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The dedication towards my medical career and passion for research has been deeply rooted in the support and encouragement of my family and people of the city where I was raised. El Paso, Texas is centered on a unique culture, which includes the importance of family. Many individuals who are born and raised here are highly capable of success, but are often cautious of personal accomplishment, as it may result in their physical separation of them from their families. My aspirations as a physician, to protect the health of the public, and to serve, have included spending years away from my loved ones, a taxing debt to pay for the invaluable progress in my medical career. The personal success I achieve will always be indebted to the support of family and city, whom I proudly represent.
My first research opportunity came in 2013 after receiving a grant from the National Science Foundation to conduct bench research with the joint University of Texas at El Paso and University of California at Santa Barbara, Partnership for Research and Education in Materials program. For two years, I developed organic photovoltaic mediums for solar cells, in search for chemically efficient means to harbor solar energy. I graduated summa cum laude from the University of Texas at El Paso, with a degree in Cellular and Molecular Biochemistry.
In 2015 I started my medical education and career at the University of Texas Medical Branch in Galveston, Texas. In 2017, I became interested in conducting bench research as I had as an undergraduate. I befriended Dr. Juan P. Olano, a pathology faculty and residency program director at the University of Texas Medical Branch, who trained me in immunohistochemistry at the Galveston National Laboratory. Our research consisted of immunoglobulin marking and creation of screening testing for Zika virus on in vitro placental samples. In 2018 we published the results of a separate project highlighting the Influenza A and B deaths of all the patients at the University of Texas Medical Branch.
In 2017, I became interested in diagnostic and interventional radiology, where I began to collaborate with Dr. Quan Nguyen, a breast radiologist and residency program director at the University of Texas Medical Branch. My experience in scientific writing, literature and chart review, and data collection allowed for the publication of various case reports. Among the first of our publications together, I assisted in the writing and editing of Spindle Cell Lipoma: Rare Breast Mass Imaging Findings and-Differential Diagnosis; and Diagnosis, Prognosis and Management of Incidental Metastatic Melanoma to Breast, Axilla and Regional Lymph Nodes in a Ninety-Year-Old Female. Later, I would write and assemble other case reports with Dr. Nguyen where I was primary author, such as in the case report: Detection of a Mammographically Occult Breast Cancer with a Challenging Clinical History.
As I became a more experienced clinical researcher, my passion for radiology propelled me to befriend mentors that would allow me to have my own research projects, and benefit from assembling original and technical research, where I would be the primary/senior and corresponding author.
As of 2019, I have published over 20 clinical diagnostic and radiology articles, of which 14 are peer reviewed and indexed in PubMed. These publications include the original article Vascular Physics: Explaining the Nature of Escape Veins and When to Use Endovascular Ligation, which explains the mechanism behind small branching venous collaterals that form from failed hemodialysis fistula grafts. Coined “escape veins,” these small branching vessels divert outward venous flow through them, resulting in an overall decreased total venous outflow and fistula graft failure. Furthermore, we use physical mathematics to prove this phenomenon, by relating venous blood flow to an electrical circuit. As Ohm’s Law and Kirchhoff's current and voltage laws explain how current is affected by resistance and branching circuits, we prove that total venous blood flow through a hemodialysis fistula graft is analogously affected by branching escape veins. In our IRB study based on patients with failed hemodialysis fistula grafts, 100% of their fistula grafts were salvaged when endovascular ligation was utilized on escape veins with a pressure gradient of at least 5 mmHg across them.
Another original article which highlights my clinical radiology research is the device innovation entailed in the publication, Larger Sizes Matter More! Applying the Matteo Mathematics Method for Endovascular Aortic Bifurcation Reconstruction to Large Venous Vascular Repair, where I am the senior author. Named after my colleague and research principle investigator, Dr. Jerry Matteo, the “Matteo Mathematics Method” is a mathematic algorithm used to accurately predict the exact diameter of kissing or chimney stents that are needed to adequately repair arterial or venous vasculature, preventing the possibility of endoleaks. Currently with physical device limitations, kissing or chimney stents must be placed side-by-side to repair vascular pathologies such as trauma or arteriosclerotic damage. Traditionally, kissing or chimney stents have been oversized in order to avoid endoleaks with little to no avail. However, the Matteo Mathematics Method accounts for the diameter of the damaged native vessel, the size of the auxiliary vessels to be stented (in our case the right and left iliac veins), and the stent graft redundant material (specific to the brand of stent graft), to predict the exact diameter stent grafts needed to eliminate the possibility of endoleaks.
My research experiences have also focused on clinical technical research, reflecting device innovation in interventional radiology. The number of minimally invasive vascular and interventional radiology procedures performed increases every year. Likewise, as the number of vascular procedures increases, the need for advanced technology and innovative devices increases. Traditionally, a catheter is used in conjunction with a guidewire in such procedures. The underlying principle of vascular and interventional radiology is to always use a guidewire prior to any advancement of a catheter. The following publications are the first to describe the use of steerable microcatheter systems, utilized in a novel fashion, defying the traditional wire and catheter system, and negating the use of guidewires. Additionally, traditional interventional procedures can now be conducted in a time efficient manner, while decreasing radiation exposure to patients. The following publications demonstrate the reported successful application of steerable microcatheter systems in acute ischemic stroke and pediatric interventions.
Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion
Abstract: Stroke is the fifth leading cause of death in the United States and is one of the leading causes of patient disability. Treatments for intracranial intravascular damage as a result of stroke have evolved extensively over recent decades, as management has become increasingly innovative. Various prospective studies and years of data have refined the current guidelines for treatment of acute ischemic stroke (AIS) and also reflect on the novel interventions for stroke management. Nonetheless, AIS remains a difficult and multifactorial etiology of disease to treat. As physicians adapt evidence-based knowledge to their interventional management of patients with AIS, the accompanied use of intravascular devices, such as steerable microcatheters, reduces radiation and procedure time. Considering all of the applications for steerable microcatheters, the use of these devices for AIS interventions may be most necessary.
Pediatric Traumas and Paradigm Shifts: The Necessary Adaption of the Steerable Microcatheter in Pediatric Interventional Radiology
Abstract: The use of traditionally available intra-arterial devices have historically been designed with the adult patient population in mind. Currently, there are not manufactured devices specifically tailored for use during pediatric interventional procedures, pressuring interventional operators to adapt commonplace and readily available devices for interventional management. Experienced interventional operators understand that pediatric and adult interventions can entail vastly different management, affecting patient care and outcomes. To address the pitfalls in pediatric interventional management, an accredited fellowship specifically for pediatric interventional radiology is available. However, devices must equally evolve with the training available in order to adequately address interventional management of the pediatric patient population. Interventional device innovation can be considered the initial step towards bridging the technical and procedural gaps necessary for refining pediatric intervention. The introduction of steerable microcatheters in interventional radiology has innovated procedural protocols, but has never been documented in pediatric patients until this time.
Many of my publications have been showcased at various conferences around the nation in the form or poster and oral presentations. I am currently continuing to produce more clinical radiology research, more especially in the field of interventional radiology. In March of 2019, I was accepted to be an integrated interventional radiology resident at the University of Florida College of Medicine in Jacksonville, Florida; it is clear that I will continue my clinical interventional radiology research with the acceptance as an interventional radiology resident. At the moment, I am working toward publishing more original research including, When Technology Exceeds Its Application: The First Reported Repair of the Iliocaval Confluence Using an Aortic Endograft; and Gadolinium- The Dark Side: A Study of Arthrographic Contrast at Extreme Concentrations. These articles are set to be published in May of 2019.
In April of 2019, I was nominated for the University of Texas Medical Branch, Dean’s Award for Research Excellence, which is awarded to a medical student who has demonstrated excellence in research during their medical school career.
In June of 2019, I will graduate from the University of Texas Medical Branch in Galveston, Texas, as one of the most published, if not the most published, medical student in the country.
My complete PubMed bibliography of published works can be found at: https://www.ncbi.nlm.nih.gov/myncbi/1LG9ffRde1Y9I_/bibliography/58191245/public/
Reviewer Keywordsescape veins interventional radiology steerable microcatheter vascular physics time is brain complicated complication size matters matteo mathematics method acute ischemic stroke aortic endograft
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