Medicine and Health Sciences Commons^™

Diagnostic Utility Of Chest Radiographs In Children With Clinically Diagnosed Pneumonia As Per The Kenya Basic Paediatric Protocol, Ivy Waruguru Wakahora

Master of Medicine in Imaging and Diagnostic Radiology

Introduction; Pneumonia causes significant morbidity and mortality in children globally, emphasizing the need for accurate diagnosis. While chest radiographs have traditionally been the gold standard for diagnosis, recent international guidelines discourage their routine use in paediatric community acquired pneumonia (pCAP). Despite this, chest radiographs are still regularly acquired for pneumonia diagnosis, resulting in practice variations and imaging overutilization. This study aims to evaluate the diagnostic utility of chest radiographs in children with clinically diagnosed pneumonia as per the Kenya Basic Paediatric Protocol (KBPP).

Materials and methods: Data was retrospectively reviewed of 159 paediatric patients at Aga Khan University Hospital, Nairobi …

Biomechanical Evaluation And Intraoperative Strategies For Addressing Suture Anchor Failure In Osteoporotic Bone, Richard Marchese, Samir Baig, Sofia P. Hidalgo, Jaclyn Brunner, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: When aiming to enhance the strength of a suture anchor construct, typically in osteoporotic bone, it is often suggested to employ a method referred to as "under-tapping" (UT). A comprehensive assessment of tapping protocols for anchor placement was conducted to ascertain if this contributes to the prevention of anchor failure. Further, supplementary fixation techniques were examined to offer methods for secure fixation in the event of unanticipated failure.

Hypothesis: Under-tapping can increase load to failure compared to standard tapping (ST). If the initial fixation fails, using larger diameter anchors or bioabsorbable Trim-IT pins (TIP) via cross-pinning can provide stable …

Incidence Of Cardiovascular Surgery Following Pediatric Posterior Sternoclavicular Dislocation: Evaluating The Necessity Of Cardiothoracic Surgeon Standby During Operative Treatment, Ryan Lebens, Christian Leonardo, Rigel Hall, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Posterior sternoclavicular (PSC) dislocations are rare events, most commonly occurring after high energy injury such as motor vehicle accident or contact sports. While rare, PSC dislocations can be life threatening due to risk of posterior displacement of the medial clavicle impinging the great vessels leading to the heart. As such, patients with sternoclavicular dislocation are at risk for intimal tears and hemorrhage. Traditional orthopedic surgery teachings state closed reductions for PSC dislocation should have cardiothoracic (CT) surgeons on standby in the event intimal tears need repair. Despite this, there lacks conclusive evidence and literature about whether CT surgeon standby …

Perioperative Continuous Glucose Monitoring In Diabetic Patients Undergoing Primary Total Joint Arthroplasty, Dorian Cohen, Mei Lin Chan, Abdullah Y. Hassan, Anna Lei, Joseph F. Lacomb, Igor Kravetz, James Nicholson

Stony Brook Orthopaedic and Musculoskeletal Journal

See article.

Postoperative Recovery Following Ankle Fracture Surgery With And Without At Home Physical Therapy System: A Prospective Randomized Control Study, John Kennedy, Amos Dai, Michelle Regan, Kaitlyn Compitello, David E. Komatsu, Megan Paulus

Stony Brook Orthopaedic and Musculoskeletal Journal

See article.

The Prevalence Of Dupuytren’S Disease In Patients With Epilepsy, Sandhya Ganesan, Kaitlyn N. Compitello, Benjamin N. Blond, David E. Komatsu, Lawrence C. Hurst

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Dupuytren’s disease (DD) is a fibroproliferative disorder characterized by progressively worsening contractures of the fingers, first web, and thumb. This condition has been associated with various risk factors, one of which includes epilepsy and recurrent seizures. Antiseizure medications (ASMs) especially phenobarbital, have been implicated in the connection between the two conditions; however, their association remains unclear.

Purpose: This study evaluated data from a TriNetX network of 132,152,597 total patients, 1,492,227 patients with epilepsy, 141,237 patients with DD, and 4,244 patients with both epilepsy and DD, to assess the correlation between DD and epilepsy and factors that may …

Utility Of Intraoperative Ultrasound In Localizing Retracted Flexor Tendon Injuries: A Cadaveric Study, Cris Min, Emil Vutescu S. Vutescu, Kenny Ling, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Flexor tendon injuries are common injuries typically seen in the working-age (20 to 45 years) young male population1. These injuries can be debilitating and lead to significant morbidity, as most flexor tendon lacerations require surgical treatment for proper healing. There is increasing use of both preoperative and postoperative ultrasound to aid in evaluation of flexor tendon injuries.

Purpose: The purpose of this study was to determine if ultrasound was a modality that could be useful intraoperatively in the localization of Zone II retracted flexor tendon injuries, as well as to determine how accurate ultrasound is in measuring the defect. …

Models Of Video Feedback For Youth Athletes Performing An American Football Tackle, Eric Schussler, Richard J. Jagacinski, Ajit Chaudhari, John A. Buford, James A. Onate

Rehabilitation Sciences Faculty Publications

Context: Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance.

Objective: To determine the effect of video feedback in the instruction of tackling form.

Design: Controlled laboratory study.

Setting: Laboratory.

Patients or Other Participants: A total of 32 youth football athletes (28 boys, 4 girls; age ¼ 11.8 6 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and …

The Impact Of Iron Supplementation On The Preterm Neonatal Gut Microbiome: A Pilot Study, Matthew Van Ormer, Maranda Thompson, Melissa Thoene, Jean-Jack Riethoven, Sathish Kumar Natarajan, Corrine K. Hanson, Ann Anderson-Berry

Journal Articles: Pediatrics

OBJECTIVE: The gastrointestinal microbiome in preterm infants exhibits significant influence on optimal outcomes-with dysbiosis shown to substantially increase the risk of the life-threatening necrotizing enterocolitis. Iron is a vital nutrient especially during the perinatal window of rapid hemoglobin production, tissue growth, and foundational neurodevelopment. However, excess colonic iron exhibits potent oxidation capacity and alters the gut microbiome-potentially facilitating the proliferation of pathological bacterial strains. Breastfed preterm infants routinely receive iron supplementation starting 14 days after delivery and are highly vulnerable to morbidities associated with gastrointestinal dysbiosis. Therefore, we set out to determine if routine iron supplementation alters the preterm gut …

Abnormalities In Pharyngeal Arch-Derived Structures In Satb2-Associated Syndrome, Yuri A. Zarate, Katherine Bosanko, Nada Derar, Jennifer L. Fish

Pediatrics Faculty Publications

SATB2-associated syndrome (SAS, glass syndrome, OMIM#612313) is a neurodevelopmental autosomal dominant disorder with frequent craniofacial abnormalities including palatal and dental anomalies. To assess the role of Satb2 in craniofacial development, we analyzed mutant mice at different stages of development. Here, we show that Satb2 is broadly expressed in early embryonic mouse development including the mesenchyme of the second and third arches. Satb2-/- mutant mice exhibit microglossia, a shortened lower jaw, smaller trigeminal ganglia, and larger thyroids. We correlate these findings with the detailed clinical phenotype of four individuals with SAS and remarkable craniofacial phenotypes with one requiring mandibular distraction in …

Importance Of Tropical Medicine, Chia-Chi Angela Fu, A Clinton White, Miguel Cabada, Ryan Northup

Posters

Overviews the importance of tropical medicine to society and global health.

Empowering And Educating Parents To Implement A Home Intervention: Effects On Preschool Children's Engagement In Hands-On Constructive Play, Michelle Boulanger Thompson, Yaoying Xu, Chin-Chih Chen, Kathleen Rudasill

Rehabilitation Sciences Faculty Publications

Constructive play is a creative process-oriented activity that promotes children’s engaged learning through building and designing with materials. This study investigated a parent-implemented intervention to promote active engagement in constructive play for preschool-aged children at risk for developmental delay. This study utilized a single-subject multiple-baseline across-participants design with four participants. Visual analysis of the data identified a functional relation between the temporal, physical, and social–emotional environmental support provided by the parents and the children’s active engagement in constructive play. Parents reported the intervention as meaningful to their lives, indicating strong social validity. These findings highlight the importance of centering and …

Social Determinants Of Health: Evaluation Using Rates Of Vision Screening And Follow-Up Examinations, Madeline Dyer

Williams Honors College, Honors Research Projects

Vision care is essential to the quality of life of young children, impacting them over the course of their lives. Social Determinants of Health (SDOH) affect the likelihood of a child having access to appropriate care specified by the Bright Futures. The aim of this study was to assess the impact of SDOH on the completion of vision screening and the rate of follow-up with an eye care provider when applicable. In addition, rates of instrument-based vision screening and recommended ophthalmology follow-up were compared with COI, a metric assessing the quality of resources available and the conditions that matter for …

Understanding Guardian Perceptions Of Whole-Foods Plant-Based Diets As Interventions In Pediatric Medicine, Vijay R. Luthra

Honors Undergraduate Theses

The obesity epidemic is widespread in American society, often affecting children who bear its consequences innocently. Due to a lack of nutrition knowledge, children rely on caregivers to meet their nutritional needs and instill healthy habits. This study examines parents' attitudes, knowledge, and behaviors, as well as perceived barriers to adopting a whole-foods plant-based diet (WFPD) for their children. Using a modified survey instrument by Morton et al., this study focused on parents and children regarding dietary choices. Participants were recruited from the waiting area of a pediatric clinic at the Medical College of Georgia between April and May 2023. …

Investigating The Association Of Demographic Factors On Methotrexate Delay-Clearance And Toxicity In Pediatric Oncology Patients: A Retrospective Chart Review, Belal Alabdul Razzak

Honors Undergraduate Theses

High-dose methotrexate (HD MTX) is critical for treating pediatric malignancies such as acute lymphoblastic leukemia and neuro-carcinoma. However, its significant toxicity due to drug accumulation poses substantial risks. This retrospective study assesses the impact of demographic factors on MTX toxicity and clearance in pediatric oncology patients. Patient records from Saint Mary Hospital were analyzed, focusing on two MTX administration protocols: a 24-hour infusion followed by alkaline hydration and a 4-hour infusion followed by alkaline hydration. We hypothesize that factors such as age, body surface area (BSA), and body mass index (BMI) are associated with MTX clearance and toxicity. The study …

Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Presentations

INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …

Safe Sleep Education For Local Refugee And Immigrant Populations, Sara Jones

Posters

Provide Safe Sleep education to local refugee and immigrant populations through their resettlement agency Jewish Vocational Services (JVS) with resources available in their first language.

Himalayan Health Exchange: Kargiakh Medical Expedition, Rachel Oldfather

Posters

Medical expedition to remote Himalayan villages involving high-altitude treks, improvised clinics, and immersion in the local Buddhist culture.

Global Health Elective - Philippines, Hannah Ho

Posters

Provides an overview of experiences working in the Philippines as a pediatric resident.

Expanding The Winter Warmth, Sarah Gwazdacz

Posters

Reviews the efforts to expand collection of winter apparel for refugee families in Kansas City.

Healthcare In Under-Resourced Areas, Gabrielle Fleming, Ryan Northup, Bill Houseworth, Lori Housworth

Posters

Describes pediatric resident's experience working in the inpatient unit, ER, PICU, and NICU in Cambodia.

Acute Postoperative Pain And Dorsal Root Ganglia Transcriptomic Signatures Following Total Knee Arthroplasty (Tka) In Rats: An Experimental Study, Justice Achonu, David E. Komatsu, Sardar Mz Uddin, Chris Gordob, Martha Kanjiya, Diane Bogdan, Adriana Dibua, Hira Iftikhar, Amanda Ackermann, Rohan J. Shah, Jason Shieh, Agnieszka B. Bialkowska, Martin Kaczocha

Stony Brook Orthopaedic and Musculoskeletal Journal

Total knee arthroplasty (TKA) is the final treatment option for patients with advanced knee osteoarthritis (OA). Unfortunately, TKA surgery is accompanied by acute postoperative pain that is more severe than arthroplasty performed in other joints. Elucidating the molecular mechanisms specific to post-TKA pain necessitates an animal model that replicates clinical TKA procedures, induces acute postoperative pain, and leads to complete functional recovery. Here, we present a new preclinical TKA model in rats and report on functional and behavioral outcomes indicative of pain, analgesic efficacy, serum cytokine levels, and dorsal root ganglia (DRG) transcriptomes during the acute postoperative period. Following TKA, …

Position Specific Injury Patterns In Male Developmental Academy Soccer Players, Andrew Donaldson, Catharine Kral, Shannon Margherio, Mckeenna Noe, Brian S. Harvey

Presentations

Background: Despite the availability of high-quality evidence describing injury patterns in European professional soccer players, there is a paucity of data regarding American athletes. This disparity is accentuated for elite youth athletes. Our study identifies position-specific injury patterns occurring in elite youth male soccer players. Hypothesis: We hypothesize that there are injury types, locations, and specific injuries that occur most frequently in elite youth soccer players and that certain positions have a higher frequency of these injuries than others. Methods: Data from a retrospective review of the IRB-approved Male Academy Soccer Registry from August 1, 2019 through June 30, 2022 …

An Educational Intervention To Improve Neonatal Icu Nurses’ Breastfeeding Support Knowledge, Self-Efficacy, And Breastfeeding Rates At Discharge, Sarah Money

DNP Projects

Background: The benefits of breastfeeding for both mother and baby are known. It is recommended that all infants be exclusively breastfed until six months (Meek & Noble, 2022; North et al., 2021). Despite this, breastfeeding rates remain low, especially in medically fragile infants requiring care in the neonatal intensive care unit (NICU) (Rollins et al., 2016). Receipt of evidence-based breastfeeding support by healthcare providers has been shown to improve breastfeeding success; however, many healthcare providers report not being comfortable or knowledgeable enough to offer support consistently (Mulcahy et al., 2022; Rollins et al., 2016).

Purpose: This study aims …

Demographic And Diagnostic Factors In Physical Therapy Attendance, William Leatherwood, Adrian Torres, Sofia Hidalgo Perea, Megan Paulus

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Previous studies have demonstrated physical therapy (PT) to be an effective nonoperative treatment for various orthopedic diagnoses. However, patients may dismiss PT in favor of another intervention for their injury. While there are many studies on PT, there is little data on patient compliance. This study aimed to elucidate patient compliance with a basic PT prescription and whether PT led to subjective injury improvement.

Methods: This is a retrospective study of patients seen in Stony Brook Orthopedic clinics from 08/01/2022 – 12/23/2022. Patients prescribed PT received a phone call six weeks after the PT prescription. The primary …

Intraoperative Nerve Stimulation As A Functional Assessment Of Acute Stretch Injury In The Rat Median Nerve, Matthew Gluck, Pierce J. Ferriter Jr., Christoph A. Schroen, Christina M. Beck, Zachary L. Bernstein, Todd A. Rubin, Michael R. Hausman, Paul J. Cagle

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Peripheral nerve injuries (PNIs) are common complications of upper extremity injuries, yet few clinical options exist to quickly and accurately assess motor nerve function intraoperatively. PNIs are a significant source of not only disability to the patient, but also cost. This study’s purpose was to evaluate the utility of intraoperative nerve stimulation in an
animal model.

Methods: A 20% stretch injury was induced in right median nerves using a custom-made stretch applicator, while left median nerves served as a control. A Checkpoint surgical nerve stimulator (Checkpoint Surgical, Cleveland, OH) was used to assess baseline nerve function in …

An Updated Ligament Evaluation Of Perilunate Instability, Emil S. Vutescu, Cris Min, Elias Georgas, Paul G. Arauz, Yi-Qian Qin, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Perilunate dislocations are rare and high-energy proximal carpal row injuries that are associated with long-term disability. The current accepted pathomechanism of this injury is progressive radial to ulnar intrinsic ligament tearing, as described by Mayfield in 1980. Since his description several other ligaments have been described as critical stabilizers of the proximal carpal row.

Purpose: To achieve perilunate instability in a biomechanical model and evaluate integrity of recently described carpal ligamentous stabilizers.

Methods: We tested six fresh-frozen cadaveric upper extremities and loaded them to failure in extension, ulnar deviation and carpal supination using a previously validated three-point …

Can Artificial Intelligence Create Research Hypotheses For Patellofemoral Instability?, Claire Parker, Sofia Hidalgo Perea, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: The purpose of this study was to elucidate if artificial intelligence (AI) can generate novel research hypotheses regarding patellofemoral instability (PFI) in the pediatric population that have not previously been investigated. We hypothesized that AI would be able to generate new hypotheses that have not yet been presented or published.

Methods: In December of 2023, Chat Generative Pre-trained Transformer-3.5 (ChatGPT) was used to create a list of 25 research hypotheses about PFI in both the adult and pediatric population. The prompt used to generate the list of hypotheses was: “List 25 detailed and reproducible research ideas regarding …

Age-Related Differences In 30-Day Postoperative Complications Following Aseptic Revision Total Shoulder Arthroplasty: A Comparison Of Patients Under And Over 80 Years Old, Rachel A. Loyst, Patricia Cerri-Droz, Stephen H. Liu, Kenny Ling, Dorian Cohen, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: This study investigates the association between patients < 80 years old and patients 80 years old and 30-day postoperative complications following aseptic revision total shoulder arthroplasty (TSA).

Materials and methods: All patients who underwent revision TSA between 2015 and 2022 from the American College of Surgeons National Surgical Quality Improvement (NSQIP) database were surveyed for this study. Patient demographics, comorbidities, and 30-day postoperative complication data were analyzed. Logistic regression was used to analyze the postoperative complications associated in patients greater than or equal to 80 years old.

Results: Compared to patients < 80 years old, patients 80 years old were independently associated with a significantly greater likelihood of experiencing any complication (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.23-2.11; P < .001), non-home discharge (OR 3.68, 95% CI 2.58-5.25; P < .001), and length of stay (LOS) > 2 days (OR 1.57, 95% CI 1.18-2.10; P = 0.002).

Conclusions: Compared to patients < 80 years old, patients 80 years old were independently associated with a significantly greater likelihood of experiencing any complication, non-home discharge, and LOS > 2 days. A better understanding of the age as a risk factor …

Pediatric Dentists’ Considerations Concerning Obesity-Related Education For Parents Of Young Children: Who Should Educate About What, How And When?, Arianne Swanson Dds, Ms, James R. Boynton Dds, Ms, Larry B. Salzmann Dds, Yu-Ju Yang Dds, Marita R. Inglehart Dipl. Psych., Dr. Phil., Dr. Phil. Habil

The Journal of the Michigan Dental Association

This study aimed to explore pediatric dentists' perspectives on obesity-related interventions for parents of young children. A web-based survey was administered to 210 American Academy of Pediatric Dentistry members. Findings revealed that respondents considered it important for various healthcare professionals, especially pediatricians and nurse practitioners, to engage in obesity-related parent education. Strong consensus existed on educating parents about the link between early childhood caries and diet, soft drink and fruit juice consumption, and healthy snacking. The study also found positive attitudes correlated with increased engagement in objective weight determination, data collection, and diet/nutrition counseling.