Medicine and Health Sciences Commons^™

Histopathological Findings Of Myocardial Tissue In Chf, Mi And Cardiac Arrest, Mohammad Malik, Johnathan Abdool, Savita Arya, Shiv Dhiman

Research Day

Introduction: Coronary arteries are responsible for perfusing the myocardium with oxygen rich blood. Based on bodily requirements, these vital arteries can quickly adjust oxygen delivery to the myocardium to meet demand. Coronary arteries, however, can become narrowed by pathologies such as atherosclerosis leading to ischemic heart disease. The most common form of ischemic heart disease (IHD) is coronary artery disease. With over 17.9 million lives lost annually, Coronary artery disease (CAD) remains the leading cause of death. CAD progressively develops overtime due to the formation of atherosclerotic plaques. These plaques can eventually rupture and result in complete occlusion of the …

Paradoxical Embolism Entrapped In A Patent Foramen Ovale, Mohammad Malik, Macy Rowan, Lucas Seibolt, Barney Beaver

Research Day

Background: According to the Centers for Disease Control (CDC), venous thromboembolisms affect 900,000 people and cause up to 100,000 deaths yearly. A less common subset of these cases includes those of which the emboli, though originating in venous vasculature, are able to pass through intracardiac defects, including a patent foramen ovale (PFO). PFOs are relatively common in the general population, with an incidence of approximately 20-30%. Though oftentimes asymptomatic, PFOs may present an opportunity for an embolism to bypass the lungs and utilize a more direct route to the systemic circulation, otherwise known as paradoxical embolism. One feared complication of …

A Unique Case Of Atrial Fibrillation Secondary To Squamous Cell Lung Carcinoma, Mohammad J. Malik, Emily K. Wilson, Vijay Bandhakavi

Research Day

Atrial fibrillation (AF) is widely considered to be the most prevalent cardiac arrhythmia with an incidence of roughly 1-2% in the United States alone. The incidence of AF has been known to increase with advancing age and thus presents a significant burden on healthcare systems across the globe. AF arises as a result of several mechanisms including structural changes that occur to the heart overtime. Here we present a case in which a 63-year-old male with no past medical history except heavy tobacco use presented to the emergency department complaining of shortness of breath. He also endorsed having palpitations and …

Liver Cirrhosis, Hydroureter And Splenomegaly In A Cadaver : A Case Study, Steven Li, Manuel S. Linarte, Teighlor N. Livingston, Nahimie K. Louissaint, Tyanna N. Mccladdie, Nishi Patel, Shiv Dhiman, Savita Arya

Research Day

Background: Liver cirrhosis is among the most common causes of death in the United States. Cirrhosis can result from alcoholic liver disease, hepatitis, or non-alcoholic fatty liver disease. Advanced cases of liver cirrhosis may result in complications such as portal hypertension, hepatosplenomegaly, varices, and many others.

Case Presentation: This report describes a case of extensive liver cirrhosis found during the cadaveric dissection of a 71-year-old male. Observation revealed a slightly enlarged, cirrhotic liver with recanalization of the umbilical vein (of the round ligament). The patient also had significant splenomegaly, indicative of portal hypertension, and dilation of the left ureter. In …

A Combined Radio-Immunotherapy Regimen Eradicates Late-Stage Melanoma In Mice., Sritha Moram, Alexander Rakhmilevich, Noah Tsarovsky, Mildred Felder, Amy Erbe, Alex Pieper, Jen Zaborek, Emily Cheng, Cole Witt, Paul Sondel

Research Day

Advanced cancers are typically resistant to treatment, which leads to most experimental cancer immunotherapy approaches being tested against smaller tumors. In this study, we show that even late-stage, weakly immunogenic mouse B78 melanomas, with tumor volumes of 1500-2000 mm3, can be eradicated by a combined radio-immunotherapy regimen (CRIR) which includes local radiotherapy, intratumoral interleukin 12, slow-release systemic interleukin 2 and checkpoint blockade with anti-CTLA-4 antibody. Flow analysis of the tumors revealed a reduction in T regulatory (Treg) cells and an increase in CD8/Treg ratios following CRIR. T cell depletion did not prevent the rapid shrinkage of treated tumors, but suppressed …

Atypical Presentation Of Obstructive Coronary Artery Disease In A Diabetic Female, Alexis Rodriguez, Zhi Kuat, Humaira Bibi, Lawrence Ukpong

Research Day

According to the World Health Organization (WHO), cardiovascular diseases (CVDs) account for 17.9 million deaths yearly and are the leading cause of mortality in the United States. CVDs are heart and blood vessel disorders, including coronary artery disease (CAD), coronary heart disease (CHD), cerebrovascular disease, cardiomyopathy, and more. In 2018, diabetic adults accounted for 1.87 million hospitalizations for major cardiovascular diseases. Diabetes Mellitus (DM) is a global epidemic affecting about 422 million people worldwide. The Centers for Disease Control and Prevention (CDC) has reported more than 37 million people in the United States are diagnosed with DM, and 1 in …

A Postmortem Analysis Of Embalmed Lungs, A Human Cadaver Study, Frederick S. Merdian, Matthew Peterman, Odinaka Osigwe, Vikash Patel, Savita Arya

Research Day

OBJECTIVE: The human cadaveric study is vital to fully understanding lung pathologies and the prevalence of potentially cancerous neoplasms upon death in the general population. Developing an accurate knowledge of human respiratory neoplastic pathology is vital in furthering the field of respiratory medicine. This study aims to analyze a cohort of lung sets belonging to human cadavers for visible potentially pathogenic neoplasms and contrast this with epidemiological data available for representative populations.

METHODS: Cadaveric lungs (n= 20 pairs; 38 individual lungs) were isolated, and gross observations were performed of the parietal surface of both lungs. These samples were part of …

Prevalence Of Hyperostosis Frontalis In Georgia Elderly Cadaver Population, Sara G. Meawad, Tristan C. Henris, Ansley Myrick, Savita Arya, Shiv Dhiman

Research Day

Introduction

Hyperostosis frontalis interna (HFI) is a condition that causes a benign thickening of the frontal bone. Many studies in the past have correlated sex with the incidence of HFI. Additionally, females, especially those postmenopausal, seem to be the predominant group affected. The primary objective of this study is to explore incidence of HFI and how it relates to the different sexes. The secondary objective is to further investigate the correlation of HFI with liver and gonadal pathologies.

Methods

A study is designed to explore the prevalence of hyperostosis frontalis interna among sexes in a sample of cadavers (n=38) at …

A Cadaveric Case Study On Metastatic Breast Cancer Pathology, Janai L. Groves, Haley B. Garrett, Savannah J. Finley, Jada M. Glenn, Itza M. Garcia, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION: Breast cancer is the second most common cancer among women in the United States. The exact etiology of breast cancer is unknown, but over 70% of breast cancer cases involve only two risk factors: being a woman and being over the age of 50. Women with a family history of breast cancer, as well as women who experience early menopause, have an even greater risk of developing this disease. When considering racial demographics, African-American women have a 4-8% lower incidence rate of breast cancer than Caucasian women but are 40% more likely to die from the disease. Breast cancer …

The Impact Of Minority Physician Representation On Minority Patient Health, Nicholas Bohannon, Emeka Ikeakanam, Evan Curry, D'Angelo Stokes, Jordan Howard, Terrence Mchugh, Jason Walker

Research Day

Background:

Before the COVID-19 pandemic, the medical profession underwent a physician burnout crisis. Post pandemic, physician burnout transformed into an epidemic that has contributed to the inability of physician supply to meet patient demand in the USA. Recent studies by the American Medical Association predict by 2034, a widespread physician shortage across both primary care and non-primary care specialties (AAMC, 2021). As a result, medical institutions have implemented programs to address this shortage. While this shortage is concerning and needs to be addressed, it isn’t the only shortage at hand. Minorities are deeply underrepresented in the medical field with respect …

A Cadaveric Case Study Of A Bifurcated Extensor Digiti Minimi And Its Implications For Medical Education, Greg Rasmussen, Jhesenia Rodriguez Victoria, Junius Rosario, Siam Shabbir, Neeti Shirke, Sofia Sirocchi, Shiv Dhiman

Research Day

INTRODUCTION: The extensor digiti minimi (EDM) is commonly presented as a single tendon originating from the muscle belly and attaching to the fifth digit. Variations in the number of EDM tendons have been previously noted, and possess potentially valuable insights for medical education.

OBJECTIVES:

The primary objective of this project was to examine the gross anatomy of the EDM tendon in a group of cadavers (n=11). The secondary objective of this project is to compare the variations discovered in this group of cadavers to other cadaveric variations reported in the literature. The tertiary objective of this project is …

Asymmetrical Axillary Artery Deviations Of The Brachial Plexus, Chadwick T. Key, Abraham Q. Khalil, Darya J. Khani, Pathya Kunthy, Alvin Lee, Shiv Dhiman

Research Day

Introduction: The relationship between the brachial plexus and other key axillary vascular structures have been explored extensively in medical literature highlighting different variations in the brachial plexus. Understanding variations provides valuable knowledge for surgical interventions. Typically at the axillary region, the lateral cord splits into the musculocutaneous nerve and the lateral root of the median nerve. The medial cord contributes the medial root to the median nerve where the axillary artery normally runs posteriorly.

Objective: The goal of this case report is to highlight a bilateral anatomical variation of the brachial plexus in relation of the progression of the axillary …

Cadaveric Study: Sign Of Leser-Trélat Associated With Breast Cancer, Brigitte L. Cochran, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION: Seborrheic keratoses (SK) is considered the most common benign skin lesions found in individuals that are middle aged and older. In dermatology practice, these lesions pose no threat to the individual but can be concerning for cosmetic and underlying malignancy reasons when they cover most of the skin surface. Of specific concern is the sign of Leser-Trélat, which has been documented as a cutaneous harbinger of underlying malignancy associated with proliferation of the size and/or number seborrheic keratoses. This rare sign is usually caused by malignancies such as gastrointestinal adenocarcinoma and lung, kidney, liver, pancreatic cancer or malignant melanoma. …

Opioid Overdose: Rural Georgia Vs. Urban Georgia - Who's Winning The Battle?, Zizah-Wosseni Blair, Justice Dove, Didem Aydin, Stacie Fairley

Research Day

INTRODUCTION: The opioid crisis is a major public health issue affecting communities across the United States, including Georgia. The widespread misuse of prescription and illicit opioids has led to a significant increase in opioid-related overdoses and deaths. The impact on Georgia communities has been devastating, affecting individuals from all walks of life and causing significant harm to families and communities. The Georgia Department of Public Health reported that the number of drug overdose deaths in the state rose by 61.9% from 2019 to 2021. Rural and Urban communities in Georgia face unique challenges in addressing this epidemic. Rural communities often …

Integrating Ai Into Culinary Medicine: A Revolution In Nutrition And Home Cooking, Emeka Ikeakanam, Evan Curry, Terrence Mchugh, Jason Walker

Research Day

Introduction

With the growing popularity of the emerging field of culinary medicine, there is a growing understanding of the culinary barriers needed to be overcome to adopt healthier eating habits. Lack of confidence, low skills, and lack of time are some of the most common barriers that prevent individuals from cooking at home. However, integrating AI can offer personalized support for home cooking and help individuals overcome these barriers. AI-powered meal planning and recipe suggestions can guide healthy and nutritious food choices that cater to their dietary needs and preferences. Additionally, AI can modify recipes to accommodate individual health conditions …

Clinical Significance Of The Anatomical Variations In Splenic Morphology, Hannah N. Jackson, Sarah Amaris, Brigitte L. Cochran, Shiv Dhiman, Savita Arya

Research Day

INTRODUCTION: From helping defend the body against infections to cleaning the blood of damaged red blood cells, the spleen is crucial to maintaining homeostasis for primates. The primary objective of this study was to analyze anatomical variations of cadaveric spleens and determine an association with demographic and clinical characteristics of individuals; and thus enrich the current understanding of splenic variations in the South Eastern part of the US.

METHODS: The present study was conducted with specimens from two gross anatomy cadaver labs, with data from donor cadavers at the Philadelphia College of Osteopathic Medicine (PCOM) Georgia and PCOM South Georgia …

Widespread Cutaneous Metastasis Of Oropharyngeal Cancer, Drew Fidler, Britany Dyer, Makayla Farr, Youmna Elkamhawy, Sammy Elmor, D’Angelo Stokes, Savita Arya

Research Day

INTRODUCTION

Oropharyngeal Cancer (OC), primarily caused by squamous cell carcinoma, has risen recently. OC is often categorized into HPV-associated carcinoma or non-HPV-associated carcinoma. Environmental factors such as tobacco and alcohol use significantly increase risk of OC and are associated with non-HPV-associated OC. While research has investigated common gene mutations associated with an increased risk of OC, there are only a few cases highlighting genes that lead to its cutaneous spread, which represents less than 10% of cases.

OBJECTIVE

This study's primary objective was to determine what genetic/environmental factors may have contributed to the development of multiple OC metastatic tumors with …

A Radiologic Analysis: Relationships Of The Thoracic Spine To Aid Palpation Of The Thoracic Transverse Processes, Christopher Baker, Darshan Patel, Michael B. Roberts, Kristie Petree, Randall L. Mcgill

Research Day

Introduction: In the field of osteopathic manipulative medicine, palpation is an important skill used by physicians to localize structures to diagnose and treat patients with somatic dysfunction throughout the musculoskeletal system. Specifically, in the thoracic spine, physicians can use the more superficial spinous process of each vertebra to assist in locating the deeper, more challenging to palpate, transverse process of the vertebra. Historically, the “rule of threes”, proposed by Mitchell et al in 1979, describing the relationships between spinous processes and transverse processes of the thoracic spine has been taught in osteopathic medical schools. However, another model was more recently …

Rare Presentation Of Metastatic Hepatocellular Carcinoma In The Finger: Case Report And Review Of Literature, F. Rhana Mousavi, Bassem Bekheit, Emon Alavi, Nick A. Hirad, Abanoub Gabra

Research Day

Hepatocellular carcinoma (HCC) is a primary tumor of the liver that primarily develops in the setting of chronic liver disease. HCC is difficult to diagnose due to it requiring the use of multiple imaging modalities with the goal to detect tumors when they are less than or equal to 2 cm in size to allow all possible treatment options to be used. Herein, we discuss a 69-year-old male with stage IV liver cancer residing in hospice presenting with left middle finger osteomyelitis and extreme pain. Radiology revealed a destructive lesion but pathology provided the diagnosis of metastatic hepatocellular carcinoma in …

Management Of Patient With Impaction Secondary To Undigested Sunflower Seed Bezoar: A Case Report, Sufia Ahmed, Anthony Adetomiwa

Research Day

Introduction: Bezoars are aggregates of undigested plant fibers, hair, or seeds that may impact in any portion of the GI tract. These bezoars if left can lead to significant complications, including perforation and peritonitis.

Methods: We report a case of a 4-year-old female patient who presented to the emergency department with constipation and severe lower abdominal pain following unsupervised consumption of a large unknown volume of sunflower seeds. Initial radiograph revealed an undigested bezoar of seeds in the sigmoid colon and rectum. The patient was managed with mineral oil enema and manual disimpaction under conscious sedation. Subsequent radiographs revealed a …

Health Disparities Within Rural Communities In The Southern Region Of The United States, D’Angelo Stokes, Jordan Howard, Terrence Mchugh, Nicholas Bohannon, Emeka Ikeakanam, Evan Curry, Jason Walker

Research Day

Intro:

Historical studies have shown that health disparities exist between urban and rural communities, however additional disparities are also known to exist within rural communities as well. These include health disparities between races, ethnicities, and socioeconomic statuses, among others. While the disparities between urban and rural communities have been researched and described more extensively, there is a paucity of information available about the disparities that exist within rural communities. Our goal in this research initiative was to characterize the disparities that exist within rural communities by examining the findings of several publications that sought to describe this phenomenon in the …

A Comparison Of Large Tbsa Scald Versus Flame Burns In Young Children, Ashley Daniel

Research Days

Background: It is generally accepted that of children with the same total body surface area of burns, those with flame burns seem to have longer lengths of stay and more complications than those with scald burns. Anecdotally we have seen the opposite to be true. Among a consortium of five US pediatric burn centers participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC), young children with scald burns seem to experience disproportionately more frequent and severe complications compared to their older counterparts and compared to patients of a similar age with flame burns.

Objectives/Goal: In this multi-institutional study, we compared …

Relationship Between Rurality And Access To Care For Families Of Hospitalized Children, Zoetta L. Mcloughlin Md

Research Days

Background: At Children’s Mercy Hospital, greater than 1 in 5 hospitalized children are from rural areas. Rural families often travel long distances for hospitalization at free-standing children’s hospitals, a median of 70 miles according to recent work. Rural families are more likely than non-rural families to experience financial insecurity, and these baseline hardships may be intensified during hospitalization due to out-of-pocket costs, lost work, inability to meet family needs, and removal from social support. However, little is known about the differences in healthcare access and resulting burdens between rural and non-rural families.

Objectives/Goal: To describe differences in demographics, health care …

Rural And Urban Caregiver Experiences Of Financial Strain And Food Insecurity During Pediatric Hospitalizations, Rachel E. Granberg

Research Days

Background: Stress is common among caregivers of hospitalized children. In addition to stress related to their child’s illness, caregivers experience stress related to financial strain and food insecurity during their child’s hospitalization. The burden of financial strain and food insecurity related to pediatric hospitalizations may vary between rural and urban populations.

Objectives/Goal: To identify financial strain and food insecurity experienced by caregivers of hospitalized children and to describe differences between rural and urban populations.

Methods/Design: A prospective cross-sectional survey enrolled a random sample of caregivers of hospitalized children between 8/31/2021 and 12/2/2022 at a single children’s hospital. Demographic information was …

Female Authorship Concordance In Academic Pediatrics, Roxana Guggenmous, Jessica L. Bettenhausen, Jessica L. Markham

Research Days

Background: Gender disparities are well described in medicine and academia. Despite a catalyzed movement towards gender equity, female physician-scientists remain at risk for experiencing biases in hiring practices, compensation, promotion, appointment to leadership positions, and achievement of extramural funding through the National Institutes of Health. In pediatrics, the female workforce has grown consistently over time, with female physicians comprising 72.3% of the workforce as of 2021, yet prior work suggests that this growth is not fully reflected in academic publications. Achieving gender parity in academic publication may help reduce gender-based disparities impacting career advancement. Therefore, we sought to describe the …

A Novel Therapy For Refractory Cbfa2t3::Glis2-Associated Amkl Using Stro-002 And Plerixafor, Amy Johnson Md, Mba, Alan S. Gamis, Arturo Molina, Soheil Meshinchi, Karen Lewing

Research Days

Background: CBFA2T3::GLIS2-associated AML (CBF/GLIS AML) is an aggressive form of AML often associated with AMKL and recognized by its unique RAM phenotype by flow. It has a very poor prognosis, frequently refractory to standard of care regimens, with extreme marrow localization of leukemic blasts likely mediated by high CXCR4 (CD184) expression. The CBFA2T3::GLIS2 fusion gene is the most common oncogenic transcript in pediatric AMKL and universally results in high expression of FOLR1 surface antigen. STRO-002, an antibody drug conjugate targeting FOLR1, is currently in Phase I clinical trials for adults with refractory ovarian and endometrial malignancies A summary of 17 …

Understanding Home Visitor Attendance At Well Child Checks: A Mixed Methods Study, Rachel Segal, Sommer Rose, Marcia Dutcher, Tyler Myroniuk, Mary Moffatt, James Anderst

Research Days

Background: Early childhood home visiting programs have variable outcomes on child health across models and studies. Given this variability, novel approaches are needed to foster consistent positive outcomes. One approach is attendance of a home visitor (HV) at medical provider well child checks (WCCs) to provide a stronger link between home visiting and the medical home. This process may be assessed in an exploratory study evaluating the qualitative perceptions and initial quantitative effects of the intervention.

Objectives/Goal: Qualitatively explore perspectives of HVs attending WCCs and quantitatively evaluate effects of the practice on (1) family compliance with American Academy of Pediatrics …

Pediatric Educational Outreach To A Community Based Emergency Department: Clinical Management Of The Febrile Infant, Jess Parker, Frances Turcotte Benedict, Emily Hillman, Ryan C. Jacobsen, Ashley K. Sherman, Arjun Sarin

Research Days

Background: Multiple studies have shown variability in the approach to treatment of febrile infants ≤ 60 days of age in community emergency departments (EDs), and the American Academy of Pediatrics (AAP) recently published new guidelines on management of febrile infants. Therefore, an opportunity exists to provide evidence-based recommendations for the care of this patient population to providers in community EDs.

Objectives/Goal: To assess 1) alignment of community ED provider practices with an AAPinformed Clinical practice guideline (CPG) for management of febrile infants ≤ 60 days of age. 2) change in comfort level and degree of alignment after targeted education.

Methods/Design: …

Inpatient Insulin Management For Severe Hypertriglyceridemia In Pediatrics, Erica Wee, Ryan Mcdonough, Matthew M. Feldt

Research Days

Background: Severe hypertriglyceridemia (SHTG) is defined as triglyceride (TG) >= 1000 mg/dL and increases the risk of developing acute pancreatitis. Insulin activates lipoprotein lipase which accelerates chylomicron degradation leading to a rapid decrease in TG levels. There is a paucity of pediatric standard of care for insulin use to treat SHTG.

Objectives/Goal: Our objective was to develop a protocol to standardize SHTG management using insulin infusion and decrease the duration of SHTG resolution while preventing hypoglycemia.

Methods/Design: Endocrinology, Evidence-Based Practice, Hospital Medicine, Critical Care, Gastroenterology, Pharmacy, and Nursing met to develop the protocol. Pediatric and adult literature were reviewed, and …

Socioeconomic Factors And Picu Interventions In High Mortality Risk Asthmatics, Hanh Ho, Paul N. Bauer, Jade B. Tam-Williams

Research Days

Background: Asthma mortality rates are overall lower in children, but studies estimate 5-10% of asthmatics have refractory mortality prone asthma. Asthmatics with repeat pediatric intensive care unit (PICU) admissions are believed to be at high mortality risk with increased health care utilization and socio-economic challenges.

Objectives/Goal: We aim to identify patients with repeat PICU admissions for status asthmaticus and characterize the levels of interventions and socio-economic status.

Methods: A retrospective chart review was done on patients with the following inclusion criteria: age 0- 18, PICU admission between January 2010 to December 2015, and a diagnosis of status asthmaticus on admission. …