Life Sciences Commons^™

Examining Addiction Treatment Facilities: An Observational Study From The Perspective Of Medical Students, Holly Hagle, Reshma Patel, Nidhi Patel, Abigail Buckholz

Research Day

At the Institute for Research, Education, and Training in Addictions (IRETA), medical students are selected nationwide to learn about addiction and interact with patients undergoing treatment. It is well known that most medical schools do not provide significant training in addiction, and part of IRETA's goal is to remedy this need. In this study, medical students took observational field notes during site visits to various addiction treatment facilities. The data consisted of a comparison of treatment programs, as well as the results of motivational interviewing of patients. A thematic analysis was then conducted by the three students and the IRETA …

Adenovirus Nephritis In Kidney Transplant Recipients: Clinical Features And Management, Osamuyi Idubor

Research Day

Background: Adenoviruses (AdV) are double-stranded DNA viruses that are well recognized as cause of significant morbidity and allograft dysfunction in transplant recipients. Adenovirus nephritis (AdN) can present with hemorrhagic cystitis or tubulointerstitial nephritis. Histological evaluation demonstrates interstitial inflammation, granulomas. Here we report 8 cases of AdN in kidney transplant recipients and their clinical course, management, and outcomes.

Methods: A retrospective search to identify cases of AdN in renal transplant recipients from 2009-2016 at the Emory Transplant Center.

Results: The diagnosis of AdN was confirmed by immunostaining on kidney transplant. All patients presented with complaints of constitutional symptoms; fever, dysuria, hematuria, …

Assessment Of Appropriate Treatment Of Staphylococcus Aureus Bacteremia, Essie Samuel

Research Day

Background: Staphylococcus aureus (S. aureus) when present within the bloodstream can result in increased rates of morbidity and 30-day all-cause mortality. Previous studies have assessed the significance of Methicillin-susceptible S. aureus (MSSA) and Methicillin-resistant S. aureus (MRSA) bacteremia, where the treatment of choice is a β-lactam (or vancomycin if penicillin-allergic) or vancomycin, respectively. Rapid and appropriate antimicrobial selection is crucial for resolution of symptoms and prevention of relapse. For S.aureus bacteremia (SAB) treatment with systemic antibiotics, a short-course (14 days) can be utilized for uncomplicated cases and for patients with complicated SAB, long-course regimens are recommended at ≥ 4 weeks. …

Delayed Severe Drug Induced Cholestasis After Anabolic Steroids Exposure, Rashed A. Alfarra, Haris Hatic, Kelly M. Adkins, Shashi Poddar

Research Day

Anabolic steroids therapy is linked to a distinctive form of acute cholestasis that generally arises within 1 to 4 months of starting therapy but may be delayed to as long as 6 to 24 months in some reported cases. We are presenting an unusual case where acute cholestasis happened 5 weeks after discontinuing short course (7 days) of anabolic steroids.

A 20-year-old African American male without significant past medical history presented with jaundice, mild nausea and generalized pruritis. He admitted to self-initiation of oral Stanozolol 40 mg daily for 7-days about 5 weeks before his admission. No prior incidence and …

Folate Deficiency In May-Thurner Syndrome, Haris Hatic, Suzanne Wang, Prasad S. Garimella

Research Day

May–Thurner Syndrome (MTS) is a condition defined by an anatomical variant that results in the compression of the left common iliac vein by the right common iliac artery. This case report describes MTS in a Hispanic female with folate deficiency. 44-year-old Nicaraguan female who is a lifelong nonsmoker without any past medical history presented with left leg pain and swelling for seven days. The patient stated that her whole left leg was edematous without erythema. No recent travel, trauma, surgery or immobilization of the lower extremity. Initial vitals on presentation were unremarkable. Physical exam revealed a tender swollen of left …

Implementing A Monitoring Program For Patients On Direct Oral Anticoagulants, Jiehyun Lee, Shally S. Singh, Michael L. Smith

Research Day

Service or Program: The Backus Hospital Medication Management Clinic located in Norwich, CT provides a newly implemented Direct Oral Anticoagulant (DOAC) management service. This service is provided by a clinical pharmacist for patients with non-valvular atrial fibrillation or venous thromboembolism. The clinical pharmacist assists in the initiation, monitors for the efficacy and safety, and provides education on the benefits and risks of DOAC therapy. The clinical pharmacist communicates to the referring physicians on any significant concerns or recommendations with DOAC therapy. Lifestyle, renal function, and other medication use will be evaluated to ensure safety and stability. The referred patients will …

Art, Technology, Medicine: Creativity And Innovation In The Health Sciences, Skye Bickett, Erica Rosalle, Meghan Di Rito

Research Day

Objectives: Our goal was to introduce our community to ways that creative or technological arts intersect with the healing arts. The event brought our community together for fun and stress relief, while teaching about different aspects of medical education, patient education, and therapy.

Methods: Drawing on the expertise of staff outside of the Library allowed us to enrich programming and make it interprofessional. The event had four components: Graphic Medicine, Art and Music Therapy, Gaming Technologies, and Health and Wellness. Each station included an example of the component, description of the modality, and a digital literature list.

Results: We asked …

Using Educational Board Games Adjunct To Traditional Lectures For Pharmacy Students In Learning Infectious Disease, Sirena Hu, Haley Ethredge, Drew Cates, Essie Samuel

Research Day

To determine if the utilization of modified games, such as ID-Candyland and ID-Taboo, are effective methods to reinforce student knowledge gained in traditional infectious diseases (ID) lectures. When confronted with various challenges of learning ID and the associated pharmacotherapy, pharmacy students often have difficulty applying knowledge learned within the traditional lecture setting to clinical practice and real-life situations involving patients. In addition to lectures and reading assignments, the utilization of educational games can extend learning opportunities, reinforce current understanding and promote a fun and competitive environment. Studies have shown that games are a powerful teaching strategy to develop creative learning …

Endovascular Intervention And Management Of Pediatric Mandibular Arteriovenous Malformation: A Case Report, Craig Schreiber, Hamza Shaikh

Research Day

Arteriovenous malformation of the mandible are a rare and potentially life threatening entity. Exsanguination from these lesions is a well documented event. Management of these lesions is unfortunately unclear and unstandardized due to their rare occurrence. Their presentation is wide and varied ranging from complaints of a loose tooth to acute hemorrhage and shock. Currently a multidisciplinary approach that typically involves input from oral maxillofacial surgeons (OMFS), otolaryngologists, and endovascular neurointerventionalists is required to manage these lesions. Often these lesions require both endovascular intervention and surgical resection. Due to the lesions high rate of recurrence and proximity to vital structures, …

Standardizing The Operative Note: A Way To Improve The Quality Of Data Collection To Optimize Patient Care, Kurt Bamberger, Leigh Gerson, James Haran

Research Day

INTRODUCTION: The standard surgical operative note serves an essential role in documenting the details of an operation; however common key details of the operative note are often omitted. This study investigated the effectiveness of implementing a Laparoscopic Cholecystectomy (LC) specific, intraoperative data collection template directly in the electronic health record to be used as an addition to the standard dictated operative note. We hypothesized that intraoperative data collection would lead to a more complete operative report.

METHODS: In this single center study, we retrospectively analyzed 211 operative notes prior to implementing an intraoperative template and 680 operative notes post template …

Filming Trauma Simulations For Medical Education: A Comparison Of First-Person View Vs. Remotely Shot Video, Christopher Capicotto, Memu-Lye Kamara, John Krutsick, Arthur Sesso

Research Day

With advancements in video technology, first-person view places observers in the vantage point of the camera operator. Lightweight wearable products, such as GoPro cameras, are capable of capturing high-resolution footage. In a 3-phase project, first-person view (FPV) footage was compared to remotely-shot video (RSV) of identical trauma scenarios viewed by medical students and residents at PCOM.

Students responded to a trauma simulation by assessing the patient, obtaining a history and stabilizing the patient. This scenario was run once using RSV and again using FPV to capture the encounter. Both formats were screened for medical students in Phase I and Phase …

A Case Series: Pre-Operative Internal Maxillary Artery Embolization Before Temporomandibular Joint Reconstruction, Amber Valeri, Joseph Georges, Carl Bifano, Hayan Dayoub, Hamza Shaikh

Research Day

Introduction: Temporomandibular joint (TMJ) ankylosis is an often-disfiguring pathology causing significant reduction in mandibular mobility leading to disability in mastication, digestion, speech, and oral hygiene. Caused by trauma, radiation, infection, and iatrogenic injury, TMJ ankylosis requires complete excision of the ankylosing mass following by arthroplasty. Substantial hemorrhage during this procedure, up to 3.7L, resulting from injury to the internal maxillary artery (IMA) as it courses around the ankylosing mass may occur. There are few data to recommend pre-operative IMA embolization, though a case series describing two patients who underwent the procedure describes significant decrease in intra-operative blood loss. Our aim …

Population And Needs Assessment Of Migraineurs Treated By Reading Health System, Lauren Chamberlain, Haley Powell, Richard Lukose

Research Day

Introduction: Migraine headaches are a common chronic condition that contributes to a significant amount of disability and economic burden. Through this study, we aim to identify the patient population that is using the Emergency Department (ED) for chronic migraine (CM) treatment within the Reading Health System (RHS).

Research Methods: We conducted congruent and retrospective chart reviews of men, women, and children of all ages presenting to the ED with a severe headache between July 2017 to February 2018. All subjects were asked the same set of standard questions by a single interviewer in person or via telephone.

Results: A total …

Sluggish Cognitive Tempo In Latino Youth, Katie Binns Fabius, Susan Panichelli Mindel

Research Day

Sluggish Cognitive Tempo (SCT) is seen in some children and may include: daydreaming, inconsistent alertness, absentmindedness, behaving or thinking slowly, appearing tired after enough sleep, and lacking energy. The symptoms can be divided into two domains: cognitive and behavioral. SCT is associated with Attention Deficit Hyperactivity Disorder (ADHD). SCT can impact academic and social functioning and be associated with elevated anxiety and depression. Literature on SCT focuses mainly on Caucasian children.

Objectives: To examine the prevalence of SCT and external correlates in a case study of four Latino children.

Methods: A case study where parents completed questionnaires about their child’s …

Bilateral Femoroacetabular Impingement: The Fate Of The Asymptomatic Hip, Ibrahim Azboy, Hasan Huseyin Ceylan, Hamed Vahedi, Hannah Groff, Javad Parvizi

Research Day

Introduction: The objective of this study was to evaluate the incidence of bilateral femoroacetabular impingement (FAI) in a consecutive group of patients and to evaluate the fate of the asymptomatic hip with

FAI.

Method: Between 2004 to 2016, 652 patients presented with hip pain arising from underlying FAI. Diagnosis of FAI was made based on clinical symptoms and imaging. 557 patients (646 hips) were included for the final analysis. Of these, 170 patients had bilateral radiological diagnosis of FAI. Of these, 88 patients presented with bilateral hip symptoms. The remaining 82 patients had unilateral hip symptoms. Of these 82 patients, …

Patient Demographics And Reported Outcomes In Funded Versus Non-Funded Studies Assessing Thromboprophylaxis After Total Joint Arthroplasty: A Systematic Review, Hannah Groff, Ibrahim Azboy, Javad Parvizi

Research Day

Background: There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), which have varying conclusions. The purpose of this study was to investigate if industry funding of the study impacted patient demographics and overall reported outcomes of studies evaluating venous thromboembolism (VTE) prophylaxis after TJA.

Methods: Electronic searches were completed for Ovid, PubMed, and Embase. Studies were included if: (1) published in the English language between 2000 and 2016 (2) including patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) (3) evaluating prevention and control of VTE with at least one thromboprophylactic agent.

Results: There were 57 …

The $94 Billion Problem: Application Of Safe Acid Technology (Sat) To Combat Biofilm Infections, Katherine Mulquin, Benjamin Lam, Christopher Capicotto, Olivia Questore

Research Day

Purpose: Biofilm infections present a major public health threat. In the U.S. alone, biofilm infections are implicated in up to 550,000 yearly fatalities with an estimated annual cost of $94 billion. Biofilm infections are difficult to treat, as biofilm-secreting bacteria are highly resistant to host immune responses. We hypothesize that Safe Acid Technology (SAT), a unique acid formulation, may reduce the risk of biofilm infections while maximizing patient safety.

Methods: SAT anti-biofilm testing was administered by the Montana State University Center for BioFilm Engineering using a single species (Pseudomonas aeruginosa) biofilm grown in the CDC reactor according …

Associations Between First Year Medical Students’ Lifestyles, Resting Blood Pressure, And Resting Ecgs, Christina Spino-Oleck, Bram Sakdiponephong, Karen Davis, Kaela Frizzell, Charlotte H. Greene Phd, Bruce Kornberg

Research Day

Introduction: There is considerable evidence that psychological stressors can impact cardiovascular

health. Medical students experience a high degree of stress based upon their responses to survey questionnaires, although there are few physiological studies that support this association that are targeted specifically to medical students. Medical students in general represent an underrepresented age group in the context of cardiovascular treatment guidelines. Therefore, medical students are a pertinent cohort for study based upon these findings.

Objective:The purpose of this study was to analyze whether medical student lifestyles impact normal baseline cardiovascular measurements of blood pressures and electrocardiograms in this population. …

The Effect Of Caffeic Acid Phenethyl Ester (Cape) On H2o2-Induced Oxidative Stress In Cultured H9c2 Cells Compared To Common Antioxidants, Dylan Lefkowitz, Robinderpal Sandhu, Alisa Kim, Andrew Castellano, Peter Wieczorek, Robert J. Barsotti, Lindon H. Young, Qian Chen

Research Day

Caffeic Acid Phenethyl Ester (CAPE) is a natural compound that has previously exhibited anti-proliferative, anti-inflammation and antioxidant activities. However, CAPE’s effects have not been fully elucidated in myoblasts under oxidative stress. We compared the effects of 24 hour pretreatment of CAPE to several known antioxidants (caffeic acid, vitamin C, and trolox) in H9c2 cells following oxidative injury by hydrogen peroxide (H2O2). H9c2 cells incubated with H2O2 treatment (100-700 μM, n=4) for 24 hours dose-dependently reduced cell viability (assessed by a cell counting assay). Compared to the reduction in viability from H2O2 500 μM treatment (22 ± 4%), H9c2 cell viability …

Efficacy Of The Mnemonic Device “March Paws” As A Checklist For Pararescuemen During Tactical Field Care And Tactical Evacuation, Stephen Rush, John Kosequat, Alex Scott, Isabelle Gallo, Kent Swats, Ian Simonsen

Research Day

Background: The application of TCCC represents evidence-based medicine to improve survival in combat. Over the past several years, USAF Pararescuemen (PJs) have expanded the mnemonic device “MARCH” to “MARCH PAWS” for use during tactical field care and tactical evacuation. It stands for massive bleeding, airway, respiration, circulation, head and hypothermia, pain, antibiotics, wounds, and splinting. We undertook this performance improvement project to determine the efficacy of this device as a treatment checklist.

Methods: The mission reports of a sixteen PJs’ combat rescue deployment to OEF from January through June 2012 were reviewed. The triage category, mechanism of injury, …

Clinical Assessment Of 4th Year Osteopathic Medical Students: Outdoor Medicine Rotation, Erik E. Langenau, Sarah Blazovic, Ashley Cochran, Sarah Corcoran, Elisa Guisto, Austin Sorchik, Cameron Williams

Research Day

Introduction: Securing clinical training sites remains a challenge for medical educators who often resort to paying preceptors or searching for new clinical training sites which haven’t traditionally taken students. We describe a unique partnership between the Boy Scouts of America and PCOM, providing a clinical training opportunity for OMS4 students at PCOM: Outdoor Clinical rotation the Summit Bechtel Family National Boy Scout Reserve in rural West Virginia at the National Scout jamboree, serving 35,000 scouts.

Methods and Curricular Design: By the end of the rotation, each PCOM student was able to (1) provide urgent care for common outdoor injuries: …

Creating A Collaborative Space: Going From Drab To Fab, Pj Grier Jr, Matt Mcnelis

Research Day

In 2017 the PA-PCOM library transformed a space into a dynamic collaborative laboratory, a.k.a. “Collab”. Steps taken to transform space included:

• New mobile furniture
• Installation of 55” touchscreen computer and software
• New painting with accent wall
• Creation of digital user guide and accessory kit

Synergistic Effects Of Methylglyoxal And Hyperglycemia On Ros Generation And The Viability Of Cultured H9c2 Myoblast Cells, Robinderpal Sandhu, Dylan Lefkovitz, Al Ibe, Alisa Kim, Peter Wieczorek, Dean Delgado, Robert J. Barsotti, Lindon H. Young, Qian Chen

Research Day

Heart damage in diabetics may be closely related to the possible synergistic cellular damage from hyperglycemia and increased methylglyoxal levels. This study investigated the effects of glucose and/or methylglyoxal and/or metformin on H9c2 reactive oxygen species (ROS) generation measured by a dichlorofluorescein diacetate (DCFDA) assay and cell viability measured by a cell counting kit-8 assay after various treatments for 24 hours.

Glucose treatment (5 mM-40 mM) displayed similar cell viability (n=4) and ROS generation (n=7) when compared to control cells. By contrast, methylglyoxal (5 µM-1400 µM) decreased cell viability at higher concentration (1000 µM (51 ± 8%); 1200 µM (41 …

Trends In Reconstructive Surgery Following Mastectomy At A Single Institution Between 2011 And 2015, Jessica Barton, Jaclyn Malat, Sergio Perez, Michael T. Brown

Research Day

Current trends show that same-day breast reconstruction after oncologic breast surgery is increasing. Data regarding the factors contributing to this increase in oncoplastic surgery is lacking. We examine the timing and type of reconstructive surgery following mastectomy at Reading Hospital between 2011 and 2015. We hypothesized that the majority of women would choose immediate reconstruction rather than delayed reconstruction following mastectomy and that the number of reconstructive surgeries would increase from 2011 to 2015 correlating with the increase in availability and popularity of oncoplastic breast procedures. This retrospective study looked at a total of 579 patients, 129 of which underwent …

Penoscrotal Transposition: A Cadaveric Review, Paul Lecker, Dominic Parfianowicz, Jayaram Kumaraswamy, Sean Deangelo, Michael Mcguinness

Research Day

Introduction: With only 20 documented cases, the congenital malformation known as complete extreme penoscrotal transposition with an intact scrotum, midline raphe, and absence of hypospadias is an extremely rare abnormality. Penoscrotal transposition occurs when the scrotum fuses above the penis for a complete abnormality or does not fuse at all for an incomplete abnormality. This failure of the scrotum to descend below the penis occurs during development, when the genital swellings fail to descend below the penis and fuse. The irregularity has been known to follow an X-linked recessive pattern in some cases. In others, it results from a …

Evaluating The Neuropsychological Presentation Of Traumatic Brain Injuries, Eric Boxer, Sarah Levin Allen

Research Day

This Neurobehavioral Capstone focused on traumatic brain injury (TBI), which is one of the leading causes of death and disability in the United States for children and young adults. TBI refers to a disruption of the brain’s normal functioning as a result of an acute external force. The most common causes for a TBI include falls, vehicular accidents, struck by or against an object, and assaults. The incidence for each cause of a TBI changes with respect to age. Severity of a TBI is determined using the Glasgow Coma Scale, which monitors the patient’s eye movements, verbal response and motor …

Modulation Of Nitric Oxide Release In Cultured Human Umbilical Vein Endothelial Cells By Myristoylated-Pkc Epsilon Activator/Inhibitor Peptides, George Ajene, Tameka Dean, Chantel Thompson, Wesley Hwang, Francis Jenney, Robert J. Barsotti, Qian Chen, Lindon H. Young

Research Day

Protein kinase C epsilon (PKCε) is known to increase endothelial nitric oxide synthase (eNOS) activity and subsequent nitric oxide (NO) release via phosphorylation at serine 1177 of eNOS in previous in vitro and in vivo animal studies under normoxic conditions. However, the role of PKCε regulating eNOS activity and NO release is not well known in human endothelial cells. Moreover, understanding the role of PKCε in regulating eNOS activity would be essential in the clinical setting of myocardial infarction. Re-establishing blood flow after thrombus removal results in endothelial dysfunction and is characterized by decreased NO bioavailability and excess reactive oxygen …

Bioactive Peptides™ To Aid In Healing Of Chronic Skin Wounds And Tissue Repair, Elizabeth Brehman, Jonathan Mclaughlin, Stephanie Scianni, Charlotte H. Greene Phd, George Petito

Research Day

When wound healing of cutaneous tissue becomes problematic, it increases patient morbidity associated with increased infection, demand on medical resources, and asserts a profound detrimental effect on the individual’s quality of life. Currently, there are limited effective strategies for addressing chronic cutaneous wounds. The study reported here is based upon the understanding that individual skin wounds may preferentially require differing proteinaceous precursors during specific phases of skin wound repair and calls attention to the possibilities in the reexamination of traditional treatments such as plant and animal-derived substances among many others. This study aimed to determine if, and which, amino acid …

Liposclerosing Myxofibrous Tumor Of The Cranial Vault, Jillian Ploof, Hamza Shaikh, Jenny Melli, George Jour, Alan Turtz

Research Day

Background and Importance: Liposclerosing myxofibrous tumor (LSMFT) are rare benign fibro-osseous tumors most frequently occurring in the proximal femur. We report the first case of this rare tumor occurring within the calvarium.

Clinical Presentation: Our patient presented with a 2-year history of enlarging, painless, fixed mass over the left forehead. She underwent surgical resection and the mass was histologically confirmed to be a liposclerosing myxofibrous tumor.

Conclusion: LSMFT is a rare tumor that should remain on the differential for lesions of the calvarium. When diagnosed, this lesion can be removed with the goal of gross total resection and …

Epithelioid Glioblastoma Presenting As Aphasia In A Young Adult With Ovarian Cancer: A Case Report, Megan M. Finneran, Joseph Georges, Michael Kakareka, Ryan Moncman, Miriam Enriquez, Alan Turtz, Steven S. Yocom, H Warren Goldman, James Barresse

Research Day

Background: Epithelioid glioblastoma (eGBM) is a recent addition to the World Health Organization’s classification of central nervous system (CNS) tumors. This rare lesion has a predilection for younger patients, can mimic metastatic disease on preoperative imaging and intraoperative pathology, and portends a poor prognosis due to propensity for leptomeningeal dissemination.

Case Description: We discuss a case of a young woman with a history of ovarian cancer who presented with seizure and a new ring-enhancing left temporal brain lesion. The patient underwent gross-total surgical resection of this lesion, during which frozen section suggested metastasis. However, pathologic interrogation showed pleomorphic epithelioid cells …