Medicine and Health Sciences Commons^™

Transcranial Magnetic Stimulation In Treatment Of Ataxia- A Novel Approach, Pravalya Varanasi, Akshatha C. J, Krishna K. R

Digital Journal of Clinical Medicine

Abstract: -

Ataxia is a disabling clinical condition characterized by impaired motor coordination, balance, with restricted treatment options. There is growing evidence of Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, as a potential treatment option in various types of ataxias. We present a case series of two patients with ataxia of a paraneoplastic cerebellar degeneration and a hereditary aetiology treated with rTMS. Both patients showed significant improvement in ataxia symptoms following rTMS stimulation targeting the cerebellum and motor cortex. These findings highlight that rTMS may be used as a potential treatment modality in cases of ataxia irrespective of …

A Study Of Electrocardiogram And Echocardiography Parameters Of Post Covid – 19 Patients, Venkateswararao K, Durga Prasad Sadhupati

Digital Journal of Clinical Medicine

Background: Coronavirus Disease – 2019 [COVID-19] infection is multisystem disease not restricted to the lungs it has negative impact on Cardiovascular system by activation of ACE-2 receptors causing plaque stability, vascular inflammation and MI. ECG and 2D ECHO is a simple bed side diagnostic test can be used to assess cardiovascular disease involvement in such patients. We aimed to find out ECG and 2D ECHO abnormalities of Covid – 19 patients. To Study relation of SARS-COV-2 infection and Prevalence of Cardiovascular disease.

Methods: We perform Cross Sectional study among 500 Post Covid – 19 patients [>20 and

Results: Out …

Subclinical Myocardial Disease: The Next Frontier In Cardiovascular Prevention., Param Darpan Sheth, Chandana S., Nimrah Rehman

Digital Journal of Clinical Medicine

Subclinical myocardial disease refers to pathological cardiac changes that precede overt symptoms. It represents an emerging frontier in cardiovascular disease prevention; wherein early detection of myocardial dysfunction could allow timely intervention to avert heart failure (HF) and other outcomes. This narrative review summarizes the current and emerging tools for detecting subclinical myocardial disease, including advanced cardiac imaging and circulating biomarkers, and discusses their potential to improve risk stratification and preventive care in asymptomatic high-risk individuals. Novel echocardiographic measures such as global longitudinal strain (GLS) can unmask subtle systolic dysfunction despite preserved ejection fraction, while cardiac magnetic resonance (CMR) tissue mapping …

Comparison Of Transversus Abdominis Plane Block Versus Intrathecal Clonidine In Lower Segment Caesarean Section - A Prospective Observational Study, Christy Maria Paul, Dr Somsundar R G Associate Professor, Dr Archana B N Assistant Professor, Dr. Shivakumar G Pofessor And Hod

Digital Journal of Clinical Medicine

Comparison of Transversus Abdominis Plane Block versus Intrathecal Clonidine in Lower Segment Caesarean Section - A Prospective Observational Study

Background and Objective: In the majority of abdominal procedures, transverse abdominis plane block, one of the fascial plane blocks, has been used extensively to treat post-operative pain. Ultrasound has gained popularity in the management of cesarean patients due to its ease of use and reduced adverse effects.To assess the effectiveness of ultrasound guided transverse abdominus plane block with intrathecal clonidine for post surgical pain control in lower segment cesarean patients.

Material and Methods: This prospective observational study was done in …

The Relationship Between Food Insecurity And Low Birthweight Across Us Counties And Related Racial Disparities, Marissa A. Beldon, Shondra L. Clay, M. Courtney Hughes, Kathryn Mazurek

Faculty Articles, Papers, and Other Scholarship

Objective

To explore the relationship between low birthweight (LBW) and food insecurity across US counties and determine whether this relationship differs between Black and White women.

Methods

LBW data was derived from the 2013–2019 National Center for Health Statistics and National Vital Statistics System Birth Files. Food insecurity data was derived from Feeding America’s 2013–2019 Map the Meal Gap project. Analyses included descriptive statistics and regression models.

Results

Data were available for 3037 US counties. Food insecurity significantly predicted county-level LBW (t(3035) = 44.48, P <  .001) and explained 39.46% of the variance in LBW (F(13,035) = 1978.03, P <  .001, R = .63). Food insecurity predicted LBW for …

Gamified Mhealth System For Evaluating Upper Limb Motor Performance In Children: Cross-Sectional Feasibility Study, Md Raihan Mia, Sheikh Iqbal Ahamed, Samuel Nemanich

Computer Science Faculty Research and Publications

Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper limb (UL) movements needed for completing activities of daily living. Gold-standard laboratory assessments of the UL are objective and precise but may not be portable, while clinical assessments can be time-intensive. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential advanced technology to assess UL motor functions.

Objective: This feasibility study examines whether MoEvGame can assess children’s whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to …

Comparative Evaluation Of Three Endodontic Rotary File Systems In S-Shaped Root Canals: An In-Depth Analysis, Mudher Bahar

Theses and Dissertations

Objective: This study compares three endodontic file systems—XP‐3D Shaper⁺, EdgeFile X7 and WaveOne Gold in S‐shaped simulated canals in resin blocks. It aimed to quantify canals volumetric changes post‐instrumentation to guide clinical selection of a system that preserves tooth structure while efficiently shaping root canals.

Methods: Thirty S‐shaped canals in resin blocks were divided into three groups (n=10) for instrumentation with XP‐3D Shaper⁺, EdgeFile X7 or WaveOne Gold using the crown‐down technique and manufacturers recommended settings. A no‐treatment control provided a baseline for volumetric changes measured via CBCT scans analyzed with ITK‐SNAP. Data were analyzed using ANOVA and Tukey’s test …

Subgingival Microbiomes Of Healthy And Periodontitis Subjects, Tareq Abdulrasoul

Theses and Dissertations

Background: Periodontitis is a common chronic inflammatory disease triggered by the dysbiosis of the subgingival microbiome. 16s rRNA sequencing has been used to profile the subgingival plaque samples in healthy and periodontitis subjects. Here, we have collected subgingival plaque samples from subjects and analyzed the microbiome profile from 16s rRNA sequencing. We hypothesized that periodontitis patients will have a different subgingival microbiome profile than that of healthy subjects.

Methods: Subgingival plaque samples were collected from periodontitis and healthy subjects who were indicated for periodontal surgeries (osseous resective and regenerative surgery for periodontitis patients or crown lengthening for healthy …

Development Of A Mediation Model Of Pain Cognition In Adult Patients With Sickle Cell Disease, Daniel M. Sop

Theses and Dissertations

Pain is a hallmark of Sickle Cell Disease (SCD), a genetic hemoglobinopathy characterized by chronic hemolytic anemia, vaso-occlusion, and organ damage. While acute vaso-occlusive crises (VOC) have been extensively studied, the mechanisms underlying chronic pain and its interplay with brain function remain unclear. This dissertation investigates the relationships between cerebral blood flow (CBF), fluid cognition, and pain sensitivity in adults with SCD, utilizing advanced imaging techniques and validated assessment tools.

Arterial spin labeling (ASL) and functional magnetic resonance imaging (fMRI) were employed to measure CBF and brain activity, respectively. Pain sensitivity was assessed using the Pain Sensitivity Questionnaire (PSQ), and …

Immersive Medical Practice And Clinical Training: Virtual And Mixed Reality In Pharmacy And Orthopedic Surgery, Silas Semprini De Toledo Contaifer

Theses and Dissertations

Extended‑reality (XR) technologies including virtual reality (VR) and mixed reality (MR) offer new ways to improve training and surgical precision. This thesis evaluates their educational and clinical impact through two complementary studies.

Specific Aim 1 compared an immersive 360° video VR module with conventional training for teaching USP < 797> sterile‑compounding skills to second‑year PharmD students (N = 36). VR trainees raised their knowledge from 6.14 ± 1.55 to 8.69 ± 1.07, yet the overall post‑test advantage versus control was not statistically significant (U = 71.50, p = 0.21). Item‑level McNemar testing showed significant VR‑exclusive gains on three critical questions (K5, K6, …

Hafnium Oxide-Based Nanoheterostructures For Catalytic Radiosensitization And Enhanced X-Ray Radiotherapy, Marlen Dariela Calix Quezada

Theses and Dissertations

Orthovoltage X-ray beams are attractive for surface and intra-operative radiotherapy. Yet, their clinical utility is constrained by rapid attenuation and the limited dose that can be delivered without harming healthy tissue. High-Z hafnium oxide (HfO₂) nanoparticles can boost local energy deposition through the photoelectric effect, while catalytic surface defects accelerate water radiolysis. Harnessing both mechanisms in a single nano-heterostructure could enable potent radiosensitization at diagnostic-range energies.

This thesis develops and evaluates HfO₂-based nanoheterostructures, both bare and Au-decorated, as catalytic radiosensitizers.

Two types of HfO₂ were evaluated, one was synthesized following a specific route and the …

Enhancing Clinical Trial Matching In Molecular Diagnostics: Using Natural Language Processing And Clustering Approaches In Hematological Malignancies, Gillian Fanning

Theses and Dissertations

Clinical trial matching is a critical component of personalized medicine, particularly in the management of hematologic malignancies. At Virginia Commonwealth University (VCU) Health, the Molecular Diagnostics (MDX) Lab produces somatic variant reports and recommends clinical trials based on the presence of clinically significant mutations. However, the current manual trial recommendation process is time-intensive and lacks scalability.

This study introduces a computational framework to streamline and standardize clinical trial matching using natural language processing (NLP) and unsupervised clustering. Trial brief descriptions were analyzed to extract frequent terms, and trials were grouped based on term similarity using joint dimensionality reduction and clustering. …

Rare Variant Analysis Of Electronic Health Record-Defined Major Depressive Disorder In The All Of Us Research Program, Stephen Emil Vieno

Theses and Dissertations

The underlying pathogenesis of MDD remains poorly understood, with multiple competing hypotheses regarding its exact etiology. As a heterogeneous disorder with relatively low heritability, large-scale genome-wide association studies of MDD have relied on increasingly large sample sizes to identify common genetic variants associated with the disorder. However, the rare variant genetic architecture of MDD is still largely unknown. The aim of the present analysis was to use the AoU—a United States-based biobank that integrates healthcare records from over 50 healthcare systems and possesses whole genome sequencing data for participants—to perform a gene set–based analysis of MDD. This analysis presented several …

Modeling Vaccination Strategies And Intervention Impacts On Infectious Disease Dynamics, Elizabeth B. Amona

Theses and Dissertations

This dissertation explores how mathematical and statistical modeling can inform vaccination strategies and evaluate the impact of interventions during infectious disease outbreaks. Motivated by the challenges observed during the COVID-19 pandemic, the research integrates compartmental modeling, Bayesian inference, and agent-based simulation to assess policy effectiveness and disease control across varying contexts. The first study develops a SEIRDV model that incorporates government interventions and vaccination rollout to examine COVID-19 dynamics in Qatar. A Bayesian approach is used to estimate parameters and compute time-varying transmission rates. The model captures shifts in transmission following policy changes and quantifies the reduction in deaths attributable …

Automated Treatment Planning Framework For Cervical Cancer In Brachytherapy, Suman Gautam

Theses and Dissertations

Brachytherapy (BT) is a critical treatment modality for cervical cancer that delivers ionizing radiation directly to the tumor using intracavitary (IC) and/or interstitial (IS) applicators. In high dose-rate (HDR) BT, a remote afterloader guides the radioactive source to specific dwell positions for defined durations, known as dwell times, allowing for a conformal dose to the tumor while minimizing exposure to surrounding organs at risk (OAR). However, due to the inherent nature of ionizing radiation, some dose to OARs is unavoidable, creating a fundamentally conflicting objective in treatment planning: maximizing tumor coverage while minimizing OAR dose. This characterizes the problem as …

Major Adverse Cardiovascular Events Are Less Frequent In Psoriasis Patients Starting Glp-1ra Compared To Controls: An Observable Retrospective Cohort Study, Ana Ormaza Vera, Marla F. Osorlo, Madison Olexson, June Choi, Chunghwan Ro, Clinton Enos

Department Dermatology Faculty Publications

Background: Psoriasis is an independent risk factor for major adverse cardiovascular events (MACE). We have previously shown that psoriasis patients with dyslipidemia have an increased incidence of MACE despite treatment with a biologic and a statin. Glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown to reduce MACE in patients with type 2 diabetes and obesity, comorbidities that commonly co-occur with psoriasis. However, the association between GLP-1RA and the incidence of MACE among patients with psoriasis remains unknown.

Methods: We conducted a retrospective cohort study from 2014-2024 using a large, multi-center, electronic health record network (TriNetX). Patients aged 18-90 who started GLP-1RA …

Irritable Bowel Syndrome Risk In Acne Patients: Implications For Dermatologic Care, Alex Y. Liu, Ana Ormaza Vera, Clinton W. Enos

Department Dermatology Faculty Publications

[Practice points]

• Clinicians should consider monitoring for early signs of irritable bowel syndrome (IBS) in adult patients with acne to facilitate prompt diagnosis and intervention.
• Clinicians should remain judicious when prescribing antibiotics for acne management to minimize potential disruptions to the gut microbiota and the risk for IBS.
• Isotretinoin may serve as a safer alternative to antibiotics in patients with acne, particularly those with gastrointestinal concerns.

Scopolamine-Induced Modulation Of Serotonin And Dopamine Transporters Activity: Behavioral And Molecular Insights Into Rapid Antidepressant Action, Deepak Karunakaran

Theses and Dissertations

Major depressive disorder (MDD) affects over 350 million individuals worldwide and is characterized by profound dysregulation of serotonin (5-HT) and dopamine (DA) systems that govern mood, reward processing, and motivation. The serotonin transporter (SERT) and dopamine transporter (DAT), both dynamically regulated through phosphorylation, serve as critical determinants of synaptic monoamine signaling. Despite decades of therapeutic development, current antidepressants require 4-6 weeks to achieve efficacy, and approximately one-third to half of patients develop treatment-resistant depression. The emergence of rapid-acting antidepressants like ketamine represents a paradigmatic shift, demonstrating symptom relief within hours; however, ketamine's therapeutic potential remains constrained by abuse liability, dissociative …

Therapy-Induced Senescence In Cancer: Developing Senolytic-Based Combination Strategies To Delay Re-Emergence Of Triple-Negative Breast Cancer, Eesha Chakraborty

Theses and Dissertations

Therapy-induce senescence (TIS) represents a major biological outcome of many anticancer treatments and is increasingly recognized as a strategic vulnerability in triple negative breast cancer, which is a highly aggressive subtype with limited therapeutic options and frequent relapse. Here, we probed TIS as a primary cellular response that may ultimately compromise long-term outcomes using standard chemotherapeutic agents in TNBC as well as the antibody-drug conjugate sacituzumab govitecan (SG). Both chemotherapy and SG reliably induced pronounced senescence across TNBC models, yielding durable growth arrest, however, also generating a persistent reservoir of viable tumor cells capable of eventual proliferative recovery, a hallmark …

Effectiveness Of Immersive Virtual Reality Combined With Task-Specific Training On Hemiplegic Arm Function Following Stroke: A Single Case Series Study, Rahsaan J. Holley

Theses and Dissertations

Motor recovery of the arm following a neurological injury is a common goal of the rehabilitation process for individuals impacted by the condition . Due to the long-term functional implications of impaired arm movement, individuals are often trained to use compensatory strategies to complete functional tasks without incorporating the weakened limb. While compensatory strategies offer stroke survivors the opportunity to regain a level of independence, such approaches fail to directly address the underlying causes of the disability (i.e., limited range of motion, decreased strength, poor coordination, motor planning difficulties) which can unfortunately result in long-term impairment and functional disability.

Motor …

Place, Culture, And Care: A Socioecological Examination Of Type 2 Diabetes Among Hispanics In The U.S., Danielle Montoya

Theses and Dissertations

Introduction: Type 2 diabetes (T2D) disproportionately affects U.S. Hispanic populations. This dissertation examined whether structural determinants fundamentally drive T2D disparities among Hispanics, with attention to within-group racial heterogeneity.

Methods: Three studies utilized nationally representative data. Study 1 examined neighborhood segregation and ethnic enclave residence associations with T2D using restricted NHANES data (2011-2018, n=5,056). Study 2 investigated acculturation and T2D associations using restricted NHANES data (2011-2018, n=4,540). Study 3 analyzed patient-provider racial/ethnic concordance and adequate diabetes care using MEPS data (2008-2021, n=17,138).

Results: Structural factors demonstrated primacy across all studies. Neighborhood segregation (aOR=1.17, p>0.05) and ethnic enclave residence showed no …

Opioid Tolerance And Withdrawal In The Mouse Colon, James Fune

Theses and Dissertations

Constipation is a major clinical obstacle associated with opioids, prompting patients to discontinue treatment due to pain, discomfort, and psychosocial stressors. Moreover, chronic users become tolerant to the analgesic effects of opioids, but not to their constipating effects. Upon cessation of long-term treatment, serious diarrhea–among other somatic signs of withdrawal–may ensue. These symptoms become a driving factor for relapse, causing patients to restart opioid treatment. In this study, we aim to understand mechanisms that contribute to opioid tolerance and withdrawal in the colon. Previous findings suggest that constipation occurs partly due to the colon’s lack of tolerance to opioids’ inhibitory …

Establishing A Conventional Linac-Based Electron Flash Beam, Justin Defrancisco

Theses and Dissertations

Problems: A rediscovered radiotherapy technique, FLASH, involves increasing the dose rate to >40 Gy/s. For a given dose, FLASH is shown to decrease the normal tissue complication probability without affecting the tumor control probability. More preclinical studies are necessary to confirm and enable these desirable properties on humans. Current preclinical investigations have diverse constraints, requiring FLASH apparatuses with flexible parameters and accurate control. However, there are limited FLASH platforms available, the existing ones are costly. Our institution is not in possession of any such infrastructure. Even if available, dosimetry and beam control in FLASH are extremely lacking. There is …

Rethinking Parkinson's Disease Genetics In The Precision Medicine Era: Why Genomic Diversity Matters?, Camilla Teixeira Pinheiro Gusmão, Giselli Scaini, Everton Ferreira De Souza, Rafael Antônio Vicente Lacerda, Matheus De Almeida Costa, Raja Mehanna, João Quevedo, Howard Lopes Ribeiro Junior

Faculty, Staff and Student Publications

No abstract provided.

Topss: Tolerability Of Transcranial Direct Current Stimulation In Pediatric Stroke Survivors, Stuart Fraser, Anna Clearman, Melika Abrahams, Bernadette Gillick, Tia Lal, Sean Savitz, Nuray Yozbatiran

Faculty, Staff and Student Publications

Background: Transcranial direct current stimulation is a non-invasive neuromodulation technique with emerging therapeutic potential in neurodevelopmental conditions. While childhood-onset stroke survivors frequently experience long-term motor impairment, there are very few studies examining the safety and feasibility of transcranial direct current stimulation in this population.

Objective: To evaluate the safety, feasibility, and tolerability of bihemispheric transcranial direct current stimulation paired with occupational therapy in children and adolescents with chronic hemiparesis following childhood-onset arterial ischemic stroke or intracranial hemorrhage.

Methods: In this single-arm, open-label pilot study, five participants aged 6-19 years of age received five daily sessions of transcranial direct current stimulation …

Smoking Habit And Long-Term Colorectal Cancer Incidence By Exome-Wide Mutational And Neoantigen Loads: Evidence Based On The Prospective Cohort Incident-Tumour Biobank Method, Tsuyoshi Hamada, Tomotaka Ugai, Carino Gurjao, Satoko Ugai, Xuehong Zhang, Koichiro Haruki, Yasutoshi Takashima, Naohiko Akimoto, Mai Chan Lau, Kosuke Matsuda, Nobuhiro Nakazawa, Mayu Higashioka, Satoshi Miyahara, Keisuke Kosumi, Yohei Masugi, Li Liu, Yin Cao, Daniel Nevo, Molin Wang, Reiko Nishihara, Sachet A Shukla, Catherine J Wu, Levi A Garraway, Jeffrey A Meyerhardt, Edward L Giovannucci, Jonathan A Nowak, Charles S Fuchs, Andrew T Chan, Mingyang Song, Marios Giannakis, Shuji Ogino

Faculty, Staff and Student Publications

Objective: To test the hypothesis that the association of smoking with long-term colorectal cancer incidence may be stronger for tumours with higher mutational and neoantigen loads.

Methods and analysis: In the Nurses' Health Study (1980-2012) and the Health Professionals Follow-up Study (1986-2012), our novel prospective cohort incident-tumour biobank method (PCIBM) used 3053 incident colorectal carcinoma cases including 752 cases with whole-exome sequencing data. Using the multivariable duplication-method Cox regression model with the inverse probability weighting to adjust for the selection bias due to tissue availability, we assessed a differential association of cigarette smoking with colorectal carcinoma incidence by an exome-wide …

Hypnosis And Mindfulness Audio Recordings For Reducing Fatigue In Individuals With Multiple Sclerosis: A Randomized Controlled Study, Mark P. Jensen, Susan Robles, Michael G. Nash, Susanne May, Dwan M. Ehde, Melissa A. Day, Owen Gottlieb, Laurence I. Sugarman, Kevin N. Alschuler

Articles

Background

Fatigue is a common problem in individuals with multiple sclerosis (MS).

Objective

The objective was to evaluate the effects on fatigue of having 4 weeks of

access to audio recordings of therapeutic hypnosis (HYP) and mindfulness meditation

(MM) practices.

Methods

A total of 333 individuals with MS and fatigue were randomly assigned to

one of the three treatment conditions for 28 weeks: (1) access to therapeutic HYP audio

recordings, (2) access to MM audio recordings, or (3) no access to recordings

(treatment as usual or TAU). Fatigue impact (primary outcome) and other outcomes

were assessed at 4, 16, and …

Identification Of Benzothiophene-Derived Inhibitors Of Flaviviruses By Targeting Rna-Dependent Rna Polymerase, Leah Liu Wang, Shazeed-Ul Karim, Aidan Hand, Ryan Brunkhorst, Mackenna Petersen, Sarah Altam, Yi Liu, Luwen Zhang, Fengwei Bai, Shi-Hua Xiang

School of Biological Sciences: Faculty Publications

Flaviviruses such as Dengue, West Nile, and Zika viruses are mosquito-borne RNA viruses that can cause serious diseases in humans. To develop effective drugs for treating these viruses’ infections, we create a new approach for developing common or shared drugs that may work for several different viral species of flaviviruses. It is based on the conserved RNA-dependent RNA polymerase (RdRp), which is the key enzyme for viral replication. We built up a common structure of RdRps (POLcon) from their consensus sequence. A conserved Triple-D structural motif was identified at the active site of POLcon that has been used for virtual …

Bacteria-Engineered Vesicles For Cancer Immunotherapy: From Immunomodulation In Vitro To Anti-Tumor Effects In Melanoma Models, Lan Li

Theses and Dissertations--Chemistry

Bacterial vesicles hold immense potential in various biomedical fields. Among these, outer membrane vesicles (OMVs) produced by Gram-negative bacteria are the most extensively studied. While the exact mechanism of OMV production remains unclear, numerous environmental factors have been shown to influence both their yield and composition. In this study, we investigated the effect of three different antimicrobial families on OMV production by E. coli. Interestingly, antimicrobials within the same family did not provide the same effects on OMV yield, suggesting that OMV production may not directly correlate with the antimicrobial mechanism of action. OMVs have demonstrated tumor-inhibitory activity in multiple …

Insights Into Factors Influencing Radical Coupling Chemistry Of Monolignols During Lignification And Induced Changes In Plant Secondary Metabolism, Rachel Poornima Sutherland

Theses and Dissertations--Chemistry

Lignin is a complex aromatic biopolymer and an important constituent in plant cell walls. The process of lignin biosynthesis, known as lignification, is poorly understood and challenging to study but has important implications in a variety of fields including sustainable energy, bioengineering, and materials science and is therefore of interest to pursue. In the final stage of lignification, H-, G-, and S-monolignols are oxidized by laccase and peroxidase enzymes to generate radical species that couple to form dimers and further oligomeric species to ultimately produce the lignin polymer. Biomimetic lignin model systems utilize in vitro oxidative coupling reactions as an …