Medical Specialties Commons^™

Commecement, Philadelphia (2021), Philadelphia College Of Osteopathic Medicine

Commencements

Philadelphia Campus D.O. Commencement program, Class of 2021. Degrees include Doctorate in Osteopathic Medicine.

Reducing Unnecessary Crossmatching For Hip Fracture Patients By Accounting For Preoperative Hemoglobin Concentration, Raj M Amin, Varun Puvanesarajah, Yash P Chaudhry, Matthew J Best, Sandesh S Rao, Steven M Frank, Erik A Hasenboehler

Orthopedic Surgery Resident Research

BACKGROUND: Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion, but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.

AIM: To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture …

Exploring The Relationship Between Traumatic Brain Injury And Post-Traumatic Epilepsy: A Review, Alayna Nelson

PCOM Capstone Projects

According to the Centers for Disease Control and Prevention (2020), traumatic brain injury (TBI) is considered a major public health problem in the United States. Each year, 2.53 million Americans, including 812,000 children, document a TBI-related emergency room visit (CDC, 2020). TBI is a disruption in the brain’s normal function, caused by a bump or blow to the head or by penetrating head injury (CDC, 2020). These injuries range in severity and can cause damage to one or multiple areas of the brain (Oleksii et al., 2019). Mild TBI, often used synonymously with concussion, comprises more than 90% of TBI …

Incorporating Adverse Childhood Experiences In Medical Student Trauma-Informed Training, Mary Catherine Minke

PCOM Capstone Projects

One of the emerging fields in public health has become how behavior and personal experiences shape the health experience. Particularly, there is interest in understanding how the environment that one lives in changes one’s biology, causing disease, and how interventions can combat this change. A 1998 study conducted by the CDC and Kaiser Health first characterized negative household environments that suffered from dysfunction or abuse and showed how this could be a leading cause of death in adults (Vincent, et al., 1998). Researchers termed these Adverse Childhood Experiences (ACEs). Since that time, additional studies have found that those who suffered …

A Clinical Review Of Robotic Navigation In Total Knee Arthroplasty: Historical Systems To Modern Design., Ahmed Siddiqi, Timothy Horan, Robert M Molloy, Michael R Bloomfield, Preetesh D Patel, Nicolas S Piuzzi

Orthopedic Surgery Resident Research

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined.Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems.In today's paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine …

Return To Play Rates After Ulnar Nerve Transposition And Decompression Surgery: A Retrospective Analysis., Christopher J Hadley, Anant Dixit, John Kunkel, Alex E White, Michael G Ciccotti, Steven B Cohen, Christopher C Dodson

Orthopedic Surgery Resident Research

Background: Medial elbow pain is a common complaint in overhead throwing athletes. The throwing motion places repetitive tensile and compressive forces on the elbow resulting in significant stress across the ulnohumeral joint. This stress can result in soft-tissue, ligamentous, and ulnar nerve injury. The purpose of this study was to retrospectively investigate the clinical findings and outcomes, including return to play rates, of patients who underwent ulnar nerve transposition surgery for isolated ulnar neuritis.

Methods: Throwing athletes who underwent isolated, primary ulnar nerve transposition surgery over an eight-year period, 2009 to 2017, were identified and included in our analysis. Nonthrowing …

The Philadelphia Surgery Conference: A Value Analysis Of A Hands-On Surgical Skill-Building Event., Luke Dipasquale, Robert Libera, Chi Chi Do-Nguyen, Elizabeth Brehman, Vishwant Tatagari, Heather Waring, Denah Appelt, Arthur Sesso

PCOM Scholarly Works

Context: Limited opportunities exist to practice technical skills and to be exposed to various surgical specialties during preclinical medical education.

Objectives: To assess the value of workshop-based educational opportunities to medical students during preclinical training.

Methods: One hundred and 75 medical and physician assistant students from 10 medical schools attended the 2019 Philadelphia Surgery Conference. All students received STOP THE BLEED® bleeding control training and participated in four workshops, chosen from a list of 23, that demonstrated a variety of surgical skills. Data collection was accomplished using both a pre- and postconference survey to assess changes in confidence of personal …

Repurposing Dextromethorphan And Metformin For Treating Nicotine-Induced Cancer By Directly Targeting Chrna7 To Inhibit Jak2/Stat3/Sox2 Signaling, Lu Wang, Du Liang, Xiao Xiong, Yusheng Lin, Jianlin Zhu, Zhimeng Yao, Shuhong Wang, Yi Guo, Yuping Chen, Kyla Geary, Yunlong Pan, Fuyou Zhou, Shegan Gao, Dianzheng Zhang, Sai-Ching Jim Yeung, Hao Zhang

PCOM Scholarly Works

Smoking is one of the most impactful lifestyle-related risk factors in many cancer types including esophageal squamous cell carcinoma (ESCC). As the major component of tobacco and e-cigarettes, nicotine is not only responsible for addiction to smoking but also a carcinogen. Here we report that nicotine enhances ESCC cancer malignancy and tumor-initiating capacity by interacting with cholinergic receptor nicotinic alpha 7 subunit (CHRNA7) and subsequently activating the JAK2/STAT3 signaling pathway. We found that aberrant CHRNA7 expression can serve as an independent prognostic factor for ESCC patients. In multiple ESCC mouse models, dextromethorphan and metformin synergistically repressed nicotine-enhanced cancer-initiating cells (CIC) …

The Effects Of Resveratrol On Prostate Cancer Through Targeting The Tumor Microenvironment., Natalie Silk, Jeremy Reich, Rahul Sinha, Shivansh Chawla, Kyla Geary, Dianzheng Zhang

PCOM Scholarly Works

Prostate cancer is one of the most common cancers diagnosed in men in the United States and the second leading cause of cancer-related deaths worldwide. Since over 60% of prostate cancer cases occur in men over 65 years of age, and this population will increase steadily in the coming years, prostate cancer will be a major cancer-related burden in the foreseeable future. Accumulating data from more recent research suggest that the tumor microenvironment (TME) plays a previously unrecognized role in every stage of cancer development, including initiation, proliferation, and metastasis. Prostate cancer is not only diagnosed in the late stages …

Identification Of 3-Chymotrypsin Like Protease (3clpro) Inhibitors As Potential Anti-Sars-Cov-2 Agents., Vicky Mody, Joanna Ho, Savannah Wills, Ahmed Mawri, Latasha Lawson, Maximilian C C J C Ebert, Guillaume M Fortin, Srujana Rayalam, Shashidharamurthy Taval

PCOM Scholarly Works

Emerging outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a major threat to public health. The morbidity is increasing due to lack of SARS-CoV-2 specific drugs. Herein, we have identified potential drugs that target the 3-chymotrypsin like protease (3CLpro), the main protease that is pivotal for the replication of SARS-CoV-2. Computational molecular modeling was used to screen 3987 FDA approved drugs, and 47 drugs were selected to study their inhibitory effects on SARS-CoV-2 specific 3CLpro enzyme in vitro. Our results indicate that boceprevir, ombitasvir, paritaprevir, tipranavir, ivermectin, and micafungin exhibited inhibitory effect towards 3CLpro enzymatic activity. The 100 …

A Case Of Diastematomyelia Presenting With Minimal Neurologic Deficits In A Middle-Aged Patient, Gabriella Mamo, Rishu Batra, Jeffrey Steinig

Transitional Year Resident Research

Diastematomyelia is a rare congenital deformity of the spine in which the spinal cord is split into two hemicords along the sagittal plane. This condition belongs to the group of spinal dysraphisms, is more common in females, and is usually diagnosed prenatally or during childhood; rarely is it diagnosed in adults. We report a male patient in his 50s in which diastematomyelia of the thoracic spine was incidentally encountered after receiving a CT scan of the chest for shortness of breath. Although most patients with this condition are symptomatic, the patient did not display any significant acute neurological complaints at …

A Rare Case Report Of A Corpus Callosal Splenial Lesion In The Context Of Atypical Neuroleptic Malignant Syndrome., Ryan Serdenes, Samuel Orr, Pamela Trio, Seetha Chandrasekhara, Meghan Musselman

Transitional Year Resident Research

In this report, we describe a case of atypical neuroleptic malignant syndrome (NMS) presenting with an isolated lesion in the splenium of the corpus callosum (ILSCC). There is a paucity of information regarding this topic within the literature and only 7 previous case reports have been published at the time of writing. To our knowledge, this case report is also the first to describe an atypical NMS variant in the context of an ILSCC. In this report, we describe the important considerations in formulating differential diagnosis for ILSCC and are the first report to propose a possible pathophysiological mechanism relating …

Bilateral Sensorineural Hearing Loss In The Setting Of Acute Methamphetamine Overdose, Jeremy Reich, Harleen Sethi, Robert Sataloff

Otolaryngology (ENT) Resident Research

Substance abuse is a rare but known cause of sensorineural hearing loss (SNHL). We report a case of acute SNHL in a 28-year-old man following an overdose of methamphetamine and incidental ingestion of fentanyl. On initial encounter, he had moderate-to-severe hearing loss in the right ear and severe-to-profound hearing loss in the left ear in addition to acute kidney injury, liver failure, and lactic acidosis. The patient was treated with a two-week course of high-dose steroids and expressed a subjective improvement in hearing. This case highlights the importance of auditory testing following a drug overdose and is one of the …

The Modern Use Of The Extended Humeral Head (Cuff Tear Arthropathy) Hemiarthroplasty., Tyler J Smith, Sarav S Shah, Justin W Peterson, Glen Ross

Orthopedic Surgery Resident Research

Today, the treatment of osteoarthritis in the rotator cuff-deficient population is largely dominated by reverse shoulder arthroplasty (RSA). Despite the popularity of and increased familiarity with this procedure, the complication rate of RSA remains significant. An extended humeral head hemiarthroplasty may provide a less invasive alternative for select patients with cuff tear arthropathy (CTA) and preserved glenohumeral active elevation. With the indications for reverse arthroplasty expanding to younger patients, there are concerns about the longevity of this implant, as well as the associated revision burden. In the setting of failed RSA, the bone stock available for glenosphere baseplate fixation can …

Digest Of The Philadelphia College Of Osteopathic Medicine (2021 No. 1), Philadelphia College Of Osteopathic Medicine

PCOM Digest 2020s

The 2021 No. 1 issue of the Digest of the Philadelphia College of Osteopathic Medicineincludes the following articles:

• Updates
• Institutional Heritage: Founders’ Day
• Meta L. Christy, DO: The First African American Osteopathic Physician
• Standing on Her Shoulders: Celebrating Meta L. Christy, DO, and African American Alumnae Trailblazers
• Class Notes

Digest Of The Philadelphia College Of Osteopathic Medicine, Philadelphia College Of Osteopathic Medicine

PCOM Digest 2020s

The (2021 No. 2) issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Updates
• Advancing Alumni
• Reimagining Public Health: Pivoting from Pandemic Response to Future Prevention
• Rethinking Burnout, Mental Health and Well-being
• A Pandemic Within a Pandemic: Addressing Marginalized and Minoritized Communities to Foster Recovery
• Class Notes

Clinical Outcomes Of Superior Capsular Reconstruction For Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft And Autograft Fascia Lata, Tyler J. Smith, Anirudh K. Gowd, John Kunkel, Lisa Kaplin, John B. Hubbard, Kevin E. Coates, Benjamin R. Graves, Brian R. Waterman

Orthopedic Surgery Resident Research

Purpose: To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. Results: A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted …

Botox Injection To Treat Strabismus After Infant Botulism Type B Infection, Sarah G Bonaffini, Victoria Cocozza, Jing Jin

Ophthalmology Resident Research

Purpose: The significance of botulinum toxin to ophthalmologists is twofold. Botulism, a medical emergency, frequently presents with ocular findings including blurred vision, diplopia, ptosis, and photophobia as a result of the neurotoxin produced by Clostridium botulinum. However, botulinum toxins also have therapeutic uses for medical conditions including strabismus. The safety and efficacy of Botulinum toxin A in patients with a history of botulism has not been reported.

Observations: We report a 9-week-old infant, diagnosed with type B toxin positive infant botulism treated with human botulism immune globulin, who developed a large angle exotropia. The infant was treated with intramuscular injections …

Perichondritis: Inspect The Lobule, Eli Bress, Jason E Cohn

Otolaryngology (ENT) Resident Research

CASE PRESENTATION: This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

DIAGNOSIS: The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged …

Histone Demethylase Phf8 Drives Neuroendocrine Prostate Cancer Progression By Epigenetically Upregulating Foxa2., Qiuli Liu, Jian Pang, Lin-Ang Wang, Zhuowei Huang, Jing Xu, Xingxia Yang, Qiubo Xie, Yiqiang Huang, Tang Tang, Dali Tong, Gaolei Liu, Luofu Wang, Dianzheng Zhang, Qiang Ma, Hualiang Xiao, Weihua Lan, Jun Qin, Jun Jiang

PCOM Scholarly Works

Neuroendocrine prostate cancer (NEPC) is a more aggressive subtype of castration-resistant prostate cancer (CRPC). Although it is well established that PHF8 can enhance prostate cancer cell proliferation, whether PHF8 is involved in prostate cancer initiation and progression is relatively unclear. By comparing the transgenic adenocarcinoma of the mouse prostate (TRAMP) mice with or without Phf8 knockout, we systemically examined the role of PHF8 in prostate cancer development. We found that PHF8 plays a minimum role in initiation and progression of adenocarcinoma. However, PHF8 is essential for NEPC because not only is PHF8 highly expressed in NEPC but also animals without …

Piwi-Interacting Rnas: Mitochondria-Based Biogenesis And Functions In Cancer, Jin-Fen Su, Anthony Concilla, Dianzheng Zhang, Fang Zhao, Fang-Fang Shen, Hao Zhang, Fu-You Zhou

PCOM Scholarly Works

PIWI-interacting RNA (piRNAs), once thought to be mainly functioning in germlines, are now known to play an essential role in somatic and cancerous tissues. Ping-pong cycle initiation and mitochondria-based phased production constitute the core of the piRNA biogenesis and these two processes are well conserved in mammals, including humans. By being involved in DNA methylation, histone marker deposition, mRNA degradation, and protein modification, piRNAs also contribute to carcinogenesis partly due to oncogenic stress-induced piRNA dysregulation. Also, piRNAs play important roles in cancer stemness, drug resistance, and tumor immunology. Results from liquid biopsy analysis of piRNA can be used in both …

The Use Of Local Medial Plantar Artery Flap For Heel Reconstruction: A Systematic Review., Jude L Opoku-Agyeman, Amber Allen, Kayla Humenansky

Plastic Surgery Resident Research

BACKGROUND: Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic.

AIM: The aim of this article is to review the literature on the use of local medial plantar artery flap for …

A Simple Technique For Intraoperative Scalp Skin Graft Depilation Using Dermabond®, Jude L Opoku-Agyeman, Kayla Humenansky, Brooke Burkey

Plastic Surgery Resident Research

Skin grafting is an essential aspect of burn and wound reconstruction. Split-thickness skin grafts (STSGs) harvested from the scalp are used for wound and burn reconstruction. Skin grafts from the scalp bear hair and hair particles. Residual hair fragments and pieces of hair in the graft have been associated with many complications, including foreign body reaction similar to pseudofolliculitis and chronic inflammation that can lead to infections. It is important to remove the hair and the hair particles from the scalp graft before its application to the donor site. Traditionally, surgeons have employed some techniques including saline agitation and mechanical …

Obesity And Its Effect On Outcomes In Same-Day Bilateral Total Knee Arthroplasty, Ethan A Remily, Nequesha S Mohamed, Wayne A Wilkie, Tyler Smith, Anthony Judice, Salvador Forte, James Nace, Ronald E Delanois

Orthopedic Surgery Resident Research

Background: The niche surgery of same-day bilateral total knee arthroplasty (sd-BTKA) continues to create debate amongst specialists in arthroplasty. To date, there is a significant lack of literature on obese patients undergoing sd-BTKA, and no study has evaluated outcomes of this procedure when compared to non-obese patients. Therefore, this study will perform a retrospective analysis to compare (I) incidence, (II) demographics, and (III) complications of sd-BTKA in non-obese, obese, and morbidly obese patients in the United States from 2009 to 2016.

Methods: The National Inpatient Sample (NIS) database was queried for all individuals that underwent sd-BTKA from 2009 to 2016. …

Percutaneous Coil Embolization To Manage Pulmonary Artery Hemorrhage After Distal Endarterectomy, Chirantan Mangukia, Paul Forfia, Anjali Vaidya, Veronica Williams, Dmitry Niman, Parth Rali, Yoshiya Toyoda

Internal Medicine Resident Research

Selective pulmonary artery coil embolization can be a viable treatment option for acute pulmonary hemorrhage after pulmonary thromboendarterectomy.

Correlation Of Ape1 With Vegfa And Cd163+ Macrophage Infiltration In Bladder Cancer And Their Prognostic Significance, Lin-Ang Wang, Bo Yang, Tang Tang, Yuxin Yang, Dianzheng Zhang, Hualing Xiao, Jing Xu, Luofu Wang, Li Lin, Jun Jiang

PCOM Scholarly Works

The present study sought to estimate the applicability of apurinic/apyrimidinic endodeoxyribonuclease 1 (APE1), vascular endothelial growth factor A (VEGFA) expression and CD163+ tumor‑associated macrophage (TAM) ratio as prognostic factors in bladder cancer (BCa). A total of 127 patients with bladder urothelial cancer who underwent radical cystectomy at Daping Hospital were recruited between January 2013 and January 2017, including 45 cases of non‑muscle invasive BCa (NMIBC) and 82 of MIBC. Immunohistochemical detection of APE1, VEGFA and CD163, as well as multiple immunofluorescence staining for APE1, VEGFA, CD163 and CD34, were performed on tissue samples. For APE1 and VEGFA, the staining was …

Endovascular Treatment Of Cervical Myelopathy From Brachiocephalic Venous Stenosis., Craig Schreiber, Alex Anavim, Mark Kotapka, Paul Brady

Neurosurgery Resident Research

Central venous stenosis is a rare cause of neurologic pathology. Here we present a case of brachiocephalic vein stenosis causing cervical myelopathy through venous engorgement. Our patient was a 51-y/o male who presented with ambulatory dysfunction so he was evaluated for cervical myelopathy. Imaging revealed cord compression from venous engorgement and brachiocephalic vein stenosis. He was treated with angioplasty and vessel stenting which significantly improved flow on postintervention imaging. In conclusion, preoperative vascular imaging should be considered in myelopathic patients as it can detect this rare but dangerous etiology.

Congenital Pulmonary Airway Malformation (Cpam): An Interesting Ent Consultation., James Ding, Lauren E Melley, Alexander Manteghi

Otolaryngology (ENT) Resident Research

A 13-month-old boy was referred to the emergency department from the pediatrician’s office for increased shortness of breath. A 2-view chest X-ray was ordered revealing right hemithorax hyperlucency, minimal lung markings, and leftward mediastinal shift.

Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants, Jason E. Cohn, Sammy Othman, Michael Toscano, Tom Shokri, Jason D Bloom, Seth Zwillenberg

Otolaryngology (ENT) Resident Research

BACKGROUND: Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures.

METHODS: A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing.

RESULTS: During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this …

To Balloon Or Not To Balloon, The Current State Of Management Of Eustachian Tube Dysfunction., David J. Lafferty, Brian J Mckinnon

Otolaryngology (ENT) Resident Research

While otologic complaints are a common reason for patients to present to an otolaryngologist, Eustachian tube dysfunction (ETD) remains a poorly understood disease whose management is unclear. Among the general population in the United States, ETD has a prevalence of 4.6% among adults and 6.1% among children. Eustachian tube dysfunction is not just a common diagnosis for otolaryngologists, ETD accounted for 2 million visits for patients less than 20 years old to primary care providers and over 2 million visits for patients older than 20 years old between 2005 and 2012. Despite the commonality of ETD, opinions differ wildly among …