Medicine and Health Sciences Commons^™

Restoration Of Penile Sensation After Dorsal Nerve Trauma In Cismen, Kevin M. Klifto, A. Lee Dellon

Research Day

Purpose: Loss of penis sensation or development of a painful penis can occur after injury to the dorsal branch of the pudendal nerve. Attempted relief of this problem through neurolysis of the dorsal nerve in the inferior pubic ramus canal has been reported rarely. While recovery of genital sensibility has been discussed frequently in transmen, this subject has been reported rarely in cismen. The purpose of this report is to review our experience with recovery of sensation after decompression of the dorsal branch of the pudendal nerve.

Methods: A retrospective chart review was carried out from 2014 to …

The Management Of Perioperative Immunosuppressant Medications For Rheumatoid Arthritis During Elective Hand Surgery, Kevin M. Klifto, Brian H. Cho, Scott D. Lifchez

Research Day

Purpose: Rheumatoid arthritis (RA) is a destructive inflammatory disease that commonly involves joints of the hand and wrist. Different recommendations exist for continuing or discontinuing immunosuppressant medications during the perioperative time period. The purpose of our study was to determine if continuing steroids, non-biologic DMARDs, and/or biologic DMARDs were associated with an increased risk of postoperative complications.

Methods: We performed a single-centered, retrospective review of a consecutive cohort of RA patients who had elective hand surgery by a single surgeon. Patients were included if they had a documented diagnosis of seropositive RA by a rheumatologist, and had elective …

The Efficacy Of Applied Behavior Analysis On The Quality Of Critical Life Skills In Autistic Youth, Olukayode A. Akinsola Jr, Denah Appelt

Research Day

Autism spectrum disorder (ASD) is a developmental disorder characterized by difficulties in social interaction, social communication, restricted and repetitive patterns of behavior, and interest or activities. As of 2013, ASD is no longer an individual entity but rather an umbrella term encompassing other distinctive developmental disorders. Signs and symptoms of ASD can appear anywhere from birth to three years of life. Various behavioral modalities exist for the treatment of ASD, which is considered to be the gold standard of care. One of the newest behavioral modalities is applied behavior analysis (ABA) therapy. The general purpose of ABA therapy is the …

Persistent Genital Arousal Disorder (Pgad): Treatment By Neurolysis Of Dorsal Branch Of Pudendal Nerve, Kevin M. Klifto, A Lee Dellon

Research Day

Introduction: Persistent genital arousal disorder (PGAD) is the female perception that they are in a state of sexual arousal, without the ability of the arousal to be satisfied by orgasm.

Aims: It is the hypothesis of this study that PGAD results from a minimal degree of nerve compression of the dorsal branch of the pudendal nerve. If this hypothesis were true, then PGAD could be treated by neurolysis of the dorsal branch of the pudendal nerve.

Methods: A retrospective chart review was carried out from 2010 through 2018, of those women having neurolysis of the dorsal branch of the pudendal …

Using Emr To Implement And Track Compliance Of A Unique Colon Bundle That Reduced Surgical Site Infection In Colorectal Surgery: A Single Institution Review, Leigh Gerson, Jessica Barton, Christina Monaco, Lisa Baro

Research Day

Background: Surgical site infections (SSI) remain a common complication of colorectal surgery and are associated with an increase in cost, hospital LOS and an increased risk of postoperative morbidity and mortality. It is well studied that surgical care bundles reduce infection, there is no established consensus on the optimal amalgamation of variables. Increasing the number of measures within the bundle is associated with a stepwise reduction in SSI. This review presents the efficacy and implementation of a detailed surgical bundle to reduce SSIs in patients undergoing colorectal surgery. We illustrate how the use of EMR aids in implementation and …

The Barriers That Deter The Geriatric Population From Receiving Healthcare, Jacquelyn Smith, Anne Egan, Denah Appelt

Research Day

In the United States, the geriatric population is considered to include individuals that are 65 years or older. In 2016, there was an estimated 49.2 million elderly Americans (Roberts, Ogunwole, Blakeslee, & Rabe 2018). Since the advances of modern medicine are prospering, this number is expected to increase drastically.

Furthermore, the geriatric population is projected to double, from 2010 to 2030, to 20% or 72 million Americans (Horton and Johnson 2010). Looking further into the future, the American geriatric population is expected to be 83.7 million in 2050 (Ortman, Velkoff, & Hogan 2014). In a 2016 Center for Disease Control …

Renal Epithelioid Angiomyolipoma: Genomic Characterization And Malignant Potential, Alan Wang, Kyle A. Blum, Jonathan Coleman, Paul Russo, A. Ari Hakimi

Research Day

Introduction:

Renal angiomyolipoma (AML) is one of the most common benign kidney tumors diagnosed. Epithelioid angiomyolipoma (eAML) is a rare variant of these kind of masses that have been classified by the World Health Organization as a potentially malignant mesenchymal neoplasm that metastasizes in one-third of cases. However, conflicting reports have brought in to question the true malignant potential of eAML. Due to eAMLs overall rarity, few studies have characterized this entity. In this study, we further define eAML by describing its genomic alterations and malignant potential by comparing it to a cohort of AML patients at a large-volume cancer …

The Effects Of Protein Kinase C Beta Ii Peptide Modulation On Superoxide Release In Rat Polymorphonuclear Leukocytes, Christina Lipscombe, Chinyere Ebo, Daphne Metellus, Jennifer Dang, Annam Humayun, Arjun Nair, Harsh Patel, Megan Michaels, Matthew Finnegan, Lucy Checchio, Faosat Muftau-Lediju, Faosat Martorana, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Phorbol 12-myristate 13-acetate (PMA; a diacylglycerol mimetic) is known to augment polymorphonuclear leukocyte (PMN) superoxide (SO) release via protein kinase C (PKC) activation. However, the role of PKC beta II (βII) mediating this response is not known. It’s known that myristic acid (myr-) conjugation facilitates intracellular delivery of the cargo sequence, and that putative PKCβII activator and inhibitor peptides work by augmenting or attenuating PKCβII translocation to cell membrane substrates (e.g. NOX-2). Therefore, we hypothesize that myr- conjugated PKCβII peptide-activator (N-myr-SVEIWD; myr-PKCβ+) would increase PMA-induced rat PMN SO release, whereas, myr-PKCβII peptide-inhibitor (N-myr-SLNPEWNET; myr-PKCβ-) would attenuate this response compared to …

The Effects Of Metformin, Aminoguanidine, And Pyridoxamine On Methylglyoxal Induced Cardiac Myocyte Injury, Amanda Harvey, Rose Martorana, Julia Colangeli, Hafsa Ahmed, Dean Delgado, Alisa Kim, Robinderpaul Sandhu, Robert J. Barsotti, Lindon H. Young, Qian Chen

Research Day

Advanced glycation end (AGE) products have been under investigation for their role in cardiovascular disease in complications. Methylglyoxal, a byproduct of glucose metabolism, is elevated in the blood of diabetic patients and has shown to be an important intermediate in the production of AGEs. Due to the highly reactive structure of methylglyoxal, it can produce high levels of reactive oxygen species (ROS) within the cell via mitochondrial modification which results in a loss of cell membrane potential and possible cell death. The role of methylglyoxal in cardiac cells is not well known; in this study methylglyoxal induced cell injury and …

Protein Kinase C Beta Ii Peptide Inhibitor Elicits Robust Effects On Attenuating Myocardial Ischemia/Reperfusion Injury, Daphne Metellus, Christina Lipscombe, Chinyere Ebo, Arjun Nair, Harsh Patel, Annam Humayun, Jennifer Dang, Megan Michaels, Matthew Finnegan, Lucy Checchio, Faosat Muftau-Lediju, Faosat Martorana, Anahi Mcintyre, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Reperfusion injury contributes to myocardial tissue damage following a heart attack partly due to the generation of reactive oxygen species (ROS) upon cardio-angioplasty. Protein kinase C beta II (PKCβII) inhibition during reperfusion with peptide inhibitor (N-myr-SLNPEWNET; PKCβII-) decreases ROS release and leukocyte infiltration in rat hind-limb and myocardial ischemia/reperfusion (I/R) studies, respectively. However, the role of activating PKCβII during reperfusion has not been previously determined. In this study, we hypothesize that myristoylated (myr)-PKCβII- will decrease infarct size and improve post-reperfused cardiac function compared to untreated controls, whereas PKCβII peptide activator (N-myr-SVEIWD; myr-PKCβII+) will show no improvement …

Muscle Circumference And Tendon Width Correlation In Rotator Cuff Tears, Michael Marcinko, Michael Bamimore, Mark Ujevic

Research Day

Introduction: Rotator cuff tears are a common pathology presenting in much of the population especially those with repetitive overhead activity. There are many papers that looked at the supraspinatus as the most commonly torn rotator cuff muscle, however, there is a lack of research on the correlation between muscle morphology and injury. This was the framework for our anatomical study using cadavers, in which the circumference of the muscle bellies and tendon widths of the supraspinatus and infraspinatus muscles were measured.

Methods: 27 Cadavers provided by the Physician assistant program and first-year Osteopathic students in their respective anatomy …

Renovate, Innovate, Rejuvenate: Transforming The Oj Snyder Memorial Library, Matt Mcnelis

Research Day

Over the course of three years the staff of the PCOM Library have worked to create new spaces, offer new services, and update old processes in order to improve the visitor experience for students and staff of PCOM. Usage of spaces and services have increased, and both staff and students have anecdotally expressed their approval of the changes.

Characterization Of Ppar-Gamma 1 And Ppar-Gamma 2 In Knockin And Knockout Mouse Models, Arielle N. Roberts, Wenxiang Hu, Mitchell A. Lazar

Research Day

The global epidemic of obesity and type II diabetes has led to a growing interest in the underlying mechanisms of metabolic diseases. The peroxisome proliferator-activated receptor gamma (PPARγ) is a member of the nuclear receptor superfamily, and is vital for the transcriptional regulation of adipogenesis, insulin sensitivity and lipid metabolism. In the mouse model, it has been demonstrated that global knockout of PPARγ leads to severe metabolic disturbance, resulting in embryonic lethality. However, the specific regulatory roles of its two protein isoforms, PPARγ1 and PPARγ2, remain uncertain, due to limitations of reagents and appropriate mouse models. To investigate the hypothesis …

A Rare Variation Of The Inferior Mesenteric Vein With Clinical Implications, Sheeva Norooz, Danielle Park, Sarah Blizard, Natalie O'Toole, Martin Dela Torre, Young Son, Michael Mcguinness, Mei Xu

Research Day

The portal venous system has unique blood drainage from the gastrointestinal tract, spleen, pancreas and gallbladder to the liver. It consists of 4 large veins: the hepatic portal, splenic (SV), superior mesenteric (SMV) and inferior mesenteric (IMV). The SMV collects the venous return from the small intestine tributaries, ileocolic, right colic, middle colic and marginal veins (MarV). The IMV receives the blood from the superior rectal, sigmoid and left colic veins. However, anatomic variations of the portal venous system have occasionally been noted. During our routine gross dissection over the past years, we have found several common variations of the …

A Feather In Our Research Cap: Implementing Redcap In The Library, Jackie Werner, Meghan Dirito, Pj Grier, Skye Bickett

Research Day

The PCOM Library works to facilitate and support research across all disciplines. One method in which the Library incorporates this concept is by implementing, promoting, and teaching REDCap, a tool for data capture and for building and managing online surveys and databases. This poster presents the PCOM Library’s experiences with all steps of planning and implementing REDCap, along with lessons learned and future steps.

Colorectal Cancer In Patients Under Age 50: Staging And Mortality At A Single Institution, Jaclyn Malat, Sarah Martin, Adrian Ong, Michael Brown

Research Day

Objective: The aim of this study is to compare stage and mortality in colorectal cancer (CRC) patients above and below age 50. We hypothesize that patients under age 50 will be diagnosed at a higher stage and have a lower mortality rate. Reports show an increase in CRC diagnoses in younger patients, however, data on this patient population is limited and further investigation is required.

Methods: A 20-year review of electronic medical records was completed from 1997 to 2017 of all patients diagnosed with CRC. This data was aggregated and univariate analysis was performed.

Results: Of the …

A Case Report: The Myxomatous Mystery, Joseph Kim, Nicole P. Pantle, Jacquelyn E. Fisher

Research Day

Introduction: Primary cardiac tumors are rare with an incidence rate of 1.38 new cases per 100,000 individuals per year. Of these tumors, 75% are benign in origin and the most common type is a myxoma with a frequency of over 50%. Myxomas most commonly arise from the left atrium followed by the right atrium. Clinical presentation of a myxoma varies depending on the location, size, and shape of the tumor. For example, a patient diagnosed with a myxoma may have constitutional symptoms, cardiovascular symptoms, pulmonary symptoms etc. or may be entirely asymptomatic. Since there is no specific symptoms presented …

Nicotine And Smoking Effects On Burn Related Reconstruction Patient Outcomes And Complications Following Hospital Admission: Systematic Review And Meta-Analysis, Kevin Klifto, Pragna Shetty, Ben Slavin, Caresse Gurno, Stella Seal, Mohammed Asif, C Scott Hultman

Research Day

Patients suffering from burn-related injuries admitted to the hospital concurrently using nicotine and/or smoke are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1986 to 2018 between 8568 burn patients admitted to the hospital who use nicotine and/or smoke to 299543 burn patients admitted who do not use nicotine and/or smoke. The PubMed, EMBASE, Cochrane Library, and Web of Science databases were systematically and independently searched. Clinical …

Illicit Substance Use Effects On Burn Related Reconstruction Patient Outcomes And Complications Following Hospital Admission: Systematic Review And Meta-Analysis, Kevin Klifto, Pragna N. Shetty, Benjamin R. Slavin, Caresse F. Gurno, Stella M. Seal, Mohammed Asif, Scott Hultman

Research Day

Patients suffering from burn-related injuries admitted to the hospital concurrent illicit substance use are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1986 to 2017 between 15653 burn patients admitted to the hospital with substance use alcohol use reported by a positive toxicology screen (amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, codeine/morphine, PCP, LSD, inhalants, solvents, aerosols, legal highs), or the patient on hospital admission to 299543 burn …

Sleep, Communicative Ability, And Dietary Intervention As Predictors Of Aggression In Children With Autism Spectrum Disorder, Rafat Omar, Elizabeth Gosch, Susan Panichelli Mindel, Johnathan Roberds

Research Day

Aggression is a common behavioral issue in children with Autism Spectrum Disorder (ASD). Aggression is often treated with evidence-based behavioral treatments such as applied behavioral analysis and functional communication training. One form of intervention that has grown in popularity is to alter the child’s diet. The most popular dietary intervention, the Autism Diet, has been utilized as a form of behavior management by parents and guardians for children diagnosed with ASD to address aggressive behavior, however its use has not been strongly supported by research. We propose that a more beneficial way of understanding aggression in ASD is to understand …

Community Paramedicine To Proactively Combat Opioid Overdoses, Jeffrey Kalczynski, Justin Canakis, Novneet Sahu

Research Day

The growing problem of opioid overdoses has traditionally been combated with a reactive approach. In New Castle County, DE, a Community Paramedicine program has been implemented to make an attempt at stopping overdoses before they happen. Community Paramedicine is a mobile integrated health program that trains paramedics to visit and treat high risk patients at their homes on a non emergent basis. The aim is to prevent acute exacerbation of chronic disease. In other jurisdictions, this model has been used in an effort to reduce abuse of the 911 system and Emergency Department by "high utilizers" of the 911 system. …

Alcohol Use Effects On Burn Related Reconstruction Patient Outcomes And Complications Following Hospital Admission: Systematic Review And Meta-Analysis, Kevin Klifto, Pragna Shetty, Ben Slavin, Caresse Gurno, Stella Seal, Mohammed Asif, C Scott Hultman

Research Day

Patients suffering from burn-related injuries admitted to the hospital concurrently consuming alcohol are believed to be at an increased risk of poor outcomes and the development of complications following burn reconstruction, however data varies within the literature and remains controversial. This systematic review and meta-analysis compared outcomes and complications from studies during the years 1958 to 2018 between 813 burn patients admitted to the hospital with alcohol use reported by a positive blood alcohol concentration (BAC), intoxication, or the patient on admission to 299543 burn patients admitted who were not consuming alcohol. The PubMed, EMBASE, Cochrane Library, and Web of …

Acute Surgical Vs. Non-Surgical Management For Ocular And Peri-Ocular Burns: Oculoplastic Systematic Review And Meta-Analysis, Kevin Klifto, Ala Elhelali, Caresse Gurno, Stella Seal, Mohammed Asif, C Scott Hultman

Research Day

Burn related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve functional and cosmetic outcomes, and correct complications following poor acute phase management. This systematic review and meta-analysis compared 272 surgical to 535 non-surgical interventions within one month of patients suffering burn-related injuries to 465 eyes, 253 eyelids, 90 eyelashes, and 0 eyebrows and evaluated associated outcomes and complications. The PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes and complications were …

Aromatherapy Use For Post-Operative Nausea And Vomiting For Patients Undergoing Same-Day Surgeries, Anna Baughman, Cooper C. Anderson, Taylor Anspach, Lisa J. Choe, Lisa Y. Follett, Aubrie Bills, Lindsey Coyle, Angelsa Slampak-Cindric, Carolyn James, Tara Leisenring, Aimee Hess

Research Day

Description: Nausea and vomiting are frequent complications of anesthesia post-operatively. There is an increased prevalence of postoperative nausea and vomiting (PONV) in patients undergoing intra-abdominal and gynecologic surgeries. Many injectable and enteral medications are available for the prevention and treatment of PONV, each with the potential for side effects. Utilization of medications requires a provider order, which has the potential to delay initiation of therapy.

The use of aromatherapy via inhalation for the treatment of PONV has been shown to eliminate nausea in up to 85% of patients. Patients have reported perceived effectiveness and favorable improvement with the use …

Effects Of Pay For Performance On Performance Outcomes In Pennsylvania’S Medicaid Managed Care Program, Harry Zobel, David Kelley, Michele Robinson, Pauline Sanders, Jennifer Ibrahim

Research Day

Background and Purpose: A goal in healthcare is to reduce costs while improving quality of care, and population health. Pay for Performance (P4P) is one intervention being utilized by Medicaid programs to achieve this goal. While P4P has become a favorite among policymakers, its effectiveness in improving health outcomes is still under investigation. We assessed the role of P4P to improve provider performance by evaluating Pennsylvania’s Medicaid Managed Care (MMC) Program.

Methods: We conducted a retrospective longitudinal analysis of providers within the HealthChoices MMC Program in Pennsylvania. We examined annual provider performance outcomes for seven providers across six …

Assessment Of Appropriate Treatment Of Staphylococcus Aureus Bacteremia, Essie Samuel

Research Day

Background: Staphylococcus aureus (S. aureus) when present within the bloodstream can result in increased rates of morbidity and 30-day all-cause mortality. Previous studies have assessed the significance of Methicillin-susceptible S. aureus (MSSA) and Methicillin-resistant S. aureus (MRSA) bacteremia, where the treatment of choice is a β-lactam (or vancomycin if penicillin-allergic) or vancomycin, respectively. Rapid and appropriate antimicrobial selection is crucial for resolution of symptoms and prevention of relapse. For S.aureus bacteremia (SAB) treatment with systemic antibiotics, a short-course (14 days) can be utilized for uncomplicated cases and for patients with complicated SAB, long-course regimens are recommended at ≥ 4 weeks. …

Folate Deficiency In May-Thurner Syndrome, Haris Hatic, Suzanne Wang, Prasad S. Garimella

Research Day

May–Thurner Syndrome (MTS) is a condition defined by an anatomical variant that results in the compression of the left common iliac vein by the right common iliac artery. This case report describes MTS in a Hispanic female with folate deficiency. 44-year-old Nicaraguan female who is a lifelong nonsmoker without any past medical history presented with left leg pain and swelling for seven days. The patient stated that her whole left leg was edematous without erythema. No recent travel, trauma, surgery or immobilization of the lower extremity. Initial vitals on presentation were unremarkable. Physical exam revealed a tender swollen of left …

Adenovirus Nephritis In Kidney Transplant Recipients: Clinical Features And Management, Osamuyi Idubor

Research Day

Background: Adenoviruses (AdV) are double-stranded DNA viruses that are well recognized as cause of significant morbidity and allograft dysfunction in transplant recipients. Adenovirus nephritis (AdN) can present with hemorrhagic cystitis or tubulointerstitial nephritis. Histological evaluation demonstrates interstitial inflammation, granulomas. Here we report 8 cases of AdN in kidney transplant recipients and their clinical course, management, and outcomes.

Methods: A retrospective search to identify cases of AdN in renal transplant recipients from 2009-2016 at the Emory Transplant Center.

Results: The diagnosis of AdN was confirmed by immunostaining on kidney transplant. All patients presented with complaints of constitutional symptoms; fever, dysuria, hematuria, …

Examining Addiction Treatment Facilities: An Observational Study From The Perspective Of Medical Students, Holly Hagle, Reshma Patel, Nidhi Patel, Abigail Buckholz

Research Day

At the Institute for Research, Education, and Training in Addictions (IRETA), medical students are selected nationwide to learn about addiction and interact with patients undergoing treatment. It is well known that most medical schools do not provide significant training in addiction, and part of IRETA's goal is to remedy this need. In this study, medical students took observational field notes during site visits to various addiction treatment facilities. The data consisted of a comparison of treatment programs, as well as the results of motivational interviewing of patients. A thematic analysis was then conducted by the three students and the IRETA …

Implementing A Monitoring Program For Patients On Direct Oral Anticoagulants, Jiehyun Lee, Shally S. Singh, Michael L. Smith

Research Day

Service or Program: The Backus Hospital Medication Management Clinic located in Norwich, CT provides a newly implemented Direct Oral Anticoagulant (DOAC) management service. This service is provided by a clinical pharmacist for patients with non-valvular atrial fibrillation or venous thromboembolism. The clinical pharmacist assists in the initiation, monitors for the efficacy and safety, and provides education on the benefits and risks of DOAC therapy. The clinical pharmacist communicates to the referring physicians on any significant concerns or recommendations with DOAC therapy. Lifestyle, renal function, and other medication use will be evaluated to ensure safety and stability. The referred patients will …