United States

Background: The uninsured population of Galveston is estimated at 18.3% of the total 53,000 individuals. Approximately 400 unhoused individuals dwell on the island, comprising .8% of the population. The Luke Society’s mission is to provide care to these patients. Luke’s provides physician consultations, medication, and comprehensive wound care. This study aims to analyze the wounds treated at this free clinic to guide public health interventions in vulnerable populations of Galveston, TX.
Methods: Twenty-six care encounters were documented between September 2024 and February 2025. Data including wound description, location, treatment, and materials provided were recorded. No demographic data or patient identifiers were collected.
Results: 38% of wounds involved the feet and 19% affected the head. 46% were infected and treated with either antibiotics or antifungals. 27% were related to a specific trauma. 73% of patients received materials for wound care and cleaning. 4 of the 26 were post surgical wounds that had been lost to follow up by their surgeon. 
Conclusions: The high prevalence of foot related wounds indicates a lack of sufficient hygiene likely attributed to the high rates of homelessness and a lack of access to consistent showers and clean socks. Head injuries could potentially be prevented with better access to helmets as many of the patients travel on bikes. Underinsured patients have a high rate of being lost to follow up leading to complications and infections following surgeries.
Public Health Implications: Preventative medicine and regular cleaning is highly important in wound care and trauma related injuries. Access to clean socks, helmets, warm water, and basic wound care supplies should be a focus in community health initiatives supporting the underinsured and unhoused populations. With these interventions, chronic wounds could heal faster and potential progression to serious infections.


AMA Research Challenge 2025 

Wound Care Trends of a Student Run Clinic in the Underinsured and Unhoused Population of Galveston, Texas

Welcome to the **largest national, multi-specialty research** event featuring research from nearly 700 medical students, residents, fellows, and international medical graduates.

Use the buttons below or navigation menu to access the event.
<br><br><br>


[![](https://assets.underline.io/uploads/markdown_image/1/image/3e33a8c754cc49610b30950617d813e7.png)](https://underline.io/events/434/sessions?searchGroup=all)
<br>
[![](https://assets.underline.io/uploads/markdown_image/1/image/551404d429c4e274f9a54cbdd7081918.png)](https://underline.io/events/434/posters?searchGroup=all)
<br>
[![](https://assets.underline.io/uploads/markdown_image/1/image/677d92f566b880cebd36905fc738fc10.png)](https://underline.io/events/434/lounge)
<br>
[![](https://assets.underline.io/uploads/markdown_image/1/image/c7392833c7261c3874c5b43fa2f4df19.png)](https://underline.io/events/434/help-desk)
<br><br>

#### Event Details

The 2023 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. **Log in at any time throughout the event to:**

* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research
* **Attend education sessions** with physician experts on key research topics

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges, and compete to win a $10,000 grand prize sponsored by Laurel Road.<br><br>

### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on February 4, 2024 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)

<br><br>

**There is no registration fee for this event! **

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals.

**Please use this link [here](https://www.ama-assn.org/about/events/ama-research-challenge) to register for free.**

Registration Is Required

AMA Research Challenge 2023

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters, score posters in the semifinals (an AMA member exclusive opportunity) and attend education sessions with experienced physicians to learn tips to advance your research and career. 

poster

Congratulations to all the researchers who have qualified for the AMA Research Challenge virtual poster symposium and semifinals!

Welcome to the **largest national, multi-specialty research event** featuring research from nearly 1,000 medical students, residents, fellows, and international medical graduates across six topic areas - basic science, clinical and translational research, clinical vignettes, health systems science, medical education, and public health and health policy.

#### Access the Event
Use the buttons below or navigation menu to access the event. 

[![](https://assets.underline.io/markdown_image/1/image/d4076f2146939317a29eb9f69c53ad41.png)](https://underline.io/events/506/sessions?searchGroup=all)
[![](https://assets.underline.io/markdown_image/1/image/6bcee0b523a4874c4292ca0415d88dde.png)](https://underline.io/events/506/posters?searchGroup=all)

#### Event Details
The 2025 AMA Research Challenge includes the following symposium halls:
* **Semifinals hall:** Features research from 54 medical students, residents and international medical graduates that received top scores during first round scoring. 
* **Poster symposium hall:** Features research from nearly 1,000 medical students, residents and international medical graduates categorized by topics and subtopics.

**Here’s how to participate:**
* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with presenters** and provide feedback to help advance their research
* **New this year: Watch live poster presentations** by topic area and engage directly with researchers

At the conclusion of this event, the AMA announced the top five finalists who advanced to the AMA Research Challenge final round, presented their research to an elite panel of judges, and competed to win a $10,000 grand prize presented by Laurel Road.

**Addison Shenk, a fourth-year medical student from Edward Via Virginia College of Osteopathic Medicine, was the winner of the 2025 AMA Research Challenge and was awarded the grand prize of $10,000, presented by Laurel Road.**

#### A message from Dr. Bobby Mukkamala, AMA President
<div style="position: relative; width: 100%; padding-bottom: 56.25%; height: 0; overflow: hidden;">
  <iframe 
    src="https://underline.io/embed/136894-ama-video?t=0"
    title="AMA Welcome Video"
    allowfullscreen
    style="position: absolute; top: 0; left: 0; width: 100%; height: 100%; border: 0;">
  </iframe>
</div>


#### Recognized Institutions
In 2025, 1,400 abstracts were submitted across six topic areas representing 174 medical schools and more than 150 residency and health care institutions. [See if your institution is represented this year!](https://drive.google.com/file/d/1eFrTqCmCeobx9pr5drJK2hllvsIpFNOY/view?usp=drive_link)

#### Grand Prize Sponsor
AMA would like to thank Laurel Road, a brand of KeyBank, for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road and KeyBank are not involved in winner selection process. The winner will be announced during the AMA Research Challenge final round. Payment of the grand prize will be directly from Laurel Road/KeyBank. See the [AMA Research Challenge Official Rules for terms and conditions](https://www.ama-assn.org/system/files/research-challenge-official-rules.pdf).

[![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)](https://www.laurelroad.com/)

#### Code of Conduct
<html>
AMA has a code of conduct for its meetings – we ask all attendees to adhere to this code to participate in this year’s meeting. Please read and <a href="https://www.ama-assn.org/about/code-conduct" target="_blank">learn more here</a> about your conduct requirements.
<br><br>
	</html>
	

#### Semifinals Judges

You need to log in with the email address you registered with. Access credentials have been sent to your email. 

Please be sure to check your spam and other email folders if you do not see an email confirmation right away.

Need help? Contact us at <support@underline.io>.

Please log in to explore this event.

If you have used the AMA Research Challenge platform previously, please click the ‘Log-in’ button below. If you do not remember your password, please click “forgot password” and follow prompts to reset your password. After resetting your password, please refresh your webpage to access the platform. 

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals. 

**Please use [this link here](https://www.ama-assn.org/member-benefits/events/ama-research-challenge) to register for free. **

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

Background: Glioblastoma multiforme (GBM) is an aggressive grade IV glioma with poor prognosis.1 The PI3K/AKT/mTOR signaling pathway is frequently dysregulated in GBM, contributing to tumor growth, stem cell survival, and immune evasion.2,3,4 This review examines the potential of this pathway to induce apoptosis and improve therapeutic outcomes.

Methods: A literature search was conducted using PubMed to identify articles published between 2018 and 2025. Search terms included “glioblastoma,” “PI3K/AKT/mTOR,” “PI3K therapy,” and “GBM tumor progression.”

Results: Mechanistic studies identify SLC25A32, β2-microglobulin (B2M), and PDIA4 as key regulators of the PI3K pathway in glioblastoma stem cell (GSC) survival. In GSCs, PI3Kα inhibitor, Alpelisib, and mTOR inhibitor, OSI-027, reduced proliferation, underscoring the pathway’s importance.4 SLC25A32, a mitochondrial folate transporter, was elevated in glioma tissue and associated with increased AKT/mTOR phosphorylation.5 B2M, upregulated in GSCs, activated the pathway by increasing PIP2 levels and promoted M2-like tumor-associated macrophage polarization, contributing to immune suppression.6 PDIA4, an ER chaperone, enhanced glycolysis and suppressed pro-apoptotic proteins, supporting GBM progression.7 A Phase I trial of Perifosine (AKT inhibitor) and Temsirolimus (mTOR inhibitor) showed synergistic tumor reduction in GBM patients, though lack of pharmacokinetic data limits mechanistic insights.8

Conclusion: Targeting the PI3K/AKT/mTOR pathway through regulators like SLC25A32, B2M, and PDIA4 shows promise in disrupting GBM survival mechanisms. Dual inhibition strategies may enhance treatment efficacy, but further mechanistic and clinical studies are needed to optimize therapeutic approaches.


Works Cited:
Wu W, Klockow JL, Zhang M, et al. Glioblastoma multiforme (GBM): An overview of current therapies and mechanisms of resistance. Pharmacol Res. 2021;171:105780. doi:10.1016/j.phrs.2021.105780
Berro A, Assi A, Farhat M, et al. Unlocking hope: Anti-VEGFR inhibitors and their potential in glioblastoma treatment. Crit Rev Oncol Hematol. 2024;198:104365. doi:10.1016/j.critrevonc.2024.104365
Agnihotri TG, Salave S, Shinde T, Srikanth I, Gyanani V, Haley JC, Jain A. Understanding the role of endothelial cells in brain tumor formation and metastasis: a proposition to be explored for better therapy. J Natl Cancer Cent. 2023;3(3):222-235. doi:10.1016/j.jncc.2023.08.001.
Eckerdt FD, Bell JB, Gonzalez C, et al. Combined PI3Kα-mTOR Targeting of Glioma Stem Cells. Sci Rep. 2020;10(1):21873. Published 2020 Dec 14. doi:10.1038/s41598-020-78788-z
Xue Z, Wang J, Wang Z, et al. SLC25A32 promotes malignant progression of glioblastoma by activating PI3K-AKT signaling pathway. BMC Cancer. 2023;23(1):589. Published 2023 Jun 26. doi:10.1186/s12885-023-11097-6
Li D, Zhang Q, Li L, et al. β2-Microglobulin Maintains Glioblastoma Stem Cells and Induces M2-like Polarization of Tumor-Associated Macrophages. Cancer Res. 2022;82(18):3321-3334. doi:10.1158/0008-5472.CAN-22-0507
Wang M, Zhang W, Liu Y, et al. PDIA4 promotes glioblastoma progression via the PI3K/AKT/m-TOR pathway. Biochem Biophys Res Commun. 2022;597:83-90. doi:10.1016/j.bbrc.2022.01.115
Kaley TJ, Panageas KS, Pentsova EI, et al. Phase I clinical trial of temsirolimus and perifosine for recurrent glioblastoma. Ann Clin Transl Neurol. 2020;7(4):429-436. doi:10.1002/acn3.51009


Targeting the PI3K/mTOR/AKT Pathway to Induce Apoptosis in Glioblastoma Multiforme: A Mechanistic Review

Over 65 million people live with epilepsy. The most devastating consequence of epilepsy is sudden death. The cause of sudden unexpected death in epilepsy (SUDEP) is unknown. Convulsive seizures can impair awareness and induce respiratory failure. SUDEP usually occurs at night with victims found prone in bed. Brain 5-HT neurons regulate seizure severity, respiratory physiology, are required for awakening to rising CO2 (CO2 arousal). In humans and nocturnal rodents, 5-HT levels are lowest at night. Mouse models of induced and spontaneous seizures (including the Scn1aR1407X/+ model of Dravet Syndrome (DS mice)) are more fatal at night. We hypothesized that the timing of seizure-associated death is regulated by a circadian rhythm and time-of-day variability in 5-HT. To address this, we employed three seizure models (DS mice, MES, and amygdala kindling) and two methods to eliminate brain 5-HT (genetic and chemical elimination). DS mice were used for spontaneous seizure experiments, and Lmx1bf/f/p (KO) or wild-type (WT) littermates were used for induced seizure experiments. KO mice lack >99% of brain 5-HT neurons. DS mice were continuously monitored in constant darkness. Spontaneous sudden deaths exhibited circadian timing, which was greatest during the subjective dark-phase. Deaths occurred more often while mice were awake, and the timing of death was independent of seizure duration, severity, and the timing of potentially fatal seizures. KO mice and WT littermates were subjected to one MES seizure at different times of day. WT mice were more likely to die during the night. However, KO mice had high mortality regardless of time of day. A cohort of DS mice received daily injections of the tryptophan hydroxylase inhibitor para-chlorophenylalanine (800 mg/kg, PCPA) or volume-matched saline. Saline-treated DS mice were more likely to die during the dark-phase, compared to PCPA-treated mice, which died more during the light-phase. Potentially fatal seizures were associated with full hindlimb extension and prolonged recovery. Recovery took longest when seizures occurred during the subjective nighttime. WT mice instrumented for amygdala kindling were used to examine the role of time-of-day seizures on CO2 arousal. Daytime seizures in kindled mice impaired CO2 arousal; however, nighttime seizures profoundly impaired CO2 arousal (over 10-fold increase). SUDEP occurs more frequently during the night and victims are often found in the prone position. Nighttime seizures may exacerbate 5-HT-associated arousal physiology and increase risk of death. Identification of mechanism of death and biomarkers that predict may help develop chronotherapeutic strategies to eliminate nighttime risk of SUDEP.

The nighttime risk of seizure-associated death is influenced by serotonin and coincident with ...

Background
Despite current treatment strategies for atherosclerosis focusing on lifestyle modification and cholesterol reduction, extracoronary vascular diseases affects >200 million patients worldwide and often remain indolent before progressing to severe disease with morbid complications. The aims of this cohort study were to (1) characterize biomarkers associated with development of severe outcomes and (2) compare pathways driving disease progression in different vascular beds in individuals with existing extracoronary vascular disease. 
Methods
We used proteomic data from individuals in the UK Biobank with extracoronary vascular disease at baseline, defined as peripheral artery disease (PAD), carotid artery stenosis (CAS), and renal artery stenosis (RAS). Severe outcomes were defined by major adverse limb events (MALE; developed after PAD), stroke (after CAS), and hemodialysis (after RAS). The first aim utilized Cox proportional hazards regression models to estimate the associations of 1,463 proteins and 249 metabolites with adjustment for age at enrollment, age at prevalent disease diagnosis, sex, cigarette smoking, systolic blood pressure, and statin prescriptions. The second aim utilized Gene Ontology and hypergeometric enrichment tools to identify enriched pathways. 
Results
There were 1370 individuals with a primary diagnosis of extracoronary vascular disease and 1463 individuals with a secondary complication. Patient with secondary complications were more likely to be older (primary diagnosis mean age = 75.63, secondary complication mean age = 76.36) with similar distributions in sex (P = 0.18), body mass index (P = 0.15), and systolic blood pressure (P = 0.40). There were 17 proteins significantly associated (P<0.001) with MALE and 15 proteins significantly associated with stroke (P<0.001). Progression of PAD and MALE was associated with proteins underlying biomineral tissue development, endothelial cell processes, and pathways involved extracellular signal-regulated kinases 1 and 2 (ERK1/2), mitogen-activated protein kinase (MAPK), interleukin-17 (IL-17), phosphoinositide 3-kinase/protein kinase B (PI3K/PKB), and signal transducer and activator of transcription (STAT). Progression of any severe complications, encompassing MALE, stroke, and hemodialysis were associated with proteins involved in vasculogenesis, endothelial cell migration, connective tissue wound healing, collagen catabolism, and pathways involving tumor necrosis factor (TNF) and nuclear factor kappa-light-chain-enhancer of activated B cells (NK-kB). 
Conclusions
Overall, severe complications of extracoronary vascular disease were associated with proteins involved in angiogenesis (PI3K/PKB, STAT), inflammation (IL-17, TNF, NK-kB), and remodeling (biomineral tissue development, connective tissue wound healing, collagen catabolism). This study provides evidence of the complex role of biomarkers in extracoronary vascular disease pathogenesis and highlights specific proteins as potential targets to improve therapeutic strategies.

Proteomics associated with development of severe complications in patients with extracoronary vascular diseases

Background 
Pancreatic neuroendocrine tumors (P-NETs) are hormone-secreting tumors originating from neuroendocrine cells in the pancreas. Due to the rarity of P-NETs, they remain under studied. Treatment involves surgical resection. Evaluation of margin definition involves both surgery and pathology as cancerous tissue is difficult to visually distinguish from normal tissue without stain. Developing methods for intraoperative margin definition could greatly improve treatment and management. A promising emerging technique is optical redox ratio imaging, a noninvasive metric of cellular metabolism quantified by the ratio of the intrinsic autofluorescence signals of nicotinamide adenine dinucleotide (NADH) to flavin adenine dinucleotide (FAD). This study aims to evaluate the use of multiphoton imaging for margin definition for fresh ex vivo P-NET samples without the use of stains. 

Methods 
Mouse xenografts were utilized, where eight mice were injected with BON-1 cells at the pancreatic tail. The resected tumor was placed immediately in fixative, and the other half was coated with DMEM (basal medium) and imaged using a Zeiss LSM 880 microscope with a tunable MaiTai HP titanium:sapphire light source. Two-photon tissue autofluorescence was excited at 780 nm. Several regions of the tumor-normal boundary were imaged. In total, 32 images were captured, 16 for NADH channel (emission at 425 nm) and 16 for FAD channel (emission at 500 nm). Three 50x50 pixel regions of interest representing tumor, tumor margin, and normal tissue were selected for each image based on the reference H&E slides. The average optical redox ratio was calculated and, statistical significance was evaluated using the pairwise Wilcoxon test with Bonferroni correction. 

Results 
The results of the pairwise Wilcoxon tests with Bonferroni correction showed significant differences for tumor vs margin (p = 0.0059) and margin vs normal (p = 0.0059), but not for tumor vs normal (p = 0.2520). 

Conclusion 
Utilizing the optical redox ratio shows promise to distinguish between tumor, tumor margin, and normal tissue in fresh P-NETs in an ex vivo xenograft model with high translational potential. This work should be further advanced by utilizing a larger dataset and training a machine learning. Future steps include intravital animal imaging, human tissue imaging, and developing custom probes for in-vivo measurements. Overall, this work shows great promise as a preliminary study to distinguish P-NET margins which could be applied within the fields of oncology, surgery and pathology.

Optical Redox Ratio Distinguishes Pancreatic Tumor Margins in an Ex Vivo Xenograft Model

Background:
Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for cognitive decline and dementia, but treatment adherence and efficacy in real-world settings may influence long-term outcomes. While continuous positive airway pressure (CPAP) is the standard of care, surgical options provide an alternative path for managing OSA. In this retrospective cohort study, we utilized the TriNetX database to examine whether surgical interventions for OSA were associated with a reduced incidence of dementia diagnoses and dementia-related pharmacotherapy compared to CPAP therapy.

Methods:
We identified adult patients (ages 45–80) with OSA using ICD-10-CM codes and divided them into two cohorts based on CPT codes indicating either CPAP initiation or surgical intervention (palatopharyngoplasty or inferior turbinate resection). Patients with cancer or cranial nerve stimulators were excluded. Propensity score matching was performed (1:1) on key demographic and clinical variables, including age, sex, race, BMI, and comorbidities. Patients were followed up from 6 months up to 10 years post-intervention for new diagnoses of Alzheimer’s disease, vascular dementia, unspecified dementia, and prescriptions for memantine or acetylcholinesterase inhibitors (AChEIs).

Results:
After propensity score matching, 9,739 patients remained in each group. Compared to surgical patients, CPAP patients had significantly higher risks of vascular dementia (RR 3.01, P=0.002), unspecified dementia (RR 5.12, P<0.001), memantine use (RR 2.92, P=0.001), and AChEIs use (RR 1.91, P=0.017). Alzheimer’s disease incidence was higher in the CPAP group (RR 2.00, P=0.054), though not statistically significant. 

Conclusion:
Surgical interventions for OSA were associated with significantly reduced long-term incidence of dementia and the need for dementia-related medications compared to CPAP in this real-world cohort. These findings suggest that in practice, where CPAP adherence is variable, surgical treatment may offer superior cognitive protection. Further prospective studies are needed to confirm causality and explore underlying mechanisms.


Dementia Outcomes in Obstructive Sleep Apnea: Surgical vs. CPAP Intervention

Background: Oropouche virus (OROV), an arbovirus transmitted by Culex and
Culicoides mosquitoes, was first identified in Trinidad in 1955. While commonly reported in South America, it had not been seen in the continental United States until 2024. We report the first two confirmed pediatric cases of OROV in South Florida, both with travel history to Cuba amid a regional outbreak in May 2024. These cases underscore the need for increased awareness, diagnostic
capability, and vector control. The first case is of a 16-year-old male on immunosuppressive therapy that presented with recurrent fever, headaches, fatigue, and decreased appetite following travel to Cienfuegos, Cuba. Initial tests for Dengue were negative and OROV antibodies returned positive (1:20). He recovered fully with outpatient supportive care. The second case we present was of a 15-year-old male who developed fever, vomiting, diarrhea, headaches, and fatigue after returning from Cuba. Multiple ED visits led to the findings of elevated monocytes and negative Dengue titers, and was ultimately admitted for supportive care. OROV antibody testing returned positive (1:160). These cases highlight OROV as an emerging arboviral illness with potential for geographic spread. Both patients exhibited biphasic illness, with symptoms including fever, headaches, and gastrointestinal upset. Laboratory findings consistently revealed monocytosis and atypical lymphocytes. Neither patient developed complications such as aseptic meningitis, although both exhibited headaches—an important consideration given the virus’s reported neuroinvasive potential. Current testing protocols rely on Dengue exclusion before pursuing OROV diagnostics, risking delayed or missed diagnoses. Broader multiplex PCR testing may improve timely detection. These cases emphasize the need for enhanced surveillance and preparedness, especially in Dengue-endemic regions. Public health measures, including vector control, travel advisories, and expanded testing access, will be essential in mitigating the impact of this emerging virus.

First Two Cases of Oropouche Virus detected at a Pediatric Hospital in South Florida

Background
Infective endocarditis (IE) typically presents with fever, malaise, and embolic phenomena. Risk factors include structural heart disease, prosthetic valves, IV drug use, and invasive procedures (1,2). Persistent hiccups (singultus), lasting over 48 hours, are rarely associated with IE and more often linked to gastrointestinal, neurologic, or metabolic disturbances (3,4). Limited reports suggest that IE may cause hiccups via phrenic or vagus nerve irritation or septic emboli to the brainstem (5–8). Group B Streptococcus (GBS) is a rare cause of adult IE but is associated with aggressive infection, especially in patients with uncontrolled diabetes (10). We describe a rare case of bivalvular GBS IE presenting with persistent hiccups.
Case Presentation
A 58-year-old man with no significant medical history presented with four days of persistent hiccups, fever, chills, diaphoresis, polydipsia, polyuria, and right upper extremity pain. Exam revealed a 3/6 holosystolic murmur and right hand swelling with limited range of motion. Labs showed WBC 17,000/µL, glucose 400 mg/dL, HbA1c 11.0%, CRP 296 mg/L, and hyponatremia. Urinalysis showed glucosuria and ketonuria. Chest X-ray revealed multifocal infiltrates. Initial management targeted presumed pneumonia. Blood cultures grew Streptococcus agalactiae (GBS). Echocardiography revealed a large mitral valve vegetation with severe regurgitation and posterior leaflet perforation, as well as a smaller tricuspid vegetation with moderate regurgitation. Diagnosis of bivalvular IE was made per Duke criteria. Antibiotics were escalated to IV ampicillin and gentamicin. The patient was transferred for surgical evaluation.
Discussion
IE remains diagnostically challenging due to its diverse presentations (1,2). Persistent hiccups are an unusual symptom, but may indicate serious underlying pathology when accompanied by systemic signs (3,4,9). In this case, persistent hiccups were linked to bivalvular GBS IE, possibly due to autonomic nerve irritation or central embolization (5–8,11). The patient’s uncontrolled diabetes likely predisposed him to severe infection, as hyperglycemia impairs neutrophil function and increases the risk of invasive disease (10,12). This case reinforces the importance of considering IE in patients with persistent hiccups and fever, even in the absence of classic risk factors, and highlights the value of early echocardiography in guiding diagnosis and management.


Persistent Hiccups as an Unusual Presentation of Group B Streptococcal Infective Endocarditis with Bivalvular Involvement

Background
The American Diabetes Association recommends annual diabetic retinopathy screening to prevent vision loss, yet national screening rates remain below the Healthy People 2030 target of 70%. Screening rates for diabetic retinopathy at Northwestern Medicine averaged 49.7% in June 2023, indicating care gaps across Chicagoland. 

Methods
Our quality improvement initiative utilized Plan-Do-Study-Act cycles, root cause analysis, and data-driven decision-making. Interventions were applied to both regional Northwestern Medicine primary care clinics and the primary care clinics of the downtown Northwestern academic center. Key interventions included pre-visit questionnaires, practice advisory tools, more frequent health maintenance standards, patient attestations, and automated MyChart messaging. The effectiveness of each intervention was assessed by aligning implementation timing with monthly screening rates. A team of quality improvement professionals evaluated each initiative's impact versus effort to determine scalability.

Results
Screening rates increased from 49.7% to 57% at the downtown campus and from 55% to 59% at regional clinics over a 22-month period.

At the downtown academic center, the implementation of a pre-visit questionnaire (allows patients to report recently completed or upcoming eye exams) in August 2024 increased rates of screening from 50% to 54% within one month. Implementation of patient attestations (allows for self-reporting of completed eye exam status in MyChart) and automated MyChart messaging (messages and scheduling options proactively sent to patients overdue for eye exam) further increased screening rates to 57% over the next 7 months. 

At the regional Northwestern primary care clinics, a standardized practice advisory (notifies staff that a patient is due for an eye exam and prompts them to set up an ophthalmology referral) introduced in June 2023 through March 2025 demonstrated steadily increasing screening rates from 55% to 59%. Additionally, updating the health maintenance frequency (requiring annual diabetic eye exams for all patients with diabetes) in September 2024 demonstrated an almost 1% increase within one month. 

High-impact, low-effort interventions included the pre-visit questionnaire, updated health maintenance frequencies, MyChart messaging, and patient attestations. Resource-intensive but effective measures also included integrating community health workers and a point-of-care camera at the downtown site. Less impactful strategies included distribution of educational materials and a self-scheduling feature.

Conclusion
This initiative highlights effective, scalable strategies for improving diabetic retinopathy screening rates at both academic and regional clinics. These findings may guide similar efforts at other health care systems to address gaps in preventive diabetes care.


Quality Improvement Methods for Improving Diabetic
Retinopathy Screening Rates at a Large Academic Medical
Center and Affiliate Medical Group

Background: Lymphomatoid papulosis (LyP) is a chronic, recurrent, self-healing cutaneous T-cell lymphoproliferative disorder characterized by CD30+ cells. It typically presents with papulonodular eruptions rather than plaques. Mycosis fungoides (MF), a primary cutaneous T-cell lymphoma, is generally persistent and non-migratory. This case highlights an unusual presentation of migratory plaque-like LyP, raising diagnostic challenges with overlap to more serious lymphoproliferations, such as MF.

Case Presentation: A 63-year-old female presented with pruritic plaques and nodules that intermittently appeared and resolved across various body sites. Past episodes were treated as fungal infections, though KOH preps were negative. She had a remote history of shingles but no other relevant systemic symptoms. Two punch biopsies were obtained a week apart, one from the right thigh and the other from the right groin.

Histopathology from both biopsies revealed an atypical intraepidermal T-cell lymphoproliferative disorder with CD30 positivity and a double-negative CD4-/CD8- phenotype by immunohistochemistry. Loss of several T-cell markers (CD2, CD5, CD7) was noted. The dermal component demonstrated a band-like infiltrate of mixed immunophenotype, including CD30 positive lymphoid cells. PAS was negative for fungal elements. T-cell receptor studies were positive for TCR beta clones (261 and 260bp; 294 and 294bp) as well as TCR gamma clones (240 and 239bp). Ancillary FISH for the DUSP22-IRF4 rearrangement is pending. Given the migratory nature of the rash, self-resolution of lesions, and histopathologic work-up with ancillary studies, a diagnosis of an unusual plaque-like variant of lymphomatoid papulosis was made.

Discussion: This case underscores a diagnostic gray zone between LyP and MF. Plaque-like LyP is rare and may be underrecognized due to its clinical resemblance to early MF. The migratory nature of the lesions and spontaneous resolution pointed toward LyP, yet the presence of plaques and immunophenotypic abnormalities added complexity. CD30+ double-negative T-cell populations are uncommon but can occur in LyP, occasionally associated with DUSP22-IRF4 rearrangements. Accurate diagnosis is crucial given the differing prognoses and management strategies between LyP and MF. This case also illustrates the value of serial biopsies and multidisciplinary pathology review in evaluating atypical cutaneous lymphoproliferative disorders.

Migratory Plaque-Like Lymphomatoid Papulosis: A Rare Clinical Presentation Mimicking Mycosis

Background
Repetitive traumatic brain injury (rTBI) is a leading risk factor for chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders. While CTE has traditionally been associated with repeated head impacts, evidence suggests that a single TBI may drive tau pathology and progressive neurodegeneration. Biological sex is also known to influence TBI outcomes, yet mechanisms underlying sex differences remain poorly defined. Existing animal models often lack reproducibility and fail to include both sexes. This study aimed to develop and validate a rigorously calibrated Drosophila melanogaster model of rTBI to investigate sex-specific behavioral, molecular, and neuropathological responses to repetitive head trauma.

Methods
An automated, CO₂-driven ballistic impactor was engineered to deliver reproducible closed-head injuries to male and female flies. Flies received five impacts per day 1 psi to model mild rTBI. Locomotor activity and cognitive function were assessed using automated tracking and value-based feeding decision paradigms, respectively. Neurodegeneration was evaluated histologically, and whole-head proteomic profiling was performed at multiple time points post-injury to identify rTBI and sexually dimorphic molecular pathways.

Results
rTBI produced dose-dependent locomotor deficits and impaired decision-making in both sexes. Females were initially more resilient to multiple injuries, exhibiting fewer locomotor deficits early post-injury, but demonstrated significantly longer recovery periods compared to males. Histological analyses revealed increased neurodegeneration present despite tau knockout (dTauKO) flies, suggesting tau-independent mechanisms. Proteomic analysis revealed sex-specific alterations in mitochondrial function, oxidative stress responses, and pathways regulating locomotion and energy metabolism, which correlated with observed behavioral phenotypes.

Conclusion
This enhanced Drosophila rTBI model provides a robust model for studying sex-specific mechanisms of neurodegeneration. Our findings suggest that both the number of injuries and cumulative force contribute to neuropathology and highlight critical differences in male and female responses to repetitive head trauma. These insights emphasize the importance of incorporating sex as a biological variable in TBI research and identify potential therapeutic targets for mitigating long-term neurological sequelae.

Premium content

Next from AMA Research Challenge 2025

Targeting the PI3K/mTOR/AKT Pathway to Induce Apoptosis in Glioblastoma Multiforme: A Mechanistic Review

Similar lecture

Wound Care Knowledge in the Community Setting: Closing the Patient Education Gap