Medicine and Health Sciences Commons^™

Pustular Psoriasis And The Potential Therapeutic Usage Of An Il-36 Receptor Monoclonal Antibody, Jeannel T. Miclat, Shafik Habal

Research Day

Pustular psoriasis is an uncommon subtype of psoriasis that dramatically affects the quality of life of affected patients. Pustules can emerge anywhere along the trunk, limbs, soles, palms, and fingers, which debilitates the functionality of these appendages. Currently, there are no approved treatments for pustular psoriasis in the US; off-label usage of psoriasis vulgaris medications is usually prescribed. These treatments are insufficient for patients with difficult to manage or severe forms of pustular psoriasis. Psoriasis vulgaris biologic medications mainly target the IL-17 and IL-23 axis. However, novel clinical findings have demonstrated that pustular psoriasis’s central inflammatory axis depends on the …

Evaluation Of Using 3d Printing To Design And Build Omm Spinal Models For Teaching And Education, John Matechak, Madison Cohen, Meagan Sherrington, Joy Zarandy

Research Day

INTRODUCTION: Understanding spinal mechanics is the foundation for osteopathic manipulative medicine (OMM) training. With such knowledge, osteopathic physicians may confidently diagnose and treat spinal somatic dysfunctions. However, a dynamic and objective teaching tool to educate students on spinal mechanics has not been established. While 3D printing is gaining utility in academia, it is only just beginning to be employed within osteopathic educational settings. A literature review found a single study exploring the use of 3D printing to educate students on rib mechanics. Our study makes use of 3D printing to develop a functional model to teach and test students on …

Rare First Rib Pseudoarthrosis With Thoracic Outlet Syndrome In Pediatric Gymnast: A Case Report, Jessica M. Kraft, Ann L. Contrucci, Gary E. Freed

Research Day

Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes.

Case presentation: A 10 year old Caucasian male presented with a two to …

Is There Any Benefit To Adding Corticosteroids To Radiofrequency Ablation Treatments: A Systemic Review., Lee James, Petar Jen, Nikolas Jen, Stefan Jen

Research Day

Introduction: Radiofrequency ablation (RFA) is a procedure done for chronic pain which uses thermal energy to nociceptive pathways with the goal of disrupting pain signaling. The thermal energy leads to nervous tissue disruption using radiofrequency currents through an electrode placed near the target area. RFA has been shown to have an increase in pain reduction as well as an increase in functional ability when compared to corticosteroid injections (CSI), another common treatment for both acute and chronic pain. Many clinicians have logically combined RFA and CI together to achieve a synergistic effect. This study aims to look at the current …

The Impact Of Focal Mechanical Vibration On Muscle Morphology: A Proof Of Concept Study Using Ultrasound Imaging With Shear Wave Elastography, Breana Fair, Amiah Williams, Hannah Yancy, Cameron Ogden, Ruth Maher

Research Day

INTRODUCTION: Focal mechanical vibration (FMV) uses mechanical vibration to stimulate specific muscles or areas of the body. The reported benefits include increased muscle strength, decreased pain, improved range of motion (ROM), and enhanced muscle coordination. When FMV is applied, it stimulates muscle fibers and sensory receptors in the muscle and tendon, which facilitates cyclical rapid muscle contraction and relaxation. When the muscle spindle is stimulated, a vibratory-induced inhibition can occur, which is frequency and amplitude-dependent, causing a reduction in muscle activity which may lead to improvements in joint mobility. Consequently, applying FMV to specific muscles increases the elasticity via contraction …

A Nine-Year Longitudinal Case Study Of A 27-Year-Old Male With Neurocysticercosis Presenting With New Onset Seizures, Ciara Doyle, Veronica Thompson, Amanda Ho, Joy Zarandy

Research Day

Background:

Taenia solium is a cestode endemic to regions of Latin America, Asia, sub-Saharan Africa and Oceania, and serves as the most common cause of acquired epilepsy in the world. T. solium eggs are transmitted fecal-orally when a human or pig host ingests contaminated food or water. Larvae hatch from the intestines and invade into muscle, tissue, or organs, forming cysts called cysticerci. Cysticerci involving the central nervous system is termed neurocysticercosis (NCC). Patients with NCC typically remain asymptomatic for 3-5 years in the viable stage until the host’s immune response is activated in the degenerating stage. Immune-mediated degradation of …

Risk Factors Associated With Platelet Transfusions In Patients Undergoing Atrial Septal Defect And Ventricular Septal Defect Repair, Louis Do, Maxwell James, Matt Lilien, Katie Liu, Laura Downey

Research Day

Introduction:

Pediatric patients often require platelet transfusions after cardiac surgery to treat cardiopulmonary bypass (CPB) induced platelet dysfunction.1 While platelet transfusions are often necessary to treat post-CPB coagulopathy, they have the highest rate of adverse events of blood component therapy in pediatric patients.2 Therefore, we sought to identify perioperative risk factors for platelet transfusions in pediatric patients undergoing atrial septal (ASD) and ventricular septal defect (VSD) repairs in order to identify modifiable factors that may aid in decreasing unnecessary transfusions at our institution.

Methods:

In this retrospective study, we analyzed the Society of Thoracic Surgeon’s Congenital Heart Surgery Database of …

End Of Life In The Ed – Brain Death And Organ Transplantation, Madison Cohen, Robert Griffin, Donald Penney

Research Day

Brain death is defined as the irreversible loss of all brain and brainstem functions. While the criteria for diagnosing brain death have been established and refined since 1995, physicians remain uncomfortable with making the diagnosis leading to delays in pronouncing the patient as brain dead. While seemingly benign, a delay in pronouncing a patient as brain dead can place a financial burden on the family and cause additional and unnecessary emotional distress. Furthermore, delayed pronunciation of death causes improper delegation of the medical care team's resources and loss of the patient's potential to serve as an organ donor. The purpose …

The Influence Of Nutrition On The Gut Microbiota And Psychiatric Disorders: A Review, Megha Bhagavan, Francis Jenney

Research Day

The symbiotic harboring of gut microorganisms within the gastrointestinal tract has a profound influence on host physiology, well-being, and disease pathology. More specifically, the gut bacteria are able to interact with dietary components from foods chosen by the host and consequently relay their beneficial or precarious effects locally and systemically. The gut bacteria have the capacity to maintain a healthy gut microbiome or perpetuate intestinal imbalance, known as gut dysbiosis. Gut dysbiosis has both local effects in gastrointestinal pathologies, such as intestinal bowel syndrome (IBS) and intestinal bowel disorder (IBD), as well as systemic pathologies, such as type II diabetes, …

Case Study: Lead Contamination In Soil And Plants Of A Metro Atlanta Home, Jaci Carithers, Samantha Gowen, Farmaan Judge, Brian Matayoshi

Research Day

INTRODUCTION: Lead contamination in housing developments of the Metro Atlanta Area has prompted the US Environmental Protection Agency (EPA) to establish the Westside Lead Superfund Site for soil and plant remediation efforts. As a result, affected residents have to review their own health and wellness in a different perspective due to the possibility of having lead contamination. No quantity of lead is considered safe in the human body, especially since it is known to compete with the functionality of calcium in many vital biological processes. Manufacturing and disposal procedures in lead-based industries have contributed to lead contamination of soil and …

An Investigation Of Oral Sex As A Risk Factor For Recurrent Vaginitis: A Case Study, Humza M. Baig, Kate B. Barker, Joy Zarandy

Research Day

Background:

Recurrent Vaginitis is defined as having three or more confirmed episodes within a year. Recurrence rates of vaginitis have been reported in up to 60% of previously infected women. The most common bacterial cause is due to Gardnerella vaginalis, while Candida albicans is the most common fungal cause; both microorganisms can cause opportunistic infections when imbalances occur in the vaginal environment. Commonly known risk factors include multiple sex partners, unprotected sex, douching, recent antibiotic use, and estrogen therapy.

Case Presentation:

A healthy 34-year-old female is complaining of recurrent episodes of vaginitis since the birth of her son two years …

Say That Again? Student Growth In Communication Through Conflict Management, Jillian Bailey, Diana Petrucello

Research Day

Objective: Effective communication is a characteristic that is required of clinicians but is difficult to teach. Students were challenged in their communication practices by placing them into non-complimentary communication style groups to help develop more effective, professional communication.

Methods: Students were given a communication social style test (i.e., "SELF profile") that divided individuals into one of 4 categories (S, E, L, and F) to help them identify how they best relate to others. The test rates individuals' responses in levels of introversion versus extroversion and task versus relationship communication preferences. Results from the profile were used to place students in …

Good Vibrations: The Impact Of Mechanical Focal Vibration On Erector Spinae Morphology And Lumbar Spine Range Of Motion, Karlee Chandler, Reily Robinson, Jedera Nwoke, Brandon Matic, Ruth Maher

Research Day

INTRODUCTION: Focal mechanical vibration (FMV) is a type of therapy that involves applying mechanical vibration to a specific body area. It is thought to enhance muscle activation and increase flexibility via the stimulation of muscle spindles. Muscle spindles detect changes in muscle length and trigger reflex contractions in the agonist and reflex relaxation of the antagonist’s muscle via reciprocal inhibition. Additionally, activities paired with FMV may increase lumbar range of motion, decrease pain, and improve lumbar muscle activity in those with low back pain. However, optimal parameters regarding frequency, intensity, and duration of FMV require further investigation. Ultrasound with shear …

Contralateral Hydronephrosis - An Overlooked Post-Stent Complication: A Case Report, Stav Gare, Arya Kishor, Diana Peterson

Research Day

Background: Nephrolithotripsy is the second most common procedure to remove kidney stones in the United States. While injury after stent placement is verified with irrigation and cystoscopy, secondary complications can arise once the stent is removed. The current case indicates complications can negatively impact the contralateral renal system.

Clinical Case: A 42-year-old Caucasian woman presents to the emergency room with severe right flank pain. Computed tomography imaging without contrast of the abdomen and pelvis showed severe right hydroureteronephrosis and a 7 mm distal right ureteral calculus. The left kidney and ureter were unremarkable. The patient had holmium laser lithotripsy to …

Alcohol And Tbi - Prophylactic Treatment Of Long-Term Symptoms Of Blast-Induced Traumatic Brain Injury, Isabella Canut, Kevin E. Wang, Diana Peterson

Research Day

INTRODUCTION: Blast-induced traumatic brain injury (TBI) is characterized by both immediate and long term symptoms that are hypothesized to result from hyper-excitation. The use of a neural depressant as a prophylactic protective measure in mice exposed to blast-induced TBI was evaluated.

OBJECTIVES: The primary objective of this study was to determine if ethanol can decrease the long-term symptoms associated with TBI.

METHODS: Mice were either orally gavaged 95% ethanol or saline prior to blast-pressure wave exposure. Animals were exposed to a blast-pressure wave at 20 psi. Pre and post-blast exposure, animals were assessed for tinnitus, depression, and motor abilities via …

Impact Of Vitrectomy On Intraocular Pressure (Iop) During And After Intraocular Injections, Soha Noorani, Tso-Ting Lai, Michelle Mccall, Lejla Vajzovic, Sandra Stinnett, Cynthia A. Toth

Research Day

Purpose: Intraocular injections raise intraocular pressure (IOP). Our hypotheses: (1) elevated IOP may limit subretinal bleb creation; (2) IOP will return to baseline faster in an eye with complete vitrectomy, including the area around the infusion port, as compared to one with more limited vitrectomy. We tested the impact of vitrectomy technique on IOP during and after intravitreal injections.

Methods: We created 4 groups with 3 postmortem porcine eyes per group based on level of vitrectomy: (1) no vitrectomy; (2) core vitrectomy; (3) complete vitrectomy under wide-field view without indentation and without attention to vitrectomy around the infusion port (3); …

Determining The Concentration Of Ethanol Needed For Motor Impairment In Smn2 Mice, Roshni R. Patel, Julienne B. Ryland, Enzo A. Ferrera, Diana Peterson

Research Day

Introduction: While the effects of ethanol on humans are well known, its influence on SMN2 mice, specifically on motor movement and coordination, have not been established.

Objectives: The primary objectives are to determine how varying levels of ethanol consumption alters: 1) the motor ability of SMN2 mice, 2) the time window of coordination impairment, and 3) how ethanol influences free-field behavior.

Methods: Motor impairment in SMN2 mice were measured with a RotoRod test (to test for coordination), and a free-field test (to monitor free movement and behavior). For each test, groups of animals were orally gavaged different concentrations of ethanol …

Investigating Physical Therapy Students’ Perceived Levels Of Self-Confidence To Apply Sensory Neuroscience Concepts, Jeanne Welch, Olawunmi Obisesan

Research Day

Purpose/Hypothesis: Guided by the theory of social constructivism, the purpose of this study was to investigate the overall impact of an experiential summative group assignment, The Great Toe Assignment (TGTA), on Doctor of Physical Therapy students’ perceptions of their level of self-confidence in applying sensory neuroscience concepts learned during an academic term. This study’s research questions were: What is the overall impact of an experiential summative group assignment on students’ perceptions of self-confidence in applying neuroscience concepts learned during an academic term? Are there any statistically significant differences in measurements of perceptions of students’ level of self-confidence measured at Week …

Participation Of Children And Youth With And Without Cerebral Palsy Across Settings: An Exploratory Study, Teresa Long Pierce, Alyssa Laforme Fiss

Research Day

Introduction: Cerebral Palsy is one of the most common pediatric health conditions resulting in childhood disability. Children with CP experience varying levels of functional impairments due to muscle weakness, alterations in muscle tone, balance deficits, and loss of selective motor control. These impairments and activity limitations are thought to contribute to lower levels of participation. Studies examining participation of children with CP have found that participation is positively correlated with increased physical activity and have concluded that environment is a significant predictor of participation. However, research examining participation across specific environments is lacking. Additionally, research investigating the influence of various …

The Impact Of Medication Therapy Management Services On Pediatric Patients With Medical Complexities, Charisma Osuagwu, Erica Wong, Savion Carswell, Sophia Jenkins, Xinyu Wang, Yujin Kim

Research Day

Introduction

Medication Therapy Management (MTM) is a service provided by healthcare providers to ensure the best medical outcomes, particularly for those with multiple chronic conditions. It is often provided for senior populations supported under the Centers for Medicare & Medicaid Services. Studies show that patients provided with MTM services have higher medication adherence rates and experience fewer complications. However, there are few studies on MTM counseling in pediatric populations. In this literature review study, we investigated the potential impact of MTM services for underserved pediatric populations with chronic conditions or disabilities who are likely to benefit from MTM services.

Methods …

Modified Excisional Biopsy Technique For Confirmed Or Highly Suspected Melanomas, Batul Momin, Katrina Hansen

Research Day

There are a variety of biopsy techniques for sampling confirmed or highly suspicious melanomas, including excisional, scoop-shave or “saucerization”, shave, and punch biopsy. Herein, we present a case in which a combination approach of saucerization and excisional biopsy was used for a patient with an inadequately sampled melanoma. In the literature, excisional biopsy remains the gold standard for diagnosing melanoma. This technique is accomplished with a full-thickness, fusiform removal of the lesion with a scalpel to the level of adipose tissue (2). The drawback to this technique is the slightly distorted anatomy that can occur during wound closure. Albeit rare, …

A Bone Of Contention: A Dynamic Ultrasound Assessment Of The Role Of The Radial Head In The Arthrokinematics Of The Proximal Radioulnar Joint, Kolson Lamb, Madison D. Hendricks, Courtney E. Grimes, Cameron A. Johnson, David Nguyen, Ruth Maher

Research Day

INTRODUCTION: The arthrokinematics of the proximal radioulnar joint (PRUJ) are believed to follow the convex-concave rule, meaning that when the convex radial head articulates with the concave radial notch on the ulna, rolling and gliding occur in opposite directions during forearm pronation and supination. Previous research using helical computerized tomography (CT) identified that the sequence of joint actions is in contrast with this rule, which would indicate a posterior glide of the radius on the ulna during pronation movement and the converse during supination.

OBJECTIVES: The aims of this study are to determine the arthrokinematics of the PRUJ while being …

Upper Urinary Tract Transitional Cell Carcinoma And Lymph Node Involvement: Pre And Post Operative Outcomes, Brittney Henderson, Son Young, Mark Quiring, Scott Serpico, Edward Wu, Emma Troyer, Ryan Moriarty, Thomas Mueller, Gordon Brown

Research Day

Background: Upper urinary tract transitional cell carcinomas (UUT-TCC) comprise any malignancy arising from the renal pelvis to distal ureter. These cancers account for approximately 5-10% of all urothelial tumors. Two-thirds of cases are invasive with an estimated 5-year survival rate less than 50%. Pathologic staging, invasion into local structures, and lymph node involvement influence the overall survival rate. Lymph node dissection (LND) is associated with higher overall survival rates in UUT-TCC patients, likely by decreasing regional lymph node metastasis. Current literature suggests that removing eight to ten regional lymph nodes may improve survival. The outcomes of upper urinary tract malignancies …

Silicone Stenting For Chronic Ureteral Obstruction Improves Stent Exchange Frequency, Bebe Eke, Noah Canvasser

Research Day

Introduction and Objective

Chronic ureter stenting is recommended for patients with malignant ureteral obstruction, or with benign ureteral obstruction that cannot tolerate or do not want definitive surgical management. Stents are exchanged at time intervals often limited by stent encrustation. Prior in vitro studies have demonstrated that silicone stents have less encrustation. Our objective was to compare patients undergoing chronic exchanges with polymer-based and silicone stents.

Methods

This IRB-approved retrospective study included all adult patients who underwent chronic ureter stent exchange from August 2017 through August 2022. Patients were stented with either a Boston Scientific PercuflexTM Plus or a Cook …

A Headfirst Approach – Concussion Management And Novel Diagnostic Testing, Madison Cohen, Kevin Wang, Julienne Ryland, Donald Penney

Research Day

INTRODUCTION: The incidence of concussions has become increasingly prevalent across a multitude of sports. Despite this, the current guidelines for concussion management are not well defined, which creates a significant barrier to proper evaluation and care.

OBJECTIVES: This manuscript was designed to help physicians, athletic trainers, coaches, and parents understand the clinical signs of concussion and management from the moment of injury to the athlete’s return to play. Additionally, we reviewed post-concussion sequelae and their incidence following concussion management.

METHODS: In order to better define the current approach to the management of sports-related concussions we completed a comprehensive literature review …

Mind The Gap: The Impact Of Neuromuscular Electrical Stimulation On The Inter Recti Distance Associated With Diastasis Recti Abdominis, Kaitlyn D. Alvarez, Jennifer M. Guilarte, Christia T. Hughey, Adriana N. Oceguera, Selamnesh Tezera, Jennifer Wiley, Ruth Maher

Research Day

INTRODUCTION: Diastasis rectus abdominis (DRA) is the thinning of the linea alba and an abnormal separation of the rectus abdominis. The diastasis condition leads to multiple limitations in physical and emotional well-being in individuals. DRA is an increase in the inter-recti distance leading to a gap between the rectus abdominis, which is wider than normal. The gap can be measured with digital handheld calipers; however, ultrasound imaging (US) using on-screen calipers has become the gold standard in assessment and monitoring the effectiveness of interventions to reduce the DRA. Research in non-parturient women and men is uncommon despite the presence of …

Exploring The Mysteries Of Blast Induced Traumatic Brain Injury With A Custom Device, Julienne B. Ryland, Enzo A. Ferrara, Roshni R. Patel, Diana Peterson

Research Day

Introduction: Exposure from blast-pressure waves caused by explosive devices have resulted in traumatic brain injuries (TBI) with a variety of symptoms (e.g., tinnitus, depression, coordination, and impaired motor abilities). Blast exposure causes tearing, shredding, and rotational forces on brain structures. This pathology is more prominent in cells at the edge of structures with varying density or in neurons with extensive physical volume or dendritic processes. Understanding the unique pathophysiology of TBI may be critical for appropriate treatment of these injuries. Our lab developed a blast-pressure wave device to produce a supersonic energy wave at 20 psi. This wave is identical …

The Effects Of Alcohol Treatment After Getting Blasted, Enzo A. Ferrara, Roshni R. Patel, Julienne B. Ryland, Diana Peterson

Research Day

Introduction: Traumatic brain injury (TBI) can be caused by exposure to blast pressure waves (i.e., bombs). Individuals in contact with blast pressure waves have been shown to experience various mental and physical symptoms, including tinnitus and depression. Blast-related damage causes micro-tears in the central nervous system that is caused by shearing, stretching, and rotational forces on neurons. This type of damage is too small to see in conventional imaging such as MRI or CT scans. Secondary damage can occur days or weeks after the blast-exposure. We hypothesize that this secondary damage is caused by hyper-excitation leading to excitotoxicity and cell …

Two Ais Cases, Two Surgeons, One Operating Room, One Day. The Results Of A Quality Improvement Initiative, Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. …

Respiratory Pathogen Panel Use In Hospitalized Infants <2 Months Of Age And Impact On Patient Management., Edward Lyon

Research Days

Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms able to simultaneously detect several respiratory viruses. RPP utilization is not well described in infants < 2 months of age, who frequently require hospitalization for management of acute respiratory illness (ARI) and/or fever. Detection of a viral pathogen in this age group could impact the clinician’s decision to perform additional evaluation and administer antimicrobials.

Objectives/Goal: We sought to understand predictive features and clinical management impact of RPP use in infants < 2 months of age.

Methods/Design: Between October 2017 to September 2021, participants, aged < 18 years, hospitalized with an acute respiratory infection (ARI) were enrolled in Kansas City’s New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, had symptoms consistent with ARI (e.g., cough, fever, nasal congestion) lasting < 14 days, and enrolled within 48 hours of admission. For this study, only participants < 2 months of age were included. All participants had a research RPP, but results were not available to the clinician. Per provider discretion, some infants also received a clinical RPP (cRPP). Demographic characteristics, laboratory evaluations, and antimicrobial management were compared between infants with and without a cRPP.

Results: Of the 139 participants < 2 months of age, 57 (41%) had a cRPP (table 1). A cRPP was more frequently obtained in infants < 1 month of age (n=34 [47%]) compared with infants 1-2 months of age (n=23 [35%]; p=0.17). 35 (61%) participants with a cRPP had a parental report of fever while 41 (50%) of those without a cRPP had one reported. Only 20 (35.1%) of White, non-hispanic participants had a cRPP compared to 42 (51.2%) p=0.082 who did not have a cRPP. Participants who had blood or CSF culture collected were more likely to have a cRPP obtained, 47 (82.5%) p=

Conclusions: Overall, < 50% of infants < 2 months of age hospitalized with ARI received cRPP testing. Obtaining a blood or CSF culture was associated with increased cRPP usage. The length of stay was not different between the two groups. 35 viral infections went undetected in participants without a cRPP even with accounting for positive rapid NAAT testing, further investigation is needed to understand how this may influence clinical care.