Medicine and Health Sciences Commons^™

A Chronic Case Of Staphylococcus Epidermidis Osteomyelitis And Abscess In The Absence Of Foot Hardware Or Prosthesis, Joshua Salazar, Lidia Dankiv, Lauren Griffith, Gianna Grogan

Research Day

The project has showcased a unique case of chronic osteomyelitis, abscess, and cellulitis formation by S.epidermidis in the absence of foot hardware or prosthesis. The patient is a 62 yo M who presented with a chronic right foot ulcer with ongoing pain on ambulation, discharge of the RLE. PMHx includes: HTN, HLD, HIV+ (undetectable viral load; CD4: 988 cells/ml), pancreatitis, peripheral arterial disease, obesity, neuropathy, chronic EtOH and marijuana use, anxiety, a family history of DVTs and CVAs. He states that the ulcer initially opened in March 2023 due to wearing shoes without socks. Since then, it has failed to …

Statin-Associated Immune Mediated Necrotizing Myopathy: A Case Report, Emily Andrews, Graham Mcdaniel, Haiping Mei

Research Day

Background: Statins are a widely used class of drugs that have been found to be safe and effective in treating hypercholesterolemia. Used for both primary and secondary prevention, statins inhibit HMG-CoA reductase, inhibiting a vital step in cholesterol production. Statin-associated muscle symptoms (SAMS) are a clinical spectrum defined as muscle pain, discomfort, and/or weakness with or without elevated CK levels. This spectrum ranges from minimal myalgias to severe statin-associated immune-mediated necrotizing myopathy (IMNM). It is known that myocytes have upregulated levels of HMG-CoA reductase in the presence of statin use. While the exact pathophysiology of statin associated IMNM has yet …

Plaque-Like Cd34+ Dermal Fibroma On The Toe: A Case Report And Literature Review, Shaina S. Gagadam, Michael Shragher, Carmen Campanelli

Research Day

Plaque-like CD34+ dermal fibroma (PDF), also referred to as medallion-like dermal dendrocyte hamartoma (MLDDH), is a rare, benign dermal neoplasm that typically presents as a slow-growing, asymptomatic plaque. PDF is most commonly seen on the neck or trunk of young women. The pathogenesis of PDF remains poorly understood. Histologically, these lesions are characterized by the proliferation of spindle-shaped fibroblasts in the dermis, which are strongly positive for CD34 and negative for markers such as S100, Melan-A, and Factor XIIIa.

We present a case of a 57-year-old female with a one-year history of a plaque-like CD34+ dermal fibroma on the dorsal …

The All Of Us Research Program Provides An Efficient Platform For Remote Training Medical/Health Science Students In Science Methodology – Showcase: Peripartum Cardiomyopathy And Its Relationship With Proxies Of Socioeconomic Status., Nicole Blatt, Robert J. Barsotti, Brian J. Balin Phd, Eleonora Savio-Galimberti

Research Day

Background: Medicine is a science-based discipline. Scientific method investigates a problem by identifying it, formulating a question and a hypothesis to explain it, testing the hypothesis, and collecting and analyzing data that can potentially reject it. Scientific method also applies to clinical problems providing a systematic approach for diagnosis and treatment. It is an iterative process requiring repetition to achieve proficiency. Iterating processes need time that must integrate with busy schedules within medical school curricula. We explored the “All of Us” NIH-research program to introduce formal training in science methodology to medical students by conducting a retrospective analysis …

Cell Permeable Pkcβii Peptide Inhibition Reduced Cell Viability In Mcf-7 Breast Cancer Cells: Implications For Er+ Breast Cancer Treatment, Sindy P. Hernandez, Lindon H. Young

Research Day

Introduction

MCF-7 human breast cancer cells have long been used as a model for hormone receptor-positive breast cancer, which is characterized by estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and human epidermal growth factor receptor 2-negative (HER2-) status. In ER+ breast cancer, estrogen binding stimulates the transcription of genes crucial to unchecked cell proliferation, such as cyclin D1. Protein Kinase C beta II (PKCβII) has been shown to enhance estrogen-driven growth in ER+ breast cancer through phosphorylation of estrogen receptors (ERs), leading to increased transcriptional activity and faster tumor growth. Additionally, PKCβII reduces apoptosis through upregulation of Bcl-2 expression and suppression …

The Influence Of Best-Selling Skincare Products: Analyzing Benefits, Risks, And The Impact On Children, Emily M. Garelick, Shane M. Swink

Research Day

In recent years, the skincare industry has experienced a surge in product availability, with an overwhelming number of options available to consumers, especially at major retail stores like Sephora. While many of these products claim to improve skin health and are often promoted by social media influencers, their widespread use raises concerns regarding both their benefits and potential risks, particularly when it comes to children and adolescents. Approximately 95% of youth aged 13–17 report using social media, with over a third indicating that they engage with these platforms "almost constantly." While most social media platforms in the U.S. set 13 …

The Different Effects Between Trimethylamine And Trimethylamine N-Oxide On H9c2 Myoblast Cells, Jessica Tiedeken, Ann Le, Juliet Melnik, Lindon H. Young, Robert J. Barsotti, Qian Chen

Research Day

Background: Trimethylamine (TMA) is a gut-derived metabolite of choline and L-carnitine that is converted to trimethylamine N-oxide (TMAO) in the liver. Elevated plasma TMAO levels are strongly associated with an increased risk of cardiovascular disease. Previous studies suggest that TMA and TMAO promote inflammation, oxidative stress, and dysregulation of cholesterol metabolism, contributing to pro-atherosclerotic changes in blood vessels. We hypothesize that high levels of TMA and TMAO induce cardiac cell damage through oxidative stress and mitochondrial dysfunction.

Goals/Methods: This study utilizes H9c2 myoblast cells to investigate the effects of TMA and TMAO on cardiac cell function. Cells were treated with …

Comparative Functional Outcomes For Ischemic Stroke Patients With And Without Covid-19, Christopher D. Howard, Jacob R. Pascual, Samantha K. Larosa, Michelle A. Cross, Katherine A. Moore, Julie M. Reichert, Isabella L. Filippone, Nicole Chiota-Mccollum, Danielle B. Cross, Lindsey L. Perea

Research Day

Background: COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. This study examines how COVID-19 affects functional outcomes of ischemic stroke patients.

Methods: Ischemic stroke patients admitted to our Joint Commission-certified primary stroke center were retrospectively analyzed from March 1, 2020, to March 1, 2022. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022). Patients were included if they were ≥18 years old and had a stroke on admission or during hospitalization. Univariate and multivariable analyses were used, …

Protein Kinase C Delta Peptide Activator Provides Protection During Hypoxia/Reoxygenation And Elicits Significant Anti-Cancer Effects In Vitro, Juliet M. Melnik, Qian Chen, Robert J. Barsotti, Lindon H. Young

Research Day

Introduction

Protein kinase C delta (PKCδ) activation is known to inhibit NOX-2/superoxide (SO) release in polymorphonuclear leukocytes (PMNs) and elicit cardioprotective effects in ischemia-reperfusion (I/R) injury. Augmenting PKCδ activity also promotes tumor suppressive effects via apoptosis. This study examined the cardioprotective and anticancer effects of PKCδ peptide activator (PKCδ+) in endothelial cells and cardiomyocytes, cardiovascular cells particularly susceptible to oxidative damage due to their high concentration of mitochondria.

Methods

Hypoxia/Reoxygenation: Human umbilical vein endothelial cells (HUVECs) and rat cardiomyocytes (H9C2 cells), were cultured at 37°C in EBM-2 medium and DMEM, respectively and pretreated with PKCδ+ (Myr+MRAAEDPM) (0.25-5μM) or untreated …

The Impact Of Interactive Food Demonstration On Nutrition Education And Dietary Habits, Danielle Mikaliunas, Yachana Panchal, Kruti Patel, Zainab Rehman, Michael B. Roberts, Farzaneh Daghigh

Research Day

Introduction: Around 60 percent of American adults have at least one chronic disease that could mostly be managed by nutrition. The Mediterranean diet has been linked to reducing the risk of numerous health conditions, including hypertension, coronary artery disease, and other cardiovascular diseases that have high prevalence in the city of Philadelphia. This diet is known for scaling back on salt and red meats along with having an increased focus on whole grains, fruits, vegetables, legumes, olive oil, and healthy fats. With its ability to provide satiety and variation based on individual palate preferences, Mediterranean cuisine has been shown to …

Adipocyte/Progenitor Communication Axis Controls Beige Adipogenesis., Briana Noel Cortez, Nabil Rabhi, Kathleen Desevin, Jean Z. Lin, Stephen R. Farmer

Research Colloquium

The unique capacity of inguinal white adipose tissue (iWAT) to brown has emerged as a promising therapeutic approach for treating obesity and its adverse complications. Both white and beige adipose arise from a subpopulation of perivascular adipocyte progenitor cells (APC) expressing SM22 (Smooth Muscle Protein 22-Alpha). However, the early signaling events controlling ACP differentiation to beige adipocytes are still unknown.

To uncover the stromal cells heterogeneity during beige adipogenesis, we performed a single cell RNA-sequencing of iWAT under control condition, treatment with β3-adrenergic receptor (ADRB3) agonist or exposure to cold. ScRNA-seq revealed the landscape of APCs undergoing beige adipogenesis. We …

Disseminated Cryptococcosis In Solid Organ Transplant Recipient, Sonal V. Jha, Thomas V. Gonzalez, Chelsea Chang

Research Colloquium

Introduction: Invasive fungal diseases (IFD) have been reported at fairly low incidences in solid organ transplant (SOT) patients. 1 However, they are known to result in high mortality, ranging from 35%-100%, likely due to a delay in treatment caused by culture-based diagnosis.2-5 Cryptococcus are the third most common cause of fungal infection in SOT patients. 6-7

Objective: Here we present a case of disseminated cryptococcus in a patient with kidney transplantation unique in its rapid onset and presence of perinephric and perihepatic abscesses. The findings presented may inform clinicians of the potentially unusual manifestations of common fungal infections in …

Hands-On Healing: The Role Of Creative Art And Clay In Happiness And Stress Reduction, Aria Mokhtari, Mahdi Ghasemi, Melika Eshaghian, Kat Bishop, Brittany Turner, Ryan Golshir, Ana De Faria Lima, Kaylee Stone, Soojin Lee, Jennifer Cooper

Symposium of Student Scholars

Stress and mental health concerns are increasing among students at Kennesaw State University. Creativity has gained recognition for their therapeutic benefits. This research investigated the impact of clay sculpting on stress reduction and emotional well-being. Through qualitative and quantitative assessments, we analyzed participants' self-reported stress levels before and after participating in clay sculpting. A pre-and post-event survey measured the impact of engagement in these activities. After evaluating feedback and statistical trends, this study can provide evidence supporting clay sculpting as an effective tool for enhancing mental well-being among students. Stress levels were assessed using numerical rating scales (a form of …

Two 55-Word Stories: Reasonable Suspicion And There’S An Art To This, Angel Ogbeide

HCA Healthcare Journal of Medicine

Narrative medicine, specifically the 55-word story, provides clinicians an opportunity to reflect on experiences they encounter and garner significant meaning from them. These 2 stories discuss difficult situations I have experienced in my practice of medicine.

“Reasonable Suspicion” is an internal reflection on the weight of the complex decisions providers are often faced with (mandatory reporting, etc) and are not emphasized enough in health care. Doing the right thing in a clinical situation is taught. How doing the right thing can make a provider feel is not.

“There’s an Art to This” discusses grief. How do you grieve a patient? …

From Molars To Bronchus; The Tale Of An Aspirated Dental Instrument, Yisroel Grabie, Sudeep Acharya, Fasih Sami Siddiqui, Gabriel A. Chavez Reyna, Michel Chalhoub

HCA Healthcare Journal of Medicine

Background

Aspiration of dental instruments is a rare event that carries potentially serious complications when it occurs, especially in older patients, where protective reflexes are diminished. Clinical management may be difficult because of the risk of granulation tissue and different retrieval strategies according to the object’s characteristics. In this report, we describe the case of an 84-year-old man who aspirated a dental bur during a routine dental procedure, necessitating immediate intervention. Timely and precise management was essential to avert severe complications.

Case Presentation

During a routine dental procedure, an 84-year-old man aspirated a bud-shaped cross-cut carbide dental bur. Despite initial …

Using Point-Of-Care Ultrasound For The Medical Management Of Marathoners And Spectators: A Case Series, Jacob D. Pope, Casey Wilson, Kelsey Daller, Jonathan Hardin, Steven Rickett

HCA Healthcare Journal of Medicine

Background

Temporary field hospitals play a crucial role in providing medical care to individuals who experience illnesses and injuries during mass gathering events. Handheld point-of-care ultrasound (POCUS) devices offer an affordable and portable adjunct for emergency care. We present multiple patients from a field hospital during a marathon event in which handheld POCUS devices changed clinical management.

Case Presentation

A 75-year-old man who had fallen was able to be discharged after a lung exam confirmed no rib fractures or pneumothorax. A hypotensive and hypoglycemic 21-year-old man had an echocardiogram confirming volume depletion. He received treatment, and a repeat exam demonstrated …

A Case Of A Massive Right Atrial Thrombus Removal Under Transesophageal Echocardiographic Guidance, Justin Phillips, Max Kabolowsky, Alex M. Hendon, Samantha Arzillo

HCA Healthcare Journal of Medicine

Background

With the advent of catheter guided interventions, practitioners have added another tool alongside chemical lysis and surgical removal to reduce the clot burden of patients with large emboli and thrombi. Due to comorbid conditions, many patients are poor candidates for surgical or chemical clot treatment but may present optimally for catheter-based thromboembolectomy. In this case, we highlight the benefits of mechanical thrombectomy with transesophageal echocardiographic guidance to reduce the clot burden of a patient who would otherwise be considered a poor candidate for surgical or chemical treatment.

Case Presentation

This case follows a 78-year-old man with a past medical …

Pembrolizumab-Associated Acute Esophageal Necrosis: A Case Report And Literature Review, Mark Tawfik, Elie Bou Sanayeh, Stephanie Chain, Ahmed Elfiky, Stephen Mulrooney

HCA Healthcare Journal of Medicine

Background

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. They pose challenges, particularly in the form of immune-related adverse events (irAEs). Although cases of gastrointestinal irAEs have been well-documented, acute esophageal necrosis (AEN) characterized by a circumferential blackening and fragility of the esophagus, weeks after immunotherapy discontinuation, has not been reported.

Case Presentation

A 75-year-old diabetic male who was recently diagnosed with high-grade papillary urothelial cancer with liver and retroperitoneal metastases and had undergone radical cystectomy with ileal conduit urinary diversion, presented to the hospital for sepsis secondary to a urinary tract infection. While in the hospital, he experienced hematemesis, …

Resolution Of Patient’S Anaphylaxis To The Moderna Covid-19 Vaccine By Desensitization, Stefan M. Pienkowski, Marek M. Pienkowski

HCA Healthcare Journal of Medicine

Introduction

Management of patients with rare anaphylaxis to COVID-19 vaccines creates a challenge. Desensitization to medications and vaccines has proven to be effective in managing anaphylactic reactions in selected individuals with a high benefit-to-risk ratio. A previous report described the successful administration of the Moderna modified messenger RNA (MmRNA) COVID-19 vaccine via a graded dose protocol to a patient with previous anaphylaxis to the MmRNA vaccine. Our report describes successful desensitization to the MmRNA vaccine followed by administration of the full dose MmRNA vaccine.

Case Presentation

A patient with a history of chronic allergies and anaphylaxis due to insect sting …

Guillain-Barré Syndrome Following Moderna Spikevax Messenger Rna Covid-19 Vaccine: A Case Analysis, Jamie Lee Aldakkour, Alvin Boyd Newman-Caro, Hector Gonzalez-Montalvo, Usama Bardan, Guruswamy Ramamurthy

HCA Healthcare Journal of Medicine

Background

Guillain-Barré Syndrome (GBS) is an acute autoimmune polyneuropathy. Cases of GBS have been reported following administration of the vaccines for swine influenza, seasonal influenza, hemagglutinin type 1 and neuraminidase type 1, and meningococcal disease. Despite these links, a causal relationship has not been confirmed.

Case Presentation

We present a case of a 70-year-old woman who presented with progressive bilateral ascending weakness and numbness and reported receiving the first dose of the Moderna COVID-19 vaccine 2 weeks prior to presentation.

Conclusion

At the time of writing, this is the first reported case of GBS following the Moderna Spikevax COVID-19 vaccine. …

Intracolonic Migration Of A Dislocated Acetabular Cup Prosthesis, Jack R. Lubka, Cyrus Tamboli, Philip Brunetti, Sarosh Tamboli, Alex Davis, Hamish Patel, Olugbenga Oyesanmi, Michael Strobbe, Shaival Thakore, Subhasis Misra, Jeffrey Mino

HCA Healthcare Journal of Medicine

Background

Acetabular cup migration is a rare complication of hip replacement surgery. If the acetabular socket of the ilium is weak, the prosthesis can erode or pass through it. There have been multiple reports of acetabular cup prosthesis migration to the colon, creating a coloarticular fistula between the hip joint and the cecum, sigmoid colon, or rectum. We report a rare presentation of a complete intracolonic migration of a prosthetic acetabular cup without creating a fistula.

Case Presentation

A 53-year-old female patient with a remote history of a total right hip replacement presented with abdominal pain and rectal bleeding. Computed …

A Rare Instance Of Streptococcus Agalactiae Pyomyoma In A Postmenopausal Patient: A Case Report, Mariah Piazza, Sai V. Nagula, Madeleine Salzberg, Darren Preuninger

HCA Healthcare Journal of Medicine

Background

Pyomyoma is a rare, but potentially fatal, complication of uterine leiomyoma. Most cases occur in postpartum or postmenopausal patients with vascular disease and arise due to infarction and infection of existing fibroids. The proposed diagnostic triad for pyomyoma includes 1) sepsis or bacteremia; 2) uterine leiomyomata; and 3) no other apparent source of infection. We present a case of a postmenopausal patient who presented with the aforementioned triad and was found to have a pyomyoma, positive for Streptococcus agalactiae.

Case Presentation

A 67-year-old woman with no known past medical history presented to the emergency department for altered mental …

An Examination Of Health Coaching As A Developing Profession, Katie Suleta, Jonathan M. Davis

HCA Healthcare Journal of Medicine

Background

Health coaching is a field that is growing in popularity. Health coaching is not regulated and there is no standard for background, education, or training for those acting as health coaches. The purpose of this study was to investigate the burgeoning field of health coaching: who is performing it and common practices.

Methods

A total of 560 health coaching websites were reviewed to record educational backgrounds, recommendations for supplements, and the sale of supplements and/or other wellness products. Multivariable logistic regression was used to test associations between characteristics of health coaches and whether they recommend supplements, sell supplements, or …

Utility Of Incorporating Radiological Findings Of Right Heart Strain In Patients With Acute Pulmonary Embolism For Risk Stratification Of Adverse Outcomes: A Retrospective Analysis, Joshua Amaya, Sameer Allahabadi, Daniel L. Habenicht, John Hunton, Amal M. Khan, Subhash Venigalla, Curran Reddy, Jeremy V. Doan, Grace Wang, Daniel R. Eickenhorst, Shovendra Gautam

HCA Healthcare Journal of Medicine

Background

Right heart (RH) strain in the setting of pulmonary embolisms can significantly increase the risk of mortality. Thus, screening for risk of complications in these patients is crucial. The goal of our study was to assess the strength of specific diagnostic findings of RH strain for predicting adverse outcomes including mortality, hospital length of stay, and the requirement of advanced interventions.

Methods

A single-center, retrospective cohort study of 81 patients diagnosed with acute pulmonary embolism with RH strain on computed tomography pulmonary angiogram (CTPA) from September 12, 2019, to August 30, 2023. Data were collected on patient computed tomography …

Combating Physician Burnout And Fostering Wellness In Graduate Medical Education For Resident Physicians, Abdulaziz Mheir, Zohare Khan, Franklin Hernandez, Alaa Mohamed, Chandan Mitra

HCA Healthcare Journal of Medicine

Background

Over the last 2 decades, there has been a cultural shift in the graduate medical education (GME) space, focusing on an important facet: physician burnout. Burnout is defined as a combination of emotional exhaustion, depersonalization, and a lack of personal accomplishment. With increasing awareness of physician burnout, various wellness initiatives have begun to be implemented throughout training programs, and their results have been measured for effectiveness in reducing burnout rates. Due to the increasing rates of burnout emerging throughout GME programs, an initiative to evaluate our internal medicine (IM) residency on this matter was discussed with all residents at …

Severity Of Sars-Cov-2 Illness In Patients With Type 1 And Type 2 Diabetes Mellitus, Anthony Shadiack, Alexis White, Prasad Munusamy, Jessica Oleske, Parisa Biazar, Serena Mitchell, Michael G. Flynn, Nayda Parisio Poldiak

HCA Healthcare Journal of Medicine

Background

Diabetes is a well-known risk factor for the severity of illness in patients with SARS-CoV-2 infection (COVID-19). However, there is less published data on illness severity differences between patients with type 1 (T1D) and type 2 (T2D) diabetes mellitus.

Methods

We performed a retrospective review of records of patients with COVID-19 (March 2020 - November 2020) extracted from a large, private hospital system database. Of the 76 467 patients with COVID-19, 54 007 (70.6%) did not have a diabetes diagnosis (NON), 22 084 (28.9%) had T2D, and 376 (0.49%) had T1D. We further subgrouped diabetic patients into groups with …

Portable Head Computed Tomography Protocol For Trauma, Christian Quinones, Alexander Bolufer, Cory Hewitt, Sagun Tuli

HCA Healthcare Journal of Medicine

The use of portable computed tomography (CT) scanners has been shown to reduce risks associated with intrahospital transport and to expedite imaging in critically ill patients. While their use is established in intensive care units, their utility on intraoperative trauma patients remains underexplored. This paper reviews existing literature on portable CT use, defines appropriate clinical indications, outlines contraindications, and identifies quality metrics and implementation challenges. It also presents a proposed protocol for integrating portable head CT imaging into trauma workflows, focusing on early identification of intracranial or spinal injuries in the operating room. The development and analysis of standardized protocols …

Opioid Epidemic In Maine: An Analysis Of Increasing Overdose-Related Deaths Following The Coronavirus, Aysel S. Hamlin

Thinking Matters Symposium

The rate of drug overdose resulting in death doubled in Maine following the COVID-19 pandemic from the onset of the COVID-19 pandemic in late 2019 through 2022. The correlation between increased isolation during the pandemic and overdose death rates sheds a concerning light on the insufficient resources for people struggling with Opioid Use Disorder (OUD) throughout Maine. The increasing trade and access to fentanyl following the pandemic accounted for the majority of drug-related deaths in Maine in 2021 and 2022. This study examines the need for long-term access to drug treatment in rural and urban Maine, both environments with varying …

Rapid Facial Enhancement Through Surgery-First Approach Correction For Class Iii Bimaxillary Protrusion And Asymmetry, Ting-Ying Wu, Liang-Chia Huang, Yu-Jen Chang

Taiwanese Journal of Orthodontics

The Surgery-First Approach (SFA) prioritizes surgical intervention before orthodontic treatment, offering a transformative strategy for managing dentofacial discrepancies. This innovative approach provides numerous advantages, including immediate enhancements in facial aesthetics, occlusion, and phonetic function while significantly reducing overall treatment duration. SFA is especially beneficial for patients exhibiting specific characteristics, such as well-aligned teeth and minimal occlusal discrepancies. In this case study, a patient presented with persistent facial asymmetry and lip protrusion despite previous orthodontic treatment. After a thorough evaluation, the patient was deemed suitable for SFA, leading to surgical intervention. Postoperative assessments demonstrated marked improvements in facial symmetry, although minor …

Modified Mma Technique For A Patient With Bimaxillary Protrusion And Osa, Chia-Shin Gan, Chia-Tze Kao, Chih-Chen Chou, Ching-Yi Tsai, Yi-Chieh Chen, Han-Hsin Ko, Wen-Ken Tai

Taiwanese Journal of Orthodontics

Bimaxillary protrusion is a common facial profile among Asians, typically managed through non-surgical orthodontic approaches. However, when an unfavorable facial profile is combined with obstructive sleep apnea (OSA), surgical intervention may become the primary treatment choice. This case report presents a modified maxillomandibular advancement (MMA) technique in a 31-year-old male patient who presented with lip protrusion and snoring. Polysomnography revealed severe OSA with an apnea-hypopnea index (AHI) of 39.7. Clinical examination showed increased lower facial height, skeletal Class II jaw relationship, and Angle Class I malocclusion with complete overbite. Through a combination of modified MMA technique and genioplasty, we successfully …