Philadelphia College of Osteopathic Medicine
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Addressing late latent syphilis in pregnancy: a case study emphasizing interdisciplinary communication and public health collaboration
Full text linkIntroduction: Congenital syphilis has re-emerged as a significant public health concern, despite being preventable through timely diagnosis and treatment during pregnancy. Late latent syphilis, particularly in high-risk populations, poses serious risks to both mother and fetus, with non-compliance to treatment exacerbating these dangers. Effective management requires coordinated efforts between healthcare providers and public health officials to ensure proper intervention and follow-up.
Objective: The objective of this study is to assess the impact of interdisciplinary communication and public health collaboration in the management of late latent syphilis during pregnancy, focusing on how coordinated care can address challenges such as patient non-compliance and mitigate the risk of congenital syphilis.
Methods: This case study focuses on a 32-year-old Hispanic female, G3P2, who was diagnosed with late latent syphilis at 22 weeks gestation through prenatal lab screening. The patient was referred to the public health department for treatment with benzathine penicillin G, administered as three weekly doses. Following non-compliance after the second dose, the health department intervened by notifying the referring physician and labor and delivery unit. The patient was subsequently re-engaged in care, and treatment was completed at 32 weeks gestation. Continuous communication between public health officials and healthcare providers ensured readiness for potential neonatal intervention in case of early labor.
Results: Despite initial non-compliance, the patient completed the prescribed treatment with the support of public health outreach. The newborn was delivered at 40 weeks and 3 days, with no signs of congenital syphilis. This case demonstrates the efficacy of interdisciplinary collaboration in overcoming barriers to treatment adherence and ensuring positive maternal-fetal outcomes.
Conclusion: The successful management of late latent syphilis in this case highlights the critical role of public health departments in addressing patient non-compliance and coordinating care. Interdisciplinary communication between healthcare providers and public health officials proved essential in preventing congenital syphilis and ensuring the health of both mother and child. This case underscores the importance of proactive public health interventions in high-risk pregnancies and the need for continuous engagement with vulnerable populations to mitigate the resurgence of congenital syphilis
From IRB Approval to Implementation: Evaluating Medication Therapy Management (MTM) Services on medication adherence in Children with Special Healthcare Needs (CSHN)
Full text linkInstitutional Review Board (IRB) reviews and approves research studies involving human subjects to ensure compliance with ethical standards set by the US government. Our research team is preparing to investigate whether Medication Therapy Management (MTM) services improve medication adherence in children with special healthcare needs (CSHN) aged 5-17, many of whom require complex medication regimens. Prior studies show that a caregiver’s socioeconomic status significantly impacts a child’s medication adherence due to financial constraints and limited healthcare literacy. MTM services could address these barriers and enhance adherence through caregiver education on medication administration and by reducing prescription burden. Before conducting our study, we must obtain IRB approval. This poster outlines the steps we have taken to secure approval, including required documentation, ethical considerations, and data security measures.
To initiate the IRB application process, one must first develop a comprehensive research plan detailing the study\u27s purpose, objectives, and methodology. Our study will evaluate the current utilization of MTM services, if present, and their impact on medication adherence in CSHN by surveying 40 caregivers and collecting information on their demographics, the child’s medical history, and adherence patterns. The insights collected may help us better understand the challenges facing caregivers of CSHN, highlight the role of MTM services, and confirm its necessity in improving medication adherence.
A key component of our IRB submission is crafting an informed consent form that clearly communicates participants’ rights, including voluntary participation, the option to skip any question, and the ability to withdraw at any time without consequences. Since our study involves minimal risk, we outline that participation requires only survey completion, with any potential emotional discomfort addressed by allowing caregivers to skip sensitive questions. Additionally, to encourage participation while avoiding coercion, we will offer a $40 Target gift card to caregivers who complete the survey.
Another important aspect of IRB approval is outlining our data security measures. We specify that data collection will occur through PCOM’s REDCap platform, which provides encryption protocols and automatically assigns unique ID numbers to de-identify participant responses. We will also implement additional safeguards, including password-protected computers and encrypted STATA18 files for data analysis, to ensure compliance with data protection regulations.
The IRB application also requires a thorough explanation of our recruitment strategy. We plan to collaborate with local community healthcare co-ops and providers in Georgia to identify and recruit eligible caregivers. To minimize bias and ensure voluntary participation, we will distribute informational flyers and rely on healthcare professionals for referrals rather than direct solicitation.
Once IRB approval is obtained, our next steps will involve implementing the survey and analyzing collected data using advanced statistical methods to identify risk factors associated with poor medication adherence. We anticipate that our findings will highlight key challenges caregivers face and contribute to the design of targeted MTM interventions to enhance pediatric health outcomes. By addressing ethical considerations and adhering to rigorous IRB standards, we aim to conduct meaningful research that contributes to advancements in pediatric medication management
Dual Arterial Supply to the Deltoid Muscle: An Aberrant Branch of the Brachial Artery in a Cadaver
Full text linkIntroduction:
An anatomical vascular anomaly was identified in the left brachium of a 75-year-old Caucasian male cadaver at the Philadelphia College of Osteopathic Medicine (PCOM) Georgia gross anatomy laboratory. The left deltoid muscle had a dual blood supply from the posterior circumflex humeral artery and the deep artery of the arm. This report describes the anomalous vascular pattern and highlights its potential clinical relevance. Awareness of anatomical variations in the vascular system is critical for optimizing outcomes in diagnostic and surgical procedures involving the upper limb.
Methods:
The cadaver was dissected during a gross anatomy laboratory at PCOM. Permissions were secured from the body donation program and the donor\u27s family to document and publish the findings for educational purposes. The aberrant vascular pattern was measured using digital calipers and documented with photographs.
Results:
The left distal deltoid muscle received arterial supply from both the posterior humeral circumflex and an ascending branch from the deep artery of the arm. The aberrant ascending artery traveled from the deep artery of the arm and through the triceps muscle to reach the distal aspect of the deltoid. Branches from this artery anastomose with branches from the posterior humeral circumflex artery within the posterior/lateral deltoid.
Discussion:
This case report highlights a rare anatomical variation in which the left deltoid muscle receives a dual arterial supply from the posterior humeral circumflex and deep brachial arteries. Such anomalies have significant implications for surgical, diagnostic, and interventional upper limb procedures. Awareness and documentation of these variations can improve patient outcomes and minimize intraoperative and diagnostic complications. Future studies should elucidate the prevalence and functional significance of rare vascular cases
Coral Beads and Ground Glass: A Case of Multicentric Reticulohistiocytosis
Full text linkIntroduction: Multicentric reticulohistiocytosis (MRH) is a rare systemic autoimmune disorder characterized by skin and joint involvement. It classically presents with symmetric erosive polyarthritis and papulonodular skin lesions and is frequently associated with underlying malignancies. MRH has fewer than 300 cases reported in medical literature worldwide since its first report in 1937, but studies suggest that approximately 25-30% of patients diagnosed with MRH have underlying malignancy. Because of its paraneoplastic nature, it is recommended that patients diagnosed with MRH promptly undergo cancer screening.
Case Presentation: In this case report, a 58 year-old male presented to the dermatology clinic complaining of a pruritic and painful rash along with numerous aching joints. His symptoms began after he was exposed to an insecticide and worsened with direct sunlight, heat, and sweat. Physical examination revealed brightly erythematous, smooth papules and nodules of the knees, elbows, and dorsal hands, red-orange dermal papules coalescing into plaques on the upper chest and back, and indurated waxy papules and plaques of the pinnae and nares. Labs were unremarkable aside from elevated monocytes on a complete blood count with a differential. Shave biopsy was performed and pathology revealed a dermal nodule of epithelioid histiocytes and scattered giant cells with pink “ground glass”-like cytoplasm. PAS and AFB stains were negative. A diagnosis of multicentric reticulohistiocytosis was made and treatment was started with corticosteroids, methotrexate, and alendronate.
Discussion: MRH is a rare autoimmune histiocytic disorder with arthropathic features similar to that seen in rheumatoid arthritis (RA). For this reason, oftentimes pharmacologic agents given in RA are also prescribed in MRH. Accurate diagnosis is dependent on histology, so biopsy of skin lesions must be taken and sent to pathology. In addition to various cancers, tuberculosis (TB) is found in approximately 5% of MRH which necessitates ordering an interferon-gamma release assay. Fortunately, both the tuberculosis and malignancy diagnostic evaluations were negative for the patient. A literature review yielded no association of MRH and the insecticide the patient used.
Conclusion: While an uncommon entity, MRH is important to keep in mind when a patient with arthritic symptoms and papulonodular lesions presents due to its strong association with malignancies and increased risk of concomitant tuberculosis. If RA and MRH are both diagnostic considerations, a biopsy of a nodule must be taken to ensure an accurate diagnosis. These patients require management from a rheumatologist and oncologist, highlighting the need for multidisciplinary treatment
Predisposing factors, outcomes, and treatment approach to fluid gusher complication during cochlear implant surgery
Full text linkOur research focused on the fluid gusher complication from cochlear implant surgery. Fluid gusher is one of the most prevalent complications of cochlear implant surgery and occurs when cerebral spinal fluid leaks from the cochleostomy site. The complication occurs with opening the round window. We performed a systematic review of the literature, focusing on overviews of cochlear implant surgery complications. There are many factors contributing to the cause of fluid gushers including, biological sex, age, time of procedure, follow up time, temporal bone abnormalities, and abnormalities of the lateral wall of the internal auditory canal. Fluid gusher puts some patients at a higher risk of developing postoperative meningitis. Treatment includes elevating the patient’s head to reduce intracranial pressure, and packing the cochleostomy/round window. Closing the cochleostomy with temporalis fascia, muscle, connective tissue, or fibrin glue in addition to intravenous 20% mannitol drip was the most frequently reported management approach. We hope continued research will develop a mainstay treatment approach for fluid gusher complications, as there is no standardized treatment protocol currently put in place
Breaking the stigma: Innovating STI testing models for black adolescent men
Full text linkIntroduction:
Of the 26 million new sexually transmitted infections (STI) in 2018, almost half were among adolescents 15 to 24 years old. Less than 3% of sexually active male adolescents have had an STI test in the past 12 months versus 26% of their female peers. Male adolescents are more likely to forego testing than female adolescents due to greater confidentiality concerns, cost/insurance barriers, and lower self-perceived risk.
Despite the high prevalence of STIs in this marginalized group, male adolescents face unique barriers to STI testing, including cost, stigma, and limited availability of youth and male-friendly services. This project aims to develop STI testing models tailored to the needs of adolescent men.
Methods:
We employed qualitative research methods to explore priorities, motivators, and challenges of STI testing among black adolescent men (15-19 years old) in Atlanta, Georgia. We conducted a literature review to identify STI testing priorities reported in the empirical literature. We then recruited a youth advisory board of black men (15-19 years old) from Atlanta, obtaining informed consent and assent. Advisory board members participated in focus groups to refine identified priorities and contribute their own through structured discussions and open-ended prompts. We used pile-sorting exercises to categorize attributes as important, unimportant, or uncertain and had participants rank-order their priorities. Discussions were audio-recorded, transcribed, and analyzed. Photographs were taken of the pile-sorting process. Researchers synthesized the findings into a summary analysis. This study was reviewed and approved by the Emory University Institutional Review Board granting a waiver of parental consent.
Results:
This is an interim report from focus group discussions with ten 15 to 19-year-old males to inform a discrete choice experiment (DCE). The priorities identified as most important among participants were privacy, connection with clinical care and treatment (or lack thereof), and comfort. Privacy is the highest priority selected by all participants, followed by comfort and connection with clinical care/treatment. When ranking the top five most important priorities, privacy and communication of results were most often selected in the top three. The location of the testing site was ranked as not important by majority of the participants. One theme that emerged from participant discussion was the willingness to engage their parents throughout the STI testing and treatment process. Participants shared that they trust their parents regarding payment (or using insurance), transportation, and booking appointments during this process. Additionally, stigma remains a powerful influence on STI intentions and practices for adolescents.
Discussion:
The youth advisory board has provided insights into STI testing priorities. The key priorities identified in this work will be further tested in the (DCE). A DCE asks participants to choose between two options that include different priorities and levels within those priorities (for example, connection with treatment or not); it has been shown to predict future behaviors. Our DCE will survey 500 individuals to clarify the priorities of STI testing. Ultimately, we will develop innovative and responsive STI testing strategies for adolescent black men in Atlanta
Liposomal formulation to treat skin infections caused by Staphylococcus Aureus
Full text linkIntroduction: Skin is the largest organ of the human body and is a strong barrier against various infections, including bacterial infections. According to the American Academy of Dermatology (AAD), over 83 million (1-in-4) individuals visit a dermatologist annually in the United States alone. However, the infection gets established and spreads depending on the individual\u27s immunity and skin conditions. Although several drug options are available for treating skin infections staphylococcus aureus, there are still several drugs that can potentially inhibit this bacterial infection but have yet to be used for several reasons, such as toxicity, solubility, etc. Liposomes can deliver a variety of natural antibacterial/inflammatory agents that are not in use due to their toxicity or solubility.
Objectives: The project is aiming to identify the natural but toxic anti-inflammatory agents (e.g., Garcinol, etc.), load them into one of the modern drug delivery systems known as \u27liposomes,\u27 and evaluate the therapeutic effect compared to using a drug without the liposomal systems.
Methods: This project has two phases: The project is in its first phase, where liposomes were prepared using the standard hydration method. Briefly, the method involves hydration of thin lipid film formed upon evaporation of organic solvents into which lipids were dissolved. Lipids 1,2-Distearoyl-sn-glycero-3-phosphocholine (DSPC) and cholesterol were ordered from Avanti-polar lipids (Alabaster, Alabama) and Garcinol was ordered from Cayman Chemicals, (Ann Arbor, Michigan). The drug Garcinol was added to the solvent and loaded into the bilayer. DSPC-cholesterol formulations were prepared using 5:2 w/w ratios. Formulations were tested for the phyisco-chemical characteristics size, zeta potential and drug loading.
In the second phase, the bactericidal and bacteriostatic properties will be tested using the Kirby-Bauer assay, minimum inhibitory concentration (MIC) determination, and minimum bactericidal concentration (MBC) determination. Likewise, with the help of advanced testing (e.g., 3D-human cell model and real-time polymerase chain reaction (RT-PCR)), it is now possible to optimize the therapeutic product before it reaches clinical trials.
Results and discussion
Multilamellar vesicles were successfully prepared with and without the incorporation of Garcinol, with no significant differences in their physicochemical properties. The average size of empty liposomes was 106 nm (±4 nm, n=4), which remained unchanged upon Garcinol incorporation (121 nm ±7.2 nm, n=4). Zeta potential measurements indicated a near-neutral charge (±9.6 mV), with no notable variations between formulations (p\u3e0.05, n=4). Drug loading efficiency for bilayer-loaded garcinol was observed to be 43–49%, demonstrating superior encapsulation compared to some previously reported data on lipophilic drug delivery. These findings suggest that the formulated liposomes offer a stable and efficient platform for Garcinol delivery. In conclusion, the aim of work is exploring the potential of liposomes (encapsulating natural anti-inflammatory agents) and to treat bacterial skin infection. The preliminary data generated from this work suggest the liposome can encapsulate garcinol and this formulation can be tested to establish treatment against staphylococcus aureus caused skin infections. This data will be used to explore other avenues such as effect of lipid compositions, co-encapsulation of anti-inflammatory agents, etc
Antioxidant effects of dimethyl fumarate in SIV-infected rhesus macaques may indicate its use as a neuroprotective adjunct in HIV treatment
Full text linkINTRODUCTION: Dimethyl fumarate (DMF) is an oral prodrug that is FDA approved for the treatment of multiple sclerosis. DMF is metabolized to monomethyl fumarate and able to cross the blood-brain barrier to illicit its central nervous system (CNS) affects. DMF is an antioxidant/anti-inflammatory that acts at the level of gene transcription through the Nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. We assessed the potential neuroprotective effects of DMF in HIV infection by using the rhesus macaque simian immunodeficiency virus (SIV) infection model. We hypothesized that DMF would increase the expression of antioxidant enzymes and subsequently reduce central nervous system oxidative stress in the setting of SIV-infection.
METHODS: Twelve rhesus macaques were used in this study and each was immunologically depleted of their CD8+ T lymphocytes to accelerate immunodeficiency and AIDS development. Ten of the twelve macaques were infected with SIV, while the remaining two acted as uninfected controls. Additionally, of the ten SIV-infected macaques, six received DMF a week prior to SIV-infection through the animals’ date of necropsy (development of terminal AIDS). Collected frozen and paraffin embedded tissues were used for western blotting and quantitative immunohistochemistry (IHC) analysis. Western blotting was done for antioxidant enzymes, NAD(P)H quinone dehydrogenase 1 (NQO1) and glutathione peroxidase (GPX1), across eleven brain regions. IHC staining looked at markers of protein and DNA oxidation, 3-nitrotyrosine (3-NT) and 8-hydroxy-2’-deoxyguanosine (8-OHdG) respectively, a lipid peroxidation enzyme, lysophosphatidylcholine acyltransferase 3 (LPCAT3), and a lipid peroxidation end product, malondialdehyde (MDA).
RESULTS: In DMF-treated, SIV-infected rhesus macaques compared to untreated, SIV-infected rhesus macaques: i) western blotting analysis revealed an overall increase in the expression of the antioxidant enzymes NQO1 and GPX1 (paired t-test) and an increase of GPX1 in specific regions (unpaired t-test) (p\u3c .05); ii) quantitative IHC analysis of oxidation markers showed a decrease in both protein (3-NT) and DNA (8-OHdG) oxidation in the cortex and brainstem, via unpaired t-test (p\u3c .05), an increase in lipid peroxidation enzyme (LPCAT3) expression in the cortex and spinal cord, via unpaired t-test (p\u3c .05), and a decrease in lipid peroxidation end product (MDA) in the cortex and spinal cord (no statistical significance).
DISCUSSION: DMF’s increase in antioxidant enzyme expression, and decrease in protein and DNA oxidation in the setting of SIV-infection suggest that the drug is effective at reducing oxidative stress within the CNS. Additionally, the inverse relationship in relative detection of lipid peroxidation enzyme and end product levels may be also indicative of DMF’s affect at limiting oxidative stress in regions more susceptible to oxidative injury. Given these findings we propose that in HIV-infected individuals, DMF may have a use as a neuroprotective adjunct to anti-retroviral therapy to help protect against CNS injury
Descriptive analysis of modified Baux scores and mortality in burn patients at JMS burn center: A five-year institutional analysis
Full text linkBackground: The modified Baux score is a widely used, easily calculated tool that combines patient age, total body surface area burned, and the presence of inhalation injury to predict mortality in burn patients. Despite its clinical utility, institutional data correlating modified Baux scores with observed mortality remain limited.
Objective: This study aims to retrospectively analyze modified Baux scores greater than 100 in a cohort of 119 patients of all ages, with 61 patients being over 50 years old, treated over the past 5 years at JMS Burn Center. The goal is to describe mortality rates across defined 10-point score intervals and to provide clinicians with straightforward, descriptive benchmarks for risk stratification.
Methods: Data from the past 5 years will be extracted for 119 patients with modified Baux scores \u3e100, including demographic details, clinical parameters, and outcome measures. Patients will be stratified into 10-point intervals (e.g., 100–109, 110–119, etc.), and the mortality rate for each interval will be calculated using descriptive statistical methods.
Expected Results: We anticipate mortality rates will progressively increase with higher modified Baux score ranges. The findings are expected to identify clinically relevant thresholds that can aid in the rapid, bedside prognostication of burn patients.
Conclusion: Validating the modified Baux score against institutional data may provide clinicians with a reliable, easily calculated tool for risk stratification and decision-making in burn care management
A case of cryptosporidiosis in an IgA deficient child
Full text linkCryptosporidium parvum is an important infectious cause of watery diarrhea in the general, pediatric, and immune-compromised populations, especially in underdeveloped countries and regions (CDC). Transmission primarily occurs through the ingestion of fecally contaminated water. After ingestion, the parasites invade the epithelial cells of the gastrointestinal tract and begin to multiply through asexual reproduction (CDC). Thus, mucosal immunity, especially by way of IgA, is likely critical in defending the host from infection (Borad). This illness is typically self-limiting in the general population. However, in the immune-compromised, it can lead to chronic diarrhea, malnutrition, and life-threatening wasting (CDC). This prognosis is especially true in the pediatric immune-compromised population, which may experience growth and developmental delays (CDC). Therefore, early diagnosis is paramount in this unique population, so that proper treatment is not delayed. This case study presents the story of a 5-year-old male with a past medical history of IgA deficiency presenting with severe vomiting and diarrhea, with an initially negative infectious work-up, who was eventually diagnosed with cryptosporidiosis. It serves as a reminder to clinicians to remain aware of this diagnosis for immune-compromised patients in rural areas