Medicine and Health Sciences Commons^™

Low-Dose Psoralen–Uv-A Maintenance Therapy Prolongs Disease-Free Remission Rates In Mycosis Fungoides Patients, Joshua M. Brady

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using Vieyra-Garcia P, Fink-Puches R, Porkert S, et al. Evaluation of Low-Dose, Low-Frequency Oral Psoralen–UV-A Treatment With or Without Maintenance on Early-Stage Mycosis Fungoides. JAMA Dermatology. 2019;155(5):538. https://doi.org/10.1001/jamadermatol.2018.5905 for a patient weighing whether to continue treatment in light of socioeconomic circumstances.

Improved Tolerability And Efficaciousness Of Miralax-Gatorade When Compared To Golytely In The Outpatient Setting, Bassem Farah

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using Gu P, Lew D, Jung OS, et al. Comparing the Real-World Effectiveness of Competing Colonoscopy Preparations: Results of a Prospective Trial. Am J Gastroenterol. 2019;114(2):305-314. https://doi.org/10.14309/ajg.0000000000000057 for a patient reluctant to undergo colonoscopy screening due to concerns about GoLYTLEY's tolerability.

Il-1 Inhibitor Anakinra Is An Effective Alternative To Standard Treatments For Reducing Pain Due To Acute Gout Flare, Cheryl Craig

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Janssen CA, Voshaar MAHO, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019;58(8):1344-1352. https://doi.org/10.1093/rheumatology/key402 for a patient with an acute gouty attack refractory to standard treatment.

Clinical Approach To A Request For Phentermine-Topiramate In A Young Woman With A History Of High-Risk Eating Behavior, Erin Spencer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Safer DL, Adler S, Dalai SS, et al. A randomized, placebo-controlled crossover trial of phentermine-topiramate ER in patients with binge-eating disorder and bulimia nervosa. Int J Eat Disord. 2019;(September):1-12. https://doi.org/10.1002/eat.23192 to inform the clinical decision of whether or not to prescribe phentermine-topiramate to an overweight 27-year-old woman who endorses risky eating behaviors.

Medication Assisted Treatment With Buprenorphine/Naloxone Or Methadone: Comparitive Outcomes In Patients With An Opioid Addiction, Deepti Shanbhag

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Hser YI, Evans E, Huang D, et al. Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial. Addiction. 2016;111(4):695-705. https://doi.org/10.1111/add.13238 for a patient with addiction to prescription opioids.

Cyclosporine Shows Benefit As Compared To Methotrexate For Treatment Of Pediatric Atopic Dermatitis Refractory To Topical Medications When Rapidity Of Clinical Response Is Of Key Importance To The Patient, Connor R. Buechler, Steven Daveluy Md

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising El-Khalawany MA, Hassan H, Shaaban D, Ghonaim N, Eassa B. Methotrexate versus cyclosporine in the treatment of severe atopic dermatitis in children: a multicenter experience from Egypt. European Journal of Pediatrics. 2012;172(3):351-356. https://doi.org10.1007/s00431-012-1893-3 for a pediatric patient with severe atopic dermatitis.

Myomectomy Has Better Reproductive Outcomes Than Uterine Artery Embolization For Patients With Symptomatic Leiomyomas Who Wish Maintain Fertility, Suha Syed

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovascular and interventional radiology. 2008;31(1):73-85. https://doi.org/10.1007/s00270-007-9195-2

Little Is Known About Cannabidiol For Improving Severe Behavioral Symptoms Of Autistic Spectrum Disorder, Keerteshwrya Mishra

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Barchel D, Stolar O, De-Haan T, et al. Oral cannabidiol use in children with autism spectrum disorder to treat related symptoms and co-morbidities. Frontiers in Pharmacology. 2019;9. https://doi.org/10.3389/fphar.2018.01521

Subcutaneous Immunoglobulin Proves To Be An Effective Alternative To Intravenous Immunoglobulin In The Treatment Of Chronic Inflammatory Demyelinating Polyneuropathy, Benjamin Ross

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising van Schaik IN, Bril V, van Geloven N, et al. Subcutaneous immunoglobulin for maintenance treatment in chronic inflammatory demyelinating polyneuropathy (PATH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2018;17(1):35-46. https://doi.org/10.1016/S1474-4422(17)30378-2

Clinical Decision Science Requires Doctors To Examine Their Own Inner World, Janice C. Lau

Clinical Research in Practice: The Journal of Team Hippocrates

The author reflects on the importance of preparation for difficult conversations with patients and their families after finding herself unprepared to compassionately communicate a clinical decision for a pediatric patient.

Transanal Irrigation Is More Beneficial In Symptomatic Management Of Neurogenic Bowel Disease Than Conservative Bowel Management, Chi-Lan Tran

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Christensen P, Bazzocchi G, Coggrave M, et al. A Randomized, Controlled Trial of Transanal Irrigation Versus Conservative Bowel Management in Spinal Cord–Injured Patients. Gastroenterology. 2006;131(3):738-747. https://doi.org/10.1053/j.gastro.2006.06.004

Changing Guidelines: Recommendation Of Early Peanut Introduction For Prevention Of Peanut Allergy In Infants With Severe Eczema, Alexandra H. Zetye

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. New Eng J Med. 2015;372(9):803-813. https://doi.org/10.1056/nejmoa1414850

Inpatient Motivational Interviewing For Adolescent Type 1 Diabetics With Poor Glycemic Control Is Ineffective, Andrew L. Roberts

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Wang Y-C, Mackenzie M, Nakonezny PA, et al. A randomized controlled trial comparing motivational interviewing in education to structured diabetes education in teens with type 1 diabetes. Diabetes Care. 2010;33(8):1741-1743. https://doi.org/10.2337/dc10-0019.

Trends In Legionnaires' Disease-Associated Hospitalizations, United States, 2006-2010, Gayathri Mudali, Paul E. Kilgore, Abdulbaset Salim, Shawn P. Mcelmurry, Marcus Zervos

Department of Pharmacy Practice

Background: Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires' disease-associated hospitalization in the United States.

Methods: In this study, we estimated the annual incidence of Legionnaires' disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires' disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in …

Antiviral Prophylaxis May Not Provide Benefit In Patients With Posner-Schlossman Syndrome, Patrick Lee

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Chee SP, Jap A. Cytomegalovirus anterior uveitis: outcome of treatment. Br J Ophthalmol. 2010 Dec;94(12):1648-52. https://doi.org/10.1136/bjo.2009.167767 for a patient on antiviral prophylaxis for recurrent episodes of Posner-Schlossman Syndrome.

Covid-19, Colleagues, Confusion, And Conversations, Nathanael R. Sanchez M.D., Katherine S. Lee , M.D., Karen Weaver M.D.

Clinical Research in Practice: The Journal of Team Hippocrates

During the COVID-19 pandemic, doctors in a community hospital reflect on their decision-making regarding treatment options for COVID-19. Whether to use hydroxychloroquine is the treatment discussed in most detail.

When Rationing Becomes Part Of Clinical Decision-Making, Christopher A. Hopper, Mitra Bahaee

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical practice-based reflection on Noack DP, Newton G. Compared to maximal current management standards, oscillating positive expiratory pressure devices have not been shown to improve clinically relevant outcomes in COPD patients with acute exacerbation. Clin. Res. Prac. 2017;3(2):eP1516. doi: 10.22237/crp/149886732.

Valbenazine Has A Small But Meaningful Benefit For Tardive Dyskinesia, Joseph Friedli, Ryan Quick, Reem Sobh, Samantha Cowing

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of

Hauser RA, Factor SA, Marder SR, et al. KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia. Am J Psychiatry. 2017;174(5):476-484. https://doi.org/10.1176/appi.ajp.2017.16091037

and

Factor SA, Remington G, Comella CL, et al. The Effects of Valbenazine in Participants with Tardive Dyskinesia: Results of the 1-Year KINECT 3 Extension Study. J Clin Psychiatry. 2017;78(9):1344-1350. https://doi.org/10.4088/JCP.17m11777

exploring the efficacy of a newer therapy for tardive dyskinesia, and describing recommendations for a patient with acute medical problems and longstanding tardive dyskinesia.

The Implementation Of Exercise For Chronic Kidney Disease And Dialysis Patients, Syed Ahmad Rizvi

Honors College Theses

While commonly known to be the organ that helps with urine production within the human body, the kidney plays one of the most crucial roles in maintaining homeostasis. When establishing all of the roles the kidney has on keeping humans healthy, there is the question of how does the body cope when a patient is diagnosed with kidney failure. One of the more common treatment options that allows the body to continue to function without a kidney is by beginning a patient on a form of dialysis. However, as with any treatment, there will always be a list of side …

Trends In The Sources Of Endophthalmitis At Kresge Eye Institute, Anita Vaishampayan, Kresge Eye Institute

Medical Student Research Symposium

Purpose

Endophthalmitis is a defined as a purulent inflammation of the intraocular fluids, namely the vitreous and aqueous humor. Endophthalmitis most commonly develops from infection, but can also be acquired from inflammatory and neoplastic conditions. We sought to determine these sources at our institute and to look for trends in our urban population.

Methods

A retrospective chart review of patients who attended the Kresge Eye Institute in Detroit, MI between 2003 to 2018 was performed. Patient list was identified from our EMR using the diagnoses codes related endophthalmitis. Information gathered included demographics, type of tissue/fluid cultured, the presumed source of …

Management Of Childhood Migraine By Headache Specialist Versus Non-Headache Specialists, Kelly Valentini, Radhika Gutta, Gunjanpreet Kaur, Ahmad Farooqi, Lalitha Sivaswamy

Medical Student Research Symposium

This study aims to compare the management practices of a headache specialist with non-headache specialists in the treatment of pediatric migraine. The use of appropriate rescue medications and prophylactic agents, application of neuro-imaging, and short-term outcomes are compared in children treated by the two groups of physicians. A retrospective cohort study was conducted utilizing the electronic medical records of children 3-18 years of age with migraine, who were evaluated at a tertiary care children’s hospital from 2016-2018. Of the 849 patients that met the study criteria, 469 were classified as having chronic migraine or high-frequency episodic migraine and were followed …

Comparison Of Pre- And Post-Operative Shoulder Muscle Emg Profiles In Reverse Total Shoulder Arthroplasty Patients, Emily Lau, Sreten Franovic, Noah Kuhlmann, Eric C. Makhni Md, Stephanie Muh Md

Medical Student Research Symposium

Background: Deltoid muscle function is central in reverse total shoulder arthroplasty (RTSA) function; however, there is limited information available regarding changes in deltoid activity before and after surgery. Few tests exist to evaluate specific muscle metrics pre and post operatively. Surface Electromyographic (EMG) is non-invasive and allows for observation of motions with multifaceted analysis of movement with minimal patient demand. Understanding the changes in shoulder muscle activation, namely in the deltoid, in patients pre and post-RTSA can further advance understanding of the procedure and rehabilitation efforts.

Methods: Nine individuals were recruited for this study: all patients underwent RTSA by a …

Assessment And Management Of Adult Preoperative Anxiety: A Survey Of The Anesthesiologist Perspective, Arif Musa, Jeffrey C. Wang, Rana Movahedi, David Safani, Christopher Cooke, Syed F. Hussain, Jahan Tajran, Shafi Hamid, Gligor Gucev

Medical Student Research Symposium

Introduction: Preoperative anxiety often goes unaccounted for in the surgical setting. Given that anesthesiologists are routinely involved in perioperative care, this study was performed to assess anesthesiologists’ views of adult preoperative anxiety assessment and management. Methods: Active members of the American Society of Anesthesiologists (ASA) were sent an online questionnaire. Survey items included demographic information in addition to questions about measurement of preoperative anxiety, management of anxiety, and which entities were allocated responsibility to reduce patient anxiety. Data were collected from February to March 2019. Results: Of 3,661 respondents, most asked their patients about preoperative anxiety (n=2332, …

Ultrasound-Guided Out-Of-Plane (Oop) Adductor Canal Continuous Catheter Placement Compared To In-Plane (Ip) Placement In Total Knee Arthroplasty: A Randomized, Single Blinded, Pilot Clinical Trial, Sandeep H. Krishnan M.D., Carter Batista M.D, Samir Patel M.D., Farhad Ghoddoussi Phd, Kaveh Nabavigahadi M.D., Brendan Lynch B.S.

Medical Student Research Symposium

Background: Adductor canal continuous catheters (ACCCs) have largely replaced femoral nerve continuous catheters for providing analgesia after total knee arthroplasty. Both have similar analgesic efficacy, but ACCCs preserve quadricep strength and facilitate patient mobility more quickly. We hypothesized that placing the ACCC using an out of-plane (OOP) technique would decrease pain scores and opioid use due to parallel alignment with the saphenous nerve when compared to the in-plane (IP) technique. Methods: Sixty-nine patients undergoing total knee arthroplasty were randomized to either the IP or OOP technique for ultrasound-guided ACCC. The primary outcomes of the investigation were hospital length of stay, …

Inflammatory Markers In Bicuspid Transcatheter Aortic Valve Replacement, Molly N. Pantelic, Paul Nona, Dee Dee Wang

Medical Student Research Symposium

Background

Aortic stenosis (AS) has a prevalence of 2%. Valve replacement is the definitive treatment for AS, with transcatheter aortic valve replacement (TAVR) offering a minimally invasive alternative to surgery.

Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. BAV patients are predisposed to AS, and comprise a distinct, younger TAVR patient population. Given limited prior work on inflammatory markers for TAVR risk assessment, this study sought to investigate if white blood cell count (WBC) correlates with BAV TAVR patient severity and post-TAVR outcomes.

Methods

A single-center retrospective analysis was performed on patients with BAV who underwent TAVR …

Atrx Loss In Pediatric Glioma Results In Epigenetic Dysregulation Of G2/M Checkpoint Maintenance And Sensitivity To Atm Inhibition, Brendan Mullan, Tingting Qin, Ruby Siada, Carla Danussi, Jacqueline Brosnan-Cashman, Drew Pratt, Taylor Garcia, Viveka Nand Yadav, Xinyi Zhao, Meredith Morgan, Sriram Venneti, Alan Meeker, Alnawaz Rehemtulla, Pedro Lowenstein, Maria Castro, Carl Koschmann

Medical Student Research Symposium

ATRX is a histone chaperone protein recurrently mutated in pediatric glioma. The mechanism which mediates the proliferative advantage of ATRX loss in pediatric glioma remains unexplained. Recent data revealed a distinct pattern of DNA binding sites of the ATRX protein using ChIP-seq in mouse neuronal precursor cells (mNPCs). Using the ATRX peaks identified in p53^-/- mNPCs, we confirmed that ATRX binding sites were significantly enriched in gene promoters (p < 0.0001) and CpG islands (p < 0.0001) compared with random regions. Gene set enrichment (GSE) analysis identified that cell cycle and regulation of cell cycle were among the most significantly enriched gene sets (p=2.52e-16 and 1.61e-9, respectively). We found that ATRX loss resulted in dysfunction of G2/M checkpoint maintenance: (1) ATRX-deficient pediatric glioblastoma (GBM) cells exhibited a seven-fold increase in mitotic index at 16 hours after sub-lethal radiation, and (2) murine GBM cells with ATRX knockdown demonstrated impaired pChk1 signaling on western blot at multiple time points after radiation compared to controls (p=0.0187). Notably, the ATM signaling (pChk2) remained intact in those cells, suggesting a potential therapeutic target. ATRX-deficient mouse cells were uniquely sensitive to ATM inhibitors at 1 uM alongside 8 Gy radiation compared to controls with intact ATRX (AZD0156: p=0.0027 and AZD01390: p=0.0436). Mice intra-cranially implanted with ATRX-deficient GBM cells showed improved survival (n=10, p=0.0018) when treated with AZD0156 combined with radiation. Our findings suggest that ATRX loss in glioma results in unique sensitivity to ATM inhibition via epigenetic dysregulation of G2/M checkpoint maintenance.

Improving Hearing Screenings With Tele-Otology, Ryan J. Miller, Joshua George-Lopez, Robert S. Hong Md, Phd

Medical Student Research Symposium

Introduction: The Lions Hearing Center of Michigan (LHC-MI) is an assistance program in Detroit that provides hearing aids to individuals in need. LHC-MI has provided thousands of hearing aids, but such efforts have been costly, requiring patients to make multiple appointments at multiple locations. To streamline this process, the LHC-MI is piloting a new program, titled “Hear Now! Detroit!”, that uses telemedicine to reach patients at community sites.

Purpose: To evaluate the feasibility of a hearing screening program that uses telemedicine to reduce the number of visits required to acquire hearing aids.

Methods: Teams of community volunteers were deployed to …

Post-Surgical Pyoderma Gangrenosum After Breast Surgery: A Case Series, Jahan Tajran, Daniella Anderson, Arif Chaudhry, Dennis Hammond

Medical Student Research Symposium

Background:

Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder that is thought to be due to innate immune system dysfunction, specifically of neutrophils. PG has been well documented in patients with autoimmune disorders like Ulcerative Colitis and Rheumatoid Arthritis. PG can also present in surgical patients, imitating a potential wound infection and necrotizing fasciitis. Although PG is a diagnosis of exclusion, prompt recognition is essential to attaining desired aesthetic outcomes, especially with breast involvement. We present a case series of four patients who developed PG following breast surgery. We analyze each patient’s medical history, symptoms, wound progression and management …

Quality Improvement In Ibd Care: The Influence Of A Qi Specific Conference For Fellows, Olayinka Afolabi, Alexis Faber, Raya Kutaimy, Paul Naylor, Murray Ehrinpreis

Medical Student Research Symposium

Given the complexity of management of inflammatory bowel disease (IBD), medical societies such as the American Gastroenterological Association (AGA) and Crohn’s and Colitis Foundation of America (CCFA) have established measures aimed at defining quality of care. In 2011, the AGA proposed 10 quality metrics for IBD, eight of these measures relate to outpatient management and two focus on inpatient management. Our objective was to evaluate compliance with these measures in our own general GI practice and determine whether a GI conference discussing quality improvement (QI) in 2017 was effective.

Intraosseous (Io) Vs Intravenous (Iv) Vascular Access For Out Of Hospital Cardiac Arrest., Syed Tariq Nabi, Megan Mackenzie, Monica Prasad, Mustapha Choucair, Peyton Johnston, Reba John, Sarah Meram, James Paxton

Medical Student Research Symposium

Over 300,000 Americans every year experience an out-of-hospital cardiac arrest (OHCA) (Benjamin EJ 2019). Of these 300,000+ patients only 10.6% of them survive to hospital discharge. Advanced Cardiac Life Support (ACLS) has been suggested to improve survival following an OHCA (Neumar, Otto et al. 2010). Current ACLS guidelines recommend obtaining vascular access, however, offer little suggestion as to which type of access device should be used. It is our belief that using an Intraosseous vascular access device will lead to shorter time to medication delivery and increased rates of return of spontaneous circulation (ROSC) compared to Intravenous vascular access. We …