Digital Commons Network^™

Inter-Institutional Analysis Of Skin Of Color Representation In Dermatological Lecture Content At Md And Do Medical Schools, Oluwafunke O. Ogunremi, Blake Fredericksen, John Komas, Sana F. Ismail, Siri Knusten-Larson, Valeriy Kozmenko, Afia Albin

Student Publications

The purpose of this study was to analyze the lecture materials provided in medical schools through a diversity lens. Skin pathologies manifest distinctively on various shades of skin and physicians must be equipped with the proper knowledge to identify and diagnose these conditions accurately and promptly. For most medical students, images in prominent textbooks and lecture slides are their first encounter with disease presentations. Therefore, it is important to analyze the diversity of skin tones in the content that is being delivered. Specifically, the use of images featuring darker skin tones compared to those depicting lighter skin tones. This study …

Merging Adoption Of Natural Climate Solutions In Agriculture With Climatic And Non-Climatic Risks Within An (Intra)Gendered Framework, Kwabena Antwi

Student Publications

The extant research on climate variability shares significant theoretical contributions to vulnerability and risks. However, the literature mostly focuses on technical solutions to climate extremes which undermines efforts to identify and solve the dynamics within gender groups in using agricultural-based natural climate solutions (NCS) to address climatic and non-climatic risks. With this in mind, this study implements both quantitative and qualitative approaches including household surveys, key informant interviews, and focus group discussions to investigate the adoption of NCS within gender groups to address climatic and non-climatic risks in three selected communities (Katanga, Dakio, and Zonno) in the Bolgatanga East District …

Frailty Status, Not Just Age, Is Associated With Postoperative Opioid Consumption: A Retrospective, Population-Based Analysis, Kyle R. Latack, Ryan Howard, Mark C. Bicket, Samantha Cooley, Vidhya Gunaseelan, Michael Englesbe, Jennifer F. Waljee

Student Publications

Objective:
To assess the relationship between postoperative opioid consumption and frailty status.

Background:
Physiologic reserve can be assessed through both chronologic age as well as measures of frailty. Although prior studies suggest that older individuals may require less opioid following surgery, chronologic age, and frailty do not always align, and little is known regarding postoperative opioid consumption patterns by frailty.

Methods:
We conducted a retrospective analysis of opioid-naïve adult patients undergoing common general, vascular, and gynecologic procedures across a statewide quality improvement program from November 6, 2017 to February 28, 2021. Our primary outcome was postoperative patient-reported opioid consumption within …

Drivers Of Perceived Discrimination Among Older Adults In India: An Intersectional Analysis, Jayantika Chakraborty, Sampurna Kundu

Student Publications

Discrimination is harmful action taken against individuals or groups to protect customary relations of power and privilege. Older adults are particularly vulnerable to experiences of discrimination that adversely affect their quality of life. We use data from the Longitudinal Ageing Study of India (LASI; Wave 1; 2017–2018) to examine different contextual forces that shape the experiences of discrimination in older adults in India, specifically gender, caste, and economic condition. We used the theory of intersectionality to hypothesize that economic condition, caste, and gender combine uniquely to engender perceived discrimination in older adults. We first used a concentration index to determine …

The Rise Of The Duodenal Switch: A Narrative Review, Daniel Tomey, Karl Hage, Noura Jawhar, Jamil Danaf, Suraj Puvvadi, Benjamin Clapp, Omar M. Ghanem

Student Publications

Background and Objective: Metabolic and bariatric surgery (MBS) is an excellent therapeutic modality for sustained weight loss management and obesity-related medical conditions resolution. In the current bariatric era, there exists multiple procedures and approaches. Despite sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) being the most commonly performed procedures, the duodenal switch (DS) is a more recent procedure that has shown promising outcomes. DS procedures include the classic biliopancreatic diversion with DS (BPD-DS) and the single anastomosis duodeno-ileostomy with sleeve (SADI-S). DS surgical techniques have been amended multiple times over the last decade in order to obtain optimal patient outcomes. …

Cardiovascular Findings In Klippel-Feil Syndrome: A Systematic Review, Abbigail Niewchas, Salma Alkhatib, Christopher Stewart, Mitchell Fisher, Randall Hansen, Alex Otto, Kent Mcintire, Suporn Sukpraprut-Braaten

Student Publications

Klippel-Feil syndrome (KFS) is a congenital disease defined by an abnormal fusion between cervical vertebrae. Due to the rarity of the disorder, its prevalence, along with its pathogenesis and associated conditions, remains to be clearly defined. The aim of this review is to summarize the findings of all case reports of KFS in PubMed over the last 10 years that describe cardiovascular disease, defects, or abnormalities. A total of 43 articles containing 46 reports were included from the 157 case reports considered. Cases were reviewed for commonality in biological sex and vertebral fusion and level using the Samartzis classification system …

Nivolumab-Induced Immune Mediated Colitis Localized To The Distal Colon: Seven Years Into Therapy, Christian Nassif, Imad I. Nassif, Mouna Todorov

Student Publications

Nivolumab targets programmed cell death protein 1 (PD-1) and is used in cancer treatment by increasing the immune response. It has rarely been associated with immune-mediated colitis (IMC). We present a 66-year-old man with metastatic lung adenocarcinoma, treated with nivolumab for seven years, who developed tenesmus and mucoid bloody diarrhea. Colonoscopy revealed endoscopic and histopathological ulcerative colitis (UC)-like changes, limited to the distal 25cm of the colon. Although nivolumab-induced IMC resembling UC is a known adverse effect, there are very few reports of nivolumab-induced IMC localized to the distal colon and occurring seven years after treatment initiation.

Association Of Coronary Endothelial Function And Angiotensin Receptor Autoantibody With Preeclampsia Among Postpartum Women, Anum S. Minhas, Arthur J. Vaught, Michael Schär, Alborz Soleimani-Fard, Neal Fedarko, Wendy Bennett, Maria Darla Esteban, Sammy Zakaria, Josef Coresh, Allison G. Hays

Student Publications

No abstract provided.

Advancing Understanding Of Dermatological Manifestations In Munchausen Syndrome By Proxy, Kelly M. Frasier, Haily A. Fritts, Vivian Li, Christina Dudzik, Michelle Sobotka, Kathleen Click, Alexandra Loperfito

Student Publications

This comprehensive review critically examines the complex relationship between Munchausen Syndrome by Proxy (MSBP) and its dermatological manifestations, uncovering new insights into the relatively uncharted territory of this psychiatric disorder. By synthesizing existing literature, case studies, and clinical observations, this paper reveals the multifaceted spectrum of dermatological phenomena seen in individuals affected by MSBP, ranging from self-inflicted injuries to entirely fabricated skin conditions. Additionally, we explore the psychological and behavioral mechanisms driving caregivers to induce or stimulate dermatological symptoms, shedding light on underlying psychopathologies, the nuanced dynamics of the caregiver-patient relationship, and patterns of pathological attachment and dependency. This review …

Enhanced Biomechanical Properties Of The Pectineal Ligament Support Its Reliability For Apical Pelvic Organ Prolapse Repair, Micaela Motzko, Makayla M. Swancutt, Edwin Glueck, Brandalynn Holland, Anna Stock, Zubeen Azari, Elif Diricanli, Jennifer F. Dennis, Melissa Zolnierz

Student Publications

Pelvic organ prolapse impacts an increasing number of women in the United States. The standard approach to correcting apical pelvic organ prolapse uses the sacral anterior longitudinal ligament (SALL) to lift the vaginal apex; however, this approach may result in recurrent prolapse. A newer procedure utilizes the pectineal ligament (PL), which may be a more reliable anchor point. This study compares the biomechanical properties of these two ligaments to elucidate which can withstand more stress to provide long-term stability following prolapse. Seventeen formalin-embalmed donors were used (PL: 17 right, 16 left; SALL, 15). The PL was evaluated to better characterize …

Single-Incision Combined Laparoscopic Right Hemicolectomy And Cholecystectomy: A Case Report, Ayub Ansari, Stephanie Yoo, Ali Thahab, Feng Meng Li, Huy T. Nguyen

Student Publications

Minimally invasive surgery has transformed the management of complex procedures, offering reduced postoperative pain, faster recovery time, and improved cosmetic outcomes. Despite the growing use of minimally invasive techniques, literature specifically addressing single-incision laparoscopic surgery (SILS) for combined hemicolectomy and cholecystectomy is limited. This report seeks to fill this gap by detailing the successful management of a patient case through a single-incision combined laparoscopic right hemicolectomy and cholecystectomy. A 66-year-old female was referred to surgical consultation following a routine screening colonoscopy that identified a greater than 5 cm sessile polyp in the ascending colon. A follow-up computed tomography (CT) scan …

Hypoxia-Inducible Factor-1Α Inhibition In Renal Cell Carcinoma, Kinsey Morey, Santosh Nimkar, Samir Dalia

Student Publications

The tumorigenesis of clear cell renal cell carcinoma (ccRCC), an aggressive variant of renal cell carcinoma (RCC), is primarily attributable to the mutational inactivation of the Von Hippel–Lindau (VHL) gene. This mutation causes VHL syndrome, which is associated with tumor growth in various body parts, including the brain, spinal cord, eyes, adrenal glands, pancreas, kidney, and reproductive tract. RCC is the leading cause of death in patients with VHL syndrome. The VHL gene acts as a tumor suppressor that prevents the proliferation of various oncogenes by controlling the hypoxia-inducible factor (HIF). The HIF pathway is directly linked to the control …

A Case Of Desmoplastic Small Round Cell Tumor: Highlighting Diagnostic Challenges And Underscoring The Need For Standardized Treatment Protocols, Sydney Carpenter, Taylor Calicchia, Marcus Yoakam, Brett Dunbar

Student Publications

Desmoplastic small round cell tumor is a rare and aggressive neoplasm, primarily affecting serosal surfaces within the abdomen and pelvic peritoneum in young males. Because of a low reported incidence, underdiagnosis and lack of current treatment guidelines pose a unique challenge for physicians and patients dealing with this disease. Therefore, it is imperative to present new information regarding this disease so that better detection and treatment guidelines can be created. This case report presents a 30-year-old male presenting with vague abdominal symptoms, ultimately diagnosed with desmoplastic small round cell tumor after image-guided biopsy. The ambiguity of initial symptoms highlights the …

Delusive Nature Of Flip-Flop Sign Secondary To Histoplasmosis, Omer Riyadh, Omron Hassan, Yashwanth Yerramalla

Student Publications

Histoplasmosis, caused by Histoplasma capsulatum, often mimics the appearance of lung cancer on fludeoxyglucose (FDG) positron emission tomography (PET) scans. The “flip-flop fungus,” due to its similar presentation on imaging modalities, can lead to false-positive results and unnecessary invasive testing. We present a 46-year-old male patient with a lung nodule and bilateral hilar lymphadenopathy on an FDG-PET scan who initially presented with chest discomfort. Histoplasma infection was confirmed through Grocott's methenamine silver (GMS) stains on bronchoscopy-guided biopsy specimens. An analysis of additional cases from the literature highlighted the diverse clinical presentations and outcomes associated with this condition that may be …

Trends In Reimbursement For All Billable Total Joint Replacement Procedures: An Analysis Of The Medicare Part B Database From 2013-2021, Nithin Gupta, Morgan Turnow, Jagroop Doad, Forrest Dunivin, Emily Sydow, Tyler Williamson, Taylor Manes, Jia Bao Lin, Jignesh Patel

Student Publications

Introduction

Total joint arthroplasty (TJA) remains highly prevalent, nearly rivaling the prevalence of other challenging conditions such as heart failure. Annually, there are over 790,000 total knee replacements and more than 450,000 hip replacements performed in the United States. As the demand for TJAs steadily increases, issues related to access, and quality have become increasingly pronounced. Despite the significant annual rise in volume of surgeries, there exists a notable gap pertaining to the epidemiology and reimbursement rates of TJAs within the United States.

Methods

Publicly available data from the Centers for Medicare & Medicaid Services Database was extracted. The dataset …

Inequities In Air Pollution On Stroke Mortality Among Older Americans: A U.S. Nationwide Analysis, Jean-Luc K. Kabangu, Danny Fowler, Amanda Hernandez, Takara R. Newsome-Cuby, Benson Joseph, John Dugan, Lane Fry, Momodou G. Bah, Sonia V. Eden

Student Publications

Background: Air pollution is a known risk factor for cardiovascular diseases, including stroke. This study examines the impact of county-level air pollution on ischemic and hemorrhagic stroke mortality among U.S. individuals aged 65 and older, emphasizing racial and socioeconomic disparities.

Methods: Using data from the Center for Disease Control (CDC) Interactive Atlas of Heart Disease and Stroke, we analyzed county-level ischemic stroke mortality rates for older residents between 2016 and 2020. The data on air pollution at the county level, specifically particulate matter (PM2.5) levels, were obtained from the CDC. We applied multivariable linear and logistic regression models to examine …

Exploring The Intersection Of Body Dysmorphic Disorder (Bdd) And Dermatological Conditions: A Narrative Review, Vivian Li, Kelly Frasier, Emily Woolhiser, Kathleen Daly, Sara Christoforides, Courtnee Harpine, Karina Stech, Stefany Acosta, Edwin D. Lephart

Student Publications

This narrative literature review examined the intricate relationship between body dysmorphic disorder (BDD) and dermatological conditions, with a brief focus on those characterized by conspicuous skin irregularities such as acne vulgaris, psoriasis, and vitiligo. Highlighting the significant prevalence of BDD among individuals afflicted with dermatological issues, our analysis illuminated the profound psychological repercussions stemming from an exaggerated preoccupation with perceived skin imperfections. Through an exploration of the underlying BDD symptoms, we analyzed the complex dynamics between skin health and mental well-being, emphasizing the disorder's impact on patients' psychological and social functioning. This narrative review further investigated the consequential effects of …

Unraveling The Puzzle: A Case Of Intricate Neurological Presentation Attributable To Hypomagnesemia, Syed H. Hussain, Mohammed Zaidi, Mariam Zaidi, Guy M. Grabau

Student Publications

Hypomagnesemia can occasionally present with severe neurological deficiencies, and it is usually attributed to an underlying renal and/or gastrointestinal pathology. Rarely, patients may present with neurological symptoms in the absence of an obvious cause. Our case highlights the importance of considering hypomagnesemia as a primary cause of those presenting with severe neurological deficits in an intensive care unit setting, as well as the significance of conducting a thorough social and medical history on these patients to elucidate their underlying causes. We discuss the case of a 48-year-old Caucasian male who acutely presented with seizures, tremors, visual hallucinations, diplopia, personality changes, …

A Systematic Review Of Phenibut Withdrawals, Christopher Stewart, Hunter Simonsen, Savitha K. Satyasi, Nauman Ashraf, Suporn Sukpraprut-Braaten

Student Publications

Phenibut is an anxiolytic agent that was originally used as a treatment for anxiety, depression, post-traumatic stress disorder (PTSD), and insomnia. It is a gamma-aminobutyric acid (GABA) mimetic, which stimulates GABA receptors in the brain. This increases the inhibitory effects of GABA leading to a greater chance of a sedative response and risk for abuse. It is not currently registered in Western countries but is easily accessible online as a supplement. This is a systematic review of case reports of phenibut patients with withdrawal symptoms published in the PubMed database between January 2010 and October 2023. Following the inclusion criteria …

Analysis Of Causes For Revision In Unicompartmental Knee Arthroplasty, Sujit Tripathy, Siddharth Satyakam Pradhan, Shahnawaz Khan, Hursch Patel

Student Publications

The study by Zhao et al identifies the factors leading to the failure of unicompartmental knee arthroplasty (UKA) in their patients. These factors include substandard suturing of the wound, the presence of osteophytes and intra-articular loose bodies causing impingement, premature loosening of the tibial component, choosing unsuitable patients for the procedure, dislocation of the movable insert, and damage to the anterior cruciate ligament and medial collateral ligament. The findings suggest that employing the correct surgical techniques and indications is essential for successful outcomes in the UKA.

Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction Or Labral Repair And Patient-Reported Outcomes: A Systematic Review, Nancy Park, Trevan Klug, Seema Patel, Serkan Surucu, Michael S. Lee, Kian Kardestuncer, Mackenzie Norman, Justin Zhu, Nicholas Pettinelli, Maxwell Modrak, Andrew E. Jimenez

Student Publications

Background: Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality.

Purpose/Hypothesis: The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs.

Study Design: Systematic review; Level of evidence, 4.

Methods: A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR …

Rural Adolescent Attitudes And Use Of Helmets While Riding Atvs, Motorcycles And Dirt Bikes, Charles A. Jennissen, Sehansa R. Karunatilaka, Brianna J. Iverson, Devin E. Spolsdoff, Kristel M. Wetjen, Brenda Vergara, Shannon R. Landers, Pam J. Hoogerwerf

Student Publications

Background: Head injuries are the most common cause of death in some motorized vehicles for which helmet use can significantly decrease the risk. Our objective was to determine rural adolescents' attitudes regarding helmets and their use while riding ATVs, motorcycles and dirt bikes.

Methods: A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees were surveyed. After compilation, data were imported into the statistical program, R ( https://www.R-project.org/ ). Descriptive statistics, contingency table, logistic regression and non-parametric alternatives to ANOVA analyses were performed.

Results: 1331 adolescents (13-18 years) participated. One half lived on a farm, …

Geographical Distribution Of Osteopathic Neurosurgery Residents, Ogechukwu Ariwodo, Andrew Greek, Ryan Wong, Vincent S. Alexander, Andrew D. Vogel, Bracken Burns, Kristen Conrad-Schnetz

Student Publications

Introduction: The neurosurgery residency match has grown increasingly competitive, especially for osteopathic (DO) medical students, amidst the transition to a single accreditation system in 2020. This shift required former American Osteopathic Association (AOA) programs to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation, leading to a notable reduction in programs with a history of accepting DO applicants. This study aims to explore both potential geographical trends in residency match among recent DO neurosurgical residents and in the number of DO neurosurgical residents pre- and post-ACGME merger.

Methods: Neurosurgery residency programs during the 2023-2024 academic year were identified, and …

Lumbar Disc Herniation With Radiculopathy: A Comparison Of Nass Guidelines And Chatgpt, Ankur Kayastha, Kirthika Lakshmanan, Michael J. Valentine, Anh Nguyen, Kaushal Dholakia, Daniel Wang

Student Publications

Background:

ChatGPT is an advanced language AI able to generate responses to clinical questions regarding lumbar disc herniation with radiculopathy. Artificial intelligence (AI) tools are increasingly being considered to assist clinicians in decision-making. This study compared ChatGPT-3.5 and ChatGPT-4.0 responses to established NASS clinical guidelines and evaluated concordance.

Methods:

ChatGPT-3.5 and ChatGPT-4.0 were prompted with fifteen questions from The 2012 NASS Clinical Guidelines for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Clinical questions organized into categories were directly entered as unmodified queries into ChatGPT. Language output was assessed by two independent authors on September 26, 2023 based …

Histopathological Evaluation Of Geriatric Ophthalmic Veins: A Cadaveric Study, Farida Mehrhoff, Keanna Theobalt, Alla G. Barry, Robert Hillard

Student Publications

Context: The ophthalmic vein (OV) has become a source of increasing curiosity since many aspects of vascular surgery of the orbit have become feasible. At the same time, histochemical analysis of veins, in general, tends to skip the OV. Moreover, age‑related changes in the OVs remain untouched. Aims: Our research explores features of aging in the OV. Settings and Design: We immunohistochemically evaluated the superior and inferior OVs in 49 orbits of 28 formalin‑embalmed human cadavers (age 77.86 ± 13.38) without visible vascular malformations. Materials and Methods: Specimens were stained by hematoxylin and eosin. Verhoeff, laminin, and CD31 stains were …

Dose-Dependent Cranial Irradiation Associations With Brain Structures And Neuropsychological Outcomes In Children With Posterior Fossa Brain Tumors, Mary Baron Nelson, Sharon O'Neil, Scarlet J. Cho, Sofia Dhanani, Jeffrey Tanedo, Brandon Shin, Jack Rodman, Arthur Olch, Kenneth Wong, Marvin D. Nelson Jr., Jonathan Finlay, Natasha Lepore

Student Publications

Background: Posterior fossa irradiation with or without whole brain irradiation results in high doses of radiation to the thalamus, hippocampus, and putamen, structures critical to cognitive functioning. As a result, children with brain tumors treated with cranial irradiation (CRT) may experience significant cognitive late effects. We sought to determine the effect of radiation to those structures on neuropsychological outcome.

Methods: Forty-seven children with a history of posterior fossa tumor (17 treated with surgery; 11 with surgery and chemotherapy; and 19 with surgery, chemotherapy, and CRT) underwent neuroimaging and neuropsychological assessment at a mean of 4.8 years after treatment, along with …

Calyceal Rupture Secondary To Nephrolithiasis: A Case Report Emphasizing Early Diagnosis And Management, Gabriel Cruz, Daniel T. Jones, Maria Theresa Lugue, Manvir S. Heer, Christopher Pace, Linsey Bui, Scott A. Silver

Student Publications

Calyceal rupture, defined as the extravasation of urine from the renal calyces into the perinephric or paranephric spaces, typically results from increased intrapelvic pressure due to urinary tract obstruction. This condition can lead to the formation of a perinephric urinoma and severe complications, such as infection, abscess formation, and impaired renal function. Timely diagnosis and management are crucial to prevent these adverse outcomes. Calyceal rupture often results from urolithiasis, with other causes including strictures, tumors, and congenital abnormalities. The rupture occurs when intrapelvic pressure exceeds the tensile strength of the calyceal walls, leading to urine leakage and potential inflammation or …

Fruquintinib-Induced Cerebellar Hemorrhage In Left-Sided Descending Metastatic Colorectal Adenocarcinoma: A Case Report And Risk Assessment, Daniel T. Jones, Gabriel Cruz, Maria Theresa Lugue, Manvir S. Heer, Marlai Sai, Christopher Pace, Linsey Bui, Scott A. Silver

Student Publications

Colorectal adenocarcinoma is the most prevalent form of colorectal cancer, representing the majority of cases in the United States. The disease is driven by a series of genetic mutations, including alterations in the adenomatous polyposis coli (APC), Kirsten rat sarcoma viral oncogene homolog G12D (KRAS), human epidermal growth factor receptor 2 immunohistochemistry 3+ (HER-2 IHC3+), checkpoint kinase 2 (CHEK-2) and tumor protein P53 (TP53) genes, which lead to malignant transformation. While the standard treatment for metastatic colorectal cancer (mCRC) typically involves chemotherapy and targeted therapies, many patients experience disease progression, necessitating the exploration of novel treatments. Fruquintinib, a highly selective …

Stone Heart Syndrome: A Curious Case Of Digoxin Toxicity And Calcium Infusion, Guleid Hussein, Peter Krastev, Arvin Junn P. Mallari, Mohamad El Labban, Sumeet Yadav, Mohamed Hassan, Mohamed Warsame, Greta Zoesch, John Trnka, Nikhil Vojjala, Shika M. Jain, Salim Surani, Syed Anjum Khan

Student Publications

Stone heart syndrome has a complex interaction with digoxin toxicity, where, theoretically, the administration of intravenous calcium can worsen a patient's condition. Research on this subject is conflicting, so it is imperative to approach it cautiously.

A Rare Case Report Of Paratesticular Leiomyosarcoma, Santosh Nimkar, Bianca M. Glass, Samir Dalia

Student Publications

A leiomyosarcoma (LMS) is a malignant mesenchymal tumor of soft tissue that rarely presents in the scrotal region. This case report describes a primary paratesticular LMS originating in the dartos layer of the scrotum in a symptomatic 37-year-old male with a history of hypertension, generalized seizure disorder post-excision of meningioma, and an extensive family history of cancer. Primary paratesticular LMSs in the superficial dartos layer are exceedingly rare. Given the rarity of this particular type of LMS, this case report includes a discussion on its prevalence and incidence. The rarity of this tumor also warrants a review of the literature …