OWH RESEARCH SYMPOSIUM 8 September 2022 6 PM 9 PM Howard University Hospital Towers Auditorium 2041 Georgia Avenue Washington, DC 20060
TABLE OF CONTENTS OWH Research Symposium Leadership........................................ Program.................................................................................... HUH CEO Biosketch, Mrs. Anita Jenkins, RCP, MBA, FABC ........... Howard University President Biosketch, Dr. Wayne Frederick........ Event Sponsor and Collaborating Organizations......................... Attending Judges...................................................................... Resident Judges........................................................................ Medical Student Judges............................................................ Panelists................................................................................... Student Research Committee..................................................... Abstracts Anesthesiology..................................................................... Dental Student Projects........................................................ Dermatology........................................................................ Emergency Medicine............................................................ Family Medicine................................................................... General Surgery................................................................... Internal Medicine................................................................. Neurology............................................................................ Neurosurgery........................................................................ Obstetrics and Gynecology.................................................. Oncology............................................................................. Ophthalmology.................................................................... Orthopaedic Surgery............................................................ Pathology............................................................................ Physiatry.............................................................................. Psychiatry............................................................................ Radiology............................................................................ Urology................................................................................ Undergraduate Student Projects........................................... Acknowledgements................................................................... 1 2 3 4 5 6 7 8 10 11 12 14 15 18 25 26 29 31 36 37 39 41 42 45 52 53 55 57 60 61 65
OWH RESEARCH SYMPOSIUM HOWARD UNIVERSITY HOSPITAL OWH FOUNDER & ADVISOR HOWARD UNIVERSITY COLLEGE OF MEDICINE OWH VP OF RESEARCH Leadership OWH RESEARCH SYMPOSIUM FOUNDER OWH RESEARCH COMMITTEE CHAIR ROLANDA WILLACY, MD (PGY-3) NDIDI NJOKU, M3 2
3 OWH RESEARCH SYMPOSIUM 2022 REGISTRATION & REFRESHMENTS 5:30 5:55PM WELCOME ROLANDA WILLACY, MD OWH Research Symposium Founder 6:00PM 6:05PM GREETINGS FROM CEO, ANITA JENKINS 6:05 6:10PM OPENING REMARKS, DR. WAYNE A.I. FREDERICK 6:10 6:15PM INTRODUCTION TO POSTER PRESENTATIONS NDIDI NJOKU, M3 OWH Symposium Student Research Committee Chair 6:15-6:20PM POSTER PRESENTATIONS 6:20 7:00PM PANEL DISCUSSION 7:05 8:00PM TABULATION OF SCORES 8:00 8:10PM NETWORKING 8:15 8:40PM RESEARCH AWARDS 8:45 8:55PM CLOSING REMARKS 8:55 9:00PM PROGRAM
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Jenkins holds an MBA from Walden University in Minneapolis, Minn., and a bachelor’s degree in business administration and management from Averett University in Danville, Va. She loves volunteering for health organizations, including: the American Heart Association and American Stroke Association; the March of Dimes; and the Leukemia & Lymphoma Society Her faith and family are her passion, Jenkins and her husband, Kevin, have five children. RCP, MBA, HOWARD UNIVERSITY HOSPITAL CHIEF EXECUTIVE OFFICER (CEO)
ANITA JENKINS,
Anita L.A. Jenkins is the chief executive officer of Howard University Hospital (HUH). She assumed her new duties on February 17, 2020 As a seasoned executive and leader, she comes to HUH with more than 20 years of successful healthcare experience. Jenkins most recently served as president of Sycamore Medical Center near Dayton, Ohio, part of the Kettering Health Net work She also oversaw Kettering Behavioral Medical Center and the Senior Division. Sycamore Medical Center is rated a 5 Star Hospital by CMS; an “A “Hospital by Leapfrog; and one of the top 100 Hospitals in the country by IBM Watson Health.
Jenkins joined the Kettering Health Network in 2015 as chief operating officer for the 500 bed Kettering Medical Center. During her four years in that role, she was responsible for the daily operations of clinical services and CV and Ortho service lines, both inpatient and outpatient. Prior to working for Kettering, Jenkins served in a variety of leadership and administrative roles at Good Samaritan Hospital Premier Health in Dayton Jenkins’ career in healthcare started as a respiratory therapist in Pittsburgh at UPMC, and then in Huntsville, Ala. She then moved to a healthcare leadership role in Danville, Va. Be ginning her career serving patients has been the guiding force behind how Jenkins approaches the business and administrative side of healthcare. Jenkins states that she has been blessed with opportunities to follow her interests in data and management without losing her desire to connect with and serve patients
FABC
Dr. Frederick also devotes his time to speaking and writing on the biggest challenges confronting our society He is a tireless advocate for social justice and a sought after perspective on the issue of diversity, equity and inclusion He uses his voice and his expertise to champion the need for greater access and opportunity for people of color in health care, higher education and society at large.
As president of Howard, Dr Frederick has worked to strengthen internal operations in order to enhance the student experience and position the University to more effectively serve the community. He has overseen a period of immense growth and transformation at Howard, including record breaking enrollment numbers and philanthropic donations.
DR. WAYNE A. I. FREDERICK HOWARD UNIVERSITY PRESIDENT 5
As the president of a historically Black college and university (HBCU); as a cancer surgeon and expert on health care disparities; and as a veteran administrator of higher education, Dr. Frederick was uniquely positioned to serve as an institutional, local and national leader during the unprecedented times of the coronavirus pandemic. He continues to provide an influential voice and guide critical actions directed at confronting all three crises health, economic and social that our country is still facing Dr. Frederick also volunteers his time by serving on the boards of numerous institutions and organizations, including the Federal Reserve Bank of Richmond, the U.S. Chamber of Commerce and Humana Inc. Dr. Frederick is also a member of surgical and medical associations, including the American Surgical Association and the American College of Surgeons.
Above all, Dr Frederick is a devoted husband and father He resides in Washington, D C with his wife, Simone, and their two children, Kirie and Wayne II
Dr Wayne A I Frederick is the 17th president of Howard University and the distinguished Charles R. Drew Professor of Surgery at the Howard University College of Medicine. He is also a practicing cancer surgeon at Howard University Hospital, where he continues to see patients and perform surgeries. Born in Trinidad and Tobago, Dr Frederick came to the United States for the first time in 1988, when he matriculated to Howard at the age of 16 to pursue a dual B.S./M.D. program. By the age of 22, he had received his Bachelor of Science degree and graduated from medical school. He also returned to Howard as a student to receive his MBA in 2011.
Entrepreneur & Founder OWH RESEARCH SYMPOSIUM SYMPOSIUM SPONSOR 2 0 2 2 COLLABORATING INTEREST GROUPS SURGERY INTEREST SOCIETY SIGN (NEUROLOGY INTEREST GROUP) PSYCHIATRY INTEREST GROUP INTERNAL MEDICINE INTEREST GROUP ORAL MAXILLOFACIAL SURGERY INTEREST GROUP OPHTHALMOLOGY INTEREST GROUP UROLOGY RESEARCH INTEREST GROUP HUCM STUDENT COUNCIL 6
Entre F BONNIE DAVIS, MD RADIOLOGY OWH RESEARCH SYMPOSIUM ATTENDING JUDGES 2 0 2 2 TERRENCE FULLUM, MD SURGERY ELLEN PRITCHETT, MD DERMATOLOGY PAMELA COLEMAN, MD UROLOGY TERRY THOMPSON, MD ORTHOPAEDIC SURGERY ROBERT WILSON, MD ORTHOPAEDIC SURGERY KATRINA CHIN LOY, MD OPHTHALMOLOGY MOSUNMOLA OYAWUSI, MD NEUROLOGY OLADUNNI FILANI, MD FAMILY MEDICINE DAMIREZ FOSSETT, MD NEUROSURGERY MALLORY WILLIAMS, MD TRAUMA SURGERY
p u OWH RESEARCH SYMPOSIUM RESIDENT JUDGES 2 0 2 2 MARIKA TATE, MD OBSTETRICS & GYNECOLOGY GARY GIBSON, MD DERMATOLOGY SWATI VANAPARTHY, MD INTERNAL MEDICINE JEDUTHEN HARRIS, MD GENERAL SURGERY KULSOOM NAQVI, MD FAMILY MEDICINE BRANDON LOURIDGE, MD FAMILY MEDICINE FLORA SARMIENTO, DMD ORAL MAXILLOFACIAL SURGERY ANDREW BOONE, MD ORTHOPAEDIC SURGERY AYIA MOHAMED, MD ORTHOPAEDIC SURGERY
OWH RESEARCH SYMPOSIUM RESIDENT JUDGES 2 0 2 2 TIFFANY BENJAMIN, MD PSYCHIATRY ANDRE ROSARIO, MD PSYCHIATRY KELLY CHUANG, DMD ORAL MAXILLOFACIAL SURGERY SNEHA RAO, MD INTERNAL MEDICINE DARNELLE ROBIN, MD GENERAL SURGERY FELIX WIREKO, MD INTERNAL MEDICINE ARJUN SAINI, MD DERMATOLOGY CHRISTA WENTT, MD ORTHOPAEDIC SURGERY 9
OWH RESEARCH SYMPOSIUM MEDICAL STUDENT JUDGES 2 0 2 2 LYDIA HALL M2 KYLA BASS M3 KIYANNA THOMAS M3 10
OWH RESEARCH SYMPOSIUM RESIDENT PANELISTS 2 0 2 2 EFTI AKAM, MD GENERAL SURGERY ANISH JAIN, MD GENERAL SURGERY BECKY LI, MD DERMATOLOGY HERAN GEBREYESUS, MD OPHTHALMOLOGY JONATHAN WILLARD M3 TEMITAYO ADANLAWO M2 DAMON ROSS, JR M1 MEDICAL STUDENT PANELISTS LAWRENCE PRINCE WRIGHT, MD GENERAL SURGERY 11
OWH RESEARCH SYMPOSIUM OWH SYMPOSIUM STUDENT RESEARCH COMMITTEE 2 0 2 2 SABRINA AARON YASHVARDHAN BATTA ROBERT EMEH BARON EDMONDSON KEALE CADE HAROLD DORSEY JERMAINE HEATH JENNIFER THELUS SANJUM SINGH NKEMDILIM NDUBUIZU ARSEMA ZADU SUMMER JACKSON JAYLA JMCGOWAN EREMY MANI OWH SYMPOSIUM RESEARCH COMMITTEE CHAIR AIYANA BATTON REGAN BURGESS ANITA OBODO
OWH RESEARCH SYMPOSIUM OWH SYMPOSIUM STUDENT RESEARCH COMMITTEE 2 0 2 2 NDIDI NJOKU OWH SYMPOSIUM RESEARCH COMMITTEE CHAIR OWH VP OF RESEARCH SABRINA AARON SURGICAL OUTCOMES CENTER REGAN BURGESS ORTHOPAEDIC WOMEN OF HOWARD ROBERT EMEH PM&R INTEREST GROUP BARON EDMONDSON HOWARD UNIVERSITY COLLEGE OF DENTISTRY ANITA OBODO ANESTHESIOLOGY INTEREST GROUP KEALE CADE HUCM SIGHT SAVERS HAROLD DORSEY HUCM RADIOLOGY INTEREST GROUP JERMAINE HEATH SURGERY INTEREST SOCIETY JENNIFER THELUS UROLOGY RESEARCH INTEREST GROUP SANJUM SINGH ORTHOPAEDIC SURGERY INTEREST SOCIETY NKEMDILIM NDUBUIZU PSYCHIATRY INTEREST GROUP ARSEMA ZADU HUCM DERMATOLOGY INTEREST GROUP YASHVARDHAN BATTA INTERNAL MEDICINE INTEREST GROUP AIYANA BATTON SIGN (NEUROLOGY INTEREST GROUP) JEREMY MANI SIGN (NEUROLOGY INTEREST GROUP) SUMMER JACKSON HU HEALTH PROFESSIONS SOCIETY/HOWARD MAPS CHAPTER JAYLA MCGOWAN HU HEALTH PROFESSIONS SOCIETY/HOWARD MAPS CHAPTER 13
ABSTRACTS
Case Presentation: A 12kg 2 year old boy presented to the ENT (ear, nose, and throat) department with a past medical history of severe obstructive sleep apnea (OSA), reactive airway disease, and seasonal allergies, for a preoperative evaluation for a tonsillectomy for OSA. He had an EKG and TTE, which was significant for a mass in the right atrium. Subsequently, the patient had a cardiac MRI, which confirmed a right atrial, smooth walled, multi lobular mass with broad based attachment to the superolateral right atrium The child was referred to oncology After an interdisciplinary meeting, the decision was made to proceed to surgery for median sternotomy and resection of the right atrial mass with pathological analysis The child was given 10mg PO Versed before entering the operating room The child had a mask induction, and PIV placed He was intubated with 4 5 cuff ETT with Mill 2 blade The child had a 22g left radial A line and 5 french 5cm left subclavian central line Patient had a median sternotomy and had no issues initiating cardiopulmonary bypass The mass was removed as well as the thymus and the patient had no issues separating from cardiopulmonary bypass Patient was extubated in the operating room and transported to PICU
Authors: Anita Obodo; Michelle DaCosta, MD, MBA
Title: Anesthetic Management of Pediatric Cardiac Tumors
Obodo, Anita HUCM M4
Presenters Anesthesiology
Introduction: Intracardiac masses are rare in the pediatric population and the majority (90%) are benign. The incidence rate is 0.017 0.28% in reported autopsy cases and an incidence of 0.14% during fetal life is reported. Rhabdomyoma is the most common presenting pediatric cardiac tumor followed by fibroma, myxomas, teratoma, and hemangioma. When intracardiac masses do present, they can create various cardiac physiology challenges.
Discussion: The presenting signs of cardiac tumors depend on the size, location of the mass and potential block of outflow or inflow tracts Most pediatric cardiac tumors are asymptomatic, and diagnosis is made based on heart murmur, arrythmias, coronary angiography, biopsy, and echocardiography Valvular insufficiency, cyanosis, respiratory distress, myocardial dysfunction, or sudden death can be the initial presentation Magnetic resonance imaging (MRI), transthoracic echocardiogram (TTE), and computed tomography (CT) are useful for establishing a diagnosis, although biopsy and histology remain the gold standard for confirmation and characterization Anesthetic management of an intracardial tumor can present with serious challenges for the anesthesiologist. Current anesthetic experience is predominately based on case reports. Cardiac masses can be associated with mass effect and pericardial effusions resulting in cardiac compression and respiratory distress after birth.
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Adeniseun, Lovelace HUCD D2
Title: Classification and characterization of a liver specific epigenetic mutant
Authors: Xiaowu Pang PhD, Lovelace Adeniseun
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Dental Student Projects
Although there is currently a vaccine for Dengue on the market today, it isn’t effective in providing balanced immunity against the 4 serotypes The current Dengue vaccine contains attenuated strains of the 4 serotypes, whose growth is highly unpredictable One serotype’s growth may dominate decreasing the efficacy of the vaccine against the other 3, which reintroduces the issue of antibody dependent enhancement For this reason, the vaccine is not recommended for everyone To develop an effective tetravalent vaccine reverse genetics and PCR were used to create a mutant dengue virus that initiates single round infection in mammalian cells and a chimeric dengue virus (insect specific) that does not infect mammalian cells The single round infection allows for the expression of viral proteins, inducing a strong cellular response The chimeric virus acts as a viral like particle to enhance the humoral response This study aims to produce a vaccine that stimulates a powerful immune response in order to provide lifelong immunity, without the need for a booster shot.
Title: Generation of Vertebrate Specific Replicative Defective Dengue virus and Chimeric Dengue Virus as vaccine candidate
Dengue virus is one of the most common infections in the world, infecting hundreds of millions and killing tens of thousands of people each year Dengue has 4 different serotypes If a person is sequentially infected with multiple serotypes, the neutralizing antibodies generated from the first infection may bind to the virus and actually increase the virus’s ability to enter cells This results in antibody dependent enhancement causing dengue hemorrhagic fever
We have developed a novel Tg(dazlCGI ef1a:gfpd2) “EpiTag” transgenic line that reliably reports dynamic tissue specific epigenetic changes during development, regeneration, and disease. The transgenic construct used in this line contains a CpG island from the dazl gene, a germ cell specific gene targeted for silencing in all somatic cells. The dazl CpG island is cloned next to a ubiquitously expressing ef1a promoter driving expression of destabilized GFP (GFPd2), allowing for dynamic visualization of rapid changes in GFP reporter expression in living animals. The EpiTag line begins expressing GFP at around 6 hpf. GFP fluorescence peaks at around 24 hpf, begins to fade by 48 hpf, and is almost undetectable by 5 dpf. GFP expression after 24 hpf can be reactivated by treatments that interfere with epigenetic silencing, validating the line as an effective “epigenetic reporter ” We are performing a large scale epigenetic mutant screen by using this epigenetic reporter line to establish mutant lines with ubiquitous or tissue specific abnormality in DNA methylation We screened 50 F2 families and established 14 mutant lines divided into two types, GFP ON and GFP OFF One of the mutants which we observed showed a GFP ON liver phenotype To detect the responsible gene, we used RNAseq based mapping to detect the responsible regions After additional analysis and subsequent data, we found the liver mutation to occur on Chromosome 20 Here we show preliminary data in the development and characterization of our liver mutant We believe that GFP upregulation is caused by abnormal low DNA methylation while GFP downregulation is caused by abnormal high GFP We are sure that the following functional analysis and characterization will contribute to reveal mechanisms of development via epigenetic regulation Barnes, Keith HUCD D1
Authors: Keith Barnes, Aniket Gore, Kiyohito Taimatsu, Daniel Castranova, Avery Swearer, Kelly Tomins, Andrew Davis, and Brant Weinstein
Authors: Ian Mahone, Wendy Lackey Cornelison. Anatomy often comes early in many medical school curricula when students may view it as primarily a surgically related discipline. Yet as many of us know, it is a vital basic science not only for future surgeons but for all those in health sciences. At WMed, students in the clerkship years are provided an opportunity to participate in an advanced musculoskeletal elective intended for those interested in orthopedic surgery or the option to create their own elective based on regional or medical specialty interest Revisiting anatomy during the clerkship years provides a unique opportunity to elaborate on the clinical significance of anatomical structures and incorporate other medical technologies into this education This presentation will describe a fourth year anatomy elective designed for a student interested in anesthesiology “Special Topics” is an elective option available to students during their clerkship years The intent is to allow students to collaborate with faculty to create two to four week courses that relate directly to their interests In this case, anesthesiology special topics elective was chosen with focus on interscalene nerve blocks (INB) and supraclavicular nerve blocks (SNB) The generalized plan of the course included: independent procedure review from anesthesiology textbooks (surface anatomy landmarks, patient positioning, technique, and ultrasound anatomy), review of normal anatomy on prosected cadavers and cross sections, mark up and dissection on a fresh frozen donor, and simulation of ultrasound guided techniques Procedure review (1 5 hours) occurred prior to each gross anatomy session to ensure that the student had an appropriate understanding of the structures involved This step was repeated with each nerve block procedure The student generated a list of structures that should be identified correctly to safely perform each type of nerve block Gross anatomy review (3 hours) was also repeated for each type of nerve block and consisted of correctly pinning and labeling structures involved in the procedure. The student then practiced ultrasound technique on the presenting author. Captured video and images were highlighted for student review of technique and anatomic structures. Finally, the student marked surface anatomy landmarks on a fresh frozen cadaver and inserted needles at injection sites. Needles remained in the cadaver as placeholders while dissection was performed around injection sites to see if placement was correct (4 hours). Revisiting gross anatomy during the clerkship years appears to increase students' confidence. Anatomy based electives for students during their clerkship years provide opportunities for advanced undergraduate medical students to consolidate anatomical knowledge. The notion that anatomy can be learned once and retained is unrealistic. We encourage faculty to consider options to create opportunities for students to revisit the anatomy lab during their clerkship rotations to better prepare for real life application in residency Ian HUCD
Experimental Methods: HNSCC lines (JHU 022, 029) and NEB stable competent E coli were employed Gel electrophoresis was used to analyze DNA fragments A nanodrop spectrophotometer was used to measure the DNA concentration
Objectives: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide The current available treatments haven’t significantly improved the 5 year survival rate of HNSCC patients in decades, indicating an urgent need to develop novel therapeutics Epidermal growth factor receptor (EGFR) plays a critical role in initiating the signaling that directs the behavior of epithelial cells in many tumors, including HNSCC EGFR overexpression has been identified in 80% 90% of HNSCC, which makes it an attractive target for the treatment development against HNSCC Previously, we have developed an immunotoxin hDT806 targeting overexpressed EGFR hDT806 exhibits potent cytotoxicity in cancer cells and efficacy in mouse models of HNSCC The present study focuses on the effects of gene delivery of immunotoxins in HNSCC cells
Results: We first constructed two immunotoxin plasmids, designated as pDT EGF and pDT 806, by linking the DNA sequence of diphtheria toxin fragment DT390 with that of EGF or the single chain variant fragment of mAb806, a specific EGFR monoclonal antibody, respectively. We transformed the plasmids into E. coli, extracted the plasmid DNAs after culturing in LB medium, and measured the DNA concentration and purity. To characterize the transgenes, we used restriction enzymes to cut the plasmids and performed gel electrophoresis to analyze the DNA fragments. Results showed DT EGF as 1.5 kb and DT 806 as 2 kb, consistent with the DNA sequencing analysis. The plasmids were administered into JHU 022 and JHU 029 via plasmid transfection. Using fluorescence microscopy and crystal violet staining we were able to demonstrate the significant cytotoxicity to the HNSCC cells.
Authors: Morgan Anderson, Clifton Enlers, Xinbin Gu, Guiqin Xie
Conclusion: We successfully generated immunotoxin plasmids and showed the significant cytotoxicity of immunotoxin gene delivery in HNSCC cells.
Anderson, Morgan HUCD D2
Mahone,
D3 16
Title: Creating Advanced Anatomy Electives for Students in the Clerkship Years
Title: Effects of Gene Delivery of Recombinant Immunotoxin in HNSCC
Ya, Cinbin HUCD
Authors: Deon Rosell and Dr. Kathleen Marrs
This paper focuses on the dental climate in America and the specialty oral and maxilla facial surgery Oral surgeons are a specialty in dentistry, and the report discusses its history and origin The article starts by defining oral cancer and its molecular The pathway section discusses a general example of carcinogens' impact on cells in the oral region This paper also displays images and symptoms of early signs of oral cancer The tobacco industry every few years changes mediums for promoting cigarettes Many of these new smoking mediums still contain the same carcinogens The report gives statistics of who oral cancer impacts also telling the tobacco industry's effects on carcinogens introduced to the community explaining how dental care in America has been neglected and shows potential solutions to the lack of appropriate dental care plans in America These dental plans are suggested because the cost of dental care in America has constantly gone up Then lastly, the paper discusses potential future cures and treatments for oral cancer New genomic methods are being made to predict quickly or confirm cancer cases in individuals They are also developing other noninvasive means of treating oral cancer using microbiology and other techniques, but the technology isn't feasible for another several year Rosell, Deon HUCD D1
Title: Youth report lower perceived social support when experiencing bias victimization
Title: Oral cancer, Carcinogen, Dental Care, Molecular Pathway, & Dentistry
Authors: Clinbin Ya, Jenna R. Kiely, BS; Brian P. Daly, PhD; Lisa M. Jones, PhD. Bias victimization is the occurrence of physical or verbal aggression based on someone’s race, ethnicity, religion, sexual orientation, gender identification, or disability status Research shows that experiencing bias victimization is associated with increased symptoms of depression and anxiety Findings suggest social support is a protective factor against such ailments Previous studies have found decreased support among individuals in rural areas after experiencing specific types victimization There are currently no studies on the relationship between experiencing any type of bias victimization and decreased social support for youth in suburban neighborhoods We sought to determine if region where youth live would affect perceived social support after experiencing bias victimization We hypothesized that those who experienced bias victimization in the past year and live in rural areas would report lower perceived social support compared to those who live in suburban areas Using the Youth Bias Victimization Survey (YBVS), youth ages 13 18 were recruited to answer questions about their experiences with bias victimization A two way analysis of variance found no interaction between region and bias victimization on social support F (1, 254) = 2 375, p = 125 However, our results do indicate that lower social support is associated with experiencing bias victimization F(1, 254) = 14 39, p < 05, specifically respondents who live in rural areas reported lower scores than that of their suburban counterparts F(1, 254) = 8.46, p < .05. This replicates findings from previous studies that social support is a protective factor, but that region does not have an impact.
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Title: A Case of Non HIV related Kaposi Sarcoma Associated with Vitiligo
Discussion: Kaposi sarcoma is a well known clinical entity which is closely related to underlying infection with the human herpesvirus 8 (HHV 8) via salivary, and less commonly, bloodborne or sexual transmission It has four main epidemiologic variants: classic, iatrogenic due to immunosuppression, AIDS related epidemic, and African endemic The African endemic variant can further be categorized into four subtypes: nodular, florid, infiltrative, and lymphadenopathic (primarily seen in children) The latter three are considered more aggressive and, in the case of lymphadenopathic endemic KS, can be fatal. Nodular endemic KS presents with painful vascular nodules affecting the lower extremities and is often associated with chronic lymphedema1. It predominantly affects HIV negative males of sub Saharan African descent and can account for up to 9% of all cancers in equatorial Africa2. Due to his localized involvement restricted to the skin, our patient likely presented with this nodular variant which fortunately follows a more indolent course. The coexistence of KS and vitiligo is a rare phenomenon which has been reported only on a few occasions in the literature3 5. Though not fully understood, there seems to be a hidden relationship between KS and other autoimmune or inflammatory skin disorders6. It has been hypothesized that inflammatory changes resulting from trauma or other dermatoses recruit HHV 8 infected cells into the skin and the inflammatory milieu induces lytic transformation and infection of neighboring cells leading to Kaposi skin lesions3.
Authors: Temitayo Adanlawo, MS; Jahdonna Isaac, MD; Wen Chen, MD; Laura Boger, MD
Adanlawo, Temitayo HUCM M2 Dermatology 18
Treatment: Based on the histopathologic and clinical findings, our patient was diagnosed with African endemic Kaposi sarcoma (KS) and vitiligo Given the absence of systemic symptoms, he was initiated on topical alitretinoin 0 1% gel for treatment of skin limited disease He was also referred to oncology with plan to initiate liposomal doxorubicin only if he develops concerning systemic involvement On follow up, there was some improvement and reduction in size of Kaposi related lesions For vitiligo, he was started on mometasone furoate 0 1% ointment However, he stopped this medication as he felt it was not effective He was transitioned to tacrolimus 0 1% ointment instead and advised to expose affected areas of vitiligo to natural sunlight 10 to 15 minutes daily
History: Our patient is a 58 year old male with a past medical history of latent tuberculosis and hypertension who presented to clinic due to 4 to 5 months of new hypopigmented lesions associated with tender red papules on his feet. He reported a few years of lower extremity swelling which then progressed with localized pain, new depigmented areas and red to brown skin nodules which would bleed when manipulated. He had no other skin involvement and no sensory deficits. He did not have a history of immunodeficiency, HIV or AIDS and had recent negative HIV test. Of note, he immigrated to the United States from Sierra Leone in 1996
Results: One hundred fifty two (152) patients were included in this study Fifty five patients were women (36 18%) The median and interquartile range (IQR) of age was 50 (37 5 63) years Ninety four patients had dermatomyositis (DM) (61 6%), 25 (16 4%) had anti synthetase syndrome (AS), 12 (7 8%) had immune mediated necrotizing myopathy (IMNM), 7 (4 6%) had inclusion body myositis (IBM), 2 (1 3%) had polymyositis (PM), 9 (5 9%) had other types of myositis including overlap myositis (OM) and 3 (1 9%) had myositis associated with graft vs host disease (GVHD)
Fourteen patients (9 2%) had a normal nailfold capillaroscopy, 81 (53 2%) had non specific abnormalities, and 58 (56 8%) had a scleroderma pattern Among these patients, 4 (6 8%) had an early pattern, 49 (84 4%) had an active pattern and 5 (8 6%) had a late pattern ) The non specific abnormalities pattern was associated with the diagnosis of AS and its clinical features of joint involvement and interstitial lung The scleroderma pattern was associated with the cutaneous features, with Gottron’s papules and V sign having the higher odd of presenting Patients with DM and positive DM and AS MSA had more capillaroscopic abnormalities than patients with IMNM and IBM Conclusions: Less than 10% of patients with IIM have a normal nailfold capillaroscopy Patients with DM and AS have more severe abnormalities than other myositis phenotypes. The non specific abnormalities were associated with anti synthetase syndrome and its clinical features whilst the scleroderma pattern was related to cutaneous features. To our knowledge, this is the biggest multicenter cohort addressing the nailfold capillaroscopy findings in patients with IIM.
Campbell, Bianca HUCM M2 19
Title: Association between nailfold capillaroscopic findings and the clinical and serological features in a multicenter cohort of patients with idiopathic inflammatory myopathies
Authors: Bianca Campbell, PharmD; Jiram Torres Ruiz, MD, PhD; Iago Pinal Fernández, MD, PhD, Albert Selva O’Callaghan, MD; Sandra Muñoz Braceras, PhD; Andrew L Mammen, MD, PhD
Background: Idiopathic inflammatory myopathies (IIM) are a heterogenous group of systemic autoimmune diseases in which nailfold capillaroscopy abnormalities have been frequently described Most studies addressing the capillaroscopic features in these patients are cross sectional, unicentric, or have not considered the myositis specific (MSA) and associated antibodies (MAA) nor the new subsets of IIM, such as the immune mediated necrotizing myopathy or the no Jo1 anti synthetase syndrome In this study, we aimed to analyze the capillaroscopic features of a multicentric cohort of patients with IIM and evaluate their relationship with their clinical and serological features.
Methods: We recruited 159 patients classified as an IIM according to the corresponding criteria and performed a nailfold capillaroscopy with an Optilia Digital Capillaroscope. Eighty three (52.2%) were from Spain, 30 (18.8%) from Mexico and 46 (28.9%) were seen at the NIH. Twenty five patients (15.7%) had prospective capillaroscopic evaluations. The clinical features, the MSA and MAA were recorded into a database. In the nailfold capillaroscopies, we measured the number of capillaries per mm, their apical diameter, the presence of thrombosis, microhemorrhages and avascular areas, as well as the amount of dilated, giant, bushy, and ramified capillaries per mm. We gave a semiquantitative value of these abnormalities to calculate a total capillaroscopic score and classify the findings as normal, non specific abnormalities or scleroderma pattern. For the comparison of the quantitative data between the diagnostic and antibodies’ groups, we used the Wilcoxson Sum Test Associations between qualitative features will be assessed with Chi square test
Title: A Report of Two Black Patients with New-Onset Vitiligo Following COVID-19 Vaccination
Physical Examination: Physical exam revealed a large (~6 8 cm) rectangular, hyperpigmented, and atrophic plaque on the occipital scalp in site of prior skin graft and a new 3 4 cm atrophic and indurated plaque with overlying mottled pigmentation on the left parietal scalp with alopecia. No cervical lymphadenopathy was appreciated.
Treatment: Once the new lesions were confirmed to be microcystic adnexal carcinoma, our patient was referred for repeat scouting biopsies across the scalp, with 5/6 samples throughout the scalp returning positive Given the indolent nature of microcystic adnexal carcinoma and the absence of good treatment alternatives, multidisciplinary care among Mohs surgery, oncology, and dermatology, as well as our patient, was pursued Conservative management with serial photos and head and neck imaging (e g ultrasound, CT, MRI) at repeat intervals was instituted At most recent examinations, disease has been stable and repeat CT showed no progression of disease
Histopathology: A punch biopsy was performed. H&E showed infiltrating strands of basaloid cells in the dermis with perineural invasion consistent with microcystic adnexal carcinoma.
Authors: Janeth R Campbell MS; Alicia C Edwards MS; Bev Fontaine MD Cheryl Burgess MD, FAAD
Title: Case Report: Milia or Microcystic Adnexal Tumor?
Fazzino, Josie HUCM
History: A 74 year old African American gentleman presented to clinic in 2017 with worsening bumps on the back of his head for the last seven months At the time, he endorsed pruritus and slight tenderness and had tried topical Neosporin without improvement A punch biopsy of the occipital scalp was performed, which returned consistent with microcystic adnexal carcinoma Our patient was then referred for Mohs microscopic surgery for surgical treatment and to Plastic Surgery for reconstruction Multiple scouting biopsies of the scalp were also obtained during surgery; all of which returned negative for extension of disease Additionally, computerized tomography scan of the head and neck showed “no extension into the musculature or into the calvarium ” After surgery, our patient completed a full course of adjuvant radiotherapy of 6000 cGy and received full body skin examinations between three and six month intervals In 2021, our patient presented to clinic for routine follow up, without new concerns, and was found to have an indurated plaque of alopecia on the left scalp.
Authors: Josie Fazzino, BA; Becky Li, MD; Mary Maiberger, MD
The COVID 19 vaccines have provided the world with an effective means by which individuals can avoid serious disease and death from COVID 19 There have been numerous cutaneous side effects reported following these vaccines, including vitiligo While vitiligo is not listed by the CDC as a selected adverse event reported after vaccination, there are an increasing number of reports strengthening their association We conducted a literature search to summarize the findings in new onset vitiligo following COVID 19 vaccination To our knowledge, there have been no reports specifying new onset vitiligo post COVID 19 vaccination in black men Herein, we discuss the rare but manageable occurrence of new onset segmental vitiligo in two black patients following an FDA approved COVID 19 vaccine Vitiligo onset in our cases presented later than in previously published case reports (race unspecified), at one to two months and within two weeks, respectively. Also in contrast to previous reports, our patients noticed depigmented lesions following the booster and second dose of vaccination sequence, rather than the first dose of vaccination. Given the novelty of COVID 19 vaccines and their potential side effects, it is essential to document significant signs or symptoms following vaccination. More data on autoimmune cutaneous reactions to COVID 19 vaccination, such as vitiligo, are needed so that health care providers can educate patients of these effects and reassure them that they are treatable and non life threatening. Risk benefit analyses derived from increased reporting and documentation may allow providers to address vaccine hesitancy after cutaneous side effects.
M2 Edwards, Alicia HUCM M2 20
Introduction: We are aware of the influence that post transplantation immunosuppression has on the development of malignancy, however limited research has explored the development of malignant cutaneous neoplasms in Black organ transplant recipients specifically While skin cancer has a significantly higher incidence rate in the White population, Black individuals tend to be diagnosed at more advanced stages, and thus have poorer prognoses With the number of solid organ transplant recipients (SOTRs) increasing, with 41,355 people receiving organ transplants in 2021 (9,253 of which identified as Black), it stands to reason that we must investigate how race and ethnicity affect the incidence and prognosis of skin cancer in non white SORTs in order to establish clear guidelines for screening and follow up post transplant.
Title: Skin Cancer in Solid Organ Transplant Recipients: The Impact of Race on Cutaneous Neoplasm Profiles
Methods: We propose to address the paucity of data on skin cancer incidence in SOTRs of color through a retrospective review of a cohort of Henry Ford Health System (HFHS) over a 29 year period. Using the United Network of Organ Sharing (UNOS)/Organ Procurement and Transplantation Network, and the HFHS Electronic Health Record (EHR), potential risk factors including race, age, sex, organ transplant type, skin cancer type and location, HPV infection history, metastasis, and mortality were obtained for each patient. The primary outcome was the first or incident squamous cell carcinoma, basal cell carcinoma or melanoma.
Results: A total of 5195 patents receiving organ transplants were included in our study, 58 of whom were excluded due to preexisting skin cancer. Of the remaining 4,662 patients, 1485 were Black, 2,928 were White and 249 self identified as “other ” A total of 495 patients went on to develop a skin cancer (basal cell, squamous cell, or melanoma) after receiving an organ transplant, 43 of whom were Black (8 7%) and 445 of whom were White (89 9%) Amongst SOTRs, SCC is the most prevalent skin cancer to develop
Conclusion: While White patients have a higher incidence of skin cancer, studies have shown a unique post transplant cutaneous risk profile for Black patients It has been hypothesized that HPV plays a crucial role in the development of genital SCC in this population When considering the incidence of skin cancer in non white SOTRs, it is essential to consider the disparities that exist within the healthcare system such as economic barriers to care, decreased skin cancer awareness, and attitudes surrounding skin cancer screening An expert panel recently recommended screening within 5 years after transplant for all Asian, Hispanic, and high risk African American patients (those undergoing thoracic organ transplant, older than 50 years, or male) who did not have a history of previous skin cancer The panel did not reach a consensus on skin cancer screening for low risk Black SOTRs Further studies building on this data exploring the unique post transplant cutaneous risk profile for Black SOTRs would help guide the protocols for skin cancer screenings in this population, thereby decreasing morbidity and mortality
James, Nia HUCM M4 21
Authors: Nia James, Nikki Pritchett MD, MPH
Authors: Toni Jenkins; Hope Mitchell, MD
Methods: A retrospective chart review was performed on new hair loss patients between 2020 2022 We looked at 25 50 patients each of KMC Dermatology, presenting with diagnoses of LPP, FFA, CCCA, or AGA were called to determine their dental history They were asked if they had any crowns/fillings, if any of their dental work contained metal, and how long they have had this dental work All responses were recorded Percentages of each answer were calculated to determine possible correlations
Introduction: Squamous Cell Carcinoma (SCC) is the most common skin cancer in Black patients It typically presents as superficial, discrete, and hard lesions arising from an indurated, rounded, and elevated base Risk factors for SCC include HPV, radiation, depressed immune system, and chronic inflammation/scarring from burns Chronic inflammation/scarring is the most prevalent risk factor for black patients Unfortunately, SCC that develops within a chronic scarring process, tends to be more aggressive and is associated with a 20 40% risk of metastasis, compared with the 1 4% metastatic rate of sun induced SCC in Caucasians
As the population diversifies it is imperative that clinicians and patients understand how skin cancer affects black patients
Introduction: Lichen Planus is a chronic, inflammatory, cutaneous, and mucosal disease. Dental amalgam sensitivity has been noted as a cause of contact dermatitis induced cutaneous Lichen Planus Pigmentosus. Associations with cutaneous Lichen Planus and Lichen Planopilaris (LPP) hair loss are commonly encountered LPP is an inflammatory, cicatricial (scarring) form of hair loss characterized by erythematous, perifollicular papules and loss of follicular orifices upon physical examination, usually affecting the vertex and parietal scalp Frontal Fibrosing Alopecia (FFA) is a patterned, cicatricial form of hair loss considered to be a prevalent form of LPP The purpose of this study is to determine if there is an association between inflammatory types of hair loss (LPP, FFA, and CCCA) and dental amalgams compared to non inflammatory hair loss (AGA) We hypothesize a positive correlation between inflammatory forms of hair loss and dental amalgam number and length of time
Title: Exploring Correlations between Dental Amalgam Induced Sensitivities and Inflammatory Hair Loss
Results: Of the 50 patients with CCCA, 86% indicated having crowns/fillings, 36% indicated having dental amalgams, 28% indicated having between 5 9 dental amalgams for more than 10 years, and 2% indicated 10 or more dental amalgams for more than 10 years.
Conclusion: The highest incidence of crowns/fillings, dental amalgams, and multiple, long term dental amalgams was observed in patients with LPP. Patients with inflammatory hair loss forms demonstrated a greater percentage of dental amalgams than those with AGA. Similarities were observed in the prevalence of dental crowns/fillings among LPP and FFA patients, but there was increased variation between the incidences and longevity of dental amalgams.
The areas of non sun exposure in which are not typically checked are the common areas in which SCC presents in this population
Case Report: A 67 year old African American retired shipbuilder, presented with a growth on the occipital scalp for 20 years The patient stated that the growth started as a “horn which was removed” at onset However, the growth recurred and due to pain, pruritus, and progressive growth over the past 2 years, the patient was prompted to present to the Dermatology clinic for evaluation. Physical examination revealed a 5 cm ulcerated plaque with well demarcated borders on the occipital scalp and lymphadenopathy on the post auricular neck. Contrast enhanced CT of the neck showed no adjacent bony destruction. A biopsy of the posterior scalp confirmed the diagnosis of well differentiated Squamous Cell Carcinoma (SCC). His tumor staging put him at T4 (because of the invasion of the occipital bone) and therefore the patient had a high risk for metastasis. Fortunately, the patient’s reactive lymph nodes were negative for cancer therefore there was no indication for chemotherapy. The patient subsequently underwent full tumor resection with staged flap and graft as well as an unremarkable lymph node dissection of the neck. The most recent CT scan was negative for cancer in the neck, negative for cancer in the chest, lymph nodes were negative and therefore this patient is at present believed to be cured.
Discussion: It is well known that cutaneous SCC (cSCC) in African American patients, though rare, presents aggressively at a late stage and more commonly in women within scarred areas such as discoid lupus erythematosus We present our case to demonstrate the rare occurrence of cSCC de novo in an African American male and to examine the social factors which led to delayed treatment and diagnosis and possible life long comorbidity
Authors: Ugonna Nwannunu, Mikayla Woodard, Meena Singh, MD, FAAD; Letitia Bradford, MD.
Nwannunu, Ugonna HUCM M2 22
Jenkins, Toni HUCM M3
Title: Squamous Cell Carcinoma in AA Male with Delayed Treatment due to Social Factors
Title: Racial differences in prescribing patterns for Psoriasis: a survey of 525 U.S. dermatologists
Petion, Elishama HUCM
Although biologics are a helpful form of treatment for psoriasis, Black and Hispanic patients receive biologic treatment less frequently than white patients.1, Factors such as cost and unfamiliarity with biologics may contribute to this disparity.2,3 Our study seeks to understand racial disparities in prescribing choices for psoriasis treatment. An online survey including demographic questions and a clinical scenario was emailed to 10,525 dermatologists in the United States (December 2021). The clinical scenario described a patient with moderate to severe psoriasis, and asked respondents to choose from several treatment recommendations: A) Start topical steroids; B) Start a biologic therapy; C) Start oral methotrexate; D) Do not treat today and follow up in 3 months; and E) Start phototherapy. A free text box was provided for participants to explain their choice Each respondent saw this clinical scenario; however, the race of the hypothetical patient was randomly assigned (Black, Hispanic, or White) The survey was completed by 525 U S dermatologists We found no significant difference in overall prescribing patterns between Black, Hispanic, and white patients Specifically, Black, and Hispanic patients were prescribed biologics at a similar rate to white patients When comparing free text data, dermatologists mentioned cost and insurance significantly more for Hispanic patients than Black patients (p= 010) There was no significant difference in mention of cost and insurance for Black or Hispanic patients compared to white patients We found no significant difference in prescribing patterns However, these data provide evidence for potential cost concerns of biologic treatment for psoriasis for Hispanic patients
Authors: Elishama Petion, BS; Sven van Egmond, MD; Isabella Joy de Vere Hunt, MD; Arsema Zadu, MS; Kanade Shinkai, MD; Julia Simard, MD; Jenna Lester, MD; Eleni Linos, MD, MPH, Dr.PH.
M2 Title: Unusual case of hyperpigmented annular mycosis fungoides in young African American male: A case report
Slack, Ashley HUCM M2
Presenter: Ashley Slack, B.S., MBS Introduction: Mycosis Fungoides is a dermatological condition in which patches composed of lymphocytes infiltrate the skin. It is also a rare form of a blood cancer known as cutaneous T cell Lymphoma. The cause MF is unknown; however, it can be associated with pre existing contact allergic dermatitis or retroviral infection. Mycosis Fungoides has a low grade or indolent course, where it may take years to slowly progress to another stage with patches signifying stage 1 and tumors signifying the final stage, or stage 4.
Case Report/Case Presentation: A 34 year old African American male presented to the dermatology clinic complaining of several hyperpigmented oval patches on his skin throughout his upper thigh, chest, and abdominal area. The patient states that he noticed the first patch appear on his thigh two years ago and consulted a physician regarding this lesion He was referred to a dermatologist for further evaluation but did not seek consultation He presented to a dermatologist several years later with a rash A biopsy was performed Pathological evaluation revealed Patch stage Mycosis Fungoides Although Mycosis Fungoides can begin as early as the first decade of life, there are only a few previous cases reported on Mycosis Fungoides seen in younger patients It is also imperative that public health outreach to the African American community regarding Mycosis Fungoides should be highly considered given that MF presents at an earlier age in African Americans and that they are more likely to have an unfavorable prognosis
23
Results: 585 Dermatologists completed the survey (response rate 5 6%) The most common treatments included isotretinoin, antibiotics, adjustment of topical treatment, spironolactone, and oral contraceptives. Dermatologists recommended isotretinoin as a first line treatment for the scenario in which the patient was a cisgender man 55.1% of the time, transgender man 53.4%, transgender woman 46.2%, and cisgender woman 40.9% of the time. The differences between recommending isotretinoin to cisgender men versus cisgender women, and between cisgender women versus transgender men, were both statistically significant (p=0.012 and p=0.031 respectively).
Zadu, Arsema HUCM M2 24
Introduction: Transgender individuals face important health issues relevant to dermatologists, including acne, and may experience healthcare discrimination Isotretinoin is commonly prescribed for severe acne however studies show that iPledge’s gender classification system was distressing and a deterrent to some transgender patients from receiving treatment (Lipoff, 2021) (Yeung et al 2016) These studies led to iPledge modifying it’s classification system to be more inclusive of transgender patients This study aims to identify gender disparities in dermatologists’ prescribing patterns for the treatment of acne
Conclusion: These results indicate a gender bias in prescribing patterns for the treatment of acne with isotretinoin, with dermatologists less likely to choose isotretinoin as the treatment option for acne in cisgender women compared to cisgender or transgender men. This could be attributable to concerns related to isotretinoin’s teratogenicity.
Title: Development of a Dermatologic Educational Module for use in Barbershops and Hair Salons: Fostering Access to Dermatologic Care Within the Black Community
Authors: Jamon Thomas, Janiene Luke, MD.
Authors: A. Zadu, S. van Egmond, I. de Vere Hunt, E. Petion, Z. Cai, H. Yeung, J. Simard, E. Linos
Methods: A literature review was conducted to better ascertain the role of barbershops and salons in health education within the community. Additionally, these papers provided a deeper understanding of the impact of health outreach in these spaces, providing examples of best practices and effective methods for implementation. Using this information, a cohesive learning module/brochure was created using computer design software. The brochures will be printed for distribution in local barbershops and hair salons.
Introduction/Background: Black barbershops and hair salons are cornerstones of the Black community they cultivate a sense of belonging, refuge, and mutual understanding These spaces hold great potential to become venues for education, training, and may serve as potential screening sites to aid in overcoming institutional and sociocultural barriers to care Extensive research on the incorporation of these forms of outreach in Black barbershops and salons has been established for fields like oncology (eg, prostate and lung cancer screenings), endocrinology (eg, diabetes screenings) and infectious disease (HIV/STI screenings); however, there is a paucity of evidence in the literature that evaluates the presence or impact of comparable interventions in the field of dermatology Given barbers and hairstylists are in frequent contact with the scalp, hair and skin of their patrons, it would be useful to equip them with an educational module to recognize common skin and hair conditions that may require a referral for evaluation and/or management by a dermatologist (eg, pseudofolliculitis barbae, acne keloidalis nuchae, acne vulgaris) The purpose of this learning module is to increase awareness, aid in earlier diagnosis/management of dermatologic conditions, and ultimately help bridge the healthcare gap for patients of color in the medical system
Results/Conclusions: The first phase of this project was development of the brochure which will be distributed to barbershops and hair salons in the Washington, DC area and in Hyattsville, Maryland. Additionally, a follow up survey study will be conducted to measure the impact of this form of health education/outreach. This study serves to determine the perceptions of stylists/barbers after reviewing/completing the educational module with respect to knowledge gained and likelihood to refer to a dermatologist for hair/scalp or skin issues
Thomas, Jamon HUCM M2
Title: Prescribing Patterns for Acne in Transgender Compared to Cisgender Patients
Methods: An online survey including demographic questions and clinical scenarios was emailed to 10,525 dermatologists in the United States (December 2021) The survey included a clinical scenario describing a patient with severe acne, for whom isotretinoin would be clinically indicated The survey randomized gender (transgender or cisgender man or woman) Dermatologists were asked what treatment they would recommend in a free text response The free text was coded in SPSS and the results were analyzed using chi square, Mann Whitney U, and independent T tests
Emergency Medicine
Methods: Cross sectional study surveying English and Spanish speaking patients 18 years and older presenting to an Urban, Level 1 Trauma ED from June August 2018 UAU was determined using a validated single item screening question recommended by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. Housing status was evaluated using items validated for housing stability. Sampling occurred in rotating 4 hour time blocks equivalent to 24 hours/day for 14 days. ED patients with and without UAU, as well as nonrespondents, were included in the analysis. Statistical significance was set at P<0.05.
Title: The Social Context of Unhealthy Alcohol Use Among Emergency Department Patients: A Cross Sectional Study
Conclusion: UAU is commonplace in ED patients yet grossly underdiagnosed Care of these patients targeting alcohol use also requires addressing social determinants of health and co occurring substance use disorders
Results: Of the one thousand two hundred sixty three eligible patients, seven hundred fifty eight patients completed the survey (60% response rate), and 296 (39%; 95% confidence interval) reported UAU. Rates of ED visits and inpatient hospitalizations were equivalent between patients with and without UAU. UAU patients were more likely than those without to be homeless/ unstably housed (69% vs 59%; P=0.018); have spent more than 2 nights in jail or prison in the last year (15% vs 7%; P<0.001); higher rates of illicit drug use (29% vs 14%, P<0.001) and prescription misuse (18% vs 10%, P<0.001). Only 20% of patients with UAU (60 of 296) had a previous diagnosis documented in their medical records
Methods: We surveyed patients in an urban, safety net ED from June August 2018 Patients completed two social needs screening tools and additional questions on housing. Housing status was determined using validated questions about housing stability. Results: Of the 1263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race/ethnicities. The median age was 42 years (interquartile range [IQR]: 29 57) and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness were male (63.3%) and Black (54.2%) p<0.001, and a disproportionate number of unstably housed patients were Latinx (56.8%) or were primarily Spanish speaking (49.3%), p<0.001. Social needs increased across the spectrum of housing from housed to unstably housed and homeless, even when controlling for demographic characteristics
Authors: Erik S Anderson, MD; Leah Fraimow Wong, BA; Rachel Blake, MS; Kierra Batiste, BS; Triveni DeFries, MD; Andrew A Herring, MD; Harrison Alter, MD, MS
Title: Association of Social Needs and Housing Status Among Urban Emergency Department Patients
Conclusion: Over 1 in 3 ED patients experience homelessness, and nearly 1 in 3 are unstably housed Notable disparities exist by housing status, and there is a clear increase of social needs across the housing spectrum EDs should consider integrating social screening tools for patients with unstable housing Blake, Rachel HUCM
Introduction: With Unhealthy Alcohol Use (UAU) associated with 10% of all U S deaths from 2006 2010 and healthcare costs rising to $45 billion in 2014, there is a strong desire to determine the specific social determinants of health, housing status, and emergency department (ED) utilization in patients with UAU to bolster current interventions
Authors: Kadia Wormley, MD; Drusia Dickson, MD; Harrison Alter, MD; Ndidi Njoku, BA; Partow Imani, MS; Erik S Anderson, MD
Njoku, Ndidi HUCM M3 25
This work adds to other literature as the rates of both illicit and prescription drug use are doubled in UAU patients
Significance follows that alcohol combined with other substances increases the risk of overdose
Introduction: People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness
During the COVID-19 Pandemic
Title: Phased Introduction to Hybrid Telehealth and In-Person Appointments and an Enhanced Clinic Model
Edwards,
Authors: Myra Khushbakht, Angel Gabriel, Coltan Edwards, Gabriella Kuffour, Mark Johnson
Results: Telehealth only services were successfully implemented in fall 2020, and in person WHN services were phased in at the beginning of 2021. By August 2021, in person appointments became an additional option for both existing and new patients during primary care nights. Patients completed a pre and post encounter COVID questionnaire for in person appointments Furthermore, expanding the provider recruitment to include residents increased provider engagement and teaching opportunities The introduction of patient navigators allowed for more efficient patient care delivery and communication Social needs were also identified via a questionnaire conducted by patient navigators after intake for 30 patients 26 7% of patients were part time employed, while 23 3% were unemployed Only 16 7% of patients were fully employed 20% of patients in the past avoided seeing a doctor previously due to cost Additionally, 13 3% of patients didn’t have enough money for food, transportation, and access to stable housing
Conclusions: The phased introduction of the hybrid clinic model provided a new way to restructure the clinic both on an operations level and by expanding the range of care options for patients Patients visiting a free clinic often have many social needs that can and should be addressed Additionally, the introduction of patient navigators allowed for a more seamless introduction to an appointment system, while expanding provider recruitment to include residents encouraged a more interdisciplinary and sustainable clinic model Coltan
HUCM M3 Family Medicine 26
Introduction: New Freedmen’s Clinic, a student run free clinic at the Howard University College of Medicine, provides primary care nights and Women Health’s Nights (WHN) The objective was to design a phased in hybrid free clinic model that provides a flexible and reliable appointment delivery system for patients and allows the clinic to better understand patients' social needs during the COVID 19 pandemic Methods: Due to the nature of procedures performed during WHN (pap smears, endometrial biopsies, breast cancer screenings), the clinic decided that WHN should remain in person under more rigorous protocols, while primary care nights were decided upon to have more flexible delivery options A HIPAA compliant patient appointment system was set up, and patient navigators were introduced into the clinic to communicate with patients under this new system Social needs of patients were identified during patient intake Walk ins were discontinued, and services were provided through appointments only Telehealth appointments were delivered either by video visit or phone call In addition, due to the constraints of the pandemic on attending recruitment, residents were invited to be providers during clinic nights as long as they had a supervising attending available during clinic hours. After the new services were put into place, the clinic steering committee was trained to address new parameters which included COVID 19 exposure questionnaires, sanitation protocol, diagnostic requests, and social distancing rules. Protocols and operation flow charts were disseminated to all involved parties, and debriefings were held for volunteers before each clinic night to ensure understanding of clinic operations.
Medical conditions were investigated to understand: (1) natural origins (2) evolutionary mismatch (3) description of the disease and (4) proposed solutions Information was collected digitally through investigation between general public informational websites such as WebMd and different scientific journals The following medical conditions were investigated: Alcoholism, Asian Flushing Syndrome, Rise of Anti Vax Movement, Body Dysmorphic Disorder, Burnout, Diabetes, Hispanic Health Paradox, and Peanut Allergy Alcohol has been consumed in larger and more potent quantities due to modern distilling methods People self medicate with alcohol to handle rising stress levels Many patients of East Asian descent lack the aldehyde dehydrogenase enzyme gene, causing a toxic build up of a metabolite of ethanol, leading to unfavorable symptoms like facial flushing, lightheadedness, and tachycardia This inheritance has persisted as a protective factor against alcoholism Solutions include self pacing, behavioral therapy, and pharmaceutical approaches to limit alcohol intake. Due to recent scientific advancements, younger generations have not witnessed the deadly bacterial and viral infections. Consequently, emotionally charged false narratives have gained traction to create a movement against vaccinations with unproven links to increased risks of autism and other medical conditions. The solution is to disseminate and create scientific material tailored to common people to dispel myths and misconceptions. With widely used technology and globalization, beauty standards have formed to be singular and unnatural with digital manipulation and affordable cosmetic surgeries, leading to comparisons to unreasonable and unattainable visual goals. Societally, there needs to be inclusion of different versions of beauty as beauty is dynamic. With industrialization and capitalism, there is more emphasis and identification with one’s work, leading to higher rates of burnout. Solutions include self care, safe and collaborative work environments, and self identification outside of work. Mass agricultural production and sedentism increases calorie consumption and decreases energy expenditure with rising rates of diabetes Preventing and managing diabetes is a consistent effort to eat healthy, exercise regularly, and reduce stress Immigrants to the U S have poor health outcomes compared to when in their countries of origin despite innovative and quality healthcare systems due to discrimination and differing lifestyle factors Culturally competent healthcare must be expanded via institutional amendments, population specific educational programming, and improvement of public health services There has been a rise in peanut allergies due to overuse of hygienic products and antibiotics Our immune systems are programmed to attack foreign invaders When not activated, the immune system will attack innocuous foreigners like peanuts, a common food eaten globally To prevent peanut allergies, infants should be slowly introduced to a variety of foods We should also reduce the overreliance on nonessential use of antibiotics and antiseptics
Title: Medicine from an Evolutionary Standpoint
Authors: Rachel Kim, BS; Rui Diogo, PhD. The literature review analyzes common medical conditions from an evolutionary medicine viewpoint to explain higher frequency and/or persistent occurrences The purpose is to create educational programming through cartoons to be easily understood and reproduced for the general, non scientific community in English and Spanish The materials can be utilized in medical offices, medical education, and non medical settings to facilitate and enhance patient education
Kim, Rachel HUCM M3 27
Case Presentation: A 54 year old female presented to the hospital with a history of alcohol use disorder, hypertension, gastrointestinal (GI) bleeding due to alcoholic gastritis, type 2 diabetes mellitus, hyperlipidemia, and colon cancer status post hemicolectomy nine months prior, with a previous admission of acute pancreatitis. She has a history of alcoholic gastritis in the past and was admitted and treated for that. She presented with sharp, burning epigastric and left upper quadrant (LUQ) pain for two days, accompanied by nausea, vomiting, loose stool, and tea colored urine Her pain was persistent, and she continued to have nausea with vomiting but no hemoptysis, hematochezia, melena, or bright red blood per rectum Physical examination of the abdomen did not show shifting dullness or fluid waves She had guarding, rigidity, and tenderness to palpation, which was greatest in the LUQ Upon admission, she had her laboratory done, which was significant for leukocytosis with a white blood cell count measuring 22 59/uL and hemoglobin 16 1 g/dL, which quickly resolved with hydration and supportive therapy Other pertinent lab findings were noted in the patient’s hepatic panel: Lipase level was significantly elevated, measuring at 2567 units, and amylase at 148 units
Title: The Need to Anticoagulate Patients With Splenic Vein Thrombosis
Introduction: Splenic vein thrombosis (SVT) mainly occurs due to acute and chronic pancreatitis It is usually asymptomatic, but patients can present with anemia, hematemesis, melena, and abdominal pain Unlike other causes of SVT, such as malignancy, the factors associated with pancreatitis related SVT are caused by transient factors such as local thrombotic inflammatory changes, extrinsic splenic vein compression from pseudocyst, or relatively reduced pancreatic perfusion. Due to the advancement in imaging techniques, such as sensitive CT scans, MRIs, and ultrasound, SVT has become easier to identify. Gastric variceal bleeding is an uncommon complication of SVT. Anatomically, the splenic vein is found posteriorly to the tail of the pancreas, so repeated irritation of the pancreas can result in direct damage to the vein, external compression, or thrombosis. This can lead to gastric varices and an increased risk of bleeding. This can be diagnosed endoscopically.
Tran, Tri HUCM M4 28
Authors: Clara Benjamin, Maya Bryant, Tri Tran, Rediet T Atalay, Girma M Ayele, Miriam B Michael
Conclusion: SVT is a common occurrence in the setting of pancreatic inflammation, and it is associated with pancreatic necrosis peripancreatic collections Recanalization is observed in almost a third of patients, irrespective of whether or not they receive systemic anticoagulation There is no clear literature written regarding the risks versus benefits of anticoagulation in the treatment of SVT Multiple factors appear to need consideration such as acuity of the clot as well as the propagation of thrombosis into the main or intrahepatic portal vein and new onset ascites as indicators to start anticoagulation These need to be weighed against the real risk of bleeding The use of diagnostic studies, CT or ultrasound, and possible endoscopic gastro duodenoscopy (EGD) to look for varices as well as the presence of cirrhosis that increases the risk of significant GI bleeding may help with the decision. The increased rate of morbidity and mortality in cases of both under or optimal treatment with anticoagulation gives a good ground for undergoing randomized controlled studies.
Title: A Case Report of Eccrine Syringofibroademona
Lower extremity amputations (LEA) among diabetic patients are a major indicator of the overall quality of diabetic care
Milestones
General Surgery
Findings: A 68 year old Black male with a history of gout, hypertension and venous stasis presented with a lesion spanning the dorsal right 1st and 2nd toes. The lesion slowly grew over one year and did not improve with topical steroids. Physical examination revealed a pink, mamillated, and verrucous plaque, roughly 4 cm in size, on the dorsal aspect of the 1st and 2nd toes on the right foot The patient experienced pain upon palpation Histologic examination showed anastomosing cords and strands of uniform small cells with eosinophilic cytoplasm and small basaloid nuclei These features were consistent with the diagnosis of eccrine syringofibroadenoma The patient subsequently was advised to undergo Mohs surgery Summary: This case demonstrates the rare occurrence of eccrine syringofibroadenoma As of 2020, only 75 cases have been reported (Sriharan, 2020) The co existence of eccrine syringofibroadenoma and squamous cell carcinoma has been reported The incidence of the malignant transformation to squamous cell carcinoma is not well understood Given the rarity and malignant potential of this tumor, a high index clinical suspicion is essential to ensure that patients are offered surgical removal in a timely fashion, especially in patients with skin of color, who experience worse outcomes of squamous cell carcinoma compared to White patients Excision with Mohs can be helpful to limit the size of excision around digits such as seen in this case Edwards, Alicia HUCM M2 29
While much has been published regarding the impact of sociodemographic factors on outcomes of care, it is not clear how these factors affect the different components of length of stay (LOS) of a patient’s hospital admission The following study examines the interaction between patients' race/ethnicity and insurance type and how this interaction affects component time intervals We collated data from the National Inpatient Sample database and identified all diabetic patients who underwent LEAs from 2005 to 2015 Patients whose procedures were due to trauma or acute limb ischemia were excluded The variable of interest was the component time intervals defined as admission to procedure, procedure to discharge, and the overall length of stay (LOS). Black patients were compared to a matched White control group. We subsequently conducted a multivariate analysis to determine the interaction between race/ethnicity and insurance status on the component time intervals. Black patients had a longer admission to procedure time (4.5 ± 5.7 days versus 3.8 ± 5.1 days, p < 0.001), longer procedure to discharge time (7.5 ± 8.5 days versus 6.4 ± 7.0 days) and longer overall LOS (12.0 ± 10.8 days versus 10.2 ± 9.0 days, p < 0.001). On sub analysis, privately insured White patients have the shortest LOS while publicly insured and uninsured Black patients had the longest LOS. There are significant racial/ethnic and insurance type disparities following LEA in patients with diabetes. Across insurance types and hospital discharge, Black patients have a longer length of hospitalization compared to their White counterparts.
Aaron, Sabrina HUCM M4
Purpose: Eccrine syringofibroadenoma is rare adnexal neoplasm with only 75 cases being reported as of 2020 Typically, this neoplasm is viewed as a relatively benign entity; however, there have been reports of malignant transformation or coexistent squamous cell carcinoma Herein we present a case of eccrine syringofibroadenoma in a black male with a lesion spanning two digits on the foot. This case highlights the importance of clinical and histopathologic correlation to help differentiate rare adnexal neoplasms on acral sites and the importance of timely diagnosis to ensure prompt referral for surgical excision.
Design: We present a case of eccrine syringofibroadenoma which was confirmed with clinical and histopathologic correlation. The patient has been referred for Mohs surgery given the rarity and the association with potential malignant transformation to squamous cell carcinoma.
Authors: Alicia Edwards MS, Arjun Saini MD, Vishal Patel MD FAAD, Ellen Pritchett MD FAAD
Authors: Oluwasegun Akinyemi, MD, MS, Siobhan Nnorom, MD, Moses Adebayo, MD, Sabrina Aaron, BS, Kindha Elleissy Nasef, BS, Edward Cornwell III, MD, Kakra Hughes, MD, Ph D
Title: Disparities in Hospitalization Among Diabetic Patients Undergoing Lower Extremity Amputation: Timing
Li, Sandy HUCM M4 30
Title: Incidence of Cleft Lip and/or Palate in Asian Subgroups in the United States
In addition to race/ethnicity specific analysis, we compared characteristics between births with CL/P and those without for the entire population We noted that consistent with current literature, mothers with CL/P births were more likely to be born in the US compared to those born outside the US, had lower levels of education, were more likely insured with Medicaid insurance, more likely to smoke cigarettes, and more likely to have comorbidities such as hypertension and DM type II Mothers with a CL/P birth were also less likely to begin prenatal care in the 1st trimester of pregnancy
Conclusions: This study used a comprehensive national database to identify possible risk factors for CL/P, to determine the incidence of CL/P among several racial and ethnic groups, as well as focusing on differences between the Asian and Pacific Islander subgroups This dataset showed us that the incidence of CL/P in Asian and Pacific Americans (54/100,000 live births) is lower than previously reported (1/500 live births) in the literature We hope for this data to help elucidate highlight health disparities across different racial and ethnic groups in terms of CL/P Ultimately, we hope for this data to support the disaggregation of Asian American and Pacific Islander data on a national level to highlight the unique challenges and needs of specific subgroups
Authors: Sandy Li, AB; Siobhan O Nnorom, MD; Richard Ngo, DMD; Oluwasegun A Akinyemi, MD; Adedoyin O Kalejaiye, MD
Introduction: This study used a large national dataset to examine the incidence of cleft lip and/or palate (CL/P) among different race/ethnicity groups in the United States In particular, we focused on Asian and Pacific Islander subgroups These subgroups are often combined into a single “Asian” category, which leads to masking of meaningful differences among the subgroups and lack of knowledge regarding health risks in the subgroups The prevalence of CL/P is often reported to be as high as 1 in 500 in Asian Americans Methods: We conducted a population based retrospective cohort study using the US vital statistics dataset of all deliveries from 2015 to 2019 (19,327,274 births) The database categorizes maternal race as the following: White, Black, American Indian/Alaskan Native, Chinese, Filipino, Japanese, Korean, Vietnamese, Hawaiian, Guamanian, Samoan, “other Asian”, “Other Pacific Islander” and “More than one race”.
Results: CL/P was present in only 0.07% of the entire cohort. The cumulative incidence of CL/P between 2015 2019 was 72.47/100,000 live births. Of all deliveries with CL/P, 57.42% were male and 42.58% were female. The incidence of CL/P differed by race/ethnicity, with the highest incidence seen in American Indians/Alaska Natives and the lowest seen in Black individuals. Using multivariable analysis, we found that White mothers had a higher likelihood of having CL/P births compared to Black and Asian and Pacific Islander mothers. When analyzing the Asian and Pacific Islander subgroups, Chinese mothers had significantly lower rates of CL/P births (39.87/100,000 live births) compared to Filipino (63.38/100,000 live births), other Asian (71.77/100,000 live births), and Pacific Islander mothers (75.72/100,000 live births). Asian Indian mothers had significantly lower rates of CL/P births (46 43/100,000 live births) compared to Other Asian, and Pacific Islander mothers
Batta, Yashvardhan
Title: Sequelae and Comorbidities of COVID 19 Manifestations on the Cardiac and the Vascular Systems
HUCM M3 Internal Medicine 31
COVID 19 patients with pre existing cardiovascular conditions are at greater risk of severe illness due to the SARS CoV 2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to preexisting hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS CoV 2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review In particular, SARS CoV 2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications Also, cardiac arrhythmias are another well known cardiovascular related complication seen in COVID 19 infections and merit discussion in this review Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS CoV 2 patients Currently, the specific causative mechanism of the increased incidence of MI is unclear However, studies suggest several links to high angiotensin converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyperinflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2 mediated cardio protection Furthermore, hypertension and SARS CoV 2 infection patients’ prognosis has shown mixed results across current studies For this reason, an in depth analysis of the interactions between SARS CoV2 and the ACE2 cardio protective mechanism is warranted Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk This review aims to discuss the current literature related to potential complications of COVID 19 infection with hypertension and the vasculature, including the cervical one Finally, age is a significant prognostic indicator among COVID 19 patients For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID 19, it is essential to explore the mechanisms by which SARS CoV 2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.
Authors: Yashvardhan Batta, Cody King, John Johnson, Natasha Haddad, Myriam Boueri, and Georges Haddad.
Case Study: Our patient is a 35 year old male presenting with widespread skin rash, itching and fever His past medical history is significant for HIV, and he is noncompliant with HAART. The patient’s roommate was diagnosed with Monkeypox one week prior. His social history is significant for smoking marijuana and five cigarettes daily. He reports using crystal meth in the past. He is allergic to penicillin G and ampicillin. His ROS is significant for skin findings, showing numerous vesicles, pustules, umbilicated pustules, ulcerated lesions all 2 5mm in diameter on the face, neck, upper back, all extremities, one on the palm of his right hand, peri anal area, and penis. The patient presents with transaminitis and eosinophilia, and reactive RPR test results. The patient meets CDC criteria for Monkeypox viral infection: the characteristic rash and epidemiological criteria. No exclusion criteria have been met thus far. While there are no signs of current opportunistic infections, the patient will receive continuation of HAART. After speaking with DC Health, the patient remained admitted and was prescribed Tecovirimat 600 mg BID for 14 days. Samples for PCR were obtained by Dermatology We counseled him on the importance of taking his HIV medication and monitoring his CD4 count and VL For DVT prophylaxis, the patient is on Lovenox We will continue to monitor LFTs and eosinophil levels
Given the reactive RPR test result, he was treated with doxycycline
Title: Monkey Pox Case Report
Discussion: The Monkeypox virus is transmitted from person to person through respiratory secretions, skin to skin contact, indirect contact with fomites, and through vertical transmission Self isolation and antiviral therapy are recommended to patients with the infection Those with a concomitant HIV infection are at an increased risk for severe disease progression and those who present with a CD4 count under 500 cells/mL should be considered for anti Monkeypox viral therapy such as Tecovirimat Patients with an HIV infection with a CD4 count greater than 350 cells/mL qualify for post exposure prophylaxis with the MVA vaccine Most recover within two to four weeks with supportive care
Chopra, Ambica HUCM M3 32
Authors: Ambica Chopra BS, Robert Emeh BS; Caroll Pinelo MD
Introduction: Monkeypox virus is a zoonotic pathogen that was first identified in the 1950s from a colony of monkeys in Singapore The first recorded case of human transmission was in the 1970s and since then, there have been outbreaks of human monkeypox infection in the United States, Central America, and West Africa The 2022 outbreak was first reported in May 2022 and in July 2022, the WHO declared Monkeypox virus infection a public health emergency Since the emergence of this outbreak, 30 50% of patients have reported HIV infections
Title: HIV Antiretroviral Therapy and Cardiovascular Effects
Introduction: With reports of its emergence as far back as the early 1900s, HIV has become one of the deadliest and most difficult viruses to treat in the era of modern medicine. Although not always effective, HIV treatment has evolved and improved substantially over the past few decades Despite the major advancements in the efficacy of HIV therapy, there are mounting concerns about the physiological, in particular cardiovascular, sequelae of current treatments
Authors: Yashvardhan Batta; Farion Cooper; Cody King; Georges Haddad.
Results: Amongst currently used classes of HIV therapies, protease inhibitors (PIs) and highly active antiretroviral therapy (HAART)/combination antiretroviral therapy (cART) were found to have an overall negative effect on the cardiovascular system Some mechanisms to explain this phenomenon include increased cardiac apoptosis, reduced repair mechanisms, block hyperplasia/hypertrophy, decreased ATP production in the heart tissue, increased total cholesterol, low density lipoproteins, triglycerides, and gross endothelial dysfunction. The review of Integrase Strand Transfer Inhibitors (INSTI), Nucleoside Reverse Transcriptase Inhibitors (NRTI), and Non Nucleoside Reverse Transcriptase Inhibitors (NNRTI) revealed mixed results, in which both positive and negative effects on cardiovascular health were observed. Concerning the specific drugs of new combination antiretroviral therapies, Biktarvy, Complera, and Juluca treatments were found to cause a marked improvement in the lipid profiles of HIV+ patients, with either a decrease or no net change in risk of cardiovascular disease. However, Odefsey treatment was associated with elevated lipid levels and pro atherogenic lipoproteins, leading to a significant increase in the risk of developing cardiovascular disease.
Cooper, Farion HUCM M3 33
Conclusion: HIV therapy has rapidly evolved over the years with new information about its residual effects on the human body being discovered daily This article has extensively outlined the individual drug classes and combination drugs with their respective mechanisms of action and overall effects on the cardiovascular system While still a relatively nascent field, more research on the cardiovascular implications of HIV therapy is crucial to accurately evaluate patient risk
Methods: We executed a computer based literature search using databases such as Pubmed to look for relevant, original articles that were published after 1998 Articles that had relevance, in any capacity, to the field of HIV therapy and its intersection with cardiovascular health were included Three reviewers performed the search and the initial selection of potentially relevant studies that met the inclusion criteria
Objectives: 1: Highlight the different forms of antiretroviral therapy, how they work, and any effects that they may have on the cardiovascular health of patients living with HIV 2 Explore the new, more common therapeutic combinations of highly active antiretroviral therapy (HAART) currently available and their effects on cardiovascular health
Title: Methylated DNA Markers Of Hepatocellular Carcinoma Do Not Discriminate Hepatocellular Adenoma From Fibronodular Hyperplasia
Ekpe, Elizabeth HUCM M4 34
Background: Obesity is known to be associated with several comorbidities, including cancer Reduced fat mass, healthy eating and regular exercise are known ways to minimize obesity associated inflammation, which is an underlying pathophysiologic mechanism of disease development It is unknown if obese adults in the United States understand the significance of these lifestyle choices on cancer development
Conclusion: HCC associated MDMs do not discriminate HCA or FNH from healthy controls or from each other. While we do not anticipate that MDMs will complement imaging for classification of benign lesions, we also do not anticipate that benign nodules, nor HCA will be a significant source of false positive liquid biopsy results in patients under surveillance for HCC Green, Kelsey HUCM M2
Background: Methylated DNA markers (MDMs) are strongly associated with hepatocellular carcinoma (HCC) in primary tumor tissues and in peripheral blood cell free DNA MDM representation in benign liver nodules, including focal nodular hyperplasia (FNH), and pre cancerous hepatocellular adenoma (HCA) are unknown We hypothesized that HCC associated MDMs, if present in HCA but not FNH, could discriminate pre cancerous from benign liver lesions
Authors: Green, Kelsey M., Mahoney, Douglas W., Taylor, William R., Foote, Patrick H.,Burger, Kelli N., Gonser, Anna M , Doering, Karen A , Torbenson, Michael S , Roberts, Lewis R , Kisiel, John B
Methods: We analyzed the 2018 Health Information National Trends Survey (HINTS 5 Cycle 2). Our analytical cohort identified 2,986 respondents in the US (weighted population size = 219,552,371). Respondents rated how much they thought the following factors had an influence on whether a person will develop cancer: (1) Being overweight or obese, (2) Eating healthy food, and (3) Exercising regularly. We used logistic regression analyses to examine the association between respondent BMI categories and whether respondents believed each factor substantially influenced the development of cancer. We used survey weights in all analyses. We calculated odds ratios (OR) and 95% confidence interval (CI).
Title: The Perceived Risk of Lifestyle Choices on Cancer Development Among Obese Adults in the United States
Conclusions: There is a general suboptimal knowledge about factors that influence cancer development among adults in the United States This is particularly worse among obese subjects There is a need for healthcare providers and public health officials to educate the population at large about risk factors for cancer development, particularly among obese subjects
Methods: After IRB approval, archival formalin fixed tissue blocks of HCC, HCA, FNH and healthy liver tissue were identified and underwent research pathology review Tumor tissues were free from systemic or local regional therapy Samples were balanced by age and sex Blinded laboratory operators extracted and bisulfite converted DNA and then used quantitative methylation specific PCR assays for CLEC11A, DAB2IP, EMX1, HOXA1, TSPYL5, ACP1, CCNJ 3707, CCNJ 3124, ECE1, PFKP, SPINT2, SCRN1, AK055957, and EFNB2, normalized to ACTB Assay products were displayed using box plots MDM classification accuracy was summarized by area under the receiver operating characteristics curve (AUC) with 95% confidence intervals and differences between stratified AUCs were based on a z test.
Results: Eligible samples came from 34 HCA, 38 FNH, and 34 HCC and 34 normal liver control samples. The median age was 44 (IQR 33, 57) years. 85% were from women. The median AUCs of MDMs for classification of HCC vs healthy control, HCC vs HCA and HCC vs FNH were 0.76 (range 0.72 0.81), 0.79 (0.72 0.86), and 0.81 (0.75 0.86), respectively. However median AUCs for HCA vs controls, FNH vs controls, and HCA vs FNH were 0.39 (0.35 0.43), 0.42 (0.40 0.46), and 0.46 (0.41 0.48), respectively. Distribution for methylated HOXA1 & TSPYL5 is shown (Figure).
Authors: Elizabeth Ekpe, BS, Princess Okwesili, BS, Daniel Larbi, MD, Shelly McDonald Pinkett, MD, Angesom Kibreab, MD, Victor Scott, MD, Charles D Howell, MD, Farshad Aduli, MD and Adeyinka O Laiyemo, MD, MPH
Aim: To evaluate the perception of obese US adults on the influence of obesity, healthy eating and regular exercise on the development of cancer
Results: The mean age of the cohort was 48.4 years, 50.1% female, 66.1% White, 10.3% Black,15.9% Hispanic, 15.8% current smokers, 27.9% with a yearly household income less than $35,000 and 30.4% had a high school education or less The perception of obese respondents was generally lower in agreeing that these putative risk factors (obesity, healthy eating, and regular exercises) affect cancer development and was statistically significantly lower with identifying obesity as influencing cancer development (Table 1)
Authors: Princess Okwesili, BS Elizabeth Ekpe, BS, Daniel Larbi, MD, Shelly McDonald Pinkett, MD, Angesom Kibreab, MD, Victor Scott, MD, Charles D. Howell, MD, Farshad Aduli, MD and Adeyinka O. Laiyemo, MD, MPH
Okwesili,
Background: It is well known that a family history of colorectal cancer (CRC) is associated with an increased risk of the disease. However, it is uncertain if knowledge of family cancer history influences CRC screening uptake independent of formal educational attainment.
Title: Education, knowledge of family cancer history, and colorectal cancer screening among U.S. adults
Aim: To evaluate the role of knowledge of family cancer history and educational attainment on CRC screening among adults in the United States
Objective: This study examined whether the loci of rs2301718 (TET2) and rs17140801 (RBFOX1) also influence specific musculoskeletal phenotypes in healthy young adults
Conclusion: Formal educational attainment significantly influences CRC screening uptake. However, acquisition of the knowledge of family cancer history should be encouraged among the population. Princess HUCM M4
Discussion: This study found significant associations between RBFOX1 and TET2 polymorphisms and bone, strength, and exercise phenotypes To our knowledge, this is the first study linking these SNPs to metabolic energy expenditure, exercise, and strength parameters Moreover, the findings demonstrated that associations vary with ethnicity and sex
Introduction: Bone growth during adolescence is essential to maximizing peak bone mass A recent study highlighted single nucleotide polymorphisms (SNPs) rs2301718 (TET2) and rs17140801 (RBFOX1) for their association with fracture risk in the elderly Further studies found these candidate loci to be important in BMD across the lifespan
Results: A total of 644 (33 8%) respondents had high school education or less, 715 (40 4%) had some college / vocation school education while 917 (25 8%) were college graduates Overall, 1,494 (64 1%) respondents reported that they knew their family cancer history well Respondents with college degrees were more likely to know their family cancer history (74 2%) versus 64 8% among those with some college / vocational training versus 55 5% among those with high school education or less (P value for trend <0 001) By education status, college graduates were more likely to have been screened for CRC (72.9%; OR=2.27; 95% CI: 1.40 3.68) as compared to 62%; OR= 1.13; 95% CI: 0.71 1.81) among those with some college or vocational training when compared to 59.7% among those with high school education or less (P value for trend = 0.017) regardless of knowledge of family cancer history. Overall, 1,494 (64.1%) respondents reported that they knew their family cancer history well and were more likely to have been screened for CRC (66.9% versus 58.9%; OR = 1.48; 95% CI: 1.04 2.10). However, formal education had more influence on CRC screening than knowledge of family cancer history (Table 1).
Title: Genetic Variation in Bone Loci Polymorphisms Correlate with Bone and Muscle Phenotypes in Young Adults
Methods: Cohorts: The Functional Single Nucleotide Polymorphism Associated with Human Muscle Size and Strength (FAMuSS) cohort participated in a strengthening program of their non dominant arm. The Assessing Inherited Markers of Metabolic Syndrome in the Young (AIMMY) cohort was recruited to identify genetic variants associated with risk for metabolic syndrome. The Applied Biosystems QuantStudio 7 Flex Real Time PCR System was used in genotyping the DNA samples. Analysis of covariance (ANCOVA) was used to test relationships among SNP genotypes and musculoskeletal phenotypes in sex stratified cohorts.
Methods: We used the 2018 Health information National Trends Survey (HINTS) 5 cycle 2 We identified 2,276 respondents (weighted population size = 132, 125, 477) who gave information regarding their highest formal educational attainment, knowledge of their family cancer history and whether they have been screened for CRC We used survey weights in all analyses to obtain national estimates and used logistic regression analyses to calculate odds ratios (OR) and 95% confidence intervals (CI) Our fully adjusted model included age, sex, race, BMI, smoking, marital status, and health insurance
Results: FAMuSS: RBFOX1 (rs17140801) was associated with greater post training bone in males, and TET2 (rs2301718) was associated with post training bone marrow volume in females. AIMMY: RBFOX1 (rs17140801) was associated with right hand grip strength in Caucasian females, total PA index in Caucasian males, and MET hours/week for African American females. TET2 (rs2301718) was associated with height in Caucasian males and African American females, and right hand grip strength, left hand grip strength, and max grip strength in African American males
Authors: Brandon Hartmann, Elijah Strong, Pavan Vemulakonda, Adriana Solis, Elmer Rajah, Austin Gillies, Madeline King, Zachary Larew, Dustin Hitte, PhD, Eric Hoffman, PhD, Karuna Panchapakesan, Heather Gordish Dressman, PhD, Laura L Tosi, MD
Significance: This study expands associations of variation in RBFOX1 and TET2 and musculoskeletal phenotypes
Hartmann, Brandon HUCM M3 35
HUCM M3 36
Title: A Review on the Clinical Significance of Hypoplastic A1 Segment in Relation to Cerebrovascular Events
Clinical Relevance: This research offers an additional etiology of cerebrovascular events Physicians are prompted to be cognizant of pathological presentations in patients with a hypoplastic A1 segment
Results: Hypoplasia of the A1 segment is usually asymptomatic and clinically tolerable. There has been an established correlation between presence of a hypoplastic A1 segment and an associated anterior communicating artery aneurysm, but the increased risk of rupture has, so far, not been significant Additionally, there have been conflicting reports detailing the extent to which a hypoplastic A1 segment predisposes patients to ischemic stroke in the ACA territory A proposed mechanism of increased risk of stroke is linked to an increase in formation of collateral arteries in the striatal areas These arteries are vulnerable to ischemic attack and have poor thromboembolism clearance Additionally, hypoplasia of the A1 segment can result in an increase in size of the contralateral internal carotid artery (ICA) and a decrease in demand on the ipsilateral ICA Thus, A1 segment hypoplasia in combination with a carotid occlusive disease is a risk factor for low flow infarcts
Authors: Andrew Wadley, Kalaila Pais, Chidi Martins, Sandra Simon, Jabari Brooks, Vance Powell, Lawrence Pais
Conclusion Our review of the literature highlights studies involving the clinical significance of the hypoplastic A1 segment Proposed areas of future research include the correlation between hypoplastic A1 segment and ischemic and hemorrhagic stroke as well as its possible genetic predisposition
Neurology Brooks, Jabari Ture
Purpose: Our purpose is to assess the extent to which a hypoplastic A1 segment (HAS) accounts for cerebrovascular events in the ACA territory of the brain. Materials and Methods: This literature review constituted an analysis of twelve articles published between the period 1990 to 2022. Pubmed was queried using the keywords “A1”, “hypoplasia”, and “stroke”. Studies pertaining to the incidence, etiology, morphology and clinical manifestations of A1 segment hypoplasia were included.
Authors: Daniel Munger, Cierra N Harper, Busha Hika, Jesutofunmi Omiye, Obi Obayashi, Olabisi Sanusi
Objective: In this study, we sought to determine the risk factors for needing a shunt after TNTS with intraoperative CSF leak in patients with pituitary adenoma.
Results: Length of stay (LOS) was the only statistically significant predictor of post operative shunt placement (p= 0.003, OR=1.272, CI: 1.087 1.489). Redo TNTS, sex, age, diabetes, smoking status, BMI and lumbar drain use were not statistically significant predictors of CSF shunt placement. Preoperative Evan’s index and perioperative complications approached significance with p values 0 089 and 0 068, respectively
Batton, Aiyana HUCM M2 Harper, Cierra HUCM M4
Authors: Aiyana D. Batton, Charles D. Blaha Ph.D., Allan J. Bieber Ph.D., Kendall H. Lee M.D., Ph.D., Suelen Boschen De Souza Ph.D. Parkinson’s Disease (PD) is well known for its signature parkinsonian symptomology of bradykinesia, rigidity, and resting tremor. However, patients diagnosed with PD often present with auditory deficits as well, such as hearing loss. Thereby suggesting that dopamine (DA) also plays a role in central auditory processing. Recently, it has been discovered that a dopaminergic pathway projects from the subparafascicular nucleus of the thalamus (SPF) to the inferior colliculus (IC) a crucial convergence hub for the ascending and descending auditory pathways However, the functionality of this pathway had yet to be tested and proven In the present study, we confirmed the functionality of this pathway using electrical stimulation to activate neurons in the SPF of anesthetized rats while simultaneously using carbon fiber microelectrodes to measure neurochemical release at the IC via paired pulse and fast scan cyclic voltammetry Stimulation of the SPF at low (60 Hz) and high frequency (90 Hz) evoked dopamine release from the IC in a frequency dependent manner DA, norepinephrine (NE), and serotonin (5 HT) reuptake inhibitors were paired with electrical stimulation and neurochemical recordings to confirm the selectivity of the neurochemical recordings for DA Therefore, the SPF IC dopaminergic pathway functionally modulates DA transmission in the IC and may be involved in the auditory processing deficits associated with PD induced dopaminergic cell loss
Conclusion: In this institutional series, LOS was a significant predictor of postoperative CSF shunt placement Preoperative Evan’s index and perioperative complications were both suggestive of CSF shunting but these did not reach statistical significance
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Methods: Using CPT codes, we identified 10 patients who underwent CSF shunt placement after TNTS for pituitary adenoma at our institution between 2012 2021. Thirty control patients were randomly selected out of 157 patients with confirmed intra operative CSF leak. Charts were reviewed for demographic factors, comorbidities, tumor size, complications and technical nuances. We performed a regression analysis to determine factors predictive of CSF shunt placement.
Title: Electrical Deep Brain Stimulation of the Subparafascicular Thalamus Nucleus Modulates Dopamine Release in the Inferior Colliculus of Anesthetized Rats
Title: Perioperative length of stay is predictive of shunt placement following transnasal transsphenoidal pituitary adenoma resection
Neurosurgery
Introduction: Post operative cerebrospinal fluid (CSF) leak after transnasal transsephenoidal (TNTS) surgery for pituitary adenoma resection continues to be a challenge with some patients requiring permanent CSF diversion in the form of a shunt Patients indicated for CSF shunt placement represent a small subset of those with refractory CSF leaks or clinical signs and symptoms of hydrocephalus Although factors such as age, female gender, BMI and intraventricular tumor extension have all been associated with risk of persistent CSF leak, specific predictors for post TNTS shunt placement remain poorly defined
Case Report: Presentation:An 83 year old male long term smoker with weeks of progressive diplopia, preserved visual acuity, headaches, facial numbness, and right III, IV, and VI cranial nerve palsies Past medical history significant for melanoma MRI revealed expansile mass in the sella turcica, 35 x 19 x 12 mm with right cavernous sinus extension (Knosp grade 4) without signs of hemorrhage Hormonal work up revealed adrenal insufficiency, mild hyperprolactinemia (21 ng/mL) and growth hormone deficiency
We report the third case of neuroendocrine tumor metastatic to the pituitary with unknown primary site Similar to our patient, the previously reported patient’s tumors had extrasellar invasion, high Knosp grade, and underwent subtotal resection Though rare, metastasis should be part of the differential diagnosis of a new pituitary mass, particularly when accompanied by cranial neuropathy, presence of diabetes insipidus and/or a history of cancer Neuroendocrine tumors comprise a small, but clinically aggressive fraction of such cases
Title: Sellar Metastatic Neuroendocrine Carcinoma of Unknown Origin: A Case Report and Review of the Literature
Introduction: Pituitary metastasis from systemic malignancy is an uncommon phenomenon, with metastasis of neuroendocrine tumors being an extremely rare subset; just two previously reported with unknown primary source
Conclusion: Pituitary metastasis from any cancer is rare, comprising an estimated 0 87% of all intracranial metastases
Authors: Miner N. Ross, Cierra N. Harper, Matthew D. Wood, Mathew Geltzeiler, Maria Fleseriu, Olabisi Sanusi
Harper, Cierra HUCM M4
Objective: We present a patient with a large neuroendocrine metastasis to the pituitary without a discernable site of origin
Treatment: High dose dexamethasone did not improve ophthalmoplegia Patient underwent endoscopic endonasal debulking Intraoperatively, mass was firm and fibrous Surgical debulking was tolerated without complications Imaging post operatively revealed residual tumor within the right cavernous sinus Cranial neuropathies did not improve and he developed mild transient SIADH He was discharged on post operative day #4 on replacement glucocorticoids Pathology: Immunohistochemical (IHC) stains for pituitary markers were negative, including Pit 1, T pit, SF 1, prolactin, human growth hormone, and adrenocorticotrophic hormone. Cytokeratin stains for Cam5.2 and CK7 were positive. Neuroendocrine markers including synaptophysin, chromogranin, and CD56 were also positive. The tumor expressed Sox 10, possibly consistent with history of melanoma; however, other melanoma markers including S 100, Melan A, HMB 45, MITF, and PRAME were negative. Stains for other sites of origin including lung (TTF 1) and gastrointestinal tract (SATB 2 and Pax 8) were either negative or in the nonspecific range. Next generation sequencing revealed pathogenic mutations in PIK3CA, RB1, and TP53, but did not yield any specific alterations to support a site of origin. Post operative Management: Outpatient staging CT scans revealed liver, lungs, hilar and mediastinal lymph nodes metastases; however, no definite primary tumor identified. Chromogranin A was 361 (nl <93). Systemic chemotherapy with carboplatin and etoposide was initiated approximately 6 weeks after surgery and the sella was treated with hypofractionated stereotactic radiotherapy to a total of 30Gy over 5 fractions Patient was stable on repeat MRI of the pituitary after chemo and radiation therapy, however his ophthalmoplegia persisted Patient subsequently refused further treatment, transitioned to hospice care, and died shortly after
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Obstetrics and Gynecology
Design: Retrospective study
Objectives: To determine if race/ethnicity is an independent predictor of adverse outcomes following diagnosis of primary ovarian cancer.
Setting: We utilized data from the Surveillance, Epidemiology, and End Results Program (SEER) database for this study.
Aaron, Sabrina HUCM M4 39
Title: Shifting Outcomes for Cervical Ectopic Pregnancies using Characteristic Transvaginal Ultrasound Findings
Authors: Adebusola Awosanya, Kalaila Pais, Fatou Tine, Siena Simmons, Oluwadamilola Thomas, Bruk Mekonen, Keren Darius, Amari Carter.
Method: We utilized the nearest neighbor propensity score matching without replacement in a 1:1 ratio to compare mortality and overall survival following primary ovarian cancer diagnosis between Non Hispanic Black (NHB) women and a control group of Non Hispanic White (NHW) women. These women were matched for age, treatment modalities (surgery/irradiation/chemotherapy), laterality, and stage of cancer at presentation
Population: We studied women with a primary diagnosis of Ovarian Cancer in the SEER database between January 1998 and December 2018.
Title: Shifting Outcomes for Cervical Ectopic Pregnancies using Characteristic Transvaginal Ultrasound Findings
Authors: Adebusola Awosanya, Kalaila Pais, Fatou Tine, Siena Simmons, Oluwadamilola Thomas, Bruk Mekonen, Keren Darius, Amari Carter
Background: Complications from ectopic pregnancies are the leading cause in mortality in women of reproductive age. Although cervical ectopic pregnancies account for just 1% of all ectopic pregnancies, they are associated with increased rates of morbidity and mortality due to initial misidentification Currently, there is no updated established extensive diagnostic criteria utilizing transvaginal ultrasound for cervical ectopic pregnancies Successful management of cervical ectopic pregnancies and prevention of negative outcomes requires an early and accurate diagnostic criteria
Conclusion: Transvaginal ultrasound diagnostic criteria outlined for cervical ectopic pregnancies and differentiation from other similarly presenting conditions are essential to the preservation of reproductive potential and other favorable outcomes for women of color.
Main Outcomes: The primary outcomes of interest were differences in mortality and survival (in months) among NHB and NHW women Results: We compared 6,801 NHB women with 27, 204 NHW women with primary ovarian cancer Prior to propensity score matching, NHB women had a higher mortality rate (56 7%vs 53 5%, p<0 001) and lower survival rate (40 1 vs 48 9 months<0 001) Following propensity score matching, there was no difference in the mortality rate between the two groups (56 7% vs 55 7% p=0 13) However, NHB women had significantly lower survival rates (40 1vs 49 6 months, p < 0 001)
Methods: A detailed systematic review of the world literature was done to identify characteristic findings on transvaginal ultrasound for cervical ectopic pregnancies as well as conditions that present similarly
Discussion: Literature review indicated that cervical ectopic pregnancies are often initially diagnosed as abortion, early low lying intrauterine pregnancies, and cervical β HCG producing malignancies due to similar clinical and sonographical findings Inclusion and exclusion criteria were developed to strengthen the diagnostic power for cervical ectopic pregnancies in comparison to other differential diagnoses This information was used to develop a diagnostic clinical flow chart to assist physicians in all settings Subsequently, a particular case at Howard University Hospital of a 37 year old G4P1021(G4P1A2) presenting with a cervical ectopic pregnancy was highlighted and used to demonstrate findings from the literature
Benjamin, Clara HUCM M4
Conclusion: Racial disparities in survival following treatment for ovarian cancer persist despite adjusting for age, stage of cancer, and treatment modalities Further research is warranted to explore patient and systemic factors such as appropriate level of care and follow up after treatment that might account for these differences
Haley, Terinney HUCM M2
Authors: Terinney Haley, MPH; Dr Denise Herd
Title: Low Breastfeeding Rates Among African American Women: Barriers, Facilitators, and Interventions
The American Academy of Pediatrics recommends continuous and exclusive breastfeeding for 6 months post birth, followed by complementary foods coupled with breastmilk for another 6 months African American women are the least likely to initiate breastfeeding and those with the shortest durations of breastfeeding (<6 months, <12 months) across all ethnicities, regardless of socioeconomic status Better understanding the structural and cultural reasons behind the disparity in breastfeeding rates across ethnicities, as well as the idiosyncratic factors impacting African American women, can provide insight to develop theory based interventions to support breastfeeding practices Breastfeeding is shown to protect against short term infections (e g ear infections, diarrhea); combat serious infections and diseases (e g respiratory tract infections, sudden infant death syndrome); and protect against chronic conditions (eg , asthma, obesity)
Breastfeeding offers maternal health benefits including a faster return of reproductive organs to their pre pregnancy state, effective pregnancy spacing, and earlier return to pre pregnancy weight Decreasing this disparity can potentially decrease infant mortality, risk of childhood diseases, and protect against preventable illness
40
The Conceptual Model for Breastfeeding Behavior (CMBB) developed by Lee et al. illustrates how internal and external factors influence breastfeeding intention and initiation through interactions across demographic, socioeconomic, and modifiable external factors. The CMBB explains how nonmodifiable factors of demographics (race/ethnicity and nativity) and socioeconomic factors (education, employment, income, age) interplay with external modifiable factors. Considering the CMBB, the Conceptual Model for African American Breastfeeding (CMAAB) was developed by the author to guide this research in grasping the complex interacting factors associated with the breastfeeding behaviors of African American women by considering additional factors including health systems, structural factors, media portrayal, industry influence, racism, discrimination, and bias. Utilizing the CMAAB, the aim of this research is to explore the complex nature of the breastfeeding disparity, with a focus on variables that contribute to African American infant feeding behaviors Infant feeding decisions for new African American mothers are the result of a complex multitude of cultural, demographic, psychosocial, socioeconomic, and structural factors This study found a multitude of barriers to breastfeeding including returning to school or work, absence of culturally relevant resources (e g information, lactation consultants), a lack of social support, and influence of cultural and socio environmental factors More specifically, experiences of racism, bias, and discrimination from providers have adverse effects on breastfeeding care, support, and outcomes, particularly initiation and duration By incorporating the CMAABB to explain challenges faced by African American women and racial disparities in breastfeeding, operationalizing the model allows practitioners to develop an inclusive understanding of the demographic, socioeconomic factors, cultural context, social environment, maternal behaviors, and interventions that guide breastfeeding behaviors among this unique population Successful breastfeeding interventions involving connected efforts between clinicians, trusted public figures, and community health workers can increase breastfeeding in this population Breastfeeding is a public health concern with significant implications in protecting against chronic health outcomes and addressing health inequities that plague African American communities
Title: NORAD and PEDIATRIC DSRCT Presenter: Whitney Phipps Long non coding RNAs (lncRNAs) present a relatively new yet promising area of research. They have since shown modulatory abilities in gene expression on all levels from chromatin remodelling to epigenetics. Their role in cancer progression, however, remains unknown. The novel lncRNA, Non coding RNA activated by DNA damage (NORAD), may shed an attractive light in the establishment and progression of the rare pediatric Desmoplastic Small Round Cell Tumor (DSRCT). NORAD has been associated with the maintenance of genomic integrity through its interactions with Pumilio proteins, which are known to regulate protein translation. With the application of CRISPR/Cas9, a doxycycline inducible system is created in a modified plasmid This, alongside homologous recombination (HR) directed repair, created a loss of function NORAD model Induction of loss of function of NORAD seemingly results in a senescent state of JN DSRCT cells which not only confirms the role of NORAD in maintaining genomic stability but provides a possible therapeutic avenue in the treatment of DSRCT With this finding new insight and queries arise in the role of NORAD and its relationship with DSRCT
HUCM M3 Oncology 41
Phipps, Whitney
Methods: This study was conducted at Howard University (HU) Department of Ophthalmology from November 25, 2020 to December 21, 2020 and was approved by the HU Institutional Review Board. Convenience sampling was used to recruit patients and written informed consent was obtained before enrollment. Each patient completed a reliable visual field test and had infrared reflective images of the optic nerve head within three months of enrollment. The LC was represented by the hyperreflective structure on imaging The anterior and posterior borders of the LC was used to determine Results: 27 eyes, 14 healthy and 13 glaucomatous were analyzed According to the Hodapp Parrish Anderson criteria, 7 eyes had mild glaucoma and 6 eyes were moderate There were statistically significant differences in LCT between the non glaucoma and glaucoma groups (t=3 37, p= 0 0024), between the mild and non glaucoma groups (t=2 55, p=0 19), and between the moderate and non glaucoma groups (t=2 24, p=0 038) There was no significant difference in LCT between the mild and moderate groups (t=0 19, p=0 85)
Title: Disparities in Eye Care Usage Across Self Reported Vision Impairment and Diabetes Status in the United States
Introduction: The lamina cribrosa (LC) is thought to be the main site of pressure related retinal ganglion cell axonal damage in glaucoma. High IOP can distort the LC, even before thinning of the retinal nerve fiber layer is detectable.
HUCM M4
Primary predictor variables included VI and diabetic status Multivariable logistic regression analyses examined associations between eye care utilization and VI, diabetic status, and sociodemographic factors (adjusted for diabetes and VI status, region, age, race, ethnicity, education, poverty income ratio, and insurance status) Results The study included 284,599 adults, majority female (55 2%), White (72 7%), and non Hispanic (84 3%) In fully adjusted regression analysis, as compared to adults without diabetes and VI, adults with either diabetes or VI had 95% and 57% higher odds for eye care usage, respectively, while adults with both diabetes and VI had over 250% higher odds for eye care usage As compared to the total study population, patients with both diabetes and VI faced disparities in educational attainment (24 9% vs 41 5% with some college or less), poverty level (13 3% vs 29 9% under the official federal income poverty level), and presence of insurance (6 5% vs 22 0% without insurance)
Lamina cribrosa thickness (LCT) may be a useful parameter to identify glaucomatous optic nerve changes.
Conclusion Further research is needed to identify social determinants health that may contribute to eye care utilization disparities Reasons for disparities in eye care utilization are multifactorial and are not completely understood These may include a lack of access to eye care and health literacy. Nonetheless, there is an increasing burden to provide annual eye care for more diabetics over time. It is crucial that all diabetics have regular diabetic retinopathy surveillance exams to decrease their likelihood of worsening eye health and progression to vision threatening diabetic retinopathy. Hence, there is a need for eye care systems to train eye care professionals to take care of the diabetic population and narrow the gaps between ethnicity, gender, and different poverty groups. Jessica
HUCM M3 42
Authors: Jessica Brinson, BS, Priyanka Kumar, MD, Jiangxia Wang, MS, Varshini Varadaraj, MD, MPH, Bonnielin K. Swenor, MPH, PhD, Adrienne Scott, MD
Cade,
Ophthalmology
Conclusions: Due to the significant differences in LCT between non glaucomatous patients and those with mild glaucoma, LCT measurements may be an additional indicator to discriminate between healthy and glaucomatous eyes Keale
Title: Disparities in Eye Care Usage Across Self Reported Vision Impairment and Diabetes Status in the United States
Authors: Keale Cade, Rodney Guiseppi, Katrina Chin Loy, Leslie Jones
Introduction Diabetic eye disease remains the most common cause of vision impairment in the working age population. Regular screening for diabetic retinopathy improves visual outcomes. However, disparities in the utilization of eye care services persist amongst socioeconomically disadvantaged Americans and racial/ethnic minorities. Assessment of eye care utilization across sociodemographic populations is critical to inform patient care resource allocation and narrow the gaps between age, ethnicity, gender, and different poverty groups. Herein, we plan to assess differences in eye care usage by sociodemographic factors across patients with visual impairment (VI) and by diabetes status.
Methods Data was collected from the 2010 to 2018 National Health Interview Survey (NHIS) The outcome measure was eye care utilization in the past year
Brinson,
Methods: I conducted a retrospective analysis utilizing Pro Sports Transactions Archive's public database that records information about all NBA injuries Information about all injuries to players in the NBA over more than the last decade was collected (10/3/10 7/17/2021) Instances involving the eye were then extracted from the excel sheet by searching for keywords associated with ocular injuries such as "Eye, Orbit, Cornea, Retina, and Eyelid " Information used in the injury notes for each damage was also used to further stratify the ocular injuries into groups The rates at which key terms were used were calculated
Conclusion: The study concluded that eye injuries make up 0.57% of all injuries recorded, significantly less than some musculoskeletal injuries (ex: to the knee, ankle, and back). Among the key terms searched, injuries to the Orbit made up the highest percentage of eye injuries, followed by those to the Cornea, Retina, and Eyelid.
Authors: Harold Dorsey, Kalaila Pais.
Pais, Kalaila HUCM M4 43
Results: A total of 18,556 transactions were included in our final datasheet Eye injuries represented 0 57% of all injuries recorded (mentioned 106 times). The frequencies of the keywords were as follows: Eye = 0.42% (78 mentions), Orbit = 0.129% (24 mentions), Cornea = 0.0377% (3 mentions), Retina = 0.016% (3 mentions), Eyelid = 0.011% (2 mentions).
Introduction: Sports are a common way by which eye injuries occur After baseball and softball, basketball is the sport most likely to lead to eye injuries Information about eye injuries experienced at the highest level of basketball, the National Basketball Association, has been documented in the literature, but not over numerous years This study aims to assess the frequency of different eye injuries in the National Basketball Association (NBA) over eleven years The results will add to the known trauma statistics in Ophthalmology by adding injury frequency data specific to the sport of basketball
Title: Ocular Trauma in the National Basketball Association
Title: Thyroid Eye Disease with Divergence Insufficiency Causing Recurrent Falls in the Elderly
Discussion: In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered in all individuals with repeated negative workup to prevent further testing or procedures Thyroid ophthalmopathy is a sequela of thyroid diseases and can affect all extraocular muscles (EOM) in varying degrees The pathophysiology of TED is from the increased size of the EOMs and retroocular connective tissue from increased fibroblast proliferation, an inflammatory response, and deposition of glycosaminoglycans Screening should consist of the assessment of EOMs in the office, forced duction test to assess the direction of restriction, orbital imaging (CT or MRI scan) to assess enlargement of EOM, thyroid function test, and autoimmune markers (thyroid stimulating immunoglobulin, thyroglobulin antibody, and thyroid peroxidase antibody) Thyroid ophthalmopathy can typically be managed with thyroid dysfunction therapy, corticosteroid therapy, ocular occlusion for diplopia, surgery, radiotherapy, or immunotherapy
Nguyen, Nguyen HUCM M4 44
Introduction: Recurrent falls are a common cause of morbidity in the elderly population, as more than one third of individuals aged 65 or older fall each year A higher mortality rate following a fall is associated with advanced age among both sexes and all racial and ethnic groups The crucial consequences of falls include fear of ambulating and falling; decreased mobility; and serious, at times fatal, injuries Fractures are the most common injuries that require hospitalization; among elderly men include fractures of the hip, ribs, spine, humerus, and pelvis, while elderly women include fractures of the hip, humerus, wrist, pelvis, and ankle In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication induced, cognitive impairment, and so on Case Report: An 84 year old female with a past medical history of hypertension, hyperthyroidism, asthma, and type 2 diabetes mellitus presented to the ED with dizziness and an episode of syncope witnessed by EMS. In addition, she has a history of recurrent falls in the recent year and was repeatedly found to have unremarkable lab results and negative imaging studies. Further history was obtained, revealing that the patient had received fresnel prism lenses a year ago and when wearing them, her diplopia resolves. However, the patient reports having many pairs of glasses and sometimes forgets which ones are “for the double vision.” She was not wearing her fresnel prism lenses during this admission. She was noted to present with slight lagophthalmos with eyelid retraction and no signs of exophthalmos in both eyes on physical exam. A comprehensive eye exam was performed in the ophthalmology clinic, which confirmed a diagnosis of divergence insufficiency with intermittent esotropia and thyroid ophthalmopathy, which was determined to be the cause of her underlying horizontal diplopia contributing to her falls. This can cause blurry vision at further distances seen especially in individuals older than 50 years Treatment is typically achieved with prism therapy, surgery in refractory patients, and now novel therapy using teprotumumab infusion The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention
Authors: Nguyen Sy Nguyen, Wei Chen Lai, Azam Husain, Sachin Rajpal, Miriam Michael
Title: A Rare Case of Transverse Myelitis with Lyme Disease: A Case Report
Conclusions: Acute Transverse Myelitis often has varying presentations, but typically has devastating effects on the body due to neurologic involvement While infectious causes represent less than 12% of cases of ATM, it is essential to identify because therapy may prove to be successful The diagnostic work up of ATM first requires an emergent MRI cord to exclude acute cord compression Further investigation will entail contrast enhanced MRI of cord and brain, serum and CSF analysis However, Lyme disease is not always identifiable with CSF collection from lumbar puncture, so the etiology of ATM may go unknown, and ultimately result in inadequate or no treatment Due to the patient’s serologies being positive for Lyme antibodies, adequate antibiotic treatment was given to resolve the condition Further research is encouraged to understand underlying risk factors and complications that may lead to Lyme disease induced ATM
Burgess, Regan
Introduction: Acute transverse myelitis (ATM) is an inflammatory disease of the spinal cord, characterized by rapid onset of bilateral neurological symptoms The inflammation of the spinal cord often leads to demyelination, which presents as muscle weakness, paralysis, autonomic dysfunction, and pain Recovery is variable, but often prolonged over many months, and can lead to minor or severe deficits Causes of this condition include idiopathic causes, systemic disease, infection with pathogens, and central nervous system disease processes Much less frequently, infection with Borrelia burgdorferi can cause Lyme disease that progresses to ATM, which is indicated in less than five reported cases in the US to date Due to Lyme disease being a very rare cause of ATM, it may prove difficult for clinicians to initially identify Our case study focuses on a 27 year old male with a past medical history of diabetes and hyperlipidemia who presented to the emergency department with a week long history of fever to 102℉, non productive cough, nausea, and decreased motor function and sensation in the bilateral lower extremities
The MRI showed a cervical canal syrinx, multilevel cervical and lumbar spondylosis, a T12 L1 left paracentral disc bulge, and a right L1 L2 neuroforaminal Tarlov cyst. The procedure resulted in the successful decompression of the spinal cord and exiting nerve roots. Serum findings were significant for elevated Lyme disease antibody titer and antibody reaction to borrelial proteins. The remainder of the CSF analysis was unremarkable. The patient was started on antibiotics and received daily pregabalin for neurogenic hand pain. Prior to discharge, motor function was continually improving with the aid of physical therapy Sensation significantly improved but remained diminished from level T12 through the bilateral feet, at the time of hospital transfer
HUCM M4 Orthopaedic Surgery 45
Case Report: We obtained an MRI of the cervical, thoracic, and lumbar spine with and without contrast, and the findings were consistent with spinal nerve compression with indications for surgical intervention. Subsequently, posterior cervical decompressive laminectomy at levels C4 C7 and posterior thoracic decompressive laminectomy at level T1 were performed; a lumbar puncture for CSF analysis was also performed in the operating room.
Authors: Latrice Johnson BS, Sabrina Aaron, Regan Burgess BS, Rolanda Willacy MD, Damirez Fossett MD
Title: Advances in Virtual Cutting Guides and Stereotactic Navigation for Complex Tumor Resections of the Sacrum and Pelvis: Case Series and Review of Literature
Authors: Garcia Findlay, Akinyemi Oluwasegun, MD
Authors: Garvin Lawrence II BSA, Takashi Hirase MD, MPH, Grant R McChesney MD, Robert Satcher MD, PhD, Alexander F Mericli MD, Laurence D Rhines MD, Justin E Bird MD
Findlay, Garcia HUCM M3
Introduction: Primary malignancies of the sacrum and pelvis are aggressive in nature and their complex anatomy increases difficulty in obtaining a negative margin to optimize postoperative prognosis This paper aims to describe an accurate and reliable alternate technique, using a combination of computer assisted design and virtual cutting guides to perform en bloc resections and safely achieve desired margins In this technique, preoperative CT scans are used to create a cutting guide that is superimposed on an intraoperative CT and allows the computer assisted navigation system to more accurately guide the surgeon’s osteotomes while also showing their real time trajectory
Introduction: Recurrent falls are a common cause of morbidity in the elderly population, as more than one third of individuals aged 65 or older fall each year A higher mortality rate following a fall is associated with advanced age among both sexes and all racial and ethnic groups The crucial consequences of falls include fear of ambulating and falling; decreased mobility; and serious, at times fatal, injuries Fractures are the most common injuries that require hospitalization; among elderly men include fractures of the hip, ribs, spine, humerus, and pelvis, while elderly women include fractures of the hip, humerus, wrist, pelvis, and ankle In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication induced, cognitive impairment, and so on.
Results: Negative margins were achieved in all patients with no intraoperative complications. There were no cases of 30 day readmissions, reoperations, 1 year mortality, or tumor recurrence at final follow up. One patient was complicated by flap necrosis, which was successfully treated with debridement and primary closure.
Garvin, Lawrence, II HUCM M3 46
Case Report: An 84 year old female with a past medical history of hypertension, hyperthyroidism, asthma, and type 2 diabetes mellitus presented to the ED with dizziness and an episode of syncope witnessed by EMS. In addition, she has a history of recurrent falls in the recent year and was repeatedly found to have unremarkable lab results and negative imaging studies. Further history was obtained, revealing that the patient had received fresnel prism lenses a year ago and when wearing them, her diplopia resolves. However, the patient reports having many pairs of glasses and sometimes forgets which ones are “for the double vision.” She was not wearing her fresnel prism lenses during this admission. She was noted to present with slight lagophthalmos with eyelid retraction and no signs of exophthalmos in both eyes on physical exam A comprehensive eye exam was performed in the ophthalmology clinic, which confirmed a diagnosis of divergence insufficiency with intermittent esotropia and thyroid ophthalmopathy, which was determined to be the cause of her underlying horizontal diplopia contributing to her falls This can cause blurry vision at further distances seen especially in individuals older than 50 years Treatment is typically achieved with prism therapy, surgery in refractory patients, and now novel therapy using teprotumumab infusion The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention
Title: Influence of Medicare on Outcomes of Hip Replacement Surgery among American Women
Discussion: In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered in all individuals with repeated negative workup to prevent further testing or procedures Thyroid ophthalmopathy is a sequela of thyroid diseases and can affect all extraocular muscles (EOM) in varying degrees The pathophysiology of TED is from the increased size of the EOMs and retroocular connective tissue from increased fibroblast proliferation, an inflammatory response, and deposition of glycosaminoglycans Screening should consist of the assessment of EOMs in the office, forced duction test to assess the direction of restriction, orbital imaging (CT or MRI scan) to assess enlargement of EOM, thyroid function test, and autoimmune markers (thyroid stimulating immunoglobulin, thyroglobulin antibody, and thyroid peroxidase antibody). Thyroid ophthalmopathy can typically be managed with thyroid dysfunction therapy, corticosteroid therapy, ocular occlusion for diplopia, surgery, radiotherapy, or immunotherapy.
Methods: A retrospective analysis was performed reviewing a single institution’s medical records between 2017 2019 6 patients that underwent resection using this technique with a minimum 12 month follow up were identified and included Two patients had primary osteosarcoma and four had primary chondrosarcoma involving the pelvis and/or sacrum
Conclusion: Although previous studies report the value of CAD and image guided navigation, to our knowledge, no prior studies have reported the successful use of merging the two techniques. Short term data suggests that using virtual cutting guides for navigated osteotomies is a safe technique that can reliably obtain negative margins in complex tumor resections of the sacrum and pelvis.
Authors: Darryl Hill, Nicholas Danford MD, Wakenda Tyler MD MPH, William Levine MD FAOA, Letitia Bradford, MD
Title: Quality Improvement Initiative: Reducing Surgical Site Infections in Medical Facility: Educational Module on Standardized Gowning Technique
Results: In the process of making educational models to help students and staff have a standardized way of donning personal protective equipment in the operating room to produce better outcomes. The residency programs and the medical students will receive a lecture on surgical safety methods. We will have a survey at the end of the lecture to evaluate the participants' understanding of the module. This project is in its preliminary phase and will be an ongoing initiative.
Objective: Our goal was to determine the prevalence of publication bias in orthopedic trauma literature. We hypothesize that the majority of orthopedic trauma literature shows a bias towards positive findings.
Conclusion: Even with the implementation of clinicaltrials gov, publication bias is still a major concern in orthopedic trauma literature Major discrepancies persist between reports to clinicaltrials gov and final publication Studies have shown that 22% of clinical trials were registered after the study was completed and that 49% had a discrepancy between registered outcomes and published outcomes Also, only 3% of clinical trials are properly registered and 44% that named a primary outcome measure in registry changed this parameter in final publication This is leading to a relatively new bias referred to as selective outcome reporting bias
Authors: Ashlynn Gunderson, Latrice Johnson, Rolanda Willacy, MD, Robert Wilson, MD
The purpose of a surgical gown is to reduce the transfer of microbes on the skin of the healthcare worker introduced into the surgical site thereby decreasing the number of surgical site infections Gowns also serve the purpose of protecting healthcare workers from bloodborne pathogens, such as HIV or Hepatitis C, from being transferred from patient to the surgical team Although governing bodies, for example the Association of periOperative Registered Nurses, suggest the use of sterile technique to properly gown and glove prior to a procedure, there isn’t any current data that definitively states the use of gowns and gloves reduce the incidence of surgical site infections
M3
Methods: We conducted an extensive literature review of publication bias in orthopedic surgery by using the PubMed database. Afterwards, we completed a systematic review of all completed orthopedic trauma trials between January 1, 2000 June 14, 2019, on clinicaltrials.gov by using the advanced search term function where we entered the information that met our inclusion criteria
Introduction: Surgical gowns are used throughout health care systems around the globe as personal protective equipment
Conclusion: Quality improvement initiatives aid in improving the quality of health care provided. Providing resources and standardized guidelines for the residents and medical students at the institution will have an overall impact on the community in which they serve.
Methods: A literature review will be conducted to evaluate the standard of surgical gowning and gloving in the operating room A video including a step by step process on how to perform a surgical aseptic hand wash; donning a surgical gown alone or with assistance from the surgical technologist; donning sterile gloves using the closed gloved technique, the open glove technique, or with help from the surgical technologist; deciding the best option for eye protection This video will be viewed by both residents and medical students at the institution, and a curriculum will be created as well
Results: Our search criteria revealed 340 published studies on clinicaltrials gov 111 clinical trials fit our inclusion criteria and we have found that 16% were not randomized, 58% had no blinding, 65% did not post results on clinicaltrials gov, with 92% of studies leading to publication did not post their results
Hill, Darryl HUCM M3 47
Gunderson, Ashlynn HUCM
Title: Quality Improvement Initiative: Reducing Surgical Site Infections in Medical Facility: Educational Module on Standardized Gowning Technique
Introduction: Publication bias is a type of bias that occurs in published academic research where the outcome of the study influences if the research study is published This practice leads to most data published in scientific journals showing positive and significant results whereas studies with non significant results are usually unsubmitted for publication In the event where negative results are submitted, it is very likely for them to be rejected It is also common for primary outcome measures to be changed during an experiment Many surgical techniques and procedures are developed based on information that is presented in these journals. The presence of publication bias in the literature threatens to overrepresent positive findings in systematic reviews while leaving out possible clinically beneficial practices from being considered. To help address this problem, the FDAAA requires that all clinical trials be registered on clinicaltrials.gov as of 2007.
Title: Multimedia Interventions and Home Exercise Program Influence on Musculoskeletal Health Following COVID-19 Quarantine
Authors: Myles Moore, Guillermo Ramirez, Kevin J Orellano, Paul Trevino, Erick Santos MD, PhD
Introduction: Movement is Life (MIL) strives to combat musculoskeletal pain, mental downtrends, and overall health decline by encouraging early interventions A previous study indicated no correlation between MIL multimedia education material (MEM) and lower extremity pain as well as home exercise programs (HEP) while the COVID 19 pandemic forced mandatory quarantine restrictions The effects of the COVID 19 pandemic have lingered and become a source of negative trends in the overall health of Americans by fostering a sedentary lifestyle while ill as well as during quarantine
This study intends to build upon previous studies by evaluating data from short term effects of this combined approach after the mandatory COVID 19 quarantine period compared to a study during the quarantine period Results showed there were small scale improvements in pain reporting at the 2 week follow up, however, preliminary data has suggested lingering lifestyle changes from quarantine may alter the effectiveness of these approaches These findings indicate that although the quarantine period is over, many people have continued habits of a sedentary lifestyle learned during the quarantine These habits further contribute to a negative effect on well being Methods: Patients were recruited with lower extremity pain including hip pain, knee pain, and ankle pain at Rio Health Medical Center. Exclusion criteria included age less than 18 years and history of prior lower extremity surgery within the past year with exception of diagnostic knee arthroscopy. Patients were given consent forms and a baseline survey (in English and Spanish upon request) that included basic demographic information along with a series of questions. The specific questions asked patients to rate their overall health, pain level, emotional wellbeing, social activity, eating habits, and desire to improve their health with variables on a scale from 1 10 (1 being poor, 10 being good). Participants were given links to the MIL brochure, a link to the MIL homepage, and at home exercises specific to their injury provided by Sports Medicine Patient Advisor. Participants then had 4 follow up surveys each week to compare with their initial responses. These follow up surveys had three additional questions to inquire about the effects that remained after the mandatory COVID 19 quarantine including physical health since mandatory quarantine restrictions were lifted, emotional health since mandatory quarantine restrictions were lifted, and employment status
Results and Conclusion: There were reported mean improvements in all categories except emotional well being within a two week span, however the improvements were not statistically significant We predict that the 4 week data will provide more statistically significant data to suggest MEM and HEP can improved health outcomes Additionally, our preliminary data that asked about patient physical and emotional well being since quarantine ended showed an average score of 5 0526 and 5 3157 respectively This data indicates that many people feel physically and emotionally the same or worse although there were small scale improvements in pain reporting at the 2 week follow up These findings suggest that the COVID 19 quarantine will have lingering effects on the patient's physical and mental health, and physicians should be aware of these changes as they navigate treatment options in the future
Moore, Myles HUCM M2 48
Authors: Nguyen Nguyen BS, Sanjum Singh BA, Harold Dorsey BS, Kalaila Pais BS, Andrew Boone MD, Robert Wilson MD, Harpal Khanuja MD
The main outcome Measures were the rates of the most injured body parts of NBA players
Results: 81 Presidents were identified across the three organizations The top 15 nationally ranked residency programs trained 32 3% of AAOS presidents, 34 6% of all AOA presidents, and 42 1% of all ABOS presidents The top three residency programs were University of Rochester (6 25%), University of Iowa(6 25%), and Harvard University (6 25%)
Conclusion: Presidents of premier national organizations in orthopaedic surgery possess unparalleled levels of scholarly output as measured by the h index. Women and racial minorities remain under represented at the highest levels of leadership. This study creates a benchmark to make future appointments in an equitable manner.
Across all three organizations, presidents were mostly male, Caucasian, and did not have an additional graduate degree. In regards to fellowship training, most presidents did not have formal fellowship training. Most presidents were affiliated with an academic institution at the time of their appointment to presidency. Most AAOS and AOA presidents had an h index of 46+ (31.3%, 39.3% respectively), whereas most ABOS presidents had an h index of 15 30 (38.1%). 19 presidents across all three organizations had funding from the National Institutes of Health (23.4%).
Methods: The AAOS, ABOS, and AOA provided names of elected Presidents Curriculum vitae were reviewed to collect demographics, training characteristics, bibliometrics, and federal research funding of contemporary Presidents (1990 2020) The online Doximity Residency Navigator service was utilized as a reference for national rankings of orthopaedic programs by reputation
Title: Demographics and Academic Backgrounds of Leadership in National Orthopaedic Associations: Examining the Presence of Racial and Gender Bias in Selection
HUCM M4
Results: We compared 789 players during the post suspension to 3,945 match controlled pre suspension players The mean age of players was 27 1± 5 years, mean BMI was 25 0± 1 2 The eight most common injuries were knee, ankle, back, hamstring, shoulder, calf, groin, and elbow injuries Prior to propensity score matching, the rates of the three most common were: knee (pre suspension: 33 79%; postsuspension: 36 88%), ankle (pre: 27 28%; post: 26 62%), back ( rpre: 18 52%, post: 14 45%) (p value: 0 022) Following propensity score matching, the results are as follows: knee (pre suspension: 29.89%; post suspension: 36.88%), ankle (pre: 27.10%; post: 26.62%), back (pre: 19.06%, post: 14.45%) (p value: <0.001).
Nguyen, Nguyen
Methods: This was a retrospective analysis of all National Basketball Association players that experienced an injury between 10/3/10 7/17/2021 The independent variables of the study were the injury date in respect to the NBA suspension COVID 19 suspension date 3/11/2020 (before vs after), BMI, age, region of basketball play, position played
Title: The Impact of the COVID-19 Lockdown on the Rate of Injuries in the National Basketball Association
Singh, Sanjum
Background: Benchmarks on the qualifications needed to achieve national leadership positions in academic orthopaedic surgery are lacking This study analyzes the academic accomplishments of elected Presidents of the American Academy of Orthopaedic Surgeons (AAOS), American Board of Orthopaedic Surgeons (ABOS), and American Orthopaedic Association (AOA)
Conclusion: Our study concluded that among the three most common injuries, the knee was noted to have a statistically significant increase post the COVID 19 NBA suspension. Moreover, there was a significant decrease in the percentage of players who suffered back and ankle injuries.
HUCM M4 49
Objective: This study aims to assess the impact of the COVID 19 lockdown on injury rates experienced by athletes of the National Basketball Association (NBA) We hypothesized that there would be a change in the incidence rates of sports related injuries on return to play post lockdown
Authors: Sanjum Singh, BA; Jason Silvestre, MD; Charles L Nelson, MD; James D Kang, MD
Purpose: To evaluate the incidence and impact of concussion injuries occurring in the WNBA Study Design: Descriptive epidemiology study
50
Methods: Publicly available records were searched to identify all documented basketball related concussions from WNBA seasons 1997 to 2020 Player demographics, injury details, and basketball career information were collected
Results: A total of 70 concussions among 55 players were reported in the WNBA from 1997 to 2020, with a mean incidence of 2.98 ± 2.3 concussions per season. Following the implementation of the WNBACP, incidence significantly increased from 1.7 to 5.0 concussions per season (P < .001). All players RTP following a first time concussion after missing a mean of 3.8 ± 4.7 games and 17.9 ± 20.7 days. After the adoption of the WNBACP, time to RTP significantly increased with games missed (P = .006) and days missed (P = .006). MPG and GS per minute were not significantly affected by sustaining a concussion (P = .451, P = .826, respectively).
Conclusions: Since the adoption of the WNBA concussion protocol in the 2012 season, incidence of concussions rose to approximately 5 instances per season. Athletes retained a high rate of RTP after missing 3 to 4 games. Player game availability and performance within the same season were not significantly affected by concussion injuries following successful RTP Walker, Jasmine HUCM M3
Title: Concussions in the Women’s National Basketball Association: Analysis of Incidence, Return-to-Play Timing, and Player Performance From 1997 to 2020
Concussion incidence and return to play (RTP) timing were evaluated before and after the institution of the WNBA concussion protocol in 2012 Minutes per game and game score per minute were compared 5 games before and 5 games after the concussion was sustained Player game availability and RTP performance were also compared with an age , body mass index , position , and experience matched control group of players who did not sustain any injuries during the index season.
Authors: Jasmine Walker, BBA, Erick M Marigi, MD, Malik Dancy, MD, Kelechi R Okoroha, MD, F Daniel Kharrazi, MD, and Nima Mehrank MD
Methods: In this study, the demographic information of orthopaedic surgeons who received significant payments in 2019 from Zimmer Biomet, Stryker, DePuy Synthes, and Smith & Nephew was collected via openpaymentsdata cms gov Payments of $30,000 or more were deemed significant to provide a sufficient sample size of at least 100 surgeons for each of the four companies The names, specialties, and locations of each payment recipient were obtained from Open Payments database (OPD) The demographic information of each recipient was determined by personal biographies and profile pictures on the public healthcare information websites Doximity, ZocDoc, WebMD, Vitals, and US News Health Additional resources were used to verify the race and family origin of recipients via ancestry com, forebear io, and fluency of languages spoken in their surname’s country of origin Each orthopaedic surgeon was described as Caucasian, Black, Asian, Hispanic, or Middle Eastern as well as male or female
Results: Analysis of the data confirms our hypothesis: gender and URM groups are underrepresented in participation with the orthopaedic implant industry when compared to their proportions in the orthopaedic workforce African Americans, Hispanic Americans, and Native Americans account for about one third of the United States’ population but only 4 5% of orthopaedic surgeons African Americans represent 1 04% (7/674) of payment recipients in 2019 while Hispanic Americans represent 1 48% (10/674) and Native Americans were not represented at all, totaling 2 52% (17/674) of payment recipients Women only accounted for 0 59% (4/674) of payment recipients The data also shows a noticeable trend in which participants become less diverse as the payment amount increases.
Conclusion: As the practice of orthopaedic surgery moves towards becoming more diverse among race and gender groups, the orthopaedic implant industry continues to lag behind. The data shows that the orthopaedic implant industry and its participants do not adequately represent all genders and minority racial groups. Trends in the data show that the top earners of the four major orthopaedic implant companies are nearly exclusively white males and there is slightly more diverse representation in lower payment groups, underlining the lack of equity within the industry.
Willard, Jonathan Research Year 51
Title: Industry Participation Trends for Orthopaedic Surgeons: How Equitable is it?
Authors: Jonathan G Willard, Letitia Bradford, MD, FAAOS, FACS, Julius K Oni, MD, FAAOS
Background: The multi billion dollar companies that produce orthopaedic implants provide medical professionals with the necessary tools for joint, trauma, spine and other orthopaedic surgeries that ultimately allow patients to return to everyday activities with less pain and more mobility. The implant industry requires the developmental skills of engineers, the business expertise of entrepreneurs and patent attorneys, and the creativity and innovation of the orthopaedic surgeons who use these tools daily in their continuous efforts to improve the field of orthopaedics. This study examines orthopaedic implant industry participation trends among practicing orthopaedic surgeons. We hypothesize that there will be an underrepresentation of gender and underrepresented minority (URM) groups in participation with the orthopaedic implant industry when compared to their proportions in the orthopaedic workforce.
Authors: Kamilah Fernandez, MD; Laraine Cheung, MD Candidate 2024; Lekidelu Taddesse Heath, MD
Introduction: Uterine fibroids or leiomyomas are benign smooth muscle neoplasms that occur in 70% of premenopausal women, most commonly in women of African descent Cotyledonoid dissecting leiomyoma is a rare subtype of leiomyomas whose gross appearance can cause concern for malignancy
Pathology Title: Cotyledenoid Dissecting Leiomyoma in an African American Woman: A Case Report
Case Report: We report a case of a cotyledonoid dissecting leiomyoma in a 34 year old African American woman with a history of symptomatic uterine fibroids and a history of anemia secondary to menorrhagia A diffusely enlarged heterogeneous uterus with a large fibroid and cervical mass was found by transabdominal and transvaginal ultrasonography The patient underwent a total abdominal hysterectomy with bilateral salpingectomy Grossly, the uterus was irregular in appearance with multiple firm or soft/cystic nodules protruding into the serosa The myometrium had intramural nodules that were lobulated and separated by deep septation and grooves resembling the cotyledons of the placenta. The cut surface of some of the nodules revealed the typical solid, grayish white, homogenous, whorled appearance. Microscopically, nodules composed of cellular, proliferation of uniform smooth muscles arranged in interlacing fascicles and areas of edema and cystic changes (perinodular hydropic degeneration). In some areas, the proliferating smooth muscle fascicles had infiltrative growth patterns dissecting through the myometrium.
Discussion: Only a few cases of cotyledonoid dissecting leiomyoma have been reported so far in the literature. The present case describes similar gross and microscopic findings of this subtype of leiomyoma with multiple, intramural septated nodules resembling cotyledons, having exophytic component in continuity with the intramural component and microscopy showing nodules of smooth muscle tumor cells arranged in interlacing fascicles, focally dissecting through the myometrium with areas of edema and perinodular degeneration Clinicians and pathologists should be aware of its existence to avoid misdiagnosis and extensive patient treatment
Cheung, Laraine HUCM M3 52
Introduction: Apraxic agraphia is a writing disorder due to loss or lack of access to motor engrams that program the movements necessary to produce letters Engrams are hypothetical permanent changes in the brain accounting for the existence of memory; a memory trace In individuals that undergo strokes, these changes in engrams may manifest as visible disturbances in writing
Title: Unique Presentation of Apraxic Agraphia Following Left Anterior Cerebral Artery and Pontine Ischemic Stroke: A Case Report
Case Report: 61 year old left handed male presented to the emergency department with bilateral lower extremity weakness Imaging revealed acute left anterior cerebral artery and pontine infarcts Patient was not a candidate for tissue plasminogen activator therapy or thrombectomy Following acute care hospitalization, patient was recommended for acute inpatient rehabilitation On presentation he was found to have a mild cognitive communication impairment Patient had intact reading and oral spelling, however when prompted to write the same words to dictation, he had legible writing but notable difficulty with letter formation Errors were characterized by letter substitution and production of numbers in place of letters. For example, when asked to write “pencil”, he wrote “91E01”; for “hammer”, he wrote “HAMM18”; and for “house”, he wrote “H0101”. Patient expressed good awareness of his errors and continued daily speech therapy to address communication deficits.
Discussion: It is not uncommon for patients with cerebrovascular accidents to have motor deficits manifesting as apraxic agraphia. However, this is a unique presentation characterized by legible writing, with errors of substituting numbers in place of letters. There is currently no consensus on which region of the brain when lesioned, can cause apraxic agraphia. Further research is needed to elucidate the mechanism of disease in apraxic agraphia.
Adedolapo, Temitope HUCM M4 Physiatry 53
Authors: Temitope Adedolapo Fasusi, MBA, Dain T Thorpe, MD, Rachna Malhotra DO
Introduction: Listeria Rhombencephalitis (LRE) is a particular form of listerial encephalitis that affects primarily the hindbrain (brainstem and cerebellum) The main etiology of LRE is Listeria monocytogenes, a gram positive, facultative intracellular bacillus The trigeminal nerve is proposed as a pathway through which Listeria monocytogenes reaches the brainstem after entering damaged oropharyngeal mucosa or periodontal tissues LRE is characterized by spectrum of symptoms due to brainstem involvement, such as multiple cranial nerve palsies or cerebellar deficits, nystagmus, vertigo, facial numbness, dysphagia, persistent hiccupping, and respiratory failure
Case Report: A 43 year old male with PMH of prediabetes presented to the acute care hospital with dizziness, headache, fever, malaise, ataxia, and dysarthria for several days. Patient had workup including MRIs of brain and spine, blood work, and lumbar puncture to test for infection. MRI revealed edema in lateral left cerebellum, and subtle enhancement in posterior fossa, cervical spinal cord, and conus medullaris. Lumbar puncture revealed CSF pleocytosis with a lymphocytic predominance (90%), elevated glucose, and elevated protein. Given his clinical presentation along with CSF findings and MRI findings, it was determined that his clinical presentation is most consistent with LRE. The patient and his wife reported that the patient eats salads frequently, and there was a reported ongoing outbreak of Listeria monocytogenes linked to salad kits distributed to stores within the Maryland area. The patient was treated with IV Ampicillin and underwent PICC line placement. He was admitted to acute inpatient rehabilitation with severe autonomic type symptoms from brainstem dysfunction causing persistent fevers and tachycardia Through an intensive inpatient rehabilitation course, the patient made functional gains, achieving supervision to modified independence for all activities of daily living and mobility and was able to be safely discharged home
Emeh, Robert HUCM M3 54
Title: The Role of Rehabilitative Treatment in Reducing Severity of Listeria Rhomboecephalitis (LRE)
Discussion: LRE is an uncommon encephalitis of the brainstem and cerebellum typically seen in the elderly, resulting in significant morbidity and mortality However, LRE is found in persons who were formerly in good health, and recognizing this disease, particularly at its early stages, is challenging LRE is often misdiagnosed initially due to a nonspecific prodrome (fever, headache, nausea and vomiting) and unusual meningeal signs In general, penicillin, ampicillin, and amoxicillin are effective treatments for LRE, but some strains are resistant An intensive inpatient rehabilitation course has been shown to improve functional & neurological outcomes of LRE Rehab supportive care includes breathing assistance, IV fluids, anti inflammatory drugs, and anticonvulsant medications Therapy includes physical, occupational, speech, and psychotherapy Early recognition and correct diagnosis, as well as the timely use of appropriate antibiotics and rehabilitative treatment, can reduce the severity of LRE This case demonstrates the importance of thorough evaluation and broad differential diagnosis for treating encephalitis Along with a thorough evaluation of a patient with encephalitis, it is important to include Listeria monocytogenes infection in the differential diagnosis, which can help lead to early, accurate diagnosis and a better outcome. In addition, the case highlights the value of utilizing acute inpatient rehabilitation to sustain hemodynamic stability and ultimately improve the patient’s clinical, neurological and functional condition.
Authors: Robert Emeh, Dain Thorpe, MD
Authors: Yasmine Griffiths, MPH, Geetanjali Chander, MD, MPH
Psychiatry Title: Factors Associated with Alcohol Use Disorder among Women attending an STI Clinic
Griffith, Yasmine HUCM M2
Title: Urban Stress and Sleep Health by Proximal Neighborhood Groups in Washington, D.C.
Authors: Alexis Jacskson, Osayi Ize Iyamu
There is strong evidence to support that African Americans are disproportionately affected by environmental factors leading to an increased risk of negative health consequences Data from the National Health Interview Survey (NHIS) collected between 1989 and 1994 found 15 to 75 percent of the disparities between Black and White respondents to be accounted for by residential context The NHIS cited environmental exposures (e g toxins), built environment (e g availability of safe recreational facilities), and social conditions (e g exposure to neighborhood violence and drugs) as factors that greatly impact health Sleep health is a complex unique system that incorporates genetic, social, and environmental components essential for optimal health. Poor sleep health is linked to adverse outcomes in metabolic and cardiovascular health and is an important pathway by which stressful/threatening neighborhood characteristics influence health. A population study indicated that sleep durations of less than 6 hours were more common among African Americans compared with other racial/ethnic groups in the United States, and this association was partially explained by African Americans more often living in high density urban environments. The aim of our study is to determine how violent crime and community stress relates to residential sleep health of various proximal neighborhood groups in Washington DC. We collected the addresses and actigraphy data from participants in the Sleep Health Urban Stress Study at Howard University then compared their sleep health measures to geographic violent crime rates as determined but the DC DOH’s Health Equity Report. We found that there were no significant correlations between the geospatial analysis and sleep health however there is a significant correlation between CSI and sleep health Alexus
HUCM M2 55
Results: The mean age of our sample was 34.6 (SD: 11.7). Women with AUD had a higher prevalence of PTSD (44% vs 21%), GAD (26% vs 12%), MDD (34% vs 13%) compared to women without AUD (p <0 05) Of women with AUD, 42% used two or more drugs, compared to 21% of those without Using the KOSS SES, 74 50% of women with AUD reported an unwanted sexual experience, compared to 46 10% of women without AUD Using multivariable analysis, controlling for age and education, women using 2 or more drugs were 2 4 (95% CI 1 3 4 3) times more likely to have an AUD compared to those with no drug use, women with 2 comorbid mental health disorders were 3 9 (95% CI 2 0 7 3) times more likely, women with 3 comorbid mental health disorders are 3 74 (95% CI 2 0 7 0) times more likely to have an AUD compared to women with no symptoms, and women who have experienced rape were 2 8 (95% CI 1 6 4 9) times more likely to have an AUD compared to women with no adverse experiences
Method: This study used baseline data from a clinical trial testing an alcohol reduction intervention among 439 women attending two urban STI clinics in Baltimore, MD AUD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) Mini International Neuropsychiatric Interview (MINI) We classified women with abuse or dependence as having an AUD. We used the NIDA ASSIST to assess use of marijuana, heroin, cocaine, or pills not prescribed by a doctor such as Xanax, Valium, oxycodone, Percocet over the past 6 months. We examined each drug individually and created a count variable to examine polysubstance use. We assessed post traumatic stress disorder symptoms (PTSD) using the Primary Care PTSD, general anxiety disorder (GAD) symptoms using the GAD 7, and major depressive symptoms (MDD) using the Patient Health Questionnaire (PHQ 9). We examined mental health comorbidities separately, then created a count variable to examine the number of comorbidities. We examined unwanted sexual experiences using the KOSS Sexual Experiences Survey (SES). We used Chi squared tests and multivariable logistic regression to examine factors associated with having an AUD.
Conclusion: In this sample, women with AUD are significantly more likely to experience symptoms of PTSD, GAD, and MDD and to use 2 or more drugs More women with AUD have suffered from more unwanted sexual experiences than those without AUD Although this population is unique in their increased susceptibility to AUD, studying their comorbidities will allow knowledge to develop upstream interventions addressing multiple comorbid factors Optimizing care for women with AUD requires assessment of multiple other co occurring conditions, including mental health, substance use disorders, and adverse experiences.
Jackson,
Background: Among women with unhealthy alcohol use attending an urban STI clinic, we have found a high level of severity, with 67 9% of 439 classified as having an alcohol use disorder (AUD) The objective of this study is to characterize sociodemographic, substance use, and mental health factors associated with AUD among women attending an urban STI clinic in order to effectively intervene
Title: The Impact of Covid 19 Related Experiences on Sleep Health in Young African American Adults
Authors: Nkemdilim C. Ndubuizu, BS, Travan L. Hurst, BS, Thomas A. Mellman, MD Much attention has been given to stress related symptoms including insomnia related to the COVID 19 pandemic. Exposure to racially targeted police violence and the disproportionate impact of COVID on their communities have been particularly salient stressors for African Americans. Aims for this presentation are to illuminate the emotional impact of COVID and racism on young adult African Americans and their relationship to sleep problems. An online survey was sent to participants in an ongoing study focusing on sleep and health along with new participants recruited through a snowball method The survey included the Insomnia Severity Index (ISI), Impact of Event scale (IES), as well as items to assess experiences with COVID, exposure to racially targeted violence, and disparate community impact Our preliminary data includes respondents who are African American and age 18 35 45% endorsed worsening sleep during the pandemic 25% had ISI scores of probable insomnia and 61% had IES scores above the threshold of concern Racism related distress was endorsed at higher levels than worries related to COVID There was a significant relationship of insomnia severity with the number of COVID related stressors and a trend level relationship with COVID worries Sleep outcomes were not correlated with racism related distress While distress related to racism was endorsed more than COVID worries, our preliminary findings suggest COVID worries but not racism exposure negatively impact sleep health This may be a consequence of habituation to the chronic stress of racism in contrast with the novel stress of COVID Our final analysis will attempt to reaffirm these findings
Ndubuizu, Nkemdilim HUCM M4 56
Authors: Geeta Ahuja, Chincherem Chime, Temitayo Adanlawo, JD Hamm, David L Woods
Objective: Our goal is to understand what factors influence trainees to select radiology as a specialty choice, understand the factors that contribute to the state of diversity in radiology, and learn about initiatives capable of making radiology a more desirable field in medicine.
Title: The Importance of Animal Tumor Models in Advancing Radiographic Imaging and Intervention
Methods
We reviewed the reasons for the lack of diversity in radiology in the United States and how future studies and initiatives can begin to address this issue. We reviewed literature targeting articles addressing five themes: 1) recruitment, 2) exposure, 3) policy and regulation, 4) levels of diversity, and 5) trainee and faculty perceptions of diversity We utilized National Center for Biotechnology Information (NCBI) and ScienceDirect databases primarily to gather the literature and Association of American Medical Colleges (AAMC) data to acquire information on the number of trainees per medical specialty In 2016, the AAMC reported that the number of black men in medical schools had not increased in about 40 years Providing even more context on the situation, they revealed that the number of black male applicants in 2014 was less than that of 1978 In light of disparities such as this within medicine, we focused primarily on the medical trainee population Most notably, we examined Underrepresented Minority (URM) trainees, which is defined as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” (AAMC) Results: The literature suggests the reasons for this lack of diversity are multifactorial, including biases within policies and committees at medical institutions, a lack of role models and early exposure to radiology, and missed opportunities to secure the interest of underrepresented populations/trainees in radiology We summarized recommendations from eight studies that obtained the insight of specific populations, such as medical students, women, and faculty from underrepresented populations in medicine on matters of diversity as well as factors that influence their specialty choice via surveys. However, not many studies surveyed those of trainees underrepresented populations in medicine on these matters. Conclusions: We found and summarized barriers to entry into radiology that can be overcome in order to increase interest in radiology in general; it is possible that similar methods will work for garnering increased interest in underrepresented populations, although this may have to be proven. This kind of work has the potential to increase diversity of the healthcare workforce which has shown to improve health outcomes, especially in minority populations.
Ahuja, Geeta HUCM Radiology 57
Williams, Chaniece HUCM M3 58
Conclusions: We found and summarized barriers to entry into radiology that can be overcome in order to increase interest in radiology in general; it is possible that similar methods will work for garnering increased interest in underrepresented populations, although this may have to be proven This kind of work has the potential to increase diversity of the healthcare workforce which has shown to improve health outcomes, especially in minority populations
Title: A Review of Diversity in Radiology
Methods We reviewed the reasons for the lack of diversity in radiology in the United States and how future studies and initiatives can begin to address this issue We reviewed literature targeting articles addressing five themes: 1) recruitment, 2) exposure, 3) policy and regulation, 4) levels of diversity, and 5) trainee and faculty perceptions of diversity. We utilized National Center for Biotechnology Information (NCBI) and ScienceDirect databases primarily to gather the literature and Association of American Medical Colleges (AAMC) data to acquire information on the number of trainees per medical specialty. In 2016, the AAMC reported that the number of black men in medical schools had not increased in about 40 years. Providing even more context on the situation, they revealed that the number of black male applicants in 2014 was less than that of 1978. In light of disparities such as this within medicine, we focused primarily on the medical trainee population. Most notably, we examined Underrepresented Minority (URM) trainees, which is defined as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” (AAMC).
Authors: Chaniece Williams, Jerome Watts, Harold Dorsey, Kalaila Pais
Objective: Our goal is to understand what factors influence trainees to select radiology as a specialty choice, understand the factors that contribute to the state of diversity in radiology, and learn about initiatives capable of making radiology a more desirable field in medicine
Results: The literature suggests the reasons for this lack of diversity are multifactorial, including biases within policies and committees at medical institutions, a lack of role models and early exposure to radiology, and missed opportunities to secure the interest of underrepresented populations/trainees in radiology We summarized recommendations from eight studies that obtained the insight of specific populations, such as medical students, women, and faculty from underrepresented populations in medicine on matters of diversity as well as factors that influence their specialty choice via surveys However, not many studies surveyed those of trainees underrepresented populations in medicine on these matters
Conclusions: Neoplasms in the maxillomandibular region share similar imaging characteristics, making it difficult to rely solely on radiographic technology for diagnosis Given the relatively low incidence and detection rate of these several neoplasm types, additional sample biopsies are needed to develop more concrete treatment guidelines Concerns regarding the classification of maxillomandibular neoplasms will require a significantly greater number of cases to examine and identify patterns of pathology Moreover, the current guidelines lack evidence based research to support a standardized approach to management and an efficient role of radiologic imaging in this process
Title: Benign and Malignant Maxillomandibular Lesions:A Review of Radiographic Imaging and Treatment
Clinical Relevance/Application: We hope this article can become a useful tool for managing physicians and radiologists who are navigating treatment options for maxillomandibular neoplasms. We hope this review serves as a guide for dictating radiologists to better discern the varying appearances of maxillomandibular lesions in order to support the management strategies of primary physicians.
Wiltz, Kylar HUCM M3 59
Methods and Materials: Over 30 articles, obtained with PubMed and Google Scholar, were used to review the varying presentations of maxillomandibular lesions In order to aid with visualization, we provide supportive data; specifically, histology and radiology imaging
Authors: Kylar Wiltz BS (Presenter), Sanjum Singh BA, Jonathan Williams BS, Natalia Eugene MD, Arvinder D Uppal MD, Bonnie Davis MD, Andre J. Duerinckx MD
Purpose: Maxillomandibular tumors can be classified as cystic benign, solid benign, or solid malignant tumors. However, they are notoriously difficult to define due to their nonspecific features. Currently, radiographic imaging is largely utilized to assist in diagnosis by noting lesion borders, periosteal reaction, and soft tissue involvement. In this way, literature has historically focused on the radiographic features of each tumor classification. However, imaging cannot definitively provide diagnosis, as subtypes have similar radiological appearances. Therefore, the aim of this review is to provide the imaging characteristics, histology, and treatment options available for each lesion in order to provide a more concise approach to assessment and management.
Results: Through our review we discovered that biopsies are the gold standard for diagnosis of maxillomandibular lesions Additionally, the location of the tumor, patient symptoms at the presentation, radiological appearance, the effect of lesion on adjacent structures, and embryological should be considered In almost all cases, chemotherapy and resection treat the affected area
Results: We identified 46 relevant papers containing six review articles and 40 studies Studies were grouped via regional distribution, and the specific questionnaires utilized for OSA (i e , Epworth Sleepiness Scale, etc ) and urologic assessment (i e , International Prostate Symptom Score, etc ) Out of the forty studies identified, only nine reported patients’ racial/ethnic breakdown and gender demographics: 272 females and 118 males of African descent Among these, there was no clear consensus on the existence of the association between OSA and nocturia in both Black men and women
Conclusion: While the OSA and nocturia relationship has been studied extensively, Black patients represent a minute subset of subjects within these studies Further investigation is necessary to determine the relationship between these two diseases, OSA and nocturia, in Black men and women Thelus, Jennifer HUCM
Methods: A comprehensive literature PubMed database search was conducted to identify studies reporting an association between OSA, nocturia, and overactive bladder syndrome. Only studies with a sample size ≥ 30 which were relevant to our query, review papers published in 2015 or later, not duplicated elsewhere, and available in the full text format were included in our review.
M3 Urology 60
Title: Review of Racial Considerations in Studies Examining the Association between Obstructive Sleep Apnea and Nocturia
Authors: Jennifer M Thelus, BS, Shaan H Desai, BS, Vanessa A Aponte, BS, Zara Martirosyan, MD, Adam R Metwalli, MD, Peter L Whitesell, MD, Pamela W Coleman, MD
Purpose: Extensive research has been conducted regarding the association between obstructive sleep apnea (OSA) and nocturia in the general population. However, it is unclear whether existing research evaluates potential racial and ethnic associations with either condition. The following review assesses the methodology previous studies utilized and whether this association persists within the Black population.
Title: Pol θ Protein Levels and Half-life in Lung Cancer Cells
Jones, Chelsey Howard University 61
Authors: Ava C Conyer, Mélanie K Prodhomme, Richard D Wood
Conyer, Ava Howard University
Lung cancer continues to be a major cause of death worldwide Recently, 83% of lung tumors were identified to display an over expression of the DNA polymerase theta DNA polymerase theta is a main factor in the DNA double strand break repair pathway called theta mediated end joining (TMEJ) TMEJ is an error prone pathway but essential to repair double strand break damage Consequently, when Pol θ is over expressed, the activity of this pathway increases which may result in an increase in mutation levels and resistance to treatment Lack of suitable antibodies and purified protein has hampered quantification of the expression of Pol θ in human cells The first objective of my project was to determine the amount of Pol θ in lung cancer cells To do this, I compared Pol θ protein levels of lung cell lines to purified full length Pol θ by immunoblot The second aspect of this project is to determine the half life of Pol θ protein This is studied after blocking the protein production with cycloheximide treatment The kineticity of the cycloheximide treatment is analyzed by immunoblotting The amount of Pol θ depends greatly on the cell line and the cancer being studied However, in over expressed Pol θ lung cancer cell lines, the average number of Pol θ molecules per cell appears to be in the order of 5.7 x 104 molecules and the mean half life of Pol θ is about 21 hours. My project will support our understanding of the thereshold where Pol θ can have an activity in cancer cells. This research sets the stage for future studies to analyze the regulation of Pol θ. Knowing precisely the protein levels of Pol θ, as well as its half life, is essential to better understanding how Pol θ may be inhibited in the fight against cancer.
As humans, we tend to measure age through the passing of milestones like anniversaries and birthdays to commemorate our time. Though does that accurately show us how we are aging physiologically? Physiological or “biological” age can be measured using advanced aging biomarkers, including indicators of immune (TNFRI), cardiovascular (systolic blood pressure), and metabolic (HbA1c) functions. These biomarkers can be influenced by multiple forces. My lab has been working on a project that helps us understand these multiple forces and how neighborhood factors, specifically historical redlining (i.e., the refusal to let someone live in certain areas due to financial risk), structural racism, and segregation can affect one's biological age, or how old your body seems due to these various extrinsic factors. To better understand why historical redlining would be associated with aging outcomes, I first diagramed the pathways linking neighborhood context to biological health outcomes; this includes various neighborhood factors that are linked to the prevalence of these biomarkers like heat islands, air pollution, and food deserts. Simultaneously, with the guidance of my mentors, I was able to draft a literature review matrix which included researching relevant articles, deciding which ones to include, and organizing said articles for an interdisciplinary audience into descriptive headers For example, one of the passages I identified found that redlining was associated with pre term birth in the New York City Area and that the more redlined and disadvantaged the neighborhood was, the higher the prevalence of adverse maternal and census tract characteristics These findings along with others, support our analysis that we must link redlining to another measure of health, biological aging We tested this relationship between redlining and biological aging by using historical data from the HOLC, or Homeowners Loan Corporation The HOLC is a company compiled and distributed by the Mapping Inequality Lab at the University of Richmond and aggregated to the census tract by the NCRC Using the census tract information obtained, we linked the redlining data to the Health and Retirement Study, a nationally representative study on U S adults 50 and older which includes biomarker information We estimated multivariate models to predict biological aging and found that older residents who lived in neighborhoods that were historically defined as “Best/Desirable”, had a biological age that was 2 years younger than older residents of neighborhoods that were historically defined as “Declining” or “Hazardous” Our work aids in our understanding of the various ways that biological aging is influenced by our environments and highlights the legacy of environmental conditions and its direct correlation to structural racism, showing how this long lasting relationship is present overtime.
Undergraduate Student Projects
Authors: Chelsey Jones, Calley Fisk, PhD and Jennifer Ailshire, PhD
Title: The Association between Residence in Historically Redlined Neighborhood and Accelerated Biological Age among Older Adults
Ama, Crystal Howard University Jarmon, Dylaan Howard University
Authors: Crystal E Ama1, Briana L Clary, Candice M Brown Tissue nonspecific alkaline phosphatase (TNAP) is an ectoenzyme found in nearly all cell types and is highly expressed in brain endothelial cells (BECs) While its enzyme activity is directly linked to BEC integrity and permeability, a comprehensive role for TNAP in the brain microvasculature remains less clear Studies have established that microvascular density and vascular network integrity are disrupted in brain regions prone to neurodegenerative disorders compared to surrounding areas We hypothesize that TNAP activity in BECs plays an important role in establishing vascular network integrity in the healthy brain, brain injury, and in neurodegenerative diseases Naïve mice with an endothelial cell deletion of Alpl, the gene that encodes TNAP (VEcKO), and their littermate controls (Alplfl/fl) were crossed with a Tdtomato reporter mouse for visualization of cerebral microvessels Brain tissue sections from perfused mice were cleared using the CUBIC protocol, followed light sheet microscopy imaging, and reconstruction of the three dimensional vasculature in Imaris 9 0 Subsequent analysis in VesselVio will be used to quantify indices of vascular network complexity in the cortex and hippocampus We expect that VEcKO mice will have decreased microvascular density and diminished vascular network complexity compared to Alplfl/fl controls
Title: The Role of H19 on Glioblastoma Invasion Signaling
Authors: Jasmine McKay, Qualia Hooker, Dr Michael Dores Glioblastomas are a lethal brain cancer and it works to hijack the brain's circuitry and spread rapidly This investigation focuses on the expression of H19 on glioblastoma cell migration and activation of mitogen activated kinase pathways In order to study glioblastomas, microglial cells (U118) were collected from patients with glioblastomas The U118 cells underwent a transfection with knockdown siRNA; half nonspecific siRNA and half H19 siRNA Next, an epidermal growth factor (EGF) signaling assay was conducted and samples were collected Then, a gel electrophoresis, western blot and invasion assay coverslips were prepared. H19 knockdown proved to prevent EGF stimulated migration and is required to enhance signaling of MAP Kinase pathways. Further experiments should be used to determine the role of H19 in cell proliferation and determine if H19 plays tumor suppressor or oncogenic properties in other cancer cells in the body.
McKay, Jasmine Howard University
Title: Structural barriers that impact African American maternal health.
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Authors: Dylaan Jarmon, Henry Emiliano, Chelsea Maldonado, Julia Hakeem, Fatou Ndiaye
Title: Utilizing Light-Sheet Microscopy to Map Cerebral Microvascular Networks in Endothelial Cell-Specific Tissue Nonspecific Alkaline Phosphatase Knockout Mice
In 2020, the Maternal Mortality rate in the U.S was more than double that of many other industrialized nations, affecting African American women more than their white counterparts . Factors such accessibility to adequate medical resources, food insecurity, and environmental injustices contribute to the rate of maternal mortality in African American women due to them being stressors that pregnant women may face. Social determinants of health, such as residence with higher exposure to air pollutants and long term high levels of stress, are correlated to adverse obstetrical outcomes. Ignoring these social determinants of health and the structural racism that persists today, disproportionately affects Black communities and leads to mistrust and low quality of care. There are a plethora of inequities that continue to plague our healthcare system. Through lectures, case studies, and interviews of healthcare professionals and medical students from Georgetown University School of Medicine, our group has gained insight to what we believe is the root of this health disparity troubling our country today To address the maternal mortality rate in African American women, we are putting research to action to create interprofessional educational tools that every health care provider in the birthing process will have access to This will be done by highlighting the dark history of structural racism and how it has played a role in the advancements of obstetrics and gynecology Our team is working on creating an educational environment, through modules and curriculum development in higher education, to provide a safe space that addresses the challenges and structural barriers that impact African American maternal health
Background: Early detection of ovarian cancer is the most effective approach for decreasing the high mortality rate of patients from this disease An effective early detection method would diagnose patients prior to the onset of symptoms microRNAs (miRNAs) have emerged as promising biomarkers for ovarian cancer diagnosis and prognosis Evaluating how miRNA expression is affected by other, more common, disease processes, like pulmonary diseases, may inform the interpretation of miRNAs as a clinical test Asthma and bronchitis are of particular interest because miRNA expression in the lung is markedly affected by environmental respiratory irritants such as cigarette smoke and air pollution Moreover, as the burden of asthma and bronchitis in the United States falls disproportionately on minority communities, a test confounded by asthma might be less generalizable to a diverse patient population
Title: Assessing the effects of chemical modifications of FDA- approved antisense oligonucleotides on mRNA splicing
Methods: miRNA profiles of 1614 women treated at a Mass General Brigham institution were analyzed In addition to the miRNA data, electronic health records were reviewed to pair the biomarker data with demographics such as age, race, ethnicity, zip code, reproductive health histories, and comorbidities, including pulmonary diseases like asthma/ bronchitis
Antisense Oligonucleotides (ASO) are an emerging class of RNA therapies that restore splicing of pre mRNAs with pathogenic mutations Chemical modifications of FDA approved ASOs include 2´ methoxyethyl (MOE) and phosphorothioate modifications, which enhance the stability and targeting of the therapies Alternative modifications including thiomorpholino (TMO) modifications have favorable hybridization characteristics, but the impact of chemical modifications on existing ASO has not been characterized We have recapitulated the therapeutic effect on mRNA splicing of phosphorothioate/MOE nusinersen in patient derived cell lines derived from people with spinal muscular atrophy (SMA) Because there is a greater rate of hybridization to the target pre mRNA, we hypothesize that TMO modifications of these ASOs will have a similar impact on mRNA splicing at lower concentrations We transfected SMA fibroblasts with both MOE and TMO ASOs at concentransion of 5 nM, 10 nM, 25 nM, 50 nM, and 100 nM; hoping to discover the capabilities of ASO’s with different chemically modified backbones on splicing correction Our hypothesis was rejected via, RT PCR and GEL Electrophoresis, there was no significant increase in splicing correction at lower concentrations with the TMO backbone compared to the MOE backbone Although our results did not come back as hypothesized, the significance of these studies is to characterize ASO chemical modifications that may be efficient at splicing correction and enable more economical treatment of neurological diseases.
Results: The analysis compared the circulating miRNA profiles of 446 asthma/bronchitis patients vs 1168 non asthma/bronchitis patients using a validated panel covering 179 miRNAs Out of the total miRNA profiles, there was only one miRNA, miR 133a 3p, that showed a significant difference between the two groups. We further focused on 8 specific miRNAs that have been associated with ovarian cancer and found no significant difference in expression between asthma/bronchitis patients vs. non asthma/bronchitis patients.
Conclusion: Asthma and bronchitis do not significantly confound measurements of miRNAs that are potential biomarkers for ovarian cancer. This further supports miRNAs as biomarkers for early detection of ovarian cancer and suggests that miRNAs are likely to be a generalizable screening test among the general population.
McGowan, Jayla Howard University Moore, Monica Howard University
Authors: Monica Moore, Laura Wollborn, MD; James Webber, PhD, Sudhanshu Mishra, Kevin M. Elias, MD
Authors: Jayla McGowan, Aspen Martin, Tyler Matheny, and Jay Hesselberth
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Title: Evaluating the Impact of Pulmonary Diseases on the Use of microRNAs as Biomarkers for Early Detection of Ovarian Cancer
Results: The SFRP 1 KO mouse had a higher cell count than the other mice After performing cell differentials, we noticed a significant difference in the number of lymphocytes and neutrophils in the KO mouse There was also an increase in transdifferentiated alveolar type 1 cells, which was expected because SFRP 1 is known to modulate the transdifferentiation process in normal lungs
Title: Understanding the mechanism of translation reinitiation by viral RNA structures
Thaxton, Salimah Howard University 64
Many viral RNAs form complex structures capable of manipulating the eukaryotic translational machinery at all phases of protein synthesis. To combat host defenses (e.g innate immune response), viruses can utilize various strategies to evade the immune response and still produce viral proteins. One example of a viral RNA structure that interacts with host cell machinery is the termination upstream ribosome binding site (TURBS) RNA motif, which enables the expression of certain viral protein coding regions through a reinitiation mechanism. Specifically, the TURBS RNA captures a ribosome after it has undergone one round of translation on the viral RNA and promotes an additional downstream initiation event. We aim to determine the structure and function of TURBS RNAs in viruses such as influenza B virus and rabbit hemorrhagic disease virus (RHDV), which will provide insight into the mechanism of terminated ribosome recapture mediated by RNA Mutating the TURBS RNA will provide insight as to how this structure achieves the proper orientation and promote favorable intermolecular relationships with the downstream terminated ribosome We used dual luciferase reporters to recapitulate the positioning of TURBS RNAs between two protein coding regions in viral genomes Translation assays in cell lysate using these reporter luciferases were useful in providing functional readouts to test how conserved nucleotides and base pairs affect reinitiation efficiency The mutations to these conserved nucleotides were found to not facilitate a huge change for the initiation of ORF2 as the wildtype was only approximately 20% greater in reinitiation efficiency for the Influenza B virus This concluded that mutating these conserved regions was not enough to disrupt this construct and that further studies will be used to assess if RHDV shows the same results By studying these RNA elements we gain a better understanding of viral proliferation, therefore, aiding the development of therapeutic interventions against viruses
Conclusion: Genetic ablation of SFRP 1 led to an altered response to LPS induced lung injury, characterized by increased lymphocytic inflammation in BALF, increased AT 2 cells, and increased percentage of lineage traced AT1 cells, compared to WT mice This suggests that SFRP 1 may play a role in alveolar epithelial cell differentiation after acute injury Understanding the role SFRP 1 has in alveolar epithelial repair could provide a new therapeutic target and advance the field of regenerative pulmonary medicine.
Authors: Salimah Thaxton, Madeline Sherlock, Jeffrey Kieft, Kate Segar
Title: The Role of SFRP 1 in Epithelial Cell Differentiation following Acute Injury
Presenter: Jordan Alexander Introduction: Secreted frizzled related protein 1 (SFRP 1) is an important modulator of the WNT Signaling pathway and is critical for early lung development. It is activated during initial lung morphogenesis and in response to injury. Prior studies demonstrate that SFRP 1 controls differentiation of bronchoalveolar stem cells (BASCs), an adult murine airway progenitor cell, and alveolar macrophages. We collected qualitative and quantitative data on cell populations in a mice model to better understand the protein’s effect on the proliferation of lineage traced alveolar type 1 cells. By using lung disassociation, flow cytometry, and diff quik staining, we gained an insight into SFRP 1’s function and importance in the process of lung repair using a mice model.
Methods: We worked with five mice total: one WT mouse injected with a phosphate buffer (PBS), one SFRP 1 KO mouse injected with lipopolysaccharide (LPS), and three WT mice injected with LPS. We injected the mice with LPS to induce an acute lung injury The methods used included lung disassociation, flow cytometry, and diff quik staining It was necessary to remove and disassociate the entire lung of the mice to ensure there was an adequate cell count to perform flow cytometry We also extracted the bronchoalveolar lavage fluid (BALF) from the mice, performed cytospins, and analyzed the resulting slides under a microscope We used GraphPad Prism to quantify our data and make our analyses
Thank you to our Panelists that shared their experiences to benefit Premedical and Medical Students in their application and Admissions process.
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Planning Committee: Garcia Findlay, Ashlynn Gunderson, Lydia Hall, Kiyanna Thomas, Jasmine Walker
There are not enough words to express our gratitude for the outpouring of support for this initiative from the Howard Community! 65
OWH RESEARCH SYMPOSIUM
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Acknowledgements
Thank you to the Howard University Hospital CEO, Mrs. Anita Jenkins and Howard University's President, Dr. Wayne Frederick for your support on our Inaugural Symposium
Thank you Dwayne Willacy for capturing the memories of this Inaugural Event
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Thank you to our Planning Committee and each and every volunteer that helped to make sure that this event