Janvi Bhavsar

Abstracts:

1) RACIAL DISPARITIES IN ACQUISITION OF LIVER TRANSPLANT IN PATIENTS OF SHORT BOWEL SYNDROME AND OTHER CAUSES OF INTESTINAL FAILURE THROUGH DESCRIPTIVE ANALYSIS OF NATIONAL INPATIENT SAMPLE 2021.

Objectives:

1) to identify, quantify, and understand the racial and socioeconomic disparities in the outcomes of pediatric liver transplantation and intestinal failure management,

2)To inform policy changes and develop targeted interventions aimed at reducing these disparities, ensuring equitable access to transplantation, and improving healthcare delivery and outcomes for all children, regardless of their racial, ethnic, or socioeconomic background.

Methods:

We conducted a descriptive analysis using the National Inpatient Sample (NIS) 2021 to examine the demographic distribution of pediatric patients undergoing liver transplants and those diagnosed with short bowel syndrome and other forms of intestinal malabsorption. The analysis utilized ICD-10 codes for liver transplants, short bowel syndrome, Whipple's disease, intestinal failure, and other causes of intestinal malabsorption.

Results:

Our analysis of the National Inpatient Sample (NIS) 2021 identified 2105 pediatric patients with liver transplants and 6275 patients with short bowel syndrome. Pediatric patients who needed liver transplant due to short bowel syndrome were 130 in number. The demographic breakdown for race/Ethnicity was: 15% White, 35% Black, 35% Hispanic, 15% Other

he demographic breakdown for race/Ethnicity for liver transplant alone was: 40% White, 17% Black, 30% Hispanic, 13% Other

he demographic breakdown for race/Ethnicity was: 40% White, 26% Black, 24% Hispanic, 10% Other

On subgroup analysis for median household income, there was no racial disparity based on household income status, p value 0.33

Conclusion:

The data highlight significant racial disparities in pediatric patients undergoing liver transplants due to short bowel syndrome, with Black and Hispanic patients being overrepresented in this group. However, advancements in IRPs and innovative treatments have improved survival rates and reduced the need for transplants. The analysis found no significant racial disparity based on median household income status (p value 0.33), suggesting that the observed disparities may not be solely due to economic factors but could be influenced by other systemic or healthcare access issues.

2) EARLY DIAGNOSIS OF CHOLEDOCHAL CYST DUE TO BETA THALASSEMIA MINOR, A RARE PRESENTATION.

Objective

To present an unusual case of CC in a 3-year-old girl with beta thalassemia minor, highlighting the atypical presentation of CC and the potential interplay between these conditions.

Design/Method

This is a case report. The information on the patient's clinical presentation does not contain any identifying information. A literature review was conducted using PubMed, focusing on studies published within the last decade.

Result

Our patient had intrahepatic and extrahepatic cystic dilatation measuring 2cm, which if had been un-influenced by other factors would have likely remained asymptomatic till adulthood. Most childhood presentations of cysts are due to large size of cyst compared to patient's body habitus which causes abdominal pain and swelling. However, our patient had beta thalassemia minor which contributed to the biliary stasis already caused by the CC which caused the choledocholithiasis. Of note, patient had a brief episode of sickness consistent with a viral upper respiratory tract infection 1 week prior to presentation that could have lead to mild hemolysis and subsequent hyperbilirubinemia due to underlying thalassemia. Removal of CC before 18 years of age, has an almost negligent risk of development into cholangiocarcinoma later in life. After 18 years of age, even complete cyst resection has a small risk of development of cholangiocarcinoma. Thus patient's beta thalassemia turned out to be a serendipitious.

Conclusion

This case report highlights an unusual presentation of choledochal cyst in a young patient with beta thalassemia minor. The interplay between these conditions led to early detection and treatment, potentially reducing the long-term risk of cholangiocarcinoma. This case underscores the importance of considering underlying hematological disorders in pediatric patients presenting with biliary symptoms.

3) Work In Progress: Prevalence Of GDM In Mothers of Children Diagnosed With MASLD, A Case Control Study, currently pending IRB approval.

-Currently a second year pediatric resident at Maimonides Medical Center

-I was interested in Pediatric GI after a rotation during intern year, I realized I enjoy helping children improve their bowel health and manage constipation effectively, nutrition and optimizing it for different health states, especially the effect nutrition has on liver, in the manner of MASLD. Very interested in hepatology in general.

- I also enjoy General Pediatrics, talking to families and watching children grow and reach their full potential.

• 2 weeks of outpatient and inpatient observership at Golisano Children's Hospital in the Pediatric Gastroenterology Department
• Observed history taking, physical examination and management of patients in both inpatient and outpatient settings, shadowing doctors and nurse practitioners each day
• Observed 10-15 patients a day
• Discussed and formulated patient diagnosis and management with the consult team consisting of attendings and residents during hospital rounds in the inpatient setting and with the attending in the outpatient setting
• Observed the working of EHR EPIC closely
• Learned about different dietary modifications for patients with IBD, failure to thrive and chronic functional constipation from the dietician
• Was introduced to and taught about the application of newest biologics used for treatment of IBD by Dr Wali
• Observed upper gastrointestinal endoscopies

• Outpatient Pediatric Clinic, about 60-70 patients a day, for 4 weeks
• Taking thorough patient histories and presenting it to Dr Beityakov
• Performing physical exam on patients and participating in discussion of management of patients
• Responsible for clinical work up (history/physical exam) of 10-20 patients each day
• Summarised medical history of patient from health records and presented it to Dr Beityakov before follow up visits
• Assisted in blood drawing, vaccination, wart removal and mastisol application
• Observed circumcision
• Learned to use ECW EHR system
• I was responsible for logging patient notes of all 60-70 patients each day
• Counselled patients and parents about test results, diagnosis and management of conditions like iron deficiency anemia under minimal supervision
• Performed COVID-19 and rapid strep tests
• Co-ordinated patient care with nurses

• Company Overview: An outpatient clinic in Miami, under a program of Florida International University Herbert Wertheim College of Medicine
• 4 weeks at Kid Care Pediatrics
• Took thorough patient histories and presented them to Dr Fernandez
• Discussed patient diagnosis and management
• Gave an oral presentation on 'Nephrotic Syndrome'
• Observed physical examination instead of performing them, due to COVID-19 rules
• Performed vision tests and other tests like checking patient milestones which did not require physical contact with patients
• Observed Dr Fernandez as she worked on the EHR system
• Provided literature on procedures, referrals and vaccines to parents of patients and counselled them about the same
• Attended daily lectures held before clinic hours on common pediatric ailments such as asthma and atopic dermatitis
• Learned Pediatric drug dosing and solved MCQs with other medical students
• An outpatient clinic in Miami, under a program of Florida International University Herbert Wertheim College of Medicine

• 4 weeks of remote clinical experience in a Family Medicine outpatient clinic conducted via an online video-conferencing platform-Zoom
• Wrote patient notes on Practice Fusion EHR system
• Discussed patient management and diagnosis with Dr Singh
• I was made in charge of formulating management plans for all pediatric patients under the supervision of Dr Singh
• Presented summary of patient's relevant medical history before each clinic visit to Dr Singh
• Observed History taking and physical examination of all patients
• Reviewed patient test results and observed the counseling of patients over diagnosis and management
• Co-ordinated patient care with a medical student who was on site for the rotation
• Solved academic MCQs with Dr Singh and the medical student at the end of each day

• Company Overview: An NGO assisting to overcome Substance Use
• Formulating creative ideas and concepts required for our Public Relations Team, Video Team and Creative Execution Team
• Meet once a week in person or via video conferencing software such as zoom and discuss ideas for busting myths about use of illicit substances such as cocaine, marijuana and methamphetamines
• Formulating poster designs to be uploaded to social media platforms
• Participated in live discussions with a panel of experts on topics such as 'Overcoming Alcohol Addiction and Drug Abuse'
• An NGO assisting to overcome Substance Use

• Company Overview: An NGO advocating for accessibility of Primary Care in underserved communities in India
• Under Clinicase Community Healthcare Wing: 'Swasth Bharath Camp' where I independently performed breast exams on 35 women and referred women with positive findings to higher centres for further evaluation
• Under Clinicase Community Healthcare Wing: 'Shishu Suraksha Camp' where we screened over 30 children for common skin conditions like scabies and ringworms and performed vision testing
• The children with positive findings were referred to higher centres for further evaluations
• An NGO advocating for accessibility of Primary Care in underserved communities in India

• Company Overview: An organisation connecting NGOs to student volunteers eager to affect change
• Under NGO 'Humana- People to People'- 'The Breakfast Revolution', where we performed physical exam and recorded anthropometric findings of 100 children in Ambujwadi, a large slum in Mumbai
• We compared these findings to that from previous camps to record health improvement post nutritional rehabilitation
• Under NGO 'Angel Express'- Camp for screening for ADHD, Anxiety and Depression among 30 children ranging in ages from 7-18
• Referred all children as determined positive by screening questionnaire to higher centres for further evaluation
• An organisation connecting NGOs to student volunteers eager to affect change

• Prerequisite for graduation with rotations through all medical and surgical specialties as an intern doctor
• Patient management under supervision of residents and attendings in both inpatient and outpatient settings, including 24 hour calls and ICU management duties
• Worked under supervised autonomy in COVID-19 isolation wards reporting directly to residents and attendings during bedside rounds
• Directly responsible for the management of 15-20 patients each day
• Worked at a community health care centre serving underserved communities under supervised autonomy
• Provided management for common ailments, screened children for malnutrition and organised immunization drives
• Worked in the Emergency Department performing triage for common complaints and interpreting ECG
• Performed phlebotomy, ABG, ryle's tube and folley's catheter insertion
• Ascitic tap performed under supervision

• Under NGO 'Pragati'- organised a Christmas celebration in the Pediatric ward of King Edward Memorial (K.E.M) hospital
• We decorated the place, organised activities, provided food and music as well as presents for all children
• Under Department of Anaesthesiology- Participated in a drive for introduction of Compression only Life Support to the pedestrians walking on a very populous area of our city, Marine Drive
• We used mannequins for demonstration, urged for participation and provided feedback and corrections
• Blood camps- over all of my years at K.E.M
• We have organised many blood camps
• Our main contribution has always been recording patient vitals and screening of volunteers donating blood

• Organised several workshops over the year
• Most notably with 'Terribly Tiny Tales' (2.5 million followers on Instagram) on content creation for the internet
• Also organised a workshop with 'Human Library', an organisation about rape victims, human trafficking survivors and people with disabilities coming forward to share their stories
• Participated in editing and illustrating 'Gosumag', our annual college magazine