Medicine and Health Sciences Commons^™

Endolymphatic Sac Tumor, Tanner P. Lyons, Laura Barry, Robert T Sataloff

Otolaryngology (ENT) Resident Research

Masses occupying the retrolabyrinthine space are uncommon and most often represent paragangliomas, choroid plexus papilloma, endolymphatic sac tumors (ELSTs) or distant metastasis. ELSTs are rare, locally invasive tumors of the inner ear, with less than 300 cases reported in the literature. ELSTs are associated with von-Hippel Lindau (VHL) disease. Patients diagnosed with an ELST should undergo genetic testing for VHL disease, and individuals with confirmed VHL disease should be screened for ELST(s).

Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis As A Possible Side Effect Of Covid-19 Vaccination., Edva Noel, Urmiya Rashid, Rizwan Rabbani, Waqas Ahmad Khan, Yves-Smith Benjamin, Iris Lee

Internal Medicine Resident Research

Vaccination is the principal tool aimed at curbing the COVID-19 pandemic that has, so far, affected tens of millions of individuals in the United States. The two available mRNA vaccines developed by Pfizer-BioNTech and Moderna possess high efficacy in preventing infection and illness severity. However, there are multiple side effects associated with these vaccines, some impacting different organs. Renal pathology is variable, with increasing cases of glomerulonephritis being observed. We report a rare acute kidney injury case due to antineutrophil cytoplasmic autoantibody (ANCA)-mediated glomerulonephritis after administering a second dose of the Pfizer-BioNTech mRNA SARS-CoV-2 vaccine. Aggravation and/or development of autoimmunity …

An Update And Report Failure Of Surgical Syndactyly Repair In Harlequin Ichthyosis., Elias H Kahan, Brian Temple, Logan Carr, Elizabeth Zellner

Plastic Surgery Resident Research

Harlequin ichthyosis (HI) is a rare congenital skin disorder caused by irregular epidermal differentiation. Syndactyly in HI is associated with thick hyperkeratotic skin flexion and angulation deformity of the hand and fingers resulting in limited function of the upper extremity. Traditional syndactyly release is limited as full-thickness skin grafts typically used in reconstruction are composed of diseased skin and require donor sites in a patient predisposed for adverse wound healing. This case report is a follow-up to a previous viewpoint written about digital escharotomies in a newborn with HI and outlines a second and fourth webspace syndactyly release with a …

Oncocytic Papillary Cystadenoma Of The Larynx: A Rare And Masquerading Entity., Samuel Bosco, James Ding, Christopher Fundakowski

Otolaryngology (ENT) Resident Research

We cared for a 59-year-old female smoker who presented with a supraglottic lesion mimicking a laryngeal saccular cyst. The lesion was found to be a oncocytic papillary cystadenoma. This is a rare, benign neoplasm that accounts for 2–4.7% of minor salivary gland neoplasms. Oncocytic papillary cystadenoma of the larynx is even more rare, compromising less than 1% of all benign laryngeal neoplasms. This case highlights the importance of comprehensive differential diagnosis for cystic laryngeal lesions.

Arthroscopic Suprapectoral Biceps Tenodesis: The Best Of Both Worlds, Tyler Pratte, Tyler Smith, Alfonso Arevalo, Joseph Wazen, David Rubenstein

Orthopedic Surgery Resident Research

Biceps tendinopathy and superior labrum anterior posterior lesions are a common source of shoulder pain and disability and can be effectively treated with biceps tenodesis. There are a variety of open and arthroscopic tenodesis techniques, but no one technique has demonstrated superiority. Arthroscopic techniques often disregard the extra-articular portions of the biceps tendon as a potential source of pain. Open techniques address this concern; however, they can be associated with wound complications, increased blood loss, nerve injury, and disruptions to surgical workflow. Here, we describe an all arthroscopic tenodesis technique at the suprapectoral zone of the tendon. This method addresses …

Unsupervised Home Exercises Versus Formal Physical Therapy After Primary Total Hip Arthroplasty: A Systematic Review, Yash P. Chaudhry, Hunter Hayes, Zachary Wells, Efstratios Papadelis, Alfonso Arevalo, Timothy Horan, Harpal S Khanuja, Carl Deirmengian

Orthopedic Surgery Resident Research

Historically, postoperative exercise and physical therapy (PT) have been viewed as crucial to a successful outcome following primary total hip arthroplasty (THA). This systematic review and meta-analysis aimed to assess differences in both short- and long-term objective and self-reported measures between primary THA patients with formal supervised physical therapy versus unsupervised home exercises after discharge. A search was conducted of six electronic databases from inception to December 14, 2020, for randomized controlled trials (RCTs) comparing changes from baseline in lower extremity strength (LES), aerobic capacity, and self-reported physical function and quality of life (QoL) between supervised and unsupervised physical therapy/exercise …

Gunshot Wound To The Chest With Retained Epicardial Bullet., Toba Bolaji, Abuoma C Ekpendu, Frederick Giberson

Transitional Year

Gunshot wounds remain the most common cause of penetrating injuries in children and adolescents and the second leading cause of death among youth in the United States. Penetrating cardiac injuries carry a significantly increased mortality rate. The extent of damage caused depends on the type of firearm, the bullet used, the velocityand the trajectory. Therefore, rapid diagnosis and treatment is of the utmost importance. We report a case of a 19-year-old boy who presented to ouremergency department (ED) after sustaining a gunshot wound (GSW) to the right chest. In the ED, the patient was stabilized and a large hematoma was …

Weight Stability In Adults With Obesity Initiating Medical Marijuana Treatment For Other Medical Conditions, Michelle R. Lent, Meghan Visek, Paulina Syracuse, Karen L Dugosh, David Festinger

PCOM Scholarly Papers

Few studies have evaluated weight change in patients who initiate medical marijuana treatment to address diagnosed health concerns. The objective of this study was to examine whether patients initiating medical marijuana use for a qualifying health condition experienced changes in health and biopsychosocial functioning over time, including weight gain or loss. Specifically, this observational, longitudinal study evaluated changes in the body mass index (BMI) of adults with co-morbid obesity (body mass index [BMI] ≥ 30 kg/m²) and severe obesity (BMI ≥ 40 kg/m2) who were starting medical marijuana treatment for any of the 23 qualifying medical conditions at …

Unresectable Primary Tracheal Synovial Sarcoma, Joann M. Butkus, Mackenzie Kramer, Daniel Eichorn, Ali Raza R. Shaikh, Rajesh R. Patel

Otolaryngology (ENT) Resident Research

Synovial sarcoma (SS) comprises less than 1% of head and neck cancers, and less than five cases of adult primary tracheal SS have been described. This case describes a patient encountered at a community-based academic hospital, and retrospective chart review was performed for data collection. A woman in her forties presented with shortness of breath due to a superior mediastinal mass found to be an unresectable primary tracheal SS. Primary treatment resorted to curative-intent radiation therapy. Subsequent metastasis required systemic chemotherapy with pazopanib. To the best of our knowledge, this is the first reported case of this nature and adds …

Early Colonoscopy In Hospitalized Patients With Acute Lower Gastrointestinal Bleeding: A Nationwide Analysis., Kuldeepsinh P Atodaria, Samyak Dhruv, Joseph M Bruno, Brisha Bhikadiya, Shravya R Ginnaram, Shreeja Shah

Internal Medicine Resident Research

Background: Performing colonoscopy within 24 h of presentation to the hospital is the accepted standard of care for patients with an acute lower gastrointestinal bleed (LGIB). Previous studies have failed to demonstrate the benefit of early colonoscopy (EC) on mortality. In this study, we wanted to see if there was a change in inpatient deaths (primary outcome), length of stay (LOS), and hospitalization charges (TOTCHG) (secondary outcomes) with EC compared to previous studies.

Methods: Adults diagnosed with LGIB were identified using the International Classification of Disease 10th Revision codes from the National Inpatient Sample database for 2016 to 2019. EC …

Laboratory-Reported Normal Value Ranges Should Not Be Used To Diagnose Periprosthetic Joint Infection., Salvador A. Forte, Joseph A. D'Alonzo, Zachary Wells, Brett Levine, Stephen Sizer, Carl Deirmengian

Orthopedic Surgery Resident Research

INTRODUCTION: Clinical laboratories offer several multipurpose tests, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are not intended to diagnose any specific disease but are used by clinicians in multiple fields. The results and laboratory interpretation (normal/abnormal) of these multipurpose tests are based on laboratory-reported normal thresholds, which vary across clinical laboratories. In 2018, the International Consensus Meeting on Musculoskeletal Infection (2018 ICM) provided a gold-standard definition to diagnose periprosthetic joint infection (PJI) which included many multipurpose laboratory tests, along with thresholds optimized to diagnose PJI. The discrepancy between laboratory-reported normal thresholds and 2018 ICM-recommended PJI-optimized …

Systematic Review Of Prevalence, Risk Factors, And Management Of Instability Following Reverse Shoulder Arthroplasty, Jeffrey J. Olson, Michael D. Galetta, Rachel E. Keller, Luke S. Oh, Evan A. O'Donnell

Orthopedic Surgery Resident Research

Background

Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability …

Antiaging Mechanism Of Natural Compounds: Effects On Autophagy And Oxidative Stress., Elizabeth Taylor, Yujin Kim, Kaleb Zhang, Lenne Chau, Bao Chieu Nguyen, Srujana Rayalam, Xinyu Wang

PCOM Scholarly Papers

Aging is a natural biological process that manifests as the progressive loss of function in cells, tissues, and organs. Because mechanisms that are meant to promote cellular longevity tend to decrease in effectiveness with age, it is no surprise that aging presents as a major risk factor for many diseases such as cardiovascular disease, neurodegenerative disorders, cancer, and diabetes. Oxidative stress, an imbalance between the intracellular antioxidant and overproduction of reactive oxygen species, is known to promote the aging process. Autophagy, a major pathway for protein turnover, is considered as one of the hallmarks of aging. Given the progressive physiologic …

The Role Of Bkca Channel Expression And Functional Regulation On The Development Of Pulmonary Hypertension In Type 2 Diabetic Individuals, Tahirah Nimi

PCOM Biomedical Studies Student Scholarship

Human pulmonary artery smooth muscle cells (HPASMC) maintain the vascular tone and exhibit myogenic reactivity in the pulmonary arteries. The BK_Ca channel, being the predominate K⁺ channel within the HPASMC, is important in regulating the pulmonary arterial pressure and because the BK_Ca channel’s activity can be modulated by various molecules, studies have evaluated the role that altered BK_Ca channel expression and function plays in the dysfunction of the HPASMC during type 2 diabetes (T2D). The results from those studies provided a basis for this project. In this study, cell cultures, western blot experiments, and cAMP assays …

Potential Differences In Male Versus Female Lymph Nodes, Vikas Damineni

PCOM Biomedical Studies Student Scholarship

The lymphatic system is one of the latest anatomical organ systems to have been discovered, and as a result, it can be considered the least understood. Limited research exists on the quantitative and qualitative values of lymph nodes. The pelvic and axillary region is anatomically unique for each sex. Observing if this extends to the lymph nodes themselves will create a clearer understanding of the lymphatic system for the medical community. The present study sought to establish potential differences in male and female lymph nodes. Quantitative data of male and female lymph nodes were collected through cadaver dissection. Fifty-three cadavers …

Synthesis And Characterization Of Novel Reformulated Bioactive Paclitaxel Complexes And Considerations For Administration Via Inhalation Method For Targeted Lung Cancer Treatment, Teighlor Nicole Livingston

PCOM Biomedical Studies Student Scholarship

Paclitaxel is a natural plant product derived from bark of the Pacific Yew Tree. The secondary metabolite has been extensively studied and developed as an anticancer agent for the treatment of ovarian, breast, and lung cancer. A significant issue with the drug is its low water solubility⏤ requiring the utilization of drug vehicles for effective drug administration. Two novel paclitaxel-containing drugs, Cu5Fe5PAC and (CUPAC)5GLU12DALB, are synthesized and tested against the National Cancer Institute’s sixty cell line panel for anticancer activity. The drugs are also analyzed using MALDI-TOF-MS, FT-IR, and 1H-NMR. One major concern with paclitaxel is the toxicity associated with …

Associating Infection By Chlamydia Pneumoniae And The Presence Of Amyloid-Β Plaques In The Brains Of Alzheimer’S Disease/Dementia Patients, Paul J. G. Carango

PCOM Biomedical Studies Student Scholarship

Sporadic late-onset AD (LOAD) is the most common form of dementia (Woods et al, 2020). In recent years, significant attention has been given to the role of infection in the pathogenesis of late-onset AD/dementia. The Cpn pathogen has been an organism of particular focus following the seminal study Balin et. al 1998 which found that Cpn DNA was present in 90% of brains from patients diagnosed with LOAD. Subsequent immunohistochemical studies demonstrated that Cpn antigens were present in the frontal and temporal cortices of LOAD brains and that Aβ amyloid plaques found in those regions of the brain co-localize with …

Abdominal Aortic Aneurysm Rupture Presenting With Focal Weakness And Altered Mental Status: A Case Report., Brigid M Garrity, Eric Sugarman, Stephen Pulley

PCOM Scholarly Papers

BACKGROUND: Abdominal aortic aneurysms (AAA) can present asymptomatically and may be found through routine screening or seen incidentally on imaging. Rupture due to weaking of the aortic wall is the main complication of an AAA and leads to approximately 200,000 deaths annually worldwide. Clinically, AAA rupture most frequently presents with abdominal and/or back pain, pulsatile abdominal mass, and hypotension. Here, we present an unusual presentation of embolic cerebrovascular accident associated with an AAA rupture.

CASE PRESENTATION: A 58-year-old African American man transported to the emergency department via ambulance presents with altered mental status and unilateral extremity weakness. The initial presentation …

Development And Evaluation Of A Remote Training Strategy For The Implementation Of Mental Health Evidence-Based Practices In Rural Schools: Pilot Study Protocol., Ricardo Eiraldi, Barry Mccurdy, Muniya S Khanna, Jessica Goldstein, Rachel Comly, Jennifer Francisco, Laura E Rutherford, Tara Wilson, Kathryn Henson, Thomas Farmer, Abbas F Jawad

PCOM Scholarly Papers

BACKGROUND: An increasing number of schools in rural settings are implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. PBIS can be used to provide the framework for the implementation of evidence-based practices (EBPs) to address children's mental health concerns. Given the large service disparities for children in rural areas, offering EBPs through PBIS can improve access and lead to better long-term outcomes. A key challenge is that school personnel need technical assistance in order to implement EBPs with fidelity and clinical effectiveness. Providing ongoing on-site support is not feasible or sustainable in the majority of rural …

Electronic Health Record-Based Recruitment And Retention And Mobile Health App Usage: Multisite Cohort Study., Janelle W Coughlin, Lindsay M Martin, Di Zhao, Attia Goheer, Thomas B Woolf, Katherine Holzhauer, Harold P Lehmann, Michelle R. Lent, Kathleen M Mctigue, Jeanne M Clark, Wendy L Bennett

PCOM Scholarly Papers

BACKGROUND: To address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep.

OBJECTIVE: The aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24.

METHODS: Using an EHR query, adult patients from …

The Phylogeny Of Rays And Skates (Chondrichthyes: Elasmobranchii) Based On Morphological Characters Revisited., Eduardo Villalobos-Segura, Giuseppe Marramà, Giorgio Carnevale, Kerin M. Claeson, Charlie J Underwood, Gavin J P Naylor, Jürgen Kriwet

PCOM Scholarly Papers

Elasmobranchii are relatively well-studied. However, numerous phylogenetic uncertainties about their relationships remain. Here, we revisit the phylogenetic evidence based on a detailed morphological re-evaluation of all the major extant batomorph clades (skates and rays), including several holomorphic fossil taxa from the Palaeozoic, Mesozoic and Cenozoic, and an extensive outgroup sampling, which includes sharks, chimaeras and several other fossil chondrichthyans. The parsimony and maximum-likelihood analyses found more resolved but contrasting topologies, with the Bayesian inference tree neither supporting nor disfavouring any of them. Overall, the analyses result in similar clade compositions and topologies, with the Jurassic batomorphs forming the sister clade …

Identification Of Novel Somatic Fusions Of Erg-Vegfa, Tmprss2-Erg, And Vegfa-Tmprss2 In Prostate Cancer Treated With Anlotinib And Androgen Deprivation Therapy: A Case Report, Qiuli Liu, Shuo Wang, Ze Wang, Peng Tang, Dianzheng Zhang, Weihua Lan, Jun Jiang

PCOM Scholarly Papers

The TMPRSS2-ERG fusion gene has frequently been found in prostate cancer and is associated with malignancy. Identifying novel fusions will help to stratify patients and establish patient-tailored therapies. A 78-year-old man presented to our hospital with severe symptoms of urinary urgency and frequency for 2 years, as well as severe bone pain for 1 year. He was diagnosed with metastatic prostate cancer with a Gleason score of 5 + 5. Three gene fusions, ERG_VEGFA, TMPRSS2_ERG, and VEGFA_TMPRSS2, were identified in the patient's prostate cancer tissue. Notably, administration of the tyrosine kinase inhibitor, anlotinib, in combination with a gonadotropin-releasing hormone agonist …

Clinical Characteristics And Quality Of Life In Adults Initiating Medical Marijuana Treatment, Lydia S. Buonomano, Matthew M. Mitnick, Thomas R. Mccalmont, Paulina Syracuse, Karen L. Dugosh, David S. Festinger, Michelle R. Lent

PCOM Scholarly Papers

Introduction: Despite the rising availability and use of medical marijuana (MM) in the USA, little is known about the demographics, clinical characteristics, or quality of life of MM patients. This study describes the demographic characteristics and health-related quality of life (HRQoL) of MM patients who are initiating treatment in Pennsylvania. Methods: Two-hundred adults naive to MM and referred for any of the 23 state-approved qualifying conditions were recruited at three MM dispensaries in Pennsylvania between September 2020 and March 2021. All participants consented to the study; completed semi-structured interviews that included demographic questionnaires, the Short Form-36 (SF-36), and …

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 …