Medicine and Health Sciences Commons^™

Socioeconomic Factors Influencing Hematological Health In Latin America, Lina M. Barrios, Ms

Student Papers, Posters & Projects

Hematological malignancies, also known as blood cancers, such as leukemia, lymphomas, and myelomas, are a significant health concern globally. The incidence of these malignancies has dramatically increased over time, leukemias being the leading cause. The incidence of blood cancers in Latin America exhibits regional variability, with leukemia being the emerging cause as the most prevalent type in children and young adults. However, the overall incidences are oddly lower than in developed countries, potentially due to the underreporting of the cases and the lack of cancer registries. This situation implies a critical need for improving surveillance and data collection methods to …

A Rat-Based Preclinical Platform Facilitating Transcatheter Hepatic Arterial Infusion In Immunodeficient Rats With Liver Xenografts Of Patient-Derived Pancreatic Ductal Adenocarcinoma, Masanori Ozaki, Ken Kageyama, Kenjiro Kimura, Shinpei Eguchi, Akira Yamamoto, Ryota Tanaka, Takehito Nota, Hiroki Yonezawa, Hideyuki Nishiofuku, Yuki Sakai, Naoki Tani, Atsushi Jogo, Mizue Terai, Takami Sato, Takeaki Ishizawa, Yukio Miki

Department of Medical Oncology Faculty Papers

Liver metastases from pancreatic ductal adenocarcinoma (PDAC) are highly fatal. A rat-based patient-derived tumor xenograft (PDX) model is available for transcatheter therapy. This study aimed to create an immunodeficient rat model with liver xenografts of patient-derived primary PDAC and evaluate efficacy of hepatic arterial infusion chemotherapy with cisplatin in this model. Three patient-derived PDACs were transplanted into the livers of 21 rats each (totally, 63 rats), randomly assigned into hepatic arterial infusion, systemic venous infusion, and control groups (n = 7 each) four weeks post-implantation. Computed tomography evaluated tumor volumes before and four weeks after treatment. Post-euthanasia, resected tumor specimens …

Accuracy Of Machine Learning To Predict The Outcomes Of Shoulder Arthroplasty: A Systematic Review, Amir H. Karimi, Joshua Langberg, Ajith Malige, Omar Rahman, Joseph A. Abboud, Michael A. Stone

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Artificial intelligence (AI) uses computer systems to simulate cognitive capacities to accomplish goals like problem-solving and decision-making. Machine learning (ML), a branch of AI, makes algorithms find connections between preset variables, thereby producing prediction models. ML can aid shoulder surgeons in determining which patients may be susceptible to worse outcomes and complications following shoulder arthroplasty (SA) and align patient expectations following SA. However, limited literature is available on ML utilization in total shoulder arthroplasty (TSA) and reverse TSA.

METHODS: A systematic literature review in accordance with PRISMA guidelines was performed to identify primary research articles evaluating ML's ability to …

Minimally Invasive Tissue Extraction: Continued Growth Through Simulation For Obgyn Residents, Angela Frankel, Md, Mph, Melanie Hotz, Md, Patrick Teefey, Md

Department of Obstetrics and Gynecology Posters

Background

• Minimally invasive surgery often requires tissue morcellation for extraction of large surgical specimens.¹
• Surgeon comfort with tissue morcellation in gynecologic surgery is vital in providing a minimally invasive (MIS) approach.
• However, OBGYN residents often feel underprepared to perform this skill independently.²
• While practicing tissue morcellation in the OR is ideal, simulation has been shown to improve resident technical skill without risking increased operative time or associated morbidity.³
• This intervention seeks to build upon a prior simulation exercise, with the ultimate goal of improving OB-GYN resident self-reported comfort with minimally invasive tissue extraction.

Addressing Intimate Partner Violence (Ipv) Amongst Pregnant And Postpartum Individuals, Charlette E. Williams, Md, Elizabeth S. Hood, Bs, Julia F. Switzer, Md

Department of Obstetrics and Gynecology Posters

Goals of Project

1. Better recognition of Intimate Partner Violence (IPV) as it relates to our poor maternal morbidity and mortality statistics/outcomes
2. Better trauma-informed education surrounding recognition of red flag signs/symptoms for House Staff/Ob-Gyn rotation students
3. Better paring of patients with resources both in the clinic setting & postpartum

Oncology Treatment Plan Updates In Epic-Beacon, Rose Dimarco, Pharmd, Bcps, Bcop, Gloria Espinosa, Mat, Pharmd, Bcop, Kelly Miskovsky, Pharmd, Bcop, Gina Hemmert, Pharmd

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Background

In Medical Oncology, the utilization of EPIC-Beacon Treatment Plans is integral for prescribing and administering cancer treatments. These treatment plans typically consist of anticancer infusion medications (chemotherapy, immunotherapy, etc.), supportive care medications, required laboratory orders, and other monitoring recommendations to ensure that patients receive safe and effective care. In 2017, TJUH transitioned from Varian’s Aria to EPIC’s electronic medical record system. Since then, there has not been a formal review of existing plans, and there are many inconsistencies between plans in different cancer types.

Problem Statement:

• Currently, there is not a formal process for review of existing treatment plans, …

An Exploratory Study Investigating The Potential Application Of Coping Strategies For Pain Used By Athletes And Their Potential Application To Patients Dealing With Chronic Pain, Joseph D. Harrington, Bs, Erika L. Manning, Phd, Md, Mph, Robert J. Diecidue, Dmd, Md, Mba, Msph

Department of Oral and Maxillofacial Surgery Posters

Abstract

• High-level athletes often have elevated tolerance for experimental pain methods.¹
• Research has not focused on the specific mechanisms behind this.
• The current study was designed to assess the potential role of coping strategies in this elevated pain tolerance - Phase 2 will examine if they can be taught to chronic orofacial pain patients.
• During Phase 1, the Coping Strategies Questionnaire² was modified for athletes and was distributed to 50 athletes to assess how athletes dealt with pain.
• In comparison to TMD patients, more of the athletes reported that they chose to ignore or reinterpret the pain, or …

Improving Behavioral Health Counseling Scheduling Rates On Same Day Of Referral, Benjamin Rogers, Md, Rachel Pallay, Md, Edward Delesky, Md, Meg Broderick, Md, Jade Enright, Md, Eunice Choe, Md

Department of Family & Community Medicine Posters

Background

• Studies suggest 1 in 5 adults in the US suffer from mental illness, with up to 46% of Philadelphia residents reporting poor mental health.
• Care integration beginning with primary care physician evaluation and management is becoming more common.
• Behavioral health counseling (BHC), provided by a primary physician and trained psychologist, is vital in management of mental health conditions.
• Studies suggest same-day scheduling of follow up appointments improves treatment adherence.
• Goal: Improve BHC scheduling rates on same-day of initial referral.

Post-Covid Small Fiber Neuropathy, Implications Of Innate Immunity, And Challenges On Ivig Therapy, Marinos Dalakas

Department of Neurology Faculty Papers

No abstract provided.

Low Absolute Risk Of Thrombotic And Cardiovascular Events In Outpatient Pregnant Women With Covid-19, Behnood Bikdeli, Darsiya Krishnathasan, Candrika Khairani, Antoine Bejjani, Julia Davies, Nicole Porio, Anthony Tristani, Andre Armero, Ali Assi, Victor Nauffal, Umberto Campia, Zaid Almarzooq, Eric Wei, Marcos Ortiz-Rios, Valeria Zuluaga-Sánchez, Aditya Achanta, Sirus Jesudasen, Bruce Tiu, Geno Merli, Orly Leiva, John Fanikos, Elvira Grandone, Aditya Sharma, Samantha Rizzo, Mariana Pfeferman, Ruth Morrison, Alec Vishnevsky, Judith Hsia, Mark Nehler, James Welker, Marc Bonaca, Brett Carroll, Samuel Goldhaber, Zhou Lan, Gregory Piazza

Division of Cardiology Faculty Papers

INTRODUCTION: Pregnancy may contribute to an excess risk of thrombotic or cardiovascular events. COVID-19 increases the risk of these events, although the risk is relatively limited among outpatients. We sought to determine whether outpatient pregnant women with COVID-19 are at a high risk for cardiovascular or thrombotic events.

MATERIALS & METHODS: We analyzed pregnant outpatients with COVID-19 from the multicenter CORONA-VTE-Network registry. The main study outcomes were a composite of adjudicated venous or arterial thrombotic events, and a composite of adjudicated cardiovascular events. Events were assessed 90 days after the COVID-19 diagnosis and reported for non-pregnant women ≤45 years, and …

Expanding The Access To Kidney Transplantation: Strategies For Kidney Transplant Programs, Angie Nishio Lucar, Ankita Patel, Shikha Mehta, Anju Yadav, Mona Doshi, Megan Urbanski, Beatrice Concepcion, Neeraj Singh, M. Lee Sanders, Arpita Basu, Jessica Harding, Ana Rossi, Oluwafisayo Adebiyi, Milagros Samaniego-Picota, Kenneth Woodside, Ronald Parsons

Department of Medicine Faculty Papers

Kidney transplantation is the most successful kidney replacement therapy available, resulting in improved recipient survival and societal cost savings. Yet, nearly 70 years after the first successful kidney transplant, there are still numerous barriers and untapped opportunities that constrain the access to transplant. The literature describing these barriers is extensive, but the practices and processes to solve them are less clear. Solutions must be multidisciplinary and be the product of strong partnerships among patients, their networks, health care providers, and transplant programs. Transparency in the referral, evaluation, and listing process as well as organ selection are paramount to build such …

The American Thoracic Society Research Program: Twenty Years Of Driving Discovery In Respiratory Medicine, Kamran Atabai, M. Safwan Badr, Jack Costello, Karen Ridge, Sharon Rounds, Michelle Turenne, Eric White, Jesse Roman

Division of Pulmonary and Critical Care Medicine Faculty Papers

No abstract provided.

Family Physicians And Menstrual Care: An Analysis Of Cera 2023, Allison Casola, Olivia Rea, Tiffany Ho

Department of Family & Community Medicine Faculty Papers

BACKGROUND: Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations.

OBJECTIVES: We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care.

DESIGN/METHODS: This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included …

Full Issue: Volume 2, Issue 1 - April 2024

Bone Bulletin

i - Editors’ Note by Ari Clements & Amit Syal

ii - Foreword by Dr. Alan Hilibrand

7 - Exploring Approaches to Treatment of Musculoskeletal Injuries by Catherine Alvaro

9 - A Spotlight on the Various Subspecialties of Orthopedic Surgery by Ryan Garemani

14 - Exploring the Importance of Implant Selection in Total Hip Arthroplasty by John Czarnecki

16 - Revolutionizing Orthopaedics: Exploring the Therapeutic Potential of Stem Cells by Harrison Fellheimer

18 - Shoulder Arthroplasty in Patients with Inflammatory Arthritis: Preoperative and Perioperative Management of Disease Modifying Anti-Rheumatic Drug Therapy by Daniel Kwak

22 - The Role of Psychological …

Redefining Recovery: Multimodal Analgesics And Tranexamic Acid In Orthopedic Surgery, Elijah Hoffman

Bone Bulletin

Introduction As the demand for joint replacements continues to rise, optimizing patient outcomes and enhancing recovery have become paramount goals for orthopedic surgeons. Patients used to have minimal mobility following a Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA) due to pain or the effects of sedation from anesthesia. This would lead to longer hospital stays, more complications, and higher opioid use.¹ These surgeries also resulted in levels of blood loss that required transfusion therapy postoperatively.² In recent years, there has been a paradigm shift in postoperative care for total joint arthroplasty (TJA), marked by significant advancements …

A Review Of The Effects Of Early Sport Specialization On The Health Of Adolescent Baseball Players, Robert C. Juniewicz

Bone Bulletin

Introduction

Participation in sports during adolescence is beneficial for participants as it improves fitness, enhances psychosocial development, increases academic performance, and boosts self-esteem.¹ One of the most popular sports among adolescent athletes is baseball, with nearly 500,000 high school players in the United States in 2020.1 While participation in sports has been shown to have clear benefits and has been steadily increasing, recent decades have also seen a dramatic rise in the level of competition.² As a direct result, there has been an increase in the prevalence of early sports specialization (ESS) with an estimated 14-47% of adolescent …

The Ins And Outs Of Wide-Awake Hand Surgery, Molly Milano

Bone Bulletin

Introduction

As the name might imply, “wide awake local anesthesia no tourniquet” (WALANT) is a surgical method to perform hand surgery using only a local anesthetic without the use of a tourniquet or any sedation and general anesthetics. The WALANT technique takes advantage of the vasoconstrictive effects of epinephrine combined with the local anesthetic effects of lidocaine to create a surgical field that does not require a tourniquet or general anesthesia.¹ The main contributor is epinephrine, which decreases bleeding in the surgical field while also lengthening lidocaine’s absorption and effect.² When first introduced to the surgical world, the …

Examining The Role Of Augmented Reality In Total Hip Arthroplasty, Joseph Raphael

Bone Bulletin

Background

In 2023, it was reported that total hip arthroplasty (THA) was the main and effective surgical treatment for advanced hip osteoarthritis, osteonecrosis, and rheumatoid arthritis.¹ As the population ages, the number of annual THA procedures is projected to grow and reach 635,000 by the year 2030.² As such, further improving outcomes in THA will benefit this large population. On average age for individuals who sustain a hip fracture is 80 years old and the lifetime prevalence of hip fractures is 20% in women and 10% in men.³ Fracture reduction and internal fixation or arthroplasty are often …

The Role Of Psychological Readiness In Recovery From Acl Injury In Female Athletes, Samantha Meacock

Bone Bulletin

The Anterior Cruciate Ligament (ACL) injury is common in sports, with female athletes facing a disproportionately higher risk in comparison to male athletes.¹ This susceptibility is the result of a complex relationship between various factors including anatomical, biomechanical, hormonal, neuromuscular, and environmental influences.² In addition, the unique challenges that females face with respect to sports, violence, body image, and family planning create additional stressors that may further contribute to an increased risk for injury.^3,4 Following ACL Reconstruction (ACLR) surgery, these gender discrepancies carry over into recovery as female athletes exhibit decreased rates of return to sport (RTS) …

Shoulder Arthroplasty In Patients With Inflammatory Arthritis: Preoperative And Perioperative Management Of Disease Modifying Anti-Rheumatic Drug Therapy, Daniel Kwak

Bone Bulletin

Introduction

Inflammatory arthritis is a debilitating systemic autoimmune and inflammatory disease that leads to joint damage, resulting in significant pain and disability. Rheumatoid arthritis (RA) is the most common inflammatory arthritis typically associated with advanced arthritic changes of the glenohumeral joint as well as with rotator cuff tears.²⁰ Since the introduction of disease modifying anti-rheumatic drug (DMARD) therapy, patients diagnosed with inflammatory rheumatic diseases have observed improvements in pain management and functional outcomes, alongside a reduction in the occurrence of upper limb arthroplasties.¹⁶ Nonetheless, total joint arthroplasty still remains common in the treatment of RA.^8,14

One recognized …

Revolutionizing Orthopaedics: Exploring The Therapeutic Potential Of Stem Cells, Harrison Fellheimer

Bone Bulletin

The development of stem cells holds the key to a revolutionary era in medicine, unlocking multisystem processes that will help restore normal function in the human body. Stem cells are undifferentiated cells that have the capability to give rise to cells of the same type, and from which new cells can arise through the process of differentiation. Several sources of stem cells can be broadly categorized into three main types: embryonic stem cells (ESC), adult stem cells, and induced pluripotent stem cells (iPSCs).¹

Exploring The Importance Of Implant Selection In Total Hip Arthroplasty, John Czarnecki

Bone Bulletin

Introduction

Total Hip Arthroplasty (THA) is a rapidly growing field within the United States. In 2023 alone, 1,050,821 arthroplasties were performed, making it the second-most performed arthroplasty of the year.1 With over a million of these procedures completed each year, there are several medical device companies that create their own implants to be used in these procedures. Each company can patent their own device and go through a thorough process involving the FDA to receive approval provided there is evidence from clinical trials that demonstrates their device improves patient outcomes.2 With the many implant options available, one question to consider …

A Spotlight On The Various Subspecialties Of Orthopedic Surgery, Ryan Garemani

Bone Bulletin

Introduction

Currently, 60% of orthopedic surgeons are specialists, 25% have specialty interests, and the remaining 15% are generalists.¹ Given the numbers, most orthopedists focus on a specific anatomical area or patient demographic, from delicate nerve work to the larger surgical field encountered in adult reconstruction. This article embarks on a journey through the diverse and impactful world of orthopedic subspecialties, shedding light on the breadth of practice offered.

According to Joseph A. Abboud, MD, a Rothman Orthopedics upper extremity surgeon, residents typically decide on a sub-specialty in their third or fourth year. For medical students, whether captivated by orthopedics …

Exploring Approaches To Treatment Of Musculoskeletal Injuries, Catherine Alvaro

Bone Bulletin

When approaching musculoskeletal injuries, there are many components of the patient assessment that contribute to different treatment options. Interviews with both an orthopedic surgeon and a sports medicine physician revealed similar yet different ways of diagnosing and treating orthopedic conditions.

Foreword, Alan S. Hilibrand

Bone Bulletin

As the Vice Chair of Academic Affairs and Faculty Development and as Director of Undergraduate Medical Education for the Department of Orthopaedic Surgery at the Sidney Kimmel Medical College, I am honored to once again have this opportunity to write a foreword for the second issue of the Bone Bulletin.

For many years, the DePalma Orthopaedic Society has provided medical students at SKMC with an excellent venue to learn about orthopaedic surgery, and its members continue to focus much time and energy on mentoring younger students interested in the field of orthopedic surgery. The DePalma leadership has worked hard …

Editors’ Note, Ari Clements, Amit Syal

Bone Bulletin

This year, we are very excited to announce the second issue of the Bone Bulletin, DePalma Orthopaedic Society’s student-run, non-peer reviewed journal for Sidney Kimmel Medical College (SKMC) students. The journal was initially started to provide another way to become involved with orthopaedics in medical school as well as providing a unique platform to report on diverse aspects of the field through editorial and opinion pieces.

By providing close 1-on-1 mentorship with a Rothman physician, the Bone Bulletin gives students a hands-on opportunity to engage with orthopaedic research and developments. Throughout this journal, you will find a variety of …

Xpo1 Blockade With Kpt-330 Promotes Apoptosis In Cutaneous T-Cell Lymphoma By Activating The P53-P21 And P27 Pathways, Nitin Chakravarti, Amy Boles, Rachel Burzinski, Paola Sindaco, Colleen Isabelle, Kathleen Mcconnell, Anjali Mishra, Pierluigi Porcu

Kimmel Cancer Center Faculty Papers

Dysregulated nuclear-cytoplasmic trafficking has been shown to play a role in oncogenesis in several types of solid tumors and hematological malignancies. Exportin 1 (XPO1) is responsible for the nuclear export of several proteins and RNA species, mainly tumor suppressors. KPT-330, a small molecule inhibitor of XPO1, is approved for treating relapsed multiple myeloma and diffuse large B-cell lymphoma. Cutaneous T-cell lymphoma (CTCL) is an extranodal non-Hodgkin lymphoma with an adverse prognosis and limited treatment options in advanced stages. The effect of therapeutically targeting XPO1 with KPT-330 in CTCL has not been established. We report that XPO1 expression is upregulated in …

Radiomic Biomarkers Of Locoregional Recurrence: Prognostic Insights From Oral Cavity Squamous Cell Carcinoma Preoperative Ct Scans, Xiao Ling, Gregory S. Alexander, Jason Molitoris, Jinhyuk Choi, Lisa Schumaker, Phuoc Tran, Ranee Mehra, Daria Gaykalova, Lei Ren

Department of Radiation Oncology Faculty Papers

INTRODUCTION: This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients.

METHODS: Computed tomography scans were collected from 78 patients with OSCC who underwent surgical treatment at a single medical center. We extracted 1,092 radiomic features from gross tumor volume in each patient's pre-treatment CT. Clinical characteristics were also obtained, including race, sex, age, tobacco and alcohol use, tumor staging, and treatment modality. A feature selection algorithm was used to eliminate the most redundant features, followed by a selection of the best subset of the Logistic regression model (LRM). The …

Predictive And Prognostic Biomarkers And Tumor Antigens For Targeted Therapy In Urothelial Carcinoma, Aditya Eturi, Amman Bhasin, Kevin Zarrabi, William Tester

Department of Medical Oncology Faculty Papers

Urothelial carcinoma (UC) is the fourth most prevalent cancer amongst males worldwide. While patients with non-muscle-invasive disease have a favorable prognosis, 25% of UC patients present with locally advanced disease which is associated with a 10-15% 5-year survival rate and poor overall prognosis. Muscle-invasive bladder cancer (MIBC) is associated with about 50% 5 year survival when treated by radical cystectomy or trimodality therapy; stage IV disease is associated with 10-15% 5 year survival. Current therapeutic modalities for MIBC include neoadjuvant chemotherapy, surgery and/or chemoradiation, although patients with relapsed or refractory disease have a poor prognosis. However, the rapid success of …

Comprehensive Guidance For The Prevention Of Periprosthetic Joint Infection After Total Joint Arthroplasty And Pitfalls In The Prevention, Javad Parvizi, Yonghan Cha, Emanuele Chisari, Kangbaek Kim, Kyung-Hoi Koo

Rothman Institute Faculty Papers

Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged population. Hip and knee are the most common joints, in which TJAs are performed. The TJA prosthesis is composed of metal, plastic, or ceramic device. Even though TJA is the most successful treatment for end-stage osteoarthritis, it is associated with various complications, and periprosthetic joint infection (PJI) is the most serious complication after TJA. With the increasing volume …