Medicine and Health Sciences Commons^™

Diagnostic Imaging Read By Ai-Assisted Technology Within The Emergency Department, Joshua Leland

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Introduction: The emergency department (ED) has had an appreciable increase in volume over the past two decades with more individuals utilizing the ED now than a decade ago which has placed a strain on healthcare resources. Specifically adding to the rising costs in healthcare are diagnostics including chest x-rays. To combat this, institutions across the nation are developing deep-learning and artificial intelligence (AI) programs to assist in reading these diagnostics. Therefore, this systematic review analyzes the use of AI programs by clinicians in the ED to read diagnostic imaging compared to those who do not use these algorithms.

Methods: This …

Treatment Of Hypothyroidism: Desiccated Thyroid Extract, Aimee Fong

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The treatment of hypothyroidism with Levothyroxine (T4) has been well studied and FDA approved. However, many patients continue to have signs and symptoms of hypothyroidism while on Levothyroxine treatment despite reaching appropriate thyroid levels. An additional thyroid treatment known as desiccated thyroid extract (DTE) is made from dried pig thyroid glands and is advertised as a “natural” alternative to Levothyroxine. Despite lack of FDA approval and studies surrounding DTE, clinicians have prescribed DTE to patients, many of whom reported relief of their symptoms. The following poster highlights the approach to the treatment of hypothyroidism with Levothyroxine and DTE and outlines …

In Patients With Hepatocellular Carcinoma (Hcc) (P), Is Bevacizumab With Atezolizumab (I) More Effective Than Sorafenib (C) In Long-Term Clinical Prognosis (O)?, Joon Lee

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Hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally. China contributes to half of the global incidence of liver cancer, with about 70-85% being HCC. Definitive treatment for this condition would be surgical resection with liver transplant but for obvious reasons, the majority of affected patients are unable to meet the necessary criteria. Sorafenib is a form of chemotherapy that has been the mainstay treatment of HCC since its approval in 2007. More recently, the combination of Bevacizumab and Atezolizumab has shown greater efficacy in the treatment of unresectable HCC. Additionally, this new combination therapy shows favorable …

Continuing Medical Education On Immunothombosis In Sepsis, Vivienne Van Nguyen

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In the past decades, the incidence of sepsis complicated by immunothrombosis has increased in critically ill patients, especially those with sepsis and septic shock. Despite intensive surveillance and prevention of the underlying causes, these disease syndromes are frequently fatal. The increased incidence of immunothrombosis in sepsis has been accompanied by many critical issues and concerns regarding current diagnostic and treatment protocols. This paper offers a concise critical assessment of the current state of knowledge about sepsis and immunothrombosis among clinicians in the ICU as well as problem concerning the recognition of sepsis and immunothrombosis and their management.

A Clinical Review Of Persistent Pulmonary Hypertension In The Newborn, Kaela Mahoney

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Persistent pulmonary hypertension in the newborn (PPHN) is an illness of the circulatory and respiratory systems which affects approximately 0.002% of newborns but carries a significant morbidity and mortality burden. Diagnostic measures are focused on determining etiology whereas treatment measures are intended to improve pulmonary function. It is crucial for neonatal providers to be aware of patients at risk for developing PPHN and be prepared to initiate treatment early. This presentation reviews pathophysiology, etiology, risk factors, diagnosis, and treatment of PPHN.

Management Of Adult Growth Hormone Deficiency Related To Hypopituitarism, Kellie Jamin

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The treatment of growth hormone deficiency (GHD) is well-established in childhood but less understood in adults, given the more complex role that growth hormone (GH) assumes in this population. Decreased functionality of the pituitary gland, otherwise known as hypopituitarism, can present with an isolated GHD in adulthood, which may result from a number of factors including neoplasm, ischemia, infection, traumatic injury, or systemic disease. Adult GHD may be definitively diagnosed with a stimulation test, the insulin tolerance test (ITT) being the study of choice. With a positive ITT, the disorder can be treated with growth hormone replacement therapy (GHRT), which …

The Effectiveness Of Probiotics In Adults With Depressive Symptoms, Brianna Rees

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Introduction: Depression affects over 21 million adults in the United States and continues to rise, affecting more people due to the recent pandemic. Because the prevalence of this debilitating mental health disease is increasing, it is even more crucial to find additional therapeutic treatments to alleviate depressive symptoms in adults whose depression is not controlled on current anti-depressant medication or therapy. Depression has been shown to be linked to the gut-brain axis, meaning gut health is connected to our mental health. Therefore, probiotics may be effective in altering the gut microbiome, and ultimately affecting cognitive patterns in the brain.

Methods: …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

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Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Queer Patients: An Underserved And At Risk Population, Joshua Schmidt

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Queer patients in America have faced a history of discrimination as both a community and as individuals. As such, this marginalization acts as a barrier to resources, including healthcare. Clinicians must be aware of said barrier and actively work towards dismantling it within their interactions with queer patients. This article makes a case for increasing sexual health conversations in order to assess queer patients and encourage a stronger patient-provider relationship for a community that is reluctant to seek medical attention, and also more likely to participate in higher risk behaviors.

Implementation Of Mental And Substance Misuse Screenings Into Routine Prep Therapy Encounters, Kieran Talkiewicz

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It has been well documented over the years that lesbian, gay, bisexual, transgender, queer/ questioning (LGBTQ+) populations are disproportionately affected by a higher burden of mental health illnesses, alcohol abuse, and illicit substance abuse when compared to heterosexual populations. This article will recommend utilizing routine Pre-Exposure Prophylaxis (PrEP) therapy encounters, a common point of contact for primary care for sexual minority populations, to perform screening for mental health and substance use. Due to men who have sex with men (MSM) being the highest utilizing population of this therapy, and disproportionately burdened by psychiatric and substance use disorders, this article will …

Case Of Acute Onset Cerebral Ischemia Involving The Subcortical Region: Corona Radiata, Devin Nichols

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Corona radiata cerebral infarcts have the capability of leaving detrimental residual deficits if not recognized and treated promptly. This article describes the presentation and management of a 43-year-old woman who was transferred from a local community hospital to a larger institution’s emergency department. Initially presenting with nausea, vomiting, and dysarthria and examined global left sided extremity weakness and dysarthria, leading to a confirmed diagnosis via magnetic resonance imaging (MRI) of a corona radiata infarction.

Complex Regional Pain Syndrome: Not A Catch-All, Amanda Shulski

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Complex Regional Pain Syndrome (CRPS) is prolonged and disproportionate neuropathic pain and inflammation which presents after surgery, fracture, or trauma to a limb. This phenomenon has been recognized in the literature since the civil war but the pathophysiology has only become clear over the last 20 years. There are no diagnostic tests for CRPS and it is a relatively rare condition with only about 20 cases in 100,000 people per year. CRPS is then under-recognized by some providers but over-diagnosed by others. Occasionally, providers use CRPS as a catch-all for unexplained pain rather than a recognized condition with specific diagnostic …

Cme: Ischemic Stroke Recognition And Management, Mae Missana

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Stroke is defined as a sudden onset of neurologic deficit caused by interrupted blood flow. Stroke is divided into two subtypes: ischemic and hemorrhagic. Roughly 87% of all strokes are ischemic with infarcts caused by obstruction to carotid artery circulation or vertebrobasilar artery circulation. Symptoms of ischemic and hemorrhagic stroke are similar on physical exam;therefore use of imaging is essential to determine treatment pathway. Asstroke is one of the leading causes of death in the United States, it is important to recognize the signs and symptoms, employ the necessary tools to evaluate and identity stroke, and deliver timely treatment to …

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

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Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

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Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …

Recolonization Of Microbiomes’ Influence On Autism Spectrum Disorder, Hattie Cole

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In recent years, there has been an increase in the number of studies conducted on the complications of gastrointestinal (GI) comorbidities associated with autism spectrum disorder (ASD) in children. Some of these GI issues include irritable bowel syndrome (IBS), diarrhea and constipation. The causes of these disorders are poorly understood. The dominant gut phyla are Firmicutes and Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria and Verrucomicrobia. Research conducted on children with ASD compared with typical developing (TD) children showed higher ratios of Firmicutes/Bacteroidetes in the ASD group. Biflobacterium, Actinobacteria phyla, has been shown to be a good intestinal bacterium that may help with …

The Safety Of Covid-19 Vaccines In Pregnancy, Lauren Zacharias

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SARS-CoV-2 has caused over 800,000 deaths in the United States since it was first detected here in 2020. Despite there being 3 available COVID-19 vaccines in the US, and recommendations by the CDC and countless other public health agencies that any potential risks are outweighed by the benefit of the vaccines, only 31% of pregnant women in the US are vaccinated against COVID-19 due to unfounded claims by an anti-vaccination movement that COVID mRNA vaccines cause infertility. This presentation explores where these claims originated, why they are untrue, the risks of COVID-19 infections in pregnancy, and the potential benefits of …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

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Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Bodily Autonomy And Anti-Vaccine Discourse During The Covid-19 Pandemic, Haley Sherman

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This paper explores the relationship between anti-vaccine discourse and ideas about bodily autonomy. I analyze the cyclical nature of vaccine hesitancy and show that it can lead to misinformation and harmful narratives. This paper uses theories of bodily autonomy that identify a concept called moral obligation. This concept, as explored by Alberto Giubilini, is a utilitarian approach in which citizens have a responsibility to their governments to get vaccinated so that, in turn, their governments can fulfill their obligation of protecting other individuals’ health (Giubilini 2020, 54). A discourse analysis of four key players in the anti-vax movement shows that …

The Outcomes Of Cemented Versus Cementless Total Knee Arthroplasty In Modern Day Patients With Osteoarthritis, Jordan Powelson

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Osteoarthritis (OA), the degeneration of cartilage and bone, is the most progressive musculoskeletal disease and a leading cause of disability in the United States, affecting over 27 million adults. Although conservative treatments for knee OA are available, total knee arthroplasty (TKA) is the only definitive treatment for end-stage knee OA. For the past several decades, the use of bone cement has been the gold standard for total knee arthroplasty, but the cementless TKA is being revisited as an option as the age of patients seeking TKA decreases and the average BMI increases. This review analyzes and compares the outcomes of …

A Case Of Protein Losing Enteropathy After Fontan Operation, Gina Kim

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Protein Losing Enteropathy (PLE) is a condition in which an excessive amount of proteins are lost through the gastrointestinal tract leading to hypoproteinemia and manifesting as edema, ascites, and diarrhea. While in most cases PLE is a treatable disorder with good outcomes, the morbidity and mortality of the disorder is significantly elevated in patients with a history of Fontan surgery–an operation used to palliate patients born with a single ventricle by rerouting venous blood return directly to pulmonary circulation. After failure of first-line therapeutics of diuretics and steroids, this case study explores the successful treatment of a 5-year-old patient with …

Vaccine Hesitancy Among Healthcare Workers In The Covid-19 Era, Gabriella Checchi

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Vaccination against harmful, deadly pathogens have been an essential tool in the scientific world and have shaped our community as we know it today. They have allowed us to live in a society where members of the community are protected from certain severe disease and can help to decrease the death toll of these diseases. Vaccines have allowed us to eradicate smallpox, a disease that ravaged the world and killed over 300 million people. They have been a one of the most useful advances in medical science so far. And yet today, as SARS-CoV-2 continues to spread rampantly throughout the …

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

Capstone Showcase

Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …

Initial Antihyperglycemic Options For Populations With Type 2 Diabetes Who Cannot Take Metformin, Rena Ogino

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Type 2 diabetes is a common disease in the United States that can result in life-threatening cardiac, vascular, and/or renal complications. The treatment of type 2 diabetes includes but is not limited to exercise, diet, multi-disciplinary approaches, and pharmaceuticals. Metformin is the first line pharmaceutical for newly diagnosed type 2 diabetes, however patients may be unable to tolerate metformin. With more than seven different antihyperglycemic drug classes and over twenty antihyperglycemic drugs, clinicians may have difficulty choosing the best agent for patients when metformin is not tolerated. This article compares common anti-hyperglycemic pharmaceutical agents and their drug classes, focusing on …

Clinical Pearls To Diagnosing Lyme Arthritis, Chandelle Keller

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Arthritis is one of the most common long term sequelae of Lyme disease infection in humans. Although the pathophysiology for Lyme arthritis is not concretely understood, there are several key features that are helpful in diagnosing Lyme disease as the culprit for the arthritic symptoms that an individual is experiencing. With a thorough history of an individuals’ age, geographic location, recent travel history and common outdoor recreational activities engaged in, a differential can be narrowed down. With the knowledge of how various arthritides present in the body, along with the use of diagnostic testing with ELISA and Western immunoblot, any …

The Benefit Of Bdnf Modification In The Treatment Of Post-Stroke Depression, Christine Gordynskiy-Ageyev

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Neuroplasticity has been a rapidly expanding area of research, and its findings have elucidated the potential of taking advantage of some of its components for the treatment of various neural pathologies. Stroke is the most common cause of long-term disability, and it is a disease process that affects many people. There are many rehabilitation programs that seek to restore a patient’s motor and cognitive functions after stroke; if not fully, then at least partially. Unfortunately, mental health changes contribute in large part to the overall disability of a patient, but these changes are not always targeted in these programs. In …

A Case Of Irritable Bowel Syndrome In The Setting Of Generalized Anxiety Disorder, Stephen Driscoll

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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by a relapsing-remitting course of abdominal discomfort and change in stool form and/or frequency in the absence of any structural or biochemical abnormalities. Currently there is debate on its pathogenesis but there is no definitive conclusion. Treatment consists of primarily playing symptomalogic catch-up with anti-spasmodics, anti-diarrheals, stool softeners, or laxatives depending on which symptoms the patient is currently experiencing. Patients with IBS typically struggle to control their symptoms long term, like the patient described in this case study. This case study explores a possible link between IBS and its’ most …

Vulvodynia: Making The Diagnosis And Improving Treatment Outcomes, Sophia Campbell

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Vulvodynia is an underdiagnosed condition that affects about 25% of women1. Patients report frustration and a lack of knowledge in the medical community regarding their symptoms of vulvar pain. Painful penetration makes performing an internal pelvic exam difficult, and patients may avoid annual gynecological appointments due to fear. It is imperative for providers to understand and implement the correct approach for accurate diagnosis. Once the diagnosis of vulvodynia has been identified, the multimodal treatment plan should be implemented to include pharmacological therapy, referral to physical therapy, and psychotherapy. With continued research and the use of evidence-based practice, the gap in …

Understanding One Dietary Supplement For Pcos, Eva Schofield

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Poly Cystic Ovarian Syndrome (PCOS) is the most common condition in women of reproductive age, yet nearly 70% of individuals with PCOS remain undiagnosed. For many women who do receive a diagnosis, it takes experiencing symptoms for two years or longer and receiving care from an average of 3 different providers before a diagnosis can be established. In an environment where prevalence is high, diagnosis rate is low and delayed, and dissatisfaction is prevalent regarding the health care women receive, many patients may turn to self-diagnosis and online resources to find their own therapeutic options. This CME article aims to …