Medicine and Health Sciences Commons^™

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, …

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 …

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 …

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 …

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 …

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. …

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 …

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 …

Plastination Procedure @ Pcom: Current Practice And Future Uses, Derek D. Jolley, Vishwant R. Tatagari, Kerin M. Claeson

Research Day

Introduction: Since its invention by German anatomist Gunther von Hagens, the process of forced-impregnation plastination of organic specimens has become the standard for the preservation of biological tissue specimens. This practice serves as the most practical method to preserve these specimens for study and is utilized at PCOM regularly for this purpose. During the steps of plastination, aqueous and lipid tissues are replaced by a curable polymer to produce plastinates that do not decompose, can be handled without gloves, and retain most characteristics of the original specimens. For decades, PCOM used this method to prepare a permanent teaching collection …

A Correlative Blood Assay To Monitor Patients At Risk For Chemotherapy-Induced Peripheral Neuropathy, Angeleah Dadivas, Kinjal Parikh, John Kennedy, Amy Brady, Margaretha Wallon

Research Day

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a disabling side effect of platinum-based chemotherapies like cis-, oxali- and carboplatin. While not all patients experience this effect, those that do are at risk for lifelong neuropathy. Platinum-based therapies cause bursts of reactive oxygen species (ROS), which can trigger structural changes in peripheral nerves including neuronopathy, axonopathy and/or myelinopathy. Glutathione, an antioxidant, plays an important role in redox homeostasis. The recycling of glutathione can be determined by the ChemoTox assay and the aim of this study was to examine its ability to predict CIPN.

Methods: Blood drawn from consented and chemotherapy …

Use Of A Custom Macro In Analysis Of Rat Sciatic Nerve Sections, Daniel R. Whiteman, Peter Tang, Hongkyun Kim, Clifford Voight, Mark C. Miller

Research Day

Introduction: Technology is a powerful analytic tool. This abstract outlines the use of a custom macro to analyze rat sciatic nerve histology sections as part of a larger study to evaluate functional and histologic outcomes after segmental nerve injury. The problem facing analysis of nerve sections is that the microscopic features of a nerve, such as the individual axon, cannot be viewed on the same scale as the entire nerve bundle. The goal of this analysis was to extrapolate the average total values of axon count, axon density, fiber diameter, and myelin thickness on a nerve section image taken at …

Fluorescence-Guided Stereotactic Biopsy: A Proof-Of-Concept Study, Robert Lynagh, Joseph Georges, Mark Ishak, Brandon Boyer, Steven S. Yocom, Denah Appelt

Research Day

Introduction: Histopathological diagnoses are often necessary for treating neuro-oncology patients. However, stereotactic biopsy (STB), a common method for obtaining tissue from deep or eloquent brain regions, fails to yield diagnostic tissue in approximately 10% of cases. This can delay initiation of treatment and may result in further invasive procedures for patients. Here, we evaluate if coupling in vivo optical imaging with a STB system can identify diagnostic tissue at the time of biopsy.

Methods: A minimally invasive fiber optic imaging system was developed by coupling a 0.65mm diameter fiber optic fluorescence microendoscope to a STB system. Human glioma …

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 …

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 …

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 …

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 …

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, …

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 …

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: …

The Role Of Autophagy During Myocardial Ischemia/Reperfusion Injury, Aloysius Ibe, Alisa Kim, Hannah Kim, Marquese Daniels, Lindon H. Young, Robert J. Barsotti, Qian Chen

Research Day

Autophagy is a housekeeping process to remove damaged cytoplasmic constituents. However, a debate persists on whether autophagy is beneficial or detrimental when an ischemic/reperfusion (I/R) insult occurs in the heart. This study tested the effects of autophagy enhancers (e.g. rapamycin and trehalose) and autophagy inhibitor (e.g. 3-methyladenine) on heart function and infarct size after global I (30 minutes) and R (45 minutes) when given prior to ischemia (pre-treatment) or at the beginning of reperfusion (post-treatment). We found that Rapamycin (25nM) pre-treatment and post-treatment significantly restored final left ventricular developed pressure (LVDP) to 75.4±9.1% and 60±5% of initial baseline respectively (both …

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 …

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 …

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. …

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 …

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, …

Neurobehavior In Humans And Its Role In Alzheimer's Disease, Aghilas Belkadi, Sarah Levin Allen

Research Day

In a neurobehavioral lens, a human is defined as the balance of the mind, body, and brain. These systems function on their own and influence each other in a dynamic equilibrium. Interactions between these systems are observed in every aspect of life. A pathological example of this relationship is that depression, a state of mind, can increase the risk of developing cardiovascular diseases. By studying a neurobehavioral model of health, empirical links between psychology and neurobiology can be uncovered. The basis of this capstone is to understand how neurobehavior works in clinical practice. This capstone project involved observation of seniors …

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 …