaluations. These results highlight the existence of significant healthcare inequalities and support the need for well-designed safety-net or incidental lung nodule programs to overcome them.

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ABSTRACT #133 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE/HEMATOLOGY/ONCOLOGY MULTIFOCAL STROKES IN ESSENTIAL THROMBOCYTOSIS: A CLINICAL VIGNETTE Tharaka R. Wijesinghe1 and Krystle Hernandez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 59-year-old male with a history of hypertension, presented with right arm weakness and slurred speech for 15 minutes. He reported having difficulty grabbing items while at the grocery store with his cousin, and after starting to slur his words, his cousin called EMS. Upon exam in the ED, he regained full strength in his right arm, but still felt like his speech was slurred. He also started experiencing tingling/numbness in both arms. Physical exam was significant for decreased strength in the right upper extremity, and speech was slow, but fluent. He was able to name, repeat, and follow commands, but had minor word-finding difficulties and a global speech delay. Significant labs included an elevated troponin to 85. EKG was concerning for new STE on V3 and hyperacute T waves on lateral leads. Initial CTH was negative for acute ischemic or hemorrhagic changes. The patient was then admitted to expedite an MRI. In the MRI suite, he started having severe non-radiating substernal chest pain with diaphoresis and altered mental status. A rapid response was called, and further labs obtained at the time showed an interval increase in the troponin to 3000 and a platelet count of 1000 x 10^9/L. The patient was started on a heparin drip and taken to the CCU for hourly neurologic checks. The patient then reported bilateral total vision loss concerning for bilateral amaurosis fugax. The heparin drip was stopped and repeat CTH remained negative. An urgent ophthalmology consult was also obtained, but no retinal hemorrhage was observed. An MRI of the brain without contrast was expedited, and recent bilateral infarcts in the right and left parietal lobes and the left frontal lobe were observed. Hematology was consulted for possible essential thrombocytosis, and the patient was started on hydroxyurea, resulting in improvement in platelet count and symptoms.

Following the stabilization of the patient, hematology recommended further testing to determine the etiology, including JAK2 and BCR ABL. JAK2 was found to be positive, which was consistent with essential thrombocytosis. This led to the diagnosis of multifocal bilateral hemispheric strokes and Type II NSTEMI secondary to essential thrombocytosis.

CONCLUSION: One major takeaway of this case was that while patients can initially remain asymptomatic from essential thrombocytosis, they are at an increased risk for both thrombosis and abnormal bleeding. This is specifically important in hospital medicine as patients with essential thrombocytosis may initially be wellappearing before decompensating in the setting of multiple infarcts or sites of bleeding in several small vessel distributions. Essential thrombocytosis can result in multiple presentations related to thrombosis in several small vessel distributions including cardiac and neurologic findings.

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ABSTRACT #134 MEDICAL EDUCATION GASTROENTEROLOGY GASTROINTESTINAL BLEEDING SIMULATION IMPROVES RESIDENT KNOWLEDGE AND CONFIDENCE Marni H. Wilkoff1, Emily S. Seltzer1, Nicholas R. Piniella2, Harrindra Seepersaud1, Priscilla Loanzon1, Susannah Kurtz1, James Salonia1, Daniela Jodorkovsky1 1 Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2RWJ Barnabas, Jersey City Medical Center; Jersey City, NJ, United States Presented at American College of Gastroenterology (ACG) Annual Scientific Meeting that was held in Washington, D.C. United States from October 25–30, 2024.

BACKGROUND/INTRODUCTION: Upper gastrointestinal (GI) bleeding from peptic ulcer disease (PUD), esophageal varices (EV), or erosive esophagitis accounts for approximately 350,000 admissions annually.

Simulation-based training is a popular medical education tool that enhances quality care and patient safety. It can also help learners recognize a disease process and initiate proper workup and treatment. To increase internal medicine (IM) resident exposure to critical aspects of GI, a GI bleed simulation curriculum was created.

METHODS: One hundred and twenty-nine IM residents, split into 16 groups, participated in a 1-hour hands-on high-fidelity manikin simulation. Pre- and post-simulation REDCap surveys were distributed and included demographic, confidence scale, and knowledge assessment questions. A case outline included a narrative description, learning objectives, critical actions, history of present illness, vital signs, and physical exam.

Participants encountered a patient with a past medical history of alcohol use disorder presenting to the emergency department with abdominal pain and swelling. A rapid response was called 12 hours after admission for hematemesis and hemodynamic instability. The case's progression was detailed with changing vital signs, exams, and labs. Key equipment included a high-fidelity manikin, code cart, introducer kit, and moulage hematemesis and melena. A post-simulation debrief focused on inpatient and outpatient management of EV and PUD, central venous access, massive transfusion protocol, and hemorrhagic shock was completed.

RESULTS: There was a significant increase in the level of confidence for interns (PGY1) and second year (PGY2) residents in all categories (p<0.05). Third year (PGY3) residents had a significant increase in confidence in managing acute variceal bleeds (p=0.029), peptic ulcer bleeding (p=0.002), and outpatient EV (p=0.003) (Table 1). There was a significant increase in PGY1 and PGY2 knowledge on treating non-variceal GI bleeds (p≤0.001, p=0.001). All residents had a significant increase in their knowledge of the appropriate timing of endoscopy for acute EV bleeds (p<0.001). Among all residents combined, there was a statistically significant increase in knowledge of discharge medications for EV and PUD (p=0.013) (Table 2).

CONCLUSION: Simulation is a prevalent tool used in medical education. This study showed that implementing a hands-on manikin simulation positively impacts IM residents' comfort and knowledge of managing GI bleeds.

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Confidence Category-no. (%) Pre-Simulation Post-Simulation Comfort Managing GI Bleeds PGY1 (n=47, n=45) 12 (25.5) 31 (68.9) PGY2 (n=43, n=41) 14 (32.6) 28 (68.3) PGY3 (n=39, n=32) 29* (76.3) 29 (90.6) Total (n=129, n=118) 55 (43.0) 88 (74.6) Acute Variceal Bleed Treatment PGY1 (n=47, n=45) 8 (17.0) 29 (64.4) PGY2 (n=43, n=41) 6 (14.0) 25 (61.0) PGY3 (n=39, n=32) 18 (46.2) 23 (71.9) Total (n=129, n=118) 32 (24.8) 77 (65.3) Peptic Ulcer Bleed Treatment PGY1 (n=47, n=45) 11 (23.4) 30 (66.7) PGY2 (n=43, n=41) 11 (25.6) 29 (70.7) PGY3 (n=39, n=32) 21 (53.8) 28 (87.5) Total (n=129, n=118) 43 (33.3) 87 (73.7) Outpatient EV Treatment PGY1 (n=47, n=45) 5 (10.6) 30 (66.7) PGY2 (n=43, n=41) 12 (27.9) 25 (61.0) PGY3 (n=39, n=32) 13 (33.3) 22 (68.8) Total (n=129, n=118) 30 (23.3) 77 (65.3) Outpatient PUD Treatment PGY1 (n=47, n=45) 11 (23.4) 31 (68.9) PGY2 (n=43, n=41) 17 (39.5) 31 (75.6) PGY3 (n=39, n=32) 25 (64.1) 26 (81.3) Total (n=129, n=118) 53 (41.1) 88 (74.6) *n=38, as one participant did not respond to this question.

Significance = p<0.05 Table 1. Analysis of Moderate/Extreme Confidence Pre- and Post-Simulation.

p-value <0.001 0.001 0.114 <0.001 <0.001 <0.001 0.029 <0.001 <0.001 <0.001 0.002 <0.001 <0.001 0.002 0.003 <0.001 <0.001 <0.001 0.110 <0.001

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Question Category-no. (%) Pre-Simulation Acute Variceal Hemorrhage Treatment PGY1 (n=47, n=45) 37 (78.7) PGY2 (n=43, n=41) 25 (58.1) PGY3 (n=39, n=32) 33 (84.6) Total (n=129, n=118) 95 (73.6) Non-variceal GI Bleed Treatment PGY1 (n=47, n=45) 27 (57.5) PGY2 (n=43, n=41) 33 (76.7) PGY3 (n=39, n=32) 39 (100) Total (n=129, n=118) 99 (76.7) Timing of Endoscopy PGY1 (n=47, n=45) 8 (17.0) PGY2 (n=43, n=41) 13 (30.2) PGY3 (n=39, n=32) 11 (28.2) Total (n=129, n=118) 32 (24.8) Discharge Medications PGY1 (n=47, n=45) 26 (55.3) PGY2 (n=43, n=41) 30 (69.8) PGY3 (n=39, n=32) 21 (53.9) Total (n=129, n=118) 77 (59.7) Significance = p<0.05 Table 2. Analysis of GI Bleed Case Survey Questions

Post-Simulation

p-value

40 (88.9) 26 (63.4) 26 (81.3) 92 (78.0)

0.187 0.621 0.707 0.429

45 (100) 41 (100) 31 (96.9) 117 (99.2)

<0.001 0.001 0.266 <0.001

41 (91.1) 35 (85.4) 26 (81.3) 102 (86.4)

<0.001 <0.001 <0.001 <0.001

30 (66.7) 35 (85.4) 23 (71.9) 88 (74.6)

0.265 0.088 0.119 0.013

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ABSTRACT #135 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY SUCCESSFUL TREATMENT OF REFRACTORY ENTEROCOLITIS USING RISANKIZUMAB Yuhong Yang1, Patrick Magahis2, David Faleck3

IMMUNE

CHECKPOINT

INHIBITOR-RELATED

1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Cornell School of Medicine, New York, NY, United States; 3Memorial Sloan Kettering Cancer Center, New York, NY, United

States

BACKGROUND/INTRODUCTION: Immune checkpoint inhibitor-related enterocolitis (irEC) is a common complication of immune checkpoint inhibitors (ICI) and is typically managed with corticosteroids, infliximab and vedolizumab. Limited data exist for additional therapies and for the management of patients refractory to these agents. This report presents three patients treated with risankizumab (anti-IL23 therapy) for refractory irEC. CASE PRESENTATION: Case 1: A woman in her 60s with metastatic renal cell carcinoma treated with lenvatinib and pembrolizumab developed grade 4 irEC affecting both the upper and lower GI tracts 18 months into treatment. She experienced transient improvement with vedolizumab (3 doses) and infliximab (3 doses, including 2 at 10 mg/kg), but had recurrent severe symptoms with fecal calprotectin (FCP)>1000, requiring multiple hospitalizations and prolonged total parenteral nutrition (TPN). She was switched to risankizumab 600mg IV, showing gradual improvement during induction. After 8 months of risankizumab, she achieved corticosteroidfree clinical remission with FCP reduced to 119 and was weaned off TPN. Case 2: A woman in her 60s with locally advanced vaginal melanoma developed grade 3 irEC affecting the upper and lower GI tracts two months after starting ipilimumab and nivolumab. Corticosteroids and infliximab (2 doses at 10mg/kg) provided inadequate control, with FCP increasing from 465 to 761. Risankizumab 600mg IV was initiated due to severe enteritis, for which vedolizumab was considered less optimal. She showed improvement after the first dose, with FCP decreasing to 124 by the second dose. After completing three induction doses, she achieved corticosteroid-free clinical remission within 1 month.

Case 3: A woman in her 70s with bladder cancer treated with chemotherapy followed by a single dose of pembrolizumab developed grade 3 irEC affecting both upper and lower GI tracts within one week of initiation.

Despite treatment with high-dose corticosteroids, infliximab (2 doses at 5mg/kg), and vedolizumab (1 dose), she remained steroid-dependent with an FCP of 534. After transitioning to risankizumab 600mg IV, she showed gradual improvement during induction and achieved corticosteroid-free clinical remission with normalization of FCP after 6 months.

CONCLUSION: This case series demonstrates the promising efficacy of risankizumab, a novel selective IL-23 inhibitor, in treating severe irEC that involved both the upper and lower GI tracts and was refractory to multiple lines of therapy.

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ABSTRACT #136 CLINICAL RESEARCH GASTROENTEROLOGY ROUTINE BIOPSIES FOR EOSINOPHILIC ESOPHAGITIS ARE UNHELPFUL IN PATIENTS WITH DYSPHAGIA WITH A NORMAL-APPEARING ESOPHAGUS ON ENDOSCOPY Ahmun Zafar1, Mako Koseki1, Daniela Jodorkovsky1, Michael S. Smith1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

BACKGROUND/INTRODUCTION: Eosinophilic esophagitis (EoE) is an increasingly recognized cause of dysphagia. While esophagogastroduodenoscopy (EGD) can identify characteristic features of EoE such as rings, furrows, and exudates, histologic confirmation through biopsies is required for diagnosis. The sensitivity and specificity of EGD for diagnosing EoE in patients with dysphagia remains underexplored. Prior EoE research has assessed the diagnostic utility of EGD in the general population, rather than focusing exclusively on patients with dysphagia. This study evaluates whether routine biopsies are necessary for accurate diagnosis in patients with dysphagia when the esophagus appears normal.

METHODS: All patients who had proximal and distal esophageal biopsies while undergoing EGD for dysphagia between 2/2018 and 5/2024 at a single high volume esophageal referral center were considered for analysis.

Demographic, endoscopic, and histologic data were collected. Patients were categorized into two groups based on visual findings: normal or abnormal (defined as mention of at least one classic EoE feature: edema, rings, exudates, furrows, or stricture). EoE was defined as at least 15 eosinophils/high-power field in either proximal or distal samples.

RESULTS: The study included 216 patients with an average age of 51.8 years (58.3% female). Among them, 25 patients (11.6%) met histologic criteria for EoE and were more likely male (p= 0.017) (Table 1). A significantly higher prevalence of EoE was observed in patients with endoscopic findings suggestive of EoE (24/41, 58.5%) compared to those with a normal-appearing esophagus (1/175, 0.6%) (p<0.001). The positive predictive value (PPV) for classic endoscopic features of EoE was 58.5%, and the negative predictive value (NPV) for normal esophagus on EGD was 99.4%. Sensitivity and specificity for classic endoscopic features of EoE were 96% and 91%, respectively. Of note, the single EoE patient with a normal esophagus was confirmed to have an alternate cause (reflux) of eosinophilia.

CONCLUSION: Among our dysphagia cohort, EoE was significantly more prevalent in patients with abnormal EGD findings. This cohort had a higher sensitivity and NPV for normal EGD compared to existing literature, suggesting a normal EGD is highly effective in excluding EoE when patients have dysphagia. This result should prompt reconsideration of whether to perform routine biopsies in dysphagia patients when the esophagus appears visually normal.

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EGD Findings

EoE on Biopsy (N = 25)

No EoE on Biopsy (N = 191)

Abnormal EGD (N = 41)

24

17

Positive Predictive Value: 58.5%

Normal EGD (N = 175)

1

174

Negative Predictive Value: 99.4%

Sensitivity: 96%

Specificity: 91%

Table 1. Diagnostic Accuracy of EGD for EoE in Dysphagia Patients

Figure 1. Prevalence of EoE in Patients with Dysphagia Based on EGD Appearance and Histology

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ABSTRACT #137 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE A RARE CASE OF DELIRIUM TREMENS WITH LOW CLINICAL INSTITUTE WITHDRAWAL ASSESSMENT FOR ALCOHOL SCORE Susu Zhou1 and Erica Grabscheid1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of General Internal Medicine (SGIM) Annual Meeting that was held in Boston, Massachusetts, United States from May 15-18, 2024.

BACKGROUND/INTRODUCTION: Delirium tremens (DT), the most severe and potentially fatal condition of alcohol withdrawal syndrome, is manifested by hallucinations, disorientation, agitation, tachycardia, hypertension, and fever. DT usually develops 48-96 hours after the cessation of heavy drinking. Mortality from DT is approximately 1-4% but can be significantly higher dependent upon timely diagnosis and proper management. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score is the most widely used tool for the diagnosis of alcohol withdrawal. CIWA criteria is dependent upon the presence of nausea/ vomiting, tremors, anxiety, agitation, paroxysmal sweats, orientation, headache, and tactile/ auditory/ visual disturbances; criteria do not include vital signs. A CIWA score of 19 or greater indicates severe withdrawal. We will describe here a rare case of delirium tremens with low CIWA score.

CASE PRESENTATION: A 77-year-old woman with past medical history of alcohol use disorder with prior hospitalizations for withdrawal but no history of withdrawal seizures or delirium tremens, Hypertension, hyperlipidemia, cerebral infarction (with no sequelae), chronic obstructive pulmonary disease on home oxygen, and hypothyroidism on levothyroxine presented to an inpatient detoxification unit. Patient reported drinking 1.75L of vodka every three days with the last drink being the night prior to presentation. Due to a complaint of chest pain and shortness of breath, the patient was transferred to the Emergency Room where the patient was noted to be restless with tremor and confused. Physical examination revealed a high blood pressure, sinus tachycardia, and the patient was febrile. The CIWA score was 4. Work-up ruled out any acute coronary event, Pulmonary Embolism, dehydration, or infectious etiology. The TSH was mildly low, but the FT4 was within normal range.

Urine toxicology was negative. Over time, the patient remained hypertensive (185/106) and tachycardic (142 bpm) with several fever spikes (101.4F). The CIWA score consistently was only 0 to 4. Given the history of excessive alcohol use and withdrawal symptoms such as tremor and disorientation, a diagnosis of DT was made.

The patient was started on a lorazepam taper, and the patient’s symptoms improved.

CONCLUSION: The patient described here exhibited clinical signs of severe alcohol withdrawal such as tremor, confusion, and noticeably unstable vitals. However, the patient only technically met criteria for ‘mild’ withdrawal based on CIWA scoring (<8). All the patient’s symptoms were successfully controlled by treating for severe alcohol withdrawal. Our report suggests that the CIWA scale has limitations as a tool in assessment of the severity of alcohol withdrawal syndrome; physicians should be mindful to rule out DT regardless of the CIWA score when applicable.

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ABSTRACT #138 CASE REPORT/CLINICAL REVIEW RHEUMATOLOGY VACATION COSTS AND VISION LOSS Vincent Courant1, Evan Zyskowski2, Mark Horowitz1 1Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-

West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the New York State Rheumatological Society Annual Meeting that was held in New York, New York, United States from October 27-29, 2024.

BACKGROUND/INTRODUCTION: Occlusive retinal vasculitis is inflammation of the arteries, veins, or capillaries that can be associated with infections, malignancy, and other systemic inflammatory conditions. In patients with Systemic Lupus Erythematosus (SLE), this occurs in only 3% of cases but causes blindness in 40% of reported cases. This case presents an unusual presentation of bilateral retinal branch artery occlusion in a patient with known SLE. As treatment guidelines for similar cases are not well established, this case documents the treatments incurred with resultant vision improvement and stabilization.

SLE is a chronic autoimmune condition that can affect any organ system in the body. In the United States, SLE is more predominant among African Americans who also tend to have the worst outcomes. Although there are many clinical features well associated with SLE, the disease manifestations can vary widely and change throughout the patient’s lifetime.

The most common features of SLE are polyarthralgias, skin lesions, fatigue, and renal complications. In onethird of patients, ocular manifestations are reported, with the most common symptom being keratoconjunctivitis (dry eyes). In rare cases, SLE can cause retinopathy by multiple etiologies such as microangiopathy related to secondary hypertension, vaso-occlusion due to hyper-thrombotic state, and retinal vasculitis from immune complex deposition. Although this occurs in only 3% of the cases, all forms of retinopathy carry the risk of progressing to blindness up to 40%, and therefore requires urgent evaluation and treatment. We present this case of a 56-year-old African American female presenting with bilateral retinal vasculitis after many years of SLE remission.

CASE PRESENTATION: A 56-year-old African American female with a history of hypertension and SLE, not on immunosuppression treatment who presented to the emergency department for sudden onset of blurry vision.

The patient was diagnosed with SLE in 2012 and treated with Hydroxychloroquine for three years before stopping treatment due to disease remission. The patient had been off immunosuppression treatment for 8 years before the current presentation.

About a month prior to presenting, the patient was on vacation in Jamaica where she noticed the development of darkening of her facial skin, polyarthralgia, and joint stiffness lasting greater than 45 minutes. When she returned to New York, she was seen by her Rheumatologist and prescribed prednisone 10mg daily for a 10-day course. 3 weeks later she noticed her vision became suddenly blurry while driving. It would be 1 week after that she would see an outpatient Ophthalmologist who recommended the patient go to the emergency department (ED). In the ED, the patient noted blurry vision in both eyes, left worse than right. Review of systems was positive for facial rash, blurry vision, and joint pain. Vitals signs notable for low grade fever of 100.6oF and mild tachycardia. On exam the patient exhibited a malar rash, Jaccoud’s arthropathy, and temporal alopecia.

Laboratory analysis was notable for hemoglobin of 11.0g/dL, an erythrocyte sedimentation rate (ESR) of 80mm/hr, C-Reactive Protein (CRP) of 16mg/dL, Ferritin of 487mg/dL, C3 of 64 mg/dL. A rheumatologic workup showed an Antinuclear Antibody (ANA) titer of 1:320 (<1:80) with positive antibody titers for SSa, SSb, Smith, and Histone. Antiphospholipid Syndrome (APLS) labs were negative. Infectious workup, including HIV, Syphilis, Hepatitis B/C, Lyme, Tuberculosis, fungal cultures and blood cultures were negative. CT scans of the head and

239

neck with CT Angiogram of the head were negative for acute process. MRI Brain was negative for acute process as well. Ophthalmologic evaluation performed bilateral fluorescein angiography showing extensive ischemia and occlusion of the macular and retinal arteries and veins with vascular leakage. Left appearing worse than right.

Due to absence of infectious process and APLS labs, the patient was diagnosed with SLE Occlusive Retinal Vasculitis. In the hospital, the patient was initially started on pulse dose intravenous steroids for 3 days. This was tapered to oral prednisone of 1mg/kg daily and was eventually started on mycophenolate mofetil (MMF) that was titrated up to 3g daily. The patient reported improvement in vision and was discharged for continued optimization of treatment regimen. Outpatient, the patient was started on standard Rituximab (RTX) induction with a slow taper of her oral steroids. Repeat fluorescein angiography at outpatient Ophthalmology visit showed improved retinal artery perfusion without choroidal neovascularization. She was found to have mid anterior uveitis, thus was continued on methylprednisolone 32mg daily.

DISCUSSION/CONCLUSION: Retinal artery occlusion is a rare and serious manifestation of SLE that can lead to permanent vision loss if not diagnosed early and treated aggressively. It is known to be caused by immune complex deposition in the vessel walls that eventually lead to inflammation and thrombosis. Our case presents an unusual treatment course where an APLS negative patient stabilized and clinically improved with high dose steroids, MMF, and then with rituximab. In literature, there are cases documenting bilateral retinal artery vasculitis but the treatments reported vary widely among cases with little data available to support one modality over another. One case noted retinal vasculitis as the presenting symptom in a 16-year-old female treated with high dose steroids and intravitreal injections, eventually switched to Azathioprine (AZA) 100mg daily as maintenance.

Another case examines a 38-year-old female stabilized with pulse dose steroids, transitioned to MMF with little improvement, but improved with RTX induction and able to taper off steroids. Other cases report a 28-year-old female not improving with steroids and cyclophosphamide but stabilized with plasma exchange and IVIG, followed by maintenance with cyclophosphamide, MMF, and belimumab. Current American College of Rheumatology (ACR) guidelines for treating non-cutaneous vasculitis in SLE denote initial treatment with pulse steroids and tapering to high dose steroids. The recommended interventions include multiple immunosuppressants, multiple biologics, IVIG, and plasma exchange but no listed intervention has efficacious priority.

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List of Abstracts 2024-2025*

241

*Research/Scholarly Work presented in 2024-2025; does not include presentations already submitted as a poster.

LIST OF ABSTRACTS 2024-2025

139

HOW LOW CAN YOU GO? HYPOALBUMINEMIA SECONDARY TO PROTEIN LOSING ENTEROPATHY IN A POST-GASTRIC BYPASS PATIENT Arushi Agarwal1 and Jessica Lim1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024. *ACG Outstanding Poster Presenter

140

A LITTLE TOO LATE - A CASE ON DELAYED DIAGNOSIS OF SACRAL STENOSIS LEADING TO IRREVERSIBLE NEUROLOGICAL DEFICITS Melissa Akselrad1 and Houman Danesh2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

141

PRE-OPERATIVE MANAGEMENT OF A PATIENT WITH ALPHA-GAL SYNDROME REQUIRING HIGH-DOSE HEPARIN FOR CORONARY ARTERY BYPASS GRAFTING SURGERY Shubhankar Anand1, Neil Patel2, Rachel Miller2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

142

OVERLAPPING SYSTEMIC LUPUS ERYTHEMATOSUS AND ANCA-ASSOCIATED VASCULITIS: A RARE CAUSE OF NEPHROTIC SYNDROME Pragati Basera1, Rodrigo Paredes de la Fuente1, Shota Obata1, Andrea Duque Lopez1, Miriam Chung1, Ruchika Batwara1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

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ARRGH YOU SURE IT'S NOT SCURVY?: A UNIQUE PRESENTATION OF VITAMIN C DEFICIENCY IN A POST‐BYPASS PATIENT Nooshin C. Beygui1, Ahmun Zafar1, Andrea Ramirez Cazares1, Grace Macmillan2, Kata Boros1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2New York Institute of Technology College Osteopathic Medicine, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

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COMPOSITE ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA AND MARGINAL ZONE BCELL LYMPHOMA Nooshin Beygui1, Rodrigo Paredes1, Ibrahim Omore2, Christian Salib2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

242

LIST OF ABSTRACTS 2024-2025

145

146

147

148

A MID-PROCEDURE PAUSE: INTRAOPERATIVE IATROGENIC PNEUMOTHORAX DURING LIPOSUCTION Christiana Choi1 and Nikita Agrawal1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

HIDDEN IN PLAIN SIGHT: IDENTIFYING MYCOBACTERIUM ABSCESSUS AS THE COVERT CAUSE OF CHRONIC LUNG CAVITARY LESIONS Christiana Choi1, Aesha Patel1, Aishwarya Puri2, Jay Guevarra2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

THE INCREASING MORTALITY FOR NON-COVID ACUTE RESPIRATORY DISTRESS SYNDROME Lorenzo Leys1, Christiana Choi1, Adrian Chernyk1, Raymond A. Jean1, Raymonde Jean1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

UTILIZATION AND CHALLENGES OF POINT-OF-CARE ULTRASOUND IN A LARGE URBAN HOSPITAL SYSTEM Christiana Choi1, Victor Wang1, Mohammed Alsaud1, Karen Go1, Sonja Mittag1, Paru Patrawalla1, Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

149

A RARE CASE OF GASTROINTESTINAL FIBRILLATION ABLATION Jake Debroff1, Kayla Hartz1, Ayanna Lewis1

BLEEDING

FOLLOWING

ATRIAL

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024. *ACG Presidential Poster Award

150

ASSOCIATIONS BETWEEN SOCIAL DETERMINANTS OF HEALTH ON PSYCHOSOCIAL WELL-BEING AND QUALITY OF LIFE IN A DIVERSE COHORT OF INDIVIDUALS WITH PERIANAL FISTULIZING CROHN’S DISEASE Shabari Shenoy1, Jake Debroff1,2, Joshua Lacoste3, Elisabeth Giselbrecht3, Nicole O. Gbenebitse4, Felix D. Rozenberg5, Laurie Keefer3, Serre-yu Wong3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4City University of New York, New York, NY, United States; 5SUNY Downstate Health Sciences University, Brooklyn, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

243

LIST OF ABSTRACTS 2024-2025

151

HERE COMES THE SUN: CHARACTERIZATION OF A COHORT OF PATIENTS WITH SUNFLOWER SEED ALLERGY Neil Patel1, Ami Shah1, Sara Dehbozorgi2, Amanda Cox1, Mary Grace Baker1 1

Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

152

153

A RARE CASE OF SERONEGATIVE AUTOIMMUNE HEPATITIS Bharati Dev1, Jake DeBroff1, Mako Koseki1, Liliana Vittini-Hernandez1, Piya Kositangool1, Kevin Jordan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

IS IT TIME TO PANIC? A RARE CASE OF MIXED ADENOCARCINOMA NEUROENDOCRINE CARCINOMA AT THE GASTROESOPHAGEAL JUNCTION Bharati Dev1, Jake DeBroff1, Mako Koseki1, Jose Duran1, Antoine Jeri-Yabar1, Adam Tillowitz1, Bruce P. Gelman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

154 155 156

NOW YOU "CT" IT? A RARE CASE OF JEJUNAL DIVERTICULITIS Bharati Dev1, Jake DeBroff1, Mako Koseki1, Sonia Mehra1, Subhash Chander1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

AN UNFORESEEN CONSEQUENCE: PULMONARY EMBOLISM POSTABLATION IN A YOUNG PATIENT WITH SUPRAVENTRICULAR TACHYCARDIA Keshav Dixit1, Andrea Monfasani1, and David J. Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

IDENTIFYING THE CHARACTERISTICS OF PATIENTS RECEIVING EARLY VERSUS LATE PERCUTANEOUS TRACHEOSTOMY Yoshiko Ishisaka1, Keshav Dixit1, Jorge Sinclair de Frias1, Shasha X. Chen1, Lina Miyakawa1, Adam Rothman 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

244

LIST OF ABSTRACTS 2024-2025

157

158

IMPACT OF A NON-INVASIVE VENTILATION SESSION ON INTERN KNOWLEDGE AND CLINICAL APPLICATION Keshav Dixit1, Agostina Velo1, Archana Pattupara1, Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

TRENDS IN TRACHEOSTOMY: A COMPARATIVE ANALYSIS FROM 2018 TO 2023 Keshav Dixit1, Yoshiko Ishisaka1, Jorge Sinclair de Frias1, Shasha X. Chen1, Lina Miyakawa1, Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

GIANT PROLACTINOMA TREATED WITH MEDICAL MANAGEMENT Paige Dixon1, Suma Gondi2, Jennifer Abrams2, Nirali Shah2

159

160

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1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

A CATECHOLAMINE CRISIS: RESISTANT HYPERTENSION BEYOND THE ADRENAL GLAND – A CASE OF PHEOCHROMOCYTOMA/PARAGANGLIOMA Tansu Eris1, Rodrigo Paredes de la Fuente1, Jared Leventhal1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

DOUBLE TROUBLE OR BETTER TOGETHER? DOUBLE ANTIBODY POSITIVE PULMONARY-RENAL SYNDROME Tansu Eris1, Niurka Liranzo Tejera1, Martin Sedlacek1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

PENILE PROSTHESIS INFECTION WITH MYCOBACTERIUM ABSCESSUS Sanah Siddiqui1, Elmarie Alexander1, Thomas F. Fusillo1, Sara Huda1, Faye E. Reiff‐ Pasarew1, Christine Stavropoulos1

162

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the both Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025 and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

245

LIST OF ABSTRACTS 2024-2025

163

RETRIEVAL AUGMENTED GENERATION FOR THE DETECTION OF MAJOR BLEEDING EVENTS IN THE ELECTRONIC HEALTH RECORD Peter Kaplinsky1, Rohan Singh1, Thomas F. Fusillo1,2, Avi Leader1, Jeffrey I. Zwicker1, Simon Mantha1 1

Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 7-10, 2024.

164

UNMASKING TB AND IRIS: MORE THAN A SIMPLE PNEUMONIA IN AN IMMUNOSUPPRESSED PATIENT Karen Go1, Hong Yu Wang1, Patricia Dharapak2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

165

LUNG FUNCTION STATUS AS A PROGNOSTIC INDICATOR IN ADENOCARCINOMA SURVIVAL: A COMPARATIVE ANALYSIS OF COPD, PRISM, AND NORMAL LUNG FUNCTION Toshiro Goto1, Rodrigo Paredes de la Fuente1, Jorge Gomez2, Christian Rolfo3, David Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University, Columbus, OH, United States 2

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

166

CLINICAL OUTCOMES OF P2Y12 INHIBITOR MONOTHERAPY VERSUS DUAL ANTIPLATELET THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE CORONARY SYNDROME Soumya Gupta1, Aditya Thakkar1, Devika Aggarwal1, Kirtipal Bhatia1, James Choi1, Kristen Carter1, Arpanjeet kaur1, and Abel Casso Dominguez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

167

EVALUATING COMPLICATIONS AND HEALTHCARE UTILIZATION OF INTRAVASCULAR ULTRASOUND GUIDED PERCUTANEOUS CORONARY INTERVENTIONS Aditya Thakkar1, Soumya Gupta1, Koushik Sanku2, Sai Karthik Kommineni3, Lalith Namburu3, Dilpat Kumar3, Manar Jbara3, Jeetendra Patel3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Medical Center of Florida, Miami, FL, United States; 3East Tennessee University, Johnson City, TN, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

246

LIST OF ABSTRACTS 2024-2025

168

NATIONWIDE ANALYSIS OF THE IMPACT OF COVID‐19 ON ECMO UTILIZATION IN PATIENTS HOSPITALIZED WITH STEMI: A RETROSPECTIVE OBSERVATIONAL STUDY Harsh Patel1, Maania Naseem2, Yash Patel3, Aditya Thakkar4, Payal Singh5, Urvish Patel6, Saketh Iswarawaka7, Abdul Qadree8, Soumya Gupta9, Omar Hassan10, Nagaraj Honganur11, Bhanu Matri12, Parth Shah13, Jose Davis14, Nilay Bhatt15 1

Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India; 2King Edward Medical University, Lahore, Punjab; Narendra Modi Medical College; 4East Tennessee State University; 5Silchar Medical College, Silchar, Assam; 6Icahn School of Medicine at Mount Sinai,New York, NY, USA, 7University of West Indies, St.Augustine; 8Merit Health Wesley, Hattiesburg, MS, United States; 9Mount Sinai Morningside/West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 10Ondokuz Mayis University, Faculty Of Medicine, Samsun, Turkiye; 11Parkview Medical Center, Pueblo, CO, United States; 11UAB Heersink School of Medicine, Montgomery, AL, United States; 12Hospital/Tower Health Medical Group, West Reading, PA, United States; 14Albert Einstein College of Medicine, New York City, NY, United States; 15HCA Houston Healthcare, Clear Lake, Texas, United States 3

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

169

OUTCOMES OF ATRIAL FIBRILLATION ABLATION IN ELDERLY: A RETROSPECTIVE COHORT STUDY Aditya Thakkar1, Soumya Gupta1, Koushik Sanku2, Sai Karthik Kommineni3, Lalith Namburu3, Dilpat Kumar3, Manar Jbara3, Jeetendra Patel3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Medical Center of Florida, Miami, FL, United States; 3East Tennessee University, Johnson City, TN, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

170

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ADDITIVE PROGNOSTIC SIGNIFICANCE OF VASCULAR DISEASE IN PATIENTS REFERRED FOR EXERCISE STRESS ECHOCARDIOGRAPHY Hannah Hart1, Alaa Omar1, Edgar Arguilan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

DURABLE RESPONSE TO PEMBROLIZUMAB IN METASTATIC PULMONARY SARCOMATOID CARCINOMA Jing Huang1, Rodrigo Paredes de la Fuente1, Toshiro Goto1, Jorge Gomez2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

172

NAVIGATING UNRESECTABLE PANCREATIC MASSES: AN ENDOSCOPIC ULTRASOUND-GUIDED APPROACH TO BILIARY DRAINAGE IN A PATIENT WITH AN INDWELLING LUMINAL STENT Rama Hussein1, Marni H. Wilkoff1, Neal Shah2, Rashmi Advani2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai South Nassau, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

247

LIST OF ABSTRACTS 2024-2025

173

NEGATIVE DOES NOT MEAN NO: EXERCISING PERSISTENCE IN THE EVALUATION OF A PANCREATIC NEUROENDOCRINE TUMOR Muhddesa Lakhana1, Rama Hussein2, Marni H. Wilkoff2, Rashmi Advani1 1

Mount Sinai South Nassau, Icahn School of Medicine at Mount Sinai, Oceanside, NY, United States; 2Mount Sinai Morningside-West Hospitals, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

174

COMPARISON OF METASTATIC PATTERNS AND RISKS BETWEEN YOUNG ONSET AND AVERAGE ONSET CHOLANGIOCARCINOMA Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Bharati Dev1, Sebastian Prado-Nuñez2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Universidad Peruana Cayetano Heredia, Lima, Peru

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

175

DISPARITIES IN STAGE AT DIAGNOSIS AMONG HISPANICS/LATINXS WITH GASTRIC CANCER IN THE UNITED STATES Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Renzo Aller-Rojas2, Francisco Arias-Reyes2, Sirish Dharmapuri1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; University of Texas Rio Grande Valley, McAllen, TX, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

176

RACIAL DISPARITIES IN RISK OF BONE METASTASIS AT DIAGNOSIS OF MALIGNANT PLEURAL MESOTHELIOMA Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Francisco Arias-Reyes2, Renzo Aller-Rojas2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Universidad Peruana de Ciencias Aplicadas, Lima, Peru

2

Presented at the World Conference on Lung Cancer (WCLC) Annual Meeting that was held in San Diego, California, United States from September 7-10, 2024.

177

ACCURACY OF INTRA-OPERATIVE CHOLANGIOGRAM FOR DETECTION OF CHOLEDOCHOLITHIASIS Do Han Kim1, Allison A. Marshall2, Yousaf Hadi2, Haley Waite3, Jacquelin Florio2, Nikhil Kumta2, Satish Nagula2, Nicholas Hoerter2 1

Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

178

ARE OUTCOMES TRULY DIFFERENT IN PATIENTS WITH ACUTE PANCREATITIS ACROSS ALL AGE? Donghyun Ko1, Do Han Kim2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1

Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Universidad de Guayaquil, Guayaquil, Ecuador; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

248

LIST OF ABSTRACTS 2024-2025

179

ENHANCING ANAL CANCER SCREENING PROFICIENCY IN INTERNAL MEDICINE RESIDENTS Patricia Miguez Arosemena1, Do Han Kim1, Allison Wang1, Emily Seltzer1, John A. Andrilli1, Frank Nelson1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

GASTROINTESTINAL XANTHOMAS AND ICHTHYOSIS Do Han Kim1, Michael Marble2, Juan E. Corral3

180

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of New Mexico Health Sciences Center, Albuquerque, NM, United States; 3Prisma Health, Greenville, SC, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

181

GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IS ASSOCIATED WITH LOWER COMPLICATIONS AND MORTALITY IN PATIENTS WITH ULCERATIVE COLITIS AND OBESITY Luis M. Nieto1, Sharon Narvaez2, Do Han Kim3, Donghyun Ko4, Saurabh Chawla1, Kenneth Vega5, Laura Davisson6, Jami A. Kinnucan7 1

Emory University School of Medicine, Atlanta, GA, United States; 2Universidad de Guayaquil, Guayaquil, Ecuador; 3Mount Sinai MorningsideWest Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 5Medical College of Georgia at Augusta University, Augusta, GA, United States; 6West Virginia University, Morgantown, WV, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

182

GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IS ASSOCIATED WITH LOWER INCIDENCE OF GASTROESOPHAGEAL REFLUX DISEASE Sharon Narvaez1, Luis M. Nieto2, Olanrewaju Adeniran3, Donghyun Ko4, Do Han Kim5, Kenneth Vega6, Treah Haggerty3, Laura Davisson3, Lawrence Tabone3, Saurabh Chawla2 1

Universidad de Guayaquil, Guayaquil, Ecuador; 2Emory University School of Medicine, Atlanta, GA, United States; 3West Virginia University, Morgantown, WV, United States; 4Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 5Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 6Medical College of Georgia at Augusta University, Augusta, GA, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

183

GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IS ASSOCIATED WITH LOWER MORTALITY AND IMPROVEMENT OF CARDIOVASCULAR OUTCOMES IN PATIENTS WITH CELIAC DISEASE AND OBESITY Donghyun Ko1, Do Han Kim2, Sharon Narvaez3, Olanrewaju Adeniran4, Luis Nieto5, Miguel Salazar6, Pedro Palacios-Argueta7, Paul Kroner8, Frank J. Lukens9 1

Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Universidad de Guayaqui, Guayaqui, Ecuador; 4West Virginia University School of Medicine, Morgantown, WV, United States; 5Emory School of Medicine, Atlanta, GA, United States; 6University of California Riverside, Riverside, CA, United States; 7Mayo Clinic Florida, Jacksonville, FL, United States; 8Riverside Regional Medical Center, Newport News, VA, United States; 9Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

249

LIST OF ABSTRACTS 2024-2025

184

GLP-1 RECEPTOR AGONISTS USE IS ASSOCIATED WITH LOWER MORTALITY AND IMPROVEMENT OF CARDIOVASCULAR OUTCOMES IN PATIENTS WITH OBESITY WHO HAVE MAFLD AND OSA Sharon Narvaez1, Luis M. Nieto2, Felipe Contreras-Yametti3, Donghyun Ko4, Do Han Kim5, Treah Haggerty6, Laura Davisson6, Edward Rojas6 1

Universidad de Guayaquil, Guayaquil, Ecuador; 2Emory University School of Medicine, Atlanta, GA, United States; 3Wellstar Health System - Cobb Medical Center, Atlanta, GA, United States; 4Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 5Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 6West Virginia University, Morgantown, WV, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

185

GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS USE IS ASSOCIATED WITH LOWER RISK OF BILIARY DISEASE OUTCOMES IN NON-DIABETIC PATIENTS WITH OBESITY: A MULTI-CENTER ANALYSIS Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Olanrewaju Adeniran4, Luis Nieto5, Miguel Salazar6, Pedro Palacios-Argueta7, Paul Kroner8, Frank J. Lukens9 1

Mount Sinai Morningside-Wes Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, School of Medicine, Atlanta, GA, United States; 4West Virginia University School of Medicine, Morgantown, WV, United States; 5Emory School of Medicine, Atlanta, GA, United States; 6University of California Riverside, Riverside, CA, United States; 7Mayo Clinic Florida, Jacksonville, FL, United States; 8Riverside Regional Medical Center, Newport News, VA, United States; 9Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

186

GLUCAGON LIKE PEPTIDE-1 RECEPTOR AGONISTS USE IS ASSOCIATED WITH LOWER 7-DAYS REPEAT ESOPHAGOGASTRODUODENOSCOPY AFTER INDEX ENDOSCOPY IN PATIENTS WITH ACHALASIA: A MULTI-CENTER ANALYSIS Donghyun Ko1, Do Han Kim2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1

Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Universidad de Guayaquil, Guayaquil, Ecuador; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

OUTCOMES AND COMPLICATIONS IN PATIENTS WITH STIMULANT ABUSE, ADMITTED FOR NONVARICEAL UPPER GASTROINTESTINAL BLEED Khaled Al Smadi1, Miguel J. Salazar2, Pedro Palacios3, Do Han Kim4, Ko Dong5, Gianina Flocco6, George Saffouri7, Harold Paredes7

187

1

University of California Riverside School of Medicine, San Bernardino, CA, United States; 2University of California Riverside, Rancho Cucamonga, CA, United States; 3Mayo Clinic, Jacksonville, FL, United States; 4Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, United States; 6Cleveland Clinic, Cleveland, OH, United States; 7University of California Riverside, Rialto, CA, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

250

LIST OF ABSTRACTS 2024-2025

188

RISK OF CONSTIPATION AND SLOW TRANSIT CONSTIPATION IN PRE- AND PERIMENOPAUSE, NON-OBESE FEMALES ON PROGESTOGEN-ONLY CONTRACEPTIVES VERSUS COMBINED ORAL CONTRACEPTIVE PILLS Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Miguel Salazar4, Luis Nieto5, Pedro Palacios-Argueta6, Paul Kroner7, Frank J. Lukens8 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, Guayaquil, Ecuador; 4University of California Riverside, Riverside, CA, United States; 5Emory School of Medicine, Atlanta, GA, United States; 6Mayo Clinic Florida, Jacksonville, FL, United States; 7Riverside Regional Medical Center, Newport News, VA, United States; 8Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

189

RISK OF DE NOVO GASTROPARESIS IN NON-DIABETIC PATIENTS WITH OBESITY TAKING TIRZEPATIDE VERSUS SEMAGLUTIDE Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, School of Medicine, Atlanta, GA, United States; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

190

RISK OF DE NOVO GASTROPARESIS IN PRE- AND PERI-MENOPAUSE, NON-OBESE FEMALES ON PROGESTOGEN-ONLY CONTRACEPTIVES VERSUS COMBINED ORAL CONTRACEPTIVE PILLS Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, School of Medicine, Atlanta, GA, United States; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

191

SINGLE CENTER ASSESSMENT OF THE BOSTON BOWEL PREPARATION SCALE SCORE AMONG PATIENTS WITH OBESITY WHO ARE RECEIVING SEMAGLUTIDE DURING THE TIME OF COLONOSCOPY Luis M. Nieto1, Sharon Narvaez2, Olanrewaju Adeniran3, Do Han Kim4, Donghyun Ko5, Shailendra Singh3, Jesse Thompson3 1

Emory University School of Medicine, Atlanta, GA, United States; 2Universidad de Guayaquil, Guayaquil, Ecuador; 3West Virginia University, Morgantown, WV, United States; 4Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

192

TIRZEPATIDE VERSUS SEMAGLUTIDE IN OBESE PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED FATTY LIVER DISEASE OR METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS Olanrewaju Adeniran1, Luis M. Nieto2, Ifeoma P. Kwentoh3, Joshua Kirkpatrick1, Ayowumi Adekolu1, Ethan M. Cohen4, Kanith Farah1, Farirai Marwizi5, Sharon Narvaez6, Do Han Kim7, Donghyun8, Islam Younes1 1

West Virginia University School of Medicine, Morgantown, WV, United States; 2Emory University School of Medicine, Atlanta, GA, United States; 3Harlem Hospital Center, New York, NY, United States; 4West Virginia University, Morgantown, WV, United States; 5St. John's Medical College and Hospital, Rockaway Park, NY, United States; 6Universidad de Guayaquil, Guayaquil, Ecuador; 7Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 8Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

251

LIST OF ABSTRACTS 2024-2025

193

194

BEYOND THE RUSH: EFFECTIVE MANAGEMENT OF DUMPING SYNDROME WITH ACARBOSE Sarah Kosse1, Niurka Liranzo Tejera1, Andrea Duque López1, Bharat Monga1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

COUNTING THE COSTS: EXPLORING INTERNAL MEDICINE RESIDENTS' AWARENESS OF FINANCIAL IMPLICATIONS IN HEALTHCARE Sarah Kosse1, Alexandria Markley1, Madelin Fenianos1, Randy Leibowitz1, Krystle Hernandez1, Vasundhara Singh1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

195

A CONCOMITANT CELIAC DISEASE DIAGNOSIS DOES NOT WORSEN CLINICAL OUTCOMES OF INFLAMMATORY BOWEL DISEASE Alexandria Markley1, Swati Patel1, Luis Rendon1, Yontan Israel2, Carlos Diola1, Haley Waite2, Peter Green3, Christopher Cao4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York Presbyterian, Columbia University, New York, NY, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

196

CELIAC DISEASE AND INFLAMMATORY BOWEL DISEASE: CHARACTERISTICS OF A DUAL DIAGNOSIS Alexandria Markley1, Luis Rendon1, Carlos Diola1, Yontan Israel2, Haley Waite2, Peter Green3, Christopher Cao4 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3New York Presbyterian/Columbia University Irving Medical Center, New York, NY, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

197

RADIATION GASTRITIS: A RARE CAUSE OF MELENA Alexandria Markley1, Ahmun Zafar1, James Scharfen1, Dylan Suyama1, Mohamed Rabie1, Phuong Nguyen1, Guangjing Zhu1, Mark Alon1, Yuying Luo1, Zoe Lawrence1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024. *ACG Outstanding Poster Presentation

BEYOND THE ITCH: DIAGNOSING AMA NEGATIVE PRIMARY BILIARY CHOLANGITIS Michihiro Matsugaki1 and Geeta Varghese1

198

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Ryan Chelsea-Clinton, William F. Ryan Community Health Center, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

252

LIST OF ABSTRACTS 2024-2025

199

BRIDGING THE GAP: MYOCARDIAL BRIDGE AS AN IMPORTANT DIFFERENTIAL DIAGNOSIS Aphrodite Megaris1, Faye Megaris2, Amit Gulati3, Mariam Khandaker1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2CUNY School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

200

ATYPICAL PRESENTATION OF AORTIC DISSECTION IN THE CONTEXT OF IGG4 DISEASE Aphrodite Megaris1, Faye Megaris2, William Wallach1, Mariam Khandaker1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; CUNY School of Medicine, New York, NY, United States

2

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

201

THE GENDER SCOPE: ELEVATING PATIENT COMFORT FOR DIRECT ACCESS PROCEDURES Sonia Mehra1, Lauren Alpert2, Jeanette Rios2, Lina H. Jandorf2, Zoë S. Gottlieb3, Tatyana Kushner3, Yuying Luo1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

202

SCHISTOSOMIASIS REACTIVE POLYARTHRITIS MASQUERADING SERONEGATIVE ARTHRITIS OF INFLAMMATORY BOWEL DISEASE Jiaxi Miao1, Aesha Patel1, Elmarie Alexander1, Rahul Gaikwad1, George McKinley1, Mark Alon1

AS

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

203 204

A CASE STUDY OF ACQUIRED HEMOPHILIA A IN A 93-YEAR-OLD FEMALE PRESENTING WITH THIGH HEMATOMA Serene Mirza1, Tharaka Wijesinghe1, Brett Sherman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

PROGRESSION OF SEVERE MALARIA IN A YOUNG MALE PATIENT FROM SENEGA Fahema Nadira1, Aesha Patel1, Krystina Woods1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

253

LIST OF ABSTRACTS 2024-2025

205

A CATECHOLAMINE CATASTROPHE: CASE OF RESISTANT HYPERTENSION DUE TO PHEOCHROMOCYTOMA Felix Adrian Valverde1, Rodrigo Paredes de la Fuente2, Richard G. Vaca2, Jared Leventhal2 1

Danbury Hospital, Danbury, CT, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

ACHIEVING REMISSION IN METASTATIC SARCOMATOID LUNG CARCINOMA WITH PEMBROLIZUMAB AND PLATINUM-DOUBLET TREATMENT Rodrigo Paredes de la Fuente1, Toshiro Goto1, Maninderjit Ghotra1, Jorge Gomez2 1

206

207

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

ASSESSING BIOMARKER TESTING AWARENESS AMONG PATIENTS AND CAREGIVERS IN NON-SMALL CELL LUNG CANCER THROUGH AN INTERDISCIPLINARY GLOBAL SURVEY Rodrigo Paredes1, Francisco Lopez-Rios2, Amy Moore3, Anne-Marie Baird4, Talia Gashi5, Shilo Shilo6, Christian Rolfo7 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hospital Universitario, Madrid, Spain; 3LUNGevity Foundation, Chicago, United States; 4Lung Cancer Europe, Ireland; 5COR2ED, Switzerland; 6Israeli Lung Cancer Foundation (ILCF), and Patient Advocates Committee at International Association for the Study of Lung Cancer (IASLC), Denver, Colorado, United States; 7Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States

Presented at the European Society of Medical Oncology (ESMO) Annual Meeting that was held in Barcelona, Spain from September 13-17, 2024.

208

CIRCULATING TUMOR DNA MUTATIONS AS MARKERS FOR BRAIN METASTASES AT DIAGNOSIS AND DURING TREATMENT Rodrigo Paredes1, Toshiro Goto1, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University, Columbus, OH, United States 2

Presented at the International Society of Liquid Biopsy (ISLB) Annual Meeting that was held in Denver, Colorado, United States from November 23-25, 2024.

209

CYTOMEGALOVIRUS INFECTIONS FOLLOWING CAR T-CELL THERAPY Poorva Bindal1, Marcela Banegas2, Rodrigo Paredes de la Fuente3, Maria Jose Hernandez Woodbine4, Pushan Aggarwal5, Jon E. Arnason,6 Carolyn D. Alonso6 1

University of Massachusetts Chan Medical School, Grafton, MA, United States; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Mount Sinai Morningside-West Hospitals, New York, NY, United States; 4Norwalk Hospital, Yale University, New Haven, CT, United States; 5Allegheny Health, Pittsburg, PA, United States; 6Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, United States 3

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 4-7, 2024.

254

LIST OF ABSTRACTS 2024-2025

210

PREDICTIVE UTILITY OF CIRCULATING TUMOR DNA IN FIRST-LINE OSIMERTINIB THERAPY FOR EGFR-MUTANT METASTATIC LUNG ADENOCARCINOMA Rodrigo Paredes1, Toshiro Goto1, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University, Columbus, OH, United States 2

Presented at the International Association for the Study of Lung Cancer (IASLC) Annual Meeting that was held in Washington, DC, United States from December 13-15, 2024.

211

ROLE OF CTDNA VARIANT ALLELE FREQUENCY IN PREDICTING RESPONSE TO IMMUNE CHECKPOINT INHIBITORS IN NON-SMALL CELL LUNG CANCER Rodrigo Paredes1, Ariel Peleg2, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University, Columbus, OH, United States 2

Presented at the International Association for the Study of Lung Cancer World Conference on Lung Cancer (WCLC) Annual Meeting that was held in San Diego, California, United States from September 7-10, 2024.

212

213

214

A FATAL CASE OF KAPOSI'S SARCOMA ASSOCIATED HERPESVIRIS HHV8 AND MULTICENTRIC CASTLEMAN'S DISEASE Aesha Patel1, Fahema Nadira1, Krystina Woods1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

A MULTIDISCIPLINARY APPROACH TO REDUCING HOSPITAL ACQUIRED PRESSURE INJURIES IN INTENSIVE CARE UNITS Aesha Patel1, Jorge Sinclair De Frias1, James Salonia1, Amanda Zotte1, Sarah Costigan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

DE-ESCALATING ANTI-PSEUDOMONAL ANTIBIOTICS IN PATIENTS WITH PNEUMONIA BASED ON RESPIRATORY CULTURES IN CRITICAL CARE UNITS AT MOUNT SINAI MORNINGSIDE-WEST- A QUALITY IMPROVEMENT PROJECT Maria Baig1, Daniel Mesa1, Aesha Patel1, Sanam Ahmed1, James Salonia1, Valida Bajrovic1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

255

LIST OF ABSTRACTS 2024-2025

215

MAJORITY OF PATIENTS VISITING THE EMERGENCY DEPARTMENT FOR CHRONIC CONSTIPATION ARE NOT ON APPROPRIATE MEDICATIONS AND LIKELY TO RETURN WITHIN ONE YEAR Swati Patel1, Joseph Menand1, Priyanka Singh1, Michael S. Smith2, Daniela Jodorkovsky1, Yuying Luo1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

216

217

218

TEACHING TO IMPROVE RESIDENT KNOWLEDGE ON SCREENING FOR BARRETT’S ESOPHAGUS Swati Patel1, Ines Varela Knorr1, Michael Smith1, Priya Simoes1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

WHEN THE HEART'S CURE BECOMES THE STOMACH'S CHALLENGE: A RARE CASE OF POST CRYOBALLON ABLATION GASTROPARESIS Swati Patel1, Adam Tillowitz1, Priya Simoes1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

COMPREHENSIVE MANAGEMENT OF A SEVERE CASE OF CANDIDA ORTHOPSILOSIS ENDOCARDITIS Usman Saeedullah1, Komail Jafri1, Harrison Bonilla1, Syed Zaidi1, Sanjay Sivalokanathan1, Edgar Argulian1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

219

HYPERSOMNIA IN THE INTENSIVE CARE UNIT: A MARKER FOR POOR OUTCOMES? Benjamin Samuel1, Christiana Choi1, Suraj Shah2, Arshdeep Dhaliwal1, Connor Smith1, Adrian Chernyk1, Keshav Dixit1, David Tai1, Dan Levendowski2, Priscilla Loanzon1, Lloyd Muzangwa1, Raymonde Ernest Jean1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Advanced Brain Monitoring, Inc., Carlsbad, CA, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

220

A RARE CASE OF DUODENAL DIVERTICULITIS: RIGHT UPPER QUANDRANT PAIN THAT ISN’T ACUTE CHOLECYSTITIS? Adam Tillowitz1, Robinderpal Sandhu1, Frank Nelson1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

256

LIST OF ABSTRACTS 2024-2025 DUODENAL DIVERTICULITIS RESULTING IN GASTRIC OUTLET OBSTRUCTION Adam Tillowitz1, Robinderpal Sandhu1, Michael S. Smith2

221

222

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

HIDING IN PLAIN SIGHT: A CASE OF CONCURRENT PUSTULAR PSORIASIS AND INFLAMMATORY BOWEL DISEASE Robinderpal Sandhu1, Emily Seltzer1, Binoy Desai1, Mantej Sehmbh1, Michael S. Smith1,2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

223

224

ACUTE INTERSTITIAL PNEUMONIA SECONDARY TO AMIKACIN LIPOSOME INHALATION SUSPENSION Hammad Sheikh1, Catherine Zaw1, Edward Eden1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

A NOVEL SIMULATION-BASED EDUCATIONAL CURRICULUM TO BRIDGE THE GAP BETWEEN SEPSIS AND POSTSEPSIS CARE Hammad Sheikh1, Harrinda Seepersaud1, Amit Pradhan1, Priscilla V. Loanzon1, Susannah Kurtz, Jacob Bell1, Ahmed Shaikh, Nikita Desia1, Adam Rothman1, James Salonia1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

225

EFFECT OF CATHETER-DIRECTED THROMBOLYSIS OR CATHETER-DIRECTED EMBOLECTOMY ON PULMONARY ARTERY PRESSURES IN INTERMEDIATE- AND HIGH-RISK PULMONARY EMBOLISM Howard Freeman1, Avinash Singh1, Hammad Sheikh1, Abdul Rehman1, Connor Smith1, Jeeyune Bahk1, Keshav Dixit1. Robert Lookstein1, David J. Steiger1,3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

226

OUTCOMES FOLLOWING CATHETER-DIRECTED THROMBOLYSIS AND CATHETERDIRECTED EMBOLECTOMY IN INTERMEDIATE AND HIGH-RISK PULMONARY EMBOLISM Hammad Sheikh1, Abdul Rehman1, Connor Smith1, Howard Freeman1, Avinash Singh1, Keshav Dixit1, Jeeyune Bahk2, Alvin Yang1, Robert Lookstein1, David J. Steiger1,3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

257

LIST OF ABSTRACTS 2024-2025

227

RARE BUT DEADLY - EOSINOPHILIC MYOCARDITIS IN A PATIENT WITH EOSINOPHILIC GRANULOMATOSIS POLYANGIITIS Samantha Shetty1, Priya Shah1, Yee Soo Kim1, Angel De La Cruz Tejada1, Ankitha Radakrishnan2, Anya Srikureja2, Adam Jacobi2, Mary Beasley2, Kiran Mahmood1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

228

UNVEILING THE BIOLOGICAL SUBTYPES OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION THROUGH UNSUPERVISED CLUSTERING OF ECG DATA Samantha Shetty1, Joshua Lampert2, Joy Jiang2, Girish Nadkarni2, Akhil Vaid2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

229

COMBINED LUNG AND LIVER TRANSPLANT FOR CIRRHOSIS, IDIOPATHIC PULMONARY FIBROSIS, AND HEMOPHILIA A Lorenzo Olivero1, Hong Liang2, Ian Makey2, Si M. Pham2, Jorge Sinclair de Frias3, Stephen Aniskevich2, Sadia Shah2, Dana Perry2, Wesley Allen2, Nathan Waldron2, Liu Yang2, Pramod K. Guru2, Candido Rivera2, Pablo Moreno Franco2, Tathagat Narula2 1

Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; 2Mayo Clinic, Jacksonville, FL, United States; 3Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

230

PERCUTANEOUS TRACHEOSTOMY TIMING AND OUTCOMES Jorge Sinclair de Frias1, Yoshiko Ishisaka1, Keshav Dixit,1 Shasha X. Chen1, Lina Miyakawa1, Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

SEPSIS OUTCOMES IN LIVER TRANSPLANTATION Jorge Sinclair de Frias1, Abigail Gabela2, Keshav Dixit1, Lorenzo Olivero3, James Salonia1

231

232

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Universidad de Panama, Panama City, Panama; 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

SEPSIS OUTCOMES IN LUNG TRANSPLANT RECIPIENTS Jorge Sinclair de Frias1, Keshav Dixit1, Abigail Gabela2, Lorenzo Olivero3, and James Salonia1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Universidad de Panama, Panama City, Panama; 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

258

LIST OF ABSTRACTS 2024-2025 SURVIVING THE ODDS: KIDNEY TRANSPLANT PATIENTS AND SEPSIS OUTCOMES Jorge Sinclair de Frias1, Abigail Gabela2, Keshav Dixit1, Lorenzo Olivero3, James Salonia1

233

1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Universidad de Panama, Panama City, Panama; 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States 2 Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

234

UNDERSTANDING SEPSIS IN HEART TRANSPLANT PATIENTS: MORTALITY AND ORGAN FAILURE PATTERNS Jorge Sinclair de Frias1, Lorenzo Olivero2, Abigail Gabela3, Keshav Dixit1, James Salonia1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; 3Universidad de Panama, Panama City, Panama 2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

235

PLEURAL EMPYEMA SECONDARY TO XANTHOGRANULOMATOUS PYELONEPHRITIS Connor Smith1, Mohammed I. Alsaud1, Bertin D. Salguero1, Omry Zuckerman1, Avinash Singh1, Susannah Kurtz1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

236

237

A NOVEL COMPARISON OF LUNG POINT OF CARE ULTRASOUND INTERVENTIONS: AN INTROSPECTIVE REVIEW OF POINT OF CARE ULTRASOUND CURRICULUM Hua-Hsin Tai1, Harrindra Seepersuad1, Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BARRIERS TO THE BRAIN: UNVEILING THE IMPACT AND DISPARITIES OF SENTINEL CEREBRAL PROTECTION IN TRANSCATHETER AORTIC VALVE REPLACEMENT PATIENTS Samuel Tan1, Lucy Zheng1, Wenchy Siu1, Robert Trenschel1, Marlon Rivera Boadla2, Sakshi Khurana3, Amit Gulati1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Maimonides Health, Brooklyn, NY, United States; 3New York/Presbyterian Columbia, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

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DELINEATING SCAD AND NON-SCAD IN ACUTE MYOCARDIAL INFARCTION: PREVALENCE, DEMOGRAPHIC PREDICTORS, AND CLINICAL OUTCOMES Samuel Tan1, Atsuyuki Watanabe1, Robert Trenschel1, Wenchy Siu1, Paulus Adinugraha1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

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LIST OF ABSTRACTS 2024-2025 LIFESTYLES VITAL SIGNS AS A TOOL TO SCREEN FOR HEALTHY HABITS Richard Vaca1, Patricia Dharapak2, Desiree Chow2

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1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

ELOTUZUMAB-IBERDOMIDE-DEXAMETHASONE COMBINATION THERAPY ACTIVATES T AND NK CELLS WITHIN THE IMMUNE MICROENVIRONMENT OF MULTIPLE MYELOMA PATIENTS Lucia Y. Chen1, Michael Amatangelo2, Adolfo Aleman3, Oliver Van Oekelen4, Tania Nevers2, Yongliang Sun2, William E. Pierceall2, Katerina Kappes5, Anna Blangiardo5, Sundar Jagannath3, Cesar Rodriguez4, Samir Parekh4 1

University of Oxford, Oxford, United Kingdom; 2Bristol Myers Squibb, Summit, NJ, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 6-9, 2024.

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CASE-BASED LEARNING IN ACTION: ELEVATING RESIDENT KNOWLEDGE ON ACHALASIA DIAGNOSIS AND MANAGEMENT Ines Varela Knorr1, Swati Patel1, Daniela Jodorkovsky1, Priya Simoes1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

HEMORRHAGIC COMPLICATION OF AN ULTRASOUND-GUIDED PARACENTESIS Emily Seltzer1, Ines Varela Knorr2, Walaa Mahmoud3, Alexander Davidovich2 1

Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

POSITIVE GASTRIC EMPTYING STUDY: GASTROPARESIS OR ACHALASIA? Ines Varela Knorr1 and Kimberly Cavailiere1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

SEDATION IN THE INTENSIVE CARE UNIT: A NOVEL ONLINE CASE-BASED INTERACTIVE LEARNING TOOL FOR RESIDENT EDUCATION Archana Pattupara1, Alexander Davidovich1, Mirna Mohanraj1, Fernando Vázquez de Lara1, Hammad Sheikh1, Gale Justin2, Lilas Armstrong-Davies2, Erik Popil2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

260

LIST OF ABSTRACTS 2024-2025

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DAPTOMYCIN-INDUCED EOSINOPHILIC PNEUMONIA: A CASE REPORT Agostina Velo1, Ilana Bandler1, Connor Welsh1, Idayat Brimah1, Edwardine Mohanraj1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

DIAGNOSIS OF AN ACTIVE TUBERCULOSIS INFECTION UTILIZING NATURAL LANGUAGE PROCESSING Agostina Velo1, Shasha X. Chen1, Sascha Adler1, Nour Ayoub1, Steven Lim1, Hong Yu Wang1, Sara Luby1, Junyu Qi1, Javier J. Zulueta1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

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REACTIVE ARTHRITIS TRIGGERED BY HAEMOPHILUS INFLUENZAE BACTEREMIA Agostina E. Velo1, Richard G. Vaca1, Lindsey Fox1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

UNCOMMON COMPLICATIONS OF SALMONELLA TYPHI Agostina E. Velo1, Caileen Sennett1, Connor Smith1, Anahi McIntyre1, Lindsey Fox1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

A RARE CASE OF MCKITTRICK-WHEELOCK SYNDROME Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Marcos Rosa-Santana2, Steven Rodriguez1, Ari Grinspan3 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2BronxCare Health System, Bronx, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

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SURVIVAL ANALYSIS AND ASSOCIATED FACTORS IN METASTATIC YOUNG ONSET CHOLANGIOCARCINOMA VERSUS METASTATIC AVERAGE ONSET CHOLANGIOCARCINOMA Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Sirish Dharmapuri1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

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WHICH CAME FIRST: THE EGGS OR THE COLITIS? A RARE PRESENTATION OF SCHISTOSOMIASIS Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Bharati Dev1, Adam Tillowitz1, Kimberly Cavaliere1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

261

LIST OF ABSTRACTS 2024-2025

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UNMASKING SHINING A LIGHT ON NIGHTS: OPTIMIZING ACADEMIC NIGHT FLOAT ROTATIONS William J. Wallach1, Aphrodite Megaris1, Christopher Tricarico2, Kimberly Christophe2, Jessica Goldberg2, Ian Yu2, Kristine Favila2, Dahlia Rizk2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

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A CASE OF REFRACTORY IMMUNE THROMBOCYTOPENIA IN THE SETTING OF ABDOMINAL SPLENOSIS Alvin Wang1, Chad Henry1, Adam Rothman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

ADAPTING AND ADVANCING: A RENAL ULTRASOUND CURRICULUM Hong Yu Wang1,2, Yoshiko Ishisaka1,2, Hayato Mitaka1,2, Elliot Charen2, Paru S. Patrawalla1,2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

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ASSOCIATION OF RACE AND ETHNICITY WITH OUTCOMES FOR PATIENTS WITH ACUTE PULMONARY EMBOLISM TREATED BY PULMONARY EMBOLISM RESPONSE TEAM Hong Yu Wang1, Abdul Rehman1, Avinash Singh1, Priyanka Sridhar1, Agostina Velo1, Destiny Nguyen1, Madeline R. Ehrlich1, David J. Steiger1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

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ASSOCIATION BETWEEN RACE AND INSURANCE WITH FOLLOW-UP RATES OF INCIDENTAL LUNG NODULES Hong Yu Wang1, Nour Ayoub1, Shasha X. Chen1, Steven Lim1, Sara Luby1, Agostina Velo1, Junyu Qi1, Sasha Alder1, Javier J. Zulueta1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

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CORRELATIONS BETWEEN IMAGING FEATURES AND FOLLOW-UP RATES FOR LUNG NODULES Sara Luby1, Nour Ayoub1, Hong Yu Wang1, Shasha X. Chen1, Steven Lim1, Agostina Velo1, Junyu Qi1, Sascha Adler1, Javier J. Zulueta1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

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LIST OF ABSTRACTS 2024-2025

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A NEW APPROACH FOR EARLY DETECTION AND MANAGEMENT OF LUNG CANCER Nour Ayoub1, Hong Yu Wang1, Junyu Qi1, Sascha Adler1, Shasha X. Chen1, Steven Lim1, Sara Luby1, Agostina Velo1, Javier J. Zulueta1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

INCIDENTAL LUNG NODULES: UNVEILING THE UNDETECTED POPULATION Steven Lim1, Sasha X. Chen1, Nour Ayoub1, Hong Yu Wang1, Sara Luby1, Agostina Velo1, Junyu Qi1, Sasha Adler1, Javier J. Zulueta1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

OPTIMIZING LUNG TRANSPLANT REFERRAL IN FELLOWSHIP CLINIC Shasha X. Chen1, Hong Yu Wang1, Jigna Zatakia, Boram Kim 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

MULTIFOCAL STROKES IN ESSENTIAL THROMBOCYTOSIS Tharaka Wijesinghe1 and Krystle Hernandez1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CAN WE BLAME IT ALL ON THE IMMUNE CHECKPOINT INHIBITOR? Yuhong Yang1, Destiny Nguyen1, Nicole Morel1, Mary O’Sullivan1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

AN OBSCURE CASE OF DYSPHAGIA Yuhong Yang1, Michael S. Smith2, Kimberly Cavailiere1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

A RARE CASE OF DUODENAL ADENOCARCINOMA IN A 22-YEAR-OLD Ahmun Zafar1, Alexandria Markley1, Allison Wang1, Mohamed Rabie1, Bruce P. Gelman1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BIAS IN THE BOWEL: DISPARITIES IN DIAGNOSTIC TESTING FOR CONSTIPATION Ahmun Zafar1, Joseph Menand1, Yuying Luo1 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

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Abstracts 2024-2025*

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*Research/Scholarly Work presented in 2024-2025; does not include presentations already submitted as a poster.

ABSTRACT #139 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY HOW LOW CAN YOU GO? HYPOALBUMINEMIA SECONDARY TO PROTEIN LOSING ENTEROPATHY IN A POST-GASTRIC BYPASS PATIENT Arushi Agarwal1 and Jessica Lim1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024. *ACG Outstanding Poster Presenter BACKGROUND/INTRODUCTION: Protein-losing enteropathy (PLE) is characterized by excessive loss of serum proteins into the gastrointestinal tract. It is a rare cause of hypoalbuminemia and can lead to anasarca, circulatory collapse, and systemic symptoms. PLE is associated with diverse etiologies stemming from a broad spectrum of diseases. It can occur as a rare complication after gastric bypass surgery, particularly in patients who have undergone Roux-enY gastric bypass, though not much literature has been published on this phenomenon. We present a case of PLE after Roux-en-Y gastric bypass.

CASE PRESENTATION: A 56-year-old female with a past medical history of Roux-en-Y gastric bypass oneyear prior, previous kidney donation, and depression presented with progressive, persistent diarrhea, weakness, and shortness of breath over several weeks. Physical exam was notable for diffuse anasarca and initial albumin was 2 g/dL. She underwent comprehensive evaluation for severe hypoalbuminemia, including infectious workup, colonoscopy and endoscopy, and malignancy screening. She was found to have an elevated alpha-1 antitrypsin fecal test. Hypoalbuminemia workup was negative for common causes, and PLE as a sequela of gastric bypass was found to be the most probable etiology.

DISCUSSION/CONCLUSION: PLE occurs via three mechanisms: inflammatory exudation, increased mucosal permeability, and intestinal loss of lymphatic fluid. The etiology of PLE encompasses a range of disorders, including primary intestinal lymphangiectasia, inflammatory bowel diseases, infections, congestive heart failure, and post-surgical states. Diagnostic evaluation typically involves laboratory tests demonstrating low serum albumin and increased fecal alpha-1 antitrypsin clearance alongside imaging and endoscopy. PLE is an uncommon condition with a complex, varied etiology, making it a challenging diagnosis in clinical practice. In the context of gastric bypass, PLE is attributed to multifactorial mechanisms such as mucosal injury, altered gastrointestinal anatomy, and bacterial overgrowth. These factors can lead to significant protein loss and subsequent hypoalbuminemia, manifesting in symptoms such as those seen in our patient. Despite its rare occurrence, the potential severity of PLE in post- gastric bypass patients necessitates clinical awareness and consideration when these patients present with hypoalbuminemia.

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ABSTRACT #140 CASE REPORT/CLINICAL REVIEW NEUROLOGY A LITTLE TOO LATE - A CASE ON DELAYED DIAGNOSIS OF SACRAL STENOSIS LEADING TO IRREVERSIBLE NEUROLOGICAL DEFICITS Melissa Akselrad1 and Houman Danesh2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Sacral stenosis involves degenerative changes in the spine, such as hypertrophy of the ligamentum flavum, facet joint arthropathy, and disc bulging, which collectively reduce the space available for the neural elements. Sacral stenosis with compression of the S3 nerve root can also occur due to venous congestion, fractures at the sacral foramina, new bone formation below the lumbosacral transition vertebrae that causes partial sacralization and incomplete fusion, and redundant nerve roots due to severe lumbar spinal canal stenosis. This can lead to neurogenic claudication, back and leg pain, numbness, weakness, bowel and bladder dysfunction. Chronic symptoms, particularly those lasting more than three months, are associated with poorer outcomes and more rapid progression of neurological deficits.

CASE PRESENTATION: A 70-year-old female awoke with sudden left leg numbness and sought emergency care, where evaluation was inconclusive. She was discharged with follow-up imaging. A week later, she collapsed when trying to stand. MRI revealed cervical stenosis, and she started physical therapy without improvement. Three months later, her condition worsened with numbness in both legs, saddle anesthesia, and urinary/bowel incontinence but no back pain. Despite these neurological changes, reflexes were normal, and myelopathy was absent. Diagnosed with functional disorder, she began psychiatric therapy. After a year without improvement, multiple specialists linked her symptoms to cervical stenosis, leading to C5-C7 fusion. Postsurgery, her condition worsened, with numbness from the waist down, sphincter loss, and severe spasms. A year later, worsening symptoms led to imaging that found L5 foraminal stenosis. Pain management diagnosed lumbar radiculopathy, treating her with epidural injections. Further exams suggested sacral pathology, and MRI revealed S3 spinal stenosis. A neurosurgeon diagnosed rare congenital sacral stenosis and recommended an S2-5 laminectomy. Three years after symptom onset, she underwent the procedure, but symptoms persisted, including lower limb numbness and worsening urinary incontinence, leading to frequent UTIs. DISCUSSION/CONCLUSION: Early detection and treatment of sacral stenosis are vital to prevent permanent neurological deficits. This condition can cause severe impairments, including cauda equina syndrome with weakness, bowel/bladder dysfunction, and sensory loss. Nerve damage severity correlates with compression degree and duration. Studies show early decompression aids recovery, while prolonged compression causes irreversible damage. Untreated S3 compression can lead to a significant decline in quality of life. These complications underscore the importance of timely diagnosis and appropriate management to prevent long-term associated morbidity.

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ABSTRACT #141 CASE REPORT/CLINICAL REVIEW ALLERGY/IMMUNOLOGY PRE-OPERATIVE MANAGEMENT OF A PATIENT WITH ALPHA-GAL SYNDROME REQUIRING HIGHDOSE HEPARIN FOR CORONARY ARTERY BYPASS GRAFTING SURGERY Shubhankar Anand1, Neil Patel2, Rachel Miller2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Alpha-gal syndrome is an IgE-mediated allergy to galactose-alpha-1,3galactose, an oligosaccharide in non-primate mammalian meat. Some alpha-gal allergic patients react to medications containing galactose-alpha-1,3-galactose, such as porcine-derived heparin. The likelihood of reaction increases with higher doses of heparin, resulting in a challenging pre-operative risk-analysis for patients undergoing cardiac procedures.

CASE PRESENTATION: A 52-year-old male with alpha-gal syndrome for 5 years and multi-vessel coronary artery disease required high-dose heparin administration for coronary artery bypass grafting (CABG). Evaluation revealed negative skin prick testing and intradermal testing (1:1000, 1:100, 1:10 dilutions) to heparin (10,000U/mL). Serum alpha-gal IgE was 0.59kU/L, and serum-IgE to beef, pork, and lamb were 0.31kU/L, 6.85kU/l, and 1.09kU/L respectively. Total IgE was 502kU/L (alpha-gal/total IgE ratio=0.12). The patient was deemed low risk for peri-operative heparin reaction. He received a three-day premedication regimen of daily prednisone/montelukast and twice-daily cetirizine plus standard 13, 7, 1 hour protocol, tolerated a challenge of 100U IV heparin, and underwent successful CABG. Subsequently, the patient received 5,000U heparin every 12 hours until post-operative day three when he developed urticaria and heparin was discontinued. Several weeks after discharge, the patient experienced a severe allergic reaction to bacon.

DISCUSSION/CONCLUSION: A thorough pre-operative evaluation of patients with alpha-gal syndrome requiring high-dose heparin is important. Utilizing heparin during cardiac surgery is preferred due to its effectiveness, short half-life, and reversibility and may be tolerated even in the presence of alpha gal, with reactions potentially minimized through pre-medication. Allergists should strive to safely evaluate patients with alpha-gal for cardiac surgery wherever possible.

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ABSTRACT #142 CASE REPORT/CLINICAL REVIEW NEPHROLOGY/RHEUMATOLOGY OVERLAPPING SYSTEMIC LUPUS ERYTHEMATOSUS AND ANCA-ASSOCIATED VASCULITIS: A RARE CAUSE OF NEPHROTIC SYNDROME Pragati Basera1, Rodrigo Paredes de la Fuente1, Shota Obata1, Andrea Duque Lopez1, Miriam Chung1, Ruchika Batwara1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Systemic lupus erythematosus (SLE) and anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) are two distinct autoimmune diseases that rarely present concurrently as an overlap syndrome. These syndromes are clinically significant, especially in patients with biopsy-proven glomerulonephritis (GN), where the prevalence of overlap syndrome is estimated to be approximately 2%.

CASE PRESENTATION: A 71-year-old woman with a history of polyarthritis and hypothyroidism presented with an 8-month history of progressive generalized weakness and bilateral lower extremity swelling. Over time, her weakness led her becoming wheelchair dependent and requiring assistance with daily activities. Initial labs showed UPCR 4.3 g/gCr, red blood cell casts, and serum creatinine of 0.69 mg/dL. Complement levels were low (C3: 46 mg/dL, C4: <4), with a positive autoimmune panel: ANA (1:160), dsDNA (1:80), MPO-ANCA (>8), and PR3-ANCA (3.4). Chest CT showed nonspecific interstitial lung disease, and muscle biopsy revealed severe inflammatory myopathy without vasculitis. Renal biopsy showed crescentic GN with IgG, IgM, C3, and light chains but negative C1q and IgA, suggesting class III lupus nephritis with possible ANCA-mediated injury. Initially treated with high-dose steroids and MMF for lupus nephritis, however, persistent proteinuria led to rituximab initiation. After two doses, proteinuria improved significantly, supporting the diagnosis of SLE/AAV overlap syndrome.

DISCUSSION/CONCLUSION: SLE and ANCA-AAV overlap syndrome is a rare but significant condition with features of both immune complex-mediated and pauci-immune glomerulonephritis. In our case, crescentic GN with immune complex deposits suggested lupus nephritis, but the absence of C1q deposits and MPOANCA/PR3-ANCA positivity indicated a pauci-immune process, highlighting diagnostic challenges. Crescentic GN, seen in about 20% of lupus nephritis cases, is a shared feature. The coexistence of ANA and ANCA complicates diagnosis, as these antibodies appear separately in lupus nephritis and ANCA-associated vasculitis.

Patients often present with severe disease, including rapidly progressive GN, significant proteinuria, and possible pulmonary involvement. Treatment requires immunosuppressive therapy targeting both conditions.

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ABSTRACT #143 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE ARRGH YOU SURE IT'S NOT SCURVY?: A UNIQUE PRESENTATION OF VITAMIN C DEFICIENCY IN A POST‐BYPASS PATIENT Nooshin C. Beygui1, Ahmun Zafar1, Andrea Ramirez Cazares1, Grace Macmillan2, Kata Boros1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2New York Institute of Technology College Osteopathic Medicine, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 47‐year‐old female with history of gastric bypass complicated by dumping syndrome, opioid use disorder on methadone, alcohol use disorder, migraines, and seizures presented with 3 weeks of painful bilateral lower extremity swelling, and 2 months of poor oral intake with persistent diarrhea. Her exam was also notable for tooth fragility, course hair, and scaling skin. Laboratory tests revealed macrocytic anemia, hypoalbuminemia without proteinuria, hypokalemia, and elevated lactate. Creatinine, liver function, and thyroid function testing were normal. Bilateral lower extremity Doppler ultrasound excluded deep vein thrombosis and lymphoscintigram was unremarkable. The patient was treated with diuretics, but her lower leg edema and pain persisted after combined intravenous and oral diuretics. Given her history of poor nutrition, alcohol use disorder, and diarrhea, she was treated with supplemental multivitamin, thiamine, folic acid, and B12. The patient's medical and surgical history, negative clinical workup, and lack of response to diuretics cast suspicion for malabsorption and nutrient deficiency. Protein‐losing gastroenteropathy was considered, but alpha‐1‐antitrypsin clearance was normal, making this unlikely. Expanded laboratory testing including both fat and water‐soluble vitamins, minerals, and iron studies revealed an undetectable vitamin C level. These labs and her physical exam findings were consistent with scurvy. She was initially treated with enteral vitamin C with minimal improvement, followed by parenteral replacement, which improved her edema, pain, and erythema.

DISCUSSION: Vitamin C is critical to collagen formation; deficiency inhibits collagen transcription and can result in unique skin findings such as scaly skin, hyperkeratosis, skin fragility, bleeding gums, and corkscrew hair.

While not commonly thought to arise due to scurvy, several reports have demonstrated cases of significant peripheral edema in patients with vitamin C deficiency. Those with limited access to food, alcohol use disorder, or gastrointestinal malabsorptive disorders are at greater risk of developing a deficiency of vitamin C. Additionally, bariatric procedures disrupt the anatomy and physiology of the gastrointestinal tract, altering nutrient and mineral absorption. The most common deficiencies reported are B12, iron, vitamin D and calcium, while less emphasis is placed on deficiencies of other micronutrients and minerals, including vitamin C. In this case, it is likely the patient's prior gastric bypass surgery coupled with her poor nutrition and alcohol use disorder resulted in a severe vitamin C deficiency. She presented uniquely with severe pain and hyperemic peripheral edema as well as classic signs of scurvy such as scaling skin and tooth fragility. Her symptoms subsequently improved with vitamin C supplementation confirming our suspicion that scurvy was affecting her clinical presentation.

CONCLUSION: We Vitamin deficiencies are a known complication of gastric bypass surgery but reports of vitamin C deficiency post‐Rouxen‐Y are less commonly reported.

This case emphasizes the importance of assessing long‐term nutritional deficiencies in gastric bypass patients. Furthermore, having an awareness of other manifestations of vitamin C and other micronutrient deficiencies – including significant painful edema – is critical for prompt recognition and minimizing delays in diagnosis and treatment.

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ABSTRACT #144 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY COMPOSITE ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA AND MARGINAL ZONE B-CELL LYMPHOMA Nooshin Beygui1, Rodrigo Paredes1, Ibrahim Omore2, Christian Salib2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Angioimmunoblastic T-cell lymphoma (AITL) is a rare, aggressive peripheral T-cell lymphoma (PTCL) marked by immune dysregulation, polymorphic histology, and resistance to chemotherapy, with a 5-year survival rate of 32%.1,2 ITL management is further complicated when presenting as a composite lymphoma, defined as coexistence of two distinct lymphoma subtypes in a single patient.3 The simultaneous occurrence of AITL and extranodal marginal zone B-cell lymphoma, as observed in this case, is exceedingly rare and presents unique diagnostic and therapeutic challenges.

CASE PRESENTATION: A 59-year-old patient presented worsening dyspnea and recurrent pleural and pericardial effusions, requiring multiple hospitalizations. The patient underwent multiple pleural and pericardial effusion. Extensive autoimmune and infectious workups were negative. CT imaging revealed diffuse lymphadenopathy. Bone marrow biopsy revealed a CD20+ B-cell population indicative of low-grade B-cell lymphoproliferative disorder. Axillary lymph node biopsy showed atypical CD4+ T-cells with CD10 and BCL6 expression, loss of CD7, dim CD3 staining, and prominent vascular proliferation, consistent with AITL. Taken together, the patient’s malignancy was consistent with composite B-cell and T-cell lymphoma. Given AITL’s aggressive nature, treatment was initiated with CHP-BV (cyclophosphamide, doxorubicin, prednisone, brentuximab vedotin), with plans for Rituximab for the B-cell component. Though the patient initially tolerated therapy, she ultimately passed of infectious complications.

DISCUSSION/CONCLUSION: AITL is an aggressive, chemotherapy-resistant T-cell lymphoma of T-follicular helper (TFH) cell origin, characterized by markers such as CD10, BCL6, and PD-1. Its coexistence with extranodal marginal zone B-cell lymphoma is rare, potentially arising from a shared clonal origin or an immunosuppressive environment fostering secondary lymphoma. Treatment was prioritized with CHP-BV (cyclophosphamide, doxorubicin, prednisone, brentuximab vedotin) instead of CHOP. Omitting vincristine reduces neurotoxicity, while brentuximab vedotin, targeting CD30, has shown improved outcomes in PTCLs. The B-cell component was planned for subsequent treatment with Rituximab, however, infectious complications, a known risk in T-cell lymphomas, ultimately led to a fatal outcome. This case demonstrates the complexity of composite lymphomas and the ongoing challenge of optimizing treatment sequencing. Further research into how to treat composite lymphomas, particularly of T-cell origin and aggressive AITL, is warranted to improve patient outcomes.

Figure 1. PET scan demonstrating highly active lymph nodes (A) and (B) the diaphragm discovered post-drainage of pleural and pericardial effusions.

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ABSTRACT #145 CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE A MID-PROCEDURE PAUSE: INTRAOPERATIVE IATROGENIC PNEUMOTHORAX DURING LIPOSUCTION Christiana Choi1 and Nikita Agrawal1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Liposuction is a relatively safe procedure often performed in an outpatient setting. Pneumothorax, the collection of gas in the pleural space resulting in lung collapse, is a rare complication of liposuction, with as few as 7 incidences out of 16,215 procedures per a study published in 2020. We report a case of intraoperative iatrogenic pneumothorax as a complication of liposuction, resulting in an emergent interruption of the procedure and a rush to the emergency department.

CASE PRESENTATION: A 37-year-old female with a past medical history of asthma was brought to the hospital while intubated and hypoxic after getting liposuction at an outpatient plastic surgery clinic. After the induction of general anesthesia, the patient was 2 hours into the operation when she was noted to be hypoxic (SpO2 87%).

The patient had received the procedure on her right arm and abdomen through entry sites below her right breast and right upper posterior thorax. Lung auscultation revealed decreased right-sided breath sounds, and the endotracheal tube (ETT) was pulled back from 22cm to 19cm. However, the patient had further respiratory decompensation and became hypoxic to 70%. The patient was brought to the emergency department for persistent hypoxia while intubated. A chest X-ray revealed right-sided large pneumothorax. Thus, a chest tube was placed with improvement in hypoxia and patient was extubated. A subsequent CT chest showed a large right pneumothorax with right middle and lower lobe atelectasis and no evidence of bullous or other interstitial lung disease as the etiology of pneumothorax. Following chest tube placement, patient had resolution of the pneumothorax, and chest tube was removed and patient was discharged home.

DISCUSSION/CONCLUSION: Pneumothorax is a rare complication of liposuction. In this particular case, it is likely that the trauma – whether from an actual puncture of the chest wall or blunt traumatic force – from the right upper posterior thorax insertion site caused a pneumothorax, as the fibrous nature of the adipose tissue and proximity to the pleural space in that particular region increase the risk. For this patient, her history of asthma could have been a contributory factor; however, the correlation between asthma and an increased risk of pneumothorax is unclear. The presentation of this patient, with hypoxia combined with decreased unilateral breath sounds in the operational site, was highly suspicious of iatrogenic pneumothorax, and timely intervention with a chest tube resulted in early stabilization of the patient. The reported cases of pneumothorax in the setting of liposuction are minimal (<0.1%). However, the current statistics may be underreported, as small pneumothoraxes may cause few or no symptoms, resulting in a lack of clinical attention. Moreover, multi-center meta-analyses have yet to be done to gain more precise insights on pneumothorax as a complication of liposuction. Understanding that iatrogenic pneumothorax can be a complication of liposuction, especially to the posterior thorax, is crucial in providing timely treatment. Although the reported number of cases is small, pneumothorax has yet to be evaluated as a complication of liposuction and may warrant further investigations.

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ABSTRACT #146 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE HIDDEN IN PLAIN SIGHT: IDENTIFYING MYCOBACTERIUM ABSCESSUS AS THE COVERT CAUSE OF CHRONIC LUNG CAVITARY LESIONS Christiana Choi1, Aesha Patel1, Aishwarya Puri2, Jay Guevarra2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Mycobacterium abscessus complex (MABC) is the second most common nontuberculous mycobacterial infection (NTM), following Mycobacterium avium complex (MAC). MABC is characterized by significant drug resistance, limiting treatment options. The diagnostic challenges associated with cavitary lesions necessitate a comprehensive approach, as MABC can mimic malignancy, vasculitis, or pulmonary manifestations of inflammatory bowel disease (IBD), leading to potential misdiagnoses. This case highlights the critical need to consider MABC in the differential diagnosis of cavitary lung lesions.

CASE PRESENTATION: A 74-year-old male with ulcerative colitis, previously treated with ustekinumab, presented with hemoptysis. He had known cavitary lung lesions, which were surgically resected in 2019, with nonspecific inflammatory pathology noted. Recent bronchoscopy and CT scans indicated an increase in cavitary lesions. Bronchoalveolar lavage (BAL) was negative for acid-fast bacilli (AFB) smear, MTB-PCR, cytology, and cultures. Differential diagnoses included NTM infection, vasculitis, and pulmonary IBD. Initial AFB smear revealed 3+ AFB, but subsequent smears were negative. The patient was started on oral augmentin and doxycycline for two weeks, suspecting Mycobacterium avium complex (MAC). Three weeks post-discharge, cultures confirmed MABC with erm-41 gene truncation. A peripherally inserted central catheter (PICC) was placed for three months of amikacin and eravacycline infusions, alongside oral azithromycin and clofazimine.

CONCLUSION: Mycobacterium abscessus complex (MABC) causes severe respiratory, skin, and mucosal infections and is one of the most antibiotic-resistant nontuberculous mycobacteria (NTM), accounting for up to 13% of NTM pulmonary disease cases. Diagnosing MABC is challenging due to its ability to mimic other infections, malignancies, and autoimmune disorders, which can lead to misdiagnosis and inappropriate treatment that exacerbates antibiotic resistance. The sensitivity of acid-fast bacilli (AFB) smears is notably low, with some studies reporting rates as low as 46%, which may contribute to delays in appropriate care, as evidenced in our patient's case where treatment was deferred for five years.

The rising antibiotic resistance complicates MABC treatment. Empiric therapy should be avoided as it may worsen resistance. While macrolides are typically used, two MABC subspecies exhibit resistance associated with the erm41 gene, which determines macrolide sensitivity. Amikacin is another mainstay of treatment, resistance rates, however, are increasing. Standard management includes long-term antibiotic regimens and regular assessments, although surgical resection may be required for localized infections. Our case underscores the necessity of including MABC in the differential diagnosis for patients presenting with cavitary lung lesions.

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ABSTRACT #147 CLINICAL RESEARCH PULMONARY/CRITICAL CARE THE INCREASING MORTALITY FOR NON-COVID ACUTE RESPIRATORY DISTRESS SYNDROME Lorenzo Leys1, Christiana Choi1, Adrian Chernyk1, Raymond A. Jean1, Raymonde Jean1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: The COVID-19 pandemic resulted in a significant increase in the number of hospitalized patients with Acute Respiratory Distress Syndrome (ARDS). Despite the increased mortality associated with COVID-19, whether the experience gained may have improved outcomes in treating non-COVID ARDS is uncertain.

METHODS: We queried the NIS between 2018 and 2021 for discharges diagnosed with ARDS with or without COVID-19. We compared trends in inpatient mortality over the study period among the COVID-19 and nonCOVID cohorts.

RESULTS: There were 413,845 discharges over the study period, of which 283,655 were related to COVID-19.

Over the study period, there was a significant increase in ARDS mortality in the overall cohort, from 36.9% in 2018 to 53.1% in 2021. This baseline mortality increased over the 2020 and 2021 periods to 42.9% and 46.9% in the non-COVID cohort and 51.3% and 54.6% in the COVID-19 cohort.

CONCLUSION: During the study period, there was a trend for increasing mortality among non-COVID ARDS patients from 2020 to 2021. Despite increased experience in ARDS management during the COVID pandemic, mortality has not improved in non-COVID ARDS, even compared to the pre-pandemic era. The study highlights the concerning trends with increased mortality among non-COVID ARDS patients during 2020-2021. This demonstrates the importance and the need for further clinical investigation regarding the challenges faced in ARDS management. Implementing appropriate and timely strategies can mitigate the associated health burden while improving the quality of care, which is crucial to improving mortality outcomes in ARDS.

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ABSTRACT #148 MEDICAL EDUCATION PULMONARY/CRITICAL CARE UTILIZATION AND CHALLENGES OF POINT-OF-CARE ULTRASOUND IN A LARGE URBAN HOSPITAL SYSTEM Christiana Choi1, Victor Wang1, Mohammed Alsaud1, Karen Go1, Sonja Mittag1, Paru Patrawalla1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Point-of-care ultrasound (POCUS) offers ease of use and rapid diagnostic capability, making it a valuable tool during acute patient decompensation and procedures. While emergency medicine and critical care medicine has integrated POCUS into its practice, internal medicine has not fully embraced its utility. This study aims to explore the current utilization and challenges of POCUS within a large urban hospital system, shedding light on barriers to its adoption among internal medicine practitioners and identifying opportunities for enhanced integration into their practice.

METHODS: We developed a survey to evaluate usage, comfort level, perceived importance, barriers, and suggestions for improving POCUS utilization. The survey was reviewed by two senior faculty members for clarity and language accuracy, then distributed via email to all hospital medicine faculty and PGY2 and PGY3 residents at Mount Sinai Morningside/West from September to November 2024. Participation was voluntary, responses anonymous, and no incentives were provided.

RESULTS: The study included 29 participants, mostly PGY2 and PGY3 residents (83.9%) and hospitalists (16.1%). Of these, 55.2% had formal POCUS training, with the highest rates in cardiac POCUS (66.7%), followed by vascular access (59.3%), thoracic (48.1%), abdominal (40.7%), and deep vein thrombosis assessment (DVT)(29.6%). POCUS was used weekly by 44.8% and daily by 27.6%, with the most frequent procedural uses being peripheral intravenous (PIV) placement (72.4%) and paracentesis (51.7%). Diagnostic applications were most common for cardiac (65.5%), lung (55.2%), abdominal (51.7%), and renal/bladder (48.3%) assessments, while DVT was less frequent (17.2%). Participants rated POCUS highly for lung, cardiac, abdominal, and renal/bladder (mean scores >4, SD <1), but lower for DVT (mean 3.39, SD 1.26). Insufficient time was the main barrier to POCUS use (mean 4, SD 1.03), with minimal credentialing concerns (mean 2.76, SD 1.43). There was strong endorsement for increased training, particularly for residents (mean 4.55, SD 0.69), and for access to expert consultations to enhance POCUS use (mean 4.35, SD 0.90).

CONCLUSION: This study highlights the significant potential of POCUS within the Internal Medicine Department of a large urban hospital system, where most participants recognized its utility. However, the infrequent usage, averaging once per week, suggests that barriers such as limited time and equipment availability hinder its implementation. Strong participant endorsement for enhanced POCUS training, along with increased access to expert consultation, highlights critical areas for development. Addressing these barriers is essential to fully integrate POCUS into practice, thereby advancing patient care within Internal Medicine.

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ABSTRACT #149 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY A RARE CASE OF GASTROINTESTINAL BLEEDING FOLLOWING ATRIAL FIBRILLATION ABLATION Jake Debroff1, Kayla Hartz1, Ayanna Lewis1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024. *ACG Presidential Poster Award BACKGROUND/INTRODUCTION: Atrial fibrillation (AF) is a common arrhythmia effecting around 60 million patients annually and can be treated both medically and with ablation procedures. One rare but dangerous complication of AF ablation is formation of an atrio-esophageal fistula, which occurs in <0.10 - 0.25% of cases.

While an anomalous connection between the left atrium and esophagus may be created by the procedure, other vascular connections can take place iatrogenically. The authors present a case of post-AF ablation gastric and celiac artery bleed.

CASE PRESENTATION: A 73-year-old male with past history of AF on Eliquis status post direct current cardioversion (DCCV) presented for evaluation of persistent symptomatic AF characterized by presyncope and palpitations. Following a successful pulmonary vein isolation and cavotricuspid isthmus ablation, the patient became hypotensive with two large episodes of hematochezia. His hemoglobin decreased from 15.3 to 10.4g/L, and a total of 2 units of packed red blood cells and a proton pump inhibitor (PPI) were given. Computed Tomography (CT) angiography of the chest and abdomen showed a small blush at the gastroesophageal junction (GEJ). Hematochezia was unresponsive to transfusion support, and hypotension persisted. Urgent esophagogastroduodenoscopy (EGD) revealed ulcerated mucosa at the GEJ with active brisk bleed, and three hemostatic clips were unsuccessfully placed. Interventional radiology subsequently performed celiac angiography showing a large active arterial hemorrhage in the area of the GEJ, followed by successful embolization of the left gastric artery with resolution of bleeding. Patient improved and was discharged on a PPI and close gastroenterology follow up for repeat EGD. DISCUSSION/CONCLUSION: Atrio-esophageal fistula is a fatal complication of AF ablation, and the thoracic vasculature adjacent to the esophagus may be vulnerable to trauma. In our case a severe unstable GEJ bleed occurred within 48 hours of the procedure. The gastric and celiac arteries, however, are not typically affected during such procedures. Techniques such as esophageal temperature monitoring and prophylactic PPI use have been suggested for complication prevention. Ultimately, proceduralist experience remains a crucial factor in avoiding such life-threatening complications. GI bleeding events post-ablations should raise clinical suspicion for post-op complications and may warrant urgent endoscopic evaluation. Future studies on prevention of fatal AF ablation complications are warranted.

Figure 1. Endoscopic view of gastroesophageal junction active bleed.

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ABSTRACT #150 CLINICAL RESEARCH GASTROENTEROLOGY ASSOCIATIONS BETWEEN SOCIAL DETERMINANTS OF HEALTH ON PSYCHOSOCIAL WELL-BEING AND QUALITY OF LIFE IN A DIVERSE COHORT OF INDIVIDUALS WITH PERIANAL FISTULIZING CROHN’S DISEASE Shabari Shenoy1, Jake Debroff1,2, Joshua Lacoste3, Elisabeth Giselbrecht3, Nicole O. Gbenebitse4, Felix D. Rozenberg5, Laurie Keefer3, Serre-yu Wong3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of

Medicine at Mount Sinai, New York, NY, United States; 4City University of New York, New York, NY, United States; 5SUNY Downstate Health Sciences University, Brooklyn, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Perianal fistulizing Crohn’s disease (PFCD) has downstream effects on several domains of patients’ lives. However, the impact of PFCD on patients' daily lives and the influence of social determinants of health (SDH) on disease experience remains unclear. We studied the impact of PFCD activity and SDH on psychosocial wellbeing and quality of life (QOL).

METHODS: Adult patients with PFCD were prospectively recruited between July 2023 and April 2024 at Mount Sinai Hospital. Crohn’s anal fistula quality of life (CAFQOL) scale, PROMIS scale for anxiety and depression, IBD Internalized Stigma Scale (modified), Everyday discrimination scale, Health Leads screening tool for SDH and Cantril ladder for life satisfaction were administered to patients. Patient data, including demographics and clinical data, were obtained from patients and chart review. Patients were grouped by PFCD disease activity based on presence of pain and/or drainage or degree of stigma based on IBD internalized stigma scale (modified). Descriptive data and independent sample t-tests were performed using SPSSv26.

RESULTS: 128 patients were included in the study of whom 97 and 31 patients had active and inactive PFCD, respectively (figure 1). Patients with active PFCD reported poorer QOL across all 3 domains A (p<0.001), B (p<0.001), C (p<0.001), higher rates of anxiety and depression (p<0.001), decreased life satisfaction (p<0.001) and higher internalized stigma (p=0.005), particularly in the domains of alienation (p<0.001), social withdrawal (p<0.001), stereotype endorsement (p<0.05) than their inactive counterparts. The active PFCD group (58%) were more likely to indicate they felt socially isolated than their inactive counterparts (18%) (p=0.003).

Participants with highest perceived stigma also reported poorer quality of life: Domain A (p=0.04), B (p=0.004), and C (p< 0.001), higher rates of depression and anxiety (p<0.001), lower life satisfaction now (p<0.001) and in 5 years (p<0.018), and higher perceived everyday discrimination (p<0.001). They were also more likely to endorse concerns around food insecurity (p=0.03), housing insecurity (p< 0.001), childcare (p<0.001), education (p< 0.001), transportation (p<0.001), and social isolation (p<0.001).

CONCLUSION: Active PFCD is associated with poor quality of life, depression and anxiety, decreased life satisfaction and higher perceived internal stigma. Higher perceived stigma also correlated to higher perceived discrimination and addressable unmet social needs.

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ABSTRACT #151 CLINICAL RESEARCH ALLERGY/IMMUNOLOGY HERE COMES THE SUN: CHARACTERIZATION OF A COHORT OF PATIENTS WITH SUNFLOWER SEED ALLERGY Neil Patel1, Ami Shah1, Sara Dehbozorgi2, Amanda Cox1, Mary Grace Baker1 1Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Morningside-

West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: We have observed an increase in sunflower seed (SFS) allergy in our practice, yet little is known about SFS allergy. Here we describe a cohort of SFS-allergic pediatric patients.

METHODS: We retrospectively reviewed the charts of all patients who had SFS serum IgE testing between March 2017-September 2018, focusing on patients who were advised to avoid SFS. Pertinent demographic and clinical data, including oral food challenge (OFC) outcomes, were recorded.

RESULTS: During the period of interest, SFS IgE testing was performed in 7% (326/5,008) of patients evaluated in our Pediatric Allergy Division; 71% (n=230) were advised to avoid SFS. Most patients were male (71%) and had atopic comorbidities: atopic dermatitis (68%), allergic rhinitis (69%), and asthma (50%). All but one patient had another food allergy, mostly to tree nuts: cashew/pistachio (92%), Brazil nut (92%), walnut/pecan (90%), macadamia (90%), hazelnut (82%). Most SFS allergy diagnoses (77%) were based on testing alone. Among those with a history of reaction (n=52), 62% (n=32) reacted to sunflower butter, with no reported reactions to sunflower oil. 125 (54%) patients were offered OFC; 83% (40/48) of patients who underwent OFC passed, and one was indeterminate. Three of seven patients who reacted were treated with epinephrine. Median SPT wheal size and SFS IgE were not significantly different between those who passed vs failed OFC (3mm, 1.87kU/L versus 5.5mm, 8.74kU/L, p>0.15).

CONCLUSION: SFS products have surged in popularity, especially as an alternative to highly-allergenic nut butters. These findings inform our knowledge of SFS allergy and may assist in diagnosis and management.

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ABSTRACT #152 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY A RARE CASE OF SERONEGATIVE AUTOIMMUNE HEPATITIS Bharati Dev1, Jake DeBroff1, Mako Koseki1, Liliana Vittini-Hernandez1, Piya Kositangool1, Kevin Jordan1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Autoimmune hepatitis (AIH) is an inflammatory disease with an incidence of 0.7 to 2 per 100,000 population. Diagnosis is clinically made with symptoms and elevated globulins and serological markers. Liver biopsy is considered when serology is negative. We present a case of seronegative AIH in the setting of negative viral, metabolic, and autoimmune workup.

CASE PRESENTATION: A 37-year-old male with no medical history presented with 6 days of generalized fatigue and elevated liver function tests. Associated symptoms included vomiting, jaundice, and epigastric discomfort. The patient denied family history of GI malignancy, autoimmune disease, hepatitis history, recent travel, or use of substances, alcohol, supplements, and over the counter medications.

Initial labs showed an aspartate aminotransferase of 1055 U/L, alanine transaminase of 2056 U/L, total bilirubin of 6.7mg/dL, direct bilirubin of 5.0mg/dL, and ferritin of 4313ug/L. Urine toxicology was normal. Viral hepatitis panel revealed immunity from vaccines. Serum immunoglobulins, toxin and autoimmune antibody levels were normal. Inflammatory markers of C-reactive protein and lactate dehydrogenase were elevated. Ceruloplasmin and alpha-1 antitrypsin were increased, ruling out genetic causes. Both abdominal ultrasound and MRCP showed hepatic steatosis.

Liver biopsy revealed macrovesicular steatosis, panacinar inflammation, and hepatocyte apoptosis. Portal tracts had moderate to severe ductal damage with no fibrosis. These findings suggested acute hepatitis of unclear etiology with concern for drug-induced liver injury versus hemophagocytic lymphohistiocytosis, however, oncological evaluation for hemophagocytic lymphohistiocytosis was negative. Workup was otherwise negative, and the patient began a steroid course for suspected autoimmune hepatitis with improvement in liver function tests.

The patient, however, did not tolerate the tapered discontinuation of steroids, as symptoms reoccurred.

Prednisone and azathioprine were promptly restarted with improvement in symptoms and bloodwork.

DISCUSSION/CONCLUSION: Seronegative AIH is very rare, constituting up to 10% of AIH cases. Seronegative AIH is determined when patients present with AIH-like symptoms in the setting of negative workup and lack of elevated globulins or serology. This diagnosis is further supported through rapid clinical improvement with steroids and azathioprine, as noted above. Seronegative AIH should be considered in patients with AIH-like symptoms in the setting of negative viral, metabolic, and serological workup.

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ABSTRACT #153 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY IS IT TIME TO PANIC? A RARE CASE OF MIXED ADENOCARCINOMA NEUROENDOCRINE CARCINOMA AT THE GASTROESOPHAGEAL JUNCTION Bharati Dev1, Jake DeBroff1, Mako Koseki1, Jose Duran1, Antoine Jeri-Yabar1, Adam Tillowitz1, Bruce P. Gelman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Mixed adenocarcinoma-neuroendocrine carcinoma (MANEC) is a rare, aggressive tumor of the gastrointestinal tract that has adenocarcinoma and neuroendocrine components.

MANEC presents in the appendix, colon, and rectum and is associated with poor long-term survival. We present a case of this unusual malignancy found at the gastroesophageal junction (GEJ).

CASE PRESENTATION: A 67-year-old female with history of hypertension and hyperlipidemia presented with 2 months of epigastric discomfort and decreased oral intake, associated with an unintentional weight loss of 20 pounds. An esophagram showed dysmotility, delayed esophageal emptying, and an irregularity at the GEJ. Esophagogastroduodenoscopy (EGD) demonstrated a mass in the distal esophagus with biopsies revealing MANEC. A PET scan highlighted metastatic disease with diffuse hypermetabolic lymph nodes. In the outpatient setting, the patient underwent esophageal dilation and chemotherapy with leucovorin calcium, fluorouracil, and irinotecan (FOLFIRI). Months later, the patient developed worsening dysphagia requiring hospitalization. An EGD with stent placement was performed, showing worsened obstruction at the GEJ with similar pathology. The stent was removed 4 days later, as it migrated and abutted the gastric wall. The patient unfortunately had an aspiration event, requiring oxygen support. She was started on palliative etoposide and carboplatin and subsequently passed away.

DISCUSSION/CONCLUSION: We present a case of an esophageal MANEC, which is a rare malignant tumor most found in the colon. Metastases are generally present at the time of presentation. Standardized treatment has not been universally agreed upon. The National Comprehensive Cancer Network suggests the use of cisplatin/carboplatin and etoposide. Due to its rarity, little is known about MANEC so its epidemiology, risk factors and treatment need to be further investigated.

Figure 1. A large, fungating mass with no bleeding was found at the GEJ, 38 – 41 cm from the incisors. The mass was partially obstructing and non-circumferential. A stent was placed under fluoroscopic and endoscopic guidance. Biopsies were positive for synaptophysin and focal gland forming areas were positive for AE1/AE3 supporting a diagnosis of MANEC. Immunohistochemistry testing for MLH1, MSH2, MSH6, and PMS2 were negative.

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ABSTRACT #154 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY NOW YOU "CT" IT? A RARE CASE OF JEJUNAL DIVERTICULITIS Bharati Dev1, Jake DeBroff1, Mako Koseki1, Sonia Mehra, Subhash Chander1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Though often incidentally found, small bowel diverticulosis occurs in up to 8% of the population. Small bowel diverticulitis, particularly within the jejunum, is much rarer – occurring in 2.3% of patients with known diverticulosis. Therefore, not much is known about the condition’s risk factors and complications. This case describes a patient with colonic diverticulosis who presented with abdominal pain and was found to have jejunal diverticulitis (JD) in the setting of an untreated H. pylori infection.

CASE PRESENTATION: A 71-year-old male with a history of colonic diverticulosis presented with 2 days of generalized fatigue, bloating, and abdominal pain associated with vomiting and fevers. Prior to presentation, the patient reported bloating for several months. The patient denied changes in eating habits and bowel movements.

Colonoscopy was done 12 years prior which showed extensive colonic diverticulosis. Initial vital signs revealed tachycardia and tachypnea with labs showing leukocytosis to 13.7 K/uL. Exam was notable for a soft, distended abdomen which was tender to palpation in the lower left quadrant. Abdominal x-ray showed no bowel obstruction.

CT with contrast of the abdomen revealed diverticulosis of both the small and large intestines. However, inflammatory changes, including fat stranding and bowel wall edema, were only present at the level of the jejunum. The patient was diagnosed with JD and received intravenous fluids, metronidazole, and ceftriaxone, with improvement in abdominal pain. However, during a follow-up visit, the patient reported ongoing epigastric discomfort and bloating. H. pylori testing was positive, and the patient subsequently started quadruple therapy with improvement in all gastrointestinal symptoms.

DISCUSSION/CONCLUSION: Though rare, small bowel diverticulitis should be considered in the differential for patients with non-specific abdominal pain. Given that routine endoscopies and colonoscopies cannot evaluate significant portions of the small bowel, jejunal diverticulosis can go unrecognized in patients with extensive colonic diverticulosis. In turn, inflammation or infection within jejunal diverticula can manifest as JD and clinical outlook could progressively worsen if not caught early. Interestingly in our case, the patient was found to have H. pylori, which may have been a source for the JD. More research needs to be done for both JD and the impact of H. pylori on small bowel diverticula.

Figure 1. Acute jejunal diverticulitis. Axial view shows bowel wall edema with poor enhancement of the bowel wall and surrounding fat stranding at the level of the jejunum.

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ABSTRACT #155 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/PULMONARY/CRITICAL CARE AN UNFORESEEN CONSEQUENCE: PULMONARY EMBOLISM POSTABLATION IN A YOUNG PATIENT WITH SUPRAVENTRICULAR TACHYCARDIA Keshav Dixit1, Andrea Monfasani1, David J. Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Catheter ablations, a commonly performed procedure to treat various cardiac arrhythmias including supraventricular tachycardia (SVT), were conducted approximately 240, 185 times in the USA from 2016 to 2020. Although considered relatively safe, complications can occur (3-5%) secondary to vascular access or from catheter-related complications such as hematomas, embolism, and thrombosis. While the overall incidence of thromboembolic complications is 0.6%, pulmonary embolism (PE), a potentially fatal complication, can occur. We present a case of PE in a young patient following catheter ablation of SVT. CASE PRESENTATION: A 19-year-old female presented to the Emergency Department (ED) with palpitations, fever, sore throat and shortness of breath persisting for two days. There was no significant medical history. The patient was taking oral contraceptive pills (OCP), smoked tobacco via hookah, and consumed alcohol. An electrocardiogram (EKG) demonstrated supraventricular tachycardia (SVT) at 204 beats per minute (bpm), which was eventually controlled with Diltiazem after failed vagal maneuvers and Adenosine administration. Her inpatient workup revealed a structurally normal heart, and she was discharged on Metoprolol. An ambulatory cardiac monitor showed a prolonged episode of tachycardia at 230 bpm. An electrophysiology study identified an inducible atrial tachycardia which was successfully ablated. During the procedure, two sheaths were inserted into each femoral vein and following extraction, manual hemostasis was applied to ensure proper closure. She returned to the ED four days later with chest pressure, bruising at the femoral access site and vaginal bleeding, which was attributed to OCP withdrawal as she had withheld this medication post-procedure. Apart from a mildly elevated troponin, routine laboratory workup was unremarkable and she was discharged. She returned two days later with persistent pleuritic chest pain. A D-dimer was elevated and a subsequent Chest computerized tomography angiogram (Chest CTA) revealed a segmental PE in the right lower lobe pulmonary artery. A lower extremity ultrasound was negative for deep vein thrombosis (DVT) and she was discharged on Eliquis following no evidence of right heart strain on echocardiogram or Chest CTA. A thrombophilia evaluation was nondiagnostic. The patient completed a three-month course of Eliquis without further complications.

DISCUSSION/CONCLUSION: This case emphasizes the possible occurrence of an infrequent yet significant complication following a commonly performed procedure. While the exact cause of our patient's PE remains unclear, it is probable that her PE occurred secondary to a post-procedural DVT in the context of OCP use. DVT post-ablation are hypothesized to be linked to the placement of catheters and sheaths which can induce vascular endothelial cell injury, venous stasis and activation of the coagulation cascade. Moreover, studies have shown a heightened risk of thrombosis with insertion of multiple femoral venous sheaths, particularly among patients who do not receive periprocedural heparin. It is crucial for clinicians to recognize PE as a potential complication of ablative procedures. Pre-procedural D-dimers or post-procedural dopplers may aid in risk stratification and diagnosis of venous thromboembolism (VTE). Further studies examining the potential efficacy of peri- or postprocedural anticoagulation among high-risk individuals could provide valuable insight into risk reduction of VTE post-ablation.

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ABSTRACT #156 CLINICAL RESEARCH PULMONARY/CRITICAL CARE IDENTIFYING THE CHARACTERISTICS OF PATIENTS RECEIVING EARLY VERSUS LATE PERCUTANEOUS TRACHEOSTOMY Yoshiko Ishisaka1, Keshav Dixit1, Jorge Sinclair de Frias1, Shasha X. Chen1, Lina Miyakawa1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Percutaneous tracheostomy is an invasive procedure offered to patients with airway compromise or ventilator dependence. Prior studies, though limited, demonstrated later time to tracheostomy in women and underrepresented minority groups. In this study, we aim to identify baseline characteristic differences between patients who underwent earlier versus later percutaneous tracheostomy.

Further, we sought to analyze changes in these baseline characteristics using different date cutoffs from intubation to tracheostomy.

METHODS: In this retrospective study, we evaluated patients who underwent percutaneous tracheostomy between April 2018 and December 2023 in the intensive care units (ICU) of a three-hospital system in New York City. Baseline characteristics including age, gender, race, ethnicity, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) score, comorbidities, the Acute Physiology and Chronic Health Evaluation (APACHE) score upon ICU admission, indication for intubation, indication for tracheostomy, blood urea nitrogen (BUN), positive end expiratory pressure (PEEP), and fraction of inspired oxygen (FiO2) on the day of tracheostomy were recorded. We stratified data based on the days from the last intubation to tracheostomy using the cutoff of 10, 11, 12, 13 and 14 days, and compared the early and late tracheostomy groups. Statistical analysis was done on RStudio, and Wilcoxon test and chi- squared tests were performed on nonnormal numerical and categorical data respectively.

RESULTS: 396 patients were included in this study. The early percutaneous tracheostomy cohort was composed of 123 patients with the cutoff of 10 days, 148 with 11 days, 167 with 12 days, 186 with 13 days, and 205 with 14 days. In all cutoffs, patients with early tracheostomy were older (p=0.06, 0.009, 0.006, 0.003, 0.001 respectively) and had a lower BMI (p=0.03, 0.01, 0.008, <0.001, 0.004 respectively). ECOG scores were higher in those with later tracheostomy except for the 12-day cutoff. Gender, race, and ethnicity did not differ between the two groups. The APACHE score was higher in the early tracheostomy group except for the cutoff of 14 days.

A significantly higher percentage of patients had failed prior extubations in the early tracheostomy group (p<0.001 in all cutoffs). Patients intubated due to COVID or prolonged respiratory failure tended to undergo tracheostomies sooner. BUN was higher in the later tracheostomy group, with no differences in comorbidities, PEEP, or FiO2 noted between early and late tracheostomy groups.

CONCLUSION: Unlike prior studies that excluded patients who were reintubated prior to tracheostomy or used data from the first intubation day to tracheostomy, our data was based on last intubation to tracheostomy timing.

This may explain the shorter time to tracheostomy noted in our patients despite their sick baseline clinical state.

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ABSTRACT #157 MEDICAL EDUCATION PULMONARY/CRITICAL CARE IMPACT OF A NON-INVASIVE VENTILATION SESSION ON INTERN KNOWLEDGE AND CLINICAL APPLICATION: A MULTISITE ASSESSMENT WITHIN AN INTERNAL MEDICINE RESIDENCY PROGRAM Keshav Dixit1, Agostina Velo1, Archana Pattupara1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

BACKGROUND/INTRODUCTION: Respiratory failure is common in patients admitted to the medicine floors and intensive care units (ICUs), where residents play a critical role as frontline providers. Non-invasive ventilation (NiV) has multiple indications and can prevent escalation of care, reduce length of stay and lower mortality rates.

The purpose of this session was to enhance Internal Medicine Interns’ knowledge and clinical application of NiV techniques, such as bi- level positive airway pressure (BiPAP), continuous positive airway pressure (CPAP), and high-flow nasal cannula (HFNC).

METHODS: As part of the Intern Bootcamp Lecture Series, a one-hour session was delivered simultaneously at two Mount Sinai Health System sites in New York City. The session comprised of two sections: a didactic portion covering the definitions, technical aspects, and indications of NiV therapies and an interactive component featuring clinical case discussions with hands-on experience using BiPAP and HFNC machines facilitated by respiratory therapists. A ten question pre- and post-session survey was utilized to measure interns’ knowledge acquisition. Fisher’s Exact Test, conducted by ChatGPT.com (model version GPT-4-turbo), was applied to assess statistically significant changes in understanding across survey questions.

RESULTS: Out of 36 interns who attended the session, 29 (81%) completed the pre-session survey, and 14 (39%) completed the post-session survey. Statistically significant improvements were observed in responses to questions on CPAP indications/contraindications (p=0.0014) and BiPAP clinical application (p=0.00006). A notable trend toward improvement (p=0.052) was also seen for another question on BiPAP comprehension. Most other questions did not show significant change, likely due to high pre-session scores.

CONCLUSION: This session successfully reinforced key concepts and improved knowledge in areas with lower pre-session comprehension. However, the small sample size and response rate limits the generalizabilty of findings. Future iterations should address engagement and expand the sample size to validate these findings.

Additionally, tailoring content to emphasize more challenging topics and assessing long-term knowledge retention could enhance the curriculum’s impact on clinical practice.

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ABSTRACT #158 CLINICAL RESEARCH PULMONARY/CRITICAL CARE TRENDS IN TRACHEOSTOMY: A COMPARATIVE ANALYSIS FROM 2018 TO 2023 Keshav Dixit1, Yoshiko Ishisaka1, Jorge Sinclair de Frias1, Shasha X. Chen1, Lina Miyakawa1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: In the decade prior to the Coronavirus (COVID-19) pandemic, there was a notable decline in the frequency and rate of percutaneous tracheostomies. However, the landscape drastically shifted during the pandemic, with a significant surge in tracheostomy utilization. In this study, we aim to identify the evolving trends in demographic and clinical factors affecting tracheostomy outcomes from 2018 to 2023.

METHODS: In this retrospective study, we reviewed 396 patients who underwent percutaneous tracheostomy following prolonged mechanical ventilation in the medical intensive care units within a three-hospital system in New York City from April 2018 to December 2023. Clinical, demographic, and laboratory data were reviewed and analyzed.

RESULTS: The number of patients undergoing percutaneous tracheostomy steadily increased annually, reaching a peak of 97 in 2022. There were no significant differences in demographics or clinical parameters such as platelet count, blood urea nitrogen, creatinine, or albumin on day of tracheostomy. Baseline functional status, as indicated by Eastern Cooperative Oncology Group (ECOG) score, varied with a notable increase in patients with higher scores in 2023. The Acute Physiology and Chronic Health Evaluation (APACHE) score also increased significantly, ranging from 19.6 ± 10.7 in 2018 to 23.9 ± 7.54 in 2023. COVID-19 related intubations were more common in 2020 and 2021, while intubations for respiratory failure peaked in 2022 at 63.9%. The predominant indication for tracheostomy, however, was altered mental status; most prevalent in 2023 at 59.3%.

Vasopressor use on the day of tracheostomy was notable, and as high as 25.4% in 2023. Antibiotic usage on tracheostomy day steadily increased from 2019 to 2023, though it was highest in 2018 at 61.5%. The time from intubation to tracheostomy decreased significantly in 2023 (11.4 ± 7.1 days) compared to previous years. Failed extubation prior to tracheostomy varied considerably, with 14.7% and 9% of patients affected in 2020 and 2021 respectively, contrasting with 38.5% and 37.3% in 2018 and 2023. Post-tracheostomy pneumonia, the most common complication, increased consistently, reaching 30.5% in 2023. ICU length-of-stay (LOS) varied, with the shortest observed in 2023 (36 ± 18.9 days) and the longest in 2018 (44.6 ± 26.2 days). Hospital LOS ranged from 53.8 ± 37.2 days in 2019 to 70.5 ± 56.1 days in 2018. ICU survival decreased significantly from 80.8% in 2018 to 66.1% in 2023, with a peak of 89.5% in 2019. No significant difference was observed in hospital survival.

CONCLUSION: Following the COVID-19 pandemic, patients were sicker, with increased use of vasopressors and antibiotics on day of tracheostomy, elevated APACHE scores upon ICU admission, poorer baseline functional status, and worsening ICU survival. These observations may stem from various factors, including inadequate medical follow-up during the pandemic, and increased provider comfort performing tracheostomies post-COVID-19. Future research is needed to analyze how the pandemic altered tracheostomy practices in terms of education, training, and post-procedural monitoring, and the impact these factors have on outcomes and mortality. While clinicians may have become more comfortable performing percutaneous tracheostomies in sicker patients, it may be necessary to reconsider the timing and selection criteria clinicians previously used for tracheostomy to minimize complications and improve outcomes.

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ABSTRACT #159 CASE REPORT/CLINICAL REVIEW ENDOCRINOLOGY GIANT PROLACTINOMA TREATED WITH MEDICAL MANAGEMENT Paige Dixon1, Suma Gondi2, Jennifer Abrams2, Nirali Shah2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Giant prolactinomas (GP) are rare pituitary adenomas over 4 cm with prolactin levels above 1000 ng/L. Limited data exists comparing surgical and medical management for GPs. This report describes a GP with neurologic symptoms that improved with dopamine agonist (DA) therapy.

CASE PRESENTATION: A 31-year-old male presented with new onset right eye vision 20/800. MRI brain showed a 4.7 cm sellar mass encasing the right cavernous and supraclinoid internal carotid artery. Prolactin level was 1097.6 ng/dL and testosterone 52.63 ng/dL, with normal TSH, IGF-1, and AM cortisol. The neurosurgical team considered resection due to the tumor's mass effect but ultimately opted for medical management; the patient was started on cabergoline 1 mg twice weekly. After two weeks his vision improved to 20/40. MRI after three months showed size decrease to 3.8 cm. After 6 months of treatment the prolactin level decreased to 78 ng/dL and the patient exhibited no new symptoms. He will continue with cabergoline and follow regularly with Neurosurgery, Endocrinology, and Ophthalmology.

DISCUSSION/CONCLUSION: While generally benign, GPs are more aggressive, often with suprasellar invasion and optic chiasm involvement. The remission rate of medically treated GPs are 60-68% compared to 90% with smaller prolactinomas. With DA therapy, 97% of patients have improvement in vision and adenoma volume is reduced in 74% of cases. Surgery may be considered when medical management cannot control tumor size or prolactin level, or in cases of apoplexy, CSF leak, or need for urgent decompression of the visual pathway.

Nonetheless, remission rates following surgery are low, with studies suggesting a 0% cure rate for GPs treated with only one surgery. Further treatments such as repeat surgery, radiation, somatostatin analogs or temozolomide require further research to assess their effectiveness. In this case, surgery was initially considered due to the extensive nature of the tumor and the mass effect on surrounding structures. However, after a trial of optimal DA therapy the patient has seen significant reduction in prolactin levels and an overall decrease in tumor burden. This case demonstrates the effectiveness of DA therapy in treating GPs despite extensive tumor involvement and neurological signs, highlighting the need for continued research into the optimal management strategies for these aggressive tumors.

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ABSTRACT #160 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/NEPHROLOGY A CATECHOLAMINE CRISIS: RESISTANT HYPERTENSION BEYOND THE ADRENAL GLAND – A CASE OF PHEOCHROMOCYTOMA/PARAGANGLIOMA Tansu Eris1, Rodrigo Paredes de la Fuente1, Jared Leventhal1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Resistant hypertension (rHTN) is defined as uncontrolled blood pressure despite a regimen of at least three maximally dosed antihypertensive agents, including a diuretic.

Pheochromocytoma and paraganglioma are key considerations in the workup for secondary hypertension, yet their diagnosis remains challenging due to variable clinical presentation and overlap with other hypertensive disorders.

CASE PRESENTATION: A 28-year-old man with a history of rHTN presented to the emergency department (ED) with severe chest pain, shortness of breath, and lower extremity edema. He reported not taking his outpatient anti-hypertensive medications for the past five days. His BP was 200/148 mmHg, HR 118 bpm, RR 36, SpO₂ 96%. Echocardiography revealed severely reduced left ventricular function with an ejection fraction of 25%, severe left ventricular hypertrophy, apical akinesis, and a large LV thrombus. A CTA of the chest and abdomen was performed to rule out aortic dissection, which revealed significant mediastinal and abdominal paraaortic soft tissue nodularity. He was admitted for acute decompensated heart failure and initiated on a furosemide drip and nitroglycerin infusion. Despite these measures, his systolic blood pressure remained above 170 mmHg. Given the patient's history of resistant hypertension and imaging findings, pheochromocytoma/paraganglioma was considered, and doxazosin was administered, resulting in a blood pressure reduction to 151/102 mmHg. Iodine-123 metaiodobenzylguanidine (MIBG) scan revealed increased radiotracer uptake in the left adrenal gland. Abdominal MRI confirmed a left adrenal mass. Biochemical testing proved the catecholamine excess with plasma renin activity within normal limits, elevated plasma metanephrines, and elevated 24-hour urine metanephrines. Due to the presence of an LV thrombus requiring anticoagulation, surgical intervention was deferred.

DISCUSSION/CONCLUSION: Excess catecholamines can be secreted by tumors in two distinct sites of origins.

Pheochromocytoma arises from chromaffin cells in the adrenal medulla, and paraganglioma originates from chromaffin cells in the autonomic ganglia. Both pheochromocytoma and paraganglioma can lead to rHTN through excessive catecholamine production. The initial diagnostic step is measuring plasma free and 24-hour urine metanephrines. After catecholamine excess is confirmed, CT abdomen and pelvis with contrast is the preferred initial imaging modality. MRI is preferred in patients with known metastatic disease, with MIBG used to rule out metastatic disease. This case highlights the severe long-term consequences of uncontrolled rHTN in a young patient. The diagnosis of pheochromocytoma is often delayed, with an average time of three years from symptom onset to diagnosis. Given the potentially life-threatening complications, clinicians should maintain a high index of suspicion and include pheochromocytoma in the workup of resistant hypertension.

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ABSTRACT #161 CASE REPORT/CLINICAL REVIEW NEPHROLOGY/RHEUMATOLOGY DOUBLE TROUBLE OR BETTER TOGETHER? DOUBLE ANTIBODY POSITIVE PULMONARY-RENAL SYNDROME Tansu Eris1, Niurka Liranzo Tejera1, Martin Sedlacek1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Pulmonary renal syndrome (PRS) is characterized by diffuse alveolar hemorrhage and glomerulonephritis, often caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis or anti-glomerular basement membrane (anti-GBM) disease. Double-positive PRS exhibits features of both anti-GBM and ANCA vasculitis. Prompt treatment is crucial due to the high mortality and morbidity of pulmonary-renal syndrome. Treatment in double-antibody positive PRS consists of glucocorticoids, immunosuppression, and plasmapheresis (PLEX), followed by a maintenance phase with glucocorticoids and immunosuppression.

CASE PRESENTATION: An 86-year-old woman was referred to the emergency department for a rise in serum creatinine (8.0 mg/dL from 0.77 mg/dL two months prior). She reported weeks of muddy urine, and fatigue. Her history included atrial fibrillation, hypertension, and MGUS with a faint IgG lambda M spike. Her vitals were unremarkable except for a BP of 140/86 mmHg. Lab results confirmed severe kidney dysfunction, metabolic acidosis, and hypocalcemia. Urinalysis showed significant proteinuria and hematuria, and urine microscopy with sheets of RBCs, no dysmorphic RBCs, and a muddy brown cast. Serologic testing revealed significantly elevated anti-MPO and anti-GBM antibodies. The patient developed flank pain and hematuria. CT abdomen pelvis on hospital day three showed non-obstructing left renal calculi, bilateral pleural effusions, and pulmonary edema.

Given positive anti-GBM antibodies, diffuse alveolar hemorrhage was suspected. Chest CT confirmed bilateral perihilar ground-glass opacities and consolidations with interlobular septal thickening. Bronchoscopy with BAL confirmed diffuse alveolar hemorrhage. A renal biopsy revealed extensive crescentic glomerulonephritis with linear IgG capillary staining, active crescents, and acute tubular injury without vasculitis or immune complexes on electron microscopy. The final diagnosis was pulmonary-renal syndrome due to dual antibody positivity with crescentic glomerulonephritis. On hospital day six, the patient developed nausea, fatigue, and confusion, prompting initiation of hemodialysis. High-dose methylprednisolone for three days was started and transitioned to a prednisone taper, cyclophosphamide 50 mg daily for a total of 1250 mg was administered along with PLEX, totaling nine sessions. Hemodialysis was required for four months before kidney function improved, with creatinine returning to 1.5 mg/dL within six months.

DISCUSSION/CONCLUSION: Double-positive PRS exhibits features of both anti-GBM disease and ANCA vasculitis, with variable renal prognosis across reported cases. DAH is subclinical in one-third of cases, similar to glomerulonephritis, where bleeding is often microscopic rather than macroscopic. The antibody profile significantly impacts treatment decisions, highlighting the importance of simultaneous antibody testing and renal biopsy in all patients with rapidly progressive glomerulonephritis.

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ABSTRACT #162 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES PENILE PROSTHESIS INFECTION WITH MYCOBACTERIUM ABSCESSUS Sanah Siddiqui1, Elmarie Alexander1, Thomas F. Fusillo1, Sara Huda1, Faye E. Reiff‐Pasarew1, Christine Stavropoulos1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the both Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025 and the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

CASE PRESENTATION: A 58‐year‐old man from Thailand presented to the emergency department with a one month history of night sweats, penile pain, swelling, and scrotal wound drainage. Five months prior, he had traveled to India for a semi‐rigid penile implant. After a diagnosis of "urethral tuberculosis" in Thailand, he began RIPE therapy (rifampin, isoniazid/pyridoxine, pyrazinamide, ethambutol) but showed no improvement and returned to the U.S. for further evaluation. Initial vitals showed a heart rate of 120 beats/min with atrial fibrillation and systolic blood pressure of 195 mmHg. On examination, he had diffuse scrotal edema, penile discharge, and a 1 cm midline scrotal wound. Labs showed leukocytosis (13,300/μL, 74% neutrophils), and scrotal ultrasound raised concern for pyocele. He was started on piperacillin‐tazobactam and continued on RIPE therapy. Infectious Disease and Urology consultations were obtained. Cultures from the wound exudate grew Enterococcus faecalis and acid‐fast bacilli, with a negative mycobacterium tuberculosis PCR. RIPE therapy was discontinued. The patient underwent explantation of the prosthesis with wound washout; intraoperative findings included gross purulence, an urethrocorporal fistula, and necrotic tissue. Cultures speciated Mycobacterium abscessus within a week. Therapy was adjusted to azithromycin, amikacin, imipenem‐cilastatin, and tigecycline. This regimen was complicated by acute kidney injury and QT prolongation, leading to the discontinuation of amikacin and azithromycin. Recurrent nausea and vomiting, likely due to tigecycline, caused severe dehydration. Susceptibility testing identified macrolide resistance (ERM gene detected), prompting consultation with a mycobacteria expert who advised imipenem, omadacycline, and linezolid. Due to omadacycline's high cost, Tigecycline was continued. The patient was discharged but faced readmissions for wound dehiscence and antimicrobial‐related side effects.

DISCUSSION: Nontuberculous mycobacterias (NTMs) are environmental pathogens that cause a spectrum of infections, including pulmonary, skin and soft tissue, and notoriously prosthetic device infections. NTMs are categorized by growth rate; rapid‐growing species (e.g., M. abscessus, M. fortuitum, M. chelonae) typically grow within seven days and are often associated with device‐related infections. Managing M. abscessus infections is challenging, particularly in macrolide‐resistant cases. For macrolide‐susceptible strains, combination therapy with azithromycin, amikacin, and omadacycline is recommended. In resistant cases, intravenous amikacin, with three additional agents, one of which is intravenous (imipenem preferred); is recommended. Linezolid, omadacycline or tigecylcine, and clofazimine are some alternatives. Given drug toxicities, multidrug therapy for NTM prosthetic infections requires careful monitoring.

CONCLUSION: This case highlights the complexities in managing M. abscessus infections, especially with macrolide resistance, which limits effective treatment options and increases adverse effects and toxicity risk when taking multiple antibiotics. It underscores the need for alternative therapies and multidisciplinary care to address the rising incidence of NTM infections and their associated challenges.

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ABSTRACT #163 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY RETRIEVAL AUGMENTED GENERATION FOR THE DETECTION OF MAJOR BLEEDING EVENTS IN THE ELECTRONIC HEALTH RECORD Peter Kaplinsky1, Rohan Singh1, Thomas F. Fusillo1,2, Avi Leader1, Jeffrey I. Zwicker1, Simon Mantha1 1Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn

School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 4-7, 2024.

BACKGROUND/INTRODUCTION: Non-Surgical Major Bleeding (NSMB) is an important clinical event associated with significant morbidity and mortality. Detecting NSMB events in the electronic health record is central to conducting research and quality assessment studies for patients on anticoagulation therapy and in other settings as well. Determining a patient’s NSMB history by means of manual clinical chart review is limited by time and human resources concerns. Natural language processing (NLP) has emerged as a promising modality for the detection of clinical events in the electronic health record. Transformer NLP models have revolutionized the field and have performed satisfactorily for varied clinical endpoints, including venous thromboembolism for which this approach has been extensively validated. However, there is a lack of data concerning the use of NLP to detect bleeding events. Training such models generally requires an arbitrarily large, annotated dataset, which necessitates significant amounts of human labor. The use of generative large language models (LLM’s) with retrieval augmented generation (RAG) is emerging as a promising modality to generate machine-derived labels without a large human-annotated set. RAG seeks to avoid hallucinations and incomplete knowledge in LLM’s by providing domain-specific context from external sources. We hypothesized RAG could be used to detect NSMB events in cancer patients.

METHODS: Clinical notes for 174 patients seen at Memorial Sloan Kettering Cancer Center (MSKCC) were assessed manually for NSMB using the CEDARS+PINES NLP platform (Mantha et al, 2024). The definition of NSMB was derived from the formulation of the International Society on Thrombosis and Haemostasis (Schulman et al, 2005) and optimized for use within a generative LLM prompt. Clinical notes were processed into chunks of 250 characters and vector encoded with the gte-large-en-v1.5 embedding model for retrieval (Li et al, 2023). The vectors for the clinical notes were stored in a Chroma vector database. The ISTH definition of NSMB was split into three components, and for each patient, the top 20 relevant chunks pertaining to each component were retrieved via vector similarity search. These chunks were further subset with a reranking model to optimize their relevance to NSMB. Finally, they were formatted into a prompt template, which was used as input to the Llama3 8B LLM (Meta Inc, 2024). To leverage the Chain-of-Thought prompting technique which elicits reasoning in LLM’s, the prompt template included the ISTH definition of NSMB and step-by-step instructions for determining if a patient had NSMB. For a given patient, the LLM outputs a binary label (NSMB detected or no evidence of NSMB) and its rationale.

RESULTS: 3,676 notes for 174 patients at MSKCC were processed with the RAG pipeline. We optimized model performance by tuning several hyperparameters. Hyperparameter options included chunk size of 250 or 500, LLM prompt strategy, reranking with a cross encoder or LLM, and LLM model choice. The final RAG pipeline used the following configuration: chunk size of 250, Llama 3 8B as the LLM and reranking model, and in-context learning with Chain-of-Thought prompting. We noted that the performance of RAG was highly sensitive to the hyperparameter choices. With a 14% prevalence of NSMB in our dataset, the model achieved a precision of 72% and recall of 72%. Our model was computationally efficient, processing all 174 samples in ~15 minutes.

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CONCLUSION: These results highlight the potential of LLM’s with RAG for the detection of NSMB in electronic health records. Such an approach could be used to augment or even replace manual chart annotation in clinical research and quality assessment studies without the need for large, human-annotated training datasets. Further refinement of these models to optimize their precision, recall, and clinical utility is warranted.

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ABSTRACT #164 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES UNMASKING TB AND IRIS: MORE THAN A SIMPLE PNEUMONIA IN AN IMMUNOSUPPRESSED PATIENT Karen Go1, Hong Yu Wang1, Patricia Dharapak2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 38 year‐old female with Crohn's disease on infliximab presented to the ED with 3 weeks of fever, cough, and shortness of breath (SOB) unresponsive to a 10‐day course of levofloxacin for presumed community acquired pneumonia (CAP). She emigrated from Ecuador in 2001 and was employed as a medical assistant in a private office. Chest X‐ray revealed a patchy area of consolidation in the left upper lung.

The fever, cough and SOB persisted despite empiric cefepime for suspected resistant CAP. A chest computed tomography (CT) angiography demonstrated a large mediastinal mass involving the hilum and encasing the left upper lobe bronchus with associated post-obstructive pneumonia. A QuantiFERON Gold‐TB test was newly positive and rare acid‐fast bacilli (AFB) were found on sputum smear. Bronchoscopy and biopsy revealed granulomas, and moderate AFB on smear, which were positive for mycobacterium tuberculosis on PCR. The patient was discharged on rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) and infliximab was held.

Twenty‐five days later, she returned with recurrent fevers, abdominal pain, nausea and vomiting, and headache despite adherence to RIPE treatment. CT chest revealed increase in necrotic mass‐like consolidation involving the left upper lobe and hilum with associated confluent, infiltrative lymphadenopathy. Brain magnetic resonance imaging (MRI) revealed a 3mmL occipital lobe focus of enhancement. Spinal fluid analysis was unremarkable.

TB‐associated immune reconstitution inflammatory syndrome (IRIS) was suspected and corticosteroids were initiated with clinical response. The patient was discharged with close Department of Health surveillance. Four months after diagnosis, she continues to endorse clinical improvement on an antituberculosis regimen.

DISCUSSION: In the United States, TB cases have been rising. Diagnosis can be challenging given the diverse presentation of disease. TB should be suspected in those with risk factors such as healthcare, residence in endemic regions, and immune compromise or immunosuppressive therapy who are not improving despite appropriate treatment. IRIS is an exaggerated inflammatory response to a pre‐existing infection following recovery of immunologic function. It reflects inflammatory burden rather than progressive infection or treatment failure. Initially associated with persons with HIV after initiation of antiretroviral therapy, IRIS is increasingly recognized in other scenarios of immune reconstitution, including withdrawal from tumor necrosis factor alpha (TNF‐α) inhibitors. IRIS can occur in two forms: "unmasking" which is a flare‐up of an underlying, undiagnosed infection once the patient is able to mount an immune response and "paradoxical" which is a recrudescence of symptoms of a treated infection. Diagnosis of paradoxical IRIS requires exclusion of other potential causes of clinical worsening. Time to onset varies by risk factor and by medication half‐life‐‐ typically 5‐16 weeks after TNF‐ α inhibitor withdrawal. IRIS can be mild or life threatening. While there is no treatment standard, corticosteroid therapy appears to shorten hospitalization and reduce morbidity.

CONCLUSION: We share a case of TB masquerading as CAP complicated by paradoxical TB‐IRIS in a patient with Crohn's disease on infliximab. With growing indications for immune modulating treatments, providers are encouraged to keep a heightened suspicion for TB and the potential for IRIS to facilitate earlier diagnosis and optimize outcomes.

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ABSTRACT #165 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE LUNG FUNCTION STATUS AS A PROGNOSTIC INDICATOR IN ADENOCARCINOMA SURVIVAL: A COMPARATIVE ANALYSIS OF COPD, PRISM, AND NORMAL LUNG FUNCTION Toshiro Goto1, Rodrigo Paredes de la Fuente1, Jorge Gomez2, Christian Rolfo3, David Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University,

Columbus, OH, United States

To be presented at the American Thoracic Society (ATS) Annual Meeting that will be held in San Francisco, California, United States from May 16-21, 2025.

BACKGROUND/INTRODUCTION: Preserved Ratio Impaired Spirometry (PRISm), defined by an FEV1 <80% predicted and FEV1/FVC ratio ≥ 0.7, is an important prognostic factor in lung cancer. While smoking is strongly linked to the occurrence and prognosis of small cell and squamous cell lung carcinomas, adenocarcinoma incidence is less affected by smoking status. PRISm and COPD are associated with increased mortality in nonsmall cell lung cancer, including adenocarcinoma, though data on progression-free survival (PFS) are limited.

We compared overall survival (OS) and PFS in lung adenocarcinoma patients with PRISm, normal lung function and COPD. METHODS: We conducted a retrospective review of adenocarcinoma patients in the Mount Sinai Health System who underwent liquid biopsies (LBs) between January 2018 and May 2024. Patients were categorized by lung function and evaluated for OS and PFS: COPD (n=31 for OS, n=18 for PFS), PRISm (n=26 for OS, n=37 for PFS), and normal lung function (n=55 for OS, n=58 for PFS). OS and PFS were analyzed with Kaplan-Meier estimates, and a Cox proportional hazards model adjusted for sex, PD-L1 expression, and cancer stage.

Statistical analysis was performed with RStudio using Chi-square tests for categorical data and Wilcoxon tests for non-normally distributed continuous data.

RESULTS: Median OS was 3.09 months (95%CI, 1.84–10.26) in patients with COPD, 23.01 months (95%CI, 12.66–51.41) in patients with PRISm, and 31.48 months (95%CI, 18.16–61.48) in patients with normal lung function. Cox regression showed significantly lower mortality for normal lung function (HR, 0.27; p=0.0026) and PRISm (HR, 0.28; p=0.0018) groups compared to COPD. Median PFS was 10 months (95%CI, 8–32) in COPD patients, 15 months (95%CI, 8–19) for PRISm patients, and 16 months (95%CI,11–28) for normal, with nonsignificant risk reductions in Cox analysis.

CONCLUSION: Lung adenocarcinoma patients with normal lung function and PRISm have significantly better OS compared to those with COPD. Minimal differences in PFS suggest lung function status may affect OS more than disease progression. The overall adverse impact of COPD may explain poorer survival, emphasizing the need for tailored interventions based on lung function status in adenocarcinoma. PRISm and normal lung function in adenocarcinoma patients are associated with better OS than COPD, although PFS differences are less pronounced. Lung function is a critical prognostic factor, underscoring the need for targeted management, particularly for patients with COPD.

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ABSTRACT #166 CLINICAL RESEARCH CARDIOLOGY CLINICAL OUTCOMES OF P2Y12 INHIBITOR MONOTHERAPY VERSUS DUAL ANTIPLATELET THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ACUTE CORONARY SYNDROME Soumya Gupta1, Aditya Thakkar1, Devika Aggarwal1, Kirtipal Bhatia1, James Choi1, Kristen Carter1, Arpanjeet Kaur1, Abel Casso Dominguez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended after percutaneous coronary intervention (PCI) to lower the risk of cardiovascular events.

However, prolonged DAPT has been shown to increase bleeding risk, while some studies have shown that shorter-duration of DAPT followed by aspirin alone increases ischemic risk. This study aimed to compare the risks and benefits of monotherapy with P2Y12 inhibitors and DAPT after PCI. METHODS: We searched the Medline, Embase, and Cochrane databases for randomized controlled trials (RCTs) involving adult patients hospitalized with ACS who underwent PCI. Our primary outcome was the composite of death, myocardial infarction (MI), and stroke. The secondary outcomes were net adverse clinical events (NACEs which is the primary outcome and risk of major bleeding), all-cause mortality, cardiac death, MI, stroke, stent thrombosis, target vessel revascularization, clinically relevant bleeding, and major bleeding. We used Review Manager 5.4 for the statistical analysis, employing risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS: Nine RCTs were included, involving a total of 34,322 patients, with 48.9% receiving P2Y12 inhibitor monotherapy after 1–3 months of DAPT. Regarding the primary outcomes, the risk of the composite of all-cause mortality, MI and stroke was significantly lower in patients receiving P2Y12 monotherapy as compared to patients on DAPT (RR, 0.91; 95%CI, 0.84–0.98; I2=0%; p=0.01). With respect to the secondary outcomes, there was a significantly lower risk of NACEs (RR, 0.86; 95%CI, 0.76–0.97; I2=58%; p=0.01), clinically relevant bleeding (RR, 0.59; 95%CI, 0.38–0.93; I2=92%; p<0.00001), major bleeding (RR, 0.57; 95%CI, 0.40–0.82; I2=79%; p=0.002) as well as cardiac death (RR, 0.80; 95%CI, 0.64–0.99; I2=0%; p=0.04) in patients receiving P2Y12 inhibitor monotherapy. There was no significant difference in the risk of all-cause mortality, MI, stroke, target vessel revascularization, and stent thrombosis between the 2 groups.

CONCLUSION: This meta-analysis found a significant decrease in the risk of the composite of death, MI, and stroke in patients receiving P2Y12 inhibitor monotherapy. It also showed that the risk of net adverse clinical events and major bleeding is lower in patients receiving P2Y12 inhibitor monotherapy.

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ABSTRACT #167 CLINICAL RESEARCH CARDIOLOGY EVALUATING COMPLICATIONS AND HEALTHCARE UTILIZATION OF INTRAVASCULAR ULTRASOUND GUIDED PERCUTANEOUS CORONARY INTERVENTIONS Aditya Thakkar1, Soumya Gupta1, Koushik Sanku2, Sai Karthik Kommineni3, Lalith Namburu3, Dilpat Kumar3, Manar Jbara3, Jeetendra Patel3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount

Sinai Medical Center of Florida, Miami, FL, United States; 3East Tennessee University, Johnson City, TN, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: While using intravenous ultrasound (IVUS) during percutaneous interventions (PCI) enhances lesion assessment, stent placement, and procedural precision, it may also potentially increase procedural costs and complications.

METHODS: We conducted our study utilizing data from the nationwide inpatient sample database from January 2016 to December 2020. The study cohort comprised 444,571 hospitalized patients who underwent PCI during their hospitalization. We compared the outcomes of interventions with the use of IVUS and those without. The primary outcome was inpatient mortality. Secondary outcomes were the length of stay, cost of hospitalization, in-hospital and procedural complications as well as the need for life-saving interventions.

RESULTS: Among 444,571 patients who underwent PCI, 37,482 (8.4%) had IVUS used during their procedure.

Among the study population, 67.3% were male, 75.4% were white, 9.5% were black and the remaining 15.1% comprised of other races. The average age of the population was 65.37 years. All outcomes in this study were adjusted for age, race, sex, and comorbidities using the Charlson comorbidity index. Cases that utilized IVUS experienced a significant reduction in in-patient mortality. However, they did have an increased risk of acute renal failure and ventricular arrhythmias. There was also an increase in procedure-related complications like access site-related hematoma, access site-related infection, deep venous thrombosis, coronary artery dissection, and coronary artery aneurysm. They also had an increased need for interventions like dialysis, extracorporeal membrane oxygenation, pressors, and blood transfusions. Additionally, this group also had a significantly higher length of stay (mean 5.2 days versus 4.9 days, p<0.001), and cost of hospitalization ($134,914 versus $117,411, p<0.001).

CONCLUSION: Although IVUS-guided PCI is linked to an uptick in certain complications and overall healthcare costs, it concurrently shows a decrease in in-hospital mortality. This contrast paints a complex picture; the modest increase in risk is counterbalanced by a critical mortality benefit. Ultimately, the benefits of potentially improved survival rates may justify the use of IVUS in PCI, particularly in settings where precision and detailed assessment can significantly impact patient outcomes.

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ABSTRACT #168 CLINICAL RESEARCH CARDIOLOGY/INFECTIOUS DISEASES NATIONWIDE ANALYSIS OF THE IMPACT OF COVID‐19 ON ECMO UTILIZATION IN PATIENTS HOSPITALIZED WITH STEMI: A RETROSPECTIVE OBSERVATIONAL STUDY Harsh Patel1, Maania Naseem2, Yash Patel3, Aditya Thakkar4, Payal Singh5, Urvish Patel6, Saketh Iswarawaka7, Abdul Qadree8, Soumya Gupta9, Omar Hassan10, Nagaraj Honganur11, Bhanu Matri12, Parth Shah13, Jose Davis14, Nilay Bhatt15 1Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India; 2King Edward Medical

University, Lahore, Punjab; 3Narendra Modi Medical College; 4East Tennessee State University; 5Silchar Medical College, Silchar, Assam; 6Icahn School of Medicine at Mount Sinai,New York, NY, USA, 7University of West Indies, St.Augustine; 8Merit Health Wesley, Hattiesburg, MS, United States; 9Mount Sinai Morningside/West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 10Ondokuz Mayis University, Faculty Of Medicine, Samsun, Turkiye; 11Parkview Medical Center, Pueblo, CO, United States; 11UAB Heersink School of Medicine, Montgomery, AL, United States; 12Hospital/Tower Health Medical Group, West Reading, PA, United States; 14Albert Einstein College of Medicine, New York City, NY, United States; 15HCA Houston Healthcare, Clear Lake, Texas, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

BACKGROUND/INTRODUCTION: ST‐segment‐elevation myocardial infarction (STEMI) presents a healthcare burden in the United States. However, STEMI patients with COVID‐19 have elevated in‐hospital mortality. The use of extracorporeal membrane oxygenation (ECMO) for COVID‐19 patients with STEMI is debated. We aimed to compare hospitalized STEMI patients with and without COVID‐19, using a national database to understand the impact of concurrent COVID‐19 infection on ECMO utilization rates.

METHODS: A retrospective cross‐sectional observational study using Nationwide inpatient sample files between January and December 2020. COVID‐19 population was identified and grouped into patients with STEMI and without‐STEMI. Amongst STEMI patients, we used ICD‐10 CM code to find out ECMO utilzation. SAS 9.4 was used for univariate (chi‐square test and unpaired t‐test) tests and mixed‐effects survey logistic regression models to obtain odds ratio (OR) and 95%CI estimation for calculating odds of utilization and predictors of utilization, keeping p<0.05 as significant.

RESULTS: We analysed 198,335 samples after excluding patients under 18 years and those with missing data for age, sex, and race. 6,455 cases had STEMI with COVID‐19, while 191,880 were STEMI without COVID‐19.

STEMI patients with COVID‐19 were more frequently female (21.55%), Hispanic (21.46%), or of African descent (14.72%). Furthermore, the incidence of STEMI associated with COVID‐19 was found to be higher among individuals belonging to the Medicare beneficiary population (53.83%) and those with lesser incomes (0‐25th percentile) (35.32%). Among patients with STEMI and COVID‐19, the prevalence of ECMO utilization was higher (0.86% versus 0.07%, p<0.0001). In regression analysis, STEMI patients with COVID‐19 had 0.67 lower odds of ECMO utilization in compared to without COVID‐19 (OR, 0.33; 95%CI, 0.25‐0.44; p<0.0001). Female (OR, 2.19; 95%CI, 1.18‐4.08), Black (OR, 3.39; 95%CI, 1.63‐7.03), patients with heart failure (OR, 4.97; 95%CI, 2.69‐ 9.18), and arrythmias (OR, 2.79; 95%CI, 1.32‐5.89) had higher ECMO utilization following STEMI. (Area under ROC/c value = 0.929) CONCLUSION: Our Though ECMO may improve survival rates for STEMI and refractory cardiogenic shock patients, especially patients with COVID‐19 according to some studies, our research shows that STEMI patients with COVID‐19 are less likely to receive ECMO. More prospective studies should be planned to evaluate the benefits of ECMO in severe COVID‐19 infection. The above findings may help healthcare providers to improve the management to mitigate the burden of COVID‐19 in STEMI patients.

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ABSTRACT #169 CLINICAL RESEARCH CARDIOLOGY OUTCOMES OF ATRIAL FIBRILLATION ABLATION IN ELDERLY: A RETROSPECTIVE COHORT STUDY Aditya Thakkar1, Soumya Gupta1, Koushik Sanku2, Sai Karthik Kommineni3, Lalith Namburu3, Dilpat Kumar3, Vijay Ramu3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Medical Center of Florida, Miami, FL, United States; 3East Tennessee University, Johnson City, TN, United

States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Atrial fibrillation is a common cardiac arrhythmia that increases in prevalence with age. Ablation has been widely used for managing atrial fibrillation, but its outcomes in octogenarians have been less thoroughly investigated.

METHODS: Data was obtained from the Nationwide Inpatient Sample database from January 2016 to December 2020. The study included all adult patients with a primary discharge diagnosis of atrial fibrillation who underwent catheter ablation during their hospitalization. These patients were then categorized into two groups based on age: below 80 and above 80 years. In-hospital outcomes for these groups were then looked at. The primary outcome was inpatient mortality. Secondary outcomes were the length of stay, cost of hospitalization, cardiac arrest, cardiac tamponade, arrhythmias, acute respiratory failure, acute renal failure, procedural complications as well as the need for dialysis, transfusions, pressors, ventilators, and tracheostomy.

RESULTS: Out of about 35 million admissions screened, 403,247 patients had atrial fibrillation as their primary discharge diagnosis, of these, 17,927 patients underwent catheter ablations during their hospitalization. Amongst them, 3,051(17%) were above the age of 80 years. The in-hospital mortality was slightly higher in the elderly compared to the younger cohort (1.1% versus 0.5%; aOR, 1.87; 95%CI, 1.20-2.92; p=0.006). They had a longer hospital stay (5.14 days versus 3.72 days; p<0.001) and lower hospitalization costs (USD $138,091 versus USD $162,788, p<0.001). Complications such as acute respiratory failure and acute renal failure were more frequent in the older age group, while no significant differences were observed in cardiac arrest, cardiac tamponade, ventricular arrhythmias, and most device-related complications. The need for new dialysis, mechanical ventilation, and pressor use was significantly less in the above 80 years old group.

CONCLUSION: The atrial fibrillation ablation in older adults, results in slightly higher in-hospital mortality and longer hospital stays compared to younger patients. Despite these differences, the overall complication rates are comparable, suggesting that age alone should not deter the selection of patients for atrial fibrillation ablation.

Further studies are needed to validate these findings and optimize management strategies for the elderly population.

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ABSTRACT #170 CLINICAL RESEARCH CARDIOLOGY ADDITIVE PROGNOSTIC SIGNIFICANCE OF VASCULAR DISEASE IN PATIENTS REFERRED FOR EXERCISE STRESS ECHOCARDIOGRAPHY Hannah Hart1, Alaa Omar1, Edgar Arguilan1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: The presence of carotid plaque (CP) may serve as an indicator of panvascular atherosclerosis. However, the observed incongruity between carotid disease and the presence and severity of coronary artery disease (CAD) suggests differing mechanisms. We investigated the prognostic value of this incongruity, considering both known atherosclerosis and myocardial ischemia.

METHODS: This In a retrospective analysis, we examined 111 patients (mean age: 64±12 years, 58% women) who underwent exercise stress echocardiography, with recent carotid artery and coronary evaluation. We computed a Vascular Disease (VasD) score, integrating the presence of carotid plaque (CP) on carotid ultrasound, known coronary artery disease (CAD), and myocardial ischemia (MyI). Subsequently, patients were followed for 5.5 years for mortality, coronary revascularization, and cardiac hospitalization.

RESULTS: During the follow-up period, 29 patients experienced the combined outcome (4 deaths, 10 revascularizations, and 22 hospitalizations). Among the cohort, 44 patients exhibited no vascular disease, while 67 displayed evidence of vascular disease, categorized as 42 with VasD of 1 (comprising 30 CP, 9 CAD, and 3 MyI), 14 with VasD of 2 (5 CP and CAD, 6 CP and MyI, 3 CAD and MyI), and 11 with VasD of 3. There were no significant differences between patients with and without VasD concerning sex, diabetes, renal function, atrial arrhythmia, baseline LVEF, and baseline diastolic function. However, patients with VasD were older, had higher H2FPEF scores, and lower exercise capacity, as well as elevated baseline and exercise-induced filling pressures. The incidence of the combined outcome showed a progressive increase with higher VasD scores (p<0.001). Survival curves depicted a rising risk of the outcome corresponding to increasing VasD scores.

CONCLUSION: The presence of vascular disease as quantified by known CAD, CP as detected by carotid ultrasound, and myocardial ischemia identified during exercise stress echocardiography demonstrates a substantial additive prognostic role in mid-term cardiovascular outcomes.

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ABSTRACT #171 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY DURABLE RESPONSE TO PEMBROLIZUMAB IN METASTATIC PULMONARY SARCOMATOID CARCINOMA Jing Huang1, Rodrigo Paredes de la Fuente1, Toshiro Goto1, Jorge Gomez2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Pulmonary Sarcomatoid Carcinoma (PSC) is a rare, aggressive NSCLC with poor prognosis, high metastatic potential, and limited treatment options. Often diagnosed at advanced stages, it is highly resistant to chemotherapy given its unique biology and limited responsiveness to conventional regimens. PSC shows elevated PD-L1 expression (25-70%), particularly in KRAS-mutated cases, making it more immunogenic than other NSCLCs [1,2]. This correlation with mutational burden supports immune checkpoint inhibitors (ICIs) as a promising therapy, with superior response rates compared to standard treatments.

CASE PRESENTATION: An 81-year-old male with an 84 pack-year smoking history presented with persistent cough and hemoptysis despite pneumonia treatment. Chest CT revealed a 4.8 × 3.6 × 4.0 cm left hilar mass, and bronchoscopy confirmed sarcomatoid carcinoma with PD-L1 >90%. Somatic testing identified a KRAS driver mutation. Staging PET/CT showed highly metastatic disease involving multiple areas of the body. The patient was initially prescribed paclitaxel-carboplatin, but progression on subsequent imaging led to the addition of pembrolizumab due to high PD-L1 expression. After three cycles of pembrolizumab, he exhibited a positive response, leading to the decision to continue immunotherapy. He completed a total of 30 cycles (two years of treatment), after which the decision was made to monitor off therapy. To this day, he remains in remission with no evidence of disease progression.

DISCUSSION/CONCLUSION: PSC tumors are large, peripherally located, and often metastatic at diagnosis, leading to poor prognosis. Their rapid growth results in a 69% progression rate at initial evaluation, median progression-free survival of 2.0 months, and 5-year survival of just 18.4%. Given 70–90% of PSC tumors express PD-L1, ICIs have emerged as a promising alternative. Our patient, whose tumor had PD-L1 >90%, initially progressed on chemotherapy but responded dramatically to pembrolizumab, achieving a near-complete remission. Now over two years disease-free, his case highlights the potential of ICIs to induce durable responses in PSC, particularly in PD-L1–high tumors. These findings support the growing role of immunotherapy in PSC and underscore the need for biomarker-driven treatment strategies. PSC is an aggressive NSCLC with limited treatment options. Immunotherapy shows promise, especially in PD-L1-positive cases. This case highlights ICIs' potential, with the patient achieving over two years of remission. Ongoing studies are essential to refine treatment strategies.

Figure 1. Staging PET/CT showed highly metastatic disease involving multiple areas of the body.

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ABSTRACT #172 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY NAVIGATING UNRESECTABLE PANCREATIC MASSES: AN ENDOSCOPIC ULTRASOUND-GUIDED APPROACH TO BILIARY DRAINAGE IN A PATIENT WITH AN INDWELLING LUMINAL STENT Rama Hussein1, Marni H. Wilkoff1, Neal Shah2, Rashmi Advani2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai South Nassau, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Pancreatic cancer causes symptomatic gastric outlet obstruction (GOO) in about 15-20% of patients. Endoscopic luminal stenting is preferred over palliative surgery as it provides immediate relief, decreases morbidity and improves 30-day quality of life, however tumor invasion (26%) and biliary obstruction (59%) are common complications. As pancreatic tumors progress, they can lead to biliary obstruction, more commonly than GOO. Endoscopic ultrasound-guided choledochoduedenostomy (EUS-CDS) is a noninvasive approach used to relieve biliary obstruction in cases with difficult biliary cannulation. Luminal access through the duodenal bulb must be preserved to employ this approach. This case outlines a patient with a pancreatic head mass that initially was treated with an uncovered luminal stent for duodenal obstruction who later required endoscopic treatment of biliary obstruction.

CASE PRESENTATION: An 89-year-old male with hypertension and diabetes was admitted for nausea and vomiting. Liver tests were normal and CT imaging showed a significantly distended stomach secondary to a 4.3 cm pancreatic mass, resulting in duodenal obstruction. EUS-guided core biopsies confirmed moderately differentiated pancreatic adenocarcinoma. An uncovered luminal stent was placed to treat the GOO. An overall non-surgical approach was ensued given the non-operable extent of disease. Months later, he presented with obstructive jaundice. ERCP revealed complete tissue ingrowth at major papilla precluding conventional retrograde access to the biliary tree. Despite an indwelling luminal stent, a safe endosonographic window was found from the duodenal bulb to the distended bile duct and an EUS-CDS was successfully placed resulting in biliary decompression. His liver enzymes significantly improved and was discharged to home hospice.

DISCUSSION/CONCLUSION: EUS-guided therapies including EUS-CDS are non-invasive, non-surgical, quality-of-life preserving techniques in patients with difficult retrograde biliary access. It is crucial to understand that biliary obstruction may eventually present with GOO in pancreatic head cancers. Appropriate therapies which would not only reduce complications associated with luminal stents but would allow for future EUS-guided access to the bile duct through the duodenum need to be considered. EUS-guided gastrojejunostomy is one approach and may be pursued if local expertise is available. An alternate approach is also prophylactic biliary stenting, if feasible, for patients presenting with GOO.

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Figure 1. Initial Endoscopic ultrasound revealing initial pancreatic head mass (A.) Repeat EUS revealing dilated CBD (B), the deployment of luminal stent into CBD (C) and post EUS-CDS (D).

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ABSTRACT #173 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY NEGATIVE DOES NOT MEAN NO: EXERCISING PERSISTENCE IN THE EVALUATION OF A PANCREATIC NEUROENDOCRINE TUMOR Muhddesa Lakhana1, Rama Hussein2, Marni H. Wilkoff2, Rashmi Advani1 1Mount Sinai South Nassau, Icahn School of Medicine at Mount Sinai, Oceanside, NY, United States; 2Mount Sinai

Morningside-West Hospitals, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Well-differentiated pancreatic neuroendocrine tumors (PanNET) account for 1-3% of pancreatic neoplasms. The most common functioning PanNET is an insulinoma. The underlying hypoglycemia associated with insulinomas may contribute to a wide range of symptoms. The presentation of insulinomas include a wide range of neurological and sympathoadrenal symptoms including visual changes, seizures palpitations, diaphoresis and tremulousness. Insulinomas are often diagnosed with imaging, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), with lab work showing high insulin levels. We present a case of a patient who was treated for suspected absence seizures for one year prior to discovering an insulinoma on Endoscopic Ultrasound (EUS), that was undetected on MRI. CASE PRESENTATION: A 29-year-old female was being seen by a Neurologist for one year of episodic disorientation, blurry vision, and unresponsiveness, and was diagnosed with absence seizures. She was placed on anti-epileptic medications, however, despite treatment, her symptoms persisted. Lab testing performed by her Neurologist revealed non-fasting serum glucose levels varying from 32mg/dL to 53mg/dL. The patient was referred to an Endocrinologist who conducted a 72-hour fasting glucose test. Her serum glucose level was 53mg/dL with C-peptide of 3.64mg/dL and a total insulin of 26.3mg/dL. The patient endorsed fatigue during times of hypoglycemia. Follow-up CT abdomen and pelvis and MRI cholangiogram were negative for pancreatobiliary pathology. The patient was referred to Interventional Gastroenterology for EUS, which revealed a 12mm by 6mm well defined, isoechoic and heterogenous lesion within the pancreatic tail. Pathology was consistent with a grade 1 well-differentiated pancreatic neuroendocrine tumor (PanNET).

DISCUSSION/CONCLUSION: Well-differentiated PanNETs are an uncommon cause of pancreatic neoplasms and are further divided into functioning and nonfunctioning tumors. Of the functioning tumors, about 30-35% are insulinomas, where patients produce excess insulin resulting in low blood glucose (< 50mg/dL) and may manifest with symptoms such as blurry vision, diaphoresis and even seizures. Both CT scan and MRI have an 89-97% sensitivity. EUS allows for direct visualization as well as biopsy. Our case highlights the importance of maintaining a high degree of suspicion in the face of persistent clinical symptoms despite negative imaging, as EUS was able to diagnose an insulinoma for our patient.

Figure 1. Isoechoic mass noted in pancreatic tail.

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ABSTRACT #174 CLINICAL RESEARCH GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY COMPARISON OF METASTATIC PATTERNS AND RISKS BETWEEN YOUNG ONSET AND AVERAGE ONSET CHOLANGIOCARCINOMA Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Bharati Dev1, Sebastian Prado-Nuñez2 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Universidad Peruana Cayetano Heredia, Lima, Peru

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: The incidence of young-onset (< 50 years) gastrointestinal malignancies is increasing. Cholangiocarcinoma, a highly fatal malignancy, is also rising in the United States. Yet, details regarding young-onset cholangiocarcinoma (YOCC) remain sparse. This study aims to elucidate the differences in metastatic patterns and risks between metastatic young-onset cholangiocarcinoma (mYOCC) and metastatic average-onset cholangiocarcinoma (mAOCC).

METHODS: We conducted a retrospective cohort study from 2018 to 2021 using the Surveillance, Epidemiology, and End Results (SEER) database to compare metastases patterns between mYOCC (age < 50 years) and mAOCC (age ≥ 50 years). Inclusion criteria comprised patients with stage IV disease according to TNM staging, histologically confirmed cholangiocarcinoma, a primary tumor classification, and complete data on demographic and metastatic site variables which included brain, lung, liver, and bone. Logistic regression analyses were adjusted for demographic variables to assess differences.

RESULTS: We identified 1,545 individuals diagnosed with mAOCC and 166 with mYOCC. Analysis revealed bone metastases in 27.11% of mYOCC patients compared to 18.77% in mAOCC. Liver metastases were more common in mAOCC at 52.36%, versus 35.54% for mYOCC. Similarly, lung metastases occurred in 35.54% of mYOCC patients and 27.06% of mAOCC patients. Brain metastases were least common, affecting 0.60% of mYOCC and 0.84% of mAOCC patients. Regression analysis indicated that mYOCC patients had a 68% increased risk of bone metastases at diagnosis (OR, 1.68; 95%CI, 1.15-2.45; p=0.007). Female patients exhibited a significantly reduced risk of developing bone metastases (OR, 0.57; 95%CI, 0.44-0.73; p<0.001).

Furthermore, there was a marginal increase in lung metastases among mYOCC patients (OR, 1.41; 95%CI, 0.99-1.99; p=0.05).

CONCLUSION: Significant disparities in metastatic patterns between mYOCC and mAOCC exist. mYOCC patients are more likely to develop bone metastases and exhibit a marginal increase in lung metastases compared to mAOCC – suggesting potential biological differences between the two age groups. The higher incidence of bone metastases in mYOCC underscores the need for enhanced screening protocols and tailored management strategies in this younger demographic to improve outcomes.

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ABSTRACT #175 CLINICAL RESEARCH GASTROENTEROLOGY/HEMATOLOGY/ONCOLOGY DISPARITIES IN STAGE AT DIAGNOSIS AMONG HISPANICS/LATINXS WITH GASTRIC CANCER IN THE UNITED STATES Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Renzo Aller-Rojas2, Francisco Arias-Reyes2, Sirish Dharmapuri1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2University of Texas Rio Grande Valley, McAllen, TX, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Racial disparities in stage at diagnosis, treatment and overall survival rates have been reported between Hispanic and non-Hispanic populations across various cancer types. Despite being classified as a low-incidence country for gastric cancer, the U.S sees approximately 26,000 new diagnoses each year. The purpose of this study is to evaluate disparities in the stage of gastric cancer at diagnosis among different racial groups and evaluate associated demographic factors.

METHODS: Using the SEER database spanning from 2000 to 2020, a retrospective cohort study of 13,383 gastric cancer patients was conducted. Selection of the population based on the ICD-O-3 2023 revision with primary site and morphology of “stomach” and site and morphology behavior recode for analysis “malignant”.

Patients with incomplete data on our independent variables were excluded from the analysis. Ordered logistic regression was used to study the association between the race and the stage of gastric cancer at diagnosis.

RESULTS: 21.3% of the study population were Hispanic, while non-Hispanics constituted 78.6%. 42.62% of individuals were in the 65-79 years sub-group category (p<0.001). Males constituted 60.52% of the population (p<0.001). 59.25% of the individuals included reported a household income of >$75,000 (p<0.001). The majority lived in Metropolitan areas (90.85%) (p<0.001). Most patients were married (62.65%) (p<0.001) and were diagnosed at stage IV (33.38%) (p<0.001). Hispanics are significantly more likely to be diagnosed at a later stage compared to non-Hispanics (OR, 1.2; 95%CI, 1.11-1.32; p<0.001). The odds of diagnosis at later stages decreases as age increases. Females had a lower odds ratio of being diagnosed at a later stage (OR, 0.85; 95%CI, 0.79-0.90; p<0.001).

CONCLUSION: Hispanics are 21% more likely to be diagnosed of gastric cancer at later stages when compared to non-Hispanics. This could be attributed to differences in healthcare access, insurance, language-barriers, utilization of preventive health services, low health literacy, unconscious bias from healthcare providers and potential differences in tumors which highlight critical areas for public health intervention aimed at reducing disparities through improved awareness campaigns and access to healthcare.

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ABSTRACT #176 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY RACIAL DISPARITIES IN RISK OF BONE METASTASIS AT DIAGNOSIS OF MALIGNANT PLEURAL MESOTHELIOMA Antoine Jeri-Yabar1, Liliana Vittini-Hernandez1, Francisco Arias-Reyes2, Renzo Aller-Rojas2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Universidad Peruana de Ciencias Aplicadas, Lima, Peru

Presented at the World Conference on Lung Cancer (WCLC) Annual Meeting that was held in San Diego, California, United States from September 7-10, 2024.

BACKGROUND/INTRODUCTION: Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer primarily caused by exposure to asbestos in occupational and environmental settings. Despite the ban on asbestos in the 1970’s, the latency period of 20-40 years post-exposure continues to pose a significant public health challenge. Bone metastases are reported in around 11% of MPM cases. To our knowledge, disparities in the presence of bone metastases at the time of MPM diagnosis among different racial groups have not yet been explored in the literature. This retrospective study aims to uncover such disparities.

METHODS: Utilizing the SEER Research Plus Database, this study focused on patients diagnosed with MPM between 2000-2020. Inclusion criteria consisted of confirmed malignant behavior, specified age, and precise histological classification of mesothelial neoplasms (morphology histology recode 9050-9059), with the primary site identified as "pleural.” Individuals aged 18 or younger were excluded. Variables studied were sex, race, survival months, median income, residential area, marital status, and metastases (bone, brain, lung, and liver) at diagnosis. Disease stage was classified into localized, regional, or advanced disease. Logistic regression was employed to assess odds of bone metastases at diagnosis among different racial groups while controlling for pertinent factors.

RESULTS: 5797 individuals were included. 79.63% were White, 3.88% Asian/Pacific Islander, 4.97% Black (B), 11.11% Hispanic, and 0.41% American Indian. 50.15% were 65-79 years of age, followed by ≥ 80 years old (31.33%). 76.90% were male, married (66.33%), lived in an urban area (89.65%) and earned at least $50,000 per year. At time of diagnosis, 5.12% had bone metastases, 0.62% brain metastases, 2.48% liver metastases and 7.16% lung metastases. Individuals with bone metastases at the time of diagnosis were more likely to be Asian/Pacific Islander when compared to White and have concomitant liver metastases, lung metastases and brain metastases. Females demonstrated reduced odds of bone metastases at MPM diagnosis. Other variables studied were not significantly associated.

CONCLUSION: Our study found that Non-Hispanic Asians/Pacific Islanders were significantly more likely to present with bone metastases at the time of MPM diagnosis compared to White population. This finding underscores the importance of integrating bone imaging more frequently into clinical evaluation of patients with advanced MPM, particularly within the API demographic. Future research endeavors should dive deeper into understanding the underlying mechanisms driving these disparities, considering genetic predisposition, environmental exposures and access to healthcare services.

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ABSTRACT #177 CLINICAL RESEARCH GASTROENTEROLOGY ACCURACY OF INTRA-OPERATIVE CHOLANGIOGRAM FOR DETECTION OF CHOLEDOCHOLITHIASIS Do Han Kim1, Allison A. Marshall2, Yousaf Hadi2, Haley Waite3, Jacquelin Florio2, Nikhil Kumta2, Satish Nagula2, Nicholas Hoerter2 1Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine

at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Intraoperative cholangiogram (IOC) is performed during cholecystectomy (CCY) with high suspicion of choledocholithiasis. Despite the availability of endoscopic ultrasound (EUS), a positive IOC is commonly followed by endoscopic retrograde cholangiopancreatography (ERCP). This study aims to evaluate the accuracy of IOC for detection of choledocholithiasis.

METHODS: We conducted a retrospective cohort study including patients ≥ 18 years of age who underwent IOC with subsequent ERCP and/or EUS at Mount Sinai Hospital, New York, between 1/1/2009 and 3/29/2023. Charts were reviewed to obtain demographic and clinical variables, including indication for CCY, lab results, and findings on IOC, EUS and/or ERCP. The IOC was positive if there was a filling defect in the bile duct or lack of duodenal filling with contrast. A false positive IOC was defined by lack of stone visualized on ERCP or EUS. Positive predictive value (PPV) of IOC was calculated; characteristics of patients with true and false positive IOC were compared using univariate analysis; multivariate binary logistic regression analysis was performed including all variables with p<0.2 on univariate tests as covariates to evaluate for independent predictors of false positive.

RESULTS: 263 patients were included, with a mean age of 48.95 years (SD=19.68). Indications for CCY were cholecystitis or cholelithiasis (63.9%), gallstone pancreatitis (15.2%) and choledocholithiasis (20.9%) (Table 1).

Mean time from IOC to ERCP and/or EUS was 1 day (SD=1.2). 12.9% of IOC’s were false positives; PPV was 87.1%. Univariate analysis revealed that age (p=0.04), lack of duodenal contrast filling (p=0.01), and post CCY serum alkaline phosphatase levels (p=0.002) were significantly associated with false positive IOC. On binary logistic regression analysis, lack of duodenal filling (OR, 2.58; 95%CI, 1.13-5.91) was noted to be an independent predictor of false positive IOC. 31 patients (11.8%) underwent EUS prior to ERCP, of which 5 patients had no stones and ERCP was deferred. None of the patients in the cohort developed choledocholithiasis, cholangitis or pancreatitis at follow up (mean=13.3 months).

CONCLUSION: Our study demonstrates a high false positive rate for IOC. Lack of duodenal filling is associated with higher odds of false positive IOC. These findings suggest an update in clinical practice to include EUS following positive IOC to improve cost-effectiveness and minimize undesirable risks of ERCP.

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ABSTRACT #178 CLINICAL RESEARCH GASTROENTEROLOGY ARE OUTCOMES TRULY DIFFERENT IN PATIENTS WITH ACUTE PANCREATITIS ACROSS ALL AGE? Donghyun Ko1, Do Han Kim2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 2Mount Sinai Morningside-West Hospitals,

Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Universidad de Guayaquil, Guayaquil, Ecuador; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: With a gradual increase in life expectancy throughout the world, diseases that were predominantly in the younger population are seen in elders. The prognosis of acute pancreatitis is currently calculated by preestablished criteria such as Ranson and BISAP; however, the cutoff values of age are exclusively >55 years and >60 years, respectively. The goal of our study is to determine if outcomes are different across all ages in patients admitted with acute pancreatitis.

METHODS: A retrospective observational study was conducted by querying the National Inpatient Sample for the years 2016 to 2019. All patients with age ≥ 18 and with discharge after admission for acute pancreatitis were included in the analysis. The sample was subsequently divided into three groups corresponding to 18 - 59 years, 60 - 79 years, and ≥ 80 years. The primary outcome was the inpatient odds of mortality in patients between all three groups admitted with acute pancreatitis. Secondary outcomes were inpatients odds of healthcare resources utilization and any complications associated with acute pancreatitis. Multivariate regression analyses were used to adjust for gender, insurance status, Charlson Comorbidity Index, income, hospital region, location, size, teaching status, comorbidities, and inpatients complications.

RESULTS: A total of 1,128,744 patients ≥ 18 years with acute pancreatitis were identified of which 770,932 (68.3%) were < 60 years, 285,572 (25.3) were ≥ 60 but < 80 years, and 72,240 (6.4%) were ≥ 80 uears. The mean ages were 42.8, 67.5, and 85.1 years respectively. For the primary outcome, elderly patients with acute pancreatitis had significantly increased adjusted odds of mortality (aOR, 2.39; p<0.001) (aOR, 6.97; p<0.001). For the secondary outcomes, elderly patients with acute pancreatitis had a significant increase in acute kidney injury (aOR, 1.77; p<0.001) (aOR, 2.67; p<0.001), and sepsis (aOR, 1.34; p<0.001) (aOR, 1.70; p<0.001). Regarding healthcare resources utilization, both groups had a higher length (aDays, 0.15; p<0.001) (aDays, 0.26; p<0.001) of stay and total hospital charges (aUS$ 2,770; p<0.001) (aUS$ 2,665; p<0.001).

CONCLUSION: Elderly patients with acute pancreatitis had a significant increase in mortality compared to younger patients. The odds of mortality were further potentiated when age was greater than 80 years.

Currently, elderly patients are categorized above the cutoff age of 60 years which in our consideration limits the calculate an accurate prognosis.

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ABSTRACT #179 CLINICAL RESEARCH GASTROENTEROLOGY ENHANCING ANAL CANCER SCREENING PROFICIENCY IN INTERNAL MEDICINE RESIDENTS Patricia Miguez Arosemena1, Do Han Kim1, Allison Wang1, Emily Seltzer1, John A. Andrilli1, Frank Nelson1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Early identification and management of precancerous anal lesions can significantly reduce the incidence of anal cancer, emphasizing the critical role of healthcare providers in screening. Despite new guidelines, there is a substantial lack of knowledge of anal cancer screening amongst all providers, including trainees, highlighting the need for further medical education to increase awareness. To address this educational gap, we conducted a targeted needs assessment to guide our intervention, ensuring it effectively addresses the specific educational deficiencies.

METHODS: A web-based survey was distributed to current internal medicine residents enrolled in a program situated in New York City. Following analysis of the targeted needs-assessment survey, a comprehensive educational session on anal cancer screening was conducted. The session covered topics such as epidemiology, pathogenesis, screening guidelines, primary and secondary prevention strategies, and included interactive casebased discussions between each thematic segment. Pre- and post-presentation, residents were invited to anonymously complete a questionnaire to evaluate their knowledge acquisition.

RESULTS: A total of ninety-two residents completed the needs assessment survey. Of these, 88% reported never having screened a patient for anal cancer. Only 15.2% knew which patients required screening.

Additionally, 89% of residents reported never having received any training or lectures on anal cancer screening.

However, 87% expressed a desire to learn about the topic. A survey was administered to residents before and after a lecture on anal cancer screening (86 residents completed the pre-lecture survey, and 89 completed the post-lecture questionnaire). Post-lecture results showed a 44% increase in correctly identifying the appropriate age to start screening high-risk populations. Participants showed a 21.3% increase in identifying immunosuppressed organ transplant patients and a 12.7% increase in recognizing women with a history of vulvar or cervical cancer as high-risk populations.

CONCLUSION: Our study demonstrates decreased awareness amongst all-level trainees. Impressively, our educational intervention significantly enhanced participants' knowledge of anal cancer and revealed a strong interest in further training. Implementation of comprehensive training sessions is crucial for improving residents' clinical practice and detecting early stages of anal cancer, thereby enhancing overall patient outcomes within this population.

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ABSTRACT #180 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY GASTROINTESTINAL XANTHOMAS AND ICHTHYOSIS Do Han Kim1, Michael Marble2, Juan E. Corral3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United

States; 2University of New Mexico Health Sciences Center, Albuquerque, NM, United States; 3Prisma Health, Greenville, SC, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: CHILD (Congenital Hemidysplasia with Icthyosiform Nevus and Limb Defects) syndrome is a rare X-linked dominant condition that primarily affects females due to its lethality in males during gestation. The disorder is caused by mutations in the NSDHL gene, which is implicated in cholesterol biosynthesis. The hallmark features include unilateral ichthyosiform erythroderma and ipsilateral limb defects.

There is paucity in the literature describing gastrointestinal findings in adults with CHILD syndrome.

CASE PRESENTATION: 35-year-old female with a past medical history of hiatal hernia, gastroesophageal reflux disease, asthma, prediabetes, and hyperlipidemia presented to the clinic for persistent heartburn despite high dose proton pump inhibitors. Physical exam was notable for xanthoma in her left cheek, scaly patches of erythroderma in skin folds of the abdomen and chest, and erythroderma and ichthyosis on the left hand involving the left 2nd digit (Figure 1). Esophagogastroduodenoscopy (EGD) revealed multiple flat yellow velvety lesions (1-4 mm) throughout all the esophagus and stomach (Figure 2). Biopsies confirmed xanthomas with foamy histiocytes (Figure 3). Genetic studies reported a variant in the gene NSDHL c.148G >A (p.G50R) of uncertain significance, a novel gene mutation suggestive of CHILD syndrome. Patient’s heartburn improved after changing to a different PPI and reinforcing adherence to lifestyle changes.

DISCUSSION/CONCLUSION: Differential diagnosis of flat yellow plaques in the foregut includes xanthomas, heterotopic sebaceous glands, lipomas and fibrolipomas (the latter two being typically polypoid). Mucosal xanthomas in the presence of ichthyosis should raise concerns for CHILD syndrome. Most patients with CHILD syndrome are diagnosed at birth or in childhood with limb defects or extensive unilateral ichthyotic erythroderma involving the trunk and limbs. This is the third case report of a mild phenotype, diagnosed in adulthood with foregut xanthomas, subtle skin features and no limb defects. Current case describes a new gene mutation in the NSDHL gene (previous mutations were c.324C >T, and c.131dupG). Further studies are required to determine the pathogenicity of this novel variant. Adults diagnosed with CHILD syndrome should be referred for genetic counseling and dermatology evaluation.

Figure 1. A. Dysplastic nail and ichthyosis, B. Multiple flat yellow lesions in gastroesophageal junction, C. Multiple flat yellow lesions in gastric cardia, D. Biopsy with foamy histiocytes confirming xanthomas

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ABSTRACT #181 CLINICAL RESEARCH GASTROENTEROLOGY GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IS ASSOCIATED WITH COMPLICATIONS AND MORTALITY IN PATIENTS WITH ULCERATIVE COLITIS AND OBESITY Luis M. Nieto1, Sharon Narvaez2, Do Han Kim3, Donghyun Ko4, Saurabh Chawla1, Kenneth Vega5, Laura Davisson6, Jami A. Kinnucan7

LOWER

1Emory University School of Medicine, Atlanta, GA, United States; 2Universidad de Guayaquil, Guayaquil,

Ecuador; 3Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 5Medical College of Georgia at Augusta University, Augusta, GA, United States; 6West Virginia University, Morgantown, WV, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: The prevalence of obesity in patients with inflammatory bowel disease (IBD) has been reported to be approximately 15% to 40 %. GLP-1 receptor agonists (GLP-1 RAs), a medication commonly used to treat diabetes and obesity, have shown promising results in reducing inflammation in animal models of colitis. Therefore, we aim to evaluate the outcomes of patients with ulcerative colitis (UC) and obesity taking GLP-1 RAs. METHODS: We performed a retrospective cohort study utilizing large population-based data from the TriNetX platform. We identified patients with obesity (body mass index of 30 or greater) and UC who received GLP-1 RAs (semaglutide, liraglutide, dulaglutide and tirzepatide) between January 1, 2019, and December 31, 2023.

This cohort of patients was matched with UC patients who did not receive GLP-1 RAs according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The endpoints were 5-year incidence of all-cause mortality, hospitalization, colorectal cancer (CRC), intestinal complications (includes megacolon, perforation, obstruction, bleeding, and abscess), corticosteroid use and extraintestinal manifestations (hepatobiliary, musculoskeletal, eye and skin manifestations). Logistic regression was used to estimate Odd Ratios (ORs).

RESULTS: A total of 16,783 adult patients with UC and obesity were identified, 2,301 of these individuals were taking GLP -1 RAs; 2,204 out of 2,301 [mean (SD) age, 58.8 (11.7) years; 1,232 (55.8%) female] were matched with 2,204 individuals [mean (SD) age, 58.5 (14.2) years; 1,240 (56.2%) female] who did not take GLP-1 RAs. The GLP-1 RAs group had significant lower odds of all-cause mortality [ORs, 0.38; 95% Confidence Interval (CI), 0.28-0.53], lower odds of hospitalization (ORs, 0.66; 95%CI, 0.52-0.85), lower odds of intestinal complications (ORs, 0.47; 95%CI, 0.34-0.66), lower odds of corticosteroid use (ORs, 0.75; 95%CI, 0.66-0.85), and hepatobiliary manifestations (cholangitis, bile duct carcinoma and cholelithiasis, ORs, 0.38; 95%CI, 0.23-0.63) when compared with the non- GLP -1 RAs group. No differences were found in the incidence of colorectal cancer and other extraintestinal manifestations.

CONCLUSION: Patients with UC and obesity who are taking GLP-1 RAs have lower odds of all-cause mortality, hospitalization, intestinal complications, corticosteroid use and hepatobiliary manifestations. Further prospective studies are needed to determine the mechanism for these clinical findings.

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ABSTRACT #182 CLINICAL RESEARCH GASTROENTEROLOGY GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IS ASSOCIATED WITH LOWER INCIDENCE OF GASTROESOPHAGEAL REFLUX DISEASE Sharon Narvaez1, Luis M. Nieto2, Olanrewaju Adeniran3, Donghyun Ko4, Do Han Kim5, Kenneth Vega6, Treah Haggerty3, Laura Davisson3, Lawrence Tabone3, Saurabh Chawla2 1Universidad de Guayaquil, Guayaquil, Ecuador; 2Emory University School of Medicine, Atlanta, GA, United States; 3West Virginia University, Morgantown, WV, United States; 4Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT,

United States; 5Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 6Medical College of Georgia at Augusta University, Augusta, GA, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions with an estimated prevalence between 6%-30% in the United States. Use of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sleeve gastrectomy (SG) have been independently associated with worsening GERD. However, there is a paucity of data related to the esophageal impact after starting GLP-1 RAs in patients with obesity and history of SG. Therefore, we aim to evaluate GERD outcomes in patients who start taking those medications after SG. METHODS: We performed a retrospective cohort study utilizing large population-based data from the TriNetX platform. We identified patients older than 18 with a history of obesity and SG before starting GLP-1 RAs (semaglutide, liraglutide, dulaglutide and tirzepatide) between January 1, 2010, and March 28, 2024. This cohort was matched with patients with a history of obesity and SG who did not receive GLP-1 RAs according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary endpoint was allcause mortality, and the secondary endpoints were incidence of new diagnosis of GERD, complications (includes Barrett’s esophagus, esophagitis, strictures, and new onset asthma), esophageal cancer, EGD needs, and Proton Pump Inhibitor (PPI) use. Logistic regression was used to estimate odd ratios (ORs).

RESULTS: A total of 4,763 adult patients with history of obesity and SG were identified, 471 of these individuals received GLP -1 RAs at some point after the procedure; 452 out of 471 [mean (SD) age, 46.6 (11.8) years; 359 (79.43%) female] were matched with 452 individuals [mean (SD) age, 46.2 (14.2) years; 361 (79.87 %) female] who did not received GLP-1 RAs. The GLP-1 RAs group had significantly lower odds of new diagnosis of GERD [OR, 0.51; 95%Confidence Interval (CI), 0.26-0.99] and lower odds of new PPI use (OR, 0.37; 95%CI, 0.190.70). No differences were found in mortality rate, incidence of complications, esophageal cancer, and needs for EGD. CONCLUSION: In this retrospective study using a large national database, we found that patients with a history of obesity and SG that started taking GLP-1 RAs have lower odds of developing GERD and starting a PPI. Also, we found that the use of GLP-1 RAs is not associated with worsening of GERD outcomes. Further prospective studies are needed to determine the mechanism for these clinical findings.

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ABSTRACT #183 CLINICAL RESEARCH GASTROENTEROLOGY GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE IS ASSOCIATED WITH LOWER MORTALITY AND IMPROVEMENT OF CARDIOVASCULAR OUTCOMES IN PATIENTS WITH CELIAC DISEASE AND OBESITY Donghyun Ko1, Do Han Kim2, Sharon Narvaez3, Olanrewaju Adeniran4, Luis Nieto5, Miguel Salazar6, Pedro Palacios-Argueta7, Paul Kroner8, Frank J. Lukens9 1 Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Universidad de Guayaqui, Guayaqui, Ecuador; 4West Virginia University School of Medicine, Morgantown, WV, United States; 5Emory School of Medicine, Atlanta, GA, United States; 6University of California Riverside, Riverside, CA, United States; 7 Mayo Clinic Florida, Jacksonville, FL, United States; 8Riverside Regional Medical Center, Newport News, VA, United States; 9Mayo Clinic, Jacksonville, FL, United States Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are drugs that are widely studied due to its weight loss and anti-inflammatory effects. Thus, promising effects are expected in patients with inflammatory diseases such as celiac disease and obesity. The aim of our study is to determine if the use of GLP-1RAs is beneficial in decreasing mortality and cardiovascular outcomes in patients with both conditions.

METHODS: A retrospective cohort study was performed using large population-based data from the TriNetX platform. Patients with celiac disease and obesity who have received GLP-1 RAs between January 1, 2010, and December 31, 2023, were identified. This group was matched with patients who did not receive GLP-RAs according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary outcome was all-cause mortality, and secondary outcomes were cardiovascular outcomes such as heart failure, acute myocardial infarction, cerebrovascular disease, coronary revascularization, and primary hypertension.

RESULTS: A total of 18,513 adult patients with celiac disease and obesity were identified, 2,631 of these individuals were taking GLP-1RAs; 2,333 out of 2,631 [mean (SD) age, 49.6 (13.6) years; 1,709 (73.3%) female] were matched with 2,333 individuals [mean (SD) age, 49.6 (16.3) years; 1,731 (74.2%) female] who did not take GLP-1RAs. The GLP-1RAs group had significantly lower mortality [Odds Ratio (OR), 0.34; 95% Confidence Interval (CI), 0.26-0.46], acute myocardial infarction (OR, 0.47; 95%CI, 0.30-0.73), cerebrovascular disease (OR, 0.66; 95%CI, 0.45-0.95), and primary hypertension (OR, 0.54; 95%CI, 0.41-0.71). No significant reduction in heart failure (OR, 0.78; 95%CI, 0.58-1.05) was observed. No patients from our study underwent coronary revascularization.

CONCLUSION: Throughout our study, lower mortality was observed in GLP-1RAs users with celiac disease and obesity. Furthermore, inflammatory heart conditions such as myocardial infarction, cerebrovascular disease, and hypertension were also associated with significant improvement. Further studies could determine the exact mechanism in which inflammatory responses are modulated through this drug.

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ABSTRACT #184 CLINICAL RESEARCH GASTROENTEROLOGY GLP-1 RECEPTOR AGONISTS USE IS ASSOCIATED WITH LOWER MORTALITY AND IMPROVEMENT OF CARDIOVASCULAR OUTCOMES IN PATIENTS WITH OBESITY WHO HAVE MAFLD AND OSA Sharon Narvaez1, Luis M. Nieto2, Felipe Contreras-Yametti3, Donghyun Ko4, Do Han Kim5, Treah Haggerty6, Laura Davisson6, Edward Rojas6 1Universidad de Guayaquil, Guayaquil, Ecuador; 2Emory University School of Medicine, Atlanta, GA, United

States; 3Wellstar Health System - Cobb Medical Center, Atlanta, GA, United States; 4Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 5Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 6West Virginia University, Morgantown, WV, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MAFLD) affects one in four people globally and is the primary cause of chronic liver disease. Numerous studies have demonstrated that compared to the general population, MAFLD is more common in people with obstructive sleep apnea (OSA).

GLP-1 receptor agonists (GLP-1 RAs) have shown promising results in treating MAFLD. Therefore, we aim to evaluate the mortality rate and occurrence of cardiovascular (CV) events in patients with obesity who have MAFLD and OSA. METHODS: We performed a retrospective cohort study utilizing large population-based data from the TriNetX platform. We identified adult patients with obesity (BMI of 30 or greater), OSA and MAFLD who received GLP-1 RAs between January 1, 2019, and April 30, 2024. This cohort of patients was matched with patients who did not receive GLP-1 RAs according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary endpoint was all-cause mortality, and the secondary endpoint were a composite of CV events and CPAP/BiPAP use. Logistic regression was used to estimate odd ratios (ORs).

RESULTS: A total of 60,258 adult patients with obesity along with MAFLD and OSA were identified, 17,112 of these individuals were taking GLP -1 RAs; 13,711 out of 17,112 [mean (SD) age, 54 (12.5) years; 7,174 (52.3%) female] were matched with 13,711 individuals [mean (SD) age, 54 (14.1) years; 7,243 (52.8%) female] who did not take GLP-1 RAs. The GLP-1 RAs group had significant lower odds of all-cause mortality [Odds Ratio (OR), 0.41; 95% Confidence Interval (CI), 0.34-0.49] and CV events including heart failure (OR, 0.55; 95%CI, 0.460.65), acute myocardial infarction (OR, 0.55; 95%CI, 0.43-0.71), HTN (OR, 0.69; 95%CI, 0.56-0.84) and cerebrovascular disease (OR, 0.59; 95%CI, 0.49-0.70) compared with the non-GLP-1 RAs group. Less use of CPAP/BiPAP was found in the GLP-1 RAs group; (OR, 0.84; 95%CI, 0.78-0.90) and (OR, 0.85; 95%CI, 0.790.91) respectively. No significant reductions in coronary revascularization (OR, 0.49; 95%CI, 0.04-5.46) and unstable angina (OR, 1.14; 95%CI, 1.02-1.27) were identified.

CONCLUSION: In this multicenter retrospective study, we found that patients with obesity and associated MAFLD and OSA who are on GLP-1 RAs have reduced rates of all-cause mortality, major CV events and less use of CPAP/BiPAP. Further prospective studies are needed to determine the mechanism for these clinical findings.

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ABSTRACT #185 CLINICAL RESEARCH GASTROENTEROLOGY GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS USE IS ASSOCIATED WITH LOWER RISK OF BILIARY DISEASE OUTCOMES IN NON-DIABETIC PATIENTS WITH OBESITY Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Olanrewaju Adeniran4, Luis Nieto5, Miguel Salazar6, Pedro Palacios-Argueta7, Paul Kroner8, Frank J. Lukens9 1Mount Sinai Morningside-Wes Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-

New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, School of Medicine, Atlanta, GA, United States; 4West Virginia University School of Medicine, Morgantown, WV, United States; 5Emory School of Medicine, Atlanta, GA, United States; 6University of California Riverside, Riverside, CA, United States; 7Mayo Clinic Florida, Jacksonville, FL, United States; 8Riverside Regional Medical Center, Newport News, VA, United States; 9Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven their efficacy in the management of both obesity and type 2 diabetes mellitus (DM). A recent meta-analysis has demonstrated the increased risk of biliary disease, specifically cholecystitis and cholelithiasis, in patients with obesity and diabetes. There is paucity in the literature describing the risk of biliary disease in non-diabetic patients with obesity.

METHODS: We performed a retrospective cohort study utilizing large population-based data from the TriNetX platform. We identified non-diabetic patients with obesity (BMI ≥ 30) who received GLP-1 RAs between January 1, 2021, and May 31, 2024. Patients with medications associated with cholecystitis, choledocholithiasis, and pancreatitis were excluded. This cohort of patients was matched with patients who did not receive GLP-1 RAs according to age, demographics, comorbidities, and medications by using 1:1 propensity matching. The primary endpoints were rates of cholecystitis, choledocholithiasis, and cholangitis. The secondary endpoint was all-cause mortality. Odds ratio (OR) with 95% confidence intervals were calculated; p-value<0.05 was considered statistically significant.

RESULTS: A total of 861,913 adult non-diabetic patients with obesity were identified, out of which 44,101 individuals were taking GLP -1 RAs; 44,100 out of 44,101 patients [mean (SD) age, 44.9 (12.3) years; 28,980 (65.7%) female] were matched with 44,100 patients [mean (SD) age, 45.4 (13.7) years; 29,018 (66.6%) female] who were not on GLP-1 RAs. The GLP-1 RAs group had a significantly lower risk of cholecystitis (OR, 0.72; 95%CI, 0.54 – 0.95), gallstone pancreatitis (OR, 0.73; 95%CI, 0.62 – 0.85), and all-cause mortality (OR, 0.17; 95%CI: 0.11 – 0.24) compared with the non-GLP-1 RAs group. No significant findings in choledocholithiasis (OR, 0.75; 95%CI, 0.56 – 1.02) and cholangitis (OR, 1.0; 95%CI, 0.42 – 2.40) were identified.

CONCLUSION: Through this multi-center retrospective study, we demonstrate that non-diabetic patients with obesity on GLP-1 RAs have decreased risk for biliary disease. The risk for cholecystitis, gallstone pancreatitis, and all-cause mortality was 28%, 27%, and 83%, respectively, lower in this cohort compared to non-diabetic non-GLP-1 RA patients with obesity. Further studies are required to determine the mechanism and importance of these findings.

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ABSTRACT #186 CLINICAL RESEARCH GASTROENTEROLOGY GLUCAGON LIKE PEPTIDE-1 RECEPTOR AGONISTS USE IS ASSOCIATED WITH LOWER 7-DAYS REPEAT ESOPHAGOGASTRODUODENOSCOPY AFTER INDEX ENDOSCOPY IN PATIENTS WITH ACHALASIA: A MULTI-CENTER ANALYSIS Donghyun Ko1, Do Han Kim2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 2Mount Sinai Morningside-West Hospitals,

Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Universidad de Guayaquil, Guayaquil, Ecuador; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Glucagon like peptide-1 receptor agonists (GLP-1RAs) are found to have beneficial effects in other conditions beyond their antidiabetic effect. Although it has minimal side effects, it is known that the use of GLP-1RAs is associated with delayed gastric emptying. This may impact the rate of repeat procedure in patients with an index esophagogastroduodenoscopy (EGD) such as in achalasia. The aim of our study is to determine an association between GLP-1 RAs use and repeat EGD in patients with achalasia.

METHODS: A retrospective cohort study was performed using large population-based data from the TriNetX platform. Patients with achalasia and index EGD who have received GLP-1RAs between January 1, 2021, and May 30, 2024, were identified. This group was matched with patients who did not receive GLP-RAs according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary outcome was repeat EGD, and secondary outcomes were other procedures such as esophagogram, esophageal dilation, chest CT, or esophageal stent placement 7 days after the index EGD. RESULTS: A total of 10,887 adult patients with achalasia and an index upper endoscopy were identified, 480 of these individuals were taking GLP -1RAs; 468 out of 480 [mean (SD) age, 60.9 (12.5) years; 298 (63.7%) female] were matched with 468 individuals (mean [SD] age, 61.6 [14.5] years; 294 [62.8%] female) who did not take GLP-1RAs. The GLP-1RAs group had significantly lower repeat EGD [Odds Ratio (OR), 0.24; 95% Confidence Interval (CI), 0.19-0.32]. No significant reductions esophagogram (OR, 0.86; 95%CI, 0.41-1.80), esophageal dilation (OR, 1.02; 95%CI, 0.42-2.48), and chest CT (OR, 1.28; 95%CI, 0.52-3.11) were observed. No patients underwent esophageal stent placement.

CONCLUSION: Throughout this study, we observed that less repeat EGD was needed in patients with achalasia under GLP-1RAs. Despite the possible side effects, beneficial effects such as weight loss and anti-inflammation of GLP-1RAs could have positively impacted to lower the repeat EGD rates. Further studies are required to determine the exact mechanism of this improvement.

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ABSTRACT #187 CLINICAL RESEARCH GASTROENTEROLOGY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH STIMULANT ABUSE, ADMITTED FOR NONVARICEAL UPPER GASTROINTESTINAL BLEED Khaled Al Smadi1, Miguel J. Salazar2, Pedro Palacios3, Do Han Kim4, Ko Dong5, Gianina Flocco6, George Saffouri7, Harold Paredes7 1University of California Riverside School of Medicine, San Bernardino, CA, United States; 2University of California

Riverside, Rancho Cucamonga, CA, United States; 3Mayo Clinic, Jacksonville, FL, United States; 4Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, United States; 6Cleveland Clinic, Cleveland, OH, United States; 7University of California Riverside, Rialto, CA, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Nonvariceal upper gastrointestinal bleed (NVUGI) carries high mortality and morbidity. Stimulant abuse is a growing epidemic with well-established increases in age adjusted mortality.

Stimulant abuse has been reported as a potential cause of serious GI complications, and outcomes in anesthesia have demonstrated higher risk for adverse events including mortality. Accordingly, we aim to investigate the effect stimulant use in NVUGI and consequences during hospitalization.

METHODS: In this study we recruited patients from the National Inpatient Sample for the years 2016-2020.

Using the ICD10-PCS codes, we recognized patients discharged after admission for NVUGI then divided them into two groups based on the presence or absence of stimulant abuse. The primary end point was in-hospital mortality while secondary end points were in-hospital systemic complications, length of stay (LOS) and healthcare related charges and costs. Multivariate logistic regression analysis was conducted to adjust for confounders.

RESULTS: A total of 1,984,524 patients with discharges after NVUGI were identified out of which 12,029 (0.6%) had associated SA. Mallory Weiss tear was the most likely cause of GI bleed (6.4% versus 3.2%; p<0.01), also higher rates of esophageal, gastric and duodenal ulcers (9.9% versus 4.5%, 16.2% versus 4.3%, 13.9% versus 11.2%; p<0.01). They were less likely females (30.1% versus 46.9%; p<0.01) and more likely younger (mean age 49.1 versus 67.5 years; p<0.01), with predominant White race in both groups (58.9% versus 67.5%; p<0.01) and more Hispanics among stimulant abuse group (19.9% versus 9.1%; p<0.01). Stimulant abuse had higher rates of OH abuse (42.9% versus 12.6%, p<0.01), cannabis abuse (20.9% versus 1.7%; p<0.01), opiate abuse (13.9% versus 1.4%; p<0.01) and tobacco abuse (2.7% versus 0.9%; p<0.01). After adjusting for confounders patients with stimulant abuse they had higher odds for SIRS (OR, 1.57 95%CI, 1.21–2.02; p<0.01), AKI (OR, 1.63; 95%CI, 1.32–2.03; p<0.01), hemodialysis (OR, 0.29; 95%CI, 0.13–0.65; p<0.01), endotracheal intubation (OR, 1.55; 95%CI, 1.28–1.88; p<0.01) and need for IR-embolization (OR, 2.17; 95%CI, 1.15–4.09; p<0.01). They did not have increased risk for mortality (OR, 0.51; 95%CI, 0.18–1.35; p=0.17), prolonged LOS or delay in EGD (OR, -0.01; 95%CI, -0.28–0.77; p=0.26) but had higher hospital charges (OR, $12,320; 95%CI, $5,224$19,415; p< 0.01).

CONCLUSION: Although patients with stimulant abuse did not have higher odds for in-hospital mortality, they had higher odds for in-hospital systemic complications. Efforts to target substance abuse should be implemented when these patients are admitted to the hospital.

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ABSTRACT #188 CLINICAL RESEARCH GASTROENTEROLOGY RISK OF CONSTIPATION AND SLOW TRANSIT CONSTIPATION IN PRE- AND PERI-MENOPAUSE, NONOBESE FEMALES ON PROGESTOGEN-ONLY CONTRACEPTIVES VERSUS COMBINED ORAL CONTRACEPTIVE PILLS: A MULTI-CENTER ANALYSIS Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Miguel Salazar4, Luis Nieto5, Pedro Palacios-Argueta6, Paul Kroner7, Frank J. Lukens8 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New

Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, Guayaquil,

Ecuador; 4University of California Riverside, Riverside, CA, United States; 5Emory School of Medicine, Atlanta, GA, United States; 6Mayo Clinic Florida, Jacksonville, FL, United States; 7Riverside Regional Medical Center, Newport News, VA, United States; 8Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Both progesterone and estrogen have been implicated in decreased colonic motility, potentially leading to slower transit times and consequently, constipation. However, this association has not been studied extensively. The aim of this study is to assess the risk of constipation and slow transit constipation in pre- and peri-menopause, non-obese females on progestogen-only contraceptives versus combined oral contraceptive pills (OCP).

METHODS: A retrospective cohort study was performed using large population-based data from the TriNetX platform. All female patients aged 18 – 51 years between January 1, 2010, and May 31, 2024, were identified.

Patients with obesity (BMI ≥ 30), diabetes mellitus, and medications associated with constipation were excluded.

Two cohorts were defined based on the treatment received, progestogen-only contraceptives versus combined OCP. The cohort of patients who received progestogen-only contraceptives was matched with patients who received combined OCP according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary outcomes were constipation, slow transit constipation, overflow incontinence.

The secondary outcomes were nausea and vomiting, abdominal pain, cholecystitis, cholelithiasis, and gastroesophageal reflux disease (GERD). Odds ratio (OR) with 95% confidence intervals were calculated; pvalue < 0.05 was considered statistically significant.

RESULTS: The progestogen-only contraceptive cohort included 74,467, while the OCP group included 96,382.

After propensity matching 1:1, 64,638 patients were included from each cohort. The mean age was 25.1 years for both cohorts. The progestogen-only group had significantly lower risk of constipation (OR, 0.83; 95%CI, 0.77 – 0.90), nausea/vomiting (OR, 0.91; 95%CI, 0.86 – 0.96), and GERD (OR, 0.80; 95%CI, 0.73 – 0.87). No significant differences were observed in slow transit constipation, overflow incontinence, abdominal pain, cholecystitis, and cholelithiasis.

CONCLUSION: Although no significant differences were observed in slow transit constipation, pre- and perimenopause, non-obese females on progestogen-only contraceptives have 17% lower risk for overall constipation when compared to those on combined OCP. Additionally, the rates of GERD and nausea and vomiting were lower in the progestogen-only cohort. Further studies are required to determine the clinical impact of contraceptive use.

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ABSTRACT #189 CLINICAL RESEARCH GASTROENTEROLOGY RISK OF DE NOVO GASTROPARESIS IN NON-DIABETIC PATIENTS WITH OBESITY TAKING TIRZEPATIDE VERSUS SEMAGLUTIDE Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New

Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, School of Medicine, Atlanta, GA, United States; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven their efficacy in the management of both obesity and type 2 diabetes mellitus (DM). Tirzepatide, a dual glucosedependent insulinotropic polypeptide (GIP) and GLP-1 RA has shown superior efficacy when compared to semaglutide. The aim of this study is to determine the risk of de novo gastroparesis in non-diabetic patients with obesity taking tirzepatide versus semaglutide.

METHODS: We performed a retrospective cohort study utilizing large population-based data from the TriNetX platform. All patients with obesity (BMI ≥ 30) who received GLP-1 RAs, specifically tirzepatide or semaglutide, were included between January 1, 2021, and May 30, 2024. Patients with type 2 diabetes mellitus (DM) were excluded. Two cohorts were defined based on the specific GLP-1 RA treatment received. The cohort of patients who received tirzepatide was matched with patients who received semaglutide according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary endpoint was gastroparesis. The secondary outcomes were gastrointestinal side effects, including nausea and vomiting, abdominal pain, diarrhea, constipation. Odds ratio (OR) with 95% confidence intervals were calculated; p-value<0.05 was considered statistically significant.

RESULTS: The tirzepatide cohort included a total of 17,733 patients, while the semaglutide group included 89,947 patients. After propensity matching 1:1, 17,728 patients were included from each cohort. In the tirzepatide group, the mean age was 46.7 years and 66.9% were female. Similarly, the semaglutide cohort had a mean age of 46.5 years and 67.4% were females. The tirzepatide cohort had significant lower risk of gastroparesis (OR, 0.36; 95%CI, 0.17 – 0.73), nausea and vomiting (OR, 0.55; 95%CI, 0.48 – 0.62), abdominal pain (OR, 0.55; 95%CI, 0.48 – 0.62), diarrhea (OR, 0.56; 95%CI, 0.47 – 0.66), and constipation (OR, 0.56; 95%CI, 0.48 – 0.65) compared with the semaglutide group.

CONCLUSION: Non-diabetic patients with obesity on tirzepatide have 64% lower risk of de novo gastroparesis when compared to non-diabetic patients with obesity taking semaglutide. Moreover, the rates of gastrointestinal side effects, such as nausea and vomiting, abdominal pain, diarrhea, and constipation are lower in the tirzepatide cohort. Further studies are required to determine the impact of tirzepatide’s dual mechanism in clinical outcomes.

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ABSTRACT #190 CLINICAL RESEARCH GASTROENTEROLOGY RISK OF DE NOVO GASTROPARESIS IN PRE- AND PERI-MENOPAUSE, NON-OBESE FEMALES ON PROGESTOGEN-ONLY CONTRACEPTIVES VERSUS COMBINED ORAL CONTRACEPTIVE PILLS Do Han Kim1, Donghyun Ko2, Sharon Narvaez3, Luis Nieto4, Pedro Palacios-Argueta5, Paul Kroner6, Frank J. Lukens7 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Yale-New

Haven Health/Bridgeport Hospital, Bridgeport, CT, United States; 3Universidad de Guayaquil, School of Medicine, Atlanta, GA, United States; 4Emory School of Medicine, Atlanta, GA, United States; 5Mayo Clinic Florida, Jacksonville, FL, United States; 6Riverside Regional Medical Center, Newport News, VA, United States; 7Mayo Clinic, Jacksonville, FL, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: There is evidence suggesting that oral contraceptive pills (OCP) may stabilize gastroparesis symptoms associated with hormonal fluctuations. Progesterone has been shown to slow gastrointestinal motility in a dose-dependent manner, theoretically worsening gastroparesis symptoms.

However, this association has not been studied. The aim of this study is to assess the risk of de novo gastroparesis in pre- and peri- menopause, non-obese females on progestogen-only contraceptives versus combined OCP. METHODS: A retrospective cohort study was performed using large population-based data from the TriNetX platform. All female patients aged 18 – 51 years between January 1, 2010, and May 31, 2024, were identified.

Patients with obesity (BMI ≥ 30), diabetes mellitus, and medications associated with gastroparesis were excluded. Two cohorts were defined based on the treatment received, progestogen-only contraceptives versus combined OCP. The cohort of patients who received progestogen-only contraceptives was matched with patients who received combined OCP according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary outcome was de novo gastroparesis, and secondary outcomes were gastroesophageal reflux disease (GERD), functional dyspepsia, nausea and vomiting, abdominal pain, cholecystitis, cholelithiasis, and Barrett’s esophagus. Odds ratio (OR) with 95% confidence intervals were calculated; p-value<0.05 was considered statistically significant.

RESULTS: The progestogen-only contraceptive cohort included 87,990, while the OCP group included 114,109. After propensity matching 1:1, 75,255 patients were included from each cohort. In the progestogenonly group, the mean age was 24.8 years. In the OCP group, the mean age was 24.7 years. The progestogenonly group had significantly lower risk of GERD (OR, 0.81; 95%CI, 0.76 – 0.87), functional dyspepsia (OR, 0.73; 95%CI, 0.58 – 0.91), and nausea and vomiting (OR, 0.91; 95%CI, 0.86 – 0.95). No significant differences were observed in de novo gastroparesis, abdominal pain, cholecystitis, cholelithiasis, and Barret’s esophagus.

CONCLUSION: Pre- and peri- menopause, non-obese females on progestogen-only contraceptives do not have increased risk of de novo gastroparesis when compared to those on combined OCP. Moreover, the rates of GERD, functional dyspepsia, and nausea and vomiting are lower in the progestogen-only cohort. Further studies are required to elucidate the mechanism of these findings.

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ABSTRACT #191 CLINICAL RESEARCH GASTROENTEROLOGY SINGLE CENTER ASSESSMENT OF THE BOSTON BOWEL PREPARATION SCALE SCORE AMONG PATIENTS WITH OBESITY WHO ARE RECEIVING SEMAGLUTIDE DURING THE TIME OF COLONOSCOPY Luis M. Nieto1, Sharon Narvaez2, Olanrewaju Adeniran3, Do Han Kim4, Donghyun Ko5, Shailendra Singh3, Jesse Thompson3 1Emory University School of Medicine, Atlanta, GA, United States; 2Universidad de Guayaquil, Guayaquil, Ecuador; 3West Virginia University, Morgantown, WV, United States; 4Mount Sinai Morningside-West Hospitals, Icahn School of

Medicine at Mount Sinai, New York, NY, United States; 5Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Semaglutide is commonly prescribed for weight loss and type 2 diabetes mellitus (DM2). However, this medication can induce a delay in gut motility, which may affect bowel preparation for colonoscopies. This study aimed to assess this primary outcome.

METHODS: Adult patients undergoing colonoscopy from 1/1/2021 through 10/31/2023 across a single center were identified. Data were collected from the medical record on patient comorbidities, type of bowel preparation, concurrent medications, and Boston Bowel Preparation Scale (BBPS). A Fisher’s exact test for the analysis of contingency tables and χ² test for categorical variables were performed to compare failure or success BPPS scores (defined by < 6 or =/ > 6, respectively). Multivariate logistic regression was used to identify predictors of inadequate bowel prep.

RESULTS: A total of 156 patients were included. The majority were female 110 (70.5%) and Caucasian 151 (96.8%). Mean BMI was 38.4 (SD ± 7.0) and the obesity classes distribution were: class I 51 (32.9%), class II 49 (31.6%) and class III 55 (35.5%). The majority of patients were taking semaglutide for more than 6 months 104 (67.9%) and did not stop the medication for colonoscopy 110 (73.8%). A significantly higher proportion of patients on semaglutide had DM2 127 (81.4%) and used other medications like antihypertensives 121 (77.5%), antiseizures 40 (25.6%), opioids 31 (19.9 %) and tricyclic antidepressants 12 (7.6%) at the time of colonoscopy.

GoLYTELY was the most used bowel preparation 116 (74.4%). Patients who stopped semaglutide 1 week or more prior colonoscopy were not associated with lower bowel prep failure, in fact a greater percentage of patients had stopped semaglutide usage in the bowel prep failure cohort, 28.6% versus 24.6% (p=0.85). In the multivariate logistic regression model, use of semaglutide, presence of DM2, other comorbidities and medications associated with bowel prep failure were examined and the only significant variables associated with failure were antihypertensives, tricyclic anti depressives and antiseizures.

CONCLUSION: In this retrospective study, semaglutide discontinuation before colonoscopy was not associated with improvement of the quality of bowel prep based on Boston Bowel Preparation Scale scores in patients with obesity. A prospective study using large sample sizes, controlling with previous failure of bowel prep and use of medication associated with constipation is needed to determine the mechanisms behind these findings.

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ABSTRACT #192 CLINICAL RESEARCH GASTROENTEROLOGY TIRZEPATIDE VERSUS SEMAGLUTIDE IN OBESE PATIENTS WITH METABOLIC DYSFUNCTIONASSOCIATED FATTY LIVER DISEASE OR METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS Olanrewaju Adeniran1, Luis M. Nieto2, Ifeoma P. Kwentoh3, Joshua Kirkpatrick1, Ayowumi Adekolu1, Ethan M. Cohen4, Kanith Farah1, Farirai Marwizi5, Sharon Narvaez6, Do Han Kim7, Donghyun8, Islam Younes1 1West Virginia University School of Medicine, Morgantown, WV, United States; 2Emory University School of Medicine,

Atlanta, GA, United States; 3Harlem Hospital Center, New York, NY, United States; 4West Virginia University, Morgantown, WV, United States; 5St. John's Medical College and Hospital, Rockaway Park, NY, United States; 6Universidad de Guayaquil, Guayaquil, Ecuador; 7Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 8Yale-New Haven Health/Bridgeport Hospital, Bridgeport, CT, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Non-alcoholic steatotic liver disease (SLD), which comprises metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatohepatitis (MASH), have been associated with increased cardiovascular and cerebrovascular risks and progression to hepatic fibrosis or hepatocellular carcinoma (HCC). Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), and tirzepatide, a combined GLP-1 RA and Glucose-dependent insulinotropic polypeptide receptor agonist (GIP RA), have shown promising results in treating MAFLD and MASH, despite their gastrointestinal (GI) side effects. Limited studies have compared the cardiovascular and cerebrovascular outcomes, the GI effects, and the risk of progression to fibrosis or HCC development in obese patients with MAFLD or MASH on either medication. We aim to evaluate these events.

METHODS: This large, retrospective, population-based cohort study utilizes data from the TriNetX platform.

Adult 18 years and above, BMI 30 or higher with MAFLD or MASH treated with tirzepatide or semaglutide between January 1, 2020, and May 30, 2024, were included. Patients who were pregnant, on other GLP-1 RA, diagnosed with SLD before and up to 3 months after initiation of either medication were excluded. The cohorts were matched according to demographics, related liver diseases, comorbidities, medications, and laboratory results using 1:1 propensity score matching (PSM).

RESULTS: Before PSM, the tirzepatide cohort included 4,376 patients, while the semaglutide cohort included 27,498 patients. 4,376 patients were matched. Given that all PSM assumptions hold, the tirzepatide group had significantly lower composite cardiovascular outcomes (RR, 0.394; 95%CI, 0.264-0.588), composite cerebrovascular outcomes (RR, 0.308; 95%CI, 0.184-0.515), GI side effects (RR, 0.643; 95%CI, 0.607-0.682), and progression to hepatic fibrosis or HCC (RR, 0.57; 95%CI, 0.377-0.86) compared to the semaglutide group.

CONCLUSION: This study shows that when compared to semaglutide, Tirzepatide was associated with reduced cardiovascular and cerebrovascular outcomes, GI side effects, and reduced progression to hepatic fibrosis or HCC in adult patients with obesity and MAFLD or MASH. Further prospective studies are needed to determine the mechanism for these clinical findings

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ABSTRACT #193 CASE REPORT/CLINICAL REVIEW GENERAL INTERNAL MEDICINE BEYOND THE RUSH: EFFECTIVE MANAGEMENT OF DUMPING SYNDROME WITH ACARBOSE Sarah Kosse1, Niurka Liranzo Tejera1, Andrea Duque López1, Bharat Monga1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 69‐year‐old male with a history of hypertension, chronic pancreatic insufficiency secondary to alcohol use and intra-ductal papillary mucinous neoplasm. Patient underwent a Whipple procedure which was complicated by recurrent gastro‐jejunal anastomotic bleeds that improved after EGD with clipping of stomach ulcer and revision of GJ with conversion to Roux‐en‐Y, ex‐lap and wash‐out. 2 months after Roux‐en‐ Y, the patient presented to the hospital with complications of site wound dehiscence and hypoglycemia. During the most recent admission, the patient's hypoglycemia and associated nausea, vomiting, diarrhea and decreased oral intake were more pronounced, unpredictable and severe. At presentation, laboratory findings showed a glucose level of 15mg/dL, requiring a D50 infusion with initial response to 90 mg/dL, followed by labile levels throughout presentation without clear improvement. As initial dietary modifications (low carbohydrate/high protein) failed, management transitioned to pharmacotherapy with acarbose which was started at 25 mg three times daily, then titrated to 50 mg three times daily. The patient's symptoms started to improve dramatically after the initiation of acarbose. Laboratory findings continued to show stable glucose levels, in the absence of any symptoms of hypoglycemia the patient had experienced during initial presentation including better oral intake, and no nausea or vomiting were reported. .

DISCUSSION: Dumping syndrome is commonly observed in patients following bariatric surgery, particularly Roux‐en‐Y gastric bypass (RYGB). It is classified into two phases: early and late. Early dumping syndrome occurs within the first hour after ingestion of a meal, leading to symptoms like dizziness, palpitations, sweating, and diarrhea. Late dumping syndrome, occurring 1‐3 hours after eating, is characterized by hypoglycemia due to the incretin‐driven hyper‐insulinemic response to an increased influx of glucose. Hypoglycemia in late dumping syndrome presents with symptoms such as shakiness, confusion, and, in severe cases, loss of consciousness.

Management strategies aim to slow gastric emptying and prevent rapid carbohydrate absorption. Acarbose, a medication that inhibits alpha‐glucosidase enzymes in the small intestine, slowing carbohydrate absorption, has been proposed as a treatment for late‐phase hypoglycemia in patients with dumping syndrome. Acarbose has been shown to improve symptomatic hypoglycemia when diet modifications alone are insufficient. Valderas et al. found that in a study of 8 patients who underwent RYGB, a dose of 100 mg of acarbose taken 15 min before each meal helped reduce symptomatic hypoglycemia. Ritz et al. initiated treatment with acarbose (50–100 mg three times daily) for 8 patients experiencing symptomatic hypoglycemia following RYGB, with favorable response and normalized blood glucose levels. Since Acarbose increases the luminal concentration of carbohydrates, common side effects include flatulence, abdominal distention, and diarrhea. These can be minimized by starting a low dose (25 mg) and gradually titrating.

CONCLUSION: Dumping syndrome is a rare complication following gastrointestinal surgeries. We present the case of a patient with dumping syndrome who developed symptomatic hypoglycemia and was successfully managed with acarbose which may be a valuable adjunct in preventing symptomatic hypoglycemia in patients at high risk of dumping syndrome, helping to reduce its severity and recurrence when other first‐line treatments are inadequate.

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ABSTRACT #194 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE COUNTING THE COSTS: EXPLORING INTERNAL MEDICINE RESIDENTS' AWARENESS OF FINANCIAL IMPLICATIONS IN HEALTHCARE Sarah Kosse1, Alexandria Markley1, Madelin Fenianos1, Randy Leibowitz1, Krystle Hernandez1, Vasundhara Singh1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

BACKGROUND/INTRODUCTION: In the ever‐evolving field of healthcare, the need for physicians to understand cost considerations is paramount. Cultivating cost awareness among residents is critical as residents play a pivotal role in shaping the future of medicine. However, the incorporation of cost‐consciousness into medical education remains a challenge, often overshadowed by clinical priorities. By examining current practices and understanding of cost awareness in residency training programs, the necessity of integrating cost consciousness into the core curriculum of medical residency programs can be determined. Embracing a holistic approach to medical education that encompasses both clinical excellence and fiscal responsibility is essential for ensuring the delivery of high‐quality, value‐based care.

METHODS: A cross‐sectional survey was conducted among Internal Medicine Residents using a questionnaire.

The survey assessed knowledge of the costs of common inpatient lab tests and imaging, perceptions of cost awareness, and attitudes towards evaluating cost when ordering tests. The cost of common labs and imaging were incorporated into 4 interactive didactic sessions, where a clinical case was discussed among Internal Medicine residents. Residents were divided into breakout groups and encouraged to order the minimum tests needed to reach a diagnosis. The group ordering the least expensive tests while still reaching the diagnosis won.

The prices were obtained from the hospital's standardized Medicare cost list and the hospital's online cost‐ estimator calculator. A post‐intervention survey was then conducted at the end of the session. When comparing the total number of question responses in both the pre‐survey (n=170) and post‐survey (n=166), there was a 41% increase in number of questions with correct responses.

RESULTS: Based on our data, 85% of the total residents who participated in the pre‐survey question (n=62) stated that they are not comfortable with their knowledge about the cost of common labs and imaging ordered.

90% of the total residents who participated in the pre‐study question (n=63) stated that they do not have adequate access to information about the cost of common labs, imaging and procedures. However, 75% of total residents who participated in the pre‐study question (n=63) stated that they agree that physicians should factor in cost when ordering labs. After the session, 93% of the residents who participated in the post survey question (n=61) agreed that participating in the cost awareness afternoon report improved their knowledge about the cost of common labs and imaging. Among the questions answered by the PGY‐1 class (n=119), 34.4% of questions were answered correctly on the pre‐survey which increased to 75% of questions answered correctly after the sessions.

CONCLUSION: The incorporation of cost‐consciousness into medical education has profound implications for patient care and healthcare system sustainability. Although some residents received prior education on cost containment, there were gaps in their knowledge of the costs of common medical tests. By providing residents with skills to navigate healthcare costs, we empower them to advocate for value‐based care. Integrating cost awareness into medical residency will help bridge the gap between clinical expertise and fiscal responsibility.

Teaching high‐value care interactively and repetitively ensures both the health and financial well‐being of patients.

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ABSTRACT #195 CLINICAL RESEARCH GASTROENTEROLOGY A CONCOMITANT CELIAC DISEASE DIAGNOSIS DOES NOT WORSEN CLINICAL OUTCOMES OF INFLAMMATORY BOWEL DISEASE Alexandria Markley1, Swati Patel1, Luis Rendon1, Yontan Israel2, Carlos Diola1, Haley Waite2, Peter Green3, Christopher Cao4 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn

School of Medicine at Mount Sinai, New York, NY, United States; 3New York Presbyterian, Columbia University, New York, NY, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), and celiac disease are all characterized by inflammation of the gastrointestinal tract. A small subset of IBD patients is also diagnosed with celiac disease, though it is unclear what impact having a secondary diagnosis of celiac disease will have on a patient’s IBD presentation and disease course. The aim of this study is to determine the distinct and shared characteristics and clinical features of patients with UC, CD, and a dual diagnosis of celiac disease-UC or celiac disease-CD. METHODS: A retrospective chart review of patients with UC, CD, and celiac disease-IBD from Mount Sinai Hospital was performed. Charts were reviewed to ensure a 1:1:1 ratio of patients in each group. Inclusion criteria included any individual with UC or CD confirmed by histology and celiac disease patients confirmed by serology and biopsy with a concomitant diagnosis of IBD confirmed by histology. Patients were excluded if data from the initial diagnosis was missing.

RESULTS: A total of 38 celiac disease -IBD patients (53% female), 38 UC patients (55% female), and 38 CD patients (50% female) were evaluated. A higher proportion of celiac disease-IBD patients had CD (73.7%) compared to UC (26.3%). Mean age was highest in CD patients at 36.7. Mean age at diagnosis was highest in celiac disease-UC patients (33.9 years) compared to celiac disease-CD (20.3 years), UC (27.7 years) and CD (24.7 years). Family history of celiac disease was significantly higher in patients with a dual diagnosis. Diarrhea, abdominal pain, extra intestinal symptoms, and bloody stools were the most common presenting symptoms in all cohorts. Patients with UC and CD has statistically higher rates of bloody stools compared to celiac diseaseIBD patients. Need for biologic therapy was similar between UC (68.4%), CD (71.0%) and celiac disease-IBD (71.0%). The percentage of patients with stricturing or penetrating disease was significantly higher in CD (55.2%) than celiac disease-IBD (14.2%). Extensive UC involvement of the colon was higher in the UC cohort (65%) compared to the celiac disease-IBD cohort (40%).

CONCLUSION: The concomitant diagnosis of celiac disease with IBD does not worsen the severity of either UC or CD. At a tertiary IBD referral center, celiac disease does not increase the rates of stricturing or penetrating CD and does not increase extent of colonic involvement in UC. Similar rates of biologic use among groups suggest a comparable IBD disease course between all cohorts.

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ABSTRACT #196 CLINICAL RESEARCH GASTROENTEROLOGY CELIAC DISEASE AND INFLAMMATORY BOWEL DISEASE: CHARACTERISTICS OF A DUAL DIAGNOSIS Alexandria Markley1, Luis Rendon1, Carlos Diola1, Yontan Israel2, Haley Waite2, Peter Green3, Christopher Cao4 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn

School of Medicine at Mount Sinai, New York, NY, United States; 3New York Presbyterian/Columbia University Irving Medical Center, New York, NY, United States; 4Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: A bidirectional association of celiac disease (CeD) and inflammatory bowel disease (IBD) has been well established. The existence of this dual diagnosis (CeD-IBD) poses questions regarding diagnosis, treatment, and potential synergistic effects on disease course. There remains a need for further understanding of the clinical implications of this dual diagnosis.

METHODS: A retrospective chart review of patients with CeD from The Mount Sinai Hospital was performed. In total, 354 patients carried a dual diagnosis of CeD-IBD. Any individual with serology and biopsy consistent with CeD and a concomitant diagnosis of IBD - either ulcerative colitis (UC) or Crohn’s Disease (CD) – confirmed by histology was included. Patients were excluded if data from initial diagnosis of either disease was missing.

RESULTS: Of the 1038 patients with CeD, a total of 38 (3.7%) carried a confirmed dual diagnosis – 53% were female and mean age of the cohort was 31.29. The most common presenting symptoms were abdominal pain and diarrhea. At initial visit, mean TTG IGA was 108 U/mL and the majority (68%) had Marsh 3 on biopsy. Mean age of diagnosis was oldest in the CeD-UC cohort. A higher proportion of CeD-IBD patients had Crohns (73.7%) compared to UC (26.3%). Interval time to second diagnosis of IBD and CeD was 4.1 years and 3.2 years respectively. Two patients had a GI infection preceding IBD diagnosis (mean interval of 16.5 days), both in the CD cohort. 71% of CeD-IBD patients required the use of biologics for treatment of IBD. 14.2% of CD patients had stricturing or penetrating disease and 40% of UC patients had extensive colonic involvement.

CONCLUSION: CeD-IBD dual diagnosis creates complex pathophysiology yet to be fully understood. Further investigation with direct comparisons to CeD and IBD cohorts may be beneficial in order to better understand the interrelation of these diseases, outline potential disease course, and guide clinical management.

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ABSTRACT #197 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY RADIATION GASTRITIS: A RARE CAUSE OF MELENA Alexandria Markley1, Ahmun Zafar1, James Scharfen1, Dylan Suyama1, Mohamed Rabie1, Phuong Nguyen1, Guangjing Zhu1, Mark Alon1, Yuying Luo1, Zoe Lawrence1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024. *ACG Outstanding Poster Presentation BACKGROUND/INTRODUCTION: Chemoradiation-induced gastritis is an uncommon complication that arises from inflammatory and ischemic damage to gastric mucosa induced by radiation and chemotherapy. The resulting gastritis can lead to symptoms such as epigastric pain, nausea, vomiting, and gastrointestinal (GI) bleeding. We present a rare case of chemoradiation-induced gastritis following radiotherapy.

CASE PRESENTATION: 72-year-old male with a history of colon cancer status post hemicolectomy, Hepatitis C status post treatment complicated by cirrhosis and hepatocellular carcinoma (HCC) status post 10 fractions of radiation presented with three months of melena and epigastric pain. Upon presentation, vitals were stable, hemoglobin was 4.6 g/dl, and digital rectal exam revealed brown stool. He was started on intravenous protonix and an esophagogastroduodenoscopy (EGD) revealed multiple gastric and duodenal ulcers as well as friable antral mucosa with oozing. Pathology revealed active chronic Russell body gastritis with erosions and reactive changes including foveolar hyperplasia, dilated capillaries and scattered smudge cells, suggestive of chemoradiation related changes. He received a total of 14 units of packed red blood cells and was discharged on oral protonix, sucralfate, and a prednisone taper. He has since resumed his chemotherapy and has not undergone further radiation.

DISCUSSION/CONCLUSION: In a patient with no other risk factors for upper GI bleeding, consider radiation exposure as a possible etiology of gastritis. In chemoradiation-induced gastritis, EGD may reveal erythematous, hemorrhagic, or ulcerated mucosa focused within the field of radiation. This finding emphasizes the importance of minimizing the field of exposure as much as possible. Characteristic histologic features include epithelial apoptosis and atypia, mucosal eosinophilia and inflammation, and vascular dilation and thrombi. Although typical management of upper GI bleeding including PPI is indicated, radiation gastritis may not respond fully to acid suppression, such as in our patient's case. Sucralfate offers some mucosal protection, and steroids can be considered for their anti-inflammatory properties. Other treatment options can be applied from treatment for the more common radiation proctitis, including argon plasma coagulation, hemospray, and hyperbaric oxygen therapy.

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Figure 1. A. Low power view of gastric antral mucosa showing chronic inflammation and expanded lamina propria. B. High power view showing numerous Russell bodies- homogeneous eosinophilic, round to oval inclusions within the plasma cell cytoplasm, in a background of chronic inflammation. C. Plasma cells with Russell bodies highlighted by CD138. D. CD79A highlighting lymphocytes and plasma cells, including plasma cells containing Russell bodies. E. Esophagogastroduodenoscopy image of friable pylorus. F. Esophagogastroduodenoscopy image of ulcer located in incisura of the stomach. G. Esophagogastroduodenoscopy image of pyloric stomach ulcer. H. Esophagogastroduodenoscopy image of duodenal ulcer.

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ABSTRACT #198 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY BEYOND THE ITCH: DIAGNOSING AMA NEGATIVE PRIMARY BILIARY CHOLANGITIS Michihiro Matsugaki1 and Geeta Varghese1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Ryan Chelsea-Clinton, William F. Ryan Community Health Center, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

CASE PRESENTATION: A 75-year-old female with controlled hypertension, hyperlipidemia, type 2 diabetes and fatty liver disease presented with a two-week history of diffuse pruritus. Prior to seeing her PCP, she went to urgent care and was given a trial of antihistamine and steroids without relief. She then went to a dermatologist, where initial lab work was done remarkable for ALP 857, AST 339, ALT 345, T. Bili 1.4. Upon further history at the PCP visit, her symptoms were associated with decreased appetite and a mild 5lb weight loss. Exam revealed normal abdominal findings and no visible rash. Additional labs and imaging were obtained, and was trialed on ursodiol for symptomatic relief. Repeat blood work showed ALP 866, AST 483, ALT 481, T. bil 1.9, direct bil 0.9, INR 1.0, GGT 1260, antinuclear antibody negative, antimitochondrial antibody (AMA) negative, hepatitis panel negative. Abdominal ultrasound presented heterogeneous normal sized liver with no intrahepatic biliary duct dilatation. Lastly, liver biopsy revealed findings compatible with early Primary Biliary Cholangitis (PBC).

DISCUSSION/CONCLUSION: PBC is a chronic, autoimmune, progressive cholestatic disease that commonly affects middle aged woman. Patients with PBC are often asymptomatic, however pruritus without rash is one of the most common presenting symptoms, with up to 70% of patients reporting pruritus prior to diagnosis. Diagnostic criteria for PBC include two of the three following conditions: ALP twice the upper limit of normal, positive AMA, histologic evidence of PBC. Histologic evidence is typically not needed in diagnosis as 95% of patients are AMA positive. In cases where suspicion for PBC given clinical context is high, liver biopsy is the next step. Studies show that clinical and serological features of AMA-negative PBC are like AMA-positive PBC, with pruritus and fatigue being the most common symptoms (1). AMA-negative PBC also has similar histologic features of AMA-positive PBC. As AMA tests have become more sensitive, there are rare instances where seroconversion may occur over time. Some reports have shown that AMA-negative patients may have a poorer prognosis (2), but further studies are needed as AMA-negative PBC are rare. For patients with pruritus, clinicians tend to lean on dermatological/allergic causes, as seen in this case when the patient went to urgent care and a dermatologist; however, it is important to widen the differential especially when initial treatments have failed. Due to the rarity of AMA negative PBC, diagnosis of AMA-negative PBC can often be delayed. Given this patient’s clinical presentation, there was a high clinical suspicion for PBC, and moving forward with a liver biopsy proved valuable in obtaining the diagnosis.

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ABSTRACT #199 CASE REPORT/CLINICAL REVIEW CARDIOLOGY BRIDGING THE GAP: MYOCARDIAL BRIDGE AS AN IMPORTANT DIFFERENTIAL DIAGNOSIS Aphrodite Megaris1, Faye Megaris2, Amit Gulati3, Mariam Khandaker1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2CUNY

School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 48‐year‐old female with Hashimoto's thyroiditis (on Synthroid), prediabetes, and active tobacco use (30 pack-years) who exercises daily presented to the ER with chest pain after a high‐intensity workout. The pain radiated to her left arm and neck and intensified to 10/10, associated with palpitations. On exam, she had cool extremities and diaphoresis. Vital signs: BP 93/63, Pulse 87, Temp 36°C, RR 17. An EKG revealed ST elevations in V3‐V6 and II, III, aVF. Initial troponin was 696, rising to 1,641 and 2,458. CPK 564, CKMB 9.0. Coronary angiography showed no obstructive coronary artery disease but identified a large myocardial bridge. Transthoracic echocardiogram (TTE) revealed an EF of 15‐20%, apical akinesis, apical ballooning consistent with Takotsubo cardiomyopathy, systolic anterior motion of the mitral valve, LV outflow tract gradient of 30‐40 mmHg, and an apical LV mural thrombus. Her course was complicated by worsening hemodynamic instability, requiring inotropic support, phenylephrine and esmolol drips. She was weaned off these medications and discharged on metoprolol and anticoagulation for the LV thrombus. She was started on guideline directed medical therapy (GDMT) for Takotsubo cardiomyopathy. Three days post‐discharge, a cardiac MRI showed EF improved to 40%. Repeat TTE two weeks later showed EF of 60% with no wall motion abnormalities. At three months, MRI showed EF of 67% and resolution of the LV thrombus and Takotsubo morphology. The patient quit smoking, adopted a healthy diet, and showed further improvement with optimization of GDMT. DISCUSSION: A myocardial bridge is when a coronary artery dives into the cardiac muscle rather than lying above it. Once considered a benign anatomical variant, myocardial bridge can have serious and potentially fatal consequences, even in patients without traditional cardiac risk factors. Myocardial bridge is often asymptomatic and may only be detected during cardiac catheterization or autopsy, with an estimated prevalence anywhere from 5‐15%. Its severity correlates with the depth of vessel involvement within the muscle. Management of myocardial bridge remains under‐researched, but medical therapy typically involves calcium channel blockers for vasospasm and beta blockers to reduce heart rate, contractility, and artery compression, while increasing diastolic filling time. Nitrates should be avoided, as they may exacerbate artery compression by vasodilating adjacent coronary segments. For severe myocardial bridge, percutaneous coronary intervention is an option, though carries risks like stent fracture, thrombosis, and perforation due to the anatomical compression from the bridge. Coronary artery bypass graft or surgical myotomy may be required in extreme cases. The relationship between myocardial bridge and Takotsubo cardiomyopathy requires more exploration. Myocardial bridge may contribute to Takotsubo cardiomyopathy, particularly with involvement of the left anterior descending artery.

Compression during ventricular systole may trigger ischemia, contributing to Takotsubo cardiomyopathy by causing LV hypokinesis, leading to blood pooling and LV elongation. Multimodality imaging techniques can help elucidate the interactions between myocardial bridge, spontaneous coronary artery dissection, and Takotsubo cardiomyopathy.

CONCLUSION: This case underscores the importance of considering myocardial bridge in differential diagnoses, as well as understanding its medical management. Further research is necessary to clarify the relationship between myocardial bridge and Takotsubo cardiomyopathy, which may lead to more effective management strategies and outcomes.

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ABSTRACT #200 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/NEPHROLOGY ATYPICAL PRESENTATION OF AORTIC DISSECTION IN THE CONTEXT OF IGG4 DISEASE Aphrodite Megaris1, Faye Megaris2, William Wallach1, Mariam Khandaker1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2CUNY School of Medicine, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 59‐year‐old male with chronic renal insufficiency due to IgG4‐related disease (on chronic steroid therapy) and autoimmune pancreatitis presented to the emergency room with lightheadedness and numbness of bilateral upper extremities after masturbation. He experienced urinary incontinence, but no loss of consciousness. EMS found him hypotensive and bradycardic (BP 84/50, HR 30s) and administered atropine and fluids. The patient was normotensive at outpatient visits and a never‐smoker. He denied chest pain and the use of sildenafil or any other medications, drugs, or sexual enhancers. On exam, a loud systolic murmur was noted, which had never been documented on outpatient notes, along with thready symmetrical pulses and delayed capillary refill. Labs showed a lactate of 2.7 mmol/L, WBC count of 17.9 k/uL, and no change to chronically elevated BUN/Cr levels. A chest X‐ray was unremarkable. The patient's blood pressure was not responding to fluids. Given the unresponsive hypotension and leukocytosis in this immunocompromised patient, an infectious workup and empiric antibiotics were initiated. A transthoracic echocardiogram to assess the murmur and cardiac function was done the next day, revealing Type A aortic dissection, confirmed by CT angiogram showing extensive dissection from the aortic root, involving major arteries. The patient was transferred to the Coronary Care Unit, started on an esmolol drip, and underwent aortic repair with an uneventful postoperative course.

DISCUSSION: Chronic corticosteroid use, which our patient was using for suppression of IgG4 disease, decreases collagen formation in vessel walls, increasing risk of aneurysm and dissection. It also contributes to chronic arterial hypertension, stressing vascular structures and raising cardiovascular risk. Increased capillary permeability may lead to fluid extravasation, impacting vascular function. Careful monitoring is crucial for patients on corticosteroids. IgG4‐related aortopathies caused by aortic inflammation due to elevated IgG4 levels often present with systemic symptoms like fever and malaise. They can mimic infectious aortitis and other autoimmune diseases. Corticosteroids are effective in reducing inflammation, but may not prevent severe complications like aortic dissection, especially if delayed, which complicates management even further given that the therapy for IgG4 disease can also directly contribute to aortopathy given its effects discussed earlier. Since patients with IgG4‐related disease are at higher risk for aortopathies, there may be benefit in baseline and regular imaging surveillance.

CONCLUSION: We This patient lacked typical aortic dissection symptoms, such as chest pain which occurs in >90% of aortic dissection patients, initially obscuring diagnosis and delaying intervention. This underscores the importance of recognizing atypical presentations and the relation with corticosteroids and IgG4 disease. Despite being on corticosteroids for his IgG4‐related renal disease, the patient developed aortopathy, emphasizing the limitations of steroid therapy in preventing such complications, even possibly contributing to them. This brings up the question of the need for routine screenings for complications, such as outpatient echocardiograms or CT angiograms. Recognizing unique risk factors and atypical manifestations associated with steroids and IgG4‐ related aortopathies is crucial for timely diagnosis and management to improve patient outcomes.

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Figure 1. Transthoracic Echocardiogram showing aortic dissection flap and aortic regurgitation

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ABSTRACT #201 CLINICAL RESEARCH GASTROENTEROLOGY THE GENDER SCOPE: ELEVATING PATIENT COMFORT FOR DIRECT ACCESS PROCEDURES Sonia Mehra1, Lauren Alpert2, Jeanette Rios2, Lina H. Jandorf2, Zoë S. Gottlieb3, Tatyana Kushner3, Yuying Luo1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Icahn

School of Medicine at Mount Sinai, New York, NY, United States;3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Data on patient preferences for endoscopist gender are conflicting, with few studies investigating the factors that contribute to preferences. We aimed to evaluate demographic predictors of endoscopist gender preferences among patients presenting for direct access colonoscopy.

METHODS: In-person, pre-procedure prospective surveys were administered to patients referred for direct access colonoscopies. Participants were notified that their survey responses would not impact their current procedure. Demographic data including age, race, sex, insurance provider, primary language spoken, and MyChart patient portal access were collected through chart review. A Chi-square analysis was performed to evaluate the association between variables of interest and patients’ endoscopist gender preference.

RESULTS: Our cohort included 66 patients with a mean age of 53.6 years (SD=9.4 years). Half (50%) of the participants were female, and the majority (69.7%) were non-White. Of the study participants, 92.4% preferred English as their primary spoken language, 72.7% used commercial health insurance, 75.8% accessed MyChart within the past thirty days, and 63.6% reported that this was their first colonoscopy. Only 3 participants (4.6%) reported being offered a choice of provider gender prior to their procedure and 19 (28.8%) participants expressed a gender preference for future procedures. There was a significant difference in preference by patient gender (45.5% women versus 12.1% men, p<0.01), patient age (33.3% <65 years old versus 0% >65 years old, p=0.04), and Asian race (75.0% Asian versus 25.8% non-Asian, p=0.04). Among those with a preference, there was a significant difference by patient gender, where all females (100%) preferred a female endoscopist vs males (75.0%) preferred a male endoscopist, p<0.01). There was no significant difference in preference when accounting for insurance type, primary language spoken, first colonoscopy, or MyChart access.

CONCLUSION: In a patient population presenting for direct access colonoscopies, over a quarter of participants expressed gender preference for their endoscopist; however, only three were asked about preference before their procedure. Female gender, younger age (< 65), and Asian race were associated with expressing a preference, with all female participants preferencing female endoscopists. This is a call to increase recruitment of female-identifying gastroenterologists and to proactively ask patient preferences to improve overall experience.

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ABSTRACT #202 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES SCHISTOSOMIASIS REACTIVE POLYARTHRITIS MASQUERADING AS SERONEGATIVE ARTHRITIS OF INFLAMMATORY BOWEL DISEASE Jiaxi Miao1, Aesha Patel1, Elmarie Alexander1, Rahul Gaikwad1, George McKinley1, Mark Alon1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: An 18‐year‐old male with a history of Hepatitis B presented to the ED with 1 month of low‐grade fevers, bilateral lower extremity arthralgias (knees, hips, lumbar spine), and 5 days of rectal bleeding.

Originally from Guinea, he recently emigrated from Nicaragua. He reported 9/10 joint pain, which started in the left foot and ascending to the hips and lumbar spine, accompanied by intermittent fevers. He denied trauma, nausea, vomiting, diarrhea, or family history of colorectal cancer but noted dark, red‐streaked stool for 5 days.

Physical exam revealed bilateral knee and hip tenderness with limited ROM, and redness on the soles, abdominal exam benign. Labs revealed iron‐deficiency anemia (Hgb 8.1, HCT 29.1, MCV 60.3, iron 16, transferrin 4.36), mild inflammatory markers (ESR 28, CRP 6.9), and negative autoimmune markers (ANA, ANCA, CCP, Ro/La, DS‐DNA). Imaging showed erosive sacroiliac (SI) joint changes consistent with seronegative spondyloarthropathy. Active hematochezia prompted colonoscopy, intra‐op findings initially suggested pancolitis ulcerative colitis (UC), and intravenous methylprednisolone was started. However, GI PCR later identified E. histolytica, prompting metronidazole initiation and steroid cessation. Biopsies finally confirmed parasitic ova indicating schistosomiasis instead of UC. He was treated with praziquantel. On discharge, paromomycin was recommended for intraluminal coverage, and he was set up for follow‐ups.

DISCUSSION: Schistosomiasis is a parasitic infection caused by waterborne trematodes, which consists of three main species that infect humans: S. mansoni, S. haematobium, and S. japonicum, all prevalent in different regions of the world, but most common in sub‐Saharan Africa, South America, East Asia, and the Middle East.

Acute infection with schistosomiasis manifests nonspecifically—commonly as intermittent fever, generalized rash, intermittent cough, and gastrointestinal complaints. Chronic infection, however, ranges from asymptomatic to fulminant disease and can manifest as liver disease, pulmonary fibrosis, bladder calcification, gastrointestinal disease, neuroschistosomiasis, etc. Although the aforementioned symptoms are well‐documented, arthropathy is rarely reported. The first de-tailed findings of schistosomiasis‐related arthropathy were described by El‐ Bassiouni. To date, reactive arthritis following parasitic infections has been infrequently studied, with schistosomiasis being among the least documented.

CONCLUSION: In patients with migrating joint pain and new‐onset hematochezia, inflammatory bowel disease (IBD) has been the pre-vailing diagnosis among teams. For this patient, bilateral SI joints with patterns of seronegative spondyloarthropathy on imaging, as well as colonoscopy findings consistent with UC, increased the pretest probability for IBD. However, recognizing infectious causes in immigrant patients proved vital to an accurate diagnosis, particularly in this case. Shortly after the colonoscopy, GI PCR revealed Entamoeba histolytica, which prevented the continuation of empiric steroid treatment and cast doubt on a preliminary UC diagnosis. Ultimately, pathology revealed Schistosoma ova within the lamina propria. Additionally, HLA‐B27 positivity is often associated with a higher risk of reactive polyarthritis. These critical findings, alongside the patient's migrating polyarthropathy, provided a strong argument for reactive arthritis from schistosomiasis as the ultimate diagnosis.

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ABSTRACT #203 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY A CASE STUDY OF ACQUIRED HEMOPHILIA A IN A 93-YEAR-OLD FEMALE PRESENTING WITH THIGH HEMATOMA Serene Mirza1, Tharaka Wijesinghel1, Brett Sherman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 93‐year‐old female with a history of stroke, hypertension, moderate aortic stenosis (AS) and peripheral vascular disease presented with four days of right lower extremity pain. She had recently been seen in vascular clinic for difficulty walking and associated pain, which was attributed to chronic venous insufficiency. In the emergency department, examination revealed ecchymosis overlying the right lateral thigh without any reported trauma and a systolic murmur but was otherwise unremarkable. She was admitted for further evaluation. Laboratory studies revealed a hemoglobin of 8.7 g/dL (baseline 11‐12 g/dL), a PTT > 200 seconds, and an INR of 1.3. CT imaging demonstrated edema in the right thigh along the course of the vastus lateralis muscle, with a rim‐enhancing suprapatellar joint effusion. Hematology was consulted, and the patient received desmopressin and prothrombin complex concentrate. The following day, she developed a second hematoma on her right arm, attributed to compression from a blood pressure cuff. Additional labs revealed normal von Willebrand factor activity and antigen levels, mixing studies which failed to correct the PTT, and low factor VIII activity, leading to a diagnosis of acquired hemophilia A (AHA). Additionally, a repeat echocardiogram showed progression of moderate aortic stenosis to severe AS. The patient was started on corticosteroids and repeat factor VIII levels are pending to evaluate treatment response.

DISCUSSION: AHA is a rare but serious bleeding disorder caused by the development of autoantibodies against factor VIII. A typical presentation involves an elderly patient with spontaneous hematomas, particularly in the muscles, with the hallmark laboratory finding of prolonged PTT that does not correct with mixing studies. In this case, the patient presented with nonspecific pain and swelling of the right lower extremity, symptoms that were initially attributed to chronic venous insufficiency until laboratory studies pointed to an acquired coagulopathy.

Unique to this case was the identification of suprapatellar hemarthrosis on CT imaging, a finding more commonly associated with congenital hemophilia; however, classic muscular hematomas were also present. AHA management typically includes hemostatic therapy for acute bleeding and immunosuppressive therapy, steroids in this case, to address the underlying autoimmunity. While most cases of AHA are idiopathic, the condition may also occur postpartum or in association with underlying malignancy. Thus the patient underwent additional testing with flow cytometry which showed no evidence of malignancy or lymphoproliferative disorders, which should be ruled out in cases of AHA. Coagulopathy can also occur in severe AS due to mechanical stress on red blood cells and platelet dysfunction, leading to bleeding. However, there are no known cases of AHA secondary to AS. CONCLUSION: AHA should be considered in elderly patients presenting with nonspecific or unexplained bleeding, particularly in the presence of significant hematoma formation. Early diagnosis and treatment are critical, and management involves immunosuppressive therapy and monitoring of factor VIII levels and PTT to assess response. This diagnosis should be suspected in patients without a history of trauma or an inherited bleeding disorder. Although rare, keeping AHA on the differential in this patient population can dictate life‐saving treatment.

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ABSTRACT #204 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/INFECTIOUS DISEASES PROGRESSION OF SEVERE MALARIA IN A YOUNG MALE PATIENT FROM SENEGA Fahema Nadira1, Aesha Patel1, Krystina Woods1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 25‐year‐old Wolof‐speaking male who recently arrived from Senegal with remote history of malaria (unclear treatment, no hospitalization) presented to the hospital with a three‐day history of dull global headache, abdominal pain, vomiting, watery diarrhea, and hematuria. Upon arrival, he was noted to be diaphoretic, dehydrated, tachycardic, and hypoglycemic. Labs were significant for severe thrombocytopenia, lactic acidosis, indirect hyperbilirubinemia, severe acute kidney injury (AKI), and parasite smear with 40% RBCs Plasmodium falciparum. Given the considerable parasite burden and his high risk for rapid decompensation, he was admitted under medicine with critical care and infectious disease consultants following closely. The patient received fluid resuscitation, platelet transfusion, and intravenous (IV) artesunate. After several hours, he became lethargic and minimally responsive, febrile to 104.1 F, hypoxic, and found to be acutely anemic with a hemoglobin of 5.9. He was subsequently admitted to the intensive care unit (ICU) for severe malaria with a guarded prognosis. In the ICU, following the completion of two doses of IV artesunate, the patient had rapid improvement of clinical course including resolution of fever, AKI, mentation, thrombocytopenia, and concurrently, reduced parasite burden to 11.2%. Chest X‐ray, CT head, US abdomen, EEG, and eye exam were negative. He was transitioned to oral artemether-lumeantrine for three days. Repeat parasite smear showed no parasitemia and he was discharged home.

DISCUSSION: Malaria is a potentially serious and life‐threatening mosquito‐borne infectious disease caused by Plasmodium parasites, which affects red blood cells. Plasmodium falciparum remains the most dangerous species, responsible for the most severe cases and deaths. Less than one percent of cases are classified as severe malaria, defined as acute malaria with signs of organ dysfunction, in the setting of hyperparasitemia.

Such signs are the result of parasitized red blood cells adhering to the endothelial cells lining small blood vessels causing small infarcts, capillary leakage, and massive intravascular hemolysis. This clinical vignette illustrates the potential of severe malaria to progress rapidly to life‐threatening multiple organ dysfunction, in this case within hours of presentation he became unresponsive and hypoxic, and concurrently the very quick response to artemisinin‐based combination therapy (ACT), in this case, clearance of parasitemia within 24‐72 hours of ACT initiation. Recognition of the importance of frequent clinical and laboratory assessments, in this case, he was screened into the ICU, and prompt treatment, in this case, the infectious disease team coordinated ACT initiation, is imperative in mitigating the high mortality associated with severe malaria.

CONCLUSION: This case presents a compelling case of a young male with a remote history of malaria, who experienced a complex clinical course. His condition was characterized by a florid progression to encephalopathy and acute hypoxic respiratory failure, com-pounded by acute anemia and severe thrombocytopenia. The patient's clinical course rapidly deteriorated, leading to shock necessitating ICU admission. This case underscores the need for heightened awareness and vigilance in diagnosing and managing severe malaria, particularly relevant in West Harlem, New York City, with the relevant epidemiological exposure within the large West African communities.

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ABSTRACT #205 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/NEPHROLOGY A CATECHOLAMINE CATASTROPHE: CASE OF RESISTANT HYPERTENSION DUE TO PHEOCHROMOCYTOMA Felix Adrian Valverde1, Rodrigo Paredes de la Fuente2, Richard G. Vaca2, Jared Leventhal2 1Danbury Hospital, Danbury, CT, United States; 2Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at

Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 28‐year‐old man, recently experiencing homelessness, presented to the emergency room of an urban medical center with complaints of severe chest pain, shortness of breath, and lower extremity edema. For the past 5 days he did not take his outpatient medications including isosorbide, doxazosin, hydralazine, nifedipine, carvedilol, and furosemide prescribed by his Nephrologist, who he sees for his advanced CKD stage 4. Vitals on admission: temperature 98.1 F, blood pressure 200/148 mmHg, heart rate 118 bpm, RR 36 rpm, SpO2 96%. He was diagnosed with acute decompensated heart failure, type 2 demand myocardial ischemia, and acute on chronic kidney disease. CTA Chest excluded aortic dissection. Echocardiogram found a large LV thrombus as well as a severely reduced function with an LVEF 25% with severe LV hypertrophy (LVH) and apical akinesis. BP became controlled after IV diuresis and with reintroduction of his home regimen. As part of his workup, plasma metanephrines were found to be elevated, an MRI confirmed a small left upper adrenal pheochromocytoma, and an MIBG (Metaiodobenzylguanidine) nuclear scan ruled out metastatic spread.

Surgical intervention was postponed due to need for anticoagulation therapy. The patient was discharged with controlled BP, placement at a shelter, all his medications including a new prescription for warfarin, and appointments with primary care, Endocrinology, Surgery, and Cardiology.

DISCUSSION: This case demonstrates the long‐term disastrous consequences of uncontrolled resistant hypertension. He already had been dealing with advanced CKD and now was diagnosed with the classic signs of catecholamine cardiomyopathy with both LVH and akinesis predominantly in the apical segments and had a large LV thrombus. His recent experience of homelessness leading to decreased access to medications only worsened an already catastrophic situation in this young patient. Pheochromocytoma leads to resistant HTN through excessive catecholamine production. The first step is measuring plasma free metanephrines, which includes normetanephrine and metanephrine. A clonidine‐suppression test can then be performed. CT or MRI adrenal imaging is then recommended and an MIBG scanning can be useful to rule out metastatic disease.

Diagnosis of pheochromocytoma is frequently delayed, with an average gap of 3 years between initial symptoms to definitive diagnosis. Given the grave consequences of this condition, it would behoove the clinician to rule out pheochromocytoma as part of resistant HTN workup. This patient also developed hypertrophic cardiomyopathy due to catecholamine released related to tachycardia induced cardiomyopathy, early resection is recommended in guidelines, and this may prevent further progression of cardiomyopathy. Perioperative medical management approach includes starting beta‐adrenergic blockers after alpha‐adrenergic blockers to avoid hypertensive crises due to unopposed alpha‐adrenergic receptors.

DISCUSSION: Pheochromocytoma should be suspected in resistant HTN and complications like cardiomyopathy should be ruled out as part of work‐up. Medical management before surgery should start with alpha‐adrenergic blockers and then beta‐adrenergic blockers. Early surgical intervention could have a role in cardiomyopathy evolution.

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ABSTRACT #206 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY ACHIEVING REMISSION IN METASTATIC SARCOMATOID LUNG CARCINOMA WITH PEMBROLIZUMAB AND PLATINUM-DOUBLET TREATMENT Rodrigo Paredes de la Fuente1, Toshiro Goto1, Maninderjit Ghotra1, Jorge Gomez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive subtype of non-small cell lung cancer (NSCLC), accounting for 0.1%–0.4% of all lung cancers. Characterized by its rapid progression and poor prognosis, PSC is often diagnosed in advanced stages and exhibits resistance to conventional chemotherapy. Despite these challenges, the exploration of novel therapeutic strategies offers new hope. This report presents the first documented case of PSC managed with chemoradiation using a platinumbased doublet followed by immunotherapy with pembrolizumab, an immune checkpoint inhibitor (ICI).

CASE PRESENTATION: An 81-year-old male with a history of tobacco use (84 pack-years) presents with subacute persistent cough and mild hemoptysis. Initially suspected to be pneumonia, he received antibiotics and steroids, temporarily resolving his symptoms. However, his condition worsened, experiencing several episodes of hemoptysis, fatigue, and a pre-syncopal event. A CT scan revealed a left hilar mass measuring 4.8 x 3.6 x 4.0 cm, with hyperintense lymph nodes and evidence of pelvic lesions. Subsequent bronchoscopy and biopsy confirmed Stage IV sarcomatoid carcinoma, a high PDL-1 expression level (>90%) and a KRAS G12C missense mutation. The patient underwent chemoradiation with weekly paclitaxel and carboplatin and radiation to the sacrum. Based on the high PDL-1 expression and advanced stage, pembrolizumab was added to the regimen.

The patient demonstrated a substantial response. After two years and 30 cycles, pembrolizumab was discontinued due to the absence of progression. The patient is currently under active surveillance.

DISCUSSION/CONCLUSION: To our knowledge, this is the first documented case of PSC managed with initial chemotherapy followed by pembrolizumab, prompted by a high PDL-1 expression. Unlike prior cases, where treatment was often interrupted due to adverse effects linked to immunotherapy, our patient completed and showed no signs of tumor activity in follow-up imaging. The treatment strategy for PSC often mirrors that of NSCLC, despite PSC's notorious resistance to chemotherapy. Recent studies have demonstrated that incorporating ICIs into the initial platinum-based chemotherapy regimen markedly improves outcomes when compared to traditional platinum doublet treatments in individuals with NSCLC. Prior studies have identified a link between tobacco use and specific mutations in PSC, notably indicating an elevated occurrence of KRAS mutations and a higher frequency of PD-L1 positive tumors. In alignment with these findings, our case demonstrated both a KRAS mutation and significant PDL-1 expression. This trend could underscore a meaningful link between tobacco-related PSC and a heightened probability of tumors expressing high levels of PD-L1, suggesting that ICIs might offer therapeutic advantages for this group. These findings could lead to the development of targeted treatment approaches tailored to this specific tumor characteristics and patient demographics. This case underscores the critical role of advanced molecular diagnostics in guiding the management of complex cancer cases. The successful application of Pembrolizumab in a patient with sarcomatoid carcinoma, characterized by a high PDL-1 expression, adds valuable insight into the potential of immunotherapy in treating rare and aggressive forms of cancer.

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ABSTRACT #207 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY ASSESSING BIOMARKER TESTING AWARENESS AMONG PATIENTS AND CAREGIVERS IN NONSMALL CELL LUNG CANCER THROUGH AN INTERDISCIPLINARY GLOBAL SURVEY Rodrigo Paredes1, Francisco Lopez-Rios2, Amy Moore3, Anne-Marie Baird4, Talia Gashi5, Shilo Shilo6, Christian Rolfo7 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Hospital

Universitario, Madrid, Spain; 3LUNGevity Foundation, Chicago, United States; 4Lung Cancer Europe, Ireland; 5COR2ED, Switzerland; 6Israeli Lung Cancer Foundation (ILCF), and Patient Advocates Committee at International Association for the Study of Lung Cancer (IASLC), Denver, Colorado, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States

Presented at the European Society of Medical Oncology (ESMO) Annual Meeting that was held in Barcelona, Spain from September 13-17, 2024.

BACKGROUND/INTRODUCTION: As targeted therapies increasingly become the standard in treating nonsmall cell lung cancer (NSCLC), understanding the engagement of patients and caregivers is essential to enhance physician-patient interactions. Variability in the comprehension of biomarker testing among both patients and clinicians can impede effective treatment decisions. This study aims to assess the awareness of biomarker testing among NSCLC patients and their caregivers, focusing on improving these interactions for better care outcomes.

METHODS: A global survey in five languages, aimed at people diagnosed with NSCLC in the past five years and caregivers of NSCLC patients. Conducted from January to April 2024 using a digital platform and shared through oncology clinics, advocacy groups, and social media, it gathered data on awareness and experiences.

This data was analyzed by participant type to identify knowledge gaps, and Chi-square tests were used to assess differences among categorical variables.

RESULTS: The survey involved 345 respondents (305 patients, 40 caregivers) from 38 countries, showing high recognition of biomarker test importance—96% of patients and 97% of caregivers deemed it extremely important.

However, understanding varied: only 19% of patients and 26% of caregivers fully grasped their results.

Knowledge of biomarker testing improved before and after tumor mutation analysis, with patients’ understanding rising from 2% to 29% (p<0.01), and caregivers from 6% to 27% (p<0.01). Despite valuing these tests, mixed satisfaction with information quality (70% of patients and 68% of caregivers were satisfied) indicates a need for better communication. Respondents suggested shorter turnaround times (56%), more detailed testing information (49%), and simpler explanations (44%). Caregivers sought quicker results (58%) and more comprehensive treatment options (45%), highlighting the need for clearer information.

CONCLUSION: This global survey has identified substantial gaps in the delivery of accurate and clear communication regarding biomarker testing in people with NSCLC and those in a caregiving capacity. These findings highlight the need for more effective communication strategies in this setting to improve healthcare access, outcomes, and advocacy.

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ABSTRACT #208 BASIC SCIENCE HEMATOLOGY/ONCOLOGY CIRCULATING TUMOR DNA MUTATIONS AS MARKERS FOR BRAIN METASTASES AT DIAGNOSIS AND DURING TREATMENT Rodrigo Paredes1, Toshiro Goto1, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University,

Columbus, OH, United States

Presented at the International Society of Liquid Biopsy (ISLB) Annual Meeting that was held in Denver, Colorado, United States from November 23-25, 2024.

BACKGROUND/INTRODUCTION: Brain metastasis is a common complication in non-small cell lung cancer (NSCLC), often associated with distinct genetic patterns. Although next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has been used as an early diagnostic tool for brain metastasis, it is still invasive.

Circulating tumor DNA (ctDNA) has been utilized to predict brain metastasis in various diseases. Our aim was to evaluate ctDNA at diagnosis and throughout the disease course to identify potential predictive markers for brain metastasis in NSCLC. METHODS: We conducted a retrospective study from January 2018 to March 2024, including 607 NSCLC patients confirmed by tissue biopsy and imaging. Guardant360 reports were used to assess genomic profiles.

Associations were analyzed using the chi-squared test, and logistic regression evaluated odds ratios (OR).

RESULTS: Patients were stratified based on those with an initial liquid biopsy before treatment (n=438). Of these, 88 (20%) had brain metastases at diagnosis. ctDNA revealed that EGFR (n=34/117, p=0.00864), MET (including exon 14 skipping mutation) (n=24/82, p=0.037), and KRAS (n=17/47, p=0.007) mutations were significantly associated with brain metastases. These mutations increased the odds of brain metastases: EGFR (OR=2.02, p=0.005), MET (OR=1.86, p=0.023), and KRAS (OR=2.4, p=0.009). Additionally we calculated the Sensitivity (SN), specificity (SP), positive predictive value, and negative predictive value of each mutation, which were as follows: EGFR (SN=38.2%, SP=76.3%, PPV=29.1%, NPV=82.9%), MET (SN=25.0%, SP=84.6%, PPV=29.3%, NPV=81.6%), and KRAS (SN=20.7%, SP=90.7%, PPV=36.2%, NPV=81.8%). Patients with at least double mutations (n=13/37) had a significant association (p=0.0007) with brain metastases at diagnosis, with higher odds (OR=4.07, p=0.0005) compared to patients without these mutations. SN and SP for predicting brain metastases with double mutations were 31.7% and 89.4%, respectively, with PPV and NPV of 35.1% and 87.9%.

In patients without brain metastases at diagnosis (n=144), 26 developed brain metastases after treatment. EGFR mutation was associated with later brain metastases (n=16/41, p=0.033, OR=2.79, p=0.021).

CONCLUSION: ctDNA can serve as a predictive tool for brain metastases in NSCLC, as evidenced by its association with specific mutations. Additionally, it can dynamically assess the risk of brain metastases during treatment, highlighting its potential utility in clinical practice.

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ABSTRACT #209 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY CYTOMEGALOVIRUS INFECTIONS FOLLOWING CAR T-CELL THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS Poorva Bindal1, Marcela Banegas2, Rodrigo Paredes de la Fuente3, Maria Jose Hernandez Woodbine4, Pushan Aggarwal5, Jon E. Arnason,6 Carolyn D. Alonso6 1University of Massachusetts Chan Medical School, Grafton, MA, United States; 2Johns Hopkins Bloomberg School of

Public Health, Baltimore, MD, United States; 3Mount Sinai Morningside-West Hospitals, New York, NY, United States; 4Norwalk Hospital, Yale University, New Haven, CT, United States; 5Allegheny Health, Pittsburg, PA, United States; 6Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 4-7, 2024.

BACKGROUND/INTRODUCTION: Chimeric antigen receptor (CAR) T-cell therapy is a rapidly evolving immunotherapy for hematological malignancies. With increasing access to this modality, there is an urgent need for a comprehensive understanding of infectious complications to optimize routine monitoring, prophylaxis and improve clinical outcomes. Cytomegalovirus (CMV) remains a clinically significant pathogen in allogeneic and autologous hematopoietic cell transplant recipients, though the clinical implications of CMV reactivation after CAR T-cell therapy are poorly characterized. . We sought to perform a systematic review and meta-analysis of the published literature to determine the overall incidence of CMV following CAR T-cell therapy.

METHODS: The study was registered on PROSPERO and we searched 5 electronic (MEDLINE, EMBASE, CINAHL, Pubmed, Cochrane) from inception to 2022. Each author independently screened titles, reviewed full texts to identify eligible studies and extracted data from included studies using Covidence, a data extraction tool for conduction of standard systematic reviews. A random effects model was used, and proportions were used as a measure of outcome. We assessed heterogeneity using I^2 statistic. Risk of bias assessments were conducted using the RoB 2.0 for RCTs and ROBINS I tool for non-RCTs. RESULTS: Our search identified 12,441 studies of which 363 underwent full-text review. 30 studies were eligible for inclusion in the analysis and enrolled a total of 2536 patients. Among these, 18 were observational cohort studies, 10 were nonrandomized clinical trials, and 2 were randomized clinical trials. All studies enrolled patients with hematologic malignancies treated with CAR T-cell therapy. The majority of the studies included patients treated with CD19 targeted CAR T-cell therapy (n=23), compared to BCMA targeted CAR T cell therapy (n=2), multiple targets (n=2) and another investigational CAR T cell product (n=3). The median duration of follow up was ³30 days in 25 studies and <30 days in 5 of the included studies. The pooled incidence of an infectious event in adult patients after CAR T-cell therapy was 38% (95%CI, 0.31-0.46; p<0.01; I2=98%]. The pooled incidence of any infectious event was significantly higher in studies where patients were treated with a BCMA-directed CAR T cell agent (64%, 95%CI, 0.53-0.74; I2 = 65%) compared to CD19-directed CAR T cell product (38%, 95%CI, 0.29-0.47; I2 = 97%; p <0.01). Sixteen studies reported viral infectious events with an overall proportion of 36% (0.360, 95% CI 0.267 to 0.453) of the included subjects. Out of the 144 specified viral events, Cytomegalovirus was the most prevalent pathogen with a proportion of 21.53% (0.2153, 95%CI 0.1481-0.2824).

Other commonly identified viral pathogens were rhinovirus, respiratory syncytial virus, and influenza with a proportion of 17.36% (0.1736, 95%CI 0.111- 0.2355), 9.72% (0.0972, 95%CI 0.0488-0.1456) and 8.3% (0.0833, 95%CI 0.0382-0.1285) respectively.

CONCLUSION: Our findings suggest that viral infections are common and seen in about one third of patients after CAR T-cell therapy. Cytomegalovirus was the most commonly identified viral pathogen following CAR Tcell therapy and was responsible for approximately one-fifth of all viral infections reported. Further studies are needed to determine the impact and clinical outcomes of CMV infection following CAR-T cell therapy.

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ABSTRACT #210 BASIC SCIENCE HEMATOLOGY/ONCOLOGY PREDICTIVE UTILITY OF CIRCULATING TUMOR DNA IN FIRST-LINE OSIMERTINIB THERAPY FOR EGFR-MUTANT METASTATIC LUNG ADENOCARCINOMA Rodrigo Paredes1, Toshiro Goto1, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University,

Columbus, OH, United States

Presented at the International Association for the Study of Lung Cancer (IASLC) Annual Meeting that was held in Washington, DC, United States from December 13-15, 2024.

BACKGROUND/INTRODUCTION: Molecular targets have transformed survival rates in lung cancer. EGFR is a key target, with third-generation EGFR tyrosine kinase inhibitors like osimertinib as first-line treatment. Liquid biopsy offers a noninvasive method for detecting actionable mutations. We aimed to evaluate the relationship between circulating tumor DNA levels known as Variant allele frequency (VAF) of EGFR mutations and survival outcomes in metastatic lung adenocarcinoma (mLUAD).

METHODS: This retrospective study was conducted at a single center from January 2018 to March 2024, involving mLUAD patients confirmed through tissue biopsy and imaging, who had pre-treatment liquid biopsies.

Guardant360 reports were used to assess gene mutations and their VAF. Patients receiving first-line osimertinib, excluding those with additional treatments, were analyzed. The median VAF of the population (2.85%) served as a cutoff to categorize patients into high and low VAF groups. Progression-free survival (PFS) was calculated from the start of therapy to disease progression or death, using Cox proportional hazards models. Pearson’s correlation was employed to examine the relationship between VAF and PFS. RESULTS: The initial cohort comprised 46 patients. After adjustments for missing data, the final analysis included 16 patients in the high VAF group and 20 in the low VAF group. A positive correlation was found between higher VAF levels and PFS (r=0.4307, p<0.01). The high VAF group showed a significantly longer median PFS compared to the low VAF group (15.24 months; 95% CI, 7.82-29.24) versus 3.68 months (95%CI, 2.30-7.89]; p<0.01). The hazard ratio (HR) for the low VAF group was 4.86 (95%CI, 1.985-11.89; p<0.01) relative to the high VAF group. Exon-specific analysis of EGFR mutations revealed a median VAF of 8.55% for exon 19 and 1.2% for exon 21 (p=0.04). The median PFS for exon 19 mutations was significantly longer than for exon 21 mutations (8.64 months; 95%CI, 6.37-17.00) versus 2.30 months (95%CI, 1.91-8.74; p=0.03). The HR for patients with exon 21 mutations was 2.13 (95% CI, 1.06-4.26), indicating a worse prognosis compared to those with exon 19 mutations. Finally, although not statistically significant (p=0.11), patients without detectable EGFR in blood tended to have better outcomes than those with detectable levels.

CONCLUSION: From our cohort, higher VAF levels were associated with longer PFS in mLUAD patients treated with osimertinib. Additionally, specific EGFR exon mutations distinctly impacted survival outcomes, highlighting the importance of detailed genetic profiling in treatment planning.

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ABSTRACT #211 BASIC SCIENCE HEMATOLOGY/ONCOLOGY ROLE OF CTDNA VARIANT ALLELE FREQUENCY IN PREDICTING RESPONSE TO IMMUNE CHECKPOINT INHIBITORS IN NON-SMALL CELL LUNG CANCER Rodrigo Paredes1, Ariel Peleg2, Shira Litchman2, Jorge Gomez2, Deborah Doroshow2, Fred R. Hirsch2, Rajwanth Veluswamy2, Thomas Marron2, Cardinale Smith2, Nicholas Rohs2, Christian Rolfo3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Ohio State University,

Columbus, OH, United States

Presented at the International Association for the Study of Lung Cancer World Conference on Lung Cancer (WCLC) Annual Meeting that was held in San Diego, California, United States from September 7-10, 2024.

BACKGROUND/INTRODUCTION: The landscape of lung cancer therapy has been transformed with the advent of immune checkpoint inhibitors (ICIs). Biomarkers such as PD-L1 expression and tumor mutational burden (TMB) have been traditionally utilized to predict responses to these therapies, particularly with respect to nonsmall cell lung cancer (NSCLC). Recent insights suggest that the variant allele frequency (VAF) of individual mutations in tissue samples could serve as a predictor for the efficacy of immunotherapies in NSCLC. This study investigates the potential of using total VAF from somatic mutations in ctDNA as a biomarker for predicting responses to ICIs in patients with NSCLC. METHODS: We conducted a retrospective analysis at a single center from January 2018 to March 2024, focusing on patients who underwent liquid biopsies. Participants included those with confirmed NSCLC at any disease stage, ascertained via tissue biopsy. Data collected included demographic information, disease characteristics (such as presence of brain metastasis at diagnosis, histological subtype), PD-L1 % expression from initial tissue samples, and first-line treatments, including the use of ICIs. ctDNA was analyzed using Guardant360 reports, excluding genetic variants with a VAF greater than 40% to filter out germline mutations. The total VAF for each patient was calculated by summing the VAFs of all somatic mutations identified. Patients were then categorized into high (≥1%) and low (<1%) VAF groups. Logistic regression was used to explore the relationship between total VAF and PD-L1 % expression, while survival outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazards models, adjusting for relevant clinical variables.

RESULTS: Our cohort included 463 patients. PD-L1 % expression and VAF were reported in 350 (76.5%) and 306 (67.6%) of the cases, respectively. Regression analysis revealed a significant negative correlation between total VAF levels and PD-L1 % expression (p=0.02). No significant demographic differences were observed between the high and low VAF groups. Survival analysis was focused on patients receiving ICIs (n= 135, 29.6%).

Of those, patients with high VAF (n= 73, 53.2%) had a mean VAF of 16.8%, while low VAF patients (n=31, 22.6%) had a mean VAF of 0.54%. It was found that patients with high VAF had significantly shorter overall survival compared to those with low VAF (6.16 months versus 13.83 months, p=0.03). Furthermore, high VAF was associated with more than twice the risk of mortality (HR, 2.554; 95%CI, 1.206 to 5.408; p<0.05), according to the Cox model adjusted for smoking history, brain metastasis, histology, and ECOG performance status.

CONCLUSION: Our study found that higher levels of VAFin ctDNA are associated with lower levels of PD-L1 expression in tissue biopsies from patients with NSCLC. Moreover, a high VAF was correlated with a marked decrease in overall survival among patients treated with ICIs, across all stages of the disease. As liquid biopsy becomes more integrated into clinical practice, its potential for providing prognostic insights and enabling a more tailored therapeutic approach may become increasingly evident. Our findings highlight the potential role of total VAF in ctDNA as a predictive biomarker for ICI therapy outcomes in patients with NSCLC.

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ABSTRACT #212 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/INFECTIOUS DISEASES A FATAL CASE OF KAPOSI'S SARCOMA ASSOCIATED HERPESVIRIS HHV8 AND MULTICENTRIC CASTLEMAN'S DISEASE Aesha Patel1, Fahema Nadira1, Krystina Woods1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 42‐year‐old male with HIV/AIDS (CD4 79, Viral Load >1.35 Million) presented to the hospital with altered mental status, fever, tachycardia, axillary lymphadenopathy and cachexia. Initial work‐up revealed profound anemia with a hemoglobin of 3.0 and no identifiable source of bleeding. Infectious screen was positive for Norovirus and Enteropathogenic E. coli gastroenteritis, and serology was positive for autoimmune hemolytic anemia. The patient was promptly started on high‐dose prednisone, empiric antibiotic treatment, Biktarvy, and Atovaquone. Pertinent labs included an elevated ESR and CRP, SPEP with immunofixation showed a polyclonal gamma elevation, IL‐6 (62.4), VEGF (171), HHV8 PCR Quant: 4.5 E + 07, IgM (558) and IgG (2141). CT imaging revealed diffuse abdominal and axillary lymphadenopathy, prompting biopsy, which confirmed Kaposi's Sarcoma‐associated Herpesvirus HHV8 and multicentric Castleman's disease (KSHV‐MCD).

The patient subsequently developed septic shock and acute respiratory failure, requiring intubation and continuous renal replacement therapy. Infectious disease consultants recommended continuation of empiric antibiotics, while hematology advised withholding chemotherapy due to concerns for immune reconstitution inflammatory syndrome. The patient was treated with solumedrol, ganciclovir, and rituximab. His course was complicated by fungemia, bacteremia, and high‐grade AV block requiring transvenous pacemaker placement.

He continued to experience refractory multiorgan failure and was eventually transitioned to comfort care.

DISCUSSION: KSHV‐MCD is a systemic inflammatory disorder characterized by lymphadenopathy, elevated inflammatory markers (e.g., ESR, CRP, IL‐6), and immune dysregulation. MCD consists of two forms: an idiopathic form, which is rare and seen in immunocompetent individuals, and a HIV‐associated form, which is driven by HHV8 and presents aggressively. Patients with HHV8‐associated MCD often develop Kaposi's sarcoma (KS), a malignant neoplasm of endothelial cells. The presentation of KSHV‐MCD includes constitutional symptoms and lymphoproliferation. As seen in this case, anemia and multi‐organ dysfunction may also occur due to systemic inflammation and bone marrow suppression. Diagnosis involves imaging to assess lymphadenopathy, biopsy for histopathological confirmation, and viral PCR to detect HHV8. Management of KSHVMCD is multifaceted, focusing on HIV control and suppression of the HHV8 infection and inflammation.

Antiretroviral therapy remains the cornerstone of treatment. Immunosuppressive therapies, particularly corticosteroids, are used to address the inflammatory components of MCD. Rituximab, a monoclonal antibody targeting B‐cells, is often used alongside IL‐6 Inhibitors. The prognosis for KSHV‐MCD remains poor, particularly when complicated by multi‐organ failure.

CONCLUSION: This case highlights the severe and often fatal course of KSHV‐MCD. Despite advances in HIV treatment, the prognosis remains challenging due to the aggressive nature of the disease and advanced immunosuppression, necessitating prompt diagnosis and treatment.

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ABSTRACT #213 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE A MULTIDISCIPLINARY APPROACH TO REDUCING HOSPITAL ACQUIRED PRESSURE INJURIES IN INTENSIVE CARE UNITS Aesha Patel1, Jorge Sinclair De Frias1, James Salonia1, Amanda Zotte1, Sarah Costigan1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

BACKGROUND/INTRODUCTION: Hospital-acquired pressure injury (HAPI) is localized skin and soft tissue damage resulting from prolonged pressure, exacerbated by friction/shearing forces during inpatient care. Risk factors include immobility, moisture exposure and poor perfusion, which are prevalent in critically ill patients.

Designated as ‘never events’ by the Centers for Medicare and Medicaid Services, HAPIs are preventable medical errors linked to increased length of stay (LOS), infection, readmissions, high costs, and mortality. We established a multidisciplinary pressure injury prevention (PIP) team to reduce preventable HAPIs through education on screening, timely skin assessments, and implementation of preventative/treatment measures.

METHODS: This initiative was implemented in the intensive care unit (ICU) at Mount Sinai West Hospital to prevent/manage HAPIs through enhanced awareness, education, and interdisciplinary collaboration. This included bi-weekly wound care team rounds comprising wound care specialists, attending physicians, nurse managers, respiratory therapists, nurses, and resident physicians. Rounds served as an educational platform for training on the Braden Scale for risk assessment, reviewing relevant literature, and performing clinical evaluations. Team members received instruction on documentation and grading of pressure injuries, while nursing staff engaged in specialized training focused on wound care. Select “Nursing Skin Champions” received home-grown education and formal Skin Savers Course training. To standardize care, we selected appropriate materials for pressure dressings and utilized tools to minimize device-related pressure injuries and facilitate timely interventions. Efficacy was evaluated by routine documentation and grading of pressure injuries by wound care specialists.

RESULTS: Of The PIP team was implemented on the 8AE unit from 2022-2024, and on the 8AW unit from 20232024. Pre-implementation data were collected from 2022 for 8AE and 2023 for 8AW, with the objective of achieving a 25% reduction in HAPIs. On 8AE, HAPIs decreased from 19 (5.4/1,000 patient days) in 2022 to 7 (2.32/1,000 patient days) post-implementation, reflecting a 57.04% reduction. By 2024 year-to-date (YTD), 8AE reported 7 HAPIs (2.8/1,000 patient days), a 48.15% reduction from pre-implementation. For 8AW, preimplementation data showed 9 HAPIs (4.6/1,000 patient days) in 2023, decreasing to 4 (1.99 per 1,000 patient days) in 2024 YTD, indicating a 56.74% reduction.

CONCLUSION: This Establishing the PIP team in ICUs has led to notable reductions in HAPIs. This initiative facilitates prevention, timely screening, and treatment to avoid ‘never events.’ Future efforts will focus on resident education through didactics, and early risk stratification using electronic health records to identify comorbid conditions predictive of HAPIs. This quality improvement initiative aims to reduce LOS, infection rates, and readmissions, enhancing patient outcomes and decreasing healthcare costs.

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ABSTRACT #214 QUALITY IMPROVEMENT INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE DE-ESCALATING ANTI-PSEUDOMONAL ANTIBIOTICS IN PATIENTS WITH PNEUMONIA BASED ON RESPIRATORY CULTURES IN CRITICAL CARE UNITS AT MOUNT SINAI MORNINGSIDE-WEST- A QUALITY IMPROVEMENT PROJECT Maria Baig1, Daniel Mesa1, Aesha Patel1, Sanam Ahmed1, James Salonia1, Valida Bajrovic1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Early administration of broad-spectrum antibiotics is a life-saving measure in critically ill patients. 2019 IDSA/ATS pneumonia guidelines state that sputum cultures are recommended in patients with severe disease and inpatients empirically treated for MRSA or Pseudomonas aeruginosa pneumonia with de-escalation of antibiotics to community-acquired pneumonia therapy if cultures do not reveal a drug-resistant pathogen and patient is clinically improving. Pseudomonas is the most common cause of nosocomial infections and has a high rate of carbapenem resistance. We undertook this project to ensure that patients receive effective treatment and are not exposed to anti-pseudomonal antibiotics for prolonged periods of time.

METHODS: We undertook a retrospective analysis of patients with pneumonia diagnosis who were started on anti-pseudomonal antibiotics and admitted to critical care units at Mount Sinai Morningside-West between January 2024 to March 2024. Targeted therapy was defined as tailoring of antibiotics to pathogen identified in culture, by changing to a narrower spectrum antibiotic or stopping antibiotics if cultures are negative.

Not targeted therapy was defined as 1. enrollment culture was negative and antibiotics were continued; 2. enrollment culture was positive and broad-spectrum antibiotic therapy was continued when a narrow-spectrum antibiotic would have been sufficient; or 3. enrollment culture was positive and grew Gram-positive organism but Gram-negative coverage was continued.

Sequential Organ Failure Assessment (SOFA) scores were also calculated.

We worked with the ICU Directors for implementation of our interventions which included: 1. Respiratory cultures to be collected by Respiratory Therapists to standardize collection process. 2. Reminders to nursing and house staff during huddles about the importance of obtaining respiratory cultures on patients with pneumonia diagnosis.

3. Educational session to critical care faculty and fellows about the impact of targeted therapy in patients with pneumonia.

RESULTS: A total of 82 patients met inclusion criteria for our pre-intervention group. 57.3% were on targeted therapy and 42.7% were on not on targeted therapy. 21.3% of patients on targeted therapy grew Pseudomonas aeruginosa in respiratory cultures; 70% had one or more risk factors for Pseudomonas as defined in the 2019 IDSA/ATS guidelines. ICU mortality in patients on targeted therapy was 29.8% and 37.1% in patients on not on targeted therapy. Cefepime was the most commonly used antibiotic (60%) in patients on not on targeted therapy.

Mean SOFA score was 5.9 in patients on targeted therapy and 4.3 in patients on not on targeted therapy.

CONCLUSION: Our preliminary data demonstrates that patients admitted to the ICU with a pneumonia diagnosis who are treated with targeted therapy have a lower ICU mortality as compared to patients who remain on broad spectrum antibiotics. The goal of our QI project is to determine whether our interventions will result in improvement in respiratory culture collection and de-escalation of antibiotics.

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ABSTRACT #215 CLINICAL RESEARCH GASTROENTEROLOGY MAJORITY OF PATIENTS VISITING THE EMERGENCY DEPARTMENT FOR CHRONIC CONSTIPATION ARE NOT ON APPROPRIATE MEDICATIONS AND LIKELY TO RETURN WITHIN ONE YEAR Swati Patel1, Joseph Menand1, Priyanka Singh1, Michael S. Smith2, Daniela Jodorkovsky1, Yuying Luo1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Chronic constipation (CC) affects up to 20% of adults in the United States and is associated with a poor quality of life and increased emergency department (ED) utilization. We aim to characterize the demographics, clinical profiles and outcomes of patients with constipation who seek emergency care at 1 tertiary center.

METHODS: This was a cross-sectional claims-based analysis utilizing a de-identified database (TriNetX). We queried all ED visits with ICD-10 codes associated with constipation between January 1st, 2018, and December 31st, 2022. Primary outcome was the proportion of patients seen in the emergency department for CC. Secondary outcomes included demographics, proportion of patients receiving various constipation agents, abdominal imaging or procedures. Database counts were rounded up to the nearest 10th digit by default.

RESULTS: Approximately 0.85% (ranging from 0.80-0.88%) of the 822,600 ED visits between 2018 and 2022 were associated with at least 1 constipation-related diagnosis. Overall, the cohort had a mean age of 57.0 (SD = 22), 57.6% women and racially diverse (28.2% white, 27.6% Black, 37.6% other, 4.6% Asian). Approximately one-third of patients (ranging from 28.2%-37.6%) were on medications for constipation in the 3-months prior to their index ED visit; most patients used osmotic laxatives (91%-96%) and/or suppository/enemas (93.8%97.9%), and a minority of patients used stimulant (4.2%-7.8%) or prescription agents for constipation (6.3%11.4%). There was an 8.6% rate for ED revisit for chronic constipation within 1 year for the entire cohort, while 43.1% were seen in the outpatient office within 3-months. Over 60% of patients had abdominal imaging (computed tomography, X-ray or magnetic resonance imaging) while in the ED, and 9.2% received a colonoscopy within 6-months. In the 3 months following the ED visit, there was a 4% increase in laxative medication claims for the entire cohort.

CONCLUSION: Only one-third of patients visiting the ED for constipation at 1 center were on appropriate medications for their constipation in the 3-months prior to their ED visit and less than 8% were on prescription agents. This may contribute to the overuse of ED resources for constipation-related visits, including procedures and imaging. Future efforts on managing constipation and assessing severity should be targeted towards patienteducation in the primary care setting.

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ABSTRACT #216 MEDICAL EDUCATION PULMONARY/CRITICAL CARE TEACHING TO IMPROVE RESIDENT KNOWLEDGE ON SCREENING FOR BARRETT’S ESOPHAGUS: A TARGETED CURRICULUM FOR HIGH-IMPACT LEARNING Swati Patel1, Ines Varela Knorr1, Michael Smith1, Priya Simoes1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

BACKGROUND/INTRODUCTION: Respiratory Internal Medicine (IM) residents at Mount Sinai MorningsideWest make up one of the largest Internal Medicine residency program in the country with over 200 residents.

They care for patients across two hospitals and five clinic sites, leading to a variability in experience and exposure. The American Board of Internal Medicine Certification Exam (ABIM) first-time pass rate has declined nationally over the past five years, dropping to 87% in 2023. To address this, we designed and created a targeted educational curriculum to unify and strengthen residents’ understanding of commonly tested Gastroenterology (GI) topics.

METHODS: We conducted a 10-question needs assessment targeting ‘High Importance’ topics from the ABIM blueprint to evaluate familiarity with core GI subjects at a large Internal Medicine residency with training at two hospitals and five outpatient sites. Based on the results, we developed interactive case-based lectures addressing topics with the lowest familiarity. These cases were presented at dedicated half-day academic sessions. Attendees of the Academic half day session were given a pre-assessment with ABIM like questions prior to the session. After the session residents’ comfort level was assessed and the same pre-assessment questions were presented in a post-assessment survey.

RESULTS: Of the 36 PGY-2 and PGY-3 trainees who responded to the needs assessment, 25 (69%) reported being unfamiliar or only somewhat familiar with the diagnosis and management of pre-malignant and malignant disorders of the GI tract. In the pre-assessment, 7 out of 19 residents (37%) correctly answered an ABIM- like question evaluating knowledge regarding Barrett’s esophagus (BE) screening. On the post-assessment questionnaire, all residents (100%) answered the same question correctly. A two proportion Z test resulted in a p-value of 0.00013. In the post-assessment questionnaire, 11 out of 14 residents (79%) reported being “comfortable” or “very comfortable” and three residents (21%) reported being “somewhat comfortable” with the diagnosis and management of neoplastic esophageal disorders. No residents reported being “uncomfortable” with this topic.

CONCLUSION: This study addressed trainee knowledge gaps by creating a targeted curriculum based on resident familiarity tailored to “high importance” test topics. Following interactive lectures delivered during dedicated educational sessions, there was a statistically significant improvement in the proportion of correct responses regarding appropriate BE screening. Study limitations include variability in resident attendance at the educational sessions and a low percentage of respondents. Additionally, the study did not assess long-term knowledge retention, which remains an area for future investigation.

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ABSTRACT #217 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY WHEN THE HEART'S CURE BECOMES THE STOMACH'S CHALLENGE: A RARE CASE OF POST CRYOBALLON ABLATION GASTROPARESIS Swati Patel1, Adam Tillowitz1, Priya Simoes1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Atrial fibrillation is the most prevalent cardiac arrythmias. Multiple studies have demonstrated that cryo-balloon ablation, which delivers targeted cryotherapy to the pulmonary vein, successfully treats atrial fibrillation, reduces the rate of arrhythmia recurrence, and has a lower incidence of adverse events when compared to antiarrhythmic medication. The rate of upper gastrointestinal (GI) complications following atrial fibrillation ablation procedures is reported to be as low as 0.74%, gastroparesis being an especially infrequent complication with an incidence of only 0.2%.

CASE PRESENTATION: A 45-year-old male with a past medical history of paroxysmal atrial fibrillation underwent cryo-balloon ablation. The following day, he began experiencing early satiety, vomiting, and abdominal distention, which progressed to an inability to tolerate any oral intake and was admitted to the hospital.

Within 10 days, the patient had lost 17 pounds. An upper gastrointestinal series done seven days after the procedure showed no evidence of gastric or duodenal obstruction, but there was significant distention of the stomach with a large amount of retained contents. He was started on oral erythromycin 250 mg four times a day, for presumed gastroparesis with some improvement in his symptoms. Four weeks after starting erythromycin therapy, a gastric emptying study showed 74% retention after four hours. Two months post-ablation, the patient’s vomiting had resolved, and he had regained 8 pounds, however he continued to experience nausea and early satiety. An upper endoscopy was relatively unremarkable with no evidence of pyloric pathology. Six months post procedure, patient had regained 20 pounds. Gastric emptying study six months post procedure continued to show severely delayed emptying.

DISCUSSION/CONCLUSION: Atrial fibrillation ablation is a well-tolerated procedure with a low risk profile but may cause significant gastrointestinal complications. Common problems include nausea, vomiting, and gastroesophageal reflux. Serious complications include esophageal injury and gastroparesis. Lower periprocedural temperatures in the inferior pulmonary veins during cryo-balloon ablation and a smaller left atrium size are associated with an increased risk of gastroparesis. Given that the esophagus is near the posterior left atrium, endocardial ablation can cause direct thermal injury to the esophagus, ischemia from anterior esophageal artery damage, and esophageal dysmotility from peri-esophageal vagal plexus injury. Gastrointestinal symptoms generally resolve within two to six months with conservative management and prokinetic agents, rarely (four patients) symptoms persist over one year.

Figure 1. Upper GI series seven days after procedure, which demonstrates a significantly distended stomach with bezoar.

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ABSTRACT #218 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/INFECTIOUS DISEASES COMPREHENSIVE MANAGEMENT OF A SEVERE CASE OF CANDIDA ORTHOPSILOSIS ENDOCARDITIS Usman Saeedullah1, Komail Jafri1, Harrison Bonilla1, Syed Zaidi1, Sanjay Sivalokanathan1, Edgar Argulian1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

CASE PRESENTATION: A 54-year-old male with a longstanding history of polysubstance use disorder (on methadone maintenance) and chronic hepatitis C presented with new-onset heart failure symptoms: exertional dyspnea, lower extremity edema, orthopnea, paroxysmal nocturnal dyspnea, and recent intravenous drug use.

Physical examination was notable for jugular venous distension, pulmonary crackles, and lower extremity edema. Cardiac auscultation revealed a high-pitched decrescendo diastolic murmur, as well as a holosystolic murmur radiating to the axilla, implicating significant aortic and mitral regurgitation. Transthoracic echocardiography (TTE) demonstrated marked left ventricular dilation and increased filling pressures, with an initially preserved left ventricular ejection fraction (LVEF) of 50–55% that subsequently deteriorated to 20–25%.

Vegetations on the aortic valve resulted in severe regurgitation, and mild to moderate mitral regurgitation was also evident. Blood cultures yielded Candida orthopsilosis, confirming a diagnosis of fungal infective endocarditis (IE). Coronary imaging ruled out significant atherosclerosis, isolating IE-induced valvular dysfunction as the driving cause of heart failure. Fungal IE constitutes a Class I indication for urgent surgical intervention, particularly in the presence of severe valvular regurgitation and heart failure. A multidisciplinary team selected a bioprosthetic aortic valve due to high concern for poor adherence to anticoagulation. The patient underwent emergent aortic valve replacement and mitral repair. Postoperatively, he received intravenous caspofungin, transitioning to an extended course of oral fluconazole per recommended antifungal protocols. In the immediate postoperative period, the patient experienced cardiogenic shock requiring inotropic support, which was subsequently weaned as he stabilized. He then commenced guideline-directed medical therapy for heart failure, including a beta-blocker, an ACE inhibitor, and diuretics. Repeat echocardiography confirmed appropriate prosthetic function and effective mitral repair, although his LV dysfunction remained severe.

DISCUSSION/CONCLUSION: Fungal IE is rare, accounting for <2% of all IE cases, with Candida orthopsilosis being particularly uncommon. Because antifungal agents alone are often insufficient against large vegetations and resistant organisms, prompt surgical debridement and prolonged antifungal therapy are paramount.

Management necessitates close collaboration among Cardiology, Cardiothoracic Surgery, Infectious Disease, and Addiction Medicine to minimize relapse in intravenous drug use. Despite successful valve surgery, this patient’s persistent severe LV dysfunction underscores the risk of irreversible myocardial damage when intervention is delayed, and emphasizes the necessity for vigilant long-term follow-up.

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ABSTRACT #219 CLINICAL RESEARCH PUMONARY/CRITICAL CARE HYPERSOMNIA IN THE INTENSIVE CARE UNIT: A MARKER FOR POOR OUTCOMES? Benjamin Samuel1, Christiana Choi1, Suraj Shah2, Arshdeep Dhaliwal1, Connor Smith1, Adrian Chernyk1, Keshav Dixit1, David Tai1, Dan Levendowski2, Priscilla Loanzon1, Lloyd Muzangwa1, Raymonde Ernest Jean1 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Advanced Brain Monitoring, Inc., Carlsbad, CA, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Research show Intensive Care Unit (ICU) patients experience poor sleep.

The impact of sleep on ICU patient recovery and outcomes is an emerging area of study. We conducted an observational study to assess sleep quality and quantity in ICU patients.

METHODS: Sleep Profiler, an FDA-approved device, was used to record physiological signals over 24 hours.

The Sleep Profiler software auto-scored patient data before analysis. The study included 56 ICU patients with at least 15 hours of valid recording. We examined associations between variables such as intubation status, ICU admission reasons, sleep time, sepsis, disposition, and sedation level defined by the Richmond AgitationSedation Scale (RASS). Patients were grouped into those with ICU hypersomnia (sleep time >11 hours, n=34) and those without hypersomnia (sleep time <11 hours, n=22). Mann-Whitney U and Chi-squared tests were used for statistical analysis.

RESULTS: We analyzed 56 patients, categorizing them into hypersomnia (>11 hours sleep, n=34) and nonhypersomnia (<11 hours sleep, n=22) groups. Hypersomnia patients were significantly older (74 versus 61.3 years, p=0.031) and had higher APACHE II scores (20.1 versus 15.1, p=0.0257). They experienced longer ICU stays (17.4 versus 10.9 days, p=0.0013) and hospital stays (26.9 versus 17.8 days, p=0.00438). Fewer hypersomnia patients were discharged home (14.7% versus 63.2%, p=0.00055). They had higher rates of sepsis (67.6% versus 36.4%, p=0.0032), intubation (70.6% versus 9.1%, p<0.0001), sedation (58.8% versus 90.9%, p=0.0143), and mortality (50% versus 13.6%, p=0.0093). Logistic regression showed ICU admission reason (Odds Ratio (OR), 7.02; p=0.037) and intubation status (OR, 335.8; p=0.047) as significant predictors of ICU hypersomnia.

CONCLUSION: This study suggests that ICU hypersomnia is associated with higher illness severity, longer hospital stays, and poorer outcomes including higher mortality. Age, coma, sepsis, intubation, and sedation are significantly related to ICU hypersomnia. Early recognition of ICU hypersomnia may have important clinical implications, potentially serving as an indicator of patient status and prognosis. Further research is needed to understand the relationship between sleep patterns and outcomes in critically ill patients.

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ABSTRACT #220 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY A RARE CASE OF DUODENAL DIVERTICULITIS: RIGHT UPPER QUANDRANT PAIN THAT ISN’T ACUTE CHOLECYSTITIS? Adam Tillowitz1, Robinderpal Sandhu1, Frank Nelson1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: The differential for right upper quadrant (RUQ) pain includes liver and gallbladder disorders, inflammatory bowel disease, pancreatic disorders, pulmonary disease, malignancy, and rarely diverticular disease. Duodenal diverticulum is a common incidental finding on computed tomography (CT) scan however, only about 10% cause symptoms with less than 1% requiring treatment due to perforation, hemorrhage, or obstruction. Here we present a rare care of perforated acute duodenal diverticulitis in a 77-yearold female who presented with right upper quadrant pain.

CASE PRESENTATION: A 77-year-old female with a past medical history of chronic obstructive pulmonary disease, hyperlipidemia, lung cancer treated with a lung resection, and appendectomy presented with right upper quadrant pain three days in duration. Upon admission, vitals were stable, however labs were notable for a leukocytosis to 17,000 WBC per microliter (17 x10ˆ9/L). A CT scan with contrast displayed duodenal diverticula with a fluid collection, duodenal inflammation, and thickening suggestive of locally perforated diverticulitis.

Gastroenterology deferred any endoscopic intervention but recommended intravenous proton pump inhibitor twice daily. In the absence of laboratory evidence of biliary obstruction and severe duodenal complications the patient was managed conservatively.

DISCUSSION/CONCLUSION: The duodenum is the second most common location of diverticula, with an estimated incidence of 22%. Duodenal diverticula are usually located near the ampulla of Vater and can be acquired or congenital. Most are acquired diverticula and extraluminal, as this is secondary to the protrusion of an outpouching near the entrance of a large vessel, while congenital diverticula are usually intraluminal and develop secondary to incomplete canalization. Historically, surgery was the preferred choice of management for duodenal diverticulitis, but with advances in medicine, nonoperative management has been reported to be successful in multiple cases. Typically, patients will present with a cholestatic pattern of liver injury and elevated transaminases. Our patient did not present typically, as she had no elevation in liver enzymes, suggesting more of an insidious presentation. Given the serious complications that can arise from duodenal diverticulitis, our case reminds practioners to keep an open mind of differentials when it comes to patients with right upper quadrant pain especially in the absence of lab abnormalities suggesting gastrointestinal pathology.

Figure 1. Perforated duodenal diverticulum encircled in red.

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ABSTRACT #221 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY DUODENAL DIVERTICULITIS RESULTING IN GASTRIC OUTLET OBSTRUCTION Adam Tillowitz1, Robinderpal Sandhu1, Michael S. Smith2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Gastric outlet obstruction (GOO) is a clinical syndrome characterized by epigastric abdominal pain and postprandial vomiting due to mechanical obstruction. The predominant etiology of GOO has changed over the past several decades, from peptic stricturing to malignancy. Duodenal strictures similarly have multiple potential causes, from acid-peptic disease to inflammation and malignancy. We present a rare case of benign GOO secondary to unresolved duodenal diverticulitis and subsequent stricture formation.

CASE PRESENTATION: An 82-year-old man with a past gastrointestinal medical history of colonic adenocarcinoma treated with right hemicolectomy and recent medically managed duodenal diverticulitis presented for outpatient endoscopy with poor oral intake and worsening non-bilious, non-bloody emesis. Upper endoscopy demonstrated severe narrowing after the duodenal bulb with concern for gastric outlet obstruction, leading to hospital admission. An upper GI series demonstrated contrast retention in the stomach, with no passage of the material beyond the duodenal bulb. Initial treatment included intravenous proton pump inhibitor (PPI), antibiotics, and nasogastric tube decompression. Endoscopy identified luminal narrowing at a deformed duodenal sweep with a clean-based ulceration and adjacent diverticulum. Balloon dilation to 12 mm was performed, after which he improved and was discharged on twice daily PPI. DISCUSSION/CONCLUSION: Gastric outlet obstruction can be localized to the antro-pyloric area, bulb or post bulbar duodenal segments. Causes for gastric outlet obstruction include peptic ulcer, inflammation (i.e. Crohn’s), infection and malignancy. A combination of dilation and medical therapy is considered first-line treatment for benign gastric outlet obstruction, though one third of patients ultimately require surgical intervention.

Duodenal diverticulitis can be complicated by perforation, abscess or fistula formation. The suspected mechanism of GOO in this case is similar to that of colonic diverticulitis, where high-grade obstruction usually is associated with stricture development due to chronic diverticular inflammation. This patient received a PPI during the month before endoscopy. Given the absence of NSAID use, negative biopsies for malignancy or H. pylori, his ulceration and eventual stricture formation likely were secondary to a previous bout of unresolved duodenal diverticulitis. This case highlights the importance of considering a broad range of diagnoses across multiple anatomic regions when considering potential etiologies of gastric outlet obstruction.

Figure 1. A. Duodenal Diverticulum B. Dilation of Duodenum

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ABSTRACT #222 CASE REPORT/CLINICAL REVIEW DERMATOLOGY/GASTROENTEROLOGY HIDING IN PLAIN SIGHT: A CASE OF CONCURRENT PUSTULAR PSORIASIS AND INFLAMMATORY BOWEL DISEASE Robinderpal Sandhu1, Emily Seltzer1, Binoy Desai1, Mantej Sehmbh1, Michael S. Smith1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount

Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Psoriasis and Inflammatory Bowel Disease (IBD) are both chronic, relapsing and remitting inflammatory conditions. Individuals with both pustular psoriasis and IBD comprise a unique patient population. Symptom presentation can include fevers, arthralgias, characteristic skin lesions and abdominal pain.

CASE PRESENTATION: A 24-year-old man with a history of scalp psoriasis presented with fevers, joint pains and a skin rash which appeared one month prior to presentation (Figure A). He was started on empiric antibiotics while a knee aspiration revealed an inflammatory process. A skin biopsy was performed consistent with pustular psoriasis. Only upon further questioning did the patient endorse a three-month history of bright red hematochezia. Initial CT imaging was unremarkable for any chest, abdominal or pelvic pathology. Infectious processes were excluded with stool PCR and C. difficile toxin, but blood and stool inflammatory markers were elevated (Table 1). Endoscopic findings included esophageal ulcers, a gastric ulcer, a normal terminal ileum, and diffuse severe edema, erythema, friability, and deep nearly confluent ulcerations in the sigmoid, with shallow ulcerations diffusely from the rectum to the transverse colon (Figure B). Histology was consistent with IBD. The patient was started on intravenous steroids, with rapid improvement in bowel symptoms and eventual resolution of skin lesions, with plans to start outpatient biologic therapy.

DISCUSSION/CONCLUSION: Roughly 2-3% of the world’s population has psoriasis, though the pustular form is quite rare. Most cases are idiopathic, though common risk factors include skin infections, sudden steroid withdrawal and electrolyte imbalances. Even more rare is concurrent pustular psoriasis and associated IBD. IBD and psoriasis both exhibit increased permeability of the intestinal mucosal border. A combination of genetic predispositions or environmental factors contribute to disease manifestations, with a central role attributed to the immune responses and T-helper cell dysregulation. This case demonstrates the need to recognize the variety of autoimmune processes that increase the likelihood of having concurrent IBD. It also underscores the importance of asking about bowel habits upon initial patient presentation as part of a review of systems. This patient did not connect his hematochezia with the rash, and therefore did not disclose this issue at first, resulting in a delay in diagnosis and treatment initiation.

Figure 1. A. Diffuse, erythematous pustules with ruptured bullae B. Diffuse, continuous ulcerations noted throughout the sigmoid colon

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ABSTRACT #223 CASE REPORT/CLINICAL REVIEW PULMONARY/CRITICAL CARE ACUTE INTERSTITIAL PNEUMONIA SECONDARY TO AMIKACIN LIPOSOME INHALATION SUSPENSION Hammad Sheikh1, Catherine Zaw1, Edward Eden1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Amikacin liposome inhalation suspension (ALIS) is the only FDA approved medication for use as an adjunctive antibiotic treatment for refractory Mycobacterium avium complex (MAC) lung disease. Through inhalation, amikacin can be delivered directly to the infected sites effectively while also limiting systemic toxicity. While greater culture conversion has been achieved in the addition of ALIS to standard guideline treatment, serious adverse effects related to ALIS cannot be ignored. The most common respiratory events noted in studies included dysphonia, cough, and dyspnea, and more serious adverse effects included death related to respiratory infections. This case presents an example of acute interstitial pneumonia related to ALIS administration.

CASE PRESENTATION: A 78-year-old female with chronic mycobacterium avium, previously treated with ethambutol, rifampin, and azithromycin for 1 year and 5 months, was prescribed inhaled Arikayce (amikacin) which led to acute interstitial pneumonia. She started developing symptoms of cough dyspnea and fatigue after the first week of daily use with ALIS. On exam, there were bilateral inspiratory crackles with no wheezing.

Pulmonary function test (PFT) showed, a very reduced FEV1 and FVC, both with normal ratio, reduced lung volumes, and severely reduced diffusing capacity when compared to prior studies. Chest radiograph (CXR) showed extensive bilateral parenchymal changes consistent with progressive interstitial changes, with more opacities in the lower lung lobes. Contiguous tomographic (CT) chest within two-weeks of the patient's symptoms demonstrated stable fibrosis with associated bronchiectasis and peripheral opacities and pleural thickening in the upper lobes, as noted previously, but with new interval development of ground glass opacities and fibrotic changes in the lower lobes. Amikacin was immediately discontinued, and the patient was started on 60mg dose of prednisone daily – which has gradually been tapered over 5 months to 10mg of prednisone. Dyspnea gradually improved over 8 weeks. Repeat PFTs after initiating steroids showed mildly reduced FVC, normal FEV1, both with normal ratio, reduced lung volumes, and severely reduced diffusing capacity. Repeat imaging and PFT are planned.

DISCUSSION/CONCLUSION: In this patient, acute interstitial pneumonia occurred within a week of starting ALIS which gradually improved with the discontinuation of ALIS and initiation of steroids. Acute interstitial pneumonia (AIP) is a rare complication related to ALIS that has only been noted in a few case reports in the literature thus far. In the CONVERT trial, drug induced lung injury due to ALIS was noted in 3.1%, but detailed descriptions are limited. ALIS has been approved as adjunctive therapy for the treatment of refractory pulmonary MAC infection. The report details a severe adverse respiratory complication. This patient's symptoms occurred rapidly after the initiation of ALIS. Corticosteroids should be considered in severe cases. Improved dyspnea, imaging, and PFT results can objectively measure patient's response to stopping therapy and steroid treatment.

Acute interstitial pneumonia should be considered in patients presenting with a rapid worsening of dyspnea after initiation of ALIS.

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ABSTRACT #224 MEDICAL EDUCATION INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE A NOVEL SIMULATION-BASED EDUCATIONAL CURRICULUM TO BRIDGE THE GAP BETWEEN SEPSIS AND POSTSEPSIS CARE Hammad Sheikh1, Harrinda Seepersaud1, Amit Pradhan1, Priscilla V. Loanzon1, Susannah Kurtz, Jacob Bell1, Ahmed Shaikh, Nikita Desia1, Adam Rothman1, James Salonia1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9 2024.

BACKGROUND/INTRODUCTION: Sepsis is a global health problem and despite improvements in care, hospital admissions attributed to sepsis continue to increase. Prompt recognition and delivery of high-quality care has improved sepsis mortality but has resulted in an increase in sepsis survivors who suffer from post-sepsis syndrome. This post-sepsis syndrome results in long-term health consequences with increased risk for exacerbation of chronic comorbidities, as well as cognitive and physical impairments. Additionally, sepsis is a major contributor to hospital readmissions, with almost one third of all sepsis survivors being readmitted to the hospital within 30 days. The goal of our novel, simulation-based educational curriculum was to evaluate and improve knowledge, understanding, and skills for sepsis and post-sepsis management.

METHODS: The curriculum focused on recognition and management of sepsis and post-sepsis syndrome. By incorporating high-fidelity simulation, residents had a unique opportunity to practice their skills managing sepsis and post-sepsis syndrome, implement the Mount Sinai Health System Stop Sepsis Guidelines, and incorporate point-of-care ultrasound (POCUS). A short didactic session, supervised by trained Critical Care faculty, focused on the educational gap in resident education for sepsis and Post-Sepsis Syndrome. A short debrief and feedback sessions were held thereafter. Learners completed pre- and post-simulation surveys to evaluate residents’ knowledge and understanding. P-values were calculated using paired two-sample t-tests, and p0.05 was considered to indicate statistical significance.

RESULTS: Fifty-six Internal Medicine residents participated, including 22 post-graduate year-1 (PGY-1) (39.3%), 18 PGY-2 (32.1%), and 16 PGY-3 (28.6%). All confirmed having never received formal training in post-sepsis care (n=56, 100%). A total of 52% (n=29) never or rarely used the Stop Sepsis Bundle. Less than half of the residents used the bundle set often, 33.9% (n=19), and only 14.2% (n=8) almost always used the bundle set.

POCUS findings in sepsis were only correctly determined in 46.4% (n=26), which further improved to 67.9% (n=38) (p<0.05). Initially, 8.93% (n=5) correctly recognized the causes of post-sepsis re-admissions, but this improved to 73.2% (n=41) in the post-assessment (p<0.05). Evaluation of resident knowledge on sepsis and post-sepsis care after simulation-based training compared to-pre-simulation survey revealed an 17.3% improvement. There was a statistically significant improvement in knowledge, as indicated by the average pretest score (Mean=0.593) and post-test score (Mean=0.772), with a t-statistic of -7.358 and a corresponding p<0.001.

CONCLUSION: Despite well-established protocols and management strategies for sepsis, recognition and compliance continue to be a challenge as reflected by our pre-session survey. Post-session surveys held after completing a high-fidelity stimulation session and didactics resulted in a statistically significant improvement in residents’ ability to recognize and manage sepsis and post-sepsis care. While sepsis guidelines have been well documented, Post-sepsis syndrome is a new area of care with limited information on strategies to minimize physical, cognitive impairment and/or health deterioration. This novel simulation-based curriculum educated residents on sepsis and Post-Sepsis Syndrome, utility of our Sepsis Bundle Set, and POCUS intervention in post-sepsis care. High-fidelity simulation can be utilized as a training tool to improve skills and knowledge among clinicians and thus improving clinical outcomes.

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ABSTRACT #225 CLINICAL RESEARCH PULMONARY/CRITICAL CARE EFFECT OF CATHETER-DIRECTED THROMBOLYSIS OR CATHETER-DIRECTED EMBOLECTOMY ON PULMONARY ARTERY PRESSURES IN INTERMEDIATE- AND HIGH-RISK PULMONARY EMBOLISM Howard Freeman1, Avinash Singh1, Hammad Sheikh1, Abdul Rehman1, Connor Smith1, Jeeyune Bahk1, Keshav Dixit1. Robert Lookstein1, David J. Steiger1,3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount

Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Risk stratification for pulmonary embolism (PE) directs potential choices of intervention. Patients with high-risk (HR) PE benefit from systemic thrombolysis, while anticoagulation alone is sufficient for low-risk PE. However, the optimal management of intermediate-risk (IR) PE, accounting for up to 40% of acute PE, remains controversial. With mortality rates ranging from 2-19% following systemic anticoagulation, evaluating and comparing the efficacy of advanced therapies is imperative. We investigated the impact of catheter-directed thrombolysis (CDT) and catheter-directed embolectomy (CDE) on pulmonary artery pressures (PAP) in IR and HR PE. METHODS: We performed a retrospective analysis of 69 consecutive patients with IRPE or HRPE admitted to three hospitals in the Mount Sinai Health System from January 2019 to December 2023 who received either CDT or CDE. The Pulmonary Embolism Response Team (PERT) determined the most appropriate intervention for each patient. Systolic, diastolic, and mean left and right PAP were measured before and after intervention.

Values were compared using Wilcoxon signed-rank test. Mean reduction in PAP between the CDT and CDE groups was compared using the Mann-Whitney test. Multivariate regression analysis was used to identify the impact of CDE or CDT on mortality, bleeding, 30-day re-admission, and serious adverse events.

RESULTS: CDT and CDE were performed in 43.5% and 56.5% of patients, respectively. The median patient age was 62 [interquartile range (IQR): 52‒71] years with 44.9% female and 55.1% male. White, Black, Asian and other races accounted for 46.4%, 42.0%, 5.8% and 5.8%, respectively. Based on the European Society of Cardiology risk stratification, there were 8.7% intermediate-low, 78.3% intermediate-high, and 13.0% high-risk patients. Chest computed tomography angiography demonstrated a saddle PE in 42% of patients and a main PA PE in 59.4% of patients. The median pre-intervention PAP in the left and right PA was 43/17 (27) and 44/18 (27) mm Hg, respectively. The median reduction in mean PAP after CDT and CDE was 5.5 (IQR: 2.5-7.25) and 7.0 (IQR: 5.0-8.75) mm Hg, respectively, which was statistically significant (p<0.0001 for CDE group and p=0.002 for CDT group). However, the difference in mean PAP reduction between the CDT and CDE groups was not statistically significant (p=0.106). There was no statistically significant difference in rates of mortality, bleeding, serious adverse events, or 30-day re-admissions following CDT or CDE, occurring in 8.7%, 7.2%, 15.9% and 10.1% of patients. The causes of death were shock (cardiogenic or obstructive) and hemorrhage in 7.2% and 1.4% of patients. Causes of 30-day re-admission included venous thromboembolism (3.0%), bleeding (1.4%), or unrelated to PE (5.8%).

CONCLUSION: CDT and CDE were associated with statistically significant reductions in mean PAP. However, there were no significant differences in the magnitude of mean PAP reduction between the two modalities, nor any significant differences in rates of mortality, 30-day re-admission, bleeding, or serious adverse events between the CDT and CDE groups.While CDT and CDE demonstrated statistically significant reductions in mean PAP, there were no differences in short-term significant clinical endpoints. Further research is required to study the long-term impacts of these interventions in patients with IR and HR PE.

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ABSTRACT #226 CLINICAL RESEARCH PULMONARY/CRITICAL CARE OUTCOMES FOLLOWING CATHETER-DIRECTED THROMBOLYSIS AND CATHETER-DIRECTED EMBOLECTOMY IN INTERMEDIATE AND HIGH-RISK PULMONARY EMBOLISM Hammad Sheikh1, Abdul Rehman1, Connor Smith1, Howard Freeman1, Avinash Singh1, Keshav Dixit1, Jeeyune Bahk2, Alvin Yang1, Robert Lookstein1, David J. Steiger1,3 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Beth Israel

Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Determining the optimal therapy for patients with intermediate-risk (IR) pulmonary embolism (PE) and high-risk (HR) pulmonary embolism (PE) who have a contraindication to systemic thrombolysis remains a key challenge for clinicians. Procedural interventions, such as catheter-directed thrombolysis (CDT) and catheter-directed embolectomy (CDE), have been employed, although there is a paucity of data directly comparing these interventions. Our study aimed to investigate the efficacy and safety outcomes of CDT and CDE in IR and HR PE. METHODS: We performed a retrospective analysis of 71 consecutive patients with IRPE or HRPE admitted to three hospitals in the Mount Sinai Health System from January 2019 to December 2023 who received either CDT or CDE. The Pulmonary Embolism Response Team (PERT) determined the most appropriate intervention for each patient. The primary and secondary outcomes were 30-day mortality, hospital and intensive care unit length of stay (LOS), need for mechanical ventilation, major bleeding, minor bleeding, serious adverse events, and 30-day re-admission rate. Propensity score weighted analysis was performed using the MatchIt package for R. RESULTS: CDT and CDE were performed in 42.5% and 54.9% of patients, respectively. The median patient age was 62 (interquartile range [IQR]: 52‒71) years and BMI was 30.1 (IQR: 26.5‒37.5) kg/m2 with 43.7% female and 56.3% male. White, Black, Asian and other races accounted for 47.9%, 40.8%, 5.6% and 5.6% respectively. Based on the European Society of Cardiology risk stratification, there were 8.4% intermediate-low, 78.8% intermediate-high, and 12.7% high-risk patients. With respect to outcomes, median hospital and ICU LOS were 5.8 days and 1.8 days, respectively. Major and minor bleeding episodes occurred in 7% of patients and serious adverse events occurred in 15.5%. There was no significant difference in mortality, major bleeding, serious adverse events, need for mechanical ventilation, 30-day re-admission rate, or ICU LOS between the CDT and CDE groups. However, patients in the CDT group had higher odds of minor bleeding (odds ratio: 1.100; p<0.001) and lower hospital LOS (incidence rate ratio: 0.002; p=0.03) than the CDE group.

CONCLUSION: Our study demonstrated that patients who underwent CDT or CDE for IRPE and HRPE had similar rates of mortality, major bleeding, serious adverse events, mechanical ventilation, and 30-day readmissions. The increased LOS in the CDE versus CDT cohort could possibly be related to the larger proportion of HRPE patients in the CDE group (20.5% versus 3.3%) and higher rates of malignancy (15.4% versus 6.7%).

The increased incidence of minor bleeding in the CDT versus CDE cohort may have been secondary to the use of thrombolytics in the CDT group. Optimal management of IRPE remains unclear. Our study suggests that significant outcomes of patients undergoing CDT and CDE are similar. However, randomized prospective studies comparing various treatment modalities are required. Further research is needed to study the long-term outcomes of patients undergoing CDT and CDE.

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ABSTRACT #227 CASE REPORT/CLINICAL REVIEW CARDIOLOGY RARE BUT DEADLY - EOSINOPHILIC MYOCARDITIS IN A PATIENT WITH EOSINOPHILIC GRANULOMATOSIS POLYANGIITIS Samantha Shetty1, Priya Shah1, Yee Soo Kim1, Angel De La Cruz Tejada1, Ankitha Radakrishnan2, Anya Srikureja2, Adam Jacobi2, Mary Beasley2, Kiran Mahmood1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Eosinophilic myocarditis (EM) is a rare inflammatory myocarditis characterized by eosinophilic infiltration of myocardial tissue. Despite the high mortality rate, EM is frequently underdiagnosed and is often first identified in postmortem studies. We share a case of EM as an early manifestation of newly diagnosed eosinophilic granulomatosis polyangiitis (EGPA).

CASE PRESENTATION: The patient is a 46-year-old female with a past medical history of ulcerative colitis and adult-onset asthma who presented to the emergency department with a 2–3-week history of worsening positional chest pain radiating to the left upper extremity. Associated symptoms include 3 months of fatigue, headaches, right foot neuropathy, urticaria, and B-symptoms. Prior to admission, the patient was started on empiric prednisone for presumed EGPA. Initial lab work on admission was notable for elevated troponin (602 ng/L), hyper-eosinophilia (19.5%), thrombocytosis (680K/uL), and elevated ESR (42 mm/h) that have improved since initiation of prednisone. Transthoracic echocardiogram revealed a newly reduced LVEF of 40% with basal and mid-septal wall motion abnormalities. Cardiac catheterization showed normal coronaries confirming the diagnosis of non- ischemic cardiomyopathy. Late gadolinium enhancement in cardiac MRI was seen in basal to mid segments with patchy pericardial enhancement, meeting the Lake Louise criteria for myocarditis. An endomyocardial biopsy showed substantial myocardial infiltration with lymphocytes, histiocytes and eosinophils, confirming the diagnosis of EM. After multidisciplinary team discussion with cardiology and rheumatology, the patient was started on guideline-directed medical therapy for her HFrEF and pulse dose steroids with a prolonged taper and cyclophosphamide. She is tolerating her treatment well.

DISCUSSION/CONCLUSION: This case highlights the importance of early recognition, comprehensive assessment and targeted treatment for EM depending on its underlying etiology. In the case of autoimmune dysfunction, it involves a combination of immunosuppressive and symptomatic therapy. Ongoing research is crucial to enhance our understanding and improve clinical outcomes, like arrhythmias and cardiogenic shock, for this complex condition.

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ABSTRACT #228 CLINICAL RESEARCH CARDIOLOGY UNVEILING THE BIOLOGICAL SUBTYPES OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION THROUGH UNSUPERVISED CLUSTERING OF ECG DATA Samantha Shetty1, Joshua Lampert2, Joy Jiang2, Girish Nadkarni2, Akhil Vaid2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Left Ventricular Diastolic Dysfunction (LVDD) presents a challenge in terms of management given its multifaceted etiology and complex presentation. Conventional diagnostic categories may fail to fully reflect underlying pathophysiology variability. Using unsupervised clustering on electrocardiogram (ECG) data is a novel approach to capture subtle changes in the electrical signatures seen in ECGs and help uncover naturally occurring patient subtypes that may be invisible to traditional echocardiographic (echo) assessment.

METHODS: We performed Natural Language Processing on long-form echo reports to extract annotations of LVDD. Echocardiogram reports were paired with an ECG performed within 7 days of the echo. Patients were excluded if their ECG diagnostic codes indicated conduction abnormalities, concurrent ischemia, and prior intervention. We applied a Convolutional Autoencoder to compress high-dimensional ECG data into a 128dimensional, feature-rich space suitable for clustering. K-means clustering was then utilized to categorize patients into groups based on transformed ECG features. Silhouette analysis was employed to determine the optimal number of clusters and quantify differences between groups. Chi-square and ANOVA tests examined for differences in age, sex, and race across clusters.

RESULTS: We identified 22,183 patients paired with 96,921 ECGs with clinician confirmed LVDD. Silhouette score analysis on K-Means clustering identified 2 as the optimal number of clusters. Labels associated with each data point were visualized in 2D and 3D projections with the t-Stochastic. Neighbor Embedding technique.

Identified clusters differed significantly in terms of age, sex, and race, with p-values of <0.00001 for each demographic.

CONCLUSION: The identification of two distinct clusters underscores the potential of ECG-based phenotyping in revealing new biological subtypes of LVDD. Extending this technique to integrate other clinical variables and longitudinal data may enhance the clinical utility of identified subtypes. Future work will look at cluster-wise distribution of co-morbidities and longitudinal outcomes. Applying similar methodologies to other cardiac disorders may improve our approach to their diagnosis and management. Employing unsupervised clustering on ECG has proven to be effective in identifying novel subtypes of LVDD, showcasing the potential of ECG data to refine diagnostic and therapeutic strategies.

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ABSTRACT #229 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE COMBINED LUNG AND LIVER TRANSPLANT FOR CIRRHOSIS, IDIOPATHIC PULMONARY FIBROSIS, AND HEMOPHILIA A Lorenzo Olivero1, Hong Liang2, Ian Makey2, Si M. Pham2, Jorge Sinclair de Frias3, Stephen Aniskevich2, Sadia Shah2, Dana Perry2, Wesley Allen2, Nathan Waldron2, Liu Yang2, Pramod K. Guru2, Candido Rivera2, Pablo Moreno Franco2, Tathagat Narula2 1Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; 2Mayo Clinic, Jacksonville, FL,

United States; 3Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Combined lung and liver transplantation (CLLT) is a rare intervention for end-stage lung and liver diseases and poses significant challenges in patients with increased bleeding risk due to hemophilia and liver coagulopathy. In this report, we present the case of a patient with IPF, HCV-associated cirrhosis, and hemophilia A who underwent CLLT, being the first reported case of a CLLT in the management of three distinct diseases, including the correction of the hemophilia phenotype CASE PRESENTATION: A 61-year-old male with mild hemophilia A, hepatitis C, and idiopathic pulmonary fibrosis (IPF) on home oxygen diagnosed in 2021, was referred for lung transplantation due to significant deterioration in his lung condition. By June 2023, the pre-transplant evaluation began, as shown in Table 1.

However, by July, he was admitted with acute on chronic hypoxic respiratory failure requiring ICU and prompting emergent listing for a CLLT and performed it on day 22. The patient's FVIII level was 23-36% on admission. We aimed for 100-120%, avoiding excesses of 200% during the pre-transplantation phase. Standard protocol for DVT prophylaxis with low-weight heparin and sequential compression devices was administered. Following V-A ECMO cannulation, the liver transplant was performed first, followed by the bilateral lung transplant. FVIII was monitored hourly during the liver transplant, keeping levels between 100-120% and avoiding >140% during ECMO. -aminocaproic acid infusion was given, and heparin was intermittently bloused to maintain ACT > 180, which was checked every 30 minutes. After the transplantation procedure, FVIII levels were monitored every 6 hours, targeting 100%. Bivalirudin was administered the next day as per our ECMO protocol. The postoperative course was uneventful showing complete recovery and transfer to the floor by day 9. The lung transplant team led the immunosuppression regimen as per protocol.

DISCUSSION/CONCLUSION: The rapid decline in pulmonary function often drives the need for CLLT, with compensated end-stage liver disease and low MELD scores, as observed in our case. Recommended preoperative FVIII levels are 80-100% for major surgeries. We aimed for 60% FVIII activity on V-A ECMO, which requires less anticoagulation than CPB due to no reservoir blood stagnation and a smaller surface area (ACT > 480s for CPB vs 180–200s for ECMO). In our experience, patients with liver failure exhibit an exaggerated response to heparin, requiring lower doses to meet VA ECMO anticoagulation targets (ACT 160- 180s).

Postoperative targets may be lower to emulate normal hemostasis in non-hemophilic individuals, thus allowing standard anticoagulation. Our patient required no further FVIII replacement. This can be attributed to the transplanted liver's ability to synthesize FVIII. This phenomenon was first reported in 1985. However, liver transplantation does not always end in a hemophilic phenotype cure, possibly due to host hemophilic cell integration into the graft. We present a unique case of CLLT in a patient with hemophilia, cirrhosis, and IPF. While CLLT is not a primary Hemophilia A treatment, it demonstrates its potential in specific cases. This underscores the need for individualized care, and multidisciplinary collaboration to refine strategies for patients with multiple coexisting conditions.

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ABSTRACT #230 CLINICAL RESEARCH PULMONARY/CRITICAL CARE PERCUTANEOUS TRACHEOSTOMY TIMING AND OUTCOMES: A RETROSPECTIVE ANALYSIS Jorge Sinclair de Frias1, Yoshiko Ishisaka1, Keshav Dixit,1 Shasha X. Chen1, Lina Miyakawa1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Percutaneous tracheostomy is often performed in the intensive care unit (ICU) for critically ill patients requiring extended mechanical respiratory support. Though the numerous benefits of tracheostomy, such as reduction in ICU length of stay (LOS), duration of ventilatory support, and need for sedation, are well known, the ideal timing of performing the procedure remains controversial. In this study, we aim to identify optimal percutaneous tracheostomy timing and its effect on a spectrum of clinical outcomes.

METHODS: We conducted a retrospective analysis of patient outcomes, focusing on those who underwent early versus late percutaneous tracheostomy within the medical ICU of a three-hospital system in New York City. The definition of early and late tracheostomy was contingent upon varying cutoff days, ranging from 10 to 14 days post-intubation. We evaluated the outcomes associated with early and late interventions for each of these cutoff days.

RESULTS: The study included 396 medical ICU admissions. Among these, the early tracheostomy cohort consisted of 123 patients when the cutoff was set at 10 days, 148 at 11 days, 167 at 12 days, 186 at 13 days, and 205 at 14 days. Patients who underwent intubation for airway compromise consistently underwent earlier tracheostomy across all cutoffs, demonstrating statistical significance. There was no statistically significant difference for in-hospital survival (p=0.437, 0.425, 0.455, 0.480, and 0.656, respectively) or ICU survival (p= 0.474, 0.566, 0.438, 0.328, 0.345, respectively) between the early and late cohorts across all five cutoffs.

However, significant differences were observed in both hospital and ICU LOS with consistently shorter LOS observed among early groups. The variance in hospital LOS ranged from 7 days for the 10 and 12-day cutoffs to 11 days for the 14-day cutoff. The difference in ICU LOS ranged from 9.65 days for the 10-day cutoff to 12.5 days for the 12-day cutoff. Regarding tracheostomy-related complications, there were no significant differences in the rates of bleeding and pneumothorax between groups. Nonetheless, pneumonia was observed more frequently in the early group at the 12, 13, and 14-day cutoffs (21% versus 11.8%, p=0.019; 21% versus 11%, p=0.009; 20.5% versus 10.5%, p=0.009, respectively).

CONCLUSION: Our analysis revealed no difference in hospital and ICU mortality between early and late percutaneous tracheostomy cohorts across different cutoff dates. Early tracheostomy correlated with shorter hospital and ICU lengths of stay, irrespective of cutoff; findings that are consistent with prior literature.

Tracheostomy-related complications showed no significant differences between groups, except for a significantly higher prevalence of pneumonia in the early cohort at 12, 13, and 14-day cutoffs. Our study findings can be used to guide discussions with patients and families regarding the timing of tracheostomy, weighing potential benefits in terms of shorter ICU and hospital LOS against the potential increased risk of specific complications like pneumonia, thus promoting shared decision-making and patient-centered approaches. However, it is important to acknowledge that definitive cutoffs for tracheostomy timing remain uncertain.

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ABSTRACT #231 CLINICAL RESEARCH INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE SEPSIS OUTCOMES IN LIVER TRANSPLANTATION: A RETROSPECTIVE ANALYSIS Jorge Sinclair de Frias1, Abigail Gabela2, Keshav Dixit1, Lorenzo Olivero3, James Salonia1 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Universidad de Panama, Panama City, Panama; 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY,

United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: The relationship between solid organ transplant (SOT) patients and sepsis outcomes remains a topic of ongoing debate and uncertainty. Observational studies have presented conflicting results, with some even suggesting a paradoxical lower risk of mortality among SOT patients with sepsis when compared with non-SOT patients. This study aims to explore and compare sepsis outcomes between liver transplant patients and non-SOT patients.

METHODS: This is a retrospective cohort analysis of patients aged 18 years admitted between January 2017 and December 2019 with a primary diagnosis of sepsis in the National Inpatient Sample. Patients were categorized into those with and without a history of liver transplant. The primary outcome assessed was inhospital mortality, while secondary outcomes examined complications such as organ failure and necessary procedures. Multivariate logistic regression analysis was employed to account for variables including age, gender, race, income quartile, comorbidities, septic shock, hospital bed size, and region.

RESULTS: A total of 6,354,549 patients were admitted with a primary diagnosis of sepsis, among whom 14,030 (0.23%) were liver transplant recipients. Liver transplant patients were more likely to be younger, male, and Hispanic. They also exhibited significantly higher rates of diabetes mellitus and renal disease but lower rates of myocardial infarction, congestive heart failure, peripheral vascular disease, dementia, chronic obstructive pulmonary disease, rheumatic diseases, and metastatic malignancy. Liver transplant recipients had a significantly higher mean CCI of 4.2 compared to 2.7 in non-liver transplant patients (p<0.0001), and they were more likely to have a CCI score of 3 or higher. Additionally, liver transplant patients were more likely to have septic shock (17.1% versus 14.4%, p<0.0001). Analysis showed that there were no significant differences on mortality rates between patients with and without liver transplant (8.1% versus 8.9%, p=0.13). However, after adjusting for baseline characteristics, liver transplant was associated with decreased odds of in-hospital mortality among patients admitted with sepsis (adjusted odds rati, 0.64; 95%CI, 0.54-0.74; p<0.0001). Secondary outcomes, such as organ failure (pulmonary, cardiovascular, hepatic, hematologic, metabolic, and renal) and procedures (transfusions, mechanical ventilation, and vasopressor use), were significantly more prevalent in the liver transplant group. However, there were no significant differences in the prevalence of neurologic failure and tracheostomy between the groups.

CONCLUSION: Liver transplant recipients admitted with sepsis exhibit distinct demographics and comorbidity profiles, with a higher risk of organ failure and procedures, yet they demonstrate decreased odds of in-hospital mortality, highlighting the complex interplay between transplantation status and critical illness outcomes. Our study adds to the evidence suggesting that liver transplant recipients with sepsis may have better outcomes in terms of in-hospital mortality, contributing to the ongoing discussion regarding mortality trends in this specific patient population.

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ABSTRACT #232 CLINICAL RESEARCH PULMONARY/CRITICAL CARE SEPSIS OUTCOMES IN LUNG TRANSPLANT RECIPIENTS: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE Jorge Sinclair de Frias1, Keshav Dixit1, Abigail Gabela2, Lorenzo Olivero3, and James Salonia1 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Universidad de Panama, Panama City, Panama; 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY,

United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Despite the heightened sepsis risk in solid organ transplant (SOT) patients, recent studies have questioned the conventional assumption that SOT patients fare worse than non-SOT counterparts. However, given the distinctive features of lung transplant recipients, their sepsis outcomes may differ significantly from other transplant groups. Our objective is to investigate the correlation between lung transplantation and sepsis outcomes.

METHODS: We performed a retrospective cohort study of the National Inpatient Sample database for all adult patients (18 years old) with sepsis as the principal diagnosis from January 1, 2017, to December 31, 2019.

Patients were categorized into those with and without a history of lung transplant. We analyzed and compared mortality rates, the occurrence of organ failure, and procedures between groups. Multivariate logistic regression analysis was employed to account for baseline characteristics.

RESULTS: A total of 6,354,549 patients were admitted with a primary diagnosis of sepsis, among whom 3,415 (0.23%) were lung transplant recipients. Lung transplant patients had a median age of 63 years, with 54.6% being male. The majority of lung transplant patients were Caucasian (77.9%). Lung transplant patients exhibited higher rates of chronic obstructive pulmonary disease, rheumatic disease, diabetes with complications, renal disease, and HIV/AIDS, and lower rates of myocardial infarction, congestive heart failure, dementia, and mild liver disease. Lung transplant patients had a significantly higher mean Charlson Comorbidity Index (CCI) (3.1 versus 2.7, p=0.0006), with 72.8% having a CCI score of 3 or more compared to non-SOT patients with 63.6% (p<0.0001). Septic shock was significantly higher in the lung transplant group (25.3% versus 14.4%, p<0.0001).

Analysis revealed significantly higher mortality rates in lung transplant patients (11.7% versus 8.9%, p=0.012) and was associated with increased unadjusted odds of in-hospital mortality (OR, 1.35; 95%CI,1.07-1.71; p=0.011). However, after adjusting for baseline characteristics, there was no difference in the odds of in-hospital mortality (aOR, 1.29; 95%CI, 0.98-1.70; p<0.072). Additionally, lung transplant patients exhibited a higher occurrence of pulmonary (49.6% versus 34.5%, p<0.0001), cardiovascular (29.7% versus 20.3%, p<0.0001), hematologic (14.2% versus 10.6%, p=0.0038), metabolic (27.9% versus 23.5%, p=0.0089), and renal (71.6% versus 47.2%, p<0.0001) organ failure. Neurologic organ failure was less likely to occur in lung transplant patients, and there was no significant difference in hepatic organ failure between groups. Additionally, all procedures, including transfusions, tracheostomy placement, mechanical ventilation use, and vasopressor use, were significantly higher in the lung transplant cohort.

CONCLUSION: Sepsis in lung transplant patients has similar mortality to non-SOT patients. However, lung transplant patients had increased susceptibility to multi-organ dysfunction, highlighting the need for proactive and individualized clinical interventions in this population. Clinicians should implement rigorous monitoring strategies for lung transplant patients with sepsis, focusing on early detection of organ dysfunction and prompt interventions to optimize outcomes.

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ABSTRACT #233 CLINICAL RESEARCH PULMONARY/CRITICAL CARE SURVIVING THE ODDS: KIDNEY TRANSPLANT PATIENTS AND SEPSIS OUTCOMES Jorge Sinclair de Frias1, Abigail Gabela2, Keshav Dixit1, Lorenzo Olivero3, James Salonia1 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States’

2Universidad de Panama, Panama City, Panama; 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY,

United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Kidney transplantation is the most prevalent solid organ transplant (SOT) procedure globally. Among kidney transplant recipients, sepsis ranks as the second leading cause of mortality, trailing behind cardiovascular disease. A detailed investigation into sepsis outcomes among kidney transplant recipients holds potential to enhance existing prevention and management strategies, as well as optimize posttransplant care for this population. Thus, our study aims to explore the relationship between prior kidney transplantation and sepsis outcomes.

METHODS: This is a retrospective cohort analysis of patients aged 18 years admitted between January 2017 and December 2019 with a primary diagnosis of sepsis in the National Inpatient Sample. Patients were categorized into those with and without a history of kidney transplant. The primary outcome assessed was inhospital mortality, while secondary outcomes examined complications such as organ failure and necessary procedures. Multivariate logistic regression analysis was employed to account for variables including age, gender, race, income quartile, comorbidities, septic shock, hospital bed size, and region.

RESULTS: 61,410 (0.97%) of the 6,354,549 patients admitted with sepsis were kidney transplant recipients.

Compared to non-SOT patients, kidney transplant patients tended to be younger, male, and more likely to be African American or Hispanic. They had significantly higher rates of comorbidities such as myocardial infarction, congestive heart failure, peripheral vascular disease, rheumatic disease, and diabetes with and without complications. On the other hand, kidney transplant patients showed lower rates of cerebrovascular accident, dementia, chronic obstructive pulmonary disease, peptic ulcer disease, moderate to severe liver disease, metastatic malignancy, and HIV/AIDS. The kidney transplant cohort also had significantly higher mean CCI (4.0 versus 2.7) with a greater likelihood of having a CCI score of 3 or higher. In addition, kidney transplant patients were less likely to have septic shock (13.3% versus 14.4%, p=0.0004). Mortality rates were significantly lower in kidney transplant patients compared to non-SOT patients (6.5% versus 9%, p<0.0001). Kidney transplant was associated with decreased unadjusted and adjusted odds of in-hospital mortality (OR, 0.70; 95%CI, 0.65-0.75; p<0.0001; aOR, 0.87; 95%CI, 0.80-0.94, p<0.0001). Comparing kidney transplant to non-SOT patients, there was a decrease in the frequency of pulmonary (26.5% versus 34.6%, p<0.0001), cardiovascular (19.3% versus 20.3%, p=0.014), hepatic (1.9% versus 3.3%, p<0.0001), and neurologic (15.3% versus 18.3%, p<0.0001) organ failure. Conversely, an increased occurrence rate of hematologic (12.9% versus 10.6%, p<0.0001), metabolic (28.2% vs 23.4%, p<0.0001), and renal (68.7% versus 47%, p<0.0001) failure was observed in the kidney transplant cohort. Kidney transplant patients required more blood transfusions and vasopressors but were less likely to require mechanical ventilation.

CONCLUSION: The observed lower mortality and unique organ failure profiles in kidney transplant recipients emphasize the importance of individualized care approaches in septic patients with history of SOT. The favorable outcomes seen in septic kidney transplant patients prompt further research into immune responses and therapeutic interventions that could benefit both transplant and non-transplant septic patients.

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ABSTRACT #234 CLINICAL RESEARCH PULMONARY/CRITICAL CARE UNDERSTANDING SEPSIS IN HEART TRANSPLANT PATIENTS Jorge Sinclair de Frias1, Lorenzo Olivero2, Abigail Gabela3, Keshav Dixit1, James Salonia1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; 3Universidad de Panama, Panama

City, Panama

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Sepsis remains a critical concern in healthcare, especially among vulnerable populations such as solid organ transplant (SOT) recipients. Among these, heart transplant patients face unique challenges due to their immunocompromised state and complex medical histories, making sepsis outcomes a crucial area of study and intervention. In our study, we aim to explore how heart transplantation affects sepsis outcomes, focusing on mortality, organ failure patterns, and procedural needs.

METHODS: We performed a retrospective cohort study of the National Inpatient Sample database for adult patients with sepsis as the principal diagnosis from January 1, 2017, to December 31, 2019. Patients were categorized into those with and without a history of heart transplant. We analyzed and compared mortality rates, the occurrence of organ failure, and procedures between groups. Multivariate logistic regression analysis was employed to account for baseline characteristics.

RESULTS: Among patients admitted with sepsis, the vast majority (N=6,349,679; 99.92%) were non-SOT recipients, while a minority (N=4,870; 0.08%) had a history of heart transplant. Heart transplant patients had a median age of 64 years, with 75.9% being male. The majority of heart transplant patients were Caucasian (64.8%), followed by African American (17.2%). They exhibited a significantly higher prevalence of comorbidities such as myocardial infarction, congestive heart failure, peripheral vascular disease, diabetes with complications, and renal disease. Conversely, lower prevalence rates of dementia, chronic obstructive pulmonary disease, rheumatic disease, liver disease, and metastatic malignancy were observed in the heart transplant group. The mean Charlson Comorbidity Index (CCI) was significantly higher in heart transplant patients (3.8 versus 2.7 in non-SOT patients, p<0.0001), with a greater likelihood of having a CCI score of 3 or higher. Nonetheless, there was no difference in the rates of septic shock between groups (p=0.103). Heart transplant patients experienced significantly lower in-hospital mortality rates (6.8% versus 8.9%, p=0.021) compared to non-SOT patients. Even after adjusting for baseline characteristics, Heart transplant was associated with reduced odds of in-hospital mortality among septic patients (OR, 0.74; 95%CI, 0.57-0.96; p=0.021; adjusted OR, 0.74; 95%CI, 0.50-0.98; p=0.036). The heart transplant cohort exhibited higher frequencies of cardiovascular (25.6% versus 20.3%, p=0.0001) and renal (66.9% versus 47.2%, p<0.0001) organ failure. Conversely, pulmonary (30.1% versus 34.5%, p=0.0045), hepatic (1.9% versus 3.3%, p=0.018), and neurologic (13.4% versus 18.3%, p=0.0001) organ failure were less common in the heart transplant group. Differences in required procedures were not significant between groups except for vasopressor use, which was higher in the Heart transplant cohort (6.9% versus 3.4%, p<0.0001).

CONCLUSION: Sepsis heart transplant recipients admitted with sepsis demonstrate lower mortality rates compared to non-SOT patients. Furthermore, Heart transplant is associated with a higher rate of cardiovascular and renal failure but a lower rate of pulmonary, hepatic, and neurologic failure. Further studies are warranted to explore the mechanisms underlying the differences in sepsis outcomes among Heart transplant and non-SOT patients, with a focus on refining risk stratification, optimizing organ support strategies, and improving overall outcomes in this vulnerable population.

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ABSTRACT #235 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE PLEURAL EMPYEMA SECONDARY TO XANTHOGRANULOMATOUS PYELONEPHRITIS Connor Smith1, Mohammed I. Alsaud1, Bertin D. Salguero1, Omry Zuckerman1, Avinash Singh1, Susannah Kurtz1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Xanthogranulomatous pyelonephritis (XGP) is a rare form of renal infection as a consequence of prolonged urinary tract obstruction. The term "xanthogranulomatous” refers to the destruction and replacement of renal tissue with granulomatous tissue containing lipid-laden macrophages. The aggressive nature of the inflammation can lead to tissue destruction and fistulization of nearby organs. In rare cases, the inflammation can invade the diaphragm and enter the pleural space. Here, we present one such case of empyema thoracis caused by XGP. CASE PRESENTATION: A 65-year-old woman with a known hydronephrotic right kidney presented to the ED with shortness of breath, cough, right-sided chest pain, weight loss, and night sweats. Physical examination revealed tachypnea, hypoxia, and decreased breath sounds on the right. Serology revealed leukocytosis and kidney injury. Chest radiography revealed a large right pleural effusion. Computed tomography (CT) of the chest demonstrated a loculated pleural effusion with significant atelectasis of the right lung. CT of the abdomen revealed severe pyelonephritis infiltrating the upper pole of the right kidney with an adjacent suprarenal abscess infiltrating the right hemidiaphragm, and a retroperitoneal abscess. A 14-French thoracostomy tube was placed with initial drainage of 1.1L of purulent appearing fluid. Pleural fluid grew out Streptococcus anginosus group and Proteus mirabilis. In addition to systemic antibiotics, intrapleural enzyme therapy was administered. A right percutaneous nephrostomy was inserted and nephrostogram demonstrated fistulization between the right kidney and the duodenum. After medical optimization, she underwent open right nephrectomy, repair of the duodenal fistula and partial colectomy. Histopathology of the right kidney revealed granulation tissue surrounded by lipid laden foamy macrophages, consistent with XGP. DISCUSSION/CONCLUSION: Xanthogranulomatous pyelonephritis is uniquely aggressive among renal infections. Its tendency to render the affected kidney nonfunctional while invading nearby organs via fistulization can result in prolonged hospitalization and poor outcome. Total nephrectomy of the affected kidney is the only definitive management but may be delayed by severe sepsis. The rare formation of thoracic empyema, as we describe here, can cause even greater surgical risk and complications. In our case, prompt chest tube placement allowed for near complete resolution of the empyema by the time of nephrectomy. In conclusion, providers should be wary of XGP when confronted with prolonged hydronephrosis and a nonfunctional kidney. A multidisciplinary, systematic assessment of the entire body is warranted when extrarenal complications such as empyema or renoduodenal fistulae are suspected. Early intervention leads to better outcomes, but if present, empyema must be optimized pre-operatively to minimize intraoperative complications.

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ABSTRACT #236 MEDICAL EDUCATION PULMONARY/CRITICAL CARE A NOVEL COMPARISON OF LUNG POINT OF CARE ULTRASOUND INTERVENTIONS: AN INTROSPECTIVE REVIEW OF POINT OF CARE ULTRASOUND CURRICULUM Hua-Hsin Tai1, Harrindra Seepersuad1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: To evaluate the effectiveness of two different teaching modalities for training resident learners on how to correctly identify various common and pathologic lung ultrasound (LUS) findings.

METHODS: This project compared two separate interventions to see which of the teaching methods was better at delivering knowledge to resident learners and increasing recognition of LUS findings. The first intervention consisted of a two-week point of care ultrasound (POCUS) elective where residents received daily small group didactic sessions on various POCUS topics, including lung ultrasound, which was then followed by hands-on practice (under the supervision of POCUS experts) with real-time feedback on image recognition and interpretation. The second intervention, performed in the simulation center in small groups, consisted of a thirtyminute lecture on thoracic ultrasound techniques and image recognition followed by a thirty-minute case-based scenario where learners evaluated a patient with sudden shortness of breath and had to use POCUS to assist in formulating a diagnosis and treatment plan. This study employed paired-sample t-tests and independent ttests to analyze the pre-test and post-test scores of assessing the alterations in learners’ common thoracic ultrasound identification. Residents were asked to identify multiple lung findings in the POCUS elective (n=41) intervention and simulation center sessions (n=224). A subset of the simulation center residents that had taken the POCUS elective prior to this intervention were compared to the rest of the residents who had never taken the POCUS elective.

RESULTS: In the POCUS elective group, residents showed significant improvement (p<0.05) in all thoracicthemed questions. In the simulation session group, residents showed significant improvement (p<0.05) in all questions except one (identifying the diaphragm). Further sub-analysis compared residents with only the simulation experience (0.887) to those who had additional prior POCUS elective experience (0.9262), showing that the mean score was higher in those with more overall POCUS experience.

CONCLUSION: The ability to gather POCUS imaging plays a critical role in utilizing and applying the learned knowledge. Both intervention groups showed improvements in learners’ recognition of thoracic POCUS findings.

Prior POCUS elective experience helped residents recognize thoracic POCUS findings better than those without experience, but this difference shrunk drastically after the simulation session. On average, those with more prior POCUS experience were better able to accurately identify thoracic POCUS imaging. Interestingly, the POCUS elective (a two-week course) taught learners how to identify LUS findings with similar success to the one-hour thoracic-specific simulation session.

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ABSTRACT #237 CLINICAL RESEARCH CARDIOLOGY BARRIERS TO THE BRAIN: UNVEILING THE IMPACT AND DISPARITIES OF SENTINEL CEREBRAL PROTECTION IN TRANSCATHETER AORTIC VALVE REPLACEMENT PATIENTS Samuel Tan1, Lucy Zheng1, Wenchy Siu1, Robert Trenschel1, Marlon Rivera Boadla2, Sakshi Khurana3, Amit Gulati1 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States;

2Maimonides Health, Brooklyn, NY, United States; 3New York/Presbyterian Columbia, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: The Sentinel Cerebral Protection System (SCPS) was initially demonstrated to lower stroke risk during transcatheter aortic valve replacement (TAVR). However, recent trials have failed to confirm these benefits and have excluded patients with specific risk factors that increase stroke risk. To evaluate the impact of the SCPS on in-hospital mortality, complications, hospital costs, and length of stay in patients undergoing TAVR, and to identify trends and disparities in SCPS utilization across different racial, ethnic, and income groups.

METHODS: This retrospective study utilized the National Inpatient Sample to identify patients undergoing TAVR and SCPS from 2017 to 2020. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included complications, hospital costs, and length of stay. Weighted multivariable logistic regression and chisquare tests were used to analyze outcomes, controlling for comorbidities, age, gender, and, when appropriate, race/ethnicity.

RESULTS: The study included 67,670 TAVR patients, with 4,410 using SCPS. SCPS prevalence increased from 180 to 2,790 over the study period without significant differences in mortality, length of stay, or cost compared to those without SCPS. Patients using SCPS had lower odds of stroke (OR, 0.48; p<0.040) and post-procedural hemorrhage (OR, 0.682; p<0.039). Hispanic patients utilizing SCPS had higher hospital costs ($55,983; p<0.010) without a difference in length of stay. SCPS was less likely to be used in Black (OR, 0.49; p<0.001) and Hispanic (OR, 0.36; p=0.013) patients. Compared to White patients in the lowest income quartile, SCPS was more likely to be used in the second (OR, 1.28; p<0.017), third (OR, 1.67; p<0.001), and fourth (OR, 1.74; p<0.001) quartiles.

No similar income-based trend was observed for other racial or ethnic groups.

CONCLUSION: SCAD No significant difference in in-hospital mortality was observed among patients using SCPS during TAVR. However, SCPS use was associated with lower odds of complications without changes in length of stay or cost. Despite these associated benefits and the absence of significant contraindications, disparities in SCPS utilization were observed across racial, ethnic, and income groups.

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ABSTRACT #238 CLINICAL RESEARCH CARDIOLOGY DELINEATING SCAD AND NON-SCAD IN ACUTE MYOCARDIAL INFARCTION: PREVALENCE, DEMOGRAPHIC PREDICTORS, AND CLINICAL OUTCOMES Samuel Tan1, Atsuyuki Watanabe1, Robert Trenschel1, Wenchy Siu1, Paulus Adinugraha1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Heart Association (AHA) Annual Meeting that was held in Chicago, Illinois, United States from November 16-18, 2024.

BACKGROUND/INTRODUCTION: Spontaneous Coronary Artery Dissection (SCAD) is an rare but increasingly recognized cause of acute myocardial infarction (AMI) traditionally thought to predominantly affect young healthy women without typical cardiac risk factors. Recent studies suggest that SCAD may be underdiagnosed, particularly among underrepresented ethnic minority groups, and that its prevalence and clinical characteristics may vary across different populations. Furthermore, gender specific differences have not yet been well explored.

Contemporary population-based studies on SCAD are lacking while comparing risk factors and trends to SCAD are not well explored. This study aims to elucidate the trends, incidence, and risk factors associated with SCAD compared to non-SCAD acute myocardial infarction (AMI) patients. We hypothesize that there are demographic and clinical differences between SCAD and non-SCAD AMI patients METHODS: We utilized data from the Nationwide Inpatient Sample (NIS) database from January 1, 2016, to December 31, 2019, identifying patients with AMI who underwent angiography. Patients were stratified into SCAD and non-SCAD AMI groups. Multivariable logistic regression was performed to identify risk factors associated with SCAD, and in-hospital outcomes were compared between the two groups.

RESULTS: Out of 1,912,780 AMI patients, 0.93% were identified with SCAD. Female SCAD patients had a median age of 57 years compared to 72 years for non-SCAD females. For males, the median age was 62 years for SCAD and 67 years for non-SCAD. Older age was associated with a lower risk of SCAD, while female sex and fibromuscular dysplasia (FMD) increased the risk. SCAD patients experienced higher in-hospital mortality (5.1% versus 3.5%), more post-procedural bleeding (8.0% versus 6.6%), and greater use of mechanical circulatory support (MCS) (13.9% versus 6.2%).

CONCLUSION: SCAD patients show distinct age and gender-specific risk factors compared to non-SCADAMI patients. SCAD is associated with higher in-hospital complications, including mortality and post-procedural bleeding. Understanding these differences is crucial for improving the diagnosis and management of SCAD in diverse patient populations.

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ABSTRACT #239 QUALITY IMPROVEMENT GENERAL INTERNAL MEDICINE LIFESTYLES VITAL SIGNS AS A TOOL TO SCREEN FOR HEALTHY HABITS Richard Vaca1, Patricia Dharapak2, Desiree Chow2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Mount Sinai Health System Department of Medicine Research Day that was held in New York, New York, United States from April 28-29, 2025.

BACKGROUND/INTRODUCTION: Unhealthy lifestyles such as poor diet, poor sleep, stress, and physical inactivity are important occult drivers of common chronic health conditions Assessing a patient’s health and wellbeing through a lifestyle ‘vital signs’ survey can augment the management of chronic diseases. A 7-question lifestyle screening questionnaire to assess domains of nutrition, exercise, sleep quality, stress management, connectedness, and readiness for change. Over a 24-week period, the questionnaire was piloted by 3 residentproviders in an urban, internal medicine resident continuity clinic within an academic health system located in the mid-Atlantic. Adult visits for follow up of chronic medical conditions or annual exam comprised the target population. Clinic residents were introduced to this quality initiative through a faculty-led didactic on lifestyle medicine.

METHODS: The project assessed the feasibility of questionnaire implementation during a resident clinic visit.

Future steps will assess 1) impact of screening on patients’ readiness for change, 2) effects on patient satisfaction scores in the domain of physician communication, 3) impact on resident confidence in counseling patients on lifestyle changes, and 4) rate of questionnaire adoption by the clinic practice.

RESULTS: Of 137 patient encounters, 42 were excluded as inappropriate leaving 97 valid encounters with a questionnaire completion rate of 43% (n= 42). Sleep quality, exercise, and stress management were the lowest scoring domains, while readiness for change was among the highest scoring domains. Ninety-two percent (n=38) of the respondents appreciated being asked about lifestyle routines, 97% (n=40) found the questionnaire easy to understand, and 63% (n=26) wanted to receive additional resources that were easy to use and facilitated a discussion about lifestyle. Provider-reported barriers to implementation included the patient’s health literacy and visit time constraints. Next steps include abbreviating the questionnaire to match, questionnaire, capturing patient demographics for analysis, and tracking resources provided at the visit wrap-up.

CONCLUSION: Unhealthy lifestyles contribute to suboptimal control of chronic disease states, but assessing for lifestyle risks can be cumbersome and inconsistent. Routine assessment of a patient’s health and well-being can augment the management of chronic disease states. Use of a lifestyle questionnaire as a screening tool in the ambulatory setting appears feasible, can facilitate discussion, and potentially motivate lifestyle changes and improve patient experience.

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ABSTRACT #240 BASIC SCIENCE HEMATOLOGY/ONCOLOGY ELOTUZUMAB-IBERDOMIDE-DEXAMETHASONE COMBINATION THERAPY ACTIVATES T AND NK CELLS WITHIN THE IMMUNE MICROENVIRONMENT OF MULTIPLE MYELOMA PATIENTS Lucia Y. Chen1, Michael Amatangelo2, Adolfo Aleman3, Oliver Van Oekelen4, Tania Nevers2, Yongliang Sun2, William E. Pierceall2, Katerina Kappes5, Anna Blangiardo5, Sundar Jagannath3, Cesar Rodriguez4, Samir Parekh4 1University of Oxford, Oxford, United Kingdom; 2Bristol Myers Squibb, Summit, NJ, United States; 3Mount Sinai Hospital,

Icahn School of Medicine at Mount Sinai, New York, NY, United States; 4Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 5Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American Society of Hematology (ASH) Annual Meeting that was held in San Diego, California, United States from December 6-9, 2024.

BACKGROUND/INTRODUCTION: Elotuzumab, a monoclonal antibody targeting SLAMF7 on multiple myeloma (MM) cells, augments immune-mediated cytotoxicity through the direct activation of NK cells. Addition of Elotuzumab to immunomodulatory drugs (IMiDs) has been shown to improve progression-free survival of MM patients compared to IMiDs alone. We have recently described the immune-stimulatory effects of cereblon E3 ligase modulators (CELMoDs) on the tumour microenvironment (Oekelen et al, Cell Reports Medicine 2024, Chen et al ASH 2023). Here, we report the detailed peripheral blood (PB) and bone marrow (BM) immunophenotypic characteristics of relapsed refractory (RR) MM patients treated as part of the phase 1 Elotuzumab-Iberdomide-Dexamethasone (Elo-Iber-Dex) clinical trial.

METHODS: We characterized paired screening and treatment (C2D15) CD138-negative samples from bone marrow (n=5) and peripheral blood (n=6) of 6 RRMM patients treated with Elo-Iber-Dex as part of the phase 1 clinical trial (NCT05560399), using a custom designed immune-focused spectral fow cytometry panel. As part of the trial, patients received Elotuzumab 10mg/kg weekly for cycles 1-2 then 20 mg/kg 4-weekly, Iberdomide 1.0mg-1.3mg once daily for 21 days per 28-day cycle, and Dexamethasone 40 mg once weekly. Immune population frequencies are reported as median percentage of the parent population.

RESULTS: The median age of our cohort was 68 years (range 53 to 76 years) and median number of prior therapy lines was 3 (range 2 to 6). Two patients were classified as high-risk by ISS and cytogenetics at diagnosis.

Of the 6 treated patients thus far, partial response (PR) or better was achieved in 3 patients (complete response (CR), n=1; very good partial response (VGPR), n=1; PR, n=1). Most peripheral blood (PB) and bone marrow (BM) immune population frequencies, including, overall monocyte, T cell and NK cell populations remained stable on treatment. Similar to previous CELMoD studies, a trend toward increased activate immune cell populations was seen, with HLADR-positive CD4 T cell populations increasing from 6.36% to 14.6% (p=0.031) in PB and 6.22% to 14.9% (p=0.31) in BM. Compared to baseline, a noticeable increase in effector memory (CD45RA-CCR7-) CD8 T cells was seen on treatment, from 33.2% to 79.3% (p=0.094) in PB and 32.2% to 56% (p=0.31) in BM. Furthermore, an increase in Ki67-positive NK cells from 3.06% to 17.6% (p=0.094) in PB and 13% to 31.5% (p=0.062) in BM was observed. CD16-bright CD56-dim cytotoxic NK cells also increased on treatment from 19.6% to 61% (p=0.094) in PB and 42.2% to 58% (p=0.31) in BM, whilst CD16-positive CD56negative NK cells significantly reduced from 58.4% to 7.53% in PB (p=0.031) and 16.7% to 2.26% in BM(p=0.12).

The proportion of cytotoxic NK cells that were Ki67-positive also increased from3.5% to 7.94% (p=0.31) in PB and 5.78% to 26.2% (p=0.062) in BM. Patients who received Daratumumab (n=4) as part of their latest line of therapy had a lower proportion of CD16-bright CD56-dim cytotoxic NK cells (18.5%) in PB at baseline compared to patients (n=2) who had not recently receive an anti-CD38 monoclonal antibody (47.7%). On treatment, a near two-fold increase in the proportion of cytotoxic NK cells in PB was seen in both groups (18.5% to 45.2% Daratumumab, 47.7% to 88.6% no Daratumumab), suggesting Elo-Iber-Dex is, to some degree,

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able to augment NK cell activity in the context of recent anti-CD38 therapy.

CONCLUSION: Albeit with a small sample size, our initial immunophenotypic analyses demonstrate trends of T and NK cell activation in both PB and BM of MM patients treated with Elo-Iber-Dex. Of note, an increase in activated CD4 T cell populations, effector memory CD8 T cell populations and CD16-bright cytotoxic NK cell populations was observed on treatment, concordant with the known immune-stimulatory effects of both Elotuzumab and Iberdomide. Further functional studies are required to elucidate the possible synergistic effects on T and NK cell activation that may occur with combined CELMoD and SLAMF7 monoclonal antibody treatment.

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ABSTRACT #241 MEDICAL EDUCATION GASTROENTEROLOGY CASE-BASED LEARNING IN ACTION: ELEVATING RESIDENT KNOWLEDGE ON ACHALASIA DIAGNOSIS AND MANAGEMENT Ines Varela Knorr1, Swati Patel1, Daniela Jodorkovsky1, Priya Simoes1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

BACKGROUND/INTRODUCTION: Internal medicine (IM) residents often encounter variability in the depth and breadth of exposure to medical subspecialties due to their rotations across multiple clinical sites. This variability may contribute to challenges in board exam preparation, reflected in the nationwide decline in the first-time pass rate for the American Board of Internal Medicine (ABIM) Certification Exam, which dropped to 87% in 2023. To address this issue, we developed a targeted educational curriculum utilizing case-based learning to unify and enhance residents’ understanding of high-yield gastroenterology (GI) topics frequently tested on the exam.

METHODS: We conducted a 10-question needs assessment focused on ‘High Importance’ topics from the ABIM blueprint to evaluate familiarity with core GI subjects among residents at a large Internal Medicine program spanning multiple hospitals and outpatient sites. Based on the results, we developed case-based lectures targeting topics with the lowest familiarity. Each session consisted of one hour of protected educational time, covering two topics in 30- minute segments. Each topic was introduced through a clinical case, fostering open discussion among residents on differentials and management strategies. In the final 5 minutes, key points from the discussion were reiterated and expanded for clarity. Residents’ knowledge was assessed using pre- and post-learning assessments administered immediately before and after each lecture. The survey responses were analyzed by categorizing questions into those answered correctly and those answered incorrectly. P-value was calculated using Fisher’s exact test.

RESULTS: Of the 35 second- and third-year residents who completed the needs assessment, 77% (27 residents) reported feeling unfamiliar or somewhat unfamiliar with the diagnosis and management of upper GI motility disorders. Nineteen residents attended our case-based lectures. In the pre-assessment, 10 out of 19 residents (52.63%) correctly answered an ABIM-style question assessing knowledge of achalasia diagnosis and management. Following the intervention, 13 out of 15 residents (86.67%) answered the same question correctly.

Statistical analysis yielded a p-value of 0.06.

CONCLUSION: Case-based learning is a highly effective teaching modality in healthcare education, particularly suited to addressing gaps caused by variability in clinical exposure. In this study, we observed an improvement in participants’ knowledge of achalasia diagnosis and management following our lectures. However, the study’s impact was limited by a low number of residents completing both the needs assessment and the pre- and postlearning assessments, which likely contributed to the lack of statistical significance in the p-value. Future research should compare case-based learning with other educational approaches and evaluate its impact on long-term knowledge retention.

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ABSTRACT #242 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY HEMORRHAGIC COMPLICATION OF AN ULTRASOUND-GUIDED PARACENTESIS Emily Seltzer1, Ines Varela Knorr2, Walaa Mahmoud3, Alexander Davidovich2 1Memorial Sloan Kettering Cancer Center, New York, NY, United States; 2Mount Sinai Morningside-West Hospitals, Icahn

School of Medicine at Mount Sinai, New York, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Hemorrhage is a known, albeit infrequent, complication of paracenteses with a frequency of 2.2%. The use of ultrasound guidance decreases this risk to about 0.19%. We present a rare case of an injury to the deep circumflex iliac artery (DCIA) during an ultrasound-guided paracentesis.

CASE PRESENTATION: A 61-year-old male with alcohol-associated cirrhosis complicated recurrent ascites requiring frequent paracenteses, presented with abdominal pain and shortness of breath. Vitals signs revealed normal blood pressure, heart rate tachycardic (105 bpm), and afebrile. His exam was pertinent for abdominal distension and lower extremity edema. His labs were notable for a hemoglobin of 9.4 g/dL (baseline), leukocytes of 6.9 × 109/L, INR of 1.4, with a MELD-Na of 10. An ultrasound-guided diagnostic and therapeutic paracentesis was performed using an 18-gauge introducer needle in the right lower quadrant (Figure 1A). Two liters of cloudyyellow fluid were removed. Several hours later, he developed abdominal pain without vital sign changes initially.

The following morning, labs revealed a hemoglobin drop to 5.7 g/dL and new tachycardia to 110 bmp. A blood transfusion was ordered followed by a CT scan of the abdomen and pelvis. Upon returning from the scan, he was found pulseless in cardiac arrest. During the resuscitation, his hemoglobin was noted to be 3.8 g/dL and the CT scan revealed hyperattenuating material within the right hemiabdomen and pelvis compatible with hemoperitoneum. Massive transfusion protocol was initiated. Return of spontaneous circulation was obtained and the patient underwent an emergent CT angiography showing active extravasation (Figure 1B). Interventional radiology performed an embolization targeted at the right DCIA. Despite all resuscitative efforts, the patient developed multiorgan failure and expired 24 hours later.

DISCUSSION/CONCLUSION: Hemorrhage following injury to the DCIA after a paracentesis has been rarely reported. The damaged vessel often has a delayed presentation of hemorrhage without any visible hematoma.

Thus, providers should maintain a high index of suspicion for post-procedure hemorrhagic complications. The use of Doppler imaging during paracenteses may be underutilized and integrating this into routine practice may decrease the risk of such complications.

Figure 1. A) Bedside ultrasound-guided paracentesis of the right lower quadrant with visible introducer tip within ascitic fluid (red arrow). 2) Computed tomography angiography scan of the abdomen and pelvis showing extravasation from the deep right circumflex artery (white arrow) with surrounding hemoperitoneum.

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ABSTRACT #243 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY POSITIVE GASTRIC EMPTYING STUDY: GASTROPARESIS OR ACHALASIA? Ines Varela Knorr1 and Kimberly Cavailiere1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Gastric emptying studies (GES) are tests that have many limitations and can be falsely prolonged in the setting of achalasia. We present three patients in which falsely prolonged GES led to misdiagnosis of gastroparesis as the cause of their symptoms.

CASE PRESENTATION: Case 1: A 67-year-old male with history of epiphrenic diverticulum and right sided vagus nerve resection presented with weight loss, dysphagia to solids and regurgitation.

Esophagogastroduodenoscopy (EGD) showed dilation of the lower third of the esophagus. GES was positive.

Originally planned for Botox injection to the pylorus and subsequent gastric peroral endoscopic myotomy if successful. However, given EGD findings and dysphagia the patient underwent esophageal manometry which showed achalasia. Consequently, he instead underwent Botox injection to the lower esophageal sphincter. Three months after, the patient’s symptoms had resolved, and he was gaining weight. Case 2: A 74-year-old female with reported history of gastroparesis presented to the office after esophagram done for dysphagia showed narrowing of the distal esophagus. Patient reported dysphagia and regurgitation to both solids and liquids for 2 years. EGD showed dilation in the esophagus, hypertonic lower esophageal sphincter and no evidence of mass.

Manometry showed Type I Achalasia. She underwent successful pneumatic dilatation, resolving her symptoms entirely. Case 3: A 45-year-old female with reported history of gastroparesis presented with bloating, nausea, regurgitation, esophageal pain, weight loss and dysphagia to solids and liquids. Symptoms started in 2018 and she had undergone an extensive work up including positive GES, esophagram concerning for achalasia and equivocal esophageal manometry. Over the years, her symptoms had worsened despite treatment, and she had lost significant weight. She underwent repeat manometry which showed Type II Achalasia. EGD was repeated which ruled out pseudo achalasia and she underwent a Heller myotomy. Two months later her symptoms had resolved. Repeat GES after surgery was negative DISCUSSION/CONCLUSION: A study that looked at postprandial gastric relaxation in achalasia suggested that patients with achalasia might have secondary neural damage extending to the proximal stomach (Bittinger et al.

1998). This case series shows that these patients might have no damage to gastric motility. These false results might be because a dilated esophagus leads to the retention of food in the esophagus mimicking delayed gastric emptying on GES.

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ABSTRACT #244 MEDICAL EDUCATION PULMONARY/CRITICAL CARE SEDATION IN THE INTENSIVE CARE UNIT: A NOVEL ONLINE CASE-BASED INTERACTIVE LEARNING TOOL FOR RESIDENT EDUCATION Archana Pattupara1, Alexander Davidovich1, Mirna Mohanraj1, Fernando Vázquez de Lara1, Hammad Sheikh1, Gale Justin2, Lilas Armstrong-Davies2, Erik Popil2 1

Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

2

Presented at the Institute for Medical Education (IME), Icahn School of Medicine at Mount Sinai Annual Meeting that was held in New York, New York, United States on April 22, 2025.

BACKGROUND/INTRODUCTION: Internal medicine residents rotating in the ICU are at the forefront in managing critically ill patients who require sedation. There is a notable knowledge deficit for these residents regarding the management sedatives in the ICU. To our knowledge, no formal curricula have been published on this subject. We have created a novel asynchronous case-based interactive learning module which aims to educate internal medicine residents on the evidence-based usage of sedatives in the ICU and assess the effectiveness of improving residents’ confidence and knowledge and utilization of sedatives in the ICU. METHODS: The curriculum was developed using Adobe Captivate in collaboration with our instructional design team. IRB approval was obtained for the study. All Internal Medicine residents were eligible to enroll. We developed four case-based modules. Learners progressed by correctly answering embedded knowledge questions. Real-time feedback for all choices, along with high-yield review points were provided. The curriculum was implemented during resident Academic Learning days in July and September 2024. Participants completed a validated pre-intervention questionnaire assessing ICU experience, knowledge, and confidence in ICU sedation management using a Likert scale, followed by the online intervention. A post-intervention survey at the end of the fourth module. The responses to the pre and post intervention questionnaires were de-identified and collected using Microsoft forms.

RESULTS: The A total of 81 residents participated, with 87.6% completing the study. At the time, 49.3% had at least four weeks of ICU rotation experience, while 76.5% reported no prior formal training on the topic. The session led to statistically significant improvements in learner confidence across all measured parameters. These included: 1) identifying Richmond Agitation Sedation Scale (RASS) and Critical Care Pain Observation Tool (CPOT) scores, 2) choosing appropriate targets for the sedatives, 3) determining readiness and in performing spontaneous awakening trials, and 4) managing specific sedatives/analgesics. Satisfaction rates were high, with 87.1% of participants very or extremely satisfied, 75.4% likely to change their practice, and 83.5% likely to refer to the module in future rotations.

CONCLUSION: This study highlights the need for structured teaching on ICU sedation management. We have developed an innovative, interactive, self-paced, asynchronous curriculum that Internal Medicine residents can review at their own convenience. Above results suggest that the curriculum effectively improved residents’ confidence and knowledge on this topic. Our data noted a discrepancy in qualitative self-reported confidence compared to quantitative knowledge based questions. This suggests that learners may overestimate their confidence with their medical knowledge. The curriculum is freely available to residents throughout their training and will be assessed at the end of the year to assess longitudinal learning and retention.

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ABSTRACT #245 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE DAPTOMYCIN-INDUCED EOSINOPHILIC PNEUMONIA: A CASE REPORT Agostina Velo1, Ilana Bandler1, Connor Welsh1, Idayat Brimah1, Edwardine Mohanraj1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Daptomycin-induced eosinophilic pneumonia (EP) is a rare cause of acute hypoxic respiratory failure (AHRF). Clinical presentation is variable, making diagnosis potentially elusive.

CASE PRESENTATION: A 70-year-old woman with left calcaneal osteomyelitis on day thirty of treatment with cefepime and daptomycin, presented with altered mental status and AHRF. The physical exam was significant for a temperature of 101.1o F, respiratory rate of 26, oxygen saturation of 88% on room air, accessory muscle use, and diminished basilar breath sounds. Laboratory studies demonstrated peripheral eosinophilia (white blood count 16.4 K/uL, eosinophils 6%), and oliguric acute kidney injury. Chest x-ray revealed bilateral airspace opacities. Echocardiogram was normal. The patient was transferred to the medical intensive care unit on day three with worsening AHRF and pulmonary infiltrates despite diuresis and broad-spectrum antibiotics. She was treated with high-flow nasal cannula (fraction of inspired oxygen (FiO2) 75%, flow of 40 L/min) and required renal replacement therapy. This non-resolving, culture-negative pneumonia with peripheral eosinophilia raised suspicion of daptomycin-induced EP. Daptomycin had been discontinued on admission. A diagnostic bronchoalveolar lavage (BAL) was deferred due to high FiO2 requirements. On day six, the patient was treated with prednisone 40 mg daily with rapid symptom improvement and de-escalation to nasal cannula 3 liters/minute the following day. After three days of steroid treatment, the chest radiograph and eosinophils normalized.

DISCUSSION/CONCLUSION: Daptomycin-induced EP is characterized by fever, dyspnea, new bilateral infiltrates, AHRF, and BAL with >25% eosinophils in the setting of daptomycin exposure. The mechanism of daptomycin-induced EP remains unclear. The proposed pathophysiology suggests that drug-derived antigens activate alveolar macrophages, resulting in eotaxin and interleukin 5 release with eosinophil migration to the lungs. Direct drug-surfactant binding may also injure alveolar epithelium. The condition typically resolves with drug discontinuation. Daptomycin-induced EP was considered on this patient's presentation prompting immediate drug discontinuation. While BAL may have provided definitive diagnosis, the risk-benefit analysis favored empiric steroid treatment over diagnostic bronchoscopy. The rapid clinical improvement strongly suggests that this was a steroid- responsive condition. There are two notable features in this case. It is often posited that drug discontinuation may be sufficient for clinical improvement. However, in several reported cases drug cessation alone was insufficient and steroid treatment proved beneficial. Additionally, in this case, a BAL was not performed. In a systematic review, 22 out of 35 patients with reported daptomycin-induced EP had a BAL performed. Only 10 had a confirmatory BAL eosinophilic count of > 25%. In patients with AHRF and high clinical suspicion of daptomycin-induced EP, bronchoscopy should not delay the initiation of steroid therapy.

Daptomycin-induced EP may improve with drug cessation. Failure to improve should prompt early steroid treatment even when diagnostic BAL is not attainable.

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ABSTRACT #246 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES/PULMONARY/CRITICAL CARE DIAGNOSIS OF AN ACTIVE TUBERCULOSIS INFECTION UTILIZING NATURAL LANGUAGE PROCESSING Agostina Velo1, Shasha X. Chen1, Sascha Adler1, Nour Ayoub1, Steven Lim1, Hong Yu Wang1, Sara Luby1, Junyu Qi1, Javier J. Zulueta1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Tuberculosis (TB) remains a persistent challenge due to the complexity of diagnosing active TB infections. Patients typically present with fever, cough, malaise, and weight loss. Chest imaging findings can vary depending on the stage of the disease. Primary TB can present with consolidation, cavitary lesions, and hilar lymphadenopathies whereas reactivation TB can manifest in branching linear and nodular opacities (tree-in-bud), patchy or lobular consolidation, pleural thickening and calcification, and traction bronchiectasis. Artificial intelligence (AI) tools are being used to improve the diagnosis of TB. We present a case of TB discovered in an incidental lung nodule (ILN) follow-up program assisted by natural language processing.

CASE PRESENTATION: A 66-year-old male non-smoker with a history of atrial fibrillation on apixaban after ablation presented to the lung nodule clinic for an ILN noted on a computed tomography (CT) coronary angiogram captured by the ILN program. The CT demonstrated a semi-solid 9mm left upper lobe nodule (LUL) with a 3mm solid component for which a 3-month follow- up was indicated. Repeat CT chest showed a right upper lobe (RUL) 5mm solid nodule, tree-in-bud and nodular opacities, bronchiectasis none of which had been seen in the original CT, and the 7mm part-solid LUL nodule. On presentation, the patient was asymptomatic, with no history of mycobacterial infection, recent pneumonia, incarceration, and exposure to mold or asbestos.

Laboratory studies were negative for QuantiFERON-Gold TB Test (QF-G), negative for human immunodeficiency virus and showed normal interleukin-2 and C-reactive protein levels. Bronchoscopy with bronchioalveolar lavage (BAL) and fluoroscopy-guided biopsy of the RUL lesion showed non-caseating granulomas on histopathology, normal CD4:CD8 ratio, with positive acid-fast bacilli (AFB) testing and positive culture for pan-susceptible Mycobacterium tuberculosis, prompting initiation of pyrazinamide, ethambutol, rifampin, and isoniazid.

DISCUSSION/CONCLUSION: This case presents the diagnosis of an active TB infection using natural language processing (NLP) in the setting of an ILN program. Of note, this patient was asymptomatic and had no risk factors for TB. Despite not having cough at the time of presentation, the positive AFB stain and culture in the BAL suggest that he was contagious. Moreover, the QF-G test (sensitivity: 94.1%, specificity: 97.3%, negative likelihood ratio: 0.029) was negative. Despite the atypical presentation and microbiologic workup, the use of the NLP-assisted program avoided a delayed diagnosis, hence reducing the spread of this disease among the community. There is growing evidence in using AI for chest radiography and tomography in TB detection, many of which are still in the developmental stage. This case illustrates one of the many utilizations that the ILN program has, exemplifying the importance of pulmonary nodule follow-up, not only for early detection of malignancy, but also for other pulmonary conditions such as infections including TB or non-tuberculosis mycobacterium. AI-assisted programs are useful tools that can assist healthcare providers in the follow-up of incidental radiological findings, promoting individual patient benefit through timely diagnosis and treatment of multiple conditions, including malignancy and infections.

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ABSTRACT #247 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES REACTIVE ARTHRITIS TRIGGERED BY HAEMOPHILUS INFLUENZAE BACTEREMIA Agostina E. Velo1, Richard G. Vaca1, Lindsey Fox1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 59‐year‐old man with well‐controlled HIV and treated hepatitis C infections presented with polyarthralgia and rash. He noticed that his right arm, left wrist, first toe and knee were painful and erythematous. He reported one day of nausea and vomiting but had no respiratory, urinary, or visual symptoms.

He denied recent infections, travel, or exposures. On presentation, he was hemodynamically stable, afebrile, and on room air. He showed erythematous macules over the left knee, hallux, and wrist with painful range of motion (picture 1), suggestive of enthesitis. The right arm was swollen, tender, and erythematous (picture 2), compatible with cellulitis. Mucous membranes were normal. Laboratory testing demonstrated leukocytosis (15.5 K/uL, 85% neutrophils), anemia (Hb 12.6 g/dL, no evidence of hemolysis), ESR 37 mm/hr, CRP 229 mg/L, normal CPK, and negative HLA‐B27. Blood cultures grew Hemophilus influenzae, and an echocardiogram showed no vegetations. Synovial fluid from the left knee showed slightly cloudy fluid with 1,150/uL cells (neutrophils 82%, macrophages 9%), without crystals, and negative Gram stain and culture. There was no evidence of sexually transmitted infection, collection, or deep venous thrombosis in the right arm. A diagnosis of H. influenzae bacteremia and cellulitis with reactive arthritis was made. He received treatment with ceftriaxone, doxycycline, and indomethacin with improvement of infection and arthralgias, and was discharged with ciprofloxacin (for a total of 14 days), NSAIDs, and follow up with Rheumatology.

DISCUSSION: Reactive arthritis is an oligoarticular sterile arthritis from the spectrum of spondyloarthritis, that can present with sacroiliitis, enthesitis, dactylitis, and eye and skin disease. It is often linked to a urogenital or gastrointestinal infection, often happening one to six weeks prior. Typical pathogens include Yersinia, Salmonella, Campylobacter, Shigella, and Chlamydia. H. influenzae is not classically recognized as a cause of reactive arthritis and there are only a few case reports in the literature, especially in children or young adults, not in the age group of our patient. Our patient had leukocytosis with bacteremia and cellulitis, making septic arthritis the primary diagnosis until proven otherwise. An arthrocentesis with a washout procedure was performed to determine the etiology of the arthritis while administering systemic antibiotics and anti‐inflammatory medications.

In this case, the patient benefited from interdisciplinary management with Infectious Diseases, Rheumatology, and Hospital Medicine to adjust the treatment based on the dynamic presentation and results. This approach can only be done in the inpatient setting. Interestingly, reactive arthritis often presents after the infection has resolved. In our case, the patient had concomitant bacteremia, making the diagnosis challenging. Despite reporting one episode of vomiting, there was no further evidence of gastrointestinal or genitourinary infection, which suggests that the H. influenzae infection was the trigger for the reactive arthritis.

CONCLUSION: H. influenzae is an infrequent cause of reactive arthritis and must be recognized as an etiology.

The diagnosis of reactive arthritis can be challenging when there is concern for septic arthritis, which needs to be ruled out to safely treat with anti‐inflammatory medications.

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ABSTRACT #248 CASE REPORT/CLINICAL REVIEW INFECTIOUS DISEASES UNCOMMON COMPLICATIONS OF SALMONELLA TYPHI: A CASE REPORT OF CONCURRENT HEMOLYSIS AND HEPATITIS Agostina E. Velo1, Caileen Sennett1, Connor Smith1, Anahi McIntyre1, Lindsey Fox1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 30‐year‐old man with a remote history of Kawasaki disease and eosinophilic esophagitis, presented with 5 days of fevers, poor appetite, fatigue, and diarrhea after returning from India. Upon arrival, he was febrile (39.1°C), had a normal heart rate, and hepatosplenomegaly. Blood cultures demonstrated Salmonella typhi, and stool polymerase chain reaction showed Salmonella species. Abdominal computed tomography showed enterocolitis, hepatosplenomegaly, and mesenteric lymphadenopathies. During hospitalization, he developed pancytopenia (WBC 3.9 × 10³/uL, hemoglobin 11.7 g/dL, platelets 102 × 10³/uL) with signs of hemolysis (haptoglobin < 8 mg/dL, LDH 1310 U/L), transaminitis (ALT 77 IU/L, AST 110 IU/L), and acute kidney injury (creatinine 1.5 mg/dL). He was treated with Ceftriaxone for Salmonella bacteremia. His hospital course was notable for worsening transaminitis (ALT 894 IU/L, AST 1188 IU/L), ultimately thought to be secondary to Salmonella hepatitis. A 14‐day course of sulfamethoxazole/trimethoprim was recommended. The patient had improved transaminitis and kidney injury on discharge, with plans to follow up as an outpatient.

DISCUSSION: This Salmonella enterica spp. are gram‐negative, rod-shaped bacteria in the Enterobacteriaceae family that are prevalent in Latin America, Africa, and Asia. Typhoidal serovars (Typhi and Paratyphi) can cause disseminated disease in immunocompetent hosts, with incubation periods of 7 to 21 days, and symptoms lasting up to 3 weeks. In addition to causing diarrhea via local inflammation, these bacteria can enter the lymphatic system through M cells in Peyer's patches, and then live and replicate intracellularly within the reticuloendothelial system causing extraintestinal manifestations such as hepatosplenomegaly, and bone marrow failure. Typhoidal serovars can also cause hemolysis through hemolysins. This patient had enteric fever due to Salmonella enterica serovar Typhi infection. The CDC estimates that 620 people are hospitalized per year in the United States for this condition, and most of the cases are in international travelers. As often described, the patient had relative bradycardia, mesenteric lymphadenopathies, and hepatosplenomegaly, which reflect the infiltration of the reticuloendothelial system. Remarkably, he also presented with hemolysis and hepatitis, both infrequent complications. Despite hemolysis having been classically described, it has not been frequently reported in the literature, except for one case report in 2024. The process is mediated by the release of hemolysin E, which is triggered by the presence of stress hormones, and usually presents within the first 14 days of infection. Mild liver test abnormalities can be seen in salmonellosis; however, severe hepatitis is uncommon and may mimic viral hepatitis. The pathogenesis is multifactorial and can be caused by direct damage from endotoxins and a combination of local inflammation and the host's immune response. When severe, the mortality can be up to 20%, but it typically responds favorably to antibiotic.

CONCLUSION: This case highlights the diverse complications of enteric fever, which remains a rare cause of hospitalization in the United States, underscoring the importance of considering this diagnosis in patients who have traveled to endemic areas, and who present with prolonged fevers and systemic symptoms such as hepatitis or hemolysis.

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ABSTRACT #249 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY SOMETIMES ALL YOU NEED IS A PROCTECTOMY: A RARE CASE OF MCKITTRICK-WHEELOCK SYNDROME Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Marcos Rosa-Santana2, Steven Rodriguez1, Ari Grinspan3 1Mount

Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2BronxCare Health System, Bronx, NY, United States; 3Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: McKittrick-Wheelock syndrome (MWS) is an uncommon but significant medical condition. It's characterized by profound electrolyte imbalances such as hyponatremia, hypokalemia and hypochloremia along with fluid depletion, secretory diarrhea and acute kidney injury, typically stemming from distal colorectal tumors, often benign villous adenomas. We present a case of an elderly male with a large rectal tubulovillous adenoma that caused development of MWS. CASE PRESENTATION: A 66-year-old male with hypertension, paraplegia secondary to gunshot wound and colectomy with Hartmann's pouch and recent admissions in the past year due to electrolyte imbalances, acute kidney injury, and syncope, presented with a 3-day history of nausea and non-bilious, non-bloody vomiting associated with syncope. Laboratory exams revealed electrolyte imbalances and acute kidney injury. The CTabdomen/pelvis revealed a concentric mass lesion at the rectosigmoid colon junction extending into the rectum with slight intussusception (Figure 1A). Flexible sigmoidoscopy revealed a villous rectal mass of 11cm, with a large amount of mucus production (Figure 1B). Robotic proctectomy was done with pathology showing tubulovilloous adenoma with focal high-grade dysplasia without invasion of lymph nodes. After proctectomy, patient had complete resolution of symptoms and electrolyte disturbances.

DISCUSSION/CONCLUSION: Adenomas are usually asymptomatic and in the case of villous adenomas, they tend to occur more frequently in the rectosigmoid area. Villous adenomas account for 5% of colonic adenomas, and 3% have secretory activity. Rarely, these adenomas can grow and cause hypersecretory complications such as diarrhea, electrolyte imbalance and renal failure. Colonoscopy is mandatory in all patients, but in the case of patients' inability to tolerate bowel preparation, flexible sigmoidoscopy is a safe alternative that permits diagnosis in 99% of cases. Aggressive fluid and electrolyte repletion is necessary while awaiting definitive surgical treatment. In conclusion, although rare, MWS should be considered in the differential diagnosis of patients that present with severe electrolyte disturbances, AKI and volume depletion. Curative treatment of MWS is surgical, with complete removal of the adenoma, and should be expedited upon diagnosis of this life-threatening syndrome.

Figure 1. A: Concentric mass lesion at the rectosigmoid junction on CTAP; B: Tubulovillous adenoma on flexible sigmoidoscopy

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ABSTRACT #250 CLINICAL RESEARCH GASTROENTEROLOGY SURVIVAL ANALYSIS AND ASSOCIATED FACTORS IN METASTATIC YOUNG ONSET CHOLANGIOCARCINOMA VERSUS METASTATIC AVERAGE ONSET CHOLANGIOCARCINOMA Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Sirish Dharmapuri1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Overall incidence of cholangiocarcinoma (CC) has been on the rise for the past few decades and is considered one of the most fatal cancers. Although 1-year mortality has improved over time, the 5-year survival is still as low as 10%. Young-onset cholangiocarcinoma (YOCC) is defined as cholangiocarcinoma diagnosed prior to age 50. Meanwhile average-onset cholangiocarcinoma (AOCC) has known risk factors and survival outcomes, little is known about young-onset disease. Our study compared overall survival (OS) between metastatic YOCC (mYOCC) and metastatic AOCC (mAOCC).

METHODS: We conducted a retrospective cohort study with survival analysis from 2018 to 2021 using the Surveillance, Epidemiology, and End Results (SEER) database to compare survival between mYOCC (age < 50 years) and mAOCC (age ≥ 50 years). Inclusion criteria comprised patients with stage IV disease according to TNM staging, histologically confirmed cholangiocarcinoma, a primary tumor classification, and complete data on demographic and metastatic site variables. Overall survival distributions were conducted using the Kaplan-Meier and log-rank test to assess differences. Cox regression model was used to study factors associated with mortality.

RESULTS: A total of 1,711 cases were included in the analysis. mYOCC comprised 9.7% (n=166) of cases, while 90.3% (n=1,545) were mAOCC. Lung and bone metastases were associated with increased mortality in patients with mYOCC (aHR, 1.16; 95%CI, 1.02-1.32; p=0.019; aHR, 1.48; 95%CI, 1.27-1.73; p<0.001). Patients who underwent chemotherapy had decreased mortality (aHR, 0.54; 95%CI, 0.43-0.67; p<0.001), similar to those who underwent radiotherapy (aHR, 0.60; 95%CI, 0.50-0.72; p<0.001) and surgery (aHR, 0.42; 95%CI, 0.310.57; p<0.001). When compared to patients with mAOCC, patients with mYOCC had significantly higher median overall survival (12 versus 8 months; log rank p=0.015).

CONCLUSION: Patients with mYOCC had better OS when compared to their older counterparts. This could be attributed to receiving greater amount of surgical, adjuvant and palliative treatments, along with better tolerance to aggressive treatments and fewer comorbidities in the YOCC population. Additional investigation into risk factors, characteristics and perhaps, value of screening in YOCC, is needed.

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ABSTRACT #251 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY/INFECTIOUS DISEASES WHICH CAME FIRST: THE EGGS OR THE COLITIS? A RARE PRESENTATION OF SCHISTOSOMIASIS Liliana Vittini-Hernandez1, Antoine Jeri-Yabar1, Bharati Dev1, Adam Tillowitz1, Kimberly Cavaliere1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Schistosomiasis is a parasitic disease caused by trematode worms, also called blood flukes. This typically manifests with gastrointestinal and genitourinary symptoms. Extraintestinal manifestations, such as arthritis, are uncommon and can often result in a presentation similar to more common diseases, such as inflammatory bowel disease (IBD), especially outside endemic regions. Here, we present a case of schistosomal colitis with concurrent arthritis in an 18-year-old male from Guinea.

CASE PRESENTATION: An 18-year-old male with past medical history of hepatitis B and C presented with arthralgias, intermittent fevers and hematochezia. He had immigrated from Nicaragua 4 months before presentation and was originally from Guinea. He reported 6 weeks of dull, constant pain that initially started in his left ankle and eventually affected bilateral hips, knees, and ankles. Laboratory tests were significant for a hemoglobin of 8.1 g/dL, MCV of 60.3 fL, WBC of 7.1 K/uL, and a differential with 21.7% eosinophils.

Rheumatoid factor, anti-CCP antibodies, ANA, anti-dsDNA antibodies, smith antibodies, p-ANCA, c-ANCA, RNP antibodies were negative. CTAP showed infectious versus inflammatory pancolitis and mild splenomegaly.

Colonoscopy was done and showed inflammation characterized by altered vascularity, congestion, erosions, erythema, friability, loss of vascularity and shallow ulcerations in a continuous and circumferential pattern from the anus to cecum (Images A and B). Intravenous steroids were started by the medicine team, due to high suspicion for ulcerative colitis. Shortly after, steroids were discontinued as biopsies showed parasitic ova within the lamina propria with surrounding inflammation, consistent with schistosomiasis. The patient was treated with praziquantel, and symptoms began to subside.

DISCUSSION/CONCLUSION: Our case highlights the rare yet significant association between schistosomal colitis and arthritis, emphasizing the diverse clinical manifestations of schistosomiasis.

The challenge lies not only in recognizing the extraintestinal manifestations, but also in differentiating them from other rheumatologic conditions, especially in non-endemic regions where clinical suspicion may be low.

Furthermore, schistosomal colitis should be considered in the differential diagnosis for IBD. Increased awareness is essential for timely diagnosis and management, ultimately improving patient outcomes and reducing morbidity associated with this disease.

Figure 1. Images A and B: Erosions and erythema of rectum and hepatic flexure, respectively

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ABSTRACT #252 MEDICAL EDUCATION GENERAL INTERNAL MEDICINE UNMASKING SHINING A LIGHT ON NIGHTS: OPTIMIZING ACADEMIC NIGHT FLOAT ROTATIONS William J. Wallach1, Aphrodite Megaris1, Christopher Tricarico2, Kimberly Christophe2, Jessica Goldberg2, Ian Yu2, Kristine Favila2, Dahlia Rizk2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

BACKGROUND/INTRODUCTION: Since the ACGME established duty hour limits in 2003, there has been an increasing prevalence of night float rotations in Internal Medicine Residency training. Conferences and formal didactics are a critical component of resident education. However, residents on night float rotations typically miss these essential educational activities that are typically held during the daytime. It is thus unsurprising that survey data has shown that both residents and faculty rate teaching and learning on day rotations more positively than night rotations citing concerns of less educational emphasis, lack of conferences, and decreased availability of attending physicians. Many programs have responded by initiating night curricula, but there remains a paucity of data on how to best implement formal resident education overnight.

METHODS: We introduced a novel night float educational initiative at a single academic medical center, wherein attending Nocturnists lead 60‐90‐minute sessions with night float Internal Medicine residents five to seven nights per week. Sessions consist of brief resident presentations of overnight admissions with discussion of their assessment and plans after which Attendings provide feedback and offer alternate differentials or treatments.

The sessions also provide a forum for questions regarding the care of cross‐coverage patients and an outlet for the Nocturnists to provide additional educational pearls. We assessed resident satisfaction via an anonymous nine question survey as well as reviewed the standard GME survey distributed to housestaff yearly over the implementation period.

RESULTS: Thirty responses were received from 105 residents who had had at least one night float rotation, ranging from PGY1 to PGY3. Of residents surveyed, 100% felt more comfortable knowing there was an internist available overnight. Sixty‐five percent preferred a flexible schedule for the teaching sessions to a fixed schedule.

Of surveyed residents, 43% described the sessions as “somewhat useful”, 37% described them as “useful” and 10% described them as “very useful.” Additionally, anonymous GME surveys results showed an improvement from 65th percentile to above 90th percentile for the question related to “supervision at night” post implementation of night teaching program. Our findings are supportive of previous data suggesting that modifications to night float curriculums can improve the CONCLUSION: Our findings are supportive of previous data suggesting that modifications to night float curriculums can improve the educational value of the rotation. Most of the residents answered favorably when asked how they viewed the teaching sessions. Limitations of our study include the response rate of 29% and lack of a randomized control group. We also surveyed a single residency program with a small group of Nocturnists potentially limiting the generalizability of our findings. However, trends in responses may be helpful for implementing and guiding future night training programs.

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ABSTRACT #253 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE A CASE OF REFRACTORY IMMUNE THROMBOCYTOPENIA IN THE SETTING OF ABDOMINAL SPLENOSIS Alvin Wang1, Chad Henry1, Adam Rothman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Immune thrombocytopenia (ITP) is an acquired thrombocytopenia caused by autoantibodies against platelet antigens that lead to platelet destruction and underproduction. Manifestations can range from chronic fatigue to varying levels of bleeding occurring in skin and mucous membranes (with development of petechia or purpura in dependent areas of the body, epistaxis, or intracranial hemorrhage).

Below we describe an interesting case of ITP that was refractory to all available modalities of treatment.

CASE PRESENTATION: A 25-year-old woman with known ITP (status post prior splenectomy and previous admissions requiring IVIG and high dose dexamethasone, and currently on daily prednisone) presented with severe thrombocytopenia (platelet level of 4,000/uL) during a routine hematology visit. Initially, patient had numerous punctate petechiae at the tips of the tongue and nares, without gingival bleeding or skin petechia.

Additional lab work at that time showed a white blood cell count of 2,200/uL, hemoglobin of 11.1 K/uL, and platelet of 3,000/uL. She was admitted for further management, with her prolonged hospital course complicated by a rapid response in setting of hypovolemic shock from massive vaginal bleeding. She underwent infusions of platelets, fresh frozen plasma, and packed red blood cells, as well as Bakri balloon placement and bilateral uterine artery embolization. Following the procedure, the patient was monitored in the intensive care unit. Over the subsequent several weeks of hospital stay, the patient was trialed on IVIG, prednisone, mycophenolate mofetil, vincristine, and eventually, weekly romiplostim and rituximab. Despite all these interventions, the patient's platelet level remained persistently low (3000-4000/uL), and she was eventually discharged with close Hematology and Gynecology follow-up. Prior to discharge, a nuclear imaging scan showed foci of uptake in the retrogastric region and left paracolic gutter, consistent with splenosis. Since discharge, the patient is being treated with twice weekly platelet transfusions and Zarxio, and weekly romiplostim and fostamatinib, with platelet numbers more recently starting to recover (currently 42,000/uL).

DISCUSSION/CONCLUSION: The ITP is a rare disease of exclusion with a slightly higher mortality rate compared to the general population. In most cases, patients die from complications of immunosuppressive therapy, splenectomy, and hemorrhage. Acute ITP typically shows quick response to first line therapy of IVIG, platelet transfusions and/or glucocorticoids depending on disease severity. About 10-20% of adults with ITP reach spontaneous remission within the first 6 months, with the remaining majority (up to two thirds) reaching stable platelet counts after first line therapy, and with eventual resolution for nearly all remaining patients after second line treatment. Of note, certain reports of recurrent ITP suggest that recurrence of hematologic diseases following splenectomy may be attributable to splenosis. Here is a unique case of a patient with thrombocytopenia secondary to ITP that was refractory to all available treatments, including splenectomy, Rituximab and thrombopoietin receptor agonists. Given prior case reports with recurrent ITP in the setting of abdominal splenosis, it is worthwhile to explore the connection between recurrent ITP with patients with presence of abdominal splenosis.

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ABSTRACT #254 MEDICAL EDUCATION PULMONARY/CRITICAL CARE ADAPTING AND ADVANCING: A RENAL ULTRASOUND CURRICULUM Hong Yu Wang1,2, Yoshiko Ishisaka1,2, Hayato Mitaka1,2, Elliot Charen2, Paru S. Patrawalla1,2 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: In 2022, we implemented a novel renal point of care ultrasound (POCUS) curriculum for Internal Medicine residents on Nephrology elective at Mount Sinai Beth Israel. Hospital Despite improvements in confidence and skill at performing POCUS for acute kidney injury post-elective, we noted minimal improvement in knowledge measured with a multiple-choice test. In response to these findings, modifications to the existing curriculum were made to improve practice with feedback and accessibility of the teaching materials. An easily accessible one-page visual summary of renal and bladder POCUS was developed and shared with learners. This supplementary material aims to enhance the educational content by providing a concise, easily digestible reference to improve knowledge in image interpretation. In our study, we aimed to evaluate the impact of this additional resource on resident performance.

METHODS: Beginning in August 2023, internal medicine residents rotating on nephrology elective received the one-page reference offering key points and guidelines in addition to the existing Renal POCUS curriculum which included pre-recorded didactic lectures and hands-on training. Residents participating in the renal POCUS program were assessed through a survey and a knowledge test before and after their 2-week elective. A retrospective review was conducted to compare the results of these knowledge tests with the outcomes from the previous curriculum, conducted between September 2022 and August 2023.

RESULTS: Out of nine residents enrolled, eight completed both the pre- and post-rotation knowledge tests and confidence surveys. There was a trend towards knowledge improvement that was not statistically significant preand post- rotation [pre 7.0 (5.75-8.25]) post 8.0 (7.25 – 8.75), p=0.057), potentially attributable to the limited sample size. A significant increase in confidence was observed across all parameters. In comparison to outcomes from previous renal POCUS curriculum—where the median pre- and post-test scores were recorded at 6.0 [IQR: 5-7] and 6.5 [IQR: 5.75-8], respectively—the present curriculum demonstrated a more substantial elevation in performance metrics.

CONCLUSION: This preliminary report demonstrates the need for ongoing quality improvement for novel curriculums to identify areas for improvement. Our study shows a potential positive impact from the addition of the one-page reference sheet. Further data collection and evaluation is needed for a more comprehensive assessment of this quality improvement initiative. Our renal POCUS curriculum was successfully integrated into an existing 2-week nephrology elective using asynchronous didactic education and hands-on practice during the elective. This integration resulted in improvements in both resident confidence and proficiency in renal POCUS following the elective. Future quality improvement efforts will continue to focus on enhancing resident competencies in POCUS education, with the goal of improving patient outcomes.

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ABSTRACT #255 CLINICAL RESEARCH HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE ASSOCIATION OF RACE AND ETHNICITY WITH OUTCOMES FOR PATIENTS WITH ACUTE PULMONARY EMBOLISM TREATED BY PULMONARY EMBOLISM RESPONSE TEAM Hong Yu Wang1, Abdul Rehman1, Avinash Singh1, Priyanka Sridhar1, Agostina Velo1, Destiny Nguyen1, Madeline R. Ehrlich1, David J. Steiger1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: The management of acute pulmonary embolism (PE) has become streamlined with the widespread implementation of PE Response Teams (PERT). We hypothesized that the standardized management of acute PE by PERT might mitigate the impacts of race and ethnicity on patient outcomes. In this study, we assessed the association of race and ethnicity with overall mortality and bleeding complications for patients with acute PE managed by PERT. METHODS: We performed a retrospective chart review of 290 patients with acute PE who were managed by PERT at one of three urban teaching hospitals in the Mount Sinai Health System (New York City) from January 2021 to October 2023. Propensity score weighting was performed using the MatchIt package for R with the optimal full matching specification. Propensity score was calculated from six variables: age, sex, BMI, PESI score, ESC risk group and presence of a saddle PE. RESULTS: Median age of patients was 65.5 (IQR: 54.2‒76) years and 51.4% (n=149) were female. White, Black and Asian races (n=163, 56.2%) accounted for 163 (56.2%), 115 (39.6%) and 10 (3.5%) patients. Twenty-four (8.3%) patients self-described as Hispanic or Latino. The median PESI score was 82 (IQR: 63‒103). The ESC risk class was low, intermediate-low, intermediate-high and high risk in 3 (1.0%), 60 (20.7%), 173 (59.6%) and 54 (18.6%) patients. Systemic anticoagulation and systemic thrombolysis were administered to 286 (98.6%) and 13 (4.5%) patients. Catheter-directed thrombolysis (CDT) was administered to 16 (5.5%) cases, while surgical or catheter-directed embolectomy was performed in 37 (12.8%) patients. The in-hospital and 30-day mortality rates were 6.9% and 10.3%. The median hospital LOS was 6 (IQR: 3‒10) days. In-hospital bleeding of any severity occurred in 23 (7.9%) patients, while in-hospital major bleeding occurred in only 5 (1.7%) patients. In the propensity score-weighted analysis, patients of Black race had lower odds of 30-day mortality when compared to White patients (OR, 0.925; p=0.039), while their odds of 30-day major bleeding were higher (OR, 1.473; p<0.0001). The hospital LOS and rate of 30-day re-admission were not significantly different for Black patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving systemic thrombolysis (OR, 0.947; p=0.004), CDT (OR, 0.941; p=0.0004) and surgical or catheter-directed embolectomy (OR, 0.854; p<0.0001) when compared to other patients. Despite this, patients of Hispanic or Latino ethnicity had lower odds of in-hospital mortality (OR, 0.937; p=0.003), although odds of 30-day mortality were not significantly different. Interestingly, Hispanic or Latino ethnicity patients had lower LOS (IRR, 0.016; p=0.001) and slightly higher odds of 30-day re-admission (OR, 1.136; p=0.043).

CONCLUSION: Within a cohort of acute PE patients managed by PERT, Black race was associated with higher odds of major bleeding and slightly lower odds of 30-day mortality. Conversely, Hispanic or Latino ethnicity was associated with lower odds of receiving systemic thrombolysis, CDT and catheter-directed or surgical embolectomy as well as slightly higher odds of 30-day re-admission. These results suggest that PERT-based care somewhat mitigates racial disparities in the management of acute PE, although ethnic disparities still remain.

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ABSTRACT #256 CLINICAL RESEARCH PULMONARY/CRITICAL CARE ASSOCIATION BETWEEN RACE AND INSURANCE WITH FOLLOW-UP RATES OF INCIDENTAL LUNG NODULES Hong Yu Wang1, Nour Ayoub1, Shasha X. Chen1, Steven Lim1, Sara Luby1, Agostina Velo1, Junyu Qi1, Sasha Alder1, Javier J. Zulueta1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Lung cancer remains the leading cause of cancer-associated mortality within the United States. The evaluation and subsequent follow-up of lung nodules are critical components in the early detection of lung cancer, thereby potentially improving patient outcomes. Research has revealed significant disparities in health outcomes among diverse racial and ethnic groups. However, investigation into the relationship between race, insurance, and the management of incidental lung nodules have been notably limited.

This study aimed to investigate the impact of race and insurance status, particularly Medicaid, on the follow-up rates for incidental lung nodules, a factor that could significantly influence early detection and treatment outcomes.

METHODS: We conducted a multi-center retrospective review of all patients identified in January and February 2022 using Natural Language Processing (NLP), which identified all chest-related imaging studies mentioning lung nodules. Scans conducted for the investigation of active malignancy, those identifying false-positive nodules, stable lung nodules, scans not requiring follow-up according to the radiologist's evaluation, and cases without a follow-up recommendation were excluded from our analysis. Electronic health records were reviewed for demographics and types of health insurance. Patients were classified into three racial categories: White, Black, and Others. Similarly, insurance status was classified into three categories: Medicaid, uninsured, and other forms of insurance. The statistical analysis of the collected data was conducted utilizing the Statistical Analysis System (SAS) software.

RESULTS: NLP identified 756 patients with lung nodules, of which 364 (48.1%) patients were included for analysis. Mean age was 68.5 + 13.57 and 143 (39.3%) were male. By race, 162 (44.5%) were White, 75 (20.6%) Black, and 127 (34.9%) other. Seventy (19.2%) patients were covered solely by Medicaid and 10 were uninsured.

In comparison to White and other racial background patients, Black patients had a significantly lower rate of appropriate follow-up of incidental nodules (OR, 0.441; 95%CI, 0.242-0.804; p=0.0075). Similarly, patients insured through Medicaid or lacking insurance were significantly less likely to undergo follow-up evaluation for their nodules (OR, 0.525; 95%CI, 0.287-0.960; p=0.0364). There was no correlation between the rate of nodule follow-up and sex.

CONCLUSION: In this study, among patients with incidental lung nodules, those who were black or were either uninsured or insured through Medicaid, had a significantly reduced rate of appropriate follow-up evaluations.

These results highlight the existence of significant healthcare inequalities and support the need for well-designed safety-net or incidental lung nodule programs to overcome them. The discrepancies in follow-up rates for lung nodules observed may also be linked to socioeconomic status, rather than only to racial distinctions. It is known that patients with Medicaid insurance face many challenges in accessing medical care. These barriers include, but not limited to, navigating healthcare services, a lack of adequate public transportation, difficulties in specialist referrals, and deficient psychosocial support. The findings in our study highlight the critical need for identifying and mitigating potential barriers to facilitate the effective delivery of patient care.

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ABSTRACT #257 CLINICAL RESEARCH PULMONARY/CRITICAL CARE CORRELATIONS BETWEEN IMAGING FEATURES AND FOLLOW-UP RATES FOR LUNG NODULES Sara Luby1, Nour Ayoub1, Hong Yu Wang1, Shasha X. Chen1, Steven Lim1, Agostina Velo1, Junyu Qi1, Sascha Adler1, Javier J. Zulueta1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Incidental lung nodules (ILNs) are frequently encountered by healthcare providers across specialties, presenting a persistent challenge in follow-up management. Despite clear guidelines from the Fleischner Society, a significant portion, up to 60%, of newly identified nodules are not followed up. This study aimed to investigate the administrative and imaging factors that might impact the followup rates of lung nodules.

METHODS: Using natural language processing (NLP), we systematically identified all chest-related imaging studies mentioning lung nodules conducted between January and February 2022 at Mount Sinai Health System.

Studies were screened for inclusion criteria, and data regarding the ordering department, specialty of the ordering physician, size of the largest nodule, and the recommended follow-up time by radiologists were extracted from electronic medical records. Subsequently, a comprehensive chart review was conducted to assess whether follow-up was or was not completed. Statistical analysis was performed using SAS software.

RESULTS: NLP identified 809 scans with potential lung nodules, of which 374 (46.22%) were included in this study. Scans ordered from the Emergency Department (ED) accounted for 24.3% (91), inpatient accounted for 10.7% (40), and scans ordered from the outpatient setting accounted for the majority at 65% (243). Indication for scans varied with 126 (33.7%) ordered for chest symptoms, 61 (16.3%) for lung cancer screening, 73 (19.5%) to follow-up on nodules, and 114 (30.5%) for other reasons. The average (SD) size of the largest nodule in the scan was 6.74 (SD=6.34) and the average time to follow-up recommended by the radiologist was 263.64 ± 137.35. In a multivariate regression analysis, scans ordered from the ED and inpatient settings were less likely to have follow-up evaluations compared to those ordered as outpatient [(OR, 0.230; 95%CI, 0.119-0.443) and (OR 0.137; 95% CI, 0.054-0.347), respectively]. Scans ordered to follow-up nodules were more likely to have a follow-up (OR, 2.536; 95%CI, 1.230-5.228). An increase in the follow-up time recommendation (per day) was associated with a decrease in the odds of having a follow-up evaluation (OR, 0.998; 95%CI, 0.996-1.000). The size of the largest nodule was not significantly associated with the follow-up rates.

CONCLUSION: Patients with nodules identified on chest-related imaging ordered in the ED and inpatient settings were less likely to have a follow-up evaluation, while those specifically ordered for nodule follow-up showed higher follow-up rates. The length of the follow-up period recommended by the radiologist has only a marginal effect on the follow-up rate. The discrepancy in follow-up compliance between these groups suggests underlying challenges in the continuity of care for patients initially under acute or unscheduled healthcare settings. The results of this study highlight the essential need for the implementation of a safety-net program and the establishment of structured follow-up protocols, especially in post-acute care settings, to improve the management of lung nodules and enhance patient outcomes.

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ABSTRACT #258 CLINICAL RESEARCH PULMONARY/CRITICAL CARE INCIDENTAL LUNG NODULE PROGRAM: A NEW APPROACH FOR EARLY DETECTION AND MANAGEMENT OF LUNG CANCER Nour Ayoub1, Hong Yu Wang1, Junyu Qi1, Sascha Adler1, Shasha X. Chen1, Steven Lim1, Sara Luby1, Agostina Velo1, Javier J. Zulueta1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Incidental lung nodules (ILNs) are commonly detected on 20-30% of computerized tomography (CT) scans, leading to over 1.5 million new nodule identifications annually in the United States. However, up to 60% of these nodules are not followed up as recommended, with 5% resulting in a lung cancer diagnosis. To address this issue, we have implemented an ILN program focused on preventing losses to follow-up and improving early detection.

METHODS: Starting in January 2023, we employed natural language processing (NLP) to screen all chestrelated radiology images conducted at Mount Sinai Morningside and West hospitals for lung nodules. Studies flagged for nodules were reviewed by a navigator to apply exclusion criteria. Included studies were then categorized based on their risk of being lost to follow-up. For studies lacking an established nodule follow-up pathway, patients were promptly informed of the findings and offered access to our lung nodule clinic.

Conversely, for studies with an established follow-up pathway, patients were notified only if the follow-up was incomplete. We defined follow-up as any of the following occurring on or before the due date: a test to assess the nodule or an encounter indicating no further follow-up is necessary.

RESULTS: From January 2023 to March 2024, we identified 4,455 studies potentially containing lung nodules.

Among these, 2,882 (64.7%) were enrolled in the program, with 922 (32.0%) having a size 8mm. Of the enrolled studies, 1,912 (66.3%) had an established follow-up pathway, while 793 (27.5%) did not; 2 were pending assessment, and 175 (6.1%) were closed for various reasons. Of the 1,161 (40.3%) scans notified about their nodules, 1024 (88.2%) were tracked to assess compliance. As of March 2024, 632 (61.7%) of the tracked studies were pending follow-up, 184 (23.1%) had been successfully followed up, and 208 (20.3%) were not followed at the due date. Upon further engagement, 53 (25.5%) of the initially unfollowed patients completed their follow-up, 155 (75.5%) were pending scheduled follow-up, and 38 (22.6%) were closed for various reasons. A total of 175 follow-up CT scans, 21 positron emission tomography scans, 219 lung nodule clinic visits, 33 biopsies, and 2 surgeries were conducted. Of the 1024 patients tracked after program engagement, 10 patients were diagnosed with lung cancer with 7 (70%) in stages I/II and 3 (30%) in stages III/IV. Of the 1912 patients tracked without any engagement by the program due to the existence of an established follow-up pathway, 30 were diagnosed with lung cancer with 11 (36.7%) in stages I/II and 19 (63.3%) in stages III/IV. CONCLUSION: Our ILN program serves as a vital healthcare safety net, detecting and monitoring potentially malignant nodules. Analyzing patient data highlights ILN management complexities and the need for targeted interventions. Next, we’ll compare program results with pre-program data to gauge impact and enhance followup rates and patient outcomes. Swift recognition and management of ILN significantly improve the prospects of successful treatment and enhance patient outcomes, particularly in cases of lung cancer where early-stage detection is crucial.

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ABSTRACT #259 CLINICAL RESEARCH PULMONARY/CRITICAL CARE INCIDENTAL LUNG NODULES: UNVEILING THE UNDETECTED POPULATION Steven Lim`, Shasha X. Chen1, Nour Ayoub1, Hong Yu Wang1, Sara Luby1, Agostina Velo1, Junyu Qi1, Sascha Adler1, Javier J. Zulueta1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Incidental lung nodules (ILNs) are commonly detected in radiographic imaging, yet studies consistently report low follow-up rates for these nodules, even when appropriate radiology recommendations are provided (1). This study seeks to delve into the characteristics of patients, their ILN followup rates, and subsequent outcomes within the context of our tertiary hospital system. By analyzing these factors comprehensively, we aim to gain insights into the challenges and opportunities for improving ILN management and patient care.

METHODS: We conducted a retrospective review of electronic medical records within the Mount Sinai System, focusing on patients with chest-related studies identifying incidental lung nodules (ILNs) through the natural language processing (NLP) program. This review encompassed patients who underwent imaging specifically between January and February 2022. Follow-up was defined as any of the following occurring on or before the due date: a test aimed at evaluating the nodule or an encounter indicating that further follow-up was unnecessary.

We excluded images performed to investigate active malignancy, those with false-positive nodules, stable lung nodules, and those did not require follow-up as per the Radiologist.

RESULTS: A total of 364 patients (61% female) with a mean age of 68.59 ± 13.55 years, who had 376 scans confirming the presence of ILNs, were included in the study. The racial distribution was as follows: 162 (44.5%) White, 75 (20.38%) Black, and 127 (34.51%) other races. Of these patients, 60 (16.30%) had solely Medicaid insurance, with 10 uninsured patients. Among the 376 scans, there were 645 solid nodules, 23 part-solid nodules, and 100 non-solid nodules, with 69 (18.35%) scans revealing multiple nodules. Regarding the primary outcome, 167 (44.41%) of the scans received appropriate follow-up, while 209 (55.58%) lacked documented follow-up.

The types of follow-up exams varied, with chest computed tomography (CT) without contrast being the most common (121), followed by tissue sampling (15), and positron emission tomography (13). Among patients with appropriate follow-up, 7 (4.19%) were diagnosed with lung cancer.

CONCLUSION: Our data confirms that the rate of appropriate follow-up for ILNs is low. An inconsistent followup rate has a direct negative impact on patient outcomes as early detection and prompt management is crucial in the management of lung cancer. Given the findings of low follow-up rates from our study, hospitals should dedicate resources towards implementing structured ILN programs to address and prevent missed opportunities for early lung cancer detection. Further data collection and ultimately enhancing the identification of individuals who are prone to be lost to follow-up and therefore delayed intervention would be the next step in our study.

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ABSTRACT #260 QUALITY IMPROVEMENT PULMONARY/CRITICAL CARE OPTIMIZING LUNG TRANSPLANT REFERRAL IN FELLOWSHIP CLINIC Shasha X. Chen1, Hong Yu Wang1, Jigna Zatakia1, Boram Kim1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Chest Physicians (CHEST) Annual Meeting that was held in Boston, Massachusetts, United States from October 6-9, 2024.

BACKGROUND/INTRODUCTION: Lung transplant referral rates have historically been lower than expected owing to healthcare disparities including age, socioeconomic status, health literacy, and patient resistance. In addition to healthcare disparities, providers’ lack of knowledge of eligibility criteria and understanding of how to make appropriate referrals may also impact referral rates. Recent data revealed that referral rates in New York City remain inferior compared to that of neighboring areas, which is concerning given the evidence that timely referral is associated with better patient outcomes. This Quality Improvement project aims to evaluate the perspectives of Pulmonary and Critical Care Medicine fellows regarding lung transplant, identify the barriers to referrals, and find ways to improve the rate of appropriate referrals in the fellows’ Pulmonary clinic.

METHODS: In August 2023, a 13-question needs and knowledge assessment survey was completed by fellows in an urban pulmonary clinic. Subsequently, an educational lecture was provided, focusing on disease specific criteria for lung transplant referral as well as elucidation of the referral process. Additionally, a one-page reference summarizing essential points and guidelines was made available in the clinic and distributed to the fellows. Following these educational interventions, an identical post-intervention survey was administered to evaluate the impact of the educational initiative on the fellows' understanding and application of lung transplant referral indications.

RESULTS: In our study, seventeen fellows were enrolled across three years of training; sixteen completed both the pre-intervention and post-intervention needs and knowledge assessment survey. When evaluating factors hindering fellows from placing referrals, leading factors included a lack of provider support and education (25%), absence of sufficient social support for the patient (16%), and insufficient time during clinic visit to discuss transplant and declining lung health (14%). There was a notable improvement in providers’ confidence in their ability to properly refer patients following the intervention. Initially, 53.6% of the fellows reported feeling “very little confidence” but post intervention this number significantly decreased to 12.3%. Conversely, the proportion of fellows reporting "complete confidence" increased from 12.5% before the intervention to 43.8% thereafter.

Furthermore, there was notable improvement in the knowledge assessment scores. Prior to the intervention, the fellows’ correct response averaged at 58%, which improved to 88% following the intervention.

CONCLUSION: Our preliminary findings demonstrate the necessity of an educational intervention to enhance fellows' knowledge and improve practices regarding lung transplant referrals. Assessing and addressing knowledge deficits about lung transplant referrals effectively improved both the fellows’ understanding and confidence in properly identifying appropriate referral candidates and navigating the logistics of the referral process. Building on the success of this preliminary cycle, the educational initiative will be integrated into the core fellowship didactic curriculum at the beginning of each academic year. Pre- and post- intervention referral rates will be examined. Auditing charts of patients who may fulfill indications for transplant referral can elucidate other barriers to this process that then can be addressed accordingly. Further, if referral rates are shown to increase with this intervention, this can be expanded beyond just fellowship teaching but to all pulmonary providers leading to greater positive impact on lung transplant referral rates.

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ABSTRACT #261 CASE REPORT/CLINICAL REVIEW HEMATOLOGY/ONCOLOGY MULTIFOCAL STROKES IN ESSENTIAL THROMBOCYTOSIS Tharaka Wijesinghe1 and Krystle Hernandez1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: A 59-year‐old male with history of hypertension presented with right arm weakness and slurred speech for 15 minutes. He reported feeling difficulty grabbing items while at the grocery store with his cousin and after starting to slur his words, EMS was called. Upon exam in the emergency department, he regained full strength in his right arm, but speech remained slurred. He also started experiencing tingling/ numbness in both arms. Physical exam was significant for decreased strength in the right upper extremity and speech was slow, but fluent. He was able to name, repeat, and follow commands, but had minor word finding difficulty and global speech delay. Significant labs included an elevated troponin to 85 ng/L. EKG was concerning for new ST elevation on V3 and hyperacute T waves on lateral leads. Initial CTH was negative for acute ischemic or hemorrhagic changes. While awaiting MRI Brain, the patient developed severe non‐radiating substernal chest pain with diaphoresis and altered mental status. A rapid response was called and further labs obtained at the time showed an interval increase in the troponin to 3000 ng/L and a platelet count of 1000 × 10^9/L. The patient was started on a heparin drip and taken to the CCU for close neurologic monitoring. The patient then reported bilateral total vision loss concerning for bilateral amaurosis fugax. The heparin drip was stopped and repeat CTH remained negative for acute findings. Urgent ophthalmology consult was also obtained, but no retinal hemorrhage was observed. MRI brain without contrast was expedited and showed recent bilateral infarcts in the right and left parietal lobes and the left frontal lobe. Hematology was consulted for possible essential thrombocytosis and the patient was started on hydroxyurea with improvement in platelet count and symptoms.

Following stabilization of the patient, further testing to determine the etiology was performed including JAK2 and BCR ABL. JAK2 was found to be positive. This led to the diagnosis of multifocal bilateral hemispheric strokes and Type II NSTEMI secondary to essential thrombocytosis.

DISCUSSION: Essential thrombocytosis is a chronic myeloproliferative neoplasm associated with clonal proliferation of platelets. The most common mutations seen in this condition include JAK2, CALR, and MPL. While patients can initially remain asymptomatic from essential thrombocytosis, they are at an increased risk for both thrombosis and abnormal bleeding. Symptoms include vasomotor manifestations such as headaches, visual disturbances, and dizziness, or with more severe complications including thrombotic or hemorrhagic events. Many clinicians may treat this like ischemic strokes, but the symptoms, including amaurosis fugax as seen in this patient, will not improve until aspirin and hydroxyurea are started to lower the platelet count.

DISCUSSION: This is a noteworthy case of JAK2 essential thrombocytosis in a classic patient. This patient's initial platelet count was elevated to 1000 × 10^9/L on admission, so essential thrombocytosis should have been higher on the differential. This case highlights the need for broad initial differentials especially when it is not possible to localize a lesion to a specific vascular distribution. Since patients with essential thrombocytosis may initially be well‐appearing before decompensating in the setting of multiple infarcts or sites of bleeding in several small vessel distributions, this condition is of practical importance in hospital medicine.

393

ABSTRACT #262 CASE REPORT/CLINICAL REVIEW CARDIOLOGY/HEMATOLOGY/ONCOLOGY/PULMONARY/CRITICAL CARE CAN WE BLAME IT ALL ON THE IMMUNE CHECKPOINT INHIBITOR? Yuhong Yang1, Destiny Nguyen1, Nicole Morel1, Mary O’Sullivan1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the Society of Hospital Medicine (SHM) Annual Meeting that was held in Las Vegas, Nevada, United States from April 22-25, 2025.

CASE PRESENTATION: An 80‐year‐old male with a history of atrial fibrillation post‐ablation on apixaban, COPD, hypertension, and Stage IIIC malignant melanoma post‐immunotherapy with nivolumab com-plicated by non‐resolving pneumonitis presented with worsening dyspnea and tachycardia. In the emergency department, he was found to have atrial flutter with rapid ventricular response (RVR), elevated high‐sensitivity troponin, and brain natriuretic peptide (BNP). Initial treatment with adenosine and diltiazem temporarily improved his heart rate, but it rebounded to 170 s. He was admitted for pneumonitis and Aflutter with RVR. The patient underwent TEE with cardioversion for atrial fibrillation but continued to experience recurrent atrial fibrillation episodes and multifocal atrial tachycardia. He was also noted to have a newly decreased left ventricular ejection fraction, raising suspicion for immune checkpoint inhibitor‐related cardiomyopathy. Left and right heart catheterization showed non‐obstructive CAD and normal right heart pressures, while cardiac MRI ruled out immunotherapy‐ induced cardiomyopathy. The patient received empirical antibiotics for possible community‐acquired pneumonia and was discharged on a prolonged prednisone taper for pneumonitis. His arrhythmia was ultimately attributed to pneumonitis and secondary cardiomyopathy due to a rapid heart rate.

DISCUSSION: Immune checkpoint inhibitors (ICIs), such as nivolumab, recently became widely used in cancer therapy, which can cause immune‐related adverse events (irAEs) in various organs. Among these, pneumonitis and cardiac complications are significant due to their potential severity. Pneumonitis is one of the most common pulmonary irAEs, occurring in approximately 3‐5% of patients treated with ICIs. It involves immune‐mediated inflammation of the lung parenchyma, with symptoms ranging from mild cough and dyspnea to severe respiratory failure. Risk factors include combination ICI therapy, underlying lung disease, and smoking history. Management involves prompt diagnosis via imaging, bronchoscopy to exclude infection, and immunosuppression, such as corticosteroids our patient was on. Cardiac irAEs, although less common (<1% incidence), are increasingly recognized and can manifest as myocarditis, pericarditis, arrhythmias, and heart failure. Myocarditis, the most severe, typically presents within weeks of ICI initiation. Cardiac MRI and endomyocardial biopsy are key for diagnosis. Our patient's ICIs were initiated months before presentation, which made cardiac irAEs less likely, though cardiac MRI was essential for confirming. Meanwhile, pneumonitis‐triggered arrhythmia represents a less defined yet plausible complication. Hypoxemia and systemic inflammation associated with pneumonitis can exacerbate cardiac irritability, leading to arrhythmias such as atrial fibrillation or flutter, especially in patients with underlying arrhythmia. Inflammation‐induced electrical re-modeling, combined with ICI‐related myocardial involvement, increases vulnerability to arrhythmias.

CONCLUSION: Awareness of immune‐related adverse events, such as pneumonitis, is crucial for timely diagnosis and multidisciplinary management, emphasizing collaboration between oncology and other teams.

394

ABSTRACT #263 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY AN OBSCURE CASE OF DYSPHAGIA Yuhong Yang1, Michael S. Smith2, Kimberly Cavailiere1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States; 2Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Ectopic gastric mucosa may appear anywhere in the gastrointestinal tract.

Its most common location is the proximal esophagus, where it is also known as cervical inlet patches (CIP), and most often asymptomatic. However, when parietal cells are present, acid secretion can lead to symptoms and tissue damage. We present a patient with a large area of ectopic gastric mucosa complicated by peptic stricture.

CASE PRESENTATION: 53-year-old woman presented with ten years of dysphagia. She noted intermittent solid food dysphagia which progressively worsened. She reported a sensation of food remaining in her throat about twice a month, associated with chest pain and difficulty swallowing both water and saliva. Prior evaluation included a normal barium esophagram, upper endoscopy (EGD), and laryngoscopy. Empiric proton pump inhibitor (PPI) and intermittent fasting improved her dysphagia. A subsequent modified barium swallow showed “esophageal dysmotility”, prompting an esophagus-focused consultation. Given the symptoms trajectory and concern for missed eosinophilic esophagitis, repeat EGD was performed. A single large bilobed and circumferential area of salmon-colored mucosa was found in the upper third of the esophagus with adjacent moderate stenosis and the distal margin. Balloon dilation was performed to a diameter of 15 mm, resulting in symptom resolution. Biopsies confirmed this tissue contained gastric mucosa. To prevent further episodes of dysphagia, the patient was started on chronic PPI therapy, and endoscopic ablation was performed to eradicate the CIP. Despite attempts to mitigate recurrent stricture by ablating only one hemi-circumference at a time, the patient developed dysphagia after the second treatment, requiring additional dilation.

DISCUSSION/CONCLUSION: Acid-secreting CIPs often produce nonspecific symptoms including throat discomfort, globus sensation, odynophagia, and dysphagia. Although rare, mucosal complications such as esophagitis, ulcers, and strictures can develop due to ongoing acid exposure. The CIP detection rate ranges from 1 to 21% in endoscopic studies, but reaches 70% in autopsy studies, suggesting the prevalence is underestimated. Due to its location, a CIP can easily be missed without a deliberate inspection of the proximal esophagus. One study reported that increased awareness of CIP could boost its endoscopic prevalence tenfold.

This case suggests a potential benefit to repeating an EGD for persistent solid food dysphagia without manometric or radiographic abnormalities.

395

Figure 1. A1-A4: Pictures from the repeat endoscopy. A1, A2, A3: Upper third of the esophagus, with a large bilobed and circumferential area of salmon-colored mucosa. A4: Upper third of the esophagus post-dilation.

B1-B4: Endoscopy picture from the first treatment. B1, B3: Upper third of the esophagus with inlet patch under narrow-band imaging. B2: Upper third of the esophagus with inlet patch. B4: Upper third of the esophagus post ablation of the left hemi-circumference of the inlet patch. C1-C4: Endoscopy picture from the second treatment.

C1: Upper third of the esophagus with inlet patch under narrow-band imaging. C2: Upper third of the esophagus with inlet patch and stricture. C3: Upper third of the esophagus with inlet patch. C4: Upper third of the esophagus after argon plasma coagulation ablation

396

ABSTRACT #264 CASE REPORT/CLINICAL REVIEW GASTROENTEROLOGY A RARE CASE OF DUODENAL ADENOCARCINOMA IN A 22-YEAR-OLD Ahmun Zafar1, Alexandria Markley1, Allison Wang1, Mohamed Rabie1, Bruce P. Gelman1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Duodenal adenocarcinoma is rare, accounting for less than 1% of all gastrointestinal malignancies. Diagnosis is often delayed until symptoms such as abdominal pain, nausea, vomiting, and weight loss are present. Anemia, obstruction, and jaundice are associated with advanced disease.

We present a case of duodenal adenocarcinoma.

CASE PRESENTATION: A 22-year-old female with no past medical history presented with two weeks of epigastric pain and one day of nausea and vomiting. Physical exam revealed epigastric tenderness. An abdominal computed tomography (CT) scan revealed a 4.2 x 4.3 cm soft tissue mass at the distal duodenum, causing proximal duodenal and stomach distention. Esophagogastroduodenoscopy (EGD) showed an ulcerated, friable mass in the third portion of the duodenum. Pathology confirmed moderately differentiated invasive adenocarcinoma arising from a small intestinal adenoma with high-grade dysplasia. Tumor marker CA19-9 was 38.6 and chest CT showed no metastases. She underwent a small bowel resection with duodenojejunostomy and resection of eight lymph nodes. Postoperative pathology confirmed invasive adenocarcinoma, moderately differentiated, invading the subserosa, with clean surgical margins and negative lymph nodes.

Immunohistochemical testing revealed intact DNA mismatch repair proteins, suggesting a low likelihood of microsatellite instability or Lynch syndrome. Following discharge, she had two negative circulating tumor DNA (ctDNA) tests and abdominal CT showed no recurrent mass or significant adenopathy. She was offered six months of capecitabine because she had eight lymph nodes, instead of 12, removed. She stopped after five weeks due to nausea and skin darkening. A second ctDNA test was negative. She was referred to genetic counseling, but further testing has not yet been completed.

DISCUSSION/CONCLUSION: Genetics, high-fat diet, smoking, and inflammatory bowel diseases have been proposed as risk factors for duodenal adenocarcinoma. Our patient had no identifiable risk factors. Diagnosis is made using endoscopy, imaging, and histology. Characteristic EGD findings include mucosal ulceration, visible mass, and stenosis or obstruction. Histologic findings include cellular atypia, glandular architecture, and nuclear pleomorphism. Imaging typically reveals a localized soft tissue mass, duodenal wall thickening, or narrowing of bowel. Surgical resection is the primary treatment. Chemotherapy and radiation are offered in advanced disease or if there is a high risk of recurrence.

397

Figure 1. A. Endoscopy of gastric body – streaky gastritis. B. Endoscopy of third portion of the duodenum with solid food residue. C. Endoscopy of third portion of the duodenum – stenosis s/p multiple biopsies. D. Pathology: high power field of malignant glands with dysplastic cells showing loss of orientation, enlarged and irregular nuclei, and prominent nucleoli. E. Pathology: low power field on slide from resection specimen showing invasive moderately differentiating adenocarcinoma invading the submucosa. F. Pathology: proliferative index Ki67 shows ~60% staining on one of the malignant invasive glands indicating high rate of cell proliferation.

398

ABSTRACT #265 CLINICAL RESEARCH GASTROENTEROLOGY BIAS IN THE BOWEL: DISPARITIES IN DIAGNOSTIC TESTING FOR CONSTIPATION Ahmun Zafar1, Joseph Menand1, Yuying Luo1 1Mount Sinai Morningside-West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Presented at the American College of Gastroenterology (ACG) Annual Meeting that was held in Philadelphia, Pennsylvania, United States from October 25-30, 2024.

BACKGROUND/INTRODUCTION: Constipation and defecatory disorders significantly impact patients' quality of life. Diagnostic procedures such as anorectal manometry (ARM) and defecography, are recommended to evaluate underlying anorectal physiology when initial treatments for constipation fail, although many patients do not undergo further work-up. We aim to identify patient-level differences between those who underwent further diagnostic workup for constipation and those who did not.

METHODS: We conducted a retrospective cohort analysis of patients with at least one billing diagnosis of constipation or defecatory disorders at one tertiary academic clinic with onsite access to ARM and defecography from January 2017 to December 2022. Patients were divided into two groups based on whether they underwent further diagnostic workup (ARM, defecography) and/or biofeedback. Demographic variables, including age, gender, race, primary language, and insurance status, were compared between groups.

RESULTS: Our entire cohort included 3084 patients, with average age 54.5 + 17.4 (66.7% younger than 65 years), 70.3% female, 31.9% White and 86.7% English speaking. 24.2% of patients underwent ARM, defecography and/or biofeedback for constipation. Patients who underwent additional workup and/or biofeedback for constipation were more likely female (73.2% versus 26.8%, p=0.048), white (41.3% versus 58.7%, p<0.001), and English-speaking (90.6% versus 9.4%, p<0.001). Patients with ten or more billing and/or encounter diagnoses for constipation were significantly more likely to have undergone further workup and/or biofeedback than patients with less than ten constipation diagnoses (42.5% versus 57.5%, p<0.001). Of the 733 patients who underwent ARM and/or defecography, 201 (27.4%) went on to get biofeedback (Figure 1).

CONCLUSION: One quarter of patients with constipation at one tertiary center with onsite access to anorectal manometry received additional work-up including anorectal manometry, defecography and/or biofeedback, higher than previously reported in the literature. However, these patients were more likely female, White, and English-speaking, highlighting potential disparities in management of refractory constipation and how algorithms are applied in the real-world.

399

Figure 1. Patient Distribution and Treatment Pathways for Constipation Workup

400

Publications 2024-2025

401

LIST OF PUBLICATIONS 2024-2025*

1

Madeline Kim, Ester Del Duca, Dante Dahabreh, Daniel Lozano-Ojalvo, Britta Carroll, Meredith Manson, Swaroop Bose, Digpal Gour, Monali NandyMazumdar, Ying Liu, Mitchelle Yu Ekey, Amira Chowdhury, Michael Angelov, Benjamin Ungar, Yeriel Estrada, Emma Guttman-Yassky. “Alopecia areata exhibits cutaneous and systemic OX40 activation across atopic backgrounds.” Allergy, 2024. PMID: 39115359

2

Richard Vaca and Nirali A. Shah. “Finding the Culprit: Cushing Syndrome Secondary to Lung Carcinoid Tumor.” American Association of Clinical Endocrinologists Clinical Case Reports, 2024. PMID: 39896959

3

Bruno Almeida Costa, Thomaz Alexandre Costa, Kevin Pak, Aesha Patel, Nicole Felix, Tarek H. Mouhieddine, Joshua Richter. “Comparative efficacy of carfilzomib, lenalidomide, and dexamethasone (KRd) versus bortezomib, lenalidomide, and dexamethasone (VRd) in newly-diagnosed multiple myeloma: A systematic review and meta-analysis.” American Journal of Hematology, 2024. PMID: 38606993

4

Subhash Chander, Roopa Kumari, Abhi Chand Lohana, Zubair Rahaman, Om Parkash, Sheena Shiwlani, Yaqub Nadeem Mohammed, Hong Yu Wang, Hao Chi, Wenchy Tan, Sanjay Kirshan Kumar, Fnu Sindhu. “Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis.”

American Journal of Kidney Diseases, 2025. PMID: 39362395

5

Alessandro Berni, Mengxi Shen, Yuxuan Cheng, Gissel Herrera, Farhan Hiya, Jeremy Liu, Liang Wang, Jianqing Li, Sandy Wenting Zhou, Omer Trivizki, Nadia K. Waheed , Robert O'Brien, Giovanni Gregori, Ruikang K. Wang, Philip J. Rosenfeld. “The Total Macular Burden of Hyperreflective Foci and the Onset of Persistent Choroidal Hypertransmission Defects in Intermediate AMD.” American Journal of Ophthalmology, 2024. PMID: 38944135

6

Adedeji Adeniyi, Shane Fuentes, Raysha Farah, Sahadah Lawani, Oliver Sosa, Mikaili Puckerine, Joel Stein, Kristian J. von Rickenbach. “Fostering Inclusivity in PM&R: A National Survey.” American Journal of Physical Medicine & Rehabilitation, 2024. PMID: 39642334

7

Mandeep Gill Sagoo, Pak Yin Lam, Tanvi Sharma, Arisma Arora, Maheen Siddiqui, Adedeji M. Adeniyi, Cecilia Brassett, Geoffroy Noel, Richard Wingate, Sean McWatt, Dana Stearns, Pilar Garcia Souto, Anette Wu. “Evaluating group dynamics through peer assessment during a global student collaboration of interprofessional healthcare education: A longitudinal study across 33 universities.” Anatomical Sciences Education, 2025. PMID: 40145343

8

Sonal Gandhi, Drew Moss, Richard Stephen Sheppard, Ibrahim Omore, Fionnuala Crowley, Tianxiang Sheng, Linda Wu, Deirdre Jill Cohen, Cardinale B Smith. “Examining the impact of specialty palliative care consultation in patients with metastatic pancreatic cancer: evaluating use at an NCI designated cancer center.” Annals of Palliative Medicine, 2025. PMID: 39963762

*Updated on May 1, 2025

402

LIST OF PUBLICATIONS 2024-2025*

9

David Rabinovitch, Shiri Shulman, Dafna Goldenberg, Liang Wang, Prashanth Iyer, Anat Loewenstein, Noah Igra, Olivia Levine, Gissel Herrera, Omer Trivizki. “Choroidal Response to Intravitreal Bevacizumab Injections in Treatment-Naïve Macular Neovascularization Secondary to Chronic Central Serous Chorioretinopathy.” Biomedicines, 2024. PMID: 39767667

10

Jesse D. Gelles, Yiyang Chen, Mark P A Luna-Vargas, Ariele Viacava Follis, Stella G. Bayiokos, Jarvier N. Mohammed, Tara M. Sebastian, M. Abdullah Al Noman, Ngoc Dung Pham, Yi Shi, Richard W. Kriwacki, Jerry E. Chipuk. “A gated hydrophobic funnel within BAX binds long-chain alkenals to potentiate pro-apoptotic function.” BioRxiv, 2024. PMID: 39763924

11

Xinhe Xue, Zoran Z. Gajic, Christina M. Caragine, Mateusz Legut, Conor Walker, James Y. S. Kim, Xiao Wang, Rachel E. Yan, Hans-Hermann Wessels, Congyi Lu, Neil Bapodra, Gamze Gürsoy, Neville E Sanjana. “Paired CRISPR screens to map gene regulation in cis and trans.” BioRxiv, 2024. PMID: 39651170

12

Santiago Thibaud, Ryan L. Subaran, Scott Newman, Alessandro Lagana, David T. Melnekoff, Saoirse Bodnar, Meghana Ram, Zachry Soens, William Genthe, Tehilla Brander, Tarek H. Mouhieddine, Oliver Van Oekelen, Jane Houldsworth, Hearn Jay Cho, Shambavi Richard, Joshua Richter, Cesar Rodriguez, Adriana Rossi, Larysa Sanchez, Ajai Chari, Erin Moshier, Sundar Jagannath, Samir Parekh, Kenan Onel. “Multiple Myeloma Risk and Outcomes Are Associated with Pathogenic Germline Variants in DNA Repair Genes.” Blood Cancer Discovery, 2024. PMID: 39283238

13

Kohei Horiuchi, Chiara Hortelano, Reza Nikfar, Joyce Fogel. “Hereditary transthyretinmediated amyloidosis masquerading as diabetic neuropathy and lumbar radiculopathy.”

BMJ Case Reports, 2024. PMID: 39266025

14

Samuel Nemiroff and Peter Goulden. “Tailoring an antihyperglycaemic regimen to a monogenic diabetes variant.” BMJ Case Reports, 2024. PMID: 39306338

15

Arjun Lalit Kalaria, Takayuki Yamada, Michele Klein-Fedyshin, Shota Obata, Massiel Cruz-Peralta, Bryce Parrish, Amaan Z. Rahman, Michele Molinari, Rajil B. Mehta.

“Subclinical rejection and allograft survival in kidney transplantation: protocol for a systematic review and meta-analysis.” BMJ Open, 2024. PMID: 39025816

16

Steven Lim, Aphrodite Megaris, Lina Miyakawa, Jason Filopei, Patricia Dharapak.

“Increasing healthcare proxy documentation in an intensive care unit: a quality improvement initiative.” BMJ Quality Improvement Reports, 2024. PMID: 39084697

17

Parissa Alerasool, Susu Zhou, Eric Miller, Jonathan Anker, Brandon Tsao, Natasha Kyprianou, Che-Kai Tsao. “A Personalized Approach for Oligometastatic Prostate Cancer: Current Understanding and Future Directions.” Cancers, 2025. PMID: 39796774

*Updated on May 1, 2025

403

LIST OF PUBLICATIONS 2024-2025*

18

Antoine Jeri-Yabar, Liliana Vittini-Hernandez, Renzo Aller-Rojas, Francisco AriasReyes, Sirish Dharmapuri. “Disparities in Stage at Diagnosis among Hispanic Patients with Gastric Cancer in the United States.” Cancers, 2024. PMID: 39409928

19

Rodrigo Paredes de la Fuente, Santiago Sucre, Cristina Ponce, Ahmed Anwer Ali Rattani, Mary Linton B. Peters. “Somatic Mutation Profile as a Predictor of Treatment Response and Survival in Unresectable Pancreatic Ductal Adenocarcinoma Treated with FOLFIRINOX and Gemcitabine Nab-Paclitaxel.” Cancers, 2024. PMID: 39123462

20

Joseph Maenza, Lakshay Chopra, Carlo Mannina, Esha Vaish, Yash Prakash, Johanna Contreras, Francesca Prandi, Ranbir Singh, Parasuram Krishnamoorthy, Sahil Khera, George Dangas, Gilbert H L Tang, Samin K. Sharma, Annapoorna S. Kini, Stamatios Lerakis. “Effect of cardiac amyloidosis on outcomes in transcatheter aortic valve replacement in low-flow low-gradient aortic stenosis.” Cardiovascular Revascularization Medicine, 2024. PMID: 39550305

21

Ranbir Singh, Yash Prakash, Lakshay Chopra, Akarsh Sharma, Samuel Maidman, Dylan Sperling, Esha Vaish, Sahil Khera, Parasuram Melarcode-Krishnamoorthy, Samin Sharma, Annapoorna Kini, Stamatios Lerakis. “Effect of cardiac amyloidosis on outcomes in transcatheter aortic valve replacement in low-flow low-gradient aortic stenosis.”

Cardiovascular Revascularization Medicine, 2025. PMID: 39848825

22

Lakshay Chopra, Carlo Mannina, Hiroki Ueyama, Jacqueline Mirza, Joseph Maenza, Ankur Dalsania, Francesca R. Prandi, Edgar Argulian, Samin Sharma, Annapoorna Kini, Stamatios Lerakis. “Outcomes in patients with low-flow very low-gradient aortic stenosis: A long-term follow-up.” Cardiovascular Revascularization Medicine, 2024. PMID: 38616462

23

Glenn Jun Kit Ho, Faith Xin Ning Tan, N. Apoorva Sasikumar, Ethan Kai Jun Tham, Donghyun Ko, Do Han Kim, Pojsakorn Danpanichkul, Zhenning Yu, Cheng Xianda, Zi Xuan Zhang, Karn Wijarnpreecha, Thanawin Pramotedham, Mazen Noureddin, Daniel Q Huang, Yoshio Sumida, Atsushi Nakajima, Ming-Hua Zheng, Hirokazu Takahashi, Cheng Han Ng, Mark Muthiah. “High Global Prevalence of Steatotic Liver Disease and Associated Subtypes: A Meta-Analysis.” Clinical Gastroenterology and Hepatology, 2025. PMID: 40204206

24

Lodoe Sangmo, Baseer Quraishi, Palak Rajauria, Elisabeth Giselbrecht, Jean-Frederic Colombel, Ryan Ungaro, Serre-Yu Wong. “Natural History of Clinically Suspected Isolated Perianal Fistulizing Crohn's Disease.” Clinical Gastroenterology and Hepatology, 2025.

PMID: 39454982

25

Shivani Handa, Ganesh Sivakumar, Andrew Srisuwananukorn, Amylou Dueck, Douglas Tremblay, John O Mascarenhas, Yelena Ginzburg, Marina Kremyanskaya, Ronald Hoffman. “Oral Decitabine/Cedazuridine Is an Effective Ambulatory Therapy for Patients with Myelofibrosis Refractory to JAK2 Inhibitor Therapy.” Clinical Lymphoma, Myeloma, and Leukemia, 2024. PMID: 38839448

*Updated on May 1, 2025

404

LIST OF PUBLICATIONS 2024-2025*

26

Fahd Yazdanie, Jeffrey R. Sims, Stephanie Ying, Poonam Misra, Manjool Shah, Joseph F. Panarelli. “Characteristics of Normal Tension Glaucoma Referrals at a Tertiary Care Center and Factors Associated with Unilateral versus Bilateral Disease.” Clinical Ophthalmology, 2025. PMID: 40191002

27

Arjun Syal, Francesca M. Cozzi, Sima Vazquez, Eris Spirollari, Alexandria F. Naftchi, Ankita Das, Christina Ng, OluwaToba Akinleye, Thomas Gagliardi, Jose F. Dominguez, Arthur Wang, Merritt D. Kinon. “Dural Closure Techniques and Cerebrospinal Fluid Leak Incidence After Resection of Primary Intradural Spinal Tumors: A Systematic Review.”

Clinical Spine Surgery, 2024. PMID: 37482628

28

Samantha R. Pianello, Joanna M. Abouezzi, Garret M. Weber, Elizabeth Drugge, Marvin S. Medow, Apolonia E. Abramowicz. “Do Program Directors of Anesthesiology Residency Programs Interpret Narrative Letters of Recommendation as Intended?” Cureus, 2024.

PMID: 39087200

29

Marlon E. Rivera Boadla, Nava R. Sharma, Jeffy Varghese, Saral Lamichhane, Muhammad H. Khan, Amit Gulati, Sakshi Khurana, Samuel Tan, Anupam Sharma.

“Multimodal Cardiac Imaging Revisited by Artificial Intelligence: An Innovative Way of Assessment or Just an Aid?.” Cureus, 2024. PMID: 39130913

30

Samuel S. Tan, Wenchy Yy Tan, Lucy S. Zheng, Paulus Adinugraha, Hong Yu Wang, Shasawat Kumar, Amit Gulati, Sakshi Khurana, Wan Lam, Thida Aye. “Multi-year population-based analysis of Asian patients with acute decompensated heart failure and advanced chronic kidney disease.” Current problems in Cardiology, 2024. PMID: 38735349

31

Andreina Carbone, Davide Turchino, Carlo Fanti, Roberta Bottino, Francesco Ferrara, Carlo Mannina, Stamatios Lerakis, Giuseppe Comentale, Salvatore Rega, Antonio Cittadini, Giovanni Esposito, Emanuele Pilato, Umberto Marcello Bracale, Eduardo Bossone. “Post-implantation syndrome in patients undergoing thoracic and abdominal endovascular aortic repair: Comprehensive systematic review and meta-analysis.” Current problems in Cardiology, 2025. PMID: 40246002

32

Ashley Sang Eun Lee, Sara Dehbozorgi, Michele Beaudoin, Mary Grace Baker.” A comprehensive guide to food allergy management for the general pediatrician.” Current Problems in Pediatric and Adolescent Health, 2025. PMID: 40221356

33

Payel Gupta, Wajiha Kazmi, Gregory Della Penna, Sneha Bupathi, Farah N. Khan. “Social Media and the Allergist.” Current Allergy and Asthma Reports, 2024. PMID: 38916674

34

Brit Trogen, Megha Verma, Scott H. Sicherer, Amanda Cox. “The Role of Food Allergy in Atopic Dermatitis.” Dermatologic Clinics of North America, 2024. PMID: 39278706

*Updated on May 1, 2025

405

LIST OF PUBLICATIONS 2024-2025*

35

Bharati Dev, Yousaf Hadi, Anam Rizvi, Christopher Cao, Brian Horwich, Nicholas A. Hoerter. “Low Rates of Aborted Endoscopy Due to Gastric Food Retention in Patients on Glucagon-Like-Peptide-1 Receptor Agonists.” Digestive Diseases and Sciences, 2025.

PMID: 40021603

36

Sayaka Nagao, Makoto Nishimura, Mako Koseki, Jacques Beauvais, Monika Laszkowska, Laura Tang, Vivian E. Strong, Mark A. Schattner. “Treatment outcomes of non-curative endoscopic submucosal dissection for superficial gastric neoplasia: A retrospective study at a tertiary care center in the United States.” Digestive Endoscopy Open, 2024. PMID: 39524150

37

Emily S. Seltzer, Mantej Sehmbhi, Robinderpal Sandhu, Kimberly Cavaliere, Yuying Luo, Michael S. Smith, Daniela Jodorkovsky. “Distal esophageal spasm and gastroesophageal reflux disease: re-examining the association.” Diseases of the Esophagus, 2024. PMID: 39341683

38

Sandhya Rao Bassin, Julia Ferreira De Carvalho, Mahima Gulati. “A Review of PlantBased Diets for Obesity Management.” Endocrine Practice, 2024. PMID: 38729570

39

Luka Katic, Ivana Ferenčak, Ana Gverić-Grginić, Ivana Goic-Barisic, Zana Rubic, Marina Radic-Skelin, Jelena Marinovic, Dora Smolić, Josipa Kuzle, Lucija Škara Abramović, Irena Tabain, Dragan Jurić, Marija Tonkic, Georgina Osorio, Anita Novak; ESCMID Food- and Water-borne Infectious Study Group (EFWISG) “Phenotypic and Whole-Genome Sequencing-Based Profiling of Antimicrobial Resistance and Virulence in Campylobacter spp. Isolated from Human Stool in a Croatian University Hospital.” Foodborne Pathogens and Disease, 2025. PMID: 40053320

40

Natalie A. Townsend, Shalini Shah, Joshua Reyes, Justin H. Townsend, Alison Bozung, Giselle Ricur, Rami J. Aboumourad. “Tele-ophthalmology as an effective triaging tool for acute ophthalmic concerns.” Frontiers in Ophthalmology, 2025. PMID: 39877035

41

Carlos R. Celis, Lucie Ecker, Giancarlo Alvarado-Gamarra, Katherine Alcalá-Marcos, Noé Atamari-Anahui, Maria Pia Balmaceda, Kevin Florian, Rodrigo Paredes de la Fuente, Leigh M. Howard, Carlos G. Grijalva, Claudio F. Lanata. “Acceptance of a third COVID-19 vaccine dose, vaccine interchangeability, and clinical trial enrolment among parents of children 12-17 years in Lima, Perú.” Frontiers in Public Health, 2024. PMID: 39206012

42

Mako Koseki, Makoto Nishimura, Tarek Nammour, Sayaka Nagao, Mark A. Schattner.

“Feasibility of esophageal endoscopic submucosal dissection after radiofrequency ablation treatment in patients with Barrett's esophagus.” Gastrointestinal Endoscopy, 2024. PMID: 38340874

43

Marni H. Wilkoff, Nicholas R. Piniella, Rashmi Advani. “Can Artificial Intelligence Create an Accurate Colonoscopy Bowel Preparation Prompt?” Gastroenterology Hepatic Advances, 2024. PMID: 39866721

*Updated on May 1, 2025

406

LIST OF PUBLICATIONS 2024-2025*

44

Yugo Suzuki, Yorinari Ochiai, Daisuke Kikuchi, Mako Koseki, Kenichi Ohashi, Shu Hoteya. “Long-term Outcome of Asymptomatic Esophageal Eosinophilia.” Gut and Liver, 2025. PMID: 38623060

45

Michael J. Fitzgerald, Jesse Galina, Emily Kolodka, Ariel Henig, Sayyida Hasan, Susan Maltse, Lewis B. Lane, Kate W. Nellans. “The Risk of Lymphedema After Breast Cancer Surgery Should Not Restrict Necessary Hand Surgery Interventions.” Hand, 2024.

PMID: 37545375

46

Christopher N. Matthews, Alaa Mabrouk Salem Omar, Mohammad I. Khan, Joseph D. Marinelli, Joseph Elias, Swiri Konje, Alba Munoz, Ga Hee Kim, Errol Moras, Kruti Gandhi, Christopher Perez Lizardo, Arpanjeet Kaur, Edgar Argulian. “Prognostic value of exercise tolerance and exercise-induced diastolic dysfunction in elderly patients referred for exercise stress echocardiography.” International Journal of Cardiology, 2025. PMID: 39442760

47

Tara Sebastian, Allison Close, Clare DeVeau, Chad Fessenden, Chi Braunreiter.

“Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.” Journal of Adolescent and Young Adult Oncology, 2024. PMID: 38708692

48

Manal Ahmidouch, Shiva K. Das, Tong Zhu, Colette Shen, Lawrence B. Marks, Bhishamjit S. Chera, David V. Fried. “Identifying dose constraints for the parotid ducts to minimize patient-reported xerostomia: Is conventional mean dose sparing of the parotid glands sufficient?” Journal of Applied Clinical Medical Physics, 2024. PMID: 39288256

49

Amara L. Plaza-Jennings, Christie B. Ryba, Jessica Tan, Jennifer El Diaz, Grace E. Mosley, Talia H. Swartz, Margaret H. Baron, Robert Fallar, Valerie Parkas. “A study of MDPhD pre-health advising identifies challenges to building a robust MD-PhD applicant pool.”

Journal of Clinical Investigation Insight, 2025. PMID: 40197371

50

Bruno Almeida Costa, Danai Dima, Tomer Mark, Norah Layla Sadek, Stephen Ijioma, David Ray, Utkarsh Goel, George Dranitsaris, Tianxiang Sheng, Erin Moshier, Tarek H Mouhieddine, Jack Khouri, Adriana Rossi. “Impact of Prior Selinexor Exposure on Outcomes of Chimeric Antigen Receptor T-Cell Therapy for Relapsed/Refractory Multiple Myeloma: An Exploratory Analysis.” Journal of Clinical Medicine, 2024. PMID: 40004846

51

Masahiko Okada, Keiko Ohgino, Kohei Horiuchi, Koichi Sayama, Daisuke Arai, Mayuko Watase, Keigo Kobayashi, Takeshi Terashima, Kota Ishioka, Masayoshi Miyawaki, Fumio Sakamaki, Keita Masuzawa, Hideki Terai, Hiroyuki Yasuda, Kenzo Soejima, Koichi Fukunaga. “Real-World Efficacy and Safety of Atezolizumab for Advanced Non-Small Cell Lung Cancer in Japan: A Retrospective Multicenter Analysis.” Journal of Clinical Medicine, 2024. PMID: 39768737

*Updated on May 1, 2025

407

LIST OF PUBLICATIONS 2024-2025*

52

Vincent A. Torelli, Sanjay Sivalokanathan, Alexander Silverman, Syed Zaidi, Usman Saeedullah, Komail Jafri, James Choi, Luka Katic, Serdar Farhan, Ashish Correa. “Role of Multimodality Imaging in Cardiac Sarcoidosis: A Retrospective Single-Center Experience.” Journal of Clinical Medicine, 2025. PMID: 39685791

53

Yuko Kiyohara, Alexandros Briasoulis, Toshiki Kuno. “Comparison of blood transfusion strategies for acute coronary syndrome patients with anemia: A meta-analysis of five randomized controlled trials.” Journal of Cardiology, 2024. PMID: 38642888

54

Chaerim Kang, Christopher J. Shin, Ji Yun Han, Spandana N. Jarmale, Ingrid U. Scott, Karen M. Sanders, Paul B. Greenberg. “Virtual Supervision in Graduate Medical Education: A Systematic Review.” Journal of Graduate Medical Education, 2024. PMID: 39148867

55

Nooshin C. Beygui, Erin Duross, Chin-I Cheng, Katherine Mesaros, Karissa Gawronski, Juliette Perzhinsky. “The Effect of the COVID-19 Pandemic on Prescribing Medications for Opioid Use Disorder in the Mid-Michigan Region.” Journal of Primary Care and Community Health, 2025. PMID: 40173284

56

Benjamin Ungar, Meredith Manson, Madeline Kim, Digpal Gour, Panipak Temboonnark, Ragasruti Metukuru, Joel Correa Da Rosa, Yeriel Estrada, Jesús Gay-Mimbrera, Pedro J. Gómez-Arias, Juan Ruano, Avner Shemer, Diane Hanna, Patrick Burnett, Emma GuttmanYassky. “Tape-strip profiling identifies unique immune and lipid dysregulation in patients with seborrheic dermatitis.” Journal of the American Academy of Dermatology, 2024.

PMID: 39900186

57

Hiroki A. Ueyama, Keitaro Akita, Yuko Kiyohara, Hisato Takagi, Alexandros Briasoulis, Jose Wiley, Sripal Bangalore, Roxana Mehran, Gregg W. Stone, Toshiki Kuno, Deepak L. Bhatt. “Optimal Strategy for Complete Revascularization in ST-Segment Elevation Myocardial Infarction and Multivessel Disease: A Network Meta-Analysis.” Journal of the American College of Cardiology, 2025. PMID: 39779054

58

Kirtipal Bhatia, Soumya Gupta, Kristen Carter, Marija Petrovic, Samantha V. Shetty, Devika Aggarwal, Abel Casso Dominguez, Stamatios Lerakis, Edgar Argulian. “SingleLeaflet Device Attachment After Mitral Transcatheter Edge-to-Edge Repair: Systematic Review and Meta-Analysis.” JACC: Cardiovascular Interventions, 2024. PMID: 39387786

59

Carlo Mannina, Akarsh Sharma, Andreina Carbone, Eduardo Bossone, Antonino Tuttolomondo, Edgar Argulian, Eric Neibart, Michael B. Hadley, Jonathan Halperin, George Dangas, Samin K. Sharma, Annapoorna Kini, Stamatios Lerakis. “Association of Systemic Inflammatory Response Syndrome with Cardiovascular Events After Mitral Transcatheter Edge-to-Edge Repair.” Journal of the American Heart Association, 2024. PMID: 39526356

*Updated on May 1, 2025

408

LIST OF PUBLICATIONS 2024-2025*

60

Catherine A. O'Connor, Emily Harrold, David Lin, Henry Walch, Andrea Gazzo, Megha Ranganathan, Sarah Kane, Fergus Keane, Joshua Schoenfeld, Drew Moss, Deborah M. Thurtle-Schmidt, Sarah P. Suehnholz, Debyani Chakravarty, Fiyinfolu Balogun, Anna Varghese, Kenneth Yu, David Kelsen, Alicia Latham, Britta Weigelt, Wungki Park, Zsofia Stadler, Eileen M. O'Reilly. “Lynch Syndrome and Somatic Mismatch Repair Variants in Pancreas Cancer.” JAMA Oncology, 2024. PMID: 39235819

61

Katherine I. Tierney, Ellen Wagenfeld-Heintz, Cynthia Bane, Silvia Linares, Megan Sandberg, Drew Moss, Abby Duerst, Claudia Walters, Terra Bautista, Lynette Gumbleton, Catherine L. Kothari. “Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.” Journal of Midwifery and Women’s Health, 2025. PMID: 39428684

62

Carlo Mannina, Kazato Ito, Zhezhen Jin, Yuriko Yoshida, Cesare Russo, Koki Nakanishi, Tatjana Rundek, Shunichi Homma, Mitchell S V Elkind, Marco R Di Tullio. “Left Atrial Function and Incident Heart Failure in Older Adults.” Journal of the American Society of Echocardiography, 2025. PMID: 39389324

63

Yuriko Yoshida, Zhezhen Jin, Cesare Russo, Shunichi Homma, Carlo Mannina, Koki Nakanishi, Tatjana Rundek, Mitchell S V Elkind, Marco R. Di Tullio. “Sleep Duration and Subclinical Left Ventricular Dysfunction in Older Adults.” Journal of the American Society of Echocardiography, 2024. PMID: 39528090

64

Fergus Keane, Catherine O'Connor, Drew Moss, Joanne F. Chou, Maria A. Perry, Fionnuala Crowley, Parima Saxena, Amelia Chan, Joshua D. Schoenfeld, Anupriya Singhal, Wungki Park, Darren Cowzer, Emily Harrold, Anna M. Varghese, Imane El Dika, Christopher Crane, James J. Harding, Ghassan K. Abou-Alfa, T. Peter Kingham, Alice C. Wei, Kenneth H. Yu, Michael I. D'Angelica, Vinod P. Balachandran, Jeffrey Drebin, William R. Jarnagin, Chaitanya Bandlamudi, David Kelsen, Marinela Capanu, Kevin C. Soares, Fiyinfolu Balogun, Eileen M. O'Reilly. “Adjuvant modified FOLFIRINOX for resected pancreatic adenocarcinoma: clinical insights and genomic features from a large contemporary cohort.” Journal of the National Cancer Institute, 2025. PMID: 39460946

65

Jeanette Rios, Lauren Alpert, Sonia Mehra, Natalia Schmidt, Tatyana Kushner. “Overview of Hepatitis C in Pregnancy: Screening, Management, and Treatment.” Journal of the Pediatric Infectious Diseases Society, 2024. PMID: 39051677

66

Antonio D'Alessio, Bernardo Stefanini, Julia Blanter, Benjamin Adegbite, Fionnuala Crowley, Vincent Yip, Sarah Slater, Claudia Angela Maria Fulgenzi, Ciro Celsa, Giulia Francesca Manfredi, Madhava Pai, Robert D. Goldin, Stephen C. Ward, Maria Isabel Fiel, Daniel H. Shu, Yung-Yeh Su, Alessio Cortellini, Marina Baretti, Robert Anders, Mark Yarchoan, Chiun Hsu, Thomas U. Marron, David J. Pinato. “Pathological response following neoadjuvant immune checkpoint inhibitors in patients with hepatocellular carcinoma: a cross-trial, patient-level analysis.” Lancet Oncology, 2024. PMID: 39437804

*Updated on May 1, 2025

409

LIST OF PUBLICATIONS 2024-2025*

67

Sara Zhukovsky, Joshua White, Rajshekhar Chakraborty, Luciano J. Costa, Oliver Van Oekelen, Douglas W. Sborov, Edward R. Scheffer Cliff, Ghulam Rehman Mohyuddin.

“Multiple myeloma clinical trials exclude patients with the highest-risk disease: a systematic review of trial exclusion criteria.” Leukemia and Lymphoma, 2024. PMID: 39314111

68

Melissa Akselrad, Michael A. Via, Jeffrey I. Mechanick. Lifestyle Medicine Approaches to Bone Health: State of the Field and Future Directions. 2025. In: Mechanick, J.I., Kushner, R.F. (eds) Lifestyle Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-828881_13

69

Ashley N. Brown, M. Marcia Lange, Lital Aliasi-Sinai, Xiaotao Zhang, Sasha Kogan, Lily Martin, Tatyana Kushner. “Adverse pregnancy outcomes and effect of treatment in Wilson disease during pregnancy: Systematic review and meta-analysis.” Liver International, 2024. PMID: 39206599

70

Antoine Jeri-Yabar, Liliana Vittini-Hernandez, Jerry K. Benites-Meza, Sebastian PradoNuñez. “Survival Analysis, Clinical Characteristics, and Predictors of Cerebral Metastases in Patients with Colorectal Cancer.” Medical Sciences, 2024. PMID: 39311160

71

Arjun Sayal, Sima Vasquez, Akiva P. Novetsky. Jared Pisapia. Robotic-Assisted Obturator Nerve Repair: A Technical Report.” Operative Neurosurgery, 2024. PMID: 39162408

72

Evan Bilsbury, Marina Mautner Wizentier, Emma Wood, Sean Doherty, James Ledwith, Juan Ding. “The Continuing Impact of the COVID-19 Pandemic on Diabetic Retinopathy Screenings.” Ophthalmic Epidemiology, 2025. PMID: 39083570

73

Grace Lee, Julie Nellis, Chau M. Pham, Randy H. Kardon, Erin M. Shriver. “Trigeminal nerve blocks attenuate afferent input to the puff-induced blink reflex in chronic orbital pain assessed by high-speed video.” Orbit, 2024. PMID: 39671190

74

Kinjal M. Patel, Kiana D. de Guzman, Keri Cronin, Noud van Helmond, Sandeep Krishnan, Ludmil Mitrev, Keyur C. Trivedi, Ronak G. Desai. “Pectoralis I and Serratus Anterior Plane Block Analgesia for Bilateral Mastectomy: A Case Series.” Pain Physician, 2024. PMID: 39688831

75

Yoshiko Ishisaka, Hong Yu Wang, Hayato Mitaka, Elliot Charen, Paru Patrawalla.

“Implementation and Assessment of a Curriculum for Renal Point of Care Ultrasound Training.” Point of Care Ultrasound Journal, 2024. PMID: 39634687

76

Priyanka Sridhar, Hong Yu Wang, Agostina Velo, Destiny Nguyen, Avinash Singh, Abdul Rehman, Jason Filopei, Madeline Ehrlich, Robert Lookstein, David J. Steiger.

“Outcomes of patients with acute pulmonary embolism managed in-house vs those transferred between hospitals: a retrospective observational study.” Research and Practice in Thrombosis and Haemostasis, 2024. PMID: 39687927

*Updated on May 1, 2025

410

LIST OF PUBLICATIONS 2024-2025*

77

Ying-Han Chen, Kimberly Zaldana, Frank Yeung, Ivan Vujkovic-Cvijin, Alexander E. Downie, Jian-Da Lin, Yi Yang, Christin Herrmann, Oyebola Oyesola, Felix Rozenberg, Robert E. Schwartz, David Kim, Kurt Tio, Yasmine Belkaid, P'ng Loke, Andrea L. Graham, Sergei B. Koralov, Ken Cadwell. “Rewilding catalyzes maturation of the humoral immune system.” Science Advances, 2025. PMID: 40053586

78

Mako Koseki, Yoshito Nishimura, Evelyn Elias, Jonathan Estaris, Fnu Chesta, Kensuke Takaoka, Theresa Shao, Nobuyuki Horita, Yu Fujiwara. “Pancreatitis in Patients with Cancer Receiving Immune Checkpoint Inhibitors: A Systematic Review and Metaanalysis.” Targeted Oncology, 2024. PMID: 39392549

79

Alison Karasz, Samuel Nemiroff, Pablo Joo, Irene Blanco, Ariel Y. Fishman, Mary S. Kelly, Steven M. Henick, Maryl Lambros, William B. Burton. “A Sense of Belonging: Perceptions of the Medical School Learning Environment among URM and Non-URM Students.” Teaching and Learning in Medicine, 2024. PMID: 37450615

80

Carlo Mannina, Lakshay Chopra, Joseph Maenza, Francesca R. Prandi, Edgar Argulian, Michael Hadley, Jonathan Halperin, Samin K. Sharma, Annapoorna Kini, Stamatios Lerakis. “Left Ventricular Remodeling in Patients with Low Flow Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.” The American Journal of Cardiology, 2024. PMID: 38925261

81

Do Han Kim, Michael Marble, Juan E Corral. “Gastrointestinal Xanthomas and Ichthyosis: A Mild Phenotype of CHILD Syndrome (NSDHL Gene Mutation).” The American Journal of Gastroenterology, 2024. PMID: 39466221

82

Sara Dehbozorgi, Nicole Ramsey, Ashley Sang Eun Lee, Amaziah Coleman, Pooja Varshney, Carla M. Davis. “Addressing Health Equity in Food Allergy.” The Journal of Allergy and Clinical Immunology, 2024. PMID: 38280451

83

Marsha Ritter Jones, James Jones, Prathyusha Pandu, Chunyan Liu, Cara D. Carey, Louis D. Falo, Kathryn M. Albers. “Neurturin GF Enhances the Acute Cytokine Response of Inflamed Skin.” The Journal of Investigative Dermatology, 2025. PMID: 39122143

84

Carolina Moreira Sarmiento, Guy Crowder, Bonnie Meatherall, Jacob Bezemer, Yenjean Hwang, Ariel Gordon, Aisha Mumtaz, Brittany Jackson, Juan David Ramírez, Alberto Paniz-Mondolfi, Carlos Franco-Paredes, Valida Bajrovic. “Challenges in the treatment of cutaneous leishmaniasis caused by L. braziliensis in four travelers: a case series.”

Therapeutic Advances in Infectious Disease, 2024. PMID: 3955383

85

Parissa Tabrizian, Allen Yu, Neha Debnath, Bryan Myers, Thomas Marron.

“Immunotherapy and Liver Transplantation: The Future or the Failure?” The Surgical Clinics of North America, 2024. PMID: 37953034

*Updated on May 1, 2025

411

LIST OF PUBLICATIONS 2024-2025*

86

Shota Obata, Sumi Hidaka, Shuzo Kobayashi. “A First Case of Bacterial Pericarditis Due to Campylobacter fetus Infection in a Kidney Transplant Recipient.” Transplant Infectious Disease, 2025. PMID: 39692587

87

Shota Obata, Frank Hullekes, Leonardo V. Riella, Paolo Cravedi. “Recurrent complementmediated Hemolytic uremic syndrome after kidney transplantation.” Transplant Reviews, 2024. PMID: 38749097

88

Luka Katic, Boris Mihaljevic, Marijo Pirija, Ivana Goic-Barisic, Marija Tonkic, Anita Novak.

“Comparison of AccuPower Diarrhea V1&V2 RT-PCR to a Chromatographic Immunoassay for Detecting Viral Pathogens from Human Diarrheal Stool Specimens.” Tropical Medicine and Infectious Diseases, 2025. PMID: 39998037

*Updated on May 1, 2025

412

Index of Posters

413

RESIDENT NAME

POSTER CATEGORY

POSTER

Abraham, Joseph

Quality Improvement

1

Adegbite, Benjamin

Clinical Research

2

Adeniyi, Adedeji

Medical Education

3

Agarwal, Arushi

Quality Improvement

4

Ajulu, Uchenna

Case Report/Clinical Review/Clinical Vignette

5

Akselrad, Melissa

Case Report/Clinical Review/Clinical Vignette

6

Aliasi-Sinai, Lital

Clinical Research

7

Alsaud, Mohammed

Case Report/Clinical Review/Clinical Vignette

8

Anand, Shubhankar

Case Report/Clinical Review/Clinical Vignette

9

Ani, Jood

Quality Improvement

10

Arabian, Jordan

Clinical Research

11

Baer, Matthew

Clinical Research

12

Basera, Pragati

Case Report/Clinical Review/Clinical Vignette

13

Bava, Hannah

Case Report/Clinical Review/Clinical Vignette

14

Benavides Leon, Raul

Case Report/Clinical Review/Clinical Vignette

15

Berman, Brandon

Case Report/Clinical Review/Clinical Vignette

16

Beygui, Nooshin

Case Report/Clinical Review/Clinical Vignette

17

Bonilla, Harrison

Clinical Research

18

Bupathi, Sneha

Case Report/Clinical Review/Clinical Vignette

19

Carter, Kristen

Clinical Research

20 414

RESIDENT NAME

POSTER CATEGORY

POSTER

Cho, Changwoong

Case Report/Clinical Review/Clinical Vignette

21

Choi, Christiana

Clinical Research

22

Choi, James

Clinical Research

23

Cosentino, Emily Renee

Case Report/Clinical Review/Clinical Vignette

24

Dawson, Sofia

Case Report/Clinical Review/Clinical Vignette

25

Deb, Mrittika

Case Report/Clinical Review/Clinical Vignette

26

Debroff, Jake

Clinical Research

27

Dehbozorgi, Sara

Case Report/Clinical Review/Clinical Vignette

28

Diaz Saravia, Sara

Clinical Research

29

Diola, Carlos

Case Report/Clinical Review/Clinical Vignette

30

Dixit, Keshav

Case Report/Clinical Review/Clinical Vignette

31

Dixon, Paige Ellen

Case Report/Clinical Review/Clinical Vignette

32

Drizik, Eduard

Basic Science

33

Duran, Jose

Case Report/Clinical Review/Clinical Vignette

34

Elias, Evelyn

Clinical Research

35

Eng, Ryan

Clinical Research

36

Eris, Tansu

Case Report/Clinical Review/Clinical Vignette

37

Fasciglione, Kimberly

Quality Improvement

38

Ferreira de Carvalho, Julia

Quality Improvement

39

Fusillo, Thomas

Clinical Research

40 415

RESIDENT NAME

POSTER CATEGORY

POSTER

Gargaritano, Kristine Lou

Medical Education

41

Gattazzo, Stefano

Quality Improvement

42

Ghotra, Maninderjit

Case Report/Clinical Review/Clinical Vignette

43

Gomez Hernandez, Christian

Clinical Research

44

Goodfarb, Justin

Clinical Research

45

Gordon, Ariel

Case Report/Clinical Review/Clinical Vignette

46

Goto, Toshiro

Clinical Research

47

Grimaldo Ochoa, Joel

Case Report/Clinical Review/Clinical Vignette

48

Guardia, Joshua

Case Report/Clinical Review/Clinical Vignette

49

Gupta, Soumya

Clinical Research

50

Hart, Hannah

Case Report/Clinical Review/Clinical Vignette

51

He, William

Clinical Research

52

Henry, Chad

Clinical Research

53

Herrera, Rayling

Case Report/Clinical Review/Clinical Vignette

54

Horiuchi, Kohei

Clinical Research

55

Hussein, Rama

Clinical Research

56

Jeri Yabar, Antoine

Case Report/Clinical Review/Clinical Vignette

57

Johnson, Samuel

Quality Improvement

58

Katic, Luka

Case Report/Clinical Review/Clinical Vignette

59

Kennedy, Madison

Case Report/Clinical Review/Clinical Vignette

60 416

RESIDENT NAME

POSTER CATEGORY

POSTER

Khan, Mohammad

Clinical Research

61

Khan, Zara

Case Report/Clinical Review/Clinical Vignette

62

Kim, Do Han

Clinical Research

63

Kiyohara, Yuko

Clinical Research

64

Koseki, Mako

Clinical Research

65

Kositangool, Piya

Quality Improvement

66

Kosse, Sarah

Medical Education

67

Kumar, Shasawat

Clinical Research

68

Lira, Javier

Case Report/Clinical Review/Clinical Vignette

69

Liranzo Tejera, Niurka

Case Report/Clinical Review/Clinical Vignette

70

Low, Scott

Case Report/Clinical Review/Clinical Vignette

71

Lutgen, Sophia

Case Report/Clinical Review/Clinical Vignette

72

Maenza, Joseph

Clinical Research

73

Mannina, Carlo

Clinical Research

74

Marinelli, Joseph

Clinical Research

75

Markley, Alexandria

Medical Education

76

Marushchak, Olga

Case Report/Clinical Review/Clinical Vignette

77

Matthews, Christopher

Clinical Research

78

McIntyre, Anahi

Medical Education

79

Megaris, Aphrodite

Quality Improvement

80 417

RESIDENT NAME

POSTER CATEGORY

POSTER

Mehra, Sonia

Clinical Research

81

Meyer, Alyson

Quality Improvement

82

Miao, Jiaxi

Case Report/Clinical Review/Clinical Vignette

83

Mirza, Serene

Case Report/Clinical Review/Clinical Vignette

84

Moeller, Cathrine

Clinical Research

85

Morel, Nicole

Case Report/Clinical Review/Clinical Vignette

86

Moss, Drew

Clinical Research

87

Mueller, Anna

Clinical Research

88

Nadira, Fahema

Case Report/Clinical Review/Clinical Vignette

89

Nedley, Natalie

Case Report/Clinical Review/Clinical Vignette

90

Nemiroff, Samuel

Case Report/Clinical Review/Clinical Vignette

91

Nguyen, Destiny

Case Report/Clinical Review/Clinical Vignette

92

Noorani, Soha

Clinical Research

93

Obata, Shota

Case Report/Clinical Review/Clinical Vignette

94

Panigrahi, Benita

Case Report/Clinical Review/Clinical Vignette

95

Paredes de la Fuente, Rodrigo

Basic Science

96

Patel, Aesha

Clinical Research

97

Patel, Swati

Quality Improvement

98

Priscan, Anamarija

Case Report/Clinical Review/Clinical Vignette

99

Quraishi, Baseer

Clinical Research

100 418

RESIDENT NAME

POSTER CATEGORY

POSTER

Ramachandra, Shruti

Case Report/Clinical Review/Clinical Vignette

101

Ramirez Cazares, Andrea Case Report/Clinical Review/Clinical Vignette

102

Rendon-Rodriguez, Luis

Clinical Research

103

Sadek, Norah

Case Report/Clinical Review/Clinical Vignette

104

Saeedullah, Usman

Case Report/Clinical Review/Clinical Vignette

105

Samuel, Benjamin

Case Report/Clinical Review/Clinical Vignette

106

Sandhu, Robinderpal

Clinical Research

107

Sawaguchi, Yoshihiro

Case Report/Clinical Review/Clinical Vignette

108

Sebastian, Tara

Clinical Research

109

Shah, Priya

Case Report/Clinical Review/Clinical Vignette

110

Sheikh, Hammad

Clinical Research

111

Shetty, Samantha

Clinical Research

112

Shichijo, Yuka

Medical Education

113

Sinclair De Frias, Jorge

Clinical Research

114

Sivakumar, Ganesh

Clinical Research

115

Smith, Connor

Clinical Research

116

Soni, Astitva

Case Report/Clinical Review/Clinical Vignette

117

Suyama, Dylan

Medical Education

118

Tai, Hua-Hsin

Medical Education

119

Tan, Samuel

Clinical Research

120 419

RESIDENT NAME

POSTER CATEGORY

POSTER

Tan, Wenchy

Clinical Research

121

Torelli, Vincent

Clinical Research

122

Torrellas, Julia

Case Report/Clinical Review/Clinical Vignette

123

Tsyngauz, Esther

Clinical Research

124

Van Oekelen, Oliver

Basic Science

125

Varela Knorr, Ines

Clinical Research

126

Velo, Agostina

Clinical Research

127

Verma, Megha

Clinical Research

128

Vittini Hernandez, Liliana

Clinical Research

129

Wagner, Anushri

Medical Education

130

Wallach, William

Medical Education

131

Wang, Hong Yu

Clinical Research

132

Wijesinghe, Tharaka

Case Report/Clinical Review/Clinical Vignette

133

Wilkoff, Marni

Medical Education

134

Yang, Yuhong

Case Report/Clinical Review/Clinical Vignette

135

Zafar, Ahmun

Clinical Research

136

Zhou, Susu

Case Report/Clinical Review/Clinical Vignette

137

Zyskowski, Evan

Case Report/Clinical Review/Clinical Vignette

138

420

Index of Authors

421

INDEX OF RESIDENT AUTHORS Abraham, Joseph: 9, 27, 34-35, 190 Adegbite, Benjamin: 9, 36-37 Adeniyi, Adedeji: 9, 38-39, 402 Agarwal, Arushi: 9, 40-41, 242, 265 Ahmidouch, Manal: 407 Ajulu, Uchenna: 9, 42-44 Akselrad, Melissa: 10, 24, 45-49, 54-55, 164, 242, 266, 410 Aliasi-Sinai, Lital: 10, 50, 410 Alsaud, Mohammed: 10, 51-52, 243, 259, 274, 365 Anand, Shubhankar: 10, 53, 242, 267 Ani, Jood: 10, 54-55 Arabian, Jordan: 10, 56-57 Baer, Matthew: 11, 58 Bapodra, Neil: 403 Basera, Pragati: 11, 59-60, 242, 268 Bava, Hannah: 11, 22, 61, 151 Benavides Leon, Raul: 11, 29, 62, 209 Berman, Brandon: 11, 12, 22, 30, 63, 65, 147-149, 216-217 Beygui, Nooshin: 17, 64, 242, 269, 270, 408 Bhatia, Harsimran: 17, 106 Bilsbury, Evan: 410 Bonilla, Harrison: 11, 12, 26, 30, 63, 65, 188, 216-217, 256, 348 Bupathi, Sneha: 12, 19, 67-68, 124, 405 Carter, Kristen: 12, 69, 246, 293, 408 Cho, Changwoong: 12, 24, 70, 164

Choi, Christiana: 12, 13, 28, 71, 75, 206, 243, 256, 271, 272, 273, 274, 341 Choi, James: 12, 16, 18, 23, 27, 72, 102-103, 123, 190-191, 246, 293, 408 Clausell, Kaitlyn: 9, 13, 15, 42-44, 73, 98-99 Cosentino, Emily Renee: 13, 73 Cronin, Keri: 410 Dawson, Sofia: 13, 74 Deb, Mrittika: 13, 75 Debroff, Jake: 13,14, 19, 76-78, 88, 130, 243, 244, 275, 276, 278, 279, 280 Dehbozorgi, Sara: 13, 79, 244, 277, 405, 411 Desai, Binoy: 27,190-191, 257, 352 Dev, Bharati: 13, 14, 19, 25, 7678, 88, 130, 177, 244, 248, 261, 278, 279, 280, 302, 383, 406 Dhaliwal, Arshdeep: 12, 28, 70, 71, 206, 256, 349 Diaz Saravia, Sara: 12, 13, 16, 22, 70, 72, 80-81, 100, 147-149 Diola, Carlos: 14, 26, 82-83, 183186, 252, 323, 324 Dixit, Keshav: 12, 14, 27, 28, 71, 84, 195-196, 206, 244, 245, 256, 257, 258, 259, 281, 282, 283, 284, 349, 355, 356, 360, 361, 362, 363, 364 Dixon, Paige Ellen: 14, 85, 245, 285 Drizik, Eduard: 14, 86-87 Duque Lopez, Andrea: 11, 59-60, 242, 252, 268, 321 Duran, Jose: 14, 88, 244, 279 Elias, Evelyn: 14, 89, 411

422

INDEX OF RESIDENT AUTHORS Eng, Ryan: 15, 90 Eris, Tansu: 15, 91-92, 245, 286, 287 Fasciglione, Kimberly: 10, 15, 5455, 93 Ferreira de Carvalho, Julia: 15, 94, 406 Fusillo, Thomas: 15, 95-96, 245, 246, 288, 289 Gargaritano, Kristine Lou: 15, 97 Gattazzo, Stefano: 15, 98-99 Ghotra, Maninderjit: 13, 16, 29, 80-81, 100, 207, 254, 336 Go, Karen: 11, 61, 243, 246, 274, 291 Gomez Hernandez, Christian: 16, 101 Goodfarb, Justin: 16, 18, 102-103, 123 Gordon, Ariel: 15, 16, 98-99, 104, 411 Goto, Toshiro: 16, 17, 25, 105, 111-112, 172, 246, 247, 254, 255, 292, 298, 336, 338, 340 Grimaldo Ochoa, Joel: 17, 106 Guardia, Joshua: 12, 17, 30, 107, 216-217 Gupta, Soumya: 12, 17, 69, 108, 246, 247, 293, 294, 295, 296, 408 Hart, Hannah: 16, 17, 18, 102103, 108, 109-110, 123, 247, 297 He, William: 17, 111-112 Henig, Ariel: 407 Henry, Chad: 17, 113, 262, 385 Herrera, Rayling: 17, 114 Horiuchi, Kohei: 18, 115, 403, 407 Huang, Jing: 247, 298 Hussein, Rama: 18, 21, 24, 27, 116-117, 143-145, 167-168, 190191, 247, 248, 299-300, 301

Jafri, Komail: 26, 29, 188, 213, 256, 348, 408 Jarmale, Spandana: 408 Jeri Yabar, Antoine: 18, 31, 118, 224-225, 244, 248, 261, 279, 302, 303, 304, 381, 382, 383, 404, 410 Johnson, Samuel: 18, 119 Katic, Luka: 12, 18, 29, 72, 120, 213, 406, 408, 412 Kennedy, Madison: 18, 121 Khan, Mohammad: 16, 18, 102103, 123, 407 Khan, Zara: 12, 19, 21, 72, 124, 142 Kim, Do Han: 10, 19, 56-57, 125126, 248, 249, 250, 251, 305, 306, 307, 308, 309, 310, 311, 312, 313, 314, 315, 316, 317, 318, 319, 320, 404, 411 Kim, Madeline: 402, 408 Kiyohara, Yuko: 19, 127, 408 Koseki, Mako: 14, 19, 21, 32, 89, 128-129, 143-145, 236-237, 244, 278, 279, 280, 406, 407, 411 Kositangool, Piya: 19, 130, 244, 278 Kosse, Sarah: 20, 131, 252, 321, 322 Kumar, Shasawat: 13, 20, 29, 73, 132, 211, 405 Lee, Grace: 410 Lim, Jessica: 242, 265 Lira, Javier: 20, 133 Liranzo Tejera, Niurka: 10, 15, 20, 53, 91-92, 93, 134, 245, 252, 287, 321 Low, Scott; 20, 135-136 Lutgen, Sophia: 20, 137-138 Maenza, Joseph; 21, 139-140, 404, 411

423

INDEX OF RESIDENT AUTHORS Mannina, Carlo: 21, 141, 404, 405, 408, 409, 411 Marinelli, Joseph: 21, 142, 407 Markley, Alexandria: 21, 26, 27, 143-145, 183-186, 190-191, 252, 263, 322, 323, 324, 325-326, 397398 Marushchak, Olga; 21, 146-147 Matsugaki, Michihiro: 252, 327 Matthews, Christopher: 21, 22, 142, 147-149, 407 McIntyre, Anahi; 22, 150, 261, 380 Megaris, Aphrodite: 15, 22, 93, 151, 153-154, 253, 262, 328, 329, 384, 403 Mehra, Sonia: 22, 152, 244, 253, 280, 331, 409 Mercurio, Ann: 20, 131 Meyer, Alyson: 22, 153-154 Miao, Jiaxi: 22, 155-156, 253, 332 Mirza, Jacqueline: 404 Mirza, Serene: 22, 157, 253, 333 Mittag, Sonja: 243, 274 Moeller, Cathrine: 23, 158 Morel, Nicole: 23, 159, 263, 394 Moss, Drew: 23, 160-161, 402, 409 Mueller, Anna: 21, 23, 142, 162 Musial, Christopher: 23, 158 Nadira, Fahema: 23, 163, 253, 255, 334, 342 Nagourney, Alexander: 12, 72 Nedley, Natalie: 24, 164 Nemiroff, Samuel: 15, 24, 94, 165, 403, 411 Nguyen, Destiny: 24, 28, 30, 166, 200-201, 221-222, 262, 263, 387, 394, 410 Noorani, Soha: 18, 24, 116-117, 167-168

Obata, Shota: 11, 24, 59-60, 169, 242, 268, 403, 412 Pak, Kevin: 402 Pandu, Prathyusha: 411 Panigrahi, Benita: 24, 170-171 Paredes de la Fuente, Rodrigo: 11, 16, 25, 59-60, 105, 172, 242, 245, 246, 247, 254, 255, 270, 286, 292, 298, 335, 336, 337, 338, 339, 340, 341, 404, 406 Patel, Aesha: 15, 17, 25, 27, 28, 30, 93, 107, 173, 194, 200-201, 221, 243, 253, 255, 272, 332, 334, 342, 343, 344, 402 Patel, Swati: 25, 174-175, 252, 256, 260, 323, 345, 346, 347, 372 Pianello, Samantha: 405 Piersaint, Jason: 18, 118 Prasad, Sonya: 11, 64 Priscan, Anamarija: 23, 25, 158, 176 Quraishi, Baseer: 25, 177-180, 404 Ramachandra, Shruti: 22, 26, 153154, 181 Ramirez Cazares, Andrea: 26, 182, 242, 269 Rendon-Rodriguez, Luis: 14, 26, 88, 183-186, 252, 323, 324 Reyes, Joshua: 406 Reznik, Madeleine: 22, 153-154 Ryba, Christie: 407 Sadek, Norah: 10, 26, 54-56, 187, 407 Saeedullah, Usman: 26, 29, 188, 213-214, 256, 348, 408 Samuel, Benjamin: 12, 17, 26, 28, 71, 113, 189, 206, 256, 349 Sandhu, Robinderpal: 27, 190191, 256, 257, 350, 351, 352, 406

424

INDEX OF RESIDENT AUTHORS Sawaguchi, Yoshihiro: 27, 192 Sebastian, Tara; 27, 193, 403, 407 Shah, Priya: 27, 194, 258, 357 Sheikh, Hammad: 27, 28, 30, 195196, 200-201, 206, 221-222, 257, 260, 353, 354, 355, 356, 375 Sherman, Brett: 22, 157, 253, 333 Shetty, Samantha: 258, 357, 358, 408 Shichijo, Yuka: 28, 199 Silverman, Alexander: 12, 21, 29, 72, 142, 213, 408 Sinclair De Frias, Jorge: 17, 28, 30, 113, 200-201, 221-222, 244, 245, 255, 258, 259, 282, 283, 343, 359, 360, 361, 362, 363, 364 Sivakumar, Ganesh: 28, 202-205, 404 Skiro, Olivia: 22, 155-156 Smith, Connor: 10, 12, 27, 28, 5152, 71, 195, 206, 256, 257, 259, 261, 349, 355, 356, 365, 380 Soni, Astitva: 29, 207-208 Suyama, Dylan: 29, 209, 252, 325 Syal, Arjun: 405, 410 Tai, Hua-Hsin: 12, 28, 29, 71, 206, 210, 256, 259, 349, 366 Tan, Samuel: 13, 16, 20, 29, 8081, 100-101, 132-133, 211, 212, 259, 367, 368, 405 Tan, Wenchy: 20, 29, 132, 211, 212, 259, 367, 368, 402, 405 Torelli, Vincent: 12, 29, 72, 213214 Torrellas, Julia: 29, 215 Trenschel, Robert W.: 259, 367, 368 Tsyngauz, Esther: 12, 30, 65-66, 216-217

Vaca, Richard Guillermo SR: 254, 260, 261, 309, 335, 369, 378-379, 402 Vaish, Esha: 12, 29, 72, 211, 404 Van Oekelen, Oliver: 30, 218, 260, 370-371, 403, 410 Varela Knorr, Ines: 15, 30, 93, 219-220, 256, 260, 346, 372, 373, 374 Velo, Agostina: 28, 30, 31, 200201, 221-222, 230, 245, 261, 262, 263, 283, 376, 377, 378-379, 380, 387, 388, 389, 390, 391, 410 Verma, Megha: 30, 223, 405 Vittini Hernandez, Liliana: 18, 31, 118, 224-225, 244, 248, 261, 278, 302, 303, 304, 381, 382, 383, 404, 410 Wagner, Anushri: 31, 226-228 Wallach, William: 17, 31, 113, 229, 253, 262, 329-330, 384 Wang, Hong Yu: 28, 30, 31, 200201, 221-222, 230, 246, 261, 262, 263, 291, 377, 386, 387, 388, 389, 390, 391, 392, 402, 405, 410 Wang, Liang: 402, 403 Watanabe, Atsuyuki: 259, 368 Wijesinghe, Tharaka: 10, 22, 31, 45-49, 157, 231, 253, 263, 333, 393 Wilkoff, Marni: 21, 31, 143-145, 232-234, 247, 248, 299-300, 301, 406 Yang, Alvin: 17, 25, 27, 28, 113, 173, 195, 206, 257, 262, 356, 385 Yang, Yuhong: 11, 23, 31, 61, 159, 235, 263, 394, 395 Yeung, Frank: 411 Ying, Stephanie: 405

425

INDEX OF RESIDENT AUTHORS Zafar, Ahmun: 32, 236-237, 242, 252, 263, 269, 325-326, 397-398, 399-400 Zaidi, Syed: 29, 213, 256, 348, 408 Zheng, Lucy: 29, 211, 259, 367, 405 Zhou, Susu: 32, 238, 403 Zyskowski, Evan: 32, 239-240

426

Thank you for attending the Mount Sinai Morningside/West Internal Medicine Residency Annual Research Week!

Residency Leadership John A. Andrilli, MD, FACP

Georgina Osorio, MD, MPH

Sreekala Raghavan, MD

Eric Wu

Mariah Soria

Denny Ayala Reyes

Residency Contact Information Email: msmwimresearch@mountsinai.org Website: https://icahn.mssm.edu/education/residenciesfellowships/list/msw-msm-internal-medicineresidency

Official Publication of Annual Mount Sinai Morningside/ West Internal Medicine Residency Research Week

Editor Georgina Osorio

Associate Editors Yoshiko Ishisaka Sara Luby Patricia Miguez Arosemena Eric Wu Denny Ayala Reyes Mariah Soria

Editorial Board John Andrilli Stephanie BehringerMassera Alfred Burger Salvador Caceros Diaz Christina Cruz Deborah Edelman Jason Filopei Lindsey Fox Tamara Goldberg Satwant Grewal Krystle Hernandez Arpanjeet Kaur Alejandro Prigollini Sreekala Raghavan Adam Rothman Caileen Sennett Vasundhara Singh

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