Digital Commons Network^™

Microbial Dysbiosis And Nutritional Factors That Promote Remyelination In Multiple Sclerosis, Katherine C. Grant, Francis Jenney

Research Day

Multiple Sclerosis (MS) is an autoimmune disease characterized by the infiltration of peripheral lymphocytes into the central nervous system, resulting in inflammation and demyelination. Microbial dysbiosis has been observed in MS patients and may play a role in the loss of immune tolerance, leading to autoimmunity. Thus, it is believed that the gut microbiota can influence the inflammation seen in MS patients through the gut-brain axis. Diet and nutrition are highly implicated in inflammatory diseases because they can control the abundance of bacterial species and transcription factors and gene expression in host cells, ultimately creating pro-inflammatory or anti-inflammatory immune responses. …

A Case Comparison Of Two Instances Of Idiopathic Intracranial Hypertension, Hannah Kruse, Roshni Patel, Julienne Ryland, L. Michael Waters

Research Day

Idiopathic Intracranial Hypertension (IIH) is a condition in which intracranial pressures become elevated with no clear or obvious cause. While the pathophysiology remains elusive, a multitude of medications, comorbid states, and risk factors have been attributed to IIH. Clinical presentation includes intense headaches with papilledema, tinnitus, and transient vision loss. IIH is a diagnosis of exclusion and patients are often instructed to lose weight and provided medication in the event of flare ups.

Case 1

Patient GA was a 23 year old Caucasian female at the time of diagnosis with a BMI of 34.3 kg/m2. Personal history at the time …

Case Review: Rattlesnake Bite With Compartment Syndrome And Fasciotomy, Darya Hosein, Tracey Bastiaans

Research Day

Introduction: In the United States, approximately 9,000 people suffer from snake bites per year with an estimated five deaths reported annually.1 Majority of venomous snake bites are from one of two broad classes, Crotalinae (pit vipers) or Elapidae (coral snakes). More than 99% of snake bites that occur in the United States are from pit vipers and majority of those are due to rattlesnakes. The presentation of envenomation by one of these classes of snakes is distinctly different from one another and management options rely on discerning the etiology of a patient’s snake bite. 2 The severity of a snake …

A Modern Collared Cementless Femoral Stem For The Arthroplasty Treatment Of Femoral Neck Fractures, Justin T. Butler, Mary Jane Mcconnell, Ryan Decook, Brian Seng, Thomas Bradbury, Brandon H. Naylor

Research Day

Background: The use of cemented femoral fixation during hip arthroplasty for femoral neck fracture (FNF) is often recommended due to a widely reported decreased risk of early perioperative fracture and reoperation. However, newer generation cementless, collared, triple-tapered stems, may offer advantages over more traditional press fit femoral components. The purpose of this study was to investigate the 30-day survivorship of a modern, collared cementless stem when treating FNFs with hip arthroplasty through the direct anterior (DA) approach.

Methods: We conducted a retrospective study of all patients who underwent hemiarthroplasty (HA) and total hip arthroplasty (THA) for isolated displaced FNF between …

Comparing Gait Biomechanics And Function In Children With Bilateral Spastic Cerebral Palsy When Wearing Oskar Afo-Footwear Combination Versus Standard Afo-Footwear Combination: An Exploratory Study, Teresa Pierce

Research Day

INTRODUCTION: Ankle foot orthoses (AFOs) are often prescribed for children with spastic cerebral palsy (CP) to enhance ankle/foot alignment and improve gait. Typical AFOs are made to hold the ankle at a right angle, or plantigrade position, without consideration of structural limitations or musculoskeletal function, causing compensatory gait patterns and compromised foot postures in children with CP with limited gastrocnemius muscle length. Literature suggests that walking ability can be maximized when AFOs are optimized to accommodate for structural limitations and tuned to facilitate a walking pattern that more closely aligns with typical gait parameters. There is limited research examining gait …

A First Year Medical Student Using Omt As An Adjunct Treatment For Managing An 80-Year-Old With Cervical Radiculopathy, Tran M. Vo, Anne K. Belocura, Jessica P. Blakley, Joy Zarandy

Research Day

Introduction

Cervical radiculopathy is commonly attributed to degenerative spinal changes associated with aging. Conservative management with NSAIDS, muscle relaxers, opioids, and glucocorticoids can relieve symptoms, but have inherent risks particularly for patients >65 years-old or with comorbidities like diabetes mellitus. Alternatively, osteopathic manipulative treatment (OMT) is relatively low risk, even when performed by a supervised first-year DO student. One study highlights the overall effectiveness of OMT performed by first- and second-year DO students on family members outside a graded environment. Our case study demonstrates how adjunct OMT in an elderly patient with symptomatic cervical radiculopathy and diabetes mellitus provides symptomatic …

Acquired Reactive Perforating Collagenosis: A Case Report, Neena Edupuganti, Joseph M. Dyer, Onyebuchi Neita

Research Day

Background:

Reactive Perforating Collagenosis (RPC), a subtype of perforating dermatosis, is a rare skin condition in which altered collagen is eliminated through the epidermis. There are two forms of RPC: (1) the inherited form which is very rare and presents in childhood, and in this case (2) the acquired form which presents in adulthood and is associated with systemic diseases, most notably reported being diabetes mellitus and/or chronic renal failure. This case highlights the importance of having a high clinical index of suspicion in patients with systemic disease who present with diffuse pruritic keratotic papules.

Case Presentation:

A 65 year-old …

Masking During The Pandemic: Their Role In Possible Delaying Medical Diagnoses; A Case Report, Sanjana Das, Ryan Kanungo, Ranjita Sengupta

Research Day

Introduction:

The COVID-19 pandemic in 2020 brought a profound global shift particularly in medicine and daily life (2). Within healthcare, masks assumed heightened significance as frontline workers attended to potentially infected/infected patients. Initially, limited data existed on effectiveness, mask types, and ideal duration of use, resulting in a generalized protocol of patients and the healthcare team wearing masks during healthcare visits (3). While serving as a shield against COVID-19, masks also possess the potential to conceal subtle disease indicators present only beneath their covering. Notably, no studies to date have explored whether the widespread use of masks throughout the pandemic …

A “Clot”-Astrophe: Recurrent Dvts In A Pediatric Patient, Pooja Parikh, Erik Zarandy, David Flowers

Research Day

Background:

Thoracic outlet syndrome is largely overlooked in the pediatric population due to its widely varied presentation and not being commonly viewed as a pediatric disorder. This case study will demonstrate an adolescent with recurrent DVTs who was found to have venous thoracic outlet syndrome caused by anatomic compression and an underlying hypercoagulable disorder. The aim of this report is to highlight the presentation of venous TOS in a pediatric patient without a clear anatomic cause or Paget Schroetter syndrome.

Case Presentation:

A 17-year-old Caucasian male with no PMHx presented to the Pediatric ED with 1 day of sudden onset …

Efavirenz, A Cyp46a1 Activator Ameliorates Pathological Neovascularization In A Mouse Model Of Oxygen-Induced Retinopathy, Shubhra Rajpurohit, Josephine M. Rudd, Allston Oxenrider, Ravirajsin N. Jadeja, Menaka C. Thounaojam

Research Day

Introduction: In a prior study, we documented the predominant reliance of the developing retina on the alternate bile acid (BA) synthesis pathway. However, in the context of oxygen-induced retinopathy (OIR) in mouse models, retinal BA synthesis undergoes significant dysregulation, marked by a pronounced reduction in the activity of the key rate-limiting enzyme, Cytochrome P450 enzymes (CYP or P450) 46A1.

Objective: The objective of this current investigation is to assess the impact of efavirenz (EFV)-mediated activation of CYP46A1 on retinal neovascularization in OIR mice, a model representative of retinopathy of prematurity (ROP).

Methods: Seven-day-old (P7) C57BL/6J mice were subjected to the …

Resolution Of Chronic Coccydynia After Osteopathic Manipulative Treatment: A Case Report, Daniel A. Valdés, Meagan Sherrington, L. Michael Waters Jr

Research Day

Coccydynia is characterized by pain or discomfort in the coccyx region, most frequently caused by direct trauma. This condition, exacerbated by sitting on flat or hard surfaces, may cause immobility and adversely impact the daily lives of those afflicted. Standard treatment options include ergonomic adaptations, manual or physical therapy, nerve blocks, or surgery. Currently, there is very little evidence supporting the use of osteopathic manipulative treatment (OMT) as a therapeutic option for patients suffering from chronic coccydynia. The authors describe the case of a 26-year-old female, previously healthy, highly active competitive volleyball player who developed chronic coccydynia following direct trauma …

41-Year-Old Female With Self-Resolving Abdominal Aorta Injury: Case Report, Nicholas Beckmann, Mykenna Nichols

Research Day

Purpose: This case report will analyze current research on the treatment of traumatic aortic injuries and describe the case of a 41-year-old female whose injury healed without intervention with the purpose of furthering knowledge of conservative treatment options for aortic injury.

Materials and Methods: This case study’s methods include a review of published literature on traumatic aortic injuries and a description of a unique case that demonstrates the importance of injury classification and noninvasive treatment.

Results: A 41-year-old female patient with high energy trauma presented with a multifocal low grade (grade 1) abdominal aorta injury which healed without surgical intervention. …

Ebstein’S Anomaly In A Professional Soccer Player: A Case Report, Erik Zarandy, Eldad G. Saler, Saavan S. Boghara, Rithvik R. Sarasani, Vraj N. Patel

Research Day

INTRODUCTION:

Ebstein’s anomaly (EA) is a rare congenital defect involving malformation of the heart’s tricuspid valve. EA is associated with other congenital heart defects as well as increased risk of cardiac arrhythmia. This makes its identification especially important in athletes, as it could lead to sudden cardiac death. In this case, a young professional soccer player was found to have EA with WPW. Our goal is to highlight the appropriate work-up and subsequent treatment and follow-up of a competitive athlete with Ebstein’s Anomaly.

CASE REPORT:

A 20-year-old male professional soccer player received a preparticipation EKG and physical and was noted …

43-Year-Old Female Without Insurance With Progressive Back Pain For Two Years Due To Multiple Symptomatic Tarlov Cysts, Shereen M. Mohammed, Fatema Z. Momin, Joy I. Zarandy

Research Day

Introduction: Tarlov Cysts (TCs) are meningeal cysts that can affect spinal nerve roots, usually in the sacrum. Pathology is largely unclear. Women are twice as affected as men, with increased incidence around 40-50 years old. These cysts are generally asymptomatic and incidentally found on imaging. Estimated prevalence is 4.6%, with approximately 1% of TCs causing nonspecific symptoms like low back pain. Due to its vague symptomatology, TCs are commonly misdiagnosed. Because most TCs are asymptomatic, treatment guidelines for symptomatic cysts are ill-defined; however, surgical removal should be considered for TCs >1.5cm or causing symptoms to prevent possible progression to nerve …

Optimizing Pediatric Care: Bridging Gaps And Addressing Disparities For Children With Disabilities Or Medical Complexities Through Medication Therapy Management (Mtm), Phuongloan Hoang, Drew Mccanless, Seana-Pierre Williams, Rajat Sharma, Mariam-Sere Diaby, Lauren Callaway, Jihui Diaz

Research Day

INTRODUCTION

Children with disabilities and medical complexity require complex medication regimens that are challenging for caregivers when managing medication. We conducted a secondary meta-analysis using data from the National Health Interview Survey (NHIS) to explore medication adherence disparities based on caregivers’ socioeconomic status. Medication Therapy Management (MTM) and similar services have been shown to improve treatment adherence. We aim to investigate the utilization of MTM services among underprivileged communities by developing a structured survey for the target population and aim to examine whether caregivers’ socioeconomic status (SES) impacts medication adherence within our study cohort. Our ultimate goal is to improve …

Where Is The Baby?, Priya Merai, Shree Desai, Rohit Karnati, Sheba Mathew, Fatema Momin, Joy Zarandy, David Adelstein

Research Day

Introduction: People experiencing homelessness can struggle to have basic healthcare needs met due to a variety of factors, potentially resulting in the progression of untreated health issues and development of complications. Since the COVID19 pandemic, rates of homelessness have increased and women are the fastest growing subgroup. Women have a higher need for preventative care, especially when considering reproductive health and gynecologic issues. Health education and treatment, even for seemingly benign conditions, is imperative for improving health outcomes of women experiencing homelessness.

Case description: A 38-year-old woman experiencing homelessness becomes unresponsive, and an onlooker calls 9-1-1. No medical history is …

Quantitative Analysis Of Cadaveric Cervical Lymph Nodes And The Relationship With Cervical Carcinoma Treatments, Samuel Ighodaro, Mierra C. Robinson, Casey Thompson, Shelley Dicecco

Research Day

Introduction

Head and Neck Lymphedema develops most commonly as a secondary effect of cancer and its treatment (Banjdar). The head and neck, or cervical, region contains an intricate network of over 300 lymph nodes and serves as a critical component of the body’s immune system (Peach). Head and cervical lymph nodes are often combined in a total number, therefore this study focused primarily on quantifying the ranges of lymph nodes that are specifically in the cervical region. Knowledge of the anatomic relationships of the lymphatic nodal levels and the structures they drain is critical in the delivery of appropriate therapy …

Compression Garments For Genital Lymphedema: A Case Series, Shelley Dicecco

Research Day

Introduction: Individuals with genital lymphedema can experience gait deviations, urinary/bowel dysfunctions, pain, cellulitis, and reduced quality of life. An important aspect of treatment is the use of compression garments to help with the reduction and/or maintenance phases. It can be difficult to select a compression garment for the genital region due to the function, location, shape, and size of the genitals. The aim of this study was to investigate the ability of off-the-shelf compression shorts with a sex-specific pad insert to maintain the reduction of edema and the health of the tissues for two patients with controlled genital lymphedema. Methods: …

Enhancing Total Hip Arthroplasty Outcomes With Internet-Based Patient Engagement Platforms, Justin T. Butler, Ryan Decook, Joyce Harary, Thomas Bradbury, Charlie Decook, Brandon Naylor

Research Day

Introduction: As Internet-based patient engagement platforms (IPEPs) become increasingly utilized following THA (total hip arthroplasty), a clearer understanding of their role in influencing clinical outcomes is needed. This study aims to determine whether increased patient engagement with an IPEP has notable impacts on patient-reported outcome measures (PROMs) and post-acute care visits.

Methods: This retrospective study analyzed 5,557 patients who underwent Total Hip Arthroplasty (THA) and participated in an Internet-based Patient Engagement Platform (IPEP) from 2018 to 2022. Patients were categorized based on their engagement levels with the IPEP, measured as high or low based on the frequency of interactions. Key …

A Review Of Current Mrna-Based Cancer Vaccinations With Special Consideration For Future Breast Cancer Prevention Strategies, Alexandra She, Alexa Cornwell, Francis Jenney

Research Day

INTRODUCTION: According to the World Cancer Research Fund International (WCRFI), breast cancer (12.5%) has now topped lung cancer (12.2%) as the most prevalent form of cancer in the world (WCRFI, 2022). While therapeutic advances continue to be made, the current treatment of cancer is widely associated with severe side effects from classic therapies such as radiation and chemotherapy. Over the last two decades, studies have examined breast cancer vaccines in pre-clinical and clinical settings. Here, we present an in-depth review of current mRNA-based cancer vaccine literature to assess the prevalence of this technology in this field of medicine. This includes …

Case Study: Lead Contamination Propagation Into Plants Of A Metro Atlanta Home, Jaci Carithers, Samantha Gowen, Mbill Khan, Gokbet Owusu-Poku, Francis Jenney

Research Day

INTRODUCTION: Lead pollution in residential areas of Metro Atlanta has spurred action from the EPA to increase efforts to remediate the contaminated soil, resulting in the designation of the Westside Lead Atlanta, GA Superfund site. Lead poses significant risks to human health, interfering with vital biological functions such as its mimicry and blocking of important calcium-dependent pathways. Contributing to this issue are the historic practices of lead-based industries with poor disposal practices, causing local soil and water pollution. This issue is evident particularly along historical railroad routes used for transporting heavy metal-laden industrial goods. The soil along these routes frequently …

Exploring Medication Adherence In Children: A Survey-Based Approach To Addressing Disparities And Improving Treatment Outcomes., Rajat Sharma, Phuongloan Hoang, Drew Mccanless, Seana-Pierre Williams, Mariam-Sere Diaby, Lauren Callaway, Jihui Diaz, Xinyu Wang, Yujin Kim

Research Day

INTRODUCTION

Medication Therapy Management (MTM) aims to boost medication adherence, primarily focusing on seniors covered by Medicare and Medicaid. However, vulnerable populations like children with medical complexity or disabilities on medication (MCDM) lack access to this service. Previous research using the NHIS database identified disparities in medication adherence rates across socioeconomic levels, education, and ethnicity among caregivers. To investigate if these disparities persist in our community, we're developing a survey to assess medication adherence rates in children with MCDM. We conducted a literature review to create a questionnaire analyzing the impact of MTM services on children with MCDM.

METHODS

From …

The Effects Of Plant Milks On Bone Growth And Bone Density In Children And Adolescents, Julienne Ryland, Jeannel Miclat, Diana Peterson

Research Day

Introduction:

Improper nutrition is a controllable factor contributing to bone development during the peak growth years of 9-16 years old. In the past few decades, cow milk and dairy products have been the primary sources of vitamin D and calcium; however, the increased prevalence of plant-based dairy products on the market resulted in nutritional differences. Plant-based products have decreased amounts of vitamin D and calcium, disrupting endochondral ossification. Furthermore, plant milk generally has lower protein and fat content than cow milk. We hypothesize that consuming plant-based products may decrease metabolic fat stores, vitamin D, and calcium availability, thus lowering bone …

Diagnostic Ambiguity Of Distal Dvt (Ddvt) Misdiagnosed As Nonpurulent Lower Extremity Cellulitis (Nlec): A Case Study, Jessica M. Ruiz-Myara, Hunter Alberto Vásquez, Joy Zarandy

Research Day

Introduction

Given the lack of a definitive diagnostic test for cellulitis, about 39% of cases are misdiagnosed. The repercussions of misdiagnosing nonpurulent lower extremity cellulitis (NLEC) for deep vein thrombosis (DVT) can be grave, considering the potential risk of pulmonary embolism (PE). While distal DVT (dDVT) is associated with <5% of PE formation, about 25% of untreated dDVT can ascend to the proximal leg veins; whereas 50% of proximal DVTs (pDVT) progress to PE development within a 3-month timeframe.

Case Report

A 50-year-old female presents to her PCP with a right medial ankle rash for 2 days. She denies inciting events, fever, chest pain, dyspnea, weeping lesions, or swelling. Past medical history includes obesity and controlled diabetes mellitus. Vitals are normal. Examination reveals a 10 x 6 cm blanchable, erythematous …

Chest Binding Alters Thoracic Anatomy In Transmasculine Youth, Julienne Ryland, Jeannel Miclat, Diana Peterson

Research Day

Introduction:

With the recent legislation restricting gender-affirming care for minors, more mechanical means of gender-confirming methods are being used as a substitute. For adolescent transmasculine people, this includes chest binding, designed to flatten breast tissue and give a more streamlined masculine appearance. Chest binding is a relatively inexpensive and widely available technique to affirm gender identity without the need for healthcare professional involvement. Although chest binders are recommended to be worn for less than 8 hours daily, transmasculine youth have been documented wearing their chest binders for upwards of 18-21 hours a day. This consistent pressure on their chest essentially …

Pregnancy And Lymphedema: Is There A Link?, Kathryn E. Downing, Shelley Dicecco

Research Day

Introduction: The current literature regarding pregnancy is lacking data on a significant population: individuals with lymphedema. This void of information ultimately creates barriers to understanding the pathology surrounding lymphedema during pregnancy and the potential for poorer outcomes due to clinical practice that is not evidence-based. This literature review aims to provide a brief overview of anatomical and physiological changes that occur with lymphedema and pregnancy, summarize the current literature on the effects of pregnancy on the lymphatic system and lymphedema, and analyze the data to develop a clinical reference for evidence-based practice.

Methods: A One search, google scholar, and Pubmed …

The Effect Of State And Trait Anxiety On Pain-Pressure Threshold, Scott Lowe, Christian T. Hughey, Kathryn E. Downing, Breana L. Fair

Research Day

Background:

The global burden of persistent pain is substantial, affecting up to 30% of the world's population. Despite growing awareness, challenges persist with accurate pain measurement, limiting research and clinical efforts. One method to assess pain perception is the Pain-Pressure Threshold (PPT), indicating the pressure at which pain is reported. Anxiety, comprising state and trait anxiety, has been suggested as a potential influencer of PPT, yet its precise impact remains uncertain. State anxiety is defined as a "transient state of arousal subjectively experienced as anxiety" Trait anxiety is “an individual's tendency to appraise situations as threatening, avoid anxiety-provoking situations, and …

The Importance Of Early Recognition And Management Of Battery Ingestion In A 15-Month-Old: A Case Study, Yuna Seo, Anna Yoon, Joy Zarandy

Research Day

INTRODUCTION

With the proliferation of home battery-powered gadgets, emergency visits for accidental pediatric battery ingestions have doubled from 2010 to 2019. Battery ingestion is associated with a risk of serious injury and potential death, particularly lithium button batteries. Tissue damage begins within15 minutes of impaction, with major corrosive injury as soon as two hours; thus, emergent management is crucial to optimize patient outcome.

CASE DESCRIPTION

A healthy, asymptomatic 15-month-old male presents with his father, a physician, for suspected ingestion of a button battery. Vital signs and physical exam are normal. Stat nose-to-rectum plain films confirm the presence of an opaque …

Estrogen Mediated Mitochondrial Dysfunction, Menopause, And The Progression Of Alzheimer’S Disease, Kristina D. Grant, Richard E. White

Research Day

Alzheimer’s Disease is a fatal and progressive neurodegenerative disease that results in losses in memory and cognitive function. Menopause is known as a woman’s transition from reproductive to post-reproductive life. During menopause, the levels of ovarian hormones, such as estrogen, decrease eventually to an undetectable level. Estrogen plays essential roles throughout the body, and the loss of estrogen during menopause has been shown to cause various symptoms, including vasomotor symptoms, changes in mood, and changes in cognition. Given that Alzheimer’s Disease is more common in postmenopausal women than men, this review aims to examine the connection between the loss of …

Collaborating With Faith-Based Organizations And Municipalities To Increase Hypertension Awareness, Antonio A. Henry, Charisma Bell, Joe Williams, Renee A. Taylor, Charlz Bisong, Adwoa Aduonum, Valerie Cadet

Research Day

Background

Conversations involving health status of underrepresented minority demographics in the U.S. often ascribe the burden of poor health to individuals rather than systemic conditions. Research has shown that ignoring the role of these conditions on health and socioeconomic status undermines community-based morbidity and mortality reduction efforts. But, while systemic approaches are paramount, the importance of healthcare institutions and professionals making meaningful relationships with community members remains essential.

This study describes medical student efforts in creating relationships with individuals and community stakeholders in the Gwinnett County area to address hypertension awareness. Awareness of hypertension, a leading cause of morbidity and …