The Medical I.B.I.S., Issue 12, 2024

UNIVERSITY

OF MIAMI | VOLUME 12 | SPRING 2024

Dean’s Letter

Once again, welcome to the latest issue of The Medical I.B.I.S., a publication by the University of Miami Miller School of Medicine produced by our students, showcasing the exceptional research endeavors of our talented student body. Their work serves as a beacon of hope, illuminating the promising future of the medical field.

At the Miller School, we are committed to fostering the growth of the next generation of innovative leaders. These individuals are poised to not only shape the future of medicine and guide healthcare systems towards delivering value-based care, but also to lead groundbreaking discoveries and their practical application to advance global health. In this pursuit, the Office of Physician Scientist Training is dedicated to empowering upcoming physician-scientists to delve into the depths of knowledge. Through the oversight and optimization of the training and development of our aspiring physician and clinician-scientists, we strive to grow their numbers and diversity, while ensuring their success in the demanding field of academic medicine.

In pursuit of these goals, we continue with our Dean’s Research Excellence Award in Medicine (DREAM) scholarship program. This initiative enables enthusiastic students to delve into hypothesis-driven, mechanism-oriented research under the mentorship of esteemed principal investigators at the Miller School. Additionally, we provide competitive stipends to up to 50 medical students eager to engage in research under an approved mentor during their 8-week summer hiatus. We anticipate that these initiatives will kindle the passion for discovery among Miller School students, leading to significant and timely contributions to scientific literature through publications in The Medical I.B.I.S. and other esteemed medical journals.

In the meantime, I encourage you to delve into the latest edition of The Medical I.B.I.S. and explore the remarkable work showcased within.

Henri Ford, MD, MHA Dean and Chief Academic Officer, UMMSM

The University of Miami Leonard M. Miller School of Medicine has been transforming lives for over 70 years. Decades of discoveries, medical advancements, and significant strides in education define the Miller School’s positive impact on health—locally, nationally, and globally.

Despite disruptions in higher education and health care due to the pandemic, we have forged ahead to find novel strategies to fight diseases, including most recently COVID-19. Those on the front lines have emerged as role models and connectors, exemplifying the spirit of service that is a key aspect of our mission.

Our students, faculty, and staff have successfully overcome considerable challenges in the face of ongoing global change, while navigating new ways to teach, learn, serve patients, and conduct research.

As president of the University and a physician, I fully understand the challenges brought about by the pandemic and the entire gamut of diseases and risk factors affecting humanity. Together, we will continue to navigate changing conditions. There will be future challenges, but rigorous science, innovative education, and an unwavering commitment to the wellbeing of our patients will enable us to continue our progress. Yours is the generation whose pledge to fairness and kindness, to civic engagement and mutual responsibility, and to innovation and creativity will allow us to emerge from this time better than we were before.

As students here, you have heard me repeatedly note the need for adaptability, resilience, and responsiveness to changing circumstances. As health care professionals, those three qualities will determine the level of care you provide to patients and populations.

I urge you to draw from our shared experience to develop not just your technical skills, but the empathy and critical thinking that will serve your patients and

the whole of society. I encourage you to seek truth, engage in respectful debate, and evaluate solutions with an uncompromising commitment to accountability.

As we approach our centennial in 2025, the University is taking strategic steps to gain a global leadership position. During the celebration of this institutional milestone, I look forward to witnessing your success in pushing the boundaries of clinical medicine, discovery, education, and community service.

Julio Frenk, MD, MPH, PhD President, University of Miami

Letter From the Editors

Dear Readers,

Welcome to the twelfth edition of The Medical I.B.I.S.!

The Medical I.B.I.S. is a student-run magazine dedicated to showcasing the innovative research being performed by medical students here at the University of Miami Miller School of Medicine. This year’s edition features research on a wide array of topics, from expanding transplant access in diabetic patients to the public health implications of firework-related injuries.

Recent years have shown us our community’s remarkable resilience and determination. Our students and faculty are constantly working toward new discoveries to advance healthcare and bridge health disparities. We hope this magazine amplifies the voices of student researchers, highlights their dedication and talent, and inspires all of us to continue to push boundaries in healthcare research.

This year’s edition of The Medical I.B.I.S. would not be possible without the dedication of our entire staff. We extend our sincere gratitude to the researchers, writers, editors, layout team, senior editors, managing editors, and everyone else who helped make this magazine possible!

Sincerely,

Shreya Ingle & Megan Zou Editors-in-Chief, The Medical I.B.I.S.

EDITORS IN CHIEF

Shreya Ingle

Megan Zou

MANAGING EDITORS

Haikel Haile

Katie Dowell-Esquivel

SENIOR EDITORS

John Zizzo

Sherry Luo

Akshara Sree Challa

Amy Thein

Jason Greenfield

WRITERS

Mason Thornton

Haikel Haile

Isha Harshe

Janice Huang

Yasmine Kamgarhaghighi

EDITORS

Matt Drewes

Sharon Hsieh

Jamie Burgess

Arpan Parekh

Linh Ton

Shriya Patel

PHOTOGRAPHERS

Esdras Lopez

SELECTION COMMITTEE

Ryan Guillen

Haikel Haile

Katie Dowell-Esquivel

LAYOUT

Isha Harshe

Mason Thornton Staff

Shreya Ingle Megan Zou Haikel Haile

Katie Dowell-Esquivel

John Zizzo

Sherry Luo

Akshara Sree Challa

Jason Greenfield

Ryan Guillen

Matt Drewes

Jamie Burgess

Arpan Parekh

Esdras Lopez

Sharon Hsieh

Shriya Patel

Mason Thornton Isha Harshe

Amy Thein

Janice Huang

Linh Ton

Yasmine Kamgarhaghighi

07

09

Innovative Fusion: A Medical Student’s Experience in Collaborative Orthopedic Research

feat. Zachary Stauber by Mason Thornton

Expanding Transplant Access for Type 2 Diabetic CKD Patients

feat. Georges AbouKasm by Isha Harshe

11

13

Determinants of Health As Predictors for Vaccine Differential Antibody Response

feat. Felipe Echeverri Tribin by Janice Huang

Understanding the Black Box of Medical School Admissions

feat. Caleigh Roach by Haikel Haile

15 Firework Injuries Spark Public Health Concern

feat. Nikhil Patel by Isha Harshe

A Deeper Look Into Fungal Keratitis

feat. Katherine Krishna by Janice Huang

Enhancing Cognitive Function in Chronic TBI: The Role of α7 nAChR Modulation

feat. Akhila Sangadi by Yasmine Kamgarhaghighi

From Orientation to Orthopedics: Giving Miller Students a Hand

feat. Nikhil Patel by Mason Thornton

The Underestimated Delay to Cancer Treatment

feat. Angela Luo by Janice Juang

Disparities in RVUs for Breast and Prostate Operations

feat. Noah Khosrowzadeh by Yasmine Kamgarhaghighi

19 17

21

23

25

Innovative Fusion: A Medical Student’s Experience in Collaborative Orthopedic Research

By: Mason Thornton

Entering medical school, Zach faced the daunting challenge of finding research opportunities, feeling uncertain about where to begin. His approach was straightforward yet effective: “I just started talking to people. I would recommend anyone in search of research to do the same. Ask your friends, get the word out that you’re looking for research. Don’t hesitate to cold email or reach out to anyone.” This proactive strategy led him to learn about Dr. Coelho’s lab, renowned for its significant contributions to the study of biomedical devices, biological materials, and innovative surgical techniques aimed at enhancing bone and soft tissue development. Intrigued by Dr. Coelho’s unique qualifications- a dental degree, a Master’s in Business Administration, and a Ph.D., which have supported his successful management for a lab for over a decade in New York City as part of NYU, Zach was drawn in.

Typically, academia and industry are seen as distinct, separate spheres, each with its own objectives and operations.. Yet, the collaboration between Zachary Stauber and Dr. Coelho’s lab represents a fusion of these worlds, offering Zach a rare chance to engage in groundbreaking research. Dr. Coelho’s lab, aided by the support of bioengineering companies, embarks on a wide array of projects across various fields, with Zach particularly drawn to Orthopedic Surgery. Dr. Coelho’s lab began to investigate a novel drilling technique, and Zach was eager to join as he found this project to be “fascinating and important for the development of my understanding of bone remodeling post-orthopedic surgery.” The purpose of this project was to compare new

drilling instrumentation which promotes increased immediate pedicle screw strength and long term osteointegration around the pedicle screw to the conventional drilling technique. The study used the iliac spine of sheep as a model for pedicle screw insertion due to its similar consistency to human vertebrae. Four screws were installed in each hip of six total sheep, half were done using the conventional drilling technique and half were done using the novel Osseodensification drilling method. The team set out to contrast the gold standard method to their novel osseointegration within the fenestrations of the pedicle screw quantitatively and qualitatively at 3- and 12- week time points. Ideally, creating a new technique will be useful in the future of pedicle screw implantation by more secure fixation in the long term.

Zach gained a greater appreciation for what his group was working towards during his rotations: “I remember during the manuscript writing phase of this project I was in my anesthesia rotation observing an orthopedic surgery. I watched as they drilled a hole for pedicle screw insertion and thought it was pretty awesome that I got to witness how much time, effort, and resources goes into the development of one surgical instrument, so similar to the one being used in the surgery. It helped me appreciate what led up to that moment in the OR. Then, I was lucky enough to speak to the patient following the surgery, who would soon be going home and eventually resuming full activity partly because of that one screw holding his bones together.” That experience allowed him to feel more proud of his work as he could recognize aspects of his work reflected in one patient.

He explains that if his group is successful, “as the American population continues to age, and bone pathologies requiring pedicle screw insertion

Zachary Stauber MD Class of 2026

Mentor: Paulo Coelho, MD, DDS, PhD, MBA: Other Activities: JMSA, Dean’s Cup Table Tennis, Coelho Lab

become more frequent, we will have trustworthy pedicle screw insertion techniques that last longer and result in less complications requiring revision surgery.”

Balancing the demands of research, education, and family life poses a significant challenge for Zach, as he is a husband and new father. “Being that I am married and have recently been blessed with my first child, possibly the cutest girl on planet earth, this challenge is one I take very seriously. I have found that efficiency is extremely important

Being efficient and staying focused on what matters most has been key for me, especially with a family to care for. Whether it’s research, family time, or personal interests, giving each aspect my full attention makes all the difference. “ “

and having the ability to compartmentalize is crucial. When I am spending time with my wife and kid, even if it is just a few minutes, I try my best to be 100% present with them. When I am on my clinical rotation, I am fully focused on the patients and my own education.

The same goes for research and any other extracurriculars that I am involved in. Luckily I have had an unbelievable medical school

experience thus far and have enjoyed every aspect of the journey so the system seems to be working well for me.”

Zach also stresses the importance of pursuing one’s interests regardless of whether they are medically-related or able to boost a CV. “One of my priorities in maintaining wellness has been to try to be involved in some things that I enjoy… For example, I love Jewish philosophy and I try to attend lectures and discussions related to the topic often. I know it may not be furthering my medical knowledge or my future residency application, but that also means there are absolutely no strings attached to it. I get to relax and enjoy the experience, knowing that I am much more than a medical student. My wife has also been an amazing pillar of support throughout my time as a student. She has been there to celebrate the good days, lean on during the tougher ones, and talk through everything in between. Thus, I would also advise other students to find someone you love and trust that they can rely on when need be; it could be a family member, a friend, or even someone from student counseling.”

In closing, Zach expresses a desire for the recognition of his colleagues, who have also contributed significantly to the lab’s research. He acknowledges Vasudev Vivekanand, Blaire Slavin, Nicholas Mirsky, Quinn Ehlen, JP Costello, Sophie Kelly, Savannah Sturm, Tina Swain, Nicholas Paolucci, Ricky Almada, Derek Sheinberg, Shangtao Wu, and Joao Kawase Brochu, alongside his wife, who has been his steadfast support as well as his loving parents. Zach’s aspiration is to continue making meaningful contributions to the field, hoping to inspire his daughter with his published work in the future.

Expanding Transplant Access for Type 2 Diabetic CKD Patients

By Isha Harshe

Diabetes is the most common cause of chronic kidney disease. It is estimated that 1 in 3 adults with diabetes will develop chronic kidney disease. Consequently, about 90% of patients with diabetes who get a pancreas transplant also have a simultaneous kidney transplant because of the devastating effects diabetes has on the kidney. Typically, these simultaneous kidney-pancreas transplants are performed as a gold-standard treatment for patients with Type 1 Diabetes. Given that Type 2 Diabetes is much more common than Type 1 Diabetes, Georges AbouKasm sought to understand whether this type of treatment can also be beneficial for patients with Type 2 Diabetes who develop chronic kidney disease.

Georges’ interest in nephrology stems from both his personal and academic experiences. Both his father and uncle were diagnosed with chronic kidney disease and received transplants. From his family, he gained not only a patient perspective but also a physician perspective on the experience of chronic kidney disease, as both his aunt and cousin are nephrologists. His family background, coupled with his ‘nephrotastic’ experience learning nephrology with Dr. Warren Kupin in his first year of medical school, sparked an interest in pursuing research experiences in this field.

to complete an 8-week research course in the field of nephrology. Through this program, he met his mentor, Mariella Ortigosa-Goggins, MD. He described working with her as his favorite part of conducting this project.

The biggest conclusion is hoping to expand access [to simultaneous kidneypancreas transplants] all across the country for these patients. “ “

This project was conducted at the Miami Transplant Institute. The aim was to perform an institution-wide outcomes analysis for simultaneous kidney-pancreas transplants in patients with chronic kidney disease and either Type 1 or Type 2 diabetes to determine if there were any differences in outcomes between patients with each type of diabetes. The study included 256 patients who underwent this procedure between the years of 2012-2023 and gathered measurements on patient survival, kidney graft survival, pancreas graft survival, and development of post-transplant diabetes. Between the two groups, it was found that there was no significant difference in average A1c levels (below diabetes range for both groups) and all survival outcomes. Thus, the major conclusion of the project was that patients with both Type 1 and Type 2 Diabetes have similar, positive outcomes with the simultaneous kidney-pancreas transplant. This finding opens the door for this type of transplant surgery to become more accessible for patients with Type 2 Diabetes.

In the summer between his first and second year of medical school, Georges participated in the UMKIIMERA program. This is an NIH-funded opportunity

This project was presented as a poster and oral presentation at the Florida Society of Nephrology Conference, as a poster presentation at the World Congress of Nephrology in Buenos Aires, and will be presented as a poster at the American Transplant

Congress this June. Georges hopes to continue being involved with this project and seeks to learn more about how to expand access to simultaneous kidney-pancreas transplants for patients with Type 2 Diabetes. He hopes to expand the project to include all simultaneous kidney-pancreas patients in Miami. This will allow him to examine more data and continue following patients for 1-2 years after their transplant, allowing for a more in-depth analysis of their outcomes.

Being involved in research is an important part of the medical student experience, but it is not always easy. Medical students are often balancing many academic, professional, and personal responsibilities. Georges recognizes the difficult nature of pursuing research as a medical student and emphasizes the importance of taking time to de-stress: “The work can always be finished later. Your health should be prioritized. Take the time to hang out with friends and stay connected to people.” To maintain his own wellness, Georges enjoys taking long walks, playing his guitar, spending time with his friends, and discovering new food places that are good and “not Miami prices!” Balancing and prioritizing mental health is key when it comes to successfully managing life as a medical student, as Georges says: “School and research will always be there, it’s not going anywhere.”

Georges AbouKasm

MD/MPH Class of 2026

Mentor: Mariella Ortigosa-Goggins, MD

Honors: UM-KIIMERA Summer Research Program Participant Poster & oral presentation at Florida Society of Nephrology, Poster Presentation at World Congress of Nephrology, Buenos Aires, Argentina, April 2024, Poster Presentation at American Transplant Congress, Philadelphia, Pennsylvania, June 2024.

Other Activities: Students for National Health Program, Miami Street Medicine, APAMSA

Future Goals: Georges has sustained an interest in nephrology since beginning this project and continues to explore other specialties of interest.

“The biggest conclusion is hoping to expand access [to simultaneous transplants] all across the country for these

Determinants of Health as Predictors for Vaccine Differential Antibody Response

By Janice Huang

As a freshman undergraduate biomedical engineering student at the University of Miami, Felipe Echeverri Tribin appreciated the beauty of applying engineering principles to analyze biological phenomena and translating knowledge to solve health problems. In pursuit of his interests, Felipe moved beyond academic curiosity and dived into hands-on research experience in sophomore year.

Felipe continued to pursue his passion for research when he became a medical student at the University of Miami Miller School of Medicine. His deep appreciation of immunology led him to conduct research with the lab of Dr. Savita Pahwa, M.D. in the Department of Microbiology & Immunology. The team he joined investigated the effects of extrinsic (modifiable) and intrinsic (identity) factors on the peak antibody response following COVID-19 primary vaccination and on the trajectory of peak antibody magnitude and durability over time.

The team followed the participants every three months for up to two years. Blood samples, demographics, and comorbid health conditions were analyzed. Using this data, cross-sectional and longitudinal models were generated to assess the relationship between selected intrinsic and extrinsic health factors. Following cross-sectional analysis, the team noted higher peak antibody titers after primary vaccination in females, those who reported recreational drug use, participants that were a younger age, and those who had

prior a COVID-19 infection. There were also other interesting findings suggesting that health factors play a significant role in shaping humoral immunogenicity. In the next phase of this study, the team will study the proteomics of patient serum to further investigate the mediators in inflammation and host immune response. Felipe hopes this will lead to exciting therapeutic possibilities.

In addition, Felipe works in the lab of Dr. (need info from felipe). He describes working in two labs in parallel as challenging and rewarding. “Open communication is the key” Felipe says. He constantly communicates with the labs and maps out the deliverables by month to ensure he is able to accomplish all that he needs to. In this way, he can prioritize tasks and achieve his goals within his already

Felipe Echeverri Tribin

MD Class of 2027

Mentors: Savita Pahwa, MD, Suresh Pallikkuth, PhD, Michael Hoffer, MD, Jean-Marie Parel, PhD, Darlene Miller, DHSc

Other Activities: DOCS Health Fair Assistant Station Manager for the Ophthalmology Station, Ophthalmology Interest Group, Ear-Nose-Throat Interest Group, Street Medicine Group, Students Interested in Plastic Surgery

Future Goals: Ophthalmology/Otolaryngology

tight schedule as a medical student. Both of his research mentors are supportive and collaborative. “I’ve learned so much from my mentors. They lead by example.” Felipe is grateful for the amazing mentorship that he receives and aspires to pay it forward by mentoring undergraduate students.

As a first year medical student, Felipe balances schoolwork, multiple research projects, wellness, and other personal

responsibilities. In his free time, he enjoys playing guitar and maintains an active lifestyle. Felipe is interested in surgical specialties, particularly ophthalmology and otolaryngology. He believes that research is such a key component in the health field and wants to work towards surgical innovation to improve patient outcomes.

I believe biomedical engineering is my bridge to transforming scientific discoveries into life changing advancements for patients. “ “

Understanding the Black Box of Medical School Admissions

By Haile Haikel

As a first-year medical student interested in teaching and technology, Caleigh Roach found an interesting opportunity to develop a deeper understanding of medical school admissions. After starting at the University of Miami Miller School of Medicine, she began analyzing webinars for aspiring applicants as part of a project started by second-year medical student Jacqueline (Jackie) Brenner, whose nonprofit organization STEM Potential held the sessions. The research aimed to find objective information to provide to applicants given the competitive nature of medical school admissions and the large number of applicants each year. Analysis of the webinars showed that advice varied between students, and the team was concerned that the information given was not representative of different experiences and backgrounds. With the objective of trying to better understand the relationship between advice provided to medical school applicants and the key factors of diversity and inclusion, the researchers used artificial intelligence (AI) to further examine the webinars for key themes and findings.

“

these inquiries were not necessarily provided by students representative of the applicants asking the questions. Thus, Caleigh, Jackie, and the rest of team worked to identify common themes of advice given and how they could impact an application.

We thought we were at a roadblock and then we realized that’s the point. The point of it is that everybody has different experiences. It is a black box. There are so many different pathways to admission

“

Performed with Jackie and Ifechi Ukeh, M.D., of the University of Maryland Medical System and reviewed by Gauri Agarwal, M.D., of UMMSM’s Department of Medical Education, 12 webinars that had occurred during the year through STEM Potential began to be analyzed by the researchers in July 2023. The webinars used for this research specifically involved those with student panelists; physician webinars were excluded from the study. A questionnaire intended for applicants had received over 30,000 responses, making it clear that many individuals were searching for information regarding the medical school application process. However, the responses to

With the use of AI, 10 main pieces of advice were found from the webinar transcripts. Common themes included topics such as curiosity, community engagement, mentorship, and gap years. ChatGPT was then fed the 10 points of advice to form the perfect application. However, one perfect application was unable to be created, emphasizing the idea that different experiences feed into one’s perspective and approach to the medical school application process. There truly is not one application that is able to encompass the myriad of characteristics and backgrounds of all applicants. Deciding to further examine the data, the project then used statistics to predict attributes of students that gave the specific advice, such as whether they went to a large undergraduate school with expansive research opportunities or whether they had parents in medicine. The team found that they were able to identify certain features of those who had given the advice, further emphasizing the importance of diversity in providing insight about medical school applications.

Overall, the research supports the concept that everyone has a unique experience and outlook that cannot be summarized by AI or in one application. While not being able to create one perfect application might seem like a roadblock, the team saw that this finding was the point of the research and that resources should support and encourage the numerous pathways to medicine. As the project continues, Caleigh’s goal is for AI to be further incorporated into medical school

Caleigh Roach

MD/MPH Class of 2027

Mentor: Gauri Agarwal, MD

Honors: Poster presentation @ AAMC Learn Serve Lead, November 2023, Seattle, Washington

Other Interests: Tutoring and teaching, playing guitar, rock climbing and mountaineering outdoors

Future Interests: Neurosurgery, Global Health, Education and Technology in Healthcare

admissions, especially with the growing number of applications. She hopes that this project has shed some light on the connection between admissions and AI and how they can continue to be integrated in the future and support diversity. Caleigh and the team are also considering feeding ChatGPT previously reviewed applications to see which were accepted versus not. One implication for the project is possibly using ChatGPT as an initial admissions screening tool to bring more insight and feedback to the process. Going forward, multiple possible ways exist to continue the work of examining the relationship between AI and admissions.

Her interest in admissions and teaching is not new to Caleigh as she started and runs a tutoring company that also provides admissions counseling and essay editing. After noticing some concerns in how tutoring tends to be organized, she has been trying to match tutors with students based on learning styles to ensure maximum benefit. Caleigh also previously worked in EMS and has served as an EMT instructor. In the future, she plans to continue being involved in teaching and thinking critically about how current processes in medical

education run. After medical school, Caleigh hopes to pursue a residency in neurosurgery with a focus on global health, using education and technology to improve healthcare. As for balancing the demands of school and personal responsibilities, she recommends that students take on projects they are passionate about. Being selective about where your time and energy goes and advocating for yourself are important points she emphasizes.

For this project, Caleigh enjoyed analyzing the webinars in depth and learning about the unique experiences of the applicants. She found it interesting to delve deeply into this work and was able to present the research at the AAMC Learn Serve Lead meeting in November 2023, where she was able to engage with admissions officers and have discussions about the role of AI in medical school admissions. The team is currently preparing a manuscript with the goal of publishing their work for further dissemination. As for the main takeaway of the research so far, Caleigh summarized two points: everyone has different experiences and there are many, valid pathways to medicine. As she continues her research, she hopes to use technology in a way that supports aspiring medical students of numerous backgrounds.

Firework Injuries Spark Public Health Concerns

By Isha Harshe

Cby Sharon Hsieh

elebrating major holidays like New Year’s or the Fourth of July is synonymous with being mesmerized by spectacular fireworks displays down to gleefully lighting a sparkler. However, a few moments of fun can quickly result in disastrous, and sometimes even life-changing, consequences for someone if they sustain an injury from unsafe handling of fireworks. Awareness of how quickly and severely injury can happen led Nikhil Patel, along with fellow Miller medical students Jon Weinerman and Jacob Mesenger, to want to understand fireworkrelated hand injury trends and identify opportunities to prevent these situations. Nikhil entered medical school with an interest in sports medicine and was already working on digitizing the Jackson emergency room orthopaedic injury patient data when he was approached by his friend Jon to join Dr. Helen Hui-Chou’s project on firework-related hand injuries. This project intrigued Nikhil because it was at the intersection of multiple interests of his – orthopaedic sports medicine, emergent care, and public health. The team focused on looking at the demographics, characteristics, outcomes, and trends of firework-related hand injuries at Ryder Trauma Center. Using the database he had helped develop, Nikhil was able to identify patients who had presented

around major holidays including Independence Day and New Year’s Eve to look for a pattern in fireworkrelated injuries. They then studied the patients’ demographics, characterized the extent of injury, and explored the causes of their injuries.

“Research is a viable aspect for any medical student because it allows them the opportunity to not only focus on what they want to pursue as a career but also develop and hone skills as a future resident and doctor because you are always learning.” “ “

The team went one step further and analyzed individuals with firework-related hand injuries in the context of their socioeconomic status. Their findings were thought-provoking– individuals from lower income areas had higher rates of firework-related injuries. This was a significant dimension to identify: tailoring prevention strategies to these at-risk populations. Overall, the study found that 88.6% of these fireworkrelated hand injuries occurred from patients holding fireworks in their hands (usually their dominant hand) and 82.9% of the injuries required surgical intervention for hand fractures. Many of these injuries also included vascular and/or nerve damage. Nikhil and his team went on to present their project at the American Association for Hand Surgery, Eastern-Atlantic Student Research Forum, and at the UM Department of Orthopaedics Annual Research Competition.

The public health implications of this project stood out for Nikhil. He emphasized the importance of understanding public health for future physicians, whether or not they are pursuing an MPH. “I believe it is crucial for medical students to receive education in public health as it enables us to integrate it into our

Other Interests: Student Government, DOCS, Orthopedic Surgery Interest Group

Future Goals: Orthopedics/Sports Medicine

Nikhil Patel

MD Class of 2025

Mentor: Helen Hui-Chou, MD, FACS

Honors:

Eastern Atlantic Student Research Forum, February 2024, Miami, FL, Podium/Oral Presentation

American Association for Hand Surgery, January 2023, University of Miami Department of Orthopaedics Annual Research Competition. May 2023, Miami, FL, Podium/ Oral Presentation medical practice. This ensures we not only are trained to treat individuals but rather populations. In doing so, we learn to minimize the risk to others and actively engage in community-based approaches regarding potential health hazards.”

Nikhil hopes that this study can serve as the basis for targeting legislative efforts and preventive public health interventions to reduce firework-related injuries in lower socioeconomic status neighborhoods. He hopes to continue to stay involved in this initiative by helping to create a classification system of how to handle these injuries. Many of these firework-related injuries often present to small community hospitals, which may not have the resources to perform the complex procedures that may be required. Thus, Nikhil envisions improved classification systems to help smaller, community hospitals identify and characterize firework-related injuries to better determine treatment algorithms and identify when a patient may need to be transferred to a different facility.

Nikhil also emphasized the importance of research in the professional development of a physician. He shared that doing research as a medical student not only allows you to focus on the specialty you want to pursue but also hone skills in lifelong learning that will be required as a future resident and attending physician. “You have to be able to read up on new papers and studies and understand the changes that are occuring in modern medicine, which is why getting involved in research as a student is so helpful.”

Although research can be a large aspect of a medical student’s experience, Nikhil also acknowledged that it does not have to all happen in the first year of medical school. If there’s one piece of advice he would give, it is this: “I am a firm believer in not doing things for the sake of building your resume. Whatever you do, do it because you are passionate and want to learn. Do it to build character and personality. Because if you do what you love then your resume will speak for itself.”

A Deeper Look Into Fungal Keratitis

By Janice Huang

After a hit to the face by a soccer ball left her with blood in her eye, Katherine Krishna found herself with a transformed outlook on life and a burning desire to pursue a career in medicine. Of course, it doesn’t hurt that ophthalmology also runs in her blood, as her father is a glaucoma specialist who trained at Bascom Palmer. Now a second-year medical student at University of Miami Miller School of Medicine, Katherine continues to build on her previous experience as an ophthalmic diagnostic technician, diving into her MD/ MBA degree and ophthalmology research. As part of the lab of Dr. Jean-Marie Parel, the Director of the Ophthalmic Biophysics Center (OBC), Katherine studies infectious keratitis with fellow medical student James Lai, who she met through playing soccer at University

of Miami during her undergraduate studies. Infectious keratitis remains the leading cause of corneal blindness in both the developed and developing world. Compared to bacterial keratitis, fungal keratitis is associated with poorer outcomes due to delayed diagnosis, antifungal resistance, and deeper penetration by fungi into the cornea. Infections attributed to Fusarium species are particularly difficult to treat, and conventional treatments have limited efficacy. However, novel treatments such as Rose Bengal photodynamic antimicrobial therapy (RB-PDAT) offer new potential.

Katherine and Dr. Parel’s team explored RB-PDAT’s fungal growth inhibiting effect on Fusarium spp. strains and the metabolic utilization changes of surviving fungal isolates after RB-PDAT use. They obtained one Fusarium oxysporum and three Fusarium solani fungal strains from patients with ocular infections and exposed the fungal strains to different conditions, including RB-PDAT. The group found that RB-PDAT inhibited growth against all strains, with full inhibition of all three F. solani strains. These results are encouraging and suggest potential use in cases refractory to standard treatment. Katherine won the “Best Cornea” poster award for her work on this project at the Women in Ophthalmology Conference in 2023. In addition, Katherine is working on a paper exploring the combination of RBPDAT and existing antifungals and is looking forward to presenting at the annual meeting of The Association for Research in Vision and Ophthalmology (ARVO) later this year.

Katherine cherishes the mentorship that she receives at OBC. She acknowledges

Katherine Krishna MD/MBA Class of 2026

Mentors: Jean-Marie Parel Ing.ETS-G, PhD, FAIMBE, FARVO,

Other Activities: Women’s club soccer team, working with Dr. Giselle Ricur on increasing teleophthalmology services

Heather Durkee, Ph.D., the senior research associate at the lab, as one of her most impactful mentors, both in science and female mentorship. In turn, Katherine brings new M1 students into the lab, where they are surrounded by a knowledgeable, resilient, and fun team.

As a busy MD/MBA student who balances clinical rotations, research, and personal responsibilities, Katherine draws inspiration from a quote by Sam Altman, CEO of OpenAI. “Optimism, obsession, self-belief, raw horsepower, and personal connections are how things get started.” She appreciates the limitations of time and energy. “I focus on a few things: school, research, quality time with friends and family, and soccer, and try not to spread myself out too thin,” Katherine says. She adds, “I recommend focusing on a couple things you are passionate about and investing heavily in those passions.”

“[I encourage] focusing on a couple things you are passionate about and investing heavily in those passions.”

“ “

Enhancing Cognitive Function in Chronic TBI: The Role of α7 nAChR Modulation

By: Yasmine Kamgarhaghighi

Second-year medical student Akhila Sangadi at the Miller School of Medicine has long been interested in the inner workings of the brain. This interest in neuroscience has taken her on a years-long research journey through both her undergraduate and now medical school career. This journey began right here in Miami when Akhila was working as an undergraduate in the neuroscience advising office at the University of Miami. While working here she was first introduced to her future research mentor, Dr. Coleen Atkins. Right before the pandemic, Akhila began working in Dr. Atkins’s laboratory as an undergraduate student. The initial purpose of her project was to determine if a positive allosteric modulator of the α7 nicotinic acetylcholine receptor, AVL-3288, would be efficacious in regaining cognitive function after traumatic brain injury (TBI). Approximately 3.3 million people in the US have chronic disabilities resulting from TBI and there are currently no FDA-approved pharmacologic therapies to treat chronic TBI symptoms. Investigation of these novel therapeutics could be monumental in improving the quality of life in TBI survivors. Akhila was beginning to work on this project when all research at the University of Miami took an unexpected turn in the form of the COVID-19 pandemic. Classes at the University of Miami became

virtual and Akhila chose to finish up her coursework from home in Massachusetts.

Akhila’s work on the project could have easily taken a long pause as she was many states away from Dr. Atkins’s laboratory here in Miami. But quite the opposite happened. She decided to continue the project in full force. She went on to remotely train other student researchers based throughout the US to assist her in completing the project and developing new techniques to determine if AVL-3288 improved pathology after TBI. And all of this was done virtually!

Akhila’s project utilized genetically modified mice that had a genetic deletion of the α7 nicotinic acetylcholine receptor to see if lack of the receptor would alter recovery after TBI. Mice were assigned to receive a TBI or remain non-injured, and they were later administered either AVL3288 or a placebo. Mice were then trained in cue and contextual fear conditioning to assess their cognitive abilities. At the conclusion of the experiment, the brains of these mice were collected to see if there were any pathological changes. Akhila quantified whether there was a loss of cortical and hippocampal volume using a non-biased, systematic analysis and to evaluate if AVL-3288 improved these pathological changes.

After all of that hard work, the results pointed to hope for patients with TBI in

Akhila

Sangadi

MD/MPH

Class of 2026

Mentor: Dr.Coleen M. Atkins, PhD

Other Activities: DOCS Health Fair manager for Women’s Health, Secretary of American Physician Scientist Association, APSA (ESRF forum, co-director of abstract), GI interest exec board (events coordinator and shadowing coordinator), SG exec board (IT Officer), Patient Care Coordinator (Miami Street Medicine), MSAT tutor, Academic Societies clinical skills trainer, Miller Mentors

the future. The drug worked; AVL-3288 recovered learning and memory in wild type mice, but did not improve learning and memory effectively in mice with genetic deletion of the α7 nicotinic acetylcholine receptor. Morphologically, the drug did not reduce either cortical or hippocampal atrophy.

Most recently, the results of this work have been published in the journal of Experimental Neurology. Moving forward, Akhila also hopes to continue to explore this field by evaluating different drugs for TBI that target different receptors. Interestingly enough, Akhila has more recently become very interested in the field of obstetrics and gynecology. At first glance, one might not see a strong connection between the fields of neuroscience and ob/gyn. However, Akhila saw a lot of overlap between the two fields as a rotating student in the specialty in the beginning of Phase 2. After looking forward to her long shifts on labor and delivery day after day, she knew she had found her likely calling. Akhila is also particularly interested in gastroenterology and the way that the gut microbiome can influence different neurological conditions. She hopes to continue to blend her interests in these different areas in research and residency. The one thing she is certain of is that research and scientific exploration will always be a part of her career. When asked how she has balanced all of her different responsibilities throughout the

years, Akhila explains that she genuinely loves medicine. She cannot imagine only studying all day and believes that if you are “organized with your time and doing things that drive you that is the most important thing.” With regards to advice for other student researchers, she says “get a planner, get your routine down, stay organized, the more you get done today the less you have to get done tomorrow and remember why you started your journey.” She herself maintains balance by meditating, doing yoga every single morning, painting, crocheting and feels that her family and friends are her main source of support.

Get a planner, get your routine down, stay organized, the more you get done today the less you have to get done tomorrow and remember why you started your journey. “ “

From Orientation to Orthopedics: Giving Miller Students a Hand

By: Mason Thornton

For the past 2 years, incoming first year students at orientation have been greeted by Nikhil Patel. Nikhil greets you with an energetic smile and fervor for the Miller School of Medicine that is evident in his words and advice. He offers simple, yet profound guidance to his incoming colleagues. “Miami is amazing and can provide all the opportunities you want, but don’t feel pressured to accomplish everything at once. Take time to explore your interests and remember that everyone’s journey is unique. Your path may evolve, and that’s okay.” Nikhil came to Miami after growing up around Tampa and attending the University of Florida for his undergraduate degree. Now, he spends his time around campus, with his loved ones and his new fiancé, or enjoying what he calls “Miami’s only quiet place” - the golf course.

“

No matter what you do, do it because you’re passionate about it. Don’t do anything because it’s a line on your resumé.

“

Nikhil has always seen himself working in a team setting. Orthopedic surgery provided the perfect intersection between his passion for collaboration, staying active, and the science of medicine. Since starting medical school, he has strived to complete research in his areas of interests, Radiology and Orthopedics. A little over a year ago, when his MS4 mentor, Dylan Luxenburg, proposed an idea to investigate Hook of Hamate injuries - a bone that affects many athletes who play tennis, golf, and hockey - Nikhil took a vested interest. “For me…it involved

a side of medicine I want to do and also affected sports that I love. I started playing golf over Covid and have loved it. Recently shot a 101 and that’s my best… so pretty impressive,” he joked. “I’m also a huge fan of the TB lightning. It’s been great these past couple years getting to see my team be so good, and I’ve been able to enjoy my team and hockey much more due to that. I grew playing tennis, really since I was a kid, but played on teams from middle school all through high school.” Together, Dylan and Nikhil seized the opportunity and pitched it to Dr. Seth Dodds. With his approval, they assembled a great and easygoing group that had each other’s backs. Everyone stepped up in the team and we couldn’t ask for better.” He acknowledges the contributions of Dylan Luxenburg, Manish Narasimman, Jonathan Weinerman, Jean-Paul Russo, Dr. Anthony Martin, Dr. Arya Minaie, and especially, Dr. Seth D Dodds.

This team set out to assess how Hook of Hamate injuries are characterized and establish a standard Return-To-Play (RTP) time for Hook of Hamate injuries. Nikhil and his team would have a lot of work ahead, as meta analyses take significant effort[JB1] . A meta analysis involves looking at every research paper that has covered a topic and screening for specific parameters to evaluate the papers at an in-depth level. For this study, the team reviewed 870

Nikhil Patel MD Class of 2025

Mentor: Seth Dodds, MD

Honors: American Association for Hand Surgery 2024 Annual Conference, 2024 ESRF Podium presentation. The abstract was accepted to the American Association for Hand Surgery Journal.

Other Interests: Golf, Hockey, Tampa Bay Sports

papers and narrowed down the papers for in-depth analysis to about 20. They examined treatment, intervention, and how these affected recovery. Their work found that out of 823 patients, 95% had a RTP rate, and the mean RTP time was 45 days across the studies. Surgeons and patients can now have a clearer expectation for Hook of Hamate injuries, knowing that recovery will take about 45-50 days with surgical intervention. This work[JB2] was presented at the American Association for Hand Surgery 2024 Annual Conference on January 9, 2024 in Nassau, Bahamas. It was also presented at the 2024 ESRF as a Podium presentation and at the University of Miami Sports Medicine Institute Research Day. Recently, the abstract was accepted to the American Association for Hand Surgery Journal.

Beyond this success, Nikhil’s path is expected to evolve. When considering his future education, Nikhil stated “Something I wish I paid more attention to was the MBA program. In the future I definitely think I’ll get an executive healthcare MBA, that way I can work to be a part of an administration, ideally a CMO position.” No matter what, Nikhil plans to keep “family and friends first, I’d do anything for my friends and for anybody who asks.” Nikhil advises, “No matter what you do, do it because you’re passionate about it. Don’t do anything because it’s a line on your resumé. It’s why I’ve done Student

Government all 3 years, because I think it’s a great opportunity to speak up for others and a great opportunity to mentor others. I was never a huge proponent of taking a wellness weekend or taking time for yourself, but over the past year and a half or so, I’ve really learned that.” Using those words to guide his actions, Nikhil is looking towards next steps. Regarding his future, he says, “I came into medical school leaning towards Orthopedic Surgery, but through rotations, I’ve really enjoyed Anesthesia and Emergency Med… my future will involve is something within the world of Sports Medicine, something that gives me a chance to grow and allows me to work alongside athletes.”

The Underestimated Delay to Cancer Treatment

By Janice Huang

“Iam shocked by the time difference for initiating breast cancer treatment between public and private insurance,” said Angela Luo, a first year M.D student at University of Miami Miller School of Medicine (UMMSM). Working alongside Dr. Jessica Meshman M.D. and Dr. Michael Butkus Ph.D., Angela is investigating the time between diagnosis and initiating treatment of breast cancer for patients with public or private insurance. Working as a medical assistant at a cardiology office during her gap years, Angela has witnessed the vital role of navigating insurance in patient care. “I’ve seen patients that need to jump many hoops to get the medication”. When she began her radiation oncology research, she was interested in whether insurance plays a significant role in initiating breast cancer treatment.

Breast cancer is the most common cancer in women in the US. Timely diagnosis and management have been shown to reduce mortality. Therefore, Angela and her team sought to determine if there is a relationship between the type of healthcare coverage (public versus private) and time to start treatment. The team analyzed a

by Sharon Hsieh

cohort of 78 patients with unilateral breast cancer from the Sylvester Comprehensive Cancer Center and found that patients with public insurance required, on average, an additional 7.48 days compared to those with private insurance. These results will raise awareness of timeline differences for treatment initiation. The care team may consult the patient, enhance the interventions, and distribute more resources to address the disparity.

As a first-year medical student, Angela balances her schoolwork, research, volunteering, and her life outside of medicine. “I think it’s important to be honest with myself and my team about how much time and effort that I can dedicate,” Angela said.. Some of her extracurriculars include volunteering at DOCS and being a part of the PR team for Keys Health Fair. She advocates for patients in the Florida Keys area and promotes community health and education. In addition, she is the MS1 director for Laennec society where she plans academic and social events. Outside of school, she enjoys playing board games and is a regional champion and the 5th best Settlers of Catan player in the US!

Angela Luo

MD Class of 2027

Mentor: Michael Butkus, PhD, Jessica Meshman, MD

Other Activities: DOCS, Academic Societies, Settlers of Catan player

Future Goals: Plastic Surgery

Angela is grateful for the inspiring mentors she has on her team. Dr. Meshman introduced her to radiation oncology.

Angela and Dan Tran, another M1 on the research team, presented their work together at the 2024 ESRF Symposium and are hoping to crystallize the findings into publication. Aspiring to become a plastic surgeon, Angela strives to excel in her schoolwork and continues to immerse herself in different research opportunities.

Disparities in RVUs for Breast and Prostate Operations

By Yasmine Kamgarhaghighi

When he began shadowing radiation oncology as a first year medical student at the Miller School, current second year student Noah Khosrowzadeh may not have known that it would lead to meeting one of his future research mentors and a chance to participate in research he was truly passionate about. What started as just a question he discussed with radiation oncology chief resident Dr. Cyrus Washington, M.D., led him to work on a research project that would lead him to international conferences and a possible publication on the horizon.

Noah’s question was this:Do prostate cancer operations and breast cancer operations pay the same in terms of reimbursement, or alternatively, is there any noteworthy difference in the compensation that physicians receive for one versus the other? It may not seem that prostate cancer and breast cancer have too many similarities that would allow for comparison. However, the two pathologies have many more similarities than the average person may think. 1 in 41 men pass away from prostate cancer and 1 in 39 women pass away from breast cancer. 12% of men will be diagnosed with prostate cancer at some point in their life compared with 13% of women that will be diagnosed with breast cancer at some point in their life. As Noah himself states, “the one major difference between the two is that one is a disease in males and one is a disease in females.”

With these similarities in mind, Noah decided to explore this question more deeply during the summer of 2023 after his first year of medical school under the mentorship of Dr. Washington and Dr. Jessica Meshman, M.D.. He chose to analyze the Relative Value Based Units (RVUs), which is what the Centers for Medicare and Medicaid Services (CMS) use, in order to decide reimbursement of physicians for services provided to patients. In this system, 1 RVU is worth 33 dollars. Noah called Medicare Services directly to get the information he needed. It took a few weeks to receive the information but what he uncovered was staggering. The reimbursement for these procedures was looked at across several different modalities for each type of operation.

Despite having very similar prevalence and mortality rates, breast cancer operations and prostate cancer operations are reimbursed differently. Across all modalities, the federal government pays 59% more for prostate operations than for breast operations and 12% per hour more of procedure time for prostate operations than breast operations. The government also pays 29% more RVU for pelvic lymph node removal than for axillary lymph node removal and 3.5% more per hour for pelvic lymph node removal. It became clear that there was a stark and concrete difference between how much more

Noah Khosrowzadeh MD Class of 2026

Mentor: Jessica Meshman, MD

Other Interests: Founding Member Radiation Oncology

(SIROS) Interest Group, Research Coordinator for the Oncology Pathway, WAC-Chair of Academic and Professional Development, Ultrasound Interest Group Executive Board

prostate operations were being reimbursed as compared to breast operations.

This work would end up taking Noah all the way to the San Antonio Breast Cancer Symposium where he presented the work. For Noah, this was one of many highlights of working on this project. He got to attend a conference alongside researchers from all over the world and as someone very interested in the field of oncology, he truly relished the experience. He also presented this work at the Annual Zubrod Sylvester Cancer Research Poster Session this past year. When asked about his favorite part of conducting this research, he points to being able to work with his friends, fellow classmates at the Miller School and also with mentors Dr. Washington and Dr. Meshman, both of whom he has the utmost respect for. Him and the rest of the team that worked on this project are also working on a manuscript and hope to go through the process of submitting it for publication soon.

With regards to next steps related to this project, Noah feels that spreading awareness would be the next most important step, especially because the RVU committee meets every few years to set new reimbursement rates. Additionally, Noah is continuing to explore his interest in radiation oncology, particularly looking at the difference in photon therapy and proton therapy, which is much newer in the field. Although proton therapy is very new, only really being introduced in 2021, it has been shown to have less rates of side effects on other organs in the body due to the dosimetry differences between this and photon therapy.

However, many insurances are hesitant to cover this treatment and this is one of many facets of this therapy that Noah hopes to uncover more about moving forward.

Making other people feel better makes me feel better. “ “

When asked how he maintains wellness while participating in research and being a medical student, Noah points to his work with Miller’s Wellness Advisory Council. He states, “Making other people feel better makes me feel better.” Last year he had the opportunity to organize pet therapy among other activities for Miller’s annual wellness week. Additionally, he feels that getting to work with close friends and mentors whom he truly admires has made all the difference and drives his passion for this work and also allows him to maintain balance.

As far as Noah’s future career goals, he is definitely interested in pursuing oncology in some capacity, but is still exploring various different fields through his clerkships. He would like to stay in Florida for residency if possible. Working on this project also has made him very interested in public health and health policy, fields he did not have as much exposure to prior to entering medical school and something he would like to explore more moving forward.

The Medical Ibis

Volume 12

Cover: AI Generated Art