The Medical I.B.I.S., Issue 8, 2020 by The Medical I.B.I.S.

MESSAGE FROM

DEAN FORD

One of my overarching goals for the Miller School of Medicine is to establish its pre-eminence in scientific research and to promote the translation of discoveries into interventions that will transform lives, build healthier communities and improve health globally. The importance of this vision has been underscored by the extraordinary toll on human life caused by the virus, SARS-CoV-2, which causes the pneumonia-like illness known as COVID-19. I am delighted to report that Miller School scientists are at the forefront of attempts to find rapid diagnostic tests and therapeutic interventions to combat this vexing virus and stop this global pandemic from both a basic science research and public health standpoint. Equally important is the need to challenge and inspire our talented students at the Miller School to engage in basic science, clinical and health services research by establishing a culture of innovation and scientific excellence that will allow the next generation of physician scientists to extend the boundaries of discovery to improve the health of humanity. In that spirit, I am proud to present the eighth annual edition of The Medical Ibis, the University of Miami Miller School of Medicine student-produced research publication. It highlights the wonderful contributions from the next generation of world-class researchers and physicians who are poised to transform lives and inspired to serve our global community.

Henri R. Ford, MD, MHA Dean and Chief Academic Officer, UMMSOM

Spring 2020 | The Medical I.B.I.S.

LETTER

FROM THE

EDITOR

Dear Readers, Welcome to the eighth edition of the Medical IBIS magazine! Each year, we showcase the cutting-edge research projects done by medical students here at the University of Miami Leonard M. Miller School of Medicine (UMMSM) and I am so proud of all of the work we have featured in this yearâ&#x20AC;&#x2122;s issue. With its diverse patient population and wide variety of research departments, UMMSM is one of the most exciting places to pursue research interests of any kind. In this issue you will read about the wide assortment of work our medical students are involved in, ranging from community service to orthopedic surgery to combating a worldwide pandemic. This has truly been an unprecedented year, especially in the field of healthcare, as the globe has come together to battle the COVID-19 pandemic. We are honored and inspired to have the opportunity to work with and learn from our distinguished faculty who are leading nationwide efforts to contain this virus. The entire Medical IBIS team salutes all the essential workers at this time, and we dedicate this issue to those working tirelessly on the frontlines. I am very proud of the entire Medical IBIS team and all of our student researchers we have featured in this issue. I look forward to this publication continuing to highlight the wonderful work done here at UMMSM and serve as a means for future collaboration among students. Sincerely,

Rhiya Mittal Editor-in-Chief, Medical IBIS

The Medical I.B.I.S. | Spring 2020

I.B.I.S. MASTHEAD EDITOR-IN-CHIEF WRITING MANAGING EDITOR PHOTOGRAPHY & LAYOUT MANAGING EDITOR SENIOR EDITORS SELECTION COMMITTEE CHAIR EDITORS PHOTOGRAPHY TEAM LAYOUT TEAM PUBLISHING TEAM SELECTION COMMITTEE MEMBERS

WRITERS

Rhiya Mittal Amoghavarsha Havanur Erin Wolfe Hardik Patel, A. Mariquit Lu Jenny Rakitina Jaqueline Baikovitz, Brett Colbert Rohit Reddy Victoria Rea-Wilson, Rohit Reddy Ahmed Yousef, Victoria Pinilla, Jun Long Ahmed Yousef, Gautam Shrivastava, Logan Stone, Jeffrey Lowell, Ryan Gallo, Brandon Rosen Nabiha Khakoo, Leena Yumeen, Kyrra Engle, Isik Surdum, Meghan Sharma, Anastasiya Plotnikova, Setareh Gooshvar, Adrienne Chevarria, Raghuram Reddy, Abby Adera, Amoghavarsha Havanur

ABOUT THE COVER

“Gloves? Check. Goggles? Check. Long gown? Check. Face mask with filtration system? Check! Though our Covid Doc and 17th century Plague Doc might have different understandings of infection and disease, both of them don PPE before bravely going out to face a pandemic. Through this retro-futuristism inspired image, I am celebrating the hard work and sacrifices of health care workers and researchers of the past and present who have been on the front lines combating infectious diseases. Thank you, throughout space and time.”

- Victoria Rea-Wilson, MD, MPH, 2021

Vic used Affinity Designer and a love of Sci-Fi to create the cover images.

Spring 2020 | The Medical I.B.I.S.

Mittal

Havanur

Wolfe

Rakitina

Baikovitz

Colbert

Yousef

Pinilla

Long

Patel

Reddy

Shrivastava

Rea-Wilson

Stone

not pictured

Lowell

Gallo

Rosen

Khakoo

Engle

Surdum

Sharma

Plotnikova

Reddy

Adera

Chevarria

Yumeen

Gooshvar

The Medical I.B.I.S. | Spring 2020

TABLE OF CONTENTS

Theoretical Cost Savings Analysis of Serving People Who Inject Drugs at Student-Run Wound Care Clinic vs Emergency Department Hardik Patel

Tracking the Coronavirus in Miami-Dade County in Real Time: The University of Miamiâ&#x20AC;&#x2122;s SPARK-C COVID-19 Testing Project Brandon Rose

Regional Genetic Responses of Porcine Talar Articular Cartilage to Impact Injury Hank Bryant, Kailey Mansour, Anrew Sama, Chris Murdock

Pathologic Response Rates After Neoadjuvant Therapy for Sarcoma Gautam Shrivastava

Evaluating the Influence of Pre-Hospital Characteristics of TBI on Race-Ethnic Differences in Mortality Sai Polineni

Malignant Hyperthermia and Associated Comorbidities Alexandra Herweck, Yingyot Arora

Spring 2020 | The Medical I.B.I.S.

THE MEDICAL I.B.I.S

Spring 2020 Vol 8, Issue 1

Comparison of Amniotic Membrane and Collagen Nerve Wraps Around Sciatic Nerve Reverse Autografts in a Rat Model Erin Wolfe

Management of Gynecomastia in Adolescents Yingyot Arora, Rhiya Mittal

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management Johnathon McCormick, Andrew Sama, Nicholas Schiller, Alexander Butler, Chester Donnally III

Cancer Stem Cells as a Therapeutic Target in 3D Tumor Models of Human Chondrosarcoma: an Encouraging Future for PRP-1 Caroline Granger

Intentional Deformity of the Tibia with a Hexapod Frame to Assist in Soft Tissue Coverage Bradley Lezak

The Medical I.B.I.S. is published by the University of Miami Miller School of Medicine Student Government

The Medical I.B.I.S. | Spring 2020

Exchanging Syringes for Lives: An MD, MPH Student’s Mission to Revolutionize the Treatment of People Who Inject Drugs By Nabiha Khakhoo

Hardik Patel, MD, MPH 2021 Honors/Presentations: 1st place poster at American College of Physicians 2019 Annual Meeting, Gold Foundation Student Summer Service Fellowship Mentors: Dr. Hansel Tookes III, M.D., MPH Future Goals: Dismantle socioeconomic barriers that prevent marginalized patient populations from obtaining medical care Other Interests: Project Manager, IDEA Clinic, IT Officer, Society of Student Run Free Clinics; Webmaster, Student Government; Head Tutor/Coordinator, NPAS; previous Editor-in-Chief, Medical IBIS

hen you first visit the city of Miami, it’s easy to fall in love with the “glitz and glam” of everything it has to offer – a bustling city life, avant-garde art districts, and an almost unparalleled level of cultural diversity. For decades, it has been recognized as one of the world’s favorite tourist destinations and, on the surface, it certainly lives up to its reputation. However, in the macrocosm of healthcare administration, it’s a completely different story. Healthcare workers and administrators who are intimately familiar with the challenges of providing adequate healthcare to the many underserved populations of Miami can attest to all sorts of obstacles with their patients, ranging from extreme destitution and lack of access to inadequate health literacy and communication barriers. These sorts of challenges are encountered on a daily basis and are contended against by dedicated physicians, nurses, medical students, and other members of the healthcare team. However, what has become an even more prevalent issue in healthcare is something that represents one of the most formidable barriers to equity in medicine, especially in the city of Miami – stigma against people who inject drugs (PWID). When Hardik P. Patel began his medical school education at the University of Miami Miller School of Medicine (UMMSM), he set his bright and eager eyes on the IDEA Clinic, a student-run free clinic affiliated with the

Spring 2020 | The Medical I.B.I.S.

first syringe service program in Florida, known as the IDEA Exchange. What started out as a small initiative grew into a full-fledged clinic under the mentorship of the esteemed Dr. Hansel Tookes, III M.D., MPH, who worked tirelessly with Hardik and the other co-founders to get the clinic up and running just two months into Hardik’s first year as a medical student. The first of its kind established by UMMSM, the IDEA Clinic caters directly to PWID by providing incision and drainage (I&D) of abscesses, HIV/HCV testing, safe injection education, and basic health screening services. The mission of the IDEA Clinic is aimed at preventing the progression of infections and wounds due to injection drug use into acute, life-threatening illnesses that not only add to the economic burden of our healthcare system but also contribute to the morbidity and mortality of this patient population.

“

This project underscored the gravity of the economic impact of the IDEA Clinic

In light of the opioid epidemic, it became evident to Hardik that the IDEA Clinic could not only make a difference in the lives of its patients but also serve as an overarching model to expand resources for PWID. He committed himself to establishing the IDEA Clinic within the community, broadening its impact with a mobile clinic unit and creating a patient navigation program to keep patients connected with the healthcare system

after their initial visit to the clinic. His overall goal was to start a dialogue about the stigma that exists against PWID and to use his experiences as a prominent member of the IDEA Clinic to encourage fellow medical students and physicians to become advocates for one of the most marginalized patient populations in todayâ&#x20AC;&#x2122;s society. Among the many research projects Hardik delved into, one of the most significant was a one-year cost savings analysis of basic wound care and screening services provided at the IDEA Clinic compared to traditional emergency departments. The charts of PWID who received medical care at the IDEA Clinic over a designated 12-month period were analyzed and the total cost of services provided was stratified into the costs of medical equipment, medication, and procedures. Since the cost of services provided by emergency departments may vary and are not readily available, the average Medicaid reimbursement rates were used as a surrogate marker for emergency room costs. The results of the study suggested that the IDEA Clinic provides both timely and cost-effective treatments, with the greatest cost savings attributed to I&D procedures and HCV testing. This project not only underscored the gravity of the economic impact of the IDEA Clinic but also brought substance to Hardikâ&#x20AC;&#x2122;s appeal for local legislators and health policy makers to pay closer attention to this patient population. It also provided a more solid founda-

tion for Hardik and the rest of the IDEA Clinic staff to champion their fight against stigma and bring greater awareness to the issue. Hardik is hopeful that other medical schools and service organizations will appreciate the value of the IDEA Clinic and perhaps establish similar student-run free clinics of their own. Currently, Hardik is completing his third year of medical school at UMMSM. He remains intimately involved with the IDEA Clinic, monitoring the patient navigation program and devising new research topics. His initial proposal to establish the patient navigation program was one of nine selected to receive funding through the Gold Foundation Student Summer Service Fellowship. He has since presented his work at a multitude of widely recognized conferences. His cost-savings research was presented at the American College of Physicians (ACP) Annual Meeting in 2019, where he was awarded first place for his poster presentation. Hardik also presented at the Society of Student Run Free Clinics (SSRFC) annual conference, the Florida Medical Association (FMA) annual meeting, and the inaugural Gold Humanism Summit. His most recent research endeavor involves utilizing point-of-care ultrasound as a diagnostic tool for PWID to support early diagnoses and provide timely treatment of soft tissue infections. This will undoubtedly prove useful in the treatment of people who inject drugs and continue to shed light on the tremendous achievements of the IDEA Clinic.

The Medical I.B.I.S. | Spring 2020

Tracking the Coronavirus in Miami-Dade County in Real Time: The University of Miami’s SPARK-C COVID-19 Testing Project By: Amoghavarsha Havanur

Brandon Rose, MD, MPH 2022 Other Activities: Vice President of Hematology/Oncology Interest Group Mentor’s Name: Erin Kobetz, Vice Provost of Research Mentor’s Degree(s): PhD, MPH Mentor’s Official Titles: Vice Provost of Research, UM

n late March, as the COVID-19 pandemic swept through the United States, the Miami-Dade County Mayor’s office reached out to Dr. Erin Kobetz, UM’s co-Vice Provost of Research. Miami-Dade had been allocated 10,000 serologic coronavirus tests. Would Dr. Kobetz be interested in using 3,500 of them for research purposes? At that time, COVID-19 tests were being reserved for symptomatic patients only. But because the virus has a long asymptomatic incubation period, this meant that COVID-19’s prevalence amongst the general population was being drastically underreported. By agreeing to test a broad, random sample of Miami-Dade residents—one of the first random community-based surveys of COVID-19 in the United States—Dr. Kobetz and her collaborators, which now include Dr. Natasha Solle, Dr. Zinzi Bailey, and Dr. Alberto Caban-Martinez, hoped to form a clear picture of the virus’s reach and impact in Miami-Dade. They call this program the Surveillance Program Assessing Risk and Knowledge of Coronavirus, or SPARK-C. As Dr. Kobetz put together a team of student leaders to fast-track this project, one name caught her eye: second-year student Brandon Rose. Dr. Kobetz was currently serving as the advisor for his MD/MPH capstone work, and she’d written the letter of recom-

Spring 2020 | The Medical I.B.I.S.

mendation for his field experience at the NIH National Cancer Institute the summer before. When she recruited him to lead the student volunteers, along with four other trusted students—Tomas Delgado, Heather Herman, Maya Lubarsky, and Maria Lugo—he was in his dedicated period for the USMLE Step 1 board exam. But when he got the call, he didn’t hesitate: “It was a no-brainer for me to work on this unique project,” Brandon recalled. “I could help contribute to our knowledge of COVID-19. That felt so much more tangible to me than studying while test availability was limited.” Later, the student captains were able to recruit four more student leaders: Brianna Mussman, Varsha Prabhakar, Apoorva Rangan, and Nicole Vecin. Ordinarily, an epidemiological study of this scope can take several months to get off the ground. Working around the clock, Dr. Kobetz and her team orchestrated an astonishing turnaround: within three weeks, they were calling their first participants on April 4th, and conducted their first round of COVID-19 tests in the field two days later. Using account information from Florida Power and Light, residents throughout Miami-Dade County were dialed at random and routed to UM’s student volunteers. Brandon, his fellow Student Captains, and the team of student volunteers—over 130 in all—explained the study procedures, obtained verbal consent, collected demographic and health information,

and scheduled participants for appointments at one of ten different community testing locations throughout Miami-Dade County. Residents who could drive were instructed to appear at their testing location and roll their windows down. Within a ten-minute block, a member of the field-testing team—composed of local firefighters, police officers, nursing students, and other UM staff—would appear in full Personal Protective Equipment (PPE) and perform a quick finger-stick, obtaining a droplet of blood to feed into a small testing cassette. The participant would then drive off, and the process would repeat for the next car—again and again, for 11 hours, at times in 90-degree heat. Within two days, each respondent would receive a call from the student team informing them of their test results and providing guidance on how to proceed. The test itself is a qualitative lateral-flow antibody test, checking for the presence of antibodies to COVID-19 in the collected blood sample. There are two types of antibodies tested—IgM, which suggests acute coronavirus infection, and IgG, indicative of a past coronavirus infection. Participants who tested positive for IgM, whether symptomatic or not, were told to self-quarantine for 14 days and asked about recent contacts. Student volunteers were also tasked with explaining the implications of the test results to participants; Brandon remembers one such case, of a participant who tested positive for IgG—suggesting a cleared past infection—but was nevertheless fearful of infecting their grandparents. “As a future physician, it’s really helpful for students to practice giving test results, especially for something that’s so heavily in the public consciousness,” Brandon realized.

In less than a month, the SPARK-C team has enrolled over 3,100 participants and conducted over 2500 tests. In addition to leading the student team, Brandon is helping to analyze the preliminary data, which indicates that some 6% of the sample population has tested positive – a figure which projects that nearly 170,000 people in Miami-Dade County may have some level of exposure to the coronavirus. Over 60% of those who tested positive were asymptomatic in the past 14 days, which implies that many residents are carrying and potentially spreading the virus without realizing it. In the future, Brandon says the team plans to analyze the data for potential community health disparities amid the COVID-19 outbreak. “Miami is uniquely set up to look at different communities because it’s demographically a very unique place,” he points out. Already they have noted differences in the spread of the virus across certain demographics; further analysis remains forthcoming. For Brandon and his peers, working on this project has been an immensely fulfilling experience. He is especially indebted to his team of fellow student captains. Although he is interested in pursuing medical oncology, he notes that “working with these big translational research projects is invaluable as a future public health physician no matter what you choose to specialize in.”

The Medical I.B.I.S. | Spring 2020

Evaluating the Influence of Pre-Hospital Characteristics of Traumatic Brain Injury on Race-Ethnic Differences in Mortality

raumatic brain injuries (TBIs) are some of the most high-risk cases a physician will face. TBI is defined as any blunt or penetrating blow to the head that causes damage to and interferes with normal brain function. Typically, the causes range from automobile accidents and sports injuries, to violent assaults. TBIs are fairly common and extremely dangerous. A severe case could leave the victim with lifelong disabilities. These include, but are not limited to, loss of fine motor skills, memory difficulties, difficulty in social relationships, and problems with walking, talking, and swallowing. To date, studies have not shown any genetic risk factor in TBI effects. There are racial disparities in recovery outcomes and mortality however. This clear extrinsic influence is exactly what drove Sai Polineni, M.P.H., a third-year medical student at UMMSM, to explore this phenomenon. As the previous president of the Student Interest Group in Neurology and cohost of Confounders, a podcast discussing modern issues in health policy, Sai is no stranger to diving into issues regarding not only the brain in a biological sense but also the inequalities that are embedded in the current healthcare system. When entering this project, Sai and his team were interested in looking at not only the outcome of the TBI but also the pre-hospital characteristics that led to significant differences in mortality rates in different race-ethnic groups. These variables could hopefully help to explain the racial disparities in mortality and lead to a better understanding of TBIs. The research project was a retrospective cohort analysis of nearly 4000 TBI cases that presented to Jackson Memorial Hospital. The cases were first sorted by race-ethnic groups, as there were prior studies that showed differences in these groups, and then further divided by gender. The findings showed significant differences across multiple categories, including insur-

By: Isik Surdum

ance status, primary payor and pre-hospital transport when it came to comparing the Black and Hispanic groups to the White group. Their findings showed that insured Black and Hispanic groups had decreased odds of mortality when compared to their uninsured groups, which was not seen in the White group. Along with this, the White group was much more likely to be air transported to a hospital compared to the Black and Hispanic group, even after adjustments for demographics, cause of injury, and more had been accounted for. These statistics help shed light on other variables that contribute to the mortality disparity seen between the groups. However, what Sai found even more interesting, was the cause and mortality risk of the TBIs also was significantly different. TBIs that were obtained through weapons or violence had a much higher mortality rate when compared to vehicular TBIs and Black and Hispanic groups were more likely to obtain the violent TBIs when compared to their White counterparts (31.7%, 14.2%, 12.2%, respectively), with rates more than double when comparing the Black and White groups. When looking at gender, Black women were more likely to die from TBIs than Black men, which is a phenomenon not seen in the White or Hispanic groups. As Sai put it, â&#x20AC;&#x153;Black women are not just at a higher risk for TBI mortality for their race, but also for their genderâ&#x20AC;?. Although the research that Sai and his team worked on received the Top Poster Award at the American Neurological Association Conference this past October, they are not planning to stop this important work any time soon. After finishing the manuscript, the team plans to dive into the National Trauma Data Bank to see if their results mirror a national phenomenon or are unique to the Miami population. The goal is to put measures in place to ameliorate the disparities uncovered by bringing these critical issues to light, and Sai plans on seeing this invaluable project through.

Sai Polineni, MD, 2021 Honors: American Neurological Association Conference Top Poster Award Mentor: Dr. M. Ross Bullock, MD, PhD Other Interests: Student Interest Group in Neurology, Confounders podcast cohost, likes to play Ultimate Frisbee Future Goals: Sai wants to become an interventional neurologist.

Spring 2020 | The Medical I.B.I.S.

Radiation, Chemotherapy, or Both?

Pathologic Response Rates After Neoadjuvant Therapy for Sarcoma By: Kyrra Engle

Gautam Shrivastava, MD, MPH 2021 Interests: Heme/Onc Interest group, DOCS Project Manager, Light of the World Health Fair. Oral Head and Neck Cancer Awareness Week (OHANCAW) Asst. Site Director, Medical IBIS, Tennis, Culinary tourism Mentor: Dr. John Jarboe Dr. Raphael Yechieli (PI) Goals: internal medicine

arcomas are a rare and heterogenous group of malignant pathologies of mesenchymal origin, largely bone and connective tissue, with approximately 80% originating in soft tissues. Each year there are approximately 12,750 new cases of soft-tissue sarcomas (STS) spread across over fifty specific subtypes which complicates the development of treatment protocols. Working with the Department of Radiation Oncology at the Sylvester Comprehensive Cancer Center, third-year MD/MPH student Gautam Shrivastava is trying to help study treatment outcomes for sarcoma patients. With an interest in rare conditions in oncology, Gautam pursued shadowing in Radiation Oncology. He spent an afternoon seeing patients with Dr. John Jarboe, then in his final year of residency, and they discussed the fluid nature of treatment protocols for the conditions seen at the clinic. Dr. Jarboe highlighted how Sylvester’s protocol pairs together conventional treatments in an aggressive neoadjuvant chemoradiotherapy, and they wanted to explore the treatment outcomes in depth. Currently, treatment approaches for STS vary widely across cancer centers, with most centers preempting surgical resection with either neoadjuvant radiation or chemotherapy alone. Taking advantage of Miami’s relatively large STS patient population, Gautam compared these two treatment protocols. With Sylvester’s neoadjuvant approach combining the two modalities for STS, the hope is to establish a standardized treatment that can be adopted by physicians across various institutions. Working alongside Dr. John Jarboe under the direction of Principal Investigator and co-leader of the Thoracic Cancers Site Disease Group Dr. Raphael Yechieli, Gau-

tam analyzed records of patients who received neoadjuvant radiation therapy, chemotherapy, or chemoradiotherapy in the treatment of STS over the last four years and assessed the pathologic response, which is when a resected tumor has at least 95% necrosis, as an outcome measure. Gautam found that patients who received neoadjuvant chemoradiotherapy had a greater pathologic response than patients who received chemotherapy or radiation alone. Since 2011, Dr. Jon Trent, Director of the Bone and Soft-Tissue Sarcoma group, has been treating STS patients with a neoadjuvant protocol that utilizes sequential chemotherapy and radiation prior to resection. While this approach has appeared effective clinically, there is a paucity of evidence in the literature validating this protocol. Gautam presented these results at the American Society of Clinical Oncology (ASCO) and Association for Radiation Oncology (ASTRO) national conferences in 2019, bolstering the case for both the use of pathologic response as a proxy outcome measure and for the aggressive neoadjuvant chemoradiotherapy practiced at Sylvester. However, the work has not stopped there. Inspired by the impact of this first study on the outcomes of Sylvester’s protocols, the work will serve as a branching point for the analysis of more STS patients and their treatment. With plans to add research into the toxicity associated with neoadjuvant therapies, as well as subtype-specific outcomes, the aims are to better understand impact and adverse effects of this aggressive treatment protocol. With future plans to pursue a career in oncology, Gautam is grateful for the opportunity to lead this project and for the mentorship he received from the Dr. Jarboe, Dr. Trent, and Dr. Yechieli along with the entire radiation oncology department.

The Medical I.B.I.S. | Spring 2020

Regional Genetic Responses of Porcine Talar Articular Cartilage to Impact Injury

nvestigation into novel orthopedic treatments takes more than a couple cell lines and a hypothesis. For this entire lab team, it took a drop tower--a feat of biomedical engineering devised by PhD. Charles Huang. Using a pig’s talus bone as a model for a human’s ankle, the team hit the joint with a drop weight and analyzed inflammatory markers to gain insights into the mechanisms of ankle inflammation. Indeed, the findings could transform the treatment of ankle injuries from broad, unspecific care to therapies tailored to the region of the bone damaged. For Hank Bryant, third year medical student, the allure of the project was its focus on such targeted therapy, which he sees as the future of orthopedic care. The talus bone, a portion of the ankle bone located between the tibia and the heel bone, is shaped somewhat like a dome with different posterior, anterior, and lateral sections. To investigate the differences between the various regions, the team struck the ankle with the drop weight with the same impact force in different locations. After culturing the cells, they harvested samples at different times after impact in order to compare marker upregulation at various periods throughout the inflammation process through qPCR. For Hank, each step was a way of deducing the best mode of treatment and the best time at which to administer it.

“Research is necessary to keep progressing in medicine- it drives the field forward.” The findings truly presented an “aha!” moment for the team. The results suggested that the planes and regions of the ankle are far more complex than the size of the small bone would imply. According to Hank, the magnitude of the inflammatory response, as indicated by the analyzed markers, varied by the region impacted, even though each was struck with the same force. It’s a notion that shatters the idea of giving a standard treatment for breaks according to the bone afflicted rather than the specific region of the bone injured. Moreover, it seemed that some regions already had a baseline level of inflammation prior to the impact. Such knowledge may allow surgeons to make far

Spring 2020 | The Medical I.B.I.S.

By Leena Yumeen more informed decisions regarding treatment by correlating the level of inflammation presented to the region afflicted. If, say, a portion of the bone known to be more resistant to impact stress is damaged, a surgeon can carry out a treatment plan that is less aggressive than that required for a region that is less resistant to such force. “We’re taking broad brushstrokes and making them more narrow,” says Hank, commenting on the leap from unspecialized care to truly specialized medicine that the study hopes to drive. The team had originally set out to understand why osteoarthritis was so common in ankles that had previously suffered breaks, yet the inflammatory markers they analyzed portrayed a far more complex story regarding the general progression of ankle inflammation. To Hank, such investigation highlights the value of continued research and the advancement of healthcare therapies. “Research is necessary to keep progressing in medicine--it drives the field forward. If we didn’t have it, we wouldn’t have these tailored therapies. We’d still be doing the same things we did 20, 30, 40, or even 50 years ago.”

Hank Bryant, MD, 2021 Honors: Orthopedic research presentations in Chicago, Arizona, and Miami student research symposium Mentors: Amiethab Aiyer, MD and Charles Huang, PhD Other Interests: biotechnology, cooking, biking, guitar, skiing Future Goals: tailoring medical therapies to better identify and prevent orthopedic injury progression. Understanding how different regions of musculoskeletal anatomy initiate specific inflammatory responses will allow us to ultimately delay, alleviate or event prevent short and long-term complications of injury

Kailey Mansour, MD, 2021 Mentors: Dr. Steve Azar, MD and Dr. Stephen Stricker, MD Other Interests: LSU football, baking, hiking, surfing Future Goals: retire in Switzerland and own a bakery there

Andrew Sama, MD, 2022 Other Interests: Grilling, playing guitar, skiing, mentorship Future Goals: Continue to publish high quality research, learn Spanish Mentor: Chester Donnally III, Dr. Amiethab Aiyer, MD

Christopher Murdock, MD, 2022 Other Interests: Student Government, VP of OSIG, Wrestling Mentor: Dr. Amiethab â&#x20AC;&#x153;Tabsâ&#x20AC;? Aiyer, MD and Dr. Chun-Yuh Huang, PhD Future Goals:To become an academic Orthopaedic Surgeon with my own translational science laboratory to provide novel solutions for my patient population and the medical community at large.

The Medical I.B.I.S. | Spring 2020

Malignant Hyperthermia and Associated Comorbidities

By: Meghan Sharma

lexandra Herweck and Yingyot Arora spent the past year working on a literature review with a goal of examining the epidemiological parameters and associated comorbidities of malignant hyperthermia (MH).

The literature review examined nine retrospective chart reviews and included several demographic groups including surgical patients, Caucasian males less than 44 years old, and patients with musculoskeletal or connective tissue diseases. Incidences of MH ranged from 0.18 to 10.4 per 100,000 discharges and exhibited a mean mortality rate of 11.5% prior to introducing the intravenous muscle relaxer dantrolene — with adults experiencing a higher mortality rate than children. While many of the studies examined the epidemiological parameters associated with MH, none examined the association between MH and cardio-metabolic conditions, including predisposing risk factors and long-term outcomes — one of Alexandra’s and Yingyot’s primary research questions. To explore this relationship, they will remain involved in the project by working to find and analyze a malignant hyperthermia database regarding cardio-metabolic conditions. Alexandra came into medical school with an interest in surgery. After shadowing one afternoon, she connected with Dr. Seth Thaller M.D., D.M.D., a Professor of Surgery in the Division of Plastic and Reconstructive Surgery. Dr. Thaller proposed a literature review

on the cardio-metabolic risk factors associated with MH and Alexandra was interested in getting involved. While being involved in research can be time-consuming, Alexandra uses to-do lists to balance her research duties with other responsibilities. She also mentions the value in setting short-term and longterm goals in different categories of her life, including career, relationships, finances, and wellness. Wellness is one of her top three priorities, and she enjoys exercising, journaling, and connecting with friends during her free time. “The biggest thing to remember is life is a journey and you have to live for today,” she advises aspiring student-researchers about maintaining wellness in their lives. “If you do this, you will be leading by example and inspiring your fellow classmates to do the same.” Yingot had an interest in surgery as well, specifically in broadening the integration of surgical practice with public health. He joined the malignant hyperthermia research team after previous mentorship experiences with Dr. Thaller. Throughout his experiences as a student-researcher, Yingyot has also learned how to manage his time through goal setting and self-reflection. “Setting realistic expectations and spending some time reflecting and learning from past successes and failures helps me maintain a growth mindset that allows me to balance my time and efforts,” he says.

Alexandra Herweck, MD, MPH, 2021

Other Interests: Women’s health and overall wellness/health - physical, nutritional, psychological/emotional, and sexual health Future Goals: OB/GYN with a potential future in reproductive endocrinology and infertility. Mentor: Seth Thaller, MD, DMD, Tenured Professor in the Department of Surgery, Division of Plastic Aesthetic and Reconstructive Surgery

Yingyot Arora, MD, MPH, 2022

Other Interests: Student Government-MD/MPH Liaison, Students Interested in Plastic Surgery Mentor: Seth Thaller, MD, DMD, Tenured Professor in the Department of Surgery, Division of Plastic Aesthetic and Reconstructive Surgery Future Goals: Hiking through the Himalayas

Spring 2020 | The Medical I.B.I.S.

Generating Connections:

Comparison of Amniotic Membrane and Collagen Nerve Wraps Around Sciatic Nerve Reverse Autografts in a Rat Model

By: Anastasiya Plotnikova

Erin Wolfe, MD, 2022 Mentor: Zubin J. Panthaki, MD, CM, FACS Other Interests: Vice President, Students Interested in Plastic Surgery; Co-president, American Physician Scientists Association; President, Medical Arts Club; Association of Women Surgeons; Painting, running, surfing Future Goals: Plastic and Reconstructive Surgery

rin Wolfe is a 2nd year MD student conducting cutting-edge research under the supervision of Dr. Zubin Panthaki, MD, CM, FACS at the Lois Pope Center at UMMSM. The Coconut Grove native completed her Bachelor of Science at Georgetown University where she first started working with animals in the context of peripheral nerve regeneration research. Motivated by a desire to improve clinical outcomes for people afflicted with peripheral nerve damage, she applied the skills she learned in her undergraduate to secure a fulltime clinical/basic science research associate position at UMMSM following graduation from Georgetown. The following year, Erin started medical school, and is now in her second year. Having finished her research, Erin reflects on her project as being essential to her understanding of how research translates into clinical application. Erin was recruited to conduct research on peripheral nerve regeneration, specifically using biomaterials such as amniotic membrane and collagen nerve wraps on a rat injury model, the model organism for peripheral nerve regeneration research. When clinically applied, this research would allow patients with nerve injuries from car accidents or various other traumas to regenerate damaged nerves, restoring the damaged limb’s function. The project is dedicated to studying a gap injury, the most severe type of nerve injury in which damage causes a gap between nerves that must be filled so that the axon can regenerate. To connect the damaged nerves, microsurgerical repair of nerves must be performed with with sutures finer than a strand of hair. Once the axons regenerate, the nerves are once again able to communicate with the spinal cord and re-innervate the muscle. Interestingly, amniotic membrane is a unique biomate-

rial that hasn’t been used in peripheral nerve regeneration but is medically relevant to a lot of dermatological wound healing specialty surgeries. Erin saw amniotic membrane being used in the UM operating rooms while she was observing plastic and reconstructive surgery at the University of Miami Hospital. She also had a chance to witness amniotic membrane heal diabetic foot wounds that wouldn’t heal otherwise during an internship at Georgetown University Hospital Center for Wound Healing. Once at UM, Wolfe got a grant for her project from the UM Tissue Bank in collaboration with UMMSM neurosurgery division so she could contribute to gathering novel preclinical data.

“You don’t know how clinically applicable [using amniotic membrane] is, but by doing benchwork, we can see that it can be relevant.” With a manuscript in progress, Wolfe enthusiastically describes that the project shows a significant difference in histological indicators between control, collagen, and amniotic membrane cells, with the amniotic membrane proving to be the best way to reestablish nerve connection. Future studies would seek to create a more durable and thicker membrane. Wolfe’s personal future plans involve selecting a specialty within the realm of surgery, but she still has a variety of options open to her. She is grateful that benchwork taught her patience and leadership while revealing the importance of having a good team. These are all skills that can be directly translated into her future career as a physician. Presented at: Plastic Surgery Research Council - Oral Presentation American Society for Peripheral Nerve - Oral Presentation

The Medical I.B.I.S. | Spring 2020

Management of Gynecomastia in Adolescents

ynecomastia is the enlargement of male breast tissue. Although physiologically benign, it can be a source of embarrassment and take a psychological toll on adolescent males. It is usually caused by an excess of the female hormone estrogen and may occur in males of all ages. Careful examination precedes a diagnosis and treatment is specific to each case and patient. However, in adolescents, treatment does not usually reach beyond observation and reassurance, with the option of pharmaceuticals or surgery being the exception, not the rule. Yingyot Arora and Rhiya Mittal, MD/MPH. students in the 2022 class at the Miller School of Medicine are interested in the access to care in the context of gynecomastia. As with all medical students interested in research, Yingyot and Rhiya had to obtain a mentor to assist in developing and completing the project. They found such a mentor in Dr. Seth Thaller MD., DMD., a tenured professor in the Division of Plastic Aesthetic and Reconstructive Surgery and conducted their research from 2018-2019.

â&#x20AC;&#x153;The overarching goal ... is to increase the awareness surrounding the psychosocial impacts of physical deformities on adolescents...â&#x20AC;? The state of healthcare in the United States is currently highly variable. It is a turbulent time rife with frustrations, concerns, and obstacles. As such, it is very important to explore and analyze the barriers to healthcare. Fundamentally, Yingyot and Rhiya were interested by the sparse data and limited published research on both sides of the healthcare access and delivery spectrum. This spectrum contributes to the unnecessary coverage and access gap that has caused the unstable setting of healthcare today. They were also interested in diving deeper into possible coverage

Spring 2020 | The Medical I.B.I.S.

By: Setareh Gooshvar

models for the treatment of gynecomastia and in addressing the psychosocial impact of gynecomastia on adolescent males. To obtain the information they needed, Yingyot and Rhiya conducted a literature review specifically aimed at identifying the socioeconomic obstacles that prevented adolescent males from accessing surgical care. This review was focused on the treatment of gynecomastia. Further, the review proposed a framework focused on revisiting the guidelines for insurance coverage. In addition to the literature review, they conducted a retrospective chart review to examine rates of complication in mastectomies for males and females. No significant differences were found in complication rates between males and females. As a result, male mastectomy was found to be a safe and effective treatment option in the event that diet and weight loss approaches do not successfully provide resolution of symptoms. Additionally, Yingyot and Rhiya found that gynecomastia can severely impact adolescent males psychosocially. The overarching goal of their research is to increase the awareness surrounding the psychosocial impacts of physical deformities on adolescents and promoting additional treatment options for individuals with gynecomastia. Additionally, since these procedures are typically considered cosmetic by insurance companies, the project encourages conversations on the benefit of these surgeries for adolescent social and mental wellbeing. Yingyot and Rhiya have hope that their project will lead to a more clear view of a structured coverage system as well as the development of guidelines that can be widely applied and practiced. Included in this is their future vision of exploring deeper into the return on investment for surgical management. Through this they hope to present a case looking at the cost savings of surgical treatment options. Regarding their career and future goals, Yingyot and Rhiya hope to continue their heavy involvement with research especially research that is interdisciplinary in the fields of public health, economics, and medicine.

Their future goals include research throughout their time in medical school and eventually as practicing physicians. With such an interest in research and medicine comes the stress inherent to such involved endeavors. However, they balance their academic, extracurricular and personal responsibilities by first and foremost staying organized. Then they focus on prioritizing activities and goals, with one of their priorities being the necessity of making time to take care of oneself physically, emotionally, and mentally. Luckily, Yingyot and Rhiya are not only researchers but also offer their own advice to aspiring medical student researchers. They emphasize the necessity to regularly find and make the time to care for yourself away from the medical school environment and its associated responsibilities. Outside of their research, they are each individually members of various extracurricular activities. Yingyot is the MD/MPH Student Government Liaison for the class of 2022 as well as being part of the Students Interested in Plastic Surgery. Rhiya is also a part of Student Government in addition to being a member of Students Interested in Plastic Surgery, Ophthalmology Interest Club, Medical IBIS, and the American Association Physicians of Indian Origin.

Rhiya Mittal, MD, MPH, 2022

Other Interests: Student Government, Students Interested in Plastic Surgery, Ophthalmology Interest Club, Medical IBIS, American Association of Physicians of Indian Origin Mentor: Seth Thaller, MD, DMD, Tenured Professor in the Department of Surgery, Division of Plastic Aesthetic and Reconstructive Surgery Future Goals: Hiking through the Himalayas with Yingyot

Yingyot Arora, MD, MPH, 2022

Additionally, they acknowledge that although school, research, and extracurriculars place a uniquely heavy demand on the individual, it is important to unplug and engage in hobbies and activities that are genuinely enjoyable so as to avoid the symptoms of burnout. Specifically, Yingyot and Rhiya enjoy all the amenities the city of Miami offers them. They attend food and music festivals, enjoy movies, and take in the stunning views. They also explore the city as a whole and indulge in the discovery of new restaurants due to their shared love of food. A strong recommendation of theirs is connecting with a group of peers who share the same values and who will support you through your career path but will also remind you to relax and smell the roses.

Read about Yingyot and Rhiyaâ&#x20AC;&#x2122;s research where it is published in Journal of Craniofacial Surgery with the PMID: 31592845.

The Medical I.B.I.S. | Spring 2020

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and ManagementBy Adrianne Chavarria

o provide insight about cervical spondylotic myelopathy (CSM), a University of Miami Miller School of Medicine MS-2 student Andrew (Drew) Sama working with Chester J. Donnally III, M.D. touches on its severity and pervasiveness in the orthopedics patient population. Not only “can it be quite debilitating for patients, but also many people will face it in their lives that have back issues.” Although CSM pathophysiology is not fully understood by scientists, there exists a consensus about the influence of aging in the severity of the disease.

America” needs to be recognized, along with the proliferation of studies that aim to facilitate earlier diagnoses. (McCormick, Sama, Schiller, Butler, & Donnally, 2020). Drew mentions that “deciding when to refer can literally prevent paralysis or horrible neurodegeneration. If there is already degeneration, compression, or impingement, the patient is prone to even further injury, which can have devastating effects.” Ultimately, earlier diagnoses lead to increased effective symptom management which decreases the risk for irreversible harm to the spinal cord, thereby increasing the patients’ quality of life.

As Drew explains, the “years of pressure and work on our back leads to degeneration of the discs and vertebrae, which can potentially compress the spinal nerves and cord. Prior trauma, autoimmune conditions, or other chronic inflammatory states can also affect prognosis.” Previously, symptom severity was determined by a scale that focused only on changes in gait. The newer, more comprehensive Japanese Orthopedic Association (JOA) scale instead analyzes upper and lower extremity sensory and muscle function as well as bladder function.

By addressing the need for earlier diagnosis, Drew and the research team leave their mark in the field by contributing to the literature on existing CSM recommendations from the AO Spine and the Cervical Spine Research Society (CSRS). Radiography plays a role in the definitive confirmation of CSM; in fact, the gold standard is MRI. Once confirmed, surgery can stave off impairments that would otherwise worsen with time. Regardless of personal choice to undergo surgical intervention, a specialist should always be in the picture to evaluate the case and determine whether or not to prescribe another intervention. It should be noted that up until now doctors neither have agreed on an “ideal” non-operative treatment for CSM nor have collected significant data on the outcomes of non-operative versus operative methods.

“... a specialist should always be in the picture to evaluate the case and determine whether or not to prescribe another intervention.” Actual detection of CSM may often indicate surgery (anterior, posterior, or combined). Alternatively, there exist non-invasive solutions that patients can opt for to manage their symptoms which include cortisone injections and physical therapy. Because having this condition can cause impaired quality of life, quick referrals are key in lessening symptomatology which places an even more essential role on accurate diagnoses. Reviewing the guidelines: a guideline for reviewing CSM, the connective tissue between better identification & patient outcomes The most common spinal degenerative disorder in Americans over the age of 55 and what accounts for “54% of nontraumatic spinal cord injury in North

Spring 2020 | The Medical I.B.I.S.

The importance on creating a guide for physicians about CSM should not be underestimated. Promoting timely interventions impact patient care by “preventing issues that can arise from missing a diagnosis or letting the condition go unchecked.” After suspecting that a patient has cervical spondylotic myelopathy, what comes next? The recommended timeline in their paper can serve as an aid for doctors who potentially are dealing with a case of CSM on their hands or questioning when to refer. According to their paper: 1. Common initial symptoms of CSM are decreased hand dexterity and gait instability. 2. Mild CSM may be managed surgically or with structured rehabilitation. 3. Moderate-severe CSM is managed almost exclusively with surgery.

4. Patients diagnosed with CSM should be referred to a spine surgeon for management.

Drew’s anatomy: the person behind the research

Drew worked with Johnathon McCormick, Nicholas Schiller, Dr. Alexander Butler, and Dr. Chester Donnally on “Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management,” which has been accepted for publication in the Journal of the American Board of Family Medicine. If Drew’s path teaches us anything, it is that how knowledgeable you feel you are about a specialty at whatever level you are should not deter you from becoming involved in a related lab if it is your passion. When Drew first embarked on this project, he wasn’t familiar with the specifics about CSM, and thinks that research is a great way to enhance one’s knowledge.

Drew believes that playing an active leadership role in Student Government (SG) and the Orthopedic Student Interest Group (OSIG) adds a meaningful component to his medical school experience. To serve as VP and Mentorship Coordinator puts him in a position “to connect people interested in orthopedics with mentors that can help them along their journey” and allows him to develop further as a well-rounded professional.

Due to his personal connection with this research topic (his father is co-chief of the Hospital for Special Surgery’s spine service), he finds working under Dr. Donnally’s instruction in this area particularly fulfilling “as it serves as an opportunity to learn more about the different conditions that both my dad and Dr. Donnally deal with, and gives me a small glimpse into the patient populations I hope to one day treat.”

They arrived at the aforementioned pearls by analyzing which research design would prove ideal for this context. Drew mentions that “we wanted something that is actually clinically applicable, that primary care doctors will use, and that can help improve patient outcomes.” With regard to other CSM-related interesting research questions, Drew soon wants to delve into early markers for CSM, either degenerative or predictive markers that can help catch it early.

Jonathan McCormick, MD, 2020 Mentors: Amiethab Aiyer, MD Other Interests: beach, volleyball, snowboarding Future Goals: complete orthopedic surgery residency and fellowship

Andrew Sama, MD, 2022 Mentors: Chester Donnally III, Dr. Amiethab Aiyer, MD Other Interests: Grilling, playing guitar, skiing, mentorship Future Goals: Continue to publish high quality research, learn Spanish

Nicholas Schiller, MD, 2022 Mentors: Dr. Rik Myers and Dr. Amiethab Aiyer, MD Other Interests: orthopedic surgery, emergency medicine, anesthesiology Future Goals: Find a field of medicine I can passionately work in for the rest of my life.

The Medical I.B.I.S. | Spring 2020

Cancer Stem Cells as a Therapeutic Target in 3D Tumor Models of Human Chondrosarcoma: An Encouraging Future for Proline Rich Polypeptide-1 (PRP-1) By Raghuram Reddy

ancer. One word. Millions of lives taken. Patients struggle to grapple against this terrifying disease that is notably one of the leading causes of death. For the past two years, Caroline Granger has joined the effort to improve cancer treatment as a researcher in Dr. Karina Galoin’s lab at the University of Miami Miller School of Medicine. Caroline’s interest in research stems from her biochemistry major and previous research experiences as an undergraduate research fellow at the Case Western Reserve University School of Medicine and in Dr. Phil McCabe’s laboratory at the University of Miami. Caroline’s research is within the field of orthopaedic oncology, specifically regarding chondrosarcoma. Chondrosarcoma is a malignant and rare type of cancer that occurs in cartilage cells of various bones such as the knee, femur, and spine. During her time in the lab, Caroline has tested the effect of Proline Rich Polypeptide 1 (PRP-1) on spheroids which serve as 3D tumor models and surrogate systems for cancer skin cells (CSCs). After years of using various research techniques including assays, western blotting, fluorescent activated cell sorting, and imaging, she has discovered that increasing the amount of the dose of PRP-1 has led to a significant reduction in decreased spheroid formation, and similarly, that 20 µg/mL is the optimal concentration in reducing colony formation. Caroline hopes to conduct future studies to fully comprehend the effects of PRP-1 on both neoplastic

and non-neoplastic tissue. She is currently researching xenograft orthotopic transplantation of chondrosarcoma spheroids into immunocompromised mice to evaluate whether PRP-1 will shrink the primary tumor and if spontaneous metastasis to the lungs will be diminished or eliminated. As a result of her research, Caroline has presented her findings at University of Miami’s Eastern Atlantic Student Research Forum and the Florida Orthopaedic Society Annual Meeting in February 2020. She will also be giving a paper presentation at the American Academy of Orthopaedic Surgeons Annual Meeting in March 2020. Moreover, she has submitted her paper for publication. For those currently conducting research, Caroline offers the following advice: “Experiments tend to fail much more often than they succeed, but when they work, you realize that every failure was worth it and the lessons learned from your failures are why you now find yourself with success.” At the University of Miami Miller School of Medicine, Caroline is the co-president of both the Orthopaedic Surgery Interest Group (OSIG) and the Association of Women Surgeons (AWS). In her free time, she enjoys listening to music and audiobooks, cooking, and participating in marathons such as the Ironman triathlon. After graduating next year, Caroline plans to continue research during residency training in orthopaedic surgery.

Caroline Granger, MD, 2021 Interests: Orthopedic Surgery Mentor: Dr. Karina Galoian, PhD Future Goals: begin orthopedic surgery residency in 2021 and pursue a career as a leader, researcher, educator, and mentor

Spring 2020 | The Medical I.B.I.S.

Break a Leg, Bradley: A Look into the Use of Intentional Deformity & Hexapod Frames Following Major Tibia Injuries

by Abby Adera

Bradley Lezak, MD, MPH, 2022 Other Interests: baseball, Admissions Ambassador, OSIG E-Board, Anatomy TA, Quality Control Director at San Juan Bosco Clinic Mentor: Dr. Stephen Quinnan, MD- Chief of Orthopedic Trauma Surgery Future Goals: Orthopedic Surgery

he year is 2006, and 12-year old Bradley Lezak has just taken a nasty tumble on the football field. Seconds later, he boasts a fully snapped tibia and fibula and is on the way to meeting his first orthopeadic surgeon. Flash forward to the year 2020 and Bradley finds himself yet again in an Orthopaedic Trauma department, only now he wears the title of a MS2 M.D./M.P.H candidate working diligently under Chief of Orthopaedic Trauma Surgery Dr. Stephen Quinnan, M.D. The work? A fascinating new approach to treating complex, acute open tibia fractures. Unlike closed fractures, orthopaedic surgeons often struggle in their methods of finding ways to close the skin following the stabilization of the tibia bone. Dr. Quinnan’s method is revolutionary in that it involves intentionally deforming the bone, in extreme cases with an angle that nears that of ninety degrees. By this process, soft tissue closure is possible.

hexapod frame is able to straighten the leg slowly over the course of 1-2 months to an ideal linear position. The multiplanar structure of the Hexapod is exponentially more versatile than the uniplanar external fixator alternatives, which cannot be manipulated postoperatively. Bradley Lezak’s role is a retrospective look into the x-rays, surgical notes, and development of patient cases in which this intentional deformity and hexapod frame technique was used to treat major open tibia injuries. He is working on a first-author publication detailing the theory, procedure, and patient outcomes of Dr. Quinnan’s unique technique. Nowhere else in the country is the intentional deformity and hexapod frame combo utilized; this paper will expose this novel treatment of complex open tibia fractures to orthopaedic trauma centers nationwide potentially leading to widespread integration.

That’s not all of the genius. Dr. Quinnan then applies a multiplanar external fixator frame called a Hexapod (Taylor Spatial) around the whole leg of the patient. The root “hexa” refers to the ability of the external fixator to mend six-axis deformities simultaneously with its two ring, six leg structure. These legs, referred to as struts, can be manipulated to different lengths, and the rings can be stretched or minimized in their diameters. All of these possible changes are guided by a computer software that is integrated into the frame. This software specialized for each patient case marks a collaboration between Dr. Quinnan’s team and an independent biotechnology company. Like magic the

The Medical I.B.I.S. | Spring 2020

Spring 2020 | The Medical I.B.I.S.