United States

Background: Despite its central role in inducing unconsciousness, anesthesia is still largely dosed without direct, patient-specific measurement of brain state. Current approaches rely on indirect proxies like heart rate and EEG monitoring with arbitrary frequency cutoffs, offering limited insight into real-time neural dynamics. This is problematic for drugs like opioids and propofol, whose EEG effects vary widely with age, neurocognitive status, and drug interactions. For example, propofol-induced alpha rhythms (8–12 Hz) may drift into theta in older adults, while opioid-related theta activity (4–8 Hz) may be challenging to detect in altered brain states. These limitations hinder precision dosing and increase risks of over- or under-sedation. To address this, we developed a switching state-space oscillator model that decomposes EEG signals into data-driven oscillatory components and dynamically identifies transitions between baseline and drug-induced brain activity—laying the foundation for personalized anesthetic monitoring.

Methods: We analyzed intraoperative EEG data from patients undergoing fentanyl or propofol induction. A state-space oscillator model decomposed EEG into rhythmic components, and a switching model compared baseline-only versus baseline-plus-drug oscillator hypotheses to identify drug-specific brain state changes. Baseline models were generalized using cluster-based analysis, and model fit was evaluated using logistic regression and posterior switching probabilities.

Results: The switching oscillator model detected robust, drug-specific EEG transitions at both individual and group levels. In fentanyl cases, the probability of detecting an opioid-induced theta signature increased by 59.8% [95% CI: 47.3%, 72.0%] from baseline to 4 minutes after administration. Among patients exhibiting this biomarker (16/21), the probability of theta-band oscillation rose significantly with increasing fentanyl effect site concentration (mean slope = 4.56, 95% CI [0.98, 9.31]). In a representative propofol case, the model captured the rapid, dose-dependent transition into an alpha-oscillatory state, with probability rising from 0.5% at baseline to 99.5% at 4 minutes after administration. These findings establish the model’s sensitivity and specificity in identifying real-time, patient-specific neurophysiologic effects of anesthetic drugs.

Conclusion: We introduce a novel EEG-based switching state-space oscillator model that precisely identifies individualized, drug-specific brain state transitions. Unlike traditional EEG monitoring, our approach robustly captures nuanced neural signatures, providing superior accuracy and patient-specificity. By demonstrating significant, dose-dependent relationships between anesthetic concentration and EEG changes, this model offers a transformative framework for precision dosing and safer anesthesia management, supporting scalable personalized neurophysiologic monitoring across clinical settings.

AMA Research Challenge 2025 

A Novel Switching Oscillator Model for EEG Based Detection of Unique Drug States During Anesthesia

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Wilson’s disease is a rare autosomal recessive disorder of abnormal copper accumulation, typically presenting with hepatic or neurological symptoms. While psychiatric manifestations are well-documented, they are rarely the initial clue to diagnosis and even less commonly progress to severe neurologic decline following standard treatment.
A 28-year-old male with a history of mild hypertension presented with six months of worsening depression, anxiety, suicidal ideation, and impulsivity. Persistent headaches and diplopia prompted an emergency department visit, where head CT revealed basal ganglia hypodensities. MRI and copper studies, along with the presence of Kayser-Fleischer rings, confirmed Wilson’s disease. Due to financial barriers, he was unable to initiate outpatient chelation and remained untreated for nine months, during which his neuropsychiatric symptoms worsened. New-onset somnolence, ataxia, dysarthria, and urinary retention led to hospitalization. Penicillamine therapy was started but discontinued after ten days due to neurostorming and clinical progression to locked-in syndrome. Repeat MRI revealed marked cytotoxic edema in the basal ganglia, thalami, midbrain, and pons. The neurology team hypothesized rapid mobilization of copper or penicillamine hypersensitivity as contributing factors. As of 283 days into hospitalization, the patient remains profoundly obtunded with minimal responsiveness, occasionally able to communicate through blinking.
This case highlights an unusual psychiatric entry point to Wilson’s disease and a rare, devastating complication of chelation therapy. Psychiatric symptoms occur in up to one third of patients with Wilson’s disease but are infrequently the presenting complaint. Furthermore, progression to locked-in syndrome following chelation therapy is not well documented in existing literature.
Clinicians should maintain a high index of suspicion for Wilson’s disease in younger individuals with atypical or rapidly progressive psychiatric symptoms. This case also raises critical considerations regarding the safety and timing of chelation therapy in patients with prolonged untreated disease, particularly when initiating treatment in those with advanced neuropsychiatric involvement.

When the Mind Speaks First: Psychiatric Entry into Wilson Disease Followed by Chelation-Induced Locked-In Syndrome

Background
Diverticulitis, a common complication of diverticulosis, typically presents with left lower quadrant pain, leukocytosis, and changes in bowel habits. The incidence increases with age and risk factors include obesity, low-fiber, high-red meat diets, constipation, a sedentary lifestyle, chronic aspirin or NSAID use, and genetic predispositions. Early diagnosis typically relies on CT imaging, but inflammatory biomarkers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may offer cost-effective, radiation-sparing diagnostic tools. Although typically uncomplicated, severe cases can result in abscesses, fistulas, or perforations. Diverticulitis places a significant burden on the healthcare system, being a leading cause of ambulatory visits, hospital admissions, and colon surgeries among gastrointestinal conditions.

Case Presentation
This case report discusses a 75-year-old morbidly obese female who developed acute perforated diverticulitis with a colovaginal fistula, identified five to six months after gynecologic operations. The patient initially experienced postoperative leukocytosis considered reactive to surgery. She later presented to the emergency department with stool passing through her vagina, abdominal pain, and nausea. A CT scan revealed diverticulosis complicated by a pericolonic abscess and colovaginal fistula. She was treated with IV antibiotics and underwent abscess drainage with plans for outpatient colonoscopy and elective single-stage surgery involving resection and anastomosis.

Discussion
This case emphasizes the importance of early recognition of diverticulitis through comprehensive clinical assessment, timely imaging, and laboratory testing. While prompt CT imaging enhances diagnostic accuracy and can reduce emergency department revisits, inflammatory markers such as the NLR and PLR, easily derived from a routine CBC, may offer additional diagnostic insight. These ratios have demonstrated high sensitivity and specificity in identifying diverticulitis and could help reduce reliance on imaging, thereby minimizing unnecessary radiation exposure in appropriate cases. Having a lower threshold for clinical suspicion for those with significant risk factors can direct further imaging and laboratory tests to prevent the development of complications such as abscesses or fistulas. Early intervention can mitigate morbidity and reduce healthcare utilization in such cases.

A Case of Perforated Diverticulitis With Colovaginal Fistula: The Value of Early Diagnostic Strategies

Abstract Title
Lupus Hepatitis complicated by Debilitating Muscle Weakness due to Somatoform Disorder 

Background
A 55-year-old female with a medical history significant for systemic lupus erythematosus (SLE) presented with an inability to ambulate due to profound fatigue and generalized muscle weakness. Her hospital course was complicated by acute liver injury attributed to lupus hepatitis. Medical workup for muscle weakness was inconclusive leading to a diagnosis of somatoform disorder. This case presents a unique intersection of medical and psychiatric challenges, offering valuable insights into the physical and psychological aspects of managing SLE. 

Case Presentation
Patient is a 55-year-old female with a medical history of SLE on chronic prednisone 10 mg daily and hypertension who presented to the hospital with diffuse muscle weakness. 
On presentation, vital signs revealed a temperature of 38°C, blood pressure of 130/62 mmHg, and heart rate of 126 bpm. EKG revealed sinus tachycardia. Laboratory studies were notable for leukopenia (WBC 2.91K/µL), transaminitis with an ALT of 500 IU/L and AST of 1,112 IU/L, total bilirubin of 1.5 mg/dL, mildly elevated CPK at 236 IU/L, and a profoundly elevated ferritin level at 15,900 ng/mL. 

Laboratory findings were consistent with an acute lupus flare, evidenced by an elevated anti-dsDNA level of 67 IU/mL (normal range <5 IU/mL), elevated anti-ENA antibodies, and low C3 and C4 titers. Negative rheumatologic and infectious workup included autoimmune hepatitis, hepatitis B, hepatitis C, Lyme disease, and blood cultures. Imaging studies, including abdominal ultrasound, CT, and MRI, revealed only an incidental 0.7 cm hemangioma. 

Workup for muscle weakness unrevealing given no acute findings on brain and diffuse spine MRIs and minimally peaking CPK to 302IU/L. The patient deferred lumbar puncture. She was later discharged to sub-acute rehabilitation. Given minimal improvement in weakness and inconsistent physical exam findings, weakness was attributed to functional neurological disorder. 

Discussion
Autoimmune hepatitis was considered less likely due to the patient's chronic use of prednisone and mycophenolate, as well as negative serologies. Although CMV testing returned positive, it was attributed to chronic immunosuppression and was considered unlikely to contribute significantly to the clinical presentation. Hepatitis A total antibodies were positive, but hepatitis A IgM was negative one week prior to hospital presentation. 

Lupus, or lupoid hepatitis, is a rare manifestation of SLE. This diagnosis occurs in approximately 2 to 6% of cases of patients previously diagnosed with lupus who develop and an acute hepatitis1,2,3. 

Sources 

1. Arnett FC, Reichlin M. Lupus hepatitis: an under-recognized disease feature associated with autoantibodies to ribosomal P. Am J Med. 1995;99(5):465-472. doi:10.1016/s0002-9343(99)80221-6 
2. Imran S, Thabah MM, Azharudeen M, Ramesh A, Bobby Z, Negi VS. Liver Abnormalities in Systemic Lupus Erythematosus: A Prospective Observational Study. Cureus. 2021;13(6):e15691. Published 2021 Jun 16. doi:10.7759/cureus.15691 
3. Piga M, Vacca A, Porru G, Cauli A, Mathieu A. Liver involvement in systemic lupus erythematosus: incidence, clinical course and outcome of lupus hepatitis. Clin Exp Rheumatol. 2010;28(4):504-510.

Lupus Hepatitis complicated by Debilitating Muscle Weakness due to Somatoform Disorder

Background 
Discount pharmacies such as Mark Cuban Cost Plus Drugs (MCCPD), GoodRx, and SingleCare have emerged to improve medication affordability in the United States (U.S.). These platforms differ in pricing strategy: MCCPD uses a cost-plus model with a 15% markup, pharmacy fee, and shipping fee, GoodRx collaborates with Pharmacy Benefit Managers to negotiate discounts, and SingleCare functions through direct-to-pharmacy partnerships. While prior research has explored pricing savings of these platforms, limited work compares these three platforms for common chronic medications. Given hypertension’s high prevalence, we evaluated how differing pricing models affect the costs of antihypertensive medication for patients.
Methods
The cross-sectional study compared out-of-pocket costs for antihypertensive drugs across the three platforms. Medications were selected based on preferred medication lists from UpToDate, restricted to low dose and 30-day supplies. MCCPD prices were nationally consistent, while GoodRx and SingleCare prices fluctuated based on ZIP Codes. Therefore, eight ZIP Codes were selected using a stratified random sampling across U.S. Census regions and urban/rural status. The prices were then collected on May 26, 2025 and analyzed descriptively to determine price differences based on platform and regionality.
Results
Among the medications analyzed, MCCPD offered the lowest price for twenty drugs (63%), GoodRx for eight drugs (25%), and SingleCare for four drugs (12%). While prices varied across platforms and savings were drug specific, the cost-plus model used by MCCPD had the lowest pricing for many medications. However, it should be noted that MCCPD was once the most expensive by a considerable margin (e.g. Amlodipine-valsartan-hydrochlorothiazide). While some geographical differences in prices were observed, there were no consistent patterns across regions.
Conclusion
All three platforms have the potential for significant cost savings with no single system being universally superior in offering the lowest price. This analysis highlights a need for price comparison across platforms for individual drugs, especially for uninsured and underinsured individuals with high co-pays. These results may shed some light on the true value of antihypertensive drugs, free from price opacity oftentimes introduced by health plans and pharmacy benefit managers. Physicians, pharmacists, and policymakers can use these findings to educate patients to better navigate healthcare costs and rally support for increased price transparency in the U.S. drug market.

Cross-platform analysis of antihypertensive drug pricing: MCCPD, GoodRx, and SingleCare

Background: Short-term medical missions (STMMs) are widely recognized for delivering healthcare to underserved communities. Tropical climates coupled with sparse dermatology resources contribute to poorer outcomes for patients in these regions especially. STMMs provide a unique experience in training medical students to treat neglected tropical diseases in addition to exposure to foreign medical systems. This study involved second-year preclinical students from Meharry Medical College, along with faculty physicians, partnering with Misión Para Cristo to participate in an STMM in Catacamas, Honduras. 
Objective: The primary objective was to evaluate the ways STMMs enhanced students’ clinical skills. An emphasis was placed on dermatologic and infectious disease cases encountered to highlight the impact of exposure to novel cases through STMMs on quality of medical education.
Methods: Thirteen medical students participated in the study. A preliminary survey was administered assessing subjective competencies before the STMM. Approximately one year post-mission, participants were invited to complete a survey assessing subjective competencies and overall satisfaction with the experience. Descriptive statistics were used for quantitative data analysis, and a Mann-Whitney U-test was conducted to compare medians. Patient diagnostic data was quantified and categorized the types of cases encountered to reflect the diversity of clinical exposure. 
Findings: Survey responses demonstrated significant improvements in clinical skill proficiency: 77% of students reported increased proficiency in vital sign measurement and history taking, 85% in physical examination skills, and 100% in treatment decision-making. Confidence in patient interactions improved in 85% of participants, with a median increase from 2 to 4 on a 5-point scale (p = 0.0008, Mann-Whitney U-test). Student satisfaction with the mission was high; six participants rated preparation for third-year clinical rotations a 5/5, and eleven rated opportunities to lead patient interactions a 5/5. Dermatologic concerns accounted for 10% of the total cases seen with significant overlap with the infectious disease cases that accounted for 21% of the total cases. Patients seen for dermatologic concerns during this STMM most frequently involved eczema, psoriasis, lichen planus, and parasitic infections including cutaneous leishmaniasis. 
Conclusions and Future Directions: Participation in this STMM significantly enhanced students’ clinical skills and confidence with patient interactions. Early clinical exposure to diverse patient populations provides an opportunity to enhance clinical approaches to disease management. These findings underscore the value of STMMs in medical education as an effective tool for building core clinical competencies and strengthening patient communication skills. Further research dedicated to the impact of STMMs on medical education stands to improve the quality of medical education and cultural competency.

The Impact of Global Health Experiences on Dermatologic Medical Education

Background
Clinical reasoning is a cornerstone of effective medical practice, but many medical students face difficulty in developing structured, evidence-based diagnostic approaches early in their training. Traditional methods of teaching diagnostic reasoning rely heavily on clinical exposure and case-based discussions, which may vary in consistency and depth. With the emergence of artificial intelligence (AI) tools such as ChatGPT, an advanced large language model capable of synthesizing clinical information, there is potential to introduce a new, interactive layer to diagnostic education. This study explores the integration of ChatGPT into internal medicine training to enhance diagnostic learning, metacognition, and confidence among medical students.

Methods
We implemented a two-week educational pilot among 22 final-year medical students during their internal medicine rotation. Each student was presented with daily standardized clinical vignettes and was instructed to independently develop a differential diagnosis and initial workup. Afterward, they submitted the same case to ChatGPT and compared the AI-generated response with their own. Students recorded insights and discrepancies in structured reflection logs. At the end of the rotation, a feedback survey was administered to evaluate the tool’s perceived educational value, usability, and influence on diagnostic confidence.

Results
Survey analysis revealed that 91 percent of participants found the AI-generated responses helpful in broadening their differential diagnoses, while 88 percent felt more confident in their diagnostic reasoning after using the tool. Students appreciated ChatGPT’s structured approach, inclusion of red flag symptoms, and reminders of rare conditions. Several noted that the AI helped identify cognitive blind spots and reinforce clinical pathways. However, concerns were expressed regarding the occasional inclusion of outdated or generalized content and lack of source citations. All students emphasized the importance of using ChatGPT under faculty supervision to avoid overreliance or misinterpretation.

Conclusion
The integration of AI tools like ChatGPT into diagnostic education shows promising potential as a supplementary resource. When combined with structured reflection and faculty oversight, AI can enhance clinical reasoning, stimulate curiosity, and bridge knowledge gaps. While not a replacement for clinical experience or traditional teaching, ChatGPT may serve as an effective adjunct in preparing students for real-world diagnostic challenges. Ongoing research is warranted to measure its long-term impact on diagnostic accuracy, knowledge retention, and clinical decision-making.



Incorporating AI Tools Like ChatGPT into Diagnostic Teaching for Medical Students

Background
A national survey revealed that only 9 medical schools met the minimum 25 hours set by the National Academy of Sciences on nutrition instruction.1 There is a gap in nutrition education within medical school curricula, impacting not only future patients but also the physicians
themselves. A qualitative survey was conducted for all graduating fourth-year medical at UTMB to assess their perception on the nutrition education received in their medical education to date. A total of 212 students (96% response rate) reported their top three concerns being lack of nutritional recommendations for obesity, lack of nutritional recommendations for dyslipidemia, and lack of knowledge for nutritional needs during the life course of pregnancy and lactation. This report underscores the lack of nutrition education in existing medical schools and to address this a new interprofessional hands-on session in the Transition to Residency course was created at UTMB.

Methods
The Nutrition 101 workshop was led by a registered and licensed dietitian with a PhD in nutrition. The interactive session was conducted in two cohorts, reaching 79 fourth-year medical students. The workshop covered sustainable eating habits, basic macronutrient and micronutrient information, meal planning, and practical applications like healthy meal preparation. Students'
perceptions were assessed through a post-session survey with a 4-point Likert scale (Not at all, Slightly, Moderately, Significantly) and a yes/no question about their preparedness for intern year.

Results
The survey, completed by 20 students (25.3% response rate), revealed that 42.86% felt the workshop would significantly improve their personal nutrition habits. Additionally, 47.62% reported increased confidence in applying the knowledge gained to future patient care, and 52.38% indicated a significant expansion in their understanding of nutrition principles. Furthermore, 57.89% agreed that the session moderately enhanced their understanding of the
relationship between nutrition and common medical conditions. All (100%) respondents felt better prepared for their intern year after the workshop.

Conclusion
The Nutrition 101 workshop addressed a critical gap in medical education by enhancing both personal and professional nutritional knowledge among future physicians. Integrating such
nutrition curriculum content into both pre-clinical and clinical years is essential for promoting healthier lifestyles among physicians and their patients. This pilot program highlights the need for national curriculum reform to include comprehensive nutrition education throughout medical training and residency programs.

Enhancing Nutritional Competence Among Medical Students: A Pilot Educational Intervention

AMA abstract category: Choose one
Public Health and Health Policy Submissions in Public Health and Health Policy must relate to the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing, and responding to infectious diseases. This topic also includes studies on COVID-19, vaccinations, and health equity.
Clinical and Translational Research Submissions in Clinical and Translational Research must center around human subject research aimed towards prevention, diagnosis, or treatment of disease processes either fully in the clinical setting, or as a bridge between the lab and clinical practice.
Note: All abstracts must be submitted using this approved template and must not include pictures, graphs, or tables. The abstract must not exceed 400 words, excluding the abstract title, page numbering, or any ancillary entrant information. Citations or references are not a necessity with the abstract. If your abstract is accepted for consideration, you may include citations or references with your poster.

Abstract Title
Community‐Led Control of Schistosomiasis in Rural Nigeria Using the Foldscope, Environmental Mapping, and Educational Initiatives
Draft 2 (word count 400)
Background
Schistosomiasis is a neglected tropical disease transmitted through freshwater contact, disproportionately affecting children in low-resource settings. In rural Nigeria communities like those in Ogun State, dependence on natural freshwater for daily occupation increased vulnerability to Schistosoma haematobium infection, which can cause hematuria, anemia, and long-term risks including bladder and cervical cancer. Limited clinic access, stigma, and low diagnostic capacity–due to the need for electricity, skilled personnel, and costly equipment of traditional microscopy–delay timely care in these regions.
Methods
This mixed-methods study (July 22 to August 1, 2025) with three components. First, it will evaluate the feasibility and diagnostic potential of a community-led screening strategy using the Foldscope, a $1 paper microscope, paired with a reusable filtration slide. The study will be conducted in Imala and Imala Odo, high-prevalence communities near the Oyan River Dam. Community health extension workers (CHEWs) will be trained to identify Schistosoma ova in urine samples from children and adults. Diagnostic results will be compared to gold-standard microscopy, and participants will receive praziquantel treatment as needed from a local clinician. Interviews with CHEWs and NTD coordinators will assess feasibility for broader implementation. Second, environmental mapping (July 17–22) will use drones and satellite imagery to locate Bulinus snail habitats and model potential transmission zones in arcGIS. Third, to promote local engagement and youth education, we are deploying a large-format, traditionally-woven mat game based on Schisto & Ladders. This locally adapted board game teaches children about symptoms, transmission, and prevention, and will be reimagined into a group game to be played in an educational setting, embodying the principles of disease transmission for spatial understanding.
Results
Preliminary findings from Houston demonstrate that the Foldscope has 79% sensitivity and 100% specificity among untrained users compared to gold-standard microscopy. In Nigeria, we anticipate enrolling 406 participants across Imala and Imala Odo during the study period. Quantitative outcome variables for evaluating Foldscope effectiveness will include sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy. Qualitative data will be through focus groups and interviews with CHEWs and local clinicians to assess the acceptability and feasibility of community-led screening. 
For the environmental mapping component, outcome variables will include vegetation density around water access points across 4 transmission hotspot sites, additionally ground-truthing verification of habitat images using vegetation and snail samples.
Conclusion
This project integrates ultra-low-cost diagnostics, geospatial surveillance, and culturally tailored education to support scalable, community-led schistosomiasis control aligned with SDGs 3, 4, 6, and 9.


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Community‐Led Control of Schistosomiasis in Rural Nigeria with a $1 microscope and Drone Mapping

Atrial fibrillation is a common arrhythmia that raises stroke risk, often requiring
anticoagulation. This case report discusses a 79-year-old female with Atrial fibrillation and prior stroke, who was intolerant to anticoagulation due to recurrent bleeding. Percutaneous left atrial appendage occlusion is the next step in management to reduce stroke. She had a patent foramen ovale closure with an Amplatzer septal occluder, posing challenges for the left atrial appendage occlusion procedure. In this case, the watchman device was successfully placed under transesophageal echocardiography and fluoroscopy, avoiding interference with the patent foramen ovale device.

Successful left atrial appendage closure using Watchman in a patient with an atrial septal defect

Educational Objective: At the conclusion of this presentation,
participants should be able to diagnose and treat
coccidioidomycosis in the larynx.​
Objective: To present a rare case of coccidioidomycosis
manifesting as a laryngeal mass and to explore the key clinical
features, diagnostic challenges, and treatment considerations
that can aid in the timely recognition or exclusion of the disease in
future cases. We also review the existing literature of
disseminated coccidioidomycosis to contextualize this case.​
Study Design: A single case report of a patient with
disseminated coccidioidomycosis is described. ​
Methods: A case report of a 26-year-old female with a history of
persistent cough and hoarseness. She presents with persistent
throat issues and voice changes. The patient was initially
prescribed antibiotics, but they were ineffective in resolving her
loss of voice. At presentation, a lesion on the right arytenoid was
found after laryngoscopy. ​
Results: Patient underwent a biopsy. Final pathology revealed
coccidiomycosis in the right supraglottic and right arytenoid
mass. ​
Conclusion: This case report highlights the importance of
including Disseminated Coccidiomycosis in the differential
diagnosis of patients with persistent hoarseness and cough,
especially in endemic regions. ​

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When the Mind Speaks First: Psychiatric Entry into Wilson Disease Followed by Chelation-Induced Locked-In Syndrome

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