Medicine and Health Sciences Commons^™

Prognostic Value Of Posterior Tilt Angle In Determining Outcome Of Internal Fixation Of Nondisplaced Femoral Neck Fractures, Christopher Talone, Efstratios Papadelis, Yash Chaudhry, Hunter Hayes, Mitesh P. Shah

Research Day

INTRODUCTION: As the population continues to age there is expected to be an increase in prevalence of femoral neck fractures. The standard tool for guiding treatment decisions in femoral neck fractures is the Garden Classification, which is based around the severity of displacement. Garden I and II fractures display minimal displacement and suggest internal fixation as the preferred surgical option rather than arthroplasty.

Recent literature indicates the rate of revision surgery following internal fixation of Garden I and II fractures is approximately 20%. Originally proposed by Palm et al, Posterior Tilt Angle (PTA) is a radiographic measurement that evaluates the …

Characterizing Prednisone Regimens For Treatment Of Cardiac Sarcoidosis, Sarah Adams, Jonathan Salas, Abhijit Bhattaru, Chaitanya Rojulpote, Paco Bravo

Research Day

INTRODUCTION:

Corticosteroids are the mainstay treatment for cardiac sarcoidosis (CS), which manifests clinically in about 5% of sarcoid patients. Current comparisons of steroid regimens in CS focus on starting dose and rarely describe taper rates or expected cumulative exposure. This study characterizes several prednisone regimens for CS to strengthen frameworks for defining treatment goals.

METHODS:

We queried a registry of 1,403 patients referred to the Hospital of the University of Pennsylvania for positron emission tomography (PET) investigation of CS. We performed chart reviews of 98 patients with myocardial inflammation on initial PET who were treatment naïve, initiated on prednisone for …

Herpes Simplex Encephalitis After Covid-19 Infection, Kurt Knepley, Robert Paschall

Research Day

A gentleman in his 60’s presented to the hospital with dyspnea, fever, and hypoxia. He was diagnosed with Covid-19 pneumonia and treated with BiPAP, oxygen, dexamethasone, enoxaparin, budesonide, and albuterol. His hospital stay lasted 33 days. He was discharged home on oxygen and steroids. He returned to the hospital 3 days later with altered mental status. He was diagnosed with HSV encephalitis and treated with 2 weeks of acyclovir. Although his HSV resolved, he suffered temporal lobe necrosis and lasting neurologic dysfunction.

HSV is the most common cause of encephalitis. HSV encephalitis can occur in a host co-infected with SARS-CoV-2 …

Early Medical Education Exposure To Diversity, Equity, Inclusion, And Justice, Maayra Butt, Natalie Santucci, Kerin M. Claeson

Research Day

INTRODUCTION: The United States currently stands as an epicenter for different identities noting variations across people in ethnicity, religion, gender, and socioeconomic status. Further intersectionality among these identities creates a diverse population of individuals subsequently reflected in the field of healthcare, one of the largest systems that encompass modern society. Medical education plays a notable role in the progression of healthcare as students are the early implementers of future healthcare systems. While it is known that early exposure to cultural humility and diversity allows students to learn and grow as future providers, exposure during professional training is often limited.

OBJECTIVES: …

Paralumbar Compartment Syndrome, A Rare Sequela Of Deadlifting, Mark Lagreca, Anthony Viola, Aakash Patel, Timothy Horan, Thomas Falconiero, Brian Danshaw, Scott Rushton

Research Day

Introduction: Compartment syndrome is a well known phenomenon that is most commonly reported in the extremities. However, paralumbar compartment syndrome is rarely described in available literature. The authors present a case of paralumbar compartment syndrome after high intensity deadlifting.

Methods: The patient is a 53 year old male who was diagnosed with paralumbar compartment syndrome one day after performing high intensity deadlifting and subsequently treated emergently with fasciotomies. The patient’s medical records were thoroughly reviewed at the presenting institution. A complete review of the current literature regarding ‘paralumbar’ or ‘paraspinal’ compartment syndrome was also performed.

Results: The patient’s paralumbar compartment …

Timing And Outcomes Of Hip Fracture Surgery During The Covid-19 Pandemic, Sherrie Wang, Makenzie Chambers, Kelsey Martin, Pietro M. Gentile, Rock Hwang, Rakesh Mashru, Kenneth Graf, Henry Dolch

Research Day

Introduction: The effects of delayed surgical repair for traumatic hip fractures have been widely discussed in the literature, and there exists a strong association between surgical timing and patient outcomes. The COVID-19 pandemic placed a significant burden on health care systems throughout the world, with hospitals reallocating both human and physical resources to care for the critically ill. The purpose of this study is to investigate if the strain placed on hospital systems by COVID-19 and the changes to hospital operational models negatively impacted time to surgery, as well as morbidity and mortality rates of hip fractures.

Methods: A retrospective …

Trends In Patient Outcome Scores In Orthopaedic Oncology: A Systematic Review, David Le, Kelsey Martin, Sean C. Clark, Tae Won B. Kim

Research Day

Introduction: The field of orthopaedic oncology has trailed in defining trends in reported outcome measures (ROMs) over the last decade. Although the Musculoskeletal Tumor Society (MSTS) Score is a well-recognized ROM, new ROMs developed and established in literature have created difficulty in identifying the standard ROM within the field. The aim of our study is to identify trends in the use of ROMs in orthopaedic oncology over time, as well as the frequency and distribution among specific pathologies and orthopaedic journals.

Methods: A systematic review was conducted of all original articles reporting on topics relating to orthopaedic oncology in five …

Implementation Of Robotic Gynecologic Surgery In A Rural Setting: Impact On Presence Of Assistant Surgeon And Route Of Hysterectomy, Alexandra Mcquillen, Natasha Alligood-Percoco, Angela Huggler

Research Day

Objective: Robot-assisted hysterectomy allows the surgeon improved visualization, range of motion, and ergonomics which in some cases may obviate the need for an assistant surgeon. In rural hospitals where physician shortages remain a major barrier to care, reducing the number of surgeons necessary to perform hysterectomy would be of significant consequence. We sought to evaluate the impact of robotic surgery on the need for an assistant surgeon at time of hysterectomy at a rural community hospital.

Methods and Procedures: We performed a retrospective chart review of hysterectomies performed at a rural community hospital by general gynecologists, focusing on the 12-month …

Covid Vaccine Adr Survey, Frederick J. Goldstein, Demetria Ruhl, Hannah Griffiths, Steven Weaner, Rebecca Weaner, Pankhuri Walia, Nathalia Galvis

Research Day

Introduction

This study is designed to analyze experiences of the PCOM Philadelphia community regarding COVID19 vaccination. While previous studies have examined specific adverse reactions to this treatment, the present survey allowed participants to indicate which vaccine they received (Pfizer-BioNTech, Moderna mRNA-1273, or J&J/Janssen) and how many doses, as well as demographic information, underlying health conditions, prior COVID infection and symptoms, and any reaction to the COVID vaccination. Prior COVID infection is taken into consideration in this survey, as previous research has indicated that 70% of people who had not been previously infected reported Pfizer vaccine side effects, while 95% of …

Acrometastasis As A Rare Presentation Of Diffuse Malignancy, Jeremy Reich, Jonathan Boyce, Lee Kripke

Research Day

Cancer metastasis to the bone distal to the knee or elbow, also known as acrometastasis, is a rare but known finding in diffuse malignancy. We report a case of acrometastasis to the left second phalanx in a 70-year-old woman with a history of invasive breast carcinoma that was in remission for four years. On initial encounter in the emergency department, she had pain and swelling over the proximal (PIP) and distal interphalangeal (DIP) joints with a lytic appearance on radiographs. A subsequent Adler PET scan demonstrated previously unknown metastatic disease in the right lower lung, mediastinal and hilar lymph nodes, …

Holmium Laser Unroofing Of Ureterocele And Removal Of Hundreds Of Stones From An Adult Duplicated Kidney: Case Report, Claire Berger, Paul Chialastri, Young Son, Benjamin A. Fink, Mark E. Quiring, Thomas J. Mueller, Robert Barsky

Research Day

Objective:

This case study presents an adult with complete unilateral duplication of the renal collecting system and ureterocele who developed upper pole hydronephrosis secondary to urolithiasis which was ultimately treated with holmium laser ablation.

Case Presentation

A 49-year-old female presented to the emergency department (ED) with left flank pain. Non-contrast computerized tomography (CT) imaging revealed complete duplication of the left renal collecting system with severe upper pole hydronephrosis and multiple urolithiasis measuring approximately 5.9 x 2.2 x 1.7 centimeters (cm) in the left distal ureter. A distal left ureteral 3.3 x 2.3 x 2.3 cm ureterocele was also seen in …

Wernicke Encephalopathy Following Gastric Bypass: A Case Report, Sarah Glisan, Nazim Khan

Research Day

Bariatric surgery is used as a treatment for morbid obesity and often results in rapid weight loss. This procedure has been associated with postoperative nutritional deficiencies. Neurological complications due to nutritional deficiencies include Wernicke encephalopathy, a disorder that affects the central and peripheral nervous system due to thiamine (vitamin B1) deficiency. Wernicke encephalopathy can lead to irreversible consequences if not treated early. Here, we present a case of a 40-year-old woman that developed Wernicke encephalopathy two months after gastric bypass surgery, with additional findings of flat affect and concurrent polyradiculopathy. Her diagnosis was delayed due to unique symptoms and an …

The Effect Of Preoperative Opioid Education On Patient’S Postoperative Opioid Usage Following Hip Arthroscopy: A Randomized, Prospective Trial, Jamie Henzes, Emma E. Johnson, Anya Hall, Joseph Brutico, Donghoon Lee, Shyam Brahmabhatt, Fotios Tjoumakaris, John Salvo

Research Day

Introduction: Over the past twenty years, opioid usage has continued to rise significantly, resulting in what many have termed an “opioid epidemic”. Several studies have noted that patients are routinely over-prescribed opioids following common surgical procedures, resulting in a large number of unused and therefore readily available opioid pills. Additionally, the highest reported age population for illicit drug usage is in individuals ages 20-39 years old, which is the same group that commonly undergoes hip arthroscopy. A previous study in patients undergoing arthroscopic rotator cuff repair demonstrated that patients who received pre-operative opioid education consumed significantly less opioids 3 …

Investigating The Relationship Between Preoperative Laboratory Values And Postoperative Complications In Radical Nephrectomy Patients., Sage Grenz, Benjamin Fink, Emiley O'Pry, Young Son, Thomas Mueller

Research Day

INTRODUCTION: Cancer involving the kidney and/or renal pelvis is one of the more frequent causes of cancer in the United States with a prevalence of more than 10 per 100,000. Radical nephrectomy is a common treatment modality for renal cell carcinoma. In an effort to optimize patient safety, many preoperative parameters are used to evaluate and assess a patient's overall health. These include, but are not limited to, patient comorbidities, tumor anatomy, and standard laboratory values. Unfortunately, the literature surrounding these values, among other preoperative laboratory values, in relation to postoperative surgical outcomes is limited. The purpose of this study …

Barriers To Recruitment For A Thc Study, Fred Goldstein, Devon Player, Joseph Radakovitz, Catherine Linh, Garrett Douglas, Ben Moran, Nathalia Galvis

Research Day

Due to ongoing efforts to increase inclusion of under-represented racial and ethnic minorities in clinical studies, researchers have conducted studies to gain greater understanding as to why members of these groups have had limited enrollment. 1 Previous research indicated a widespread lack of trust in the medical community regarding clinical studies, particularly in populations of color due to knowledge of the Tuskegee study.2 Specifically, to date, there appears to be no investigation which explores reasons for hesitation to volunteer to participate in a study utilizing delta-9-tetrahydrocannabinol (THC) to reduce chronic neuropathic pain. Our PCOM IRB-approved project will attempt to uncover …

Refractory Herpes Virus Pseudotumor In An Immunocompromised Patient, Pavan Patel, Smera Saikumar, David York

Research Day

Background: HSV infections can characteristically present as pseudotumor in patients with uncontrolled HIV infection. Herpes simplex virus type 2 (HSV-2) infection rates range from 60% to 90% in individuals who are co-infected with HIV.

Case Presentation: A 48-year-old patient who presented with large fungating mass near her right inferior vulva with hardness and induration. The mass was 4 cm x 3 cm in size and was excised in the operating room. The pathology was negative for malignancy, however, it showed lymphoplasmacytic proliferation with immunostaining positive for HSV virus.

Conclusion: Any patient that presents with a tumor-like mass in their perineum …

Urothelial Carcinoma Arising Within Bladder Diverticulum Secondary To Benign Prostatic Hyperplasia: Report Of A Cadaveric Case And Review Of Literature, Lan Huynh, Zhi Kuat, Brandon Stevens, Shiv Dhiman, Savita Arya

Research Day

Bladder diverticulum, which can be present in 1% to 10% of the general population, is an outpouching of the bladder urothelium through the muscular bladder wall. The vast majority of bladder diverticula are acquired and occur more commonly in men with neurogenic dysfunction or bladder outlet obstruction. Due to the lack of a muscular layer, bladder diverticulum loses its contractility and ability for effective urine emptying, which increases the risks of chronic inflammation and malignant transformation. Neoplasms arising within diverticula are uncommon, which vary from 0.8% to 13% of vesical diverticulum cases reported and have the potential to invade perivesical …

Case Report: Abdominal Aortic Aneurysm, Aishwarya Reddy, Jeffry Rima, Nick Morey, Jalisa Jones, Connor Lambert, Shiv Dhiman, S Arya

Research Day

Many research studies have demonstrated that age is a primary risk factor for the prevalence of diseases within developed countries, most notably concerning cardiovascular disease, which has been found to be the leading cause of death globally. Among the diseases that fall beneath this umbrella term of cardiovascular disease, aortic aneurysms (AA) and cerebrovascular accident (CVA; i.e. stroke) are two of the more prevalent and well-known diseases that are identified among the elderly population. However, despite the increasing prevalence of both AAs and CVAs within the elderly in tandem with their shared risk factors - hypertension, smoking, hyperlipidemia, etc. - …

A Paraurethral Aggressive (Deep) Angiomyxoma, Smera Saikumar, Pavan Patel, Christian Edwards, Geosette Garcia, Daniel York, Hyder Naqvi

Research Day

Background: Aggressive angiomyxomas (AAs) are rare mesenchymal tumors that are histologically composed of myxoid stroma and vasculature. AAs are typically located in the pelvis and perineum and occur more frequently in females of reproductive age. Although a complete resection of the AA is the definitive cure, it is often difficult to achieve due to a lack of capsule in the tumor.

Case Presentation: In this report, we outline a patient who had a paraurethral tumor for eight months before symptoms were observed. The mass measured 3.55 cm x 2.0 cm x 1.5 cm and was excised in the operating room …

Concurrent Malignant And Benign Nephrosclerosis In An Elderly Cadaver With Previously Diagnosed Cerebral Atherosclerosis, Destiny Sciuva, Jake Winchester, Emon Alavi, Sritha Moram, Dhruvi Patel, Alexander Cohen, Shiv Dhiman, Savita Arya

Research Day

We report histopathological features of concurrent malignant and benign nephrosclerosis in an 83-year-old elderly cadaver. Upon routine dissection in a medical school cadaveric anatomy lab, the abdomen of an 83-year-old female showed contracted and granular bilateral kidneys, with subsequent measurements identifying decreased size. Tissue samples were retrieved from the left anterior descending artery, left ventricle wall, bilateral kidneys and lungs. Histopathology slides were prepared using hematoxylin and eosin (H&E) stains. The samples were retrieved from a female cadaver in the Philadelphia College of Osteopathic Medicine, Georgia Body Donor Program. Histopathological findings in the kidneys included fibrinoid necrosis of arterioles, diffuse …

Racial Discrepancies In Pulse Oximetry Reading And Their Effects On Self-Monitoring Devices Usage And Clinical Decision-Making, Lola Sewo, Anthony Dove, Justice Dove, Dana Marie-Gould, Destandreana Norwood, Laurie'l Latimer, Robert Walker

Research Day

INTRODUCTION: As technology use rises and the use of pulse oximetry data increases, the demand for accurate oxygen saturation (SpO2) readings is paramount to ensure health equity among all populations. Pulse oximetry is a non-invasive tool used to monitor SpO2. Self-monitoring devices, such as SMART devices, allow for portable and cost-effective utilization; therefore, self-monitoring device usage and pulse oximetry data are quickly becoming more available to patients and their providers. Pulse oximetry is a critical component used when evaluating the severity of arterial deoxygenation. Providers often use data from pulse oximetry to determine treatment options. Recent studies have found …

Superficial Ulnar Artery And Its Clinical Significance, Lola Sewo, Maxwell Dacquel, Sumbal Irshad, Vinayak Narayan, Sager Pattani, Shiv Dhiman

Research Day

We present a case with an atypical variation of the ulnar artery discovered while examining a cadaver in our routine Gross Anatomy lab dissection. A superficial ulnar artery was found in a 55-year-old male cadaver originating directly from the brachial artery. This is a rare variation where the route of the ulnar artery runs superficially to the flexor compartment in the forearm. Based on previous cadaver studies, the incidence of such variation in the adult population appears to be approximately 3.75%. Deviations in the ulnar artery can lead to a potential risk of injury to patients during surgery. The superficial …

Gross Anatomy Of Bifid Xiphoid Process, Shahrzad Zamani, Sara Meawad, Tamryn Van Der Horn, Shiv Dhiman

Research Day

Introduction: Xiphoid process is the ossified extension of the lower sternum in the chest midline of human adults. Natural variance in this process results in the less common bifurcated morphology.

Objective: The primary objective of this study was to explore the distribution of the bifid variant. As a secondary objective, we aimed to compare bifurcated Xiphoid processes to other possible variations.

Methods: A case study was designed to explore the distribution of bifid variants in a sample of cadavers (n=30) at a large medical education institution. The dependent variable was binarized (bifid or normal) and univariate analyses were performed based …

Benign Cyst In The Popliteal Fossa: A Cadaveric Case Study, Rachel Sackett, Morgan Ivey, Terrance Orange, Randall Sheffield, Nabeel Siddiqi, Shiv Dhiman, Savita Arya

Research Day

During routine dissection of 10 cadavers that originated from the Body Donor Program at Philadelphia College of Osteopathic Medicine South Georgia, an 82-year-old female with a Baker's cyst anomaly located medially in the right popliteal fossa was encountered. The Baker's cyst contained synovial fluid in a thick bursal covering. This finding is suggestive of pathology in the knee joint, such as arthritis or a tear in cartilage or ligaments. This case study analyzes the Baker's cyst found during dissection and its clinical significance.

Colorectal Metastasis Within An Adult Male Cadaver: Case Report And Review Of Literature, Destandreana Norwood, Dana-Marie Gould, Laurie'l Latimer, Georgina Boateng, Brigitte Cochran, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION:

During a routine lab dissection, lesions were found to be scattered along the mesentery of the colon and small intestines, as well as the abdominal peritoneum. Due to its presentation and histological analysis, a diagnosis of adenocarcinoma was made. Adenocarcinomas are mucus-secreting cells that are found within and near the glands of organ (Nakhaie, Mohsen et al., 2020). One of the most common clinical manifestations of adenocarcinomas is within the colorectal region due to the numerous mucous secreting cells found within these sites. Literature reviews have indicated that different metastasis patterns that can differentiate between adenocarcinomas of various histological …

Hypersensitivity Pneumonitis: A Clinical Case With Rapid Resolution On Imaging, Jordan Erdfrocht, Max Kabolowsky, Lyndsey Nguyen, Alyson Meyer, Christine Sykalo

Research Day

Introduction

Hypersensitivity pneumonitis is a rare interstitial disorder characterized by an immune reaction of the lung parenchyma, usually to a sensitized allergen. Pneumonitis is a common cause of respiratory decline among those with comorbid conditions such as chronic obstructive pulmonary disease and congestive heart failure. The use of corticosteroids in patients with pneumonitis is well documented, but their role in the treatment is not clearly understood.

Case Presentation

Patient is a 58-year-old female with past medical history of polymyalgia rheumatica, osteoporosis, and current smoker who presented with a three day history of progressive shortness of breath, dyspnea on exertion, orthopnea, …

Covid-19 In Children: A Pediatric Case Of Multisystem Inflammatory Syndrome And Shock, Max Kabolowsky, Lyndsey Nguyen, Jen Petar, Ravi Raman

Research Day

Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition characterized by fever, systemic inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C generally occurs 2 to 6 weeks after SARS-CoV-2 infection. The incidence of MIS-C is unknown, although it appears to occur in less than 1 percent of children with confirmed SARS-CoV-2 infection. MIS-C has overlapping clinical features of toxic shock syndrome and Kawasaki disease, although the pathogenesis is unclear. Epidemiologists, researchers, and clinicians are struggling to describe and characterize the disease phenomenon while treating patients at the …

Robotic Versus Laparoscopic Cholecystectomy: A Meta-Analysis, Lana Aleuy, Oluwaferanmi Akande, Aliu Sanni

Research Day

Background: Laparoscopic cholecystectomy (LC) remains the gold standard management of benign gallbladder disease. The adoption of the robotic platform that offers high-resolution 3- dimensional images, dexterity, better range of motion, and precise control in comparison to laparoscopic cholecystectomy (LC) into general practice is still lacking. Recent data on the safety and efficacy of Robotic cholecystectomy (RC) in comparison to LC has not yet been analyzed. The aim of this study is to evaluate the effectiveness and safety of RC compared to LC for gallbladder disease from articles published after 2017.

Methods: A systematic review was conducted using EMBASE, PubMed, and …

Isolation And Recording Of Thalamic Neuronal Activity From Ventral Medial And Ventral Lateral Thalamic Nuclei In Rat, Michael Bien, Halley Fowler, Jessica Hiscox, Anum Ul-Haque, Huo Lu

Research Day

The cerebellum, known for its role in coordination and motor adaptation, is hypothesized to travel through the thalamus in its signaling to and from the cerebral cortex, specifically through the ventral medial (VM) and ventral lateral (VL) thalamic nuclei. The thalamus is located within the diencephalon between the midbrain and cerebral cortex. It is an important relay center between the cerebellum and the motor cortex.

Isolation and recording of electrical activity from neurons in the ventral medial and ventral lateral thalamic nuclei in rats is the first step to study the thalamic response to electrical cerebellar stimulation in future experiments. …

Study Of Soil Lead Levels In Gwinnett County, Jaci Carithers, Alexis Katz, Philipa Wang, Farmaan Judge, Brian Matayoshi

Research Day

INTRODUCTION: The CDC estimates that over half a million US children between ages 1-5 have blood lead levels high enough to damage their health. No level of lead can exist safely in the human body, especially since lead does not aid any of its biological processes and, actually, impedes these processes. Past use of lead paint, leaded gasoline, and manufacturing and disposal procedures in lead-based industries have contributed to lead contamination of soil and water. Now, the risks of lead contaminated soil and produce in urban community gardens pose a new challenge. Saikawa Labs at Emory discovered lead slag in …