Philadelphia College of Osteopathic Medicine
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Stimulant use and comorbid tic disorders in the pediatric population: Clinical considerations and treatment implications
Full text linkIntroduction: Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently treated with stimulant medications such as methylphenidate and amphetamines. However, concerns persist regarding the potential exacerbation or onset of tic disorders in children receiving stimulant therapy which often leads to hesitancy to begin or continue treatment. The U.S. Food and Drug Administration (FDA) has issued warnings about stimulant-induced tics, included in the packaging of dextroamphetamine (Adderall). There is conflicting evidence concerning the worsening of tics as a side effect to simulants, highlighting the need for careful clinical evaluation in patients with comorbid tic disorders prior to starting medication regimens. This study examines the relationship between stimulant use and tic disorders to inform clinical decision-making based on current published data.
Methods: A comprehensive literature review was conducted, including meta-analyses, randomized controlled trials, and observational studies evaluating the effects of stimulant medications on tic disorders. Data were extracted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), FDA medication labels, and published clinical guidelines. Studies assessing tic onset, severity, and management strategies were analyzed.
Results: Evidence suggests that while stimulant medications can precipitate or exacerbate tics in some individuals, the majority of children with ADHD and comorbid tic disorders tolerate stimulant therapy without significant worsening of symptoms. Some studies indicate that tic emergence may be dose-dependent, while others suggest a transient nature of stimulant-induced tics. Alternative pharmacological treatments, including alpha-2 adrenergic agonists (e.g., clonidine, guanfacine), have been associated with improved symptom management and reduced tic-related risks.
Discussion: The treatment of ADHD in children with comorbid tic disorders requires an individualized approach. While stimulants remain a viable option for many patients, clinicians must consider the potential for tic exacerbation and explore alternative treatment strategies when necessary. Close monitoring, patient-specific adjustments, and shared decision-making with caregivers are essential for optimizing therapeutic outcomes. Future research should further explore long-term outcomes and best practices for managing ADHD with comorbid tic disorders
Acute kidney injury secondary to post-streptococcal glomerulonephritis in a pediatric patient
Full text linkPost-streptococcal glomerulonephritis (PSGN) is a major cause of acute kidney injury (AKI) in children. It follows a Group-A Streptococcal skin or throat infection characterized by complement activation and immune complex deposition, leading to glomerular inflammation and impaired renal function. While PSGN typically presents with hematuria, proteinuria, hypertension, and edema, cases with atypical presentations and no recent history of Strep infection, can delay diagnosis (Dhakal et al., 2023).
We report the case of a 16-year-old female with AKI and acute gastroenteritis with no history of sick contacts. Specifically, she presented with a 2-day history of weakness, nausea, vomiting, and 8 hours of anuria. Viral swabs were positive for Enterovirus/Rhinovirus and negative for Group-A Streptococcus. Initial urinalysis (UA) revealed elevated WBC, and RBC, as well as muddy brown casts consistent with Acute Tubular Necrosis (ATN). Subsequent serologic testing revealed elevated anti-streptolysin O (ASO) titers, confirming a preceding streptococcal infection. A diagnosis of PSGN was established, with AKI attributed to immune-mediated glomerular injury. The patient was treated with supportive care, and antibiotics and referred to nephrology for follow-up. This case highlights the variable presentations of PSGN and emphasizes the importance of considering post-infectious glomerulonephritis in pediatric patients with AKI. Prompt recognition and supportive management are crucial for optimizing renal recovery and preventing long-term sequelae
Expanded Analysis of Anatomical Variability in Lung Morphology: Implications for Pulmonary Disease and Clinical Outcomes
Full text linkIntroduction
Unfolding the relationship between lung morphology and clinical outcomes may enhance our ability to understand and manage pulmonary diseases. While variations in lung anatomy—such as fissure completeness, the presence of a lingula, and lung impressions—are well documented, their clinical relevance, particularly within specific regions like South Georgia, remains underexplored. Building on our previous research, this study expands the sample size and further investigates these anatomical variations to strengthen our understanding of their potential impact on patient outcomes.
Objective
The goal of this research is to utilize a larger and more diverse sample of cadavers from the South Georgia region to analyze lung morphology variations and their potential correlations with clinical outcomes. By increasing the number of cadavers examined, we aim to enhance the statistical power of our findings and refine our understanding of how these anatomical patterns may serve as prognostic markers, ultimately informing diagnostic and therapeutic approaches in respiratory medicine.
Methods
This study employs a systematic and comprehensive approach to assessing lung morphology. Anatomical features such as the presence or absence of lung fissures, lingula dimensions, and abnormal lung impressions are meticulously documented. Additionally, data from the medical histories of the cadavers are analyzed to determine possible associations between lung morphology variations and clinical conditions. With the expanded sample size, we aim to strengthen our previous findings and identify new trends that may not have been evident in our initial study.
Results
Preliminary findings from our expanded dataset reaffirm the presence of significant anatomical variability among cadavers. Certain lung variations appear more frequently than others and may be associated with a higher incidence of specific pulmonary diseases. By analyzing a larger cohort, we have gained deeper insights into the potential links between lung morphology and disease prevalence in the South Georgia population. This study underscores the value of cadaveric research in bridging the gap between anatomical variation and clinical significance.
Conclusion
Expanding our research at PCOM South Georgia has allowed for a more robust analysis of lung morphology in this regional population. Our findings reinforce the importance of considering anatomical variations in pulmonary disease assessment, diagnosis, and treatment. Future studies with even larger cohorts and advanced imaging techniques could further refine our understanding and contribute to the development of personalized clinical methodologies for respiratory care
Digitized ASIC (Adaptation, Standardization, Integration, and Compliance) Framework: An Innovation for Optimizing Technologies and Innovations for Medical and Higher Education.
Full text linkThis article serves several specific purposes: Presenting transferable information on transforming innovative ideas into educational products with practical applications; showcasing a digitized version of a leading innovation aimed at optimizing technologies and innovations in medical education, health professions education, and higher education; advancing an evidence-based approach to integrating innovations into educational ecosystems and promoting education through innovations and technologies. A 10-step approach to developing the ASIC framework (ASIC stands for Adaptation, Standardization, Integration, and Compliance) is presented, with explanations and illustrations of the processes and activities involved. Empirical evidence and sound principles are provided in support of activities to assure the validity and reliability of methods or procedures. The product of this innovative process is presented and described for the benefit of educators, academic leaders, and industry stakeholders on evidence-based practical approaches to deploying technologies for educational purposes to benefit learners or teachers, and the general society. The ASIC framework\u27s four tenets, which include Adaptation, Standardization, Integration, and Compliance, are clearly defined. Evidence is presented to support ASIC tenets\u27 roles in deploying educational technologies and innovations, as well as in transformation agendas involving leading changes with innovation. Possible applications of this successful approach to educational change agenda and roles are also presented. Adequate reference is made to a need to premise interventions on relevant theories and principles including the adult learning theory, cognitive load theory, Bloom\u27s taxonomy, and connectivism. The IDEO model for leading change with innovation is also highlighted. This article could help educators, innovators, and other stakeholders by providing evidence on methodical approaches to developing and deploying useful innovations
Surgical repair of an atypical midsubstance distal biceps tendon partial tear: a case report
Full text link[No abstract available
PCSK-9 Inhibitors Treatment: The Cardiovascular Disparity
Full text linkIntroduction: According to the Center for Disease Control and Prevention (CDC) and American Heart Association (AHA), cardiovascular disease is the leading cause of death in the United States. This phenomenon disproportionally affects the African American population, who have a 31% higher mortality rate than non-Hispanic Caucasian individuals. A retrospective review of PCSK-9 medication use, specifically in a patient population that had minimal representation in the large, landmark clinical trials, can lead to better understanding about the therapeutic potential in cardiovascular disease reduction and patient outcomes attributed to medication use. Education regarding this novel drug class, medication access and patient support, and the cardiovascular implications of uncontrolled LDL-C will be necessary to reduce the significant morbidity and mortality currently present.
Methods: A retrospective analysis of patients who identify as African American and were prescribed a PCSK-9 inhibitor, as well as all patient populations who were prescribed a PCSK-9 inhibitor since January 1, 2015 through September 12, 2024 was conducted within a health system with three primary care practice clinics in an urban community in a major metropolitan city. A survey using Likert scale questions was distributed December 5, 2024 to twenty-one primary care physicians. A Continuing Medical Education-accredited presentation on this pharmacologic class was presented December 13, 2024. A post-intervention survey was distributed after the educational intervention. Both pre- and post- intervention survey results were analyzed January 2025. A paired sample t-test and Cohen’s d analyses were applied for outcome statistical analysis.
Results: Of the 6,521 patients who had a current diagnosis of hyperlipidemia including all patient demographics, only five patients were prescribed a PCSK-9 inhibitor medication. Four patients identified as African American and one patient identified as Caucasian. All five patients identified as female. Although there was significant LDL-C reduction and total cholesterol reduction compared to baseline, there is insufficient data to draw appropriate conclusions due to low medication utilization and lack of patient follow-up. Six of twenty-one physicians completed both the pre- and post-intervention survey. Pre- and post-intervention survey analysis revealed a statistically significant difference between the providers’ responses regarding their concerns/questions about prescribing a PCSK-9 inhibitor and understanding the necessary documentation for medication approval through insurance (p = 0.022, p = 0.038 respectively). The effect size in survey responses is considered large for both significant findings (Cohen’s d = 1.088 and 0.913, respectively).
Conclusion: Further studies are necessary to evaluate the potential benefits of PCSK-9 medication use in patient populations at significant risk of cardiovascular disease within the United States. Interdisciplinary collaboration involving clinical pharmacists within primary care management is necessary to reduce the existing barriers that patients face regarding medication access as well as support prescribing practitioners to achieve optimal patient outcomes regarding chronic disease management
Bridging Pharmacy and Medicine: A Collaborative Approach to Drug-Induced Liver Injury
No full textDrug-induced liver Injury (DILI) is one of the leading causes of acute liver failure and poses a significant challenge in drug development and clinical practice. Clinical presentation of patients can vary from hepatomegaly, jaundice, and ascites to the dangerous outcome of encephalopathy. While the actual incidence is difficult to report, the annual reported incidence of DILI is 15-20 per 100,000 a year. Alarming enough, there is a large discrepancy between the common drugs associated with DILI and the number of prescriptions for these medications each year. Common medicines like Amoxicillin/Clavulanate, a first-line antibiotic, were prescribed approximately 28.7 million times in 2022, and even the drug class statins with 237.9 million prescriptions between 2010-2011 that have only increased due to the health crisis, with Atorvastatin prescribed 110 million times during 2022. We strive to enhance the understanding of healthcare professionals about DILI, its phenotypes, and strategies to minimize its risk in clinical settings across a multi-disciplinary team and relate these effects with five commonly implicated drugs associated with DILI. By informing multiple healthcare providers about the dangers associated with DILI and educating patients alike, we aim to promote awareness of DILI
Impact of epicardial-specific Crk-CrkL genetic deletions on cardiac structure and function in mice
No full textINTRODUCTION: Crk and CrkL are intracellular cytoplasmic adaptor proteins that contribute to congenital heart disease. They mediate multiple signaling pathways involved in biological processes including cell migration, proliferation, apoptosis, adhesion, survival, and differentiation. Both Crk and CrkL have shared functions in the cardiac neural crest cells for cardiac outflow tract septation as well as shared functions in the endocardial lineage for atrioventricular valve development. Recently, we observed Crk and CrkL expression in the epicardium and epicardium-derived cells (EPDCs) that form the coronary vessels and cardiac fibroblasts in the embryonic mouse heart. The roles of the Crk-CrkL adaptor proteins in the epicardium, its derivatives, and the coronary vasculature have not been established in the adult mammalian heart.
OBJECTIVE: This study aimed to explore the role of Crk and CrkL in the epicardium and its derivatives and their impact on cardiovascular structure and function. More specifically, this study determined whether a correlation existed between the number of Crk-CrkL allelic deletions and the degree of cardiovascular structural and functional alterations in the adult mouse heart.
METHODS: We examined cardiovascular structure and functional parameters in Crklox/lox/CrkLlox/lox control mice and compared them to mice with epicardial-specific deletion of one or both Crk-CrkL alleles with the Wilms’ tumor 1 (Wt1) Cre-drive recombinase that include:
2-allele conditional knockout (2aCKO) manifesting as Crklox/+/CrkLlox/+ ;Wt1-Cre
3 allele conditional knockout (3aCKO) of Crk/CrkL manifesting as Crklox/lox/CrkLlox/+ ; Wt1-Cre or Crklox/+/CrkLlox/lox ;Wt1-Cre
4 allele conditional knockout (4aCKO) of Crk/CrkL manifesting as Crklox/lox/CrkLlox/lox
We acquired a series of physiologic data from 4-, 8-, and 12-month-old mice via high-frequency echocardiographic measurements of parameters of cardiac contractility and cardiac structure that included ejection fraction, cardiac output, left ventricular (LV) mass, anterior wall thickness during systole and diastole, and posterior wall thickness during systole and diastole. We used the VEVO Lab integrated computer software to trace left ventricular borders which yielded measurements for all parameters. These measurements were compiled and compared between both control and Crk-CrkL epicardial-deletion mice in all age groups.
RESULTS: Our lab observed a consistent trend of increased LV mass and marginally increased wall thicknesses in both 2aCKO and 3aCKO mice when compared to control mice. These findings suggest a potential link between the expression of Crk-CrkL and LV hypertrophy.
CONCLUSION: Collectively, these data demonstrate that Crk and CrkL play a vital role in development of the epicardium and its derivatives. Conditional loss of Crk-CrkL from these epicardial tissues appears to impact cardiac structural morphology and function. Furthermore, there is speculation that this may alter how the heart maintains the performance of the systemic circulation. We will conduct future studies to determine the underlying mechanism and whether these structural alterations confer a phenotypic benefit or detriment to the mammalian heart
Impact of demographics on CDK4/6 inhibitor outcomes in metastatic breast cancer
No full textBackground
Cyclin-dependent kinase 4 and 6 inhibitors (CDKis) are the standard first-line therapy for patients with estrogen receptor-positive (ER+) metastatic breast cancer (MBC). However, these medications can be expensive, potentially limiting access and affecting patient outcomes. Breast cancer prognosis varies significantly by race, socioeconomic status, and other demographic factors, yet the specific impact of CDKi access in these populations remains underexplored. Understanding disparities in CDKi accessibility and outcomes is crucial to addressing potential inequities in MBC treatment.
Research Design and Methods
In this retrospective review, data was collected from patients with ER+ MBC who were prescribed first-line CDKi therapy at a large NCI-designated cancer center from January 2015 through December 2022. Data abstraction included time from CDKi prescription to drug initiation (TTI), time from CDKi initiation to progression of disease (TTP), and time from CDKi initiation to death or June 30, 2022. Additional variables included age, race, partner status, insurance type, body mass index (BMI), and number of comorbidities. Descriptive, comparative, and correlational statistics were used, including Kaplan-Meier survival analysis. Multivariate logistic regression was performed to analyze independent predictors of outcomes.
Results
The analysis was conducted from July 2022 to May 2023 and included 173 patients. There were no significant differences in time to initiation (TTI) or time to progression (TTP) of CDKi therapy based on age, race, or other demographic variables. A trend toward shorter overall survival was observed in patients with Medicaid insurance compared to those with Medicare; however, this was not statistically significant (Hazard Ratio [HR] = 0.54, p = 0.063, 95% CI = 0.28–1.03). In the multivariate model assessing TTI to death, patients with Medicaid insurance had significantly shorter overall survival than those with private insurance (HR = 0.37, p = 0.013, 95% CI = 0.16–0.81).
Conclusions
Medicaid insurance is associated with worse MBC therapy outcomes independent of TTI delay. While the specific relationship between insurance status and CDKi outcomes remains unclear, this finding suggests broader disparities in cancer care access and treatment continuity. Future research should explore structural barriers and potential interventions, such as treatment personalization and improved healthcare navigation, to mitigate these disparities