Medicine and Health Sciences Commons^™

Neoadjuvant Versus Adjuvant Therapy For Stage Iiib-Iiid Melanoma, Bhumik Patel, Sangnya Upadhyaya

Rowan-Virtua Research Day

The treatment landscape for advanced stage melanoma is rapidly evolving due to advancements in our understanding of melanoma biology and the emergence of novel therapies. This necessitates a comprehensive review to guide clinicians in adopting evidence based and patient centric approaches to treat stage IIIB-IIID melanoma. A literature review was conducted to synthesize current information on the most optimal treatment available. Data available from different clinical trials found that neoadjuvant therapy was a more effective treatment compared to adjuvant therapies alone. Furthermore, neoadjuvant therapy with combination therapy was more efficacious in producing a complete pathological response compared to monotherapy. A …

A Hiccup In The Road: Omm In The Medically Complex, Catherine F. Alapatt

Rowan-Virtua Research Day

Many patients in the hospital require multiple medications to treat their medical concerns. While medications may be highly effective, they can cause a variety of side effects. Osteopathic Manipulative Medicine (OMM) can be used as an adjuvant therapy, potentially decreasing the number of medications that patients are on and their side effects. We present a unique case of a patient with intractable hiccups who could not be solely managed with medications alone. OMM was used in this patient’s treatment plan, reducing the number of medications. The implications of this case demonstrate the need for OMM to be used more frequently …

Cut The Pressure: Blood Pressure Screening In A Community Based Setting, Harold Kareem Knight Jr., Katharine Milani

Rowan-Virtua Research Day

This study addresses the pressing issue of cardiovascular health disparities in African American males through community-based interventions, specifically blood pressure screenings and surveys conducted in a local barbershop setting. Despite a preference among participants for clinical settings, an overwhelming 97.7% expressed high comfort levels in the community-based environment, highlighting the importance of culturally sensitive approaches in healthcare delivery. With 92.5% indicating willingness to return for future screenings, the study underscores the efficacy of non-traditional settings in fostering healthcare engagement. Findings suggest the potential for broader impact through scalable, community-centric initiatives, offering promising avenues for improving health outcomes in underserved populations.

Characterization Of The Potential Of Mouse Mammary Tumor Virus (Mmtv) To Disrupt Mammary Epithelial Cell Gene Expression And Its Consequences, Neena G. Panicker

Thesis/ Dissertation Defenses

The mouse mammary tumor virus (MMTV) is a betaretrovirus known to induce breast cancer in mice. Unlike most other tumorigenic retroviruses that target hematopoietic cells, MMTV primarily targets mammary epithelial cells for infection and transformation. This makes it a valuable model for studying human breast cancer, which also originates from mammary epithelial cells. MMTV is transmitted through milk, with the highest expression occurring in lactating mammary glands due to the mammary gland enhancer and hormone-responsive elements (HREs) in its promoter. However, not much is known about how MMTV affects these cells at the molecular level. Since elevated hormonal induction during …

A Rare Case Of High Grade Lymphoma Presenting As Large Bowel Obstruction With Testicular Mass, Gianna Martini, Gino Pezzone, Tiffany Pompa, Vijaykumar Gandhi

Research Day

Large bowel obstructions can occur in many settings, including a volvulus, adhesive disease, strictures, hernias, and malignancy. In the setting of malignancy, a bowel resection is the most common initial treatment option, and histologic examination of the resected specimen can identify the underlying source of the obstructing mass. Most commonly, large bowel obstruction is due to colorectal cancer, and if metastasis is present, it will most commonly involve the liver, followed by the lungs, bone, and brain. We present a case of a 36-year-old male who presents with a large bowel obstruction and a testicular mass noted on admission. The …

The Use Of A Behavior And Symptoms Rating Scale As A Predictor Of Suicidal Ideations And Attempts In Adolescent Psychiatric Inpatients, Jessica L. Lamont-George, Susan Panichelli Mindel, Robert A. Ditomasso, Jacquelyn D'Amico

Research Day

Introduction: Suicidality is a health concern among adolescents. Approximately, 1 million people attempt suicide each year and it is the second leading cause of death for those aged 10-19. Inpatient hospitalizations may be beneficial for individuals who pose a danger to themselves or others since it provides a safe environment for the individual to receive individualized care. Many individuals who have been admitted for psychiatric inpatient hospitalization have suicidal ideations or attempts. The Child and Adolescent Behavior Assessment-Youth Scale (CABA-Y) explores an individual’s stressors and problem behaviors that may be contributing to the reasons for hospitalization.

Objective: The purpose of …

Exploring The Demographic Dynamics Of Bronchopulmonary Dysplasia: Insights From A Multicenter Study, Pallavi Kawatra, Sharon Mcgrath Morrow, Joseph Collaco, Nancy Li, Yun Li

Research Day

Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly seen in premature infants, characterized by impaired lung development and respiratory complications. Its prevalence has been steadily increasing due to advancements in neonatal care, resulting in improved survival rates of extremely premature infants. This study aims to explore the demographic relationship between gestational age and BPD outcomes, shedding light on the impact of prematurity on disease severity and long-term pulmonary health.

Methods: Data was collected from 1351 patients, with 894 patients from Johns Hopkins and 457 from Children's Hospital of Philadelphia (CHOP) from 2008 to 2023. Three hundred forty-three patients …

Renal Function As A Predictor For Post-Amputation Mortality, Danich Qadir, Theja Bhamidipati, Nadia Awad, Evan Deutsch

Research Day

Abstract

The impact of renal insufficiency on mortality and healing potential in patients undergoing limb amputation is well-known. Previous literature has pointed towards renal function and dialysis dependency as the largest contributory factors towards postoperative complications. This study reviews renal function as an independent risk factor for post-amputation complications and examines the relationship between the degree of renal dysfunction and thelikelihood of post-amputation complications.

Methods

The NSQIP database for Division of Vascular Surgery from 2022-2023 was queried and 139 amputations were reviewed. Five cases were excluded due to incomplete renal data. A total of 134 cases remained for analysis. Patient …

Bertolotti’S Syndrome: Discovery In An Elderly Patient With Persistent Back Pain, Antonio Forte, Patrick Frick, Ron Lincow

Research Day

Background: Bertolotti’s syndrome is a congenital disorder where a lumbosacral transitional vertebrate articulates with the iliac crest of the pelvis, often causing back pain in young adult patients. In the elderly, this condition is rarely incidentally found and may be due to extraforaminal stenosis with the iliac crest.

Case Summary: We report the unusual case of a 76-year-old with an over 20-year history of bilateral back pain that occasionally radiates into the left buttock and calf found to have L5 left-sided lumbosacral articulation incidentally on lumbar imaging among multiple levels of spinal stenosis. This patient completed conservative management and multiple …

Informed Consent In Shoulder And Elbow Surgery, Puru Sadh, Antonio J. Almeda-Lopez, Benjamin Hershfeld, Dan Monessa, Brandon Klein, Randy M. Cohn, Adam D. Bitterman

Research Day

Introduction:

Informed consent, a dynamic process, involves explaining procedure details to patients. Crucial for preserving autonomy, it requires comprehensive discussions, emphasizing necessity for documentation. Laws ensure awareness, but legal standards lack protection against paternalistic bias, posing legal risks. In orthopaedics, inadequacies in informed consent training contribute to litigation.

Methods:

A comprehensive literature review was conducted using the PubMed database to explore the landscape of informed consent practices in the context of shoulder and elbow surgery. The search strategy utilized a combination of Medical Subject Headings (MeSH) terms and free-text keywords, including "informed consent," "shoulder surgery," "elbow surgery," and "patient communication." …

Mycobacterium Avium Complex-Associated Vertebral Osteomyelitis In An Immunocompetent Patient: A Case Report, Jory P. Parson, Jack A. Grossweiler, Ira M. Garonzik, James E. Conway

Research Day

Introduction

Mycobacterium avium complex (MAC) infection in the spine is extremely rare, with its pathogenesis and epidemiology remaining poorly understood. Clinically, MAC infections commonly present with pulmonary, musculoskeletal, and disseminated disease. Manifestation of MAC infections, specifically disseminated disease to the spine, is uncommon in patients without human immunodeficiency virus or acquired immune deficiency syndrome.

Case Presentation

In December 2017, a 46-year-old immunocompetent man presented with severe lower back pain, right lower extremity pain, and a previous L5-S1 fusion. Imaging revealed pseudarthrosis at L5-S1 with halos around S1 screws. In March 2018, he underwent revision surgery with partial relief and began …

Clinical Outcomes And Complication Rates When Using Lyoplant Onlay Between Serial Craniectomy And Cranioplasty: A Single-Center Experience, Nathaniel Neavling, Manisha Koneru, Hamail Iqbal, Joseph Ifrach, Clint Badger, Corey Mossop, Ajith Thomas, Daniel Tonetti

Research Day

Introduction: Decompressive craniectomy is a pervasive treatment modality for malignant ischemic stroke and traumatic injury. Usage of dural substitute onlay during craniectomy closure is largely determined by provider preference. Complication rates and clinical outcomes associated with Lyoplant (Aesculap, Center Valley, PA, USA) onlay is currently not well characterized. Here, we examined the rate of complications and clinical outcomes in craniectomies performed with either Lyoplant or another dural substitute.

Methods: Patients undergoing cranioplasty following either ischemic stroke or traumatic injury at a single site were analyzed between December 2013 and June 2023. Mann-Whitney U tests and Fisher’s exact tests were performed …

Premature Closure Of The Ductus Arteriosus As A Cause Of Intrauterine Fetal Demise: A Case Report, Amélie Harpey, Walter Kobasa, Noel Anupol

Research Day

INTRODUCTION

The ductus arteriosus (DA) is a cardiac structure present in utero, allowing for the bypass of the pulmonary circulation during fetal development. The DA closes within 24-48 hours of birth. DA patency is maintained in utero by a low oxygen gradient in the blood, endothelial NO production, and prostaglandins E1 and E21. Premature closure of the DA is a rare condition and can be idiopathic, a result of abnormal levels of circulating prostaglandins, or secondary to maternal ingestion of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or polyphenol-rich foods2. Prenatal closure of the DA can lead to cardiovascular dysfunction, resulting in …

Quantifying Pthlh And Ihh Gene Expression In The Growth Plate Forming And Non-Forming Ends Of The Mouse Metatarsal, Maria Biancaniello, Sherrie Wallace, Sarah Doelp, Kelsey M. Kjosness, Philip Reno

Research Day

INTRODUCTION: The Parathyroid hormone-related protein (PTHrP, the product of the Pth-like hormone, Pthlh, gene)/Indian hedgehog (Ihh) feedback loop is a fundamental regulator of skeletal growth plates. The chondrocytes within the growth plate undergo the sequential resting, proliferative, and hypertrophic stages before being replaced by bone. Just prior to undergoing hypertrophy, pre-hypertrophic chondrocytes express Ihh, which signals back to resting cells to promote the expression of Pthlh. PTHrP then signals proliferating chondrocytes to limit their differentiation to hypertrophy and maintain a pool of mitotic cells in the growth plates of typical long bones. However, the metatarsals (MT) do not grow like …

Improvement In Coma Recovery Scale-Revised Score Following Trendelenburg Positioning In Syndrome Of The Trephined: A Case Report, Jesus Alvarado Salinas, Kayla Davenport, Ranjeev Chabra, Mithra B. Maneyapanda

Research Day

Disclosures: None

Setting: Inpatient Rehabilitation Facility

Patient: 44-year-old woman status post decompressive hemicraniectomy with suspected syndrome of the trephined.

Case Description: The patient sustained a non-traumatic brain injury secondary to ruptured right posterior communicating artery aneurysm. She required aneurysm coiling and right decompressive hemicraniectomy. Her course was complicated by right hemispheric strokes, seizures, and hydrocephalus requiring ventriculoperitoneal shunt (VPS) placement. She was admitted to inpatient rehabilitation for a specialized disorder of consciousness (DOC) program 6 weeks after the initial bleed. Her initial Coma Recovery Scale-Revised (CRS-R) score was a 3 of 23 indicating unresponsive wakefulness syndrome (UWS).

Assessment/Results: Patient remained …

Vesicular Eruption In A Woman With Systemic Lupus Erythematosus, Shane B. Devine, Harold Essenfeld, Katrina Hansen

Research Day

Introduction

Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune blistering disorder that presents as a vesiculobullous eruption in around 5% of patients with a known diagnosis of systemic lupus erythematosus (SLE). The incidence of BSLE is greater in middle aged, African-American females. In some cases, BSLE is the initial clinical presentation leading to a SLE diagnosis. The development of BSLE may be associated with active extra-cutaneous manifestations of SLE, so a prompt diagnosis of BSLE is crucial to prevent any further complications of SLE. We present a case of a vesicular eruption in a woman with a previous diagnosis …

Childhood Obesity Treatment And Approach Quality Improvement Project, Kimberly Townsend, Autumn Dye

Research Day

Introduction

Childhood obesity has become an important public health issue in the United States. Obesity is defined as a BMI at or above the 95th percentile for age and sex. Childhood obesity can be associated with many comorbidities and adverse effects, including type 2 diabetes, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia.

Methods

The data was taken from data collected throughout 2023 and 2024 from the AAP QI project on childhood obesity and treatment. The data was collected from charts at PCOM’s Lancaster Avenue clinic. Additional methods will include a literature review to outline the importance of …

Treatment Of Rosacea During Pregnancy: A Literature Review, Emily M. Garelick, Margaret C. Hurley, Lauren Noto-Bell

Research Day

Rosacea is a chronic inflammatory skin condition that affects the face and presents in many forms, including pustules, papules, painful erythema, edema, and more. The pathogenesis of rosacea is largely undetermined, but general mechanisms include immune dysregulation, neurovascular reactivity, skin barrier dysfunction and demodex infestation, genetics, and certain environmental triggers. Rosacea is commonly exacerbated during pregnancy, but the lack of treatments that are safe for a developing fetus poses a problem for patients and their physicians. The go-to treatment for rosacea consists of a variety of topical and oral antibiotics and anti-inflammatory medications that are typically not recommended for use …

The Prevalence Of Demodex Folliculorum And Brevis Colonization In Patients Presenting With Blepharitis To An Outpatient Resident Clinic, David Broytman, Eric Rosenberg, Alanna Nattis, Ryan Kent, Vinh Ngo

Research Day

Purpose: To examine the prevalence of Demodex in two large, tertiary care, outpatient resident clinic settings; meanwhile, exploring demographic variables, use of ocular medications, and OTC cosmetic products with respect to prevalence. Lastly, analyze potential inadequacies in the rate of treatment amongst patients in the resident clinic setting.

Methods: A cross-sectional non-randomized, prospective study investigating the prevalence of Demodex folliculorum (DF) and brevis (DB) in patients presenting with blepharitis, and in control patients without clinical evidence of dry eye blepharitis syndrome (DEBS). Epilation of one eyelash from each lid was performed and studied under high power light microscopy. Each patient …

Analyses Of The Correlation Of Hpv Vaccination And Oropharyngeal Cancer/Lesion In Men: From Allofus Research Database, Anna M. Terzian, Ahmad B. Cader, Qian Chen

Research Day

Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. It is most well-known as the leading cause of cervical cancer. However, there is a rising prevalence of HPV-related oropharyngeal cancers, particularly in men from high-income countries. Therefore, it is urgent to advocate prevention. This study aims to understand the correlation between the HPV vaccination and reduced HPV-related oropharyngeal cancer development. Additionally, many factors, such as race, income, risky sexual behavior, smoking, and recreational drugs are worth analyzing to appreciate their role in cancer development. This study was conducted using the AllofUs research database. The keywords included …

Challenges In Capacity: A Case Report Exploring Social Determinants Of Health And Psychiatric Illness, Hunter Smith, Jacob Light, Jenys Allende

Research Day

I. Introduction

An assessment of capacity is a critical part of the surgical consent process in order to ensure that the patient understands the risks, benefits, and alternatives to treatment. When a patient refuses life-saving care, it is essential to evaluate them to determine their capacity for decision-making. While there are specific components to a capacity evaluation, the capacity assessment process can be clouded by other factors in the patient’s history. The purpose of this case study is to illuminate the myriad challenges faced by surgeons assessing capacity in patients with complex social and psychiatric backgrounds.

II. Case

A 53-year-old …

Postoperative Stomach Volvulus And Pancreatitis Following A Sleeve Gastrectomy, Shane B. Devine, Sam J. King, Bradley J. Chatterton, Kurt Knepley

Research Day

Introduction

The laparoscopic vertical sleeve gastrectomy is the most common bariatric procedure performed globally. The greater curvature and fundus of the stomach are stapled off and removed, forming a narrower and less distensible stomach, resulting in reduced caloric intake. Postoperative complications include gastroesophageal reflux disease, leakage of the staple line, intraluminal and intra-abdominal bleeding and porto-mesenteric vein thrombosis. Additionally, gastric obstruction has been reported as a complication in 0.2-4% of cases. Most obstructions are due to either mechanical narrowing or malrotation of the sleeve caused by improper alignment of the staples. We present a patient with gastric outlet obstruction missed …

Double Crush Syndrome Presenting As Foot Drop Due To A Peroneal Neuropathy And An L5 Radiculopathy: A Case Report, James Petrera, Ronald Lincow

Research Day

Introduction: The purpose of this research is to describe a patient who presented with double crush syndrome that originally presented with signs and symptoms of a peroneal neuropathy at the fibular head. However, Electromyography (EMG) later confirmed an L5 lumbar radiculopathy. In this case report, we aim to present a rare occurrence which has been recognized, however, very few detailed reports exist.

Case Description: This is a case report of a 77-year-old male farmer who presented to the private practice with complaints of right foot-drop and bilateral low back pain. These symptoms began after falling off a ladder about 2 …

Academic Degree Bias Among Speaking And Leadership Roles At The American Academy Of Orthopaedic Surgeons Annual Meeting 2016-2021, Lucas Bartlett, Alton Daley, Adam Kazimierczak, Brandon Klein, Casey Humbyrd, Adam Bitterman, Randy Cohn

Research Day

Objective: This study examined the proportion of osteopathic physicians (DO) across various speaking and leadership roles at recent American Academy of Orthopaedic Surgeons (AAOS) annual meetings.

Design: Meeting programs from the AAOS were publicly accessed and compiled between 2016 and 2021. Two categories of AAOS meeting participants were created. Invited speaker and faculty roles included moderators of symposia and program committee members while authors of presented papers were classified into academic roles. The proportion of DOs in each role type (invited speaker, academic) were recorded for each meeting program. The representation of DO's in these roles were then examined longitudinally …

Protein Kinase C Epsilon Peptide Inhibitor Conjugated With Myristic Acid And Trans-Activator Of Transcription Attenuates Myocardial Ischemia-Reperfusion Injury In A Porcine In Vivo Model, Logan T. Clair, Sunit G. Singh, Tameka C. Dean, Desmond Boakye Tanoh, Kayla Harrell, Arjun Nair, Cameron Stinson, Annam Humayun, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Protein Kinase C epsilon (PKCε) signaling is known to mediate superoxide production from mitochondrial and uncoupled endothelial nitric oxide synthase sources in myocardial ischemia-reperfusion (I/R) injury. Previously, PKCε peptide inhibitor conjugated with myristic acid and trans-activator of transcription (N-Myr-Tat-CC-EAVSLKPT [PKCε-]; Myr-Tat-PKCε-) exhibited profound reduction in infarct size compared to Myr-PKCε- or Tat-PKCε- in ex vivo rat hearts♰. This study aims to evaluate the effects of Myr-Tat-PKCε- in porcine myocardial I/R in vivo compared to a scrambled control peptide.

Male Yorkshire castrated pigs (38-54kg) were subjected to regional I(1hr)/R(3hrs) via catheter-balloon in the left anterior descending coronary artery (LAD) at the …

Management Of Large Bladder Calculi Utilizing Dual-Action Percutaneous Lithotripsy Via Suprapubic Tube Sheath: A Novel Technique, Kayla G. Meyer, Kristofer Muzzi, Nicole Ambrose, Zachary Snow, Zachariah Taylor, Teodora Schellato, Noah R. May

Research Day

Introduction:

Development of bladder calculi is a common occurrence in patients with poor bladder emptying or retained foreign bodies within the bladder. These calculi cause irritative voiding symptoms and increase the likelihood of refractory urinary tract infections. Many techniques exist to treat bladder calculi, including endoscopic and open-surgical approaches. We present a novel technique to treat exceptionally large or difficult-to-treat bladder calculi.

Methods:

The study included three patients with bladder calculi ranging from 1.3 cm to 6.8 cm. The novel technique involved percutaneous access to the bladder using a suprapubic tube (SPT) trocar and sheath, enabling the use of a …

Comparing Practice Patterns In Acute Ischemic Priapism Management, Sami Musallam, Kayla Meyer, Noah May

Research Day

Introduction:

While AUA guidelines recommend a specific protocol for managing acute ischemic priapism, its implementation varies between emergency department (ED) providers and urologists. The absence of well-established dosing guidelines for phenylephrine further compounds its variability. Our study aims to assess the divergence in practice patterns between ED staff and urologists in the management of priapism, with a particular focus on the use of corporal blood gas and intracavernosal (IC) phenylephrine injection.

Methods:

We queried Epic electronic health records (EHR) from four Philadelphia area community hospitals for ED encounters with priapism ICD-10 codes between January 2018 and February 2023. Exclusions included …

Surgically Treated Ischial Tuberosity Avulsion Fractures In Adolescents: Risks And Outcomes Of Three Fixation Constructs, Brendan A. Williams, Matthew Titus, Nathan Chaclas, Kathleen J. Maguire, J. Todd Lawrence

Research Day

Background:

Avulsion fractures of the ischial tuberosity (AFIT) are uncommon injuries that sometimes require operative fixation for significant displacement and/or associated neurologic symptoms. Various fixation methods have been utilized, including screws, suture anchors, and cortical suspensory buttons. The purpose of this study is to review a consecutive series of surgically managed AFITs at a single institution and compare outcomes among fixation strategies. We hypothesized there would be no difference in outcomes between fixation types.

Methods:

We conducted a retrospective review of all patients treated operatively at a single institution from 2010-2022 for AFIT identified by CPT code (27215). We collected …

Body Mass Index Does Not Predict Injury Pattern Or Outcome After Motorcycle Crash, Madison E. Morgan, Lindsay Periera, Anthony Allsbrook, Jennifer Q. To, Odessa R. Pulido, Hannah Shin, Alison Muller, Adrian Ong, Christopher A. Butts, Maxwell A. Braverman

Research Day

Introduction: The obesity epidemic plagues the United States, affecting approximately 42% of the population. The relationship of obesity with injury severity and outcomes has been poorly studied among motorcycle collisions (MCC). This study aimed to compare injury severity, mortality, injury regions, and hospital and intensive care unit length of stay (LOS) between obese and normal-weight MCC patients.

Methods: Trauma registries from three Pennsylvania Level 1 trauma centers were queried for adult MCC patients (January 1, 2016-December 31, 2020). Obesity was defined as adult patients with body mass index 30 kg/m2 and normal weight was defined as body mass index/m2 but …

Naltrindole Inhibits Phorbol 12-Myristate 13-Acetate-Induced Superoxide Release By A Novel Mechanism Related To Reduced Intracellular Calcium Levels In Polymorphonuclear Leukocytes, Jennifer Dang, Cameron Stinson, Devani Johnson, Mai A. Le, Logan Clair, James Ramsarran, Desmond B. Tanoh, Annam Humayun, Alexandra Barrera, Juliet Melnik, Tameka Dean, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Introduction:

We recently showed that naltrindole (NTI) 100-200µM attenuated phorbol 12-myristate 13-acetate (PMA) induced polymorphonuclear leukocytes (PMNs) superoxide (SO) release by a novel mechanism of action (MOA) devoid of opioid receptors. We hypothesize that NTI’s novel MOA is a reduction of intracellular calcium (Ca2+). To test this hypothesis, we conducted PMA-induced PMN SO release using KB-R7943(KB). KB is known to reduce intracellular Ca2+ via inhibition of reverse mode Na+/Ca2+ exchanger and is used as a positive control to attenuate PMA-induced PMN SO release. Naloxone (NX), a broad-spectrum opioid receptor antagonist, is used as a negative control and should have no …