Medicine and Health Sciences Commons^™

Exuberant Arytenoid Edema Following Gore-Tex Thyroplasty, Mopileola Tomi Adewumi, Eli Bress, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Arytenoid edema is not a well-described complication of thyroplasty. We report a case of exuberant arytenoid edema following thyroplasty in a 33-year-old female. The diagnosis was made post-operative day 1, the patient was immediately started on a 6-day course of methylprednisone with voice rest. The arytenoid edema completely resolved within 1 week.

Fusion Versus Fixation In Complex Comminuted C3-Type Tibial Pilon Fractures: A Systematic Review., Yash P Chaudhry, Efstratios Papadelis, Hunter Hayes, Philip F Stahel, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries.

METHODS: A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH …

Neuron-Specific Imp2 Overexpression By Synapsin Promoter-Driven Aav9: A Tool To Study Its Role In Axon Regeneration., Sarah Blizard, Danielle Park, Natalie O'Toole, Sheeva Norooz, Martin Dela Torre, Young Son, Adam Holstein, Scarlett Austin, Joshua Harman, Samantha Haraszti, Daved Fared, Mei Xu

PCOM Scholarly Papers

Insulin-like growth factor II mRNA-binding protein (IMP) 2 is one of the three homologues (IMP1-3) that belong to a conserved family of mRNA-binding proteins. Its alternative splice product is aberrantly expressed in human hepatocellular carcinoma, and it is therefore identified as HCC. Previous works have indicated that IMP1/ZBP1 (zipcode binding protein) is critical in axon guidance and regeneration by regulating localization and translation of specific mRNAs. However, the role of IMP2 in the nervous system is largely unknown. We used the synapsin promoter-driven adeno-associated viral (AAV) 9 constructs for transgene expression both in vitro and in vivo. These viral vectors …

Application Of Single-Cell Rna Sequencing Technology In Liver Diseases: A Narrative Review., Lian He, Anjing Lu, Lin Qin, Qianru Zhang, Hua Ling, Daopeng Tan, Yuqi He

PCOM Scholarly Papers

Objective: This review aimed to summarize the application of single-cell transcriptome sequencing technology in liver diseases.

Background: The increasing application of single-cell ribonucleic acid (RNA) sequencing (scRNA-seq) in life science and biomedical research has greatly improved our understanding of cellular heterogeneity in immunology, oncology, and developmental biology. scRNA-seq has proven to be a powerful tool for identifying and classifying cell subsets, characterizing rare or small cell subsets and tracking cell differentiation along the dynamic cell stages. Globally, liver disease has high rates of morbidity and mortality, and its exact pathological mechanism remains unclear, current treatment options are limited to clearance …

Pcom Georgia Biomedical Sciences Class Of 2023 Composite Sheet, Philadelphia College Of Osteopathic Medicine

Class Composite Sheets

PCOM Georgia Biomedical Sciences Class of 2023 student portraits, matriculating Fall 2021.

Cartilaginous Choristoma Of The External Auditory Canal., Harleen K Sethi, Melanie Shpigel, Ghiath Alnouri, Jing Zhou, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Cartilaginous choristoma is a rare benign lesion of the external auditory canal, generally found incidentally on physical exam in an asymptomatic patient. Our patient had the largest cartilaginous choristomas described in the literature to date. Additionally, this reviews the nomenclature and differential diagnoses of masses within the external auditory canal.

Mitochondrial Targeted Antioxidants, Mitoquinone And Skq1, Not Vitamin C, Mitigate Doxorubicin-Induced Damage In H9c2 Myoblast: Pretreatment Vs. Co-Treatment, Brian Sacks, Halil Onal, Rose Martorana, Amogh Sehgal, Amanda Harvey, Catherine Wastella, Hafsa Ahmad, Erin Ross, Adona Pjetergjoka, Sachin Prasad, Robert J. Barsotti, Lindon H. Young, Qian Chen

PCOM Scholarly Papers

BACKGROUND: Preconditioning of the heart ameliorates doxorubicin (Dox)-induced cardiotoxicity. We tested whether pretreating cardiomyocytes by mitochondrial-targeted antioxidants, mitoquinone (MitoQ) or SKQ1, would provide better protection against Dox than co-treatment.

METHODS: We investigated the dose-response relationship of MitoQ, SKQ1, and vitamin C on Dox-induced damage on H9c2 cardiomyoblasts when drugs were given concurrently with Dox (e.g., co-treatment) or 24 h prior to Dox (e.g., pretreatment). Moreover, their effects on intracellular and mitochondrial oxidative stress were evaluated by 2,7-dichlorofluorescin diacetate and MitoSOX, respectively.

RESULTS: Dox (0.5-50 μM, n = 6) dose-dependently reduced cell viability. By contrast, co-treatment of MitoQ (0.05-10 μM, n …

Addressing And Inspiring Vaccine Confidence In Black, Indigenous, And People Of Color During The Coronavirus Disease 2019 Pandemic, Jasmine R Marcelin, Talia H Swartz, Fidelia Bernice, Vladimir Berthaud, Robbie Christian, Christopher Da Costa, Nada Fadul, Michelle Floris-Moore, Matifadza Hlatshwayo, Patrik Johansson, Ravina Kullar, Kimberly Manning, Edo-Abasi U. Mcgee, Christopher Medlin, Damani A Piggott, Uzma Syed, Jessica Snowden, Tina Tan, Jacinda C Abdul-Mutakabbir

PCOM Scholarly Papers

During the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed profound health inequities suffered by Black, Indigenous, and People of Color (BIPOC). These manifested as differential access to testing early in the pandemic, rates of severe disease and death 2-3 times higher than white Americans, and, now, significantly lower vaccine uptake compared with their share of the population affected by COVID-19. This article explores the impact of these COVID-19 inequities (and the underlying cause, structural racism) on vaccine acceptance in BIPOC populations, ways to establish trustworthiness of healthcare institutions, increase vaccine access for BIPOC communities, and inspire confidence in COVID-19 …

Hereditary Angioedema., Helen Lesser, Jason E Cohn

Otolaryngology (ENT) Resident Research

A 14-year-old African American female presented to the emergency department with spontaneous, sudden-onset lip swelling for 1 h. On examination, there was significant water-bag edema of the upper lip extending to the philtrum and premaxilla. Nasopharyngeal laryngoscopy revealed a patent airway without edema. She was initiated on intravenous dexamethasone, famotidine, and diphenhydramine, after which her edema improved but did not resolve. She was subsequently transferred to a local pediatric hospital and upon further testing she was found to have a C1 esterase inhibitor de novo gene mutation. Angioedema causes localized, non-pitting edema of the dermis, subcutaneous and submucosal tissue, and …

Reducing Unnecessary Crossmatching For Hip Fracture Patients By Accounting For Preoperative Hemoglobin Concentration, Raj M Amin, Varun Puvanesarajah, Yash P Chaudhry, Matthew J Best, Sandesh S Rao, Steven M Frank, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.

AIM: To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture …

Examining Concurrent Validity Between Comlex-Usa Level 2-Cognitive Evaluation And Comlex-Usa Level 2-Performance Evaluation., Brandon Craig, Xiaolin Wang, Jeanne Sandella, Tsung-Hsun Tsai, David Kuo, Charles Finch

PCOM Scholarly Papers

CONTEXT: The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs.

OBJECTIVES: To explore the concurrent validity of L2-CE with L2-PE. …

Conus Medullaris Termination In Adult Females, Vishwant Tatagari, Elizabeth Brehman, Jacob Newman, Deonnie Huang, Kerin M. Claeson

Research Day

Objective: The primary objective of this study was to determine the termination level of the spinal cord in a sample population of adult female cadavers.

Introduction: The conus medullaris represents the tapered, distal-most end of the spinal cord. It tends to be found somewhere between the L1-L2 lumbar vertebrae and can sometimes be higher or lower. Studies report the conus medullaris can be found anywhere from the lower third of T11 to the upper third of L3 with the average termination point around the lower third of L1. We aim to describe the level of conus medullaris termination in a …

Bleeding After Endoscopic Peg-Tube Removal On Patient Taking Clopidogrel, Sahil Patel, Michael Steinbook

Research Day

A 64-year-old man who is taking Clopidogrel was getting his PEG-tube removed endoscopically. Post-procedure, he started profusely coughing up blood clots. As a result, a repeat esophagogastroduodenoscopy had to be performed and revealed no blood in the esophagus or stomach. Upon further evaluation, the source of his blood clots was an ongoing episode of epistaxis which started following his COVID-19 test via nasopharyngeal swab three days prior. With the increasing need for COVID-19 testing, screening for epistaxis prior to performing out-patient procedures can help differentiate epistaxis from other procedurally-related complications

No Pain No Gain: Student Performance Over Time On The Revised Neurophysiology Of Pain Questionnaire, Ruth Maher, Jeanne P. Welch

Research Day

Purpose/Hypothesis: Core competencies in pain management for pre-licensure health professional education have been established. The purpose of this study was to assess the effect of 10-hours of pain neurophysiology education (PNE) on physical therapy students' understanding of pain and retention of key concepts.

Number of Subjects: Thirty-three second-year physical therapy students.

Materials and Methods: Ten hours of PNE was embedded in a clinical neuroscience course which included a 2-hour lab assignment called “The Matrix”. The content was guided by key principles recommended by the International Association for the study of Pain (IASP). The lab assignment included case studies that required …

Measuring The Effect Of A Resuscitation Academy On Out Of Hospital Cardiac Arrest Resuscitation Rates, Matthew Momjian, Jeffrey Kalczynski, Patrick Lombardi, Justin Canakis, Anna Mereminskaya, Thomas Depietro, Josh Baron

Research Day

According to the American Heart Association (AHA), rates of successful resuscitation after out of hospital cardiac arrest (OHCA) vary across the country. Amongst 132 counties in the United States, the rates of CPR survival to hospital discharge ranges between 3.4%-22.0%, and the rates of CPR survival with functional recovery ranges from 0.8%-20.1%. This large degree of variability between regions has been improved through programs that educate Emergency Medical Service (EMS) departments on ways to improve outcomes through an evidence-based lens. The Medic One EMS department in Seattle and King County, Washington developed a resuscitation academy (RA) that improved cardiac arrest …

Utilization, Utility, And Variability In Usage Of Adjunctive Hyperbaric Oxygen Therapy In Spinal Management: A Review Of The Literature, Kurt Knepley, Jennifer Mao, Patrick Laird, Nicholas Imperato, Asham Khan, Justice Agyei, Tim O'Conner, John Pollina, Jeffrey Mullin

Research Day

The objective of this review was to understand the clinical utilization, utility, and variability in the usage of adjunctive hyperbaric oxygen therapy (HBOT). Surgical site infection is associated with high morbidity and mortality, increased health care expenditure, and decreased quality of life. With the increasing prevalence of adult spinal deformity and spinal fusion surgery, it is imperative to understand the potential benefits of adjunctive treatments. HBOT is a safe and common procedure indicated to treat various medical conditions. We conducted a literature search across 3 databases for English articles published between December 1, 2019 and December 1, 2000. Thirteen studies …

Virtually Building A Community Of Experts In The Medication-Assisted Treatment (Mat) Of Opioid Use Using The Project Echo Model, Matthew Momjian, Justin Canakis, Faraz Yousefian, Hayden Pond, Adrienne White, Gregory Mayer, Alison Essary

Research Day

Purpose: Project Extension for Community Healthcare Outcomes (ECHO) utilizes telemedicine to connect a multidisciplinary team of experts with a network of primary care physicians to enable rapid dissemination of evidence-based guidelines and practices at scale. In this study, the Project ECHO model disseminated the Arizona Pain and Addiction Curriculum to providers in rural Arizona with the goal to educate providers on MAT.

Methods: Participants engaged in biweekly, virtual teleECHO sessions and post-session surveys were used to collect data on provider satisfaction, self-efficacy, knowledge, barriers to change and changes in practice behavior. Results: Between February 2020 – November 2020, the MAT-ECHO …

Clinical Relevance Of Quantifying Pelvic Lymph Nodes For Predicting And Treating Genital Lymphedema, Shelley Dicecco

Research Day

Anatomical research on the pelvic lymph nodes (LN) is inadequate. According to previous research there are between 41-154 LNs in the pelvic region (Inguinals-Lumbar) based on reported mean values across several studies. This range should be considered too large for a surgeon to decide how many LN to remove for diagnosing cancer without causing unnecessary harm or for a lymphedema therapist to explain expectations of involvement or improvement to a person with lymphedema. A more precise understanding of numbers and LN removed can help guide a therapist’s treatment with genital lymphedema. Muscles can assist in pumping fluid from an involved …

Bridging The Gap: The Lived Experience Of Women With Diastasis Recti Abdominis, Jennifer Wiley, Ruth Maher

Research Day

Research on Diastasis recti abdominis (DRA) has primarily focused on diagnostic tools, surgical and conservative treatments. Despite the association of significant physical symptoms and impact on quality of life, evidence is absent regarding knowledge or education provided to women about this condition.

Purpose: This study explored the lived experience of women who either self-identified or were medically diagnosed with DRA. A deeper insight into the experience of women with DRA may serve to enhance the patient-provider interaction during this critical time.

Methods: Qualitative methodology with a basic interpretive approach and purposive sampling was used. Participants shared their experiences through a …

A Short Story - The Effect Of Innovo® Shorts On Pelvic Floor Function, Ruth Maher

Research Day

The silent epidemic of urinary incontinence (UI) is described by the World Health Organization (WHO) as one of the last medical taboos and it interferes with the lives of millions of women. Only 25% of those with UI seek care, and of those, less than half receive treatment. The most common type of UI is stress urinary incontinence (SUI) which affects approximately 40% of community-dwelling women. The International Continence Society defines SUI as the complaint of involuntary leakage of urine on effort or exertion or with sneezing or coughing. This occurs in response to sudden increases in intra-abdominal pressure (IAP) …

Strabismus Decompensation As A Possible Neurological Manifestation Of Covid-19: A Case Report, Tyler Stevens

Research Day

A 27-year-old female presents to the emergency room with acute onset horizontal binocular diplopia and a history of COVID-19 infection two weeks prior. She has a history of longstanding intermittent right esotropia. Before her COVID-19 infection she only had diplopia after extended reading and typically sees clearly. After the infection, she has constant double vision which started acutely and worsened over several hours. Her only other symptom at the time was increased fatigue. During examination of eye tracking, there was a left esotropia when looking left and a right esotropia when looking right. She was discharged with a Medrol Dosepak …

Covid Smell Tracker: A Research-Based Mobile Application To Study Smell Loss In Subjects With Covid-19, John Pueringer, Matthew Brennan, Tory Mcknight, Mindy Rabinowitz, Elina Toskala, Gurston Nyquist, Marc Rosen, Aykut Unsal

Research Day

Introduction: Up to 60% of people infected with SARS-CoV-2 report anosmia or ageusia during their disease course. “COVID Smell Tracker” is a smart phone application (app) developed to elucidate the onset, duration and extent of anosmia and ageusia through questionnaires.

Methods: “COVID Smell Tracker” is publicly available on smart phone devices (www.covidsmelltracker.org). Users complete surveys around demographics, medical history, COVID status and symptomology. Deidentified responses were collated and analyzed using descriptive statistics.

Results: Of the 266 users included, the majority were located in Europe (43%) and North America (33%). Male, Caucasian users were most common (54.9% and 61.7% respectively), followed …

Resveratrol's Effect On The Androgen Receptor Pathway As A Target For Decreasing Growth And Invasion Of Melanoma And Methods Of Application, Anthony Concilla, Tala Mourabet, Natalie Silk, Kyla Geary, Dianzheng Zhang

Research Day

Introduction: Melanoma is predicted to be the fifth most common cause of cancer mortality in the U.S. in 2021. Although melanoma affects both sexes, current literature shows it is more prevalent and more deadly in men. Several potential reasons for this difference have been proposed, but most literature describes a gap in male knowledge concerning skin cancer and unwillingness to go to the dermatologist as an explanation. That said, the androgen receptor has been proven to play a role in melanoma growth and metastasis, and may play a part in the difference in incidence and mortality rates between sexes. Resveratrol, …

Development Of Humanized Mouse Model For Organ Transplantation, Daniel D. Horuzsko, Ashwin Ajith, Laura Mulloy, A. Musa, Valia Bravo-Egana, Imran Gani, Anatolij Horuzsko

Research Day

Purpose of Study: Solid organ transplantation has been a life-saving procedure for thousands of patients worldwide. Recent advances on improving donor-screening diagnostics have aimed at identification of the most compatible donor for the transplant recipient to maximize allograft survival. Current standards of donor selection relies on HLA typing and in vitro mixed lymphocyte reaction (MLR) which do not take into account the in vivo environment and recipient’s adaptive immune response. Humanized mouse models are an appealing alternative that permits personalized investigation of the immunocompatibility of potential donor tissues for the recipient human immune system without putting patients at risk. By …

The Sebaceous Gland - Friend Or Foe?, Gelan Shamloul, Frederick Lombard, Marina D'Angelo, Amor Khachemoune

Research Day

Introduction: Sebaceous glands are sebum-secreting components of pilosebaceous units, that play a key role in eccrine emulsification, the impermeability of skin and hair, cytokine, chemokine, interleukin, pheromone, and fatty acid synthesis, acid mantle formation, and hormone production. Although the sebaceous gland has been heavily investigated, many advances in the physiology and pathology of the sebaceous gland have since been identified.

Objective: The primary objective of this publication was to perform an updated literature review of the embryology, evolution, structure and function, and pathophysiological disorders associated with the sebaceous gland.

Methods: We performed a literature search using PubMed database with keywords …

30-90 Day Benefit Of Using Interreality Care To Reduce Unnecessary Hospital Admissions Among High-Risk Patients, Kaelin Demuth, Julio Llanga, Will Brewster, Michael Shen, Marla Golden

Research Day

Background: Reducing unnecessary hospital admission/ER visits on HMO/MSO/ACO patients is very challenging beyond traditional 30-90 day readmission threshold. Our study focused on expanding an Interreality (On-Site & On-Line) Care (IC) model (EHJ 2018;39:S225) in high-risk patients in an HMO setting.

Methods: IC model was created by integrating: 1. On-Site Care: ARNP & testing at patients’ residency; 2. On-Line Care: 24/7 monitoring & specialty cardiology/pulmonary intervention; and 3. A new high-risk care system with telemedicine, device, monitoring, protocols & management. A group of 57 Medicare Advantage patients with multiple admission/ER visits from 3 different healthcare organizations were referred to a MSO …

Family History Of Acl Tears As Non-Modifiable Risk Factor In Acl Injury, Michael Valenzuela, Robert Roundy, Marshall Williams, Mathew Pombo

Research Day

Background: 100,000-200,000 anterior cruciate ligament (ACL) injuries occur each year in the United States. These injuries result in significant burden to the patient, and predisposition to ACL injuries is often multifactorial. Some researchers have looked into the genetic component to ACL injuries, both at the population and molecular level. We aim to study a large orthopaedic population in order to assess the association between personal and family history of an ACL injury.

Hypothesis/Purpose: We hypothesize that patients with a first-degree relative, who have a history of ACL injury, will have increased odds to sustain an ACL injury themselves.

Study Design: …

The Benefits Of Peer-Lead Mock Focused Exam Workshops, Aarushi Kalra, Steve E. Carter, Andrew J. Manhan, Fahad Marmarchi, John Lee, Ali Moradi

Research Day

Context: Mock examinations are commonplace in many academic settings and are offered as a study aid to students with the hope of lowering stress levels and increasing their preparedness for the actual exam. In contrast, mock exams are rarely offered by faculty in clinical training due to their expense and administrative burden (1). Students taking objective structured clinical examinations, (OSCEs), have been proven to benefit from participating in mock exams (2). However, this is something that has not been explored in the context of the Focused Exam Workshop (FEW). While OSCEs focus solely on biomechanical skills, the FEW allows students …

Inhibiting Ror1 Expression In Androgen-Independent Prostate Cancer Reduces Aggressive Cancer Phenotypes By Modulation Of Akt-Gsk3Ꞵ Pathway, Vignesh Sivaganesh, Nazifa Promi, Salma Maher, Bela Peethambaran

Research Day

Prostate cancer is a disease that has a high prevalence and mortality amongst men. The severity of the cancer is stratified by risk, which is based on the Gleason grade, prostate-specific antigen (PSA) level, and clinical staging. Unlike breast cancer which can be classified into subtypes based on molecular heterogeneity, prostate cancer has no such classification and is treated with observation, prostatectomy, or radiation if local, and non-specific chemotherapy and androgen deprivation therapy (ADT) if metastatic. It is of the utmost importance to investigate molecular targets that can specifically eradicate prostate cancer while retaining the functions of normal tissue. Receptor …

The Mind-Body Connection: Exploring The Defining Characteristics Of Two Aging Phenotypes, Kiyana Harris, Xue-Lian Sun, Mei-Ling Ge, Qian-Li Xue

Research Day

Introduction: Built on the theory of mind-body connection, there has been a growing interest in phenotypes combining physical frailty and cognitive decline. Two examples are motoric cognitive risk syndrome (MCR) and cognitive frailty (CF). MCR, defined by co-presentation of slow gait and subjective cognitive complaint without dementia or mobility disability, is considered a “pre-dementia syndrome.” CF, defined as having both physical frailty and cognitive impairment in the absence of dementia, is posited to be caused by physical frailty. Although both MCR and CF have been associated with dementia risk, the relationship between the two is unknown. We aimed to (1) …