Sanja Kupesic Plavsic

• MD, PhD
• Head of Faculty at Texas Tech University Health Sciences Center

Background: The objective of this study was to quantify the association between graduation from our annual comprehensive Institutional Faculty Development Course (IFDC) and being promoted from assistant professor to associate professor at our health sciences center. Methods: A retrospective cohort study (October 2008-October 2019) was conducted us...

The novel coronavirus disease 2019 (COVID-19) has caused a rapid and massive transition to online education. We describe the response of our Office of Faculty Development at Texas Tech University Health Sciences Center El Paso (TTUHSC EP) to this unprecedented challenge during and after this post-pandemic crisis. The initiatives for emergency trans...

Ubiquitous exposure to endocrine disruptive chemicals (EDC) among women of reproductive age is alarming. Exposure to EDCs could be contributing to infertility. We determined the association between common EDCs and self-reported infertility among U.S. women, 18–45 years of age using the National Health and Nutrition Examination Surveys (NHANES) for...

The objective of this paper is to introduce selected statistical and epidemiologic topics that are of interest to interdisciplinary teams of healthcare quality professionals, educators, technical staff, and researchers who participate in clinical simulation scholarship. Four research vignettes in the setting of a hypothetical clinical simulation tr...

Background: The Accreditation Council for Graduate Medical Education expects residents to attain competency in systems-based practice by advocating for quality patient care, working in interprofessional teams, and implementing system solutions to prevent errors. Diabetes in pregnancy was identified as an area for improvement through comprehensive...

Three-dimensional transvaginal ultrasound (3D TVUS) has gradually evolved into the safe, widely available, and reasonably cheap imaging modality that offers numerous advantages for diagnostic workup of infertile patients. Adding coronal plane and surface rendering has improved the accuracy of ultrasound for detection of various uterine anomalies an...

Background: The purpose of this study was to evaluate the maternal outcome in women with very advanced maternal age (VAMA) at childbirth (>45 years) compared to advanced maternal age (35-39 and 40-44 years). Methods: Retrospective cohort study using the Texas Public Use Data File, years 2013-2014. Maternal age was a three-level variable: 35-39 (...

Objectives: Inconsistent results have been reported by authors of studies of the management of pediatric patients with ovarian torsion (OT). Our objective was to identify predictors of oophorectomy in girls hospitalized throughout Texas with OT. Methods: The Texas Public Use Data File (years 2013-2014) was queried for the records of girls under...

Saline infusion sonography (SIS), also known as hysterosonography or sonohysterography, is a minimally invasive ultrasound (US) technique that involves infusion of a small volume of sterile saline into the uterine cavity. It acts as a negative contrast medium that delineates hyperechogenic endometrial lining. Contrast enhanced sonographic studies p...

Contraception is an essential component of health care for reproductive-age women. It is estimated that up to two-thirds of pregnancies in diabetic patients are unplanned. This chapter provides a comprehensive overview of hormonal contraception, emergency contraception, and long-acting reversible contraception and their use specifically in women wi...

Background: Pelvic ultrasound is a critical diagnostic imaging tool in obstetrics and gynaecology. Training opportunities in transvaginal ultrasound have not kept pace with the demand among learners because of the increased complexity of modern ultrasound technology and duty-hour restrictions. Ultrasound simulation training has the potential to ov...

Objective: To assess the effect of letrozole in combination with low dose gonadotropins for ovulation induction in anovulatory infertility from polycystic ovary syndrome (PCOS) and controlled ovarian stimulation for endometriosis, and unexplained infertility patients. Study design: Retrospective cohort study in a setting of private Reproductive...

“Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand.” —Confucius, 450 BC Use of simulation technology allows learners to perform repetitive ultrasound examinations and practice at their own pace without compromising patient comfort and/or safety. Structured training and incremental exposure to different patho...

Objectives: To assess the inter-rater reliability of standardized patients (SPs) as they assess the clinical skills of medical students and to detect possible rating bias in SPs. Methods: The ratings received by 6 students examined in 4 clinical stations by 13 SPs were examined. Each SP contributed at least 3 and at most 10 pairwise ratings, wit...

Introduction The benefi ts and uses of ultrasound (US) are well documented for procedural and diagnostic purposes. A number of studies have evaluated the utility of simulation-based US training in achieving competency and improving safety. To the best of our knowledge, no previous studies have attempted to synthesize the effectiveness of US simulat...

The association between adenomyosis, assisted reproductive technology outcomes, and pregnancy complications is well established. The purpose of this retrospective study was to assess the most common sonographic features of adenomyosis and prevalence of coexisting pathology. Systematic retrospective assessment of 828 transvaginal color Doppler ultra...

The preimplantation ultrasound (US) refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques (ART) to optimize the infertility treatment outcomes. After a thorough evidence based literature review, we propose the use of transvaginal three-dimensional (3D) US during the early follicular phase. A systematic approa...

The etiology of postpartum hemorrhage (PPH) is diverse and management depends on identifying the cause and tailoring treatment appropriately. The major causes of PPH are uterine atony, endometritis, retained placental tissue, placental abnormalities, i.e. placenta accreta, increta and percreta, subinvolution of the placental implantation site, arte...

Acute myocardial infarction (AMI) during pregnancy and the puerperium is a rare but devastating event. The objective of this study was to describe the clinical and epidemiological features of pregnancy-related AMI. A retrospective study was conducted using Texas hospital inpatient data (years 2004-2007). Diagnoses and procedures had been coded usin...

Ovarian function is important to measure in patients receiving cancer treatments that desire future fertility. Patients with cervical cancer, which affects women of child-bearing age, may be interested in how receiving treatment for the cervical cancer will affect their fertility. Depending on the type and stage of the cancer, women have different...

Aim To evaluate the role of second mid-trimester ultrasound in prenatal detection of gastrointestinal (GI) fetal anomalies and compare the ultrasonographic findings with postnatal diagnosis. Materials and methods A 5-year retrospective study included 16,334 neonates delivered at a tertiary referral center. All neonates were evaluated by a second m...

Arteriovenous malformations (AVM) of the uterus can cause life-threatening hemorrhage. Unexplained, heavy vaginal bleeding in a reproductive age woman should raise suspicion for an AVM. Here a 37-year-old woman had increasingly severe vaginal bleeding for 15 days. Serum β-hCG was elevated. Two-dimensional transvaginal ultrasound suggested retained...

Ultrasound has made significant advancements in reproductive medicine, especially infertility of a female cause. It is a useful tool in the diagnosis and management of various disorders. Transvaginal ultrasonography in particular plays a vital role in infertility treatment as it allows for evaluation of normal and stimulated ovarian cycles, aspirat...

Ultrasound is a powerful tool that can improve patient safety, save lives and reduce the cost of healthcare services in both developed and developing countries. A critical step in this direction is the availability of high quality training programs and continuous medical education. While scientific medicine is based on evidence, practice of ultraso...

Objective The use of transabdominal and transvaginal ultrasound is the test of choice in many Obstetrics and Gynecology practices. The objective of our study is to demonstrate how simulated ultrasound teaching could improve residents’ knowledge between PGY1 and PGY2 years in the area of (1) the ability to perform an accurate transabdominal and tran...

Adrenal cysts are a rare diagnosis, particularly in pregnancy. We report the case of a 32-year-old pregnant woman with an adrenal pseudocyst in her 28th week of pregnancy. This represents the 13th case of an adrenal pseudocyst in pregnancy reported in the literature. The patient presented to our facility complaining of abdominal pain, believing she...

Pelvic ultrasound simulation training using high-fidelity mannequins can provide a safe and controlled learning environment to foster the ultrasound education of medical students, residents and faculty. The instruction can be tailored to the specific needs of the learners. Topics for instruction range from teaching basic anatomy and ultrasound scan...

The potential teratogenic effects of psychotropic medication use during pregnancy have been scrutinized ever since thalidomide contributed to phocomelia in the 1950's. Up to 35% of the half a million women becoming pregnant each day take psychotropic medication(s). Teratogens alter normal intrauterine fetal growth, anatomic structures, functioning...

This paper repots the findings of a survey performed at Ian Donald Inter-University School of Ultrasound to evaluate the technology readiness of the faculty for distance learning. Of 75 potential respondents, 55 participants completed the survey with a response rate of 73.3%. The 20 item survey was created and approved by Ian Donald IRB. The survey...

This review article describes the development of the use of ultrasound guidance for neuraxial blocks in obstetric anesthesia. Current evidence of the clinical utility and application, basic lumbar spine sonoanatomy and practical clinical approach of the ultrasound-guided technique for neuraxial blocks are presented and discussed. Suggested curricul...

Implantation of the zygote outside the uterine cavity occurs in 2% of all pregnancies. The rate of ectopic pregnancies has increased from 0.5% in 1970 to 2% today. The prevalence of ectopic pregnancy in all women presenting to an emergency department with first-trimester bleeding, lower abdominal pain or a combination of the two is between 6 and 16...

Gestational diabetes mellitus (GDM) is defined as glucose intolerance that begins or is first recognized during pregnancy. Numerous clinical factors are associated with an increased likelihood of GDM, such as increasing age, obesity, ethnicity, family history of diabetes and past obstetric history. There is a well-documented relationship between ma...

Leadership and directors of Ian Donald Inter-University School of Medical Ultrasound are aware of the importance and complexity of ultrasound education. Web-based learning is perceived by adult learners as a better strategy of assimilating information, because it can be accessed anytime and anywhere. At the time of global conference an update about...

Postpartum fever and infection remain a significant cause of morbidity in postpartum period. Ultrasound is useful for assessment of the patients who present with temperature elevation, vaginal bleeding, pelvic and/or abdominal pain and signs of infection. Sonography can also be used to detect mastitis and breast abscess. Different types of imaging...

Gestational trophoblastic diseases (GTD) comprise several entities which all arise due to abnormal growth of trophoblastic cells of the placenta. These disease processes range from benign to malignant. GTD are classified as complete hydatidiform mole, partial mole, invasive mole and choriocarcinoma. The imaging of choice for detecting trophoblastic...

Delayed postpartum hemorrhage, defined as bleeding following delivery up to 6 weeks postpartum, is a risk following cesarean or vaginal delivery. Episodes most commonly occur between 8 and 14 days postpartum. Here, we present a case of a 24-year-old woman presenting with delayed postpartum hemorrhage 14 days after delivery, which later proved to be...

Purpose: To assess the association between fetal sex pairing in twin pregnancies and adverse perinatal and infant outcomes. Methods: A retrospective cohort study of 9770 infants from 4885 twin pregnancies delivered in 2007 was conducted with a statewide hospital discharge database for Texas. Log-binomial regression models based on generalized es...

Three-dimensional (3D), two-dimensional (2D) ultrasound and saline infusion sonography (SIS) are beneficial tools in diagnosing congenital uterine anomalies. This article illustrates six various case scenarios based on 3D ultrasound images in order to review the concepts of ultrasound diagnosis of congenital uterine anomalies and apply it to the pr...

New technology in ultrasound imaging is allowing women to view more visually precise images of their fetuses than ever before. Maternal-fetal bonding describes the attachment interaction that forms between a mother and her unborn child. Ultrasound diagnosis modalities including two-dimensional (2D), three-dimensional (3D) and four-dimensional (4D)...

Purpose This study evaluates the accuracy and reliability of off-line volume measurement using virtual organ computer-aided analysis (VOCALTM) and two-dimensional (2D) ultrasound by novices. Methods Thirty medical students, 15 sonographers and three experts were recruited to measure a liver, a gestational sac and a breast cancer lesion using 2D ul...

Over the past few decades, the use of intrauterine devices (IUDs) as long-term contraception has steadily been increasing. Along with the increased use of IUDs, many possible complications have been made apparent. This article presents an overview of normal IUD placement, possible complications and their diagnosis using ultrasound. Ultrasound has e...

We present a 39-year-old G0P0 with history of infertility treatment-caused ovarian hyperstimulation and uterine fibroids, who was found to have a rare pathological presentation. Peritoneal lesions were identified during laparoscopic treatment for this patient's fibroids. Histological evaluation of these lesions revealed leiomyomatosis peritonealis...

To investigate the association between increased yolk sac diameter and abnormal karyotype. Retrospective analysis of 42 patients with no history of diabetes between 6 and 12 weeks of gestation with increased yolk sac diameter measuring ≥6 mm was evaluated by transvaginal ultrasound. Sonographic findings were correlated with karyotype. The Fisher's...

Uterine bleeding is a symptom seen by gynecologists in approximately 70% of their visits with women of peri and postmenopausal age. A common symptom, postmenopausal bleeding sometimes can be indicative of malignant pathology. While traditional diagnosis took place via endometrial biopsy, diagnosis is trending toward the use of ultrasound. Benefits...

In an emergency setting pelvic ultrasound is the tool of choice for the evaluation of the patients presenting with acute pelvic pain. It has a high sensitivity and specificity for detection of pelvic pathology, low cost, widespread availability and lack of ionizing radiation. This article presents a variety of case scenarios regarding the nonpregna...

Abnormal uterine bleeding is defined as any alteration in the volume, pattern or duration of menstrual blood flow. Abnormal uterine bleeding can be due to a number of organic and dysfunctional causes. This article presents different case scenarios of nonpregnant reproductive age patients presenting with abnormal genital tract bleeding. These cases...

Transvaginal sonography is indispensable for monitoring of follicular growth and is used for aspirating the follicular fluid for oocyte retrieval. Its use has improved the accuracy of embryo replacement into the uterus, or via the uterus, into the Fallopian tube and guidance of Fallopian-tube catheterization. Other ultrasonically guided procedures...

Introduction Two percent of all 1st trimester pregnancies in the United States are ectopic. Transvaginal ultrasound is considered the mainstay in diagnosis. Color Doppler ultrasound can prove to be an added helpful modality in identifying ectopic pregnancies. Case report An 18-year-old nulliparous female presented with vaginal bleeding and lower a...

The educational program of the Paul L. Foster School of Medicine in El Paso, Texas integrates the basic and clinical sciences and organizes them according to the organ-system based units. The reproduction unit focuses on human reproduction, pregnancy and illnesses associated with the female genital tract and breast. The sequence of 13 clinical pres...

During the last two decades three-dimensional (3D) ultrasound has become increasingly popular around the world. There have been a great number of research papers studying its feasibility as well as reliability and accuracy. Compared to two-dimensional (2D), 3D ultrasound produces better visualization with minimal probe manipulation. The sonographer...

We report the case of a 39-year-old woman who presented with a pelvic mass extending into the upper abdomen. Transabdominal sonography revealed a complex left adnexal mass. Color Doppler imaging and spectral Doppler analysis showed increased vascularity with low impedance blood flow signals, suggestive of neovascularization. The patient underwent a...

Diagnosis of uterine ectopic pregnancy of interstitial or cervical location poses a challenge to the sonographer to assess the exact locationand determine the best treatment option.In the presented case, gray scale ultrasound raised the suspicion of cornual pregnancy. Color Doppler and Pulsed Doppler waveformanalysis has identified the typical peri...

Adnexal masses have an etiological spectrum ranging from gynecologic to non-gynecologic causes. Because they can be benign or malignant, their evaluation has to include a careful analysis of the patients history, a physical examination, and laboratory and imaging tests. Transvaginal ultrasonography remains the standard for evaluation of adnexal mas...

A fundamental understanding of human embryology is an essential skill for the majority of practicing physicians. However, its perceived difficulty, in context of the constant competition for time needed to learn other basic science disciplines, makes teaching embryology in undergraduate medical education a universal challenge. Sonography is now com...

Although gross anatomical instruction has always been considered a foundation for medical education and practice, curricular changes have altered the manner in which it is taught. The integration of basic biomedical sciences began with the case-western reserve curriculum. Under the leadership of Dr. Henry Mandin, the University of Calgary School of...

At Texas Tech University Health Sciences Center in El Paso we have developed an animal model to study mammary carcinogenesis and neovascularization. Seven-week-old female Sprague Dawley rats are injected with N-methyl-N-nitrosourea (MNU) intraperitoneally at a concentration of 50 mg/kg bodyweight. The rats are palpated twice a week for development...

Paul L Foster School of Medicine is adopting a clinical presentation based curriculum that encompasses an approach of teaching clinical knowledge, medical skills and diagnostic imaging to the first and second year medical students. This approach may help our students to better integrate knowledge they acquire during the first two years of their med...

Physiology ties together many related disciplines including anatomy, histology, biochemistry, and cell biology. Mastering the concepts of physiology is essential to understanding the principles of medicine. Learning physiology requires acquisition of facts, but this alone provides little in the way of useful knowledge. Currently, educators are chal...

Pregnancy is the culmination of many unexplained anatomical, physiological, and biochemical processes. While many aspects of pregnancy remain vague, ultrasound imaging techniques have provided a clearer understanding of many aspects of the process. This has included a more complete description of the ovulation process and implantation of the blasto...

The menstrual cycle is nature's repeating preparation for pregnancy. Each month, the uterine lining develops in anticipation of implantation by a fertilized ovum. If this occurs, hormones from the reproductive organs stabilize the vascular tissue of the endometrium which provides an environment for the developing embryo. If the awaited implantation...

Maternal infections with TORCH group of organisms during pregnancy pose a threat to the fetus in acquisition of congenital abnormalities. Detailed ultrasonographic screening and serological testing provide vital clues to the early diagnosis of these infections in the fetus. We summarize the clinical features associated with TORCH with special empha...

CT of the cadavers and on site 3-D ultrasound imaging significantly increase the amount of visual information and improve students' understanding of anatomy leading to more efficient assimilation of the basic science knowledge. In addition to cadaveric CT and ultrasound imaging, students are provided with normal and abnormal radiographic studies of...

The challenge of integrating basic science and clinical knowledge contents has become an educational imperative at Paul L Foster School of Medicine clinical presentation based curriculum. During the first two years of our curriculum, students are introduced to clinical applications of basic science knowledge. For better understanding and appreciati...

To correlate preoperative ultrasound and color Doppler findings in patients with surgically proven adnexal torsion. A 5-year retrospective study included 36 patients with acute lower abdominal and/or pelvic pain. Twenty-four patients had complete adnexal torsion followed by adnexectomy. Twelve patients with partially twisted adnexa underwent detors...