Philadelphia College of Osteopathic Medicine
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Case Report: The Treatment of Chronic Pelvic Pain Utilizing Topical Amitriptyline-Ketamine Compound Cream
Full text linkChronic pelvic pain (CPP) is a complex syndrome often associated with a variety of somatic, psychological, and functional impairments. This case report describes a 45-year-old woman with a history of CPP secondary to a traumatic delivery, who presented with persistent vaginal and perineal pain unresponsive to prior conservative therapies, including gabapentin and physical therapy. Following initiation of a multimodal treatment regimen incorporating a compounded topical cream containing 2% amitriptyline (AMI) and 0.5% ketamine (KET), the patient reported substantial improvement in pain, functionality, and quality of life. While the cream was well tolerated initially, prolonged use led to adverse effects, including vivid dreams and nocturnal orgasmic contractions, necessitating reduced frequency of application. Despite this, the patient experienced continued significant pain relief and was able to resume daily activities with minimal impact on her quality of life. This case highlights the potential utility of compounded topical AMI-KET cream as part of a multimodal treatment approach for CPP, particularly in patients who are unsuitable for or unwilling to undergo interventional procedures. Further research is warranted to better define the role of topical AMI-KET cream in the management of CPP
Bladder Neoplasia in the Setting of Polycystic Kidney Disease: Observations from a Post-Mortem Case Study
Full text linkIntroduction
Polycystic kidney disease (PKD) is a serious genetic condition where many fluid-filled sacs, called cysts, grow in the kidneys, often leading to long-term kidney problems and kidney failure. It mainly shows up as autosomal dominant polycystic kidney disease (ADPKD), affecting about 1 in 400 to 1,000 people. Beyond affecting the kidneys, PKD is now understood to be a condition that can involve other parts of the body, including the liver, pancreas, and, rarely, the bladder. While the kidney-related issues of PKD, like cyst growth and its risks, have been well researched, the possibility of cancer developing in other organs, especially the bladder, is still a largely unexplored area in medical studies. This lack of knowledge is important because recent findings suggest that the environment inside these cysts might share features with solid tumors, such as uncontrolled cell growth, difficulty in cell death, and increased blood vessel formation, prompting questions about whether PKD patients might be more prone to cancer overall.
Objectives
The main goal of this study is to examine the details of bladder cancer found during a post-mortem examination of a patient with polycystic kidney disease, focusing on what the cancer looks like under a microscope and how it might be connected to the cysts already present. These objectives aim to deepen our understanding of bladder cancer in PKD for future studies and better care based on what we learn from this post-mortem case and the latest research.
Methods
This study was conducted in a cadaver laboratory, examining a preserved specimen diagnosed with polycystic kidney disease (PKD) and coexisting bladder neoplasia. A detailed gross anatomical dissection was performed to assess the extent of cystic involvement in the kidneys and any pathological changes associated with the bladder tumor. The kidneys were systematically dissected to evaluate cyst distribution, size, and impact on surrounding structures, while the bladder was examined for tumor location, size, invasion into adjacent tissues, and any signs of metastasis. Histological samples from the kidneys and bladder were obtained and processed for microscopic examination. Findings were compared to known clinical presentations of PKD and bladder neoplasia to determine potential anatomical and pathological correlations.
Results
Will be further evaluated with the return of histological specimens.
Conclusion
The cadaveric dissection revealed extensive cystic involvement of the kidneys consistent with polycystic kidney disease (PKD), alongside a bladder neoplasm demonstrating localized invasion. Gross and histological analysis highlighted structural alterations in renal architecture due to cyst expansion, potentially influencing urinary tract dynamics and neoplastic progression. The coexistence of these conditions suggests a possible interplay between chronic renal pathology and bladder tumor development, warranting further investigation into shared pathophysiological mechanisms. These findings contribute to the anatomical and pathological understanding of PKD and bladder neoplasia, emphasizing the value of cadaveric studies in correlating disease processes with clinical implications
Hand sanitizer intoxication in disguise: A case study
Full text linkBackground
Hand Sanitizer intoxication often presents nonspecific symptoms like tachycardia, drowsiness, vomiting, and abdominal pain that can delay diagnosis and lead to more serious consequences like seizure and coma (Slaughter, 2014; Lacouture, 1983). This case describes a patient with sudden onset of altered mental status that resolved within 24 hour that was later found to be secondary to hand sanitizer intoxication.
Case
Patient is a 33-year-old female with history unspecified depressive disorder, alcohol dependence, and generalized anxiety disorder admitted to medicine floor in hospital for treatment of alcohol withdrawal. Patient was placed on CIWA protocol, given IV thiamine, and treated as indicated by CIWA and the patient improved. On day 5 of her hospital stay, the patient experienced an unwitnessed fall and was found on the floor with altered mental status. The patient’s UDS was negative and she returned back to her baseline within 24 hours. After being transferred to Crisis Center for language suspicious for suicidality, the patient revealed that she had ingested 2 large cups of hand sanitizer before her unwitnessed fall.
Discussion
As hand sanitizer use has become essential to the hospital experience and infectious disease control, knowledge of the complications of hand sanitizer ingestion and poison education should also be as widespread. Understanding hand sanitizer intoxication, the way it presents, and its complications are important for early diagnosis, treatment, and prevention of further disease
Investigation into the Epicardial Requirement for Crk and CrkL Adaptor Proteins in the Mammalian Heart
No full textCrk and CrkL are adaptor proteins that mediate intracellular signaling critical for tissue morphogenesis, yet their roles in epicardial function and coronary vascular development remain incompletely defined. This study investigates the requirement for Crk and CrkL in the epicardium using an epicardial-specific Crk-CrkL 3-allele conditional knockout (Crk-CrkL 3acKO) mouse model. Epicardial deletion of Crk and CrkL resulted in early reductions in compact myocardium thickness and impaired migration of Wilms’ Tumor 1 (Wt1)-positive epicardium-derived cells into the myocardium at E13.5, with partial recovery by E17.5. Vascular Endothelial (VE)-Cadherin immunostaining revealed superficial displacement of developing coronary vessels at early stages. Smooth Muscle 22 alpha (SM22α) and Periostin expression patterns appeared unaffected, although limited embryo availability restricted comprehensive evaluation of vascular smooth muscle and fibroblast contributions. Transcriptomic profiling of adult Crk-CrkL 3acKO mouse hearts revealed persistent alterations in gene expression, including dysregulation of pathways related to cardiovascular development and function, extracellular matrix remodeling, cellular function and metabolism, and immune activation in comparison to Crk-CrkL control hearts. We identified key dysregulated biological functions, canonical pathways, and upstream regulators using Ingenuity Pathway Analysis. This suggests that early epicardial defects have enduring molecular consequences. These findings establish Crk and CrkL as critical regulators of epicardial behavior, coronary vessel formation, and long-term cardiac gene expression
Comparative Functional Outcomes for Ischemic Stroke Patients with and without COVID-19
No full textBackground: COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. This study examines how COVID-19 affects functional outcomes of ischemic stroke patients. Methods: Ischemic stroke patients admitted to our Joint Commission-certified primary stroke center were retrospectively analyzed from March 1, 2020, to March 1, 2022. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022). Patients were included if they were ≥18 years old and had a stroke on admission or during hospitalization. Univariate and multivariable analyses were used, with a significance threshold of p\u3c 0.05. Results: Out of 1,171 patients, those who tested positive for COVID-19 had significantly worse outcomes. Demographics, clinical data, and outcomes are found in Table 1. COVID-19 Positive patients experienced fewer days between stroke and death (4 days vs. 25 days, p=0.047), higher modified Rankin Scale (mRS) scores at discharge (3 vs. 1, p=0.001), and increased rates of altered consciousness (41.46% vs. 21.86%, p=0.03). In the vaccination period subgroup, COVID-positive patients had fewer days from stroke to death (4 days vs. 42 days, p=0.047), worse mRS scores (3 vs. 1, p=0.009), longer delays in discharge placement (0 vs. 1 day, p=0.020), and higher rates of altered consciousness (57.89% vs. 23.71%, p=0.001). Additionally, COVID-negative patients were more likely to be discharged home (49.52% vs. 36.84%, p=0.021). Multivariable analysis identified higher NIHSS at admission (OR: 1.028 [1.003-1.053], p=0.027), older age (OR: 1.027 [1.011-1.045], p=0.001), and a history of diabetes (OR: 1.596 [1.056-2.413], p=0.027) as increased mortality risks. Conclusion: COVID-19 is associated with worse recovery outcomes and discharge delays for ischemic stroke patients compared to those without COVID-19. Further research is needed to explore these differences and their implications for stroke management amid the ongoing global health crisis
The Relationship Between Perceived Racial Stress and Academic Achievement of African American Students
Full text linkEducational institutions are not only places of learning, but they can be places of refuge and support for students. Academic engagement and performance can be negatively affected for ethnic students of color. This can lead to a disconnection between the education system of teachers, administrators, and students. Studies suggest racial stress contributes to negative environmental factors, to which African American (Black) students have been found to be especially vulnerable. Overlooked, ignored, and misunderstood environmental factors for African American students exacerbate educational obstacles, widening achievement gaps and increasing attrition rates. A lack of culturally guided knowledge among stakeholders lessens the opportunity to provide a quality education for African American students. The purpose of this study was to confirm if the learning experience of African American students was impacted when they experienced racial stress. Additionally, this study examined several challenges in racial raising awareness on such links and increasing success among African American students, as well as all ethnic minority youth. The aim was to further research on racial stress as a predictor of academic performance. Self-report measures of perceived racial discrimination experience and grade point averages were gathered from Black college students ages 18 and older and confirmed a negative relationship. Implications and risk factors are also discussed
Improving the Quality of Veteran Health Care by Optimizing VA Integrated Primary Care: 20 Years and Beyond of the Center for Integrated Healthcare
Full text linkPrimary care patients often present with mental and behavioral health concerns, such as depression or insomnia, leaving medical teams scrambling. To help fill this gap and increase access to care while aligning with patient preferences, a new service delivery model of integrated care, characterized by embedding behavioral health providers within medical teams, was embraced in a grassroots effort, with the VA being one of the first healthcare systems to implement it throughout all primary care settings. A common challenge to grassroot efforts is the lack of research establishing effectiveness and identifying ways to optimize the innovation’s impact. Innovative VA leaders and Congress recognized integrated care’s promise but also realized the importance of and need for research, training, and implementation support to optimize its success resulting in the creation of the VA Center for Integrated Healthcare (CIH) in 2004. To assist in overcoming the known lengthy timeline of translating research into practice and vice versa, CIH integrated research with training and implementation support through a purposeful and highly collaborative approach impacting both the CIH structure and processes, which contributed to a high level of productivity over the past 20 years helping to optimize evidence-based mental and behavioral health care for Veterans. This article will describe CIH’s successes in bringing evidence-based integrated care practices to over 450,000 Veterans annually and how this novel approach contributed. Exemplars are provided on how internal synergies created more empirical evidence for integrated care and greater utilization of evidence-based practices within integrated care settings
Enhancing Antibiotic Stewardship Through Interprofessional Collaboration
No full textIntroduction: The World Health Organization defines antimicrobial resistance (AMR) as the development of resistance by microorganisms to antimicrobial medications after exposure; AMR is responsible for more than one hundred thousand deaths per year. Antimicrobial stewardship, a broader term that encompasses antibiotics, focuses on managing and supervising antimicrobials to ensure the most effective and beneficial treatment, ultimately reducing the incidence of AMR. The purpose of this study is to raise awareness of the importance of antibiotic stewardship through interprofessional collaboration among healthcare professional students.
Methods: During the 2024 United States Antibiotic Awareness Week (USAAW), activities were conducted throughout the week with the goal of spreading awareness. These activities included three speaker-led events featuring a diverse group of healthcare professionals, an “Antimicrobial Take Back” event, and an educational TV series on antibiotic awareness that was posted on the university TV announcements. At the end of each speaker-led event, students were given the opportunity to participate in a survey that gathered feedback on whether and how the event increased their awareness of antibiotics. Likert scale survey data was collected to provide a comprehensive and descriptive analysis, with a focus on enhancing antimicrobial stewardship through interprofessional collaboration.
Results: The attendance for event one was 40 students. The attendance for event two was 32 students. The attendance for event three was 32 students. The attendance for event four was 60 students.
Discussion: Most participants reported a significant improvement in their understanding of antimicrobial stewardship after attending the event, progressing from no understanding or fairly good to a higher level of awareness. This outcome suggests that the event\u27s goal of enhancing understanding and raising awareness about antimicrobial stewardship was successfully achieved. As a result, students expressed confidence in their ability to consult antibiograms, discuss inappropriate antibiotic use with colleagues, and educate their communities about antimicrobial resistance.
Several students highlighted the importance of aligning prescriptions with specific infections and consulting pharmacists when uncertainty arises, emphasizing the practical value of the information provided.Looking ahead, students offered constructive feedback to help refine future events and ensure even greater impact. A common theme was the need for more clarity on certain topics (e.g., antibiotic data vocabulary) to better enable students to translate knowledge into practical applications. Additionally, some students suggested incorporating more interactive activities, which could further increase engagement. Overall, the event succeeded in delivering actionable insights and fostering interprofessional collaboration across multiple programs within the medical school
Raising awareness of critical health impact of high blood pressure in underserved communities via early detection and education
No full textINTRODUCTION:
Blood pressure is a clinical measurement of arterial pressure, which reflects the pulsatile pressures that the body experiences as the heart pumps (WHO, 2023). High blood pressure, or hypertension, is a condition generally defined as a systolic blood pressure (SBP) ≥130 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg (CDC, 2023). Persistent hypertension can cause damage to the arteries, heart, brain, kidneys, and retina. Literature suggests a correlation between lower socioeconomic status and higher prevalence of hypertension (Beckman, 2017). This disparity can be attributed to multiple factors such as limited access to healthcare, medication, education, or healthy/fresh food and elevated stress levels. Underserved communities and a lack of accessible healthcare has additionally been shown to lead to poorer control of an individual’s hypertension (Anstey, 2019) (Elnaem, 2022). Uncontrolled hypertension is well-established as a leading component of cardiovascular disease, stroke, and renal disease. The aim of this project is to mitigate health inequality through increased awareness, early detection, and proper management of hypertension.
METHODS:
We reached out to underserved communities in Philadelphia through the PCOM Sponsored Community-Based Research Project. Blood pressure screenings were offered to community participants. Questionnaires were distributed to identify risk factors associated with hypertension including age, medical history, current medication, smoking, alcohol consumption, sleep patterns, exercise, dietary choices, and family history. Trained individuals obtained blood pressure measurements from participants using an Omron Gold BP Monitor. In the case of elevated blood pressure, measurements were repeated using a manual blood pressure cuff after 5 minutes of rest (Mayo, 2024). The average was then recorded. Additional information was provided regarding associated health risks and the importance of a healthy lifestyle for hypertension prevention and management.
Results:
In concordance with PCOM Hearts and Lancaster Healthcare Center, we have collected blood pressure data from 95 individuals so far. Returning individuals had multiple measurements recorded. Participants were grouped according to previous history of no hypertension or hypertension. Individuals who had elevated blood pressures during screening without previous diagnosis received additional advice on follow up with a physician. Participants were educated on the difference between normal blood pressure and hypertension. Participants were educated on how to take their blood pressure at home, with blood pressure monitors provided if they did not already have one.
Conclusion:
Hypertension is a significant public health concern that disproportionately affects populations of disadvantaged socioeconomic status. We are currently in the process of collecting further data and hope to analyze these results in the coming months. Future directions will include consideration of factors such as BMI impact on hypertension
Challenges and Opportunities in Establishing a Student-Run Clinic in Rural Southwest Georgia
No full textStudent-run free clinics across the United States often act as a safety net for populations with poor healthcare access, specifically targeting uninsured individuals who may fall in between the cracks of the United States healthcare system. Based on the last national research study of student-run free clinics in 2014, 140,000 Americans receive care annually at 208 student-run free clinics with over 75% of accredited medical schools supporting at least one student-run free clinic. Despite this well-recognized, and an array of opportunities and benefits to patients, students, and institutions, these organizations tend to encounter significant challenges to growth and establishment. These challenges can be exacerbated when focusing on a rural area like Moultrie, Georgia with a population of 14,565 where 27.5% of the population lives in poverty. With a small surrounding population, first and second-year students at Philadelphia College of Osteopathic Medicine - South Georgia have few clinical volunteer opportunities before starting clinical rotations. Many studies have shown the educational benefits that a student-run clinic can have on students including improving clinical skills, interprofessional skills, confidence, leadership, health literacy awareness, and much more. Therefore, not having an opportunity like this puts students at a disadvantage compared to other schools. With most medical schools being in urban or suburban areas it is not common to have the opportunity to implement a student-run free clinic in a rural area. This article discusses some of the challenges and opportunities that have come with starting a student-run free clinic in a rural, medically underserved area