Medical Specialties Commons^™

Altitude Illness, Kali Hepner

Capstone Showcase

With an increasing number of individuals traveling to high altitudes, it is important to address the risk these individuals face of developing altitude related illnesses. An example of high altitude related illness might be the elevation transition of travelers flying into Denver, Colorado (1,673 m) with the intention to then drive up to Rocky Mountain National Park’s Alpine Visitor Center (3,595 m) in the same day. This poses increased risk of unacclimatized visitors experiencing altitude illness in remote areas of the national park. This poster summarizes the diagnosis, prevention, and treatment of altitude illnesses so that clinicians and travelers may …

The Outcomes Of Cemented Versus Cementless Total Knee Arthroplasty In Modern Day Patients With Osteoarthritis, Jordan Powelson

Capstone Showcase

Osteoarthritis (OA), the degeneration of cartilage and bone, is the most progressive musculoskeletal disease and a leading cause of disability in the United States, affecting over 27 million adults. Although conservative treatments for knee OA are available, total knee arthroplasty (TKA) is the only definitive treatment for end-stage knee OA. For the past several decades, the use of bone cement has been the gold standard for total knee arthroplasty, but the cementless TKA is being revisited as an option as the age of patients seeking TKA decreases and the average BMI increases. This review analyzes and compares the outcomes of …

A Case Of Protein Losing Enteropathy After Fontan Operation, Gina Kim

Capstone Showcase

Protein Losing Enteropathy (PLE) is a condition in which an excessive amount of proteins are lost through the gastrointestinal tract leading to hypoproteinemia and manifesting as edema, ascites, and diarrhea. While in most cases PLE is a treatable disorder with good outcomes, the morbidity and mortality of the disorder is significantly elevated in patients with a history of Fontan surgery–an operation used to palliate patients born with a single ventricle by rerouting venous blood return directly to pulmonary circulation. After failure of first-line therapeutics of diuretics and steroids, this case study explores the successful treatment of a 5-year-old patient with …

A Clinical Review Of Persistent Pulmonary Hypertension In The Newborn, Kaela Mahoney

Capstone Showcase

Persistent pulmonary hypertension in the newborn (PPHN) is an illness of the circulatory and respiratory systems which affects approximately 0.002% of newborns but carries a significant morbidity and mortality burden. Diagnostic measures are focused on determining etiology whereas treatment measures are intended to improve pulmonary function. It is crucial for neonatal providers to be aware of patients at risk for developing PPHN and be prepared to initiate treatment early. This presentation reviews pathophysiology, etiology, risk factors, diagnosis, and treatment of PPHN.

Management Of Adult Growth Hormone Deficiency Related To Hypopituitarism, Kellie Jamin

Capstone Showcase

The treatment of growth hormone deficiency (GHD) is well-established in childhood but less understood in adults, given the more complex role that growth hormone (GH) assumes in this population. Decreased functionality of the pituitary gland, otherwise known as hypopituitarism, can present with an isolated GHD in adulthood, which may result from a number of factors including neoplasm, ischemia, infection, traumatic injury, or systemic disease. Adult GHD may be definitively diagnosed with a stimulation test, the insulin tolerance test (ITT) being the study of choice. With a positive ITT, the disorder can be treated with growth hormone replacement therapy (GHRT), which …

Diagnostic Imaging Read By Ai-Assisted Technology Within The Emergency Department, Joshua Leland

Capstone Showcase

Introduction: The emergency department (ED) has had an appreciable increase in volume over the past two decades with more individuals utilizing the ED now than a decade ago which has placed a strain on healthcare resources. Specifically adding to the rising costs in healthcare are diagnostics including chest x-rays. To combat this, institutions across the nation are developing deep-learning and artificial intelligence (AI) programs to assist in reading these diagnostics. Therefore, this systematic review analyzes the use of AI programs by clinicians in the ED to read diagnostic imaging compared to those who do not use these algorithms.

Methods: This …

The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor

Capstone Showcase

Natural brain processes make all individuals susceptible to unconscious bias; however, stressful, fearful, or anger-evoking situations as well as the negative influence of media and social surroundings increase the risk of holding obstructive bias, and there is a greater risk of being negatively impacted by this phenomenon when belonging to a minority population (Rose & Flores, 2020). As a result, high rates of infant mortality (10.2 deaths per 1,000 live births for the Non-Hispanic Black population compared to 4.1 in the White population) and cardiovascular related diseases (190.0 cases per 1,000 in the Non-Hispanic Black population compared to 161.3 in …

Detecting Multiple Myeloma In The Primary Care Setting, Anna Schweidler

Capstone Showcase

Multiple myeloma (MM) is a hematological malignancy arising from differentiated B-lymphocyte white blood cells called plasma cells. Hematological malignancies are the fourth most diagnosed cancers, composing approximately 9% of all cancer diagnoses. Specifically, multiple myeloma attributes to approximately 2% of cancer diagnoses in the United States². MM incidence has increased significantly over the past years, increasing 40% in the United States and 126% globally from 1990-2016 ². Affecting 7.0 out of every 100,000 people², multiple myeloma is considered a rare form of blood cancer. Many strides have been made in the treatment of multiple myeloma …

Comparison Of Psychotherapy To Mdma-Assisted Psychotherapy In The Treatment Of Patients With Ptsd, Julia Hasircoglu

Capstone Showcase

Post traumatic stress disorder (PTSD) is a devastating disease that has high morbidity and mortality. Despite therapy, almost half of patients with PTSD will have chronic and devastating symptoms. The novel agent methylenedioxymethamphetamine (MDMA) has shown promise in phase 3 clinical trials; and, investigation into other therapies is warranted given our current treatment resistance. The objective of the research is to compare the use of MDMA assisted psychotherapy to psychotherapy alone.

Eagle Syndrome: Efficacies Of Medical And Surgical Treatments, Kirklin Mitchell

Capstone Showcase

Eagle Syndrome is a rare syndrome caused by elongation of the styloid process of the temporal bone or calcification of the stylohyoid ligament occurring in a very small percentage of the population that can cause a wide range of common symptoms, leading to it being often misdiagnosed. While there are no set standards for treating Eagle Syndrome, both pharmaceutical and surgical options exist. Pharmaceutical options are often ineffective in long term treatment so surgery is usually required for full symptom resolution. Transoral and Transcervical surgeries have similar efficacies but each come with important drawbacks when considering which type of surgery …

Antibiotics May Be Unnecessary In The Treatment Of Acute Uncomplicated Diverticulitis, Madison Gump

Capstone Showcase

Acute diverticulitis is one of the most common gastrointestinal diseases worldwide and is increasing in prevalence. Symptoms include abdominal pain, fever, changes in bowel habits, nausea, and vomiting. Traditionally, this disease has been treated with antibiotics, but new research has emerged that has provided evidence that it may be safe to treat acute uncomplicated cases without antibiotics. This represents an area of medicine where it may be possible to reduce the use of unnecessary antibiotics and, therefore, contribution to bacterial antibiotic resistance. The current research studies do have some limitations and future studies with larger, more diverse patient populations and …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

Capstone Showcase

Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

In Patients With Hepatocellular Carcinoma (Hcc) (P), Is Bevacizumab With Atezolizumab (I) More Effective Than Sorafenib (C) In Long-Term Clinical Prognosis (O)?, Joon Lee

Capstone Showcase

Hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally. China contributes to half of the global incidence of liver cancer, with about 70-85% being HCC. Definitive treatment for this condition would be surgical resection with liver transplant but for obvious reasons, the majority of affected patients are unable to meet the necessary criteria. Sorafenib is a form of chemotherapy that has been the mainstay treatment of HCC since its approval in 2007. More recently, the combination of Bevacizumab and Atezolizumab has shown greater efficacy in the treatment of unresectable HCC. Additionally, this new combination therapy shows favorable …

The Diverse Neurological Manifestations Of The Sars-Cov-2 Pandemic, Asmeda Spalding

Capstone Showcase

SARS-CoV-2 remains an international public health concern and can be encountered in all aspects of healthcare. Although most neurological manifestations are benign, clinicians must be aware and able to recognize more serious conditions that require urgent referral and intervention. Patients at risk for severe cases should be given extra attention given their propensity for neurological and clinical deterioration. This article highlights the most common and urgent neurological symptoms and diagnoses of the COVID-19 pandemic as well as clinical pearls for their identification.

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Percutaneous Coronary Intervention Using Second Generation Drug-Eluting Stents Vs Coronary Artery Bypass Graft In Left Main Coronary Artery And Multivessel Coronary Artery Disease, Eric Kim

Capstone Showcase

Many of the studies that are used in reference to the clinical decision making between PCI vs CABG use BMS or first-generation DES as a comparison. With the advancement of stent technology, second-generation DES have emerged with improved efficacy and overall outcome rates compared to BMS and first-generation DES. Some of the newer studies such as EXCEL1-2 , demonstrated noninferiority of second-generation DES to CABG but there are limited studies that support this conclusion. Currently, the studies remain divided in the impact of newer-generation PCIs, and 10-year follow up studies may be required to further validate noninferiority before it can …

Does The Novel Coronavirus Use The Ocular Surface As An Entrance Into The Body Or As An Infection Site?, Remzi Karadag, Alp Kayiran, Christopher J Rapuano

Wills Eye Hospital Papers

This study attempts to review whether the coronavirus disease-2019 (COVID-19) is transmitted through the ocular surface and examine the symptoms and signs of ocular disease. Considering that COVID-19 is transmitted by airborne droplets and close contact with infected individuals, we will also review the conditions to which eye clinics and ophthalmologists should pay attention to prevent the transmission of the disease. Although some researchers have argued that COVID-19 transmission cannot occur through the ocular surface, most of them are of the opinion that the ocular surface is a potential pathway of transmission. Until date, ocular signs and symptoms have been …

Dual Paraneoplastic Syndrome In Small Lung Cancer, Kamil Sardarli, Austin M. Morris, Jamal Abukhaled

Conference Presentation Abstracts

Introduction: Small cell lung cancer (SCLC) is an aggressive neuroendocrine lung cancer associated with paraneoplastic syndromes – syndrome of inappropriate ADH (SIADH) in 7-16% of cases and Ectopic ACTH Syndrome (EAS) in 3.5-4.3% of cases. Both syndromes are associated with a poor prognosis in patients with SCLC. We describe a patient who presented with SIADH, leading to a diagnosis of SCLC who subsequently developed EAS. Case Description: A 71-year-old female with a past medical history of hypertension, depression, and tobacco use presented with lethargy. She noted headache, but otherwise was unable to provide history due to altered mentation. Per her …

The Morbidity Of Greater Trochanteric Pain Syndrome Is Similar To That Of Pre-Tha Hip Osteoarthritis, Sonia Wadekar, Avneesh Chhabra, Emily Middleton, Yin Xi, Joel Wells

MEDI 9331 Scholarly Activities Clinical Years

Aims: We sought to characterize the morbidity upon presentation of GTPS and compared it to patients with end-stage, hip osteoarthritis (OA) awaiting total hip arthroplasty (THA). We hypothesize that patients with GTPS will have similar or worse morbidity than hip OA patients.

Methods: This retrospective case-control study examined patient reported outcomes measures (PROMs) on activity limitations, quality of life, pain, and level of disability, in 156 GTPS patients (193 hips) and 300 pre-THA hip OA patients (326 hips). All patients presented at a single academic medical center. Patients with secondary hip conditions or previous hip surgeries were excluded from the …

Further Decoding The Molecular Relationship Between Pancreatic Adenocarcinoma And Diabetes Mellitus, Russell H. Moreland Iii, Sheema Khan

MEDI 9331 Scholarly Activities Clinical Years

Pancreatic ductal adenocarcinoma (PDAC) is a devastating malignancy, especially as there are no current reliable methods of screening. Recently literature reports a significant relationship with pancreatic ductal adenocarcinoma and diabetes mellitus (DM). The pathologic molecular mechanism is not completely understood but it may hold insights into the development of novel screening and treatment options. In our study we compiled a list of 74 proteins involved in the PDAC and DM pathway, with 47 showing increased expression levels and 11 with decreased expression levels. These proteins are currently undergoing further computational analysis to identify their pathway interactions.

Dose Accumulation For Mr-Guided Adaptive Radiotherapy: From Practical Considerations To State-Of-The-Art Clinical Implementation, Brigid A Mcdonald, Cornel Zachiu, John Christodouleas, Mohamed A Naser, Mark Ruschin, Jan-Jakob Sonke, Daniela Thorwarth, Daniel Létourneau, Neelam Tyagi, Tony Tadic, Jinzhong Yang, X Allen Li, Uffe Bernchou, Daniel E Hyer, Jeffrey E Snyder, Edyta Bubula-Rehm, Clifton D Fuller, Kristy K Brock

Faculty, Staff and Student Publications

MRI-linear accelerator (MR-linac) devices have been introduced into clinical practice in recent years and have enabled MR-guided adaptive radiation therapy (MRgART). However, by accounting for anatomical changes throughout radiation therapy (RT) and delivering different treatment plans at each fraction, adaptive radiation therapy (ART) highlights several challenges in terms of calculating the total delivered dose. Dose accumulation strategies-which typically involve deformable image registration between planning images, deformable dose mapping, and voxel-wise dose summation-can be employed for ART to estimate the delivered dose. In MRgART, plan adaptation on MRI instead of CT necessitates additional considerations in the dose accumulation process because MRI …

Complexities And Complications Of Extreme Obesity, Haval Ali, Udit Naik, Michelle Mcdonald, Mohammad Almosa, Karen Horn, Alexis Staines, Louis Maximilian Buja

Faculty, Staff and Student Publications

Obesity is a common chronic disorder and has detrimental long-term consequences if left untreated. Herein, we report a case of a young lady who suffered from morbid obesity and many of its consequences, and we present a literature review of these complications. While the cause of obesity is multifactorial, the genetic component is particularly important in the pathophysiology of marked obesity. Resistance to Leptin is considered one of the main causes of obesity. There is a unique relationship between polycystic ovary syndrome and obesity, as observed in our case. Obesity is associated with cardiovascular and lung diseases such as heart …

Cross-Talk Between Histone Methyltransferases And Demethylases Regulate Rest Transcription During Neurogenesis, Jyothishmathi Swaminathan, Shinji Maegawa, Shavali Shaik, Ajay Sharma, Javiera Bravo-Alegria, Lei Guo, Lin Xu, Arif Harmanci, Vidya Gopalakrishnan

Faculty, Staff and Student Publications

The RE1 Silencing Transcription Factor (REST) is a major regulator of neurogenesis and brain development. Medulloblastoma (MB) is a pediatric brain cancer characterized by a blockade of neuronal specification. REST gene expression is aberrantly elevated in a subset of MBs that are driven by constitutive activation of sonic hedgehog (SHH) signaling in cerebellar granular progenitor cells (CGNPs), the cells of origin of this subgroup of tumors. To understand its transcriptional deregulation in MBs, we first studied control of Rest gene expression during neuronal differentiation of normal mouse CGNPs. Higher Rest expression was observed in proliferating CGNPs compared to differentiating neurons. …

Racial And Socioeconomic Disparities In Patients With Meningioma: A Retrospective Cohort Study, Hudin N Jackson, Caroline C Hadley, A Basit Khan, Ron Gadot, James C Bayley, Arya Shetty, Jacob Mandel, Ali Jalali, K Kelly Gallagher, Alex D Sweeney, Arif O Harmanci, Akdes S Harmanci, Tiemo Klisch, Shankar P Gopinath, Ganesh Rao, Daniel Yoshor, Akash J Patel

Faculty, Staff and Student Publications

BACKGROUND: Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.

OBJECTIVE: To determine factors that contribute to different clinical outcomes in racial populations.

METHODS: We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and …

Fairly Predicting Graft Failure In Liver Transplant For Organ Assigning, Sirui Ding, Ruixiang Tang, Daochen Zha, Na Zou, Kai Zhang, Xiaoqian Jiang, Xia Hu

Faculty, Staff and Student Publications

Liver transplant is an essential therapy performed for severe liver diseases. The fact of scarce liver resources makes the organ assigning crucial. Model for End-stage Liver Disease (MELD) score is a widely adopted criterion when making organ distribution decisions. However, it ignores post-transplant outcomes and organ/donor features. These limitations motivate the emergence of machine learning (ML) models. Unfortunately, ML models could be unfair and trigger bias against certain groups of people. To tackle this problem, this work proposes a fair machine learning framework targeting graft failure prediction in liver transplant. Specifically, knowledge distillation is employed to handle dense and sparse …

Patients' Preferences For Androgen Deprivation Therapy In The Treatment Of Intermediate-Risk Prostate Cancer, Brian De, Lisa M Lowenstein, Kelsey L Corrigan, Lauren M Andring, Deborah A Kuban, Scott B Cantor, Robert J Volk, Karen E Hoffman

Faculty, Staff and Student Publications

Background. For men with intermediate-risk prostate cancer (IRPC), adding short-term androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) has shown efficacy, but men are often reluctant to accept it because of its impact on quality of life. Methods. We conducted time tradeoffs (score of 1 = perfect health and 0 = death) and probability tradeoffs with patients aged 51 to 78 y who had received EBRT for IRPC within the past 2 y. Of 40 patients, 20 had received 6 mo of ADT and 20 had declined. Utility assessments explored 4 ADT-related side effects: hot flashes, fatigue, loss …

Predicting Clinical Response To Everolimus In Er+ Breast Cancers Using Machine-Learning, Aritro Nath, Patrick A Cosgrove, Jeffrey T Chang, Andrea H Bild

Faculty, Staff and Student Publications

Endocrine therapy remains the primary treatment choice for ER+ breast cancers. However, most advanced ER+ breast cancers ultimately develop resistance to endocrine. This acquired resistance to endocrine therapy is often driven by the activation of the PI3K/AKT/mTOR signaling pathway. Everolimus, a drug that targets and inhibits the mTOR complex has been shown to improve clinical outcomes in metastatic ER+ breast cancers. However, there are no biomarkers currently available to guide the use of everolimus in the clinic for progressive patients, where multiple therapeutic options are available. Here, we utilized gene expression signatures from 9 ER+ breast cancer cell lines and …

The Impact Of Merkel Cell Polyomavirus Positivity On Prognosis Of Merkel Cell Carcinoma: A Systematic Review And Meta-Analysis, Aimin Yang, Wilson Adrian Wijaya, Lei Yang, Yinhai He, Ying Cen, Junjie Chen

Faculty, Staff and Student Publications

INTRODUCTION: There are numerous findings over the past decade have indicated that Merkel cell carcinoma (MCC) may have two pathways of pathogenesis: one related to ultraviolet irradiation and the other to the Merkel cell polyomavirus (MCPyV). However, the predictive and clinicopathological value of MCPyV positivity in MCC patients is still debatable. This article aims to examine the most recent data regarding this issue.

METHODS: The thorough literature searches were conducted in the Medline Ovid, PubMed, Web of Science, the Cochrane CENTRAL Databases, and Embase Databases until December 31, 2021. The associations between overall survival (OS), Merkel cell carcinoma-specific survival (MSS), …

Enhancing Diagnosis Through Technology: Decision Support, Artificial Intelligence, And Beyond, Robert El-Kareh, Dean F Sittig

Faculty, Staff and Student Publications

Patient care in intensive care environments is complex, time-sensitive, and data-rich, factors that make these settings particularly well-suited to clinical decision support (CDS). A wide range of CDS interventions have been used in intensive care unit environments. The field needs well-designed studies to identify the most effective CDS approaches. Evolving artificial intelligence and machine learning models may reduce information-overload and enable teams to take better advantage of the large volume of patient data available to them. It is vital to effectively integrate new CDS into clinical workflows and to align closely with the cognitive processes of frontline clinicians.

Leveraging Deep Learning-Based Segmentation And Contours-Driven Deformable Registration For Dose Accumulation In Abdominal Structures, Molly M Mcculloch, Guillaume Cazoulat, Stina Svensson, Sergii Gryshkevych, Bastien Rigaud, Brian M Anderson, Ezgi Kirimli, Brian De, Ryan T Mathew, Mohamed Zaid, Dalia Elganainy, Christine B Peterson, Peter Balter, Eugene J Koay, Kristy K Brock

Faculty, Staff and Student Publications

PURPOSE: Discrepancies between planned and delivered dose to GI structures during radiation therapy (RT) of liver cancer may hamper the prediction of treatment outcomes. The purpose of this study is to develop a streamlined workflow for dose accumulation in a treatment planning system (TPS) during liver image-guided RT and to assess its accuracy when using different deformable image registration (DIR) algorithms.

MATERIALS AND METHODS: Fifty-six patients with primary and metastatic liver cancer treated with external beam radiotherapy guided by daily CT-on-rails (CTOR) were retrospectively analyzed. The liver, stomach and duodenum contours were auto-segmented on all planning CTs and daily CTORs …