Medicine and Health Sciences Commons^™

Prognostic Value Of Posterior Tilt Angle In Determining Outcome Of Internal Fixation Of Nondisplaced Femoral Neck Fractures, Christopher Talone, Efstratios Papadelis, Yash Chaudhry, Hunter Hayes, Mitesh P. Shah

Research Day

INTRODUCTION: As the population continues to age there is expected to be an increase in prevalence of femoral neck fractures. The standard tool for guiding treatment decisions in femoral neck fractures is the Garden Classification, which is based around the severity of displacement. Garden I and II fractures display minimal displacement and suggest internal fixation as the preferred surgical option rather than arthroplasty.

Recent literature indicates the rate of revision surgery following internal fixation of Garden I and II fractures is approximately 20%. Originally proposed by Palm et al, Posterior Tilt Angle (PTA) is a radiographic measurement that evaluates the …

Covid Vaccine Adr Survey, Frederick J. Goldstein, Demetria Ruhl, Hannah Griffiths, Steven Weaner, Rebecca Weaner, Pankhuri Walia, Nathalia Galvis

Research Day

Introduction

This study is designed to analyze experiences of the PCOM Philadelphia community regarding COVID19 vaccination. While previous studies have examined specific adverse reactions to this treatment, the present survey allowed participants to indicate which vaccine they received (Pfizer-BioNTech, Moderna mRNA-1273, or J&J/Janssen) and how many doses, as well as demographic information, underlying health conditions, prior COVID infection and symptoms, and any reaction to the COVID vaccination. Prior COVID infection is taken into consideration in this survey, as previous research has indicated that 70% of people who had not been previously infected reported Pfizer vaccine side effects, while 95% of …

Timing And Outcomes Of Hip Fracture Surgery During The Covid-19 Pandemic, Sherrie Wang, Makenzie Chambers, Kelsey Martin, Pietro M. Gentile, Rock Hwang, Rakesh Mashru, Kenneth Graf, Henry Dolch

Research Day

Introduction: The effects of delayed surgical repair for traumatic hip fractures have been widely discussed in the literature, and there exists a strong association between surgical timing and patient outcomes. The COVID-19 pandemic placed a significant burden on health care systems throughout the world, with hospitals reallocating both human and physical resources to care for the critically ill. The purpose of this study is to investigate if the strain placed on hospital systems by COVID-19 and the changes to hospital operational models negatively impacted time to surgery, as well as morbidity and mortality rates of hip fractures.

Methods: A retrospective …

Herpes Simplex Encephalitis After Covid-19 Infection, Kurt Knepley, Robert Paschall

Research Day

A gentleman in his 60’s presented to the hospital with dyspnea, fever, and hypoxia. He was diagnosed with Covid-19 pneumonia and treated with BiPAP, oxygen, dexamethasone, enoxaparin, budesonide, and albuterol. His hospital stay lasted 33 days. He was discharged home on oxygen and steroids. He returned to the hospital 3 days later with altered mental status. He was diagnosed with HSV encephalitis and treated with 2 weeks of acyclovir. Although his HSV resolved, he suffered temporal lobe necrosis and lasting neurologic dysfunction.

HSV is the most common cause of encephalitis. HSV encephalitis can occur in a host co-infected with SARS-CoV-2 …

Early Medical Education Exposure To Diversity, Equity, Inclusion, And Justice, Maayra Butt, Natalie Santucci, Kerin M. Claeson

Research Day

INTRODUCTION: The United States currently stands as an epicenter for different identities noting variations across people in ethnicity, religion, gender, and socioeconomic status. Further intersectionality among these identities creates a diverse population of individuals subsequently reflected in the field of healthcare, one of the largest systems that encompass modern society. Medical education plays a notable role in the progression of healthcare as students are the early implementers of future healthcare systems. While it is known that early exposure to cultural humility and diversity allows students to learn and grow as future providers, exposure during professional training is often limited.

OBJECTIVES: …

Wernicke Encephalopathy Following Gastric Bypass: A Case Report, Sarah Glisan, Nazim Khan

Research Day

Bariatric surgery is used as a treatment for morbid obesity and often results in rapid weight loss. This procedure has been associated with postoperative nutritional deficiencies. Neurological complications due to nutritional deficiencies include Wernicke encephalopathy, a disorder that affects the central and peripheral nervous system due to thiamine (vitamin B1) deficiency. Wernicke encephalopathy can lead to irreversible consequences if not treated early. Here, we present a case of a 40-year-old woman that developed Wernicke encephalopathy two months after gastric bypass surgery, with additional findings of flat affect and concurrent polyradiculopathy. Her diagnosis was delayed due to unique symptoms and an …

Barriers To Recruitment For A Thc Study, Fred Goldstein, Devon Player, Joseph Radakovitz, Catherine Linh, Garrett Douglas, Ben Moran, Nathalia Galvis

Research Day

Due to ongoing efforts to increase inclusion of under-represented racial and ethnic minorities in clinical studies, researchers have conducted studies to gain greater understanding as to why members of these groups have had limited enrollment. 1 Previous research indicated a widespread lack of trust in the medical community regarding clinical studies, particularly in populations of color due to knowledge of the Tuskegee study.2 Specifically, to date, there appears to be no investigation which explores reasons for hesitation to volunteer to participate in a study utilizing delta-9-tetrahydrocannabinol (THC) to reduce chronic neuropathic pain. Our PCOM IRB-approved project will attempt to uncover …

Holographic Cell Differentiation In Mixed-Species Populations, Matt Phillips, Cole Anderson, Savannah Holmes, Ezra Wylie, Ellie Evans, Thiago Vecchi, Taylor Murphy, Clint Flinders, Hunter Houtz, Carson Stubbs, Vern Hart

Utah Space Grant Consortium

Survival rates for most cancers have increased steadily over the past few decades as new technologies have led to better treatment outcomes. However, this process often relies heavily on the detection of cancer in its earliest stages, before symptoms occur or a tumor is visible in a CT or MR image. This is particularly true for diseases such as pancreatic cancer that exhibit almost no symptoms until very late stages and have extremely low survival rates as a result. Even some commonly treatable diseases, such as breast cancer, become far more problematic in later stages. As such, any efforts to …

Enhanced Neural Network-Based Cell Identification Through Vectorized Phase Information In Reconstructed Holograms, Tyler Daynes, Jeremy Tait, Rylee Russell, Harrison Welch, Vern Hart

Utah Space Grant Consortium

Survival rates for most cancers have increased steadily over the past few decades as new technologies have led to better treatment outcomes. However, this process often relies heavily on the detection of cancer in its earliest stages, before symptoms occur or a tumor is visible in a CT or MR image. This is particularly true for diseases such as pancreatic cancer that exhibit almost no symptoms until very late stages and have extremely low survival rates as a result. Even some commonly treatable diseases, such as breast cancer, become far more problematic in later stages. As such, any efforts to …

Urine Oxygen Partial Pressure Monitoring To Assess Acute Kidney Injury Risk, Lars Lofgren, Kai Kück, Natalie Silverton

Utah Space Grant Consortium

Acute kidney injury (AKI) is a common complication associated with cardiac surgery. AKI is associated with increased hospital costs, hospital length of stay (LOS), and mortality risk. The KDIGO criteria are the most common diagnostic criteria and are based on changes in serum creatinine and decreased urine output. While useful for estimating renal function, serum creatinine and urine output are not renal specific, can be influenced by factors other than kidney injury and lead to delayed AKI diagnosis which precludes injury prevention. To overcome these limitations, researchers have primarily focused on chemical biomarkers. The use of these tests is limited …

Investigating The Effects Of Radiation And Microgravity On Human Brain Organoids, Bailey Mcfarland, Chen Cheng, Yu Huang

Utah Space Grant Consortium

The brain is arguably the most important and complex component of any crewed mission. New technological developments must be made to gauge the damage of space to the brain, especially in complex and long-term missions. While it is understood that microgravity and radiation cause changes in the brain of astronauts, the nature and effects of these changes are largely unknown. To aid in elucidating these effects, we conducted experiments using a rotary cell culture system (RCCS) and are working actively with NASA to implement a chronic low-dose gamma radiation system. Initial trends in the effects of microgravity on brain organoids …

Variation In Thiopurine Metabolism In Hispanic Children, Kayeleigh Higgerson Do

Research Days

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Overall survival rate is > 90% in the United States. However, ethnic and racial disparities remain. Hispanic patients have an inferior overall survival compared to non-Hispanics. The reasons for these differences remain unclear. Mercaptopurine (6MP) is a crucial drug in ALL treatment. Variations in the TMPT and NUDT15 genes lead to altered 6MP metabolism and accumulation of toxic metabolites (6TGN or 6MMPN). Each metabolite is associated with specific dose-limiting toxicities. The accumulation of 6TGN causes myelosuppression, and increased 6MMPN causes GI toxicity. While variants in these genes have been identified …

Potassium Status In Pediatric Chronic Kidney Disease, Katherine L. Kurzinski

Research Days

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Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median serum potassium …

Association Of Rare Variants In Kidney Developmental Genes With Hypertension And Ckd: A Uk Biobank Study, Benjamin L. Spector

Research Days

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Background: Prior studies show chronic kidney disease (CKD) is heritable but only a few common variants have been associated with CKD and kidney dysfunction. Much of CKD heritability remains unknown and limited studies have explored the role of rare genetic variants in this missing heritability.

Objectives/Goal: Identify rare genetic variants in renal developmental genes associated with hypertension and CKD.

Methods/Design: We examined the association between rare variants in 58 candidate genes from five renal developmental compartments and presence of CKD and elevated blood pressure (BP) in 49,989 individuals using whole exome sequencing and phenotypic data …

Type 2 Diabetes Mellitus During The Covid-19 Pandemic, Erica Wee

Research Days

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Background The prevalence of type 2 diabetes mellitus (T2D) in youth has increased significantly over the past decades secondary to the increased prevalence of obesity. Epidemiologic data estimates that the incidence of youth-onset T2D increased 5% per year between 2002 and 2012. Recent studies have shown that childhood obesity increased with the COVID-19 pandemic. However, if this resulted in increased incidence of T2D has not been well-reported.

Objectives: This study seeks to evaluate new-onset T2D in youth during the COVID-19 pandemic (March 2020 to February 2021). We examined the frequency of new-onset T2D and proportion …

Treatment Of Recurrent Wilms Tumor With Irinotecan/Temozolomide, Meagan Vacek

Research Days

Background: Despite improvement in relapse free survival (RFS) in recurrent Wilms tumor, the 4- year RFS rate for patients treated with vincristine/dactinomycin/doxorubicin is approximately 40%. Ifosfamide, carboplatin and etoposide are commonly used in relapsed solid tumors but have significant toxicities and require hospital admission for administration. Our patient focused on quality of life, and this led to exploration of other treatment options.

Objectives/Goal: Describe a case of multiply relapsed Wilms tumor with management on oral chemotherapy for improved quality of life and remission for almost 1 year.

Methods/Design: Case Report

Results: The patient is an 11-year-old female diagnosed with Wilms …

Increasing Incentive Spirometry Use In Patients With Sickle Cell Disease Admitted To Children’S Mercy Hospital, Thomas Cochran, Alexandra Prosser

Research Days

Background: Acute chest syndrome is one of the leading causes of morbidity and mortality in patients with sickle cell disease. The National Heart, Lung, and Blood Institute (NHLBI) provides specific recommendations for providing ten breaths of incentive spirometry (IS) every two hours while awake for patients with sickle cell disease to help prevent development of acute chest syndrome.

Problem Statement: We reviewed provision of incentive spirometry at Children’s Mercy between 08/01/2021 and 11/01/2021. Data was collected and the target population was identified via a report generated from the electronic medical records with specific criteria. Of those patients admitted with sickle …

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic (130 bpm), …

Acute Complications In Pediatric Patients With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Mixed Hyperosmolar Diabetic Ketoacidosis, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), and mixed DKA and HHS (hyperosmolar DKA) are hyperglycemic emergencies for which children with diabetes mellitus (DM) are admitted to the hospital. To date, there is little evidence to guide the management of pediatric diabetic patients with hyperosmolarity.

Objectives: The objective of this study is to compare the in-hospital complications at our institution in patients who have isolated DKA to those with a component of hyperosmolarity.

Methods: We reviewed medical records of patients from 01/2019 through 12/2020 admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality …

Case Series: Bone Marrow Failure In Teen Siblings With Unique Rps19 Variant, Alexandra Prosser

Research Days

Background: Upon diagnosis of aplastic anemia, inherited bone marrow failure syndromes and acquired etiologies must be considered. Investigating causality is particularly important when multiple family members are affected. It is also essential to identify novel causative genetic variants of bone marrow failure to direct treatment in these patients.

Objectives: To describe the diagnosis and management of siblings who presented two weeks apart with severe pancytopenia and were diagnosed with severe aplastic anemia.

Methods: The first patient is a 13-year-old non-binary female who presented with severe pancytopenia on routine labs. Bone marrow biopsy revealed marked hypocellularity (0-10%) with hypoplasia. The second …

Memory T Cell Populations In Human Leukemia, Sara Mcelroy

Research Days

Background: Incorporating the immune system into cancer management is an area of robust research. Treatment modalities aimed at activating cytotoxic T cells against malignancies include immune checkpoint inhibitors, bispecific T-cell engagers, and chimeric antigen receptor (CAR) tumor-specific T cells. Most anti-cancer T cell research is narrowly focused, but knowledge about the nature of diverse sub-populations of T cells in cancer, particularly memory T cells, is vital prior to potential incorporation into therapies. T memory stem cells (Tscm) are of interest due to their longevity and powerful abilities of self-renewal and creating the full spectrum of memory CD8+ T cells, including …

Quality Improvement Project To Improve Provider-To-Nursing Communication During Daily Rounds, Kayeleigh Higgerson Do, Sara Mcelroy Md

Research Days

Problem Statement/Question: We aim that by June 2021, our Heme/Onc resident service daily table rounds will include 80% of bedside nurses to improve communication between the provider team and bedside nurse.

Background/Project Intent (Aim Statement): Daily rounds on our Heme/Onc resident service include table rounds (discussion of overnight events and daily plan) and bedside rounds (team goes to see patients and relay daily plan). These rounds infrequently include the bedside nurse caring for the patient, leading to poor communication of the plan from the provider team. This is a problem, because it has the potential to lead to medical errors …

Acute Kidney Injury In Youth With Diabetes Admitted With Isolated Diabetic Ketoacidosis, Isolated Hyperglycemic Hyperosmolar State, And Hyperosmolar Diabetic Ketoacidosis: A Single Center Experience, Erica Zarse

Research Days

Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies for which children are admitted to the hospital.

Objectives/Goal: Our objective was to compare acute kidney injury (AKI) between youth with isolated DKA to those with hyperosmolarity and explore associations to risk of AKI.

Methods/Design: Charts were reviewed from 01/2019 through 12/2020 for youth admitted with DKA (serum bicarbonate ≤16 mEq/L) and/or HHS (blood glucose ≥600 mg/dL and osmolality ≥320 mOsm/kg). Isolated HHS youth were combined with hyperosmolar DKA for analysis. AKI was defined as elevated creatinine level for age. The total amount of isotonic fluids administered was …

The Racial And Ethnic Makeup Of The Asthma Clinical Trials Informing The 2020 Nhlbi Asthma Guidelines Update, Esosa Adah

Research Days

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Rationale: Black/African American and Hispanic people in the United States are disproportionately impacted by asthma with increased prevalence, morbidity, and mortality. However, these groups are often under-represented in asthma clinical and translational research studies which is a barrier to achieving health equity. We describe the racial/ethnic makeup of participants included in clinical trials which informed the recent 2020 National Heart, Lung, and Blood Institute(NHLBI) asthma management guidelines focused update.

Methods: We identified clinical trials included within the 2020 NHLBI asthma management guidelines focused update. We determined the frequency (%) of studies reporting study participant racial/ethnic …

Variation In Laboratory & Radiographic Workup And Outcome In Children Hospitalized With Common Musculoskeletal Infections, Emily Bonanni

Research Days

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Background: Common pediatric musculoskeletal infections (MSKIs) require prompt recognition & treatment to prevent significant morbidity and mortality. Variation in initial workup of these infections & associations with clinical outcomes is not well studied and could aid development of evidence-based guidelines to provide high-value care for all MSKIs.

Objectives/Goal: Examine variation in initial lab testing & imaging obtained in patients hospitalized for common MSKIs and explore association with clinical outcomes (length of stay (LOS), cost, 30-day readmission).

Methods/Design: We performed a retrospective, multicenter cohort study of hospitalized children aged 6 months to 18 years with a …

Financial Outcomes By Severity Across Children's Hospitals, Jonathan Hartley

Research Days

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Background: Hospitalizations represent a significant driver of healthcare costs for children. Little is known about how payor type and the severity of children cared for on the pediatric medical inpatient floor impact a hospital’s financial outcomes.

Objectives/Goal: The primary objective of this study is to compare financial outcomes of pediatric hospitalizations to the medical inpatient floor across patient severity quartiles. Secondary objectives included financial outcomes stratified by payor type across severity quartiles.

Methods/Design: Retrospective cohort study included children aged 0-18 years discharged during calendar year 2019 from hospitals that reported clinical information to the Pediatric …

Spending On Public Benefit Programs And Exposure To Adverse Childhood Experiences, Megan Collins

Research Days

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Background: Adverse childhood experiences (ACEs) have been shown to be associated with poor health outcomes, and children living in poverty are more likely to experience ACEs. Our objective was to estimate the association between spending on benefit programs and cumulative exposure to ACEs among children.

Methods: This cross-sectional study examined state and federal spending, at the state-level, on 5 categories of public benefit programs: cash, housing, and in-kind assistance; housing infrastructure; childcare assistance; refundable Earned Income Tax Credit; and Medical Assistance Programs (e.g., Medicaid). The primary exposure was median annual spending per person living below …

Everyday Ethics And Equity At The Bedside, Shika Kalevor, Angie Knackstedt

Research Days

Background: Traditional bioethics training, although important, may not be completely suited to the nursing role. In contrast to traditional clinical ethics, which focuses on healthcare dilemmas, everyday ethics focuses on routine clinical encounters between clinicians, patients, and families and may be better suited to help nurses address issues such as bias and racism at the bedside.

Objectives/Goal: This study aims to provide a data-backed approach to ethics education for nurses as it pertains to improvements in the understanding of Diversity, Equity, & Inclusion (DEI) efforts in healthcare. This study also provides an opportunity for the field of bioethics to provide …

Barriers And Facilitators To Precision Medicine For Black Children With Autism Spectrum Disorder, Rachel Goodson

Research Days

Background: The field of pharmacogenomics (identification of biomarkers regarding drug metabolism and activity to inform precision prescribing) is rapidly advancing for individuals on the autism spectrum, but these advancements are not equitably benefiting all communities. Specifically, utilization data suggests that Black families may be less likely to have access to clinical precision medicine supports. Moreover, historic underrepresentation of African-descended populations in genetic reference samples means that emerging research on precision medicine will retain these biases and perpetuate disparities in downstream clinical benefit. These issues are especially relevant to the autism community, who are more likely to receive psychotropic medications that …

Likelihood Ratios For Reactions To Egg Based On Specific Ige And Oral Challenges, Melissa Anderson

Research Days

Background: Specific IgE (sIgE) to foods has been used to predict the risk of a systemic reaction (SR) when the food is ingested. An arbitrary cutoff of 0.35 is often used to separate a positive likelihood ratio (LR+) from a negative one (LR-), yet there is little evidence supporting the use of this value.

Objectives/Goal: The objective of this project was to establish a more accurate method for estimating the probability of food allergy to egg.

Methods/Design: Egg-sIgEs were measured and open oral egg challenges were performed on 155 children with a clinical history of egg allergy. Logistic regression (LR) …