Medicine and Health Sciences Commons^™

End Of Life In The Ed – Brain Death And Organ Transplantation, Madison Cohen, Donald Penney

The Journal of Integrated Primary Care

Every year thousands of Americans die awaiting an organ transplant. While our knowledge and experience with organ transplantation has only improved, organ availability continues to be a major issue due to a lack of suitable donor organs. A large population of organ donors are those who have been clinically diagnosed as brain dead. Brain death is defined as the irreversible loss of all brain and brainstem functions. Despite brainstem functions being lost, mechanical ventilation and perfusion techniques allow for proper organ maintenance. This gives brain-dead individuals a unique opportunity to serve as multiple organ donors. However, due to mistrust of …

Perioperative Opioids And Survival Outcomes In Resectable Head And Neck Cancer: A Systematic Review., Eric V Mastrolonardo, Derek S Mann, Harleen K. Sethi, Bo H Yun, Elliott M Sina, Maria Armache, Brooke Worster, Christopher E Fundakowski, Leila J Mady

Otolaryngology (ENT) Resident Research

BACKGROUND: Opioids are a mainstay in pain control for oncologic surgery. The objective of this systematic review is to evaluate the associations of perioperative opioid use with overall survival (OS) and disease-free survival (DFS) in patients with resectable head and neck cancer (HNC).

METHODS: A systematic review of PubMed, SCOPUS, and CINAHL between 2000 and 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating perioperative opioid use for patients with HNC undergoing surgical resection and its association with OS and DFS were included.

RESULTS: Three thousand three hundred seventy-eight studies met initial inclusion …

Age-Related Decline In Hippocampal Tyrosine Phosphatase Ptpro Is A Mechanistic Factor In Chemotherapy-Related Cognitive Impairment., Zhimeng Yao, Hongmei Dong, Jianlin Zhu, Liang Du, Yichen Luo, Qing Liu, Shixin Liu, Yusheng Lin, Lu Wang, Shuhong Wang, Wei Wei, Keke Zhang, Qingjun Huang, Xiaojun Yu, Weijiang Zhao, Haiyun Xu, Xiaofu Qiu, Yunlong Pan, Xingxu Huang, Sai-Ching Jim Yeung, Dianzheng Zhang, Hao Zhang

PCOM Scholarly Papers

Chemotherapy-related cognitive impairment (CRCI) or "chemo brain" is a devastating neurotoxic sequela of cancer-related treatments, especially for the elderly individuals. Here we show that PTPRO, a tyrosine phosphatase, is highly enriched in the hippocampus, and its level is tightly associated with neurocognitive function but declined significantly during aging. To understand the protective role of PTPRO in CRCI, a mouse model was generated by treating Ptpro-/- female mice with doxorubicin (DOX) because Ptpro-/- female mice are more vulnerable to DOX, showing cognitive impairments and neurodegeneration. By analyzing PTPRO substrates that are neurocognition-associated tyrosine kinases, we found that SRC and EPHA4 are …

Republication Of "Uses Of Braces And Orthotics For Conservative Management Of Foot And Ankle Disorders"., Osama Elattar, Tyler Smith, Adam Ferguson, Daniel Farber, Keith Wapner

Orthopedic Surgery Resident Research

Nonsurgical management is almost always considered the first-line treatment for the vast majority of foot and ankle pathologies. Foot orthoses, shoe modifications, and therapeutic footwear are considered essential tools for successful conservative management of different foot and ankle disorders. Orthopedic foot and ankle surgeons should have a meticulous understanding of the lower extremity biomechanics as well as the pathoanatomy and the sequelae of diseases affecting the foot and/or ankle. This is essential to the understanding of the desired effects of the different inserts, orthotics, shoe modifications, or braces that may be prescribed for these conditions. In this article, we will …

Establishment Of A Consensus Protocol To Explore The Brain Pathobiome In Patients With Mild Cognitive Impairment And Alzheimer's Disease: Research Outline And Call For Collaboration., Richard Lathe, Nikki M Schultek, Brian J. Balin, Garth D Ehrlich, Lavinia Alberi Auber, George Perry, Edward B Breitschwerdt, David B Corry, Richard L Doty, Robert A Rissman, Peter L Nara, Ruth Itzhaki, William A Eimer, Rudolph E Tanzi

PCOM Scholarly Papers

Microbial infections of the brain can lead to dementia, and for many decades microbial infections have been implicated in Alzheimer's disease (AD) pathology. However, a causal role for infection in AD remains contentious, and the lack of standardized detection methodologies has led to inconsistent detection/identification of microbes in AD brains. There is a need for a consensus methodology; the Alzheimer's Pathobiome Initiative aims to perform comparative molecular analyses of microbes in post mortem brains versus cerebrospinal fluid, blood, olfactory neuroepithelium, oral/nasopharyngeal tissue, bronchoalveolar, urinary, and gut/stool samples. Diverse extraction methodologies, polymerase chain reaction and sequencing techniques, and bioinformatic tools will …

The Daily Activity Of Patients With Heart Failure During Covid-19 Pandemic., Christine Sykalo, Ugochukwu Egolum, Hua Ling

PCOM Scholarly Papers

BACKGROUND: Sedentary behavior is thought to contribute to worsening heart failure syndromes. Here, we examined whether the shelter-in-place order during the coronavirus disease 2019 (COVID-19) pandemic changed daily activity duration, which was monitored by an implantable cardiac device-based multisensor index and alert algorithm called HeartLogic.

METHODS: We performed a retrospective review of the HeartLogic data from patients with heart failure managed at our clinic and compared the individual daily activity duration 90 days prior to vs. after implementation of the shelter-in-place order. The activity data were prepared by Boston Scientific. Demographic data were extracted from our electronic medical record.

RESULTS: …

Commencement, South Georgia (2023), Philadelphia College Of Osteopathic Medicine

Commencements

South Georgia Campus Commencement Program, 2023. Degrees include Doctor of Osteopathic Medicine and Master of Science in Biomedical Sciences.

Commencement Speaker: Jim Matney, Colquitt Regional Medical Center

Commencement, Georgia (2023), Philadelphia College Of Osteopathic Medicine

Commencements

Georgia Campus Commencement Program, 2023. Degrees include Doctor of Osteopathic Medicine, Doctor of Pharmacy, Doctor of Physical Therapy, Master of Science in Biomedical Sciences, Master of Science in Medical Laboratory Science, and Master of Science in Health Sciences - Physician Assistant Studies.

Commencement Speaker: Julie Ginn Moretz, Augusta University Health System

Commencement, Philadelphia (2023), Philadelphia College Of Osteopathic Medicine

Commencements

Philadelphia Campus Commencement Program, 2023. Degrees include Doctor of Osteopathic Medicine, Doctor of Philosophy in Educational Psychology, Doctor of Psychology in Clinical Psychology, Doctor of Psychology in School Psychology, Educational Specialist in School Psychology, Master of Science in Applied Behavioral Analysis, Master of Science in Applied Positive Psychology, Master of Science in Biomedical Sciences, Master of Science in Forensic Medicine, Master of Science in Mental Health Counseling, Master of Science in Organizational Development and Leadership, Master of Science in Health Sciences - Physician Assistant Studies, Master of Science in Public Health Management and Administration, and Master of Science in School …

An Investigation Of Oral Sex As A Risk Factor For Recurrent Vaginitis: A Case Study, Humza M. Baig, Kate B. Barker, Joy Zarandy

Research Day

Background:

Recurrent Vaginitis is defined as having three or more confirmed episodes within a year. Recurrence rates of vaginitis have been reported in up to 60% of previously infected women. The most common bacterial cause is due to Gardnerella vaginalis, while Candida albicans is the most common fungal cause; both microorganisms can cause opportunistic infections when imbalances occur in the vaginal environment. Commonly known risk factors include multiple sex partners, unprotected sex, douching, recent antibiotic use, and estrogen therapy.

Case Presentation:

A healthy 34-year-old female is complaining of recurrent episodes of vaginitis since the birth of her son two years …

End Of Life In The Ed – Brain Death And Organ Transplantation, Madison Cohen, Robert Griffin, Donald Penney

Research Day

Brain death is defined as the irreversible loss of all brain and brainstem functions. While the criteria for diagnosing brain death have been established and refined since 1995, physicians remain uncomfortable with making the diagnosis leading to delays in pronouncing the patient as brain dead. While seemingly benign, a delay in pronouncing a patient as brain dead can place a financial burden on the family and cause additional and unnecessary emotional distress. Furthermore, delayed pronunciation of death causes improper delegation of the medical care team's resources and loss of the patient's potential to serve as an organ donor. The purpose …

A Headfirst Approach – Concussion Management And Novel Diagnostic Testing, Madison Cohen, Kevin Wang, Julienne Ryland, Donald Penney

Research Day

INTRODUCTION: The incidence of concussions has become increasingly prevalent across a multitude of sports. Despite this, the current guidelines for concussion management are not well defined, which creates a significant barrier to proper evaluation and care.

OBJECTIVES: This manuscript was designed to help physicians, athletic trainers, coaches, and parents understand the clinical signs of concussion and management from the moment of injury to the athlete’s return to play. Additionally, we reviewed post-concussion sequelae and their incidence following concussion management.

METHODS: In order to better define the current approach to the management of sports-related concussions we completed a comprehensive literature review …

Silicone Stenting For Chronic Ureteral Obstruction Improves Stent Exchange Frequency, Bebe Eke, Noah Canvasser

Research Day

Introduction and Objective

Chronic ureter stenting is recommended for patients with malignant ureteral obstruction, or with benign ureteral obstruction that cannot tolerate or do not want definitive surgical management. Stents are exchanged at time intervals often limited by stent encrustation. Prior in vitro studies have demonstrated that silicone stents have less encrustation. Our objective was to compare patients undergoing chronic exchanges with polymer-based and silicone stents.

Methods

This IRB-approved retrospective study included all adult patients who underwent chronic ureter stent exchange from August 2017 through August 2022. Patients were stented with either a Boston Scientific PercuflexTM Plus or a Cook …

A Nine-Year Longitudinal Case Study Of A 27-Year-Old Male With Neurocysticercosis Presenting With New Onset Seizures, Ciara Doyle, Veronica Thompson, Amanda Ho, Joy Zarandy

Research Day

Background:

Taenia solium is a cestode endemic to regions of Latin America, Asia, sub-Saharan Africa and Oceania, and serves as the most common cause of acquired epilepsy in the world. T. solium eggs are transmitted fecal-orally when a human or pig host ingests contaminated food or water. Larvae hatch from the intestines and invade into muscle, tissue, or organs, forming cysts called cysticerci. Cysticerci involving the central nervous system is termed neurocysticercosis (NCC). Patients with NCC typically remain asymptomatic for 3-5 years in the viable stage until the host’s immune response is activated in the degenerating stage. Immune-mediated degradation of …

Is There Any Benefit To Adding Corticosteroids To Radiofrequency Ablation Treatments: A Systemic Review., Lee James, Petar Jen, Nikolas Jen, Stefan Jen

Research Day

Introduction: Radiofrequency ablation (RFA) is a procedure done for chronic pain which uses thermal energy to nociceptive pathways with the goal of disrupting pain signaling. The thermal energy leads to nervous tissue disruption using radiofrequency currents through an electrode placed near the target area. RFA has been shown to have an increase in pain reduction as well as an increase in functional ability when compared to corticosteroid injections (CSI), another common treatment for both acute and chronic pain. Many clinicians have logically combined RFA and CI together to achieve a synergistic effect. This study aims to look at the current …

Rare First Rib Pseudoarthrosis With Thoracic Outlet Syndrome In Pediatric Gymnast: A Case Report, Jessica M. Kraft, Ann L. Contrucci, Gary E. Freed

Research Day

Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.

Case presentation: A 10 year old Caucasian male presented with a two to …

Upper Urinary Tract Transitional Cell Carcinoma And Lymph Node Involvement: Pre And Post Operative Outcomes, Brittney Henderson, Son Young, Mark Quiring, Scott Serpico, Edward Wu, Emma Troyer, Ryan Moriarty, Thomas Mueller, Gordon Brown

Research Day

Background: Upper urinary tract transitional cell carcinomas (UUT-TCC) comprise any malignancy arising from the renal pelvis to distal ureter. These cancers account for approximately 5-10% of all urothelial tumors. Two-thirds of cases are invasive with an estimated 5-year survival rate less than 50%. Pathologic staging, invasion into local structures, and lymph node involvement influence the overall survival rate. Lymph node dissection (LND) is associated with higher overall survival rates in UUT-TCC patients, likely by decreasing regional lymph node metastasis. Current literature suggests that removing eight to ten regional lymph nodes may improve survival. The outcomes of upper urinary tract malignancies …

Modified Excisional Biopsy Technique For Confirmed Or Highly Suspected Melanomas, Batul Momin, Katrina Hansen

Research Day

There are a variety of biopsy techniques for sampling confirmed or highly suspicious melanomas, including excisional, scoop-shave or “saucerization”, shave, and punch biopsy. Herein, we present a case in which a combination approach of saucerization and excisional biopsy was used for a patient with an inadequately sampled melanoma. In the literature, excisional biopsy remains the gold standard for diagnosing melanoma. This technique is accomplished with a full-thickness, fusiform removal of the lesion with a scalpel to the level of adipose tissue (2). The drawback to this technique is the slightly distorted anatomy that can occur during wound closure. Albeit rare, …

Pustular Psoriasis And The Potential Therapeutic Usage Of An Il-36 Receptor Monoclonal Antibody, Jeannel T. Miclat, Shafik Habal

Research Day

Pustular psoriasis is an uncommon subtype of psoriasis that dramatically affects the quality of life of affected patients. Pustules can emerge anywhere along the trunk, limbs, soles, palms, and fingers, which debilitates the functionality of these appendages. Currently, there are no approved treatments for pustular psoriasis in the US; off-label usage of psoriasis vulgaris medications is usually prescribed. These treatments are insufficient for patients with difficult to manage or severe forms of pustular psoriasis. Psoriasis vulgaris biologic medications mainly target the IL-17 and IL-23 axis. However, novel clinical findings have demonstrated that pustular psoriasis’s central inflammatory axis depends on the …

A Bone Of Contention: A Dynamic Ultrasound Assessment Of The Role Of The Radial Head In The Arthrokinematics Of The Proximal Radioulnar Joint, Kolson Lamb, Madison D. Hendricks, Courtney E. Grimes, Cameron A. Johnson, David Nguyen, Ruth Maher

Research Day

INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination.

OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being …

Malignancy Or Dermatophyte Infection? The Challenges In Evaluation Of Chronic Diffuse Rashes, Margi Nayak, Humaira Bibi, Anthony Cimmino, Xuan Ouyang, Jonathan Fairley

Research Day

Introduction: The purpose of our case presentation is to help understand the use of diagnostic studies in differentiating diffuse rashes with potentially underlying malignant etiology from infectious etiology.

A 40 y.o. F with a past medical history significant for anemia presented to the ED with painful rashes that had been getting worse for over 1 year. She mentioned that initially the rash began on her arm around the time when her 2 dogs were being treated for fungal infection and then it started spreading to her chest, back, upper extremities, lower extremities, abdomen, and genital areas as well. She described …

The Impact Of Medication Therapy Management Services On Pediatric Patients With Medical Complexities, Charisma Osuagwu, Erica Wong, Savion Carswell, Sophia Jenkins, Xinyu Wang, Yujin Kim

Research Day

Introduction

Medication Therapy Management (MTM) is a service provided by healthcare providers to ensure the best medical outcomes, particularly for those with multiple chronic conditions. It is often provided for senior populations supported under the Centers for Medicare & Medicaid Services. Studies show that patients provided with MTM services have higher medication adherence rates and experience fewer complications. However, there are few studies on MTM counseling in pediatric populations. In this literature review study, we investigated the potential impact of MTM services for underserved pediatric populations with chronic conditions or disabilities who are likely to benefit from MTM services.

Methods …

A Seemingly Low Risk Patient Develops Urosepsis As A Complication Of Transrectal Prostate Biopsy: A Case Study, Nicole Peritz, Gabrielle Oquendo, Yuhyun Kang, Elijah Humphries, Joy Zarandy

Research Day

Background:

Prostate cancer (PCa) is the most common cancer in men, and the second most common cause of cancer deaths in the United States. Approximately 1 million Americans undergo prostate biopsies annually, with 97% undergoing the transrectal prostate biopsy (TRPB). While TRPB is reliable and relatively low risk, nearly 7% of patients develop infectious complications, with 3% requiring hospitalization due to sepsis. Risk factors for developing infection post-TRPB include antibiotic resistance, >10 biopsy cores, diabetes mellitus, indwelling catheter, and African-American ethnicity. Identifying risk factors, considering a transperineal biopsy approach, and utilizing pre-procedural practices like rectal sterilization, screening urinalysis, prophylactic antibiotics, …

Participation Of Children And Youth With And Without Cerebral Palsy Across Settings: An Exploratory Study, Teresa Long Pierce, Alyssa Laforme Fiss

Research Day

Introduction: Cerebral Palsy is one of the most common pediatric health conditions resulting in childhood disability. Children with CP experience varying levels of functional impairments due to muscle weakness, alterations in muscle tone, balance deficits, and loss of selective motor control. These impairments and activity limitations are thought to contribute to lower levels of participation. Studies examining participation of children with CP have found that participation is positively correlated with increased physical activity and have concluded that environment is a significant predictor of participation. However, research examining participation across specific environments is lacking. Additionally, research investigating the influence of various …

Management Of Patient With Impaction Secondary To Undigested Sunflower Seed Bezoar: A Case Report, Sufia Ahmed, Anthony Adetomiwa

Research Day

Introduction: Bezoars are aggregates of undigested plant fibers, hair, or seeds that may impact in any portion of the GI tract. These bezoars if left can lead to significant complications, including perforation and peritonitis.

Methods: We report a case of a 4-year-old female patient who presented to the emergency department with constipation and severe lower abdominal pain following unsupervised consumption of a large unknown volume of sunflower seeds. Initial radiograph revealed an undigested bezoar of seeds in the sigmoid colon and rectum. The patient was managed with mineral oil enema and manual disimpaction under conscious sedation. Subsequent radiographs revealed a …

Rare Presentation Of Metastatic Hepatocellular Carcinoma In The Finger: Case Report And Review Of Literature, F. Rhana Mousavi, Bassem Bekheit, Emon Alavi, Nick A. Hirad, Abanoub Gabra

Research Day

Hepatocellular carcinoma (HCC) is a primary tumor of the liver that primarily develops in the setting of chronic liver disease. HCC is difficult to diagnose due to it requiring the use of multiple imaging modalities with the goal to detect tumors when they are less than or equal to 2 cm in size to allow all possible treatment options to be used. Herein, we discuss a 69-year-old male with stage IV liver cancer residing in hospice presenting with left middle finger osteomyelitis and extreme pain. Radiology revealed a destructive lesion but pathology provided the diagnosis of metastatic hepatocellular carcinoma in …

A Radiologic Analysis: Relationships Of The Thoracic Spine To Aid Palpation Of The Thoracic Transverse Processes, Christopher Baker, Darshan Patel, Michael B. Roberts, Kristie Petree, Randall L. Mcgill

Research Day

Introduction: In the field of osteopathic manipulative medicine, palpation is an important skill used by physicians to localize structures to diagnose and treat patients with somatic dysfunction throughout the musculoskeletal system. Specifically, in the thoracic spine, physicians can use the more superficial spinous process of each vertebra to assist in locating the deeper, more challenging to palpate, transverse process of the vertebra. Historically, the “rule of threes”, proposed by Mitchell et al in 1979, describing the relationships between spinous processes and transverse processes of the thoracic spine has been taught in osteopathic medical schools. However, another model was more recently …

A Cadaveric Case Study On Lung Cancer Pathology, Anna Beth Boyette, Sarah Kate Boyette, Haley Garrett, Janai Groves, Perry Chandler Mullis, Sofia Sirocchi, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION: Lung cancer is the most commonly diagnosed cancer amongst both genders, currently accounting for about 18% of all cancer deaths.

OBJECTIVES: The overall purpose of this study was to evaluate the pathology associated with the patient’s cause of death, cardiorespiratory failure and lung cancer. The secondary aims of this study were to confirm the presence of malignant neoplasms within a human cadaver, determine the type of cancer present, and take specimens for histological examination to evaluate the patient’s cause of death.

METHODS: This is a case report from one of the cadavers in the Gross Anatomy laboratory at the …

A Cadaveric Case Study On Metastatic Breast Cancer Pathology, Janai L. Groves, Haley B. Garrett, Savannah J. Finley, Jada M. Glenn, Itza M. Garcia, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION: Breast cancer is the second most common cancer among women in the United States. The exact etiology of breast cancer is unknown, but over 70% of breast cancer cases involve only two risk factors: being a woman and being over the age of 50. Women with a family history of breast cancer, as well as women who experience early menopause, have an even greater risk of developing this disease. When considering racial demographics, African-American women have a 4-8% lower incidence rate of breast cancer than Caucasian women but are 40% more likely to die from the disease. Breast cancer …

Cadaveric Study: Sign Of Leser-Trélat Associated With Breast Cancer, Brigitte L. Cochran, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION: Seborrheic keratoses (SK) is considered the most common benign skin lesions found in individuals that are middle aged and older. In dermatology practice, these lesions pose no threat to the individual but can be concerning for cosmetic and underlying malignancy reasons when they cover most of the skin surface. Of specific concern is the sign of Leser-Trélat, which has been documented as a cutaneous harbinger of underlying malignancy associated with proliferation of the size and/or number seborrheic keratoses. This rare sign is usually caused by malignancies such as gastrointestinal adenocarcinoma and lung, kidney, liver, pancreatic cancer or malignant melanoma. …